High daily pill burden affects quality of life and mortality. High interdialytic weight gain (IDWG) is associated with increased mortality. We examined the association between pill burden and IDWG in hemodialysis patients. This cross‐sectional study was conducted in six dialysis centers in Japan in June 2017. The exposure was the number of daily tablets, and outcome was defined as 1 day of relative IDWG divided by post‐dialysis weight from the previous session. Among 188 outpatients (mean age, 68.7 [SD, 10.3] years; men, 67.0%; median dialysis vintage, 76.0 [interquartile range, 36.5, 131.5] months), the mean number of daily tablets was 19.7 ± 9.9, and mean relative weight gain was 3.5 ± 1.2%. Multiple linear regression analysis showed a regression coefficient of 0.021 (95% confidence interval: 0.004‐0.039), indicating that one additional tablet prescription increased the IDWG by 0.021%. In hemodialysis patients, the daily pill burden was a significant, independent risk for increased relative IDWG.

PDI endoscopic appearance of CMV colitis is variable; round-shaped ulcers are the most distinctive features, but not specific. The definitive diagnosis requires histopathologic evidence of viral cytopathic effects, and the sensitivity is augmented by immunohistochemistry or polymerase chain reaction (PCR) for CMV deoxyribonucleic acid (DNA) (3,4). The colitis in our patient was not self-limited, but subsequently improved with ganciclovir therapy. A meta-analysis of immunocompetent patients with CMV colitis reported a lower rate of spontaneous remission (18.8%) and a mortality of 56% in individuals with renal failure, diabetes mellitus, pregnancy, or untreated cancer (1). Antiviral therapy is probably beneficial to patients with comorbidities or persistent symptoms. In conclusion, the presence of B. fragilis in PD peritonitis is more commonly associated with intra-abdominal pathologic states, and CMV colitis should be considered even in the absence of immunosuppression. DISCLOSURESThe authors have no financial conflicts of interest to declare.

Background:The aim of present study was to evaluate the effects of one-hour discussion on the choice of dialysis modality at the outpatient clinic.Methods: Charts of consecutive patients who had started maintenance dialysis from May 2013 to April 2021 were retrospectively reviewed. Characteristics at the start of dialysis were compared between patients participated and not participated in the discussion. Results: Of the 620 incident dialysis patients, 128 patients had participated in the discussion. After propensity score matching (1:1), 127 patients who participated in the discussion tended to have fewer urgent hospitalizations (13.4% vs. 21.3%, p = 0.068). In addition, more patients who initiated peritoneal dialysis (PD) (30.7% vs. 9.4%, p < 0.001). On multivariate analysis, participation in the discussion (OR 4.81,; p < 0.001) was related to PD initiation. Conclusion:One-hour discussion on the choice of dialysis modality may increase PD initiations and decrease the number of urgent hospitalizations.

Background/Aims: The association of diastolic blood pressure (DBP) with incidence of chronic kidney disease (CKD) in the general population is not well examined. Methods: Using national health check-up database from 2008 to 2011 in the general Japanese population aged 39–74 years, we evaluated the association between DBP and incidence of CKD 2 years later in 127,954 participants without CKD. DBP was categorized by every 5 mm Hg from the lowest (<60 mm Hg) to the highest category (>100 mm Hg) and was further stratified into those with and without antihypertensive medications (BP meds). We calculated the OR for estimating adjusted risk of incident CKD using logistic regression model. Results: Participants were 62% female and 25.9% with BP meds, mean age of 76 years with estimated glomerular filtration rate of 78.2 ± 13.4 and DBP of 76 ± 11 mm Hg. Two years later, 12,379 (9.7%) developed CKD. Compared to DBP 60–64 mm Hg without BP meds as reference, multivariate analysis showed no difference in CKD risk at any DBP category among those without BP meds. However, in those with BP meds, risk increased according to lower DBP from 95 to 60 mm Hg (p for trend 0.05) with OR 1.51 (95% CI 1.14–1.99) in DBP <60 mm Hg. In subgroup analysis within those with or without BP meds, CKD risk was lower at higher DBP (p for trend 0.02) only in those without BP meds. Conclusion: Lower DBP was associated with higher risk of incident CKD only in the general population taking antihypertensive medication.

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