Tokushima-shi, Japan
Tokushima-shi, Japan

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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.


PubMed | Tokushima University, Kawashima Hospital and Kawashima Dialysis Clinic
Type: Journal Article | Journal: Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy | Year: 2016

In hemodialysis patients, mineral and bone disorder is an important risk factor for cardiovascular disease and subsequent death through the progression of vascular calcification. Serum phosphorus plays a major role in this process. In the present study, we retrospectively analyzed the effects of oral phosphate binder, lanthanum carbonate (LC), on the mortality in hemodialysis patients. Among a total of 841 patients who underwent maintenance hemodialysis on 1 July 2010, patients who were treated with LC (LC group, N=324) and those who were treated without LC (NLC group, N=517) were compared with respect to their all-cause mortality for a long-term observation period of up to 36months. The mortality rate was compared using the Cox proportional hazard model adjusted by the propensity score. The adjusted hazard ratio for mortality in the LC group versus NLC group was 0.515 (95% confidence interval, 0.328-0.807), suggesting that the use of LC is associated with an almost 50% reduction in the mortality rate. The present retrospective study including all hemodialysis patients demonstrated, for the first time, an association between the use of LC and improved prognosis in hemodialysis patients. Randomized controlled trials should be done in the future to validate our present findings.


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 .


Shima K.,Kawashima Hospital | Komatsu M.,Kawashima Hospital | Kawahara K.,Kinasi Ohbayashi Hospital | Minaguchi J.,Kawashima Hospital | Kawashima S.,Kawashima Hospital
Nephrology | Year: 2010

Aim: No suitable index or optimal target for diabetic control has been established for diabetic patients with end-stage renal disease (ESRD) undergoing haemodialysis. To address these issues, the single-centre observational study was conducted. Methods: Two hundred and forty-five diabetic ESRD patients (23.3% female; age at initiation of haemodialysis 61.7 ± 10.7 years) at start of haemodialysis between 1 January 1995 and 31 December 2004 were enrolled. Subjects were grouped according to glycaemic control level throughout the observational period as follows: mean postprandial plasma glucose (PPG) <8.9 mmol/L, 8.9 mmol/L ≤ PPG < 10.0 mmol/L, 10.0 mmol/L ≤ PPG < 11.1 mmol/L, 11.1 mmol/L ≤ PPG < 12.2 mmol/L and PPG ≥ 12.2 mmol/L; and HbA1c < 6.0%, 6.0-6.4%, 6.5-6.9% and ≥7.0%. Survival was then followed until 31 December 2005. Results: Cumulative survival of groups of 10.0 mmol/L ≤ PPG < 11.1 mmol/L, 11.1 ≤ PPG < 12.2 and PPG ≥ 12.2 mmol/L was significantly lower than that for PPG < 8.9 mmol/L as determined by Kaplan-Meier estimation (P = 0.016, 0.009 and 0.031, respectively; log-rank test). In both uni- and multivariate Cox proportional hazard models, mortality hazard ratios were significantly higher for PPG ≥ 10.0 mmol/L than for PPG < 8.9 mmol/L (P = 0.002-0.021). Kaplan-Meier survival curves grouped by HbA1c levels showed no correlation between HbA1c and survival during the observational period. No significant difference in mortality hazard ratios was seen for any HbA1c groups evaluated by Cox proportional hazard model. Conclusion: Intensive management of diabetic control at a stringent mean on-study PPG < 10.0 mmol/L will improve the life expectancy in diabetic dialysis patients. However, no range of HbA1c values obtained in this study showed any clear difference in clinical outcomes. © 2010 Asian Pacific Society of Nephrology.


PubMed | Naval Medical Center San Diego, Kawashima Hospital and Tokushima University
Type: Journal Article | Journal: Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs | Year: 2016

Human mercaptoalbumin (HMA) is a reduced form of albumin that is associated with cardiovascular disease in dialysis patients. Albumin-leaky hemodialysis (HD) is increasingly recognized as a gold standard therapy because it is correlated with better prognosis compared to conventional HD. However, albumin-leaky HD induces low serum albumin concentration because of albumin leakage, which is a classical risk factor for mortality. The aim of this study was to explain the preferable prognosis in patients undergoing albumin-leaky HD with low serum albumin concentration. Ten HD patients were enrolled. They were preconditioned with albumin-non-leaky HD (mean albumin leakage: 1.0g) for 2months. Subsequently, albumin-leaky HD (9.1g) was performed for 6months, followed by relatively non-leaky HD (within 3.0g). The ratio and level of HMA were evaluated. The amount of albumin leakage was related to the ratio of HMA, and inversely correlated with serum albumin concentration. The level of HMA was maintained regardless of albumin leakage. Regarding HMA level, a moderate amount of albumin leakage was acceptable. A stably maintained HMA level in albumin-leaky HD patients can contribute to preferable prognosis even if they have low serum albumin concentration.


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.


