Short Communication: Links between Dental Hygiene Curriculum and Dental Hygiene Task Analysis / 치위생과학회지

Background@#The problem with current dental hygienist education is that it operates as an education system based on the national examination rather than on a practical basis; thus, graduates have difficulties in practice after obtaining their license. This study aimed to propose a job-oriented curriculum by analyzing the links between the task analysis of Korean dental hygienists and dental hygiene learning goals. @*Methods@#This study performed a relationship analysis based on a second job analysis study of dental hygienists conducted by the Korea Health Personnel Licensing Examination Institute and the learning goals of the Korean Dental Hygiene Faculty Association. @*Results@#Based on the links between the task and learning goals of the dental hygienist, they were classified into six types: 1) tasks listed in the license exam and learning goal, 2) tasks not listed in the license exam but listed in learning goals, 3) tasks not listed in learning goals, 4) learning goals not related to tasks, 5) learning goals listed in a few tasks, and 6) tasks related to several learning goals. The results showed that most of them correspond to the 5th classification, followed by the 3rd and 4th categories, which are mostly basic science learning goals. Tasks without learning goals are not included in the curriculum; thus, the curriculum needs to be supplemented. The overlapping learning goals of several subjects for one job skill must be reduced in job-oriented education. @*Conclusion@#We suggest that the dental hygiene curriculum be developed based on task analysis and reflected in the national dental hygienist exam. The clinical practice performance of dental hygienists will take further leap forward through task-oriented education.

A patient with multiple arterial stenosis diagnosed with Alagille syndrome: A case report

Alagille syndrome (AGS) is a rare autosomal dominant inherited disorder, with major clinical manifestations of bile duct paucity, cholestasis, cardiovascular anomaly, ophthalmic abnormalities, butterfly vertebrae, and dysmorphic facial appearance. It is caused by heterozygous mutations in JAG1 or NOTCH of the Notch signaling pathway presenting with variable phenotypic penetrance and involving multiple organ systems. The following case report describes a unique case of a 16-year-old female with AGS who presented with the primary complaint of renovascular hypertension. She had a medical history of ventricular septal defect and polycystic ovary syndrome. The patient had a dysmorphic facial appearance including frontal bossing, bulbous tip of the nose, a pointed chin with prognathism, and deeply set eyes with mild hypertelorism. Stenoocclusive changes of both renal arteries, celiac artery, lower part of the abdominal aorta, and left intracranial artery, along with absence of the left internal carotid artery were found on examination. Whole exome sequencing was performed and revealed a pathologic mutation of JAG1, leading to the diagnosis of AGS. Reverse phenotyping detected butterfly vertebrae and normal structure and function of the liver and gallbladder. While the representative symptom of AGS in most scenarios is a hepatic problem, in this case, the presenting clinical features were the vascular anomalies. Clinical manifestations of AGS are diverse, and this case demonstrates that renovascular hypertension might be in some cases a presenting symptom of AGS.

A Case Report of Bilateral Retinal Racemose Hemangioma Restricted to Peripapillary Area

PURPOSE: The authors of the present case report observed a bilateral retinal racemose hemangioma which was located within the peripapillary area. CASE SUMMARY: A 17-year-old man presented with floaters in both eyes. Fundus revealed tortuous and anastomosed retinal vasculature around the optic disc. In addition, fluorescein angiography showed a non-leaking retinal arteriovenous anastomosis. Seven years after the initial visit, vitreous hemorrhage occurred in the patient's left eye, and then 1 year later, subretinal hemorrhage was found in his left eye. CONCLUSIONS: Because retinal racemose hemangioma can accompany vitreous hemorrhage and subretinal hemorrhage regardless of size, a routine periodic ophthalmic examination is recommended.

