2022/05/26 更新

写真a

ワカスギ ミナコ
若杉 三奈子
WAKASUGI Minako
所属
医歯学総合研究科 特任准教授
職名
特任准教授
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外部リンク

学位

  • 公衆衛生学修士(専門職学位) ( 2010年3月   東京大学 )

  • 博士(医学) ( 1999年3月   新潟大学 )

研究キーワード

  • Nephrology

  • Public health

  • Clinical epidemiology

研究分野

  • ライフサイエンス / 腎臓内科学

  • ライフサイエンス / 衛生学、公衆衛生学分野:実験系を含まない

  • ライフサイエンス / 医療管理学、医療系社会学

経歴(researchmap)

  • 新潟大学大学院医歯学総合研究科   Graduate School of Medical and Dental Sciences   特任准教授

    2015年8月 - 現在

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  • 新潟大学   医歯学総合研究科   助教

    2015年3月 - 2015年7月

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  • 新潟大学   医歯学系   特任助教

    2010年4月 - 2015年2月

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経歴

  • 新潟大学   医歯学総合研究科   特任准教授

    2020年4月 - 現在

  • 新潟大学   医歯学総合研究科   特任准教授

    2015年8月 - 2020年3月

  • 新潟大学   医歯学総合研究科 生体機能調節医学専攻 内部環境医学   助教

    2015年3月 - 2015年7月

  • 新潟大学   医歯学総合研究科   特任助教

    2010年4月 - 2015年2月

所属学協会

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委員歴

  • 日本腎臓学会   CKDガイドライン改定委員  

    2015年8月 - 2018年12月   

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    団体区分:学協会

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  • 日本透析医学会   統計調査委員会 統計解析小委員会 委員  

    2014年7月 - 2021年6月   

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    団体区分:学協会

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  • 日本透析医学会   学術委員会 学術専門部小委員会 委員  

    2014年7月 - 2021年6月   

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    団体区分:学協会

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  • 日本腎臓学会   評議員  

    2014年4月 - 現在   

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    団体区分:学協会

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  • 日本腎臓学会   症例評価委員会委員  

    2014年1月 - 2015年   

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    団体区分:学協会

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取得資格

  • 医師

  • 日本内科学会認定内科医

  • 日本内科学会総合内科専門医

  • 日本腎臓学会腎臓専門医

  • 日本骨粗鬆症学会認定医

 

論文

  • Healthy Lifestyle and Incident Hypertension and Diabetes in Participants with and without Chronic Kidney Disease: The Japan Specific Health Checkups (J-SHC) Study 査読

    Minako Wakasugi, Ichiei Narita, Kunitoshi Iseki, Koichi Asahi, Kunihiro Yamagata, Shouichi Fujimoto, Toshiki Moriyama, Tsuneo Konta, Kazuhiko Tsuruya, Masato Kasahara, Yugo Shibagaki, Masahide Kondo, Tsuyoshi Watanabe

    Internal Medicine   2022年3月

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    担当区分:筆頭著者, 責任著者   記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Japanese Society of Internal Medicine  

    DOI: 10.2169/internalmedicine.8992-21

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  • Sex Differences in Cause-specific Mortality in Japanese Dialysis Patients. 査読

    Minako Wakasugi, Ichiei Narita

    Internal medicine (Tokyo, Japan)   2022年2月

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    担当区分:筆頭著者, 責任著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Objective The survival advantage of females over males is lost in dialysis patients in many countries. Japanese female hemodialysis patients, however, have a survival advantage over their male counterparts. This study explored causes of death that contribute to sex differences in all-cause mortality in Japanese dialysis patients. Methods Data from the Japanese Society for Dialysis Therapy registry and National Vital Statistics from 2017 and 2018 were used. Standardized mortality ratios, male-to-female mortality rate ratios, and age-adjusted differences between sexes were calculated for all-cause, cardiovascular, and non-cardiovascular mortality, as well as cause-specific mortality, in dialysis patients and the general population. Results During the 2-year study period, 41,006 and 21,254 deaths occurred in 417,740 and 225,292 patient-years in male and female dialysis patients, respectively. The age-standardized all-cause mortality ratio was 1.21 (95% confidence interval, 1.20-1.23) for male patients compared to female patients. The male-to-female mortality rate ratio for cardiovascular disease was about 1.4 in younger age categories but closer to 1.0 in older age categories. Conversely, the ratio for non-cardiovascular disease was about 1.3 in older age categories but closer to 1.0 in younger age categories. Death from infectious disease, malignancy, and heart failure contributed to 38.4%, 22.7%, and 12.1%, respectively, of the male-to-female difference in all-cause mortality of dialysis patients. Conclusion Low cardiovascular mortality in younger age categories and low non-cardiovascular mortality in older age categories contributed to the survival advantage of female Japanese dialysis patients. Infectious disease was the greatest contributor to sex differences in all-cause mortality.

    DOI: 10.2169/internalmedicine.8981-21

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  • Authors' reply. 査読

    Minako Wakasugi, Akio Yokoseki, Masakazu Wada, Takeshi Momotsu, Kenji Sato, Hiroyuki Kawashima, Kazutoshi Nakamura, Osamu Onodera, Ichiei Narita

    Journal of bone and mineral metabolism   2022年2月

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    担当区分:筆頭著者, 責任著者   記述言語:英語  

    DOI: 10.1007/s00774-022-01315-9

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  • Smoking and risk of fractures requiring hospitalization in hemodialysis patients: a nationwide cohort study in Japan. 査読 国際誌

    Minako Wakasugi, Junichiro James Kazama, Kosaku Nitta, Ichiei Narita

    Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association   2021年10月

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    担当区分:筆頭著者, 責任著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Smoking is a well-established lifestyle risk factor for fractures in the general population, but evidence specific to hemodialysis populations is lacking. This nationwide cohort study used data from the Japanese Society for Dialysis Therapy Renal Data Registry to examine the association between smoking status and fractures. METHODS: A total of 154,077 patients (64.2% men; mean age, 68 years) aged ≥20 years undergoing maintenance hemodialysis thrice a week at the end of 2016 were followed for 1 year. Among these, 19,004 (12.3%) patients were current smokers. Standardized incidence rate ratios of hospitalization due to any fracture were calculated and analyzed by multivariable logistic regression analysis, controlling for potential confounders. Propensity score matching and subgroup analyses were also performed as sensitivity analyses. RESULTS: During the 1-year follow-up period, 3,337 fractures requiring hospitalization (1,201 hip, 479 vertebral, and 1,657 other fractures) occurred in 3,291 patients. The age- and sex-standardized incidence ratio for current smokers was 1.24 (95% confidence interval, 1.12-1.39) relative to non-smokers. Standardized incidence ratios were similar after stratification by age group and sex. Multivariable logistic regression analysis revealed a 1.25-fold higher risk of any fracture requiring hospitalization (95% confidence interval, 1.10-1.42) in current smokers relative to non-smokers in a fully adjusted model. Propensity score matching showed similar results (odds ratio, 1.25; 95% confidence interval, 1.05-1.48). Subgroup analyses for baseline covariates revealed no significant interactions. CONCLUSIONS: Smoking is a significant risk factor for any fracture requiring hospitalization in hemodialysis patients.

    DOI: 10.1093/ndt/gfab307

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  • Polypharmacy, chronic kidney disease, and incident fragility fracture: a prospective cohort study 査読

    Minako Wakasugi, Akio Yokoseki, Masakazu Wada, Takeshi Momotsu, Kenji Sato, Hiroyuki Kawashima, Kazutoshi Nakamura, Osamu Onodera, Ichiei Narita

    Journal of Bone and Mineral Metabolism   40 ( 1 )   157 - 166   2021年9月

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    担当区分:筆頭著者, 責任著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

    INTRODUCTION: Polypharmacy is associated with an increased risk of fracture in aging populations, but no study has accounted for the impact of kidney function on this association. This study aimed to examine the association between polypharmacy and incident fragility fracture based on chronic kidney disease (CKD) status. MATERIALS AND METHODS: Participants were 2023 patients (55% men; mean age, 69 years) of Sado General Hospital enrolled in the Project in Sado for Total Health (PROST) between June 2008 and December 2016. Among these, 65%, 28%, and 7% had non-CKD, non-dialysis-dependent CKD, and dialysis-dependent CKD, respectively. Multivariable Cox proportional hazards analysis was conducted with adjustments for potential confounders. RESULTS: Prevalences of polypharmacy (≥ 5 medications) and hyperpolypharmacy (≥ 10 medications) among participants were 43% and 9% for non-CKD, 62% and 23% for non-dialysis-dependent CKD, and 85% and 34% for dialysis-dependent CKD, respectively. During a median follow-up of 5.6 years, 256 fractures occurred. More medications were associated with a higher risk of fractures. Specifically, compared to participants without polypharmacy, adjusted hazard ratios were 1.32 (95% CI 0.96-1.79) and 1.99 (1.35-2.92) for those with polypharmacy and hyperpolypharmacy, respectively, after adjusting for osteoporosis risk factors, CKD status, and comorbidities. No effect modification by CKD status was observed (interaction P = 0.51). Population-attributable fractions of hyperpolypharmacy for fracture were 9.9% in the total cohort and 42.1% in dialysis-dependent CKD patients. CONCLUSION: Hyperpolypharmacy is associated with an increased risk of fragility fracture regardless of CKD status, and has a strong impact on incident fragility fractures in dialysis-dependent CKD patients.

