101
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Sim JH, Han SS, Lee DS, Kim YS, Lee H, Kim HR. Analysis of Immune Cell Repopulation After Anti-thymocyte Globulin Administration for Steroid-Resistant T-cell–mediated Rejection. Transplant Proc 2020; 52:759-766. [DOI: 10.1016/j.transproceed.2020.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/03/2020] [Accepted: 01/22/2020] [Indexed: 01/05/2023]
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102
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Moon JJ, Kim Y, Kim DK, Joo KW, Kim YS, Han SS. Association of hypoalbuminemia with short-term and long-term mortality in patients undergoing continuous renal replacement therapy. Kidney Res Clin Pract 2020; 39:47-53. [PMID: 31995708 PMCID: PMC7105631 DOI: 10.23876/j.krcp.19.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 08/20/2019] [Revised: 10/21/2019] [Accepted: 11/19/2019] [Indexed: 01/09/2023] Open
Abstract
Background Hypoalbuminemia reflects several pathological conditions, including nutritional deficiencies and chronic inflammation. However, its relationship with short-term and long-term mortality in patients undergoing continuous renal replacement therapy (CRRT) remains unclear. The present study aimed to assess the effect of hypoalbuminemia on mortality in a large cohort of patients undergoing CRRT. Methods The study retrospectively reviewed 1,581 patients who underwent CRRT for the treatment of acute kidney injury from 2010 to 2016. The patients were categorized by tertiles of serum albumin levels at CRRT initiation. The odds ratios and hazard ratios for the risk of all-cause mortality were calculated before and after adjustment for multiple covariates. Results The mean albumin level was 2.7 ± 0.6 g/dL at CRRT initiation. During a median follow-up period of 14 days (maximum, 4 years), 1,040 patients (65.8%) died. The risk of overall mortality was higher in the first tertile group than in the third tertile group (hazard ratio, 1.9 [1.63-2.21]). When the mortality rate was stratified by timeframe, the risk was steadily higher in the first tertile group than in the third tertile group (odds ratios: 3.0 [2.34-3.87] for 2-week mortality, 2.7 [2.12-3.52] for 1-month mortality, 2.7 [2.08-3.53] for 6-month mortality, and 2.8 [2.11-3.62] for 1-year mortality). Additionally, the rates of intensive care unit mortality and in-hospital mortality were higher in the first tertile group than in the third tertile group. Conclusion The initial hypoalbuminemia was independently associated with short-term and long-term mortality in patients undergoing CRRT. Thus, the serum albumin level should be monitored during CRRT.
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Affiliation(s)
- Jong Joo Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yaerim Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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103
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Islam J, Lee HJ, Yang SH, Kim DK, Joo KW, Kim YS, Seo SU, Seong SY, Lee DS, Youn JI, Han SS. Expansion of Myeloid-Derived Suppressor Cells Correlates with Renal Progression in Type 2 Diabetic Nephropathy. Immune Netw 2020; 20:e18. [PMID: 32395370 PMCID: PMC7192828 DOI: 10.4110/in.2020.20.e18] [Citation(s) in RCA: 6] [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: 12/01/2019] [Revised: 01/27/2020] [Accepted: 02/06/2020] [Indexed: 01/04/2023] Open
Abstract
Type 2 diabetic nephropathy (T2DN) progresses with an increasingly inflammatory milieu, wherein various immune cells are relevant. Herein, we investigated the levels of myeloid-derived suppressor cells (MDSCs) and their clinical implication in patients with T2DN. A total of 91 subjects (T2DN, n=80; healthy, n=11) were recruited and their PBMCs were used for flow cytometric analysis of polymorphonuclear (PMN-) and monocytic (M-) MDSCs, in addition to other immune cell subsets. The risk of renal progression was evaluated according to the quartiles of MDSC levels using the Cox model. The proportion of MDSCs in T2DN patients was higher than in healthy individuals (median, 6.7% vs. 2.5%). PMN-MDSCs accounted for 96% of MDSCs, and 78% of PMN-MDSCs expressed Lox-1. The expansion of PMN-MDSCs was not related to the stage of T2DN or other kidney disease parameters such as glomerular filtration rate and proteinuria. The production of ROS in PMN-MDSCs of patients was higher than in neutrophils of patients or in immune cells of healthy individuals, and this production was augmented under hyperglycemic conditions. The 4th quartile group of PMN-MDSCs had a higher risk of renal progression than the 1st quartile group, irrespective of adjusting for multiple clinical and laboratory variables. In conclusion, PMN-MDSCs are expanded in patients with T2DN, and may represent as an immunological biomarker of renal progression.
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Affiliation(s)
- Jahirul Islam
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Hack June Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Seung Hee Yang
- Kidney Research Institute, Seoul National University Hospital, Seoul 03080, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Kidney Research Institute, Seoul National University Hospital, Seoul 03080, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Kidney Research Institute, Seoul National University Hospital, Seoul 03080, Korea
| | - Yon Su Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Kidney Research Institute, Seoul National University Hospital, Seoul 03080, Korea
| | - Sang-Uk Seo
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea.,Wide River Institute of Immunology, Seoul National University College of Medicine, Hongcheon 25159, Korea
| | - Seung-Yong Seong
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea.,Wide River Institute of Immunology, Seoul National University College of Medicine, Hongcheon 25159, Korea.,Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Dong-Sup Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Je-In Youn
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul 03080, Korea.,Wide River Institute of Immunology, Seoul National University College of Medicine, Hongcheon 25159, Korea.,Research Institute, ProGen Inc., Seongnam 13488, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Kidney Research Institute, Seoul National University Hospital, Seoul 03080, Korea
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104
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Kwon S, Kim DK, Oh KH, Joo KW, Lim CS, Kim YS, Han SS. Apolipoprotein B is a risk factor for end-stage renal disease. Clin Kidney J 2020; 14:617-623. [PMID: 33623687 PMCID: PMC7886579 DOI: 10.1093/ckj/sfz186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/21/2019] [Accepted: 12/02/2019] [Indexed: 11/15/2022] Open
Abstract
Background Apolipoprotein B (ApoB), a constituent of lipid particles, is known to increase the risk of cardiovascular diseases. However, the association between ApoB and end-stage renal disease (ESRD) remains to be resolved. Our objective was to determine whether the ApoB concentration has an association with the risk of ESRD. Methods Serum ApoB, ApoA1, conventional lipid parameters and lipid subfractions were analyzed in 9403 subjects. The hazard ratio (HR) for the risk of ESRD was calculated using tertiles of ApoB concentration. Results ESRD developed in 110 patients (1.2%) during 10 years of follow-up. Several lipid parameters were compared for their association with the risk of ESRD, of which ApoB was best and its relationship was also independent of other clinical parameters. Individuals in the second and third ApoB tertiles had a higher risk of ESRD than those in the first tertile, with HRs of 1.5 [95% confidence interval (CI) 0.89–2.61] and 2.6 (1.56–4.20), respectively. A high ApoB:ApoA1 ratio was associated with a higher risk of ESRD, but ApoA1 had no independent association. Even after adjusting the competing risk for all-cause death, high ApoB concentrations had an association with the risk of ESRD. Conclusions High ApoB concentration is associated with a higher risk of ESRD, despite adjustment for other lipid and clinical parameters. Accordingly, the monitoring of ApoB may be helpful for the prediction of ESRD.
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Affiliation(s)
- Soie Kwon
- 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
| | - Kook-Hwan Oh
- 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
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,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
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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105
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Kang MW, Kim J, Kim DK, Oh KH, Joo KW, Kim YS, Han SS. Machine learning algorithm to predict mortality in patients undergoing continuous renal replacement therapy. Crit Care 2020; 24:42. [PMID: 32028984 PMCID: PMC7006166 DOI: 10.1186/s13054-020-2752-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/27/2020] [Indexed: 01/13/2023]
Abstract
Background Previous scoring models such as the Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) and the Sequential Organ Failure Assessment (SOFA) scoring systems do not adequately predict mortality of patients undergoing continuous renal replacement therapy (CRRT) for severe acute kidney injury. Accordingly, the present study applies machine learning algorithms to improve prediction accuracy for this patient subset. Methods We randomly divided a total of 1571 adult patients who started CRRT for acute kidney injury into training (70%, n = 1094) and test (30%, n = 477) sets. The primary output consisted of the probability of mortality during admission to the intensive care unit (ICU) or hospital. We compared the area under the receiver operating characteristic curves (AUCs) of several machine learning algorithms with that of the APACHE II, SOFA, and the new abbreviated mortality scoring system for acute kidney injury with CRRT (MOSAIC model) results. Results For the ICU mortality, the random forest model showed the highest AUC (0.784 [0.744–0.825]), and the artificial neural network and extreme gradient boost models demonstrated the next best results (0.776 [0.735–0.818]). The AUC of the random forest model was higher than 0.611 (0.583–0.640), 0.677 (0.651–0.703), and 0.722 (0.677–0.767), as achieved by APACHE II, SOFA, and MOSAIC, respectively. The machine learning models also predicted in-hospital mortality better than APACHE II, SOFA, and MOSAIC. Conclusion Machine learning algorithms increase the accuracy of mortality prediction for patients undergoing CRRT for acute kidney injury compared with previous scoring models.
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Affiliation(s)
- Min Woo Kang
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jayoun Kim
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
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106
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Yun D, Kim DK, Oh KH, Joo KW, Moon KC, Kim YS, Lee K, Han SS. MEST-C pathological score and long-term outcomes of child and adult patients with Henoch-Schönlein purpura nephritis. BMC Nephrol 2020; 21:33. [PMID: 32000703 PMCID: PMC6993338 DOI: 10.1186/s12882-020-1691-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 01/14/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Henoch-Schönlein purpura nephritis (HSPN), a small-vessel vasculitis, shares renal pathological features with immunoglobulin A nephropathy. Oxford classification of immunoglobulin A nephropathy pathology has been updated to the MEST-C score, but its application in HSPN remains unresolved. METHODS Two hundred and thirteen patients with biopsy-proven HSPN were retrieved from the Seoul National University Hospital between 2000 and 2017. Renal outcome risks (i.e., end-stage renal disease or doubling of serum creatinine) were evaluated according to MEST-C scores after stratification by age: 113 children aged < 18 years (9.2 ± 3.6 years) and 100 adults aged ≥18 years (38.6 ± 18.3 years). We pooled our data with four previous cohort studies in which MEST or MEST-C scores were described in detail. RESULTS Twenty-one child (19%) and 16 adult (16%) patients reached the renal outcome during the median follow-up periods of 12 years and 13 years, respectively (maximum 19 years). In children, M1 and T1/T2 scores revealed worse renal outcomes than did M0 and T0 scores, respectively, whereas the T score was the only factor related to worse outcomes in adult patients after adjusting for multiple clinical and laboratory variables. The pooled data showed that M1, S1, and T1/T2 in children and E1 and T1/T2 in adults were correlated with poorer renal outcomes than those of their counterpart scores. CONCLUSIONS The Oxford classification MEST-C scores can predict long-term renal outcomes in patients with HSPN.
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Affiliation(s)
- Donghwan Yun
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyoungbun Lee
- Department of Pathology, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea.
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea.
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107
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Kim JE, Kim YC, Min SL, Lee H, Ha J, Chin HJ, Kim YS, Han SS. Transplant outcomes in kidney recipients with lupus nephritis, and systematic review. Lupus 2020; 29:248-255. [DOI: 10.1177/0961203320902524] [Citation(s) in RCA: 3] [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] [Indexed: 12/14/2022]
Abstract
Background Despite improved survival of patients with lupus nephritis (LN), some require kidney transplantation because of progression to end-stage renal disease (ESRD). However, the transplant outcomes of these patients and other recipients have not been thoroughly compared. Methods In total, 1848 Korean kidney recipients who underwent transplantation from 1998 to 2017 at two tertiary referral centers were evaluated retrospectively. Among them, 28 recipients with LN, and 50 control recipients matched by age, sex, and donor type, were compared with respect to graft and patient survival. We pooled our data with 17 previous cohort studies in which the graft survival of recipients with LN was described in detail. Results During the median follow-up period of 9.5 years (maximum 21 years), graft failure (GF) occurred in 10.7% and 16.0% of LN and control recipients, respectively. No differences were found in the rates of GF and death-censored graft failure or patient survival between the two groups. The risks of acute T cell-mediated and antibody-mediated rejection were also similar between the two groups. The pooled analysis showed similar 1- and 5-year graft survival rates between LN and control recipients. Conclusions Kidney transplantation is an acceptable option in patients with concurrent LN and ESRD.
