The association of body weight change with chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM) is unclear. In this nationwide, Korean population-based cohort study, we investigated the association between body weight change and CKD in patients with T2DM using data from the Korean National Health Insurance Service (NHIS). Between January 2009 and December 2012, we analyzed data from 981,953 patients with T2DM without proteinuria who underwent two consecutive general health checkups. The mean interval between the two examinations was 715 ± 115 days. Body weight change was categorized as severe (≤ − 10%) and moderate (− 10% to ≤ − 5%) weight loss, stable weight (− 5% to ≤ 5%), and moderate (5% to ≤ 10%) and severe (> 10%) weight gain; during follow-up, the percentage of participants who developed incident CKD in these groups was 8.78%, 7.58%, 7.18%, 8.17%, and 9.26%, respectively. In a multivariate analysis using the stable weight group as reference, odds ratios (95% confidence interval) for CKD were 1.020 (0.972–1.070), 0.971 (0.948–0.995), 1.209 (1.179–1.241), and 1.528 (1.459–1.601) in the severe weight loss, moderate weight loss, moderate weight gain, and severe weight gain groups. Thus, in this nationwide Korean cohort of adults with T2DM without proteinuria, weight gain > 5% was consistently associated with higher odds of incident CKD, whereas moderate weight loss was associated with slightly lower odds. Severe weight loss showed higher crude CKD incidence but no independent association after multivariable adjustment, suggesting that marked weight loss should be interpreted cautiously.

Purpose: Despite the high prevalence of sarcopenia and the significant burden of septic acute kidney injury (AKI), the impact of sarcopenia on renal outcomes in patients with septic AKI has not been studied. Therefore, we aimed to evaluate the effect of sarcopenia on the renal prognosis of patients with septic AKI. Materials and Methods: This retrospective study enrolled patients with septic AKI between July 2008 and March 2019. Sarcopenia was identified by measuring the total abdominal muscle area using abdominal CT. Patients were divided into sarcopenia and non-sarcopenia groups. The effect of sarcopenia on 90-day renal outcomes, including a >50% decrease in the estimated glomerular filtration rate, dialysis dependence, and requirement for continuous renal replacement therapy within 90 days, was analysed. Additionally, the effect of sarcopenia on 90-day mortality was assessed. Results: Of the 608 enrolled patients with septic AKI, 273 (44.9%) were assigned to the sarcopenia group. At baseline, there were no significant differences in the severity score and distribution of AKI stages between the two groups. There was no significant between-group difference in the 90-day renal outcomes. Moreover, sarcopenia was not associated with 90-day renal outcomes across all AKI stages in stratified multivariable logistic analysis. In contrast, the 90-day mortality rates were significantly higher in the sarcopenia group than in the non-sarcopenia group (30.0% vs. 17.3%, respectively; p<0.001). Conclusion: Sarcopenia was significantly associated with an increased 90-day mortality rate; however, no significant association with 90-day renal progression was observed in patients with septic AKI.

BACKGROUND:Infective endocarditis has low prevalence but a high mortality rate. Left-sided infective endocarditis (LSIE) has a higher mortality rate than right-sided infective endocarditis. Surgical treatment is occasionally considered for LSIE; however, few data are available on the long-term prognostic factors for LSIE after surgical treatment. This study investigated the risk factors for long-term mortality in LSIE patients who underwent surgical treatment. METHODS:This retrospective study enrolled adult patients with LSIE who were admitted to Severance Hospital in South Korea and underwent surgical treatment from November 2005 to August 2017. The primary outcome was risk factors for overall all-cause mortality. Multivariable Cox regression analysis was performed to identify risk factors for long-term mortality of patients with LSIE who received surgical treatment. RESULTS:This study enrolled 239 with LSIE who underwent surgery. The median follow-up period was 75.9 months, and there were 34 deaths (14.2%) during the study period. Multivariable Cox analysis showed that central nervous system complications (hazard ratio [HR]: 3.55, 95% confidence interval [CI]: 1.76-7.17, P <  0.001), chronic liver disease (CLD) (HR: 4.33, 95% CI: 1.57-11.91, P =  0.005), and age ≥  65 years (HR: 2.65, 95% CI: 1.28-5.51, P =  0.009) were risk factors for overall mortality. Kaplan-Meier analysis indicated a significant difference in survival between patients with and without CNS complications (P <  0.001, log-rank). CONCLUSION:Central nervous system complications, CLD, and older age were associated with long-term mortality in surgically treated patients with LSIE. Preventive strategies for CNS complications would improve the treatment of LSIE.

