통상적인 투석처방을 받는 혈액투석 환자에서 실제 투석량에 영향을 미치는 인자의 분석

김연선 ( Yeun Sun Kim ),이현희 ( Hyun Hee Lee ),이종호 ( Jong Ho Lee ),김은수 ( Eun Soo Kim ),진경순 ( Kyoung Soon Jin ),김정곤 ( Jung Gon Kim ),유승민 ( Seung Min Yoo ),이준승 ( Joon Seung Lee ),정우경 ( Woo Kyung Chung ),주권욱 대한내과학회 2005 대한내과학회지 Vol.69 No.5

목적 : 적절한 혈액투석의 평가에 요소역동학을 이용한 Kt/V지표가 사용되나 일부 환자에서는 적절한 Kt/V값을 유지하지 못하여 이로 인한 임상적 문제가 발생할 수 있다. 저자들은 통상적인 주 3회, 회당 4시간의 혈액투석을 처방받는 환자에서 처방된 투석량과 전달된 투석량을 조사하고, 부적절한 투석량 전달에 미치는 요인을 분석하고자 하였다. 방법 : 안정된 상태로 투석 중인 97명의 만성신부전 환자를 대상으로 처방된 투석량은 Kt/V공식에서 K값으로 in vitro 요소청소율을 V값으로 Watson 식을 이용한 요소분포용적을 구하여 계산하였고, 전달된 투석량은 Daugirdas의 single pool, variable volume공식을 사용하여 계산하였다. 또, 전달된 투석량에 영향을 줄 수 있는 기술적, 임상적 인자들별로 전달된 투석량의 차이를 분석하였다. 결과 : 처방된 투석량의 평균은 1.37±0.21, 전달된 투석량의 평균은 1.23±0.27로 양의 상관관계는 있었으나 유의한 차이를 보였다(p<0.03). 전달된 투석량이 1.2 미만인 군은 45%였고, 이 군은 체중이 높았으며, 투석 처방량이 낮았다. ΔKt/V값은 헤파린을 사용한 군에서 사용하지 않은 군에 비해 유의하게 낮았으며(0.11±0.16 vs. 0.28±0.20, p<0.002), 저혈압, 투석 중 증상, 투석시간의 단축, 재순환율 등의 인자에 따른 차이는 보이지 않았다. 결론 : 통상적인 투석 처방으로 혈액투석 중인 환자에서 체중, 투석 처방량, 헤파린 사용 여부 등의 인자들이 투석의 적절도에 영향을 줄 수 있으므로 환자에 따른 개별적 처방이 필요함을 알 수 있었다. Background : Although adequate removal of small solutes are essential for effective hemodialysis, many patients are suffering from inadequate delivery of hemodialysis, especially with the conventional fixed regimen of dialysis for 4 hours three times per week. We tried to evaluate actual delivered dose of hemodialysis in patients receiving 4 hours of low-flux hemodialysis, and to analyze factors affecting inadequate delivery of hemodialysis. Methods : 97 stable maintenance hemodialysis patients who were undergoing 4 hours of hemodialysis thrice weekly were included for analysis. Prescribed dose of dialysis was calculated by Kt/V where K was in vitro urea clearance of dialyzer membrane and V was estimated according to the Watson`s formula. Delivered dose of dialysis was calculated according to the Daugirdas equation. To find factors that may impair adequate delivery of hemodialysis, various clinical and technical parameters were analyzed. Results : Prescribed dose of hemodialysis was 1.37±0.21, while delivered dose was 1.23±0.27, and thus, there was a significant difference (p<0.03). In 45% of the patients, delivered dose was less than 1.2. They were heavier and prescribed dose was low. ΔKt/V (Prescribed dose-Delivered dose) was significantly greater in patients who did not use heparin therapy compared to patients who used heparin. Other parameters such as hypotension, missed treatment, sex, type of vascular access and degree of recirculation were not associated with impaired delivery of hemodialysis. Conclusions : Delivered dose of hemodialysis can be affected by patient`s body weight, prescribed dose and heparin use in conventional low-flux hemodilaysis regimen. Therefore, each patient should be prescribed individually for adequate delivery of hemodialysis, and delivered dose should be measured regularly.(Korean J Med 69:510-517, 2005)

