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Lim CY, Park JY, Kim DY, Yoo KD, Kim HJ, Kim Y, Shin SJ. Terminal lucidity in the teaching hospital setting. Death Stud 2018; 44:285-291. [PMID: 30513269 DOI: 10.1080/07481187.2018.1541943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 09/27/2018] [Accepted: 10/02/2018] [Indexed: 06/09/2023]
Abstract
Terminal lucidity is an unpredictable end-of-life experience that has invaluable implications in preparation for death. We retrospectively evaluated terminal lucidity at a university teaching hospital. Of 338 deaths that occurred during the study period (187 in the ICU and 151 in general wards), terminal lucidity was identified in 6 cases in general wards. Periods of lucidity ranged from several hours to 4 days. After experiencing terminal lucidity, half of the patients died within a week, and the remainder died within 9 days. More attention should be directed toward understanding terminal lucidity to improve end-of-life care in a meaningful way.
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Affiliation(s)
- Chi-Yeon Lim
- Clinical Trial Center, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
| | - Do Yeun Kim
- Department of Hematology and Medical Oncology, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
| | - Kyung Don Yoo
- Department of Internal Medicine Dongguk University School of Medicine, Gyeongju, Republic of Korea
| | - Hyo Jin Kim
- Department of Internal Medicine Dongguk University School of Medicine, Gyeongju, Republic of Korea
| | - Yunmi Kim
- Department of Internal Medicine Dongguk University School of Medicine, Gyeongju, Republic of Korea
| | - Sung Joon Shin
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
- W Maurice Young Center for Applied Ethics, University of British Columbia, Vancouver, Canada
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Kim HJ, Kim Y, Kim S, Chin HJ, Lee H, Lee JP, Kim DK, Oh KH, Joo KW, Kim YS, Nah DY, Shin SJ, Kim KS, Park JY, Yoo KD. Age, sex, and the association of chronic kidney disease with all-cause mortality in Buddhist priests: An analysis of the standardized mortality ratio from the Korean Buddhist priests cohort. Medicine (Baltimore) 2018; 97:e13099. [PMID: 30407320 PMCID: PMC6250507 DOI: 10.1097/md.0000000000013099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/08/2018] [Indexed: 12/27/2022] Open
Abstract
Buddhist priests lead a unique lifestyle, practicing asceticism, with a vegetarian diet. Such behavior may have an impact on clinical outcomes. Hence, we explored the mortality among Korean Buddhist priests as compared with the general population.This study is a single-center, retrospective study. Among the 3867 Buddhist priests who visited Dongguk University Gyeongju Hospital between January 2000 and February 2016, 3639 subjects were available for mortality data from Statistics Korea. Standardized mortality ratio (SMR) was computed for all causes of death and compared with the general population using national statistics in Korea. Information regarding end-stage renal disease (ESRD) was investigated from the Korean Society of Nephrology registry. Among the 3639 patients, the baseline laboratory results were obtained in 724 patients. Chronic kidney disease (CKD) was defined as dipstick proteinuria ≥1 or an estimated glomerular filtration rate <60 mL/min/1.73 m.The mean age was 50.0 ± 12.5 years, and 51.0% were men. During the follow-up period for 31.1 ± 35.6 months, 55 (7.6%) patients died. During the follow-up period, 3 (0.4%) and 23 (3.2%) patients developed ESRD and urinary stone, respectively. The SMR for all causes of death was 0.76 (95% confidence interval [CI] 0.57-0.99; men 0.91, 95% CI 0.65-1.23; women 0.52, 95% CI 0.28-0.87). Among 724 patients, 74 (10.2%) patients had CKD. The SMR for non-CKD patients (0.61, 95% CI 0.43-0.85) was significantly lower than the general population. Female and patients older than 50 years (0.74, 95% CI 0.55-0.98) had a significantly lower SMR. In the Cox proportional hazards model with adjustment, older age (adjusted HR 1.04, 95% CI 1.10-1.07) and presence of CKD (adjusted HR 2.55, 95% CI 1.07-6.06) were independently associated with increased all-cause mortality.Buddhist priests and especially Buddhist priests without CKD showed a significantly lower mortality compared with the general population.
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Affiliation(s)
- Hyo Jin Kim
- Department of Internal Medicine, Dongguk University College of Medicine
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongsangbuk-do
| | - Yunmi Kim
- Department of Internal Medicine, Dongguk University College of Medicine
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongsangbuk-do
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University Hospital
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital
| | - Deuk-Young Nah
- Department of Internal Medicine, Dongguk University College of Medicine
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongsangbuk-do
| | - Sung Joon Shin
- Department of Internal Medicine, Dongguk University College of Medicine
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Gyeonggi-do, Republic of Korea
| | - Kyung Soo Kim
- Department of Internal Medicine, Dongguk University College of Medicine
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Gyeonggi-do, Republic of Korea
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University College of Medicine
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Gyeonggi-do, Republic of Korea
| | - Kyung Don Yoo
- Department of Internal Medicine, Dongguk University College of Medicine
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongsangbuk-do
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Kim Y, Yoo KD, Kim HJ, Koh J, Yu Y, Kwon YJ, Kim GH, Yoo TH, Lee J, Jin DC, Choi BS, Kim YH, Oh KH. Association of serum mineral parameters with mortality in hemodialysis patients: Data from the Korean end-stage renal disease registry. Kidney Res Clin Pract 2018; 37:266-276. [PMID: 30254851 PMCID: PMC6147195 DOI: 10.23876/j.krcp.2018.37.3.266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/22/2018] [Accepted: 05/26/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We investigated the associations between mineral metabolism parameters and mortality to identify optimal targets in Korean hemodialysis patients. METHODS Among hemodialysis patients registered in the end-stage renal disease registry of the Korean Society of Nephrology between March 2012 and June 2017, those with serum calcium, phosphorus, and intact parathyroid hormone (iPTH) measured at enrollment were included. Association of serum levels of calcium, phosphorus, and iPTH with all-cause mortality was analyzed. RESULTS Among 21,433 enrolled patients, 3,135 (14.6%) died during 24.8 ± 14.5 months of follow-up. After multivariable adjustment, patients in the first quintile of corrected calcium were associated with lower mortality (hazard ratio [HR], 0.84; 95% confidence interval [95% CI], 0.71-0.99; P = 0.003), while those in the fifth quintile were associated with higher mortality (HR, 1.39; 95% CI, 1.20-1.61; P < 0.001) compared with those in the third quintile. For phosphorus, only the lowest quintile was significantly associated with increased mortality (HR, 1.24; 95% CI, 1.08-1.43; P = 0.003). The lowest (HR, 1.18; 95% CI, 1.02-1.36; P = 0.026) and highest quintiles of iPTH (HR, 1.24; 95% CI, 1.05-1.46; P = 0.013) were associated with increased mortality. For target counts achieved according to the Kidney Disease Outcomes Quality Initiative guideline, patients who did not achieve any mineral parameter targets hadhigher mortality than those who achieved all three targets (HR, 1.37; 95% CI, 1.12-1.67; P = 0.003). CONCLUSION In Korean hemodialysis patients, high serum calcium, low phosphorus, and high and low iPTH levels were associated with increased all-cause mortality.
