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Zhang Y, Yang Z, Yang H, Li X, Liu Z, Bai Y, Qian G, Wu H, Li J, Guo Y, Yang S, Chen L, Yang J, Han J, Ma S, Yang J, Yu L, Shui R, Jin X, Wang H, Zhang F, Chen T, Li X, Zong X, Liu L, Fan J, Wang W, Zhang Y, Shi G, Wang D, Tao S. A multi-center study on the association between serum magnesium levels and allostatic load in hemodialysis patients. Front Physiol 2022; 13:963914. [PMID: 36262256 PMCID: PMC9574054 DOI: 10.3389/fphys.2022.963914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: Serum magnesium (Mg2+) levels are associated with insulin resistance, hypertension, lipid abnormalities, and inflammation. However, limited studies have indicated the relationship between Mg2+ and multiple system indexes. The purpose of this study was to investigate the association between Mg2+ and allostatic load (AL) in hemodialysis patients. Methods: A cross-sectional survey was conducted on hemodialysis patients from different centers in Anhui Province, China, between January and December 2020. A total of 3,025 hemodialysis patients were recruited. Their clinical data were measured before hemodialysis. Information was collected by an online self-reported questionnaire and medical record. Serum Mg2+ was divided into three groups by tertiles. A score of AL greater than or equal to 3 was defined as high AL. A binary logistic regression model was applied to examine the relationship between serum Mg2+ and AL. Results: A total of 1,222 patients undergoing hemodialysis were included, 60% of whom were males (733/1,222). The mean (standard deviation) age of patients was 55.90 (12.75). The median level of serum Mg2+ was 1.22 mmol/L. The rate of high AL levels was 23.4%. Serum Mg2+ was negatively correlated with body mass index, fasting blood glucose (Glu), and C-reactive protein and positively correlated with high-density lipoprotein, low-density lipoprotein, total cholesterol, diastolic blood pressure (DBP), and serum phosphorus. After adjusting for gender, anxiety, diabetes, family residence, lipid-lowering agents, antihypertensive medications, albumin, and Glu, the binary logistic regression model showed that patients with lower levels of serum Mg2+ were more likely have high AL (OR for the T1 group of serum Mg2+:1.945, 95% CI: 1.365–2.773, and OR for the T2 group of serum Mg2+:1.556, 95% CI: 1.099–2.201). Conclusion: Our data support the hypothesis that higher serum Mg2+ concentrations may contribute to lower health risk in hemodialysis populations. Further randomized controlled trials and cohort studies are warranted to verify whether Mg2+ supplementation could be part of routine examinations in hemodialysis populations.
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Affiliation(s)
- Yingxin Zhang
- Department of Nephrology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Zhengling Yang
- Department of Nephrology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Huan Yang
- Department of Nephrology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Xiuyong Li
- Blood Purification Center, No. 2 People’s Hospital of Fuyang City, Fuyang, China
| | - Zhi Liu
- Department of Nephrology, The First Affiliated Hospital of Anhui University of Science and Technology, Huainan, China
| | - Youwei Bai
- Department of Nephrology, The Second People’s Hospital of Lu’an City, Lu’an, China
| | - Guangrong Qian
- Department of Nephrology, Maanshan People’s Hospital, Maanshan, China
| | - Han Wu
- Blood Purification Center, Bozhou People’s Hospital, Bozhou, China
| | - Ji Li
- Department of Nephrology, Tongling People’s Hospital, Tongling, China
| | - Yuwen Guo
- Department of Nephrology, Lujiang County People’s Hospital, Lujiang, China
| | - Shanfei Yang
- Department of Nephrology, Shouxian County Hospital, Shouxian County, China
| | - Lei Chen
- Department of Nephrology, Hefei Jinnan Kidney Hospital, Hefei, China
| | - Jian Yang
- Department of Nephrology, Funan County People’s Hospital, Funan County, China
| | - Jiuhuai Han