    DOI: 10.1007/s00774-021-01272-9

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  • The Effect of CKD on Associations between Lifestyle Factors and All-cause, Cancer, and Cardiovascular Mortality: A Population-based Cohort Study. 査読

    Minako Wakasugi, Ichiei Narita, Kunitoshi Iseki, Koichi Asahi, Kunihiro Yamagata, Shouichi Fujimoto, Toshiki Moriyama, Tsuneo Konta, Kazuhiko Tsuruya, Masato Kasahara, Yugo Shibagaki, Masahide Kondo, Tsuyoshi Watanabe

    Internal medicine (Tokyo, Japan)   60 ( 14 )   2189 - 2200   2021年2月

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    担当区分:筆頭著者, 責任著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Objective Results from previous studies on the dose-dependent effect of adhering to multiple lifestyle factors on all-cause mortality in patients with chronic kidney disease (CKD) are inconsistent, despite the reported dose-dependent effect in the general population. This study aimed to examine whether CKD modifies the dose-dependent effect of adhering to multiple lifestyle factors on mortality. Methods This population-based prospective cohort study targeted 262,011 men and women aged 40-74 years at baseline. Of these, 18.5% had CKD, which was defined as GFR <60 ml/min/1.73 m2, ≥1+ proteinuria on urinalysis, or both. The following lifestyle behaviors were considered healthy: no smoking, body mass index <25 kg/m2, moderate or lower alcohol consumption, regular exercise, and healthy eating habits. Healthy lifestyle scores were calculated by adding the total number of lifestyle factors for which each participant was at low risk. Cox proportional hazards models were used to examine associations between healthy lifestyle scores and all-cause, cancer, and cardiovascular mortality, and whether CKD modified these associations. Results During a median follow-up of 4.7 years, 3,471 participants died. The risks of all-cause and cancer mortality decreased as the number of five healthy lifestyle factors that were adhered to increased, irrespective of the CKD status. The risk of cardiovascular mortality, however, was modified by CKD (interaction p=0.07), and an unhealthy lifestyle and CKD synergistically increased cardiovascular mortality. Conclusion A healthy lifestyle can reduce the risk of all-cause and cancer death in patients with or without CKD, while the prevention of CKD is essential for reducing the risk of cardiovascular death.

    DOI: 10.2169/internalmedicine.6531-20

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  • Hematuria, bone health, and cardiovascular mortality. 査読

    Minako Wakasugi, Junichiro James Kazama

    Clinical and experimental nephrology   25 ( 5 )   562 - 563   2021年1月

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    担当区分:筆頭著者, 責任著者   記述言語:英語  

    DOI: 10.1007/s10157-020-02016-1

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  • Long-term excess mortality after hip fracture in hemodialysis patients: a nationwide cohort study in Japan. 査読

    Minako Wakasugi, Junichiro James Kazama, Atsushi Wada, Takayuki Hamano, Ikuto Masakane, Ichiei Narita

    Journal of bone and mineral metabolism   38 ( 5 )   718 - 729   2020年9月

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    担当区分:筆頭著者, 責任著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

    INTRODUCTION: Fracture dialysis patients have a higher risk of 1-year mortality compared with non-fracture dialysis patients. However, it is unclear whether excess mortality persists for more than a year. MATERIALS AND METHODS: We conducted a nationwide cohort study in 162,360 hemodialysis patients in Japan. Study outcomes were 5-year all-cause mortality and cause-specific mortality. Cox proportional hazards regression was used to examine the association between hip fracture and mortality in two cohorts: the full cohort, which included potential confounders as covariates in multivariable-adjusted regression models, and the propensity score-matched cohort. RESULTS: Crude mortality rates for fracture patients were double those of non-fracture patients and persisted during the 5-year period. The association between hip fracture and mortality was significant even after adjusting for premorbid conditions (hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.13-1.32). Similar findings were observed in the propensity score-matched cohort of 2410 patients (HR 1.20, 95% CI 1.05-1.36). While cause-specific mortality rates for all categories, with the exception of sudden deaths, were higher for fracture patients relative to non-fracture patients in the full unmatched cohort, only the mortality rate for heart disease was significantly higher for fracture patients relative to non-fracture patients in the propensity score-matched cohort. CONCLUSION: Excess mortality persisted for many years after hip fracture in hemodialysis patients, and was still present after adjusting for several premorbid conditions and propensity score matching.

    DOI: 10.1007/s00774-020-01110-4

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  • Lifetime and age-conditional risk estimates of end-stage kidney disease requiring maintenance dialysis in Japan. 査読

    Minako Wakasugi, Ichiei Narita

    Clinical and experimental nephrology   24 ( 6 )   518 - 525   2020年6月

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    担当区分:筆頭著者, 責任著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Lifetime risk is an epidemiologic measure that expresses the probability of disease in the remaining lifetime for an index age. It is also an easily understandable statistical measure used to communicate the absolute risk of disease to the lay population. The lifetime risk of end-stage kidney disease (ESKD) has never been reported for the Japanese population. Here, we used data from the Japanese Society of Dialysis Therapy (JSDT) to estimate the lifetime risk of ESKD by sex in Japan. METHODS: The lifetime risk of ESKD was estimated using life-table methods. We defined an incident case of ESKD as a patient with loss of kidney function that resulted in maintenance dialysis therapy. The number of incident cases of ESKD and number of ESKD deaths in 2017 were obtained from data published by the JSDT. The population and total number of deaths in Japan for the same year were obtained from National Vital Statistics. By including all-cause mortality, risks were adjusted for competing causes of death. RESULTS: The cumulative incidence of ESKD from birth until age 95 years was 3.14% [95% confidence interval (CI) 3.10-3.18] for men and 1.42% (1.39-1.44) for women. These probabilities illustrate that approximately 1 in 32 men and 1 in 71 women in Japan will develop ESKD that results in maintenance dialysis therapy in their lifetime. CONCLUSIONS: Considerable sex differences were found in the lifetime risk of ESKD in Japan. This easily understandable information could be used to assist in public health education and planning.

    DOI: 10.1007/s10157-020-01860-5

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  • The Association between Earlobe Creases and Cardiovascular Events in Japanese Hemodialysis Patients: A Prospective Cohort Study. 査読

    Minako Wakasugi, Masaaki Nagai, Saori Yokota, Kentaro Omori, Hirokazu Fujikawa, Ikuo Aoike, Tsukasa Omori, Junichiro James Kazama, Ichiei Narita

    Internal medicine (Tokyo, Japan)   59 ( 7 )   927 - 932   2020年4月

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    担当区分:筆頭著者, 責任著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Objective The earlobe crease, a wrinkle extending from the tragus to the outer border of the earlobe, is a well-known surrogate marker for a high risk of cardiovascular disease. However, information is lacking about its association with cardiovascular events among hemodialysis patients, who already have an increased risk of cardiovascular disease. We tested the hypothesis that earlobe creases are independently associated with the risk of cardiovascular events among Japanese hemodialysis patients. Methods This prospective cohort study followed 247 adult hemodialysis patients with no history of cardiovascular disease for 4 years. The presence of earlobe creases was defined by two researchers using photos of patients' earlobes on both sides while blinded to one another's assessments and clinical data. The primary outcome was defined as the first fatal or nonfatal cardiovascular event (myocardial infarction, ischemic or hemorrhagic stroke, or peripheral vascular disease requiring aortic or peripheral vascular bypass surgery or below- or above-the-knee amputation). A Fine-Gray competing risks regression model was used to examine the association between earlobe creases and cardiovascular events. Results During the 4-year follow-up period, 43 patients suffered cardiovascular events. After the competing risk of non-cardiovascular death was accounted for, patients with earlobe creases had an increased cumulative incidence of cardiovascular events compared to those without earlobe creases (subhazard ratio =2.04, 95% confidence interval: 1.09 to 3.82). This association was no longer significant after adjusting for age. Conclusion Earlobe creases were not independently associated with cardiovascular events among Japanese hemodialysis patients, suggesting that these marks are simply indicative of advanced age.

    DOI: 10.2169/internalmedicine.3943-19

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  • Secular trends in end-stage kidney disease requiring renal replacement therapy in Japan: Japanese Society of Dialysis Therapy Registry data from 1983 to 2016. 査読 国際誌

    Minako Wakasugi, Junichiro J Kazama, Ichiei Narita

    Nephrology (Carlton, Vic.)   25 ( 2 )   172 - 178   2020年2月

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    担当区分:筆頭著者, 責任著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

    AIM: We aimed to describe secular trends in the incidence of end-stage kidney disease (ESKD) requiring renal replacement therapy (RRT) in Japan, and to assess the effect of population aging on the incidence of ESKD. METHODS: The national incidence of ESKD requiring RRT was calculated using published data and Japan's population statistics. Age-standardized incidence was calculated by direct standardization using the World Standard Population. The average annual percentage of change (APC) in rates and corresponding 95% confidence interval (CI) were computed for trends by joinpoint regression analysis. To assess the effect of population aging on the incidence of ESKD requiring RRT, we used the method proposed by Bashir and Estève, which splits the crude incidence into three components: population structure, population size, and age-independent risk. RESULTS: Age-standardized incidence trends (1983-1996) increased significantly in both men (APC 6.33, 95% CI: 5.39-7.29) and women (APC 5.25, 95% CI: 4.26-6.24). With a significant inflection point in 1996, the trend was stable for men (APC -0.16, 95% CI: -0.48 to 0.17) but significantly decreased for women (APC -1.98, 95% CI: -2.38 to -1.59) from 1996 to 2016. The main reason for the increase in those with ESKD requiring RRT has changed; before 1996, the change in age-independent risk was the main contributor, but after 1996, the change in age structure with a higher proportion of older individuals was the main contributor. CONCLUSION: The increase in number of ESKD patients requiring RRT dramatically changed in Japan during the 1983 to 2016 period.

    DOI: 10.1111/nep.13595

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  • Hemodialysis Product and Hip Fracture in Hemodialysis Patients: A Nationwide Cohort Study in Japan. 査読 国際誌

    Minako Wakasugi, Junichiro J Kazama, Kan Kikuchi, Kaoru Yasuda, Atsushi Wada, Takayuki Hamano, Ikuto Masakane, Ichiei Narita

    Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy   23 ( 6 )   507 - 517   2019年12月

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    担当区分:筆頭著者, 責任著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

    Some have raised concerns that longer and more frequent hemodialysis (HD) would be associated with bone fractures due to excess phosphate removal. We examined the effects of hemodialysis product (HDP) on hip fracture incidence among Japanese HD patients using registry data of the Japanese Society for Dialysis Therapy. During a 1-year study period, 1411 hip fractures occurred among 135 984 patients. After adjusting for demographic and clinical factors, patients with a high HDP did not show a significant risk of hip fracture. Interestingly, patients with polycystic kidney disease had a lower risk of hip fracture. Our findings did not support the hypothesis that patients undergoing longer and more frequent HD would face a higher risk of hip fracture than those undergoing shorter and less frequent HD. Polycystic kidney disease was identified as a new significant factor for hip fracture; relative to glomerulonephritis, this condition was associated with a lower risk of hip fracture.

