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Ishiyama K, Sato T. Efficacy of LDL apheresis for the treatment of cholesterol crystal embolism: A prospective, controlled study. Ther Apher Dial 2021; 26:456-464. [PMID: 34216189 DOI: 10.1111/1744-9987.13706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/24/2021] [Accepted: 07/01/2021] [Indexed: 11/29/2022]
Abstract
This study was performed to evaluate the efficacy and safety of LDL apheresis (LDL-A) for the treatment of cholesterol crystal embolism (CCE) after cardiovascular procedures. We conducted a prospective multicenter study of 34 patients with CCE and 15 historical control patients. The present participants underwent six sessions of LDL-A for 4 weeks and underwent medical therapy with corticosteroids and statins. The mean creatinine concentration and estimated glomerular filtration rate at baseline were 3.82 ± 2.29 mg/dL and 17.8 ± 9.9 mL/min/1.73 m2 , respectively. The prevalence of maintenance dialysis at 24 weeks was significantly lower in the present participants than in the historical controls (3.1% vs. 40.0%, respectively; p < 0.0001), but the mortality rate at 24 weeks was comparable (19% vs. 33%, respectively). Although 45 adverse events occurred in 23 participants, there were no unexpected adverse events. LDL-A for CCE reduces the prevalence of maintenance dialysis 24 weeks later and is well tolerated. This study was registered in the Japan Registry of Clinical Trials (jRCTs022180029) and clinicaltrials.gov (NCT01726868).
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Affiliation(s)
- Katsuya Ishiyama
- Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Miyagi, Japan.,Department of Comprehensive Medicine for Kidney Disease-related Disorders, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Faculty of Medicines, Division of Nephrology and Endocrinology, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Toshinobu Sato
- Department of Nephrology, Japan Community Health Care Organization Sendai Hospital, Sendai, Miyagi, Japan.,Department of Comprehensive Medicine for Kidney Disease-related Disorders, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Ito K, Ookawara S, Ueda Y, Hayasaka H, Kofuji M, Uchida T, Matsumoto H, Yamaguchi A, Morishita Y. Improvement of bilateral lower-limb muscle oxygenation by low-density lipoprotein apheresis in a patient with peripheral artery disease undergoing hemodialysis. Nefrologia 2018; 39:90-92. [PMID: 29422296 DOI: 10.1016/j.nefro.2017.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/28/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Kiyonori Ito
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Susumu Ookawara
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
| | - Yuichiro Ueda
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideyuki Hayasaka
- Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaya Kofuji
- Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takayuki Uchida
- Department of Clinical Engineering, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Harunobu Matsumoto
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Yue XD, Wang JY, Zhang XR, Yang JH, Shan CY, Zheng MY, Ren HZ, Zhang Y, Yang SH, Guo ZH, Chang B, Chang BC. Characteristics and Impact Factors of Renal Threshold for Glucose Excretion in Patients with Type 2 Diabetes Mellitus. J Korean Med Sci 2017; 32:621-627. [PMID: 28244288 PMCID: PMC5334160 DOI: 10.3346/jkms.2017.32.4.621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 12/03/2016] [Indexed: 01/04/2023] Open
Abstract
Sodium glucose co-transporter 2 (SGLT-2) inhibitors are newly developed but promising medicine for type 2 diabetes. However, patients with a different renal threshold for glucose excretion (RT(G)) may have a different reaction to this medicine. Therefore, the objective of this study was to investigate the characteristics of RT(G) and its impact factors in patients with type 2 diabetes mellitus (T2DM). The clinical and laboratory data of 36 healthy individuals and 168 in-hospital patients with T2DM were collected and analyzed, RT(G) was calculated using blood glucose (BG) measured by dynamic BG monitoring, urinary glucose excretion (UGE) and estimated glomerular filtration rate (eGFR). The characteristics of RT(G) were investigated. The risk factors for high RT(G) were analyzed using non-conditional logistic regression analysis. Our results found that RT(G) of the T2DM group was higher than that of the healthy individuals (P < 0.05); and 22.22% from the healthy individuals group but 58.33% from the T2DM group had high RT(G). Age, duration of diabetes, body mass index (BMI), and homeostasis model assessment insulin resistance index (HOMA-IR) were independently associated with high RT(G) (P < 0.05). Further stratified analysis revealed that RT(G) in T2DM patients increased with age, duration of diabetes, and BMI. In conclusion, RT(G) is increased in patients with T2DM, especially in those with longer diabetic duration, higher BMI, and those who are older. Therefore, these patients may be more sensitive to SGLT-2 inhibitors.
