Korean Journal of Internal Medicine最新文献

Background/aims: The corona virus disease 2019 posed a major risk for end-stage kidney disease (ESKD) cases. Our study aimed to assess changes in kidney replacement therapy (KRT) trends and healthcare access for these patients during the pandemic.

Methods: We retrospectively analyzed nationwide data from July 2017 to June 2022 to assess changes in KRT and ESKD incidence. KRT modalities included peritoneal dialysis (PD), hemodialysis (HD), and kidney transplantation (KT). We utilized the interrupted time series (ITS) method to compare changes in KRT modality before and after the incidence of the COVID-19 pandemic.

Results: ESKD incidence remained stable from 2018 to April 2022. The ITS analysis confirmed that the pandemic did not significant impact overall KRT incidence. PD cases decreased (5.7% to 1.3%), while HD cases increased (81.6% to 85%), and KT recipient remained relatively stable (12.7% to 17.3%). The hospitalization and hospital stay decreased in nursing hospital (165.01 days to 147.77 days) and general hospital (61.34 days to 55.58 days) during the pandemic, however, remained unchanged for PD and KT.

Conclusion: Our findings indicate no significant changes in ESKD incidence in South Korea during the pandemic. However, there were shifts in modality distribution, with decreased PD and increased HD cases. Notably, HD cases showed a significant reduction in hospital admissions and length of stay. The healthcare system demonstrated stability during the pandemic, with minimal disruptions in ESKD care.

Interest in kidney transplant studies in the elderly population is increasing as more research has been conducted on the immune system. With this review, we hope to encourage the need for research on kidney transplantation in the elderly.

Background/aims: We investigated sudomotor dysfunction, small fiber neuropathy (SFN), and their clinical significance in female fibromyalgia patients.

Methods: Fibromyalgia patients and healthy controls (HCs) were recruited. Clinical and laboratory data were measured. Electrochemical skin conductance (ESC) values of hands and feet were assessed by SUDOSCAN. Additionally, several other methods were employed, including nerve conduction study (NCS), electromyography (EMG), and questionnaires. Spearman correlation coefficient was calculated to identify factors associated with ESC values of SUDOSCAN.

Results: Twenty-two female fibromyalgia patients and 22 female HCs were recruited. The fibromyalgia group had lower EQ5D and higher Toronto Clinical Neuropathy scores than the HC group. Most of the EMG/NCS findings of motor and proximal sensory nerves were comparable between the fibromyalgia and HC groups, whereas sensory nerve action potential amplitudes of distal sensory nerves were significantly lower in the fibromyalgia group. Mean ESC values of hands and feet were significantly lower in the fibromyalgia group than in the HC group (57.6 ± 16.2 vs. 68.8 ± 10.3 μS, p = 0.010 for hands, 64.9 ± 11.5 vs. 72.0 ± 8.2 μS, p = 0.025 for feet, respectively). Moderate to severe SFN was more common in the fibromyalgia group (68.2%) than in the HC group (68.2 vs. 50%, p = 0.019). Fibromyalgia disease duration was significantly correlated with the ESC values of hands/feet, and tricyclic antidepressant (TCA) responders had higher ESC values than non-responders.

Conclusion: SFN was commonly detected in fibromyalgia patients who had normal EMG/NCS findings and was more severe in fibromyalgia patients with longer disease duration. SUDOSCAN may predict response to TCA therapy.

Background/aims: Non-alcoholic fatty liver disease (NAFLD), now the most common chronic liver worldwide, has become a significant public health concern. This study aims to analyze the evolving epidemiology of NAFLD in South Korea.

Methods: We utilized claim data from the Korean National Health Insurance Service from 2010 to 2022 to analyze NAFLD's incidence, prevalence, and progression.

Results: From 2010 to 2022, the incidence and prevalence rates of NAFLD each increased from 1.87% to 4.47% and from 10.49% to 17.13%, respectively. The differences in prevalence rates between urban and rural areas were minimal in 2012 and 2022, yet both areas showed significant increases in the prevalence of NAFLD over the decade. The NAFLD group had a higher prevalence of comorbidities compared to the control group, and the most common comorbid condition was hypertension. Moreover, the ten-year incidence rates of malignancy, heart disease, and stroke in the NAFLD group were 13.42%, 15.72%, and 8.36%, respectively, which were significantly higher than those in the control group. The incidence rates of cirrhosis and hepatocellular carcinoma in NAFLD over 10 years were 2.22% and 0.77%, respectively. The total medical costs of NAFLD patients more than doubled over ten years and were all significantly higher than those of the control group.

