Recovery and long-term renal outcome of patients with anti-neutrophil cytoplasmic antibody-associated vasculitis who are on dialysis at presentation

이여진,안수민,오지선,김용길,이창근,유빈,홍석찬 대한류마티스학회 2023 대한류마티스학회지 Vol.30 No.4

Objective: Renal involvement in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) can lead to severe renal dysfunction requiring dialysis at diagnosis. We aimed to study the clinical and pathologic characteristics of patients with AAV dependent on dialysis at presentation and the long-term renal outcomes of patients who recovered from dialysis. Methods: This retrospective study analyzed data of patients diagnosed with AAV who were on dialysis from July 2005 to May 2021 at a single tertiary center in Korea. Results: Thirty-four patients were included in the study (median age: 64.5 years, females: 61.8%), of which 13 discontinued and 21 continued dialysis. The proportion of normal glomeruli (p<0.001) and interstitial fibrosis (p=0.024) showed significant differences between both groups. Multivariable analysis showed that the proportion of normal glomeruli was associated with dialysis discontinuation (odds ratio=1.29, 95% confidence interval 0.99~1.68, p=0.063), although without statistical significance. Treatment modalities, including plasmapheresis, did not show significance with dialysis discontinuation. In the follow-up analysis of 13 patients who had discontinued dialysis for a median of 81 months, 12 did not require dialysis, and their glomerular filtration rate values significantly increased at follow-up time compared to when they stopped dialysis (37.5 [28.5~45.5] vs. 24.0 [18.5~30.0] mL/ min/1.73 m²; p=0.008). Conclusion: Approximately 38% of AAV patients on dialysis discontinued dialysis, and the recovered patients had improved renal function without dialysis during longer follow-up. Patients with AAV on dialysis should be given the possibility of dialysis discontinuation and renal recovery, especially those with normal glomeruli in kidney pathology.

지속성 외래 복막투석 환자의 투석기간에 따른 영양상태

서지연(Seo Ji-Yeon),김남호(Kim Nam-Ho),허영란(Heo Young-Ran) 한국영양학회 2012 Journal of Nutrition and Health Vol.45 No.1

Patients undergoing peritoneal dialysis are at risk for protein-energy malnutrition because of nutrient losses during dialysis. This study determined the nutritional status of patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Forty-four patients receiving CAPD were divided into two groups according to dialysis period. We investigated the nutritional status of the patients by measuring anthropometric and biochemical parameters, as well as food intake, self-appetite, dietary habits, a subjective global assessment, and a total nutritional status assessment. Group Ⅰ subjects (7 males, 13 females) had received dialysis for < 2 years, whereas the group Ⅱ subjects (18 males, 6 females) received dialysis for ≥ 2 years. Energy intake with added dextrose in the dialysate per ㎏ of body weight was 30.3 ± 5.8 ㎉ in group Ⅰ and 29.0 ± 8.1 ㎉ in group Ⅱ. The average protein intake per ㎏ of weight was 1.0 ± 0.3 g in group Ⅰ and 1.0 ± 0.4 g in group Ⅱ, which were less than the recommended protein intake for patients undergoing CAPD (1.2-1.5 g/㎏). Mean serum albumin level was significantly lower in group Ⅱ than that in group Ⅰ (p < 0.05). A recent self-appetite score was significantly higher in group Ⅱ than that in group Ⅰ (p < 0.01). The dietary habits score was significantly lower in group Ⅱ than that in group Ⅰ (p < 0.05). The subjective global assessment was significantly higher in group Ⅰ (85.0%) than that in group Ⅱ (54.2%) under normal nutrition status (p < 0.05). The dialysis period was significantly and negatively correlated with the subjective global assessment (r = -0.502, p < 0.01) and the total nutritional status assessment (r = -0.575, p < 0.01). These results demonstrated that patients undergoing CAPD for ≥ 2 years had worse nutritional status than those who had been undergoing dialysis for < 2 years. Good nutritional status can predict the long-term survival of patients undergoing peritoneal dialysis. Additionally, the exact evaluation of nutritional status before 2 years will be important to maintain long-term dialysis therapy in patients undergoing CAPD.

