Masahiko Nakamoto

Publications (7)10.87 Total impact

• Source

  Available from: advancesinpd.com

  Article: Early estimation of high peritoneal permeability can predict poor prognosis for technique survival in patients on peritoneal dialysis.

  Hidetomo Nakamoto, Hirokazu Imai, Hideki Kawanishi, Masahiko Nakamoto, Jun Minakuchi, Shinichi Kumon, Syuichi Watanabe, Yoshhiko Shiohira, Takeo Ishii, Toshihiko Kawahara, Hiromichi Suzuki
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  ABSTRACT: At the beginning of continuous ambulatory peritoneal dialysis (CAPD), different patients exhibit large differences in peritoneal permeability. To determine if early estimation of peritoneal permeability can predict the prognosis of CAPD, we used data from a personal dialysis capacity (PDC) study group in Japan to investigate patient and technique survival rates. Based on the data from a previously reported, prospective multicenter study encompassing eight dialysis centers in Japan (Am J Kidney Dis 2002; 40:1045-54), we recalculated patient and technique survival data. We reviewed the records of 139 patients newly initiated on CAPD from January 1995 to December 1999. Peritoneal permeability was estimated by PDC test within the first year after initiation. We divided the patients into paired groups according to several peritoneal permeability variables as calculated by the PDC test (area, plasma loss, and peritoneal creatinine clearance), and we compared patient and technique survival rate between the groups. The mean age of the patients was 49.6 years +/- 14.9 years (standard deviation). The mean pore area of peritoneum was 19,936 +/- 8383 cm/1.73 m2. Estimation of patient survival by the Kaplan-Meier method showed 94.2%, 88.4%, 84.1%, and 79.7% at 1, 2, 3, and 5 years respectively. Estimated technique survival (including death as an endpoint) by the Kaplan-Meier method showed 90.6%, 76.8%, 67.4%, and 54.3% at 1, 2, 3, and 5 years respectively. In the high peritoneal permeability group (high area and high plasma loss), the technique survival at 5 years was significantly lower than in the low peritoneal permeability group [area: 55.9% (high) vs. 72.7% (low), p = 0.0459; plasma loss: 43.3% (high) vs. 62.8% (low), p = 0.0197). We observed no significant difference in patient survival between the high and low peritoneal permeability patients. In the high peritoneal creatinine clearance group, patient and technique survival were both significantly lower than in the high peritoneal creatinine clearance group. Patients with high peritoneal permeability as calculated by the PDC test at the start of PD had a poor prognosis for technique and patient survival on CAPD. We conclude that early estimation of high peritoneal permeability can predict poor outcome for patients on CAPD.
  Advances in peritoneal dialysis. Conference on Peritoneal Dialysis 02/2006; 22:11-7.
• Article: Encapsulating peritoneal sclerosis in Japan: a prospective, controlled, multicenter study.

  Hideki Kawanishi, Yoshindo Kawaguchi, Hiroyoshi Fukui, Shigeko Hara, Akio Imada, Hitoshi Kubo, Masao Kin, Masahiko Nakamoto, Seiji Ohira, Takao Shoji
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  ABSTRACT: Encapsulating peritoneal sclerosis (EPS) is recognized as a rare but serious complication of peritoneal dialysis (PD). The aim of this study was to determine the incidence, clinical features, and mortality rate of EPS. The authors requested the registration of all PD patients in facilities across Japan where more than 10 patients were treated with PD in this prospective multicenter study. During the 4-year study, the incidence of EPS was observed in the enrolled patients. A total of 1,958 patients who were treated with PD in 57 facilities were followed up from April 1999 through March 2003. EPS occurred in 48 patients, corresponding to an overall incidence of 2.5%. In 33 of the 48 (68.8%) patients, EPS was found after discontinuation of PD. The incidence (and mortality rate) of EPS was 0%, 0.7% (0%), 2.1% (8.3%), 5.9% (28.6%), 5.8% (61.5%), and 17.2% (100%) in patients who had undergone PD for 3, 5, 8, 10, 15, and more than 15 years, respectively. The recovery ratio with total parenteral nutrition, corticosteroids and surgical treatment were 0%, 38.5%, and 58.3%, respectively. Eighteen patients (37.5%) died, 22 (45.8%) recovered, and the status of the other 8 (16.7%) remained unchanged. The results of this prospective multicenter study showed that the incidence of EPS was 2.5% within a 4-year observation period and that two thirds of the cases were diagnosed after discontinuation of PD. Because of the current progress in diagnostic technology and therapeutic methodology, it appears that PD can be continued successfully with an acceptable, low risk for EPS for at least 8 years, whereas stricter caution is required for patients receiving PD for longer periods.
  American Journal of Kidney Diseases 11/2004; 44(4):729-37. · 5.43 Impact Factor
• Article: Dialysis dose and nutrition in Japanese peritoneal dialysis patients.

