Objective: Epoetin beta pegol (C.E.R.A.) has a long half-life and exerts a more sustained effect on erythropoiesis as compared to epoetin beta. Therefore, the effects of C.E.R.A. on the correction of anemia and iron dynamics are potentially different from those of epoetin beta (EPOβ). We evaluated the state of anemia and the iron dynamics after treatment switch from EPOβ to C.E.R.A. in this clinical study. Subjects: A total of 8 patients undergoing stable maintenance hemodialysis were enrolled. Patients receiving under 4,500 IU/week of EPOβ were switched to C.E.R.A. 100 μg, and those receiving 4,500 IU/week or over of EPOβ were switched to C.E.R.A. 150 μg. Methods: The serum concentrations of erythropoietin (EPO), Fe, TSAT, ferritin and hepcidin-25, and the reticulocyte counts and hemoglobin (Hb) levels were measured on the 2^nd, 4^th, 7^th, 14^th, 21^st and 28^th day after the 1^st intravenous injection, and on the 14^th and 28^th day after the 2^nd and 3^rd intravenous injections and the data were analyzed. Results: While the serum EPO concentrations were significantly higher until the 14^th day (p<0.05), the serum Fe, TSAT and ferritin showed a tendency to become lower from the 7^th day, and the serum hepcidin-25 became significantly lower from the 2^nd day. The levels of each of the serum markers returned to the baseline after the 28^th day. Similar changes of the iron dynamics were observed after the 2^nd and 3^rd injections. Conclusions: Following treatment switch from EPOβ to C.E.R.A., dramatic changes of both the parameters of iron dynamics and hematopoiesis were observed during the 4-week observation period after the treatment switch, and the Hb level was stably maintained for 12 weeks. Based on these findings, we do not recommend routine measurement of the serum markers related to the iron dynamics on the 7^th and/or 14^th day after switching of treatment from EPOβ to C.E.R.A.

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Arteriosclerotic disease is a common complication in hemodialysis patients. We searched for a useful predictive factor for the presence of cerebro- and cardiovascular disorder (CCVD) based on hemodialysis patients' carotid artery flow-velocity waveforms. In 87 hemodialysis patients, the peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI) and end diastolic velocity ratio (ED ratio) were analyzed by carotid ultrasound examination. We examined the relationship between these flow-velocity waveforms and the maximum intima-media thickness (max-IMT), cardio-ankle vascular index (CAVI) and aortic calcification index (ACI). There were significant negative correlations between the EDV and max-IMT, CAVI and ACI. The EDV and ED ratio of the CCVD (+) group were significantly higher than those of the CCVD (-) group. We then divided all subjects into two groups according to the mean value of EDV (11 cm/sec). The incidence of CCVD in the lower-EDV group (<11 cm/sec) was significantly higher than that in the higher-EDV group (≥11 cm/sec). These findings suggest that the EDV and ED ratio are useful markers, as well as predictors of occlusive disease in hemodialysis patients. They further suggest that a low level of EDV is related to the incidence of CCVD in hemodialysis patients.

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This report presents the case of a 56-year-old male patient who had received maintenance hemodialysis for 7 years. The patient experienced a sudden decrease in blood pressure and right acute abdomen during hemodialysis. CT revealed a massive right perirenal hematoma. A right hemorrhage was diagnosed and the patient was treated by transcatheter arterial embolization (TAE). There was remission of the abdominal pain the next day. The patient was discharged on postoperative day 16. CT showed that the perirenal hematoma was reduced after three months. Perirenal hematoma can be caused by trauma, renal cancer, or renal cyst, among others. Drugs were suspected to have been the cause of the hematoma in the current case because the patient had been taking aspirin following CABG (coronary artery bypass graft). It is important to be aware that a differential diagnosis of acute abdomen in maintenance hemodialysis patients is renal hemorrhage. Patients should be followed up by CT to rule out malignancy.

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We report a case of lumbar vertebral osteomyelitis and iliopsoas muscle abscess in a hemodialysis patient with a hemodialysis catheter. A male patient in his 80s was admitted to another hospital for uremia due to end-stage renal disease. A non-cuffed hemodialysis catheter was inserted from the right femoral vein and hemodialysis was initiated. On the 24th day after catheter insertion, the patient developed jaundice and was transferred to our hospital for management. During his hospital stay, he was diagnosed with catheter-related blood stream infection (CRBSI), lumbar vertebral osteomyelitis and iliopsoas muscle abscess as metastatic infectious complications caused by Enterococcus faecalis. We treated the patient with intravenous ampicillin (ABPC) and continuous hemodiafiltration, but he died from septic shock 9 days after admission. In cases with CRBSI arising during hemodialysis in patients with hemodialysis catheters, CRBSI should be diagnosed early and adequate therapy started to prevent critical metastatic infectious complications.

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