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Lee JH, Lee H, Kim K, Lee SW, Song JH, Hwang SD. The Effect of Induction Therapy on Antibody-Mediated Rejection in Kidney Transplantation: A Network Meta-Analysis Using Recent Data. Transplant Proc 2024; 56:530-533. [PMID: 38490831 DOI: 10.1016/j.transproceed.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/16/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Various induction regimens are available for kidney transplantation (KT); however, which is superior remains unclear. Moreover, although the induction regimens are effective and important for reducing side effects, their respective relationships with antibody-mediated rejection (AMR) after transplantation remain unclear. Therefore, this study aimed to elucidate the most effective induction regimen for AMR reduction through network analysis. METHODS We performed a comprehensive search of databases, including basiliximab, alemtuzumab, antithymocyte globulin (ATG), and daclizumab as induction regimens for KT from inception to September 1, 2022. Using a network meta-analysis, we investigated the priorities of 5 induction regimens for patient survival, graft failure, and graft rejection after ABO-incompatible KT. RESULTS In total, 25 studies comprising 1768 people were included in this network meta-analysis. The primary outcome was the AMR rate of other induction regimens compared with that of basiliximab, whereas the secondary outcomes were heart failure, stroke, hospitalization, peripheral artery disease, myocardial infarction, anemia, leukopenia, herpes zoster, or adverse events. Notably, ATG reduced the AMR rate by 59% (odds ratio, 0.41; 95% credible interval, 0.20-0.90), whereas the other drugs did not show statistical significance. Furthermore, secondary outcomes did not significantly differ between the induction regimens. CONCLUSION ATG is widely used in KT induction regimens. Our results showed that ATG reduced the risk of AMR in KT recipients when compared with other induction drugs; therefore, it appears to be an efficient choice of induction regimen to reduce AMR after KT.
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Affiliation(s)
- Jin Ho Lee
- Division of Nephrology, Department of Internal Medicine, Leesin Hemodialysis and Intervention Clinic, Busan, South Korea
| | - Heeryong Lee
- Division of Nephrology, Department of Internal Medicine, Leesin Hemodialysis and Intervention Clinic, Busan, South Korea
| | - Kipyo Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea
| | - Joon Ho Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea
| | - Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea.
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Lee JH, Lee HR, Lee SW, Song JH, Hwang SD. Effect of Induction Therapy Dose on Survival in Abo-Incompatible Kidney Transplantation: A Network Meta-Analysis Using Recent Data. Transplant Proc 2024; 56:511-514. [PMID: 38378338 DOI: 10.1016/j.transproceed.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/16/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Rituximab is an essential induction immunosuppressant for ABO-incompatible kidney transplantation (KT) (ABOi-KT). However, studies on the optimal dose of rituximab are insufficient, and there are dosage differences between transplant centers and countries. Therefore, we conducted a study to determine the survival outcomes of patients receiving the most effective and safe dose of rituximab during ABOi-KT. METHODS Studies on rituximab dose were divided into four groups: ABO compatible, 1) placebo, 2) rituximab 200 mg, 3) rituximab 200-500 mg, and 4) rituximab 500 mg. We searched the CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded databases from 1970 to February 2022.9 . The inclusion criteria were adult patients (>18 years old). Reviews, observational studies, and clinical trials that did not clearly define outcomes or that did not have graft failure as an outcome were excluded. We performed direct and indirect network meta-analyses using Bayesian models and ranked different rituximab doses using a generation mixed treatment comparison (GeMTC) and Stata version 13. The NMA approach was evaluated using the GRADE framework, which specifies four levels of certainty for a given result: high, moderate, low, and very low. The outcomes included patient survival, graft failure, and bacterial and viral infections. RESULTS Twenty-five trials, including 5,378 subjects, were divided into the following four groups: 1) placebo, 2) rituximab 200 mg, 3) rituximab 200-500 mg, and 4) rituximab 500 mg. We focused on survival outcomes according to the dose of rituximab when patients received induction therapy for ABOi-KT. The mortality rate was significantly lower in the ABO-compatible and rituximab 200 mg groups (odds ratio [OR] 0.27, 95% CrI: 0.071-0.91 and OR 0.14, 95% CrI 0.036-0.47), compared with that in the placebo group. CONCLUSIONS We found that low-dose rituximab in ABO-i KT was effective compared to the high-dose and placebo in maintaining the survival rate. However, large-scale and long-term data are necessary for further validation of our findings. Additionally, the use of smaller doses of rituximab will require further discussion.
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Affiliation(s)
- Jin Ho Lee
- Division of Nephrology, Department of Internal Medicine, Leesin Hemodialysis and Intervention Clinic, Busan, Korea
| | - Hee Ryong Lee
- Division of Nephrology, Department of Internal Medicine, Leesin Hemodialysis and Intervention Clinic, Busan, Korea
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Joon Ho Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.
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Lee JH, Lee H, Kim K, Lee SW, Song JH, Hwang SD. High-Dose Intravenous Immunoglobulin to Treat Anti-Thymocyte Globulin Induction-Related BK Virus and Cytomegalovirus Infection in Patients with ABO-Incompatible Kidney Transplantation. Transplant Proc 2024; 56:726-728. [PMID: 38388292 DOI: 10.1016/j.transproceed.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND ABO-incompatible (ABOi) transplantation is a novel method transplantation method that carries a heightened risk of infection caused by the use of high immunosuppressant doses. This elevated risk is particularly concerning for viral infections, such as cytomegalovirus (CMV) and the BK virus (BKV) increases. Herein, we present a case where high-dose intravenous immunoglobulin (IVIG) was effective in treating viral infections after transplantation. METHODS A 41-year-old man underwent an ABOi transplantation. The initial isoagglutinin titer was 1:32. The patient received 200 mg of rituximab, and 3 rounds of plasmapheresis were performed. Subsequently, renal function remained normal; however, 7 months later, the renal function declined, and BK nephropathy and CMV infection were diagnosed through biopsy and serologic tests. The FK level was reduced, and mycophenolate mofetil was discontinued. Although ciprofloxacin and leflunomide were administered, their effects were minimal. Therefore, high-dose IVIG (1 g/kg) was administered 5 times over 5 weeks, which led to a reduction in BK viral load and CMV infectivity in the serum. CONCLUSIONS High-dose IVIG may serve as a promising alternative treatment to mitigate early transplant rejection and BKV and CMV infections.
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Affiliation(s)
- Jin Ho Lee
- Division of Nephrology, Department of Internal Medicine, Leesin Hemodialysis and Intervention Clinic, Busan, South Korea
| | - Heeryong Lee
- Division of Nephrology, Department of Internal Medicine, Leesin Hemodialysis and Intervention Clinic, Busan, South Korea
| | - Kipyo Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea
| | - Joon Ho Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea
| | - Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea.
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Lee JH, Lee H, Kim K, Lee SW, Song JH, Hwang SD. Effect of Plasmapheresis on the Efficacy of Rituximab in Antibody-Mediated Rejection Patients. Transplant Proc 2024; 56:723-725. [PMID: 38383260 DOI: 10.1016/j.transproceed.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/16/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Rituximab and plasmapheresis (PP) suppress and eliminate antibody production in patients experiencing antibody-mediated rejection (AMR). Herein, we discuss a case where rituximab was less effective after PP for treating AMR. CASE A 55-year-old male patient underwent kidney transplantation. His renal function remained normal for 1 year. Subsequently, renal function declined, and (donor-specific antibodies showed positive results. A biopsy of the transplanted kidney revealed AMR. On the day of the biopsy, the medical staff administered 200 mg of rituximab, followed by IV immunoglobulin (IVIg) and PP the next day. The time interval between PP + IVIg treatment and rituximab was 12 h. As a result, the B-cell markers CD19 and CD20 did not decrease sufficiently, and the patient's creatinine and glomerular filtration rate muscles did not recover adequately. CONCLUSION We report a case in which PP was administered shortly after rituximab injection, resulting in insufficient B-cell inhibition due to the removal of rituximab.
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Affiliation(s)
- Jin Ho Lee
- Division of Nephrology, Department of Internal Medicine, Leesin Hemodialysis and Intervention Clinic, Busan, South Korea
| | - Heeryong Lee
- Division of Nephrology, Department of Internal Medicine, Leesin Hemodialysis and Intervention Clinic, Busan, South Korea
| | - Kipyo Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea
| | - Joon Ho Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea
| | - Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea.
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Kim K, Kim JE, Kim JH, Ahn SH, Jung CY, Hwang SD, Lee SW, Song JH. Real-world evidence of constipation and laxative use in the Korean population with chronic kidney disease from a common data model. Sci Rep 2024; 14:6610. [PMID: 38503885 PMCID: PMC10951406 DOI: 10.1038/s41598-024-57382-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/18/2024] [Indexed: 03/21/2024] Open
Abstract
Constipation is a highly prevalent gastrointestinal disorder in patients with chronic kidney disease (CKD). However, our understanding of its epidemiology and management in CKD is limited. We aimed to explore real-world data on constipation and laxative use in patients with CKD in a nationwide population-based cohort from the Korean Health Insurance Review and Assessment-National Patient Sample database. This study analyzed retrospective health claims data in Korea from 2012 to 2017 that were transformed into the Observational Medical Outcomes Partnership Common Data Model. The pooled proportion of constipation diagnoses was 30.5% in all patients with CKD and 15.9%, 16.5%, 17.4%, 29.9%, and 43.3% in patients with CKD stages 1-5, respectively, suggesting a higher prevalence in advanced CKD. Patients receiving peritoneal dialysis or hemodialysis had the highest prevalence of constipation, while transplant recipients showed a prevalence comparable to that of patients with early CKD. Patients with CKD had a significantly higher risk of constipation than age- and sex-matched non-CKD individuals (range of odds ratio [OR]:1.66-1.90). Laxative prescribing patterns differed by CKD severity. Osmotic agents were prescribed in more than half of patients with advanced CKD, while magnesium salts and bulking agents were prescribed less frequently. The CKD patients with constipation were more likely to be prescribed constipation-inducing medications, including antipsychotic and neurological medications. Our findings provide real-world constipation and laxative prescription status in the Korean CKD population, revealing a significantly higher risk of constipation and different laxative prescribing patterns in patients with CKD.
