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Inoue M, Nakai K, Tanaka S, Mitsuiki K, Tokumoto M, Tsuruya K, Kitazono T, Nakano T. Prevalence of hyponatremia and associated factors in patients with chronic kidney disease: the Fukuoka Kidney Disease Registry (FKR) study. Clin Exp Nephrol 2023; 27:1023-1031. [PMID: 37642786 DOI: 10.1007/s10157-023-02395-1] [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] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Hyponatremia is a common and important electrolyte disorder. However, the prevalence and factors associated with hyponatremia in patients with chronic kidney disease (CKD) are unknown. METHODS We studied the factors associated with hyponatremia (< 135 mEq/L) in CKD patients registered in the Fukuoka Kidney Disease Registry (FKR) study using a logistic regression model variable selected using the variable reduction method. RESULTS We analyzed the baseline characteristics of 4367 participants with CKD (age, 64 ± 16 years; male, 56.1%). Hyponatremia was detected in 2.0% of the patients at baseline, and multivariate logistic analysis showed that the independent factors for hyponatremia were body mass index (odds ratio [OR] 0.91; 95% confidence interval [CI] 0.85-0.97), prescription of benzodiazepine (OR 2.31; 95% CI 1.39-3.86), blood hemoglobin level (OR 0.76; 95% CI 0.65-0.88), and serum C-reactive protein level (OR 1.27; 95% CI 1.04-1.54). CONCLUSION The cross-sectional analysis using baseline data from the FKR study revealed independent factors associated with hyponatremia in patients with decreased kidney function. Longitudinal analyses of the FKR cohort are needed to evaluate the effects of these factors on the prognosis of hyponatremia in patients with CKD.
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Affiliation(s)
- Megumi Inoue
- Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Kentaro Nakai
- Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Shigeru Tanaka
- Department of Medicine and Clinical Science, Graduated School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan
| | - Koji Mitsuiki
- Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Masanori Tokumoto
- Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, Kashihara, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduated School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduated School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan.
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Bussaka S, Suehiro T, Mitsuiki K, Morioka T, Shono T, Fujiki F, Nakano T. Non-convulsive status epilepticus possibly induced by a rapid correction of severe hyperkalemia: a case report and literature review. BMC Nephrol 2023; 24:93. [PMID: 37038101 PMCID: PMC10084670 DOI: 10.1186/s12882-023-03141-1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 03/24/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Patients with chronic kidney disease frequently develop neurological complications including confusion and altered consciousness. Non-convulsive status epilepticus, which is characterized by a change in behavior and/or mental process accompanied by epileptiform discharges on electroencephalogram in the absence of convulsive seizures, is one of the overlooked causes of altered consciousness. The incidence and precise pathophysiological mechanism of non-convulsive status epilepticus in patients with kidney disease, and especially in patients with electrolyte disturbances, remains unknown. We recently treated an older patient with chronic kidney disease and severe hyperkalemia in whom non-convulsive status epilepticus developed following a correction of severe hyperkalemia. CASE PRESENTATION An 82-year-old male was admitted to our hospital at midnight because of weakness of all four limbs (Day 1). He underwent urgent hemodialysis for severe hyperkalemia (9.84 mEq/L) and his serum potassium concentration decreased to 4.97 mEq/L. He regained full consciousness and his limb weakness improved on the morning of Day 2, but he became confused in the evening. Electroencephalogram revealed repeated low-voltage ictal discharges in the right occipital region and a diagnosis of non-convulsive status epilepticus was made. Following medication with fosphenytoin and phenytoin, the patient became fully alert and orientated on Day 8. CONCLUSION We speculate that a rapid correction of hyperkalemia was the possible cause of non-convulsive status epilepticus development. To our knowledge, this is the first report of non-convulsive status epilepticus from a potassium abnormality. We described a case of this condition in detail and summarized 78 previous case reports of non-convulsive status epilepticus with kidney disease or electrolyte disturbances.
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Affiliation(s)
- Saki Bussaka
- Department of Nephrology, Harasanshin Hospital, 1-8, Taihakumachi, Hakata-Ku, Fukuoka, Fukuoka, 812-0033, Japan
| | - Takaichi Suehiro
- Department of Nephrology, Harasanshin Hospital, 1-8, Taihakumachi, Hakata-Ku, Fukuoka, Fukuoka, 812-0033, Japan.
| | - Koji Mitsuiki
- Department of Nephrology, Harasanshin Hospital, 1-8, Taihakumachi, Hakata-Ku, Fukuoka, Fukuoka, 812-0033, Japan
| | - Takato Morioka
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Japan
| | - Tadahisa Shono
- Department of Neurosurgery, Harasanshin Hospital, Fukuoka, Japan
| | - Fujio Fujiki
- Department of Neurology, Harasanshin Hospital, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Yamada S, Tanaka S, Arase H, Hiyamuta H, Kitamura H, Tokumoto M, Mitsuiki K, Tsuruya K, Kitazono T, Nakano T. Association between prevalence of laxative use and history of bone fractures and cardiovascular diseases in patients with chronic kidney disease: the Fukuoka Kidney disease Registry (FKR) study. Clin Exp Nephrol 2023; 27:151-160. [PMID: 36318395 DOI: 10.1007/s10157-022-02289-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Constipation is a common complication in patients with chronic kidney disease (CKD) and is involved in the pathogenesis of dysbiosis and progression of CKD. However, little is known about its association with disorders of the bone-cardiovascular axis in patients with CKD. METHODS We performed a cross-sectional analysis of 3878 patients with CKD using the baseline dataset of the Fukuoka Kidney disease Registry study, as a multicenter, prospective cohort study of pre-dialysis CKD patients. The main exposure of interest was constipation defined as use of at least one type of laxative. The main outcomes were the histories of bone fractures and cardiovascular diseases (CVDs) as manifestations of disorders of the bone-cardiovascular axis. RESULTS The prevalences of laxative use and histories of bone fractures and CVDs increased as kidney function declined. Among the 3878 patients, 532 (13.7%) patients used laxatives, 235 (6.1%) patients had prior bone fractures, and 1001 (25.8%) patients had prior CVDs. Histories of bone fractures and CVDs were significantly more prevalent among laxative users (P < 0.05). Multivariable-adjusted logistic regression analysis revealed that patients with laxatives had a significantly higher odds ratios for histories of bone fractures and CVDs than those without laxatives [adjusted odds ratios (95% confidence intervals) 1.67 (1.20-2.31) and 1.70 (1.30-2.22), respectively, P < 0.05]. CONCLUSIONS These results suggest that constipation indicated by laxative use is associated with increased prevalences of historical bone fractures and CVDs in pre-dialysis patients with CKD.
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Affiliation(s)
- Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan
| | - Shigeru Tanaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan
| | - Hokuto Arase
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan
| | - Hiroto Hiyamuta
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan
| | - Hiromasa Kitamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan
| | - Masanori Tokumoto
- Division of Nephrology, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Koji Mitsuiki
- Division of Nephrology, Harasanshin Hospital, Fukuoka, Japan
| | | | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 8128582, Japan.
