Publications by authors named "Keiji Hirai"
Purpose: The aim of this study was to investigate the additional effects of empagliflozin on liraglutide in patients with advanced-stage type 2 diabetic kidney disease.
Patients And Methods: Forty-one patients were randomly assigned (1:1) to treatment with liraglutide alone during the first 6 months and subsequent treatment with liraglutide plus empagliflozin during the next 6 months (liraglutide plus empagliflozin group) (n = 20) or treatment with liraglutide alone for 12 months (liraglutide group) (n = 21). Liraglutide was administered subcutaneously once daily at a starting dose of 0.
Article Synopsis
- * Machine learning techniques, specifically the random forest method, identified the key clinical factors influencing estimated GFR (eGFR) after one year, which led to the development of a new approximation formula.
- * The resulting formula relies on age, hemoglobin levels, uric acid levels, and eGFR, showing a strong correlation with actual eGFR values (r = 0.884; p < 0.001), making it a useful tool for prediction in the general population.
Article Synopsis
- Vascular access via arteriovenous fistula (AVF) is crucial for patients on hemodialysis but may lead to decreased cerebral oxygenation.
- A study measured cerebral oxygen saturation using near-infrared spectroscopy in 48 patients with chronic kidney disease before and after AVF creation, finding a significant drop in oxygen levels post-surgery.
- The results indicated that patients with diabetes had lower oxygen saturation before AVF compared to non-diabetics, and changes in heart rate were linked to fluctuations in cerebral oxygen levels, highlighting the need for further research on AVF's effects on brain oxygenation.
Background: We assessed the anti-SARS-CoV-2 spike antibody response to four doses of BNT162b2 mRNA COVID-19 vaccine in Japanese hemodialysis patients and determined factors associated with the anti-SARS-CoV-2 spike antibody titer after the fourth dose.
Methods: Fifty-one patients were enrolled in this single-center, prospective, longitudinal study. Change in anti-SARS-CoV-2 spike antibody titers between after the second and fourth doses were evaluated.
Key Clinical Message: Bilateral ureterolithiasis is rare but can cause acute kidney injury (AKI). Clinicians should first examine for post-renal causes of AKI, even if the patient lacks subjective symptoms.
Abstract: This letter describes a case of bilateral ureterolithiasis which presented with post-renal acute kidney injury (AKI) and was successfully treated by bilateral retrograde ureteric stenting.
Hepatic Oxygenation Changes and Symptomatic Intradialytic Hypotension.
Kidney Blood Press Res
June 2024
Introduction: Clinical studies on differences among changes in cerebral and hepatic oxygenation during hemodialysis (HD) in patients with and without intradialytic hypotension (IDH) are limited. We investigated changes in intradialytic cerebral and hepatic oxygenation before systolic blood pressure (SBP) reached the nadir during HD and compared these differences between patients with and without symptomatic IDH.
Methods: We analyzed data from 109 patients with (n = 23) and without (n = 86) symptomatic IDH who were treated with HD.
Article Synopsis
- Many chronic kidney disease (CKD) patients, especially those on peritoneal dialysis (PD), suffer from sarcopenia, making muscle mass evaluation crucial for management.
- The study measured psoas muscle mass index (PMI) in 68 PD patients and found that men had a significantly higher PMI than women.
- Factors such as gender, body mass index (BMI), serum creatinine, serum albumin levels, and vitamin D use were identified as independently associated with PMI, indicating the need for future studies on nutrition and vitamin D's effects on muscle mass in PD patients.
Background: We assessed the anti-SARS-CoV-2 spike antibody response to the third dose of BNT162b2 mRNA COVID-19 vaccine in Japanese hemodialysis patients and determined factors associated with the anti-SARS-CoV-2 spike antibody titer after the third dose of COVID-19 vaccine.
Methods: Overall, 64 patients were enrolled in this single-center, prospective, longitudinal study. Anti-SARS-CoV-2 spike antibody titers were compared between hemodialysis patients and 18 healthcare workers.
Background: Minimal change nephrotic syndrome (MCNS) can be complicated by thymoma; however, no standard therapy for thymoma-associated MCNS has yet been established. We herein describe a case of steroid-resistant MCNS associated with thymoma, treated effectively with rituximab.
Case Presentation: A 71-year-old Japanese man was referred to our department with severe proteinuria (20 g/gCr).
Identification of Messenger RNA Signatures in Age-Dependent Renal Impairment.
Diagnostics (Basel)
December 2023
In general populations, age-dependent renal impairment contributes to the progression of renal dysfunction. It has not been known which molecules are involved in age-dependent renal impairment. Messenger RNA (mRNA) has been reported to modulate various renal diseases, and we therefore investigated mRNA signatures in age-dependent renal impairment.
View Article and Find Full Text PDFObjective: We investigated the efficacy and safety of dotinurad, a selective urate reabsorption inhibitor, in hyperuricemic patients with advanced chronic kidney disease (CKD) (stage G3-5).
Patients And Methods: We retrospectively analyzed the cases of 34 patients (mean age, 68.6 ± 13.
