Jwa-Kyung Kim

Hallym University Medical Center, Sŏul, Seoul, South Korea

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Publications (32)70.87 Total impact

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    ABSTRACT: Successful arteriovenous fistula (AVF) maturation is often challenging in obese patients. Optimal initial intraoperative blood flow (IOBF) is essential for adequate AVF maturation. This study was conducted to elucidate the effect of obesity on IOBF and radiocephalic AVF maturation. Patients with a newly created radiocephalic AVF were included (N = 252). Obesity was defined as a baseline body mass index (BMI) ≥25 kg/m(2), and primary maturation failure was defined as failure to use the AVF successfully by 3 months after its creation. IOBF was measured immediately after construction of the AVF with a VeriQ system (MediStim, Oslo, Norway). The mean BMI was 24.1 ± 3.9 kg/m(2), and the prevalence of obesity was 31.3%. Particularly, 8.3% (21 patients) had a BMI ≥30 kg/m(2). Primary maturation failure occurred in 100 patients (39.7%), and an IOBF <190 mL/min was closely associated with the risk of maturation failure (relative risk, 3.05; 95% confidence interval, 1.52-6.11). Compared with nonobese patients, obese subjects had a significantly higher prevalence of diabetes and elevated high-sensitivity C-reactive protein levels, whereas diameters of vessels were similar. When the patients were further divided into three groups as BMI <25, 25 to 29.9, and ≥30 kg/m(2), patients in the higher BMI group showed significantly lower IOBF and higher maturation failure rate. According to multivariate analysis, the statistically significant variables that determined maturation failure were obesity, previous vascular disease, increased high-sensitivity C-reactive protein levels, and IOBF <190 mL/min. Obese patients had a significantly lower IOBF, and both obesity and low IOBF contributed to the primary maturation failure of AVF. Obesity-associated inflammation and atherosclerosis might play roles in this association. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 07/2015; DOI:10.1016/j.jvs.2015.05.008 · 2.98 Impact Factor
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    ABSTRACT: Previous cross-sectional studies demonstrated the close relationship between visceral obesity and the increased prevalence of proteinuria. But, little is known about the role of changes in visceral fat mass (∆VFM) over several years in the development of proteinuria. In this longitudinal cohort study with the general population, the changes in ∆VFM as well as baseline VFM on proteinuria development were evaluated. Healthy individuals (n = 2393) who participated in two health screening exams were analyzed. Subjects were divided into three groups based on gender-specific tertiles of baseline VFM and ∆VFM. Each patient was tested for proteinuria using a dipstick, and proteinuria was defined as 1+ or greater. The mean age was 51.9±7.7 years, and the incidence of proteinuria was 3.9% (n = 93). During the 4 years, 52.5% of the subjects experienced a decline in ∆VFM. However, subjects who developed proteinuria exhibited a significant increase in ∆VFM. Even after adjustment for age, smoking, systolic and diastolic BP, serum creatinine, and hs-CRP levels, the highest tertiles for baseline VFM [men, odds ratio (OR) 3.43, 95% confidence interval (CI) 1.22-9.67; women, OR 2.01, 95% CI 1.05-4.15] and ∆VFM (men, OR 2.92, 95% CI 1.22-6.99; women, OR 3.16, 95% CI 1.56-6.39) were independent predictors of proteinuria development. Following adjustment of both parameters, subjects in the highest baseline VFM and ∆VFM tertiles exhibited the greatest risk of proteinuria development, which suggested the additive harmful effects of the two factors. Baseline VFM and greater increase in ∆VFM were both important risk factors for developing proteinuria in the general population. Appropriate education and interventions to prevent accumulation of VFM should be the major focus of preemptive strategies.
