Objective: This study aimed to explore the relationship between the modified creatinine index (mCI) and handgrip strength, and that with nutritional indicators, as well as assess the effect of the residual renal function on mCI. Methods: A total of 107 outpatients undergoing hemodialysis were included, with a mean age of 68.6 years and an average dialysis duration of 12.1 years. Correlations between mCI and handgrip strength, albumin (ALB), body mass index (BMI), geriatric nutritional risk index (GNRI), normalized protein catabolic rate (nPCR), and creatinine generation rate (％CGR) were evaluated. Patients were divided into two groups based on their residual renal function: those with a dialysis history of more or less than 5 years, and their indices were compared. Results: mCI demonstrated significant positive correlations with handgrip strength (r＝0.62), GNRI (r＝0.52), ALB (r＝0.44), BMI (r＝0.37), nPCR (r＝0.42), and ％CGR (r＝0.65), all with p ＜0.001. Comparisons between the groups showed that mCI, nPCR, and ％CGR were significantly lower (p＜0.01) in patients with a residual renal function. Care‒dependent patients were predominant in the group with mCI, handgrip strength, and GNRI all below their respective cutoff values. Conclusion: mCI may serve as an indicator of skeletal muscle mass in hemodialysis patients; however, the impact of any residual renal function should be taken into consideration.

Owing to expansion of the aging population, increasing numbers of patients are undergoing hemodialysis as well as surgeries and procedures to treat various complications. We investigated the application of protocols for modification of anticoagulants after such treatments. The study included 229 patients who received surgery in the Departments of Surgery, Ophthalmology, and Urology and also those who underwent endoscopic mucosal resection in the Department of Gastroenterology. On admission, anticoagulants used included unfractionated heparin (UFH, 80.0％), low‒molecular‒weight heparin (LMWH, 19.1％), and nafamostat (NM, 0.9％). The anticoagulants were administered as follows: UFH, 921.9±315.6 units (initial dose) and 691. 9±203.9 units/hour (maintenance dose); LMWH, 703.5±246.3 units (initial dose) and 542.4±210.8 units/hour (maintenance dose); NM 25.0±7.1 mg/hour (maintenance dose). Of 229 patients, 93.0％ were eligible for the protocols and 88.7％ received modified treatment based on them. The dose of each anticoagulant used did not significantly differ from that applied preoperatively. Our protocols were developed and implemented by a team comprising physicians, nurses, and clinical engineers involved in dialysis therapy, as well as a team of physicians and nurses from the department performing the invasive procedure. Perioperative management of patients who undergo hemodialysis requires interdepartmental and interprofessional collaboration, and protocols for anticoagulation modification in patients who undergo hemodialysis are important tools to facilitate team medicine.

This study aimed to improve support for elderly patients in need of care while receiving outpatient dialysis. The focus was on ensuring that elderly patients continued to receive support while undergoing outpatient dialysis. The study involved 3 days of participant observation and semi‒structured interviews with 6 nurses caring for elderly patients undergoing dialysis. The results were analyzed using text mining. The following areas were identified: From the nursing practice scene: (1) Understanding risks during dialysis and guidance on recuperation; (2) Estimates and understanding of recuperation; (3) Implementation of foot care. From interviews: (1) Communication with elderly patients; (2) Recuperation living environment; (3) Insights into regional cooperation; (4) Issues in geriatric nursing. Correspondence analysis revealed that there was an association between the interview and pre‒visit, and between the start and end of dialysis. Nurses provide highly individualized care based on clinical judgment, and support the continuation of dialysis treatment while promoting risk management and self‒care support for elderly patients. Furthermore, through multidisciplinary collaboration and family support, it was also suggested that nurses comprehensively assessed patients’ treatment life and contributed to the maintenance and improvement of their overall quality of life.

There has been a rise in the use of the tunneled cuffed catheter (TCC) due to increases in the aging population undergoing hemodialysis as well as duration of hemodialysis. However, there are limited reports on its long‒term results in Japan. Therefore, we evaluated the results of first implantation of TCC (CentrosFLO) in 65 patients from October 2020 to April 2024. They comprised 40 male and 25 female patients with a mean age of 77 (57‒90) years, involving 31 cases of Bridge Use (BU) for temporary implantation and 34 cases of Permanent Use (PU) for other purposes, all implanted via the right internal jugular vein. The local infection rates were 0.18 and 0.06 for bloodstream infections per 1,000 catheter days, respectively. Interestingly, the patency rate was 100％ at 2 years. Survival rates were 79 and 72％ at 1 and 2 years for BU and 41 and 25％ at 1 and 2 years for PU, respectively. Thus, with TCC (CentrosFLO), although its use involves some associated complications, the long‒term patency results are satisfactory, and so it can be applied without any apprehensions.

An 82‒year‒old man was prescribed oral tenapanor, a selective Na/H exchanger 3 inhibitor, to manage hyperphosphatemia. Twenty‒eight days after its oral administration was initiated, he presented with diffuse erythema and itching on the trunk, both upper arms, and both thighs, leading to hospitalization. A drug rash associated with tenapanor use was suspected, resulting in its discontinuation. The skin rash had improved by the seventh day of hospitalization. A drug‒induced lymphocyte stimulation test for tenapanor was conducted on the ninth day of hospitalization, which yielded a negative result. Given the rapid resolution of the rash following its discontinuation and absence of symptom recurrence while all other oral medications were continued, tenapanor was considered the most likely causative agent. While this agent has been primarily associated with various adverse gastrointestinal reactions, it is essential to recognize that it may also lead to drug rashes, as noted in this case.