Prevalence of Anemia and Calcium-Phosphorus Abnormalities in Hemodialysis Patients in Southwestern Seoul / 대한내과학회지

BACKGROUND/AIMS: The number of hemodialysis patients and dialysis centers is increasing each year, but there are no quality standards for facilities. Thus, the Korean Society of Nephrology carried out a pilot project regarding a hemodialysis center accreditation system. This study was aimed at surveying the prevalence of anemia and abnormalities of calcium or phosphorus metabolism in hemodialysis patients in southwestern Seoul. METHODS: We investigated anemia, serum calcium, and phosphorus levels in 1,524 patients in 25 hemodialysis units. The rate of iron injections in patients with iron deficiency was also evaluated. Each item was compared between accredited (n = 12) and non-accredited centers (n = 13). RESULTS: The mean hemoglobin in subjects was 10.5 +/- 1.5 g/dL. The prevalences of anemia and iron deficiency were 27.4% and 25.2%, respectively. The rate of iron injection in patients with iron deficiency was 48.1%. The mean phosphorus level was 5.1 +/- 1.9 mg/dL and the proportion of patients with Ca x P < 55 mg2/dL2 was 70.7%. The prevalence of anemia, iron deficiency, and Ca x P were similar between accredited and non-accredited centers. The rate of iron injection in iron deficiency was higher in accredited (65.6%) than non-accredited centers (30.9%). CONCLUSIONS: Management of anemia and levels of calcium or phosphorus were acceptable in hemodialysis patients in southwestern Seoul, although some facilities should make more efforts to improve iron deficiency. The availability of data from a hemodialysis center accreditation system allowed us a unique opportunity to further explore the relationships between anemia, abnormalities of mineral metabolism, and outcomes.

Prevalence of Anemia and Calcium-Phosphorus Abnormalities in Hemodialysis Patients in Southwestern Seoul / 대한내과학회지

BACKGROUND/AIMS: The number of hemodialysis patients and dialysis centers is increasing each year, but there are no quality standards for facilities. Thus, the Korean Society of Nephrology carried out a pilot project regarding a hemodialysis center accreditation system. This study was aimed at surveying the prevalence of anemia and abnormalities of calcium or phosphorus metabolism in hemodialysis patients in southwestern Seoul. METHODS: We investigated anemia, serum calcium, and phosphorus levels in 1,524 patients in 25 hemodialysis units. The rate of iron injections in patients with iron deficiency was also evaluated. Each item was compared between accredited (n = 12) and non-accredited centers (n = 13). RESULTS: The mean hemoglobin in subjects was 10.5 +/- 1.5 g/dL. The prevalences of anemia and iron deficiency were 27.4% and 25.2%, respectively. The rate of iron injection in patients with iron deficiency was 48.1%. The mean phosphorus level was 5.1 +/- 1.9 mg/dL and the proportion of patients with Ca x P < 55 mg2/dL2 was 70.7%. The prevalence of anemia, iron deficiency, and Ca x P were similar between accredited and non-accredited centers. The rate of iron injection in iron deficiency was higher in accredited (65.6%) than non-accredited centers (30.9%). CONCLUSIONS: Management of anemia and levels of calcium or phosphorus were acceptable in hemodialysis patients in southwestern Seoul, although some facilities should make more efforts to improve iron deficiency. The availability of data from a hemodialysis center accreditation system allowed us a unique opportunity to further explore the relationships between anemia, abnormalities of mineral metabolism, and outcomes.

A Case of Splenic Infarction Complicating Lymphoma

Splenic infarcts are comparatively less common lesions. Caused by the occlusion of the major splenic artery or any of its branches, they are almost always due to emboli that arise in the heart. The spleen, along with the kidneys and brain, ranks as one of the most frequent sites of localization of systemic emboli. Infarcts may be small or large, multiple or single, and sometimes involve the entire organ. Usually these infarcts are of the bland anemic type. Septic infarcts are found in vegetative endocarditis of the valves of the left side of the heart. Much less often, infarcts in the spleen are caused by local thromboses, especially in leukemia, myeloproliferative syndrome, sickle cell anemia, polyarteritis nodosa, Hodgkin's disease, and bacteremic diseases. We experienced a rather unusual splenic infarction due to lymphoma in a 80-year-old man.

