• Journal of Yeungnam Medical Science
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• 제38권2호
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• pp.136-141
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• 2021

Background: Postoperative acute kidney injury (AKI), which increases the risk of postoperative morbidity and mortality, poses a major concern to surgeons. We conducted this study to analyze the risk factors associated with the occurrence of AKI after orthopedic surgery. Methods: This was a retrospective study that included 351 patients who underwent total hip or knee replacement surgery at Inje University Haeundae Paik Hospital between January 2012 and December 2016. Results: AKI occurred in 13 (3.7%) of the 351 patients. The patients' preoperative estimated glomerular filtration rate (eGFR) was 66.66 ±34.02 mL/min/1.73 m² in the AKI group and 78.07±21.23 mL/min/1.73 m² in the non-AKI group. The hemoglobin levels were 11.21±1.65 g/dL in the AKI group and 12.39±1.52 g/dL in the non-AKI group. Hemoglobin level was related to increased risk of AKI (odds ratio [OR], 0.13; 95% confidence interval [CI], 0.02-0.68; p=0.016). Administration of crystalloid or colloid fluid alone and the perioperative amount of fluid did not show any significant relationship with AKI. Further analysis of the changes in eGFR was performed using a cutoff value of 7.54. The changes in eGFR were significantly related to decreased risk of AKI (OR, 0.74; 95% CI, 0.61-0.89; p=0.002). Conclusion: Renal function should be monitored closely after orthopedic surgery if patients have chronic kidney disease and low hemoglobin level. Predicting the likelihood of AKI occurrence, early treatment of high-risk patients, and monitoring perioperative laboratory test results, including eGFR, will help improve patient prognosis.

• Journal of Preventive Medicine and Public Health
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• 제56권3호
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• pp.282-290
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• 2023

Objectives: This study aimed to evaluate the potential interaction between kidney function and the non-linear association between serum calcium levels and cardiovascular disease (CVD) mortality. Methods: This study included 8927 participants enrolled in the Dong-gu Study. Albumin-corrected calcium levels were used and categorized into 6 percentile categories: <2.5th, 2.5-25.0th, 25.0-50.0th, 50.0-75.0th, 75.0-97.5th, and >97.5th. Restricted cubic spline analysis was used to examine the non-linear association between calcium levels and CVD mortality. Cox proportional hazard regression was used to estimate hazard ratios (HRs) for CVD mortality according to serum calcium categories. All survival analyses were stratified by the estimated glomerular filtration rate. Results: Over a follow-up period of 11.9±2.8 years, 1757 participants died, of whom 219 died from CVD. A U-shaped association between serum calcium and CVD mortality was found, and the association was more evident in the low kidney function group. Compared to the 25.0-50.0th percentile group for serum calcium levels, both low and high serum calcium tended to be associated with CVD mortality (<2.5th: HR, 6.23; 95% confidence interval [CI], 1.16 to 33.56; >97.5th: HR, 2.56; 95% CI, 0.76 to 8.66) in the low kidney function group. In the normal kidney function group, a similar association was found between serum calcium levels and CVD mortality (<2.5th: HR, 1.37; 95% CI, 0.58 to 3.27; >97.5th: HR, 1.65; 95% CI, 0.70 to 3.93). Conclusions: We found a non-linear association between serum calcium levels and CVD mortality, suggesting that calcium dyshomeostasis may contribute to CVD mortality, and kidney function may modify the association.

• 대한한방내과학회지
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• 제44권3호
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• pp.354-365
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• 2023

Objective: This study aimed to assess the safety and effect on glucose level of Bojungikgi-tang in patients with type 2 diabetes mellitus. Methods: To review patients' clinical characteristics and laboratory tests retrospectively, we investigated 15 hospitalized patients with type 2 diabetes mellitus who took Bojungikgi-tang at Kyung Hee University Korean Medical Hospital for at least one day between January 2012 and December 2022. The blood glucose levels, including fasting blood sugar (FBS), 2-hour postprandial glucose (PP2) levels, and glycated hemoglobin level, were collected to determine the effect of the Bojungikgi-tang on blood sugar changes. Furthermore, to evaluate the safety of Bojungikgi-tang, hepatic function and renal function tests were implemented, including aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, γ-glutamyltransferase, blood urea nitrogen, creatinine, and Modification of Diet in Renal Disease estimated glomerular filtration rate. Results: When Bojungikgi-tang and a standard treatment for diabetes were administered for patients with type 2 diabetes, it was confirmed that there were no statistically significant changes in FBS and PP2 levels in the analysis of each medication taken. There was no significant difference in the safety profile after taking Bojungikgi-tang. Conclusions: The combined administration of Bojungikgi-tang with standard hypoglycemic medication for patients with type 2 diabetes may not affect blood glucose levels and safety.

