RESUMEN
Peripheral arterial disease (PAD) is common in hemodialysis patients and predicts a poor prognosis. We conducted a prospective cohort study to identify risk factors for PAD including skin perfusion pressure (SPP) in hemodialysis patients. The cohort included 373 hemodialysis patients among 548 patients who received hemodialysis at Oyokyo Kidney Research Institute, Hirosaki, Japan from August 2008 to December 2010. The endpoints were lower limb survival (peripheral angioplasty or amputation events) and overall survival of 2 years. Our results showed that <70 mmHg SPP was a poor prognosis for the lower limb survival and overall survival. We also identified age, history of cardiovascular disease, presence of diabetes mellitus, smoking history, and SPP < 70 mmHg as independent risk factors for lower limb survival and overall survival. Then, we constructed risk criteria using the significantly independent risk factors. We can clearly stratify lower limb survival and overall survival of the hemodialysis patients into 3 groups. Although the observation period is short, we conclude that SPP value has the potential to be a risk factor that predicts both lower limb survival and the prognosis of hemodialysis patients.
RESUMEN
The oral adsorbent AST-120 has the potential to delay dialysis initiation and improve survival of patients on dialysis. We evaluated the effect of AST-120 on dialysis initiation and its potential to improve survival in patients with chronic kidney disease. The present retrospective pair-matched study included 560 patients, grouped according to whether or not they received AST-120 before dialysis (AST-120 and non-AST-120 groups). The cumulative dialysis initiation free rate and survival rate were compared by the Kaplan-Meier method. Multivariate analysis was used to determine the impact of AST-120 on dialysis initiation. Our results showed significant differences in the 12- and 24-month dialysis initiation free rate (P < 0.001), although no significant difference was observed in the survival rate between the two groups. In conclusion, AST-120 delays dialysis initiation in chronic kidney disease (CKD) patients but has no effect on survival. AST-120 is an effective therapy for delaying the progression of CKD.
RESUMEN
BACKGROUND: We investigated the biochemical outcome of small-volume prostate cancers [tumor volume (TV) < 0.5 mL, SVCa] and insignificant prostate cancers (TV <0.5 mL without any Gleason pattern 4/5 elements, InsigCa) treated with radical prostatectomy. METHODS: Between April 2000 and May 2010, 609 patients with prostate cancer underwent radical prostatectomy at Hirosaki University Graduate School of Medicine. Of these, 237 were excluded from the study because of preoperative adjuvant therapy. The remaining 372 patients underwent routine histopathological and TV evaluations. Biochemical recurrence (BCR) was defined as the presence of prostate-specific antigen (PSA) levels greater than 0.2 ng/mL after prostatectomy. RESULTS: The median patient age was 68 years (range 48-78 years) and the median preoperative PSA level was 7.50 ng/mL. The mean follow-up period was 45.9 months and the mean TV was 2.16 mL. Sixty patients (16.3%) had SVCa and 14 (3.7%) had InsigCa. The 5-year BCR-free survival rate for patients with SVCa was 67.3% and that for patients with a TV of 0.5 or greater was 87.1%. A significant difference was seen between the groups using the log-rank test (P = 0.008). We could not identify any BCR in patients with InsigCa. CONCLUSION: Despite the limited number of cases, patients with InsigCa did not develop BCR whereas 12.9% of those with SVCa developed BCR after radical prostatectomy within 5 years. Accurate prediction of the biochemical outcome of SVCa remains difficult and further studies are needed.