의료보장 형태가 혈액투석 서비스 제공에 미치는 영향에 대한 다수준 분석

정진희,권순만,김경훈,이선경,김동숙,Jung, Jin-Hee,Kwon, Soon-Man,Kim, Kyoung-Hoon,Lee, Seon-Kyoung,Kim, Dong-Sook 대한예방의학회 2010 예방의학회지 Vol.43 No.3

Objectives: This study aims to compare quality indicators for the hemodialysis services between patients with health insurance and those with medical aid. Methods: This study used data from sampled hospitals that provided a hemodialysis service. A total of 2287 patients were selected, and the information for hemodialysis service has been granted from medical record reviews. A multi-level regression analysis was used to examine the differences in process and outcome indicators for hemodialysis between patients with health insurance and those with medical aid. Process indicators were defined as: frequency of hemodialysis, hemodialysis time, erythropoietin (EPO) use, measurement of hemodialysis dose at least once a month, measurement of phosphate at least once every three months, and measurement of albumin at least once every three months. Outcome indicators were defined as: hemodialysis adequacy, anemia management, blood pressure management, and calcium, phosphate and nutrition management. The total scores for outcome indicators ranged from 0 (worst) to 4 (best). Results: There was a significant difference in the measurement of hemodialysis dose at least once a month between patients with health insurance and those with medical aid (OR 0.66, 95% CI = 0.43 - 0.99). However, frequency of hemodialysis, hemodialysis time, EPO use, measurement of phosphate at least once every three months, measurement of albumin at least once every three months, hemodialysis adequacy management, Hb${\geq}$11 g/dL, blood pressure within the range of 100-140 /60-90 mmHg, calcium x phosphate${\leq}$55 $g^2/dL^2$ and albumin${\geq}$4 g/dL were not significantly different between the groups. Conclusions: There were no significant differences in outcome indicators for hemodialysis between the groups. Further studies are warranted into the mechanism that results in no differences in the outcome indicators for hemodialysis.

황색포도알균이 가장 흔한 원인인 우리나라 4개 대학병원의 감염성심내막염의 특징

서성우,김태형,현민수,추은주,전민혁,문철,송단,김종화,이용관,최종효,전웅,조영신,최문한 대한감염학회 2008 Infection and Chemotherapy Vol.40 No.6

Background : To evaluate whether Staphylococcus aureus is actually the leading cause of infective endocarditis in Korea, investigation on updated clinical pictures, treatments, and prognosis was performed. This study also aims to describe differences in clinical characteristics of infective endocarditis in patients undergoing maintenance hemodialysis. Materials and Methods : Fifty five patients who were diagnosed with infective endocarditis, using modified Duke criteria, at 4 Soon Chun Hyang University Hospitals (located in Seoul, Bucheon, Cheonan, and Gumi) from January of 2000 to June of 2007 were enrolled. Patients were separated into two groups; those on hemodialysis and those who were not on hemodialysis (control group). Medical records and laboratory results of each patient were reviewed retrospectively. Results : The positive rate of blood culture was 72.7%. Staphylococcus aureus was isolated in 38.2% of the patients, making it the most common causative organism of infective endocarditis. It was also the most common organism in both hemodialysis group and non-hemodialysis group. Six patients (10.9%) died while admitted to the hospital and the in-hospital death rate for hemodialysis group was significantly higher. Conclusion : In most parts of the world, S. aureus is increasingly becoming the principal causative organism of infective endocarditis. To our knowledge, this is the first study that shows S. aureus to be the most common causative organism of infective endocarditis in Korea, and that Korea is not except from this global epidemiology. Background : To evaluate whether Staphylococcus aureus is actually the leading cause of infective endocarditis in Korea, investigation on updated clinical pictures, treatments, and prognosis was performed. This study also aims to describe differences in clinical characteristics of infective endocarditis in patients undergoing maintenance hemodialysis. Materials and Methods : Fifty five patients who were diagnosed with infective endocarditis, using modified Duke criteria, at 4 Soon Chun Hyang University Hospitals (located in Seoul, Bucheon, Cheonan, and Gumi) from January of 2000 to June of 2007 were enrolled. Patients were separated into two groups; those on hemodialysis and those who were not on hemodialysis (control group). Medical records and laboratory results of each patient were reviewed retrospectively. Results : The positive rate of blood culture was 72.7%. Staphylococcus aureus was isolated in 38.2% of the patients, making it the most common causative organism of infective endocarditis. It was also the most common organism in both hemodialysis group and non-hemodialysis group. Six patients (10.9%) died while admitted to the hospital and the in-hospital death rate for hemodialysis group was significantly higher. Conclusion : In most parts of the world, S. aureus is increasingly becoming the principal causative organism of infective endocarditis. To our knowledge, this is the first study that shows S. aureus to be the most common causative organism of infective endocarditis in Korea, and that Korea is not except from this global epidemiology.

