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대한신장학회> Kidney Research and Clinical Practice(구 대한신장학회지)

Kidney Research and Clinical Practice(구 대한신장학회지) update

  • : 대한신장학회
  • : 의약학분야  >  내과학
  • : KCI등재
  • : SCOPUS
  • : 연속간행물
  • : 격월
  • : 2211-9132
  • : 2211-9140
  • : 대한신장학회지(~2006) → The Korean Journal of Nephrology(2007~) → KINDEY Research and Clinal Practice(2012~)

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수록범위 : 1권1호(1982)~41권3호(2022) |수록논문 수 : 3,906
Kidney Research and Clinical Practice(구 대한신장학회지)
41권3호(2022년 05월) 수록논문
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KCI등재 SCOPUS

2Are older adults safe and suitable candidate donors or recipients for kidney transplantation?

저자 : Yu Ah Hong

발행기관 : 대한신장학회 간행물 : Kidney Research and Clinical Practice(구 대한신장학회지) 41권 3호 발행 연도 : 2022 페이지 : pp. 271-274 (4 pages)

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KCI등재 SCOPUS

3Claudins in kidney health and disease

저자 : Chor Ho Jo , Sua Kim , Gheun-ho Kim

발행기관 : 대한신장학회 간행물 : Kidney Research and Clinical Practice(구 대한신장학회지) 41권 3호 발행 연도 : 2022 페이지 : pp. 275-287 (13 pages)

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Claudins are strategically located to exert their physiologic actions along with the nephron segments from the glomerulus. Claudin-1 is normally located in the Bowman's capsule, but its overexpression can reach the podocytes and lead to albuminuria. In the proximal tubule (PT), claudin-2 forms paracellular channels selective for water, Na+, K+, and Ca2+. Claudin-2 gene mutations are associated with hypercalciuria and kidney stones. Claudin-10 has two splice variants, -10a and -10b; Claudin-10a acts as an anion-selective channel in the PT, and claudin-10b functions as a cation-selective pore in the thick ascending limb (TAL). Claudin-16 and claudin-19 mediate paracellular transport of Na+, Ca2+, and Mg2+ in the TAL, where the expression of claudin-3/16/19 and claudin-10b are mutually exclusive. The claudin-16 or -19 mutation causes familial hypomagnesemia with hypercalciuria and nephrocalcinosis. Claudin-14 polymorphisms have been linked to increased risk of hypercalciuria. Claudin-10b mutations produce HELIX syndrome, which encompasses hypohidrosis, electrolyte imbalance, lacrimal gland dysfunction, ichthyosis, and xerostomia. Hypercalciuria and magnesuria in metabolic acidosis are related to downregulation of PT and TAL claudins. In the TAL, stimulation of calcium-sensing receptors upregulates claudin-14 and negatively acts on the claudin-16/19 complex. Claudin-3 acts as a general barrier to ions in the collecting duct. If this barrier is disturbed, urine acidification might be impaired. Claudin-7 forms a nonselective paracellular channel facilitating Cl- and Na+ reabsorption in the collecting ducts. Claudin-4 and -8 serve as anion channels and mediate paracellular Cl- transport; their upregulation may contribute to pseudohypoaldosteronism II and salt-sensitive hypertension.

KCI등재 SCOPUS

4Diagnosing metabolic acidosis in chronic kidney disease: importance of blood pH and serum anion gap

저자 : Jun-ya Kaimori , Yusuke Sakaguchi , Sachio Kajimoto , Yuta Asahina , Tatsufumi Oka , Koki Hattori , Yohei Doi , Yoshitaka Isaka

발행기관 : 대한신장학회 간행물 : Kidney Research and Clinical Practice(구 대한신장학회지) 41권 3호 발행 연도 : 2022 페이지 : pp. 288-297 (10 pages)

