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  • Urinary Potassium Excretion and Progression of CKD

    Kim, Hyung Woo   Park, Jung Tak   Yoo, Tae-Hyun   Lee, Joongyub   Chung, Wookyung   Lee, Kyu-Beck   Chae, Dong-Wan   Ahn, Curie   Kang, Shin-Wook   Choi, Kyu Hun   Han, Seung Hyeok  

    Background and objectives Data on whether low or high urinary potassium excretion is associated with poor kidney outcome have been conflicting. The aim of this study was to clarify the association between urinary potassium excretion and CKD progression. Design, setting, participants, & measurements We investigated the relationship between lower urinary potassium excretion and CKD progression and compared three urinary potassium indices among 1821 patients from the Korean Cohort Study for Outcome in Patients with CKD. Urinary potassium excretion was determined using spot urinary potassium-to-creatinine ratio, spot urinary potassium concentration, and 24-hour urinary potassium excretion. Patients were categorized into four groups according to quartiles of each urinary potassium excretion metric. The study end point was a composite of a >=3D 50% decrease in eGFR from baseline values and ESKD. Results During 5326 person-years of follow-up, the primary outcome occurred in 392 (22%) patients. In a multivariable cause-specific hazard model, lower urinary potassium-to-creatinine ratio was associated with higher risk of CKD progression (adjusted hazard ratio, 1.47; 95% confidence interval, 1.01 to 2.12) comparing the lowest quartile with the highest quartile. Sensitivity analyses with other potassium metrics also showed consistent results in 855 patients who completed 24-hour urinary collections: adjusted hazard ratios comparing the lowest quartile with the highest quartile were 3.05 (95% confidence interval, 1.54 to 6.04) for 24-hour urinary potassium excretion, 1.95 (95% confidence interval, 1.05 to 3.62) for spot urinary potassium-to-creatinine ratio, and 3.79 (95% confidence interval, 1.51 to 9.51) for spot urinary potassium concentration. Conclusions Low urinary potassium excretion is associated with progression of CKD.
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  • Urinary Potassium Excretion and Progression of Chronic Kidney Disease

    Kim, Hyung Woo   Park, Jung Tak   Yoo, Tae-Hyun   Lee, Joongyub   Chung, Wookyung   Lee, Kyu-Beck   Chae, Dong-Wan   Ahn, Curie   Kang, Shin-Wook   Choi, Kyu Hun   Han, Seung Hyeok  

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  • Renal function and decline in functional capacity in older adults.

    Chin, Ho Jun   Ahn, Shin Young   Ryu, Jiwon   Kim, Sejoong   Na, Ki Young   Kim, Ki Woong   Chae, Dong-Wan   Kim, Cheol-Ho   Kim, Kwang-Il  

    BACKGROUND: longitudinal relationship between renal function, disability and mortality has not been evaluated.; OBJECTIVE: we investigated the temporal association between renal function and disability, and aimed to identify the influence of disability on mortality according to renal function in a cohort of older Koreans.; DESIGN/SETTING: Korean Longitudinal Study on Health and Aging is a prospective, population-based cohort.; SUBJECTS: community-dwelling Koreans =E2=89=A565 years of age.; MAIN OUTCOME MEASURES: Korean version of activities of daily living (ADL), Instrumental activities of daily living (IADL) and all-cause mortality.; RESULTS: a total of 984 participants were followed for 5 years with a 70.9% participation rate. The participants were categorized into three groups according to their baseline estimated glomerular filtration rates (eGFRs) (Group I, =E2=89=A560; Group II, 45-59; and Group III, <45 ml/min/1.73 m(2)). Baseline eGFR was higher in participants who maintained functional status compared with participants who died or had disability at follow-up examination. The incidence of ADL/IADL decline was 13, 12.5 and 29.5% in participants who showed improvement, no change, and decline in renal function, respectively (P =3D 0.01). The hazard ratio for mortality in the subgroup with IADL disability was 1.87 (95% CI: 1.10-3.20, P =3D 0.022) in Group I, and 2.53 (95% CI: 1.57-4.09, P<0.001) in Groups II and III after adjustment.; CONCLUSIONS: impaired renal function was related to disability and ADL/IADL decline. The effect of ADL/IADL disability on mortality was more prominent in participants with impaired eGFR. =C2=A9 The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email:
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  • Systolic and diastolic dysfunction affects kidney outcomes in hospitalized patients.

