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Hasegawa H, Tsukada Y, Wakabayashi M, Nomura S, Sasaki T, Nishizawa Y, Ikeda K, Takeshita N, Teramura K, Ito M. Impact of near-infrared fluorescence imaging with indocyanine green on structural sequelae of anastomotic leakage after laparoscopic intersphincteric resection of malignant rectal tumors. Tech Coloproctol 2022; 26:561-570. [DOI: 10.1007/s10151-022-02631-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/02/2022] [Indexed: 12/16/2022]
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2
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Affiliation(s)
- Yoshiki Nishizawa
- Department of Neurology, U.S. Naval Hospital
Yokosuka, 82, Inaoka-Cho, Yokosuka-City, Kanagawa, 238-0001,
Japan
| | - Yoji Hoshina
- Department of Neurology, U.S. Naval Hospital
Yokosuka, 82, Inaoka-Cho, Yokosuka-City, Kanagawa, 238-0001,
Japan
- Address correspondence to author: Yoji Hoshina, MD,
Department of Neurology, U.S. Naval Hospital Yokosuka, 82, Inaoka-cho,
Yokosuka-city, Kanagawa, Japan, Tel: +81-46-816-7144,
| | - Virginia Baker
- Department of Neurology, U.S. Naval Hospital
Yokosuka, 82, Inaoka-Cho, Yokosuka-City, Kanagawa, 238-0001,
Japan
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Tsujimoto Y, Kuratsune D, Kabayama S, Miyazaki M, Watanabe Y, Nishizawa Y, Nakayama M. Amelioration of fatigue in chronic dialysis patients with dialysis solution employing electrolyzed water containing molecular hydrogen (H2) and its association with autonomic function balance. Ren Replace Ther 2021. [DOI: 10.1186/s41100-021-00376-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
Enhanced oxidative stress is involved with fatigue in hemodialysis (HD) patients. Molecular hydrogen (H2) could improve the redox status. Thus, the study examines whether HD solution rendered by electrolyzed water containing H2 (E-HD) could impact the fatigue and autonomic balance of patients.
Methods
This single-arm, prospective observational study examined 95 patients on chronic HD (54 males; mean age and HD duration; 71.4 years and 10.6 years). Fatigue status on HD and HD-free days was compared between control HD (CHD) and 8 weeks after commencement of E-HD, using a visual analog scale (VAS) and an original scale. Autonomic balance was analyzed with the degree of activities of the sympathetic and parasympathetic nervous system via frequency analysis of a continuous beat interval.
Results
Patients were classified into three groups according to the presence of subjective fatigue during the period of CHD: Group A (40.0%), fatigue only on HD days; Group B (11.6%), presence of fatigue on both HD and HD-free days; and Group C (48.4%), freedom from fatigue. During the 8-week observation period of E-HD, VAS scores were significantly decreased on HD days in Group A, while Group B showed no significant changes in VAS on HD days, but significant decreases on HD-free days. No consistent changes were found in Group C. Significant increases in percentages of patients who reported absence of fatigue were seen in Group A on HD days and in Group B on HD-free days in week 8. Regarding changes in autonomic balance parameters after E-HD commencement, a positive correlation was identified between changes in VAS and autonomic balance in Group A.
Conclusion
E-HD may ameliorate fatigue in patients with subjective symptoms on HD and HD-free days. The influence of autonomic balance by E-HD and its impact on fatigue needs to be elucidated.
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Muso E, Sakai S, Ogura Y, Yukawa S, Nishizawa Y, Yorioka N, Saito T, Mune M, Sugiyama S, Iino Y, Hirano T, Hattori M, Watanabe T, Yokoyama H, Sato H, Uchida S, Wada T, Shoji T, Oda H, Mori K, Kimura H, Ito O, Nishiyama A, Maruyama S, Inagi R, Fujimoto S, Tsukamoto T, Suzuki Y, Honda H, Babazono T, Tsuruya K, Yuzawa Y. Favorable therapeutic efficacy of low-density lipoprotein apheresis for nephrotic syndrome with impaired renal function. Ther Apher Dial 2021; 26:220-228. [PMID: 34057286 PMCID: PMC9290660 DOI: 10.1111/1744-9987.13694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/29/2021] [Accepted: 05/24/2021] [Indexed: 12/01/2022]
Abstract
Many reports have shown the therapeutic efficacy of LDL apheresis (LDL-A) in drug-resistant nephrotic syndrome (NS) for improvement of heavy proteinuria and severely impaired renal function. To obtain comprehensive results in a large number of cases, a post hoc analysis of the Prospective Observational survey on the Long-Term Effects of the LDL-Apheresis on the Drug Resistant Nephrotic Syndrome (POLARIS) study was performed by stratifying enrolled cases according to the pretreatment estimated glomerular filtration rate (eGFR) levels indicating normal (N) (≥60 ml/min/1.73 m2 ), moderately impaired (M) (≥30 to <60 ml/min/1.73 m2 ), and severely impaired (S) (<30 ml/min/1.73 m2 ) renal function. Significant improvements of proteinuria and renal function were found in Group N and, most interestingly, in Group M. A tendency for improvement in proteinuria was found in Group S. Most cases in all groups had not entered end-stage renal disease at 2 years after LDL-A treatment. These results suggest that LDL-A has therapeutic efficacy even in cases in which renal function has declined to 30 ml/min/1.73 m2 .
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Affiliation(s)
- Eri Muso
- Department of Food and Nutrition, Faculty of Contemporary Home Economics, Kyoto Kacho University, Kyoto, Japan.,Department of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | | | | | | | | | | | | | | | | | | | | | - Motoshi Hattori
- Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Hitoshi Yokoyama
- Department of Nephrology, Kanazawa Medical University School of Medicine, Uchinada, Japan
| | - Hiroshi Sato
- Sendai Hospital of East Japan Railway Company, Sendai, Japan
| | - Shunya Uchida
- Department of Health Care, Teikyo Heisei University, Tokyo, Japan
| | - Takashi Wada
- Department of Nephrology and Laboratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Faculty of Medicine, Kanazawa University, Kanazawa, Japan
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Kiyoshi Mori
- School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Hideki Kimura
- Department of Clinical Laboratory, University of Fukui Hospital, Fukui, Japan
| | - Osamu Ito
- Division of General Medicine and Rehabilitation, Tohoku Medical and Pharmaceutical University Faculty of Medicine, Sendai, Japan
| | - Akira Nishiyama
- Department of Pharmacology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Reiko Inagi
- Division of CKD Pathophysiology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Shoichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Tatsuo Tsukamoto
- Department of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Hirokazu Honda
- Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
| | - Tetsuya Babazono
- Department of Medicine, Diabetes Center, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, Kashiwara, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
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Kazama S, Anzai H, Matsuzawa N, Nishimura Y, Ishii H, Nishizawa Y, Kanda H, Kawashima Y, Sakamoto H. A case of resected retroperitoneal metachronous solitary metastasis from caecal cancer. Ann R Coll Surg Engl 2020; 102:e198-e201. [PMID: 32538111 DOI: 10.1308/rcsann.2020.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Colorectal cancer metastasis to the retroperitoneum, especially solitary metastasis allowing curative resection, is rare. We report a case of complete resection of retroperitoneal metachronous solitary metastasis from caecal cancer without distant metastasis. An 80-year-old woman with caecal cancer underwent laparoscopic ileocaecal resection with regional lymph node dissection. According to the eighth edition of the TNM classification, the pathological diagnosis was stage IIA (T3N0M0). Six months following the surgery, computed tomography revealed a solitary mass of 2cm diameter, dorsal to the right kidney. A second procedure for the removal of the tumour was performed. The lesion was pathologically diagnosed as a metachronous solitary retroperitoneal metastasis from caecal cancer. The patient is surviving and free from recurrence 17 months following the second procedure.
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Affiliation(s)
- S Kazama
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan
| | - H Anzai
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan
| | - N Matsuzawa
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan
| | - Y Nishimura
- Department of Pathology, Saitama Cancer Center, Saitama, Japan
| | - H Ishii
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan
| | - Y Nishizawa
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan
| | - H Kanda
- Department of Pathology, Saitama Cancer Center, Saitama, Japan
| | - Y Kawashima
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan
| | - H Sakamoto
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan
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Kitaguchi D, Nishizawa Y, Sasaki T, Tsukada Y, Ikeda K, Ito M. Recurrence of rectal anastomotic leakage following stoma closure: assessment of risk factors. Colorectal Dis 2019; 21:1304-1311. [PMID: 31199545 DOI: 10.1111/codi.14728] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/12/2019] [Indexed: 02/08/2023]
Abstract
AIM In patients with a previous history of rectal anastomotic leakage (AL), the surgical indications and timing for closure of a diverting stoma have to be carefully judged. Even if AL has apparently healed before stoma closure, re-leakage may occur after closure. The aim of this study was to determine the incidence and risk factors for recurrent AL following stoma closure. We also examined the treatment strategies aiming to minimize the risk of recurrent AL. METHODS From January 2009 to December 2016, 1008 patients underwent sphincter-saving surgery [low anterior resection, all-sphincter-preserving rectal resection with hand-sewn coloanal anastomosis (CAA) and intersphincteric resection (ISR)] for primary rectal cancer with curative intent at our hospital. A total of 69 patients with AL with a Clavien-Dindo Grade III or more who subsequently underwent closure of a diverting stoma were retrospectively reviewed for this study. RESULTS The incidence of recurrent leakage after stoma closure in this series was 13% overall with an incidence of 25% in the CAA/ISR group and 5% in the low anterior resection group. Significant risk factors included hand-sewn anastomosis (P = 0.0257) compared to stapled anastomosis, ischaemia at the anastomotic site as the cause of initial AL (P < 0.001) and a shorter interval between confirmation of healing and stoma closure (P = 0.00952). CONCLUSION Ischaemia at the anastomotic site was the main risk factor for recurrent leakage, particularly after CAA/ISR. Additional treatment options before stoma closure should be considered to avoid re-leakage in such cases.
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Affiliation(s)
- D Kitaguchi
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - Y Nishizawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - T Sasaki
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - Y Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - K Ikeda
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
| | - M Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwanoha, Kashiwa, Chiba, Japan
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Sugimoto T, Inoue D, Maehara M, Oikawa I, Shigematsu T, Nishizawa Y. Efficacy and safety of once-monthly risedronate in osteoporosis subjects with mild-to-moderate chronic kidney disease: a post hoc subgroup analysis of a phase III trial in Japan. J Bone Miner Metab 2019; 37:730-740. [PMID: 30523414 DOI: 10.1007/s00774-018-0977-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 10/31/2018] [Indexed: 11/29/2022]
Abstract
Limited data are available on the safety and efficacy of anti-resorptive agents, particularly once-monthly bisphosphonates, for use in osteoporotic patients with chronic kidney disease (CKD). We conducted a post hoc analysis of data from a 12-month, randomized, double-blind, phase III study to evaluate the safety and efficacy of once-monthly risedronate (RIS-OM) 75 mg tablets in Japanese osteoporosis patients with mild-to-moderate CKD. Patients who received RIS-OM 75 mg were stratified by baseline estimated glomerular filtration rate (eGFR; ≥ 90, ≥ 60 to < 90, or ≥ 30 to < 60 mL/min/1.73 m2). Safety endpoints were incidence of adverse events (AEs) and percent change from baseline in eGFR, serum creatinine, calcium, and phosphorus. Efficacy endpoints were percent change from baseline in lumbar spine bone mineral density (BMD) and bone turnover markers (BTMs). In 420 patients included (age 67.7 ± 6.7 years, women 98.8%), the incidence of all AEs, gastrointestinal disorders, acute phase reaction, non-vertebral fractures, and renal and urinary disorders was not significantly different among subgroups. Interaction between subgroups and time was significant for eGFR (p = 0.010) and serum creatinine (p = 0.001) but considered to be regression to the mean and clinically insignificant. BMD significantly increased while BTMs significantly decreased from baseline with a similar degree of change among the subgroups. In conclusion, RIS-OM 75 mg showed consistent safety and efficacy in suppressing bone turnover and increasing BMD in Japanese primary osteoporosis patients with mild-to-moderate CKD. These results should, however, be interpreted with caution because the number of patients with moderate CKD was limited.
