Tokyo Kyosai Hospital

Meguro-ku, Japan

Tokyo Kyosai Hospital

Meguro-ku, Japan
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PubMed | Red Cross, Tokyo Metropolitan Tama Medical Center, The University of Shimane, Soka Municipal Hospital and 9 more.
Type: Journal Article | Journal: Arthritis research & therapy | Year: 2017

Sulfamethoxazole-trimethoprim (SMX/TMP) is a standard drug for the prophylaxis of Pneumocystis pneumonia (PJP) in immunosuppressed patients with systemic rheumatic diseases, but is sometimes discontinued due to adverse events (AEs). The objective of this non-blinded, randomized, 52-week non-inferiority trial was to quest an effective chemoprophylaxis regimen for PJP with a low drug discontinuation rate. Results at week 24 were reported.Adult patients with systemic rheumatic diseases who started prednisolone 0.6mg/kg/day were randomized into three dosage groups: a single-strength group (SS, SMX/TMP of 400/80mg daily), half-strength group (HS, 200/40mg daily), and escalation group (ES, started with 40/8mg daily, increasing incrementally to 200/40mg daily). The primary endpoint was non-incidence rates (non-IR) of PJP at week 24.Of 183 patients randomly allocated at a 1:1:1 ratio into the three groups, 58 patients in SS, 59 in HS, and 55 in ES started SMX/TMP. A total of 172 patients were included in the analysis. No cases of PJP were reported up to week 24. Estimated non-IR of PJP in patients who received daily SMX/TMP of 200/40mg, either starting at this dose or increasing incrementally, was 96.8-100% using the exact confidence interval as a post-hoc analysis. The overall discontinuation rate was significantly lower with HS compared to SS (p=0.007). The discontinuation rates due to AEs were significantly lower with HS (p=0.006) and ES (p=0.004) compared to SS. The IR of AEs requiring reduction in the dose of SMX/TMP (p=0.009) and AEs of special interest (p=0.003) were different among the three groups with significantly higher IR in SS compared to HS and ES.Although there were no PJP cases, the combined group of HS and ES had an excellent estimated non-IR of PJP andboth were superior in safety to SS. From the perspective of feasibility and drug discontinuation rates, the daily half-strength regimen was suggested to be optimal for prophylaxis of PJP in patients with systemic rheumatic diseases.The University Hospital Medical Information Network Clinical Trials Registry number is UMIN000007727 , registered 10 April 2012.


Iseki K.,University of Ryukyus | Tsuruya K.,Kyushu University | Kanda E.,Tokyo Kyosai Hospital | Nomura T.,Chiyoda Corporation | Hirakata H.,Red Cross
Nephron - Clinical Practice | Year: 2014

Sleep disorder and poor sleep quality are common in chronic hemodialysis (HD) patients. They have been claimed as a cause of morbidity and mortality. The relationship between the degree of sleepiness and survival has not been studied. We studied the degree of sleepiness in 1,252 adult HD patients (age ≥20 years) recruited into the Dialysis Outcomes Practice Pattern Study in Japan (J-DOPPS III), using the Japanese version of the Epworth Sleepiness Scale (JESS) questionnaire. Demographic data were presented for three subgroups: low, intermediate, and high JESS score. Cox proportional hazard regression analysis was performed to estimate the independent effect of several variables on survival. The hazard ratio for mortality was 2.312 (95% CI 1.267-4.220; p = 0.006) for those with a high JESS score (vs. those with a low JESS score) after adjusting for age, vintage (length of time on HD), sex, diabetes, body mass index, cardiovascular disease, HD treatment regimen (time, frequency, and single-pool Kt/V), laboratory data (serum albumin, creatinine, and total cholesterol), and medication (antihypertensive drugs, erythropoietin, vitamin D, and phosphate binders). Patients ≥70 years of age with comorbid conditions (congestive heart failure, stroke, and diabetes) showed a significantly higher JESS score (≥16). The JESS score did not show interaction by age. Results showed that the degree of sleepiness is related to survival in Japanese HD patients, particularly in elderly patients. © 2015 S. Karger AG, Basel.