Clinical Features and Prognosis of Patients Who Started Hemodialysis Treatment over 60 Years Old

BACKGROUND: Observation on the hemodialysis treatment; whether there are any different effects on mortality rate, side effects, or effectiveness of the treatment depending on patients' age. METHODS: Chronic renal failure patients who started hemodialysis treatment between 2002 and 2003 were separated in two groups, 33 patients of 60 and older and 76 patients under 60. We investigated mortality rate difference, A-V shunt re-operation, and total protein and albumin level. Also, comparing and analyzing the urea reduction ratio, we examined whether effectiveness is different depending on the patients' age. RESULTS: The 3 year survivor rate of patients who initially started hemodialysis treatment over 60 was 66.7%, and that of the patients under 60 resulted as 73.1%. The average total protein lefel for over 60 was 6.48g/dL and for under 60 was 6.80g/dL, and albumin for over 60 was 3.15g/dL and under 60 was 3.46g/dL. We identified that the patients who repeated shunt operation in over 60 group was 4(12%) and in under 60 group was 4(5.2%). Effectiveness of the treatment, Urea Reduction Ratio(URR), for both groups was 71%. CONCLUSION: The 3 year survivor rate of patients who initially started hemodialysis treatment over 60 was lower than the control group, but considering the remaining life expectancy, it seems to be no significant difference between the groups; and the treatment effectiveness was same in both groups.

The Clinical Observation of Glomerulonephritis in the Elderly

BACKGROUND: The glomerulonephritis appears in various clinical presentations. Renal biopsy is important diagnostic tool for treatment decision and prognosis prediction of glomerulonephritis. We tried to study on the clinical presentations of glomerulonephritis through histopathological findings and treatment responses in elderly patients. METHODS: We made an retrospective analysis in elderly patients aged over 60 years performed renal biopsy in our medical center from January 1991 to February 2005. RESULTS: Of all the 42 patients, the mean age of the patients was 64.6+/-3.5 years, 24 male and 18 female patients were included(1.3:1). Patients aged 60-64 years (n=26, 62%) were majority. On clinical indications of renal biopsies, 17 patients had nephrotic syndrome, 10 had asymptomatic urinary abnormality, 5 had gross hematuria, and 5 had acute azotemia. The results of renal biopsies presented that 30 patients (71%) had primary glomerulonephritis, 9 patients (22%) had secondary glomerulonephritis. Among primary glomerulonephritis, membranous nephropathy (n=10) was most common, followed by IgA nephropathy (n=7),focal segmental glomerulos-clerosis (n=3), membranoproliferative glomerulonephritis (n=2), and mesangioproliferative glomerulonephritis (n=2). In secondary glomer-ulonephritis, there were diabetic nephropathy (n=2), lupus nephritis (n=2), cancer-related nephritis (n=2), poststreptococcal glomer-ulonephritis (n=1), Henoch-Schonlein nephritis (n=1), amyloidosis (n=1). In the cases of nephrotic syndrome, primary nephrotic syndrome (n=12, 71%) is more prevalent than secondary nephrotic syndrome (n=3, 18%). The most common cause of primary nephrotic syndrome was membranous nephropathy (n=8). The causes of asymptomatic urinary abnormality were IgA nephropathy (n=4), lupus nephritis (n=2), membranous nephropathy (n=1), mesangioproliferative glomerulonephritis (n=1). By the complications of renal biopsy, only a few patients presented new-onset hematuria, hematoma, aggravation of hypertension, but, severe complication including an infection or a death was none. 8 of 12 patients with primary nephrotic syndrome were treated, 5 patients of those were shown complete response (n=3) or partial response (n=2). CONCLUSION: Various clinical presentations of glomerulonephritis were shown to elderly patients. Number of complications after renal biopsies were relatively small, and good responsiveness to treatment could be expected in the elderly patients. Therefore it is reasonable to perform a renal biopsy if indicated.

