Why should we focus on high-volume hemodiafiltration?

( Sug-Kyun Shin ),( Young-Il Jo ) 대한신장학회 2022 Kidney Research and Clinical Practice Vol.41 No.6

Though noticeable technological advances related to hemodialysis (HD) have been made, unfortunately, the survival rate of dialysis patients has yet to improve significantly. However, recent research findings reveal that online hemodiafiltration (HDF) significantly improves patient survival in comparison to conventional HD. Accordingly, the number of patients receiving online HDF is increasing. Although the mechanism driving the benefit has not yet been fully elucidated, survival advantages are mainly related to the lowering of cardiovascular mortality. High cardiovascular mortality among HD patients is seemingly attributable to the cardiovascular changes that occur in response to renal dysfunction and the HD-induced myocardial stress and injury, and online HDF appears to improve such secondary cardiovascular changes. Interestingly, patient survival improves only if the convection volume is supplied sufficiently over a certain level during online HDF treatment. In other words, survival improvement from online HDF is related to convection volume. Therefore, there is a growing interest in high-volume HDF in terms of improving the survival rate. The survival improvement will require a minimum convection volume of 23 L or more per 4-hour session for postdilution HDF. To obtain an optimal high convection volume in online HDF, several factors, such as the treatment time, blood flow rate, filtration fraction, and dialyzer, need to be considered. High-volume HDF can be performed easily and safely in routine clinical practice. Therefore, when the required equipment is available, performing high-volume HDF will help to improve the survival rate of dialysis patients.

C-reactive Protein and Neointimal Hyperplasia in Hemodialysis PTFE Graft

( Sug Kyun Shin ),( Tadashi Kuji ),( Takahisa Masaki ),( John K Leypoldt ),( Alfred K Cheung ) 대한신장학회 2005 추계학술대회 초록집 Vol.24 No.2

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 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.

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.

지속성 외래 복막투석 환자에서 저칼슘 복막투석액의 임상적 유용성

한대석,강신욱,최규헌,이호영,신석균,노현진 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.5

Hypercalcemia is a common complication in CAPD patients treated with calcium-containing phosphate binders and using the standard dialysate(SCD) calcium concentration of 3.5mEq/L. We performed a retrospective study in 25 CAPD patients to determine whether a low calcium dialysate(LCD) containing 2.5mEq/L calcium would reduce the incidence of hypercalemia with adequate control of serum inorganic phosphate levels and diminish the need to use aluminum-containing phosphate binders. All patients had previously used SCD before converting to LCD. The incidence of hypercalcemia(more than 2 episodes of corrected serum calcium?10.5mg/dL) tended to be lower after converting to LCD?0.27 (0-2.76) vs. 0(0-1.97) episodes/patient-year?. Intact PTH level increased from 38.8(0.1-1599.3)pg/mL to 70.6(9.5-1540.0)pg/mL after conversion, but there was no statistical sifnificance. Serum calcium, inorganic phosphate, alkaline phosphatase and bicarbonate levels did not change after converting to LCD. We were able to reduce aluminum roxide dosage〔1.09 (0-10.88) vs. 0(0-3.26)g/day/patient〕and increase calcium carbonate dosage(1.95-+0.92 vs. 2.98-+2.14g/day/ patient) after conversion significantly(P$lt;0.05). The frequency of peritonitis was similar in LCD and SCD period. In conclusion, low calcium dialysate is useful in diminishing aluminum-containing phosphate binder dosage and increasing calcium carbonate dosage to maintain a similar phosphate value. Its effects on renal osteodystrophy remain to be assessed.

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.

A randomized crossover study of single biweekly administration of epoetin-α compared with darbepoetin-α in chronic kidney disease patients not receiving dialysis

( Ha Young Na ),( Yong Kyu Lee ),( Sug Kyun Shin ),( Dong Ho Yang ),( Woong Cheon ),( Jung Hwan Park ),( Jong Ho Lee ),( Jong Oh Song ),( Young Il Jo ) 대한신장학회 2014 Kidney Research and Clinical Practice Vol.33 No.4

Background: Recent evidence demonstrates that high doses of epoetin-alpha(EPO-α) can be administrated at extended intervals, despite its relatively shortserum half-life. However, no prospective randomized trials on the effects ofextended dosing intervals of EPO-α compared with darbepoetin-alpha (DA-α) havebeen performed. This study was designed to investigate whether a single biweekly(Q2W) administration of a high dose of EPO-α is as effective as DA-α for anemia inchronic kidney disease (CKD) patients not receiving dialysis. Methods: Sixty non-dialysis CKD patients were equally randomized to either Q2Wsubcutaneous EPO-α (10,000 unit) or DA-α (50 μg) therapy groups for the first6 weeks. After a 6-week washout period, the participants of the EPO-α and DA-αtreatment groups switched to the alternate regimen for 6 weeks. The meanhemoglobin (Hb) levels after erythropoiesis stimulating agent (ESA) therapy andpercentage change in Hb levels from baseline to the end of the study were analyzed. Results: The mean Hb levels of postESA therapy increased significantly comparedwith those of preESA therapy in both ESA regimens. The percentage increase in Hblevels and erythropoietin resistance index did not show a significant differencebetween the different ESA regimens. No difference was observed between theregimens regarding mean Hb levels after ESA therapy. Additionally, there were noserious adverse effects leading to withdrawal from treatment. Conclusion: Biweekly high doses of EPO-α therapy may be equally as effective asQ2W DA-α therapy in maintaining target Hb levels in non-dialysis CKD patients.

광주광역시 미술관 건축의 입지요소에 관한 조사연구 : 전문가와 일반인 두 집단을 대상으로 a comparison between the professionals and the public

윤대한,이현정,신석균 대한건축학회 2001 대한건축학회 학술발표대회 논문집 - 계획계/구조계 Vol.21 No.1

Art Museums have been drawn more attention on their public role as an institution to promote arts and culture and educate the public. From the perspective that the mass public should use art museums, the location of art museums is decided after a careful consideration on the opinions both from the art professionals and the public as well. This study extracted 12 factors for locating new art museums; the characteristics of museum, the surrounding environments, the accessibility, the relation to other cultural institutions, the impact on urban planning, the impact on local development, the level of recognition of place, the image of place, the size of museum, the management/administration of museum, the potential of future extension, the level of difficulty of realization. The study, then, conducted questionnaire surveys on two groups, the art professionals and the public. The data gathered from the surveys was analyzed by SPSS to examine the relationships between museum-locating factors and the comparison between the two groups.