지속성 외래 복막투석 환자에서 발생한 당뇨병성 근육 경색증

정택균 ( Taek Kyun Jeong ),이연경 ( Youn Kyoung Lee ),정균호 ( Gyun Ho Jeong ),박병석 ( Byong Seok Park ),마성권 ( Seong Kwon Ma ),김수완 ( Soo Wan Kim ),김남호 ( Nam Ho Kim ),최기철 ( Ki Chul Choi ) 대한신장학회 2003 Kidney Research and Clinical Practice Vol.22 No.1

Diabetic muscle infarction (DMI) is a rare condition occurring in subjects with long-standing complicated diabetes mellitus. We report DMI in a 65-vear-old man with type 2 diabetes mellitus undergoing continous ambulatory peritoneal dialysis (CAPD) with review of this condition in the literature. He had been suffered from type 2 diabetes mellitus for 21 years. In 1997, he reached end-stage renal disease and had received on renal replacement therapy with CAPD since then. In June 2002, he presented with sudden and spontaneous onset of severe pain in the right thigh region. He was afebrile, and the right thigh was swollen and tender but not erythematous. Laboratory data on admission included white blood cell count of 15,800/㎣, hemoglobin 9.0g/dL, platelet count 264,000/㎣, BUN 102.3mg/dL, serum creatinine 9.9 mg/dL, fasting blood glucose 85 mg/dL, postprandial 2 hours blood glucose 162 mg/dL, hemoglobin AIC 5.84%, ESR 125 mm/h (it was 52 mm/h one month earilier), CRP 18.9 mg/dL, and normal levels of creatinine kinase. Magnetic resonance imaging (MRI) showed asymmetry of the muscle in T1-weighted images and increased signal intensity involving the medial portion of right thigh (adductor longus, adductor magnus, vastus intermedius muscle, etc) in T2-weighted images with no contrast enhancement. Radioistope venography of the ileo-femoral veins was was normal, excluding deep venous thrombosis as a cause. The right thigh was explored surgically and a biopsy taken from the vastus intermedius muscle was consistent with chronically inflammed scar tissue with no evidence of malignancy. A biopsy taken from the vastus intermedius muscle showed hemorrhagic necrosis of skeletal muscle, with lymphcytic infiltration. Most of the blood vessels appeared normal. The swelling resolved spontaneously following a few weeks of bedrest and analgesia. To our knowledge, this is the first reported case of DMI in patients undergoing renal replacement therapy in Korea.

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

Nitric Oxide is a Marker of Peritonitis in Patients on Continuous Ambulatory Peritoneal Dialysis

김수완(Soo Wan Kim),정택균(Taek Kyun Jeong),이승철(Seong Cheol Lee),김남호(Nam Ho Kim),이기영(Ki Young Lee),최기철(Ki Chul Choi),강영준(Young Joon Kang) 대한내과학회 1998 대한내과학회 추계학술대회 Vol.55 No.-

지속성 외래 복막투석 환자에서 복막 평형검사

김기영(Ki Young Kim),정택균(Taek Kyun Jeong),정권(Kwon Jung),하정훈(Jeong Hoon Ha),이성철(Seong Cheol Lee),김수완(Soo Wan Kim),김남호(Nam Ho Kim),최기철(Ki Chul Choi),강영준(Young Joon Kang) 대한내과학회 1998 대한내과학회지 Vol.54 No.4

N/A Objectives: The peritoneal equilibration test(PET) is routinely performed in adults treated with chronic peritoneal dialysis to assess the peritoneal transport rate and to optimize treatment prescription. This study focuses on the evaluation of characteristics of peritoneal solute transport rates and physical and serological factors affecting peritoneal transport rate performed in our continuous ambulatory peritoneal dialysis(CAPD) patients due to guide adequate peritoneal dialysis form. Methods: We analyzed 95 PET results which had been tested on the 28th day of CAVD and physical and serological values, such as age, sex, diabetes mellitus, height, weight, body surface area, arterial blood pressure, blood urea nitrogen, creatinine, glucose, cholesterol, triglyceride, total protein, albumin, hematocrit, hemoglobin, sodium, potassium, phosphate which had been obtained on the day of PET. Results: 1) According to transport rate, high transport rate group was 9 cases(9.5%), high average transport group 26 cases(27.4%), low average transport rate group 32 cases(33.6%), and low transport rate group 28 cases (29.5%) respectivly. 2) The average of 4hour D/Pcr was 0.60, 4hour D/Do glucose was 0.46, and drain volume was 2480ml. Thus the average of peritoneal solute transport rate of total patients was low average transport rate. 3) Factors affecting peritoneal solute transport rate were age, body surface area, plasma albumin, serum creatinine and triglyceride level. Conclusion: These findings suggest that high dose peritoneal dialysis form should be used in our CAPD patients because most of them have low average peritoneal transport rate, and age, body surface area, plasma albumin, serum creatinine, and triglyceride level should be considered when select the adequate peritoneal dialysis form.