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Affiliation(s)
- Toshitsugu Sugimoto
- Internal Medicine, 1, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Daisuke Inoue
- Third Department of Medicine, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara-shi, Chiba, 299-0111, Japan.
| | - Masayuki Maehara
- EA Pharma Co., Ltd., 2-1-1 Irifune, Chuo-ku, Tokyo, 104-0042, Japan
| | - Ichiro Oikawa
- EA Pharma Co., Ltd., 2-1-1 Irifune, Chuo-ku, Tokyo, 104-0042, Japan
| | - Takashi Shigematsu
- Department of Nephrology, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8509, Japan
| | - Yoshiki Nishizawa
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
- Inoue Hospital, 16-17 Enoki-cho, Suita-shi, Osaka, 564-0053, Japan
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Kondo A, Nishizawa Y, Tsunemori H, Taketani H, Yamamoto N, Okazoe H, Fujita T, Sugimoto M, Suzuki Y. Use of a linear stapler for urethral and dorsal vein complex transection during laparoscopic total pelvic exenteration in rectal cancer. Tech Coloproctol 2019; 23:487-490. [DOI: 10.1007/s10151-019-01974-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
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9
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Kitaguchi D, Nishizawa Y, Sasaki T, Tsukada Y, Ito M. Clinical benefit of high resolution anorectal manometry for the evaluation of anal function after intersphincteric resection. Colorectal Dis 2019; 21:335-341. [PMID: 30537066 DOI: 10.1111/codi.14528] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 11/12/2018] [Indexed: 02/08/2023]
Abstract
AIM Intersphincteric resection (ISR) is an advanced anus-preserving operation for treating low rectal cancer while avoiding colostomy. High-resolution anorectal manometry (HR-ARM) allows objective and accurate evaluation of anal function. However, correlations between anal function after ISR and HR-ARM parameters are unknown. The aim of the study was to evaluate HR-ARM for objective evaluation of anal function after ISR. METHOD A total of 81 patients who underwent ISR at our hospital between October 2014 and March 2016 were identified from our prospectively collected database and electronic medical records. Of these, 68 patients who had been evaluated using HR-ARM both before and after ISR were included in the study. Faecal incontinence (FI) was assessed by Wexner score. Multivariate analysis was performed to determine risk factors for severe FI after ISR. RESULTS Maximum resting pressure (MRP) (P < 0.001) and maximum squeeze pressure (P = 0.04) were significantly lower after ISR, and MRP (P < 0.001) and maximum squeeze pressure (P = 0.02) were significantly lower after total (or subtotal) ISR than after partial ISR. The overall incidence of severe FI after ISR was 18% (12/68), and a high pressure zone before ISR ≤ 3 cm (P = 0.007) and MRP before ISR > 60 mmHg (P = 0.02) were independently associated with an elevated incidence of severe FI after ISR. Decreased preoperative MRP also correlated with severe FI after ISR (P = 0.008). CONCLUSION HR-ARM is reliable for the evaluation of anal function after ISR, and the high pressure zone and MRP may be useful preoperative predictors of severe FI after ISR.
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Affiliation(s)
- D Kitaguchi
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Y Nishizawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - T Sasaki
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Y Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - M Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba, Japan
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10
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Sugimoto T, Shiraki M, Nakano T, Kishimoto H, Ito M, Fukunaga M, Sone T, Hagino H, Miki T, Nishizawa Y, Akachi S, Nakamura T. A randomized, double-blind, placebo-controlled study of once weekly elcatonin in primary postmenopausal osteoporosis. Curr Med Res Opin 2019; 35:447-454. [PMID: 29986611 DOI: 10.1080/03007995.2018.1498780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Very few reports have described changes in bone mineral density (BMD) with long-term, once weekly administration of elcatonin, and its effects in reducing incident fractures remain unverified. Therefore, the efficacy and safety of once weekly elcatonin were examined over a 3 year period. METHODS This was a multicenter, double-blinded, randomized, placebo-controlled study. Postmenopausal women with primary osteoporosis received either 20 units of elcatonin (EL group, n = 433) or placebo (P group, n = 436) once a week for 144 weeks (3 years) intramuscularly. The primary endpoint was the incidence of new vertebral fractures at 24, 48, 72, 96, 120, and 144 weeks after the start. Secondary endpoints were the incidence of non-vertebral fractures, changes in lumbar, hip total and femoral neck BMD, and the incidence of adverse drug reactions (ADRs). RESULTS No significant reduction in the incidence of new vertebral fractures was found in the EL group. The percentage increase in lumbar BMD was significantly higher in the EL group from 24 weeks to the last administration. Although the EL group showed tendencies toward smaller decreased hip total and femoral neck BMD, no significant differences were observed between groups. The incidence of ADRs was significantly greater in the EL group, although these have all been previously reported and no new safety concerns were identified. CONCLUSIONS Once weekly injection of 20 units of elcatonin significantly increased lumbar BMD over a 3 year period and did not cause any safety problems, but no significant reduction in the incidence of vertebral or non-vertebral fractures was demonstrated.
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Affiliation(s)
- Toshitsugu Sugimoto
- a Internal Medicine 1 , Shimane University Faculty of Medicine , Shimane , Japan
| | - Masataka Shiraki
- b Research Institute and Practice for Involutional Diseases , Nagano , Japan
| | | | | | - Masako Ito
- e Center for Diversity and Inclusion, Nagasaki University , Nagasaki , Japan
| | | | - Teruki Sone
- g Department of Nuclear Medicine, Kawasaki Medical School , Okayama , Japan
| | - Hiroshi Hagino
- h School of Health Science , Tottori University , Tottori , Japan
| | - Takami Miki
- i Izumiotsu Municipal Hospital , Osaka , Japan
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Shoji T, Inaba M, Fukagawa M, Ando R, Emoto M, Fujii H, Fujimori A, Fukui M, Hase H, Hashimoto T, Hirakata H, Honda H, Hosoya T, Ikari Y, Inaguma D, Inoue T, Isaka Y, Iseki K, Ishimura E, Itami N, Ito C, Kakuta T, Kawai T, Kawanishi H, Kobayashi S, Kumagai J, Maekawa K, Masakane I, Minakuchi J, Mitsuiki K, Mizuguchi T, Morimoto S, Murohara T, Nakatani T, Negi S, Nishi S, Nishikawa M, Ogawa T, Ohta K, Ohtake T, Okamura M, Okuno S, Shigematsu T, Sugimoto T, Suzuki M, Tahara H, Takemoto Y, Tanaka K, Tominaga Y, Tsubakihara Y, Tsujimoto Y, Tsuruya K, Ueda S, Watanabe Y, Yamagata K, Yamakawa T, Yano S, Yokoyama K, Yorioka N, Yoshiyama M, Nishizawa Y. Effect of Oral Alfacalcidol on Clinical Outcomes in Patients Without Secondary Hyperparathyroidism Receiving Maintenance Hemodialysis: The J-DAVID Randomized Clinical Trial. JAMA 2018; 320:2325-2334. [PMID: 30535217 PMCID: PMC6583075 DOI: 10.1001/jama.2018.17749] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Patients with chronic kidney disease have impaired vitamin D activation and elevated cardiovascular risk. Observational studies in patients treated with hemodialysis showed that the use of active vitamin D sterols was associated with lower risk of all-cause mortality, regardless of parathyroid hormone levels. OBJECTIVE To determine whether vitamin D receptor activators reduce cardiovascular events and mortality in patients without secondary hyperparathyroidism undergoing hemodialysis. DESIGN, SETTING, AND PARTICIPANTS Randomized, open-label, blinded end point multicenter study of 1289 patients in 207 dialysis centers in Japan. The study included 976 patients receiving maintenance hemodialysis with serum intact parathyroid hormone levels less than or equal to 180 pg/mL. The first and last participants were enrolled on August 18, 2008, and January 26, 2011, respectively. The final date of follow-up was April 4, 2015. INTERVENTIONS Treatment with 0.5 μg of oral alfacalcidol per day (intervention group; n = 495) vs treatment without vitamin D receptor activators (control group; n = 481). MAIN OUTCOMES AND MEASURES The primary outcome was a composite measure of fatal and nonfatal cardiovascular events, including myocardial infarctions, hospitalizations for congestive heart failure, stroke, aortic dissection/rupture, amputation of lower limb due to ischemia, and cardiac sudden death; coronary revascularization; and leg artery revascularization during 48 months of follow-up. The secondary outcome was all-cause death. RESULTS Among 976 patients who were randomized from 108 dialysis centers, 964 patients were included in the intention-to-treat analysis (median age, 65 years; 386 women [40.0%]), and 944 (97.9%) completed the trial. During follow-up (median, 4.0 years), the primary composite outcome of cardiovascular events occurred in 103 of 488 patients (21.1%) in the intervention group and 85 of 476 patients (17.9%) in the control group (absolute difference, 3.25% [95% CI, -1.75% to 8.24%]; hazard ratio, 1.25 [95% CI, 0.94-1.67]; P = .13). There was no significant difference in the secondary outcome of all-cause mortality between the groups (18.2% vs 16.8%, respectively; hazard ratio, 1.12 [95% CI, 0.83-1.52]; P = .46). Of the 488 participants in the intervention group, 199 (40.8%) experienced serious adverse events that were classified as cardiovascular, 64 (13.1%) experienced adverse events classified as infection, and 22 (4.5%) experienced malignancy-related serious adverse events. Of 476 participants in the control group, 191 (40.1%) experienced cardiovascular-related serious adverse events, 63 (13.2%) experienced infection-related serious adverse events, and 21 (4.4%) experienced malignancy-related adverse events. CONCLUSIONS AND RELEVANCE Among patients without secondary hyperparathyroidism undergoing maintenance hemodialysis, oral alfacalcidol compared with usual care did not reduce the risk of a composite measure of select cardiovascular events. These findings do not support the use of vitamin D receptor activators for patients such as these. TRIAL REGISTRATION UMIN-CTR Identifier: UMIN000001194.
