BackgroundCardiovascular disease is the main cause of mortality in dialysis patients. Carotid intima–media thickness (CIMT) is used as a surrogate marker of early atherosclerosis. Atherosclerosis can cause vascular access failure. The purpose of this study was to define the clinical features of atherosclerosis in hemodialysis patients based on CIMT and to define the relationship between CIMT and access failure.MethodsIn this cross-sectional study, the CIMT of 60 patients on hemodialysis was examined using B-mode Doppler ultrasonography between May 2012 and November 2012. Carotid atherosclerosis was defined as a CIMT≥0.9 mm or the incidence of atherosclerotic plaques.ResultsThe patients’ mean age was 54.5±10.6 years, and 60% of the patients were male. The CIMT was 0.81±0.47 mm (range, 0.35–2.50 mm). The group with atherosclerosis was characterized by older age compared with those without atherosclerosis. Patients with atherosclerosis showed much shorter durations of access patency than their counterparts in the nonatherosclerosis group (hazard ratio, 2.822; 95% confidence interval, 1.113–7.156; P=0.029). Moreover, being overweight was associated with a 2.47-fold (95% confidence interval, 1.101–5.548) increased primary access failure.ConclusionThis study shows that atherosclerosis is associated with older age. Patients who are overweight and have atherosclerosis may have shortened access patency.

Abstract. The present study reports the case of a patient that developed spontaneous perirenal hematoma during treatment with bevacizumab-containing chemotherapy. A 44-year-old woman with metastatic sigmoid colon cancer, who was being treated with bevacizumab (5 mg/kg, intravenous, 90 min biweekly), was admitted to hospital following 3 cycles of chemotherapy, with a sudden onset of dyspnea and oliguria. An emergency hemodialysis was performed and a large right perirenal hematoma was diagnosed using computed tomography. The patient was immediately instructed to discontinue chemotherapy, including bevacizumab. However, the right perirenal hematoma increased in size and a left perirenal hematoma developed 3 weeks later. The two perirenal hematomas stabilized 7 weeks subsequent to the termination of bevacizumab treatment. Spontaneous perirenal hematoma due to bevacizumab treatment is an extremely rare occurrence. However, physicians should be aware of this potential complication associated with bevacizumab treatment.

Thrombotic thrombocytopenic purpura (TTP), a fatal disease, is mostly idiopathic but can occur secondary to cancer, infection, transplantation, pregnancy, surgery, or drugs. The mechanism of TTP is still unknown, however, and detection is difficult because of unclear diagnosis criteria. Colonic stent insertion is commonly used in management of malignant colon obstruction. This is a very safe procedure with a low procedure-related mortality rate, but serious complications can develop. The authors first experienced a patient with TTP when the phenomenon occurred after stent insertion for palliation of obstructive colon cancer and therefore would like to report the case.