1
|
Moon J, Usmanova G, van der Schans J, Noh JW, Biesma R. Evaluation of interventions for essential newborn care practices at home-based delivery in India. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.038] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
India has the largest share of neonatal mortality, accounting for 21.7 per 1,000 in 2019, while the global goal is at least 12 per 1,000 by 2030. More than 20% of deliveries still occur at home in India for various reasons. Several national interventions were designed to ensure essential practices even at home by engaging skilled birth attendants (SBAs), antenatal care (ANC), and community health workers (CHWs). This study evaluates the effectiveness of these interventions on essential newborn care practices (EP); clean cord care, thermal care, and breastfeeding. Using data from the 2015-2016 India Demographic and Health Survey (n = 9,273), this study employs structural equation modeling to confirm the relationship between SBA, ANC, CHWs` counseling, and EP, including indirect effects of ANC and CHWs and moderating effects of women's empowerment. The results show that SBA and ANC have significant direct effects (standardised coefficient=0.105 and 0.056, respectively) on EP, and ANC and CHWs have significant indirect effects (0.015 and 0.004) in the well-fitted model (CFI=0.938, TLI=0.920, RMSEA (upper 90% CI)=0.028 (0.029), SRMR=0.044). The empowerment-related factors which had a significant positive moderating effect on the paths from SBA to EP and from ANC to EP are decision-making power (0.007, 0.003), allowed mobility (0.002, 0.001), and education (0.009, 0.004). More than 90% of EP variance is not associated with the factors in this model (standardised coefficient=0.958). SBA demonstrated the most considerable effectiveness for EP, while ANCs and CHW indirectly impacted EP. Improving women's empowerment can be an effective strategy to enhance EP. Previous literature said that the other factors explaining EP could be quality of care, other interventions for a safe birth, and cultural characteristics. Policymakers are recommended to consider comprehensive factors to address barriers to safe home birth and design CHW's intervention to persuade SBA.
Key messages
Collapse
Affiliation(s)
- J Moon
- Graduate School of Medical Sciences, University of Groningen , Groningen, Netherlands
| | - G Usmanova
- Monitoring, Evaluation and Research, Jhpiego, New Delhi, India
| | - J van der Schans
- Department of Health Sciences, University of Groningen , Groningen, Netherlands
- Faculty of Economics and Business, University of Groningen , Groningen, Netherlands
| | - JW Noh
- Division of Health Administration, Yonsei University, Seoul , South Korea
| | - R Biesma
- Department of Health Science, Global Health, University of Groningen , Groningen, Netherlands
| |
Collapse
|
2
|
Moon J, Kang SJ, Noh JW. Evaluation of primary health care system in Yangon Region, Myanmar: a mixed-method approach. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.016] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Many low- and middle-income countries and international organizations have invested resources to strengthen primary health care services. Despite efforts from the Ministry of Health on primary health care, barriers to accessing health care services and health inequality in Myanmar still exist. This study aimed to identify the challenges and unmet needs in the current primary health care services by assessing the experiences and perceptions of healthcare workers and local leaders in three townships (Htantabin, Hmawbi, and Taikkyi) in Yangon, Myanmar.
Methods
The study was conducted among healthcare professionals and community leaders in three townships. By adopting a mixed-method approach, a cross-sectional health needs assessment survey was conducted for quantitative data (n = 66), and focus group discussions (15 group discussions) were conducted online for qualitative data.
Results
As a result of the survey regarding six domains; hygiene, primary medical care, maternal and child health, infectious diseases, non-communicable diseases, and leadership, enhancing the management and leadership capacity had the lowest average score on the current achievement (2.81 out of 5), while strengthening infectious disease control service and accessibility was perceived as the highest mean on the priority of intervention (4.28 out of 5) and the impact of the intervention (4.7). The focus group discussions revealed that while specific infrastructures and equipment necessary for the category were addressed, the need for financial support has been the recurrent theme throughout the discussions.
Conclusions
Utilizing the World Health Organization’s six-building block framework, our findings suggest that a long-term targeted financial investment in the primary health care system is critical in Myanmar by increasing health care expenditure per capita. At the same time, related barriers and facilitators should be considered to optimize the effectiveness of prioritized interventions.
Key messages
• Health care providers and local leaders perceived the management and leadership capacity as the lowest current achievement.
• A long-term targeted financial investment in the primary health care system is critical in Myanmar.
Collapse
Affiliation(s)
- J Moon
- Graduate School of Medical Sciences, University of Groningen , Groningen, Netherlands
| | - SJ Kang
- Institute of Health and Environment, Seoul National University , Seoul, South Korea
| | - JW Noh
- Division of Health Administration, Yonsei University , Wonju, South Korea
| |
Collapse
|
3
|
Choi SR, Lee YK, Park HC, Kim DH, Cho AJ, Kim J, Yun KS, Noh JW, Kang MK. The paradoxical effect of aldosterone on cardiovascular outcome in maintenance hemodialysis patients. Kidney Res Clin Pract 2021; 41:77-88. [PMID: 34974657 PMCID: PMC8816408 DOI: 10.23876/j.krcp.21.096] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/19/2021] [Indexed: 11/04/2022] Open
Abstract
Background Patients with end-stage kidney disease face increased risk of cardiovascular events, and left ventricular diastolic dysfunction (LVDD) contributes to the high occurrence of cardiovascular mortality (CM). Although a high serum aldosterone (sALD) level is involved in the development of cardiovascular complications in the general population, this association is unclear in patients undergoing hemodialysis. We aimed to determine the impact of sALD on LVDD and CM among hemodialysis patients (HDPs). Methods We performed a prospective cohort study of maintenance HDPs without cardiovascular disease. The patients were divided into two groups according to the median level of sALD. All patients underwent baseline echocardiography to evaluate diastolic dysfunction (E/e´ ratio > 15). The LVDD and CM rates were compared between the high and low aldosterone groups. Results We enrolled a total of 60 adult patients (mean age, 57.9 ± 12.1 years; males, 30.0%). The low aldosterone group had an increased left ventricular diastolic dimension compared with the high aldosterone group (52.2 ± 8.4 mm vs. 50.3 ± 5.2 mm, respectively; p = 0.03). Low log-aldosterone (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.19-0.86) and large left atrial dimension (OR, 1.31; 95% CI, 1.11-1.54) were independent risk factors for LVDD at baseline. In addition, Cox regression analysis demonstrated that low sALD was an independent predictor of CM in HDPs (hazard ratio, 0.46; 95% CI, 0.25-0.85; p = 0.01) during follow-up. Conclusion Low sALD was not only associated with LVDD but was also an independent predictor of CM among HDPs regardless of their interdialytic weight gain.
Collapse
Affiliation(s)
- Sun Ryoung Choi
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Dongtan, Republic of Korea.,Kidney Research Institute, Hallym University, Seoul, Republic of Korea
| | - Young-Ki Lee
- Kidney Research Institute, Hallym University, Seoul, Republic of Korea.,Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Hayne Cho Park
- Kidney Research Institute, Hallym University, Seoul, Republic of Korea.,Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Do Hyoung Kim
- Kidney Research Institute, Hallym University, Seoul, Republic of Korea.,Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - AJin Cho
- Kidney Research Institute, Hallym University, Seoul, Republic of Korea.,Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Juhee Kim
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Kyu Sang Yun
- Kidney Research Institute, Hallym University, Seoul, Republic of Korea.,Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jung-Woo Noh
- Kidney Research Institute, Hallym University, Seoul, Republic of Korea.,Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Min-Kyung Kang
- Department of Cardiology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| |
Collapse
|
4
|
Kim DH, Lee YK, Kim J, Park HC, Yun KS, Cho AJ, Yoon JW, Koo JR, Noh JW. Effects of the route of erythropoietin administration on hemoglobin variability and cardiovascular events in hemodialysis patients. Kidney Res Clin Pract 2021; 40:724-733. [PMID: 34510858 PMCID: PMC8685368 DOI: 10.23876/j.krcp.20.260] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/06/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Despite of the routine use of erythropoietin in hemodialysis patients to correct anemia, its administration route's effects on hemoglobin variability and cardiovascular events remain elusive. Herein, we determined different erythropoietin administration routes' effects on hemoglobin variability in hemodialysis patients and the associated factors of hemoglobin variability and cardiovascular events. Methods This is a post hoc analysis of a prospective, controlled, randomized, unblinded study with 78 Korean hemodialysis patients receiving intravenous (n = 40) or subcutaneous (n = 38) erythropoietin therapy. We evaluated hemoglobin variability by calculating the frequency of hemoglobin measurements outside the target range during all visits. The high-frequency group was defined by those with hemoglobin variability over the median value (25%) while the low-frequency group was defined by those with hemoglobin variability of <25%. Results In this analysis, 37 patients (51.1%) were males, and the mean age was 50.6 ± 12.5 years. The frequency of the value being outside the target hemoglobin range was higher in the subcutaneous group compared to the intravenous group (p = 0.03). The low-frequency group required significantly lower erythropoietin doses compared to the high-frequency group. In the adjusted Cox analysis, the parameter high group was a significant independent risk factor for cardiovascular events (p = 0.03). Conclusion The risk out of the target hemoglobin range increased with subcutaneous administration compared with intravenous erythropoietin administration in hemodialysis patients. An increased frequency of the value being outside the target hemoglobin range was also associated with an increased risk of cardiovascular events.
