• Korean Circulation Journal
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• v.54 no.9
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• pp.549-561
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• 2024

Background and Objectives: The efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) may depend on renal function, and this raises theoretical concern over its effects on cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Methods: This systematic review and updated meta-analysis of randomized controlled trials (RCTs) compared cardiovascular outcomes of patients with T2DM and CKD treated with SGLT2i to placebo. PubMed, Embase, and Cochrane were systematically searched. Prespecified subgroup analyses were performed in strata of estimated glomerular filtration rate (eGFR) of <45 mL/min/1.73 m² and 45 to 59 mL/min/1.73 m². Results: Nine RCTs comprising 29,146 patients were selected. Average follow-up ranged from 0.75 to 4.2 years. SGLT2i were shown to reduce the risk of all-cause mortality (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.79-0.97; p=0.01), the composite of cardiovascular mortality or hospitalizations for heart failure (HHF: HR, 0.71; 95% CI, 0.65-0.78; p<0.001), cardiovascular mortality (HR, 0.86; 95% CI, 0.76-0.98; p=0.02), HHF (HR, 0.62; 95% CI, 0.55-0.71; p<0.001), major adverse cardiovascular events (HR, 0.85; 95% CI, 0.77-0.94; p=0.002), stroke (HR, 0.76; 95% CI, 0.59-0.97; p=0.03), and myocardial infarction (HR, 0.78; 95% CI, 0.67-0.91; p=0.001). These findings were consistent over strata of eGFR, albeit with a lower incidence of stroke in patients treated with SGLT2i with eGFR <45 mL/min/1.73 m² (p-value for interaction=0.04). Conclusions: Compared with a placebo, patients with T2DM and CKD treated with SGLT2i experience a reduction in all-cause mortality, cardiovascular mortality, and HHF.

• Korean Journal of Clinical Pharmacy
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• v.30 no.1
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• pp.36-43
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• 2020

Background: Tacrolimus, a calcineurin inhibitor, is an immunosuppressant used in post-transplantation maintenance therapy. The drug has a narrow therapeutic range and requires periodic therapeutic drug monitoring. Although many studies have reported the effects of intrapatient variability of tacrolimus on survival, rejection, and complications in renal transplant recipients, very few studies have reported these effects in liver transplant recipients. The purpose of this study was to evaluate the effect of intrapatient variability of tacrolimus on clinical outcomes after liver transplantation. Methods: Intrapatient variability was calculated using individual, averaged tacrolimus concentrations. Patients were divided into two groups according to their median variability value: high-variability and low-variability groups. The rate of deviation from the therapeutic range, incidence of acute rejection, post-transplant diabetes, incidence of infection, and estimated glomerular filtration rate (eGFR) after transplantation were compared between the groups. Results: Of the total patients (n=82), the high-variability group (n=41) exhibited significantly greater deviation from the therapeutic range (65.92% vs. 56.84%; p<0.001). There was no significant difference in acute rejection or post-transplantation diabetes incidence or eGFR; however, the number of infection in the first 6 months was significantly lower in the low-variability group (0.4 vs. 0.9 times; p=0.039). Multiple linear regression analysis showed that the number of infection significantly increased as intrapatient variability increased (p=0.015). Conclusion: High intrapatient variability in tacrolimus concentrations was strongly associated with an increased frequency of deviation from the suggested therapeutic range and an increased number of infection.

• Journal of Yeungnam Medical Science
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• v.37 no.4
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• pp.314-320
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• 2020

Background: A diabetic foot is the most common cause of non-traumatic lower extremity amputations (LEA). The study seeks to assess the risk factors of amputation in patients with diabetic foot ulcers (DFU). Methods: The study was conducted on 351 patients with DFUs from January 2010 to December 2018. Their demographic characteristics, disease history, laboratory data, ankle-brachial index, Wagner classification, osteomyelitis, sarcopenia index, and ulcer sizes were considered as variables to predict outcome. A chi-square test and multivariate logistic regression analysis were performed to test the relationship of the data gathered. Additionally, the subjects were divided into two groups based on their amputation surgery. Results: Out of the 351 subjects, 170 required LEA. The mean age of the subjects was 61 years and the mean duration of diabetes was 15 years; there was no significant difference between the two groups in terms of these averages. Osteomyelitis (hazard ratio [HR], 6.164; 95% confidence interval [CI], 3.561-10.671), lesion on percutaneous transluminal angioplasty (HR, 2.494; 95% CI, 1.087-5.721), estimated glomerular filtration rate (eGFR; HR, 0.99; 95% CI, 0.981-0.999), ulcer size (HR, 1.247; 95% CI, 1.107-1.405), and forefoot ulcer location (HR, 2.475; 95% CI, 0.224-0.73) were associated with risk of amputation. Conclusion: Osteomyelitis, peripheral artery disease, chronic kidney disease, ulcer size, and forefoot ulcer location were risk factors for amputation in diabetic foot patients. Further investigation would contribute to the establishment of a diabetic foot risk stratification system for Koreans, allowing for optimal individualized treatment.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.6
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• pp.652-657
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• 2000