Recombinant Human Erythropoietin ( Epoetin ) 을 투여받는 혈액투석 환자에서 철분 결핍에 대한 Iron Sucrose ( Venofer(R) ) 의 효과 및 안전성

조민석(Min Seok Cho),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) 대한신장학회 2002 Kidney Research and Clinical Practice Vol.21 No.5

배 경 : 최근 국내에서는 빈혈이 지속되는 혈액투석 환자에서 보험 규제 및 경제적인 여건 때문에 충분한 양의 erythropoietin (Epoetin)이 투여되지 못하는 경우가 많으며, 철 결핍성 빈혈인 경우 iron sucrose 정주 요법이 사용되기 시작하고 있으나, 아직까지 국내에서는 이에 대한 연구가 없는 실정이다. 본 연구는 제한된 양의 Epoetin을 투며 받는 혈액투석 환자에서 iron sucrose의 정주 강화 요법 후의 빈혈 및 철분 지표, 그리고 혈압의 변화를 측정함으로써 iron sucrose의 효과 및 안전성을 알아보고자 하였다. 방 법 : 전남대학교병원에서 주 3회 혈액투석을 반고있는 성인 환자 중 Hemoglobin (Hb) 치가 10 g/dL 미만, hematocrit (Hct) 치 30% 이하이면서 혈청 ferritin 치가 100 ng/mL 미만이거나. transferrin saturation (TSAT)이 20% 미만인 총 19명의 환자를 대상으로 하였다. 총 1,000 ㎎의 iron sucrose (Venofera)를 10번에 걸쳐 생리 식염수 100 mL에 혼합하여 혈액투석 마지막 60분간에 걸쳐 정주 하였다 (강화 요법). 이후 3개월간 혈청 ferritin, TSAT 수치에 따라 용량을 주당 25-100 ㎎으로 조절하여 투여하였다 (유지 요법). 목표 Hgb 치를 10 g/dl., 목표 Hct 치를 30%로 하였다. Iron sucrose의 효과를 평가하기 위하여, 혈청 철분 지표와 빈혈 지표를 첫 번째 정주 직전 및 강화 요법 시작 1개월 후 및 이후 3개월간에 걸친 유지 요법 중 매월 측정하여 비교하였다. 안전성 평가를 위해 수축기 및 이완기 혈압을 iron sucrose 10회 강화 요법 정주 1시간 전 및 정주 종료 시에 측정하여 iron sucrose 투어 진 측정된 혈압 치와 비교하였으며, 또한 기타 부작용을 관찰하였다. 혈액학적 및 생화학적 지표를 첫 번째 정주 직전 및 강화 요법 시작 1개월 후 측정하여 비교하였다. 결 과 : Iron sucrose 1,000 ㎎ 강화 요법 후 Hgb, Hct, 혈청 iron 및 ferritin, TSAT, MCV 및 MCH 치는 유의하게 증가하였다 (각각 p<0.001, p<0.001, p<0.01, p<0.001, P<0.01, p<0.01, p<0.01). 이후 3개월간의 유지 요법 시 Hgb, Hct, 혈청 ferritin, 그리고 TSAT치는 기저 치에 비해 유의한 증가를 지속하였다. Iron sucrose 투여 시 심각한 부작용은 관찰되지 않았으며, iron sucrose 투여 1시간 전 혈압과 투여 종료시의 혈압은 유의한 차이가 없었다. Iron sucrose 투여 후 혈청 알부민 치는 유의하게 증가하였으나 (p=.037), 다른 혈액학적 및 생화학적 지표들은 유의한 차이가 없었다. 결 론 : 혈액투석 증인 철분 결점 상태를 보이는 말기 신질환 환자에서 iron sucrose의 정주는 안전하며 효과적인 철분 공급 방법으로 생각되었다. Background : The objective of the present study was to assess the efficacy and safety of iron sucrose by determining the subsequent change in hemoglobin (Hgb), hematocrit (Hct), transferrin saturation (TAST), serum ferritin values and blood pressures in hemodialysis patients receiving Epoetin. Methods : A total of 19 adult patients who had been receiving hemodialysis three times a week at Chonnam Natinal University Hospital were assigned. Their Hgb level was less than 10 g/dL and their serum ferritin level was less than 100 ng/mL, and/or TSAT was less than 20%. Iron sucrose was administered as 1,000 ㎎ in 10 divided doses diluted in 100 mL normal saline over the last 60 minutes during hemodialysis with a one-time prior test dose of 20 ㎎ on 10 consecutive dialysis sessions. Iron sucrose dosage was adjusted to 25-100 ㎎/week depending on serum ferritin level, and TSAT in the following 3 months. Epoetin administration was stopped due to insurance regulation when Hgb level was more than 10 g/dI. and Hct level was more than 30 %. To evaluate efficacy of iron sucrose, assessment of serum iron parameters and anemia indices was determined just before the first dose (baseline), at 1 month after the first dose (loading) and then, monthly for 3 months (maintenance). To evaluate safety of iron sucrose, we recorded blood pressure 1 hour before and at the time of completion of iron sucrose injection, and also recorded blood pressure during observation sessions before dialysis and at intervals of 2 hours and 4 hours after starting dialysis. We determined routine serum chemistry and hematologic results at 1 month after the first dose and compared results with those obtained at baseline. Results : 1,000 ㎎ iron surcose injection in 10 divided dose (loading) produced a significant rise in Hgb, Hct, serum iron, serum ferritin, TSAT, MCV and MCH at I month after first dose (respectively p<0.001, p<0.0.001, p<0.01, p<0.001, p<0.01, p<0.01, p<0.01). During the following maintenance period of 3 months, Hgb, Her, serrum ferritin, and TSAT level remained more elevated than at baseline respectively. In 19 enrolled patients, we experienced no serious adverse drug reactions and no significant changes in intradialytic blood pressure associated with iron sucrose administration. Serum albumin concentrations was higher at 1 month than at base line and however, changes in other serum chemistry and hematologic results were not statistically significant. Conclusion : Intravenous iron sucrose administration is an efficient and safe method to supply iron in end-stage renal disease patients receiving Epoetin with iron deficiency, who are undergoing hemodialysis.