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Affiliation(s)
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine, Japan
- Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine, Japan
| | - Masaaki Inaba
- Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine, Japan
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology, and Metabolism, Tokai University School of Medicine, Kanagawa, Japan
| | - Ryoichi Ando
- Department of Nephrology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Masanori Emoto
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Japan
| | - Hisako Fujii
- Department of Drug and Food Evaluation, Osaka City University Graduate School of Medicine, Japan
| | - Akira Fujimori
- Blood Purification and Kidney Center, Konan Hospital, Hyogo, Japan
| | - Mitsuru Fukui
- Laboratory of Statistics, Osaka City University Graduate School of Medicine, Japan
| | - Hiroki Hase
- Department of Nephrology, Toho University School of Medicine, Tokyo, Japan
| | | | - Hideki Hirakata
- Division of Nephrology, Fukuoka Renal Clinic, Fukuoka, Japan
| | - Hirokazu Honda
- Division of Nephrology, Department of Medicine, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Tatsuo Hosoya
- Department of Pathophysiology and Therapy in Chronic Kidney Disease, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Daijo Inaguma
- Department of Nephrology, Fujita Health University School of Medicine, Aichi, Japan
| | | | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Japan
| | - Kunitoshi Iseki
- Clinical Research Support Center, Tomishiro Central Hospital, Japan
| | - Eiji Ishimura
- Department of Nephrology, Osaka City University Graduate School of Medicine, Japan
| | - Noritomo Itami
- Department of Nephrology, Itami Kidney Clinic, Hokkaido, Japan
| | - Chiharu Ito
- Department of Internal Medicine, Haga Red Cross Hospital, Tochigi, Japan
| | - Toshitaka Kakuta
- Division of Nephrology, Endocrinology, and Metabolism, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Toru Kawai
- Medical Corporation Chuou Naika Clinic, Hiroshima, Japan
| | - Hideki Kawanishi
- Department of Artificial Organs, Tsuchiya General Hospital, Hiroshima, Japan
| | - Shuzo Kobayashi
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Junko Kumagai
- Akane Foundation Omachi Tsuchiya Clinic, Hiroshima, Japan
| | | | | | - Jun Minakuchi
- Department of Kidney Disease, Kawashima Hospital, Tokushima, Japan
| | - Koji Mitsuiki
- Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Japan
| | - Takashi Mizuguchi
- Department of Hematology, Dialysis, and Diabetes Mellitus, Kochi-Takasu Hospital, Kochi, Japan
| | - Satoshi Morimoto
- Department of Medicine, Endocrinology, and Hypertension, Tokyo Women's Medical University, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Tatsuya Nakatani
- Department of Urology, Osaka City University Graduate School of Medicine, Japan
| | - Shigeo Negi
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Shinichi Nishi
- Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine, Hyogo, Japan
| | | | - Tetsuya Ogawa
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Kazumichi Ohta
- Department of Urology, Kochi Takasu Hospital, Kochi, Japan
| | - Takayasu Ohtake
- Department of Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Mikio Okamura
- Department of Internal Medicine, Kayashima Ikuno Hospital, Osaka, Japan
| | - Senji Okuno
- Department of Internal Medicine, Kidney Center, Shirasagi Hospital, Osaka, Japan
| | | | - Toshitsugu Sugimoto
- Department of Internal Medicine, Shimane University Faculty of Medicine, Shimane, Japan
| | - Masashi Suzuki
- Department of Nephrology, Shinraku-En Hospital, Niigata, Japan
| | | | - Yoshiaki Takemoto
- Department of Urology, Osaka City University Graduate School of Medicine, Japan
| | - Kenji Tanaka
- Department of Internal Medicine, Suiyukai Clinic, Nara, Japan
| | - Yoshihiro Tominaga
- Department of Transplant and Endocrine Surgery, Nagoya 2nd Red Cross Hospital Japan
| | - Yoshiharu Tsubakihara
- Department of Safety Management in Health Care Sciences, Graduate School of Health Care Sciences, Jikei Institute, Osaka, Japan
| | | | | | - Shinichiro Ueda
- Department of Clinical Pharmacology and Therapeutics, University of the Ryukyus Graduate School of Medicine, Okinawa, Japan
| | | | - Kunihiro Yamagata
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | | | - Shozo Yano
- Department of Laboratory Medicine, Shimane University Faculty of Medicine, Japan
| | - Keitaro Yokoyama
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Japan
| | - Yoshiki Nishizawa
- Hemodialysis Center, Inoue Hospital, Soryu Medical Corporation, Osaka, Japan
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12
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Bando H, Tsukada Y, Inamori K, Fukuoka S, Sasaki T, Nishizawa Y, Wakabayashi M, Kojima M, Togashi Y, Yuki S, Komatsu Y, Homma S, Hatanaka Y, Matsuno Y, Uemura M, Kato T, Sato A, Nishikawa H, Ito M, Yoshino T. VOLTAGE: Multicenter phase Ib/II study of nivolumab monotherapy and subsequent radical surgery following preoperative chemoradiotherapy (CRT) with capecitabine in patients with locally advanced rectal cancer (LARC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Receptor for advanced glycation end-products (RAGE) is known to be involved in both micro- and macrovascular complications in diabetes. Among numerous truncated forms of RAGE recently described, the C-terminally truncated form of RAGE has received much attention. This form of RAGE, carrying all of the extracellular domains but devoid of the trans-membrane and intracytoplasmic domains, is released outside from cells, binds ligands including AGEs, and is capable of neutralizing RAGE signaling on endothelial cells in culture. This form of RAGE is generated as a splice variant and is named endogenous secretory RAGE (esRAGE). Adenoviral overexpression of esRAGE reverses diabetic impairment of vascular dysfunction, suggesting that esRAGE may be an important inhibitor of RAGE signaling in vivo and potentially be useful for prevention of diabetic vascular complications. An ELISA system to measure plasma esRAGE was recently developed, and the pathophysiological roles of esRAGE have begun to be unveiled clinically. Plasma esRAGE levels are decreased in patients with several metabolic diseases including type 1 and type 2 diabetes, metabolic syndrome and hypertension. In cross-sectional analysis, plasma esRAGE levels are inversely correlated with carotid or femoral atherosclerosis. In an observational cohort of patients with end-stage renal disease, cumulative incidence of cardiovascular death was significantly higher in subjects with lower plasma esRAGE levels. These findings suggest that plasma esRAGE may act as a protective factor against and a novel biomarker for the occurrence of metabolic syndrome and cardiovascular diseases.
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Affiliation(s)
- Hidenori Koyama
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Hiroshi Yamamoto
- Department of Biochemistry and Molecular Vascular Biology, Kanazawa University Graduate School of Medical Science, Kanazawa 920–8640, Japan
| | - Yoshiki Nishizawa
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
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14
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Yamamoto Y, Tsukada Y, Bando H, Sasaki T, Nishizawa Y, Kojima M, Kuwata T, Ito M, Yoshino T. Clinical implementation of the universal tumor screening with the mismatch repair (MMR) proteins on decision impact of adjuvant chemotherapy in patients with resected stage II/III colorectal cancer (CRC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx659.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Imaizumi K, Suzuki T, Shimomura M, Tsukada Y, Sasaki T, Nishizawa Y, Kojima M, Ito M, Nakatsura T. Immunological features of resected tumor after neoadjuvant chemotherapy (NAC) and chemoradiotherapy (CRT) become the superior prediction markers for recurrence in rectal cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Affiliation(s)
- Y. Nishizawa
- Engineering and Development Division Mitsubishi Atomic Power Industry, Inc. Omiya, Saitama, Japan
| | - S. Oshima
- Engineering and Development Division Mitsubishi Atomic Power Industry, Inc. Omiya, Saitama, Japan
| | - T. Maekawa
- Engineering and Development Division Mitsubishi Atomic Power Industry, Inc. Omiya, Saitama, Japan
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17
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Shigematsu T, Muraoka R, Sugimoto T, Nishizawa Y. Risedronate therapy in patients with mild-to-moderate chronic kidney disease with osteoporosis: post-hoc analysis of data from the risedronate phase III clinical trials. BMC Nephrol 2017; 18:66. [PMID: 28201994 PMCID: PMC5311729 DOI: 10.1186/s12882-017-0478-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 02/08/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The clinical effect of bisphosphonate treatment has not been clearly evaluated by kidney function in Japanese Chronic Kidney Disease (CKD) patients with osteoporosis. This study analyzed the data from three risedronate Japanese phase III trials. The clinical effect of risedronate therapy was evaluated in CKD patients with osteoporosis. METHODS The Japanese clinical trials involved 852 subjects who received risedronate (2.5 mg once daily or 17.5 mg once weekly) and whose estimated glomerular filtration rate (eGFR) were calculable and at ≥ 30 mL/min. The subjects were divided into subgroups according to the eGFR level: ≥ 90 mL/min/1.73 m2, ≥ 60 to < 90 mL/min/1.73 m2, ≥ 30 to < 60 mL/min/1.73 m2. Lumbar spine bone mineral density (BMD), bone turnover markers (BTMs) and adverse events were evaluated at 48 weeks. RESULTS Adverse event incidence was similar among three subgroups. There was also no exacerbation of impaired kidney function associated with risedronate administration in the subjects with eGFR above 30 mL/min/1.73 m2. Risedronate administration induced a significant increase in lumbar spine BMD and significant inhibition of BTMs in three subgroups. CONCLUSIONS The risedronate therapy showed similar clinical effects in CKD patients with osteoporosis compared to those without CKD.
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Affiliation(s)
- Takashi Shigematsu
- Department of Nephrology, Wakayama Medical University, 811-1 Kimiidera, Wakayama-City, Wakayama 641-8509 Japan
| | - Ryoichi Muraoka
- Data Science Group, Clinical Development Department, EA Pharma Co., Ltd, Tokyo, Japan
| | | | - Yoshiki Nishizawa
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
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18
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Watanabe Y, Akizawa T, Saito A, Gejyo F, Suzuki M, Nishizawa Y, Tomino Y, Tsubakihara Y, Akiba T, Hirakata H, Kawanishi H, Bessho M, Udagawa Y, Aoki K, Uemura Y, Ohashi Y. Effect of Predialysis Recombinant Human Erythropoietin on Early Survival After Hemodialysis Initiation in Patients With Chronic Kidney Disease: Co-JET Study. Ther Apher Dial 2016; 20:598-607. [PMID: 27928910 DOI: 10.1111/1744-9987.12425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/10/2016] [Accepted: 03/22/2016] [Indexed: 12/17/2022]
Abstract
Progression of anemia in patients with chronic kidney disease (CKD) is associated with an increased risk of death and hospitalization. It is not sufficiently clear whether treating renal anemia with recombinant human erythropoietin (rHuEPO) has a beneficial effect on early survival after hemodialysis (HD) initiation in patients with CKD. The study was an open-label multicenter retrospective cohort study to evaluate the relationship between rHuEPO treatment and early survival after HD initiation in patients with CKD. Predialysis patients with CKD were divided into two groups: an rHuEPO-treated group (rHuEPO group) and a non-treatment group. The primary endpoint was all-cause mortality in the year after HD initiation. A total of 3261 patients were enrolled (2275 in the rHuEPO group and 986 in the non-treatment group). One-year survival was 95.36% in the rHuEPO group and 90.36% in the non-treatment group. The survival rate was significantly higher in the rHuEPO group (P < 0.0001). The results of multivariate analysis confirmed that predialysis treatment with rHuEPO is a predictor for reduced mortality risk (hazard ratio = 0.61, 95% confidence interval: 0.42-0.87, P = 0.006). Risk for the composite event of death/hospitalization was also lower in the rHuEPO group (hazard ratio = 0.88, 95% confidence interval: 0.78-0.98, P = 0.026). The results of this study suggest that treatment with rHuEPO can decrease early mortality risk after initiation of HD in patients with CKD. A prospective study is needed to further investigate early survival after HD initiation.
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Affiliation(s)
- Yuzo Watanabe
- Department of Internal Medicine, Kasugai Municipal Hospital, Kasugai, Aichi, Japan
| | - Tadao Akizawa
- Department of Nephrology, Showa University School of Medicine, Shinagawa-ku, Tokyo, Japan
| | - Akira Saito
- Department of Nephrology, Shonan Tobu Sogou Hospital, Chigasaki, Kanagawa, Japan
| | - Fumitake Gejyo
- Niigata University Graduate School of Medicine and Dental Sciences, Chuoku, Niigata, Niigata, Japan
| | | | - Yoshiki Nishizawa
- Osaka City University Graduate School of Medicine, Abeno, Osaka, Japan
| | - Yasuhiko Tomino
- Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yoshiharu Tsubakihara
- Course of Safety Management in Health Care Sciences, Graduate School of Health Care Sciences, Jikei Institute, Yodogawa-ku, Osaka-shi, Japan.,Osaka, Japan
| | - Takashi Akiba
- Department of Blood Purification, Kidney Center, Tokyo Women's Medical University, Shinjyuku-ku, Tokyo, Japan
| | - Hideki Hirakata
- Department of Nephrology, Fukuoka Red Cross Hospital, Minami-ku, Fukuoka, Fukuoka, Japan
| | - Hideki Kawanishi
- Department of Artificial Organs, Tsuchiya General Hospital, Naka-ku, Hiroshima, Hiroshima, Japan
| | - Masami Bessho
- Department of Hematology, Saitama Medical School, Moroyama-cho, Iruma-gun, Saitama, Japan
| | - Yukio Udagawa
- Pharmacovigilance Department, Chugai Pharmaceutical Co., Ltd., Chuo-ku, Tokyo, Japan
| | - Kotonari Aoki
- Pharmacovigilance Department, Chugai Pharmaceutical Co., Ltd., Chuo-ku, Tokyo, Japan
| | - Yukari Uemura
- Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yasuo Ohashi
- Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Bunkyo-ku, Tokyo, Japan
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19
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Endo H, Okami J, Okuyama H, Nishizawa Y, Imamura F, Inoue M. The induction of MIG6 under hypoxic conditions is critical for dormancy in primary cultured lung cancer cells with activating EGFR mutations. Oncogene 2016; 36:2824-2834. [DOI: 10.1038/onc.2016.431] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 10/05/2016] [Accepted: 10/11/2016] [Indexed: 02/08/2023]
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20
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Shoji T, Inaba M, Nishizawa Y. Vitamin D receptor activator and prevention of cardiovascular events in hemodialysis patients—rationale and design of the Japan Dialysis Active Vitamin D (J-DAVID) trial. Ren Replace Ther 2016. [DOI: 10.1186/s41100-016-0029-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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21
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Inoue D, Muraoka R, Okazaki R, Nishizawa Y, Sugimoto T. Efficacy and Safety of Risedronate in Osteoporosis Subjects with Comorbid Diabetes, Hypertension, and/or Dyslipidemia: A Post Hoc Analysis of Phase III Trials Conducted in Japan. Calcif Tissue Int 2016; 98:114-22. [PMID: 26466937 PMCID: PMC4723633 DOI: 10.1007/s00223-015-0071-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 10/03/2015] [Indexed: 12/14/2022]
Abstract
Many osteoporotics have comorbid diabetes mellitus (DM), hypertension (HT), and dyslipidemia (DL). However, whether such comorbidities alter response to anti-osteoporotic treatment is unknown. We did post hoc analyses of combined data from three risedronate Japanese phase III trials to determine whether the presence of DM, HT, or DL affects its efficacy and safety. Data from 885 subjects who received 48-week treatment with risedronate were collected and combined from the three phase III trials. They were divided into two groups by the presence or absence of comorbidities: DM (n = 53) versus non-DM (n = 832); HT (n = 278) versus non-HT (n = 607); and DL (n = 292) versus non-DL (n = 593). Bone mineral density (BMD), urinary type 1 collagen N-telopeptide (uNTX), and serum bone-specific alkaline phosphatase (BAP) were measured at baseline and sequentially until 48 weeks. BMD or bone markers were not different between any of the two groups. Overall, BMD was increased by 5.52%, and uNTX and BAP were decreased by 35.4 and 33.8%, respectively. Some bone markers were slightly lower in DM and DL subjects, but the responses to risedronate were not significantly different. Statin users had lower uNTX and BAP, but showed no difference in the treatment response. All the other medications had no apparent effect. Adverse event incidence was marginally higher in DL compared with non-DL (Relative risk 1.06; 95% confidence interval 1.01-1.11), but was not related to increase in any specific events. Risedronate shows consistent safety and efficacy in suppressing bone turnover and increasing BMD in osteoporosis patients with comorbid DM, HT, and/or DL.
