Diabetes mellitus (DM) is a worldwide public issue that has increased the risks for cardiovascular morbidity and mortality. It is the most common cause of chronic kidney diseases, which necessitates renal replacement therapy. Diabetic nephropathy is one of the long-term complications of DM. Renal replacement therapy has reduced the acute complications of renal dysfunction and prolonged patient survival. However, quality of life should be considered from the patient's viewpoint. Although new treatments have been developed via experimental studies, many trials failed to show beneficial effects in clinical practice in terms of long-term complications. Since there are many limitations to large clinical studies, we hope that improved approaches for individual patients will lead to new methods to increase the effectiveness of agents though big-data analysis in the future.
Diabetes Mellitus ; Diabetic Nephropathies* ; Hope ; Humans ; Mortality ; Quality of Life ; Renal Insufficiency, Chronic ; Renal Replacement Therapy

No abstract available.
*Echocardiography, Doppler ; Female ; Heart Failure, Diastolic/*mortality/*ultrasonography ; Humans ; Male ; Renal Insufficiency, Chronic/*mortality

Hypertension affects the majority of patients with chronic kidney disease (CKD) and increases the risk of cardiovascular disease, end-stage renal disease and mortality. Previously, many hypertension guidelines have suggested blood pressure targets in patients with CKD. Recently, the American College of Cardiology/American Heart Association 2017 Guideline for Hypertension suggests a new definition for hypertension and therapeutic targets, which were equally applicated to patients with CKD. These changes reflect the results of the Systolic Blood Pressure Intervention Trial (SPRINT) study, but the renal outcome of intensive blood pressure control was not good. Furthermore, the majority of hypertension guidelines including those of the Korean Society of Hypertension and the European Society of Hypertension have retained the traditional definition. Herein, we intend to analyze in detail the effect of intensive blood pressure control on kidney through the post-hoc analyses of the SPRINT study.
Blood Pressure ; Cardiovascular Diseases ; Diagnosis ; Heart ; Humans ; Hypertension ; Kidney ; Kidney Failure, Chronic ; Mortality ; Renal Insufficiency, Chronic

Hepatitis C virus (HCV) infection is prevalent in patients with chronic kidney disease, especially those on hemodialysis. Chronic HCV infection in patients with end-stage renal disease is associated with increased morbidity and mortality in the pre- and post-kidney transplant periods. Increased mortality is associated with liver complications and an elevated cardiovascular risk in HCV-infected patients on hemodialysis. Antiviral treatment may improve the prognosis of patients with HCV, and standard interferon remains the cornerstone of treatment. Direct-acting antiviral agents (DAA) are a potential new treatment modality for chronic HCV infection. Whatever DAA combination is administered, the use of ribavirin is still problematic in this population and this might affect the virological outcomes of some anti-HCV therapies.
Antiviral Agents ; Hepacivirus* ; Hepatitis C ; Humans ; Interferons ; Kidney Failure, Chronic ; Liver ; Mortality ; Prognosis ; Renal Dialysis ; Renal Insufficiency, Chronic* ; Ribavirin

Aggressive treatment of hypertension has been proved to reduce morbidity and mortality. Data from recent clinical trials indicate that, for all stages of hypertension, the target BP should be a maximum BP <140/90 mmHg, with diastolic BP values as low as 70 mmHg. For patients with diabetes mellitus or chronic renal disease, this target value should be even lower, <130/80 mmHg. As significant morbidity and mortality attributable to hypertension occur in patients who are not diagnosed as having hypertension but whose blood pressure is in prehypertension range, 120~139/80~89 mmHg, lowering BP levels in this group is recommended as well, with lifestyle modification or drug therapy for some indicated patients being first-line therapy. Because controlling BP to <140/90 mmHg often requires use of two or more agents, selection of drugs for combination therapy should be based not only on antihypertensive efficacy, but also on compelling indications and tolerability of the regimens. This review presents the latest findings on the antihypertensive therapy and emphasizes the importance of decreasing BP per the JNC-7 guidelines.
Blood Pressure ; Diabetes Mellitus ; Drug Therapy* ; Humans ; Hypertension ; Life Style ; Mortality ; Prehypertension ; Renal Insufficiency, Chronic