The kidneys play a vital role in the maintenance of normal body fluid volumes and in the composition of the extracellular fluid compartments. There are normally more than 2 million functioning glomeruli that regulate total body water and solute concentrations. As renal failure progresses, there is a decrease in the number of functioning nephrons. Chronic renal failure(CRF) is the consequence of a multitude of diseases that cause permanent destruction of the nephron. Azotemia is an elevation in blood urea nitrogen(BUN) and serum creatinine levels subsequent to a decreased glomerular filtration rate(GFR), which results in uremia. This loss of renal function can cause functional and metabolic abnomalities of body. For this problem, oral & maxillofacial surgeons have demanded to routinely treat patients with CRF. However, there has not been a reported case of orthognathic surgery by bilateral sagittal split ramus osteotomy(BSSRO) in patients with CRF, which can cause multiple complications in healthy patients. We report developmental mechanism of complication associated with CRF and preop. and postop. care of orthognathic surgery by BSSRO in Cl III patient with severe chronic renal failure.

• The Journal of Internal Korean Medicine
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• v.42 no.5
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• pp.727-737
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• 2021

Objectives: This study investigated the effect of Korean medicine on an elderly patient with posterior circulation cerebral infarction, chronic kidney disease (CKD), and early neurological deterioration (END). Methods: The patient, who already had CKD, was treated with Korean medicine, comprising herbal medicine, acupuncture, moxa, and cupping combined with Western medicine (antiplatelet, diabetes) and physical therapy. A manual muscle test (MMT) and a modified Barthel index (MBI) were used to observe the treatment effects, and blood tests were performed to check estimated glomerular filtration rate (eGFR), creatinine and blood urea nitrogen (BUN), which represent renal function. Results: After the treatment, MMT, MBI, and renal function scores had increased. Conclusions: This study suggests that Korean medicine can effectively treat posterior circulation cerebral infarction with END in CKD, but further studies should be conducted.

• The Journal of Korean Obstetrics and Gynecology
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• v.32 no.3
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• pp.142-161
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• 2019

Objectives: The purpose of this study is to report the effect and safety of traditional Korean medicine (TKM) for enhanced recovery after surgery (ERAS) after gynecological surgery. Methods: The study is conducted by analyzing the medical records of the hospitalized patients in TKM hospital. Eighty-six patients were enrolled who received TKM for ERAS after gynecological surgery from January 2015 to April 2018. We performed statistical analysis by using SPSS ver. 25.0. To prove the effect and safety of TKM for ERAS, we analyzed symptoms and Hemoglobin (Hb), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and serum creatinine (Cr) with glomerular filtration rate (GFR). In addition, we checked other adverse reactions that the patients complained to prove the safety of TKM for ERAS. Results: Among symptoms of pain, there was a statistically significant decrease in abdominal pain, lower back pain, and shoulder pain. Other symptoms showed statistically significant improvement in fatigue, abdominal tympanosis, operation-site discomfort, dizziness, urinary discomfort, throat discomfort, constipation, dyspepsia and colporrhagia. Anemia in both ferritin combination treatment group and herbal medicine only group showed significant improvement. There was no liver damage or renal damage by TKM. Conclusions: The result has shown that TKM for ERAS after gynecological surgery is effective and safe. The further study of TKM for ERAS with more patients is needed.