Collapse
Affiliation(s)
- Do Hyoung Kim
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea.,Korean Association for the Study of Renal Anemia and Artificial Intelligence, Seoul, Republic of Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea.,Korean Association for the Study of Renal Anemia and Artificial Intelligence, Seoul, Republic of Korea
| | - Juhee Kim
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hayne Cho Park
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Kyu Sang Yun
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
| | - AJin Cho
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jong-Woo Yoon
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ja-Ryong Koo
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jung-Woo Noh
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
5
|
Kim DH, Lee YK, Park HC, Kim J, Yun KS, Cho AJ, Noh JW, Kim H, Kim SH, Yoon JW. Stepwise achievement of high convection volume in post-dilution hemodiafiltration: A prospective observational study. Semin Dial 2021; 34:368-374. [PMID: 33774852 DOI: 10.1111/sdi.12966] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/13/2021] [Accepted: 03/01/2021] [Indexed: 12/28/2022]
Abstract
High-volume online hemodiafiltration (HDF) has been reported to reduce the patient's mortality. However, achieving a high convection volume is challenging. In this prospective study, we investigated the feasibility of achieving high-volume HDF with ≥21 L substitution volume via modification of blood flow rate (BFR), needle size, and dialysis membrane. In 30 patients undergoing hemodialysis, we followed a stepwise protocol and gradually increased the BFR (280→300→330 ml/min; steps 1, 2, and 3) and needle size (16→15 G; step 4). After changing dialyzer surface area (1.8 m2 →2.5 m2 ), the BFR and needle size were similarly increased stepwise (steps 5, 6, 7, and 8). The mean substitution volume was 18.7 ± 2.2 L at step 1 and it significantly increased to 25.1 ± 2.6 L by step 8. A substitution volume of 21 L was achieved by 13.3% of patients in step 1 and by 96.7% after step 8. The substitution volume was higher for the dialyzer with a large surface area and for the larger needle (15 G). Between steps 1 and 8, the Kt/V and β2 microglobulin reduction ratios also improved significantly. High-volume HDF is feasible through a stepwise increase in the BFR, needle size, and surface area of the dialysis membrane.
Collapse
Affiliation(s)
- Do Hyoung Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hayne Cho Park
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Juhee Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Kyu Sang Yun
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - AJin Cho
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jung-Woo Noh
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyunsuk Kim
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Seok-Hyung Kim
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| | - Jong-Woo Yoon
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea
| |
Collapse
|
6
|
Lee YK, Choi SR, Park HC, Kim DH, Cho A, Kim J, Yoon JW, Noh JW, Kang MK. P1271PARADOXICAL EFFECT OF ALDOSTERONE ON CARDIOVASCULAR OUTCOME IN MAINTENANCE HEMODIALYSIS PATIENTS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1271] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Patients with end-stage renal disease have an increased risk of cardiovascular (CV) mortality and left ventricular diastolic dysfunction (LVDD) is known to contribute to its high occurrence. Although high serum aldosterone level is involved in the development of CV complications in general population, this association is unclear in patients undergoing hemodialysis (HD). We aimed to determine the impact of serum aldosterone on LVDD and CV mortality among HD patients.
Method
We performed a prospective cohort study of maintenance HD patients without CV disease. Patients were divided into two groups according to the median level of serum aldosterone (44 ng/dL). All patients underwent echocardiography to evaluate diastolic dysfunction. Proportions of LVDD and CV mortality were compared between high and low aldosterone groups.
Results
We enrolled a total of 60 adult patients (mean age 57.9±12.1 years, male 30.0%). Low aldosterone group had an increased left ventricular diastolic dimension compared with high aldosterone group (52.2±8.4 vs. 50.3±5.2 mm, p=0.033). The E/è ratio (19.5±7.5 vs. 14.6±5.2, p=0.024) was significantly higher among patients in low aldosterone group compared to high aldosterone group. There were no significant differences either in ejection fraction, LVMI, or the proportion of LVH between two groups. Low log-aldosterone (odds ratio 0.403; 95% confidence interval 0.188-0.862) and large left atrial dimension (1.308; 1.114-1.536) were independent risk factors for LVDD. In addition, cox regression analysis demonstrated that low log-aldosterone was an independent predictor of CV mortality in HD patients (hazard ratio 0.505; 95% confidence interval 0.294-0.869, p=0.014).
Conclusion
Low serum aldosterone was not only associated with LVDD but also an independent predictor of CV mortality among HD patients.
Collapse
Affiliation(s)
- Young-Ki Lee
- Hallym University College of Medicine, Internal Medicine, Seoul, Korea, Rep. of South
| | - Sun Ryoung Choi
- Hallym University College of Medicine, Internal Medicine, Seoul, Korea, Rep. of South
| | - Hayne Cho Park
- Hallym University College of Medicine, Internal Medicine, Seoul, Korea, Rep. of South
| | - Do Hyoung Kim
- Hallym University College of Medicine, Internal Medicine, Seoul, Korea, Rep. of South
| | - Ajin Cho
- Hallym University College of Medicine, Internal Medicine, Seoul, Korea, Rep. of South
| | - Juhee Kim
- Hallym University College of Medicine, Internal Medicine, Seoul, Korea, Rep. of South
| | - Jong-Woo Yoon
- Hallym University College of Medicine, Internal Medicine, Seoul, Korea, Rep. of South
| | - Jung-Woo Noh
- Hallym University College of Medicine, Internal Medicine, Seoul, Korea, Rep. of South
| | - Min-Kyung Kang
- Hallym University College of Medicine, Internal Medicine, Seoul, Korea, Rep. of South
| |
Collapse
|
7
|
Park HC, Lee SH, Kim J, Kim DH, Cho AJ, Jeon HJ, Oh J, Noh JW, Jeong DW, Kim YG, Lee CH, Yoo KD, Lee YK. Effect of isolation practice on the transmission of middle east respiratory syndrome coronavirus among hemodialysis patients: A 2-year prospective cohort study. Medicine (Baltimore) 2020; 99:e18782. [PMID: 32011472 PMCID: PMC7220504 DOI: 10.1097/md.0000000000018782] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Hemodialysis (HD) patients had a high rate of infection transmission and mortality during the middle east respiratory syndrome coronavirus (MERS-CoV) outbreak in Saudi Arabia. A standardized guideline on isolation technique for exposed HD patients is not available. Thus, this study aimed to evaluate the effect of different isolation strategies on the prevention of secondary viral transmission and clinical outcomes among exposed HD patients.During the 2015 MERS-CoV outbreak in Korea, 116 patients in 3 HD units were incidentally exposed to individuals with confirmed MERS-CoV infection and underwent different types of isolation, which were as follows: single-room isolation (n = 54, 47%), cohort isolation (n = 46, 40%), and self-imposed quarantine (n = 16, 13%). The primary outcome was rate of secondary viral transmission. The secondary outcome measures were changes in clinical and biochemical markers during the isolation period, difference in clinical and biochemical markers according to the types of isolation practice, and effect of isolation practice on patient survival.During a mean isolation period of 15 days, no further cases of secondary transmission were detected among HD patients. Plasma hemoglobin, serum calcium, and serum albumin levels and single-pool Kt/V decreased during the isolation period but normalized thereafter. Patients who were subjected to self-imposed quarantine had higher systolic and diastolic blood pressure, lower total cholesterol level, and lower Kt/V than those who underwent single-room or cohort isolation. During the 24-month follow-up period, 12 patients died. However, none of the deaths occurred during the isolation period, and no differences were observed in patient survival rate according to different isolation strategies.Although 116 participants in 3 HD units were incidentally exposed to MERS-CoV during the 2015 outbreak in Korea, strict patient surveillance and proper isolation practice prevented secondary transmission of the virus. Thus, a renal disaster protocol, which includes proper contact surveillance and isolation practice, must be established in the future to accommodate the needs of HD patients during disasters or outbreaks.
Collapse
Affiliation(s)
- Hayne Cho Park
- Department of Internal Medicine, Kangnam Sacred Heart Hospital
- Hallym University Kidney Research Institute
| | - Sang-Ho Lee
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong
| | - Juhee Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital
| | - Do Hyoung Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital
- Hallym University Kidney Research Institute
| | - AJin Cho
- Department of Internal Medicine, Kangnam Sacred Heart Hospital
- Hallym University Kidney Research Institute
| | - Hee Jung Jeon
- Hallym University Kidney Research Institute
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul
| | - Jieun Oh
- Hallym University Kidney Research Institute
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul
| | - Jung-Woo Noh
- Department of Internal Medicine, Kangnam Sacred Heart Hospital
- Hallym University Kidney Research Institute
| | - Da-Wun Jeong
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong
| | - Yang-Gyun Kim
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong
| | - Chang-Hee Lee
- Department of Anesthesiology, Gangneung Medical Center, Gangneung
| | - Kyung Don Yoo
- Department of Internal Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Kangnam Sacred Heart Hospital
- Hallym University Kidney Research Institute
| |
Collapse
|
8
|
Cho AJ, Choi MJ, Lee YK, Hoon HC, Koo JR, Yoon JW, Noh JW. Effects of aspirin resistance and mean platelet volume on vascular access failure in hemodialysis patients. Korean J Intern Med 2019; 34:1304-1312. [PMID: 30025441 PMCID: PMC6823566 DOI: 10.3904/kjim.2018.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/05/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Maintaining the patency of vascular access (VA) in hemodialysis (HD) patients is important and can be life-saving. We investigated the effects of aspirin resistance and mean platelet volume (MPV) on VA failure in HD patients. METHODS We enrolled 163 patients on maintenance HD. VA failure was defined as thrombosis or a decrease of > 50% of the normal vessel diameter, as revealed by angiography. RESULTS Aspirin resistance was observed in 17 of 109 patients in whom this parameter was measured, and was not significantly associated with VA failure (p = 0.051). The mean MPV was 9.15 ± 0.05 fL. The 163 patients were grouped by the median MPV value (9.08 fL) at baseline; patients with higher MPVs (n = 82) had lower platelet counts (p = 0.002) and albumin levels (p = 0.009). During 34 months of follow-up, 65 VA failures (39.9%) occurred. The Kaplan-Meier curve revealed significant differences between the two groups in terms of cumulative VA failure (54.1% vs. 35.3%, p = 0.018). On multivariate analysis, the MPV (hazard ratio [HR], 1.794; 95% confidence interval [CI], 1.066 to 3.020; p = 0.028), platelet count (HR, 1.003; 95% CI, 1.001 to 1.006; p = 0.01), and smoking status (HR, 1.894; 95% CI, 1.019 to 3.519; p = 0.043) independently predicted VA failure. CONCLUSION A high MPV was associated with an increased risk of VA failure, whereas aspirin resistance showed only a weak association. The MPV may predict VA survival in HD patients.
