Present dialysis condition from the annual statistical data from Japanese Society for Dialysis Therapy Number of chronic dialysis patients in Japan Japanese Society for Dialysis Therapy (JSDT) reports the annual statistical data of dialysis patients at the end of December. According to the data from JSDT in 2016, about 330,000 patients were receiving maintenance dialysis treatment, and this corresponds to about 2600 persons per million in the population (Figure 1). The number of dialysis patients continues to increase, but the increasing rate has already peaked. By the way, only 3% of end-stage renal disease (ESRD) patients are peritoneal dialysis (PD) patients (9021 patients) in Japan. 1 Mean age and original disease of dialysis patients Figure 2 shows the transition of average ages of dialysis patients. The patients with newly initiated dialysis and that of patients already on dialysis were 69.4 and 68.2 years at the end of 2016. The average age of both

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The primary treatment strategy for arterio-venous graft (AVG) infection includes appropriate antibiotic use and removal of the infected graft. It is well known that patients with hemodialysis are likely to experience compromised wound healing, which often leads to various postoperative complications. Negative pressure wound therapy (NPWT) is a non-invasive procedure that promotes wound healing by sealing the wound under negative pressure. Although NPWT is practically accepted in general surgery, there are only a few reports of this strategy to the vascular access operation for patients with hemodialysis due to the possibility of severe bleeding. In the present report, we report a case of a patient who successfully achieved safe and early wound closure by NPWT against compromised wound healing after AVG infection.

Background: There have been a number of reports suggesting that LDL apheresis, including LDL adsorption and double filtration plasmapheresis (DFPP), can be applied for the treatment of lower extremity peripheral arterial disease (PAD) in hemodialysis patients, whereas there is no definitive recommendation for the use of LDL apheresis.Study Design: The change of skin perfusion pressure (SPP) during LDL apheresis was measured in every single treatment to determine the effect of LDL adsorption and DFPP on improving blood flow in lower extremity PAD hemodialysis patients. Eleven hemodialysis patients treated with more than two series of LDL apheresis were involved in the study. "One series" included 10 treatments of LDL apheresis according to the Japanese health care insurance system.Results: In total, 320 treatments (32 series) of LDL apheresis were performed utilizing either LDL adsorption or DFPP treatment in 11 patients. The SPP values pre-and post-apheresis were recorded in 315 treatments (228 LDL adsorption and 87 DFPP). The SPP was significantly improved after both LDL adsorption (P < .001) and DFPP (P = .002) treatment. The median change of SPP was significantly larger in the LDL adsorption group (12.6 mm Hg, range: À48.5, 77.0 mm Hg) than in the DFPP group (6.7 mm Hg, range: À42.0, 72.5 mm Hg) (P = .003). The LDL adsorption consistently offered a significant increase in the SPP, whereas DFPP treatment seemed to have modest effects on the improvement of SPP compared to the LDL adsorption.Conclusions: These data indicate that LDL adsorption should be considered the primary LDL apheresis therapy for lower extremity PAD in hemodialysis patients to achieve improvement of blood flow. K E Y W O R D Schronic kidney disease, double filtration plasmapheresis, LDL apheresis, peripheral arterial disease, skin perfusion pressure Hitoshi Yoshimura and Yuki Yoshikawa contributed equally to the study.