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Nitta K, Nakai S, Masakane I, Hanafusa N, Goto S, Taniguchi M, Hasegawa T, Wada A, Hamano T, Hoshino J, Joki N, Yamamoto K, Miura K, Abe M, Nakamoto H, Maeno K, Kawata T, Oyama C, Seino K, Sato T, Sato S, Ito M, Kazama J, Ueda A, Saito O, Ando T, Ogawa T, Kumagai H, Terawaki H, Ando R, Abe M, Kashiwagi T, Hamada C, Shibagaki Y, Hirawa N, Shimada H, Ishida Y, Yokoyama H, Miyazaki R, Fukasawa M, Kamijyo Y, Matsuoka T, Kato A, Mori N, Ito Y, Kasuga H, Koyabu S, Arimura T, Hashimoto T, Inaba M, Hayashi T, Yamakawa T, Nishi S, Fujimori A, Yoneda T, Negi S, Nakaoka A, Ito T, Sugiyama H, Masaki T, Nitta Y, Okada K, Yamanaka M, Kan M, Ota K, Tamura M, Mitsuiki K, Ikeda Y, Nishikido M, Miyata A, Tomo T, Fujimoto S, Nosaki T, Oshiro Y. Annual dialysis data report of the 2018 JSDT Renal Data Registry: dementia, performance status, and exercise habits. Ren Replace Ther 2021. [DOI: 10.1186/s41100-021-00357-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
AbstractAccording to the annual survey of the Japanese Society for Dialysis Therapy Renal Data Registry (JRDR) conducted at the end of 2018, there were a total of 339,841 patients receiving dialysis (hereinafter, dialysis patients) in Japan. The survey included questions regarding the presence/absence of dementia, the performance status (PS), and the exercise habits of individual patients. The survey revealed that 10.8% of all dialysis patients had dementia (1.8% in the age group of less than 65 years, 6.8% in the age group of 65–74 years, and 22.7% in the age group of 75 years or older). These prevalences of dementia were approximately equal to those estimated from the survey conducted in 2010. Regarding PS, the percentage of patients with lower activity levels tended to be relatively high among patients who were less than 15 years old and those who were 60 years old or older. Concerning the exercise habits of dialysis patients, the percentage of patients who were classified as “not at all or hardly” in response to the question about exercise habit was the highest (60–80%) of all the exercise habit classifications in each of the age groups analyzed.
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Kuroki Y, Hori K, Tsuruya K, Matsuo D, Mitsuiki K, Hirakata H, Nakano T, Kitazono T. Association of blood pressure after peritoneal dialysis initiation with the decline rate of residual kidney function in newly-initiated peritoneal dialysis patients. PLoS One 2021; 16:e0254169. [PMID: 34237104 PMCID: PMC8266121 DOI: 10.1371/journal.pone.0254169] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background Lower blood pressure (BP) levels are linked to a slower decline of kidney function in patients with chronic kidney disease (CKD) without kidney replacement therapy. However, there are limited data on this relation in peritoneal dialysis (PD) patients. Here we evaluated the association of BP levels with the decline of residual kidney function (RKF) in a retrospective cohort study. Methods We enrolled 228 patients whose PD was initiated between 1998 and 2014. RKF was measured as the average of creatinine and urea clearance in 24-hr urine collections. We calculated the annual decline rate of RKF by determining the regression line for individual patients. RKF is thought to decline exponentially, and thus we also calculated the annual decline rate of logarithmic scale of RKF (log RKF). We categorized the patients’ BP levels at 3 months after PD initiation (BP3M) into four groups (Optimal, Normal & High normal, Grade 1 hypertension, Grade 2 & 3 hypertension) according to the 2018 European Society of Cardiology and European Society of Hypertension Guidelines for the management of arterial hypertension. Results The unadjusted, age- and sex-adjusted, and multivariable-adjusted decline rate of RKF and log RKF decreased significantly with higher BP3M levels (P for trend <0.01). Compared to those of the Optimal group, the multivariable-adjusted odds ratios (95% confidence interval) for the faster side of the median decline rate of RKF and log RKF were 4.04 (1.24–13.2) and 5.50 (1.58–19.2) in the Grade 2 and 3 hypertension group, respectively (p<0.05). Conclusions Higher BP levels after PD initiation are associated with a faster decline in RKF among PD patients.
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Affiliation(s)
- Yusuke Kuroki
- Nephrology & Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
- * E-mail:
| | - Kei Hori
- Division of Nephrology, Munakata Medical Association Hospital, Fukuoka, Japan
| | | | - Dai Matsuo
- Division of Nephrology, Munakata Medical Association Hospital, Fukuoka, Japan
| | - Koji Mitsuiki
- Nephrology & Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Hideki Hirakata
- Nephrology & Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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6
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Nakai K, Yamamoto S, Inoue M, Kohara C, Shukuri T, Motoyama K, Mitsuiki K. Pretransplant dialysis treatment and vascular calcification of the iliac artery and abdominal aorta in kidney transplant patients. Ren Replace Ther 2021. [DOI: 10.1186/s41100-021-00349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
Introduction
Patients with chronic kidney disease often suffer from cardiovascular disease, and vascular calcification has been identified as one of the risk factors for cardiovascular disease. We aimed to examine the effect of dialysis treatment before kidney transplantation on graft survival, vascular calcification, and its progression after kidney transplantation.
Methods
Among the 102 patients who underwent kidney transplant between 2008 and 2017, two patients were excluded for moved and lost to follow-up and primary nonfunction. The clinical characteristics and laboratory data were assessed according to pretransplant treatment modality. Rapid progression of vascular calcification was defined when patients showed an increase in the highest tertile of progression of each iliac artery calcification thickness (IACT) and aortic calcification index (ACI).
Results
Cox proportional hazard models did not show any significant association between pretransplant treatment modality and graft survival to the doubling of creatinine from nadir creatinine during the first 3 months after kidney transplantation. At baseline, the IACT was significantly higher in hemodialysis patients than in preemptive kidney transplant patients, whereas the ACI was comparable among the pretransplant treatment modality groups. IACT was independently associated with dialysis vintage. There was no significant association between rapid progression of vascular calcification (IACT and ACI) and dialysis modality.
Conclusions
Dialysis modality was an independent factor related to IACT, whereas there was no legacy effect for the progression of vascular calcification after kidney transplantation.
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Katafuchi R, Nagae H, Masutani K, Nakano T, Munakata M, Tsuruya K, Mitsuiki K. Clinicopathological significance of light chain deposition in IgA nephropathy. Clin Exp Nephrol 2021; 25:621-632. [PMID: 33646451 DOI: 10.1007/s10157-021-02026-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 01/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Clinicopathological significance of light chain deposition in IgA nephropathy and the relation of monotypic IgA deposition to bone marrow abnormalities are important issues to be clarified. METHODS We retrospectively investigated light chain deposition in 526 patients with IgA nephropathy. We divided the patients into 5 groups according to the balance of intensity of both light chain deposition: lambda monotypic, lambda dominant, polytypic, kappa dominant and kappa monotypic. Clinicopathological parameters were compared among the groups. The relation of monotypic IgA deposition to hematological malignancy was also evaluated. RESULTS The prevalence of monotypic IgA deposition was 6.3%, 33 patients (21 lambda and 12 kappa). Thirty-two (4.0%) and 10 patients (1.9%) were classified into lambda and kappa dominant groups, respectively. Polytypic IgA deposition was observed in 455 patients (85.7%). Age of onset, age at biopsy, urinary protein creatinine ratio, the percentage of global glomerulosclerosis, and the degree of IgA and C3 deposition were different among the groups. However, there was no gradual difference according to the groups. No patient with monotypic IgA deposition showed hematological abnormality at biopsy and during follow-up. CONCLUSIONS The prevalence of IgA monotypic deposition was extremely low. Clinicopathologically, we could not differentiate patients with monotypic IgA deposition from those with polytypic one and no hematological disorder was documented in patients with monotypic IgA deposition. Whether IgA nephropathy with monotypic IgA deposition and that with polytypic one is the same entity or not, and relation between monotypic IgA deposition and hematological malignancy should be clarified by further investigations.