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Affiliation(s)
- Daisuke Inoue
- Third Department of Medicine, Teikyo University Chiba Medical Center, 3426-3, Anesaki, Ichihara-shi, Chiba, 299-0111, Japan.
| | - Ryoichi Muraoka
- Data Science Group, Clinical Development Department, Ajinomoto Pharmaceuticals Co., Ltd., Tokyo, Japan
| | - Ryo Okazaki
- Third Department of Medicine, Teikyo University Chiba Medical Center, 3426-3, Anesaki, Ichihara-shi, Chiba, 299-0111, Japan
| | - Yoshiki Nishizawa
- Department of Metabolism, Endocrinology, and Molecular Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Toshitsugu Sugimoto
- First Department of Internal Medicine, Faculty of Medicine, Shimane University, Matsue, Shimane, Japan
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22
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Ohara M, Imanishi Y, Nagata Y, Ishii A, Kobayashi I, Mori K, Ito M, Miki T, Nishizawa Y, Inaba M. Clinical efficacy of oral risedronate therapy in Japanese patients with Paget's disease of bone. J Bone Miner Metab 2015; 33:584-90. [PMID: 25319558 DOI: 10.1007/s00774-014-0623-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/10/2014] [Indexed: 11/29/2022]
Abstract
Paget's disease of bone (PDB) is a chronic disorder characterized by localized bone regions with excessive bone turnover. Although oral risedronate (17.5 mg daily for 8 weeks) was recently approved in Japan, its efficacy is not well understood. We retrospectively examined the efficacy of oral risedronate in PDB patients in a clinical setting. Eleven patients whose serum alkaline phosphatase (ALP) level exceeded the upper limit of the normal range were treated. Patients whose ALP levels normalized and remained so for 12 months after therapy initiation were defined as responders. Treatment was repeated if bone pain recurred or if serum ALP levels increased at least 25% above the nadir. Six patients (55%) were responsive to the therapy. A higher prevalence of skull lesions, higher serum calcium levels at treatment initiation and antecedent treatments of bisphosphonates were predictors of resistance against the therapy. Fresh frozen serum samples obtained from some treatment sessions were evaluated for metabolic bone markers such as bone-specific ALP (BAP), type I procollagen N-terminal pro-peptide (PINP), N-treminal crosslinking telopeptide of type I collagen and C-treminal crosslinking telopeptide of type I collagen (CTX). A significant reduction of P1NP preceded that of serum ALP levels in the responders, which was followed by a similar occurrence for BAP and osteocalcin (BGP) levels. A temporary decrease in CTX levels was noted. No significant changes in markers (including ALP level) were observed in non-responder and repeat-treatment groups. P1NP levels may be more useful than ALP levels in assessing treatment efficacy. Repeat treatment effectiveness for the repeat-treatment group was limited.
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Affiliation(s)
- Masaya Ohara
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-Ku, Osaka, 545-8585, Japan
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23
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Muso E, Mune M, Hirano T, Hattori M, Kimura K, Watanabe T, Yokoyama H, Sato H, Uchida S, Wada T, Shoji T, Takemura T, Yuzawa Y, Ogahara S, Sugiyama S, Iino Y, Sakai S, Ogura Y, Yukawa S, Nishizawa Y, Yorioka N, Imai E, Matsuo S, Saito T. A Prospective Observational Survey on the Long-Term Effect of LDL Apheresis on Drug-Resistant Nephrotic Syndrome. Nephron Extra 2015; 5:58-66. [PMID: 26557843 PMCID: PMC4592509 DOI: 10.1159/000437338] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS LDL apheresis (LDL-A) is used for drug-resistant nephrotic syndrome (NS) as an alternative therapy to induce remission by improvement of hyperlipidemia. Several clinical studies have suggested the efficacy of LDL-A for refractory NS, but the level of evidence remains insufficient. A multicenter prospective study, POLARIS (Prospective Observational Survey on the Long-Term Effects of LDL Apheresis on Drug-Resistant Nephrotic Syndrome), was conducted to evaluate its clinical efficacy with high-level evidence. METHODS Patients with NS who showed resistance to primary medication for at least 4 weeks were prospectively recruited to the study and treated with LDL-A. The long-term outcome was evaluated based on the rate of remission of NS 2 years after treatment. Factors affecting the outcome were also examined. RESULTS A total of 58 refractory NS patients from 40 facilities were recruited and enrolled as subjects of the POLARIS study. Of the 44 subjects followed for 2 years, 21 (47.7%) showed remission of NS based on a urinary protein (UP) level <1.0 g/day. The UP level immediately after LDL-A and the rates of improvement of UP, serum albumin, serum creatinine, eGFR, and total and LDL cholesterol after the treatment session significantly affected the outcome. CONCLUSIONS Almost half of the cases of drug-resistant NS showed remission 2 years after LDL-A. Improvement of nephrotic parameters at termination of the LDL-A treatment was a predictor of a favorable outcome.
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Affiliation(s)
- Eri Muso
- Division of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Institute, Tokyo, Japan
| | | | - Tsutomu Hirano
- Department of Diabetes, Metabolism and Endocrinology, Tokyo, Japan
| | - Motoshi Hattori
- Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenjiro Kimura
- Department of Nephrology and Hypertension, Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tsuyoshi Watanabe
- Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hitoshi Yokoyama
- Division of Nephrology, Kanazawa Medical University School of Medicine, Uchinada, Japan
| | - Hiroshi Sato
- Department of Clinical Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan
| | - Shunya Uchida
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Takashi Wada
- Department of Laboratory Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Tetsuo Shoji
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Tokyo, Japan
| | - Tsukasa Takemura
- Department of Pediatrics, Kinki University School of Medicine, Osaka, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Satoru Ogahara
- Division of Nephrology and Rheumatology, Department of Internal Medicine, Fukuoka, Japan
| | | | - Yasuhiko Iino
- Department of Nephrology, Nippon Medical School, Tokyo, Japan
| | | | - Yousuke Ogura
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | | | - Yoshiki Nishizawa
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Tokyo, Japan
| | | | - Enyu Imai
- Nakayamadera Imai Clinic, Takarazuka, Japan
| | - Seiichi Matsuo
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takao Saito
- General Medical Research Center, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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24
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Shoji S, Okuno S, Yamakawa T, Eiji I, Nishizawa Y, Inaba M. FP805CHANGES IN BODY FAT AND LEAN MASS AFTER INTRODUCTION OF HEMODIALYSIS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv184.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Nakatsuka K, Miki T, Nishizawa Y, Tabata T, Inoue T, Morii H, Ogata E. Circulating bone Gla protein in end-stage renal disease determined by newly developed two-site immunoradiometric assay. Contrib Nephrol 2015; 90:147-54. [PMID: 1959340 DOI: 10.1159/000420137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
As a marker for bone formation, bone Gla protein (BGP) levels in the circulation have been measured in clinical research and management for metabolic bone diseases. We evaluated the clinical availability of a newly developed two-site immunoradiometric assay (IRMA) for human BGP and determined the serum BGP concentrations using this methodology in patients with abnormal calcium metabolism including those with end-stage renal disease undergoing maintenance dialysis. A cross-reactivity test revealed that this assay system specifically recognizes intact molecules (1-49) of BGP and excludes fragments of the molecules (1-19, 12-33, 23-33). Serum BGP levels in dialysis patients were positively correlated with those by conventional radioimmunoassay (RIA) (r = 0.918, p less than 0.00001, n = 37) as well as normal individuals (r = 0.935, p less than 0.0001, n = 16). However, the levels of BGP determined by IRMA were estimated to be significantly lower than those by RIA (23.6 +/- 9.8 vs. 29.6 +/- 9.1 ng/ml, p less than 0.00001). These results suggest that this IRMA system, with a rapid and easy procedure, excludes fragment forms of BGP in the circulation, which are found in uremic sera and probably attributed to increased bone resorption. Further studies are needed to ensure that serum intact BGP levels mainly reflect BGP production in osteoblasts, particularly in end-stage renal disease.
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Affiliation(s)
- K Nakatsuka
- Second Department of Internal Medicine, Osaka City University Medical School, Japan
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Nishitani H, Miki T, Morii H, Nishizawa Y, Ishimura E, Hagiwara S, Nakatsuka K, Yamakawa M. Decreased bone mineral density in diabetic patients on hemodialysis. Contrib Nephrol 2015; 90:223-7. [PMID: 1959351 DOI: 10.1159/000420147] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Renal osteodystrophy in hemodialyzed patients with DM-HD shows different features from that in non-DM,HD. Two studies were done. One was a comparison of BMD in 30 non-DM,HD patients and 30 DM-HD patients. The second was a comparison of possible factors affecting calcium metabolism in the higher and lower BMD groups (n = 20/21) in the DM-HD patients. BMD was measured by dual-energy X-ray absorptiometry (DEXA; Hologic QDR 1,000/W) in the third lumbar vertebra (L3), head, pelvis, and whole body. The BMDs of the DM-HD group were lower in these areas and whole body than that in the non-DM,HD group. A significant difference was found in the head BMD (p less than 0.05). In the second study, factors which may contribute to the differences in BMD were compared in the DM-HD patients divided into higher and lower BMD of the head. The group with higher head BMD had a value 110% of the mean value or more. Clinical and biochemical test results (age, the time since the first dialysis, body weight, the degree of obesity, height, serum calcium, serum phosphate, serum aluminum, serum c-PTH level and the dose of 1 alpha-OH-D3) were compared. The degree of obesity of the patients with higher BMD was significantly larger than that with lower BMD (p less than 0.005).
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Affiliation(s)
- H Nishitani
- Second Department of Internal Medicine, Osaka City University Medical School, Japan
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Kawagishi T, Morii H, Nakatsuka K, Sasao K, Kawasaki K, Miki T, Nishizawa Y. Parathyroid hormone secretion in diabetes mellitus. Contrib Nephrol 2015; 90:217-22. [PMID: 1959350 DOI: 10.1159/000420146] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
To investigate the parathyroid function in diabetes mellitus, we performed an oral phosphate load in 6 diabetic patients and 6 nondiabetic subjects without renal failure (serum creatinine less than 1.5 mg/dl). Each subject received a total of 2.0 g of phosphate daily per os on 5 consecutive days. Blood and urine samples were obtained daily before and 2 h after the administration of phosphate in the morning. All subjects responded with a similar increase in the serum phosphorus concentration and fall in the ionized calcium concentration. Intact parathyroid hormone levels rose by 2.6-fold in the control subjects but by less than 1.5-fold in the diabetic subjects. It was concluded that hyporesponsiveness of the parathyroid hormone to phosphate administration was found in the diabetic patients without renal failure.
