Authorship：Lead author   Language：English  

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/m2, whereas it decreased gradually in patients with a baseline BMI ≥ 25 kg/m2 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

Open Access

Web of Science

Scopus

PubMed

Language：English   Publisher：International Journal of Cardiology  

Background: The natural history of aortic stenosis (AS) progression, especially before severe AS development, is not well documented. We aimed to investigate the time course of peak aortic jet velocity (Vmax) and AS progression risk according to baseline Vmax, particularly whether there is a Vmax threshold. Methods: In a retrospective multicenter cohort study of patients on hemodialysis with aortic valve calcification, we investigated the time series of Vmax and the relationship between the baseline Vmax and progression to severe AS by analyzing longitudinal echocardiographic data. Results: Among 758 included patients (mean age, 71 years; 65% male), patients with Vmax <1.5, 1.5–1.9, 2.0–2.4, 2.5–2.9, and 3.0–3.9 m/s were 395 (52%), 216 (29%), 85 (11%), 39 (5.1%), and 23 (3.0%), respectively. The Vmax slope was gradual (mean 0.05–0.07 m/s/year) at Vmax <2 m/s, but steeper (mean 0.13–0.21 m/s/year) at Vmax ≥2 m/s. During a median 3.2-year follow-up, 52 (6.9%) patients developed severe AS. While patients with Vmax <2 m/s rarely developed severe AS, the risk of those with Vmax ≥2 m/s increased remarkably with an increasing baseline Vmax; the adjusted incidence rates in patients with Vmax <1.5, 1.5–1.9, 2.0–2.4, 2.5–2.9, and 3.0–3.9 m/s were 0.59, 0.57, 4.25, 13.8, and 56.1 per 100 person-years, respectively; the adjusted hazard ratio per 0.2 m/s increase in the baseline Vmax was 1.49 (95% confidence interval: 1.32–1.68) when Vmax ≥2 m/s. Conclusions: The risk of progression to severe AS increased with the baseline Vmax primarily at ≥2 m/s; a Vmax threshold of 2 m/s was observed.

DOI： 10.1016/j.ijcard.2024.131822

Web of Science

Scopus

PubMed

Language：English   Publisher：Hypertension Research  

It is controversial whether renin-angiotensin system inhibitors (RASIs) should be stopped in patients with advanced chronic kidney disease (CKD). Recently, it was reported that stopping RASIs in advanced CKD was associated with increased mortality and cardiovascular (CV) events; however, it remains unclear whether stopping RASIs before dialysis initiation affects clinical outcomes after dialysis, which this study aimed to evaluate. In this multicenter prospective cohort study in Japan, we included 717 patients (mean age, 67 years; 68% male) who had a nephrology care duration ≥90 days, initiated hemodialysis, and used RASIs 3 months before hemodialysis initiation. The multivariable adjusted Cox models were used to compare mortality and CV event risk between 650 (91%) patients who continued RASIs until hemodialysis initiation and 67 (9.3%) patients who stopped RASIs. During a median follow-up period of 3.5 years, 170 (24%) patients died and 228 (32%) experienced CV events. Compared with continuing RASIs, stopping RASIs was unassociated with mortality (adjusted hazard ratio [aHR]: 0.82; 95% confidence interval [CI]: 0.50–1.34) but was associated with higher CV events (aHR: 1.59; 95% CI: 1.06–2.38). Subgroup analyses showed that the risk of stopping RASIs for CV events was particularly high in patients aged <75 years, with a significant interaction between stopping RASIs and age. This study revealed that patients who stopped RASIs immediately before dialysis initiation were associated with subsequent higher CV events. Active screening for CV disease may be especially beneficial for these patients. (Figure presented.)

DOI： 10.1038/s41440-024-01616-8

Open Access

Web of Science

Scopus

PubMed

Language：English   Publisher：Kidney360  

Background:Protein-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 h per treatment session) offers both enhanced removal of uremic solutes and better fluid management, generally allowing more liberalized dietary protein and calorie intake. This study aimed to evaluate the difference in plasma metabolite profiles among patients receiving in-center daytime extended-hours hemodialysis and those receiving conventional hemodialysis.Methods:Pre-dialysis plasma samples were obtained from 188 patients on extended-hours hemodialysis (21.9 h/week) and 286 patients on conventional hemodialysis (12.1 h/week) 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. Additionally, 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).Results:Significant 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]).Conclusions:Extended-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

Open Access

Scopus

PubMed

Total pages：7   Responsible for pages：7   Language：Japanese

Event date： 2024.10

Language：English   Presentation type：Poster presentation  

Venue：San Diego Convention Center   Country：United States  

Event date： 2024.6

Language：Japanese   Presentation type：Oral presentation (general)  

Event date： 2024.5

Language：English   Presentation type：Poster presentation  

Venue：Stockholmsmässan Mässvägen 1 Älvsjö 125 80 Stockholm   Country：Sweden  

Event date： 2023.11

Language：English   Presentation type：Poster presentation  

Country：United States  

Event date： 2022.6

Language：Japanese  

JRBRにおける日本の腎生検統計の報告を4カ月おきに行っている