Iron Metabolism in Chronic Kidney Disease Patients.
Authors: Honda H, Hosaka N, Ganz T, Shibata T Abstract BACKGROUND: Anemia is a common comorbidity in patients with chronic kidney disease (CKD) and occurs due to diminished renal function. The main cause of such anemia is decreased erythropoietin (EPO) production and secretion from the kidney and a lower erythropoietic response to EPO. Treatment therefore involves erythropoiesis-stimulating agents (ESAs). Optimal erythropoietic response to ESA therapy also requires adequate iron management. However, iron metabolism is also dysregulated in CKD patients. SUMMARY: During erythropoiesis, biomarkers of iron metaboli...
Source: Contributions to Nephrology - April 18, 2019 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Blood Purification for Paediatric Patients.
Authors: Ishikawa K, Oyama K Abstract BACKGROUND: Recent technical and experimental advances in extracorporeal blood purification therapy (eBPT) can be applied in paediatric patients, including neonates. However, there are several specific issues in performing eBPT in paediatric patients in regard to the safety and effectiveness of treatments. The aim of this review is to explore the technical aspects of acute paediatric eBPT, especially regarding renal replacement therapy and the present situation in Japan. SUMMARY: In children requiring eBPT, especially small children and neonates, it is difficult to secure s...
Source: Contributions to Nephrology - April 18, 2019 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

New Japanese Society of Dialysis Therapy Guidelines for Peritoneal Dialysis.
Authors: Ito Y, Tawada M, Yuasa H, Ryuzaki M Abstract BACKGROUND: The Japanese Society for Dialysis Therapy established 14 clinical practice guidelines (CPGs) for various fields of renal replacement therapy. About 10 years have passed since the previous peritoneal dialysis (PD) guidelines were established. We commenced the establishment of new PD guidelines in 2016. Recently, the methods for development of CPGs have changed dramatically. SUMMARY: The previous guidelines were described in a textbook-like format. However, these kinds of guidelines no longer meet the definition of CPGs as defined by the National A...
Source: Contributions to Nephrology - April 18, 2019 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Carnitine Profile by Tandem Mass Spectrometry and Dialysis Patients.
Authors: Kamei D, Kamei Y, Tanaka N, Tsukada M, Miwa N, Hanafusa N, Mineshima M, Nitta K, Tsuchiya K Abstract BACKGROUND: Carnitine deficiency is a common condition in hemodialysis patients. Therefore, abnormalities in fatty acid metabolism and organic acid metabolism are also common in dialysis patients. Tandem mass spectrometry is a standard technique in pediatric and neonatal medicine. However, it could be a new powerful tool in other fields for estimating the state of intracellular fatty acid metabolism. SUMMARY: Tandem mass spectrometry has recently revealed the relationships between carnitine profile and ...
Source: Contributions to Nephrology - April 18, 2019 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Chronic Inflammation and Progression of Diabetic Kidney Disease.
Authors: Furuya F, Ishii T, Kitamura K Abstract BACKGROUND: From a global perspective, diabetic kidney disease (DKD) is the leading cause of not only chronic kidney disease and end-stage renal disease but also cardiovascular disease (CVD). SUMMARY: In the early stages of diabetes, patients have a high risk of developing microvascular complications, loss of kidney function, CVD, infection, and death. Hyperglycemia, free fatty acids, and insulin resistance induce metabolic imbalance and DKD initiation. Inflammation is recognized to play a role in DKD pathogenesis. Our recent study indicated that angiopoietin-like...
Source: Contributions to Nephrology - April 18, 2019 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Recent Advances in the Management of Vascular Calcification in Patients with End-Stage Renal Disease.
Authors: Nitta K, Ogawa T, Hanafusa N, Tsuchiya K Abstract BACKGROUND: Vascular calcification (VC) is common in patients with chronic kidney disease (CKD) including end-stage renal disease (ESRD). The pathogenesis of VC is complex, resulting in increased arterial stiffening, which is associated with cardiovascular mortality. In addition to traditional cardiovascular risk factors, CKD patients also have a number of non-traditional cardiovascular risk factors that may play an important role in the pathogenesis of VC. SUMMARY: Management of CKD-mineral bone disorder using conventional therapeutic approaches, which...
