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Okamura S, Niihata K, Nishiwaki H, Tsujii S, Ishii H, Hayashino Y, Kurita N. Association between physical activity and kidney function decline in patients with type 2 diabetes: a prospective cohort study (Diabetes Distress and Care Registry at Tenri [DDCRT 11]). J Nephrol 2023; 36:2657-2660. [PMID: 37382876 DOI: 10.1007/s40620-023-01691-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/23/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Shintaro Okamura
- Department of Endocrinology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan
| | - Kakuya Niihata
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Fukushima, 960-1295, Japan
| | - Hiroki Nishiwaki
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Fukushima, 960-1295, Japan
- Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, 227-8501, Japan
- Showa University Research Administration Center (SURAC), Showa University, Shinagawa, Tokyo, 142-8555, Japan
| | - Satoru Tsujii
- Department of Endocrinology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan
| | - Hitoshi Ishii
- Department of Doctor-Patient Relationships, Nara Medical University, Kashihara, Nara, 634-8521, Japan
| | - Yasuaki Hayashino
- Department of Endocrinology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan.
| | - Noriaki Kurita
- Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima, Fukushima, 960-1295, Japan
- Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukushima, Fukushima, 960-1295, Japan
- Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Fukushima, 960-1295, Japan
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Jeong E. Impact on health outcomes of hemodialysis patients based on the experience level of registered nurses in the hemodialysis department: a cross-sectional analysis. FRONTIERS IN HEALTH SERVICES 2023; 3:1154989. [PMID: 37720846 PMCID: PMC10499627 DOI: 10.3389/frhs.2023.1154989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/12/2023] [Indexed: 09/19/2023]
Abstract
Background The aim of the study is to improve the policy of health authorities regarding registered nurses (RNs) staffing by understanding how the health outcomes of hemodialysis (HD) patients vary depending on the level of HD nursing experience of at least 2 years. Methods The study included 21,839 patients who started maintenance HD for 3 months in early 2013 in the same medical institutions. Demographic variables such as sex, age, and causes of HD; institutional variables such as type of institution and number of RNs; and health outcomes such as HD adequacy, systolic and diastolic blood pressure (SBP, DBP), hemoglobin (Hb), and serum albumin were collected through web-based questionnaires. To determine the relationship between variables, t-test, chi-square test, and ANOVA were employed. Binary logistic regression was used to examine the odds ratio. Results Institutions with 100% of experienced RNs with at least 2 years of experience in HD units were found to have higher NKF K-DOQI criteria satisfaction rate than Institutions with <50% of experienced RNs with at least 2 years of experience in HD units for all health outcomes, except DBP (42.9% vs. 38.8%, p < .001) and Hb (27.8% vs. 24.4%, p < .001). Four of the six health-related variables-HD adequacy (Kt/v, urea reduction rate, URR), SBP, and serum albumin-were higher in institutions with 100% of experienced RNs than those with less than 50%. Conclusions In order to improve HD patients' health outcomes, HD institutions should prioritize recruiting RNs who are proficient in HD care. A higher proportion of skilled RNs results in a higher ability to prepare for emergencies and early detection of patient complications. RNs with extensive experience in HD nursing, therefore, promote quality management of HD patients.
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Affiliation(s)
- EunYoung Jeong
- Department of Nursing, Wonkwang University, Iksan, Republic of Korea
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Inagaki K, Tsuji M, Furusawa S, Suzuki A, Masuda D, Takanashi M, Akahori T. Vascular access interventional therapy of early arteriovenous fistula occlusion leading to long-term patency: A case report. J Vasc Access 2023:11297298231190253. [PMID: 37574936 DOI: 10.1177/11297298231190253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
Arteriovenous fistulas (AVFs) are frequently used for hemodialysis access, but approximately 15%-20% of AVFs fail to mature within 3 months of their creation. Vascular access interventional therapy (VAIVT) is typically performed for treating an immature AVF. However, it should be performed 4-6 weeks or later after AVF creation. Here, we present a case in which VAIVT effectively addressed AVF occlusion that occurred only 9 days after its creation. The patient was an 82-year-old woman with chronic kidney disease who underwent surgery to create a left radiocephalic AVF for hemodialysis. Nine days postoperatively, disappearance of the AVF sound prompted an angiography, revealing thrombosis near the AVF anastomosis. VAIVT successfully restored blood flow, resulting in AVF maturation, and with no thrombosis or flow dysfunction at 21 months after VAIVT. To the best of our knowledge, this case presents the earliest successful intervention for an occluded AVF.
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Affiliation(s)
- Koji Inagaki
- Department of Nephrology, Chutoen General Medical Center, Kakegawa, Shizuoka, Japan
| | - Masashi Tsuji
- Department of Nephrology, Chutoen General Medical Center, Kakegawa, Shizuoka, Japan
| | - Shin Furusawa
- Department of Nephrology, Chutoen General Medical Center, Kakegawa, Shizuoka, Japan
| | - Akira Suzuki
- Department of Nephrology, Chutoen General Medical Center, Kakegawa, Shizuoka, Japan
| | - Daiki Masuda
- Department of Nephrology, Chutoen General Medical Center, Kakegawa, Shizuoka, Japan
| | - Masahiro Takanashi
- Department of Nephrology, Chutoen General Medical Center, Kakegawa, Shizuoka, Japan
| | - Toshiyuki Akahori
- Department of Nephrology, Chutoen General Medical Center, Kakegawa, Shizuoka, Japan
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Wakasugi M, Narita I. Birth cohort effects in incident renal replacement therapy in Japan, 1982-2021. Clin Exp Nephrol 2023; 27:707-714. [PMID: 37014536 DOI: 10.1007/s10157-023-02345-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/24/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND This study aimed to investigate the long-term trends of incident end-stage kidney disease (ESKD) requiring renal replacement therapy (RRT) in Japan using age-period-cohort analysis and evaluated birth cohort effects for incident ESKD requiring RRT. METHODS The number of incident RRT patients aged between 20 and 84 years by sex from 1982 to 2021 was extracted from the Japanese Society of Dialysis Therapy registry data. Annual incidence rates of RRT were calculated using census population as denominators, and changes in the incidence rates were evaluated using an age-period-cohort model. The age and survey year period categories generated 20 birth cohorts with 5-year intervals (from 1902-1907 to 1997-2001). RESULTS The incidence rates of RRT in both sexes initially rose in the birth cohorts born in the early 1900s, and then decelerated and peaked during 1940-1960s in men and 1930-1940s in women, following a steady decline in both sexes. Compared with the reference 1947-1951 birth cohort, the highest cohort rate ratio was 1.14 (95% CI, 1.04-1.25) in the 1967-1971 birth cohort in men and 1.04 (95% CI, 0.98-1.10) in the 1937-1941 birth cohort in women. CONCLUSIONS Significant cohort effects were identified in both sexes, but the peak of RRT was different for each sex. Our findings suggest that men born between 1940 and 1960s and women born between 1930 and 40 s may be important target populations to consider when decreasing incidence rates of RRT among the general Japanese population.
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Affiliation(s)
- Minako Wakasugi
- Department of Inter-Organ Communication Research, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8510, Japan.
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Takenaka T, Ohno Y, Eguchi K, Miyashita H, Suzuki H, Shimada K. Central and brachial pulse pressure predicts cardiovascular and renal events in treated hypertensive patients. Blood Press 2022; 31:64-70. [PMID: 35438015 DOI: 10.1080/08037051.2022.2062295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSES Central blood pressure is a stronger predictor of cardiovascular prognosis rather than brachial blood pressure. The reflection wave reaches the abdominal aorta sooner than ascending aorta. Thus, the contribution of central pulse pressure (cPP) to renal events may differ from that of cardiovascular events. METHODS The subanalysis of the ABC-J II study was performed. Subjects were 3434 treated hypertensive patients with a mean follow-up of 4.7 years. Left ventricular hypertrophy, an index of cardiovascular risk, correlated with cPP better than central systolic blood pressure in this cohort. The contribution of brachial pulse pressure (bPP) and cPP to cardiovascular and renal events was analysed. RESULTS Cox proportional-hazard analysis revealed that sex (p < 0.001), height (p < 0.05), history of cardiovascular diseases (p < 0.001), number of antihypertensive drugs (p < 0.05), and cPP (p < 0.05) contributed to cardiovascular events. However, Cox proportional-hazard analysis disclosed that baseline serum creatinine (p < 0.001) and bPP (p < 0.05) predicted renal events. After adjusting for the history of cardiovascular diseases, Cox regression demonstrated only sex as a significant predictor of cardiovascular events. After adjusting for baseline serum creatinine, no parameters were shown to predict renal events. CONCLUSIONS The present findings support our previous data that the absence of cardiovascular or renal diseases is an important determinant for event-free survival, and suggest that cPP and bPP contribute to cardiovascular and renal events in treated hypertensive patients.
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Affiliation(s)
- Tsuneo Takenaka
- Kokusai Iryo Fukushi Daigaku, Nephrology, Minato-ku, Tokyo, Japan
| | - Yoichi Ohno
- Saitama Ika Daigaku, Nephrology, Iruma-gun, Saitama, Japan
| | - Kazuo Eguchi
- Jichi Ika Daigaku Fuzoku Byoin, Cardiology, Shimotsuke, Tochigi, Japan
| | - Hiroshi Miyashita
- Jichi Ika Daigaku Fuzoku Byoin, Cardiology, Shimotsuke, Tochigi, Japan
| | | | - Kazuyuki Shimada
- Jichi Ika Daigaku Fuzoku Byoin, Cardiology, Shimotsuke, Tochigi, Japan
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Wang Y, Zhao P, Li N, Dong Z, Lin L, Liu J, Liang S, Wang Q, Tang J, Luo Y. A Study on Correlation between Contrast-Enhanced Ultrasound Parameters and Pathological Features of Diabetic Nephropathy. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:228-236. [PMID: 34789402 DOI: 10.1016/j.ultrasmedbio.2021.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/12/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
The objective of this study was to evaluate the correlation between contrast-enhanced ultrasound (CEUS) parameters and histopathological features in patients with diabetic nephropathy (DN). Sixty-two patients with DN (44 men, mean age: 52.61 ± 10.63 y) were enrolled. They underwent renal biopsy for DN at the Department of Ultrasound, PLA Hospital, between May 2017 and February 2020. Renal tissue was obtained by ultrasound-guided percutaneous needle biopsy. CEUS was performed, and time-intensity curves (TICs) and renal perfusion parameters were analyzed. Differences in CEUS parameters were analyzed according to the glomerular classification and interstitial fibrosis-tubular atrophy (IFTA) score. Continuous variables were evaluated using the analysis of variance or Mann-Whitney U-test. Discontinuous variables were compared with the χ2-test. Spearman correlation analyses evaluated associations among quantitative ultrasound perfusion parameters and histopathological characteristics. Peak enhancement (PE), wash-in rate (WiR), wash-in perfusion index (WiPI) and wash-out rate (WoR) of the cortex, and their cortex/medulla ratios, decreased with increasing glomerular classification grade (p < 0.05). The fall time (FT) of the cortex, and their cortex/medulla ratios, increased with increasing glomerular classification grade (p < 0.05). There were no significant differences in the CEUS parameters for different IFTA scores. The perfusion volume-relevant parameters (such as PE, WiR and WiPI) had a negative correlation (p < 0.05), while the perfusion time-relevant parameters (such as RT and FT) had a positive correlation (p < 0.05), with the severity of glomerular lesions, glomerulosclerosis rate and number of Kimmelstiel-Wilson lesions. The CEUS parameters of the cortex could reflect pathological characteristics, especially changes in glomerular lesions.
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Affiliation(s)
- Yiru Wang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China; Medical School of Chinese PLA, Beijing, China
| | - Ping Zhao
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China; Medical School of Chinese PLA, Beijing, China
| | - Nan Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zheyi Dong
- Department of Nephrology, First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, Beijing Key Laboratory of Kidney Diseases, Beijing, China; State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China
| | - Lin Lin
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jiaona Liu
- Department of Nephrology, First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, Beijing Key Laboratory of Kidney Diseases, Beijing, China; State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China
| | - Shiyuan Liang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qian Wang
- Department of Nephrology, First Medical Center, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, Beijing Key Laboratory of Kidney Diseases, Beijing, China; State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China
| | - Jie Tang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China; Medical School of Chinese PLA, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China; Medical School of Chinese PLA, Beijing, China; State Key Laboratory of Kidney Diseases, National Clinical Research Center of Kidney Diseases, Beijing, China.
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Ni Z, Jin H, Lu R, Zuo L, Yu W, Ren Y, Yang Q, Xiao J, Zhang Q, Zhang L, Zhang X, Chen Q, Chen C, Shao G, Luo Q, Yao L, Qin S, Peng H, Zhao Q. Hyperkalaemia prevalence, recurrence and treatment in patients on haemodialysis in China: protocol for a prospective multicentre cohort study (PRECEDE-K). BMJ Open 2021; 11:e055770. [PMID: 34937724 PMCID: PMC8705221 DOI: 10.1136/bmjopen-2021-055770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Hyperkalaemia (HK) is a potentially life-threatening electrolyte imbalance associated with several adverse clinical outcomes and is common in patients with kidney failure. However, there is no evidence on the occurrence, recurrence and treatment of HK in patients on haemodialysis (HD) in China. METHODS AND ANALYSIS The HK Prevalence, Recurrence, and Treatment in Haemodialysis Study is a prospective, multicentre, observational, cohort study being conducted across 15-18 sites in China. Approximately 600 patients with end-stage kidney disease on HD are anticipated to be enrolled and will be followed up for 24 weeks. Patients will be in the long interdialytic interval (LIDI) at enrolment and will receive follow-up care every 4 weeks in LIDI for pre-dialysis and post-dialysis (at enrolment only) serum potassium measurements. To obtain pre-dialysis serum potassium levels in the short interdialytic interval (SIDI), a follow-up visit will be performed in the SIDI during the first week. Information on concomitant medications, blood gas analysis and biochemistry measurements will be obtained at enrolment and at each follow-up visit. The primary endpoint will be the proportion of patients experiencing HK (defined as serum potassium level >5.0 mmol/L) at the study enrolment or during the 24-week follow-up. The key secondary endpoint will be the proportion of patients experiencing HK recurrence (defined as any HK event after the first HK event) within 1-6 months (if applicable) during the 24-week follow-up, including enrolment assessment. ETHICS AND DISSEMINATION This study has been approved by Shanghai Jiaotong University School of Medicine, Renji Hospital Ethics Committee (2020-040). Other participating subcentres must also obtain ethics committee approval prior to the start of the study. The Good Clinical Practice regulations shall be strictly followed during the test implementation. Amendments to the protocol will be reviewed by the ethics committees. Written informed consent will be obtained from all participants before collection of any patient data and patient information. The findings of this study will be disseminated through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04799067).
