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Association between Serum Uric Acid Level and ESRD or Death in a Korean Population
Kim Kipyo,Go Suryeong,Son Hyung Eun,Ryu Ji Young,이하정,Heo Nam Ju,신호준,박정환 대한의학회 2020 Journal of Korean medical science Vol.35 No.28
Background: Serum uric acid (SUA) is recognized as a risk factor for chronic kidney disease (CKD) and mortality. However, there is controversy as to whether a high or low level of SUA is related to the risk of CKD progression or death, and whether it differs between males and females. Methods: We included 143,762 adults who underwent voluntary health screening between 1995 and 2009 in Korea. For each sex, we divided participants into sex-specific quintiles according to SUA levels and compared end-stage renal disease (ESRD) incidence and mortality between the groups with low and high SUA levels and those with middle SUA levels. Sex-specific Cox proportional hazard analyses were performed for ESRD and all-cause mortality. Results: Among the 143,762 participants, 0.2% (n = 272) developed ESRD. The hazard ratio (HR) of ESRD was higher in the highest (adjusted HR, 2.13; 95% confidence interval [CI], 1.18–3.84) and lowest (adjusted HR, 1.90; 95% CI, 1.02–3.51) SUA quintiles than in the middle SUA quintile in males and the highest SUA quintile in females (adjusted HR, 2.31; 95% CI, 1.10–4.84). Four-point three percent (n = 6,215) of participants died during a mean follow-up period of 157 months. The hazard ratio (HR) of all-cause mortality was higher in the highest SUA quintile than in the middle SUA quintile in males (adjusted HR, 1.15; 95% CI, 1.03–1.28) and females (adjusted HR, 1.17; 95% CI, 1.01–1.35). Conclusion: Elevated levels of SUA are associated with increased risk for ESRD and all-cause mortality in both sexes. Low levels of SUA might be related to ESRD and death only in males, showing U-shaped associations. Our findings suggest sex-specific associations between SUA levels and ESRD development and mortality.
Severe Hypocalcemia in a Patient with Tuberous Sclerosis Complex
Kipyo Kim,Sejoong Kim,Ki Young Na,Dong-Wan Chae,Ho Jun Chin 전해질고혈압연구회 2019 Electrolytes & Blood Pressure Vol.17 No.1
Tuberous sclerosis complex(TSC) is an autosomal dominant genetic dis- order affecting multiple organs, including the brain, skin, lung, and kidney. Among the multiple comorbidities in TSC, bone mineral disturbances remain relatively unrecognized, and only a few studies have reported alteration in calcium homeostasis. Hypocalcemia is a serious medical condition in pati- ents with TSC who are at high risk for seizures. Therefore, hypocalcemia should be thoroughly evaluated by obtaining a history of associated medica- tion use and measuring vitamin D levels. Here, we report the case of a patient with TSC who presented with severe hypocalcemia which may have been related to a history of anticonvulsant use and a recent decline in kidney function, and was successfully treated with calcium and vitamin D replacement.
( Kipyo Kim ),( Eunji Baek ),( Suryeong Go ),( Hyung-eun Son ),( Ji-young Ryu ),( Yongjin Yi ),( Jong Cheol Jeong ),( Sejoong Kim ),( Ho Jun Chin ) 대한신장학회 2021 Kidney Research and Clinical Practice Vol.40 No.2
Backgrounds: Recently, alternative surrogate endpoints such as a 30% or 40% decline in estimated glomerular filtration rate (eGFR) or eGFR slope over 2 to 3 years have been proposed for predicting renal outcomes. However, the impact of GFR estimation methods on the accuracy and effectiveness of surrogate markers is unknown. Methods: We retrospectively enrolled participants in health screening programs at three hospitals from 1995 to 2009. We defined two different participant groups as YR1 and YR3, which had available 1-year or 3-year eGFR values along with their baseline eGFR levels. We compared the effectiveness of eGFR percentage change or slope to estimate end-stage renal disease (ESRD) risk according to two estimating equations (modified Modification of Diet in Renal Disease equation [eGFRm] and Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation [eGFRc]) for GFR. Results: In the YR1 and YR3 groups, 9,971 and 10,171 candidates were enrolled and ESRD incidence during follow-up was 0.26% and 0.19%, respectively. The eGFR percentage change was more effective than eGFR slope in estimating ESRD risk, regardless of the method of estimation. A 40% of decline in eGFR was better than 30%, and a 3-year baseline period was better than a 1-year period for prediction accuracy. Although some diagnostic indices from the CKD-EPI equation were better, we found no significant differences in the discriminative ability and hazard ratios for incident ESRD between eGFRc and eGFRm in either eGFR percentage change or eGFR slope. Conclusion: There were no significant differences in the prediction accuracy of GFR percentage change or eGFR slope between eGFRc and eGFRm in the general population.
