Tsutomu Sanaka

Edogawa Hospital, Edo, Tōkyō, Japan

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Publications (126)174.41 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background/Aims: Combining peritoneal dialysis (PD) and hemodialysis (HD) has been common treatment option in Japan. Methods: In this retrospective, multicenter, observational study, the clinical characteristics and outcomes of 104 patients (57 ± 11 years, males 72%) who had switched from PD alone to combined therapy with PD and HD were studied. Clinical parameters were measured at baseline and after 3 months of combined therapy. Results: At baseline, urine volume, dialysate-to-plasma ratio of creatinine (D/P Cr), and total Kt/V were 150 ml/day (range: 0-2,000 ml/day), 0.67 ± 0.11, and 1.8 ± 0.4, respectively. During the first 3 months of combined therapy, body weight, urine volume, serum creatinine level, and D/P Cr decreased, whereas hemoglobin levels increased. Conclusions: In patients where PD does not result in acceptable outcomes, combined therapy with PD and HD may have potential benefits in terms of dialysis adequacy and hydration status. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=368389 © 2014 S. Karger AG, Basel.
    Blood Purification 11/2014; 38(2):149-153. DOI:10.1159/000368389 · 1.92 Impact Factor
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    ABSTRACT: BACKGROUND AND OBJECTIVES: A 1-year multicenter prospective randomized controlled study was conducted on the effects of vitamin E-bonded polysulfone dialyzers on erythropoiesis-stimulating agent response in hemodialysis patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Major inclusion criteria were use of high-flux polysulfone dialyzers with 50-70 ml/min β2-microglobulin clearance over 3 months, transferrin saturation over 20%, same erythropoiesis-stimulating agent for over 3 months, and hemoglobin at 10-12 g/dl. Hemodialysis patients were placed in four interventional groups: two hemoglobin ranges (10.0-10.9 or 11.0-11.9 g/dl) and two dialyzers. Patients were randomly assigned by central registration to a vitamin E-bonded polysulfone dialyzers or polysulfone control group. Primary end point was relative erythropoiesis resistance index at baseline between groups at 12 months. Erythropoiesis resistance index was defined as total weekly erythropoiesis-stimulating agent dose divided by hemoglobin. RESULTS: There were no statistically significant differences in age or sex. There was no significant difference in relative erythropoiesis resistance index between vitamin E-bonded polysulfone dialyzers and control groups at 12 months (vitamin E-bonded polysulfone dialyzers: 1.1, control: 1.3). The vitamin E-bonded polysulfone dialyzers group showed better relative erythropoiesis resistance index than the control group at 11.0-11.9 g/dl hemoglobin (vitamin E-bonded polysulfone dialyzers: 1.0, control: 1.4 at 12 months, significant difference) but no difference at 10.0-10.9 g/dl hemoglobin. CONCLUSIONS: The overall relative erythropoiesis resistance index showed no difference between the vitamin E-bonded polysulfone dialyzers and control groups, although the change in relative erythropoiesis resistance index differed according to hemoglobin level.
