Showing papers by "Masaaki Nakayama published in 2013"
TL;DR: Tissue accumulation of AGEs, measured as skin autofluorescence, is a strong and independent predictor of progression of CKD.
Abstract: Background
Advanced glycation end product (AGE) accumulation is thought to be a measure of cumulative metabolic stress that has been reported to independently predict cardiovascular disease in diabetes and renal failure. The aim of this study was to evaluate the association between AGE accumulation, measured as skin autofluorescence, and the progression of renal disease in pre-dialysis patients with chronic kidney disease (CKD).
47 citations
TL;DR: It is suggested that MG-induced hypertension and cardio–renal injury and increased inflammation and carbonyl and oxidative stress were partially preventable by an ARB.
Abstract: One major precursor of carbonyl stress, methylglyoxal (MG), is elevated in the plasma of chronic kidney disease (CKD) patients, and this precursor contributes to the progression of vascular injury, hypertension and renal injury in diabetic nephropathy patients. This molecule induces salt-sensitive hypertension via a reactive oxygen species-mediated pathway. We examined the role of MG in the pathogenesis of hypertension and cardio–renal injury in Dahl salt-sensitive (Dahl S) rats, which is a rat model of CKD. Nine-week-old Dahl S rats were fed a 1% NaCl diet, and 1% MG was added to their drinking water for up to 12 weeks. Blood pressure and cardio–renal injuries were compared with rats treated with tap water alone. The angiotensin II receptor blocker (ARB), candesartan (10 mg kg−1 day−1), was administered to MG Dahl S rats to determine the impact of this drug on the pathogenesis of MG-induced CKD. A progressive increase in systolic blood pressure was observed (123±1–148±5 mm Hg) after 12 weeks of MG administration. MG administration significantly increased urinary albumin excretion, glomerular sclerosis, tubular injury, myocardial collagen content and cardiac perivascular fibrosis. MG also enhanced the renal expression of Nɛ-carboxyethyl-lysine (an advanced glycation end product), 8-hydroxydeoxyguanosine (a marker of oxidative stress), macrophage (ED-1) positive cells (a marker of inflammation) and nicotinamide adenine dinucleotide phosphate (NAD(P)H) oxidase activity. Candesartan treatment for 4 weeks significantly reduced these parameters. These results suggest that MG-induced hypertension and cardio–renal injury and increased inflammation and carbonyl and oxidative stress, which were partially preventable by an ARB.
36 citations
TL;DR: The use of allopurinol in hypertensive subjects with impaired kidney function appears to be beneficial in preventing cardiovascular morbidity and all-cause mortality, indicating that this xanthine oxidase inhibitor protects the vascular system, at least in this specific group.
Abstract: Background
The present study aimed to clarify the beneficial effect of allopurinol on cardiovascular morbidity and mortality in a cohort of hypertensive nephropathy patients with impaired kidney function.
32 citations
TL;DR: The mechanisms by which kidney dysfunction develops within CHF are reviewed, and the rationale for using peritoneal dialysis as a new therapeutic approach in the nonuremic setting of CHF is discussed.
Abstract: Cardiorenal syndrome (CRS) type II is a serious condition in which chronic cardiac abnormalities cause worsening kidney function, leading to permanent chronic kidney damage. Management of CRS type ...
21 citations
TL;DR: Trans-peritoneal administration of H2 reduces peritoneal and systemic OS, and the redox state of albumin in effluent and blood was determined using high-performance liquid chromatography.
Abstract: Oxidative stress (OS) related to glucose degradation products such as methylglyoxal is reportedly associated with peritoneal deterioration in patients treated with peritoneal dialysis (PD). However, the use of general antioxidant agents is limited due to their harmful effects. This study aimed to clarify the influence of the novel antioxidant molecular hydrogen (H2) on peritoneal OS using albumin redox state as a marker. Effluent and blood samples of 6 regular PD patients were obtained during the peritoneal equilibrium test using standard dialysate and hydrogen-enriched dialysate. The redox state of albumin in effluent and blood was determined using high-performance liquid chromatography. Mean proportion of reduced albumin (ƒ(HMA)) in effluent was significantly higher in H2-enriched dialysate (62.31 ± 11.10%) than in standard dialysate (54.70 ± 13.08%). Likewise, serum ƒ(HMA) after administration of hydrogen-enriched dialysate (65.75 ± 7.52%) was significantly higher than that after standard dialysate (62.44 ± 7.66%). Trans-peritoneal administration of H2 reduces peritoneal and systemic OS.
