1.A More Appropriate Cardiac Troponin T Level That Can Predict Outcomes in End-Stage Renal Disease Patients with Acute Coronary Syndrome.
Dong Ryeol RYU ; Jung Tak PARK ; Jung Hwa CHUNG ; Eun Mi SONG ; Sun Hee ROH ; Jeong Min LEE ; Hye Rim AN ; Mina YU ; Wook Bum PYUN ; Gil Ja SHIN ; Seung Jung KIM ; Duk Hee KANG ; Kyu Bok CHOI
Yonsei Medical Journal 2011;52(4):595-602
PURPOSE: Cardiac troponin T (cTnT), a useful marker for diagnosing acute myocardial infarction (AMI) in the general population, is significantly higher than the usual cut-off value in many end-stage renal disease (ESRD) patients without clinically apparent evidence of AMI. The aim of this study was to evaluate the clinical usefulness of cTnT in ESRD patients with acute coronary syndrome (ACS). MATERIALS AND METHODS: Two hundred eighty-four ESRD patients with ACS were enrolled between March 2002 and February 2008. These patients were followed until death or June 2009. Medical records were reviewed retrospectively. The cut-off value of cTnT for AMI was evaluated using a receiver operating characteristic (ROC) curve. We calculated Kaplan-Meier survival curves, and potential outcome predictors were determined by Cox proportional hazard analysis. RESULTS: AMIs were diagnosed in 40 patients (14.1%). The area under the curve was 0.98 in the ROC curve (p<0.001; 95% CI, 0.95-1.00). The summation of sensitivity and specificity was highest at the initial cTnT value of 0.35 ng/mL (sensitivity, 0.95; specificity, 0.97). Survival analysis showed a statistically significant difference in all-cause and cardiovascular mortalities for the group with an initial cTnT > or =0.35 ng/mL compared to the other groups. Initial serum cTnT concentration was an independent predictor for mortality. CONCLUSION: Because ESRD patients with an initial cTnT concentration > or =0.35 ng/mL have a poor prognosis, it is suggested that urgent diagnosis and treatment be indicated in dialysis patients with ACS when the initial cTnT levels are > or =0.35 ng/mL.
Acute Coronary Syndrome/blood/complications/*diagnosis/mortality
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Aged
;
Biological Markers/blood
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Female
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Humans
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Kidney Failure, Chronic/blood/complications/*diagnosis/mortality
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Male
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Middle Aged
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Prognosis
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Retrospective Studies
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Sensitivity and Specificity
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Troponin T/*blood
2.The relationship between plasma leptin and nutritional status in chronic hemodialysis patients.
Ja Ryong KOO ; Ky Yong PAK ; Ken Ho KIM ; Rho Won CHUN ; Hyung Jik KIM ; Dong Wan CHAE ; Moon Gi CHOI ; Jung Woo NOH
Journal of Korean Medical Science 1999;14(5):546-551
Leptin serves an important role in suppressing appetite in mice and is known to be elevated in chronic renal failure (CRF) patients. But clinical significance of leptin as an appetite-reducing uremic toxin, remains to be determined. So we studied the relationship between plasma leptin and nutritional status in 46 chronic hemodialysis (HD) patients. Pre HD leptin was measured and divided by body mass index (BMI) to give adjusted leptin levels. KT/Vurea (K, dialyzer urea clearance; T, duration of HD; V, volume of distribution of urea), C-reactive protein (CRP), plasma insulin and nutritional parameters such as serum albumin, normalized protein catabolic rate (nPCR), subjective global assessment (SGA), BMI and mid-arm muscle circumference (MAMC) were also measured. Mean plasma leptin levels were 8.13+/-2.91 ng/mL (male 3.15+/-0.70; female 14.07+/-6.14, p<0.05). Adjusted leptin levels were positively correlated with nPCR (male r=0.47, p<0.05; female r=0.46, p<0.05), SGA (male r=0.43, p<0.05; female r=0.51, p<0.05) and MAMC (male r=0.60, p<0.005; female r=0.61, p<0.05). They did not correlate with KT/Vurea, serum albumin, hematocrit, bicarbonate, insulin and CRP. Presence of DM and erythropoietin therapy had no effect on leptin levels. These results suggest that leptin is a marker of good nutritional status rather than a cause of protein energy malnutrition in chronic HD patients.
