Echocardiographic parameters can predict cardiovascular events in several clinical settings. However, which echocardiographic parameter is most predictive of each cardiovascular or non-cardiovascular event in patients starting hemodialysis remains unresolved. Echocardiography was used in 189 patients at the time of starting hemodialysis. We established primary outcomes as follows: cardiovascular events (ischemic heart disease, cerebrovascular disease, peripheral artery disease, and acute heart failure), fatal non-cardiovascular events, all-cause mortality, and all combined events. The most predictable echocardiographic parameter was determined in the Cox hazard ratio model with a backward selection after the adjustment of multiple covariates. Among several echocardiographic parameters, the E/e' ratio and the left ventricular end-diastolic volume (LVEDV) were the strongest predictors of cardiovascular and non-cardiovascular events, respectively. After the adjustment of clinical and biochemical covariates, the predictability of E/e' remained consistent, but LVEDV did not. When clinical events were further analyzed, the significant echocardiographic parameters were as follows: s' for ischemic heart disease and peripheral artery disease, LVEDV and E/e' for acute heart failure, and E/e' for all-cause mortality and all combined events. However, no echocardiographic parameter independently predicted cerebrovascular disease or non-cardiovascular events. In conclusion, E/e', s', and LVEDV have independent predictive values for several cardiovascular and mortality events.
*Echocardiography ; Female ; Heart Failure/*diagnosis/mortality ; Humans ; Kidney Failure, Chronic/mortality/*therapy ; Male ; Middle Aged ; Predictive Value of Tests ; Prognosis ; *Renal Dialysis ; Risk Factors ; Ventricular Function, Left/*physiology

Diabetic kidney disease is a microvascular complication of diabetes mellitus and the leading cause of end-stage renal disease resulting in renal replacement therapy. Approximately 30% to 40% of diabetic patients have diabetic kidney disease, which contributes to a significant increase in morbidity and mortality. Microalbuminuria is considered the gold standard for diabetic kidney disease diagnosis; however, its predictive value is restricted. Although blood glucose control, blood pressure control, and angiotensin converting enzyme inhibitors have been the primary treatment strategies, there are no definitive treatment modalities capable of inhibiting the progression of kidney dysfunction in these patients. This study was undertaken to answer seven questions regarding the various aspects of diabetic kidney disease. Why does it develop? what kind of factors affect its development? How is it diagnosed? What are its possible biomarkers? When is a kidney biopsy necessary? What are the preventive and therapeutic options? And what are the novel treatments?
Angiotensin-Converting Enzyme Inhibitors ; Biomarkers ; Biopsy ; Blood Glucose ; Blood Pressure ; Diabetes Mellitus ; Diabetic Nephropathies ; Diagnosis ; Humans ; Kidney ; Kidney Failure, Chronic ; Mortality ; Renal Replacement Therapy

BACKGROUND/AIMS: This study analyzed the risk factors for technique survival in dialysis patients and compared technique survival rates between hemodialysis (HD) and peritoneal dialysis (PD) in a prospective cohort of Korean patients. METHODS: A total of 1,042 patients undergoing dialysis from September 2008 to June 2011 were analyzed. The dialysis modality was defined as that used 90 days after commencing dialysis. Technique survival was compared between the two dialysis modalities, and the predictive risk factors were evaluated. RESULTS: The dialysis modality was an independent risk factor predictive of technique survival. PD had a higher risk for technique failure than HD (hazard ratio [HR], 10.8; 95% confidence interval [CI], 1.9 to 62.0; p = 0.008) during a median follow-up of 11.0 months. In the PD group, a high body mass index (BMI) was an independent risk factor for technique failure (HR, 1.3; 95% CI, 1.0 to 1.8; p = 0.036). Peritonitis was the most common cause of PD technique failure. The difference in technique survival between PD and HD was more prominent in diabetic patients with a good nutritional status and in non-diabetic patients with a poor nutritional status. CONCLUSIONS: In a prospective cohort of Korean patients with end-stage renal disease, PD was associated with a higher risk of technique failure than HD. Diabetic patients with a good nutritional status and non-diabetic patients with a poor nutritional status, as well as patients with a higher BMI, had an inferior technique survival rate with PD compared to HD.
Adult ; Aged ; Body Mass Index ; Humans ; Kidney Failure, Chronic/diagnosis/mortality/*therapy ; Male ; Middle Aged ; Nutritional Status ; Peritoneal Dialysis/adverse effects/mortality ; Prospective Studies ; *Renal Dialysis/adverse effects/mortality ; Republic of Korea ; Risk Factors ; Time Factors ; Treatment Outcome