Article Synopsis
- A rare case of renal vein thrombosis (RVT) is reported in a patient suffering from vasculitis, highlighting the complications not previously documented, including hemolytic anemia.
- The patient, a 69-year-old Japanese man, experienced severe proteinuria and was diagnosed with bilateral RVT and pulmonary embolism after imaging tests.
- Treatment involved anticoagulation therapy, which successfully reduced D-dimer levels and improved urinary protein excretion, emphasizing the need for vigilance in similar cases during steroid therapy.
Article Synopsis
- Intradialytic hypotension (IDH) is linked to increased mortality in hemodialysis patients, but its effects on liver and brain oxygen saturation have been less explored.
- A study measured liver and brain oxygen levels in 91 hemodialysis patients, finding that those with IDH experienced a significant drop in both at the onset of the condition, particularly more so in the liver.
- The results highlight that the difference in oxygen saturation changes between the liver and brain is closely related to IDH development and the fluid removal rate during hemodialysis.
Article Synopsis
- Hepato-splanchnic circulation plays a crucial role in oxygenating abdominal organs and maintaining blood volume during hemodialysis (HD), but its relationship with clinical factors is not fully understood.
- A study with 91 HD patients measured hepatic oxygen saturation and found that those with intradialytic hypotension (IDH) experienced significantly greater decreases in liver oxygen levels compared to those without IDH.
- Results indicated that changes in hepatic oxygenation were linked to systemic blood pressure and ultrafiltration rate, suggesting a complex interaction that requires further research for clarity.
Background: We determined the effects of roxadustat on the values of anemia, iron metabolism, renal function, proteinuria, and lipid metabolism and identified the associated factors of the change in hemoglobin levels after roxadustat administration in non-dialysis chronic kidney disease (CKD) patients who were receiving an erythropoietin-stimulating agent (ESA).
Methods: We conducted retrospective analysis of the changes in hemoglobin, serum ferritin, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride levels; transferrin saturation; the estimated glomerular filtration rate; and the urinary protein/creatinine ratio over 24 weeks after the change from an ESA to roxadustat in 50 patients with non-dialysis CKD and anemia (roxadustat group). Seventy-two patients with non-dialysis CKD and anemia who proceeded ESA therapy were used as the control (ESA) group.
The role of exogenous microRNAs (miRNAs) in renal fibrosis is poorly understood. Here, the effect of exogenous miRNAs on renal fibrosis was investigated using a renal fibrosis mouse model generated by unilateral ureteral obstruction (UUO). miRNA microarray analysis and quantitative reverse-transcription polymerase chain reaction showed that miR-122-5p was the most downregulated (0.
View Article and Find Full Text PDFA 60-year-old woman with POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome and intractable ascites presented with acute renal failure and received hemodialysis (HD) therapy. Due to frequent intradialytic hypotension, ultrafiltration with cell-free and concentrated ascites reinfusion therapy (CART) was performed to adequately manage the body fluid status and massive ascites. During HD with CART, her blood pressure was maintained compared with that during HD without CART, and an ultrafiltration volume of 3.
View Article and Find Full Text PDFArticle Synopsis
- The study investigates reasons for arteriovenous fistula (AVF) failure in end-stage renal disease (ESRD) patients over time, focusing on intraoperative blood flow as a potential predictor.
- It analyzed data from 130 patients who received new radiocephalic AVFs, finding that higher intraoperative blood flow was correlated with lower failure rates up to 24 months post-surgery.
- Specifically, a blood flow of >225 mL/min was identified as critical for maintaining AVF function long-term, suggesting it could serve as a reliable marker for AVF failure in these patients.
In chronic kidney disease (CKD) patients, the prevalence of cognitive impairment increases with CKD progression; however, longitudinal changes in cognitive performance remain controversial. Few reports have examined the association of cerebral oxygenation with cognitive function in longitudinal studies. In this study, 68 CKD patients were included.
View Article and Find Full Text PDFA 68-year-old man received hemodialysis (HD) for the treatment of end-stage renal failure for 6 years. Five years prior to carotid artery stenting (CAS), a neck ultrasound performed to screen for carotid atherosclerosis revealed an asymptomatic right internal carotid artery stenosis. One month prior, the stenotic lesion progressed to 74% by cerebral angiography; therefore, CAS was performed.
View Article and Find Full Text PDFBackground: Age-dependent renal impairment contributes to renal dysfunction in both the general population and young and middle-aged patients with renal diseases. Pathological changes in age-dependent renal impairment include glomerulosclerosis and tubulointerstitial fibrosis. The molecules involved in age-dependent renal impairment are not fully elucidated.
View Article and Find Full Text PDFArticle Synopsis
- The study examined factors affecting the antibody levels after the second dose of the COVID-19 vaccine (BNT162b2) in Japanese patients on hemodialysis, focusing on their unique health conditions.
- Researchers analyzed data from 75 hemodialysis patients, comparing their antibody levels to those of 22 healthcare workers to understand disparities.
- Key findings revealed that autoimmune diseases, lymphocyte counts, hemoglobin levels, and blood urea nitrogen levels were significantly linked to lower antibody responses in hemodialysis patients compared to healthcare workers.