Hemodialysis Using Heparin Bound Hemophan Hemodialysis in ESRD Patients at High Risk for Bleeding: A Seven-Year Experience / 대한신장학회잡지

OBJECTIVE: Positively charged N, N-diethyl-aminoehtyl groups on Hemophan enable negative charged heparin to be bound with the dialyzer membrane and hemodialysis using heparin bound Hemophan (HBH- HD) could be a hemodialysis modality in patients at risk of bleeding. We designed simplified heparin binding technique and evaluated the bleeding risk and efficiency of HBH-HD in chronic renal failure patients at risk of bleeding. METHODS: During the period from April 1995 through April 2002, 159 patients at high bleeding risk received 1057 HBH-HD (dialyzer: GFS plus 11, Gambro). The duration of each HBH-HD was standardized to 4 hours at blood-flow rate of 200-250 mL/min. To evaluate safety of HBH-HD, we measured serum heparin concentration (HC) and activated partial thromboplastin time (aPTT) at baseline, 15, 60, 120 minutes and endpoint (240 minutes) (n= 40). To evaluate the dialysis efficiency, HBH-HD and routine hemodialysis with systemic heparinization (R-HD) were compared for total blood compartment volume (TBCV) loss, dialyzer urea clearance (K) and Kt/V in same study group patients (n=20). RESULTS: Clotting of dialyzer necessitating termination of dialysis occurred in 11 (1.0%) out of 1, 057 dialyses at 150 minutes, and clotting requiring change of blood line occurred in 64 dialyses (6.1%) between 150 and 230 minutes. There was a slight increase in the aPTT (mean+/-SD, 49.8+/-10.5 sec) and HC (0.14+/-0.06 U/mL) at 15 min, compared to predialysis levels of 44.3+/-12.9 sec and 0.11+/-0.06 U/ mL, respectively (p>0.05). But no increase in aPTT, HC was observed in measurements at 60 min, 120 min, and at the endpoint. TBCV loss was significantly higher in HBH-HD (mean+/-SD, 17.2+/-9.6%), compared to R-HD (2.8+/-1.2%) (p0.05). CONCLUSION: HBH-HD could be a safe and efficient HD technique in patients at high risk of bleeding. Extracorporeal clotting, however, should be observed carefully during HBH-HD.

Plasma total homocysteine and folate concentration in patients with chronic renal failure and renal transplant recipients / 대한내과학회지

BACKGROUND: A few articles reported that the plasma total homocysteine(tHcy) concentration of renal transplant recipients(RTR) was higher than that of normal controls, but lower than that of patients with chronic renal failure. But renal function of the RTR was variable, and plasma tHcy concentration of RTR with normal renal function was unknown. We compared plasma tHcy concentration of RTR with normal renal function to normal controls and evaluated the relation between folate concentration, the independent factor of plasma tHcy concentration, and plasma tHcy in patients with chronic renal failure in predialysis, hemodialysis(HD) and continuous ambulatory peritoneal dialysis(CAPD). METHODS: We measured fasting plasma level of total homocysteine by high-performance liquid chromatography and folate concentration in 36 predialysis CRF patients(Ccr<25mL/min), 37 HD patients, 28 CAPD patients, 41 RTR(serum creatinine< or =1.4mg/dL) and 37 healthy controls. RESULTS: 1)Mean(+/-SD) tHcy concentration in predialysis CRF(21.93+/-14.33micromol/L), HD(18.24+/-8.73micromol /L) and CAPD(17.16+/-7.8micromol/L) patients was significantly higher than that in controls (8.91+/-4.11micromol/L, P<0.05) but tHcy concentration of RTR group(8.99+/-3.99micromol/L)had no difference from that of normal controls 2)In predialysis patients, CAPD patients, and HD patients showed a significant negative correlation between serum folate and plasma tHcy concentrations (r=-0.18, p<0.05). 3)In predialysis, HD and CAPD patients, mean plasma folate concentration in patients with 1mg/ day-folate supplementation(20.41+/-15.65ng/mL) was higher than patients without 1mg/day-folate supplementation (10.20+/-8.24ng/mL)(p<0.05) and mean plasma tHcy concentration in patients with 1mg/day-folate supplementation (17.87+/- 7.94micromol/L) was lower than patients without 1mg/day-folate supplementation(21.87+/-13.35micromol/L)(p<0.05). CONCLUSION: Plasma tHcy concentration in RTR with normal renal function had no difference with that in normal controls. In predialysis, HD, and CAPD patients, plasma tHcy had negative correlation with plasma folate concentration and plasma tHcy in patients with 1mg folate supplementation, usual dose in chronic renal failure, was higher than that in patients without folate supplementation and lower than that in normal controls.

