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( Hyoungnae Kim ),( Young Youl Hyun ),( Hae-ryong Yun ),( Young Su Joo ),( Yaeni Kim ),( Ji Yong Jung ),( Jong Cheol Jeong ),( Jayoun Kim ),( Jung Tak Park ),( Tae-hyun Yoo ),( Shin-wook Kang ),( Kook 대한신장학회 2023 Kidney Research and Clinical Practice Vol.42 No.4
Background: The new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations without a race coefficient have gained recognition across the United States. We aimed to test whether these new equations performed well in Korean patients with chronic kidney disease (CKD). Methods: This study included 2,149 patients with CKD G1-G5 without kidney replacement therapy from the Korean Cohort Study for Outcome in Patients with CKD (KNOW-CKD). The estimated glomerular filtration rate (eGFR) was calculated using the new CKD-EPI equations with serum creatinine and cystatin C. The primary outcome was 5-year risk of kidney failure with replacement therapy (KFRT). Results: When we adopted the new creatinine equation [eGFR<sub>cr</sub> (NEW)], 81 patients (23.1%) with CKD G3a based on the current creatinine equation (eGFR<sub>cr</sub>) were reclassified as CKD G2. Accordingly, the number of patients with eGFR of <60 mL/min/1.73 m<sup>2</sup> decreased from 1,393 (64.8%) to 1,312 (61.1%). The time-dependent area under the receiver operating characteristic curve for 5-year KFRT risk was comparable between the eGFR<sub>cr</sub> (NEW) (0.941; 95% confidence interval [CI], 0.922-0.960) and eGFRcr (0.941; 95% CI, 0.922-0.961). The eGFR<sub>cr</sub> (NEW) showed slightly better discrimination and reclassification than the eGFR<sub>cr</sub>. However, the new creatinine and cystatin C equation [eGFR<sub>cr-cys</sub> (NEW)] performed similarly to the current creatinine and cystatin C equation. Furthermore, eGFR<sub>cr-cys</sub> (NEW) did not show better performance for KFRT risk than eGFR<sub>cr</sub> (NEW). Conclusion: Both the current and the new CKD-EPI equations showed excellent predictive performance for 5-year KFRT risk in Korean patients with CKD. These new equations need to be further tested for other clinical outcomes in Koreans.
Kim, Hyoungnae,Yun, Hae-Ryong,Park, Seohyun,Jhee, Jong Hyun,Park, Jung Tak,Yoo, Tae-Hyun,Lee, Kyu-Beck,Kim, Yeong-Hoon,Sung, Su-Ah,Lee, Joongyub,Kang, Shin-Wook,Choi, Kyu Hun,Ahn, Curie,Han, Seung Hye Elsevier 2018 Cytokine Vol.103 No.-
<P><B>Abstract</B></P> <P><B>Background</B></P> <P>Adiponectin is an adipokine secreted by adipocytes. A low adiponectin level is a significant risk factor of diabetes mellitus and cardiovascular disease. Recent studies have shown that adiponectin is negatively associated with hematopoiesis and predicts the development of anemia in the general population. In chronic kidney disease (CKD) patients, circulating adiponectin level is paradoxically elevated and the role of adiponectin is complex. Therefore, we evaluated the relationship between adiponectin and anemia in these patients.</P> <P><B>Methods</B></P> <P>This prospective longitudinal study included 2113 patients from the KNOW-CKD study (KoreaN cohort study for Outcome in patients With CKD), after excluding 125 without data on adiponectin levels. Hemoglobin levels were measured yearly during a mean follow-up period of 23.7 months. Anemia was defined as hemoglobin levels of <13.0 and 12.0 g/dL for men and women, respectively.</P> <P><B>Results</B></P> <P>Mean patient age was 53.6 ± 12.2 years, and 1289 (61%) were men. The mean estimated glomerular filtration rate (eGFR) was 50.4 ± 30.2 mL min<SUP>−1</SUP> 1.73 m<SUP>−2</SUP>. Serum adiponectin level was inversely associated with body mass index, eGFR, log-transformed C-reactive protein, and positively with Charlson comorbidity index, urine protein to creatinine ratio, and high density lipoprotein cholesterol. In addition, serum adiponectin level was also negatively correlated with hemoglobin level and reticulocyte production index in both men and women. In multivariable linear regression analysis after adjustment of multiple confounders, adiponectin was negatively associated with hemoglobin (men, <I>β</I> = −0.219, <I>P</I> < .001; women, <I>β</I> = −0.09, <I>P</I> = .025). Among 1227 patients without anemia at baseline, 307 newly developed anemia during the follow-up period. In multivariable Cox regression analysis after adjustment of confounders, high adiponectin level was significantly associated with an increased risk of incident anemia (per 1 µg/mL increase, hazard ratio, 1.02; 95% confidence interval 1.01–1.04; <I>P</I> = .001).</P> <P><B>Conclusions</B></P> <P>A high serum adiponectin level is independently associated with a low hemoglobin level and predicts the development of anemia in patients with CKD. These findings reveal the potential role of adiponectin in CKD-related anemia.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Adiponectin is negatively associated with hemoglobin in general population. </LI> <LI> The role of adiponectin is complex in patients with chronic kidney disease. </LI> <LI> Serum adiponectin is a predictive marker of anemia development in patients with chronic kidney disease. </LI> </UL> </P>