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Affiliation(s)
- Kipyo Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon, 22332, Republic of Korea
| | - Ji-Eun Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon, 22332, Republic of Korea
| | - Jae Ho Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon, 22332, Republic of Korea
| | - Seong Hee Ahn
- Department of Endocrinology and Metabolism, Inha University Hospital, Inha University College of Medicine, Incheon, 22332, Republic of Korea
| | - Chai Young Jung
- Biomedical Research Institute, Inha University Hospital, Incheon, 22332, Republic of Korea
| | - Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon, 22332, Republic of Korea
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon, 22332, Republic of Korea
| | - Joon Ho Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon, 22332, Republic of Korea.
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Kim KM, Jeong SA, Ban TH, Hong YA, Hwang SD, Choi SR, Lee H, Kim JH, Kim SH, Kim TH, Koo HS, Yoon CY, Kim K, Ahn SH, Kim YK, Yoon HE. Status and trends in epidemiologic characteristics of diabetic end-stage renal disease: an analysis of the 2021 Korean Renal Data System. Kidney Res Clin Pract 2024; 43:20-32. [PMID: 38268124 PMCID: PMC10846995 DOI: 10.23876/j.krcp.23.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/10/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024] Open
Abstract
Korean Renal Data System (KORDS) is a nationwide end-stage renal disease (ESRD) registry database operated by the Korean Society of Nephrology (KSN). Diabetes mellitus is currently the leading cause of ESRD in Korea; this article provides an update on the trends and characteristics of diabetic ESRD patients. The KORDS Committee of KSN collects data on dialysis centers and patients through an online registry program. Here, we analyzed the status and trends in characteristics of diabetic chronic kidney disease stage 5D (CKD 5D) patients using data from 2001 to 2021. In 2021, the dialysis adequacy of hemodialysis (HD) was lower in diabetic CKD 5D patients than in nondiabetic CKD 5D patients, while that of peritoneal dialysis (PD) was similar. Diabetic CKD 5D patients had a higher proportion of cardiac and vascular diseases and were more frequently admitted to hospitals than nondiabetic CKD 5D patients, and the leading cause of death was cardiac disease. From 2001 to 2020, diabetic CKD 5D patients had a higher mortality rate than nondiabetic CKD 5D patients, but in 2021 this trend was reversed. Diabetic PD patients had the highest mortality rate over 20 years. The mortality rate of diabetic HD patients was higher than that of nondiabetic HD patients until 2019 but became lower starting in 2020. There was a decreasing trend in mortality rate in diabetic CKD 5D patients, but cardiac and vascular diseases were still prevalent in diabetic CKD 5D patients with frequent admissions to hospitals. More specialized care is needed to improve the clinical outcomes of diabetic CKD 5D patients.
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Affiliation(s)
- Kyeong Min Kim
- Department of Internal Medicine, Daejeon Eulji Medical Center, Eulji University College of Medicine, Daejeon, Republic of Korea
| | - Seon A Jeong
- The Korean Society of Nephrology, Seoul, Republic of Korea
| | - Tae Hyun Ban
- Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yu Ah Hong
- Department of Internal Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seun Deuk Hwang
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Sun Ryoung Choi
- Department of Internal Medicine, Samyook Medical Center, Seoul, Republic of Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Su Hyun Kim
- Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Republic of Korea
| | - Tae Hee Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ho-Seok Koo
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Chang-Yun Yoon
- Yoon’s Medical Clinic Dialysis Center, Seoul, Republic of Korea
| | - Kiwon Kim
- Seoul One Clinic, Anyang, Republic of Korea
| | - Seon Ho Ahn
- Department of Internal Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine Iksan, Republic of Korea
| | - Yong Kyun Kim
- Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Cell Death Disease Research Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye Eun Yoon
- Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Choi YH, Jo S, Lee RW, Kim JE, Paek JH, Kim B, Shin SY, Hwang SD, Lee SW, Song JH, Kim K. Changes in CT-Based Morphological Features of the Kidney with Declining Glomerular Filtration Rate in Chronic Kidney Disease. Diagnostics (Basel) 2023; 13:diagnostics13030402. [PMID: 36766507 PMCID: PMC9914455 DOI: 10.3390/diagnostics13030402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
Chronic kidney disease (CKD) progression involves morphological changes in the kidney, such as decreased length and thickness, with associated histopathological alterations. However, the relationship between morphological changes in the kidneys and glomerular filtration rate (GFR) has not been quantitatively and comprehensively evaluated. We evaluated the three-dimensional size and shape of the kidney using computed tomography (CT)-derived features in relation to kidney function. We included 257 patients aged ≥18 years who underwent non-contrast abdominal CT at the Inha University Hospital. The features were quantified using predefined algorithms in the pyRadiomics package after kidney segmentation. All features, except for flatness, significantly correlated with estimated GFR (eGFR). The surface-area-to-volume ratio (SVR) showed the strongest negative correlation (r = -0.75, p < 0.0001). Kidney size features, such as volume and diameter, showed moderate to high positive correlations; other morphological features showed low to moderate correlations. The calculated area under the receiver operating characteristic (ROC) curve (AUC) for different features ranged from 0.51 (for elongation) to 0.86 (for SVR) for different eGFR thresholds. Diabetes patients had weaker correlations between the studied features and eGFR and showed less bumpy surfaces in three-dimensional visualization. We identified alterations in the CKD kidney based on various three-dimensional shape and size features, with their potential diagnostic value.
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Affiliation(s)
- Yoon Ho Choi
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Jacksonville, FL 32224, USA
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Seongho Jo
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Ro Woon Lee
- Department of Radiology, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Ji-Eun Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Jin Hyuk Paek
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Byoungje Kim
- Department of Radiology, Keimyung University School of Medicine, Daegu 42601, Republic of Korea
| | - Soo-Yong Shin
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Joon Ho Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Kipyo Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
- Correspondence: ; Tel.: +82-32-890-3246
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Lee JH, Lee H, Kim K, Lee SW, Song JH, Hwang SD. Acute Anti-A/B Antibody-Mediated Rejection After ABO-Incompatible Kidney Transplantation Treated With Bortezomib and Plasmapheresis: A Case Report. Transplant Proc 2022; 54:540-543. [DOI: 10.1016/j.transproceed.2021.10.027] [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] [Received: 09/18/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
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Kim JE, Hwang SD, Lee SW, Song JH, Kim K. Potassium Channel Syndrome Caused by Nicorandil in Chronic Kidney Disease: A Case Report and Literature Review. Electrolyte Blood Press 2022; 20:17-20. [DOI: 10.5049/ebp.2022.20.1.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ji-Eun Kim
- Department of Internal Medicine, Inha University Hospital, Incheon, Republic of Korea
| | - Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Joon Ho Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - Kipyo Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
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Lee HR, Kim K, Lee SW, Song JH, Lee JH, Hwang SD. Effect of rituximab dose on induction therapy in ABO-incompatible living kidney transplantation: A network meta-analysis. Medicine (Baltimore) 2021; 100:e24853. [PMID: 33725841 PMCID: PMC7969271 DOI: 10.1097/md.0000000000024853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/05/2020] [Accepted: 01/28/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Rituximab is an induction immunosuppressant essential for ABO-incompatible kidney transplantation (ABOi KT). However, studies on its dosing, which differs among countries and transplant centers, are lacking. Therefore, we retrospectively investigated the effectiveness of the induction dose of rituximab against patient mortality, graft failure, and adverse events. METHODS We included the studies referring to at least 2 of eligible induction doses (200 mg, 200-500 mg, or 500 mg) of rituximab during ABOi KT and relevant outcomes such as patient survival, graft failure, and bacterial and viral infections. We performed direct and indirect network meta-analyses using Bayesian models and ranked different rituximab doses using generation mixed treatment comparison. Publications were retrieved using CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded databases from 1970 to February 2020 and analyzed. The GRADE of network meta-analysis approach specified 4 levels of certainty for a given result: high, moderate, low, and very low. RESULTS Among the 4256 patients from 21 trials, glomerular filtration rate, graft loss, antibody-mediated rejection, T-cell mediated rejection, fungal infection, bacterial infection, and CMV infection did not differ among ABOi groups treated with different rituximab doses. The effect on mortality was significantly higher in rituximab 200 to 500 mg, and rituximab 500 mg groups (odds ratios [OR] 3.5, 95% CrI: 1.3-9.8, and OR 3.0, 95% CrI 1.1-9.8), but not in rituximab 20 mg group (OR 0.45, 95% CrI 0.036-2.5). The incidence of BK virus was significantly lower in the rituximab 200-mg group than in the other groups. DISCUSSION In ABO-incompatible kidney transplantation, low-dose rituximab is more efficacious than higher doses and reduces serious infection risks. Additional randomized controlled trials might be needed to confirm these findings due to small sample size.