- Department of Nephrology, Anqing Municipal Hospital, Anqing, China
| | - Shengyin Ma
- Department of Nephrology, Anhui Wanbei Coal-Electricity Group General Hospital, Suzhou, China
| | - Jing Yang
- Department of Nephrology, The First People’s Hospital of Hefei, Hefei, China
| | - Linfei Yu
- Department of Nephrology, The People’s Hospital of Taihu, Taihu County, China
| | - Runzhi Shui
- Blood Purification Center, Huangshan City People’s Hospital, Huangshan, China
| | - Xiping Jin
- Department of Nephrology, Huainan Chao Yang Hospital, Huainan, China
| | - Hongyu Wang
- Department of Nephrology, Lixin County People’s Hospital, Lixin County, China
| | - Fan Zhang
- Department of Nephrology, Dongzhi County People’s Hospital, Dongzhi County, China
| | - Tianhao Chen
- Department of Nephrology, Tianchang City People’s Hospital, Tianchang, China
| | - Xinke Li
- Department of Nephrology, Xiaoxian People’s Hospital, Xiaoxian County, China
| | - Xiaoying Zong
- Department of Nephrology, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Li Liu
- Department of Nephrology, The Second People’s Hospital of Hefei, Hefei, China
| | - Jihui Fan
- Department of Nephrology, Huaibei People’s Hospital, Huaibei, China
| | - Wei Wang
- Department of Nephrology, The People’s Hospital of Xuancheng City, Xuancheng, China
| | - Yong Zhang
- Department of Nephrology, Lujiang County Hospital of TCM, Lujiang County, China
| | - Guangcai Shi
- Department of Nephrology, The Fifth People’s Hospital of Hefei, Hefei, China
| | - Deguang Wang
- Department of Nephrology, The Second Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Deguang Wang, ; Shuman Tao,
| | - Shuman Tao
- Department of Nephrology, The Second Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Deguang Wang, ; Shuman Tao,
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Di Mario F, Regolisti G, Greco P, Maccari C, Superchi E, Morabito S, Pistolesi V, Fiaccadori E. Prevention of hypomagnesemia in critically ill patients with acute kidney injury on continuous kidney replacement therapy: the role of early supplementation and close monitoring. J Nephrol 2020; 34:1271-1279. [PMID: 33001413 DOI: 10.1007/s40620-020-00864-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
Hypomagnesemia is a common electrolyte disorder in critically ill patients and is associated with increased morbidity and mortality risk. Many clinical conditions may contribute to hypomagnesemia through different pathogenetic mechanisms. In patients with acute kidney injury (AKI) the need for continuous or prolonged intermittent kidney replacement therapy (CKRT and PIKRT, respectively) may further add to other causes of hypomagnesemia, especially when regional citrate anticoagulation (RCA) is used. The basic principle of RCA is chelation of ionized calcium by citrate within the extracorporeal circuit, thus blocking the coagulation cascade. Magnesium, a divalent cation, follows the same fate as calcium; the amount lost in the effluent includes both magnesium-citrate complexes and the free fraction directly diffusing through the hemofilter. While increasing the magnesium content of dialysis/replacement solutions may decrease the risk of hypomagnesemia, the optimal concentration for the variable combination of solutions adopted in different KRT protocols has not yet been identified. An alternative and effective approach is based on including early intravenous magnesium supplementation in the KRT protocol, and close monitoring of serum magnesium levels, especially in the setting of RCA. Thus, strategies aimed at precisely tailoring both dialysis prescriptions and the composition of KRT fluids, as well as early magnesium supplementation and close monitoring, could represent a cornerstone in reducing KRT-related hypomagnesemia.
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Affiliation(s)
- Francesca Di Mario
- Dipartimento di Medicina e Chirurgia, UO Nefrologia, Unità Operativa di Nefrologia, Azienda Ospedaliero-Universitaria Parma, Università̀ di Parma, Via Gramsci 14, 43100, Parma, Italy.