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)

당뇨병성 신증 환자에서 발기부전

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 Chun Choi ) 대한내과학회 2003 대한내과학회지 Vol.64 No.2

목적: 당뇨병과 신기능이 저하된 남자환자에서 발기부전은 흔하게 발생한다고 알려져 있다. 이 중 당뇨병 신증으로 치료 중인 2형 당뇨병 환자를 대상으로 발기부전(erectile dysfunction, ED)의 유병률과 이와 관련된 위험인자들을 알아보고자 이 연구를 시행하였다. 방법: 2001년 7월부터 2002년 2월까지 전남대학교 병원에 미세 알부민뇨나 현성 신증으로 내원한 환자 및 현재 투석 중인 2형 당뇨병을 가지고 있는 남성 환자 106명을 대상으 Background: Erectile dysfunction (ED) is prevalent among patients with diabetes mellitus and impaired renal function. To estimate the prevalence of ED in diabetic nephropathy and to identify its risk factors, we carried out a survey of patients with diabe

당뇨병성 신증 환자에서 저분자량 헤파린 Dalteparin Sodium 사용 중 발생한 후복막강 혈종 1예

정택균,정균호,박병석,마성권,김수완,김남호,최기철 대한내과학회 2003 대한내과학회지 Vol.64 No.3

신대체 요법의 유무에 관계없이 신기능 장애가 있는 환자에서 항응고 치료로 저분자량 헤파린 (dateparin, enoxaparin 등)을 사용할 경우에는 제제에 관계없이 심한 출혈의 위험성이 높아질 수 있기 때문에 세심한 주의를 요한다. 6~8일 이상 투여하는 것은 삼가고 심각한 출혈을 일으킬 수 있음을 항상 주지하여야 하며 , 특히 항응고 치료 과정 중에 치료 전 없었던 옆구리, 서혜부, 하요부 및 하지의 통증 , 빈혈, 저혈압 등이발생하였을 때 후복막강 혈종의 가능성을 항상 고려하여야 할 것이다. Retroperitoneal Hematoma is a rare intraabdominal bleeding occurring in patients with low-molecular weight heparin anti-coagulant therapy. we report a case of dalteparin sodium-associated retroperitoneal hematoma in a 70-year-old man with diabetic nephropathy with review of this condition in the literature. He had been suffered from type 2 diabetes mellitus and hypertension for 15 years. In July 2002, he was admitted to our hospital because of unstable angina and left pleural effusion. He was treated with dalteparin sodium and aspirin for unstable angina. On the second hospital day, he was referred to division of nephrology for diabetic nephropathy. Laboratory data on admission included white blood cell count of 4,500/㎣, hemoglobin 9.6 g/dL, platelet count 294,000/㎣, BUN 58.1 mg/dL, serum creatinine 4.1 mg/dL, blood glucose 178 mg/dL, hemoglobin A1c5.9T, PT 13.9 sec (INR: 1.09), and aPTT 50 sec, On days 6 through 8, he had lower back pain, lower extremity pain and neuropathy, anemia and hypotension. Abdominal ultrasound showed 6×6 cm-sized well marginated mixed echogenic lesion in psoas muscle and fluid collection in retroperitoneal cavity. Magnetic resonance imaging (MRI) showed increased signal intensity and thickening of the right psoas muscle including 4.7×2.3×21 cm-sized cytic lesion and 6.2×5.3×3.7 cm-sized cystic lesion on the lateral portion of right psoas muscle in T2-weighted images. Percutaneous drainage of cystic lesion was performed by right lateral approach. Hemodialysis was begun without heparinization. Abdominal CT showed 5.5×5 cm-sized