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Affiliation(s)
- Ritsuko Katafuchi
- Kidney Unit, National Hospital Organization, Fukuoka-Higashi Medical Center, Fukuoka, Japan. .,Division of Nephrology, Medical Corporation Houshikai, Kano Hospital, 1-2-1, Chuoekimae, Shingu-machi, Kasuya-gun, Fukuoka, 811-0120, Japan.
| | - Hiroshi Nagae
- Kidney Unit, National Hospital Organization, Fukuoka-Higashi Medical Center, Fukuoka, Japan
| | - Kosuke Masutani
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mikio Munakata
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Kidney Unit, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | | | - Koji Mitsuiki
- Kidney Unit, Fukuoka Red Cross Hospital, Fukuoka, Japan
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Tsuchimoto A, Matsukuma Y, Ueki K, Tanaka S, Masutani K, Nakagawa K, Mitsuiki K, Uesugi N, Katafuchi R, Tsuruya K, Nakano T, Kitazono T. Utility of Columbia classification in focal segmental glomerulosclerosis: renal prognosis and treatment response among the pathological variants. Nephrol Dial Transplant 2020; 35:1219-1227. [PMID: 30649467 DOI: 10.1093/ndt/gfy374] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 04/03/2018] [Accepted: 11/07/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The utility of the Columbia classification (Col-class) for focal segmental glomerulosclerosis (FSGS) has not yet been fully proven. METHODS We extracted 201 FSGS patients from 10 nephrology centers in Japan and investigated the difference of a composite renal endpoint, defined as doubling of serum creatinine and/or development of end-stage renal disease, in pathological variants. Sensitivity analysis was used to prove the utility of the Col-class to predict renal outcomes. Additionally, the renal protective effects of steroids and/or immunosuppression (steroid/IS) were investigated in patients stratified according to the Col-class. RESULTS The patients were classified into the following variants: not otherwise specified [NOS; n = 121 (60.1%)], perihilar [n = 31 (15.4%)], cellular [n = 19 (9.5%)], tip [n = 17 (8.5%)] and collapsing [n = 13 (6.5%)]. No tip variant patients reached the renal endpoint. The renal outcome in the collapsing variant was significantly poorer than that in the NOS [hazard ratio (HR) 3.71; P = 0.005]. In the sensitivity analysis, the area under the receiver operating characteristic curve for the renal endpoint was increased by adding Col-class to a model including common risk factors (P = 0.021). In a subgroup treated without steroid/IS, the outcome in the cellular variant was worse than that in the NOS (HR 5.10; P = 0.040) but the difference was not observed in the subgroup with steroid/IS (HR 0.54; P = 0.539). CONCLUSIONS The Col-class is useful to predict renal prognosis in Japanese patients with FSGS. In addition to good prognosis in the tip variant and poor in the collapsing variant, good clinical course in the cellular variant treated with steroid/IS was suggested.
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Affiliation(s)
- Akihiro Tsuchimoto
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuta Matsukuma
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenji Ueki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigeru Tanaka
- Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Kosuke Masutani
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | | | - Koji Mitsuiki
- Kidney Unit, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Noriko Uesugi
- Department of Pathology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ritsuko Katafuchi
- Kidney Unit, National Fukuoka Higashi Medical Center, Fukuoka, Japan
| | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Inoue M, Nakai K, Mitsuiki K. Triamterene in lithium-induced nephrogenic diabetes insipidus: a case report. CEN Case Rep 2020; 10:64-68. [PMID: 32772236 DOI: 10.1007/s13730-020-00517-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022] Open
Abstract
Lithium-induced nephrogenic diabetes insipidus (NDI) is a rare and difficult-to-treat condition. We describe the case of an 81-year-old woman with bipolar treated with lithium and no previous history of diabetes insipidus. She was hospitalized due to disturbance of consciousness and was diagnosed with, hypercalcemia, hyperparathyroidism, and NDI. Parathyroidectomy was contraindicated and parathyroid hormone level was improved insufficiently after cinacalcet initiation, percutaneous ethanol injection therapy was performed for the enlarged parathyroid gland. After improvement in hypercalcemia and unsuccessful indapamide treatment, triamterene was administrated to control polyuria. Lithium is one of the indispensable maintenance treatment options for bipolar disorder, but it has the side effect of NDI. Lithium enters the collecting duct's principal cells mainly via the epithelial sodium channel (ENaC) located on their apical membranes, ENaC shows high selectivity for both sodium and lithium, is upregulated by aldosterone, and inhibited by triamterene. To our knowledge, this is the first publication on triamterene use in lithium-induced NDI patients.
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Affiliation(s)
- Megumi Inoue
- Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, 3-1-1 Ogusu, Minami-ku, Fukuoka, 815-8555, Japan
| | - Kentaro Nakai
- Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, 3-1-1 Ogusu, Minami-ku, Fukuoka, 815-8555, Japan
| | - Koji Mitsuiki
- Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, 3-1-1 Ogusu, Minami-ku, Fukuoka, 815-8555, Japan.
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10
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Kuroki Y, Mitsuiki K, Nakagawa K, Tsuruya K, Katafuchi R, Hirakata H, Nakano T. Late renal recovery after treatment over 1 year post-onset in an atypical hemolytic uremic syndrome: a case report. BMC Nephrol 2020; 21:236. [PMID: 32571244 PMCID: PMC7310110 DOI: 10.1186/s12882-020-01897-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/17/2020] [Indexed: 11/27/2022] Open
Abstract
Background Atypical hemolytic uremic syndrome (aHUS) is a life-threatening disease that leads to end-stage kidney disease if only a poor response to plasma exchanges (PEs) or eculizumab therapy is achieved. Case presentation A 58-year-old Japanese man presented with thrombocytopenia, anemia, and kidney failure requiring dialysis without any underlying disease. A kidney biopsy revealed marked mesangiolysis in all glomeruli, compatible with thrombotic microangiopathy (TMA). Based on the positive anti- factor H antibody and negative result for secondary TMA, we diagnosed him as aHUS. Despite eculizumab administration after eight sessions of PE, neither platelet normalization nor kidney recovery was achieved. Eight months later, we discontinued eculizumab therapy due to anaphylactic reaction. At 15 months after the onset of TMA, his platelet count increased gradually from 40 to 150 × 103/μL with a decreased serum creatinine level and increased urine output, eventually allowing the withdrawal of dialysis therapy. A second kidney biopsy showed mesangial widening compatible with the healing of TMA. Conclusions This case indicates that aHUS with PEs and eculizumab therapy has the potential for renal recovery even if over 1 year has passed.
