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A prime determinant in selecting dialysis modality: peritoneal dialysis patient survival.

Kidney Research and Clinical Practice.2017;36(1):22-28. doi:10.23876/j.krcp.2017.36.1.22

The number of patients with end-stage renal disease (ESRD) has rapidly increased, as has the cost of dialysis. Peritoneal dialysis (PD) is an established treatment for ESRD patients worldwide; it has a variety of advantages, including autonomy and flexibility, as well as economic benefits in many countries compared to hemodialysis (HD). However, the long-term survival rate of PD remains poor. Although direct comparison of survival rate between the dialysis modalities by randomized controlled trials is difficult due to the ethical issues, it has always been a crucial point when deciding which dialysis modality should be recommended to patients. Recently, in many countries, including the United States, Brazil, Spain, Australia, and New Zealand, the survival rate in PD patients has significantly improved. PD patient survival in Korea has also improved, but Korean PD patients are known to have higher risk of mortality and major adverse cardiovascular, cerebrovascular events than HD patients. Herein, we further evaluate why Korean PD patients had worse outcomes; we suggest that special attention should be paid to patients with diabetes, coronary artery disease, or congestive heart failure when they choose PD as the first dialysis modality in order to reduce mortality risk.
Australia ; Brazil ; Cardiovascular Diseases ; Coronary Artery Disease ; Dialysis* ; Ethics ; Heart Failure ; Humans ; Kidney Failure, Chronic ; Korea ; Mortality ; New Zealand ; Peritoneal Dialysis* ; Pliability ; Renal Dialysis ; Spain ; Survival Rate ; United States

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The role of renal proximal tubule transport in the regulation of blood pressure.

Shoko HORITA ; Motonobu NAKAMURA ; Masashi SUZUKI ; Nobuhiko SATOH ; Atsushi SUZUKI ; Yukio HOMMA ; Masaomi NANGAKU

Kidney Research and Clinical Practice.2017;36(1):12-21. doi:10.23876/j.krcp.2017.36.1.12

The electrogenic sodium/bicarbonate cotransporter 1 (NBCe1) on the basolateral side of the renal proximal tubule plays a pivotal role in systemic acid-base homeostasis. Mutations in the gene encoding NBCe1 cause severe proximal renal tubular acidosis accompanied by other extrarenal symptoms. The proximal tubule reabsorbs most of the sodium filtered in the glomerulus, contributing to the regulation of plasma volume and blood pressure. NBCe1 and other sodium transporters in the proximal tubule are regulated by hormones, such as angiotensin II and insulin. Angiotensin II is probably the most important stimulator of sodium reabsorption. Proximal tubule AT(1A) receptor is crucial for the systemic pressor effect of angiotensin II. In rodents and rabbits, the effect on proximal tubule NBCe1 is biphasic; at low concentration, angiotensin II stimulates NBCe1 via PKC/cAMP/ERK, whereas at high concentration, it inhibits NBCe1 via NO/cGMP/cGKII. In contrast, in human proximal tubule, angiotensin II has a dose-dependent monophasic stimulatory effect via NO/cGMP/ERK. Insulin stimulates the proximal tubule sodium transport, which is IRS2-dependent. We found that in insulin resistance and overt diabetic nephropathy, stimulatory effect of insulin on proximal tubule transport was preserved. Our results suggest that the preserved stimulation of the proximal tubule enhances sodium reabsorption, contributing to the pathogenesis of hypertension with metabolic syndrome. We describe recent findings regarding the role of proximal tubule transport in the regulation of blood pressure, focusing on the effects of angiotensin II and insulin.
Acidosis, Renal Tubular ; Angiotensin II ; Blood Pressure* ; Diabetic Nephropathies ; Homeostasis ; Humans ; Hypertension ; Insulin ; Insulin Resistance ; Kidney Tubules, Proximal ; Plasma Volume ; Rabbits ; Rodentia ; Sodium ; Sodium-Bicarbonate Symporters

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Medical big data: promise and challenges.

Choong Ho LEE ; Hyung Jin YOON

Kidney Research and Clinical Practice.2017;36(1):3-11. doi:10.23876/j.krcp.2017.36.1.3

The concept of big data, commonly characterized by volume, variety, velocity, and veracity, goes far beyond the data type and includes the aspects of data analysis, such as hypothesis-generating, rather than hypothesis-testing. Big data focuses on temporal stability of the association, rather than on causal relationship and underlying probability distribution assumptions are frequently not required. Medical big data as material to be analyzed has various features that are not only distinct from big data of other disciplines, but also distinct from traditional clinical epidemiology. Big data technology has many areas of application in healthcare, such as predictive modeling and clinical decision support, disease or safety surveillance, public health, and research. Big data analytics frequently exploits analytic methods developed in data mining, including classification, clustering, and regression. Medical big data analyses are complicated by many technical issues, such as missing values, curse of dimensionality, and bias control, and share the inherent limitations of observation study, namely the inability to test causality resulting from residual confounding and reverse causation. Recently, propensity score analysis and instrumental variable analysis have been introduced to overcome these limitations, and they have accomplished a great deal. Many challenges, such as the absence of evidence of practical benefits of big data, methodological issues including legal and ethical issues, and clinical integration and utility issues, must be overcome to realize the promise of medical big data as the fuel of a continuous learning healthcare system that will improve patient outcome and reduce waste in areas including nephrology.
Bias (Epidemiology) ; Classification ; Data Mining ; Decision Support Systems, Clinical ; Delivery of Health Care ; Epidemiology ; Ethics ; Humans ; Learning ; Nephrology ; Propensity Score ; Public Health Surveillance ; Statistics as Topic

