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신장 ; 복막투석에서 장기 기술 생존: 단일 임상기관 연구
서혜진 ( Hye Jin Seo ),현승혜 ( Seung Hyea Hyun ),김건현 ( Gun Hyun Kim ),전주현 ( Joo Hyun Chun ),최지영 ( Ji Young Choi ),조지형 ( Ji Hyung Cho ),김찬덕 ( Chan Duck Kim ),박선희 ( Sun Hee Park ),김용림 ( Yong Lim Kim ) 대한내과학회 2010 대한내과학회지 Vol.79 No.3
목적: 지난 20년간 복막투석용 도관의 연결시스템이 발달함에 따라 기술 생존율이 향상을 보인다는 국내외 여러 기관의 보고가 있었다. 이에 대해 본 저자들은 복막 기술 생존율과 기술 실패의 원인을 분석하고자 하였다. 방법: 1994년 이후 본원에서 복막투석을 시행한 환자들의 자료를 후향적으로 수집하였다. 복막투석 시작 당시 15세 미만이거나, 관찰 기간이 1개월 미만인 경우, 그리고 기록이 잘 보존되지 않은 환자의 경우는 제외하였다. 총 608명의 환자를 대상으로 복막투석의 기술 생존율과 탈락의 원인을 분석하였다. 결과: 608명 중 남자가 342명(56.3%), 여자가 266명(43.7%)이었다. 생존 분석은 Kaplan-Meier 방법과 log-rank test를 이용하여 분석하였다. 복막투석 시작 당시의 평균연령은 50.7±15.1세였고, 평균 복막투석 지속기간은 50.2±41.5개월이었다. 만성신부전의 원인 질환으로는 당뇨병이 241명(39.6%)으로 가장 많았고, 만성 사구체 신염이 226명(37.2%), 고혈압이 79명(13.0%)이었다. 기술 생존율은 각각 1년째 97.3%, 3년째 91.7%, 5년째 82.3%, 10년째가 67.5%였다. 당뇨병 유무는 기술 생존율에 영향을 미치지 않았다(p=0.26). 60세 이전에 투석을 시작한 군에서 60세 이후에 투석을 시작한 군보다 기술 생존율이 높았다(p=0.005). 복막 투석 중단의 원인 중 기술적 원인으로는 복막염이 68명(71.6%)으로 가장 많았고, 도관 기능부전이 10명(10.5%), 한외여과 실패 7명(7.4%) 및 부적절한 투석이 6명(6.3%), 도관 감염이 4명(4.2%)이었다. 결론: 복막염은 여전히 복막투석 중단의 가장 큰 원인이었으며, 복막투석의 기술 생존율을 높이기 위해서는 복막염을 최소화하는 것이 중요한 것 같다. Background/Aims: Continuous ambulatory peritoneal dialysis (CAPD) is an established treatment in patients with end-stage renal disease (ESRD), and innovations in the connection system have improved the survival of peritoneal dialysis patients over the last two decades. We investigated the outcome of CAPD over a 15-year period at our institution. Methods: Patients who underwent peritoneal dialysis since 1994 were recruited retrospectively. Patients younger than 15 years at the initiation of CAPD and those who had less than 1 month of follow-up or missing data were excluded. The technique survival rate and causes of technique failure were evaluated. Results: In all, 608 CAPD patients (342 males, 56.3%) were analyzed using the Kaplan-Meier method and log-rank test. The mean age at the start of CAPD was 50.7±15.1 years and the mean duration of CAPD was 50.2±41.5 months. The most common primary renal disease was diabetes (39.6%), followed by chronic glomerulonephritis (37.2%) and hypertension (13.0%). The 1-, 3-, 5-, and 10-year death-censored technique survival rates were 97.3, 91.7, 82.8, and 67.5%, respectively. Sex or diabetic status did not affect the technique survival rate. Patients younger than 60 years at the start of CAPD had a better technique survival than older patients (p=0.005). The main cause of technique failure was peritonitis (71.6%), followed by mechanical malfunction (10.5%), ultrafiltration failure (7.4%), and inadequate dialysis (6.3%). Conclusions: Complicating peritonitis was the most common cause of CAPD technique failure at our center. To reduce the technique failure in high-risk groups, more intensive management is needed. (Korean J Med 79:258-262, 2010)
손혁수 ( Hyuk Su Son ),김건현 ( Gun Hyun Kim ),김민선 ( Min Seon Kim ),여주천 ( Ju Chun Yeo ),이봉렬 ( Bong Ryeol Lee ),정병천 ( Byung Chun Jung ),이종주 ( Jong Joo Lee ) 대한내과학회 2005 대한내과학회지 Vol.69 No.-
