1
|
Oda Y, Ishioka K, Ohtake T, Oki R, Taguchi S, Matsui K, Mochida Y, Moriya H, Hidaka S, Kobayashi S. Dialysis-related Amyloidosis Presenting as a Fever of Unknown Origin: Symptoms and Management. Intern Med 2023; 62:3669-3677. [PMID: 37164661 PMCID: PMC10781552 DOI: 10.2169/internalmedicine.1095-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/26/2023] [Indexed: 05/12/2023] Open
Abstract
A 74-year-old woman with a 34-year history of hemodialysis presented with an intermittent fever, which later coincided with recurrent bilateral shoulder and hip joint pain. Imaging studies suggested amyloid arthropathy, which was histologically confirmed by a synovial biopsy. Increasing β2-microglobulin clearance during dialysis alone attenuated the intermittent fever and joint pain, but the symptoms did not disappear until the administration of prednisolone 10 mg/day. Reported cases of dialysis-related amyloidosis with a fever imply that changing to blood purification methods with high β2-microglobulin clearance is crucial for controlling the condition long-term, whereas concurrent use of anti-inflammatory agents promptly alleviates the symptoms.
Collapse
Affiliation(s)
- Yasuhiro Oda
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Japan
| | - Kunihiro Ishioka
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Japan
| | - Takayasu Ohtake
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Japan
| | - Rikako Oki
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Japan
| | - Shinya Taguchi
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Japan
| | - Kenji Matsui
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Japan
| | - Yasuhiro Mochida
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Japan
| | - Hidekazu Moriya
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Japan
| | - Sumi Hidaka
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Japan
| | - Shuzo Kobayashi
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Japan
| |
Collapse
|
2
|
Ohtake T, Kobayashi S. Vascular Involvement in Patients with Lower Extremity Artery Disease: Difference of Distribution Pattern among Smoking, Diabetes Mellitus, and End-Stage Renal Disease. J Atheroscler Thromb 2023; 30:1305-1306. [PMID: 36878537 PMCID: PMC10564642 DOI: 10.5551/jat.ed228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 03/07/2023] Open
Affiliation(s)
- Takayasu Ohtake
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
- Regenerative Medicine, The Center for Cell Therapy & Regenerative Medicine, Shonan Kamakura General Hospital, Kamakura,
Japan
- Shonan Research Institute of Innovative Medicine (sRIIM), Kamakura, Japan
| | - Shuzo Kobayashi
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
- Shonan Research Institute of Innovative Medicine (sRIIM), Kamakura, Japan
| |
Collapse
|
3
|
Ohtake T, Itaba S, Salybekov AA, Sheng Y, Sato T, Yanai M, Imagawa M, Fujii S, Kumagai H, Harata M, Asahara T, Kobayashi S. Repetitive administration of cultured human CD34+ cells improve adenine-induced kidney injury in mice. World J Stem Cells 2023; 15:268-280. [PMID: 37181001 PMCID: PMC10173816 DOI: 10.4252/wjsc.v15.i4.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/24/2023] [Accepted: 03/21/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND There is no established treatment to impede the progression or restore kidney function in human chronic kidney disease (CKD).
AIM To examine the efficacy of cultured human CD34+ cells with enhanced proliferating potential in kidney injury in mice.
METHODS Human umbilical cord blood (UCB)-derived CD34+ cells were incubated for one week in vasculogenic conditioning medium. Vasculogenic culture significantly increased the number of CD34+ cells and their ability to form endothelial progenitor cell colony-forming units. Adenine-induced tubulointerstitial injury of the kidney was induced in immunodeficient non-obese diabetic/severe combined immunodeficiency mice, and cultured human UCB-CD34+ cells were administered at a dose of 1 × 106/mouse on days 7, 14, and 21 after the start of adenine diet.
RESULTS Repetitive administration of cultured UCB-CD34+ cells significantly improved the time-course of kidney dysfunction in the cell therapy group compared with that in the control group. Both interstitial fibrosis and tubular damage were significantly reduced in the cell therapy group compared with those in the control group (P < 0.01). Microvasculature integrity was significantly preserved (P < 0.01) and macrophage infiltration into kidney tissue was dramatically decreased in the cell therapy group compared with those in the control group (P < 0.001).
CONCLUSION Early intervention using human cultured CD34+ cells significantly improved the progression of tubulointerstitial kidney injury. Repetitive administration of cultured human UCB-CD34+ cells significantly improved tubulointerstitial damage in adenine-induced kidney injury in mice via vasculoprotective and anti-inflammatory effects.
Collapse
Affiliation(s)
- Takayasu Ohtake
- Regenerative Medicine, The Center for Cell Therapy & Regenerative Medicine, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
- Kidney Disease and Transplant center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
- Regenerative Medicine, Shonan Research Institute of Innovative Medicine, Kamakura 247-8533, Kanagawa, Japan
| | - Shoichi Itaba
- Kamakura Techno-science Inc., Kamakura 248-0036, Japan
| | - Amankeldi A Salybekov
- Regenerative Medicine, Shonan Research Institute of Innovative Medicine, Kamakura 247-8533, Kanagawa, Japan
| | - Yin Sheng
- Advanced Medicine Science, Tokai University School of Medicine, Isehara 259-1193, Japan
| | - Tsutomu Sato
- Regenerative Medicine, Shonan Research Institute of Innovative Medicine, Kamakura 247-8533, Kanagawa, Japan
| | - Mitsuru Yanai
- Department of Pathology, Sapporo Tokushukai Hospital, Sapporo 004-0041, Japan
| | - Makoto Imagawa
- Department of Pathology, Sapporo Medical Center, Sapporo 004-0041, Japan
| | - Shigeo Fujii
- Kamakura Techno-science Inc., Kamakura 248-0036, Japan
| | | | | | - Takayuki Asahara
- Regenerative Medicine, Shonan Research Institute of Innovative Medicine, Kamakura 247-8533, Kanagawa, Japan
- Cell Processing and Cell/Genome Analysis Center, The Center for Cell Therapy & Regenerative Medicine, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanagawa, Japan
| | - Shuzo Kobayashi
- Regenerative Medicine, Shonan Research Institute of Innovative Medicine, Kamakura 247-8533, Kanagawa, Japan
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Kanazawa, Japan
| |
Collapse
|
4
|
Maesato K, Kobayashi S, Ohtake T, Mochida Y, Ishioka K, Oka M, Moriya H, Hidaka S. Transcranial Doppler Echography Measurement in Hemodialysis Patients: The Potential Role of Angiotensin II Receptor Blockades on Cerebrovascular Circulation. J Clin Med 2023; 12:jcm12062295. [PMID: 36983296 PMCID: PMC10058379 DOI: 10.3390/jcm12062295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Background: Although hemodialysis (HD) patients have an elevated risk of strokes, there are few reports about transcranial doppler (TCD) echography measurements. It is well-known that angiotensin II receptor blockades (ARBs) protect against cardiovascular complications. In this study, we measured intracranial artery (ICA) velocity using TCD echography and studied the associated factors with its velocity in HD patients by a comparison with or without ARBs. Methods: We conducted a cross-sectional study in a single hospital. We included 61 patients who had measurable ICA velocity by TCD echography. Among them, the ARB usage group consisted of 22 subjects, whilst the non-ARB usage group consisted of 39 subjects. Results: Patients in the ARB (+) and ARB (-) groups did not show any difference in basic characteristics. ICA blood flow velocity in all intracranial arteries tended to show greater values in the ARB group than those in the non-ARB group. Particularly, blood velocity in the middle cerebral artery (MCA) (maximal flow velocity) statistically increased in the ARB group, respectively. In a univariate analysis, MCA maximum velocity was significantly associated with ARB usage (p = 0.011) and low hematocrit levels (p = 0.045). The multivariate analysis chose only ARB usage as an independent factor associated with left MCA maximum velocity (p = 0.022). Conclusions: We showed that dialysis patients with ARBs have significantly higher ICA blood velocity. ARBs might have a potential benefit for maintaining ICA blood flow in HD patients.
Collapse
Affiliation(s)
- Kyoko Maesato
- Correspondence: ; Tel.: +81-467-46-1717; Fax: +81-467-45-0190
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Nishimura A, Hidaka S, Kawaguchi T, Watanabe A, Mochida Y, Ishioka K, Mwanatanbwe M, Ohtake T, Kobayashi S. Relationship between Lower Extremity Peripheral Arterial Disease and Mild Cognitive Impairment in Hemodialysis Patients. J Clin Med 2023; 12:jcm12062145. [PMID: 36983147 PMCID: PMC10058216 DOI: 10.3390/jcm12062145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 02/21/2023] [Accepted: 03/03/2023] [Indexed: 03/12/2023] Open
Abstract
Background: The link between arterial stiffness and mild cognitive impairment (MCI) in patients on hemodialysis (HD) has been receiving increased attention. The purpose of this study was to investigate the relationship between cognitive function and ankle brachial index (ABI) and toe brachial index (TBI) values in patients on hemodialysis. Of the 100 participants (mean age: 67.9 years; average history of hemodialysis: 7.3 years). Of these, 46.0% had MCI. The MoCA-J scores were significantly higher in the ABI ≥ 1.06 group. However, the MoCA-J scores divided into the two groups according to the TBI cutoff value were not significantly different. In a multiple regression model with the MoCA-J scores as the objective variable, the ABI was a significantly associated factor. This study indicates that a low ABI might be associated with MCI.
Collapse
Affiliation(s)
- Akinori Nishimura
- Rehabilitation Unit, Shonan Kamakura General Hospital, Okamoto 1370_1, Kamakura 247-8533, Japan
- Correspondence:
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
- Shonan Research Institute of Innovative Medicine (sRIIM), Kamakura 247-8533, Japan
| | - Takayuki Kawaguchi
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira 187-8553, Japan
| | - Aki Watanabe
- School of Allied Health Sciences, Kitasato University, Sagamihara 252-0373, Japan
| | - Yasuhiro Mochida
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Kunihiro Ishioka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Milanga Mwanatanbwe
- Department of Pathology, University of Mbuji-Mayi, Mbuji-Mayi 8010, Democratic Republic of the Congo
- International Division of Tokushukai of Medical Corporation, Tokushukai, Chiyoda-ku 102-0074, Japan
| | - Takayasu Ohtake
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
- Shonan Research Institute of Innovative Medicine (sRIIM), Kamakura 247-8533, Japan
| | - Shuzo Kobayashi
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
- Shonan Research Institute of Innovative Medicine (sRIIM), Kamakura 247-8533, Japan
| |
Collapse
|
6
|
Ohtake T, Mitomo A, Yamano M, Shimizu T, Mochida Y, Ishioka K, Oka M, Maesato K, Moriya H, Hidaka S, Mwanatambwe M, Kobayashi S. Impact of Arterial Calcification of the Lower Limbs on Long-Term Clinical Outcomes in Patients on Hemodialysis. J Clin Med 2023; 12:jcm12041299. [PMID: 36835836 PMCID: PMC9967859 DOI: 10.3390/jcm12041299] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/06/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Lower limbs' arterial calcification is significantly associated with the clinical severity of lower extremity artery disease (LEAD) in patients undergoing hemodialysis (HD). However, the association between arterial calcification of the lower limbs and long-term clinical outcomes in patients on HD has not been elucidated. Calcification scores of the superficial femoral artery (SFACS) and below-knee arteries (BKACS) were quantitatively evaluated in 97 HD patients who were followed for 10 years. Clinical outcomes, including all-cause and cardiovascular mortality, cardiovascular events, and limb amputation were evaluated. Risk factors for clinical outcomes were evaluated using univariate and multivariate Cox proportional hazard analyses. Furthermore, SFACS and BKACS were divided into three groups (low, middle, and high), and their associations with clinical outcomes were evaluated using Kaplan-Meier analysis. SFACS, BKACS, C-reactive protein, serum albumin, age, diabetes, presence of ischemic heart disease, and critical limb-threatening ischemia were significantly associated with 3-year and 10-year clinical outcomes in the univariate analysis. Multivariate analysis showed that SFACS was an independent factor associated with 10-year cardiovascular events and limb amputations. Kaplan-Meier life table analysis showed that higher SFACS and BKACS levels were significantly associated with cardiovascular events and mortality. In conclusion, long-term clinical outcomes and the risk factors in patients undergoing HD were evaluated. Arterial calcification of the lower limbs was strongly associated with 10-year cardiovascular events and mortality in patients undergoing HD.