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Affiliation(s)
- Hee Ryong Lee
- Division of Nephrology, Department of Internal Medicine, Leesin Hemodialysis and Intervention Clinic, Busan
| | - Kipyo Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Joon Ho Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
| | - Jin Ho Lee
- Division of Nephrology, Department of Internal Medicine, Leesin Hemodialysis and Intervention Clinic, Busan
| | - Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon, Republic of Korea
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Kim HS, Lee JH, Lee DY, Kim HY, Kim DH, Oh JS, Sin YH, Kim JK, Hwang SD. Allograft dysfunction and parenchymal necrosis associated with renal artery stenosis and perigraft hematoma after kidney transplantation. Korean Journal of Transplantation 2020; 34:126-131. [PMID: 35769345 PMCID: PMC9187043 DOI: 10.4285/kjt.2020.34.2.126] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 04/11/2020] [Accepted: 04/12/2020] [Indexed: 11/21/2022] Open
Abstract
Transplant renal artery stenosis (TRAS) is one cause of allograft dysfunction. TRAS causes parenchymal necrosis and graft insufficiency. Herein, we report the case of a 40-year-old female with end-stage renal disease due to immunoglobulin A nephropathy, who underwent kidney transplantation with her elder sister. The surgery was successful and the allograft showed primary graft function. At postoperative day (POD) 2, urine output decreased sharply. We checked a non-enhanced abdominal computed tomography scan which showed subcapsular and pelvic cavity hematomas. She underwent hematoma removal surgery with renal upper polar capsulotomy. Bleeding control was successful, but her serum creatinine was 5.4 mg/dL. At POD 25, abdomen magnetic resonance angiography showed significant stenosis at the anastomosis site between the graft renal artery and the recipient’s internal iliac artery. Then, percutaneous transluminal angioplasty was implemented. Significant stenosis (>80%) was detected at the anastomotic site and a 5-mm stent was inserted at stenotic lesion with post-stent balloon angioplasty using a 5-mm balloon catheter. The renal arterial diameter and blood flow were normalized. At postoperative 5 months, a 99mTc dimercaptosuccinic acid scan showed multiple focal radioisotope defects. At 54 months after renal transplantation, her serum creatinine level was 4.0 mg/dL and her glomerular filtration rate was 13 mL/min/1.73 m2. Hence, we report that TRAS can cause parenchymal necrosis and allograft dysfunction.
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Affiliation(s)
- Han Sae Kim
- Department of Internal Medicine, Q Hospital, Busan, Korea
| | - Jin Ho Lee
- Department of Internal Medicine, Bongseng Memorial Hospital, Busan, Korea
| | - Dong Yeol Lee
- Department of Internal Medicine, Bongseng Memorial Hospital, Busan, Korea
| | - Hee Yeoun Kim
- Department of Internal Medicine, Bongseng Memorial Hospital, Busan, Korea
| | - Dong Han Kim
- Department of Internal Medicine, Bongseng Memorial Hospital, Busan, Korea
| | - Joon Seok Oh
- Department of Internal Medicine, Bongseng Memorial Hospital, Busan, Korea
| | - Yong Hun Sin
- Department of Internal Medicine, Bongseng Memorial Hospital, Busan, Korea
| | - Joong Kyung Kim
- Department of Internal Medicine, Bongseng Memorial Hospital, Busan, Korea
| | - Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
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Hwang SD, Kim K, Kim YJ, Lee SW, Lee JH, Song JH. Effect of statins on cardiovascular complications in chronic kidney disease patients: A network meta-analysis. Medicine (Baltimore) 2020; 99:e20061. [PMID: 32481375 DOI: 10.1097/md.0000000000020061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The rates of cardiovascular mortality and morbidity are increased in advanced chronic kidney disease (CKD). Mild to moderate CKD is associated with an increase in cardiovascular events. This study aims to investigate the effects of statins on patient mortality and cardiac events. STUDY APPRAISAL AND SYNTHESIS METHODS Studies on statins (atorvastatin, rosuvastatin, fluvastatin, lovastatin, pravastatin, simvastatin, and simvastatin + ezetimibe) in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and Science Citation Index Expanded databases from 1970 to February 2019 were analyzed. Inclusion criteria were randomized control trials and adult patients (>18 years old). Reviews, observational studies, and clinical trials that did not clearly define outcomes or that did not have thrombosis as an outcome were excluded. We performed direct and indirect network meta-analysis using Bayesian models and ranked different statins using generation mixed treatment comparison (GeMTC) and Stata version 13. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) of network meta-analysis approach specified 4 levels of certainty for a given result: high, moderate, low, and very low. The outcomes were cardiac events, cardiac mortality, and all-cause mortality. RESULTS Nineteen studies (45,863 patients) were included. Compared with placebos, pravastatin 40 mg group showed a significantly lower patient mortality (odds ratio 0.66 [95% credible interval, 0.46-0.91]).Atorvastatin 80 mg, fluvastatin 40 mg, lovastatin 20 mg, pravastatin 40 mg, and simvastatin 40 mg showed significant results in reducing cardiac events.In rank probability, pravastatin showed the best effect at all-cause mortality rate. Lovastatin, fluvastatin, and pravastatin showed good effects in the 1st, 2nd, and 3rd ranks in cardiac events. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Pravastatin 40 mg demonstrated the best effect on all-cause mortality, and was observed to be effective with high ranking in cardiac events. We anticipate that the data of this study will assist physicians in making informed decisions when selecting statins, such as pravastatin, as a treatment option for CKD patients.
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Affiliation(s)
- Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon
| | - Kipyo Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon
| | - Yoon Ji Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Mediplex Sejong Hospital, Incheon
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon
| | - Jin Ho Lee
- Division of Nephrology, Department of Internal Medicine, Leesin Hemodialysis and Intervention Clinic, Busan, South Korea
| | - Joon Ho Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon
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Kim YJ, Hwang SD, Lim S. Effects of Sodium-Glucose Cotransporter Inhibitor/Glucagon-Like Peptide-1 Receptor Agonist Add-On to Insulin Therapy on Glucose Homeostasis and Body Weight in Patients With Type 1 Diabetes: A Network Meta-Analysis. Front Endocrinol (Lausanne) 2020; 11:553. [PMID: 32973680 PMCID: PMC7466678 DOI: 10.3389/fendo.2020.00553] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/06/2020] [Indexed: 12/16/2022] Open
Abstract
Many patients with type 1 diabetes (T1D) do not achieve the glycemic target goal with insulin treatment. In this study, we aimed to evaluate the efficacy and safety of add-on to insulin therapy in patients with T1D. We conducted direct and indirect network meta-analyses using Bayesian models and ranked hypoglycemic agents via mixed treatment comparison, using data from the CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded databases. Randomized controlled trials (RCTs) involving patients with T1D treated with insulin and add-on metformin or sodium-glucose cotransporter inhibitors or glucagon-like peptide-1 receptor agonists from January 1970 to September 2019 were included in this study. Twenty-three RCTs with 5,151 subjects were divided into the following groups: insulin alone, insulin+metformin, insulin+canagliflozin, insulin+dapagliflozin, insulin+empagliflozin, insulin+sotagliflozin, insulin+liraglutide, and insulin+exenatide. HbA1c level in the insulin+sotagliflozin group was significantly lower than that in the insulin alone group (mean difference: -0.43, 95% credible interval: -0.62 to -0.23). Total daily insulin dose in the insulin+sotagliflozin group was significantly lower than that in the insulin alone group. Compared with that in the insulin alone group, body weight in the groups treated with insulin+add-on canagliflozin, sotagliflozin, and exenatide was significantly decreased by 4.5, 2.8, and 5.1 kg, respectively. Hypoglycemic episodes did not differ among the groups. In patients with T1D, insulin+sotagliflozin decreased the HbA1c level, daily insulin dose, and body weight without hypoglycemia compared with insulin monotherapy. Insulin+canagliflozin or insulin+exenatide was effective in reducing body weight compared with insulin alone. In conclusion, sotagliflozin treatment decreased not only the HbA1c levels and insulin dose but also the body weight without causing hypoglycemia in patients with T1D. Treatment with canagliflozin and exenatide effectively reduced body weight in patients with T1D. However, ketoacidosis associated with the use of SGLT inhibitors should be considered in these patients. Thus, our results suggest that sotagliflozin has a high probability of being ranked first as an adjunctive therapy to insulin in patients with T1D.
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Affiliation(s)
- Yoon Ji Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Mediplex Sejong Hospital, Incheon, South Korea
| | - Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, South Korea
| | - Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- *Correspondence: Soo Lim
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Jhee JH, Hwang SD, Song JH, Lee SW. The Impact of Comorbidity Burden on The Association between Vascular Access Type and Clinical Outcomes among Elderly Patients Undergoing Hemodialysis. Sci Rep 2019; 9:18156. [PMID: 31796787 PMCID: PMC6890785 DOI: 10.1038/s41598-019-54191-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/06/2019] [Indexed: 11/13/2022] Open
Abstract
The optimal vascular access type for elderly hemodialysis patients is controversial. We evaluated the impact of comorbidity burden on the association between vascular access type and mortality risk among 23,100 hemodialysis patients aged ≥65 years from the Korean Society of Nephrology End-Stage Renal Disease registry data. Subjects were stratified into tertiles according to the simplified Charlson comorbidity index (sCCI), and the survival and hospitalization rates were compared with respect to vascular access type: arteriovenous fistula (AVF), arteriovenous graft (AVG), and central venous catheter (CVC). Among all tertiles of sCCI, CVC use showed highest risk of mortality than AVF use. In the lowest to middle tertile, no difference was observed in survival rates between the use of AVF and AVG. However, in the highest tertile, AVG use showed higher risk of mortality than AVF use. When subjects were classified according to a combination of sCCI tertile and access type (AVF vs. AVG), patients with the highest CCI with AVG showed 1.75-folded increased risk of mortality than those with the lowest sCCI with AVF. Hospitalization rates due to access malfunction were highest in patients with CVC in all sCCI tertiles. In the highest tertile, patients with AVG showed increased rates of hospitalization compared to those with AVF due to access malfunction. However, hospitalization rates due to access infection were highest in patients with AVG in all tertiles. The use of AVF may be of benefit and switching to AVF should be considered in elderly hemodialysis patients with a high burden of comorbidity.
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Affiliation(s)
- Jong Hyun Jhee
- Division of Nephrology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University, College of Medicine, Incheon, Korea
| | - Joon Ho Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University, College of Medicine, Incheon, Korea
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University, College of Medicine, Incheon, Korea.
