Auscultation as vascular access (VA) monitoring is performed frequently at each hemodialysis session, but it is largely dependent on the subjective judgment and experience of the staff, and there are some difficulties in sharing information with other staff. The electronic stethoscope “HVSI (Hemodialysis Vascular Sound Index) Monitor” (manufactured by Air Water Medical) was launched in May 2024 (Fig. 1). In addition to its use as a stethoscope, it can also quantify vascular sounds, and these are measured as HVSI values. On the other hand, the Access Blood Flow (Qa) obtained using the ultrasound dilution method, the Qa (DU) obtained using the ultrasound Doppler method, and the Resistance Index (RI) are well-known as indicators for VA surveillance. In this study, we measured the HVSI and compared it with the conventional VA surveillance index. We conducted a cross-sectional study of the correlation between the HVSI value measured by the HVSI monitor and conventional surveillance indicators, using 104 hemodialysis patients with arterio-venous fistula (AVF) who underwent hemodialysis at our hospital between May 2024 and December 2024. The measurement items HVSI, Qa, Qa (DU), and RI were measured at the start of dialysis at approximately the same time. Qa (DU) and RI were measured using the HS2 manufactured by KONICA MINOLTA, and the measurements were taken in the brachial artery. The NIPRO HD03 dialysis monitor was used to measure Qa. HVSI measurements were taken directly above the AVF anastomosis. The measurement values were expressed as median (IQR), and Spearman's rank correlation was used to examine the correlation. In addition, ROC analysis was used to examine the threshold values for detecting Qa, Qa (DU) 350 ml/min or less, and RI 0.6 or more. This study protocol was conducted in accordance with the Principles of the Declaration of Helsinki. The ethics review boards of Osaka Metropolitan University approved the study (No. 2021-243). Opt-out consent was obtained instead of written informed consent; i.e. we provided patients with information explaining the proposed project (purpose, required individual data, and duration of the study) by means of an information sheet or hospital website and gave them the opportunity to opt out. The measured values were HVSI: 196 (113, 400), Qa: 780 (510, 1010) ml/min, Qa (DU): 657 (454, 894) ml/min, and RI: 0.52 (0.46, 0.57). HVSI was significantly positively correlated with Qa and Qa (DU), and significantly negatively correlated with RI (ρ = 0.47, P < 0.001, ρ = 0.55, P < 0.001, ρ = −0.31, P < 0.001). The threshold values for the HVSI values that detect Qa/Qa (DU) 350 or less were 96/178, and the AUCs were 0.75/0.82, respectively. HVSI was not a useful indicator for RI. The HVSI value, which is a monitoring indicator, was found to have a positive correlation with Qa and Qa (DU), which are established as surveillance indicators, and a weak negative correlation with RI. In addition, it was shown that it is possible to set a certain threshold for reduced blood flow. In the past, monitoring using a stethoscope was influenced by the subjective factors of the staff, but by using the HVSI Monitor, an electronic stethoscope, it is now possible to treat it as an objective indicator called the HVSI value. In addition, HVSI monitors are relatively inexpensive, and the method for measuring HVSI values is simple and the measurement time is short, so it was thought that they could be a game changer for the daily management of VA.

Since 2021, Japan has been classified as a country with a low prevalence of tuberculosis (TB). Although dialysis patients have significantly higher incidences of TB and mortality, no recent nationwide surveys have assessed the TB status among dialysis patients in Japan. We conducted a nationwide cross-sectional survey of all 4167 dialysis facilities registered with the Japanese Society for Dialysis Therapy and collected facility-level data between April 2022 and March 2024. The survey assessed TB diagnoses (latent tuberculosis infection [LTBI] and active TB), diagnostic triggers, screening practices and treatment rates for LTBI, epidemiological data and clinical characteristics of active TB, incidence of TB close contacts, healthcare providers' perceptions of TB in dialysis patients, and challenges associated with managing TB in dialysis patients. Survey responses were received from 2468 facilities with 194,720 dialysis patients. Among these patients, 331 were diagnosed with LTBI and 196 developed active TB during the 2-year study period. The LTBI rate was 85.0 cases per 100,000 person-years (95% confidence interval: 75.8-94.2), and the estimated annual rate of active TB was 50.3 cases per 100,000 person-years (95% confidence interval: 43.3-57.5). LTBI was most frequently diagnosed during screening before dialysis initiation (42.7%); however, only 4.5% of facilities conducted routine interferon-gamma release assay screening. The LTBI treatment rate was 75.2%. Among patients with active TB, diabetic nephropathy was the most prevalent underlying disease (44.2%); additionally, extrapulmonary TB was frequently observed. The incidence of active TB was highest among patients approximately 70 years of age (40.2%). Furthermore, 22.2% of patients developed TB within 3 months after dialysis initiation and 61.6% developed TB more than 1 year later. The mortality rate of these patients was 28.8%. Concerningly, 43.2% of dialysis healthcare staff appeared unaware of the TB risk, and 63.8% of facilities reported challenges regarding patient transfer and care coordination. TB is a significant burden among dialysis patients in Japan. Therefore, early awareness and treatment of TB, standardized LTBI screening protocols, robust treatment infrastructure with enhanced awareness among healthcare providers, as well as strengthened collaboration between medical institutions, government agencies, and TB-specialized healthcare facilities are necessary.

