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Tokushima-shi, Japan

Takura T.,Osaka University | Kawanishi H.,Tsuchiya General Hospital | Minakuchi J.,Kawashima Hospital | Nagake Y.,Nagake Clinic | Takahashi S.,International Kidney Evaluation Association
Blood Purification | Year: 2013

Background/Aims: Evaluation of the socioeconomic value of medical intervention and establishment of the resources necessary for clinical practice are important for new developments in medical technology. The aim of this study was to determine the socioeconomic value of on-line hemodiafiltration (HDF). Methods: The subjects were 24 patients who underwent hemodialysis (HD) (9 HDF, 15 HD) for chronic renal failure. A total of 288 dialysis interventions were observed for 4 weeks in three clinics. Cost-effectiveness was evaluated based on quality-adjusted life years (Qaly) and a visual analog scale. Results: EuroQOL-5D (0.776 ± 0.015) and visual analog scale (67.9 ± 1.2) in the HDF group were higher than those in the HD group at baseline. The incremental cost utility ratio for HDF was 641.7 (JPY 10,000/Qaly) based on Qaly (0.776 ± 0.015) and reimbursement for medical fees (JPY 4,982,736 ± 7,852), and was lower than the incremental cost utility ratio for HD. Conclusion: These results suggest that on-line HDF could be cost-effective. Copyright © 2013 S. Karger AG, Basel.

Tahara Y.,Meimai Central Hospital | Shima K.,Kawashima Hospital
Diabetes Research and Clinical Practice | Year: 2010

Aim: To evaluate error levels in hemoglobin A1c (A1C) and glycated albumin (GA) in type 2 diabetic patients due to inter-individual variability. Methods: Type 2 diabetic patients with stable glycemic control and without complications affecting either A1C or GA were enrolled (n= 154; age 68.4 ± 9.9 years). Blood examination was performed 1-4. h after breakfast or lunch every 2-3 months on ≥3 occasions. A1C data were changed to IFCC values for analysis. Results: A1C and GA correlated significantly with postprandial plasma glucose. The correlation coefficient between A1C and GA was 0.728 (p<0.001) when calculated using raw data and 0.747 (p<0.001) when calculated using averaged data for each patient. The ratio R of GA to A1C was 3.88±0.50 for raw data and 3.88±0.47 for averaged data, indicating coefficients of variation of R (CVR) of 12.9% and 12.1%, respectively. Multiple regression analysis reduced CVR to 11.2%. After dividing CVR2 into CVA1C2 and CVGA2, CVA1C and CVGA were calculated as 9.1% for raw data and 8.6% for averaged data, and were reduced to 7.9% after multiple regression analysis. Conclusions: Error levels in A1C and GA reach 7.9-9.1%, suggesting the existence of maximal 18% errors in A1C and GA levels. © 2010 .

Nouh M.A.A.M.,Kagawa University | Kuroda N.,Red Cross | Yamashita M.,Kagawa University | Hayashida Y.,Kagawa University | And 7 more authors.
BJU International | Year: 2010

OBJECTIVE To evaluate the clinical outcomes and histological types of renal cell carcinoma (RCC) arising in patients with end-stage renal disease (ESRD), and to analyse the relationship of histopathological features with the duration of dialysis. PATIENTS AND METHODS Clinical characteristics and outcomes of 34 patients who had a radical nephrectomy for RCC arising in ESRD between November 1994 and June 2008 were investigated. Archive paraffin-embedded tissue specimens obtained from 27 patients were histochemically and immunohistochemically analysed to determine the histopathological type. RESULTS There was one death from cancer and one patient with local progression within a median observation period of 29.5 months. Acquired cystic disease (ACD)-associated RCC, clear cell-papillary RCC, mucinous tubular and spindle-cell carcinoma, and Xp11.2 translocation/TFE3 gene fusion were identified in eight, two, three and one patient, respectively. Conventional clear-cell RCC was the predominant histological type (nine of 15) in patients with a duration of dialysis of <10 years, while ACD-associated RCC was predominant (seven of 12) in those with dialysis for ≥10 years. Sarcomatoid foci were identified in three patients with dialysis for ≥10 years. Papillary adenoma was microscopically identified as a satellite tumour in 10 patients. CONCLUSION The spectrum of histological types of RCCs arising in ESRD is distinct from that of sporadic RCCs. Patients with a longer duration of dialysis should have particular attention for progression and metastasis. Immunohistochemical profiling is efficient in the histological classification of RCCs arising in ESRD, although knowledge about genetic changes remains to be accumulated. © 2009 BJU International.