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Affiliation(s)
- J E Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Y C Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - S-l Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - H Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - J Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - H J Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Y S Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - S S Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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108
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Kang MW, Park S, Lee S, Lee Y, Cho S, Han K, Cho H, Kim Y, Kim YC, Han SS, Lee H, Lee JP, Joo KW, Lim CS, Kim YS, Kim DK. Glomerular hyperfiltration is associated with dementia: A nationwide population-based study. PLoS One 2020; 15:e0228361. [PMID: 31990949 PMCID: PMC6986766 DOI: 10.1371/journal.pone.0228361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 10/16/2019] [Accepted: 01/13/2020] [Indexed: 01/06/2023] Open
Abstract
Background Glomerular hyperfiltration may be a clinical phenotype of endothelial dysfunction. Endothelial dysfunction may cause vascular dementia through the deterioration of cerebral blood flow. We aimed to identify the risk of dementia in people with glomerular hyperfiltration. Methods Using the Korean National Health Information Database, we included subjects aged ≥45 years who underwent national health screening examinations between 2012 and 2015 and who had no previous history of end-stage renal disease or dementia (n = 2,244,582). The primary exposure was glomerular hyperfiltration. We divided the subjects into groups by sex and five-year age intervals and categorized each group into 8 intervals according to estimated glomerular filtration (eGFR). The subjects with an eGFR ≥95th percentile in each group were defined as the hyperfiltration group. The outcomes were development of all types of dementia, Alzheimer's dementia and vascular dementia. Multivariable Cox proportional hazards models were used to analyze the hazard ratios (HRs) for outcomes. Results The Hyperfiltration group showed a higher risk for the development of all types of dementia [adjusted HR 1.09 (95% CI, 1.03–1.15)] and vascular dementia [adjusted HR 1.33 (95% CI, 1.14–1.55)] than the reference group. However, the association between hyperfiltration and Alzheimer's dementia was not statistically significant. Conclusions Glomerular hyperfiltration may be associated with dementia. In this respect, subjects with glomerular hyperfiltration should be monitored more closely for signs and symptoms of dementia.
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Affiliation(s)
- Min Woo Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sehoon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Soojin Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yeonhee Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Semin Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyungdo Han
- Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Hanna Cho
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yaerim Kim
- Department of Internal Medicine, Keimyung School of Medicine, Seoul, Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, 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 Boramae Medical Center, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Soo Lim
- 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 Boramae Medical Center, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
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109
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Kim Y, Park S, Kim MH, Song SH, Lee WM, Kim HS, Jin K, Han S, Kim YC, Han SS, Lee H, Lee JP, Joo KW, Lim CS, Kim YS, Kim DK. Can a semi-quantitative method replace the current quantitative method for the annual screening of microalbuminuria in patients with diabetes? Diagnostic accuracy and cost-saving analysis considering the potential health burden. PLoS One 2020; 15:e0227694. [PMID: 31961894 PMCID: PMC6974274 DOI: 10.1371/journal.pone.0227694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/08/2019] [Accepted: 12/25/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Diabetes is a global epidemic, and the high cost of annually and quantitatively measuring urine albumin excretion using the turbidimetric immunoassay is challenging. We aimed to determine whether a semi-quantitative urinary albumin-creatinine ratio test could be used as a screening tool for microalbuminuria in diabetic patients. METHODS We assessed the diagnostic accuracy of the semi-quantitative method. The costs of false results in the semi-quantitative method were calculated based on the annual probability of disease progression analyzed through a systematic literature review and meta-analysis. The pooled long-term cost-saving effect of the semi-quantitative method compared with the quantitative test was assessed using a Markov model simulating a long-term clinical setting. Diagnostic accuracy and the cost-saving effect were also validated in an independent external cohort. RESULTS Compared with the quantitative test, the semi-quantitative method had sensitivities of 93.5% and 81.3% and specificities of 61.4% and 63.1% in the overall sample of diabetic patients (n = 1,881) and in diabetic patients with eGFR ≥60 ml/min/1.73 m2 and a negative dipstick test (n = 1,110), respectively. After adjusting for direct and indirect medical costs, including the risk of disease progression, which was adjusted by the meta-analyzed hazard ratio for clinical outcomes, it was determined that using the semi-quantitative method could save 439.4 USD per person for 10 years. Even after adjusting the result to the external validation cohort, 339.6 USD could be saved for one diabetic patient for 10 years. CONCLUSIONS The semi-quantitative method could be an appropriate screening tool for albuminuria in diabetic patients. Moreover, it can minimize the testing time and inconvenience and significantly reduce national health costs.
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Affiliation(s)
- Yaerim Kim
- Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seokwoo Park
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Myung-Hee Kim
- Department of Dental Hygiene, College of Health Science, Eulji University, Gyeonggi-do, Korea
| | - Sang Hoon Song
- Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea
| | - Won Mok Lee
- Department of Laboratory Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Hye Soon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Kyubok Jin
- Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Seungyeup Han
- Division of Nephrology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Yong Chul Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung Seok Han
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hajeong Lee
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Division of Nephrology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kwon Wook Joo
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Soo Lim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Division of Nephrology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yon Su Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ki Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
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Jo HA, Kim DK, Park S, Kim Y, Han SS, Yang BR, Choi SH, Kim MS, Lee J, Lee H, Lee JP, Lim CS, Kim YS, Joo KW. Cardiovascular risk of nonsteroidal anti-inflammatory drugs in dialysis patients: a nationwide population-based study. Nephrol Dial Transplant 2020; 36:909-917. [DOI: 10.1093/ndt/gfz276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Indexed: 01/30/2023] Open
Abstract
Abstract
Background
Given the cardiovascular risk of nonsteroidal anti-inflammatory drugs (NSAIDs), it is essential to identify the relationship between NSAIDs and cardiovascular outcomes in dialysis patients who have elevated cardiovascular risk.
Methods
A case-crossover study was conducted to assess the association of NSAIDs with major adverse cardiac and cerebrovascular events (MACCEs) and mortality using the Korean Health Insurance dataset. The case period was defined as 1–30 days prior to the event date and the control periods were defined as 61–90 days and 91–120 days prior to the event date.
Results
There were 3433 and 8524 incident dialysis patients who experienced MACCEs and mortality, respectively, after exposure to NSAIDs within 120 days before each event. NSAIDs significantly increased the risk of MACCEs {adjusted odds ratio [aOR] 1.37 [95% confidence interval (CI) 1.26–1.50]} and mortality [aOR 1.29 (95% CI 1.22–1.36)]. Nonselective NSAIDs, but not selective cyclooxygenase-2 inhibitors, significantly increased the risk of MACCEs and mortality. However, the MACCE and mortality risk did not increase in a dose-dependent manner in the analysis according to the cumulative defined daily dosage of NSAIDs. The incidence of MACCEs in the case period tended to be more common in patients who had recent exposure to NSAIDs than in patients who did not have recent exposure to NSAIDs.
Conclusions
Clinicians should be particularly cautious when prescribing NSAIDs to dialysis patients considering the associations of NSAIDs with cardiovascular outcomes and mortality, which might occur independent of the dose and duration of exposure.
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Affiliation(s)
- Hyung Ah Jo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Ilsan, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seokwoo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yaerim Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Bo Ram Yang
- Division of Clinical Epidemiology, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - So-Hyun Choi
- Department of Statistics, Kyungpook National University, Daegu, Korea
| | - Mi-Sook Kim
- Department of Statistics, Kyungpook National University, Daegu, Korea
| | - Joongyub Lee
- Department of Prevention and Management, Inha University Hospital, Incheon, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- 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
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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111
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Yu MY, Kim JE, Lee S, Choi JW, Kim YC, Han SS, Lee H, Cha RH, Lee JP, Lee JW, Kim DK, Kim YS, Yang SH. Krüppel-like factor 15 is a key suppressor of podocyte fibrosis under rotational force-driven pressure. Exp Cell Res 2020; 386:111706. [PMID: 31697927 DOI: 10.1016/j.yexcr.2019.111706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/20/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 11/16/2022]
Abstract
Krüppel-like factor 15 (KLF15) is a well-known transcription factor associated with podocyte injury and fibrosis. Recently, hypertensive nephropathy was discovered to be closely related to podocyte injury and fibrosis. However, methods to stimulate hypertension in vitro are lacking. Here, we constructed an in vitro model mimicking hypertension using a rotational force device to identify the role of KLF15 in fibrosis due to mechanically induced hypertensive injury. First, we found that KLF15 expression was decreased in patients with hypertensive nephropathy. Then, an in vitro study of hypertension due to rotational force was conducted, and an increase in fibrosis markers and decrease in KLF15 levels were determined after application of 4 mmHg pressure in primary cultured human podocytes. KLF15 and tight junction protein levels increased with retinoic acid treatment. siRNA-mediated inhibition of KLF15 exacerbated pressure-induced fibrosis injury, and KLF15 expression after treatment with angiotensin II was similar to that observed after treatment with the blood pressure modeling device. Furthermore, the reduced KLF15 levels after mechanical pressure application were restored after the administration of an antihypertensive drug. KLF15 expression was also low in vivo. We confirmed the protective role of KLF15 in fibrosis using a mechanically induced in vitro model of hypertensive injury.
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Affiliation(s)
- Mi-Yeon Yu
- Department of Internal Medicine, Hanyang University Guri Hospital, Republic of Korea
| | - Ji Eun Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Saram Lee
- Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Jin Woo Choi
- Interdisciplinary Program in Bioengineering Major, Graduate School, Seoul National University, Seoul, Republic of Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Seok Han
- 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; Kidney Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ran Hui Cha
- Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jae Wook Lee
- Nephrology Clinic, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Kidney Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Kidney Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Hee Yang
- Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea; Kidney Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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112
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Park S, Lee S, Kim Y, Lee Y, Kang MW, Han K, Han SS, Lee H, Lee JP, Joo KW, Lim CS, Kim YS, Kim DK. Altered Risk for Cardiovascular Events With Changes in the Metabolic Syndrome Status: A Nationwide Population-Based Study of Approximately 10 Million Persons. Ann Intern Med 2019; 171:875-884. [PMID: 31766057 DOI: 10.7326/m19-0563] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Population-scale evidence for the association between dynamic changes in metabolic syndrome (MetS) status and alterations in the risk for major adverse cardiovascular events (MACE) is lacking. OBJECTIVE To investigate whether recovery from or development of MetS in a population is associated with an altered risk for MACE. DESIGN Nationwide cohort study. SETTING An analysis based on the National Health Insurance Database of Korea. PARTICIPANTS A total of 27 161 051 persons who received national health screenings from 2009 to 2014 were screened. Those with a history of MACE were excluded. We determined the MetS status of 9 553 042 persons using the following harmonizing criteria: MetS-chronic (n = 1 486 485), MetS-developed (n = 587 088), MetS-recovery (n = 538 806), and MetS-free (n = 6 940 663). MEASUREMENTS The outcome was the occurrence of MACE, including acute myocardial infarction, revascularization, and acute ischemic stroke, identified from the claims database. The incidence rate ratios (IRRs) were calculated with adjustments for body mass index, comorbidity scores, previous metabolic variables, and other clinical or demographic variables. RESULTS At a median follow-up of 3.54 years, the MetS-recovery group (incidence rate, 4.55 per 1000 person-years) had a significantly lower MACE risk (adjusted IRR, 0.85 [95% CI, 0.83 to 0.87]) than that of the MetS-chronic group (incidence rate, 8.52 per 1000 person-years). The MetS-developed group (incidence rate, 6.05 per 1000 person-years) had a significantly higher MACE risk (adjusted IRR, 1.36 [CI, 1.33 to 1.39]) than that of the MetS-free group (incidence rate, 1.92 per 1000 person-years). Among the MetS components, change in hypertension was associated with the largest difference in MACE risk. LIMITATION Limited assessment of mortality and short follow-up. CONCLUSION Recovery from MetS was significantly associated with decreased risk for MACE, whereas development of MetS was associated with increased risk. PRIMARY FUNDING SOURCE Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea.
