https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/208 2026-04-03T23:15:32Z https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/63510 Title: Patency of arteriovenous fistulas and grafts for dialysis access: An analysis using the Korean National Health Insurance Service database from 2008 to 2019 Authors: Mo, Hyejin; Kwon, Sukyung; Kim, Daehwan; Kim, Ye Jee; Kim, Hyangkyoung; Yang, Seung Boo; Kwon, Young Joo; Korean Soc Dialysis Access Abstract: Background Arteriovenous (AV) access practice and its outcomes vary internationally. To provide a better understanding of the patterns and outcomes of AV access creation, we investigated the patency and risk factors of arteriovenous fistulas (AVFs) and grafts (AVGs) as initial AV access in the Korean adult population using data from the last 10 years. Methods The National Health Insurance Service database was queried retrospectively to identify patients undergoing hemodialysis with AVFs and AVGs as well as their clinical characteristics and outcomes from 2008 to 2019. AV access patency and its associated risk factors were evaluated. Results During the study period, 64,179 AVFs and 21,857 AVGs were placed. The mean patient age was 62.6 ± 13.6 years (21.5% were ⩾75 years old), and 39.3% patients were women. More than half of the patients underwent AV access creation at tertiary care hospitals. At 1 year, the primary, primary assisted, and secondary patency rates were 62.2%, 80.7%, and 94.2% for AVFs, and 46.0%, 68.4%, and 86.8% for AVGs, respectively. AVG, older age, female sex, diabetes, and creation at general hospitals (vs tertiary hospitals) were associated with decreased patency outcomes (all, p < 0.05). Conclusion This study using national data showed that three quarters of patients with AV access had AVF and AVF showed superior performance to AVG and identified several patient and center factors related to AV access patency in Korea. 2024-09-01T00:00:00Z https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/64057 Title: PREVALENCE OF POLYPHARMACY AND ASSOCIATED ADVERSE OUTCOMES IN KIDNEY TRANSPLANT RECIPIENTS Authors: Kim, Sungyeon; Kim, Myung-Gyu; Koo, Tai Yeon Abstract: Background and Aims Polypharmacy (PP) continues to increase, and is associated with numerous adverse clinical outcomes and mortality. Although the burden of medication in kidney transplant recipients (KTRs) is well-known, PP has not been characterized in detail in the KTRs. The aim of this study was to assess the prevalence of PP among KTRs and the association between PP and clinical outcomes in the KTRs. Method A total of 1,080 KTRs from multicenter observational cohort study in Korea between 2012 and 2016 (KNOW-KT) were included in the study. PP was defined as the use of more than 10 medications per day. Results The PP prevalence at 1, 2, 3, 5, and 8 years after transplantation was 37.9%, 37.3%, 36.5%, 37.1% and 25.4%, respectively. The prevalence of diabetes, dyslipidemia and history of cardiovascular disease was significantly higher in PP group than in non-PP group (the use of fewer than 10 medications). The mean follow-up period was 6.9 years, and there were 69 graft failures, 63 new-onset cardiovascular diseases, and 36 deaths. When the effect of PP prescribed at 1-year post-transplant on clinical outcomes was analyzed, there was no difference in glomerular filtration rate between the non-PP and PP groups, and the hazard ratio of graft failure and death in the PP group was 1.07 (0.718 to 1.59) and 1.37 (0.71 to 2.64), respectively, compared to the non-PP group. However, multivariate analysis adjusted for classical risk factors showed that PP independently increased the risk of new cardiovascular disease (adjusted HR 1.78 (1.07-2.96)) after KT. Conclusion These results showed that PP is common in KTRs, and considering the adverse effects of PP on KT outcomes, physician's attention and efforts are needed to systematically manage and prevent inappropriate PP after KT. Long-term and large-scale research is needed to establish management guidelines for PP in the future. 202306-01-01T00:00:00Z https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/64143 Title: Spexin-based galanin receptor 2 agonist improves renal injury in mice with type 2 diabetes Authors: Cha, Jin Joo; Park, Boo Yeon; Yoon, Sung Gi; Park, Hye Jin; Yoo, Ji Ae; Ghee, Jung Yeon; Cha, Dae Ryong; Seong, Jae Young; Kang, Young Sun Abstract: The spexin-based GALR2 agonist (NS200) is a novel drug, which has shown antidepressant and anxiolytic action in a recent experimental study. In this study, we investigated the effects of NS200 on renal injury in an animal model of type 2 diabetes. Eight-week-old diabetic db/db mice were administered NS200 for 12 weeks. NS200 was intraperitoneally administered at a dose of 1.0 mg/kg/day. Metabolic parameters and structural and molecular changes in the kidneys were compared among the three groups: non-diabetic db/m control, db/db mice, and NS200-treated db/db mice. In db/db mice, NS200 administration did not impact the body weight, food and water intake, urinary volume, fasting blood glucose level, or HbA1c levels. Insulin and glucose tolerance were also unaffected by NS200 treatment. However, NS200 improved urinary albumin excretion and glomerulosclerosis in diabetic kidneys. Activation of TGF beta 1 and insulin signaling pathways, such as PI3 K /AKT/ERK, were inhibited by NS200. In conclusion, a spexin-based GALR2 agonist attenuated diabetic nephropathy by alleviating renal fibrosis in mice with type 2 diabetes. Spexin-based GALR2 agonists have considerable potential as novel treatment agents in diabetic nephropathy. 2023-12-01T00:00:00Z https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/64377 Title: Resistant hypertension: consensus document from the Korean society of hypertension Authors: Park, Sungha; Shin, Jinho; Ihm, Sang Hyun; Kim, Kwang-il; Kim, Hack-Lyoung; Kim, Hyeon Chang; Lee, Eun Mi; Lee, Jang Hoon; Ahn, Shin Young; Cho, Eun Joo; Kim, Ju Han; Kang, Hee-Taik; Lee, Hae-Young; Lee, Sunki; Kim, Woohyeun; Park, Jong-Moo Abstract: Although reports vary, the prevalence of true resistant hypertension and apparent treatment-resistant hypertension (aTRH) has been reported to be 10.3% and 14.7%, respectively. As there is a rapid increase in the prevalence of obesity, chronic kidney disease, and diabetes mellitus, factors that are associated with resistant hypertension, the prevalence of resistant hypertension is expected to rise as well. Frequently, patients with aTRH have pseudoresistant hypertension [aTRH due to white-coat uncontrolled hypertension (WUCH), drug underdosing, poor adherence, and inaccurate office blood pressure (BP) measurements]. As the prevalence of WUCH is high among patients with aTRH, the use of out-of-office BP measurements, both ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM), is essential to exclude WUCH. Non-adherence is especially problematic, and methods to assess adherence remain limited and often not clinically feasible. Therefore, the use of HBPM and higher utilization of single-pill fixed-dose combination treatments should be emphasized to improve drug adherence. In addition, primary aldosteronism and symptomatic obstructive sleep apnea are quite common in patients with hypertension and more so in patients with resistant hypertension. Screening for these diseases is essential, as the treatment of these secondary causes may help control BP in patients who are otherwise difficult to treat. Finally, a proper drug regimen combined with lifestyle modifications is essential to control BP in these patients. 2023-11-01T00:00:00Z