Postdialysis serum sodium changes and systolic blood pressure in patients undergoing online hemodiafiltration and high-flux hemodialysis

BACKGROUND: Because hemodiafiltration (HDF) involves large amounts of ultra-filtration and substitution fluid infusion, its effects on serum electrolytes may be different from those of hemodialysis (HD). Serum sodium and blood pressures were compared between patients undergoing online HDF and high-flux HD (HFHD). METHODS: Thirty-two of 101 patients on HFHD switched voluntarily to online HDF. Their pre- and postdialysis serum measurements were compared with those of the remaining 69 HFHD patients. RESULTS: Online HDF patients had lower pre- and postdialysis systolic blood pressures (SBPs) than HFHD patients (predialysis, 136+/-21 vs. 145+/-19 mmHg, P<0.05; postdialysis, 129+/-22 vs. 142+/-25 mmHg, P<0.05). Pre- and postdialysis serum sodium concentrations were not significantly different between online HDF and HFHD (predialysis, 138+/-2 vs. 137+/-3 mEq/L; postdialysis, 134+/-2 vs. 134+/-2mEq/L). However, the change in serum sodium concentration after dialysis was greater in online HDF than HFHD patients (-3.7+/-2.2 vs. -2.5+/-2.8 mEq/L, P<0.05). The change in serum sodium concentrationwas correlated with postdialysis SBP (r=0.304, P<0.005) and pulse pressure (r=0.299, P<0.005). Predialysis SBP (r=0.317, P<0.005) and pulse pressure (r=0.324, P=0.001) were also correlated with the postdialysis serum sodium change. CONCLUSION: Compared with HFHD, online HDF has a greater serum sodium lowering effect. This might contribute to the ability of online HDF to stabilize both pre- and postdialysis SBP.

Corrigendum to "Hwang KS, Kim GH: Thiazide-induced Hyponatremia. Electrolyte Blood Press 8:51-57, 2010"

In several sections of our review paper, cited in the title, we have found some errors in quotation of sentences from the Dr. Aaron Spital's review article entitled "Diuretic-induced hyponatremia" published in American Journal of Nephrology 19:447-452, 1999. Quotation marks were missed, and we should have specifically acknowledged the source of our statements.

Hemoglobin Variability Associated with Different Erythropoiesis Stimulating Agents in Hemodialysis Patients / 대한신장학회지

PURPOSE: This study was undertaken to examine whether differences exist in the hemoglobin variability according to the types of erythropoiesis stimulating agent (ESA) in hemodialysis (HD) patients. METHODS: Clinical data were retrospectively analyzed from 72 patients on maintenance hemodialysis who were using darbepoetin alfa (n=27), epoetin beta (n=27), and epoetin alpha (n=18). As parameters of hemoglobin variability, hemoglobin cycling, the variance of hemoglobin and the SD/mean of hemoglobin were analyzed. Hemoglobin cycling was defined as the presence of cycles with an amplitude >1.5 g/dL and lasting more than 2 months. RESULTS: Hemoglobin cycling was present in 53 (73.6%) out of 72 HD patients. Hemoglobin cycling in patients receiving darbepoetin alfa had greater frequency (1.63+/-0.93 vs. 1.00+/-0.88 times/year, p<0.05), amplitude (2.88+/-1.48 vs. 1.88+/-1.60 g/dL, p<0.05), and velocity (1.21+/-0.74 vs. 0.73+/-0.66 g/dL/month, p<0.05) than that in patients receiving epoetin beta. The variance of hemoglobin in patients receiving epoetin beta (0.79+/-0.53 g/dL) was smaller than that in patients receiving darbepoetin alfa (1.29+/-0.70 g/dL, p<0.05) and epoetin alfa (1.08+/-0.52 g/dL, p<0.05). Also, the ratio of SD/mean of hemoglobin in patients receiving epoetin beta (8.20+/-2.59%) was lower than that in patients receiving darbepoetin alfa (10.81+/-2.10%, p<0.05) and epoetin alfa (10.30+/-2.10%, p<0.05). CONCLUSION: Hemoglobin variability is differential according to various ESAs, and it may be less with epoetin beta compared with darbepoetin alpha and epoetin alpha.

