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Long-Term Outcome of 102 Cases of Lupus Nephritis: A Single-Center Cohort Study in Japan

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International Journal of Clinical Medicine 2017年第12期8卷 668-679页

作者： Mio Kodama Keiko Uchida Kazunori Karasawa Takahito Moriyama Kosaku nitta Department of Medicine Kidney Center Tokyo Women’s Medical University Tokyo Japan

Background: The mortality rate is higher in SLE patients with lupus nephritis (LN) than in those without nephropathy. Objectives: The aim of this study was to identify the factors affecting the long-term renal outcome in 102 patients with LN. Methods: This was a retrospective cohort study. Logistic regression analysis was used in a model to determine how independent variables predicted the outcome. The survival analysis was based on the Kaplan-Meier curve with subjects censored for death. Results: The 15-year survival rate was 93.5%, and the renal function non-deterioration rate was 78.3%. No influence of individual types of immunosuppressant drugs used was found on the renal function deterioration rate. In this study, the results of analysis identified only daily urinary protein excretion level as having any significant effect on the risk of progression of LN to renal failure. Conclusions: These results suggest that remission induction therapy and maintenance therapy focused on long-term preservation of renal function need to be selected for LN patients with a high daily urinary protein value at the start of treatment and for LN patients who fail to show any reduction of the daily urinary protein excretion level to 0.5 g or less at one year after the biopsy.

关键词： Lupus Nephritis Outcome Renal Function Proteinuria Mortality

A CONSIDERATION ON INTERFERENCE BETWEEN NOISE SOURCE AND NOISE RECEIVER

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A CONSIDERATION ON INTERFERENCE BETWEEN NOISE SOURCE AND NOI...

Echocardiographic Parameters as Cardiovascular Mortality Predictors in Chronic Hemodialysis Patients

1992 International Symposium on Electromagnetic Compatibility(EMC’92/Beijing)

作者： Atsuo Mutoh Shuichi nitta Nobuyoshi Yamakoshi Tokyo University of Agriculture and Technology 2-24-16 Naka-cho Koganel Tokyo 184 JAPAN

＜正＞This paper describes the mutual interference between noise source and noise victim. Paying attention to resonance points shown on frequency- impedance characteristics curve of source,victim （noise receiver） and their combination, respectively,the influence of victim characteristics for noise source characteristics and the dominance of victim are clarified under various coupling conditions.

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International Journal of Clinical Medicine 2014年第12期5卷 635-643页

作者： Misato Koeda Tetsuya Ogawa Kyoko Ito Takaaki Tsutsui Kosaku nitta Department of Medicine Kidney Center Tokyo Women’s Medical University Tokyo Japan Department of Medicine Medical Center East Tokyo Women’s Medical University Tokyo Japan Department of Nephrology Hidaka Hospital Gunma Japan

Background: Hemodialysis (HD) patients have high rates of cardiovascular (CV) mortality. Although structural and functional echocardiographic alterations in HD patients have been the subject of several survival analysis studies, the prognostic value of these alterations is not well established. The aim of this study was to determine the prognostic value of echocardiographic parameters in chronic HD patients. Objectives: One hundred eighteen HD patients were clinically evaluated and underwent Doppler echocardiography, being followed for 45.7 ± 13.6 months. The outcome measures were CV mortality. The predictive value of echocardiographic variables was evaluated by Cox regression model and survival curves were constructed using the Kaplan-Meier method and log-rank test to compare them. Results: CV diseases accounted for 46.4% of all deaths during the follow-up period. We found that the event-free survival rates in one and two years were 96.5% and 83.0%, respectively. Diabetes and E/e' ratio were predictors of CV outcome by multivariate analyses. Conclusion: Diabetes and diastolic dysfunction are independent predictors of CV mortality in chronic HD patients.

关键词： Diastolic Dysfunction Echocardiography Hemodialysis Cardiovascular Mortality Prognosis

A Low Serum Albumin Level Predicts Cardiovascular Events in Hemodialysis Patients with Preserved Left Ventricular Ejection Fraction

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International Journal of Clinical Medicine 2015年第2期6卷 85-95页

作者： Mizuki Komatsu Masayuki Okazaki Ken Tsuchiya Hiroshi Kawaguchi Kosaku nitta Department of Nephrology Jyoban Hospital Fukushima Japan Department of Medicine Kidney Center Tokyo Women’s Medical University Tokyo Japan

