Koichi Asahi

INTRODUCTION AND AIMS: Only a few studies have addressed the association of dietary or exercise habits with mortality in CKD patients. Further, it remains unknown whether the associations are different from those in non-CKD general population.

INTRODUCTION AND AIMS: Recently, some clinical trials and meta-analyses revealed blood pressure (BP) lowering is effective to reduce risk of cardiovascular death (CVD) for both patients with and without chronic kidney disease (CKD). However, evidence for setting-up appropriate BP control to reduce risk of CVD in patients with CKD is insufficient in Japan.

症例は85歳女性. 6年前に経腹直筋アプローチで挿入された腹膜透析カテーテルを抜去した3時間後, 抜去創の直下に直径10cmを超える巨大皮下腫瘤が出現した. 手術室で創部の再解放が行われ, 下腹膜動脈断端からの出血が確認されたため, 結紮止血および血腫吸引が行われた. その後の経過は順調であった. 経腹直筋アプローチで挿入された腹膜透析カテーテルを抜去する際には, 下腹壁動脈損傷の可能性を念頭に置く必要がある.

Methylglyoxal (MG), one of the uremic toxins, is a highly reactive alpha-dicarbonyl compound. Recent clinical studies have demonstrated the close associations of cognitive impairment (CI) with plasma MG levels and presence of kidney dysfunction. Therefore, the present study aims to examine whether MG is a direct causative substance for CI development. Eight-week-old male Sprague-Dawley (SD) rats were divided into two groups: control (n = 9) and MG group (n = 10; 0.5% MG in drinking water), and fed a normal diet for 12 months. Cognitive function was evaluated by two behavioral tests (object exploration test and radial-arm maze test) in early (4–6 months of age) and late phase (7–12 months of age). Serum MG was significantly elevated in the MG group (495.8 ± 38.1 vs. 244.8 ± 28.2 nM; p < 0.001) at the end of study. The groups did not differ in cognitive function during the course of study. No time-course differences were found in oxidative stress markers between the two groups, while, antioxidants such as glutathione peroxidase and superoxide dismutase activities were significantly increased in the MG group compared to the control. Long-term MG administration to rats with normal kidney function did not cause CI. A counter-balanced activation of the systemic anti-oxidant system may offset the toxicity of MG in this model. Pathogenetic significance of MG for CI requires further investigation.

At 14:46 on 11 March 2011, northeastern Japan was struck by a major earthquake measuring 9.0 on the Richter scale (the Great East Japan Earthquake). Several reports have suggested a transient blood pressure (BP) increase after a major earthquake, but its impact on BP in chronic dialysis patients has not been reported. In a retrospective review of 25 hemodialysis patients who were residents of Koriyama City, changes in the morning home BP after the earthquake were investigated. Home systolic and diastolic BPs were significantly elevated 1 week after the earthquake (158 ± 16 mm Hg vs. 151 ± 13 mm Hg, P < 0.01, for systolic; 81 ± 13 mm Hg vs. 78 ± 11 mm Hg, P = 0.01, for diastolic). Mean home BP 1 week after the earthquake was unchanged from baseline in patients treated with sympatholytics and/or renin‐angiotensin system (RAS) inhibitors. BP values returned to baseline by 4 weeks after the earthquake, but percent changes in mean BP were significantly greater even 2 weeks, 4 weeks, and 6 weeks after the earthquake in patients not treated with RAS inhibitors than in those treated with RAS inhibitors (2 weeks 7.0% ± 4.5% vs. 0.2% ± 5.0%, P < 0.01; 4 weeks 4.4% ± 5.9% vs. −1.8% ± 5.3%, P = 0.02; 6 weeks 4.6% ± 4.9% vs. −1.9% ± 3.9%, P < 0.01). On multiple regression analysis, RAS inhibitor use had an independent relationship with percentage increases in mean BP during the 6 weeks after the earthquake. Home BP was significantly increased after a major earthquake in patients on chronic hemodialysis. Prolonged deterioration of BP control after the earthquake was associated with non‐use of RAS inhibitors.