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Affiliation(s)
- T Kawagishi
- Second Department of Internal Medicine, Osaka City University Hospital, Japan
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Koyama H, Tahara H, Shoji T, Nishizawa Y, Inaba M, Otani S, Yanagisawa M, Ishiguro Y, Takanashi N, Morii H. Uremic serum contains humoral factor(s) larger than fifty kilodaltons which suppresses endothelin production in cultured endothelial cells. Contrib Nephrol 2015; 90:111-5. [PMID: 1959336 DOI: 10.1159/000420132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Direct effects of human uremic serum on the production of endothelin-1 in cultured porcine endothelial cells were examined in this study. Uremic serum decreased the level of monomeric endothelin-1 secreted into the culture medium by endothelial cells. This effect occurred at a transcriptional step because uremic serum decreased the endothelin-1 mRNA level in those cells. For the partial characterization of this inhibitory activity, uremic serum was fractionated with a centricut column. Uremic serum contains humoral factor(s) larger than 50 kD which suppress the endothelin-1 mRNA level in cultured endothelial cells.
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Affiliation(s)
- H Koyama
- Second Department of Internal Medicine, Osaka City University Medical School, Japan
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Nishizawa Y, Morii H, Ogura Y, De Luca HF. Clinical trial of 26,26,26,27,27,27-hexafluoro-1,25-dihydroxyvitamin D3 in uremic patients on hemodialysis: preliminary report. Contrib Nephrol 2015; 90:196-203. [PMID: 1659967 DOI: 10.1159/000420143] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A clinical trial was done by the Group, Japan to evaluate the efficacy of 26,27-F6-1,25(OH)2D3 on the calcium and bone metabolism of 43 uremic patients on hemodialysis, 24 men and 19 women with a mean age of 50.9 +/- 2.1 years. The initial dose administered orally was 0.05 micrograms/day for 2 weeks. Then the dose was increased every 2 weeks by 0.05 micrograms each time until the dose of 0.3 micrograms/day was reached or until serum calcium increased. 26,27-F6(OH)2D3 increased serum calcium levels significantly at a mean dose of 0.08 +/- 0.03 micrograms/day and at 0.05 micrograms/day of dose comparison in hemodialyzed patients. It decreased the serum level of PTH significantly at a mean dose of 0.14 +/- 0.06 micrograms/day and at 0.3 micrograms/day by dose comparison. The serum level of bone Gla protein increased significantly at a mean dose of 0.18 +/- 0.07 micrograms/day and at 0.25 micrograms/day by dose comparison in the same patients. These results suggest that 26,27-F6-1,25(OH)2D3 has a higher potency in calcium mobilization than 1,25(OH)2D3 in uremic patients on hemodialysis.
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Affiliation(s)
- Y Nishizawa
- Second Department of Internal Medicine, Osaka City University Medical School, Japan
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Fukuda S, Koyama H, Kondo K, Fujii H, Hirayama Y, Tabata T, Okamura M, Yamakawa T, Okada S, Hirata S, Kiyama H, Kajimoto O, Watanabe Y, Inaba M, Nishizawa Y. Effects of nutritional supplementation on fatigue, and autonomic and immune dysfunction in patients with end-stage renal disease: a randomized, double-blind, placebo-controlled, multicenter trial. PLoS One 2015; 10:e0119578. [PMID: 25746727 PMCID: PMC4352065 DOI: 10.1371/journal.pone.0119578] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 01/30/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Fatigue is a predictor of cardiovascular events in patients with end-stage renal disease (ESRD) undergoing hemodialysis treatment. We hypothesized that multinutritional support would improve quality of life, fatigue symptoms, and potential quantitative measures including endocrine, immune and autonomic functions in patients with ESRD undergoing hemodialysis. METHODS Two hundred and two hemodialysis patients were randomly assigned to receive active treatment (containing vitamin B1, vitamin B2, niacin, vitamin B6, vitamin B12, folic acid, vitamin C, carnitine, coenzyme Q10, naïve galacto-oligosaccharide, and zinc) or placebo after each dialysis session for 12 weeks. The patients and attending physicians were blinded to the treatment, and 172 patients (86 in each group) completed the study. Fatigue was evaluated via fatigue questionnaire at 0, 4, and 12 weeks. To assess human herpes virus (HHV) 6 and 7 reactivation, numbers of viral DNA copies were determined in saliva by polymerase chain reaction at weeks 0 and 12. Autonomic function was determined via measurement of beat-to-beat variation by using acceleration plethysmography. RESULTS Clinical characteristics, changes in fatigue, quality of life score, endocrine functions, and laboratory data did not differ significantly between the two groups. Several parameters of heart rate variability significantly increased after nutritional treatment compared to placebo. Nutritional drink for 12 weeks significantly suppressed HHV7 DNA copy numbers. Similarly, HHV6 DNA copy numbers tended to be decreased by treatment but without reaching statistical significance. CONCLUSIONS Nutritional supplementation may modulate immune and autonomic dysfunction in ESRD patients undergoing hemodialysis.
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Affiliation(s)
- Sanae Fukuda
- University of Welfare Sciences, Kasiwara, Osaka, 582-0026, Japan; RIKEN Center for Life Science Technologies, Kobe, Hyogo, 650-0047, Japan; Department of Physiology, Osaka City University Graduate School of Medicine, Osaka, 545-8585, Japan
| | - Hidenori Koyama
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, 545-8585, Japan; Department of Internal Medicine, Division of Diabetes, Endocrinology and Metabolism, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Kazuhiro Kondo
- Department of Virology, The Jikei University School of Medicine, Tokyo, 105-8461, Japan
| | - Hisako Fujii
- Department of Physiology, Osaka City University Graduate School of Medicine, Osaka, 545-8585, Japan; Center for Drug & Food Clinical Evaluation, Osaka City University Hospital, Osaka, 540-0051, Japan
| | - Yoshinobu Hirayama
- College of Pharmaceutical Sciences, Ritsumeikan University, Kusatsu, 525-8577, Japan
| | | | | | | | | | - Sumio Hirata
- Kumamoto University School of Pharmacy, Kumamoto, 862-0973, Japan
| | - Hiroshi Kiyama
- Nagoya University School of Medicine, Nagoya, 466-8550, Japan
| | - Osami Kajimoto
- Department of Medical Science on Fatigue, Osaka City University Graduate School of Medicine, Osaka, 545-8585, Japan
| | - Yasuyoshi Watanabe
- RIKEN Center for Life Science Technologies, Kobe, Hyogo, 650-0047, Japan; Department of Physiology, Osaka City University Graduate School of Medicine, Osaka, 545-8585, Japan
| | - Masaaki Inaba
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, 545-8585, Japan
| | - Yoshiki Nishizawa
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, 545-8585, Japan
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Shoji T, Emoto M, Nishizawa Y, Inaba M. Endocrine and Metabolic Changes Affecting Cardiovascular Disease in Dialysis Patients. J Ren Nutr 2015; 25:223-5. [DOI: 10.1053/j.jrn.2014.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 10/29/2014] [Indexed: 12/16/2022] Open
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Masuda M, Ishimura E, Ochi A, Tsujimoto Y, Tahahra H, Okuno S, Tabata T, Nishizawa Y, Inaba M. Serum β2-microglobulin correlates positively with left ventricular hypertrophy in long-term hemodialysis patients. Nephron Clin Pract 2014; 128:101-6. [PMID: 25376242 DOI: 10.1159/000365447] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/24/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS β2-Microglobulin (β2-MG) is a major protein component of dialysis-related amyloidosis. In long-term hemodialysis (HD) patients, β2-MG amyloid deposits not only in osteoarticular tissues, but also in systemic tissues, including the heart. The purpose of this study was to investigate the relationship between serum β2-MG concentrations and echocardiographic parameters in long-term HD patients in a cross-sectional study. METHODS Measurement of serum β2-MG concentrations and echocardiography were performed in 251 patients who had undergone HD therapy for more than 10 years. RESULTS The left ventricular mass index (LVMI) of the higher serum β2-MG (≥30 mg/l) group was significantly higher than that of the lower serum β2-MG (<30 mg/l) group (151.5 ± 45.7 vs. 137.0 ± 44.5 g/m(2), p = 0.020). In simple regression analyses, serum β2-MG concentrations correlated significantly and positively with interventricular septum thickness (IVST) (r = 0.215, p < 0.001), posterior left ventricular wall thickness (PWT) (r = 0.249, p < 0.001), left ventricular wall thickness (LVWT) (r = 0.252, p < 0.001), relative wall thickness (RWT) (r = 0.153, p = 0.015) and LVMI (r = 0.171, p = 0.007). Multiple regression analyses revealed that serum β2-MG concentrations correlated significantly and positively with IVST, PWT, LVWT and RWT. CONCLUSION Serum β2-MG concentrations correlated significantly and positively with the echocardiographic parameters of left ventricular hypertrophy (LVH) in long-term HD patients. Thus, deposition of β2-MG amyloid in the heart may be associated with LVH progression.
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Affiliation(s)
- Mio Masuda
- Department of Metabolism, Endocrinology, Molecular Medicine, and Nephrology, Osaka City University Graduate School of Medicine, Osaka, Japan
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Ishimura E, Okuno S, Ichii M, Norimine K, Yamakawa T, Shoji S, Nishizawa Y, Inaba M. Relationship between serum sclerostin, bone metabolism markers, and bone mineral density in maintenance hemodialysis patients. J Clin Endocrinol Metab 2014; 99:4315-20. [PMID: 25093620 DOI: 10.1210/jc.2014-2372] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND Sclerostin, which is secreted exclusively by osteocytes, is a negative regulator of bone formation. The role of sclerostin in chronic kidney disease-mineral and bone disorder is not well known. In the present study, we examined the relationship between serum sclerostin levels, bone turnover markers, and bone mineral density (BMD) of the radius in maintenance hemodialysis patients. METHODS This was a cross-sectional study that analyzed sclerostin, bone alkaline phosphatase (a bone formation marker), and tartrate-resistant acid phosphatase 5b (a bone resorption marker) in stored serum samples from 181 hemodialysis patients (age, 68 ± 11 y; 105 males and 76 females; hemodialysis duration, 6.9 ± 5.9 y). The BMD in the distal one-third of the radius and in the ultradistal radius, which are enriched with cortical and cancellous bone, respectively, was examined by dual-energy x-ray absorptiometry. RESULTS Serum sclerostin was 125 ± 53 pmol/L (mean ± SD). Serum sclerostin correlated significantly and negatively with serum bone alkaline phosphatase and tartrate-resistant acid phosphatase 5b (r = -0.265, P < .001; r = -0.218, P < .01, respectively). The BMD in the distal one-third of the radius and in the ultradistal radius both correlated significantly and positively with serum sclerostin levels (r = 0.454, P < .0001; r = 0.329, P < .0001, respectively). In multiple regression analysis, serum sclerostin was associated significantly and independently with BMD of both parts of the radius (β = 0.200, P < .001; β = 0.218, P < .05), after adjustment for age, hemodialysis duration, and bone metabolism markers. CONCLUSION Serum sclerostin was associated significantly, independently, and positively with BMD of both cortical and cancellous bone. Sclerostin is considered to be one of the factors associated with chronic kidney disease-mineral and bone disorder in hemodialysis patients.