단일 기관에서 장기 치료한 복막투석과 혈액투석 환자의 치료 경과 비교

김정민 ( Jeong-min Kim ),이세진 ( Se-jin Lee ),서동균 ( Dong-kyun Seo ),이기영 ( Ki-young Lee ),류상열 ( Sang Ryol Ryu ),이소영 ( So-young Lee ) 대한내과학회 2017 대한내과학회지 Vol.92 No.1

목적: 투석을 시작한지 3년이 지났으며 잔여 신기능이 없어졌다고 생각되는 환자들의 혈액투석 치료와 복막투석 치료 간의 치료 경과를 비교하였다. 대상 및 방법: 을지병원에서 36개월 이상 투석 치료를 받는 투석 환자를 대상으로 하였다. 대상 환자들의 의무기록을 조사하였고, 검사실 소견을 평균하여 기록하였다. 투석 적절도와 체수분량을 측정하였고 염증성 사이토카인을 측정하여 치료 방법에 따른 차이를 비교하였다. 결과: 총 80명의 환자 중 복막투석 환자 39명, 혈액투석환자 41명이었고 두 군 간에 평균 연령, 남녀비에는 차이가 없었다. 혈액투석 환자의 경우 97.5%의 환자가 Kt/V 1.2 이상을 만족하였으나 복막투석 환자의 경우 58%만이 이 기준을 만족하였다. 복막투석 환자가 더 BMI가 높았고 중성지방 수치가 높았으며 저밀도콜레스테롤이 높은 경향을 보였고 두군 간의 수분 조절 상태에 큰 차이는 없었다. 염증 수치는 Kt/V가 1.7 미만, 저투과도를 보이는 복막투석 환자군에서 더 의미 있게 높게 측정되었다. 결론: 장기 복막투석 환자의 경우, 혈액투석에 비해 효율적인 투석 적절도 유지가 어렵다. 이러한 투석 효율의 감소가 복막투석 환자를 상대적인 과염증 상태에 이르게 하는 원인이 될 수 있다고 생각된다. 따라서 장기 복막투석 환자의 경우, 투석 효율을 높이고 관리가 철저히 이루어질 수 있도록 환자 교육과 의료진의 관심이 더욱 필요한 치료군이라고 생각된다. Background/Aims: Improvements in dialysis therapies and patient care are leading to more patients receiving dialysis for longer periods of time. Survival rates with peritoneal dialysis (PD) are superior to those with hemodialysis (HD) during the initial 2-3 years; however, data comparing the outcomes of these two methods are lacking. Thus, we performed a retrospective study of patients treated with dialysis for longer than 3 years to investigate patient condition according to mode of dialysis. Methods: A total of 80 patients currently being treated by dialysis for at least 36 months at the Eulji Medical Center were included in this study. Patients` laboratory data and admissions histories over the prior 3 years were reviewed. Dialysis adequacy, body composition, and cytokine levels were quantified. Results: A total of 39 PD and 41 HD patients, with no difference in mean age or gender, were compared. Regarding dialysis adequacy, 97.5% of HD patients met the criterion of 1.2 Kt/V or higher, whereas only 58% of PD patients satisfied the required weekly Kt/V of 1.7. Inflammatory cytokines were significantly elevated in PD patients; however, PD patients with adequate dialysis expressed the same inflammatory cytokines as HD patients. Conclusions: The delivery of adequate dialysis to PD patients over extended periods of time is difficult. Thus, more rigorous management of PD patients is required to avoid insufficient dialysis and inflammation. (Korean J Med 2017;92:45-52)

The Incidences and Characteristics of Various Cancers in Patients on Dialysis: a Korean Nationwide Study

권순길,한정호,김혜영,강길원,강민석,Yeonkook J. Kim,민진수 대한의학회 2019 Journal of Korean medical science Vol.34 No.25