    DOI: 10.1111/1744-9987.12807

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  • Functional impairment attenuates the association between high serum phosphate and mortality in dialysis patients: a nationwide cohort study. 査読 国際誌

    Minako Wakasugi, Junichiro James Kazama, Atsushi Wada, Takayuki Hamano, Ikuto Masakane, Ichiei Narita

    Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association   34 ( 7 )   1207 - 1216   2019年7月

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    担当区分:筆頭著者, 責任著者   記述言語:英語   掲載種別:研究論文(学術雑誌)  

    BACKGROUND: Both functional impairment and abnormalities in mineral and bone disorder (MBD) parameters are well-known predictors of mortality in dialysis patients. However, previous studies have not evaluated whether functional impairment modifies the association between MBD parameters and mortality. METHODS: A nationwide prospective cohort study was conducted using data from the Japanese Society for Dialysis Therapy Renal Data Registry collected at the end of 2009 and 2010. The Eastern Cooperative Oncology Group performance status (PS) was used to assess functional status. Cox proportional hazards models were used to assess the associations of baseline functional status, serum phosphate, albumin-corrected calcium and intact parathyroid hormone (PTH) with 1-year all-cause mortality. RESULTS: By 31 December 2010, 18 447 of 220 054 prevalent dialysis patients (8.4%) had died. Mortality significantly increased with worsening PS grade. PS grade modified the association of serum phosphate levels with mortality (Pinteraction = 0.001). Worsening PS grade attenuated the association of hyperphosphatemia (≥7.4 mg/dL) with mortality, and hyperphosphatemia was no longer significant on mortality among patients with the worst PS grade (hazard ratio = 1.1, 95% confidence interval 0.88-1.39), compared with the level between 3.5 and 4.7 mg/dL. In contrast, hypophosphatemia (<3.5 mg/dL) had a greater adjusted risk of mortality irrespective of PS grade. Serum-corrected calcium (Pinteraction = 0.26) and intact PTH (Pinteraction = 0.17) showed consistent associations with mortality irrespective of PS grade. Findings were robust in several sensitivity analyses. CONCLUSIONS: Functional impairment was significantly associated with 1-year mortality and attenuated the effect of hyperphosphatemia on mortality among prevalent dialysis patients.

    DOI: 10.1093/ndt/gfy253

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  • 透析導入の見合わせ(非導入)割合の推計 査読

    若杉 三奈子, 成田 一衛

    日本腎臓学会誌   61 ( 2 )   91 - 97   2019年3月

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    担当区分:筆頭著者, 責任著者   記述言語:日本語   出版者・発行元:(一社)日本腎臓学会  

    目的:すべての末期腎不全患者が腎代替療法を受けるわけではなく、透析導入の見合わせ(以下、非導入)という選択肢もある。豪州の推計では、加齢とともに非導入割合が増大したが、わが国の現状は不明である。そこで、公表データを用いて、わが国高齢者の非導入割合を推計した。方法:2014年の人口動態統計(死因統計)、ならびに、日本透析医学会の維持透析患者死亡数、透析導入患者数を用いた。慢性腎不全を原死因とする死亡患者数から維持透析患者の全死亡数を差し引いた人数を、非導入患者数と定義した。性・年齢階級別に非導入患者数を求め、同年の導入患者数との和を分母、非導入患者数を分子とした非導入割合を求めた。感度分析として、2012、2013、2015、2016年のデータでも同様の検討を行った。結果:2014年の慢性腎不全を原死因とする死亡者数は20,989人と、同年の維持透析患者全死亡数29,525人よりも少なかった。すなわち、維持透析患者死亡例の多くは、慢性腎不全以外の原死因で死亡診断書・検案書が書かれていた。男女とも85歳未満では慢性腎不全を原死因とする死亡者数よりも維持透析患者死亡数が上回っていたため、上記で定義した非導入患者数の推計が不可能であった。そのため、計算可能な85歳以上について検討した。2014年の慢性腎不全を原死因とする85歳以上の死亡者数は、男性4,540人、女性6,993人、これらのうち、非導入で死亡したと考えられる人数は、男性1,183人、女性4,007人と推計された。非導入の割合は、85〜89歳男性6.5%、女性22.1%、90〜94歳男性68.4%、女性85.1%、95歳以上男性90.5%、女96.7%と、男女とも加齢とともに増大した。感度分析でも同様の結果であった。研究の限界:別の原死因に分類されている非導入患者も多いと考えられ、真の非導入割合はこれよりも大きい。総括:わが国においても、加齢とともに非導入割合は増大する。更なる高齢化が予測されるわが国では、非導入選択の機会が増える可能性があり、非導入の判断基準となるエビデンスが求められる。(著者抄録)

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  • Hyperphosphatemia is not significantly associated with increased all-cause mortality in Korean hemodialysis patients 査読

    Wakasugi M, Sakaguchi Y

    Kidney Research and Clinical Practice   37 ( 4 )   420 - 421   2018年12月

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    担当区分:筆頭著者, 責任著者  

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  • Parathyroid Hormone and Bone in Dialysis Patients 査読

    Junichiro James Kazama, Minako Wakasugi

    Therapeutic Apheresis and Dialysis   22 ( 3 )   229 - 235   2018年6月

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    記述言語:英語   出版者・発行元:Blackwell Publishing Ltd  

    Bone maintains extracellular calcium levels through a system called bone remodeling. Parathyroid hormone (PTH) is the major initiator of this system, which is secreted by the information through calcium sensing receptor in parathyroid cells. PTH modifies calcified bone morphology through a process of its bone action. Therefore, extremely hyperactivated parathyroid function seen in patients with chronic kidney disease has been considered to have a negative impact on the bone mechanical properties. While skeletal deformities and fragility fractures were common among dialysis patients up to the 1970s, after which methods for the treatment of hyperparathyroidism were developed, we now seldom encounter those cases with severe secondary hyperparathyroidism in Japan. In a three-dimensional morphometry of biopsied iliac bone samples obtained from dialysis patients, PTH level was inversely correlated with cortical bone thickness, however, this relationship disappeared among those with intact PTH &lt
    1000 pg/mL. Higher PTH levels were associated with more complicated and irregular cancellous bone surface, but this change was not accompanied with decreased cancellous bone connectivity. These findings theoretically support the recent clinical study results that PTH levels no longer show a tight correlation with fracture risk in dialysis patients. Nevertheless, the use of calcium sensing receptor agonist is likely to be associated with reduced hip fracture risk in dialysis patients. Further study is needed to reveal its pharmacological mechanism on bone.

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  • Emotional disturbance assessed by the Self-Rating Depression Scale test is associated with mortality among Japanese Hemodialysis patients. 査読

    Kazama S, Kazama JJ, Wakasugi M, Ito Y, Narita I, Tanaka M, Horiguchi F, Tanigawa K

    Fukushima journal of medical science   64 ( 1 )   23 - 29   2018年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)  

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  • Hip Fracture Trends in Japanese Dialysis Patients, 2008-2013 査読

    Minako Wakasugi, Junichiro James Kazama, Atsushi Wada, Takayuki Hamano, Ikuto Masakane, Ichiei Narita

    American Journal of Kidney Diseases   71 ( 2 )   173 - 181   2018年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:W.B. Saunders  

    Background: Contrary to observations of decreasing rates in Western nations for the past 2 decades, age-adjusted rates of hip fracture in the general population in Japan have continually increased. This study aimed to analyze recent changes in trends of hip fracture incidence among Japanese dialysis patients between 2008 and 2013. Study Design, Setting, &amp
    Participants: Using data from the Japanese Society for Dialysis Therapy Renal Data Registry database from 2007 to 2013, we created a point-prevalent study cohort for each study year. Prevalent dialysis cohorts included patients 20 years or older without a history of hip fracture who were receiving maintenance dialysis in Japan on December 31 of each year. Factors: Age, sex, and calendar year. Outcomes: Hip fracture incidence rates. Measurements: Unadjusted hip fracture rates were estimated using number of events per 1,000 patient-years in each year and then standardized for age to the 2013 dialysis population. Average annual percentage of change in rates and corresponding 95% CI were computed for trend by joinpoint regression analysis. Results: During the study period, 6,615 and 4,963 hip fractures were recorded among female and male dialysis patients, respectively. Age-standardized hip fracture rates decreased steadily from 2008 (21.1/1,000 patient-years) to 2013 (17.7/1,000 patient-years) among women, but remained constant from 2008 (8.6/1,000 patient-years) through 2013 (8.2/1,000 patient-years) among men. Decreases in the joinpoint trend for hip fracture were significant among female (−3.6% [95% CI, −6.9 to −0.2] per year), but not among male, dialysis patients (−1.4% [95% CI, −5.7 to 3.0] per year) from 2008 through 2013. Limitations: Only the first hip fracture event was considered in calculations of fracture rates. Conclusions: In contrast to the increasing incidence of hip fracture in the general Japanese population, we found that the incidence of hip fracture in Japanese dialysis patients between 2008 and 2013 decreased among women, but did not change in men.

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  • Premature mortality due to nephrotic syndrome and the trend in nephrotic syndrome mortality in Japan, 1995–2014 査読

    Minako Wakasugi, Junichiro James Kazama, Ichiei Narita

    Clinical and Experimental Nephrology   22 ( 1 )   55 - 60   2018年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Springer Tokyo  

    Background: This study analysed the trend in mortality from nephrotic syndrome in Japan from 1995 to 2013. Moreover, to better understand premature death from nephrotic syndrome, the average years of life lost due to nephrotic syndrome were estimated. Methods: National death certificate data were evaluated. Age-standardised mortality rates from nephrotic syndrome were calculated by direct standardisation using the World Standard Population. Trends for average annual changes in percentages were determined by joinpoint regression analysis. Average years of life lost were estimated by dividing total years of life lost by the number of deaths from nephrotic syndrome. Years of life lost were estimated by the constant end-point method, with 65 years as the endpoint. Average years of life lost due to malignant neoplasms, the leading cause of death in Japan, were estimated for comparison. Results: There were 9945 deaths (4872 men and 5073 women) during the study period. The numbers of deaths and crude overall mortality rates increased, while age-standardised mortality rates continuously decreased, for both sexes. The annual percentage changes were −1.9% [95% confidence interval (CI), −2.3 to −1.4%] for men and −3.5% (95% CI −4.1 to −2.9%) for women. The average years of life lost due to nephrotic syndrome decreased during the study period, but were greater than for patients who died of malignant neoplasm. Conclusions: Mortality and premature mortality rates from nephrotic syndrome significantly decreased in Japan between 1995 and 2014. Despite these improvements, nephrotic syndrome patients ≤65 years of age still have a poor prognosis.