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Affiliation(s)
- Yusuke Kuroki
- Nephrology & Dialysis Center, Japanese Red Cross Fukuoka Hospital, 3-1-1, Ogusu, Minami-ku, Fukuoka, 815-8555, Japan.
| | - Koji Mitsuiki
- Nephrology & Dialysis Center, Japanese Red Cross Fukuoka Hospital, 3-1-1, Ogusu, Minami-ku, Fukuoka, 815-8555, Japan
| | - Kaneyasu Nakagawa
- Nephrology & Dialysis Center, Japanese Red Cross Fukuoka Hospital, 3-1-1, Ogusu, Minami-ku, Fukuoka, 815-8555, Japan
| | | | - Ritsuko Katafuchi
- Division of Nephrology, National Hospital Organization Fukuokahigashi Medical Center, Koga, Japan
| | - Hideki Hirakata
- Nephrology & Dialysis Center, Japanese Red Cross Fukuoka Hospital, 3-1-1, Ogusu, Minami-ku, Fukuoka, 815-8555, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Nakai K, Yamamoto S, Tomooka H, Inoue M, Kohara C, Shukuri T, Takae K, Nishiki T, Motoyama K, Mitsuiki K. P1262VASCULAR CALCIFICATION OF ABDOMINAL AORTA AND COMMON ILIAC ARTERY AFTER KIDNEY TRANSPLANTATION. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1262] [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
Vascular calcification is a risk factor for cardiovascular disease and mortality in dialysis and transplant patients. Previous studies have shown that coronary artery calcification correlates with cardiovascular mortality. However, it is not known whether vascular calcification of the abdominal aorta and common iliac artery (CIA) may impact clinical outcomes after kidney transplantation. The aim of this study was to identify the risk factors of vascular calcification after kidney transplantation.
Method
In this retrospective study, we assessed 100 patients who underwent kidney transplantation between 2008 and 2017. Of these, 62 patients received a computed tomography (CT) scan of the abdomen twice with an interval of at least 6 months. We examined the characteristics of vascular calcification of the abdominal aorta and iliac artery and divided the patients into three groups based on dialysis modality before transplantation: hemodialysis (HD group), peritoneal dialysis (PD group) and preemptive kidney transplantation (PEKT group). Then, we identified the risk factors for the progression of calcification. Abdominal aortic calcification was assessed based on the aortic calcification index (ACI), and calcification of CIA was assessed based on the maximal thickness of calcification.
Results
At baseline, abdominal aortic calcification was present in 66% of patients, and the median ACI was 10 [0-30]. Calcification of the CIA was present in 62% of patients, and maximal thickness of the CIA was 2.4 mm [0-4.6]. The mean duration of follow-up was 68 ± 29 months, and the mean interval of CT was 40 ± 29 months. After kidney transplantation, the progression rate of ACI and maximal thickness of CIA were 1.6 ± 2.5 per year and 0.17 ± 0.41 mm per year, respectively. The maximal thickness of CIA calcification was significantly higher, and ACI tended to be higher in the HD group than in the PEKT group. Age, male gender, diabetes mellitus and dialysis vintage were the independent variables related to both ACI and maximal thickness of CIA calcification. The progression rates of ACI and maximal thickness of CIA were comparable among the three groups in terms of dialysis modality. Age and rejection within the first 6 months were independent risk factors for ACI progression, and diabetes mellitus was an independent risk factor for progression of maximal thickness of CIA. No significant association was found between the progression of vascular calcification and dialysis-related parameters, including dialysis modality and vintage.
Conclusion
This study suggests that dialysis vintage was the independent variable related to calcification of the abdominal aorta and common iliac artery, whereas dialysis modality was not a significant predictor of vascular calcification and its progression in these blood vessels.
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Affiliation(s)
- Kentaro Nakai
- Japanese Red Cross Fukuoka Hospital, Division of Nephrology and Dialysis Center, Fukuoka, Japan
| | - Shutaro Yamamoto
- Japanese Red Cross Fukuoka Hospital, Division of Nephrology and Dialysis Center, Fukuoka, Japan
| | - Haruka Tomooka
- Japanese Red Cross Fukuoka Hospital, Division of Nephrology and Dialysis Center, Fukuoka, Japan
| | - Megumi Inoue
- Japanese Red Cross Fukuoka Hospital, Division of Nephrology and Dialysis Center, Fukuoka, Japan
| | - Chiaki Kohara
- Japanese Red Cross Fukuoka Hospital, Division of Nephrology and Dialysis Center, Fukuoka, Japan
| | - Tomoya Shukuri
- Japanese Red Cross Fukuoka Hospital, Division of Nephrology and Dialysis Center, Fukuoka, Japan
| | - Keita Takae
- Japanese Red Cross Fukuoka Hospital, Division of Nephrology and Dialysis Center, Fukuoka, Japan
| | - Takehiro Nishiki
- Japanese Red Cross Fukuoka Hospital, Department of Surgery, Fukuoka, Japan
| | - Kentaro Motoyama
- Japanese Red Cross Fukuoka Hospital, Department of Surgery, Fukuoka, Japan
| | - Koji Mitsuiki
- Japanese Red Cross Fukuoka Hospital, Division of Nephrology and Dialysis Center, Fukuoka, Japan
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12
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Nakagawa K, Yamada S, Matsukuma Y, Nakano T, Mitsuiki K. Survival comparison between superficialization of the brachial artery and tunneled central venous catheter placement in hemodialysis patients with heart failure: A retrospective study. Ther Apher Dial 2019; 24:408-415. [PMID: 31730268 DOI: 10.1111/1744-9987.13457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/02/2019] [Revised: 10/31/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022]
Abstract
It remains unclear which vascular access provides better survival in hemodialysis patients with heart failure, superficialization of the brachial artery (SBA), or tunneled central venous catheter (TCVC). We retrospectively followed up 60 hemodialysis patients with heart failure who underwent SBA (n = 36) or TCVC placement (n = 24). During the median 2.2-year follow-up period, 36 patients died. The median survival time was significantly longer for the SBA group than for the TCVC group (5.7 vs 1.7 years; P < .05, log-rank test). A multivariate-adjusted Cox regression analysis showed that SBA was associated with a reduced risk of all-cause death (hazard ratio [HR] 0.30; 95% confidence interval [CI] 0.14-0.65). In the cohort of propensity score-matched 15 pairs, patients with SBA experienced fewer all-cause deaths (HR 0.29; 95% CI 0.10-0.77). Our study suggests that SBA is an alternative option in hemodialysis patients with heart failure.