Background: The numbers of patients on dialysis and their life expectancies are increasing. Reduced renal function is associated with an increased risk of cancer, but the cancer incidence and sites in dialysis patients compared with those of the general population require further investigation. We investigated the incidences of various cancers in dialysis patients in Korea and used national health insurance data to identify cancers that should be screened in dialysis clinics. Methods: We accessed the Korean National Health Insurance Database and excerpted data using the International Classification of Disease codes for dialysis and malignancies. We included all patients who commenced dialysis between 2004 and 2013 and selected the same number of controls via propensity score matching. Results: A total of 48,315 dialysis patients and controls were evaluated; of these, 2,504 (5.2%) dialysis patients and 2,201 (4.6%) controls developed cancer. The overall cancer risk was 1.54-fold higher in dialysis patients than in controls (adjusted hazard ratio, 1.71; 95% confidence interval, 1.61–1.81). The cancer incidence rate (incidence rate ratio [IRR], 3.27) was especially high in younger dialysis patients (aged 0–29 years). The most common malignancy of end-stage renal disease patients and controls was colorectal cancer. The major primary cancer sites in dialysis patients were liver and stomach, followed by the lung, kidney, and urinary tract. Kidney cancer exhibited the highest IRR (6.75), followed by upper urinary tract (4.00) and skin cancer (3.38). The rates of prostate cancer (0.54) and oropharyngeal cancer (0.72) were lower than those in the general population. Conclusion: Dialysis patients exhibited a higher incidence of malignancy than controls. Dialysis patients should be screened in terms of colorectal, liver, lung, kidney and urinary tract malignancies in dialysis clinics.

투석 보류와 투석 중단의 결정에 대한 의사들의 태도

윤영섭 ( Yeong Seop Yun ),권순효 ( Soon Hyo Kwon ),정재면 ( Jae Myun Jung ),전진석 ( Jin Seok Jeon ),노현진 ( Hyun Jin Noh ),한동철 ( Dong Cheol Han ) 대한신장학회 2009 Kidney Research and Clinical Practice Vol.28 No.1

목적: 국외의 경우 사전의사결정서와 투석 보류 및 중단지침을 통해 환자와 의료진 모두 투석 중단에 대한 갈등과 고민을 최소화하고자 하고 있다 그러나 아직 국내에서는 투석 중단에 대한 연구가 거의 없다. 이에 저자들은 신장내과 의사들의 투석 보류와 중단에 대한 태도를 알아보고자 본 연구를 시행하였다. 방법: 2006년 1월부터 2008년 1월까지 내과의원, 종합병원 대학병원에서 투석환자를 진료하는 내과의사 45명을 대상으로 투석 보류와 중단에 대한 설문 조사를 시행하였다. 투석 보류와 중단에 대한 항목은 Likert식의 5점 척도로 구성되었고 투석 치료에 관한 사전의사결정서 작성과 투석중단 가이드라인 필요성에 대한 항목은 3점 척도로 구성되었다. 결과: 투석 보류와 중단 모두의 경우에서 치매 환자보다 식물상태 환자에서 더 강하게 동의하는 것으로 나타났다. 의식 상태가 명료한 말기 신질환 환자가 투석을 원하지 않을 경우 투석을 중단하는 것에 동의하는 것보다 시작을 보류하는 것에 더 강한 동의를 보였다. 하지만 치매나 식물상태의 경우에는 투석 보류와 중단 요구간에 대상자의 태도에는 의미 있는 차이가 없었다. 투석 시작 전 투석 중단에 관한 사전 의사 결정서에 대해서는 반대의견이 더 많았으나 투석 보류와 중단 가이드라인 제정에 대해서는 대부분 찬성하였다. 결론: 환자의 신경학적 이상에 따라 투석유보와 중단에 대해서 상반된 태도를 보였으나 투석 보류와 중단에 대한 지침의 필요성에서 대부분 찬성하였다. Purpose: In many countries, patients and dialysis unit physicians attempt to address issues regarding withholding and withdrawing dialysis through advance directives and clinical guidelines for dialysis utilization. However, there are only a few reports of withholding and withdrawing dialysis in Korea. This study was developed to investigate the attitudes of dialysis unit physicians regarding withholding and withdrawing dialysis in Korea. Methods: A questionnaire survey was conducted among 45 dialysis unit physicians from January, 2006 to January, 2008. Physicians were asked about their decision making process to withhold and withdraw dialysis, and their opinions regarding the necessities of advance directives and guidelines for withholding and withdrawing dialysis. Results: Analysis of surveys revealed that physicians agreed more about whether to withhold and withdraw dialysis in vegetative patients compared to patients with dementia (p<0.001, p<0.001). There were more agreements about whether to withhold dialysis than whether to withdraw dialysis in patients with unimpaired cognition (p<0.037). However, there were no differences in agreements between withholding and withdrawing dialysis in patients with severe neurological impairments. There appeared to be a general consensus regarding the need for guidelines addressing withholding and withdrawing dialysis (84.4%). However, opinions supporting the necessity for advance directives were not strongly favored (33.3%). Conclusion: Conflicting opinions are present among dialysis unit physicians regarding whether to withhold and withdraw dialysis according to a patient`s neurological impairments. However, most dialysis unit physicians were of one accord regarding the need of guidelines for withholding and withdrawing dialysis.