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  • Self-reported slower eating is associated with a lower salt intake: A population-based cross-sectional study 査読

    Minako Wakasugi, Junichiro James Kazama, Ichiei Narita

    Internal Medicine   57 ( 11 )   1561 - 1567   2018年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Japanese Society of Internal Medicine  

    Objective Evidence suggests that the eating rate is positively associated with the body weight and blood pressure. Furthermore, people who are overweight or obese tend to have higher salt intakes than those of normal weight. To investigate whether or not the eating rate is also associated with the salt intake, a cross-sectional study was conducted using health examination survey data collected in 2014 from 7,941 residents of Sado City, Niigata, Japan. Methods The eating rates were evaluated using a questionnaire
    11.7% of participants rated themselves as slow eaters, 65.6% as normal eaters, and 22.7% as fast eaters. The salt intake was estimated from sodium and creatinine spot urine measurements using Tanaka’s formula. Associations with eating rate were evaluated using multivariate linear regression analyses, with normal eaters as the reference (set at 0). Results Self-reported eating rates were positively associated with the salt intake after adjustment for age and sex [β coefficient (95% confidence interval) for slow-0.51 (-0.67,-0.35)
    fast 0.18 (0.05, 0.30)]. Further adjustment for the body mass index showed that slower eaters had lower salt intakes than normal eaters, but there was no marked difference in the salt intake between normal and fast eaters. The association between slower eating and a lower salt intake persisted after further adjustment for comorbidities [slow-0.33 (-0.49,-0.18)]. Conclusion Our results suggest that reducing eating rates may be an effective strategy for reducing dietary salt intake as well as preventing obesity.

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  • Prevalence of Earlobe Creases and Their Association With History of Cardiovascular Disease in Patients Undergoing Hemodialysis: A Cross-Sectional Study 査読

    Minako Wakasugi, Junichiro James Kazama, Kazuko Kawamura, Suguru Yamamoto, Masaaki Nagai, Kentaro Omori, Saori Yokota, Hirokazu Fujikawa, Ikuo Aoike, Tsukasa Omori, Ichiei Narita

    Therapeutic Apheresis and Dialysis   21 ( 5 )   478 - 484   2017年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:Blackwell Publishing Ltd  

    Earlobe creases are surrogate markers for high risk of cardiovascular disease. There is no data concerning earlobe creases among hemodialysis patients, who have an increased risk of cardiovascular disease. A cross-sectional study was conducted to determine the prevalence of earlobe creases and their association with prevalent cardiovascular disease among hemodialysis patients. Patients undergoing hemodialysis were recruited from five outpatient hemodialysis centers. Both earlobes were photographed during a dialysis session with the patient in a supine position and the photos evaluated independently by two experienced nephrologists blinded to the participants' clinical characteristics. Prevalent cardiovascular diseases were defined as a history of myocardial infarction, cerebrovascular accident, or peripheral vascular disease. Sensitivity, specificity, and positive and negative predictive values for detection of prevalent cardiovascular disease were calculated. Logistic analysis was used to examine the association between earlobe creases and prevalent cardiovascular disease. Earlobe creases were identified in 24.5% of 330 hemodialysis patients (200 men
    mean age, 67.8 years). The prevalence of earlobe creases increased with age for men (P for trend &lt
    0.0001), but not for women (P for trend = 0.07). Sensitivity, specificity, and positive and negative predictive values were 30.9% (95% confidence interval, 21.9–41.6), 77.5% (71.9–82.3), 30.9% (21.9–41.6), and 77.5% (71.9–82.3), respectively. Multivariate logistic analyses indicated the prevalence of earlobe crease was not associated with prevalent cardiovascular diseases. The prevalence is similar to that previously reported for Japanese individuals not undergoing dialysis. No association between earlobe creases and prevalent cardiovascular diseases was identified.

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  • Prevalence of Earlobe Creases and Their Association With History of Cardiovascular Disease in Patients Undergoing Hemodialysis: A Cross-Sectional Study 査読

    Minako Wakasugi, Junichiro James Kazama, Kazuko Kawamura, Suguru Yamamoto, Masaaki Nagai, Kentaro Omori, Saori Yokota, Hirokazu Fujikawa, Ikuo Aoike, Tsukasa Omori, Ichiei Narita

    THERAPEUTIC APHERESIS AND DIALYSIS   21 ( 5 )   478 - 484   2017年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY  

    Earlobe creases are surrogate markers for high risk of cardiovascular disease. There is no data concerning earlobe creases among hemodialysis patients, who have an increased risk of cardiovascular disease. A cross-sectional study was conducted to determine the prevalence of earlobe creases and their association with prevalent cardiovascular disease among hemodialysis patients. Patients undergoing hemodialysis were recruited from five outpatient hemodialysis centers. Both earlobes were photographed during a dialysis session with the patient in a supine position and the photos evaluated independently by two experienced nephrologists blinded to the participants' clinical characteristics. Prevalent cardiovascular diseases were defined as a history of myocardial infarction, cerebrovascular accident, or peripheral vascular disease. Sensitivity, specificity, and positive and negative predictive values for detection of prevalent cardiovascular disease were calculated. Logistic analysis was used to examine the association between earlobe creases and prevalent cardiovascular disease. Earlobe creases were identified in 24.5% of 330 hemodialysis patients (200 men; mean age, 67.8 years). The prevalence of earlobe creases increased with age for men (P for trend &lt;0.0001), but not for women (P for trend = 0.07). Sensitivity, specificity, and positive and negative predictive values were 30.9% (95% confidence interval, 21.9-41.6), 77.5% (71.9-82.3), 30.9% (21.9-41.6), and 77.5% (71.9-82.3), respectively. Multivariate logistic analyses indicated the prevalence of earlobe crease was not associated with prevalent cardiovascular diseases. The prevalence is similar to that previously reported for Japanese individuals not undergoing dialysis. No association between earlobe creases and prevalent cardiovascular diseases was identified.

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  • Association between Overall Lifestyle Changes and the Incidence of Proteinuria: A Population-based, Cohort Study 査読

    Minako Wakasugi, Junichiro Kazama, Ichiei Narita, Kunitoshi Iseki, Shouichi Fujimoto, Toshiki Moriyama, Kunihiro Yamagata, Tsuneo Konta, Kazuhiko Tsuruya, Koichi Asahi, Masahide Kondo, Issei Kurahashi, Yasuo Ohashi, Kenjiro Kimura, Tsuyoshi Watanabe

    INTERNAL MEDICINE   56 ( 12 )   1475 - 1484   2017年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    Objective This study aimed to examine the association between the changes in an overall healthy lifestyle, as quantified by the number of unhealthy lifestyle factors and obesity status, and the incidence of proteinuria in the general Japanese population.
    Methods A retrospective cohort study was conducted among 99,404 (men, 36.9%) participants aged from 40-74 years of age who underwent two health check-ups with a 1-year interval in Japan between 2008 and 2009. Any participants with chronic kidney disease at baseline were excluded. The smoking status, body mass index, physical activity, alcohol consumption, and healthy eating habits were combined into a simple overall healthy lifestyle score ranging from 0 to 5. The changes in overall healthy lifestyle scores from baseline (range, -5 to + 5) and the incidence of proteinuria, defined by a dipstick urinalysis (score &gt;= 1+), were assessed at the second check-up. A logistic regression analysis was used to examine the association between the changes in overall healthy lifestyle scores and the incidence of proteinuria.
    Results After one year of follow-up, 3.9% of men and 2.4% of women developed proteinuria. Each increase (or decrease) in the changes in overall healthy lifestyle scores was associated with a reduced (or increased) risk of proteinuria in both men (odds ratio (OR) 0.87; 95% confidence interval (CI), 0.81-0.94) and women (OR 0.87; 95% CI, 0.80-0.94) after adjusting for age, baseline lifestyle scores, hypertension, diabetes mellitus, and hypercholesterolemia. Stratified analyses based on age, the presence or absence of hypertension, or diabetes mellitus revealed similar results.
    Conclusion Overall lifestyle changes, even within a year, were found to influence the incidence of proteinuria.

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  • Mortality trends among Japanese dialysis patients, 1988-2013: a joinpoint regression analysis 査読

    Minako Wakasugi, Junichiro James Kazama, Ichiei Narita

    NEPHROLOGY DIALYSIS TRANSPLANTATION   31 ( 9 )   1501 - 1507   2016年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:OXFORD UNIV PRESS  

    Evaluation of mortality trends in dialysis patients is important for improving their prognoses. The present study aimed to examine temporal trends in deaths (all-cause, cardiovascular, noncardiovascular and the five leading causes) among Japanese dialysis patients.
    Mortality data were extracted from the Japanese Society of Dialysis Therapy registry. Age-standardized mortality rates were calculated by direct standardization against the 2013 dialysis population. The average annual percentage of change (APC) and the corresponding 95% confidence interval (CI) were computed for trends using joinpoint regression analysis.
    A total of 469 324 deaths occurred, of which 25.9% were from cardiac failure, 17.5% from infectious disease, 10.2% from cerebrovascular disorders, 8.6% from malignant tumors and 5.6% from cardiac infarction. The joinpoint trend for all-cause mortality decreased significantly, by -3.7% (95% CI -4.2 to -3.2) per year from 1988 through 2000, then decreased more gradually, by -1.4% (95% CI -1.7 to -1.2) per year during 2000-13. The improved mortality rates were mainly due to decreased deaths from cardiovascular disease, with mortality rates due to noncardiovascular disease outnumbering those of cardiovascular disease in the last decade. Among the top five causes of death, cardiac failure has shown a marked decrease in mortality rate. However, the rates due to infectious disease have remained stable during the study period [APC 0.1 (95% CI -0.2-0.3)].
    Significant progress has been made, particularly with regard to the decrease in age-standardized mortality rates. The risk of cardiovascular death has decreased, while the risk of death from infection has remained unchanged for 25 years.