Source: Contributions to Nephrology - April 18, 2019 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Clinical Benefit of an Adsorptive Technique for Elderly Long-Term Hemodialysis Patients.
Authors: Kuragano T, Kida A, Yahiro M, Nakanishi T Abstract BACKGROUND: With the advancement of technology, a dialysis membrane has been developed to achieve the efficient removal of beta-2 microglobulin (β2MG), which could not be removed with previous hemodialysis (HD) membranes. Recently, there has been an increase in the population of elderly chronic kidney disease (CKD) patients with chronic inflammation and malnutrition. The optimal extracorporeal circulation treatment for elderly CKD patients is not certain. SUMMARY: We have reported the clinical advantages, such as improvements in nutritional, infla...
Source: Contributions to Nephrology - April 18, 2019 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Anemia Management Considering the Pathophysiology of Elderly Chronic Kidney Disease Patients.
Authors: Kuragano T, Mizusaki K, Kimura T, Nakanishi T Abstract The results of previous large clinical trials have revealed that low hemoglobin (Hb) levels are significantly associated with adverse events (cardiovascular disease, infection, hospitalization, and mortality) in patients with chronic kidney disease (CKD). However, in the general population, the mean Hb levels differ by sex and age. Furthermore, the comorbidities and activities of daily living of elderly patients are markedly different from those of nonelderly patients. CKD in elderly patients is accompanied by not only chronic inflammation, which is mo...
Source: Contributions to Nephrology - April 18, 2019 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

The Current Status and Future of Peritoneal Dialysis in Japan.
Authors: Nakamoto H Abstract BACKGROUND: Recent reports have outlined the present conditions and future prospects of Japanese patients on dialysis. Japan currently has the most rapidly aging population in the world and its dialysis population is also aging rapidly. SUMMARY: Patients on dialysis in Japan have an extremely good prognosis, probably because of the national health insurance system with efficient introduction of patients to dialysis, creation of a good arteriovenous shunt, an adequate patient education system, management by skilled medical, nursing, and technical staff, and good hygiene. However, alt...
Source: Contributions to Nephrology - April 18, 2019 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Current Topics in Vascular Access: Superficialization of Arteriovenous Fistula.
Authors: Nanami M, Suemitsu K, Nagasawa Y, Hasuike Y, Kuragano T, Nakanishi T Abstract BACKGROUND: An arteriovenous fistula (AVF) is considered the gold standard modality of vascular access (VA) for maintenance hemodialysis (HD) because of its superior patency, few complications, provision of high quality of life, and low risk of patient mortality. The rapid growth of the aging population and the high prevalence of comorbidities, particularly diabetes mellitus and peripheral vascular disease, in patients requiring HD inevitably deteriorate the ability to construct and maintain a conventional AVF because of these pa...
Source: Contributions to Nephrology - April 18, 2019 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Hypoxia-Inducible Factor-Prolyl Hydroxylase Domain Inhibitors to Treat Anemia in Chronic Kidney Disease.
Authors: Sakashita M, Tanaka T, Nangaku M Abstract BACKGROUND: Hypoxia-inducible factor (HIF) stabilizers, also known as inhibitors of HIF prolyl hydroxylase domain (PHD) inhibitors enzymes, are novel small-molecule agents to treat renal anemia. They increase endogenous erythropoietin (EPO) production by stabilizing HIF. This review focuses on the mechanisms by which PHD inhibitors ameliorate anemia in chronic kidney disease (CKD) and summarizes the current clinical experience with and prospects for these drugs. SUMMARY: Anemia is a serious complication of CKD and is an independent risk factor for congestive he...
Source: Contributions to Nephrology - April 18, 2019 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Correlation between Aortic Calcification Score and Biochemical Parameters in Hemodialysis Patients.
Authors: Maruyama N, Higuchi T, Ono M, Oguma H, Nakamura Y, Utsunomiya K, Akiya Y, Horikami T, Yamazaki T, Okawa E, Ando H, Abe M Abstract BACKGROUND: The purpose of this study was to determine the correlation between aortic calcification and demographic and biochemical parameters in hemodialysis patients. SUMMARY: Calcification scores of the aortic arch and abdominal aorta were determined from multi-slice computed tomography scans and evaluated according to the Agatston score. The associations between demographic and biochemical parameters and aortic calcification score were determined. In total, 190 patients ...