2세 미만 만성 신부전 환아에서의 만성 투석

손영배,남숙현,곽민정,김수진,진동규,백경훈,Sohn, Young-Bae,Nam, Sook-Hyun,Kwak, Min-Jung,Kim, Su-Jin,Jin, Dong-Kyu,Paik, Kyung-Hoon 대한소아신장학회 2007 Childhood kidney diseases Vol.11 No.1

목적 : 영유아 만성 신부전 환자의 투석은 어른에 비해 여러 가지 면에서 어려움이 있다. 본 연구에서는 2세 미만 영유아에서 만성투석을 시행한 10례에 대한 경험을 고찰하여 보다 나은 투석 치료의 방향을 제시하고자 하였다. 방법 : 1999년 3월부터 2007년 2월까지 삼성서울병원에서 3개월 이상 만성 투석을 시행한 2세 미만의 만성 신부전 환아 10례의 의무기록을 후향적으로 조사하였다. 결과 : 대상 환아의 만성 신부전의 원 질환은 이형성신이 5례로 가장 많았다. 10명의 환아 중 남아는 6명, 여아는 4명이었다. 투석 시작 시 연령의 중간값은 3개월(22일-20개월)이었고 투석 시작 시 체중은 3.75 kg(2.2-10.3 kg)이었다. 투석시작 시 혈청 크레아티닌은 4.3 mg/dL(1.4-11.4 mg/dL)이었다. 투석기간은 29.5개월(3-62개월)이었다. 10명의 환아 중 2명은 혈액투석만 시행하였고, 4명은 복막투석만 시행하였다. 4명은 혈액투석과 복막투석을 모두 시행했다. 10명 중 9명은 적혈구 생성인자(Erythropoietin)를 투여 받았으며 고혈압 조절을 위해 항고혈압제를 복용하였다. 최근 추적관찰에서 1례는 신장 이식을 받았고, 2례는 패혈증으로 사망했으며, 5례는 복막투석 중이고, 2례는 추적관찰 되지 않았다. 투석의 합병증으로 감염이 가장 흔했고, 혈액투석 시 도관 확보 및 유지가 중요했다. 투석 시작 시와 비교해 투석 5개월 후 체중과 신장의 mean SDS 는 악화 되었으나 투석 1년 후에는 호전되었고 복막투석이 혈액투석보다 성장 면에서 유리한 경향을 보였다. 결론 : 2세 미만 영유아에서 만성 투석을 하는 경우 감염을 예방하고 도관을 잘 유지해야 한다. 적절한 영양공급을 통해 성장을 보완하고 보존적 치료를 병행하면 영유아에서 비교적 안전하게 투석치료를 할 수 있고 향후 신 이식이 가능하도록 생존율을 높이고 삶을 질을 호전시킬 수 있을 것으로 기대된다. Purpose : Dialysis in children with chronic renal failure presents with many difficulies. The purpose of this study is to find an improved method in chronic dialysis in infants and children less than 2 years of age by analyzing the experience with 10 cases. Methods : A retrospective review of the medical records of 10 patients(6 boys and 4 girls) was conducted. The patients had chronic renal failure and underwent chronic dialysis at Samsung medical center from March 1999 to February 2007. Results : At Initiation of dialysis, the median age was 3 months old(22 days-20 months), the median body weight was 3.75 kg(2.2-10.3 kg), and the median serum creatinine level was 4.3 mg/dL(2.0-11.4 mg/dL). The median duration of dialysis was 29.5 months(3-62 months). Dysplastic kidney disease was the most common underlying renal disease. Two patients were treated with hemodialysis, 4 patients with peritoneal dialysis, and 4 patients eventually switched dialysis modality. Nine of the 10 patients took erythropoietin and anti-hypertensive drugs. At the end of the follow up period, 1 patient received kidney transplantation, 2 patients died due to sepsis, and 5 patients were treated with peritoneal dialysis. Two patients were lost to follow up. The most common complication of dialysis was infection. Achieving vascular access and maintaining proper catheter function were the most important factors in treating patients with hemodialysis. The growth status of patients was aggravated after 6 month of dialysis but improved after 1 year of dialysis. Patients showed better growth on peritoneal dialysis than hemodialysis. Conclusion : Chronic dialysis can be performed successfully in infants and children under 2 years of age. Vascular access was the main limitation of hemodialysis, and infection was the common problem in both hemodialysis and peritoneal dialysis. To improve the patients survival rate and quality of life, major efforts should be directed toward the prevention of infection and preservation of catheter function. (J Korean Soc Pediatr Nephrol 2007;11:41-50)