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Affiliation(s)
- Yunmi Kim
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju,
Korea
| | - Kyung Don Yoo
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju,
Korea
| | - Hyo Jin Kim
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju,
Korea
| | - Junga Koh
- Department of Internal Medicine, Gangneung Dongin Hospital, Gangneung,
Korea
| | - Yeonsil Yu
- Department of Internal Medicine, J Hospital, Seongnam,
Korea
| | - Young Joo Kwon
- Division of Nephrology, Korea University Guro Hospital, Korea University College of Medicine, Seoul,
Korea
| | - Gheun-Ho Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul,
Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul,
Korea
| | - Joongyub Lee
- School of Medicine, Inha University, Incheon,
Korea
- Department of Prevention and Management, Inha University Hospital, Incheon,
Korea
| | - Dong-Chan Jin
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Bum Soon Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Yeong Hoon Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan,
Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
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Yoo KD, Kim CT, Kim Y, Kim HJ, Park JY, Park JI, Oh YK, Kang SW, Yang CW, Kim YL, Kim YS, Lim CS, Lee JP. Effect of Renin-Angiotensin-Aldosterone System Blockade on Outcomes in Patients With ESRD: A Prospective Cohort Study in Korea. Kidney Int Rep 2018; 3:1385-1393. [PMID: 30450465 PMCID: PMC6224622 DOI: 10.1016/j.ekir.2018.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 07/28/2018] [Accepted: 07/30/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Conflicting results still exist regarding the benefit of renin-angiotensin-aldosterone system (RAAS) blockade on clinical outcomes in dialysis patients. The aim of this study was to evaluate the effects of RAAS blockade on survival in Korean patients with end-stage renal disease (ESRD). Methods Our analysis was based on the data of 5223 patients enrolled from the Clinical Research Center for ESRD, a nationwide prospective observational cohort. Multivariate Cox regression was applied for risk factor analysis with the cumulative duration of RAAS blockade use as time-varying covariate. The risks for mortality from all causes and major cardiovascular event-free survival were estimated. Results Compared to the control group, patients in the RAAS group were younger but had a higher proportion of diabetes mellitus, had higher systolic blood pressure, required a greater number of prescribed antihypertensive drugs, and had a longer dialysis duration. On multivariate time-varying Cox regression analysis, the RAAS group with cumulative duration of >90 days was significantly associated with a lower risk of mortality from all causes after adjustment for confounding (hazard ratio [HR] = 0.45, 95% confidence interval [CI] = 0.35-0.58, P < 0.0001). Major cardiovascular event-free survival was also better for the RAAS group than for the control group on multivariate analysis (HR = 0.27, 95% CI = 0.20-0.37, P < 0.0001), considering the cumulative duration of RAAS blockade use. Conclusion In Korean patients with ESRD, we reported a specific benefit of RAAS blockade in improving overall survival after adjustment for confounding factors from real-world data.
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Affiliation(s)
- Kyung Don Yoo
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Clara Tammy Kim
- Institute of Life and Death Studies, Hallym University, Chuncheon, Korea
| | - Yunmi Kim
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Hyo Jin Kim
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Ji In Park
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Yun Kyu Oh
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Woo Yang
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Correspondence: Jung Pyo Lee, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 156-707, Korea.
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Abstract
Although it is known that the prevalence rates of chronic diseases depend on income level, annual changes of the control rate have not been evaluated. In this cross-sectional study, we analyzed the variation in rate of well-controlled status of chronic diseases based on the annual income level using data from national nutrition surveys conducted between 2010 and 2015.Prevalence and controlled rate of hypertension, diabetes mellitus, and chronic kidney disease were analyzed in relation to annual income levels, using data from the Korea National Health and Nutrition Examination Survey (KNHANES), obtained from 2010 to 2015. We also analyzed the incidence of use of necessary medical care services and the reasons cited for not using these services.The data of 28,759 persons were analyzed. The average age increased, and sex ratio remained unchanged over the study period. Although the prevalence rates of diabetes increased, that of increased glycated hemoglobin gradually decreased. A significant change has been shown recently on the prevalence rates of hypertension patients. The prevalence rates of chronic kidney disease stayed unchanged during the course of the study period. The incidence of controlled chronic disease status increased with the income level, and over time during the study, in the case of diabetes and chronic kidney disease. However, while controlled hypertension status rate increased from year to year, there was no trend of increase with increased income level. The incidence of participants not using hospital services declined with increasing income level, but the rate of economic causes being cited as reasons for not using hospital services increased over time and showed no change among income levels. Results of regression analysis of prevalence rates of chronic diseases by income level showed that lower income groups tended to have higher odds ratios for chronic diseases.Our results suggest that the incidence rate of well-controlled chronic disease status remains low in lower income groups. These results imply that financial status may play an important role in the management of chronic diseases.
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Affiliation(s)
- Kun Kug Choi
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine
| | - Seung Hyuk Kim
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine
| | - Kyung Don Yoo
- Division of Nephrology, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju
| | - Hyo Jin Kim
- Division of Nephrology, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju
| | - Ji In Park
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon
| | - Subin Hwang
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Kyeonggi-do, Republic of Korea
| | - Ho Suk Ku
- Department of Internal Medicine, Inje University Seoul Paik Hospital, Inje University School of Medicine
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Park JY, Lim CY, Puurveen G, Kim DY, Lee JH, Do HH, Kim KS, Yoo KD, Kim HJ, Kim Y, Shin SJ. Effect of the Contents in Advance Directives on Individuals' Decision-Making. Omega (Westport) 2018; 81:436-453. [PMID: 29898635 DOI: 10.1177/0030222818782344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Completing an advance directive offers individuals the opportunity to make informed choices about end-of-life care. However, these decisions could be influenced in different ways depending on how the information is presented. We randomly presented 185 participants with four distinct types of advance directive: neutrally framed (as reference), negatively framed, religiously framed, and a combination. Participants were asked which interventions they would like to receive at the end of life. Between 60% and 70% of participants responded "accept the special interventions" on the reference form. However, the majority (70%-90%) chose "refuse the interventions" on the negative form. With respect to the religious form, 70% to 80% chose "not decided yet." Participants who refused special life-sustaining treatments were older, female, and with better prior knowledge about advance directives. Our findings imply that the specific content of advance directives could affect decision-making with regard to various interventions for end-of-life care.
