Naoki Hamaguchi

Vitamin K_2 Alters Bone Metabolism Markers in Hemodialysis Patients with a Low Serum Parathyroid Hormone Level

Background: A low level of intact parathyroid hormone (PTH) is an indicator of adynamic bone disease in hemodialysis patients, and is associated with a significant increase of all-cause mortality. Thus, effective treatment for adynamic bone disease is required. We previously investigated the effect of vitamin K2 on adynamic bone disease. In this study, we assessed the efficacy of oral vitamin K2 in a controlled trial. Methods: Forty hemodialysis patients with low intact PTH levels (<100 pg/ml) were randomly divided into two groups, which were a vitamin K2 group receiving oral menatetrenone (45 mg/day) for 1 year and a control group without vitamin K2. Venous blood samples were collected at baseline and during the study for measurement of bone metabolism parameters. Results: Thirty-three patients completed follow-up. There was a significant increase of the serum intact osteocalcin level after 1 month of vitamin K2 administration. Serum levels of intact PTH, bone alkaline phosphatase, and cross-linked N-terminal telopeptide of type I collagen increased significantly after 12 months in the vitamin K2 group. The serum osteoprotegerin level was decreased after 12 months in the vitamin K2 group, but the change was not significant. Conclusion: Vitamin K2 therapy improves bone remodeling in hemodialysis patients with a low intact PTH level.

Study of the effects of pravastatin in patients with glomerulonephritis associated with hyperlipidemia

Abstract Pravastatin was administered at a dosage of 10 mg/d for 24 weeks to 21 outpatients with glomerulonephritis with accompanying hyperlipidemia who presented with total serum cholesterol levels of ≥220 mg/dL. As a result, significant reductions in total serum cholesterol, low-density lipoprotein cholesterol (LDL-C), and apolipoprotein (apo) B levels were observed at 12 and 24 weeks after drug administration when compared with the levels observed before treatment (total cholesterol, 308.7 ± 52.3 mg/dL vs 250.8 ± 40.8 mg/dL vs 238.4 ± 34.5 mg/dL; LDL-C, 215.0 ± 47.8 mg/dL vs 158.5 ± 38.4 mg/dL vs 153.0 ± 33.5 mg/dL; and apo B, 143.2 ± 28.3 mg/dL vs 111.3 ± 18.0 mg/dL vs 112.1 ± 19.7 mg/dL; P P

Measurement of bone mass by microdensitometry in patients undergoing hemodialysis.

慢性血液透析患者 (HD患者) の腎性骨異栄養症 (ROD) の詳細を知る目的にて慢性血液透析患者88例 (男性59例, 女性29例), 健常者60例 (男性30例, 女性30例) においてmicrodensitometry法を用いて骨量を測定した. 更には得られた骨量と臨床的諸因子, 治療との関連性について多変量解析により検討した. その結果, 1. 40歳代のHD患者では同年代の健常者に比しMCIの有意な低下が認められた. 2. MCIの低下に寄与すると考えられる項目は, 年齢60歳以上, 透析期間61か月以上, オステオカルシン10.1ng/ml以上, 血清カルシウム5.0mEq/l以下, 抗リン剤としてアルミゲル, 炭酸カルシウム単独投与等であった. 3. 30-50歳代のHD患者では同年代の健常者に比しΣGS/Dの有意な低下が認められた. 4. ΣGS/Dの低下に寄与すると考えられる項目は, 透析期間61か月以上, 年齢40歳以上, 性別女性, フェリチン251ng/ml以上, オステオカルシン10.1ng/ml以上, C-PTH 3.1ng/ml以上等であった. 以上より, RODの進展防止にはMD法による骨量指標と共に各種臨床的諸因子を総合的に判断し, 少なくとも適切なる抗リン剤, ビタミンD3の投与が重要であると考えられた.