Nakajima K.,Josai University | Nakajima K.,Kuki General Hospital | Oda E.,Medical Check up Center | Kanda E.,Tokyo Kyosai Hospital
Blood Pressure | Year: 2016

Background. High serum sodium (sNa) concentrations may be associated with hypertension, which deteriorates kidney function. However, it is equivocal whether high sNa concentrations are associated with impaired kidney function independently of blood pressure (BP) or serum chloride (sCl). Therefore, we addressed this issue in an apparently healthy population. Methods. Clinical variables including estimated glomerular filtration rate (eGFR) were examined in 3603 men and women (aged 25-75 years) who underwent health-screening check-ups. sNa concentrations were classified into five categories. Results. Most parameters, including age and BP, increased with increasing sNa, whereas eGFR decreased. Logistic regression analysis showed that, compared with low-normal sNa (≤ 140 mEq/l), high sNa (≥ 144 mEq/l) was significantly associated with elevated BP (≥ 130/85 mmHg) even after adjustment for blood hematocrit, eGFR, serum potassium (sK) concentration and sCl. The highest sNa category was significantly associated with reduced eGFR (< 60 ml/min/1.73 m2) independently of elevated BP. Unlike adjustment for sK, adjustment for sCl strengthened the association between high sNa and elevated BP but attenuated the association between high sNa and reduced eGFR. Conclusions. These results suggest that high sNa concentrations, even within the normal range, are independently associated with elevated BP and impaired kidney function. These associations may be substantially modified by sCl. © 2015 Scandinavian Foundation for Cardiovascular Research.


Kanda E.,Tokyo Kyosai Hospital | Kanda E.,Tokyo Medical and Dental University | Ai M.,Tokyo Medical and Dental University | Kuriyama R.,Kokubunji Minamiguchi Clinic | And 2 more authors.
American Journal of Nephrology | Year: 2014

Background/Aims: Non-volatile acid is produced by metabolism of organic sulfur in dietary protein, and promotes kidney damage. We investigated the role of dietary acid load, in terms of net endogenous acid production (NEAP), in chronic kidney disease (CKD) progression. Methods: 217 CKD patients on low-protein diet with a normal serum bicarbonate level were enrolled in this retrospective cohort study in Japan. The primary outcome was 25% decline in estimated glomerular filtration rate (eGFR) or start of dialysis. Their NEAP was measured every 3 months. The patients were categorized into four groups on the basis of quartiles of NEAP every 3 months. The groups were treated as time-dependent variables. Results: The average age (SD) was 70.6 (7.1) years; eGFR 23.5 (14.2) ml/min/1.73 m2. Analysis using extended Cox models for the NEAP groups adjusted for baseline characteristics (referring to group 1 showing the lowest NEAP) showed that high NEAP was associated with a high risk of CKD progression; group 2, adjusted hazard ratio (HR) 3.930 (95% confidence interval (CI) 1.914, 8.072); group 3, adjusted HR 4.740 (95% CI 2.196, 10.288); group 4, adjusted HR 4.303 (95% CI 2.103, 8.805). Logistic regression analysis adjusted for baseline characteristics showed that the occurrence of hypoalbuminemia or hyperkalemia was associated with low serum bicarbonate level and the presence of complications at baseline, but not with NEAP. Conclusion: In elderly CKD patients, our findings suggest that high NEAP is independently associated with CKD progression. The decrease in NEAP may be an effective kidney-protective therapy. © 2014 S. Karger AG, Basel.


Kanda E.,Tokyo Kyosai Hospital | Kanda E.,Tokyo Medical and Dental University | Ai M.,Tokyo Medical and Dental University | Yoshida M.,Tokyo Medical and Dental University | And 2 more authors.
BMC Nephrology | Year: 2013