AIMS:The association between chronic kidney disease (CKD) and/or proteinuria and the risk of infective endocarditis (IE) in patients with CKD without replacement therapy remains unclear. This study evaluated the effect of CKD and/or proteinuria on the risk of IE among patients with diabetes. METHODS:In this nationwide population-based cohort study, data on patients with diabetes who underwent a health checkup in 2009 were obtained from the Korean National Health Insurance Service database. Patients were categorised into three groups according to the estimated glomerular filtration rate (eGFR) and six groups according to dipstick proteinuria and were followed up until December 2018. The primary outcome was the development of IE, which was defined using ICD-10 codes (I33.x, I38.x, I39.8) combined with hospitalisation for >14 days or death within 14 days. The relative risk of IE was estimated using adjusted hazard ratios (aHRs). RESULTS:In total, 866,918 patients were included, of whom 107,746 had an eGFR <60 mL/minute/1.73 m2. During the follow-up (median, 12.3 years), 821 cases of IE occurred. Patients with an eGFR <60 mL/minute/1.73 m2 had a higher risk of IE (aHR: 1.357, 95% confidence interval 1.098-1.676) than those with an eGFR ≥90 mL/minute/1.73 m2. The risk of IE increased as the severity of proteinuria increased, irrespective of the presence of CKD. CONCLUSION:CKD and proteinuria in the population with diabetes are associated with an increased risk of developing IE. The association of proteinuria with the risk of IE may be more significant than that of impaired renal function. However, as this study relied on claim codes and single-time-point assessments of kidney parameters, potential misclassification and residual confounding-including lack of adjustment for healthcare-related exposures-should be considered.

Abstract Background Renal replacement therapy (RRT) is an important treatment option for septic acute kidney injury (AKI); however, the optimal timing for its initiation remains controversial. Here, we aimed to investigate the clinical outcomes of early continuous renal replacement therapy (CRRT), which was defined as CRRT initiation within 6 hours of the onset of septic AKI, which is earlier than the time of initiation defined in previous studies.Figure 1.Study flowchart. Methods We used clinical data sourced from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. This study included patients aged ≥18 years who met the sepsis diagnostic criteria and received CRRT because of stage 2 or 3 AKI. Early and late CRRT were defined as CRRT initiation within 6 hours and after 6 hours of the development of septic AKI, respectively.Table 1.Clinical characteristics of patients with sepsis after propensity matching Results Of the 33,236 patients diagnosed with sepsis, 553 underwent CRRT for septic AKI. After excluding cases of early mortality and patients with a history of dialysis, 45 and 334 patients were included in the early and late CRRT groups, respectively. After propensity score matching, the 28-day mortality rate was significantly lower in the early CRRT group than that in the late CRRT group (26.7% vs. 43.9%, P=0.035). The early CRRT group also had a significantly greater number of days free of mechanical ventilation (median days, 19; interquartile range [IQR] 3–25) and vasopressor administration (median days, 21, IQR 5–26) than did the late CRRT group (median days, 10.5; IQR, 0–23; P=0.037 and median days, 13.5; IQR, 0–25; P=0.028, respectively). The Kaplan–Meier curve also showed that early CRRT initiation was associated with an improved 28-day mortality rate (log-rank test, P=0.040). In contrast, there was no significant difference in the 28-day mortality between patients who started CRRT within 12 h and those who did not (log-rank test, P=0.237).Table 2.Clinical outcomes of patients with sepsis after propensity score matching Conclusion Early CRRT initiation can improve the survival of patients with septic AKI. CRRT must be initiated as early as possible after the onset of septic AKI, preferably within 6 hours.Figure 2.Kaplan-Meier survival curves of patients with septic acute kidney injury after propensity score matching.A. Comparison of 28-day survival and B. 90-day mortality among patients with sepsis between continuous renal replacement therapy initiation < 6 hours and ≥ 6 hours. C. Comparison of 28-day survival and D. 90-day mortality among patients with sepsis between continuous renal replacement therapy initiation < 12 hours and ≥ 12 hours. Disclosures All Authors: No reported disclosures

