Explore the vast range of titles available.

IntroductionThis study aimed to assess the effectiveness of calcimimetics in reducing the risk of fractures in dialysis patients with secondary hyperparathyroidism (SHPT).Material and methodsA comprehensive literature search was conducted using PubMed, Embase, and Cochrane Library for articles published through December 9, 2023. The quality of each trial was evaluated using the Cochrane Collaboration tool. Meta-analysis was performed using a random-effects model, and effect measures across studies were synthesized. The risk ratio (RR) and 95% confidence interval (CI) were used to quantify the risk of fracture.ResultsWe identified seven studies involving 6481 dialysis patients with SHPT. The administration of calcimimetics reduced fracture incidence compared to placebo or conventional treatment (RR: 0.50, 95% CI 0.29–0.88, p = 0.02). Calcimimetics demonstrated a low number needed to treat (NNT) to prevent an incident fracture (NNT: 47).ConclusionThe use of calcimimetics offers a significant benefit in reducing the risk of fractures in patients undergoing dialysis with SHPT.

Introduction Nutritional management is crucial in patients with chronic kidney disease. Therefore, it is important to assess nutritional status and detect malnutrition, especially in patients with diabetes. However, there is currently a lack of evidence regarding the relationship between nutritional indices and renal function in patients with type 2 diabetes. This study investigated whether the geriatric nutritional risk index (GNRI) is related to renal prognosis in type 2 diabetes patients. Materials and Methods The study included 946 type 2 diabetes patients enrolled in the Fukushima Cohort Study. The primary endpoint of this study was a renal event, defined as a combination of a 50% decline in eGFR from baseline and end‐stage kidney disease. All‐cause death and new cardiovascular events were also measured as secondary outcomes. The association between GNRI and these endpoints was assessed using Cox regression analysis. Results The median patient age was 66 years, 57% were men, the median eGFR was 67.9 mL/min/1.73 m2, and the median GNRI was 100.0. Compared to patients in the highest GNRI tertile, patients in the lowest tertile had a significantly increased risk of the renal event (HR 5.15, 95% CI 2.51–10.6) and all‐cause death (HR 2.30, 95% CI 1.20–4.42). A significant association was not observed between GNRI levels and cardiovascular events. Conclusions We observed an association between poor nutritional status, assessed by GNRI, and adverse outcomes in patients with type 2 diabetes. Nutritional status assessment has potential utility as a prognostic tool for individuals with type 2 diabetes. To prevent the progression of renal dysfunction and improve clinical prognosis in patients with diabetes, nutritional assessment, and management are of vital importance. The results of our observational cohort study indicate that a lower GNRI is associated with the risk of occurrence of a renal event, cardiovascular events, and all‐cause death in patients with type 2 diabetes. Overall, this study not only highlights the GNRI as a useful nutritional screening tool in patients with type 2 diabetes, but also underscores the importance of nutritional status assessment in these patients.

Introduction The red blood cell distribution width/albumin ratio (RAR) has been reported to be a prognostic marker for adverse clinical outcomes. However, there is limited data on the relationship between RAR and renal function in patients with type 2 diabetes mellitus (T2DM). This study aimed to investigate the effect of RAR on renal prognosis in patients with T2DM. Research Design and Methods This retrospective cohort study included 907 patients with T2DM enrolled in the Fukushima Cohort Study, divided into two groups (high and low RAR) according to their baseline RAR. The association between RAR and renal events was assessed using Kaplan–Meier curves and multivariate Cox regression analyses. Receiver operating characteristic (ROC) curve analyses, as well as the net reclassification index (NRI) and integrated discrimination improvement (IDI), examined the differences between RAR and red blood cell distribution width (RDW) alone. Results The high RAR group showed an increased risk of renal events in the Kaplan–Meier curve analysis. Compared with the low RAR group, the high RAR group showed an increased risk of renal events (adjusted hazard ratio [HR]: 3.40, 95% confidence interval: 1.76–6.57). RAR exhibited a significantly higher area under the curve (AUC), NRI, and IDI for renal events than RDW. Conclusion We observed an association between high RAR and worse renal outcomes in patients with T2DM. RAR assessment may have potential utility as a predictive tool for renal prognosis. Red cell distribution width (RDW)/serum albumin ratio (RAR) is a novel and simple inflammatory marker and has emerged as a reliable prognostic marker in various diseases. Our study reveals that a high RAR is a practical and easily obtainable predictive tool for assessing renal risk in patients with T2DM, thereby offering a tangible benefit to healthcare professionals and patients. Given the increasing global prevalence of T2DM and its association with chronic kidney disease, identifying simple and accessible biomarkers for predicting renal outcomes is crucial for improving patient management. Our study significantly contributes to diabetes care in clinical practice for early risk stratification of patients with T2DM.