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15
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Lee JH, Kim HY, Lee DY, Kim YJ, Lee HR, Oh JS, Sin YH, Kim JK, Hwang SD. Efficacy and Safety of Ultra-Low-Dose Valganciclovir Chemoprophylaxis for Cytomegalovirus Infection in High-Risk Kidney Transplantation Patients. Transplant Proc 2019; 51:2689-2692. [DOI: 10.1016/j.transproceed.2019.04.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/30/2019] [Accepted: 04/11/2019] [Indexed: 10/26/2022]
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16
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Kim S, Lee YS, Kim DH, Yang A, Lee T, Hwang SD, Kwon DG, Lee JE. Long-term follow-up on MURCS (Müllerian duct, renal, cervical somite dysplasia) association and a review of the literature. Ann Pediatr Endocrinol Metab 2019; 24:207-211. [PMID: 31607116 PMCID: PMC6790868 DOI: 10.6065/apem.2019.24.3.207] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 04/01/2019] [Accepted: 04/12/2019] [Indexed: 11/20/2022] Open
Abstract
Müllerian duct aplasia-renal aplasia-cervicothoracic somite dysplasia (MURCS) association is a unique development disorder with four common types of malformations that include uterine aplasia or hypoplasia, renal ectopy or agenesis, vertebral anomalies, and short stature. The majority of MURCS patients are diagnosed with primary amenorrhea from late-adolescence. However, a few cases with MURCS association are not well diagnosed during childhood and long-term outcomes are not well reported. We report a case of an 8-year-old girl with MURCS association who presented with recurrent urinary tract infections and multiple congenital malformations, and who was followed for 10 years until adulthood. MURCS association should be considered as one of the differential diagnoses when evaluating prepubertal females with vertebral and renal malformations.
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Affiliation(s)
- Sun Kim
- Department of Pediatrics, Inha University Graduate school of Medicine, Inha University Hospital, Incheon, Korea
| | - Yeong Seok Lee
- Department of Pediatrics, Inha University Graduate school of Medicine, Inha University Hospital, Incheon, Korea
| | - Dong Hyun Kim
- Department of Pediatrics, Inha University Graduate school of Medicine, Inha University Hospital, Incheon, Korea
| | - Aram Yang
- Department of Pediatrics, Inha University Graduate school of Medicine, Inha University Hospital, Incheon, Korea
| | - Tack Lee
- Department of Urology, Inha University College of Medicine, Incheon, Korea
| | - Seun Deuk Hwang
- Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Dae Gyu Kwon
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Korea
| | - Ji Eun Lee
- Department of Pediatrics, Inha University Graduate school of Medicine, Inha University Hospital, Incheon, Korea
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Hwang SD, Lee JH, Jhee JH, Song JH, Kim JK, Lee SW. Impact of body mass index on survival in patients undergoing peritoneal dialysis: Analysis of data from the Insan Memorial End-Stage Renal Disease Registry of Korea (1985-2014). Kidney Res Clin Pract 2019; 38:239-249. [PMID: 31096315 PMCID: PMC6577214 DOI: 10.23876/j.krcp.18.0106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/07/2018] [Revised: 12/30/2018] [Accepted: 01/22/2019] [Indexed: 12/11/2022] Open
Abstract
Background Significant increases in the prevalence of obesity have been observed among patients with peritoneal dialysis (PD). The impact of body mass index (BMI) on survival remains unknown in Korean PD patients. Methods Among data of 80,674 patients on PD acquired from the Insan Memorial ESRD Registry database for the years 1985 to 2014, 6,071 cases were analyzed. Subjects were classified by baseline BMI; < 21.19 kg/m2 (quartile 1, n = 1,518), 21.19 to 23.18 kg/m2 (quartile 2, reference; n = 1,453), 23.19 to 25.71 kg/m2 (quartile 3, n = 1,583), and > 25.71 kg/m2 (quartile 4, n = 1,517). Results Mean age was 65.8 years, and baseline BMI was 23.57 kg/m2. Numbers of male and diabetic patients were 3,492 (57.5%) and 2,192 (36.1%), respectively. Among 6,071 cases, 2,229 (36.7%) all-cause deaths occurred. As a whole, Kaplan–Meier survival curves according to BMI quartiles was significantly different (P = 0.001). All-cause mortality was significantly higher in quartile 4 than in the reference (hazard ratio [HR] = 1.154, 95% confidence interval [CI], 1.025–1.300; P = 0.018). There was no statistical difference in all-cause mortality among BMI quartiles in diabetic patients on PD. In non-diabetic patients, all-cause mortality of quartiles 1 and 3 was not different from the reference, but the HR was 1.176 times higher in quartile 4 (95% CI, 1.024–1.350; P = 0.022). Conclusion Baseline BMI > 25.71 kg/m2 seems to be an important risk factor for all-cause mortality in Korean PD patients.
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Affiliation(s)
- Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Jin Ho Lee
- Division of Nephrology, Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea
| | - Jong Hyun Jhee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Joon Ho Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Joong Kyung Kim
- Division of Nephrology, Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
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LEE JINHO, Lee DY, Kim HY, Oh JS, Kim SM, Park YK, Sin YH, Kim JK, Hwang SD, Song JH. SP510Clinical outcomes according to the type of peritoneal dialysis catheter: coiled versus straight tip. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- JIN HO LEE
- Bong Seng Memorial Hospital, BUSAN, Republic of Korea
| | - Dong Yeol Lee
- Bong Seng Memorial Hospital, BUSAN, Republic of Korea
| | - Hee Yeoun Kim
- Bong Seng Memorial Hospital, BUSAN, Republic of Korea
| | - Joon Seok Oh
- Bong Seng Memorial Hospital, BUSAN, Republic of Korea
| | - Seong Min Kim
- Bong Seng Memorial Hospital, BUSAN, Republic of Korea
| | - Yong Ki Park
- Bong Seng Memorial Hospital, BUSAN, Republic of Korea
| | - Yong Hun Sin
- Bong Seng Memorial Hospital, BUSAN, Republic of Korea
| | | | - Seun Deuk Hwang
- Inha University College of Medicine, Incheon, Republic of Korea
| | - Joon Ho Song
- Inha University College of Medicine, Incheon, Republic of Korea
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Jhee JH, Hwang SD, Song JH, Lee SW. Upper Normal Serum Creatinine Concentrations as a Predictor for Chronic Kidney Disease: Analysis of 14 Years' Korean Genome and Epidemiology Study (KoGES). J Clin Med 2018; 7:E463. [PMID: 30469454 PMCID: PMC6262490 DOI: 10.3390/jcm7110463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 01/10/2023] Open
Abstract
Both serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) have been used to assess kidney function in public health check-ups. However, when the sCr is within the normal levels but the eGFR is <60 mL/min/1.73 m², a dilemma arises, as the patients might progress to chronic kidney disease (CKD) after several years. We aimed to evaluate the association between normal sCr and the risk of incident CKD in the general population. For this, 9445 subjects from the Korean Genome and Epidemiology Study, with normal sCr and eGFR of >60 mL/min/1.73 m² were analyzed. The subjects were classified into quartiles based on sCr levels. The primary outcome was the development of eGFR <60 mL/min/1.73 m² on two consecutive measures. During a mean follow-up of 8.4 ± 4.3 years, 779 (8.2%) subjects developed eGFR <60 mL/min/1.73 m². The incidence of the development of eGFR <60 mL/min/1.73 m² was higher in the higher quartiles than in the lowest quartile. In multivariable Cox analysis, the highest quartile was associated with an increased risk for the development of eGFR <60 mL/min/1.73 m² (hazard ratio (HR), 4.71; 95% confidence interval (CI), 3.29⁻6.74 in females; HR, 12.77; 95% CI, 7.69⁻21.23 in males). In the receiver operating characteristic curve analysis, adding sCr to the traditional risk factors for CKD improved the accuracy of predicting the development of eGFR <60 mL/min/1.73 m² (area under the curve, 0.83 vs. 0.80 in females and 0.85 vs. 0.78 in males), and the cutoff value of sCr was 0.75 mg/dL and 0.78 mg/dL in females and males. Cautious interpretation is necessary when sCr is within the normal range, considering that the upper normal range of sCr has a higher risk of CKD development.
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Affiliation(s)
- Jong Hyun Jhee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University, College of Medicine, Incheon 22332, Korea.
| | - Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University, College of Medicine, Incheon 22332, Korea.
| | - Joon Ho Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University, College of Medicine, Incheon 22332, Korea.
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University, College of Medicine, Incheon 22332, Korea.
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Hwang SD, Lee JH, Lee SW, Kim JK, Kim MJ, Song JH. Risk of overhydration and low lean tissue index as measured using a body composition monitor in patients on hemodialysis: a systemic review and meta-analysis. Ren Fail 2018; 40:51-59. [PMID: 29347876 PMCID: PMC6014525 DOI: 10.1080/0886022x.2017.1419963] [Citation(s) in RCA: 18] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Overhydration and sarcopenia, related to an individual's nutritional status, have been associated with increased cardiovascular mortality and poor prognosis in patients on hemodialysis. The purpose of this study was to investigate the prediction of overhydration and sarcopenia on mortality in patients on hemodialysis using a body composition monitor. We conducted a systematic review and meta-analysis using a random-effects model. We searched the Cochrane Central Register, OVID MEDLINE, EMBASE and PubMed databases for all studies published prior to December 9, 2016 and reviewed the reference lists of relevant reviews, registered trials and relevant conference proceedings. The overhydration group (fluid excess, >15% vs. the normohydration group) and the low lean tissue index group ( <10%) were compared with a reference group. Six trials, consisting of 29,469 patients, were included in the pooled analysis. The pooled hazard ratio for overall survival of the overhydration group, compared with the reference normohydration group was 1.798 (95% confidence interval [CI]: 1.53-2.804, p = .001). The hazard ratio for mortality in the low lean tissue index group was 1.533 (95% CI, 1.411-1.644; p = .001) in the random-effects model. The results from the most recent study showed the greatest heterogeneity in the sensitivity analysis. Low lean tissue index and overhydration, measured using a body composition monitor, were associated with a high mortality rate in patients on hemodialysis.