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common genetic disorder that accounts for 8-10% of patients receiving renal replacement therapy in Unites States and Europe, and approximately 2% in Korea. ADPKD patients on renal replacement therapy constitute a particular group with typical clinical charateristics and differences from other patients on renal replcement therapy. The objective of this study was to assess clinical features, morbidity, mortality and technical survival in end stage renal disease (ESRD) patients with ADPKD and compare these between each renal replacement therapy. METHODS: We retrospectively analyzed 70 ADPKD patients who received renal replacement therapy in Yonsei university medical center (Jan. 1980-Dec. 2001). RESULTS: Among a total of 70 patients, 41 patients were male and 29 patients were female. Mean age was 45.6+/-10.7 years and average time from diagnosis of ADPKD to start of renal replacement therapy was 5.1+/-5.6 years. As the initial mode of renal replacement therapy, 25 patients started on hemodialysis, 26 patients started on CAPD and 19 patients received renal transplantation. Clinical features and laboratory findings at the initiation of renal replacement therapy had no significant differences between each renal replacement therapy. Cumulative and technical survival in ESRD patients with ADPKD receiving each renal replacement therapy had no significant differences according to Kaplan-Meier. Seven patients died within study period, including 3 hemodialysis patients, 2 CAPD patients and 2 renal transplantation patients. The most common cause of death was infection followed by bleeding and malignancy. Among patients on CAPD, 10 patients had stopped CAPD because of peritonitis, hernia, ultrafiltration failure and CAPD leakage. CONCLUSION: In summary, there were no significant differences of clinical features, cumulative and technical survival between each renal replacement therapy in ADPKD patients. The most frequent reason for cessation of CAPD was peritonitis. The most common cause of death was infection in ESRD patients with ADPKD.
Academic Medical Centers ; Cause of Death ; Diagnosis ; Europe ; Female ; Hemorrhage ; Hernia ; Humans ; Kidney Failure, Chronic* ; Kidney Transplantation ; Korea ; Male ; Mortality ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Polycystic Kidney, Autosomal Dominant* ; Renal Dialysis ; Renal Replacement Therapy* ; Retrospective Studies ; Ultrafiltration

BACKGROUND/AIMS: It has been suggested that chronic kidney disease (CKD) is a risk factor for Clostridium difficile infection (CDI) and is associated with increased mortality among patients infected with C. difficile. However, recent studies of the clinical impact of CKD on CDI in Asians are still insufficient. We sought to determine the relationship between CKD and CDI in a Korean population. METHODS: This was a single-center, retrospective case-control study. In total, 171 patients with CDI were included as cases and 342 age- and gender-matched patients without CDI were used as controls. We compared the prevalence of CKD in the study sample and identified independent risk factors that could predict the development or prognosis of CDI. RESULTS: Independent risk factors for CDI included stage IV to V CKD not requiring dialysis (odds ratio [OR], 2.90) and end-stage renal disease requiring dialysis (OR, 3.34). Patients with more advanced CKD (estimated glomerular filtration rate < 30) and CDI showed higher in-hospital mortality and poorer responses to the initial metronidazole therapy. CONCLUSIONS: More advanced CKD is an independent risk factor for CDI and is associated with higher in-hospital mortality and poor treatment responses in CDI patients. Thus, in CKD patients, careful attention should be paid to the occurrence of CDI and its management to improve the outcome of CDI.
Aged ; Anti-Infective Agents/therapeutic use ; Chi-Square Distribution ; Clostridium difficile/*pathogenicity ; Enterocolitis, Pseudomembranous/diagnosis/drug therapy/*microbiology/mortality ; Female ; Hospital Mortality ; Humans ; Kidney Failure, Chronic/*complications/diagnosis/therapy ; Logistic Models ; Male ; Metronidazole/therapeutic use ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Prevalence ; Renal Dialysis ; Renal Insufficiency, Chronic/*complications/diagnosis/mortality/therapy ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Treatment Outcome