Background: Renal replacement therapy (RRT) is an important treatment option for sepsis- associated acute kidney injury (AKI); however, the optimal timing for its initiation remains controversial. Herein, we investigated the clinical outcomes of early continuous kidney replacement therapy (CKRT), defined as CKRT initiation within 6 hours of sepsis-associated AKI onset, which was earlier than the initiation time defined in previous studies. Methods: We used clinical data sourced from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. This study included patients aged >= 18 years who met the sepsis diagnostic criteria and received CKRT because of stage 2 or 3 AKI. Early and late CKRTs were defined as CKRT initiation within 6 hours and after 6 hours of the development of sepsis- associated AKI, respectively. Results: Of the 33,236 patients diagnosed with sepsis, 553 underwent CKRT for sepsis- associated AKI. After excluding cases of early mortality and patients with a dialysis history, 45 and 334 patients were included in the early and late CKRT groups, respectively. After propensity score matching, the 28-day mortality rate was significantly lower in the early CKRT group than in the late CKRT group (26.7% vs. 43.9%, P = 0.035). The early CKRT group also had a significantly greater number of days free of mechanical ventilation (median, 19; interquartile range [IQR], 3-25) and vasopressor administration (median, 21; IQR, 5-26) than the late CKRT group did (median, 10.5; IQR, 0-23; P = 0.037 and median, 13.5; IQR, 0-25; P = 0.028, respectively). The Kaplan-Meier curve also showed that early CKRT initiation was associated with an improved 28-day mortality rate (log-rank test, P = 0.040). In contrast, there was no significant difference in the 28-day mortality between patients who started CKRT within 12 hours and those who did not (log-rank test, P = 0.237). Conclusion: Early CKRT initiation improved the survival of patients with sepsis-associated AKI. Initiation of CKRT should be considered as early as possible after sepsis-associated AKI onset, preferably within 6 hours.

Purpose To investigate the relationship between contrast medium administration and long-term mortality and renal function in patients with septic acute kidney injury (AKI). Materials and methods We performed a retrospective, propensity-matched cohort study involving 1521 adult patients admitted with septic shock. Patients with septic AKI who underwent contrast or non-contrast CT scans were enrolled. The primary outcomes were the rates of 90-day mortality and dialysis within 90 days. The secondary outcomes included worsening of AKI, in-hospital mortality, and maintenance of dialysis after 90 days. Results During the study period, 609 patients with septic AKI were identified; 220 (36.1%) underwent contrast CT and 389 (63.9%) underwent non-contrast CT. After propensity score matching, 133 pairs were obtained. There were no significant differences between the contrast and non-contrast CT groups in 90-day mortality (54.9% vs. 58.6%, P = 0.579), dialysis within 90 days (6.8% vs. 8.3%, P = 0.655), worsening AKI (2.3% vs. 3.0%, P = 0.706), in-hospital mortality (10.6% vs. 14.4%, P = 0.369), or maintenance of dialysis after 90 days (0.0% vs. 0.8%, P > 0.99). Conclusions The administration of intravenous contrast medium was not associated with long-term mortality, deterioration of renal function, or dialysis in patients with septic AKI.

