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Aim: The effectiveness of the coronavirus disease (COVID‐19) vaccine in Japanese patients undergoing haemodialysis has previously not been evaluated on a large scale. We analyzed data from the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR), covering nearly all Japanese patients undergoing dialysis (~95% coverage), to examine the association between COVID‐19 vaccination and infection or mortality. Methods: We used data from the JRDR end‐of‐year surveys conducted in 2020 and 2021, including information on the COVID‐19 vaccination and infection months. COVID‐19 infection incidence and its associated mortality rates based on vaccination status (time updated) and odds ratio (OR) (vaccinated vs. unvaccinated) were estimated monthly from April 2021, when vaccination commenced in Japan. Results: COVID‐19 infection analysis included 228 865 patients (215 941 vaccinated and 12 924 unvaccinated patients at the end of 2021). The age‐ and sex‐adjusted ORs (aORs) were significantly lower in August, September, October and November 2021, especially in September (aOR [95% confidence interval (CI)]: 0.25 [0.18–0.36]). Additional adjustments for past medical history and laboratory results rarely affected these results. Similarly, in the COVID‐19‐related mortality analysis with 228 731 patients, including 216 781 vaccinated and 11 950 unvaccinated at the end of 2021, COVID‐19‐related mortality risk was significantly lower in the vaccinated group in August, September, October and November (aOR [95% CI]: August, 0.32 [0.12–0.84], September, 0.04 [0.01–0.11]; October, 0.10 [0.01–0.81]; November, 0.05 [0.00–0.79]). Conclusion: In Japanese patients undergoing haemodialysis, the first or second COVID‐19 vaccine dose was significantly associated with decreased COVID‐19 infection and mortality rates, suggesting its effectiveness in this population. [ABSTRACT FROM AUTHOR]

Background Peritoneal dialysis (PD)-related peritonitis is a major complication of PD. Wide variations in peritonitis prevention, treatment strategies and consequences are seen between countries. These between-country differences may result from modifiable risk factors and clinical practices. Methods A total of 1225 Japanese PD patients were included and prospectively followed in the Peritoneal Dialysis Outcomes and Practice Patterns Study phase 1 (2014–2018) and phase 2 (2018–2022). Associations between PD-related peritonitis and various risk factors were assessed by Cox proportional hazards survival models. Results During follow-up (median 1.52 years), 539 peritonitis episodes were experienced by 364 patients. The country crude peritonitis rate was 0.27 episodes/patient-year. In the fully adjusted model, noticeable patient-level factors associated with experiencing any peritonitis included age {hazard ratio [HR] 1.07 per 5-year increase [95% confidence interval (CI) 1.01–1.14]}, serum albumin level [HR 0.63 per 1 g/dl higher (95% CI 0.48–0.82)] and continuous ambulatory peritoneal dialysis (PD) [HR 1.31 versus automated PD (95% CI 1.05–1.63)]. The adoption of antibiotic prophylaxis practice at the time of PD catheter insertion [HR 0.63 (95% CI 0.51–0.78)] or when having complicated dental procedures [HR 0.74 (95% CI 0.57–0.95)] or lower endoscopy [HR 0.69 (95% CI 0.54–0.89)] were associated with lower hazards of any peritonitis, while a routine facility practice of having more frequent regular medical visits was associated with a higher hazard. Conclusion Identification of risk factors in Japan may be useful for developing future versions of guidelines and improving clinical practices in Japan. Investigation of country-level risk factors for PD-related peritonitis is useful for developing and implementing local peritonitis prevention and treatment strategies [ABSTRACT FROM AUTHOR]

Introduction: In the present study, the efficacy of sotrovimab and molnupiravir in dialysis patients with COVID‐19 was investigated using a registry of COVID‐19 in Japanese dialysis patients. Methods: Dialysis patients with confirmed SARS‐CoV‐2 during the COVID‐19 (Omicron BA.1 and BA.2) pandemic were analyzed. Patients were classified into four treatment groups: molnupiravir monotherapy (molnupiravir group), sotrovimab monotherapy (sotrovimab group), molnupiravir and sotrovimab combination therapy (combination group), and no antiviral therapy (control group). The mortality rates in the four groups were compared. Results: A total of 1480 patients were included. The mortality of the molnupiravir, sotrovimab, and combination groups were significantly improved compared to the control group (p < 0.001). Multivariate analysis indicated that antiviral therapy improves the survival of dialysis patients with COVID‐19 (hazard ratio was 0.184 for molnupiravir, 0.389 for sotrovimab, and 0.254 for combination groups, respectively). Conclusion: Sotrovimab showed efficacy in Omicron BA.1 but attenuated in BA.2. Molnupiravir also showed efficacy in BA.2, suggesting administration of molnupiravir would be important. [ABSTRACT FROM AUTHOR]

