Kiyoshi Kurokawa's research while affiliated with National Graduate Institute for Policy Studies and other places
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Publications (618)
Background
Socioeconomic status (SES) factors such as employment, educational attainment, income, and marital status can affect the health and well-being of the general population and have been associated with the prevalence of chronic kidney disease (CKD). However, no studies to date in Japan have reported on the prognosis of patients with CKD wit...
To help relieve the burden of dietary restrictions experienced by many hemodialysis (HD) patients, dialysis staff may encourage patients, with no consideration to the degree of family support. Here, we clarified the effect of staff encouragement and living conditions on the burden of dietary restrictions in HD patients. This retrospective cohort st...
Cinacalcet lowers parathyroid hormone levels. Whether it can prolong survival of people with chronic kidney disease (CKD) complicated by secondary hyperparathyroidism (SHPT) remains controversial, in part because a recent randomized trial excluded patients with iPTH < 300 pg/ml. We examined cinacalcet's effects at different iPTH levels. This was a...
Background
Dialysis guidelines in Japan recommend more frequent measurement of mineral metabolism markers than the Kidney Disease: Improving Global Outcomes guidelines. However, the extent to which frequent marker measurement contributes to achievement of target ranges and to therapy adjustment is unknown.
Methods
This multicenter cohort study inv...
Background
The extent of contribution of disturbed magnesium balance to mortality remains unclear among hemodialysis patients.
Methods
This was a cohort study involving 3276 patients on maintenance hemodialysis at 86 facilities in Japan from 2008 to 2010 who had secondary hyperparathyroidism (SHPT). Baseline serum magnesium (sMg) values were categ...
Introduction and Aims: On-line dialysance (Kt) and thermodilution (BTM-Qa) methods could be important components in vascular access monitoring programs.
This study evaluated the efficiency of these two methods in reducing the thrombosis rate and access-related costs compared
with a historic control group.
Methods: We studied 148 long-term hemodial...
In elderly hemodialysis (HD) patients, the risk of medication-related problems is particularly high. Thus, certain medications should generally not be prescribed to those patients. The Beers criteria for potentially inappropriate medications (PIMs) have been publicized. Still, with regard to elderly HD patients, the prevalence and risk factors for...
Background:
Vascular access (VA) guidelines recommend the native arteriovenous fistula (AVF) as VA of first choice for chronic hemodialysis patients. AVF management is important in hemodialysis patient care. AVF survival is associated with various physical factors, but the effects of dialysis treatment factors upon AVF survival are still not clear...
MBD-5D (Mineral and Bone Disorders Outcomes Study for Japanese Chronic Kidney Disease stage 5D patients) is a prospective, multicenter, observational study on hemodialysis patients with secondary hyperparathyroidism (SHPT). Here, we report the results of a “survey on practice patterns” that 79 facilities responded to at the end of a study and compa...
Background/aims:
Resistance to erythropoiesis-stimulating agent (ESA) is associated with mortality in hemodialysis (HD) patients. Time-dependent variability of ESA resistance has been not investigated adequately, although consistently high ESA resistance is expected to be a high risk for mortality. Our aim, therefore, was to investigate consistent...
Background and objectives:
Prescription patterns for hemodialysis patients with secondary hyperparathyroidism have varied widely since market introduction of cinacalcet. This study examined associations between prescription patterns and subsequent laboratory values.
Design, setting, participants, & measurements:
Using a Mineral and Bone Disorder...
We previously demonstrated that anemia was not associated with mortality in hemodialysis patients with cardiovascular disease (CVD). Since diabetes mellitus (DM) accelerates CVD, the influence of DM on the relationship between anemia and mortality was examined using the data obtained from 1,385 DM patients and 2,583 non-DM hemodialysis patients rec...
Control of serum concentrations of calcium (Ca), phosphorus (P), and parathyroid hormone (PTH) is essential for management of secondary hyperparathyroidism (SHPT).
This is a planned interim analysis of a longitudinal cohort study. The settings are dialysis facilities in Japan. Eligible patients comprise all those who were receiving hemodialysis at...
