The daily management of non-cuffed hemodialysis catheters is guided by various domestic and international references, including guidelines from the Japanese Society for Dialysis Therapy, Japanese Society of Anesthesiologists, and Centers for Disease Control and Prevention in the United States. However, the recommendations of different societies differ in some areas, and the actual management methods of dialysis facilities remain unknown. In order to clarify the differences between the guidelines and actual practice patterns, we conducted a questionnaire survey on catheter management among dialysis physicians at 42 facilities participating in the Japanese National University Hospital Association for Blood Purification Divisions. The survey revealed that catheter management methods differed among facilities, including catheter insertion site management, connection site management, catheter locking method, length of indwelling, and timing of catheter replacement. It is important to know how other facilities manage catheters because this will lead to a review of management methods in our own facilities. Moreover, there is potential for application in terms of task shifting and medical education. Data accumulation is important because there is insufficient evidence to support catheter management methods in some areas.

We conducted a study to determine the optimal timing for treating arteriovenous graft (AVG) outflow tract stenosis by comparing intervention intervals pre and post stent graft implantation. This study included cases of stent graft implantation for upper limb AVG outflow tract stenosis in our department from August 2020 to December 2022. We compared the mean number of days between the three VAIVT sessions before stent graft implantation (Pre-SG) and the first VAIVT session after stent graft implantation (Post-SG). The median Pre-SG in all 31 patients was 98 days (interquartile range： 61 to 146 days) and the median Post-SG was 403 days (195 to 539 days), which represents a significant fourfold increase in VAIVT intervals (p＜0.05). However, in three cases, Post-SG was shorter than Pre-SG. To ensure long-term patency after stent graft implantation, it is important to select a large-diameter, more central vein with a high patency rate as the site of AVG placement from the beginning, to ensure complete coverage of the target lesions, and use the elephant trunk technique.

Peritoneal dialysis (PD) -associated peritonitis is a common complication in PD patients, often attributed to touch contamination and exit-site infections. This report describes a rare case in which bacterial translocation from advanced colorectal cancer was considered as the underlying cause of PD-associated peritonitis. A 78-year-old female with chronic kidney disease (CKD) underwent PD at our hospital four years ago. She presented with cloudy effluent and abdominal pain, leading to a diagnosis of PD-associated peritonitis and subsequent hospitalization. Intraperitoneal cefotaxime (CAZ) and intravenous vancomycin (VCM) were initiated, improving the abdominal pain and cell count. Due to the favorable susceptibility of Escherichia coli isolated from effluent culture, CAZ was switched to cefazolin (CEZ) on the 6th day. However, recurrence of an elevated effluent cell count on the 9th day prompted consideration of bacterial translocation from organic lesions in the intestine. Colonoscopy revealed a type 2 (ulcerative localized) tumor in the transverse colon, leading to a diagnosis of bacterial translocation due to colorectal cancer. In cases of recurrent elevation of the effluent cell count during PD-associated peritonitis treatment, consideration of colorectal malignancy as a potential cause of secondary infection from intraperitoneal organs is important to facilitate a thorough examination.

A 71-year-old female presented to our hospital with anemia and rouleaux formation of red blood cells on a blood test with fundus hemorrhage. Serum immunoelectrophoresis revealed IgA-λ type monoclonal proteinemia. We identified immature plasma cells and some with two nuclei without proliferation on bone marrow biopsy. She had a history of Sjögren syndrome persisting for about 15 years to date, and her IgG levels were very high. Her blood was markedly viscous, and we diagnosed her with IgA-λ type multiple myeloma and hyperviscosity syndrome. She underwent plasma exchange for the hyperviscosity syndrome, and we confirmed the decrease of immunoglobulin levels before chemotherapy. About two weeks later, we performed double filtration plasmapheresis for the rebound of immunoglobulin. IgA-λ type multiple myeloma with hyperviscosity syndrome is rare, and we successfully administered chemotherapy by conducting plasma exchange and DFPP in advance, avoiding the exacerbation of hyperviscosity syndrome.

Inguinal hernia is a relatively common non-infectious complication after starting peritoneal dialysis (PD). Between April 2015 and May 2022, 19 patients were treated with PD. Among them, 3 patients who underwent tension-free repair were analyzed. The patients were all men and their ages at hernia diagnoses were 82, 77, 76, and 76 years, respectively. All patients showed end-stage renal disease due to nephrosclerosis without a history of peritonitis or abdominal surgery. All hernias were diagnosed after the start of continuous ambulatory peritoneal dialysis (CAPD), and automated peritoneal dialysis (APD) was not performed in any cases. The durations from PD to hernia formation were 14, 8, 5, and 1 month, respectively. The hernias were all indirect inguinal hernias, with diagnoses of three cases of L2 and one case of L3 based on the new JHS classification. All cases were repaired by the mesh plug method, and hernia sacs were simply inverted in the abdominal cavity. The periods until the resumption of CAPD after surgery were 12, 5, 3, and 2 days, respectively. Postoperative interim hemodialysis (HD) was performed in 2 cases. All cases returned to CAPD with regular exchange volumes (2.0 L) on the date of resuming CAPD. No recurrence was noted on abdominal examinations for 52, 31, 30, and 23 months, respectively. However, one patient died of sepsis at 52 months after surgery. Mesh plug repair without hernia sac incision is effective for inguinal hernia in patients on CAPD.