Source: Contributions to Nephrology - April 18, 2019 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Economic Issues of Chronic Kidney Disease and End-Stage Renal Disease.
Authors: Takemoto Y, Naganuma T Abstract BACKGROUND: With the growth in the global economy, the number of patients worldwide undergoing renal replacement therapy such as hemodialysis is increasing by 6-7% annually. Accordingly, medical costs for the treatment of chronic kidney disease (CKD) progressing to end-stage renal disease (ESRD) as well as for renal replacement therapy have become a major issue. SUMMARY: It has been reported that in the United States, the annual medical cost for a patient with CKD is approximately USD 20,000, and that the total medical cost for a CKD patient is higher than that of an ESR...
Source: Contributions to Nephrology - April 18, 2019 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

The Hepcidin-Anemia Axis: Pathogenesis of Anemia in Chronic Kidney Disease.
Authors: Nakanishi T, Kimura T, Kuragano T Abstract BACKGROUND: The pathogenesis of anemia in chronic kidney disease (CKD) could be multifactorial. In recent animal studies, hepcidin knockout (KO) mice with adenine-induced CKD did not exhibit anemia and iron deficiency. Hepcidin has emerged as a major player in the development of anemia in CKD. We suspected that erythropoietin (EPO) deficiency may not be the mainstay of anemia in CKD, although relative EPO deficiency could contribute to the failure to increase hemoglobin (Hb) levels. Some factors may interfere with the differentiation of erythroids. SUMMARY:...
Source: Contributions to Nephrology - April 18, 2019 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Eosinophilic Inflammation in Peritoneal Fibrosis Patients Undergoing Peritoneal Dialysis.
Authors: Kobayashi T, Noguchi T, Saito K, Shirasaki F, Kita H, Nagata M, Okada H, Nakamoto H Abstract BACKGROUND: Renal replacement therapy is vital for patients with chronic renal failure. Each type of renal replacement therapy has its own characteristics, and patients select it according on their living environment or conception of quality of life. Under the recent medical environment in Japan, economic burden of dialysis is another concern. For patients with chronic renal failure, the outcome of dialysis is vital. How to prevent or control side effects and complications is also important. One type of dialysis tr...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Current Perspectives on Sudden Cardiac Death in Hemodialysis Patients.
Authors: Joki N, Tokumoto M, Takahashi N, Nishimura M Abstract BACKGROUND: Recent lines of evidence suggest that, as in other countries, sudden cardiac death (SCD) is more common in the Japanese dialysis clinical setting than we previously thought. SUMMARY: Three specific important findings may underlie the increased incidence of SCD in dialysis patients. Even after successful coronary revascularization, hemodialysis (HD) patients continue to have a higher incidence of SCD than the general population. Second, about 70% or more of end-stage kidney disease patients have concentric and eccentric left ventricular h...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Strategy for Prevention of Left Ventricular Remodeling in Predialysis and Dialysis Patients.
Authors: Io H, Suzuki Y Abstract BACKGROUND: Currently, left ventricular (LV) hypertrophy and dysfunction are considered the strongest predictors of cardiovascular mortality in chronic kidney disease (CKD) patients. We investigated the factors associated with elevated LV mass index (LVMI) using echocardiography and assessed the strategies used to treat CKD (stages 1-5D) patients. SUMMARY: In study 1, we prospectively determined correlations among biochemical values, physical specimens, and LVMI using echocardiography in hemodialysis (HD) and peritoneal dialysis (PD) patients (stage 5D). In study 2, biochemical ...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Asymptomatic Cerebrovascular Disease in Dialysis Patients.
