The positive rate of anti-BP180NC16a antibody was lower in BP patients with DPP4I than without DPP4I, regardless of type 2 diabetes mellitus. The antibody titer was low in both the overall and type 2 diabetes mellitus populations. The prevalence of BP in 9,304 patients receiving DPP4Is was 0.0859%, which is higher than that in the general population. As DPP4Is are common diabetes treatments, we must be aware of the risk of BP.

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Aims Aortic valve calcification in aortic sclerosis, a precursor of aortic stenosis (AS), is not always present in all three leaflets; how calcification develops in each leaflet is unknown. We aimed to investigate the natural history of calcification development in each aortic valve leaflet and the prognostic value of the number of calcified leaflets. Methods and results In a retrospective multicentre cohort study of patients undergoing haemodialysis without AS, we observed calcification development in each aortic valve leaflet using echocardiography. We investigated the association between the number of calcified leaflets and AS development and mortality using time-to-event analysis. Among the 1507 patients (mean age, 66 years; 66% male) included in the longitudinal echocardiography analysis, 709 (47%) had aortic sclerosis at baseline: one-leaflet calcified, 370 (52%); two-leaflet calcified, 215 (30%); and three-leaflet calcified, 124 (17%). The median time for one calcified leaflet increase was 3–4 years, and 251 (17%) patients developed AS during a median 3.2-year follow-up. The increased number of calcified aortic valve leaflets was associated with developing AS; compared with that of one-leaflet calcified, the adjusted hazard ratios (aHRs) [95% confidence intervals (CIs)] of two- and three-leaflet calcified were 2.12 (1.49–3.00) and 4.43 (3.01–6.52), respectively; the aHR (95% CI) per one calcified leaflet increase was 2.24 (1.96–2.55). It was also associated with all-cause mortality; the aHR (95% CI) per one calcified leaflet increase was 1.18 (1.08–1.27). Conclusion The number of calcified aortic valve leaflets strongly predicted AS development and even mortality in patients undergoing haemodialysis, suggesting the usefulness of assessing calcification for each valve leaflet separately using echocardiography.

Background Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are considered to have the potential to maintain renal function by correcting glomerular hypertension in patients with diabetic kidney disease (DKD). The aim of this study is to demonstrate the renoprotective effect of SGLT2i by measuring renal hemodynamics, including glomerular filtration fraction (FF), in type 2 diabetic patients with moderate renal dysfunction. Methods Renoprotective effect of canagliflozin derived from test of renal hemodynamics in diabetic kidney disease (FAGOTTO) study is a 12-week multicenter, open-label, randomized (1:1), parallel-group trial of type 2 diabetic patients with diabetic kidney disease (30 ≤ estimated glomerular filtration rate [eGFR] ≤ 60 mL/min/1.73 m2). A total of 110 patients are to be randomly allocated to receive once-daily canagliflozin 100 mg or control (standard therapy). FF will be calculated by dividing the measured GFR (mGFR) by the effective renal plasma flow (eRPF). mGFR and eRPF will be measured by the clearance of inulin and para-aminohippuric acid (PAH), respectively. The primary endpoint of this trial is the percentage change in FF after 4 weeks of treatment in the canagliflozin and control groups. Discussion The FAGOTTO study will elucidate the mechanism of the renoprotective action of SGLT2i. The background, rationale, and study design of this trial are presented. To date, > 80 patients have been enrolled in this trial. The study will end in 2025. Trial registration jRCT (Japan Registry Of Clinical Trials) jRCTs041200069. Date of registration: November 27, 2020.

Introduction: Since the emergence of the COVID-19 pandemic, patients with SARS-CoV-2 infection have been seen to have various presentations and outcomes. Several recent studies had explored the differences in characteristics and outcomes of COVID-19 in the different patient population, and some with renal complications. There is, however, no systematic review of ESRD patients with hemodialysis who are infected with SARS-CoV-2. We performed a systematic review to evaluate the prevalence and case fatality rate (CFR) of COVID-19 infection in ESRD patients with hemodialysis. Methods: Systematic search was conducted using PubMed, Embase, Scopus, Web of Science, and CENTRAL for observational studies of COVID-19 infection in hemodialysis patients with prevalence or case fatality outcomes in the English language up to June 30, 2020. The meta-analysis was done using a random-effects model. Outcomes were prevalence and CFR with 95% confidence intervals. Also, global COVID-19 data were retrieved for estimating the prevalence and CFR of the general population as referencing points. Results: Of 3,272 potential studies, 14 studies were included in the meta-analysis (13,883 patients in 7 countries). Seven studies (13,172 patients in five countries) contained prevalence data whereas ten studies (2,626 patients in 7 countries) had case-fatality data. The pooled prevalence of COVID-19 in HD patients was 6.8% (95% CI 4.9 -9.1%) which was significantly higher than the global average prevalence (0.1%, 95% CI 0.1-0.1%). The overall case fatality rate in hemodialysis patients was 17.8% (95% CI 10.8 -24.9%) which was significantly higher than the global average CFR (5.0%, 95% CI 5.0 -5.0%). Conclusions: The prevalence and case fatality rate of SARS-CoV-2 infection in hemodialysis patients across the globe are significantly higher than the global average.