Questionnaire-based Survey of Demographic and Clinical Characteristics, Health Behaviors, and Mental Health of Young Korean Adults with Early-onset Diabetes

Background@#The incidence of early-onset diabetes is increasing among young adults.However, there are limited data on the characteristics and management of young Korean adults with diabetes. This study assessed the clinical and demographic characteristics, health behaviors, and mental health among young Korean adults with diabetes mellitus. @*Methods@#This cross-sectional study included young Korean adults with diabetes (n = 225) with an onset age of 20–39 years from four university hospitals. Demographic characteristics, management of diabetes, and mental health were assessed using a questionnaire survey. @*Results@#Type 2 diabetes was the most common type (73.3%), and 13.8% of participants were classified as other types or unknown. Approximately, 64.7% of participants had a strong family history of diabetes, and 76% had treatment within three months of diagnosis.Approximately, 11.1% of participants had diabetic complications; 39.1% of participants received insulin injections, including oral anti-diabetic medications. Additionally, 30.4% were smokers, and only 28% had active physical activity; 26.5% of participants had >3 hours of screen time. One third of participants never had breakfast, and 60.5% went out to eat at least three times a week. Half of the participants showed moderate to severe stress perception, and 21.4% of patients had moderate to severe levels of depression based on the Korean version of Beck Depression Inventory score. @*Conclusion@#Early-onset diabetes was associated with a strong family history and early insulin treatment. Young adults with diabetes had poor health behaviors and frequent mental depression. These findings suggest the necessity of health policies for improving health behaviors and mental distress.

Questionnaire-based Survey of Demographic and Clinical Characteristics, Health Behaviors, and Mental Health of Young Korean Adults with Early-onset Diabetes

Background@#The incidence of early-onset diabetes is increasing among young adults.However, there are limited data on the characteristics and management of young Korean adults with diabetes. This study assessed the clinical and demographic characteristics, health behaviors, and mental health among young Korean adults with diabetes mellitus. @*Methods@#This cross-sectional study included young Korean adults with diabetes (n = 225) with an onset age of 20–39 years from four university hospitals. Demographic characteristics, management of diabetes, and mental health were assessed using a questionnaire survey. @*Results@#Type 2 diabetes was the most common type (73.3%), and 13.8% of participants were classified as other types or unknown. Approximately, 64.7% of participants had a strong family history of diabetes, and 76% had treatment within three months of diagnosis.Approximately, 11.1% of participants had diabetic complications; 39.1% of participants received insulin injections, including oral anti-diabetic medications. Additionally, 30.4% were smokers, and only 28% had active physical activity; 26.5% of participants had >3 hours of screen time. One third of participants never had breakfast, and 60.5% went out to eat at least three times a week. Half of the participants showed moderate to severe stress perception, and 21.4% of patients had moderate to severe levels of depression based on the Korean version of Beck Depression Inventory score. @*Conclusion@#Early-onset diabetes was associated with a strong family history and early insulin treatment. Young adults with diabetes had poor health behaviors and frequent mental depression. These findings suggest the necessity of health policies for improving health behaviors and mental distress.

Different Seasonal Variations of Potassium in Hemodialysis Patients with High Longitudinal Potassium Levels: A Multicenter Cohort Study Using DialysisNet

Purpose@#To determine seasonal variations in serum potassium levels among hemodialysis patients. @*Materials and Methods@#This was a multicenter cohort study of patients whounderwent hemodialysis and were registered in DialysisNet at our four associated general hospitals between January and December 2016. Month-to-month potassium variability was quantified as SD/√{n/(n-1)}, and a non-hierarchical method was used to cluster groups according to potassium trajectories. Seasonal variations in potassium levels were analyzed using a cosinor analysis. @*Results@#The analysis was performed on 279 patients with a mean potassium level of 5.08±0.58 mmol/L. After clustering, 52.3% (n=146) of patients were included in the moderate group (K+ , 4.6±0.4 mmol/L) and 47.7% (n=133) in the high group (K+ , 5.6±0.4 mmol/L). The mean potassium level peaked in January in the moderate group (4.83±0.74 mmol/L) and in August in the high group (5.51±0.70 mmol/L). In the high potassium group, potassium levels were significantly higher in summer than in autumn (p<0.001) and spring (p=0.007). Month-to-month potassium variability was greater in the high group than in the moderate group (0.59±0.19 mmol/L vs. 0.52±0.21 mmol/L, respectively, p=0.012). Compared to patients in the first quartile of potassium variability (≤0.395 mmol/L), those with higher variability (2nd–4th quartiles) were 2.8–4.2 fold more likely to be in the high potassium group. @*Conclusion@#Different seasonal patterns of serum potassium were identified in the moderate and high potassium groups, with potassium levels being significantly higher in the summer season in the high potassium group and in winter for the moderate potassium group.