The annual survey of the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR) was sent to 4521 dialysis facilities at the end of 2022, among which 4464 facilities (98.7

Chronic kidney disease (CKD) is the fastest growing cause of death, expected to become the fifth global cause of death and the third in some countries with long life expectancy, such as Japan and Spain, by 2050. This reflects societal aging, as advancing kidney age is the main risk factor for CKD. The forecasted 140% increase in the death rate from CKD by 2050 is reduced to 33% when adjusted for age. The increasing mortality burden is paralleled by higher personal, healthcare, socio-economic and environmental burdens and the need for kidney replacement therapy to treat kidney failure. To some extent, the higher CKD burden represents the price of success in prolonging longevity by decreasing other causes of death. Now is the time to act to minimize the negative impact of CKD on aging societies through primary prevention and early diagnosis and treatment of CKD. Action aimed at maintaining kidney health and delaying biological kidney aging will contribute to healthy aging, as the kidneys have gerosuppressor functions and CKD has the highest negative impact on body aging among chronic non-communicable diseases. This action should be part of a move towards novel holistic approaches to healthy longevity represented by concepts such as cardiovascular-kidney-metabolic health, geromedicine, gerosuppressors and organ rejuvenation. We discuss a conceptual framework for the present and future of kidney aging and kidney health in the elderly, emphasizing opportunities for intervention that underlie the Japanese Society of Nephrology and European Renal Association call to action on Achieving Kidney Health in Aging/Aged Societies.

In Japan, Mongolia, and Indonesia, dialysis care has been covered by national health insurance and social welfare programs as of 2022, which covers much of the cost burden. However, the proportion of this burden varies by country and Japan is the only one of these countries in which medical fees are fully covered for all dialysis patients. As systems for dialysis medical care coverage have been established, the number of dialysis patients has increased dramatically in each country. However, the cost of dialysis treatment itself is very high relative to personal income in all countries. This puts pressure on national healthcare budgets and gives rise to concerns about the sustainability of dialysis care in the future. Peritoneal dialysis (PD) is less expensive than hemodialysis (HD) in Mongolia and Indonesia, and a PD-first policy is considered effective in reducing costs. Nevertheless, an overwhelming number of patients still undergo HD. Despite the difficulties faced by these three countries in obtaining funds for dialysis treatment, among Asian countries, Mongolia and Indonesia are considered to have relatively advanced healthcare systems. It is considered that there has been progress in the provision of dialysis treatment subsidies to the citizens of these countries.

Background: Several epidemiological studies have indicated that metabolic syndrome (MetS) after renal transplantation is caused by an accumulation of non-immunological risks of renal transplantation, and affects the prognosis of the kidney and the patient by increasing the risk of arteriosclerosis and cardiovascular complications. The incidence of MetS in Japanese renal transplant recipients is 14.9 to 23.8%, but its effects on cardiovascular events and kidney prognosis are not clear. Here, we report the results of a longitudinal study on MetS in renal transplant recipients. Methods: A retrospective cohort study was conducted in 104 stable renal transplant recipients who attended our outpatient department from January 2006 to June 2007 and were diagnosed with MetS at least 6 months after renal transplantation until 31 December 2020, or did not have MetS. The impact of MetS on composite vascular events was examined using multivariate Cox proportional hazards analysis. Results: The hazard ratios for the impact of MetS on composite vascular events diagnosed by NCEP Japan, NCEP Original, NCEP Asia, and IDF criteria on composite vascular events were 2.78 (95% CI: 1.15 to 6.75, p = 0.024), 2.65 (95% CI: 1.04 to 6.80, p = 0.042), 2.37 (95% CI: 0.93 to 6.01, p = 0.070), and 1.91 (95% CI: 0.77 to 4.75, p = 0.164), respectively. P for interaction was used to test the influence of each indicator, but was not statistically significant. Conclusions: MetS is a robust risk factor for graft loss and development of cardiovascular events in Japanese renal transplant recipients, even during long-term follow-up. This finding emphasizes the importance of monitoring and managing MetS in this population to improve long-term outcomes.