장기 복막투석 동물 모델에서 물수송체의 역할

박민선(MS Park),차정호(JH Cha),김진(J Kim),(Soren Nielsen) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.2

N/A Sufficient fluid removal is vital to renal replace-ment therapy in end-stage renal failure patients. Aquaporins are integral membrane proteins and the primary water channels that allow water transport only. Type 1, 3 and 4 aquaporins were found in peritoneal capillary walls and peritoneal mesothelial cells. Approximately 5096 of total amount of free water transported during peritoneal dialysis is through aquaporins. Ultrafiltration failure and fluid overload are found in some of long-term continous ambulatory peritoneal dialysis(CAPI3) patients and are major causes of withdrawl from CAPD. Long- term use of high glucose containing dialysis solutions, and functional and morphological changes of aquaporins were suggested as possible mechanisms of ultrafiltration failure. However, a direct relation between alterations of aquaporins in the peritoneum and ultrafiltration failure in long-term CAPD has not been reported yet. In this study peritoneal aquaporins and ultrafiltration were evaluated after long-term peritoneal exposure to high glucose containing dialy- sis solutions in rats. Sprague-Dawley rats with normal kidney func- tions were used. Twenty five milliliter of 4.25% glucose containing dialysis solutions were injected into the peritoneal cavity twice a day for 12 weeks in 13 rats(dialysis-group). The other 13 rats were used without intraperitoneal injection as controls (control-group). One rat from each group died during the study was excluded. After 12 weeks of intraperitoneal injection, a 2 hour peritoneal transport study was done in 9 rats from each group. To calculate intraperitoneal fluid absorption rate, (131)I labelled human serum albumin(RISA) was used as a volume marker. Mesenteries were taken from the remaining three rats from each group for immuno-histochemistry for aquaporin type l. Intraperitoneal volume after 2 hour dialysis was significantly lower in dialysis-group than in control-group(33.7±3.6 vs 39.4±6.1mL, p<0,05). The peri- toneal fluid absorption rate was significamtly higher in dialysis-group than in contml-group(0,070±0.051 vs 0.049±0.016 mL/min, p<0.05). Dg'P> srxlium was signifieantly higher in dialysis-group than in con- trol-group(0.890±0.014 vs 0.856±0.038, p<0.05).D₂P₂urea and D2/D0 glucose did not differ between the two groups. Immunohistochemistry revealed that aquaporin type 1 was strongly stained in the me-sentery capillary walls in control-group, while it was almost disappeared in dialysis-group. In conclusion, long-term use of high glucose containing dialysis solutions decreased aquaporin type 1 population in the peritoneum and ultrafil-tration volume. Increased peritoneal fluid absorption rate is also in part responsible for decreased ultra- filtration volume after long-term use of dialysie solutions.

무뇨의 복막투석 환자에서 투석의 적절도

송호철 ( Song Ho Cheol ),김영옥 ( Kim Yeong Og ),김병수 ( Kim Byeong Su ),신미정 ( Sin Mi Jeong ),김영수 ( Kim Yeong Su ),신석준 ( Sin Seog Jun ),진동찬 ( Jin Dong Chan ),김용수 ( Kim Yong Su ),최의진 ( Choe Ui Jin ),장윤식 ( Jang 대한신장학회 2004 Kidney Research and Clinical Practice Vol.23 No.2

