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Kang SH, Do JY. Phase Angle as a Risk Factor for Mortality in Patients Undergoing Peritoneal Dialysis. Nutrients 2023; 15:4991. [PMID: 38068848 PMCID: PMC10707951 DOI: 10.3390/nu15234991] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
Phase angle (PhA) is measured using bioimpedance analysis and calculated using body reactance and resistance in the waveform at 50 kHz. Further studies are necessary to clarify the predictive efficacy of PhA in the mortality of peritoneal dialysis (PD) patients. The objective of this study was to assess the utility of PhA for predicting patient mortality and technique failure and compare the predictability of PhA with other risk factors. Our study had a retrospective cohort design. Our center routinely evaluates bioimpedance measurements for all prevalent PD patients (n = 199). The PhA was measured using multifrequency bioimpedance analysis. Our study evaluated patient and technique survival. There were 66, 68, and 65 patients in the low, middle, and high tertiles of PhA, respectively. The PhA values of the low, middle, and high tertiles were 3.6° (3.4-3.9), 4.4° (4.2-4.7), and 5.5° (5.2-6.0), respectively. The 5-year patient survival rates for the high, middle, and low tertiles were 100%, 81.7%, 69.9%, respectively (p < 0.001). The 5 year technique survival rates for the high, middle, and low tertiles were 91.9%, 74.8%, 63.7%, respectively (p = 0.004). Patient and technique survival increased as the PhA tertiles increased. Both univariate and multivariate Cox regression analyses demonstrated a consistent pattern. The prediction of patient or technique survival was better in PhA than in the other classical indicators. The present study demonstrated that PhA may be an effective indicator for predicting patient or technique survival in PD patients. Furthermore, it suggests that routine measurement of PhA and pre-emptive intervention to recover PhA according to causes of low PhA may help improve patient or technique survival in PD patients.
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Affiliation(s)
| | - Jun-Young Do
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea;
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Kang SH, Kim GO, Kim BY, Son EJ, Do JY. Correlation between Statin Solubility and Mortality in Patients on Chronic Hemodialysis. Diagnostics (Basel) 2023; 13:3290. [PMID: 37892111 PMCID: PMC10605997 DOI: 10.3390/diagnostics13203290] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/15/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
This study aimed to evaluate the effect of statin solubility on the survival of patients undergoing hemodialysis (HD). This retrospective study used laboratory and clinical data from a national HD quality assessment program and claims data (n = 53,345). The use of statins was defined as prescription ≥30 days during 6 months of each HD quality assessment period. We divided the patients into three groups based on the use and solubility of statins: No group, patients without a prescription of statins (n = 37,944); Hydro group, patients with a prescription of hydrophilic statins (n = 2823); and Lipo group, patients with a prescription of lipophilic statins (n = 12,578). The 5-year survival rates in the No, Hydro, and Lipo groups were 69.6%, 67.9%, and 67.9%, respectively (p < 0.001 for the trend). Multivariable Cox regression analyses showed that the Lipo group had better patient survival than the No group. However, multivariable analyses did not show statistical significance between the Hydro and No or Lipo groups. In all subgroups based on sex, age, presence of diabetes mellitus, and heart disease, the Lipo group had better patient survival than the No group. We identified no significant association between hydrophilic and lipophilic statins and patient survival. However, patients taking lipophilic statins had a modest survival benefit compared with those who did not receive statins.
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Affiliation(s)
- Seok-Hui Kang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea;
| | - Gui-Ok Kim
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju 26465, Republic of Korea; (G.-O.K.)
| | - Bo-Yeon Kim
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju 26465, Republic of Korea
| | - Eun-Jung Son
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju 26465, Republic of Korea; (G.-O.K.)
| | - Jun-Young Do
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea;
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Kang SH, Kim BY, Son EJ, Kim GO, Do JY. Influence of Different Types of β-Blockers on Mortality in Patients on Hemodialysis. Biomedicines 2023; 11:2838. [PMID: 37893212 PMCID: PMC10603865 DOI: 10.3390/biomedicines11102838] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/08/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Previous results regarding the association between types of β-blockers and outcomes in patients on hemodialysis (HD) were inconsistent. Our study aimed to evaluate patient survival according to the type of β-blockers administered using a large sample of patients with maintenance HD. Our study included patients on maintenance HD patients from a national HD quality assessment program (n = 54,132). We divided included patients into four groups based on their use and type; Group 1 included patients without a prescription of β-blockers, Group 2 included patients with a prescription of dialyzable and cardioselective β-blockers, Group 3 included patients with a prescription of non-dialyzable and non-cardioselective β-blockers, and Group 4 included patients with prescription of non-dialyzable and cardioselective β-blockers. The number of patients in Groups 1, 2, 3, and 4 were 34,514, 2789, 15,808, and 1021, respectively. The 5-year survival rates in Groups 1, 2, 3, and 4 were 69.3%, 66.0%, 68.8%, and 69.2%, respectively. Univariate Cox regression analyses showed the hazard ratios to be 1.10 (95% CI, 1.04-1.17) in Group 2 and 1.05 (95% CI, 1.02-1.09) in Group 3 compared to Group 1. However, multivariate Cox regression analyses did not show statistical significance among the four groups. Our study showed that there was no significant difference in patient survival based on the use or types of β-blockers.
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Affiliation(s)
- Seok-Hui Kang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea;
| | - Bo-Yeon Kim
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju 26465, Republic of Korea
| | - Eun-Jung Son
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju 26465, Republic of Korea
| | - Gui-Ok Kim
- Quality Assessment Department, Health Insurance Review and Assessment Service, Wonju 26465, Republic of Korea
| | - Jun-Young Do
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea;
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Kang SH, Kim BY, Son EJ, Kim GO, Do JY. Association between Iron Status and Survival in Patients on Chronic Hemodialysis. Nutrients 2023; 15:nu15112577. [PMID: 37299540 DOI: 10.3390/nu15112577] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
The aim of this study was to evaluate survival rates according to iron status in patients undergoing maintenance hemodialysis (HD). Thus, the National HD Quality Assessment Program dataset and claims data were used for analysis (n = 42,390). The patients were divided into four groups according to their transferrin saturation rate and serum ferritin levels: Group 1 (n = 34,539, normal iron status); Group 2 (n = 4476, absolute iron deficiency); Group 3 (n = 1719, functional iron deficiency); Group 4 (n = 1656, high iron status). Using univariate and multivariable analyses, Group 1 outperformed the three other groups in terms of patient survival. Using univariate analysis, although Group 2 showed a favorable trend in patient survival rates compared with Groups 3 and 4, the statistical significance was weak. Group 3 exhibited similar patient survival rates to Group 4. Using multivariable Cox regression analysis, Group 2 had similar patient survival rates to Group 3. Subgroup analyses according to sex, diabetic status, hemoglobin level ≥ 10 g/dL, and serum albumin levels ≥ 3.5 g/dL indicated similar trends to those of the total cohort. However, subgroup analysis based on patients with a hemoglobin level < 10 g/dL or serum albumin levels < 3.5 g/dL showed a weak statistical significant difference compared with those with hemoglobin level ≥ 10 g/dL, or serum albumin levels ≥ 3.5 g/dL. In addition, the survival difference between Group 4 and other groups was greater in old patients than in young ones. Patients with a normal iron status had the highest survival rates. Patient survival rates were similar or differed only modestly among the groups with abnormal iron status. In addition, most subgroup analyses revealed similar trends to those according to the total cohort. However, subgroup analyses based on age, hemoglobin, or serum albumin levels showed different trends.
