Silent cerebral infarction predicts vascular events in hemodialysis patients

Silent cerebral infarction predicts vascular events in hemodialysis patients.BackgroundCardiovascular disease is the leading cause of death in hemodialysis (HD) patients. We have previously reported a higher incidence of silent cerebral infarction (SCI) in HD patients compared with the control group using MRI studies. In the present study, we examined whether or not SCI could predict vascular events in HD patients.MethodsCranial magnetic resonance imaging (MRI) was performed on 119 HD patients without symptomatic cerebrovascular disease. SCI was detected by MRI, and the patients were prospectively followed up. The end points of the study were the incidence of major events related to vascular events (cerebral events, cardiac events, and sudden deaths). We investigated the prognostic role of SCI in cerebral, cardiac, and vascular events by using the Kaplan-Meier method and Cox proportional hazards analysis.ResultsThe prevalence of SCI was 49.6% in HD patients. During a follow-up period of maximum 60 months, vascular events, which included 13 cerebral events, 5 cardiac events, and 3 sudden deaths, occurred in 21 patients. The presence of SCI was predictive for a higher cerebral and vascular morbidity compared to the absence of SCI [18.6% (N = 11) vs. 3.3% (N = 2), P = 0.0169, and 30.5% (N = 18) vs. 5.0% (N = 3), P = 0.0006, respectively]. By multivariate Cox proportional hazards analysis, SCI remained a powerful independent predictor of cerebral and vascular events (hazard ratio for cerebral events 7.33, 95% CI 1.27–42.25: for vascular events 4.48, 95% CI 1.09–18.41).ConclusionThe findings of the present study indicate that the presence of SCI is a new risk factor for vascular events in HD patients

ドルニエリソトリプターコンパクトを用いた上部尿路結石症に対する体外衝撃波による結石破砕術の経験

1997年5月～1998年2月の間に腎結石40例, 尿管結石40例(男性60例, 女性20例)についてドルニエリソトリプターコンパクトを用いた治療を行った.結石のサイズは5～80mmであった.大多数の症例は無麻酔で行ったが, 3例に硬膜外麻酔を必要とした.また4例に尿管ステント留置後に治療を行った.全ての症例において結石砕石は認められた.1ヵ月後の評価では砕石効果と完全排石率は91%と54%, 又, 3ヵ月後の評価では砕石効果と完全排石率は91%と68%であった.腎盂腎炎や腎周囲血腫, 大量の血尿等の重篤な副作用はみられなかった.ドルニエリソトリプターコンパクトは腎尿管結石の治療において安全で砕石効果が優れていると考えられたBetween May 1997 and February 1998, 40 cases of renal stones and 40 cases of ureteral stones in 60 males and 20 females were treated with the Dornier Lithotripter Compact. The size of the stones ranged from 5 mm to 80 mm. Three patients required epidural anesthesia and 4 patients required a ureteral stent. Fragmentation of the stones was observed in all patients. After 1 month, the efficacy and stone free rates were 91% and 54%, respectively. After 3 months, they were 91% and 68%, respectively. There were no serious side effects such as pyelonephritis, perirenal hematomas, and massive hematuria. In conclusion, the Dornier Lithotripter Compact proved to be a safe and highly effective lithotripter for the treatment of renal and ureteral stones

Hemodiafiltration in Japan: current status and future directions

Abstract Hemodiafiltration (HDF) therapy has become standard treatment in Japan and Europe, but evidence from Europe is not directly applicable to HDF in Japan because HDF therapy differs greatly in the two regions. Japanese dialysis membranes vary widely, including use of protein-leaking and non-leaking membranes, and the molecular weight of solutes that can be removed is generally larger in Japan than in Europe. Given the characteristics of pre-dilution, the volume of replacement fluid itself cannot be used as a marker for solute removal, and the relationship of this volume to life prognosis is still unknown. Under these circumstances, the JAMREDS, a multicenter study led by the Japanese Society for Hemodiafiltration, was started in April 2020. The goal of the study is to determine whether α1-microglobulin reduction rate can be used as a marker for the prognosis of hemodialysis patients, including life prognosis and cardiovascular event onset. The JAMREDS is being performed from a new perspective of solute removal by HDF. This research design is reasonable and highly original for HDF in Japan, in view of the wide variety of membrane types and treatment modes, and the results of the study will be of particular interest