Collapse
Affiliation(s)
- AJin Cho
- Division of Nephrology, Department of Internal Medicine, Hallym University College of Medicine and Hallym University Kidney Research Institute, Hallym University Medical Center, Seoul, Korea
| | - Myung Jin Choi
- Division of Nephrology, Department of Internal Medicine, Hallym University College of Medicine and Hallym University Kidney Research Institute, Hallym University Medical Center, Seoul, Korea
| | - Young-Ki Lee
- Division of Nephrology, Department of Internal Medicine, Hallym University College of Medicine and Hallym University Kidney Research Institute, Hallym University Medical Center, Seoul, Korea
| | - Han Chae Hoon
- Division of Nephrology, Department of Internal Medicine, Hallym University College of Medicine and Hallym University Kidney Research Institute, Hallym University Medical Center, Seoul, Korea
| | - Ja-Ryong Koo
- Division of Nephrology, Department of Internal Medicine, Hallym University College of Medicine and Hallym University Kidney Research Institute, Hallym University Medical Center, Seoul, Korea
| | - Jong-Woo Yoon
- Division of Nephrology, Department of Internal Medicine, Hallym University College of Medicine and Hallym University Kidney Research Institute, Hallym University Medical Center, Seoul, Korea
- Correspondence to Jung-Woo Noh, M.D. Division of Nephrology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Korea Tel: +82-2-829-5108 Fax: +82-2-829-5309 E-mail:
| | - Jung-Woo Noh
- Division of Nephrology, Department of Internal Medicine, Hallym University College of Medicine and Hallym University Kidney Research Institute, Hallym University Medical Center, Seoul, Korea
- Correspondence to Jung-Woo Noh, M.D. Division of Nephrology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Korea Tel: +82-2-829-5108 Fax: +82-2-829-5309 E-mail:
| |
Collapse
|
9
|
Kim H, Ryu J, Lee YK, Choi MJ, Cho A, Koo JR, Baik SY, Lee EH, Yoon JW, Noh JW. Seropositive rate of the anti-hepatitis A immunoglobulin G antibody in maintenance hemodialysis subjects from two hospitals in Korea. Korean J Intern Med 2019; 34:1297-1303. [PMID: 29466851 PMCID: PMC6823562 DOI: 10.3904/kjim.2017.293] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 09/25/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Hepatitis A virus (HAV) is a self-limiting infectious disease, but 1% of subjects develop fulminant hepatitis. The prevalence of the anti-HAV immunoglobulin G (IgG) antibody in hemodialysis subjects in Korea remains unknown. The purpose of this study was to describe and compare the seropositive rate of anti-HAV antibody among hemodialysis subjects in two hospitals according to age group. METHODS A total of 170 hemodialysis subjects were evaluated for the seropositive rate of the anti-HAV IgG antibody and its titer. RESULTS Of the 170 maintenance hemodialysis subjects in two hospitals (Kangnam 92 vs. Chuncheon 78), 79 (46.5%) were male. The mean age was 53.2 years old, and 94.1% of the subjects were over 40 years old. The median vintage of hemodialysis was 29.0 months. Anti-HAV antibody was found in 163 subjects (95.9%), with no significant difference between the two areas (Kangnam 97.8% [n = 90] vs. Chuncheon 93.6% [n = 73]). Subjects younger than 40 years old showed a seropositive rate of 50%, while the seropositive rate increased with age for subjects aged 40 or older (p for trend < 0.001). Seropositive subjects from Kangnam showed a higher anti-HAV antibody titer than those from Chuncheon (median: Kangnam 14.2 vs. Chuncheon 11.7). Only age influenced seropositivity. The only factor that influenced the antibody level was the location of hospital (p < 0.001). CONCLUSION The seropositive rate of the anti-HAV antibody in hemodialysis subjects was 95%, which is similar to findings in the general population. Active immunization against hepatitis A is strongly recommended for hemodialysis subjects under 40 years of age after anti-HAV testing.
Collapse
Affiliation(s)
- Hyunsuk Kim
- Division of Nephrology, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Jiwon Ryu
- Division of Nephrology, Department of Internal Medicine, Cheju Halla Hospital; Jeju, Korea
| | - Young-Ki Lee
- Division of Nephrology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Myung Jin Choi
- Division of Nephrology, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Ajin Cho
- Division of Nephrology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Ja-Ryong Koo
- Division of Nephrology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Sae Yun Baik
- Laboratory Medicine, Green Cross Laboratories, Youngin, Korea
| | - Eun Hee Lee
- Laboratory Medicine, Green Cross Laboratories, Youngin, Korea
| | - Jong-Woo Yoon
- Division of Nephrology, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Jung-Woo Noh
- Division of Nephrology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
- Correspondence to Jung-Woo Noh, M.D Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University Kangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Korea Tel: +82-2-829-5108 Fax: +82-2-846-4669 E-mail:
| |
Collapse
|
10
|
Han C, Lee YK, Park HC, Cho A, Choi SR, Yoon JW, Koo JR, Kim HJ, Noh JW, Park MJ. Serum alkaline phosphatase and γ-glutamyl transferase in acute pyelonephritis. Kidney Res Clin Pract 2019; 38:205-211. [PMID: 30841691 PMCID: PMC6577211 DOI: 10.23876/j.krcp.18.0074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/13/2018] [Accepted: 01/07/2019] [Indexed: 11/30/2022] Open
Abstract
Background Elevated serum alkaline phosphatase (AP) and γ-glutamyl transferase (γ-GT) are commonly observed in patients with acute pyelonephritis. The goal of this study was to examine the clinical significance of elevated serum AP and γ-GT levels and to explore the mechanisms underlying these changes. Methods We examined serum AP and γ-GT levels in 438 patients with acute pyelonephritis. Urine AP/creatinine (Cr), urine γ-GT/Cr, fractional excretion of AP, and fractional excretion of γ-GT (FEγ-GT) were evaluated in patients with elevated and normal serum levels. AP isoenzymes were also examined. Results We identified 77 patients (17.6%) with elevated serum AP and 134 patients (30.6%) with elevated serum γ-GT. Among them, both enzymes were elevated in 64 patients (14.6%). Older age, longer hospital stay, elevated baseline serum Cr, and complicated pyelonephritis were associated with increases in serum AP and γ-GT. Multivariate analysis showed that high serum AP levels were significantly correlated with renal impairment (odds ratio, 2.13; 95% confidence interval, 1.08–4.19; P = 0.029). FEγ-GT was significantly lower in patients with elevated serum enzyme levels. The liver fraction for AP isoenzyme profile did not increase in patients with elevated serum AP. Conclusion Our results demonstrated that elevated serum AP and γ-GT levels are associated with complicated pyelonephritis and renal impairment. Lower FEγ-GT levels in patients with elevated serum enzymes may be the result of decreased urinary excretion of these enzymes.
Collapse
Affiliation(s)
- Chaehoon Han
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Hayne Cho Park
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Ajin Cho
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Sun Ryoung Choi
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Jong-Woo Yoon
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Ja Ryong Koo
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Hyung Jik Kim
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Jung-Woo Noh
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Min-Jeong Park
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea
| |
Collapse
|
11
|
Choi YJ, Lee YK, Kim EY, Park HC, Cho A, Han CH, Noh JW, Yoon JW, Kim HS. FP534IS ACHIEVING HIGH CONVECTION VOLUME FOR HEMODIAFILTRATION FEASIBLE IN ROUTINE CLINICAL PRACTICE? Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp534] [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: 11/12/2022] Open
Affiliation(s)
- Yoo Jin Choi
- Hallym University College of Medicine, Seoul, Republic of Korea
| | - Young-Ki Lee
- Hallym University College of Medicine, Seoul, Republic of Korea
| | - Eun Yi Kim
- Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hayne Cho Park
- Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ajin Cho
- Hallym University College of Medicine, Seoul, Republic of Korea
| | - Chae Hoon Han
- Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jung-Woo Noh
- Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jong-Woo Yoon
- Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hyun Sook Kim
- Hallym University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
12
|
Lee YK, Cho A, Yoon JW, Choi YJ, Kim EY, Park HC, Han CH, Noh JW. FP324EFFECTS OF PHOSPHATE AND POTASSIUM CONTAINING DIALYSATE DURING CONTINUOUS RENAL REPLACEMENT THERAPY IN ACUTE KIDNEY INJURY. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp324] [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)
- Young-Ki Lee
- Hallym University College of Medicine, Seoul, Republic of Korea
| | - Ajin Cho
- Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jong-Woo Yoon
- Hallym University College of Medicine, Seoul, Republic of Korea
| | - Yoo Jin Choi
- Hallym University College of Medicine, Seoul, Republic of Korea
| | - Eun Yi Kim
- Hallym University College of Medicine, Seoul, Republic of Korea
| | - Hayne Cho Park
- Hallym University College of Medicine, Seoul, Republic of Korea
| | - Chae Hoon Han
- Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jung-Woo Noh
- Hallym University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
13
|
Kim JK, Kim SG, Oh JE, Lee YK, Noh JW, Kim HJ, Song YR. Impact of sarcopenia on long-term mortality and cardiovascular events in patients undergoing hemodialysis. Korean J Intern Med 2019; 34:599-607. [PMID: 29161801 PMCID: PMC6506738 DOI: 10.3904/kjim.2017.083] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [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: 02/28/2017] [Accepted: 04/11/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS A high body mass index (BMI) is known to correlate with better survival in patients on hemodialysis (HD). However, the impacts of body composition and sarcopenia on survival have not been well studied in this population. METHODS One hundred and forty-two prevalent HD patients were recruited and followed prospectively for up to 4.5 years. Low muscle mass (measured using a portable, whole-body, bioimpedance spectroscopic device) was defined as a lean tissue index (LTI) two standard deviations (SD) or more below the normal gender-specific mean for young people. Low muscle strength was a handgrip strength (HGS) of less than 30 kg in males and less than 20 kg in females. Sarcopenia was considered present when both LTI and HGS were reduced. RESULTS The mean age was 59.8 ± 13.1 years; 57.0% were male and 47.2% had diabetes. Forty-seven patients (33.1%) had sarcopenia. During follow-up, 28 patients (19.7%) died, and low LTI (adjusted hazard ratio [HR], 2.77; 95% confidence interval [CI], 1.10 to 6.97) and low HGS (HR 5.65; 95% CI, 1.99 to 16.04) were independently associated with mortality. Sarcopenia was a significant predictor for death (HR, 6.99; 95% CI, 1.84 to 26.58; p = 0.004) and cardiovascular events (HR, 4.33; 95% CI, 1.51 to 12.43; p = 0.006). CONCLUSION Sarcopenia was strongly associated with long-term mortality and cardiovascular events in HD patients. Assessment of muscle strength and muscle mass may provide additional prognostic information to survival in patients with end-stage renal disease.
