Abstract Background and Aims CKD progression in Japanese patients with advanced chronic kidney disease (CKD)—an estimated glomerular filtration rate (eGFR) <45 ml/min/1.73m2—has remained largely unexamined. Method We conducted a nationwide cohort study of Japanese patients with advanced CKD. We recruited 2,249 advanced CKD patients (eGFR<45/ml/min/1.73m2) receiving nephrologist care from a national sample of 31 facilities throughout Japan, randomly selected with stratification by region and facility size, aligned with the international CKD Outcomes and Practice Patterns Study (CKDopps). From baseline data, we calculated annual eGFR decline by CKD stage and causes of CKD over 4 years before enrollment. Variability of eGFR decline was calculated from standard error of the regression. Results The reported causes of CKD were 552(25%) had diabetic kidney diseases (DKD), 131(6%) had PKD, 591(26%) had nephrosclerosis, 299(13%) had glomerulonephritis, and 676(30%) had other renal diseases. Of 1939 eligible patients with eGFR data more than two years, median (IQR) annual eGFR declines (ml/min/1.73m2/year) in PKD and DKD patients were 2.30 (1.16, 3.38) and 1.18 (0.23, 3.69) in G3b, 2.60 (1.81, 3.40) and 1.97 (0.20, 4.75) in G4, and 4.00 (2.00, 5.60) and 3.94 (2.05, 7.05) in G5, respectively. These eGFR declines were significantly faster than those of other kidney diseases. On the other hand, the variability of the decline in PKD patients was significantly smaller than that of DKD patients (0.43 vs 0.71, p<0.001). This trend was consistent in all CKD stages. Conclusion Our study clarified that, similar to DKD patients, annual eGFR decline of PKD patients was significantly faster than those of other kidney diseases throughout all stages. Furthermore, the variability of the decline in PKD patients was smaller than those of others. These data suggest that comprehensive nephrology care should be needed especially for these patients.
different hemodynamic parameters in the central aorta.Subendocardial viability ratio (SEVR) represents a non-invasive measure of coronary perfusion and is defined as diastolic to systolic pressure-time integral ratio.The aim of our study was to assess the impact of SEVR on mortality in non-dialysis CKD patients.METHODS: We examined 88 CKD patients (mean age 60613.4years, 66% men, 24% diabetics, 44% smokers, mean cystatin C 2.3 mg/L).SEVR was noninvasively assessed by applanation tonometry (SphygmoCor V R , Atcor, Australia).According to the manufacturer instructions regarding normal SEVR values, patients were divided to a low (SEVR<130%, n=24) and normal SEVR group (SEVR>130%, n=64).Kaplan-Meier survival curves and Cox regression model were used in statistical analyses.Patients were observed from the date of the SEVR measurement until their death or maximally up to 2234 days or 6.1 years (mean 1747 days or 4.8 years).RESULTS: SEVR values in all patients were 79-235% (mean 151.5%;SD635%).During the follow-up period, 10 (42%) patients in the low SEVR group and 11 (17%) patients in the normal SEVR group died.A Kaplan-Meier curve showed that the survival rate of the low SEVR group was significantly lower than that of the normal SEVR group (Log Rank test: P<0.003).In a Cox regression model, which included age, smoking, diabetes, cystatin C, cholesterol, high sensitive C-reactive protein, troponin I, 24hour mean arterial pressure, only age (P<0.0001),diabetes (P<0.004), and SEVR (P<0.028)turned out to be independent predictors of death.
Aim: This study aimed to examine the effects of exercise training on kidney function and nutrition status in obese Chronic Kidney Disease (CKD) patients. Methods: This is a prospective randomized controlled trial. Twelve adult obese CKD patients were randomly assigned to dietary instruction alone group (Group-D) or to both dietary instruction and exercise training group (Group-E). All patients received supervised dietary advice including calorie, protein, and salt intake for a period of 12 weeks. In addition, patients in Group-E underwent a fitness-training program. A change in glomerular filtration rate (GFR) was the main outcome. Secondary outcomes were changes in body mass index, serum creatinine-based estimated-GFR, serum albumin, and albuminuria. Results: Changes in GFR and all secondary outcomes were not statistically significant in either of the two groups. Although exercise training did not appear to significantly affect serum albumin levels in either group, it did present with a large sized effect. Conclusion: Exercise training might not have any effect on kidney function; however, the combination of exercise training along with dietary advice may prove to be more effective in maintaining the nutrition status when compared with dietary instructions alone in obese CKD patients. These results suggest that appropriate exercise training with dietary instructions is recommended for the treatment of obese CKD patients.
