Renal Replacement Therapy
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Timing-adjusted iron dosing enhances erythropoiesis-stimulating agent-induced erythropoiesis response and iron utilization
Renal Replacement Therapy - Tập 3 - Trang 1-7 - 2017
We recently demonstrated, using an index of recently synthesized hemoglobin, reticulocyte hemoglobin (Ret-Hb), that iron administration remarkably improves hemoglobin (Hb) synthesis during the period of high activation of erythropoiesis induced by the administration of a continuous erythropoietin receptor activator (CERA). We aimed to investigate whether repetition of iron dosing sustains effective erythropoiesis and suppresses iron storage. In a 3-month comparison of monthly CERA administration, 104 hemodialysis patients were randomized into two groups that received 40 mg iron intravenously 3 times; the first-week iron group [n = 51], given iron in the first week after CERA administration, during the period of high activation of erythropoiesis, and the third-week iron group [n = 53], given iron in the third week at the time of mild erythropoiesis activation. Initial mean CERA dosages were 123.5 ± 67.5 μg/month and did not differ between the groups. Hb levels were not different between the groups throughout the study. One-week increases in Ret-Hb levels after CERA administration were higher, during the first and the third month, in the group given iron in the first week compared with the third-week iron group (241.9 ± 63.3 vs. 196.2 ± 82.8 mg/dL, P = 0.004; 227.2 ± 83.5 vs. 187.9 ± 88.7 mg/dL, P = 0.037, respectively). The increase in ferritin levels was suppressed 3 months later in the first-week iron group compared with that of the third-week iron group (22.3 ± 64.0 vs. 69.0 ± 76.6 ng/mL, P = 0.002). Hepcidin levels decreased 1 week after CERA administration in both groups and were not different between the groups. Timing-adjusted iron administration increased the levels of recently produced Hb and iron utilization and suppressed the ferritin levels. The iron administration timing deserves consideration when optimizing the efficiency of erythropoiesis-stimulating agents in patients undergoing hemodialysis.
UMIN000016375
. Registered 29 January 2015.
Annual Dialysis Data Report 2015, JSDT Renal Data Registry
Renal Replacement Therapy - Tập 4 - Trang 1-99 - 2018
The annual survey of Japanese Society for Dialysis Therapy Renal Data Registry (JRDR) was conducted for 4380 dialysis facilities at the end of 2015, among which 4321 facilities (98.7%) responded. The response rate of the 2015 survey was comparable with the past, even though it was the first year after the new anonymization method. The number of chronic dialysis patients in Japan continues to increase every year; it has reached 324,986 at the end of 2015. The mean age was 67.86 years. At the end of 2015, the prevalence rate was 2592 patients per million population. Diabetic nephropathy was the most common primary disease among the prevalent dialysis patients (38.4%), followed by chronic glomerulonephritis (29.8%) and nephrosclerosis (9.5%). The rate of diabetic nephropathy and nephrosclerosis has been increasing year by year, whereas that of chronic glomerulonephritis was declining. The number of incident dialysis patients during 2015 was 39,462; it has remained stable since 2008. The average age was 69.20 years, and diabetic nephropathy (43.7%) was the most common cause in the incident dialysis patients. These patients caused by diabetes did not change in number for the last several years. Meanwhile, 31,608 patients died in 2015; the crude mortality rate was 9.6%. The patients treated by hemodiafiltration (HDF) have been increasing rapidly from the revision of medical reimbursement for HDF therapy in 2012. It has attained 53,776 patients at the end of 2015, which were 10,493 greater than that in 2014. In particular, the number of online HDF patients increased about ten times 2012. The number of peritoneal dialysis (PD) patients was 9322 in 2015, which was slightly increased than 2014. Twenty percent of PD patients treated in the combination of hemodialysis (HD) or HDF therapy. Five hundred seventy-two patients underwent home HD therapy at the end of 2015; it increased by 43 from 2014. Further JRDR data analyses could clarify the relationships between various dialysis modalities, patient care, and clinical outcomes; furthermore, it could also make it possible to establish clinical practice guidelines or medical reimbursement revisions based on the evidence. JRDR was approved by the ethical committee of JSDT and has been registered in the “University hospital Medical Information Network (UMIN) Clinical Trials Registry” as an approved number of
UMIN000018641
since 2015.
