국내 혈액투석용 정수시설의 기술적 고찰

신석균 ( Sug Kyun Shin ),신기호 ( Ki Ho Shin ),문광백 ( Kwang Baek Moon ),김용림 ( Yong Lim Kim ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

단회뇨의 protein/creatinine ratio를 이용한 일일 뇨단백량 예측에 영향을 미치는 인자

강신욱(Shin Wook Kang),최규헌(Kyu Hun Choi),이호영(Ho Yung Lee),한대석(Dae Suk Han),유태현(Tae Hyeon Yoo),류동렬(Dong Yul Ryu),신석균(Sug Kyun Shin),하성규(Sung Kyu Ha),노현진(Hyun Jin Noh),송현용(Hyun Yong Song),황재하(Jae Ha Hwang) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1

N/A It's well known that protein/creatinine ratio(P/C ratio) in random urine samples reflects 24-hour urine protein. However, the factors affecting accurate quantitation of proteinuria using random urine P/C ratio are not fully evaluated. The aim of this study is to evaluate factors affecting accurate quantitaion of proteinuria using random urine P/C ratio. 118 patients admitted in Yonsei university medical center during June 1998 and Dec. 1998 were assessed for the measurement of random urine protein/creatinine ratio from second voided urine. 118 patients(mean age 41.5year, male: female 2.36: 1) had mean creati-nine level 1.83±1.78mg/dL, 24-hour pmteinuria 6.06±7.64g/day and P/C ratio 4.80±4.48, All the patiient.s were divided into A, B, C, I, II, K, IV according to serum creatinine level and 24-hour proteinurim amount. The correlation coefficient(R value) between proteinuria and P/C ratio are shown that in all pa- tients is 0.875, group A(Cr≤1.4) 0.884, group B(1A <Cr≤4.0) 0.819, group C(4,0<Cr) 0.844, gmup I (24-hr pro'≤0.3) 0.8%, group II(0.3<24-hr pro≤1.0) 0.813, group III(1.0<24-hr pro≤3.5) 0.716, group IV (3.5<24-hr pro) 0.637. These R value were statisti-cally significant(p value<0.05).(Cr serum creatinine, mg/dL, 24-hr pro ' 24-hour urine protein amount, g/day). Greater amount of proteinuria in 24-hour urine less correlated in sensitivity, specificity and positive predictive value with random urine P/C ratio. To evaluate factors affecting accurate quantitation of proteinuria by P/C ratio, multiple regression analysis was performed. The factors affecting accurate quantitation of proteinuria using random urine P/C ratio was 24-hour urine protein amount, not serum creatinine. Especially, in the patients with 24-hour pro-teinuria less than 4.0g/day, the random urine P/C ratio predicted 24-hour urine protein amount most accurately. In conclusion, random urine P/C ratio was well correlated with 24-hour proteinuria in the non-ne-phrotic range proteinuria especially, under 4.0g/day, irrespective of serum creatinine level.

이차성 부갑상선 기능 항진증이 있는 지속성 외래 복막투석(CAPD) 환자에서 칼시트리올(칼시오) 경구 충격요법과 저용량 매일요법의 비교 연구

강신욱(Shin Wook Kang),최규헌(Kyu Hun Choi),이호영(Ho Yung Lee),한대석(Dae Suk Han),유태현(Tae Hyeon Yoo),신석균(Sug Kyun Shin),하성규(Sung Kyu Ha),노현진(Hyun Jin Noh),류동렬(Dong Ryeol Ryu),송현용(Hyun Yong Song),황재하(Jae Ha Hwan 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3