Collapse
Affiliation(s)
- Jwa-Kyung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sung Gyun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ji-Eun Oh
- Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Jung-Woo Noh
- Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Hyung Jik Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Young Rim Song
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
- Correspondence to Young Rim Song, M.D. Department of Internal Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang 14068, Korea Tel: +82-31-380-3720 Fax: +82-31-386-2269 E-mail:
| |
Collapse
|
14
|
Choi YJ, Lee YK, Park HC, Kim EY, Cho A, Han C, Choi SR, Kim H, Kim EJ, Yoon JW, Noh JW. Prediction of vascular access stenosis: Blood temperature monitoring with the Twister versus static intra-access pressure ratio. PLoS One 2018; 13:e0204630. [PMID: 30372435 PMCID: PMC6205593 DOI: 10.1371/journal.pone.0204630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 09/11/2018] [Indexed: 11/21/2022] Open
Abstract
Background The Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines recommend intra-access flow (Qa) measurement as the preferred vascular access surveillance method over static intra-access pressure ratio (SIAPR). Recently, it has become possible to perform Qa measurement during hemodialysis using thermodilution method called blood temperature monitoring (BTM) with the Twister device. The aim of this study was to investigate the correlation between Qa by BTM and SIAPR and to compare the performance of two tests in prediction of vascular access stenosis. Methods The study was performed from January 2016 to November 2017 and included 97 patients with arteriovenous fistulas (AVF). Qa by BTM and SIAPR were simultaneously measured every 1~3 months with a total of 449 measurements during study period. Results In our study population, mean age was 59.9±10.0 years and 61.9% were diabetes. The mean Qa obtained by BTM was 1186±588 mL/min. There was no correlation between Qa by BTM and venous SIAPR (r = 0.061, P = 0.196). Angiography identified 36 stenotic AVFs (37.1%) among the study subjects. They included 13 cases with only inflow stenosis, 6 with only outflow stenosis, and 17 with stenosis on both sides. Receiver-operating characteristic (ROC) curve analysis showed that Qa by BTM had higher discriminative ability to diagnose vascular access stenosis compared to SIAPR (P <0.001). The Qa less than 583 mL/min showed the highest diagnostic accuracy in vascular stenosis prediction. Conclusion Intradialytic measurement of Qa by BTM showed better diagnostic power over venous SIAPR in prediction of vascular access stenosis.
Collapse
Affiliation(s)
- Yoo Jin Choi
- Hemodialysis Center, Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
- * E-mail:
| | - Hayne Cho Park
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Eun Yi Kim
- Hemodialysis Center, Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Ajin Cho
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Chaehoon Han
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Sun Ryoung Choi
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Hanmyun Kim
- Department of Radiology, Hallym University College of Medicine, Seoul, Korea
| | - Eun-Jung Kim
- Department of Internal Medicine, Sahmyook Medical Center, Internal Medicine, Seoul, Korea
| | - Jong-Woo Yoon
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Jung-Woo Noh
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| |
Collapse
|
15
|
Choi YJ, Lee YK, Cho A, Kim EY, Choi SR, Kim EJ, Yoon JW, Noh JW. FP572PREDICTION OF VASCULAR ACCESS STENOSIS: BLOOD TEMPERATURE MONITORING WITH TWISTER VS STATIC INTRA-ACCESS PRESSURE RATIO. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp572] [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)
- Yoo Jin Choi
- Internal Medicine, Hallym University College of Medicine, Seoul, Korea, Republic of
| | - Young-Ki Lee
- Internal Medicine, Hallym University College of Medicine, Seoul, Korea, Republic of
| | - Ajin Cho
- Internal Medicine, Hallym University College of Medicine, Seoul, Korea, Republic of
| | - Eun Yi Kim
- Internal Medicine, Hallym University College of Medicine, Seoul, Korea, Republic of
| | - Sun Ryoung Choi
- Internal Medicine, Sahmyook Medical Center, Seoul, Korea, Republic of
| | - Eun-Jung Kim
- Internal Medicine, Sahmyook Medical Center, Seoul, Korea, Republic of
| | - Jong-Woo Yoon
- Internal Medicine, Hallym University College of Medicine, Seoul, Korea, Republic of
| | - Jung-Woo Noh
- Internal Medicine, Hallym University College of Medicine, Seoul, Korea, Republic of
| |
Collapse
|
16
|
Lee YK, Cho A, Yoon JW, Kim EY, Choi YJ, Noh JW, Shin YJ. SP444ABNORMAL KIDNEY FUNCTION PREDICTS THE DEVELOPMENT AND PROGRESSION OF DIABETIC RETINOPATHY IN KOREAN PATIENTS WITH TYPE 2 DIABETES. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp444] [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)
- Young-Ki Lee
- Internal Medicine, Hallym University College of Medicine, Seoul, Korea, Republic of
| | - Ajin Cho
- Internal Medicine, Hallym University College of Medicine, Seoul, Korea, Republic of
| | - Jong-Woo Yoon
- Internal Medicine, Hallym University College of Medicine, Seoul, Korea, Republic of
| | - Eun Yi Kim
- Internal Medicine, Hallym University College of Medicine, Seoul, Korea, Republic of
| | - Yoo Jin Choi
- Internal Medicine, Hallym University College of Medicine, Seoul, Korea, Republic of
| | - Jung-Woo Noh
- Internal Medicine, Hallym University College of Medicine, Seoul, Korea, Republic of
| | - Young Joo Shin
- Ophthalmology, Hallym University College of Medicine, Seoul, Korea, Republic of
| |
Collapse
|
17
|
Cho AJ, Lee YK, Oh J, Yoon JW, Shin DH, Jeon HJ, Choi MJ, Noh JW. The relationship between intradialytic hypotension and vascular calcification in hemodialysis patients. PLoS One 2017; 12:e0185846. [PMID: 29049308 PMCID: PMC5648120 DOI: 10.1371/journal.pone.0185846] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 09/20/2017] [Indexed: 12/28/2022] Open
Abstract
Background Vascular calcification is associated with structural and functional abnormality of the heart and blood vessels. We investigated the relationship between intradialytic hypotension (IDH) and vascular calcification in hemodialysis (HD) patients, and their impacts on cardiovascular events (CVEs). Method We enrolled 191 maintenance HD patients who underwent plain abdomen radiography for abdominal aortic calcification score (AACS). A nadir systolic blood pressure (BP) < 90 mm Hg or the requirement of bolus fluid administration was required to quantify the hypotension diagnosis. IDH was defined as > 2 hypotension episodes during 10 HD treatments. Results Among the 191 patients, IDH occurred in 32. AACS was higher in the IDH group compared with the no-IDH group (8.4 ± 6.0 vs. 4.9 ± 5.2, respectively; P = 0.001). High AACS was an independent risk factor after adjustment for age, diabetes mellitus, ultrafiltration, diastolic BP, and calcium level (odds ratio (OR) = 1.09, 95% CI = 1.01–1.18; P = 0.03). Patients with both IDH and AACS ≧ 4 had the highest cumulative CVE rate (27.9%, P = 0.008) compared with 11.2%, 12.5%, and 6% for those with AACS ≧ 4 only, with IDH only, and neither, respectively. In multivariate analysis, the presence of both IDH and AACS ≧ 4 was a significant predictor of CVE (hazard ratio (HR) = 2.84, 95% CI = 1.04–7.74, P = 0.04). Conclusion IDH is associated with abdominal aortic calcification and is an independent risk factor for IDH. Both IDH and high AACS were significant predictors of CVE.
