Faculty Profiles - IMAIZUMI Takahiro

Papers - IMAIZUMI Takahiro

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Laboratory frailty index improves prediction of in-hospital falls among older adults. Open Access

Nakashima H, Imaizumi T, Komiya H, Morohashi A, Watanabe K, Fujisawa C, Yamada Y, Nagao Y, Umegaki H

Aging clinical and experimental research Vol. 37 ( 1 ) page： 179 2025.6

Factors associated with awareness of chronic kidney disease, and impact of awareness on renal prognosis Open Access

Hattori, A; Imaizumi, T; Toda, T; Sakurai, D; Takai, N; Miki, T; Maekawa, M; Kato, S; Hagiwara, Y; Yoshida, Y; Maruyama, S

CLINICAL AND EXPERIMENTAL NEPHROLOGY Vol. 29 ( 5 ) page： 596 - 606 2025.5

Language：English Publisher：Clinical and Experimental Nephrology

Background: Chronic kidney disease (CKD) awareness could help prevent disease progression through modifiable risk factors. However, few patients with CKD are aware of their disease. We aimed to investigate the factors associated with CKD awareness and impact of CKD awareness on renal prognosis. Methods: We investigated the proportion of participants with CKD who answered ‘aware of CKD’ in the questionnaire among those undergoing health check-ups from 2013 to 2022. Participants included working-age employees and their dependents covered by health insurance associations for large and medium-sized companies. The outcome was defined as the change from ‘unaware’ to ‘aware’ of CKD; multivariable logistic regression analysis assessed the association of urine tests or nutritional guidance with CKD awareness. A control group was randomly selected from the unaware group and matched for age, sex, estimated glomerular filtration rate (eGFR), urinary protein categories, and follow-up period. Changes in eGFR slopes before and after awareness were compared using linear mixed-effects models. Results: Of the 13,489 participants, 2.8% were aware of CKD at baseline; of the 1,614 with CKD-related disease codes, only 19.6% were aware. The odds ratios of urine tests or nutritional guidance in relation to awareness occurrence were 1.98 (1.29–3.05) and 3.01 (1.38–6.53), respectively. The difference in the eGFR slope improvement from before to after CKD awareness was + 0.92 mL/min/1.73 m<sup>2</sup> per year (0.18–1.67; P = 0.015) in the aware group. Conclusion: Our findings suggest that urine tests and nutritional guidance may promote CKD awareness, which may help slow its progression.

DOI： 10.1007/s10157-024-02605-4

Development and validation of an algorithm for identifying patients undergoing dialysis from patients with advanced chronic kidney disease Open Access

Imaizumi, T; Yokota, T; Funakoshi, K; Yasuda, K; Hattori, A; Morohashi, A; Kusakabe, T; Shojima, M; Nagamine, S; Nakano, T; Huang, Y; Morinaga, H; Ohta, M; Nagashima, S; Inoue, R; Nakamura, N; Ota, H; Maruyama, T; Gobara, H; Endoh, A; Ando, M; Shiratori, Y; Maruyama, S

CLINICAL AND EXPERIMENTAL NEPHROLOGY Vol. 29 ( 5 ) page： 650 - 661 2025.5

Language：English Publisher：Clinical and Experimental Nephrology

Background: Identifying patients on dialysis among those with an estimated glomerular filtration rate (eGFR) < 15 mL/min/1.73 m<sup>2</sup> remains challenging. To facilitate clinical research in advanced chronic kidney disease (CKD) using electronic health records, we aimed to develop algorithms to identify dialysis patients using laboratory data obtained in routine practice. Methods: We collected clinical data of patients with an eGFR < 15 mL/min/1.73 m<sup>2</sup> from six clinical research core hospitals across Japan: four hospitals for the derivation cohort and two for the validation cohort. The candidate factors for the classification models were identified using logistic regression with stepwise backward selection. To ensure transplant patients were not included in the non-dialysis population, we excluded individuals with the disease code Z94.0. Results: We collected data from 1142 patients, with 640 (56%) currently undergoing hemodialysis or peritoneal dialysis (PD), including 426 of 763 patients in the derivation cohort and 214 of 379 patients in the validation cohort. The prescription of PD solutions perfectly identified patients undergoing dialysis. After excluding patients prescribed PD solutions, seven laboratory parameters were included in the algorithm. The areas under the receiver operation characteristic curve were 0.95 and 0.98 and the positive and negative predictive values were 90.9% and 91.4% in the derivation cohort and 96.2% and 94.6% in the validation cohort, respectively. The calibrations were almost linear. Conclusions: We identified patients on dialysis among those with an eGFR < 15 ml/min/1.73 m<sup>2</sup>. This study paves the way for database research in nephrology, especially for patients with non-dialysis-dependent advanced CKD.

