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- 저자 : ( Horng Ruey Chua ) (검색결과 2 건)
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( Sean Wy Lee ),( Clara Lee Ying Ngoh ),( Horng Ruey Chua ),( Sabrina Haroon ),( Weng Kin Wong ),( Evan Jc Lee ),( Titus Wl Lau ),( Sunil Sethi ),( Boon Wee Teo ) 대한신장학회 2019 Kidney Research and Clinical Practice Vol.38 No.1
Background: Chronic kidney disease (CKD) is associated with fluid retention, which increases total body water (TBW) and leads to changes in intracellular water (ICW) and extracellular water (ECW). This complicates accurate assessments of body composition. Analysis of bioelectrical impedance may improve the accuracy of evaluation in CKD patients and multiple machines and technologies are available. We compared body composition by bioimpedance spectroscopy (BIS) against multi-frequency bioimpedance analysis (BIA) in a multi-ethnic Asian population of stable, non-dialysis CKD patients. Methods: We recruited 98 stable CKD patients comprising 54.1% men and 70.4% Chinese, 9.2% Malay, 13.3% Indian, and 8.2% other ethnicities. Stability was defined as no variation in serum creatinine > 20% over three months. Patients underwent BIS analyses using a Fresenius body composition monitor, while BIA analyses employed a Bodystat Quadscan 4000. Results: Mean TBW values by BIS and BIA were 33.6 ± 7.2 L and 38.3 ± 7.4 L; mean ECW values were 15.8 ± 3.2 L and 16.9 ± 2.7 L; and mean ICW values were 17.9 ± 4.3 L and 21.0 ± 4.9 L, respectively. Mean differences for TBW were 4.6 ± 1.9 L (P < 0.001), for ECW they were 1.2 ± 0.5 L (P < 0.001), and for ICW they were 3.2 ±1.8 L (P < 0.001). BIA and BIS measurements were highly correlated: TBW r = 0.970, ECW r = 0.994, and ICW r = 0.926. Compared with BIA, BIS assessments of fluid overload appeared to be more associated with biochemical and clinical indicators. Conclusion: Although both BIA and BIS can be used for body water assessment, clinicians should be aware of biases that exist between bioimpedance techniques. The values of body water assessments in our study were higher in BIA than in BIS. Ethnicity, sex, body mass index, and estimated glomerular filtration rate were associated with these biases.
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( Wei Ying Jen ),( Margaret L Teng ),( Wee Chuan Hing ),( Valerie Ma ),( Shridhar Ganpathi Iyer ),( Chung Cheen Chai ),( Horng Ruey Chua ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Premixed hypotonic solutions of 0.33% saline + 5% dextrose + 10mmol/ L potassium-chloride (0.33S, tonicity 133mEq/L) and 0.9% saline ±dextrose (NS, tonicity 308mEq/L) are common peri-operative maintenance fiuids, but their effects on serum biochemistry are unclear. Methods: Using a single-centre, prospectively-maintained electronic database, we retrospectively examined post-operative biochemistry in adults maintained on exclusively 0.33S or NS peri-operatively, from March 2012 to September 2013. Outcomes included new-onset post-operative hyponatremia, hypokalaemia, hypoglycaemia, and acute kidney injury (AKI, =1.5x increase in serum creatinine); multivariate analyses were adjusted for demographics, comorbidities, surgery-types/duration, infusion time/ volumes, and hospital length-of-stay. Results: We studied 279 patients given 0.33S, and 279 NS controls matched for cumulative infusion volume. Mean age was 59(±18) years. More NS patients had diabetes mellitus, ischemic heart disease and chronic kidney disease (p<0.05). Surgery types included gastrointestinal/hepatobiliary (43%), orthopaedic (30%) and nephrectomy (3%). Mean fi uid volumes administered were 6.9(±3.3)L of 0.33S and 7.1(±5.6)L of NS (p=0.57), with 100% versus 52% of drips containing dextrose, respectively. More 0.33S patients (versus NS) developed hyponatremia (30% versus 17%, p<0.001); this difference was signifi cant for gastrointestinal/hepatobiliary (p=0.001) but not orthopaedic (p=0.74) surgeries. Less 0.33S patients (versus NS) had hypokalaemia (1% versus 10%, p<0.001), hypoglycaemia (1% versus 4%, p=0.01), and AKI (3% versus 8%, p=0.007). On multivariate analyses, 0.33S, gastrointestinal/hepatobiliary surgeries and nephrectomy were independently associated with hyponatremia; while NS, hypertension, longer infusion hours, and nephrectomy were independently associated with AKI (p<0.05). Conclusions: 0.33S infusion in post-surgical patients, especially post-gastrointestinal/ hepatobiliary surgeries, is strongly associated with hyponatremia, but with less hypokalaemia or hypoglycaemia, compared with NS. The association between NS administration and AKI is heavily confounded by baseline comorbidities and requires further prospective evaluation. Both fi uid types are not appropriate for isolated use, and more balanced maintenance fi uids are desired.
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