• Journal of Korea Entertainment Industry Association
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• v.13 no.4
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• pp.363-368
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• 2019

The aim of this study was to assess gender difference in the association of obesity and abdominal obesity and chronic kidney disease(CKD). The study subjects were Korean adults 20 years or older(n=9,409) who participated in the Korea National Health and Nutrition Examination Survey 2013-2014. In men, after adjusting for relevant variables, the Odds ratio(OR) of CKD[estimated glomerular filtration rate(eGFR) < 60ml/min/1.73m²] with a normal weight group[body mass index(BMI) < 23.0kg/m²], as a reference were significant for the obesity[BMI ≥ 25.0kg/m², 1.83(95% CI, 1.20-2.80)], but abdominal obesity[waist measurement(WM) ≥ 90cm, 1.30(95% CI, 0.89-1.89)] group compared to the normal group(WM < 90cm) was not significant. However, in women, the OR of CKD with a normal group(WM < 80cm) as a reference were significant for the abdominal obesity[WM ≥ 80cm, 1.52(95% CI, 1.52-2.28)] group, but obesity group[1.37(95% CI, 0.89-2.11)] compared to the normal weight group was not significant. In conclusion, the obesity in Korean men and abdominal obesity in women were positively associated with CKD.

• The Korean Journal of Nuclear Medicine
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• v.35 no.2
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• pp.89-99
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• 2001

Purpose: In this study, we developed a new software tool for the analysis of renal scintigraphy which can be modified more easily by a user who needs to study new clinical applications, and the appropriateness of the results from our program was studied. Materials and Methods: The analysis tool was programmed with IDL5.2 and designed for use on a personal computer running Windows. For testing the developed tool and studying the appropriateness of the calculated glomerular filtration rate (GFR), $^{99m}Tc$-DTPA was administered to 10 adults in normal condition. In order to study the appropriateness of the calculated mean transit time (MTT), $^{99m}Tc-DTPA\;and\;^{99m}Tc-MAG3$ were administered to 11 adults in normal condition and 22 kidneys were analyzed. All the images were acquired with ORBITOR. the Siemens gamma camera. Results: With the developed tool, we could show dynamic renal images and time activity curve (TAC) in each ROI and calculate clinical parameters of renal function. The results calculated by the developed tool were not different statistically from the results obtained by the Siemens application program (Tmax: p=0.68, Relative Renal Function: p:1.0, GFR: p=0.25) and the developed program proved reasonable. The MTT calculation tool proved to be reasonable by the evaluation of the influence of hydration status on MTT. Conclusion: We have obtained reasonable clinical parameters for the evaluation of renal function with the software tool developed in this study. The developed tool could prove more practical than conventional, commercial programs.

• Korean Journal of Clinical Laboratory Science
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• v.53 no.3
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• pp.208-216
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• 2021

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to investigate the status of renal function in patients with COVID-19. The study surveyed a total of 649 patients hospitalized with COVID-19 at a hospital located in southern Gyeonggi Province, South Korea over a one month period in January 2021. The parameters analyzed were blood urea nitrogen (BUN), creatinine, sodium, potassium, chloride, and estimated glomerular filtration rate (eGFR). The BUN and creatinine of the COVID-19 patients were found to be higher than the normal reference range, specially in males, and in the elderly (60s and 80s or older). The serum electrolyte levels of the patients were observed to be within the reference intervals. Of the subjects, males over 80 years of age had a Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) of 60 mL/min/1.73 m² or less. Recent research suggests that some severe cases of COVID-19 are showing signs of kidney damage, even in those with no prior underlying kidney disease. Thus, assessment of kidney function using multiple indicators could help diagnose abnormal renal function in patients with COVID-19.

• Journal of the Korean Society of Radiology
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• v.14 no.7
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• pp.871-879
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• 2020

The purpose of this study was to analysis the correlation between kidneys function indicators and these size in ultrasonography. A total of 170 (male:86, female:84) patients of sex and age groups were examined by abdominal ultrasonography. The patients classified as those in their 20's, 30's, 40's, and over 50's. We measured the length, width, and cross-sectional height of the kidneys twice. At this time, the length of these were measured from the maximum upper to the maximum lower pole and the widest width in the same ultrasonography was measured to obtain the cross-sectional area. Other relevant indicators included body surface area, serum creatinine, glomerular filtration rate (GFR), MDRD (Modification of diet in renal disease) and C-G (Cockcroft-Gault). Significant comparisons of differences between relevant factors by age groups and sex were conducted with a one-way distribution analysis. Correlation analysis was also performed between relevant factors by using Pearson and Spearman correlation coefficient. It was defined as meaningful when the p-value was less than 0.05. As a result, the length, the width, and the cross-sectional area of kidneys were correlated with GFR, C-G, MDRD. Therefore, it is expected that the accuracy of diagnosis of kidneys disease will be increased if the relevant indicators are evaluated together rather than measuring only length of these in ultrasonography.