Collapse
Affiliation(s)
- Takayasu Ohtake
- Department of Kidney and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
- Regenerative Medicine, The Center for Cell Therapy & Regenerative Medicine, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura 247-8533, Japan
- Shonan Research Institute of Innovative Medicine (sRIIM), Kamakura 247-8533, Japan
- Correspondence: ; Tel.: +81-467-46-1717; Fax: +81-467-45-0190
| | - Ayaka Mitomo
- Department of Kidney and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Mizuki Yamano
- Department of Kidney and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Toshihiro Shimizu
- Department of Kidney and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Yasuhiro Mochida
- Department of Kidney and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Kunihiro Ishioka
- Department of Kidney and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Machiko Oka
- Department of Kidney and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Kyoko Maesato
- Department of Nephrology, Tokyo Nishi Tokushukai Hospital, Tokyo 196-0003, Japan
| | - Hidekazu Moriya
- Department of Kidney and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
| | - Sumi Hidaka
- Department of Kidney and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
- Shonan Research Institute of Innovative Medicine (sRIIM), Kamakura 247-8533, Japan
| | - Milanga Mwanatambwe
- Department of Pathology, University of Mbuji Mayi, Mbujimayi 433, Congo
- International Division of Tokushukai of Medical Corporation, Tokushukai, Tokyo 188-0013, Japan
| | - Shuzo Kobayashi
- Department of Kidney and Transplant Center, Shonan Kamakura General Hospital, Kamakura 247-8533, Japan
- Shonan Research Institute of Innovative Medicine (sRIIM), Kamakura 247-8533, Japan
| |
Collapse
|
7
|
Ishioka K, Hidaka S, Fujiwara N, Yamano M, Mochida Y, Oka M, Maesato K, Moriya H, Ohtake T, Kobayashi S. Association between zinc deficiency and aorta stiffness in non-diabetic hemodialysis patients. PLoS One 2023; 18:e0268875. [PMID: 36607966 PMCID: PMC9821515 DOI: 10.1371/journal.pone.0268875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 12/07/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Zinc deficiency (Zn < 60 μg/dL) is known to play an important role for vascular calcification. However, little data is available regarding the association between zinc deficiency and aorta stiffness in dialysis patients. Thus, we studied the relationship between zinc deficiency and aorta stiffness in non-diabetic hemodialysis (HD) patients. METHODS Of 150 patients receiving maintenance HD at our hospital, we included 79 non-diabetic HD patients (age: 70±11 years, 49 men) after excluding 71 diabetic HD patients. Zinc deficiency was defined as Zn <60 μg/dL during pre-HD blood sampling. The association between zinc deficiency and aorta stiffness was analyzed. Aorta stiffness was evaluated as brachial-ankle pulse wave velocity (baPWV). Other surrogate markers for cardiovascular complications were also measured. RESULTS The zinc deficiency group (ZD group) included 45 patients (57.0%). Compared to the zinc non-deficiency group (ZND group), patients with ZD group were significantly older, higher levels of CRP and hypoalbuminemia. Moreover, they had significantly higher levels of baPWV, and lower levels of ankle-brachial pressure index (ABI) (p<0.05). After adjusting for hypoalbuminemia, and CRP, multivariate analysis showed that age and zinc level were independent predictors of baPWV. CONCLUSION The study suggested that zinc deficiency may be an independent risk factor for aorta stiffness, even after adjusting for malnutrition and inflammation.
Collapse
Affiliation(s)
- Kunihiro Ishioka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
- * E-mail:
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Naoki Fujiwara
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Mizuki Yamano
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yasuhiro Mochida
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Machiko Oka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kyoko Maesato
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hidekazu Moriya
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Takayasu Ohtake
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shuzo Kobayashi
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| |
Collapse
|
8
|
Hara A, Wada T, Muso E, Maruyama S, Kato S, Furuichi K, Yoshimura K, Toyama T, Sakai N, Suzuki H, Tsukamoto T, Miyazaki M, Sato E, Abe M, Shibagaki Y, Narita I, Goto S, Sakamaki Y, Yokoyama H, Mori N, Tanaka S, Yuzawa Y, Hasegawa M, Matsubara T, Wada J, Tanabe K, Masutani K, Abe Y, Tsuruya K, Fujimoto S, Iwatsubo S, Tsuda A, Suzuki H, Kasuno K, Terada Y, Nakata T, Iino N, Sofue T, Miyata H, Nakano T, Ohtake T, Kobayashi S. Effect of Low-Density Lipoprotein Apheresis on Quality of Life in Patients with Diabetes, Proteinuria, and Hypercholesterolemia. Blood Purif 2022; 52:373-381. [PMID: 36521435 DOI: 10.1159/000527900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/16/2022] [Indexed: 12/23/2022]
Abstract
<b><i>Introduction:</i></b> Treating diabetic nephropathy with low-density lipoprotein (LDL) apheresis reduces proteinuria and improves prognosis. However, its impact on patients’ quality of life (QoL) is unclear. This study evaluated the effect of LDL apheresis on QoL in patients with diabetes, proteinuria, and hypercholesterolemia. <b><i>Methods:</i></b> In this nationwide multicenter prospective study, we enrolled 40 patients with diabetes. Inclusion criteria were proteinuria (defined as an albumin/creatinine ratio ≥3 g/g), serum creatinine levels <2 mg/dL, and serum LDL ≥120 mg/dL despite drug treatment. LDL apheresis was performed 6–12 times within 12 weeks. The 36-item Short Form Health Survey (SF-36) was used to analyze QoL. <b><i>Results:</i></b> The study enrolled 35 patients (27 men and 8 women; mean age 58.9 ± 11.9 years). A comparison of baseline SF-36 values with those at the end of the course of apheresis found an improvement in the mean physical component summary (37.9 ± 11.4 vs. 40.6 ± 10.5, <i>p</i> = 0.051) and a significant increase in the mean mental component summary (MCS) (49.4 ± 8.4 vs. 52.5 ± 10.9, <i>p</i> = 0.026). A multivariable linear regression analysis revealed a history of coronary heart disease negatively correlated with the MCS increase at the end of the course of apheresis (<i>β</i> coefficient −6.935, 95% confidence interval, 13.313 to−0.556, <i>p</i> = 0.034). <b><i>Conclusion:</i></b> Our results suggest that LDL apheresis may improve the mental and physical QoL in patients with diabetes, proteinuria, and hypercholesterolemia.
Collapse
Affiliation(s)
- Akinori Hara
- Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan
- Department of Hygiene and Public Health, Kanazawa University, Kanazawa, Japan
| | - Takashi Wada
- Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Eri Muso
- Department of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sawako Kato
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kengo Furuichi
- Department of Nephrology, Kanazawa Medical University School of Medicine, Kanazawa, Japan
| | - Kenichi Yoshimura
- Innovative Clinical Research Center, Kanazawa University Hospital, Kanazawa, Japan
| | - Tadashi Toyama
- Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan
- Innovative Clinical Research Center, Kanazawa University Hospital, Kanazawa, Japan
| | - Norihiko Sakai
- Division of Nephrology, Kanazawa University Hospital, Kanazawa, Japan
- Department of Nephrology and Laboratory Medicine, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Suzuki
- Department of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Tatsuo Tsukamoto
- Department of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Mariko Miyazaki
- Division of Nephrology, Endocrinology, and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Eiichi Sato
- Division of Nephrology, Department of Internal Medicine, Shinmatsudo Central General Hospital, Matsudo, Japan
| | - Masanori Abe
- Divisions of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shin Goto
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuichi Sakamaki
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hitoshi Yokoyama
- Department of Nephrology, Kanazawa Medical University School of Medicine, Kanazawa, Japan
| | - Noriko Mori
- Department of Nephrology, Shizuoka General Hospital, Shizuoka, Japan
| | - Satoshi Tanaka
- Department of Nephrology, Shizuoka General Hospital, Shizuoka, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Midori Hasegawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Takeshi Matsubara
- Department of Nephrology, Kyoto University, Graduate School of Medicine, Kyoto, Japan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Katsuyuki Tanabe
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kosuke Masutani
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yasuhiro Abe
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | | | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shuji Iwatsubo
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Akihiro Tsuda
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hitoshi Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kenji Kasuno
- Division of Nephrology, Department of General Medicine, University of Fukui School of Medical Sciences, Fukui, Japan
| | - Yoshio Terada
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Takeshi Nakata
- Department of Endocrinology, Metabolism, Rheumatology, and Nephrology, Faculty of Medicine, Oita University, Oita, Japan
| | - Noriaki Iino
- Department of Nephrology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Tadashi Sofue
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa Universityi, Kawasak, Japan
| | - Hitomi Miyata
- Department of Nephrology, Kyoto Katsura Hospital, Kyoto, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takayasu Ohtake
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shuzo Kobayashi
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| |
Collapse
|
9
|
Moriya H, Mochida Y, Ishioka K, Oka M, Maesato K, Yamano M, Suzuki H, Ohtake T, Hidaka S, Kobayashi S. Impact of Contrast-Induced Nephropathy on Long-Term Renal Function after Coronary Angiography and Contrast-Enhanced Computed Tomography. Cardiol Cardiovasc Med 2022; 6:473-479. [PMID: 36212510 PMCID: PMC9536241 DOI: 10.26502/fccm.92920285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND It remains unclear whether contrast-induced nephropathy (CIN) has a prognostic impact on subsequent renal dysfunction and whether deteriorating renal function is a risk factor for CIN. This study aimed to evaluate the occurrence of CIN in patients with pre-existing renal dysfunction and investigate the long-term effects of worsening renal function after coronary angiography or contrast-enhanced computed tomography (CT). The prognostic factors of worsening renal dysfunction were also analyzed. METHODS This was a prospective cohort study of patients at risk for CIN, defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 on coronary angiography or eGFR <45 mL/min/1.73 m2 on contrast-enhanced CT. Serum creatinine levels and the 2-year prognosis were evaluated. CIN was defined as an increase in serum creatinine level by more than 0.5 mg/dL or a 25% increase from the previous value within 72 hours after contrast administration. The primary endpoint was the proportion of patients who had serum Cr doubling or induction of dialysis within 2 years according to CIN occurrence. RESULTS Of the 410 patients, 19 patients developed CIN (8/142 patients on coronary angiography and 11/268 patients on contrast-enhanced CT), and 38 patients had worsened renal function (21/142 patients on coronary angiography and 17/268 patients on contrast-enhanced CT). CIN was not associated with worsening renal function at 2 years. Analysis by renal function at the time of coronary angiography or contrast-enhanced CT (i.e., eGFR ≥30 ml/min/1.73 m2 and eGFR ≤1.73 m2) found no between-group difference in the occurrence of CIN. CONCLUSIONS CIN is not a prognostic risk factor for the long-term of chronic kidney disease after coronary angiography or contrast-enhanced CT. Pre-existing renal dysfunction is also not a risk factor for CIN, even if the eGFR is <30 ml/min/1.73 m2.
Collapse
Affiliation(s)
- Hidekazu Moriya
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yasuhiro Mochida
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kunihiro Ishioka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Machiko Oka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kyoko Maesato
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Mizuki Yamano
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hiroyuki Suzuki
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Takayasu Ohtake
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Shuzo Kobayashi
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| |
Collapse
|
10
|
Matsui K, Kamata W, Mochida Y, Ishioka K, Moriya H, Hidaka S, Ohtake T, Tamai Y, Kobayashi S. Acquired aplastic anemia complicated with anti-glomerular basement membrane disease successfully treated with immunosuppressive therapy: a case report. BMC Nephrol 2022; 23:136. [PMID: 35392836 PMCID: PMC8991481 DOI: 10.1186/s12882-022-02772-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aplastic anemia (AA) is a rare but fatal disorder characterized by pancytopenia due to bone marrow hypoplasia. Anti-glomerular basement membrane disease (anti-GBM disease) is an immune complex small-vessel vasculitis that presents as rapidly progressive glomerulonephritis and/or pulmonary hemorrhage. Although both involve autoreactive T cells that are partially triggered by human leukocyte antigen (HLA)-DR15, there have been no reports of their co-existence and the treatment strategy is not well understood. CASE PRESENTATION A 67-year-old woman presented with fever, malaise, and acute kidney injury with proteinuria and hematuria requiring hemodialysis. She was diagnosed with anti-GBM antibody disease based on high serum anti-GBM antibody titer and crescentic glomerulonephritis on a renal biopsy. Pulse administration of methylprednisolone (MP), oral prednisolone (PSL), and plasmapheresis were performed. Only 2 weeks after the diagnosis of anti-GBM disease, the patient developed pancytopenia requiring frequent blood transfusions. The blood cell count did not recover even 1 month after discontinuing the drugs that could cause pancytopenia. Bone marrow examination showed hypocellularity without abnormal infiltrates or fibrosis, which led to the diagnosis of severe acquired AA. Further HLA phenotyping revealed that she had HLA-DR15. Increased dose of PSL with the secondary MP pulse and the addition of cyclosporine improved pancytopenia. Although she remained dialysis-dependent, anti-GBM disease and pancytopenia did not recur for more than 2 years. CONCLUSIONS We report the first case of acquired AA complicated with anti-GBM disease in an elderly woman with HLA-DR15, which was successfully treated with immunosuppressive therapy (IST). This report is valuable not only because it shows they may co-occur, but also because it provides a therapeutic option for this complex condition. It was also suggested that pancytopenia in patients with anti-GBM disease recalls serious hematologic diseases including AA that require immediate treatment based on bone marrow examination.
