Abstract:
INTRODUCTION:Evidence using real-world data is sparse regarding the effects of oral anticoagulants (OACs) among patients with kidney disease. The aim of this study was to investigate the effects of kidney disease on ischemic stroke (IS) or systemic embolism (SE) among patients taking OAC, using large-scale real-world data in Japan. METHODS:This was a retrospective cohort study using claims data and health checkup data from health insurance associations in Japan, from January 2005 to June 2017. We enrolled 21,581 patients diagnosed with atrial fibrillation (AF). Of the total population, 11,848 (54.9%) patients were taking OAC. A Cox proportional hazards model was used to examine the effect of kidney disease on IS/SE with or without OAC. RESULTS:During follow-up, 208 participants who were not taking OAC (mean follow-up 2.6 years) and 200 who were taking OAC (mean follow-up 3.0 years) experienced IS/SE. The % IS/SE incidence rates with and without kidney disease were 2.42/person-year and 0.63/person-year in the total population, 3.66/person-year and 0.76/person-year in the group without OAC use, and 1.52/person-year and 0.55/person-year in patients with OAC use, respectively. Hazard ratios (HRs) and 95% confidence intervals (CIs) of kidney disease for IS/SE were high, irrespective of OAC, even after adjustment: adjusted HR 2.62 (95% CI: 1.72-3.99) without OAC and adjusted HR 2.03 (95% CI: 1.20-3.44) with OAC; p = 0.193 for interaction between no OAC and OAC. Although bleeding risk was also high for kidney disease irrespective of OAC use (HR 2.93 [95% CI: 2.27-3.77] in the total population, HR 3.08 [95% CI: 2.15-4.43] in the group without OAC, and HR 2.73 [95% CI: 1.90-3.91] in the group with OAC use), net clinical benefit indicated that the benefit of OAC use exceeded the risk of bleeding: HR 4.50 (95% CI: 0.76-8.23) among those with kidney disease and HR 0.35 (95% CI: 0.04-0.66) among those without kidney disease. CONCLUSION:Although we found that OAC use was effective and recommended for patients with AF, advanced kidney disease is still an independent risk factor for IS/SE, even in patients taking OAC. Physicians should be aware of this risk and strictly control modifiable risk factors, regardless of OAC use.
journal_name
Am J Nephroljournal_title
American journal of nephrologyauthors
Maeda T,Nishi T,Funakoshi S,Tada K,Tsuji M,Satoh A,Kawazoe M,Yoshimura C,Arima Hdoi
10.1159/000509567subject
Has Abstractpub_date
2020-01-01 00:00:00pages
659-668issue
8eissn
0250-8095issn
1421-9670pii
000509567journal_volume
51pub_type
杂志文章abstract:BACKGROUND:Patients with primary hyperoxaluria (PH) overproduce oxalate which is eliminated via the kidneys. If end-stage kidney disease develops they are at high risk for systemic oxalosis, unless adequate oxalate is removed during hemodialysis (HD) to equal or exceed ongoing oxalate production. The purpose of this st...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000360624
更新日期:2014-01-01 00:00:00
abstract::Hyperkalemia is a commonly encountered problem in dialysis patients with end-stage renal disease. In this study we evaluated the effect of mineralocorticoid therapy (MCT; fludrocortisone 0.1-0.3 mg per os daily) on serum potassium of hyperkalemic end-stage renal disease patients. Consecutive monthly clinical and bioch...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000168604
更新日期:1993-01-01 00:00:00
abstract::A patient with unilateral gross hematuria was found to have mesangial proliferation and IgM deposition on renal biopsy, consistent with the entity of primary renal hematuria. This case refutes previous assumptions that renal biopsy is normal in patients with unilateral hematuria. Glomerular lesions may be more common ...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000167127
更新日期:1986-01-01 00:00:00
abstract::A patient with advanced chronic renal failure secondary to polycystic kidney disease suffered an episode of volume contraction during which his urinary sodium concentration fell to less than 5 mEq daily. Urine sodium excretion remained at this level when later in his course he became clinically volume expanded. The pa...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000166535
更新日期:1981-01-01 00:00:00
abstract::Hepcidin is a key regulator of iron metabolism. In this study, we examined whether measurement of hepcidin is useful in assessing recombinant human erythropoietin (rHuEPO) responsiveness in regular hemodialysis (HD) patients in a cross-sectional fashion. We examined the association between serum prohepcidin, a prohorm...
