Superior outcomes of kidney transplantation compared with dialysis An optimal matched analysis of a national population-based cohort study between 2005 and 2008 in Korea

Data regarding kidney transplantation (KT) and dialysis outcomes are rare in Asian populations. In the present study, we evaluated the clinical outcomes associated with KT using claims data from the Korean national public health insurance program. Among the 35,418 adult patients with incident dialysis treated between 2005 and 2008 in Korea, 1539 underwent KT. An optimal balanced risk set matching was attempted to compare the transplant group with the control group in terms of the overall survival and major adverse cardiac event-free survival. Before matching, the dialysis group was older and had more comorbidities. After matching, there were no differences in age, sex, dialysis modalities, or comorbidities. Patient survival was significantly better in the transplant group than in the matched control group (P<0.001). In addition, the transplant group showed better major adverse cardiac event-free survival than the dialysis group (P<0.001; hazard ratio, 0.49; 95% confidence interval, 0.32-0.75). Korean patients with incident dialysis who underwent long-term dialysis had significantly more cardiovascular events and higher all-cause mortality rates than those who underwent KT. Thus, KT should be more actively recommended in Korean populations.OAIID:RECH_ACHV_DSTSH_NO:T201619962RECH_ACHV_FG:RR00200001ADJUST_YN:EMP_ID:A079841CITE_RATE:1.206FILENAME:Superior_outcomes_of_kidney_transplantation.14.pdfDEPT_NM:컴퓨터공학부EMAIL:[email protected]_YN:YFILEURL:https://srnd.snu.ac.kr/eXrepEIR/fws/file/91ab95e8-39ce-4d72-8fb3-f6b12c82256d/linkCONFIRM:

Comparative analysis of the tonsillar microbiota in IgA nephropathy and other glomerular diseases

Immunoglobulin A nephropathy (IgAN) involves repeated events of gross haematuria with concurrent upper airway infections. The mucosal immune system, especially the tonsil, is considered the initial site of inflammation, although the role of the tonsillar microbiota has not been established in IgAN. In this study, we compared the tonsillar microbiota of patients with IgAN (n = 21) and other glomerular diseases (n = 36) as well as, healthy controls (n = 23) from three medical centres in Korea. The microbiota was analysed from tonsil swabs using the Illumina MiSeq system based on 16S rRNA gene. Tonsillar bacterial diversity was higher in IgAN than in other glomerular diseases, although it did not differ from that of healthy controls. Principal coordinates analysis revealed differences between the tonsillar microbiota of IgAN and both healthy and disease controls. The proportions of Rahnella, Ruminococcus_g2, and Clostridium_g21 were significantly higher in patients with IgAN than in healthy controls (corrected p < 0.05). The relative abundances of several taxa were correlated with the estimated glomerular filtration rate, blood urea nitrogen, haemoglobin, and serum albumin levels. Based on our findings, tonsillar microbiota may be associated with clinical features and possible immunologic pathogenesis of IgAN.

Recalibration and Validation of the Charlson Comorbidity Index in Korean Incident Hemodialysis Patients

<div><p>Background</p><p>Weights assigned to comorbidities to predict mortality may vary based on the type of index disease and advances in the management of comorbidities. We aimed to develop a modified Charlson comorbidity index (CCI) in incident hemodialysis patients (mCCI-IHD), thereby improving risk stratification for mortality.</p><p>Methods</p><p>Data on 24,738 Koreans who received their first hemodialysis treatment between 2005 and 2008 were obtained from the Korean Health Insurance dataset. The mCCI-IHD score were calculated by summing up the weights which were assigned to individual comorbidities according to their relative prognostic significance determined by multivariate Cox proportional hazards model. The modified index was validated in an independent nationwide prospective cohort (n=1,100).</p><p>Results</p><p>The Cox proportional hazards model revealed that all comorbidities in the CCI except ulcers significantly predicted mortality. Thus, the mCCI-IHD included 14 comorbidities with re-assigned severity weights. In the validation cohort, both the CCI and the mCCI-IHD were correlated with mortality. However, the mCCI-IHD showed modest but significant increases in <i>c</i> statistics compared with the CCI at 6 months and 1 year. The analyses using continuous net reclassification improvement revealed that the mCCI-IHD improved net mortality risk reclassification by 24.6% (95% CI, 2.5-46.7; <i>P</i>=0.03), 26.2% (95% CI, 1.0-51.4; <i>P</i>=0.04) and 42.8% (95% CI, 4.9-80.8; <i>P</i>=0.03) with respect to the CCI at 6 months and 1 and 2 years, respectively.</p><p>Conclusions</p><p>The mCCI-IHD facilitates better risk stratification for mortality in incident hemodialysis patients compared with the CCI, suggesting that it may be a preferred index for use in clinical practice and the statistical analysis of epidemiological studies.</p></div

Distribution of the CCI and mCCI-IHD scores for the development cohort.

<p>(A) Distribution of the CCI scores (n = 18,872), excluding patients with no comorbidity (n = 5,866). (B) Distribution of the mCCI-IHD scores (n = 18,087), excluding patients with no comorbidity (n = 6,651). The y-axis shows the number of subjects. The solid line represents a density curve, calculated by approximation, to identify the overall pattern and deviation. The vertical dotted lines (red) represents the 50^th and 90^th percentile values. CCI, Charlson comorbidity index; mCCI-IHD, modified Charlson comorbidity index for incident hemodialysis patients.</p

Survival curves obtained using the Kaplan-Meier method (A and B) and Cox regression analysis (C and D) in the validation cohort differentiated by the 4 risk groups of CCI (A and C) and mCCI-IHD (B and D).

<p>CCI, score 2 (n = 236, 21.5%); scores 3–4 (n = 537, 48.8%); scores 5–6 (n = 234, 21.3%); and score ≥7 (n = 93, 8.5%). mCCI-IHD, score 0 (n = 247, 22.5%); scores 1–4 (n = 480, 43.6%); scores 5–9 (n = 290, 26.4%); and score ≥10 (n = 83, 7.5%). ^aAdjusted for age, sex, health security system, timing of referral to nephrologist, primary cause of end-stage renal disease, body mass index, hemoglobin, albumin, calcium, and phosphorus. CCI, Charlson comorbidity index; mCCI-IHD, modified Charlson comorbidity index for incident hemodialysis patients.</p

Weights for comorbidities in the development cohort.

<p>^aAdjusted for age, sex and all comorbidities</p><p>Weights for comorbidities in the development cohort.</p