    Clinical Journal of the American Society of Nephrology 04/2013; 8(6). DOI:10.2215/CJN.04680512 · 5.25 Impact Factor
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    ABSTRACT: Case 1: A 57-year-old man was admitted to our hospital with polyarthritis, purpura and edema on both legs, and colicky abdominal pain with bloody diarrhea after common cold-like symptoms. A laboratory examination revealed nephrotic syndrome. He was diagnosed with HSP by skin and kidney biopsies. Treatment was initially started with prednisolone 50 mg/day intravenously. Although purpura on the lower extremities and polyarthritis partially improved after 2 weeks, his abdominal pain with melena worsened. Leukocytapheresis (LCAP) using Cellsorba E column was performed a total of 7 times twice a week. Intestinal bleeding with extrarenal symptoms disappeared after LCAP therapy. However, this therapy was not effective for edema and proteinuria; therefore, methylprednisolone pulse therapy was performed for 3 days, followed by oral prednisolone with cyclosporin. A significantly decrease was observed in proteinuria. Case 2: A 50-year old man was admitted to the Department of Dermatology of our hospital with arthralgia, a purpuric rash, and a submucosal abscess of the left inguinal region. He was diagnosed with HSP by skin biopsy, and a skin culture showed streptococcal infection; therefore, 30 mg/day of oral prednisolone was initiated. However, he suffered from colicky abdominal pain, melena, and edema with hematoproteinuria. He was referred to our division, and methylprednisolone pulse therapy was performed for 3 days after renal biopsy, followed by 50 mg/kg prednisolone intravenously. Although edema and proteinuria were markedly reduced, his abdominal pain and melena persisted. LCAP using Cellsorba E column was then performed a total of 3 times. Intestinal bleeding disappeared after LCAP therapy. In conclusion, we clarified the efficacy of LCAP therapy in 2 adult cases with HSP and severe extrarenal symptoms.
    Nihon Toseki Igakkai Zasshi 01/2013; 46(7):671-680. DOI:10.4009/jsdt.46.671
  • Nihon Toseki Igakkai Zasshi 01/2012; 45(9):853-862. DOI:10.4009/jsdt.45.853
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    ABSTRACT: Since April 2010, combination therapy consisting of peritoneal dialysis and hemodialysis (PD+HD) can be calculated as a medical service covered by the Japanese National Health Insurance. Prior to April 2010, billing for medical service fees was confusing and hindered the widespread adoption of PD+HD combination therapy. Therefore, the EARTH (Evaluation on the Adequacy of Renal Replacement Therapy) Study Group conducted a questionnaire survey to investigate the actual state of affairs with regard to billing for medical service fees related to PD+HD combination therapy. A questionnaire survey was conducted between August 2009 and September 2009 at 30 facilities by the EARTH Study Group. PD+HD combination therapy had been performed at 29 of these facilities. During this 1-month period, 1,267 patients underwent PD, and 281 of these patients underwent PD+HD combination therapy. The following items included in the insurance billings for these patients were reviewed : management fees for continuous ambulatory peritoneal dialysis (PD management fees), PD material costs, outpatient medical management fees for chronic maintenance dialysis patients (medical management fees), HD material costs, and HD procedure fees. The actual situation regarding billing for these items was determined at only 16 facilities that responded that they were performing PD and HD as combination therapy within their own facility. The results showed that PD material costs were billed at all 16 facilities and PD management fees were billed at all 16 facilities except one. Medical management fees were billed at 6 facilities (37.5%). HD material costs were billed at 14 facilities (87.5%), but were not billed at the other 2 facilities. HD procedure fees were billed at only 2 facilities (12.5%). The results for the insurance billing at 13 facilities that responded that they had asked another facility to perform HD showed that there were 15 different patterns of billing for PD performed at the facility itself and HD performed at the other facility. Prescription drug fees or specific health insurance fees for medical materials can be calculated for PD+HD combination therapy according to the insurance calculation rules. Furthermore, this can be done in cases in which HD and PD are performed at different sites. However, only 3 (23.1%) of the 13 facilities interpreted the rule as such to claim the medical fees. This survey showed that there is a great deal of confusion at clinical sites with regard to the billing rules for PD+HD combination therapy.
    Nihon Toseki Igakkai Zasshi 01/2011; 44(3):251-259. DOI:10.4009/jsdt.44.251
  • Tsutomu Sanaka · Madoka Ishii · Aiko Miyazaki
    Nippon rinsho. Japanese journal of clinical medicine 11/2010; 68 Suppl 9:426-9.
  • Tsutomu Sanaka
    Nippon rinsho. Japanese journal of clinical medicine 11/2010; 68 Suppl 9:514-8.