| | - Giuseppe Regolisti
- Dipartimento di Medicina e Chirurgia, UO Nefrologia, Unità Operativa di Nefrologia, Azienda Ospedaliero-Universitaria Parma, Università̀ di Parma, Via Gramsci 14, 43100, Parma, Italy
| | - Paolo Greco
- Dipartimento di Medicina e Chirurgia, UO Nefrologia, Unità Operativa di Nefrologia, Azienda Ospedaliero-Universitaria Parma, Università̀ di Parma, Via Gramsci 14, 43100, Parma, Italy
| | - Caterina Maccari
- Dipartimento di Medicina e Chirurgia, UO Nefrologia, Unità Operativa di Nefrologia, Azienda Ospedaliero-Universitaria Parma, Università̀ di Parma, Via Gramsci 14, 43100, Parma, Italy
| | - Eleonora Superchi
- Dipartimento di Medicina e Chirurgia, UO Nefrologia, Unità Operativa di Nefrologia, Azienda Ospedaliero-Universitaria Parma, Università̀ di Parma, Via Gramsci 14, 43100, Parma, Italy
| | - Santo Morabito
- UOSD Dialisi, Azienda Ospedaliero-Universitaria Policlinico Umberto I, "Sapienza" Università̀ di Roma, Rome, Italy
| | - Valentina Pistolesi
- UOSD Dialisi, Azienda Ospedaliero-Universitaria Policlinico Umberto I, "Sapienza" Università̀ di Roma, Rome, Italy
| | - Enrico Fiaccadori
- Dipartimento di Medicina e Chirurgia, UO Nefrologia, Unità Operativa di Nefrologia, Azienda Ospedaliero-Universitaria Parma, Università̀ di Parma, Via Gramsci 14, 43100, Parma, Italy
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Yang W, Wang E, Chen W, Chen C, Chen S. Continuous Observation of Serum Total Magnesium Level in Patients Undergoing Hemodialysis. Blood Purif 2020; 50:196-204. [PMID: 32866952 DOI: 10.1159/000509788] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Magnesium is an indispensable cation and plays an important physiological role in the body. Most previous studies focused on the single measurement of serum magnesium in patients undergoing hemodialysis. However, scant studies focused on continuous observations of serum magnesium levels. OBJECTIVE To provide continuous observations of serum magnesium levels in patients on maintenance hemodialysis (MHD). The levels of magnesium in patients initiating hemodialysis are also recorded and analyzed in the present study. METHODS In this retrospective study, we serially investigated the measurements of serum total magnesium in MHD patients and patients initiating hemodialysis. Our data were followed up for one year. We provided real-time update on the levels of serum magnesium in patients on hemodialysis. RESULTS On January 1, 2019, a total of 356 end-stage renal disease patients were receiving hemodialysis in our hospital. On December 31, 2019, the number had increased to 383. We found that serum total magnesium levels were in the normal range before initiating hemodialysis. With the initiation of hemodialysis, the levels of serum total magnesium increased. In patients on MHD, hypermagnesemia was very common. Hypomagnesemia was rare when 0.5 mmol/L magnesium dialysate was used. We did not find proton pump inhibitor associated hypomagnesemia. CONCLUSION We find that serum total magnesium levels are in the normal range before initiating hemodialysis. However, in patients on MHD, hypermagnesemia is common when 0.5 mmol/L magnesium dialysate is used. Hypomagnesemia is very rare. Hypomagnesemia in patients on MHD is an indicator of poor condition.
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Affiliation(s)
- Wenfang Yang
- Department of Nephrology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Erli Wang
- Clinical Laboratory, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Wenxiu Chen
- Department of Nephrology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Chunming Chen
- Department of Nephrology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Shanying Chen
- Department of Nephrology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China,
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4
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Geng X, Yu J, Xu J, Jin S, Shao W, Wang Y, Guo M, Cao X, Zou J, Xu X, Ding X. Role of magnesium in the risk of intradialytic hypotension among maintenance hemodialysis patients. Hemodial Int 2020; 24:351-358. [PMID: 32395903 DOI: 10.1111/hdi.12833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/20/2020] [Accepted: 04/02/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Xuemei Geng
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai Institute of Kidney and Dialysis, Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai Medical Center of Kidney Disease Shanghai China
| | - Jinbo Yu
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai Institute of Kidney and Dialysis, Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai Medical Center of Kidney Disease Shanghai China
| | - Jiarui Xu
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai Institute of Kidney and Dialysis, Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai Medical Center of Kidney Disease Shanghai China
| | - Shi Jin
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai Institute of Kidney and Dialysis, Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai Medical Center of Kidney Disease Shanghai China
| | - Wenqi Shao
- Department of Laboratory Medicine Zhongshan Hospital, Fudan University Shanghai China
| | - Yimei Wang