Dietary protein intake(DPI) and Nutritional Indices in Predialysis Patients with Different Stages of Chronic Renal Insufficiency / 대한신장학회잡지

Although dietary protein restriction may protect against progression of renal failure, it is important to consider whether protein restriction can be attained without inducing malnutrition. We assessed the calculated dietary protein intake(cDPI) by 24 hour urinary collection and food intake, biochemical nutritional indices and the results of anthropometric measurement in 83 predialysis patients with different stages of chronic renal failure(CRF) and 84 controls. Dietary interventions were minimal. We categorized patients into three groups according to whether their creatinine clearance(Ccr) was greater than 25(group A), 10 to 25(group B), or less than 10ml/min(group C). 1) The mean(+/-SD) cDPI was significantly lower in group C(0.77+/-0.17g/kg/day) and group B(0.84+/- 0.16g/kg/day) than in group A(1.04+/-0.21g/kg/day) and controls(1.14+/-0.22g/kg/day)(P<0.05). The mean (+/-SD) high biologic value protein intake was significantly lower in group C(0.29+/-0.25g/kg/day) and group B(0.39+/-0.27g/kg/day) than in group A (0.48+/-0.35g/kg/day)(P<0.05). The cDPI(r=0.50, P< 0.05), high biologic value protein intake(r=0.39, P< 0.05) were positively correlated with the Ccr. 2) The mean (SD) total lymphocyte count (TLC) was significantly lower in group C(1,554+/-368/mm3) and group B(1,972+/-470/mm3) than in group A(2,111+/-540/mm3) and controls(2,177+/-589/mm3)(P<0.05). The TLC was positively correlated with the Ccr(r= 0.28, P<0.05). The levels of albumin and transferrin were lower in patients with CRF than in controls (P<0.05). There was no difference in the levels of albumin, transferrin, prealbumin, insulin-like growth factor-1, cholesterol and anthropometric measurements among the different stages of CRF. CONCLUSION: In predialysis patients with CRF, the dietary protein and high biologic value protein intake spontaneously decreases as renal function declines. Several nutritional indices, such as TLC, albumin and transferrin were lower in predialysis patient with CRF than controls. Therefore objective measurement of DPI should be considered to educate a low protein diet in predialysis patients with CRF.

Estimation of Creatinine Clearance in Patients with Malignancy / 대한신장학회잡지

No abstract available.

Apolipoprotein E Gene Polymorphism and Plasma Lipid Levels in Male Korean Patients with Chronic Renal Failure / 대한신장학회잡지

Accelerated atherosclerosis is not only a frequent complication but also the most common cause of death in patients with chronic renal failure (CRF). Although mechanisms are unclear, disorder of lipid metabolism may be a major factor. Since apolipo-protein (apo) E is known to play a major regulatory role in lipid metabolism, we evaluated apo E genotype in 72 male patients with CRF and compared with that in 194 rnale normal controls. In addition, we measured plasma lipid and apolipoprotein concentrations and evaluated them according to apo E genotype in patients and controls. Apo E genotype was determined with the INNO-LiPA Apo E kit (Innogenetics, Belgium), which is based on reverse hybridization. The results are as follows ; 1) The distribution of the three major apo E alleles in patients with CRF ( e 2: 6.2%, e 3: 80.6%, e 4: 13.2%) was not different from that in controls ( e 2: 4.1%, e 3: 87.6%, e 4: 8.3%). 2) In patients with CRF, total cholesterol, lowdensity lipoprotein (LDL) and high-density lipoprotein (HDL) levels were significantly lower and the triglyceride and lipoprotein (a) levels were significantly higher than those in controls. 3) In controls, E 4/3 group had significantly lower levels of HDL than E 3/3 and E 3/2 groups. In patients with CRF, E 4/3 group had significantly higher levels of total cholesterol and apo B lipoprotein than E3/2 group. In conclusion, although there was no significant difference in the apo E genotype frequencies between male patients with CRF and controls, apo E polymorphism may play an important role in the determination of individual differences in plasma lipids in male patients with CRF.

Minimal Change Disease and Focal Segmental Glomerulosclerosis in Identical Twin Brothers / 대한신장학회잡지

The simultaneous occurrence of primary glomerulonephritis in identical twins has been rarely reported previously. It has suggested that genetic factors may play an important role in the pathogenesis of primary glomerulonephritis. We describe a pair of 17-year-old identical twin brothers with asymptomatic proteinuria, one with histologically proven minimal change disease and the other with focal segmental glomerulosclerosis. HLA typing in twin brothers revealed an identical phenotype consisting of A25, A33, B44, B54, Cwl, Cw7, DR7 and DRB1. To our knowledge, this is the first case of glomerulonephritis in identical twins in Korea.