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Affiliation(s)
- Zhaohui Ni
- Department of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haijiao Jin
- Department of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Renhua Lu
- Department of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Weimin Yu
- Department of Nephrology, Shanxi Bethune Hospital, Taiyuan, China
| | - Yuqing Ren
- Department of Nephrology, Yangquan Coal Industry (Group) General Hospital, Yangquan, China
| | - Qiongqiong Yang
- Department of Nephrology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jie Xiao
- Department of Nephrology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qinghong Zhang
- Department of Nephrology, Taihe Hospital, Shiyan, Hubei, China
| | - Lihong Zhang
- Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xinzhou Zhang
- Department of Nephrology, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Qinkai Chen
- Department of Nephrology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Chaosheng Chen
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Guojian Shao
- Department of Nephrology, Wenzhou Central Hospital, Wenzhou, Zhejiang, China
| | - Qun Luo
- Department of Nephrology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Li Yao
- Department of Nephrology, The first hospital of China Medical University, Shenyang, China
| | - Shuguang Qin
- Department of Nephrology, Guangzhou First People's Hospital, Guangzhou, Guangdong, China
| | - Hui Peng
- Department of Nephrology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Qing Zhao
- Medical Affaires, AstraZeneca Investment China Co, Shanghai, China
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Maruyama Y, Niikura T, Nakashima A, Yamamoto H, Yokoo T. Long-term changes in anemia-related parameters among Japanese dialyzed patients assessed by newly developed web-based system. Ther Apher Dial 2021; 26:362-367. [PMID: 34213076 DOI: 10.1111/1744-9987.13705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
Anemia treatment is crucial in the management of dialyzed patients. Although Hb and serum ferritin levels are commonly used as indicators for treatment, these values change over time due to changes in policy, drugs for treating anemia, and target levels suggested by clinical guidelines. To clarify long-term changes in anemia-related parameters in Japan, we extracted annual patient data from a newly developed web-based system by the Japanese Society for Dialysis Therapy, the Web-based Analysis of Dialysis Data Archives system. Hb levels gradually increased from 2008 to 2019. Serum ferritin levels and transferrin saturation tended to increase between 2012 and 2019. Although these changes were found in all dialyzed patients, these were more pronounced in patients on peritoneal dialysis. We believe that our results can contribute to a better understanding of the results of clinical studies assessing the effects of treatment for anemia on clinical outcomes among dialyzed patients.
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Affiliation(s)
- Yukio Maruyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahito Niikura
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Akio Nakashima
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyasu Yamamoto
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Li PKT, Choy ASM, Bavanandan S, Chen W, Foo M, Kanjanabuch T, Kim YL, Nakayama M, Yu X. Anemia Management in Peritoneal Dialysis: Perspectives From the Asia Pacific Region. Kidney Med 2021; 3:405-411. [PMID: 34136787 PMCID: PMC8178472 DOI: 10.1016/j.xkme.2021.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Anemia is an important complication in patients with chronic kidney disease. Peritoneal dialysis (PD) is one of the most common modalities of kidney replacement therapy for patients with end-stage kidney disease. PD is particularly prevalent in the Asian Pacific region. Among the different countries and regions, including mainland China, Hong Kong, Japan, Malaysia, Singapore, South Korea, and Thailand, PD accounts for 2.8% to 74.6% of the dialysis population. In addition, 82% to 96% of the PD populations from these countries and regions are receiving erythropoiesis-stimulating agents (ESAs). Asian Pacific countries and regions follow the latest KDIGO (Kidney Disease: Improving Global Outcomes) guidelines for the initiation of treatment of anemia in PD patients. The types of ESAs commonly used include shorter-acting (epoetin alfa and beta) and longer-acting agents, including darbepoetin alfa or methoxy polyethylene glycol-epoetin beta. The most commonly used ESAs in Mainland China, Malaysia, Singapore, and Thailand are the shorter-acting agents, whereas in Hong Kong, Japan, and South Korea, longer-acting ESAs are most common. Oral iron therapy is still the most commonly used iron supplement. The route and dosage of iron administration in PD patients requires more research studies. With the introduction of oral hypoxia-inducible factor prolyl hydroxylase inhibitors into clinical use, the landscape of treatment of anemia in the PD population in the Asia Pacific region may change in the coming years.
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Affiliation(s)
- Philip Kam Tao Li
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Agnes Shin Man Choy
- Department of Medicine and Therapeutics, Carol and Richard Yu Peritoneal Dialysis Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Sunita Bavanandan
- Department of Nephrology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission of China and Guangdong Province, Guangzhou, China
| | - Marjorie Foo
- Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Talerngsak Kanjanabuch
- Center of Excellence in Kidney Metabolic Disorders and Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yong-Lim Kim
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | | | - Xueqing Yu
- Department of Nephrology, Guangdong Provincial People’s Hospital, Guangzhou, China
- Guangdong Academy of Medical Sciences, Guangzhou, China
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Kobayashi H, Konno M, Utsugisawa T, Tanabe K, Kanno H. Preoperative autologous blood donation for kidney transplant and end-stage renal disease patients: A single-center study. Transfus Apher Sci 2021; 60:103149. [PMID: 34148766 DOI: 10.1016/j.transci.2021.103149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 04/06/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
Abstract
Although preoperative autologous blood donation (PABD) has many advantages, there has been a decrease in the performance due to a decrease in the residual risk of allogeneic blood transfusion. In allogeneic blood transfusion, anti HLA antibodies and donor-specific antibodies mediate antibody-mediated rejection, which results in graft failure. PABD for anemic patients such as those with end-stage renal disease (ESRD) and a kidney transplant is relatively contraindicated. In this study, we aimed to investigate the characteristics of patients who underwent PABD and elucidate the safety and feasibility of PABD. We performed PABD safely in ten ESRD patients and nine kidney transplant patients and retrospectively analyzed medical records of the hospital. All kidney transplant patients avoided allogeneic blood transfusion, but 4 out of 10 ESRD patients had allogeneic blood transfusion, even if their blood donation volume was larger than those of the kidney transplant patients. It depends on the type of operation; cardiovascular surgery was more common in ESRD patients, and orthopedic surgery was more common in kidney transplant patients. There was profuse bleeding in cardiovascular surgery compared to orthopedic surgery because of longer operation time of the former. Completely avoiding allogeneic blood transfusion in major surgery was rather difficult even if PABD was performed. To prevent the formation of anti- HLA antibodies, PABD would be considered for ESRD patients undergoing kidney transplantation and kidney transplant patients that are potential candidates for secondary kidney transplantation.
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Affiliation(s)
- Hirohito Kobayashi
- Division of Transfusion and Cell Therapy, Tokyo Women's Medical University Medical Center East, Tokyo, Japan; Department of Urology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
| | - Mayumi Konno
- Department of Transfusion Medicine and Cell Processing, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Taiju Utsugisawa
- Department of Transfusion Medicine and Cell Processing, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Hitoshi Kanno
- Department of Transfusion Medicine and Cell Processing, Tokyo Women's Medical University Hospital, Tokyo, Japan
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11
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Maruyama Y, Kanda E, Kikuchi K, Abe M, Masakane I, Yokoo T, Nitta K. Association between anemia and mortality in hemodialysis patients is modified by the presence of diabetes. J Nephrol 2021; 34:781-790. [PMID: 33555578 DOI: 10.1007/s40620-020-00879-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/20/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The prevalence and severity of anemia differ between diabetic and non-diabetic patients. We investigated whether the effect of hemoglobin (Hb) on patient outcome was affected by the presence or absence of diabetes among Japanese patients receiving chronic hemodialysis (HD). METHODS We enrolled 149,308 patients from a nationwide dialysis registry in Japan at the end of 2012 (mean age, 67.6 ± 12.3 years; male, 61.7%; diabetes, 43.5%; median dialysis duration, 65 months) who underwent three HD sessions weekly. One-year all-cause and cardiovascular (CV) mortality were assessed using Cox regression analysis and competing-risks regression analysis. We used multiple imputation to deal with missing covariate data. RESULTS Baseline Hb and serum ferritin levels were independently associated with all-cause and CV mortality. In non-diabetic patients, a significantly higher risk for all-cause mortality compared to the reference group (10 to 11 g/dL) was observed in patients with Hb < 8 g/dL (hazard ratio (HR): 1.266; 95% confidence interval (CI) 1.097-1.460) and 8 to 9 g/dL(HR: 1.153; 95% CI 1.030-1.290). On the other hand, diabetic HD patients in the same Hb category group did not have increased risk of all-cause mortality. CONCLUSIONS We found that non-diabetic HD patients had an increased risk of all-cause mortality if they had lower Hb levels, whereas the effect of Hb levels on mortality was attenuated in diabetic HD patients. These data suggest that the association between Hb levels and mortality rate could be different between diabetic and non-diabetic HD patients.
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Affiliation(s)
- Yukio Maruyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-ku, Tokyo, 1058461, Japan. .,Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.
| | - Eiichiro Kanda
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.,Medical Science, Kawasaki Medical School, Okayama, Japan
| | - Kan Kikuchi
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.,Shimoochiai Clinic, Tokyo, Japan
| | - Masanori Abe
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.,Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Ikuto Masakane
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.,Department Nephrology, Honcho Yabuki Clinic, Yamagata, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi Minato-ku, Tokyo, 1058461, Japan
| | - Kosaku Nitta
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.,Fourth Department of Internal Medicine, Tokyo Women's Medical University, Tokyo, Japan
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12
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Maruyama Y, Araki M, Wada K, Yoshinaga K, Mitsui Y, Sadahira T, Nishimura S, Edamura K, Kobayashi Y, Watanabe M, Watanabe T, Monga M, Nasu Y, Kumon H. Long-term ureteroscopic management of upper tract urothelial carcinoma: 28-year single-centre experience. Jpn J Clin Oncol 2021; 51:130-137. [PMID: 32715306 DOI: 10.1093/jjco/hyaa132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/06/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Long-term survival outcomes of patients who undergo endoscopic management of non-invasive upper tract urothelial carcinoma remain uncertain. The longest mean follow-up period in previous studies was 6.1 years. This study reports the long-term outcomes of patients with upper tract urothelial carcinoma who underwent ureteroscopic ablation at a single institution over a 28-year period. METHODS We identified all patients who underwent ureteroscopic management of upper tract urothelial carcinoma as their primary treatment at our institution between January 1991 and April 2011. Survival outcomes, including overall survival, cancer-specific survival, upper-tract recurrence-free survival and renal unit survival, were estimated using Kaplan-Meier methodology. RESULTS A total of 15 patients underwent endoscopic management, with a mean age at diagnosis of 66 years. All patients underwent ureteroscopy, and biopsy-confirmed pathology was obtained. Median (range; mean) follow-up was 11.7 (2.3-20.9, 11.9) years. Upper tract recurrence occurred in 87% (n = 13) of patients. Twenty percent (n = 3) of patients proceeded to nephroureterectomy. The estimated cancer-specific survival rate was 93% at 5, 10, 15 and 20 years. Estimated overall survival rates were 86, 80, 54 and 20% at 5, 10, 15 and 20 years. Only one patient experienced cancer-specific mortality. The estimated mean and median overall survival times were 14.5 and 16.6 years, respectively. The estimated mean cancer-specific survival time was not reached. CONCLUSIONS Although upper tract recurrence is common, endoscopic management of non-invasive upper tract urothelial carcinoma provides a 90% cancer-specific survival rate at 20 years in selected patients.
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Affiliation(s)
- Yuki Maruyama
- Department of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Motoo Araki
- Department of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Koichiro Wada
- Department of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Kasumi Yoshinaga
- Department of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Yosuke Mitsui
- Department of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Takuya Sadahira
- Department of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Shingo Nishimura
- Department of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Kohei Edamura
- Department of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Yasuyuki Kobayashi
- Department of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Masami Watanabe
- Department of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Toyohiko Watanabe
- Department of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Manoj Monga
- Department of Urology, The Cleveland Clinic, Cleveland, OH, USA
| | - Yasutomo Nasu
- Department of Urology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Hiromi Kumon
- Innovation Center Okayama for Nanobio-Targeted Therapy, Okayama University, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.,Niimi University, 1263-2, Niimi, Okayama, 718-8585, Japan
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13
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Kawaguchi T, Hamano T, Masakane I, Wada A, Okada E, Kadomura M, Imasawa T. Association of kidney transplantation with mortality on hemodialysis after graft failure. J Nephrol 2021; 34:521-530. [PMID: 33394343 DOI: 10.1007/s40620-020-00929-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although a substantial number of patients return to dialysis after kidney transplant failure, it remains controversial whether transplant-failure patients have a higher mortality risk than transplant-naïve patients on dialysis who have never undergone kidney transplantation. We compared outcomes of transplant-failure and transplant-naïve patients on hemodialysis. METHODS Data from the Japanese National Dialysis Registry (2012-2013) were analyzed, including 220,438 prevalent hemodialysis patients. Multivariable Cox models were used to compare all-cause, cardiovascular, and infection-related mortality during 1-year follow-up between transplant-failure and transplant-naïve patients. Multiple imputation and propensity score matching were utilized as sensitivity analyses. RESULTS During 209,377 patient-years of follow-up, 18,648 all-cause deaths (8.5% of all patients), 7700 cardiovascular deaths (41% of all-cause deaths), and 3806 infection-related deaths (20% of all-cause deaths) were observed. Adjusted hazard ratios [95% confidence intervals] for all-cause, cardiovascular, and infection-related deaths among transplant-failure patients were 0.81 [0.59-1.11], 0.54 [0.30-0.98], and 1.54 [0.92-2.59], respectively. Sensitivity analyses using multiple imputation and propensity score matching yielded similar results. CONCLUSIONS This Japanese cohort study suggested that a cardiovascular mortality risk of transplant-failure patients could be significantly lower than that of transplant-naïve patients, while there might be a trend toward a higher infection-related mortality risk in transplant-failure patients. However, this retrospective, single-country study can introduce an immortal time bias in transplant-failure patients, and limit the external validity. Further prospective studies are warranted to improve the comparability of outcomes between transplant-failure and transplant-naïve patients, and to examine worldwide the generalizability of the potential cardiovascular benefit of kidney transplantation even after returning to dialysis.
