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Clinical Characteristics and Survival Analysis of Elderly Patients Undergoing Continuous Ambulatory Peritoneal Dialysis.

Jae Won YANG ; Jae Seok KIM ; Bi Ro KIM ; Min Soo KIM ; Jong Myoung YOO ; Seung Tae HAN ; Jeong Wook CHOI ; Byoung Geun HAN ; Seung Ok CHOI

Korean Journal of Nephrology.2008;27(3):348-357.

PURPOSE: The increased prevalence and incidence of end-stage renal disease in the elderly is a worldwide phenomenon. We investigated the survival rate, technical success, cause of death and the predictors of death in patients starting peritoneal dialysis over 65 years of age. METHODS: We analyzed 67 patients; 37 were in the elderly group (>65 years of age) and 30 in the control group (45-64 years of age) that started peritoneal dialysis between January 1995 and June 2006. Clinical characteristics and laboratory findings at the beginning of dialysis and 6 months later were retrospectively analyzed. In addition, the survival rate and independent predictors of survival were analyzed. RESULTS: The prevalence of complication was not different in the two groups. However, leakage of dialysate was more common in the elderly group. The duration of patient survival, serum albumin levels and BMI were lower in the elderly group. The multivariate analysis showed that age, presence of diabetes, initial albumin level, and residual renal function was associated with patient survival, gender, age, initial albumin level, and the prevalence of peritonitis affected the technical success rate. CONCLUSION: Among elderly patients, leakage was more prevalent compared to the younger patients and the most common cause of death was cardiovascular disease. The presence of diabetes, a low serum albumin and BMI, and residual renal function were associated with the duration of survival
Aged ; Cardiovascular Diseases ; Cause of Death ; Dialysis ; Humans ; Incidence ; Kidney Failure, Chronic ; Multivariate Analysis ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Prevalence ; Retrospective Studies ; Serum Albumin ; Survival Analysis* ; Survival Rate

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The Association of KLOTHO Gene Polymorphism with Serum Osteoprotegerin Levels in Maintenance Hemodialysis Patients.

Yong Su LEE ; Hyang KIM ; Hyun Sock KIM ; Kyu Beck LEE

Korean Journal of Nephrology.2008;27(3):341-347.

PURPOSE: Klotho mutant mice showed abnormal calcium and vitamin D metabolism, hyperphosphatemia and vascular calcification. We observed the frequencies of klotho gene polymorphism and investigated their relation with some clinical parameters including serum osteoprotegerin (OPG) levels in maintenance hemodialysis (HD) patients. METHODS: Total 88 patients (mean age 58+/-13 years, male:female=47:41) on maintenance HD were enrolled. The genotypings for G-395A in promoter and C1818T in exon 4 of klotho gene were performed with real-time polymerase chain reaction. We measured blood pressure, body mass index (BMI), and serum calcium, phosphorus, parathyroid hormone (PTH), alkaline phosphatase, hs-CRP, lipid profiles and OPG. RESULTS: In G-395A in promoter, the distribution of genotypes was GG 66% (n=58), GA 23% (n=20) and AA 11% (n=10), respectively and the allele frequencies were 0.773 for G allele and 0.227 for A allele. In C1818T in exon 4, the distribution of genotypes was CC 63% (n=55), CT 30% (n=26), and TT 7% (n=7), and the frequencies were 0.773 for C allele and 0.227 for T allele. G-395A shows correlations with BMI and HDL-cholesterol (p<0.005). G-395A and C1818T in klotho gene show no statistical correlation with other clinical parameters of vascular calcification including OPG. CONCLUSION: Klotho G-395A and C1818T polymorphisms are not correlated with OPG in maintenance HD patients. Further research needs for the other klotho polymorphisms on chronic kidney disease and end-stage renal disease.
Alkaline Phosphatase ; Alleles ; Animals ; Blood Pressure ; Body Mass Index ; Calcium ; Exons ; Gene Frequency ; Genotype ; Glucuronidase ; Humans ; Hyperphosphatemia ; Mice ; Osteoprotegerin ; Parathyroid Hormone ; Phosphorus ; Real-Time Polymerase Chain Reaction ; Renal Dialysis ; Renal Insufficiency, Chronic ; Vascular Calcification ; Vitamin D

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Intensive Hemodialysis in Patients with ESRD Improves Cardiac Function Through Inflammatory Regulation.