Abstract Background and Aims The routine evaluation of VA involves visual, palpatory, and auscultatory examinations, as well as monitoring of venous pressure and other parameters. Surveillance indices include Flow Volume (FV) and Resistance Index (RI) obtained by Doppler ultrasound (DU) and Access Blood Flow (Qa) obtained by the Ultrasound Dilution Method (UDM) are well known. On the other hand, the MSS-U11C electronic stethoscope (Fig. 1) and dedicated application (Fig. 2) developed by Pioneer Inc. converts vascular sound into digital data and calculates the INDEX value obtained from the sound intensity (dB) analyzed by the vascular sound visualization system. In this study, we examined the correlation between INDEX values and conventional surveillance indices. Method 1. Eighty-three cases in which INDEX, FV, RI, and Qa were simultaneously measured in hemodialysis patients with AVF at the Artificial Kidney Department of Osaka Metropolitan University Hospital were included. 2. The measurement site for INDEX was just above the anastomosis of the AVF. 3. FV and RI were measured using a KONICA MINOLTA SONIMAGE HS2 diagnostic ultrasound system with the brachial artery as the measurement site. 4. Measurements were expressed in Median [IQR], and for statistical examination, Pearson's correlation coefficient was used for the correlation of each measurement, transformed to the natural logarithm to satisfy the assumption of normality of the residuals. The significance level for all hypothesis tests was 5%. For statistical analysis, R version 4.2.1 (https://www.r-project.org/foundation/) with the “rms” and “RcmdrPlugin.EZR ” packages were used. 5. This study protocol was conducted in accordance with the Principles of the Declaration of Helsinki. The ethics review boards of Osaka Metropolitan University approved the study (No. 2021-243). Opt-out consent was obtained instead of written informed consent. Results INDEX showed a significant positive correlation with Qa and FV (R = 0.449, P = 0.002 / R = 0.484, P < 0.001, respectively), INDEX showed a significant negative correlation with RI (R = −0.336, P = 0.002). Conclusion INDEX measurement using an electronic stethoscope is a monitoring index and showed a positive correlation with FV and Qa, which are established surveillance indices, and a weak negative correlation with RI. In Japan, FV and RI are commonly used as surveillance indices, but it has been reported that these indices can be underestimated or overestimated depending on the skill of the examiner, and that Qa requires specialized equipment and cannot be measured depending on the puncture site. We believe that monitoring by stethoscope is influenced by subjective factors of staff members, which may lead to differences in evaluation, but INDEX could become a more quantitative and standardized indicator. In addition, the electronic stethoscope could be used without any difference compared to the stethoscope currently in clinical use.

INTRODUCTION:Recent advances in dialysis therapy have made it possible to remove middle molecules. Removal of small-middle molecules, such as β2-microglobulin, can now be achieved with conventional hemodialysis (HD), and removal of large-middle molecules has become a target, particularly for α1-microglobulin (AMG, 33 kD). The AMG reduction rate has emerged as a target for improvement of various clinical symptoms, but the effects on prognosis have yet to be determined. The "Japanese study of the effects of AMG (α1-microglobulin) reduction rates on survival" (JAMREDS) was started in April 2020, with the goal of determining if the AMG reduction rate associates with the risk of mortality and cardiovascular disease (CVD) events.METHODS:JAMREDS is a prospective observational study in patients on HD to examine the effects of: (1) AMG reduction rate on survival outcome and CVD events; (2) dialysis treatment modalities (HD, intermittent infusion hemodiafiltration(iHDF), pre/post-dilution online HDF) on survival and CVD events (based on AMG reduction rates with treatment mode); and (3) AMG reduction rates on survival and CVD events in patients undergoing each therapy (iHDF, pre/post-dilution online HDF). The number of planned subjects was 4,000 in preplanning. Data are collected using RED-Cap, which is an EDC system. A total of 9,930 patients were enrolled at the beginning of the study at 59 registered facilities. The JAMREDS observation period will continue until the end of 2023, after which the data will be cleaned and confirmed before analysis.CONCLUSION:This study may provide new evidence for the relationship between the amount of removed large-middle molecules (such as AMG) and the mortality and CVD risk. Comparisons with convection volumes will also be of interest.