  Makoto Ishizaki, Akihiro C Yamashita, Hideki Kawanishi, Masahiko Nakamoto, Hiroyuki Hamada
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  ABSTRACT: In the present study, we tried to determine the relationship between dialysis dose and nutrition in PD patients. We enrolled 100 Japanese outpatients, including 11 diabetic patients, who were on continuous ambulatory peritoneal dialysis [CAPD (n = 74)] and automated peritoneal dialysis [APD (n = 26)] at 49 local hospitals. In all patients, a peritoneal function test (PET) was performed using the PD NAVI software (JMS, Hiroshima, Japan). The PD NAVI software measured parameters of nutrition and dialysis dose; percentage creatinine generation rate (%CGR); percentage lean body mass normalized to body weight (%LBM); normalized protein nitrogen appearance (nPNA); total fluid removal (TFR), including urine; weekly total Kt/V; and creatinine clearance (CCr). The %CGR correlated linearly with %LBM and nPNA, parameters of the nutrition status of the patients. The %CGR also showed a significant linear correlation with Kt/V, CCr, and TFR. Patients with a %CGR below 100% (the "low group") numbered 37 (32 men, 5 women). The CCr and TFR values in that group were lower than the CCr and TFR values in the other patients (the "high group"). Conclusively, the dialysis dose did not reach the solute clearance values proposed by the National Kidney Foundation Dialysis Outcomes Quality Initiative. That finding may be the result of prescribing and monitoring dialysis therapy based on the PET The %CGR by PD NAVI may become an important index for clinical evaluation of PD dose and optimal dialysis prescription.
  Advances in peritoneal dialysis. Conference on Peritoneal Dialysis 02/2004; 20:141-3.
• Article: Searching for the reasons for drop-out from peritoneal dialysis: a nationwide survey in Japan.

  Yoshindo Kawaguchi, Takashi Ishizaki, Akio Imada, Seiji Oohira, Satoru Kuriyama, Hidetomo Nakamoto, Masahiko Nakamoto, Makoto Hiramatu, Kenzi Maeda, Kazuo Ota
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  ABSTRACT: We wanted to clarify, in a large population, the reasons that peritoneal dialysis (PD) was interrupted and to propose appropriate strategies that might prolong the use of PD as a renal replacement therapy. We enrolled 5 391 patients from 439 centers into the study. Each center used a worksheet to report details about patients who either transferred to hemodialysis (HD) or died on continuous ambulatory peritoneal dialysis (CAPD) over a 6-month period from 1 April 2000, to 30 September 2000. We collected 252 drop-out cases from 141 centers. Of the 252 cases, 170 (67.5%) involved transfer to HD, and 82 (32.5%) involved death while on PD. Primary renal diseases were chronic nephritis (CN: 51.6%), diabetic nephropathy (DM: 26.6%), nephrosclerosis (4%), and unspecified or other condition (15.8%). Mean duration on PD in drop-out cases was 4.47 years. The age of patients at transfer to HD was younger (53.7 years) than the age of patients at death on PD (65.2 years). Patients with CN remained on PD significantly longer than did patients with DM (5 years vs 2.4 years). The three main reasons for PD discontinuation were overhydration because of ultrafiltration failure (UFF) or poor compliance with salt and fluid restrictions (34.1%); peritonitis (30.1%); and preference of the physician, patient, or family (6.5%). The proportional share represented by those three major reasons varied with the number of years since PD initiation (from 1 year to more than 8 years). Patients who had been on PD for a longer time were more likely to drop out because of UFF and less likely to drop out because of peritonitis. The three major causes of death on CAPD were cerebrovascular accident (22%), ischemic heart disease (14.6%), and sudden death (9.8%). Approximately 10% of patients drop out from PD programs annually in Japan. To prolong PD treatment, new solutions that better preserve peritoneal function need to be developed, and patients and caregivers alike need to receive intensive education in preventing and treating peritonitis.
  Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis. 12/2003; 23 Suppl 2:S175-7.
• Article: Re-evaluation of adequate dose in Japanese peritoneal dialysis patients.

