Korean Journal of Internal Medicine最新文献

Shared decision-making (SDM) enables patients to actively engage in healthcare decisions by ensuring that treatment options align with their values and preferences. The use of SDM is increasingly recognized in the context of selecting kidney replacement therapy (KRT) for patients with chronic kidney disease (CKD). This study reviews the general concept of SDM and global clinical studies on its application in selecting KRT options. Studies have demonstrated the significant benefits of SDM in KRT, including enhanced patient knowledge, satisfaction, autonomy, and increased peritoneal dialysis (PD) selection rates, which may contribute to cost savings. However, challenges remain in implementing SDM owing to time constraints, its dynamic nature, and insufficient incentives. Building on established frameworks, particularly Clayman's six-step model, we propose a new six-step SDM framework tailored to KRT to facilitate its implementation and promote adoption. Further research is required to validate the long-term impacts of SDM, address the heterogeneity of existing interventions, and identify the most effective models for clinical use.

Background/aims: This study aimed to assess the real-world treatment outcomes in South Korean patients with epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) receiving first-line (1L) EGFR tyrosine kinase inhibitors (TKIs).

Methods: We used the Health Insurance Review and Assessment Service database, which includes the data of a large proportion of the Korean population. Patients with EGFR-positive NSCLC who received gefitinib, erlotinib, or afatinib as the 1L treatment between 2012 and 2018 were included. Survival outcomes, subsequent therapies, and treatment patterns were analyzed.

Results: Among the 9,478 patients included, gefitinib (56.68%) was the most commonly prescribed 1L EGFR-TKI, followed by afatinib (25.30%) and erlotinib (18.02%). The median time to next treatment was 16.4 to 18.8 months. Overall survival (OS) was significantly different among the three treatment groups; the median OS was 28.8, 25.3, and 23.9 months for patients who were treated with afatinib, gefitinib, and erlotinib, respectively (p < 0.001). For the patients who received second-line (2L) therapy (n = 4,904, 51.74%), pemetrexed monotherapy was most commonly used (47.70%), followed by osimertinib (21.59%). Patients who received osimertinib as the 2L treatment had longer OS compared to those receiving pemetrexed (median OS: not reached vs. 25.3 to 28.8 months).

Conclusion: Our real-world study demonstrated survival outcomes that were comparable to those observed in clinical trials for patients with EGFR-mutant NSCLC treated with EGFR-TKIs. Detection of the acquired T790M mutation and subsequent osimertinib treatment had significant prognostic value.

Korea is experiencing rapid population aging and entered a super-aged society in December 2024. This demographic shift underscores the growing prevalence of sarcopenia, a progressive skeletal muscle disorder related to aging, characterized by reduced muscle mass, strength, and function, which significantly affects the morbidity and quality of life of older adults. Although sarcopenia is defined as a medical condition (ICD-10-CM M62.84; KCD-8 M62.5), no effective pharmacological treatment exists, emphasizing the importance of non-pharmacological prevention and management strategies. Definitions of sarcopenia have been proposed by the European Working Group on Sarcopenia in Older People (EWGSOP), the Asian Working Group for Sarcopenia (AWGS), and the Korean Working Group on Sarcopenia (KWGS). The current interventions focus on exercise and nutritional supplementation. Protein intake above the generally recommended dietary allowance, along with resistance exercise, is strongly recommended for the prevention and management of sarcopenia. Asian intervention studies have highlighted the benefits of multimodal programs that combine exercise, nutrition, and geriatric care. However, standardized protocols remain inconclusive. Variations in diagnostic criteria and ethnic differences further complicate the management of sarcopenia. Future large-scale studies are needed to establish effective preventive measures and therapeutic strategies for sarcopenia with a focus on tailored interventions and standardized protocols for Asians.

Background/aims: While the clinical effectiveness of guideline-directed medical therapy (GDMT) is well established in patients with acute myocardial infarction (AMI), its specific impact on cause-specific mortality remains unclear. This study aimed to investigate the impact of GDMT on both cardiac and non-cardiac mortality in AMI patients.

Methods: Data of the KAMIR-NIH, a multicenter prospective registry of AMI in Korea between 2011 and 2015, were included. The competing risks of cardiac and non-cardiac death in patients who received GDMT were compared with those who did not, using a multivariable-adjusted cumulative incidence analysis of propensity score-matched patients. Primary endpoint of interest was 3-year cardiac and non-cardiac mortality.

Results: Of the 12,815 patients enrolled, 2,700 matched pairs with a mean age of 64.9 ± 12.2 years were analyzed. The cumulative incidence of cardiac death (5.0% vs. 8.6%; subdistribution hazard ratio [sHR] 0.53; 95% CI 0.43-0.67) and non-cardiac death (3.2% vs. 4.5%; sHR 0.69; 95% CI 0.52-0.92) was significantly lower in patients receiving GDMT compared to those who did not (all p < 0.05). These results were also consistent in 30-day landmark analyses.

Conclusion: In patients with AMI, the use of GDMT was linked to a reduced risk of both cardiac and non-cardiac death over a period of 3 years. These findings support the continued adoption of GDMT in clinical practice.

Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, highlighting the need for effective preventive strategies. This consensus statement emphasizes the critical role of regular physical activity, including aerobic and muscle-strengthening exercises, in reducing key CVD risk factors such as hypertension, dyslipidemia, obesity, and insulin resistance. Recommendations are provided for the general adult population as well as specific subgroups, including older adults, pregnant and postpartum women, individuals with CVD, and those with physical limitations. The importance of reducing sedentary behavior and integrating physical activity into daily life is also addressed. Recommendations should focus on tailored interventions, supportive environments, and evidence-based policies that encourage active lifestyles. Further research specific to the Korean population will enhance the development of evidence-based, population-tailored guidelines for more effective CVD prevention in Korea.

