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Contributions to Nephrology

Hiroaki Hara, Yumiko Nakamura, Minoru Hatano, Takatsugu Iwashita, Taisuke Shimizu, Tomonari Ogawa, Koichi Kanozawa, Hajime Hasegawa
As the aging of the population progresses in Japan, the nutritional problems in dialysis patients are being highlighted. Frailty is a clinical concept including body weight loss, muscle weakness, fatigability, decreased walking speed, and decreased physical activity, which means an intermediate concept between healthy subjects and disability subjects, indicating that their activities of daily living are not decreased but they cannot smoothly perform housework or exercise. Morbidity of dialysis patients is known to be high, and mortality of dialysis patients with frailty is 3 times higher...
2018: Contributions to Nephrology
Yusuke Sasaki, Tomonari Ogawa, Yuki Kanayama, Kenta Tokui, Takashi Morita, Kunihiko Yasuda, Yoshimi Okada, Hiroaki Hara, Taisuke Shimizu, Hajime Hasegawa
There are approximately 1,330,000 chronic renal failure patients in Japan, and over 30,000 patients are introduced to dialysis therapy annually. By the end of 2015, there were over 320,000 dialysis patients in Japan. Various groups have been working hard to educate all people involved including the patient, their families, doctors, nurses, and caregivers on three important topics: hemodialysis, peritoneal dialysis, and kidney transplantation. Recently, there has been a growing interest in home hemodialysis...
2018: Contributions to Nephrology
Taisuke Shimizu, Masaaki Terao, Hiroaki Hara, Takatsugu Iwashita, Tomonari Ogawa, Koichi Kanozawa, Hajime Hasegawa
Proximal salt reabsorption in the hypertrophied tubules in the early phase of chronic renal failure (CRF) would be diminished according to the inhibited expression of proximal salt-transporting molecules, which may be facilitated by the inhibition of Na-K-ATPase expression. Results from animal models suggest that patients with early-phase CRF would easily develop hyponatremia and, in contrast, patients showing developed CRF would be more likely to show dehydration or hypernatremia. Several large-scale studies of individuals with chronic kidney disease (CKD) revealed that hyponatremia is much more common than hypernatremia in patients with earlier stages of CKD...
2018: Contributions to Nephrology
Motoshi Hattori
BACKGROUND: End-stage renal disease (ESRD) in children is considered a rare but serious condition. Information on the epidemiology, demographics, treatment modality at the start of renal replacement therapy (RRT), and mortality of pediatric patients with ESRD is essential for a better understanding of this disease. Additionally, international comparisons of this information on pediatric patients with ESRD may improve outcomes in these children. Here, I will provide information on epidemiological and demographic characteristics of pediatric Japanese patients with ESRD and the current trend of pediatric RRT in Japan...
2018: Contributions to Nephrology
Chizuru Yamashita, Kazuhiro Moriyama, Daisuke Hasegawa, Yoshitaka Hara, Naohide Kuriyama, Tomoyuki Nakamura, Junpei Shibata, Hidefumi Komura, Osamu Nishida
BACKGROUND: Sepsis frequently leads to multiple organ failure due to the uncontrolled amplification and spread of inflammation, even if the infectious source is controlled. Lipopolysaccharide (LPS), a typical pathogen-associated molecular pattern (PAMP), is adsorbed by the polymyxin B-immobilized fiber column (PMX). PMX has been used for decades in Europe. Results of a North American randomized controlled trial (RCT) on PMX have recently been announced in a press release; results of large-scale observational studies and meta-analyses have also been reported in the last several years...
2018: Contributions to Nephrology
Tomohito Sadahiro, Hiroko Yuzawa, Tomonori Kimura, Moe Oguchi, Tomohiro Morito, Shohei Mizushima, Yousuke Hirose
Continuous venovenous hemodiafiltration is the modality of choice for acute blood purification therapy at almost all medical institutions in Japan. Nafamostat mesilate, an ultrashort-acting anticoagulant, is widely used for anticoagulation. Due to restrictions imposed by national health insurance, Japanese institutions use an effluent flow rate of 15 mL/kg/h, which is lower than the standard effluent flow rate used in the West. In addition, hemofilters are believed to adsorb cytokines, and thus some institutions also proactively perform continuous renal replacement therapy with a hemofilter at an early stage for cytokine modulation in patients with sepsis...