    PLoS ONE 06/2015; 10(6):e0131119. DOI:10.1371/journal.pone.0131119 · 3.23 Impact Factor
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    ABSTRACT: To investigate the preventive effects of low-dose proton-pump inhibitors (PPIs) for upper gastrointestinal bleeding (UGIB) in end-stage renal disease. This was a retrospective cohort study that reviewed 544 patients with end-stage renal disease who started dialysis at our center between 2005 and 2013. We examined the incidence of UGIB in 175 patients treated with low-dose PPIs and 369 patients not treated with PPIs (control group). During the study period, 41 patients developed UGIB, a rate of 14.4/1000 person-years. The mean time between the start of dialysis and UGIB events was 26.3 ± 29.6 mo. Bleeding occurred in only two patients in the PPI group (2.5/1000 person-years) and in 39 patients in the control group (19.2/1000 person-years). Kaplan-Meier analysis of cumulative non-bleeding survival showed that the probability of UGIB was significantly lower in the PPI group than in the control group (log-rank test, P < 0.001). Univariate analysis showed that coronary artery disease, PPI use, anti-coagulation, and anti-platelet therapy were associated with UGIB. After adjustments for the potential factors influencing risk of UGIB, PPI use was shown to be significantly beneficial in reducing UGIB compared to the control group (HR = 13.7, 95%CI: 1.8-101.6; P = 0.011). The use of low-dose PPIs in patients with end-stage renal disease is associated with a low frequency of UGIB.
    04/2015; 21(16):4919-24. DOI:10.3748/wjg.v21.i16.4919
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    ABSTRACT: Although various modalities of hemodialysis (HD) are presumed to have different effects on insulin resistance (IR), the relationship between hemodiafiltration (HDF) and IR has not been fully evaluated. In a cross-sectional study, 82 non-diabetic HD patients were enrolled. The patients were divided into two groups according to the median homeostasis model assessment index (HOMA-IR) value of 1.685. Clinical and biochemical data were compared, and multivariate logistic regression analysis was performed to identify the independent factors associated with higher HOMA-IR. The higher HOMA-IR group had increased body mass index (BMI), decreased HDL cholesterol, and lower beta-2 microglobulin reduction rate (β2-MG RR) compared to the lower HOMA-IR group. HOMA-IR was significantly correlated with β2-MG RR. In addition, HDF patients had lower HOMA-IR levels compared with low flux hemodialysis patients. On multivariate logistic regression analysis, BMI and HDF treatment were independent factors associated with higher and lower HOMA-IR, respectively. This study suggests that HDF treatment may reduce IR in non-diabetic HD patients. © 2015 S. Karger AG, Basel.
    Blood Purification 03/2015; 39(1-3):224-229. DOI:10.1159/000368882 · 1.92 Impact Factor
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    ABSTRACT: Chronic kidney disease (CKD) is an established risk factor for numerous cardiovascular diseases including stroke. The relationship between the baseline estimated glomerular filtration rate (eGFR) and clinical 3-month outcomes in patients with acute ischemic stroke were evaluated in this study. This was a prospective cohort study involving a hospital-based stroke registry; 1373 patients with acute ischemic stroke were enrolled. Patients were divided into the following four groups according their eGFR (calculated using the CKD Epidemiology Collaboration equations): ≥60, 45-59, 30-44, and <30 mL/min/1.73 m(2). The primary endpoint of poor functional outcome was defined as 3-month death or dependency (modified Rankin Scale score ≥3); secondary endpoints were neurological deterioration (increase in National Institutes of Health Stroke Severity score of ≥4 at discharge compared to baseline) during hospitalization and in-hospital mortality. The overall eGFR was 84.5±20.8 mL/min/1.73 m(2) (mean±SD). The distribution of baseline renal impairment was as follows: 1,218, 82, 40, and 33 patients had eGFRs of ≥60, 45-59, 30-44, and <30 mL/min/1.73 m(2), respectively. At 3 months after the stroke, 476 (34.7%) patients exhibited poor functional outcome. Furthermore, a poor functional outcome occurred more frequently with increasingly advanced stages of CKD (rates of 31.9%, 53.7%, 55.0%, and 63.6% for CKD stages 1/2, 3a, 3b, and 4/5, respectively; p<0.001). Multivariate analysis revealed that a baseline eGFR of <30 mL/min/1.73m(2) increased the risk of a poor functional outcome by 2.37-fold (p=0.047). In addition, baseline renal dysfunction was closely associated with neurological deterioration during hospitalization and with in-hospital mortality. A low baseline eGFR was strongly predictive of both poor functional outcome at 3 months after ischemic stroke and neurological deterioration/mortality during hospitalization.