저자들은 좌측 옆구리 통증을 주소로 입원한 환자에게서 발견된 원발성 유미 심낭증을 심장막천자술과 배액으로 진단 및 치료하였고, 특별한 재발없이 호전된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Chylopericardium is a particularly rare clinical entity, generally related to thoracic and cardiac surgery, chest trauma, mediastinal tumor, mediastinal radiation, thrombosis of the subclavian vein, congenital lymphangiomatosis and large granular lymphocytosis. Unlike chylopericardium, primary chylopericardium is more rare disorder and should be diagnosed after exclusion of the known causes. We present a case of a 51-year-old male who was discovered to have a primary chylopericardium confirmed by an echocardiography & fluid analysis by pericardiocentesis. Primary chylopericardium was managed successfully with pericardiocentesis and drainage. We present the case with a review of literature. (Korean J Med 69:S824-S829, 2005)
지속외래복막투석 환자에서 잔여신기능의 감소에 영향을 미치는 인자
박선희 ( Sun Hee Park ),김건현 ( Gun Hyun Kim ),현승혜 ( Seung Hyea Hyun ),서혜진 ( Hye Jin Seo ),최지영 ( Ji Young Choi ),조지형 ( Ji Hyung Cho ),김찬덕 ( Chan Duck Kim ),김용림 ( Yong Lim Kim ) 대한신장학회 2010 Kidney Research and Clinical Practice Vol.29 No.6
Purpose: Preservation of residual renal function (RRF) after initiation of peritoneal dialysis (PD) is beneficial for patient survival. It is unclear that same risk factors of pre-dialysis chronic kidney disease (CKD) patients affect RRF in PD patients. This study was aimed to evaluate factors affecting RRF after commencement of PD. Methods:Data from 80 patients commencing CAPD at Kyungpook National University Hospital between January 2001 and December 2008 were retrospectively collected. After PD commencement, biochemical and clinical data at baseline (1 month), 6, and 12 month were obtained. RRF was calculated as the average of creatinine clearance and urea nitrogen clearance from 24-hour urine collection and normalized with body surface area and mean RRF decline rate was calculated by dividing RRF difference between baseline to 12 month by period. Results:Mean RRF decline rate (mL/min/1.73m2/month) was negatively correlated with left ventricular posterior wall thickness (LVPWT) (R2=0.097, p=0.023) and proteinuria (R2=0.126, p=0.003), whereas positively correlated with hematocrit (R2=0.076, p=0.013) at baseline. Comparison between the two groups divided by median RRF decline rate (-0.082 mL/min/1.73m2/ month) showed that baseline proteinuria (p<0.001), the number of antihypertensive agents (p=0.030) and LVPWT (p=0.039) were higher in the decline group. In addition, the number of antihypertensive agents was higher in the decline group at 1 year, although there was no difference of blood pressure between the two groups. Using multiple binary logistic regression, it was shown that more rapid RRF decline (<-0.082 mL/min/ 1.73m2/month) was likely to have higher proteinuria [adjusted odd ratio (AOR) 3.310, 95% confidence interval (CI) 1.363-8.041], and thicker LVPWT [AOR 1.682, 95% CI 1.043-2.711] at baseline. Conclusion:Decline of RRF during a year after commencement of PD was associated with baseline proteinuria and LVPWT.