感染症は本邦における透析患者の死因として第2位にあげられる．なかでも敗血症は直接生命を脅かすものとして最も警戒すべき感染症である．最近9年間に自施設で経験した敗血症症例を集積し解析を行った．延べ205名の患者に計465回の血液培養検査を試み，陽性率は23.7％であった．この結果73例が臨床的に敗血症と診断された．患者背景として糖尿病合併は46例，カテーテル留置ありは47例であった．菌種については球菌：桿菌の比率は約4：1であり，最も頻度の高い菌種はブドウ球菌であった．メチシリン耐性ブドウ球菌の検出頻度は増加していた．転帰については過半数の38例が経過中に死亡した．メチシリン耐性菌がそのうちの24例を占め，致死率の高さが再認識された．また多変量解析の結果，危険因子としてCRPならびに血小板数の...
INTRODUCTION AND AIMS: Anti-HBs formation is impaired in HD patients naturally infected with HBV (14 - 31% of cases) or undergoing a planned immunization
(20 – 40% of cases). Our aim was to determine the potential association between development of anti-HBs and demographic, clinical
and laboratory data of HD patients. Special attention was paid to...
INTRODUCTION AND AIMS: Higher residential altitude has been associated with greater erythropoietin response and longer survival in ESRD patients.
It has been hypothesized that persistent activation of hypoxia-inducible factors (HIF) at higher altitude may explain these
associations. Animal models have shown that inactivation of prolyl-hydroxylases...
INTRODUCTION AND AIMS: Declining renal function is associated with a progressive increase in serum fibroblast growth factor-23 (FGF-23) levels.
In patients on renal replacement therapy (RRT), high FGF-23 circulating levels have been associated with vascular calcifications
and mortality, suggesting that FGF-23 could be a uremic toxin. In this perspe...
The Mineral and Bone Disorder Outcomes Study for Japanese CKD Stage 5D Patients (MBD-5D) is a multicenter, prospective observational study of hemodialysis patients with secondary hyperparathyroidism (SHPT) in Japan, where the national guideline recommends targets for serum calcium (8.4-10.0 mg/dl), phosphorus (3.5-6.0 mg/dl), and intact parathyroid...
Secondary hyperparathyroidism is common in patients with mineral and bone disorders related to chronic kidney disease. Guidelines for the management of secondary hyperparathyroidism in hemodialysis patients have been promulgated, but evidence on the relationship between treatment and survival is still insufficient. Studying hemodialysis patients wi...
We examined associations of C-reactive protein (CRP) levels with mortality in Japanese hemodialysis patients and trends in prevalence of CRP measurement at hemodialysis facilities internationally. To assess whether measurement of CRP may influence outcomes, we examined associations of facility prevalence of CRP measurement with mortality.
CRP measu...
AST-120, an oral adsorbent currently on-label only in Asian countries with phase III trials ongoing in the US, slows renal disease progression in patients with diabetes and advanced-stage chronic kidney disease (CKD). The objective of this study is to evaluate the cost-effectiveness of using AST-120 to treat patients with type 2 diabetes and advanc...
In April 2006, Japan's health insurance system instituted a bundling policy that included recombinant human erythropoietin (rHuEPO) in outpatient hemodialysis therapy. To evaluate outcomes of this, we analyzed a prospective cohort of hemodialysis patients in the Japan Dialysis Outcomes and Practice Patterns Study, in 53 facilities using prevalent c...
Angiotensin II type 1 receptor blockers (ARB) retard the progression of hypertensive diabetic kidney disease. Clinical evidence suggests that the dose of ARB required to correct hypertension is suboptimal for renoprotection evaluated by proteinuria. No systematic, prospective study has yet evaluated separately the effect of increasing doses of ARB...
Whether health-related quality of life (HRQoL) can be accurately predicted in patients with extremely low HRQoL as a result of diabetic complications is unclear. We investigated the impact of HRQoL on mortality risk in patients with diabetes on haemodialysis.
Data from the Dialysis Outcomes Practice Pattern Study (DOPPS) were analysed for randomly...
Given the clear benefits of mortality reduction observed for most beta-blockers in clinical trials, they are relatively underused in hemodialysis patients. Since the outcomes associated with the use of beta-blockers are not fully known, we investigated their effect on mortality among a cohort of hemodialysis patients.
Data were analyzed from the Di...
Pre-dialysis early referral is associated with improved survival in patients on dialysis. Here, we examined the association between pre-dialysis early referral and post-dialysis Mental Health (MH) in hemodialysis patients.
