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Featured researches published by Kyung Don Yoo.


Medicine | 2017

Circulating TNF receptors predict cardiovascular disease in patients with chronic kidney disease

Eunjin Bae; Ran Hui Cha; Yong C. Kim; Jung N. An; Dong K. Kim; Kyung Don Yoo; Su M. Lee; Myoung-Hee Kim; Jung Tak Park; Shin-Wook Kang; Jae Y. Park; Chun S. Lim; Yon Su Kim; Seung Hee Yang; Jung P. Lee

Abstract Cardiovascular disease (CVD) is the main public health problem in patients with chronic kidney disease (CKD); however, there is no established biomarker for predicting CVD morbidity and mortality in CKD. The aim of this study was to evaluate the role of circulating tumor necrosis factor receptors (cTNFRs) in predicting CVD risk in CKD patients. We prospectively recruited 984 patients with CKD from 11 centers between 2006 and 2012. The levels of cTNFR1 and cTNFR2 were determined by performing an enzyme-linked immunosorbent assay. During the mean follow-up period of 4 years, 36 patients experienced a CVD event. The median serum concentrations of cTNFR1 and cTNFR2 were 2703.4 (225.6–13,057.7) and 5661.0 (634.9–30,599.6)u200apg/mL, respectively, and the cTNFR1 level was closely correlated with the cTNFR2 level (ru200a=u200a0.86, Pu200a<u200a.0001). The urinary protein-to-creatinine ratio (UPCR) and estimated glomerular filtration rate (eGFR) were significantly correlated with the cTNFR2 level (ru200a=u200a0.21 for UPCR, ru200a=u200a−0.67 for eGFR; Pu200a<u200a.001 for all). Similar correlations were observed for serum cTNFR1 (ru200a=u200a0.21 for UPCR, ru200a=u200a−0.75 for eGFR; Pu200a<u200a.001 for all). In the Cox proportional hazard analyses, cTNFR1 (hazard ratio [HR] 2.506, 95% confidence interval [CI] 1.186–5.295, Pu200a=u200a.016) and cTNFR2 (HR 4.156, 95% CI 1.913–9.030, Pu200a<u200a.001) predicted CVD risk even after adjustment for clinical covariates, such as UPCR, eGFR, and high-sensitivity C-reactive protein. cTNFR1 and 2 are associated with CVD and other risk factors in CKD, independently of eGFR and UPCR. Furthermore, cTNFRs could be relevant predictors of CVD in CKD patients.


PLOS ONE | 2017

Cancer in Korean patients with end-stage renal disease: A 7-year follow-up

Kyung Don Yoo; Jung Pyo Lee; Su Mi Lee; Jae Yoon Park; Hajeong Lee; Dong Ki Kim; Shin-Wook Kang; Chul Woo Yang; Yong-Lim Kim; Chun Soo Lim; Kwon Wook Joo; Yon Su Kim; Abelardo Aguilera

Background The effectiveness of dialysis on the incidence of cancer in patients with end-stage renal disease (ESRD) remains to be clarified. In this study, we evaluated the incidence rate and type of cancer among patients with ESRD, compared to the general population, through a prospective 7-year follow-up. We also calculated the cumulative incidence rate of cancer associated with ESRD, with stratification to control for the competing risk of death. Methods This prospective observational cohort study was conducted using data from a nationwide study on patients with ESRD in Korea. A total of 5,235 patients, ≥18 years old, with ESRD were identified from the national registry as being treated by dialysis between August 2008 and December 2014. The standardized incidence ratio (SIR) and cumulative incidence rate of specific cancers were evaluated and compared to the general population. Results A total of 5,235 participants were included. During the 7 year observation period, 116 (2.2%) participants had been diagnosed as cancer. The SIR of overall cancer was 0.94 [95% confidence interval (CI), 0.72–1.19] and was comparable to the rate for the general population. Although the digestive organs were the most frequent site of a primary site cancer (N = 39, 33.6%), the SIR was highest for urinary tract cancer [4.7, 95% CI, 2.42–8.19]. The five year standardized cumulative incidence of cancer was higher for females than for males, and for non-diabetic compared to diabetic causes of ESRD. We estimated that the five year standardized cumulative incidence was highest [8.4, 95% CI, 5.07–13.75] in patients with ESRD, caused by glomerulonephritis. Conclusion A screening program should be necessary for urinary tract cancer in Korean patients with ESRD. Cancer screening programs for patients with ESRD in Korea should be emphasized on female patients and patients with non-diabetic ESRD.


