Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

<title>Abstract</title><sec>
<title>Background</title>
The Japanese population is aging quickly. New methods of supporting peritoneal dialysis (PD) for elderly patients are essential if we are to increase the number of such patients.


</sec><sec>
<title>Methods</title>
We established a two-way communication system between a central hospital and stations for visiting nurses. Home care nurses provided physicians at the central hospital with clinical findings for patients undergoing assisted PD. We compared 11 patients undergoing PD assisted by home care nurses in continuous interactive communication with the central hospital (cases) with 11 patients undergoing unassisted PD who were matched by sex, primary disease, estimated glomerular filtration rate at the start of PD, and age at the start of PD (controls). The variables compared were hospitalization due to heart failure, exit-site infection, peritonitis, and the composite of these causes during a 1-year period. In addition, we compared patient clinical factors between groups.


</sec><sec>
<title>Results</title>
Although differences in the number of hospitalizations attributable to exit-site infection, peritonitis, and heart failure were not significant, the difference in the number of hospitalizations attributable to a composite of these causes was significant. Exit-site scores were significantly better in the case group than in the control group.


</sec><sec>
<title>Conclusions</title>
PD assisted by home care nurses using an established continuous interactive communication system was associated with significantly better exit-site scores. Fewer cases than controls were hospitalized.


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DOI： 10.1186/s41100-021-00359-3

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

<title>Abstract</title><sec>
<title>Background</title>
Renal anemia is the important complication in patients undergoing peritoneal dialysis (PD), and heart failure (HF) is the important complication in patients on dialysis. Decreasing endogenous erythropoietin (EPO) in patients with chronic kidney disease is a major cause of renal anemia. On the other hand, high levels of EPO have been associated with the prognosis of patients with chronic HF. The association between plasma EPO and HF in patients on PD remains unclear. This study was designed to test our hypothesis that the plasma EPO level in patients on PD was associated with the markers of HF.


</sec><sec>
<title>Methods</title>
We investigated 39 patients undergoing PD at our hospital. We measured plasma EPO before erythropoiesis-stimulating agent (ESA) administration at the regular outpatient visits and then at 2 weeks after the final dose of ESA was administered and investigated the clinical factors. We estimated the correlations between the plasma EPO and the other parameters, and constructed univariate and multivariate logistic regression models for the risk for HF to estimate the effectiveness of plasma EPO and other factors on HF treatment in patients undergoing PD.


</sec><sec>
<title>Results</title>
The plasma EPO concentration was positively correlated with the ESA dose and negatively correlated with serum ferrum, transferrin saturation, and body mass index and showed no correlation with other factors, such as the New York Heart Association (NYHA) classification and ferritin level. In univariate analysis, the factors significantly associated with HF risk were N-terminal pro-brain natriuretic peptide (NT-pro BNP), cardiothoracic ratio (CTR), serum creatinine (Cr), serum beta 2 microglobulin, dialysate dose, left ventricular mass index, left ventricular end-systolic diameter, left ventricular end-diastolic diameter, and weekly Kt/V. We performed a multivariate analysis with NT-pro BNP, Cr, and CTR, and all three factors were significant in the analysis.


</sec><sec>
<title>Conclusion</title>
The plasma EPO level in patients undergoing PD was positively correlated with the monthly ESA dose and was not significant as a marker of HF, as judged with the NYHA classification. Therefore, the plasma EPO level may not be a useful marker for HF in patients undergoing PD.


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DOI： 10.1186/s41100-021-00319-x

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Other Link： http://link.springer.com/article/10.1186/s41100-021-00319-x/fulltext.html