( Hyoungnae Kim ),( Joohwan Kim ),( Changhwan Seo ),( Misol Lee ),( Min-uk Cha ),( Su-young Jung ),( Jong Hyun Jhee ),( Seohyun Park ),( Hae-ryong Yun ),( Youn Kyung Kee ),( Chang-yun Yoon ),( Hyung J 대한신장학회 2017 Kidney Research and Clinical Practice Vol.36 No.1
Background: Many epidemiologic studies have reported on the controversial concept of the obesity paradox. The presence of acute kidney injury (AKI) can accelerate energy-consuming processes, particularly in patients requiring continuous renal replacement therapy (CRRT). Thus, we aimed to investigate whether obesity can provide a survival benefit in this highly catabolic condition. Methods: We conducted an observational study in 212 patients who had undergone CRRT owing to various causes of AKI between 2010 and 2014. The study end point was defined as death that occurred within 30 days after the initiation of CRRT. Results: Patients were categorized into three groups according to tertiles of body mass index (BMI). During 30 days after the initiation of CRRT, 39 patients (57.4%) in the highest tertile died, as compared with 58 patients (78.4%) in the lowest tertile (P = 0.02). In a multivariable analysis adjusted for cofounding factors, the highest tertile of BMI was significantly associated with a decreased risk of death (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.37- 0.87; P = 0.01). This significant association remained unaltered for 60-day (HR, 0.64; 95% CI, 0.43-0.94; P = 0.03) and 90-day mortality (HR, 0.66; 95% CI, 0.44-0.97; P = 0.03). Conclusion: This study showed that a higher BMI confer a survival benefit over a lower BMI in AKI patients undergoing CRRT.
( Min-ho Kim ),( Hyung Jung Oh ),( Soon Hyo Kwon ),( Jin Seok Jeon ),( Hyunjin Noh ),( Dong Cheol Han ),( Hyoungnae Kim ),( Dong-ryeol Ryu ) 대한신장학회 2021 Kidney Research and Clinical Practice Vol.40 No.4
Background: Metformin has recently been shown not to increase the risk of lactic acidosis in patients with chronic kidney disease (CKD). Thus, the criteria for metformin use in this population has expanded. However, the relationship between metformin use and clinical outcomes in CKD remains controversial. Methods: This study considered data from 97,713 diabetes patients with an estimated glomerular filtration rate of <60 mL/min/1.73 ㎡. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), and the secondary outcomes were all-cause mortality and incident end-stage renal disease (ESRD). Results: Metformin users had a significantly higher risk of MACCE than non-users (hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.14-1.26; p < 0.001). However, metformin users had a lower risk of all-cause mortality (HR, 0.78; 95% CI, 0.74-0.81; p < 0.001) and ESRD (HR, 0.44; 95% CI, 0.42-0.47; p < 0.001) during follow-up than non-users did. The relationships between metformin use and clinical outcomes remained consistent in propensity score matching analyses and subgroup analyses of patients with adequate adherence to anti-diabetes medication. Conclusion: Treatment with metformin was associated with an increased risk of MACCE in patients with diabetes and CKD. However, metformin users had a lower risk of all-cause mortality and ESRD during follow-up than non-users did. Therefore, metformin needs to be carefully used in patients with CKD.
( Ji Yong Jung ),( Kyung Don Yoo ),( Eunjeong Kang ),( Hee Gyung Kang ),( Su Hyun Kim ),( Hyoungnae Kim ),( Hyo Jin Kim ),( Tae-jin Park ),( Sang Heon Suh ),( Jong Cheol Jeong ),( Ji-young Choi ),( Yo 대한신장학회 2021 Kidney Research and Clinical Practice Vol.40 No.4
The Korean Society of Nephrology (KSN) has published a clinical practice guideline (CPG) document for maintenance hemodialysis (HD). The document, 2021 Clinical Practice Guideline on Optimal HD Treatment, is based on an extensive evidence-oriented review of the benefits of preparation, initiation, and maintenance therapy for HD, with the participation of representative experts from the KSN under the methodologists’ support for guideline development. It was intended to help clinicians participating in HD treatment make safer and more effective clinical decisions by providing user-friendly guidelines. We hope that this CPG will be meaningful as a recommendation in practice, but not on a regulatory rule basis, as different approaches and treatments may be used by health care providers depending on the individual patient’s condition. This CPG consists of eight sections and 15 key questions. Each begins with statements that are graded by the strength of recommendations and quality of the evidence. Each statement is followed by a summary of the evidence supporting the recommendations. There is also a link to full-text documents and lists of the most important reports so that the readers can read further (most of this is available online).