PLOS ONE | 2017

Lower serum potassium associated with increased mortality in dialysis patients: A nationwide prospective observational cohort study in Korea

Sunhwa Lee; Eunjeong Kang; Kyung Don Yoo; Yunhee Choi; Dong Ki Kim; Kwon Wook Joo; Seung Hee Yang; Yong Lim Kim; Shin-Wook Kang; Chul Woo Yang; Nam Ho Kim; Yon Su Kim; Hajeong Lee

Background Abnormal serum potassium concentration has been suggested as a risk factor for mortality in patients undergoing dialysis patients. We investigated the impact of serum potassium levels on survival according to dialysis modality. Methods A nationwide, prospective, observational cohort study for end stage renal disease patients has been ongoing in Korea since August 2008. Our analysis included patients whose records contained data regarding serum potassium levels. The relationship between serum potassium and mortality was analyzed using competing risk regression. Results A total of 3,230 patients undergoing hemodialysis (HD, 64.3%) or peritoneal dialysis (PD, 35.7%) were included. The serum potassium level was significantly lower (P < 0.001) in PD (median, 4.5 mmol/L; interquartile range, 4.0–4.9 mmol/L) than in HD patients (median, 4.9 mmol/L; interquartile range, 4.5–5.4 mmol/L). During 4.4 ± 1.7 years of follow-up, 751 patients (23.3%) died, mainly from cardiovascular events (n = 179) and infection (n = 120). In overall, lower serum potassium level less than 4.5 mmol/L was an independent risk factor for mortality after adjusting for age, comorbidities, and nutritional status (sub-distribution hazard ratio, 1.30; 95% confidence interval 1.10–1.53; P = 0.002). HD patients showed a U-shaped survival pattern, suggesting that both lower and higher potassium levels were deleterious, although insignificant. However, in PD patients, only lower serum potassium level (<4.5 mmol/L) was an independent predictor of mortality (sub-distribution hazard ratio, 1.35; 95% confidence interval 1.00–1.80; P = 0.048). Conclusion Lower serum potassium levels (<4.5 mmol/L) occur more commonly in PD than in HD patients. It represents an independent predictor of survival in overall dialysis, especially in PD patients. Therefore, management of dialysis patients should focus especially on reducing the risk of hypokalemia, not only that of hyperkalemia.


American Journal of Physiology-renal Physiology | 2016

Cln 3-requiring 9 is a negative regulator of Th17 pathway-driven inflammation in anti-glomerular basement membrane glomerulonephritis

Hajeong Lee; Jae Wook Lee; Kyung Don Yoo; Joo-Yeon Yoo; Jung Pyo Lee; Dong Ki Kim; Ho Joon Chin; Yon Su Kim; Seung Hee Yang

T helper 17 (Th17) lymphocytes promote renal inflammation in anti-glomerular basement membrane glomerulonephritis (anti-GBM GN), and signal transducer and activator of transcription 3 (STAT3) mediates activation of Th17 lymphocytes by IL-6 and transforming growth factor-β (TGF-β). Cln 3-requiring 9 (Ctr9), a subunit of RNA polymerase-associated factor complex (PAFc), regulates the transcription of IL-6/STAT3-dependent genes. Here, we investigated the role of Ctr9 in regulating Th17-driven inflammation in anti-GBM GN. In mice, STAT3β or IL-17 knockout ameliorated anti-GBM autoantibody-induced renal injury. This phenomenon was associated with decreases in retinoic acid receptor-related orphan receptor γt (RORγt), IL-17, phosphorylated STAT3, and proinflammatory cytokines. Compared with wild-type mice, Ctr9 increased in both STAT3β(-/-) and IL-17(-/-) mice injected with anti-GBM IgG, showing a negative correlation with Th17-related transcripts. Small interfering RNA (siRNA)-mediated knockdown of Ctr9 in intrarenal lymphocytes further upregulated Th17-related transcripts, consistent with repression of Th17 differentiation by Ctr9. Interestingly, Ctr9 was also expressed in human and mouse mesangial cells and downregulated in response to anti-GBM IgG or to TGF-β plus IL-17. Ctr9 in mesangial cells was even more repressed in the presence of both anti-GBM IgG and Th17-activating cytokines. Consistent with these findings, renal biopsies obtained from patients with anti-GBM GN showed consistent downregulation of Ctr9 and upregulation of phosphorylated STAT3 and IL-17 in the glomerulus. We conclude that Ctr9 is a negative regulator of Th17 differentiation in anti-GBM GN and repressed by anti-GBM IgG and IL-17 in mesangial cells.


