Objective： To investigate the prevalence of hypozincemia in patients undergoing hemodialysis and evaluate the clinical effects of zinc replacement therapy. Methods： Serum zinc concentrations were measured in maintenance hemodialysis patients. In those diagnosed with hypozincemia, the presence of zinc deficiency‒related symptoms was assessed. Zinc acetate hydrate was administered to patients who selected therapeutic zinc replacement. A prospective observational study was conducted over a 12‒month period to assess changes in the ESA resistance index (ERI), serum albumin (Alb) levels, and improvement in symptoms. Results： Hypozincemia was detected in 220 of 223 patients (98.7％). Symptoms of zinc deficiency were present in 56 of the 220 patients. Of these, 74 patients (47 symptomatic, 27 asymptomatic) opted for zinc replacement therapy. No significant changes in ERI or serum Alb levels were observed during the follow‒up period. Symptom improvement rates among symptomatic patients were as follows： stomatitis, 100％；nail deformity, 75％；fatigue, 50％；dermatitis, 50％；decreased appetite, 42％；dysgeusia, 33％；alopecia, 25％；and erectile dysfunction, 0％. Conclusions：Hypozincemia was highly prevalent among patients undergoing hemodialysis. While no significant changes were observed in ERI or Alb levels following zinc supplementation therapy, symptomatic improvement was observed in 23 of 47 patients (48.9％) with zinc deficiency‒related symptoms.

[Purpose] To investigate the association between changes in the blood β₂‒microglobulin (β₂‒MG) level after COVID‒19 vaccination and incidence of COVID‒19 in patients undergoing hemodialysis. [Methods] We evaluated changes in serum β₂‒MG before and after the seventh COVID‒19 vaccination (Δβ₂‒MG) in 350 patients undergoing hemodialysis at our facility. The incidence after the seventh vaccination was followed for one year. [Results] On univariate Cox proportional hazards analysis, lower Δβ₂‒MG was correlated with a significantly increased risk of developing COVID‒19. Based on multivariate Cox proportional hazards analysis, lower Δβ₂‒MG was significantly correlated with the risk of developing COVID‒19 independently of age, sex, and duration of dialysis. Lower Δβ₂‒MG was a risk factor for developing COVID‒19 in both models in which serum albumin, body mass index, and diabetes mellitus were used as explanatory factors instead of duration of dialysis. [Conclusion] The results suggest that changes in β₂‒MG after COVID‒19 vaccination are correlated with the incidence of COVID‒19 in patients undergoing hemodialysis.

[Objective]To investigate changes in blood pressure, pulse, and atrial natriuretic peptide (ANP) levels after administration of Sacubitril/Valsartan (ARNI) to patients with hypertension complicated by hemodialysis. [Subjects and Methods] Subjects comprised a total of 48 dialysis patients (mean age： 72.5 years； males/females： 26/22). Patients showing resistance to standard antihypertensive treatment were started on 100 mg of ARNI. Blood pressure, pulse, and ANP levels were measured before and up to 18 months after treatment. [Results] Patients were evaluated every month up to 3 months after administration and every 3 months thereafter. ANP levels (pg/mL) increased significantly after 1 month of treatment compared with those before treatment (86.1±54.9 before treatment, 212.6±257.5 after 1 month of treatment；p ＜0.0001). SBP decreased significantly from the first month of treatment (170.6 before treatment, 155.6 after the first month；p ＜0.0001). DBP also decreased significantly in the first month after treatment (82.5 before treatment, 76.3 in the first month after treatment；p ＜0.0001). No significant changes in pulse were observed. Comparison of daily urinary output showed that oliguric and anuric patients also showed a reduction in blood pressure and an increase in ANP levels.

A 78‒year‒old male patient was referred to our hospital in August of year X for chemotherapy after being diagnosed with multiple lymph node and pulmonary metastases secondary to bladder cancer. He presented with gross hematuria in year X ‒ 5 and was diagnosed with non‒muscle‒invasive bladder cancer. He subsequently underwent transurethral resection of the bladder tumor followed by intravesical Bacillus Calmette‒Guérin therapy. By February of year X, the disease had progressed to muscle‒invasive bladder cancer. Following neoadjuvant chemotherapy, he underwent robot‒assisted laparoscopic radical cystectomy with bilateral ureterocutaneostomy. His medical history was significant for end‒stage renal disease secondary to IgA nephropathy, requiring maintenance hemodialysis. First‒line chemotherapy with gemcitabine and carboplatin was discontinued due to a drug‒induced rash. Pembrolizumab‒based second‒line therapy was initiated but discontinued owing to immune‒related adverse events and further disease progression. Third‒line therapy with enfortumab vedotin at the standard dosage of 1.25 mg/kg was initiated in March of year X＋1. Despite favorable tolerability and the absence of adverse events, disease progression after five cycles necessitated discontinuation. He subsequently required palliative care and died in November of year X＋1.

We report a case of peritoneal dialysis catheter exit‒site infection involving a 69‒year‒old male. The patient had been on peritoneal dialysis for 10 years, with additional hemodialysis once weekly for the past 7 years. In March, erythema and purulent discharge were observed at the catheter exit site, and Serratia marcescens was detected. Despite antibiotic treatment, the infection persisted. Culture results later identified Mycobacterium abscessus subsp. abscessus, leading to the initiation of combination antimicrobial therapy. It was considered that the infection was facilitated by compromised skin barrier function due to bullous pemphigoid localized around the catheter exit site. Following catheter removal, antimicrobial therapy was continued for 4 months, resulting in clinical improvement. This case highlights important considerations on treating refractory nontuberculous mycobacterial infections, emphasizing the significance of exit‒site skin condition management, timely catheter removal, and appropriate antimicrobial therapy.