    Choi, Jae Shin   Baek, Seon Ha   Chin, Ho Jun   Na, Ki Young   Chae, Dong-Wan   Kim, Yon Su   Kim, Sejoong   Han, Seung Seok  

    BACKGROUNDS: Knowledge on cross-talk between the heart and kidney has been established by basic and clinical research. Nevertheless, the effects of systolic and diastolic heart dysfunctions on the development of acute kidney injury (AKI) and end-stage renal disease (ESRD) remain unresolved in hospitalized patients.; METHODS: A total of 1327 hospitalized patients who had baseline transthoracic echocardiography performed were retrospectively analyzed. Patients were categorized by the quartiles of ejection fraction (EF) and the ratio of the early transmitral blood flow velocity to early diastolic velocity of the mitral annulus (E/e'). The odds ratios (ORs) for AKI and the hazard ratios (HRs) for ESRD were calculated after adjustment of multiple covariates.; RESULTS: During hospital admission, AKI occurred in 210 (15.8%) patients. The lowest quartile of EF was associated with a risk of AKI (OR, 1.60 [1.07-2.41]) and the highest quartile of E/e' was associated with a risk of AKI (OR, 1.90 [1.26-2.41]). When two echocardiographic parameters were combined, patients with a low EF (first to second quartiles) and high E/e' (fourth quartile) showed the highest OR for AKI (OR, 2.27 [1.49-3.45]) compared with the counterpart patients. When the risk of ESRD was evaluated, E/e', but not EF, was a significant parameter of high risk (fourth vs. first quartiles: HR, 4.13 [1.17-14.64]).; CONCLUSIONS: Baseline systolic and diastolic dysfunction is related to subsequent risks of AKI and ESRD in hospitalized patients. Monitoring of these parameters may be a useful strategy to predict the risk of these adverse events in the kidney.=20
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  • Additional role of urine output criterion in defining acute kidney injury

    Han, Seung Seok   Kang, Kyung Ja   Kwon, Soon Jung   Wang, Su Jung   Shin, Sun Hee   Oh, Se-Won   Na, Ki Young   Chae, Dong-Wan   Kim, Suhnggwon   Chin, Ho Jun  

    Background. Diagnosis of acute kidney injury (AKI) has been a major concern due to its association with increased morbidity and mortality. However, the clinical implication of the urine output criterion (UOCr) in diagnosing AKI has not been fully established. Methods. We assessed the incidence of AKI among 1625 critically ill patients and analysed the overall survival rates based on the serum creatinine criterion (CrCr) and UOCr, both of which have been defined by the AKI Network (AKIN). Results. Within 7 days of admission, the risk rate of AKI was 57.0% and the rate determined by UOCr alone was 25.7%. AKI determined by the UOCr alone increased hazard ratios (HRs) for mortality; 1.81 (Stage 1), 2.96 (Stage 2) and 4.17 (Stage 3) compared to non-AKI. However, the difference in mortality between Stages 2 and 3 using the CrCr alone was not significant (P = 0.881). In patients with Stages 2 and 3 by the CrCr, the UOCr further separated the survival rates (P = 0.001 among the four UOCr stages). The diuretic dose did not alter the discriminative function of the UOCr for survival rates. However, 42.1% of non-AKI cases, as determined by the UOCr, were identified as AKI cases by the CrCr. Conclusion. Although some AKI cases were not identified by the UOCr alone, the UOCr has an additional role in AKI staging, regardless of diuretic use.
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  • Dipeptidyl peptidase IV inhibitor attenuates kidney injury in rat remnant kidney

    Joo, Kwon Wook   Kim, Sejoong   Ahn, Shin-young   Chin, Ho Jun   Chae, Dong-Wan   Lee, Jeonghwan   Han, Jin Suk   Na, Ki Young  