Scientific Reports | 2017

A Machine Learning Approach Using Survival Statistics to Predict Graft Survival in Kidney Transplant Recipients: A Multicenter Cohort Study

Kyung Don Yoo; Junhyug Noh; Hajeong Lee; Dong Ki Kim; Chun Soo Lim; Young Hoon Kim; Jung Pyo Lee; Gunhee Kim; Yon Su Kim

Accurate prediction of graft survival after kidney transplant is limited by the complexity and heterogeneity of risk factors influencing allograft survival. In this study, we applied machine learning methods, in combination with survival statistics, to build new prediction models of graft survival that included immunological factors, as well as known recipient and donor variables. Graft survival was estimated from a retrospective analysis of the data from a multicenter cohort of 3,117 kidney transplant recipients. We evaluated the predictive power of ensemble learning algorithms (survival decision tree, bagging, random forest, and ridge and lasso) and compared outcomes to those of conventional models (decision tree and Cox regression). Using a conventional decision tree model, the 3-month serum creatinine level post-transplant (cut-off, 1.65u2009mg/dl) predicted a graft failure rate of 77.8% (index of concordance, 0.71). Using a survival decision tree model increased the index of concordance to 0.80, with the episode of acute rejection during the first year post-transplant being associated with a 4.27-fold increase in the risk of graft failure. Our study revealed that early acute rejection in the first year is associated with a substantially increased risk of graft failure. Machine learning methods may provide versatile and feasible tools for forecasting graft survival.


Nephrology | 2017

Different association between renal hyperfiltration and mortality by sex

Kyung Don Yoo; Hyung-Jin Yoon; Seung-Sik Hwang; Nam Ju Heo; Ho Jun Chin; Seung Hee Yang; Kwon Wook Joo; Yon Su Kim; Hajeong Lee

Renal hyperfiltration (RHF) is a marker of early kidney injury that was recently shown to be a novel marker of mortality. However, it has no clear definition. In this study, we suggested an age‐ and sex‐adjusted RHF definition and explored the association between RHF and mortality by sex.


Nephrology Dialysis Transplantation | 2018

Pregnancy in women with immunoglobulin A nephropathy: are obstetrical complications associated with renal prognosis?

Sehoon Park; Kyung Don Yoo; Joong Shin Park; Joon-Seok Hong; Seungdon Baek; Su-Kil Park; Ho Jun Chin; Ki Young Na; Yunhee Choi; Dong Ki Kim; Kook-Hwan Oh; Kwon Wook Joo; Yon Su Kim; Hajeong Lee

BackgroundnRecent studies regarding immunoglobulin A nephropathy (IgAN) suggest no relationship between pregnancy and disease progression, although complicated pregnancies and impaired renal function are closely related.nnnMethodsnThis study used a propensity-score-matched cohort analysis. Among biopsy-confirmed IgAN women in three hospitals in Korea, those who experienced pregnancy after their diagnosis were included in the study group. Renal outcome was the composite of serum creatinine doubling, estimated glomerular filtration rate (eGFR) halving and events of end-stage renal disease. Pregnancies with preterm birth, low birth weight and pre-eclampsia were defined as complicated.nnnResultsnOverall, 59 IgAN women who became pregnant after their diagnosis, and the same number of IgAN women who did not experience pregnancy were included in the control group. Although pregnancy itself did not worsen renal outcomes [adjusted hazard ratio (HR): 1.51; 95% confidence interval (CI) 0.57-4.01; Pu2009=u20090.41], mothers with complicated pregnancies experienced worse renal prognosis, even after adjustment for baseline and pre-gestational characteristics (adjusted HR: 5.07; 95% CI 1.81-14.22; Pu2009=u20090.002). Moreover, this relationship was only significant in mothers with decreased renal function (eGFR <60u2009mL/min/1.73 m2) (adjusted HR: 18.70; 95% CI 1.63-214.40; Pu2009=u20090.02), baseline hypertension (adjusted HR: 4.17; 95% CI 1.13-15.33; Pu2009=u20090.03) and overt proteinuria (≥1u2009g/day) (adjusted HR: 4.21; 95% CI 1.24-14.27; Pu2009=u20090.02). In contrast, patients who experienced pregnancies without complications showed better renal outcomes than did those without post-biopsy pregnancy (Pu2009=u20090.01).nnnConclusionnObstetric complications in patients with high renal risk, rather than pregnancy itself, are associated with renal progression of IgAN women.


