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Article ; Online: Epidemiological characteristics of cancers in patients with end-stage kidney disease

Min-Jeong Lee / Eunyoung Lee / Bumhee Park / Inwhee Park

Scientific Reports, Vol 11, Iss 1, Pp 1-

a Korean nationwide study

2021 Volume 10

Abstract: Abstract Patients with end-stage kidney disease (ESKD) have been reported to have an increased risk of cancer. However, the epidemiological characteristics of cancer in ESKD patients remain unclear. Therefore, this study aimed to investigate the ... ...

Abstract	Abstract Patients with end-stage kidney disease (ESKD) have been reported to have an increased risk of cancer. However, the epidemiological characteristics of cancer in ESKD patients remain unclear. Therefore, this study aimed to investigate the epidemiological characteristics of cancer in ESKD patients and the differences based on the renal replacement therapy provided. Data on ESKD patients were obtained from the South Korean nationwide cohort Health Insurance Review and Assessment Service database. This study included 58,831 eligible patients of the total 813,907 patients diagnosed with ESKD between January 1, 2007 and December 31, 2017. Of the 58,831 ESKD patients, 3292 (5.6%) were newly diagnosed with cancer. The average duration between the diagnosis of ESKD and cancer was 3.3 ± 1.9 years (mean ± standard deviation), with no differences between hemodialysis, peritoneal dialysis, and kidney transplant groups. The most commonly observed cancer sites in ESKD patients were the colorectum, lung, and liver. The incidence of cancer increased progressively among patients undergoing kidney transplant, peritoneal dialysis, and hemodialysis in that order. Hemodialysis patients were found to have an increased risk of digestive tract cancer compared with kidney transplant patients (adjusted hazard ratio = 1.9; 95% confidence interval: 1.31–2.81; P < 0.001). The study findings may be a useful reference for cancer-screening guidelines.
Keywords	Medicine ; R ; Science ; Q
Subject code	610 ; 616
Language	English
Publishing date	2021-02-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Characteristics of fracture in patients who firstly starts kidney replacement therapy in Korea

Youngrong Kim / Eunyoung Lee / Min-Jeong Lee / Bumhee Park / Inwhee Park

Scientific Reports, Vol 12, Iss 1, Pp 1-

a retrospective population-based study

2022 Volume 9

Abstract: Abstract The incidence of fractures in patients with end-stage kidney disease (ESKD) is high which is associated with high morbidity and mortality. Since fractures are preventable diseases to some extent, epidemiologic studies are needed a lot. The aim ... ...

Abstract	Abstract The incidence of fractures in patients with end-stage kidney disease (ESKD) is high which is associated with high morbidity and mortality. Since fractures are preventable diseases to some extent, epidemiologic studies are needed a lot. The aim of this study is to explore the epidemiology of fractures by modality of kidney replacement therapy (KRT). We performed a retrospective analysis of 52,777 patients dependent on KRT from 2008 to 2017 using the National Health Insurance System of Republic Korea. Fractures were occurred in 8995 (17.04%) of 52,777 patients with ESKD. Hemodialysis and kidney transplant patients had the highest (57.4 per 1000 person-year) and the lowest (25.2 per 1000 person-year) incidence rate, respectively. The two most common fracture sites were the lower limb and upper limb, regardless of KRT modality. The first fractures were about 2.55 ± 2.07 years after KRT initiation, the earliest in Hemodialysis patients. Diabetes mellitus, cerebrovascular disease, chronic lung and liver disease were risk factors of fractures. The use of steroids, anti-osteoporosis medications, and some classes of psychotropics and opioids was associated with an elevated risk. The results of this study inform the understanding of fractures in KRT patients.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Risk of fracture according to glucocorticoid use after renal biopsy

Eunyoung Lee / Min-Jeong Lee / Bumhee Park / Inwhee Park

Scientific Reports, Vol 10, Iss 1, Pp 1-

a nationwide population-based study

2020 Volume 9

Abstract: Abstract Few data are available regarding fracture risk in patients treated with glucocorticoids, including patients with kidney disease. A population-based retrospective cohort study was performed using Health Insurance Review and Assessment Service ... ...

