Background : Hemodialysis (HD) patients often have severe morbidity and mortality, with critical limb ischemia (CLI) being a cause of major amputation and death. In the clinical setting, the predictive ability of patient ambulatory status on outcome in patients on HD due to diabetic nephropathy (DN) is not well known.
Aim : To investigate the association of ambulatory status with clinical outcome in end-stage renal disease patients on HD and its predictive ability for CLI-free survival.
Methods : In the multi-center, observational Prospective REgistry with the DIalysis patient due to diabetes to prevent CriTical limb ischemia (PREDICT) study, 173 patients on HD due to DN were enrolled between April 2012 and August 2013 from 9 institutions. We investigated ambulatory status, ankle-brachial index, lower limb artery lesions by duplex ultrasound, and laboratory findings every 6 months for 2 years. The primary endpoint was CLI-free survival at 2 years.
Results : Complete follow-up was possible for 164 patients (94.2％) at 2 years. Average age was 68 (range : 58-74) years and average HD duration was 49.4 (range : 23.5-90.5) months. The CLI-free survival rate of ambulatory patients was significantly higher than that of non-ambulatory patients (84.9％ vs. 62.7％, p＝0.0006). Survival rate was also significantly higher in the ambulatory group (89.2％ vs. 69.8％, p＝0.01). Cox regression analysis revealed a significant association between ambulatory status and CLI or death (hazard ratio 6.06, 95％ confidence interval 1.34-732.3 ; p＝0.02).
Conclusion : This study revealed that ambulatory status might predict mid-term CLI-free survival in HD patients with DN.

抄録全体を表示

Background : Cardio-renal-anemia syndrome (CRAS) is known as a vicious circle, since chronic heart failure (CHF), chronic kidney disease (CKD), and anemia are exacerbated by each other. However, it remains unclear whether CKD and anemia would be associated with cardiovascular events in asymptomatic patients at risk for HF.
Methods : We retrospectively enrolled patients without prior HF history who were hospitalized for cardiovascular diseases between 2005 and 2012. Patients were divided into two groups with or without RAS defined as suffering from CKD (estimated Glomerular filtration rate (eGFR) <60mL/min/1.73m²) and anemia (hemoglobin <13g/dL in men and <12g/dL in women). The primary endpoint was major adverse cardiovascular events (MACE), the composite of cardio-vascular death and HF hospitalization.
Results : A total of 1801 patients were enrolled. The mean age was 69.6±10.6 years, and 76％ were men. The mean LV ejection fraction was 66.9±12.3％, and stage A HF was present in 73％ of the patients. Over a 4.6-year median follow-up, primary endpoint was observed in 129 patients. In Kaplan-Meier analysis, patients with RAS (n＝217) showed worse prognoses than those without RAS (n＝1584). In multivariable Cox proportional hazards analysis, after the adjustment for age, sex, and conventional risk factors, RAS showed significant association with the incidence of MACE (HR 1.86 ; 95％ CI 1.20-2.89, P＝0.005).
Conclusions : In patients at risk for HF, RAS was significantly associated with future cardiovascular events. Investigation of the impact of early intervention for preventing CKD and anemia on those patients' prognosis is warranted.

抄録全体を表示

Background : The relationship of physical activity (PA) and health-related quality of life (HRQoL) in hospitalized and terminally ill cancer patients has yet to be determined. The present study was performed to evaluate PA status and the relationships between PA and HRQoL outcomes in advanced and hospitalized terminally ill cancer patients.
Materials and Methods : Patients with advanced, and/or metastatic malignancies were eligible. PA had been measured for 1 week using a uniaxial accelerometer and divided into “light” activity level on the best PA over the past week (PA <150 minutes) or “high” activity on the best PA over the past week (PA ≥150 minutes). HRQoL was measured by the European Organization for Research and Treatment of Cancer QLQ-C30 (EORTC QLQ-C30). In addition, cancer-related symptoms and the ability to perform basic movements and activities of daily living (ADL) were also measured. We examined differences in PA level by binomial logistic and multiple linear regression analyses.
Results : Ninety-seven subjects were enrolled in the study. The high PA group (PA ≥150) had significantly higher HRQoL and increased ability to perform basic movements and ADL. The most important factor associated with engagement in PA was the ability to perform basic movements.
Conclusion : This study showed that hospitalized and terminally ill cancer patients with PA ≥150 minutes per week had higher HRQoL. Advanced patients in hospitalization presenting with PA ≥150 have the potential for improved HRQoL by palliative rehabilitation.

抄録全体を表示

Background : It is important to identify patients with primary aldosteronism (PA) who have a high possibility of having aldosterone-producing adenoma (APA). However, the usefulness of the adrenocorticotropic hormone (ACTH) stimulation test for such purposes is controversial. This study aimed to evaluate the diagnostic accuracy of the ACTH stimulation test, corrected for serum potassium concentration, in the identification of unilateral lesion among patients with PA.
Methods : Seventy-nine patients with PA admitted to three medical centers were included in the study. ACTH stimulation tests and saline infusion tests (SITs) were performed. Plasma aldosterone concentration (PAC) was examined at 0, 30, and 60 min following ACTH stimulation and at 240 min following SIT. Receiver operator characteristic curve analysis was used to evaluate the diagnostic accuracy. Medical records were reviewed retrospectively.
Results : The area under the curve (AUC) at 240 min following SIT was 0.920, and the optimal cut-off value was 133.7pg/mL, with a sensitivity of 92.3％ and a specificity of 93.1％. For the ACTH stimulation test, the AUCs for the PAC-to-potassium concentration ratio at 0, 30, and 60 min were 0.979, 0.984, and 0.971, respectively. The most effective parameter for predicting unilateral lesion suggesting APA was the PAC-to-potassium concentration ratio at 30 min, with a sensitivity of 100％ and a specificity of 95.5％.
Conclusion : These results show that the PAC-to-potassium concentration ratio at 30 min in the ACTH stimulation test, as well as the PAC at 240 min in the SIT, is an excellent and practical indicator for identifying unilateral lesion in patients with PA.

抄録全体を表示