Authors: Naganuma T, Takemoto Y Abstract Cerebrovascular disease is a major cause of death in dialysis patients, who have a much higher incidence of stroke compared to the normal population. Recent studies have shown that asymptomatic cerebral small-vessel disease, including silent brain infarction (SBI), white matter hyperintensities (WMHs), and cerebral microbleeds (CMBs), is related to the future onset of stroke. Cerebral small-vessel disease is caused by microvascular damage to the small penetrating arteries of the middle cerebral artery including arteriolosclerosis, fibrinoid necrosis, and lipohyalinosis attri...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Brain Atrophy and Cognitive Impairment in Chronic Kidney Disease.
Authors: Tsuruya K, Yoshida H Abstract BACKGROUND: There is an increasing prevalence of dementia associated with population aging, and anti-dementia measures have now become of increasing importance in Japan. Chronic kidney disease (CKD) is a risk factor for cognitive impairment. SUMMARY: We previously demonstrated that hemodialysis patients have a higher prevalence of brain atrophy, even at younger age, than the general population, and also demonstrated the association between frontal lobe atrophy and frequency of rapid decline in blood pressure during the hemodialysis session. Recently, we demonstrated that d...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Targets and Therapeutics for Glycemic Control in Diabetes Patients on Hemodialysis.
Authors: Maruyama N, Abe M Abstract BACKGROUND: For diabetes patients without nephropathy, glycemic control is important to reduce the risk or delay the progression of diabetes complications, including nephropathy. In diabetes patients on hemodialysis, good glycemic control is necessary to improve prognosis. Many factors influence the blood glucose level of diabetes patients on hemodialysis, such as factors associated with end-stage kidney disease and factors related to hemodialysis. Therefore, since glucose metabolism in diabetes patients on hemodialysis has unique characteristics, it is necessary to manage blood ...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Intravenous Maxacalcitol Therapy Correlates with Serum Fibroblast Growth Factor 23 Levels in Hemodialysis Patients Independent of Serum Phosphate or Calcium Levels.
Authors: Ohya M, Yashiro M, Sonou T, Okuda K, Tatsuta K, Mima T, Tone Y, Negi S, Saika Y, Shigematsu T Abstract Fibroblast growth factor 23 (FGF23) is a regulator of phosphate and vitamin D homeostasis that carries out primary bone- and mineral-related physiological functions to increase renal phosphate excretion and reduce 1α-hydroxylation of 25-hydroxyvitamin D. In a negative endocrine feedback loop, 1,25-dihydroxyvitamin D also stimulates FGF23 secretion. Previous studies have assessed the correlation between vitamin D receptor activator therapy and FGF23 concentrations, and to our knowledge, none has asse...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Importance of Physiological Erythropoiesis in the Treatment of Chronic Kidney Disease-Associated Anemia.
Authors: Kuragano T, Nakanishi T Abstract Recent large clinical trials have reported that despite the maintenance of target hemoglobin (Hb) levels, higher doses of erythropoiesis-stimulating agents (ESAs) and/or iron preparations are significantly associated with higher risks of adverse events and death in maintenance hemodialysis (MHD) patients. Higher doses of ESAs have been demonstrated to result in a higher risk for cardiovascular disease due to elevated blood pressure or increased thrombogenicity. In addition, a high dose of iron might enhance inflammatory responses to infection and impair the phagocytic funct...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Magnesium in Hemodialysis Patients: A New Understanding of the Old Problem.
Authors: Sakaguchi Y, Hamano T, Isaka Y Abstract BACKGROUND: Despite the prognostic significance of mineral and bone disorders in patients undergoing hemodialysis, very few studies have focused on magnesium metabolism in this population. Nephrologists have paid much attention to hypermagnesemia, which is sometimes caused by magnesium administration, but the clinical implication of low magnesium has been largely overlooked. Recently, several cohort studies have reported that lower serum magnesium levels are associated with an increased risk of all-cause and cardiovascular mortality among hemodialysis patients. In ad...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Does Combined Therapy with Peritoneal Dialysis and Hemodialysis Improve Prognosis?
Authors: Maruyama Y Abstract BACKGROUND: Peritoneal dialysis (PD) is recommended as first-line renal replacement therapy for end-stage renal disease. Combined therapy with PD and hemodialysis (HD) is an option for patients on PD with inadequate dialysis and/or fluid overload that has rapidly gained popularity in Japan. SUMMARY: The clinical benefits of combined therapy have been recognized. After switching from PD alone to combined therapy, there is a decrease in body weight, blood pressure, and serum creatinine, as well as an increase in the hemoglobin level, suggesting significant improvement in dialysis and ...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Pathogenesis and Management of Vascular Calcification in Patients with End-Stage Renal Disease.