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  • Age-and gender-specific incidence rates of renal replacement therapy in Japan: an international comparison 査読

    Wakasugi Minako, Kazama Junichiro James, Narita Ichiei

    Renal Replacement Therapy   2 ( 1 )   1   2016年

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  • Anticipated Increase in the Number of Patients Who Require Dialysis Treatment Among the Aging Population of Japan 査読

    Minako Wakasugi, Junichiro James Kazama, Ichiei Narita

    THERAPEUTIC APHERESIS AND DIALYSIS   19 ( 3 )   201 - 206   2015年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    The aging population is anticipated to have a large impact on the number of incident dialysis patients, as the risk of end-stage kidney disease increases with age. This study aimed to examine trends in the sex- and age-specific incidence rates of dialysis between 2008 and 2012, and to assess the impact of population aging on the number of incident dialysis patients over the next decade in Japan. Incidence was calculated using published data and Japan's population statistics. The 2012 incidence was extrapolated, and projected future demographic changes within the Japanese population were used to estimate the number of incident dialysis patients in 2020 and 2025. As a general trend, the sex- and age-specific incidence rates of dialysis decreased gradually between 2008 and 2012, except among men aged 80 years. The total number of incident dialysis patients was projected to increase by 12.8% from 36590 in 2012 to 41270 in 2025. Greater increases were observed in the oldest age group (85 years). In 2025, the number of incident dialysis patients in this group was projected to increase by 92.6% in men and 62.2% in women. This study shows the number of patients who initiate dialysis treatment is projected to increase over the next decade in Japan due to aging of the population. Effective strategies are needed to offset the challenges faced by the aging population, with a particular focus on octogenarians and older, given the notable proportion of patients requiring dialysis treatment in the future.

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  • Higher Mortality Due to Intracerebral Hemorrhage in Dialysis Patients: A Comparison with the General Population in Japan 査読

    Minako Wakasugi, Koji Matsuo, Junichiro James Kazama, Ichiei Narita

    THERAPEUTIC APHERESIS AND DIALYSIS   19 ( 1 )   45 - 49   2015年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    Cerebrovascular diseases, including intracerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage, remain prevalent causes of morbidity and mortality among dialysis patients. Their mortality rate for cerebrovascular diseases is roughly three times higher than that in the general population. However, whether mortality rates for all subtypes of cerebrovascular diseases are equally higher has not been evaluated. The aim of this study was to determine the mortality rate for each stroke subtype, comparing dialysis patients and the general population in Japan. We used mortality data reported by the Japanese Society for Dialysis Therapy and national Vital Statistics data between 2008 and 2009. We calculated standardized mortality ratios and compared the mortality rates for stroke subtypes including intracerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage. During the 2-year study period, 51994 and 933 deaths from intracerebral hemorrhage, 79124 and 511 deaths from cerebral infarction, and 24957 and 147 deaths from subarachnoid hemorrhage were recorded per 252 million person-years and per 546474 dialysis patient-years, respectively. Standardized mortality ratios among dialysis patients relative to the general population were 3.8 (95% confidence interval, 3.6-4.1), 1.3 (1.2-1.4), and 1.3 (1.1-1.6) for intracerebral hemorrhage, cerebral infarction, and subarachnoid hemorrhage, respectively. Intracerebral hemorrhage was the highest cause of mortality in the dialysis population, although cerebral infarction was the highest in the general population. Relative to the general population in Japan, Japanese dialysis patients had higher mortality rates, especially for intracerebral hemorrhage.

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  • Association between Hypouricemia and Reduced Kidney Function: A Cross-Sectional Population-Based Study in Japan 査読

    Minako Wakasugi, Junichiro James Kazama, Ichiei Narita, Tsuneo Konta, Shouichi Fujimoto, Kunitoshi Iseki, Toshiki Moriyama, Kunihiro Yamagata, Kazuhiko Tsuruya, Koichi Asahi, Kenjiro Kimura, Masahide Kondo, Issei Kurahashi, Yasuo Ohashi, Tsuyoshi Watanabe

    AMERICAN JOURNAL OF NEPHROLOGY   41 ( 2 )   138 - 146   2015年

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    記述言語:英語   出版者・発行元:KARGER  

    Background: Hypouricemia, conventionally defined as a serum uric acid level of = 2 mg/dl, is considered a biochemical disorder with no clinical significance. However, individuals with renal hypouricemia have a high risk of urolithiasis and exercise-induced acute kidney injury, both of which are risk factors for reduced kidney function. Methods: To test the hypothesis that individuals with hypouricemia would be at a higher risk of reduced kidney function, we conducted a population-based cross-sectional study using data from the Specific Health Checkups and Guidance System in Japan. Logistic analysis was used to examine the relationship between hypouricemia and reduced kidney function, defined as estimated glomerular filtration rate &lt;60 ml/min/1.73 m(2). Results: Among 90,710 men (mean age, 63.8 years) and 136,935 women (63.7 years), 193 (0.2%) and 540 (0.4%) were identified as having hypouricemia, respectively. The prevalence of hypouricemia decreased with age in women (p for trend &lt;0.001), but not in men (p for trend = 0.24). Hypouricemia was associated with reduced kidney function in men (odds ratio, 1.83; 95% confidence interval, 1.23-2.74), but not in women (0.61; 0.43-0.86), relative to the reference category (i.e., serum uric acid levels of 4.1-5.0 mg/dl) after adjusting for age, drinking, smoking, diabetes, hypertension, hypercholesterolemia, obesity, and history of renal failure. Sensitivity analyses stratified by diabetic status yielded similar results. Conclusions: This study is the first to provide evidence that hypouricemia is associated with reduced kidney function in men. Further research will be needed to determine the long-term prognosis of individuals with hypouricemia. (C) 2015 S. Karger AG, Basel

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  • Associations between the Intake of Miso Soup and Japanese Pickles and the Estimated 24-hour Urinary Sodium Excretion: A Population-based Cross-sectional Study 査読

    Minako Wakasugi, Junichiro James Kazama, Ichiei Narita

    INTERNAL MEDICINE   54 ( 8 )   903 - 910   2015年

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:JAPAN SOC INTERNAL MEDICINE  

    Objective In Japan, reducing the consumption of miso soup and Japanese pickles, both traditional Japanese dishes, is recommended in order to decrease dietary salt intake. With the Westernization of dietary habits, however, these dishes are now consumed less frequently, and thus a reduction in their effect on sodium intake is suspected. This study examined cross-sectional associations between the frequency of intake of miso soup and Japanese pickles and the estimated 24-hour urine sodium excretion using data obtained from health examination surveys conducted in 2013 in Sado City, Japan.
    Methods The level of daily salt intake was estimated based on spot urine sodium and creatinine measurements. The frequency of intake of miso soup and Japanese pickles was determined using a self-reported questionnaire. Multiple linear regression models were used to assess associations.
    Results Among a total of 8,821 participants (3,956 men; age range, 19-97 years), the mean daily salt intake was 9.4 g/day. The frequency of intake of miso soup and Japanese pickles increased with age and was associated with the level of daily salt intake (p for trend &lt;0.0001). A linear regression model analysis adjusted for age, sex, body mass index, hypertension, diabetes, hypercholesterolemia and chronic kidney disease revealed that daily salt intake was associated with the frequency of intake of miso soup (p&lt;0.0001) and Japanese pickles (p&lt;0.0001) in all age groups, except those &gt;= 80 years of age.
    Conclusion These findings suggest that reducing the consumption of miso soup and Japanese pickles may be an effective approach for decreasing the level of dietary salt intake in the general Japanese population, although not in octogenarians or nonagenarians.

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  • Intracerebral hemorrhage was the highest cause of mortality among stroke subtypes in Japanese dialysis patients 査読

    Minako Wakasugi, Junichiro J. Kazama, Ichiei Narita

    HEMODIALYSIS INTERNATIONAL   18 ( 4 )   848 - 849   2014年10月

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    記述言語:英語   出版者・発行元:WILEY-BLACKWELL  

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  • Association between Combined Lifestyle Factors and Non-Restorative Sleep in Japan: A Cross-Sectional Study Based on a Japanese Health Database 査読

    Minako Wakasugi, Junichiro James Kazama, Ichiei Narita, Kunitoshi Iseki, Toshiki Moriyama, Kunihiro Yamagata, Shouichi Fujimoto, Kazuhiko Tsuruya, Koichi Asahi, Tsuneo Konta, Kenjiro Kimura, Masahide Kondo, Issei Kurahashi, Yasuo Ohashi, Tsuyoshi Watanabe

    PLOS ONE   9 ( 9 )   e108718   2014年9月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:PUBLIC LIBRARY SCIENCE  

    Background: Although lifestyle factors such as cigarette smoking, excessive drinking, obesity, low or no exercise, and unhealthy dietary habits have each been associated with inadequate sleep, little is known about their combined effect. The aim of this study was to quantify the overall impact of lifestyle-related factors on non-restorative sleep in the general Japanese population.
    Methods and Findings: A cross-sectional study of 243,767 participants (men, 39.8%) was performed using the Specific Health Check and Guidance System in Japan. A healthy lifestyle score was calculated by adding up the number of low-risk lifestyle factors for each participant. Low risk was defined as (1) not smoking, (2) body mass index,&lt;25 kg/m(2), (3) moderate or less alcohol consumption, (4) regular exercise, and (5) better eating patterns. Logistic regression analysis was used to examine the relationship between the score and the prevalence of non-restorative sleep, which was determined from questionnaire responses. Among 97,062 men (mean age, 63.9 years) and 146,705 women (mean age, 63.7 years), 18,678 (19.2%) and 38,539 (26.3%) reported non-restorative sleep, respectively. The prevalence of non-restorative sleep decreased with age for both sexes. Compared to participants with a healthy lifestyle score of 5 (most healthy), those with a score of 0 (least healthy) had a higher prevalence of non-restorative sleep (odds ratio, 1.59 [95% confidence interval, 1.29-1.97] for men and 2.88 [1.74-4.76] for women), independently of hypertension, hypercholesterolemia, diabetes, and chronic kidney disease. The main limitation of the study was the cross-sectional design, which limited causal inferences for the identified associations.
    Conclusions: A combination of several unhealthy lifestyle factors was associated with non-restorative sleep among the general Japanese population. Further studies are needed to establish whether general lifestyle modification improves restorative sleep.