journal_title:American journal of nephrology
pub_type: 临床试验,杂志文章
doi:10.1159/000109968
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:Serum creatinine (SCr) levels are decreased following traumatic amputation, leading to the overestimation of glomerular filtration rate (GFR). β-Trace protein (BTP) and β2-microglobulin (B2M) strongly correlate with measured GFR and have not been studied following amputation. We hypothesized that BTP and B2M...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000443775
更新日期:2015-01-01 00:00:00
abstract:BACKGROUND/AIMS:Living donor nephrectomy can be associated with increases in blood pressure several years following the procedure, but the best method to assess blood pressure during the living donor evaluation process is unclear. METHODS:Living kidney donors underwent casual clinic and ambulatory blood pressure monit...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000335070
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:The optimal level of serum ferritin (s-ft) for anemia control and good survival in hemodialysis (HD) patients remains unclear. A 10-year survey was performed to clarify the appropriate quantities of s-ft and investigate the relationships among s-ft, transferrin saturation (TSAT), and mortality in HD patients...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000370317
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND/AIMS:The shortage in organ supply has required the use of expanded criteria donors (ECD) for kidney transplantation. Current pre-transplant evaluations of ECD organs are based on histological, clinical or mixed criteria. This monocentric study investigates the predictivity of Karpinski's histological score o...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000346257
更新日期:2013-01-01 00:00:00
abstract::Fifty-four patients with noninsulin-dependent diabetes mellitus, who had established nephropathy, were examined to evaluate the risk factors for the progression of diabetic nephropathy. Time-averaged values of blood pressure, serum total cholesterol and fasting plasma glucose concentrations, and the degree of proteinu...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000168891
更新日期:1995-01-01 00:00:00
abstract::This study describes 10 cases of IgM nephropathy in whom the main morphological findings consisted of diffuse mesangial deposition of IgM and varying degrees of mesangial cell proliferation. In addition, focal segmental sclerosis was present in 1 patient and global sclerosis in another. An ill-defined electron-dense d...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000167485
更新日期:1987-01-01 00:00:00
abstract:BACKGROUND:The use of complementary/alternative medicine has garnered rising interest in recent years. Natural products including herbs, vitamins, and minerals are the most popularly consumed. The Internet is a ubiquitous source of information/market for these supplements. AIM:To systematically evaluate the dietary an...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000368724
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND:Overt albuminuria (urinary albumin-creatinine ratio [ACR] > 300 mg/g) is an established risk factor for progression of nephropathy and total mortality. However, whether a reduction in ACR translates into a reduction in mortality and/or cardiovascular (CV) events among insulin-treated patients with type 2 dia...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000496276
更新日期:2019-01-01 00:00:00
abstract::Glomerulosclerosis frequently complicates most renal diseases and is characterized by mesangial matrix accumulation. Oxidized low-density lipoprotein (Ox-LDL) could induce oxidative stress and profibrotic gene expression in mesangial cells. This article will review our current understanding of the pathogenetic mechani...
journal_title:American journal of nephrology
pub_type: 杂志文章,评审
doi:10.1159/000151277
更新日期:2009-01-01 00:00:00
abstract::Ultramorphological images and details of an uremic echinocyte are shown. The images confirm the existence of uremic echinocytes and demonstrate that atomic force microscopy can provide high-resolution images of cell surfaces. ...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000168714
更新日期:1994-01-01 00:00:00
abstract:BACKGROUND:Chronic kidney disease (CKD) impairs intestinal barrier function which by allowing influx of noxious products causes systemic inflammation. We have recently shown that intestinal barrier dysfunction in CKD is due to degradation of epithelial tight junction (TJ) which is, in part, mediated by influx of urea a...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000351171
更新日期:2013-01-01 00:00:00
abstract::A renal transplant recipient with a remote history of end-stage renal disease due to postpartum hemolytic-uremic syndrome (HUS) presented with acute renal failure after having stable renal allograft function for 9 years. A diagnosis of thrombotic microangiopathy was made based on clinical and histologic findings at re...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000169094
更新日期:1997-01-01 00:00:00
abstract:BACKGROUND:To promote understanding of immunoglobulin A nephropathy (IgAN) pathophysiology, we tried to elucidate glomerular protein profiles in IgAN, using microsieving that we established recently to isolate glomeruli from renal biopsy samples and proteomic approaches. METHODS:Glomeruli were isolated from renal biop...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000357788