Authors: Ogawa T, Nitta K Abstract Vascular calcification is common in patients with end-stage renal disease (ESRD). In addition to traditional cardiovascular risk factors, ESRD patients also have a number of nontraditional cardiovascular risk factors that may play an important role in the pathogenesis of vascular calcification. The transformation of vascular smooth muscle cells into osteoblast-like cells may be a key element in the pathogenesis of vascular calcification in the presence of calcium and phosphate deposition due to abnormal bone metabolism and impaired renal excretion. Vascular calcification causes in...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Total Renal Care Approach for Patients with End-Stage Renal Disease.
Authors: Kamijo Y, Fujimoto S, Ishibashi Y Abstract BACKGROUND: Advances in dialysis medicine have enabled end-stage renal disease (ESRD) patients to live longer. ESRD patients and their family members experience the illness in everyday life, and patients are required to manage their own disease to live longer. Psychological flexibility benefits a person and leads to healthier outcomes. Constructing an independent-minded attitude toward their lives with ESRD is preferably needed. SUMMARY: Holistic care is needed to see patients with ESRD and their families because they are faced with life-long illness. From the...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Ferritin: Diversity and Management of Ferritin Measurement Methods.
Authors: Kamei D, Mineshima M, Tsukada M, Miwa N, Hanafusa N, Tsuchiya K Abstract BACKGROUND: Serum ferritin is one of the most important and widely used markers of iron metabolism, and is a recommended standard index of iron dynamics in guidelines for renal anemia in many countries. However, serum ferritin measurement has several disadvantages. For example, it is prone to being influenced by underlying disease, and there is considerable systematic bias among different methods of measurement. SUMMARY: Systematic bias affects not only the measurement results, but also the therapeutic strategy to be used in accor...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Current Status and Treatment Strategies of Hemodialysis-Associated Pruritus.
Authors: Takahashi N, Yoshizawa T, Tsuchiya S Abstract BACKGROUND: Hemodialysis-associated pruritus (HAP) is often treatment-resistant, and is a serious comorbidity that adversely affects prognosis and reduces patient quality of life through sleep disruption and depression. SUMMARY: HAP can arise from a combination of several causes; accordingly, it is often resistant to treatment. HAP patients need the specific causes of their itching to be identified, with a comprehensive approach to treatment. We have implemented our own therapeutic algorithm, which covers cause specification, for HAP since June 2009. This r...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Effects of Levocarnitine on Cardiac Function and Renal Anemia in Hemodialysis Patients.
Authors: Higuchi T Abstract BACKGROUND: Carnitine deficiency is a common condition in hemodialysis patients. There have been numerous reports on the efficacy of levocarnitine therapy in hemodialysis patients, including different views. Reported effects of levocarnitine are: (1) improvement of renal anemia, (2) improvement of cardiac functions, (3) effects on muscle spasm and asthenia, (4) anti-atherogenic effects, (5) anti-oxidant and anti-inflammatory effects, and (6) inhibitory effects on dialysis hypotension. SUMMARY: Here, I present the effects of levocarnitine on renal anemia in hemodialysis patients with ...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Management of Physical Frailty in Patients Requiring Hemodialysis Therapy.
Authors: Matsuzawa R, Roshanravan B Abstract BACKGROUND: The mean age of people undergoing dialysis therapy has been on the rise because of improved survival in this patient population, as well as the reduced availability of transplants for elderly patients. Aging in Japanese dialysis patients is more rapid than those in the United States and Europe. Frailty is generally considered as an age-related fragile state, and a condition in which the individual is in a vulnerable state at increased risk of adverse health outcomes and/or dying when exposed to a stressor. This review focuses on the underscoring the importanc...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Advances and Developments in Vascular Access in Japan.
