In hemodialysis patients, fatigue, especially chronic fatigue, impairs quality of life (QOL) and is a risk factor for various diseases, especially cardiovascular diseases. We performed a co-operative study of fatigue, involving 287 maintenance hemodialysis patients that were being treated at the dialysis centers of two hospitals. This study showed that fatigue in hemodialysis patients was more severe on dialysis days than on non-dialysis days, and it was also more severe when the delta% change in interdialytic body weight gain was>8%. Fatigue was correlated with the dialysis period, but not age. Fatigue was inversely correlated with the serum albumin level, which is a predictor of nutritional status, on both dialysis and non-dialysis days. In addition, patients who walked at least 30 minutes every day as physical exercise felt less fatigue. It was demonstrated that improving and maintaining nutritional status as well as promoting daily activity are important for maintaining and improving QOL among hemodialysis patients.

A 67-year-old male patient with gout-induced end-stage renal disease had been receiving maintenance hemodialysis therapy for 35 years. He was admitted to our hospital because of visual hallucinations, disturbances of consciousness, involuntary movement, and inarticulation, and a cerebral infarction was suspected. Prior to developing these symptoms, he had been administered 0.125 mg/2 days digoxin and 40 mg/day aprindine hydrochloride (for heart failure with paroxysmal atrial fibrillation) for two weeks at another hospital. At our hospital, we switched him from hemodialysis to online hemodiafiltration because he exhibited intradialytic hypotension. His serum digoxin level was high (2.3 ng/mL). After the digoxin was stopped, the visual hallucinations, disturbances of consciousness, and involuntary movement resolved within two weeks. However, the inarticulation did not improve. Therefore, the patient’s serum aprindine hydrochloride level was measured. It was found to be high (3.02 μg/mL). Thus, the aprindine hydrochloride dose was reduced to 30 mg/day. The patient’s symptoms improved significantly. It is necessary to pay attention to the side effects of aprindine hydrochloride, even in patients with appropriate serum aprindine hydrochloride levels.

A 27-year-old female was admitted to hospital because of multi-joint pain and palpable purpura on both legs after an upper respiratory infection. Three days later, macroscopic hematuria and proteinuria were detected. IgA deposition in the skin, abnormal gastric histopathological findings, and endocapillary proliferative glomerulonephritis with IgA deposition in the mesangial region were observed. The patient was diagnosed with IgA vasculitis. Intravenous steroid pulse therapy was ineffective; therefore, plasma exchange and an immunosuppressant were added. The day after 3 rounds of plasma exchange had been performed, a systemic tonic-clonic seizure occurred. Multiple white-matter lesions of the cerebral cortex were found on magnetic resonance imaging after the convulsion, but they had disappeared 16 days after the seizure. Thus, the patient was diagnosed with posterior reversible encephalopathy syndrome. We reported a case of posterior reversible encephalopathy syndrome caused by various factors, such as IgA vasculitis, immunosuppressive treatment, and plasma exchange for nephrotic syndrome.