Effects of residential greenness on clinical outcomes of patients with chronic kidney disease: a large-scale observation study

( Jae Yoon Park ),( Jiyun Jung ),( Yong Chul Kim ),( Hyewon Lee ),( Ejin Kim ),( Yon Su Kim ),( Ho Kim ),( Jung Pyo Lee ) 대한신장학회 2021 Kidney Research and Clinical Practice Vol.40 No.2

Background: As industrialization and urbanization are accelerating, the distribution of green areas is decreasing, particularly in developing countries. Since the 2000s, the effects of surrounding greenness on self-perceived health, including physical and mental health, longevity, and obesity have been reported. However, the effects of surrounding green space on chronic kidney disease are not well understood. Therefore, we investigated the impact of residential greenness on the mortality of chronic kidney disease patients and progression from chronic kidney disease to end-stage renal disease (ESRD). Methods: Using a large-scale observational study, we recruited chronic kidney disease patients (n = 64,565; mean age, 54.0 years; 49.0% of male) who visited three Korean medical centers between January 2001 and December 2016. We investigated the hazard ratios of clinical outcomes per 0.1-point increment of exposure to greenness using various models. Results: During the mean follow-up of 6.8 ± 4.6 years, 5,512 chronic kidney disease patients developed ESRD (8.5%) and 8,543 died (13.2%). In addition, a 0.1-point increase in greenness reduced all-cause mortality risk in chronic kidney disease and ESRD patients and progression of chronic kidney disease to ESRD in a fully adjusted model. The association between mortality in ESRD patients and the normalized difference vegetation index was negatively correlated in people aged >65 years, who had normal weight, were nonsmokers, and lived in a nonmetropolitan area. Conclusion: Chronic kidney disease patients who live in areas with higher levels of greenness are at reduced risk of all-cause mortality and progression to ESRD.

초음파 영상을 이용한 만성 콩팥병의 진단

안유지,예수영 한국방사선학회 2017 한국방사선학회 논문지 Vol.11 No.3

Chronic kidney disease can be treated if it is detected early, but as the disease progresses, it becomes impossible to recover. Finally, renal replacement therapy such as transplantation or dialysis should be used. Ultrasonography is used to diagnose kidney cancer, inflammatory disease, nodular disease, and chronic kidney disease. It is used to identify information about degree of inflammation using information such as kidney size, internal echo characteristics. Currently, the degree of disease in the clinic uses the value of glomerular filtration rate. However, even in ultrasound, changes in the degree of inflammation and disease can be observed. In this study, we used ultrasound images to quantify the changes in brightness, size, cortex, and subclinical changes of the kidney with progression of the disease, and compared them with the glomerular filtration rate used in clinical practice . In 105 cases, we performed 35 cases of normal kidney, 35 cases of early kidney disease, and 35 cases of terminal kidney. The brightness of the cortex of the image was obtained and the difference in brightness between the cortex and the proximal portion was obtained by the slope. The graph of the portion which was not smooth due to the ultrasonic characteristics was used as the function regrass. The size reduction was obtained from the original data. The results were as follows: It was proportional to the glomerular filtration rate. It is considered that the algorithm can be applied to the disease if the algorithm study continues. 만성 콩팥질환은 조기에 발견할 경우 치료가 가능하지만 질병이 진행될수록 회복이 불가능해지며 결국 이식이나 투석 등 신대체요법을 사용하여야 한다. 초음파 검사는 콩팥암, 염증성질환, 결절성 질환, 만성콩팥질환 등을 진단하는 검사 방법으로 콩팥의 크기, 내부 에코의 특성 등의 정보를 이용하여 염증의 정도에 대한 정보를 확인하기 위해서 사용된다. 현재 임상에서 질병의 정도는 사구체 여과율의 수치를 사용한다. 하지만 초음파에서도 염증과 질병의 정도 변화는 관찰이 가능하다. 본 연구에서는 초음파 영상을 컴퓨터 알고리즘을 이용하여 콩팥의 질병이 진행됨에 따라 변화하는 명도와 크기, 겉질과 속질의 불분명해지는 것을 수치로 정량화하여 임상에서 사용되고 있는 사구체여과율과 비교하여 영상이 일치하는지 실험하였다. 전체 영상 105증례에서 정상 콩팥 영상 35증례, 초기 콩팥질환 영상 35증례, 말기 콩팥질환 영상 35증례로 실험하였다. 영상의 겉질의 명도를 구하고 겉질과 신동 부분의 명도차이를 기울기로 구했고, 초음파 특성상 매끄럽지 못한 부분의 그래프는 함수 regrass를 이용하였다. 크기감소는 원본 데이터의 값으로 구하였다. 분석한 결과 영상은 영상의학과 판독과 일치하였고, 사구체 여과율과 비례하였다. 이는 향후 알고리즘 연구가 계속 진행된다면 초음파 영상의 질병에 대한 적용이 가능할 것으로 사료된다.

