PURPOSE: Acute kidney injury (AKI) is a frequent condition with a high mortality rate that requires continuous renal replacement therapy (CRRT). We evaluated the Simplified Acute Physiology Score 3 (SAPS 3) and Acute Physiology and Chronic Health Evaluation II (APACHE II) score, determined at the start of CRRT, for predicting mortality in AKI. METHODS: We retrospectively analyzed the demographic, clinical, and laboratory data of 89 patients with AKI or acute-on-chronic kidney disease who received CRRT between September 2006 and September 2009. We calculated the SAPS 3 and APACHE II score at the start of CRRT. RESULTS: The average age of the 89 patients was 64.4+/-13.9 (17-92) years. Fifty-nine (66.3%) were male. Eighteen (20.2%) patients had chronic kidney disease and 30 (33.7%) had diabetes. The overall mortality was 75.3%. The average SAPS 3 was 89.4+/-14.9 and the average APACHE II score was 28.4+/-5.2. The SAPS 3 was higher in non-survivors than survivors (p=0.038). Infection was more common in non-survivors (p=0.036). There were no significant differences between the two groups for other conditions. The variables influencing mortality on univariate analysis were SAPS 3 and presence of infection. The area under the receiver-operating characteristic curve for SAPS 3 was 0.69 (95% CI. 0.54-0.83). At a SAPS 3 of 84, the sensitivity for predicting mortality was 71.6% and the specificity was 69.2%. CONCLUSION: The SAPS 3 determined before starting CRRT could be a predictor of hospital mortality in patients with AKI.
Acute Kidney Injury ; APACHE ; Hospital Mortality ; Humans ; Kidney Diseases ; Male ; Renal Insufficiency, Chronic ; Renal Replacement Therapy ; Retrospective Studies ; Sensitivity and Specificity ; Survivors

The present study investigated the prognostic factors predicting survival of patients with sepsis and acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT). This retrospective observational study included 165 sepsis patients treated with CRRT. The patients were divided into two groups; the survivor group (n=73, 44.2%) vs. the nonsurvivor group (n=92, 55.8%). AKI was defined by the 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guidelines. We analyzed medical histories, clinical characteristics and laboratory findings of the enrolled patients when they started CRRT. In addition, we performed binary logistic regression and cox regression analysis. In the survivor group, urine output during the first day was significantly higher compared with the nonsurvivor group (55.7±66.3 vs. 26.6±46.4, p=0.001). Patients with urine output <30 mL/hour during the 1st day showed worse outcomes than ≥30 mL/hour in the logistic regression (hazard ratio 2.464, 95% confidence interval 1.152-5.271, p=0.020) and the cox regression analysis (hazard ratio 1.935, 95% confidence interval 1.147-3.263, p=0.013). In conclusion, urine output may predict survival of septic AKI patients undergoing CRRT. In these patients, urine output <30 mL/hour during the first day was the strongest risk factor for in-hospital mortality.
Acute Kidney Injury ; Biomarkers ; Hospital Mortality ; Humans ; Kidney Diseases ; Logistic Models ; Observational Study ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors ; Sepsis ; Survivors

BACKGROUND AND OBJECTIVES: The burden of acute kidney injury (AKI) has not been explored in Jordanian patients who receive hematopoietic stem cell transplant (HSCT). The aim of this study was to evaluate the frequency, risk factors, and mortality of AKI among patients who underwent HSCT. METHODS: A retrospective pilot study included 70 adult patients who received peripheral HSCT was conducted. Weekly measurement of serum creatinine (SCr) was obtained for 3 months after chemotherapy and HSCT. Then, stages of Risk, Injury, and Failure of Kidney were determined based on the Kidney Disease for Improving Global Outcomes (KDIGO). RESULTS: The median follow-up was 41 months. Mortality was reported in 16 patients (23%). Out of 60 patients that had SCr values, 19 patients (31.6%) had AKI in 90 days after chemotherapy. Allogeneic HSCT, male donors, high-dose melphalan protocols and values of blood urea nitrogen (BUN) were significantly higher among patients with AKI. CONCLUSIONS: Combining many nephrotoxic drugs and dosing adjustments should be considered in uniform protocols. Multidisciplinary care should be utilized to assess early kidney dysfunction that decreases adverse events and improves outcomes.
Acute Kidney Injury ; Adult ; Blood Urea Nitrogen ; Clothing ; Creatinine ; Drug Therapy ; Follow-Up Studies ; Hematopoietic Stem Cells ; Humans ; Incidence ; Jordan ; Kidney ; Kidney Diseases ; Male ; Melphalan ; Mortality ; Pilot Projects ; Prognosis ; Retrospective Studies ; Risk Factors ; Tissue Donors