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Affiliation(s)
- Seok-Hui Kang
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, 170 Hyeonchung-Ro, Nam-Gu, Daegu 42415, Republic of Korea
| | - Bo-Yeon Kim
- Health Insurance Review and Assessment Service, 60 Hyeoksin-Ro, Wonju-si 26465, Republic of Korea
| | - Eun-Jung Son
- Health Insurance Review and Assessment Service, 60 Hyeoksin-Ro, Wonju-si 26465, Republic of Korea
| | - Gui-Ok Kim
- Health Insurance Review and Assessment Service, 60 Hyeoksin-Ro, Wonju-si 26465, Republic of Korea
| | - Jun-Young Do
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, 170 Hyeonchung-Ro, Nam-Gu, Daegu 42415, Republic of Korea
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Lee YK, Kim YH, Kim DH, Kim JH, Lee JH, Park JH, Ko GJ, Hwang WM, Gil HW, Kang YS, Jin KB, Do JY, Kim SJ, Kim BS, Shin HS. Shared decision-making intervention regarding dialysis modality in patients with CKD stage 5. Medicine (Baltimore) 2023; 102:e33695. [PMID: 37171361 PMCID: PMC10174414 DOI: 10.1097/md.0000000000033695] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Patients with kidney failure must make complicated decisions about the dialysis modalities used either at home or in-hospital. Different options have varying levels of impact on patients' physical and psychological conditions and their social life. The purpose of this study was to evaluate the implementation of an intervention designed to achieve shared decision making (SDM) in patients' options for dialysis. METHODS SDM was performed after consent was written for stage 5 chronic kidney disease patients before dialysis, and 435 cases were performed in 408 patients from December 16, 2019 to June 30, 2021. Among these, 101 patients were compared by SDM measurement scale, patient satisfaction, disease recognition scale survey, and dialysis method. RESULTS The average age of participants was 56 years, with a gender composition of 55 males (54.5%) and 46 females (45.5%). Following SDM, the final dialysis methods decided upon by patients and clinicians were peritoneal dialysis (67 patients, 66.3%), hemodialysis (22 patients, 21.8%), and kidney transplantation (1 patient, 1.0%). CONCLUSIONS Among participating patients, SDM was effective when used to decide on dialysis treatment, and patients were satisfied with the dialysis method decision process. On the disease awareness scale, those who participated in this project had relatively high positive and low negative perceptions, so it can be concluded that SDM was relatively effective. The implementation of SDM was helpful in selecting patients' best dialysis methods, and SDM scale results were higher in the peritoneal dialysis group than in the hemodialysis group.
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Affiliation(s)
- Young-Ki Lee
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Yang-Hyeon Kim
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
| | - Do-Hyoung Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jin-Heog Kim
- Department of Bigdata and Applied Statistics, College of Science and Technology, Dongguk University, Gyeongju, Republic of Korea
| | - Jeong-Hwan Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hyeon Park
- Department of Internal Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Gang-Jee Ko
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Won-Min Hwang
- Department of Internal Medicine, Konyang University Hospital, Daejeon, Republic of Korea
| | - Hyo-Wook Gil
- Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | | | - Kyu-Bok Jin
- Division of Nephrology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Keimyung University Kidney Institute, Keimyung University School of Medicine, Daegu, Republic of Korea
| | | | - Se-Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, Korea
| | | | - Ho Sik Shin
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University College of Medicine, Busan, South Korea
- Transplantation Research Institute, Kosin University College of Medicine, Busan, South Korea
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Heo JY, Do JY, Lho Y, Kim AY, Kim SW, Kang SH. TGF-β1 Receptor Inhibitor SB525334 Attenuates the Epithelial to Mesenchymal Transition of Peritoneal Mesothelial Cells via the TGF-β1 Signaling Pathway. Biomedicines 2021; 9:biomedicines9070839. [PMID: 34356903 PMCID: PMC8301792 DOI: 10.3390/biomedicines9070839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 11/30/2022] Open
Abstract
We investigated the effect of SB525334 (TGF-β receptor type 1 (TβRI) inhibitor) on the epithelial to mesenchymal transition (EMT) signaling pathway in human peritoneal mesothelial cells (HPMCs) and a peritoneal fibrosis mouse model. In vitro experiments were performed using HPMCs. HPMCs were treated with TGF-β1 and/or SB525334. In vivo experiments were conducted with male C57/BL6 mice. The 0.1% chlorhexidine gluconate (CG) was intraperitoneally injected with or without SB52534 administration by oral gavage. Mice were euthanized after 28 days. EMT using TGF-β1-treated HPMCs included morphological changes, cell migration and invasion, EMT markers and collagen synthesis. These pathological changes were reversed by co-treatment with SB525334. CG injection was associated with an increase in peritoneal fibrosis and thickness, which functionally resulted in an increase in the glucose absorption via peritoneum. Co-treatment with SB525334 attenuated these changes. The levels of EMT protein markers and immunohistochemical staining for fibrosis showed similar trends. Immunofluorescence staining for EMT markers showed induction of transformed cells with both epithelial and mesenchymal cell markers, which decreased upon co-treatment with SB525334. SB525334 effectively attenuated the TGF-β1-induced EMT in HPMCs. Cotreatment with SB525334 improved peritoneal thickness and fibrosis and recovered peritoneal membrane function in a peritoneal fibrosis mouse model.
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Affiliation(s)
- Jung-Yoon Heo
- Department of Internal Medicine, Smart-Aging Convergence Research Center, College of Medicine, Yeungnam University, Daegu 42415, Korea; (J.-Y.H.); (Y.L.)
| | - Jun-Young Do
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea; (J.-Y.D.); (A.-Y.K.)
| | - Yunmee Lho
- Department of Internal Medicine, Smart-Aging Convergence Research Center, College of Medicine, Yeungnam University, Daegu 42415, Korea; (J.-Y.H.); (Y.L.)
| | - A-Young Kim
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea; (J.-Y.D.); (A.-Y.K.)
| | - Sang-Woon Kim
- Division of Gastro-Enterology, Department of Surgery, College of Medicine, Yeungnam University, Daegu 42415, Korea;
| | - Seok-Hui Kang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu 42415, Korea; (J.-Y.D.); (A.-Y.K.)
- Correspondence: ; Tel.: +82-53-620-3836
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Do JY, Kim YL, Park JW, Chang KA, Lee SH, Ryu DH, Kim CD, Park SH, Yoon KW. The Association between the Vascular Endothelial Growth Factor–to–Cancer Antigen 125 Ratio in Peritoneal Dialysis Effluent and the Epithelial-to-Mesenchymal Transition in Continuous Ambulatory Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080802803s20] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We examined peritoneal growth factors, mesothelial mass, and epithelial-to-mesenchymal transition (EMT) in response to peritoneal exposure to peritoneal dialysate with standard and low concentrations of glucose degradation products (GDPs). We randomized 56 incident continuous ambulatory peritoneal dialysis (CAPD) patients to receive either low-GDP (30 patients) or high-GDP (standard) peritoneal dialysis (PD) solution (26 patients). The effects of the PD solutions on EMT and peritoneal growth factors in overnight dialysate effluent were compared at 1, 6, and 12 months. Assessment of EMT was performed after human peritoneal mesothelial cells (HPMCs) were cultured from overnight effluent. The low-GDP solution group showed significantly higher dialysate levels of cancer antigen 125 (CA125), fibronectin, transforming growth factor β(TGFβ)–induced gene product (βig-h3), and interleukin-6 (IL-6), but the rate of EMT was significantly lower in the low-GDP solution group during the initial 12 months of CAPD treatment. After adjusting peritoneal growth factors for dialysate CA125 concentration, the low-GDP solution group showed significantly lower ratios of fibronectin/CA125, βig-h3/CA125, IL-6/CA125, TGFβ/CA125, and vascular endothelial growth factor (VEGF)/CA125 than did patients in the high-GDP (standard) solution group. Factors associated with higher EMT were the type of solution (high in GDPs), the mass of HPMCs (low CA125), and higher VEGF/CA125. Adjustment of dialysate VEGF for effluent CA125 revealed a significant association with EMT. It suggests that fibroblastoid transition from HPMCs could be affected by the intraperitoneal VEGF per unit mass of HPMCs.
