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진동찬 대한의사협회 2013 대한의사협회지 Vol.56 No.7
The Korean Society of Nephrology (KSN) launched the End-Stage Renal Disease (ESRD)Patient Registry in 1985, and the online internet registry program was begun in 2001. The increasing number of elderly people and diabetic patients in Korea has resulted in a very rapid increase in the number of ESRD patients. The total number of dialysis patients was 50,289:42,596 receiving hemodialysis (HD) and 7,694 receiving peritoneal dialysis (PD) at the end of 2011. The prevalence of dialysis therapy was 972.4 patients per million population (PMP), and the proportion of dialysis therapy was HD: 84.7% and PD: 15.3%. The primary causes of ESRD were diabetic nephropathy (47.1%), hypertensive nephrosclerosis (19.6%), and chronic glomerulonephritis (10.4%). The mean urea reduction ratio of hemodialysis was 68.11% in male HD patients and 74.09% in female HD patients. The mean Kt/V was 1.395 in male patients and 1.660 in female patients. The most common cause of death was cardiac arrest (26%), followed by sepsis (9.7%), cerebro-vascular accident (8.7%), respiratory infection (8.4%), and myocardial infarction (6.6%), respectively. The five-year survival rates of male and female dialysis patients were 65.3%and 68.0% in Korea.
Current Status of Dialysis Therapy in Korea
진동찬 대한내과학회 2011 The Korean Journal of Internal Medicine Vol.26 No.2
The number of patients with end-stage renal disease (ESRD) i with diabetes increases in Korea. ESRD Registry Committee of t therapy data in Korea through an online registry program on the Korea at the end of 2009 was as follows. First, total number of pa peritoneal dialysis [PD], 7,618; functioning kidney transplant [KT per million population (PMP). Proportion of patients undergoing re PD, and 20.2% with KT. Second, a total of 8,906 (HD, 6,540; PD developed ESRD in 2009. Third, the most common primary cau tensive nephrosclerosis (18.3%), and chronic glomerulonephritis 73.8% in male and female patients, respectively, undergoing HD patients. Fifth, the overall 5-year survival rate of male patients un was 67.4%.
진동찬,박철휘,윤선애,김인식,차상복,선희식,김부성 대한내과학회 1990 대한내과학회지 Vol.38 No.4
One of the significant complications of acute pancreatitis is pancreatic phlegmon, which is defined as "a solid mass of indurated pancreas and adjacent retroperitoneal tissue due to edema, infiltration by inflammatory cells and tissue necrosis." Pancreatic phlegmon can usually be resolved in a few weeks by nonsurgical conservative therapy. However, it is clinically important to differentiate pancreatic phlegmon from pseudocysts and abscesses, which do need surgical intervention. We recently experienced a pancreatic phlegmon patient, a 56-year-old alcoholic male, whose mass measured 24×16×22㎝ by CT and was resolved with conservative management.
건강보험심사평가원의 혈액투석 적정성 평가와 연관된 진료 변화 분석
진동찬,신영신,김묘정,강미연,원은미,양기화 대한내과학회 2018 대한내과학회지 Vol.93 No.2
Background/Aims: The appropriateness assessment of hemodialysis therapy by Korean Health Insurance Review & Assessment service was conducted five times. The purpose of this study was to analyze the effect of the appropriateness assessment on the clinical hemodialysis treatment through the analysis of the medical expenses. Methods: The medical insurance claims during the three months before and after the second, third, and fourth appropriateness assessment and the patient survival rate were analyzed according to the appropriateness rating level. Results: The medical costs per patient during the three months before and after the assessment period were 6 to 8% lower than that of the assessment period. The medication cost (drug fee) was the best part of the evaluation because the cost differences according to the appropriateness rating grade were obvious. In addition, the cost of erythropoietin gradually decreased over each evaluation period, but there was no cost decrease in other drugs and the diabetic drug was even slightly increased. Patient survival rate according to the appropriateness rating grade was not large, but grade 2 was the best which was followed by grade 1 and grade 3, 4, and 5 were almost the same. Patient survival rate according to the appropriateness rating grade was not significant. Conclusions: The variation of medical costs associated with the assessment implicates the necessity of all year-round assessment. In addition, drug costs among the medical expenses seem to be the best reflected part of the evaluation grade because of the difference in grade of appropriateness assessment. 목적: 건강보험심상평가원의 혈액투석 적정성 평가가 5차례 시행되었으며 이 평가가 임상적 혈액투석 시행에 매우 큰영향을 주어 투석 치료가 질적 향상을 이루고 있다고 보이며향후 가감 지급의 적용을 계획하고 있다. 이 적정성 평가가임상투석 진료에 미친 영향을 의료비의 객관적 분석을 통하여 말기 신부전 환자 관리에 어떤 영향을 미쳤는지를 분석하였다. 방법: 건강보험심사평가원의 혈액투석 적정성 평가 기간 및 평가 기간 전후 3개월의 진료 비용을 2차(2010년), 3차(2012년), 4차(2014년) 적정성 평가를 대상으로 각 의료비용을 분석하고 적정성 평가 등급에 따른 의료 내용을 비교하고 환자 생존율을 분석하였다. 또한 동정맥루 관리 관련 지표와 연계하여 동정맥루의 합병증 발생에 의한 시술의변화를 분석하였다. 결과: 환자 당 의료 비용의 차이는 평가 전, 후 3개월 평균이 평가 기간에 비하여 6-8% 적어 적정성 평가 기간의 의료비용이 높았으며 이는 3차례 평가 기간 모두 비슷한 모양을보였다. 혈액투석 전체 비용 중 투석비와 투석액의 고정 비용이 약 80%이고 약제비는 혈액투석 적정성 평가의 등급별차이가 뚜렷하여 평가의 등급이 가장 잘 반영된 부분으로 판단된다. 또한 조혈제 비용은 각 평가 기간에 걸쳐 차차 감소하였으나 다른 약제의 감소는 없었으며 당뇨병 약제는 약간증가하였다. 검사실 검사와 영상의학적 검사는 3, 6, 9, 12월로 검사가 집중되는 형태를 보여 월별 편차가 심하다. 그리고 혈관성형술 전체 건수가 매우 빠른 속도로 증가하고 있으나 상대적으로 동정맥루 수술 건수는 많이 증가하지 않으므로 동정맥루 감시프로그램에 의하여 조기 혈관성형술로 유지하는 효과로 보인다. 적정성 평가 등급에 따른 환자 생존율을 보면 등급별 차이는 크지 않으나 2등급이 가장 좋으며이어서 1등급이고 3, 4, 5등급은 거의 같다. 결론: 건강보험심사평가원의 혈액투석 적정성 평가 기간전후의 진료 비용을 분석하여 환자 당 의료 비용의 차이는평가 전, 후 3개월 평균이 평가 기간에 비하여 6-8% 적음을확인하였으며 이는 지속적인 평가가 필요함을 보여준다. 또한 진료 비용 중 약제비는 혈액투석 적정성 평가의 등급별차이가 뚜렷하여 평가의 등급이 가장 잘 반영된 부분으로 보인다.