N/A The most widely used method for treatment of secondary hyperparathyroidism(SH) in CAPD patients has been the administration of calcitriol by oral route. In this study, we compared the efficacy and safety of daily low dose calcitriol therapy with those of intermittent high dose pulse therapy. The study group consisted of 38 patients undergoing CAPD with serum intact PTH level of more than 200pg/ mL. Twenty patients were randomly administered daily low dose calcitriol(0.25μg/day for 1 month followed by 0.5μg daily dose for the next 3 mon-ths) while 18 patients were given intermittent pulse therapy(0.5μg-0.5μg-0.75μg 3 times a week for 1 month, increased to 1.0μg-1.25μg-1.25μg 3 times a week for the next 3 months). Thirty five patients completed the study : 17 on daily oral calcitriol (M: F=0.7:1, mean age=47.3±10.6 years, mean duration of CAPD=48.9±41.1 months), and 18 on oral pulse calcitriol(M: F=1.6: 1, mean age=41.5±12.7 years, mean duration of CAPD=49.2±41.6 months). The baseline serum levels of calcium, phosphorus, i-PTH, alkaline phosphatase, and total CO₂were not different be- tween daily and pulse group(9.5±0.8 vs 9.3±0.9mg/ dL, 5.8±1.3 vs 5.1±1.2mg/dL, 443.1±162.5 vs 546±385.9pg/mL, 91.8±47.7 vs 108.9±66.5IU/L, 23.7±1.9 vs 25.5±2.0mEq/L, p>0.05, respectively). The i-PTH level decreased significantly in daily calcitriol group after 1 month(332.8±214.8pg/mL, p<0.01), and at final evaluation(180.4±254.8pg/mL, p<0.01). In pulse calcitriol group, i-PTH level also decreased signi-ficantly to 400,4±225.8pg/mL(p<0.05), 89.4±122.6 pg/mL(p<0.01), respectively. The rate of decline in i-PTH level from baseline were similar(daily=25.4±22.7 vs pulse=19.5±12.6%decline/month, p>0.05). The serum calcium increased similarly in both groups after treatment(daily=10.6±0.8 vs pulse=l0.1±1.0mg/ dL, p>0.05). Hypercalcemia(>11.0mg/dL) was rarely observed in all patients(daily=5, pulse=8 episodes). In conclusion, both daily and pulse calcitriol therapy were similarly effective and safe in control of SH.

전화추후관리 프로그램이 복막투석환자의 치료지속이행, 투석적절도와 감염발생도에 미치는 효과

전시자,신석균,노영숙,이숙정,박애희,박양숙,박영미,Chon, Si-Ja,Shin, Sug-Kyun,Roh, Young-Sook,Lee, Suk-Jeong,Park, Ai-Hee,Park, Yang-Sook,Park, Young-Mi 한국가정간호학회 2009 가정간호학회지 Vol.16 No.2

Purpose: The objective of this study was to identify the effects of a telephone follow-up program on patient compliance, urea kinetic modeling and incidence of infection in patients with continuous ambulatory peritoneal dialysis (CAPD). Method: A pretest-posttest design with a nonequivalent control group was used to examine the effects of a telephone follow-up program for 12 weeks in a group of 39 CAPD patients. The telephone follow-up group of 17 patients received telephone follow-up 10 min once a week for 1 month and 10 min twice a month for 2 months during 12 weeks compared to control group of 22 who patients received usual care. Results: The telephone follow-up group showed no significant changes in patient compliance and urea kinetic modeling, although patients with CAPD receiving a telephone follow-up showed reduced incidence of exit site infection during the intervention compared with the control group. Conclusion: Telephone follow-up program for CAPD patients may decrease the incidence of exit site infection. Future studies with a larger sample be done utilizing diet and exercise reinforcement program combined with telephone follow-up as a nursing intervention for patients with CAPD.

이차성 부갑상선 기능 항진증을 가진 복막투석 환자에서 경구 칼시트리올 치료 반응에 관여하는 요인

강신욱(Shin Wook Kang),최규헌(Kyu Hun Choi),이호영(Ho Yung Lee),한대석(Dae Suk Han),신석균(Sug Kyun Shin),하성규(Sung Kyu Ha),노현진(Hyun Jin Noh),송현용(Hyun Yong Song),노현정(Hyun Jung Roh),유태현(Tae Hyun Yoo),황재하(Jae Ha Hwang) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.1