Conclusion: A significant increase in NAFLD prevalence and its impact on healthcare utilization was observed in South Korea. With NAFLD leading to serious liver diseases and increased healthcare costs, integrated care strategies that include both medical treatment and lifestyle modifications are essential.

Diabetic nephropathy (DN), a leading cause of chronic kidney disease and end-stage kidney disease (ESKD), poses global health challenges given its increasing prevalence. DN increases the risk of mortality and cardiovascular events. Early identification and appropriate DN management are crucial. However, current diagnostic methods rely on general traditional markers, highlighting the need for DN-specific diagnostics. Metabolomics, the study of small molecules produced by metabolic activity, promises to identify specific biomarkers that distinguish DN from other kidney diseases, decode the underlying disease mechanisms, and predict the disease course. Profound changes in metabolic pathways are apparent in individuals with DN, alterations in the tricarboxylic acid cycle and amino acid and lipid metabolism, suggestive of mitochondrial dysfunction. Metabolomics aids prediction of chronic kidney disease progression; several metabolites serve as indicators of renal functional decline and the risk of ESKD. Integration of such information with other omics data will further enhance our understanding of DN, paving the way to personalized treatment. In summary, metabolomics and multi-omics offer valuable insights into DN and are promising diagnostic and prognostic tools.

Background/aims: Few real-world studies explored factors associated with latent tuberculosis infection (LTBI) treatment-related adverse drug reactions (ADRs). This study evaluate ADRs that lead to the discontinuation of LTBI treatment and identify the associated factors, including age groups and drug regimens.

Methods: Using the Korean national tuberculosis registry and HHC investigation database linked to the National Health Insurance Service claims database, we examined treatment discontinuation due to ADRs among HHCs on LTBI treatment from January 2015 to December 2018. Multivariable logistic regression analysis was conducted to examine factors associated with ADRs, including demographics, LTBI treatment, comorbidities, and steroid use.

Results: Among 11,913 participants initiated LTBI treatment, 633 participants (5.3%) discontinued treatment due to ADRs. The primary contributors to discontinuation were adverse skin reactions (2.0%) and abnormal liver function (1.9%). Risk associated with ADRs and abnormal liver function showed age-related increase, except for the age group 66-75 (adjusted odds ratio [AOR] 3.82, 95% confidence interval [CI] 2.31-6.31) which reported lower OR to that of age group 36-65 (AOR 4.38, 95% CI 3.09-6.21). Three months isoniazid/rifampin and 4 months rifampin exhibited a lower odds of ADRs and abnormal liver function when compared to 6-9 months isoniazid.

Conclusion: We discovered the real-world prevalence of LTBI treatment discontinuation due to ADRs among HHCs. Our findings suggest a notably increased odds of ADRs resulting in discontinuation with age of 76 years or above, emphasizing careful attention when prescribing LTBI treatment in this population. Further studies are warranted to validate these results.

Background/aims: With the global increase in patients with solid malignancies, it is helpful to understand the outcomes of intensive care unit (ICU) admission for these patients. This study evaluated the risk factors for ICU mortality and the shortand long-term outcomes in patients with solid malignancies who had unplanned ICU admission.

Methods: This retrospective cohort study included patients with solid malignancies treated at the medical ICU of a single tertiary center in South Korea between 2016 and 2022.

Results: Among the 955 patients, the ICU mortality rate was 23.5%. Lung cancer was the most common cancer type (34.2%) and was significantly associated with increased ICU mortality (odd ratio [OR] 1.58, p = 0.030). Higher Sequential Organ Failure Assessment scores at ICU admission (OR 1.11, p < 0.001), the need for mechanical ventilation (OR 6.74, p < 0.001), or renal replacement therapy during the ICU stay (OR 2.49, p < 0.001) were significantly associated with higher ICU mortality. The 1-year survival rate after ICU admission was 29.3%, with a median survival of 37 days for patients requiring mechanical deviaventilation, and 23 days for patients requiring renal replacement therapy.

Conclusion: This study showed that critically ill patients with solid malignancies had poor 1-year survival despite relatively low ICU mortality. These findings highlight the need for careful consideration of ICU admission in patients with solid malignancy, and decision-making should be based on an understanding of the expected short- and long-term prognosis of ICU admission after an informed discussion among patients, families, and physicians.