Variation in the rate of well-controlled status of chronic disease by income level in Korea : 2010 to 2015

Choi, Kun Kug,Kim, Seung Hyuk,Yoo, Kyung Don,Kim, Hyo Jin,Park, Ji In,Hwang, Subin,Chin, Ho Jun,Ku, Ho Suk Williams & Wilkins Co 2018 Medicine Vol.97 No.34

<P><B>Abstract</B></P><P>Although it is known that the prevalence rates of chronic diseases depend on income level, annual changes of the control rate have not been evaluated. In this cross-sectional study, we analyzed the variation in rate of well-controlled status of chronic diseases based on the annual income level using data from national nutrition surveys conducted between 2010 and 2015.</P><P>Prevalence and controlled rate of hypertension, diabetes mellitus, and chronic kidney disease were analyzed in relation to annual income levels, using data from the Korea National Health and Nutrition Examination Survey (KNHANES), obtained from 2010 to 2015. We also analyzed the incidence of use of necessary medical care services and the reasons cited for not using these services.</P><P>The data of 28,759 persons were analyzed. The average age increased, and sex ratio remained unchanged over the study period. Although the prevalence rates of diabetes increased, that of increased glycated hemoglobin gradually decreased. A significant change has been shown recently on the prevalence rates of hypertension patients. The prevalence rates of chronic kidney disease stayed unchanged during the course of the study period. The incidence of controlled chronic disease status increased with the income level, and over time during the study, in the case of diabetes and chronic kidney disease. However, while controlled hypertension status rate increased from year to year, there was no trend of increase with increased income level. The incidence of participants not using hospital services declined with increasing income level, but the rate of economic causes being cited as reasons for not using hospital services increased over time and showed no change among income levels. Results of regression analysis of prevalence rates of chronic diseases by income level showed that lower income groups tended to have higher odds ratios for chronic diseases.</P><P>Our results suggest that the incidence rate of well-controlled chronic disease status remains low in lower income groups. These results imply that financial status may play an important role in the management of chronic diseases.</P>

Framingham risk score and risk of incident chronic kidney disease: A community-based prospective cohort study

( Changhyun Lee ),( Hae-ryong Yun ),( Young Su Joo ),( Sangmi Lee ),( Joohwan Kim ),( Ki Heon Nam ),( Jong Hyun Jhee ),( Jung Tak Park ),( Tae-hyun Yoo ),( Shin-wook Kang ),( Seung Hyeok Han ) 대한신장학회 2019 Kidney Research and Clinical Practice Vol.38 No.1

Background: Cardiovascular disease and chronic kidney disease share several common risk factors. The Framingham risk score is hypothesized to predict chronic kidney disease development. We determined if the Framingham risk scoring system can correctly predict incident chronic kidney disease in the general population. Methods: This study included 9,080 subjects who participated in the Korean Genome and Epidemiology Study between 2001 and 2014 and had normal renal function. The subjects were classified into low- (< 10%), intermediate- (10-20%), and high- ( > 20%) risk groups based on baseline Framingham risk scores. The primary endpoint was de novo chronic kidney disease development (estimated glomerular filtration rate [eGFR], < 60 mL/min/1.73 m2). Results: During a mean follow-up duration of 8.9 ± 4.3 years, 312 (5.3%), 217 (10.8%), and 205 (16.9%) subjects developed chronic kidney disease in the low, intermediate, and high risk groups, respectively (P < 0.001). Multivariable analysis after adjustment for confounding factors showed the hazard ratios for the high- and intermediate risk groups were 2.674 (95% confidence interval [CI], 2.197-3.255) and 1.734 (95% CI, 1.447-2.078), respectively. This association was consistently observed irrespective of proteinuria, age, sex, obesity, or hypertension. The predictive power of this scoring system was lower than that of renal parameters, such as eGFR and proteinuria, but increased when both were included in the prediction model. Conclusion: The Framingham risk score predicted incident chronic kidney disease and enhanced risk stratification in conjunction with traditional renal parameters in the general population with normal renal function.