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Affiliation(s)
- Eiji Ishimura
- Department of Nephrology, Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Kidney Center, Shirasagi Hospital, Osaka 545-8585, Japan
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Ishimura E, Okuno S, Okazaki H, Norimine K, Yamakawa K, Yamakawa T, Shoji S, Nishizawa Y, Inaba M. Significant Association Between Bone-Specific Alkaline Phosphatase and Vascular Calcification of the Hand Arteries in Male Hemodialysis Patients. Kidney Blood Press Res 2014; 39:299-307. [DOI: 10.1159/000355807] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2014] [Indexed: 11/19/2022] Open
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Rothuizen TC, Ocak G, Verschuren JJ, Dekker FW, Rabelink TJ, Jukema JW, Rotmans JI, Silva V, Raimann JG, Grassmann A, Marcelli D, Usvyat L, Canaud B, Kotanko P, Pecoits-Filho R, Consortium M, Strippoli GF, Sue YM, Tang CH, Chen TH, Hong CY, Ochi A, Ishimura E, Masuda M, Tsujimoto Y, Okuno S, Tabata T, Nishizawa Y, Inaba M, Moon Ki H, Do Hyoung K, Min Jee H, Hyun K, Wang Soo L, Su-Hyun K, Selim G, Stojceva-Taneva O, Tozija L, Dzekova-Vidimliski P, Trajceska L, Gelev S, Amitov V, Petronievic Z, Sikole A, Kee YK, Kim YL, Han JH, Oh HJ, Park JT, Han SH, Yoo TH, Kang SW, Okute Y, Shoji T, Sonoda M, Kuwamura Y, Tsujimoto Y, Tabata T, Shioi A, Tahara H, Emoto M, Inaba M, El Amrani M, Asserraji M, Benyahia M, Galloway PA, Yiu V, Hiemstra TF, Nilssen C, Zannad F, Jardine A, Schmieder R, Fellstrom B, Holdaas H, Mjoen G, Eftimovska - Otovic N, Babalj - Banskolieva E, Bogdanoska - Kostadinoska S, Grozdanovski R, Silva BC, Freitas GR, Silva VB, Abensur H, Luders C, Pereira BJ, Castro MC, Oliveira RB, Moyses RM, Elias RM, Perez De Jose A, Abad S, Vega A, Reque J, Quiroga B, Lopez-Gomez JM, Sasaki K, Yamguchi K, Hesaka A, Iwahashi E, Sakai S, Fujimoto T, Minami S, Fujita Y, Yokoyama K, Kidir V, Ersoy I, Altuntas A, Inal S, Do an A, Sezer MT, Azar H, Chacra D, Dabar G, Chelala D, Zhao L, Huang S, Liang T, Tang H, Turkmen K, Demirtas L, Akbas EM, Buyuklu M, Bakirci E, Kocyigit I, Ozcelik O, Guney I, Mumajesi S, Velaj A, Idrizi A, Pasko N, Cadri V, Barbullushi M, Bolleku E, Strakosh A, Cenaj A, Kacori V, Zekollari E, Rista E, Dusha D, Belba A, Thereska N, Gelev S, Toshev S, Trajceska L, Pavleska S, Selim G, Dzekova P, Shikole A, Naess H, Fellstrom B, Jardine AG, Schmieder RE, Zannad F, Holdaas H, Mjoen G, Sasaki K, Yamguchi S, Hesaka A, Iwahashi E, Sakai S, Fujimoto T, Minami S, Fujita Y, Yokoyama K, Bilevich O, Bunova S, Semchenko S, Schwermer K, Hoppe K, Klysz P, Baum E, Sikorska D, Radziszewska D, Sawatiuk P, Olejniczak P, Pawlaczyk K, Lindholm B, Oko A, El Amrani M, Asserraji M, Rbaibi A, El Kharass A, Benyahia M, Rroji ( Molla) M, Seferi S, Cafka M, Spahia N, Likaj E, Thereska N, Barbullushi M, Pelletier CC, Jolivot A, Kalbacher E, Panaye M, Bureau Du Colombier P, Juillard L, Burmeister JE, Mosmann CB, Bastos JP, Burmeister BO, Munaro G, Pereira JD, Youssef DW, Rosito GA. DIALYSIS CARDIOVASCULAR COMPLICATIONS 2. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ito M, Oishi R, Fukunaga M, Sone T, Sugimoto T, Shiraki M, Nishizawa Y, Nakamura T. The effects of once-weekly teriparatide on hip structure and biomechanical properties assessed by CT. Osteoporos Int 2014; 25:1163-72. [PMID: 24345886 PMCID: PMC3923120 DOI: 10.1007/s00198-013-2596-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 08/19/2013] [Indexed: 12/21/2022]
Abstract
SUMMARY Once-weekly administration of 56.5 μg teriparatide improved cortical bone parameters and biomechanical parameters at the proximal femur by CT geometry analysis. INTRODUCTION The aim of this study was to evaluate the effects of weekly administration of teriparatide [human PTH (1-34)] on bone geometry, volumetric bone mineral density (vBMD), and parameters of bone strength at the proximal femur which were longitudinally investigated using computed tomography (CT). METHODS The subjects were a subgroup of a recent, randomly assigned, double-blind study (578 subjects) comparing the anti-fracture efficacy of a once-weekly subcutaneous injection of 56.5 μg teriparatide with placebo (TOWER trial). RESULTS Sixty-six ambulatory postmenopausal women with osteoporosis were enrolled at 15 study sites having multi-detector row CT, and included women injected with teriparatide (n = 29, 74.2 ± 5.1 years) or with placebo (n = 37, 74.8 ± 5.3 years). CT data were obtained at baseline and follow-up scans were performed at 48 and 72 weeks. The data were analyzed to obtain cross-sectional densitometric, geometric, and biomechanical parameters including the section modulus (SM) and buckling ratio (BR) of the femoral neck, inter-trochanter, and femoral shaft. We found that once-weekly teriparatide increased cortical thickness/cross-sectional area (CSA) and total area, and improved biomechanical properties (i.e., decreasing BR) at the femoral neck and shaft. Teriparatide did not change the cortical perimeter. CONCLUSIONS Our longitudinal analysis of proximal femur geometry by CT revealed that once-weekly administration of 56.5 μg teriparatide improved cortical bone parameters at the femoral neck and shaft and also improved biomechanical parameters.
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Affiliation(s)
- M Ito
- Medical Work-Life-Balance Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan,
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Akizawa T, Saito A, Gejyo F, Suzuki M, Nishizawa Y, Tomino Y, Tsubakihara Y, Akiba T, Hirakata H, Watanabe Y, Kawanishi H, Bessho M, Udagawa Y, Aoki K, Uemura Y, Ohashi Y. Low hemoglobin levels and hypo-responsiveness to erythropoiesis-stimulating agent associated with poor survival in incident Japanese hemodialysis patients. Ther Apher Dial 2014; 18:404-13. [PMID: 24571446 DOI: 10.1111/1744-9987.12155] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Although erythropoiesis-stimulating agents (ESAs) are effective at treating anemia, the association between hemoglobin (Hb) levels and survival is still unclear, especially for the incident Japanese hemodialysis (HD) population. The Japan Erythropoietin Treatment (JET) Study is an open multi-center, prospective, observational study designed to evaluate the relationship between the maintenance of Hb levels and new HD patient prognosis after the first administration of epoetin beta. Landmark analyses were performed to examine the relationship between Hb levels at 6 months and survival. Among a total of 10,310 patients, 6631 completed the initial 6 months of epoetin beta treatment (induction phase) and were followed up for a further 2.5 years (maintenance phase). Three-year survival rate of patients with <9 g/dL Hb levels after 6 months was 74.1%, which was significantly lower than 89.3% for patients with Hb levels 10 to 11 g/dL; the adjusted hazard ratio (HR) was 2.08 (95% CI, 1.57-2.77; P < 0.0001). Moreover, the 3-year survival rate for poor responders defined by Hb levels <10 g/dL and weekly epoetin beta doses ≥ 9000 IU during the induction phase was 71.6%, which was significantly lower than 89.4% for the group, which had Hb levels 10 to 11 g/dL excluding poor responders and those with excursion; the HR was 1.71 (95% CI, 1.13-2.60; P = 0.0118). Adverse events related to the treatment were reported in 71 of 10,310 patients (0.69%). These findings suggest that the achieved low Hb levels and poor response to ESA therapy are significantly associated with high mortality.
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Affiliation(s)
- Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
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Sugiguchi S, Goto H, Inaba M, Nishizawa Y. Preferential reduction of bone mineral density at the femur reflects impairment of physical activity in patients with low-activity rheumatoid arthritis. Mod Rheumatol 2014. [DOI: 10.3109/s10165-009-0242-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ando K, Nitta K, Rakugi H, Nishizawa Y, Yokoyama H, Nakanishi T, Kashihara N, Tomita K, Nangaku M, Takahashi K, Isshiki M, Shimosawa T, Fujita T. Comparison of the antialbuminuric effects of benidipine and hydrochlorothiazide in Renin-Angiotensin System (RAS) inhibitor-treated hypertensive patients with albuminuria: the COSMO-CKD (COmbination Strategy on Renal Function of Benidipine or Diuretics TreatMent with RAS inhibitOrs in a Chronic Kidney Disease Hypertensive Population) study. Int J Med Sci 2014; 11:897-904. [PMID: 25013370 PMCID: PMC4081312 DOI: 10.7150/ijms.9026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 05/14/2014] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE This study evaluated the non-inferiority of renoprotection afforded by benidipine versus hydrochlorothiazide in hypertensive patients with chronic kidney disease (CKD). METHODS In this prospective, multicenter, open-labeled, randomized trial, the antialbuminuric effects of benidipine and hydrochlorothiazide were examined in renin-angiotensin system (RAS) inhibitor-treated patients with blood pressure (BP) readings of ≥ 130/80 mmHg and ≤ 180/110 mmHg, a urinary albumin to creatinine ratio (UACR) of ≥ 300 mg/g, and an estimated glomerular filtration rate (eGFR) of ≥ 30 ml/min/1.73m(2). Patients received benidipine (n = 176, final dose: 4.8 mg/day) or hydrochlorothiazide (n = 170, 8.2 mg/day) for 12 months. RESULTS Benidipine and hydrochlorothiazide exerted similar BP- and eGFR-decreasing actions. The UACR values for benidipine and hydrochlorothiazide were 930.8 (95% confidence interval: 826.1, 1048.7) and 883.1 (781.7, 997.7) mg/g at baseline, respectively. These values were reduced to 790.0 (668.1, 934.2) and 448.5 (372.9, 539.4) mg/g at last observation carried forward (LOCF) visits. The non-inferiority of benidipine versus hydrochlorothiazide was not demonstrated (benidipine/hydrochlorothiazide ratio of LOCF value adjusted for baseline: 1.67 (1.40, 1.99)). CONCLUSIONS The present study failed to demonstrate the non-inferiority of the antialbuminuric effect of benidipine relative to that of hydrochlorothiazide in RAS inhibitor-treated hypertensive patients with macroalbuminuria.