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Affiliation(s)
- Seun Deuk Hwang
- a Division of Nephrology and Hypertension, Department of Internal Medicine , Inha University College of Medicine , Incheon , Korea
| | - Jin Ho Lee
- b Divison of Nephrology, Department of Internal Medicine , Bong Seng Memorial Hospital , Busan , Korea
| | - Seoung Woo Lee
- a Division of Nephrology and Hypertension, Department of Internal Medicine , Inha University College of Medicine , Incheon , Korea
| | - Joong Kyung Kim
- b Divison of Nephrology, Department of Internal Medicine , Bong Seng Memorial Hospital , Busan , Korea
| | - Moon-Jae Kim
- a Division of Nephrology and Hypertension, Department of Internal Medicine , Inha University College of Medicine , Incheon , Korea
| | - Joon Ho Song
- a Division of Nephrology and Hypertension, Department of Internal Medicine , Inha University College of Medicine , Incheon , Korea
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Lee JH, Hwang SD, Song JH, Kim H, Lee DY, Oh JS, Sin YH, Kim JK. Placement of tunneled cuffed catheter for hemodialysis: Micropuncture kit versus Angiocath IV catheter. J Vasc Access 2018; 20:50-54. [PMID: 30071773 DOI: 10.1177/1129729818777963] [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: 11/15/2022] Open
Abstract
INTRODUCTION Tunneled cuffed catheters provide stable, instantaneous, long-term intravenous access for hemodialysis. Because catheterization is often performed in emergency situations, speed and accuracy are emphasized. METHODS We retrospectively compared the Micropuncture kit with the standard 18-gauge Angiocath IV catheter for tunneled cuffed catheter insertion in the right jugular vein. From June 2016 to May 2017, 31 tunneled cuffed catheters were successfully inserted via the Micropuncture kit and another 31 via the Angiocath IV catheter. All patients underwent the same ultrasound-guided procedure performed by a single experienced interventionalist. Procedure time was the time from draping of the patient to the completion of povidone dressing after the catheterization. In our center, the Angio Lab nurse maintains records, including procedure time and method for every procedure. All patient records were retrospectively tracked through electronic medical record review. The primary outcome was procedure time and the secondary outcomes were complications and cost-effectiveness. RESULTS There were no significant differences in the patients' demographic data between the two groups. However, procedure time was significantly shorter in the Angiocath group than in the Micropuncture group (12.4 ± 3.5 vs 17.6 ± 6.9 min, p = 0.001); there were no serious complications, such as hemorrhage, pneumothorax, or hematoma, in both groups. Moreover, cost-effectiveness was better in the Angiocath group than in the Micropuncture group (0.34 vs 52 US$, p < 0.01). CONCLUSIONS Using the Angiocath IV catheter can reduce procedure time and cost with no severe complications. Moreover, experienced practitioners can reduce the risk of complications when using Angiocath. There are several limitations to this study. First, it was retrospective; second, it was not randomized; and finally, it was conducted by only one experienced interventionalist.
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Affiliation(s)
- Jin Ho Lee
- 1 Division of Nephrology, Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea
| | - Seun Deuk Hwang
- 2 Division of Nephrology and Hypertension, Department of Internal Medicine, School of Medicine, Inha University, Incheon, Korea
| | - Joon Ho Song
- 2 Division of Nephrology and Hypertension, Department of Internal Medicine, School of Medicine, Inha University, Incheon, Korea
| | - HeeYeoun Kim
- 1 Division of Nephrology, Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea
| | - Dong Yeol Lee
- 1 Division of Nephrology, Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea
| | - Joon Seok Oh
- 1 Division of Nephrology, Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea
| | - Yong Hun Sin
- 1 Division of Nephrology, Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea
| | - Joong Kyung Kim
- 1 Division of Nephrology, Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea
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Hwang SD, Lee JH, Lee SW, Kim JK, Kim MJ, Song JH. Comparison of ultrasound scan blood flow measurement versus other forms of surveillance in the thrombosis rate of hemodialysis access: A systemic review and meta-analysis. Medicine (Baltimore) 2018; 97:e11194. [PMID: 30045249 PMCID: PMC6078674 DOI: 10.1097/md.0000000000011194] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The benefit of access flow surveillance in preventing vascular access thrombosis and failure remains controversial, as many randomized clinical trials (RCTs) have failed to demonstrate consistent results. The aim of this study was to perform a meta-analysis including newly published RCTs with a subgroup analysis for arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs). METHODS A systematic review of the available literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. An electronic search was conducted using the MEDLINE, EMBASE, and Cochrane Library databases of RCTs conducted from 1970 to 2017 that involved access flow surveillance. As a result, 9 RCTs met our criteria. The control group was defined by indirect and various surveillance methods such as dynamic venous pressure measurement and physical examination. Conversely, the interventional group was defined as a noninvasive duplex ultrasound scan (USS) or ultrasound dilution that directly measured the flow of vascular access. RESULTS The studies included 990 patients comprising 658 native AVFs and 332 AVGs. The prevalence of diabetes was 29.3%and 30.5% in the interventional and control groups, respectively. The estimated overall pooled risk ratio (RR) of thrombosis was 0.782 [95% confidence interval (95% CI), 0.553-1.107; P = .17], favoring interventional group, although this was not statistically significant. In the subgroup analysis, the pooled RR of thrombosis was .562 (95% CI, 0.346-0.915; P = .02) for AVFs, which significantly favored the interventional group. Conversely, the pooled RR for AVGs was 1.104 (95% CI, 0.672-1.816; P = .70). CONCLUSION The surveillance method to measure access flow through USS showed a significant benefit for reducing thrombosis in AVFs. The result encourages adherence to the current guidelines for AVFs. However, no benefit was found regarding AVGs. Recent guidelines with a "one-size-fits-all" approach may be revised to a "tailored-to-risk" approach.
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Affiliation(s)
- Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon
| | - Jin Ho Lee
- Division of Nephrology, Department of Internal Medicine, Bongseng-Memorial Hospital, Busan, Korea
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon
| | - Joong kyung Kim
- Division of Nephrology, Department of Internal Medicine, Bongseng-Memorial Hospital, Busan, Korea
| | - Moon-Jae Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon
| | - Joon Ho Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University School of Medicine, Incheon
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Kim KI, Hwang SD, Cho MY, Jung SH, Kim YC, Jeong HD. A natural infection by the red sea bream iridovirus-type Megalocytivirus in the golden mandarin fish Siniperca scherzeri. J Fish Dis 2018; 41:1229-1233. [PMID: 29806082 DOI: 10.1111/jfd.12815] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 06/08/2023]
Abstract
An outbreak of a Megalocytivirus infection was found in the golden mandarin fish Siniperca scherzeri during September and October 2016, in Korea. Phylogeny and genetic diversity based on the major capsid protein (MCP) and adenosine triphosphatase (ATPase) genes showed a new strain. Designated as GMIV, this strain derived from the golden mandarin fish was suggested to belong to the red sea bream iridovirus (RSIV)-subgroup I. Additionally, this train clustered with the ehime-1 strain from red sea bream Pagrus major in Japan and was distinguished from circulating isolates (RSIV-type subgroup II and turbot reddish body iridovirus [TRBIV] type) in Korea. The infection level, evaluated by qPCR, ranged from 8.18 × 102 to 7.95 × 106 copies/mg of tissue individually, suggesting that the infected fish were in the disease-transmitting stage. The diseased fish showed degenerative changes associated with cytomegaly in the spleen as general sign of Megalocytivirus infection. The results confirm that the RSIV-type Megalocytivirus might have crossed the environmental and species barriers to cause widespread infection in freshwater fish.
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Affiliation(s)
- K I Kim
- Pathology Division, National Institute of Fisheries Science, Busan, Korea
| | - S D Hwang
- Aquatic Disease Control Division, National Institute of Fisheries Science, Busan, Korea
| | - M Y Cho
- Pathology Division, National Institute of Fisheries Science, Busan, Korea
| | - S H Jung
- Pathology Division, National Institute of Fisheries Science, Busan, Korea
| | - Y C Kim
- Department of Aquatic Life Medicine, Pukyong National University, Busan, Korea
| | - H D Jeong
- Department of Aquatic Life Medicine, Pukyong National University, Busan, Korea
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Hwang SD, Park KM, Lee SW, Han JY, Kim MJ, Song JH. Graft Contrast-Induced Nephropathy Caused by Prerenal Transplant Computed Tomography: A Case Report. Transplant Proc 2018; 50:1196-1198. [PMID: 29731093 DOI: 10.1016/j.transproceed.2018.01.020] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/22/2017] [Accepted: 01/22/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND We report a case of posttransplant contrast-induced nephropathy (CIN) that occurred after performing computed tomography (CT) scanning for pretransplant cardiac and vascular evaluation. CASE PRESENTATION The patient had an 8-year history of hemodialysis and was admitted to the hospital for a kidney transplant from a deceased donor. Cardiac CT imaging and 3-dimensional low-extremity CT angiography were performed to confirm the patient's cardiac and iliac artery function. After successful transplantation surgery, the patient had a urine output of 250 mL and a reduced creatinine level from 8.8 to 2.3 mg/dL on postoperative day 4. However, urine output suddenly decreased to 30 mL and the creatinine level suddenly increased to 7.6 md/dL without any symptoms such as fever or graft tenderness. The patient tested negative for panel-reactive antibodies and donor-specific antibodies, and he was discharged 1 week later with an improvement in symptoms. Results of a graft biopsy indicated CIN, and the contrast-enhanced kidney was observed on noncontrast CT imaging that was performed immediately after transplantation to rule out vascular problems as well as other complications. CONCLUSIONS There may be residual contrast present from pretransplant CT imaging, which could affect the functional kidney grafts after transplantation and can lead to CIN. This scenario could potentially lead to loss of graft function, suggesting that caution should be observed when ordering CT imaging in this patient population.
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Affiliation(s)
- S D Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - K-M Park
- Department of General Surgery, Inha University, Incheon, Republic of Korea
| | - S W Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - J-Y Han
- Department of Pathology, Inha University Hospital, Inha University Medical College, Incheon, Republic of Korea
| | - M-J Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea
| | - J H Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Republic of Korea.