BACKGROUND: Long-term survival rate of chronic renal failure patients has been increasing gradually since the development of renal replacement therapy. At present, death cause of patients under the renal replacement therapy is well known, however, there is few clinical research on that of patients before starting the therapy and the referral time to a nephrologist. We have analyzed the death cause of patients before starting the renal replacement therapy and to investigate if the death has associated with the referral time to a nephrologist. METHODS: We investigated chronic renal failure patients who had been admitted Sanggye Paik Hospital from January 1997 to December 2000. Specific target was the deceased among the chronic renal failure patients who had not undergone renal replacement therapy. Our research was done in a retrograde study. We divided the target group into diabetic group and non-diabetic group. RESULTS: Among 29 expired patients, male patients were 17 and female were 12, and their average age was 61+/-12.3 years. As the cause of chronic renal failure, diabetes was 15, hypertension was 8, glomerular disease was 4, and unidentified was 2. Diabetic group were 15(51.7%) and non-diabetic group were 14(48.3%). Average age was 57.3+/-9.5 years in the diabetic group and 58.9+/-10.2 years in the non-diabetic group. The rate of male and female was 9:6 in the diabetic group and 8:6 in the non-diabetic group, so the rate seems similar in both of groups. BUN and creatinine in blood was compared at the hospital admission, the diabetic group had an average BUN of 54.3+/-12.4 mg/dL and average creatinine of 7.1+/- 2.5 mg/dL and the non-diabetic group had an average BUN 98.9+/-10.6 mg/dL and average creatinine of 9.3+/-3.0 mg/dL. Albumin in blood was 3.4+/-0.6g/dL in the diabetic and 3.6+/-0.8g/dL in the non-diabetic. As the death cause, sepsis was 17(58.6%), cardiovascular disease 5(17.5%), intracranial hemorrhage 4(13.8%), and liver disease was 3(10.1%). As the cause of sepsis, pneumonia was 9(52.9%), catheter infection 5(29.4%), peritoneum 2(11.7%) and urinary track infection was 1(6.0%). The initial meeting with a nephrologist prior to dialysis occurred as follow; in the diabetic group, early refer was 4(26.6%) and delay refer was 11(73.4%), and in the non-diabetic early refer was 2(14.2%) and delay refer was 12(85.8%). CONCLUSION: As for chronic renal failure patients before starting the renal replacement therapy, a physician should give an continual attention to the patients and refer them to a nephrologist promptly for the renal replacement therapy. In addition, a nephrologist should not lose the time for dialysis by analyzing the patient's condition thoroughly and starting the renal replacement therapy at the opportune moment, which could be helpful to reduce patients' medical expense and death rate.
Cardiovascular Diseases ; Catheters ; Cause of Death* ; Creatinine ; Dialysis ; Female ; Humans ; Hypertension ; Intracranial Hemorrhages ; Kidney Failure, Chronic* ; Liver Diseases ; Male ; Mortality ; Peritoneum ; Pneumonia ; Referral and Consultation ; Renal Replacement Therapy* ; Sepsis ; Survival Rate