A Case of Acute Renal Failure due to Rhabdomyolysis Associated with Dermatomyositis in Breast Cancer / 대한신장학회잡지

Dermatomyositis is a clinical syndrome of unknown etiology characterized by a nonpurulent inflammatory myopathy involving striated skeletal muscle associated with rheumatoid arthritis, or systemic lupus erythematosus, sometimes underlying malignancy. A few cases of acute renal failure due to rhabdomyolysis in dermatomyositis has been reported. But, no case combined with breast cancer have been reported. We experienced a case of acute renal failure due to rhabdomyolysis associated with dermatomyositis. The patient was admitted to the our hospital due to breast cancer. After breast cancer operation, she complained of progressive muscle weakness. The heliotrope rash involved the eyelid, bridge of nose and forehead. And eczematoid dermatitis involved the lower abdomen and both forearm and hands. The laboratory findings revealed LDH 2,944IU/L, CPK 2,244IU/L and SGOT 214IU/L. Serum myoglobin and aldolase were increased, and antinuclear antibody was 1:40(positive, homogenous pattern). Electromyogram revealed myopathic findings compatible with dermatomyositis. Then, the patient developed acute renal failure requring hemodialysis. After acute hemodialysis, acute renal failure resolved. But, the patient died on the 113th hospital day due to sepsis. Here, we report a case of acute renal failure due to nontraumatic rhabdomyolysis associated with dermatomyositis in breast cancer.

The Effect of Non-Ionic Contrast Media on Q-T Interval and ST-T Wave of ECG during Coronary Angiography

BACKGROUND: During coronary angiography, some electrocardiographic changes occured due to contrast media, which do life threatening influences. METHODS: We compared the electrocardiographic changes which were induced by injection of three radiopaque contrast media during selective coronary angiography in 49 patients with chest pain. One of the contrast media was high osmolar ionic(Urografin_76) and the another was low osmolar ionic(Hexabrix) and the last was non-ionic(Ioversol). Electrocardiograms were obtained before, during and after selective coronary angiography. RESULTS: The changes of S-T segment or T were decreased in non-ionic group rather than high osmolar or ionic group. And there was significant Q-Tc interval prolongation among all three groups except comparision of low osmolar ionic contrast dye and non-ionic contrast dye in left coronary angiography. CONCLUSION: Non-ionic low osmolar contrast media was safer than high osmolar or ionic contrast medial because of lesser change of Q-Tc interval during selective coronary angiography.

Clinical Study of Risk Factors in Patients with Acute Myocardial Infarction

BACKGROUND: The major risk factors such as hypercholesterolemia, hypertension, diabetes melitus and cigarrete smoking have not been studied in an attempt to provide a composition of major risk factors in Korea. Also we have met with some patients without major risk factors. METHODS: A Retrospective Study was done on 160 patients of acute myocardial infarction who had been admitted to National Medical Center within 48 hours from onset, from January 1948 to December 1992 and studied on major risk factors of acute myocardial infarction. RESULTS: 1) Among major risk factors, smoking was found in 50%, hypertension in 49%, diabetes in 25% and hypercholesterolemia in 21%. 2) The percentage of patients without major risk factors was 19%. 3) Among major risk factors, hypertension, hypercholesterolemia and diabetes were increasing tendencies, recentely. CONCLUSION: Some patients with acute myocardial infarction don't have any major risk factors. Also hypertension, hypercholesterolemia and diabetes were increasing tendencies. So further study for other risk factors is needed and preventive management should require a commitment to behavior modification and alteration in life-style.