The patient was a 69‒year‒old woman. Due to chronic renal failure caused by diabetic nephropathy, she underwent peritoneal dialysis (PD) catheter implantation in X‒9 and started PD 6 months later. She developed four dialysate leaks from abdominal wall scar hernias and underwent closure (simple closure； mesh technique). In late August X, drainage became poor, and CT confirmed leakage from a left abdominal wall hernia. Due to the marked possibility of improvement by closure of the site and patient’s strong desire to continue PD, the hernia sac was identified from the superficial side of the body and abdominal wall scar hernia repair was performed. To date, the patient has shown no recurrence, received stable PD, and exhibited no change in peritoneal function. In the present case of recurrent abdominal wall scar hernia due to abdominal wall fragility, the combination of PD prescription and surgical closure facilitated the long‒term continuation of PD.

The patient was an 82‒year‒old man with chronic renal failure due to diabetic nephropathy, who had been receiving outpatient treatment. Following cerebral infarction, his renal function deteriorated further, necessitating the creation of an arteriovenous graft in his right forearm and initiation of hemodialysis. During hospitalization, he developed a fever and was diagnosed with methicillin‒resistant Staphylococcus aureus (MRSA) bacteremia. Despite continued antimicrobial therapy, blood cultures remained persistently positive. Given the high prevalence of infective endocarditis in such cases, repeated echocardiographic evaluations were conducted； however, no valvular vegetations were detected. Initially, no signs of infection, such as erythema, existed around the vascular graft. However, localized erythema near the anastomosis subsequently appeared. Ultimately, vascular ultrasound revealed mobile vegetations attached to the vascular wall, clarifying the infection source. This case highlights the potential utility of vascular ultrasound in diagnosing arteriovenous graft infections.

A 71‒year‒old male on maintenance hemodialysis for end‒stage renal disease was referred to our hospital complaining of nausea and limb weakness, which developed within 1 h of consuming gastropods that he had purchased from a local grocery store and cooked himself without removal of the salivary gland at home. A physical examination revealed neurological abnormalities, including dysarthria, diplopia, and limb weakness. However, acute intracranial lesions were not observed. Based on the patient’s clinical course and non‒specific systemic symptoms, he was diagnosed with tetramine poisoning. The symptoms persisted after admission, but they showed marked improvement during hemodialysis, performed 13 hours after the reported ingestion. The symptoms subsequently resolved completely. Tetramine, which exists in the salivary glands of gastropods, is mostly excreted by the kidneys. Therefore, patients with severe renal impairment have a higher risk of prolonged and severe poisoning due to reduced tetramine clearance. Tetramine is a small‒molecule compound with low‒level plasma protein binding, making it highly removable by hemodialysis. Therefore, in patients with severe renal impairment who have a history of gastropod consumption and present with these symptoms, it is important to suspect tetramine poisoning and promptly initiate hemodialysis therapy.

[Objectives] Using real‒time continuous glucose monitoring (rt‒CGM), we evaluated the effects of tirzepatide in patients with type 2 diabetes (T2D) undergoing hemodialysis (HD). [Subjects] Two male patients with T2D undergoing HD were included in this study. The first patient was a 75‒year‒old man (HD duration： 7 months, T2D duration： 33 years, BMI： 26.1 kg/m²). The second patient was a 60‒year‒old man (HD duration： 20 months, T2D duration： 5 years, BMI： 24.7 kg/m²). [Methods] We monitored blood glucose, glycated albumin (GA), and serum albumin (Alb) monthly before and after the initiation of tirzepatide. Additionally, rt‒CGM was utilized for four months to assess glycemic variability. [Results] Time in range (TIR) on rt‒CGM improved immediately after tirzepatide initiation without an increase in time below range (TBR). GA and insulin dosage also decreased. Furthermore, their BMI remained over 24 kg/m² and Alb was unchanged over the four‒month observation period. [Conclusion] In patients with T2D undergoing HD, tirzepatide demonstrated immediate glycemic benefits without compromising the nutritional status.

Plasma exchange (PE) against toxic epidermal necrosis (TEN) has been recognized as one of the therapeutic options, but its efficacy in patients with TEN who require maintenance hemodialysis remains unclear. Herein, we reviewed our experience of three hemodialysis patients with TEN in our hospital. Case 1 involved a 72‒year‒old woman with end‒stage kidney disease (ESKD) of unknown etiology who had received hemodialysis for two years and was admitted at 23 days after administration of meropenem hydrate to treat an abscess around the kidney complicated with renal cell carcinoma. Her TEN severity score was 6. Intravenous methylprednisolone (IVMP) and intravenous immunoglobulin (IVIG) therapies were performed, and then five sessions of PE using albumin preparation were also provided. However, she subsequently died of sepsis. Case 2 involved a 79‒year‒old woman with ESKD due to unknown etiology under hemodialysis for seven years who was admitted at 2 days after the administration of amoxicillin to treat fever of unknown origin. Her disease severity score was 4. Three sessions of PE using an albumin preparation after the administration of IVMP and IVIG resulted in a favorible outcome. Case 3 involved a 74‒year‒old woman with ESKD due to autosomal dominant polycystic kidney disease who had received hemodialysis for one year and was admitted 4 days after the administration of phosphomycin for a leg ulcer. Her disease severity score was 4. Four sessions of PE using fresh frozen plasma after the administration of IVMP improved her condition. Taken together, TEN in patients requiring dialysis tends to be severe； therefore, multidisciplinary management consisting of strong immunosuppressive therapy and PE is considered to be critical.

We present the case of a 48‒year‒old female who had received peritoneal dialysis (PD) for 7 years after preeclampsia. She had also developed rheumatoid arthritis and psoriasis, treated with corticosteroid and trimethoprim‒sulfamethoxazole. She presented with white‒yellow and cream‒like purulent discharge from the PD catheter‒epidermal interface. Empiric antibiotic therapies were initiated with cephem and a new quinolone agent, which failed to resolve the infection. Nocardia was identified after culture of purulent drainage from the exit‒site swab. To classify the species, 16S rRNA gene sequencing analysis was carried out and antimicrobial susceptibility was tested. As a result, Nocardia farcinica was identified and found to be susceptible to oral antibiotics such as trimethoprim‒sulfamethoxazole and AMPC/CVA. The patient then received an agent that led to the disappearance of purulent discharge. Discharge of pus from the exit site recurred； however, antibiotic therapies were continued for 2‒3 months. As a result of recurrence, we discontinued antibiotic therapies. Removal of the old PD catheter and insertion of a new catheter on the opposite side led to no new episode of recurrence. Refractory catheter‒related infection raises the suspicion of atypical organisms, including Nocardia. We describe the first reported case in over 30 years of PubMed surveys of cutaneous nocardiosis on the exit site of a PD catheter.