DOI： 10.1007/s10157-024-02614-3

Outcomes and cost-effectiveness of intermediate care units for patients discharged from the intensive care unit: a nationwide retrospective observational study Open Access

Ikumi, S; Tarasawa, K; Shiga, T; Imaizumi, T; Kaiho, Y; Iwasaki, Y; Yabuki, S; Wagatsuma, Y; Takaya, E; Fushimi, K; Ito, Y; Fujimori, K; Yamauchi, M

CRITICAL CARE Vol. 29 ( 1 ) page： 157 2025.4

Language：English Publisher：Critical Care

Background: The clinical and economic impacts of intermediate care units (IMCUs) on intensive care unit (ICU)-discharged patients remain unclear due to inconsistent outcomes in previous studies. Under Japan’s National Health Insurance Scheme, ICUs are categorized by staffing intensity (high or low). Using a nationwide inpatient database in Japan, we evaluated the clinical outcomes and cost-effectiveness of IMCUs for ICU-discharged patients. Methods: This retrospective observational study used a Japanese administrative database to identify patients admitted to the high-intensity ICU in hospitals with IMCUs between April 2020 and March 2023. Patients were categorized into the IMCU (IMCU group) and general ward (non-IMCU) groups. Propensity scores were estimated using a logistic regression model incorporating 14 variables, including patient demographics, and treatments received during ICU stay. One-to-one propensity score matching balanced baseline characteristics of each group. Clinical outcomes were compared between both groups, including in-hospital mortality, ICU readmission, length of ICU stay, length of hospital stay, and total medical costs. Surgical status and surgical area (e.g., cardiovascular) were considered in subgroup analyses. Data analyses were conducted using the chi-square test for categorical variables and t-test for continuous variables. Results: Overall, 162,243 eligible patients were categorized into the IMCU (n = 21,548) and non-IMCU (n = 140,695) groups. Propensity score matching generated 18,220 pairs. The IMCU group had lower in-hospital mortality and ICU readmission rates than the non-IMCU group. However, total costs were higher in the IMCU group. Subgroup analyses revealed the IMCU group had significantly lower mortality and lower total costs than the non-IMCU group in the cardiovascular [open thoracotomy] surgery subgroup. Conclusions: Discharge to an IMCU is associated with lower in-hospital mortality and ICU readmission rates compared to general ward discharge. High-risk subgroups, such as cardiovascular surgery patients, experienced cost-effective benefits from IMCU care. These findings highlight an association between IMCU admission and improved patient outcomes, suggesting a potential role in optimizing resource use in intensive care. Given the likelihood of selection bias in admission allocation, these findings should be interpretation with caution.

DOI： 10.1186/s13054-025-05393-9

Plasma Metabolite Profiles Between In-Center Daytime Extended-Hours and Conventional Hemodialysis Open Access

Takami, N; Okazaki, M; Ozeki, T; Imaizumi, T; Nishibori, N; Kurasawa, S; Hishida, M; Akiyama, S; Saito, R; Hirayama, A; Kasuga, H; Kaneda, F; Maruyama, S

KIDNEY360 Vol. 6 ( 3 ) page： 420 - 431 2025.3

Language：English Publisher：Kidney360

Key PointsSignificant differences in 39 plasma metabolites were observed between patients on extended-hours hemodialysis and those on conventional hemodialysis.Extended-hours hemodialysis had a lower lactate-to-pyruvate ratio and higher branched-chain amino acids than conventional hemodialysis.Extended-hours hemodialysis may have favorable metabolic and nutritional benefits for patients undergoing maintenance hemodialysis.BackgroundProtein-energy wasting, characterized by disordered body protein catabolism resulting from metabolic and nutritional derangements, is associated with adverse clinical outcomes in patients undergoing hemodialysis. Extended-hours hemodialysis (≥6 hours per treatment session) offers both enhanced removal of uremic solutes and better fluid management, generally allowing more liberalized dietary protein and calorie intake. The aim of this study was to evaluate the difference in plasma metabolite profiles among patients receiving in-center daytime extended-hours hemodialysis and those receiving conventional hemodialysis.MethodsPredialysis plasma samples were obtained from 188 patients on extended-hours hemodialysis (21.9 h/wk) and 286 patients on conventional hemodialysis (12.1 h/wk) in Japan in 2020 using capillary electrophoresis-mass spectrometry. Group differences were compared for 117 metabolites using Wilcoxon rank-sum tests with multiple comparisons and partial least squares discriminant analysis. In addition, propensity score-adjusted multiple regression analyses were performed to evaluate group differences for known uremic toxins, branched-chain amino acids, and lactate-to-pyruvate ratio (a possible surrogate marker of mitochondrial dysfunction).ResultsSignificant differences were observed in 39 metabolites, largely consistent with the high variable importance for prediction in partial least squares discriminant analysis. Among known uremic toxins, uridine and hypoxanthine levels were significantly higher in the conventional hemodialysis group than in the extended-hours hemodialysis group, whereas trimethylamine N-oxide levels were higher in the extended-hours hemodialysis group than in the conventional hemodialysis group. Patients on extended-hours hemodialysis had higher levels of all branched-chain amino acids and a lower lactate-to-pyruvate ratio than those on conventional hemodialysis (significant difference of -8.6 [95% confidence interval, -9.8 to -7.4]).ConclusionsExtended-hours hemodialysis was associated with a more favorable plasma metabolic and amino acid profile; however, concentrations of most uremic toxins did not significantly differ from those of conventional hemodialysis.

