A newspaper article in August 2016 reported that about 40 medical facilities refused dialysis to a human immunodeficiency virus (HIV) patient. To investigate this situation, Infection Survey Subcommittee in the Japanese Society for Dialysis Therapy conducted a questionnaire survey. It was sent to 4,039 facilities, of which 2,583 facilities (64.0%) responded to the survey questions. In the past 5 years, 215 facilities (8.3%) were requested to accept HIV patients for dialysis and 40.1% of these “refused” acceptance. Although manuals, written policy and procedure, for a needle piercing accident existed in most of the facilities that accepted the patients, many facilities did neither prepare the stocks of anti-HIV drugs nor co-operate with HIV core hospitals. Principal reasons for “the refusal” were listed as the lack of medical experience with HIV patients, anxiety of healthcare providers with regards to HIV infection risk, lack of stocks of anti-HIV drugs for needle piercing accidents, and lack of cooperation with HIV core hospitals. The proportion of facilities expected to accept HIV patients in the future was as low as 16.9% among all facilities that responded to the survey. The Japanese Society for Dialysis Therapy will need to strengthen the cooperation with other academic societies and disseminate basic knowledge on HIV and its infection control measures to develop and establish the acceptance system of maintenance dialysis for HIV patients.

Due to the introduction of new non-cuffed catheters, we performed a comparative study examining the frequency of insufficient blood flow and the indwelling duration between patients that were treated with conventional catheters and those that were treated with the new catheters. We retrospectively studied the frequency of insufficient blood flow in patients that received catheter treatment between January 2015 and February 2016, in whom 148 catheters were used. Insufficient blood flow was defined as when the catheter connection had to be reversed. We defined the patients treated with conventional catheters as group A, and the remaining patients as group B. As for the backgrounds of the two groups, the frequency of internal jugular vein placement was significantly higher in group A than in group B (p=0.004). Insufficient blood flow occurred in 29.7% of all 148 catheters and was significantly less common in group B (19.0%) than in group A (37.6%) (p=0.014). Insufficient blood flow was also significantly less common in group B than in group A after femoral vein placement (p=0.005). There were no significant intergroup differences in the indwelling period (p=0.904), but catheter changes due to various problems were significantly less common in group B (p=0.024). The new catheters significantly reduced the frequency of insufficient blood flow. In addition, the new catheters were suggested to be especially useful for femoral vein placement.

Dialysis fluid purification is one way to ensure the safety of dialysis therapy. The level of endotoxins (ET) is an important index for safety management during dialysis because ET exhibit strong and extensive physiological activity. We evaluated the accuracy of a newly developed ET measurement method based on bioluminescence technology, using a common protocol at multiple facilities. In accordance with the validation guidelines prepared by the Japanese Society for Hemodiafiltration, we prepared a common protocol and performed the following evaluations at 6 facilities: the validity of the calibration curve, a blank test, a reaction interfering factor test, and assessments of the assay’s detection limit and the quantitation limit for dialysate measurement. These evaluations indicated that the bioluminescence-based method fulfilled the validation requirements of the HDF Research Group. In conclusion, since it exhibits high sensitivity and allows quick measurements, the new method was confirmed to be useful for biological contamination control of dialysis fluid.

The guidelines for latent tuberculosis infections (LTBI) recommend screening hemodialysis patients for LTBI; however, the need to screen hemodialysis patients for LTBI is not widely accepted. In particular, there have been few reports about LTBI at the initiation of hemodialysis. Hence, we investigated the prevalence and characteristics of LTBI among hemodialysis patients at the start of hemodialysis. Twenty-seven out of 151 new hemodialysis patients were diagnosed with LTBI (prevalence: 17.9%). LTBI were associated with smoking. According to our results, since the prevalence of LTBI among new hemodialysis patients was relatively high, we recommend screening end-stage kidney disease patients for LTBI at the initiation of hemodialysis.

【Aim】Hemodialysis (HD) using citrate-containing acetate-free dialysate had a strong ameliorating effect on metabolic acidosis in our clinic, but metabolic acidosis was not sufficiently improved in some HD patients. Ferric citrate (FC) is an iron-containing phosphate binder, and was reported to increase serum bicarbonate concentrations. The acidosis-ameliorating effect of FC was retrospectively investigated. 【Patients and Methods】Chronic kidney disease-mineral and bone disorder parameters, the anemia-related index, and the pre-dialysis serum bicarbonate concentration were compared in 72 outpatient maintenance HD patients who were changed from existing phosphate binders to FC or had FC added to their existing phosphate binders. 【Results】The data obtained before and 3 months after the initiation of FC treatment were compared. Although the mean pre-dialysis bicarbonate concentration was not affected by the administration of FC in all patients, it increased significantly in 30 patients with pre-dialysis bicarbonate concentrations of <22 mEq/L. The absorption of FC-derived iron led to the number of patients with absolute iron deficiency (defined as a transferrin saturation value of <20% and a serum ferritin level of <100 ng/mL) markedly decreasing, and the mean erythropoiesis-stimulating agent dose decreased significantly. 【Conclusion】FC is a phosphate binder, which ameliorates renal anemia and metabolic acidosis. It is particularly useful for HD patients with metabolic acidosis, who are at risk of ectopic calcification.

Lubiprostone is a new laxative, that locally activates the type-2 chloride channels in the gastrointestinal epithelium, inducing net fluid secretion. We examined the effects of lubiprostone on the serum levels of electrolytes. Twenty-four μg lubiprostone was added to conventional laxatives every day in 7 hemodialysis patients who had chronic constipation. The changes in defecation frequency and electrolyte concentrations induced by lubiprostone were examined after 2, 4, 6, and 8 weeks. Lubiprostone reduced defecation in all 7 patients, but 1 patient stopped taking it after 2 weeks because they suffered nausea, and 2 patients stopped taking it after 4 and 6 weeks, respectively, because of diarrhea. The mean serum phosphate level had decreased from 5.8±0.9 to 5.1±0.8 (p=0.034, n=7) after 2 weeks’ lubiprostone treatment. After 4 weeks, 5 of 6 patients exhibited reduced serum phosphate levels, and after 8 weeks all 4 of the remaining patients continued to exhibit reduced serum phosphate levels. The serum phosphate levels of all 3 patients who stopped taking lubiprostone rose again. No changes in predialysis systolic blood pressure were observed, but the volume of water removed was decreased in 6 patients. One patient exhibited difficulties with water removal after 2 weeks. In conclusion, lubiprostone reduced hyperphosphatemia in hemodialysis patients with chronic constipation.