Cisplatin nephropathy in patients with lung cancer / 대한내과학회지

BACKGROUND/AIMS: This study characterized the cisplatin nephrotoxicity occurring in patients treated with chemotherapy for lung cancer. METHODS: In all, 124 patients with lung cancer received cisplatin 70 mg/m2 on day 1 every three weeks for up to six cycles with preventive hydration using 3 L of 0.45% saline. Acute and chronic cisplatin nephropathy were defined as an increase in serum creatinine > or =30% at 3 weeks after each cisplatin administration and an increase in serum creatinine > or = 50% after the six cycles of chemotherapy, respectively. RESULTS: Acute cisplatin nephropathy occurred in 23 of 124, 8 of 110, 6 of 92, 10 of 68, 7 of 59, and 7 of 45 patients after the 1st to 6th cycle of chemotherapy, respectively. In all, 51 patients (51.5%) experienced acute cisplatin nephropathy. Chronic cisplatin nephropathy occurred in 25 out of 45 patients (55.5%). The occurrence of chronic cisplatin nephropathy was significantly associated with that of acute cisplatin nephropathy (p<0.01). In chronic cisplatin nephropathy, the serum creatinine increased to 1.82+/-1.18 mg/dL from the basal 0.82+/-0.11 mg/dL (p<0.01). It was 1.60+/-1.05 mg/dL at the end of the follow-up period (112+/-90 days). CONCLUSIONS: Despite prophylactic hydration, the incidence of cisplatin nephropathy in patients with lung cancer is still high. Acute cisplatin nephropathy may predispose patients to chronic cisplatin nephropathy, but the latter does not seem to be progressive.

Thiazide-Induced Hyponatremia

The importance of thiazide-induced hyponatremia (TIH) is reemerging because thiazide diuretic prescription seems to be increasing after the guidelines recommending thiazides as first-line treatment of essential hypertension have been introduced. Thiazide diuretics act by inhibiting reabsorption of Na+ and Cl- from the distal convoluted tubule by blocking the thiazide-sensitive Na+/Cl- cotransporter. Thus, they inhibit electrolyte transport in the diluting segment and may impair urinary dilution in some vulnerable groups. Risk factors predisposing to TIH are old age, women, reduced body masses, and concurrent use of other medications that impair water excretion. While taking thiazides, the elderly may have a greater defect in water excretion after a water load compared with young subjects. Hyponatremia is usually induced within 2 weeks of starting the thiazide diuretic, but it can occur any time during thiazide therapy when subsequent contributory factors are complicated, such as reduction of renal function with aging, ingestion of other drugs that affect free water clearance, or changes in water or sodium intake. While some patients are volume depleted on presentation, most appear euvolemic. Notably serum levels of uric acid, creatinine and urea nitrogen are usually normal or low, suggestive of syndrome of inappropriate secretion of antidiuretic hormone. Despite numerous studies, the pathophysiological mechanisms underlying TIH are unclear. Although the traditional view is that diuretic-induced sodium or volume loss results in vasopressin-induced water retention, the following 3 main factors are implicated in TIH: stimulation of vasopressin secretion, reduced free-water clearance, and increased water intake. These factors will be discussed in this review.

A Case of Peritoneal Dialysis Peritonitis Due to Methicillin-Resistant Staphylococcus auricularis / 대한신장학회지

Although coagulase-negative staphyloccus is the most common organism causing peritonitis in peritoneal dialysis (PD) patients, only one case of PD peritonitis due to Staphylococcus auricularis, the normal flora of external auditory meatus, has been reported over the world. Here we add a case of PD peritonitis caused by methicillin-resistant Staphylococcus auricularis, which was successfully treated with vancomycin. A 79-year-old male PD patient was admitted because of abdominal pain and cloudy peritoneal fluid. At admission, the exit site was clear, and no rebound tenderness was noted although the abdominal wall was diffusely tender. Gram stain of the peritoneal fluid did not reveal any organism, but white blood cell count was 1,210/mm3, with 80% polymorphonuclear cells and 10% lymphocytes. Empirical antibiotic therapy was started with intraperitoneal cefazolin and ceftazidime. Over the next few days, however, the peritoneal fluid was still turbid and showed an elevated cell count. Then, the result of peritoneal fluid culture identified that the organism was oxacillin-resistant Staphylococcus auricularis. Thus the antibiotics were switched into vancomycin, and intraperitoneal vancomycin 1 gm was administered three times at 5 days' intervals to achieve completely clear peritoneal fluid. Staphylococcus auricularis should be considered as a new potential skin organism causing PD peritonitis.