  • Nihon Toseki Igakkai Zasshi 01/2010; 43(1):77-85. DOI:10.4009/jsdt.43.77
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    ABSTRACT: The development of a glucose-free peritoneal dialysis (PD) solution is important because glucose has been associated with functional and morphological damage to the peritoneal membrane. The ultrafiltration (UF) and biocompatibility of new PD solutions containing taurine (PD-taurine) instead of glucose as an osmolite were tested in a rat PD model. To determine the solution's UF ability, different concentrations of taurine in PD solutions were compared to glucose-based PD solutions (PD-glucose) by giving single intraperitoneal injections for 2, 4, and 6 hours. To examine the biocompatibility of PD-taurine, the rats were divided into 3 groups: a 3.86% PD-glucose group, a 3.5% PD-taurine group and a not dialyzed group. The rats were given 10-mL injections of PD fluids intraperitoneally 3 times daily for 7 days. A peritoneal equilibration test (PET) was performed using a 1.9% xylitol solution at the time the rats were sacrificed. Mesothelial cell monolayers were obtained from the animals and studied based on a population analysis. The net UF of PD-taurine increased in a dose-dependent manner; the 3.5% PD-taurine solution was equivalent to the 3.86% PD-glucose solution after 4 hours. The PET showed that the drainage volume and the D(4)/D(0) ratio for xylitol after 4 hours with PD-taurine solution were significantly greater than with the PD-glucose solution (p < 0.001 and p < 0.001 respectively). Mesothelial and fibroblast-like cell proliferation was significantly less with PD-taurine than with PD-glucose (p < 0.01). These results indicate that PD-taurine resulted in net UF equivalent to that of PD-glucose and was more biocompatible than PD-glucose with respect to the peritoneal membrane.
    Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis 01/2009; 29(2):204-16. · 2.20 Impact Factor
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    ABSTRACT: Adiponectin is an adipocyte hormone that ameliorates insulin resistance and prevents diabetes. Patients with impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) are at a high risk of developing diabetes and cardiovascular diseases. Since treatment with angiotensin II receptor blockers retards the development of diabetes, the effects of losartan on serum adiponectin levels were examined with regard to insulin sensitivity in pre-diabetic patients. Sixty-five patients with IFG/IGT (42 males, 23 females, 63+/-13 years old) were randomized to receive 25-100 mg of losartan (n=33) or a calcium channel blocker (CCB, n=32) for 3 months. Before and after the treatment, changes in blood pressure, insulin sensitivity (HOMA-R) and serum concentrations of high molecular weight (HMW)-adiponectin and free fatty acid (FFA) were assessed. At baseline, the HMW-adiponectin concentration negatively correlated with the patient's body mass index, HOMA-R and triglyceride levels, and positively correlated with high-density lipoprotein (HDL)-cholesterol levels. However, the HMW-adiponectin concentration showed no correlation with blood pressure. HMW-adiponectin concentrations were similar between the losartan group and the CCB group. Both the losartan and CCB treatments similarly and significantly reduced the mean blood pressure (107+/-7 mmHg to 95+/-7 mmHg, p<0.0001, and 104+/-6 mmHg to 93+/-9 mmHg, p<0.0001, respectively). Losartan treatment resulted in a significant increase in HMW-adiponectin concentrations (45.9%) and a significant decrease in HOMA-R (23.9%) and FFA concentrations (26.5%); the percent changes were greater than those induced by CCB treatment (p<0.001, p<0.05 and p<0.01, respectively). We conclude that losartan increases the serum HMW-adiponectin concentration and concurrently improves insulin sensitivity in subjects with IFG/IGT. These results suggest that losartan may prevent diabetes by increasing serum adiponectin levels.
