심포지움 : 복막 투석이 장기적인 신대체 요법으로 가능한가?

김용림 ( Yong Lim Kim ) 대한내과학회 1999 대한내과학회 추계학술발표논문집 Vol.1999 No.2

심포지움 : 복막 투석이 장기적인 신대체 요법으로 가능한가?

김용림 ( Yong Lim Kim ) 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-

심포지움 : 복막 투석이 장기적인 신대체 요법으로 가능한가?

김용림(Yong Lim Kim) 대한내과학회 1999 대한내과학회지 Vol.57 No.4

N/A

컴퓨터화 된 요소 역동학 모델 ( Urea Kinetic Modeling ) 을 이용한 지속성 외래 복막투석 환자의 투석용량에 따른 투석적절도 연구

김용림(Yong Lim Kim),김준철(Jun Chul Kim),김찬덕(Chan Duck Kim),김준홍(Jun Hong Kim),조동규(Dong Kyu Cho) 대한내과학회 1999 대한내과학회지 Vol.57 No.3

The DOQI guidelines recommend that the delivered PD dose should be a total weekly Kt/Vurea and Ccr values of at least 2.0 and 60 L/week/1.73 m2 for CAPD patients. To achieve these recommended guidelines, the standard regime of four 2-L daily exchanges may not be sufficient even for Oriental patients whose body size are relatively smaller than those of Westerners. However, the option of a two-and-a-half liter bag (2.5L) and a simple automated overnight exchange device for a fifth exchange are not available in some countries. In order to evaluate the percentage of CAPD patients who receive dialysis meeting DOQI guidelines in different dialysis prescriptions, 110 Korean patients, treated for over a 3 month on CAPD, with a mean age of 46.912.6 years and dialysis duration of 37.6±28.1 months (range 3-116), were studied. Methods : Baseline urea kinetic data from a 24-hour dialysate collection was obtained and analyzed using the computerized urea kinetic model of peritoneal urea transport (PACK-PD, vers 1.01, Fresenius). The potential Kt/Vurea and Ccr values using four 2L and 2.5L daily exchanges were calculated with the PC program. Results : The mean weekly Kt/Vurea and Ccr values were 2.01±0.67 and 66.4±29.6 L/week/1.73 m2 respectively, with a median body surface area (BSA) of 1.61 m2 (75th percentile 1.73 m2). The mean 24 hour dialysate-to-plasma creatinine ratio was 0.75±0.16. Fourty-five of the 110 patients (41%) had no residual renal function. Upon logistic regression analysis, Kt/Vurea was independent factor affecting serum albumin and NPCR. 1) In forty-eight (44%) of the 110 patients, both Kt/Vurea and Ccr values with four 2-L daily exchanges were adequate. In twenty-two (20%), one of Kt/Vurea and Ccr values with four 2-L daily exchanges was inadequate. In fourty (36%), both Kt/Vurea and Ccr values with four 2-L daily exchanges were inadequate. 2) In eighty-four (77%) of the 110 patients, both Kt/Vurea and Ccr values with four 2.5-L daily exchanges were adequate. In nineteen (17%), one of Kt/Vurea and Ccr values with four 2.5-L daily exchanges was inadequate. In seven (6%), both Kt/Vurea and Ccr values with four 2.5-L daily exchanges were inadequate. 3) In three (7%) of the fourty-five anuric patients, both Kt/Vurea and Ccr values with four 2-L daily exchanges were adequate. In eleven (24%), one of Kt/Vurea and Ccr values with four 2-L daily exchanges was inadequate. In thirty-one (69%), both Kt/Vurea and Ccr values with four 2-L daily exchanges were inadequate. 4) In twenty-seven (60%) of the fourty-five anuric patients, both Kt/Vurea and Ccr values with four 2.5-L daily exchanges were adequate. In thirteen (29%), one of Kt/Vurea and Ccr values with four 2.5-L daily exchanges was inadequate. In five (11%), both Kt/Vurea and Ccr values with four 2.5-L daily exchanges were inadequate. Conclusion : The anuric Korean patients may need four 2.5L daily exchanges for acceptable adequacy target. Special attention must be given to those patients with no residual renal function. (Korean J Med 57:313-322, 1999)

간경변증이 동반된 말기신부전환자에서의 지속성 외래복막투석

김용림(Yong Lim Kim),권태환(Tae Hwan Kwon),조동규(Dong Kyu Cho) 대한내과학회 1996 대한내과학회지 Vol.51 No.2