• Korean Journal of Radiology
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• 제22권9호
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• pp.1547-1554
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• 2021

Objective: We aimed to investigate whether repeated intravascular administration of iodinated contrast media (ICM) or gadolinium-based contrast agents (GBCAs) within a short interval was associated with an increased risk of post-contrast acute kidney injury (PC-AKI). Materials and Methods: This retrospective study included 300 patients (mean age ± standard deviation, 68.5 ± 8.1 years; 131 male and 169 female) who had undergone at least one ICM-enhanced perfusion brain CT scan, had their baseline and follow-up serum creatinine levels available, and had not undergone additional contrast-enhanced examinations 72 hours before and after a time window of interest were included. The study population was divided into three groups: single-dose group and groups of patients who had received multiple contrast administrations in the time window of interest with the minimum contrast repeat interval either within 4 hours (0-4-hour group) or between 4 to 48 hours (4-48-hour group). Multivariable logistic regression analysis was conducted to evaluate the association between AKI and repeated ICM administrations. A similar supplementary analysis was performed including both ICM and GBCA. Results: When ICM was only considered ignoring GBCA, among 300 patients, 207 patients received a single dose of ICM, 58 had repeated doses within 4 hours (0-4-hour group), and 35 patients had repeated doses between 4 to 48 hours (4-48-hour group). Most patients (> 95%) had a baseline estimated glomerular filtration rate (eGFR) of ≥ 30 mL/min/1.73 m². AKI occurred in 7.2%, 13.8%, and 8.6% of patients in the single-dose, 0-4-hour, and 4-48-hour groups, respectively. In the 0-4-hour and 4-48-hour groups, additional exposure to ICM was not associated with AKI after adjusting for comorbidities and nephrotoxic drugs (all p values > 0.05). Conclusion: Repeated intravascular administrations of ICM within a short interval did not increase the risk of AKI in our study patients suspected of acute stroke with a baseline eGFR of ≥ 30 mL/min/1.73 m².

• Childhood Kidney Diseases
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• 제11권2호
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• pp.247-254
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• 2007

목 적 : 세계적으로 급성 신부전을 가진 소아중환자의 경우 신대체요법으로서 CRRT가 우선적으로 적용되고 있는데 국내에서 CRRT에 대한 치료 결과나 이에 미치는 예후인자에 대한 연구가 드문 설정이다. 이에 저자들은 CRRT를 시행 받은 소아 환자군을 대상으로 치료결과와 예후인자를 알아보기 위해 본 연구를 시행하였다. 방 법 : 2003년 1월부터 2006년 12월까지 세브란스 어린이병원 소아과에서 CRRT를 시행 받은 소아 중환자 32명을 대상으로 하여 환자들이 입상적 특징과 생존율, 그리고 이에 미치는 예후인자를 생존군과 사망군으로 나누어 비교하였다. 결 과 : 총 32명의 평균 나이는 7.5세로 범위는 생후 4일에서 16살까지였고 평균 몸무게는 25.8kg로 최소 3.2kg 최고 63kg였다. 기저 질환 중 조혈모세포이식과 악성종양 환자군이 가장 많았고, 이 군에서 생존율이 가장 낮았다. 전체 생존자는 11명으로 생존율은 34.4%였고 예후인자에 대한 연구에서 CRRT 시작시 PRISM III 점수($9.8{\pm}5.3$ vs. $26.7{\pm}7.6$, P<0.0001), 승압제 사용 수 ($2.1{\pm}1.2$ vs. $3.0{\pm}1.0$, P=0.038)와 수분 저류 정도 (%FO, $5.2{\pm}6.0$ vs. $15.0{\pm}8.9$, P=0.002)가 사망군보다 생존군에서 의미 있게 낮았다. 또 다중 회귀분석을 통해 높은 수분 저류만이 독립적 위험인자임을 확인하였다. 결 론 : 저자는 이 연구를 통해 소아 급성 신부전 환자에서 생존율이 환자의 중증도와 체내 수분 저류와 연관성이 높다는 것을 확인하였고, 환자의 전신상태가 보다 좋을 때 특히 수분 저류가 시작되기 전에 CRRT를 빨리 시작하는 것이 생존율을 높일 수 있다는 결론을 얻을 수 있었다.

• Childhood Kidney Diseases
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• 제11권2호
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• pp.239-246
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• 2007

목 적 : 소아에서 진행하는 신기능 저하는 그들의 인생에 일생 동안 심각한 영향을 준다. 소아 만성 신질환의 치료에 있어서 궁극적인 목표는 생명을 연장시키는 것뿐 아니라 만성 신질환에 이환됨으로써 발생하는 여러 합병증을 예방하고 성장과 발달을 향상시키는 것이다. 저자들은 소아 만성 신질환에서 신기능 감소와 관련된 위험요인을 분석하고자 한다. 방 법 : 1999년 8월부터 2007년 3월까지 만성 신질환에서 2기에서 4기에 해당하는 환자들의 임상적 특성을 후향적으로 조사하였다. 추정 사구체여과율은 혈중 크레아티닌과 키를 이용하여 Schwartz 공식으로 계산하였다. 연간 eGFR변화는 연구시작시의 eGFR과 마지막 추적 관찰시의 eGFR간의 차이를 추적 관찰 기간으로 나누어 계산하였다. 환자들을 추적 관찰중에 측정한 혈청 칼슘과 무기인과 함께 연령과 성별 및 원인 신질환도 연간 eGFR 변화와의 관련성을 조사하였다. 결 과 : 전체 환자는 61명이었고 이중 남자는 44명, 여자는 17명이었다. 연구 시작 시 환자들의 연령은 $7.1{\pm}4.7$세이었다. 전체 환자들의 연간 eGFR 변화는 $-1.2{\pm}11.9 mL/min/1.73m^2/year$이었다. 나이가 많거나(P=0.012), 저칼슘혈증이 있을 때(P=0.012), 고인산혈증인 경우(P=0.002) 신기능 감소와 유의한 관련이 있었다. 결 론 : 나이가 많거나, 저칼슘혈증과 고인산혈증은 소아 만성 신질환의 더 빠른 진행과 연관성이 있다.