Impact of Acute Kidney Injury on Clinical Outcomes after ST Elevation Acute Myocardial Infarction

PURPOSE: This study aimed to compare the incidence and clinical significance of transient versus persistent acute kidney injury (AKI) on acute ST elevation myocardial infarction (STEMI). MATERIALS AND METHODS: The study was a retrospective cohort of 855 patients with STEMI. AKI was defined as an increase of > or =0.3 mg/dL in creatinine level at any point during hospital stay. The study population was classified into 5 groups: 1) patients without AKI; 2) patients with mild AKI that was resolved by discharge (creatinine change less than 0.5mg/dL compared with admission creatinine during hospital stay, transient mild AKI); 3) patients with mild AKI that did not resolve by discharge (persistent mild AKI); 4) patients with moderate/severe AKI that was resolved by discharge (creatinine change more than 0.5 mg/dL compared with admission creatinine, transient moderate/severe AKI); 5) patients with moderate/severe AKI that did not resolve by discharge (persistent moderate/severe AKI). We investigated 1-year all-cause mortality after hospital discharge for the primary outcome of the study. The relation between AKI and 1-year mortality after STEMI was analyzed. RESULTS: AKI occurred in 74 (8.7%) patients during hospital stay. Adjusted hazard ratio for mortality was 3.139 (95% CI 0.764 to 12.897, p=0.113) in patients with transient, mild AKI, and 8.885 (95% CI 2.710 to 29.128, p<0.001) in patients with transient, moderate/severe AKI compared to patients without AKI. Persistent moderate/severe AKI was also independent predictor of 1 year mortality (hazard ratio, 5.885; 95% CI 1.079 to 32.101, p=0.041). CONCLUSION: Transient and persistent moderate/severe AKI during acute myocardial infarction is strongly related to 1-year all cause mortality after STEMI.

Prevalence and Factors of Chronic Kidney Disease / 대한신장학회지

PURPOSE: The prevalence of chronic kidney disease (CKD) is increasing. Accordingly, hospitalization and mortalities associated with CKD also have increased. The present study aimed to determine the prevalence of CKD, and explore the causative risk factors. METHODS: One thousand one hundred and forty-seven patients who underwent the mass health screening test at Chonnam National University Hospital between July 2007 and December 2007 were studied. The prevalence of CKD and possible risk factors such as gender, previous history of diabetes mellitus and hypertension, smoker status (current and ex-smoker), BMI, increased LDL cholesterol, triglyceride levels, HDL cholesterol level and anemia were analyzed. RESULTS: There were 631 male and 616 female subjects. Mean age was 48.6 years and mean glomerular filtration rate was 117.2+/-28.7 ml/min/1.73m2. The prevalence of CKD was 10.3%, and the prevalence of advanced CKD (CKD stage 3-5) was 0.5%. The prevalence of advanced CKD was higher in subjects with diabetes. The awareness of CKD was very low. Factors independently associated with CKD were sex favoring men (odd ratio [OR], 2.106; 95% CI, 1.436-3.090), smoker (OR, 0.575; 95% CI, 0.382-0.867), DM (OR, 2.395; 95% CI, 1.338-4.286), inadequate blood sugar (OR, 2.536; 95% CI, 1.267-5.077), HDL<40 mg/dL (OR, 0.418; 95% CI, 0.191-0.915) in a univariate analysis. With a multivariate analysis, female gender (OR, 2.123; 95% CI, 1.209-3.730) was the only independent risk factor for CKD. CONCLUSION: Since the CKD is a public health burden, closer attention is needed to prevent the CKD in the high-risk group.

Impact of renal dysfunction on clinical outcomes of acute ischemic stroke / 대한내과학회지

