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Hideki Kawanishi

Publications and source records attributed to Hideki Kawanishi.

At least 19 recordsLinked to original sources
PubMed2006

On-line continuous hemodiafiltration in sepsis.

On-line products of substitution fluid by bicarbonate buffered dialysate permits virtually unlimited fluid volume exchange during continuous hemodiafiltration (CHDF) to critical care. In on-line hemodiafiltration (HDF), endotoxin free dialysate obtained using pyrogen cut filters is infused into the blood circuit, and HDF is automatically performed using the close-loop balancing system of the dialysis machine. On-line CHDF is the application of this on-line HDF to continuous renal replacement therapy in the critical care field. We performed on-line CHDF of the totally in 123 septic shock patients during a 5-year period and the mean survival rate was 54%. We concluded that on-line CHDF system is safe and effective at maintaining acute kidney injury with sepsis.

Critical Care↗
PubMed2006

Early estimation of high peritoneal permeability can predict poor prognosis for technique survival in patients on peritoneal dialysis.

At the beginning of continuous ambulatory peritoneal dialysis (CAPD), different patients exhibit large differences in peritoneal permeability. To determine if early estimation of peritoneal permeability can predict the prognosis of CAPD, we used data from a personal dialysis capacity (PDC) study group in Japan to investigate patient and technique survival rates. Based on the data from a previously reported, prospective multicenter study encompassing eight dialysis centers in Japan (Am J Kidney Dis 2002; 40:1045-54), we recalculated patient and technique survival data. We reviewed the records of 139 patients newly initiated on CAPD from January 1995 to December 1999. Peritoneal permeability was estimated by PDC test within the first year after initiation. We divided the patients into paired groups according to several peritoneal permeability variables as calculated by the PDC test (area, plasma loss, and peritoneal creatinine clearance), and we compared patient and technique survival rate between the groups. The mean age of the patients was 49.6 years +/- 14.9 years (standard deviation). The mean pore area of peritoneum was 19,936 +/- 8383 cm/1.73 m2. Estimation of patient survival by the Kaplan-Meier method showed 94.2%, 88.4%, 84.1%, and 79.7% at 1, 2, 3, and 5 years respectively. Estimated technique survival (including death as an endpoint) by the Kaplan-Meier method showed 90.6%, 76.8%, 67.4%, and 54.3% at 1, 2, 3, and 5 years respectively. In the high peritoneal permeability group (high area and high plasma loss), the technique survival at 5 years was significantly lower than in the low peritoneal permeability group [area: 55.9% (high) vs. 72.7% (low), p = 0.0459; plasma loss: 43.3% (high) vs. 62.8% (low), p = 0.0197). We observed no significant difference in patient survival between the high and low peritoneal permeability patients. In the high peritoneal creatinine clearance group, patient and technique survival were both significantly lower than in the high peritoneal creatinine clearance group. Patients with high peritoneal permeability as calculated by the PDC test at the start of PD had a poor prognosis for technique and patient survival on CAPD. We conclude that early estimation of high peritoneal permeability can predict poor outcome for patients on CAPD.

Creatinine↗
PubMed2006

Impact on peritoneal membrane of use of icodextrin-based dialysis solution in peritoneal dialysis patients.