Trends of Clinical Practice for Obstructive Sleep Apnea Following the Change in the National Health Insurance Coverage

Objectives@#We aimed to investigate the recent changes in clinical practice in Korea after the introduction of the national health insurance coverage for polysomnography and positive airway pressure (PAP) treatment for obstructive sleep apnea syndrome (OSAS) in July 2018. @*Methods@#We assessed the amount, cost, and geographic distribution of healthcare utilization associated with the diagnostic codes of sleep apnea, polysomnography tests, and PAP treatment using the Korea National Health Insurance Database. Furthermore, the specialties of the prescribing physician and the type of health institute were investigated. @*Results@#The number of patients who used health resources under the diagnostic codes of sleep apnea has increased since 2018. In total, 81,016 polysomnography tests were performed from July 2018 to December 2019, and 58,213 patients underwent PAP treatment from July 2018 to March 2020. The total medical cost associated with sleep apnea was 56,517,061 thousand won in 2019. Auto-titrating PAP accounted for 85.1% of all PAP devices prescribed, and the overall adherence rate for PAP was 69.3%. PAP was prescribed most frequently in private clinics (49.9%) and mostly by physicians of ear-nose-throat (66.6%), neurology (18.7%), and psychiatry (10.3%) specializations. PAP was used more frequently by those living in urban areas than by those living in rural areas. @*Conclusions@#Recent changes in the national health insurance coverage have resulted in a surge in the healthcare utilization related to OSAS. There was a regional variation in OSAS treatment, suggesting an inequality in the availability of healthcare for OSAS and the need to improve the awareness regarding OSAS.

Trends of Clinical Practice for Obstructive Sleep Apnea Following the Change in the National Health Insurance Coverage

Objectives@#We aimed to investigate the recent changes in clinical practice in Korea after the introduction of the national health insurance coverage for polysomnography and positive airway pressure (PAP) treatment for obstructive sleep apnea syndrome (OSAS) in July 2018. @*Methods@#We assessed the amount, cost, and geographic distribution of healthcare utilization associated with the diagnostic codes of sleep apnea, polysomnography tests, and PAP treatment using the Korea National Health Insurance Database. Furthermore, the specialties of the prescribing physician and the type of health institute were investigated. @*Results@#The number of patients who used health resources under the diagnostic codes of sleep apnea has increased since 2018. In total, 81,016 polysomnography tests were performed from July 2018 to December 2019, and 58,213 patients underwent PAP treatment from July 2018 to March 2020. The total medical cost associated with sleep apnea was 56,517,061 thousand won in 2019. Auto-titrating PAP accounted for 85.1% of all PAP devices prescribed, and the overall adherence rate for PAP was 69.3%. PAP was prescribed most frequently in private clinics (49.9%) and mostly by physicians of ear-nose-throat (66.6%), neurology (18.7%), and psychiatry (10.3%) specializations. PAP was used more frequently by those living in urban areas than by those living in rural areas. @*Conclusions@#Recent changes in the national health insurance coverage have resulted in a surge in the healthcare utilization related to OSAS. There was a regional variation in OSAS treatment, suggesting an inequality in the availability of healthcare for OSAS and the need to improve the awareness regarding OSAS.

Prevalence of Chronic Kidney Disease in Korea: the Korean National Health and Nutritional Examination Survey 2011-2013

Chronic kidney disease is a leading public health problem related to poor quality of life and premature death. As a resource for evidence-informed health policy-making, we evaluated the prevalence of chronic kidney disease using the data of non-institutionalized adults aged ≥ 20 years (n = 15,319) from the Korean National Health and Nutrition Examination Survey in 2011-2013. Chronic kidney disease was defined as a urine albumin-to-creatinine ratio ≥ 30 mg/g or an estimated glomerular filtration rate < 60 mL/min/1.73 m2 using the Chronic Kidney Disease-Epidemiology Collaboration equation. The total prevalence estimate of chronic kidney disease for adults aged ≥ 20 years in Korea was 8.2%. By disease stage, the prevalence of chronic kidney disease was as follows: stage 1, 3.0%; stage 2, 2.7%; stage 3a, 1.9%; stage 3b, 0.4%; and stages 4-5, 0.2%. When grouped into three risk categories according to the 2012 Kidney Disease: Improving Global Outcomes guidelines, the proportions for the moderately increased risk, high risk, and very high risk categories were 6.5%, 1.2%, and 0.5%, respectively. Factors including older age, diabetes, hypertension, cardiovascular disease, body mass indexes of ≥ 25 kg/m2 and < 18.5 kg/m2, and rural residential area were independently associated with chronic kidney disease. Based on this comprehensive analysis, evidence-based screening strategies for chronic kidney disease in the Korean population should be developed to optimize prevention and early intervention of chronic kidney disease and its associated risk factors.

