Objective: Peritoneal function during peritoneal dialysis (PD) declines over time due to peritoneal inflammation; however, the immunological mechanism has not been fully clarified. Here, we examined changes in each cellular fraction in the peritoneal dialysis effluent by flow cytometry and their relationship to peritoneal damage.Patients and Methods: We enrolled 23 patients who began PD between 2006 and 2017 and had available datasets of the peritoneal equilibration test and flow cytometric analysis for at least three consecutive visits, with an interval of six months from six months after introducing PD. The levels and changes in each cellular fraction, dialysate/plasma (D/P) creatinine ratio, and the forward scatter (FSC) ratio of mesothelial cells to lymphocytes were compared using a simple linear regression analysis.Results: Among the examined variables, only the fraction of CD8+ TCM cells during the first observation was significantly correlated with the change rate in the D/P creatinine ratio (β=1.47, P=0.001, adjusted R2=0.379). The CD8+ naïve T and CD8+ TCM cell fractions were negatively correlated with the change rate of the D/P creatinine ratio (naïve T cells: β=−0.058, P=0.022, adjusted R2=0.188; TCM cells: β=−0.096, P=0.046, adjusted R2=0.137). In addition, the change rates of the D/P creatinine ratio tended to be higher, though not significantly (one way ANOVA; P=0.080), in accordance with the increase in the change rate of the CD8+ effector memory T cells (TEM).Conclusion: The CD8+ naïve T and TCM cells may transition into TEM cells by repeated exposure to the dialysate over time. The TEM cells residing in the peritoneum may play a significant role in the progression of peritoneal damage.

Drug therapy is necessary to treat metastatic and recurrent breast cancer. In Japan, two types of cyclin-dependent kinases (i.e., CDK4/6 inhibitors) are covered under the national healthinsurance system: palbociclib (since December 2017) and abemaciclib (since November 2018). Although there are many reports on the use and side effects of palbociclib in clinical practice, there are few such reports on abemaciclib. Therefore, we investigated the rate of neutropenia and associated background factors in patients taking abemaciclib. Of the 39 patients taking abemaciclib recruited for the study, 22 satisfied the inclusion criteria. Of these, 7 developed Grade 3 or higher neutropenia and had a significantly lower body weight and body mass index (BMI). Furthermore, the white blood cell and neutrophil counts before administration were significantly lower in the expression group compared with the non-expressing group. To predict the development of Grade 3 or higher neutropenia, the receiver operating characteristic (ROC) curve was used to calculate a BMI cut-off value of 23.9 (specificity 85.7%, sensitivity 73.3%, area under the ROC curve 0.80). Based on this cut-off value, BMI was divided into two groups (<23.9 and ≥23.9) and Fisher's exact test was performed. Patients with a low body mass index were more likely to develop Grade 3 or higher neutropenia as a result of increased dosage per kilogram body weight, while among patients with BMI < 25, those with BMI < 23.9 were at high risk of developing Grade 3 or higher neutropenia. Accordingly, caution is required in the treatment of such patients.

In hemodialysis, an adsorbent is used to remove phosphorus from the blood.Because phosphorus adsorbents contain iron, they may cause iron excess, and appropriate management is thus required.In recent years, the use of sucroferric oxyhydroxide (SO), which has become available, is said to be associated with lower iron absorption and is less likely to cause iron excess, as compared with conventional ferric citrate hydrate (FCH). However, in clinical trials of SO conducted in Japan, serum ferritin (Ft) and transferrin saturation (TSAT) tended to increase, and this may cause iron excess similar to FCH. Therefore, we report here on the phosphorus adsorption effect and the influence on iron-related benefit of SO.Among 12 patients, iron-related abnormalities were observed in 3 patients and adverse events such as diarrhea and nausea were observed in 7 patients.In 8 patients who continued taking SO for up to 24 weeks, serum phosphorus (P) decreased, Ft and TSAT increased, Hb, Fe, Ca did not change significantly, and the dose of erythropoiesis-stimulating agents (ESA) decreased. The rate of change of Ft was greater in 5 patients with iron deficiency than in 3 patients with non-ferrous deficiency. SO administration tended to decrease P and improve iron deficiency.In addition, there was a decrease in the dose of ESA, suggesting the possibility of contributing to pharmaceutical cost reduction.Conversely, in patients with iron deficiency, iron-related abnormalities were observed in 3 patients, and about half had adverse events with subjective symptoms 4 weeks after the start of treatment with SO.Therefore, the administration of SO takes into account the effects on iron-related values as well as FCH, it is thus considered important to adjust the dose of SO or ESA depending on the condition while monitoring clinical laboratory values and adverse events from the beginning of administration.