Nihon Toseki Igakkai Zasshi
Online ISSN : 1883-082X
Print ISSN : 1340-3451
ISSN-L : 1340-3451
Volume 51, Issue 3
Displaying 1-7 of 7 articles from this issue
  • Naoto Usui, Tomoko Izumi, Akihito Inatsu, Hideki Hisadome, Takurou Kob ...
    2018 Volume 51 Issue 3 Pages 203-209
    Published: 2018
    Released on J-STAGE: March 28, 2018
    JOURNAL FREE ACCESS

    We investigated the relationships between intradialytic hypotension (IDH) and estimated peak oxygen uptake (peak VO2) or heart rate recovery after exercise (HRR), and whether the latter two parameters are useful indicators of IDH. We enrolled 216 hemodialysis patients who underwent cardiac stress tests using a bicycle ergometer. IDH was defined as when a patient required treatment for hypotension during hemodialysis. Compared with the non-IDH group, the IDH group had lower estimated peak VO2 and HRR values (p<0.001). After adjusting for the serum albumin level, cardiac function, and risk factors for arteriosclerosis, estimated peak VO2 (odds ratio [OR]: 0.80, p=0.001, 95% confidence interval [CI]: 0.70 to 0.91) and HRR (OR: 0.91, p=0.009, 95%CI: 0.85 to 0.98) remained significant risk factors for IDH. The optimal cut-off point for estimated peak VO2 was 13.8 mL/kg/min (sensitivity: 0.86, specificity: 0.69, p<0.001), and that for HRR was 7 beats (sensitivity: 0.80, specificity: 0.62, p<0.001). Thus, we concluded that estimated peak VO2 and HRR are independent risk factors for and useful indicators of IDH because the obtained cut-off points for these parameters were highly accurate predictors of IDH.

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  • Yuya Sakai, Toru Nagai, Eriko Suzuki, Maiko Tsuchiya, Miho Suzuki, Yum ...
    2018 Volume 51 Issue 3 Pages 211-217
    Published: 2018
    Released on J-STAGE: March 28, 2018
    JOURNAL FREE ACCESS

    Higher body mass index (BMI) values have been reported to be associated with a lower risk of mortality in hemodialysis patients, which is referred to as reverse epidemiology. However, concomitant malnutrition and inflammation might have confounding effects on this relationship. In this study, we aimed to clarify whether the relationship between BMI and mortality in Japanese hemodialysis patients is affected by malnutrition or inflammation. We examined the risk of mortality according to BMI in 259 hemodialysis patients and also in the 167 patients who were free from malnutrition and inflammation. Among all 259 subjects, a BMI of ≥25.0 kg/m2 was not found to be associated with a decreased risk of mortality (using a BMI of 22.0 to 25.0 kg/m2 as a reference). Among the 167 patients who were free from malnutrition and inflammation, the risk of mortality was significantly increased by a BMI of ≥25.0 kg/m2 (hazard ratio: 7.85 [1.77-56.27]). Thus, reverse epidemiology was not observed among these Japanese hemodialysis patients, and being obese was only found to be a risk factor for mortality among the Japanese hemodialysis patients who were free from malnutrition and inflammation. This suggests that the influence of obesity on the risk of mortality is affected by race and/or malnutrition and inflammation. Future studies are required to clarify the mechanism responsible for mortality in obese hemodialysis patients and to identify appropriate nutritional interventions for such patients.

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  • Mutsumi Uesugi, Takayasu Taira, Chihiro Shiga, Go Oda, Koichi Azuma, T ...
    2018 Volume 51 Issue 3 Pages 219-222
    Published: 2018
    Released on J-STAGE: March 28, 2018
    JOURNAL FREE ACCESS

    This study aimed to determine the effects of comprehensive rehabilitation on the serum phosphate levels and ability to perform activities of daily living (ADL) of elderly hemodialysis (HD) patients in a geriatric healthcare facility. This study was a retrospective, single-center, before-after study of 72 HD patients (32 males, 40 females; mean age: 78.3±9.0). In addition, we divided the subjects into three groups based on their serum phosphate levels; i.e., into high (>6.0 mg/dL, n=10), moderate (≥3.5 and ≤6.0 mg/dL, n=45), and low (<3.5 mg/dL, n=17) serum phosphate groups. Blood tests and the functional independence measure (FIM) were performed at the baseline and after 3 months. The subjects’ FIM scores significantly increased during the study (baseline: 88.8±24.4, 3 months: 92.4±22.5, p=0.0014). Subgroup analysis showed significant changes in the serum phosphate levels (mg/dL±SD) of the high (baseline: 6.6±0.9, 3 months: 4.9±0.9, p=0.002) and low serum phosphate groups (baseline: 2.6±0.7, 3 months: 3.8±0.9, p<0.001). A combination of nutritional care and exercise in long-term healthcare facilities can have beneficial effects on the serum phosphate levels and ability to perform ADL of elderly HD patients.