Despite numerous studies on the effect of each dialysis modality on mortality, the issue remains controversial. We investigated the hazard rate of mortality in patients with incident end-stage renal disease (ESRD) concerning initial dialysis modality (hemodialysis vs. peritoneal dialysis). Using a nationwide, multicenter, prospective cohort in South Korea, we studied 2207 patients, of which 1647 (74.6%) underwent hemodialysis. We employed the weighted Fine and Gray model over the follow-up period using inverse probability of treatment and censoring weighting. Landmark analysis was used for identifying the changing effect of dialysis modality on individuals who remained event-free at each landmark point. No significant difference in hazard rate was observed overall. However, the peritoneal dialysis group had a significantly higher hazard rate than the hemodialysis group among patients under 65 years after 4- and 5- year follow-up. A similar pattern was observed among those with diabetes mellitus. Landmark analysis also showed the higher hazard rate for peritoneal dialysis at 2 years for the education-others group and at 3 years for the married group. These findings may inform dialysis modality decisions, suggesting a preference for hemodialysis in young patients with diabetes, especially for follow-ups longer than 3 years.

Background: Ultrafiltration with continuous kidney replacement therapy (CKRT) can be used to manage fluid balance in critically ill patients with acute kidney injury (AKI). We aimed to assess whether bioimpedance analysis (BIA)-guided volume management was more efficacious than conventional management for achieving estimated euvolemia (e-euvolemia) in CKRT-treated patients. Methods: In a multi-center randomized controlled trial from July 2017 to July 2020, the patients with AKI requiring CKRT were eligible if the weight at the start of CKRT had increased by ≥5% compared to the weight at the time of admission, or total body water (TBW)/ height (H) 2 ≥13 L/m 2 . We randomly assigned 208 patients to the control (conventional fluid management; N=103) and intervention groups (BIA-guided fluid management; N=105). Primary outcome was the proportion of attaining e-euvolemia seven days post-randomization. E-euvolemia was defined as the difference between TBW/H 2 D 7 and D 0 was <–2.1 L/m 2 , or when TBW/H 2 measured on D 7 was <13 L/m 2 . The 28-, 60-, and 90-day mortality rate were secondary outcomes. Results: The primary outcome occurred in 34 patients in the intervention group and 27 in the control group (47% versus 41%; P =0.50). The mean value of TBW/H 2 measured on D 7 was the same at 13.9 L/m 2 in both groups. The differences between TBW/H 2 D 7 and D 0 were -1.13 L/m 2 in the intervention group and -1.08 L/m 2 in the control group ( P =0.84). Patients in the intervention group had a significantly higher proportion of reaching e-euvolemia on D 1 than those in the control group (13% versus 4%, P =0.02). Adverse events did not differ significantly between the groups. Conclusions: BIA-guided volume management did not affect the proportion of reaching the estimated euvolemia at seven days of the start of CKRT. Trial registration: ClinicalTrials.gov, ID: NCT03330626 (Registered on 6 November 2017; Seven study participants were retrospectively registered; nonetheless, IRB approval of each institution was completed before study participant registration).

BACKGROUND:Ultrafiltration with continuous kidney replacement therapy (CKRT) can be used to manage fluid balance in critically ill patients with acute kidney injury (AKI). We aimed to assess whether bioimpedance analysis (BIA)-guided volume management was more efficacious than conventional management for achieving estimated euvolemia (e-euvolemia) in CKRT-treated patients. METHODS:In a multi-center randomized controlled trial from July 2017 to July 2020, the patients with AKI requiring CKRT were eligible if the weight at the start of CKRT had increased by ≥5% compared to the weight at the time of admission, or total body water (TBW)/ height (H)2 ≥13 L/m2. We randomly assigned 208 patients to the control (conventional fluid management; N=103) and intervention groups (BIA-guided fluid management; N=105). Primary outcome was the proportion of attaining e-euvolemia seven days post-randomization. E-euvolemia was defined as the difference between TBW/H2 D7 and D0 was <-2.1 L/m2, or when TBW/H2 measured on D7 was <13 L/m2. The 28-, 60-, and 90-day mortality rate were secondary outcomes. RESULTS:The primary outcome occurred in 34 patients in the intervention group and 27 in the control group (47% versus 41%; P=0.50). The mean value of TBW/H2 measured on D7 was the same at 13.9 L/m2 in both groups. The differences between TBW/H2 D7 and D0 were -1.13 L/m2 in the intervention group and -1.08 L/m2 in the control group (P=0.84). Patients in the intervention group had a significantly higher proportion of reaching e-euvolemia on D1 than those in the control group (13% versus 4%, P=0.02). Adverse events did not differ significantly between the groups. CONCLUSIONS:BIA-guided volume management did not affect the proportion of reaching the estimated euvolemia at seven days of the start of CKRT. TRIAL REGISTRATION:ClinicalTrials.gov, ID: NCT03330626 (Registered on 6 November 2017; Seven study participants were retrospectively registered; nonetheless, IRB approval of each institution was completed before study participant registration).