    Journal of Clinical Neurology 01/2015; 11(1):73-9. DOI:10.3988/jcn.2015.11.1.73 · 1.81 Impact Factor
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    ABSTRACT: Background With increasing age, body fat increases and muscle mass reduces. Even people with a normal weight may have a higher percentage of body fat. The aim of this study is to investigate the association between increased body fat and renal function decline (RFD) in the general elderly population with normal or mildly impaired renal function. Method We conducted a prospective study of 615 healthy individuals in the general Korean population aged ≥60 years who participated in two health screening check-ups separated by a 4-year period. Obesity was defined as the highest sex-specific tertiles of the percentage body fat (PBF). The main outcome was changes of estimated glomerular filtration rate (eGFR) during the 4 years. Significant RFD was defined as a decrease of eGFR over the upper quartile (≤−2.1% per year). Results The mean age was 67.2±6.6 years. The median value of the absolute decline in the eGFR and the percent change was −3.0 mL/minute/1.73 m2 and −0.87%/year in men and −3.1 mL/minute/1.73 m2 and −0.89%/year in women, respectively. When stratified by sex-specific PBF tertiles, pronounced differences were observed in both sexes; those at the highest tertile of PBF showed the greatest decline in eGFR. Even after adjustments for traditional risk factors of RFD, PBF was independently associated with eGFR changes (β=−0.181; P<0.001). In addition, the harmful effect of a high PBF was consistently found in subjects with a normal weight, too (β=−0.141; P=0.006). Cases of significant RFD occurred in 181 participants (29.4%), and the risk was higher in obese participants as compared with the nonobese participants. The odd ratios (95% confidence interval) for significant RFD were 2.76 (1.28–7.74) in men and 2.02 (1.06–4.43) in women in a whole population and 3.15 (1.03–18.52) in men and 1.44 (1.01–3.28) in women with a normal weight, respectively. Conclusion Among the elderly population without comorbidities, increased body fat has a harmful effect on RFD, irrespective of body weight.
    Clinical Interventions in Aging 08/2014; 9:1277-1286. DOI:10.2147/CIA.S66714 · 1.82 Impact Factor
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    ABSTRACT: Introduction and Aims: Both increased albuminuria and reduced kidney function predict blood pressure (BP) progression in the community, and exacerbate each other’s effects. We investigated associations and interactions between these two risk factors, BP changes and hypertension incidence in community-dwelling elderly men. Methods: Cross-sectional and longitudinal observational study in the Uppsala Longitudinal Study of Adult Men. 1051 men (all aged 71 years) with assessments on urinary albumin excretion rate (UAER, performed on an overnight urine collection.), 24-hour ambulatory BP monitoring (ABPM) and cystatin-C estimated glomerular filtration rate (eGFR). Of these, 574 men attended re-examination after 6 years, and ABPM measurements were again recorded. Results: UAER associated with ABPM measurements both at baseline and longitudinally. In longitudinal analysis, there were significant interactions between UAER and kidney function in their associations with changes of systolic BP, mean arterial pressure, and pulse pressure. After stratification for renal function state, UAER independently predicted BP changes only in those who had eGFR<60 mL/min/1.73m2. At re-examination, 71 new cases of hypertension were recorded. In multivariable logistic models of hypertension incidence, similar interactions were observed: UAER was an independent predictor of incident hypertension only in those with reduced renal function. These associations were evident also in the subpopulation of participants with normal range UAER (<20ug/min). Conclusions: UAER, even within the normal range, associates with BP progression and hypertension incidence in community-dwelling elderly men but only in those with concurrent reduction of renal function. View larger version: In this window In a new window Download as PowerPoint Slide
    Nephrology Dialysis Transplantation 05/2014; 29 Suppl 3(suppl 3):iii79-iii89. DOI:10.1093/ndt/gfu142 · 3.49 Impact Factor
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    02/2014; 34(1):128-30. DOI:10.3747/pdi.2012.00329