AbstractThe annual survey of the Japanese Society for Dialysis Therapy (JSDT) Renal Data Registry (JRDR) at the end of 2021 was conducted at 4508 facilities, of which 4454 facilities (98.8%) returned the facility questionnaire and 4251 (94.3%) returned the patient questionnaire, giving response rates as high as those in previous years. The number of dialysis patients in Japan has been increasing year by year, reaching 349,700 as of the end of 2021 or 2786 patients per million population according to the results of the facility survey. The mean age of patients based on the patient survey was 69.67 years, with the most common primary disease being diabetic nephropathy (39.6%), followed by chronic glomerulonephritis (24.6%) and nephrosclerosis (12.8%). The number of incident dialysis patients in 2021 based on the facility survey was 40,511, a decrease of 233 patients from 2020. The mean age of incident dialysis patients based on the patient survey was 71.09 years, with diabetic nephropathy being the most common primary disease with a frequency of 40.2%, 0.5% points less than the previous year. Nephrosclerosis (18.2%) was the second most common primary disease, surpassing chronic glomerulonephritis (14.2%) as in the previous year. The annual number of deceased patients in 2021 based on the facility survey was 36,156, with an annual crude mortality rate of 10.4%. The leading causes of death, in descending order, were heart failure (22.4%), infection (22.0%), and malignancy (8.4%), with similar rates as the previous year. The number of patients on hemodiafiltration (HDF) has increased rapidly since 2012, reaching 176,601 according to the facility survey at the end of 2021, accounting for 50.5% of all maintenance dialysis patients. The number of patients on peritoneal dialysis (PD) was 10,501 and has been increasing since 2017. Of the PD patients, 20.3% were on combination therapy with hemodialysis (HD) or HDF, and this proportion has remained almost constant. The number of patients on home HD as of the end of 2021 was 748, a decrease of 3 patients from the end of 2020. In 2021, the facility survey items included disaster preparedness, in addition to items from the previous year, including coronavirus disease 2019 (COVID-19), malignancy, and history of kidney donation for living donor kidney transplantation. These data provide basic information on individual diseases and patients, and the results are expected to be used to propose more effective routine clinical management patterns.Trial registration The JRDR was approved by the Japanese Society for Dialysis Therapy ethics committee. It was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry on September 10, 2020 and in the UMIN clinical trials registration system (UMIN000018641).

AbstractOn 1 December 2019, an outbreak of coronavirus disease 2019 (COVID-19) occurred in Wuhan, China, and quickly spread around the world. In an effort to prevent transmission, global traffic flows were affected and lectures by international speakers at the 2022 Annual Meeting of the Japanese Society for Dialysis Therapy were streamed over the internet. Speakers from Vietnam, Indonesia, and Mongolia reported on the status of COVID-19 infection in dialysis patients from December 2019 to June 2022. In addition, the situation in Japan is discussed in the introduction. In Japan, the mortality rate due to COVID-19 infection in dialysis patients was approximately 20% in a national statistical survey before the introduction of the vaccine, and decreased to 3.1% with the introduction of the vaccine. In Vietnam, the mortality rate was 42% in non-vaccinated recipients and 21% in two-dose recipients, but this was reported by a single center. Mortality among dialysis patients with COVID-19 infection in Indonesia was 57%, although reported by a single center. In Indonesia, 6 million people were infected with COVID-19, and the number of COVID-19 cases among dialysis patients was estimated to be around 52,200. Mongolia was considered to be the country that was able to move to vaccination while most effectively controlling the domestic spread of severe acute respiratory syndrome coronavirus 2 compared with many other countries.

