School of Medicine, Apheresis and Dialysis Center (Shinanomachi)



Career 【 Display / hide

  • 2005.04

    Hiratsuka City Hospital, Junior Resident

  • 2007.04

    Graduate School of Medicine, Keio University, Graduate Student

  • 2011.04

    Keio University Hospital, Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University Hospital, Senior Resident

  • 2014.10

    Kawasaki Municipal Ida Hospital, Department of Nephrology, Deputy Head Physician

  • 2015.04

    School of Medicine, Keio University, Division of Endocrinology, Metabolism and Nephrology, Research Associate

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Academic Background 【 Display / hide

  • 1999.04

    Keio University, School of Medicine

    University, Graduated

  • 2007.04

    Keio University, 医学研究科

    Graduate School, Withdrawal after completion of doctoral course requirements, Doctoral course

Academic Degrees 【 Display / hide

  • 博士(医学), Keio University


Papers 【 Display / hide

  • Exercise Parameters Predict Technique Survival in Patients on Peritoneal Dialysis

    Nakayama T., Uchiyama K., Washida N., Morimoto K., Muraoka K., Adachi K., Kasai T., Miyashita K., Wakino S., Itoh H.

    Blood Purification (Blood Purification)  50 ( 3 ) 380 - 389 2021

    ISSN  02535068

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    Objective: The incremental shuttle walking test (ISWT) is an important marker of aerobic capacity in patients on peritoneal dialysis (PD). This study aimed to evaluate its predictive value for PD-related outcomes. Methods: This single-center cohort study recruited outpatients on maintenance PD from our hospital between March 2017 and March 2018. Exercise capacity was assessed using measurement of ISWT and handgrip and quadriceps strength. Patients were divided into 2 groups according to the median of exercise capacity and prospectively followed up until cessation of PD, death, or the study end (October 2019). The primary end point of this study was technique survival rate, and secondary outcomes were rates of peritonitis-free survival and PD-related hospitalization-free survival. Results: Among the 50 participants, age and PD vintage were [median (IQR)] 62.5 (58.3-70) and 3.5 (1.3-6.5) years, respectively. At the end of the study, 3 of the 28 participants (11%) in the long-ISWT group and 13 of the 22 participants (59%) in the short-ISWT group were transferred to hemodialysis. The short-ISWT group showed lower technique survival rate (p < 0.001), peritonitis-free survival rate (p = 0.01), and PD-related hospitalization-free survival rate (p < 0.01) than the long-ISWT group, whereas those survival rates did not differ when participants were divided by handgrip or quadriceps strength. Multivariate analysis revealed lower ISWT to be independently associated with technique failure (p = 0.002). Conclusion: The ISWT is an important predictor of technique survival for patients on PD. Monitoring and enhancing ISWT as a marker of aerobic capacity might improve PD-related outcomes.

  • Eosinophilic Reaction at the Time of Catheter Insertion Predicts Survival in Patients Initiating Peritoneal Dialysis

    Uchiyama K., Washida N., Kusahana E., Nakayama T., Morimoto K., Itoh H.

    Blood Purification (Blood Purification)   2021

    ISSN  02535068

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    Introduction: Despite excellent biocompatibility, insertion of silicone peritoneal dialysis (PD) catheters can induce minor foreign body reaction, affecting long-term patient outcomes. We evaluated the effect of eosinophilic reaction associated with PD catheter insertion on outcomes of patients initiating PD. Methods: Eosinophilic reaction to PD catheter insertion was defined as the ratio of peripheral blood eosinophil count at 1 week after insertion (E1W) to pre-insertion eosinophil count (E0), and the association of E1W/E0 with technique survival, peritonitis-free survival, and heart failure (HF)-related hospitalization-free survival was analyzed. Results: This retrospective cohort study included 116 patients (89 male patients) who underwent PD catheter insertion between January 2008 and June 2018 (61.3 ± 12.9 years). The follow-up duration was 46.2 (23.8-75.3) months. E1W was significantly higher than E0 (median, 333 vs. 234/μL, p < 0.001), with a median E1W/E0 of 1.54. The log-rank test showed that technique survival, peritonitis-free survival, and HF-related hospitalization-free survival were significantly better in patients with E1W/E0 < 1.54 than in those with E1W/E0 ≥ 1.54 (p = 0.002, <0.001, and <0.001, respectively). By the Cox regression analysis adjusted for age, sex, the Charlson comorbidity index, the estimated glomerular filtration rate, and the geriatric nutritional risk index, E1W/E0 remained a significant risk factor for technique failure, peritonitis, and hospitalization for HF (hazard ratio (HR) 1.68, p = 0.01; HR 2.19, p < 0.001; HR 2.15, p < 0.001, respectively). Conclusion: Eosinophilic reaction at the time of PD catheter insertion is a novel marker that may predict outcomes in patients initiating PD.