Chang Su BOO ; Young Seok WOO ; Jae Won LEE ; Gang Jee KO ; Sang Kyung JO ; Won Yong CHO ; Hyoung Kyu KIM

Korean Journal of Nephrology.2008;27(3):333-340.

PURPOSE: CHF is a life threatening acute complication in ESRD populations. An intensive hemodialysis (HD) has been effective in reducing intravascular volume and in removing uremic toxin with improved systolic function. Although recent progress has identified an inflammation as an important contributor to the pathogenesis of CVD, the effect of intensive HD on inflammatory parameters and left ventricle (LV) systolic dysfunction is not clear. The purpose of this study is to examine the effect of intensive HD on LV systolic function and serum cytokines levels. METHODS: Among ESRD patients who underwent dialysis and developed acute pulmonary edema due to LV systolic dysfunction were enrolled. Intensive HD consisted of daily 4 hours HD for 7 consecutive days. Data were prospectively collected and 2-D echocardiography was done before and after intensive HD. Serum levels of TNF-alpha and IL-10 were compared and lipopolysaccharide (LSP)-stimulated of these cytokines were measured. RESULTS: After intensive HD, weight and mean arterial blood pressure decreased significantly and ejection fraction (EF) increased significantly. Serum IL-10 and TNF-alpha levels decreased significantly after intensive HD. In contrast, LPS stimulated production of these cytokines increased significantly after intensive HD. The difference of CRP between after HD and before HD was negatively correlated with the difference of EF. CONCLUSION: In ESRD patients with acute LV dysfunction, intensive HD significantly improved EF and restored the immune responsiveness. These results suggest that intensive HD has the advantage of improving EF through modulating inflammation and correcting immune dysfunction in ESRD patients with acute LV dysfunction.
Arterial Pressure ; Cytokines ; Dialysis ; Echocardiography ; Heart Failure ; Heart Ventricles ; Humans ; Imidazoles ; Inflammation ; Interleukin-10 ; Kidney Failure, Chronic ; Nitro Compounds ; Prospective Studies ; Pulmonary Edema ; Renal Dialysis ; Stroke Volume ; Tumor Necrosis Factor-alpha

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The Clinical Outcome of Acute Renal Failure Requiring Hemodialysis after Coronary Intervention in Patients with Chronic Kidney Disease.

Young Hwan LIM ; Hae Won JUNG ; Yu Ji LEE ; Na Ree KANG ; Jung Eun LEE ; Wooseong HUH ; Ha Young OH ; Yoon Goo KIM ; Dae Joong KIM

Korean Journal of Nephrology.2008;27(3):327-332.

PURPOSE: Acute renal failure requiring dialysis (ARFD) after coronary intervention is a rare but serious complication, and it is associated with poor prognosis. This study investigated the clinical characteristics and risk factors of ARFD after coronary intervention in patients with chronic kidney disease (CKD). METHODS: This study included 178 adult patients with CKD (baseline serum creatinine of >1.3 mg/dL) undergoing coronary intervention at Samsung Medical Center from April 2003 through June 2007. We retrospectively evaluated the incidence, clinical outcome, and risk factor of ARFD via medical records. ARFD was defined as a decrease in renal function necessitating hemodialysis in the first 7 days after percutaneous coronary intervention. The estimated glomerular filtration rate (eGFR) was obtained using the Levey Modification of Diet in Renal Disease (MDRD) formula. RESULTS: Ten of the 178 patients (5.6%) developed ARFD with a subsequent in-hospital mortality rate of 10% (n=1). According to CKD stage, incidence of ARFD was 0/136 patients (baseline eGFR 30 to 90 ml/min/1.73m2 4/32 (15 to 29,) and 7/10 (<15) respectively (0% vs 9.4% vs 70%, p<0.0001). Multivariate analysis found eGFR (OR=0.5, 95% CI 0.3 to 0.9, p=0.02) to be only independent predictor of ARFD. Of those who developed ARFD (n=10), 2 patients stopped dialysis, 8 had required permanent dialysis. CONCLUSION: Incidence of ARFD increased according to the severity of renal dysfunction. The majority of ARFD patients had required permanent dialysis.
Acute Kidney Injury ; Adult ; Contrast Media ; Coronary Angiography ; Creatinine ; Dialysis ; Diet ; Glomerular Filtration Rate ; Hospital Mortality ; Humans ; Incidence ; Medical Records ; Multivariate Analysis ; Percutaneous Coronary Intervention ; Prognosis ; Renal Dialysis ; Renal Insufficiency, Chronic ; Retrospective Studies ; Risk Factors

