Comparison of circuit patency and exchange rates between the original and generic versions of nafamostat mesylate in critically ill adults receiving continuous renal replacement therapy / 고신대학교의과대학학술지

Background@#Nafamostat mesylate is widely used as an anticoagulant in continuous renal replacement therapy (CRRT). The generic versions of nafamostat mesylate have identical main components to the original product. However, it is questionable whether the generic versions have the same efficacy as the original. Therefore, we compared the circuit patency and exchange rates of the original nafamostat mesylate and a generic version to determine which is more efficient as an anticoagulant in CRRT. @*Methods@#This retrospective study enrolled 1,255 patients hospitalized to receive CRRT who received the original version of nafamostat mesylate or a generic version between January 2010 and July 2018. We evaluated the filter lifespan, number of filters used per day, mean blood flow, and transmembrane pressure (TMP). @*Results@#The mean filter lifespan was 36.3±15.1 hours in the original product group and 22.2±16.2 hours in the generic product group, which was not a statistically significant difference (p=0.060). The mean TMP was 62.2±47.3 mmHg in the original product group and 74.5±45.6 mmHg in the generic product group (p=0.045). @*Conclusions@#This retrospective study suggests no meaningful difference in filter lifespan between the original and generic versions of nafamostat mesylate. However, TMP was lower in the original product group than in the generic product group.

Clinical Efficacy of the Transradial Approach in Percutaneous Intervention for a Malfunctioning Arteriovenous Fistula

Purpose@#To evaluate the effectiveness of the transradial artery approach (TRA) for treating malfunctioning arteriovenous fistulas (AVFs) in patients on hemodialysis. @*Materials and Methods@#A retrospective analysis was conducted in this single-center study of TRA endovascular procedures in 73 patients (43 male and 30 female; mean age of 67.4 years (range, 42–92 years) with malfunctioning AVFs, between January 2008 and April 2019. Patients’ baseline and lesion characteristics, technical and clinical success, and complications were evaluated, and functional patency was analyzed using the Kaplan-Meier method. @*Results@#Radial artery approaches were successful in all patients. Angioplasty performed using the TRA achieved technical and clinical success rates of 98.6%(72/73) and 91.7%(67/73), respectively. The median primary patency time was 18.8 ± 15.9 months. The primary functional patency rates at 3, 6, and 12 months were 82.1%, 68.6%, and 63.9%, respectively. There were no major complications or adverse events, such as hand ischemia, related to the radial artery approach. @*Conclusion@#In selected cases, the TRA can be used complementary to the transvenous approach to treat malfunctioning AVFs.

The Natural Course of Total Kidney Volume in Patients with Autosomal Dominant Polycystic Kidney Disease undergoing Hemodialysis / 고신대학교의과대학학술지

Objectives@#The natural course of native kidneys after hemodialysis initiation in patients with autosomal dominant polycystic kidney disease (ADPKD) remains poorly understood. @*Methods@#We measured the total volumes of native kidneys in 12 patients who had at least one enhanced computed tomography (CT) image both before and after initiation of hemodialysis (group 1) and in 18 patients who had no image before dialysis but more than two images after dialysis (group 2). In patients with images, the last image was used for analysis only after dialysis. @*Results@#The mean total kidney volume (TKV) (± SD) before hemodialysis initiation was 3132 ± 1413 mL and the mean TKV of the last image was 3047 ± 1323 mL in group 1. The mean TKV change rate (%) was - 5.2 ± 27.4% (P > 0.05) during follow-up of 3.9 ± 1.9 years in group 1. The mean TKV change rate was 2.8 ± 34.4% (P > 0.05) in group 2. The follow-up period after dialysis initiation ranged from 4.2 ± 4.7 to 8.0 ± 5.2 years. @*Conclusions@#The results suggest that the TKV of native polycystic kidneys decreases substantially after hemodialysis initiation. This reduction occurs mainly during the early post-hemodialysis period and followed by a slow enlargement of TKV.

Renal and Urinary Manifestations of Inflammatory Bowel Disease / 대한소화기학회지

The incidence of inflammatory bowel disease (IBD) is increasing rapidly and extra-intestinal manifestations in IBD are also increasing. The prevalence of renal and urinary involvement in IBD ranges from 4–23%. Nephrolithiasis is the most common urinary complication in IBD patients. Parenchymal renal disease is rare but has been well documented and presents most commonly as glomerulonephritis or tubulointerstitial nephritis. The overall morbidity of IBD-related renal manifestations is significant. Therefore, a high index of clinical suspicion and optimal monitoring of the renal function are needed for the early diagnosis and prevention of IBD-related renal manifestations and complications.

Renal and Urinary Manifestations of Inflammatory Bowel Disease / 대한소화기학회지

The incidence of inflammatory bowel disease (IBD) is increasing rapidly and extra-intestinal manifestations in IBD are also increasing. The prevalence of renal and urinary involvement in IBD ranges from 4–23%. Nephrolithiasis is the most common urinary complication in IBD patients. Parenchymal renal disease is rare but has been well documented and presents most commonly as glomerulonephritis or tubulointerstitial nephritis. The overall morbidity of IBD-related renal manifestations is significant. Therefore, a high index of clinical suspicion and optimal monitoring of the renal function are needed for the early diagnosis and prevention of IBD-related renal manifestations and complications.