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Metabolic acidosis is one of the most common complications of chronic kidney disease (CKD). It is associated with the progression of CKD, and many other functional impairments. Until recently, only serum bicarbonate levels have been used to evaluate acid-base changes in patients with reduced kidney function. However, recent emerging evidence suggests that nephrologists should reevaluate the clinical approach for diagnosing metabolic acidosis in patients with CKD based on two perspectives; pH and anion gap. Biochemistry and physiology textbooks clearly indicate that blood pH is the most important acid-base parameter for cellular function. Therefore, it is important to determine if the prognostic impact of hypobicarbonatemia varies according to pH level. A recent cohort study of CKD patients showed that venous pH modified the association between a low bicarbonate level and the progression of CKD. Furthermore, acidosis with a high anion gap has recently been recognized as an important prognostic factor, because veverimer, a nonabsorbable hydrochloride-binding polymer, has been shown to improve kidney function and decrease the anion gap. Acidosis with high anion gap frequently develops in later stages of CKD. Therefore, the anion gap is a time-varying factor and renal function (estimated glomerular filtration rate) is a time-dependent confounder for the anion gap and renal outcomes. Recent analyses using marginal structural models showed that acidosis with a high anion gap was associated with a high risk of CKD. Based on these observations, reconsideration of the clinical approach to diagnosing and treating metabolic acidosis in CKD may be warranted.

KCI등재 SCOPUS

5Risk factors for overcorrection of severe hyponatremia: a post hoc analysis of the SALSA trial

저자 : Huijin Yang , Songuk Yoon , Eun Jung Kim , Jang Won Seo , Ja-ryong Koo , Yun Kyu Oh , You Hwan Jo , Sejoong Kim , Seon Ha Baek

발행기관 : 대한신장학회 간행물 : Kidney Research and Clinical Practice(구 대한신장학회지) 41권 3호 발행 연도 : 2022 페이지 : pp. 298-309 (12 pages)

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Background: Hyponatremia overcorrection can result in irreversible neurologic impairment such as osmotic demyelination syndrome. Few prospective studies have identified patients undergoing hypertonic saline treatment with a high risk of hyponatremia overcorrection.
Methods: We conducted a post hoc analysis of a multicenter, prospective randomized controlled study, the SALSA trial, in 178 patients aged above 18 years with symptomatic hyponatremia (mean age, 73.1 years; mean serum sodium level, 118.2 mEq/L). Overcorrection was defined as an increase in serum sodium levels by >12 or 18 mEq/L within 24 or 48 hours, respectively.
Results: Among the 178 patients, 37 experienced hyponatremia overcorrection (20.8%), which was independently associated with initial serum sodium level (≤110, 110-115, 115-120, and 120-125 mEq/L with 7, 4, 2, and 0 points, respectively), chronic alcoholism (7 points), severe symptoms of hyponatremia (3 points), and initial potassium level (<3.0 mEq/L, 3 points). The NASK (hypoNatremia, Alcoholism, Severe symptoms, and hypoKalemia) score was derived from four risk factors for hyponatremia overcorrection and was significantly associated with overcorrection (odds ratio, 1.41; 95% confidence interval, 1.24-1.61; p < 0.01) with good discrimination (area under the receiver-operating characteristic [AUROC] curve, 0.76; 95% CI, 0.66-0.85; p < 0.01). The AUROC curve of the NASK score was statistically better compared with those of each risk factor.
Conclusion: In treating patients with symptomatic hyponatremia, individuals with high hyponatremia overcorrection risks were predictable using a novel risk score summarizing baseline information.

KCI등재 SCOPUS

6Role of bicarbonate and volume therapy in the prevention of acute kidney injury in rhabdomyolysis: a retrospective propensity score-matched cohort study

저자 : Hye Won Kim , Sejoong Kim , Jung Hun Ohn , Nak-hyun Kim , Jongchan Lee , Eun Sun Kim , Yejee Lim , Jae Ho Cho , Hee Sun Park , Jiwon Ryu , Sun-wook Kim

발행기관 : 대한신장학회 간행물 : Kidney Research and Clinical Practice(구 대한신장학회지) 41권 3호 발행 연도 : 2022 페이지 : pp. 310-321 (12 pages)