DOI： 10.34067/KID.0000000675

Clinically meaningful eGFR slope as a surrogate endpoint differs across CKD stages and slope evaluation periods: the CKD-JAC study Open Access

Imaizumi, T; Komaba, H; Hamano, T; Nangaku, M; Murotani, K; Hasegawa, T; Fujii, N; Nitta, K; Isaka, Y; Wada, T; Maruyama, S; Fukagawa, M

CLINICAL KIDNEY JOURNAL Vol. 18 ( 2 ) page： sfae398 2025.2

Language：English Publisher：Clinical Kidney Journal

Background: The slope of estimated glomerular filtration rate (eGFR) is a promising surrogate endpoint in patients with chronic kidney disease (CKD). However, current evidence is mainly derived from Western populations with CKD stages 1-3. In addition, stage-by-stage analysis has never been formally performed. Methods: We analyzed data from the Chronic Kidney Disease Japan Cohort Study, which included a large proportion of patients with CKD stages 4 and 5. We estimated eGFR slopes over three evaluation periods (0.5, 1, and 2 years) using mixed effects models and examined their associations with kidney failure with replacement therapy across CKD stages. Results: Of 2713 patients with an available 1-year eGFR slope, 985 subsequently initiated kidney replacement therapy. Overall, a slower eGFR decline was strongly associated with a lower risk of subsequent kidney failure with replacement therapy. The association was pronounced with higher baseline CKD stages and attenuated with shorter evaluation periods. The estimated deceleration in eGFR decline over 1 year associated with a 20% lower risk of subsequent kidney failure with replacement therapy was 1.91 (1.60-2.37), 1.12 (1.00-1.28), and 1.06 (0.81-1.60) ml/min/1.73 m2 per year in patients with CKD stages 3, 4, and 5, respectively. Conclusion: Our results support the potential of eGFR slope as a surrogate across different stages of CKD in Asians and suggest that a shorter evaluation period than 2 years may be feasible for patients with late-stage CKD. Our findings provide valuable insights for the future design of clinical trials in CKD patients, especially those with more advanced CKD.

DOI： 10.1093/ckj/sfae398

Association between hemoglobin level and mortality in patients undergoing maintenance hemodialysis: a nationwide dialysis registry in Japan Open Access

Kosugi, T; Hasegawa, T; Imaizumi, T; Nishiwaki, H; Honda, H; Ito, Y; Tsuruya, K; Abe, M; Hanafusa, N; Kuragano, T

CLINICAL AND EXPERIMENTAL NEPHROLOGY Vol. 29 ( 6 ) page： 831 - 842 2025.2

Language：English Publisher：Clinical and Experimental Nephrology

Background: The optimal hemoglobin (Hb) range in patients undergoing hemodialysis remains controversial. We aimed to investigate the association between Hb levels and mortality in patients undergoing hemodialysis and explore the potential factors modifying this association. Methods: This observational study utilized a nationwide database from the Japanese Renal Data Registry spanning from 2019 to 2021. This study included 265,779 patients undergoing hemodialysis thrice a week. The association between Hb levels and all-cause and cause-specific mortality was investigated using Cox regression analysis. The nonlinear relationship between Hb levels and outcomes was investigated using restricted cubic spline analysis. Results: During a median follow-up period of 24 months, 45,734 patients died. Compared to the reference Hb category of 10–10.9 g/dL, the risk of all-cause mortality was higher in the Hb categories of < 9.0, 9.0–9.9, and ≥ 13 g/dL with adjusted hazard ratios (95% confidence intervals) of 1.24 (1.20–1.29), 1.09 (1.06–1.12), and 1.19 (1.14–1.25), respectively. Restricted cubic spline analysis also showed a U-shaped relationship between Hb level and mortality. The subgroup analysis indicated that the Hb category of 12.0–12.9 g/dL was associated with increased mortality risk in patients with a dialysis vintage of ≥ 10 years and those with a history of cerebral infarction. Conclusion: Hb levels of < 10.0 and ≥ 13.0 g/dL were significantly associated with an increased mortality risk compared to an Hb level of 10.0–10.9 g/dL in patients undergoing hemodialysis.