Background: Cardiovascular (CV) diseases are the most frequent cause of death in hemodialysis (HD) patients. The aim of this study was to identify risk factors for CV events in HD patients with preserved left ventricular ejection fraction (PEF). Objectives: A total of 213 HD patients (69 years, 64.1% males) were enrolled. Demographic, laboratory test, and echocardiographic data were recorded, and CV events during the 32-month follow-up period were documented. Results: During the follow-up period, 31 patients (14.6%) died and 50 patients (23.5%) suffered a fatal or nonfatal CV event. Age and serum albumin, C-reactive protein, total cholesterol, non-HDL cholesterol, and NT-proBNP levels were associated with CV events according to a univariate analyses. A multivariate analysis identified a low serum albumin value

关键词： Cardiovascular Events Albumin Echocardiography Hemodialysis Mortality

Safety assessment of dextrin hydrogel adhesion barrier (AdSpray®) for elective laparoscopic cholecystectomy

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Laparoscopic, Endoscopic and Robotic Surgery 2022年第2期5卷 61-65页

作者： Toshiro Masuda Hiroshi Takamori Moeko Kato Chisho Mitsuura Yuta Shiraishi Rumi Itoyama Kenji Shimizu Ryuichi Karashima Hidetoshi nitta Hideo Baba Department of Surgery Saiseikai Kumamoto HospitalKumamoto861-4193Japan Department of Gastroenterological Surgery Graduate School of Life SciencesKumamoto UniversityKumamoto860-0811Japan

Objective:Adhesion barriers have not traditionally been used during laparoscopic cholecystectomy(lapchole),and so there are no data confirming the safety of the dextrin hydrogel adhesion barrier(AdSpray®)for the use during *** aim of this prospective study is to investigate the safety of AdSpray®for elective ***:Between July 2019 and March 2021,we conducted a prospective study at Saiseikai Kumamoto Hospital to assess the safety of applying AdSpray®around the hepatoduodenal ligament,liver surface,and port area after extraction of the gallbladder during elective *** assessed patient morbidity,mortality,and laboratory data on postoperative day 1 and at the outpatient follow-up ***:A total of 100 patients(43 men,57 women)received AdSpray®application during elective lapchole at our *** mean patient age was 56.5±14.8 y,and the mean body mass index was 25.1±4.8 kg/*** gallbladder drainage was performed in 3(3.0%)patients as conservative treatment for acute *** mean operative time was 91.7±35.1 min,and the median blood loss was 5 mL(range,5e120 mL).Intraoperative gallbladder perforation was observed in 4.0%of patients(n=4).There was no intraoperative bile duct ***(1.0%)patient had a postoperative subhepatic fluid collection without bacterial *** mean white blood cell count and C-reactive protein level was significantly elevated on postoperative day 1 but returned to preoperative levels by the time of the follow-up *** patients were successfully discharged after surgery,and the median postoperative hospital stay was 2 d(range,2e9 d).Conclusion:Applying AdSpray®during elective lap-chole is safe,with an acceptable rate of postoperative complications.

关键词： Adhesion barrier Dextrin hydrogel Laparoscopic cholecystectomy

Fibroblast Growth Factor 23 and Left Ventricular Hypertrophy in Hemodialysis Patients

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International Journal of Clinical Medicine 2014年第17期5卷 1102-1110页

作者： Ayaka Saito Takako Onuki Yoshihisa Echida Shigeru Otsubo Kosaku nitta Department of Medicine Kidney Center Tokyo Women’s Medical University Tokyo Japan Department of Medicine Towa Hospital Tokyo Japan Department of Blood Purification Sangenjaya Hospital Tokyo Japan

Background: Left ventricular hypertrophy (LVH) is a common cardiovascular complication and an independent risk factor for cardiovascular death in hemodialysis (HD) patients. Previous studies have shown that fibroblast growth factor 23 (FGF23), which has an important role in phosphate metabolism, is elevated in HD patients. Objectives: The aim of this study was to determine the association of FGF23 and LVH and the prognostic value of serum FGF23 level in HD patients. One hundred seven HD patients were evaluated for LVH by echocardiography. Serum FGF23 levels were measured using a commercial enzyme-linked immunosorbent assay kit. Results: Patients with LVH were more likely to have higher systolic blood pressure (BP) and LVH was significantly associated with female gender and higher serum levels of phosphate and calcium ×phosphate products. LVH was also associated with higher serum FGF23 level. Multivariate analysis indicated that serum FGF23 level, systolic BP, and serum phosphate level remained correlated with LVH. This suggested that serum FGF23 level is independently associated with LVH in our HD patients. Cox analysis indicated no significant difference in risk of death for patients with elevated serum FGF23 level. Conclusion: LVH has a high prevalence in HD patients, and FGF23 is independently associated with LVH but is not a predictor for prognosis during a 4-year follow-up period.