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Affiliation(s)
- Takehiko Kawaguchi
- Department of Nephrology, National Hospital Organization Chibahigashi National Hospital, 673 Nitona-cho, Chuo-ku, Chiba, 260-8712, Japan.
| | - Takayuki Hamano
- Committee of Renal Data Registry, The Japanese Society for Dialysis Therapy, Tokyo, Japan.,Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ikuto Masakane
- Committee of Renal Data Registry, The Japanese Society for Dialysis Therapy, Tokyo, Japan.,Department of Nephrology, Yabuki Hospital, Yamagata, Japan
| | - Atsushi Wada
- Committee of Renal Data Registry, The Japanese Society for Dialysis Therapy, Tokyo, Japan.,Department of Nephrology, Kitasaito Hospital, Asahikawa, Japan
| | - Eri Okada
- Department of Nephrology, National Hospital Organization Chibahigashi National Hospital, 673 Nitona-cho, Chuo-ku, Chiba, 260-8712, Japan
| | - Moritoshi Kadomura
- Department of Nephrology, National Hospital Organization Chibahigashi National Hospital, 673 Nitona-cho, Chuo-ku, Chiba, 260-8712, Japan
| | - Toshiyuki Imasawa
- Department of Nephrology, National Hospital Organization Chibahigashi National Hospital, 673 Nitona-cho, Chuo-ku, Chiba, 260-8712, Japan
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14
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Kurokawa Y, Kaida Y, Hazama T, Nakayama Y, Otome T, Shibata R, Ito S, Kodama G, Nakamura N, Kambe T, Moriyama T, Nagata A, Minami A, Ando R, Wada Y, Sugiyama M, Usui M, Chiba M, Moriyama A, Ohara A, Miyazaki H, Kakuma T, Fukami K. Effect of switching from cinacalcet to etelcalcetide on secondary hyperparathyroidism in patients undergoing hemodialysis: an ESCORT trial. RENAL REPLACEMENT THERAPY 2020. [DOI: 10.1186/s41100-020-00310-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Etelcalcetide is the first intravenously administered calcimimetic agent used to manage secondary hyperparathyroidism (SHPT) in hemodialysis (HD) patients. We evaluated the safety and efficacy of replacing cinacalcet with etelcalcetide in HD patients.
Methods
One hundred and thirty-three patients HD on cinacalcet were screened, and 93 patients with serum-intact parathyroid hormone (iPTH) level of ≥ 60 pg/mL and serum albumin-corrected calcium (cCa) level of ≥ 8.4 mg/dL were enrolled. The patients were divided into three groups based on the dose of cinacalcet (i.e., 25, 50, and ≥ 75 mg) and switched to etelcalcetide. Etelcalcetide was administered three times per week for 24 weeks. The primary and secondary endpoints were etelcalcetide conversion dose and etelcalcetide effectiveness for iPTH levels (target range: 60–240 pg/mL), respectively.
Results
Of the 68 patients whose iPTH level was within the management target at screening, 60 patients maintained the target level at the end of the study. Among patients whose iPTH level exceeded 240 pg/mL at screening, it decreased from 401 ± 246 pg/mL to 220 ± 209 pg/mL (p < 0.001) at the end of the study. Among 22 patients with the iPTH level of ≥ 240 pg/mL, 17 achieved the target level. The mean dose of cinacalcet was 41.4 ± 22.2 mg/day and that of etelcalcetide at the end of the study was 6.4 ± 3.7 mg/session in all patients. In 45 patients whose iPTH level was within the management target throughout the study and active vitamin D agent and calcium-based phosphate binder doses were constant, the mean dose of cinacalcet was 45.0 ± 22.4 mg/day and that of etelcalcetide at the end of the study was 6.1 ± 3.1 mg/session. The spKt/V might affect the ratio of etelcalcetide per session to oral cinacalcet per day (45 patients, p = 0.087; 90 patients, p < 0.05) in the generalized linear model. Etelcalcetide-induced severe adverse events were not observed.
Conclusions
This study reports the conversion dose of etelcalcetide and demonstrates its safety and efficacy in HD patients with SHPT previously treated with cinacalcet.
Trial registration
UMIN, UMIN000027637; Registered on June 5, 2017.
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15
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Shimada K, Matsui I, Inoue K, Matsumoto A, Yasuda S, Katsuma Y, Sakaguchi Y, Tanaka M, Sugimoto K, Kaimori JY, Takabatake Y, Isaka Y. Dietary casein, egg albumin, and branched-chain amino acids attenuate phosphate-induced renal tubulointerstitial injury in rats. Sci Rep 2020; 10:19038. [PMID: 33149246 PMCID: PMC7643071 DOI: 10.1038/s41598-020-76228-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/26/2020] [Indexed: 01/24/2023] Open
Abstract
Dietary phosphate intake is closely correlated with protein intake. However, the effects of the latter on phosphate-induced organ injuries remain uncertain. Herein, we investigated the effects of low (10.8%), moderate (23.0%), and high (35.2%) dietary casein and egg albumin administration on phosphate-induced organ injuries in rats. The moderate and high casein levels suppressed renal tubulointerstitial fibrosis and maintained mitochondrial integrity in the kidney. The serum creatinine levels were suppressed only in the high casein group. Phosphate-induced muscle weakness was also ameliorated by high dietary casein. The urinary and fecal phosphate levels in the early experiment stage showed that dietary casein did not affect phosphate absorption from the intestine. High dietary egg albumin showed similar kidney protective effects, while the egg albumin effects on muscle weakness were only marginally significant. As the plasma branched-chain amino acid levels were elevated in casein- and egg albumin-fed rats, we analyzed their effects. Dietary supplementation of 10% branched-chain amino acids suppressed phosphate-induced kidney injury and muscle weakness. Although dietary protein restriction is recommended in cases of chronic kidney disease, our findings indicate that the dietary casein, egg albumin, and branched-chain amino acid effects might be reconsidered in the era of a phosphate-enriched diet.
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Affiliation(s)
- Karin Shimada
- Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Isao Matsui
- Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Kazunori Inoue
- Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ayumi Matsumoto
- Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Seiichi Yasuda
- Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yusuke Katsuma
- Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yusuke Sakaguchi
- Department of Inter-organ Communication Research in Kidney Disease, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Minoru Tanaka
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan.,Department of Rehabilitation Science, Graduate School of Health Sciences, Kobe University, 7-10-2 Tomoga-oka, Suma, Kobe, Hyogo, 654-0142, Japan.,Department of Rehabilitation Science, Osaka Health Science University, 1-9-27 Tenma, Kita-ku, Osaka, 530-0043, Japan
| | - Ken Sugimoto
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Jun-Ya Kaimori
- Department of Inter-organ Communication Research in Kidney Disease, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yoshitsugu Takabatake
- Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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16
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Initial responsiveness to darbepoetin alfa and its contributing factors in non-dialysis chronic kidney disease patients in Japan. Clin Exp Nephrol 2020; 25:110-119. [PMID: 32949295 PMCID: PMC7880978 DOI: 10.1007/s10157-020-01969-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/04/2020] [Indexed: 11/01/2022]
Abstract
BACKGROUND Hyporesponsiveness to erythropoiesis-stimulating agents (ESAs) is associated with cardiovascular events and poor renal outcome in patients with chronic kidney disease (CKD). This study aimed to investigate the initial responsiveness to darbepoetin alfa (DA) and its contributing factors using the data from the BRIGHTEN. METHODS Of 1980 patients enrolled at 168 facilities, 1695 were included in this analysis [285 patients were excluded mainly due to lack of hemoglobin (Hb) values]. The initial ESA response index (iEResI) was defined as a ratio of Hb changes over 12 weeks after DA administration per weight-adjusted total DA dose and contributing factors to iEResI were analyzed. RESULTS The mean age was 70 ± 12 years (male 58.8%; diabetic nephropathy 27.6%). The median creatinine and mean Hb levels at DA initiation were 2.62 mg/dL and 9.8 g/dL, respectively. The most frequent number of DA administration during 12 weeks was 3 times (41.1%), followed by 4 (15.6%) times with a wide distribution of the total DA dose (15-900 μg). Remarkably, 225 patients (13.3%) did not respond to DA. Multivariate analysis showed that male gender, hypoglycemic agent use, iron supplementation, high eGFR, low Hb, low CRP, low NT-proBNP, and low urinary protein-creatinine ratio were independently associated with better initial response to DA (P = < 0.0001, 0.0108, < 0.0001, 0.0476, < 0.0001, 0.0004, 0.0435, and 0.0009, respectively). CONCLUSIONS Non-responder to DA accounted for 13.3% of patients with non-dialysis CKD. Iron supplementation, low CRP, low NT-proBNP, and less proteinuria were predictive and modifiable factors associated with better initial response to DA.
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17
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Nakanishi T, Nanami M, Kuragano T. The pathogenesis of CKD complications; Attack of dysregulated iron and phosphate metabolism. Free Radic Biol Med 2020; 157:55-62. [PMID: 31978539 DOI: 10.1016/j.freeradbiomed.2020.01.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/07/2020] [Accepted: 01/20/2020] [Indexed: 01/17/2023]
Abstract
Chronic kidney disease (CKD) patients have a tremendously higher risk of developing cardiovascular disease (CVD) and infection than the non-CKD population, which could be caused by intertwining actions of hyperphosphatemia and CKD associated misdistribution of iron. CVD is often associated with vascular calcification, which has been attributed to hyperphosphatemia, and could be initiated in mitochondria, inducing apoptosis, and accelerated by reactive oxygen species (ROS). The production of ROS is principally linked to intracellular ferrous iron. For infection, the virulence and pathogenicity of a pathogen is directly related to its capacity to acquire iron for proliferation and to escape or subvert the host's immune response. Iron administration for renal anemia can sometimes be overdosed, which could decrease host immune mechanisms through its direct effect on neutrophils, macrophages and T cell function. Hyperphosphatemia has been demonstrated to be associated with an increased incidence of infection. We hypothesized two possible mechanisms: 1) fibroblast growth factor-23 levels are increased in parallel with serum phosphate levels and directly impair leukocyte recruitment and host defense mechanisms, and 2) circulating non-transferrin-bound iron (NTBI) is increased due to decreased iron binding capacity of the carrier protein transferrin in high-phosphate conditions. From these observations, maintaining an adequate serum range of phosphate levels and minimizing intracellular iron accumulation could attenuate the development of CKD complications.
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Affiliation(s)
- Takeshi Nakanishi
- Department of Nephrology, Sumiyoshigawa Hospital, Japan; Department of Internal Medicine, Division of Kidney and Dialysis, Hyogo College of Medicine, Japan.
| | - Masayoshi Nanami
- Department of Internal Medicine, Division of Kidney and Dialysis, Hyogo College of Medicine, Japan.
| | - Takahiro Kuragano
- Department of Internal Medicine, Division of Kidney and Dialysis, Hyogo College of Medicine, Japan.
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18
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Nakanishi T, Kuragano T. Potential hazards of recent trends in liberal iron use for renal anemia. Clin Kidney J 2020; 14:59-69. [PMID: 33564406 PMCID: PMC7857828 DOI: 10.1093/ckj/sfaa117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/30/2020] [Indexed: 12/17/2022] Open
Abstract
A randomized controlled trial,the Proactive IV Iron Therapy in Haemodialysis Patients (PIVOTAL), has recently shown that a high-dose (‘proactive’) intravenous iron regimen was superior to a low-dose (‘reactive’) regimen for hemodialysis patient outcomes and overall safety. However, even in the low-dose group, a substantial amount of iron was administered to maintain serum ferritin >200 ng/mL. This type of comparison may have strongly affected the safety results. Iron has two opposite effects on erythropoiesis: it activates erythroid differentiation directly by supplying iron but inhibits it indirectly by stimulating hepcidin and enhancing oxidative stress. Hepcidin plays an essential role not only in iron homeostasis and the anemia of chronic kidney disease, but also in its complications such as atherosclerosis and infection. Its main stimulation by iron—and to a lesser degree by inflammation—should urge clinicians to avoid prescribing excessive amounts of iron. Furthermore, as serum ferritin is closely correlated with serum hepcidin and iron storage, it would seem preferable to rely mainly on serum ferritin to adjust iron administration, defining an upper limit for risk reduction. Based on our estimations, the optimal range of serum ferritin is ∼50–150 ng/mL, which is precisely within the boundaries of iron management in Japan. Considering the contrasting ranges of target ferritin levels between end-stage renal disease patients in Japan and the rest of the world, the optimal range proposed by us will probably be considered as unacceptable by nephrologists abroad. Only well-balanced, randomized controlled trials with both erythropoiesis-stimulating agents and iron will allow us to settle this controversy.