A Case of Lymphocytic Interstitial Pneumonia Manifested as a Multi-focal Consolidation / 결핵및호흡기질환

Lymphocytic interstitial pneumonia (LIP) is a rare disorder characterized by a diffuse infiltration of the alveolar space, interstitium by lymphocytes, plasma cells, and reticuloendothelial cells. Although its etiology is unknown, LIP has been associated with autoimmune disorders and with viral infections. Because it's clinical and radiographic features are nonspecific, a confirmatory diagnosis is performed by open lung biopsy. A 59-year-old female presented dry cough, which had been present for 1 month. On initial findings of multifocal consolidation at the right middle lobe on both lower lobes in chest radiography, the first diagnosis of cryptogenic organizing pneumonia was suggested. On open lung biopsy, LIP was diagnosed. The patient had no autoimmune disease, viral infection or monoclonal gammopathy. After 3 months of corticosteroid treatment, the patient experienced improved symptoms, reduced abnormalities on chest radiography, and improved pulmonary function testing.

A Case of Recurrent Extramammary Paget's Disease after Kidney Transplantation / 대한신장학회지

The incidence of malignant disease increases in kidney transplant recipients taking immunosuppressive therapy. Extramammary Paget's disease, a very rare dermatologic malignancy, is characterized by frequent recurrences and coexistence with other malignancies. Although skin cancer is the most common malignancy occurring after kidney transplantation, extramammary Paget's disease has not been reported in Korea. In this paper, we report a case of recurrent extramammary Paget's disease after renal transplantation. A 66-year old man, who underwent renal transplantation from a living unrelated donor 15 years ago, was diagnosed to have extramammary Paget's disease 7 years ago. At this admission he was troubled with a pruritic skin lesion in his suprapubic area which previously occurred twice. The recurring Paget's disease was treated with radical resection and coverage. No further recurrences have been developed during the following 12 months until now.

A Case of Resistant Polymyositis That Was Successfully Treated with Tacrolimus / 대한류마티스학회지

Polymyositis is one form of inflammatory myopathy. In some patients, this disease does not entirely respond to conventional initial therapy with glucocorticoid, methotrexate and azathioprine. Multiple options exist for treating these patients, but only intravenous immune globulin has been subjected to a randomized clinical trial. We report here on a case of polymyositis that did not respond to multiple drug therapy, but it did respond to tacrolimus. After treatment with tacrolimus, the patient's disease has been well controlled for many years.

A Case of Recurrent Intestinal Pseudo-obstruction in a Patient with Systemic Lupus Erythematosus / 대한류마티스학회지

Gastrointestinal manifestations are common in systemic lupus erythematosus (SLE). Intestinal pseudo-obstruction (IpO) is a rare, poorly understood and recently recognized gastrointestinal manifestation of SLE. We report a 26-year-old female with SLE for 3 years. 10 months ago, IpO was diagnosed first, and it was responded well to high-dose steroid therapy. After then, oral prednisolone and azathioprine were administered, but the patient had been lost to follow up until recurrence of IpO. She was admitted with diffuse abdominal pain, distension, frequent vomiting, and intermittent dysuria due to recurrent IpO accompanied with bilateral ureterohydronephrosis. Despite of high dose steroid therapy, her symptom and imaging findings were not improved. The patient was treated with pulses of cyclophosphamide, and then the patient's symptoms and signs were gradually subsided. Three weeks following cyclophosphamide therapy, she was able to eat without vomiting and following abdominal CT showed nearly complete resolution of diffuse intestinal distension and bilateral ureterohydronephrosis. High level of awareness of IpO in SLE and appropriate medical treatment is needed to prevent unnecessary surgical treatment. And if this complication is refractory to corticosteroid, active immunosuppressive therapy, such as cyclophosphamide, should be considered.