Potential and Therapeutic Efficacy of Cell-based Therapy Using Mesenchymal Stem Cells for Acute/chronic Kidney Disease

Yun, Chul Won,Lee, Sang Hun MDPI 2019 INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES Vol.20 No.7

<P>Kidney disease can be either acute kidney injury (AKI) or chronic kidney disease (CKD) and it can lead to the development of functional organ failure. Mesenchymal stem cells (MSCs) are derived from a diverse range of human tissues. They are multipotent and have immunomodulatory effects to assist in the recovery from tissue injury and the inhibition of inflammation. Numerous studies have investigated the feasibility, safety, and efficacy of MSC-based therapies for kidney disease. Although the exact mechanism of MSC-based therapy remains uncertain, their therapeutic value in the treatment of a diverse range of kidney diseases has been studied in clinical trials. The use of MSCs is a promising therapeutic strategy for both acute and chronic kidney disease. The mechanism underlying the effects of MSCs on survival rate after transplantation and functional repair of damaged tissue is still ambiguous. The paracrine effects of MSCs on renal recovery, optimization of the microenvironment for cell survival, and control of inflammatory responses are thought to be related to their interaction with the damaged kidney environment. This review discusses recent experimental and clinical findings related to kidney disease, with a focus on the role of MSCs in kidney disease recovery, differentiation, and microenvironment. The therapeutic efficacy and current applications of MSC-based kidney disease therapies are also discussed.</P>

Intensity of statin therapy and renal outcome in chronic kidney disease: Results from the Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease

( Jong Hyun Jhee ),( Young Su Joo ),( Jung Tak Park ),( Tae-hyun Yoo ),( Sue Kyung Park ),( Ji Yong Jung ),( Soo Wan Kim ),( Yun Kyu Oh ),( Kook-hwan Oh ),( Shin-wook Kang ),( Kyu Hun Choi ),( Curie A 대한신장학회 2020 Kidney Research and Clinical Practice Vol.39 No.1

Background: Higher statin intensity is associated with a lower risk of mortality in patients with cardiovascular disease. However, little is known about the relationship between statin intensity and chronic kidney disease (CKD) progression. Methods: We studied whether statin intensity affects kidney function decline in 1,073 patients from the Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease. The participants were classified based on statin intensity as low, moderate, and high. The study endpoint was CKD progression (composite of doubling of serum creatinine, ≥ 50% decrease in estimated glomerular filtration rate [eGFR] from baseline, or end-stage renal disease). Results: The mean age was 56.0 ± 11.4 years, and 665 (62.0%) participants were male. The mean eGFR was 51.7 ± 26.7 mL/min/1.73 ㎡; there were no differences in baseline eGFR among statin intensity groups. During the median follow-up of 39.9 (25.4-61.6) months, 255 (23.8%) patients reached the study endpoint. In multivariable Cox model after adjustment of confounders, the hazard ratios (95% confidence interval) for adverse kidney outcome were 0.97 (0.72-1.30) and 1.15 (0.60-2.20) in moderate and high statin intensity groups, respectively, compared with the low intensity group. In addition, no significant association was observed in subgroups stratified by age, sex, eGFR, and atherosclerotic cardiovascular disease risk scores. Conclusion: We did not observe any significant association between intensity of statin therapy and progression of CKD. Long-term kidney outcomes may not be affected by statin intensity.

