Survival Analysis of Korean End-Stage Renal Disease Patients According to Renal Replacement Therapy in a Single Center

This study was to investigate clinical characteristics and any differential trends in survival among renal replacement therapy (hemodialysis [HD], peritoneal dialysis [PD], and kidney transplantation [KT]) in Korean end-stage renal disease (ESRD) population. We tried to analyze retrospectively the survival rate adjusted by risk factors and the relative risk stratified by key risk factors among 447 ESRD patients who began dialysis or had a kidney transplant at Ajou University Hospital from 1994 to 2004. In adjusted Cox survival curves, the KT patients had the best survival rate, and the HD patients had better survival than PD patients. The consistent trends in different subgroups stratified by age and diabetes were as following: 1) The risk of death for PD and HD was not proportional over time, 2) The relative risk of PD was similar or lower than that of HD for the first 12 months, but it became higher at later period. The significant predictors for mortality were age (over 55 yr), presence of diabetes, cerebrovascular accident at ESRD onset, and more than one time of hospitalization caused by malnutrition. Further large-scaled, multicenter-based comparative study is needed in Korean ESRD patients and more meticulous attention is required in high-risk patients.

Survival Differences by Dialysis Modality among Incident End-stage Renal Disease Patients with Preexisting Coronary Artery Disease / 대한신장학회잡지

BACKGROUND: The question of which dialysis modality should be recommended to end-stage renal disease (ESRD) patients with a history of coronary artery disease (CAD) is encountered frequently in clinical practice, and the answer is still controversial. We tried to explore the patient's survival difference by the dialysis modality in incident ESRD patients with CAD. METHODS: We retrospectively analyzed survival differences by dialysis modality in 56 new ESRD patients with preexisting CAD (HD: PD=30: 26) at yearly intervals with Poisson regression from September 1994 to February 2000. We also investigated the predictors of mortality with multivariate analysis by time-dependent Cox regression. RESULTS: There were no significant differences in age, sex, diabetes, co-morbidity, severity of CAD on commencement of dialysis between HD and PD patients with CAD. Cardiovascular deaths were observed in only HD group. In the CAD group, the relative risk (RR) of mortality in HD patients was equal or higher than that in PD patients for the first 3 years, but RR became lower in HD patient after 3 years. The significant predictors of mortality in CAD group were age, diabetes, arrhythmia and history of cardiac arrest at the time of dialysis initiation. CONCLUSION: When we choose a dialysis modality in incident ESRD patient with preexisting CAD, we could consider an early survival benefit of PD over HD and integrated dialysis approach as a treatment option in this patient group. Further investigation including control group is needed to evaluate in the multicenter, large-scaled manner.

Quantitative Viral Load Monitoring and Cidofovir Therapy in BK Virus Nephropathy / 대한신장학회잡지

BACKGROUND: BK virus nephropathy (BKVN) has been increasingly recognized as an important cause of renal transplant dysfunction, but no specific antiviral therapy is currently available. Furthermore, a method evaluating the degree of viral infection has not been developed yet. Recently, there have been several case reports in which BKVN was successfully treated with cidofovir injection. In the current study, we report a case with BKVN successfully treated with cidofovir injection. In addition, we assessed the usefulness of quantitative viral load monitoring using a competitive polymerase chain reaction (PCR) in the treatment of BKVN. METHODS: A renal allograft recipient with BKVN was injected with cidofovir. To monitor BK viral load in urine and plasma, we developed a competitive PCR assay and followed the patient prospectively. RESULTS: A 49 year old renal transplant recipient developed a progressive rise in serum creatinine reaching 1.9 mg/dL at 15 months post-transplantation. Subsequently, the patient was diagnosed as BKVAN by allograft biopsy. At this time, BKV DNA was detected in plasma and urine. Despite a reduction of the dose of mycophenolate mofetil, serum creatinine continued to rise, which prompted the initiation of cidofovir trial. The patient was given intravenous cidofovir. After cidofovir treatment, BK virus associated findings disappeared on repeat biopsy, and BK virus in plasma was decreased to the undetectable level. For 7 months after cidofovir treatment, her renal function remained stable. CONCLUSION: Cidofovir therapy may be effective in the treatment for BKVN. Viral load in plasma reflected well the clinical and pathological course of the BK virus infection.

Comparison of Absorption Profile between Microemulsion and Non-microemulsion Cyclosporine in Stable Renal Transplant Recipients and Therapeutic Drug Monitoring / 대한신장학회잡지

BACKGROUND: Cyclosporine has a narrow therapeutic window and many serious side effects. The new oral microemulsion cyclosporine is known to have better absorption profile than non-microemulsion cyclosporine. The purpose of this study was to confirm above finding in stable renal transplant patients and also to compare correlation between AUC0-4 and C0, C2. METHODS: We checked the absorption profile of microemulsion cyclosporine group (N=15, ME group) and non-microeulsion cyclosporine group (N=15, NE group). All Patients had received renal transplantation at least 12 months before. Blood sampling for cyclosporine level was drawn before and at 1, 2, 3 hour after the cyclosporine morning dose (respectively C0, C1, C2 and C3). AUC0-4 was calculated with the formula: 256+C1+0.9xC2+1.4xC3. Age, sex, body weight, serum creatinine and cyclosporine dose were not different between ME group and NE group, but duration after transplantation was significantly higher in NE group (4.7+/-0.8 versus 3.0+/-1.9 year, p<0.05). RESULTS: AUC0-4 in ME group was significantly higher than NE group (2, 816+/-721 versus 2, 055+/-658 ng.h/mL, p<0.05). AUC0-4/dose, Cmax and Cmax/ dose were significantly higher in ME group. But these statistical differences were not consistent in both sexes. The difference of absorption profile between ME and NE group existed only in the female sex. In ME group, C1 correlated best with AUC0-4 (C0: r=0.493, C1: r=0.911, C2: r=0.906, C3: r= 0.789) and in NE group, C2 was the best (C0: r= 0.064, C1: r=0.958, C2: r=0.980, C3: r=0.912). CONCLUSION: Microemulsion cyclosporine is more bioavailable than non-microemulsion cyclosporine in stable renal transplant patients. C2 is better single time point marker for therapeutic drug monitoring in stable renal transplant patients than C0.