This retrospective study investigated whether repetitive exposure to intravenous iodinated contrast media (ICM) affects long-term renal function in patients who undergo curative surgery for early gastric cancer (EGC) collected from the Korean Health Insurance and Review Assessment (HIRA) database. Patients diagnosed with gastric cancer between January 2010 and December 2013 underwent regular computed tomography (CT) scans to monitor for extragastric recurrence. Patients who already had chronic kidney disease (CKD) before cancer diagnosis or had undergone chemotherapy or repeated surgery were excluded. A nested case–control study design was chosen to analyze the effect of repetitive ICM exposure to long-term renal function by comparing patients who developed CKD 2 years after cancer diagnosis and patients who did not. Among 59,971 patients collected according to inclusion and exclusion criteria, 1021 were diagnosed with CKD 2 years after cancer diagnosis. Using 1:5 matching after adjusting for age, sex and date of cancer diagnosis, 5097 control patients were matched to 1021 CKD patients. Conditional logistic regression showed that the number of CTs taken using ICM slightly increased the odds of CKD (odds ratio, 1.080; 95% confidence interval (CI): 1.059, 1.100; P < 0.0001). Thus, the administration of ICM might contribute to chronic renal function impairment.

Renal fibrosis is the final manifestation of chronic kidney disease (CKD) regardless of etiology. Hypoxia-inducible factor-2 alpha (HIF-2α) is an important regulator of chronic hypoxia, and the late-stage renal tubular HIF-2α activation exerts protective effects against renal fibrosis. However, its specific role in progressive renal fibrosis remains unclear. Here, we investigated the effects of the long-term tubular activation of HIF-2α on renal function and fibrosis, using in vivo and in vitro models of renal fibrosis. Progressive renal fibrosis was induced in renal tubular epithelial cells (TECs) of tetracycline-controlled HIF-2α transgenic (Tg) mice and wild-type (WT) controls through a 6-week adenine diet. Tg mice were maintained on doxycycline (DOX) for the diet period to induce Tg HIF-2α expression. Primary TECs isolated from Tg mice were treated with DOX (5 μg/ml), transforming growth factor-β1 (TGF-β1) (10 ng/ml), and a combination of both for 24, 48, and 72 hr. Blood was collected to analyze creatinine (Cr) and blood urea nitrogen (BUN) levels. Pathological changes in the kidney tissues were observed using hematoxylin and eosin, Masson's trichrome, and Sirius Red staining. Meanwhile, the expression of fibronectin, E-cadherin and α-smooth muscle actin (α-SMA) and the phosphorylation of p38 mitogenactivated protein kinase (MAPK) was observed using western blotting. Our data showed that serum Cr and BUN levels were significantly lower in Tg mice than in WT mice following the adenine diet. Moreover, the protein levels of fibronectin and E-cadherin and the phosphorylation of p38 MAPK were markedly reduced in the kidneys of adenine-fed Tg mice. These results were accompanied by attenuated fibrosis in Tg mice following adenine administration. Consistent with these findings, HIF-2α overexpression significantly decreased the expression of fibronectin in TECs, whereas an increase in α-SMA protein levels was observed after TGF-β1 stimulation for 72 hr. Taken together, these results indicate that long-term HIF-2α activation in CKD may inhibit the progression of renal fibrosis and improve renal function, suggesting that long-term renal HIF-2α activation may be used as a novel therapeutic strategy for the treatment of CKD. [BMB Reports 2023; 56(3): 196-201].

