المؤلفون: Kazuyoshi Okada, Manabu Tashiro, Hiroyuki Michiwaki, Tomoko Inoue, Hisato Shima, Jun Minakuchi

المصدر: Renal Replacement Therapy, Vol 10, Iss 1, Pp 1-10 (2024)

مصطلحات موضوعية: Hypoalbuminuria, α1-Microglobulin, Super high-flux, Albumin leaking, Online hemodiafiltration, Diseases of the genitourinary system. Urology, RC870-923

الوصف: Abstract It has been reported that survival on mild hypoalbuminemia due to high albumin leakage did not worsen in patients on hemodialysis (HD) or online hemodiafiltration (OHDF) even though the level of serum albumin is a classic nutrition marker associated with mortality. Survival was also equivalent on HD and OHDF for patients with similar levels of albumin leakage and serum albumin. Furthermore, survival on HD using a super high-flux (SHF) albumin-leaking membrane was better than that on HD using a SHF membrane, and survival on SHF albumin-leaking HD with high albumin leakage was better than that on OHDF with low albumin leakage. The following hypothesis regarding crosstalk between α1-microglobulin (α1MG) and albumin is proposed that can explain the mechanism by which the level of serum human mercaptoalbumin (HMA) increases postdialysis and decreases predialysis. At initiation of and during dialysis, the production of free α1MG in the liver increases by upregulation of the α1MG-bikunin precursor gene. The free α1MG rapidly reacts with some substances that are reversibly bound to human nonmercaptoalbumin (HNA)-1, resulting in the conversion to HMA and free α1MG with reduced activity (i.e., free α1MG with reduced or no antioxidant capacity) during dialysis and in the increased serum HMA level postdialysis. In addition, it is possible that both hypoalbuminemia and the conversion of HNA-1 to HMA increase the free form of indoxyl sulfate, which is removed by diffusion. The antioxidant capacity in serum after dialysis is mainly due to the very large amount of HMA, resulting in the conversion to HNA and the decreased serum HMA level before dialysis. However, the very small amount of free α1MG produced in the liver has strong antioxidant activity after dialysis.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2059-1381Test

الوصول الحر: https://doaj.org/article/cd90379e7c864e02ac8e8b9af5c4be8cTest

المؤلفون: Hisato Shima, Jun Minakuchi, Kazuyoshi Okada, Manabu Tashiro, Megumi Harada, Takuya Okamoto, Tomoko Inoue, Toshio Doi, Yusuke Higashiguchi

المصدر: Internal Medicine. 2024, 63(3):433

المؤلفون: Hiroyasu Bando, Hiroyuki Azuma, Hisato Shima, Jun Minakuchi, Kazuyoshi Okada, Manabu Tashiro, Naohito Iwasaka, Takuji Ohara, Takuya Okamoto, Tomoko Inoue, Toshio Doi, Yoko Nishiuchi, Yoshio Fukata, 井上 朋子, 土井 俊夫, 坂東 弘康, 小原 卓爾, 岡本 拓也, 岡田 一義, 岩坂 尚仁, 島 久登, 東 博之, 水口 潤, 深田 義夫, 田代 学, 西内 陽子

المصدر: 日本透析医学会雑誌 / Nihon Toseki Igakkai Zasshi. 2024, 57(1):23

المؤلفون: Kazuyoshi Okada, Yoshindo Kawaguchi, 岡田 一義, 川口 良人

المصدر: 日本透析医学会雑誌 / Nihon Toseki Igakkai Zasshi. 2024, 57(1):1

المؤلفون: Hisato Shima, Takuya Okamoto, Manabu Tashiro, Tomoko Inoue, Seiichiro Wariishi, Hiroyasu Bando, Hiroyuki Azuma, Naohito Iwasaka, Takuji Ohara, Toshio Doi, Kazuyoshi Okada, Jun Minakuchi

المصدر: Renal Replacement Therapy, Vol 9, Iss 1, Pp 1-7 (2023)

مصطلحات موضوعية: Culture-negative peritonitis, Peritoneal dialysis, Gender, Dialysate cell counts, β2-microglobulin, Diseases of the genitourinary system. Urology, RC870-923