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Affiliation(s)
- Kaneyasu Nakagawa
- Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuta Matsukuma
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Mitsuiki
- Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
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13
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Sakoh T, Taniguchi M, Yamada S, Ohnaka S, Arase H, Tokumoto M, Yanagida T, Mitsuiki K, Hirakata H, Nakano T, Kitazono T, Tsuruya K. Short- and Long-term Effects of Dialysate Calcium Concentrations on Mineral and Bone Metabolism in Hemodialysis Patients: The K4 Study. Kidney Med 2019; 1:296-306. [PMID: 32734210 PMCID: PMC7380384 DOI: 10.1016/j.xkme.2019.08.002] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
RATIONALE & OBJECTIVE The short- and long-term impact of conversion of dialysate calcium concentration from either 2.5 or 3.0 mEq/L to 2.75 mEq/L on mineral and bone metabolism remains unknown in hemodialysis patients. STUDY DESIGN Nonrandomized intervention study. SETTING & POPULATION 12 hemodialysis patients treated at baseline with a 2.5-mEq/L dialysate calcium concentration and another 12 hemodialysis patients treated with a 3.0-mEq/L dialysate calcium concentration. INTERVENTION Use of 2.75-mEq/L dialysate calcium concentration. OUTCOMES Changes in intradialytic calcium and phosphate clearance and changes in predialysis and intradialytic serum and ionized mineral and biochemical parameters over the 24 weeks following dialysate calcium conversion. RESULTS Conversion of dialysate calcium concentration from 2.5 to 2.75 mEq/L increased intradialytic calcium loading and serum total and ionized calcium levels, whereas conversion of dialysate calcium from 3.0 to 2.75 mEq/L decreased intradialytic calcium loading and serum total and ionized calcium levels. Dialysate calcium concentration conversion did not affect intradialytic serum parathyroid hormone level, intradialytic phosphate elimination, or predialysis serum calcium, phosphate, parathyroid hormone, and fibroblast growth factor 23 levels. Intradialytic calcium influx was determined by dialysate calcium concentration and predialysis serum calcium levels, whereas intradialytic phosphate elimination was determined by predialysis serum phosphate levels. LIMITATIONS Small sample size and no control groups treated with 2.5- and 3.0-mEq/L dialysate calcium concentrations during the 24 weeks of the observation period. CONCLUSIONS Conversion of dialysate calcium concentration from either 3.0 or 2.5 to 2.75 mEq/L results in expected changes in calcium loading based on predialysis calcium concentration. The dialysate calcium concentration should be personalized based on clinical factors. FUNDING None. TRIAL REGISTRATION University Hospital Medical Information Network, www.umin.ac.jp/english/, R000040105, UMIN000035184.
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Affiliation(s)
- Teppei Sakoh
- Division of Nephrology, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | | | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shotaro Ohnaka
- Division of Nephrology, Steel Memorial Yawata Hospital, Fukuoka, Japan
| | - Hokuto Arase
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masanori Tokumoto
- Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Taihei Yanagida
- Division of Nephrology, Steel Memorial Yawata Hospital, Fukuoka, Japan
| | - Koji Mitsuiki
- Division of Nephrology, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Hideki Hirakata
- Division of Nephrology, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan.,Fukuoka Renal Clinic, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Nephrology, Nara Medical University, Nara, Japan
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14
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Uchida M, Hada M, Yamada M, Inma D, Ariyoshi S, Aoki K, Inoue S, Shimazoe T, Mitsuiki K, Haraguchi T. Impact of a systematic education model for palliative care in cancer. Pharmazie 2019; 74:499-504. [PMID: 31526444 DOI: 10.1691/ph.2019.9417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In clinical practice, pharmacists are continually required to improve their knowledge and expertise; however, the postgraduate education system for professional development cannot be confidently stated to be well established. The establishment of a systematic and multifaceted educational curriculum should be useful to improve home care and pharmacists' contribution; therefore, we developed a curriculum in collaboration with the university faculty of pharmaceutical sciences, department of pharmacy in hospital, and the Fukuoka Pharmaceutical Association. Class topics were extracted from the "Kanwa-Iryou-Yakugaku", edited by the Japanese Society for Pharmaceutical Palliative Care and Sciences. The items are necessary to perform palliative care as a pharmacist. A class schedule of 6 days (24 classes in total) was formulated. Questionnaires on comprehension degree before and after each class were provided to the participants. Comprehension was assessed on a scale of 1 to 10, where "I do not understand at all" was 1 and "I understand enough" was 10. The average recovery rates of questionnaires from each class were 92.6 % and 88.9 % before and after class, respectively. The average number of participants who completely answered the questionnaire before and after class was 45.6; therefore, these data were analyzed. Comprehension degree on each topic had significantly increased after attendance of all classes (p < 0.01). The comprehension degree of participants of the medical science of palliative care did greatly improve. Consequently, it is clear that the standard education model constructed was meaningful for the professional development of pharmacists in palliative care medicine.
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15
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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.
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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
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16
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Nakagawa K, Kuroki Y, Uchida Y, Arase H, Matsukuma Y, Izumaru K, Mitsuiki K. SP596SUPERFICIALIZATION OF BRACHIAL ARTERY IS ASSOCIATED WITH BETTER SURVIVAL COMPARED TO TUNNELED CENTRAL VENOUS CATHETER PLACEMENT IN HEMODIALYSIS PATIENTS WITH HEART FAILURE. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx153.sp596] [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
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17
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Tanaka S, Ninomiya T, Fujisaki K, Yoshida H, Nagata M, Masutani K, Tokumoto M, Mitsuiki K, Hirakata H, Fujimi S, Kiyohara Y, Kitazono T, Tsuruya K. The Fukuoka Kidney disease Registry (FKR) Study: design and methods. Clin Exp Nephrol 2016; 21:465-473. [PMID: 27339444 DOI: 10.1007/s10157-016-1294-4] [Citation(s) in RCA: 10] [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: 02/23/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is an established independent risk factor for progression to end-stage renal disease (ESRD) and incidence of cardiovascular disease (CVD). The onset and progression of CKD are associated with both genetic predisposition and various lifestyle-related factors, but little is known about the influence of genetic-environmental interactions on the incidence of ESRD or CVD in patients with CKD. METHODS The Fukuoka Kidney disease Registry (FKR) Study is designed as one of the largest prospective, multicenter, observational cohort studies in non-dialysis dependent CKD patients. The FKR Study aims to enroll approximately 5000 individuals at multiple clinical centers and follow them for up to at least 5 years. At baseline, subjects enrolled in the FKR Study will fill out extensive lifestyle-related questionnaires. Further, their health status and treatments will be monitored annually through a research network of nephrology centers. Blood and urine samples, including DNA/RNA, will be collected at the time of enrolment and every 5-years follow-up. CONCLUSIONS The FKR Study will provide many insights into the onset and progression of CKD, which will suggest hypothesis-driven interventional clinical trials aimed at reducing the burden of CKD. The features of the FKR Study may also facilitate innovative research to identify and validate novel risk factors, including genetic susceptibility and biomarkers, using biomaterials by high-throughput omics technologies.