Collapse
Affiliation(s)
- Kenji Matsui
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, Kanawaga, 247-8533, Japan.
| | - Wataru Kamata
- Division of Hematology, Shonan Kamakura General Hospital, Kamakura, Kanawaga, Japan
| | - Yasuhiro Mochida
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, Kanawaga, 247-8533, Japan
| | - Kunihiro Ishioka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, Kanawaga, 247-8533, Japan
| | - Hidekazu Moriya
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, Kanawaga, 247-8533, Japan
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, Kanawaga, 247-8533, Japan
| | - Takayasu Ohtake
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, Kanawaga, 247-8533, Japan
| | - Yotaro Tamai
- Division of Hematology, Shonan Kamakura General Hospital, Kamakura, Kanawaga, Japan
| | - Shuzo Kobayashi
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, Kanawaga, 247-8533, Japan
| |
Collapse
|
11
|
Abe T, Matsuo H, Abe R, Abe S, Asada H, Ashida A, Baba A, Eguchi K, Eguchi Y, Endo Y, Fujimori Y, Furuichi K, Furukawa Y, Furuya M, Furuya T, Hanafusa N, Hara W, Harada-Shiba M, Hasegawa M, Hattori N, Hattori M, Hidaka S, Hidaka T, Hirayama C, Ikeda S, Imamura H, Inoue K, Ishizuka K, Ishizuka K, Ito T, Iwamoto H, Izaki S, Kagitani M, Kaneko S, Kaneko N, Kanekura T, Kitagawa K, Kusaoi M, Lin Y, Maeda T, Makino H, Makino S, Matsuda K, Matsugane T, Minematsu Y, Mineshima M, Miura K, Miyamoto K, Moriguchi T, Murata M, Naganuma M, Nakae H, Narukawa S, Nohara A, Nomura K, Ochi H, Ohkubo A, Ohtake T, Okada K, Okado T, Okuyama Y, Omokawa S, Oji S, Sakai N, Sakamoto Y, Sasaki S, Sato M, Seishima M, Shiga H, Shimohata H, Sugawara N, Sugimoto K, Suzuki Y, Suzuki M, Tajima T, Takikawa Y, Tanaka S, Taniguchi K, Tsuchida S, Tsukamoto T, Tsushima K, Ueda Y, Wada T, Yamada H, Yamada H, Yamaka T, Yamamoto K, Yokoyama Y, Yoshida N, Yoshioka T, Yamaji K. The Japanese Society for Apheresis clinical practice guideline for therapeutic apheresis. Ther Apher Dial 2021; 25:728-876. [PMID: 34877777 DOI: 10.1111/1744-9987.13749] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Most of the diseases for which apheresis therapy is indicated are intractable and rare, and each patient has a different background and treatment course prior to apheresis therapy initiation. Therefore, it is difficult to conduct large-scale randomized controlled trials to secure high-quality evidence. Under such circumstances, the American Society for Apheresis (ASFA) issued its guidelines in 2007, which were repeatedly revised until the latest edition in 2019. The ASFA guidelines are comprehensive. However, in the United States, a centrifugal separation method is mainly used for apheresis, whereas the mainstream procedure in Japan is the membrane separation method. The target diseases and their backgrounds are different from those in Japan. Due to these differences, the direct adoption of the ASFA guidelines in Japanese practice creates various problems. One of the features of apheresis in Japan is the development of treatment methods using hollow-fiber devices such as double filtration plasmapheresis (DFPP) and selective plasma exchange and adsorption-type devices such as polymyxin B-immobilized endotoxin adsorption columns. Specialists in emergency medicine, hematology, collagen diseases/rheumatology, respiratory medicine, cardiovascular medicine, gastroenterology, neurology, nephrology, and dermatology who are familiar with apheresis therapy gathered for this guideline, which covers 86 diseases. In addition, since apheresis therapy involves not only physicians but also clinical engineers, nurses, dieticians, and many other medical professionals, this guideline was prepared in the form of a worksheet so that it can be easily understood at the bedside. Moreover, to the clinical purposes, this guideline is designed to summarize apheresis therapy in Japan and to disseminate and further develop Japanese apheresis technology to the world. As diagnostic and therapeutic techniques are constantly advancing, the guidelines need to be revised every few years. In order to ensure the high quality of apheresis therapy in Japan, both the Japanese Society for Apheresis Registry and the guidelines will be inseparable.
Collapse
|
12
|
Isobe T, Matsui K, Ishioka K, Mochida Y, Moriya H, Hidaka S, Ohtake T, Etani T, Yasui T, Kobayashi S. Recurrent hemorrhagic shock from hemorrhagic cystitis due to neurogenic bladder. IJU Case Rep 2021; 4:379-381. [PMID: 34755061 PMCID: PMC8560437 DOI: 10.1002/iju5.12354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/19/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Hemorrhagic cystitis is characterized by gross hematuria, with hemorrhagic shock a rare complication. However, to our knowledge, its exact frequency has not been reported. CASE PRESENTATION We report a case of an 86-year-old woman who showed repeated hemorrhagic cystitis with massive bleeding and hemorrhagic shock. The hemorrhagic cystitis was supposedly caused by the administration of aspirin and a neurogenic bladder. A urethral catheter was indwelled and hemorrhagic cystitis subsequently ceased. CONCLUSION A review of patients with hemorrhagic cystitis at our hospital showed that only 3.3% experienced hemorrhagic shock. This case was even rarer because the patient experienced recurrent hemorrhagic shocks. A neurogenic bladder, which reduces the bladder's ability to function as a uroepithelial barrier against recurrent bacterial infections, caused the condition in this case. This report highlights how hemorrhagic cystitis can sometimes cause hemorrhagic shock.
Collapse
Affiliation(s)
- Teruki Isobe
- Kidney Disease and Transplant CenterShonan Kamakura General HospitalKamakuraKanawagaJapan
- Department of Nephro‐urologyGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
| | - Kenji Matsui
- Kidney Disease and Transplant CenterShonan Kamakura General HospitalKamakuraKanawagaJapan
| | - Kunihiro Ishioka
- Kidney Disease and Transplant CenterShonan Kamakura General HospitalKamakuraKanawagaJapan
| | - Yasuhiro Mochida
- Kidney Disease and Transplant CenterShonan Kamakura General HospitalKamakuraKanawagaJapan
| | - Hidekazu Moriya
- Kidney Disease and Transplant CenterShonan Kamakura General HospitalKamakuraKanawagaJapan
| | - Sumi Hidaka
- Kidney Disease and Transplant CenterShonan Kamakura General HospitalKamakuraKanawagaJapan
| | - Takayasu Ohtake
- Kidney Disease and Transplant CenterShonan Kamakura General HospitalKamakuraKanawagaJapan
| | - Toshiki Etani
- Department of Nephro‐urologyGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
| | - Takahiro Yasui
- Department of Nephro‐urologyGraduate School of Medical SciencesNagoya City UniversityNagoyaJapan
| | - Shuzo Kobayashi
- Kidney Disease and Transplant CenterShonan Kamakura General HospitalKamakuraKanawagaJapan
| |
Collapse
|
13
|
Suzuki H, Ohtake T, Tsukiyama T, Morota M, Ishioka K, Moriya H, Mochida Y, Hidaka S, Sato T, Asahara T, Kobayashi S. Acute kidney injury successfully treated with autologous granulocyte colony-stimulating factor-mobilized peripheral blood CD34-positive cell transplantation: A first-in-human report. Stem Cells Transl Med 2021; 10:1253-1257. [PMID: 33955678 PMCID: PMC8380438 DOI: 10.1002/sctm.20-0561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/18/2021] [Accepted: 03/13/2021] [Indexed: 12/14/2022] Open
Abstract
A 36-year-old man with severe acute kidney injury (AKI) was admitted to Shonan Kamakura General Hospital in Japan. He was diagnosed with refractory hypertension based on a severely elevated blood pressure of 224/116 mmHg and retinal, cardiac, and brain damage revealed by electrocardiogram, fundoscopy, and magnetic resonance imaging, respectively. Although hemodialysis was withdrawn following strict blood pressure control by an angiotensin receptor blocker, severe kidney insufficiency persisted. Therefore, we performed an autologous granulocyte colony-stimulating factor-mobilized peripheral blood CD34-positive cell transplantation. Collected CD34-positive cells were directly infused to both renal arteries. The patient's general condition was unremarkable after intervention, and the serum creatinine level gradually improved to 2.96 mg/dL 23 weeks after cell therapy. Although transient fever and thrombocytosis were observed after intervention, no major adverse events were observed. This patient is the first case in a phase I/II clinical trial of autologous granulocyte colony-stimulating factor-mobilized peripheral blood CD34-positive cell transplantation for severe AKI with a CD34-positive cell dose-escalating protocol (trial number jRCTb030190231).
Collapse
Affiliation(s)
- Hiroyuki Suzuki
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Takayasu Ohtake
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Toshitaka Tsukiyama
- Department of Radiology and Interventional Radiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Marie Morota
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kunihiro Ishioka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hidekazu Moriya
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yasuhiro Mochida
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Tsutomu Sato
- Clinical Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Takayuki Asahara
- Regenerative Medicine Science, Tokai University School of Medicine, Isehara, Japan
| | - Shuzo Kobayashi
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| |
Collapse
|
14
|
Taguchi S, Hidaka S, Yanai M, Ishioka K, Matsui K, Mochida Y, Moriya H, Ohtake T, Kobayashi S. Renal hemosiderosis presenting with acute kidney Injury and macroscopic hematuria in Immunoglobulin A nephropathy: a case report. BMC Nephrol 2021; 22:132. [PMID: 33858363 PMCID: PMC8048362 DOI: 10.1186/s12882-021-02334-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/02/2021] [Indexed: 11/19/2022] Open
Abstract
Background Macroscopic hematuria-associated acute kidney injury (AKI) is a well-known complication of immunoglobulin A (IgA) nephropathy. In such cases, intratubular obstruction by red blood cell (RBC) casts and acute tubular necrosis are mainly observed pathologically. Herein, we report the case of a patient with IgA nephropathy presenting with AKI following an episode of macrohematuria. The patient presented with severe renal tubular hemosiderosis and acute tubular necrosis and without any obvious obstructive RBC casts. Case presentation A 68-year-old woman, who was diagnosed with IgA nephropathy on renal biopsy 6 years ago, was admitted to our hospital after an episode of macroscopic glomerular hematuria and AKI following upper respiratory tract infection. Renal biopsy showed mesangial proliferation of the glomeruli, including crescent formation in 17 % of the glomeruli, and acute tubular necrosis without obvious hemorrhage or obstructive RBC casts. The application of Perls’ Prussian blue stain showed hemosiderin deposition in the renal proximal tubular cells. Immunofluorescence showed granular mesangial deposits of IgA and C3. Based on these findings, she was diagnosed with acute tubular necrosis with a concurrent IgA nephropathy flare-up. Moreover, direct tubular injury by heme and iron was considered to be the cause of AKI. She was treated with intravenous pulse methylprednisolone followed by oral prednisolone. Thereafter, the gross hematuria gradually faded, and her serum creatinine levels decreased. Conclusions IgA nephropathy presenting with acute kidney injury accompanied by macrohematuria may cause renal hemosiderosis and acute tubular necrosis without obstructive RBC casts. Hemosiderosis may be a useful indicator for determining the pathophysiology of macroscopic hematuria-associated AKI. However, renal hemosiderosis may remain undiagnosed. Thus, Perls’ Prussian blue iron staining should be more widely used in patients presenting with hematuria.
Collapse
Affiliation(s)
- Shinya Taguchi
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, 247-8553, Kamakura, Kanagawa, Japan. .,Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, 236-0004, Yokohama, Japan.