Abstract	Abstract Few data are available regarding fracture risk in patients treated with glucocorticoids, including patients with kidney disease. A population-based retrospective cohort study was performed using Health Insurance Review and Assessment Service database, a South Korean nationwide cohort set. This study identified 44,702 patients with diagnosis code of kidney diseases who received a renal biopsy between January 1, 2012 and December 31, 2017. A total of 8,624 patients met all study inclusion criteria. A total of 1,406 fractures of any site were observed in the study period. The glucocorticoid-exposed group had more fractures than the unexposed (14.4% vs 8.8%, P < 0.0001). Vertebral fractures were the most common, followed by upper limb, and lower limb fractures. The exposed group showed a remarkably higher hazard ratio of fracture risk (HR 6.0, 95% CI 5.01–7.23) than the unexposed group, indicating systemic glucocorticoid exposure was highly associated with fracture risk. Although HR increased at doses even less than 5 mg/day, it was independent of dose. Older age showed a significant effect on fracture risk (HR 1.2, 95% CI 1.05–1.44), even after adjusting for systemic glucocorticoid exposure. Glucocorticoids was associated with higher risk of fracture even at a low daily dose and short term exposure.
Keywords	Medicine ; R ; Science ; Q
Subject code	610 ; 616
Language	English
Publishing date	2020-08-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Preexisting comorbidities are associated with the mortality rate as well as the predialysis adverse events in incident dialysis patients

Min-Jeong Lee / Inwhee Park / Heungsoo Kim / Gyu-Tae Shin / Jong Cheol Jeong

Kidney Research and Clinical Practice, Vol 40, Iss 3, Pp 419-

2021 Volume 431

Abstract: Background Optimal estimated glomerular filtration rate (eGFR) to start maintenance dialysis is controversial. Observational studies have reported that initiation of dialysis at high eGFRs is associated with worse postdialysis survival. Methods We ... ...

Abstract	Background Optimal estimated glomerular filtration rate (eGFR) to start maintenance dialysis is controversial. Observational studies have reported that initiation of dialysis at high eGFRs is associated with worse postdialysis survival. Methods We retrospectively investigated 1,038 incident dialysis patients who started maintenance dialysis during 2010–2015. Patients were assessed for comorbidities and adverse events during the transitional period of dialysis initiation. Patients were classified as planned dialysis (PD) vs. unplanned dialysis (UD) according to indications for dialysis initiation. Results UD group comprised 352 patients (33.9%). Mean eGFR at dialysis initiation was higher in UD patients than PD patients (7.9 ± 5.1 vs. 5.9 ± 3.4 mL/min/1.73 m2, p < 0.001). Mean Davies comorbidity index in the UD group was higher (vs. PD group, 1.3 ± 1.0 vs. 0.9 ± 1.0, p < 0.001). Patients with more comorbidities experienced more ischemic heart disease (hazard ratio [HR], 4.36; 95% confidence interval [CI], 1.71–11.14) in the medium-risk group and HR of 8.84 (95% CI, 3.06–25.55) in the high-risk group (vs. low-risk group, p < 0.001)) during the predialysis period. High-risk group had increased postdialysis mortality (HR, 2.48; 95% CI, 1.46–4.20; p = 0.001). Adjusted HR of mortality was higher in the medium-risk group of UD patients (HR, 1.72; 95% CI, 1.16–2.56; p = 0.007). Conclusion Patients with more comorbidities were at increased risk of predialysis ischemic heart disease and postdialysis mortality. UD patients in the medium-risk population had increased risk of postdialysis mortality. Dialysis start should be individualized by considering comorbidities.
Keywords	comorbidity ; dialysis ; glomerular filtration rate ; mortality ; Internal medicine ; RC31-1245 ; Specialties of internal medicine ; RC581-951
Subject code	610
Language	English
Publishing date	2021-09-01T00:00:00Z
Publisher	The Korean Society of Nephrology
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Characterization of Medication Trends for Chronic Kidney Disease