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    ABSTRACT: The non-invasive differentiation of ischemic and non-ischemic acute heart failure (AHF) not resulting from acute myocardial infarction is difficult and has therapeutic and prognostic implications. The aim of this study was to assess whether plasma B-type natriuretic peptide (BNP) can identify ischemic etiology in patients with stage 4-5 chronic kidney disease (CKD) presenting with AHF. Design and Methods We prospectively analyzed 61 patients. The diagnosis of ischemic AHF was confirmed by coronary angiography or stress myocardial perfusion imaging. Plasma levels of BNP were measured at admission (BNP1) and 48h after admission (BNP2). The mean age of the study patients was 67years. In these patients, 70.5% had diabetes and 47.5% had dialysis-dependent CKD; 28 of these patients (45.9%) had an ischemic etiology with significantly higher concentrations of BNP1 and BNP2 than did patients without ischemia. The area under the receiver operating characteristic curve was 0.755 (P=0.001) for BNP1 and 0.868 (P<0.001) for BNP2 to detect ischemic etiology of AHF. Plasma BNP1>2907ng/L (odds ratio [OR], 10.9; 95% confidence interval [CI] 2.5-48.4; P=0.002) and BNP2>2322ng/L (OR 93.1, 95% CI 7.0-1238.7; P=0.001) were independently associated with an ischemic etiology of AHF. Plasma BNP may represent a clinically useful non-invasive tool for identification of ischemic etiology of AHF in patients with stage 4-5 CKD. The trial registration number is NCT0122886.
    Clinical biochemistry 01/2014; 47(6). DOI:10.1016/j.clinbiochem.2014.01.025 · 2.28 Impact Factor
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    ABSTRACT: Non-diabetic chronic kidney disease (CKD) patients are a heterogeneous group with a variety of prognosis. We investigated the role of subclinical carotid atherosclerosis for the prediction of adverse cardiovascular (CV) outcomes in these patients, and tried to identify clinical and echocardiographic parameters associated with subclinical carotid atherosclerosis. As a prospective design, 182 asymptomatic non-diabetic CKD patients underwent carotid ultrasonography and Doppler echocardiography. Carotid atherosclerosis was defined as a carotid intima-media thickness >=1.0 mm and/or the presence of plaque. During the mean follow-up period of 28.8 +/- 16.1 months, 23 adverse CV events occurred. Patients with carotid atherosclerosis (99, 54.4%) showed significantly higher rates of annual CV events than those without (8.6 vs. 1.5%, p <0.001). Particularly, the presence of carotid plaque was a powerful predictor of adverse CV outcomes (OR 7.80, 95% CI 1.45-45.97). Clinical parameters associated with the presence of subclinical carotid atherosclerosis were old age, previous history of hypertension, increased pulse pressure, and higher high-sensitivity C-reactive protein (hs-CRP) level. By echocardiography, early diastolic mitral annular velocity (E') and the ratio of early peak transmitral inflow velocity (E) to E' (E/E') were closely related with the presence of carotid atherosclerosis. A multivariate analysis showed that age, hs-CRP, and E/E' were significant determinants of carotid atherosclerosis. Carotid plaque, even subclinical, was closely associated with a poor prognosis in non-diabetic CKD patients. Increased age, hs-CRP level, and E/E' ratio may be useful markers suggesting the presence of carotid atherosclerosis in these patients.
    BMC Cardiovascular Disorders 11/2013; 13(1):96. DOI:10.1186/1471-2261-13-96 · 1.50 Impact Factor
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    ABSTRACT: Osteoprotegerin (OPG) and fetuin-A are vascular calcification regulators that may be related to high cardiovascular (CV) mortality in hemodialysis (HD) patients. We evaluated the relationship between OPG, fetuin-A, and pulse wave velocity (PWV), a marker of vascular stiffness, and determined whether OPG and fetuin-A were independent predictors of CV events in HD patients. We conducted a prospective observational study in 97 HD patients. OPG and fetuin-A were measured at baseline and arterial stiffness was evaluated by PWV. All patients were stratified into tertiles according to serum OPG levels. A significant trend was observed across increasing serum OPG concentration tertiles for age, HD duration, systolic blood pressure, cholesterol, triglycerides, and PWV. Multiple linear regression analysis revealed that diabetes (β = 0.430, p = 0.000) and OPG levels (β = 0.308, p = 0.003) were independently associated with PWV. The frequency of new CV events was significantly higher in the upper OPG tertiles compared with those in the lower OPG tertiles. In Cox proportional hazards analysis, upper tertiles of OPG levels were significantly associated with CV events (hazard ratio = 4.536, p = 0.011). Serum OPG, but not fetuin-A, levels were closely associated with increased vascular stiffness, and higher OPG levels may be independent predictors of new CV events in HD patients.