BACKGROUND AND OBJECTIVES: Contrast-induced nephropathy (CIN) is associated with increased morbidity and mortality in coronary angiography. Although the mechanism is unclear, N-acetylcysteine (NAC) is known to protect against CIN. Preliminary studies with NAC have found conflicting results for the prevention of CIN in patients undergoing coronary angiography. This study was designed to evaluate the efficacy and safety of NAC for the prevention of CIN in patients undergoing coronary angiography. SUBJECTS AND METHODS: 48 patients with chronic renal insufficiency (mean [+/-SD] serum creatinine concentration, 2.06+/-0.56 mg/dL), who were undergoing coronary angiography with a nonionic, low-osmolar contrast agent, were prospectively studied. Patients were randomly assigned to receive either the antioxidant, NAC (600 mg orally twice daily), and 0.45% saline intravenously (n=25), before and after administration of contrast agents, or saline only (n=23). The renal function parameters were assessed 48 hour before and after radiocontrast media administration. RESULTS: 14 of the 48 patients (29%) showed an increase in the 0.5 mg/dL serum creatinine concentration after 48 hours of contrast media administration: 4 of the 25 patients in the NAC group (16%) and 10 of the 23 in the control group (43%; p=0.036; relative risk, 0.37; 95% confidence interval, 1.04 to 7.79). In the NAC group, the mean serum creatinine concentration insignificantly increased (p=0.54), from 2.2+/-0.8 to 2.3+/-0.9 mg/dL, after 48 hours of contrast media administration; whereas, in the control group, the mean serum creatinine concentration significantly increased (p=0.011), from 1.9+/-0.4 to 2.2+/-0.8 mg/dL. The absolute change in serum creatinine concentration was significantly greater in the control than the NAC group (p=0.044). CONCLUSION: Prophylactic oral administration of the antioxidant NAC, along with hydration, prevents the decrease in the renal function induced by a nonionic, low-osmolality contrast agent in patients with chronic renal insufficiency.
Acetylcysteine* ; Administration, Oral ; Contrast Media ; Coronary Angiography* ; Creatinine ; Humans ; Mortality ; Prospective Studies ; Renal Insufficiency, Chronic

OBJECTIVE: The aim of this study was to analyze the long-term survival of subjects with peripheral artery disease (PAD). METHODS: The data included 415 Korean PAD patients aged ≥20 years hospitalized from 1994 through 2004 at a single tertiary center in Korea. Death data were obtained from all participants between 1994 and 2009. RESULTS: The mean of age was 64.4±9.3 years in PAD. The proportion of peripheral vascular bypass operation (re-vascularized) was about 50%. The proportion of males was 90.6% in PAD. Five- and 10- year survival rates were 79.2% and 60.5% in PAD, respectively. The 5- and 10- year survival rates were 83.0% and 64.1% in re-vascularized group, and 75.5% and 56.3% in non-revascularized group (p<0.05). For PAD, the adjusted hazard ratios (HRs) were 1.75 (95% confidence interval (CI) 1.17-2.68) in over 65 years, 1.53 (95% CI 1.05-2.27) in diabetes, and 2.21 (95% CI 1.51-3.23) in chronic kidney disease (CKD). Interestingly, HRs in PAD were 0.55 (95% CI 0.34-0.84) in overweight and 0.45 (95% CI 0.25-0.76) in obesity. CONCLUSIONS: The 5- and 10- year survival rates were 79.2% and 60.5% in PAD. The survival rate in re-vascularized group was higher than that in non-revascularized group. Independent predictors of mortality were age, diabetes, and CKD in PAD. Obesity showed improved survival rates.
Humans ; Korea ; Male ; Mortality ; Obesity ; Overweight ; Peripheral Arterial Disease* ; Renal Insufficiency, Chronic ; Survival Rate*

Cardiovascular morbidity and mortality are very common in patients with chronic kidney disease, which may result in part from vascular calcification. Vascular calcification requires osteoblastic trans-differentiation of vascular smooth muscle cells through an active and highly regulated process that is morphologically and functionally similar to bone formation in a number of ways. Multiple studies have been published on this topic, but the precise mechanism of vascular calcification remains unclear. This review presents recent insights into the mechanism of vascular calcification, as well as therapies that modulate mineral metabolism.
Humans ; Metabolism ; Miners ; Mortality ; Muscle, Smooth, Vascular ; Osteoblasts ; Osteogenesis ; Renal Insufficiency, Chronic ; Vascular Calcification

Humans ; Hospital Mortality ; ROC Curve ; Emergency Service, Hospital ; Heart Failure ; Renal Insufficiency, Chronic ; Retrospective Studies

Since the first report of coronary artery bypass grafting (CABG) in patients with end-stage renal disease in 1974, numerous reports have documented the feasibility of CABG in patients with chronic renal diseases. Patients with chronic renal failure often have comorbid disorders such as hypertension, and diabetes mellitus, each with their own complications and associated impact on both short and long-term survivals. In addition, infection and sepsis have been identified as significant causes of morbidity and mortality in most series of patients with end-stage renal disease undergoing cardiac surgical procedure. As a result of these and other factors such as perioperative volume and electrolyte disturbances, patients with chronic renal failures are at an increased risk of complication and mortality after CABG. We report 3 cases of "Off-pump" CABG in the chronic renal failure patients.
Cardiac Surgical Procedures ; Coronary Artery Bypass* ; Coronary Vessels* ; Diabetes Mellitus ; Humans ; Hypertension ; Kidney Failure, Chronic* ; Mortality ; Renal Insufficiency ; Renal Insufficiency, Chronic ; Sepsis