[Purpose] We considered how to interpret the values of dialysate electrolytes obtained using a blood gas analyzer (GAS). [Method] The final electrolyte concentrations of Kindaly 4E (K.4E), prepared so that the measured value was the same as the theoretical value, and Kindaly AF‒4(KAF4), prepared according to the instructions for use, were measured using a biochemical auto‒analyzer (BAA) and GAS. [Results] Na, K, and Cl were significantly higher using GAS than BAA. Na‒Cl‒0.25 in K.4E, which represents HCO₃, was 27.5 mmol/L, the same as the theoretical value. HCO₃ (24.45 mmol/L) and iCa (1.19 mmol/L) using GAS were significantly lower than the theoretical values. [Discussion] Since dialysate does not contain solid components such as proteins and lipids, Na, K, and Cl values using BAA, which are calibrated with normal serum, are lower than those using GAS. The difference between Na‒Cl‒0.25 using BAA and HCO₃ using GAS is considered to be due to the fact that Na, K, and Cl measured using the ion selective electrode method (ISE) represent total amounts, while Ca and HCO₃ measured by GAS represent ionized amounts. [Conclusion] Dialysis fluid electrolyte concentrations should be considered in terms of ion amounts.

Chronic kidney disease‒associated pruritus (CKD‒aP) is a complication whose symptoms are often difficult to control. In this study, we analyzed the efficacy of difelikefalin for CKD‒aP patients and associated factors. The study included 12 CKD‒aP patients who were newly initiated on difelikefalin between December 2023 and February 2024, and trends in the Worst Itch‒Numerical Rating Scale (WI‒NRS) score and 5‒D‒Itch Scale were evaluated over a 12‒week period. The change from the baseline in the WI‒NRS score at 12 weeks was －3.46 ± 2.21. In addition, rates of achieving improvement in the WI‒NRS score of 3/4 points or more at 12 weeks were 66.7 and 50%, respectively. Significant differences were observed in CRP levels when comparing groups achieving improvement in the NRS score of 3/4 points or more and those that did not. This study revealed that the drug difelikefalin could become a new treatment option for patients with CKD‒aP.

Purpose： Among hemodialysis patients, aortic valve stenosis (AS) is a common and serious complication. Incidences of AS patients over the last 6 years were investigated. Furthermore, backgrounds of AS patients and their prognoses following aortic valve replacement therapy were studied. Subjects and Methods： Among 448 patients undergoing hemodialysis therapy, AS was diagnosed based on cardiac ultrasound examination, requiring an aortic valve max pressure gradient (⊿maxPG) of more than 20 mmHg, calcification of 3 valves, and valve area of less than 1 cm². Patients with ⊿maxPG over 40 mmHg were referred to cardio‒surgeons and underwent valve replace therapy (n＝33)：surgical aortic valve replacement (SAVR) ＝27； transcatheter aortic valve intervention (TAVI) ＝6. Survival rates among patients receiving aortic valve replacement (AVR) were assessed by Kaplan Meyer analysis. Results： Annual incidences of AS from 2016 to 2022 were 10, 11, 9, 10, 11, 12, and 9％ respectively. Values for age and duration of hemodialysis were higher in AS patients. However, the incidence of diabetes mellitus was lower in AS patients. Ca, Pi, and I‒PTH were not different between AS and nonAS patients. Survival rates among patients receiving AVR were 90％ for 5 years and 70％ for 10 years. The survival rate of all AS patients for the 3 years after 2016 was 48％, and that after 2019 was 74％. Conclusion： The incidence of AS has not markedly changed over the last 6 years. As background characteristics of AS patients, a more advanced age and longer‒term hemodialysis were observed. However, Ca, P, and I‒PTH did not differ. The survival rate of patients undergoing AVR over 5 years was 90％, being almost equivalent to that of non‒AS patients. Diagnosis in the early stage of AS and aortic valve replacement therapy were effective to extend the lives of AS patients.