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Affiliation(s)
- Sehoon Park
- Seoul National University College of Medicine, Seoul, and Armed Forces Capital Hospital, Gyeonggi-do, Korea (S.P.)
| | - Soojin Lee
- Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea (S.L., Y.L., M.W.K.)
| | - Yaerim Kim
- Keimyung University School of Medicine, Daegu, Korea (Y.K.)
| | - Yeonhee Lee
- Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea (S.L., Y.L., M.W.K.)
| | - Min Woo Kang
- Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea (S.L., Y.L., M.W.K.)
| | - Kyungdo Han
- College of Medicine, Catholic University of Korea, Seoul, Korea (K.H.)
| | - Seung Seok Han
- Seoul National University Hospital and Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea (S.S.H., H.L., K.W.J., Y.S.K., D.K.K.)
| | - Hajeong Lee
- Seoul National University Hospital and Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea (S.S.H., H.L., K.W.J., Y.S.K., D.K.K.)
| | - Jung Pyo Lee
- Seoul National University Boramae Medical Center and Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea (J.P.L., C.S.L.)
| | - Kwon Wook Joo
- Seoul National University Hospital and Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea (S.S.H., H.L., K.W.J., Y.S.K., D.K.K.)
| | - Chun Soo Lim
- Seoul National University Boramae Medical Center and Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea (J.P.L., C.S.L.)
| | - Yon Su Kim
- Seoul National University Hospital and Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea (S.S.H., H.L., K.W.J., Y.S.K., D.K.K.)
| | - Dong Ki Kim
- Seoul National University Hospital and Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea (S.S.H., H.L., K.W.J., Y.S.K., D.K.K.)
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Park JG, Lee CR, Kim MG, Kim G, Shin HM, Jeon YH, Yang SH, Kim DK, Joo KW, Choi EY, Kim HR, Kwak C, Kim YS, Choi M, Lee DS, Han SS. Kidney residency of VISTA-positive macrophages accelerates repair from ischemic injury. Kidney Int 2019; 97:980-994. [PMID: 32143848 DOI: 10.1016/j.kint.2019.11.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 07/27/2019] [Revised: 11/21/2019] [Accepted: 11/27/2019] [Indexed: 01/04/2023]
Abstract
Tissue-resident macrophages have unique tissue-specific functions in maintaining homeostasis and resolving inflammation. However, the repair role and relevant molecules of kidney-resident macrophages after ischemic injury remain unresolved. To this end, mice without kidney-resident R1 macrophages but containing infiltrating monocyte-derived R2 macrophages were generated using differential cellular kinetics following clodronate liposome treatment. When ischemia-reperfusion injury was induced in these mice, late phase repair was reduced. Transcriptomic and flow cytometric analyses identified that V-domain Ig suppressor of T cell activation (VISTA), an inhibitory immune checkpoint molecule, was constitutively expressed in kidney-resident R1 macrophages, but not in other tissue-resident macrophages. Here, VISTA functioned as a scavenger of apoptotic cells and served as a checkpoint to control kidney-infiltrating T cells upon T cell receptor-mediated stimulation. Together these functions improved the repair process after ischemia-reperfusion injury. CD14+ CD33+ mononuclear phagocytes of human kidney also expressed VISTA, which has similar functions to the mouse counterpart. Thus, VISTA is upregulated in kidney macrophages in a tissue-dependent manner and plays a repair role during ischemic injury.
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Affiliation(s)
- Jun-Gyu Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Cho-Rong Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Gang Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Gwanghun Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Mu Shin
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Yun-Hui Jeon
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hee Yang
- Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Dong Ki Kim
- Kidney Research Institute, Seoul National University, Seoul, Korea; 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
| | - Eun Young Choi
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Hang-Rae Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Yon Su Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea; Kidney Research Institute, Seoul National University, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Murim Choi
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Dong-Sup Lee
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea; Kidney Research Institute, Seoul National University, Seoul, Korea.
| | - Seung Seok Han
- Kidney Research Institute, Seoul National University, Seoul, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Lee Jung Y, Park JY, Lee CS, Kim DK, Lim CS, Kim YS, Oh KH, Han SS. Effect of Liver Cirrhosis on the Outcomes of Peritoneal Dialysis. Perit Dial Int 2019; 39:502-508. [PMID: 31582468 DOI: 10.3747/pdi.2018.00247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/07/2018] [Accepted: 04/29/2019] [Indexed: 12/17/2022] Open
Abstract
Background:Peritoneal dialysis (PD) has become an increasingly important treatment modality for end-stage renal disease. However, application of PD in patients with liver cirrhosis (LC) and subsequent outcomes have not been thoroughly evaluated.Methods:A total of 1,366 patients (≥ 18 years old) who started PD at 4 tertiary referral centers between January 2000 and December 2015 were initially reviewed. Among them, 45 patients with LC were finally analyzed (LC-PD). Using the multivariate Cox hazard ratio (HR) model, outcomes such as technique failure, infection, and mortality in patients with LC-PD were compared with those in non-LC-PD patients (non-LC-PD) or patients with LC who received hemodialysis (LC-HD). All of the patients were selected by 1:1 matching of age, sex, catheter insertion date, and diabetes mellitus.Results:During the mean follow-up duration of 43 ± 35.8 months, 12 patients with LC-PD experienced technique failure, and this rate was similar to that of non-LC-PD patients. In evaluating infection episodes, the most common causes for peritonitis and exit-site infection were Escherichia coli (5.8%) and Staphylococcus aureus (19.3%), respectively; these event rates of LC-PD did not differ from those of non-LC-PD. The all-cause mortality rate of the LC-PD group was not different from that of the non-LC-PD and LC-HD groups.Conclusion:Dialysis outcomes such as technique failure, infection, and mortality are not affected by the presence of LC. Accordingly, PD therapy is a good option in patients with LC.
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Affiliation(s)
- Young Lee Jung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Gyeonggi-do, Korea
| | - Chung Sik Lee
- Department of Internal Medicine, Cheju Halla General Hospital, Jeju-do, 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 College of Medicine, Seoul, Korea.,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
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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115
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Kim Y, Park N, Kim J, Kim DK, Chin HJ, Na KY, Joo KW, Kim YS, Kim S, Han SS. Development of a new mortality scoring system for acute kidney injury with continuous renal replacement therapy. Nephrology (Carlton) 2019; 24:1233-1240. [PMID: 31487094 DOI: 10.1111/nep.13661] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2019] [Indexed: 11/27/2022]
Abstract
AIM On the basis of the worst outcomes of patients undergoing continuous renal replacement therapy (CRRT) in intensive care unit, previously developed mortality prediction model, Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) and the Sequential Organ Failure Assessment (SOFA) needs to be modified. METHODS A total of 828 patients who underwent CRRT were recruited. Mortality prediction model was developed for the prediction of death within 7 days after starting the CRRT. Based on regression analysis, modified scores were assigned to each variable which were originally used in the APACHE II and SOFA scoring models. Additionally, a new abbreviated Mortality Scoring system for AKI with CRRT (MOSAIC) was developed after stepwise selection analysis. RESULTS We used all the variables included in the APACHE II and SOFA scoring models. The prediction powers indicated by C-statistics were 0.686 and 0.683 for 7-day mortality by the APACHE II and SOFA systems, respectively. After modification of these models, the prediction powers increased up to 0.752 for the APACHE II and 0.724 for the SOFA systems. Using multivariate analysis, seven significant variables were selected in the MOSAIC model wherein its C-statistic value was 0.772. These models also showed good performance with 0.720, 0.734 and 0.773 of C-statistics in the modified APACHE II, modified SOFA and MOSAIC scoring models in the external validation cohort (n = 497). CONCLUSION The modified APACHE II/SOFA and newly developed MOSAIC models could be more useful tool for predicting mortality for patients receiving CRRT.
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Affiliation(s)
- Yaerim Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.,Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Nanhee Park
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Jayoun Kim
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Dong Ki Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Kwon Wook Joo
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,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 Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Seung Seok Han
- Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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116
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Moon H, Chin HJ, Na KY, Joo KW, Kim YS, Kim S, Han SS. Hyperphosphatemia and risks of acute kidney injury, end-stage renal disease, and mortality in hospitalized patients. BMC Nephrol 2019; 20:362. [PMID: 31533650 PMCID: PMC6751585 DOI: 10.1186/s12882-019-1556-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 06/12/2019] [Accepted: 09/06/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hyperphosphatemia is associated with vascular calcification and bone mineral disorders and is a major concern among patients with chronic kidney disease (CKD). However, the relationship between hyperphosphatemia and renal outcome in non-CKD patients has not been studied. Furthermore, the clinical implications of hyperphosphatemia in relation to the risks of acute kidney injury (AKI), end-stage renal disease (ESRD), and mortality after hospitalization remain unresolved. METHODS A total of 20,686 patients (aged ≥18 years) admitted to Seoul National University Bundang Hospital from January 2013 to December 2013 were retrospectively reviewed. Patients were divided into quartiles according to serum phosphorus level at the time of admission. The odds ratios (ORs) for AKI and hazard ratios (HRs) for ESRD and all-cause mortality were calculated after adjustment of multiple covariates. RESULTS AKI developed in 2319 patients (11.2%), with higher ORs for patients in the third and fourth quartiles (1.4 [1.24-1.68] and 2.8 [2.44-3.22], respectively) compared with the first quartile group. During a median follow-up period of 4.0 years, 183 patients (0.88%) developed ESRD and 3675 patients (17.8%) died. Patients in the fourth quartile had higher risks of ESRD and mortality than patients in the first quartile (HRs, 2.3 [1.46-3.75] and 1.4 [1.22-1.49], respectively). These trends remained consistent in patients with an estimated glomerular filtration rate > 60 ml/min/1.73 m2. CONCLUSIONS Hyperphosphatemia is related to the risks of AKI, ESRD, and mortality, and it may therefore be necessary to monitor serum phosphorus level in hospitalized patients, irrespective of kidney function.
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Affiliation(s)
- Hongran Moon
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, Korea. .,Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea.
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, Korea.
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117
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Chang SH, Kim TJ, Kim Y, Han SS, Lee SK, Sim JH, Kim YJ, Lee SJ, Rhyu IJ, Nam KH, Mohan C, Kim HR. Impacts of GFP-FoxP3 + regulatory T cells on lupus hallmarks differ by genetic background and type of GFP knock-in. Autoimmunity 2019; 52:199-207. [PMID: 31468991 DOI: 10.1080/08916934.2019.1657098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/26/2022]
Abstract
FoxP3 reporter mice expressing green fluorescence protein (GFP) have been used as a very convenient tool to investigate the impact of regulatory T (Treg) cells on pathogenesis in autoimmune diseases. Here, we found that GFP-FoxP3+ knock-in (KI) mice showed alterations in the production of anti-nuclear autoantibodies (ANAs) and nephritis with different extent, depending on the presence or absence of lupus susceptibility gene locus 1 (Sle1) and KI method: contrasting with B6.Sle1.fGFP-FoxP3 mice, expressing GFP via N-terminal insertion, B6.Sle1.iGFP-FoxP3, expressing GFP via bicistronic internal ribosome entry site-driven promotion, exhibited significantly lower penetrance of serum ANA, comparing to control B6.Sle1 mice. Moreover, B6.Sle1.GFP-FoxP3+ mice reduced the Sle1-induced splenomegaly and B-cell expansion independently of the KI method employed, mainly by reducing the numbers of transitional 1 (T1) B cells and CD21-CD23- B cells, including plasmablasts and plasma cells. The absolute numbers of both splenic CD4+ T cells and Treg cells from B6.Sle1.GFP-FoxP3 KI mice were significantly reduced but their proportion was not changed, compared to B6.Sle1 mice. Although the glomerular basement membranes were thickened in both B6.Sle1 and B6.Sle1.iGFP-FoxP3 mice, they were thinner in B6.Sle1.fGFP-FoxP3 mice. The latter mice expressed more nephrophilic autoantibodies and deposited more complement component 3 in glomeruli compared to B6.iGFP-FoxP3 mice. FoxP3+ Treg cells may modulate B-cell tolerance in lupus-prone B6.Sle1 mice, presumably by modulating pathogenic, nephrophilic autoantibody production and nephritis.