N/A Calcitriol therapy is an important treatment for the prevention and control of secondary hyperparathyroidism in continuous ambulatory peritoneal dialysis (CAPD) patients. However, this often has been limited by the associated hypercalcemia and hyperphosphatemia due to increase in intestinal calcium and phosphorus absorption. Many studies reported that these limitations could be avoided by changing routes, frequency and dose of calcitriol treatment. But, there are still controversy about each methods and the results on the PTH response to conventional calcitriol treatment in CAPD patients. This study was performed to evaluate the factors affecting the response to oral calcitriol in CAPD patients. A retrospective study was done in 92 CAPD patients with secondary hyperparathyroidism(intact PTH level >200pg/ml) on oral calcitriol treatment. After baseline study of serum calcium, phosphorus, alkaline phosphatase, BUN, creatinine and intact PTH, calcitriol therapy was begun via oral rou- te, daily. Serum calcium, phosphorus, alkaline phosphatase, BUN, creatinine, intact FI'H and other bio- chemical markers were checked at 3 month, 6 month after treatment. Parathyroid gland ultrasonography was performed to detect parathyroid hypertrophy and nodule and to measure the diameter of parathymid gland. All the patients were divided into two groups according to percent reduetion of i-PTH(initial PTH PTH after 3, 6 months)×100/initial PTH(%),△PTH during oral calcitriol therapy for 3 and 6 months(group I ; △PTH >30%, group II ; △PTH <30%). Result: 1) All 92 patients(mean age 46.5 11.3yr, M: F 45: 47, mean CAPD duration 51.3 39.4 months) were administered oral calcitriol, daily. Mean calcitriol dose during 3 month was 0.43 0.22μg and during 6month 0.43 0.24μg. 2) After 3-month treament, there were significant differences in initial i-PTH, the diameter of parathyroid gland, initial phosphorus, intial total alkaline phosphatase and duration of CAPD between group I and II(406.7±196.5 vs. 871.0±478Apglml, 6.2±2.6 vs. 13.1±5.2mm, 5.0±1.3 vs. 5.7±1.3mg/dl, 93.7±4L1 vs. 171.9±137.6IU/L, 40.1±34.9 vs. 73.5±37.8months, p< 0.05, respectively). 4) After 6-month treament, there were significant differences in initial i-PTH, the diameter of parathyroid gland, intial total alkaline phosphatase and duration of CAPD between group I and II(474.1±266.6 vs. 889.7±485.4pg/ml, 6.4±2.7 vs. 14.5±5.1mm, 107.9±80.1 vs. 180.7±121.5IU/L, 40.5± 32.9 vs. 81.8±35.3months, p<0.05, respectively). 5) The significant negative correlation was shown between △PTH and the duration of peritoneal dialysis, the diameter of parathyroid gland, initial PTH level and PTH response during 3-month and 6-month oral calcitriol treatment. The response to oral calcitriol was poor when i-PTH level more than 500pg/ml(kappa 0.429, p value <0.01), the diameter of parathyroid gland more than 10.0mm(kappa 0.641, p value<0.01), the duration of CAPD more than 55months(kappa 0.524, p value< 0.01). These data suggested that initial i-PTH level, the diameter of parathyroid gland size and the duration of CAPD were independent risk factors of the poor response to oral calcitriol therapy in CAPD patients with secondary hyperparathyroidism.

혈액투석 환자의 빈혈 치료에 있어서 고용량의 피하 Recombinant Human Erythropoietin 의 유효성 및 안전성 평가: 다기관 무작위 배정, 공개, 제 3상 연구

이정은 ( Jung Eun Lee ),신석균 ( Sug Kyun Shin ),최승옥 ( Seung Ok Choi ),김문재 ( Moon Jae Kim ),이호영 ( Ho Yung Lee ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1

지속성 외래 복막투석 환자에서 발생한 호산구성 복막염의 임상적 특징

조영일 ( Young Il Jo ),신석균 ( Sug Kyun Shin ),송종오 ( Jong Oh Song ) 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.2