Objectives: The spontaneous tendency to arterial hypotension in cirrhotic patients makes adequate hemodialysis therapy extremely difficult. Hemodialysis in these patients may produce intradialytic hypotension, limiting the amount of ultrafiltration. These patients are also at high risk for gastrointestinal bleeding, which can be exacerbated by anticoagulation, Recently peritoneal dialysis has been suggestad for the management of this population. Methods: Seven patients with chronic renal failure and liver cirrhosis treated by CAPD are described. Six of the seven patients were complicated by ascites on starting CAPD. Hepatocellular carcinoma was identified in one patient. Three had been transferred from hemodialysis for hemodynamic intolerance, one for vascular access problem. All PD catheters were surgically placed. Results: The hemodynamic tolerance was excellent in all patients. Four patients developed bleeding immediately after catheter insertion, Two patients developed early leaks and one patient late leak. Four patients had a decline in serum albumin level of 0.5 gm/dL or more during the course of chronic PD, Peritonitis occurred on average at 8.7 month interval. Three episodes of catheter removal occurred in 148 patient-months of PD(0.24 per patient-year). Four patients died while maintained on PD; three deaths were due to hepatic encephalopathy on PD for duration of 4 to 60 months and the fourth was due to peritonitis after 24 months of PD. One patient died due to malnutrition after 2 months on switching to hemodialysis because of peritonitis after 32 months of PD. Conclusion: Early mechanical complications after catheter insertion(bleeding, leak) were more common than usual. But CAPD was better tolerable than hemodialysis and may be a reasonable choice with an acceptable survival rate in end-stage renal disease patients with preexisting liver cirrhosis.

HLA 일배체 부적합 혈연관계 생체 신이식에서 공여자 연령이 이식신 및 환자 생존율에 미치는 영향

김준홍(Jun Hong Kim),김찬덕(Chan Duk Kim),김석재(Seog Jae Kim),백미영(Mi Young Baek),권태환(Tae Hwan Kwon),김용림(Yong Lim Kim),조동규(Dong Kyu Cho),김영욱(Young Wook Kim),권태균(Tae Gyun Kwon),장세국(Sae Kook Chang) 대한내과학회 1998 대한내과학회지 Vol.54 No.3

Objectives: Renal transplantation has become the therapy of choice for patients suffering from end-stage renal disease. But because of progressive disparity between the number of patients in needs of a transplant and the number of ideal kidneys available for transplantation, increasing numbers of kidneys are recovered for transplantation from donors that are not considered ideal, especially from donors over the age of 55. In country such as Korea, the number of cadaveric transplants is limited due to cultural and religious prejudices of the population, poor legal definition and deficient organization of cadaveric donor work-up. Therefore the main source is living related donors(LRD), especially the parent. But in Korea, there is few reports about the influence of donor age on outcome in living related kidney transplantation. Thus we performed this study to estimate the influence of donor age in itself on the outcome of the one HLA-haplotype mismatched living related kidney transplantation. Methods: The effect of donor age on the outcome of One HLA-haplotype mismatched living related kidney transplantation was studied in 71 recipients who under- went kidney transplantation from January 1981 to March 1995. The outcomes of 25 recipients from the older age group(?55 years: Group A) and 46 recipients from the younger age group(<55 years: Group B) were retrospectively reviewed. Patient death with a functioning graft was considered graft loss. Results: Demographic characteristics between 2 groups were similar, The 1-year and 3-year patient survival rates in recipients(group A and B) were similar regardless of donor age(96.0% and 90.8% vs.97.4% and 90.3%, respectively). The 1-year and 3-year graft survival rates in recipients(group A and B) were not significantly different (91.4% and 63.9% vs 92.7% and 79.3%, respectively). The mean levels of serum creatinine at discharge were significantly higher in group A. Short-term and intermediate-term renal function, as assessed by serum creatinine, was inferior in the group A throughout the follow-up periods of 3 years. The causes of graft loss in the first 3 years after transplantation were irreversible rejection(71%) and the patient death with functioning graft(29%) in group A, while the causes of graft loss in group B were irreversible rejection(50%), patient death with a functioning graft(40%) and technical reason(10%). Conclusion: These results of our analysis suggest that similar outcome can be achieved after living related renal transplantation from older donor. Therefore the kidneys may be used from donors over 55 years old on condition that the donors undergo complete and exhaustive work-up.