당화알부민의 검사수행능력 및 혈액투석 중인 당뇨병 환자에서의 임상적 유용성

박해일,김영식,이제훈,김용구,신석준 대한진단검사의학회 2009 Annals of Laboratory Medicine Vol.29 No.5

Background : The HbA1c has been considered to underestimate glucose level in diabetic patients on hemodialysis, therefore, glycated albumin (GA) was recently introduced to assess the glycemic control for those cases. We evaluated the performance of GA assay kit of Lucica GA-L (Asahi Kasei Pharma Co., Japan) and compare it with HbA1c for estimating glucose levels. Methods : Tests for precision, linearity and interference were performed and reference interval was determined. Thirty eight of non-hemodialysis and seventy of hemodialysis patients were recruited, whose glucose levels of three-, two- and one-month prior to this study were available for calculating weighted means of glucose (WMGs). The correlation coefficients and the slopes of regression equation between WMG and HbA1c or GA were compared between two groups. Multiple linear regression analyses were used to determine significant predictor for HbA1c and GA. Results : Total CV was 2.2% at concentration of 13.7% and 2.8% at 24.6%. The dilution curve between 15.7% and 62.1% was linear. Reference intervals were 10.0% to 16.5% for male and 11.4% to 17.6% for female. The correlation coefficients between WMG and GA were 0.682-0.713 in hemodialysis and 0.640-0.677 in non-hemodialysis. Those between WMG and HbA1c were 0.568-0.625 in hemodialysis and 0.735-0.783 in non-hemodialysis. The slopes of regression equation between GA and WMG in hemodialysis were 0.080-0.090 and 0.130-0.147 in non-hemodialysis. Those between HbA1c and WMG in hemodialysis were 0.012-0.014 and 0.029-0.032 in non-hemodialysis. GA was not influenced by hemodialysis status while HbA1c was. Conclusions : The claimed performance characteristic of Lucica GA-L were verified. WMG were better reflected by GA rather than HbA1c in patients on hemodialysis. 배경 : HbA1c는 혈액투석환자에서는 혈당을 저평가하는 경 향이 있어 근래에는 당화알부민이 혈당조절지표로서 대두되고 있다. 저자들은 당화알부민 시약인 Lucica GA-L (Asahi Kasei Pharma Co., Japan)의 검사수행능을 검증하고 그것의 평균혈당 추정능을 HbA1c와 비교하고자 했다. 방법 : 정밀도와 직선성, 간섭물질에 대한 검증을 시행하고 참 고치를 설정했다. 3개월, 2개월, 1개월 전의 혈당 결과를 가진 ‘비투석군’38명과‘혈액투석군’70명에서 HbA1c와 당화알부 민을 측정하고 두 군에서 혈당 가중평균과 HbA1c 또는 당화알 부민의 상관계수와 단순선형회귀식의 기울기를 비교하였다. 단 계별 변수선택법으로 중회귀분석을 시행하여 혈액투석여부가 HbA1c와 당화알부민에 유의한 영향을 미치는지 보고자 했다. 결과 : 총변이계수는 당화알부민 13.73%에서 2.2%였고 24.62 %에서 2.8%였다. 15.74-62.09%의 농도 범위에서 직선성이 확 인되었다. 참고치는 남성에서 9.98-16.49%, 여성에서 11.35- 17.55%이었다. 혈액투석군에서의 혈당 가중평균과 HbA1c의 상관계수는 0.568-0.625이었고 비투석군에서는 0.735-0.783 이었다. 혈당 가중평균과 당화알부민의 상관계수는 혈액투석군 에서 0.682-0.713이었고 비투석군에서는 0.640-0.677이었 다. 혈액투석군에서 HbA1c와 혈당가중평균의 회귀식 기울기는 0.012-0.014로 비투석군의 0.029-0.032에 비해 약 44.0% 수 준이었고 당화알부민과 혈당가중평균의 회귀식 기울기는 혈액 투석군에서 0.080-0.090으로 비투석군에서의 0.130-0.147에 비해 약 62.0% 수준이었다. HbA1c와 당화알부민 사이의 회귀 식 기울기는 혈액투석군에서 0.119로 비투석군의 0.163에 비해 약 73.0% 수준이었다. 중회귀분석 상, 혈액투석여부가 HbA1c 에는 유의한 영향을 준 반면, 당화알부민에는 그렇지 않았다. 결론 : 당화알부민 시약 Lucica GA-L의 검사수행능은 적절 한 것으로 확인되었다. 혈액투석군에서 측정된 HbA1c는 비투 석군에 비해 혈당가중평균에 둔감하게 반응하고 혈액투석 여부 의 영향을 받으므로 혈액투석 환자에서는 HbA1c의 약점을 보 완하기 위한 당화알부민의 측정이 추천된다.