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Affiliation(s)
- Katsuyuki Ando
- 1. Division of Molecular Cardiovascular Metabolism, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kosaku Nitta
- 2. Department of Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiromi Rakugi
- 3. Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshiki Nishizawa
- 4. Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hitoshi Yokoyama
- 5. Division of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Takeshi Nakanishi
- 6. Department of Internal Medicine, Division of Kidney and Dialysis, Hyogo College of Medicine, Nishinomiya, Japan
| | - Naoki Kashihara
- 7. Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Japan
| | - Kimio Tomita
- 8. Department of Nephrology, Graduate School of Faculty of Life Science, Kumamoto University, Kumamoto, Japan
| | - Masaomi Nangaku
- 9. Department of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Katsutoshi Takahashi
- 9. Department of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masashi Isshiki
- 9. Department of Nephrology and Endocrinology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Tatsuo Shimosawa
- 10. Department of Clinical Laboratory, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Toshiro Fujita
- 11. Division of Clinical Epigenetics, Research Center for Advanced Science and Technology, University of Tokyo, Tokyo, Japan
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Fujii H, Koyama H, Fukuda S, Tokai H, Tajima S, Koizumi JI, Yamaguti K, Kuratsune H, Watanabe Y, Hirayama Y, Shoji T, Inaba M, Nishizawa Y. Autonomic Function is Associated With Health-Related Quality of Life in Patients With End-Stage Renal Disease: A Case-Control Study. J Ren Nutr 2013; 23:340-7. [DOI: 10.1053/j.jrn.2012.12.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 12/21/2012] [Accepted: 12/26/2012] [Indexed: 11/11/2022] Open
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Akizawa T, Saito A, Gejyo F, Suzuki M, Nishizawa Y, Tomino Y, Tsubakihara Y, Akiba T, Hirakata H, Watanabe Y, Kawanishi H, Bessho M, Udagawa Y, Aoki K, Uemura Y, Ohashi Y. Impacts of Recombinant Human Erythropoietin Treatment During Predialysis Periods on the Progression of Chronic Kidney Disease in a Large-Scale Cohort Study (Co-JET study). Ther Apher Dial 2013; 18:140-8. [DOI: 10.1111/1744-9987.12066] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Tadao Akizawa
- Division of Nephrology; Department of Medicine; Showa University School of Medicine; Tokyo Japan
| | | | - Fumitake Gejyo
- Niigata University Graduate School of Medical and Dental Sciences; Niigata Japan
| | | | | | - Yasuhiko Tomino
- Division of Nephrology; Department of Internal Medicine; Juntendo University Faculty of Medicine; Tokyo Japan
| | - Yoshiharu Tsubakihara
- Department of Comprehensive Kidney Disease Research; Osaka University Graduate School of Medicine; Osaka Japan
| | - Takashi Akiba
- Department of Blood Purification; Kidney Center; Tokyo Women's Medical University; Tokyo Japan
| | - Hideki Hirakata
- Department of Nephrology; Fukuoka Red Cross Hospital; Fukuoka Japan
| | - Yuzo Watanabe
- Department of Internal Medicine; Kasugai Municipal Hospital; Nagoya Japan
| | - Hideki Kawanishi
- Department of Artificial Organs; Tsuchiya General Hospital; Hiroshima Japan
| | - Masami Bessho
- Department of Hematology; Saitama Medical School; Saitama Japan
| | - Yukio Udagawa
- Pharmacovigilance Department; Chugai Pharmaceutical Co., Ltd.; Tokyo Japan
| | - Kotonari Aoki
- Pharmacovigilance Department; Chugai Pharmaceutical Co., Ltd.; Tokyo Japan
| | - Yukari Uemura
- Department of Biostatistics, School of Public Health; The University of Tokyo; Tokyo Japan
| | - Yasuo Ohashi
- Department of Biostatistics, School of Public Health; The University of Tokyo; Tokyo Japan
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Ochi A, Ishimura E, Tsujimoto Y, Kakiya R, Tabata T, Mori K, Fukumoto S, Tahara H, Shoji T, Yasuda H, Nishizawa Y, Inaba M. Hair magnesium, but not serum magnesium, is associated with left ventricular wall thickness in hemodialysis patients. Circ J 2013; 77:3029-36. [PMID: 23979658 DOI: 10.1253/circj.cj-13-0347] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Extracellular magnesium (Mg) accounts for approximately 1% of the total body Mg. Clinically, serum Mg concentration is measured, but it does not necessarily reflect total body Mg status. Although relationships have been reported between reduced Mg and cardiovascular disease in non-dialysis patients, there have been few such studies in hemodialysis patients. It was hypothesized that reduced Mg, as represented by lower Mg concentration in the hair, would be associated with echocardiographic parameters in chronic hemodialysis patients. METHODS AND RESULTS Hair Mg concentration was measured in 79 male hemodialysis patients using inductively coupled plasma mass spectrometry, and the relationships between hair Mg concentration and echocardiographic parameters were investigated. There was no significant correlation between Mg concentration in the hair and in serum. Hair Mg concentration in the patients with high-left ventricular mass index (LVMI) was significantly lower than that in the low-LVMI patients. Hair Mg concentration correlated significantly and negatively with posterior left ventricular wall thickness, interventricular septum thickness, left ventricular wall thickness (LVWT), and relative wall thickness. Serum Mg concentration, however, did not correlate with any of these echocardiographic parameters. CONCLUSIONS In hemodialysis patients, hair Mg concentration is a biomarker, independent of serum Mg concentration. Hair Mg, but not serum Mg, was significantly and negatively associated with LVWT. Reduced tissue Mg concentration, as measured in the hair, may be associated with left ventricular hypertrophy in hemodialysis patients.
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Affiliation(s)
- Akinobu Ochi
- Metabolism, Endocrinology, Molecular Medicine and Nephrology, Osaka City University Graduate School of Medicine
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Kawai Y, Kato A, Nishizawa Y, Kondo E, Saito A, Wakabayashi T, Akaike H, Tanaka T, Nakano T, Ouchi K, Miyashita N. P343 Prevalence of macrolide-resistant Mycoplasma pneumoniae infection in pediatric patients: a multicenter epidemiological study. Int J Antimicrob Agents 2013. [DOI: 10.1016/s0924-8579(13)70584-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Gelev S, Toshev S, Trajceska L, Pavleska S, Selim G, Dzekova P, Shikole A, Gelev S, Toshev S, Trajceska L, Pavleska S, Selim G, Dzekova P, Shikole A, Ulu SM, Yilmaz F, Ahsen A, Akci A, Yuksel S, Mihaescu A, Olariu N, Avram C, Schiller O, Schiller A, Xiao DM, Niu JY, Gu Y, Drechsler C, van den Broek H, Vervloet M, Hoekstra T, Dekker F, Ketteler M, Brandenburg V, Turkvatan A, Kirkpantur A, Mandiroglu S, Afsar B, Seloglu B, Alkis M, Erkula S, GURBUZ H, Serin M, CALIK Y, Mandiroglu F, Balci M, Choi BS, Choi SR, Park HS, Hong YA, Chung BH, Kim YS, Yang CW, Kim YS, Park CW, Jung JY, Sung JY, Kim AJ, Kim HS, Lee C, Ro H, Chang JH, Lee HH, Chung W, Sezer S, Bal Z, Tutal E, Bal U, Erkmen Uyar M, Ozdemir Acar N, Karakas Y, Sahin G, Urfali F, Bal C, Akcar Degirmenci N, Sirmagul B, Janda K, Krzanowski M, Dumnicka P, Kusnierz-Cabala B, Sulowicz W, Balci M, Kirkpantur A, Mandiroglu S, Afsar B, Seloglu B, Alkis M, Serin M, CALIK Y, Erkula S, GURBUZ H, Mandiroglu F, Turkvatan A, Valtuille RA, Gonzalez MS, Casos ME, Yoshida T, Yamashita M, Hayashi M, Raikou VD, Tentolouris N, Makropoulos I, Kaisidis P, Boletis JN, Abdalla AA, Roche D, Forbes JF, Hannigan A, Hegarty A, Cronin CJ, Casserly LF, Stack AG, Guinsburg A, Raimann JG, Usvyat L, Kooman J, Marelli C, Etter M, Marcelli D, Levin NW, Kotanko P, Kim CS, Choi JS, Bae EH, Ma SK, Kim SW, Ryu JH, Lee S, Ryu DR, Kim SJ, Kang DH, Choi KB, Shoji T, Tsuchikura S, Shimomura N, Kakiya R, Tsujimoto Y, Tabata T, Emoto M, Nishizawa Y, Inaba M, Selim G, Stojceva-Taneva O, Tozija L, Georgievska-Ismail L, Gelev S, Dzekova-Vidimliski P, Trajceska L, Petronievic Z, Sikole A, Wu CJ, Pan CF, Chen HH, Lin CJ, Kim Y, Kim JK, Song YR, Kim SG, Kim HJ, Kuwahara M, Bannai K, Kikuchi K, Yamato H, Segawa H, Miyamoto KI, De Mauri A, Chiarinotti D, Ruva CE, David P, Capurro F, De Leo M, Han JH, Kim HR, Ko KI, Kim CH, Koo HM, Doh FM, Lee MJ, Oh HJ, Han SH, Yoo TH, Choi KH, Kang SW, Shibata K, Sohara H, Kuji T, Kawata S, Kogudhi N, Nishihara M, Satta H, Jung JY, Ro H, Lee C, Kim SM, Kim AJ, Kim HS, Chang JH, Lee HH, Chung W, Kramann R, Erpenbeck J, Becker M, Brandenburg V, Kruger T, Marx N, Floege J, Schlieper G, Power A, Fogarty D, Wheeler D, Kerschbaum J, Schwarz CP, Mayer G, Prajitno CW, Matsuzawa R, Matsunaga A, Ishii A, Abe Y, Yoneki K, Harada M, Takagi Y, Yoshida A, Takahira N, Sirch J, Pfeiffer S, Fischlein T, El-Nahid MS, Issac MS, Bal Z, Tutal E, Bal U, Erkmen Uyar M, Guliyev O, Sayin B, Sezer S, Bajari T, Hermann M, Gmeiner B, Regele H, Aumayr K, Gensberger ET, Scharrer S, Sengoge G, Novo A, Tania S, Anes E, Domingues A, Mendes E, Batista G, Viana J, Rroji M, Cafka M, Seferi S, Seiti J, Petrela E, Likaj E, Thereska N, Selim G, Stojceva-Taneva O, Tozija L, Georgievska-Ismail L, Gelev S, Dzekova-Vidimliski P, Trajceska L, Petronievic Z, Sikole A, Turkmen K, Ozcicek F, Erdur F, Turk S, Yeksan M, Tonbul H, Castellano S, Palomares I, Merello JI, Mandiroglu S, Torkvatan A, Balci M, Seloglu B, Alkis M, Serin M, Erkula S, Gurbuz H, Calik Y, Afsar B, Mandiroglu F, Kirkpantur A, Ulusal Okyay G, Okyay K, Polattas Solak E, Sahinaslan A, Pasaoglu O, Ayerden Ebinc F, Boztepe Derici U, Sindel S, Arinsoy T, Lee YK, Son SY, Choi MJ, Lee SM, Yoon JW, Koo JR, Noh JW, Vaziri ND, Matias P, Amaral T, Ferreira AC, Mendes M, Azevedo A, Jorge C, Aires I, Gil C, Ferreira A, Carretero Dios D, Merello Godino JI, Moran Risco JE, Castellano Gasch S, Schwermer K, Hoppe K, Klysz P, Radziszewska D, Sikorska D, Nealis J, Polcyn-Adamczak M, Zaremba-Drobnik D, Pawlaczyk K, Oko A, Mentese A, Yavuz A, Karahan C, Sumer A, Ozkan G, Ulusoy S, Yildiz G, Duman A, Aydin H, Yilmaz A, Hur E, Magden K, Cetin G, Candan F, Franczyk-Skora B, Gluba A, Kowalczyk M, Banach M, Rysz J, Novo A, Domingues A, Preto L, Sousa T, Mendes E, Batista G, Vaz J, Oue M, Kuragano T, Hamahata S, Fukao W, Toyoda K, Nakanishi T, Otsubo S, Tsuchiya K, Akiba T, Nitta K, Afsar B, Saglam M, Yuceturk C, Agca E, Tosic J, Djuric Z, Popovic J, Buzadzic I, Djuric P, Jankovic A, Dimkovic N, Simone S, Dell'Oglio MP, Ciccone M, Castellano G, Corciulo R, Balestra C, Giangrande M, Gigante M, Grandaliano G, Gesualdo L, Pertosa GP, Mohamed EA, Marouane B, Mohamed Reda EF, Aziz R, Hicham B, Youssef B, Abdennasser EK, Salaheddine T, Mohammed A, Hwang JC, Jiang MY, Lu YH, Wang CT, Grzegorzewska A, Cieszynski K, Niepolski L, Sowinska A, Abdallah E, Al-Helal B, Waked E, Abdel-Khalik A, Nabil M, El-Shanawany F, Tekce H, Kursat S, Bahadir Colak H, Aktas G, Ozcicek A, Turkmen K, Ozcicek F, Akbas E, Demirtas L, Ozbicer A, Cetinkay R, Capoglu I, Valocikova I, Valocik G, Vachalcova M, Kolesarova E, Nowak A, Friedrich B, Artunc F, Serra A, Breidthardt T, Twerenbold R, Peter M, Potocki M, Muller C. Cardiovascular complications in CKD 5D. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Shoji T, Kakiya R, Hayashi T, Tsujimoto Y, Sonoda M, Shima H, Mori K, Fukumoto S, Tahara H, Shioi A, Tabata T, Emoto M, Nishizawa Y, Inaba M. Serum n-3 and n-6 polyunsaturated fatty acid profile as an independent predictor of cardiovascular events in hemodialysis patients. Am J Kidney Dis 2013; 62:568-76. [PMID: 23602192 DOI: 10.1053/j.ajkd.2013.02.362] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 02/05/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Unlike the n-6 polyunsaturated fatty acid (PUFA) arachidonic acid (AA), n-3-PUFAs such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) appear to have beneficial effects on inflammation, thrombosis, and cardiovascular disease (CVD). We examined possible alterations in serum PUFA profiles in patients on maintenance hemodialysis therapy and its association with CVD risk. STUDY DESIGN An observational study including cross-sectional and longitudinal analyses. SETTING & PARTICIPANTS Single-center study of 517 maintenance hemodialysis patients in an urban area in Japan. PREDICTORS Serum EPA, DHA, and AA concentrations and EPA:AA, DHA:AA, and (EPA+DHA):AA ratios. OUTCOMES CVD events, including ischemic heart disease, stroke, peripheral artery disease, pulmonary edema, and valve disease. RESULTS Hemodialysis patients showed lower (EPA+DHA):AA, EPA:AA, and DHA:AA ratios than 122 controls similar in age and sex. During follow-up, 190 CVD events were recorded. (EPA+DHA):AA ratio was not associated significantly with CVD in unadjusted analysis, but was associated significantly and inversely with CVD in Cox models adjusted for age and other confounding variables, with HRs in the range of 1.71-1.99 in the lowest versus highest quartile of (EPA+DHA):AA ratios. Similarly, EPA:AA and DHA:AA ratios showed inverse associations with CVD, whereas serum EPA, DHA, and AA concentrations were not predictive of CVD. LIMITATIONS No information for dietary intake, use of dietary supplements, or cell membrane PUFA content. CONCLUSIONS In hemodialysis patients, serum PUFA profile is unfavorably altered, and the low n-3-PUFA:AA ratios are independent predictors of CVD.