The usefulness of icodextrin-containing peritoneal dialysis (PD) solution for the management of body fluid and blood pressure has been reported. However, icodextrin PD solution is a foreign solution in the body, and the possible induction of intraperitoneal inflammation has been reported. In this study, we investigated at 6-month intervals the influence of icodextrin solution on peritoneal permeability and inflammatory reactions in patients in whom glucose solution had been changed to icodextrin solution for the overnight dwell. We enrolled 9 anuric PD patients (5 men, 4 women) of mean age 58 +/- 5.9 years (range: 45.6-64.8 years) into the study. The patients' mean duration of PD was 61.9 +/- 42 months (range: 6.7-142.5 months). The cause of end-stage renal disease was chronic glomerulonephritis in all patients. For evaluation ofperitoneal permeability, we performed peritoneal equilibration tests (PETs) immediately after an overnight dwell and determined the dialysate-to-plasma ratios of creatinine (D/P Cr), beta2-microglobulin (D/P beta2m), albumin (D/P Alb), immunoglobulin G (D/P IgG), and alpha2-macroglobulin (D/P alpha2m). We also measured interleukin-6 (IL-6) and fibrinogen degradation products (FDPs) in overnight effluent as indices of inflammation and of the fibrinolysis-coagulation system. The evaluation was performed every 6 months for 24 months. The FDPs in effluent increased significantly at 6 months after the change to icodextrin solution, and IL-6 tended to increase. The D/P beta2m, D/P Alb, D/P IgG, and D/P alpha2m all significantly increased in the course of follow-up. In the PETs, the D/P Cr increased slightly, but the change was nonsignificant. At 30 months after the change to icodextrin solution, 1 patient was diagnosed as having a risk of encapsulating peritoneal sclerosis (pre-EPS). In this patient, rapid increases in IL-6, D/P Cr and macromolecular and small molecular D/P by PET were noted after the change to icodextrin solution. Steroids were administered after the diagnosis of pre-EPS, with the result that the IL-6 level rapidly decreased and the D/P Cr and D/P of small molecules and macromolecules slightly decreased. Icodextrin dialysis solution increased peritoneal permeability. Although the cause was unclear, icodextrin may have changed peritoneal reactivity. Long-term use of icodextrin PD solution requires further investigation.

Albumins↗
PubMed2006

Experience of 100 surgical cases of encapsulating peritoneal sclerosis: investigation of recurrent cases after surgery.

Since 1993, we have performed enterolysis for encapsulating peritoneal sclerosis (EPS) in 86 patients. Five patients died after surgery, but the remaining 81 patients achieved symptomatic improvement. However, some of the surviving patients developed symptoms of intestinal obstruction after several months, and EPS recurrence remains our greatest challenge. In the present study, we identified factors related to recurrence by clinically comparing 47 recurrent and nonrecurrent patients that we were able to follow for more than 2 years after surgery. In the 47 patients we followed, 11 (23.4%) experienced recurrence, and 10 of those patients underwent a second surgery. Four patients needed a third surgery. The mean time to recurrence was 15.2 months, and all patients with recurrence, except one, experienced their recurrence within 20 months. We observed no differences between the recurrent and nonrecurrent patients in follow-up period, age, history of peritoneal dialysis, use or nonuse of steroids after surgery, thickness of the submesothelial compact zone, or inflammatory cell infiltration. However, the number of microvessels was significantly higher in the recurrent patients. Our surgical experience with EPS shows recurrence in approximately 23% of patients. The results of the present study suggest that peritoneal microvascular hyperplasia is a factor involved in recurrence, and that patients with recurrence may have an irreversible pathologic condition and may experience repeated recurrences.

Adolescent↗
PubMed2005

Encapsulating peritoneal sclerosis.

Since the first peritoneal dialysis (PD) patients with encapsulating peritoneal sclerosis (EPS) were reported in 1980, EPS has been considered primarily a fatal complication. The incidence of EPS in PD patients has been reported to be from 0.7% to 7.3%, and the rate appears to be higher in patients receiving long-term treatment. Most data from Japan has shown an overall incidence of 2.5% with an evident negative effect of increasing duration of PD, which also augments mortality. Since EPS occurred after withdrawal from PD in more than half of the patients, strict monitoring is necessary when a long-term PD patient is withdrawn from PD. Maintaining patients on standard PD for more than 8 years using conventional solutions is associated with a substantial risk for development of EPS. Appropriate treatment according to the disease stage is most important in EPS treatment. Therefore, when examining a PD patient complaining of gastrointestinal symptoms, the possibility of EPS has to be kept in mind. Basic therapeutic tactics for EPS include appropriate use of steroids. If the state of bowel obstruction persists, laparotomy and enterolysis should be performed to obtain a complete cure. It is now recognized that EPS is not a fatal complication of PD.

Humans↗
PubMed2005

Epidemiology of encapsulating peritoneal sclerosis in Japan.

