研究者詳細 - 山本　卓

論文 - 山本　卓

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慢性腎臓病患者の腰椎海綿骨スコアと骨塩量横断研究

齋藤耕吉, 山本卓, 若松拓也, 風間順一郎

日本骨形態計測学会雑誌 34 ( 1 ) 152 - 152 2024年5月

Correction to: Protein intake and its relationship with frailty in chronic kidney disease.

Nobuyuki Shirai, Suguru Yamamoto, Yutaka Osawa, Atsuhiro Tsubaki, Shinichiro Morishita, Toshiko Murayama, Ichiei Narita

Clinical and experimental nephrology 28 ( 5 ) 454 - 456 2024年5月

慢性腎臓病における感染症の重症化に関連する因子の検討

若松拓也, 山本卓, 成田一衛

新潟県医師会報 ( 888 ) 8 - 9 2024年3月

Systemic Amyloid A Amyloidosis Secondary to Xanthogranulomatous Pyelonephritis. 査読

Masato Habuka, Mizusa Nishikiori, Chihiro Oikawa, Megumi Takahashi, Yuichi Sakamaki, Asa Ogawa, Norio Miyajima, Yasuhiko Tanabe, Keiichi Honma, Kunihiko Wakaki, Suguru Yamamoto, Ichiei Narita

Internal medicine (Tokyo, Japan) 63 ( 4 ) 593 - 599 2024年2月

記述言語：英語掲載種別：研究論文（学術雑誌）

The combination of systemic amyloid A (AA) amyloidosis and xanthogranulomatous pyelonephritis (XGP) resulting from a chronic urinary tract infection is extremely rare. We herein report a case of systemic AA amyloidosis secondary to XGP for which clinical remission developed after nephrectomy. To our knowledge, this is the first case report describing the clinical improvement of systemic AA amyloidosis secondary XGP after nephrectomy in Japan. Clinicians should be aware of this uncommon combination and search for amyloid depositions in cases of XGP.

DOI： 10.2169/internalmedicine.1806-23

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シングルルーメンカテーテルの有用性について

吉澤優太, 大塚忠司, 山本卓, 永野敦嗣, 甲田亮, 飯野則昭, 宮崎慧, 若松拓也, 飯田倫理, 青柳竜治, 伊藤徹, 亀田茂美, 成田一衛

Niigata Blood Purification Conferenceプログラム・一般演題抄録 2023 10 - 10 2023年12月

Hemolysis Precedes Urine Color Change in Patients Undergoing Open-Heart Surgery on Cardiopulmonary Bypass. 国際誌

Kenta Takeishi, Suguru Yamamoto, Yasuto Sato, Osamu Takahashi, Nobuko Fujita, Kohei Abe, Yoko Fukui, Megumi Kameda, Tokujiro Uchida, Yasuko Nagasaka

Cureus 15 ( 12 ) e49971 2023年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

PURPOSE: Red-colored urine often occurs in patients in the perioperative period who undergo cardiac surgery using cardiopulmonary bypass (CPB). This urine color change has been utilized for approximating hemolysis during CPB without a proven relationship for ongoing hemolysis. This case series study aimed to examine the relationship between plasma free hemoglobin (Hb) levels and quantified measures of urine color. METHODS: Ten patients were enrolled in this study. Blood and urine were collected for analyses for the following time points: before surgery, two hours after the initiation of CPB, every 30 min during CPB thereafter, and 0, 2, 4, 12, and 24 hours after the completion of CPB. We measured free Hb in plasma and urine using the azide-methemoglobin method. Photographs of urine were obtained, and the luminance of the three basic colors (red/green/blue) was analyzed by quantitative luminance contrast analysis to find a correlation for hemolysis. RESULTS: Median levels of plasma free Hb were 0.015 (0.010-0.080, n = 10) g/dL at baseline. During the CPB, increases in plasma free Hb levels were measured: median plasma free Hb levels were increased to 0.100 g/dL (0.020-0.240, p = 0.039, vs. baseline, n = 9) at two hours into CPB, median and range, respectively. In contrast, increases in urinary free Hb levels and/or urine color changes were measured only after cessation of CPB in nine patients. CONCLUSION: Urine color change or elevation of urinary free Hb levels followed the elevation of plasma free Hb levels with considerable delay.