DOI： 10.1007/s10157-025-02632-9

Correction of profound hyponatraemia following rapid bolus therapy: effectiveness of the Barsoum-Levine formula based on the Edelman equation Open Access

Nagase, K; Imaizumi, T; Yamamori, A; Hiramatsu, Y; Kambe, M; Kang, YR; Kishima, Y; Kozaki, Y; Nagase, FN; Iwasaki, K; Ito, Y; Ikai, H; Yamamoto, M; Murai, Y; Yokoyama-Kokuryo, W; Takizawa, N; Shimizu, H; Fujita, Y; Watanabe, T

CLINICAL KIDNEY JOURNAL Vol. 18 ( 2 ) page： sfae402 2025.2

Language：English Publisher：Clinical Kidney Journal

Background: The optimal treatment for profound hyponatraemia remains uncertain. Recent clinical studies have demonstrated that a standardized bolus of hypertonic saline is effective, but relying solely on this approach may not fully address the individual variability of hyponatraemia among patients. We evaluated the effectiveness of rapid bolus (RB) administration of hypertonic saline followed by predictive correction (PC) using an infusate and fluid loss formula identical to the Barsoum-Levine formula based on the Edelman equation (RB-PC) for managing profound hyponatraemia. Methods: In this retrospective observational cohort study, we evaluated 276 patients aged >18 years with s[Na] levels ≤120 mEq/L (January 2014-December 2023). Using propensity score matching (PSM), we assessed s[Na] elevations at 6 h post-treatment initiation and the rate of appropriate hyponatraemia correction between the RB-PC and PC groups. We defined the appropriate correction as a change in s[Na] in the range of 4-10 mEq/L within the first 24 h and ≤18 mEq/L within the first 48 h following corrective treatment initiation. Results: Among 276 patients with profound hyponatraemia (s[Na] ≤120 mEq/L), 49 and 108 underwent treatment with RB-PC therapy and with PC therapy without RB, respectively. Post-PSM, 84 patients were selected and allocated to the RB-PC (n = 42) or PC group (n = 42). In PSM analysis, patients with RB-PC experienced a higher elevation in s[Na] at 6 h after treatment initiation than PC (4.0 vs 2.4 mEq/L, P < 0.001). The rate of appropriate correction was similar between the RB-PC and PC groups (90.5% vs 90.5%, P = 1). Conclusions: RB-PC can quickly elevate s[Na] levels and achieve appropriate correction of s[Na] in patients with profound hyponatraemia.

DOI： 10.1093/ckj/sfae402

Prevention of central venous catheter occlusion by saline with or without heparin in intensive care unit after surgical intervention: a double-blind, randomized trial Open Access

Nakamoto, M; Tamura, T; Kobayashi, E; Kawaguchi, M; Matsuoka, Y; Fujii, A; Ando, M; Kubo, Y; Imaizumi, T; Miyagawa, Y; Inagaki, T; Suzuki, S; Nishiwaki, K

NAGOYA JOURNAL OF MEDICAL SCIENCE Vol. 87 ( 1 ) page： 51 - 59 2025.2

Assessment of adverse events stratified by timing of leadless pacemaker implantation with cardiac implantable electronic devices extraction due to infection: A systematic review and meta-analysis Open Access

Inoue, N; Ito, Y; Imaizumi, T; Morikawa, S; Murohara, T

JOURNAL OF ARRHYTHMIA Vol. 41 ( 1 ) page： e13208 2025.2

Language：English Publisher：Journal of Arrhythmia

Background: Removal of cardiac implantable electronic devices (CIEDs) is strongly recommended for CIED-related infections, and leadless pacemakers (LPs) are increasingly used for reimplantation. However, the optimal timing and safety of LP implantation after CIED removal for infection remains unclear. This systematic review and meta-analysis aimed to assess complication rates (all-cause mortality and reinfection) when LP implantation was performed simultaneously with or after CIED removal. Methods: Studies published from 2015 to September 2024 were searched in PubMed, Cochrane Library, and Google Scholar. Observational studies and case series on CIED removal and LP implantation were eligible. The primary outcomes were all-cause mortality and reinfection post-LP implantation. Pooled estimates were obtained using the Freedman-Tukey double arcsine transformation. Study quality was assessed using the MINORS criteria, with data extraction and independent assessment by two authors. Results: Of 396 records, 16 studies were included in the analysis, with 653 patients (mean age:76.9 years). The incidence of isolated pocket infections was 46.7% (95% CI: 32.7%–61.2%) and systemic infections at 46.3% (95% CI: 29.5%–64.0%). The primary outcome incidence was 19.4% (95% CI: 12.8%–28.3%, I<sup>2</sup>: 0%) for simultaneous CIED extraction and LP implantation compared with 7.79% (4.37%–13.5%, I<sup>2</sup>: 4%) for LP implantation after CIED extraction (p =.009). All-cause mortality rates were 22.8% (95% CI: 15.9%–31.6%, I<sup>2</sup>: 0%) for simultaneous implantation and 8.71% (4.46%–16.3%, I<sup>2</sup>: 21%) after extraction (p = 0.008). Reinfection was not observed in any of these studies. Conclusion: Simultaneous CIED extraction and LP implantation due to infection may be associated with an increased risk of all-cause mortality.