Background: Metabolic acidosis leads to chronic kidney disease (CKD) progression. The guidelines recommend a lower limit of serum bicarbonate level, but no upper limit. For serum bicarbonate level to be clinically useful as a therapeutic target marker, it is necessary to investigate the target serum bicarbonate level within the normal range to prevent CKD progression. Methods. One hundred and thirteen elderly CKD patients, whose serum bicarbonate level was controlled within the normal range, were enrolled in this retrospective cohort study in Ibaraki, Japan. Outcome was defined as a decrease of 25% or more in estimated glomerular filtration rate (eGFR) or starting dialysis. We used Cox proportional hazard models adjusted for patients' characteristics to examine the association between serum bicarbonate level and the outcome. Results: Female patients were 36.3%: average age (SD), 70.4 (6.6) years; eGFR, 25.7 (13.6) ml/min/1.73 m§ssup§2§esup§; serum bicarbonate level, 27.4 (3.2) mEq/l. Patients with the lowest quartile of serum bicarbonate levels [23.4 (1.8) mEq/l] showed a high risk of CKD progression compared with patients with high serum bicarbonate levels [28.8 (2.3) mEq/l]: adjusted hazard ratio (HR), 3.511 (95% CI, 1.342-9.186). A 1 mEq/l increase in serum bicarbonate level was associated with a low risk of CKD progression: adjusted HR, 0.791 [95% confidence interval (CI), 0.684-0.914]. Conclusions: In elderly CKD patients, our findings suggest that serum bicarbonate level is independently associated with CKD progression, and that a high serum bicarbonate level is associated with a low risk of CKD progression. A high target serum bicarbonate level within the normal range may be effective for preventing CKD progression. © 2013 Kanda et al.; licensee BioMed Central Ltd.


Kanda E.,Tokyo Kyosai Hospital | Kanda E.,Tokyo Medical and Dental University | Yoshida M.,Tokyo Medical and Dental University | Sasaki S.,Tokyo Medical and Dental University
BMC Nephrology | Year: 2012

Background: Elderly patients with chronic kidney disease (CKD) are usually at a high risk of fractures due to both osteoporosis and CKD-mineral bone disease (MBD). A new marker is needed to prevent fractures and control CKD-MBD from the early to advanced stages of CKD. In the early stage of CKD, fibroblast growth factor 23 (FGF23) level increases before parathyroid hormone (PTH) and phosphate levels increase, and steadily increases with the progression of kidney disease. It has been reported that FGF23 is related to the overall fracture risk. We investigated the usefulness of FGF23 as a marker for evaluating the risk of vertebral fracture and CKD-MBD in elderly CKD patients. Methods. One hundred and five elderly predialysis CKD patients who had never been treated for osteoporosis and had never used calcium supplements, vitamin D supplements, or phosphate binders were enrolled in this cross-sectional study in Tokyo, Japan. We investigated the prevalence of vertebral fracture and measured serum calcium, phosphate, 1,25(OH)2 vitamin D [1,25(OH)2D], intact PTH, FGF23, alkaline phosphatase, and urinary N-terminal telopeptide levels. Then, we examined the relationship between the level of FGF23 and those of bone-metabolism-related markers and identified markers associated with vertebral fractures in elderly CKD patients. Results: The background features of the patients were as follows: female, 32.4%; diabetes mellitus, 39.0%; average age (standard deviation), 73.2 (7.7) years; and estimated glomerular filtration rate (eGFR), 45.7 (24.1) ml/min/1.73m2. Adjusted multivariate regression analysis showed that the natural logarithm value of FGF23 level [ln(FGF23)] was positively associated with body mass index (p=0.002), serum phosphate level (p=0.0001), and negatively with eGFR (p=0.0006). Multivariate logistic regression analysis showed that vertebral fracture was independently associated with ln(FGF23) (adjusted odds ratio, 4.44; 95% confidence interval, 1.13-17.46). A receiver-operating-characteristic curve of ln(FGF23) showed that the optimal cutoff level of FGF23 indicative of vertebral fracture was 56.8pg/ml (sensitivity, 0.82; specificity, 0.63). Conclusions: FGF23 level was independently associated with the levels of bone-metabolism-related markers and vertebral fracture. FGF23 is a new candidate marker for detecting abnormalities of bone metabolism and vertebral fracture in elderly CKD patients. © 2012 Kanda et al.; licensee BioMed Central Ltd.