배 경 : 복막투석 환자에서 투석적절도는 찬자의 유병률 및 사망률과 깊은 관련이 있으며 National Kidney Foundation-Dialysis Outcome Quality Initiative (NKF~DOQI) 기준은 지속성 외래 복박투석 환자의 적절한 투식을 위하여 주당 Kt/Vurea는 2.0 이상, 크레아티닌 청소율 (CCr)을 60 L/week/1.73 ㎡ 이상 유지하는 것을 추천하고 있으며 또한 잔여신기능의 중요성을 강조하였다. 본 연구에서는 잔여신기능이 없는 무뇨의 복막투석 환자들을 대상으로 하루 8 L의 투석이 DOQI 기준에 부합하는지 여부와 잔여신기능이 없는 복막투석 환자에서 투석적 절도에 영향을 미치는 인자와 투석횟수의 증가시 투석적절도의 변화를 관찰하였다. 방 법 : 하주 8 L의 복막투석을 시행하는 무뇨의 말기신부전 환자 27명을 대상으로 각각 1주일간 표준용량 방법 (일일 2 L씩 4회)을 실시하였고, 그 후 다시 7일간 고용량 방법 (일일 2 L씩 5회)을 설시하여, 주당 Kt/vurea아 크레아티닌 청소율을 측정하여 복막투석의 적절도를 평가하였다. 또한 투석량의 증가시 투석적절도의 변화를 관찰하였으며, 하루 10 L 투석시에 적절한 투석하게 투석이 되는 환자의 임상인자를 분석하였다. 결 과 : 대상환자는 남자 12명, 여자 15명, 연령은 49±12세, 체중 59.2±10.1 ㎏, 투석기간 은 51±15개월이었고, 말기신부전의 원인 질환은 당뇨성신증 (11명), 만성사구체신염 (8명), 고혈압성신증 (4명), 기타질환 (4명)이었다. 표준용량 복막투석을 시행한 환자와 고용량 복막투석을 시행하였을 경우 평균 주당 Kt/vurea는 1.7±0.3에서 2.1±0.4로 증가하였고 평균 주당 크레아티닌 청소율은 48.8土7.2 L/l.73 ㎡에서 63.1±12.1 L/l.73 ㎡로 증가하였다 (p<0.05). 표준용량 복막투석시에 대상환자 27명중 2명의 환자에서 적절히 투석이 되었으나 고용량 복막투석시에는 14명의 환자에서 적절한 투석이 되었다. 고용량 투석에서 NKF-DOQIl 기준 이상의 적절한 투석을 보인 군 (14명)은 부적절한 투석을 보인 군 (13명)에 비하여 연령, 성별, 당뇨의 유무, 투석기간, 4시간 D/Pcreatinine 비율에서는 차이를 보이지 않았으나 요소질소 분포체액량 (volume of urea distribution)이 낮았으며 이 차이는 통계적으로 유의하였다 (p<0.05). 결 론 : 이상의 결과로 잔여신기능이 없는 복막투석 환자에서 하루 8 L 투석에도 불구하고 대상환자 대부분에서 DOQIl 기준 이하로 투석이 되고 있었다. DOQI 기준 이상으로 투석이 되기 위해 투석량의 증가가 필요하며, 향후 한국인에서의 DOQIl 기준의 임상적 의미를 알기 위해 더 많은 활자를 대상으로 전향적 연구가 필요하리라 생각된다. Background : Failure to achieve target values for both urea (Kt/V) and creatinine clearance has been associated with increased morbidity and mortality in CAPD patients. Current standard of adequacy CAPD is to provide a weekly normalized urea clearance of 2.0 or more and a creatinine clearance of 60 liter/1.73 m² or more. Conventional CAPD in patients without residual renal function is associated with worse clinical outcomes. This study was designed to study the effect of increasing daily exchange frequency on dialysis adequacy in anuric CAPD patients. Methods : The 27 anuric CAPD patients (patients on 4×2 L daily exchanges for 7 days) were selected and then they received standard dose dialysis (4×2 L daily exchanges for 7 days) followed by high dose dialysis (5×2 L daily exchanges). Weekly Kt/Vurea and weekly Ccr were measured at the end of standard and high dose dialysis. Adequate dialysis was defined as satisfying both weekly Kt/Vurea >2.0, weekly Ccr >60 L/1.73 m² according to DOQI guideline Results : Selected patients were 12 men and 15 women, mean age was 49±12 years, mean weight was 59.2±10.1 kg, mean peritoneal dialysis duration was 51±15 months. Weekly Kt/V was 1.7±0.3 in standard dose dialysis patients and 2.1±0.4 in high dose dialysis patients, mean Ccr was 48.8±7.2 L/week/1.73 m² in high dose dialysis patients. This difference is statistically significant (p<0.05). Among 27 patients, only 2 standard dose dialysis patients were on adequate dialysis but in high dose dialysis group, 14 patients were on adequate dialysis according to DOQI guideline. In high dose dialysis 14 on adequate dialysis and 13 inadequate dialysis were divided and their clinical factors were analyzed. Only volume of urea distribution (30.9±5.9 L vs 37.7±7.6 L) was significantly different (p<0.05). Conclusion : This study revealed most standard dose of anuric CAPD patients, who receiving daily 8 L dialysis did not dialyzed adequately by DOQI guideline. Increasing the number of exchanges effectively increased Kt/Vurea and weekly creatinine clearance in anuric CAPD patients. (Korean J Nephrol 2004;23(2):318-324)