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Affiliation(s)
- Shigeru Tanaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Toshiharu Ninomiya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Division of Research Management, Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiichiro Fujisaki
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hisako Yoshida
- Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masaharu Nagata
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kosuke Masutani
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masanori Tokumoto
- Department of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Koji Mitsuiki
- Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Hideki Hirakata
- Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | | | - Yutaka Kiyohara
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. .,Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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18
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Tsuruya K, Yoshida H, Kuroki Y, Nagata M, Mizumasa T, Mitsuiki K, Yoshiura T, Hirakawa M, Kanai H, Hori K, Hirakata H, Kitazono T. Brain Atrophy in Peritoneal Dialysis and CKD Stages 3-5: A Cross-sectional and Longitudinal Study. Am J Kidney Dis 2015; 65:312-21. [DOI: 10.1053/j.ajkd.2014.07.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 07/17/2014] [Indexed: 01/24/2023]
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19
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Mizumasa T, Hirakata H, Kuroki Y, Katafuchi R, Yotsueda H, Mitsuiki K, Nakashima Y, Tsuruya K. Diabetes influences peritoneal morphology in uremic patients at the initiation of peritoneal dialysis. Perit Dial Int 2012; 33:175-81. [PMID: 22942267 DOI: 10.3747/pdi.2011.00205] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The peritoneum begins to undergo morphologic changes before the start of peritoneal dialysis (PD), particularly in diabetic patients. The present study was conducted to investigate the effects of diabetes on the peritoneum. METHODS This study involved 17 patients who began receiving PD and had diabetes as an underlying disease (DM group), and 30 patients without diabetes who served as a control group (nonDM group). At the start of PD, the parietal peritoneum was sampled to assess submesothelial connective tissue thickness, number of capillaries and postcapillary venules, and indications of vasculopathy (grades 0 - 3). RESULTS Submesothelial connective tissue thickness was significantly greater in the DM group than in the nonDM group (p < 0.01). The number of capillaries was significantly greater in the DM group (p < 0.01). Based on multivariate linear regression analysis, diabetes was identified as a significant independent variable of both submesothelial connective tissue thickness and number of capillaries (p < 0.01). CONCLUSIONS In diabetic patients, morphologic changes of the peritoneum are marked at the start of PD.
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Affiliation(s)
- Tohru Mizumasa
- Nephrology and Dialysis Center, Fukuoka Red-Cross Hospital, Fukuoka City, Japan.
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Katafuchi R, Ninomiya T, Nagata M, Mitsuiki K, Hirakata H. Validation study of oxford classification of IgA nephropathy: the significance of extracapillary proliferation. Clin J Am Soc Nephrol 2012; 6:2806-13. [PMID: 22157710 DOI: 10.2215/cjn.02890311] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED BACKGROUND AND OBJECTIVES The Oxford classification of IgA nephropathy (IgAN) includes mesangial hypercellularity, endocapillary hypercellularity, segmental glomerulosclerosis (S), and tubular atrophy/interstitial fibrosis (T) as prognosticators. The value of extracapillary proliferation (Ex) was not addressed. Because the Oxford classification excludes patients with urinary protein <0.5 g/d and eGFR <30 ml/min per 1.73 m(2) at biopsy, the significance of Ex should be confirmed by validation cohorts that include more rapidly progressive cases. We present such a study. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The significance of pathologic features for development end-stage renal failure (ESRF) was examined by multivariate analysis in 702 patients with IgAN. The association of Ex with kidney survival was examined by univariate analysis in 416 patients who met the Oxford criteria and 286 who did not, separately. RESULTS In a multivariate model, S and T were significantly associated with ESRF. With addition of Ex, not S but Ex was significant for ESRF. In univariate analysis, kidney survival was significantly lower in patients with Ex than in those without, in patients who did not meet the Oxford criteria, but such a difference was not found in patients who met it. CONCLUSIONS The prognostic significance of Ex was evident in our cohort. It seems that Ex did not emerge from the Oxford classification as a prognosticator because of exclusion of severe cases (eGFR <30 ml/min per 1.73 m(2)). We suggest that extracapillary proliferation be included in the next version of the Oxford classification of IgAN to widen the scope of the classification.
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Affiliation(s)
- Ritsuko Katafuchi
- Kidney Unit, National Fukuoka Higashi Medical Center, 1-1-1, Chidori, Koga-City, Fukuoka, 811-3195, Japan.
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Mitsuiki K, Harada A, Okura T, Higaki J. Histologically advanced IgA nephropathy treated successfully with prednisolone and cyclophosphamide. Clin Exp Nephrol 2007. [PMID: 18085391 DOI: 10.1007/s.10157-007-0497-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND No definitive therapeutic consensus has been established for progressive immunoglobulin A nephropathy (IgAN). METHODS We retrospectively investigated 35 patients with histologically advanced IgAN. The patients were divided into two groups: 27 received prednisolone and cyclophosphamide (PSL+CPA group) and 8 received supportive treatment (control group). The initial doses of PSL and CPA were 30 mg/day and 50 mg/day, respectively. PSL was tapered to 2.5 mg/day over 2 years and CPA was discontinued at 6 months. RESULTS In the control group, mean follow-up duration was 22.9 months, renal progression rate was -20.9 x 10(-3) dl/mg per month, and all patients developed endstage renal disease within 5 years. In the PSL+CPA group, mean follow-up duration was 64.3 months, renal progression rate was -1.5 x 10(-3) dl/mg per month, and renal survival at 5 years was 89.8%. Renal prognosis was markedly improved in the PSL+CPA group compared with the control group. The patients in the PSL+CPA group were divided into two subgroups according to baseline serum creatinine (<2 mg/dl or > or =2 mg/dl); renal survival in the two subgroups was similar (84.4% versus 100% at 5 years). Adverse effects of PSL+CPA were minimal and mild. CONCLUSIONS It is possible that PSL+CPA therapy safely improved the renal prognosis of patients with severe IgAN who would otherwise have required dialysis therapy within 5 years. However, a prospective, multicenter clinical trial is required to prove the effects and safety of this treatment.
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Affiliation(s)
- Koji Mitsuiki
- The Kidney Center, Matsuyama Red Cross Hospital, Bunkyo-cho 1, Matsuyama, 790-8524, Japan.
| | - Atsumi Harada
- The Kidney Center, Matsuyama Red Cross Hospital, Bunkyo-cho 1, Matsuyama, 790-8524, Japan
| | - Takafumi Okura
- Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Jitsuo Higaki
- Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Ehime, Japan
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Suzuki T, Horita S, Kadoya K, Mitsuiki K, Aita K, Harada A, Nitta K, Nagata M. C4d Immunohistochemistry in glomerulonephritis with different antibodies. Clin Exp Nephrol 2007; 11:287-291. [PMID: 18085389 DOI: 10.1007/s10157-007-0496-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2007] [Accepted: 07/29/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND The presence of C4d in the kidney is generally detected particularly for the diagnosis of antibody-mediated rejection in renal transplants. In frozen sections of immunofluorescence (IF) staining with anti-C4d monoclonal antibodies (mAbs), we noted intrinsic C4d deposition even in normal glomeruli though their pathogenic or an intrinsic role is unkown. An anti-C4d polyclonal antibody (C4dpAb), which is suitable for paraffin immunoperoxidase (IP) staining, is less used than mAbs, and it has demonstrated that intrinsic C4d is not evident. To establish a stable and reproducible procedure for C4d detection with the C4dpAb and to determine the staining characteristics of it, the present study aimed to test whether the method was comparable with IF with a mAb. METHODS We compared the C4dpAb with the mAb in adjacent sections of human diseased kidneys, and then compared IP with IF of C4dpAb. Two ways of antigen retrieval was examined for IP. RESULTS On comparing the two antibodies for glomerular staining with IF, we found that the pattern and intensity (C4dpAb showed intrinsic C4d with IF) were similar. In addition, C4dpAb staining with IP and IF demonstrated that the intrinsic staining in the normal glomerulus was mostly undetectable by IP, whereas IF showed distinct staining. Likewise, C4d deposition with IP in some cases was apparently weaker than that on IF, suggesting that this deposition is not intrinsic but indicates pathogenic complement activation. CONCLUSIONS The advantage of the C4dpAb for immunohistochemistry is of value for reconsidering the role of C4d in glomerular diseases.