更新日期:2014-01-01 00:00:00
abstract::In general, nonrheumatic atrial fibrillation is associated with a high risk of stroke. However, its impact on stroke in the setting of chronic hemodialysis treatment is insufficiently addressed in the literature. We assessed the incidence of stroke among 430 chronic hemodialysis patients and the impact of atrial fibri...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000046216
更新日期:2001-01-01 00:00:00
abstract:BACKGROUND/AIM:Nephropathy after ingestion of Chinese herbs is known as a rapidly progressive form of interstitial renal fibrosis after a slimming regimen containing aristolochic acid that was identified first in Belgium. Intake of traditional Chinese herbal medicines is very popular in Taiwan. So we looked for similar...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000046647
更新日期:2001-11-01 00:00:00
abstract:BACKGROUND:Familial juvenile hyperuricemic nephropathy (FJHN) is an autosomal dominant disorder characterized by early onset of hyperuricemia, decreased fractional renal urate excretion and progressive interstitial nephropathy. Mutations in the uromodulin (UMOD) gene encoding uromodulin/Tamm-Horsfall, a glycosylphospha...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000339752
更新日期:2012-01-01 00:00:00
abstract::The use of Dacron cuff double-lumen permanent catheters for hemodialysis has become more common in the dialysis unit as patients await for creation or maturation of a permanent hemoaccess for various reasons. Placement of these catheters is often done by surgeons. Nephrologists skilled in the placement of temporary ce...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000013425
更新日期:1999-01-01 00:00:00
abstract:BACKGROUND:The outcome-predictability of baseline and instantaneously changing serum calcium in hemodialysis patients has been examined. We investigated the mortality-predictability of time-averaged calcium values to reflect the 'cumulative' effect of calcium burden over time. METHODS:We employed a Cox model using up-...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000319861
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND/AIMS:Three different apo E alleles (E2, E3 and E4) produce apo E isoproteins, which regulate the metabolism of lipoproteins. This study investigated the apo E polymorphisms as a prognostic factor for the development of diabetic nephropathy (DN). METHODS:A total of 525 type 2 diabetic patients were enrolled ...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000324561
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND/AIMS:Epithelial-to-mesenchymal cell transformation (EMT) is the trans-differentiation of tubular epithelial cells into myofibroblasts, an event underlying progressive chronic kidney disease in diabetes, resulting in fibrosis. Mainly reported in proximal regions of the kidney, EMT is now recognized as a key c...
journal_title:American journal of nephrology
pub_type: 杂志文章,评审
doi:10.1159/000256659
更新日期:2010-01-01 00:00:00
abstract::Several medical inventors in Europe and North America brought the artificial kidney (hemodialysis) to practical usefulness in the late 1940s, but there were very few early successes. It was used at first for only desperate cases of acute renal failure. Renal authorities in the 'metabolic' tradition favored newly quant...
journal_title:American journal of nephrology
pub_type: 历史文章,杂志文章
doi:10.1159/000169117
更新日期:1997-01-01 00:00:00
abstract:BACKGROUND:Aldosterone plays an important role in fibrosis. Recent studies showed that Na(+)-H(+) exchanger isoform 1 (NHE1) is involved in mineralocorticoid-induced organ fibrosis. In this study, we examined the role of NHE1 in aldosterone-induced fibronectin accumulation in rat mesangial cells and the signaling pathw...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000256665
更新日期:2010-01-01 00:00:00
abstract::An 18-year-old woman complained of fever and edema and was admitted to Showa University Hospital for treatment of thrombocytopenia and deteriorating renal function. Laboratory studies demonstrated the presence of lupus anticoagulant (LA), prolongation of prothrombin time, hemolytic anemia, a negative Coombs' test, the...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000013526
更新日期:1999-01-01 00:00:00
abstract:BACKGROUND/AIMS:In chronic hemodialysis patients, we evaluated determinants of repetitive ventricular tachyarrhythmias which included late potentials and heart rate variability. METHODS:We compared the presence of late potentials and heart rate variability obtained by ambulatory electrocardiogram (ECG), findings of ec...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000013351
更新日期:1998-01-01 00:00:00
abstract::The treatment of peritonitis in continuous ambulatory peritoneal dialysis patients is empiric until the bacteriological results are available. The Lymulus amebocyte lysate assay (LAL) is a very sensitive method for the detection of endotoxin, a structural component of gram-negative bacteria. We performed the LAL assay...
journal_title:American journal of nephrology
pub_type: 杂志文章
doi:10.1159/000168412
更新日期:1992-01-01 00:00:00