Adult
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Biological Markers/blood
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Cross-Sectional Studies
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Female
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Human
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Kidney Failure, Chronic/therapy
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Kidney Failure, Chronic/complications
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Kidney Failure, Chronic/blood*
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Leptin/blood*
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Male
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Middle Age
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Nutrition Disorders/etiology
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Nutrition Disorders/diagnosis
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Nutritional Status*
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Obesity/metabolism
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Obesity/etiology
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Renal Dialysis*/adverse effects
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Sex Factors
3.Five cases of cytomegalovirus infection detected by in situ hybridization and antigenemia assay.
Jin Hong YOO ; Jong Young CHOI ; Yang Ree KIM ; Yeong Jin CHOI ; Sang In SHIM ; Hak Ki KIM ; Chul Woo YANG ; Yong Soo KIM ; Chi Wha HAHN ; Wan Shik SHIN ; Chong Won PARK ; Moon Won KANG ; Choon Choo KIM ; Byung Kee BANG ; Dong Jip KIM
Journal of Korean Medical Science 1994;9(6):507-512
We report five cases of cytomegalovirus infection in immunocompromised patients which were detected by either cytomegalovirus antigenemia assay or in situ hybridization. Four cases had leukemia and the other had chronic renal failure. All the three BMT recipients suffered from GvHD. Interestingly, there was an unique case of CMV disease without a history of BMT, which reminded us that CMV could attack immunocompromised patients who had not undergone transplantation, too. Four out of five cases died. We think that cytomegalovirus infection or disease should not be regarded as a minor problem in post-transplantation infection in Korea.
Adolescent
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Adult
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Antigens, Viral/*blood
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*Bone Marrow Transplantation
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Case Report
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Cytomegalovirus/*immunology
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Cytomegalovirus Infections/complications/*diagnosis
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Fatal Outcome
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Graft vs Host Disease/complications
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Human
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Immunocompromised Host
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In Situ Hybridization
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Kidney Failure, Chronic/complications
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Kidney Transplantation
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Leukemia/*complications/therapy
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Leukemia, Lymphocytic, Acute, L2/complications/therapy
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Leukemia, Myelocytic, Acute/complications/therapy
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Leukemia, Myeloid, Chronic/complications/therapy
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Male
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Viremia/*diagnosis
4.Associations between Oxidized LDL to LDL Ratio, HDL and Vascular Calcification in the Feet of Hemodialysis Patients.
Won Suk AN ; Seong Eun KIM ; Ki Hyun KIM ; Hae Rahn BAE ; Seo Hee RHA
Journal of Korean Medical Science 2009;24(Suppl 1):S115-S120
Cardiovascular mortality is associated with vascular calcification (VC) in hemodialysis (HD) patients. The present study was designed to find factors related with medial artery calcification on the plain radiography of feet by comparing C-reactive protein (CRP), plasminogen activator inhibitor type 1 (PAI-1) and lipid profile including oxidized low density lipoprotein (ox-LDL) and to elucidate associations among these factors in HD patients. Forty-eight HD patients were recruited for this study. VC in the feet was detected in 18 patients (37.5%) among total patients and 12 patients (85.7%) among diabetic patients. Diabetes, cardiovascular disease (CVD), pulse pressure, ox-LDL/LDL were higher and high density lipoprotein (HDL) was lower in patients with VC than in patients without VC. Negative associations were found between HDL and CRP, PAI-1. PAI-1 had positive association with ox-LDL/LDL. History of CVD was the only determinant of vascular calcification on the plain radiography of feet. Ox-LDL/LDL, HDL, CRP, and PAI-1 were closely related with one another in HD patients. History of CVD is the most important factor associated with the presence of VC and low HDL and relatively high oxidized LDL/LDL ratio may affect VC formation on the plain radiography in the feet of HD patients.
