212
￭ Sat-313 ￭
Plasma endocan level as a predictor of cardiovascular events in patients on hemodialysis
경희대학교병원 신장내과
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이지영
Background/Aims: Endocan, a proteoglycan which is a potential biomarker of endothelial dysfunction, has been shown to be associated with increased cardiovascular risk. We investigated plasma levels of endocan in patients with end-stage renal disease (ESRD) on hemodialysis to predict the risk of car- diovascular diseases. Methods: A total of 400 adult patients with ESRD undergoing hemodialysis were prospectively enrolled in 4 tertiary hospitals of South Korea from June 2016 to May 2018. They were observed for development of the cardiovascular composite outcomes. We compared clinical charac- teristics and the plasma levels of endocan between 53 patients with cardiovascular composite outcomes and 347 control patients without cardiovascular composite outcomes, and developed the predictive markers of cardiovascular diseases using Cox proportional-hazard analysis. Results: Previous histories of diabetes, acute coronary syndrome, arrhythmia and congestive heart failure were higher in ESRD patients with the cardiovascular composite outcomes than control patients. Patients with cardiovascular composite outcomes showed lower levels of hemoglobin, albumin, and high-density lipoproteins com- pared with control patients. Higher level of plasma endocan and white blood cells were associated with patients with cardiovascular composite outcomes.
Cox proportional-hazard analysis showed that previous histories of diabetes, acute coronary syndrome, arrhythmia and plasma level endocan were sig- nificantly associated with cardiovascular composite outcomes: hazard ratios were 2.05 (95% confidential interval (CI), 1.03 to 4.06) (p=0.04) for diabetes, 2.42 (95% CI, 1.25 to 4.65) (p=0.01) for acute coronary syndrome, and 6.38 (95% CI, 1.14 to 35.56) (p=0.04) for endocan (log pg/mL). The patients with level of endocan > 3.24 log pg/mL showed significantly higher cumulative incidence of the cardiovascular composite outcomes in Kaplan-Meier curve (p<0.001). Conclusions: Plasma Endocan level can a useful biomarker for prediction of cardiovascular diseases in patients with ESRD on hemodialysis.
￭ Sat-314 ￭
Efficacy of metformin in patients with type 2 diabetic chronic kidney disease at stage 3B and 4
1서울대병원, 2보라매병원
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권소이
1,2, 김용철
1, 정영리
2, 안정남
2, 김동기
1, 임춘수
2, 이정표
2Background/Aims: Metformin is widely used as the best pharmacological option in the patients with type 2 diabetes mellitus. However, use of this drug has not been recommended in individuals with impaired kidney function because of the perceived risk of lactic acidosis. We aimed to assess the efficacy and safety of metformin is widely used as the best pharmacological option in the patients with type 2 diabetes mellitus. However, use of this drug has not been recommended in individuals with impaired kidney function because of the perceived risk of lactic acidosis. We aimed to assess the efficacy and safety of metformin in patients with type 2 diabetic chronic kidney disease (CKD).tformin in patients with type 2 diabetic chronic kidney disease (CKD).
Methods: We conducted a retrospective, observational, cohort study of 11,678 patients with type 2 diabetic CKD who followed the nephrology clinic at two tertiary hospitals from 2001 to 2016. We compared 3768 patients who used metformin with 7910 who did not use metformin. The primary outcome was defined as all-cause mortality. Secondary outcomes were kidney function, end-stage renal disease (ESRD) progression and event of lactic acidosis.
Results: The patients who used metformin had more female proportion, lower eGFR, and higher HbA1c level at the time of enrollment. The metfor- min-used group was better able to preserve kidney function. The all-cause mortality for the metformin-used group was significantly better than that for the non-metformin user in the multivariable Cox analysis (P value <0.001 adjusted hazard ratio [aHR] 0.55, 95% confidence interval [C.I.] 0.45 - 0.62). Also, the MFM group has a longer duration of ESRD progression. (P-value=0.002, aHR 0.78, 95% CI 0.67 – 0.92). Also, there was no lactic acidosis event in both groups. Conclusions: In Korean diabetic CKD patients, metformin could be safely used. However, more researches about how to use such as dose and monitoring are needed.
