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지속성 외래 복막투석 환자의 합병증 및 생존율에 관한 임상적 고찰
김형직(Hyung Jik Kim),하성규(Sung Kyu Ha),최규헌(Kyu Hun Choi),이호영(Ho Yung Lee),한대석(Dae Suk Han),김문재(Moon Jae Kim) 대한내과학회 1989 대한내과학회지 Vol.37 No.3
N/A From March 1983 through August 1987, 140 patients with end stage renal disease of various causes were treated by continuous ambulatory peritoneal dialysis(CAPD). The following results were obtained: 1) Peritonitis was the most common complication and the incidence was 1 episode/8.9 patient-months. 2) The positive rate in gram stain or culture of peritoneal dialysate was 31.3%, of which 35.6% was Staphylococcus epidermidis. 3) Peritonitis incidence according to the peritoneal dialysis solution used showed 1 episode/11.2 patient-months with Dianeal® and 1 episode/7.0 patient-months with Peritosol®. 4) The catheter was removed in 12.4% of all patients. The most common cause for catheter removal was peritonitis, which accounted for 76.5% of cases. 5) Patient survival and technical success rates at the end of the first year were 93.3% and 90.7% respectively. 6) Peritonitis incidences were 2.27 episodes/patient/ year in 1983, 0.98 episodes/patient/year in 1984, 1.01 episodes/patient/year in 1985, 1.39 episodes/patient/ year in 1986, and 1.32 episodes/patient/year in 1987. Peritonitis still remains the most frequent complication of continuous ambulatory peritoneal dialysis(CAPD). In order to reduce its incidence, further efforts are required.
혈액투석중인 만성신부전 환자에서 혈압조절의 양상과 투석적절도가 혈압에 미치는 영향
김명빈(Myung Bin Kim),박규용(Ky Yong Park),김근호(Guen Ho Kim),전노원(Rho Won Chun),김형직(Hyung Jik Kim),채동완(Dong Wan Chae),노정우(Jung Woo Noh),구자룡(Ja Ryong Koo) 대한내과학회 1999 대한내과학회지 Vol.56 No.5
N/A Objective : Volume expansion has been known to be the major factor in the development of hypertenision in chronic hemodialysis(HD) patients. But some HD patients remain hypertensive even with adequate volume control, which suggests the role of undefined uremic toxin in the pathogenesis of hypertension. So we aimed to evaluate the status of blood pressure (BP) control and the effect of Kt/V (as a marker for removal of uremic toxin) on BP in chronic HD patients. Methods : The status of BP control was obtained from records of 8 HD session in 132 patients in November 1996 and 127 patients in November 1997. Of 132 patients studied in 1996, 70 patients underwent a follow-up evaluation in 1997. All patients were dialyzed 3 times a week, 4 hours a session. Postdialytic cyclic 3',5' guanosine monophosphate (cGMP) level was measured in 48 patients as a marker of volume status. Results : The prevalence of postdialytic hypertension (>140/90mmHg) was 73.5 in 1996 and 65.3% in 1997. Normotensive patients (postdialytic mean BP <114 mmHg) had higher Kt/V value than hypertensive patients in both 1996 and 1997. But there was no difference in the degree of ultrafiltration (UF) and cGMP level between two groups. Postdialytic mean BP was inversely correlated with Kt/V level but had no relationship with degree of UF and cGMP level in both 1996 and 1997. The group in which postdialytic mean BP had been decreased during 1 year study period had higher degree of elevation in Kt/V than the group in which postdialytic mean BP had been increased. The changes of postdialytic weight and degree of UF during study period were similar between two groups. The number of antihypertensives used were also inversely correlated with Kt/V but not correlated with degree of UF and cGMP level in both 1996 and 1997. Conclusion : Our study indicate that increasing HD adequacy is associated with improved control of postdialytic mean BP and less use of antihypertensive drugs. UF and antihypertensive drugs may not be adequate form of hypertension treatment as once thought and increasing HD adequacy can be an alternative method.