Background and Purpose—: In hemodialysis patients, previous reports have described a high prevalence of cerebral microbleeds (CMBs), but no longitudinal studies have been performed to determine the clinical significance of CMBs in these patients. In this study, we investigated whether the presence of CMBs was a predictor of future strokes in hemodialysis patients. Methods—: Cranial MRI, including T2*-weighted magnetic resonance imaging, was performed on 179 hemodialysis patients with no past history of cerebrovascular events. The patients were followed prospectively until death or renal transplantation. We used the Cox proportional hazards model with inverse probability of treatment weighting using the propensity score to compare the event-free survivals of patients with/without CMBs. For sensitivity analyses, stratification by propensity score quintile and regression adjustment were used. Results—: CMBs were detected in 45 of the 179 patients. During a median follow-up period of 5.0 years, stroke occurred in 24 patients, including 12 with intracerebral hemorrhage and 12 with cerebral infarctions. Cox proportional hazards analysis with inverse probability of treatment weighting using the propensity score revealed that the presence of CMBs was a strong and significant predictor of intracerebral hemorrhage (hazard ratio, 26.53; 95% confidence interval, 2.88–244.90) but not cerebral infarction (hazard ratio, 0.91; 95% confidence interval, 0.25–3.34). Sensitivity analyses yielded similar results. Conclusions—: This study showed that the presence of CMBs was an independent and strong predictor of intracerebral hemorrhage in stroke-free hemodialysis patients, indicating that hemodialysis patients with CMBs should be carefully monitored for future onset of intracerebral hemorrhage.

The recent development of gradient-echo T2*-weighted magnetic resonance imaging (MRI) has enabled the highly accurate detection of prior cerebral microbleeds (CMBs), which might indicate a higher risk of future intracerebral hemorrhage (ICH) and be a marker of cerebral small-vessel disease in the general population. The present study investigated the clinical factors associated with the presence of CMBs in hemodialysis (HD) patients. Cranial MRI, including T2*-weighted MRI, was performed on 179 HD patients without symptomatic cerebrovascular disease and 58 healthy control subjects, and we investigated the prevalence of CMBs and clinical factors associated with the presence of CMBs. We also investigated the relationship between CMBs and other cerebral small-vessel diseases. The prevalence of CMBs was significantly higher in the HD patients than in the healthy subjects (45 patients (25.1%) vs. none in the healthy controls (0%), p < 0.0001). Multiple logistic regression analysis showed that independent and significant factors associated with the presence of CMBs were age, systolic blood pressure, diastolic blood pressure and pulse pressure. Moreover, the presence of CMBs correlated significantly with the presence of lacunar infarcts, periventricular hyperintensity and deep and subcortical white matter hyperintensity. These findings indicated a high prevalence of CMBs among HD patients, and that older age and high blood pressure were strong factors associated with the presence of CMBs. Moreover, CMBs were closely associated with other cerebral small-vessel diseases.

In this study, we report on an experience with the use of a novel agent "roxadustat," a hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI), for posttransplant anemia (PTA) in renal transplant recipients. Five renal transplant recipients treated as outpatients receiving 150 or 250 µg of "epoetin beta pegol," an erythropoiesis-stimulating agent (ESA), once every 3 months were converted to roxadustat, an HIF-PHI. The dose was 100 mg 3 times a week taken orally on Monday, Wednesday, and Friday. Data check was conducted at 1 month and every 3 months after its introduction, and hemoglobin (Hb), ferritin, and transferrin saturation (TSAT) levels were compared. At 1 month after conversion to roxadustat, Hb levels increased in all cases, the use of roxadustat was suspended/decreased in 2 cases who had Hb overshoot at 1 month, and ferritin and TSAT levels decreased in the initial stage of roxadustat conversion. During a 9-month period, Hb levels tended to increase in cases receiving oral iron administration, graft function was hardly affected, and there were no complications such as thrombosis. In conclusion, conversion from ESA to roxadustat was effective in the treatment of PTA. However, our overshoot case suggested that it might be better to start at a low dose in patients with low body weight, those undergoing iron administration, and those receiving a low dose of ESA. Furthermore, the low levels of ferritin and TSAT we observed at an early stage after roxadustat conversion suggested that there was an increased efficiency in iron utilization.

We have performed selective plasma exchange (SePE) as apheresis before ABO-incompatible kidney transplantation since 2015. In this study, we divided the SePE sessions into two groups, those using albumin alone (Group A) and those partially using fresh frozen plasma (FFP) (Group F), and compared their clinical efficacies. A total of 58 sessions of SePE (Group A: n = 41, Group F: n = 17) were performed in 30 recipients of ABOi kidney transplantation during the study period and the decrease in isoagglutinin titers, changes in the levels of serum IgG and IgM as well as coagulation factors (fibrinogen, factor XIII), and incidence of side effects were retrospectively compared. There was a more significant decrease of isoagglutinin titers in Group F compared to Group A. Immunoglobulins and coagulants were replenished in Group F. Meanwhile, the incidence of side effects was significantly higher in Group F. SePE using FFP, which can effectively decrease isoagglutinins titers and replenish immunoglobulin and coagulation factors, may be a beneficial treatment modality as apheresis before ABO-incompatible kidney transplantation, in spite of a disadvantage that there are many side effects.