Objective The National Kidney Foundation (NKF) Kidney Disease Outcome Quality Initiative (KDOQI) guidelines have recommended the use of arteriovenous fistula (AVF) at the initiation of dialysis. However, there are significant differences in the dialysis environments of Japan and the United States, and there are few people who receive hemodialysis via a central venous catheter (CVC) in Japan. The aim of the present study was to examine the association between the type of vascular access at the initiation of dialysis and the incidence of mortality in Japan. Methods This study was a prospective, multicenter, cohort study. The data was collected by the Aichi Cohort study of Prognosis in Patients newly initiated into dialysis (AICOPP) in which 18 Japanese tertiary care centers participated. The present study enrolled 1,524 patients who were newly introduced to dialysis (the patients started maintenance dialysis between October 2011 and September 2013). After excluding 183 patients with missing data, 1,341 patients were enrolled. The Cox proportional hazards model was used to evaluate mortality based on the type of vascular access. The types of vascular access were divided into four categories: AVF, arteriovenous graft (AVG), CVC changed to AVF during the course (CAVF), CVC changed to AVG during the course (CAVG). Results A multivariate analysis revealed that AVG, CAVF and CAVG were associated with a higher risk of mortality in comparison to AVF [hazard ratio (HR), 1.60; p=0.048; HR, 2.26; p= 0.003; and HR, 2.45; p=0.001, respectively]. Conclusion The research proved that the survival rate among patients in whom hemodialysis was initiated with AVF was significantly higher than that in patients in whom hemodialysis was initiated with AVG or CVC.

Body Cell Mass (BCM) is a sum of all metabolically active cells of the body. Aim of the study was to compare BCM with other nutritional and inflammatory markers in patients with chronic kidney disease (CKD) stage 4-5 (NKF) without dialysis treatment and in hemodialysis patients(HD). We included 45 adult patients with CKD and eGFR o30 ml/min not treated with dialysis (26 male, age: 59,7 7 16,8) and 39 adults treated with HD three times a week, for more than three months (26 male, 5 diabetics, age: 59,8 716). Body composition was measured using multifrequency biopimpedance spectroscopy: Body Composition Monitor -FMC. We used BCM index (BCMI) defined as BCM divided by height to the power of 2. To measure hand grip strength (HGS) we used dynamometr Jamar. In statistics analysis we used Pearson correlations (SPSS v18). Predialysis group: BCMI: 7,1 7 1,6 kg/m 2 , Lean Tissue Index (LTI): 12,9 7 2,4 kg/m 2 , Fat Tissue Index (FTI): 14,7 7 5,4 kg/m 2 , BMI: 28,2 7 5 kg/m 2 , serum creatinine level (SCr): 3,9 7 2,1 mg/dl, eGFR: 18,3 77,0034 ml/min/1,73 m 2 , albumin (SA): 3,9 7 0,3 g/dl, prealbumin (PA): 32,8 78,8 mg/dl, CRP: 0,5 7 0,3 mg/dl. A positive correlation was found with BCMI and HGS (r ¼ 0,55; p ¼0,001), PA (r ¼ 0,41; p ¼0,004) and SCr (r ¼ 0,37; p ¼0,012). A negative correlation was found between BCMI and age (r ¼ -0,48; p¼0,006), CRP (r ¼ -0,33; p¼ 0,028). We do not observed correlation with BMI and SA. HD group: BCMI: 6,4 7 1,7 kg/m 2 , LTI: 12,1 7 2,3 kg/m 2 , FTI: 12 7 6 kg/m 2 , BMI: 24,8 7 4,8, SCr: 8,9 7 2,6 mg/dl, TP: 6,7 7 0,6 g/dl, SA: 3,9 7 0,47 g/dl, PA 33,8 7 11,4 g/dl, CRP: 1,1 7 1,4 mg/dl. A positive, significant correlation was found between BCMI and HGS (r ¼ 0,47; p¼ 0,003). A negative correlation was found with BCMI and age (r ¼ -0,55; p¼0,0005) and with CRP (r ¼ -0,31), but not statistically significant. We do not observed correlation between BCMI and BMI, SCr, TP, SA, PA, hemodialysis vintage, Kt/V. Assessment of body compartments is important tool in estimation nutritional status in patients with stage IV-V CKD and hemodialysis patients. Analysis of body composition in association with other markers worth to be studied, especially in larger groups of patients.

Diltiazem overdose has a high mortality rate due to cardiotoxicity associated with bradycardia and hypotension. A previous article reported that this type of overdose can cause acute tubular necrosis, which was not pathologically, but rather clinically, diagnosed. We herein report the case of a 55-year-old man who sustained nonoliguric acute kidney injury after taking 60 diltiazem tablets. A kidney biopsy performed six days after admission showed ischemic, not toxic, acute tubular necrosis. The patient's kidney function improved spontaneously. In this case report, we clarify the cause of renal impairment caused by diltiazem overdose pathologically. Physicians should therefore consider ischemic acute tubular necrosis as a cause of kidney injury in patients with diltiazem overdose.

house officers (first year residents) reported that a 'renal diet' should be low in protein, salt, potassium, phosphate but only 38% of medical officers reported the same. While 100% of medical doctors stated that renal patients are at risk of compromised nutrition, only 45% of them would refer all renal patients to a dietitian. 47% of nurses believed that 'renal diet' low in potassium, salt, phosphate and protein should be prescribed to all patients with chronic renal failure. Only 38% of nurses were aware of the need for higher protein diet for patients on dialysis. In conclusion, there is a need to improve the knowledge of medical doctors and nursing staff in renal nutrition.http://dx.