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  • High rates of death and hospitalization follow bone fracture among hemodialysis patients 査読

    Minako Wakasugi, Junichiro J. Kazama, Ichiei Narita

    KIDNEY INTERNATIONAL   86 ( 3 )   649 - 649   2014年9月

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    記述言語:英語   出版者・発行元:NATURE PUBLISHING GROUP  

    DOI: 10.1038/ki.2014.156

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  • Association between warfarin use and incidence of ischemic stroke in Japanese hemodialysis patients with chronic sustained atrial fibrillation: a prospective cohort study 査読

    Minako Wakasugi, Junichiro James Kazama, Akihide Tokumoto, Kensuke Suzuki, Shinji Kageyama, Kaoru Ohya, Yoshiaki Miura, Mamoru Kawachi, Takuma Takata, Masaaki Nagai, Minoru Ohya, Keiko Kutsuwada, Hideo Okajima, Isei Ei, Sachio Takahashi, Ichiei Narita

    CLINICAL AND EXPERIMENTAL NEPHROLOGY   18 ( 4 )   662 - 669   2014年8月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER  

    Although generally recommended for atrial fibrillation (AF) in the general population, the efficacy and safety of warfarin in hemodialysis patients remains controversial. Warfarin use in hemodialysis patients may confer an additional risk of bleeding that is not appreciated in patients without renal failure because hemodialysis patients have platelet defects and receive anticoagulation agents during dialysis. The incidence of major bleeding was reported to be higher in Japanese AF patients on warfarin therapy compared to patients in other countries, suggesting that racial differences may influence bleeding tendency. Thus, examining risks and benefits of warfarin therapy in Japanese hemodialysis patients with AF is important.
    In order to determine associations between warfarin use and new ischemic stroke events, major bleeding, and all-cause mortality, a prospective cohort study of 60 Japanese hemodialysis patients with chronic sustained AF was conducted using Cox proportional modeling and propensity score matching.
    The mean patient age was 68.1 years. During 110 person-years of follow-up, 13 ischemic strokes occurred. After adjusting for CHADS2 score, warfarin use was not associated with a significant reduction in ischemic stroke events [hazard ratio (HR) 3.36; 95 % confidence interval (CI) 0.94-11.23]. Similar results were obtained after propensity score matching (HR 3.36; 95 % CI 0.67-16.66). Warfarin use was not associated with significant increases in major bleeding or all-cause mortality.
    These results suggest that warfarin may not prevent ischemic stroke in Japanese hemodialysis patients with chronic sustained AF. Adequately powered studies are needed to determine the risks and benefits of anticoagulation therapy in these patients.

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    その他リンク: http://orcid.org/0000-0003-1555-7736

  • Regional Variation in Hip Fracture Incidence Among Japanese Hemodialysis Patients 査読

    Minako Wakasugi, Junichiro James Kazama, Atsushi Wada, Masatomo Taniguchi, Yoshiharu Tsubakihara, Kunitoshi Iseki, Ichiei Narita

    THERAPEUTIC APHERESIS AND DIALYSIS   18 ( 2 )   162 - 166   2014年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    Hip fracture incidence in Japanese hemodialysis patients is five-fold higher than in the general population, although the mechanisms underlying this difference are not fully understood. Substantial regional variation exists in hip fracture incidence in the general Japanese population, despite a uniform health care and insurance system and lack of ethnic and racial variation. In this study, we determined whether the regional variation seen in the general population also applies to hemodialysis patients in Japan. Standardized incidence ratios were calculated for each regional district, and regional variations of hip fracture incidence among hemodialysis patients were evaluated using data obtained from the Japanese Society for Dialysis Therapy registry (data collected from December 2007 to December 2008). Standardized hip fracture incidence ratios across the districts ranged from 0.71 to 1.29 for male and 0.49 to 1.36 for female hemodialysis patients. Incidence ratios tended to be higher in western Japan and lower in eastern Japan, suggesting that regional variation also exists among hemodialysis patients. Our findings suggest that common risk factors for hip fracture may be shared among the general population and hemodialysis patients. Further research aimed at identifying factors, including those associated with regional variation, may help decrease hip fracture incidence in both the general population and hemodialysis patients in Japan.

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  • A hip fracture in a dialysis patient with Aβ2M amyloidosis. 査読

    Kazama JJ, Yamamoto S, Wakasugi M, Narita I

    Kidney international   85 ( 1 )   214 - 215   2014年1月

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    記述言語:英語   出版者・発行元:1  

    DOI: 10.1038/ki.2013.412

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  • Cause-specific excess mortality among dialysis patients: Comparison with the general population in Japan 査読

    Minako Wakasugi, Junichiro James Kazama, Suguru Yamamoto, Kazuko Kawamura, Ichiei Narita

    Therapeutic Apheresis and Dialysis   17 ( 3 )   298 - 304   2013年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:3  

    Despite significant therapeutic advances, mortality of dialysis patients remains unacceptably high. The aim of this study is to compare mortality and its causes in dialysis patients with those in the general Japanese population. We used data for 2008 and 2009 from the Japanese Society for Dialysis Therapy registry and a national Vital Statistics survey. Cardiovascular mortality was defined as death attributed to heart failure, cerebrovascular disorders, myocardial infarction, hyperkalemia/sudden death, and pulmonary thromboembolism. Non-cardiovascular mortality was defined as death attributed to infection, malignancies, cachexia/uremia, chronic hepatitis/cirrhosis, ileus, bleeding, suicide/refusal of treatment, and miscellaneous. We calculated standardized mortality ratios and age-adjusted mortality differences between dialysis patients and the general population for all-cause, cardiovascular versus non-cardiovascular, and cause-specific mortality. During the 2-year study period, there were 2284272 and 51432 deaths out of 126 million people and 273237 dialysis patients, respectively. The standardized mortality ratio for all-cause mortality was 4.6 (95% confidence interval, 4.6-4.7) for the dialysis patients compared to the general population. Age-adjusted mortality differences for cardiovascular and non-cardiovascular disease were 33.1 and 30.0 per 1000 person-years, respectively. The standardized mortality rate ratios were significant for all cause-specific mortality rates except accidental death. Our study revealed that excess mortality in dialysis patients compared to the general population in Japan is large, and differs according to age and cause of death. Cause-specific mortality studies should be planned to improve life expectancies of dialysis patients. © 2012 The Authors Therapeutic Apheresis and Dialysis © 2012 International Society for Apheresis.

    DOI: 10.1111/j.1744-9987.2012.01144.x

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  • Increased risk of hip fracture among Japanese hemodialysis patients 査読

    Minako Wakasugi, Junichiro James Kazama, Masatomo Taniguchi, Atsushi Wada, Kunitoshi Iseki, Yoshiharu Tsubakihara, Ichiei Narita

    JOURNAL OF BONE AND MINERAL METABOLISM   31 ( 3 )   315 - 321   2013年5月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER JAPAN KK  

    Incidence of hip fracture in dialysis patients is significantly higher than that in the general population. As information is lacking about Asian dialysis patients, we compared the incidence of hip fracture in hemodialysis patients with that in the general population in Japan. We conducted a retrospective cohort study using panel data from the Japanese Society for Dialysis Therapy registry. The study included patients without history of hip fracture who received hemodialysis three times per week as of December 31, 2007. We compared the observed number of hip fractures to the expected number derived from a national survey, and calculated standardized incidence ratios (SIRs) and the incidence rate difference. Subgroup analysis was performed according to vintage and diabetic status. During the one-year study period, 1,437 hip fractures were recorded in the 128,141 hemodialysis patients (61.9 % male). The overall incidence was 7.57 and 17.43 per 1,000 person-years in men and women, respectively. The SIRs for male and female patients were 6.2 [95 % confidence interval (CI) 5.7-6.8] and 4.9 (95 % CI 4.6-5.3) compared to the general population, and remained nearly constant until 16 years vintage, but increased steeply thereafter. The incidence rate difference of hip fracture increased with age. The SIRs for diabetics of both genders were higher than those for non-diabetics. Our study provides additional evidence that hip fracture risk among Asian dialysis patients is also significantly higher than in the general population.

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  • A combination of healthy lifestyle factors is associated with a decreased incidence of chronic kidney disease: A population-based cohort study 査読

    Minako Wakasugi, Junichiro J. Kazama, Suguru Yamamoto, Kazuko Kawamura, Ichiei Narita

    Hypertension Research   36 ( 4 )   328 - 333   2013年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:4  

    A combination of healthy lifestyle factors is associated with lower risks of coronary heart disease, diabetes and stroke, but little is known about its association with chronic kidney disease (CKD). This study analyzed the effect of a combination of healthy lifestyle factors on the incidence of proteinuria among participants without CKD. Of the 7565 persons aged 40-79 years who participated in the Specific Health Checkups and Guidance System in Sado Island, Japan in 2008, 4902 participants (2015 males) without CKD were included. The healthy lifestyle score was calculated by summing the total number of lifestyle factors for which the participants were at low risk. Low risk was defined as (1) nonsmoker, (2) body mass index (BMI) &lt
    25 kg m -2, (3) moderate or less alcohol consumption, (4) regular exercise and (5) better eating patterns. Logistic analysis was used to examine the relationship between the baseline score in 2008 and the development of proteinuria in 2009. Proteinuria developed in 2.2% of participants (males, 3.2
    females, 1.5%). Compared with participants with a healthy lifestyle score of 0 to 2, participants with a score of 5 had a lower risk (odds ratio: 0.39, 95% confidence interval: 0.16-0.94), independently of having diabetes, hypertension and hypercholesterolemia. Overall, 47% of the cases in this cohort could be attributed to lack of adherence to this low-risk pattern. These findings underscore the importance of a healthier lifestyle in preventing CKD. © 2013 The Japanese Society of Hypertension All rights reserved.