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, 247-8553, Kamakura, Kanagawa, Japan
| | - Mitsuru Yanai
- Department of Pathology, Sapporo Tokushukai Hospital, 1-1-1 Oyachi-higashi, Atsubetsu-ku, 004-0041, Sapporo, Hokkaido, Japan.,Hokkaido Renal Pathology Center, IT-FRONTBuilding, 28-196, N9W15, Chuo-ku, 060-0009, Sapporo, Hokkaido, Japan
| | - Kunihiro Ishioka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, 247-8553, Kamakura, Kanagawa, Japan
| | - Kenji Matsui
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, 247-8553, Kamakura, Kanagawa, Japan
| | - Yasuhiro Mochida
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, 247-8553, Kamakura, Kanagawa, Japan
| | - Hidekazu Moriya
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, 247-8553, Kamakura, Kanagawa, Japan
| | - Takayasu Ohtake
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, 247-8553, Kamakura, Kanagawa, Japan
| | - Shuzo Kobayashi
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, 247-8553, Kamakura, Kanagawa, Japan
| |
Collapse
|
15
|
Oki R, Hidaka S, Sasaki A, Teshima S, Mochida Y, Miyake K, Ishioka K, Moriya H, Ohtake T, Kobayashi S. De novo ulcerative colitis after kidney transplantation treated with infliximab. CEN Case Rep 2021; 10:500-505. [PMID: 33829404 PMCID: PMC8494858 DOI: 10.1007/s13730-021-00599-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/27/2021] [Indexed: 01/20/2023] Open
Abstract
Diarrhea is a common complication in kidney transplant recipients. Common causes of diarrhea include infection, side effect from medication, rejection, and malignancy. A less common but important cause of diarrhea is de novo inflammatory bowel disease (IBD). This is unexpected, as these patients are already immunosuppressed. Herein, we present the case of a 45-year-old man with end-stage kidney disease because of focal segmental glomerulosclerosis who underwent preemptive kidney transplantation, with his mother as donor. His immunosuppressive regimen included methylprednisolone, mycophenolate mofetil, and tacrolimus. He had no episodes of graft dysfunction, rejection, or infectious events. Two and a half years post-transplantation, he developed bloody diarrhea. After excluding infections, colonoscopy was performed and revealed edematous mucosa and erythema with pigmentation, which are typical findings in ulcerative colitis. Despite therapy with 5-aminosalicylate and granulocyte monocyte apheresis, he presented with massive bloody diarrhea. We initiated infliximab, an anti-tumor necrosis factor-α (TNF-α) agent. He responded very well and achieved remission within 6 months after initiation of infliximab, while administration of the other immunosuppressants was maintained. His course was uneventful and no complications developed. Management of immunosuppressants for de novo IBD after organ transplantation is complicated, because treatment of IBD, graft function protection, and prevention of infection must be considered. Therefore, cooperation between transplantation physicians and gastroenterologists is essential during therapy.
Collapse
Affiliation(s)
- Rikako Oki
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-0072, Japan.
- Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan.
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-0072, Japan
| | - Akiko Sasaki
- Shonan Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shinichi Teshima
- Department of Pathology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yasuhiro Mochida
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-0072, Japan
| | - Katsunori Miyake
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-0072, Japan
| | - Kunihiro Ishioka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-0072, Japan
| | - Hidekazu Moriya
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-0072, Japan
| | - Takayasu Ohtake
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-0072, Japan
| | - Shuzo Kobayashi
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-0072, Japan
| |
Collapse
|
16
|
Affiliation(s)
- Takayasu Ohtake
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital
| | - Shuzo Kobayashi
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital
| |
Collapse
|
17
|
Mochida Y, Ohtake T, Ishioka K, Miyake K, Moriya H, Hidaka S, Kobayashi S. Angiectasia of the parietal pleura in a hemodialysis patient with central venous stenosis and bloody pleural effusion: a case report. CEN Case Rep 2020; 10:78-82. [PMID: 32876866 DOI: 10.1007/s13730-020-00523-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 08/19/2020] [Indexed: 11/29/2022] Open
Abstract
Pleural effusion in hospitalized patients with long-term hemodialysis (HD) has been frequently reported. The most common causes of unilateral pleural effusions include hypervolemia, parapneumonic, uremic effusion, and malignancy. In contrast, central venous stenosis (CVS) has rarely been shown to result in pleural effusion. CVS is often diagnosed by percutaneous angiography, yet there are no reports of cases where percutaneous angiography missed CVS and instead intrathoracic endoscopy was performed. Herein, we report a case of CVS with angiectasia of the parietal pleura detected on intrathoracic endoscopy. A 62-year-old man with HD presented with massive unilateral pleural effusion. Although the cause of pleural effusion was suspected to be CVS, percutaneous angiography did not show apparent stenosis, and as a result, other potential causes of bloody effusion were investigated. The intrapleural cavity was assessed using intrathoracic endoscopy, which revealed angiectasia and no malignancy. As these findings might be suggestive of congestive and dilated vessels with venous stenosis or occlusion, 3D-computed tomography (CT) scans were performed instead of percutaneous angiography to determine whether a stenosis or occlusion was present. Brachiocephalic vein stenosis was found near the aortic arch. CVS was treated through ligation of the arteriovenous fistula (AVF), resulting in a dramatic decrease in the left pleural effusion. This case would suggest that CVS should be suspected when angiectasia of the parietal pleura is observed in HD patients. In addition, the benefit of utilizing 3D-CT should be considered when HD patients present with a unilateral hemothorax on the same side as that of the AVF, particularly when on the left side.
Collapse
Affiliation(s)
- Yasuhiro Mochida
- Japan Department of Cardiology, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
| | - Takayasu Ohtake
- Japan Department of Cardiology, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Kunihiro Ishioka
- Japan Department of Cardiology, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Katsunori Miyake
- Japan Department of Cardiology, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Hidekazu Moriya
- Japan Department of Cardiology, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Sumi Hidaka
- Japan Department of Cardiology, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Shuzo Kobayashi
- Japan Department of Cardiology, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| |
Collapse
|
18
|
Kashihara N, Nishio T, Osonoi T, Saka Y, Imasawa T, Ohtake T, Mizuno H, Shibagaki Y, Kim H, Yajima T, Sarai N. Correction of serum potassium with sodium zirconium cyclosilicate in Japanese patients with hyperkalemia: a randomized, dose-response, phase 2/3 study. Clin Exp Nephrol 2020; 24:1144-1153. [PMID: 32779057 PMCID: PMC7599176 DOI: 10.1007/s10157-020-01937-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/19/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sodium zirconium cyclosilicate (SZC) is an oral potassium binder approved to treat hyperkalemia in adults in a number of countries, including Japan. METHODS This phase 2/3, randomized, double-blind, placebo-controlled, dose-response study (ClinicalTrials.gov: NCT03127644) was designed to determine the efficacy and safety of SZC in Japanese adults with hyperkalemia. Patients with serum potassium (sK+) concentrations ≥ 5.1- ≤ 6.5 mmol/L were randomized 1:1:1 to SZC 5 g, SZC 10 g, or placebo three times daily for 48 h (six doses total). The primary efficacy endpoint was the exponential rate of change in sK+ over 48 h. The proportion of patients with normokalemia (sK+ 3.5-5.0 mmol/L) at 48 h and adverse events (AEs) were also evaluated. RESULTS Overall, 103 patients (mean age, 73.2 years; range 50-89 years) received SZC 5 g (n = 34), SZC 10 g (n = 36), or placebo (n = 33). The exponential rate of sK+ change from 0 to 48 h versus placebo was - 0.00261 (SZC 5 g) and - 0.00496 (SZC 10 g; both P < 0.0001). At 48 h, the proportions of patients with normokalemia were 85.3%, 91.7%, and 15.2% with SZC 5 g, SZC 10 g, and placebo, respectively. No serious AEs were reported. Hypokalemia (sK+ < 3.5 mmol/L) occurred in two patients in the SZC 10 g group; normokalemia was re-established within 6 days and no treatment-related AEs were reported. CONCLUSION SZC is effective and well tolerated in Japanese patients with hyperkalemia.
Collapse
Affiliation(s)
- Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Okayama, Japan
| | - Toshiki Nishio
- Nephrology Dialysis Center, Kusatsu General Hospital, Shiga, Japan
| | - Takeshi Osonoi
- Department of Internal Medicine, Nakakinen Clinic, Ibaraki, Japan
| | - Yosuke Saka
- Department of Nephrology, Kasugai Municipal Hospital, Aichi, Japan
| | | | - Takayasu Ohtake
- Department of Nephrology, Shonan Kamakura General Hospital, Kanagawa, Japan
| | | | - Yugo Shibagaki
- Division of Nephrology and Hypertension, St. Marianna University School of Medicine Hospital, Kanagawa, Japan
| | - Hyosung Kim
- Research and Development, AstraZeneca K.K, 1-8-3, Marunouchi, Chiyoda-ku, Tokyo, 100-0005, Japan
| | - Toshitaka Yajima
- Research and Development, AstraZeneca K.K, 1-8-3, Marunouchi, Chiyoda-ku, Tokyo, 100-0005, Japan
| | - Nobuaki Sarai
- Research and Development, AstraZeneca K.K, 1-8-3, Marunouchi, Chiyoda-ku, Tokyo, 100-0005, Japan.
| |
Collapse
|
19
|
Ohtake T, Mochida Y, Ishioka K, Moriya H, Hidaka S, Hirata M, Yamada H, Kumagai H, Kobayashi S. Improvement of microcirculatory impairment in patients with predialysis chronic kidney disease after AST-120 administration. Ren Replace Ther 2020. [DOI: 10.1186/s41100-020-00276-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Endothelial dysfunction starts at an earlier stage in patients with chronic kidney disease (CKD), and induces macro- and microcirculatory impairments. We evaluated whether uremic toxin-lowering therapy could improve endothelial function in patients with CKD.
Methods
We performed a prospective interventional trial with 30 predialysis non-diabetic CKD patients who were administered oral adsorbent AST-120 (6 g/day) for 12 months. Surrogate markers of endothelial function including flow-mediated dilation (FMD) and skin perfusion pressure (SPP) were serially evaluated along with serum indoxyl sulfate (IS) levels and renal function. Renal function was evaluated based on blood urea nitrogen, serum creatinine (sCr) levels, and estimated glomerular filtration ratio (eGFR).
Results
Monthly decline in renal function (slope of reciprocal sCr) after AST-120 administration did not change compared to that during the pre-treatment period. However, serum IS levels significantly decreased at 3 months after AST-120 administration (p < 0.01), and it was sustained during the period of AST-120 administration (p < 0.01). Although FMD did not improve, SPP was constantly elevated after AST-120 administration, and was significantly higher at 12 months compared with baseline value (69.7 ± 14.6 vs. 78.8 ± 18.9 mmHg, p < 0.05). A significant correlation between the change of IS and SPP from baseline values was shown at 6 months after AST-120 administration (r = − 0.558, p = 0.02).
Conclusion
Microcirculatory impairment was improved after AST-120 administration in patients with predialysis CKD.
Trial registration
UMIN, UMIN000013577. Registered on March 31, 2014,
Collapse
|
20
|
Mochida Y, Ohtake T, Morota M, Ishioka K, Moriya H, Hidaka S, Kobayashi S. P0742ASSOCIATION BETWEEN EOSINOPHILIA AND RENAL PROGNOSIS IN PATIENTS WITH CHOLESTEROL CRYSTAL EMBOLISM. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Approximately, 20%-70% of patients with cholesterol crystal embolism (CCE) have eosinophilia. However, it remains unknown how eosinophilia influences on renal prognosis in patients with CCE. In this study, we investigated an association between eosinophil count (Eo) and renal prognosis in CCE patients on steroid therapy.
Method
The present study is a single-center retrospective cohort study in patients with pathological proven CCE and Chronic kidney disease from April 2007 to May 2018. This study included the patients who are not treated with maintenance dialysis nor steroid, and moreover followed until November 2019. We analyzed the validity of eosinophil counts using receiver operating characteristic (ROC) curve analysis. In the statistical analysis, renal survival was calculated with the Kaplan– Meier method, and comparisons between higher and low Eo groups were made with the log-rank test.
Results
Thirty-two patients with pathological diagnosed CCE were enrolled and followed-up for 11.0 (4.7-43.6) months. There were significant differences in the white blood cell (p=0.03), hemoglobin (p=0.007), serum creatinine levels (p=0.03), phosphate (p=0.045), Calcium×Phosphate (p=0.03), and Eo (p=0.016) between the renal survival and renal death groups. Using the receiver operating characteristic curve analysis with Youden index, Eo of 810/µL showed the sensitivity and specificity 71% and 88% for detecting renal death, respectively (area under the carve; 0.789). Comparing the outcomes in patients having Eo ≥ and <810/µL by using the log-rank test, there are significantly higher renal death rate in CCE patients with Eo ≥810/µL (p=0.004).