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Affiliation(s)
- Jae Yoon Park
- Department of Nephrology, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
| | - Chi-Yeon Lim
- Clinical Trial Center, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
| | - Gloria Puurveen
- W. Maurice Young Center for Applied Ethics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Do Yeun Kim
- Department of Hematology and Medical Oncology, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
| | - Jae Hang Lee
- Department of Thoracic Surgery, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
| | - Han Ho Do
- Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
| | - Kyung Soo Kim
- Department of Nephrology, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
| | - Kyung Don Yoo
- Department of Nephrology, Dongguk University Gyeongju Hospital, Dongguk University School of Medicine, Gyeongju, Republic of Korea
| | - Hyo Jin Kim
- Department of Nephrology, Dongguk University Gyeongju Hospital, Dongguk University School of Medicine, Gyeongju, Republic of Korea
| | - Yunmi Kim
- Department of Nephrology, Dongguk University Gyeongju Hospital, Dongguk University School of Medicine, Gyeongju, Republic of Korea
| | - Sung Joon Shin
- Department of Nephrology, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea.,W. Maurice Young Center for Applied Ethics, University of British Columbia, Vancouver, British Columbia, Canada
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Han SS, Yu MY, Yoo KD, Lee JP, Kim DK, Kim YS, Yang SH. Loss of KLF15 accelerates chronic podocyte injury. Int J Mol Med 2018; 42:1593-1602. [PMID: 29901095 DOI: 10.3892/ijmm.2018.3726] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 06/06/2018] [Indexed: 11/06/2022] Open
Abstract
Krüppel‑like factor 15 (KLF15), also known as kidney‑enriched transcription factor, is known to participate in podocyte differentiation. However, the role of KLF15 in chronic podocyte injury remains incompletely understood, particularly in proteinuric disease models. In the present study, the 5/6 nephrectomy mouse model was used to induce chronic podocyte injury. Human primary podocytes were isolated by flow cytometry and cultured to emulate the injury process in an in vitro system. Biopsied kidney tissue samples were obtained from patients with primary membranous nephropathy or diabetic nephropathy in order to analyze the relationship between glomerular KLF15 expression and subsequent outcomes. When 5/6 nephrectomy was predisposed to progressive kidney damage, fibrosis markers increased, while podocyte KLF15 expression decreased. In addition, increased fibrosis marker expression in human primary podocytes following treatment with transforming growth factor‑β was aggravated by the knockdown of KLF15. These trends were reversed after cultured podocytes were treated with cyclosporine. When patients were grouped according to KLF15 expression levels in kidney tissue, the low expression groups were demonstrated to have worse renal outcomes, such as non‑remission of disease and end‑stage renal disease. In conclusion, the present findings revealed that low expression of KLF15 was associated with chronic podocyte injury.
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Affiliation(s)
- Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Mi-Yeon Yu
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Kyung Don Yoo
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Gyeongsangbuk‑do 13620, Republic of Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Seung Hee Yang
- Kidney Research Institute, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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Yoo KD, Yoon HJ, Hwang SS, Heo NJ, Chin HJ, Yang SH, Joo KW, Kim YS, Lee H. Different association between renal hyperfiltration and mortality by sex. Nephrology (Carlton) 2018; 22:804-810. [PMID: 27436787 DOI: 10.1111/nep.12857] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 06/18/2016] [Accepted: 07/13/2016] [Indexed: 12/31/2022]
Abstract
AIM Renal hyperfiltration (RHF) is a marker of early kidney injury that was recently shown to be a novel marker of mortality. However, it has no clear definition. In this study, we suggested an age- and sex-adjusted RHF definition and explored the association between RHF and mortality by sex. METHODS We analyzed data from individuals receiving routine health examinations from 1995 to 2009. RHF was defined as an estimated glomerular filtration rate over the 95th percentile matched for age and sex. RESULTS A total of 114 966 individuals were included. During the 75-month of observation period, 2559 (2.2%) participants died. Among those, 71.4% were men. Because sex and RHF had a significant interaction for mortality (P for interaction < 0.001), we performed survival analysis according to sex. RHF was related to lower body weight and a higher proportion of cigarette smoking in men, whereas these relationships were not found in women. In the Kaplan-Meier curve, RHF was associated with higher mortality rate than non-RHF in both sexes, but this relationship was more prominent in men. In the multivariate analysis, RHF remained as an independent risk factor for all-cause mortality even after adjustment for confounding in men (hazard ratio, 1.34; 95% confidence interval, 1.12-1.59; P = 0.001). In women, RHF was not associated with increased mortality. CONCLUSIONS We demonstrated that RHF was a significant risk factor for mortality in men but not in women. The mechanisms and clinical implications of these different associations according to sex require a further clarification.
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Affiliation(s)
- Kyung Don Yoo
- Department of Internal Medicine, Dongguk University Medical Center, Gyeongju, Korea
| | - Hyung-Jin Yoon
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Sik Hwang
- Department of Social and Preventive Medicine, Inha University College of Medicine, Incheon, Korea
| | - Nam Ju Heo
- Department of Internal Medicine, Healthcare System Gangnam Center Seoul National University Hospital, Seoul, Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Kidney Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Seung Hee Yang
- Kidney Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Kwon Wook Joo
- Kidney Research Institute, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yon Su Kim
- Kidney Research Institute, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hajeong Lee
- Kidney Research Institute, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Park HC, Lee YK, Yoo KD, Jeon HJ, Kim SJ, Cho A, Lee J, Kim YG, Lee SH, Lee SO. Korean clinical practice guidelines for preventing the transmission of infections in hemodialysis facilities. Kidney Res Clin Pract 2018; 37:8-19. [PMID: 29629273 PMCID: PMC5875572 DOI: 10.23876/j.krcp.2018.37.1.8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 12/27/2017] [Accepted: 12/28/2017] [Indexed: 11/04/2022] Open
Abstract
Patients receiving hemodialysis are vulnerable to infectious diseases due to their impaired immunity and high risk of exposure to pathogens. To protect patients, staff, and visitors from potential infections, each hemodialysis unit should establish and follow standard infection control and prevention measures. Therefore, clinical practice guidelines were developed by a working group of nephrologists and infection control specialists to provide evidence-based guidance for dialysis physicians and nurses, with the aim of preventing infection transmission and controlling infection sources in hemodialysis facilities. The areas of infection control covered by these guidelines include standard precautions, isolation strategies, vascular access, water treatment, cleaning/disinfecting/sterilizing, and vaccination. This special report summarizes the key recommendations from the Korean clinical practice guidelines for preventing the transmission of infections in hemodialysis facilities.
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Affiliation(s)
- Hayne Cho Park
- Division of Nephrology, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Kyung Don Yoo
- Department of Internal Medicine, Dongguk University Medical Center, Dongguk University College of Medicine, Gyeongju, Korea
| | - Hee Jung Jeon
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Seung Jun Kim
- Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Ajin Cho
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Jacob Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Yang-Gyun Kim
- Department of Internal Medicine, Kyung Hee University Hospital at Kangdong, Seoul, Korea
| | - Sang-Ho Lee
- Department of Internal Medicine, Kyung Hee University Hospital at Kangdong, Seoul, Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Yoo KD, Noh J, Lee H, Kim DK, Lim CS, Kim YH, Lee JP, Kim G, Kim YS. A Machine Learning Approach Using Survival Statistics to Predict Graft Survival in Kidney Transplant Recipients: A Multicenter Cohort Study. Sci Rep 2017; 7:8904. [PMID: 28827646 PMCID: PMC5567098 DOI: 10.1038/s41598-017-08008-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 07/07/2017] [Indexed: 01/20/2023] Open
Abstract
Accurate prediction of graft survival after kidney transplant is limited by the complexity and heterogeneity of risk factors influencing allograft survival. In this study, we applied machine learning methods, in combination with survival statistics, to build new prediction models of graft survival that included immunological factors, as well as known recipient and donor variables. Graft survival was estimated from a retrospective analysis of the data from a multicenter cohort of 3,117 kidney transplant recipients. We evaluated the predictive power of ensemble learning algorithms (survival decision tree, bagging, random forest, and ridge and lasso) and compared outcomes to those of conventional models (decision tree and Cox regression). Using a conventional decision tree model, the 3-month serum creatinine level post-transplant (cut-off, 1.65 mg/dl) predicted a graft failure rate of 77.8% (index of concordance, 0.71). Using a survival decision tree model increased the index of concordance to 0.80, with the episode of acute rejection during the first year post-transplant being associated with a 4.27-fold increase in the risk of graft failure. Our study revealed that early acute rejection in the first year is associated with a substantially increased risk of graft failure. Machine learning methods may provide versatile and feasible tools for forecasting graft survival.