Aged
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C-Reactive Protein/metabolism
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Cardiovascular Diseases/blood/complications/diagnosis
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Female
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Foot
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Humans
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Kidney Failure, Chronic/blood/complications/diagnosis
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Lipoproteins, HDL/*metabolism
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Lipoproteins, LDL/*metabolism
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Male
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Middle Aged
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Plasminogen Activator Inhibitor 1/metabolism
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*Renal Dialysis
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Risk Factors
5.Carpal Tunnel Syndrome and Peripheral Polyneuropathy in Patients with End Stage Kidney Disease.
Hee Kyu KWON ; Sung Bom PYUN ; Won Yong CHO ; Chang Su BOO
Journal of Korean Medical Science 2011;26(9):1227-1230
This study was designed to identify the causes of the development of carpal tunnel syndrome (CTS) associated with end stage kidney disease (ESKD). A total of 112 patients with ESKD, 64 on hemodialysis (HD) and 48 on peritoneal dialysis (PD), were enrolled. The duration of ESKD and dialysis, the site of the arteriovenous (A-V) fistula for HD, laboratory data such as blood urea nitrogen, creatinine, and beta-2-microglobulin were determined. Clinical evaluation of CTS and electrophysiological studies for the diagnosis of CTS and peripheral neuropathy were performed. The electrophysiological studies showed that the frequency of CTS was not different in the HD and PD groups (P = 0.823) and the frequency of CTS was not different in the limb with the A-V fistula compared to the contralateral limb (P = 0.816). The frequency of HD and PD were not related to beta-2-microglobulin levels, an indicator of amyloidosis. The frequency of CTS did not increase as the severity of the peripheral neuropathy and the duration of ESKD and dialysis increased (P = 0.307). The results of this study do not support that microglobulin induced amyloidosis or placement of an A-V fistula are associated with an increase in CTS.
Adult
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Aged
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Amyloidosis/complications
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Arteriovenous Fistula/complications
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Blood Urea Nitrogen
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Carpal Tunnel Syndrome/*complications/*diagnosis
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Creatinine/blood
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Electrophysiological Phenomena
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Female
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Humans
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Kidney Failure, Chronic/*complications/*therapy
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Male
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Middle Aged
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Peritoneal Dialysis/adverse effects
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Polyneuropathies/*complications/*diagnosis
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Renal Dialysis/adverse effects
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beta 2-Microglobulin/blood
6.N-terminal Pro-Brain Natriuretic Peptide Levels Predict Left Ventricular Systolic Function in Patients with Chronic Kidney Disease.
Jung Eun LEE ; So Yeon CHOI ; Wooseong HUH ; Seong Woo PARK ; Dae Joong KIM ; Ha Young OH ; Yoon Goo KIM
Journal of Korean Medical Science 2009;24(Suppl 1):S63-S68
N-terminal pro-brain natriuretic peptide (NT-proBNP) can be a useful marker for left ventricular (LV) dysfunction in patients without kidney disease. This study was conducted to clarify the relationship between NT-proBNP and LV systolic function in patients with decreased renal function. We studied 256 chronic kidney disease (CKD) patients, patients on dialysis were excluded. The median glomerular filtration rate was 24 (13-36) mL/min/1.73 m(2) and the median NT-proBNP was 4,849 (1,310- 19,009) pg/mL. The prevalence of LV systolic dysfunction increased from the lower to the upper NT-proBNP quartiles (I, 17%; II, 34%; III, 61%; and IV, 72%; p<0.001 for trend). The NT-proBNP quartile was an independent predictor of LV systolic dysfunction after adjustment for renal function, compared with quartile I: II, odds ratio (OR) 3.99 (95% confidence interval [CI],1.34-11.93); III, OR 11.28 (95% CI, 3.74-33.95); and IV, OR 36.97 (95% CI, 11.47-119.1). Area under the curve and optimum cut points for NT-proBNP to detect LV systolic dysfunction were 0.781 and 2,165 pg/mL in CKD stage 3, 0.812 and 4,740 pg/mL in CKD stage 4, and 0.745 and 15,892 pg/ mL in CKD stage 5. The NT-proBNP level was a predictor of LV systolic dysfunction in CKD patients. Optimum cut points should be stratified according to renal function.