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Kim MJ, Jee JH, Hwang SD. SP090ELEVATED BLOOD PRESSURE IS THE MOST COMMON TRIGGER FACTOR OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME IN PATIENTS WITH CHRONIC KIDNEY DISEASE. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Moon-Jae Kim
- Div. of Nephrology-Hypertension, Inha University Hospital, Incheon City, Korea, Republic of
| | - J H Jee
- Div. of Nephrology-Hypertension, Inha University Hospital, Incheon City, Korea, Republic of
| | - S D Hwang
- Div. of Nephrology-Hypertension, Inha University Hospital, Incheon City, Korea, Republic of
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26
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Cha B, Kim DY, Jang H, Hwang SD, Choi HJ, Kim MJ. Unusual Case of Posterior Reversible Encephalopathy Syndrome in a Patient with Anti-glomerular Basement Membrane Antibody Glomerulonephritis: A Case Report and Review of the Literature. Electrolyte Blood Press 2017; 15:12-16. [PMID: 29042902 PMCID: PMC5641497 DOI: 10.5049/ebp.2017.15.1.12] [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: 05/10/2017] [Accepted: 09/12/2017] [Indexed: 01/13/2023] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is characterized by a clinical and radiological entity with the sudden onset of seizures, headache, altered consciousness, and visual disturbances in patients with the findings of reversible vasogenic subcortical edema without infarction. Hypertension, renal disease, and autoimmune disease are co-morbid conditions of PRES. Nevertheless, there have only been a few case reports of PRES in a patient with anti-glomerular basement membrane antibody glomerulonephritis (anti-GBM GN). This paper presents the possible first Korean case of a 36-year-old woman with the striking features of PRES. She presented with a sudden onset of visual blindness, headache, and seizure. The brain MRI images revealed hyperintense lesions in both the occipital and parietal lobes, which suggested vasogenic edema. Three months before this presentation, she was diagnosed with anti-GBM GN. Since then, she underwent immunosuppression with cyclophosphamide and steroid, and hemodialysis for renal failure with a treatment of anti-GBM GN.
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Affiliation(s)
- Boram Cha
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Dae Young Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Hyunil Jang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Huck Jei Choi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Moon-Jae Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
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Kim YJ, Hwang SD, Oh TJ, Kim KM, Jang HC, Kimm H, Kim HC, Jee SH, Lim S. Association Between Obesity and Chronic Kidney Disease, Defined by Both Glomerular Filtration Rate and Albuminuria, in Korean Adults. Metab Syndr Relat Disord 2017; 15:416-422. [PMID: 28832275 DOI: 10.1089/met.2017.0053] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) has often been defined based on glomerular filtration rate (GFR) alone. The Kidney Disease: Improving Global Outcomes guideline highlights albuminuria in the CKD definition. Thus, we investigated the association between obesity and CKD, as defined by both GFR and albuminuria, in Korean adults. METHODS We used Korea National Health and Nutrition Examination Survey 2011-2014 data (N = 19,331, ≥19 years old) representing the national Korean population. CKD was classified by (1) estimated GFR (eGFR) < 60 mL/min/1.73 m2 (CKDGFR); (2) albumin-to-creatinine ratio (ACR) ≥30 mg/gram (CKDACR); and (3) eGFR < 60 mL/min/1.73 m2 or ACR ≥30 mg/gram (CKDRisk). Associations between obesity and each CKD category were evaluated using multivariate logistic regression analysis. RESULTS The prevalence rates of CKDGFR, CKDACR, and CKDRisk were 2.2%, 6.7%, and 8.1%, respectively. Compared with the normal body mass index (BMI; 18.5-22.9 kg/m2) group, men with BMI ≥ 25 kg/m2 had 1.88 times greater risk of CKDGFR in the adjusted model [95% confidence interval (CI), 1.26-2.80; P = 0.002]; BMI was not significantly associated with CKDGFR in women. In contrast, both men and women with BMI ≥ 25 kg/m2 had 1.58 and 1.40 times higher risk of CKDACR (95% CI, 1.21-2.07 and 1.08-1.81, respectively, both P < 0.01). Obese men and women had 1.65 and 1.38 times higher risk of CKDRisk (95% CI, 1.29-2.12 and 1.09-1.75, respectively, both P < 0.01). CONCLUSIONS Obesity was significantly associated with an increased ACR-based CKD risk. Longitudinal studies are needed to investigate the role of overweight and obesity in the development and progression of CKD.
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Affiliation(s)
- Yoon Ji Kim
- 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, Mediplex Sejong Hospital , Incheon, South Korea
| | - Seun Deuk Hwang
- 2 Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine , Incheon, South Korea
| | - Tae Jung Oh
- 3 Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam, South Korea
| | - Kyoung Min Kim
- 3 Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam, South Korea
| | - Hak Chul Jang
- 3 Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam, South Korea
| | - Heejin Kimm
- 4 Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University , Seoul, South Korea
| | - Hyeon Chang Kim
- 5 Department of Preventive Medicine, Yonsei University College of Medicine , Seoul, South Korea .,6 Department of Preventive Medicine, Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine , Seoul, South Korea
| | - Sun Ha Jee
- 4 Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University , Seoul, South Korea
| | - Soo Lim
- 3 Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine , Seongnam, South Korea
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28
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Hwang SD, Kim SH, Kim YO, Jin DC, Song HC, Choi EJ, Kim YL, Kim YS, Kang SW, Kim NH, Yang CW, Kim YK. Serum Alkaline Phosphatase Levels Predict Infection-Related Mortality and Hospitalization in Peritoneal Dialysis Patients. PLoS One 2016; 11:e0157361. [PMID: 27310428 PMCID: PMC4911047 DOI: 10.1371/journal.pone.0157361] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 05/28/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Serum alkaline phosphatase (ALP) levels have been reported to be associated with all-cause and cardiovascular mortality in peritoneal dialysis (PD) patients. However, it is unclear whether serum ALP levels predict infection-related clinical outcomes in PD patients. The aim of this study was to determine the relationships between serum ALP levels, infection-related mortality and hospitalization in PD patients. METHODS PD patients from the Clinical Research Center registry for end-stage renal disease, a multicenter prospective observational cohort study in Korea, were included in the present study. Patients were categorized into three groups by serum ALP tertiles as follows: Tertile 1, ALP <78 U/L; Tertile 2, ALP = 78-155 U/L; Tertile 3, ALP >155 U/L. Tertile 1 was used as the reference category. The primary outcomes were infection-related mortality and hospitalization. RESULTS A total of 1,455 PD patients were included. The median follow-up period was 32 months. The most common cause of infection-related mortality and hospitalization was PD-related peritonitis. Multivariate Cox regression analyses showed that patients in the highest tertiles of serum ALP levels were at higher risk of infection-related mortality (HR 2.29, 95% CI, 1.42-5.21, P = 0.008) after adjustment for clinical variables. Higher tertiles of serum ALP levels were associated with higher risk of infection-related hospitalization (Tertile 2: HR 1.56, 95% CI, 1.18-2.19, P = 0.009, tertile 3: HR 1.34, 95% CI, 1.03-2.62, P = 0.031). CONCLUSIONS Our data showed that elevated serum ALP levels were independently associated with a higher risk of infection-related mortality and hospitalization in PD patients.
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Affiliation(s)
- Seun Deuk Hwang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su-Hyun Kim
- Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Young Ok Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Chan Jin
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Chul Song
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Euy Jin Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yon-Su Kim
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Nam-Ho Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Chul Woo Yang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Kyun Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Cell Death Disease Research Center, The Catholic University of Korea, Seoul, Korea
- * E-mail:
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29
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Jang H, Hwang SD, Lee SW. Perirectal Abscess: Camouflaged as Culture Negative Peritonitis in a Continuous Ambulatory Peritoneal Dialysis Patient. Ther Apher Dial 2016; 20:206-8. [DOI: 10.1111/1744-9987.12384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 09/13/2015] [Accepted: 10/16/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Hyunil Jang
- Division of Nephrology and Hypertension, Department of Internal Medicine; Inha University College of Medicine; Incheon Korea
| | - Seun Deuk Hwang
- Division of Nephrology and Hypertension, Department of Internal Medicine; Inha University College of Medicine; Incheon Korea
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine; Inha University College of Medicine; Incheon Korea
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30
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Hwang SD, Chung BH, Oh EJ, Choi BS, Park CW, Kim YS, Yang CW. Effect of Pretransplant Rituximab Use on Posttransplant Clinical Outcomes in Patients with High Panel Reactive Antibody Scores. Nephron Clin Pract 2015; 130:239-44. [PMID: 26182858 DOI: 10.1159/000435924] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 06/11/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Whether desensitization treatment is needed before kidney transplant (KT) in patients with high panel reactive antibody (PRA) scores but negative cross-matching (XM) tests remains controversial. This study aimed to investigate the effect of pretransplant rituximab (RTX) treatment on clinical outcomes in these patients. METHODS The study included 52 patients with PRA >50% but negative XM tests before transplantation. A single dose of RTX was administered before KT in 32 patients (RTX group). The 20 patients without RTX treatment were considered as controls (CON group). We compared the development of acute antibody-mediated rejection (AMR), rejection-free survival, allograft function, allograft and patients' survival rates and infection rates between the 2 groups. RESULTS The rate of acute AMR development was significantly lower in the RTX group than in the CON group (p = 0.009), and rejection-free survival in the RTX group was higher than in the CON group (p = 0.042). The 3-year graft and patient survival rates were higher in the RTX group than in the CON group (p = 0.007 and p = 0.037, respectively). There were no significant differences in infection rates between the groups. CONCLUSIONS Pretransplant use of RTX improved the post-transplant clinical outcomes in patients with high PRAs but negative XM tests.
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Affiliation(s)
- Seun Deuk Hwang
- Transplant Research Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Abstract
PURPOSE Due to their comorbidities, dialysis patients have many chances to undergo radiologic procedures using iodinated contrast media. We aimed to assess time-sequenced blood oxidative stress level after contrast exposure in hemodialysis (HD) patients compared to those in the non-dialysis population. MATERIALS AND METHODS We included 21 anuric HD patients [HD-coronary angiography (CAG) group] and 23 persons with normal renal function (nonHD-CAG group) scheduled for CAG, and assessed 4 oxidative stress markers [advanced oxidation protein products (AOPP); catalase; 8-hydroxydeoxyguanosine; and malondialdehyde] before and after CAG, and subsequently up to 28 days. RESULTS In the nonHD-CAG group, only AOPP increased immediately after CAG and returned to baseline within one day. However, in the HD-CAG group, all four oxidative stress markers were significantly increased starting one day after CAG, and remained elevated longer than those in the nonHD-CAG group. Especially, AOPP level remained elevated for a month after contrast exposure. CONCLUSION Our study showed that iodinated contrast media induces severe and prolonged oxidative stress in HD patients.