Background/aims: Chronic kidney disease (CKD) is associated with complications that affect physical function and mobility. This study investigated the associations between kidney function, proteinuria, and lower-extremity dysfunction.

Methods: Data were obtained from the Korean National Health Insurance Service Health Screening Program, including individuals aged 66 years who participated in the National Screening Program for Transitional Ages in Korea. Participants were stratified based on estimated glomerular filtration rate (eGFR) into four groups: Group 1 (eGFR ≥ 90 mL/min/1.73 m2), Group 2 (60 ≤ eGFR < 90 mL/min/1.73 m2), Group 3 (30 ≤ eGFR < 60 mL/min/1.73 m2), and Group 4 (eGFR < 30 mL/min/1.73 m2). Lower-extremity dysfunction was assessed using two physical tests measuring function and balance. Multivariable logistic regression was performed to examine the associations between kidney function, proteinuria, and lower-extremity dysfunction.

Results: Group 2 served as the reference. Both decreased (Groups 3 and 4) and elevated (Group 1) eGFR levels were significantly associated with an increased risk of lower-extremity dysfunction (Group 4: adjusted OR 1.40, 95% CI 1.10-1.78; Group 1: adjusted OR 1.19, 95% CI 1.12-1.25). Similar patterns were observed for balance dysfunction. A U-shaped relationship was identified between eGFR and lower-extremity dysfunction. Proteinuria was independently associated with balance dysfunction (adjusted OR 1.35, 95% CI 1.20-1.51) but not with lower-extremity dysfunction.

Conclusion: A U-shaped relationship was identified between renal function and lower-extremity dysfunction, with both lower and elevated eGFR linked to increased risks of impairment, underscoring the need for regular assessment of lower-extremity function and appropriate interventions in patients with CKD, elevated eGFR, or proteinuria.

Background/aims: Although COVID-19 vaccines reduce COVID-19 severity, various safety concerns have emerged. This study, involving a population-based cohort, used health insurance data to investigate potential vaccine-related major outcomes, including cardiac, pulmonary, and thromboembolic diseases.

Methods: This retrospective cohort study involved data from 2,017,884 vaccinated (at least two doses) individuals and 334,583 unvaccinated individuals. The incidences of myocarditis, myocardial infarction, atrial fibrillation, interstitial lung disease, pulmonary thromboembolism, deep vein thrombosis, and cerebrovascular disease were compared between the vaccinated and the unvaccinated groups at 1 week to 3 months after vaccination.

Results: The study population had a mean age of 54 years (male: 44.6%). Among the vaccinated, 57.7% received the mRNA vaccine only, whereas 35.5% received the adenoviral vector vaccine alone. Multivariate logistic analysis revealed that vaccination was significantly associated with the early development of myocarditis. The mRNA vaccine, a younger age, and retrohyperlipidemia were independent indicators of poor myocarditis prognosis after vaccination. However, the incidence of myocardial infarction at 1-2 weeks post-vaccination, as well as pulmonary thromboembolism and cerebrovascular disease (both at 3 months post-vaccination), were significantly lower in the vaccinated group when compared with the unvaccinated one. However, there was no significant association between vaccination and interstitial lung disease, atrial fibrillation, or deep vein thrombosis.

Conclusion: The younger male population (age: < 45 years) should be cautious about receiving the COVID-19 mRNA vaccine and should be closely monitored for myocarditis after vaccination. Vaccination was associated with short-term protection against venous and arterial thrombotic events, as well as hemorrhagic events.

Background/aims: The role of pro-inflammatory factors in the pathogenesis of inflammatory bowel diseases (IBD), is not well understood. This study investigated the association between the predicted pro-inflammatory high-sensitivity C-reactive protein (hs-CRP) score and IBD.

Methods: This study involved 127 case/non-case pairs matched by age and sex of participants who underwent gastrointestinal endoscopy in Korea. Participants provided comprehensive sociodemographic, lifestyle, and dietary data. We obtained odds ratio (OR) and 95% confidence interval (CI) for IBD prevalence by tertiles of the predicted pro-inflammatory hs-CRP score using multivariable-adjusted logistic regression models at a two-sided p < 0.05.

Results: Higher predicted pro-inflammatory hs-CRP score was associated with a higher IBD prevalence; OR (95% CI): 1.00, 0.88 (0.38, 2.07) and 8.11 (2.07, 31.81; p for trend = 0.006). Similar increased trends of IBD prevalence with score increase were observed for men and women. The association was more pronounced for UC prevalence when we separated UC and CD. Compared to the low category, OR (95% CI) were 5.78 (1.29, 25.89) for UC but 1.44 (0.31, 6.69) for CD in the dichotomized higher category. The area under the curve for predicted pro-inflammatory hs-CRP score was 0.72 (95% CI: 0.64, 0.81) for UC and 0.68 (95% CI: 0.58, 0.77) for CD, indicating moderate predictive ability.

Conclusion: Higher predicted pro-inflammatory hs-CRP score was significantly associated with an increased prevalence of IBD, particularly UC, and could be a valuable indicator for discriminating people at risk of IBD, offering insights into disease aetiology and opportunities for targeted interventions.