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Time-averaged Concentration Hemoglobin and Erythropoietin Requirement According to Hemoglobin of Different Session of HD of the Week.

Eun Hee JANG ; Woo Hun KANG ; So yeon CHOI

Korean Journal of Nephrology.2008;27(3):319-326.

PURPOSE: The time average hemoglobin concentration (Hb-Tac) is more likely to represent hemodialysis (HD) patients' true hemoglobin due to variable hemoglobin concentration. This study was performed to evaluate the effect of erythropoietin adjustment on the Hb-Tac according to the Hb of different hemodialysis days. METHODS: A controlled, randomized, cross-over study, where 20 stable hemodialysis patients (7 males, 13 females, mean age 57.8+/-3.0 year, mean HD duration 973+/-707 days) acted as their own controls. EPO adjustment was performed by protocol and according to preHD Hb of the first HD session (group A) or the second HD session (group B) in cross over for each 8 weeks. Serial Hb-tac were calculated by equation [mid week preHD Hb+[midweek pre HT [midweek preHD Hb+(midweek postHD Hb-preHD Hb)/3] every two weeks during the entire study periods. Their iron status were monitored and maintained adequately as K/DOQI guidelines. RESULTS: There was no significant difference in clinical parameters except age during the entire study period. Mean hemoglobin at randomization and after 8, 16 weeks were 10.0+/-0.60, 10.10+/-1.19, 10.1+/-1.03, respectively, in group A compared with 9.93+/-0.62, 9.72+/-1.00, 10.3+/-1.12 g/dL in group B. Mean weekly epoetin alfa dosage at randomization and after 8, 16 weeks were 107.2+/-74.7, 123.2+/-43.1, 123.0+/-85.0 IU/kg/week, respectively in group A compared with 95.4+/-94.7, 107.4+/-60.7, 125.5+/-85.0 IU/kg/week in group B. There were no significant differences in Hb-tac and EPO dosage. Addition of antihypertensive occurred in three patients during EPO adjustment to preHD Hb of the first session. CONCLUSION: EPO dose adjustment according to the different day preHD Hb does not affect the Hb-tac and total EPO.
Anemia ; Cross-Over Studies ; Erythropoietin ; Female ; Hemoglobins ; Humans ; Iron ; Male ; Random Allocation ; Recombinant Proteins ; Renal Dialysis ; Epoetin Alfa

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15-Deoxy-Delta(12,14)-Prostaglandin J2 and Proinflammatory Cytokines in IgA Nephropathy.

You Seok JEONG ; Sang Heon SONG ; Dong Won LEE ; Soo Bong LEE ; Byeong Yun YANG ; Ihm Soo KWAK

Korean Journal of Nephrology.2008;27(3):307-318.

