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

배경: 동맥경화는 투석치료를 받고 있는 말기 신질환 환자에서 중요한 문제이고 이는 하나의 염증질환으로 대별된다. 심혈관계 질환은 만성 신부전 환자의 주요한 사인이고 사망원인의 약 50%를 차지한다. 본 연구는 대표적인 염증반응의 표지자인 CRP와 투석환자에서 심혈관계 위험과의 상관관계를 알아보고자 하였다. 방법: 투석환자에서 후향적 연구를 시행하였다. 환자는 CRP치가 상승된 군 (CRT>8 mg/L; n=11)과 CRP치가 정상인 군(CRP≤8mg/L 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 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

N/A 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)

만성 신부전 환자에서 고호모시스틴혈증에 관한 연구

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 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.

신이식 환자에서 혈청 호모시스틴 농도의 변화

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

배경 : 신이식 후에 발생하는 심혈관계 질환은 이식신의 손실과 함께 환자 사망의 주요한 원인으로 알려져 있다. 알려진 심혈관계 질환의 위험인자들로는 고지혈증, 고혈압, 당뇨병, 고령 및 흡연 등이 있으며, 또한 급성 거부반응의 유무, 좌심실 비대, C-reactive protein 등 염증 반응과 함께 고호모시스틴 혈증 등이 보고되고 있다. 호모시스틴은 신장 사구체를 통하여 배설되는 아미노산으로 말기 신질환 및 신이식 환자에서의 심혈관계 질환의 위험인자로 생각되고 있으나, 신이식 후 호모시스틴 농도의 변화 및 엽산과 비타민 보충 요법 등의 치료 효과는 아직 확립되어 있지 않다. 본 연구에서는 말기 신질환 환자들에서 신이식을 시행한 후 고호모시스틴 혈증의 발생과 이에 영향을 미치는 인자들에 대해 조사하였다. 대상 및 방법 : 정상 대조군 21명, 만성 신부전으로 최소 2개월 이상 치료 중인 환자 중 만성 신부전 보존 치료군 37명과 신이식 환자 48명을 대상으로 혈청 호모시스틴 농도와 혈청 호모시스틴 농도에 영향을 미치는 인자 등을 조사하였다. 결과 : 고호모시스틴혈증(정상대조군의 95백분위수 14.54 μmol/L 이상)의 유병율은 정상 대조군, 만성 신부전 보존 치료군과 신이식 환자군에서 각각 4.8%, 83.8%, 45.8%였다. 신이식 환자군 중 고호모시스틴 혈증은 정상 신기능군(혈청 크레아티닌 농도 남: 1.2 mg/dL, 여: 1.1 mg/dL 이하)과 비정상 신기능군에서는 각각 18.8%, 59.4%였다. 신이식 환자군(16.38±6.48 μmol/L)에서의 혈청 호모시스틴 농도는 정상 대조군(8.80±2.07 μmol/L)과 비교하여 유의하게 높았으나(p<0.01), 만성신부전 보존 치료군(24.68±9.01 μmol/L)과 비교하여 유의하게 낮았다(p<0.01). 또한 신이식 환자들 중 혈청 크레아티닌 정상군(12.02±3.68 μmol/L)에서 비정상군(18.57±6.51 μmol/L)에서의 혈청 호모시스틴 농도과 비교하여 유의하게 낮았다(p<0.01). 다중 회귀 분석상 신이식 환자들에서 혈청 호모시스틴 농도에 영향을 주는 독립적 인자는 혈청 크레아티닌 농도이었으며, 전혈 사이클로스포린 농도나 비타민 및 엽산 보충 요법의 유무와는 무관하였다. 결론 : 본 연구에서 신이식 환자의 혈청 호모시스틴 농도는 정상인에 비하여 유의하게 높았으나 보존 치료 중인 말기 신부전 환자와 비교시 유의하게 낮았다. 혈청 호모시스틴 농도에 영향을 주는 인자는 혈청 크레아티닌 농도였다. 또한 이러한 혈청 호모시스틴 농도의 감소가 신이식 환자에서의 심혈관 질환 발생의 감소에 기여할 것인지는 추후 연구가 필요할 것으로 사료된다. 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)

혈액투석 환자에서 요독 가려움증에 대한 임상적 고찰

배은희 ( Eun Hui Bae ),강우헌 ( Woo Heon Kang ),박정우 ( Joung Woo Park ),배우균 ( Woo Kyoun Bae ),이균상 ( Kyun Sang Lee ),마성권 ( Seong Kwon Ma ),김남호 ( Nam Ho Kim ),최기철 ( Ki Chul Choi ),김수완 ( Soo Wan Kim ) 대한신장학회 2006 Kidney Research and Clinical Practice Vol.25 No.5

혈액투석환자의 우울성향과 가족기능

이균상,윤수진,문호성,김문재 대한가정의학회 1996 Korean Journal of Family Medicine Vol.17 No.7

지속성 외래 복막투석 환자에서 영양상태와 투석의 적절도

박미정,이균상,조민석,김정기,박병석,마성권,나명윤,염충호,정권,김수완,김남호,최기철 대한신장학회 2001 대한신장학회잡지 Vol.20 No.4

외래환자의 피로에 대한 분석

윤방부,이균상,강희철,신경균 대한가정의학회 1999 Korean Journal of Family Medicine Vol.20 No.8

골다공증의 관련 요인

윤수진,이균상,문호성 대한가정의학회 1996 Korean Journal of Family Medicine Vol.17 No.12