Hiroshi Kishimoto

Poor Glycemic Control is a Significant Predictor of Cardiovascular Events in Chronic Hemodialysis Patients With Diabetes

We investigated the impact of glycemic control on the emergence of cardiovascular disease (CVD) in diabetic patients who were on maintenance hemodialysis in a prospective observational study. One hundred and thirty‐four diabetic hemodialysis patients (63 ± 10 years‐old, hemodialysis duration of 4.5 ± 3.9 years) at a single dialysis center were enrolled. The cohort was observed prospectively for 5 years, and the emergence of fatal and non‐fatal CVD was recorded. Patients were categorized into two groups; good (mean hemoglobin (Hb) A1C <7.0%, N = 65) and poor HbA1C (mean HbA1C ≥7.0%, N = 69). The relationship between glycemic control and CVD emergence was evaluated by Kaplan‐Meier estimation and Cox proportional hazard models. During the follow‐up period, 50 CVD events were observed. The cumulative CVD incidence in the poor HbA1C group was significantly higher than that of the good HbA1C group, as determined by Kaplan‐Meier estimation (P = 0.0250, log‐rank test). After adjustment for gender, age, duration of dialysis, and past history of CVD, a multivariate Cox proportional hazard model showed that poor HbA1C was a significant predictor of CVD events (hazards ratio [HR] 1.828 [95% CI, 1.008–3.314], P = 0.0470). When ischemic heart disease, cerebral infarction, and arteriosclerosis obliterans were determined as an endpoint, both HbA1C levels and the poor HbA1C group were significant predictors for the emergence of CVD (HR 1.269 per 1% HbA1C [95%CI, 1.022–1.574], P = 0.0307,and HR 2.816 [95% CI, 1.377–5.759], P = 0.0046, respectively). In diabetic hemodialysis patients, poor glycemic control is a significant, independent predictor of the emergence of CVD, indicating the importance of careful management of glycemic control in hemodialysis patients.

THE ANTIHYPERTENSIVE EFFECT OF CALCITONIN GENE-RELATED PEPTIDE IN RATS WITH NOREPINEPHRINE- AND ANGIOTENSIN II-INDUCED HYPERTENSION

To investigate the role of calcitonin gene-related peptide (CGRP) in blood pressure regulation, we used rats with hypertension, induced by the chronic infusion of norepinephrine or angiotensin II, and examined changes in the systemic hemodynamics using the radioactive microspheres method. CGRP (0.05 micrograms/kg per min) administered simultaneously with norepinephrine (1.8 mg/kg per day) significantly reduced the systolic blood pressure of conscious rats compared with norepinephrine infusion alone. Similarly CGRP given with angiotensin II (0.9 mg/kg per day) significantly reduced the systolic blood pressure compared with angiotensin II alone. The antihypertensive effect of CGRP was sustained for 6 days. CGRP infusion decreased the total peripheral resistance but caused no change in cardiac output compared with rats given only pressor substances. Thus, a subdepressor dose of CGRP can modulate the vasopressor effects of norepinephrine and angiotensin II. CGRP may be involved in the regulation of blood pressure via an effect on peripheral vascular resistance.

High-density-lipoprotein metabolism during a very-low-calorie diet.

We examined the changes in high-density-lipoprotein (HDL) metabolism in eight female obese patients undergoing a very-low-calorie diet (VLCD). In the first half of the study, HDL cholesterol (HDL-C), apolipoprotein A-I (apo A-I), and apo A-II showed a parallel decrease. Although lipoprotein lipase (LPL) and hepatic lipase (HTGL) did not change, lecithin: cholesterol acyltransferase (LCAT) decreased. In the latter half of the protocol, HDL-C and apo A-I increased whereas apo A-II decreased, resulting in increased apo A-I-A-II ratios. There was no change in LPL, HTGL, or LCAT. LCAT and apolipoprotein composition may be important in HDL-C changes after VLCD.