The dipeptidyl peptidase-4 inhibitor may improve the insulin secretion in type 2 diabetes patients just after starting hemodialysis treatment: preliminary study
Renal Replacement Therapy - Tập 2 - Trang 1-5 - 2016
Dipeptidyl peptidase-4 inhibitors (DPP-4i) have become widely used in hemodialysis patients with type 2 diabetes mellitus (T2DM). This study aimed at testing the hypothesis that administration of alogliptin, a DPP-4i, soon after hemodialysis initiation improves beta cell function in hemodialysis patients with T2DM. Patients with end-stage renal disease and T2DM (n = 10) not previously treated with DPP-4i (mean age, 54.2 years) were enrolled. The study end point was the acute insulin response to glucose assessed by a frequently sampled intravenous glucose tolerance test (IVGTT) that was conducted during the hemodialysis session just before lunch using an external circulation circuit. All patients received 6.25 mg alogliptin for 2 weeks. Blood glucose (Glu), serum insulin (IRI), and C-peptide (CPR) were measured before (0 min) in addition to 5 and 15 min after the glucose load. Glucagon-like peptide-1 (GLP-1) was measured before the glucose load. Glu(0) significantly decreased after the 2-week DPP-4i treatment (174 ± 20 vs. 150 ± 27 mg/dL, P = 0.023). IRI(5) significantly increased after the DPP-4i treatment (14.6 ± 31.7 vs. 23.4 ± 16.6 μU/mL, P = 0.038), but IRI(0) and IRI(15) did not change significantly. GLP-1 also significantly increased after the DPP-4i treatment (6.6 ± 4.4 vs. 2.6 ± 0.8 pmol/L, P = 0.012). Inhibition of DPP-4 with alogliptin improved endogenous insulin secretion in response to intravenous glucose in hemodialysis patients with T2DM.
Successful renal transplantation following hemodialysis as bridging therapy in a patient with Fechtner syndrome: a case report and literature review
Renal Replacement Therapy - Tập 9 - Trang 1-7 - 2023
Fechtner syndrome, also referred to as nonmuscle myosin heavy chain 9-related disease (MYH9-RD), is an autosomal-dominant genetic disorder. It is caused by abnormalities in the MYH9 gene, which encodes the nonmuscle conventional (class II) myosin heavy chain A (NMMHC-IIA). Its clinical manifestations include mild macrothrombocytopenia with leukocyte inclusions, hearing loss, cataracts, and renal failure. We present the case of a 34-year-old female patient with Fechtner syndrome in whom end-stage renal disease (ESRD) developed. During childhood, she presented with the typical symptoms of MYH9-RD, including thrombocytopenia, leukocyte inclusion bodies, onset of nephropathy, sensorineural hearing loss, and cataracts, wherein a clinical diagnosis of Fechtner syndrome was established. Her renal function deteriorated during adolescence. Furthermore, the patient underwent renal biopsy at the age of 18 years, which revealed focal segmental glomerulosclerosis. She was started on hemodialysis at the age of 33 years, followed by a living-donor renal transplantation after 5 months. She achieved a target platelet count of 50 × 109/L for arteriovenous fistula creation and 100 × 109/L for renal transplantation via platelet transfusions. Heparin use was avoided as an anticoagulant during hemodialysis. Since the patient expressed a desire for childbearing, genetic testing was performed, revealing an in-frame deletion of 21 nucleotides at 3195–3215 in exon 25 (A1065_A1072 del) of NMMHC-IIA, which has been reported to correlate with mild renal dysfunction. Our patient’s condition progressed into ESRD. Although genetic testing techniques have made great strides in recent years, our case clearly presents the difficulty in assuming an association between genetic abnormalities and clinical manifestations. Our case may provide further understanding of the management of ESRD in patients with MYH9-RD-related thrombocytopenia based on the results of genetic testing.