BACKGROUND/AIMS: Chronic kidney disease is recognized as an independent risk factor for coronary artery disease. It is unknown whether renal function predicts clinical outcomes of acute ischemic stroke. The present study was aimed at examining the correlation between the degree of renal dysfunction and stroke outcome. METHODS: Our retrospective study included 282 consecutive patients hospitalized due to acute ischemic stroke. Renal function was assessed by the estimated Glomerular filtration rate (GFR), using two METHODS: Cockcroft-Gault equation and Modification of Diet in Renal Disease (MDRD) equation. Each of the estimated GFRs were categorized into three groups (Group I: > or = 60 mL/min/1.73 m2, Group II: 45~59 mL/min/1.73 m2, Group III: 15~44 mL/min/1.73 m2). From collected patient databases, we compared mortality and rate of hospitalization to GFR at 1 month and 12 months follow up. RESULTS: Our study found that, based on the GFR, the 1 year mortality, using the Cockcroft-Gault equation, was 6.0% in group I, 20.3% in group II and 21.1% in group III and, using the MDRD equation, 9.1%, 12.5% and 37.5%, respectively. Patients with lower GFRs exhibited an increased odds ratio for 1 year mortality when estimated by the Cockcroft-Gault equation: 3.97 (1.7~9.2, 95% CI) in group II and 4.16 (1.2~14.5, 95% CI) in group III. Based on the MDRD equation, patients with lower GFRs also exhibited an increased odds ratio for 1-year mortality: 1.43 (0.5~4.4, 95% CI) in group II and 6.00 (1.3~26.8, 95% CI) in group III. The adjusted odds ratio for 1-year mortality also increased based on our analysis using either equation. CONCLUSIONS: Decline of GFR and severity of chronic kidney disease are associated with poor clinical outcomes of acute ischemic stroke.

Diagnostic Performance of Fractional Excretion of Urea in Evaluating Patients with Acute Kidney Injury with Diuretics Treatment / 대한신장학회지

PURPOSE:Although fractional excretion of sodium (FENa) has been used to distinguish transient-acute kidney injury (T-AKI) from persistent-AKI (P-AKI), the availability of FENa in the diagnosis of T-AKI is reported low in patients with diuretics use. We compared the diagnostic performance of fractional excretion of urea (FEUrea) with that of FENa in patients with diuretics use. METHODS:One hundred seven AKI patients were classified as having T-AKIor P-AKI according to the clinical context. Each group was again subdivided according to exposure to diuretics. According to the cut off value generated by receiver operating characteristic (ROC) curves, sensitivity and specificity of FENa and FEUrea were compared with each other. RESULTS:The numbers of patients administered with diuretics were 67 out of total 107 AKI patients (63%), 27 out of 52 (52%) of T-AKI patients, and 40 out of total (65) 55 (73%) of P-AKI patients. When the cutoff value of T-AKI was defined as FENa < or =1.5 and FEUrea < or = 30 according to the ROC curves, sensitivity and specificity of FENa were 96% and 100% in non-diuretics group, and 63% and 98% in diuretics group, respectively. Sensitivity and specificity of FEUrea were 92% and 87% in non- diuretics group, and 96% and 83% in diuretics group, respectively. CONCLUSION:FEUrea is as good as FENa at distinguishing T-AKI from P-AKI in patients administered with diuretics.

Renoprotective effect of deflazacort in IgA nephropathy with proteinuria / 대한내과학회지

BACKGROUND/AIMS: Steroid therapy is reported to improve the clinical outcome of IgA nephropathy. In addition, recent studies have revealed that deflazacort has fewer side effects than prednisolone. This study examined the effect of steroids and compared the clinical efficacy of deflazacort and prednisolone in patients with IgA nephropathy. METHODS: We retrospectively reviewed 136 patients with biopsy-proven IgA nephropathy who received deflazacort (n=50), prednisolone (n=29), or neither (n=59), and in whom blood pressure was controlled with angiotensin converting enzyme inhibitors or angiotensin receptor blockers. The mean duration of steroid administration was 9.5+/-9.1 months. The initial clinical status and change in the amount of protein in the 24-hour urine were compared among the three groups. RESULTS: The baseline characteristics (age, blood pressure, serum creatinine level, initial protein in the 24-hour urine, and creatinine clearance) did not differ significantly among the groups. The decrement of protein in the 24-hour urine was higher in the deflazacort and prednisolone groups, as compared with the control group (4.4+/-5.4, 4.2+/-1.5, and 2.1+/-3.1 g/day, respectively, p=0.013). The increment in the creatinine clearance was higher in the deflazacort and prednisolone groups, as compared with the control group (11.5+/-16.4, 12.3+/-26.2, and 4.8+/-14.91.3+/-0.9, respectively, p=0.009). There were no significant differences in the above parameters between the deflazacort and prednisolone groups. CONCLUSIONS: Steroid therapy reduces urinary protein excretion in IgA nephropathy, and the clinical efficacy of deflazacort and prednisolone was found to be similar.