Conclusion
Higher eosinophilia was a prognostic risk factor for renal death in the patients with CCE.
Collapse
Affiliation(s)
| | | | - Marie Morota
- Shonan Kamakura General Hospital, Kamakura, Japan
| | | | | | - Sumi Hidaka
- Shonan Kamakura General Hospital, Kamakura, Japan
| | | |
Collapse
|
21
|
Miyake K, Iwagami M, Ohtake T, Moriya H, Kume N, Murata T, Nishida T, Mochida Y, Isogai N, Ishioka K, Shimoyama R, Hidaka S, Kashiwagi H, Kawachi J, Ogino H, Kobayashi S. Association of pre-operative chronic kidney disease and acute kidney injury with in-hospital outcomes of emergency colorectal surgery: a cohort study. World J Emerg Surg 2020; 15:22. [PMID: 32216810 PMCID: PMC7098074 DOI: 10.1186/s13017-020-00303-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/12/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pre-operative kidney function is known to be associated with surgical outcomes. However, in emergency surgery, the pre-operative kidney function may reflect chronic kidney disease (CKD) or acute kidney injury (AKI). We examined the association of pre-operative CKD and/or AKI with in-hospital outcomes of emergency colorectal surgery. METHODS We conducted a retrospective cohort study including adult patients undergoing emergency colorectal surgery in 38 Japanese hospitals between 2010 and 2017. We classified patients into five groups according to the pre-operative status of CKD (defined as baseline estimated glomerular filtration rate < 60 mL/min/1.73 m2 or recorded diagnosis of CKD), AKI (defined as admission serum creatinine value/baseline serum creatinine value ≥ 1.5), and end-stage renal disease (ESRD): (i) CKD(-)AKI(-), (ii) CKD(-)AKI(+), (iii) CKD(+)AKI(-), (iv) CKD(+)AKI(+), and (v) ESRD groups. The primary outcome was in-hospital mortality, while secondary outcomes included use of vasoactive drugs, mechanical ventilation, blood transfusion, post-operative renal replacement therapy, and length of hospital stay. We compared these outcomes among the five groups, followed by a multivariable logistic regression analysis for in-hospital mortality. RESULTS We identified 3002 patients with emergency colorectal surgery (mean age 70.3 ± 15.4 years, male 54.5%). The in-hospital mortality was 8.6% (169/1963), 23.8% (129/541), 15.3% (52/340), 28.8% (17/59), and 32.3% (32/99) for CKD(-)AKI(-), CKD(-)AKI(+), CKD(+)AKI(-), CKD(+)AKI(+), and ESRD, respectively. Other outcomes such as blood transfusion and post-operative renal replacement therapy showed similar trends. Compared to the CKD(-)AKI(-) group, the adjusted odds ratio (95% confidence interval) for in-hospital mortality was 2.54 (1.90-3.40), 1.29 (0.90-1.85), 2.86 (1.54-5.32), and 2.76 (1.55-4.93) for CKD(-)AKI(+), CKD(+)AKI(-), CKD(+)AKI(+), and ESRD groups, respectively. Stratified by baseline eGFR (> 90, 60-89, 30-59, and < 30 mL/min/1.73 m2) and AKI status, the crude in-hospital mortality and adjusted odds ratio increased in patients with baseline eGFR < 30 mL/min/1.73 m2 among patients without AKI, while these were constantly high regardless of baseline eGFR among patients with AKI. Additional analysis restricting to 2162 patients receiving the surgery on the day of hospital admission showed similar results. CONCLUSIONS The differentiation of pre-operative CKD and AKI, especially the identification of AKI, is useful for risk stratification in patients undergoing emergency colorectal surgery.
Collapse
Affiliation(s)
- Katsunori Miyake
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
- Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masao Iwagami
- Department of Health Services Research, University of Tsukuba, Ibaraki, Japan.
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Takayasu Ohtake
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hidekazu Moriya
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Nao Kume
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Takaaki Murata
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Tomoki Nishida
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yasuhiro Mochida
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Naoko Isogai
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kunihiro Ishioka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Rai Shimoyama
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hiroyuki Kashiwagi
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Jun Kawachi
- Department of Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | | | - Shuzo Kobayashi
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| |
Collapse
|
22
|
Ikee R, Oka M, Maesato K, Mano T, Moriya H, Ohtake T, Kobayashi S. Eosinophilic Peritonitis and Ultrafiltration Failure on Initiation of CAPD. Perit Dial Int 2020. [DOI: 10.1177/089686080802800218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- R. Ikee
- Department of Nephrology and Kidney & Dialysis Center Shonan Kamakura General Hospital Kamakura, Kanagawa, Japan
| | - M. Oka
- Department of Nephrology and Kidney & Dialysis Center Shonan Kamakura General Hospital Kamakura, Kanagawa, Japan
| | - K. Maesato
- Department of Nephrology and Kidney & Dialysis Center Shonan Kamakura General Hospital Kamakura, Kanagawa, Japan
| | - T. Mano
- Department of Nephrology and Kidney & Dialysis Center Shonan Kamakura General Hospital Kamakura, Kanagawa, Japan
| | - H. Moriya
- Department of Nephrology and Kidney & Dialysis Center Shonan Kamakura General Hospital Kamakura, Kanagawa, Japan
| | - T. Ohtake
- Department of Nephrology and Kidney & Dialysis Center Shonan Kamakura General Hospital Kamakura, Kanagawa, Japan
| | - S. Kobayashi
- Department of Nephrology and Kidney & Dialysis Center Shonan Kamakura General Hospital Kamakura, Kanagawa, Japan
| |
Collapse
|
23
|
Matsui K, Mochida Y, Ishioka K, Moriya H, Hidaka S, Ohtake T, Kobayashi S. A case of enteric peritonitis in a patient with stage 5 kidney disease due to cholesterol crystal embolization. ARCH ESP UROL 2020; 40:220-221. [PMID: 32063204 DOI: 10.1177/0896860819887293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | | | | | | | - Shuzo Kobayashi
- Kidney Disease and Transplantation Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| |
Collapse
|
24
|
Matsuura R, Hidaka S, Ohtake T, Mochida Y, Ishioka K, Maesato K, Oka M, Moriya H, Kobayashi S. Intradialytic hypotension is an important risk factor for critical limb ischemia in patients on hemodialysis. BMC Nephrol 2019; 20:473. [PMID: 31856757 PMCID: PMC6923908 DOI: 10.1186/s12882-019-1662-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 12/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Critical limb ischemia (CLI) and intradialytic hypotension (IDH) are common complications in patients on hemodialysis (HD). However, limited data are available on whether IDH is related to CLI in these patients. The aim of this retrospective study was to evaluate whether IDH is a risk factor for CLI in HD patients. METHODS We examined the frequency of IDH in 147 patients who received HD between January 1 and June 30, 2012. Blood pressure was measured during HD every 30 min and IDH was defined as a ≥ 20 mmHg fall in systolic blood pressure compared to 30 min before and a nadir intradialytic systolic blood pressure < 90 mmHg. The primary study outcome was newly developed CLI requiring revascularization treatment or CLI-related death. We assessed the association of IDH with outcome using a multivariable subdistribution hazard model with adjustment for male, age, smoking and history of cardiovascular disease. RESULTS The median follow-up period was 24.5 months. Fifty patients (34%) had episodes of IDH in the study entry period. During follow-up, 14 patients received endovascular treatment and CLI-related death occurred in 1 patient. Factors associated with incident CLI in univariate analysis were age, smoking, diabetes mellitus, peripheral arterial disease, history of cardiovascular disease, and IDH. IDH was significantly associated with the outcome with the subdistribution hazard ratio of 3.13 [95% confidence interval, 1.05-9.37]. CONCLUSIONS IDH was an independent risk factor for incident CLI in patients on HD.
Collapse
Affiliation(s)
- Ryo Matsuura
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, 247-8533, Japan.,Department of Nephrology and Endocrinology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, 247-8533, Japan.
| | - Takayasu Ohtake
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, 247-8533, Japan
| | - Yasuhiro Mochida
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, 247-8533, Japan
| | - Kunihiro Ishioka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, 247-8533, Japan
| | - Kyoko Maesato
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, 247-8533, Japan
| | - Machiko Oka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, 247-8533, Japan
| | - Hidekazu Moriya
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, 247-8533, Japan
| | - Shuzo Kobayashi
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, 247-8533, Japan
| |
Collapse
|
25
|
Iwagami M, Moriya H, Doi K, Yasunaga H, Isshiki R, Sato I, Mochida Y, Ishioka K, Ohtake T, Hidaka S, Noiri E, Kobayashi S. Seasonality of acute kidney injury incidence and mortality among hospitalized patients. Nephrol Dial Transplant 2019; 33:1354-1362. [PMID: 29462342 DOI: 10.1093/ndt/gfy011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/06/2018] [Indexed: 01/08/2023] Open
Abstract
Background Understanding disease seasonality is important for improving clinical practice, hospital resource utilization and community-based preventive care. However, no studies have investigated the seasonality of acute kidney injury (AKI). Methods In the Tokushukai Medical Database, which includes 38 Japanese community hospitals, we identified hospitalized patients with AKI based on the Kidney Disease: Improving Global Outcomes serum creatinine criteria from January 2012 to December 2014. We plotted the number and proportion of patients with AKI among hospitalized patients by month of hospital admission. Subgroup analyses were conducted by the admission diagnosis category, timing of AKI diagnosis and age. We also examined the association between month of hospital admission and AKI, adjusting for patient characteristics and AKI risk factors. Finally, we assessed seasonal variations in disease severity and 30-day mortality of patients with AKI. Results We identified 81 279 (14.6%) patients with AKI among 555 940 hospitalized patients. The proportion of patients with AKI was highest in January (16.7%) and lowest in June (13.4%). Subgroup analyses suggested that the seasonality of AKI incidence was driven by community-acquired AKI associated with the admission diagnosis of cardiovascular and pulmonary diseases among older patients. The adjusted odds ratio for AKI (January versus June) was 1.24 (95% confidence interval, 1.17-1.31). Patients with AKI showed a larger number of failing organs in winter, and their 30-day mortality was 16.4% in spring, 14.5% in summer, 15.6% in autumn and 18.4% in winter. Conclusion AKI is more common among hospitalized patients and patients with AKI are more severely ill in winter.
Collapse
Affiliation(s)
- Masao Iwagami
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidekazu Moriya
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, University of Tokyo Hospital, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Rei Isshiki
- Department of Nephrology and Endocrinology, University of Tokyo Hospital, Tokyo, Japan
| | - Izumi Sato
- Center for Pharmacoepidemiology and Treatment Science, Rutgers, The State University of New Jersey, NJ, USA.,Department of Pharmacoepidemiology, Kyoto University, Kyoto, Japan
| | - Yasuhiro Mochida
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kunihiro Ishioka
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Takayasu Ohtake
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Sumi Hidaka
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Eisei Noiri
- Department of Nephrology and Endocrinology, University of Tokyo Hospital, Tokyo, Japan
| | - Shuzo Kobayashi
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| |
Collapse
|
26
|
Matsui K, Mochida Y, Ishioka K, Moriya H, Hidaka S, Ohtake T, Kobayashi S. SP633POOR OUTCOME ASSOCIATED WITH HIGH RATES OF TEMPORARY CATHETER USE IN VERY ELDERLY INCIDENT HEMODIALYSIS PATIENTS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kenji Matsui
- Shonan Kamakura General Hospital, Kamakura, Japan
| | | | | | | | - Sumi Hidaka
- Shonan Kamakura General Hospital, Kamakura, Japan
| | | | | |
Collapse
|
27
|
Hidaka S, Ohtake T, Oka M, Ozawa K, Tamura T, Shibata K, Nishihara M, Kuji T, Oshikawa J, Satta H, Imoto K, Kunieda T, Kobayashi S. FP742MILD COGNITIVE IMPAIRMENT IS ASSOCIATED WITH SARCOPENIA IN HEMODIALYSIS PATIENTS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sumi Hidaka
- Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Machiko Oka
- Shonan Fujisawa Tokushukai Hospital, Fujisawa, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Oki R, Hidaka S, Moriya H, Miyake K, Oda Y, Matsui K, Taguchi S, Mochida Y, Ishioka K, Ohtake T, Kobayashi S. Remarkable Improvement of Cardiac Function After Pre-emptive Kidney Transplant in a Patient With Severe Mitral Regurgitation Accompanied by Low Cardiac Function: A Case Report. Transplant Proc 2019; 51:548-550. [PMID: 30879587 DOI: 10.1016/j.transproceed.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/09/2018] [Indexed: 10/27/2022]
Abstract
Patients with end-stage renal disease are at a high risk for cardiovascular diseases. It is controversial whether end-stage renal disease patients with low cardiac function can safely accept kidney transplant. Here, we present a 42-year-old kidney transplant recipient with severe mitral regurgitation accompanied by low cardiac function. He wanted to undergo a pre-emptive kidney transplant from his uncle. We decided to perform living kidney transplant prior to cardiac surgery. Despite adequate ultrafiltration and hemodiafiltration before operation, the patient's ejection fraction still remained 35% 1 day before transplant. He showed complete recovery of cardiac function in only 2 days after pre-emptive kidney transplant, although his body weight did not change before and after the operation. Early removal of the uremic toxin or inflammatory cytokines may play a role in rapid improvement of the cardiac function. Increase of vasoactive substances by improvement of kidney function may lead to reduction of afterload and amelioration of cardiac microcirculation. This report also suggests that optimal timing for operation might be important.