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Affiliation(s)
- Soog-Hee Chang
- Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae-Joo Kim
- Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yongbaek Kim
- Laboratory of Veterinary Clinical Pathology, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea.,Research Institute for Veterinary Science, College of Veterinary Medicine, Seoul National University, Seoul, Republic of Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Kyung Lee
- Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hyun Sim
- Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Joo Kim
- Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Se Jeong Lee
- Department of Anatomy, Korea University College of Medicine, Seoul, Republic of Korea
| | - Im Joo Rhyu
- Department of Anatomy, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ki-Hoan Nam
- Biomedical Mouse Resource Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Cheongwon-Gun, Republic of Korea
| | - Chandra Mohan
- Department of Biomedical Engineering, University of Houston, Houston, TX, USA
| | - Hang-Rae Kim
- Department of Anatomy and Cell Biology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,BK21Plus Biomedical Science Project, Seoul National University College of Medicine, Seoul, Republic of Korea.,Medical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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118
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Jang H, Joo KW, Han SS. Monitoring globotriaosylsphingosine in a Korean male patient with Fabry disease. Kidney Res Clin Pract 2019; 38:250-252. [PMID: 31016956 PMCID: PMC6577222 DOI: 10.23876/j.krcp.18.0156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Heejoon Jang
- 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
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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119
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Kim JE, Han A, Lee H, Ha J, Kim YS, Han SS. Impact of Pneumocystis jirovecii pneumonia on kidney transplant outcome. BMC Nephrol 2019; 20:212. [PMID: 31182046 PMCID: PMC6558901 DOI: 10.1186/s12882-019-1407-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 09/27/2018] [Accepted: 06/03/2019] [Indexed: 12/19/2022] Open
Abstract
Backgrounds Pneumocystis jirovecii pneumonia (PCP) remains an important cause of morbidity and mortality in kidney transplant recipients. While the acute phase toxicity in patients with PCP is well-characterized, there is a lack of data on the effects of PCP on long-term graft outcome. Method This retrospective observational study analyzed 1502 adult patients who underwent kidney transplantation at Seoul National University Hospital between 2000 and 2017. After a propensity score matching was performed, the graft and survival outcomes were compared between PCP-negative and PCP-positive groups. Results A total of 68 patients (4.5%) developed PCP after transplantation. The multivariable Cox analysis showed that positivity for cytomegalovirus and lack of initial oral antibiotic prophylaxis were risk factors of post-transplant PCP. The PCP-positive group had higher hazard ratios of graft failure [adjusted hazard ratio (HR), 3.1 (1.14–8.26); P = 0.027] and mortality [adjusted HR, 11.0 (3.68–32.80); P < 0.001] than the PCP-negative group. However, the PCP event was not related with subsequent development of de novo donor-specific antibodies or pathologic findings, such as T-cell or antibody mediated rejection and interstitial fibrosis and tubular atrophy. Conclusions PCP is a risk factor of long-term graft failure and mortality, irrespective of rejection. Accordingly, appropriate prophylaxis and treatment is needed to avoid adverse transplant outcomes of PCP. Electronic supplementary material The online version of this article (10.1186/s12882-019-1407-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ji Eun Kim
- Transplantation Center, Seoul National University Hospital, Seoul, South Korea
| | - Ahram Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea.
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120
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Affiliation(s)
- Ji Eun Kim
- Transplantation CenterSeoul National University Hospital Seoul South Korea
| | - Jongwon Ha
- Transplantation CenterSeoul National University Hospital Seoul South Korea
- Department of SurgerySeoul National University College of Medicine Seoul South Korea
| | - Yon Su Kim
- Transplantation CenterSeoul National University Hospital Seoul South Korea
- Department of Internal MedicineSeoul National University College of Medicine Seoul South Korea
| | - Seung Seok Han
- Transplantation CenterSeoul National University Hospital Seoul South Korea
- Department of Internal MedicineSeoul National University College of Medicine Seoul South Korea
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121
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Kang MW, Chin HJ, Joo KW, Na KY, Kim S, Han SS. Hyperuricemia is associated with acute kidney injury and all-cause mortality in hospitalized patients. Nephrology (Carlton) 2019; 24:718-724. [PMID: 30644622 DOI: 10.1111/nep.13559] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2019] [Indexed: 12/12/2022]
Abstract
AIM Hyperuricemia is a risk factor for high morbidity and mortality in several diseases. However, the relationship between uric acid (UA) and the risk of acute kidney injury (AKI) and mortality remain unresolved in hospitalized patients. METHODS Data from 18 444 hospitalized patients were retrospectively reviewed. The odds ratio (OR) for AKI and the hazard ratio (HR) for all-cause mortality were calculated based on the UA quartiles after adjustment for multiple variables. All analyses were performed after stratification by sex. RESULTS The fourth quartile group (male, UA > 6.7 mg/dL; female, UA > 5.4 mg/dL) showed a higher risk of AKI compared with the first quartile group (male, UA < 4.5 mg/dL; female, UA < 3.6 mg/dL), with the following OR: 3.2 (2.55-4.10) in males (P < 0.001); and 3.1 (2.40-4.19) in females (P < 0.001). There were more patients who did not recover from AKI in the fourth quartile compared with the first quartile, with the following OR: 2.0 (1.32-3.04) in males (P = 0.001) and 2.4 (1.43-3.96) in females (P = 0.001). The fourth quartile group had a higher risk of all-cause mortality compared with the first quartile group, with the following HR: 1.4 (1.20-1.58) in males (P < 0.001) and 1.2 (1.03-1.46) in females (P = 0.019). The in-hospital mortality risk was also higher in the fourth quartile compared with the first quartile, which was significant only in males (OR, 2.1 (1.33-3.31) (P = 0.002)). CONCLUSION Hyperuricemia increases the risks of AKI and all-cause mortality in hospitalized patients.
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Affiliation(s)
- Min Woo Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Kwon-Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
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122
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Lee Y, Park J, Jang MJ, Moon HR, Kim DK, Oh KH, Joo KW, Lim CS, Kim YS, Na KY, Han SS. Development of model to predict end-stage renal disease after coronary artery bypass grafting: The ACHE score. Medicine (Baltimore) 2019; 98:e15789. [PMID: 31124973 PMCID: PMC6571385 DOI: 10.1097/md.0000000000015789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/05/2018] [Revised: 04/22/2019] [Accepted: 05/02/2019] [Indexed: 01/27/2023] Open
Abstract
Because end-stage renal disease (ESRD) increases the risks of morbidity and mortality, early detection and prevention of ESRD is a critical issue in clinical practice. However, no ESRD-prediction models have been developed or validated in patients undergoing coronary artery bypass grafting (CABG).This is a retrospective multicenter cohort study, recruited between January 2004 and December 2015. A cohort of 3089 patients undergoing CABG in two tertiary referral centers was analyzed to derive a risk-prediction model. The model was developed using Cox proportional hazard analyses, and its performance was assessed using C-statistics. The model was externally validated in an independent cohort of 279 patients.During the median follow-up of 6 years (maximum 13 years), ESRD occurred in 60 patients (2.0%). Through stepwise selection multivariate analyses, the following three variables were finally included in the ESRD-prediction model: postoperative Acute kidney injury, underlying Chronic kidney disease, and the number of antiHypertensive drugs (ACHE score). This model showed good performance in predicting ESRD with the following C-statistics: 0.89 (95% confidence interval [CI] 0.84-0.94) in the development cohort and 0.82 (95% CI 0.60-1.00) in the external validation cohort.The present ESRD-prediction model may be applicable to patients undergoing CABG, with the advantage of simplicity and preciseness.
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Affiliation(s)
- Yeonhee Lee
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Jiwon Park
- Medical Research Collaborating Center, Seoul National University Hospital
| | - Myoung-Jin Jang
- Medical Research Collaborating Center, Seoul National University Hospital
| | - Hong Ran Moon
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine
- Department of Internal Medicine, Boramae Medical Center, Seoul
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University College of Medicine
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine
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123
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Jo HA, Han SS, Lee S, Kim JY, Yang SH, Lee H, Yang JS, Lee JP, Joo KW, Lim CS, Kim YS, Ahn C, Han JS, Kim DK. The association of tumor necrosis factor superfamily 13 with recurrence of immunoglobulin A nephropathy in living related kidney transplantation. BMC Nephrol 2019; 20:33. [PMID: 30704417 PMCID: PMC6357388 DOI: 10.1186/s12882-019-1222-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/17/2018] [Accepted: 01/18/2019] [Indexed: 11/25/2022] Open
Abstract
Background An increasing amount of evidence has demonstrated an association between an increase in the level of tumor necrosis factor superfamily 13 (TNFSF13) and immunoglobulin A nephropathy (IgAN) progression. We aimed to evaluate if the level of pre-transplant serum TNFSF13 is predictive of IgAN recurrence after kidney transplantation. Methods This analysis was based on the clinical and laboratory data of 69 patients with IgAN who underwent first kidney transplantation with no evidence of mesangial IgA deposits in zero-time transplantation biopsy. We measured pre-transplant serum TNFSF13, total IgA, and galactose-deficient IgA1 levels. Results The recurrence rate of IgAN over a median follow-up duration of 5.1 years was 15.9% (11/69 patients), with a mean time to the first recurrence of 1.7 years. The high pre-transplant TNFSF13 level was associated with IgAN recurrence after kidney transplantation among patients who received a graft from a living related donor. Conclusions This study highlights association of TNFSF13 levels in recurrent IgAN patients who undergo living related donor transplantation. Further research is needed to clarify mechanisms by which TNFSF13 affects the recurrence of IgA nephropathy.
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Affiliation(s)
- Hyung Ah Jo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Inje University Ilsan Paik Hospital, Ilsan, Republic of Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Sunhwa Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Joo Young Kim
- Kidney Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Seung Hee Yang
- Kidney Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Jae Seok Yang
- Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Surgery, Transplantation Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Seoul National University, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Suk Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Kidney Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Kidney Research Institute, Seoul National University, Seoul, Republic of Korea.
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Bae E, Han SS, Park DJ, Lee H, Yu MY, Kim KH, Kim MC, Cho JY, Min SI, Ha J, Kim YS, Yang SH. The level of intracellular tacrolimus in T cell is affected by CD44 +ABCB1 +activities triggered by inflammation. EUR J INFLAMM 2019. [DOI: 10.1177/2058739219845155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Rejection is an important issue in kidney transplant. Although with adequate trough level of tacrolimus, acute rejection occurs, and we are focused on these cases. We hypothesized that the lower concentration of tacrolimus in the peripheral blood mononuclear cell would be a cause of rejection; in this regard, we describe ABCB1, which regulates intracellular concentration of tacrolimus. The effect of inflammation on the intracellular concentration of tacrolimus was evaluated, as was the association between that concentration and ABCB1 and CD44 activities. Seven kidney recipients experiencing acute rejection were prospectively enrolled. Both the whole blood concentration of tacrolimus and intracellular concentration of tacrolimus were measured at the time of enrollment and after stabilization. A human T lymphoblastoid cell line (Jurkat T cell) was treated with various concentrations of tacrolimus for 21 h and then stimulated for 3 h. The levels of mRNA interleukin-2, interleukin-8, and interferon-γ decreased dose dependently by tacrolimus. Furthermore, a fluorescence-activated cell sorter was used to count cells expressing CD44 and ABCB1; changes in intracellular concentration of tacrolimus were explored after tacrolimus treatment and stimulation. Also, B6 splenocytes were tested in the same manner as previous Jurkat T cell experiments. The tacrolimus ratio of three patients was lower at the time of acute rejection than when patients were stabilized. In vitro, the intracellular concentration of tacrolimus decreased after stimulation. Under the same conditions, CD44+ABCB1+cells increased in proportion on tacrolimus treatment and stimulation. This work supports the hypothesis that inflammation reduces the intracellular tacrolimus level, possibly via drug efflux mediated by CD44+ABCB1+and inflammation could lead to acute rejection.
