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투석환자에서 C-reactive protein과 심혈관계 질환의 발생과의 관계
이균상 ( Kyun Sang Lee ),이연경 ( Youn Kyoung Lee ),박병석 ( Byoung Seok Park ),정택균 ( Taek Kyun Jeong ),정균호 ( Gyun Ho Jeong ),마성권 ( Seong Kwon Ma ),김수완 ( Soo Wan Kim ),김남호 ( Nam Ho Kim ),최기철 ( Ki Chul Choi ) 대한내과학회 2002 대한내과학회지 Vol.63 No.6
Background: Atherosclerosis, a major problem in patients undergoing chronic dialysis treatment, has been characterized as an inflammatory disease. Cardiovascular disease is the major cause of mortality, accouting for approximately half of all deaths in th
지속성 외래 복막투석 환자에서 영양상태와 투석의 적절도
박미정(Mi Jung Park),이균상(Kyun Sang Lee),조민석(Min Seok Cho),김정기(Jeong Ki Kim),박병석(Byoung Seok Park),마성권(Seong Kwon Ma),고정희(Jung Hee Ko),나명윤(Myong Yun Nah),염충호(chung Ho Yeum),정권(Jung Gwon),김수완(Soo Wan Kim) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4
Purpose - Malnutrition is common in CAPD patients and depends on many factors such as dialysis-related and nondialysis-related factors. The present study aimed to assess nutritional status, dialysis adequacy and their relationships with overall mortality and morbidity. Methods - We studied 102 patients who had been receiving CAPD for at least 6 months. Dialysis adequacy was assessed by parameters derived from urea kinetic modeling(UKM) and nutritional status was assessed by serum biochemical measurement, normalized protein catabolic rate(nPCR), normalized protein equvalent of total nitrogen appearance(nPNA) and urea kinetic studies. Spearman's simple correlation and multiple linear stepwise regression analysis were used to assess correlation between dialysis adequacy and nutritional status in CAPD patients. We compared the differences between patients who suffered morbid events, defined as either an infectious complication or hospitalization, and patients who remained well. Results : The results showed that the total dialysis dose(total weekly Kt/Vurea ) has statistically significant correlation with nPCR(r=0.234, p=0.028), nPNA (r=0.246, p=0.021), total weekly creatinine clearance (WCC)(r=0.479, p=0.0001), serum albumin levels(r= 0.233, p=0.029), serum cholesterol(r=0.266, p=0.013), serum BUN(r=-0.290, p=0.006) and serum creatinine levels(r=-0408, p-0.0001). nPNA was positively correlated with serum cholesterol(r=0.217, p=0.045), serum transferrin(r=0.218, p=0.042) and serum ferritin levels(r=0.220, p=0.043). Patients who suffered morbid events had an old age(p=0.001), long duration of CAPD(p=0.0001), higher CRP(p=0.021), lower serum albumin level(p=0.020), lower hematocrit(p=0.049) and lower WCC(p=0.017). Conclusions: These results indicate that adequate dialysis is very important for the maintenance of adequant nutrition because nutritional status positively correlated with dialysis dose, which is best assessed by UKM. In addition, assessment of nutritional status and dialysis adequacy are important in predicting clinical outcomes in CAPD patients.
