Background: Critical limb ischemia (CLI) and intradialytic hypotension (IDH) are common complications in patients on hemodialysis (HD). However, limited data are available on whether IDH is related to CLI in these patients. The aim of this retrospective study was to evaluate whether IDH is a risk factor for CLI in HD patients.Methods: We examined the frequency of IDH in 147 patients who received HD between January 1 and June 30, 2012. Blood pressure was measured during HD every 30 min and IDH was defined as a ≥ 20 mmHg fall in systolic blood pressure compared to 30 min before and a nadir intradialytic systolic blood pressure < 90 mmHg. The primary study outcome was newly developed CLI requiring revascularization treatment or CLI-related death. We assessed the association of IDH with outcome using a multivariable subdistribution hazard model with adjustment for male, age, smoking and history of cardiovascular disease.Results: The median follow-up period was 24.5 months. Fifty patients (34%) had episodes of IDH in the study entry period. During follow-up, 14 patients received endovascular treatment and CLI-related death occurred in 1 patient. Factors associated with incident CLI in univariate analysis were age, smoking, diabetes mellitus, peripheral arterial disease, history of cardiovascular disease, and IDH. IDH was significantly associated with the outcome with the subdistribution hazard ratio of 3.13 [95% confidence interval, 1.05–9.37].Conclusions: IDH was an independent risk factor for incident CLI in patients on HD.

Background: Approximately, 20–70% of patients with cholesterol crystal embolism (CCE) have eosinophilia. However, it remains unknown how eosinophilia influences renal prognosis in patients with CCE. In this study, we investigated the association between eosinophil count (Eo) and renal prognosis in CCE patients on steroid therapy. Methods: The present study is a single-centered retrospective cohort study in patients with renal dysfunction and CCE from April 2007 to May 2018. This study included the patients who were treated with neither maintenance dialysis nor steroid before CCE diagnosis, and followed-up for kidney function until November 2019. We assessed whether eosinophilia at the time of CCE diagnosis was related to renal death after treating with steroid therapy. Results: Thirty patients with pathologically diagnosed CCE were enrolled and followed-up for 11.0 (5.2–43.4) months. There were significant differences in the white blood cell count (p = 0.01), hemoglobin (p = 0.009), serum creatinine levels (p = 0.008), phosphate (p = 0.049), and Eo (p = 0.008) between the renal survival and renal death groups. Using the receiver operating characteristic curve analysis with Youden index, Eo of 810/µL showed 100% sensitivity and 69.6% specificity for detecting renal death (area under the curve: 0.839). Comparing the outcomes in patients having Eo ≥ and < 810/µL using the log-rank test, there is a significantly higher renal death rate in CCE patients with Eo ≥ 810/µL (p = 0.0016). Conclusion: Higher eosinophilia was a prognostic risk factor for renal death in the patients with CCE.

Background: Vascular calcification (VC) is a characteristic feature of atherosclerosis in patients with chronic kidney disease (CKD), and coronary artery calcification (CAC) significantly impacts future cardiovascular events and mortality. Although factors associated with CAC are well reported, only a few studies have evaluated the factors associated with the progression of CAC in pre-dialysis patients with CKD. Methods: We quantitatively evaluated CAC progression using the CAC score (CACS) measured using 16-row multi-detector computed tomography and assessed associated factors in 74 patients with CKD. Results: The median annual increase in CACS was 23.7 (IQR 2.0–73.0). CAC progression was associated with serum phosphate and plasma asymmetric dimethylarginine (ADMA) levels, an endogenous inhibitor of nitric-oxide synthase and a marker of endothelial dysfunction and atherosclerosis, in univariate analysis. Multivariate analysis revealed that ADMA is an independent risk factor for CAC progression in patients with CKD. The annual change in CACS was significantly different between patients with ADMA values 0.51 (p < 0.05). Elevated ADMA levels were also significantly associated with estimated glomerular filtration rate (eGFR) decline in the univariate analysis. Conclusions: ADMA is a novel risk factor for CAC progression in patients with CKD. Vascular endothelial cell dysfunction, represented by elevated ADMA levels, may contribute to the progression of vascular calcification in patients with pre-dialysis CKD.

In the patients with severe atherosclerotic renal artery stenosis (ARAS), the evaluation of long-term clinical outcome after percutaneous transluminal renal angioplasty (PTRA) has yet been insufficient. The aim of this study was to focus on only patients with severe ARAS and to evaluate the more long-term clinical outcome after PTRA. We performed a single-center retrospective review of the outcome after PTRA. All eligible patients had ARAS of ≥ 75% by catheter renal angiography and underwent PTRA in our hospital from July 2004 to December 2007. We investigated long-term changes of renal function and the other clinical outcomes in patients with severe ARAS. The median follow-up period was 83 months. The overall mean stenosis rate was 87%. There were 24 patients with 75 ≤ and < 90%, 38 patients with 90 ≤ and < 95%, and 12 patients with ≥ 95% stenosis. Serum creatinine(S-Cr) levels were from 1.27 ± 0.68 at baseline to 1.33 ± 0.65 mg/dl at 84 months after PTRA in overall (p = 0.255). The renal size was also preserved for long-term in overall. Although serum creatinine level in patients with renal major axis < 85 mm at PTRA significantly increased (p < 0.05) after 60 months post PTRA, it did not worsen in patients with renal major axis more than 85 mm during observational period. The number of anti-hypertension drugs decreased from baseline (p = 0.0037), and both systolic and diastolic blood pressure significantly decreased (p < 0.001) after PTRA. Finally, 4 patients had renal death, and 14 patients died. Overall survival for 60 months was 85%. We demonstrated that PTRA for patients with severe ARAS significantly decreased blood pressure, and preserved renal function and renal size for long term. This study was admitted by Tokushukai Group Institutional Review Board. (IRB no. TGE00532-024 )

INTRODUCTION AND AIMS: Peripheral arterial disease (PAD) is highly prevalent in hemodialysis (HD) patients (15-40%). Furthermore, critical limb ischemia (CLI), seriously advanced stage of PAD, has strong impact on mortality in HD patients. However, sufficient therapeutic effect has not been achieved by several kinds of therapies for CLI in HD patients. We performed cell-besed therapy for CLI in HD patients to clarify its safety and efficacy.