Historical overview and current practice of peritoneal dialysis in Japan
Renal Replacement Therapy - Tập 8 - Trang 1-7 - 2022
In the early days of peritoneal dialysis (PD) therapy, its limited duration and peritoneal deterioration were argued to be its disadvantages. Biocompatible solutions and hybrid therapy have been used in Japan to overcome these issues, which resulted in a decrease in encapsulating peritoneal sclerosis (EPS) incidence and an extension of PD continuation; these results have been disseminated worldwide. Peritoneal dialysis outcomes and practice patterns study (PDOPPS), a prospective observational study, has begun to confirm the outcomes of PD therapy, and sufficient evidence has been published, which has influenced the preparation of PD guidelines. Current thinking about PD emphasizes the need to maintain quality of life and life goals as care goals for patients and to provide high-quality care. However, we must conduct basic research on the prevention of peritoneal deterioration.
Assisted peritoneal dialysis: strategies and outcomes
Renal Replacement Therapy - Tập 8 - Trang 1-7 - 2022
Assisted peritoneal dialysis (asPD) is a modality intended for not self-sufficient patients, mainly elderly, who are not able to perform peritoneal dialysis (PD) alone and require some help to manage the treatment. In the last decades, many countries developed strategies of asPD to face with aging of dialysis population and give an answer to the increasing demand of health service for elderly. Model of asPD varies according to the type of assistants employed and intensity of assistance provided. Both health care and non-health care assistants have been used with good clinical results. A mixed model of help, using different professional figures for short time or for longer according to patients’ need, has been proved successful and cost-effective. Outcomes of asPD are reported in different ways, and the comparative effect of asPD is unclear. Quality of life has rarely been evaluated; however, patients seem to be satisfied with the assistance provided, since it allows them to both retain independence and to be relieved from the burden of self-care. Assisted PD should not be intended as a PD-favoring strategy, but as a model that allows home dialysis also in patients who would not be eligible for PD because of social, cognitive or physical barriers.
Relationship between blood pressure response during hemodialysis and exercise tolerance or heart rate recovery measured using cardio-pulmonary exercise testing in maintenance hemodialysis patientsAbstract
Background
Methods
Results
Conclusion
Renal Replacement Therapy - Tập 6 Số 1 - 2020
This study investigated the association between the blood pressure response during hemodialysis (HD) and exercise tolerance or heart rate recovery (HRR) measured with cardiopulmonary exercise testing (CPX).
The study enrolled 23 patients who had been undergoing 4-h regular maintenance HD. The maximum workload (Loadpeak), peak oxygen uptake (VO2peak), workload and oxygen uptake at the anaerobic threshold (LoadAT and VO2AT, respectively), and HRR were measured with CPX. The average systolic blood pressure during HD (SBPav) was measured, and the number of times the SBP was less than 100 mmHg was determined in the 2-week period after CPX.
The SBPav showed a significant correlation with LoadAT (
Exercise intolerance and HRR in HD patients may be associated with blood pressure instability during HD.
Fat embolism syndrome after humerus and pelvis fracture complicated by acute kidney injury requiring blood purification: a case report and literature reviewAbstract
Background
Case presentation
Conclusions
Renal Replacement Therapy - Tập 9 Số 1
Fat embolism syndrome (FES) is a rare syndrome that typically occurs 12–72 h after long bone or pelvic fractures with a classic triad of respiratory distress, neurologic changes, and petechial rash. Although Gurd’s criteria for FES include anuria or oliguria, the mechanism of acute kidney injury (AKI) remain unknown. Here, we present a case of FES complicated by AKI that required blood purification.