Background The 2020 Japanese Society for Dialysis Therapy Renal Data Registry (JRDR) annual survey was sent to 4493 dialysis facilities in Japan. Methods Questionnaires were sent to all facilities that provide patients with dialysis therapy in Japan. Data were collected and compiled to form cross-sectional results of renal replacement therapy from various aspects. Results In total, 4437 facilities (98.8%) responded to the facility questionnaire and 4271 (95.1%) responded to the patient questionnaire. The number of chronic dialysis patients in Japan continues to increase every year, reaching 347,671 at the end of 2020 and giving a prevalence rate of 2754 patients per million population. The mean age was 69.40 years. Diabetic nephropathy was the most common primary disease among the prevalent dialysis patients (39.5%), followed by chronic glomerulonephritis (25.3%) and nephrosclerosis (12.1%). There were 40,744 incident dialysis patients during 2020, representing a decrease of 141 from 2019. The average age of patients on dialysis was 70.88 years, with diabetic nephropathy being the most common underlying disease (40.7%) second most common was nephrosclerosis (17.5%), which was unchanged from the previous year and surpassed chronic glomerulonephritis (15.0%). There were 34,414 patient deaths in 2020; the crude mortality rate was 9.9%. The main causes of death were heart failure (22.4%), infection (21.5%), and malignancy (9.0%), which were almost the same as the percentages for the previous year. Since 2012, the number of patients treated by hemodiafiltration has increased rapidly; in 2020, the number of patients on this modality was 163,825, accounting for 47.1% of all patients on maintenance dialysis. The number of patients on peritoneal dialysis has been on the rise since 2017, reaching 10,338 in 2020; 20.8% of whom received combined therapy with hemodialysis or hemodiafiltration, showing no change from the previous year. A total of 751 patients were on home hemodialysis at the end of 2020, representing a decrease of 9 from the end of 2018. In 2020, coronavirus disease 2019 (COVID-19) infection and malignancy were added as new items in the survey. Continuing on from the 2019 survey, history of kidney donation for a living-donor transplant was investigated. Conclusions Present issues and challenges in renal replacement therapy were identified in the responses to the new questionnaire items included in this survey. A more detailed evaluation with adjustment for patient background factors should clarify the characteristics of the underlying diseases and conditions in dialysis patients. Trial registration The JRDR was approved by the Japanese Society for Dialysis Therapy ethics committee. It was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry on 10 September 2020 and in the UMIN clinical trials registration system (UMIN000018641).

BackgroundIn the use of therapeutic plasma exchange (TPE) as antibody removal therapy for ABO-incompatible (ABOi) kidney transplantation, it is technically possible to perform online hemodiafiltration (OHDF) and TPE simultaneously for patients who are receiving OHDF. In this study, we report tandem therapy of pre-dilution OHDF and centrifugal plasma exchange (cTPE), instead of membrane plasma exchange, which is the mainstay of TPE in Japan.MethodsA total of 14 sessions of tandem cTPE and pre-dilution OHDF were performed as preoperative antibody removal therapy for 6 ABOi kidney transplant recipients. cTPE intra-circuit pressure, decreased antibody titer, and adverse events were evaluated. The study was carried out following the ethical standards of the Declaration of Helsinki and Istanbul. Donors were not prisoners or individuals who were coerced or paid.ResultsThe tandem therapy was completed safely in 12 of the 14 sessions, with no problems such as pressure upper and lower limit alarms or circuit coagulation. In 2 sessions, the tandem therapy had to be interrupted due to coagulation on the dialysis circuit side. Antibody titers were reduced by a median of 3-fold for both IgG and IgM. There was no acute antibody-associated rejection.ConclusionsIn preoperative apheresis therapy for ABOi kidney transplantation, tandem therapy of pre-dilution OHDF and cTPE may be a useful treatment option that can be performed safely and results in sufficient reduction of antibody levels.

BackgroundsThere are advantages and disadvantages with closure of an arteriovenous fistula (AVF) after kidney transplantation, but some cases require closure. The general procedure for closure is angioplasty with exposure of the anastomotic site, but this is often time-consuming and complicated. We have developed a simpler, less invasive, and shorter procedure for AVF closure, in which the anastomotic site itself is not peeled off and the outflow vein close to this site is ligated using 1-0 silk. In this study, we examined the utility of this procedure.MethodsA retrospective case series study was conducted by review of electronic medical records of patients and surgeries. All patients (n = 52) who underwent AVF closure after kidney transplantation at our hospital between January 2008 and April 2021 were reviewed. Perioperative and long-term postoperative results were examined. This study was carried out following the ethical standards of the Declaration of Helsinki and Istanbul. Donors were not from prisoners, or from those individuals who are coerced of paid.ResultsSimple ligation was performed for 46 patients (88.5%). The median time after renal transplantation was 40 (24.5-66.5) months. Median operative time and blood loss were 20 (12.2-30) minutes and 10 (5-15) mL, respectively. Two patients (4.3%) developed the aneurysm after the AVF closure using the simple ligation.ConclusionThe simple ligation technique had a relatively shorter operative time and only 2 cases had aneurysm formation. These results suggest that this technique is an option for closure of an AVF after kidney transplantation.