  • Efficacy of dexmedetomidine on peritoneal dialysis catheter insertion

    Nakayama T., Uchiyama K., Morimoto K., Washida N., Kasai T., Nakamichi R., Kusahana E., Wakino S., Itoh H.

    International Urology and Nephrology (International Urology and Nephrology)   2021

    ISSN  03011623

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    Purpose: Dexmedetomidine (DEX) is a sedative agent with minimal respiratory and hemodynamic effects. The present study aimed to evaluate its effectiveness in peritoneal dialysis (PD) catheter insertion. Methods: This single-center retrospective study included patients who underwent PD catheter insertion under spinal anesthesia in our hospital between January 2016 and December 2020. Patients were divided into the DEX and non-DEX groups according the use of DEX. After 1:1 propensity score matching to adjust for age, sex, body mass index, mean blood pressure (BP), and Charlson comorbidity index, we compared operation-related outcomes, including peak numerical rating scale (NRS), occurrence of nausea, vital signs, or operative time between the two groups. Results: Of a total of 44 patients, 9 patients received DEX, and 35 did not. After propensity score matching, each group consisted of 8 patients. Peak NRS was significantly lower (P = 0.003) in the DEX group compared with the non-DEX group. Maximum mean BP during the operation was also significantly lower in the DEX group compared with the non-DEX group (P = 0.020), with no significant differences in minimum mean BP between the two groups (P = 0.831). The DEX group showed a trend of shortened operative time (P = 0.068). There were no significant differences in the occurrence of nausea (P = 1.000). Moreover, there was no clinically important adverse event associated with use of DEX. Conclusion: The use of DEX in PD catheter insertion under spinal anesthesia could safely improve operative analgesia.

  • Bullous pemphigoid in patients receiving peritoneal dialysis: a case series and a literature survey

    Morimoto K., Yoshida T., Washida N., Uchiyama K., Nakayama T., Itoh H., Oya M.

    Renal Failure (Renal Failure)  43 ( 1 ) 651 - 657 2021

    ISSN  0886022X

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    Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease. Although several cases of BP in end-stage renal disease patients receiving peritoneal dialysis (PD) or hemodialysis have been reported, the incidence of BP in these patients remains unknown. We recently experienced three PD patients diagnosed with BP. The skin injury was likely to be a trigger of BP in all the three PD patients. Nifedipine and icodextrin exposures were possible factors directly or indirectly affecting the onset of BP, because they were common in the three cases. We also report that the incidence of BP in PD patients was 3/478.3 person-years in a single-center 10-year study. This case series with a literature survey describes that the skin and tissue injuries are potential triggers responsible for the onset of BP in dialysis patients and that the incidence of BP in these patients seems to be much higher than that in the general population.

  • Effects of exercise on residual renal function in patients undergoing peritoneal dialysis: A post-hoc analysis of a randomized controlled trial

    Uchiyama K., Washida N., Morimoto K., Muraoka K., Nakayama T., Adachi K., Kasai T., Miyashita K., Wakino S., Itoh H.

    Therapeutic Apheresis and Dialysis (Therapeutic Apheresis and Dialysis)  24 ( 6 ) 668 - 676 2020.12

    ISSN  17449979

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    We aimed to investigate the effects of exercise on renal outcomes in patients undergoing peritoneal dialysis (PD). In a post-hoc analysis of a randomized controlled trial of a 12-week home-based exercise program involving 47 patients undergoing PD, we excluded 18 patients with anuria and analyzed 13 and 16 patients in the usual care and exercise groups, respectively. The primary outcomes were weekly renal creatinine clearance (CCr) and urinary biomarkers: liver-type fatty acid-binding protein (L-FABP) and the microalbumin-to-creatinine ratio (ACR). Although the maintenance of weekly renal CCr in the exercise group was not significantly different compared with that in the usual care group (P =.09), urinary L-FABP levels (P =.02) and ACR (P =.04) were significantly decreased in the exercise group. To the best of our knowledge, this is the first study to demonstrate the beneficial effects of exercise on renal outcomes in patients undergoing PD.

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Reviews, Commentaries, etc. 【 Display / hide