DOI： 10.1002/joa3.13208

Exploring the impact of perioperative analgesia on postoperative chronic analgesic prescriptions in patients with lung cancer undergoing minimally invasive thoracic surgery: A retrospective observational study Open Access

Yabuki, S; Kaiho, Y; Tarasawa, K; Ikumi, S; Iwasaki, Y; Imaizumi, T; Fujimori, K; Fushimi, K; Yamauchi, M

EUROPEAN JOURNAL OF PAIN Vol. 29 ( 2 ) page： e4774 2025.2

Language：English Publisher：European Journal of Pain

Background: Lung cancer surgery is associated with a high incidence of chronic postsurgical pain (CPSP), which necessitates long-term analgesic prescriptions. However, while essential for managing pain, these have shown various adverse effects. Current guidelines recommend using peripheral nerve blocks over epidural anaesthesia for perioperative analgesia in minimally invasive thoracic surgery (MITS). However, the impact of perioperative analgesia on chronic analgesic prescriptions remains unclear. Therefore, this study investigated chronic analgesic prescription patterns following MITS in patients with lung cancer who received either perioperative epidural anaesthesia or nerve block. Methods: We conducted a retrospective cohort study using data from the Japanese Diagnosis Procedure Combination database. Data were extracted from patients with primary lung cancer who underwent MITS between April 2018 and March 2022. Patients were divided into two groups based on the perioperative analgesia they received: the epidural anaesthesia group and the nerve block group. We compared the proportion of analgesic prescriptions 3–6 months postoperatively between both groups using multivariable logistic regression analysis. Inverse probability of treatment weighting was used to balance the covariates between the two groups. Results: Among the 38,719 eligible patients, 4513 (11.6%) were prescribed postoperative analgesics. We found no significant difference in the proportion of analgesic prescriptions between the epidural anaesthesia and nerve block groups (odds ratio, 1.00; 95% confidence interval, 0.99–1.01). Conclusions: This nationwide retrospective study suggests that the choice between perioperative epidural anaesthesia or nerve block in patients with lung cancer undergoing MITS does not influence the proportion of postoperative chronic analgesic prescriptions.

DOI： 10.1002/ejp.4774

Association between Serum Iron Store Biomarkers and All-Cause Mortality in Japanese Patients Undergoing Hemodialysis: A Nationwide Cohort Study

Nishiwaki, H; Imaizumi, T; Hasegawa, T; Kosugi, T; Maruyama, Y; Tsuruya, K; Ito, Y; Honda, H; Abe, M; Hanafusa, N; Kuragano, T

AMERICAN JOURNAL OF NEPHROLOGY page： 1 - 11 2025.1

Language：English Publisher：American Journal of Nephrology

Introduction: We evaluated the association between ironrelated biomarkers key indicators of iron metabolism and inflammation, and crucial in the management of anemia in patients undergoing hemodialysis and all-cause mortality. This study aimed to clarify the nuanced relationship between these biomarkers and mortality outcomes, addressing the limitations of traditional cutoff-based analyses. Methods: We conducted a cohort analysis of patients undergoing dialysis across Japan using data from the Japan Renal Database collected between 2019 and 2020. Patients who had been on dialysis for at least 3 months by the end of 2019 were considered eligible. The associations between iron-related biomarkers and all-cause within 1 year were analyzed using Cox proportional hazards models. The relationship between each biomarker and outcome was illustrated using restricted cubic spline curves, while the combined association of serum ferritin and transferrin saturation (TSAT) with mortality was shown using contour plots. Results: A total of 215,927 patients were included in the analysis. During the follow-up period, 17,803 (8.24%) deaths were recorded. Contour plots demonstrated increased mortality risk in areas with low ferritin and TSAT levels. Additionally, even in regions with high TSAT levels, there was a trend toward increased mortality risk with increasing ferritin levels. Conversely, in areas with low ferritin levels, there was a trend toward a decreased risk of death with increasing TSAT. Conclusions: Our findings highlight the complex interplay between serum ferritin and TSAT levels, emphasizing the limitations of relying on single cutoff values for clinical decision-making. The study underscores the need for individualized approaches to iron management in patients undergoing hemodialysis.