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Kidney disease and obesity paradox.

Jongha PARK

Kidney Research and Clinical Practice.2017;36(1):1-2. doi:10.23876/j.krcp.2017.36.1.1

No abstract available.
Kidney Diseases* ; Kidney* ; Obesity*

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Asymptomatic renal pseudoaneurysm after percutaneous renal biopsy Volume 32, Issue 2, June 2013, pp. 87-89.

Gi Young YUN ; Seung Kyu KIM ; Seung Kyo PARK ; Sung Jin MOON ; Jung Eun LEE ; Suk Won SONG ; Kwang Hun LEE ; Hyeong Cheon PARK ; Sung Kyu HA ; Hoon Young CHOI

Kidney Research and Clinical Practice.2013;32(3):144-144.

No abstract available.

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Determining when to measure vascular access flow ...that may not be enough.

Shin Young AHN ; Sejoong KIM

Kidney Research and Clinical Practice.2013;32(3):142-143.

No abstract available.

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Two cases of idiopathic membranous nephropathy treated with rituximab.

Jae Young YOON ; Seung Tae HAN ; Ajin CHO ; Hye Ryoun JANG ; Jung Eun LEE ; Wooseong HUH ; Dae Joong KIM ; Ha Young OH ; Yoon Goo KIM

Kidney Research and Clinical Practice.2013;32(3):138-141.

Idiopathic membranous nephropathy is a common cause of nephrotic syndrome, and has been reported as a cause of idiopathic primary glomerulonephropathy in up to 90% of patients. However, the treatment options remain controversial. We report two cases of idiopathic membranous nephropathy that were treated with rituximab. A 54-year-old man and a 64-year old man were admitted for rituximab therapy. They had previously been treated with combinations of immunosuppressive agents including cyclophosphamide, cyclosporine, mycophenolate, and steroids. However, the patients' heavy proteinuria was not resolved. Both patients received rituximab therapy, 2 weeks apart. After several months of follow-up and a second round of rituximab treatment for each patient, their proteinuria decreased and partial remission of disease was achieved in both patients.
Antibodies, Monoclonal, Murine-Derived ; Cyclophosphamide ; Cyclosporine ; Follow-Up Studies ; Glomerulonephritis, Membranous* ; Humans ; Immunosuppressive Agents ; Middle Aged ; Nephrotic Syndrome ; Proteinuria ; Steroids ; Rituximab

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Membranous glomerulonephritis in a patient with myelodysplastic syndrome-refractory cytopenia with multilineage dysplasia.

Kwang Il KO ; Mi Jung LEE ; Fa Mee DOH ; Hyang Mo KOO ; Chan Ho KIM ; Dong Ho SHIN ; Hyung Jung OH ; Seung Hyeok HAN ; Shin Wook KANG ; Kyu Hun CHOI ; Tae Hyun YOO

Kidney Research and Clinical Practice.2013;32(3):134-137.

A 74-year-old woman presented with edema in the lower extremities. Laboratory tests revealed anemia, thrombocytopenia, hypoalbuminemia, hypercholesterolemia, and nephrotic-range proteinuria. Myelodysplastic syndrome-refractory cytopenia with multilineage dysplasia (MDS-RCMD) was confirmed by bone marrow biopsy. Renal biopsy demonstrated membranous glomerulonephritis (MGN), stage I. Based on these clinicopathologic results, she was diagnosed as having MGN with MDS-RCMD. This is a rare case report of MGN in a parient with MDS-RCMD featuring nephrotic syndrome.
Aged ; Anemia ; Biopsy ; Bone Marrow ; Edema ; Female ; Glomerulonephritis, Membranous* ; Humans ; Hypercholesterolemia ; Hypoalbuminemia ; Lower Extremity ; Myelodysplastic Syndromes ; Nephrotic Syndrome ; Proteinuria ; Thrombocytopenia

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The effect of on-line hemodiafiltration on heart rate variability in end-stage renal disease.

Kyung Won PARK ; Sang Kyun BAE ; Buhyun LEE ; Jeong Hun BAEK ; Jin Woo PARK ; Sung Jin MOON ; Soo Young YOON

Kidney Research and Clinical Practice.2013;32(3):127-133.