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  • Mizuki Miyabe, Tsutomu Tabata, Shoko Tsuchikura, Naoko Shimomura, Yosh ...
    2018 Volume 51 Issue 3 Pages 223-228
    Published: 2018
    Released on J-STAGE: March 28, 2018
    JOURNAL FREE ACCESS

    We present two cases of severe hyperglycemia in hemodialysis patients with type 2 diabetes mellitus. Case 1 involved a 65-year-old male. Although his blood glucose level was 972 mg/dL, his calculated effective osmolality (without urea) was <320 mOsm/L. The hyperglycemia was promptly improved by insulin treatment and hemodialysis. Case 2 involved a 90-year-old female patient with convulsive seizures and loss of consciousness. She was receiving continuous tube feeding. Her blood glucose level was 994 mg/dL, and her effective plasma osmolality was 321 mOsm/L. She was diagnosed with a hyperosmolar hyperglycemic state. She did not undergo hemodialysis during her hospitalization. Although her hyperglycemia was only treated with insulin, it took time for her blood glucose level to improve, and she had a high insulin requirement. Even in patients with severe hyperglycemia, plasma osmotic pressure values can be affected by whether the patient drinks water before developing symptoms. Hemodialysis and insulin treatment promptly improved hyperglycemia in these cases.

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  • Saiko Nishioka, Shohei Fukunaga, Nanae Matsuo, Yukio Maruyama, Izumi Y ...
    2018 Volume 51 Issue 3 Pages 229-233
    Published: 2018
    Released on J-STAGE: March 28, 2018
    JOURNAL FREE ACCESS

    The patient was a 68-year-old male. He had been diagnosed with IgA nephropathy based on a kidney biopsy 6 years ago. However, he missed his clinic appointment. He was emergently admitted to our hospital due to a headache and alexia. At the time of his hospitalization, his neurological signs had disappeared. On the other hand, a clinical examination demonstrated evidence of end-stage kidney disease and hypertension (serum creatinine: 8.60 mg/dL, serum potassium: 6.7 mEq/L, blood pressure: 245/112 mmHg). Brain magnetic resonance imaging (MRI) showed multiple microbleeds in the bilateral medulla oblongata, cerebellum, and cerebral hemisphere and angioedema in the right parietal occipital lobe. The patient was diagnosed with cerebral amyloid angiopathy (CAA) and posterior reversible encephalopathy syndrome (PRES) based on brain MRI. Hemodialysis was initiated immediately on admission, and antihypertensive therapy was started promptly. The patient’s blood pressure gradually came under control. On day 14 of the illness, brain MRI showed that the posterior leukoencephalopathy had improved. CAA usually occurs in elderly individuals, and it is characterized by the deposition of β-amyloid in the walls of cerebral blood vessels. CAA sometimes causes inflammatory CAA. In this case, the leukoencephalopathy was probably caused by PRES because of its rapid improvement.

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  • Hideaki Tomomatsu, Seiji Nagamachi, Tsugumi Horikiri, Masatsugu Sameji ...
    2018 Volume 51 Issue 3 Pages 235-242
    Published: 2018
    Released on J-STAGE: March 28, 2018
    JOURNAL FREE ACCESS

    A 67-year-old female had been on dialysis for 4 years. She had been started on hemodialysis at another hospital for end-stage renal failure due to diabetic nephropathy. In May 2014, she developed pancytopenia, and in June of that year she was diagnosed with myelodysplastic syndrome (MDS) on the basis of bone marrow aspiration. As the anemia progressed, the dose of the short-acting erythropoiesis-stimulating agent (ESA) that she was being treated with was increased; however, the patient continued to require frequent blood transfusions. When low-dose epoetin beta pegol (a continuous erythropoietin receptor activator, CERA) was added to the short-acting ESA in December of that year, her anemia improved markedly, and eventually, blood transfusions were not required. The concomitant administration of a short-acting ESA and low-dose CERA therapy eliminated the need for blood transfusions in a maintenance hemodialysis patient with MDS.

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  • Yusaku Hashimoto, Sayaka Kato, Daisuke Takahashi, Satoshi Ototake, Ats ...
    2018 Volume 51 Issue 3 Pages 243-249
    Published: 2018
    Released on J-STAGE: March 28, 2018
    JOURNAL FREE ACCESS

    A 60-year-old female, who had been on hemodialysis (HD) for 28 years due to drug-induced renal failure, was referred and admitted to our hospital because of a month-long post-HD fever. She had a history of pulmonary mycobacterium avium complex (MAC) infection. The fever increased after HD, but normalized by the following day. In physical, laboratory, and imaging examinations, there was no evidence of an active infection. Modifying the patient’s HD conditions, including the dialyzer membrane and anti-coagulant treatment, was ineffective against the post-HD fever. Two weeks after admission, the patient complained of right chest pain, combined with right-dominant pleural effusion and a persistent high fever. A polymerase chain reaction (PCR) test of her bronchoalveolar lavage fluid for MAC produced a negative result. Infectious pleuritis was also excluded based on bacterial cultures and a PCR test for tuberculosis. Immunological staining revealed markedly elevated levels of myeloperoxidase-specific anti-neutrophil cytoplasmic antibody (MPO-ANCA) in both serum and pleural fluid, leading to a diagnosis of suspected MPO-ANCA-associated vasculitis. The patient was treated with prednisolone after chemotherapy for pulmonary MAC disease. The fever immediately resolved after the steroid therapy, and the pleural effusion subsequently disappeared. The patient’s clinical course was strongly suggestive of aseptic pleuritis caused by MPO-ANCA-associated vasculitis. When fever occurs after HD, we need to consider both HD-related and-unrelated febrile disorders, such as vasculitis.

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