1.Advanced chronic kidney disease: a strong risk factor for Clostridium difficile infection.
Sun Chul KIM ; Min Young SEO ; Jun Yong LEE ; Ki Tae KIM ; Eunjung CHO ; Myung Gyu KIM ; Sang Kyung JO ; Won Yong CHO ; Hyoung Kyu KIM
The Korean Journal of Internal Medicine 2016;31(1):125-133
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
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Anti-Infective Agents/therapeutic use
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Chi-Square Distribution
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Clostridium difficile/*pathogenicity
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Enterocolitis, Pseudomembranous/diagnosis/drug therapy/*microbiology/mortality
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Female
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Hospital Mortality
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Humans
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Kidney Failure, Chronic/*complications/diagnosis/therapy
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Logistic Models
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Male
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Metronidazole/therapeutic use
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Middle Aged
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Multivariate Analysis
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Odds Ratio
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Prevalence
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Renal Dialysis
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Renal Insufficiency, Chronic/*complications/diagnosis/mortality/therapy
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Republic of Korea/epidemiology
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Retrospective Studies
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Risk Factors
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Treatment Outcome
2.Comparison of Drug-Eluting Stents in Acute Myocardial Infarction Patients with Chronic Kidney Disease.
Daisuke HACHINOHE ; Myung Ho JEONG ; Shigeru SAITO ; Min Chol KIM ; Kyung Hoon CHO ; Khurshid AHMED ; Seung Hwan HWANG ; Min Goo LEE ; Doo Sun SIM ; Keun Ho PARK ; Ju Han KIM ; Young Joon HONG ; Youngkeun AHN ; Jung Chaee KANG ; Jong Hyun KIM ; Shung Chull CHAE ; Young Jo KIM ; Seung Ho HUR ; In Whan SEONG ; Taek Jong HONG ; Donghoon CHOI ; Myeong Chan CHO ; Chong Jin KIM ; Ki Bae SEUNG ; Wook Sung CHUNG ; Yang Soo JANG ; Seung Woon RHA ; Jang Ho BAE ; Seung Jung PARK
The Korean Journal of Internal Medicine 2012;27(4):397-406
BACKGROUND/AIMS: To determine which drug-eluting stents are more effective in acute myocardial infarction (MI) patients with chronic kidney disease (CKD). METHODS: This study included a total of 3,566 acute MI survivors with CKD from the Korea Acute Myocardial Infarction Registry who were treated with stenting and followed up for 12 months: 1,845 patients who received sirolimus-eluting stents (SES), 1,356 who received paclitaxel-eluting stents (PES), and 365 who received zotarolimus-eluting stents (ZES). CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 calculated by the modification of diet in renal disease method. RESULTS: At the 12-month follow-up, patients receiving ZES demonstrated a higher incidence (14.8%) of major adverse cardiac events (MACEs) compared to those receiving SES (10.1%) and PES (12%, p = 0.019). The ZES patients also had a higher incidence (3.9%) of target lesion revascularization (TLR) compared to those receiving SES (1.5%) and PES (2.4%, p = 0.011). After adjusting for confounding factors, ZES was associated with a higher incidence of MACE and TLR than SES (adjusted hazard ratio [HR], 0.623; 95% confidence interval [CI], 0.442 to 0.879; p = 0.007; adjusted HR, 0.350; 95% CI, 0.165 to 0.743; p = 0.006, respectively), and with a higher rate of TLR than PES (adjusted HR, 0.471; 95% CI, 0.223 to 0.997; p = 0.049). CONCLUSIONS: Our findings suggest that ZES is less effective than SES and PES in terms of 12-month TLR, and has a higher incidence of MACE due to a higher TLR rate compared with SES, in acute MI patients with CKD.
Aged
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*Drug-Eluting Stents/adverse effects
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Female
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Humans
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Male
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Middle Aged
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Myocardial Infarction/*etiology/mortality/*therapy
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Paclitaxel/administration & dosage
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Prospective Studies
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Registries
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Renal Insufficiency, Chronic/*complications
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Republic of Korea/epidemiology
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Sirolimus/administration & dosage/analogs & derivatives
3.Erythropoiesis-stimulating Agents and Anemia in Patients with Non-dialytic Chronic Kidney Disease.
Sun Moon KIM ; Kyeong Min KIM ; Soon Kil KWON ; Hye Young KIM
Journal of Korean Medical Science 2016;31(1):55-60
Anemia is common in patients with advanced chronic kidney disease (CKD). Though erythropoiesis-stimulating agents (ESAs) have been strongly endorsed in guidelines, it is of particular financial interest. Recently, the reimbursement of ESAs in non-dialytic patients was started by the Korean National Health Insurance System. Thus, we investigated the impact of the reimbursement of ESAs on the anemia care in non-dialytic CKD patients. Medical records of patients with advanced CKD (estimated GFR <30 mL/min/1.73 m2) were reviewed. Use of ESAs, blood transfusion, and hemoglobin concentrations were analyzed from one year prior to reimbursement to three years following. We used multivariable modified Poisson regression to estimate the utilization prevalence ratio (PRs). A total of 1,791 medical records were analyzed. The proportion of patients receiving ESAs increased from 14.8% before reimbursement to a peak 33.6% in 1 yr after reimbursement; thereafter, ESA use decreased to 22.4% in 3 yr after reimbursement (compared with baseline; PR, 2.19 [95% CI, 1.40-3.42]). In patients with Hb <10 g/dL, the proportion of receiving ESAs increased from 32.1% before reimbursement to 66.7% in 3 yr after reimbursement (compared with baseline; PR, 2.04 [95% CI, 1.25-3.32]). Mean hemoglobin concentrations were 10.06±1.54 g/dL before reimbursement and increased to 10.78±1.51 g/dL in 3 yr after the reimbursement change (P=0.001). However, the requirement of blood transfusion was not changed over time. With the reimbursement of ESAs, the advanced CKD patients were more likely to be treated with ESAs, and the hemoglobin concentrations increased.
Adolescent
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Adult
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Aged
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Anemia/complications/*drug therapy/epidemiology
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Blood Transfusion
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Female
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Glomerular Filtration Rate
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Hematinics/*therapeutic use
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Hematocrit
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Hemoglobins/analysis
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Humans
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Male
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Middle Aged
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National Health Programs
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Poisson Distribution
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Prevalence
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Renal Insufficiency, Chronic/complications/*drug therapy/epidemiology
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Republic of Korea/epidemiology
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Retrospective Studies
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Young Adult