혈액투석중인 만성 신부전 환자에서 혈청 Neopterin 농도에 관한 연구

박용현(Yong Hyun Park),문경협(Kyung Hyub Hyub),박광기(Kwang Ki Park),조규웅(Kyu Woong Cho),음선홍(Sun Hong Eum),김광선(Kwang Sun Kim),최기철(Ki Chul Choi),강영준(Young Joon Kang) 대한내과학회 1990 대한내과학회지 Vol.39 No.2

N/A Neopterin is a low-molecular-weight product released by human macrophages upon stimulation with interferon gamma. It permits the quantification of the level of cellulalr immune activation in vivo. We measured the level of serum neopterin and creatinine concentrations in 20 patients before and after hemodialysis in order to test whether hemodialysis induces specific activation of the T-lymphocyte macrophage axis. The results were as follows: 1) In normal adults, the serum neopterin level was 6.7±1.3 nmol/L with no sex difference. 2) In 20 hemodialysis patients, the serum neopterin level before hemodialysis was 246.2±97.6 nmol/L and increased significantly compared to normal adults (p<0.001). 3) In 20 hemodialysis patients, the serum neopterin level was 163.0±76.7 nmol/L after hemodialysis and decreased significantly (p<0.001), the neopterin/creatinine ratio was 25.4±14.7, 32.8±23.7 before and after hemodialysis, respectively, and there was no significant difference between both groups. 4) In groups of short-term hemodialysis (less than three months), the serum neopterin level was 248.4±100.6, 181.7±91.2nmol/L before and after hemodialysis, respectively. In groups of long-term hemodialysis (more than one year), the neopterin level was 244.0±99.9, 144.2±57.6 nmol/L before and after hemodialysis, respectively, and decreased significantly after hemodialysis in both groups (p<0.001), and there was no significant difference between both groups. 5) In 12 male hemodialysis patients, the serum neopterin level was 226.4±97.6, 145.5±60.5nmol/L before and in after hemodialysis, respectively, and in eight female hemodialysis patients, the serum neopterin level was 275.9±96.0, 189.1±94.4 nmol/L before and after hemodialysis, respectively, and decreased significantly in both groups (p<0,05, respectively). There was no significant difference between both groups.Neopterin is a low-molecular-weight product released by human macrophages upon stimulation with interferon gamma. It permits the quantification of the level of cellulalr immune activation in vivo. We measured the level of serum neopterin and creatinine concentrations in 20 patients before and after hemodialysis in order to test whether hemodialysis induces specific activation of the T-lymphocyte macrophage axis. The results were as follows: 1) In normal adults, the serum neopterin level was 6.7±1.3 nmol/L with no sex difference. 2) In 20 hemodialysis patients, the serum neopterin level before hemodialysis was 246.2±97.6 nmol/L and increased significantly compared to normal adults (p<0.001). 3) In 20 hemodialysis patients, the serum neopterin level was 163.0±76.7 nmol/L after hemodialysis and decreased significantly (p<0.001), the neopterin/creatinine ratio was 25.4±14.7, 32.8±23.7 before and after hemodialysis, respectively, and there was no significant difference between both groups. 4) In groups of short-term hemodialysis (less than three months), the serum neopterin level was 248.4±100.6, 181.7±91.2nmol/L before and after hemodialysis, respectively. In groups of long-term hemodialysis (more than one year), the neopterin level was 244.0±99.9, 144.2±57.6 nmol/L before and after hemodialysis, respectively, and decreased significantly after hemodialysis in both groups (p<0.001), and there was no significant difference between both groups. 5) In 12 male hemodialysis patients, the serum neopterin level was 226.4±97.6, 145.5±60.5nmol/L before and in after hemodialysis, respectively, and in eight female hemodialysis patients, the serum neopterin level was 275.9±96.0, 189.1±94.4 nmol/L before and after hemodialysis, respectively, and decreased significantly in both groups (p<0,05, respectively). There was no significant difference between both groups.