DOI： 10.7759/cureus.49971

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Active Vitamin D Use and Fractures in Hemodialysis Patients: Results from the International DOPPS. 査読国際誌

Hirotaka Komaba, Junhui Zhao, Angelo Karaboyas, Suguru Yamamoto, Indranil Dasgupta, Mohamed Hassan, Li Zuo, Anders Christensson, Christian Combe, Bruce M Robinson, Masafumi Fukagawa

Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research 38 ( 11 ) 1577 - 1585 2023年11月

記述言語：英語掲載種別：研究論文（学術雑誌）

Active vitamin D is commonly used to control secondary hyperparathyroidism in dialysis patients, but it is unknown whether active vitamin D directly improves bone strength, independent of its effect to suppress parathyroid hormone (PTH). We analyzed the association between prescription of active vitamin D and incidence of any fracture and hip fracture in 41,677 in-center hemodialysis patients from 21 countries in phases 3-6 (2005-2018) of the Dialysis Outcomes and Practice Patterns Study (DOPPS). We used Cox regression, adjusted for PTH and other potential confounders, and used a per-protocol approach to censor patients at treatment switch during follow-up. We also used a facility preference approach to minimize confounding by indication. Overall, 55% of patients were prescribed active vitamin D at study enrollment. Event rates (per patient-year) were 0.024 for any fracture and 0.010 for hip fracture. The adjusted hazard ratio (95% confidence interval) comparing patients prescribed vs. not prescribed active vitamin D was 1.02 (0.90-1.17) for any fracture and 1.00 (0.81-1.23) for hip fracture. In the facility preference approach, there was no difference in fracture rate between facilities with higher vs. lower active vitamin D prescriptions. Thus, our results do not suggest a PTH-independent benefit of active vitamin D in fracture prevention and support the current KDIGO guideline suggesting the use of active vitamin D only in subjects with elevated or rising PTH. Further research is needed to determine the role of active vitamin D beyond PTH control. This article is protected by copyright. All rights reserved.

DOI： 10.1002/jbmr.4913

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Frailty in Patients on Dialysis Surviving for More than 40 Years is Common and Severe: A Nationwide Cross-Sectional Study

Yamamoto Suguru, Niihata Kakuya, Toida Tatsunori, Abe Masanori, Hanafusa Norio, Kurita Noriaki

SSRN (プレプリント) 2023年10月

Assessing fluid volume and determining outcomes of acute heart failure using plasma human atrial natriuretic peptide. 査読

Yuya Suzuki, Tadashi Otsuka, Yuki Yoshioka, Tomomichi Iida, Shingo Maruyama, Hirofumi Watanabe, Ryohei Kaseda, Suguru Yamamoto, Yoshikatsu Kaneko, Shin Goto, Ryuji Aoyagi, Ichiei Narita

Clinical and experimental nephrology 27 ( 6 ) 565 - 573 2023年6月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The post-dialysis plasma level of human atrial natriuretic peptide (hANP) reflects the fluid volume in patients on hemodialysis. The threshold hANP level is reportedly 100 pg/mL; however, the clinical usefulness of the threshold hANP level for volume control has not been sufficiently studied. METHODS: We conducted a single-center, retrospective, observational study that included 156 hemodialysis patients without atrial fibrillation. First, we examined the usefulness of the threshold hANP level (100 pg/mL) for predicting hypoxemia due to congestion in a short-term observational study from December 30, 2015 to January 5, 2016. Subsequently, we conducted a 5-year follow-up study wherein the outcomes were hospitalization due to acute heart failure (AHF), development of cardiovascular diseases (CVD), and all-cause death. Finally, we collected echocardiography data to investigate the relationship between cardiac function and hANP. RESULTS: Our short-term observational study showed that patients with an hANP level ≥ 100 pg/mL developed hypoxemia due to congestion (odds ratio, 3.52; 95% confidence interval, 1.06-11.71; P = 0.040). At the 5-year follow-up, patients with an hANP level ≥ 100 pg/mL had significantly higher rates of hospitalization due to AHF, CVD, and all-cause death based on the log-rank test (P = 0.003, P = 0.019, P < 0.001, respectively). Cardiac disfunctions were significantly associated with the high hANP level. CONCLUSIONS: The hANP level is indicative of both fluid volume and cardiac dysfunction. A threshold hANP level of 100 pg/mL can serve as a predictive marker for AHF and a practical indicator for volume control.