The influence of hypophosphatemia on outcomes of low- and high-intensity continuous renal replacement therapy in critically ill patients with acute kidney injury

BACKGROUND: The purpose of this study was to assess the role of hypophosphatemia in major clinical outcomes of patients treated with low- or high-intensity continuous renal replacement therapy (CRRT). METHODS: We performed a retrospective analysis of data collected from 492 patients. We divided patients into two CRRT groups based on treatment intensity (greater than or equal to or less than 40 mL/kg/hour of effluent generation) and measured serum phosphate level daily during CRRT. RESULTS: We obtained a total of 1,440 phosphate measurements on days 0, 1, and 2 and identified 39 patients (7.9%), 74 patients (15.0%), and 114 patients (23.1%) with hypophosphatemia on each of these respective days. In patients treated with low-intensity CRRT, there were 23 episodes of hypophosphatemia/1,000 patient days, compared with 83 episodes/1,000 patient days in patients who received high-intensity CRRT (P < 0.01). Multiple Cox proportional hazards analysis showed that Acute Physiology and Chronic Health Evaluation (APACHE) III score, utilization of vasoactive drugs, and arterial pH on the second day of CRRT were significant predictors of mortality, while serum phosphate level was not a significant contributor to mortality. CONCLUSION: APACHE score, use of vasoactive drugs, and arterial pH on the second CRRT day were identified as significant predictors of mortality. Hypophosphatemia might not be a major risk factor of increased mortality in patients treated with CRRT.

The clinical features and infectious etiologies of acute diarrhea in immunocompromised hosts / 고신대학교의과대학학술지

OBJECTIVES: The acute diarrhea is a common complaint among immunocompromised hosts, and may cause life threatening event. The infectious etiologies vary depending on virus, bacteria, and parasites. The most common etiology of acute gastroenteritis is known as enteric virus in Korea. But there are few studies about the infectious etiology of acute gastroenteritis in immunocompromised hosts. The aim of this study was to investigate the infectious etiologies of acute diarrhea in immunocompromised hosts. METHODS: Seventy three patients were enrolled prospectively in a university hospital from January 2013 to July 2014. Immunocompromised hosts included above 65-year-old people, patients with chronic diseases, solid organ or stem cell transplants, solid organ malignancies, hematologic malignancies, immunosuppressive or steroid taking patients. The clinical data were collected and stool samples collected during diarrhea were undergone laboratory analysis for enteric viruses and bacterial enteropathogens including Salmonella spp., Shigella spp., and Clostridium difficile. RESULTS: Fifty five patients were analyzed as follows : above 65 year-old people were 36 cases (66%), previous antibiotic usage was 22 cases (41.5%). 44 cases (81.1%) were admitted to general ward whereas 9 cases to ICU (17%). 41 cases (73.6%) were treated with antibiotics. Positive C. difficile toxin assays were 6 cases (11.9%). Other infectious etiologies were not found. CONCLUSIONS: C. difficile infection was more common infectious etiology while enteric viruses and other bacteria are not associated with acute diarrhea among immunocompromised hosts in this study. So C. difficile infection must be considered preferentially in immunocompromised hosts with acute diarrhea.

Changes in Insulin Sensitivity and Lipid Profile in Renal Transplant Recipients Converted from Cyclosporine or Standard Release Tacrolimus to Once-Daily Prolonged Release Tacrolimus / 대한이식학회지

BACKGROUND: Tacrolimus (Tac) can cause impaired insulin release and dyslipidemia, and may affect the development of post-transplant diabetes mellitus. However, these effects on insulin sensitivity and lipid profile have not been compared in renal transplant recipients receiving traditional twice-daily tacrolimus (TacBID) or cyclosporine and those receiving once-daily prolonged release formulation of tacrolimus (TacOD). METHODS: We conducted an observational prospective study of 15 stable non-diabetic renal transplant recipients to observe the changes in insulin sensitivity and lipid profiles for 1 year at a tertiary hospital. We evaluated the levels of hemoglobin A1c, total cholesterol, high density lipoprotein, low density lipoprotein, triglycerides, apolipoprotein A1, apolipoprotein B, serum creatinine, fasting plasma glucose, fasting insulin, homeostatic model assessment of β-cell (HOMA-β) and HOMA-insulin resistance index at baseline and at 2 and 4 months. To analyze differences in parameters, we conducted a Wilcoxon rank sum test and general linear model (GLM)-repeated measures analysis of variance (ANOVA) in both groups (cyclosporine to TacOD conversion group/TacBID to TacOD conversion group). RESULTS: At baseline, parameters did not differ between groups. GLM-repeated measures ANOVA revealed no change in insulin sensitivity or lipid profile after conversion at baseline or at 2 and 4 months. There were no complications after conversion from standard TacBID or cyclosporine to TacOD. CONCLUSIONS: There was no change in insulin sensitivity or lipid profile in renal transplant recipients. Any conversion from TacBID to TacOD should be performed in a controlled manner under close surveillance.