Aged
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Area Under Curve
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Female
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Glomerular Filtration Rate
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Humans
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Kidney Failure, Chronic/*complications/pathology
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Male
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Middle Aged
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Natriuretic Peptide, Brain/*blood
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Peptide Fragments/diagnostic use
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Prevalence
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Protein Structure, Tertiary
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Sensitivity and Specificity
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Ventricular Dysfunction, Left/complications/diagnosis
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*Ventricular Function, Left
7.Cutoff value of serum procalcitonin as a diagnostic biomarker of infection in end-stage renal disease patients.
Wan Soo LEE ; Dae Woong KANG ; Jong Hun BACK ; Hyun Lee KIM ; Jong Hoon CHUNG ; Byung Chul SHIN
The Korean Journal of Internal Medicine 2015;30(2):198-204
BACKGROUND/AIMS: Serum procalcitonin (PCT) levels are low in healthy individuals but are elevated in patients with a serious bacterial infection or sepsis. In this study, we examined the ability of serum PCT concentration to diagnose infections in end-stage renal disease (ESRD) patients, and sought to determine an appropriate threshold level. METHODS: Serum PCT levels were measured in ESRD patients on antibiotic therapy for a suspected bacterial infection (ESRD infection [iESRD] group, n = 21), and compared with those of ESRD patients on hemodialysis with no sign of infection (ESRD control [cESRD] group, n = 20). RESULTS: The mean serum PCT concentration of the iESRD group was significantly higher than in the cESRD group (2.95 +/- 3.67 ng/mL vs. 0.50 +/- 0.49 ng/mL, p = 0.006), but serum PCT concentrations did not correlate with severity of infection. The optimized threshold level derived for serum PCT was 0.75 ng/mL, rather than the currently used 0.5 ng/mL; this threshold demonstrated a sensitivity and specificity of 76.2% and 80.0% for infection and 100% and 60.6% for systemic inflammatory response syndrome, respectively, compared with the cutoff of 0.5 ng/mL. CONCLUSIONS: This study suggests that serum PCT at a cutoff value of 0.75 ng/mL is an appropriate indicator of infection in ESRD patients.
Adult
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Aged
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Area Under Curve
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Bacterial Infections/*blood/complications/*diagnosis/microbiology
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Biomarkers/blood
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Calcitonin/*blood
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Case-Control Studies
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Female
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Humans
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Inflammation Mediators/*blood
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Kidney Failure, Chronic/*complications/diagnosis/therapy
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Male
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Middle Aged
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Peritoneal Dialysis
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Predictive Value of Tests
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Protein Precursors/*blood
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ROC Curve
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Renal Dialysis
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Reproducibility of Results
;
Up-Regulation
8.Lysophosphatidylcholine, Oxidized Low-Density Lipoprotein and Cardiovascular Disease in Korean Hemodialysis Patients: Analysis at 5 Years of Follow-up.