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Affiliation(s)
- Seun Deuk Hwang
- Division of Nephrology, Department of Internal Medicine, Kwandong University Medical College, 24 Beomil-ro 579beon-gil, Gangneung 210-701, Korea.
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Hwang SD, Midorikawa N, Punnarak P, Kikuchi Y, Kondo H, Hirono I, Aoki T. Inhibition of Hirame rhabdovirus growth by RNA aptamers. J Fish Dis 2012; 35:927-934. [PMID: 22943666 DOI: 10.1111/jfd.12000] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2012] [Revised: 07/19/2012] [Accepted: 07/24/2012] [Indexed: 06/01/2023]
Abstract
RNA aptamers are artificial nucleic acids that specifically bind to a wide variety of targets. They are an effective tool for pharmaceutical research and development of antiviral agents. Here, we describe four Hirame rhabdovirus (HIRRV)-RNA aptamers (H1, H2, H3 and H4) that we obtained from an in vitro process called the systematic evolution of ligands by exponential enrichment (SELEX). The HIRRV-RNA aptamers specifically bind to HIRRV. Hirame natural embryo (HINAE) cells treated with virus and the RNA aptamer showed a decrease in appearance of cytopathic effect when compared with control (treated only with virus). Rhodovulum sulfidophilum was transformed with genes for the RNA aptamers, and the aptamers were detected in the culture medium, indicating that they were secreted from the cells. Thus, the recombinant R. sulfidophilum might be a powerful tool for the prevention of HIRRV in aquaculture.
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Affiliation(s)
- S D Hwang
- Laboratory of Genome Science, Tokyo University of Marine Science and Technology, Minato-ku, Tokyo, Japan
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33
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Park MS, Yim AS, Chung SH, Lee EY, Cha MK, Kim JH, Song KI, Han DC, Hwang SD, Moon C, Lee HB. Effect of prolonged subcutaneous implantation of peritoneal catheter on peritonitis rate during CAPD: a prospective randomized study. Blood Purif 2000; 16:171-8. [PMID: 9681160 DOI: 10.1159/000014331] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We conducted a prospective randomized controlled study to confirm our earlier observation that prolonged subcutaneous implantation of peritoneal catheter reduced peritonitis rate when compared to retrospective data from patients with catheters placed by conventional access technique. A total of 60 patients were randomized into two groups: 30 patients had catheters left implanted subcutaneously for 6 weeks (I) and the other 30 patients had catheters inserted by conventional technique and had 6 weeks of break-in period (C). Subgroups of 15 patients each with new and conventional techniques used Y-connector (IY, CY) and remaining patients used standard spikes (IS, CS). Mean age was 47.7 years (range 16-71); 61.0% were male and 44.1% diabetics. Peritonitis, exit site infection, simultaneous peritonitis and exit site infection, and complication related to Staphylococcus or Pseudomonas infections were observed for up to 2 years in each patient after initiation of bag exchange or until termination of CAPD by transfer to hemodialysis or by death. Total duration of observation was 493.2 patient-months for new access technique and 409.6 patient-months for conventional technique. Patients in IY group had the lowest incidence of peritonitis (1/14.9 patient-months) and exit site infection (1/16.8 patient-months) among four subgroups. Peritonitis rate in IY was significantly lower compared to CY or CS. The total peritonitis-free period in those patients who did not experience peritonitis during the observation period was also significantly longer in IY (120 patient-months) than in CY (26 patient-months), IS (10.6 patient-months), or CS (10.4 patient-months). Simultaneous peritonitis and exit site infection was observed in none of IY group but 3 episodes in CY, 4 episodes in IS, and 3 episodes in CS. The rates of complications related to Staphylococcus aureus and Pseudomonas infections were also significantly lower in IY than in CY, IS, or CS. Technique survival did not differ between the two groups. The present results confirm our previous observation that the new access technique reduces the incidence of peritonitis probably by reducing infection via periluminal route. The Y-connector system further reduces peritonitis rate by reducing infection via intraluminal route.
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Affiliation(s)
- M S Park
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
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34
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Park MS, Lee HA, Chu WS, Yang DH, Hwang SD. Peritoneal accumulation of AGE and peritoneal membrane permeability. Perit Dial Int 2000; 20:452-60. [PMID: 11007378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND In continuous ambulatory peritoneal dialysis (CAPD), the peritoneal membrane is continuously exposed to high-glucose-containing dialysis solutions. Abnormally high glucose concentration in the peritoneal cavity may enhance advanced glycosylation end-product (AGE) formation and accumulation in the peritoneum. Increased AGE accumulation in the peritoneum, decreased ultrafiltration volume, and increased peritoneal permeability in long-term dialysis patients have been reported. AIM The purpose of the study was to evaluate the relation between peritoneal membrane permeability and peritoneal accumulation of AGE. METHODS Peritoneal membrane permeability was evaluated by peritoneal equilibration test (PET) using dialysis solutions containing 4.25% glucose. Serum, dialysate, and peritoneal tissue levels of AGE were measured by ELISA method using polyclonal anti-AGE antibody. Peritoneal biopsy was performed during peritoneal catheter insertion [new group (group N), n = 18] and removal [long-term group (group LT), n = 10]. Peritoneal catheters were removed due to exit-site infection not extended into the internal cuff (n = 6) and ultrafiltration failure (n = 4) after 51.6+/-31.5 months (13 - 101 months) of dialysis. PET data obtained within 3 months after the initiation of CAPD or before catheter removal were included in this study. Ten patients in group N and 4 patients in group LT were diabetic. Patients in group LT were significantly younger (46.5+/-11.1 years vs 57.5+/-1.3 years) and experienced more episodes of peritonitis (3.5+/-2.1 vs 0.2+/-0.7) than group N. RESULTS Peritoneal tissue AGE level in group LT was significantly higher than in group N, in both nondiabetic (0.187+/-0.108 U/mg vs 0.093+/-0.08 U/mg of hydroxyproline, p < 0.03) and diabetic patients (0.384+/-0.035 U/mg vs 0.152+/-0.082 U/mg of hydroxyproline, p < 0.03), while serum and dialysate levels did not differ between the groups in both nondiabetic and diabetic patients. Drain volume (2600+/-237 mL vs 2766+/-222 mL, p = 0.07) and D4/D0 glucose (0.229+/-0.066 vs 0.298+/-0.081, p < 0.009) were lower, and D4/P4 creatinine (0.807+/-0.100 vs 0.653+/-0.144, p< 0.0001) and D1/P1 sodium (0.886+/-0.040 vs 0.822+/-0.032, p < 0.0003) were significantly higher in group LT than in group N. On linear regression analysis, AGE level in the peritoneum was directly correlated with duration of CAPD (r = 0.476, p = 0.012), number of peritonitis episodes (r = 0.433, p = 0.0215), D4/P4 creatinine (r = 0.546, p < 0.027), and D1/P1 sodium (r = 0.422, p = 0.0254), and inversely correlated with drain volume (r = 0.432, p = 0.022) and D4/D0 glucose (r = 0.552, p < 0.0023). AGE level in the peritoneal tissue and dialysate were significantly higher in diabetics than in nondiabetics in group LT, while these differences were not found in group N. Serum AGE level did not differ between nondiabetics and diabetics in either group N or group LT. Drain volume and D4/D0 glucose were lower and D4/P4 creatinine and D1/P1 sodium higher in diabetics than in nondiabetics in both groups. CONCLUSION Peritoneal accumulation of AGE increased with time on CAPD and number of peritonitis episodes, and was directly related with peritoneal permeability. Peritoneal AGE accumulation and peritoneal permeability in diabetic patients were higher than in nondiabetic patients from the beginning of CAPD.
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Affiliation(s)
- M S Park
- Department of Internal Medicine, School of Medicine, Soon Chun Hyang University, Seoul, Korea.
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Kim YS, Kim SI, Hwang SG, Kim JO, Cho JY, Lee JS, Lee MS, Hwang SD, Shim CS. Diversity of core promoter mutations in immune clearance phase of chronic HBV infection. Eur J Gastroenterol Hepatol 1999; 11:821-5. [PMID: 10514111 DOI: 10.1097/00042737-199908000-00002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND/AIMS Transcription of HBV (hepatitis B virus) pre-core and pre-genomic mRNAs is controlled by core promoter. Therefore, mutations in the core promoter region might change the activity of liver diseases through an altered transcriptional level of the mRNA. The present study was carried out to determine the diversity of HBV core promoter sequences in chronic HBV carriers. METHODS DNA sequences in the core promoter region were determined after cloning the PCR product. Two groups of chronic HBV carriers with HBeAg, including five cases of asymptomatic carriers (ASCs, 21 clones) and eight with chronic hepatitis (CH, 50 clones) were studied. RESULTS Mutations in the core promoter were found in three out of the ASCs (11 clones), and in all eight cases in the CH group (48 clones). While mutations at nucleotide 1762 (A-->T) and 1764(G-->A) were not found in ASC, mutations at the same positions were found in all the cases of CH group (40 clones) (P=0.003). Diverse patterns of mutations in the core promoter were observed in each patient in the CH group. CONCLUSIONS Further studies are needed to determine whether the diversity of HBV core promoter mutations has clinical significance such as the seroconversion of HBeAg to anti-HBe.