Collapse
Affiliation(s)
- AJin Cho
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University, Hallym University College of Medicine, Seoul, Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University, Hallym University College of Medicine, Seoul, Korea
- * E-mail: (YKL); (JO); (JWY)
| | - Jieun Oh
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
- * E-mail: (YKL); (JO); (JWY)
| | - Jong-Woo Yoon
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Gangwon-do, Korea
- * E-mail: (YKL); (JO); (JWY)
| | - Dong Ho Shin
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hee Jung Jeon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Myung-Jin Choi
- Department of Internal Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Gangwon-do, Korea
| | - Jung-Woo Noh
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University, Hallym University College of Medicine, Seoul, Korea
| |
Collapse
|
18
|
Kim EJ, Choi MJ, Lee JH, Oh JE, Seo JW, Lee YK, Yoon JW, Kim HJ, Noh JW, Koo JR. Extracellular Fluid/Intracellular Fluid Volume Ratio as a Novel Risk Indicator for All-Cause Mortality and Cardiovascular Disease in Hemodialysis Patients. PLoS One 2017; 12:e0170272. [PMID: 28099511 PMCID: PMC5242490 DOI: 10.1371/journal.pone.0170272] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [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: 08/28/2016] [Accepted: 01/02/2017] [Indexed: 01/12/2023] Open
Abstract
Background In hemodialysis patients, fluid overload and malnutrition are accompanied by extracellular fluid (ECF) expansion and intracellular fluid (ICF) depletion, respectively. We investigated the relationship between ECF/ICF ratio (as an integrated marker reflecting both fluid overload and malnutrition) and survival and cardiovascular disease (CVD) in the context of malnutrition-inflammation-arteriosclerosis (MIA) complex. Methods Seventy-seven patients from a single hemodialysis unit were prospectively enrolled. The ECF/ICF volume was measured by segmental multi-frequency bioimpedance analysis. MIA and volume status were measured by serum albumin, C-reactive protein (CRP), pulse wave velocity (PWV) and plasma B-type natriuretic peptide (BNP), respectively. Results The mean ECF/ICF ratio was 0.56±0.06 and the cut-off value for maximum discrimination of survival was 0.57. Compared with the low ECF/ICF group, the high ECF/ICF group (ratio≥0.57, 42%) had higher all-cause mortality, CVD, CRP, PWV, and BNP, but lower serum albumin. During the 5-year follow-up, 24 all-cause mortality and 38 CVD occurred (18 and 24, respectively, in the high ECF/ICF group versus 6 and 14 respectively in the low ECF/ICF group, P<0.001). In the adjusted Cox analysis, the ECF/ICF ratio nullifies the effects of the MIA and volume status on survival and CVD and was an independent predictor of all-cause mortality and CVD: hazard ratio (95% confidence interval); 1.12 (1.01–1.25) and 1.09 (1.01–1.18) for a 0.01 increase in the ECF/ICF ratio. The degree of malnutrition (albumin), inflammation (CRP), arteriosclerosis (PWV), and fluid overload (BNP) were correlated well with the ECF/ICF ratio. Conclusions Hemodialysis patients with high ECF/ICF ratio are not only fluid overloaded, but malnourished and have stiff artery with more inflammation. The ECF/ICF ratio is highly related to the MIA complex, and is a major risk indicator for all-cause mortality and CVD.
Collapse
Affiliation(s)
- Eun-Jung Kim
- Department of Internal Medicine, Hallym Kidney Research Institute, College of Medicine, Hallym University, Chuncheon, Korea
- Division of Nephrology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong-si, Korea
| | - Myung-Jin Choi
- Department of Internal Medicine, Hallym Kidney Research Institute, College of Medicine, Hallym University, Chuncheon, Korea
| | - Jeoung-Hwan Lee
- Department of Internal Medicine, Hallym Kidney Research Institute, College of Medicine, Hallym University, Chuncheon, Korea
| | - Ji-Eun Oh
- Department of Internal Medicine, Hallym Kidney Research Institute, College of Medicine, Hallym University, Chuncheon, Korea
| | - Jang-Won Seo
- Department of Internal Medicine, Hallym Kidney Research Institute, College of Medicine, Hallym University, Chuncheon, Korea
- Division of Nephrology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong-si, Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym Kidney Research Institute, College of Medicine, Hallym University, Chuncheon, Korea
| | - Jong-Woo Yoon
- Department of Internal Medicine, Hallym Kidney Research Institute, College of Medicine, Hallym University, Chuncheon, Korea
| | - Hyung-Jik Kim
- Department of Internal Medicine, Hallym Kidney Research Institute, College of Medicine, Hallym University, Chuncheon, Korea
| | - Jung-Woo Noh
- Department of Internal Medicine, Hallym Kidney Research Institute, College of Medicine, Hallym University, Chuncheon, Korea
| | - Ja-Ryong Koo
- Department of Internal Medicine, Hallym Kidney Research Institute, College of Medicine, Hallym University, Chuncheon, Korea
- Division of Nephrology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong-si, Korea
- * E-mail:
| |
Collapse
|
19
|
Yoon JW, Lee YK, Choi MJ, Ryu JW, Koo JR, Noh JW. FP730PREVALENCE OF ADRENAL INSUFFICIENCY AND METHOD OF ACTH STIMULATION IN CHRONIC HEMODIALYSIS PATIENTS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv183.48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
20
|
Lee YK, Choi HY, Kim K, Cho A, Yoon JW, Noh JW, Kang WH, Choi YI, Kim EH, Shin YS, Kim DJ. FP725EFFECTS OF PATIENT SOLICITATION OF DIALYSIS FACILITIES ON PATIENTS’ SURVIVAL IN KOREA. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv183.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
21
|
Affiliation(s)
- A Rum Han
- Department of Internal Medicine, and Hallym Kidney Research Institute Hallym University College of Medicine, Seoul, Korea
| | - Young Ki Lee
- Department of Internal Medicine, and Hallym Kidney Research Institute Hallym University College of Medicine, Seoul, Korea
| | - Hyun Yon Jung
- Department of Internal Medicine, and Hallym Kidney Research Institute Hallym University College of Medicine, Seoul, Korea
| | - Jae Hyun Park
- Department of Internal Medicine, and Hallym Kidney Research Institute Hallym University College of Medicine, Seoul, Korea
| | - Jung-Woo Noh
- Department of Internal Medicine, and Hallym Kidney Research Institute Hallym University College of Medicine, Seoul, Korea
| | - Eun Suk Nam
- Department of Pathology, Hallym University College of Medicine, Seoul, Korea
| |
Collapse
|
22
|
Moh IH, Lee YK, Kim HJ, Jung HY, Park JH, Ahn HK, Noh JW. Empyema necessitatis in a patient on peritoneal dialysis. Tuberc Respir Dis (Seoul) 2014; 77:94-7. [PMID: 25237382 PMCID: PMC4165667 DOI: 10.4046/trd.2014.77.2.94] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/20/2014] [Accepted: 05/30/2014] [Indexed: 11/24/2022] Open
Abstract
Empyema necessitatis is a rare complication of an empyema. Although the incidence is thought to be decreased in the post-antibiotic era, immunocompromised patients such as patients with chronic kidney disease on dialysis are still at a higher risk. A 56-year-old woman on peritoneal dialysis presented with an enlarging mass on the right anterior chest wall. The chest computed tomography scan revealed an empyema necessitatis and the histopathologic findings revealed a granulomatous inflammation with caseation necrosis. The patient was treated with anti-tuberculous medication.
Collapse
Affiliation(s)
- In Ho Moh
- Department of Internal Medicine, Hallym Kidney Research Institute, Seoul, Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym Kidney Research Institute, Seoul, Korea
| | - Hee Joon Kim
- Department of Internal Medicine, Hallym Kidney Research Institute, Seoul, Korea
| | - Hyun Yon Jung
- Department of Internal Medicine, Hallym Kidney Research Institute, Seoul, Korea
| | - Jae Hyun Park
- Department of Internal Medicine, Hallym Kidney Research Institute, Seoul, Korea
| | - Hye-Kyung Ahn
- Department of Pathology, Hallym University College of Medicine, Seoul, Korea
| | - Jung-Woo Noh
- Department of Internal Medicine, Hallym Kidney Research Institute, Seoul, Korea
| |
Collapse
|
23
|
Choi MJ, Yoon JW, Han SJ, Choi HH, Song YR, Kim SG, Oh JE, Lee YK, Seo JW, Kim HJ, Noh JW, Koo JR. The prevention of contrast-induced nephropathy by simultaneous hemofiltration during coronary angiographic procedures: a comparison with periprocedural hemofiltration. Int J Cardiol 2014; 176:941-5. [PMID: 25200848 DOI: 10.1016/j.ijcard.2014.08.095] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 08/16/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Periprocedural (6 h pre- and 24 h post-angiography) hemofiltration appears to effectively prevent contrast-induced nephropathy (CIN) in chronic kidney disease (CKD) patients undergoing coronary angiography. However, this procedure over-uses medical resources, and the cessation of hemofiltration during coronary angiography results in persistent renal injury. In comparison, simultaneous hemofiltration performed only during coronary angiography requires fewer medical resources and can provide instantaneous protection against CIN. METHODS Sixty-eight CKD patients (serum creatinine, 2.51±1.15 mg/dL) undergoing coronary angiography were randomized in a 1:2 ratio to receive either periprocedural (n=23) or simultaneous (n=45) hemofiltration. The expected CIN rate was similar for the two groups (41.3% versus 40.0%, p=0.769). RESULTS On day 3 after contrast exposure, four and seven patients in the periprocedural and simultaneous groups, respectively experienced CIN (17.4% versus 15.6%, p=0.846). On days 5-30, seven and three patients in the periprocedural and simultaneous groups, respectively experienced CIN (30.4% versus 6.7%, p=0.009). The serum creatinine levels of patients in the periprocedural group transiently decreased on day 1 and persistently increased during days 5-30 compared with the simultaneous group. This difference between the two groups in terms of creatinine levels over time was statistically significant (F statistic=6.830; p=0.001, by ANCOVA). The cost of hemofiltration was doubled in the periprocedural group ($1066±83 versus $504±40, p<0.001). CONCLUSIONS Simultaneous hemofiltration provide equal early (day 3) and better late-stage (days 5-30) renal protection against CIN at a significantly lower cost compared with periprocedural hemofiltration.