BACKGROUND: The autonomic nervous system plays a central role in the maintenance of hemodynamic stability. Cardiac autonomic dysfunction may result in serious complications, such as sudden cardiac death. Heart rate variability (HRV) is sigificantly reduced in patients undergoing chronic hemodialysis (HD). The aim of this study was to evaluate the effect of on-line hemodiafiltration (OL-HDF) on the autonomic nervous system in chronic HD patients. METHODS: Forty chronic HD patients were prospectively studied. The participants were divided into conventional HD and OL-HDF groups. They received regular high-flux HD or OL-HDF for 4-hour sessions, three times a week. Time-and frequency-domain measures of the 24-hour HRV were analyzed during the interdialytic period prior to postdilution OL-HDF and every 6 months for 24 months. The 7-year survival was also evaluated. RESULTS: Among the 40 participants, 15 patients in the HD group and 11 patients in the OL-HDF group completed the study. There was no difference in the baseline characteristics. After 24 months of treatment, beta2-microglobulin concentration decreased (from 33.4 +/- 15.2 mg/dL to 28.4 +/- 6.2 mg/dL, P = 0.02) in the OL-HDF group, while there was no change in the HD group In the HRV analysis, the frequency-domain HRV parameters increased significantly compared with baseline in the OL-HDF group [natural logarithmic high frequency (lnHF), 3.15 +/- 3.36 ms2 vs. 4.42 +/- 3.81 ms2; ln low frequency (LF), 3.56 +/- 3.17 ms2 vs. 4.78 +/- 3.99 ms2; ln very low frequency (VLF), 4.90 +/- 4.62 ms2 vs. 6.38 +/- 5.54 ms2; LF/HF ratio, 1.4 +/- 0.4 vs. 2.5 +/- 0.1]. The survival rate was similar between the groups. CONCLUSION: This study shows that OL-HDF improved autonomic nervous system dysfunction in chronic HD patients.
Autonomic Nervous System ; Death, Sudden, Cardiac ; Heart Rate* ; Heart* ; Hemodiafiltration* ; Hemodynamics ; Humans ; Kidney Failure, Chronic* ; Prospective Studies ; Renal Dialysis ; Survival Rate

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De novo glomerulitis associated with graft-versus-host disease after allogeneic hematopoietic stem cell transplantation: A single-center experience.

Yul Hee CHO ; Seok Hui KANG ; Yaeni KIM ; Myung Hyun LEE ; Gun Hee AN ; Byung Ha CHUNG ; Bum Soon CHOI ; Chul Woo YANG ; Yong soo KIM ; Yeong Jin CHOI ; Cheol Whee PARK

Kidney Research and Clinical Practice.2013;32(3):121-126.

BACKGROUND: Nephrotic syndrome (NS) and proteinuria are uncommon, often unrecognized manifestations of graft-versus-host disease (GVHD) after hematopoietic stem cell transplantation (HSCT). Only a few isolated case reports and case series involving smaller number of patients who developed NS after HSCT have been published. METHODS: We reviewed the renal histopathological examination findings and clinical records of 15 patients who developed proteinuria after HSCT at Seoul and Yeouido St. Mary's Hospital (Seoul, Korea). We also measured the anti-PLA2 Rantibodies (M-type phospholipase A2 receptor) in the serum samples from the seven patients at the time of renal biopsy. RESULTS: All patients had GVHD. The most common indication for biopsy was proteinuria ( > 1 g/day), with nine patients having nephrotic range proteinuria. The most common histopathological finding was membranous nephropathy (MN; n = 12).Other findings were membranoproliferative glomerulonephritis, C1q nephropathy, and diabetic nephropathy. Eleven patients were treated with immunosuppressive agents, and three patients were treated only with angiotensin II receptor blocker. The overall response rate, including complete remission (urinary protein level < 0.3 g/day) and partial remission (urinary protein level = 0.31-3.4 g/day), was 73%. The mean follow-up period was 26 months, and none of the patients developed end-stage renal disease. All of the seven patients with MN had negative findings for anti-PLA2R antibodies, measured using an enzyme-linked immunosorbent assay kit. CONCLUSION: In this study the findings of 15 renal biopsies were analyzed and to our knowledge this is the largest clinicopathological study of GVHD-related biopsy-proven nephropathy. Approximately 80% of the patients were MN and 73% responded either partially or completely to immunosuppressive treatment. Currently, there is an increase in the incidence of GVHD-mediated renal disease, and therefore, renal biopsy is essential for diagnosing the nephropathy and preventing the progression of renal disease.
Antibodies ; Biopsy ; Diabetic Nephropathies ; Enzyme-Linked Immunosorbent Assay ; Follow-Up Studies ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Graft vs Host Disease* ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Immunosuppressive Agents ; Incidence ; Kidney Failure, Chronic ; Nephrotic Syndrome ; Phospholipases A2 ; Proteinuria ; Receptors, Angiotensin

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