DOI： 10.1159/000543888

Longitudinal impact of extended-hours hemodialysis with a liberalized diet on nutritional status and survival outcomes: findings from the LIBERTY cohort Open Access

Imaizumi, T; Okazaki, M; Hishida, M; Kurasawa, S; Nishibori, N; Nakamura, Y; Ishikawa, S; Suzuki, K; Takeda, Y; Otobe, Y; Kondo, T; Kaneda, F; Kaneda, H; Maruyama, S

CLINICAL AND EXPERIMENTAL NEPHROLOGY Vol. 29 ( 6 ) page： 818 - 830 2025.1

Language：English Publisher：Clinical and Experimental Nephrology

Background: Protein-energy wasting (PEW), a unique weight loss linked to nutritional and metabolic abnormalities, is common in patients undergoing hemodialysis (HD) and associated with adverse outcomes. This study investigated whether extended-hours HD combined with a liberalized diet could overcome PEW and improve survival. Methods: The body mass index (BMI) and survival outcomes in patients undergoing extended-hours HD were evaluated for up to 8 years using data from the LIBeralized diet Extended-houRs hemodialysis Therapy (LIBERTY) cohort. Extended-hours HD was defined as weekly dialysis length ≥ 18 h. Results: The LIBERTY cohort included 402 patients who initiated extended-hours HD. An increase in the length and frequency of HD sessions was observed over time, with approximately 70% and 20% of patients undergoing extended-hours HD for > 21 h/week and > 3 sessions/week at 5 years, respectively. The BMI and percentage creatinine generation rate were maintained over time, with no substantial increase in the phosphorus and potassium levels. The estimated BMI initially increased, and thereafter plateaued over time in patients with a baseline BMI < 25 kg/m<sup>2</sup>, whereas it decreased gradually in patients with a baseline BMI ≥ 25 kg/m<sup>2</sup> after several years from baseline. Ninety-one patients died, and 108 discontinued extended-hours HD during the median follow-up period of 6.2 years (interquartile range, 3.5–8.0), yielding a 5-year survival rate of 85%. Conclusions: Extended-hours HD with a liberalized diet may help achieve favorable survival outcomes and maintain nutritional status. Thus, it is a promising treatment option for managing PEW in patients undergoing HD.

DOI： 10.1007/s10157-024-02602-7

Nutritional Status Modifies the Association Between Hemoglobin Level and Mortality in Older Patients Undergoing Hemodialysis: A Nationwide Dialysis Registry in Japan. Open Access

Kosugi T, Hasegawa T, Imaizumi T, Nishiwaki H, Honda H, Ito Y, Tsuruya K, Abe M, Hanafusa N, Kuragano T

Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation 2025.1

Language：English Publisher：Journal of Renal Nutrition

Objectives: Anemia is a common complication associated with adverse outcomes in older patients undergoing hemodialysis (HD). They also tend to experience malnutrition, which can affect the course of anemia. We hypothesized that the optimal hemoglobin (Hb) level varies depending on nutritional status in older patients undergoing HD and aimed to investigate the association between Hb levels and mortality according to nutritional status. Methods: This is an observational study utilizing a nationwide Japanese database from 2019 to 2021. This study included 95,771 patients aged ≥75 years undergoing HD thrice a week. The nutritional risk index for Japanese hemodialysis patients (NRI-JH) was calculated. The association between Hb levels and mortality was investigated using Cox regression analysis stratified by NRI-JH. A nonlinear relationship was investigated using restricted cubic spline analysis. Results: During a median follow-up period of 24 months, 27,611 patients died. In the low-risk NRI-JH group, the risk of all-cause mortality was higher in the Hb categories of <9.0, 9.0-9.9, and ≥13 g/dL compared to the reference Hb category of 10-10.9 g/dL, with the adjusted hazard ratios and 95% confidence intervals of 1.45 (1.32-1.59), 1.15 (1.08-1.22), and 1.18 (1.07-1.29), respectively. In contrast, the impact of Hb levels on mortality was significantly attenuated in the high-risk NRI-JH group, with a mild increased risk in the <9.0 g/dL category (adjusted hazard ratio, 1.07; 95% confidence interval, 1.01-1.15). Conclusion: Among older patients undergoing HD, the impact of Hb levels on mortality was attenuated in the high-risk NRI-JH group.

DOI： 10.1053/j.jrn.2025.01.003

Efficacy and safety of avacopan in antineutrophil cytoplasmic autoantibody-associated vasculitis: a retrospective cohort study in Japan Open Access

Tagami, G; Yamaguchi, M; Sugiyama, H; Kinashi, H; Imai, K; Kamiya, K; Katsuno, T; Imaizumi, T; Banno, S; Ito, Y; Ishimoto, T

