정혜연, 김성연, 이충만, 정의석, 박진아, 유연실, 강나리, 김민영

198

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Dietary behaviors and factors related to LSD in population with sodium diet-related diseases

서울의료원

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정혜연, 김성연, 이충만, 정의석, 박진아, 유연실, 강나리, 김민영

Background/Aims: High sodium intake is associated with hypertension, cerebrovascular disease, and renal disease. Meanwhile, levels of a daily sodium intake still exceed the sodium intake of 2000 mg recommended by the WHO. We evaluated the characteristics of dietary behaviors and the factors related to low sodium diet (LSD) in the high-risk participants, using data from the 7th KNHANES (2017). Methods: This study analyzed data of 5655 participants ≥ 18 years old who completed urinary evaluation in KNHANES (2017). The 24hr urine sodium excretion level was estimated using the INTERSALT formula. LSD was defined as 24hr urine sodium ≤2g/day. The high-risk participant was required at least one of the following diseases: hypertension, coro- nary heart disease, stroke, and renal disease. Results: Among 5655 participants, 1479 (26.2%) were classified as the high-risk participants. The high-risk participants showed lower education level, higher incidence of dyslipidemia, metabolic syndrome, DM, and proteinuria, and higher level of SBP, DBP, BMI, and fasting glucose than the non-risk participants. Incidence of nutrition education was 7.6% in the high-risk participants and 5.2% in the non-risk participants. Meanwhile, the high-risk participants consumed lower calories, protein, fat and more sodium than non-risk participants. In the high-risk partic- ipants, the significant factors related with LSD were younger age (≥40 vs <40, OR 0.016, 95% CI 0.002-0.121; ≥70 vs <40, OR 0.053, 95% CI 0.007-0.376), female (OR 40.682, 95% CI 17.089-96.844), BMI (OR 0.743, 95% CI 0.685-0.806), DBP (OR 0.967, 95% CI 0.944-0.991), GFR (OR 0.977, 95% CI 0.963-0.992), proteinuria (1+ vs 0, OR 6.729, 95% CI 2.736-16.552; 2+ vs 0, OR 0.455, 95% CI 0.158-1.308; 3+ vs 0, OR 1.370, 95% CI 0.187-10.030; 4+ vs 0, OR 5.251, 95% CI 1.174-23.491). Conclusions: High-risk participants consumed lower-quality diet although they received more nutrition education than non-risk participants. LSD was associated with young age, female, low level of BMI, DBP, and GFR, and proteinuria. Nutrition ed- ucation was not associated with LSD. Effective education and intervention for LSD should be required.

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New oral anticoagulants and the risk of contrast-induced nephropathy after computed tomography

서울대학교병원 내과

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조세민, 윤동환, 한승석, 이하정, 김동기, 주권욱, 김연수, 김용철

Background/Aims: Contrast-induced nephropathy (CIN) is a great concern in relation to worse renal outcome. However, the relationship between the use of new oral anticoagulants (NOAC) and the risk of CIN remains unresolved. Methods: A total of 2,158 patients from 2007 to 2018 who received prophy- lactic hydration with normal saline and N-acetylcysteine before and after computed tomography with intravenous contrast medium were reviewed. Among them, NOAC (apixaban, edoxaban, rivaroxaban, dabigatran) and warfarin were used in 34 and 65 patients, respectively. The risk of CIN was compared be- tween patients with and without these agents. Additionally, a propensity score matching was performed in a 1:4 block for variables such as age, sex, weight, blood pressures, comorbidities, contrast volume, drugs and baseline serum creatinine (sCr). CIN was defined in two ways: an increase in sCr by ≥ 0.3 mg/dL or ≥ 1.5 times above baseline within 96 hours, and an increase in sCr by ≥ 0.5 mg/dL or ≥ 1.25 times above baseline within 96 hours. The risk of end-stage renal disease or all-cause mortality was also evaluated. Results: The events of CIN occurred in 141 patients (6.5%). The risk of CIN in the NOAC group was not higher than in the warfarin or non-agent group: odds ratios were 2.27 (0.576-8.972). The risks of end-stage renal disease and mortal- ity after intravenous contrast medium use did not differ between the groups. These trends remained consistent irrespective of multivariable adjustment.

When a propensity score matching was applied, the NOAC group had a similar risk of CIN to the non-use group with an odds ratio of 5.71 (0.462-70.644).

Conclusions: The use of NOAC does not increase the risk of CIN in patients who undergo computed tomography with intravenous contrast medium.