2018: Contributions to Nephrology
Shingo Kato, Akira Ishibashi, Kaori Sugiura, Kazuhito Kani, Tomonari Ogawa, Hajime Hasegawa, Koji Yakabi
BACKGROUND: Idiopathic acute-on-chronic inflammation in the gastrointestinal tract is an etiology of inflammatory bowel disease (IBD). Granulocyte and monocyte adsorptive apheresis (GMA) is a nonpharmacological treatment tool for patients with IBD. Here, we present a review of the positioning and possibilities of GMA for patients with IBD. SUMMARY: GMA decreases inflammatory cytokines and upregulates regulatory T cells. Intensive GMA is significantly more effective than weekly GMA in patients with IBD...
2018: Contributions to Nephrology
Tomonari Ogawa, Hideki Yoshino, Yusuke Sasaki, Yuki Kanayama, Tatsuro Sano, Yuta Kogure, Koichi Kanozawa, Hajime Hasegawa
Plasma exchange (PE) therapy is the most commonly used treatment in Japan today. The issue with PE is that it removes coagulation factors and other essential molecules during the treatment process. Fresh frozen plasma (FFP) is used to replace the essential molecules which are lost. However, FFP can be a source of various complications. We have been researching an alternative method, selective PE, consisting of a membrane with smaller pores, which prevents large and essential molecules from being removed while removing waste from the patient's blood...
2018: Contributions to Nephrology
Kengo Furuichi, Takashi Wada
Plasma exchange or double filtration plasmapheresis for rapidly progressive glomerulonephritis, and low-density lipoprotein (LDL) apheresis or leukocytapheresis for nephritic syndrome are two major apheresis therapies for kidney diseases. In addition to these apheresis therapies, plasma exchange for lupus nephritis or LDL apheresis for refractory focal segmental glomerulonephritis is clinically valuable and established. Although several possibilities of apheresis for kidney diseases were speculated in animal experiments or human studies, clinical applications have thus far been limited...
2018: Contributions to Nephrology
Michio Mineshima
Most of chronic renal disease patients receive 4-h hemodialysis (HD) sessions thrice a week. This is the minimum therapy needed to maintain life. This conventional HD therapy protocol is, however, inadequate to prevent dialysis-related complications. On the other hand, some intensive HD therapies, such as "short daily dialysis," "quotidian dialysis," etc., are being adopted in some dialysis institutions for maximizing the beneficial effects of HD on the quality of life/activities of daily living of the patients...
2018: Contributions to Nephrology
Koji Tomori, Hirokazu Okada
Home hemodialysis (HHD) has been available as a modality of renal replacement therapy since the 1960s. HHD allows intensive dialysis such as nocturnal hemodialysis or short daily hemodialysis. Previous studies have shown that patients receiving HHD have an increased survival and better quality of life compared with those receiving in-center conventional HD. However, HHD may increase the risk for specific complications such as vascular access complications, infection, loss of residual kidney function and patient and caregiver burden...
2018: Contributions to Nephrology
Hideki Kawanishi
Most hemodialysis (HD) in Japan is based on the central dialysis fluid delivery system (CDDS). With CDDS, there is an improvement in work efficiency, reduction in cost, and a reduction in regional and institutional differences in dialysis conditions. This has resulted in an improvement in the survival rate throughout Japan. However, as the number of cases with various complications increases, it is necessary to select the optimal dialysis prescription (including hours and frequency) for each individual in order to further improve survival rates...
2018: Contributions to Nephrology
Masaaki Nakayama, Kimio Watanabe, Yoshimitsu Hayashi, Hiroyuki Terawaki, Wan-Jun Zhu, Shigeru Kabayama, Sadayoshi Ito
BACKGROUND: Improved biocompatibility of peritoneal dialysis solution (PDS) is crucial for peritoneal membrane preservation, thereby ensuring long-term peritoneal dialysis (PD) and preventing encapsulating peritoneal sclerosis. We previously reported the protective effect of molecular hydrogen (H2) on mesothelial cells from PDS in nonuremic rats. SUMMARY: In the present study, we examined the effect of H2-containing PDS (commercially available neutral pH type) regarding the protection of peritoneal tissue in experimental chronic kidney disease rats...