Since the first peritoneal dialysis (PD) patients with encapsulating peritoneal sclerosis (EPS) were reported in 1980, EPS has been considered primarily a fatal complication. The incidence of EPS in PD patients has been reported to range from 0.7% to 7.3%, and the rate appears to be higherin patients receiving long-term treatment. The most recent data from Japan show an overall incidence of 2.5%, with a clear impact of extended PD duration, which also augments mortality. The incidence increases and the prognosis worsens with longer durations of PD. The incidences (and mortality rates) for EPS were 0% (0%), 0.7% (0%), 2.1% (8.3%), 5.9% (28.6%), 5.8% (61.5%), and 17.2% (100%) for patients who had undergone PD for 3, 5, 8, 10, 15, and >15 years respectively. Because EPS occurs after withdrawal from PD in more than half of patients with the condition, strict monitoring is necessary when a long-term patient is withdrawn from PD. Maintaining patients on standard PD for more than 8 years using conventional solutions is associated with a substantial risk for the development of EPS.

Humans↗
PubMed2005

Successful surgical management of encapsulating peritoneal sclerosis.

BACKGROUND: Encapsulating peritoneal sclerosis (EPS) is a serious complication of long-term peritoneal dialysis (PD). The mortality rate for EPS has been high, primarily because of complications related to bowel obstruction. Also, therapeutic guidelines for EPS have not yet been established. In our hospital, favorable postoperative results were obtained in 50 patients whose EPS was treated surgically. PATIENTS: All patients had chronic glomerulonephritis as the underlying kidney disease. All had undergone PD for between 29 months and 220 months (average: 113.9 months). During the course of PD, 3 patients developed EPS and were subsequently transferred to hemodialysis (HD). The other 47 patients (94.0%) developed EPS after discontinuation of PD. The reasons for transfer to HD were inadequate ultrafiltration (26 patients), bacterial peritonitis (16 patients), hypoalbuminemia (2 patients), renal transplantation (3 patients), and occurrence of EPS (3 patients). INTERVENTION: At laparotomy, a definitive diagnosis of EPS was established in all patients by the presence of clumped intestine cocooned with a dense sclerotic membrane. In all cases, the small intestine was completely released by ablation of the capsules, resulting in resolution of the bowel obstruction symptoms. In 5 patients, the large intestine was ablated solely at the region of the sigmoid colon. The operating time varied from 3 hours to 18 hours (average: 6.9 hours). Oral food intake was initiated 5 - 60 days (average: 10.2 days) after surgery. RESULTS: Perforation of the small intestine was detected postoperatively in 2 patients, who died 26 days and 37 days after surgery. The remaining 48 patients were followed for between 9 months and 107 months (average: 34.6 months). During follow-up, 6 - 12 months after the initial surgery, 4 patients experienced a recurrence of bowel obstruction symptoms that required a second laparotomy with enterolysis. Excluding the 2 patients with fatal outcomes, 46 patients (96%) experienced complete relief from bowel obstruction symptoms. The remaining 2 patients continued to experience mild, sub-acute bowel obstruction symptoms that could be successfully controlled solely by diet. CONCLUSIONS: Surgical treatment of 50 patients with EPS produced successful outcomes in all but 2 patients (96% success). Encapsulating peritoneal sclerosis should be actively treated by surgeons who genuinely understand this pathologic condition.

Adolescent↗
PubMed2005

Recommendations on the management of encapsulating peritoneal sclerosis in Japan, 2005: diagnosis, predictive markers, treatment, and preventive measures.

This comprehensive update on the management of encapsulating peritoneal sclerosis incorporates insights gained from recently published findings and the accumulated experience of the authors. Aspects covered include diagnosis, risk factors and predictive markers, treatment, and prevention, including criteria for withdrawal from peritoneal dialysis.

Biomarkers↗
PubMed2005

Effect of icodextrin-based peritoneal dialysis solution on peritoneal membrane.