박미정(Mi Jung Park),이균상(Kyun Sang Lee),조민석(Min Seok Cho),김정기(Jeong Ki Kim),박병석(Byoung Seok Park),마성권(Seong Kwon Ma),고정희(Jung Hee Ko),나명윤(Myong Yun Nah),염충호(chung Ho Yeum),김수완(Soo Wan Kim),김남호(Nam Ho Kim 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.4
Objective : It has been reported that hyperhomocysteinemia is an independent risk factor for atherosclerotic complications, although the mechanisms re- main unclear. The major determinents of total fasting plasma homocysteine(tHcy) concentrations have been recently reported but there are still conflicting data on the influence of those in peritoneal and hemodialysis patients. Therefore, we evaluated the prevalence and association of vascular complications and the determinents of hyperhomocysteinemia in chronic renal failure patients receiving conservative treatment(predialysis), peritoneal dialysis(PD) and hemodia-lysis (HD) patients. Methods We measured the factors, including fasting plasma vitamine levels(folate, vitamin E4 and vitamin B12), serum creatinine concentration, dialysis adequacy-related varibles as well as associated risk factors for vascular diseases that might affect tHcy concentrations in 37 predilysis, 30 PD, 34 HD patients and 21 normal persons. Continuous variables were compared using independent sample t-test. Spearman's correlation was used to determine the strength of association between tHcy and other predictive varia41es. Percentages were compared using Pearson's chi-square test or Fisher's exact test, depending on the frequencies. Independent determinents of tHcy concentration and atherosclerotic vascular complications were identified using multiple regression analysis. Results : The prevalence of hyperhomocysteinemia was 83.8, 72, 88% among predialysis, PD and HD patients, respectively(Odds ratio was 103.33, 81.43, 150.0 vs. controls, respectively). tHcy values in pre- dialysis, PD and HD patients are significantly higher than those in controls(24.68±9.01, 21.04±8.82, 23.62± 9.46 vs. 8.80±2.07 ㎛oL/L, repectively, p<0.01). Pre- dialysis, PD and HD patients with atherosclerotic vascular complications had higher tHcy concentrations than did predialysis, PD and HD patients with- out vascular complications(21.93±8.71 vs. 32.09±4.71 ㎛oL/L, p<0.01, 17.57±5.85 vs. 28.74±9.70 ㎛oL/L, p<0.01, 19.00±4.29 vs. 33.28±10.13, p<0.01 respectively). We also observed increasing odds ratios of vascular events with increasing tHcy concentrations. For predialysis, PD and HD patients, fasting plasma folate level had negative correlation with tHcy concentrations by spearman's simple correlaltion. And using muliple regression analysis, we recognized hyperhomocysteinemia is an independent risk factor for atherosclerosis and fasting plasma folate is a major determinent of tHcy concentrations in predialysis, PD and HD patients. Conclusions: Hyperhomocysteinemia in predialysis, PD and HD patients was more prevalent than that in norrnal controls. Risk of atherosclerotic vascular complications increased with increasing tHcy concentrations. Hyperhomocysteinemia is an independent risk factor for atherosclerosis and fasting plasma folate is a major determinent of tHcy concentrations in predialysis, PD and HD patients.
지속성 외래 복막투석 환자에서 혈청 부갑상선호르몬 마그네슘 치의 관계
조민석(Min Seok Cho),이균상(Kyun Sang Lee),이연경(Youn Kyoung Lee),마성권(Seong Kwon Ma),고정희(Jeong Hee Ko),김수완(Soo Wan Kim),김남호(Nam Ho Kim),최기철(Ki Chul Choi) 대한내과학회 2001 대한내과학회지 Vol.61 No.5
Background : One of the most common complications in patients with end stage renal disease is renal osteodystrophy and parathyroid hormone (PTH) plays a key role in the pathogenesis of renal osteodystr ophy. It is known that patients undergoing CAPD (continuous ambulatory peritoneal dialysis ) have increased risk of low turnover bone disease and relative hypoparathyroidism is related to its pathogenesis. Fact or srelated to relative hypoparathyroidism are increased in extracellular calcium level, accumulation of aluminum, vitamin D treatment, good control of serum phosphate, diabetes mellitus, and old age. Recently it has been believed that magnesium plays an import ant role in regulating secretion of PTH. The aim of this study was to evaluate the relationship between serum PTH and serum magnesium as a factor increasing the frequency of relative hypoparathyroidism. Methods : Author studied 56 patients who had undergone CAPD for more than 6 months without any significant problems and had been followed by Chonnam National University Hospital. No patient had been previously treated with vitamin D or aluminum hydroxide. The patients had used peritoneal dialysate with the magnesium concentration of 0.5 mEq/ L. Biochemical parameters were checked. Results : 1. The mean serum magnesium level was 1.99 ±0.36 mEq/ L. Among total 56 patients, 15 patients (26.8%) showed hypermagnesemia (serum magnesium > 2.2 mEq/ L), and 5 patients (8.9%) showed hypomagnesemia (serum magnesium < 1.6 mEq/ L) 2. On all 56 patients, serum Ipth level was not correlated with serum magnesium level. But, it was inversely correlated with serum total calcium and ionized calcium levels, respectively (r =- 0.365, p =0.006; r =- 0.515 p <0.001). 