Histopathologic and clinicopathologic classifications of antineutrophil cytoplasmic antibody-associated glomerulonephritis: a validation study in a Korean cohort

Lim Jeong-Hoon,Han Man-Hoon,Kim Yong-Jin,전예나,Jung Hee-Yeon,최지영,Cho Jang-Hee,Kim Chan-Duck,김용림,이하정,Kim Dong Ki,문경철,Park Sun-Hee 대한신장학회 2021 Kidney Research and Clinical Practice Vol.40 No.1

Background: Antineutrophil cytoplasmic antibodies (ANCA)-associated glomerulonephritis (AAGN) is a common cause of rapidly progressive glomerulonephritis and requires prompt and proper immunosuppressive therapy to improve renal prognosis. This study aimed to evaluate the predictive value of two different classifications for renal outcomes in Korean AAGN patients. Methods: Ninety-two patients who were diagnosed with AAGN at two tertiary hospitals between 2004 and 2018 were retrospectively analyzed retrospectively. The histopathologic classification according to glomerular pathology and the clinicopathologic classification according to normal glomeruli ratio, degree of interstitial fibrosis/tubular atrophy, and baseline renal function were evaluated using the Cox proportional hazards model. Results: Forty-five patients (48.9%) progressed to end-stage kidney disease (ESKD) during the observation period. The mean age was 61.0 ± 15.3 years, and most patients had myeloperoxidase-ANCA (93.5%). In the histopathologic classification, the best renal survival occurred in the focal class, whereas the sclerotic class had the worst renal survival (sclerotic class vs. focal class; adjusted hazard ratio [aHR], 5.05; 95% confidence interval [CI], 1.32–19.31; p = 0.018). The mixed class had intermediate renal outcomes (mixed class vs. focal class; aHR, 4.23; 95% CI, 1.23–14.58; p = 0.022). In the clinicopathologic classification, the high-risk group had poor renal outcomes compared with the low-risk group (aHR, 6.56; 95% CI, 1.25–34.26; p = 0.026), but renal outcomes did not differ between the low- and medium-risk groups. Conclusion: In Korean AAGN patients, histopathologic and clinicopathologic classifications had predictive value for renal outcomes, especially in the sclerotic class or the high-risk group with higher risk of progression to ESKD despite treatment.

복막투석에서 야간저류 후 투석액 대 혈장 sodium 농도비의 유용성

신용봉 ( Yong Bong Shin ),이현철 ( Hyun Chul Lee ),최혁준 ( Hyok Joon Choi ),조지형 ( Ji Hyung Cho ),장민화 ( Min Hwa Jang ),조영준 ( Yung Jun Cho ),박선희 ( Sun Hee Park ),조동규 ( Dong Kyu Cho ),김용림 ( Yong Lim Kim ) 대한내과학회 2002 대한내과학회지 Vol.63 No.6

Background: Standard PET (peritoneal equilibration test) is time consuming and it cannot reflect the water removal accurately because it measures solute transport by diffusion only. Thus, it is important to find parameters that can be used to predict both

연령에 따른 유아의 컴퓨터쓰기와 연필쓰기

김영실(Kim Young-Sil),함은숙(Ham Yun-Suk),김용림(Kim Yong-Lim) 한국어린이미디어학회 2003 어린이미디어연구 Vol.2 No.-

본 연구에서는 유아의 컴퓨터쓰기와 연필쓰기가 연령에 따라 차이가 있는지, 그리고 이들 간에 상관이 있는지를 알아보았다. 3세, 4세, 5세 유아 61명에게 개별면접을 실시하여 컴퓨터쓰기 표본과 연필쓰기 표본을 수집하였다. 컴퓨터쓰기는 양연임과 김영실(2001)의 컴퓨터쓰기 단계를, 연필쓰기는 Sulzby(1990)의 쓰기체제를 근거로 하여 분석하였다. 분석 결과 유아의 컴퓨터쓰기와 연필쓰기는 연령에 따라 차이가 있었으며, 연령이 증가함에 따라 발달하는 경향을 보였다. 컴퓨터쓰기와 연필쓰기는 4세 유아에게서 통계적으로 유의미한 상관관계가 있었다. This study examines whether age difference affects children's performance on writing with the computer and writing with the pencil and whether there is a relationship between the two writing skills. For this study, 61children aged 3 to 5 were interviewed individually and their computer and pencil writing samples were collected. Computer writing samples were analyzed on the basis of "Level of Children's Computer writing(Yang & Kim, 2001); pencil writing samples were analyzed on the basis of "Six Categories of Writing(Sulzby, 1990). The analysis showed that children on different age groups displayed different levels of competency in the computer writing and pencil writing skills and that the competency developed with the advancement in age. It also showed that there was a statistically meaningful correlationship between computer and pencil writing in the case of 4-year-old children.

연령에 따른 유아의 컴퓨터로 쓰기와 연필로 쓰기

김영실 ( Kim Yeong Sil ),함은숙 ( Ham Eun Sug ),김용림 ( Kim Yong Lim ) 한국유아교육학회 2003 한국유아교육학회 학술대회자료집 Vol.2003 No.-