We examined data from the Dialysis Outcomes and Practice Patterns Study (DOPPS), a prospective and observational study of hemod...
The carbonaceous oral adsorbent AST-120 slows the deterioration of kidney function in patients with advanced chronic kidney disease (CKD). However, information about AST-120 in patients with less severe stages of CKD is lacking.
Randomized controlled trial.
75 medical facilities, 460 patients with CKD with serum creatinine (sCr) concentrations less...
The main objective of the study was to estimate a preference-based Short Form (SF)-6D index from the SF-36 for Japan and compare it with the UK results.
The SF-6D was translated into Japanese. Two hundred and forty-nine health states defined by this version of the SF-6D were then valued by a representative sample of 600 members of the Japanese gene...
Bodily pain and psychiatric distress are common symptoms in patients with dialysis. However, the temporal relationships have not yet been investigated. Objective. To evaluate the longitudinal association between depressive symptoms and subsequent risk of developing severe bodily pain in dialysis patients. Design. Prospective cohort study.
We assess...
Recent reports suggest a cross-sectional association between psychiatric distress and pruritus in patients on haemodialysis (HD). However, no study has examined the likelihood of developing severe pruritus in patients on HD with depressive symptoms.
To evaluate the relationship between baseline depressive symptoms and subsequent risk of developing...
Localization of pepsinogens I and II mRNA in the human gastric mucosa was investigated by an in situ hybridization method using digoxigenin labeled cDNA probes. Gastric fundic mucosa from healthy volunteers, which was stained with digoxigenin labeled pepsinogens I and II cDNA probes, showed positive staining in the cytoplasm of both chief cells and...
A comprehensive profile of genes expressed at the mRNA level (transcriptome) in human renal tissue is important for elucidating the pathogenesis and treatment of IgA nephropathy (IgAN). The recent development of complementary DNA (cDNA) array hybridization allows the parallel monitoring of thousands of genes expressed in renal tissue. High-density...
End-stage renal disease (ESRD) is a major source of morbidity and the increasing number of chronic dialysis patients is a significant health-care issue in many developed as well as developing countries. In the present brief review the current status of chronic dialysis is discussed; and Japan and the USA, two major countries in which chronic dialys...
It is well established that mesangial cell proliferation plays a major role in glomerular injury and progressive renal injury. The expression of a number of different genes has been reported in proliferative mesangial cells in culture. However, the relevance of these genes to renal injury in general and IgA nephropathy (IgAN) remains to be establis...
Background. Marked hyperplasia of the parathyroid gland (PTG) is a characteristic feature of severe hyperparathyroidism in patients under chronic haemodialysis treatment. Percutaneous ethanol injection therapy (PEIT) is now becoming popular in Japan as a treatment option for secondary hyperparathyroidism (SHPT) and its cost is covered by the Nation...
Considerable controversy exists over the impact of the biocompatibility and flux characteristics of dialyzer membranes on anemia in chronic hemodialysis patients.
A subset of 1,207 subjects from the Japanese arm of DOPPS phase II was analyzed.
Patient characteristics included mean age 59 years, male sex 60%, BMI 20.6, time on dialysis therapy 7.8 y...
In 2000, the Japanese Society for Parathyroid Intervention issued the ‘Guidelines for percutaneous ethanol injection therapy
of the parathyroid glands in chronic dialysis patients’. Since then, the concept of ‘selective PEIT’ has been well accepted
and the number of patients treated by this method in Japan has increased. Recently, it has been repor...
Japanese haemodialysis (HD) patients not only have a very low mortality and hospitalization risk but also low haemoglobin (Hb) levels. Internationally, anaemia is associated with mortality, hospitalization and health-related quality of life (QoL) measures of HD patients.
Longitudinal data collected from 1999 to 2006 from 60 to 64 representative Jap...
Serine protease inhibitors (serpin) play a central role in various pathological processes including coagulation, fibrinolysis, malignancy, and inflammation. Inhibition of serpins may prove therapeutic. As yet, however, only very few small molecule serpin inhibitors have been reported. For the first time, we apply a new approach of virtual screening...
Poor sleep quality (SQ) affects many haemodialysis (HD) patients and could potentially predict their morbidity, mortality, quality of life (QOL) and patterns of medication use.
