[A cross-sectional study of renal function based on estimated glomerular filtration rate and urinary protein levels related to risk factors for cardiovascular events and metabolic syndrome in local residents].

OBJECTIVES: In a cross-sectional study, we investigated renal function based on estimated glomerular filtration rate (eGFR) and urinary protein levels from Specific Health Examinations in Kitakyushu city related to risk factors for cardiovascular events and metabolic syndrome in residents. METHODS: For this study, 21,625 citizens (male/female=8,637/12,988) of Kitakyushu city were investigated. Citizens were enrolled in national health insurance and data were collected from a database classified for "Specific Health Guidance" by the Kokura Medical Association health testing and services center in 2010. RESULTS: As a whole, the stage of CKD increased with age, especially among those aged 70-74 years; 32% were at CKD stage 3. Only 11% of the CKD stage 3 group had a positive urinary protein (UP) test. Subjects in stages 3-5 CKD had a higher ratio of abdominal obesity, higher systolic and diastolic blood pressure, increased fasting blood glucose, HbA1c, and fasting triglyceride levels, and lower levels of HDL-C in comparison to subjects with CKD in stages 1-2. These factors increase the complication ratio of MetS for subjects in stages 3-5. The group with a history of stroke or heart disease had a significantly lower eGFR. CONCLUSION: There is a strong relationship between CKD and risk factors for cardiovascular events and MetS. It has been indicated that lifestyle modifications, suggested by primary care doctors, are very important for the early prevention of CKD. A new preventive CKD system in Kitakyushu city, based on a Specific Health Examination, began during the fiscal year 2011, and this system is expected to decrease the incidence of end-stage renal disease and cardiovascular events.

Short- and Long-term Effects of Dialysate Calcium Concentrations on Mineral and Bone Metabolism in Hemodialysis Patients: The K4 Study.

RATIONALE & OBJECTIVE: The short- and long-term impact of conversion of dialysate calcium concentration from either 2.5 or 3.0 mEq/L to 2.75 mEq/L on mineral and bone metabolism remains unknown in hemodialysis patients. STUDY DESIGN: Nonrandomized intervention study. SETTING & POPULATION: 12 hemodialysis patients treated at baseline with a 2.5-mEq/L dialysate calcium concentration and another 12 hemodialysis patients treated with a 3.0-mEq/L dialysate calcium concentration. INTERVENTION: Use of 2.75-mEq/L dialysate calcium concentration. OUTCOMES: Changes in intradialytic calcium and phosphate clearance and changes in predialysis and intradialytic serum and ionized mineral and biochemical parameters over the 24 weeks following dialysate calcium conversion. RESULTS: Conversion of dialysate calcium concentration from 2.5 to 2.75 mEq/L increased intradialytic calcium loading and serum total and ionized calcium levels, whereas conversion of dialysate calcium from 3.0 to 2.75 mEq/L decreased intradialytic calcium loading and serum total and ionized calcium levels. Dialysate calcium concentration conversion did not affect intradialytic serum parathyroid hormone level, intradialytic phosphate elimination, or predialysis serum calcium, phosphate, parathyroid hormone, and fibroblast growth factor 23 levels. Intradialytic calcium influx was determined by dialysate calcium concentration and predialysis serum calcium levels, whereas intradialytic phosphate elimination was determined by predialysis serum phosphate levels. LIMITATIONS: Small sample size and no control groups treated with 2.5- and 3.0-mEq/L dialysate calcium concentrations during the 24 weeks of the observation period. CONCLUSIONS: Conversion of dialysate calcium concentration from either 3.0 or 2.5 to 2.75 mEq/L results in expected changes in calcium loading based on predialysis calcium concentration. The dialysate calcium concentration should be personalized based on clinical factors. FUNDING: None. TRIAL REGISTRATION: University Hospital Medical Information Network, www.umin.ac.jp/english/, R000040105, UMIN000035184.

[Characteristics of the patients who received parathyroidectomy within 5 years after the initiation of hemodialysis].