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Affiliation(s)
- Takeshi Nakanishi
- Department of Nephrology, Gojinkai Sumiyoshigawa Hospital, Nishinomiya, Japan
- Division of Kidney and Dialysis, Department of Cardiovascular and Renal Medicine, Nishinomiya, Japan
- Correspondence to: Takeshi Nakanishi; E-mail:
| | - Takahiro Kuragano
- Division of Kidney and Dialysis, Department of Cardiovascular and Renal Medicine, Nishinomiya, Japan
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19
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Effective Method Using a Stool in Cardiopulmonary Resuscitation (CPR) on Dialysis Chair. Emerg Med Int 2020; 2020:5691607. [PMID: 32802512 PMCID: PMC7403903 DOI: 10.1155/2020/5691607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/07/2020] [Indexed: 11/28/2022] Open
Abstract
Background Heart failure is the leading cause of death in dialysis patients. Cardiac arrest due to hypotension may also occur during dialysis therapy. If cardiac arrest is elicited, manual chest compressions (MCCs) should be started as soon as possible. However, all types of dialysis chairs are not stable for MCC, because there is no steady support between the backboard of the dialysis chair and the floor. These conditions may alter the effectiveness of MCC. Methods We investigated whether a round chair is effective in supporting the dialysis chair for MCC. Four adult males performed MCC on a mannequin placed on three dialysis chairs. MCC was performed in sets of 2 (each set was 100 times per minute) per person, with and without a round chair. A total of 4,800 compressions were performed by four executors. Results When the chair was not used as a stabilizer, the mean values of the fluctuation range were 20.8 ± 8.1 mm, 18.7 ± 5.5 mm, and 12.8 ± 1.8 mm, respectively. When the chair was used, the mean values of the fluctuation range were 6.1 ± 1.1 mm, 7.5 ± 2.1 mm, and 1.0 ± 0 mm, decreasing by 70%, 59%, and 92%. Conclusion MCC performed with the stool under the backrest as a stabilizer was effective in supporting the dialysis chair.
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20
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Jamal A, Babazono A, Li Y, Yoshida S, Fujita T. Multilevel analysis of hemodialysis-associated infection among end-stage renal disease patients: results of a retrospective cohort study utilizing the insurance claim data of Fukuoka Prefecture, Japan. Medicine (Baltimore) 2020; 99:e19871. [PMID: 32358355 PMCID: PMC7440133 DOI: 10.1097/md.0000000000019871] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The presence of comorbid conditions along with heterogeneity in terms of healthcare practices and service delivery could have a significant impact on the patient's outcomes. With a strong interest in social epidemiology to examine the impact of health services and variations on health outcomes, the current study was conducted to analyse the incidence of hemodialysis-associated infection (HAI) as well as its associated factors, and to quantify the extent to which the contextual effects of the care facility and regional variations influence the risk of HAI.A total of 6111 patients with end-stage renal disease who received hemodialysis treatment between 1 October 2015 and 31 March 2016 were identified from the insurance claim database as a population-based, close-cohort retrospective study. Patients were followed for one year from April 1, 2016 to March 31, 2017. A total of 200 HAI cases were observed during the follow-up and 12 patients died within 90 days of the onset of HAI. Increased risks for HAI were associated with moderate (HR 1.73, 95% confidence interval [CI] 1.00-2.98) and severe (HR 1.87, 95% CI 1.11-3.14) comorbid conditions as well as malignancy (HR 1.36, 95% CI 1.00-1.85). Increased risk was also seen among patients who received hemodialysis treatment from clinics (HR 2.49, 95% CI 1.1-5.33). However, these statistics were no longer significant when variations at the level of care facilities were statistically controlled. In univariate analyses, no statistically significant association was observed between 90-day mortality and baseline patients, and the characteristics of the care facility.The results of the multivariate, multilevel analyses indicated that HAI variations were only significant at the care facility level (σ 2.07, 95% CI 1.3-3.2) and were largely explained by the heterogeneity between care facilities. The results of this study highlight the need to look beyond the influence of patient-level characteristics when developing policies that aim at improving the quality of hemodialysis healthcare and service delivery in Japan.
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Affiliation(s)
- Aziz Jamal
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Health Administration Program, Faculty of Business and Management, University Teknologi MARA, Selangor, Malaysia
| | - Akira Babazono
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yunfei Li
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinichiro Yoshida
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takako Fujita
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Japan
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21
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Nawata K, D’Agostino RS, Habib RH, Kumamaru H, Hirahara N, Miyata H, Motomura N, Takamoto S, Shahian DM, Grover FL. First Database Comparison Between the United States and Japan: Coronary Artery Bypass Grafting. Ann Thorac Surg 2020; 109:1159-1164. [DOI: 10.1016/j.athoracsur.2019.07.095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/24/2019] [Accepted: 07/29/2019] [Indexed: 11/30/2022]
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22
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Fujimoto K, Adachi H, Yamazaki K, Nomura K, Saito A, Matsumoto Y, Igarashi K, Uranishi H, Sakaguchi S, Matsuura T, Imura J, Okino K, Mukai K, Okushi Y, Kagaya Y, Tsuruyama Y, Okada K, Miyatake N, Haraguchi T, Iida Y, Yokoyama H. Comparison of the pain-reducing effects of EMLA cream and of lidocaine tape during arteriovenous fistula puncture in patients undergoing hemodialysis: A multi-center, open-label, randomized crossover trial. PLoS One 2020; 15:e0230372. [PMID: 32210455 PMCID: PMC7094835 DOI: 10.1371/journal.pone.0230372] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 02/26/2020] [Indexed: 11/18/2022] Open
Abstract
Arteriovenous fistula puncture pain is a serious problem for patients undergoing dialysis and a good indication for topical anesthetics. No previous study has compared lidocaine/prilocaine cream (EMLA) with lidocaine tape for pain relief during arteriovenous fistula puncture in patients undergoing maintenance hemodialysis. To this end, we conducted a multicenter randomized crossover study including 66 patients (mean age, 65.8 years; males, 57.6%) undergoing maintenance hemodialysis thrice/week. Subjects were assigned to Sequence EL (EMLA administration followed by lidocaine, with 1-week wash-out) or Sequence LE (reverse administration, first lidocaine then EMLA). All subjects completed the study. At each puncture site, 1 g EMLA (25 mg lidocaine + 25 mg prilocaine) or one sheet of lidocaine tape (18 mg lidocaine) was applied 1 h or 30 min prior to arteriovenous fistula puncture, respectively. The primary endpoint was puncture pain relief, which was measured using a 100-mm visual analog scale. The secondary endpoints included quality of life, which was measured by SF-36, and safety. EMLA produced a 10.1-mm greater visual analog scale improvement than lidocaine tape (P = 0.00001). However, there was no statistically significant difference in the quality of life between the two groups, and no significant carryover/period effect was observed in any analysis. Further, no drug-related adverse events were observed. Taken together, these results suggest that EMLA cream is superior to lidocaine tape for the relief of arteriovenous fistula puncture pain in patients undergoing maintenance hemodialysis. Trial registration: University Hospital Medical Information Network Clinical Trials Registry (UMIN000027885).
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Affiliation(s)
- Keiji Fujimoto
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
- * E-mail:
| | - Hiroki Adachi
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | | | - Kanae Nomura
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Atsushi Saito
- Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | | | | | | | | | - Toshikazu Matsuura
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | | | - Kazuaki Okino
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Kiyotaka Mukai
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Yuki Okushi
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Yu Kagaya
- Keiju Medical Center, Ishikawa, Japan
| | - Yuko Tsuruyama
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Keiichiro Okada
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Nobuhiko Miyatake
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | | | - Yasuo Iida
- Department of Mathematics, Kanazawa Medical University, Ishikawa Japan
| | - Hitoshi Yokoyama
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
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23
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Deng Y, Shu Y, Gong R. Calciphylaxis in patient with peritoneal dialysis: A case report. COGENT MEDICINE 2020. [DOI: 10.1080/2331205x.2020.1736250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Yunlei Deng
- Department of Nephrology, the Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, the Second Affiliated Chengdu Clinical College of Chongqing Medical University Chengdu China
| | - Ying Shu
- Department of Nephrology, the Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, the Second Affiliated Chengdu Clinical College of Chongqing Medical University Chengdu China
| | - Rong Gong
- Department of Nephrology, the Third People’s Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, the Second Affiliated Chengdu Clinical College of Chongqing Medical University Chengdu China
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24
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Hashimoto N, Matsui I, Ishizuka S, Inoue K, Matsumoto A, Shimada K, Hori S, Lee DG, Yasuda S, Katsuma Y, Kajimoto S, Doi Y, Yamaguchi S, Kubota K, Oka T, Sakaguchi Y, Takabatake Y, Hamano T, Isaka Y. Lithocholic acid increases intestinal phosphate and calcium absorption in a vitamin D receptor dependent but transcellular pathway independent manner. Kidney Int 2020; 97:1164-1180. [PMID: 32354638 DOI: 10.1016/j.kint.2020.01.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 01/04/2020] [Accepted: 01/17/2020] [Indexed: 10/24/2022]
Abstract
Phosphate/calcium homeostasis is crucial for health maintenance. Lithocholic acid, a bile acid produced by intestinal bacteria, is an agonist of vitamin D receptor. However, its effects on phosphate/calcium homeostasis remain unclear. Here, we demonstrated that lithocholic acid increases intestinal phosphate/calcium absorption in an enterocyte vitamin D receptor-dependent manner. Lithocholic acid was found to increase serum phosphate/calcium levels and thus to exacerbate vascular calcification in animals with chronic kidney disease. Lithocholic acid did not affect levels of intestinal sodium-dependent phosphate transport protein 2b, Pi transporter-1, -2, or transient receptor potential vanilloid subfamily member 6. Everted gut sac analyses demonstrated that lithocholic acid increased phosphate/calcium absorption in a transcellular pathway-independent manner. Lithocholic acid suppressed intestinal mucosal claudin 3 and occludin in wild-type mice, but not in vitamin D receptor knockout mice. Everted gut sacs of claudin 3 knockout mice showed an increased permeability for phosphate, but not calcium. In patients with chronic kidney disease, serum 1,25(OH)2 vitamin D levels are decreased, probably as an intrinsic adjustment to reduce phosphate/calcium burden. In contrast, serum and fecal lithocholic acid levels and fecal levels of bile acid 7α-dehydratase, a rate-limiting enzyme involved in lithocholic acid production, were not downregulated. The effects of lithocholic acid were eliminated by bile acid adsorptive resin in mice. Thus, lithocholic acid and claudin 3 may represent novel therapeutic targets for reducing phosphate burden.
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Affiliation(s)
- Nobuhiro Hashimoto
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Isao Matsui
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Satoshi Ishizuka
- Division of Fundamental Agriscience Research, Research Faculty of Agriculture, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Kazunori Inoue
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ayumi Matsumoto
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Karin Shimada
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shota Hori
- Division of Fundamental Agriscience Research, Research Faculty of Agriculture, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Dong Geun Lee
- Division of Fundamental Agriscience Research, Research Faculty of Agriculture, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Seiichi Yasuda
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yusuke Katsuma
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Sachio Kajimoto
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yohei Doi
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Satoshi Yamaguchi
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Keiichi Kubota
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tatsufumi Oka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yusuke Sakaguchi
- Department of Inter-Organ Communication Research in Kidney Disease, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshitsugu Takabatake
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takayuki Hamano
- Department of Inter-Organ Communication Research in Kidney Disease, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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25
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Goto S, Hamano T, Ogata S, Masakane I. Seasonal variations in cause-specific mortality and transition to renal replacement therapy among patients with end-stage renal disease. Sci Rep 2020; 10:2325. [PMID: 32047207 PMCID: PMC7012814 DOI: 10.1038/s41598-020-59153-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 01/24/2020] [Indexed: 12/03/2022] Open
Abstract
Despite some studies showing seasonal variations in mortality and the transition to renal replacement therapy in patients with end-stage renal disease, detailed evidence is still scarce. We investigated seasonal variations in patients with end-stage renal disease using a large Japanese database for dialysis patients. We compared the fractions of all-cause and cause-specific mortality and the transition to renal replacement therapy among seasons and performed a mixed-effects Poisson regression analysis to compare the mortality among seasons after adjustment for some variables. The initiation of hemodialysis was highest in winter and lowest in summer. Seasonality in the initiation of peritoneal dialysis and transition to kidney transplantation differed from hemodialysis. All-cause mortality was highest in the winter and lowest in the summer. Death from coronary artery disease, heart failure, cerebral hemorrhage, and infectious pneumonia had similar seasonality, but death from cerebral infarction, septicemia, or malignant tumor did not have similar seasonality. In conclusion, the initiation of hemodialysis, all-cause mortality, and mortality from coronary heart disease, heart failure, cerebral hemorrhage, and infectious pneumonia were significantly highest in winter and lowest in summer. However, the initiation of peritoneal dialysis, transition to kidney transplantation, or mortality from cerebral infarction, septicemia, or malignant tumor did not have similar seasonal variations.
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Affiliation(s)
- Shunsuke Goto
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan. .,Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Takayuki Hamano
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.,Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoshi Ogata
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.,Department of Clinical Nutrition, Hiroshima International University, Kure, Japan
| | - Ikuto Masakane
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.,Department of Nephrology, Honcho Yabuki Clinic, Yamagata, Japan
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26
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Nishi S, Yamada M, Tsuruya K, Masakane I, Nakamoto H. JR-131, a Biosimilar of Darbepoetin Alfa, for the Treatment of Hemodialysis Patients With Renal Anemia: A Randomized, Double-Blinded, Parallel-Group Phase 3 Study. Ther Apher Dial 2019; 24:126-135. [PMID: 31325212 PMCID: PMC7079119 DOI: 10.1111/1744-9987.13422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/09/2019] [Accepted: 07/15/2019] [Indexed: 01/24/2023]
Abstract
The aim of this study was to compare the efficacy and safety of intravenous JR‐131, a darbepoetin alfa biosimilar, to darbepoetin alfa in hemodialysis patients with renal anemia. In this 24‐week, multicenter, randomized, double‐blinded, parallel‐group phase 3 study, 334 hemodialysis patients with renal anemia who had been receiving darbepoetin alfa were randomized to either JR‐131 or darbepoetin alfa group. The initial dose was set based on the darbepoetin alfa dose during the observation period. The primary endpoint was change in hemoglobin level from baseline to end of treatment. The 95% confidence interval of the difference in the change in hemoglobin level between the groups was −0.19 to −0.20 g/dL, within the equivalent margin of −0.5 to 0.5 g/dL. No notable treatment‐emergent adverse events were observed in either group. JR‐131 was therapeutically equivalent to darbepoetin alfa, and the safety profile of JR‐131 was similar to that of darbepoetin alfa.