关键词： Fibroblast Growth Factor 23 Hemodialysis Left Ventricular Hypertrophy Prognosis

Geriatric Nutritional Risk Index as a Simple Predictor of Mortality in Maintenance Hemodialysis Patients: A Single Center Study

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International Journal of Clinical Medicine 2015年第5期6卷 354-362页

作者： Sayaka Takahashi Keiko Suzuki Fumiko Kojima Yoshiko Tanaka Kosaku nitta Department of Nephrology Shinjuku Ishikawa Clinic Department of Medicine Kidney Center Tokyo Women’s Medical University Tokyo Japan

Background: Malnutrition is associated with higher risk of mortality in maintenance hemodialysis (MHD) patients. The geriatric nutritional risk index (GNRI) has been developed as a tool to assess the nutritional risk. Objectives: The purpose of the present study was to examine the significance of the GNRI as a mortality predictor in MHD patients. Methods: We retrospectively examined the GNRI of 259 MHD patients aged 59.2 ± 12.8 years, and followed up for 36 months. The patients were divided into two groups according to GNRI values of 91.0. Predictors for all-cause mortality were examined using Kaplan-Meier and Cox proportional-hazards analyses. Results: During the follow-up period of 36 months, a total of 76 patients died. Kaplan-Meier survival analysis showed that the subjects with a GNRI 91 (n = 230) (Log-rank test,

关键词： Hemodialysis Malnutrition Geriatric Nutritional Risk Index Mortality

Inhibition of the Renin-Angiotensin System and Cardiovascular Mortality in Chronic Hemodialysis Patients

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International Journal of Clinical Medicine 2011年第2期2卷 57-63页

作者： Kiyotsugu Omae Tetsuya Ogawa Masao Yoshikawa Michihiro Mitobe Kosaku nitta Department of Medicine Kidney Center Tokyo Women"s Medical University Yoshikawa Hospital

INTRODUCTION: Since the outcomes associated with the use of renin-angiotensin-system inhibitors (RASi) by hemodialysis (HD) patients are not fully known, we investigated their effect on the cardiovascular mortality of chronic HD patients. METHODS: Data from 388 HD patients (237 men and 151 women) who were routinely treated for at least 6 months were analyzed. Treatment with a RASi was the major predictor variable. The main outcome measure was cardiovascular mortality. Cox regression analysis was used to assess for the use of RASi and risk of death. RESULTS: Hypertension was diagnosed in 320 patients (82.5%), and 197 (50.8%) of them were treated with a RASi (treated group) and 191 (49.2%) were not (untreated group). The treated group had a higher prevalence of hypertension, history of congestive heart failure, and presence of ST-T changes. Kaplan-Meier analysis revealed a reduction in risk of cardiovascular death in the treated group during the follow-up period (fig. 2;log-rank: p=0.0379). The multivariate analysis showed that treatment with a RASi was also independently associated with reduced cardiovascular mortality (hazard ratio= 0.184;p=0.0161). CONCLUSIONS: The results of this study suggest a possible association between the treatment with RASi and reduced risk of cardiovascular mortality, independent of their effect of lowering blood pressure.

关键词： Renin-Angiotensin-System Inhibitors Cardiovascular Outcomes Hypertension Hemodialysis

Effect of Sevelamer Hydrochloride on the Serum Calcitriol Concentration in Hemodialysis Patients

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International Journal of Clinical Medicine 2014年第20期5卷 1320-1327页

作者： Kazumichi Matsushita Keitaro Sato Kohei Unagami Kosaku nitta Kiichiro Tago Matsushita Nephrology Clinic Yamanashi Japan Department of Medicine Kidney Center Tokyo Women’s Medical University Tokyo Japan

Back ground: There are no published clinical data in hemodialysis (HD) patients with mineral bone disorder (CKD-MBD) regarding the effect of sevelamer hydrochloride on the absorption of the oral calcitriol. Objectives: The aim of the present study was to determine the association of the sevelamer hydrochloride and serum 1-25(OH)2D concentration during oral calcitriol therapy. Methods: This was a before-and-after study in HD patients. Forty-six patients co-administered with phosphate-binder and calcitriol for CKD-MBD therapy took lanthanum carbonate (LC) and sevelamer hydrochloride (SH) for 4 weeks, respectively with calcitriol. The serum 1-25(OH)2D concentration was assessed after each period. Results: Serum 1-25(OH)2D concentration was significantly reduced with co-administration of SH compared to LH (mean, calcitriol with LC→SH: 19.9 pg/ml → 14.2 pg/ml, p 2D concentrations after oral calcitriol administration compared to LH in HD patients. When we use SH as a phosphate binder with calcitriol for HD patients with CKD-MBD, we should consider the inhibitory effect of SH on oral calcitriol absorption.

关键词： Hemodialysis Calcitriol Sevelamer Hydrochrolide Lanthanum Carbonate Bioavailability