    Hypertension Research 09/2008; 31(8):1611-8. DOI:10.1291/hypres.31.1611 · 2.94 Impact Factor
  • Sayako Hoshi · Yutaka Yamaguchi · Tsutomu Sanaka · Tatsuo Hosoya
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    ABSTRACT: Although pathological changes in the vascular lesions of malignant nephrosclerosis have been quantified, little is understood about interstitial changes. We quantified pathological changes such as glomerular damage (glomerular sclerosis and collapse), vascular patency and interstitial fibrosis to determine statistical correlations with clinical data. We examined 25 patients who were diagnosed with malignant hypertension and investigated correlations among age, urinary protein, SUN, 1/Cre, systolic BP and diastolic BP (from medical charts), interstitial fibrosis, glomerular damage, acute tubular damage (semiquantified by scoring) and arterial and arteriolar patency (from renal biopsies). Interstitial fibrosis inversely correlated with 1/Cre (p=0.0114), interlobular arterial patency (p= 0.0139) and total vascular patency (p = 0.0499). Glomerular damage tended to correlate with urinary protein, but the values did not reach the level of statistical significance (p=0.0666). On the other hand, glomerular damage correlated with neither interstitial fibrosis nor vascular patency. Acute tubular damage closely correlated with both diastolic (p= 0.0086) and systolic (p = 0.0075) BP. Interstitial damage increases with decreasing interlobular arterial patency and renal function decreases with increasing interstitial damage. Since acute tubular damage that can progress to chronic interstitial damage closely correlates with BP, the control of BP might indirectly influence the prognosis of renal function.
    Nippon Jinzo Gakkai shi 02/2008; 50(4):488-98.
  • Nihon Toseki Igakkai Zasshi 01/2008; 41(11):785-792. DOI:10.4009/jsdt.41.785
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    ABSTRACT: The presence of peripheral arterial disease substantially increases the risk for both morbidity and mortality among end-stage renal disease patients. Low-density lipoprotein (LDL) apheresis has been also applied for the treatment of peripheral arterial disease to reduce LDL levels, resulting in the improvement of the blood flow to the ischemic limbs. In this study, we investigated the continuous changes of the tissue blood flows in the lower limbs and head during LDL-apheresis treatment by a non-invasive method (the non-invasive continuous monitoring method (NICOMM) system). In this study, the tissue blood flow in both the head and lower limbs showed a significantly enhancement from before to after treatment. The tissue blood flow in the lower limbs showed a significantly larger improvement than that in the head. The short-term effects of LDL apheresis were confirmed by using the NICOMM system; thus, this system will be useful for the determination of the appropriate schedule of LDL apheresis for long-term effectiveness.
    Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 11/2007; 11(5):325-30. DOI:10.1111/j.1744-9987.2007.00497.x · 1.53 Impact Factor
  • Nippon Jinzo Gakkai shi 02/2007; 49(8):871-8.
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    ABSTRACT: We compared the histological changes before and after treatment in 14 cases of myeloperoxidase antineutrophil cytoplasmic autoantibodies (MPO-ANCA) related nephritis in whom we were able to perform two renal biopsies. The results show that the clinical findings and acute glomerular and tubulointerstitial injuries decreased, while chronic glomerular injuries increased. No changes were seen in minor glomerular abnormalities(MGAs) or chronic tubulointerstitial injuries between the first and second biopsies. In the vascular system, no treatment related aggravation of arteriosclerosis occurred and it was found that fibrinoid necrosis disappeared with treatment. Finally, in MPO-ANCA related nephritis, the care given between the first and second biopsies caused acute glomerular injuries to become chronic glomerular injuries, but no changes were detected in the MGA. We believe that the changes in acute tubulointerstitial injuries reflected an improvement in renal function, since the acute tubulointerstitial injuries obviously improved in response to PSL, contributing to the improved renal function. In other words, MPO ANCA-related nephritis is a condition that involves "acute glomerulonephritis+ acute tubulointerstitial nephritis + angiitis," and it is thought that the characteristics of each are independent. We believe that the renal function improved as the acute tubulointerstitial nephritis improved, while the acute glomerular injuries developed into chronic glomerular injuries.
