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Kamakura, Japan

Marshall M.R.,University of Auckland | Young B.A.,University of Washington | Fox S.J.,Counties Manukau District Health Board | Cleland C.J.,Counties Manukau District Health Board | And 3 more authors.
Hemodialysis International | Year: 2015

An effective home hemodialysis program critically depends on adequate hub facilities and support functions and on transparent and accountable organizational processes. The likelihood of optimal service delivery and patient care will be enhanced by fit-for-purpose facilities and implementation of a well-considered governance structure. In this article, we describe the required accommodation and infrastructure for a home hemodialysis program and a generic organizational structure that will support both patient-facing clinical activities and business processes. © 2015 International Society for Hemodialysis. Source


Ikee R.,Kidney and Dialysis Center | Honda K.,Kidney and Dialysis Center | Ishioka K.,Kidney and Dialysis Center | Oka M.,Kidney and Dialysis Center | And 5 more authors.
Hypertension Research | Year: 2010

Increased prevalence of aortic and mitral valve calcification has been reported in patients on hemodialysis, but it remains unknown whether aortic and mitral valve calcification arise from similar pathogenesis. We detected heart valve calcification using two-dimensional echocardiography, and we related valve calcification to various clinical parameters in patients treated with hemodialysis three times a week for more than 1 year. In 112 patients (77 men and 35 women, age 6710 years, duration on hemodialysis 9567 months), aortic and mitral valve calcification were observed in 84 (75.0%) and 58 (51.7%) patients, respectively. Aortic valve calcification was associated with increased age, higher serum calcium, lower serum albumin, lower total cholesterol and higher high-sensitivity C-reactive protein. Multivariate analysis showed that increased age and higher serum calcium were independently associated with aortic valve calcification. Conversely, mitral valve calcification was associated with increased age, higher high-sensitivity C-reactive protein and higher serum Β2-microglobulin, but not with higher serum calcium. In multivariate analysis, increased age and higher serum Β2- microglobulin were independently associated with mitral valve calcification. Serum Β2-microglobulin was associated with longer duration on hemodialysis, malnutrition inflammation (lower serum albumin and higher high-sensitivity C-reactive protein) and dyslipidemia. Considering the results in previous studies showing that the distribution of Β2- microglobulin amyloid deposition was consistent with that of tissue calcification in patients on hemodialysis, Β2-microglobulin may have pathogenic roles in valve calcification. © 2010 The Japanese Society of Hypertension All rights reserved. Source


Moriya H.,Kidney and Dialysis Center | Ishioka K.,Kidney and Dialysis Center | Honda K.,Kidney and Dialysis Center | Oka M.,Kidney and Dialysis Center | And 5 more authors.
Therapeutic Apheresis and Dialysis | Year: 2010

Beraprost sodium (BPS) is a stable, orally active prostaglandin I 2 (PGI2) analog with antiplatelet and vasodilating properties. It has been reported that PGI2 has pleiotropic effects that are anti-inflammatory and anti-atherogenic. In this study, we aim to determine the relationship between PGI2 and renal anemia. We conducted a prospective randomized trial including 20 hemodialysis patients. Ten patients were assigned to be treated with 120 μg/day of BPS and the other patients were assigned to a control group. After six months, the titer of hemoglobin had significantly increased in the BPS group compared to the baseline (11.1 ± 0.3 g/dL vs. 10.3 ± 1.4 g/dL, respectively), and there was a significant difference between the BPS group and the control group. The level of ferritin was lower in the BPS group compared to the control group, but the average dose of erythropoietin did not significantly change. These findings suggest that BPS may improve renal anemia in hemodialysis patients. © 2010 International Society for Apheresis. Source


Ohtake T.,Kidney and Dialysis Center | Ishioka K.,Kidney and Dialysis Center | Honda K.,Kidney and Dialysis Center | Oka M.,Kidney and Dialysis Center | And 6 more authors.
Hemodialysis International | Year: 2010

The risk factors of coronary artery calcification (CAC) and the impact of CAC on cardiovascular events, cardiovascular deaths, and all-cause deaths in hemodialysis (HD) patients have not been fully elucidated. We examined the CAC score (CACS) in 74 HD patients using electron-beam computed tomography. Fifty-six patients underwent a second electron-beam computed tomography after a 15-month interval to evaluate CAC progression. We evaluated (1) the risk factors for CAC and its progression and (2) the impact of CAC on the prognosis. In the cross-sectional study, HD vintage and high-sensitive C-reactive protein (hsCRP) were the independent risk factors for CAC. In the prospective cohort study, delta CACS (progression of CAC) was significantly correlated with hsCRP, fibrinogen, and serum calcium level in the univariate analysis. Stepwise multiple regression analysis revealed that only hsCRP was the independent risk factor for CAC progression in HD patients. Kaplan-Meier survival analysis revealed that cardiovascular events (P<0.0001), cardiovascular deaths (P=0.039), and all-cause deaths (P=0.026) were significantly associated with CACS. In conclusion, CAC had significantly progressed in HD patients during the 15-month observation period. Microinflammation was the only independent risk factor for CAC progression in HD patients. The advanced CAC was a significant prognostic factor in HD patients, i.e., which was strongly associated with future cardiovascular events, cardiovascular deaths, and all-cause deaths. © 2010 The Authors. Journal compilation © 2010 International Society for Hemodialysis. Source

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