    Background: The inhibition of dipeptidyl peptidase (DPP) IV shows protective effects on tissue injury of the heart, lung, and kidney. Forkhead box O (FoxO) transcriptional factors regulate cellular differentiation, growth, survival, the cell cycle, metabolism, and oxidative stress. The aims of this study were to investigate whether the DPP IV inhibitor sitagliptin could attenuate kidney injury and to evaluate the status of FoxO3a signaling in the rat remnant kidney model. Methods: Rats were received two-step surgery of 5/6 renal mass reduction and fed on an oral dose of 200 mg/kg/day sitagliptin for 8 weeks. Before and after the administration of sitagliptin, physiologic parameters were measured. After 8 weeks of treatment, the kidneys were harvested. Results: The sitagliptin treatment attenuated renal dysfunction. A histological evaluation revealed that glomerulosclerosis and tubulointerstitial injury were significantly decreased by sitagliptin. Sitagliptin decreased DPP IV activity and increased the renal expression of glucagon-like peptide-1 receptor (GLP-1R). The subtotal nephrectomy led to the activation of phosphatidylinositol 3-kinase (PI3K)-Akt and FoxO3a phosphorylation, whereas sitagliptin treatment reversed these changes, resulting in PI3K-Akt pathway inactivation and FoxO3a dephosphorylation. The renal expression of catalase was increased and the phosphorylation of c-Jun N-terminal kinase (JNK) was decreased by sitagliptin. Sitagliptin treatment reduced apoptosis by decreasing cleaved caspase-3 and -9 and Bax levels and decreased macrophage infiltration. Conclusions: In rat remnant kidneys, DPP IV inhibitor attenuated renal dysfunction and structural damage. A reduction of apoptosis, inflammation and an increase of antioxidant could be suggested as a renoprotective mechanism together with the activation of FoxO3a signaling. Therefore, DPP IV inhibitors might provide a promising approach for treating CKD, but their application in clinical practice remains to be investigated.
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  • Glomerular Hypertrophy Is a Risk Factor for Relapse in Minimal Change Disease Patients

    Lee, Sung Woo   Yu, Mi-Yeon   Baek, Seon Ha   Ahn, Shin Young   Kim, Sejoong   Na, Ki Young   Chae, Dong-Wan  

    Background/Aims: Patients with minimal change disease (MCD) have a high relapse rate, which results in many complications. Identifying the risk factors for relapse is crucial, but little is known about these factors. Therefore, we performed the current study to determine the factors related to relapse in this patient population. Methods: We retrospectively analyzed 51 adult patients with biopsy-proven primary MCD treated between 2003 and 2013. The demographic, physiologic, laboratory and therapeutic data were gathered from the electronic medical records database. Lesions of the glomerulus, tubulointerstitium and vasculature were analyzed for associations with relapse. Results: During a median 50.9 months, 96.1% (49 of 51) of patients had achieved complete remission, and the rest ultimately achieved at least partial remission. A total of 56.9% (29 of 51) patients experienced at least 1 episode of relapse after the first remission. Patients with relapse had a higher rate of glomerular hypertrophy (GH; 34.5%) than those without relapse (9.1%; p < 0.05). After adjusting for confounders, GH was associated with increased odds of relapse (OR 15.992; 95% CI 1.537-166.362; p =3D 0.02). In a subgroup analysis according to median age, sex and tubulointerstitial (TI) lesions, the association between GH and relapse was evident only in men and in the group with TI lesions. Conclusion: GH is associated with relapse in adult patients with MCD, particularly in men and in those with TI lesions. Frequent monitoring and early intervention are needed in these groups. Future large prospective cohort studies are needed to confirm the study results. (C) 2015 S. Karger AG, Basel
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  • Increased Plasma Osmolar Gap Is Predictive of Contrast-Induced Acute Kidney Injury

    Kim, Sejoong   Sung, Jiyoon   Kang, Woong Chul   Ahn, Shin Young   Kim, Dong Ki   Chin, Ho Jun   Na, Ki Young   Joo, Kwon Wook   Chae, Dong-Wan  

    Contrast-induced acute kidney injury (CIAKI) is a common complication after percutaneous coronary artery intervention (PCI). It is urgent to find a novel, easily measurable and accurate predictor for the early detection of CIAKI. Hyperosmolarity and large amounts of contrast media are risk factors for CIAKI. However, there is no study on plasma osmolar gap as a predictor of CIAKI. We enrolled 89 patients undergoing elective PCI and tested changes of serum sodium, osmolar gap, and renal function at 0, 6, 12 and 24 hours. Plasma osmolar gap was calculated using the following formula: measured plasma osmolarity - [2(Na) + serum urea nitrogen/2.8 + glucose/18]. CIAKI was defined as follows: increase in serum creatinine of >= 50%, increase in serum creatinine of >= 0.3 mg/dL, or decrease in estimated glomerular filtration rate of >= 25% within 24 hours after PCI. The incidence of CIAKI was 13.5% (12/89 patients). The CIAKI group had higher plasma osmolar gaps 6 hours after PCI. The adjusted hazard ratio of the plasma osmolar gap from hour 6 (1-mOsm/L increments) to the development of CIAKI was 1.12 (95% confidence interval [CI], 1.01-1.26; P = 0.041). Sensitivity and specificity of 7 mOsm/L or higher plasma osmolar gap at hour 6 were 70.0% and 76.6%, respectively (area under the ROC curve = 0.77 [95% Cl, 0.65-0.89]). Increased plasma osmolar gap may precede the development of CIAKI in patients undergoing PCI. In conclusion, plasma osnnolar gap may be a useful predictor for the development of CIAKI.
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  • Outcomes of predialysis nephrology care in elderly patients beginning to undergo dialysis.