Using changes in cell counts and levels of cancer antigen 125 (CA125), fibrinogen degradation product (FDP), and interleukin-6 (IL-6) in effluent before and after the use of icodextrin-based peritoneal dialysis solution (icodextrin), we evaluated the effects of icodextrin on peritoneal membrane. The subjects were 8 anuric patients (4 men, 4 women) who had been using a 2.5% glucose-based dialysis solution (glucose solution) for the overnight dwell. The mean age of the patients was 57.9 +/- 6.1 years, and their mean duration of continuous ambulatory peritoneal dialysis was 61.6 +/- 44.3 months. In all patients, chronic glomerulonephritis was the cause of end-stage renal disease. We changed the 2.5% glucose solution used for the 8-hour dwell to an icodextrin, and we compared cell counts in effluent and levels of IL-6, FDP, and CA125 in the overnight effluent before, and 12 and 36 weeks after, the switch to the icodextrin. When 2.5% glucose solution was used for the overnight 8-hour dwell, the mean cell count in the effluent was 5.5 +/- 3 cells/mm3. However, 12 and 36 weeks after the start of icodextrin, mean cell counts in effluent were significantly increased to 15.3 +/- 7.7 cells/mm3 (p < 0.01) and 16.5 +/- 11.2 cells/mm3 (p < 0.01) respectively. Values of effluent CA125, FDP, and IL-6 obtained during the use of a glucose solution were compared to values obtained 12 and 36 weeks after the start of icodextrin. Effluent levels of CA125 and IL-6 did not vary before and after the use of the icodextrin, but levels of FDP in the icodextrin effluent were higher than the levels found in the effluent of a 2.5% glucose solution (7278.8 +/- 2915 ng/mL before the start of icodextrin; 29,875 +/- 13,227 ng/mL 12 weeks after icodextrin introduction, p < 0.01; and 12,062.9 +/- 5684.6 ng/mL 36 weeks after icodextrin introduction). Icodextrin induced a subclinical inflammatory response in the peritoneum. Therefore, biocompatibility of an icodextrin solution is not always superior to that of a glucose solution, and further research is needed to clarify the influence of long-term icodextrin use on the peritoneum.

Anuria↗
PubMed2005

Markers in peritoneal effluent for withdrawal from peritoneal dialysis: multicenter prospective study in Japan.

The most serious problem in peritoneal dialysis (PD) is the risk of final complication by encapsulating peritoneal sclerosis (EPS) because of peritoneal deterioration. Markers useful for the noninvasive evaluation ofperitoneal deterioration are therefore required. In this multicenter prospective study of stable PD patients, we compared the dialysate-to-plasma (D/P) concentration ratios of albumin, immunoglobulin G, and c2-macroglobulin, and effluent levels of interleukin 6 (IL-6) and fibrinogen/fibrin degradation products (FDPs) to clarify the relationship between inflammation, fibrinolysis markers, and permeability to large molecules. At the beginning of the present study, significantly positive correlations were noted between the IL-6 and FDP concentrations and the D/P ratios of albumin and a2-macroglobulin. In addition, a significantly positive correlation was noted between the FDP and IL-6 concentrations. However, the D/P ratio of creatinine obtained by peritoneal equilibration test did not positively correlate with those markers. Moreover, a significantly positive correlation was noted between changes in the effluent concentrations of FDPs and IL-6 and in permeability markers for large molecules. The effluent IL-6 and FDP concentrations reflect a chronic inflammatory state in the peritoneum, which is associated with increased permeability to large molecules. In individual PD patients, careful observation of the clinical course and evaluation of changes in such markers are expected to predict peritoneal deterioration and the development of EPS.

Albumins↗
PubMed2004

Clinical results of daily hemofiltration.

Various types of daily hemodialysis (HD) have been developed. However, a water treatment system is essential for HD, which markedly prevents daily home HD. Hemofiltration (HF) can be simply performed only with substitution fluid without a water treatment system. This advantage is applied to daily HF. To perform this procedure at home, a simple system is needed. A system in which a dialyzer was combined with a circuit as one cartridge with bag-type substitution fluid was developed by NxStage Inc. This system facilitates not only HF via a supply of 15 l of bag-type substitution fluid, but also automatic washing/priming of the circuit and returning which can be achieved by applying the current CAPD management system. This daily HF may contribute to routine home HD in the future.

