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Nishimura M.,National Hospital Organization Chiba East National Hospital | Kato Y.,National Hospital Organization Nagoya Medical Center | Tanaka T.,National Hospital Organization Mie Chuo Medical Center | Todo R.,National Hospital Organization Osaka Medical Center | And 6 more authors.
Hypertension Research | Year: 2013

The Home Blood Pressure for Diabetic Nephropathy (HBP-DN) study is a prospective cohort study to determine the optimal home blood pressure (HBP) required to improve the prognosis of type 2 diabetic patients with microalbuminuria. The glomerular filtration rate (GFR) is heterogeneous in microalbuminuric diabetic patients. The first step of the HBP-DN study explored the significance of estimating GFR for the identification of patients for whom HBP measurement would be more helpful. The patients were divided into two groups based on their estimated GFR (eGFR): a low eGFR group (eGFR <60 ml min -1 per 1.73 m2, N=75) and a preserved eGFR group (eGFR ≥60 ml min-1 per 1.73 m2, N=193). HBP, variability of HBP and a previous history of vascular complications were compared between the two groups. The number of antihypertensive drugs used for the patients and the s.d. of home systolic blood pressure (HSBP) in the low eGFR group were significantly higher than those in the preserved eGFR group. A stepwise multiple linear regression analysis also revealed that the low eGFR group was independently correlated with the s.d. of HSBP. A multiple logistic regression analysis revealed that a low eGFR was an independent risk factor for coronary heart disease and advanced retinopathy. Estimating the GFR is important to identify patients with elevated blood pressure variability, as well as those with a high risk of vascular complications. Measuring HBP would be more helpful for the effective and safe treatment of hypertension in patients with a low eGFR than in those with a preserved eGFR. © 2013 The Japanese Society of Hypertension. All rights reserved.

Imasawa T.,National Hospital Organization Chiba East National Hospital | Fukuda N.,Nagoya Sakae Clinic | Hirose S.,Dialysis Center | Suganuma S.,Kidney Clinic Setagaya | And 6 more authors.
Therapeutic Apheresis and Dialysis | Year: 2013

Low birth weight (LBW) is thought to be one of the risk factors for the progression of kidney diseases. This study hypothesized that the onset age of kidney disease, the rate of progression of kidney disease, or the age at the time of hemodialysis (HD) induction among HD patients that were born with LBW is different from those without a history of LBW. A questionnaire survey in nine dialysis units in Japan was performed and 427 answer sheets were collected. There were statistically significant differences in the present age, the age of kidney disease onset, and the age of HD induction between LBW group and normal birth weight group (NBW). An analysis limited to participants whose underlying disease was diabetic nephropathy revealed that the duration from the onset of nephropathy to HD induction was much shorter in HD patients with a history of LBW than those with a NBW history. In addition, the Pearson's correlation coefficient between the birth weight and the period from onset of diabetic nephropathy to HD induction was 0.283. Although these results might partly support the primary hypothesis, the necessity to perform other clinical studies is also emphasized. © 2012 The Authors Therapeutic Apheresis and Dialysis © 2012 International Society for Apheresis.

Kawasaki T.,National Hospital Organization Chiba East National Hospital | Kawasaki T.,Chiba University | Sasaki Y.,National Hospital Organization Chiba East National Hospital | Nishimura H.,National Hospital Organization Chiba East National Hospital | And 4 more authors.
Kekkaku | Year: 2010

[Purpose] To observe the current situation of tuberculosis and its control measures in hemodialysis facilities in Chiba Prefecture, Japan. [Method] Questionnaires on medical dialysis and tuberculosis were sent to hemodialysis facilities in Chiba Prefecture. [Results] The questionnaires were answered by 55 of 127 facilities. Of the respondents, 46 (83.6%) were not aware of the recommendation of treatment for latent tuberculosis infections in Japanese patients. Moreover, 30 (54.5%) facilities did not examine patients for tuberculosis prior to the initiation of hemodialysis. Of the 21 facilities that did assess patients for tuberculosis infection, only 5 (23.8%) performed a tuberculin skin test or QuantiFERON®TB-2G. Three of the five (60.0%) that were treating tuberculosis by themselves expressed fear or uncertainty about the diagnosis and treatment of latent tuberculosis infections. During January 2006 through December 2007, tuberculosis patients were detected in 11 facilities, and the proportion of extrapulmonary tuberculosis among these patients was 52.4%. Seven facilities reported that they took no control measures against tuberculosis. [Conclusion] It is important to inform medical dialysis facilities about latent tuberculosis infections, the early diagnosis of tuberculosis, and the combination of nosocomial infection control. It is also important for experts in hemodialysis and tuberculosis to work closely together.

