| アブストラクト | OBJECTIVES: Renal failure and hepatic cirrhosis are mutually aggravating factors. However, no specific therapeutic strategies for hepatic encephalopathy (HE) and end-stage kidney disease have been established. The coexistence, with an extremely poor prognosis, makes randomized controlled trials unfeasible. We evaluated whether an infusion of branched-chain amino acids was associated with mortality in patients hospitalized for HE and end-stage kidney disease. DESIGN AND METHODS: Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified patients with HE and end-stage kidney disease who received hemodialysis within 2 days of admission from July 2011 to March 2017. We divided the patients into those who received branched-chain amino acid infusion within 2 days of admission and those who did not. We conducted analyses using overlap weights based on propensity scores to compare in-hospital mortality between the groups. Sub-group analysis was conducted by stratifying patients by Child-Pugh class. RESULTS: We identified 553 eligible patients, including 503 patients who received branched-chain amino acid infusion and 50 who did not. The patients who received branched-chain amino acid infusion had lower mortality than those who did not (10.2% vs. 20.1%, relative risk 0.51, 95% confidence interval 0.27-0.95). Sub-group analysis showed that branched-chain amino acid infusion was associated with decreased in-hospital mortality in patients with Child-Pugh class C (16.2% vs. 39.0%, relative risk 0.41, 95% confidence interval 0.23-0.76). CONCLUSIONS: Branched-chain amino acid infusion may improve the prognosis of HE in patients with end-stage kidney disease, particularly those with lower liver function. Further research is necessary to provide a suitable treatment for HE in patients with end-stage kidney disease. |
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| 投稿日 | 2021/8/29 |
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| 投稿者 | Okada, Akira; Yamana, Hayato; Yamaguchi, Satoko; Kurakawa, Kayo Ikeda; Michihata, Nobuaki; Matsui, Hiroki; Fushimi, Kiyohide; Nangaku, Masaomi; Yamauchi, Toshimasa; Yasunaga, Hideo; Kadowaki, Takashi |
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| ジャーナル名 | Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation |
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| 組織名 | Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate;School of Medicine, The University of Tokyo, Tokyo, Japan.;Department of Health Services Research, Graduate School of Medicine, The;University of Tokyo, Tokyo, Japan.;Department of Clinical Epidemiology and Health Economics, The University of;Tokyo, Tokyo, Japan.;Department of Health Policy and Informatics, Tokyo Medical and Dental University,;Tokyo, Japan.;Division of Nephrology and Endocrinology, Graduate School of Medicine, The;Department of Diabetes and Metabolism, Graduate School of Medicine, The;School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Diabetes;and Metabolism, Graduate School of Medicine, The University of Tokyo, Tokyo,;Japan; Toranomon Hospital, Tokyo, Japan. Electronic address:;t-kadowaki@toranomon.kkr.or.jp. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/34452811/ |
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