Background: The Great East Japan Earthquake and the Fukushima Daiichi nuclear disaster forced the evacuation of residents and led to many changes in lifestyle for the evacuees. The Comprehensive Health Check was implemented to support the prevention of lifestyle-related disease and we analyzed the effect of prolonged evacuation (average of 3.0 years) on the new onset of hyper-LDL cholesterolemia.Methods: The study participants were Japanese adults living near the Fukushima Daiichi nuclear power plant in Fukushima Prefecture. Annual health checkups focusing on metabolic syndromes were conducted for persons ≥40 years by the Specific Health Checkup. Based on data from annual checkups from 2011 or 2012, we followed 18,670 participants without hyper-LDL cholesterolemia who underwent at least one other annual checkup during 2013–2015.Results: We found that the new onset of hyper-LDL cholesterolemia was 31% higher in evacuees than in non-evacuees. Evacuees had a significantly higher prevalence of obesity, hypertension, and diabetes, and higher frequency of weight change. Furthermore, logistic regression model analysis showed that the evacuation was significantly associated with the new onset of hyper-LDL cholesterolemia after adjusting age, gender, body mass index, smoking habit, alcohol consumption, diabetes, weight change, sleep deprivation, and exercise.Conclusion: The findings of the present study suggest that prolonged evacuation after a disaster is a risk factor for the new onset of hyper-LDL cholesterolemia, and lead to an increase in cardiovascular disease. It is therefore important to follow-up evacuees and recommend lifestyle changes where necessary.

IntroductionFracture dialysis patients have a higher risk of 1-year mortality compared with non-fracture dialysis patients. However, it is unclear whether excess mortality persists for more than a year.Materials and methodsWe conducted a nationwide cohort study in 162,360 hemodialysis patients in Japan. Study outcomes were 5-year all-cause mortality and cause-specific mortality. Cox proportional hazards regression was used to examine the association between hip fracture and mortality in two cohorts: the full cohort, which included potential confounders as covariates in multivariable-adjusted regression models, and the propensity score-matched cohort.ResultsCrude mortality rates for fracture patients were double those of non-fracture patients and persisted during the 5-year period. The association between hip fracture and mortality was significant even after adjusting for premorbid conditions (hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.13–1.32). Similar findings were observed in the propensity score-matched cohort of 2410 patients (HR 1.20, 95% CI 1.05–1.36). While cause-specific mortality rates for all categories, with the exception of sudden deaths, were higher for fracture patients relative to non-fracture patients in the full unmatched cohort, only the mortality rate for heart disease was significantly higher for fracture patients relative to non-fracture patients in the propensity score-matched cohort.ConclusionExcess mortality persisted for many years after hip fracture in hemodialysis patients, and was still present after adjusting for several premorbid conditions and propensity score matching.

The red blood cell distribution width–albumin ratio (RAR) is a prognostic factor for adverse outcomes in various populations. However, whether RAR is associated with renal outcomes remains unclear. Therefore, we aimed to investigate the impact of RAR on the prognosis in patients with chronic kidney disease (CKD). We conducted a retrospective cohort study using 997 CKD patients who were enrolled in the Fukushima Cohort Study. Patients were categorized into tertiles (T1-3) according to the baseline RAR. The associations of RAR with end-stage kidney disease (ESKD) were assessed using Kaplan–Meier curves and multivariable cox regression analyses. Receiver operating characteristic (ROC) curves were performed to test whether significant differences were present between red cell distribution width (RDW) and RAR. The median age was 66, 57% were men, the median eGFR was 47.8 ml/min/1.73 m 2 , and the median value of RAR was 3.5. The higher RAR group showed an increased risk for ESKD in the Kaplan–Meier curve analysis. Compared to the lowest RAR group, higher RAR groups had a higher risk of ESKD (hazard ratio [HR] 1.37, 95% CI 0.68–2.78 and 2.92, 95% CI 1.44–5.94) for T2 and T3 groups, respectively. ROC curve analysis proved that the discriminating ability of RAR for ESKD was superior to RDW. A higher RAR value was associated with worse renal outcomes in patients with CKD. RAR could be a convenient and useful prognostic marker for renal prognosis.

Osteoporosis is defined simply as “a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture. Thus, any bone lesion that causes fragility fracture is osteoporosis, which has quite heterogeneous backgrounds. Chronic kidney disease-related bone and mineral disease (CKD-MBD) is defined as “a systemic disorder of mineral and bone metabolism due to CKD, which is manifested by abnormalities in bone and mineral metabolism and/or extra-skeletal calcification”. Although CKD-MBD is one of the possible causes of osteoporosis, we do not have evidences that CKD-MBD is the only or crucial determinant of bone mechanical strength in CKD patients. The risk of hip fracture is considerably high in CKD patients. Drugs that intervene in systemic mineral metabolism, indeed, lead to the improvement on bone histology in CKD patients. However, it remains unclear whether the intervention in systemic mineral metabolism also improves bone strength, today. Thus, the use of drugs that directly act on bone and the introduction of fracture liaison concept are promising strategies for fragility fracture prevention among CKD patients, as well as treatment for CKD-MBD.

Chronic kidney disease-related mineral and bone disease (CKD-MBD) is a syndrome defined as a systemic mineral metabolic disorder associated with CKD, and the term renal osteodystrophy indicates a pathomorphological concept of bone lesions associated with CKD-MBD. Cortical bone thinning, abnormalities in bone turnover and primary/secondary mineralization, elevated levels of circulating sclerostin, increased apoptosis in osteoblasts and osteocytes, disturbance of the coupling phenomenon, iatrogenic factors, accumulated micro-crackles, crystal/collagen disorientation, and chemical modification of collagen crosslinks are all possible candidates found in CKD that could promote osteopenia and/or bone fragility. Some of above factors are the consequences of abnormal systemic mineral metabolism but for others it seem unlikely. We have used the term uremic osteoporosis to describe the uremia-induced bone fragility which is not derived from abnormal systemic mineral metabolism. Interestingly, the disease aspect of uremic osteoporosis appears to be similar to that of senile osteoporosis.