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Background: Although bicarbonate has traditionally been used to treat patients with rhabdomyolysis at high risk of acute kidney injury (AKI), it is unclear whether this is beneficial. This study compared bicarbonate therapy to non-bicarbonate therapy for the prevention of AKI and mortality in rhabdomyolysis patients.
Methods: In a propensity score-matched cohort study, patients with a creatine kinase (CK) level of >1,000 U/L during hospitalization were divided into bicarbonate and non-bicarbonate groups. Patients were subgrouped based on low-volume (<3 mL/kg/hr) or high-volume (≥3 mL/kg/hr) fluid resuscitation in the first 72 hours. Logistic regression analyses were used to identify the impacts of bicarbonate use and fluid resuscitation on AKI risk and need for dialysis. The Kaplan-Meier method was used to estimate survival. Volume overload and electrolyte imbalances were assessed.
Results: Among 4,077 patients, we assembled a cohort of 887 pairs of patients treated with and without bicarbonate. Bicarbonate group had a higher incidence of AKI, higher rate of dialysis dependency, higher 30-day mortality, and longer hospital stay than the non-bicarbonate group. Further, patients who received high-volume fluid therapy had worse renal outcomes and a higher mortality than those who received low-volume fluids regardless of bicarbonate use. Bicarbonate use, volume overload, and AKI were associated with higher mortality. Volume overload was significantly higher in the bicarbonate group than in the non-bicarbonate group.
Conclusion: Bicarbonate or high-volume fluid therapy for patients with rhabdomyolysis did not reduce AKI or improve mortality compared to non-bicarbonate or low-volume fluid therapy. Limited use of bicarbonate and adjustment of fluid volume may improve the short- and long-term outcomes of patients with rhabdomyolysis.

KCI등재 SCOPUS

7Estimating baseline creatinine values to define acute kidney injury in critically ill pediatric patients

저자 : Yeon Joo Lee , Young Seo Park , Seong Jong Park , Won Kyoung Jhang

발행기관 : 대한신장학회 간행물 : Kidney Research and Clinical Practice(구 대한신장학회지) 41권 3호 발행 연도 : 2022 페이지 : pp. 322-331 (10 pages)

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Background: Acute kidney injury (AKI) is a common complication in critically ill children. However, the common lack of baseline serum creatinine values affects AKI diagnosis and staging. Several approaches for estimating baseline creatinine values in those patients were evaluated.
Methods: This single-center retrospective study enrolled pediatric patients with documented serum creatinine measurements within 3 months before admission and more than two serum creatinine measurements within 7 days after admission to the pediatric intensive care unit of a tertiary care children's hospital between January 2016 and April 2020. Four different approaches for estimating AKI using serum creatinine measurements were compared: 1) back-calculation using age-adjusted normal reference glomerular filtration rates, 2) age-adjusted normal reference serum creatinine values, 3) minimum values measured within 7 days after admission, and 4) initial values upon admission.
Results: The approach using minimum values showed the best agreement with the measured baseline value, with the largest intraclass correlation coefficient (0.623), smallest bias (-0.04), and narrowest limit of agreement interval (1.032). For AKI diagnosis and staging, the minimum values were 80.8% and 76.1% accurate, respectively. The other estimated baseline values underestimated AKI and showed poor agreement with baseline values before admission, with a misclassification rate of up to 42% (p < 0.001).
Conclusion: Minimum values of serum creatinine measured within 7 days after hospital admission showed the best agreement with creatinine measured within 3 months before admission, indicating the possibility of using it as a baseline when baseline data are unavailable. Further large-scale studies are required to accurately diagnose AKI in critically ill children.

KCI등재 SCOPUS

8Recalibration and validation of the Charlson Comorbidity Index in acute kidney injury patients underwent continuous renal replacement therapy

저자 : Jinwoo Lee , Jiyun Jung , Jangwook Lee , Jung Tak Park , Chan-young Jung , Yong Chul Kim , Dong Ki Kim , Jung Pyo Lee , Sung Jun Shin , Jae Yoon Park

발행기관 : 대한신장학회 간행물 : Kidney Research and Clinical Practice(구 대한신장학회지) 41권 3호 발행 연도 : 2022 페이지 : pp. 332-341 (10 pages)

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Background: Comorbid conditions impact the survival of patients with severe acute kidney injury (AKI) who require continuous renal replacement therapy (CRRT). The weights assigned to comorbidities in predicting survival vary based on type of index, disease, and advances in management of comorbidities. We developed a modified Charlson Comorbidity Index (CCI) for use in patients with AKI requiring CRRT (mCCI-CRRT) and improved the accuracy of risk stratification for mortality.
Methods: A total of 828 patients who received CRRT between 2008 and 2013, from three university hospital cohorts was included to develop the comorbidity score. The weights of the comorbidities were recalibrated using a Cox proportional hazards model adjusted for demographic and clinical information. The modified index was validated in a university hospital cohort (n = 919) using the data of patients treated from 2009 to 2015.
Results: Weights for dementia, peptic ulcer disease, any tumor, and metastatic solid tumor were used to recalibrate the mCCI-CRRT. Use of these calibrated weights achieved a 35.4% (95% confidence interval [CI], 22.1%-48.1%) higher performance than unadjusted CCI in reclassification based on continuous net reclassification improvement in logistic regression adjusted for age and sex. After additionally adjusting for hemoglobin and albumin, consistent results were found in risk reclassification, which improved by 35.9% (95% CI, 23.3%-48.5%).
Conclusion: The mCCI-CRRT stratifies risk of mortality in AKI patients who require CRRT more accurately than does the original CCI, suggesting that it could serve as a preferred index for use in clinical practice.