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Affiliation(s)
- Jun-Young Do
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Yong-Lim Kim
- Yeungnam University Hospital, and Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Jong-Won Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Kyung-Ae Chang
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Seung-Hyun Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Dong-Han Ryu
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Chan-Duk Kim
- Yeungnam University Hospital, and Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Sun-Hee Park
- Yeungnam University Hospital, and Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Kyung-Woo Yoon
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
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Do JY, Kim YL, Park JW, Cho KH, Kim TW, Yoon KW, Kim CD, Park SH, Han JH, Song IH. The Effect of Low Glucose Degradation Product Dialysis Solution on Epithelial-To-Mesenchymal Transition in Continuous Ambulatory Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080502503s06] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
♦ Background Human peritoneal mesothelial cells (HPMCs) undergo a transition from an epithelial phenotype to a mesenchymal phenotype (EMT) during peritoneal dialysis (PD). That transition may be directly related to failure of peritoneal membrane function. ♦ Objective In a randomized prospective controlled study, we investigated the effect of low glucose degradation product (GDP) dialysis solution on the transition of HPMCs. ♦ Methods Among new continuous ambulatory PD patients, 60 patients completed a 12-month protocol (low-GDP solution group, n = 32; high-GDP solution group, n = 28). At the 1st, 6th, and 12th months, HPMCs drained from overnight effluent were cultured on T25. When they had nearly reached confluence, cell scores were measured blindly by the same person (score 1 = cobblestone-shaped HPMCs, score 2 = mixed, score 3 = fibroblast dominant). Cell scores and clinical indices, including peritoneal markers, were compared between the low-GDP and high-GDP groups at the 1st, 6th, and 12th months. The factors associated with EMT were analyzed with generalized estimating equations using STATA 7.0 (STATA Corp., College Station, Texas, USA). In addition, vimentin and cytokeratin 8/18 stains were used to verify EMT in cultured cells and peritoneal specimens in some patients. ♦ Results ( 1 ) The low-GDP group showed higher dialysate cancer antigen 125 levels from the 1st to 12th months (55.4 ± 24.8 vs 8.8 ± 1.7, 56.7 ± 28.1 vs 22.1 ± 11.3, and 54.2 ± 28.2 vs 24.6 ± 16.5 U/mL, at the 1st, 6th, and 12th months, respectively; all p = 0.000). ( 2 ) The low-GDP group showed lower cell scores at the 1st, 6th, and 12th months (1.22, 1.22, and 1.56 vs 1.61, 1.75, and 2.14; p < 0.05, p < 0.01, and p < 0.01, respectively). ( 3 ) At the 12th month, the number of fibroblast-dominant cultures (score 3) was significantly lower in the low-GDP group [4/32 (12.5%) patients vs 14/28 (50%), p < 0.05]. ( 4 ) Both cobblestone-shaped HPMCs and fibroblastoid cells were positively stained with cytokeratin and vimentin. ( 5 ) There were many cytokeratin- and vimentin-positive cells in the submesothelial area in the peritoneal biopsy specimens. (6) The consistent factor associated with EMT was only high-GDP solution (60 patients, n = 178, beta coefficient 0.312, p = 0.000; 46 patients, n = 137, beta coef: 0.228, p = 0.000) and not numbers of peritonitis episodes, duration of angiotensin-converting enzyme inhibitor and/or angiotensin receptor blocker medication, or diabetes. ♦ Conclusion Low-GDP solution showed beneficial effects such as rapid remesothelialization and less EMT in the peritoneum with time on PD.
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Affiliation(s)
- Jun-Young Do
- Department of Internal Medicine, Yeungnam University Hospital;, Daegu, Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University Hospital;, Daegu, Korea
| | - Jong-Won Park
- Department of Internal Medicine, Yeungnam University Hospital;, Daegu, Korea
| | - Kyu-Hyang Cho
- Department of Internal Medicine, Yeungnam University Hospital;, Daegu, Korea
| | - Tae-Woo Kim
- Department of Internal Medicine, Yeungnam University Hospital;, Daegu, Korea
| | - Kyung-Woo Yoon
- Department of Internal Medicine, Yeungnam University Hospital;, Daegu, Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, Kyungpook National University Hospital;, Daegu, Korea
| | - Sun-Hee Park
- Department of Internal Medicine, Kyungpook National University Hospital;, Daegu, Korea
| | - Jin-Hyun Han
- Department of Internal Medicine, Yeungnam University Hospital;, Daegu, Korea
| | - In-Han Song
- Department of Anatomy, Yeungnam University Hospital, Daegu, Korea
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Lee JH, Ha Chung B, Joo KW, Shin SK, Kim YL, Na KY, Do JY, Park SK, Shin BC, Lee JS, Kim YW, Kim SW, Lee KW, Kang GW, An WS, Shin GT, Han S, Yang CW. Efficacy and safety of CKD-11101 (darbepoetin-alfa proposed biosimilar) compared with NESP in anaemic chronic kidney disease patients not on dialysis. Curr Med Res Opin 2019; 35:1111-1118. [PMID: 30569763 DOI: 10.1080/03007995.2018.1560134] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of CKD-11101 (biosimilar darbepoetin-alfa, Chong Kun Dang Pharm.) compared with NESP® in treatment of anaemia in patients with chronic kidney disease not on dialysis. CLINICAL TRIAL REGISTRATION NCT03431623. METHOD In this multi-centre, randomized, double-blind study, patients were treated with CKD-11101 and NESP. The efficacy evaluation period (EEP) was 24 weeks, during which patients were treated every 2 weeks. All patients who completed the EEP were treated with CKD-11101 every 2 weeks for the first 4 weeks and every 4 weeks for the safety evaluation period (SEP), which was from 24 weeks to 52 weeks. The primary efficacy endpoint was the change in mean haemoglobin (Hb) level from baseline to end of EEP and mean dose needed to achieve the target Hb. RESULTS The mean Hb level was increased in both groups during the EEP (both p < 0.001). The difference in mean Hb level change between the two groups was 0.01 g/dL (95% CI = -0.213-0.242), indicating that CKD-11101 was equivalent to NESP. The difference in mean administration dose between groups was -1.40 mcg (95% CI = -6.859-4.059) included in the equivalent range. The incidence of AEs and ADRs was not different between the two groups, and the frequency of ADRs was favourable in both groups (1.2% in CKD-11101 vs 7.7% in the NESP to CKD-11101 conversion group). CONCLUSION CKD-11101 has an equivalent therapeutic effect as NESP in chronic kidney disease patients with renal anaemia. CKD-11101 can be safely used for long-term treatment and in patients converted from NESP.
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Affiliation(s)
- Jong Hoon Lee
- a Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine , The Catholic University of Korea , Seoul , Korea
| | - Byung Ha Chung
- a Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine , The Catholic University of Korea , Seoul , Korea
| | - Kwon Wook Joo
- b Division of Nephrology, Department of Internal Medicine , Seoul National University College of Medicine , Seoul , Korea
| | - Sug Kyun Shin
- c Division of Nephrology, Department of Internal Medicine , National Health Insurance Corporation IIsan Hospital , Goyang , Korea
| | - Yong-Lim Kim
- d Division of Nephrology, Department of Internal Medicine , Kyungpook National University School of Medicine , Daegu , Korea
| | - Ki Young Na
- e Division of Nephrology, Department of Internal Medicine , Seoul National University Bundang Hospital , Seongnam , Korea
| | - Jun-Young Do
- f Division of Nephrology, Department of Internal Medicine , Yeungnam University School of Medicine , Daegu , Korea
| | - Su-Kil Park
- g Division of Nephrology, Department of Internal Medicine , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Korea
| | - Byung Chul Shin
- h Division of Nephrology, Department of Internal Medicine, College of Medicine , Chosun University , Gwangju , Korea
| | - Jong Soo Lee
- i Division of Nephrology, Department of Internal Medicine , Ulsan University Hospital , Ulsan , Korea
| | - Yang-Wook Kim
- j Division of Nephrology, Department of Internal Medicine , Inje University, Haeundae Paik Hospital , Busan , Korea
| | - Soo Wan Kim
- k Division of Nephrology, Department of Internal Medicine , Chonnam National University Medical School , Gwangju , Korea
| | - Kang Wook Lee
- l Division of Nephrology, Department of Internal Medicine , Chungnam National University Hospital , Daejeon , South Korea
| | - Gun Woo Kang
- m Division of Nephrology, Department of Internal Medicine , Catholic University of Daegu School of Medicine , Daegu , Korea
| | - Won Suk An
- n Division of Nephrology, Department of Internal Medicine, College of Medicine , Dong-A University , Busan , Korea
| | - Gyu-Tae Shin
- o Division of Nephrology, Department of Nephrology , Ajou University School of Medicine , Suwon , Korea
| | - Seungyeup Han
- p Division of Nephrology, Department of Internal Medicine , Keimyung University School of Medicine , Daegu , Korea
| | - Chul Woo Yang
- a Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine , The Catholic University of Korea , Seoul , Korea
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Van Biesen W, Verger C, Heaf J, Vrtovsnik F, Britto ZML, Do JY, Prieto-Velasco M, Martínez JP, Crepaldi C, De Los Ríos T, Gauly A, Ihle K, Ronco C. Evolution Over Time of Volume Status and PD-Related Practice Patterns in an Incident Peritoneal Dialysis Cohort. Clin J Am Soc Nephrol 2019; 14:882-893. [PMID: 31123180 PMCID: PMC6556715 DOI: 10.2215/cjn.11590918] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 04/10/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Volume overload is frequent in prevalent patients on kidney replacement therapies and is associated with outcome. This study was devised to follow-up volume status of an incident population on peritoneal dialysis (PD) and to relate this to patient-relevant outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This prospective cohort study was implemented in 135 study centers from 28 countries. Incident participants on PD were enrolled just before the actual PD treatment was started. Volume status was measured using bioimpedance spectroscopy before start of PD and thereafter in 3-month intervals, together with clinical and laboratory parameters, and PD prescription. The association of volume overload with time to death was tested using a competing risk Cox model. RESULTS In this population of 1054 participants incident on PD, volume overload before start of PD amounted to 1.9±2.3 L, and decreased to 1.2±1.8 L during the first year. At all time points, men and participants with diabetes were at higher risk to be volume overloaded. Dropout from PD during 3 years of observation by transfer to hemodialysis or transplantation (23% and 22%) was more prevalent than death (13%). Relative volume overload >17.3% was independently associated with higher risk of death (adjusted hazard ratio, 1.59; 95% confidence interval, 1.08 to 2.33) compared with relative volume overload ≤17.3%. Different practice patterns were observed between regions with respect to proportion of patients on PD versus hemodialysis, selection of PD modality, and prescription of hypertonic solutions. CONCLUSIONS In this large cohort of incident participants on PD, with different treatment practices across centers and regions, we found substantial volume overload already at start of dialysis. Volume overload improved over time, and was associated with survival.