    DOI: 10.1038/hr.2012.186

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  • Differences in the local and national prevalences of chronic kidney disease based on annual health check program data 査読

    Minako Wakasugi, Junichiro James Kazama, Ichiei Narita

    CLINICAL AND EXPERIMENTAL NEPHROLOGY   16 ( 5 )   749 - 754   2012年10月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:SPRINGER  

    Chronic kidney disease (CKD) is now recognized as a global public health problem, and evaluating the prevalence of CKD at the local level is important and helpful for assessing health care needs and targeted interventions. To assess the current picture concerning CKD in a local area, local and national prevalences of CKD were compared by calculating standardized rate ratios (SRRs) and confidence intervals (CIs).
    For the national prevalence of CKD, the data from a previous report that showed age- and sex-specific prevalence of each stage of CKD on the basis of a large dataset from the Japanese annual health check program were used. Using annual health check program data in Sado City, the SRRs and CIs were calculated.
    The SRRs were 0.70 for males and 0.60 for females, indicating that Sado City had a 30 % lower prevalence of CKD for males and a 40 % lower for females than the national average. The 95 % CIs of the SRRs were calculated as 0.64-0.72 for males and 0.55-0.64 for females. Thus, the prevalence of CKD for both males and females in Sado City is significantly lower than the national average for Japan.
    Because this methodology adjusts for age and sex, it can serve as a useful tool to assess the current picture related to CKD in a local area. We believe that this could be an important step for improving local care to prevent the development of CKD.

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  • High Mortality Rate of Infectious Diseases in Dialysis Patients: A Comparison With the General Population in Japan 査読

    Minako Wakasugi, Kazuko Kawamura, Suguru Yamamoto, Junichiro James Kazama, Ichiei Narita

    THERAPEUTIC APHERESIS AND DIALYSIS   16 ( 3 )   226 - 231   2012年6月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    Infectious disease is the second leading cause of death among dialysis patients, and it is generally assumed that the mortality rate of infectious disease is considerably higher in dialysis patients than in the general population. There are no comprehensive studies on this issue and on the contribution of each category of infectious disease to excess mortality in dialysis patients in Japan. We used mortality data reported to the Japanese Society for Dialysis Therapy and national Vital Statistics data for 2008 and 2009. We calculated standardized mortality ratios and compared the mortality rates for each category of infectious disease. During the 2-year study period, 274 683 and 10 435 deaths from infectious diseases were recorded in 126 million people and 273 237 dialysis patients, respectively. The standardized mortality ratio for all infectious diseases was 7.5 (95% confidence interval, 7.37.6) in dialysis patients with respect to the general population in Japan. The categories of infectious disease with a significantly higher standardized mortality ratio among the dialysis patients were sepsis, peritonitis, influenza, tuberculosis, and pneumonia and in that order. In particular, the mortality rate of sepsis contributed to 69.5% of the difference in infectious disease mortality between dialysis patients and the general population. This study underlines markedly increased mortality from infectious diseases, particularly from sepsis, in dialysis patients compared with the general population.

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  • Weight gain after 20 years of age is associated with prevalence of chronic kidney disease. 査読

    Wakasugi M, Narita I, Iseki K, Moriyama T, Yamagata K, Tsuruya K, Yoshida H, Fujimoto S, Asahi K, Kurahashi I, Ohashi Y, Watanabe T

    Clinical and experimental nephrology   16 ( 2 )   259 - 268   2012年4月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:2  

    DOI: 10.1007/s10157-011-0565-3

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  • Use of Japanese Society for Dialysis Therapy Dialysis Tables to Compare the Local and National Incidence of Dialysis 査読

    Minako Wakasugi, Junichiro James Kazama, Ichiei Narita

    THERAPEUTIC APHERESIS AND DIALYSIS   16 ( 1 )   63 - 67   2012年2月

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    記述言語:英語   掲載種別:研究論文(学術雑誌)   出版者・発行元:WILEY-BLACKWELL  

    The Japanese Society for Dialysis Therapy generates many tables of data on dialysis patients in their annual reports. These tables, derived from over 37 000 patients who started dialysis in 2008, allow comparison of the local incidence of new dialysis patients with the national incidence by estimating a standardized incidence ratio and confidence interval. Since this method adjusts for age and gender, it may be useful to evaluate local strategies for managing chronic kidney disease, including the response to campaigns and local quality assurance. Furthermore, the end-stage renal disease population of other countries can also be directly compared by this method. That is, the age- and gender-adjusted incidence of dialysis can be calculated for another country and compared with the national data for Japan. This might be one step toward improving local care and preventing the progression of chronic kidney disease.

    DOI: 10.1111/j.1744-9987.2011.01030.x

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  • 患者対透析スタッフ比率と都道府県別標準化死亡比 構造方程式モデリング 査読

    若杉 三奈子, 成田 一衛

    日本腎臓学会誌   63 ( 1 )   179 - 186   2021年1月

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    担当区分:筆頭著者, 責任著者   記述言語:日本語   出版者・発行元:(一社)日本腎臓学会  

    目的:患者対看護師比率(看護師1人に対する患者の人数)に代表される医療スタッフの人員配置は、患者アウトカムに影響を与えることが知られているが、透析医療での検討は少ない。本研究は、都道府県別に集約されたデータを用いて、患者対透析医療スタッフ比率の透析患者死亡率に与える影響を、構造方程式モデリングを用いて検証した。方法:一般社団法人日本透析医学会発行の「わが国の慢性透析療法の現況」2016〜2017年データを分析に用いた。透析患者総数を専従の、看護師、臨床工学技士、医師数で除して、患者対看護師比率、患者対臨床工学技士比率、患者対医師比率を求めた。性年齢を調整した透析患者の標準化死亡比(standardized mortality ratio:SMR)を都道府県別に計算し、患者対透析医療スタッフ比率のSMRに対する影響を検証した。結果:透析患者のSMRは76.8〜132.0%と、都道府県により異なっていた。患者対看護師比率、患者対臨床工学技士比率、患者対医師比率の中央値(範囲)は、それぞれ8.8(6.3〜14.5)、23.6(11.4〜45.9)、69.6(42.3〜142.2)と、これらも都道府県により異なっていた。患者対臨床工学技士比率(標準化推計値=0.35、p=0.049)および患者対医師比率(標準化推計値=0.36、p=0.011)は、SMRに対して、それぞれ有意な正の直接効果を有していた。患者対看護師比率、患者対臨床工学技士比率、患者対医師比率から成る本モデルは高い適合度を示し(χ二乗値=0.233、自由度=1,CFI=1.000,GFI=.997,AGFI=.975,RMSEA=.000)、本モデルにより都道府県SMR差の19%を説明することができた。研究の限界:本研究は、都道府県の集約値を用いた生態学的研究であるため、生態学的誤謬(ecological fallacy)の可能性がある。総括:性年齢で調整したわが国の維持透析患者の死亡率には、都道府県差が存在する。患者対看護師比率を維持したまま、患者対臨床工学技士比率を下げる(すなわち、臨床工学技士数を増やす)、あるいは、患者対医師比率を下げる(すなわち、医師数を増やす)ことで、その較差の一部を低減化できる可能性が示唆された。(著者抄録)

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  • 【CKD対策の最新動向】CKD対策の効果 査読

    若杉 三奈子

    日本腎臓学会誌   61 ( 2 )   86 - 90   2019年3月

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    記述言語:日本語   出版者・発行元:(一社)日本腎臓学会  

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  • 慢性腎臓病(CKD)対策の評価―年齢調整透析導入率は低下したが,透析導入患者数減少は未達成― 査読

    若杉三奈子, 成田一衛

    日本腎臓学会誌   60 ( 1 )   41‐49   2018年1月

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    担当区分:筆頭著者, 責任著者   記述言語:日本語  

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  • 医政展望 2025年、このままでは県内の大腿骨近位部骨折発症数は増加する 骨折発症率を低下させる戦略と、新潟大学地域医療長寿学講座の果たす役割

    若杉 三奈子, 風間 順一郎, 今井 教雄, 成田 一衛, 遠藤 直人, 堂前 洋一郎

    新潟県医師会報   ( 790 )   12 - 15   2016年1月

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    記述言語:日本語   出版者・発行元:新潟県医師会  

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  • 15 新発田地区糖尿病地域連携パス運用2年間のまとめ(Ⅰ.一般演題, 第40回新潟糖尿病談話会)

    酒巻 裕一, 本間 則行, 若杉 三奈子, 山崎 美穂子, 島 賢治郎, 大瀧 陽子, 遠藤 晶子, 渡辺 由美子, 山田 邦子, 新発田地区糖尿病地域連携パス研究会

    新潟医学会雑誌   129 ( 8 )   474 - 474   2015年8月

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    記述言語:日本語   出版者・発行元:新潟医学会  

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  • Clinical nephroiogy C.全身性疾患と腎障害 2.CKD患者の骨折 招待

    若杉三奈子, 風間順一郎, 成田一衛

    Annual Review 腎臓   2015   157 - 163   2015年1月

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    記述言語:日本語  

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  • CKDと骨折 招待

    若杉三奈子, 風間順一郎, 成田一衛

    Osteoporosis Jpn   22 ( 1 )   44 - 47   2014年1月

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    記述言語:日本語  

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  • 特定健康診査による個人リスク評価に基づく,保健指導と連結した効果的な慢性腎臓病(CKD)地域医療連携システムの制度設計 5つの健康習慣(禁煙,体重管理,節酒,身体活動,食事)と回復性睡眠に関する研究

    成田一衛, 若杉三奈子

    特定健康診査による個人リスク評価に基づく、保健指導と連結した効果的な慢性腎臓病(CKD)地域医療連携システムの制度設計 平成25年度 総括・分担研究報告書   40‐44   2014年

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    記述言語:日本語  

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  • CKDと骨折 (第15回日本骨粗鬆症学会 シンポジウム6 CKD患者の骨)

    若杉 三奈子, 風間 順一郎, 成田 一衛

    オステオポローシスジャパン : 日本骨粗鬆症学会雑誌   22 ( 1 )   44 - 47   2014年

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    記述言語:日本語   出版者・発行元:ライフサイエンス出版 ; 1993-  

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    その他リンク: http://search.jamas.or.jp/link/ui/2014189725