BACKGROUND: Despite improvements in dialysis care, the mortality of patients with end-stage renal disease(ESRD) remains high. Patients who die within the first 90 days after beginning dialysis are not included in mortality rates and may be absent from incidence count. Therefore, the identification of modifiable characteristics associated with the risk of death during the first 90 days of treatment could lead to improved survival during this interval. METHODS: We performed a retrospective analysis in 986 patients(at least 1 year survival from initiating dialysis were 920 patients, and 66 patients died within 90 days after dialysis) who were initiated renal replacement therapy first at Yonsei Medical Center from Jan 1994 to Jun 1999. RESULTS: The 1 year mortality rate of total patients was 10.4%, and early death rate was 6.9%. The mean survival duration was 28.9+/-23.0 days. Characteristics independently associated with increased risk of early death included older age, inflammation, nutritional impairment, more comorbid condition and previous history of cardiovascular disease at starting dialysis. But Diabetes was not increased early death rate. By multivariate logistic regression analysis, old age, combined comorbid conditions, especially malignancy and congestive heart failure, low serum album and elevated C-reactive protein level were the independent risk factors affecting early death. Other variables such as sex, dyslipidemia, hypertension and diabetes mellitus were not significant risk factors. The leading cause of death in early death group was infection rather than cardiovascular accidents. CONCLUSION: Proper treatment of infection and improved nutritional status by adequate predialytic managements may contribute to their prolonged survival on dialysis patients.
C-Reactive Protein ; Cardiovascular Diseases ; Cause of Death ; Diabetes Mellitus ; Dialysis ; Dyslipidemias ; Heart Failure ; Humans ; Hypertension ; Incidence ; Inflammation ; Kidney Failure, Chronic* ; Logistic Models ; Mortality ; Nutritional Status ; Renal Replacement Therapy ; Retrospective Studies ; Risk Factors

The aim of this study was to evaluate the survival of 395 previously untreated cervical cancer patients with at least one high risk factor following concurrent chemoradiation and to assess the toxicities. Two different chemotherapy regimens were used for concurrent chemoradiation. In the patients with squamous cell carcinoma, 100 mg/m2 of cisplatin was infused intravenously, followed immediately by five consecutive daily administrations of 5-fluorouracil, 1,000 mg/m2/day, each infused intravenously over 24 hr. As for the patients with adenocarcinoma, 70 mg/m2 of cisplatin, 250 mg/m2 of cytoxan and 45 mg/m2 of adriamycin were administered intravenously on days 1, 2, and 3, respectively. The 5-year survival rate was 54.4+ACU- with stage III and IV, 62.6+ACU- with lymph node metastasis on computed tomogram or MRI, 77.9+ACU- with stage I-II disease with lesion size +AD4- or +AD0-4 cm, and 50.3+ACU- with small cell carcinoma or adenocarcinoma. Side effects from concurrent chemoradiation such as nausea, vomiting, and alopecia were present in all 395 cases. Anemia, leukopenia, thrombocytopenia, hepatotoxicity, and nephrotoxicity were observed to varying degrees, but there was no toxic death. This study suggests that cisplatin-based concurrent chemoradiation in treating cervical cancer patients with high risk factors is effective and relatively well tolerated, with acceptable toxicity.
Adenocarcinoma/radiotherapy ; Adenocarcinoma/mortality ; Adenocarcinoma/drug therapy ; Adult ; Aged ; Antineoplastic Agents, Combined/therapeutic use+ACo- ; Antineoplastic Agents, Combined/adverse effects ; Carboplatin/administration +ACY- dosage ; Carcinoma, Squamous Cell/radiotherapy ; Carcinoma, Squamous Cell/mortality ; Carcinoma, Squamous Cell/drug therapy ; Cervix Neoplasms/radiotherapy+ACo- ; Cervix Neoplasms/mortality ; Cervix Neoplasms/drug therapy ; Chemotherapy, Adjuvant/adverse effects ; Cisplatin/administration +ACY- dosage ; Combined Modality Therapy ; Comparative Study ; Cyclophosphamide/administration +ACY- dosage ; Doxorubicin/administration +ACY- dosage ; Female ; Fluorouracil/administration +ACY- dosage ; Gastrointestinal Diseases/etiology ; Gastrointestinal Diseases/epidemiology ; Hematologic Diseases/etiology ; Hematologic Diseases/epidemiology ; Hepatitis, Toxic/etiology ; Hepatitis, Toxic/epidemiology ; Human ; Kidney Diseases/epidemiology ; Kidney Diseases/chemically induced ; Korea/epidemiology ; Life Tables ; Lymphatic Metastasis ; Middle Age ; Particle Accelerators ; Radiotherapy, High-Energy+ACo-/adverse effects ; Retrospective Studies ; Risk ; Survival Analysis ; Treatment Outcome