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Affiliation(s)
- Taisei Suzuki
- Molecular Pathology, Biomolecular and Integrated Medical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennohdai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shigeru Horita
- Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Koji Kadoya
- The Pathology Department, Matsuyama Red Cross Hospital, Ehime, Japan
| | - Koji Mitsuiki
- The Kidney Center, Matsuyama Red Cross Hospital, Ehime, Japan
| | - Kumi Aita
- Molecular Pathology, Biomolecular and Integrated Medical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennohdai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Atsumi Harada
- The Kidney Center, Matsuyama Red Cross Hospital, Ehime, Japan
| | - Kosaku Nitta
- Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Michio Nagata
- Molecular Pathology, Biomolecular and Integrated Medical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennohdai, Tsukuba, Ibaraki, 305-8575, Japan.
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Mitsuiki K, Harada A, Okura T, Higaki J. Histologically advanced IgA nephropathy treated successfully with prednisolone and cyclophosphamide. Clin Exp Nephrol 2007; 11:297-303. [PMID: 18085391 DOI: 10.1007/s10157-007-0497-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Accepted: 08/07/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND No definitive therapeutic consensus has been established for progressive immunoglobulin A nephropathy (IgAN). METHODS We retrospectively investigated 35 patients with histologically advanced IgAN. The patients were divided into two groups: 27 received prednisolone and cyclophosphamide (PSL+CPA group) and 8 received supportive treatment (control group). The initial doses of PSL and CPA were 30 mg/day and 50 mg/day, respectively. PSL was tapered to 2.5 mg/day over 2 years and CPA was discontinued at 6 months. RESULTS In the control group, mean follow-up duration was 22.9 months, renal progression rate was -20.9 x 10(-3) dl/mg per month, and all patients developed endstage renal disease within 5 years. In the PSL+CPA group, mean follow-up duration was 64.3 months, renal progression rate was -1.5 x 10(-3) dl/mg per month, and renal survival at 5 years was 89.8%. Renal prognosis was markedly improved in the PSL+CPA group compared with the control group. The patients in the PSL+CPA group were divided into two subgroups according to baseline serum creatinine (<2 mg/dl or > or =2 mg/dl); renal survival in the two subgroups was similar (84.4% versus 100% at 5 years). Adverse effects of PSL+CPA were minimal and mild. CONCLUSIONS It is possible that PSL+CPA therapy safely improved the renal prognosis of patients with severe IgAN who would otherwise have required dialysis therapy within 5 years. However, a prospective, multicenter clinical trial is required to prove the effects and safety of this treatment.
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Affiliation(s)
- Koji Mitsuiki
- The Kidney Center, Matsuyama Red Cross Hospital, Bunkyo-cho 1, Matsuyama, 790-8524, Japan.
| | - Atsumi Harada
- The Kidney Center, Matsuyama Red Cross Hospital, Bunkyo-cho 1, Matsuyama, 790-8524, Japan
| | - Takafumi Okura
- Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Jitsuo Higaki
- Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Ehime, Japan
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Mitsuiki K, Harada A, Miyata Y. Reticulocyte hemoglobin content in hemodialysis patients with acute infection. Clin Exp Nephrol 2004; 8:257-62. [PMID: 15480904 DOI: 10.1007/s10157-004-0295-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 11/18/2003] [Accepted: 05/21/2004] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reticulocyte hemoglobin content (CHr) has recently become available as a direct marker of the iron status in hemodialysis patients undergoing recombinant human erythropoietin (rHuEPO) therapy. This study evaluated the stability of CHr in hemodialysis patients with acute infectious disease. METHODS We retrospectively selected 22 hemodialysis patients who had acute respiratory tract infection and who showed transient elevation of C-reactive protein (CRP), and we investigated changes in parameters for erythropoiesis, iron status, and inflammation, i.e., hematocrit (Ht), transferrin saturation (TSAT), CHr, serum ferritin, and CRP, in the preinfection, infection, and postinfection phases. Throughout the observation period, doses of rHuEPO and iron supplements had not been changed. We divided the patients into two groups, those who showed a decrease in Ht in the infection phase (group 1; n = 12) and those who did not show a change in Ht in this phase (group 2; n = 10). We defined the differences between the parameters in the preinfection phase and the infection phase as Delta, and performed correlation analysis between them. RESULTS CRP in group 1 was significantly higher than that in group 2 in the infection phase. In group 1, TSAT significantly decreased, from 32.9 +/- 8.8% (preinfection phase) to 16.9 +/- 5.0% (infection phase), and CHr also significantly decreased, from 33.1 +/- 1.5 pg to 30.4 +/- 2.0 pg. In group 2, however, although TSAT significantly decreased, from 34.8 +/- 4.6% to 27.0 +/- 9.3%, CHr showed no significant change (from 33.4 +/- 0.9 pg to 33.0 +/- 1.4 pg). There was a significantly high correlation between DeltaHt and DeltaCHr, but there was a low correlation between DeltaHt and DeltaTSAT ( r = 0.505; P = 0.0153 versus r = 0.175; P = 0.4420). Furthermore, the correlation between DeltaCRP and DeltaCHr was quite high ( r = -0.722; P = 0.0001). CONCLUSIONS TSAT overreacts to inflammation, failing to reveal the correct status of available iron for erythropoiesis in acute inflammatory disease, but the use of CHr is expected to avoid these disadvantages, providing a reliable direct marker of iron status in the acute infection phase.
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Affiliation(s)
- Koji Mitsuiki
- The Kidney Center, Matsuyama Red Cross Hospital, 1 Bunkyo-cho, Matsuyama 790-8524, Japan.
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Mitsuiki K, Harada A. [Management of cardiac complications in patients with end stage renal failure]. Nihon Rinsho 2004; 62 Suppl 6:58-61. [PMID: 15250268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Kimura H, Miyoshi K, Maeda H, Ikeda H, Mitsuiki K, Harada A. [Case of cholesterol crystal embolism occurring after treatment of cerebral infarction with urokinase]. Nihon Jinzo Gakkai Shi 2004; 46:377-81. [PMID: 16773802] [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] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
A 74-year-old man with hypertension and diabetes mellitus was admitted to our hospital because of acute exacerbation of chronic renal failure after treatment with urokinase for a cerebral infarction. A percutaneous renal biopsy was performed to examine the cause of renal damage, revealing glomerulosclerosis and cholesterol clefts in the small arteries. Subsequently eosinophil was increased to 21% and livedo reticularis was found in the patient's foot. A skin biopsy was performed, and cholesterol clefts were again found in the small arteries. For the reason, our diagnosis was cholesterol crystal embolism. Although 30 mg of prednisolone was administered, the patient's renal function did not improve and maintenance hemodialysis therapy was necessary. This is a rare case of cholesterol crystal embolism caused by urokinase without any invasive vascular procedures.