Collapse
Affiliation(s)
- Myung-Jin Choi
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea
| | - Jong-Woo Yoon
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea
| | - Sang-Jin Han
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea
| | - Hyun-Hee Choi
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea
| | - Young-Rim Song
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea
| | - Sung-Gyun Kim
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea
| | - Ji-Eun Oh
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea
| | - Young-Ki Lee
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea
| | - Jang-Won Seo
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea; Division of Nephrology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Republic of Korea
| | - Hyung-Jik Kim
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea
| | - Jung-Woo Noh
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea
| | - Ja-Ryong Koo
- Department of Internal Medicine, College of Medicine, Hallym University, Republic of Korea; Hallym University Kidney Research Institute, Republic of Korea; Division of Nephrology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Republic of Korea.
| |
Collapse
|
24
|
Kim H, Moh I, Jung DH, Lee YK, Woo JY, Lee Y, Noh JW. A Tubercus Sclerosis Case Accompanied by Cystic Angiomyolipoma and Chronic Kidney Disease Diagnosed during Treatment for Acute Cerebral Infarction. KMJ 2013. [DOI: 10.7180/kmj.2013.28.2.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
<p>Symptoms of tuberous scelrosis (TS) are mainly related with brain and kidneys. Seizure, mental retardation, other behavioral problems are dominant. A spectrum of renal tumors from benign angiomyolipoma (AML) to polycystic kidney disease, and rarely malignant renal cell carcinoma have been observed. Cystic AML is a rare phenotype of AML. No case of TS with renal cystic AML has been reported in Korea yet. And chronic kidney disease (CKD) in TS has been seldom reported. We experienced a TS case accompanied by renal cystic AML and CKD diagnosed in a 48-year-old female patient who was hospitalized for left side weakness and seizure under the diagnosis of acute cerebral infarction.</p>
Collapse
|
25
|
Abstract
PURPOSE Patients with chronic kidney disease frequently show cognitive dysfunction. The association of depression and cognitive function is not well known in maintenance dialysis patients. We evaluated cognitive impairment and depression, as well as their relationship in regards to methods of dialysis, maintenance hemodialysis (MHD) and chronic peritoneal dialysis (CPD). MATERIALS AND METHODS Fifty-six maintenance dialysis patients were recruited and their clinical and laboratory data were collected. The Korean version of the mini-mental state exam (K-MMSE) was applied to screen the patient's cognitive function, while the Korean version of the Beck Depression Inventory (K-BDI) was used for depression screening. RESULTS The average age of the participants was 54.2±10.2 years; 29 (51.8%) were female. The average dialysis vintage was 4.2±3.8 years. The CPD group showed significantly higher K-MMSE score (27.8±2.9 vs. 26.1±3.1, p=0.010) and lower K-BDI score (12.0±8.4 vs. 20.2±10.4, p=0.003) compared with the MHD group. The percentage of patients with depression symptoms was higher in the MHD group (51.7% vs. 18.5%). There was a negative correlation between cognitive function and prevalence of depressive symptoms. Depression and education level were shown to be independent predictors for cognitive impairment in multivariate analysis. CONCLUSION Cognitive impairment was closely correlated with depression. It is important to detect cognitive impairment and depression early in maintenance dialysis patients with simple bedside screening tools.
Collapse
Affiliation(s)
- San Jung
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul 150-950, Korea.
| | | | | | | | | |
Collapse
|
26
|
Song YJ, Lee YK, Choi SR, Kim JH, Kim SW, Noh JW. Giant Right Atrial Thrombus associated with Tunneled Cuffed Hemodialysis Catheter: A Case of Successful Treatment with Thrombolytic Agent and Anticoagulant. KMJ 2013. [DOI: 10.7180/kmj.2013.28.1.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
There are a variety of tunneled cuffed hemodialysis catheter-related complications including infection, thrombus formation, and catheter dysfunction. Catheter-related thrombus in right atrium is a rare complication and treatment guideline for atrial thrombus does not exist. A 3.0×2.8 cm sized giant atrial thrombus was found in a 35-year-old female hemodialysis patient. She was treated with catheter removal, thrombolysis and anticoagulation therapy. Size of atrial thrombus was gradually decreased and left ventricular systolic function was clearly improved after treatment. We experienced and reported a case of giant right atrial thrombus associated with tunneled cuffed hemodialysis catheter that was successful treated with thrombolytic agent and anticoagulant.
Collapse
|
27
|
Lee YK, Lee DH, Kim JK, Park MJ, Yan JJ, Song DK, Vaziri ND, Noh JW. Lysophosphatidylcholine, oxidized low-density lipoprotein and cardiovascular disease in Korean hemodialysis patients: analysis at 5 years of follow-up. J Korean Med Sci 2013; 28:268-73. [PMID: 23400766 PMCID: PMC3565139 DOI: 10.3346/jkms.2013.28.2.268] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 11/16/2012] [Indexed: 11/21/2022] Open
Abstract
Although oxidized low-density lipoprotein (LDL) and lysophosphatidylcholine (LPC) have been proposed as important mediators of the atherosclerosis, the long-term contribution to the risk of cardiovascular disease (CVD) in hemodialysis patients has not been evaluated. This study investigated the relation between oxidized LDL and LPC levels with long term risk of CVD. Plasma oxidized LDL and LPC levels were determined in 69 Korean hemodialysis patients as a prospective observational study for 5 yr. During the observation period, 18 cardiovascular events (26.1%) occurred including 6 deaths among the hemodialysis patients. The low LPC level group (≤ 254 µM/L, median value) had much more increased risk of CVD compared to the high LPC level group (> 254 µM/L) (P = 0.01). However, serum levels of oxidized LDL were not significantly different between groups with and without CVD. In adjusted Cox analysis, previous CVD, (hazard ratio [HR], 5.68; 95% confidence interval [CI], 1.94-16.63, P = 0.002) and low LPC level (HR, 3.45; 95% CI, 1.04-11.42, P = 0.04) were significant independent risk factors for development of CVD. It is suggested that low LPC, but not oxidized LDL, is associated with increased risk of CVD among a group of Korean hemodialysis patients.
Collapse
Affiliation(s)
- Young-Ki Lee
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Dong Hun Lee
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Jin Kyung Kim
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Min-Jeong Park
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Ji-Jing Yan
- Department of Pharmacology, Hallym University College of Medicine, Chuncheon, Korea
| | - Dong-Keun Song
- Department of Pharmacology, Hallym University College of Medicine, Chuncheon, Korea
| | - Nosratola D Vaziri
- Division of Nephrology and Hypertension, Department of Medicine, University of California, Irvine, Irvine, California, USA
| | - Jung-Woo Noh
- Department of Internal Medicine, Hallym Kidney Research Institute, Hallym University College of Medicine, Seoul, Korea
| |
Collapse
|
28
|
Choi MJ, Seo JW, Yoon JW, Lee SK, Kim SJ, Lee YK, Noh JW, Koo JR. The Malnutrition-Inflammation-Depression-Arteriosclerosis Complex Is Associated with an Increased Risk of Cardiovascular Disease and All-Cause Death in Chronic Hemodialysis Patients. ACTA ACUST UNITED AC 2012; 122:44-52. [DOI: 10.1159/000348509] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 01/30/2013] [Indexed: 11/19/2022]
|
29
|
Kim JY, Hyun YY, Lee JE, Yoon HR, Kim GH, Yoo HW, Cho ST, Chun NW, Jeoung BC, Kim HJ, Kim KW, Kim SN, Kim YA, Lee HA, Lee JY, Lee YC, Lim HK, Oh KS, Son SH, Yu BH, Wee KS, Lee EJ, Lee YK, Noh JW, Kim SJ, Choi KB, Yu SH, Pyo HJ, Kwon YJ. Serum globotriaosylceramide assay as a screening test for fabry disease in patients with ESRD on maintenance dialysis in Korea. Korean J Intern Med 2010; 25:415-21. [PMID: 21179280 PMCID: PMC2997971 DOI: 10.3904/kjim.2010.25.4.415] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 02/04/2010] [Accepted: 06/22/2010] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND/AIMS Fabry disease is an X-linked recessive and progressive disease caused by α-galactosidase A (α-GaL A) deficiency. We sought to assess the prevalence of unrecognized Fabry disease in dialysis-dependent patients and the efficacy of serum globotriaosylceramide (GL3) screening. METHODS A total of 480 patients of 1,230 patients among 17 clinics were enrolled. Serum GL3 levels were measured by tandem mass spectrometry. Additionally, we studied the association between increased GL3 levels and cardiovascular disease, cerebrovascular disease, or left ventricular hypertrophy. RESULTS Twenty-nine patients had elevated serum GL3 levels. The α-GaL A activity was determined for the 26 patients with high GL3 levels. The mean α-GaL A activity was 64.6 nmol/hr/mg (reference range, 45 to 85), and no patient was identified with decreased α-GaL A activity. Among the group with high GL3 levels, 15 women had a α-GaL A genetics analysis. No point mutations were discovered among the women with high GL3 levels. No correlation was observed between serum GL3 levels and α-GaL A activity; the Pearson correlation coefficient was 0.01352 (p = 0.9478). No significant correlation was observed between increased GL3 levels and the frequency of cardiovascular disease or cerebrovascular disease. CONCLUSIONS Fabry disease is very rare disease in patients with end-stage renal disease. Serum GL3 measurements as a screening method for Fabry disease showed a high false-positive rate. Thus, serum GL3 levels determined by tandem mass spectrometry may not be useful as a screening method for Fabry disease in patients with end stage renal disease.
