Introduction Recently, although there are many reports showing that serum magnesium concentration is a predictor of mortality in dialysis patients, the observation periods of those reports were of short duration, typically around 12 months. Thus, we investigated this relationship over a longer follow‐up period. Methods This retrospective, observational study included a total of 83 non‐diabetic hemodialysis patients. The follow‐up period was 120 months. Patients were divided into two groups, those with serum magnesium ≥2.5 mg/dL (Mg ≥2.5 mg/dL group) and serum magnesium <2.5 mg/dL (Mg <2.5 mg/dL group), and Kaplan‐Meier analysis and Cox proportional hazards analysis were conducted. In addition to the above analysis, single and multiple regression analysis were performed at baseline to reveal the relationship between serum magnesium and clinical parameters. Findings During the follow‐up period, 31 out of 83 patients died. Kaplan‐Meier analysis showed a significantly higher incidence of death in the Mg <2.5 mg/dL group (log‐rank test 4.951, P = 0.026). Multivariate Cox proportional hazards analysis showed a 62% decreased risk of mortality in the Mg ≥2.5 mg/dL group compared to the Mg <2.5 mg/dL group after adjustment for several confounding factors. Simple correlation coefficient analysis showed positive correlations of serum magnesium levels with serum creatinine, phosphorus, high‐density lipoprotein, ankle‐brachial index and KT/V, and a negative correlation with age. Multiple linear regression analysis showed that the ankle‐brachial index was the only parameter that had a positive and significant correlation with the serum magnesium level. Conclusion Our study demonstrated that higher serum magnesium levels were associated with improved survival in non‐diabetic hemodialysis patients.

Background: Although individuals undergoing maintenance hemodialysis are a major sarcopenic population, there are few methods to assess their skeletal muscle mass conveniently. Here, we investigated the usefulness of serum myostatin and insulin-like growth factor-1 (IGF-1) measurements for the evaluation of skeletal muscle mass. Methods: We examined 117 patients undergoing conventional hemodialysis. The serum myostatin level and IGF-1 level were measured once and compared to clinical parameters (especially skeletal muscle mass-related factors) in hemodialysis patients. Results: The myostatin levels were positively correlated with body cell mass, arm muscle circumference, basal metabolic rate, creatinine, creatinine phosphokinase, and albumin and negatively correlated with body fat rate, arm circumferencearm muscle circumference, age, and C-reactive protein (CRP). The IGF-1 levels were positively correlated with body cell mass, body mass index, arm muscle circumference, arm circumference-arm muscle circumference, blood urea nitrogen, creatinine, protein catabolism rate, transferrin, cholesterol, and triglyceride, and negatively with age and human atrial natriuretic polypeptide. Conclusions: Our findings indicate that serum myostatin might be a useful biomarker for predicting muscle mass and serum IGF-1 might be a useful predictor of nutritional status in hemodialysis patients.

Background: Proteasomes are found in both the cell nucleus and cytoplasm and play a major role in the ubiquitindependent and-independent non-lysosomal pathways of intracellular protein degradation. Proteasomes are also involved in the turnover of various regulatory proteins, antigen processing, cell differentiation, and apoptosis. To determine the diagnostic value of serum proteasome in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), we investigated patients with AAV at various stages of the disease. Methods: Serum 20S-proteasome was measured by ELISA in 44 patients with MPO-ANCA-associated microscopic polyangiitis (MPA) and renal involvement. Thirty of the patients provided serum samples before the initial treatment, and 30 provided samples during remission; 16 provided samples at both time points. Results: The mean serum 20S-proteasome level was significantly higher in the active-vasculitis patients (3414.6 ± 2738.9 ng/mL; n = 30) compared to the inactive-vasculitis patients (366.4 ± 128.4 ng/mL; n = 30; p < 0.0001) and 40 controls (234.9 ± 90.1 ng/mL; p < 0.0001). There were significant positive correlations between the serum 20Sproteasome level and the Birmingham Vasculitis Activity Score (BVAS) (r = 0.581, p < 0.0001), the ANCA titer (r = 0.384, p < 0.0001), the white blood cell (WBC) count (r = 0.284, p = 0.0042), the platelet count (r = 0.369, p = 0.0002), and the serum C-reactive protein (CRP) level (r = 0.550, p < 0.0001). There were significant negative correlations between the serum 20S-proteasome level and both the hemoglobin concentration (r = − 0.351, p = 0.0003) and the serum albumin level (r = − 0.460, p < 0.0001). In a multiple regression analysis, there was a significant positive correlation between the serum 20S-proteasome level and only the BVAS results (β = 0.851, p = 0.0009). In a receiver operating curve analysis, the area under the curve for the serum 20S-proteasome level was 0.996, which is higher than those of the WBC count (0.738) and the serum CRP level (0.963). Conclusion: The serum level of 20S-proteasome may be a useful marker for disease activity in AAV.

Alagille syndrome is an inherited multisystemic disorder. We herein report an atypical case of a Japanese adult patient with Alagille syndrome. He had been diagnosed with Alagille syndrome as an infant based on a liver biopsy. At 27 years of age, he needed to start hemodialysis therapy, but an arteriovenous fistula was not created because his peripheral blood vessels were too narrow. He also had a recurrent brain infarction due to cerebral vascular stenosis. Alagille syndrome is generally recognized as a pediatric hepatic disease, but general physicians should be aware of its potential existence with renal involvement and vascular abnormalities.

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