Peritoneal dialysis (PD)‒related peritonitis is a serious complication that can cause PD withdrawal and be fatal. An 80‒year‒old woman started PD 10 years ago due to end‒stage renal failure caused by nephrosclerosis. She was converted to PD and hemodialysis (HD) 9 years ago and continued without PD‒related complications. At the age of 80 years, she was admitted with a diagnosis of PD‒related peritonitis for the first time. Antibiotics were started on the first day, and the patient’s condition resolved temporarily. However, Serratia marcescens was detected on PD drainage culture. On the 7th day, abdominal pain flared up and persisted even after antimicrobial therapy. On the 10th day, simple computed tomography of the abdomen showed encapsulated ascites with air bubbles, and emergency laparotomy was performed on the same day. The small intestine showed thickening of the wall and adhesions due to inflammation. Postoperatively, fever resolved, abdominal pain disappeared, and she was transferred to receive HD alone. Currently, she is doing well under outpatient follow‒up. PD‒related peritonitis caused by Serratia marcescens is a serious disease, and PD‒related peritonitis itself could lead to the development of encapsulating peritoneal sclerosis with neutral‒pH peritoneal dialysate. Therefore, it is important to be aware that PD‒related peritonitis can worsen rapidly after the initial onset of the disease.

Aortic stenosis (AS) can cause difficulties in patients undergoing dialysis and affect their prognosis. Renal failure is also known as a factor accelerating the progression of AS. We report a 77-year-old male with a history of dialysis whose AS rapidly progressed in a short period of time, leading to cardiac dysfunction and difficulty in dialysis, who was managed with a comprehensive approach. The patient was admitted for investigation of chest pain, and echocardiography revealed discordant severe AS with normal flow and a low-pressure gradient. In accordance with the guidelines, we determined that he did not have true severe AS, and scheduled follow-up. However, he developed cardiac dysfunction and dialysis became difficult four months later. Due to his poor general condition, it was not possible to assess the severity of AS using dobutamine stress echocardiography. The evaluation taking into account the velocity ratio suggested that it was true severe AS. Therefore, balloon aortic valvuloplasty was performed as the bridging therapy to transcatheter aortic valve implantation (TAVI), followed by TAVI as definitive treatment. There are some cases of rapid progression of AS and limitations to examination and treatment available for AS patients associated with dialysis due to its complexity and uniqueness of the pathology. For patients with AS associated with dialysis, individualized treatment approaches must be considered based on the specific situation.

The patient was a 43‒year‒old woman who developed short bowel syndrome 23 years ago. Dialysis was initiated five months prior to this hospitalization due to end‒stage renal failure caused by repeated dehydration and oxalic acid nephropathy. Her serum selenium concentration (Se) was 6.2 μg/dL at the start of dialysis. She was hospitalized due to a cuff‒type catheter infection and low body weight, and treated with selenium‒free central venous nutrition. The left ventricular ejection fraction (EF) was 69％ at the time of admission, but on the 65th day of hospitalization, EF was found to be 27％ and Se was 2.2 μg/dL； the patient was suspected to have cardiomyopathy due to selenium deficiency, and so sodium selenite at 100 μg/day was started. EF was 42％ and Se was 8.1 μg/dL on the 92th day of hospitalization, and 60％ and 10.7 μg/dL, respectively, on the 120th day of hospitalization, leading to a diagnosis of cardiomyopathy due to selenium deficiency, and sodium selenite administration was stopped. However, on the 150th day of hospitalization, Se decreased to 5.0 μg/dL. Sodium selenite administration was consequently resumed, and the Se level has remained at around 9 μg/dL.

Objective： To examine the efficacy of using the toe‒brachial pressure index (TBI) as a prognostic indicator of major adverse cardiovascular events (MACE) in patients undergoing maintenance hemodialysis (HD). Methods： Prognostic factor analysis was conducted in 157 HD patients, involving the evaluation of various parameters including the ankle‒brachial pressure index (ABI), TBI, and skin perfusion pressure (SPP), in relation to the occurrence of MACE. Results： Cox proportional hazards model analysis revealed TBI to be the most significant independent prognostic factor (p ＜0.001). In receiver operating characteristic (ROC) curve analysis for MACE prediction, TBI demonstrated superior predictive capability with an area under the curve of 0.79 and optimal cut‒off value of 0.56. Conclusion： TBI is an effective prognostic indicator of MACE in hemodialysis patients.