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Affiliation(s)
- Shinichi Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masayuki Yamada
- Data Science Division, Kissei Pharmaceutical Co., Ltd, Tokyo, Japan
| | | | | | - Hidetomo Nakamoto
- Department of General Internal Medicine, Saitama Medical University, Saitama, Japan
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27
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Nishi S, Yamada M, Tsuruya K, Masakane I, Nakamoto H. Long-Term Safety and Efficacy of JR-131, a Biosimilar of Darbepoetin Alfa, in Japanese Patients With Renal Anemia Undergoing Hemodialysis: Phase 3 Prospective Study. Ther Apher Dial 2019; 24:136-145. [PMID: 31304637 PMCID: PMC7078934 DOI: 10.1111/1744-9987.13420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 12/30/2022]
Abstract
The objective of this study was to evaluate the safety and efficacy of JR‐131, a biosimilar of darbepoetin alfa, for long‐term treatment of renal anemia patients undergoing hemodialysis. In this multicenter, single‐arm, phase 3 study, 159 patients with renal anemia who had been receiving darbepoetin alfa or recombinant human erythropoietins were treated with intravenous JR‐131 for 52 weeks. In patients receiving darbepoetin alfa, JR‐131 was administered at the same dose, while in patients receiving recombinant human erythropoietin the dose was determined based on the 1:200 conversion ratio following the Japanese darbepoetin alfa package insert. No notable adverse drug reactions were reported, and no anti‐JR‐131 antibodies were detected. The hemoglobin levels were maintained in the range of 10.0–12.0 g/dL throughout the study. JR‐131 proved to be a useful and lower‐cost alternative to darbepoetin alfa in the management of renal anemia in patients undergoing hemodialysis.
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Affiliation(s)
- Shinichi Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masayuki Yamada
- Data Science Division, Kissei Pharmaceutical Co., Tokyo, Japan
| | | | | | - Hidetomo Nakamoto
- Department of General Internal Medicine, Saitama Medical University, Saitama, Japan
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28
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Kakio Y, Uchida HA, Takeuchi H, Okuyama Y, Umebayashi R, Watatani H, Maeshima Y, Sugiyama H, Wada J. Report of health checkup system for chronic kidney disease in general population in Okayama city: effect of health guidance intervention on chronic kidney disease outcome. Int J Nephrol Renovasc Dis 2019; 12:143-152. [PMID: 31308723 PMCID: PMC6612981 DOI: 10.2147/ijnrd.s198781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/22/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND From 2011, Okayama municipal government started the health checkup follow-up project to find those who were unaware of suffering chronic kidney disease and to prevent from aggravation of CKD stage. In this study, we aimed to evaluate the effect of 2 years' CKD-follow-up project regarding renal function and CKD risks. PATIENTS AND METHODS Those who received a health checkup by the national health insurance in Okayama city in 2011 were recruited. The patients with lifestyle-related diseases or metabolic syndrome were excluded. Subjects who had an estimated glomerular filtration rate<50 mL/min/1.73 m2 or urinary protein positive by dipstick test were defined as compromised renal function group. They were recommended to visit a medical institution. Non-compromised renal function participants with two or more risks for CKD (hyperglycemia, higher blood pressure, dyslipidemia, hyperuricemia) were recommended to receive a health guidance (risk group). The change of renal function and CKD risks between 2011 and 2013 in each group was examined. RESULTS A total of 28,309 people received a health checkup in 2011. In compromised renal function group, 39.5% (96/243) of the subjects improved their CKD stages in 2013 regardless of the visit of medical institutions or the frequency of receiving health checkup. In risk group, 63.4% (260/410) of the subjects decreased their CKD risks in 2013 independent of the reception of health guidance. CONCLUSION In both compromised renal function group and risk group, more than half of subjects kept their kidney function (217/243) and decreased the number of CKD risks (260/410) in 2 years' follow-up. Receiving a health checkup itself and notification of one's own health condition could exert a protective effect on kidney function.
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Affiliation(s)
- Yuki Kakio
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Haruhito A Uchida
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hidemi Takeuchi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuka Okuyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryoko Umebayashi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroyuki Watatani
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yohei Maeshima
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hitoshi Sugiyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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29
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Shimohata T, Mawatari K, Uebanso T, Honjo A, Tsunedomi A, Hatayama S, Sato Y, Kido J, Nishisaka R, Yoshimoto A, Yamashita T, Amano S, Maetani-Yasui M, Iba H, Harada Y, Nakahashi M, Yasui-Yamada S, Hamada Y, Nakagawa T, Sogabe M, Emoto T, Akutagawa M, Okahisa T, Kinouchi Y, Takahashi A. Bacterial Contamination of Hemodialysis Devices in Hospital Dialysis Wards. THE JOURNAL OF MEDICAL INVESTIGATION 2019; 66:148-152. [PMID: 31064928 DOI: 10.2152/jmi.66.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Chronic care patients undergoing hemodialysis for treatment of end-stage renal failure experience higher rates of bloodstream-associated infection due to the patients' compromised immune system and management of the bloodstream through catheters. Staphylococcus species are acommon cause of hemodialysis catheterrelated bloodstream infections. We investigated environmental bacterial contamination of dialysis wards and contamination of hemodialysis devices to determine the source of bacteria for these infections. All bacterial samples were collected by the swab method and the agarose stamp method. And which bacterium were identified by BBL CRYSTAL Kit or 16s rRNA sequences. In our data, bacterial cell number of hemodialysis device was lower than environment of patient surrounds. But Staphylococcus spp. were found predominantly on the hemodialysis device (46.8%), especially on areas frequently touched by healthcare-workers (such as Touch screen). Among Staphylococcus spp., Staphylococcus epidermidis was most frequently observed (42.1% of Staphylococcus spp.), and more surprising, 48.2% of the Staphylococcus spp. indicated high resistance for methicillin. Our finding suggests that hemodialysis device highly contaminated with bloodstream infection associated bacteria. This study can be used as a source to assess the risk of contamination-related infection and to develop the cleaning system for the better prevention for bloodstream infections in patients with hemodialysis. J. Med. Invest. 66 : 148-152, February, 2019.
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Affiliation(s)
- Takaaki Shimohata
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuromoto-cho,Tokushima City, Tokushima, Japan
| | - Kazuaki Mawatari
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuromoto-cho,Tokushima City, Tokushima, Japan
| | - Takashi Uebanso
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuromoto-cho,Tokushima City, Tokushima, Japan
| | - Airi Honjo
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuromoto-cho,Tokushima City, Tokushima, Japan
| | - Akari Tsunedomi
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuromoto-cho,Tokushima City, Tokushima, Japan
| | - Sho Hatayama
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuromoto-cho,Tokushima City, Tokushima, Japan
| | - Yuri Sato
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuromoto-cho,Tokushima City, Tokushima, Japan
| | - Junko Kido
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuromoto-cho,Tokushima City, Tokushima, Japan
| | - Risa Nishisaka
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuromoto-cho,Tokushima City, Tokushima, Japan
| | - Ayumi Yoshimoto
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuromoto-cho,Tokushima City, Tokushima, Japan
| | - Tomoko Yamashita
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuromoto-cho,Tokushima City, Tokushima, Japan
| | - Sachie Amano
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuromoto-cho,Tokushima City, Tokushima, Japan
| | - Miki Maetani-Yasui
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuromoto-cho,Tokushima City, Tokushima, Japan.,College of Health and Human Sciences, Osaka Prefecture University, Habikino,Habikino-shi, Osaka, Japan
| | - Hitomi Iba
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuromoto-cho,Tokushima City, Tokushima, Japan.,Department of Health and Nutrition, Faculty of Health Management, Nagasaki International University, Huis TenBosch-cho, Sasebo-shi, Nagasaki, Japan
| | - Yumi Harada
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuromoto-cho,Tokushima City, Tokushima, Japan
| | - Mutsumi Nakahashi
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuromoto-cho,Tokushima City, Tokushima, Japan
| | - Sonoko Yasui-Yamada
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University GraduateSchool, Kuromoto-cho, Tokushima City, Tokushima, Japan
| | - Yasuhiro Hamada
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University GraduateSchool, Kuromoto-cho, Tokushima City, Tokushima, Japan
| | - Tadahiko Nakagawa
- Department of General Medicine and Community Health Science, Institute ofBiomedical Sciences, Tokushima University Graduate School, Kuromoto-cho, Tokushima City, Tokushima, Japan.,Department ofGastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuromoto-cho, Tokushima City,Tokushima, Japan
| | - Masahiro Sogabe
- Department of General Medicine and Community Health Science, Institute ofBiomedical Sciences, Tokushima University Graduate School, Kuromoto-cho, Tokushima City, Tokushima, Japan.,Department ofGastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuromoto-cho, Tokushima City,Tokushima, Japan
| | - Takahiro Emoto
- Department of Electrical and Electronic Engineering, Institute of Socio Techno Sciences, Tokushima University GraduateSchool, Kuromoto-cho, Tokushima City, Tokushima, Japan
| | - Masatake Akutagawa
- Department of Electrical and Electronic Engineering, Institute of Socio Techno Sciences, Tokushima University GraduateSchool, Kuromoto-cho, Tokushima City, Tokushima, Japan
| | - Toshiya Okahisa
- Department of General Medicine and Community Health Science, Institute ofBiomedical Sciences, Tokushima University Graduate School, Kuromoto-cho, Tokushima City, Tokushima, Japan.,Department ofGastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuromoto-cho, Tokushima City,Tokushima, Japan
| | - Yohsuke Kinouchi
- Department of Electrical and Electronic Engineering, Institute of Socio Techno Sciences, Tokushima University GraduateSchool, Kuromoto-cho, Tokushima City, Tokushima, Japan
| | - Akira Takahashi
- Department of Preventive Environment and Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, Kuromoto-cho,Tokushima City, Tokushima, Japan
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30
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Son R, Fujimaru T, Kimura T, Taki F, Futatsuyama M, Nagahama M, Nakayama M, Komatsu Y. Association between serum ferritin levels and clinical outcomes in maintenance hemodialysis patients: a retrospective single-center cohort study. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0212-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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31
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Kabinga SK, Kayima JK, McLigeyo SO, Ndungu JN. Hemodialysis vascular accesses in patients on chronic hemodialysis at the Kenyatta National Hospital in Kenya. J Vasc Access 2019; 20:697-700. [PMID: 31057048 DOI: 10.1177/1129729819845571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The objective of our study was to document the level of preparedness for renal replacement therapy assessed by incident hemodialysis vascular access and the access at least 3 months after initiation of hemodialysis at Kenyatta National Hospital, Nairobi. METHODS Between June and July 2018, we carried out a cross-sectional descriptive study on the preparedness for hemodialysis by patients who were on chronic hemodialysis in the Kenyatta National Hospital Renal Department. Sociodemographic, medical history, duration of follow-up, and state of preparedness parameters were obtained through interview and entered into the questionnaire. The data were entered in preprogrammed format in the Statistical Package for the Social Sciences (SPSS) version 20.0 for analyses. RESULTS Eighty-two patients were enrolled. Males were 50% (41). The mean age was 45.39 ± 15.96 years but females were 5 years younger than their male counterparts. About 85.4% of the patients were drawn from the hypertension and diabetes clinics, and the mean, mode, and median of the duration of follow-up were 41, 0, and 0 months, respectively, in these clinics. Almost three in every four patients (74.4%) were initiated on hemodialysis as emergency (p value < 0.001). About 80% were initiated hemodialysis via acute catheters placed in the jugular and subclavian veins (p value < 0.001). At least 3 months later, 40% still had acute catheters on the same veins (p value < 0.001). Acute venous catheters in the femoral veins were in 9.2% at initiation and 6.6% of the patients at least 3 months later. Less than 2% of the patients had arteriovenous fistulae at initiation, which rose to 14.5% in 3 months. Tunneled catheters were placed in 11.8% initially and at least 3 months, were almost in 40% of the patients. CONCLUSION In conclusion, our young hemodialysis population mainly drawn from hypertension and diabetes clinic requires more input in hemodialysis vascular access planning. Focused individualized follow-up and early referrals to nephrologists are required. Uptake of arteriovenous grafts for hemodialysis might reduce the prevalence of hemodialysis catheters. As it is, this population is threatened with iterative vascular accesses complications as well as real danger of exhaustion of their vascular capital. There is real danger of increase in mortality from access complications.
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Affiliation(s)
- Samuel K Kabinga
- East African Kidney Institute, University of Nairobi, Nairobi, Kenya
| | - Joshua K Kayima
- East African Kidney Institute, University of Nairobi, Nairobi, Kenya
| | - Seth O McLigeyo
- East African Kidney Institute, University of Nairobi, Nairobi, Kenya
| | - John N Ndungu
- Renal Department, Kenyatta National Hospital, Nairobi, Kenya
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Sakaguchi Y, Hamano T, Wada A, Masakane I. Types of Erythropoietin-Stimulating Agents and Mortality among Patients Undergoing Hemodialysis. J Am Soc Nephrol 2019; 30:1037-1048. [PMID: 31015255 DOI: 10.1681/asn.2018101007] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/01/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Despite the widespread use of erythropoietin-stimulating agents (ESAs) to treat anemia in patients undergoing hemodialysis, the relative mortality risks associated with use of different types of ESAs are unknown. METHODS To compare the mortality risk associated with use of short-acting ESAs versus long-acting ESAs, we conducted a nationwide cohort study of 194,698 hemodialysis patients in Japan who received either a short-acting (epoetin α/β or epoetin κ) or a long-acting (darbepoetin or epoetin β pegol) ESA. Study outcomes were 2-year all-cause and cause-specific mortality. In addition to Cox proportional hazards models, we performed an instrumental variable analysis in which facility-level long-acting ESA prescription rates were taken as the instrumental variable. RESULTS During the 2-year follow-up period, 31,557 deaths occurred. In a multivariable Cox model, long-acting ESA users had a 13% higher rate of deaths compared with short-acting ESA users, a significant difference (P<0.001). Similar results were obtained in other analyses. This difference in risk was pronounced among patients receiving high doses of ESA (for whom the adjusted 2-year number needed to harm for death was 30.8). Long-acting ESA use was associated with an increased rate of death from cardiovascular diseases, infection, and malignancies. In the instrumental variable analysis, long-acting ESA users remained at a significantly higher risk of death. Compared with anemic (hemoglobin 9.0-9.9 g/dl) short-acting ESA users, long-acting ESA users who achieved more optimal hemoglobin levels (10.0-10.9 g/dl) showed a higher mortality rate. CONCLUSIONS Among patients undergoing hemodialysis, use of long-acting ESAs might be associated with a higher risk of death than use of short-acting ESAs.