198

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￭

Dietary behaviors and factors related to LSD in population with sodium diet-related diseases

서울의료원

*

정혜연, 김성연, 이충만, 정의석, 박진아, 유연실, 강나리, 김민영

Background/Aims: High sodium intake is associated with hypertension, cerebrovascular disease, and renal disease. Meanwhile, levels of a daily sodium intake still exceed the sodium intake of 2000 mg recommended by the WHO. We evaluated the characteristics of dietary behaviors and the factors related to low sodium diet (LSD) in the high-risk participants, using data from the 7th KNHANES (2017). Methods: This study analyzed data of 5655 participants ≥ 18 years old who completed urinary evaluation in KNHANES (2017). The 24hr urine sodium excretion level was estimated using the INTERSALT formula. LSD was defined as 24hr urine sodium ≤2g/day. The high-risk participant was required at least one of the following diseases: hypertension, coro- nary heart disease, stroke, and renal disease. Results: Among 5655 participants, 1479 (26.2%) were classified as the high-risk participants. The high-risk participants showed lower education level, higher incidence of dyslipidemia, metabolic syndrome, DM, and proteinuria, and higher level of SBP, DBP, BMI, and fasting glucose than the non-risk participants. Incidence of nutrition education was 7.6% in the high-risk participants and 5.2% in the non-risk participants. Meanwhile, the high-risk participants consumed lower calories, protein, fat and more sodium than non-risk participants. In the high-risk partic- ipants, the significant factors related with LSD were younger age (≥40 vs <40, OR 0.016, 95% CI 0.002-0.121; ≥70 vs <40, OR 0.053, 95% CI 0.007-0.376), female (OR 40.682, 95% CI 17.089-96.844), BMI (OR 0.743, 95% CI 0.685-0.806), DBP (OR 0.967, 95% CI 0.944-0.991), GFR (OR 0.977, 95% CI 0.963-0.992), proteinuria (1+ vs 0, OR 6.729, 95% CI 2.736-16.552; 2+ vs 0, OR 0.455, 95% CI 0.158-1.308; 3+ vs 0, OR 1.370, 95% CI 0.187-10.030; 4+ vs 0, OR 5.251, 95% CI 1.174-23.491). Conclusions: High-risk participants consumed lower-quality diet although they received more nutrition education than non-risk participants. LSD was associated with young age, female, low level of BMI, DBP, and GFR, and proteinuria. Nutrition ed- ucation was not associated with LSD. Effective education and intervention for LSD should be required.

￭

￭

New oral anticoagulants and the risk of contrast-induced nephropathy after computed tomography

서울대학교병원 내과

*

조세민, 윤동환, 한승석, 이하정, 김동기, 주권욱, 김연수, 김용철

Background/Aims: Contrast-induced nephropathy (CIN) is a great concern in relation to worse renal outcome. However, the relationship between the use of new oral anticoagulants (NOAC) and the risk of CIN remains unresolved. Methods: A total of 2,158 patients from 2007 to 2018 who received prophy- lactic hydration with normal saline and N-acetylcysteine before and after computed tomography with intravenous contrast medium were reviewed. Among them, NOAC (apixaban, edoxaban, rivaroxaban, dabigatran) and warfarin were used in 34 and 65 patients, respectively. The risk of CIN was compared be- tween patients with and without these agents. Additionally, a propensity score matching was performed in a 1:4 block for variables such as age, sex, weight, blood pressures, comorbidities, contrast volume, drugs and baseline serum creatinine (sCr). CIN was defined in two ways: an increase in sCr by ≥ 0.3 mg/dL or ≥ 1.5 times above baseline within 96 hours, and an increase in sCr by ≥ 0.5 mg/dL or ≥ 1.25 times above baseline within 96 hours. The risk of end-stage renal disease or all-cause mortality was also evaluated. Results: The events of CIN occurred in 141 patients (6.5%). The risk of CIN in the NOAC group was not higher than in the warfarin or non-agent group: odds ratios were 2.27 (0.576-8.972). The risks of end-stage renal disease and mortal- ity after intravenous contrast medium use did not differ between the groups. These trends remained consistent irrespective of multivariable adjustment.

When a propensity score matching was applied, the NOAC group had a similar risk of CIN to the non-use group with an odds ratio of 5.71 (0.462-70.644).

Conclusions: The use of NOAC does not increase the risk of CIN in patients who undergo computed tomography with intravenous contrast medium.