Collapse
Affiliation(s)
- R Oki
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan.
| | - S Hidaka
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - H Moriya
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - K Miyake
- Department of Kidney transplant surgery, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Y Oda
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - K Matsui
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - S Taguchi
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Y Mochida
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - K Ishioka
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - T Ohtake
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - S Kobayashi
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| |
Collapse
|
29
|
Sato S, Teshima S, Nakamura N, Ohtake T, Kikuchi J, Kishi H, Nomura K, Kurose N, Masaki Y, Tamaru JI. Intravascular large B-cell lymphoma involving large blood vessels, three autopsy cases. Pathol Int 2019; 69:97-103. [DOI: 10.1111/pin.12751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/05/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Shuku Sato
- Department of Hematology; Shonan Kamakura General Hospital; Kamakura Japan
- Department of Pathology; Tokai University; School of Medicine; Isehara Japan
| | - Shinichi Teshima
- Department of Pathology; Shonan Kamakura General Hospital; Kamakura Japan
| | - Naoya Nakamura
- Department of Pathology; Tokai University; School of Medicine; Isehara Japan
| | - Takayasu Ohtake
- Department of Nephrology, Immunology, and Vascular Medicine; Shonan Kamakura General Hospital; Kamakura Japan
| | - Jun Kikuchi
- Department of Pathology; Saitama Medical Center; Saitama Medical University; Saitama Japan
| | - Hirohisa Kishi
- Department of Pathology; Saitama Medical Center; Saitama Medical University; Saitama Japan
- Department of Pathology; Doai Memorial Hospital; Tokyo Japan
| | - Kyoichi Nomura
- Department of Neurology; Saitama Medical Center; Saitama Medical University; Saitama Japan
| | - Nozomu Kurose
- Department of Pathology; Kanazawa Medical University; Kanazawa Japan
| | - Yasufumi Masaki
- Department of Hematology and Immunology; Kanazawa Medical University; Kanazawa Japan
| | - Jun-ichi Tamaru
- Department of Pathology; Saitama Medical Center; Saitama Medical University; Saitama Japan
| |
Collapse
|
30
|
Shoji T, Inaba M, Fukagawa M, Ando R, Emoto M, Fujii H, Fujimori A, Fukui M, Hase H, Hashimoto T, Hirakata H, Honda H, Hosoya T, Ikari Y, Inaguma D, Inoue T, Isaka Y, Iseki K, Ishimura E, Itami N, Ito C, Kakuta T, Kawai T, Kawanishi H, Kobayashi S, Kumagai J, Maekawa K, Masakane I, Minakuchi J, Mitsuiki K, Mizuguchi T, Morimoto S, Murohara T, Nakatani T, Negi S, Nishi S, Nishikawa M, Ogawa T, Ohta K, Ohtake T, Okamura M, Okuno S, Shigematsu T, Sugimoto T, Suzuki M, Tahara H, Takemoto Y, Tanaka K, Tominaga Y, Tsubakihara Y, Tsujimoto Y, Tsuruya K, Ueda S, Watanabe Y, Yamagata K, Yamakawa T, Yano S, Yokoyama K, Yorioka N, Yoshiyama M, Nishizawa Y. Effect of Oral Alfacalcidol on Clinical Outcomes in Patients Without Secondary Hyperparathyroidism Receiving Maintenance Hemodialysis: The J-DAVID Randomized Clinical Trial. JAMA 2018; 320:2325-2334. [PMID: 30535217 PMCID: PMC6583075 DOI: 10.1001/jama.2018.17749] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Patients with chronic kidney disease have impaired vitamin D activation and elevated cardiovascular risk. Observational studies in patients treated with hemodialysis showed that the use of active vitamin D sterols was associated with lower risk of all-cause mortality, regardless of parathyroid hormone levels. OBJECTIVE To determine whether vitamin D receptor activators reduce cardiovascular events and mortality in patients without secondary hyperparathyroidism undergoing hemodialysis. DESIGN, SETTING, AND PARTICIPANTS Randomized, open-label, blinded end point multicenter study of 1289 patients in 207 dialysis centers in Japan. The study included 976 patients receiving maintenance hemodialysis with serum intact parathyroid hormone levels less than or equal to 180 pg/mL. The first and last participants were enrolled on August 18, 2008, and January 26, 2011, respectively. The final date of follow-up was April 4, 2015. INTERVENTIONS Treatment with 0.5 μg of oral alfacalcidol per day (intervention group; n = 495) vs treatment without vitamin D receptor activators (control group; n = 481). MAIN OUTCOMES AND MEASURES The primary outcome was a composite measure of fatal and nonfatal cardiovascular events, including myocardial infarctions, hospitalizations for congestive heart failure, stroke, aortic dissection/rupture, amputation of lower limb due to ischemia, and cardiac sudden death; coronary revascularization; and leg artery revascularization during 48 months of follow-up. The secondary outcome was all-cause death. RESULTS Among 976 patients who were randomized from 108 dialysis centers, 964 patients were included in the intention-to-treat analysis (median age, 65 years; 386 women [40.0%]), and 944 (97.9%) completed the trial. During follow-up (median, 4.0 years), the primary composite outcome of cardiovascular events occurred in 103 of 488 patients (21.1%) in the intervention group and 85 of 476 patients (17.9%) in the control group (absolute difference, 3.25% [95% CI, -1.75% to 8.24%]; hazard ratio, 1.25 [95% CI, 0.94-1.67]; P = .13). There was no significant difference in the secondary outcome of all-cause mortality between the groups (18.2% vs 16.8%, respectively; hazard ratio, 1.12 [95% CI, 0.83-1.52]; P = .46). Of the 488 participants in the intervention group, 199 (40.8%) experienced serious adverse events that were classified as cardiovascular, 64 (13.1%) experienced adverse events classified as infection, and 22 (4.5%) experienced malignancy-related serious adverse events. Of 476 participants in the control group, 191 (40.1%) experienced cardiovascular-related serious adverse events, 63 (13.2%) experienced infection-related serious adverse events, and 21 (4.4%) experienced malignancy-related adverse events. CONCLUSIONS AND RELEVANCE Among patients without secondary hyperparathyroidism undergoing maintenance hemodialysis, oral alfacalcidol compared with usual care did not reduce the risk of a composite measure of select cardiovascular events. These findings do not support the use of vitamin D receptor activators for patients such as these. TRIAL REGISTRATION UMIN-CTR Identifier: UMIN000001194.
Collapse
Affiliation(s)
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan
- Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine, Japan
| | - Masaaki Inaba
- Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine, Japan
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine, Kanagawa, Japan
| | - Ryoichi Ando
- Department of Nephrology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Masanori Emoto
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Japan
| | - Hisako Fujii
- Department of Drug and Food Evaluation, Osaka City University Graduate School of Medicine, Japan
| | - Akira Fujimori
- Blood Purification and Kidney Center, Konan Hospital, Hyogo, Japan
| | - Mitsuru Fukui
- Laboratory of Statistics, Osaka City University Graduate School of Medicine, Japan
| | - Hiroki Hase
- Department of Nephrology, Toho University School of Medicine, Tokyo, Japan
| | | | - Hideki Hirakata
- Division of Nephrology, Fukuoka Renal Clinic, Fukuoka, Japan
| | - Hirokazu Honda
- Division of Nephrology, Department of Medicine, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Tatsuo Hosoya
- Department of Pathophysiology and Therapy in Chronic Kidney Disease, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Daijo Inaguma
- Department of Nephrology, Fujita Health University School of Medicine, Aichi, Japan
| | | | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Japan
| | - Kunitoshi Iseki
- Clinical Research Support Center, Tomishiro Central Hospital, Japan
| | - Eiji Ishimura
- Department of Nephrology, Osaka City University Graduate School of Medicine, Japan
| | - Noritomo Itami
- Department of Nephrology, Itami Kidney Clinic, Hokkaido, Japan
| | - Chiharu Ito
- Department of Internal Medicine, Haga Red Cross Hospital, Tochigi, Japan
| | - Toshitaka Kakuta
- Division of Nephrology, Endocrinology, and Metabolism, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Toru Kawai
- Medical Corporation Chuou Naika Clinic, Hiroshima, Japan
| | - Hideki Kawanishi
- Department of Artificial Organs, Tsuchiya General Hospital, Hiroshima, Japan
| | - Shuzo Kobayashi
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Junko Kumagai
- Akane Foundation Omachi Tsuchiya Clinic, Hiroshima, Japan
| | | | | | - Jun Minakuchi
- Department of Kidney Disease, Kawashima Hospital, Tokushima, Japan
| | - Koji Mitsuiki
- Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Japan
| | - Takashi Mizuguchi
- Department of Hematology, Dialysis, and Diabetes Mellitus, Kochi-Takasu Hospital, Kochi, Japan
| | - Satoshi Morimoto
- Department of Medicine, Endocrinology, and Hypertension, Tokyo Women's Medical University, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Tatsuya Nakatani
- Department of Urology, Osaka City University Graduate School of Medicine, Japan
| | - Shigeo Negi
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Shinichi Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Hyogo, Japan
| | | | - Tetsuya Ogawa
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Kazumichi Ohta
- Department of Urology, Kochi Takasu Hospital, Kochi, Japan
| | - Takayasu Ohtake
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Mikio Okamura
- Department of Internal Medicine, Kayashima Ikuno Hospital, Osaka, Japan
| | - Senji Okuno
- Department of Internal Medicine, Kidney Center, Shirasagi Hospital, Osaka, Japan
| | | | - Toshitsugu Sugimoto
- Department of Internal Medicine, Shimane University Faculty of Medicine, Shimane, Japan
| | - Masashi Suzuki
- Department of Nephrology, Shinraku-En Hospital, Niigata, Japan
| | | | - Yoshiaki Takemoto
- Department of Urology, Osaka City University Graduate School of Medicine, Japan
| | - Kenji Tanaka
- Department of Internal Medicine, Suiyukai Clinic, Nara, Japan
| | - Yoshihiro Tominaga
- Department of Transplant and Endocrine Surgery, Nagoya 2nd Red Cross Hospital Japan
| | - Yoshiharu Tsubakihara
- Department of Safety Management in Health Care Sciences, Graduate School of Health Care Sciences, Jikei Institute, Osaka, Japan
| | | | | | - Shinichiro Ueda
- Department of Clinical Pharmacology and Therapeutics, University of the Ryukyus Graduate School of Medicine, Okinawa, Japan
| | | | - Kunihiro Yamagata
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | | | - Shozo Yano
- Department of Laboratory Medicine, Shimane University Faculty of Medicine, Japan
| | - Keitaro Yokoyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Japan
| | - Yoshiki Nishizawa
- Hemodialysis Center, Inoue Hospital, Soryu Medical Corporation, Osaka, Japan
| |
Collapse
|
31
|
Tanaka Y, Masaki T, Uojima H, Ohtake T, Fujikawa T, Yamanouchi Y, Wada N, Kubota K, Hidaka H, Nakazawa T, Shibuya A, Aoyama T, Sung JH, Kako M, Kobayashi S, Takeuchi Y, Koizumi W. Glecaprevir and pibrentasvir combination therapy for hepatitis C virus-infected Japanese patients on hemodialysis. Ren Replace Ther 2018. [DOI: 10.1186/s41100-018-0193-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
32
|
Komaru Y, Ishioka K, Mochida Y, Maesato K, Moriya H, Hidaka S, Ohtake T, Kobayashi S. Renal infarction secondary to polycythaemia vera treated by percutaneous transluminal renal angioplasty. Nephrology (Carlton) 2018; 23:891-892. [PMID: 30134507 DOI: 10.1111/nep.13218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Yohei Komaru
- Department of Kidney Disease and Transplant Centre, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kunihiro Ishioka
- Department of Kidney Disease and Transplant Centre, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yasuhiro Mochida
- Department of Kidney Disease and Transplant Centre, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kyoko Maesato
- Department of Kidney Disease and Transplant Centre, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hidekazu Moriya
- Department of Kidney Disease and Transplant Centre, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Sumi Hidaka
- Department of Kidney Disease and Transplant Centre, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Takayasu Ohtake
- Department of Kidney Disease and Transplant Centre, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Shuzo Kobayashi