Shima K.,Kawashima Hospital | Komatsu M.,Kawashima Hospital | Noma Y.,Kawashima Hospital | Miya K.,Kawashima Hospital
Internal Medicine | Year: 2014

Objective The aim of this study was to compare the utility of hemoglobin A1c (HbA1c) and glycated albumin (GA) for evaluating the efficacy of the dipeptidyl peptidase-4 (DPP-4) inhibitor, sitagliptin, in patients with type 2 diabetes. Methods Sitagliptin (50 mg) was administered orally once daily in 67 outpatients with type 2 diabetes. Drug effectiveness was deemed present if the HbA1c or GA level decreased by 5% at week 4 and week 12 relative to the baseline value. Results The mean HbA1c level decreased from 8.1±1.0% at baseline to 7.8±0.9% at week 4 and 7.2±0.8% at week 12. The mean GA level decreased from 25.0±4.5% at baseline to 22.2±3.8% at week 4 and 20.8± 3.5% at week 12. At week 4 and week 12, the drug was effective in 37.8% and 71.6% of the patients, respectively, when assessed based on changes in HbA1c, and in 83.6% and 97.0% of the patients, respectively, when assessed based on changes in GA. Conclusion GA is superior to HbA1c for evaluating the efficacy of sitagliptin treatment in patients with type 2 diabetes. © 2014 The Japanese Society of Internal Medicine.


Shima K.,Kawashima Hospital | Chujo K.,Kawashima Hospital | Yamada M.,Kawashima Hospital | Komatsu M.,Kawashima Hospital | And 2 more authors.
Annals of Clinical Biochemistry | Year: 2012

Background: Glycated haemoglobin (HbA1c) concentration is lower relative to glyacemic control in diabetic patients on haemodialysis. However, it is unknown as to whether this is also true for diabetic patients with end-stage renal disease but not on haemodialysis. Methods: Correlations between HbA1c or glycated albumin (GA) and estimated glomerular filtration rate (eGFR) (determined by serum creatinine concentration, sex and age) were investigated in 86 diabetic patients with renal dysfunction not on dialysis. The mean values of HbA1c and of red blood cell (RBC) lifespan were compared among four groups of patients: Group 1 (n = 30, eGFR ≥ 60 mL/min/1.73 m2), Group 2 (n = 30, eGFR, 60 mL/min/1.73 m2 but ≥30 mL/min/1.73 m2), Group 3 (n = 13, eGFR, 30 mL/min/1.73 m2 but ≥15 mL/min/1.73 m2) and Group 4 (n = 13, eGFR, 15 mL/min/1.73 m2 without haemodialysis). RBC lifespan was determined in each subject from the difference between alveolar carbon monoxide (CO) concentration and atmospheric CO concentration. Results: HbA1c was significantly correlated with eGFR (r = 0.37, P = 0.0004), but GA was not. The HbA1c values in Group 3 (6.8+0.6%) and Group 4 (6.3+0.5%) were significantly lower than that in Group 1 (7.4+0.8%), but there was no difference between Group 2 (7.2+0.7%) and Group 1. There was a significant correlation between RBC lifespan and eGFR, and the mean RBC lifespan in Group 3 (96+35 d) and Group 4 (94+30 d) were significantly shorter than that in Group 1 (127+30 d). Conclusions: Diabetic patients with stage 4 or 5 chronic kidney disease not on haemodialysis had significantly lower values of HbA1c and shorter RBC lifespan compared with diabetic patients without renal dysfunction.


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.


Tsuchida K.,Kawashima Hospital | Minakuchi J.,Kawashima Hospital
Blood Purification | Year: 2013

There are two types of hemodiafiltration (HDF) treatments, predilution and postdilution. In Japan, clinical doctors have been using the on-line HDF treatment for renal replacement therapy for 20 years. However, this treatment is not popular in Japan because it has not been recognized by the government. Generally, the advantage of postdilution HDF over predilution HDF resides in the fact that it removes low-weight molecular proteins (LWMPs) and protein-binding uremic toxin. Thus, postdilution on-line HDF has been widely used in the world, but in Japan predilution on line-HDF has been the preferred treatment. There are several reasons why predilution on-line HDF has been the preferred treatment in Japan. Predilution on-line HDF is superior to postdilution on-line HDF in removing LWMPs and protein-binding uremic toxin, for example p-cresol and homocysteine. In addition, there are several reports on the biocompatibilities in predilution on-line HDF. Predilution on-line HDF is associated with reduced shear stress, and the synthesis of cytokine and cellular adhesion molecules. Moreover, with predilution on-line HDF/hemofiltration, blood pressure remains stable during treatment. In Japan, over 90% of dialysis patients have been receiving hemodialysis (HD) therapy with the ultra-high flux dialysis membrane. These ultra-high flux dialysis membranes achieve β2- microglobulin clearance rates of >50 ml/min. In addition, these membranes have the same power as postdilution HDF because they allow automatic internal filtration. Thus, in spite of HD treatment, as a result, the effect is the same as with postdilution HDF treatment. There have been small and retrospective studies on predilution on-line HDF, and we must use a hemodiafilter during the on-line HDF treatment. However, the hemodiafilter has been unsuccessful in reaching the LWMP removal rates which we demand. And the most important point is to carry out a prospective multicenter randomized controlled trial of predilution on-line HDF in the near future. Copyright © 2013 S. Karger AG, Basel.

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