Young Ki LEE ; Dong Hun LEE ; Jin Kyung KIM ; Min Jeong PARK ; Ji Jing YAN ; Dong Keun SONG ; Nosratola D VAZIRI ; Jung Woo NOH
Journal of Korean Medical Science 2013;28(2):268-273
Although oxidized low-density lipoprotein (LDL) and lysophosphatidylcholine (LPC) have been proposed as important mediators of the atherosclerosis, the long-term contribution to the risk of cardiovascular disease (CVD) in hemodialysis patients has not been evaluated. This study investigated the relation between oxidized LDL and LPC levels with long term risk of CVD. Plasma oxidized LDL and LPC levels were determined in 69 Korean hemodialysis patients as a prospective observational study for 5 yr. During the observation period, 18 cardiovascular events (26.1%) occurred including 6 deaths among the hemodialysis patients. The low LPC level group (< or = 254 microM/L, median value) had much more increased risk of CVD compared to the high LPC level group (> 254 microM/L) (P = 0.01). However, serum levels of oxidized LDL were not significantly different between groups with and without CVD. In adjusted Cox analysis, previous CVD, (hazard ratio [HR], 5.68; 95% confidence interval [CI], 1.94-16.63, P = 0.002) and low LPC level (HR, 3.45; 95% CI, 1.04-11.42, P = 0.04) were significant independent risk factors for development of CVD. It is suggested that low LPC, but not oxidized LDL, is associated with increased risk of CVD among a group of Korean hemodialysis patients.
Adult
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Aged
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Asian Continental Ancestry Group
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Cardiovascular Diseases/*diagnosis/etiology/mortality
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Case-Control Studies
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Female
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Follow-Up Studies
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Humans
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Kidney Failure, Chronic/blood/complications/diagnosis
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Lipoproteins, LDL/*blood
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Lysophosphatidylcholines/*blood
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Male
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Middle Aged
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Proportional Hazards Models
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Prospective Studies
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Renal Dialysis
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Republic of Korea
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Risk Factors
9.Prevalence of Occult Hepatitis B Virus Infection in Hemodialysis Patients.
Jeong Hwan YOO ; Seong Gyu HWANG ; Dong Ho YANG ; Myung Su SON ; Chang Il KWON ; Kwang Hyun KO ; Sung Pyo HONG ; Pil Won PARK ; Kyu Sung RIM
The Korean Journal of Gastroenterology 2013;61(4):209-214
BACKGROUND/AIMS: The prevalence of occult HBV infection depends on the prevalence of HBV infection in the general population. Hemodialysis patients are at increased risk for HBV infection. The aim of this study was to determine the prevalence of occult HBV infection in hemodialysis patients. METHODS: Total of 98 patients undergoing hemodialysis in CHA Bundang Medical Center (Seongnam, Korea) were included. Liver function tests and analysis of HBsAg, anti-HBs, anti-HBc and anti-HCV were performed. HBV DNA testing was conducted by using two specific quantitative methods. RESULTS: HBsAg was detected in 4 of 98 patients (4.1%), and they were excluded. Among 94 patients with HBsAg negative and anti-HCV negative, one (1.1%) patient with the TaqMan PCR test and 3 (3.2%) patients with the COBAS Amplicor HBV test were positive for HBV DNA. One patient was positive in both methods. Two patients were positive for both anti-HBs and anti-HBc and one patient was negative for both anti-HBs and anti-HBc. CONCLUSIONS: The present study showed the prevalence of occult HBV infection in HBsAg negative and anti-HCV negative patients on hemodialysis at our center was 3.2%. Because there is possibility of HBV transmission in HBsAg negative patients on hemodialysis, more attention should be given to prevent HBV transmission.
Adult
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Aged
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Aged, 80 and over
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Antibodies/blood
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DNA, Viral/analysis
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Feces/*virology
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Female
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Hepatitis B/complications/*epidemiology/transmission
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Hepatitis B Core Antigens/immunology
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Hepatitis B virus/genetics/immunology
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Hepatitis C Antibodies/blood
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Humans
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Kidney Failure, Chronic/*complications/diagnosis
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Male
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Middle Aged
;
Polymerase Chain Reaction
;
Prevalence
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Renal Dialysis
;
Risk Factors