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Background Some types of antihypertensive drugs may have pleiotropic effects in patients with chronic kidney disease (CKD). However, whether triple combination therapy with angiotensin II receptor blockers (ARBs), calcium channel blockers (CCBs), and thiazide diuretics (TZD) confer renoprotective effects in normotensive CKD remains unknown. Thus, we explored this issue using a normotensive rat remnant kidney model. Methods Sprague-Dawley rats were randomly allocated into four groups: sham (n = 10), 5/6 nephrectomy (NTx) (n = 9), NTx treated with telmisartan and amlodipine (dual) (n = 8), and NTx treated with telmisartan, amlodipine, and hydrochlorothiazide (triple) (n = 7), and followed for 4 weeks. Blood pressure (BP), blood chemistry including renal function, urinary albumin excretion (UAE), and renal pathology were evaluated in all groups. Results There was no significant change in systolic BP among the four groups during the study period. Serum blood urea nitrogen (BUN) was significantly higher, and 24-h creatinine clearance (Ccr) was lower in all NTx groups (p < 0.001). Dual therapy further increased the glomerular diameter in NTx rats (p < 0.001), which was significantly ameliorated by triple therapy (p < 0.001). Triple therapy, but not dual therapy, significantly reduced NTx-induced UAE levels (p < 0.05), whereas BUN, 24-h Ccr, and tubulointerstitial injury scores were comparable among all the NTx groups. Conclusions Our results suggest that triple combination therapy with telmisartan, amlodipine, and hydrochlorothiazide could ameliorate glomerular hypertrophy and albuminuria in normotensive CKD rats in a BP-lowering independent manner.

BackgroundAutosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder caused by mutations in the polycystic kidney disease (PKD) gene. Although tolvaptan has benefits for renal involvement, the different effects depending on the gene mutation type are unknown. Thus, we explore the different effects of tolvaptan on the annual changes in total kidney volume (%TKV) and estimated glomerular filtration rate (eGFR) according to the gene mutation type in ADPKD patients.MethodsIn total, 135 ADPKD patients were screened, and 22 patients taking tolvaptan for at least a year were retrospectively studied at the Kurume University Hospital. We examined the decline in renal function and %TKV by computed tomography and analyzed the gene mutation. Patients were classified into the following four groups according to gene mutation type:PKD1-truncated,PKD1-non-truncated,PKD2, and mutation not found. Patients were treated with tolvaptan, and the effects of tolvaptan were analyzed according to the gene mutation type.ResultsPatients (age: 52.3 ± 11.2 years) were administered tolvaptan at a dose of 45 or 60 mg. No variation was observed in the annual changes in eGFR (%eGFR) (before: − 10.5% ± 13.9%, after: − 14.4% ± 8.1%,P = 0.139), whereas %TKV was significantly improved after the tolvaptan treatment (before: 14.9% ± 8.0%, after: − 5.4% ± 7.6%,P ConclusionsA year treatment with tolvaptan significantly improved %TKV in patients with ADPKD, regardless of the gene mutation type.

Background and Aims Sleep-disordered breathing (SDB) is known as a novel risk factor for cardiovascular disease, and one of five adults suffer from SDB in general population. In non-dialysis chronic kidney disease (CKD) and hemodialysis (HD) patients, a high prevalence of SDB has been reported due to the excess accumulation of extracellular fluid. However, precise prevalence and associated factors of SDB in patients with peritoneal dialysis (PD) has not been known. This cross-sectional study aimed to investigate the prevalence and determinant factors associated with SDB in patients with CKD. Method This was a single-center retrospective cohort study recruited 334 patients with CKD stages 1-3a, 3b-5, HD, and PD enrolled from 2018 to 2020. All patients were hospitalized and received our CKD educational program, and did not have sleep complaints. The diagnosis and assessment of the severity of SDB were evaluated using PULSOX-Me300 and SAS2100 systems. The 3% oxygen desaturation index and SpO2 were measured during sleep. SDB was defined as 3% oxygen desaturation index (ODI)>15.0 and SpO2 Results Proportion of the patients with CKD1-3a, CKD3b-5, HD, and PD were 28%, 53%, 11%, and 8%, respectively. Thirty-one% of the patients were diagnosed with SBD in all CKD patients. In a generalized linear model, 3% ODI>15.0 and SpO215 and SpO2 Conclusion We reported for the first time that the prevalence of SDB was very high and that the severity of SDB was significantly associated with BMI in patients with PD. These findings suggest that the extracellular fluid overload and excess glucose exposure due to PD fluid might accelerate SDB in patients with PD. Further clinical studies are needed to determine whether PD-associated SDB might influence the development of cardiovascular disease in CKD patients.

A hydrogen ion beam of 1.1 A, 35 keV was extracted for 1 hour from a modified duo PIGatron ion source. The extraction grids and the plasma source were cooled effectively and the ion source was operated stably. When the arc plasma current was controlled by the feedback signal from the accel current, the sufficiently stable ion beam was extracted from 2 msec to 1 hour after the ignition of arc plasma. The stabilities of the ion beam power and the divergence angle were both less than ± 0.5%.

A hydrogen ion beam, (35 keV, 1 A) was extracted for 1 hour from a modified duoPIGatron ion source. The extraction grids and the plasma source were effectively cooled and the steady-state beam was extracted. When the arc plasma current was controlled by the feedback signal from the accel current, a sufficiently stable ion beam was extracted for 1 hour from 2 ms after the ignition of arc plasma. The stability of the ion beam power and the divergence angle were both less than ±0.5%.

A three-dimensional simulation code for ion-beam formation has been developed for the quantitative evaluation of the beamlet deflection arising from the displacement of the extraction electrode. The code gives a good simulation of the experimentally-observed relations between the deflection angle of the beamlet and the mutual displacement among the extraction electrodes.