Constipation is Closely Associated with Depression in Patients with End-Stage Renal Disease Undergoing Hemodialysis or Peritoneal Dialysis / 대한신장학회지

PURPOSE: Constipation is a frequent complaint among dialysis patients. However, factors that contribute to constipation in these patients have not been evaluated rigorously. The aim of study was to assess the prevalence and factors that contribute to constipation in patients with End-Stage Renal Disease (ESRD) undergoing hemodialysis (HD) or peritoneal dialysis (PD). METHODS: Patients undergoing HD or PD for more than six months in the six dialysis centers were asked to complete a self-administered questionnaire that is designed to assess constipation by Rome- III criteria. Beck depression inventory (BDI) were assessed. A total of 146 patients (HD 91, PD 55) completed the study. RESULTS: The prevalence of constipation was 33% in 91 HD patients and 31% in 55 PD patients. Prevalence of constipation was 32% and did not differ by dialysis mode. Older age, unemployed state, high cumulative illness rating scale and high BDI were associated with constipation. In multivariate analysis, BDI was an independent factor associated with constipation. The prevalence of constipation was 18% and 50% for patients with BDI or =15, respectively. The odd ratio for constipation in patients with BDI > or =15 was 3.4 (95% CI, 1.4-8.1). CONCLUSION: Careful psychogenic attention must be paid to ESRD patients with constipation.

Effects of Losartan on the Urinary Angiotensinogen Excretion in Chronic Non-diabetic Proteinuric Renal Disease / 대한신장학회지

PURPOSE: There were experimental evidences supporting that intrarenal activation of the renin-angiotensin system contributes to increase BP, proteinuria and urinary angiotensinogen (UAGT) excretion. The purpose of this prospective, open label, controlled study was to investigate the effect of losartan on proteinuria and UAGT excretion in chronic non-diabetic proteinuric (0.4 to 2.0 g/day) renal disease with normal renal function (glomerular filtration rate, GFR>60 mL/min/1.73m2). METHODS: Thirty two patients were randomly allocated to the losartan group (100 mg/day; n=17) or the control group (n=15). Systolic BP, diastolic BP, estimated GFR, urinary protein to creatinine ratio (UP/Cr), UAGT and plasma angiotensinogen (PAGT) level were compared between two groups at baseline, 6 months and 12 months. RESULTS: UP/Cr (1.13+/-0.36 g/g vs. 1.07+/-0.34 g/g) was similar in two groups at baseline. Target BP (<140/90 mmHg) was maintained in both groups. After 6 months, UP/Cr (0.63+/-0.35 g/g vs. 0.97+/-0.41 g/g, p<0.01) was significantly decreased in the losartan group compared to the control group. In addition, UAGT (baseline 1.0) was noticeably suppressed in the losartan group (0.72+/-0.42 vs. 1.07+/-0.81, p=0.13). However, PAGT was not changed in both groups. Moreover, our study at 12 months period has demonstrated continuous suppression of UP/Cr (0.79+/-0.53 g/g vs. 1.00+/-0.50 g/g, p=0.06) and UAGT (0.60+/-0.51 vs. 1.51+/-1.36, p<0.05) in the losartan group. UP/Cr was highly correlated with UAGT (Correlation Coefficient=0.74, p<0.01), but not with PAGT. CONCLUSION: Losartan not only induced a remarkable decrease in proteinuria but also contributed a reduction in UAGT in patients with chronic non-diabetic proteinuric renal disease.

The Changes of Clinical Markers, beta2-microglobulin and Oxidized LDL, after Converting to On-line Hemodiafiltration from High-flux Hemodialysis / 대한신장학회지

