A 51-year-old man was admitted with hyperglycemia and a duodenal tumor. Although his glycemic control was poor, basal C-peptide levels were not suppressed. Further examination revealed a mass measuring 7.8 cm in diameter in the third portion of the duodenum. Duodenectomy revealed a slow-growing sessile tumor located near Treitz's ligament. The immunohistochemical profile of sections of the specimen revealed the presence of somatostatin. The patient's serum somatostatin was elevated to 300 pg/ml preoperatively, but was reduced to 10 pg/ml postoperatively. Glycemic control also normalized after the operation.

Background: Ferric citrate hydrate (FCH), an iron-based phosphate binder, affects mineral and iron metabolism in patients with chronic kidney disease (CKD). The long-term impact of FCH on iron overload is unknown. With this study, we investigated whether the type of dialysis is associated with FCH-related iron accumulation. Methods: This single-center, retrospectively registered, cohort study was performed in Kariya-Toyota General Hospital, Japan, among outpatients undergoing maintenance hemodialysis (HD) or peritoneal dialysis (PD) between July 2014 and January 2017. It included 136 subjects receiving FCH treatment (104 HD patients and 32 PD patients). Their iron metabolism parameters and FCH-associated adverse events were assessed over 80 weeks. Results: In both groups, the weekly darbepoetin alpha dose and erythropoiesis resistance index declined significantly by 16 weeks, although mean hemoglobin concentrations remained stable (10-11 g/dL), and transferrin saturation peaked at 24 weeks. The difference in the weekly darbepoetin alpha dose for HD and PD patients was 16.5 and 12. 0 μg/week, respectively, (P < 0.01). Increases in iron stores were different between the two groups. Peak mean increase in serum ferritin levels (169.0 vs. 63.0 ng/mL, respectively; P = 0.001) in PD patients at 40 weeks was significantly earlier than that in HD patients. The adverse events observed suggest that FCH treatment was more likely to be discontinued within the first 16 weeks due to hemoglobin overshooting in HD patients and after 40 weeks due to ferritin overload in PD patients. Conclusions: Oral iron supplementation with FCH was successful in all dialysis patients. However, the type of dialysis is a major factor associated with iron accumulation during long-term FCH treatment and more likely to occur in PD patients not experiencing regular, dialysis-associated iron loss. Therefore, the method of dialysis should be taken into consideration when evaluating iron stores of patients with CKD to determine the appropriate starting dose of FCH.

End-stage renal disease is associated with atherothrombosis (ATIS), which, in turn, can promote peripheral arterial occlusive disease (PAOD), coronary artery disease (CAD), and/or cerebrovascular disease (CVD). The aim of this study was to determine whether low plantar skin perfusion pressure (SPP) was related to ATIS among 122 patients receiving maintenance hemodialysis (HD) from March to November 2013 at our outpatient facility. We routinely measured SPP and used the value for analysis. In addition, we retrospectively evaluated the prevalence of ATIS with patients categorized to CAD, CVD, or PAOD groups. Of the 122 outpatients, ATIS was diagnosed in about half (N = 60, 49.2% vs. 62, 50.8%; average SPP, 56.6 vs. 72.9 mm Hg, respectively). These data show that SPP was significantly lower in patients with ATIS (difference, 16.3 mm Hg; P < 0.001) and there was a negative relationship between average SPPs and past history of ATIS complications. When the patients were stratified by the presence of diabetes mellitus, this trend was stronger. Particularly, receiver operating characteristic analysis of HD patients with diabetes revealed a cutoff point of 53.0 mm Hg and an area under the curve value of 0.84, with a sensitivity of 77.0% and specificity of 91.3%. Therefore, we concluded that SPP enables the evaluation of not only local PAOD, but also systemic ATIS. Moreover, we found that a cutoff point of 53.0 mm Hg was useful for detection of ATIS in HD patients.

Aim: Peritonitis is a critical complication in patients undergoing peritoneal dialysis.Patient characteristics, especially conscientiousness, potentially influence self-care activity. This study aimed to examine the relationship between the peritonitis risk and the patient conscientiousness.Methods: This retrospective observational study was conducted at three Japanese medical centres in 2018. Adult patients undergoing peritoneal dialysis were evaluated for conscientiousness with the Japanese version of the Ten-Item Personality Inventory. We followed the patients from peritoneal dialysis induction retrospectively on chart review. The primary outcome was time to first episode of peritonitis after initiation of peritoneal dialysis in the entire observation period. Hazard ratios were estimated using a Cox model adjusted for potential confounders.Results: Among 111 patients enrolled, 32 experienced peritonitis. The patients were divided into the more conscientious group (n = 64) and less conscientious group (n = 47) based on a mean conscientiousness score of 3.991. Additionally, less conscientious patients tended to be at higher risk for peritonitis during the entire study period (hazard ratio adjusted for age and sex, 1.99; 95% confidence interval, 0.98-4.03; p = .057). The increased risk in the less conscientious group was statistically significant in the first year (adjusted hazard ratio, 6.98; 95% confidence interval, 1.42-34.40; p = .017). Conclusion:Less conscientious patients significantly have shorter peritonitis-free survival in the early phase after peritoneal dialysis induction although not significantly during the entire study period. Personality trait assessment using the Ten-Item Personality Inventory could be helpful in educating and following up patients undergoing peritoneal dialysis.

No abstract