Tsutomu Sakurada

More Stable and Reliable Pharmacokinetics with Preprandial Administration of Cyclosporine Compared with Postprandial Administration in Patients with Refractory Nephrotic Syndrome

Study Objective. To compare the absorption profile of cyclosporine after preprandial administration with that after postprandial administration, and to determine which administration time resulted in a more stable absorption profile and the timing of the drug concentration that was the most reliable marker for monitoring drug absorption.

Morphological characteristics in peritoneum in patients with neutral peritoneal dialysis solution

Peritoneal dialysis solution (PDS) plays a role in functional and morphological damage to the peritoneum. This study aimed to clarify the effect of neutral PDS in preventing morphological changes by assessing peritoneal damage and comparing morphological alterations between PD patients treated with neutral PDS and acidic PDS. Sixty-one patients participated from seven hospitals. All patients were treated with neutral PDS excluding icodextrin, during their entire PD treatment, and experienced no episode of peritonitis. The thickness of submesothelial compact (SMC) zone and the presence of vasculopathy in the anterior parietal abdominal peritoneum were assessed. The impact of icodextrin, hybrid therapy, and peritoneal rest and lavage in morphological alterations were determined. There was no significant difference in the average SMC thickness between neutral and acidic PDS. The vessel patency in patients using neutral PDS was significantly higher compared to that in acidic PDS at any time during PD. There were no significant suppressive effects from interventions or use of icodextrin with respect to peritoneal morphological injury. A monolayer of mesothelial cell was observed in approximately half the patients, especially in their receiving lavage patients. Neutral PDS, accompanied by other preventive approaches against peritoneal injury, might suppress the development of peritoneal morphological alterations.

The first case report of peritoneal dialysis related peritonitis caused by Microbacterium paraoxydans.

Peritonitis is still the major complication associated with peritoneal dialysis (PD). Microbacterium spp., a type of coryneform bacteria, is an environmental bacterium isolated from soil, waste water and animals. Human infection is rare, and only few cases have so far been reported in immunocompromised hosts, such as PD patients. Microbacterium paraoxydans, one type of Microbacterium spp. was identified for the first time in 2003. Only two cases of infection of Microbacterium paraoxydans have so far been reported. We herein report the first case of PD-related peritonitis caused by Microbacterium paraoxydans, which was identified by a sequence determination of the 16S rRNA gene. Based on the results of antibiotic sensitivity, the intravenous administration of erythromycin (EM) and oral administration of sulfamethoxazole/trimethoprim (ST) were selected, and PD was interrupted. EM administration was stopped after a total of 14 days. ST was administered for a total of 21 days, and later PD was resumed. Thereafter, no recurrence or relapse of peritonitis without removal of the PD catheter was observed. Microbacterium spp. exhibits multidrug resistance and such an infection is refractory in many cases. We assume that both accurate species identification and the use of antibiotic sensitivity tests are essential to effectively treat this kind of infection.

Relation of physical function and physical activity to sarcopenia in hemodialysis patients: A preliminary study

a Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, Kawasaki, Japan b Department of Rehabilitation Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Japan c Graduate School of Health Sciences, Kobe University, Kobe, Japan d Division of Nephrology and Hypertension, Department of Medicine, Kawasaki Municipal Tama Hospital, Kawasaki Japan e Division of Nephrology and Hypertension, Department of Medicine, St. Marianna University School of Medicine Hospital, Kawasaki, Japan f Japan Community Health Care Organization Tokyo Takanawa Hospital, Tokyo, Japan

Alteration of energy production by the heart in CRF patients undergoing peritoneal dialysis

Cardiovascular disease is commonly observed in patients with chronic renal failure and this is a leading cause of death in patients with end-stage renal disease undergoing maintenance dialysis. Myocardial energy production is a very crucial aspect of cardiac function. Therefore, to evaluate energy metabolism of myocardial muscle in peritoneal dialysis (PD) patients, we carried out the following study using Magnetic resonance spectroscopy (MRS).

Efficacy of oral powder compared with chewable tablets for lanthanum carbonate administration in hemodialysis patients.