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Affiliation(s)
- Kyung Don Yoo
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Junhyug Noh
- Department of Computer Science and Engineering, College of Engineering, Seoul National University, Seoul, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Young Hoon Kim
- Department of Surgery, College of Medicine, Ulsan University, Asan Medical Center, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Gunhee Kim
- Department of Computer Science and Engineering, College of Engineering, Seoul National University, Seoul, Korea.
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Yoo KD, Lee JP, Lee SM, Park JY, Lee H, Kim DK, Kang SW, Yang CW, Kim YL, Lim CS, Joo KW, Kim YS. Cancer in Korean patients with end-stage renal disease: A 7-year follow-up. PLoS One 2017; 12:e0178649. [PMID: 28692695 PMCID: PMC5503228 DOI: 10.1371/journal.pone.0178649] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 05/16/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The effectiveness of dialysis on the incidence of cancer in patients with end-stage renal disease (ESRD) remains to be clarified. In this study, we evaluated the incidence rate and type of cancer among patients with ESRD, compared to the general population, through a prospective 7-year follow-up. We also calculated the cumulative incidence rate of cancer associated with ESRD, with stratification to control for the competing risk of death. METHODS This prospective observational cohort study was conducted using data from a nationwide study on patients with ESRD in Korea. A total of 5,235 patients, ≥18 years old, with ESRD were identified from the national registry as being treated by dialysis between August 2008 and December 2014. The standardized incidence ratio (SIR) and cumulative incidence rate of specific cancers were evaluated and compared to the general population. RESULTS A total of 5,235 participants were included. During the 7 year observation period, 116 (2.2%) participants had been diagnosed as cancer. The SIR of overall cancer was 0.94 [95% confidence interval (CI), 0.72-1.19] and was comparable to the rate for the general population. Although the digestive organs were the most frequent site of a primary site cancer (N = 39, 33.6%), the SIR was highest for urinary tract cancer [4.7, 95% CI, 2.42-8.19]. The five year standardized cumulative incidence of cancer was higher for females than for males, and for non-diabetic compared to diabetic causes of ESRD. We estimated that the five year standardized cumulative incidence was highest [8.4, 95% CI, 5.07-13.75] in patients with ESRD, caused by glomerulonephritis. CONCLUSION A screening program should be necessary for urinary tract cancer in Korean patients with ESRD. Cancer screening programs for patients with ESRD in Korea should be emphasized on female patients and patients with non-diabetic ESRD.
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Affiliation(s)
- Kyung Don Yoo
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Su Mi Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University College of Medicine, Gyeongju, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Woo Yang
- Department of Internal Medicine, Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
- * E-mail:
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Park HC, Lee YK, Lee SH, Yoo KD, Jeon HJ, Ryu DR, Kim SN, Sohn SH, Chun RW, Choi KB. Middle East respiratory syndrome clinical practice guideline for hemodialysis facilities. Kidney Res Clin Pract 2017; 36:111-116. [PMID: 28680819 PMCID: PMC5491158 DOI: 10.23876/j.krcp.2017.36.2.111] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/20/2017] [Indexed: 01/30/2023] Open
Abstract
The Korean Society of Nephrology participated in the task force team consisting of government authorities and civilian experts to prevent and control the spread of Middle East respiratory syndrome (MERS) in 2015. The Korean Society of Nephrology MERS Task Force Team took an immediate action and drafted ‘the clinical recommendation for hemodialysis facilities’ to follow when the first and the only confirmed case was reported in the hemodialysis unit. Owing to the dedicated support from medical doctors, dialysis nurses, and related medical companies, we could prevent further transmission of MERS infection successfully in hemodialysis units. This special report describes the experience of infection control during MERS outbreak in 2015 and summarizes the contents of ‘the clinical practice guideline for hemodialysis facilities dealing with MERS patients’ built upon our previous experience.
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Affiliation(s)
- Hayne Cho Park
- Division of Nephrology, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Sang-Ho Lee
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Kyung Don Yoo
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Hee Jung Jeon
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Seong Nam Kim
- Kim Seong Nam Internal Medicine Clinic, Seoul, Korea
| | | | - Rho Won Chun
- Chun Rho Won Internal Medicine Clinic, Seoul, Korea
| | - Kyu Bok Choi
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
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Park S, Yoo KD, Park JS, Hong JS, Baek S, Park SK, Chin HJ, Na KY, Choi Y, Kim DK, Oh KH, Joo KW, Kim YS, Lee H. Pregnancy in women with immunoglobulin A nephropathy: are obstetrical complications associated with renal prognosis? Nephrol Dial Transplant 2017; 33:459-465. [DOI: 10.1093/ndt/gfx061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/20/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sehoon Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Don Yoo
- Department of Internal Medicine, Dongguk University Medical Center, Gyeongju, Gyeongsangnam-do, Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul Korea
| | - Joon-Seok Hong
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Seungdon Baek
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su-Kil Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yunhee Choi
- Medical Research Collaborating Center, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ki Kim
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kwon Wook Joo
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yon Su Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hajeong Lee
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Park JY, Yoo KD, Kim YC, Kim DK, Joo KW, Kang SW, Yang CW, Kim NH, Kim YL, Lim CS, Kim YS, Lee JP. Early dialysis initiation does not improve clinical outcomes in elderly end-stage renal disease patients: A multicenter prospective cohort study. PLoS One 2017; 12:e0175830. [PMID: 28414758 PMCID: PMC5393880 DOI: 10.1371/journal.pone.0175830] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 04/01/2017] [Indexed: 12/02/2022] Open
Abstract
Background The optimal timing for initiating dialysis in end-stage renal disease (ESRD) is controversial, especially in the elderly. Methods 665 patients ≥65 years old who began dialysis from August 2008 to February 2015 were prospectively enrolled in the Clinical Research Center for End-Stage Renal Disease cohort study. Participants were divided into 2 groups based on the median estimated glomerular filtration rate at the initiation of dialysis. Propensity score matching (PSM) was used to compare the overall survival rate, cardiovascular events, Kidney Disease Quality of Life Short Form 36 (KDQOL-36) results, Karnofsky performance scale values, Beck’s depression inventory values, and subjective global assessments. Results The mean patient age was 72.0 years, and 61.7% of the patients were male. Overall, the cumulative survival rates were lower in the early initiation group, although the difference was not significant after PSM. Additionally, the survival rates of the 2 groups did not differ after adjusting for age, sex, Charlson comorbidity index and hemoglobin, serum albumin, serum calcium and phosphorus levels. Although the early initiation group showed a lower physical component summary score on the KDQOL-36 3 months after dialysis, the difference in scores was not significant 12 months after dialysis. Furthermore, the difference was not significant after PSM. The Karnofsky performance scale, Beck’s depression inventory, and subjective global assessments were not significantly different 3 and 12 months after dialysis initiation. Conclusions The timing of dialysis initiation is not associated with clinical outcomes in elderly patients with ESRD.