PURPOSE: This study was performed to demonstrate a correlation among urinary 15d-PGJ2, proinflammatory cytokines (i.e. IL-23, IL-6, and TGF-beta1), and CRP, and to determinate the contributors to prognostic score and proteinuria in IgAN patients. METHODS: Fifty-four patients with biopsy-proven IgAN were enrolled. For comparison with IgAN, five MCD patients were also enrolled. Immunohistochemical staining for PPAR-gamma in kidney tissue and measurements of urinary IL-6, IL-23, TGF-beta1, 15d-PGJ2 and serum CRP were performed RESULTS: There was no difference according to PPAR-gamma staining. 15d-PGJ2 was negatively correlated with urinary IL-23, TGF-beta1, and CRP. Among proinflammatory cytokines and CRP, there were positive relationships with each other except for IL-23 and CRP. TGF-beta1 in the group having proteinuria more than 3 g/day was statistically higher than that in the sole hematuria group. However, in multivariate regression analysis, not a single relation was found between TGF-beta1 and proteinuria. Prognostic score was correlated with IL-6, IL-23, TGF-beta1, CRP, 15d-PGJ2, and 24hr proteinuria. 24hr proteinuria was correlated with IL-6 and 15d-PGJ2. In multivariate regression analysis, CRP, 15d-PGJ2, and 24hr proteinuria contributed to prognostic score, and only 15d-PGJ2 contributed to 24hr proteinuria. Last, urinary 15d-PGJ2 in IgAN was higher than that in MCD. CONCLUSION: Endogenous 15d-PGJ2 was associated with inflammation and might be considered as a material which could delay the damage of kidney in IgAN. In the future, larger cohort and long-term follow-up studies are needed to demonstrate the role of 15d-PGJ2 as prognostic indicator or marker of kidney damage.
Cohort Studies ; Corneal Dystrophies, Hereditary ; Cytokines ; Follow-Up Studies ; Glomerulonephritis, IGA ; Hematuria ; Humans ; Immunoglobulin A ; Inflammation ; Interleukin-23 ; Interleukin-6 ; Kidney ; Prostaglandin D2 ; Proteinuria ; Transforming Growth Factor beta1

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The Relative Risk of Diseases Related to Chronic Kidney Disease according to the Estimated Glomerular Filtration Rate in the Elderly Population.

Seung Seok HAN ; Ki Woong KIM ; Ho Jun CHIN ; Ki Young NA ; Suhnggwon KIM ; Dong Wan CHAE

Korean Journal of Nephrology.2008;27(3):299-306.

PURPOSE: The chronic kidney disease (CKD) is defined as structural or functional abnormalities of the kidney diagnosed by abnormalities of pathology, composition of blood or urine, imaging tests and glomerular filtration rate (GFR) less than 60 mL/min/1.73m2. GFR less than 60 mL/min/1.73m2 is known to increase the number of complications. This guideline is universally used but there are no studies on whether the guideline is applicable to Korean people, especially to elderly population. METHODS: We randomly selected 1,000 subjects aged more than 65 years who lived in Seong-nam city during September, 2005. We used the modified MDRD equation to estimate the glomerular filtration rate (eGFR) and categorized the subjects into 5 groups (group 1: GFR >70, group 2: 60-70, group 3: 50-60, group 4: 40-50, group 5: <40 mL/min/1.73m2). RESULTS: The mean creatinine level was 1.1 (+/-0.3) mg/dL and the mean value of eGFR was 60.9 (+/-12.9) mL/min/1.73m2. The frequency of subjects with eGFR less than 60 mL/min/1.73m2 was 48%. The frequencies of old age, female, hypertension, coronary heart disease, anemia, hypoalbuminemia, proteinuria, and increased waist circumference increased as eGFR fell. When evaluating the odds ratios of complications of CKD (Group 2-5 versus Group 1), the risk of coronary heart disease was increased in Group 3, 4, 5, hypertension in Group 4, 5 and diabetes mellitus, anemia, and proteinuria in Group 5, respectively. CONCLUSION: The prevalence of CKD in the elderly population was high. The elderly Koreans with CKD showed increasing comorbidities at a lower GFR.
Aged ; Anemia ; Comorbidity ; Coronary Disease ; Creatinine ; Diabetes Mellitus ; Female ; Glomerular Filtration Rate ; Humans ; Hypertension ; Hypoalbuminemia ; Kidney ; Odds Ratio ; Prevalence ; Proteinuria ; Renal Insufficiency, Chronic ; Waist Circumference

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Apoptosis of Podocyte and Role of TGF-beta1 LAP in Unilateral Ureteral Obstruction in Mice.

Won Dong LEE ; Mi Seon KANG ; Sun Woo KANG ; Yang Wook KIM ; Yeong Hoon KIM

Korean Journal of Nephrology.2008;27(3):290-298.