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Affiliation(s)
- Yusuke Sakaguchi
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
| | - Takayuki Hamano
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
| | - Atsushi Wada
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
| | - Ikuto Masakane
- Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan
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Hanafusa N, Tsuchiya K, Nitta K. Dialysate sodium concentration: The forgotten salt shaker. Semin Dial 2018; 31:563-568. [DOI: 10.1111/sdi.12749] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Norio Hanafusa
- Department of Blood Purification; Tokyo Women’s Medical University; Tokyo Japan
| | - Ken Tsuchiya
- Department of Blood Purification; Tokyo Women’s Medical University; Tokyo Japan
| | - Kosaku Nitta
- Department of Nephrology; Tokyo Women’s Medical University; Tokyo Japan
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Purrunsing Y, Zhang J, Cui Y, Liu W, Xu Y, Hong X, Xing C, Zha X, Wang N. Sixty-Two-Year-Old Male Suffering From Uremic Leontiasis Ossea Caused by Severe Secondary Hyperparathyroidism. JBMR Plus 2018; 2:240-245. [PMID: 30283905 PMCID: PMC6124177 DOI: 10.1002/jbm4.10038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/01/2018] [Accepted: 01/30/2018] [Indexed: 01/02/2023] Open
Abstract
Secondary hyperparathyroidism (SHPT) is a long‐term complication of chronic kidney disease–mineral and bone disorder (CKD‐MBD). SHPT is characterized by hyperplasia of the parathyroid glands and abnormal secretion of parathyroid hormones (PTH), calcium and phosphorous metabolic disorders, renal osteodystrophy, vascular and soft tissue calcification, malnutrition, and other multiple system complications, which can seriously affect the quality of life of the patient and increase the risk of cardiovascular disease and mortality rate. Uremic leontiasis ossea (ULO) is a medical condition only rarely encountered clinically. SHPT causes craniofacial bone deformity accompanied by lesions of the nerve, cardiovascular, respiratory, bone, or other systems within the body. The case discussed here is related to severe SHPT. A 62‐year‐old male patient was suffering from leontiasis ossea, pectus excavatum, vascular calcification, spontaneous bone fractures, and lower limb deformities. He was undergoing hemodialysis and given total parathyroidectomy (TPTX) with autotransplantation (AT). We further analyzed the multivariate therapeutic effects of TPTX on this patient in order to provide clinical data for standardized treatment of individuals with CKD‐MBD. © 2018 The Authors JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Yogendranath Purrunsing
- Department of Nephrology First Affiliated Hospital with Nanjing Medical University Nanjing Jiangsu Province People's Republic of China
| | - Jingjing Zhang
- Department of Nephrology First Affiliated Hospital with Nanjing Medical University Nanjing Jiangsu Province People's Republic of China
| | - Ying Cui
- Department of Nephrology First Affiliated Hospital with Nanjing Medical University Nanjing Jiangsu Province People's Republic of China
| | - Wei Liu
- Department of Nuclear Medicine First Affiliated Hospital with Nanjing Medical University Nanjing Jiangsu Province People's Republic of China
| | - Yi Xu
- Department of Radiology First Affiliated Hospital with Nanjing Medical University Nanjing Jiangsu Province People's Republic of China
| | - Xunning Hong
- Department of Radiology First Affiliated Hospital with Nanjing Medical University Nanjing Jiangsu Province People's Republic of China
| | - Changying Xing
- Department of Nephrology First Affiliated Hospital with Nanjing Medical University Nanjing Jiangsu Province People's Republic of China
| | - Xiaoming Zha
- Department of General Surgery First Affiliated Hospital with Nanjing Medical University Nanjing Jiangsu Province People's Republic of China
| | - Ningning Wang
- Department of Nephrology First Affiliated Hospital with Nanjing Medical University Nanjing Jiangsu Province People's Republic of China
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Kishida K, Maruyama Y, Asari K, Nakao M, Matsuo N, Tanno Y, Ohkido I, Ikeda M, Yokoyama K, Yokoo T. Clinical outcome of incident peritoneal dialysis patients with diabetic kidney disease. Clin Exp Nephrol 2018; 23:409-414. [DOI: 10.1007/s10157-018-1646-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 09/18/2018] [Indexed: 11/28/2022]
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Arimura T, Shiba T, Takahashi M, Kumashiro S, Osamura H, Matsumoto T, Sakai K, Hori Y. Assessment of ocular microcirculation in patients with end-stage kidney disease. Graefes Arch Clin Exp Ophthalmol 2018; 256:2335-2340. [PMID: 30203105 DOI: 10.1007/s00417-018-4137-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 08/16/2018] [Accepted: 09/05/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To determine the impact that end-stage kidney disease (ESKD) has on ocular microcirculation in the optic nerve head (ONH) and choroid area shown by laser speckle flowgraphy (LSFG). METHODS We studied 24 consecutive Japanese patients with ESKD who visited the department of Nephrology at our hospital and 55 age- and gender-matched subjects who had undergone polysomnography. The mean blur rates (MBRs) in vessels (MBR-Vessel), in the tissue (MBR-Tissue), throughout the ONH (MBR-All), and throughout the choroid (MBR-Choroid) were analyzed. We divided the MBR-Tissue into four sections (superior, temporal, inferior, and nasal). The results of systemic and ocular parameters were compared between the ESKD patients and control subjects. We performed single and multiple regression analyses to determine the MBR section(s) that correlated most strongly with serum creatinine and the estimated glomerular filtration rate (eGFR) and to identify the independent factors for selected MBR sections in the ESKD patients. RESULTS All sections of the ONH in the ESKD patients were significantly lower than those in the control subjects. MBR-Choroid was not significantly different between the control and ESKD groups. The single regression analyses revealed that MBR-Tissue had the strongest correlations with creatinine and the eGFR. The multiple regression analyses revealed hematocrit, creatinine, and eGFR as factors independently contributing to the MBR-Tissue. The inferior section of MBR-Tissue was most strongly correlated with creatinine and the eGFR. CONCLUSION The MBRs in the ONH of the ESKD patients decrease compared with control subjects and the inferior section of MBR-Tissue is correlated with serum creatinine and eGFR.
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Affiliation(s)
- Tetsushi Arimura
- Department of Ophthalmology, School of Medicine Toho University, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Tomoaki Shiba
- Department of Ophthalmology, School of Medicine Toho University, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Mao Takahashi
- Cardiovascular Center, Toho University Sakura Medical Center, Chiba, Japan
| | - Shun Kumashiro
- Department of Ophthalmology, School of Medicine Toho University, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Hironori Osamura
- Department of Ophthalmology, School of Medicine Toho University, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Tadashi Matsumoto
- Department of Ophthalmology, School of Medicine Toho University, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Ken Sakai
- Department of Nephrology, Toho University School of Medicine, Tokyo, Japan
| | - Yuichi Hori
- Department of Ophthalmology, School of Medicine Toho University, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
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Gastric Cancer Patients Receiving Maintenance Hemodialysis After Surgery With and Without Postoperative Chemotherapy: A Case Series of 6. Int Surg 2018. [DOI: 10.9738/intsurg-d-16-00127.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background:
The management of gastric cancer patients who received gastrectomy and/or postoperative chemotherapy is of high importance. However, the safety and efficacy of chemotherapy in hemodialysis patients have not been established. In this study, we report 6 cases of hemodialysis patients who underwent gastrectomy for gastric cancer.
Case Presentation:
The presented cases included 5 men and 1 woman, with a mean age of 66.3 years (range, 59–74 years). All patients underwent standard laparotomy, with 3 of 6 patients (50%) experiencing postoperative complications. Three patients who did not experience any postoperative complications could receive subsequent chemotherapy. S-1 chemotherapy regimen and uracil and tegafur chemotherapy regimen were administered to 1 and 2 patients, respectively. These 3 patients did not experience any chemotherapy-related side effects. Among the 4 patients who received a diagnosis of pathologic stages II to III, 2 patients treated with postoperative chemotherapy achieved better prognoses than those who did not receive chemotherapy (mean, 25.5 versus 5.0 months).
Discussion and Conclusion:
Hemodialysis patients with gastric cancer who received gastrectomy exhibited a high morbidity rate. Postoperative chemotherapy can be performed immediately after surgery in patients who do not experience postoperative complications. S-1 regimen and uracil and tegafur regimen could be administered safely in hemodialysis patients. Postoperative chemotherapy may lead to a good prognosis in gastric cancer patients receiving hemodialysis.
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Clinical prediction models for progression of chronic kidney disease to end-stage kidney failure under pre-dialysis nephrology care: results from the Chronic Kidney Disease Japan Cohort Study. Clin Exp Nephrol 2018; 23:189-198. [PMID: 30069609 PMCID: PMC6510807 DOI: 10.1007/s10157-018-1621-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/24/2018] [Indexed: 01/14/2023]
Abstract
Background Reliable prediction tools are needed to identify patients with chronic kidney disease (CKD) at greater risk of developing end-stage kidney failure (ESKF). We developed and validated clinical prediction models (CPMs) for CKD progression to ESKF under pre-dialysis nephrology care using CKD-Japan Cohort (CKD-JAC) data. Methods We prospectively followed up 2034 participants with CKD, defined as an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2, aged 20–75 years for a mean of 3.15 years. We randomly divided the overall analysis set into development and validation cohorts. In the development cohort, CPMs were developed using Cox proportional hazard regression, and the goodness of fit was evaluated. In the validation cohort, discrimination and calibration of the developed CPMs were evaluated. We also validated developed CPMs in the dataset with the bootstrap method. Results ESKF onset was observed in 206 and 216 patients in the development (20.3%) and validation (21.2%) cohorts, respectively. Goodness of fit, discrimination, and calibration were worse for a simple model including age, sex, and eGFR than for a complicated model (plus albuminuria, systolic blood pressure, diabetes, serum albumin, and hemoglobin). The mean absolute difference between the observed and predictive probabilities of ESKF onset at 3 years was lower for the complicated model than for the simple model (1.57 vs. 1.87%). Conclusions CPMs employing readily available data could precisely predict progression to ESKF in patients with CKD stage G3a to G5. These developed CPMs may facilitate more appropriate clinical care and shared decision-making between clinicians and patients. Electronic supplementary material The online version of this article (10.1007/s10157-018-1621-z) contains supplementary material, which is available to authorized users.
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Nakao T, Kanazawa Y, Takahashi T. Once-weekly hemodialysis combined with low-protein and low-salt dietary treatment as a favorable therapeutic modality for selected patients with end-stage renal failure: a prospective observational study in Japanese patients. BMC Nephrol 2018; 19:151. [PMID: 29954331 PMCID: PMC6022443 DOI: 10.1186/s12882-018-0941-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 06/05/2018] [Indexed: 02/06/2023] Open
Abstract
Background For patients with end-stage renal failure (ESFR), thrice-weekly hemodialysis is a standard care. Once-weekly hemodialysis combined with low-protein and low-salt dietary treatment (OWHD-DT) have been rarely studied. Therefore, here, we describe our experience on OWHD-DT, and assess its long-term effectiveness. Methods We instituted OWHD-DT therapy in 112 highly motivated patients with creatinine clearance below 5.0 mL/min. They received once-weekly hemodialysis on a diet of 0.6 g/kg/day of protein adjusted for sufficient energy intake, and less than 6 g/day of salt intake. Serial changes in their clinical, biochemical and nutritional parameters were prospectively observed, and the weekly time spent for hospital visits as well as their monthly medical expenses were compared with 30 age, sex- and disease-matched thrice-weekly hemodialysis patients. Results The duration of successfully continued OWHD-DT therapy was more than 4 years in 11.6% of patients, 3 years in 16.1%, 2 years in 24.1% and 1 year in 51.8%. Time required per week for hospital attendance was 66.7% shorter and monthly medical expenses were 50.5% lower in the OWHD-DT group than in the thrice-weekly hemodialysis group (both p < 0.001). Patient survival rates in the OWHD-DT group were better than those in the Japan Registry (p < 0.001). Serum urea nitrogen significantly decreased; hemoglobin significantly increased; and albumin and body mass index were not significantly different from baseline values. In the OWHD-DT patients, serum albumin at 1 and 2 years after initiation of therapy was significantly higher compared with prevalent thrice-weekly hemodialysis patients. Furthermore, residual urine output was significantly higher in the OWHD-DT patients than in those receiving thrice-weekly hemodialysis (p < 0.05). Interdialytic weight gain over the course of the entire week between treatments in patients on OWHD-DT were 0.9 ± 1.0, 2.0 ± 1.3, 1.9 ± 1.2, 1.9 ± 1.5 and 1.8 ± 1.0 kg at 1, 6, 12, 18 and 24 months, respectively, though the weekly weight gain for thrice-weekly hemodialysis group (summed over all 3 treatments) was 8.6 ± 0.63 kg, p < 0.001. Conclusions OWHD-DT may be a favorable therapeutic modality for selected highly motivated patients with ESRF. However, this treatment cannot be seen as a general maintenance strategy. Trial registration UMIN000027555, May 30, 2017 (retrospectively registered).