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Affiliation(s)
- Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Gyeonggi-do, Korea
| | - Kyung Don Yoo
- Department of Internal Medicine, Dongguk University Medical Center, Gyeongsangbuk-do, Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Woo Yang
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Nam-Ho Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Chun-Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
- * E-mail:
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Lee S, Kang E, Yoo KD, Choi Y, Kim DK, Joo KW, Yang SH, Kim YL, Kang SW, Yang CW, Kim NH, Kim YS, Lee H. Lower serum potassium associated with increased mortality in dialysis patients: A nationwide prospective observational cohort study in Korea. PLoS One 2017; 12:e0171842. [PMID: 28264031 PMCID: PMC5338775 DOI: 10.1371/journal.pone.0171842] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 01/26/2017] [Indexed: 12/20/2022] Open
Abstract
Background Abnormal serum potassium concentration has been suggested as a risk factor for mortality in patients undergoing dialysis patients. We investigated the impact of serum potassium levels on survival according to dialysis modality. Methods A nationwide, prospective, observational cohort study for end stage renal disease patients has been ongoing in Korea since August 2008. Our analysis included patients whose records contained data regarding serum potassium levels. The relationship between serum potassium and mortality was analyzed using competing risk regression. Results A total of 3,230 patients undergoing hemodialysis (HD, 64.3%) or peritoneal dialysis (PD, 35.7%) were included. The serum potassium level was significantly lower (P < 0.001) in PD (median, 4.5 mmol/L; interquartile range, 4.0–4.9 mmol/L) than in HD patients (median, 4.9 mmol/L; interquartile range, 4.5–5.4 mmol/L). During 4.4 ± 1.7 years of follow-up, 751 patients (23.3%) died, mainly from cardiovascular events (n = 179) and infection (n = 120). In overall, lower serum potassium level less than 4.5 mmol/L was an independent risk factor for mortality after adjusting for age, comorbidities, and nutritional status (sub-distribution hazard ratio, 1.30; 95% confidence interval 1.10–1.53; P = 0.002). HD patients showed a U-shaped survival pattern, suggesting that both lower and higher potassium levels were deleterious, although insignificant. However, in PD patients, only lower serum potassium level (<4.5 mmol/L) was an independent predictor of mortality (sub-distribution hazard ratio, 1.35; 95% confidence interval 1.00–1.80; P = 0.048). Conclusion Lower serum potassium levels (<4.5 mmol/L) occur more commonly in PD than in HD patients. It represents an independent predictor of survival in overall dialysis, especially in PD patients. Therefore, management of dialysis patients should focus especially on reducing the risk of hypokalemia, not only that of hyperkalemia.
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Affiliation(s)
- Sunhwa Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eunjeong Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Don Yoo
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Republic of Korea
| | - Yunhee Choi
- Seoul National University Hospital, Medical Research Collaborating Center, Seoul, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Hee Yang
- Seoul National University Kidney Research Institute, Seoul, Republic of Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chul Woo Yang
- Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Nam Ho Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Seoul National University Kidney Research Institute, Seoul, Republic of Korea
- * E-mail:
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Yeo SH, Kwak JH, Kim YU, Lee JS, Kim HJ, Park KH, Lee JS, Ha GY, Lee JH, Lee JY, Yoo KD. Peritoneal dialysis-related peritonitis due to Halomonas hamiltonii: A first case report. Medicine (Baltimore) 2016; 95:e5424. [PMID: 27893682 PMCID: PMC5134875 DOI: 10.1097/md.0000000000005424] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Halomonas hamiltonii is a Gram-negative, halophilic, motile, and nonspore-forming rod bacterium. Although most Halomonas sp. are commonly found in saline environments, it has rarely been implicated as a cause of human infection. Herein, the authors present a case report of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis attributed to H hamiltonii. CASE PRESENTATION An 82-year-old male patient who had been receiving CAPD therapy presented to an emergency department with complaints of abdominal pain and cloudy dialysate that had persisted for 2 days. The peritoneal dialysate was compatible with CAPD peritonitis, with white blood cell count of peritoneal effluent of 810/mm and neutrophils predominated (60%). Two days after culture on blood agar medium, nonhemolytic pink mucoid colonies showed, with cells showing Gram-negative, nonspore-forming rods with a few longer and larger bacilli than usual were found. We also performed biochemical tests and found negative responses in K/K on the triple sugar iron test and H2S and equivocal (very weak) response in the motility test, but positive responses to catalase, oxidase, and urease tests. The partial sequence of the 16S rRNA gene of a bacterium detected by peritoneal fluid culture was utilized for a Basic Local Alignment Search Tool search, which revealed that the organism was H hamiltonii. Intraperitoneal antibiotics were administered for 21 days, and the patient was discharged without clinical problems. CONCLUSION We present here the first case report of CAPD-related peritonitis caused by H hamiltonii, which was identified using molecular biological techniques. Although guidelines do not exist for the treatment of infections caused by this organism, conventional treatment for Gram-negative organisms could be effective.
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Affiliation(s)
- Se Hwan Yeo
- Department of Internal Medicine, Dongguk University
| | | | - Yeo Un Kim
- Department of Internal Medicine, Dongguk University
| | - Jin Suk Lee
- Department of Internal Medicine, Dongguk University
| | - Hyo Jin Kim
- Department of Internal Medicine, Dongguk University
| | | | - Jung Sook Lee
- Korean Collection for Type Cultures, Biological Resource Center, Korea Research Institute of Bioscience and Biotechnology, Jeongeup
| | - Gyoung Yim Ha
- Department of Laboratory Medicine, Dongguk University, Gyeongju
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Lee H, Lee JW, Yoo KD, Yoo JY, Lee JP, Kim DK, Chin HJ, Kim YS, Yang SH. Cln 3-requiring 9 is a negative regulator of Th17 pathway-driven inflammation in anti-glomerular basement membrane glomerulonephritis. Am J Physiol Renal Physiol 2016; 311:F505-19. [DOI: 10.1152/ajprenal.00533.2015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 05/13/2016] [Indexed: 01/17/2023] Open
Abstract
T helper 17 (Th17) lymphocytes promote renal inflammation in anti-glomerular basement membrane glomerulonephritis (anti-GBM GN), and signal transducer and activator of transcription 3 (STAT3) mediates activation of Th17 lymphocytes by IL-6 and transforming growth factor-β (TGF-β). Cln 3-requiring 9 (Ctr9), a subunit of RNA polymerase-associated factor complex (PAFc), regulates the transcription of IL-6/STAT3-dependent genes. Here, we investigated the role of Ctr9 in regulating Th17-driven inflammation in anti-GBM GN. In mice, STAT3β or IL-17 knockout ameliorated anti-GBM autoantibody-induced renal injury. This phenomenon was associated with decreases in retinoic acid receptor-related orphan receptor γt (RORγt), IL-17, phosphorylated STAT3, and proinflammatory cytokines. Compared with wild-type mice, Ctr9 increased in both STAT3β−/− and IL-17−/− mice injected with anti-GBM IgG, showing a negative correlation with Th17-related transcripts. Small interfering RNA (siRNA)-mediated knockdown of Ctr9 in intrarenal lymphocytes further upregulated Th17-related transcripts, consistent with repression of Th17 differentiation by Ctr9. Interestingly, Ctr9 was also expressed in human and mouse mesangial cells and downregulated in response to anti-GBM IgG or to TGF-β plus IL-17. Ctr9 in mesangial cells was even more repressed in the presence of both anti-GBM IgG and Th17-activating cytokines. Consistent with these findings, renal biopsies obtained from patients with anti-GBM GN showed consistent downregulation of Ctr9 and upregulation of phosphorylated STAT3 and IL-17 in the glomerulus. We conclude that Ctr9 is a negative regulator of Th17 differentiation in anti-GBM GN and repressed by anti-GBM IgG and IL-17 in mesangial cells.