PURPOSE: Hemodiafiltration with the on-line regeneration of ultrafiltrate (on-line hemodiafiltration, OL- HDF) provides better clearance of both small and large solutes than high-flux hemodialysis (HFHD) and may reduce inflammation and oxidative stress. The purpose of this observational study was to ascertain whether OL-HDF improves clinical markers after switching from HFHD to OL-HDF in patients with end-stage renal disease. METHODS: Fourteen stable patients on HFHD for at least 6 months were switched to OL-HDF. We observed changes in subjective symptoms, the levels of hemoglobin, erythropoietin dose, Kt/V, URR, beta 2-microglobulin, plasma oxidized LDL (OxLDL) and CRP for twelve-months period. RESULTS: There were improvements in subjective symptoms including fatigue, anorexia, insomnia and itching sensation (p<0.05). There were significant increases in Kt/V (1.63+/-0.17 vs. 1.77+/-0.24, p< 0.05) and URR (75.1+/-3.2 vs. 77.2+/-3.9%, p<0.05). Even though erythropoietin dose was not changed, hemoglobin level was increased (10.6+/-1.3 vs. 11.4+/-1.0, p<0.05). Beta 2-microglobulin clearance was significantly increased (17.7+/-4.4 vs. 21.9+/-6.1 mL/min, p<0.05). However, the pre-dialysis level of beta 2-microglobulin was not significantly reduced. The pre-dialysis level of CRP was not changed. OxLDL reduction ratio was not changed. On the other hand, the pre-dialysis plasma level of OxLDL was significantly reduced (32.36+/-6.03 vs. 26.05+/-6.00 U/L, p<0.05). CONCLUSION: OL-HDF improved several subjective symptoms, anemia, the clearance of small solute, beta 2-microglobulin level and reduced plasma OxLDL after switching from HFHD. Less OxLDL may be generated in OL-HDF compared with HFHD.

Brain Natriuretic Peptide (BNP), N-terminal pro-BNP (NT-proBNP) and Cardiac Troponin T (cTnT) as Markers of Cardiac Diseases in Stable Hemodialysis Patients / 대한신장학회지

PURPOSE: The prevalence of coronary artery disease and left ventricular hypertrophy (LVH) is higher in patients with chronic kidney disease (CKD) than in the general population. In the general population, BNP, NT-proBNP, and cTnT are useful markers of cardiac disease. Recently, studies on biomarkers in patients with CKD have been reported. However, the effect of renal disease on these markers is still uncertain particularly in hemodialysis patients. We investigated the potential of BNP, NT-proBNP, and cTnT as biomarkers of cardiac disease in hemodialysis patients. Methods: We prospectively studied 27 hemodialysis patients without cardiovascular event within the last 6 months. We performed an echocardiography and blood samples for plasma BNP, NT-proBNP and cTnT. RESULTS: Median BNP, NT-proBNP, and cTnT level (pg/mL) were 433, 10,598, and 0.021, respectively. NT-proBNP was correlated with BNP (r=0.940, p=0.000) and cTnT (r=0.504, p=0.009). There was a negative correlation between BNP and left ventricular ejection fraction (LVEF) (r=-0.502, p=0.008), between NT-proBNP and LVEF (r=-0.556, p=0.003), and between cTnT and LVEF (r=-0.513, p=0.007). There was a positive correlation between BNP and LV mass index (LVMI) (g/m2) (r=0.619, p=0.001). Also, a positive correlation between NT-proBNP and LVMI was shown (r=0.718, p=0.000). There was an insignificant positive correlation between cTnT and LVMI (r=0.369, p=0.063). Albumin, cholesterol, LDL-cholesterol, and NT-proBNP had an independent effect on LVEF (R2=0.80). Age, body mass index, LDL-cholesterol, NT-proBNP, and cTnT had an independent effect on LVMI (R2=0.78). Conclusion: BNP, NT-proBNP, and cTnT may be as a noninvasive diagnostic or prognostic marker of cardiac disease in stable hemodialysis patients.

A Case of Spontaneous Renal Artery Dissection Secondary to Fibromuscular Dysplasia and Treatment by Renal Arterial Stenting / 대한신장학회잡지

Isolated spontaneous renal artery dissection (SRAD) associated with fibromuscular dysplasia (FMD) is a rare condition that can result in renal infarction. Treatment and long-term management of patients with this condition is controversial. We report the case of a patient with SRAD secondary to FMD who was treated by renal arterial stenting. A previous healthy 50-year-old white male presented to the emergency department with acute right flank pain. Blood pressure was 150/90 mmHg and serum creatinine was 1.6 mg/dL. A CT scan of the abdomen showed multifocal right renal infarction. The patient was started on anticoagulant regimen of heparin. Renal angiography showed the dissection of right renal artery and stenosis of mid-segment of right main renal artery and intrarenal branches. We decided to perform percutaneous balloon angioplasty and stenting for the purpose of dilating the stenotic renal artery, preventing recurrence of the disease and controlling hypertension and elevated creatinine. A dissected intimal flap was closed successfully by renal artery stenting and stenotic renal artery was dilated by stenting and balloon angioplasty. Five days after the procedure, he was discharged with warfarin. Three months later, he had normal renal function and blood pressure without antihypertensive medication was mildly elevated at 145/104 mmHg. Conclusively, stent implantation to renal artery dissection can be effective, reliable and feasible and can be an alternative to surgical treatment.