Overseas Support in the Field of Vascular Access

Since joining the Non-Governmental Organization Ubiquitous Blood Purification International in 2014, professionals who are mainly members of the Japanese Society for Dialysis Therapy (JSDT) have worked toward promoting dialysis therapy in several countries through help with organization of local nephrology societies and conducting educational activities. Since 2016, training at our hospital has been provided for doctors and dialysis staff from these countries as part of the activities of the JSDT. These activities also involve technical training for vascular access (VA) surgery and management. To date, lectures and practical teaching on VA procedures have been given in Cambodia and Vietnam, and a hands-on seminar on echo-guided puncture and VA management was held in Mongolia. In Mongolia and Myanmar, a plan to provide systemic VA surgery education has been developed, at the request of local nephrology societies. Doctors and medical staff from Vietnam, Laos, Cambodia, Nepal and Indonesia have visited our hospital and have observed operations as part of their training. To achieve sustainable medical support and academic activities, we have found it to be important to have a counterpart society in each country, and guidance has been provided when required on organization of a national nephrology society

Comparison of Glucose Tolerance between Kidney Transplant Recipients and Healthy Controls

Post-transplant hyperglycemia and new-onset diabetes mellitus after transplantation (NODAT) are common and important metabolic complications. Decreased insulin secretion and increased insulin resistance are important to the pathophysiologic mechanism behind NODAT. However, the progression of glucose intolerance diagnosed late after kidney transplantation remains clearly unknown. Enrolled in this study were 94 kidney transplant recipients and 134 kidney transplant donors, as the healthy controls, who were treated at our institution. The 75 g-oral glucose tolerance test (OGTT) was performed in the recipients, and the healthy controls received an OGTT before donor nephrectomy. We assessed the prevalence of glucose intolerance including impaired fasting glucose and/or impaired glucose tolerance, as well as insulin secretion and insulin resistance using the homeostasis model assessment, and compared the results between the two groups. Multivariate analysis after adjustment for age, gender, body mass index, estimated glomerular filtration rate, and systolic blood pressure showed that the prevalence of glucose intolerance, insulin resistance, insulin secretion, and 2 h plasma glucose levels were significantly higher in the kidney transplant recipients compared to the healthy controls. Elevation of insulin secretion in kidney transplant recipients may be compensatory for increase of insulin resistance. Impaired compensatory pancreas β cell function may lead to glucose intolerance and NODAT in the future

The clinical significance of BK viremia and the effect of cyclosporine and/or mizoribine on BK virus infection

Introduction: The diagnosis of BK virus nephropathy is based on renal biopsy findings, and the diagnosis of presumptive BK virus nephropathy is made by sustained plasma BK virus DNA loads of > 4 log10 copies/ml. However, the BK virus plasma viral load cutoff of 4 log10 copies/ml may underestimate the diagnosis of BK virus nephropathy. In this study, we evaluated the clinical significance of BK viremia in kidney transplant recipients. Patients and Methods: From January 2010 to November 2015, we experienced 8 kidney transplant recipients who developed BK viremia. We retrospectively analyzed these recipients, focusing on the plasma BK viral load at onset of BK viremia, time to BK viremia after transplantation, frequency of BK virus nephropathy, and our treatment for BK viremia. Results: The median plasma BK virus polymerase chain reaction at the diagnosis of BK viremia was 1600 copies/ml (370–9400 copies/ml). The median time to BK viremia after transplantation was 10.9 months (1.4–67.9 months). Three patients were associated with BK virus nephropathy on biopsy. Clearance of BK viremia was observed in all of these cases after intervention. Conclusions: Our study demonstrated that intervention in BK viremia with a viral load of < 4 log10 copies/ml may be needed to prevent the development of graft dysfunction and BK virus nephropathy in kidney transplant recipients. Keywords: BK virus, BK viremia, Kideny transplantation, Mizoribine, Cyclosporin