Aged↗
PubMed2004

Kinetics and dose of daily hemofiltration.

Daily hemofiltration (D-HF) is a new treatment modality that shows unique solute removal characteristics and possibly provides high quality of life for patients with end-stage renal disease. We evaluated solute removal characteristics of D-HF for 5 patients by kinetic modeling analysis. Five patients treated with normal 4-hour x 3 times/week hemodialysis (HD) were switched to D-HF (2-hour x 6 times/week). Ultrafiltration rates (Q(F)) or small solute clearances ranged from 63 to 106 ml/min. All the pertinent kinetic parameters were determined from patients' physical data and the HD portion of the clinical measurements. The two-compartment kinetic model predicted the concentration changes after switching from normal HD to D-HF. In all 5 patients, concentrations of small solutes such as urea-nitrogen (UN) increased whereas that of beta(2)-microglobulin (beta(2)-MG) decreased after switching from normal HD to D-HF. Predicted solute concentrations and clinical measurements for UN and beta(2)-MG were in good agreement with average error less than 10%. The model predicted that Q(F) = 155 ml/min may be necessary for the time-averaged concentration (TAC) of UN to be unchanged. The model also predicted that the 7 times/week D-HF should not increase the pretreatment concentration of UN, expecting even much lower beta(2)-MG concentration after switching from normal HD to D-HF. D-HF is superior to normal HD for removing larger solutes but may increase the TAC of small solutes. A 7-day treatment (7 times/week) D-HF may improve the solute removal capacity of small solutes.

Appointments and Schedules↗
PubMed2004

Complementary dialysis for daily dialysis.

The greatest benefit of PD ist the continuous maintenance of a stable electrolyte and acid-base balance, as well as a continuous solute, sodium and water removal. Moreover, PD is effective in preserving residual renal function (RRF). However, when RRF declines, complications will occur if not compensated for by an increase in both the dialysis dose and ultrafiltration. Combination therapy PD and HD has been implemented to address the weakness of PD. The weak points of PD are declining UF volume and solute removal over time. The most important weak point of HD is the intermittent nature of the treatment. Based on this, the following concept was developed. At the start of dialysis, PD should be initiated in order to maintain RRF. In this stage, the function of PD is a complement to the RRF. When RRF declines, combination PD and HD should be considered. Subsequently, to achieve sufficient solute removal and ultrafiltration, the number of HD sessions should increase and PD prescription may decrease, resulting in three HD sessions per week and low-volume PD on non-HD days. Thus, PD complements HD in the end. If this integration can become a reality, we can accomplish 'real' daily dialysis.

Appointments and Schedules↗
PubMed2004

Encapsulating peritoneal sclerosis in Japan: a prospective, controlled, multicenter study.

BACKGROUND: Encapsulating peritoneal sclerosis (EPS) is recognized as a rare but serious complication of peritoneal dialysis (PD). The aim of this study was to determine the incidence, clinical features, and mortality rate of EPS. METHODS: The authors requested the registration of all PD patients in facilities across Japan where more than 10 patients were treated with PD in this prospective multicenter study. During the 4-year study, the incidence of EPS was observed in the enrolled patients. RESULTS: A total of 1,958 patients who were treated with PD in 57 facilities were followed up from April 1999 through March 2003. EPS occurred in 48 patients, corresponding to an overall incidence of 2.5%. In 33 of the 48 (68.8%) patients, EPS was found after discontinuation of PD. The incidence (and mortality rate) of EPS was 0%, 0.7% (0%), 2.1% (8.3%), 5.9% (28.6%), 5.8% (61.5%), and 17.2% (100%) in patients who had undergone PD for 3, 5, 8, 10, 15, and more than 15 years, respectively. The recovery ratio with total parenteral nutrition, corticosteroids and surgical treatment were 0%, 38.5%, and 58.3%, respectively. Eighteen patients (37.5%) died, 22 (45.8%) recovered, and the status of the other 8 (16.7%) remained unchanged. CONCLUSION: The results of this prospective multicenter study showed that the incidence of EPS was 2.5% within a 4-year observation period and that two thirds of the cases were diagnosed after discontinuation of PD. Because of the current progress in diagnostic technology and therapeutic methodology, it appears that PD can be continued successfully with an acceptable, low risk for EPS for at least 8 years, whereas stricter caution is required for patients receiving PD for longer periods.