  • 透析室での臨床研究―研究デザインと研究のまとめ方 II 観察研究(3)症例対照研究 招待

    若杉三奈子

    臨床透析   29 ( 4 )   409 - 415   2013年4月

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    記述言語:日本語  

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  • わが国における透析患者の感染症死亡率は一般住民の7倍である 心血管病だけではなく、非心血管病死亡、特に感染症対策も重要である 招待

    若杉 三奈子, 風間 順一郎, 成田 一衛

    日本透析医会雑誌   28 ( 1 )   170 - 172   2013年4月

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    記述言語:日本語   出版者・発行元:(公社)日本透析医会  

    薬剤や医療技術の進歩にもかかわらず透析患者の死亡率は依然高く、透析患者の生命予後には改善の余地がある。透析患者の死亡原因として、心血管病のみならず非心血管病も重要であることが示されてきている。しかし、一般住民と比べたわが国透析患者の疾患別死亡率については、これまで検討がなされていなかった。日本国民は世界でトップレベルの長寿を誇り、心血管病の発症も欧米諸国に比べて低い。そのため、わが国の透析患者の生命予後を改善するためには、わが国の一般住民と比べた研究が必要である。そこで公表されているデータを用いて、わが国の一般住民と比較した透析患者の標準化死亡率比および死亡率差を検討した。透析患者の標準化死亡率比は4.6(95%信頼区間4.6〜4.7)と高く、さらに透析患者の死亡原因では心血管病よりも非心血管病が多く、一般住民との死亡率差は両者でほぼ同等であることが明らかになった。この非心血管病死亡の約半数を占めるのは感染症であり、透析患者の標準化感染症死亡率比は7.5(95%信頼区間7.3〜7.6)と高いことが明らかになった。透析患者の生命予後改善のためには、心血管病のみならず非心血管病の対策も同程度に重要であり、特に、この非心血管死亡の約半数を占める感染症についてのわが国独自の研究が急務である。(著者抄録)

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  • 7. わが国の透析患者における感染症死亡率 ‐ 一般住民との比較 ‐ 招待

    若杉三奈子, 若杉三奈子, 川村和子, 風間順一郎, 成田一衛

    日本透析医学会雑誌   46 ( 2 )   183 - 184   2013年2月

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    記述言語:日本語   出版者・発行元:The Japanese Society for Dialysis Therapy  

    DOI: 10.4009/jsdt.46.183

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  • 慢性腎臓病(CKD)診療の新たなステージ―『CKD診療ガイド2012』を手がかりとして―2.『CKD診療ガイド2012』改訂のポイント 1)CKDの新しい分類法:重症度分類について 招待

    若杉三奈子, 成田一衛

    Prog Med   33 ( 2 )   191 - 194   2013年2月

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    記述言語:日本語  

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  • 特定健康診査による個人リスク評価に基づく,保健指導と連結した効果的な慢性腎臓病(CKD)地域連携システムの制度設計 地域における慢性腎臓病(CKD)の包括的評価に関する研究

    成田一衛, 若杉三奈子

    特定健康診査による個人リスク評価に基づく、保健指導と連結した効果的な慢性腎臓病(CKD)地域医療連携システムの制度設計 平成24年度 総括・分担研究報告書   33‐38   2013年

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    記述言語:日本語  

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  • 透析患者の大腿骨頸部骨折は,CKD‐MBDガイドライン遵守のみでは減少しない可能性がある

    若杉三奈子, 風間順一郎, 成田一衛

    季刊腎と骨代謝   25 ( 4 )   350 - 350   2012年10月

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    記述言語:日本語   出版者・発行元:(株)日本メディカルセンター  

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  • 5つの健康習慣(禁煙,体重管理,飲酒,運動,食事)は慢性腎臓病の発症率を減少させる

    若杉三奈子, 風間順一郎, 山本卓, 川村和子, 成田一衛

    日本高血圧学会総会プログラム・抄録集   35th   417 - 417   2012年9月

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    記述言語:日本語   出版者・発行元:(NPO)日本高血圧学会  

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  • CKD進展予防のための保健指導プログラム策定に向けた特定健診データベース解析

    渡辺毅, 旭浩一, 松川洋子, 若杉三奈子, 成田一衛, 矢野裕一朗, 佐藤佑二, 藤元昭一

    CKD進展予防のための特定健診と特定保健指導のあり方に関する研究 平成23年度 総括研究報告書   5 - 7   2012年

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    記述言語:日本語  

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  • ^<99m>Tc-MIBIシンチグラフィの有用性 : システマティックレビューおよびメタアナリシス 査読

    若杉 三奈子, 風間 順一郎, 成田 一衛

    日本透析医学会雑誌 = Journal of Japanese Society for Dialysis Therapy   44 ( 1 )   65 - 72   2011年1月

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    記述言語:日本語   出版者・発行元:社団法人 日本透析医学会  

    【背景】二次性副甲状腺機能亢進症の術前局在診断に,99mTc-methoxyisobutylisonitrileシンチグラフィ(以下99mTc-MIBIと略す)が日本国内で汎用されている.その理由は,本法が他の画像診断に比較して優れているという定評が臨床現場にあるからであるが,十分証明されてはいない.【目的】日本の二次性副甲状腺機能亢進症患者で副甲状腺摘出腺数をゴールドスタンダードとした場合,99mTc-MIBIの感度を明らかにする.【研究デザイン】システマティックレビューおよびメタアナリシス.【データ源】PubMed,医中誌Web,手検索.【研究の選択】適格基準:日本で副甲状腺摘出術を行った二次性副甲状腺機能亢進症患者で,術前局在診断に99mTc-MIBIを施行.除外基準:原発性副甲状腺機能亢進症患者データと区別不能,99mTc-MIBIの撮影方法が不明,初回手術ではない,症例報告,総説,英語以外の外国語論文,論文化されていない抄録.【アウトカム】主要アウトカムは摘出腺数に対する99mTc-MIBIの感度,副次アウトカムは他の術前画像診断の感度.【結果】ケース・シリーズ8論文,症例数合計96名,摘出副甲状腺数348腺が該当し,99mTc-MIBIの感度は72%[95%信頼区間=67〜77%]であった.他の術前画像診断の感度は,US 68%(163/238腺),CT 40%(...

    DOI: 10.4009/jsdt.44.65

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  • 腎移植と骨・ミネラル代謝 1 腎移植レシピエントと骨折 招待

    若杉三奈子, 風間順一郎

    季刊腎と骨代謝   24 ( 1 )   7-14   2011年1月

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    記述言語:日本語  

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  • がん登録の現状と問題点について 査読

    若杉三奈子, 小山博史

    医療情報学連合大会論文集   30th   1318-1319 - 1319   2010年11月

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    記述言語:日本語   出版者・発行元:(一社)日本医療情報学会  

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  • Collagenous colitisを合併した血液透析患者の1例 査読

    若杉三奈子, 若杉三奈子, 市川紘将, 本間照, 若木邦彦, 本間則行

    日本透析医学会雑誌   43 ( 12 )   999 - 1003   2010年

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    記述言語:日本語  

    DOI: 10.4009/jsdt.43.999

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▶ 全件表示

講演・口頭発表等

  • Bone fractures 招待 国際会議

    Minako WAKASUGI

    KDIGO CKD-MBD Implementation Summit  2018年4月 

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    記述言語:英語   会議種別:口頭発表(招待・特別)  

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受賞

  • CKD Frontier Award

    2021年2月   第10回CKD Frontier Meeting  

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  • 令和2年度新潟大学優秀論文表彰

    2021年2月   新潟大学  

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  • 平成28年度JBMM論文賞(Best Paper Award)

    2016年5月   日本骨代謝学会   受賞論文:Increased risk of hip fracture among Japanese hemodialysis patients.

    若杉三奈子

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共同研究・競争的資金等の研究

  • 集計表を用いた二次分析の実践と課題に関する研究

    2018年4月 - 2022年3月

    科学研究費補助金(基盤研究(C)) 

    若杉三奈子

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    担当区分:研究代表者  資金種別:競争的資金

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  • 耳朶皺襞の評価者間一致率および心血管病との関連についての検討

    研究課題/領域番号:23590781  2011年 - 2015年

    文部科学省  科学研究費補助金(基盤研究(C))  基盤研究(C)

    若杉 三奈子

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    担当区分:研究代表者  資金種別:競争的資金

    耳朶皺襞とは耳朶に斜めに走る襞のことであり、その存在は動脈硬化性疾患、すなわち、心血管病の危険因子であることが、欧米人のみならず、日本男性の剖検例でも報告されている。 しかし、耳朶皺襞は、心血管病の独立した危険因子であるという報告も多数ある一方で、関連を認めない、あるいは、単に加齢による影響を見ているにすぎないという報告もあり、まだ一定の見解が得られていない。その理由として、耳朶皺襞の評価者間一致率(Kappa統計量)がこれまで一度も検討されていないことが考えられる。すなわち、もしも耳朶皺襞を異なった評価で判断していれば、一定の見解が得られない可能性がある。 そこで本研究では、心血管病のハイリスク集団である透析患者を対象として、耳朶皺襞の評価者間一致率を検討し、さらに心血管病との関係を明らかにする。これにより、ベッドサイドで簡便に行えるスクリーニング検査として、耳朶皺襞の有無が使えるかどうかが明らかになり、その知見は実際の臨床現場で役に立つこととなる。 研究初年度である今年度は、研究計画書の作成、倫理委員会への申請を行った。208名の血液透析患者の同意を得て、両耳朶の写真撮影を行った。患者の臨床情報を知らない医師2名が耳朶皺襞を評価し、その評価者間一致率(Kappa統計量)を求めた。さらに、これまで報告のない維持透析患者における耳朶皺襞陽性割合を明らかにした。評価方法が一定ではないため単純な比較はできないが、この透析患者での陽性割合の数字は、これまで日本人で報告されている他の集団の数字よりも高い可能性が考えられた。 さらに、耳朶皺襞と心血管病との関連を明らかにするために、心血管病の既往との関連について横断研究を行い、さらに発症との関連を明らかにするために前向き研究を開始した。

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その他教育活動及び特記事項

  • 平成26年度 新潟高理数科 校外研修 模擬講義

    2014年8月