- Department of Kidney Disease and Transplant Centre, Shonan Kamakura General Hospital, Kanagawa, Japan
| |
Collapse
|
33
|
Ohtake T, Mochida Y, Ishioka K, Oka M, Maesato K, Moriya H, Hidaka S, Higashide S, Ioji T, Fujita Y, Kawamoto A, Fukushima M, Kobayashi S. Autologous Granulocyte Colony-Stimulating Factor-Mobilized Peripheral Blood CD34 Positive Cell Transplantation for Hemodialysis Patients with Critical Limb Ischemia: A Prospective Phase II Clinical Trial. Stem Cells Transl Med 2018; 7:774-782. [PMID: 30059194 PMCID: PMC6216433 DOI: 10.1002/sctm.18-0104] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 05/22/2018] [Accepted: 06/05/2018] [Indexed: 12/29/2022] Open
Abstract
Critical limb ischemia (CLI) is a devastating disease in patients undergoing hemodialysis (HD). Based on the unsatisfactory results of autologous mononuclear cell transplantation for patients with CLI undergoing HD, we conducted a phase II clinical trial to evaluate the safety and efficacy of granulocyte colony‐stimulating factor (G‐CSF)‐mobilized peripheral blood‐derived autologous purified CD34 positive (CD34+) cell transplantation for CLI in patients undergoing HD. Six patients with CLI (two with Rutherford category 4 and four with Rutherford category 5) were enrolled. As for primary endpoint, there were no major adverse events related to this therapy. As for efficacy, the amputation‐free survival rate was 100% at 1 year after cell therapy. Both rest pain scale and ulcer size were significantly improved as early as 4 weeks after therapy compared with baseline (p < .01), and three out of five ulcers completely healed within 12 weeks after cell transplantation. Clinical severity, including Fontaine scale and Rutherford category, significantly improved at 24 weeks after cell transplantation (p < .05), and further improved at 52 weeks (p < .01) compared with baseline. The improvement rate from CLI stage to non‐CLI stage was 83.3% at 52 weeks. Toe skin perfusion pressure and absolute claudication distance were also significantly improved. In conclusion, G‐CSF‐mobilized peripheral blood CD34+ cell transplantation was safe, feasible, and effective for patients with CLI undergoing HD. stem cells translational medicine2018;7:774–782
Collapse
Affiliation(s)
- Takayasu Ohtake
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan.,Division of Regenerative Medicine, Department of Center for Clinical and Translational Science, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yasuhiro Mochida
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kunihiro Ishioka
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Machiko Oka
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kyoko Maesato
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hidekazu Moriya
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Sumi Hidaka
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Satoshi Higashide
- Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan
| | - Tetsuya Ioji
- Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan
| | - Yasuyuki Fujita
- Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan
| | - Atsuhiko Kawamoto
- Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan
| | - Masanori Fukushima
- Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan
| | - Shuzo Kobayashi
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan.,Division of Regenerative Medicine, Department of Center for Clinical and Translational Science, Shonan Kamakura General Hospital, Kamakura, Japan
| |
Collapse
|
34
|
Ishioka K, Ohtake T, Moriya H, Mochida Y, Oka M, Maesato K, Hidaka S, Kobayashi S. High prevalence of peripheral arterial disease (PAD) in incident hemodialysis patients: screening by ankle-brachial index (ABI) and skin perfusion pressure (SPP) measurement. Ren Replace Ther 2018. [DOI: 10.1186/s41100-018-0168-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
35
|
Ohtake T, Kobayashi S, Slavin S, Mochida Y, Ishioka K, Moriya H, Hidaka S, Matsuura R, Sumida M, Katagiri D, Noiri E, Okada K, Mizuno H, Tanaka R. Human Peripheral Blood Mononuclear Cells Incubated in Vasculogenic Conditioning Medium Dramatically Improve Ischemia/Reperfusion Acute Kidney Injury in Mice. Cell Transplant 2018; 27:520-530. [PMID: 29737200 PMCID: PMC6038042 DOI: 10.1177/0963689717753186] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Acute kidney injury (AKI) is a major clinical problem that still has no established treatment. We investigated the efficacy of cultured human peripheral blood mononuclear cells (PBMNCs) for AKI. Ischemia/reperfusion injury (IRI) was used to induce AKI in male nonobese diabetic (NOD/severe combined immunodeficiency) mice aged 7 to 8 wk. PBMNCs were isolated from healthy volunteers and were subjected to quality and quantity controlled (QQc) culture for 7 d in medium containing stem cell factor, thrombopoietin, Flt-3 ligand, vascular endothelial growth factor, and interleukin 6. IRI-induced mice were divided into 3 groups and administered (1) 1 × 106 PBMNCs after QQc culture (QQc PBMNCs group), (2) 1 × 106 PBMNCs without QQc culture (non-QQc PBMNCs group), or (3) vehicle without PBMNCs (IRI control group). PBMNCs were injected via the tail vein 24 h after induction of IRI, followed by assessment of renal function, histological changes, and homing of injected cells. Blood urea nitrogen and serum creatinine (Cr) 72 h after induction of IRI in the QQc PBMNCs group dramatically improved compared with those in the IRI control and the non-QQc PBMNCs groups, accompanied by the improvement of tubular damages. Interstitial fibrosis 14 d after induction of IRI was also significantly improved in the QQc PBMNCs group compared with the other groups. The renoprotective effect noted in the QQc PBMNCs group was accompanied by reduction of peritubular capillary loss. The change of PBMNCs’ population (increase of CD34+ cells, CD133+ cells, and CD206+ cells) and increased endothelial progenitor cell colony-forming potential by QQc culture might be one of the beneficial mechanisms for restoring AKI. In conclusion, an injection of human QQc PBMNCs 24 h after induction of IRI dramatically improved AKI in mice.
Collapse
Affiliation(s)
- Takayasu Ohtake
- 1 Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan.,2 Division of Regenerative Medicine, Department of Center for Clinical and Translational Science, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Shuzo Kobayashi
- 1 Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan.,2 Division of Regenerative Medicine, Department of Center for Clinical and Translational Science, Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Yasuhiro Mochida
- 1 Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kunihiro Ishioka
- 1 Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hidekazu Moriya
- 1 Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Sumi Hidaka
- 1 Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Ryo Matsuura
- 4 Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Maki Sumida
- 4 Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Daisuke Katagiri
- 4 Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Eisei Noiri
- 4 Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Kayoko Okada
- 5 Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Ochanomizu, Japan
| | - Hiroshi Mizuno
- 5 Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Ochanomizu, Japan
| | - Rica Tanaka
- 5 Department of Plastic and Reconstructive Surgery, Juntendo University School of Medicine, Ochanomizu, Japan
| |
Collapse
|
36
|
Ohtake T, Mochida Y, Ishioka K, Moriya H, Hidaka S, Noiri E, Tanaka R, Kobayashi S. FP227HUMAN PERIPHERAL BLOOD MONONUCLEAR CELLS INCUBATED IN VASCULOGENIC CONDITIONING MEDIUM DRAMATICALLY IMPROVE ISCHEMIA/REPERFUSION ACUTE KIDNEY INJURY IN MICE. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Takayasu Ohtake
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
- Center for Clinical and Translational Science, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Yasuhiro Mochida
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kunihiro Ishioka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hidekazu Moriya
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Sumi Hidaka
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Eisei Noiri
- Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Rica Tanaka
- Plastic and reconstructive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shuzo Kobayashi
- Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kamakura, Japan
- Center for Clinical and Translational Science, Shonan Kamakura General Hospital, Kamakura, Japan
| |
Collapse
|
37
|
Mochida Y, Ohtake T, Miyashita Y, Ishioka K, Oka M, Maesato K, Moriya H, Hidaka S, Saito S, Kobayashi S. Long-term clinical outcome of patients with severe atherosclerotic renal artery stenosis after percutaneous transluminal renal angioplasty. Ren Replace Ther 2018. [DOI: 10.1186/s41100-018-0147-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
38
|
Uojima H, Kobayashi S, Hidaka H, Matsumoto S, Ohtake T, Kinbara T, Oka M, Yamanouchi Y, Kunieda T, Yamanoue H, Kanemaru T, Tsutsumi K, Fujikawa T, Sung JH, Kako M. Virological response to daclatasvir and asunaprevir combination therapy for chronic hepatitis C virus genotype 1b infection in dialysis patients: a prospective, multicenter study. Ren Replace Ther 2017. [DOI: 10.1186/s41100-016-0091-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
39
|
Nohara C, Ohtake T, Hirabayashi K, Arii K, Kobayashi M, Okamura M, Fujita S, Takubo H. Retrospective study of percutaneous endoscopic gastrostomy in neurodegenerative disease. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
40
|
Iwagami M, Moriya H, Noiri E, Doi K, Hidaka S, Ohtake T, Kobayashi S. SP187SEASONALITY OF ACUTE KIDNEY INJURY INCIDENCE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
41
|
Mochida Y, Ohtake T, Ishioka K, Oka M, Maesato K, Moriya H, Hidaka S, Kobayashi S. SP533IMPACT OF SLEEP-DISORDERED BREATHING ON CARDIOVASCULAR EVENTS AND MORTALITY IN HEMODIALYSIS PATIENTS. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx152.sp533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
42
|
Ohtake T, Mochida Y, Ishioka K, Oka M, Maesato K, Moriya H, Hidaka S, Kobayashi S. SP534EFFECT OF AUTOLOGOUS G-CSF-MOBILIZED CD34+ CELL TRANSPLANTATION IN HEMODIALYSIS PATIENTS WITH CRITICAL LIMB ISCHEMIA. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx152.sp534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
43
|
Moriya H, Mochida Y, Ishioka K, Oka M, Maesato K, Hidaka S, Ohtake T, Kobayashi S. Plasma neutrophil gelatinase-associated lipocalin (NGAL) is an indicator of interstitial damage and a predictor of kidney function worsening of chronic kidney disease in the early stage: a pilot study. Clin Exp Nephrol 2017; 21:1053-1059. [PMID: 28397074 DOI: 10.1007/s10157-017-1402-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 03/11/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND The aim of this study was to examine whether plasma neutrophil gelatinase-associated lipocalin (NGAL) levels predict the outcome of kidney function and correlate with the severity of tubulointerstitial damages in patients with chronic kidney disease (CKD). METHODS In this prospective 18-month cohort study of 112 patients with CKD between 2010 and 2011, associations between plasma NGAL levels and estimated glomerular filtration ratio (eGFR), further worsening of kidney function and histological lesion on kidney biopsy were investigated. RESULTS Serum levels of creatinine and eGFR before the study were 1.48 ± 0.65 mg/dl and 42.6 ± 22.0 ml/min/1.73 m2. Median plasma NGAL level was 148.5 (83.75-248.25) ng/ml and showed no correlation with eGFR or age. 87 out of 112 patients were able to follow up for 18 months. Patients with higher levels of NGAL (>107.8 ng/ml) showed significantly more decrease in eGFR in CKD stage 1 or 2 than those with lower levels of NGAL (≦107.8 ng/ml), while there was no difference in change in eGFR in CKD stage 3-5 between patients with higher and lower levels of NGAL. In the kidney biopsy of 27 patients out of enrolled patients, plasma NGAL levels correlated significantly with the degree of interstitial cell infiltration and fibrosis, but did not correlate with that of glomerular sclerosis. In ROC analysis, plasma NGAL levels predicted tubulointerstitial cell infiltrations more accurately [AUC = 0.8300 than eGFR (AUC = 0.716)]. CONCLUSION Plasma NGAL is a useful marker of interstitial lesions in patients with CKD and a predictor of further kidney worsening in the early CKD stage.