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Affiliation(s)
- Xiao Dan Yue
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Jing Yu Wang
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Xin Rong Zhang
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Ju Hong Yang
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Chun Yan Shan
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Miao Yan Zheng
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Hui Zhu Ren
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Yi Zhang
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Shao Hua Yang
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Zhen Hong Guo
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Bai Chang
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Bao Cheng Chang
- Key Laboratory of Hormones and Development, Ministry of Health, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital, and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China.
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Efficacy of low-density lipoprotein apheresis combined with corticosteroids for cholesterol crystal embolism. Clin Exp Nephrol 2016; 21:228-235. [DOI: 10.1007/s10157-016-1272-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
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Sawa Y, Matsuda K, Tatsumi E, Matsumiya G, Tsukiya T, Abe T, Fukunaga K, Kishida A, Kokubo K, Masuzawa T, Myoui A, Nishimura M, Nishimura T, Nishinaka T, Okamoto E, Tokunaga S, Tomo T, Yagi Y, Yamaoka T. Journal of Artificial Organs 2015: the year in review : Journal of Artificial Organs Editorial Committee. J Artif Organs 2016; 19:1-7. [PMID: 26896942 DOI: 10.1007/s10047-016-0886-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Y Sawa
- Division of Cardiovascular Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - K Matsuda
- Emergency and Critical Care Medicine, University of Yamanashi Hospital, Yamanashi, Japan
| | - E Tatsumi
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - G Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - T Tsukiya
- Department of Artificial Organs, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - T Abe
- Department of Urology, Iwate Medical University School of Medicine, Iwate, Japan
| | - K Fukunaga
- Faculty of Health Sciences, Kyorin University, Tokyo, Japan
| | - A Kishida
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Tokyo, Japan
| | - K Kokubo
- Department of Medical Engineering and Technology, Kitasato University School of Allied Health Science, Kanagawa, Japan
| | - T Masuzawa
- Department of Mechanical Engineering, Ibaraki University, Ibaraki, Japan
| | - A Myoui
- Medical Center for Translational Research, Osaka University Hospital, Osaka, Japan
| | - M Nishimura
- Division of Organ Regeneration Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - T Nishimura
- Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Tokyo, Japan
| | - T Nishinaka
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - E Okamoto
- Department of Human Science and Informatics, School of Bioscience and Engineering, Tokai University, Sapporo, Japan
| | - S Tokunaga
- The Department of Cardiovascular Surgery, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - T Tomo
- Second Department of Internal Medicine, Faculty of Medicine, Oita University, Oita, Japan
| | - Y Yagi
- Department of Clinical Engineering, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - T Yamaoka
- Department of Biomedical Engineering, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
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Kobayashi H, Abe M, Murata Y, Maruyama T, Furukawa T, Oikawa O, Okada K. Low-density lipoprotein apheresis for corticosteroid-resistant skin lesions caused by cholesterol crystal embolism: a case report and review of the literature. J Artif Organs 2015; 18:285-9. [PMID: 25821197 DOI: 10.1007/s10047-015-0830-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/08/2015] [Indexed: 11/25/2022]
Abstract
Cholesterol crystal embolism (CCE) is an arterio-arterial embolism originating from the breakdown of atherosclerotic plaques in the aortic wall. The embolism affects the skin and kidney particularly, as well as frequently affects the gastrointestinal tract and other organs. Although there are no clearly effective direct therapies for CCE, corticosteroid therapy and combination therapy with low-density lipoprotein apheresis (LDL-A) followed by corticosteroids were recently reported to be effective for renal manifestations in some cases. However, few cases offer suggestions for the treatment of skin lesions caused by CCE. We report here a case of a 58-year-old man diagnosed with CCE with skin manifestations and kidney dysfunction who achieved complete remission after LDL-A. LDL-A may be a useful treatment for CCE, particularly in cases with skin manifestations.
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Affiliation(s)
- Hiroki Kobayashi
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kami-chou, Itabashi-ku, Tokyo, 173-8610, Japan
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