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Affiliation(s)
- Hiroshi Kimura
- Kidney Center, Matsuyama Red Cross Hospital, Ehime, Japan
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Mitsuiki K, Harada A, Miyata Y. Assessment of iron deficiency in chronic hemodialysis patients: investigation of cutoff values for reticulocyte hemoglobin content. Clin Exp Nephrol 2003; 7:52-7. [PMID: 14586744 DOI: 10.1007/s101570300007] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Recently, the usefulness of reticulocyte hemoglobin content (CHr) as a ferrokinetic marker in hemodialysis patients who receive recombinant human erythropoietin (rHuEPO) has been reported. However, a definite index for iron deficiency has not been established. In this study, a CHr cutoff value was investigated. METHODS We retrospectively selected 27 hemodialysis patients by the following criteria: (1) hematocrit (Ht) values less than 30%, (2) patients receiving a stable dose of rHuEPO for at least 3 months, (3) patients who had not received iron supplements for at least 3 months, and had begun receiving iron supplements, (4) the doses of rHuEPO and iron supplements were unchanged for 8 weeks following the start of iron administration. The iron supplement was administered at a dose of 40 mg/week, and Ht, CHr, transferrin saturation (TSAT), and serum ferritin were measured. The difference between the peak Ht value obtained at weeks 4-8 and Ht at baseline was calculated (DeltaHt). Patients with a DeltaHt of 3% or more were categorized as iron-deficient at baseline (group 1; n = 17). Patients with a DeltaHt of less than 3% were categorized as iron-sufficient at baseline (group 2; n = 10). Each parameter was compared between the groups. RESULTS Significant negative correlations between DeltaHt and CHr at baseline, and DeltaHt and TSAT at baseline were observed. CHr and TSAT were significantly lower in group 1 than in group 2 at baseline. CHr was less than 32 pg in all patients in group 1, and greater than 32 pg in nine of the ten patients in group 2. If the CHr cutoff value was 32 pg, sensitivity was 100% and specificity was 90%. CONCLUSIONS It is considered that 32 pg is appropriate for the CHr cutoff value.
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Affiliation(s)
- Koji Mitsuiki
- The Kidney Center, Matsuyama Red Cross Hospital, 1 Bunkyo-cho, Matsuyama 790-8524, Japan.
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Mitsuiki K, Harada A, Miyata Y. Reduction of recombinant human erythropoietin maintenance dose by supplementation with a low-dose iron preparation, given intravenously. Clin Exp Nephrol 2001. [DOI: 10.1007/s10157-001-8018-z] [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: 11/25/2022]
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Tsuruya K, Harada A, Hirakata H, Mitsuiki K, Johko T, Kondoh H, Takechi S, Fujishima M. Combination therapy using prednisolone and cyclophosphamide slows the progression of moderately advanced IgA nephropathy. Clin Nephrol 2000; 53:1-9. [PMID: 10661476] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
AIM We retrospectively examined the effect of combination therapy using prednisolone (PSL) and cyclophosphamide (CPA) on the progression of IgA nephropathy (IgAN) in 45 patients with moderate to severe histological changes. PATIENTS AND METHODS Patients were recruited from 129 consecutive patients with IgAN seen over 10 years based on semiquantitative histological grading. They were divided into two groups: PSL+CPA group (n = 26, male/female = 11/15, age 40+/-3 years (SEM)) or control group undergone conventional therapy with or without antiplatelet agents (n = 19, male/female = 10/9, age 41+/-3). In PSL+CPA group, PSL and CPA treatment commenced using a dose of 30 and 50 mg/day, respectively. PSL was reduced by 5 mg every month. RESULTS The clinical parameters at the start of treatment such as age, gender, histological score, blood pressure, urinary protein excretion and serum creatinine concentration (SCr) were not different between the groups. The mean observation period in PSL+CPA group (3.3+/-0.3 years) was not different from the control group (4.0+/-0.7 years). In PSL+CPA group, urinary protein excretion, defined as the ratio of urinary protein to creatinine concentration (UP/UCr), significantly decreased from 3.9+/-0.4 to 1.3 +/-0.2 (p<0.01), whereas it remained high in the control group (3.8+/-0.7 to 2.7+/-0.8). The progression rate (PR), which was determined by the slope of the correlation between time after renal biopsy and reciprocal SCr, was significantly lower in PSL+CPA (0.054+/-0.014) than in the control group (0.172+/-0.032 dl/mg/year, p<0.001). Our results indicated that PSL+CPA combination therapy was effective in slowing the progression of moderately advanced IgAN. CONCLUSION We suggest that the immunosuppressive treatment with CPA is sometimes necessary to preserve renal function in patients with histologically advanced IgAN.
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Affiliation(s)
- K Tsuruya
- The Kidney Center, Matsuyama Red Cross Hospital, Japan
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Takeda K, Harada A, Kubo M, Inenaga T, Tsuruya K, Mitsuiki K, Hirakata H, Fujishima M. Successful use of single-lumen, urokinase immobilized femoral catheters as a temporary access for haemodialysis. Nephrol Dial Transplant 1998; 13:130-3. [PMID: 9481728 DOI: 10.1093/ndt/13.1.130] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
METHODS Placement of a femoral vein catheter as a temporary vascular access for haemodialysis was conducted and the indications, catheter patency rate, and incidence of catheter-related infections were examined. An urokinase immobilized femoral vein catheter (UIFC) is a soft polyurethane single-lumen catheter 2.7 mm in diameter and 22 cm in length which needs no heparin infusion (Japan Shawood Co., Ltd., Tokyo; Unitica Co., Ltd., Hyogo, Japan). A soft silicon rubber was attached to the tip of the catheter in order to avoid excessive bleeding during insertion. Aseptic adhesive wound dressing was employed at the exit-site which was cleansed with popidone-iodine and renewed at each dialysis session. RESULTS Eighty-one UIFCs were used for haemodialysis in 64 patients (acute renal failure: 11; vascular access trouble: 53; initiation of chronic dialysis: 17). The average age of the patients was 58 +/- 13 years, ranging from 26 to 80 years. The mean duration of catheter indwelling was 22.4 +/- 13.1 days. An adequate blood flow of 180-200 ml/min was obtained through UIFC and returned to another peripheral vein punctured at each dialysis session. Unexplained fever occurred in four cases while the UIFC was in place (4.9%) but culture of either blood or the catheter tip was negative for bacteria. The catheter was removed immediately and fever subsided in all cases. The overall catheter survival rate was 84% at 34 days calculated using the Kaplan-Meier method. Catheter insertion was easy to perform and no serious complications such as pulmonary embolism or septicaemia occurred. CONCLUSION Our modified type of UIFC is very useful as a temporary access for haemodialysis with a very low incidence of catheter-related infections and no need for heparinization. Excellent catheter patency was maintained with the plug system and careful dressing techniques without unnecessary bleeding during catheter care.
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Affiliation(s)
- K Takeda
- Kidney Center, Matsuyama Red Cross Hospital, Japan
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