    Nippon Jinzo Gakkai shi 02/2007; 49(4):438-45.
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    ABSTRACT: In clinical practice, the prediction of changes in blood pressure during hemocatharsis therapy depends on invasive monitoring, the physician's experience, or blood pressure measurement when patients ask for it. It is extremely difficult to predict blood pressure variation in patients under general anesthesia or with disturbance of consciousness. Therefore, the prediction of blood pressure variation during hemocatharsis therapy is an important issue. To address this issue, we invented a new noninvasive continuous blood flow monitor using arteriolar blood flow measurement by laser Doppler flowmetry. Then we examined and determined some extremely important phenomena, including the relationship between rapid blood pressure change and arteriolar blood flow, and failures of the cerebral blood flow autoregulatory mechanism, through measurements in clinical practice of hemodialysis, specific hemocatharsis therapy, and drug monitoring. The results suggest that blood pressure variation during hemocatharsis therapy is highly predictable by arteriolar blood flow measurement. Therefore, this new method for arteriolar blood flow measurement might be widely useful for patients under anesthesia, anesthesia monitoring in neonatal infants and animals (no conversation ability), as well as for hemocatharsis therapy.
    Journal of Artificial Organs 02/2007; 10(1):36-41. DOI:10.1007/s10047-006-0357-9 · 1.39 Impact Factor
  • Chieko Higuchi · Hideki Nishimura · Tsutomu Sanaka
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    ABSTRACT: Conventional peritoneal dialysis fluid (PDF) is a bioincompatible solution because of several components. These unphysiological compositions might contribute to the development of peritoneal fibrosis. In the present overview we summarize the influence of each composition of PDF (acidic pH, high concentration of glucose and glucose degradation products; advanced glycation end-products and lactate) on the peritoneal fibrotic changes in long peritoneal dialysis (PD) patients. We also summarized the report of new approaches to the prevention of peritoneal fibrosis in Japan.
    Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 09/2006; 10(4):372-9. DOI:10.1111/j.1744-9987.2006.00391.x · 1.53 Impact Factor
  • Tsutomu Sanaka
    Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 09/2006; 10(4):303-4. DOI:10.1111/j.1744-9987.2006.00398.x · 1.53 Impact Factor
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    ABSTRACT: Advancement in blood purification therapy extends not only to consoles and dialyzers, but also to patient management during blood purification therapy. However, no monitor has been devised for hemodynamics during blood purification therapy that is carried out continuously and non-invasively. By studying the laser Doppler flowmeter (LDF), we have developed a probe that can continuously measure changes in blood flow in tissues of the head and lower extremities during blood purification therapy. By applying the improved LDF, we have developed a non-invasive continuous monitoring method (NICOMM). Hemodynamics in various types of blood purification therapies were also studied by simultaneously measuring with an automatic oscillometric sphygmomanometer.
    Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 09/2006; 10(4):380-6. DOI:10.1111/j.1744-9987.2006.00392.x · 1.53 Impact Factor
  • Tsutomu Sanaka
    Nippon rinsho. Japanese journal of clinical medicine 03/2006; 64 Suppl 2:509-12.

Publication Stats

562 Citations
174.41 Total Impact Points

Institutions

  • 2013
    • Edogawa Hospital
      Edo, Tōkyō, Japan
  • 1991–2010
    • Tokyo Women's Medical University
      • • School of Medicine
      • • Department of Medicine IV (Nephrology)
      Edo, Tōkyō, Japan
  • 2005
    • Ajinomoto-Genetika Research Institute
      Moskva, Moscow, Russia
  • 2003
    • Showa University
      Shinagawa, Tōkyō, Japan
  • 1987–1997
    • Tokyo Junshin Women's College
      • • Department of Medicine
      • • Kidney Center
      Edo, Tōkyō, Japan