The aim of this study was to evaluate the survival of 395 previously untreated cervical cancer patients with at least one high risk factor following concurrent chemoradiation and to assess the toxicities. Two different chemotherapy regimens were used for concurrent chemoradiation. In the patients with squamous cell carcinoma, 100 mg/m2 of cisplatin was infused intravenously, followed immediately by five consecutive daily administrations of 5-fluorouracil, 1,000 mg/m2/day, each infused intravenously over 24 hr. As for the patients with adenocarcinoma, 70 mg/m2 of cisplatin, 250 mg/m2 of cytoxan and 45 mg/m2 of adriamycin were administered intravenously on days 1, 2, and 3, respectively. The 5-year survival rate was 54.4+ACU- with stage III and IV, 62.6+ACU- with lymph node metastasis on computed tomogram or MRI, 77.9+ACU- with stage I-II disease with lesion size +AD4- or +AD0-4 cm, and 50.3+ACU- with small cell carcinoma or adenocarcinoma. Side effects from concurrent chemoradiation such as nausea, vomiting, and alopecia were present in all 395 cases. Anemia, leukopenia, thrombocytopenia, hepatotoxicity, and nephrotoxicity were observed to varying degrees, but there was no toxic death. This study suggests that cisplatin-based concurrent chemoradiation in treating cervical cancer patients with high risk factors is effective and relatively well tolerated, with acceptable toxicity.
Adenocarcinoma/radiotherapy ; Adenocarcinoma/mortality ; Adenocarcinoma/drug therapy ; Adult ; Aged ; Antineoplastic Agents, Combined/therapeutic use+ACo- ; Antineoplastic Agents, Combined/adverse effects ; Carboplatin/administration +ACY- dosage ; Carcinoma, Squamous Cell/radiotherapy ; Carcinoma, Squamous Cell/mortality ; Carcinoma, Squamous Cell/drug therapy ; Cervix Neoplasms/radiotherapy+ACo- ; Cervix Neoplasms/mortality ; Cervix Neoplasms/drug therapy ; Chemotherapy, Adjuvant/adverse effects ; Cisplatin/administration +ACY- dosage ; Combined Modality Therapy ; Comparative Study ; Cyclophosphamide/administration +ACY- dosage ; Doxorubicin/administration +ACY- dosage ; Female ; Fluorouracil/administration +ACY- dosage ; Gastrointestinal Diseases/etiology ; Gastrointestinal Diseases/epidemiology ; Hematologic Diseases/etiology ; Hematologic Diseases/epidemiology ; Hepatitis, Toxic/etiology ; Hepatitis, Toxic/epidemiology ; Human ; Kidney Diseases/epidemiology ; Kidney Diseases/chemically induced ; Korea/epidemiology ; Life Tables ; Lymphatic Metastasis ; Middle Age ; Particle Accelerators ; Radiotherapy, High-Energy+ACo-/adverse effects ; Retrospective Studies ; Risk ; Survival Analysis ; Treatment Outcome

In order to evaluate whether immunosuppressive agents such as mycophenolate mofetil (MMF) and azathioprine would differently influence the outcome of the renal transplants, we prospectively analyzed the incidence of acute rejection episodes, cytomegalovirus infection within the first 6 months following renal transplantation and 5 yr graft survival rate after minimizing influences of donor factors by grafting the same cadaveric donor kidney. There was no significant difference in sex, HLA mismatch, cold ischemic time, and patients' weight between the two groups. Contrary to the previous studies which demonstrated that MMF could lower the incidence of acute rejection episodes and improved graft survival rate, the two groups showed no significant difference in the incidence of acute rejection episodes and 5-yr graft survival rate as well. This discrepancy in these results might explain that donor factors could be important to cadaveric renal transplantation. Thus, we suggest that the influences of donor factors should be considered in further clinical studies of cadaveric renal transplantation.
ABO Blood-Group System ; Adult ; Azathioprine/*pharmacology ; Body Weight ; Cadaver ; Cytomegalovirus/metabolism ; Cytomegalovirus Infections/metabolism ; Female ; Graft Rejection ; Graft Survival ; Histocompatibility Testing ; Humans ; Immunophenotyping ; Immunosuppressive Agents/pharmacology ; Ischemia ; Kidney Diseases/mortality/therapy ; Kidney Transplantation/*methods ; Male ; Middle Aged ; Mycophenolic Acid/*analogs & derivatives/*pharmacology ; Prospective Studies ; Time Factors ; Tissue Donors ; Treatment Outcome