Fluid balance is a critical prognostic factor for patients with severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). This study evaluated whether repeated fluid balance monitoring could improve prognosis in this clinical population. This was a multicenter retrospective study that included 784 patients (mean age, 67.8 years; males, 66.4%) with severe AKI requiring CRRT during 2017–2019 who were treated in eight tertiary hospitals in Korea. Sequential changes in total body water were compared between patients who died (event group) and those who survived (control group) using mixed-effects linear regression analyses. The performance of various machine learning methods, including recurrent neural networks, was compared to that of existing prognostic clinical scores. After adjusting for confounding factors, a marginal benefit of fluid balance was identified for the control group compared to that for the event group ( p = 0.074). The deep-learning model using a recurrent neural network with an autoencoder and including fluid balance monitoring provided the best differentiation between the groups (area under the curve, 0.793) compared to 0.604 and 0.606 for SOFA and APACHE II scores, respectively. Our prognostic, deep-learning model underlines the importance of fluid balance monitoring for prognosis assessment among patients receiving CRRT.

Background; Acute kidney injury (AKI) is the most frequent complication seen in patients with septic shock and is an independent risk factor for death. Although renal-replacement therapy (RRT) is standard care for patients with severe septic AKI, the optimal timing of RRT initiation remains controversial. Methods; The PubMed, Cochrane, and Embase databases were searched from their inception to June 2021 to identify the ideal timing of RRT initiation in patients with septic AKI by comparing 28- and 90-day mortality rates. Results; Among a total of six studies including 1,058 patients, the 28-day mortality rate was significantly lower in the early RRT-treated group compared to the late group [RR=0.69; 95% CI (0.51-0.94); P=0.018]. Moreover, among the five studies including 938 patients, the 90-day mortality rate was also significantly lower in the early RRT-treated group than the late group [RR=0.61; 95% CI (0.47-0.80); P=0.01]. In a subgroup analysis for continuous RRT (CRRT), we also found significantly lower 28- and 90-day mortality rates in the early CRRT-treated group compared to the late group. Conclusion; This study showed that early initiation of RRT might reduce 28- and 90-day mortality compared with late initiation in septic AKI patients.

AbstractBackgroundDespite medical advances, septic shock remains one of the main causes of high mortality in critically ill patients. Although sarcopenia is considered a predictor of mortality in septic shock patients, most studies have only investigated short‐term mortality, and those on long‐term prognosis are limited. We investigated the impact of sarcopenia on long‐term mortality in a large patient population with septic shock.MethodsA retrospective cohort study comprising 905 patients with septic shock was conducted from 2008 to 2019. Sarcopenia was defined based on the measurement of the total abdominal muscle area, assessed using abdominal computed tomography scans. Thereafter, we stratified the patients into two groups—sarcopenia and non‐sarcopenia groups—and compared the impact of sarcopenia on short‐term (28 days) and long‐term (1 year and overall) mortality using multivariable Cox proportional analysis.ResultsA total of 905 patients were included, and the mean age was 65.7 ± 15.1 years. Among them, 430 (47.5%) patients were male and 407 (45.0%) had sarcopenia. We found that the 28 day, 1 year, and overall mortality rates in the sarcopenia group were significantly higher than those in the non‐sarcopenia group (13.8% vs. 6.4%, P < 0.001; 41.8% vs. 21.7%, P < 0.001; 62.2% vs. 35.7%, P < 0.001, respectively). Univariable Cox analysis showed that the sarcopenia group had a significant association with the increase in each mortalities compared with the non‐sarcopenia group (28 day mortality, hazard ratio (HR) = 2.230, 95% confidence interval (CI) [1.444–3.442], P < 0.001; 1 year mortality, HR = 2.189, 95% CI [1.720, 2.787], P < 0.001; overall mortality, HR = 2.254, 95% CI [1.859, 2.734], P < 0.001). Multivariable Cox analysis showed that both the short‐term and long‐term mortality rates remained significantly higher in the sarcopenia group than in the non‐sarcopenia group, even after adjusting for confounding variables (28 day mortality, HR = 2.116, 95% CI [1.312, 3.412], P = 0.002; 1 year mortality, HR = 1.679, 95% CI [1.291, 2.182], P < 0.001; overall mortality, HR = 1.704, 95% CI [1.381, 2.102], P < 0.001).ConclusionsSarcopenia was associated with both short‐term and long‐term mortality in patients with septic shock. In clinical settings, close attention should be paid to these patients for both short‐term and long‐term outcomes.