Chronic renal failure (CRF) is a functional diagnosis characterized by a progressive and generally irreversible decline in glomerular filtration rate (GFR). It is caused by a number of diseases, most commonly diabetes, glomerulonephritis, hypertension and the genetic diseases. The renal function of CRF patients declines by unrelenting progressive loss of nephron that persists long after the inciting event. CRF is not a curable disease. The aim of the treatment of CRF is to halt or delay the progression of renal failure and amelioration of symptoms, not to cure of the disease. Systemic hypertension, glomerular hypertension, proteinuria and protein-rich diet contribute to the progression of renal failure. Restriction of dietary protein intake help to preserve residual renal function. Among the antihypertensives, angiotensin converting enzyme inhibitor (ACEI) is the drug of choice for blood pressure control in CRF patients, because this class of drug reduces intraglomerular pressure. There is a growing awareness of a need not only to identify CRF patients at an earlier stage in the disease process, but also to initiate treatment strategies earlier to delay progression of CRF and to define the optimal time required to prepare CRF patients for renal replacement therapy. Early referral to the nephrologist is important for timely intervention. The consequences of late referral include increased morbidity and mortality. There is also an impact on patient's quality of life and missed opportunities for pre-emptive transplantation. Late referral also limits therapeutic options, and these limitations exert adverse effects on long-term outcomes once patients are on dialysis.
Antihypertensive Agents ; Blood Pressure ; Diagnosis ; Dialysis ; Diet ; Diet Therapy ; Dietary Proteins ; Drug Therapy ; Glomerular Filtration Rate ; Glomerulonephritis ; Humans ; Hypertension ; Kidney Failure, Chronic* ; Mortality ; Nephrons ; Peptidyl-Dipeptidase A ; Proteinuria ; Quality of Life ; Referral and Consultation ; Renal Insufficiency ; Renal Replacement Therapy

OBJECTIVETo analyze the clinical features of hemodialysis patients complicated by infective endo carditis.

METHODSThe clinical features of six such patients admitted to Peking Union Medical College Hospital during the year 1990 to 2009 were analyzed. All of them were diagnosed based on Chinese Children Diagnostic Criteria for Infective Endocarditis.

RESULTSThe average age of the six patients was 52.3 +/- 19.3 years old. Four were males. Vascular accesses at the onset of infective endocarditis were as follows: permanent catheters in three, temporary catheters in two, and arteriovenous fistula in one. Three were found with mitral valve involvement, two with aortic valve involvement, and one with both. Five vegetations were found by transthoracic echocardiography, and one by transesophageal echocardiography. Four had positive blood culture results. The catheters were all removed. Four of the patients were improved by antibiotics treatment, in which two were still on hemodialysis in the following 14-24 months and the other two were lost to follow-up. One patient received surgery, but died of heart failure after further hemodialysis for three months. One was well on maintenance hemodialysis for three months after surgery.

CONCLUSIONSInfective endocarditis should be suspected when hemodialysis patients suffer from long-term fever, for which prompt blood culture and transthoracic echocardiography confirmation could be performed. Transesophageal echocardiography could be considered even when transthoracic echocardiography produces negative findings. With catheters removed, full course of appropriate sensitive antibiotics and surgery if indicated could improve the outcome of chronic hemodialysis patients complicated by infective endocarditis.

Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents ; therapeutic use ; Echocardiography, Transesophageal ; Endocarditis ; diagnosis ; drug therapy ; mortality ; Female ; Humans ; Kidney Failure, Chronic ; therapy ; Male ; Middle Aged ; Renal Dialysis ; adverse effects ; Risk Factors