الوصف: Abstract Background Empirical antibiotic treatment against peritoneal dialysis (PD)-related peritonitis should be immediately initiated before PD effluent culture results are obtained. As culture results guide the choice of antibiotics, culture-negative peritonitis (CNP) is a serious issue. In addition, the identification of the causative organism often indicates a possible source of infection. This study aimed to clarify the predictors of CNP. Methods This single-center, retrospective study was conducted from November 2007–December 2018 in patients undergoing PD with peritonitis at our institution, where 204 peritonitis episodes (57 culture-negative, 147 culture-positive) were investigated based on demographics, and clinical parameters. CNP predictors were investigated using logistic regression. Results CNP rate was significantly higher in female and in patients with higher platelet counts, lower dialysate cell counts at peritonitis diagnosis, and higher serum β2-microglobulin levels. In multivariate logistic regression, female sex (odds ratio [OR] 2.69, 95% confidence interval [CI] 1.31–5.54), dialysate cell count at diagnosis (OR0.99, 95% CI 0.99–0.99), and serum β2-microglobulin level (OR 1.04, 95% CI 1.00–1.07) were significantly associated with CNP. The areas under the receiver operating characteristic curve for female patients, dialysate cell counts at diagnosis of peritonitis, serum β2-microglobulin level, and female patients + dialysate cell counts at diagnosis of peritonitis + serum β2-microglobulin level were 0.604, 0.694, 0.603, and 0.751, respectively. Conclusions Female sex, dialysate cell counts at peritonitis diagnosis, and serum β2-microglobulin levels may be predictors of CNP.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2059-1381Test

الوصول الحر: https://doaj.org/article/dffd31c6a1404dea88da58e644c141abTest

المؤلفون: Kazuyoshi Okada, Manabu Tashiro, Hiroyuki Michiwaki, Tomoko Inoue, Hisato Shima, Jun Minakuchi, Shu Kawashima

المصدر: Renal Replacement Therapy, Vol 9, Iss 1, Pp 1-10 (2023)

مصطلحات موضوعية: Albumin leakage, Super high-flux, Hemodialysis, Online hemodiafiltration, Polyethersulfone, Diseases of the genitourinary system. Urology, RC870-923

الوصف: Abstract Background Survival is equivalent between super high-flux hemodialysis (SHF-HD) and online hemodiafiltration (OHDF) with similar albumin leakage. According to the 2013 Japanese dialyzer performance classification, survival on HD is optimal when a type II dialyzer (β2-microglobulin clearance ≥ 70 mL/min) is used. Here, we investigated whether survival could be improved by SHF-HD using a type II-b dialyzer (sieving coefficient for albumin ≥ 0.03) with high albumin leakage compared with OHDF or SHF-HD using a type II-a dialyzer (sieving coefficient for albumin

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2059-1381Test

الوصول الحر: https://doaj.org/article/bd0dcc935c6543ed9f6b3fd2c163137eTest

المؤلفون: Manabu Tashiro, Kazuyoshi Okada, Yusaku Tanaka, Hiroyuki Michiwaki, Hisato Shima, Tomoko Inoue, Toshio Doi, Jun Minakuchi

المصدر: Journal of Clinical Medicine, Vol 13, Iss 7, p 1865 (2024)

مصطلحات موضوعية: hemodialysis, online hemodiafiltration, albumin leakage, mortality, solute removal, Medicine

