Feasibility of computed tomography-based assessment of skeletal muscle mass in hemodialysis patients.

BACKGROUND: Sarcopenia is a major health issue especially in patients on maintenance hemodialysis. Low skeletal muscle mass is included in the diagnostic criteria for sarcopenia. The skeletal muscle mass is usually evaluated by modalities such as bioimpedance analysis (BIA) or dual-energy X-ray absorptiometry, however the assessment of skeletal muscle mass using computed tomography (CT) images has not been established. The purpose of the study was to investigate the feasibility of the assessment of skeletal muscle mass using CT images in hemodialysis patients. METHODS: Skeletal muscle mass index (SMI) was measured by BIA and psoas muscle index (PMI) was measured by cross-sectional CT images in 131 patients. The relationship between SMI and PMI and the diagnostic ability of PMI for low muscle mass were evaluated. Furthermore, the patients were followed up and long-term survival in patients with low and high PMI were compared. RESULTS: PMI measured at the L3 vertebral level was strongly correlated with SMI (r = 0.597, p < 0.001). Age, sex, and SMI were the influencing factors for PMI. Patients with low PMI showed higher incidence rates of mortality during the follow up. CONCLUSIONS: PMI assessed by CT image can be an alternative to BIA in patients on hemodialysis.

A case of acute kidney injury and disseminated intravascular coagulation associated with influenza B viral infection.

There are few reports of acute kidney injury (AKI) associated with influenza viral infection. We treated a case of AKI that developed after an influenza B viral infection. A 35-year-old man visited a local physician for a fever and was diagnosed with influenza B. He was prescribed laninamivir, then returned to the physician 5 days later with dyspnea and was referred to Hospital A. Upon admission, respiratory arrest developed, for which he received tracheal intubation and mechanical ventilation. AKI was noted after admission and the patient was transferred to our hospital the next day. AKI and disseminated intravascular coagulation (DIC) were present at the time of transfer, thus a transfusion and continuous hemodiafiltration (CHDF) were performed, and administrations of thrombomodulin alpha and antithrombin III were initiated. Although the patient had DIC, AKI, and disturbance of consciousness, and was in a clinical state resembling influenza-associated encephalopathy, there was no clear abnormality shown in CT scans of the head. Urine output, renal function, and respiratory condition gradually improved, thus CHDF was stopped and extubation performed. The patient had no complications and was discharged on hospital day 22. Some reports have been presented regarding cases of AKI due to rhabdomyolysis associated with influenza viral infection, whereas our patient developed AKI as a complication of an influenza B viral infection without rhabdomyolysis or hemolytic uremic syndrome. Influenza B may cause AKI and DIC, and affected patients can be in a serious condition requiring immediate attention.

Effect of lanthanum carbonate treatment on bone in Japanese dialysis patients with hyperphosphatemia.

Lanthanum carbonate (LC), a newly developed non-calcium-containing phosphate binder, has been shown to possess high phosphate-binding capacity and safety when used for hyperphosphatemia in patients with chronic kidney disease undergoing dialysis. The effects of LC on bone metabolism in Japanese dialysis patients have not been investigated; therefore, we performed histomorphometric analysis on bone from dialysis patients with hyperphosphatemia. This was a prospective, open-label study in Japanese chronic kidney disease patients on dialysis, with a flexible daily dosage of 750-4500 mg to achieve target phosphorus levels of 3.5-5.5 mg/dL (1.10-1.78 mmol/L). Bone biopsy samples for histomorphometric analysis were obtained at baseline and after treatment with LC. The median bone lanthanum level increased during the LC treatment from 54.1 µg/kg at baseline to 4270.9 µg/kg at three years. After one year of treatment with LC, two cases with an initial classification of osteitis fibrosa improved toward normal bone turnover. The diagnosis of normal remained the same for up to three years. We also noted that two cases with a baseline classification of adynamic bone disease improved after one year, and was maintained for three years. Our data suggest that LC is effective not only for treating hyperphosphatemia, but also for improving renal osteodystrophy in Japanese dialysis patients.