만성 신장질환자의 혈액투석 중 부작용에 대한 일반투석과 profiling 투석법의 비교

강해숙,강현주,강의정,유난영,김아름,공진화,양영옥 병원간호사회 2007 임상간호연구 Vol.13 No.1

Purpose: The purpose of this study was to evaluate adverse reactions during hemodialysis with gradient ultrafiltration and high sodium dialysate could be reduced as compared to conventional hemodialysis. Method: Thirteen outpatients who had been on hemodialysis three times in a week for more than 6 months were recruited. he data were collected for 8 weeks from July 3 through August 26, 2006. Patients received conventional hemodialysis for the first four weeks, and then received profiling dialysis of gradient ultrafiltration & high sodium dialysate for the second four weeks. The collected data were analyzed with mean, standard deviation, paired t-test at significant level of .05. Result: The incident frequency of hypotension during sodium profiling hemodialysis was reduced, compared to conventional hemodialysis(t=1.210, p=.020). At the same time, the number of nursing interventions during sodium profiling hemodialysis was reduced significantly. Although systolic and diastolic blood pressure measured after profiling hemodialysis and conventional hemodialysis were not significantly different, the levels of systolic and diastolic BP were increased and concentration level of sodium was increased from 138.0±2.2mEq/L in conventional hemodialysis(the first four weeks) to 140±2.9mEq/L in profiling hemodialysis(the second four weeks) with t=-1.627, p=.114. Conclusion: Due to the reduced number of adverse reactions and nursing interventions in profiling hemodialysis, we can expect an increase in patient's compliance toward hemodialysis. This study suggest that profiling hemodialysis would be more efficient hemodialysis and more effective nursing interventions in occurrence of adverse reactions. However, because of the limited number of cases of this study, the effectiveness of profiling hemodialysis is yet to be determined.

혈액투석 중 운동프로그램이 혈액투석 환자의 체력, 생리·혈액지표 및 삶의 질에 미치는 효과: 체계적 문헌고찰

유향숙 ( You Hyang-sook ) 한국유산소운동과학학회 2018 한국유산소운동과학회지 Vol.16 No.1

Purpose: The purpose of this study was to analyze the effects of hemodialysis on Korean hemodialysis patients and to provide data for exercise practice and institutionalization of exercise program. Method: KISS, RISS and the database of the National Assembly Library were used to search the literature. The main search terms were ‘hemodialysis & exercise’ and ‘exercise during hemodialysis.’ Result: A total of 195 documents were searched for the main search terms. A total of 8 documents were selected, excluding duplicate documents and non - research related documents. Exercise program during hemodialysis showed effects on physical fitness, physiological, psychological aspects of hemodialysis patients. Conclusion: Therefore, the exercise program during hemodialysis is an effective intervention for the patient to perform safely and continuously and is considered as a good alternative for the patient. In the future, it will be necessary for the hemodialysis patients to practice the regular and long-term exercise during the hemodialysis based on the exercise guidelines for the hemodialysis patients through extensive research in Korea.