Microscopic polyangiitis (MPA) is a systemic vasculitis affecting small vessels. To determine the clinical features and outcomes of MPA in Korean patients, we retrospectively reviewed the medical records of patients diagnosed with MPA at a single medical center in Korea between 1989 and 2006. The 18 patients who met the Chapel Hill criteria for MPA had a mean (+/-SD) age at the time of diagnosis of 62.4+/-12.7 yr. Renal manifestations and general symptoms were the most common features of MPA, with lung involvement also very common. Antineutrophil cytoplasmic antibodies (ANCA) were present in 17 of the 18 patients (94%). Of 17 patients treated with steroids and cyclophosphamide, 11 (65%) had stable or improved course. One patient treated with steroids without cyclophosphamide showed disease progression. Ten of the 18 patients (56%) died at a median follow-up of 8 months. MPA in Korean patients was distinguished by a higher rate of lung involvement, especially alveolar hemorrhage, which was the leading cause of death in our patients. Korean patients were also older at MPA onset and were more likely positive for ANCA. Other overall clinical manifestations did not differ significantly.
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Antibodies, Antineutrophil Cytoplasmic/blood ; Cyclophosphamide/therapeutic use ; Drug Therapy, Combination ; Female ; Hemorrhage/etiology ; Humans ; Kidney Failure/etiology ; Korea ; Lung Diseases/etiology ; Male ; Middle Aged ; Polyarteritis Nodosa/*diagnosis/drug therapy/mortality ; Pulmonary Alveoli/blood supply/pathology ; Retrospective Studies ; Steroids/therapeutic use ; Survival Analysis ; Treatment Outcome

BACKGROUN: Chief complaint is the primary history, quoted from patient, and the starting point of medical service. Physicians need to know what complaints are in the society and how they would be going. We to described what symptoms patients had, what diagnoses were made, and how was the mortality of patients admitted in Seoul National University Hosptial (SNUH) during the past 7 years (1991.1~1997.12). METHODS: In the past 7 years, 235,426 admitted cases were in SNUH. We computerized demographic factors, chief complaints, diagnoses at discharge, and mortality of patients. We categorized chief complaints as 93 major groups, dissected further with modifiers. The diagnoses were coded as ICD-10 and the mortality data was gathered through access to the annual police mortality data. We figured out the estimated mortality rate according to the chief complaint and/or diagnosis, using life table analysis through SSPS version 10.0. RESULTS: The most frequent chief complaint was pain, followed by chemotherapy, mass, dyspnea, bleeding and so on. Upper 20 symptom-groups occupied over 80 percents. We described specific symptoms, demographic factors, diagnoses, and rates of mortality in a certain chief complaint group. For example, abdominal pain, chest pain, lumbar pain, pain on lower extremity, and headache were seen frequently in the pain category. Symptom which had the worst prognosis was swallowing difficulty because almost half of patients with it had malignancy. We showed descriptive data of liver cirrosis, diabetes mellitus, angina pectoris, chronic renal failure, and pulmonary tuberculosis. For example, we found the painless angina pectoris had worse prognosis than the painful cases. We also discussed the usefulness of these data to education, medical service, medical research, and quality improvement in medicine. CONCLUSION: We figured out clinically important chief complaints, their diagnoses, and their mortality rate of patients admitted in SNUH. We hope nation-wide survey like this study would be planned in near future. We could use it's data in many fields, such as educational renovation, medical reseasrch, medical quality control and so on.
Abdominal Pain ; Angina Pectoris ; Chest Pain ; Deglutition ; Demography ; Diabetes Mellitus ; Diagnosis* ; Drug Therapy ; Dyspnea ; Education, Medical ; Headache ; Hemorrhage ; Hope ; Humans ; International Classification of Diseases ; Kidney Failure, Chronic ; Life Tables ; Liver ; Lower Extremity ; Mortality* ; Police ; Prognosis ; Quality Control ; Quality Improvement ; Seoul* ; Tuberculosis, Pulmonary