KCI등재 SCOPUS

9Humoral response to viral vector COVID-19 vaccine in hemodialysis patients

저자 : Niranjan Raja , Arul Rajagopalan , Jegan Arunachalam , Arun Prasath , Rakesh Durai , Manorajan Rajendran

발행기관 : 대한신장학회 간행물 : Kidney Research and Clinical Practice(구 대한신장학회지) 41권 3호 발행 연도 : 2022 페이지 : pp. 342-350 (9 pages)

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Background: The coronavirus disease 2019 (COVID-19) vaccine is not readily available in many countries where dosing interval is spaced more than ideal. Patients with chronic kidney disease, especially those on maintenance hemodialysis, have a tendency for a reduced immune response. This study was undertaken to demonstrate the distinct humoral immune response to the viral vector COVID-19 vaccine in patients with kidney failure receiving maintenance hemodialysis.
Methods: The study was carried out with two cohorts: 1) patients receiving maintenance hemodialysis and 2) healthcare workers from the same dialysis center as controls, each group with 72 subjects. Participants received a dose of Covishield ChAdOx1 nCoV-19 coronavirus vaccine. The humoral immunological response was determined using electrochemiluminescence immunoassay which quantitatively measures antibodies to the severe acute respiratory syndrome coronavirus 2 spike protein receptor-binding domain.
Results: All study subjects in the control group developed a humoral response (antibody titer of ≥0.8 U/mL), while only 64 of 72 in the dialysis group (88.9%) were responders. Age (ρ = -0.234, p = 0.04) and sodium level (ρ = 0.237, p = 0.04) correlated with low antibody titer in bivariate analysis. In multivariate analysis, only age (odds ratio, 1.10; 95% confidence interval, 1.01-1.22; p = 0.045)
was associated with nonresponders.
Conclusion: Our study demonstrated a weak antibody response of hemodialysis patients to the viral vector COVID-19 vaccine. Older age was associated with nonresponders. Evaluation of both humoral and cellular immunity after the second vaccine dose and serial antibody titers can help determine the need for booster shots.

KCI등재 SCOPUS

10The combined clinical impact of red blood cell distribution width and vascular calcification on cardiovascular events and mortality in patients with end-stage kidney disease

저자 : Da Won Kim , Munpyo Lee , Kwon Jae Lee , Yeon Hee Lee , Dongryul Kim , Seok Joon Shin , Hye Eun Yoon

발행기관 : 대한신장학회 간행물 : Kidney Research and Clinical Practice(구 대한신장학회지) 41권 3호 발행 연도 : 2022 페이지 : pp. 351-362 (12 pages)

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Background: Little is known about how the interaction between red blood cell distribution width (RDW) and vascular calcification (VC) affects cardiovascular (CV) events and mortality in end-stage kidney disease (ESKD) patients. This study investigated the combined prognostic effect of RDW and VC in ESKD patients starting dialysis.
Methods: A retrospective single-center study of 582 ESKD patients was conducted. VC was assessed by calculating the aortic calcification index (ACI) using computed tomography. Patients were divided into low ACI-low RDW, low ACI-high RDW, high ACI-low RDW, and high ACI-high RDW groups based on median ACI (17.12) and RDW (14.3) values. The association between RDW and VC and the composite endpoint of CV events and death was analyzed.
Results: During a median follow-up of 3.1 years (range, 1.5-5.5 years), 165 CV events (28.4%) and 124 deaths (21.4%) occurred. Cox regression showed that the low ACI-high RDW (adjusted hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.04-2.66; p = 0.03) and high ACI-low RDW (adjusted HR, 1.95; 95% CI, 1.21-3.14; p = 0.006) groups had a greater risk of CV events and death than the low ACI-low RDW group. The high ACI-high RDW group had the greatest risk (adjusted HR, 2.23; 95% CI, 1.42-3.52; p = 0.001). The effect of the interaction between ACI and RDW on CV events and mortality was statistically significant (p = 0.005).
Conclusion: High RDW and VC interact to increase the risk of CV events and death in ESKD patients.

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