    The Korean Journal of Internal Medicine 11/2013; 28(6):668-77. DOI:10.3904/kjim.2013.28.6.668
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    ABSTRACT: Valvular calcification is associated with significant morbidity and mortality in patients with end stage renal disease (ESRD). This study examined the hypothesis that valvular calcification is a marker of myocardial ischemia in asymptomatic high-risk patients with ESRD. Echocardiography and myocardial perfusion single-photon emission computed tomography were performed in 285 asymptomatic high-risk patients with ESRD at initiation of dialysis. We evaluated the extent and severity of myocardial ischemia by the summed difference score (SDS) and defined the presence of myocardial ischemia as SDS ≥ 3 and moderate to severe ischemia as SDS ≥ 8. The presence of cardiac valvular calcification was assessed by echocardiography and defined as aortic valve calcification or mitral valve calcification. Eighty-five (29.9%) patients had echocardiographic evidence of cardiac valvular calcification. The presence of myocardial ischemia was significantly associated with aortic valve calcification (odds ratio [OR] = 3.19; 95% confidence interval [CI] = 1.76-5.78; p < 0.001), mitral valve calcification (OR = 3.31; 95% CI = 1.74-6.28; p < 0.001), and cardiac valvular calcification (OR = 3.18; 95% CI = 1.79-5.65; p < 0.001). The presence of moderate to severe myocardial ischemia (SDS ≥ 8) was independently associated with cardiac valvular calcification (OR = 2.86; 95% CI = 1.12-7.27; p = 0.028). Valvular calcification was significantly associated with the presence of inducible myocardial ischemia in asymptomatic patients with ESRD, and may be a potential marker of patients at high-risk for the presence of silent myocardial ischemia.
    Atherosclerosis 08/2013; 229(2):369-73. DOI:10.1016/j.atherosclerosis.2013.05.026 · 3.97 Impact Factor
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    ABSTRACT: Silent myocardial ischemia is highly prevalent in patients with end-stage renal disease (ESRD), and is associated with poor cardiovascular outcomes. However, the criteria for coronary artery disease screening remain unclear in asymptomatic patients. The goal of this study was to evaluate whether baseline echocardiographic parameters can predict myocardial ischemia in asymptomatic patients with ESRD. We investigated 259 high-risk asymptomatic patients with ESRD who underwent both echocardiography and myocardial perfusion single-photon emission computed tomography at the initiation of dialysis. We defined the presence of myocardial ischemia as a reversible or fixed perfusion defect. Silent myocardial ischemia was found in 99 (38.2 %) high-risk asymptomatic patients with ESRD at the initiation of dialysis. In patients with myocardial ischemia, left ventricular (LV) end systolic volume index, LV mass index, left atrial volume index (LAVI), and the ratio of early mitral inflow velocity to peak mitral annulus velocity were significantly higher, and LV ejection fraction was significantly lower, than those without myocardial ischemia. Multivariate analysis showed that LAVI, LV ejection fraction, and regional wall motion abnormalities were independently associated with the presence of silent myocardial ischemia. Severe (LA) enlargement was independently associated with the presence of silent myocardial ischemia (odds ratio 1.97; 95 % confidence interval 1.08-3.57; p = 0.026). LA enlargement is a potential marker for identifying patients with ESRD at high risk of silent myocardial ischemia.