This article describes recent advances and future directions in the field of vascular access in Japan. SUMMARY: In vascular access techniques using patients' own vessels, such as creating an internal shunt and superficialization of the brachial artery, management and monitoring to maintain healthy conditions is crucial. New materials composed of synthetic products, such as artificial blood vessels, catheters, and vessel-enlarging balloon catheters, are continuously under development, and the full range of use of these products as well as their mode of use to maximize their benefits are currently being studied. Key Mess...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Intermittent Infusion Hemodiafiltration: The Principle and Its Clinical Application.
Authors: Eguchi K, Mineshima M, Kamei D, Tsuchiya K Abstract The present study aimed to propose a new hemodiafiltration (HDF) method (intermittent infusion HDF) that repeats intermittent infusion during hemodialysis to temporarily enhance peripheral circulation and improves solute removal efficiency through (a) correcting blood distribution (increase in effective vascular surface area), (b) stirring body fluids, and (c) promoting solute removal and examining its clinical effects. PMID: 30041214 [PubMed - in process] (Source: Contributions to Nephrology)
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Treatment of Hepatitis C Virus Infection in Dialysis Patients.
Authors: Kikuchi K Abstract Since 2014, all-oral, interferon (IFN)-free, direct-acting antiviral (DAA) regimens including daclatasvir + asunaprevir dual regimen, ledipasvir/sofosbuvir combination, ombitasvir/paritaprevir/ritonavir combination, elbasvir + grazoprevir dual regimen, and glecaprevir/pibrentasvir combination have been approved for the treatment of hepatitis C. Studies on DAA regimens reported that DAA therapy causes far fewer adverse reactions compared with IFN therapy and exhibits high efficacy in treating hepatitis C virus (HCV) infection in hemodialysis patients, although the ledipasvir/sofosbuvir co...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Current Status of Peritoneal Dialysis in Japan.
Authors: Ito Y, Tawada M, Tine S, Mizuno M, Suzuki Y, Katsuno T Abstract BACKGROUND: As an effective renal replacement therapy, peritoneal dialysis (PD) is as important as hemodialysis (HD) and renal transplantation. PD is beneficial for social rehabilitation and home medical care. However, in Japan, there are fewer PD patients than HD patients. SUMMARY: According to the JSDT 2015 registry, PD patients accounted for only 2.9% of all dialysis patients, and they have been gradually decreasing since 2009. One of the reasons why PD is not widely used in Japan is that there is insufficient evidence supporting its us...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Current State of Peritoneal Dialysis in Children.
In this study, approximately half of the patients received KTx from their parents. Key Messages: Because PD is the only treatment option available to patients, especially infants and young children, to become a bridge to KTx, its management and outcome must be efficient. PMID: 30041217 [PubMed - in process] (Source: Contributions to Nephrology)
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Effect of Combined Peritoneal Dialysis and Hemodialysis on Health-Related Quality of Life.
Authors: Watanabe Y, Okada H Abstract BACKGROUND: In Japan, combined peritoneal dialysis (PD) and hemodialysis (HD) therapy is performed widely as an established modality of renal replacement therapy. This combination therapy is indicated for patients who cannot maintain adequate solute clearance using a standard PD prescription, or those who have uremic symptoms or a state of persistent fluid overload. A common treatment schedule for combined PD + HD therapy consists of 5 days of PD and one HD session per week. A 4- to 5-h HD session is performed with a high-flux membrane dialyzer. On the HD day and the following ...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Peritoneal Dialysis in Elderly Patients.
Authors: Sakai K, Nihei H Abstract BACKGROUND: Dialysis is now often being initiated in older patients. In Japan, patients are around 69 years of age on initiation of dialysis. The total dialysis population undergoing peritoneal dialysis (PD) stands at just 3% in Japan, a much lower proportion than in other industrialized countries. Under the current policy, there has been a move away from hospital-based care of elderly patients to home-based care. Here, in the context of this change, we describe the experiences of our elderly patients in initiating and maintaining PD. SUMMARY: From 2003 to 2016, a total of 128...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Blood Pressure Control in Peritoneal Dialysis Patients.