A 79-year-old woman was admitted to our hospital because of a right humerus and pelvic fracture caused by a traffic accident. On the second day of hospitalization, she developed impaired consciousness, respiratory failure, and disseminated intravascular coagulation (DIC). Chest radiography revealed bilateral diffuse alveolar infiltration. Brain magnetic resonance imaging revealed diffuse high signal intensity on diffusion-weighted imaging and diffuse low signal intensity on susceptibility-weighted imaging in the cerebral and cerebellar regions. The diagnosis of FES was confirmed and the patient was treated with methylprednisolone (40 mg/day) and ulinastatin. On the third day of hospitalization, she was admitted to our department because of AKI with oliguria. Although echocardiography showed an elevated right ventricular artery systolic pressure suggestive of pulmonary hypertension (PH), pulmonary congestion was initially considered on chest imaging, and hemodialysis and rapid ultrafiltration were initiated. However, she developed hypovolemic shock and treatment was switched to continuous hemodiafiltration and slow ultrafiltration. Thereafter, her consciousness, hypoxemia, DIC and PH completely improved. She was weaned from blood purification therapy on the 29th day of hospitalization. She had hemolytic anemia that might have been caused by thrombotic microangiopathy (TMA), but it resolved without plasmapheresis. On the 51st day of hospitalization, the patient was transferred to another hospital for rehabilitation.
FES can be complicated by AKI. In this case, DIC, which was difficult to differentiate from TMA, and/or renal congestion were considered to be a cause of AKI. Chest radiographs of FES may be indistinguishable from pulmonary congestion. In our case, chest radiography showed bilateral diffuse alveolar infiltrates which was not indicative of pulmonary congestion but pulmonary involvement of FES. FES is associated with PH, which may lead to right heart failure. Therefore, the patient could have developed hypovolemic shock due to hemodialysis and rapid ultrafiltration. Clinicians should pay attention to the hemodynamics when blood purification for FES is performed.
Consensus-based proposal for forgoing dialysis therapy in Japan
Renal Replacement Therapy - Tập 8 - Trang 1-7 - 2022
The Japanese Society for Dialysis Therapy published a proposal in 2014 and revised it to Shared Decision Making for the Initiation and Continuation of Dialysis: A Proposal from the Japanese Society for Dialysis Therapy in 2020 to strictly adhere to guidelines of the Ministry of Health, Labour and Welfare, because forgoing life-sustaining treatment to respect the will of patients in end-of-life care is not stipulated by law in Japan. The revised proposal describes the process of providing information about renal replacement therapy, the natural course of end-stage kidney disease, and conservative kidney management (CKM), the conditions when providing CKM information to be considered by healthcare teams, the process of providing information about CKM if patients with decision-making capacity or families of patients without decision-making capacity wish to make the decision to forgo dialysis, the process of shared decision making for choosing CKM, and the importance of performing advance care planning (ACP) with patients and their families for making advance directives, etc. We need to promote ACP and to establish the content and practice of palliative care for patients after choosing CKM in collaboration with home-cased care doctors.
Triglyceride to high-density lipoprotein cholesterol ratio predicts cardiovascular events in maintenance hemodialysis patients
Renal Replacement Therapy - Tập 2 - Trang 1-8 - 2016
The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio has been shown to be a predictor of cardiovascular (CV) outcomes in the general population. The aim of this study was to determine whether the TG/HDL-C ratio is a predictor of CV events and all-cause mortality in maintenance hemodialysis (MHD) patients. We performed a retrospective, observational cohort study in which we enrolled 193 MHD patients from a single center in Japan who had been followed up for a median of 3.9 years. The outcomes were the occurrence of a CV event and all-cause mortality during the follow-up period. Baseline TG/HDL-C ratios were investigated for associations with outcomes by using Cox regression models adjusted for demographic parameters. Overall, 88 of the subjects experienced a CV event, and 32 patients had died, of whom 4 died due to CV events. Patients with higher TG/HDL-C levels (tertile 3) had a higher incidence of CV events (adjusted hazard ratio [HR] 1.82, 95 % confidence interval [CI] 1.01–3.35) and higher all-cause mortality (adjusted HR 6.13, 95 % CI 2.13–20.22) than the patients in tertile 1. Kaplan–Meier analyses by the log-rank test showed that the TG/HDL-C ratio had significant predictive power for detecting a CV event. The TG/HDL-C ratio is a reliable and easily accessible marker for predicting CV events and mortality in MHD patients.
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