    The international journal of cardiovascular imaging 05/2013; 29(7). DOI:10.1007/s10554-013-0233-7 · 2.32 Impact Factor
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    ABSTRACT: BACKGROUND & AIMS: We investigated the prevalence of sarcopenia in elderly patients with end-stage renal disease (ESRD) and its relationship with various markers of nutrition, cognitive function, depressive symptoms, inflammation and β2-microglobulin. METHODS: A cross-sectional study was conducted with 95 patients having ESRD aged over 50 years. Sarcopenia was defined as a decline in both muscle mass and strength. RESULTS: The mean age was 63.9 ± 10.0 years; 56.8% were men and 52.6% had diabetes. Sarcopenia was highly prevalent in elderly patients with ESRD (37.0% in men and 29.3% in women). Subjective Global Assessment (SGA), inflammatory markers and β2-microglobulin levels were significantly associated with sarcopenia, even after adjustment for age, gender, diabetes, and body mass index. Additionally, patients with depressive symptoms showed a higher risk of sarcopenia relative to those without depressive symptoms (odds ratio, OR = 6.87, 95% confidence interval, CI = 2.06-22.96) and sarcopenia was more likely to be present in patients with mild cognitive dysfunction (OR = 6.35, 95% CI = 1.62-34.96). CONCLUSIONS: Sarcopenia is highly prevalent in elderly patients with ESRD and is closely associated with SGA, inflammatory markers, β2-microglobulin, depression and cognitive dysfunction.
    Clinical nutrition (Edinburgh, Scotland) 04/2013; 33(1). DOI:10.1016/j.clnu.2013.04.002 · 3.94 Impact Factor
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    ABSTRACT: Background Dialysis patients have impaired host defense mechanisms and frequently require antibiotics for various infective complications. In this study, we investigated whether dialysis patients have greater risk for Clostridium difficile-associated diarrhea (CDAD).Methods During the 4-year study period (2004–2008), 85 patients with CDAD were identified based on a retrospective review of C difficile toxin assay or histology records. Nosocomial diarrheal patients without CDAD were considered as controls (n=403). We assessed the association between renal function and the prevalence and clinical outcomes of CDAD.ResultsThere was a significant difference in the prevalence rate of chronic kidney disease (CKD) between CDAD and non-CDAD patients (P<0.001). Sixteen patients (18.8%) of the CDAD group were treated with dialysis, whereas 21 patients (5.2%) of the non-CDAD group were treated with dialysis. There was a significant association between renal function and CDAD in patients on dialysis [odds ratio (OR)=4.44, 95% confidence interval (CI) 2.19–8.99, P<0.001], but not in patients with CKD stage 3–5 (OR=1.10, 95% CI 0.63–1.92, P=0.73). In multivariate analysis, CKD stage 5D was an independent risk factor for the development of CDAD (OR=13.36, 95% CI 2.94–60.67, P=0.001).Conclusion Our data indicate that dialysis patients might be at a greater risk of developing CDAD, which suggests that particular attention should be provided to CDAD when antibiotic treatment is administered to dialysis patients.
    03/2013; 32(1):27–31. DOI:10.1016/j.krcp.2012.12.002
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    ABSTRACT: Purpose Cinacalcet is effective for treating refractory secondary hyperparathyroidism (SHPT), but little is known about the response rates and clinical factors influencing the response. Materials and Methods A prospective, single-arm, multi-center study was performed for 24 weeks. Cinacalcet was administered to patients with intact parathyroid hormone (iPTH) level greater than 300 pg/mL. Cinacalcet was started at a dose of 25 mg daily and titrated until 100 mg to achieve a serum iPTH level <300 pg/mL (primary end point). Early response to cinacalcet was defined as a decrease of iPTH more than 50% within one month. Results Fifty-seven patients were examined. Based on the magnitude of iPTH decrease, patients were divided into responder (n=47, 82.5%) and non-responder (n=10, 17.5%) groups. Among the responders, 38 achieved the primary end point, whereas 9 patients showed a reduction in serum iPTH of 30% or more, but did not reach the primary end point. Compared to non-responders, responders were significantly older (p=0.026), female (p=0.041), and diabetics (p<0.001). Additionally, early response was observed more frequently in the responders (30/47, 63.8%), of whom the majority (27/30, 90.0%) achieved the primary end point. Multivariate analysis showed that lower baseline iPTH levels [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.93-0.99], the presence of diabetes (OR 46.45, CI 1.92-1125.6) and early response (OR 21.54, CI 2.94-157.7) were significant clinical factors affecting achievement of iPTH target. Conclusion Cinacalcet was effective in most hemodialysis patients with refractory SHPT. The presence of an early response was closely associated with the achievement of target levels of iPTH.