Language：English  

DOI： 10.1093/omcr/omab103

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Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The number of patients on peritoneal dialysis (PD) in our hospital has increased during the past 5 years, but the number discontinuing PD has also increased. The purpose of this study was to identify the risk factors for PD discontinuation by analyzing the association between technical survival period (defined as the duration of PD) and various clinical factors. METHODS: We retrospectively investigated 87 patients who were started on PD at our hospital and attended regularly from April 2015 to March 2020, and we analyzed the association between technical survival period and various clinical factors. We also looked for associations between technical survival period and hospitalizations for heart failure, peritonitis, and exit-site infections among patients undergoing PD. RESULTS: The patients using renin-angiotensin-aldosterone system inhibitors (RASi) (P = 0.0218), those with left ventricular ejection fraction (LVEF) > 50% (P = 0.0194) when they started PD, and those with estimated glomerular filtration rate (eGFR) ≥ 6 (mL/ min/1.73m2) (P = 0.0013) at the initiation of PD showed significantly longer technical survival period, and those who were hospitalized for heart failure had significantly shorter period (P = 0.0008). CONCLUSION: Treatment of RASi, LVEF > 50% and eGFR ≥ 6 mL/ min/1.73m2 when the initiation of PD and better volume control to prevent ultrafiltration failure and heart failure may improve technical survival period in patients undergoing PD.

DOI： 10.1272/jnms.JNMS.2022_89-201

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BACKGROUND: Peritonitis is one of the most common complications in patients who are undergoing peritoneal dialysis (PD). However, it is difficult to predict or prevent the onset of endogenous peritonitis. In this study, we investigated the risk of developing endogenous peritonitis in patients receiving PD. METHODS: We included all of the patients who underwent PD at our hospital from April 2015 to March 2020. There were 22 cases of peritonitis, including 18 cases of endogenous peritonitis without evidence of exit-site infection or technical failure. We considered older age, female sex, obesity, diabetes mellitus, diverticulosis, and constipation as important risk factors for endogenous peritonitis. We included these as confounding factors with a current or previous history of smoking in univariate logistic regression models. RESULTS: In this study, previous or current history of smoking (p = 0.0065) was the most significant risk factor for endogenous peritonitis in univariate logistic regression model. In addition, smoking was also the most significant independent risk factor for endogenous peritonitis (p = 0.0034) in our multivariate logistic regression models. It was not primary objective that diabetes mellitus was also significant in univariate and multivariate logistic regression analysis. CONCLUSIONS: Smoking is the significant independent risk factor for endogenous peritonitis in patients undergoing PD. The discontinuation of smoking may lower the risk of endogenous peritonitis in this patient group.

DOI： 10.1272/jnms.JNMS.2021_88-604

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Language：Japanese   Publisher：日本内科学会-関東地方会  

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Language：English   Publishing type：Research paper (scientific journal)  

Purpose: Peritoneal dialysis (PD)-related peritonitis and lower limb ulcer are the important complications in patients undergoing PD. Although the association between lower limb ulcer and peritonitis in patients undergoing PD is unclear, based on our clinical experience and the clinical importance of the complications in patients undergoing PD, we hypothesized that lower limb ulcer is associated with peritonitis in patients on PD. Patients and Methods: In this single center, retrospective cohort study, we studied 87 patients who started undergoing PD at our hospital from April 2015 to March 2020. We compared these 8 patients with lower limb ulcer with the other 79 patients without lower limb ulcer. We compared between the patients in the objection period of this study about peritonitis using Log rank test, and used the unpaired t-test and Fisher's exact test to compare the clinical factors between the two groups. Moreover, we used univariate and multivariate logistic regression analyses to study the association of PD-related peritonitis with the clinical factors. Results: The period developed first peritonitis of the patients on PD with lower limb ulcer was significant shorter than those without lower limb ulcer in Log rank test (P = 0.011). The Fisher's exact test and unpaired t-test showed that the difference in the prevalence of PD-related peritonitis (P = 0.009), peritonitis/patient years (P = 0.036), the BMI (P = 0.007) and icodextrin (P = 0.001) were significant. Lower limb ulcer had significant associations with peritonitis in patients on PD in both univariate [odds ratio (OR) 8.461, 95% confidence interval (CI) 1.854-45.60, P = 0.006] and multivariate [OR 7.169, 95% CI 1.519-39.480, P = 0.013] logistic regression analysis. Conclusion: In conclusion, lower limb ulcer may be associated with peritonitis in patients undergoing PD. Further large-scale, prospective studies are required to confirm these results.