high attenuated lesion in right psoas muscle and 5×3 cm, 3×2 cm, 4.5×2.5 cm, 4×2.5 cm-sized heterogeneous, slightly high attenuated lesions in the right lower abdomen and cul-de-sac in the scans with no enhancement. He was treated by conservative therapy. He recovered gradually. Patients with kidney diseases receiving low molecular weight heparin (dalteparin, enoxaparin, etc) should be closely monitored to prevent serious bleeding complications. The possibility of retroperitoneal hematoma should be considered, whenever symptoms including lower back pain, inguinal pain, leg pain, anemia, or hypotension occurred during the lower molecular weight heparin anticoagulant therapy. To our knowledge, this is the first reported case of retroperitoneal hematoma in a patient during dalteparin sodium (Fragmin^??) anticoagulant therapy. (Korean J Med 64:322-327, 2003)

만성 신부전 환자에서의 혈청지질과 지단백질

김현수,김남호,최기철,강정채,이성철,이태희,정익주,정민영,강영준,김수완,정권,김형준,정택균,나명윤,정균호,바종춘 대한신장학회 1998 Kidney Research and Clinical Practice Vol.17 No.5

We measured serum lipoprotein(a) [Lp(a)] concentrations in 304 uremic patients treated on predialysis, hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD), and compared them with those in 43 normal controls. The mean values were 46.1mg/dl in predialysis, 35.7mg/dl in HD, 54.7mg/dl in CAPD patients and 17.0mg/dl in controls, respectively. Serum Lp(a) levels were elevated both in the predialysis patients (P<0.001) and in the CAPD patients (P<0.001) compared with those in controls, and were also elevated in the CAPD patients (P<0.01) compared with HD patients. Serum Lp (a) levels tended to be higher in HD patients compared with controls, although these differences did not reach statistical significance. We observed statistically significant positive correlations of Lp(a) to serum levels of total cholesterol (TC) (r=0.279, P<0.01), LDL-cholesterol (r=0.335, P<0.01), and Apo(B) (r=0.352, P<0.01), and significant negative correlation of Lp(a) to serum level of albumin (r=-0.278, P<0.01) in 304 CRF patients. CAPD patients had a more atherogenic lipoprotein profile than did HD patients: besides significantly higher Lp(a) levels (P<0.01), total (P<0.001) and LDL (P<0.001) cholesterol, triglycerides (P<0.05), and apo (B)(P<0.001) were significantly elevated in comparison to HD patients. The marked elevation of serum Lp(a) in patients on CAPD may be due to increased hepatic synthesis as a consequence of the substantial amounts of plasma proteins lost in the dialysate. The increased serum concentrations of Lp(a) may contribute to the high risk for atherosclerosis in end stage renal disease, especially in patients treated by CAPD.