Adult↗
PubMed2004

Dialysis dose and nutrition in Japanese peritoneal dialysis patients.

In the present study, we tried to determine the relationship between dialysis dose and nutrition in PD patients. We enrolled 100 Japanese outpatients, including 11 diabetic patients, who were on continuous ambulatory peritoneal dialysis [CAPD (n = 74)] and automated peritoneal dialysis [APD (n = 26)] at 49 local hospitals. In all patients, a peritoneal function test (PET) was performed using the PD NAVI software (JMS, Hiroshima, Japan). The PD NAVI software measured parameters of nutrition and dialysis dose; percentage creatinine generation rate (%CGR); percentage lean body mass normalized to body weight (%LBM); normalized protein nitrogen appearance (nPNA); total fluid removal (TFR), including urine; weekly total Kt/V; and creatinine clearance (CCr). The %CGR correlated linearly with %LBM and nPNA, parameters of the nutrition status of the patients. The %CGR also showed a significant linear correlation with Kt/V, CCr, and TFR. Patients with a %CGR below 100% (the "low group") numbered 37 (32 men, 5 women). The CCr and TFR values in that group were lower than the CCr and TFR values in the other patients (the "high group"). Conclusively, the dialysis dose did not reach the solute clearance values proposed by the National Kidney Foundation Dialysis Outcomes Quality Initiative. That finding may be the result of prescribing and monitoring dialysis therapy based on the PET The %CGR by PD NAVI may become an important index for clinical evaluation of PD dose and optimal dialysis prescription.

Biological Transport↗
PubMed2004

Correlation between peritoneal permeability and ultrafiltration volume with icodextrin-based peritoneal dialysis solution.

In the present study, we evaluated peritoneal transport characteristics during the use of icodextrin-based peritoneal dialysis (PD) solution, determining ultrafiltration (UF) and dialysate-to-plasma creatinine (D/P(Cr)) in a peritoneal equilibration test (PET). The subjects of the study were 8 anuric patients who, at the time of enrollment into the study, were receiving continuous ambulatory peritoneal dialysis (CAPD) and using a 2.5% glucose-based dialysis solution overnight. The mean age of the patients was 57.9 +/- 6.1 years (range: 45.2 - 64.1 years), and their mean duration of CAPD was 61.6 +/- 44.3 months (range: 5.6 - 140.1 months). We changed the 2.5% glucose solution that the patients were using for the 8-hour overnight dwell to icodextrin and measured the resulting UF. We also performed a PET before and 12 weeks after the start of icodextrin. After the start of icodextrin, PETs were carried out immediately after the icodextrin dwell; after rinsing twice with 2.5% glucose solution following an icodextrin dwell; and after an 8-hour dwell with glucose solution. The UF for 8-hour dwells increased significantly 12 weeks after the start of icodextrin (356.3 +/- 102.9 mL with 2.5% glucose at baseline vs. 517.5 +/- 102.8 mL with icodextrin, p < 0.001). However, the daily total UF was unchanged after the start of icodextrin (924.3 +/- 281.3 mL vs. 934.6 +/- 263.4 mL). As compared with the D/P(Cr) before the start of icodextrin, the D/P(Cr) after the start of icodextrin was significantly increased immediately after an icodextrin dwell (0.57 +/- 0.1 vs. 0.63 +/- 0.1, p < 0.01) and after twice rinsing with 2.5% glucose solution following an icodextrin dwell (0.57 +/- 0.1 vs. 0.66 +/- 0.2, p < 0.01). However, before or after the start of icodextrin, the D/P(Cr) after an 8-hour dwell with glucose solution did not change (0.57 +/- 0.1 vs. 0.57 +/- 0.1, p < 0.01). The D/P(Cr) measured in a PET was high immediately after a dwell with icodextrin. Those results may reflect an effect of icodextrin on the small pores. Before a PET, dialysis should be performed using a glucose solution.

Anuria↗