title: Possible prevention of uremic nausea by vitamin D receptor activators in non-dialysis patients with stage 5 chronic kidney disease.
abstract: BACKGROUND
  Nausea is a major uremic symptom and a frequent indication for starting dialysis. However, preventive medication for uremic nausea has not yet been identified. Vitamin D receptor activators (VDRAs) may prevent uremic nausea via their pleiotropic actions. The objective of this study was to explore whether VDRA administration during the predialysis period is associated with a reduced prevalence of uremic nausea just prior to beginning dialysis.
  
  
  METHODS
  A multicenter, retrospective, cross-sectional study was performed to identify a medication to prevent uremic nausea. Patients with stage 5 CKD who were followed-up over 3 months were included. The primary outcomes examined were the prevalence of uremic nausea, congestive heart failure (CHF), and intractable edema at dialysis commencement. The predictor variable was VDRA use during the predialysis period.
  
  
  RESULTS
  One thousand five hundred and thirty six patients who had just begun dialysis in nine Japanese facilities between January 2006 and October 2013 were included. Two hundred and thirty (15.0%) patients had commenced dialysis because of uremic nausea, and three hundred and ninety two (25.5%) patients had been using VDRAs before initiating dialysis. Logistic regression analysis showed that, among the medications examined in this study, only VDRA use was independently associated with a lower frequency of uremic nausea (OR 0.512, 95% CI 0.347-0.738, P = 0.0003). On the other hand, CHF and intractable edema were not associated with VDRA administration.
  
  
  CONCLUSIONS
  Use of VDRAs during the predialysis period was the only factor associated with a lower prevalence of uremic nausea, suggesting that VDRAs may prevent uremic nausea in patients with advanced CKD.
authors.affiliation: Division of Nephrology and Hypertension, The Jikei University School of Medicine Katsushika Medical Center, 6-41-2 Katsushika-ku, Tokyo, 125-8506, Japan. aoto-jinnai@jikei.ac.jp.
authors.forename: Masato
authors.identifier: http://orcid.org/0000-0003-3583-5975
authors.initials: M
authors.lastname: Ikeda
authors.affiliation: Division of Nephrology and Hypertension, The Jikei University School of Medicine Katsushika Medical Center, 6-41-2 Katsushika-ku, Tokyo, 125-8506, Japan.
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Ueda
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Maruyama
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Keitaro
authors.initials: K
authors.lastname: Yokoyama
authors.affiliation: Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yokoo
authors.affiliation: Division of Nephrology, Toho University Ohashi Medical Center, Tokyo, Japan.
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Joki
authors.affiliation: Department of Nephrology, Musashino Red Cross Hospital, Tokyo, Japan.
authors.forename: Ryoichi
authors.initials: R
authors.lastname: Ando
authors.affiliation: Dialysis Center, Kawakita General Hospital, Tokyo, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Shinoda
authors.affiliation: Kidney Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
authors.forename: Daijo
authors.initials: D
authors.lastname: Inaguma
authors.affiliation: Division of Clinical Engineering, Department of Technology, Kanagawa Institute of Technology, Kanagawa, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Yamaka
authors.affiliation: Division of Internal Medicine, Department of Nephrology, St. Luke's International Hospital, Tokyo, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Komatsu
authors.affiliation: Division of Nephrology, Division of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Koiwa
authors.affiliation: Division of Nephrology and Blood Purification Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Sakaguchi
authors.affiliation: Division of Nephrology and Blood Purification Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Negi
authors.affiliation: Division of Nephrology and Blood Purification Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Shigematsu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000932:Antiemetics / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D004487:Edema / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009325:Nausea / Q000175:diagnosis / Q000453:epidemiology / Q000378:metabolism / Q000517:prevention & control*; D016017:Odds Ratio; D015995:Prevalence; D018167:Receptors, Calcitriol / Q000819:agonists* / Q000378:metabolism; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D012189:Retrospective Studies; D012307:Risk Factors; D015398:Signal Transduction / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D014511:Uremia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism
chemical_list: D000932:Antiemetics; D018167:Receptors, Calcitriol
keywords: Activator; Chronic kidney disease; Dialysis; Nausea; Uremic; Vitamin D receptor