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Affiliation(s)
- Eunjin Bae
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong Jun Park
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Mi-Yeon Yu
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Kyu Hong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Min Chang Kim
- Department of Clinical Pharmacology and Therapeutics, College of Medicine, Seoul National University, Seoul, Korea
| | - Joo-Youn Cho
- Department of Clinical Pharmacology and Therapeutics, College of Medicine, Seoul National University, Seoul, Korea
| | - Sang-Il Min
- Department of Surgery, College of Medicine, Seoul National University, Seoul, Korea
| | - Jongwon Ha
- Department of Surgery, College of Medicine, Seoul National University, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Seung Hee Yang
- Department of Kidney Research Institute, Seoul National University, Seoul, Korea
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125
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Kim MH, Kim YC, Lee JP, Kim H, Kim DK, Ryu DR, Han SS, Lee J, Kim YL, Kang SW, Cho JH, Kim YS. Three-year income trends in Korean adults commencing haemodialysis: A prospective cohort. Nephrology (Carlton) 2018; 23:625-632. [PMID: 28444811 DOI: 10.1111/nep.13065] [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] [Received: 04/20/2016] [Revised: 04/12/2017] [Accepted: 04/24/2017] [Indexed: 11/27/2022]
Abstract
AIM This study aimed to explore the trends in individual income and to estimate the change in average monthly income for patients undergoing haemodialysis therapy. METHODS The main data source was the Clinical Research Center (CRC) for End-Stage Renal Disease in Korea. In addition to the cohort data, a survey was conducted to capture personal income for 3 years. To estimate the change in monthly income over time using repeated measures, a random coefficient model using penalized quasi-likelihood methods based on restricted or residual maximum likelihood estimation was used. RESULTS During the 3-year study period, 138 subjects aged 20 and over who answered the question about pre-dialysis income were traced and analyzed. The median value of monthly income was $US564.4 in the 1st year, $470.4 in the 2nd year, and $733.8 in the 3rd year, representing a 70%, 75%, and 61% decrease compared to pre-dialysis income ($1881.5), respectively. By using mixed analysis, we found that monthly income change was $1283 (95% CI, -1621.5, -945.1), $1182 USD (95% CI, -1540.8, -823.1), and $1041 (95% CI, -1457.6, -623.6) in the 1st , 2nd , and 3rd year, respectively, compared to pre-dialysis income after controlling for other covariates. Women and less educated patients had a relatively higher reduction of income, despite the low starting point. CONCLUSIONS The monthly income of dialysis patients reduced substantially over the study period, especially at the time of the first survey. Considering the social security system, haemodialysis patients face significant personal financial burdens due to their ESRD unrelated to the direct costs of dialysis treatment.
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Affiliation(s)
- Myoung-Hee Kim
- Department of Dental Hygiene, College of Health Science, Eulji University, Gyeonggi-do, Korea.,Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung Pyo Lee
- Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.,N-Bio, Seoul National University, Seoul, Korea
| | - Ho Kim
- Department of Epidemiology and Biostatistics, School of Public Health, Seoul National University, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jeonghwan Lee
- Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea.,Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea
| | - Yong-Lim Kim
- Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea.,Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Shin-Wook Kang
- Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea.,Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jang-Hee Cho
- Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea.,Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yon Su Kim
- Clinical Research Center for End Stage Renal Disease in Korea, Daegu, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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126
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Moon H, Lee Y, Kim S, Kim DK, Chin HJ, Joo KW, Kim YS, Na KY, Han SS. Differential Signature of Obesity in the Relationship with Acute Kidney Injury and Mortality after Coronary Artery Bypass Grafting. J Korean Med Sci 2018; 33:e312. [PMID: 30473653 PMCID: PMC6249171 DOI: 10.3346/jkms.2018.33.e312] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/30/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Obesity is related to several comorbidities and mortality, but its relationship with acute kidney injury (AKI) and long-term mortality remain undetermined in patients undergoing coronary artery bypass grafting. METHODS Data from 3,018 patients (age ≥ 18 years) who underwent coronary artery bypass graft surgery from two tertiary referral centers were retrospectively reviewed between 2004 and 2015. Obesity was defined using the body mass index, according to the World Health Organization's recommendation. The odds and hazard ratios in post-surgical, AKI, and all-cause mortality were calculated after adjustment for multiple covariates. Patients were followed for 90 ± 40.9 months (maximum: 13 years). RESULTS Among the cohort, 37.4%, 2.4%, 21.1%, 35.1%, and 4.0% of patients were classified as normal weight, underweight, overweight-at-risk, obese I, and obese II, respectively. Post-surgical AKI developed in 799 patients (26.5%). Patients in the obese groups (overweight-at-risk to obese II) had a higher risk of AKI than did those in the normal-weight group. During the follow-up period, 787 patients (26.1%) died. Underweight patients had a higher risk of mortality than did normal-weight patients, whereas overweight-at-risk, obese I, and obese II patients showed better survival rates. CONCLUSION After coronary artery bypass graft surgery, obese patients encountered a high risk of AKI, and underweight patients exhibited a low chance of survival. Awareness of both obese and underweight statuses should be raised in these patients.
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Affiliation(s)
- Hongran Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yeonhee Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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127
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Choi JS, Baek SH, Chin HJ, Na KY, Chae DW, Kim YS, Kim S, Han SS. Systolic and diastolic dysfunction affects kidney outcomes in hospitalized patients. BMC Nephrol 2018; 19:292. [PMID: 30352558 PMCID: PMC6199698 DOI: 10.1186/s12882-018-1103-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 07/22/2018] [Accepted: 10/15/2018] [Indexed: 01/20/2023] Open
Abstract
Backgrounds Knowledge on cross-talk between the heart and kidney has been established by basic and clinical research. Nevertheless, the effects of systolic and diastolic heart dysfunctions on the development of acute kidney injury (AKI) and end-stage renal disease (ESRD) remain unresolved in hospitalized patients. Methods A total of 1327 hospitalized patients who had baseline transthoracic echocardiography performed were retrospectively analyzed. Patients were categorized by the quartiles of ejection fraction (EF) and the ratio of the early transmitral blood flow velocity to early diastolic velocity of the mitral annulus (E/e’). The odds ratios (ORs) for AKI and the hazard ratios (HRs) for ESRD were calculated after adjustment of multiple covariates. Results During hospital admission, AKI occurred in 210 (15.8%) patients. The lowest quartile of EF was associated with a risk of AKI (OR, 1.60 [1.07–2.41]) and the highest quartile of E/e’ was associated with a risk of AKI (OR, 1.90 [1.26–2.41]). When two echocardiographic parameters were combined, patients with a low EF (first to second quartiles) and high E/e’ (fourth quartile) showed the highest OR for AKI (OR, 2.27 [1.49–3.45]) compared with the counterpart patients. When the risk of ESRD was evaluated, E/e’, but not EF, was a significant parameter of high risk (fourth vs. first quartiles: HR, 4.13 [1.17–14.64]). Conclusions Baseline systolic and diastolic dysfunction is related to subsequent risks of AKI and ESRD in hospitalized patients. Monitoring of these parameters may be a useful strategy to predict the risk of these adverse events in the kidney.
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Affiliation(s)
- Jae Shin Choi
- Department of Internal Medicine, Hana General Hospital, Cheongju-si, Chungcheongbuk-do, South Korea
| | - Seon Ha Baek
- Department of Internal Medicine, Hallym University Dongtan Hospital, Gyeonggi-do, South Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea. .,Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 03080, South Korea.
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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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129
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Ahn SY, Kim DK, Han SS, Park JH, Shin SJ, Lee SH, Choi BS, Lim CS, Kim S, Chin HJ. Weight loss has an additive effect on the proteinuria reduction of angiotensin II receptor blockers in hypertensive patients with chronic kidney disease. Kidney Res Clin Pract 2018; 37:49-58. [PMID: 29629277 PMCID: PMC5875576 DOI: 10.23876/j.krcp.2018.37.1.49] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 11/23/2017] [Revised: 01/14/2018] [Accepted: 01/25/2018] [Indexed: 12/11/2022] Open
Abstract
Background Weight reduction is a lifestyle intervention that has been introduced for prevention and management of chronic kidney disease (CKD). We investigate the additive anti-proteinuric effect of weight reduction on the usage of angiotensin II receptor blockers (ARBs) and its potential mechanisms in hypertensive CKD patients. Methods This study is a subanalysis of data from an open-label, randomized, controlled clinical trial. Among the 235 participants, 227 were assigned to subgroups according to changes in body weight. Results Fifty-eight participants (25.6%) were assigned to group 1 (≥1.5% decrease in body weight after 16 weeks), 32 participants (14.1%) were assigned to group 2 (1.5–0.1% decrease in body weight), and 136 participants (59.9%) were assigned to group 3 (≥ 0.0% increase in body weight). Characteristics at enrollment were not different among the three groups, but mean differences in weight and percent changes in urinary sodium excretion over the period were statistically different (P < 0.001 and P = 0.017). Over the study period, unintentional weight loss independently increased the probability of reduced albuminuria (group 1, relative risk 6.234, 95% confidence interval 1.913–20.315, P = 0.002). Among urinary cytokines, only podocalyxin level decreased significantly in participants who lost weight (P = 0.013). Conclusion We observed that weight loss had an additive effect on the anti-proteinuric effects of ARBs in nondiabetic hypertensive CKD patients, although it was minimal. An additive effect was shown in both obese and non-obese participants, and its possible mechanism is related to reduction of podocyte damage.
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Affiliation(s)
- Shin Young Ahn
- Department of Internal Medicine, Korea University Medical Center Guro Hospital, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung Hwan Park
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Sung Joon Shin
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Sang Ho Lee
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Bum Soon Choi
- Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | | | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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130
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Han SS, Yang SH, Jo HA, Oh YJ, Park M, Kim JY, Lee H, Lee JP, Lee SH, Joo KW, Lim CS, Kim YS, Kim DK. BAFF and APRIL expression as an autoimmune signature of membranous nephropathy. Oncotarget 2017; 9:3292-3302. [PMID: 29423047 PMCID: PMC5790464 DOI: 10.18632/oncotarget.23232] [Citation(s) in RCA: 5] [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: 07/03/2017] [Accepted: 11/14/2017] [Indexed: 12/16/2022] Open
Abstract
Background Based on the fact that B-cell activating factor (BAFF) and a proliferation-inducing ligand (APRIL) have a regulatory role in B cell biology, excessive levels of these cytokines can promote autoimmune pathogenesis. However, the expression and implication remain unresolved in cases of membranous nephropathy (MN). Results The plasma BAFF levels of the primary MN patients were higher than those of healthy controls but lower than those of secondary MN patients, whereas the APRIL levels were similar between the MN patients and healthy controls. The BAFF levels were higher in relapse cases, whereas the APRIL levels were higher in the patients who did not experience remission compared with the counterpart patients. The ectopic expression of BAFF and APRIL was observed in the glomeruli or circulating B cells of MN patients, and this high expression trend was similar to that of lupus patients. Conclusions Expression profile of BAFF and APRIL in MN is similar to that of other autoimmune disease, which affects the kidney outcomes. Methods Plasma BAFF and APRIL levels were measured upon kidney biopsy in patients with primary (n = 89) and secondary MN (n = 13), and the results were compared with the levels in healthy controls (n = 111). The kidney outcomes (e.g., remission and relapse) were traced for the median of 3 years. Aberrant expression of the cytokines was evaluated in the kidney and circulating B cells using immunohistochemistry and flow cytometry analyses, respectively.