DOI： 10.1007/s10157-023-02333-1

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Sodium Magnetic Resonance Imaging Shows Impairment of the Counter-current Multiplication System in Diabetic Mice Kidney. 査読国際誌

Yusuke Nakagawa, Ryohei Kaseda, Yuya Suzuki, Hirofumi Watanabe, Tadashi Otsuka, Suguru Yamamoto, Yoshikatsu Kaneko, Shin Goto, Yasuhiko Terada, Tomoyuki Haishi, Susumu Sasaki, Ichiei Narita

Kidney360 4 ( 5 ) 582 - 590 2023年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

Sodium magnetic resonance imaging can non-invasively assess sodium distribution, specifically sodium concentration in the countercurrent multiplication system in the kidney, which forms a sodium concentration gradient from the cortex to the medulla, enabling efficient water reabsorption. This study aimed to investigate whether sodium magnetic resonance imaging can detect changes in sodium concentrations under normal conditions in mice and in disease models such as a mouse model with diabetes mellitus. Methods: We performed sodium and proton nuclear magnetic resonance imaging using a 9.4-T vertical standard-bore super-conducting magnet. Results: A condition of deep anesthesia, with widened breath intervals, or furosemide administration in 6-week-old C57BL/6JJcl mice showed a decrease in both tissue sodium concentrations in the medulla and sodium concentration gradients from the cortex to the medulla. Further, sodium magnetic resonance imaging revealed reductions in the sodium concentration of the medulla and in the gradient from the cortex to the medulla in BKS.Cg-Leprdb+/+ Leprdb/Jcl mice at very early type-2 diabetes mellitus stages compared to corresponding control BKS.Cg-m+/m+/Jcl mice. Conclusions: The kidneys of BKS.Cg-Leprdb+/+ Leprdb/Jcl mice aged 6 weeks showed impairments in the countercurrent multiplication system. We propose the utility of 23Na MRI for evaluating functional changes in diabetic kidney disease, not as markers that reflect structural damage. Thus, 23Na MRI may be a potential very early marker for structures beyond the glomerulus; this may prompt intervention with novel efficacious tubule-targeting therapies.

DOI： 10.34067/KID.0000000000000072

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THE EVALUATION OF FLUID VOLUME AND PROGNOSIS IN HEMODIALYSIS PATIENTS UTILIZING PLASMA HUMAN ATRIAL NATRIURETIC PEPTIDE

Suguru Yamamoto

Nephrology Dialysis Transplantation 2023年

Bilateral refractory pneumothorax treated by pleurodesis and bronchial occlusion in a COVID-19 patient. 国際誌

Satoshi Tanaka, Yoshihiro Takayama, Riiko Kitou, Ryo Asakawa, Satoshi Tobita, Akihiro Ike, Masahiro Kawada, Suguru Yamamoto, Kiyonobu Ueno

Clinical case reports 10 ( 12 ) e6754 2022年12月

記述言語：英語掲載種別：研究論文（学術雑誌）

Coronavirus disease 2019 (COVID-19) has become a worldwide outbreak, and it can cause various symptoms and complications. However, pneumothorax secondary to COVID-19 is relatively uncommon. We herein report a 60-year-old man with bilateral refractory pneumothorax with severe COVID-19. In patients with poor general health and who are difficult to undergo surgery for pneumothorax post-COVID-19, internal treatments such as chest drainage, bronchial occlusion, and pleurodesis are essential to relieving refractory pneumothorax. It also indicates that autologous blood patch pleurodesis is a useful method in terms of efficacy and side effects.