Kuroda F.,Chibaken Saiseikai Narashino Hospital | Kuroda F.,Chiba University | Tanabe N.,Chiba University | Igari H.,National Hospital Organization Chiba East National Hospital | And 5 more authors.
Internal Medicine | Year: 2014

Objective: We aimed to investigate the incidence and clinical characteristics of nontuberculous mycobacterial (NTM) pulmonary disease as a complication of chronic thromboembolic pulmonary hypertension (CTEPH).Methods: We conducted a retrospective study of 10 cases (5.6%) complicated by NTM pulmonary disease among 180 CTEPH patients.Results: Isolated species of avium (n=5), kansasii (n=2), intracellulare (n=1), abscessus (n=1) and fortuitum (n=1) were detected. NTM-infected lesions were observed in 33 of 180 (18.3%) lung segments obtained from the 10 patients, and complete obstruction due to chronic pulmonary thromboembolism was detected in 65 of the 180 segmental pulmonary arteries (36.1%). The NTM-infected segments in the CTEPH patients were significantly associated with obstructed rather than unobstructed pulmonary artery segments [25 of 65 (38.5%) vs. 8 of 115 (6.9%), p<0.01]. Cavitary, nodular, ectatic and ground-glass lesions were seen in 14, 22, seven and four of the 180 segments, respectively. Thirteen of the 14 cavitary (92.9%) lesions were located in nonperfused segments. Five patients with NTM disease underwent pulmonary endarterectomy (PEA). Of the 18 assessable NTM-infected segments in six NTM-treated patients, 17 were located in non-perfused segments and one was located in a previously perfused segment. All NTM-infected segments improved among three segments reperfused with PEA. In contrast, only eight (57.1%) NTM-infected segments improved among 14 continuously non-perfused segments. A lower body mass index was found to be a significant risk factor for NTM disease in the CTEPH patients.Conclusion: This is the first report to document NTM-disease complications in patients with CTEPH. Reperfusion in cases of NTM lesions may improve the response to NTM drug therapy. © 2014 The Japanese Society of Internal Medicine.

Nishimura M.,National Hospital Organization Chiba East National Hospital | Kato M.,Hokkaido Medical Center | Shimada F.,Chiba Medical Center | Kato Y.,Nagoya Medical Center | And 9 more authors.
Diabetology International | Year: 2011

Aims: Controlling hypertension has been revealed to be as important as controlling hyperglycemia to prevent the progression of diabetic nephropathy. Home blood pressure (HBP) measurement is useful for the treatment of hypertension. This study aimed to determine whether HBP measurement is a stronger predictor of the progression of diabetic nephropathy than clinic blood pressure (CBP) measurement. Method: A multicenter follow-up study was performed at the Japan National Hospital Organization. A database of type 2 diabetic patients was constructed. In addition to CBP measurement patients, those using HBP were included in the database. Fifty-four patients with diabetic nephropathy were extracted from the database and analyzed. The rate of decline of the estimated glomerular filtration rate (eGFR) was calculated as the outcome. Correlations between the rate of eGFR decline and various clinical and laboratory parameters, including HBP and CBP measurement, were analyzed. Results: The white-coat effect and reverse white-coat effect were frequently observed. The rate of eGFR decline correlated significantly with home systolic blood pressure (HSBP) measurement, but not with clinic systolic blood pressure (CSBP) measurement. Stepwise multiple linear regression analysis was performed. The rate of eGFR decline was significantly explained by the morning HSBP reading. The rate of eGFR decline was also significantly explained by the average of the morning HSBP readings during the follow-up period, the eGFR and age at baseline in the model, which included CBP and HBP measurements during the follow-up period instead of those at baseline. Conclusion: Home blood pressure measurement is useful for predicting the prognosis of diabetic nephropathy. © 2011 The Japan Diabetes Society.

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