    Yonsei medical journal 03/2013; 54(2):453-63. DOI:10.3349/ymj.2013.54.2.453 · 1.26 Impact Factor
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    ABSTRACT: Background Obesity and metabolic syndrome play causative roles in the increasing prevalence of proteinuria in the general population. However, in young adult women the clinical significance of incidentally discovered proteinuria and its association with metabolic syndrome are unclear. We investigated the prevalence and risk factors for proteinuria in this population. Methods A total of 10,385 women aged 20 to 39 years who underwent health screenings were surveyed. Each patient was tested for proteinuria with a dipstick (−, ±, 1+, 2+, or 3+), and proteinuria was defined as 1+ or greater. Persistent proteinuria was established by confirming proteinuria in a subsequent test. Metabolic syndrome was defined in accordance with the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asia. Results The mean age was 28.9 ± 5.5 years, and the prevalence of persistent proteinuria was 1.0%. Among these subjects with persistent proteinuria, obesity and metabolic syndrome were found in 10.4% and 5.2%, respectively. Metabolic syndrome, as well as its components of hypertension, hyperglycemia, central obesity, low high-density lipoprotein levels, and high triglyceride levels, was closely related to the presence of proteinuria. In addition, a wide pulse pressure of ≥40 mmHg was another independent risk factor for proteinuria [odds ratio (OR) 3.29, 95% confidence interval (CI) 1.03–11.91)]. This had an additive effect on metabolic syndrome in terms of predicting proteinuria. Even in subjects without metabolic syndrome, the influence of an increased pulse pressure was consistent (OR 2.75, 95% CI 1.03–8.61). Conclusions Specific attention to proteinuria may be necessary in asymptomatic young women aged 20 to 39 years if they have metabolic syndrome or a wide pulse pressure.
    BMC Nephrology 02/2013; 14(1):45. DOI:10.1186/1471-2369-14-45 · 1.52 Impact Factor
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    ABSTRACT: Purpose This study was undertaken to investigate the effects of gamma linolenic acid (GLA) on inflammation and extracellular matrix (ECM) synthesis in mesangial and tubular epithelial cells under diabetic conditions. Materials and Methods Sprague-Dawley rats were intraperitoneally injected with either a diluent [n=16, control (C)] or streptozotocin [n=16, diabetes (DM)], and eight rats each from the control and diabetic groups were treated with evening primrose oil by gavage for three months. Rat mesangial cells and NRK-52E cells were exposed to medium containing 5.6 mM glucose and 30 mM glucose (HG), with or without GLA (10 or 100 µM). Intercellular adhesion molecule-1 (ICAM-1), monocyte chemoattractant protein-1 (MCP-1), and fibronectin (FN) mRNA and protein expression levels were evaluated. Results Twenty-four-hour urinary albumin excretion was significantly increased in DM compared to C rats, and GLA treatment significantly reduced albuminuria in DM rats. ICAM-1, MCP-1, FN mRNA and protein expression levels were significantly higher in DM than in C kidneys, and these increases were significantly abrogated by GLA treatment. In vitro, GLA significantly inhibited increases in MCP-1 mRNA expression and protein levels under high glucose conditions in HG-stimulated mesangial and tubular epithelial cells (p<0.05, respectively). ICAM-1 and FN expression showed a similar pattern to the expression of MCP-1. Conclusion GLA attenuates not only inflammation by inhibiting enhanced MCP-1 and ICAM-1 expression, but also ECM accumulation in diabetic nephropathy.
