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Kimata N.,Tokyo Womens Medical University | Fuller D.S.,Arbor Research Collaborative for Health | Saito A.,Shonantoubu General Hospital | Akizawa T.,Showa University | And 4 more authors.
Hemodialysis International

Pruritus affects many patients undergoing hemodialysis (HD). In this study, pruritus and its relationship to morbidity, quality of life (QoL), sleep quality, and patient laboratory measures were analyzed in a large sample of Japanese patients undergoing HD. Severity of patient-reported pruritus symptoms experienced during a 4-week period was collected from 6480 Japanese patients undergoing HD in three phases of the Dialysis Outcomes and Practice Patterns Study (DOPPS; 1996-2008; 60-65 study facilities/phase). Adjusted linear and logistic regressions were used to identify associations of pruritus with treatment parameters and QoL outcomes. Adjusted Cox regressions examined the influence of pruritus severity on mortality. Moderate to extreme pruritus was experienced by 44% of prevalent patients undergoing HD in the Japanese Dialysis Outcomes and Practice Patterns Study. Many patient characteristics were significantly associated with pruritus, but this did not explain the large differences in pruritus among facilities (20-70%). Pruritus was slightly less common in patients starting HD than in patients on dialysis >1 year. Patients with moderate to extreme pruritus were more likely to feel drained (adjusted odds ratio=2.2-5.8, P<0.0001), have poor sleep quality (adjusted odds ratio=1.9-3.7, P<0.0001), and have QoL mental and physical composite scores 2.3-6.7 points lower (P<0.0001) than patients with no/mild pruritus. Pruritus in patients undergoing HD was associated with a 23% higher mortality risk (P=0.09). The many poor outcomes associated with pruritus underscore the need for better therapeutic agents to provide relief for the 40-50% of prevalent patients undergoing HD substantially affected by pruritus. Pruritus in new patients with end-stage renal disease likely results from uremia or pre-existing conditions (not HD per se), indicating the need to understand development of pruritus before end-stage renal disease. © 2014 International Society for Hemodialysis. Source

Okamoto T.,Shonantoubu General Hospital | Goto M.,Shonantoubu General Hospital | Tomita I.,Shonantoubu General Hospital | Murayama A.,Shonantoubu General Hospital | And 3 more authors.
Japanese Journal of Cancer and Chemotherapy

In 2001, a 72-year-old woman, who had undergone left mastectomy for breast carcinoma 36 years ago, was admitted because of dysphagia. Chest CT showed pleural effusion in the right side and no tumor in the breast. Chest drainage was performed. Cytology of chest effusion revealed adenocarcinoma. A high serum CA15-3 level was noted. She was diagnosed with a pleural recurrence of breast cancer, so administration of CAF agents (4 courses) was started. Pleural effusion was improved and the serum CA15-3 level was reduced. She was then clinically followed on medication with oral anastrozole (Al). After 4 years, progression of disease was noted. The serum CA15-3 level was elevated. A tumor measuring 3 cm was confirmed on the right chest wall. The tumor was removed under local anethesia and pathological findings showed invasive ductal carcinoma expressing estrogen receptor. Chemotherapy with taxane had to be withdrawn because of its side effect. Administration of S-1 was then started. The serum CA15-3 level was gradually elevated. Thereafter, the regimen was switched to combined S-1 and toremifene citrate. The serum CA15-3 level was reduced and sustained for several months. However, she died of multiple organ metastasis in 2008. Source

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