Authors: Ryuzaki M Abstract In the general population, hypertension (HT) is defined as systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg. In dialysis patients, the definition is thought to be the same as in the general population. But there is no clear description about the definition of HT for dialysis patients, especially in peritoneal dialysis (PD) patients. The prevalence of HT in PD patients is much higher compared to the general population. The association of BP and cardiovascular (CV) mortality in PD patients who are not exposed to huge hemodynamic changes during ...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

The Role of Non-Tuberculous Mycobacteria in Peritoneal Dialysis-Related Infections: A Literature Review.
Authors: Washida N, Itoh H Abstract BACKGROUND: Peritonitis is one of the most frequent reasons for withdrawal of peritoneal dialysis (PD). Although most cases of PD-related peritonitis can be treated with antibiotics, it is occasionally refractory and culture-negative. SUMMARY: The causes of refractory PD-related peritonitis include antibiotic-resistant bacteria, fungal peritonitis, biofilm formation in PD catheters, bacterial translocation from the gastrointestinal tract, and encapsulating peritoneal sclerosis. Among them, culture-negative peritonitis is notable, and non-tuberculous mycobacteria (NTM) can be ...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Translational Research of Peritoneal Dialysis Solution with Dissolved Molecular Hydrogen.
Authors: Nakayama M, Watanabe K, Hayashi Y, Terawaki H, Zhu WJ, Kabayama S, Ito S Abstract BACKGROUND: Improved biocompatibility of peritoneal dialysis solution (PDS) is crucial for peritoneal membrane preservation, thereby ensuring long-term peritoneal dialysis (PD) and preventing encapsulating peritoneal sclerosis. We previously reported the protective effect of molecular hydrogen (H2) on mesothelial cells from PDS in nonuremic rats. SUMMARY: In the present study, we examined the effect of H2-containing PDS (commercially available neutral pH type) regarding the protection of peritoneal tissue in experimental ...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

A Perspective on the Current Status of Home Hemodialysis.
Authors: Kawanishi H Abstract Most hemodialysis (HD) in Japan is based on the central dialysis fluid delivery system (CDDS). With CDDS, there is an improvement in work efficiency, reduction in cost, and a reduction in regional and institutional differences in dialysis conditions. This has resulted in an improvement in the survival rate throughout Japan. However, as the number of cases with various complications increases, it is necessary to select the optimal dialysis prescription (including hours and frequency) for each individual in order to further improve survival rates. To perform intensive HD, home HD is esse...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Home Hemodialysis: Benefits, Risks, and Barriers.
Authors: Tomori K, Okada H Abstract Home hemodialysis (HHD) has been available as a modality of renal replacement therapy since the 1960s. HHD allows intensive dialysis such as nocturnal hemodialysis or short daily hemodialysis. Previous studies have shown that patients receiving HHD have an increased survival and better quality of life compared with those receiving in-center conventional HD. However, HHD may increase the risk for specific complications such as vascular access complications, infection, loss of residual kidney function and patient and caregiver burden. In Japan, only 529 patients (0.2% of the total ...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Intensive Hemodialysis: Effects of Treatment Time and Frequency on Time-Averaged Concentrations of Solutes.
Authors: Mineshima M Abstract Most of chronic renal disease patients receive 4-h hemodialysis (HD) sessions thrice a week. This is the minimum therapy needed to maintain life. This conventional HD therapy protocol is, however, inadequate to prevent dialysis-related complications. On the other hand, some intensive HD therapies, such as "short daily dialysis," "quotidian dialysis," etc., are being adopted in some dialysis institutions for maximizing the beneficial effects of HD on the quality of life/activities of daily living of the patients. In this paper, the effects of dialysis treatment time ...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Apheresis for Kidney Disease.
Authors: Furuichi K, Wada T Abstract Plasma exchange or double filtration plasmapheresis for rapidly progressive glomerulonephritis, and low-density lipoprotein (LDL) apheresis or leukocytapheresis for nephritic syndrome are two major apheresis therapies for kidney diseases. In addition to these apheresis therapies, plasma exchange for lupus nephritis or LDL apheresis for refractory focal segmental glomerulonephritis is clinically valuable and established. Although several possibilities of apheresis for kidney diseases were speculated in animal experiments or human studies, clinical applications have thus far been ...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Our Approaches to Selective Plasma Exchange.