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Affiliation(s)
- Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Wook Lee
- Nephrology Clinic, National Cancer Center Hospital, Seoul, Republic of Korea
| | - Kyung Don Yoo
- Department of Medical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Dongguk University Medical Center, Gyeongju, Republic of Korea
| | - Joo-Yeon Yoo
- Life Science, Pohang University of Science and Technology, Pohang, Republic of Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Kidney Research Institute, Seoul National University, Seoul, Republic of Korea; and
| | - Ho Jun Chin
- Nephrology Clinic, National Cancer Center Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Medical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
- Kidney Research Institute, Seoul National University, Seoul, Republic of Korea; and
| | - Seung Hee Yang
- Kidney Research Institute, Seoul National University, Seoul, Republic of Korea; and
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Yoo KD, Kim CT, Kim MH, Noh J, Kim G, Kim H, An JN, Park JY, Cho H, Kim KH, Kim H, Ryu DR, Kim DK, Lim CS, Kim YS, Lee JP. Superior outcomes of kidney transplantation compared with dialysis: An optimal matched analysis of a national population-based cohort study between 2005 and 2008 in Korea. Medicine (Baltimore) 2016; 95:e4352. [PMID: 27537562 PMCID: PMC5370789 DOI: 10.1097/md.0000000000004352] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Data regarding kidney transplantation (KT) and dialysis outcomes are rare in Asian populations. In the present study, we evaluated the clinical outcomes associated with KT using claims data from the Korean national public health insurance program. Among the 35,418 adult patients with incident dialysis treated between 2005 and 2008 in Korea, 1539 underwent KT. An optimal balanced risk set matching was attempted to compare the transplant group with the control group in terms of the overall survival and major adverse cardiac event-free survival. Before matching, the dialysis group was older and had more comorbidities. After matching, there were no differences in age, sex, dialysis modalities, or comorbidities. Patient survival was significantly better in the transplant group than in the matched control group (P < 0.001). In addition, the transplant group showed better major adverse cardiac event-free survival than the dialysis group (P < 0.001; hazard ratio, 0.49; 95% confidence interval, 0.32-0.75). Korean patients with incident dialysis who underwent long-term dialysis had significantly more cardiovascular events and higher all-cause mortality rates than those who underwent KT. Thus, KT should be more actively recommended in Korean populations.
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Affiliation(s)
- Kyung Don Yoo
- Department of Internal Medicine, Division of Nephrology, Dongguk University Medical Center
| | | | - Myoung-Hee Kim
- Department of Dental Hygiene, College of Health Science, Eulji University, Daejeon
| | - Junhyug Noh
- College of Engineering, Seoul National University
| | - Gunhee Kim
- College of Engineering, Seoul National University
| | - Ho Kim
- School of Public Health, Seoul National University, Seoul
| | - Jung Nam An
- Department of Internal Medicine, Seoul National University Boramae Medical Center
| | - Jae Yoon Park
- Department of Internal Medicine, Division of Nephrology, Dongguk University Medical Center
| | - Hyunjeong Cho
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Kyoung Hoon Kim
- Department of Public Health, Graduate School, Korea University, Seoul
| | - Hyunwook Kim
- Department of Internal Medicine, Wonkwang University College of Medicine, Sanbon Hospital, Gyeonggi-do
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center
- Correspondence: Jung Pyo Lee, Department of Internal Medicine, Seoul National University Boramae Medical Center, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 156-707, Republic of Korea (e-mail: )
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Abstract
Minimal change disease (MCD) is a well-known benign primary glomerulonephritis because of its distinct rare tendency to progress to end-stage renal disease. However, factors associated with relapse in adults are not well known. We aimed to identify predictors of relapse in adult-onset MCD patients.A retrospective cohort of 195 patients with adult-onset primary MCD with nephritic syndrome and disease onset between 1979 and 2013 was followed up for >12 months. The number of relapses was counted and predictors of relapse were analyzed.A total of 195 patients were included. Median age at diagnosis was 38 years (IQR, 23-53 years) and 113 (57.9%) were men. During 81 months (IQR, 44-153 months) of follow-up, 92% of patients achieved remission after initial treatment. However, only 60 (32.8%) did not experience a relapse and 11 patients failed to remit. Among the remaining 124 patients, 65 experienced a relapse once or twice and 59 experienced a relapse more than twice. Younger onset age, increased severity of nephrotic features such as lower serum albumin levels and higher cholesterol level were associated with relapse. Interestingly, the grade of mesangial proliferation was lower in patients who experienced a relapse. Initial combined treatment with corticosteroids (CS) and cyclophosphamide reduced the number of relapses. In addition, patients with shorter treatment duration tended to experience relapse more often. Multivariate analysis showed that younger onset age, combined mesangial proliferation, initial treatment regimen, and treatment duration were independent risk factors for relapse. Progression to end-stage renal disease was developed in only a patient.In conclusion, more than two-thirds of adult-onset nephrotic MCD patients experienced relapse, although their renal progression was rare. Younger onset age, CS without cyclophosphamide treatment, and shorter treatment duration were independent risk factors for relapse in adult-onset MCD patients.
