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진호준 ( Ho Jun Chin ) 대한내과학회 2013 대한내과학회지 Vol.85 No.1
Elderly population is growing in Korea along with increase in the prevalence of chronic diseases, such as chronic kidney disease. The proportion of elderly population aged 65 years or more among patients with incident end stage renal disease (ESRD) is increasing and has reached to 35.8% in 2011. Functional independence should be considered for management of elderly population with chronic disease because it is related to patient`s quality of life and mortality. However, functional disability in the elderly is increasing with progression of renal dysfunction and initiation of dialysis. The renal replacement therapy could not make the elderly patients with ESRD avoid of functional disability and mortality. Considering that the mortality of the elderly with ESRD is dependent on the baseline co-morbid conditions and functional disability, the nephrologists and the geriatricians need to propose the proper guidelilnes for management of the elderly patients with ESRD in near future. (Korean J Med 2013;85:29-32)
특집-만성 콩팥병, 적극적 치료가 필요하다 : 우리나라의 만성 콩팥병
진호준 ( Ho Jun Chin ),김성권 ( Suhng Gwon Kim ) 대한내과학회 2009 대한내과학회지 Vol.76 No.5
Chronic kidney disease (CKD) is an important problem worldwide. CKD is defined as either a glomerular filtration rate (GFR) of less than 60 mL/min/1.73 m2 body surface area (BSA) or the presence of kidney damage, most commonly assessed by the presence of albuminuria for at least three consecutive months. In Korea, the reported overall prevalence of CKD is 13.7%, and the prevalence of CKD according to stage is 2.0, 6.7, 4.8, 0.2, and 0.0% for stages 1 to 5, respectively. This review emphasizes the importance of awareness, making an early diagnosis, and an appropriate management strategy for CKD. (Korean J Med 76:511-514, 2009)
진호준 ( Ho Jun Chin ),나기영 ( Ki Young Na ),정해일 ( Hae Il Cheong ),김연수 ( Yon Su Kim ),김성권 ( Suhng Gwon Kim ),채동완 ( Dong Wan Chae ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.2
목적: 요산은 고혈압의 발병원인으로 거론되고 있으며 신질환에서 고혈압과 신 동맥 병변을 유발하여 신기능 악화에 관여하는 것으로 보고되고 있다. 본 연구에서는 IgA 신병증에서 가능한 교란 변수 효과를 배제하여 요산의 신기능 악화인자 역할을 조사하고 그 병리 기전으로 요산과 고혈압 및 신동맥 병변과의 관련성을 조사하였다. 방법: 신조직 검사에서 확진을 받은 서울대학교 병원의 IgA 신병증 환자 172명을 대상으로 하였다. 신기능 악화 기준은 추적 도중 혈청 크레아티닌이 신 조직 검사 당시 혈청 크레아티닌의 2배 이상 증가하는 경우로 정하였다. 고요산군은 정상인 혈청 요산 수치의 4사분위에 해당되는 요산 수치를 가진 환자군으로 정하였다. 결과: IgA 신병증에서 혈중 요산 수치는 간질 섬유화, 세뇨관 위축, 세동맥 경화의 존재와 관련이 있었고, 추적 전후 혈압의 변동과는 무관하였다. 고요산군은 다변량 분석에서 IgA 신병증의 신기능 악화에 대한 위험인자 이었다. 고혈압, 사구체 여과율, 병리 소견으로 세분하여 분석한 결과 고요산군은 고혈압 유무와 세동맥 경화 유무에 관련없이 신병증의 예후를 결정하는 독립적인 인자이었고, 사구체 여과율이 60mL/min/1.73m2 이상인 환자군에서도 예후 인자로 분석되었다. 결론: IgA 신병증에서 고요산혈증은 신 동맥 병변과 신기능 악화와 관련이 있었다. Purpose: Many evidences about hyperuricemia as a risk factor to hypertension and renal progression in kidney diseases have been reported. We have analyzed the impact of uric acid on renal progression of IgA nephropathy while getting rid of possible confounding variables and revealed the possible pathophysiology of uric acid in terms of hypertension or renal vasculopathy provoked by uric acid. Methods: We selected 172 patients with IgA nephropathy diagnosed by renal biopsy at Seoul National University Hospital. We adapted the criteria of renal progression as the final value of serum creatinine increased more then twice compared to the value at renal biopsy. Results: Serum uric acid was correlated with the severity of interstitial fibrosis and tubular atrophy and the presence of artherosclerosis. The incidence of hypertension during follow-up period was not different between low uric acid group and high uric acid group. The high uric acid level was an independent risk factor to renal progression in IgA nephropathy with multivariate analysis regardless of the presence of hypertension or artherosclerosis of renal pathologic finding. The high uric acid level was also a risk factor to renal progression in patients with estimated GFR more than 60 mL/min/1.73m2. Conclusion: Serum uric acid was related to the presence of artherosclerosis and the renal progression of IgA nephropathy.