Data on SQ were collected from 11,351 patients in 308 dialysis units in seven countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS) between 1996 and 2001 th...
Summary This report describes a case of POEMS syndrome with extremely rare complications of thrombocytopenia and biliverdinaemia. The thrombocytopenia appeared to be due to immunopathogenesis. Steroid treatment resulted in complete disappearance of the biliverdinaemia in this patient as well as symptoms and signs of POEMS syndrome, suggesting that...
End-stage renal disease (ESRD) affects 230,000 Japanese, with about 36,000 cases diagnosed each year. Recent increases in ESRD incidence are attributed mainly to increases in diabetes and a rapidly aging population. Renal transplantation is rare in Japan. In private dialysis clinics, the majority of treatment costs are paid as fixed fees per sessio...
Abnormalities in mineral metabolism have been linked to mortality in hemodialysis (HD) patients. We postulated that these abnormalities would have a particularly large deleterious impact on deaths due to cardiovascular causes in Japan. This study describes the recent status of abnormal mineral metabolism, significant predictors, and potential conse...
The Dialysis Outcomes and Practice Patterns Study (DOPPS) reported high incidence of depression in haemodialysis patients. Hypercalcaemia and high parathyroid hormone (PTH) levels are aetiological factors of psychological disorders. We examined the association between mineral metabolism abnormalities and mental health in Japanese-DOPPS patients.
We...
There are few data on the target level of glycaemic control among patients with diabetes on haemodialysis. We investigated the impact of glycaemic control on mortality risk among diabetic patients on haemodialysis.
Data were analysed from the Dialysis Outcomes Practice Pattern Study (DOPPS) for randomly selected patients on haemodialysis in Japan....
Skeletal resistance to parathyroid hormone (PTH) is well known to the phenomenon in chronic renal failure patient, but the detailed mechanism has not been elucidated. In the process of analyzing an animal model of renal failure with low bone turnover, we demonstrated decreased expression of PTH receptor (PTHR) accompanying renal dysfunction in this...
Serum hepatocyte growth factor (HGF) concentrations were measured in healthy volunteers, chronic renal failure patients without renal replacement therapy and haemodialysis patients. Serum HGF concentrations in healthy volunteers, chronic renal failure patients and haemodialysis patients were 0.18 ± 0.04 (s.d.), 0.28 ± 0.06 and 0.46 ± 0.22 ng/mL, re...
To evaluate the effect of 24R,25-dihydroxyvitamin D3 (24,25D) on uraemic bone disease, we treated the model rats of mild renal failure either with 0.5 μg/kg bodyweight (BW) of 24,25D, or with 5 μg/kg BW of 24,25D, or with 0.01 μg/kg BW of 1,25-dihydroxyvitamin D3 (1,25D), or with 0.01 μg/kg BW of 1,25D and 0.5 μg/kg BW of 24,25D, or with vehicle al...
The decreased density of the vitamin D receptor (VDR) plays an important role in the pathogenesis and progression of parathyroid hyperplasia in renal failure. In chronic dialysis patients, VDR density is less in nodular hyperplasia than in diffuse hyperplasia and the difference of cell proliferation has been also suggested by DNA analysis. to prove...
Pirfenidone (PFD) is a new drug which has been shown to prevent or even reverse the extracellular matrix accumulation in several organs. to examine the effect of PFD on the progressive glomerulosclerosis, we treated model rats with irreversible chronic renal disease per orally with 500 mg/kg bodyweight of PFD per day. the model rats were made by in...
Severe secondary hyperparathyroidism in chronic dialysis patients has been recently treated by supraphysiological concentration of calcitriol achieved through pulse therapy. However, there are many patients resistant to this therapy, who usually have larger parathyroid gland(s). to overcome this resistance, calcitriol was injected directly into the...
22-Oxa-1,25-dihydroxyvitamin D3 (OCT) is an analogue of vitamin D with less calcemic action than 1,25-dihydroxyvitamin D3 (1,25D3), and thus may be advantageous in the treatment of secondary hyperparathyroidism in dialysis patients. to further elucidate the mechanisms of less-calcemic action of OCT in chronic renal failure, we examined the effects...
Information about residual renal function (RRF) and outcomes associated with practices of diuretic use in patients with end-stage renal disease is not available worldwide.