BMC RHEUMATOLOGY Vol. 9 ( 1 ) page： 8 2025.1

Language：English Publisher：BMC Rheumatology

Background: Avacopan, an oral C5a receptor antagonist, demonstrated efficacy as an alternative to glucocorticoid therapy in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) in the phase 3 ADVOCATE trial. However, limited real-world data exist on the outcomes and experiences associated with avacopan use for AAV in Japan. Methods: We performed a single-centre retrospective analysis and evaluated 21 patients with newly diagnosed or relapsed AAV who received avacopan. The co-primary outcomes were clinical remission at 6 and 12 months. Results: Among the 21 patients, 20 (95.2%) achieved clinical remission at 6 months, and 19 (90.4%) sustained remission at 12 months. The median time from initiation of immunosuppressive therapy to the start of avacopan was 12 days (interquartile range, 5–26). Adverse events were reported in 10 patients (47.6%), with elevated liver enzyme levels observed in eight patients (38.1%) as the most frequent complication. Avacopan was discontinued in nine patients (42.9%). Despite early discontinuation, these patients achieved comparable rates of clinical remission at 6 months, sustained remission at 12 months, and experienced a reduction in glucocorticoid doses relative to those who continued avacopan. Conclusions: A high incidence of adverse events, particularly liver enzyme elevation, and frequent early discontinuations of avacopan were observed. Nevertheless, favourable clinical outcomes and reduced glucocorticoid doses were achieved regardless of avacopan discontinuation. Further studies are warranted to validate the optimal use of avacopan in clinical practice.

DOI： 10.1186/s41927-025-00456-4

Renal anemia and hyporesponsiveness to ESA for preservation of residual kidney function in patients undergoing peritoneal dialysis Open Access

Imaizumi, T; Hasegawa, T; Kosugi, T; Nishiwaki, H; Abe, M; Hanafusa, N; Honda, H; Tsuruya, K; Ito, Y; Kuragano, T

SCIENTIFIC REPORTS Vol. 15 ( 1 ) page： 2689 2025.1

Language：English Publisher：Scientific Reports

Preservation of residual kidney function (RKF) is important in patients undergoing peritoneal dialysis (PD). We aimed to examine the association between anemia management and residual urine output using data from a nationwide survey of dialysis patients. After excluding patients with anuria at baseline from the Total cohort of 2,712, 659 of 1,640 patients developed anuria during a median follow-up of 2.5 (interquartile range: 1.5–4.2) years. Urine volume decreased more rapidly as hemoglobin decreased or as the erythropoiesis-stimulating agent (ESA) resistance index (ERI) increased. The hazard ratios with 95% confidence intervals for the development of anuria, defined as residual urine volume ≤ 100 mL/day, were 1.65 (1.20–2.27), 1.39 (1.08–1.77), and 1.32 (1.07–1.63) for hemoglobin levels of < 9.0, 9.0–9.9, and 10.0–10.9 g/dL compared with 11.0–11.9 g/dL, and 1.35 (1.10–1.66) and 1.41 (1.14–1.73) for the second and third tertiles of ERI compared with the first tertile. In conclusion, patients with a low hemoglobin level or a high ERI were more likely to experience a decline in residual urine output and to develop anuria. Further studies are needed to investigate the effects of interventions that could improve renal anemia and/or ESA hyporesponsiveness on RKF preservation.

DOI： 10.1038/s41598-025-87456-z

Development of a Prognostic Model for Stage IV Colorectal Cancer Using Metastatic Patterns Open Access

Kawamura, H; Imaizumi, T; Miyakawa, T; Nakao, E; Katagata, M; Todate, Y; Takano, Y; Kono, K; Honda, M

ANTICANCER RESEARCH Vol. 45 ( 1 ) page： 341 - 350 2025.1

Language：English Publisher：Anticancer Research

Background/Aim: Metastatic patterns are the most convenient and common prediction models for the prognosis of patients with stage IV colorectal cancer. However, current prediction models do not include the severity of metastases in organs and exclude certain types of metastatic patterns. The aim of this study was to develop a prediction model that included several metastatic organs as well as the severity of liver and lung metastases, based on the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma: the 3<sup>rd</sup> English Edition. Patients and Methods: We performed a state-wide cohort study and developed a prediction model using Cox proportional hazard regression analysis, utilizing data on patients with stage IV colorectal cancer in hospital-based cancer registries of all nine designated cancer hospitals across Fukushima Prefecture, Japan. Results: The study included 1,230 patients with stage IV colorectal cancer. The prediction score consisted of the severity of liver and lung metastases, peritoneal dissemination, non-regional lymph node metastases, and other organ metastases (scale: 0-9 on a 10-point scale; divided into a 2-point scale, grade: I-V). The study found that the model had good discrimination properties, with a Harrell’s concordance index of 0.64 (95% confidence interval: 0.62-0.66), and the grade was an independent prognostic factor [hazard ratio (HR)=1.83; 95% confidence interval=1.68-2.00; p<0.001]. Conclusion: We created a practical prediction model for stage IV colorectal cancer that can be applied at the time of diagnosis, using only metastatic patterns. Further external validation studies are required to ensure the accuracy of this model.