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Affiliation(s)
- Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium;
| | - Christian Verger
- Registre de dialyse péritonéale de langue Française, Pontoise, France
| | - James Heaf
- Department Medicine, Zealand University Hospital, Roskilde, Denmark
| | | | | | - Jun-Young Do
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | | | - Juan Pérez Martínez
- Servicio de Nefrología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Carlo Crepaldi
- Department of Nephrology Dialysis and Transplantation, International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy; and
| | - Tatiana De Los Ríos
- Clinical and Epidemiological Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Adelheid Gauly
- Clinical and Epidemiological Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Katharina Ihle
- Clinical and Epidemiological Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Claudio Ronco
- Department of Nephrology Dialysis and Transplantation, International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy; and
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Yu Z, Lambie M, Chess J, Williams A, Do JY, Topley N, Davies SJ. Peritoneal Protein Clearance Is a Function of Local Inflammation and Membrane Area Whereas Systemic Inflammation and Comorbidity Predict Survival of Incident Peritoneal Dialysis Patients. Front Physiol 2019; 10:105. [PMID: 30833904 PMCID: PMC6387967 DOI: 10.3389/fphys.2019.00105] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/28/2019] [Indexed: 11/16/2022] Open
Abstract
It is not clear whether the association of increased peritoneal protein clearance (PPCl) with worse survival on peritoneal dialysis (PD) is a consequence of either local or systemic inflammation or indicative of generalized endothelial dysfunction associated with comorbidity. To investigate this we determined the relationship of PPCl to comorbidity, membrane area (equivalent to low molecular weight peritoneal solute transport rate), local and systemic inflammation and hypoalbuminaemia, and for each of these with patient survival. 257 incident patients from three GLOBAL Fluid Study centers were included in this analysis. Clinical profiles were collected at baseline along with a peritoneal equilibration test, 24-h dialysate protein and paired plasma and dialysate cytokine measurements. Although peritoneal protein clearance was associated with increased age and severe comorbidity on univariate analysis, only dialysate IL-6, peritoneal solute transport rate, plasma albumin and cardiac comorbidities (ischaemic heart disease and left ventricular dysfunction) were independent explanatory variables on multivariate analysis. While peritoneal protein clearance and daily peritoneal protein loss were associated with survival in univariate analysis, on multivariate analysis only plasma IL-6, age, residual kidney function, comorbidity, and plasma albumin were independent predictors. Peritoneal protein clearance is primarily a function of peritoneal membrane area and local membrane inflammation. The association with comorbidity and survival is predominantly explained by its inverse relationship to hypoalbuminaemia, especially in diabetics.
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Affiliation(s)
- Zanzhe Yu
- Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mark Lambie
- Institute of Applied Clinical Science, Keele University, Stoke-on-Trent, United Kingdom
| | - James Chess
- Renal Unit, Morriston Hospital, Abertawe and Bro Morgannwg University Health Board, Swansea, United Kingdom
| | - Andrew Williams
- Renal Unit, Morriston Hospital, Abertawe and Bro Morgannwg University Health Board, Swansea, United Kingdom
| | - Jun-Young Do
- Division of Nephrology, Yeungnam University Hospital, Daegu, South Korea
| | - Nicholas Topley
- Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Simon J Davies
- Institute of Applied Clinical Science, Keele University, Stoke-on-Trent, United Kingdom
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Elphick EH, Teece L, Chess JA, Do JY, Kim YL, Lee HB, Davison SN, Topley N, Davies SJ, Lambie M. Biocompatible Solutions and Long-Term Changes in Peritoneal Solute Transport. Clin J Am Soc Nephrol 2018; 13:1526-1533. [PMID: 30171050 PMCID: PMC6218832 DOI: 10.2215/cjn.02380218] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/27/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES The inflammation-driven increase in peritoneal solute transport rate that occurs during long-term peritoneal dialysis is associated with higher mortality, hospitalization, and encapsulating peritoneal sclerosis. Because biocompatible solutions were developed to mitigate these effects, we examined the association with their use and longitudinal peritoneal solute transport rate. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We analyzed subjects from the multinational prospective Global Fluid Study with three or more peritoneal solute transport rate measurements >2 months from the start of peritoneal dialysis. Follow-up was for 7.5 years (median, 2.3 years; interquartile range, 1.8-3.6) in biocompatible solutions and 12.8 years (median, 3.2 years; interquartile range, 1.9-4.3) for standard solutions. Using a random intercept/slopes multilevel model, we examined the association of patients using biocompatible solutions and peritoneal solute transport rate over time, adjusting for center effects, dialysate dextrose concentration, baseline dialysate IL-6 concentration, icodextrin use, residual kidney function, and peritonitis. RESULTS Of 366 patients, the 71 receiving biocompatible solutions throughout their time on peritoneal dialysis had a mean adjusted dialysate-to-plasma creatinine ratio of 0.67 compared with 0.72 for standard solutions (P=0.02). With duration of treatment, there was a continuous increase in peritoneal solute transport rate in patients using standard solutions (range, 2 months to 4 years). In contrast, patients using biocompatible solutions had peritoneal solute transport rates that plateaued after 2 years of therapy. These changes in peritoneal solute transport rate were independent of baseline inflammation and time-varying predictors of faster peritoneal solute transport rate. In patients suffering episodes of peritonitis while using standard solutions, there was an associated increase in peritoneal solute transport rate of 0.020 (95% confidence interval, 0.01 to 0.03) per episode, whereas in patients using biocompatible solutions, there was no change in this parameter (-0.014; 95% confidence interval, -0.03 to <0.01). CONCLUSIONS These data suggest that a different temporal pattern in changes in peritoneal solute transport rate occurs during the course of peritoneal dialysis according to solution type and that patients using biocompatible solutions may avoid the increase in solute transport associated with peritonitis.
