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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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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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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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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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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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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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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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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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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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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担当区分：筆頭著者,　責任著者  

DOI： 10.23876/j.krcp.18.0129

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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.

DOI： 10.1053/j.ajkd.2017.07.017

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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.

DOI： 10.1007/s10157-017-1417-6

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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.

DOI： 10.2169/internalmedicine.9725-17

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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.

DOI： 10.1111/1744-9987.12567

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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.

DOI： 10.1111/1744-9987.12567

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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.

DOI： 10.2169/internalmedicine.56.8006

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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.

DOI： 10.1093/ndt/gfw249

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出版者・発行元：BioMed Central  

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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.

DOI： 10.1111/1744-9987.12266

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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.

DOI： 10.1111/1744-9987.12192

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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.

DOI： 10.2169/internalmedicine.54.4336

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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

DOI： 10.1159/000381106

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記述言語：英語   出版者・発行元：WILEY-BLACKWELL  

DOI： 10.1111/hdi.12212

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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.

DOI： 10.1371/journal.pone.0108718

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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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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.

DOI： 10.1007/s10157-013-0885-6

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

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.

DOI： 10.1111/1744-9987.12074

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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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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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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.

DOI： 10.1007/s00774-012-0411-z

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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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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.

DOI： 10.1007/s10157-012-0628-0

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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.

DOI： 10.1111/j.1744-9987.2012.01062.x

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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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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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掲載種別：研究論文（学術雑誌）   出版者・発行元：MDPI AG  

Previous cohort studies have reported conflicting associations between alcohol consumption and chronic kidney disease, characterized by proteinuria and low glomerular filtration rate (GFR). This systematic review, which included 14,634,940 participants from 11 cohort studies, assessed a dose-dependent association of alcohol consumption and incidence of proteinuria and low estimated GFR (eGFR) of &lt;60 mL/min/1.73 m2. Compared with non-drinkers, the incidence of proteinuria was lower in drinkers with alcohol consumption of ≤12.0 g/day (relative risk 0.87 [95% confidence interval 0.83, 0.92]), but higher in drinkers with alcohol consumption of 36.1–60.0 g/day (1.09 [1.03, 1.15]), suggesting a J-shaped association between alcohol consumption and the incidence of proteinuria. Incidence of low eGFR was lower in drinkers with alcohol consumption of ≤12.0 and 12.1–36.0 than in non-drinkers (≤12.0, 12.1–36.0, and 36.1–60.0 g/day: 0.93 [0.90, 0.95], 0.82 [0.78, 0.86], and 0.89 [0.77, 1.03], respectively), suggesting that drinkers were at lower risk of low eGFR. In conclusion, compared with non-drinkers, mild drinkers were at lower risk of proteinuria and low eGFR, whereas heavy drinkers had a higher risk of proteinuria but a lower risk of low eGFR. The clinical impact of high alcohol consumption should be assessed in well-designed studies.

DOI： 10.3390/nu15071592

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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.2176-23

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Overweight/obesity is a significant risk factor for chronic kidney disease and end-stage kidney disease (ESKD) in the general population. This study evaluated the impact of sex- and prefecture-specific prevalence of overweight/obesity on standardized incidence rates (SIRs) of treated ESKD in Japan. METHODS: We conducted an ecological study of all prefectures in Japan (n = 47) using data from the Japanese Society of Dialysis Therapy, national census, the NDB Open Data, and the Statistics of Physicians, Dentists and Pharmacists. We calculated the prevalence of overweight/obesity and proteinuria, standardized mortality ratio, and ratio of nephrology specialists for each prefecture, and explored associations of these variables with sex- and prefecture-specific SIRs of treated ESKD using bivariate association analysis, multiple regression analysis, and structural equation modeling (SEM). RESULTS: Prefecture-specific SIRs ranged from 0.72 to 1.24 for men and 0.69-1.41 for women. Prefecture-specific SIRs were significantly correlated with both the prevalence of overweight/obesity and prevalence of proteinuria. The prevalence of overweight/obesity showed direct, positive, and significant associations with prefecture-specific SIRs in men (standardized estimate (β) = 0.43, p < 0.001) and women (β = 0.40, p < 0.001). The prevalence of proteinuria showed a significant association with prefecture-specific SIRs only in women (β = 0.33, p = 0.01). The SEM models explained 26% of the variance in SIR for men and 28% for women. CONCLUSIONS: Our findings provide evidence that the prefecture-specific prevalence of overweight/obesity in Japan can explain regional variation in prefecture-specific SIRs of treated ESKD in both sexes.

DOI： 10.1007/s10157-022-02284-z

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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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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 Science and Business Media LLC  

DOI： 10.1007/s10157-014-1045-3

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その他リンク： http://link.springer.com/article/10.1007/s10157-014-1045-3/fulltext.html

記述言語：日本語  

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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

記述言語：日本語   出版者・発行元：(一社)日本腎臓学会  

J-GLOBAL

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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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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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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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記述言語：日本語   出版者・発行元：(一社)日本内科学会  

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記述言語：日本語  

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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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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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記述言語：日本語  

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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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記述言語：日本語  

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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  

J-GLOBAL

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記述言語：英語  

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

症例は83歳，女性．83歳から慢性腎不全のため，血液透析を導入．透析導入時の血液検査で，高ガンマグロブリン血症と抗核抗体320倍を認めたが，その他自己免疫疾患を示唆する所見は認めなかった．また，慢性腎不全の原疾患は不明であった．週3回の外来血液透析を継続中，平成20年6月末から水様性下痢（5～6行/日）が出現．整腸剤，塩酸ロペラミド，バンコマイシンなどの内服を行ったが，下痢は慢性再発性に出現を繰り返していた．下痢に伴う低アルブミン血症，浮腫を認めた．それまで服用していたランソプラゾールを塩酸ラニチジンに変更したが，下痢は出現を繰り返し，大腸内視鏡検査を行った．肉眼では異常所見を認めずほぼ正常の粘膜所見であり，横行結腸からの粘膜生検で粘膜表層部上皮直下にエオシン好性で，マッソントリクローム染色では25～35μm幅の沈着物を帯状に認め，粘膜固有層全層に小型リンパ球，形質細胞といった慢性炎症性細胞浸潤に加え，好酸球浸潤が目立ち，collagenous colitisと診断した．塩酸ラニチジンを中止後，下痢は消失し，低アルブミン血症も徐々に改善した．Collagenous colitisは1976年にLindstromによって報告され，慢性水様性下痢，肉眼的にほぼ正常な大腸所見，特徴的組織所見を有する臨床的症候群である．欧米では数百例の報告があり，慢性水様性下痢の原因として決して稀ではないと報告されている．本邦での報告例はまだ少ないが，年々増加傾向にある．病因は不明だが，自己免疫や薬剤の関与などが考えられている．本例も薬剤中止後に下痢が消失したことから，その関与が考えられた．透析患者での報告はまだないが，慢性下痢の鑑別疾患の一つとして念頭に置くことが必要と考え，報告した．

DOI： 10.4009/jsdt.43.999

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