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Affiliation(s)
- Toshiyuki Nakao
- Department of Clinical Research, Organization for Kidney and Metabolic Disease Treatment, 1-32-1, Okusawa, Setagaya ward, Tokyo, 158-0083, Japan. .,Department of Human Nutrition, Tokyo Kaseigakuin University, 22, sanbanchou, Chiyoda ward, Tokyo, 102-8341, Japan. .,Bousei Shinjuku- minamiguchi Clinic, 2-9-2 Yoyogi, Shibuya, Tokyo, 151-0053, Japan.
| | - Yoshie Kanazawa
- Department of Clinical Research, Organization for Kidney and Metabolic Disease Treatment, 1-32-1, Okusawa, Setagaya ward, Tokyo, 158-0083, Japan.,Department of Human Nutrition, Tokyo Kaseigakuin University, 22, sanbanchou, Chiyoda ward, Tokyo, 102-8341, Japan
| | - Toshimasa Takahashi
- Department of Clinical Research, Organization for Kidney and Metabolic Disease Treatment, 1-32-1, Okusawa, Setagaya ward, Tokyo, 158-0083, Japan.,Bousei Shinjuku- minamiguchi Clinic, 2-9-2 Yoyogi, Shibuya, Tokyo, 151-0053, Japan
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Nakashita Y, Sano T, Yoshioka H, Shimada T, Hori R, Usami M, Hamada Y. Nonconcordant regulation of mitochondrial respiratory complexes in the kidneys of 5/6 nephrectomized mice. THE JOURNAL OF MEDICAL INVESTIGATION 2018; 64:255-261. [PMID: 28954992 DOI: 10.2152/jmi.64.255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Hyperglycemia induces nonconcordant regulation of renal mitochondrial respiratory complexes, increases oxidative stress, and causes diabetic nephropathy. Hypertension is a complication associated with diabetes and involves glomerular hyperfiltration, the effects of which on mitochondrial respiratory complexes are not well understood. To investigate the effect of glomerular hyperfiltration on renal mitochondrial respiratory complexes, we used the 5/6 nephrectomized BKS. Cg-Dock7m+/+Leprdb/J, Dock7m+/+Leprdb mice (db/m-5/6Nx mice) as a model for glomerular hyperfiltration. The BKS. Cg-Dock7m+/+Leprdb/J, +Leprdb/+Leprdb mice (db/db mice), a model for type 2 diabetes, was used as the positive control. We investigated the activities and protein levels of the mitochondrial complex, and the mitochondrial DNA and adenosine triphosphate content in the kidneys of these models. Blood chemistry and renal histopathological examination were performed for characterization of the disease. Both models showed expansion of the mesangial matrix of the glomeruli, which is indicative of glomerular hyperfiltration. The activities of complexes I and IV and the protein levels of complexes I and III were nonconcordant in db/m-5/6Nx mice. In conclusion, we demonstrated that nonconcordant regulation of mitochondrial complexes in db/m-5/6Nx mice involved with glomerular hyperfiltration. The progression and/or severity of nephropathy might be affected through a synergistic effect of mitochondrial dysfunction in hyperglycemia and glomerular hyperfiltration. J. Med. Invest. 64: 255-261, August, 2017.
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Affiliation(s)
- Yukie Nakashita
- Drug Safety Research Laboratories, Takeda Pharmaceutical Company Limited.,Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School
| | - Tomoya Sano
- Drug Safety Research Laboratories, Takeda Pharmaceutical Company Limited
| | - Hiroaki Yoshioka
- Drug Safety Research Laboratories, Takeda Pharmaceutical Company Limited
| | - Tomoki Shimada
- Drug Safety Research Laboratories, Takeda Pharmaceutical Company Limited
| | - Ryotaro Hori
- Drug Safety Research Laboratories, Takeda Pharmaceutical Company Limited
| | - Makoto Usami
- Division of Nutrition and Metabolism, Kobe University Graduate School of Health Sciences
| | - Yasuhiro Hamada
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School.,Department of Nutrition, Tokushima University Hospital
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Kanazawa Y, Nakao T, Murai S, Okada T, Matsumoto H. Diagnosis and prevalence of protein-energy wasting and its association with mortality in Japanese haemodialysis patients. Nephrology (Carlton) 2018; 22:541-547. [PMID: 27165723 DOI: 10.1111/nep.12814] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/06/2016] [Accepted: 05/08/2016] [Indexed: 12/14/2022]
Abstract
AIM The International Society of Renal Nutrition and Metabolism (ISRNM) has proposed the diagnostic criteria for protein-energy wasting (PEW). We studied Japanese haemodialysis (HD) patients to verify the diagnostic method, especially with respect to the body mass index (BMI) criterion, as well as the prevalence of PEW and its association with mortality. METHODS Japanese patients receiving maintenance HD at three outpatient clinics in Tokyo (n = 210) were enrolled, and prospectively followed-up for 3 years. PEW was diagnosed at baseline, according to the four categories (serum chemistry, body mass, muscle mass and dietary intake) recommended by the ISRNM. For the category of body mass, we select a body mass index (BMI) and set up three thresholds, <18.5, <20.0 and <23.0 kg/m2 , as the diagnostic criterion. The patients who satisfied at least three out of the four categories were diagnosed as PEW. RESULTS Protein-energy wasting, when the threshold of a BMI among the diagnostic criteria was defined as <18.5 kg/m2 , was recognized as an independent risk factor for mortality. However, PEW was not recognized as a risk factor when the BMI diagnostic criterion was set at <20.0 or <23.0 kg/m2 . Overall, 14.8% of the patients had PEW. The survival rate of PEW patients was significantly lower than that of non-PEW patients (log rank, P < 0.001). CONCLUSIONS The diagnosis algorithm of PEW proposed by an expert panel of the ISRNM strongly associates with mortality. However, given differences in body size in Japan, we suggest to revise the BMI criterion from <23.0 kg/m2 to <18.5 kg/m2 .
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Affiliation(s)
- Yoshie Kanazawa
- Tokyo Kaseigakuin University, Tokyo, Japan.,Organization for Kidney Metabolic Disease Treatment, Tokyo, Japan
| | - Toshiyuki Nakao
- Organization for Kidney Metabolic Disease Treatment, Tokyo, Japan.,Bousei Shinjuku Minamiguchi Clinic, Tokyo, Japan
| | | | - Tomonari Okada
- Department of Nephrology, Tokyo Medical University, Tokyo, Japan
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Fukagawa M, Yokoyama K, Shigematsu T, Akiba T, Fujii A, Kuramoto T, Odani M, Akizawa T. A phase 3, multicentre, randomized, double-blind, placebo-controlled, parallel-group study to evaluate the efficacy and safety of etelcalcetide (ONO-5163/AMG 416), a novel intravenous calcimimetic, for secondary hyperparathyroidism in Japanese haemodialysis patients. Nephrol Dial Transplant 2018; 32:1723-1730. [PMID: 28057872 PMCID: PMC5837215 DOI: 10.1093/ndt/gfw408] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/03/2016] [Indexed: 01/22/2023] Open
Abstract
Background Secondary hyperparathyroidism (SHPT) is a major complication associated with chronic kidney disease. We evaluated the efficacy and safety of etelcalcetide (ONO-5163/AMG 416), a novel intravenous calcimimetic, in Japanese haemodialysis patients with SHPT. Methods In this phase 3, multicentre, randomized, double-blind, placebo-controlled, parallel-group study, etelcalcetide was administered three times per week at an initial dose of 5 mg, and subsequently adjusted to doses between 2.5 and 15 mg at 4-week intervals for 12 weeks. A total of 155 SHPT patients with serum intact parathyroid hormone (iPTH) levels ≥300 pg/mL were assigned to receive etelcalcetide (n = 78) or placebo (n = 77). The primary endpoint was the proportion of patients with decreased serum iPTH to the target range proposed by the Japanese Society for Dialysis Therapy (60–240 pg/mL). The major secondary endpoint was the proportion of patients with ≥30% reductions in serum iPTH from baseline. Results The proportion of patients meeting the primary endpoint was significantly higher for etelcalcetide (59.0%) versus placebo (1.3%). Similarly, the proportion of patients meeting the major secondary endpoint was significantly higher for etelcalcetide (76.9%) versus placebo (5.2%). Serum albumin-corrected calcium, phosphorus and intact fibroblast growth factor-23 levels were decreased in the etelcalcetide group. Nausea, vomiting and symptomatic hypocalcaemia were mild with etelcalcetide. Serious adverse events related to etelcalcetide were not observed. Conclusions This study demonstrated the efficacy and safety of etelcalcetide. As the only available intravenous calcium-sensing receptor agonist, etelcalcetide is likely to provide a new treatment option for SHPT in haemodialysis patients.
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Affiliation(s)
- Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Keitaro Yokoyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Shigematsu
- Division of Nephrology, Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | | | | | | | - Motoi Odani
- Data Science, Ono Pharmaceutical Co. Ltd, Osaka, Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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Yasuda F, Mii A, Morita M, Aoki M, Tagawa M, Aratani S, Kaneko T, Sakai Y, Shimizu A. Importance of frequency and morphological characteristics of nodular diabetic glomerulosclerosis in diabetic nephropathy. Hum Pathol 2018; 75:95-103. [PMID: 29408640 DOI: 10.1016/j.humpath.2018.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 01/20/2018] [Accepted: 01/29/2018] [Indexed: 12/12/2022]
Abstract
The Renal Pathology Society proposed a pathological classification for diabetic nephropathy (DN) (RPS 2010). We retrospectively examined the renal structural-functional relationships using the RPS 2010 classification in 49 DN cases. We also evaluated the importance of the percentage of glomeruli with nodular diabetic glomerulosclerosis and their morphological characteristics (cellular, cellular and extracellular matrix [ECM] or ECM types) in the pathology of DN. The classes of DN (RPS 2010) were significantly correlated with the duration of diabetes mellitus (DM), degree of proteinuria, a decreased estimated glomerular filtration rate (eGFR), and the stages of Japanese clinical DM and chronic kidney disease (CKD). When the percentage of glomeruli with nodular glomerulosclerosis (IIIA <25%, IIIB 25-50%, IIIC 50-75%, and IIID >75%) was added to class III in this classification, the classes of DN had a greater correlation with the levels of proteinuria. The morphological characteristics of nodular glomerulosclerosis such as cellular, cellular and ECM, or ECM type were associated with several clinical parameters including the duration of DM, degree of proteinuria, a decreased eGFR, and/or the stages of clinical DM and CKD. Mesangial red blood cell fragments that is indicative of microvascular injury was found in cellular or cellular and ECM types of nodular glomerulosclerosis. The RPS 2010 classification is useful as a DN pathological classification that indicates a good correlation with the clinical characteristics of DN. In addition, the frequency and morphological characteristics of nodular diabetic glomerulosclerosis is important for the evaluation of the pathology in DN.
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Affiliation(s)
- Fumihiko Yasuda
- Department of Analytic Human Pathology, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
| | - Akiko Mii
- Department of Nephrology, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Megumi Morita
- Department of Nephrology, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Michiko Aoki
- Department of Analytic Human Pathology, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
| | - Masako Tagawa
- Department of Analytic Human Pathology, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
| | - Sae Aratani
- Department of Analytic Human Pathology, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan; Department of Nephrology, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Tomohiro Kaneko
- Department of Nephrology, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Yukinao Sakai
- Department of Nephrology, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan.
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Yamashita K, Mizuiri S, Nishizawa Y, Kenichiro S, Doi S, Masaki T. Oral iron supplementation with sodium ferrous citrate reduces the serum intact and c-terminal fibroblast growth factor 23 levels of maintenance haemodialysis patients. Nephrology (Carlton) 2017; 22:947-953. [PMID: 27558654 PMCID: PMC5725691 DOI: 10.1111/nep.12909] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/07/2016] [Accepted: 08/16/2016] [Indexed: 12/15/2022]
Abstract
AIM Iron deficiency stimulates fibroblast growth factor 23 (FGF23) transcription. This study aimed to determine whether oral ferrous iron (Fe2+ ) reduces the serum FGF23 levels of iron-deficient maintenance haemodialysis (MHD) patients in the same way as oral ferric iron (Fe3+ ) METHODS: Thirty-one MHD patients with iron deficiency were enrolled in this prospective study. Patients who had taken iron supplements during the 8 weeks before the study were excluded. The patients' iron stores and their serum FGF23, phosphate, intact parathyroid hormone (iPTH), albumin, C-reactive protein (CRP), and albumin-adjusted calcium (Ca) levels were examined at the baseline and after 3 months' treatment with sodium ferrous citrate (Fe2+ ). RESULTS The patients' transferrin saturation values and serum iron and ferritin levels were significantly increased after 3 months' treatment (P < 0.01), as were their serum albumin levels (P < 0.05). Conversely, their serum intact FGF23 (iFGF23) [1820 (342-4370) vs 1240 (214-2940) pg/mL, P < 0.05], C-terminal FGF23 (cFGF23) [309 (120-1211) vs 259 (99-600) pg/mL, P < 0.05)], and CRP levels (P < 0.01) were significantly reduced after 3 months' treatment. No changes were detected in the patients' serum iFGF23:cFGF23 ratios or their serum phosphate, Ca, or iPTH levels. The changes in the patients' serum iFGF23 and cFGF23 levels induced by sodium ferrous citrate supplementation were shown to be attributable to changes in their serum ferritin levels (P < 0.05). CONCLUSION Short-term oral iron supplementation with sodium ferrous citrate replenished the iron stores and reduced the serum iFGF23 and cFGF23 levels of MHD patients with iron deficiency without affecting their serum phosphate, Ca, or iPTH levels.