DOI： 10.1002/ccr3.6754

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Secondary hyperparathyroidism, weight loss, and longer term mortality in haemodialysis patients: results from the DOPPS. 査読国際誌

Hirotaka Komaba, Junhui Zhao, Suguru Yamamoto, Takanobu Nomura, Douglas S Fuller, Keith P McCullough, Pieter Evenepoel, Anders Christensson, Xinju Zhao, Mona Alrukhaimi, Fadwa Al-Ali, Eric W Young, Bruce M Robinson, Masafumi Fukagawa

Journal of cachexia, sarcopenia and muscle 12 ( 4 ) 855 - 865 2021年8月

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

BACKGROUND: Wasting is a common complication of kidney failure that leads to weight loss and poor outcomes. Recent experimental data identified parathyroid hormone (PTH) as a driver of adipose tissue browning and wasting, but little is known about the relations among secondary hyperparathyroidism, weight loss, and risk of mortality in dialysis patients. METHODS: We included 42,319 chronic in-centre haemodialysis patients from the Dialysis Outcomes and Practice Patterns Study phases 2-6 (2002-2018). Linear mixed models were used to estimate the association between baseline PTH and percent weight change over 12 months, adjusting for country, demographics, comorbidities, and labs. Accelerated failure time models were used to assess 12 month weight loss as a mediator between baseline high PTH and mortality after 12 months. RESULTS: Baseline PTH was inversely associated with 12 month weight change: 12 month weight loss >5% was observed in 21%, 18%, 18%, 17%, 15%, and 14% of patients for PTH ≥600 pg/mL, 450-600, 300-450, 150-300, 50-150, and <50 pg/mL, respectively. In adjusted analyses, 12 month weight change compared with PTH 150-299 pg/mL was -0.60%, -0.12%, -0.10%, +0.15%, and +0.35% for PTH ≥600, 450-600, 300-450, 50-150, and <50 pg/mL, respectively. This relationship was robust regardless of recent hospitalization and was more pronounced in persons with preserved appetite. During follow-up after the 12 month weight measure [median, 1.0 (interquartile range, 0.6-1.7) years; 6125 deaths], patients with baseline PTH ≥600 pg/mL had 11% [95% confidence interval (CI), 9-13%] shorter lifespan, and 18% (95% CI, 14-23%) of this effect was mediated through weight loss ≥2.5%. CONCLUSIONS: Secondary hyperparathyroidism may be a novel mechanism of wasting, corroborating experimental data, and, among chronic dialysis patients, this pathway may be a mediator between elevated PTH levels and mortality. Future research should determine whether PTH-lowering therapy can limit weight loss and improve longer term dialysis outcomes.

DOI： 10.1002/jcsm.12722

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/jcsm.12722

Prognostic significance of serum cytokines during acute exacerbation of idiopathic interstitial pneumonias treated with thrombomodulin. 国際誌

Toru Arai, Hiroto Matsuoka, Masaki Hirose, Hiroshi Kida, Suguru Yamamoto, Yoshitaka Ogata, Masahide Mori, Kazuyoshi Hatsuda, Chikatoshi Sugimoto, Kazunobu Tachibana, Masanori Akira, Yoshikazu Inoue

