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Glomerular Filtration Rate and Patient Prognosis in Diabetic Patients with End-stage Renal Disease
No full textWhen to initiate dialysis in patients with end-stage renal disease (ESRD) has been a controversial issue. The current study was designed to determine whether glomerular filtration rate (GFR) at the time of onset of dialysis predicts survival in diabetic ESRD patients. A total of 475 diabetic patients, 330 men and 145 women, who consecutively started dialysis between 1994 and 2001 were included in the study. Mean age at the onset of dialysis was 59 ± 12 (SD) years. Patients were divided into five categories (quintiles) based on the distribution of GFR, estimated using the Modification Diet Renal Disease (MDRD) Study Group equation (MDRD-GFR). The end-point for survival analysis was all-cause death during the follow-up period. Patients were censored at the time of kidney transplantation, loss to follow-up, or on December 31, 2002, whichever occurred first. Five-year survivals for the first to fifth GFR quintiles were 61.1, 58.4, 67.3, 63.8, and 68.4%, respectively (p=0.694, logrank test). There were no significant differences in the survival among the five groups based on Cox's proportional hazard analysis. Therefore, MDRD-GFR has little or no predictive value in determining patient survival, and there is insufficient evidence to advocate starting dialysis solely on the basis of MDRD-GFR in diabetic patients with ESRD
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Association of Metabolic Syndrome With Development and Progression of Nephropathy in Patients With Type 2 Diabetes
No full text(医学部内科学(第三)教室岩本安彦教授退任記念特別号
Diagnosis and Treatments of Diabetic Nephropathy(Series "Treatment of Diabetes Mellitus" (6))
No full textDiabetic nephropathy has been the leading cause of end-stage renal disease in Japan since 1998. Mortality rates after commencing dialysis are higher in diabetic patients than in non-diabetic patients; therefore, early diagnosis and treatment of this serious complication are issues of prime importance. Diabetic nephropathy is classified into the following 5 stages; stage 1: normoalbuminuria, stage 2: microalbuminuria, stage 3: clinical albuminuria, stage 4: renal failure, and stage 5: dialysis stage. For quantitative evaluation of albuminuria in diabetic patients, measurement of albumin excretion in a 24-h urine collection has been the gold standard; however, collection errors due to improper timing and missed samples may lead to significant over- and under-estimation of albuminuria. For convenience and consistency, recent guidelines recommended measurement of albumin-to-creatinine ratio (ACR) in a random spot urine collection. Normoalbuminuria is diagnosed if ACR < 30 mg/g creatinine, microalbuminuria if ACR was 30-299 mg/g creatinine, and clinical albuminuria if ACR ⪰ 300 mg/g creatinine. Evidence indicates strict glycemic control and tightly lowering blood pressure are both effective to prevent the onset and progression of nephropathy. Hemoglobin Aic, as a measure of glycemic control, is recommended to maintain<6.5%. Recent guidelines proposed lower values of blood pressure (130/80 mmHg) for diabetic patients than for non-diabetic patients (140/90 mmHg). Regarding the selection of antihypertensive drugs, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are recommended as the first line therapy for hypertension in diabetes. Most of diabetic patients, especially those with advanced nephropathy, require more than two antihypertensive drugs to establish target levels of blood pressure; therefore, adding calcium-channel blockers, beta-adrenergic blockers, and small dose of diuretics should be considered as appropriate according to each patient's condition
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Dialysis and Transplantation in Diabetic Patients with End-Stage Renal Disease(Series "Treatment of Diabetes Mellitus" (5))
No full textDiabetic nephropathy is the leading cause of end-stage renal disease (ESRD) among incident dialysis patients in most industrialized countries, including Japan. Diabetic nephropathy is associated with a higher mortality during renal replacement therapy (RRT) than are non-diabetic renal diseases. This excess mortality results mainly from higher prevalence of cardiovascular diseases at the onset of RRT. Hemodialysis, continuous ambulatory peritoneal dialysis (CAPD), and kidney transplantation are treatment of choice for ESRD in diabetic patients as well as non-diabetic individuals; however, the vast majority of diabetic patients undergo hemodialysis in Japan. Dialysis modality should be selected based upon comorbid conditions, personality, and family background of each patient. Kidney transplantation is associated with better survival and quality of life in diabetic patients. In addition, successful pancreas and kidney transplantation provides both an insulin-independent euglycemia and withdrawal from dialysis therapy. As of May 2005, a total of 37 patients with type 1 diabetes and ESRD underwent pancreas transplantation simultaneously with or subsequently to kidney transplantation in Japan. Improvements in graft procurement and immunosuppressive regimens and modifications in operative technique have provided excellent pancreatic graft survival
The Effect of Angiotensin IV on Plasminogen Activator Inhibitor-1 Expression in Rat Mesangial Cells Cultured in High Glucose
No full textAngiotensin II (Ang II) contributes to the development of diabetic glomerulosclerosis by increasing glomerular plasminogen activator inhibitor-1 (PAI-1) expression. Biological activities of angiotensin IV (Ang IV), the Ang degradation product, on renal cells and association between Ang IV and diabetic nephropathy are unclear. We aimed to elucidate effects of Ang IV on PAI-1 expression in rat mesangial cells (RMCs) cultured in high glucose. Primary cultures of RMCs were obtained from isolated, collagenase-treated rat glomeruli. Effects of Ang II/IV and high ambient glucose on PAI-1 antigen and mRNA in RMCs were examined. Inhibitory effects of angiotensin type 1, 2, and 4 receptor antagonists on Ang II- and IV-mediated PAI-1 expression were also determined. PAI-1 antigen and mRNA were measured by enzyme-linked immunosorbent assay and reverse transcriptase-polymerase chain reaction, respectively. Ang IV significantly increased both protein and mRNA levels of PAI-1 in RMCs cultured in normal and high glucose conditions. Ang IV-induced increased PAI-1 protein and mRNA were completely attenuated by coculturing with AT4 receptor antagonist, but not with ATI or AT2 receptor antagonist. These data suggest that Ang IV may be implicated in the pathogenesis of diabetic nephropathy through increasing mesangial cell PAI-1 expression
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