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Affiliation(s)
- Hajeong Lee
- From the Department of Internal Medicine (HL, DKK, KHO, KWJ, YSK, CA, JSH, CSL), Seoul National University Hospital; Kidney Research Institute (YKO, DKK, KWJ, YSK, CA, JSH, CSL), Seoul National University; Department of Internal Medicine (YKO, CSL), Seoul National University Boramae Medical Center, Seoul; and Department of Internal Medicine (KDY), Dongguk University Medical Center, Gyeongju, Republic of Korea
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An JN, Kim YH, Park JB, Hwang JH, Yoo KD, Park JY, Kim CT, Kim HL, Kim YJ, Han DJ, Lim CS, Kim YS, Lee JP. The reciprocal interaction between LV remodelling and allograft outcomes in kidney transplant recipients. Heart 2015; 101:1826-33. [PMID: 26416838 DOI: 10.1136/heartjnl-2015-308142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/01/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the incidence and related clinical factors of LV hypertrophy (LVH) regression after kidney transplantation and its effect on graft outcome. METHODS Among the 3373 kidney transplant recipients who were enrolled in a multicentre cohort from 1997 to 2012, a total of 767 patients who underwent echocardiography before and after transplantation were included in this study followed for a median of 7.5 years. RESULTS LVH regression steadily increased from 7.4% at 1 year to 35.4% at 5 year over the 5-year post-transplantation period. The probability of LVH regression decreased in the patients who received a kidney transplant due to end-stage renal disease of unknown aetiology (p=0.041) or who underwent pretransplant haemodialysis (p=0.020). The probability of LVH regression also decreased as the pretransplant LV mass index (p<0.001) and post-transplant systolic blood pressure increased (p=0.005). Conversely, LVH regression was significantly associated with the highest tertile of the pretransplant haemoglobin level (p=0.029). Furthermore, in the 5th year after transplantation, persistent LVH was independently associated with allograft failure (HR 1.95; 95% CI 1.14 to 3.33; p=0.015) and the LV mass index reliably predicted graft outcome. CONCLUSIONS LVH consistently regressed after kidney transplantation in most patients. Persistent LVH, low haemoglobin levels and elevated blood pressure were associated with an increased risk of allograft failure in kidney transplant recipients.
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Affiliation(s)
- Jung Nam An
- Division of Nephrology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea Division of Nephrology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hoon Kim
- Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ho Hwang
- Division of Nephrology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Kyung Don Yoo
- Division of Nephrology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Yoon Park
- Division of Nephrology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Clara Tammy Kim
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Duck-Jong Han
- Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - Chun Soo Lim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea Division of Nephrology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yon Su Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Division of Nephrology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea Division of Nephrology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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71
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Yoo KD, Kang S, Choi Y, Yang SH, Heo NJ, Chin HJ, Oh KH, Joo KW, Kim YS, Lee H. Sex, Age, and the Association of Serum Phosphorus With All-Cause Mortality in Adults With Normal Kidney Function. Am J Kidney Dis 2015; 67:79-88. [PMID: 26341926 DOI: 10.1053/j.ajkd.2015.06.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 06/29/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND High serum phosphorus levels are associated with cardiovascular morbidity and mortality in kidney disease. Although serum phosphorus levels possibly influence on mortality in individuals without kidney disease, this is uncertain because of the variable sex- and age-based distribution of serum phosphorus levels. STUDY DESIGN Observational cohort study. SETTING & PARTICIPANTS Clinical and biochemical data were collected from 138,735 adults undergoing routine health checkups in 3 tertiary hospitals. Individuals with estimated glomerular filtration rates < 60 mL/min/1.73 m2 and urine dipstick albumin ≥ 1+ were excluded. PREDICTOR Sex-specific quartiles of serum phosphorus and sex. OUTCOMES All-cause mortality. RESULTS The study included 92,756 individuals. Generally, women showed higher serum phosphorus levels than men. In women, serum phosphorus levels increased with age until 60 years old, then decreased with age. Men with higher serum phosphorus levels were younger and less likely to have hypertension, whereas women with higher serum phosphorus levels were older and more likely to have diabetes and hypertension. During a median follow-up of 75 months, 1,646 participants died. In the overall population, higher serum phosphorus levels were an independent predictor for all-cause mortality after adjustment (adjusted HR for the highest vs. lowest quartile, 1.34; 95% CI, 1.15-1.56; P<0.001). We observed that this increased risk was present in men but not in women (adjusted HR of 1.43 [95% CI, 1.22-1.68] vs. 1.01 [95% CI, 0.76-1.33]), but interaction by sex was not significant (P=0.8). LIMITATIONS A single phosphorus measurement and low power to test for interactions by sex and age. CONCLUSIONS We demonstrated that higher serum phosphorus levels influenced all-cause mortality in individuals with normal kidney function. Our findings suggest that the association may differ by sex, but future studies with adequate power to test for effect modification are needed to confirm our findings.
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Affiliation(s)
- Kyung Don Yoo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soohee Kang
- Medical Research Collaborating Center, Seoul National University College of Medicine, Seoul, Korea
| | - Yunhee Choi
- Medical Research Collaborating Center, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hee Yang
- Kidney Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Nam Ju Heo
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Ho Jun Chin
- Kidney Research Institute, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Kidney Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Kidney Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea; Kidney Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
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An JN, Yoo KD, Hwang JH, Kim HL, Kim SH, Yang SH, Kim JH, Kim DK, Oh YK, Kim YS, Lim CS, Lee JP. Circulating tumour necrosis factor receptors 1 and 2 predict contrast-induced nephropathy and progressive renal dysfunction: A prospective cohort study. Nephrology (Carlton) 2015; 20:552-9. [DOI: 10.1111/nep.12448] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Jung Nam An
- Division of Nephrology; Department of Internal Medicine; Seoul National University Boramae Medical Center; Seoul Korea
- Division of Cardiology; Department of Internal Medicine; Seoul National University Boramae Medical Center; Seoul Korea
| | - Kyung Don Yoo
- Division of Cardiology; Department of Internal Medicine; Seoul National University Boramae Medical Center; Seoul Korea
| | - Jin Ho Hwang
- Division of Nephrology; Department of Internal Medicine; Seoul National University College of Medicine; Seoul Korea
| | - Hack-Lyoung Kim
- Division of Nephrology; Department of Internal Medicine; Chung-Ang University Hospital; Seoul Korea
| | - Sang-Hyun Kim
- Division of Nephrology; Department of Internal Medicine; Chung-Ang University Hospital; Seoul Korea
| | - Seung Hee Yang
- Seoul National University Kidney Research Institute; Seoul Korea
| | - Jin Hyuk Kim
- Division of Nephrology; Department of Internal Medicine; Seoul National University Boramae Medical Center; Seoul Korea
| | - Dong Ki Kim
- Division of Cardiology; Department of Internal Medicine; Seoul National University Boramae Medical Center; Seoul Korea
| | - Yun Kyu Oh
- Division of Nephrology; Department of Internal Medicine; Seoul National University Boramae Medical Center; Seoul Korea
| | - Yon Su Kim
- Division of Cardiology; Department of Internal Medicine; Seoul National University Boramae Medical Center; Seoul Korea
| | - Chun Soo Lim
- Division of Nephrology; Department of Internal Medicine; Seoul National University Boramae Medical Center; Seoul Korea
| | - Jung Pyo Lee
- Division of Nephrology; Department of Internal Medicine; Seoul National University Boramae Medical Center; Seoul Korea
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73
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Yoo KD, An JN, Kim CT, Cho JH, Kim CD, Park SK, Chae DW, Oh YK, Lim CS, Kim YS, Kim YH, Lee JP. Clinical outcomes in Asian elderly kidney transplant recipients: a multicenter cohort study. Transplant Proc 2015; 47:600-7. [PMID: 25891695 DOI: 10.1016/j.transproceed.2015.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 01/28/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The kidney transplantation rate in elderly patients is increasing rapidly. However, the clinical outcomes of kidney transplantation in elderly patients have not yet been thoroughly evaluated. METHODS This multicenter cohort study included adult kidney transplant recipients (KTRs) admitted to five major tertiary hospitals in Korea between 1997 and 2012. A total of 3,565 adult participants were enrolled. Patient survival, allograft survival, and biopsy-proven acute rejection (BPAR) of 242 elderly recipients (≥ 60 years) were assessed and compared with those of a younger population. RESULTS Patients were divided into five groups according to age at time of transplantation. The proportion of elderly patients was 6.7 % (mean age, 63.1 ± 2.7 years; n = 242). The numbers of male patients (69.4%), those with diabetes mellitus history (36.3%), and those with pretransplantation ischemic heart disease history (17.7%) were significantly higher in the elderly group than in the younger age groups. Elderly patients were more likely to receive a cadaveric kidney, and overall mortality rates were significantly higher in the elderly patients (1-year survival 93.3%, 5-year survival 91.3%). However, death-censored allograft survival rate and BPAR were not affected by patient age (P = .104 and .501, respectively). Among the elderly, BPAR and female donors were independent risk factors for allograft loss. CONCLUSION The overall survival rate of the elderly KTRs was significantly lower than that of younger KTRs. However, the death-censored allograft survival rate did not differ between groups. Kidney transplantation should not be stagnated especially in elderly patients with end-stage renal disease.