Collapse
Affiliation(s)
- Hidekazu Moriya
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, 247-8533, Japan. .,Department of Center of Clinical and Translational Science, Shonan Kamakura General Hospital, Kanagawa, Japan.
| | - Yasuhiro Mochida
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, 247-8533, Japan.,Department of Center of Clinical and Translational Science, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kunihiko Ishioka
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, 247-8533, Japan.,Department of Center of Clinical and Translational Science, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Machiko Oka
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, 247-8533, Japan.,Department of Center of Clinical and Translational Science, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kyoko Maesato
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, 247-8533, Japan.,Department of Center of Clinical and Translational Science, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Sumi Hidaka
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, 247-8533, Japan.,Department of Center of Clinical and Translational Science, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Takayasu Ohtake
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, 247-8533, Japan.,Department of Center of Clinical and Translational Science, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Shuzo Kobayashi
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, 247-8533, Japan.,Department of Center of Clinical and Translational Science, Shonan Kamakura General Hospital, Kanagawa, Japan
| |
Collapse
|
44
|
Ohtake T, Kobayashi S. Impact of vascular calcification on cardiovascular mortality in hemodialysis patients: clinical significance, mechanisms and possible strategies for treatment. Ren Replace Ther 2017. [DOI: 10.1186/s41100-017-0094-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
45
|
Affiliation(s)
- Peter V. Hobbs
- Atmospheric Sciences Dept., University of Washington, USA,
- On leave of absence at Scott Polar Research Institute, University of Cambridge, England
| | | | - T. Ohtake
- Geophysical Institute, University of Alaska, USA
- Presently associated with the Atmospheric Science Dept., Colorado State University, USA
| |
Collapse
|
46
|
Ohtake T, Mochida Y, Matsumi J, Tobita K, Ishioka K, Oka M, Maesato K, Moriya H, Hidaka S, Saito S, Kobayashi S. Beneficial Effect of Endovascular Therapy and Low-Density Lipoprotein Apheresis Combined Treatment in Hemodialysis Patients With Critical Limb Ischemia due to Below-Knee Arterial Lesions. Ther Apher Dial 2016; 20:661-667. [DOI: 10.1111/1744-9987.12450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/13/2016] [Accepted: 05/05/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Takayasu Ohtake
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Yasuhiro Mochida
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Junya Matsumi
- Department of Cardiology and Catheterization; Shonan Kamakura General Hospital; Kamakura Japan
| | - Kazuki Tobita
- Department of Cardiology and Catheterization; Shonan Kamakura General Hospital; Kamakura Japan
| | - Kunihiro Ishioka
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Machiko Oka
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Kyoko Maesato
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Hidekazu Moriya
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Sumi Hidaka
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Shigeru Saito
- Department of Cardiology and Catheterization; Shonan Kamakura General Hospital; Kamakura Japan
| | - Shuzo Kobayashi
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| |
Collapse
|
47
|
Arinaga Y, Sato F, Piller N, Kakamu T, Kikuchi K, Ohtake T, Sakuyama A, Yotsumoto F, Hori T, Sato N. A 10 Minute Self-Care Program May Reduce Breast Cancer-Related Lymphedema: A Six-Month Prospective Longitudinal Comparative Study. Lymphology 2016; 49:93-106. [PMID: 29906367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Patients with breast cancer-related lymphedema (BCRL) need a life-long self-care program that they can adhere to enable them to manage their lymphedema. The objective of this study was to assess the effectiveness of a holistic BCRL self-care program that patients could easily adhere to and comply with. A prospective, longitudinal, comparative study between affected arms and unaffected arms in unilateral breast cancer patients was implemented over a six-month period. Both the lymphedematous and unaffected arms of 23 patients with unilateral BCRL were followed and measured. The daily 10-minute holistic BCRL self-care program consisted of modified Japanese rajio taiso (Japanese radio calisthenics), a gentle arm exercise combined with deep breathing, skin moisturizing care using a traditional lymphatic drainage technique, and basic self-care education. Arm and edema volume, relative volume change, resistance of the skin to compression (fibrosis), lymphedema-related symptoms, skin condition, and self-care were assessed. At the end of six-months the volume of all limb segments and resistance of the tissues to compression at all measurement points of the affected arm were significantly reduced. On the unaffected side, only the volume of the forearm and the whole arm was significantly reduced and fibrosis significantly reduced only in the forearm. There was no significant difference in edema volume and relative volume change. Lymphedema-related symptoms significantly improved. Perceived adherence, effectiveness, burden, score and average time for self-care significantly increased. Our results demonstrate that this 10-minute self-care program may improve BCRL and its self-care.
Collapse
|
48
|
Hidaka S, Tamura T, Maesato K, Mochida Y, Ishioka K, Oka M, Moriya H, Ohtake T, Kobayashi S. FP670LONG-ACTING CERA INCREASES THE CIRCULATING CD34 POSITIVE CELLS MORE PROMINENT THAN SHORT-ACTING EPOETIN-BETA IN PATIENTS UNDERGOING HEMODIALYSIS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv182.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
49
|
Isshiki R, Kobayashi S, Iwagami M, Tsutumi D, Mochida Y, Ishioka K, Oka M, Maesato K, Moriya H, Ohtake T, Hidaka S. Cerebral blood flow in patients with peritoneal dialysis by an easy Z-score imaging system for brain perfusion single-photon emission tomography. Ther Apher Dial 2015; 18:291-6. [PMID: 24965295 DOI: 10.1111/1744-9987.12107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cognitive impairment has long been recognized as a complication of chronic kidney disease. However, there is little information available regarding regional cerebral blood flow (rCBF) in patients with peritoneal dialysis (PD). Therefore, we evaluated rCBF using brain single photon emission computed tomography (SPECT). We conducted a cross-sectional study in our hospital. Eighteen consecutive PD patients who could visit the hospital by themselves without any history of stroke were examined by Technetium-99 m-labeled ethylcrysteinate dimer brain SPECT. An easy Z-score imaging system (eZIS) was used to compare rCBF in PD patients with those in age-matched healthy controls. We also evaluated cognitive dysfunction with the mini-mental state examination (MMSE) questionnaire. Only one patient showed an MMSE score of 18 points, and the remaining 14 patients were considered as normal (MMSE ≥ 27), and three patients were considered to have mild cognitive impairment (24 ≤ MMSE ≤ 26). In all patients, rCBF in the posterior cingulated gyri, precunei, and parietal cortices was significantly decreased. The ratio of the reduction of rCBF in each region relative to that of rCBF across the whole brain correlated positively with the PD duration (r = 0.559; P < 0.05). The serum β2-microglobulin level was significantly higher in patients who had a higher ratio of rCBF reduction compared with those with lower ratios. In conclusion, all PD patients in the present study had decreased rCBF irrespective of MMSE scores.
Collapse
Affiliation(s)
- Rei Isshiki
- Department of Nephrology, Immunology, and Vascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Humalda JK, Assa S, Navis GJ, Franssen CFM, De Borst MH, Ogawa H, Ota Y, Watanabe T, Watanabe Y, Nishii H, Sato A, Waniewski J, Debowska M, Wojcik-Zaluska A, Ksiazek A, Zaluska W, Guastoni CM, Turri C, Toma L, Rombola G, Frattini G, Romei Longhena G, Teatini U, Siriopol DC, Stuard S, Ciolan A, Mircescu G, Raluca D, Nistor I, Covic A, De Roij Van Zuijdewijn CL, Chapdelaine I, Nube MJ, Blankestijn PJ, Bots ML, Konings SJ, Van Den Dorpel MA, Van Der Weerd NC, Ter Wee PM, Grooteman MP, Djuric PS, Jankovic A, Tosic J, Bajcetic S, Damjanovic T, Popovic J, Dimkovic N, Dimkovic N, Marinkovic J, Djuric Z, Knezevic V, Lazarevic T, Ljubenovic S, Markovic R, Rabrenovic V, Djukanovic L, Djuric PS, Popovic J, Jankovic A, Tosic J, Radovic Maslarevic V, Dimkovic N, Mathrani V, Drew P, Chess JI, Williams AI, Robertson S, Jibani M, Aithal VI, Kumwenda M, Roberts G, Mikhail AI, Grzegorzewska AE, Ostromecki G, Mostowska A, Sowi ska A, Jagodzi ski PP, Wu HY, Chen HY, Hsu SP, Pai MF, Yang JY, Peng YS, Hirose M, Hasegawa T, Kaneshima N, Sasai F, Komukai D, Takahashi K, Koiwa F, Shishido K, Yoshimura A, Selim G, Stojceva-Taneva O, Tozija L, Dzekova-Vidimliski P, Trajceska L, Petronievic Z, Gelev S, Amitov V, Sikole A, Moon SJ, Yoon SY, Shin DH, Lee JE, Kim HJ, Park HC, Hadjiyannakos D, Filiopoulos V, Loukas G, Pagonis S, Andriopoulos C, Drakou A, Vlassopoulos D, Catarino C, Cunha P, Ribeiro S, Rocha-Pereira P, Reis F, Sameiro-Faria M, Miranda V, Bronze-Rocha E, Belo L, Costa E, Santos-Silva A, De Mauri A, Brambilla M, Chiarinotti D, Lizio D, Matheoud R, Conti N, Conte MM, Carriero A, De Leo M, Karpetas AV, Sarafidis PA, Georgianos PI, Koutroumpas G, Divanis D, Vakianis P, Tzanis G, Raptopoulou K, Protogerou A, Stamatiadis D, Syrganis C, Liakopoulos V, Efstratiadis G, Lasaridis AN, Georgianos PI, Sarafidis PA, Karpetas AV, Koutroumpas G, Divanis D, Tersi M, Tzanis G, Raptopoulou K, Protogerou A, Syrganis C, Stamatiadis DN, Liakopoulos V, Efstratiadis G, Lasaridis AN, Kuczera P, Adamczak M, Wiecek A, Bove S, Giacon B, Corradini R, Prati E, Brognoli M, Tommasi A, Sereni L, Palladino G, Moriya H, Mochida Y, Ishioka K, Oka M, Maesato K, Hidaka S, Ohtake T, Kobayashi S, Moura A, Madureira J, Alija P, Fernandes JC, Oliveira JG, Lopez M, Filgueiras M, Amado L, Miranda V, Sameiro-Faria M, Vieira M, Santos-Silva A, Costa E, Lee JE, Seok JH, Choi HY, Ha SK, Park HC, Bossola M, Laudisio A, Antocicco M, Tazza L, Colloca G, Tosato M, Zuccala G, Ettema EM, Kuipers J, Assa S, Groen H, Gansevoort RT, Stade K, Bakker SJL, Gaillard CAJM, Westerhuis R, Franssen CFM, Bacchetta J, Couchoud K, Semlali S, Sellier-Leclerc AL, Bertholet-Thomas A, Cartier R, Cochat P, Ranchin B, Kim JC, Park K, Van Ende C, Wilmes D, Lecouvet FE, Labriola L, Cuvelier R, Van Ingelgem G, Jadoul M, De Mauri A, Doriana C, Brambilla M, Matheoud R, David P, Capurro F, Brustia M, Ruva CE, De Leo M, Bossola M, Giungi S, Di Stasio E, Tazza L, Lemesch S, Leber B, Horvath A, Ribitsch W, Schilcher G, Zettel G, Tawdrous M, Rosenkranz AR, Stadlbauer-Kollner V, Matsushima H, Oyama A, Bosch Benitez-Parodi E, Baamonde Laborda E, Batista Garcia F, Perez Suarez G, Anton Perez G, Garcia Canton C, Toledo Gonzalez A, Lago Alonso MM, Checa Andres MD, Cobo G, Di Gioia C, Camacho R, Garcia Lacalle C, Ortega O, Rodriguez I, Herrero J, Oliet A, Ortiz M, Mon C, Vigil A, Gallar P, Bossola M, Pellu V, Di Stasio E, Giungi S, Nebiolo PE, Sasaki K, Yamguchi S, Hesaka A, Iwahashi E, Sakai S, Fujimoto T, Minami S, Fujita Y, Yokoyama K, Shutov E, Ryabinskya G, Lashutin S, Gorelova E, Volodicheva E, Podesta MA, Cancarini G, Cucchiari D, Montanelli A, Badalamenti S, Graziani G, Bossola M, Distasio E, Tazza L, Pchelin I, Shishkin A, Fedorova Y, Kao CC, Chu TS, Tsai TJ, Wu KD, Wu MS, Kim JC, Park K, Raikou V, Kaisidis P, Tsamparlis E, Kanellopoulos P, Boletis J, Ueda A, Hirayama A, Owada S, Nagai K, Saito C, Yamagata K. DIALYSIS. PATHOPHYSIOLOGY AND CLINICAL STUDIES. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|