Introduction: Inadequate dialysis and fluid overload are corrected after starting combined therapy with peritoneal dialysis (PD) and hemodialysis (HD). However, the effects on anemia management has not been elucidated. Methods: We conducted a prospective, multicenter, observational cohort study of 40 PD patients (age, 60 ± 10 years; male, 88%; median PD duration, 28 months) starting combined therapy and investigated changes in several clinical parameters, including erythropoiesis‐stimulating agent (ESA) resistance index (ERI). Results: ERI decreased significantly during 6 months after switching to combined therapy (from 11.8 [IQR 8.0–20.4] units/week/kg/(g/dL) to 7.8 [IQR 3.9–18.6] units/week/kg/(g/dL), p = 0.047). Body weight, urinary volume, serum creatinine and the dialysate‐to‐plasma creatinine ratio (D/P Cr) decreased, whereas hemoglobin and serum albumin increased. In subgroup analysis, the changes in ERI were not affected by cause for starting combined therapy, PD holiday and D/P Cr. Conclusion: Although detailed mechanism was unclear, ESA responsiveness improved after switching from PD alone to combined therapy. [ABSTRACT FROM AUTHOR]

Background: Although severe atherosclerotic renal artery stenosis (ARAS) is a predictor of future cardiovascular events, large trials have not shown the benefits of percutaneous transluminal renal angioplasty (PTRA). This study aimed to validate the safety and efficacy of PTRA using low-concentration digital subtraction angiography (LC-DSA) in patients with severe ARAS and advanced chronic kidney disease (CKD). Materials and Methods: This prospective study was conducted between August 2018 and October 2021. Eighteen patients with 20 lesions, CKD stage 3b or worse, and significant renal artery stenosis were included and underwent PTRA using ultra-low-dose contrast medium. The primary endpoint was a change in renal function based on serum creatinine (sCr) level. Results: The mean sCr level significantly improved from 3.34 ± 1.8 mg/dL pre-PTRA to 2.48 ± 1.19 mg/dL at 1 month post-PTRA (P =.02). The mean amount of contrast used was 8.3 ± 3.9 mL per vessel. More severe stenosis and rapid deterioration of renal function before treatment were associated with improved kidney function. No cardiovascular or renal complications such as stroke or contrast-induced nephropathy were observed during the 30-day period. Conclusions: PTRA using an ultra-low-dose contrast medium is safe and provides acceptable results. [ABSTRACT FROM AUTHOR]

Introduction: This study compared the outcomes of dialysis patients who received SARS‐CoV‐2 vaccine with those who did not use data from the Japanese COVID‐19 registry. Methods: A total of 1260 dialysis patients with confirmed positive SARS‐CoV‐2 infection was included in this study. Patients were divided into two groups: patients who experienced breakthrough infection and those who were unvaccinated. The need of oxygen supplementation and mortality risks were compared using multivariate logistic regression analysis. Results: The mortality rate was 24.2% in unvaccinated patients and 8.6% in breakthrough patients. The odds ratio of need of oxygen supplementation in the breakthrough patients relative to unvaccinated patients was 0.197. The hazard ratio of mortality in the breakthrough patients relative to unvaccinated patients was 0.464. Conclusion: Our prospective observational study showed that SRAS‐CoV‐2 vaccination in hemodialysis patients is vital for reducing need of oxygen supplementation and mortality risk. [ABSTRACT FROM AUTHOR]

Introduction: Although combined therapy with peritoneal dialysis (PD) and hemodialysis (HD) is widespread in Japan, its clinical utility has been reported only in retrospective or before‐and‐after test lacking a control group. Methods: We conducted a prospective, multicenter, observational cohort study of 176 incident PD patients and compared patient survival and changes in clinical parameters between patients on different dialysis modalities. Results: During a median follow‐up of 41 months, 47 patients transferred to combined therapy and 35 patients transferred directly to HD. Patients transferred to combined therapy had a significantly better survival than those transferred directly to HD. However, we could not establish this difference in a multivariate analysis because only six patients died among these groups. The decreases in urea nitrogen and serum creatinine were more prominent among patients directly transferred to HD. Conclusion: This is the first report revealing clinical feasibility of transfer to combined therapy for PD patients. [ABSTRACT FROM AUTHOR]