Minoru Hatano

Protein Energy Wasting and Sarcopenia in Dialysis Patients

As the aging of the population progresses in Japan, the nutritional problems in dialysis patients are being highlighted. Frailty is a clinical concept including body weight loss, muscle weakness, fatigability, decreased walking speed, and decreased physical activity, which means an intermediate concept between healthy subjects and disability subjects, indicating that their activities of daily living are not decreased but they cannot smoothly perform housework or exercise. Morbidity of dialysis patients is known to be high, and mortality of dialysis patients with frailty is 3 times higher. Sarcopenia is one of the principal reasons for or triggers of frailty. It is a disease setting showing decreased muscle volume and quality associated with decreased physical function or quality of life. Recent mean age at dialysis therapy induction is getting near to 70 years old in Japan. Japanese dialysis patients who are elderly and present organ failure would have a double risk for sarcopenia. Patients with advanced stages of CKD are generally given protein diet, and it has been reported that a low protein intake in dialysis patients would be a significant risk for developing sarcopenia and increasing mortality. Recently, the focus has been on protein energy wasting (PEW) - an underlying disease condition in sarcopenia or frailty. PEW is an energy wasting condition occurring in dialysis patients, and the cause of PEW is principally decreased food intake and increased catabolism. It has recently been revealed that decreased protein intake would be a risk factor for increased mortality in dialysis patients. The incidence of PEW in dialysis patients is reported to be 14%. To avoid sarcopenia and PEW leading to frailty, we should pay much more attention to an appropriate protein and calorie intake rather than restriction in dialysis patients.

Evaluation of the functions of the temporary catheter with various tip types

Introduction: A temporary catheter (TC) is used short‐term and for emergencies. There are some cases when we cannot withdraw blood immediately after inserting the catheter in our patients. The reason is said to be the tips of the TC sticking to the vascular walls.

562 THE EFFECT TO SODIUM EXCRETION AND BLOOD PRESSURE WITH DPP-4 INHIBITORS

Background: The diabetes patients are known to be easy to present with salt sensitive hypertension. On the other hand, there is GLP-1 receptor to renal proximal tubule, and acts on sodium diuresis through NHE3. However, the effect to sodium diuresis and the blood pressure with the DPP-4 inhibitors were unknown. Aims: We examine sodium diuresis and the antihypertensive effects with the DPP-4 inhibitors by the short-term effects in the inpatients and the long-term effects in the outpatients. Methods: We gave DPP-4 inhibitor (either of sitagliptin 50–100 mg, vildagliptin 50–100 mg, alogliptin 12.5–25 mg) for patients less than 2.0 mg/dl of serum creatinine level. In the inpatients, we calculated urinary salt excretion using urine collection for 24 hours within one week around dosage. In the outpatients, we calculated sodium excretion quantity estimation level using first or second urinary in the morning, and measured the mean of home blood pressure. Results: In 23 inpatients, by the DPP-4 inhibitor dosage, urinary salt excretion significantly increased 1.8 ± 0.6 g for 24 hours. On the other hand, systolic and diastolic blood pressure significantly had decreased 6 ± 2mmHg and 5 ± 2mmHg, each. In 37 outpatients, quantity of salt excretion estimation level significantly increased 0.7 ± 0.2 g/day. The systolic blood pressure significantly had decreased 2 ± 1mmHg. The meaningful these effects were seen in alogliptin and sitagliptin, but was not seen in vildagliptin. Conclusion: By the dosage of the urine excretion type DPP-4 inhibitors for the diabetes, urinary sodium excretion increase, and blood pressure decrease.