Kipyo Kim,Sang Ho Lee,Sung Woo Lee,Jung Pyo Lee,Ho Jun Chin 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.5
Background/Aims: This study aimed to investigate long-term temporal trends and outcomes of biopsy-proven kidney diseases in a multicenter kidney biopsy cohort, focusing on hypertension and diabetes, the leading causes of end-stage kidney disease (ESKD). Methods: The study included a total of 21,426 patients who underwent kidney biopsy from 1979 to 2018 in 18 hospitals in Korea. We selected subgroups of adults with diabetes (n = 2,813) or clinically presumed hypertensive nephrosclerosis (HTN, n = 2,917). Clinical, demographic, and laboratory data were collected in conjunction with pathologic findings. The prevalence of pathologically confirmed kidney diseases over time and their associations with clinical outcomes were evaluated. Results: The prevalence of biopsy-proven diabetic nephropathy (DN) has increased significantly from 2.5% to 6.0% in the total cohort in the recent 30 years with an increase in the prevalence of diabetes. Approximately 68% of total diabetic patients had non-diabetic renal disease (NDRD); the proportion was retained since 2000s. DN showed a significantly higher risk of ESKD than NDRD (hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.35 to 1.88). The prevalence of biopsy- proven HT-N remained < 2% in the total cohort for several decades. There was no difference in risks of ESKD between patients with or without biopsy-proven HT-N (HR, 0.93; 95% CI, 0.54 to 1.59). Conclusions: In recent decades, the prevalence of diabetes and DN has significantly increased in the kidney biopsy cohort, showing an increased risk of ESKD. Despite the large numbers of patients meeting the clinical criteria of HT-N, most of those were diagnosed with pathologic diagnoses other than HT-N.
유전자 알고리즘의 다양성과 수렴성을 고려한 새로운 선택기법
김기표(Kipyo Kim),안창욱(Chang Wook Ahn),R.S.Ramakrishna(R.S.Ramakrishna) 한국정보과학회 2003 한국정보과학회 학술발표논문집 Vol.30 No.1B
본 논문은 유전자 알고리즘의 다양성(diversity)을 유지하면서 동시에 수렴(convergence) 속도를 향상시키기 위한 새로운 선택기법을 제안한다. 이를 위해 적합도가 높은 염색체를 다음 세대로 전달하면서 동시에 적합도가 낮은 염색체에 대해서도 일정 수준 전달되게 하였다. 또한 기존의 여러 선택기법 중 가장 일반적으로 사용되는 토너먼트 선택 기법의 문제점을 고찰하고, 제안 알고리즘의 최적도 및 수렴속도를 모의 실험을 통해 비교 및 분석한다. 실험 결과로부터 제안 알고리즘은 기존의 토너먼트 선택기법에 비해 우수함을 확인 하였다.
( Ji-eun Kim ),( Seun Deuk Hwang ),( Seoung Woo Lee ),( Joon Ho Song ),( Kipyo Kim ) 대한전해질학회 2022 Electrolytes & Blood Pressure Vol.20 No.1
Nicorandil is an anti-anginal drug that is commonly used in the treatment of ischemic heart disease. Nicorandil acts as a nitrate donor and ATP-sensitive potassium channel agonist, inducing coronary artery vasodilation. Potassium efflux through ATP-sensitive potassium channels activated by nicorandil can cause refractory hyperkalemia, particularly in patients with chronic kidney disease (CKD). Here, we report the case of an 85-year-old man who presented with severe refractory hyperkalemia, despite proper medical management. His serum potassium level increased from 4.96 to 7.21mEq/L 7 days after restarting nicorandil. Hyperkalemia resolved shortly after discontinuation of nicorandil, which was presumed to be the offending drug. Previously, a few cases reported nicorandil-induced hyperkalemia called potassium channel syndrome in patients with CKD, and hyperkalemia can be reversed by ceasing nicorandil or using sulfonyl urea drugs. Given that CKD patients may have several contributing factors to this adverse event, clinicians should be aware of the risk of nicorandil-induced hyperkalemia, and medication review and drug discontinuation should be considered.
Effect of blood pressure and glycemic control on the plasma cell-free DNA in hemodialysis patients
( Da Wun Jeong ),( Ju Young Moon ),( Young Wook Choi ),( Haena Moon ),( Kipyo Kim ),( Yu Ho Lee ),( Se Yeun Kim ),( Yang Gyun Kim ),( Kyung Hwan Jeong ),( Sang Ho Lee ) 대한신장학회 2015 Kidney Research and Clinical Practice Vol.34 No.4
Background: The plasma levels of cell-free DNA (cfDNA) are known to be elevated under inflammatory or apoptotic conditions. Increased cfDNA levels have been reported in hemodialysis (HD) patients. The aim of this study was to investigate the clinical significance of cfDNA in HD patients. Methods: A total of 95 patients on HD were enrolled. We measured their predialysis cfDNA levels using real-time EIF2C1 gene sequence amplification and analyzed its association with certain clinical parameters. Results: The mean plasma cfDNA level in the HD patients was 3,884 ± 407 GE/mL, and the mean plasma cfDNA level in the control group was 1,420 ± 121 GE/mL (P < 0.05). Diabetic patients showed higher plasma cfDNA levels compared with nondiabetic patients (P < 0.01). Patients with cardiovascular complications also showed higher plasma cfDNA levels compared with those without cardiovascular complication (P < 0.05). In univariable analysis, the cfDNA level was associated with 3-month mean systolic blood pressure (SBP), white blood cell, serum albumin, creatinine (Cr), normalized protein catabolic rate in HD patients. In diabetic patients, it was significantly correlated with SBP, hemoglobin A1c, and serum albumin. In multivariate analysis, SBP was the independent determinant for the cfDNA level. In diabetic patients, cfDNA level was independently associated with hemoglobin A1c and SBP. Conclusions: In patients with HD, cfDNA is elevated in diabetic patients and patients with cardiovascular diseases. Uncontrolled hypertension and poor glycemic control are independent determinants for the elevated cfDNA. Our data suggest that cfDNA might be a marker of vascular injury rather than proinflammatory condition in HD patients.