Michio Odaka

Five-Year Survival for End-Stage Renal Disease Patients in the United States, Europe, and Japan, 1982 to 1987

We compared the 5-year survival for new end-stage renal disease (ESRD) patients accepted for renal replacement therapy (RRT) between 1982 and 1987 in the United States (n = 150,862), Europe (European Dialysis and Transplant Association [EDTA]) (n = 124,796), and Japan (n = 66,244). Given these large samples that approach a census in each of the three regions, all results are statistically significant. Our analysis showed that the US patients were older and more likely to be diabetic than the patients in either EDTA or Japan. After correction for patient differences in age composition and the percent diabetic, Japan had the highest survival, followed by EDTA, and then the US. Overall, the US 5-year survival was 40%. When comparison is done by age, only the youngest patients in the US (less than 15 years) have longer survival than their counterparts in Europe and Japan. For ages greater than 14 years, the survival differences between the US and EDTA and between the US and Japan grow larger with higher patient age. The comparisons of mortality by diagnosis showed that the differences between the US and EDTA and between the US and Japan were least for diabetes. For non-diabetic patients, the age adjusted relative risk (RR) of mortality for the US compared with EDTA was 1.22, ie, 22% higher in the US; for the US compared with Japan, the RR was 1.40. In contrast, the RR for diabetic patients in the US compared with EDTA was 1.07, and 1.23 for the US compared with Japan.(ABSTRACT TRUNCATED AT 250 WORDS)

Mortality in Chronic Dialysis Patients in Japan

Results of all forms of dialysis undertaken in Japan since 1980 through 1988 are presented. Gross mortality and actuarial survival are presented, including age-adjusted survival. The addition of older patients has not as yet increased Japanese mortality, which is markedly higher in the first year of dialysis than in later years.

Clinical Experience of Bead-Shaped Charcoal Haemoperfusion in Chronic Renal Failure and Fulminant Hepatic Failure

A new dialysis system using direct haemoperfusion with collodion-micro-encapsulated, albumin-coated, bead-shaped petroleum activated carbon and artificial kidney in series has been devised. This new system has been applied to the purpose of treatment of patients in chronic renal failure, fulminant hepatic failure and intoxication.

Adsorption of lipoprotein containing apolipoprotein-B through plasma separation for treatment of familial hypercholesterolemia.

For the treatment of familial hypercholesterolemia, Liposorber LA-40 was clinically applied. The Liposorber is a commercially developed affinity adsorbent for plasma perfusion which selectivily adsorbs low density lipoproteins and very low density lipoproteins and is specially designed for plasmapheretic treatment of hypercholesterolemia. The Liposorber column, containing activated cellulose beads having an affinity for liporpotein containing apolipoprotein-B, has an excellent adsorption capacity, excellent selectivity, minimum albumin loss. This new apheresis system was applied to 2 clinical cases. After seven months of trial perfusion every 2 weeks, patient condition was good, with a level of total cholesterol under 300 mg/dl. No replacement fluids were given during or after treatment. In this paper, clinical results of these patients were shown and the mechanism of adsorption of this specific adsorbent was discussed.

Experimental and Clinical Study on ATP-MgCl2 Administration for Postischemic Acute Renal Failure

The present study was undertaken to investigate the effect of ATP-MgCl2 on the recovery of renal function following renal ischemia. Bilateral renal ischemia was produced for 90 minutes in dogs. Immediately after the release of ischemia, ATP-MgCl2 (50 mumoles/kg) was given intravenously. Serum creatinine and FeNa were measured following the release of ischemia. Renal cellular energy charge, glomerular endothelial thickness and per cent circularity of interstitial cells were measured. Creatinine and FeNa were significantly lower in ATP-MgCl2 treated dogs compared to those in saline treated controls. Changes in energy charge, glomerular endothelial thickness and per cent circularity indicated ischemically induced renal cellular edema was reversed with ATP-MgCl2 through the improvement of energy metabolism. Taking those experimental data into consideration, ATP-MgCl2 was given to 16 acute renal failure patients and 13 patients survived. ATP-MgCl2 administration is effective for the treatment of acute renal failure.