Background: Generalizing an 'optimal' blood pressure (BP) level for individuals with hypertension remains controversial due to the implementation of different medical guidelines. This study investigated the association of BP with major adverse cardiovascular and cerebrovascular events (MACCE) and determined the optimal BP for patients with hypertension. Method: A total of 934 179 individuals who received antihypertensive medications were selected from the National Health Insurance Service Examination Database between 2003 and 2011 in Korea. Their BP was measured at the index date, which was the first health examination. The study outcomes were MACCE, including acute myocardial infarction, heart failure, stroke, and all-cause mortality. The participants were monitored until in December, 2017. The hazard ratios were calculated using Cox proportional hazard models. The cumulative incidence of MACCE for each BP group was estimated using the Kaplan-Meier method. Results: A lower risk of MACCE was observed at a SBP of 120-129 mmHg and a DBP of 80-89 mmHg. The endpoint-specific incidence rates and hazard ratios for acute myocardial infarction, heart failure, stroke, and all-cause mortality were the lowest at a SBP of 120-129 mmHg and a DBP of 80-89 mmHg. Conclusion: Even though this observational study did not support inference of a causal relationship, a SBP of 120-129 mmHg and a DBP of 80-89 mmHg may be safely recommended considering the possibility of MACCE in Korean patients with hypertension. In addition, the target BP should be tailored individually according to age, sex, and comorbidities.

Appropriate dietary adjustment in patients with chronic kidney disease (CKD) is important, and nutritional guidelines recommend different dietary management depending on the CKD stage. However, there is no study, to our knowledge, of the characteristics of dietary intake according to CKD stages. We tried to assess the comparison of nutritional intake according to CKD stages. A cross-sectional study was conducted to reveal the characteristics of dietary intake among patients with CKD based on the Korean National Health and Nutritional Examination Survey between 2011 and 2014. Of 16,878 participants, we classified non-CKD (n = 14,952) and CKD (n = 1,926), which was stratified into five groups (I, II, IIIa, IIIb, and IV-V). We investigated the characteristics of dietary intake, such as energy, water, protein, fat, carbohydrate, sodium, potassium, calcium, and phosphorus, according to stage of CKD. We also explored nutritional intake according to CKD stage among patients with early CKD (stage I and II) and advanced CKD (stage IIIa, IIIb, and IV-V). Intake of majority of nutrients and energy tended to be decreased as CKD progressed. In early CKD stage, intake of energy, water, protein, fat, carbohydrate, potassium, calcium and phosphorus seemed to be statistically significant decreased as CKD progressed. In advanced CKD stage, intake of potassium and calcium seemed to be decreased as CKD progressed, but the intake of energy was about to be lower limit. Appropriate dietary education and CKD recognition are needed to improve nutritional intake depending on the CKD stage.