AbstractThe coronavirus disease 2019 (COVID-19) pandemic affected the entire world with unprecedented impact on the health care and economy of countries. India, the most populous country, faced enormous challenges across its diverse population groups. The end-stage renal disease (ESRD) patients on dialysis, especially hemodialysis, were a high-risk group with inevitable regular hospital visits in contrast to the home peritoneal dialysis group. The unplanned lockdown and home confinement posed many risks to dialysis patients due to dialysis unit closures, logistical issues, and severe COVID-19-related morbidities. We have paucity of data on mortality of dialysis patients in India. We describe the reported and available data on COVID-19 in India from across different centers. The vaccination provided by two different pharmaceuticals such as Covaxin and Covishield in a small cohort of dialysis patients reduced infection and severity.

Tools that can be used to estimate antibody waning following COVID-19 vaccinations can facilitate an understanding of the current immune status of the population. In this study, a two-compartment-based mathematical model is formulated to describe the dynamics of the anti-SARS-CoV-2 antibody in healthy adults using serially measured waning antibody concentration data obtained in a prospective cohort study of 673 healthcare providers vaccinated with two doses of BNT162b2 vaccine. The datasets of 165 healthcare providers and 292 elderly patients with or without hemodialysis were used for external validation. Internal validation of the model demonstrated 97.0% accuracy, and external validation of the datasets of healthcare workers, hemodialysis patients, and nondialysis patients demonstrated 98.2%, 83.3%, and 83.8% accuracy, respectively. The internal and external validations demonstrated that this model also fits the data of various populations with or without underlying illnesses. Furthermore, using this model, we developed a smart device application that can rapidly calculate the timing of negative seroconversion.

Hemodiafiltration (HDF) therapy has become standard treatment in Japan and Europe, but evidence from Europe is not directly applicable to HDF in Japan because HDF therapy differs greatly in the two regions. Japanese dialysis membranes vary widely, including use of protein-leaking and non-leaking membranes, and the molecular weight of solutes that can be removed is generally larger in Japan than in Europe. Given the characteristics of pre-dilution, the volume of replacement fluid itself cannot be used as a marker for solute removal, and the relationship of this volume to life prognosis is still unknown. Under these circumstances, the JAMREDS, a multicenter study led by the Japanese Society for Hemodiafiltration, was started in April 2020. The goal of the study is to determine whether α1-microglobulin reduction rate can be used as a marker for the prognosis of hemodialysis patients, including life prognosis and cardiovascular event onset. The JAMREDS is being performed from a new perspective of solute removal by HDF. This research design is reasonable and highly original for HDF in Japan, in view of the wide variety of membrane types and treatment modes, and the results of the study will be of particular interest.

Introduction: In the present study, the efficacy of sotrovimab and molnupiravir in dialysis patients with COVID-19 was investigated using a registry of COVID-19 in Japanese dialysis patients.Methods: Dialysis patients with confirmed SARS-CoV-2 during the COVID-19 (Omicron BA.1 and BA.2) pandemic were analyzed. Patients were classified into four treatment groups: molnupiravir monotherapy (molnupiravir group), sotrovimab monotherapy (sotrovimab group), molnupiravir and sotrovimab combination therapy (combination group), and no antiviral therapy (control group). The mortality rates in the four groups were compared.Results: A total of 1480 patients were included. The mortality of the molnupiravir, sotrovimab, and combination groups were significantly improved compared to the control group (p < 0.001). Multivariate analysis indicated that antiviral therapy improves the survival of dialysis patients with COVID-19 (hazard ratio was 0.184 for molnupiravir, 0.389 for sotrovimab, and 0.254 for combination groups, respectively).Conclusion: Sotrovimab showed efficacy in Omicron BA.1 but attenuated in BA.2. Molnupiravir also showed efficacy in BA.2, suggesting administration of molnupiravir would be important.