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Affiliation(s)
- Emma H. Elphick
- Institute of Applied Clinical Sciences, Keele University, Stoke on Trent, United Kingdom
| | - Lucy Teece
- Institute of Applied Clinical Sciences, Keele University, Stoke on Trent, United Kingdom
| | | | - Jun-Young Do
- Division of Nephrology, Yeungnam University Hospital, Daegu, South Korea
| | - Yong-Lim Kim
- Renal Unit, Kyungpook National University Hospital, Daegu, South Korea
| | - H. Bahl Lee
- Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, South Korea
| | - Sara N. Davison
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada; and
| | - Nicholas Topley
- Wales Kidney Research Unit, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Simon J. Davies
- Institute of Applied Clinical Sciences, Keele University, Stoke on Trent, United Kingdom
| | - Mark Lambie
- Institute of Applied Clinical Sciences, Keele University, Stoke on Trent, United Kingdom
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13
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Kang SH, Cho KH, Park JW, Do JY. Low appendicular muscle mass is associated with mortality in peritoneal dialysis patients: a single-center cohort study. Eur J Clin Nutr 2017; 71:1405-1410. [PMID: 28656967 DOI: 10.1038/ejcn.2017.104] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 05/03/2017] [Accepted: 05/10/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND/OBJECTIVES There are few studies of the association between low appendicular muscle mass (LAM) and clinical outcomes in peritoneal dialysis (PD) patients. We aimed to determine the clinical association between LAM and clinical outcomes in PD patients. SUBJECT/METHODS We reviewed all PD patients who underwent PD between January 2001 and April 2014. Each patient's appendicular lean mass was estimated using dual-energy X-ray absorptiometry. The appendicular muscle mass index (AMI) was calculated using total appendicular lean mass (kg) over body mass index (kg/m2). The cut-off AMI value for LAM was <0.789 for men and <0.512 for women. RESULTS The number of patients in the Non-LAM and LAM groups was 328 and 303, respectively. The median follow-up durations in the Non-LAM and LAM groups were 47 and 49 months, respectively. The numbers of deaths in the Non-LAM and LAM groups were 96 (29.3%) and 160 (52.8%), respectively. In a comparison with the Non-LAM group, the hazard ratio in the LAM group was 1.74 (95% confidence interval (CI), 1.35-2.24) in univariate and 1.71 (95% CI, 1.28-2.26) in multivariate Cox regression analysis. In addition, the hazard ratio for a 0.1 increase in baseline AMI was 0.89 (95% CI, 0.84-0.95) in univariate analysis and 0.84 (95% CI, 0.76-0.91) in multivariate analysis. Analyses using the 1-year AMI showed trends similar to those for the initial AMI. CONCLUSIONS Our study showed the association of LAM with mortality in the incident PD patients.
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Affiliation(s)
- S H Kang
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - K H Cho
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - J W Park
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - J Y Do
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
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Kang SH, Park JW, Cho KH, Do JY. Association Between Periodontitis and Low-Grade Albuminuria in Non-Diabetic Adults. Kidney Blood Press Res 2017; 42:338-346. [PMID: 28578341 DOI: 10.1159/000477784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 02/21/2017] [Indexed: 11/19/2022] Open
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15
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Kang SH, Jung DJ, Cho KH, Park JW, Lee KY, Do JY. Association Between HbA1c Level and Hearing Impairment in a Nondiabetic Adult Population. Metab Syndr Relat Disord 2016; 14:129-34. [DOI: 10.1089/met.2015.0092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Seok Hui Kang
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Da Jung Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Kyu Hyang Cho
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Jong Won Park
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea
| | - Kyu-Yup Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jun-Young Do
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea
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Lambie M, Elphick E, Riley L, Bankart J, Chess J, Do JY, Lee HB, Kim YL, Davison S, Dorval M, Williams P, Topley N, Davies S. SaO012LONGITUDINAL EFFECT OF BIOCOMPATIBLE SOLUTIONS ON PERITONEAL SOLUTE TRANSPORT: RESULTS FROM THE GLOBAL FLUID STUDY. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv147.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cho KH, Do JY, Kang SH, Park JW, Yoon KW, Jung SY, Lee J. FP603IMPACT OF PRESERVING RESIDUAL RENAL FUNCTION ON BODY COMPOSITION CHANGES AND CLINICAL OUTCOMES IN THE DIABETIC CAPD PATIENTS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv180.55] [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: 11/14/2022] Open
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Hwang MJ, Do JY, Choi EW, Seo JH, Nam YJ, Yoon KW, Park JW, Cho KH, Kang SH, Jin HJ. Immunoglobulin E-mediated hypersensitivity reaction after intraperitoneal administration of vancomycin. Kidney Res Clin Pract 2014; 34:57-9. [PMID: 26484021 PMCID: PMC4570630 DOI: 10.1016/j.krcp.2014.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 08/26/2014] [Accepted: 09/12/2014] [Indexed: 11/27/2022] Open
Abstract
Intraperitoneal (IP) vancomycin is widely used to treat Gram-positive peritonitis associated with peritoneal dialysis. There have been two cases of red man syndrome (RMS), a vancomycin-specific nonimmunologic reaction, associated with IP vancomycin. However, immune-mediated hypersensitivity reaction to IP vancomycin has not yet been reported. A 49 year old woman on continuous ambulatory peritoneal dialysis developed her first peritonitis episode. The patient was treated with IP vancomycin once/wk for 4 weeks. She experienced mild itching and flushing throughout her body for 1 day after the second treatment. Whenever vancomycin was administered, generalized urticaria and a prickling sensation developed, and the intensity increased gradually; however, these symptoms improved after vancomycin was discontinued. An allergic skin test was performed 6 weeks after the previous urticarial episode, and an intradermal skin test revealed a positive response to vancomycin. To our knowledge, this is the first case report of immunoglobulin E-mediated hypersensitivity reaction to IP vancomycin administration.
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Affiliation(s)
- Mun-Ju Hwang
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Jun-Young Do
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Eun-Woo Choi
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Joon-Hyuk Seo
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Yoon-Jung Nam
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Kyung-Woo Yoon
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Jong-Won Park
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Kyu-Hyang Cho
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Seok-Hui Kang
- Division of Nephrology, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
| | - Hyun-Jung Jin
- Division of Pulmonology and Allergy, Regional Center for Respiratory Disease, Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea
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Affiliation(s)
- Yo-Han Jeong
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Jong-Won Park
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Jun-Young Do
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Kyu-Hyang Cho
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Seok-Hui Kang
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Mun-Ju Hwang
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Eun-Woo Choi
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Dong-Won Lee
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Kyung-Woo Yoon
- Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Yong-Jin Kim
- Department of Pathology, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
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Li PKT, Culleton BF, Ariza A, Do JY, Johnson DW, Sanabria M, Shockley TR, Story K, Vatazin A, Verrelli M, Yu AW, Bargman JM. Randomized, controlled trial of glucose-sparing peritoneal dialysis in diabetic patients. J Am Soc Nephrol 2013; 24:1889-900. [PMID: 23949801 DOI: 10.1681/asn.2012100987] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Glucose-containing peritoneal dialysis solutions may exacerbate metabolic abnormalities and increase cardiovascular risk in diabetic patients. Here, we examined whether a low-glucose regimen improves metabolic control in diabetic patients undergoing peritoneal dialysis. Eligible patients were randomly assigned in a 1:1 manner to the control group (dextrose solutions only) or to the low-glucose intervention group (IMPENDIA trial: combination of dextrose-based solution, icodextrin and amino acids; EDEN trial: a different dextrose-based solution, icodextrin and amino acids) and followed for 6 months. Combining both studies, 251 patients were allocated to control (n=127) or intervention (n=124) across 11 countries. The primary endpoint was change in glycated hemoglobin from baseline. Mean glycated hemoglobin at baseline was similar in both groups. In the intention-to-treat population, the mean glycated hemoglobin profile improved in the intervention group but remained unchanged in the control group (0.5% difference between groups; 95% confidence interval, 0.1% to 0.8%; P=0.006). Serum triglyceride, very-low-density lipoprotein, and apolipoprotein B levels also improved in the intervention group. Deaths and serious adverse events, including several related to extracellular fluid volume expansion, increased in the intervention group, however. These data suggest that a low-glucose dialysis regimen improves metabolic indices in diabetic patients receiving peritoneal dialysis but may be associated with an increased risk of extracellular fluid volume expansion. Thus, use of glucose-sparing regimens in peritoneal dialysis patients should be accompanied by close monitoring of fluid volume status.