Lanthanum carbonate (LC) has been administered in a chewable tablet form for patients with hyperphosphatemia undergoing dialysis. However, some patients have difficulty chewing the tablets. LC oral powder has recently been released in Japan. The purpose of this study was to clarify the efficacy of LC oral powder form compared with that of chewable tablet form. The efficacy and safety of LC oral powder was retrospectively assessed in hemodialysis patients who switched from chewable tablet form to oral powder form without dose modification. Thirty‐six patients (mean age, 66.8 ± 10.5 years; male, 64%; 39% with diabetes; mean duration of dialysis treatment, 99.2 ± 95.6 months) were enrolled in this study between June and July of 2012. Changes in clinical data and adverse events after the switch to oral powder form were investigated. The average dose of LC was 1180 ± 520 mg/day. Serum phosphorus levels were significantly decreased after the switch from chewable tablet form to oral powder form (5.3 ± 1.7 mg/dL at baseline vs. 4.9 ± 1.2 mg/dL at after 1 month after, P = 0.038). In contrast, no significant differences were observed in serum calcium and parathyroid hormone levels. Furthermore, no significant differences were evident in weight gain after the switch to oral powder form (2.5 ± 1.2 kg at baseline vs. 2.4 ± 1.1 kg at 1 month after the switch, P = 0.29). No serious adverse events were recorded. Our results suggest that LC is more effective in oral powder form than chewable tablet form for hemodialysis patients.

Poor nutritional status is associated with low physical activity in patients undergoing peritoneal dialysis

a Department of Rehabilitation Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Japan b Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, Kawasaki, Japan c Graduate School of Health Sciences, Kobe University, Kobe, Japan d Division of Nephrology and Hypertension, Kawasaki Municipal Tama Hospital, Kawasaki, Japan e Division of Nephrology and Hypertension, St. Marianna University Yokohama City Seibu Hospital, Yokohama, Japan f Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan g Japan Community Health care Organization Tokyo Takanawa Hospital, Tokyo, Japan

A rare case of peritoneal dialysis-related peritonitis caused by goldfish water tankderived Aeromonas hydrophila.

CASE PRESENTATION A 62-year-old man was diagnosed with peritoneal dialysis (PD)-related peritonitis following diarrhea and determination of a dialysate leukocyte count of 10,224/μL. We cultured peritoneal effluent and started intraperitoneal antibiotic therapy. Peritonitis immediately improved. Peritoneal effluent culture yielded Aeromonas hydrophila. The medical interview revealed that the patient kept goldfish as pets. We suspected that the fish tank water was the source of the infection, considering the association of A. hydrophila with aquatic environments. Culturing of tank water confirmed the presence of Aeromonas. Furthermore, we observed that one of the goldfish was suffering from lepidorthosis, which is commonly caused by Aeromonas, and we then confirmed that the fishs infection was caused by an aeromonad. CONCLUSION Aeromonas species have rarely been identified as the pathogens in PD-related peritonitis; to our knowledge, there hitherto have been no reports identifying the source of this organism. We present here the process of this infection as elucidated through investigation of the living environment of the patient.

Collagenous Colitis Associated with Rabeprazole in a Peritoneal Dialysis Patient.

endoscopic appearance of CMV colitis is variable; round-shaped ulcers are the most distinctive features, but not specific. The definitive diagnosis requires histopathologic evidence of viral cytopathic effects, and the sensitivity is augmented by immunohistochemistry or polymerase chain reaction (PCR) for CMV deoxyribonucleic acid (DNA) (3,4). The colitis in our patient was not self-limited, but subsequently improved with ganciclovir therapy. A meta-analysis of immunocompetent patients with CMV colitis reported a lower rate of spontaneous remission (18.8%) and a mortality of 56% in individuals with renal failure, diabetes mellitus, pregnancy, or untreated cancer (1). Antiviral therapy is probably beneficial to patients with comorbidities or persistent symptoms. In conclusion, the presence of B. fragilis in PD peritonitis is more commonly associated with intra-abdominal pathologic states, and CMV colitis should be considered even in the absence of immunosuppression.

Re-Embedding Catheter Technique at the Discontinuation of Peritoneal Dialysis

The removal of a peritoneal dialysis catheter (PDC) is an important procedure, much like the placement of a PDC. In our institution, the removal of a PDC was always performed under spinal or general anesthesia. However, we might hesitate to remove a PDC in some patients under such anesthesia when their general condition is too poor due to severe cerebrovascular and/or cardiac disease. Therefore, we attempted a re-embedding catheter technique in 4 patients. In this report, we review the advantages and disadvantages of this technique and compare it with traditional techniques.