Background and Purpose： We investigated the usefulness of venocutaneous fistula (VCF). Subjects： Sixty‒five patients (27 males and 38 females； 74 limbs) who underwent VCF at Bousei Daiichi Clinic and Unuma Higashi Clinic from May 2017 to October 2023 were included. All patients presented with difficulty in AVF and AVG creation due to their poor general and vascular conditions. The usefulness of this method was examined based on the results of fistula creation surgery and dialysis using the fistula. Results： No serious complications were observed during or after the procedure. Infection and blood infection rates were 0.27/1000 and 0.09/1000 fistula maintenance days, respectively. Secondary patency rates based on the Kaplan‒Meier method were 82.6 and 62.6％ at 1 and 3 years, respectively. During the observation period, 6 cases of intra‒femoral venous thrombosis were observed. Survival rates were 52.1 and 32.3％ at 1 and 3 years, respectively. Conclusion： This method is associated with good patency and low infection rates, and is considered to be a promising alternative method for patients presenting with difficult creation of vascular access.

[Background] For the management of secondary hyperparathyroidism (SHPT) in hemodialysis patients using calcimimetics in real‒world practice in Japan, switching between four commonly used calcimimetics, taking into account the characteristics of each patient, may be a useful treatment option. Here, we investigated the effectiveness and safety of switching from evocalcet to upacicalcet in patients with SHPT undergoing hemodialysis. [Methods] Among 54 outpatients on maintenance hemodialysis with SHPT who were taking evocalcet at our hospital between December 2021 and January 2022, informed consent was obtained from 42 patients, and their data from 48 weeks before and 48 weeks after switching were prospectively compared. The results were also analyzed by patient group according to the evocalcet dose before switching. The endpoints were the corrected serum calcium level and serum levels of phosphorus, whole‒parathyroid hormone (PTH), tartrate‒resistant acid phosphatase (TRACP)‒5b, and bone‒type alkaline phosphatase (BAP). For safety evaluation, the occurrence of adverse drug reactions after administration of upacicalcet was investigated by interview. [Results] In all 42 eligible patients and patients with an evocalcet dose of 1 mg/day, there were no significant changes in any endpoints before or after switching from evocalcet to upacicalcet. Patients with an evocalcet dose lower than 1 mg/day showed significant decreases in whole‒PTH and TRACP‒5b levels, while those with a dose of 2 mg/day exhibited an increase in whole‒PTH levels. In patients with a dose of 3 mg/day or higher, there were significant elevations in serum corrected calcium and whole‒PTH levels. Regarding safety evaluation, no adverse drug reactions related to upacicalcet administration were observed. [Conclusion] This study supports the effectiveness and safety of switching from evocalcet to upacicalcet in SHPT patients. However, patients switching from an evocalcet dose exceeding 1 mg/day require an appropriate upacicalcet dose increase.

This study aimed to explore the phosphorus content of the frozen, chilled, and retort‒pouch food gyoza and Chinese dumplings. Phosphorus levels of seven kinds of gyoza and eight kinds of Chinese dumplings were measured using vanadomolybdate absorption spectrophotometry. The phosphorus content of 100 g of gyoza ranged between 50.4 and 100.2 mg, with Kibun exhibiting the highest value of 100.2 mg among the seven gyozas. Since only Kibun was chilled, it was considered to contain a high level of preservatives such as organic acids. Osho had a low phosphorus content due to the small amount of meat used； however, the phosphorus/protein ratio was high, suggesting that it contained a high proportion of inorganic phosphorus. The phosphorus content of 100 g of Chinese dumplings ranged between 61.9 and 89.2 mg. All eight items contained less phosphorus than the values stated in the table of ingredients. Among these, Kiyouken, despite having no additives, showed the highest value due to its high pork content. Conversely, the Shisen Chinese dumpling was considered to have a low value due to its low meat and high vegetable contents. This study identified no correlation between the number and type of additives listed on the ingredient label and phosphorus content. Among all samples, the most suitable options for dialysis patients were identified as： Seven for gyoza and Shisen for Chinese dumplings.

