Hyperuricemia and chronic kidney disease: to treat or not to treat

Hyperuricemia is common in chronic kidney disease (CKD) and may be present in 50% of patients presenting for dialysis. Hyperuricemia can be secondary to impaired glomerular filtration rate (GFR) that occurs in CKD. However, hyperuricemia can also precede the development of kidney disease and predict incident CKD. Experimental studies of hyperuricemic models have found that both soluble and crystalline uric acid can cause significant kidney damage, characterized by ischemia, tubulointerstitial fibrosis, and inflammation. However, most Mendelian randomization studies failed to demonstrate a causal relationship between uric acid and CKD, and clinical trials have had variable results. Here we suggest potential explanations for the negative clinical and genetic findings, including the role of crystalline uric acid, intracellular uric acid, and xanthine oxidase activity in uric acid-mediated kidney injury. We propose future clinical trials as well as an algorithm for treatment of hyperuricemia in patients with CKD

Hyperfractionated Radiotherapy with Concurrent Docetaxel for Advanced Head and Neck Cancer: A Phase II Study

Aim: To evaluate the value of hyperfractionated radiotherapy with concurrent use of low-dose docetaxel in locally-advanced head and neck squamous cell cancer (HNSCC). Patients and Methods: Patients eligible for this study had confirmed diagnosis of HNSCC stages II (>10 cm3) to IVB. Radiotherapy was delivered twice daily at 1.2 Gy/fraction to a total dose of 72.0 Gy. Docetaxel (10 mg/m2) was administered weekly during radiotherapy. Results: From March 2003 to October 2008, 70 patients were treated. Primary sites included the oropharynx (n=25), hypopharynx (n=24), larynx (n=18), and other sites (n=3). Major grade 3 acute toxicities included mucositis (n=43) and treatment-related pain (n=20). The median follow-up period for surviving patients was 43 months. The 5-year local control rate and overall survival rate were 62.6% and 61.6%, respectively. Conclusion: This modality is a valuable treatment option for the management of locally-advanced HNSCC

Hyperfractionated radiotherapy with concurrent docetaxel in advanced head and neck cancer: a phase II study

Purpose: To evaluate the value of hyperfractionated radiotherapy with concurrent use of low dose docetaxel in locally advanced head and neck cancer.Methods: Patients eligible for this study had confirmed diagnosis of squamous cell carcinoma stages II (>10 m3), III, IVA and IVB of the head and neck. Radiotherapy was delivered twice a day at 1.2 Gy/fraction to a total dose of 72.0 Gy. Docetaxel (10 mg/m2) was administered weekly during radiotherapy.Results: From March 2003 to October 2008, 70 patients were treated. Primary sites included the oropharynx (n=25), hypopharynx (n=24), larynx (n=18), and other sites (n= 3). Stages II (n=11), III (n=16), IVA (n=33) were included. Major grade 3 acute toxicities included mucositis (n=42) and treatment related pain (n=12). The median follow-up period for surviving patients was 43 months. The 2-year local control rate and overall survival rate were 72.5% and 70.0%, respectively.Conclusion: Hyperfractionated radiotherapy with concurrent docetaxel is a valuable treatment modality for the management of locally advanced head and neck cancer.The 6th S. Takahashi Memorial Symposium & The 6th Japan-US Cancer Therapy International Joint Symposiu

Low serum albumin as a risk factor for infection-related in-hospital death among hemodialysis patients hospitalized on suspicion of infectious disease: a Japanese multicenter retrospective cohort study

Abstract Background Serum albumin is a marker of nourishment and inflammation. Although hypoalbuminemia in hemodialysis patients is reported as a risk factor for poor prognosis, few studies describe its effects on infectious diseases specifically. This study aimed to examine the relationship between the serum albumin level on admission and infection-related in-hospital death among hemodialysis patients. Methods This was a multicenter retrospective observational study that was undertaken in Japan. We reviewed the medical records of 507 hemodialysis patients aged > 18 years, whose blood cultures were obtained based on suspicion of infectious disease, and who were managed at seven Japanese tertiary dialysis units from August 2011 to July 2013. The outcome measure was infection-related in-hospital death. Multivariate logistic regression models adjusted for age, sex, the dialysis vintage, diabetes mellitus, bacteremia, and log C-reactive protein levels were used for the statistical analysis. Results Four hundred patients were analyzed and allocated to three groups based on their serum albumin levels: marked hypoalbuminemia (< 2.5 mg/dL), mild hypoalbuminemia (≤ 2.5–< 3.5 mg/dL), and normal albumin levels (≤ 3.5 mg/dL). The infection-related in-hospital death rates were 22.9% (n = 11), 12.5% (n = 25), and 4.6% (n = 7), respectively. The multivariate logistic regression models determined that a low serum albumin level was an independent risk factor for infection-related in-hospital death (odds ratio 0.35, 95% confidence interval 0.18–0.66). Conclusions A low serum albumin level strongly predicts infection-related in-hospital death in hemodialysis patients hospitalized on suspicion of infection. Like those with bacteremia or diabetes mellitus, hemodialysis patients with hypoalbuminemia require careful management of their infections

Radiotherapy with fraction size of 2.25 Gy in T1-2 laryngeal and hypopharyngeal cancer

This study was carried out to evaluate the influence of fraction size 2.25 Gy on local control of T1 and T2 laryngeal and hypopharyngeal cancers. Between August 2002 and December 2010, 80 patients with T1 and T2 laryngeal or hypopharyngeal cancers were treated with definitive radiotherapy with a fraction size of 2.25 Gy. Primary sites were the larynx in 69 and the hypopharynx in 11. Fifty-three patients wereT1 and 27 were T2. All patients pathology was squamous cell carcinoma except one carcinosarcoma.Radiotherapy was delivered 5 days/week with a 4-MV photon beam up to a total dose of 63.0 Gy. Median treatment time was 41 days. Statistical analysis of survival was calculated using the Kaplan&#8211;Meier method.No acute toxicity greater than grade 2 (CTCAE ver. 3.0.) including mucositis and dermatitis was observed.All but one patient had a complete response. The partial response patient received salvage surgery. The median follow-up period was 47 months (ranging from 4 to 108 months). No late toxicity greater than 1 was observed. Nine patients developed recurrence, seven local and two neck lymph nodes. Three patients died, one from laryngeal cancer and two from intercurrent diseases. The 5-year local control rates (LCRs) in the entire group, larynx T1, larynx T2 and hypopharynx T1 were 85.8%, 97.6%, 70.1% and 85.7%, respectively. The LCRs of T1 improved compared with our historical control, but not those of T2.The 2.25-Gy fraction size is safe and may have the potential to achieve good LCR in T1 lesions