الوصف: Background: Online hemodiafiltration (OHDF) has a lower mortality rate than hemodialysis (HD). We aimed to investigate the impact of the albumin leakage on the mortality of patients receiving HD or OHDF. Methods: In this single-center study, consecutive patients receiving renal replacement therapy between January and April 2018 were retrospectively registered. Using (1:1) propensity score matching, 3-year all-cause mortality was compared between patients receiving HD and OHDF, and the impact of albumin leakage on the mortality rate in both groups was investigated. Results: Of the 460 patients, 137 patients receiving HD were matched with an equal number of patients receiving OHDF. OHDF was associated with higher albumin leakage (p < 0.001) and a lower mortality than HD (log-rank test, p < 0.001). Albumin leakage was associated with mortality in patients receiving HD (per 1 g increase, hazard ratio (HR): 0.495, 95% confidence interval (CI): 0.275–0.888) and patients receiving OHDF (per 1 g increase, HR: 0.734, 95% CI: 0.588–0.915). Patients receiving HD, with the highest albumin leakage tertile (>3 g), had a similar mortality rate to patients receiving OHDF, with similar albumin leakage. Conclusions: The negative relationship between albumin leakage and mortality suggests the benefit of removing middle- to -large-molecular-weight substances to improve survival.

وصف الملف: electronic resource

العلاقة: https://www.mdpi.com/2077-0383/13/7/1865Test; https://doaj.org/toc/2077-0383Test

الوصول الحر: https://doaj.org/article/464442cc253e440da32729571d4bb37eTest

المؤلفون: Hisato Shima, Takuya Okamoto, Manabu Tashiro, Tomoko Inoue, Maho Iwaki, Seiichiro Wariishi, Kazuyoshi Okada, Toshio Doi, Jun Minakuchi

المصدر: Renal Replacement Therapy, Vol 9, Iss 1, Pp 1-7 (2023)

مصطلحات موضوعية: Stenotrophomonas maltophilia, Peritoneal dialysis, Peritonitis, Diabetes mellitus, Catheter removal, Diseases of the genitourinary system. Urology, RC870-923

الوصف: Abstract Background Stenotrophomonas maltophilia (S. maltophilia) is being increasingly recognized as an important cause of nosocomial infections, particularly in immunocompromised patients, such as patients undergoing dialysis. S. maltophilia peritonitis is strongly associated with the loss of peritoneal catheter among patients undergoing peritoneal dialysis (PD) owing to its resistance to different groups of antibiotics. Thus, the aim of this study was to investigate the characteristics of and risk factors for S. maltophilia peritonitis in patients undergoing PD. Methods This single-center, retrospective, case–control study was conducted between April 2013 and October 2022. Patients who were undergoing PD at Kawashima Hospital and were diagnosed with S. maltophilia peritonitis were included in this study. Controls were randomly selected from among patients who were undergoing PD and were diagnosed with peritonitis caused by microorganisms other than S. maltophilia. The demographic data, clinical characteristics, and initial treatment data of the patients were analyzed to determine the risk factors for PD-related S. maltophilia peritonitis. Results Five patients with S. maltophilia peritonitis and 15 controls (three controls to one case) were included in this study. The incidence of S. maltophilia peritonitis was significantly more frequent among patients with diabetes mellitus (80.0% vs. 20.0%; p = 0.031) and among patients with higher white blood cell counts in the dialysate after appropriate antibiotic therapy (2561/µL [349–4654/µL] vs. 20/µL [20–23/µL]; p = 0.0006) than among the control patients. Although all the patients were treated with appropriate antibiotics after the identification of S. maltophilia, they had a significantly higher rate of catheter removal than the controls (80.0% vs. 0.0%; p = 0.001). Conclusions Diabetes mellitus may be an important risk factor for S. maltophilia peritonitis in patients undergoing PD.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2059-1381Test

الوصول الحر: https://doaj.org/article/d263c83051e84c6188f795198d237334Test

المؤلفون: Hisato Shima, Toshio Doi, Takuya Okamoto, Tomoko Inoue, Manabu Tashiro, Seiichiro Wariishi, Kazuhiko Kawahara, Kazuyoshi Okada, Jun Minakuchi

المصدر: BMC Nephrology, Vol 24, Iss 1, Pp 1-6 (2023)

مصطلحات موضوعية: Crescentic IgA nephropathy, Nephrotic syndrome, Pregnancy, Steroid, Normotensive, Diseases of the genitourinary system. Urology, RC870-923

