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￭♣ S-467 ￭
Urinary angiotensinogen excretion and low serum K levels in patients with polycystic kidney disease
연세대학교 세브란스병원 신장내과
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이상미, 김형래, 유태현
Background: Increased activity of intrarenal renin-angiotensin-aldosterone system (RAAS) is a major pathogenic mechanism for developing early hy- pertension in patients with autosomal dominant polycystic kidney disease (ADPKD). Meanwhile, intrarenal RAAS is an important component for renal potassium handling and maintaining potassium balance. Recent HALT trial for ADPKD to prove benefit of dual RAAS blockades showed that episodes of hyperkalemia were infrequent unlike previous studies in patients with diabetic nephropathy where hyperkalemia frequently occurred. Therefore, we investigated whether high intrarenal RAAS activity affects serum potassium levels in patients with ADPKD. Methods: This prospective longitudinal study was conducted with 1788 subjects from the KNOW-CKD (KoreaN cohort study for Outcome in patients with CKD). Baseline urinary angiotensi- nogen (AGT) / creatinine (Cr) ratio was measured by commercially available enzyme-linked immunosorbent assay kit. Propensity score matching (PSM) analysis was used to compare between ADPKD and non-PKD. Results: The mean age was 54.0±12.2 years, and 690 (38.6%) patients were female. The average estimated glomerular filtration rate was 50.1±29.9 mL/min/1.73 m2. The risk of hyperkalemia (serum potassium ≥ 5.0 mmol/L) was significantly lower in ADPKD than other cause of CKD after adjusting covariables. In multivariate linear regression analysis, urinary AGT/Cr ratio was negatively correlated with serum potassium (β＝-0.054, p＝0.015), and positively associated with transtubular potassium gradient (TTKG, β＝
0.091, p＜0.001). After PSM, patients with ADPKD had a significantly lower serum potassium levels (p＝0.002) with conversely elevated TTKG (p＝
0.015). In addition, urinary AGT/Cr ratio was significantly higher in ADPKD than non-PKD (p＝0.026). Conclusions: A high urinary AGT/Cr ratio is associated with a low serum potassium level in patients with ADPKD. Intensive use of RAAS blockade may be more safely because risk of hyper- kalemia is low in this population.
￭♣ S-468 ￭
Relationship among obesity, acute kidney injury, and long term coronary artery bypass grafting
서울대학교병원 내과학교실
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문홍란, 이연희, 김세중, 김동기, 진호준, 주권욱, 김연수, 나기영, 한승석
Background: Obesity is an important health concern and related with several comorbidities and mortality. However, its relationship with acute kidney injury (AKI) and long-term mortality remains unresolved, particularly in Korean patients undergoing coronary artery bypass grafting (CABG).
Methods: A total of 3018 patients (aged ≥18 years) were retrospectively reviewed from two tertiary referral centers between 2004 and 2017. Obesity was defined using body mass index (BMI), according to the World Health Organization recommendation. The odds ratios (ORs) and hazard ratios (HRs) for post-surgical AKI and all-cause mortality were calculated after adjusting for multiple covariates. Patients were followed for 90±40.9 months (maximum 13 years). Results: The proportions of normal weight, underweight, overweight at risk, obese I, and obese II status were 31.7%, 2.4%, 27.8%, 35.1%, and 4.0%, respectively. Post-surgical AKI developed in 799 patients (26.5%). The obese group had a higher OR of AKI [1.72 (1.149-2.560)] than the normal weight group (p＝0.008), whereas other groups with abnormal weight status did not confer the higher risk of AKI than the normal weight group. This result suggest that obesity was an indicator of the AKI risk in the CABG subset. However, the relationship trend with mortality was different from the above one. During the follow-up period, 787 patients (26.1%) died. The group with underweight status had a higher HR of mortality [2.69 (1.957-3.687)] than the normal weight group, whereas the groups with overweight at risk, obese I, and obese II status had lower HRs than the normal weight group, as follows: 0.59 (0.486-0.706) , 0.61 (0.512-0.720) and 0.62 (0.410-0.926), respectively. These results suggest that normal weight status did not guarantee the lowest mortality in the CABG subset. Conclusion: Obesity is related with the high risk of AKI, but not with the high mortality in Korean patients undergoing CABG. Rather, the patients with overweight at risk, obese I status showed better survival rates than the patients with normal weight. These results should be monitored in clinical practice, based on the consideration for several confounding factors, such as inflammation and malnutrition.