Tsuchida K.,Kawashima Hospital | Minakuchi J.,Kawashima Hospital
Contributions to Nephrology | Year: 2011

Over 2,000 substances have been reported as uremic substances that are accumulated or produced due to renal failure that causes various clinical symptoms and complications. These substances include many medium to large molecular weight (MW) substances such as β 2-microglobulin (β 2-MG). In hemofiltration/hemodiafiltration (HD/HDF) therapy using high-performance membrane targeting less albumin loss and removal of β 2-MG with a MW of 11,800, many cases showed insufficient improvement in the clinical outcome contrary to the decrease in serum β 2-MG concentration. Focusing on these facts, HD/HDF therapy, which associates albumin loss, was implemented targeting the substances in the regions whose MWs are larger than β 2-MG. HD/HDF therapy with protein-permeable membrane, compared to the therapy without protein-permeable membrane, achieved higher success in the removal of larger MW substances including β 2-MG, cytokine, homocysteine and complement factor D, and higher clinical outcomes were reported, such as prevention of development of amyloidosis, anemia, osteoarthritis and pruritus, and improvement in life prognosis and biocompatibility in Japan. Therefore, in the current circumstances, it is essential to administer a treatment that can get as close to the glomerular basement membrane as possible, use dialysis membrane to effectively remove a wide range of substances, and aim to remove all of the substances accumulated in the body of patients with kidney dysfunction. Copyright © 2011 S. Karger AG, Basel.

Tsuchida K.,Kawashima Hospital | Minakuchi J.,Kawashima Hospital
Contributions to Nephrology | Year: 2011

Beta-2-microglobulin (β 2M) clearance has been improved in recent dialysis membranes and minimum albumin leakage has been achieved in most membranes today since dialysis membranes are now classified by β 2M clearance in terms of the reimbursement by health insurance. Kawanishi et al. suggested that 'the desirable albumin leakage in one treatment is less than 4 g '. Function classification type IV or type V dialysis membranes have leakages as low as 3 g, while most resulted in < 1 g leakage. However, some high-performance membranes (HPMs) have around 8 g of leakage, which requires further study of the clinical efficacy using such dialysis membranes. The comparison of albumin leakage in one dialysis treatment (4 h: blood flow volume of 250 ml/min) revealed that PES-210D has an overwhelmingly high albumin leakage of 7.69 ± 1.01 g. The data were without any significant difference between the PES-D membrane user group and the non-PES-D membrane user group for hemoglobin, hematocrit, β 2M protein, catabolic rate, body mass index, and muscle mass. However, the PES-D membrane user group had a significantly lower number of hospitalizations and other complication events. When comparing the event contents, the PES-D membrane user group had no cardiac failure and lower DRA, however it had more vascular access problems. In normal renal function, approximately 10 g of albumin is filtered in the glomerulus per day, decomposed in the renal tubule and reabsorbed as amino acid, and re-synthesized into albumin in the liver. On the contrary, in dialysis patients, albumin that is bound to biologically active substances and/or the oxidized form of albumin that has lost its antioxidant effect cannot be filtered from the kidney and accumulate. Therefore, the idea regarding albumin leakage is to remove biologically active substances that bind to albumin and function as uremic toxin, remove albumin without the antioxidant effect, and facilitate synthesis of new albumin with an antioxidant effect. Copyright © 2011 S. Karger AG, Basel.

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