PURPOSE: It was well known that transforming growth factor (TGF)-beta1 plays a pivotal role in interstitial fibrosis and loss of podocyte. We explored the effects of exogenous administration of TGF-beta1 latency-associated peptide (LAP) in a model of renal fibrosis induced by unilateral ureteral obstruction (UUO) and examined whether TGF-beta1 LAP can inhibit apoptosis of podocyte. METHODS: Twenty four male BALB/c mice were unilaterally obstructed of proximal ureters by ligation. Half of the mice with operation and half of 8 control were administered recombinant human LAP intraperitoneally. One to three mice per group were euthanized on days 3, 7, 14, and 21 after operation for observation of renal fibrosis and apoptosis of podocyte. RESULTS: Interstitial fibrosis was less severe in LAP-treated group. Obstructed kidneys from LAP- untreated mice had more glomerular apoptotic podocytes (TUNEL assay) compared to LAP-treated mice at day 7, 14, and 21 after operation. CONCLUSION: Intraperitoneal administration of TGF-beta1 LAP prevents the loss of podocyte & renal damage partially up to day 14 after operation.
Animals ; Apoptosis ; Fibrosis ; Humans ; Kidney ; Ligation ; Male ; Mice ; Podocytes ; Transforming Growth Factor beta1 ; Transforming Growth Factors ; Ureter ; Ureteral Obstruction

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The Effect of FR167653, p38 Mitogen-Activated Protein Kinase (MAPK) Inhibitor, on the Expression of Slit Diaphragm-Associated Proteins in Experimental Diabetic Nephropathy.

Dong Ryeol RYU ; Tae Hyun YOO ; Dong Sub JUNG ; Seung Jae KWAK ; Je Hyun PARK ; Sun Ha LEE ; Jin ji LEE ; Jung Hwa RYU ; Mina YU ; Seung Jung KIM ; Duk Hee KANG ; Kyu Bok CHOI ; Kyun Il YOON ; Dae Suk HAN ; Shin Wook KANG

Korean Journal of Nephrology.2008;27(3):280-289.

PURPOSE: This study was undertaken to investigate the effect of a p38 mitogen-activated protein kinase (p38 MAPK) inhibitor, FR167653, on urinary albumin excretion and on the expression of slit diaphragm-associated proteins in diabetic rats. METHODS: Thirty-two Sprague-Dawley rats were injected with diluent [control (C), N=16] or streptozotocin intraperitoneally (DM, N=16). Eight rats from each group were treated with 5 mg/kg/day FR 167653 (C+FR, DM+FR) for 6 weeks. At the time of sacrifice, 24-hour urinary albumin excretion was determined by ELISA. Glomerular nephrin, P-cadherin, and ZO-1 mRNA and protein expression were determined by real-time PCR and Western blot, respectively, with sieved glomeruli. RESULTS: Urinary albumin excretion was significantly higher in DM compared to C rats, and this increase in albuminuria was significantly inhibited by the administration of FR167653 in DM rats. Glomerular phospho-p38 MAPK protein expression was significantly increased in DM rats compared to C rats, and FR167653 treatment significantly attenuated the increase in phospho-p38 MAPK expression in DM glomeruli. Nephrin mRNA and protein expression were higher in 6-week DM compared to C glomeruli, and these increases were significantly abrogated with FR167653 treatment in DM rats. In contrast, FR167653 had no effects on the decrease in P-cadherin expression and the increase in ZO-1 expression observed in DM glomeruli. CONCLUSION: These findings suggest that FR167653, a p38 MAPK inhibitor, reduce the amount of albuminuria in early diabetic nephropathy, and this anti-proteinuric effect seems to be related with the change of glomerular nephrin expression.
Albuminuria ; Animals ; Blotting, Western ; Cadherins ; Diabetic Nephropathies ; Enzyme-Linked Immunosorbent Assay ; Membrane Proteins ; p38 Mitogen-Activated Protein Kinases ; Protein Kinases ; Proteins ; Pyrazoles ; Pyridines ; Rats ; Rats, Sprague-Dawley ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Streptozocin

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Calcineurin Inhibitor-induced Hyperlipidemia and Diabetes Mellitus.

Chul Woo YANG

Korean Journal of Nephrology.2008;27(3):277-279.

No abstract available.
Calcineurin ; Diabetes Mellitus ; Hyperlipidemias

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