DOI： 10.21873/anticanres.17422

Development and validation of a prediction model for people with mild chronic kidney disease in Japanese individuals Open Access

Miki, T; Sakoda, T; Yamamoto, K; Takeyama, K; Hagiwara, Y; Imaizumi, T

BMC NEPHROLOGY Vol. 25 ( 1 ) page： 339 2024.10

Language：English Publisher：BMC Nephrology

Background: Chronic kidney disease (CKD) poses significant health risks due to its asymptomatic nature in early stages and its association with increased cardiovascular and kidney events. Early detection and management are critical for improving outcomes. Objective: This study aimed to develop and validate a prediction model for hospitalization for ischemic heart disease (IHD) or cerebrovascular disease (CVD) and major kidney events in Japanese individuals with mild CKD using readily available health check and prescription data. Methods: A retrospective cohort study was conducted using data from approximately 850,000 individuals in the PREVENT Inc. database, collected between April 2013 and April 2023. Cox proportional hazard regression models were utilized to derive and validate risk scores for hospitalization for IHD/CVD and major kidney events, incorporating traditional risk factors and CKD-specific variables. Model performance was assessed using the concordance index (c-index) and 5-fold cross-validation. Results: A total of 40,351 individuals were included. Key predictors included age, sex, diabetes, hypertension, and lipid levels for hospitalization for IHD/CVD and major kidney events. Age significantly increased the risk score for both hospitalization for IHD/CVD and major kidney events. The baseline 5-year survival rates are 0.99 for hospitalization for IHD/CVD and major kidney events are 0.99. The developed risk models demonstrated predictive ability, with mean c-indexes of 0.75 for hospitalization for IHD/CVD and 0.69 for major kidney events. Conclusions: This prediction model offers a practical tool for early identification of Japanese individuals with mild CKD at risk for hospitalization for IHD/CVD and major kidney events, facilitating timely interventions to improve patient outcomes and reduce healthcare costs. The models stratified patients into risk categories, enabling identification of those at higher risk for adverse events. Further clinical validation is required.

DOI： 10.1186/s12882-024-03786-6

Development and validation of machine learning models to predict postoperative infarction in moyamoya disease

Fuse Y., Ishii K., Kanamori F., Oyama S., Imaizumi T., Araki Y., Yokoyama K., Takasu S., Seki Y., Saito R.

Journal of neurosurgery Vol. 141 ( 4 ) page： 927 - 935 2024.10

Publisher：Journal of neurosurgery

OBJECTIVE: Cerebral infarction is a common complication in patients undergoing revascularization surgery for moyamoya disease (MMD). Although previous statistical evaluations have identified several risk factors for postoperative brain ischemia, the ability to predict its occurrence based on these limited predictors remains inadequately explored. This study aimed to assess the feasibility of machine learning algorithms for predicting cerebral infarction after revascularization surgery in patients with MMD. METHODS: This retrospective study was conducted across two centers and harnessed data from 512 patients with MMD who had undergone revascularization surgery. The patient cohort was partitioned into internal and external datasets. Using perioperative clinical data from the internal cohort, three distinct machine learning algorithms-namely the support vector machine, random forest, and light gradient-boosting machine models-were trained and cross-validated to predict the occurrence of postoperative cerebral infarction. Predictive performance validity was subsequently assessed using an external dataset. Shapley additive explanations (SHAP) analysis was conducted to augment the prediction model's transparency and to quantify the impact of each input variable on shaping both the aggregate and individual patient predictions. RESULTS: In the cohort of 512 patients, 33 (6.4%) experienced postrevascularization cerebral infarction. The cross-validation outcomes revealed that, among the three models, the support vector machine model achieved the largest area under the receiver operating characteristic curve (ROC-AUC) at mean ± SD 0.785 ± 0.052. Notably, during external validation, the light gradient-boosting machine model exhibited the highest accuracy at 0.903 and the largest ROC-AUC at 0.710. The top-performing prediction model utilized five input variables: postoperative serum gamma-glutamyl transpeptidase value, positive posterior cerebral artery (PCA) involvement on preoperative MRA, infarction as the rationale for surgery, presence of an infarction scar on preoperative MRI, and preoperative modified Rankin Scale score. Furthermore, the SHAP analysis identified presence of PCA involvement, infarction as the rationale for surgery, and presence of an infarction scar on preoperative MRI as positive influences on postoperative cerebral infarction. CONCLUSIONS: This study indicates the usefulness of employing machine learning techniques with routine perioperative data to predict the occurrence of cerebral infarction after revascularization procedures in patients with MMD.

DOI： 10.3171/2024.1.JNS232173

Regional Comparison in Cerebral Performance Outcome of Out-of-Hospital Cardiac Arrest: The All-Japan Utstein Registry. Open Access

Igeta R, Otaka S, Imaizumi T, Kajino K, Khoujah D, Ito F, Endo T, Chiba T, Ikeda S, Shiga T

Cureus Vol. 16 ( 10 ) page： e72622 2024.10

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