Authors: Ogawa T, Yoshino H, Sasaki Y, Kanayama Y, Sano T, Kogure Y, Kanozawa K, Hasegawa H Abstract Plasma exchange (PE) therapy is the most commonly used treatment in Japan today. The issue with PE is that it removes coagulation factors and other essential molecules during the treatment process. Fresh frozen plasma (FFP) is used to replace the essential molecules which are lost. However, FFP can be a source of various complications. We have been researching an alternative method, selective PE, consisting of a membrane with smaller pores, which prevents large and essential molecules from being removed while removi...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Changes in Treatment with Granulocyte and Monocyte Adsorptive Apheresis from the Past to Future in Patients with Inflammatory Bowel Disease.
Authors: Kato S, Ishibashi A, Sugiura K, Kani K, Ogawa T, Hasegawa H, Yakabi K Abstract BACKGROUND: Idiopathic acute-on-chronic inflammation in the gastrointestinal tract is an etiology of inflammatory bowel disease (IBD). Granulocyte and monocyte adsorptive apheresis (GMA) is a nonpharmacological treatment tool for patients with IBD. Here, we present a review of the positioning and possibilities of GMA for patients with IBD. SUMMARY: GMA decreases inflammatory cytokines and upregulates regulatory T cells. Intensive GMA is significantly more effective than weekly GMA in patients with IBD. The frequency of GMA s...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Current Practices in Acute Blood Purification Therapy in Japan and Topics for Further Study.
Authors: Sadahiro T, Yuzawa H, Kimura T, Oguchi M, Morito T, Mizushima S, Hirose Y Abstract Continuous venovenous hemodiafiltration is the modality of choice for acute blood purification therapy at almost all medical institutions in Japan. Nafamostat mesilate, an ultrashort-acting anticoagulant, is widely used for anticoagulation. Due to restrictions imposed by national health insurance, Japanese institutions use an effluent flow rate of 15 mL/kg/h, which is lower than the standard effluent flow rate used in the West. In addition, hemofilters are believed to adsorb cytokines, and thus some institutions also proacti...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Evidence and Perspectives on the Use of Polymyxin B-Immobilized Fiber Column Hemoperfusion among Critically Ill Patients.
Authors: Yamashita C, Moriyama K, Hasegawa D, Hara Y, Kuriyama N, Nakamura T, Shibata J, Komura H, Nishida O Abstract BACKGROUND: Sepsis frequently leads to multiple organ failure due to the uncontrolled amplification and spread of inflammation, even if the infectious source is controlled. Lipopolysaccharide (LPS), a typical pathogen-associated molecular pattern (PAMP), is adsorbed by the polymyxin B-immobilized fiber column (PMX). PMX has been used for decades in Europe. Results of a North American randomized controlled trial (RCT) on PMX have recently been announced in a press release; results of large-scale obse...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Current Trend of Pediatric Renal Replacement Therapy in Japan.
Authors: Hattori M Abstract BACKGROUND: End-stage renal disease (ESRD) in children is considered a rare but serious condition. Information on the epidemiology, demographics, treatment modality at the start of renal replacement therapy (RRT), and mortality of pediatric patients with ESRD is essential for a better understanding of this disease. Additionally, international comparisons of this information on pediatric patients with ESRD may improve outcomes in these children. Here, I will provide information on epidemiological and demographic characteristics of pediatric Japanese patients with ESRD and the current tren...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research

Dysnatremia in Renal Failure.
Authors: Shimizu T, Terao M, Hara H, Iwashita T, Ogawa T, Kanozawa K, Hasegawa H Abstract Proximal salt reabsorption in the hypertrophied tubules in the early phase of chronic renal failure (CRF) would be diminished according to the inhibited expression of proximal salt-transporting molecules, which may be facilitated by the inhibition of Na-K-ATPase expression. Results from animal models suggest that patients with early-phase CRF would easily develop hyponatremia and, in contrast, patients showing developed CRF would be more likely to show dehydration or hypernatremia. Several large-scale studies of individuals wi...
Source: Contributions to Nephrology - July 26, 2018 Category: Urology & Nephrology Tags: Contrib Nephrol Source Type: research