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Affiliation(s)
- Kazuomi Yamashita
- Department of NephrologyHiroshima University HospitalHiroshimaJapan
- Department of NephrologyIchiyokai Harada HospitalHiroshimaJapan
| | - Sonoo Mizuiri
- Department of NephrologyIchiyokai Harada HospitalHiroshimaJapan
| | | | | | - Shigehiro Doi
- Department of NephrologyHiroshima University HospitalHiroshimaJapan
| | - Takao Masaki
- Department of NephrologyHiroshima University HospitalHiroshimaJapan
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Deterioration of Cerebral Oxygenation by Aortic Arch Calcification Progression in Patients Undergoing Hemodialysis: A Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2852514. [PMID: 29109958 PMCID: PMC5646289 DOI: 10.1155/2017/2852514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 08/05/2017] [Accepted: 08/24/2017] [Indexed: 01/21/2023]
Abstract
Background Near-infrared spectroscopy revealed that the regional saturation of oxygen (rSO2) in cerebral tissue is lower in hemodialysis (HD) patients than in healthy subjects. However, no study has examined the changes in cerebral oxygenation by aortic arch calcification (AAC) progression in HD patients. Methods A total of 104 HD patients were divided into four groups by AAC grade determined using chest radiography: 23 patients at grade 0, 24 at grade 1, 30 at grade 2, and 27 at grade 3. Differences in clinical parameters, including cerebral rSO2, among AAC grades were investigated and atherosclerotic parameters affecting cerebral rSO2 values were identified. Results Cerebral rSO2 significantly decreased as AAC progressed (AAC grade 3 versus grade 0, p < 0.01 versus grade 1, p < 0.05). Multivariate logistic regression analysis was performed using parameters with p values < 0.20 in univariate analysis between cerebral rSO2 values less than the mean and atherosclerotic parameters. AAC grades 2 and 3, serum phosphate level, and history of smoking were factors associated with the cerebral rSO2 decrease. Conclusions Cerebral rSO2 significantly decreased as AAC progressed and was independently associated with higher AAC grade, serum phosphate level, and history of smoking.
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Nishijima T, Kawasaki Y, Mutoh Y, Tomonari K, Tsukada K, Kikuchi Y, Gatanaga H, Oka S. Prevalence and factors associated with chronic kidney disease and end-stage renal disease in HIV-1-infected Asian patients in Tokyo. Sci Rep 2017; 7:14565. [PMID: 29109535 PMCID: PMC5674012 DOI: 10.1038/s41598-017-15214-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/23/2017] [Indexed: 11/28/2022] Open
Abstract
This single-center cross-sectional study determined the prevalence and factors associated with chronic kidney disease (CKD) and end-stage renal disease (ESRD) in HIV-1-infected Asian patients at the largest HIV clinic in Japan. HIV-1-infected patients who visited the clinic between September and December 2016 were analyzed. CKD was defined as estimated glomerular filtration rate of <60 ml/min/1.73 m2 or proteinuria ≥1+, observed at least over three months. A logistic regression model was used to estimate the effects of various variables on CKD. The study included 1,990 patients; with 97% Asians, 34% aged of ≥50 years, and 94% had HIV-1 load <50 copies/ml. The median time from HIV-1 diagnosis to study enrollment and duration of ART were 9.1 years (IQR4.8–14.2) and 7.35 years (IQR3.28–12), respectively. CKD and ESRD were diagnosed in 256 (13%) and 9 (0.5%) patients, respectively. The prevalence of CKD was 18.6% for age 50–59, 28.5% for 60–69, and 47% for over 70. Older age, heavier body weight, diabetes mellitus, hypertension, and longer duration of ART, but not duration of TDF exposure, were associated with CKD. The traditional risk factors, rather than HIV-1-related variables, were associated with CKD, suggesting the importance of management of such comorbidities in maintenance of renal function.
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Affiliation(s)
- Takeshi Nishijima
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Yohei Kawasaki
- Department of Drug Evaluation & Informatics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Yoshikazu Mutoh
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kiyomi Tomonari
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kunihisa Tsukada
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshimi Kikuchi
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroyuki Gatanaga
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
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Masakane I, Hasegawa T, Ogata S, Kimata N, Nakai S, Hanafusa N, Hamano T, Wakai K, Wada A, Nitta K. Peritoneal Dialysis Registry With 2013 Survey Report. Ther Apher Dial 2017; 20:557-568. [PMID: 28033679 DOI: 10.1111/1744-9987.12520] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Since 2009, the peritoneal dialysis (PD) registry has been carried out as part of the annual nationwide survey conducted by the Statistical Survey Committee of the Japanese Society for Dialysis Therapy with the cooperation of the Japanese Society for Peritoneal Dialysis. In this study, the current status of PD patients is reported on the basis of the results of the survey conducted at the end of 2013. The subjects were PD patients who lived in Japan and participated in the 2013 survey. Descriptive analysis was performed for various items including the current status of the combined use of PD and another dialysis method such as hemodialysis (HD) or hemodiafiltration (HDF), the method of exchanging dialysate, the use of an automated peritoneal dialysis (APD) machine, and the incidences of peritonitis and catheter exit-site infection. From the results of the facility survey in 2013, the number of PD patients was 9392, a decrease of 122 from that in 2012. Among the entire dialysis patient population, 3.0% were PD patients, a decrease of 0.1%. Among the studied patients, 292 had a peritoneal catheter and underwent peritoneal lavage, 174 were started on PD in 2013 but introduced to other blood purification methods in 2013, and 1920 underwent both PD and another dialysis method such as HD or HDF. The percentage of patients who underwent PD and another dialysis method increased with the number of years on PD: <1 year, 3.5%; 1 to < 2 years, 8.4%; 2 to < 4 years, 15.3%; 4 to < 6 years, 27.1%; 6 to < 8 years, 39.3%; 8 to < 10 years, 47.1%; and ≥ 10 years, 57.5%. The percentage of PD patients for whom the dialysate was completely manually exchanged was 31.6%, whereas the percentages of PD patients who used a bag-exchange device based on ultraviolet-light irradiation and that based on thermal sterile joint systems were 52.1 and 14.9%, respectively. The mean incidence of peritonitis was 0.22 per patient per year (once per 54.5 patients per month). The mean incidence of catheter exit-site infection was 0.34 per patient per year (once per 35.3 patients per month).
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Affiliation(s)
- Ikuto Masakane
- Statistical Survey Committee, Japanese Society for Dialysis Therapy, Japan
| | - Takeshi Hasegawa
- Subcommittee of Statistical Analysis, Japanese Society for Dialysis Therapy, Japan
| | - Satoshi Ogata
- Statistical Survey Committee, Japanese Society for Dialysis Therapy, Japan
| | - Naoki Kimata
- Statistical Survey Committee, Japanese Society for Dialysis Therapy, Japan
| | - Shigeru Nakai
- Statistical Survey Committee, Japanese Society for Dialysis Therapy, Japan
| | - Norio Hanafusa
- Statistical Survey Committee, Japanese Society for Dialysis Therapy, Japan
| | - Takayuki Hamano
- Statistical Survey Committee, Japanese Society for Dialysis Therapy, Japan
| | - Kenji Wakai
- Statistical Survey Committee, Japanese Society for Dialysis Therapy, Japan
| | - Atsushi Wada
- Statistical Survey Committee, Japanese Society for Dialysis Therapy, Japan
| | - Kosaku Nitta
- President, Japanese Society for Dialysis Therapy, Japan
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Nagai K, Matsuura M, Tsuchida K, Kanayama HO, Doi T, Minakuchi J. Prognostic factors for mortality in middle-aged and older hemodialysis patients: a 5-year observational study. J Artif Organs 2017; 21:94-101. [PMID: 28918555 DOI: 10.1007/s10047-017-0993-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 09/11/2017] [Indexed: 02/05/2023]
Abstract
Clinical guidelines for hemodialysis therapy have been described in an evidence-based manner with most evidence from randomized control trials or retrospective studies in which all generations of the hemodialysis patients were enrolled. Therefore, the question still remains whether these guidelines can be applied to increasing older patients. This study is an observational study, including 735 patients who received maintenance hemodialysis in April 2006. At baseline, the participants' age was 62.1 ± 12.8 years (mean ± SD). Hemodialysis duration was 103.7 ± 89.3 months. In a 5-year observation period (actual follow-up period: 1551 ± 499 days), 175 patients died. Prognostic factors were investigated by multivariate analysis with Cox proportional hazard model. Next, we stratified the patients according to their age. 363 patients were included in the middle-aged patient's category between 40 and 64 years, and 314 were involved in the older patient's category between 65 and 84 years old. As a subanalysis, significant predictors of 5-year survival were examined in the age-stratified cohort. Then, Kt/V, serum β2-microglobulin and calcium concentration were significant predictors in our entire cohort, as well as body mass index, neutrophil count, and serum sodium concentration even after adjustment for age, gender, diabetic status and hemodialysis duration. However, Kt/V, serum β2-microglobulin and calcium concentration controlled by hemodialysis prescriptions were independent risk factors especially in older patients, not in middle-aged patients. In conclusion, hemodialysis prescriptions for lowering uremic toxins and managing mineral-bone disorder are important to decrease the risk of death even in older hemodialysis patients.
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Affiliation(s)
- Kojiro Nagai
- Department of Nephrology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.
| | - Motokazu Matsuura
- Department of Nephrology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Kenji Tsuchida
- Department of Kidney Disease (Dialysis and Transplantation), Kawashima Hospital, 1-39, Kitasakoichiban-cho, Tokushima, 770-0011, Japan.
| | - Hiro-Omi Kanayama
- Department of Urology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Toshio Doi
- Department of Nephrology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Jun Minakuchi
- Department of Kidney Disease (Dialysis and Transplantation), Kawashima Hospital, 1-39, Kitasakoichiban-cho, Tokushima, 770-0011, Japan
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Wakasugi M, Kazama JJ, Kawamura K, Yamamoto S, Nagai M, Omori K, Yokota S, Fujikawa H, Aoike I, Omori T, Narita I. Prevalence of Earlobe Creases and Their Association With History of Cardiovascular Disease in Patients Undergoing Hemodialysis: A Cross-Sectional Study. Ther Apher Dial 2017; 21:478-484. [PMID: 28880437 DOI: 10.1111/1744-9987.12567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 03/21/2017] [Accepted: 04/25/2017] [Indexed: 11/28/2022]
Abstract
Earlobe creases are surrogate markers for high risk of cardiovascular disease. There is no data concerning earlobe creases among hemodialysis patients, who have an increased risk of cardiovascular disease. A cross-sectional study was conducted to determine the prevalence of earlobe creases and their association with prevalent cardiovascular disease among hemodialysis patients. Patients undergoing hemodialysis were recruited from five outpatient hemodialysis centers. Both earlobes were photographed during a dialysis session with the patient in a supine position and the photos evaluated independently by two experienced nephrologists blinded to the participants' clinical characteristics. Prevalent cardiovascular diseases were defined as a history of myocardial infarction, cerebrovascular accident, or peripheral vascular disease. Sensitivity, specificity, and positive and negative predictive values for detection of prevalent cardiovascular disease were calculated. Logistic analysis was used to examine the association between earlobe creases and prevalent cardiovascular disease. Earlobe creases were identified in 24.5% of 330 hemodialysis patients (200 men; mean age, 67.8 years). The prevalence of earlobe creases increased with age for men (P for trend <0.0001), but not for women (P for trend = 0.07). Sensitivity, specificity, and positive and negative predictive values were 30.9% (95% confidence interval, 21.9-41.6), 77.5% (71.9-82.3), 30.9% (21.9-41.6), and 77.5% (71.9-82.3), respectively. Multivariate logistic analyses indicated the prevalence of earlobe crease was not associated with prevalent cardiovascular diseases. The prevalence is similar to that previously reported for Japanese individuals not undergoing dialysis. No association between earlobe creases and prevalent cardiovascular diseases was identified.
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Affiliation(s)
- Minako Wakasugi
- Division of Comprehensive Geriatrics in Community, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Junichiro James Kazama
- Departments of Nephrology and Hypertension, Fukushima Medical University, Niigata, Japan
| | - Kazuko Kawamura
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Suguru Yamamoto
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | | | | | | | | | | | | | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Shigematsu T, Fukagawa M, Yokoyama K, Akiba T, Fujii A, Odani M, Akizawa T. Long-term effects of etelcalcetide as intravenous calcimimetic therapy in hemodialysis patients with secondary hyperparathyroidism. Clin Exp Nephrol 2017; 22:426-436. [PMID: 28836058 DOI: 10.1007/s10157-017-1442-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/03/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Secondary hyperparathyroidism (SHPT) is a serious major complication in hemodialysis patients with chronic kidney disease. Long-term maintenance of serum phosphate, calcium, and parathyroid hormone (PTH) levels in appropriate ranges in these patients is a major challenge. We investigated the efficacy and safety of long-term treatment with etelcalcetide, a novel intravenous calcimimetic, in Japanese SHPT patients on long-term hemodialysis. METHODS This study was a multicenter open-label study. A total of 191 hemodialysis patients with serum intact PTH (iPTH) > 240 pg/mL were enrolled. Etelcalcetide was administered thrice weekly for 52 weeks, with an initial dose of 5 mg and flexibility to adjust the dose between 2.5 and 15 mg and to adjust the dosing of concomitant medications for SHPT. The efficacy endpoint was the proportion of patients with serum iPTH decreased to the target range (60-240 pg/mL). RESULTS Serum iPTH levels decreased immediately after etelcalcetide was started. At the end of the study, 87.5% (95% confidence interval 81.4-92.2; 140/160 patients) of patients achieved target serum iPTH levels, with control of serum calcium and phosphate levels. Adverse events, mostly mild to moderate, were reported by 96.8% of patients and led to study discontinuation in 7.4% of patients. Nausea, vomiting, and symptomatic hypocalcemia were found in 4.7, 9.5, and 1.1%, with 0.5, 1.1, and 1.1% considered treatment-related. CONCLUSIONS Etelcalcetide effectively maintained serum iPTH, calcium, and phosphate levels in appropriate ranges with concomitant medications for SHPT for 52 weeks in Japanese hemodialysis patients, and was safe and well tolerated. REGISTRATION NUMBER JapicCTI-142665.
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Affiliation(s)
- Takashi Shigematsu
- Department of Nephrology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan.
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Keitaro Yokoyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Akifumi Fujii
- Clinical Development Planning, Ono Pharmaceutical Co. Ltd, Osaka, Japan
| | - Motoi Odani
- Data Science, Ono Pharmaceutical Co. Ltd, Osaka, Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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