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Affiliation(s)
- K D Yoo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - J N An
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - C T Kim
- School of Public Health, Seoul National University, Seoul, Korea
| | - J H Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - C D Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - S K Park
- Department of Internal Medicine, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - D W Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Y K Oh
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - C S Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Y S Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Y H Kim
- Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea.
| | - J P Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
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74
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Kim DM, Hong JH, Kim SY, Yoo KD, Seo JY, Rhee KJ, Kim BO, Goh CW, Park KM, Kim JH, Huh JH, Kim HJ, Byun YS. Primary cardiac angiosarcoma presenting with cardiac tamponade. Korean Circ J 2010; 40:86-9. [PMID: 20182594 PMCID: PMC2827808 DOI: 10.4070/kcj.2010.40.2.86] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Revised: 06/22/2009] [Accepted: 06/24/2009] [Indexed: 11/11/2022] Open
Abstract
Primary cardiac angiosarcoma is a very rare disease with a poor prognosis. We report a case of a patient with a primary cardiac angiosarcoma who presented with cardiac tamponade; the angiosarcoma was successfully resected surgically.
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Affiliation(s)
- Dae Myung Kim
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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75
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Yoo KD, Park SH, Kim DM, Seo JY, Lee HR, Yuh YJ, Kim SR, Shin E, Yoo SJ. A Case of Hantavirus Pulmonary Syndrome Mimicking Apalastic Anemia with Invasive Aspergillosis. Korean J Hematol 2009. [DOI: 10.5045/kjh.2009.44.3.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kyung Don Yoo
- Department of Internal Medicine, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul, Korea
| | - Sang Hoon Park
- Department of Internal Medicine, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul, Korea
| | - Dae Myung Kim
- Department of Internal Medicine, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul, Korea
| | - Ji Young Seo
- Department of Internal Medicine, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul, Korea
| | - Hyo Rak Lee
- Department of Internal Medicine, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul, Korea
| | - Young Jin Yuh
- Department of Internal Medicine, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul, Korea
| | - Sung Rok Kim
- Department of Internal Medicine, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul, Korea
| | - Eunah Shin
- Department of Pathology, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul, Korea
| | - Soo Jin Yoo
- Department of Laboratory Medicine, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul, Korea
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Ko SH, Song KH, Park SA, Kim SR, Cha BY, Son HY, Moon KW, Yoo KD, Park YM, Cho JH, Yoon KH, Ahn YB. Cardiovascular autonomic dysfunction predicts acute ischaemic stroke in patients with Type 2 diabetes mellitus: a 7-year follow-up study. Diabet Med 2008; 25:1171-7. [PMID: 19046195 DOI: 10.1111/j.1464-5491.2008.02567.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS We investigated whether cardiovascular autonomic neuropathy (CAN) is associated with acute ischaemic stroke in patients with Type 2 diabetes. METHODS From 1999 to 2000, cardiovascular autonomic function tests were conducted in patients with Type 2 diabetes (n = 1458). Patients were followed up between 2006 and 2007. Standard tests for CAN measured heart rate variability parameters [expiration-to-inspiration (E/I) ratio, responses to the Valsalva manoeuvre and standing]. Using the American Diabetes Association criteria, the CAN scores were determined from the results of each test as follows: 0 = normal, 1 = abnormal (total maximum score 3). We assessed the development of acute ischaemic stroke events. RESULTS The prevalence of CAN at baseline was 55.7% (E/I 17.1%, Valsalva 39.4%, posture 27.3%) (n = 1126). During follow-up, 131 patients (11.6%) developed acute ischaemic stroke. The vascular events were more frequent in older patients (P < 0.001) and in those with diabetes of longer duration (P = 0.022), hypertension (P < 0.001) or diabetic retinopathy (P = 0.03) than in patients without vascular events. Patients with ischaemic stroke had higher creatinine levels (P = 0.045) and higher urine albumin excretion (P = 0.025) than those of patients without stroke. Cox proportional hazard regression analysis revealed that the CAN score was associated with the development of acute ischaemic stroke (total score 0 vs. 3, adjusted hazard ratio 2.7, 95% CI 1.3-5.5, P = 0.006). CONCLUSION Cardiovascular autonomic dysfunction was significantly associated with the development of ischaemic stroke in patients with Type 2 diabetes.
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Affiliation(s)
- S H Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea
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77
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Jeon HK, Youn HJ, Yoo KD, Park JW, Kim HY, Rhim HY, Chae JS, Kim JH, Choi KB, Hong SJ. Transthoracic echocardiographic demonstration of massive pulmonary thrombus caused by protein C deficiency. J Am Soc Echocardiogr 2000; 13:682-4. [PMID: 10887354 DOI: 10.1067/mje.2000.104648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Few cases of pulmonary embolism detected by transthoracic echocardiography (TTE) have been reported. We present a case of a patient affected by pulmonary embolism caused by protein C deficiency. Transthoracic echocardiography showed a thrombus in transit (ie, visualization of a thrombus within the pulmonary artery). A hypercoagulable state caused by deficiency of protein C is a rare cause of pulmonary thromboembolism. Our experience demonstrates a massive pulmonary thrombus resulting from such a deficiency. Transthoracic echocardiography should be considered as the first diagnostic method for patients with suspected pulmonary embolism.
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Affiliation(s)
- H K Jeon
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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78
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Lee MY, Jin SW, Yoo KD, Gho DH. Incidence of Atrial Fibrillation and Cerebral Stroke in Patients Treated with Ventricular Pacing and Dual-Chamber Pacing. Korean Circ J 2000. [DOI: 10.4070/kcj.2000.30.6.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- M Y Lee
- Cardiology Division, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - S W Jin
- Cardiology Division, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - K D Yoo
- Cardiology Division, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - D H Gho
- Cardiology Division, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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