    Baek, Seon Ha   Ahn, Shin young   Lee, Sung Woo   Park, Youn Su   Kim, Sejoong   Na, Ki Young   Chae, Dong-Wan   Kim, Suhnggwon   Chin, Ho Jun  

    BACKGROUND: The proportion of elderly patients beginning to undergo dialysis is increasing globally. Whether early referral (ER) of elderly patients is associated with favorable outcomes remains under debate. We investigated the influence of referral timing on the mortality of elderly patients.; METHODS: We retrospectively assessed mortality in 820 patients aged =E2=89=A570 years with end-stage renal disease (ESRD) who initiated hemodialysis at a tertiary university hospital between 2000 and 2010. Mortality data was obtained from the time of dialysis initiation until December 2010. We assigned patients to one of two groups according to the time of their first encounters with nephrologists: ER (=E2=89=A5 3 months) and late referral (LR; < 3 months).; RESULTS: During a mean follow-up period of 25.1 months, the ER group showed a 24% reduced risk of long-term mortality relative to the LR group (HR =3D 0.760, P =3D 0.009). Rate of reduction in 90-day mortality for ER patients was 58% (HR =3D 0.422, P=3D0.012). However, the statistical significance of the difference in mortality rates between ER and LR group was not observed across age groups after 90 days. Old age, LR, central venous catheter, high white blood cell count and corrected Ca level, and lower levels of albumin, creatinine, hemoglobin, and sodium were significantly associated with increased risk of mortality.; CONCLUSIONS: Timely referral was also associated with reduced mortality in elderly ESRD patients who initiated hemodialysis. In particular, the initial 90-day mortality reduction in ER patients contributed to mortality differences during the follow-up period.=20
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  • Activation of hypoxia-inducible factor attenuates renal injury in rat remnant kidney

    Song, Young Rim   You, Sun Jin   Lee, Yun-Mi   Chin, Ho Joon   Chae, Dong-Wan   Oh, Yun Kyu   Joo, Kwon Wook   Han, Jin Suk  

    Methods. Two weeks after a subtotal nephrectomy, rats received a continuous infusion of dimethyloxalylglycine (DMOG) for 4 weeks to activate HIF.Results. The DMOG infusion halted the progression of proteinuria. A histological evaluation revealed that the glomerulosclerosis and tubulointerstitial injury were significantly decreased by DMOG treatment. DMOG increased renal HIF-1 alpha protein. The expression of glucose transporter-1 (GLUT-1) and prolyl hydroxylase 3 (PHD3) and the immunostaining of vascular endothelial growth factor (VEGF) were increased by DMOG. DMOG-treated rats showed less podocyte injury manifested by decreased immunostaining of desmin and the restoration of podoplanin staining. Furthermore, plasma malondialdehyde (MDA), a marker of oxidative stress, showed a tendency to decrease, and the renal expression of catalase, an antioxidant, was significantly increased by DMOG. The DMOG treatment decreased macrophage infiltration and reduced fibrosis, as manifested by decreased type IV collagen and osteopontin expression.Conclusions. Activation of HIF by DMOG halted the progression of proteinuria and attenuated structural damage by preventing podocyte injury in the remnant kidney model. This renoprotection was accompanied by a reduction of oxidative stress, inflammation and fibrosis.
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  • Clinical implications of pathologic diagnosis and classification for diabetic nephropathy.