  Akihiro C Yamashita, Makoto Ishizaki, Masahiko Nakamoto, Hideki Kawanishi, Hiroyuki Hamada
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  ABSTRACT: Our objective in the present study was to evaluate the dialysis dose required to maintain Japanese peritoneal dialysis (PD) patients in good condition. From 32 local hospitals, we selected 100 stable patients without diabetes mellitus who were on continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD), and we performed the peritoneal function test using the newly developed PD NAVI software (JMS, Hiroshima, Japan). Weekly total Kt/V and creatinine clearance (CCr) were calculated and plotted against body weight (BW) to evaluate the PD dose. In CAPD patients (n = 58), we found an inverse linear correlation between total Kt/V and BW (r = -0.576). In the same patients, total Kt remained essentially constant (60 L/week). Those results imply that most patients were being treated with the same PD regimen (2 L, 4 times daily), and that smaller patients were generally receiving a greater PD dose relative to body size than were the larger patients. In APD patients (n = 21), total Kt/V and total CCr normalized to 1.73 m2 did not change with BW. Total Kt and non normalized CCr gradually increased with BW, although the correlation was not significant. Those findings suggest that most APD patients received prescriptions that were more closely based on body size. In conclusion, smaller patients generally receive a greater PD dose than do larger patients, and targeting a single value of Kt/V or CCr may not always be relevant for adequate dialysis.
  Advances in peritoneal dialysis. Conference on Peritoneal Dialysis 02/2003; 19:103-5.
• Article: Re-evaluation of adequate dose in Japanese PD patients

  Akihiro Yamashita, Makoto Ishizaki, Masahiko Nakamoto, Hideki Kawanishi, Hiroyuki Hamada
  Advances in Peritoneal Dialysis. 01/2003; 19:103-105.
• Article: Effect of diabetes on peritoneal function assessed by personal dialysis capacity test in patients undergoing CAPD.

  Hidetomo Nakamoto, Hirokazu Imai, Hideki Kawanishi, Masahiko Nakamoto, Jun Minakuchi, Shinichi Kumon, Syuichi Watanabe, Yoshiki Shiohira, Takeo Ishii, Toshihiko Kawahara, Koichi Tsuzaki, Hiromichi Suzuki
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  ABSTRACT: We evaluated differences in individual peritoneal membrane transport function and nutritional status in patients with diabetes mellitus (DM) and nondiabetic (non-DM) patients on continuous ambulatory peritoneal dialysis (CAPD). We used a newly developed peritoneal function test, personal dialysis capacity, in 88 patients (44 DM and 44 non-DM) on CAPD for 1 to 210 months. Sex, age, past history of peritonitis, and duration of CAPD were matched in DM and non-DM patients. Serum albumin (mean +/- SEM) was lower in DM compared with non-DM patients: 3.0 +/- 0.1 g/dL (30 +/- 1 g/L) versus 3.5 +/- 0.1 g/dL (35 +/- 1 g/L), P < 0.001. Peritoneal area and dialysis protein loss were greater in DM versus non-DM patients. In multiple linear regression analysis, the only independent predictor of serum albumin in patients with DM was dialysis protein loss. In contrast, age, past history of peritonitis, duration of CAPD, caloric intake, protein nitrogen appearance and protein catabolic rate, and residual renal function did not correlate with serum albumin in DM patients. In non-DM patients, age, duration of CAPD, and past history of peritonitis, but not dialysis protein loss, were independent predictors of serum albumin. There was a significant correlation in DM patients, but not in non-DM CAPD patients, between dialysis protein loss and urinary excretion of protein (r = 0.866, P = 0.0005). In this multicenter study, peritoneal membrane transport and peritoneal protein permeability were significantly higher in DM than in non-DM patients. Hypoproteinemia in DM patients is attributable to the high permeability of the peritoneal membrane undergoing CAPD.
  American Journal of Kidney Diseases 11/2002; 40(5):1045-54. · 5.43 Impact Factor