BMJ open respiratory research 8 ( 1 ) 2021年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Acute exacerbation (AE) has been reported to herald a poor prognosis in idiopathic pulmonary fibrosis and is now thought to do so in idiopathic interstitial pneumonias (IIPs). However, the pathophysiology of AE-IIPs is not sufficiently understood. In our previously reported SETUP trial, we found better survival in patients with AE-IIPs treated with corticosteroids and thrombomodulin than in those treated with corticosteroids alone. In that study, we collected serum samples to evaluate changes in cytokine levels and retrospectively examined the prognostic significance and pathophysiological role of serum cytokines in patients with AE-IIPs. METHODS: This study included 28 patients from the SETUP trial for whom serial serum samples had been prospectively obtained. AE-IIPs were diagnosed using the Japanese Respiratory Society criteria. All patients were treated with intravenous thrombomodulin and corticosteroids from 2014 to 2016. Serum levels of 27 cytokines were measured using Bio-Plex. The high-resolution CT pattern at the time of diagnosis of AE was classified as diffuse or non-diffuse. RESULTS: Univariate analysis revealed that higher serum levels of interleukin (IL)-2, IL-7, IL-9, IL-12, IL13, basic fibroblast growth factor, granulocyte-macrophage colony-stimulating factor, interferon-γ inducible protein-10, platelet-derived growth factor and regulated on activation, normal T cell expressed and secreted (RANTES) at AE were significant predictors of 90-day survival. The HRCT pattern was also a significant clinical predictor of 90-day survival. Multivariate analysis with stepwise selection identified a higher serum RANTES level at AE to be a significant predictor of 90-day survival, including after adjustment for HRCT pattern. Multivariate analysis with stepwise selection suggested that a marked increase in the serum IL-10 level on day 8 could predict 90-day mortality. CONCLUSIONS: A higher serum RANTES level at AE the time of diagnosis predicted a good survival outcome, and an elevated serum IL-10 level on day 8 predicted a poor survival outcome. TRIAL REGISTRATION NUMBER: UMIN000014969.

DOI： 10.1136/bmjresp-2021-000889

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Aberrant mucosal immunoreaction to tonsillar microbiota in immunoglobulin A nephropathy 査読国際誌

Hiroki Yamaguchi, Shin Goto, Nao Takahashi, Masafumi Tsuchida, Hirofumi Watanabe, Suguru Yamamoto, Yoshikatsu Kaneko, Koichi Higashi, Hiroshi Mori, Yukio Nakamura, Arata Horii, Ken Kurokawa, Ichiei Narita

Nephrology Dialysis Transplantation 36 ( 1 ) 75 - 86 2021年1月

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 University Press (OUP)

<title>Abstract</title>
<sec>
<title>Background</title>
Immunoglobulin A nephropathy (IgAN) is the most common glomerulonephritis worldwide, characterized by mesangial polymeric IgA1 deposition. IgAN is believed to develop owing to aberrant mucosal immunoreaction against commensals in the tonsils. However, the exact interrelation between pathogenic IgA and mucosal microbiota in IgAN patients is unclear.

</sec>
<sec>
<title>Methods</title>
Biopsy-proven IgAN or recurrent tonsillitis (RT) patients who had undergone tonsillectomy were enrolled. We used 16S ribosomal RNA gene amplicon sequencing with a flow cytometry-based bacterial cell sorting technique) and immunoglobulin repertoire sequencing of the IgA heavy chain to characterize IgA-coated bacteria of the tonsillar microbiota (IgA-SEQ) and their corresponding IgA repertoire. Furthermore, we fractionated patient serum using gel-filtration chromatography and performed flow cytometry-based analysis of IgA binding to bacteria cultured from incised tonsils.

</sec>
<sec>
<title>Results</title>
Tonsillar proliferation-inducing ligand and B-cell activating factor levels were significantly higher in IgAN than in RT patients. IgA-SEQ for tonsillar microbiota revealed the preferential binding ability of IgA to Bacteroidetes in IgAN tonsils compared with those from RT patients. Expression of immunoglobulin heavy (IGH) constant alpha 1 with IGH variable 3–30 was significantly higher in IgAN than that in RT, and positively correlated with the IgA-coated enrichment score of Bacteroidetes. Serum polymeric IgA, comprising high levels of GdIgA1, exhibited considerable binding to Bacteroidetes strains cultured from the tonsils of IgAN patients.

</sec>
<sec>
<title>Conclusions</title>
These findings provide evidence that aberrant mucosal immune responses to tonsillar anaerobic microbiota, primarily consisting of members of the phylum Bacteroidetes, are involved in IgAN pathophysiology.