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Affiliation(s)
- Philip K T Li
- Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Cho KH, Do JY, Park JW, Yoon KW, Kim YL. The effect of low-GDP solution on ultrafiltration and solute transport in continuous ambulatory peritoneal dialysis patients. Perit Dial Int 2013; 33:382-90. [PMID: 23284074 DOI: 10.3747/pdi.2011.00279] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Several studies have reported benefits for human peritoneal mesothelial cell function of a neutral-pH dialysate low in glucose degradation products (GDPs). However, the effects of low-GDP solution on ultrafiltration (UF), transport of solutes, and control of body water remain elusive. We therefore investigated the effect of low-GDP solution on UF, solute transport, and control of body water. METHODS Among 79 new continuous ambulatory peritoneal dialysis (CAPD) patients, 60 completed a 12-month protocol (28 in a lactate-based high-GDP solution group, 32 in a lactate-based low-GDP solution group). Clinical indices--including 24-hour UF volume (UFV), 24-hour urine volume (UV), residual renal function, and dialysis adequacy--were measured at months 1, 6, and 12. At months 1, 6, and 12, UFV, glucose absorption, 4-hour dialysate-to-plasma (D/P) creatinine, and 1-hour D/P Na(+) were assessed during a modified 4.25% peritoneal equilibration test (PET). Body composition by bioelectric impedance analysis was measured at months 1 and 12 in 26 CAPD patients. RESULTS Daily UFV was lower in the low-GDP group. Despite similar solute transport and aquaporin function, the low-GDP group also showed lower UFV and higher glucose absorption during the PET. Factors associated with UFV during the PET were lactate-based high-GDP solution and 1-hour D/P Na(+). No differences in volume status and obesity at month 12 were observed, and improvements in hypervolemia were equal in both groups. CONCLUSIONS Compared with the high-GDP group, the low-GDP group had a lower UFV during a PET and a lower daily UFV during the first year after peritoneal dialysis initiation. Although the low-GDP group had a lower daily UFV, no difficulties in controlling edema were encountered.
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Affiliation(s)
- Kyu-Hyang Cho
- Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea
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Cho KH, Do JY, Kang SH, Park JW, Yoon KW. IMPACT OF RESIDUAL RENAL FUNCTION ON CHANGES OF BODY COMPOSITION IN DIABETIC CAPD PATIENTS. Kidney Res Clin Pract 2012. [DOI: 10.1016/j.krcp.2012.04.360] [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: 10/28/2022] Open
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Cho JH, Do JY, Kim SH, Kim JY, Seo JJ, Choi JY, Park SH, Kim CD, Jung SY, Cho KH, Park JW, Lee DH, Song KE, Kim YL. Impact of dialysis modality on the incidence of 2009 pandemic H1N1 influenza in end-stage renal disease patients. Perit Dial Int 2012; 31:347-50. [PMID: 21555416 DOI: 10.3747/pdi.2010.00158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jang-Hee Cho
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Republic of Korea
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Cho JH, Do JY, Oh EJ, Ryu HM, Park SY, Kim SO, Hyun SH, Seo HJ, Kim GH, Choi JY, Kim CD, Park SH, Kim YL. Are ex vivo mesothelial cells representative of the in vivo transition from epithelial-to-mesenchymal cells in peritoneal membrane? Nephrol Dial Transplant 2011; 27:1768-79. [PMID: 22025117 DOI: 10.1093/ndt/gfr604] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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
BACKGROUND We investigated whether ex vivo mesothelial cells found in peritoneal dialysis (PD) effluents were representative of the in vivo epithelial-to-mesenchymal transition (EMT) in peritoneal membrane. METHODS Thirty-six male Sprague-Dawley rats were equally divided into three groups: Group C (control), no PD; Group D, infused with 4.25% Dianeal and Group P, infused with 4.25% Physioneal. PD infusions (25 mL) were given twice daily for 8 weeks. The in vivo study included morphometric analyses performed on the peritoneal membranes of tissue specimens obtained at the end of the study. The ex vivo study included peritoneal mesothelial cells collected from PD effluent and cultured to confluence. Cells were scored with light microscopy. RESULTS PD for 8 weeks induced significant EMT. The in vivo expression of EMT markers (α-smooth muscle actin:E-cadherin ratio, matrix metalloproteinase-2 and Snail) was higher in Group D than in Group P. However, ex vivo EMT marker expression was similar in cells derived from Groups D and P. A significant correlation was observed among in vivo EMT markers. Moreover, the ex vivo cell score increased with time on PD. However, changes in the ex vivo cell score did not correlated with changes in the in vivo EMT marker expression. Furthermore, we found no correlation between ex vivo and in vivo cells in the expression of EMT markers. CONCLUSIONS In this animal study, ex vivo findings did not reflect the in vivo EMT changes in the peritoneum. It may be necessary to improve the current methodology for ex vivo studies.
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Affiliation(s)
- Ji-Hyung Cho
- Department of Internal Medicine, CHA Gumi Medical Center, CHA University, Gumi-si, Korea
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Park JW, Yook JM, Ryu HM, Choi SY, Morishita M, Do JY, Park SH, Kim CD, Choi JY, Chung HY, Kim YL. Phosphate-induced apoptosis in human peritoneal mesothelial cells in vitro. Am J Nephrol 2011; 34:77-86. [PMID: 21677430 DOI: 10.1159/000329081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 04/30/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND It has been demonstrated that phosphate uptake through the type III sodium-dependent phosphate co-transporter, Pit-1, induced apoptosis of aortic vascular smooth muscle cells and endothelial cells in vitro. However, the apoptotic effects of high phosphate (HP) level in human peritoneal mesothelial cells (HPMCs) are not known. METHODS To examine whether Pit-1 is expressed in HPMCs, we checked the Western blot assay of immunoreactive Pit-1 and the transcription of Pit-1 by reverse transcriptase PCR. We treated several different phosphate concentrations (1-4 mM) and calcium concentrations (1.8 and 2.8 mM) on HPMCs to assess the effects of concentration. MTT, TUNEL assays, and flow cytometry analysis using Annexin V and propidium iodide were performed to identify cell death and apoptosis. Bax and Bcl-2 by Western blot and caspase-3 activity were evaluated by colorimetric assay. In addition, phosphonoformic acid (PFA) and pan-caspase inhibitor, Z-VAD-FMK, were given to prevent phosphate-induced apoptosis. RESULTS Pit-1 expression on HPMCs was demonstrated. Apoptosis in HPMCs significantly increased with a high concentration of phosphate in a dose- and time-dependent manner, and was enhanced in the presence of 2.8 mM calcium. HP concentrations significantly decreased the anti-apoptotic Bcl-2/Bax ratio and increased caspase-3 activity. The treatment with PFA and Z-VAD-FMK prevented cell death by HP. CONCLUSION Phosphate uptake through Pit-1 induces apoptosis in HPMCs by a caspase-related mechanism.
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Affiliation(s)
- Jong-Won Park
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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Choi JY, Yoon YJ, Choi HJ, Park SH, Kim CD, Kim IS, Kwon TH, Do JY, Kim SH, Ryu DH, Hwang GS, Kim YL. Dialysis modality-dependent changes in serum metabolites: accumulation of inosine and hypoxanthine in patients on haemodialysis. Nephrol Dial Transplant 2010; 26:1304-13. [PMID: 20844182 DOI: 10.1093/ndt/gfq554] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The body metabolism of patients with end-stage renal disease may be altered in response to long-term dialysis treatment. Moreover, the pattern of serum metabolites could change depending on the type of dialysis modality used. However, dialysis modality-dependent changes in serum metabolites are poorly understood. Our aim was to profile comprehensively serum metabolites by exploiting a novel method of (1)H-NMR-based metabonomics and identify the differences in metabolite patterns in subjects receiving haemodialysis (HD) and peritoneal dialysis (PD). METHODS Anuric and non-diabetic HD patients were matched to PD patients for age, sex and dialysis duration. Accurate concentrations of serum metabolites were determined using the target-profiling procedure, and differences in the levels of metabolites were compared using multivariate analysis. RESULTS Principal Components Analysis score plots showed that the metabolic patterns could be discriminated by dialysis modalities. Hypoxanthine and inosine were present only with HD, whereas serum xanthine oxidase activity and uric acid levels were not different. In contrast, PD was associated with higher levels of lactate, glucose, maltose, pyruvate, succinate, alanine, and glutamate linked to glucose metabolism and the tri-carboxylic acid cycle. Maltose appeared only in patients using icodextrin solution for PD. Known uraemic retention solutes such as urea, creatinine, myo-inositol and trimethylamine-N-oxide were increased in both dialysis groups. CONCLUSIONS Metabonomics shows apparent differences in the profiles of serum metabolites between HD and PD, which were influenced by dialysis-related processes. Inosine and hypoxanthine are present only in HD patients, which is likely to represent more hypoxic and oxidative stress.