Long Term Result of Ldl Selective Plasma Adsorption Therapy on Familial Hypercholesterolemia

A newly developed low density lipoprotein (LDL) selective adsorption column from the separated plasma was applied to one patient of heterozygous familial hypercholesterolemia for 20 months at intervals of two weeks. LDL selective adsorption column, Liposorber LA-40, contains 400 ml of swollen dextran sulfate cellulose beads. The long-term, 20 month results of treatment with LDL selective plasma adsorption therapy are reported. LDL selective plasma adsorption therapy by Liposorber is useful in decreasing LDL-cholesterol of familial hypercholesterolemia and is more specific and produces a smaller loss of useful components of the serum than the double filtration plasmapheresis treatment. This treatment is effective in improving clinical conditions of familial hypercholesterolemia. In spite of our lengthy treatment with this therapy, no blood transfusion and no replacement of fluids was done in 20 months.

Tissue blood flow in brain, liver, renal cortex, and renal medulla in experimental hemorrhagic shock.

Cerebral, hepatic, renal cortical, and medullary tissue blood flows of the dog during hemorrhagic shock were measured continuously using the thermoelectrical method. The effects of blood replacement, adrenergic α-stimulator and -blockade and hydrocortisone on the tissue blood flows were studied. After hemorrhage, cerebral blood flow was well maintained while renal cortical blood flow was poorly maintained. Following retransfusion, the blood flow returned rapidly to the brain and slowly to the renal cortex. Norepinephrine, phentolamine, and hydrocortisone were not effective in maintaining the organ blood flows in shock. However, when norepinephrine was given systemically and phentolamine administered to the renal artery simultaneously during shock, both cerebral and renal flows were well maintained. After the blood replacement and administration of α-blockade or hydrocortisone, all the measured blood flows returned to normal levels.

Gastric blood flow of the corpus and the antrum measured by a thermoelectrical method

ConclusionThe gastric blood flow of corpus and antrum was simultaneously measured using a modified thermocouple method stimulated by intravenous administration of histamine, Leogastrin, pentagastrin or secretin. Attitude of the change of gastric blood flow in corpus and antrum showed different attitude between the both in depend on kind of the stimulants. The change of blood flow of the corpus didn’t indicate the changing antral blood flow of the stomach. This results suggest that each stimulant has a characteristic affective mechanism.

Successful change of treatment from double filtration plasmapheresis to immunoadsorption plasmapheresis in a patient with myasthenia gravis.

血漿二重濾過法 (DFPP) と血漿免疫吸着法 (IAPP) を施行した重症筋無力症 (MG) の1例を報告する. 症例は55歳女性で, 主訴は, 眼瞼下垂, 四肢筋力低下, 易疲労性, 嚥下困難であった, 薬剤不応性のMGと診断され, DFPPを開始した. DFPPにて神経症状の改善が認められたが, 著しい低蛋白血症となり大腸憩室炎も出現して呼吸機能が著しく低下したため, 血液浄化法をIAPPに変えた. IAPPに変更後胸水貯留を認めたが, 神経症状が改善し血液浄化法から離脱し, 入院後8か月に退院した. DFPPは, 2次フィルターとしてEvaflux 3Aを, IAPPは, 吸着器としてイムソーバTR-350を用いた. 施行回数は, DFPPが20回, IAPPが17回で, 血漿処理量はともに2.5lであった. IgGの除去率は, DFPPで54%, IAPPで39%, 抗AChR抗体の除去率は, DFPPで46%, IAPPで59%であった. 長期間頻回DFPPでは低蛋白血症と自己防禦能低下による重症感染症に留意する必要がある.

Evaluation of access for acute hemopurification in children.

救急医療, 集中治療さらに血液浄化法の進歩により小児における急性腎不全および急性肝不全の治療が可能となった. 我々は, 小児15例に急性血液浄化法を施行し急性腎不全12例中9例を救命したが, 急性肝不全3例は全例死亡した. 小児急性血液浄化においては体重20kg以下の低体重児のaccessが問題となるので検討した.急性腎不全に対し腹膜透析を体重4.4kgから18kgの4例で単独で施行し, 血液透析を, 体重14kgから64kgの症例で行った. 低体重児の血流量は, 血漿交換では, arterial lineや16Gの中心静脈カテーテルの大腿静脈穿刺でも十分であったが, 血液透析では不十分であった. 体重40kg以上では, 12Fr FDLカテーテルの大腿静脈穿刺をはじめ大腿動脈穿刺や足背部外シャントでも血液透析に十分な血流量が得られた. 外シャントでは, 3-5ml/kg/minの血流量が得られ血液透析に対して十分な血流量を得た. 低体重児では, blood accessとして最近開発された8 FrのFDLカテーテルを大腿静脈に留置するのが適切と思われた.