</sec>

DOI： 10.1093/ndt/gfaa223

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Aberrant mucosal immunoreaction to tonsillar microbiota in immunoglobulin A nephropathy. 国際誌

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 36 ( 1 ) 75 - 86 2021年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Immunoglobulin A nephropathy (IgAN) is the most common glomerulonephritis worldwide, characterized by mesangial polymeric IgA1 deposition. IgAN is believed to develop owing to aberrant mucosal immunoreaction against commensals in the tonsils. However, the exact interrelation between pathogenic IgA and mucosal microbiota in IgAN patients is unclear. METHODS: Biopsy-proven IgAN or recurrent tonsillitis (RT) patients who had undergone tonsillectomy were enrolled. We used 16S ribosomal RNA gene amplicon sequencing with a flow cytometry-based bacterial cell sorting technique) and immunoglobulin repertoire sequencing of the IgA heavy chain to characterize IgA-coated bacteria of the tonsillar microbiota (IgA-SEQ) and their corresponding IgA repertoire. Furthermore, we fractionated patient serum using gel-filtration chromatography and performed flow cytometry-based analysis of IgA binding to bacteria cultured from incised tonsils. RESULTS: Tonsillar proliferation-inducing ligand and B-cell activating factor levels were significantly higher in IgAN than in RT patients. IgA-SEQ for tonsillar microbiota revealed the preferential binding ability of IgA to Bacteroidetes in IgAN tonsils compared with those from RT patients. Expression of immunoglobulin heavy (IGH) constant alpha 1 with IGH variable 3-30 was significantly higher in IgAN than that in RT, and positively correlated with the IgA-coated enrichment score of Bacteroidetes. Serum polymeric IgA, comprising high levels of GdIgA1, exhibited considerable binding to Bacteroidetes strains cultured from the tonsils of IgAN patients. CONCLUSIONS: These findings provide evidence that aberrant mucosal immune responses to tonsillar anaerobic microbiota, primarily consisting of members of the phylum Bacteroidetes, are involved in IgAN pathophysiology.

DOI： 10.1093/ndt/gfaa223

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Type I Angiotensin II Receptor Blockade Reduces Uremia-Induced Deterioration of Bone Material Properties. 査読国際誌

Takuya Wakamatsu, Yoshiko Iwasaki, Suguru Yamamoto, Koji Matsuo, Shin Goto, Ichiei Narita, Junichiro J Kazama, Kennichi Tanaka, Akemi Ito, Ryosuke Ozasa, Takayoshi Nakano, Chisato Miyakoshi, Yoshihiro Onishi, Shingo Fukuma, Shunichi Fukuhara, Hideyuki Yamato, Masafumi Fukagawa, Tadao Akizawa

Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research 36 ( 1 ) 67 - 79 2021年1月

記述言語：英語掲載種別：研究論文（学術雑誌）

Chronic kidney disease (CKD) is associated with a high incidence of fractures. However, the pathophysiology of this disease is not fully understood, and limited therapeutic interventions are available. This study aimed to determine the impact of type-1 angiotensin II receptor blockade (AT-1RB) on preventing CKD-related fragility fractures and elucidate its pharmacological mechanisms. AT-1RB use was associated with a lower risk of hospitalization due to fractures in 3276 patients undergoing maintenance hemodialysis. In nephrectomized rats, administration of olmesartan suppressed osteocyte apoptosis, skeletal pentosidine accumulation and apatite disorientation, and partially inhibited the progression of the bone elastic mechanical properties, while the bone mass unchanged. Olmesartan suppressed angiotensin II-dependent oxidation stress and apoptosis in primary cultured osteocytes in vitro. In conclusion, angiotensin II-dependent intraskeletal oxidation stress deteriorated the bone elastic mechanical properties by promoting osteocyte apoptosis and pentosidine accumulation. Thus, AT-1RB contributes to the underlying pathogenesis of abnormal bone quality in the setting of CKD, possibly by oxidative stress.