건강검진을 받은 대상에서 만성 신질환의 빈도와 관련 이상
진호준 ( Ho Jun Chin ),오국환 ( Kook Hwan Oh ),오윤규 ( Yoon Kyu Oh ),나기영 ( Ki Young Na ),주권욱 ( Kwon Wook Joo ),임춘수 ( Chun Soo Lim ),김연수 ( Yon Su Kim ),채동완 ( Dong Wan Chae ),안규리 ( Cu Rie Ahn ),한진석 ( Jin Suk Ha 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.2
목적: 말기 신부전을 포함한 만성 신질환은 세계적으로 지속적으로 증가하고 있으며 사회적인 의료 부담을 증가시키고 있으나 국내에서는 만성 신질환에 대한 대규모 역학조사 결과가 없는 실정이다. 방법: 분당서울대학교 병원에서 최근 2년간 건강검진을 받은 18세 이상의 14,856명을 대상군으로 정하였다. 미국신장협회의 만성 신질환 진단기준을 이용하였으며 사구체 여과율은 수정된 MDRD 공식으로 계산하였다. 결과: 대상군의 평균 사구체 여과율은 83.3 mL/min/1.73 m2이었으며 연령이 10년 증가할 때마다 5.0 mL/min/1.73 m2씩 감소하였다. 만성 신질환 1기에 해당되는 대상군은 3.2% 이었고 2기와 3기 이상인 군은 각각 9.4%와 3.5%이었다. 만성 신질환의 빈도는 고혈압 혹은 당뇨가 있는 군에서 없는 군보다 많았다. 만성 신질환과 연관된 고혈압, 심혈관계 질환 병력, 고요산혈증, 고칼륨혈증, 고인산혈증과 고중성지방혈증은 사구체 여과율이 정상인 만성 신질환인 경우에서도 그 빈도가 신질환이 없는 군에 비하여 높았다. 만성 신질환을 가진 대상군에서 만성 신질환을 인지하고 있었던 경우는 6.3%이었으며, 혈압과 혈당이 비신질환자에 비하여 적절하게 조절되는 비율이 낮았다. 결론: 건강검진을 받은 대상자들에서 만성 신질환과 유관 질환은 의미있게 높게 조사되었으나 신질환에 대한 인지도와 적절한 혈압과 혈당이 유지되는 비율이 비신질환자에 비하여 낮았다. Purpose: The prevalence of chronic kidney disease (CKD) is increasing in Korea. Considerable resources have been consumed for patients with CKD. This study investigated the prevalence, the associated disorders, and the awareness of CKD and the current status of appropriate control for blood pressure and blood sugar in subjects with CKD. Methods: We included 14,856 subjects who underwent a health check-up in Seoul National University Bundang Hospital during the last 2 years. We selected K/DOQI guideline of CKD. We used the modified MDRD equation to estimate the glomerular filtration rate (eGFR). Results: The mean eGFR was 83.3 mL/min/1.73m2 and it decreased with aging at the rate of 5 (mL/min/1.73m2)/10 years. The prevalences of CKD stage 1, stage 2, and stage more than 3 were 3.2%, 9.4%, and 3.5%, respectively. The prevalence of CKD was higher in subjects with hypertension or diabetes mellitus than in subjects without it. The CKD was associated with disorders of hypertension, cardiovascular diseases, hyperuricemia, hyperphosphatenemia, hyperkalemia, and hypertriglyceridemia. The prevalence of reported kidney disease was only 6.5% in subjects with eGFR less than 60 mL/min/1.73m2. The frequency of adequate control of blood pressure and blood sugar in subjects with CKD was lower than in subjects without CKD. Conclusion: The subjects were rarely aware of CKD whereas the frequencies of CKD and the associated diseases were considerably high. We have to pay more attention to diagnose and treat the CKD.