OBJECTIVE:To investigate imaging biomarkers of microperfusion in contrast-induced nephropathy (CIN) using contrast-enhanced ultrasound (CEUS).MATERIALS AND METHODS:The CIN model was fabricated by administering indomethacin (10 mg/kg), L-NAME (15 mg/kg), and iopamidol (10 mL/kg) to Sprague-Dawley rats. After 24 hours, CEUS was performed on CIN (n = 6) and control (n = 6) rats with sulphur hexafluoride microbubbles (SonoVue). From time-intensity curves obtained from the kidney arriving time (AT), acceleration time (AC), time to peak (TTP), and peak enhancement (PE) were measured and compared between the groups. After CEUS, the rats were sacrificed, and cell apoptosis markers were evaluated to confirm the development of CIN.RESULTS:Among CEUS parameters, AT (7.8 ± 1.6 vs. 4.2 ± 0.5 s, p = 0.002), AC (4.7 ± 1.4 vs. 2.0 ± 0.4 s, p = 0.002), and TTP (12.5 ± 2.9 vs. 6.2 ± 0.6 s, p = 0.002) were significantly prolonged in the CIN group compared to controls. PE was significantly higher in the control group than in the CIN group (17.1 ± 1.9 vs. 12.2 ± 2.0 dB, p = 0.004). In kidney tissue, mRNA and protein levels of the apoptotic makers were significantly higher in the CIN group than in the control group (p = 0.003 and p = 0.002).CONCLUSION:CEUS parameters can be used as imaging biomarkers for microperfusion in CIN. In rats with CIN, AT, AC, and TTP were significantly prolonged, while PE was significantly lower compared to controls.

Background Because of high cost of continuous renal replacement therapy (CRRT) and the high mortality rate among severe acute kidney injury patients, careful identification of patients who will benefit from CRRT is warranted. This study determined factors associated with mortality among critically ill patients requiring CRRT. Methods This was a retrospective observational study of 414 patients admitted to the intensive care unit of four hospitals in South Korea who received CRRT from June 2017 to September 2018. Patients were divided according to degree of fluid overload (FO) and disease severity. The Cox proportional hazards model was used to explore the effect of relevant variables on mortality. Results In-hospital mortality rate was 57.2%. Ninety-day mortality rate was 58.5%. Lower creatinine and blood pH were significant predictors of mortality. A one-unit increase in the Sequential Organ Failure Assessment (SOFA) score was associated with increased risk of and 90-day mortality (hazard ratio [HR], 1.07; p < 0.001). The risk of 90-day mortality in FO patients was 57.2% (p < 0.001) higher than in those without FO. High SOFA score was associated with increased risk for 90-day mortality (HR, 1.79; p = 0.03 and HR, 3.05; p = 0.001) in patients without FO and with FO ≤ 10%, respectively. The highest mortality rates were in patients with FO > 10%, independent of disease severity. Conclusion FO increases the risk of mortality independent of other factors, including severity of acute illness. Prevention of FO should be a priority, especially when managing the critically ill.

The association between increased red blood cell distribution width (RDW) and mortality among patients treated on an outpatient basis in the nephrology outpatient clinic is unclear. Therefore, our study aimed to investigate the association between baseline and time-averaged RDW and mortality risk in patients treated in our nephrology outpatient clinic. Our multi-center retrospective analysis was based on data of 16,417 outpatient nephrology patients with available baseline renal function and RWD values. The median baseline RDW was 13.0% (range, 10.0–32.1%). The high-RDW group was defined as the top quartile (≥ 13.8%, n = 4302). The crude mortality rate was 15.0% (n = 1806) at a median follow-up of 127.5 months. From the results of the multivariate Cox proportional hazards regression model adjusted for covariates, including eGFR, hemoglobin, and factors of anemia treatment, patients with a high time-averaged RDW had increased mortality risk (adjusted hazard ratio, 1.505; 95% confidence interval, 1.326–1.708; P < 0.001), irrespective of sex, presence of anemia, and chronic kidney disease, except in individuals aged < 45 years. Thus, increased baseline and time-averaged RDW were significantly associated with increased mortality in patients aged > 45 years treated on an outpatient basis in the nephrology clinic.