Plasma exchange (PEX) can be an effective treatment in anti-neutrophil cytoplasmic antibody-associated vasculitis with severe renal damage; however, it is still controversial. Among cases of newly diagnosed AAV with rapidly progressive glomerulonephritis at our department from 2008 onward, 11 patients who received PEX (seven cases for severe renal damage [R-PEX] and four cases for lung hemorrhage [L-PEX]) were retrospectively analyzed. All cases of R-PEX were dependent on hemodialysis at the beginning of PEX and all received seven sessions of PEX (50 mL/kg or 1.3 plasma volume per exchange) within 2 weeks. All cases became dialysis-independent within 8 weeks, with 3- and 12-month cumulative renal survival rates of 100% and 80%, respectively. All cases of L-PEX retained their renal function. In rapidly developing, newly dialysis-dependent antibody-associated vasculitis with rapidly progressive glomerulonephritis patients with normal renal function before disease onset, standard PEX can be expected to induce sufficient renal recovery to establish dialysis independence.
Polyuria in post-kidney transplant (KT) patients is a common condition generally attributed to delayed tubular function, fluid administration, and solute diuresis. Since excessive water intake post-KT physiologically suppresses arginine vasopressin (AVP) secretion, central diabetes insipidus (CDI) caused by deficient primary AVP release can be overlooked. Although DDAVP (desmopressin) - a selective AVP V2 receptor agonist - has been used to treat massive polyuria, CDI rarely progresses to kidney injury due to the preservation of fluid balance by thirst-dependent osmoregulation. Administration of DDAVP in post-KT recipients with mild polyuria and subclinical CDI is difficult to assess, and whether long-term use of DDAVP is beneficial for the transplanted kidney has not been established. We present the case of a 36-year-old Japanese female who was diagnosed with subclinical/partial CDI post KT. CDI was caused by a sequela of suprasellar germinoma. Graft function gradually declined without evidence of hypovolemia or hypernatremia, and a kidney biopsy revealed advanced ischemic kidney injury. Although daily oral DDAVP administration did not increase extracellular fluid volume, treatment resulted in a gradual improvement of graft function, and a follow-up transplanted kidney biopsy indicated substantial recovery.
Decreased physical activity in hemodialysis (HD) patients causes various structural, metabolic, and functional abnormalities due to uremic changes in skeletal muscles. Electrical stimulation (ES) of the lower limbs was found to be effective in patients with cardiac insufficiency for exercise tolerance. This study compared the effects of ES and variable load ergometers on the lower limbs in HD patients. We performed a prospective, double-center, open-label, randomized controlled trial. Eligible patients were aged over 65 years, had end-stage renal disease, and underwent maintenance HD. The primary endpoint was muscle power, and the secondary endpoints included changes in dialysis efficiency, serum phosphorus, and inflammatory markers. Thirty HD outpatients were randomly assigned to the following groups: exercise (EX), ES, or control (SED). In EX and ES groups, patients were instructed to exercise twice a week for 12 weeks, depending on their physical capabilities. The safety and efficacy of aerobic training and ES during HD were confirmed when a sudden decrease in blood pressure or any other side effects did not occur. A repeated measures analysis of variance was performed as the principal method to evaluate time (baseline vs. 12 weeks) and group (EX vs. ES vs. SED) comparisons for the experimental outcomes. The efficiency of HD significantly increased in the ES and EX groups (p ≤ 0.02). Moreover, the ES group experienced a significant increase in muscle power (p = 0.01) and the weight bearing index (p = 0.04) and a significant decrease in serum phosphorus level (p = 0.04) and tumor necrosis factor-alpha (TNF-α) level (p = 0.04) from baseline to 12 weeks. Furthermore, there was a significant increase in serum TNF-α level (p ≤ 0.03) over time in both the EX and SED groups. The safety and efficacy of aerobic training and ES during HD were confirmed when a sudden decrease in blood pressure or any other side effects did not occur. Therefore, ES may improve the patient's condition, similar to lower limb exercises, and ES should be considered as an option for rehabilitation programs in HD patients. UMIN Clinical Trials Registry ( UMIN-CTR R 000032202 ); retrospectively registered on April 11, 2018
The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.
Purpose: There are few reports of long-term follow-up of changes in health status, including convalescent rehabilitation, in frail elderly adults.This study aimed to compare changes in physical strength between community-dwelling elderly adults with and without prefrailty after 4 years of participation in a preventive healthcare class.Methods: Prefrailty was defined as grip strength <30 kg for the men and <20 kg for the women.Health exercise classes had been con ducted since 2011.Subjects were divided into two groups (with prefrailty and without prefrailty) based on grip strength before partici pation.We compared the changes in grip strength and 10-m walking speed after 4 years between the two groups.Results: From 2011 to 2015, 178 people (50 men and 128 women) participated in the class es, including 19 men and 35 women with prefrailty.Twenty-two men and 43 women participated in the classes for 4 years, including 3 men and 6 women with prefrailty.Change in grip strength after 4 years was -0.49±1.11kg for those with prefrailty and -1.34±0.50kg for those without.Change in walking speed was +0.10±0.17m/s for those with prefrailty and +0.04±0.08 m/s for those without.There were no significant gender differences.An analysis of covariance using age as a co-variable showed that the change of grip strength was significantly different between two groups (with prefrailty and without prefrailty)(p<0.05).Conclusions: Continued participation in preventative healthcare classes effectively increases leg strength, even in elderly adults with prefrailty.
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