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Affiliation(s)
- Tetsuo Shoji
- Department of Geriatrics and Vascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
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Abstract
BACKGROUND Disorders of mineral and bone metabolism have been implicated as a risk factor in the high mortality in patients with chronic kidney disease (CKD). Hyperphosphatemia, disorders of vitamin D metabolism and secondary hyperparathyroidism of uremia (SHPT) are therapeutic targets in these patients to improve the mortality. Animal models for CKD are indispensable and uremic rats produced by 5/6-nephrectomies are one of the most useful animal models for the development of new therapeutic agents. As there are limitations of uremic rats such as short lifespan and less severity of secondary hyperparathyroidism distinct from CKD patients on maintenance hemodialysis, the development of new model animals is expected. OBJECTIVE This review discusses the molecular pathogenesis of hyperfunctioning parathyroid diseases and the applications of animal models exhibiting hyperparathyroidisms in the aspect of the development of new therapeutics. CONCLUSION PTH-cyclin D1 transgenic mice, with parathyroid-targeted overexpression of cyclin D1 oncogene, not only developed abnormal parathyroid cell proliferation but, notably, also developed biochemical hyperparathyroidism with characteristic abnormalities in bone. The mice exhibit age-dependent development of biochemical hyperparathyroidism, which enables testing of the drug precisely. In addition, the mice develop parathyroid cell hyperplasia, followed by monoclonal expansion, which is observed in refractory SHPT patients.
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Affiliation(s)
- Yasuo Imanishi
- Osaka City University Graduate School of Medicine, Metabolism, Endocrinology and Molecular Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545 8585, Japan +81 6 6645 3806 ; +81 6 6645 3808 ;
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Ishimura E, Okuno S, Tsuboniwa N, Norimine K, Fukumoto S, Yamakawa K, Yamakawa T, Shoji S, Nishizawa Y, Inaba M. Significant positive association between parathyroid hormone and fat mass and lean mass in chronic hemodialysis patients. J Clin Endocrinol Metab 2013; 98:1264-70. [PMID: 23393179 DOI: 10.1210/jc.2012-3883] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND It has been reported that there is a significant positive relationship between PTH and body weight or body mass index in the general population. However, little is known about this relationship in dialysis patients in whom PTH levels are higher. It is also not known whether fat mass or lean mass is associated with serum PTH among these patients. In the present study, we examined the association of intact PTH with fat mass and lean mass in hemodialysis patients. METHODS Serum intact PTH, calcium, and phosphate were measured in 590 hemodialysis patients (age, 60.2 ± 12.2 y; median hemodialysis duration, 59.6 mo; 343 males and 247 females; diabetics, 27.7%). Fat mass and lean mass were measured by dual-energy x-ray absorptiometry. RESULTS Intact PTH correlated significantly and positively with body weight and body mass index in all patients. Intact PTH correlated significantly and positively with fat mass and lean mass in males (P < .01), and tended to correlate positively with fat mass and lean mass in females (P < .1). In multiple regression analyses after adjustment for age, gender, hemodialysis duration, calcium, phosphate, vitamin D use, and phosphate binder use, intact PTH was associated significantly with body weight (β = .190; P < .0001), body mass index (β = .177; P < .0001), fat mass (β = .142; P < .0005), and lean mass (β = .192; P < .01). Furthermore, intact PTH was associated significantly and independently with both fat mass and lean mass after adjustment (R(2) = .206; P < .0001). CONCLUSION Serum intact PTH in chronic hemodialysis patients is associated significantly and positively with body composition of fat mass and lean mass.
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Affiliation(s)
- Eiji Ishimura
- Department of Nephrology, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
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Okuno S, Ishimura E, Tsuboniwa N, Norimine K, Yamakawa K, Yamakawa T, Shoji S, Mori K, Nishizawa Y, Inaba M. Significant inverse relationship between serum undercarboxylated osteocalcin and glycemic control in maintenance hemodialysis patients. Osteoporos Int 2013; 24:605-12. [PMID: 22581293 DOI: 10.1007/s00198-012-2003-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 03/20/2012] [Indexed: 01/29/2023]
Abstract
SUMMARY Increased levels of serum undercarboxylated osteocalcin, which were associated with bone metabolism markers, correlated inversely with indices of glucose metabolism (plasma glucose, hemoglobin A1C, and glycated albumin) in hemodialysis patients with abnormalities of bone metabolism. INTRODUCTION Undercarboxylated osteocalcin (ucOC), a possible marker of bone metabolism and one of the osteoblast-specific secreted proteins, has recently been reported to be associated with glucose metabolism. We tested the hypothesis that ucOC levels are associated with indices of glucose metabolism in chronic hemodialysis patients with abnormalities of bone metabolism. METHODS Serum ucOC, bone alkaline phosphatase (BAP, a bone formation marker), and tartrate-resistant acid phosphatase-5b (TRACP-5b, a bone resorption marker) were measured in 189 maintenance hemodialysis patients (96 diabetics and 93 non-diabetics), and their relationships with glucose metabolism were examined. RESULTS ucOC correlated positively with BAP (ρ = 0.489, p < 0.0001), TRACP-5b (ρ = 0.585, p < 0.0001) and intact parathyroid hormone (iPTH; ρ = 0.621, p < 0.0001). Serum ucOC levels in the diabetic patients were lower than those of non-diabetic patients (p < 0.001), although there were no significant differences in serum BAP or TRACP-5b between diabetic and non-diabetic patients. Serum ucOC correlated negatively with plasma glucose (ρ = -0.303, p < 0.0001), hemoglobin A1C (ρ = -0.214, p < 0.01), and glycated albumin (ρ = -0.271, p < 0.001), although serum BAP or TRACP-5b did not. In multiple linear regression analysis, log [plasma glucose], log [hemoglobin A1C], and log [glycated albumin] were associated significantly with log [ucOC] after adjustment for age, gender, hemodialysis duration, and body mass index but were not associated with log [BAP], log [TRACP-5b], or log [intact PTH]. CONCLUSION Increased levels of serum ucOC, which were associated with bone metabolism markers, were inversely associated with indices of glucose metabolism in hemodialysis patients.
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Affiliation(s)
- S Okuno
- Kidney Center, Shirasagi Hospital, Osaka, Japan
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Monden M, Koyama H, Otsuka Y, Morioka T, Mori K, Shoji T, Mima Y, Motoyama K, Fukumoto S, Shioi A, Emoto M, Yamamoto Y, Yamamoto H, Nishizawa Y, Kurajoh M, Yamamoto T, Inaba M. Receptor for advanced glycation end products regulates adipocyte hypertrophy and insulin sensitivity in mice: involvement of Toll-like receptor 2. Diabetes 2013; 62:478-89. [PMID: 23011593 PMCID: PMC3554382 DOI: 10.2337/db11-1116] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Receptor for advanced glycation end products (RAGE) has been shown to be involved in adiposity as well as atherosclerosis even in nondiabetic conditions. In this study, we examined mechanisms underlying how RAGE regulates adiposity and insulin sensitivity. RAGE overexpression in 3T3-L1 preadipocytes using adenoviral gene transfer accelerated adipocyte hypertrophy, whereas inhibitions of RAGE by small interfering RNA significantly decrease adipocyte hypertrophy. Furthermore, double knockdown of high mobility group box-1 and S100b, both of which are RAGE ligands endogenously expressed in 3T3-L1 cells, also canceled RAGE-medicated adipocyte hypertrophy, implicating a fundamental role of ligands-RAGE ligation. Adipocyte hypertrophy induced by RAGE overexpression is associated with suppression of glucose transporter type 4 and adiponectin mRNA expression, attenuated insulin-stimulated glucose uptake, and insulin-stimulated signaling. Toll-like receptor (Tlr)2 mRNA, but not Tlr4 mRNA, is rapidly upregulated by RAGE overexpression, and inhibition of Tlr2 almost completely abrogates RAGE-mediated adipocyte hypertrophy. Finally, RAGE(-/-) mice exhibited significantly less body weight, epididymal fat weight, epididymal adipocyte size, higher serum adiponectin levels, and higher insulin sensitivity than wild-type mice. RAGE deficiency is associated with early suppression of Tlr2 mRNA expression in adipose tissues. Thus, RAGE appears to be involved in mouse adipocyte hypertrophy and insulin sensitivity, whereas Tlr2 regulation may partly play a role.
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Affiliation(s)
- Masayo Monden
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hidenori Koyama
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Hyogo College of Medicine, Nishinomiya, Japan
- Corresponding author: Hidenori Koyama,
| | - Yoshiko Otsuka
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tomoaki Morioka
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Katsuhito Mori
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takuhito Shoji
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yohei Mima
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koka Motoyama
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinya Fukumoto
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Atsushi Shioi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masanori Emoto
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiko Yamamoto
- Department of Biochemistry and Molecular Vascular Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hiroshi Yamamoto
- Department of Biochemistry and Molecular Vascular Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yoshiki Nishizawa
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masafumi Kurajoh
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tetsuya Yamamoto
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masaaki Inaba
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
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Nishizawa Y, Ohta H, Miura M, Inaba M, Ichimura S, Shiraki M, Takada J, Chaki O, Hagino H, Fujiwara S, Fukunaga M, Miki T, Yoshimura N. Guidelines for the use of bone metabolic markers in the diagnosis and treatment of osteoporosis (2012 edition). J Bone Miner Metab 2013; 31:1-15. [PMID: 23143508 DOI: 10.1007/s00774-012-0392-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 09/11/2012] [Indexed: 01/22/2023]
Abstract
Recently the clinical application of bone metabolic markers has achieved significant progress and the measurements of these indices give us a better understanding of the pathogenesis of osteoporosis. Bone metabolic markers were adapted to select drug treatment for osteoporosis and to evaluate drug efficacy. Therefore, the proper application and assessment of bone metabolic markers in clinical practice is very important. To achieve these aims, the committee on the guidelines for the use of biochemical markers of bone turnover in osteoporosis authorized by the Japan Osteoporosis Society has summarized recent progress in bone markers and proposed the proper utilization of bone markers. Although the use of bone metabolic markers now has an important role in the daily management of osteoporosis, their use in Japan is still insufficient because of insurance coverage limitations. Since the Japan Osteoporosis Society first created the 2001 guidelines, new bone metabolic markers have been introduced into clinical practice. The availability of new osteoporosis treatments that promote bone formation has changed the clinical application of bone metabolic markers in current practice. Therefore, revisions to the current clinical practice are needed which led to the proposal to create these new 2012 guidelines.
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