Sungdam Han / Minkook Son / Byungjin Choi / ChulHyoung Park / Dong Ho Shin / Jong Hwan Jung / Min-Jeong Lee / Gyu-Tae Shin / Heungsoo Kim / Rae Woong Park / Inwhee Park

BioMed Research International, Vol

Mineral and Bone Disorder Treatment Using Electronic Health Record-Based Common Data Model

2021 Volume 2021

Abstract: Chronic kidney disease–mineral bone disorder (CKD-MBD) is the most common complication in CKD patients. Although there is a consensus on treatment guidelines for CKD-MBD, it remains uncertain whether these treatment recommendations reflect actual ... ...

Abstract	Chronic kidney disease–mineral bone disorder (CKD-MBD) is the most common complication in CKD patients. Although there is a consensus on treatment guidelines for CKD-MBD, it remains uncertain whether these treatment recommendations reflect actual practice. Therefore, the aim of this study was to investigate the CKD-MBD medication trend in real-world practice. This was a retrospective and observational study using a 12-year period database transformed into a common data model from three tertiary university hospitals. Study populations were subjects initially diagnosed as CKD. The date of diagnosis was designated as the index date. New patients were categorized year to year from 2008 to 2019 with a fixed observation period of 365 days to check the prescription of CKD-MBD medications including calcium-containing phosphate binder, noncalcium-containing phosphate binder, aluminium hydroxide, vitamin D receptor activator (VDRA), and cinacalcet. The numbers of CKD patients in the three hospitals were 7555, 2424, and 5351, respectively. The proportion for patients with CKD-MBD medication prescription decreased yearly regardless of hospital and CKD stage (p for trend < 0.05). The use of aluminium hydroxide disappeared steadily while the use of VDRA increased annually in all settings. Despite these changes in prescription patterns, the mean value for CKD-MBD-related serologic markers was almost within target range. The proportion of the population within the target value was not significantly changed. Irrespective of hospital and CKD stage, similar trends of prescription for CKD-MBD medications were observed in real-world practice. Further research with a distributed network study may be helpful to understand medication trends in CKD-MBD treatment.
Keywords	Medicine ; R
Subject code	616
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Hindawi Limited
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Comparison of estimated glomerular filtration rate equations at the time of hemodialysis initiation

Min-Jeong Lee / Seirhan Kim / Inwhee Park / Heungsoo Kim / Gyu-Tae Shin

Kidney Research and Clinical Practice, Vol 34, Iss 4, Pp 207-

2015 Volume 211

Abstract: Background: Estimated glomerular filtration rate (eGFR) is one of the most important guidelines in deciding the optimal timing of dialysis initiation. In the present study, we calculated the eGFR at the time of hemodialysis (HD) initiation using 5 ... ...

Abstract	Background: Estimated glomerular filtration rate (eGFR) is one of the most important guidelines in deciding the optimal timing of dialysis initiation. In the present study, we calculated the eGFR at the time of hemodialysis (HD) initiation using 5 commonly used equations to relate them with clinical and laboratory characteristics of the patients and to evaluate which of these equations best define the eGFR at HD initiation. Methods: We retrospectively analyzed 409 end-stage renal disease patients who were newly started on HD treatment in our institution. The eGFR was calculated using the Cockcroft–Gault equation, the Cockcroft–Gault equation corrected for body surface area, the Modification of Diet in Renal Disease (MDRD) equation, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, and the Nankivell equation. Results: The mean eGFRs at HD start were significantly different across the equations. The mean eGFR was 7.8 mL/min for the corrected Cockcroft–Gault equation, 7.7 mL/min for the Cockcroft–Gault equation, 6.2 mL/min/1.73 m2 for the MDRD equation, and 5.6 mL/min/1.73 m2 for the CKD-EPI equation. The corrected Cockcroft–Gault, the MDRD, and the CKD-EPI equations were well correlated with all CKD-specific complications including hypertension, anemia, hyperkalemia, metabolic acidosis, hypocalcemia, hyperphosphatemia, and hyperparathyroidism. The mean eGFR calculated by the corrected Cockcroft–Gault equation showed the lowest coefficient of variation among all the equations. Conclusions: The eGFR at HD initiation are significantly different according to the used eGFR equations, and the corrected Cockcroft–Gault equation may be the best in defining the eGFR at HD initiation.
Keywords	Corrected Cockcroft-Gault equation ; End-stage renal disease ; Estimated glomerular filtration rate ; Hemodialysis ; Internal medicine ; RC31-1245 ; Specialties of internal medicine ; RC581-951
Subject code	616
Language	English
Publishing date	2015-12-01T00:00:00Z
Publisher	The Korean Society of Nephrology
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Clinical analysis of single filtration plasmapheresis using continuous renal replacement therapy machines in kidney transplantation