The association between shift work and chronic kidney disease in manual labor workers using data from the Korea National Health and Nutrition Examination Survey (KNHANES 2011–2014)

엄준영,김형렬,강구혁,최영곤,박태휘,김수영,장성실,추원오 대한직업환경의학회 2018 대한직업환경의학회지 Vol.30 No.-

Objective: Kidneys are organs having a biological clock, and it is well known that the disruption of the circadian rhythm increases the risk of chronic kidney disease (CKD), including the decline of renal and proteinuria. Because shift work causes circadian disruption, it can directly or indirectly affect the incidence of chronic kidney disease. Therefore, the purpose of this study was to investigate the association between shift work and chronic kidney disease using a Korean representative survey dataset. Methods: This study was comprised of 3504 manual labor workers over 20 years of age from data from the fifth and sixth Korea National Health and Nutrition Examination Survey (2011–2014). The work schedules were classified into two types: day work and shift work. The estimated glomerular filtration rate, which is the ideal marker of renal function, was estimated according to the Chronic Kidney Disease Epidemiology Collaboration creatinine equation, and chronic kidney disease was defined as urinary albumin to a creatinine ratio equal to or high than 30 mg/g and/ or estimated glomerular filtration rate lower than 60 mL/min/1.73m2. The cross-tabulation analysis and multivariate logistic regression analysis were performed to confirm the association between shift work and chronic kidney disease stratified by gender. Results: The risk of CKD showed a significant increase (odds ratio = 2.04, 95% confidence interval = 1.22, 3.41) in the female worker group. The same results were obtained after all confounding variables were adjusted (odds ratio = 2. 34, 95% confidence interval = 1.35, 4.07). However, the results of the male worker group were not significant. Conclusions: In this study using nationally representative surveys, we found that the risk of CKD was higher female workers and shift work. Future prospective cohort studies will be needed to clarify the causal relationship between shift work and CKD.

Tumor Necrosis Factor (TNF-α) and C-reactive Protein (CRP) are Positively Associated with the Risk of Chronic Kidney Disease in Patients with Type 2 Diabetes

여은실,황지윤,박지은,최영주,허갑범,김화영 연세대학교의과대학 2010 Yonsei medical journal Vol.51 No.4

Purpose: Chronic low-grade inflammation may induce chronic kidney disease in patients with type 2 diabetes. This study investigated the relation between inflammatory biomarkers and chronic kidney disease in patients with type 2diabetes, which has not yet been reported in Asian populations. Materials and Methods: A cross-sectional study was performed in 543 patients recruited from diabetic clinics for an ongoing, prospective study. Multivariate logistic regression was used to evaluate the association between inflammatory biomarkers and the presence of chronic kidney disease (estimated glomerular filtration rate < 60mL/min per 1.73 m2 by the simplified Modification of Diet in Renal Disease equation using plasma creatinine). Results: The risk of chronic kidney disease increased in the highest quartiles of C-reactive protein (CRP) [multivariate odds ratio (OR) = 3.73; 95% CI = 1.19-1.70] and tumor necrosis factor-α (multivariate OR = 4.45; 95% CI = 1.63-12.11) compared to the lowest quartiles after adjustments for age, sex, zinc intake, and other putative risk factors for chronic kidney disease. Conclusion: Our results suggest that CRP and tumor necrosis factor-αmay be independent risk factors for chronic kidney disease in patients with type 2diabetes. A causal mechanism of this association should be evaluated in a followup study of Korean patients with type 2 diabetes.

The association between shift work and chronic kidney disease in manual labor workers using data from the Korea National Health and Nutrition Examination Survey (KNHANES 2011–2014)

Jun Young Uhm,Hyoung-Ryoul Kim,Gu Hyeok Kang,Young Gon Choi,Tae Hwi Park,Soo Young Kim,Seong Sil Chang,Won Oh Choo 대한직업환경의학회 2019 대한직업환경의학회지 Vol.30 No.-