Thirteen patients, who received parathyroidectomy within 5 years after the initiation of hemodialysis, were discussed on their clinical characteristics and their prognoses. 204 patients received the first parathyroidectomy due to secondary hyperparathyroidism in our department, 13 of which were selected on dialysis duration. 9 patients were female and origin of CRF were analgesics-induced interstitial nephritis in 2 and prune-belly syndrome in 1. There were 2 patients who suffered from renal disease more than 30 years. Concomitant primary hyperparathyroidism was suspected in 1 case. In all cases, PTx achieved adequate control of 2HPT after the operation.

Early effects of parathyroidectomy on erythropoietin production in secondary hyperparathyroidism.

BACKGROUND: Secondary hyperparathyroidism (2-HPT) has an adverse effect on renal anemia and may cause a hyporesponsiveness to recombinant human erythropoietin (rHuEpo) in patients with chronic renal failure. The early effects of parathyroidectomy (PTx) on renal anemia, erythropoietin production, and nutritional state were examined. METHODS: Twenty-nine patients under hemodialysis therapy received a PTx for 2-HPT. They were prospectively studied regarding hematological parameters, rHuEpo use, plasma erythropoietin levels, and nutritional condition until 12 months after PTx. RESULTS: The hemoglobin level showed a significant increase from 3 months after PTx (10.2% +/- 1.5% to 11.2% +/- 1.3%; P <0.01), associated with a consistent increase of the reticulocyte count. These changes lasted until 12 months after PTx. The plasma erythropoietin level showed a gradual increase of up to about 5 times the level of the preoperative value, until 12 months after PTx (22.6 +/- 10.1 to 106.3 +/- 112.1 mU/mL; P <0.001). The weekly dose of rHuEpo administration decreased after 3 months. The serum levels of albumin and total protein also significantly and gradually improved until 12 months after PTx. CONCLUSIONS: PTx caused a significant early improvement in renal anemia in patients with secondary hyperparathyroidism. This effect may be caused by an enhanced erythropoietin production and may also be partially due to the improved nutritional state after PTx.

Impaired taste acuity in patients with diabetes mellitus on maintenance hemodialysis.

AIMS: It has been reported that taste acuity for the four primary tastes, sour, sweet, salty and bitter, is impaired in hemodialysis (HD) patients. However, there have been no studies reported on taste acuity of diabetic HD patients. The present study aimed to quantify and compare the taste acuity of diabetic and non-diabetic HD patients, and further to determine if there were correlations between diminished taste acuity and certain blood serum parameters typically askew in hemodialysis patients. METHODS: In a test group of 24 diabetic and 24 non-diabetic HD patients matched for age, body mass index and duration of HD, taste acuity for the four tastes was determined by asking patients to identify them at varying concentrations. RESULTS: Statistical analyses indicate that bitter and total taste acuity were significantly impaired in diabetic HD patients. In diabetic HD patients, correlation was found between sweet, salty or total taste acuity and blood urea nitrogen or normalized protein catabolic rate. CONCLUSIONS: We conclude that taste acuity is partially impaired in diabetic HD patients, and suggest this contributes to reduced appetite, leading to malnutrition and poor prognoses.

A huge fecalith associated with dialysis-related gastrointestinal amyloidosis.

A 60-year-old man who had been receiving dialysis for more than 30 years was admitted for treatment of cellulitis in his right thigh on November 7, 2003. He suffered from an ileus on December 14 and was found to have a huge, 7-cm-diameter, well-circumscribed fecalith, incarcerated at the splenic flexure of the colon. It was proving difficult to pass this naturally and surgical removal was thought to be too risky. Using a colonoscope and a water-jet probe, the fecalith was broken up; the ileus then improved and the patient was able to take oral fluids. Unfortunately, he died of cardiac failure on February 13, 2004. We conducted an autopsy, with his family's consent, and found generalized amyloidosis. Deposits of amyloid were seen in all layers of the colon. Because of this, we hypothesized that peristalsis had been poor and this had led to paralytic ileus due to stasis, which, in turn, had led to the formation of the huge fecalith. In Japan it is not rare for a patient to be on dialysis for more than 25 years and it may be that this is a cause of generalized amyloidosis. There have been no such cases of fecalith associated with gastrointestinal amyloidosis described previously, which is why we decided to report this case here.