3. Among the 49 patients whose serum Ipth level was less than 300 pg/ Ml, serum Ipth level was inversely correlated with serum magnesium level (r =- 0.295, p =0.039), and inversely correlated with serum total calcium and ionized calcium levels, respectively (r =- 0.546, p <0.001; r =- 0.572 p <0.001). 4. Among the 49 patient s whose serum Ipth level was less than 300 pg/ Ml, lower Ipth group (serum Ipth<120 pg/ Ml) showed higher serum magnesium level (p =0.037), higher serum total calcium level (p <0.001), and lower bone isoenzyme of alkaline phosphatase level (p <0.001) than those of higher Ipth group (120 pg/ Ml serum ≤Ipth<300 pg/ Ml). Conclusion : Among the CAPD patient s whose serum Ipth level was less than 300 pg/ Ml, there was a significantly inverse correlation between serum Ipth level and serum magnesium level. This study indicates that not only serum calcium level, but also serum magnesium level are import ant in the regulation of serum Ipth levels of CAPD patients who have been dialyzed by low-magnesium peritoneal dialysate.(Korean J Med 61:527- 536, 2001)
김여경(Yeo Kyeoung Kim),이연경(Youn Kyoung Lee),이균상(Kyun Sang Lee),조민석(Min Seok Cho),정택균(Taek Kyun Jeong),박병석(Byoung Seok Park),정균호(Gyun Ho Jeong),마성권(Seong Kwon Ma),김수완(Soo Wan Kim),김남호(Nam Ho Kim),최기철(Ki 대한내과학회 2002 대한내과학회지 Vol.63 No.3
Background : Cardiovascular disease (CVD) after kidney transplantation is a major cause of both graft loss and patient death in kidney transplant recipeints. There are several well known risk factors of CVD, such as hyperlipidemia, hypertension, diabetes melitus, old age and smoking. Non-classic risk factors are acute rejection episode, LVH, C-reactive protein and hyperhomocysteinemia. Homocysteine is an amino acid filtered through the glomerulus and hyperhomocysteinemia is considered as a risk factor of CVD in end-stage renal disease (ESRD) and kidney transplant patients. So homocysteine lowering trials, such as folic acid and vitamine supplement therapy, are being made. We evaluated the prevelance and determinants of hyperhomocysteinemia in kidney transplant recipients. Methods : We measured serum total homocysteine concentration (tHcy) and its determinants in 21 normal persons, 37 chronic renal failure (CRF) patients with conservative treatment (predialysis) and 48 kidney transplant patients. Results : The prevalence of hyperhomocysteinemia was 4.8%, 83.8% and 45.8% among normal persons, predialysis and kidney tranplant patients, respectively. Among the kidney transplant recipients the prevelence of hyperhomocysteinemia was 18.8% in normal renal function (serum creatitine concentration male: below 1.2 mg/dL, female: below 1.1 mg/dL) group and 59.4% in abnormal renal function group. The tHcy values in kidney transplant patients are significantly lower than those in predialysis patients (16.38±6.48 μmol/L vs. 24.68±9.01 μmol/L, p<0.01), but higher than those in normal persons (16.38±6.48 μmol/L vs. 8.80±2.07 μmol/L, p<0.01). Among the kidney transplant recipients the tHcy values in normal creatinine group are significantly lower than those in abnormal creatinine group (12.02±3.68 μmol/L vs. 18.57±6.51 μmol/L, p<0.01). Using muliple regression analysis, this study showed increased serum creatinine concentration is a major determinant of tHcy concentrations in kidney transplant recipients and hyperhomocysteinemia is not correlated with whole blood trough level of cyclosporin (mean 126.26±62.19 ng/mL, range: 26∼322 ng/mL) or vitamines supplement therapy. Conclusion : In this study the serum homocysteine values in kidney transplant recipients were higher than in normal control group but significantly lower than in CRF patients with conservative treatment. The major determinant for serum homocysteine concentration is a serum creatinine concentration.(Korean J Med 63:306-313, 2002)