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Affiliation(s)
- Ji-Young Choi
- Division of Nephrology, Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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Cho JH, Hur IK, Kim CD, Park SH, Ryu HM, Yook JM, Choi JY, Choi HJ, Choi HJ, Park JW, Do JY, Kim YL. Impact of systemic and local peritoneal inflammation on peritoneal solute transport rate in new peritoneal dialysis patients: a 1-year prospective study. Nephrol Dial Transplant 2010; 25:1964-73. [PMID: 20100731 DOI: 10.1093/ndt/gfp767] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [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
BACKGROUND The association between peritoneal solute transport rates (PSTRs) and inflammatory markers in patients on peritoneal dialysis (PD) is still under investigation. We aimed to elucidate their relationship during the first year on PD. METHODS We performed a prospective observational study with 187 incident PD patients who were treated with either biocompatible solution (BCS) or conventional solution (CS). Peritoneal dialysate effluent (PDE) and blood samples for the markers and the calculation of mass transfer area coefficient of creatinine (MTAC) were performed at 1, 6 and 12 months after commencing PD. RESULTS Of the 187 enrolled patients, 110 completed a 1-year study protocol. All PDE markers [interleukin-6 (IL-6), transforming growth factor-beta (TGF-beta), TGF-beta-induced gene-h3 (beta ig-h3), vascular endothelial growth factor (VEGF)] except CA125 increased over time, whereas PSTRs, high-sensitivity C-reactive protein (hs-CRP) and serum IL-6 levels did not change. Serum albumin and log PDE appearance rates (ARs) of IL-6, TGF-beta and CA125 predicted MTAC. The Delta value (12-month minus 1-month) of PDE AR of IL-6 was correlated with those of all other PDE markers. Both 12-month IL-6 and Delta IL-6 ARs in PDE were highest in the upper Delta MTAC tertile. PSTRs in the CS group, unlike BCS, had a tendency to increase over time, demonstrating a time-by-group interaction. Solution type and MTAC were not associated with patient and technique survival. CONCLUSIONS The change in PSTR during the first year of PD is related to PDE IL-6 AR, which may represent intraperitoneal inflammation; however, there does not seem to be a close association between PSTR and the degree of systemic inflammation.
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Affiliation(s)
- Ji-Hyung Cho
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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Cho KH, Do JY, Park JW, Yoon KW. Effect of icodextrin dialysis solution on body weight and fat accumulation over time in CAPD patients. Nephrol Dial Transplant 2009; 25:593-9. [PMID: 19767632 DOI: 10.1093/ndt/gfp473] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [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
BACKGROUND The purpose of this study was to analyse the changes of body composition and the effects of icodextrin dialysis solution over time on peritoneal dialysis (PD) in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS Among 183 incident patients, 75 patients finished a complete 36-month protocol. Clinical indices including daily glucose absorption and body composition, by bioelectrical impedance analysis (BIA), were measured in both groups (icodextrin group: 36 patients, non-icodextrin group: 39 patients) at the 1st (baseline), 12th, 24th and 36th months. RESULTS There were significant increases in body weight and fat mass during the 36 months after initiation of CAPD. It was found that 78% of 3 years of weight gain occurred during the first year and 88% of weight gain at the end of the first year was fat mass gain. The icodextrin group showed a significantly lower percent of fat mass during the first 36 months (P < 0.05) and also less changes in body weight, fat mass, percent (%) fat mass, visceral fat area and waist/hip ratio at 1, 2 and 3 years than the non-icodextrin group. There were no significant changes in total body water (TBW), extra cellular fluid (ECF), oedema index and lean body mass (LBM) through comparable daily and ultrafiltration volume (UFV) between the two groups during the initial 3 years. Factors associated with the higher percent of fat mass gain over time on peritoneal dialysis were age, diabetes, gender (female) and non-icodextrin group (all, P < 0.01, generalized estimating equation). CONCLUSION The application of icodextrin solution may be a better option to alleviate excessive fat gain over time for patients on PD.
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Affiliation(s)
- Kyu-Hyang Cho
- Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea
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Chin HJ, Cho HJ, Lee TW, Na KY, Yoon HJ, Chae DW, Kim S, Jeon US, Do JY, Park JW, Yoon KW, Shin YT, Lee KW, Na KR, Cha DR, Kang YS. The heme oxygenase-1 genotype is a risk factor to renal impairment of IgA nephropathy at diagnosis, which is a strong predictor of mortality. J Korean Med Sci 2009; 24 Suppl:S30-7. [PMID: 19194559 PMCID: PMC2633190 DOI: 10.3346/jkms.2009.24.s1.s30] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [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: 09/02/2008] [Accepted: 11/03/2008] [Indexed: 11/20/2022] Open
Abstract
The induction of heme oxygenase-1 (HO-1) ameliorates oxidative stress and inflammatory process, which play important roles in IgA nephropathy. We hypothesized length polymorphism in the promoter region of the HO-1 gene, which is related to the level of gene transcription, is associated with disease severity of IgA nephropathy. The subjects comprised 916 patients with IgA nephropathy and gene data. Renal impairment was defined as an estimated glomerular filtration rate less than 60 mL/min/1.73 m(2) at diagnosis. The short (S: <23), medium (M: 23-28), and long (L: >28) (GT) repeats in the HO-1 gene was determined. The frequencies of S/S, S/M, M/M, S/L, L/M, and L/L genotypes were 7.2%, 6.9%, 3.1%, 30.8%, 22.7%, and 29.4%, respectively. The baseline characteristics were not different. In the S/S genotypic group, the renal impairment rate was 18.2%, which was lower than 32.2% in the group with M/M, L/M, or L/L genotype. The odds ratio of renal impairment in S/S genotype, compared to that in M/M, L/M, or L/L genotype, was 0.216 (95% confidence interval, 0.060-0.774, p=0.019). The HO-1 gene promoter length polymorphism was related to the renal impairment of IgA nephropathy at diagnosis, which is an important risk factor for mortality in IgA nephropathy patients.
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Affiliation(s)
- Ho Jun Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Renal Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jin Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae Woo Lee
- Renal Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyung Jin Yoon
- Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Renal Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Suhnggwon Kim
- Renal Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Un Sil Jeon
- Biotechnology Center, Pohang University of Science and Technology, Pohang, Korea
| | - Jun-Young Do
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Jong-Won Park
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Kyung-Woo Yoon
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Young-Tai Shin
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kang Wook Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ki-Ryang Na
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Dae Ryong Cha
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Young Sun Kang
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
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Do JY, Kim YL, Park JW, Chang KA, Lee SH, Ryu DH, Kim CD, Park SH, Yoon KW. The association between the vascular endothelial growth factor-to-cancer antigen 125 ratio in peritoneal dialysis effluent and the epithelial-to-mesenchymal transition in continuous ambulatory peritoneal dialysis. Perit Dial Int 2008; 28 Suppl 3:S101-S106. [PMID: 18552237] [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: 05/26/2023] Open
Abstract
We examined peritoneal growth factors, mesothelial mass, and epithelial-to-mesenchymal transition (EMT) in response to peritoneal exposure to peritoneal dialysate with standard and low concentrations of glucose degradation products (GDPs). We randomized 56 incident continuous ambulatory peritoneal dialysis (CAPD) patients to receive either low-GDP (30 patients) or high-GDP (standard) peritoneal dialysis (PD) solution (26 patients). The effects of the PD solutions on EMT and peritoneal growth factors in overnight dialysate effluent were compared at 1, 6, and 12 months. Assessment of EMT was performed after human peritoneal mesothelial cells (HPMCs) were cultured from overnight effluent. The low-GDP solution group showed significantly higher dialysate levels of cancer antigen 125 (CA125), fibronectin, transforming growth factor beta(TGFbeta)-induced gene product (betaig-h3), and interleukin-6 (IL-6), but the rate of EMT was significantly lower in the low-GDP solution group during the initial 12 months of CAPD treatment. After adjusting peritoneal growth factors for dialysate CA125 concentration, the low-GDP solution group showed significantly lower ratios of fibronectin/CA125, betaig-h3/CA125, IL-6/CA125, TGFbeta/CA125, and vascular endothelial growth factor (VEGF)/CA125 than did patients in the high-GDP (standard) solution group. Factors associated with higher EMT were the type of solution (high in GDPs), the mass of HPMCs (low CA125), and higher VEGF/CA125. Adjustment of dialysate VEGF for effluent CA125 revealed a significant association with EMT. It suggests that fibroblastoid transition from HPMCs could be affected by the intraperitoneal VEGF per unit mass of HPMCs.