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Affiliation(s)
- Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Seung Hee Yang
- Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Hyung Ah Jo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yun Jung Oh
- Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Minkyoung Park
- Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Joo Young Kim
- Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Kidney Research Institute, Seoul National University, Seoul, Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sang-Ho Lee
- Department of Internal Medicine, College of medicine, Kyung Hee University, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,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.,Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Kidney Research Institute, Seoul National University, Seoul, Korea
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131
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Ahn EJ, Kang H, Choi GJ, Yang SY, Shin HY, Baek CW, Jung YH, Woo YC, Han SS. Streamlined Liner of the Pharynx Airway: Randomised Comparison of Size Selection Strategies with Regard to Patient Height versus Thyroid Cartilage Width. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791502200507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction Streamlined Liner of the Pharynx Airway (SLIPA) is a disposable supraglottic airway. There are two strategies to select the size of SLIPA: by height and width of thyroid cartilage. This study compared the utility of the two strategies in selecting the optimal size. Methods One hundred forty-two patients were randomly divided into two groups with size selection by height (H) and the maximal width of the thyroid cartilage (T). The SLIPA size was selected by height in group H, and by the width of thyroid cartilage in group T. After inserting SLIPA, the investigator made note of the oropharyngeal leakage pressure (OLP) and the degree of insertion difficulty. We set the OLP as a primary outcome. In cases of an OLP <15 cmH2O, the investigator manipulated the apparatus to try to reposition it. If air still leaked, another attempt was made using a SLIPA one size larger until an OLP >15 cmH2O was achieved in up to three attempts. After insertion, the investigator measured the inspiratory and expiratory tidal volume. Post-operatively, the presence of blood or regurgitated fluid on the device was evaluated. Results OLP for group T was higher than that of group H (p=0.009). The need for manipulation and the leak fraction was higher in group H than in group T (p=0.008 and 0.034, respectively). The degree of insertion difficulty, number of trials and incidence of blood and regurgitated fluid on the device were similar between the two groups. Conclusions Both the width and height of thyroid cartilage can be used for selecting the optimal SLIPA size. (Hong Kong j.emerg.med. 2015;22:303-311)
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Affiliation(s)
| | | | | | | | | | | | | | | | - SS Han
- Chung-Ang University, College of Medicine, Department of Obstetrics and Gynecology, Seoul, Korea
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132
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Lee S, Lee Y, Jang H, Moon H, Kim DK, Han SS. Heart rate is associated with mortality in patients undergoing continuous renal replacement therapy. Kidney Res Clin Pract 2017; 36:250-256. [PMID: 28904876 PMCID: PMC5592892 DOI: 10.23876/j.krcp.2017.36.3.250] [Citation(s) in RCA: 4] [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: 01/20/2017] [Revised: 04/04/2017] [Accepted: 04/12/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Heart rate (HR) is an essential vital sign based on the finding that HR beyond its normal range is associated with several conditions or diseases, including high mortality in several clinical settings. Nevertheless, the clinical implications of HR remain unresolved in patients undergoing continuous renal replacement therapy (CRRT). METHODS This retrospective cohort study included 828 patients who underwent CRRT due to acute kidney injury between 2010 and 2014. HR and other baseline parameters at the time of CRRT initiation were retrieved. The odds ratio (OR) of 30-day mortality was calculated using a multivariate logistic model. RESULTS CRRT significantly lowered the HR of patients such that the pre- and post-CRRT HRs (average 6 hours) were 107 beats/min and 103 beats/min, respectively (P < 0.001). When we explored the relationship with 30-day mortality, only HR at the time of CRRT initiation, but not pre- or post-CRRT HR, had a significant relationship with mortality outcome. Based on this result, we divided patients into quartiles of HR at the time of CRRT initiation. Mortality OR in the 4th quartile HR group was 2.6 (1.78-3.92) compared with the 1st quartile HR group. This relationship remained consistent despite adjusting for 28 baseline covariates: OR, 1.7 (1.09-2.76); P = 0.020. However, HR was not associated with the weaning rate from CRRT. CONCLUSION High HR at the time of CRRT initiation is subsequently related with high mortality. These results can be a basis for a future predictive model of CRRT-related mortality.
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Affiliation(s)
- Soojin Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yeonhee Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Heejoon Jang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hongran Moon
- 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.,Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Kidney Research Institute, Seoul National University, Seoul, Korea
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Abstract
Despite the current knowledge about the risk of stroke and its related factors in general population, this issue in elderly patients receiving dialysis remains unresolved. Firstly, to compare the risk of stroke between hemodialysis (HD) and peritoneal dialysis (PD), data on 13,065 incident dialysis patients (aged ≥ 65 years; 10,675 in HD and 2,390 in PD) were retrieved from the Korean Health Insurance dataset. Secondly, to identify the risk factors of stroke amongst various clinical and laboratory parameters in HD, 980 elderly patients were retrospectively analyzed using an independent prospective cohort from 31 dialysis centers. For a mean duration of 1.8 years (maximum of 5 years), the risk of all cardiovascular diseases (ischemic heart disease and stroke) did not differ between HD and PD. However, when analyses were conducted separately by subtype, the risk of stroke, not ischemic heart disease, was significantly higher in HD patients than in PD patients. When the risk factors of stroke were probed after HD for a mean duration of 2.6 years (maximum of 7 years), the absolute dependence on social support, a previous history of cardiovascular disease, high levels of low-density lipoprotein cholesterol, and the use of a high number of anti-hypertensive drugs were identified as being significant. Based on the discrepancy of stroke risk between modalities and the HD-tailored risk factors of stroke, the monitoring and management of these factors may be a key strategy to reduce the risk of stroke in elderly patients receiving dialysis.
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Affiliation(s)
- Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ryeol Ryu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yong Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Shin Wook Kang
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Yon Su 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.
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134
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Wesemann DR, Granato A, Tong P, Zuo T, Chaudhary N, Han SS. IgH isotype-specific B cell receptor dosage regulates B cell fate. The Journal of Immunology 2017. [DOI: 10.4049/jimmunol.198.supp.74.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Immunoglobulin heavy chain (IgH) isotypes (e.g. IgM, IgG and IgE) are generated as secreted/soluble antibodies (sIg) or as membrane-bound (mIg) B cell receptors (BCR) through alternative RNA splicing. IgH isotype dictates soluble antibody function, but how mIg isotype influences B cell behavior is unclear. We examined IgH isotype-specific BCR function by engineering polyclonal Ighγ1/γ1 and Ighɛ/ɛ mice, which initially produce IgG1 or IgE from their respective native genomic configurations. Transcripts producing IgM, IgG1, and IgE are produced in an alternative splice form bias hierarchy, where mIgμ>mIgγ1>mIgɛ—influencing respective BCR densities and fitness for populating the periphery—a pattern replicated in activated and memory B cells from wild-type mice. Restrained B cell development from Ighγ1/γ1 and Ighɛ/ɛ mice was proportional to sIg/mIg ratios, and was rescued by enforced expression of the respective mIgs. In addition, enhanced BCR signaling by way of PTEN deletion in IgE B cells generated functional IgE memory responses from IgE memory B cells themselves, which are normally absent under normal conditions, indicating that weak signal strength normally restrains IgE responses. Thus, IgH isotype-specific mIg dosage regulates B cell fate by influencing quantitative baseline BCR signal strength.
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135
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Han SS, Park S, Kang SH, Cho GY, Kim DK, Kim S, Chin HJ, Chae DW, Na KY. Usefulness of Preoperative Echocardiography to Predict Acute Kidney Injury and Long-Term Mortality After Coronary Artery Bypass Grafting. Am J Cardiol 2017; 119:231-236. [PMID: 27839773 DOI: 10.1016/j.amjcard.2016.09.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Received: 05/22/2016] [Revised: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 11/17/2022]
Abstract
Acute kidney injury (AKI) is a common complication in patients undergoing coronary artery bypass grafting (CABG), which is associated with significant morbidity and mortality. This study identified echocardiographic predictors of AKI and determined whether these predictors were related to long-term mortality in CABG. This retrospective cohort study included 1,300 patients who underwent echocardiography before CABG at 2 tertiary referral centers from 2004 to 2010. The best echocardiographic predictor of AKI was determined using multivariate and stepwise selection methods. Patients were followed for 72 ± 28.8 months (maximum 11 years) for all-cause mortality. We measured the adjusted odds ratio and hazard ratio for AKI and all-cause mortality, respectively, according to the chosen parameter. E/e' was the best predictor of AKI among echocardiographic parameters. The high E/e' group (>15) exhibited a greater odds ratio for AKI (2.2 [1.51 to 3.27]) than the low E/e' group (<8). The high E/e' group required a longer hospital stay (16 days [12 to 23 days]) than the low E/e' group (14 days [11 to 17 days]). There were 272 deaths (21%) during follow-up. The high E/e' group exhibited a greater hazard ratio for long-term mortality (1.9 [1.34 to 2.76]) than the low E/e' group, and this difference remained statistically significant regardless of the occurrence of AKI and the size of the ejection fraction volume. E/e' in preoperative echocardiography is the best predictor of AKI and long-term mortality in patients undergoing CABG.
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Affiliation(s)
- Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seokwoo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Si-Hyuck Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Goo-Yeong Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.
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136
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Park S, Kang E, Park S, Kim YC, Han SS, Ha J, Kim DK, Kim S, Park SK, Han DJ, Lim CS, Kim YS, Lee JP, Kim YH. Metabolic Acidosis and Long-Term Clinical Outcomes in Kidney Transplant Recipients. J Am Soc Nephrol 2016; 28:1886-1897. [PMID: 28031407 DOI: 10.1681/asn.2016070793] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 11/23/2016] [Indexed: 01/07/2023] Open
Abstract
Metabolic acidosis (MA), indicated by low serum total CO2 (TCO2) concentration, is a risk factor for mortality and progressive renal dysfunction in CKD. However, the long-term effects of MA on kidney transplant recipients (KTRs) are unclear. We conducted a multicenter retrospective cohort study of 2318 adult KTRs, from January 1, 1997 to March 31, 2015, to evaluate the prevalence of MA and the relationships between TCO2 concentration and clinical outcomes. The prevalence of low TCO2 concentration (<22 mmol/L) began to increase in KTRs with eGFR<60 ml/min per 1.73 m2 and ranged from approximately 30% to 70% in KTRs with eGFR<30 ml/min per 1.73 m2 Multivariable Cox proportional hazards models revealed that low TCO2 concentration 3 months after transplant associated with increased risk of graft loss (hazard ratio [HR], 1.74%; 95% confidence interval [95% CI], 1.26 to 2.42) and death-censored graft failure (DCGF) (HR, 1.66; 95% CI, 1.14 to 2.42). Cox regression models using time-varying TCO2 concentration additionally demonstrated significant associations between low TCO2 concentration and graft loss (HR, 3.48; 95% CI, 2.47 to 4.90), mortality (HR, 3.16; 95% CI, 1.77 to 5.62), and DCGF (HR, 3.17; 95% CI, 2.12 to 4.73). Marginal structural Cox models adjusted for time-varying eGFR further verified significant hazards of low TCO2 concentration for graft loss, mortality, and DCGF. In conclusion, MA was frequent in KTRs despite relatively preserved renal function and may be a significant risk factor for graft failure and patient mortality, even after adjusting for eGFR.
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Affiliation(s)
| | | | | | | | | | - Jongwon Ha
- Surgery, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | - Duck Jong Han
- Division of Kidney Transplantation, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; and
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | | | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Young Hoon Kim
- Division of Kidney Transplantation, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea; and
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137
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Han SS, Han M, Park JY, An JN, Park S, Park SK, Han DJ, Na KY, Oh YK, Lim CS, Kim YS, Kim YH, Lee JP. Posttransplant Hyponatremia Predicts Graft Failure and Mortality in Kidney Transplantation Recipients: A Multicenter Cohort Study in Korea. PLoS One 2016; 11:e0156050. [PMID: 27214138 PMCID: PMC4877062 DOI: 10.1371/journal.pone.0156050] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 05/09/2016] [Indexed: 11/18/2022] Open
Abstract
Although hyponatremia is related to poorer outcomes in several clinical settings, its significance remains unresolved in kidney transplantation. Data on 1,786 patients who received kidney transplantations between January 2000 and December 2011 were analyzed. The patients were divided into two groups according to the corrected sodium values for serum glucose 3 months after their transplantations (<135 mmol/L vs. ≥135 mmol/L). Subsequently, the hazard ratios (HRs) for biopsy-proven acute rejection, graft failure, and all-cause mortality were calculated after adjustments for several immunological and non-immunological covariates. 4.0% of patients had hyponatremia. Patients with hyponatremia had higher risks for graft failure and all-cause mortality than did the counterpart normonatremia group; the adjusted HRs for graft failure and mortality were 3.21 (1.47-6.99) and 3.03 (1.21-7.54), respectively. These relationships remained consistent irrespective of heart function. However, hyponatremia was not associated with the risk of acute rejection. The present study addressed the association between hyponatremia and graft and patient outcomes in kidney transplant recipients. Based on the study results, our recommendation is to monitor serum sodium levels after kidney transplantations.