Objective: Kidneys are organs having a biological clock, and it is well known that the disruption of the circadian rhythm increases the risk of chronic kidney disease (CKD), including the decline of renal and proteinuria. Because shift work causes circadian disruption, it can directly or indirectly affect the incidence of chronic kidney disease. Therefore, the purpose of this study was to investigate the association between shift work and chronic kidney disease using a Korean representative survey dataset. Methods: This study was comprised of 3504 manual labor workers over 20 years of age from data from the fifth and sixth Korea National Health and Nutrition Examination Survey (2011–2014). The work schedules were classified into two types: day work and shift work. The estimated glomerular filtration rate, which is the ideal marker of renal function, was estimated according to the Chronic Kidney Disease Epidemiology Collaboration creatinine equation, and chronic kidney disease was defined as urinary albumin to a creatinine ratio equal to or high than 30 mg/g and/or estimated glomerular filtration rate lower than 60 mL/min/1.73m2. The cross-tabulation analysis and multivariate logistic regression analysis were performed to confirm the association between shift work and chronic kidney disease stratified by gender. Results: The risk of CKD showed a significant increase (odds ratio = 2.04, 95% confidence interval = 1.22, 3.41) in the female worker group. The same results were obtained after all confounding variables were adjusted (odds ratio = 2. 34, 95% confidence interval = 1.35, 4.07). However, the results of the male worker group were not significant. Conclusions: In this study using nationally representative surveys, we found that the risk of CKD was higher female workers and shift work. Future prospective cohort studies will be needed to clarify the causal relationship between shift work and CKD.

정상 범위의 혈중 요산과 만성신질환

최재경,최재일 대한임상건강증진학회 2010 Korean Journal of Health Promotion Vol.10 No.1

Background: Hyperuricemia is related to renal disease. However, normal uric acid levels have been seen with renal disease. The aim of this study was to investigate the association between normal uric acid levels and chronic kidney disease. Methods: Our subjects included 3,011 patients, 50 years and older, who underwent health examinations at the health promotion center at a university hospital in Seoul from July 2006 to June 2008. We categorized normal serum uric acid levels below 7 mg/dL into four quartiles and assessed the association between chronic kidney disease and increasing uric acid levels. Results : After adjusting for age, gender, education level, income, smoking status, at-risk drinking, regular exercise, obesity, hypertension, diabetes mellitus, and metabolic syndrome, odds ratios of chronic kidney disease for the quartiles of normal serum uric acid levels were 1.53 (95% CI, 1.00-2.34), 1.97 (95% CI, 1.27-3.08), 3.92 (95% CI, 2.46-6.25), compared with the bottom quartile (less than 4.20 mg/dL); and this showed a positive trend (P<0.001). Conclusions : We observed that even within the normal serum uric acid range, increasing levels of uric acid was associated with the risk of chronic kidney disease. Follow-up studies are needed to confirm whether rising, though normal, levels of uric acid, per se, is an early risk for chronic kidney disease and to determine whether its reduction would prevent the development of the disease. 연구배경: 고요산혈증은 신질환과 관련이 있다. 또한, 정상 범위의 요산치에서도 관련성이 있을 수 있다. 이에 본 연구는 정상범위의 혈중 요산과 만성신질환과의 관련성을 살펴보고자 한다. 방법: 본 연구는 2006년 7월부터 2008년 6월까지 서울의 일개 대학병원 건강증진센터에서 검진을 받은 50세 이상의 성인 3,011명을 대상으로 하였다. 혈중 요산 7 mg/dL 미만인 정상 범위의 혈중 요산 내에서 4등분하여 요산치 증가와 만성신질환의 관계를 조사하였다. 결과: 정상 혈중 요산치 내에서 나이, 성별, 교육수준, 월평균 수입, 흡연상태, 위험음주, 정기적 운동, 비만, 고혈압, 당뇨, 대사증후군 등을 보정한 후 가장 낮은 요산 범위(≤4.20 mg/dL)를 나타내는 군에 대해 요산이 증가하는 군으로 갈수록 만성신질환의 교차비가 1.53 (95% 신뢰수준, 1.00- 2.34), 1.97 (95% 신뢰수준, 1.27-3.08), 3.92 (95% 신뢰수준, 2.46-6.25)로 증가하는 경향을 보였다(P for trend<0.001). 결론: 정상 범위의 혈중 요산치 내에서 요산의 증가는 만성신질환의 위험과 관련이 있다. 정상 범위의 혈중 요산치 내에서 요산의 증가가 신질환 발생에 대한 초기의 위험인자인지와 정상 범위 내에서도 요산을 감소시키면 만성신질환의 발생을 예방할 수 있는지에 대한 추가 연구가 필요하다.