DOI： 10.2147/IJNRD.S295948

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Peritonitis is a common complication of peritoneal dialysis (PD) and can result in PD catheter removal, permanent hemodialysis, and, potentially, death. Prediction and prevention of PD-related peritonitis are thus extremely important. In 2016, the International Society for Peritoneal Dialysis published guidelines for patients with peritonitis undergoing PD. The guidelines cover most cases of PD-related peritonitis caused by bacteria and include clear indications for catheter removal. However, difficulties often arise when deciding the timing of catheter removal. When multiple enteric organisms are identified in a culture of dialysis effluent, peritonitis may be caused by intra-abdominal pathology, which is associated with substantial mortality. In such cases, catheter removal is considered. In this report, we describe a case in which, during antibiotic therapy for PD-related peritonitis due to Enterococcus faecalis alone, the patient developed a relapse of peritonitis caused by a newly detected Gram-negative, rod-like Pseudomonas aeruginosa. He required catheter removal because of the possibility of peritonitis recurrence. Although additional study is required, early catheter removal may be effective when a new organism is detected during antibiotic therapy for PD-related peritonitis caused by an organism not meeting the definition of refractory peritonitis.

DOI： 10.1272/jnms.JNMS.2020_87-511

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Language：Japanese   Publisher：(一社)日本アフェレシス学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本臨床薬理学会  

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Language：English   Publisher：Medical Association of Nippon Medical School  

DOI： 10.1272/jnms.2018_85-11

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Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1007/s11255-015-1118-6

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DOI： 10.1007/s13730-012-0041-2

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Language：English   Publisher：ELSEVIER SCIENCE BV  

DOI： 10.1016/j.cca.2011.09.024

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Language：Japanese   Publishing type：Research paper (scientific journal)  

It has been reported that glomerulosclerosis with IgA deposition is likely to be complicated with alcoholic liver cirrhosis. On the other hand, it is said that complications of nephrotic syndrome or rapidly progressive glomerulonephritis (RPGN) are relatively rare. We experienced two patients with alcoholic liver cirrhosis complicated with RPGN syndrome who had obtained favorable outcomes through the use of steroids and immune system suppressors. Case 1 was a 55-year-old male. He was being treated for alcoholic liver cirrhosis, but as bloody urine was noticed macroscopically, his renal function rapidly decreased. Specimens from a renal biopsy showed endocapillary proliferative lesions accompanying necrotic lesions. Granular deposition of IgA(IgA1) and C3 was seen along the capillary walls and in the mesangial areas. After the combined treatments of bilateral palatotonsillectomy, three courses of steroid semi-pulse therapy and post-therapy with steroids and mizoribin (MZR) were started, his hematuria and proteinuria disappeared and renal function improved markedly. Case 2 was a 37-year-old male with alcoholic liver cirrhosis complicated with hepatic encephalopathy. Although he was being treated at another hospital, nephritic syndrome occurred with rapidly worsening renal function and massive ascites. After continuous drainage of the ascites, we performed a renal biopsy. Mild proliferative lesions and notable wrinkling, thickening and doubling of the basal membrane were seen. Crescent formations were found in about half of the glomeruli. The fluorescent antibody technique showed positive pictures of IgA (IgA1) and C3. When three courses of steroid semi-pulse therapy and post therapy with steroids and MZR were combined, his proteinuria and serum Cre level decreased and stagnated ascites markedly decreased. The two cases were diagnosed as having secondary IgA nephropathy induced by the deposition of the IgA1 derived mainly from the intestinal tract, which had increased in the blood due to alcoholic liver cirrhosis. Active use of immune system suppressor therapy was effective.

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Language：English   Publisher：The Medical Association of Nippon Medical School  

A 72-year-old man was admitted to our hospital because of progressive renal dysfunction persisting for 1.5 months. Physical examination showed livedo reticularis of the toes of both feet, peripheral edema, and gait disturbance due to the toe pain. The levels of blood urea nitrogen (50.0 mg/dL) and creatinine (2.81 mg/dL) were elevated, and eosinophilia (10%, 870/μL) was noted. A biopsy of the area of livedo reticularis revealed cholesterin crystals. The patient had not undergone angiography, anticoagulation therapy, or antithrombotic treatment. Idiopathic cholesterol crystal embolization was diagnosed. Transesophageal echocardiography revealed intimal thickening of the aorta and plaque. Oral steroid therapy was started because of the progressive renal dysfunction. After steroid therapy, the symptoms improved. Early diagnosis and treatment are important. Renal dysfunction is a common symptom in elderly patients. Cholesterol crystal embolization should also be considered as a cause of unexplained renal dysfunction, especially in such patients.<br>