The Korean Society of Nephrology (KSN) launched a nationwide end-stage renal disease (ESRD) patient registry in 1985 called the Insan Prof. Byung-Suk Min Memorial ESRD Patient Registry. KSN members voluntarily participate in this registry, which has been collecting data through the Internet since 2000. The KSN ESRD patient registry data were reviewed to elucidate the major changes and improvements in dialysis therapy in Korea. The data review revealed: a rapid increase in the number of patients with ESRD; an increase in the number of patients with diabetic nephropathy; a decrease in the proportion of patients undergoing peritoneal dialysis; an increase in the role of private dialysis clinics; an increase in the number of elderly patients undergoing dialysis and the number of patients undergoing long-term dialysis; a decrease in mean blood pressure and an increase in pulse pressure; improvement in anemia treatment; improvement in dialysis adequacy; and improvement in the survival of patients undergoing dialysis. In conclusion, improvements have been made in blood pressure control, anemia treatment, and dialysis adequacy despite increases in the number of elderly patients, diabetic patients, and patients on long-term dialysis during the last two decades in Korea.
Diabetic Retinopathy/diagnosis/mortality/*therapy ; Humans ; Kidney Failure, Chronic/diagnosis/mortality/*therapy ; Peritoneal Dialysis/trends ; Private Sector/trends ; Quality Improvement/trends ; Quality Indicators, Health Care/trends ; Registries ; Renal Dialysis/adverse effects/mortality/standards/*trends ; Republic of Korea/epidemiology ; Risk Factors ; Time Factors ; Treatment Outcome

BACKGROUND/AIMS: To compare the clinical characteristics and outcomes of systemic lupus erythematosus between male and female Korean patients. METHODS: A retrospective analysis was performed at a single tertiary hospital from August 1994 to May 2010. Male patients were matched with two to three female patients based on age and disease duration. Organ damage was assessed using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index (SLICC/ACR DI). RESULTS: Fifty-three male patients were compared with 150 female patients. Renal disorders were found more frequently in male patients at disease onset (p < 0.001); the adjusted odds ratio (OR) demonstrated a significant sex preponderance for renal manifestations (OR, 3.26; 95% confidence interval [CI], 1.62 to 6.57). Diffuse proliferative lupus nephritis and end-stage renal disease requiring dialysis during the disease course were more prevalent in male patients (p = 0.025 and p < 0.001, respectively). The risk for requiring long-term dialysis was significantly higher in male than in female patients (OR, 4.02; 95% CI, 1.07 to 15.06), as was the mean SLICC/ACR DI (1.55 +/- 1.35 vs. 1.02 +/- 1.57, respectively; p = 0.028). CONCLUSIONS: Our data demonstrate that Korean patients with lupus have characteristics similar to those of cohorts reported previously. Male patients had significantly higher incidences of renal manifestations and organ damage.
Adult ; *Asian Continental Ancestry Group ; Female ; Humans ; Immunosuppressive Agents/therapeutic use ; Incidence ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/diagnosis/ethnology/therapy ; Lupus Erythematosus, Systemic/diagnosis/*ethnology/mortality/therapy ; Lupus Nephritis/diagnosis/ethnology/therapy ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Prevalence ; Prognosis ; Renal Dialysis ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Sex Distribution ; Sex Factors ; Tertiary Care Centers ; Time Factors ; Young Adult

BACKGROUND/AIMS: The effect of high-flux (HF) dialysis on mortality rates could vary with the duration of dialysis. We evaluated the effects of HF dialysis on mortality rates in incident and prevalent hemodialysis (HD) patients. METHODS: Incident and prevalent HD patients were selected from the Clinical Research Center registry for end-stage renal disease (ESRD), a Korean prospective observational cohort study. Incident HD patients were defined as newly diagnosed ESRD patients initiating HD. Prevalent HD patients were defined as patients who had been receiving HD for > 3 months. The primary outcome measure was all-cause mortality. RESULTS: This study included 1,165 incident and 1,641 prevalent HD patients. Following a median 24 months of follow-up, the mortality rates of the HF and low-flux (LF) groups did not significantly differ in the incident patients (hazard ratio [HR], 1.046; 95% confidence interval [CI], 0.592 to 1.847; p = 0.878). In the prevalent patients, HF dialysis was associated with decreased mortality compared with LF dialysis (HR, 0.606; 95% CI, 0.416 to 0.885; p = 0.009). CONCLUSIONS: HF dialysis was associated with a decreased mortality rate in prevalent HD patients, but not in incident HD patients.
Aged ; Chi-Square Distribution ; Female ; Humans ; Incidence ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/diagnosis/*mortality/*therapy ; Male ; Middle Aged ; Multivariate Analysis ; Prevalence ; Proportional Hazards Models ; Prospective Studies ; Registries ; Renal Dialysis/adverse effects/methods/*mortality ; Republic of Korea/epidemiology ; Risk Factors ; Time Factors ; Treatment Outcome