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Affiliation(s)
- Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Miyeun Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Yoon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Nam An
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.,Department of Critical Care Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seokwoo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Su-Kil Park
- Department of Internal Medicine, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - Duck-Jong Han
- Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yun Kyu Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,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.,Kidney Research Institute, 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
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.,Kidney Research Institute, Seoul National University College of Medicine, Seoul, Korea
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138
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Han SS, Joo KW, Han JS, Kim YS, Kim DK. MP588PROBING RISK OF STROKE AND ITS RELATED FACTORS IN ELDERLY DIALYSIS PATIENTS. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw198.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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139
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Han SS, Yang SH, Kim MC, Cho JY, Min SI, Lee JP, Kim DK, Ha J, Kim YS. Monitoring the Intracellular Tacrolimus Concentration in Kidney Transplant Recipients with Stable Graft Function. PLoS One 2016; 11:e0153491. [PMID: 27082871 PMCID: PMC4833335 DOI: 10.1371/journal.pone.0153491] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 11/29/2015] [Accepted: 03/30/2016] [Indexed: 11/18/2022] Open
Abstract
Although monitoring the intracellular concentration of immunosuppressive agents may be a promising approach to individualizing the therapy after organ transplantation, additional studies on this issue are needed prior to its clinical approval. We investigated the relationship between intracellular and whole blood concentrations of tacrolimus (IC-TAC and WB-TAC, respectively), the factors affecting this relationship, and the risk of rejection based upon IC-TAC in stable kidney recipients. Both IC-TAC and WB-TAC were measured simultaneously in 213 kidney recipients with stable graft function using LC-MS/MS. The tacrolimus ratio was defined as IC-TAC per WB-TAC. The genetic polymorphism of ABCB1 gene and flow cytometric analyses were conducted to probe the correlation between tacrolimus concentrations and the immunoreactivity status as a potential risk of rejection, respectively. The correlation between IC-TAC and WB-TAC was relatively linear (r = 0.67; P<0.001). The factors affecting the tacrolimus ratio were sex, hematocrit, and the transplant duration, as follows: a high tacrolimus ratio was noted in female patients, patients with a low hematocrit, and patients with a short transplant period. However, the tacrolimus ratio did not reflect the prior clinical outcomes (e.g., rejection) or the genetic polymorphism of ABCB1. After stimulation with phorbol-12-myristate 13-acetate and ionomycin, the proportion of T cells producing interferon-gamma or interleukin-2 was higher in the low-IC-TAC group than in the high-IC-TAC group. Further studies are required to evaluate the value of the intracellular tacrolimus concentrations in several clinical settings, such as rejection, infection, and drug toxicity.
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Affiliation(s)
- Seung Seok Han
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hee Yang
- Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Min Chang Kim
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine, Seoul, Korea
| | - Joo-Youn Cho
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Il Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Pyo Lee
- Kidney Research Institute, Seoul National University, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ki Kim
- Kidney Research Institute, Seoul National University, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yon Su Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
- Kidney Research Institute, Seoul National University, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
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140
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Han SS, Yang SH, Choi M, Kim HR, Kim K, Lee S, Moon KC, Kim JY, Lee H, Lee JP, Jung JY, Kim S, Joo KW, Lim CS, Kang SW, Kim YS, Kim DK. The Role of TNF Superfamily Member 13 in the Progression of IgA Nephropathy. J Am Soc Nephrol 2016; 27:3430-3439. [PMID: 27068226 DOI: 10.1681/asn.2015060677] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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: 06/21/2015] [Accepted: 03/08/2016] [Indexed: 12/28/2022] Open
Abstract
TNF superfamily member 13 (TNFSF13) has been identified as a susceptibility gene for IgA nephropathy in recent genetic studies. However, the role of TNFSF13 in the progression of IgA nephropathy remains unresolved. We evaluated two genetic polymorphisms (rs11552708 and rs3803800) and plasma levels of TNFSF13 in 637 patients with IgA nephropathy, and determined the risk of ESRD according to theses variable. Neither of the examined genetic polymorphisms associated with a clinical outcome of IgA nephropathy. However, high plasma levels of TNFSF13 increased the risk of ESRD. To explore the causal relationship and underlying mechanism, we treated B cells from patients (n=21) with or without recombinant human TNFSF13 (rhTNFSF13) and measured the expression of IgA and galactose-deficient IgA (GdIgA) using ELISA and flow cytometry. Treatment with rhTNFSF13 significantly increased the total IgA level among B cells, and TNFSF13 receptor blockade abrogated this increase. Furthermore, the absolute levels of GdIgA increased with rhTNFSF13 treatment, but the total IgA-normalized levels did not change. Both RNA sequencing and quantitative PCR results showed that rhTNFSF13 did not alter the expression of glycosyltransferase enzymes. These results suggest that high plasma TNFSF13 levels associate with a worse prognosis of IgA nephropathy through the relative increase in GdIgA levels.
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Affiliation(s)
- Seung Seok Han
- Departments of *Internal Medicine.,Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Seung Hee Yang
- Kidney Research Institute, Seoul National University, Seoul, Korea
| | | | | | - Kwangsoo Kim
- Division of Clinical Bioinformatics, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | | | - Kyung Chul Moon
- Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Young Kim
- Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Hajeong Lee
- Departments of *Internal Medicine.,Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Jung Pyo Lee
- Departments of *Internal Medicine.,Kidney Research Institute, Seoul National University, Seoul, Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ji Yong Jung
- Department of Internal Medicine, Gachon University of Medicine and Science, Incheon, Korea; and
| | | | - Kwon Wook Joo
- Departments of *Internal Medicine.,Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Chun Soo Lim
- Departments of *Internal Medicine.,Kidney Research Institute, Seoul National University, Seoul, Korea.,Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Yon Su Kim
- Departments of *Internal Medicine.,Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Dong Ki Kim
- Departments of *Internal Medicine, .,Kidney Research Institute, Seoul National University, Seoul, Korea
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141
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Han SS, Bae E, Kim DK, Kim YS, Han JS, Joo KW. Dysnatremia, its correction, and mortality in patients undergoing continuous renal replacement therapy: a prospective observational study. BMC Nephrol 2016; 17:2. [PMID: 26732402 PMCID: PMC4702339 DOI: 10.1186/s12882-015-0215-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 03/03/2015] [Accepted: 12/22/2015] [Indexed: 12/30/2022] Open
Abstract
Background Although dysnatremia has been reported to be correlated with mortality risk, this issue remains unresolved in patients undergoing continuous renal replacement therapy (CRRT). Furthermore, it has not been determined whether change in or correction of sodium is related to mortality risk in this subset. Methods A total of 569 patients were prospectively enrolled at the start of CRRT between May 2010 and September 2013. The patients were divided into 5 groups: normonatremia (135–145 mmol/L), mild hyponatremia (131.1–134.9 mmol/L), moderate to severe hyponatremia (115.4–131.0 mmol/L), mild hypernatremia (145.1–148.4 mmol/L), and moderate to severe hypernatremia (148.5–166.0 mmol/L). The non-linear relationship between sodium and mortality was initially explored. Subsequently, the odds ratios (ORs) for 30-day mortality were calculated after adjustment of multiple covariates. Results The relationship between baseline sodium and mortality was U-shaped. The mild hyponatremia, moderate to severe hyponatremia, and moderate to severe hypernatremia groups had greater ORs for mortality (1.65, 1.91, and 2.32, respectively) than the normonatremia group (all P values < 0.05). However, later sodium levels (24 and 72 h after CRRT) did not predict 30-day mortality. Furthermore, the changes in sodium over 24 or 72 h, including the appropriate correction of dysnatremia, did not show any relationships with mortality, irrespective of baseline sodium level. Conclusions Sodium level at the start of CRRT was a strong predictor of mortality. However, changes in sodium level and the degree of sodium correction were not associated with the mortality risk in the patients with CRRT. Electronic supplementary material The online version of this article (doi:10.1186/s12882-015-0215-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 03080, South Korea
| | - Eunjin Bae
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 03080, South Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 03080, South Korea.,Kidney Research Institute, Seoul National University College of Medicine, 03080, Seoul, South Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 03080, South Korea.,Kidney Research Institute, Seoul National University College of Medicine, 03080, Seoul, South Korea
| | - Jin Suk Han
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 03080, South Korea.,Kidney Research Institute, Seoul National University College of Medicine, 03080, Seoul, South Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 03080, South Korea. .,Kidney Research Institute, Seoul National University College of Medicine, 03080, Seoul, South Korea.
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Han SS, Bae E, Song SH, Kim DK, Kim YS, Han JS, Joo KW. NT-proBNP Is Predictive of the Weaning from Continuous Renal Replacement Therapy. TOHOKU J EXP MED 2016; 239:1-8. [DOI: 10.1620/tjem.239.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Eunjin Bae
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Sang Hoon Song
- Department of Laboratory Medicine, Seoul National University College of Medicine
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine
- Kidney Research Institute, Seoul National University College of Medicine
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University College of Medicine
- Kidney Research Institute, Seoul National University College of Medicine
| | - Jin Suk Han
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine
- Kidney Research Institute, Seoul National University College of Medicine
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143
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Han SS, Bae E, Ahn SY, Kim S, Park JH, Shin SJ, Lee SH, Choi BS, Chin HJ, Lim CS, Kim S, Kim DK. Urinary adiponectin and albuminuria in non-diabetic hypertensive patients: an analysis of the ESPECIAL trial. BMC Nephrol 2015; 16:123. [PMID: 26232133 PMCID: PMC4522110 DOI: 10.1186/s12882-015-0124-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 01/28/2015] [Accepted: 07/28/2015] [Indexed: 12/18/2022] Open
Abstract
Background Although adiponectin levels have been reported to be correlated with albuminuria, this issue remains unresolved in non-diabetic hypertensive subjects, particularly when urinary adiponectin is considered. Methods Urinary adiponectin levels were examined using an enzyme-linked immunosorbent assay in 229 participants. who used olmesartan as a hypertensive agent. Their albuminuria levels were measured for 16 weeks after randomization and initiation of conventional or intensive diet education. Linear or logistic regression models were applied, as appropriate, to explore the relationship with albuminuria itself or its response after the intervention. Results Urinary adiponectin levels were positively related to baseline albuminuria level (r = 0.529). After adjusting for several covariates, the adiponectin level was associated with the albuminuria level (β = 0.446). Among the 159 subjects with baseline macroalbuminuria, the risk of consistent macroalbuminuria (> 300 mg/day) at 16 weeks was higher in the 3rd tertile of adiponectin than in the 1st tertile (odds ratio = 6.9), despite diet education. In contrast, among all subjects, the frequency of the normoalbuminuria achievement (< 30 mg/day) at 16 weeks was higher in the 1st tertile than in the 3rd tertile (odds ratio = 13.0). Conclusions Urinary adiponectin may be a useful biomarker for albuminuria or its response after treatment in non-diabetic hypertensive patients. Electronic supplementary material The online version of this article (doi:10.1186/s12882-015-0124-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea.
| | - Eunjin Bae
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea.
| | - Shin Young Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea. .,Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, 463-707, South Korea.
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea. .,Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, 463-707, South Korea.
| | - Jung Hwan Park
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, 143-729, South Korea.
| | - Sung Joon Shin
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Gyeonggi-do, 410-773, South Korea.
| | - Sang Ho Lee
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, 134-727, South Korea.
| | - Bum Soon Choi
- Department of Internal Medicine, Seoul St. Mary's Hospital, Seoul, 137-701, South Korea.
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea. .,Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, 463-707, South Korea.
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea. .,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, 156-707, South Korea.
| | - Suhnggwon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea.
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 110-744, South Korea.