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Affiliation(s)
- Jun-Young Do
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea.
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Kim SM, Chang KA, Jung SY, Park CS, Park JW, Do JY, Kim YJ, Yoon KW. A Case of Adult onset Henoch-Schönlein Purpura with Acute Renal Failure. Yeungnam Univ J Med 2008. [DOI: 10.12701/yujm.2008.25.1.58] [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: 11/04/2022] Open
Affiliation(s)
- Seok-Min Kim
- Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Kyung-Ae Chang
- Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Sun-Young Jung
- Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Chan-Soh Park
- Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jong-Won Park
- Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jun-Young Do
- Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Yong-Jin Kim
- Department of Pathology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Kyung-Woo Yoon
- Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Korea
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Kim CD, Lee HJ, Kim DJ, Kim BS, Shin SK, Do JY, Jang MH, Park SH, Kim YS, Kim YL. High Prevalence of Leukoaraiosis in Cerebral Magnetic Resonance Images of Patients on Peritoneal Dialysis. Am J Kidney Dis 2007; 50:98-107. [PMID: 17591529 DOI: 10.1053/j.ajkd.2007.03.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Accepted: 03/22/2007] [Indexed: 11/11/2022]
Abstract
BACKGROUND Leukoaraiosis is a term used to define the abnormal appearance of subcortical white matter of the brain by means of neuroimaging and is regarded as an intermediate surrogate of stroke. The goal of this study is to identify the prevalence of leukoaraiosis and analyze predictors of risk of leukoaraiosis. STUDY DESIGN Cross-sectional study. SETTING & PARTICIPANTS 57 peritoneal dialysis (PD) patients without diabetes treated in 3 academic medical-associated dialysis units who did not have a history of cerebrovascular disease or neurological symptoms compared with a convenience sample of 57 age- and sex-matched hypertensive control subjects with normal renal function. PREDICTOR End-stage renal disease treated by PD compared with hypertension, adjusted for clinical and laboratory characteristics. OUTCOME & MEASUREMENT Hyperintense areas on magnetic resonance imaging T2 high-signal intensity scoring system. RESULTS The prevalence of leukoaraiosis was significantly greater in patients on PD therapy than controls (68.4% versus 17.5%; P < 0.001). High T2 signal intensity score in patients on PD therapy compared with controls was significantly higher in the anterior circulation of the brain, relatively sparing the posterior fossa. End-stage renal disease, age, and poor control of blood pressure were significant independent predictors of leukoaraiosis. LIMITATIONS There is the possibility that biases regarding the selection of enrolled patients had an influence on a study result. CONCLUSIONS Cerebral magnetic resonance imaging of PD patients without evidence of cerebrovascular disease showed a high prevalence of leukoaraiosis in the anterior circulation of the brain. Old age, poorly controlled hypertension, and the PD procedure itself and/or end-stage renal disease seem to be associated with the presence of leukoaraiosis.
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Affiliation(s)
- Chan-Duck Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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Do JY, Kim YL, Park JW, Cho KH, Kim TW, Yoon KW, Kim CD, Park SH, Han JH, Song IH. The effect of low glucose degradation product dialysis solution on epithelial-to-mesenchymal transition in continuous ambulatory peritoneal dialysis patients. Perit Dial Int 2005; 25 Suppl 3:S22-5. [PMID: 16048250] [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: 05/03/2023] Open
Abstract
BACKGROUND Human peritoneal mesothelial cells (HPMCs) undergo a transition from an epithelial phenotype to a mesenchymal phenotype (EMT) during peritoneal dialysis (PD). That transition may be directly related to failure of peritoneal membrane function. OBJECTIVE In a randomized prospective controlled study, we investigated the effect of low glucose degradation product (GDP) dialysis solution on the transition of HPMCs. METHODS Among new continuous ambulatory PD patients, 60 patients completed a 12-month protocol (low-GDP solution group, n = 32; high-GDP solution group, n = 28). At the 1st, 6th, and 12th months, HPMCs drained from overnight effluent were cultured on T25. When they had nearly reached confluence, cell scores were measured blindly by the same person (score 1 = cobblestone-shaped HPMCs, score 2 = mixed, score 3 = fibroblast dominant). Cell scores and clinical indices, including peritoneal markers, were compared between the low-GDP and high-GDP groups at the 1st, 6th, and 12th months. The factors associated with EMT were analyzed with generalized estimating equations using STATA 7.0 (STATA Corp., College Station, Texas, USA). In addition, vimentin and cytokeratin 8/18 stains were used to verify EMT in cultured cells and peritoneal specimens in some patients. RESULTS (1) The low-GOP group showed higher dialysate cancer antigen 125 levels from the 1st to 12th months (55.4 +/- 24.8 vs 8.8 +/- 1.7, 56.7 +/- 28.1 vs 22.1 +/- 11.3, and 54.2 +/- 28.2 vs 24.6 +/- 16.5 U/mL, at the 1st, 6th, and 12th months, respectively; all p = 0.000). (2) The low-GOP group showed lower cell scores at the 1st, 6th, and 12th months (1.22, 1.22, and 1.56 vs 1.61, 1.75, and 2.14; p < 0.05, p < 0.01, and p < 0.01, respectively). (3) At the 12th month, the number of fibroblast-dominant cultures (score 3) was significantly lower in the low-GOP group [4/32 (12.5%) patients vs 14/28 (50%), p < 0.05]. (4) Both cobblestone-shaped HPMCs and fibroblastoid cells were positively stained with cytokeratin and vimentin. (5) There were many cytokeratin- and vimentin-positive cells in the submesothelial area in the peritoneal biopsy specimens. (6) The consistent factor associated with EMT was only high-GOP solution (60 patients, n = 178, beta coefficient 0.312, p = 0.000; 46 patients, n = 137, beta coef: 0.228, p = 0.000) and not numbers of peritonitis episodes, duration of angiotensin-converting enzyme inhibitor and/or angiotensin receptor blocker medication, or diabetes. CONCLUSION Low-GDP solution showed beneficial effects such as rapid remesothelialization and less EMT in the peritoneum with time on PD.
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Affiliation(s)
- Jun-Young Do
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea.
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Baek SH, Takayama K, Kudo I, Inoue K, Lee HW, Do JY, Chang HW. Detection and characterization of extracellular phospholipase A2 in pleural effusion of patients with tuberculosis. Life Sci 1991; 49:1095-102. [PMID: 1895872 DOI: 10.1016/0024-3205(91)90597-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [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: 12/29/2022]
Abstract
Extracellular phospholipase A2 activity has been identified in pleural fluid of patients with tuberculosis. This enzyme is a calcium requiring protein and has a pH optimum of 10.0. The enzyme was inhibited by the active site-directed histidine reagent, rho-bromophenacyl bromide. Ionic and non-ionic detergents, or the sulfhydryl reagent dithiothreitol, caused loss of enzyme activity. When substrate specificity was tested using 2-[1-14C]linoleoyl phospholipids as substrates, phosphatidyl-ethanolamine was the best substrate, followed by phosphatidylserine and phosphatidylcholine. This phospholipase A2 showed high affinity for heparin, and was recognized by a monoclonal antibody raised against phospholipase A2 from human synovial fluid. These findings suggest that an extracellular phospholipase A2, which may belong to the 14K group II phospholipase A2 family, exists in the pleural fluid of patients with tuberculosis.
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Affiliation(s)
- S H Baek
- Department of Biochemistry, College of Pharmacy, Yeungnam University, Gyongsan, Korea
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Abstract
The aroma of fruits and vegetables may be considered to originate from the basic nutrients such as carbohydrates, proteins, and fats, as well as vitamins and minerals. These nutrients, in turn, are produced by photosynthetic and related metabolic activities occurring in the plant. Current interests in aroma of fruits and vegetables have been shifting from isolation and identification to elucidation of their formation pathways either of biogenetic or processing nature. This article is intended to provide a summary on the development and degradation of aroma of selected major fruits and vegetables, 20 in each category. It reveals that information concerning this matter is still meager at present and that much more exploratory research is needed.
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