Incidence of acute cholecystitis underwent cholecystectomy in incident dialysis patients: a nationwide population-based cohort study in Korea

최한림,권순길,Han Joung-Ho,Lee Junsung,강길원,Kang Minseok 대한신장학회 2022 Kidney Research and Clinical Practice Vol.41 No.2

Background: Patients on dialysis have numerous gastrointestinal problems related to uremia, which may represent concealed cholecystitis. We investigated the incidence and risk of acute cholecystitis in dialysis patients and used national health insurance data to identify acute cholecystitis in Korea. Methods: The Korean National Health Insurance Database was used, with excerpted data from the insurance claim of the International Classification of Diseases code of dialysis and acute cholecystitis treated with cholecystectomy. We included all patients who commenced dialysis between 2004 and 2013 and selected the same number of controls via propensity score matching.Results: A total of 59,999 dialysis and control patients were analyzed; of these, 3,940 dialysis patients (6.6%) and 647 controls (1.1%) developed acute cholecystitis. The overall incidence of acute cholecystitis was 8.04-fold higher in dialysis patients than in controls (95% confidence interval, 7.40–8.76). The acute cholecystitis incidence rate (incidence rate ratio, 23.13) was especially high in the oldest group of dialysis patients (aged ≥80 years) compared with that of controls. Dialysis was a significant risk factor for acute cholecystitis (adjusted hazard ratio, 8.94; 95% confidence interval, 8.19–9.76). Acute cholecystitis developed in 3,558 of 54,103 hemodialysis patients (6.6%) and in 382 of 5,896 patients (6.5%) undergoing peritoneal dialysis. Conclusions: Patients undergoing dialysis had a higher incidence and risk of acute cholecystitis than the general population. The possibility of a gallbladder disorder developing in patients with gastrointestinal problems should be considered in the dialysis clinic.

REVIEW : Major changes and improvements of dialysis therapy in Korea: review of end-stage renal disease registry

( Dong Chan Jin ) 대한내과학회 2015 The Korean Journal of Internal Medicine Vol.30 No.1

The Korean Society of Nephrology (KSN) launched a nationwide end-stage renal disease (ESRD) patient registry in 1985 called the Insan Prof. Byung-Suk Min Memorial ESRD Patient Registry. KSN members voluntarily participate in this registry, which has been collecting data through the Internet since 2000. The KSN ESRD patient registry data were reviewed to elucidate the major changes and improvements in dialysis therapy in Korea. The data review revealed: a rapid increase in the number of patients with ESRD; an increase in the number of patients with diabetic nephropathy; a decrease in the proportion of patients undergoing peritoneal dialysis; an increase in the role of private dialysis clinics; an increase in the number of elderly patients undergoing dialysis and the number of patients undergoing long-term dialysis; a decrease in mean blood pressure and an increase in pulse pressure; improvement in anemia treatment; improvement in dialysis adequacy; and improvement in the survival of patients undergoing dialysis. In conclusion, improvements have been made in blood pressure control, anemia treatment, and dialysis adequacy despite increases in the number of elderly patients, diabetic patients, and patients on long-term dialysis during the last two decades in Korea.