Hamano T.,Osaka University |
Matsui I.,Osaka University |
Mikami S.,Higashikohri Hospital |
Tomida K.,Kansai Rosai Hospital |
And 4 more authors.
Journal of the American Society of Nephrology | Year: 2010
Fetuin-A is an important inhibitor of extraosseous calcification, but some of the studies that used ELISAs did not identify a significant relationship between serum fetuin-A levels and vascular calcification in patients with chronic kidney disease (CKD). Here, we used centrifugation to separate a fetuin-mineral complex (FMC) composed of fetuin-A, fibrinogen, fibronectin-1, and calcium from the serum of hemodialysis patients. In addition, we analyzed serum fetuin-A levels of 73 patients with diabetes and CKD (predialysis) after centrifugation. Fetuin-A concentrations were significantly lower in supernatants than in serum from patients at any stage of CKD, indicating systemic circulation of FMC in these patients. With greater severity of CKD, the contribution of FMC to total fetuin-A increased. Despite the absence of a correlation between serum fetuin-A and coronary artery calcification scores (CACS), supernatant fetuin-A negatively correlated with CACS and the extent to which centrifugation reduced fetuin-A (reduction ratio [RR]) positively correlated with CACS. In a longitudinal study of 12 hemodialysis patients with secondary hyperparathyroidism, parathyroidectomy and cinacalcet therapy each significantly reduced the RR without changing supernatant fetuin-A levels after 1 month, suggesting a reduction in FMC. Moreover, the magnitude of cinacalcet-induced reduction in parathyroid hormone correlated with the decrease in RR but not with changes in serum or supernatant fetuin-A. These data suggest that a quantitative measure of FMC, not supernatant or serum fetuin-A as measured in previous studies, reflects extraosseous calcification stress. Copyright © 2010 by the American Society of Nephrology.
Shoda E.,Hyogo Prefectural Nishinomiya Hospital
Clinical calcium | Year: 2015
Fragility fracture is increasing with increasing in population of elderly. Especially hip fracture is increasing rapidly and has many problems such as deterioration of QOL and growing medical expenses. In hip fracture, it is necessary to leave the bed in early period after injury and begin the rehabilitation for start to walk again. So surgical treatment is usually advocated as soon as possible after injury. Hip fracture is mainly classified to femoral neck fracture which is intra-articular fracture of hip joint and trochanteric fracture which is extra-articular fracture. Surgical treatment is different in these fractures. In this article, diagnosis and treatment of these femoral neck fracture and trochanteric fracture, especially surgical methods are mentioned.
Sakaguchi Y.,Osaka University |
Fujii N.,Hyogo Prefectural Nishinomiya Hospital |
Shoji T.,Osaka General Medical Center |
Hayashi T.,Osaka General Medical Center |
And 2 more authors.
Kidney International | Year: 2014
Although previous studies in the general population showed that hypomagnesemia is a risk for cardiovascular diseases (CVD), the impact of magnesium on the prognosis of patients on hemodialysis has been poorly investigated. To gain information on this we conducted a nationwide registry-based cohort study of 142,555 hemodialysis patients to determine whether hypomagnesemia is an independent risk for increased mortality in this population. Study outcomes were 1-year all-cause and cause-specific mortality with baseline serum magnesium levels categorized into sextiles. During follow-up, a total of 11,454 deaths occurred, of which 4774 had a CVD cause. In a fully adjusted model, there was a J-shaped association between serum magnesium and the odds ratio of all-cause mortality from the lowest to highest sextile, with significantly higher mortality in sextiles 1-3 and 6. Similar associations were found between magnesium and both CVD and non-CVD mortality. The proportion of patients with a baseline intact parathyroid hormone level under 50 pg/ml was significantly higher in the highest sextile; however, after excluding these patients, the CVD mortality risk in the highest sextile was attenuated. Thus, hypomagnesemia was significantly associated with an increased risk of mortality in hemodialysis patients. Interventional studies are needed to clarify whether magnesium supplementation is beneficial for improving patient prognosis © 2013 International Society of Nephrology.
Nakano C.,Osaka University |
Hamano T.,Osaka University |
Hamano T.,University of Pennsylvania |
Fujii N.,Hyogo Prefectural Nishinomiya Hospital |
And 9 more authors.
Clinical Journal of the American Society of Nephrology | Year: 2012
Background and objectives Hyperphosphatemia, vitamin D deficiency, hyperparathyroidism, and high serum fibroblast growth factor 23 (FGF23) levels, when studied separately, were found to predict the progression of CKD. However, studies with simultaneous measurement of mineral bone disorder (MBD)-related factors were scarce. This study aimed to identify factors predicting renal outcome independent of other factors. Design, setting, participants, & measurements This was a prospective cohort study of 738 Japanese predialysis outpatients in the nephrology departments of two hospitals. The outcome was defined as a doubling of serum creatinine or initiation of dialysis. ResultsMean estimated GFR (eGFR)was 35ml/min per 1.73m 2. At enrollment, the increase in intact FGF23with decreasing eGFR was the earliest among changes in MBD-related factors, followed by 1,25-dihydroxyvitamin D decrease, parathyroid hormone increase, and phosphate increase. During a median duration of 4.4 years, 213 patients reached the endpoint. In a multivariable Cox model, high FGF23 and low 25-hydroxyvitamin D (25D) levels were the only MBD-related factors associated with a higher risk of renal endpoint (adjusted hazard ratio [95%confidence interval] per unit change of log FGF23 and 10 ng/ml of 25D: 1.83 [1.28-2.61] and 0.61 [0.41-0.90], respectively). There was no significant interaction between 25D and FGF23 (P=0.11). Active vitamin D therapy, serum phosphate, 1,25-dihydroxyvitamin D, and parathyroid hormone levels were not related to the renal endpoint. Treating death as a competing risk or multiple imputation for missing values yielded similar results. Conclusions Combined use of two markers is useful for the risk stratification of renal outcome. © 2012 by the American Society of Nephrology.
Kashiwazaki M.,Hyogo Prefectural Nishinomiya Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013
Patients with advanced hepatocellular carcinoma( HCC) with massive portal venous tumor thrombus (PVTT) face a dismal prognosis as no standard therapy has been defined. A cancer board was established at our hospital 5 years ago. The aim of this retrospective study was to evaluate our surgical and multidisciplinary treatment for HCC with massive PVTT. From July 2007 to June 2012, 8 patients with HCC with PVTT extending into the main portal trunk were treated. Hemihepatectomy and PVTT removal were performed in 4 patients. Postoperative multidisciplinary treatment included transarterial chemoembolization, hepatic arterial infusion therapy, and administration of sorafenib. In 1 patient, intrahepatic recurrence and bilateral adrenal metastases were resected. There was no in- hospital mortality. The median postoperative hospital stay was 30 days. The overall median survival for patients who underwent surgery and who did not undergo surgery was 344.5 days and 67 days, respectively. Resection for HCC with PVTT extending into the main portal trunk is acceptable at medium-scale teaching hospitals in Japan. Surgery and postoperative multidisciplinary therapy may improve the outcome of patients with HCC with massive PVTT.