20 citations
TL;DR: The quake caused acute changes in the home BP and the fact that BP elevation correlated with renal function suggests a possible mechanism of CKD, such as enhanced activity of the sympathetic nervous system in such patients.
Abstract: Blood pressure (BP) transiently increases after major earthquakes. Although home BP increased in hypertensive patients after the Great East Japan Earthquake (measuring 9.0 on the Richter scale) on March 11th, 2011, such profiles in patients with chronic kidney disease (CKD) have not been investigated. This retrospective single-center observational study included 38 patients with CKD at the predialysis stage [male, n = 27 (71 %); mean age 66.0 years; mean estimated glomerular filtration rate (eGFR) 46.0 mL/min/1.73 m²] who lived in Fukushima City. We compared their morning BP between two and four weeks after the quake with that of a control group of 39 non-CKD patients with hypertension. Systolic BP (SBP) remained elevated for one week after the quake in the CKD and non-CKD groups [before vs. after the quake 133.7 ± 15.6 vs. 136.9 ± 16.9 (p = 0.017) and 129.9 ± 7.8 vs. 133.3 ± 9.3 mmHg (p = 0.009), respectively]. Increases in SBP in the morning after the quake were statistically significant in the group with but not in that without CKD (7.1 and 3.4 mmHg; p = 0.038 and 0.221, respectively). Multivariate analysis revealed that a low eGFR was an independent risk factor for elevated SBP after the quake. The quake caused acute changes in the home BP and the fact that BP elevation correlated with renal function suggests a possible mechanism of CKD, such as enhanced activity of the sympathetic nervous system in such patients.
15 citations
TL;DR: It is hypothesized that recurrent infection after unroofing surgery is partly attributable to the persistence of causative micro-organisms in the wound.
Abstract: Peritoneal catheter infection is a common and significant problem in maintaining peritoneal dialysis (PD). Although the incidence rate of peritonitis related to exit-site and catheter infection has diminished with the increasing use of exit-site antibiotic prophylaxis (1), persistent exit-site infection can lead to infection of the superficial cuff in two-cuff devices. Intractable cuff infection leads directly to catheter loss and withdrawal from PD. In fact, PD-related infections are the major cause of withdrawal from PD (2,3). Therefore, once intractable superficial cuff infection has occurred, the proper strategy should be pursued. Unroofing of the tunnel tract and removal of the superficial cuff (“unroofing surgery”) is a strategy widely used to treat superficial cuff infection (4). It is simpler and less costly than other strategies, such as catheter removal with (simultaneous or delayed) catheter replacement (5) or replacement of the infected external tubing segment by catheter splicing (6). Although the published results of unroofing surgery are generally favorable (7,8), infection still recurs in some cases. We hypothesized that recurrent infection after unroofing surgery is partly attributable to the persistence of causative micro-organisms in the wound. Standard unroofing surgery consists of
12 citations
TL;DR: Long-term ad libitum consumption of H2-enriched electrolyzed water can ameliorate the processes of kidney injury and cardiac remodeling with aging in Dahl SS rats by suppressing, at least partly, elevated inflammation and oxidative stress.
Abstract: Recent studies have revealed the biological effects of H2 in suppressing organ injuries due to acute inflammation and oxidative stress. Dahl salt-sensitive (SS) rats naturally develop elevated blood pressure (BP) and kidney injury with aging. The present study examined the effect of long-term supplementation of H2 in drinking water on age-related changes. Four-week-old male Dahl SS rats were fed 3 types of water (n = 30 each) for up to 48 weeks: filtered water (FW), water with a high H2 content (492.5 ppb) obtained with water electrolysis (EW), or dehydrogenated EW (DW). Animals were subjected to histological analysis at 16, 24, and 48 weeks. The FW group showed progressive BP elevation and increases in albuminuria and cardiac remodeling during the course of treatment. Histologically, there were significant changes as a function of aging, i.e., glomerular sclerosis with tubulointerstitial fibrosis in the kidney, and increased cardiomyocyte diameter with interstitial fibrosis in the heart at 48 weeks. These changes were related to the enhanced inflammation and oxidative stress in the respective organs. However, there were no striking differences in BP among the groups, despite histological alterations in the EW group being significantly decreased when compared to FW and DW in both organs, with concurrently lower oxidative stress and inflammatory markers at 48 weeks. Long-term ad libitum consumption of H2-enriched electrolyzed water can ameliorate the processes of kidney injury and cardiac remodeling with aging in Dahl SS rats by suppressing, at least partly, elevated inflammation and oxidative stress.