목적 : 국내의 지속적 외래 복막투석 (CAPD) 환자에서 발생하는 호산구성 복막염의 임상적인 특징 및 임상적 의의, 복막 기능에 미치는 영향 등에 대해서 아직 연구된 바가 전혀 없다. 저자들은 CAPD 환자에서 발생하는 호산구성 복막염의 임상적 특징을 조사하여 향후 그 임상적 중요성을 밝히는데 도움을 얻고자 하였다. 방법 : 2000년 1월부터 2001년 12월 사이에 두 곳의 신장센터에서 CAPD를 시작한 환자 중에서 3개월 이상 CAPD를 지속한 환자 112명을 후향적으로 분석하였다. 결과 : 대상 환자들의 평균 연령은 59.2±14.7세 (평균±표준편차)였으며, 남녀비는 1:1.1이었다. 112명의 대상환자에서 12.6±6.7개월 동안 총 1,024회 (환자당 연간 10.5±7.1회/년/환자)의 복막투석 배액검사를 시행하였다. 호산구성 복막염은 연구기간 동안 대상 환자 112명 중 5명 (4.4%)에서 각각 1예씩 발생하여 연간 환자 100명당 약 4.25예의 발생빈도를 보였다. 발생시기는 CAPD 시작 후 7.3±11.7주 (2일-7개월)였는데, 60% (3예)가 CAPD 시작 후 2주 이내에 발생하였다. 5예 중에서 3예는 복막액이 혼탁하였고, 그 중 1예는 심한 복통이 동반되었다. 말초 혈액의 호산구증가증이 80% (4예)에서 동반되었다. 호산구성 복막염이 특별한 치료없이 호전된 것은 80%(4예)였으며, 심한 복통이 있었던 1예는 prednisolone을 경구투여하여 치료하였다. 호산구성 복막염의 지속기간은 2.8±1.3일 (1-4)이었다. 모든 대상 환자를 호산구성 복막염이 발생한 군과 발생하지 않은 군으로 나누어 비교하였을 때, 나이, 성별, 원인 신질환, 세균성 복막염, 기존의 헤파린 또는 항생제 사용, 복막투석액내의 적혈구, 알레르기 병력, 사용한 투석액 종류 등은 두 군 간에 유의한 차이가 없었다 (p>0.05). 두 군 사이에 유의한 차이를 보인 것은 말초혈액의 호산구증가증이었다 (80.0& vs, 15.8%, p=0.0027). 결론 : CAPD 환자에서 호산구성 복막염은 흔하지 않은 질환으로서, 대부분 CAPD를 시작한지 2주 이내에 발생하여 2.8±1.3일 정도 지속된 후에 저절로 호전이 되었다. 그러나, 일부는 복막액 혼탁과 복통 등 세균성 복막염과 비슷한 증상을 나타내었고 증상이 심한 경우에는 prednisolone 치료가 필요하였다. 호산구성 복막염의 예측인자는 말초혈액의 호산구증가증이었다. Background : The clinical characteristics and significance of peritoneal fluid eosinophilia (PFE) in patients on continuous ambulatory peritoneal dialysis (CAPD) in Korea were uncertain. The present study was performed to clarify the clinical characteristics of PFE in our CAPD patients. Methods : Between January 2000 and December 2001, we analyzed retrospectively the clinical data of 112 patients on CAPD at two renal centers. Results : The mean period of the observation was 12.6±6.7 months, and the total number of peritoneal effluent sampling was 1,024 (10.5/patient-year). PFE was found in 4.4% of patients. The incidence of PFE was 4.25 per 100 patients/year. Sixty percent of patients with PFE experienced within 2 weeks of initiatuon of dialysis. The duration of PFE episode varied from 1 to 4 days with the mean value of 2.8 days. All PFE episodes except one patient with abdominal pain treated by oral prednisolone had no symptoms and was spontaneously resolved. The only distinction between the patients with PFE and those without was concomitant peripheral blood eosinophilia (80.0% vs. 15.8%, p=0.0027). Other factors such as age, sex, primary renal disease, bacterial peritonitis, peritoneal fluid, and allergic history were not significantly different between the two groups. Conclusion : The majority of PFE episode in CAPD patients developed within 2 weeks of initiation of dialysis and spontaneously resolved without treatment. Peripheral blood eosinophilia was a good predictor of PFE.

투석치료와 잔여신기능이 만성 신부전 환자의 후각기능에 미치는 영향

조영일(Young Il Jo),신석균(Sug Kyun Shin),김진국(Jin Kook Kim),김성렬(Seong Ryol Kim),이해운(Hae Woon Lee),이준상(Joon Sang Lee),강동구(Dong Koo Kang),송종오(Jong Oh Song) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.5