Eunsoo Lim / Yujeong Kim / Jong Cheol Jeong / Inwhee Park / Heungsoo Kim / Su Hyung Lee / Chang-Kwon Oh / Gyu-Tae Shin

Kidney Research and Clinical Practice, Vol 36, Iss 2, Pp 192-

2017 Volume 199

Abstract: Background: Plasmapheresis has become an essential element of kidney transplantation (KT). In the present study, we report clinical outcomes of filtration plasmapheresis using continuous renal replacement therapy machines with a single filter for the ... ...

Abstract	Background: Plasmapheresis has become an essential element of kidney transplantation (KT). In the present study, we report clinical outcomes of filtration plasmapheresis using continuous renal replacement therapy machines with a single filter for the first time in Korea. Methods: We retrospectively analyzed six patients who underwent filtration plasmapheresis for KT in our center; plasmapheresis was performed using the Plasmaflex (Baxter®) with a TPE 2000 filter set (Baxter®) in our hemodialysis unit. Five percent albumin was used as the replacement fluid, and intravenous immunoglobulin G was administered after each plasmapheresis session. The target preoperative ABO isoagglutinin titer was less than 1:8. Results: Filtration plasmapheresis was performed in four patients for ABO-incompatible KT, one for antibody-mediated rejection after KT, and the last one for positive T cell crossmatch. Altogether, 46 sessions of plasmapheresis were performed. ABO isoagglutinin titers successfully declined to or below the target level in all patients, and all patients successfully received KT with no significant antibody titer rebound. Acute antibody-mediated rejection and positive T cell crossmatch were well treated with filtration plasmapheresis, and no patient required fresh frozen plasma infusion for coagulopathy. There were one episode of hypotension and three of hypocalcemia. No patients experienced bleeding, infection, or allergic reaction. Conclusion: Filtration plasmapheresis was effective and safe. Although our result is from a single center, our protocol appears to be promising.
Keywords	Filtration ; Kidney transplantation ; Plasmapheresis ; Internal medicine ; RC31-1245 ; Specialties of internal medicine ; RC581-951
Subject code	616 ; 610
Language	English
Publishing date	2017-06-01T00:00:00Z
Publisher	The Korean Society of Nephrology
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Can we predict when to start renal replacement therapy in patients with chronic kidney disease using 6 months of clinical data?

Min-Jeong Lee / Joo-Han Park / Yeo Rae Moon / Soo-Yeon Jo / Dukyong Yoon / Rae Woong Park / Jong Cheol Jeong / Inwhee Park / Gyu-Tae Shin / Heungsoo Kim

PLoS ONE, Vol 13, Iss 10, p e

2018 Volume 0204586

Abstract: PURPOSE:We aimed to develop a model of chronic kidney disease (CKD) progression for predicting the probability and time to progression from various CKD stages to renal replacement therapy (RRT), using 6 months of clinical data variables routinely ... ...