Relationships of Total Lymphocyte Count and Subpopulation Lymphocyte Counts with the Nutritional Status in Patients Undergoing Hemodialysis/Peritoneal Dialysis / 고신대학교의과대학학술지

OBJECTIVES: Dialysis patients' nutritional indicators are quite subjective and complex and cannot be easily measured in clinical settings. Based on previous reports that total lymphocyte count (TLC) and subpopulation lymphocyte counts (SLCs) are associated with nutritional status in patients with dialysis, we designed this study to examine the relationships of the TLC and SLCs with clinical outcome and nutritional status in patients undergoing maintenance hemodialysis (HD) and peritoneal dialysis (PD). METHODS: In this prospective, observational study, we enrolled 66 patients (50 HD patients and 16 PD patients) receiving stable maintenance dialysis. We evaluated the baseline parameters of height; weight; TLC; SLCs expressing CD3, CD4, CD8 and CD19; CBC; iron profile (iron, TIBC, ferritin); BUN; Cr; Na; K; total CO2; Ca; P; iPTH; protein; albumin; total cholesterol; HDL; LDL; uric acid and CRP and calculated Onodera's prognostic nutritional index (OPNI) and the Geriatric Nutritional Risk Index (GNRI) at baseline and three months. To analyze differences in the TLC and SLCs between the HD group and the PD group, we performed an independent samples t-test. Logistic regression analysis was performed to predict malnutrition in dialysis patients. In addition, to analyze changes in TLC, SLCs expressing each marker (CD3, CD4, CD8 and CD19) and other nutritional markers, we performed general linear model (GLM)-repeated measures ANOVA. RESULTS: Mean age was 55.8 ± 12.7 years in HD paitents and 49.8 ± 14.5 years in PD patients. The duration of dialysis was 59.7 ± 52.9 months in HD patients and 66.1 ± 33.6 years in PD patients. Logistic regression analysis revealed that patients aged 60 years or older, women, and those whose CD19 SLCs were lower than 100 had a higher risk of developing malnutrition. In GLM-repeated measures ANOVA, CD19 SLCs were significantly higher in women and in patients with a shorter period of dialysis. CONCLUSIONS: Our results indicate that GNRI, OPNI, TLC and SLCs (especially CD19 count) may be significant nutritional markers in HD and PD patients.

The Usefulness of Endobronchial Ultrasonogram for Peripheral Lung Lesion / 결핵및호흡기질환

BACKGROUND: Endobronchial ultrasonogram (EBUS) has increased the diagnostic yield of a bronchoscopic biopsy of peripheral pulmonary lesions (PPL). This study evaluated the diagnostic yield of EBUS-guided transbronchial biopsy (TBB) and the visibility of EBUS PPL. METHODS: Between August 2007 and November 2008, 50 patients (32 men and 18 women, median age, 61.1+/-10 yrs; range, 16 to 80 yrs) whose PPL lesions could not be detected with flexible bronchoscopy were enrolled in this study. Among the 50 patients, 40 cases were malignant lesions (adenocarcinoma 25, squamous cell carcinoma 10, small cell carcinoma 5) and 10 cases were benign lesions (tuberculoma 7, fungal ball 1, other inflammation 2). RESULTS: The mean diameter of the target lesion was 35.4+/-4.3 mm. Of the 50 patients examined, the overall diagnostic yield by EBUS-TBLB was 46.0% (23/50). The visualization yield of EBUS was 66.0% (33/50). A definitive diagnosis of PPL localized by EBUS was established using EBUS-TBLB in 69.6% (23/33) of cases. The diagnostic yields from washing cytology and brushing cytology from a bronchus identified by EBUS were 27.0% and 45.4% respectively. The diagnostic yields reached 78.7% when the three tests (washing cytology, brushing cytology and EBUS-TBLB) were combined. The visualization yield of EBUS in lesions or =20 mm (p=0.04). The presence of a bronchus leading to a lesion (open bronchus sign) on the chest CT scan was associated with a high visualization yield on EBUS (p=0.001). There were no significant complications associated with EBUS-TBLB. CONCLUSION: EBUS-TBLB is a safe and effective method for diagnosing PPL. The lesion size and open bronchus signs are significant factors for predicting the visualization of EBUS.

A case of acute suppurative thyroiditis with thyrotoxicosis / 대한내과학회지

Acute suppurative thryroiditis is a rare disease because the thyroid gland is resistant to infection. Thyroid function tests are usually normal in acute suppurative thryroiditis. We care for a patient with acute suppurative thryroiditis and associated thyrotoxicosis. A 73-year-old diabetic woman presented with pain over the thyroid gland and an elevated serum thyroid hormone level and decreased radioiodine uptake, as occurs in subacute thyroiditis. A neck computed tomography showed an abscess in the right lobe of the thyroid gland. A neutrophilic infiltration was shown in a fine needle aspiration biopsy, and Gram negative Burkholderia gladioli grew from the aspirate culture. Antibiotic treatment ameliorated the symptoms of infection, followed by normalization of thyroid function.