( Ji Yong Jung ),( Kyung Don Yoo ),( Eunjeong Kang ),( Hee Gyung Kang ),( Su Hyun Kim ),( Hyoungnae Kim ),( Hyo Jin Kim ),( Tae-jin Park ),( Sang Heon Suh ),( Jong Cheol Jeong ),( Ji-young Choi ),( Yo 대한내과학회 2022 The Korean Journal of Internal Medicine Vol.37 No.4
The Korean Society of Nephrology (KSN) has published a clinical practice guideline (CPG) document for maintenance hemodialysis (HD). The document, 2021 Clinical Practice Guideline on Optimal HD Treatment, is based on an extensive evidence-oriented review of the benefits of preparation, initiation, and maintenance therapy for HD, with the participation of representative experts from the KSN under the methodologists’ support for guideline development. It was intended to help clinicians participating in HD treatment make safer and more effective clinical decisions by providing user-friendly guidelines. We hope that this CPG will be meaningful as a recommendation in practice, but not on a regulatory rule basis, as different approaches and treatments may be used by health care providers depending on the individual patient’s condition. This CPG consists of eight sections and 15 key questions. Each begins with statements that are graded by the strength of recommendations and quality of the evidence. Each statement is followed by a summary of the evidence supporting the recommendations. There are also a link to full-text documents and lists of the most important reports so that the readers can read further (most of this is available online).
Seo, Changhwan,Kim, Seonghun,Lee, Misol,Cha, Min-Uk,Kim, Hyoungnae,Park, Seohyun,Yun, Hae-Ryong,Jhee, Jong Hyun,Kee, Youn Kyung,Han, Seung Hyeok,Yoo, Tae-Hyun,Kang, Shin-Wook,Park, Jung Tak American Association of Clinical Endocrinologists 2018 Endocrine practice Vol.24 No.3
<P>Conclusion: THRT may decrease the risk of CVD in DMN patients with SCH. Randomized trials are needed to verify this finding.</P>
Obesity, Metabolic Abnormality, and Progression of CKD
Yun, Hae-Ryong,Kim, Hyoungnae,Park, Jung Tak,Chang, Tae Ik,Yoo, Tae-Hyun,Kang, Shin-Wook,Choi, Kyu Hun,Sung, Suah,Kim, Soo Wan,Lee, Joongyub,Oh, Kook-Hwan,Ahn, Curie,Han, Seung Hyeok,Park, Seohyun,Jhe Elsevier 2018 American Journal of Kidney Diseases Vol.72 No.3
<P><B>Rationale & Objective</B></P> <P>Recent studies have yielded conflicting findings on the association between obesity and progression of chronic kidney disease (CKD). Few studies have evaluated whether metabolic abnormalities may accelerate the rate of progression of CKD.</P> <P><B>Study Design</B></P> <P>Prospective observational cohort study.</P> <P><B>Setting & Participants</B></P> <P>1,940 participants from the Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD)</P> <P><B>Predictors</B></P> <P>Obesity and metabolic abnormality. Obesity was defined as body mass index ≥ 25kg/m<SUP>2</SUP>. Metabolic abnormality was defined as the presence of 3 or more of the following 5 components: hypertension, fasting glucose level > 125mg/dL or the presence of type 2 diabetes, triglyceride level > 150mg/dL or use of lipid-lowering drugs, high-density lipoprotein cholesterol level ≤ 40mg/dL in men and ≤ 50mg/dL in women, and high-sensitivity C-reactive protein level > 1mg/L.</P> <P><B>Outcome</B></P> <P>A composite of a 50% decline in estimated glomerular filtration rate from the baseline value or end-stage kidney disease.</P> <P><B>Analytic Approach</B></P> <P>Multivariable cause-specific hazards models implemented to assess the association between obesity, metabolic abnormality, and CKD progression.</P> <P><B>Results</B></P> <P>During a mean follow-up of 3.1 years, the primary outcome occurred in 395 (20.4%) patients. In multivariable analyses, after adjustment for confounding factors, obesity and metabolic abnormality were significantly associated with 1.41-fold (95% CI, 1.08-1.83; <I>P</I> =0.01) and 1.38-fold (95% CI, 1.03-1.85; <I>P</I> =0.03) increased risk for adverse renal outcomes, respectively. Patients were categorized into 4 groups depending on the presence of obesity and metabolic abnormality. Compared with those with neither obesity nor metabolic abnormality, those with obesity and metabolic abnormality had a greater risk for CKD progression (HR, 1.53; <I>P</I> =0.03). Those with obesity without metabolic abnormality also had a higher rate of CKD progression (HR, 1.97; <I>P</I> =0.01).</P> <P><B>Limitations</B></P> <P>Observational study, limited power to detect cardiovascular disease outcomes, unmeasured confounders.</P> <P><B>Conclusions</B></P> <P>Both metabolic abnormality and obesity are associated with a significantly increased risk for CKD progression. Notably, obese patients without metabolic abnormality also have an elevated risk for CKD progression.</P>