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai Institute of Kidney and Dialysis, Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai Medical Center of Kidney Disease Shanghai China
| | - Man Guo
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai Institute of Kidney and Dialysis, Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai Medical Center of Kidney Disease Shanghai China
| | - Xuesen Cao
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai Institute of Kidney and Dialysis, Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai Medical Center of Kidney Disease Shanghai China
| | - Jianzhou Zou
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai Institute of Kidney and Dialysis, Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai Medical Center of Kidney Disease Shanghai China
| | - Xialian Xu
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai Institute of Kidney and Dialysis, Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai Medical Center of Kidney Disease Shanghai China
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai Institute of Kidney and Dialysis, Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai Medical Center of Kidney Disease Shanghai China
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5
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Mizuiri S, Nishizawa Y, Yamashita K, Ono K, Usui K, Arita M, Naito T, Doi S, Masaki T, Shigemoto K. Relationship of serum magnesium level with body composition and survival in hemodialysis patients. Hemodial Int 2019; 24:99-107. [DOI: 10.1111/hdi.12797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/12/2019] [Accepted: 10/15/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Sonoo Mizuiri
- Division of NephrologyIchiyokai Harada Byoin, 7‐10 Kairoyama‐cho, Saeki‐ku Hiroshima 731‐5134 Japan
| | - Yoshiko Nishizawa
- Division of NephrologyIchiyokai Harada Byoin, 7‐10 Kairoyama‐cho, Saeki‐ku Hiroshima 731‐5134 Japan
| | - Kazuomi Yamashita
- Division of NephrologyIchiyokai Harada Byoin, 7‐10 Kairoyama‐cho, Saeki‐ku Hiroshima 731‐5134 Japan
| | - Kyoka Ono
- Division of NephrologyIchiyokai Harada Byoin, 7‐10 Kairoyama‐cho, Saeki‐ku Hiroshima 731‐5134 Japan
| | - Koji Usui
- Ichiyokai Ichiyokai Clinic10‐3 Asahien, Saeki‐ku Hiroshima 731‐5133 Japan
| | - Michiko Arita
- Iciyokai East Clinic1‐3‐53 Danbaraminami Minami‐ku Hiroshima 732‐0814 Japan
| | - Takayuki Naito
- Ichiyokai Yokogawa Clinic2‐7‐9 Yokogawacho Nishi‐ku Hiroshima 733‐0011 Japan
| | - Shigehiro Doi
- Department of NephrologyHiroshima University, 1‐2‐3 Kasumi Minami‐ku Hiroshima 734‐8551 Japan
| | - Takao Masaki
- Department of NephrologyHiroshima University, 1‐2‐3 Kasumi Minami‐ku Hiroshima 734‐8551 Japan
| | - Kenichiro Shigemoto
- Division of NephrologyIchiyokai Harada Byoin, 7‐10 Kairoyama‐cho, Saeki‐ku Hiroshima 731‐5134 Japan
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Chacar FC, Kogika MM, Ferreira AC, Kanayama KK, Reche A. Total serum magnesium in cats with chronic kidney disease with nephrolithiasis. J Feline Med Surg 2019; 21:1172-1180. [PMID: 30694098 PMCID: PMC10814274 DOI: 10.1177/1098612x18823588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Magnesium has been 'the forgotten ion' for many years. Over the past decade, however, the role of magnesium in essential physiological functions and several illness conditions have been elucidated. Nevertheless, the investigation of magnesium in cats with chronic kidney disease (CKD) and nephrolithiasis is yet to be determined. The purpose of this study was to investigate whether CKD cats with nephrolithiasis have changes in total serum magnesium concentrations, and whether magnesium disorders may be associated with other electrolyte disturbances, as well as with prognosis. We also aimed to evaluate whether total serum magnesium concentration differs between CKD cats with and without nephrolithiasis. METHODS Total serum magnesium concentrations were assessed in 42 cats with CKD with stage 1-4 nephrolithiasis. The correlation between magnesium and other electrolytes, as well as Kaplan-Meier survival analysis, were performed. We also selected 14 control cats with CKD without nephrolithiasis age-matched with 14 cats with CKD with nephrolithiasis. RESULTS Hypermagnesemia was observed in 16/42 (38.1%) and hypomagnesemia in 6/42 (14.3%) cats. Serum magnesium abnormalities were observed in cats of all stages, and marked hypermagnesemia was noted in cats with stage 4 CKD with nephrolithiasis (P <0.001). There was a negative correlation between total serum magnesium and ionized calcium (r = -0.64; P <0.01), and a positive correlation between total serum magnesium and serum phosphorus (r = 0.58, P = 0.01). Cats with CKD with nephrolithiasis and hypomagnesemia or hypermagnesemia had higher mortality than those with normal total serum magnesium concentration (P <0.01), regardless of CKD stage. There was no difference in total serum magnesium concentration between CKD cats with and without nephrolithiasis. CONCLUSIONS AND RELEVANCE Cats with CKD with nephrolithiasis have magnesium abnormalities. Hypomagnesemia and hypermagnesemia were associated with an increase in mortality, and thus total serum magnesium abnormalities may be used as prognostic factors in these cases.