9 citations
TL;DR: HCP is an important complication in MPO-ANCA-related vasculitis, and needs to be considered during the clinical course, according to a 75-year-old woman with rapidly progressive glomerulonephritis.
Abstract: A 75-year-old woman presented with rapidly progressive glomerulonephritis with positive results for anti-myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA). Corticosteroid therapy was successfully introduced. However, 7 months later, magnetic resonance imaging revealed marked swelling in the falx cerebri and high density regions were apparent on gallium scintigraphy, leading to diagnosis of hypertrophic cranial pachymeningitis (HCP). Symptoms improved with intensified corticosteroid therapy, but radiological examination 9 months later revealed right nasal sinus inflammation accompanied by osteolytic change. Granulomatosis with polyangiitis (Wegener's) was finally diagnosed. HCP is an important complication in MPO-ANCA-related vasculitis, and needs to be considered during the clinical course.
8 citations
TL;DR: In hypertensive patients, the A2 and A3 levels of albuminuria on the CLINITEK MICROALB CREATININE TEST are associated with a previous history of CVD, independent of eGFR, and this test may help to perform CVD risk stratification.
Abstract: OBJECTIVE Albuminuria is thought to reflect generalized endothelial dysfunction. In hypertensive patients, albuminuria increases the risk of cardiovascular disease (CVD) events. Therefore, screening for albuminuria is critical for stratifying risks in hypertensive patients. However, a limited number of Japanese studies have performed quantitative examinations of albuminuria. The objective of this study was to examine the utility of the CLINITEK MICROALB CREATININE TEST for albuminuria screening. MATERIALS The CLINITEK MICROALB CREATININE TEST consists of a urine test strip that assesses albumin excretion corrected for the urine creatinine levels in only 60 seconds without the need for any special facilities. The CLINITEK MICROALB CREATININE TEST was performed in 5,647 Japanese hypertensive patients, excluding diabetic patients, and the clinical significance of the test was evaluated. RESULTS According to the CLINITEK MICROALB CREATININE TEST, the A1 (albumin creatinine ratio: ACR <30 mg/g･creatinine), A2 (ACR 30-299 mg/g･creatinine) and A3 (ACR ≥ 300 mg/g･creatinine) levels of albuminuria were present in 61.2%, 32.5% and 6.3% of the patients surveyed, respectively. The proportions of A2 and A3 patients increased with chronic kidney disease (CKD) stage, blood pressure, age and previous history of CVD. According to a multivariate logistic regression analysis, the A2 and A3 levels of albuminuria were found to be independently associated with a previous history of CVD (odds ratio: 1.36, 95% confidence interval: 1.08-1.72, p<0.01) after adjusting for age, diabetes, blood pressure and estimated glomerular filtration rate (eGFR). CONCLUSION In hypertensive patients, the A2 and A3 levels of albuminuria on the CLINITEK MICROALB CREATININE TEST are associated with a previous history of CVD, independent of eGFR. Therefore, by reflecting the status of systemic vascular injury, this test may help to perform CVD risk stratification.
6 citations
TL;DR: Aftercare for the prevention of a secondary health disaster in survivors of major earthquake survivors and their care in the aftermath of major earthquakes.
Abstract: Aftercare for the prevention of a secondary health disaster in survivors of major earthquakes
TL;DR: Lower levels of predialytic PEDF was associated with an increased risk of mortality and significantly higher incidences of all‐cause mortality and cardiovascular accident were observed in the lower PEDf group than in the higher P EDF group.
Abstract: Pigment epithelium-derived factor (PEDF) plays a protective role against atherosclerosis. Although serum PEDF level is increased in patients undergoing regular hemodialysis (HD), the pathophysiological role of PEDF in HD patients is unknown. We measured serum PEDF levels in 74 HD patients, and the association between serum PEDF and adverse events such as all-cause death and cardiovascular accident was evaluated prospectively. During the follow up of 45.4 ± 25.1 months, 24 patients (32.4%) experienced cardiovascular accident and 18 (24.3%) died. Significantly higher incidences of all-cause mortality and cardiovascular accident were observed in the lower PEDF group than in the higher PEDF group. After adjusting for propensity score calculated from multiple confounding factors (age, gender, systolic blood pressure, history of previous cardiovascular disease, level of carbonyl content, albumin, hemoglobin, total cholesterol, creatinine, C-reactive protein, dialysis vintage, Kt/V-urea and history of diabetes), lower predialytic PEDF was a significant risk factor for all-cause mortality (relative hazard = 6.060, standard error = 0.68467, P = 0.0085). Lower levels of predialytic PEDF was associated with an increased risk of mortality.