이온치환투석제거율로 측정한 적절 혈액투석의 신뢰도

오준석 ( Joon Seok Oh ),김성민 ( Sung Min Kim ),신용훈 ( Yong Hun Sin ),김중경 ( Joong Kyung Kim ),손영기 ( Young Ki Son ),안원석 ( Won Suk An ),김성은 ( Seong Eun Kim ),김기현 ( Ki Hyun Kim ) 대한신장학회 2011 Kidney Research and Clinical Practice Vol.30 No.3

Purpose: Quantification of the dialysis dose is an essential element in the management of hemodialysis. The author investigates the reliability of hemodialysis adequacy measured by ionic dialysance (Online clearance monitoring(R), OCM). Because OCM is a non-invasive and instantly accessible method, it could be replaced Kt/V derived from single-pool variable volume urea kinetic model (UKM). Methods: Kt/V using UKM and OCM were measured simultaneously in 51 patients who have received hemodialysis therapy via arteriovenous fistula. The analysis of the data collected from 186 hemodialysis sessions were performed. Results: Kt/V of conventional hemodialysis, high efficiency hemodialysis and hemodiafiltration measured by UKM were 1.39±0.24, 1.41±0.23 and 1.53±0.17, and by OCM were 1.24±0.17, 1.26±0.19 and 1.39±0.19, respectively. The data of UKM were significantly higher than those of OCM (p=0.00). Also, there were strong positive correlations between UKM and OCM in hemodialysis (r=0.80, p=0.00), high efficiency hemodialysis (r=0.65, p=0.00) and hemodiafiltration (r=0.67, p=0.00). Conclusion: The Kt/V using OCM measured by ionic dialysance provided slightly lower data than that of UKM derived from single-pool variable volume urea kinetic model, but it may be a reliable test to evaluate dialysis adequacy in conventional hemodialysis, high efficiency hemodialysis and hemodiafiltration.

혈액투석환자가 지각한 의료인 지지와 우울과의 관계연구

이정자 ( Joung-ja Lee ) 한국고등직업교육학회 2001 한국고등직업교육학회논문집 Vol.2 No.1

The purpose of this study was to identify the relationship of perceived medical personnel’s support and depression of patients undergoing hemodialysis and to provide the basic informations for supportive nursing intervention. The research data were collected through structured questionaries from January 10, 2000 to January 29, 2000. The 76 subjects participated for this study were patients with chronic renal failure, who were undergoing hemodialysis regularly at 2 general hospitals. The tools used in this study were Zung's Self-Rating Depression Scale and the medical personnel’s support scale modified by Hyun-Sook Kang. The data were analyzed through t-test, ANOVA, Pearson's Correlation Coefficient using SPSS program. The results from this study were as follows ; 1. The level of depression of patients undergoing hemodialysis revealed to be significantly different in age(F=8.2371. P=.0001), marriage status(F=5.1517, P=.0071), level of education(F=3.5541, P=.0059) and period of hemodialysis(F=4.2513, P=.0058). But The level of depression revealed not to be significantly different in the sex differences, religion and number of families. 2. The perceived medical personnel’s support revealed to be significantly different in age(F 4.3736. P=.0068), religion(F=3.2586, P=.0230) and level of education(F=3.2527, P=.0183). But the perceived medical personnel’s support revealed not to be significantly different in sex, marriage status, number of families and period of hemodialysis. 3. It was revealed that the higher the level of perceived medical personnel’s support was, the lower the level of depression patients undergoing hemodialysis was(r=-.1813, P=.004). In conclusion, it was shown that the level of depression of patients undergoing hemodialysis was significantly different in age, marriage status, level of education and period of hemodialysis and that the perceived medical personnel's support was significantly different in age, religion and level of education, number of families and period of hemodialysis. It was shown that the higher the level of perceived medical personnel’s support was, the lower the level of depression of patients undergoing hemodialysis was.