الوصف: Abstract Background Crescentic immunoglobulin A (IgA) nephropathy, defined as > 50% of the glomeruli with crescents, often has a poor renal prognosis. Because of the high prevalence of pre-eclampsia in the second trimester of pregnancy, we often fail to investigate the new onset of glomerulonephritis and the aggravation of subclinical nephropathies. We report a case of nephrotic syndrome suggestive of crescentic IgA nephropathy possibly triggered by pregnancy. Case presentation A 33-year-old multipara was referred for persistent proteinuria, hematuria, and hypoalbuminemia two months postpartum. The patient was diagnosed with proteinuria for the first time at 36 weeks of gestation. The patient was normotensive during pregnancy. Renal biopsy revealed crescentic IgA nephropathy, with cellular crescents in 80% of the glomeruli and no global sclerosis. After treatment with pulse steroids followed by high-dose oral glucocorticoids and tonsillectomy, a gradual improvement was seen in proteinuria, hematuria, and hypoalbuminemia. Conclusion Although the precise mechanism remains unclear, pregnancy possibly triggered the new onset of crescentic IgA nephropathy or the aggravation of subclinical IgA nephropathy.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1471-2369Test

الوصول الحر: https://doaj.org/article/32e6e79120a3463687b07fd91ab82728Test

المؤلفون: Kazuyoshi Okada, Manabu Tashiro, Hiroyuki Michiwaki, Tomoko Inoue, Hisato Shima, Jun Minakuchi, Shu Kawashima

المصدر: Renal Replacement Therapy, Vol 8, Iss 1, Pp 1-14 (2022)

مصطلحات موضوعية: Albumin leakage, Hypoalbuminemia, Super high-flux hemodialysis, Online hemodiafiltration, Survival, Diseases of the genitourinary system. Urology, RC870-923

الوصف: Abstract Background All-cause mortality is lower with a high substitution volume in predilution (pre) and postdilution (post) online hemodiafiltration (OHDF) than with hemodialysis (HD), and mortality does not significantly differ between pre- and post-OHDF groups. Despite the improved survival with a high substitution volume, there may be limitations. On the other hand, either normoalbuminemia or high albumin leakage in HD can reduce mortality, and super high-flux (SHF) membrane dialyzers can reduce mortality compared with low-flux and high-flux membrane dialyzers. Here, we investigated the associations of serum albumin concentration (s-Alb), albumin leakage, and substitution volume with all-cause mortality in OHDF and SHF-HD. Methods In a 3-year retrospective observational study of patients receiving dialysis from April 1 to July 1, 2017, we developed a propensity score-matched model using 783 stable patients (SHF-HD, 355; OHDF, 428). We used the log-rank test to compare Kaplan–Meier survival curves and Cox regression analysis to calculate hazard ratio (HR). Cox regression analysis was also used to compare the effect of estimated albumin leakage (EAL) and substitution volume on 3-year all-cause mortality. Results All-cause mortality was significantly lower with high EAL than with low EAL (SHF-HD: P = 0.012, log-rank test; HR, 0.44; 95% confidence interval [CI] 0.23–0.85; OHDF: P = 0.027, log-rank test; HR, 0.41; 95% CI 0.18–0.93). The mortality of high EAL was not significantly different between high and low s-Alb in SHF-HD (3.5 ± 0.1 and 3.2 ± 0.2 g/dL) and OHDF (3.6 ± 0.2 and 3.2 ± 0.1 g/dL), despite significant differences in s-Alb. Mortality did not significantly differ between SHF-HD and OHDF with higher EAL ranges or a lower difference in EAL. Mortality in pre-OHDF was significantly correlated with EAL (P = 0.007, beta − 0.32) rather than substitution volume, and mortality in post-OHDF was not analyzed because of fewer deaths. Conclusions The results suggest that survival is improved more with high EAL than with low EAL in both OHDF and SHF-HD patients, that high EAL with mild-to-moderate hypoalbuminemia does not necessarily worsen survival in OHDF and SHF-HD patients, and that survival is equivalent between OHDF and SHF-HD patients with a similar level of EAL.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2059-1381Test

الوصول الحر: https://doaj.org/article/7a9b6f24e54e49229b2a293031a2c9c8Test