Collapse
Affiliation(s)
- Jeong-Yup Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Lee YK, Koo JR, Kim JK, Park II, Joo MH, Yoon JW, Noh JW, Vaziri ND. Effect of Route of EPO Administration on Hemodialysis Arteriovenous Vascular Access Failure: A Randomized Controlled Trial. Am J Kidney Dis 2009; 53:815-22. [DOI: 10.1053/j.ajkd.2008.12.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2008] [Accepted: 12/22/2008] [Indexed: 11/11/2022]
|
31
|
Koo JR, Yoon JY, Joo MH, Lee HS, Oh JE, Kim SG, Seo JW, Lee YK, Kim HJ, Noh JW, Lee SK, Son BK. Treatment of Depression and Effect of Antidepression Treatment on Nutritional Status in Chronic Hemodialysis Patients. Am J Med Sci 2005; 329:1-5. [PMID: 15654172 DOI: 10.1097/00000441-200501000-00001] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [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: 11/27/2022]
Abstract
BACKGROUND Depression, which is the most common psychological complication in patients with end-stage renal disease (ESRD), has an impact on the clinical outcome and is associated with malnutrition in chronic hemodialysis patients. This study evaluated the effect of antidepression treatment on nutritional status in depressed chronic hemodialysis patients. METHODS Sixty-two ESRD patients who underwent dialysis for more than 6 months were interviewed and completed a Beck Depression Inventory assessment. Thirty-four patients who had scores greater than 18 on the Beck Depression Inventory score and met Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for major depressive disorder were selected to receive paroxetine 10 mg/day and psychotherapy for 8 weeks. The remaining 28 patients were assigned to the control group. Change in the severity of depressive symptoms was ascertained by administering the Hamilton Depression Rating Scale. Nutritional status was evaluated by normalized protein catabolic rate, serum albumin and blood urea nitrogen level. RESULTS All patients successfully completed 8 weeks of antidepression treatment. Antidepression treatment decreased the severity of depressive symptoms (Hamilton Depression Rating Scale score: 16.6 +/- 7.0 versus 15.1 +/- 6.6, P < 0.01) and increased normalized protein catabolic rate (1.04 +/- 0.24 versus 1.17 +/- 0.29 g/kg/day, P < 0.05), serum albumin (37.3 +/- 2.0 versus 38.7 +/- 3.2 g/l, P < 0.005), and prehemodialysis blood urea nitrogen level (24.3 +/- 5.6 versus 30.2 +/- 7.9 mmol/L, P < 0.001). In the control group, no change was noted during the study period. CONCLUSION This study suggests that antidepressant medication with supportive psychotherapy can successfully treat depression and improve nutritional status in chronic hemodialysis patients with depression.
Collapse
Affiliation(s)
- Ja-Ryong Koo
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Hallym University, Chunchon, Kangwon Do, South Korea.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Koo JR, Yoon JW, Kim SG, Lee YK, Oh KH, Kim GH, Kim HJ, Chae DW, Noh JW, Lee SK, Son BK. Association of depression with malnutrition in chronic hemodialysis patients. Am J Kidney Dis 2003; 41:1037-42. [PMID: 12722038 DOI: 10.1016/s0272-6386(03)00201-4] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.3] [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: 11/29/2022]
Abstract
BACKGROUND Depression is the most common psychological complication and may increase mortality in chronic hemodialysis patients. Because depression could be associated with poor oral intake and activation of proinflammatory cytokines that could further increase mortality by malnutrition, we investigated the relation between depression and nutritional status in chronic hemodialysis patients. METHODS Sixty-two Korean patients completed the Beck Depression Inventory (BDI) questionnaire, and the diagnosis of depression was confirmed by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for major depressive disorder. Nutritional status was evaluated using serum albumin level, normalized protein catabolic rate, subjective global assessment (SGA), and anthropometric measurement. RESULTS Mean BDI score was 22.7 +/- 11.4, and 35 patients (56.5%) had a BDI score greater than 21, which is the suggested cutoff score for the diagnosis of depression for the Korean population. Of 40 patients who had a score higher than 18 on the BDI, 34 patients met DSM-IV criteria for major depressive disorder. BDI score correlated negatively with a variety of nutritional parameters: serum albumin level (r = -0.47; P < 0.001), normalized protein catabolic rate (r = -0.32; P < 0.05), SGA (r = -0.47; P < 0.01), triceps skinfold thickness (r = -0.40; P < 0.05), midarm muscle circumference (r = -0.57; P < 0.01), and body mass index (r = -0.28; P < 0.05). Multiple regression analysis also identified BDI score as an independent determinant for all kinds of nutritional parameters. CONCLUSION In patients on chronic hemodialysis therapy, depression is related closely to nutritional status and could be an independent risk factor for malnutrition.
Collapse
Affiliation(s)
- Ja-Ryong Koo
- Department of Internal Medicine, Division of Nephrology, College of Medicine, Hallym University, Chuchon, Kangwon Do, South Korea.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Koo JR, Kim JC, Yoon JW, Kim GH, Jeon RW, Kim HJ, Chae DW, Noh JW. Failure of continuous venovenous hemofiltration to prevent death in paraquat poisoning. Am J Kidney Dis 2002; 39:55-9. [PMID: 11774102 DOI: 10.1053/ajkd.2002.29880] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [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: 11/11/2022]
Abstract
Paraquat poisoning is characterized by multiorgan failure and pulmonary fibrosis with respiratory failure. Multiorgan failure with circulatory collapse is a major cause of early death within 3 days of paraquat ingestion. Recent studies suggested that continuous venovenous hemofiltration (CVVH) had a role in the treatment of multiorgan failure by promoting hemodynamic stability. We therefore evaluated the effect of prophylactic CVVH in 80 patients with paraquat poisoning (August 1996 to February 1999). The amount ingested was 2.1 +/- 1.0 mouthfuls (as 20% concentrate). All patients were treated with hemoperfusion (HP; duration, 6.4 +/- 3.0 hours) within 24 hours of ingestion and then randomly assigned to the HP-alone or HP-CVVH group. Forty-four patients underwent HP only, and 36 patients underwent CVVH (duration, 57.4 +/- 31.3 hours; ultrafiltration volume, 40.2 +/- 4.8 L/d) after HP. Although time to death after ingestion was significantly longer in the HP-CVVH than HP group (5.0 +/- 5.0 versus 2.5 +/- 2.1 days; P < 0.05), there was no difference in mortality rates between the two groups (66.7% versus 63.6%; P = 0.82). In the HP group, early circulatory collapse was a major cause of death compared with the HP-CVVH group, in which late respiratory failure was a major cause of death. In conclusion, prophylactic CVVH after HP prevented early death caused by circulatory collapse and prolonged survival time. However, it could not prevent late death caused by respiratory failure and did not provide a survival benefit in acute paraquat poisoning.
Collapse
Affiliation(s)
- Ja-Ryong Koo
- Division of Nephrology, College of Medicine, Hallym University, Chunchon, Kangwon Do, Seoul, Korea.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Kim JT, Park JY, Seo HS, Oh HG, Noh JW, Kim SW, Youn HJ. Identification of Acanthocephala discovered in changran-pickles and myungran-pickles. J Vet Sci 2001; 2:111-4. [PMID: 14614280] [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: 04/27/2023] Open
Abstract
To identify acanthocephala found in 'Changran-pickles' and 'Myungran-pickles' each organ was measured in permanent slides. In the present report, the results obtained were as follows: 1. Morphology of male worms: Worms possessed 18-19 longitudinal rows, with 4 hooks per row, which became smaller towards the base of proboscis. Each worm contained two testis and six cement glands arranged linearly. Body 22.0 by 0.8-0.6 mm and 15.0 by 0.6-0.4 mm, proboscis 284.8 by 227.6 micro m and 524.9 by 151.4 micro m, proboscis sheath 1570.7 by 72.7 micro m and 751.9 by 280.4 micro m, lemnisci length 2566.7 and 1085.6, testis 2202.9-1860.5 by 737.0-575.7 micro m and 1033.8-981.1 by 463.1-351.6 micro m, cement glands 940.2 by 441.2 micro m and 610.0 by 369.1 micro m. 2. Morphology of female worms: Worms possessed 14-18 longitudinal rows, with 6-10 hooks per row and become smaller toward the base of proboscis. Each worm contained an uterine bell and uterus in the posterior portion and the eggs filled the body cavity. Body, approximately 14.0 - 51.0 mm by 0.7-0.5 - 2.2-1.4 mm, proboscis 466.1-268.9 micro m by 259.9-252.0 micro m, proboscis sheath 1550.7-506.0 by 298.8-231.1 micro m, lemnisci length 1325.7-473.1 micro m, eggs approximately 112.4 by 28.5 micro m - 51.7 by 14.0 micro m. In this present study, the acanthocephala collected in 'Changran-pickles' and 'Myungran-pickles' were identified as Echinorhynchus gadi by morphological features.