Osaki S.,Nara Medical University | Osaki M.,Tokyo Kyosai Hospital
Polymer Journal | Year: 2011

During their evolutionary history, some species of spiders have changed from a nocturnal to a diurnal lifestyle, and the important change in their environment was irradiation by sunlight. Orb webs of diurnal spiders may be markedly affected by exposure to ultraviolet (UV) irradiation, whereas those of nocturnal spiders may be unaffected. It is of great interest to consider the effects of UV rays on the mechanical properties of spider silks from the viewpoint of evolution. The webs of orb-weaving spiders must trap insect prey, which closely relates to the breaking energy of the spider silk constituting the orb webs. The effects of UV rays on the mechanical properties, particularly the mechanical breaking energy, of the silks of diurnal and nocturnal spiders were investigated. UV rays mechanically strengthened the draglines of diurnal Nephila clavata and two other kinds of diurnal spiders (Leucauge blanda and Argiope bruennichii), suggesting that the ability of the orb web to capture insects requires less maintenance. However, UV rays mechanically weakened the draglines of nocturnal Yaginumia sia and one other kind of nocturnal spider (Neosona nautica), suggesting a decrease in the ability of the orb web to capture insects. The results provide strong support that diurnal spiders are in a more evolved stage than nocturnal spiders, so they secrete silks with an evolved mechanical resistance against UV irradiation. This study suggests a means to search for biological materials with resistance to UV rays. © The Society of Polymer Science, Japan (SPSJ) All rights reserved.


Beaubrun A.C.,University of North Carolina at Chapel Hill | Kanda E.,Tokyo Kyosai Hospital | Bond T.C.,Emory University | McClellan W.M.,Emory University
Renal Failure | Year: 2013

Medical Evidence Report Form CMS-2728 data is frequently used to study US dialysis patients, but the validity of these data have been called into question. We compared predialysis erythropoietin use as recorded on Form CMS-2728 with claims data as part of an assessment of quality of care among hemodialysis patients. Medicare claims were linked to Form CMS-2728 data for 18,870 patients. Dialysis patients, 67 years old or older, who started dialysis from 1 June 2005 to 31 May 2007 were eligible. Logistic and multivariate regressions were used to compare the use of either Form CMS-2728 or the corresponding claims data to predict mortality and the probability of meeting target hemoglobin levels. The sensitivity, specificity, and kappa coefficient for the predialysis erythropoietin indicator were 58.0%, 78.4%, and 0.36, respectively. Patients with a predialysis erythropoietin claim were less likely to die compared with patients without a claim (odds ratio = 0.80 and 95% confidence interval = 0.74-0.87), but there was no relationship observed between predialysis care and death using only Form CMS-2728 predictors. At the facility level, a predialysis erythropoietin claim was associated with a 0.085 increase in the rate of meeting target hemoglobin levels compared with patients without a claim (p = 0.041), but no statistically significant relationship was observed when using the Form CMS-2728 indicators. The agreement between Form CMS-2728 and claims data is poor and discordant results are observed when comparing the use of these data sources to predict health outcomes. Facilities with higher agreement between the two data sources may provide greater quality of care. © 2013 Informa Healthcare USA, Inc.


Aruga S.,Tokyo Kyosai Hospital
Clinical calcium | Year: 2011

Patients with urolithiasis have been increasing in the world, especially morbidity of calcium nephrolithiasis has been increasing in the advanced countries. The changes in the environmental factors including alternation of diet are said to be associated with the increment of morbidity of kidney stone. Idiopathic hypercalciuria is one of the most important risk factor of calcium nephrolithiasis and is classified into absorptive, resorptive, and renal leak. Though the origins of these three types of hypercalciuria are different, increased bone resorption and increased calcium absorption from gut tend to be observed simultaneously. Not only genetic abnormalities in the proteins which are involved in calcium metabolisms but environmental factors such as high sodium intake and chronic acid load caused by increased ingestion of animal protein have been considered to be associated with increased urinary calcium excretion. Renal metabolisms of oxalate and phosphate which are important compositions of calcium containing stone, uric acid as a promoter and citrate as a inhibitor of nephrolithiasis are also described.


Hosoda H.,Tokyo Kyosai Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2010

31-year-old man who complained of chest pain due to chest wall wound caused by tumble. He took chest X-ray examination and suggested of having mediastinal tumor. Computed tomography (CT) scan revealed 3.0 cm mass in diameter with irregular shaped calcification and lobulated cystic lesion (size : 21 x 17 x 41 mm). The mediastinal tumor was totaly removed by surgical operation. No invasive portion was observed between mediastinal pleura and solid tumor. Pathological examination revealed that tumor was composed of mucoepidermoid carcinoma of the thymus and postoperative adjuvant radiotherapy was performed. The patient have survived without disease for 3 years after surgery.

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