장기 혈액 투석 환자에서 주당 투석 회수에 따른 투석 적절도 비교

김명식,김영일,최홍집,박원도 인제대학교 1996 仁濟醫學 Vol.17 No.3

장기 혈액 투석을 받고 있는 만성 신부전 환자의 주당 투석 회수에 따른 투석 적절도를 비교 평가하기 위해 요소 동력학 모형을 이용하여 구한 지표와 혈청내 각종 생화학적 영양 지표를 측정하였다. Objectives : To assess adequacy of dialysis according to frequency of hemodialysis per week in patients with end stage renal diseases, we calculated the dose of dialysis with urea kinetic modeling and checked serum levels of several biochemical nutritional parameters. And then, we compared above values. Methods and Materials : We selected 40 patients undergoing maintenance hemodialysis over 3 months from January 1993 to December 1994. We divided them 2 groups such as group 1, those who had taken hemodialysis three times(23) a week, and group 2, those who had taken hemodialysis 2 times(17) a week. Monthly, we checked pre-hemodialysis serum bevels of biochemical nutritional parameters such as cholesterol, BUN, creatinine, potassium, phosphorus and albumin, measured their arterial pressures at blood sampling day, and calculated Kt/V urea, weekly Kt/V urea, NPCR(normalized protein catabolic rate) and URR(urea reduction ratio) with urea kinetic modeling during study periods. After then, we calculated their mean values. Results : 1) Clinical characteristics Mean ages were 47.82±2.58 years in group 1 and 48.34±2.77 years in group 2. There was no statistical difference in mean age between two groups. Mean dialyzer blood flow rates were 227.10±4.40mL/min in group 1 and 239.78±2.70mL/min in group 2, and total minutes per sessions 236.03±3.33 min in group 1 and 285.26±3.52 min in group 2. There were statistical differences in level of mean dialyzer blood flow ramie and total minutes per session between two groups (p<0.01). 2) Serum biochemical nutritional parameters In group 1 and group 2, mean values of serum concentration of cholesterol were 150.43±9.13mg/dL and 146.62±773mg/dL, those of BUN 72.10±3.85mg/dL and 75.51±3.79mg/dL, those of creatinine 10.02±0.60mg/dL and 11.36±0.76mg/dL, those of potassium 5.33±0.16mEq/L and 5.50±0.14mEq/L, those of phosphorus 4.81±0.24mg/dL and 5.05±0.32mg/dL, and those of albumin 3.96±0.11g/dL and 4.11±0.05g/dL, respectively. There was no statistical difference in mean pre-hemodialysis serum concentrations of cholesterol, BUN, creatinine, potassium, phosphorus and albumin between two groups. Serum level of creatinine showed positive correlation with that of albumin(r = 0.514, p<0.01) in study patients. 3) Urea kinetic modeling parameters In group 1 and group 2, mean values of Kt/V urea were 1.09±0.05 and 1.47±0.05, those of weekly Kt/V urea 3.25±0.15 and 2.94±0.09, and those of URR 0.60±0.01 and 0.71±0.02, respectively. There were statistical differences in mean values of UKM parameters such as Kt/V urea, weekly Kt/V urea and URR between two groups(p<0.01) Mean value of NPCR was 0.94±0.04g/kg/day in group 1 and 0.85±0.03g/kg/day in group 2. There was statistical difference in mean value of NPCR between two groups(p<0.05). Supposed no residual renal clearance, NPCR showed positive correlation with weekly-Kt/V urea (r = 0.413, p<0.01). 4) Mean arterial pressure Mean arterial pressures were 109.48±3.77mmHg in group 1 and 111.61±1.99mmHg in group 2. There was no statistical difference between two groups. Conclusion : In assessment of adequacy of hemodialysis according to the frequency per week, we could conclude that no difference in serum biochemical nutritional parameters including albumin between two groups, despite of less weekly-Kt/V urea in group 2 than that in group 1, was due to faster blood flow and longer total minutes per session during hemodialysis(i.e., increase in Kt/V urea and urea reduction ratio) in group 2. So, we can overcome the difference in weekly-Kt/V urea even in those who take hemodialysis two times a week, if we Increase the level of Kt/V urea or urea reduction ratio during hemodialysis.