Diuretic use was investigated in 16,420 hemodialysis patients from the Dialysis Outcomes and Practice Patterns Study, a prospective observational study of hemodialysis patients s...
Many hemodialysis patients in Japan have symptoms of depression, but whether those patients are treated appropriately is unknown. As part of the Dialysis Outcomes and Practice Patterns Study, data on symptoms of depression, physician-diagnosed depression, prescribed medications, and death were collected prospectively in cohorts in Japan (n=1603) an...
The international Dialysis Outcomes and Practice Patterns Study (DOPPS) is well suited to evaluate levels of deviation from emerging and established guidelines to clinical practice of hemodialysis, over time and by country. The DOPPS can also evaluate whether the target levels that are chosen in the guidelines are in agreement with outcomes such as...
We aimed to investigate prognostic factors for a composite end-point of end-stage renal disease (ESRD) and the progression of renal disease in Japanese patients with chronic renal disease. Using a composite end-point comprising a doubling of serum creatinine (sCr), an increase in sCr level to 6.0 mg/dL, or initiation of dialysis and renal transplan...
Many factors are involved in the pathogenesis of diabetic nephropathy. A single gene abnormality may be prerequisite but insufficient to the disease to manifest. It is therefore only when a second or sometimes a third damage is associated that the consequences of pathogenic phenotypes become evident. We generated the triple transgenic mice overexpr...
The present study has been undertaken to unravel the critical factors involved in the progression of diabetic nephropathy (DN).
A unique type 2 diabetic rat model with a wide range of metabolic derangements and hypertension has been utilized, the spontaneously hypertensive/NIH-corpulent rat SHR/NDmcr-cp(cp/cp). It develops histologically evident gl...
Clinical studies have demonstrated that some antihypertensive agents provide renoprotection independent of BP lowering. Recent in vitro and in vivo studies evaluated the mechanisms involved in this protection. First, the in vitro effects of several angiotensin II type 1 receptor blockers (ARB), calcium channel blockers (CCB), and beta blockers (BB)...
An imbalance between protein load and folding capacity is referred to as endoplasmic reticulum (ER) stress. As a defense mechanism, cells express ER stress inducible chaperons, such as oxygen-regulated proteins 150 (ORP150) and glucose-regulated proteins (GRPs). While ER stress is important in various diseases, a pathophysiologic role for ER stress...
The number of patients with chronic kidney disease (CKD) in Japan is currently rising. Therefore, measures to control the progression of CKD from a predialysis condition to endstage renal failure are urgently required. We are conducting a clinical trial to investigate the efficacy of an oral carbonaceous adsorbent (Kremezin) in patients at the pred...
Oxidative tissue damage in vivo is a complex phenomenon involving many factors and pathways. Proteins are particularly attractive targets for oxidative products analysis in order to understand better the physiopathology of human diseases. Protein modifications serve as footprints of biochemical processes. They also help ascertain the mechanism of a...
Adynamic bone disease (ABD), which is characterized by reduced bone formation and resorption, has become an increasingly common manifestation of bone abnormalities in patients with end-stage renal failure. It has been recognized that skeletal resistance to parathyroid hormone (PTH) underlies the pathogenesis of ABD; however, the mechanisms of such...
A considerable number of gastric cancers derive from stomach mucosa where chronic atrophic gastritis is severe and extensive. Based on the fact that the serum pepsinogen levels provide a precise measure of the extent of chronic atrophic gastritis, we have devised a mass screening method involving serum pepsinogen measurement to identify subjects at...
The international Dialysis Outcomes and Practice Patterns Study (DOPPS I and II) allows description of variations in kidney transplantation and wait-listing from nationally representative samples of 18- to 65-year-old hemodialysis patients. The present study examines the health status and socioeconomic characteristics of United States patients, the...
The intracellular polymerization of abnormal serine protease inhibitors (serpins) results in liver or neuronal cell abnormalities recently identified as "serpinopathies." It was demonstrated in transgenic rats that overexpression of megsin, a recently discovered serpin located in the kidney, produces renal and pancreatic lesions characteristic of s...
Predictors and consequences of altered mineral metabolism: The Dialysis Outcomes and Practice Patterns Study.
Background
Altered mineral metabolism contributes to bone disease, cardiovascular disease, and other clinical problems in patients with end-stage renal disease.
Methods
This study describes the recent status, significant predictors, and p...