2018: Contributions to Nephrology
Naoki Washida, Hiroshi Itoh
BACKGROUND: Peritonitis is one of the most frequent reasons for withdrawal of peritoneal dialysis (PD). Although most cases of PD-related peritonitis can be treated with antibiotics, it is occasionally refractory and culture-negative. SUMMARY: The causes of refractory PD-related peritonitis include antibiotic-resistant bacteria, fungal peritonitis, biofilm formation in PD catheters, bacterial translocation from the gastrointestinal tract, and encapsulating peritoneal sclerosis...
2018: Contributions to Nephrology
Munekazu Ryuzaki
In the general population, hypertension (HT) is defined as systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure (DBP) ≥90 mm Hg. In dialysis patients, the definition is thought to be the same as in the general population. But there is no clear description about the definition of HT for dialysis patients, especially in peritoneal dialysis (PD) patients. The prevalence of HT in PD patients is much higher compared to the general population. The association of BP and cardiovascular (CV) mortality in PD patients who are not exposed to huge hemodynamic changes during hemodialysis (HD) has been inconsistently reported...
2018: Contributions to Nephrology
Ken Sakai, Hiroshi Nihei
BACKGROUND: Dialysis is now often being initiated in older patients. In Japan, patients are around 69 years of age on initiation of dialysis. The total dialysis population undergoing peritoneal dialysis (PD) stands at just 3% in Japan, a much lower proportion than in other industrialized countries. Under the current policy, there has been a move away from hospital-based care of elderly patients to home-based care. Here, in the context of this change, we describe the experiences of our elderly patients in initiating and maintaining PD...
2018: Contributions to Nephrology
Yusuke Watanabe, Hirokazu Okada
BACKGROUND: In Japan, combined peritoneal dialysis (PD) and hemodialysis (HD) therapy is performed widely as an established modality of renal replacement therapy. This combination therapy is indicated for patients who cannot maintain adequate solute clearance using a standard PD prescription, or those who have uremic symptoms or a state of persistent fluid overload. A common treatment schedule for combined PD + HD therapy consists of 5 days of PD and one HD session per week. A 4- to 5-h HD session is performed with a high-flux membrane dialyzer...
2018: Contributions to Nephrology
Hiroshi Hataya
BACKGROUND: Recent statistics have revealed that the number of patients with preemptive kidney transplant (KTx) has increased to 21.9% between 2006 and 2011. However, factors like body height, lack of kidney source, and severe complications render some patients ineligible for KTx. Peritoneal dialysis (PD) acts as the bridging therapy to KTx, especially for infants and young children. Because the period of PD treatment is relatively longer in Japan due to the lack of kidney donors, management of PD is imperative for the success of the treatment...
2018: Contributions to Nephrology
Yasuhiko Ito, Mitsuhiro Tawada, Sun Tine, Masashi Mizuno, Yasuhiro Suzuki, Takayuki Katsuno
BACKGROUND: As an effective renal replacement therapy, peritoneal dialysis (PD) is as important as hemodialysis (HD) and renal transplantation. PD is beneficial for social rehabilitation and home medical care. However, in Japan, there are fewer PD patients than HD patients. SUMMARY: According to the JSDT 2015 registry, PD patients accounted for only 2.9% of all dialysis patients, and they have been gradually decreasing since 2009. One of the reasons why PD is not widely used in Japan is that there is insufficient evidence supporting its use...
2018: Contributions to Nephrology
Kan Kikuchi
Since 2014, all-oral, interferon (IFN)-free, direct-acting antiviral (DAA) regimens including daclatasvir + asunaprevir dual regimen, ledipasvir/sofosbuvir combination, ombitasvir/paritaprevir/ritonavir combination, elbasvir + grazoprevir dual regimen, and glecaprevir/pibrentasvir combination have been approved for the treatment of hepatitis C. Studies on DAA regimens reported that DAA therapy causes far fewer adverse reactions compared with IFN therapy and exhibits high efficacy in treating hepatitis C virus (HCV) infection in hemodialysis patients, although the ledipasvir/sofosbuvir combination cannot be used for dialysis patients because sofosbuvir is contraindicated for patients with estimated glomerular filtration rate of <30 mL/min/1...
2018: Contributions to Nephrology
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