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Han SS, Park JY, Kang S, Kim KH, Ryu DR, Kim H, Joo KW, Lim CS, Kim YS, Kim DK. Dialysis Modality and Mortality in the Elderly: A Meta-Analysis. Clin J Am Soc Nephrol 2015; 10:983-93. [PMID: 25941194 DOI: 10.2215/cjn.05160514] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [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: 05/24/2014] [Accepted: 02/20/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Identifying the appropriate choice between hemodialysis (HD) and peritoneal dialysis (PD) is an unresolved issue in elderly patients with ESRD, who are at high risk for death but have a low chance of receiving kidney transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data on 13,065 incident dialysis Korean patients (age≥65 years) receiving HD (n=10,675) or PD (n=2390) were obtained from the Korean Health Insurance dataset. Multiple statistical approaches, including the multivariate Cox model, were used to compare mortality between Korean patients receiving PD and those receiving HD. Subsequently, meta-analysis of previous comparison studies (published since the year 2000; population-based studies) and the Korean dataset was performed. RESULTS During a mean duration of 1.8±1.3 years (maximum of 5 years), the Korean PD group had a higher mortality rate than the Korean HD group (hazard ratio [HR], 1.20 [95% confidence interval (95% CI), 1.13 to 1.28]; P<0.001 by multivariate Cox model). The discrepancy between the two modalities was greater in the presence of certain conditions, such as diabetes mellitus or longer dialysis duration. In the meta-analysis, 15 studies involving >631,421 elderly patients were reviewed. Compared with HD, the pooled HR with PD was 1.10 (95% CI, 1.01 to 1.20). When the meta-analysis was stratified by confounding factors, the survival benefit from HD was particularly strong in subgroups that had diabetes mellitus, had long dialysis duration (>1 year), or contained cohorts starting dialysis in the 1990s. CONCLUSIONS A meta-analysis that included results in Korean patients suggests a higher risk for death in elderly patients receiving PD than in those receiving HD.
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Affiliation(s)
- Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Yoon Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | | | - Kyoung Hoon Kim
- Department of Public Health, Graduate School, Korea University, Seoul, Korea
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Hyunwook Kim
- Department of Internal Medicine, Wonkwang University College of Medicine, Sanbon Hospital, Gyeonggi-do, Korea; and
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Kidney Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Chun Soo Lim
- Kidney Research Institute, Seoul National University Hospital, Seoul, Korea; 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; Kidney Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Kidney Research Institute, Seoul National University Hospital, Seoul, Korea;
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Han SS, Shin N, Baek SH, Ahn SY, Kim DK, Kim S, Chin HJ, Chae DW, Na KY. Effects of acute kidney injury and chronic kidney disease on long-term mortality after coronary artery bypass grafting. Am Heart J 2015; 169:419-25. [PMID: 25728733 DOI: 10.1016/j.ahj.2014.12.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 12/20/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND Both acute kidney injury (AKI) and chronic kidney disease (CKD) are important issues in patients undergoing coronary artery bypass grafting (CABG), particularly with regard to mortality. However, their synergistic or discrete effects on long-term mortality remain unresolved. METHODS A total of 1,899 patients undergoing CABG were retrospectively analyzed. The adjusted hazard ratios for all-cause mortality were calculated after stratifying the timeframes. To evaluate the synergistic effects between AKI and CKD, the relative excess risk due to interaction was applied. RESULTS The presence of AKI, CKD, or both increased the hazard ratios for mortality, compared with the absence of both: AKI alone, 1.84 (1.464-2.319); CKD alone, 2.46 (1.735-3.478); and AKI and CKD together, 3.21 (2.301-4.488). However, the relationships with mortality were different between AKI and CKD, according to the timeframes: AKI primarily affected early mortality, particularly within 3 years, whereas CKD had a relatively constant effect on both the early and late periods. When the parameters from the relative excess risk due to interaction were obtained, there was a synergistic additive effect on early mortality between AKI and CKD. CONCLUSIONS The relationships with mortality after CABG were different between AKI and CKD. However, their effects were not exclusive but synergistic.
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Han SS, Baek SH, Ahn SY, Chin HJ, Na KY, Chae DW, Kim S. Anemia Is a Risk Factor for Acute Kidney Injury and Long-Term Mortality in Critically Ill Patients. TOHOKU J EXP MED 2015; 237:287-95. [DOI: 10.1620/tjem.237.287] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine
| | - Seon Ha Baek
- Department of Internal Medicine, Seoul National University College of Medicine
- Department of Internal Medicine, Seoul National University Bundang Hospital
| | - Shin Young Ahn
- Department of Internal Medicine, Seoul National University College of Medicine
- Department of Internal Medicine, Seoul National University Bundang Hospital
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University College of Medicine
- Department of Internal Medicine, Seoul National University Bundang Hospital
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University College of Medicine
- Department of Internal Medicine, Seoul National University Bundang Hospital
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University College of Medicine
- Department of Internal Medicine, Seoul National University Bundang Hospital
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University College of Medicine
- Department of Internal Medicine, Seoul National University Bundang Hospital
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147
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Han SS, Cho GY, Park YS, Baek SH, Ahn SY, Kim S, Chin HJ, Chae DW, Na KY. Predictive value of echocardiographic parameters for clinical events in patients starting hemodialysis. J Korean Med Sci 2015; 30:44-53. [PMID: 25552882 PMCID: PMC4278026 DOI: 10.3346/jkms.2015.30.1.44] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 05/26/2014] [Accepted: 09/04/2014] [Indexed: 12/18/2022] Open
Abstract
Echocardiographic parameters can predict cardiovascular events in several clinical settings. However, which echocardiographic parameter is most predictive of each cardiovascular or non-cardiovascular event in patients starting hemodialysis remains unresolved. Echocardiography was used in 189 patients at the time of starting hemodialysis. We established primary outcomes as follows: cardiovascular events (ischemic heart disease, cerebrovascular disease, peripheral artery disease, and acute heart failure), fatal non-cardiovascular events, all-cause mortality, and all combined events. The most predictable echocardiographic parameter was determined in the Cox hazard ratio model with a backward selection after the adjustment of multiple covariates. Among several echocardiographic parameters, the E/e' ratio and the left ventricular end-diastolic volume (LVEDV) were the strongest predictors of cardiovascular and non-cardiovascular events, respectively. After the adjustment of clinical and biochemical covariates, the predictability of E/e' remained consistent, but LVEDV did not. When clinical events were further analyzed, the significant echocardiographic parameters were as follows: s' for ischemic heart disease and peripheral artery disease, LVEDV and E/e' for acute heart failure, and E/e' for all-cause mortality and all combined events. However, no echocardiographic parameter independently predicted cerebrovascular disease or non-cardiovascular events. In conclusion, E/e', s', and LVEDV have independent predictive values for several cardiovascular and mortality events.
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Affiliation(s)
- Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Goo-Yeong Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Youn Su Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seon Ha Baek
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Shin Young Ahn
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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148
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Han SS, Ahn SY, Ryu J, Baek SH, Kim KI, Chin HJ, Na KY, Chae DW, Kim S. U-shape relationship of white blood cells with acute kidney injury and mortality in critically ill patients. TOHOKU J EXP MED 2014; 232:177-85. [PMID: 24621861 DOI: 10.1620/tjem.232.177] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Low or high counts of white blood cells (WBCs) and WBC subtypes can be a predictor of morbidity and mortality in several clinical settings. However, the correlations of WBC and its subtypes with acute kidney injury (AKI) and mortality remain unresolved in critically ill patients. The counts of WBC and subtypes, such as neutrophil, lymphocyte, monocyte, and eosinophil, were measured in 2,079 patients admitted to the intensive care unit (ICU) from June 2004 through June 2010. The non-linear relationship between WBC counts and AKI risk was initially explored by a restricted cubic spline analysis. The odds ratios (ORs) for AKI and 1-year mortality were calculated after adjustment for multiple covariates. The relationship between WBC counts and AKI risk was U-shaped. Accordingly, we divided patients into quintiles according to the counts of WBC or subtypes. The 1(st) and 5(th) quintiles of WBC counts had greater ORs for AKI (1.42 and 2.05, respectively) and mortality (1.40 and 1.36, respectively) compared with the 3(rd) quintile. After stratification by WBC subtype, the 5(th) quintile of neutrophil counts and the 1(st) quintiles of lymphocyte and monocyte counts tended to have higher ORs for AKI (1.69, 1.40, and 1.77, respectively). For mortality, the 1(st) quintiles of neutrophil, lymphocyte, and eosinophil counts were associated with higher mortality compared with the 3(rd) quintile (the ORs were 1.48, 1.57, and 1.42, respectively). Both leukopenia and leukocytosis are associated with AKI and mortality risk in critically ill patients. This result may be attributable to the change in the subtype counts.
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Affiliation(s)
- Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine
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Chon SB, Kim TS, Oh WS, Lee SJ, Han SS, Kim WJ. Pulmonary tuberculosis among patients hospitalised with community-acquired pneumonia in a tuberculosis-prevalent area. Int J Tuberc Lung Dis 2014; 18:761-2. [PMID: 24200280 DOI: 10.5588/ijtld.13.0183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING A suburban teaching hospital in a tuberculosis (TB) prevalent area. OBJECTIVES To evaluate the proportion of pulmonary TB among patients hospitalised with suspected community-acquired pneumonia (CAP), and to develop a diagnostic index for identifying TB among these patients. DESIGN TB cases confirmed using 1) sputum culture, or 2) both sputum acid-fast bacilli smear and polymerase chain reaction for Mycobacterium tuberculosis, were compared with non-tuberculous CAP by demographic, clinical, laboratory and radiographic information. Using multiple logistic regression analysis, risk factors for TB were identified. A diagnostic index was developed by summing up their simplified regression coefficients. Its performance was checked using c-statistic. RESULTS TB was the second leading cause of CAP (37/528, 7.0%). Risk factors were initial symptoms >7 days, serum albumin <3.5 g/dl, cavitary/nodular infiltrates and upper lobe involvement (1 point for each). The c-statistic of the index was 0.856 (95%CI 0.789-0.923), and for bootstrapping samples of 1000 repetitions it was 0.856 (95%CI 0.791-0.921). For scores ≥2, sensitivity and specificity were respectively 81.1% and 75.8%. CONCLUSION TB is one of the leading causes of CAP in TB-prevalent areas. Our diagnostic index may help clinicians identify TB immediately from CAP and initiate appropriate isolation and optimal treatment.
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Affiliation(s)
- S-B Chon
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
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Han SS, Ahn SY, Ryu J, Baek SH, Chin HJ, Na KY, Chae DW, Kim S. Proteinuria and hematuria are associated with acute kidney injury and mortality in critically ill patients: a retrospective observational study. BMC Nephrol 2014; 15:93. [PMID: 24942179 PMCID: PMC4072664 DOI: 10.1186/1471-2369-15-93] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 05/23/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Proteinuria and hematuria are both important health issues; however, the nature of the association between these findings and acute kidney injury (AKI) or mortality remains unresolved in critically ill patients. METHODS Proteinuria and hematuria were measured by a dipstick test and scored using a scale ranging from a negative result to 3+ in 1883 patients admitted to the intensive care unit. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The odds ratios (ORs) for AKI and 3-year mortality were calculated after adjustment for multiple covariates according to the degree of proteinuria or hematuria. For evaluating the synergistic effect on mortality among proteinuria, hematuria, and AKI, the relative excess risk due to interaction (RERI) was used. RESULTS Proteinuria and hematuria increased the ORs for AKI: the ORs of proteinuria were 1.66 (+/-), 1.86 (1+), 2.18 (2+), and 4.74 (3+) compared with non-proteinuria; the ORs of hematuria were 1.31 (+/-), 1.58 (1+), 2.63 (2+), and 2.52 (3+) compared with non-hematuria. The correlations between the mortality risk and proteinuria or hematuria were all significant and graded (Ptrend<0.001). There was a relative excess risk of mortality when both AKI and proteinuria or hematuria were considered together: the synergy indexes were 1.30 and 1.23 for proteinuria and hematuria, respectively. CONCLUSIONS Proteinuria and hematuria are associated with the risks of AKI and mortality in critically ill patients. Additionally, these findings had a synergistic effect with AKI on mortality.
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Affiliation(s)
- Seung Seok Han
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Shin Young Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Jiwon Ryu
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon-si, Gangwon-do, Korea
| | - Seon Ha Baek
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, USA
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