    Oh, Se Won   Kim, Sejoong   Na, Ki Young   Chae, Dong-Wan   Kim, Suhnggwon   Jin, Dong Chan   Chin, Ho Jun  

    AIM: The usefulness of renal pathologic diagnosis in type II DM (diabetes mellitus) remains debate.; METHODS: We grouped the pathologic diagnoses as pure DN (diabetic nephropathy), NDRD (non-diabetic renal disease), and NDRD mixed with DN (Mixed). We classified pure DN as the criteria suggested by Tervaert. We compared the accuracy of clinical parameters to predict DN and usefulness of pathology to predict renal prognosis.; RESULTS: Among 126 enrolled patients, there were 50 pure DN, 65 NDRN, and 11 Mixed. The sensitivity and specificity for predicting DN with the presence of retinopathy were 77.8-73.6% and, with a cut-off value of 7.5 years of diabetic duration, the sensitivity and specificity were 64.5-67.2%. ESRD (end stage renal disease) occurred in 44.0% of DN, 18.2% of Mixed, and 12.3% of NDRD (p<0.001). Among pure DN, Class IV showed the lowest estimated glomerular filtration rate (eGFR). We estimated the 5-year renal survival rate as 100.0% in Classes I and IIa, 75.0% in Class IIb, 66.7% in Class III, and 38.1% in Class IV (p=0.002).; CONCLUSIONS: Nephropathy of type II DM was diverse and could not be completely predicted by clinical parameters. The renal pathologic diagnosis was a good predictor for renal prognosis in type II DM. Copyright 2012 Elsevier Ireland Ltd. All rights reserved.
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  • CRP level and HDL cholesterol concentration jointly predict mortality in a Korean population.

    Kim, Kwang-Il   Oh, Se Won   Ahn, Soyeon   Heo, Nam Ju   Kim, Sejoong   Chin, Ho Jun   Na, Ki Young   Chae, Dong-Wan   Kim, Cheol-Ho   Kim, Suhnggwon  

    BACKGROUND: C-reactive protein (CRP) and high-density lipoprotein (HDL) cholesterol are well-known cardiovascular predictors. However, the joint effect of these parameters on long-term mortality has not been established.; METHODS: We studied a total of 92,500 subjects older than 20 years who underwent routine health examination at the three health care centers affiliated with Seoul National University. High-sensitivity CRP and the lipid profile were obtained at baseline. Subjects were followed for a median of 45.5 months. Mortality data were obtained from the National Statistics Office of Korea.; RESULTS: There were 649 deaths (0.7%) during the follow-up. The leading cause of death was cancer. The subjects who died were significantly older, had a male predominance, and had increased levels of inflammatory markers. A significant mortality difference was identified according to the CRP and HDL cholesterol levels. Considering both parameters jointly, subjects with a CRP =E2=89=A51.4 mg/L (highest quartile) and HDL cholesterol <45 mg/dL (lowest quartile) were at the highest risk for all-cause mortality, even after adjusting for covariates (hazard ratio 2.29, 95% confidence interval, 1.83~2.87). After matching on the propensity score, 6304 subjects with a high CRP and low HDL cholesterol were at high risk of death (hazard ratio 2.52, 95% confidence interval, 1.59~4.01). Interestingly, the joint effect of CRP and HDL cholesterol was observed for cardiovascular as well as cancer-related mortality prediction.; CONCLUSIONS: Elevated CRP and low HDL cholesterol jointly contribute to the prediction of all-cause, cancer, and cardiovascular mortality in Koreans. The interactive relationship between them in mediating inflammatory processes might explain these results. Copyright =C2=A9 2012 Elsevier Inc. All rights reserved.
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    Chin, Ho Jun   Chae, Dong-Wan  

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  • Lean Mass Index: A Better Predictor of Mortality than Body Mass Index in Elderly Asians

    Han, Seung Seok   Kim, Ki Woong   Kim, Kwang-Il   Na, Ki Young   Chae, Dong-Wan   Kim, Suhnggwon   Chin, Ho Jun  