    Yonsei medical journal 11/2012; 53(6):1165-75. DOI:10.3349/ymj.2012.53.6.1165 · 1.26 Impact Factor
  • Jwa-Kyung Kim · Sung Gyun Kim · Hyung Jik Kim · Young Rim Song
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    ABSTRACT: OBJECTIVES: Depression is associated with a poorer prognosis in patients with end-stage renal disease (ESRD). Increasing evidence indicates that glial pathology and blood-brain-barrier (BBB) dysfunction are involved in the pathophysiology of depression. S100B, a protein expressed in astro- and oligodendroglia in the human brain is considered a biomarker of depression. Our objective was to investigate the relationship between S100B and depressive symptoms in patients undergoing hemodialysis (HD). DESIGN AND METHODS: Seventy-eight Korean patients undergoing chronic HD without significant neurological issues participated in a cross-sectional observation study. Depressive symptoms were assessed with the Beck Depression Inventory-II (BDI-II), and serum S100B levels were measured using blood samples obtained prior to a mid-week HD session. RESULTS: The mean age of patients was 59.0years, and the mean dialysis duration was 51.7months. About 45% of patients undergoing HD met criteria for depression (BDI-II≥20). Serum S100B levels were significantly higher in patients with depression compared with patients without depression (115.1±45.4 vs. 66.1±35.3pg/mL, p<0.001). S100B (r=0.556, p<0.001) and high-sensitivity C-reactive protein (hs-CRP; r=0.422, p<0.001) and β2-microglobulin (r=0.391, p<0.001) levels were positively correlated with BDI-II scores. A multivariate regression analysis showed that both S100B and hs-CRP were significantly associated with BDI-II scores. CONCLUSIONS: The results showed a close association between S100B and depressive symptoms in patients undergoing HD. However, the mechanisms underlying this relationship are currently unknown and warrant further investigation.
    Clinical biochemistry 08/2012; 45(18). DOI:10.1016/j.clinbiochem.2012.08.014 · 2.28 Impact Factor
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    ABSTRACT: BACKGROUND: The leptin/adiponectin (L/A) ratio has been suggested to be an atherosclerotic index for diabetic patients and a useful marker of insulin resistance in patients with and without diabetes. Even though end-stage renal disease (ESRD) patients on peritoneal dialysis (PD) are well characterized by abnormal adipocytokine metabolism, the significance of alterations in the L/A ratio is largely unexplored in these patients. In this prospective study, we investigated the associations of leptin, adiponectin, and the L/A ratio with clinical outcomes in nondiabetic PD patients. ♢ METHODS: The study included 131 stable nondiabetic ESRD patients who had been on PD for more than 3 months. Serum leptin and adiponectin levels were determined at baseline. Mortality was evaluated over a 5-year follow-up period. ♢ RESULTS: During the follow-up period, 22 patients died (16.8%), including 10 (45.5%) as a result of cardiovascular disease. The L/A ratio showed a significant positive correlation with body mass index [BMI (r = 0.47, p < 0.001)], high-sensitivity C-reactive protein (r = 0.32, p < 0.001), and triglycerides (r = 0.43, p < 0.001). In addition, we observed significant inverse correlations between the L/A ratio and percentage lean body mass (r = -0.30, p = 0.001) and high-density lipoprotein cholesterol (r = -0.31, p = 0.001). In contrast to individual leptin and adiponectin levels, the L/A ratio was found to be independently associated with an increased mortality risk (relative risk: 1.15; 95% confidence interval: 1.05 to 1.27; p = 0.003) even after adjustments for age and BMI. ♢ CONCLUSIONS: The L/A ratio might be better related to patient outcomes than adipocytokines are individually in nondiabetic patients undergoing PD.
    08/2012; 33(1). DOI:10.3747/pdi.2011.00066

Publication Stats

148 Citations
70.87 Total Impact Points

Institutions

  • 2011–2015
    • Hallym University Medical Center
      • • Department of Neurology
      • • Department of Internal Medicine
      Sŏul, Seoul, South Korea
    • Hallym University
      • College of Medicine
      Sŏul, Seoul, South Korea
  • 2011–2013
    • Yonsei University Hospital
      • Department of Internal Medicine
      Sŏul, Seoul, South Korea
  • 2011–2012
    • Yonsei University
      • Department of Internal Medicine
      Sŏul, Seoul, South Korea