DOI： 10.1002/jbmr.4159

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Fibroblast Growth Factor 23 and Mortality Among Prevalent Hemodialysis Patients in the Japan Dialysis Outcomes and Practice Patterns Study. 査読国際誌

Hirotaka Komaba, Douglas S Fuller, Masatomo Taniguchi, Suguru Yamamoto, Takanobu Nomura, Junhui Zhao, Brian A Bieber, Bruce M Robinson, Ronald L Pisoni, Masafumi Fukagawa

Kidney international reports 5 ( 11 ) 1956 - 1964 2020年11月

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

INTRODUCTION: Elevated fibroblast growth factor 23 (FGF23) levels have been strongly associated with mortality in the predialysis and incident hemodialysis populations, but few studies have examined this relationship in a large cohort of prevalent hemodialysis patients and in particular among persons with high dialysis vintage. To address this, we analyzed data from the Japan Dialysis Outcomes and Practice Patterns Study (J-DOPPS). METHODS: We included 1122 prevalent hemodialysis patients from the J-DOPPS phase 5 (2012-2015) who had FGF23 measurements. We evaluated the association of FGF23 levels with all-cause mortality and cardiovascular composite outcome using Cox regression adjusted for potential confounders. RESULTS: At study enrollment, median dialysis vintage was 5.8 years (interquartile range, 2.7-12.4 years) and median FGF23 level was 2113 pg/ml (interquartile range, 583-6880 pg/ml). During 3-year follow-up, 154 of the 1122 participants died. In adjusted analyses, higher FGF23 was associated with a greater hazard of death (hazard ratio per doubling of FGF23, 1.12; 95% confidence interval, 1.03-1.21); however, the association became weaker as the dialysis vintage increased and finally disappeared in the highest tertile (>9.4 years). Similar patterns of effect modification by dialysis vintage were observed for cardiovascular composite outcome and in time-dependent models. CONCLUSION: Elevated FGF23 was associated with mortality and cardiovascular events in prevalent hemodialysis patients, but the association was attenuated at longer dialysis vintages. This novel finding suggests that long-term hemodialysis patients may be less susceptible to the detrimental effects of FGF23 or correlated biological processes, and additional studies are needed to gain understanding of these possibilities.

DOI： 10.1016/j.ekir.2020.08.013

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Effect of sucroferric oxyhydroxide on gastrointestinal microbiome and uremic toxins in patients with chronic kidney disease undergoing hemodialysis. 査読

Akira Iguchi, Suguru Yamamoto, Akira Oda, Kenichi Tanaka, Junichiro James Kazama, Takako Saeki, Hajime Yamazaki, Ken Ishioka, Tatsuo Suzutani, Ichiei Narita

Clinical and experimental nephrology 24 ( 8 ) 725 - 733 2020年4月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: In patients with chronic kidney disease (CKD), dysbiosis in the gastrointestinal microbiome is thought to be associated with increased production of uremic toxins, such as indoxyl sulfate (IS) and p-cresyl sulfate (PCS). Sucroferric oxyhydroxide (SFO), an iron-based phosphate binder, may affect the gastrointestinal microbiome and the production of uremic toxins. We aimed to examine whether SFO administration affected distribution of gastrointestinal microbiome and serum uremic toxin levels in CKD patients undergoing hemodialysis. METHODS: In this single-center, open-label, interventional study, 18 maintenance hemodialysis patients with hyperphosphatemia were prescribed with SFO. We collected serum samples before and after 3 months of administration, and serum levels of IS and PCS were measured. A control group of 20 hemodialysis patients without SFO was evaluated. We evaluated gastrointestinal microbiome of patients pre- and post-SFO administration by 16S rDNA sequencing and bioinformatics analysis. RESULTS: Serum IS and PCS levels were significantly elevated after administration of SFO (IS before 2.52 ± 1.60 mg/dl vs. after 3.13 ± 1.51 mg/dl, P = 0.008; PCS before 2.32 ± 2.44 mg/dl vs. after 3.45 ± 2.11 mg/dl, P = 0.002), while serum IS and PCS levels did not change in the control group. Microbiome analysis in the SFO group showed no significant change in diversity and major components in phylum, class, order, family, gene, and species. CONCLUSION: Administration of SFO increased the serum levels of IS and PCS with no change of major components of gastrointestinal microbiome.

DOI： 10.1007/s10157-020-01892-x

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SEVERITY OF PRURITUS IN HEMODIALYSIS PATIENTS: RELATIONSHIP TO UREMIC TOXINS AND DIALYSIS MODALITY

Suguru Yamamoto

Nephrology Dialysis Transplantation 2020年

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