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Affiliation(s)
- Fernanda Chicharo Chacar
- Internal Medicine, School of Veterinary Medicine and Animal Science/University of Sao Paulo, Sao Paulo, Brazil
| | - Marcia Mery Kogika
- Internal Medicine, School of Veterinary Medicine and Animal Science/University of Sao Paulo, Sao Paulo, Brazil
| | - Andréa C Ferreira
- Internal Medicine, School of Veterinary Medicine and Animal Science/University of Sao Paulo, Sao Paulo, Brazil
| | - Khadine K Kanayama
- Internal Medicine, School of Veterinary Medicine and Animal Science/University of Sao Paulo, Sao Paulo, Brazil
| | - Archivaldo Reche
- Internal Medicine, School of Veterinary Medicine and Animal Science/University of Sao Paulo, Sao Paulo, Brazil
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Mizuiri S, Nishizawa Y, Yamashita K, Naito T, Ono K, Tanji C, Usui K, Doi S, Masaki T, Shigemoto K. Hypomagnesemia is not an independent risk factor for mortality in Japanese maintenance hemodialysis patients. Int Urol Nephrol 2019; 51:1043-1052. [PMID: 30977017 PMCID: PMC6543028 DOI: 10.1007/s11255-019-02073-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 01/03/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE It is unclear whether hypomagnesemia is an independent risk factor or innocent bystander for mortality in maintenance hemodialysis (MHD) patients. Thus, we studied associations between hypomagnesemia and all-cause as well as cardiovascular (CV) mortality in MHD patients. METHODS Baseline clinical characteristics and coronary artery calcium score (CACS) of 353 Japanese MHD patients were reviewed. Three-year survival rate and mortality risk factors were assessed. RESULTS Median (interquartile range) age, dialysis vintage, serum magnesium (Mg), serum albumin and CACS of the subjects were 68 (60-78) years, 75 (32-151) months, 2.4 (2.2-2.7) mg/dl, 3.6 (3.3-3.8) g/dl, and 1181 (278-3190), respectively. During the 3-year period, 91 patients died. Kaplan-Meier overall 3-year survival rates were 59.0% in in patients with Mg < 2.4 mg/dl (n = 136) and 82.3% in patients with Mg ≥ 2.4 mg/dl (n = 217), (P < 0.0001). In Cox regression models not incorporating serum albumin, Mg < 2.4 mg/dl was significantly associated with 3-year all-cause death, independent of age, dialysis vintage, average ultrafiltration, Log (CACS + 1), warfarin use, serum potassium, high-sensitivity C-reactive protein (hsCRP), phosphate, uric acid, and intact parathyroid hormone [Hazard ratio (HR) 95% confidence interval (CI): 2.82 (1.31-6.29), P = 0.0078], and CV death, independent of age, dialysis vintage, Log (CACS + 1), warfarin use, serum hsCRP, and uric acid [HR (95% CI): 4.47 (1.45-16.76), P = 0.0086]. Nevertheless, associations of Mg < 2.4 mg/dl with all-cause and CV mortality were all absent in models that included serum albumin. CONCLUSIONS Hypomagnesemia is not an independent risk factor for mortality but is associated with malnutrition in MHD patients.
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Affiliation(s)
- Sonoo Mizuiri
- Division of Nephrology, Ichiyokai Harada Hospital, 7-10 Kairoyama-cho, Saeki-ku, Hiroshima, 731-5134, Japan.
| | - Yoshiko Nishizawa
- Division of Nephrology, Ichiyokai Harada Hospital, 7-10 Kairoyama-cho, Saeki-ku, Hiroshima, 731-5134, Japan
| | - Kazuomi Yamashita
- Division of Nephrology, Ichiyokai Harada Hospital, 7-10 Kairoyama-cho, Saeki-ku, Hiroshima, 731-5134, Japan
| | - Takayuki Naito
- Division of Nephrology, Ichiyokai Harada Hospital, 7-10 Kairoyama-cho, Saeki-ku, Hiroshima, 731-5134, Japan
| | - Kyoka Ono
- Division of Nephrology, Ichiyokai Harada Hospital, 7-10 Kairoyama-cho, Saeki-ku, Hiroshima, 731-5134, Japan
| | - Chie Tanji
- Ichiyokai Ichiyokai Clinic, 10-3 Asahien, Saeki-ku, Hiroshima, 731-5133, Japan
| | - Koji Usui
- Ichiyokai Ichiyokai Clinic, 10-3 Asahien, Saeki-ku, Hiroshima, 731-5133, Japan
| | - Shigehiro Doi
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8551, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi Minami-ku, Hiroshima, 734-8551, Japan
| | - Kenichiro Shigemoto
- Division of Nephrology, Ichiyokai Harada Hospital, 7-10 Kairoyama-cho, Saeki-ku, Hiroshima, 731-5134, Japan
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