목 적 : 만성 신부전 환자에서 신기능 감소에 따른 후각장애는 심각한 영양장애를 유발할 수 있다. 저자들은 만성 신부전 환자에서 후각기능에 영향을 주는 요인과 적절한 투석치료가 이러한 후각장애에 어떤 영향을 미치는지에 대해서 알아보고자 하였다. 방 법 : 혈액투석을 시행 중인 환자 (HD군) 28명, 복막투석을 시행 중인 환자 (PD군) 22명, 투석치료를 시행하지 않는 만성 신부전 환자 (pre-dialysis관) 20명, 그리고 신기능이 정상인 자원자 (control군) 20명을 대상으로 하였다 CC-SIT (1?-item Cross-Cultural Smell Identification Test) 키트를 이용한 후각기능 검사를 시행하였고, Ccr, Kru, URR, Kt/V_urea, total Kt/V 등의 인자와 후각기능과의 상관관계를 평가하였다. 결 과 : Pre-dialysis군의 CC-SIT 점수는 대조군에 비해 유의하게 낮았으며 (p=0.01), HD군 및 PD군은 대조군과 유의한 차이가 없었다 (p=0.28). 혈액투석 전과 후의 CC-SfT 점수는 차이가 없었다. HD군에서는 total Kt/V와 CC-SIT 점수사이에 상관관계를 보였으며 (r=0.,39, p=0.03), HD군 및 PD군에서 Kt/V_urea, URR 및 Kru와 CC-SIT 점수 사이에는 상관성이 없었다 (p>0.05). 만성 신부전 환자에서 후각기능에 영향을 주는 인자는 total Kt/V와 Ccr 이었는데, total Kt/V는 HD군에서만 CC-SIT 점수와 양의 상관관계를 보였고, Ccr은 pre-dialysis군과 대조군에서만 CC-SIT 점수와 양의 상관성을 보였다 (r=0.58, p=0.0001). 연령은 대조군에서만 CC-SIT 점수와 음의 상관성을 보였다 (r=-0.76, p=0.0001). BUN, 혈청 Cr 농초, 혜모글로빈, 혈청 알부민 농도, nPCR, i-PTH, 성별, 원인 신질환, 투석기간 둥은 모든 군에서 CC-SIT 점수와 유의한 상관성이 관찰되지 않았다 (p>0.05). 결 론 : 만성 신부전 환자에서 후각기능은 신기능이 감소함에 따라 저하되며, 적절한 투석치료를 시행하는 환자에서는 후각기능이 정상 대조군의 수준으로 개선된다. 만성 신부전 환자에서 후각기능에 영향을 주는 인자는 비투석군에서는 Ccr, 혈액투석군에서는 total Kt/V이다. Purpose : The object of the present study were to clarify the effect of dialysis treatment and residual renal function on olfactory function of patients with chronic renal failure and to assess the correlations between the Cross Cultural Smell Identification Test (CC-SIT) scores and various clinical variables. Methods : Ninety subjects were studied and divided four groups; age- and sex-matched healthy controls (Control, n=20), patients with varying degree of renal insufficiency but not on dialysis (Predialysis, n=20), patients on CAPD (PD, n=22), and patients on hemodialysis (HD, n=28). We performed olfactory function test using the CC-SIT kit and compared the CC-SIT scores of each of the groups. Results : The CC-SIT scores of each of the groups were; Control : 8.6±1.5, Pre-dialysis : 7.2±2.0, PD:8.1±1.2, HD:8.5±1.4. In Pre-dialysis group, the CC-SIT scores were significantly lower than Control group (p=0.01). But, no significant difference was observed in the CC-SIT scores between HD and PD group and control group (p>0.05). Creatinine clearance was positively correlated with the CC-SIT scores in control and Pre-dialysis group (r=0.58, p= 0.0001). Total Kt/V was positively correlated with the CC-SIT scores only in HD group (r=0.39, p0.03). But, no correlation was found between Kt/ V_urea, URR or residual renal function and the CC-SIT scores in HD and PD group (p>0.05). Age was negatively correlated with the CC-SIT scores only in Control group (r=-0.76, p=0.0001). Conclusion : Our results indicate that smell disturbance in patients with chronic renal faliure can be recovered by adequate dialysis treatment.

지속성 외래 복막투석 환자에서 발생한 반코마이신 내성 장구균 복막염에 대한 리네졸리드 (Linezolid)치료 경험

유동은 ( Dong Eun Yoo ),김민경 ( Min Kyeung Kim ),허애정 ( Ae Jung Huh ),김영아 ( Young Ah Kim ),강이화 ( Ea Wha Kang ),유태현 ( Tae Hyun Yoo ),신석균 ( Sug Kyun Shin ) 대한신장학회 2007 Kidney Research and Clinical Practice Vol.26 No.2

Peritonitis is one of the major complications of CAPD (continuous ambulatory peritoneal dialysis). Among its causative organisms, vancomycin-resistant enterococcus (VRE) is rare, but serious causative organism, because it is refractory to antibiotics commonly used for CAPD peritonitis. Some drugs such as linezolid and dalfopristin have been introduced for VRE infections nowadays, but reports about usefulness of those drugs in VRE peritonitis are rare. We experienced a case of CAPD peritonitis caused by VRE, which was treated successfully with removal of CAPD catheter and use of linezolid. We report our experience with review of the literature.

투석 : 국내 혈액투석여과요법의 현황

김양욱 ( Yang Wook Kim ),신기호 ( Ki Ho Shin ),문광백 ( Kwang Baek Moon ),신석균 ( Sug Kyun Shin ),김현철 ( Hyun Chul Kim ) 대한신장학회 2008 춘계학술대회 초록집 Vol.28 No.1