DOI： 10.1272/jnms.78.252

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(株)東京医学社  

骨粗鬆症の疑いで二重エネルギーX線吸収測定法(DXA)による骨密度測定を行った腹膜透析患者20例を対象として、骨粗鬆症の実態および骨量に影響を与える因子について検討した。DXAの結果、骨粗鬆症は4例、骨減少症は9例に認め、DXA測定時の生化学的検査、栄養状態、骨代謝マーカー、体重、BMIと骨密度との関連性について検討した結果、BMDと相関する患者背景は脆弱性骨折の有無のみであり、重回帰分析においてBMDの値を予測する独立した因子はALP、NT-proBNP、TRACP-5bであった。また、骨粗鬆症の発症に対する多重ロジスティック分析の多変量解析では有意な因子はなく、最も重要と思われる因子はALPであった。腹膜透析患者においても骨粗鬆症の診療にあたっては骨密度と骨代謝マーカーを総合的に評価する必要があることが示唆された。

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

J-GLOBAL

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Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：(株)東京医学社  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：臨床体液研究会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：臨床体液研究会  

多発性嚢胞腎(PKD)患者におけるトルバプタン中止の短期的影響について検討した。ADPKD患者9例を対象とし、内服中止を選択したADPKD 6例(男性3名、女性3名、46.8±8.1歳)を中止群、治験終了後も同量継続した1例と減量し継続した2例の計3例(男性2名、女性1名、47.0±4.6歳)を継続群とした。両群間の治験終了前後の1/Cr、eGFR、及び腎容積の低下速度は有意に変化しなかった。中止群で休薬後に尿量減少の自覚はあったが血清Na値は有意に変化せず、尿比重も低値のままであった。高用量トルバプタンを12ヵ月の短期間中止しても有意な腎機能の悪化を認めなかった。長期にわたる飲水習慣がついていたため、中止群では治験中程ではないが、治験終了後も多くの水分摂取を自己継続し、水分摂取、体液量維持が腎機能保持に重要であると思われた。

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：日本内科学会-関東地方会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本移植学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2014298113

Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Other Link： http://search.jamas.or.jp/link/ui/2013173189

Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：日本内科学会-関東地方会  

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Language：Japanese   Publisher：(一社)日本内科学会  

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Language：Japanese   Publisher：(一社)日本内科学会  

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Language：Japanese   Publisher：日本神経治療学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

アルコール性肝硬変にIgA沈着を伴う糸球体硬化症を合併しやすいことは以前から報告されているが、ネフローゼ症候群や急速進行性腎炎症候群をきたすことは比較的稀といわれている。急速進行性腎炎症候群を合併したアルコール性肝硬変患者に対し、副腎皮質ステロイド薬(以下、ステロイド)、免疫抑制薬を使用し良好な経過を得た2例を経験した。症例1は55歳、男性。アルコール性肝硬変にて消化器内科通院中であったが、肉眼的血尿を認めた後、急速に腎機能が低下した。腎生検像は壊死性病変を伴う管内増殖性病変を呈し、蛍光抗体法ではIgAとC3のparamesangiumから係蹄壁への沈着を認めた。沈着しているIgAのサブタイプはIgA1であった。両側口蓋扁桃摘出術および、3クールのステロイドセミパルス療法、後療法としてステロイドにミゾリビン(MZR)を併用した。血尿および蛋白尿は陰性化し、腎機能も著明な改善を示した。症例2は37歳、男性。アルコール性肝硬変から肝性脳症をきたし、他院で加療中であったが、ネフローゼ症候群に加え腎機能も急速に悪化、大量の腹水を認めたため当科に転院となった。腹水持続ドレナージ後に腎生検を施行、糸球体は全体的にやや虚脱傾向を伴い、分節性から全節性の軽度の増殖性病変を認め、係蹄基底膜のwrinkling、肥厚や二重化が目立った。また、約半分の糸球体に半月体の形成を認めた。蛍光抗体法ではIgAとC3を主体とした陽性像が見られ、IgAのサブタイプはIgA1であった。3クールのステロイドセミパルス療法、後療法としてステロイドにMZRを併用したところ、蛋白尿の減少とともに血清Cre値の低下を認め、腹水の貯留も劇的に減少した。2症例ともアルコール性肝硬変により血中に上昇した、主に腸管由来IgA1の糸球体への沈着が引き金となった二次性IgA腎症と診断した。積極的な免疫抑制療法が有効であった。(著者抄録)