Abstract	PURPOSE:We aimed to develop a model of chronic kidney disease (CKD) progression for predicting the probability and time to progression from various CKD stages to renal replacement therapy (RRT), using 6 months of clinical data variables routinely measured at healthcare centers. METHODS:Data were derived from the electronic medical records of Ajou University Hospital, Suwon, South Korea from October 1997 to September 2012. We included patients who were diagnosed with CKD (estimated glomerular filtration rate [eGFR] < 60 mL·min-1·1.73 m-2 for ≥ 3 months) and followed up for at least 6 months. The study population was randomly divided into training and test sets. RESULTS:We identified 4,509 patients who met reasonable diagnostic criteria. Patients were randomly divided into 2 groups, and after excluding patients with missing data, the training and test sets included 1,625 and 1,618 patients, respectively. The integral mean was the most powerful explanatory (R2 = 0.404) variable among the 8 modified values. Ten variables (age, sex, diabetes mellitus[DM], polycystic kidney disease[PKD], serum albumin, serum hemoglobin, serum phosphorus, serum potassium, eGFR (calculated by Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]), and urinary protein) were included in the final risk prediction model for CKD stage 3 (R2 = 0.330). Ten variables (age, sex, DM, GN, PKD, serum hemoglobin, serum blood urea nitrogen[BUN], serum calcium, eGFR(calculated by Modification of Diet in Renal Disease[MDRD]), and urinary protein) were included in the final risk prediction model for CKD stage 4 (R2 = 0.386). Four variables (serum hemoglobin, serum BUN, eGFR(calculated by MDRD) and urinary protein) were included in the final risk prediction model for CKD stage 5 (R2 = 0.321). CONCLUSION:We created a prediction model according to CKD stages by using integral means. Based on the results of the Brier score (BS) and Harrel's C statistics, we consider that our model has significant explanatory power to predict the probability and ...
Keywords	Medicine ; R ; Science ; Q
Subject code	616
Language	English
Publishing date	2018-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A quantitative method for assessment of prescribing patterns using electronic health records.

Dukyong Yoon / Inwhee Park / Martijn J Schuemie / Man Young Park / Ju Han Kim / Rae Woong Park

PLoS ONE, Vol 8, Iss 10, p e

2013 Volume 75214

Abstract: BACKGROUND: Most available quality indicators for hospitals are represented by simple ratios or proportions, and are limited to specific events. A generalized method that can be applied to diverse clinical events has not been developed. The aim of this ... ...

Abstract	BACKGROUND: Most available quality indicators for hospitals are represented by simple ratios or proportions, and are limited to specific events. A generalized method that can be applied to diverse clinical events has not been developed. The aim of this study was to develop a simple method of evaluating physicians' prescription patterns for diverse events and their level of awareness of clinical practice guidelines. METHODS AND FINDINGS: We developed a quantitative method called Prescription pattern Around Clinical Event (PACE), which is applicable to electronic health records (EHRs). Three discrete prescription patterns (intervention, maintenance, and discontinuation) were determined based on the prescription change index (PCI), which was calculated by means of the increase or decrease in the prescription rate after a clinical event. Hyperkalemia and Clostridium difficile-associated diarrhea (CDAD) were used as example cases. We calculated the PCIs of 10 drugs related to hyperkalemia, categorized them into prescription patterns, and then compared the resulting prescription patterns with the known standards for hyperkalemia treatment. The hyperkalemia knowledge of physicians was estimated using a questionnaire and compared to the prescription pattern. Prescriptions for CDAD were also determined and compared to clinical knowledge. Clinical data of 1698, 348, and 1288 patients were collected from EHR data. The physicians prescribing behaviors for hyperkalemia and CDAD were concordant with the standard knowledge. Prescription patterns were well correlated with individual physicians' knowledge of hyperkalemia (κ = 0.714). Prescribing behaviors according to event severity or clinical condition were plotted as a simple summary graph. CONCLUSION: The algorithm successfully assessed the prescribing patterns from the EHR data. The prescription patterns were well correlated with physicians' knowledge. We expect that this algorithm will enable quantification of prescribers' adherence to clinical guidelines and be used to ...
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2013-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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