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Affiliation(s)
- Y S Kim
- Institute for Digestive Research, Department of Internal Medicine, Soonchunhyang University, Seoul, Korea
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Han KJ, Jung IS, Kim CK, Park SK, Kim DW, Baick SH, Won JH, Hong DS, Hwang SD, Moon C, Park HS. A case of CMV disease of the jejunum in a patient with non-Hodgkin's lymphoma. Korean J Intern Med 1998; 13:143-6. [PMID: 9735673 PMCID: PMC4531948 DOI: 10.3904/kjim.1998.13.2.143] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
CMV infection may occur anywhere in the gastrointestinal tract. Among the small intestine, ileum is the most common site of CMV disease and infection of jejunum is a rare one in patients with CMV gastroenteritis. Although rare, the reason why the recognition of this diagnosis is important is that it cause the lethal hemorrhage and perforation of gastrointestinal tract when its diagnosis and treatment was delayed. Rapid diagnosis are able to using the immunohistochemical stain in shell vial culture of infected specimen or peripheral neutrophils preparation in viremic patients within 8 to 36 hours. The treatment of choice is antiviral agent or surgical resection. We experienced a case of CMV disease of jejunum in patient with non-Hodgkin's lymphoma who showed severe ulceration in jejunum and massive intestinal hemorrhage, and he survived after successful treatment with segmental resection of jejunum and intravenous ganciclovir.
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Affiliation(s)
- K J Han
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
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Woo JH, Kim YS, Hwang SD. Regulation of toxic shock syndrome toxin-1 gene in Staphylococcus aureus. Mol Cells 1997; 7:28-33. [PMID: 9085261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Staphylococcus aureus produces various proteins in response to discrete signals from the external environment like many other pathogenic microorganisms. Certain staphylococcal exoproteins including toxic shock syndrome toxin-1 (TSST-1) are secreted according to the stimuli from the environment, and the quantity synthesized is influenced by a number of different parameters. Using a transposon Tn551-mediated mutagenesis, a mutant (RN 6390) defective in TSST-1 from synthesis was constructed. TSST-1 from wild strain and mutant stain were purified and quantitated from culture supernatants of Staphylococcus aureus. The mutant strain RN 6390 produced only 2% of TSST-1 compared with that produced by the wild strain RN4282. Southern blot hybridization with a tst (TSST-1 gene) probe indicated that the inactivated chromosomal locus is distinct from the tst. These results suggest that transposition by Tn551 inactivated a chromosomal locus whose activity was essential for the expression of the TSST-1 gene.
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Affiliation(s)
- J H Woo
- Department of Internal Medicine, Soon Chun Hyang University, Asan, Korea
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Abstract
The sample of mental patients in sheltered care has a lower arrest rate than the general population in California in all categories of crimes, except for violent crimes. For violent crimes, the sheltered-care population is likely to be arrested at 1.33 times the rate of the state population, even when the heterogeneity of aggravated assault was taken into consideration. This indicates empirically that the mentally ill in sheltered care are more dangerous than the general population. For prediction of criminality, four factors are found to be significant predictors of resident criminality after 1973: (a) prior crime history, (b) age, (c) use of alcohol and drugs, and (d) sex (male). Among these factors, prior crime history is the single most powerful predictor of resident criminal activity. This is another confirmation of most of the previous research findings. Although there have been controversies over the issue of the dangerousness of the mentally ill, the results of this study, overall, support the most recent findings of studies in which the mentally ill population pose greater threats to the community than the general population. Now it is time to consider more specific and practical measures to monitor and carefully follow up the discharged population, especially those with prior crime history, and prevent further violent crimes. This will in turn help to promote the reintegration of the mentally ill in the community.
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Affiliation(s)
- S D Hwang
- College of Social Sciences, Choongjoo, Korea
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Han DC, Kim JH, Cha MK, Song KI, Hwang SD, Lee HB. Effect of HMG CoA reductase inhibition on TGF-beta 1 mRNA expression in diabetic rat glomeruli. Kidney Int Suppl 1995; 51:S61-5. [PMID: 7474692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- D C Han
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
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Segal SP, Hwang SD. Licensure of sheltered-care facilities: does it assure quality? Soc Work 1994; 39:124-131. [PMID: 8310318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
In California, licensure was intended to assure a minimum level of quality in sheltered-care facilities for the mentally ill population. This longitudinal study relates characteristics of facilities, their residents, and communities to subsequent licensure and considers differences between licensed and unlicensed facilities at follow-up. Initial interviews were completed in 214 facilities in 1973 six months before the implementation of the California Residential Facilities Licensing Act. Follow-up interviews occurred in 1985. Results indicate that although licensure occurred with greater frequency among facilities serving the most disabled population, licensure neither predicts nor has as its apparent consequence the development of higher-quality facilities. An alternative approach to quality assurance is offered.
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Affiliation(s)
- S P Segal
- Mental Health and Social Welfare Research Group, School of Social Welfare, University of California, Berkeley 94720
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Lee SK, Park MS, Han DC, Hwang SD, Moon C, Lee HB. Effects of erythropoietin-induced hemopoiesis on peritoneal transport and on in vitro T cell response in CAPD. Adv Perit Dial 1992; 8:453-6. [PMID: 1361846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
UNLABELLED In order to investigate the therapeutic efficacy of subcutaneously administered erythropoietin (rHuEPO) and the effects of rHuEPO-induced hemopoiesis on peritoneal transport and on cellular immune responses, we performed standardized peritoneal equilibration tests and measured T cell subsets and phytohemagglutinin (PHA)-induced interleukin-2 receptor (IL-2R) expression of PBMC by flow cytometry before and after subcutaneous rHuEPO (Eprex-, Cilag), 4000 U twice weekly, in 13 stable CAPD patients. Hct increased from 21.3 +/- 3.4% to 30.0 +/- 4.8% after 1 mo and to 32.7 +/- 4.9% after 2 mon of rHuEPO. Drained volume after 4 hrs of dwell with 4.25% dialysate increased from 2,675 +/- 204 ml to 2,807 +/- 174 ml (P < 0.05). D4/P4 creatinine increased from 0.68 +/- 0.07 to 0.71 +/- 0.06 (P < 0.05) and creatinine clearance from 7.57 +/- 0.71 to 8.03 +/- 0.63 ml/min (P < 0.05). The number of total circulating lymphocytes, T4,T8, T4/T8 with or without PHA did not change after rHuEPO. PHA-induced IL-2R expression by PBMC as expressed by mean channel of fluorescence intensity increased from 149.8 +/- 6.7 to 156.8 +/- 6.1 (P < 0.05). CONCLUSION Subcutaneous rHuEPO is effective in correcting anemia in CAPD patients. rHuEPO-induced hemopoiesis is associated with increase in peritoneal creatinine and water transport and also with PHA-induced IL-2R expression.
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Affiliation(s)
- S K Lee
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
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Han DC, Cha HK, So IN, Chung SH, Park MS, Lee SK, Woo JH, Hwang SD, Moon C, Lee HB. Subcutaneously implanted catheters reduce the incidence of peritonitis during CAPD by eliminating infection by periluminal route. Adv Perit Dial 1992; 8:298-301. [PMID: 1361810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
UNLABELLED Recent experiences with Y-connectors suggest that the flush-before-fill effectively reduces intraluminal infection. Periluminal infection, however, remains an important route of peritonitis (P). We have recently reported reduced P incidence with the introduction of a new access technique as described by Moncrief in which the external segment of peritoneal catheter is left implanted subcutaneously for 6 weeks before exteriorization and bag exchanges. P developed once every 14.0 patient-mos with the new access while the incidence was one episode per 10.7 mos with conventional access. Significantly fewer patients with the new access compared to those with conventional access experienced P during the observation period (p < 0.01). Although the overall incidence of exit-site infection (ESI) was not different, there were significantly fewer episodes of simultaneous P and ESI with the new access (2P in 47 episodes of ESI) than with conventional access (36P in 126 ESI). While 10 of the 36 episodes of simultaneous infection in the conventional technique were caused by same organisms, none of the 2 episodes with the new access technique was caused by same organisms. CONCLUSION The results of this study suggest that the new access technique reduces P incidence by virtually eliminating infection by the periluminal route.
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Affiliation(s)
- D C Han
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
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Hwang SD, Shun YJ, Meng CL. [Primary culture of human gingival tissue cells in vitro]. Zhonghua Ya Yi Xue Hui Za Zhi 1991; 10:88-97. [PMID: 1726486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In order to establish and understand the in vitro human gingival cell culture system, this study presents newly developed and characterized primary culture cell types derived from human gingival tissues. Cell cultures were established from human gingival tissues by means of the explant technique and monolayer culture. Cells were studied under stable growth conditions and were characterized in terms of their morphology, Giemsa staining, anti-epithelial cytoskeletal staining, and proliferative parameters. At confluence, disoriented fibroblast cells formed the multilayered culture. The epithelial nature of the epithelioid cells was confirmed by staining for cytoplasmic keratin which is an exclusive epithelial cell protein. The growth curve and cell doubling time of the fibroblasts were evaluated. The results indicate that both epithelial cells and fibroblasts can be cultured from human gingival tissue. This technique provides us with a stable source of normal cells for further in-depth in vitro studies.
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Affiliation(s)
- S D Hwang
- Army General Hospital 804, Taiwan, ROC
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Abstract
We studied platelet function and plasma factor VIII in 15 healthy individuals and 41 uremic patients to evaluate the effect of dialysis on the hemostatic defect in uremia. Platelet counts and bleeding times were normal in all subjects. Platelet retention on glass beads was significantly reduced in all uremic patients. Platelet aggregation induced by collagen and ADP were significantly reduced in uremic patients on conservative therapy. ADP-induced platelet aggregation was normal but collagen-induced aggregation remained abnormal in hemodialysis (HD) patients. Both ADP- and collagen-induced aggregation were normal in patients on continuous ambulatory peritoneal dialysis (CAPD). FVIII: C was normal in all uremic patients. Both FVIII:vWF and FVIII R:Ag were significantly elevated in all uremic patients. In conclusion, platelet function was significantly defective and FVIII:vWF and FVIII R:Ag significantly elevated in uremia. HD and CAPD did not influence factor VIII levels or function nor did they improve platelet retention. Platelet aggregation improved partially on HD and completely on CAPD.
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