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Language：Japanese   Publisher：(株)東京医学社  

51歳男。高血圧、糖尿病、慢性腎不全にて通院中であり、膜透析導入されていた。今回、腹痛が出現し、血性の排液を認め入院となった。腹部CTで上腸間膜動脈走行部位に造影効果のない腫瘤を認め、MRIのT1強調画像でhigh、T2でlowを呈したため血腫が疑われ、同部位からの漏出が血性排液の原因と判断した。腹部透析は一時中止し、腹腔内洗浄のみとして血液透析を実施したところ、腹痛は入院後2日で消失し、血性排液は数日後に自然消失した。

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：(一社)日本腎臓学会  

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Language：Japanese   Publisher：(一社)日本透析医学会  

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Language：Japanese   Publisher：日本内科学会-関東地方会  

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Language：Japanese   Publisher：日本医科大学医学会  

Chronic kidney disease (CKD) is defined by two criteria. One criterion is abnormal renal function or morphology, especially proteinuria. A second criterion is an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73m² calculated with the serum creatinine concentration. CKD is classified on the basis of eGFR from stage 1 to stage 5. CKD is a common cause of cardiovascular disease (CVD). CVD is a major cause of morbidity and mortality in patients with CKD. Management of hypertension in patients with CKD aims to prevent CVD and provide renoprotection. First-line agents for controlling blood pressure are inhibitors of the renin-angiotensin system: angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. These agents are superior to other classes of antihypertensive agents in reducing the amount of urinary protein and in preserving renal function. In CKD, the target blood pressure is less than 130/80mmHg, and 125/75mmHg, if the amount of urinary protein is more than 1g/day. To achieve the target blood pressure, other classes of antihypertensive agents, such as diuretics and calcium channel blockers, should also be administered.<br>

DOI： 10.1272/manms.6.17

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本内科学会-関東地方会  

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Language：Japanese   Publisher：(一社)日本内科学会  

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Language：Japanese  

CiNii Books

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Other Link： http://search.jamas.or.jp/link/ui/2009072565

Language：Japanese   Publisher：日本内科学会-関東地方会  

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Language：English   Publisher：ELSEVIER SCIENCE BV  

Background: Arteriosclerosis obliterans (ASO) is a serious complication in patients with end-stage renal disease (ESRD) caused by diabetic nephropathy. Adsorption of low-density lipoprotein (LDL) has been performed to treat ASO. While efficacy of this treatment has been reported in limb ischemia, the mechanism underlying the benefit remains unclear. We investigated how LDL adsorption affected soluble adhesion molecules; P-selectin, an endothelial and platelet activation marker; inflammatory cytokines such as interleukin (IL)-1 beta, IL-6 and tissue necrosis factor (TNF)-alpha; and lipids in serum.
Methods: Selective LDL adsorption by dextran sulfate columns (LDL apheresis) was performed weekly for 10 weeks to treat eight hemodialysis patients with ASO, ESRD, and type 2 diabetes mellitus. Serum was sampled before and immediately after apheresis.
Results: LDL apheresis was performed safely. After LDL apheresis lipid concentrations were significantly reduced and clinical findings, such as Fontaine's classification and ankle brachial pressure index values, were improved. Pretreatment concentrations of soluble intercellular and vascular cell adhesion molecules (sICAM-1 and sVCAM-1) and also P-selectin were higher in patients than healthy controls. After apheresis these decreased, especially P-selectin. IL-1 beta, IL-6, and TNF-alpha concentrations before apheresis were similar to those in controls and were unaffected by treatment.
Conclusion: Effectiveness of LDL apheresis against ASO may involve decreased endothelial cell and platelet activation. (c) 2006 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.cca.2006.09.026

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Language：Japanese   Publisher：日本内科学会-関東地方会  

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Language：Japanese   Publisher：(一社)日本頭痛学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本内科学会-関東地方会  

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