RESUMEN
BACKGROUND: Patients with end-stage kidney disease (ESKD) face higher risks of life-threatening events including cardiovascular disease. Various risk factors are identified as agents influencing the life prognosis of ESKD patients. Herein, we evaluated the risk factors related to the outcomes of Japanese patients with dialysis induction. We present the study protocol, the patients' baseline characteristics, and their outcomes. METHODS: The Ibaraki Dialysis Initiation Cohort (iDIC) Study is a prospective multi-center cohort study in collaboration with 60 tertiary-care facilities in Ibaraki Prefecture, Japan. We collected baseline data from clinical records and analyzed blood and urine samples of these facilities' patients with diabetic nephropathy, hypertensive nephrosclerosis, and chronic glomerulonephritis (CGN). The study's primary outcome was the survival rate at 24 months after dialysis induction. We performed a Kaplan-Meier analysis for cumulative survival and a Cox proportional hazards analysis for all-cause mortality and hospitalization. RESULTS: We analyzed 636 patients' cases (424 males, 212 females, age 67.4 ± 13.1 yrs. [mean ± SD]). We compared the patients' baseline data with those of similar cohort studies. As the primary kidney disease, 327 cases (51.4%) were diagnosed as diabetic nephropathy, 101 (15.9%) as hypertensive nephrosclerosis, and 114 (17.9%) as CGN. The mean serum creatinine value was 9.1 ± 2.9 mg/dL. The mean estimated glomerular filtration rate was 5.6 ± 1.8 mL/min/1.73m2. The cumulative survival rates at 6 months and 24 months after dialysis induction were 95.2 and 87.7%, respectively. The cumulative survival rate was significantly lower with increasing age. A Cox proportional hazards regression analysis demonstrated that high age was significantly associated with all-cause mortality. CONCLUSIONS: Regarding the clinical characteristics of these newly induced dialysis patients, the same trend as in other cohort studies was observed. Another study is underway to explore prognostic factors based on the iDIC Study's findings.
Asunto(s)
Nefropatías Diabéticas , Fallo Renal Crónico , Nefroesclerosis , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Nefropatías Diabéticas/diagnóstico , Femenino , Tasa de Filtración Glomerular , Humanos , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/etiología , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Diálisis Renal/efectos adversosRESUMEN
A 79-year-old man underwent a transrectal prostate needle biopsy with a prostate-specific antigen (PSA) level of 12.0 ng/ml. He was diagnosed with adenocarcinoma (Gleason score 4ï¼3, cT3aN0M0) and underwent radiation therapy. Eight months later, he was administered hormone therapy because of a rise in PSA level to 8.4 ng/ml. One year and 5 months later, he experienced back pain, and computed tomography revealed multiple lymphadenopathies and irregular prostate enlargement. The PSA level was 0.097 ng/ml. Re-biopsy of the prostate and biopsy of the lymph node were performed. Pathological examination revealed neuroendocrine differentiation of the prostate. The disease progressed rapidly, and the patient died 4 months after the biopsy. Neuroendocrine differentiation of prostate cancer is rare, and its development may not be consistent with PSA levels. Therefore, periodic imaging examinations should be conducted, even when PSA levels are low.