한국인에서 고요산혈증 및 대사 증후군이 고혈압의 발생에 미치는 영향
진호준 ( Ho Jun Chin ),나기영 ( Ki Young Na ),김연수 ( Yon Su Kim ),채동완 ( Dong Wan Chae ),김성권 ( Suhng Gwon Kim ) 대한내과학회 2007 대한내과학회지 Vol.73 No.1
요산은 건강 검진을 받은 대상군에서 성별 및 대사 증후군과 무관하게 고혈압 발병의 위험인자이었으며, 대사증후군 역시 고혈압 발병에 중요한 위험인자이었다. Backgrouds: Uric acid has been proposed as an important risk factor for the development of primry hypertension. Many factors related to the serum uric acid level also influence the prevalence and incidence of hypertension. Especially, hyperuricemia is considered a secondary phenomena of metabolic syndrome. We evaluated the impact of uric acid and metabolic syndrome on the development of hypertension, with exclusion of the possible effects of confounding factors on both the uric acid level and the incidence of hypertension. Methods: We included 2,390 subjects without hypertension who had undergone multiple health check-ups at the Seoul National University Hospital during the last 10 years. We selected the JNC VII criteria for hypertension and the modified ATP III criteria for metabolic syndrome. Results: During the mean follow-up period of 54.3 months, hypertension was developed in 32.2% of the subjects. The incidence of hypertension in the high uric acid group was higher than that in the low uric acid group. Metabolic syndrome was an independent risk factor for hypertension and it was closely related to the prevalence of high uric acid level. Uric acid was also an independent risk factor for hypertension in each gender. The relationship between uric acid and hypertension was evident for the subjects without metabolic syndrome. Conclusions: Serum uric acid was a risk factor for hypertension in each gender regardless of the absence of metabolic syndrome. Metabolic syndorme also contributed to the development of hypertension.(Korean J Med 73:58-66, 2007)
전자의무기록 팝업차트를 활용한 CRRT 관리의 질향상 활동
고수령,이안나,김기표,진호준,나기영,채동완,김세중,Go, Su-Ryeong,Lee, An-Na,Kim, Ki-Pyo,Chin, Ho-Jun,Na, Ki-Young,Chae, Dong-Wan,Kim, Se-Joong 한국의료질향상학회 2019 한국의료질향상학회지 Vol.25 No.1
Purpose: The time lag between the decision to initiate continuous renal replacement therapy (CRRT) and its actual initiation remains a major barrier in our intensive care units. We developed a CRRT pop-up chart on EMR for managing CRRT machines. Methods: This study measured time interval between the decision to prepare the CRRT machine and the actual use of the machine before and after using a CRRT pop-up chart. This study conducted a questionnaire of the medical staff to assess the changes in the quality of CRRT preparation. Results: A total of 95 patients on CRRT is analyzed. The time to find an available CRRT machine is decreased by 24.6%. The time to move a CRRT machine to the patient's bedside is decreased by 55.8%. Medical surveys of 44 nurses gave the following results. 1) The time to apprehend machines for 1 to 3 minutes is improved from 29.5% to 81.8%, and the time to apprehend machines over 3 minutes is decreased from 70.5% to 18.2%. 2) The number (6-all) of known machine locations is improved from 22.7% to 63.4%. 3) Interruption of a nurse's work due to telephone calls asking for the possession of movable CRRT equipment also is improved. Scores of 1-4 are improved from 15.9% to 41%. Scores of 5-7 are reduced from 52% to 15.9%. Conclusions: CRRT pop-up chart is shortened the time lag of CRRT machine preparation, reduced the nurse's phone workload and helped to improve the quality of CRRT care.