PLOS ONE | 2017

Early dialysis initiation does not improve clinical outcomes in elderly end-stage renal disease patients: A multicenter prospective cohort study

Jae Yoon Park; Kyung Don Yoo; Yong Chul Kim; Dong Ki Kim; Kwon Wook Joo; Shin-Wook Kang; Chul Woo Yang; Nam Ho Kim; Yong Lim Kim; Chun Soo Lim; Yon Su Kim; Jung Pyo Lee

Background The optimal timing for initiating dialysis in end-stage renal disease (ESRD) is controversial, especially in the elderly. Methods 665 patients ≥65 years old who began dialysis from August 2008 to February 2015 were prospectively enrolled in the Clinical Research Center for End-Stage Renal Disease cohort study. Participants were divided into 2 groups based on the median estimated glomerular filtration rate at the initiation of dialysis. Propensity score matching (PSM) was used to compare the overall survival rate, cardiovascular events, Kidney Disease Quality of Life Short Form 36 (KDQOL-36) results, Karnofsky performance scale values, Beck’s depression inventory values, and subjective global assessments. Results The mean patient age was 72.0 years, and 61.7% of the patients were male. Overall, the cumulative survival rates were lower in the early initiation group, although the difference was not significant after PSM. Additionally, the survival rates of the 2 groups did not differ after adjusting for age, sex, Charlson comorbidity index and hemoglobin, serum albumin, serum calcium and phosphorus levels. Although the early initiation group showed a lower physical component summary score on the KDQOL-36 3 months after dialysis, the difference in scores was not significant 12 months after dialysis. Furthermore, the difference was not significant after PSM. The Karnofsky performance scale, Beck’s depression inventory, and subjective global assessments were not significantly different 3 and 12 months after dialysis initiation. Conclusions The timing of dialysis initiation is not associated with clinical outcomes in elderly patients with ESRD.


Kidney research and clinical practice | 2017

Middle East respiratory syndrome clinical practice guideline for hemodialysis facilities

Hayne Cho Park; Young-Ki Lee; Sang-Ho Lee; Kyung Don Yoo; Hee Jung Jeon; Dong-Ryeol Ryu; Seong Nam Kim; Seung Hwan Sohn; Rho Won Chun; Kyu Bok Choi

The Korean Society of Nephrology participated in the task force team consisting of government authorities and civilian experts to prevent and control the spread of Middle East respiratory syndrome (MERS) in 2015. The Korean Society of Nephrology MERS Task Force Team took an immediate action and drafted ‘the clinical recommendation for hemodialysis facilities’ to follow when the first and the only confirmed case was reported in the hemodialysis unit. Owing to the dedicated support from medical doctors, dialysis nurses, and related medical companies, we could prevent further transmission of MERS infection successfully in hemodialysis units. This special report describes the experience of infection control during MERS outbreak in 2015 and summarizes the contents of ‘the clinical practice guideline for hemodialysis facilities dealing with MERS patients’ built upon our previous experience.


Omega-journal of Death and Dying | 2018

Effect of the Contents in Advance Directives on Individuals’ Decision-Making

Jae Yoon Park; Chi-Yeon Lim; Gloria Puurveen; Do Yeun Kim; Jae Hang Lee; Han Ho Do; Kyung Soo Kim; Kyung Don Yoo; Hyo Jin Kim; Yunmi Kim; Sung Joon Shin

Completing an advance directive offers individuals the opportunity to make informed choices about end-of-life care. However, these decisions could be influenced in different ways depending on how the information is presented. We randomly presented 185 participants with four distinct types of advance directive: neutrally framed (as reference), negatively framed, religiously framed, and a combination. Participants were asked which interventions they would like to receive at the end of life. Between 60% and 70% of participants responded “accept the special interventions” on the reference form. However, the majority (70%–90%) chose “refuse the interventions” on the negative form. With respect to the religious form, 70% to 80% chose “not decided yet.” Participants who refused special life-sustaining treatments were older, female, and with better prior knowledge about advance directives. Our findings imply that the specific content of advance directives could affect decision-making with regard to various interventions for end-of-life care.

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Yon Su Kim

Seoul National University

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Dong Ki Kim

Seoul National University

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Hajeong Lee

Seoul National University

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Jung Pyo Lee

Seoul National University

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Kwon Wook Joo

Seoul National University

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Seung Hee Yang

Seoul National University

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