    OBJECTIVES: To evaluate the correlation between body mass index (BMI), body composition, and all-cause mortality in an elderly Asian population. DESIGN: A prospective observational cohort study with 3.5-year follow-up. SETTING: The Korean Longitudinal Study on Health and Aging Project for elderly residents in Seongnam City, Korea. PARTICIPANTS: Eight hundred seventy-seven subjects aged 65 and older for whom baseline body composition data was available. MEASUREMENTS: BMI, waist circumference, and body composition of each subject was evaluated. Body composition was examined using bioelectrical impedance analyses of measures, including lean mass (kg), fat mass (kg), and fat proportion (%). In addition, lean mass index (LMI, kg/m(2)) was calculated by dividing lean mass by the square of height. Participants were divided into three groups: Group 1 (< 25th percentile), Group 2 (25-75th percentiles), and Group 3 (>= 75th percentile) for BMI, waist circumference, body composition, and LMI. RESULTS: In the fully adjusted Cox proportional hazard model, BMI, waist circumference, and fat composition were not correlated with mortality, but higher lean mass and LMI were considered predictors of lower mortality when comparing Group 3 and Group 1 (in lean mass, relative risk reduction of 84%, 95% confidence interval (CI) = 45-96%, P = .004; in LMI, relative risk reduction of 69%, 95% CI = 12-89%, P = .03). CONCLUSION: The present study indicates that the recommendation of low BMI as a means of obtaining a survival advantage in the elderly is not supported. Instead, higher lean mass and higher LMI are associated with better survival in the elderly Asian population. J Am Geriatr Soc 58:312-317, 2010.
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  • Predictive value of echocardiographic parameters for clinical events in patients starting hemodialysis.

    Han, Seung Seok   Cho, Goo-Yeong   Park, Youn Su   Baek, Seon Ha   Ahn, Shin Young   Kim, Sejoong   Chin, Ho Jun   Chae, Dong-Wan   Na, Ki Young  

    Echocardiographic parameters can predict cardiovascular events in several clinical settings. However, which echocardiographic parameter is most predictive of each cardiovascular or non-cardiovascular event in patients starting hemodialysis remains unresolved. Echocardiography was used in 189 patients at the time of starting hemodialysis. We established primary outcomes as follows: cardiovascular events (ischemic heart disease, cerebrovascular disease, peripheral artery disease, and acute heart failure), fatal non-cardiovascular events, all-cause mortality, and all combined events. The most predictable echocardiographic parameter was determined in the Cox hazard ratio model with a backward selection after the adjustment of multiple covariates. Among several echocardiographic parameters, the E/e' ratio and the left ventricular end-diastolic volume (LVEDV) were the strongest predictors of cardiovascular and non-cardiovascular events, respectively. After the adjustment of clinical and biochemical covariates, the predictability of E/e' remained consistent, but LVEDV did not. When clinical events were further analyzed, the significant echocardiographic parameters were as follows: s' for ischemic heart disease and peripheral artery disease, LVEDV and E/e' for acute heart failure, and E/e' for all-cause mortality and all combined events. However, no echocardiographic parameter independently predicted cerebrovascular disease or non-cardiovascular events. In conclusion, E/e', s', and LVEDV have independent predictive values for several cardiovascular and mortality events. =20
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  • Compartmental-modelling-based measurement of murine glomerular filtration rate using F-18-fluoride PET/CT

    Lee, Hyo Sang   Kang, Yeon-koo   Lee, Hyunjong   Han, Jeong Hee   Moon, Byung Seok   Byun, Seok-Soo   Chae, Dong-Wan   Kang, Keon Wook   Lee, Won Woo  

    Accurate measurement of glomerular filtration rate (GFR) is essential for optimal decision making in many clinical settings of renal failure. We aimed to show that GFR can be accurately measured using compartmental tracer kinetic analysis of F-18-fluoride dynamic PET/CT. Twenty-three male Sprague-Dawley rats of three experimental groups (cyclosporine-administered [n =3D 8], unilaterally nephrectomized [n =3D 8], and control [n =3D 7]) underwent simultaneous F-18-fluoride dynamic PET/CT and reference Cr-51-EDTA GFR (GFR(CrEDTA)) test at day 0 and post-intervention day 3. F-18-fluoride PET GFR (GFR(F-PET)) was calculated by multiplying the influx rate and functional kidney volume in a single-tissue-compartmental kinetic model. Within-test repeatability and between-test agreement were evaluated by intraclass correlation coefficient (ICC) and Bland-Altman analysis. In the control group, repeatability of GFR(F-PET) was excellent (ICC =3D 0.9901, repeatability coefficient =3D 12.5%). GFR(F-PET) significantly decreased in the renally impaired rats in accordance with respective GFR(CrEDTA) changes. In the pooled population, GFR(F-PET) agreed well with GFR(CrEDTA) with minimal bias (-2.4%) and narrow 95% limits of agreement (-25.0% to 20.1%). These data suggest that the single-compartmental kinetic analysis of F-18-fluoride dynamic PET/CT is an accurate method for GFR measurement. Further studies in humans are warranted.
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