Electrolyzed water hemodialysis, developed with the aim of improving biocompatibility in dialysis treatment, is a dialysis system that uses electrolyzed water (containing trace amounts of hydrogen gas) generated by water electrolysis. This method has been reported to reduce cardio‒ and cerebrovascular events, overall mortality, and dialysis‒related fatigue. The current study investigated the status of outpatients undergoing this treatment across 19 facilities in Japan. The survey period spanned five years, from the end of 2018 to that of 2022, with a total of 2,482 subjects. During an observation period of 29.0 months, there were 303 deaths, with a mortality rate of 50.5 per 1,000 person‒years. Independent risk factors for mortality included age, history of stroke, and nutritional status. The leading cause of death was infection (20.6％), followed by heart failure (13.3％). Based on the above results, it will be necessary to conduct comparative studies with conventional dialysis in the future to clarify the clinical usefulness of this treatment method.

This retrospective study compared the plasma refilling rate (PRR) after fluid removal cessation in hemodialysis (HD) and hemodiafiltration (HDF), while also examining its specificity using a blood volume monitor. We enrolled randomly selected patients： 10 each undergoing HD and HDF, along with 5 patients who transitioned from HD to HDF. We observed changes in median PRR over 15 minutes following the cessation of fluid removal after total ultrafiltration. In the randomized HD and HDF groups, we compared five randomly selected treatments, resulting in a total of 50 treatments. In the transitioned HD to HDF group, we compared four treatments from 2 weeks before and after the transition, for a total of 20 treatments. Results indicated a tendency for PRR to increase approximately 6 minutes and 20 seconds after total ultrafiltration completion in the HDF group compared with HD. Additionally, median PRR was significantly higher in the HDF group, noted between both the randomized HD and HDF groups (p＜0.05) and between the transitioned HD to HDF groups (p＜0.01). Therefore, HDF may contribute to increased PRR after the completion of total ultrafiltration during treatment.

A 67‒year‒old woman undergoing maintenance hemodialysis with a tunneled catheter presented with catheter dysfunction. Thrombolytic therapy with urokinase was attempted, but it failed to restore the function of the occluded catheter. We then administered alteplase, a recombinant tissue‒type plasminogen activator, for thrombolytic therapy, which successfully restored the function. In foreign countries, alteplase has been used in addition to urokinase, and some reports have shown that alteplase is more effective than urokinase in restoring dysfunction. As urokinase is currently in short supply, alteplase may be an option for patients with occluded tunneled catheters.

A 42‒year‒old female patient with end‒stage renal failure caused by congenital anomalies of the kidney and urinary tract (CAKUT) underwent living‒donor kidney transplant in X‒19. Although she was maintained on immunosuppressive therapy including steroids, her renal function deteriorated. She consequently began continuous ambulatory peritoneal dialysis (CAPD). After the initial infusion of dialysate, she experienced chest discomfort. Chest radiography revealed right‒sided pleural effusion. CT peritoneography indicated a diaphragmatic defect, leading to a diagnosis of pleuroperitoneal communication. We injected dialysate mixed with indigo carmine into the abdominal cavity to identify the defect and subsequently performed diaphragm repair surgery on the 9th hospital day. CAPD was resumed on the 15th hospital day. However, chest discomfort reappeared the next day. Chest radiography revealed an increase in right‒sided pleural effusion, suggesting recurrence of pleuroperitoneal communication. Thus, she was switched to hemodialysis. In this patient, the underlying CAKUT and prolonged steroid use may have contributed to diaphragm fragility, resulting in the development and recurrence of pleuroperitoneal communication. It may be important to consider the primary disease and use of immunosuppressants when selecting renal replacement therapy after graft failure.