Collapse
Affiliation(s)
- J T Kim
- Department of Parasitology, College of Veterinary Medicine, Seoul National University, Suwon 441-744, Korea
| | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
Ionophorous antibiotics have been popularly used in the treatment of avian coccidiosis. Tissue residue of these antibiotics may be found in poultry, we have sought safe alternative anticoccidial herbal materials for the control of avian coccidiosis. Efficacy of extracts from 15 different herbs, including Bupleurum chinese DC, Sophora flavescens Aiton, and Artemisia annua Linne was tested against Eimeria tenella. One-day-old broiler chicks were infected with a USDA reference book of E. tenella, and administered various herbal extracts. Survival rates, lesion scores, body weight gains, bloody diarrhea, and oocysts excretions were investigated at the first and the second week after infection. Bloody diarrhea in the S. flavescens and Sinomenium acutum treated groups was milder than that of the other infected groups. Survival rates in the groups treated with Ulmus macrocarpa (100%), Pulsatilla koreana, Torilis japonica, Artemisia asiatica and S. flavescens (90%) were higher than that of the infected control group (70%). Lesion scores in the groups treated with U. macrocarpa (1.40+/-1.14) or Pulsatilla koreana (1.60+/-1.82) were significantly lower than those of the infected control group (3.00+/-1.10). During the first week after infection, the weight gains in the groups treated with Quisqualis indica (232.9+/-43.5 g), S. flavescens (214.4+/-46.1 g) and S. acutum (211.3+/-29.4 g) were significantly higher than the infected control group (172.4+/-17.6 g). In conclusion, the data of the survival rates, bloody diarrhea symptoms, lesion scores, body weight gains and oocyst excretions indicate that the extract of S. flavescens was the most effective. P. koreana, S. acutum, U. macrocarpa and Q. indica were also effective. Further research on the above herbal materials will be carried out by the authors by chemical analysis of the extracts.
Collapse
Affiliation(s)
- H J Youn
- College of Veterinary Medicine, Seoul National University, 441-744, Suweon, South Korea.
| | | |
Collapse
|
36
|
Lim CS, Zheng S, Kim YS, Ahn C, Han JS, Kim S, Lee JS, Chae DW, Koo JR, Chun RW, Noh JW. Th1/Th2 predominance and proinflammatory cytokines determine the clinicopathological severity of IgA nephropathy. Nephrol Dial Transplant 2001; 16:269-75. [PMID: 11158399 DOI: 10.1093/ndt/16.2.269] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [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: 11/14/2022] Open
Abstract
BACKGROUND IgA nephropathy is one of the most common forms of primary glomerulonephritis in adults. Its pathogenesis is complex. The nature of infiltrating and proliferating cells and of cellular mediators could contribute to the progression of IgA nephropathy towards end-stage renal failure. METHODS To evaluate this hypothesis, we attempted to quantify the magnitude of intrarenal gene expression of various cytokines (IL-1 beta, TNF-alpha, IL-6, IL-15, IL-2, IFN-gamma, IL-10) and chemokines (IL-8, RANTES, MCP-1) in 48 renal core biopsy specimens, diagnosed as IgA nephropathy by immunofluorescence microscopy. Semi-quantitative reverse-transcriptase polymerase chain reaction using internal competitors was used for the quantification of gene transcripts. RESULTS The expression of intrarenal gene transcripts of various cytokines and chemokines was closely interrelated, but not associated with the pathological grading system. The IFN-gamma/IL-10 ratio was higher in patients with renal dysfunction than in those with normal renal function (P=0.0483). Gene transcript levels of proinflammatory cytokines were related to the amount of proteinuria. In patients with severe glomerular sclerosis, the ratio of IFN-gamma/IL-10 gene transcripts was high (P=0.04). IL-10 gene transcript level was related to the severity of tubulointerstitial damage. The levels of gene expression of IL-10 (P=0.009), IFN-gamma (P=0.03), and TNF-alpha (P=0.005) were related to the degree of mesangial matrix expansion and the extent of intrarenal arteriolar changes correlated with the expression of the IL-8 gene transcript (r=0.43, P=0.004). CONCLUSIONS We propose that Th1/Th2 predominance and the level of proinflammatory cytokines could determine the pathogenetic processes and the severity of the clinical manifestations of IgA nephropathy.
Collapse
Affiliation(s)
- C S Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
Leptin serves an important role in suppressing appetite in mice and is known to be elevated in chronic renal failure (CRF) patients. But clinical significance of leptin as an appetite-reducing uremic toxin, remains to be determined. So we studied the relationship between plasma leptin and nutritional status in 46 chronic hemodialysis (HD) patients. Pre HD leptin was measured and divided by body mass index (BMI) to give adjusted leptin levels. KT/Vurea (K, dialyzer urea clearance; T, duration of HD; V, volume of distribution of urea), C-reactive protein (CRP), plasma insulin and nutritional parameters such as serum albumin, normalized protein catabolic rate (nPCR), subjective global assessment (SGA), BMI and mid-arm muscle circumference (MAMC) were also measured. Mean plasma leptin levels were 8.13+/-2.91 ng/mL (male 3.15+/-0.70; female 14.07+/-6.14, p<0.05). Adjusted leptin levels were positively correlated with nPCR (male r=0.47, p<0.05; female r=0.46, p<0.05), SGA (male r=0.43, p<0.05; female r=0.51, p<0.05) and MAMC (male r=0.60, p<0.005; female r=0.61, p<0.05). They did not correlate with KT/Vurea, serum albumin, hematocrit, bicarbonate, insulin and CRP. Presence of DM and erythropoietin therapy had no effect on leptin levels. These results suggest that leptin is a marker of good nutritional status rather than a cause of protein energy malnutrition in chronic HD patients.
Collapse
Affiliation(s)
- J R Koo
- Department of Nephrology, College of Medicine, Hallym University, Chunchon, Korea.
| | | | | | | | | | | | | | | |
Collapse
|
38
|
de Miguel MH, Yeung HN, Goyal M, Noh JW, Aisen AM, Phan SH, Wiggins RC. Evaluation of quantitative magnetic resonance imaging as a noninvasive technique for measuring renal scarring in a rabbit model of antiglomerular basement membrane disease. J Am Soc Nephrol 1994; 4:1861-8. [PMID: 7919135 DOI: 10.1681/asn.v4111861] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Renal function tests are an insensitive means of detecting progressive scarring of the kidney such as occurs in chronic allograft rejection and lupus nephritis. Alternative approaches for the measurement of small progressive changes in renal structure on a repetitive basis are needed. Quantitative magnetic resonance imaging (proton T1 relaxation time) was assessed for this purpose. A rabbit model of antiglomerular basement membrane disease that develops glomerular and interstitial inflammation followed by scarring of the renal cortex was used. Longitudinal studies of cortical T1 showed a marked prolongation of T1 during the initial inflammation and edema associated with glomerular crescent formation (Day 7). The T1 remained prolonged up to Day 120 in animals with significant fibrosis and crescent formation when the wet/dry weight ratio (a measure of edema) had returned to baseline. T1 was a more sensitive index of renal injury than was serum creatinine for all of the end points measured (cortical hydroxyproline per dry weight, percent crescent formation, or histologic fibrosis score). It was concluded from these studies that measurement of renal cortical T1 is quite a sensitive index of renal injury, probably more sensitive than the measurement of serum creatinine, but that this method does not discriminate between edema and scarring.
Collapse
Affiliation(s)
- M H de Miguel
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | | | | | | | | | | | | |
Collapse
|
39
|
Fougères A, Noh JW, Grayson TP, Mandel L. Measurement of phase differences between two partially coherent fields. Phys Rev A 1994; 49:530-534. [PMID: 9910258 DOI: 10.1103/physreva.49.530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
40
|
Noh JW, Fougères A, Mandel L. Measurements of the probability distribution of the operationally defined quantum phase difference. Phys Rev Lett 1993; 71:2579-2582. [PMID: 10054717 DOI: 10.1103/physrevlett.71.2579] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
|
41
|
Noh JW, Fougères A, Mandel L. Reply to "Comment on 'Further investigations of the operationally defined quantum phase' ". Phys Rev A 1993; 48:1719. [PMID: 9909782 DOI: 10.1103/physreva.48.1719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
42
|
|
43
|
Noh JW, Fougères A, Mandel L. Reply to "Comment on 'Operational approach to the phase of a quantum field' ". Phys Rev A 1993; 47:4535-4536. [PMID: 9909469 DOI: 10.1103/physreva.47.4535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
|
44
|
Noh JW, Wiggins R, Phan SH. Urine transforming growth factor-beta activity is related to the degree of scarring in crescentic nephritis in the rabbit. Nephron Clin Pract 1993; 63:73-8. [PMID: 8446255 DOI: 10.1159/000187146] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Crescentic nephritis was induced in rabbits by injection of antirabbit glomerular basement membrane (GBM) antibodies. Urine samples were obtained by catheterization and assayed for transforming growth factor-beta (TGF-beta) activity. On day 31, all animals were sacrificed for evaluation of renal cortical histopathology and collagen content. The results show that control rabbit urine contains measurable amounts of TGF-beta. Urine TGF-beta activity was expressed in relation to urine creatinine concentration to correct for variation in urine concentration. When expressed in this manner, urine TGF-beta activity increased from day 2 onwards, peaked on day 7 and returned to normal levels after day 14. This time course is identical to that previously seen for the cortical and glomerular production of TGF-beta in the same model. Furthermore, when the normalized TGF-beta values for each animal were compared to their respective fibrosis parameters on day 31, significant correlations were observed for the values of urine TGF-beta activities on day 7 and all indices of fibrosis. These results suggest that measurements of urine TGF-beta activity at certain critical stages of disease could be useful in predicting the progression to end-stage renal disease with fibrosis and might serve as a helpful noninvasive adjunct in monitoring response to therapy.
Collapse
Affiliation(s)
- J W Noh
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor 48109-0602
| | | | | |
Collapse
|
45
|
|
46
|
|
47
|
|
48
|
Abstract
Dieulafoy’s disease is a distinctive arteriovenous malformation of the stomach, which presents with massive or recurrent gastrointestinal bleeding. A case of Dieulafoy’s disease in an adult female, in which an endoscopic Nd: YAG (neodymium: yttrium aluminum garnet) laser was used successfully in controlling bleeding, is presented here.
Collapse
|