A Case of Spontaneous Repture of Renal Artery Aneurysm in Polyarteritis Nodosa / 대한신장학회잡지

Although renal aneurysmal formation in polyarteritis nodosa is common, it is rare to form complication of perirenal hematoma caused by spontaneous rupture of renal aneurysm. It should be differentiated from renal tumor, arterio-venous malforrnation, renal infarction, coagulopathy, and acute hydronephrosis in considering the cause of perirenal hematoma. In addition to that, it is a potential life-threatening complication and its early recognition and prompt treatrnent are emphasized. We describe a patient with polyarteritis nodosa who developed spontaneous perinenal hematoma due to repture of renal aneurysm, who had nonspecific symptoms. We thought polyarteritis nodosa based on present illness and clinical background, then immediately performed angiography and coil embolization. So the patient could be treated with cyclophosphamide and steroid successfully. Polyarteritis nodosa is a relatively rare disease, but should be included as one of the differential diagnosis whenever perirenal hematoma occurs.

A Case of Renal Hypouricemia and Hypercalciuria / 대한신장학회잡지

We encountered a case of renal hypouricemia and absorptive hypercalciuria. Although renal hypouricemia is asymptomatic as usual, it is rarely complicated with acute renal failure and urolithiasis. A 43-year-old man had hypouricemia (serum uric acid, 0.6-1.0mg/dl) with an increased renal uric acid clearance (69.4ml/min), hypercalciuria (367.2mg/day). In present case, there was no response of uric acid excretion to either pyrazinamide or probenecid and hypercalciuria disappeared after calcium restriction diet. These results suggest that the present case had the defect of both pre-and postsecretory reabsorption of uric acid and absorptive hypercalciuria.

Clinical Feature and Response to Plasma Exchange in Adult Patients with Diarrhea-associated Hemolytic Uremic Syndrome (D+HUS) / 대한신장학회잡지

Diarrea-associated hemolytic uremic syndrome (HUS) is very rare in adults. Few reports are available on clinical features and plasma exchange in adult patients with diarrhea-associated HUS in Korea. We retrospectively examined the records of five adult patients with diarrhea-associated HUS admitted to Samsung Seoul Hospital between January 1995 and December 1997. If the patient had neurologic abnormalities, or there was rapid clinical deterioration, with the hematocrit decreasing below 20%, the platelet count falling below 10,000/mm3, the creatinine concentration increasing above 5.0 mg/dl, plasma exchange was begun. There were 4 females and 1 male. Patients ranged in age from 16 to 61 years. All patients presented with diarrhea and abdominal pain, and 3 patients had bloody diarrhea. The mean time between the onset of diarrhea and thrombocytopenia was 4.4+/-1.9 days (range, 1 to 6). All patients received 7 to 24 plasma exchanges. The mean exchanged plasma volume was 1.1+/-0.2 times of patients own plasma volume. The pattern of clinical response to plasma exchange was initial normalization of platelet count (8.0+/-3.8 days), followed by normalization of LDH level (20.2+/-14.5 days) and creatinine concentration (25.8+/-13.8 days). Metabolic alkalosis developed in two patients undergoing daily plasma exchange. We successfully managed the metabolic alkalosis with continuous venovenous hemofiltration. The mean duration of hospitalization was 28.8+/-11.2days (range, 20 to 42). All patients successfully recovered without any sequale. Although this study is based on small case series, we suggested that plasma exchange may improve the outcome in adult diarrhea-associated HUS.

A Case of Langerhan's Symbol 146/f "Times New Roman" Cell Histiocytosis with Diabetes Insipidus / 대한신장학회잡지

Central diabetes insipidus (CDI) is a clinical syndrome that result from a failure of the neurohypophyseal axis to produce or release a sufficient quantity of arginine vasopressin (AVP) to permit normal function of the urinary concentrating mechanism. Polyuria and polydipsia are the symptoms associated with CDI. The most common cause of CDI is idiopathic variety and head trauma, neurohypophyseal surgery, primary or metastatic brain tumors acount for most of the remaining cases. CDI in Langerhans cell histiocytosis (LCH) is thought to be to infiltration of the hypothalamus-neurohypophyseal system. We report a patient with CDI and LCH underwent water depriviation test, MR imaging of the pituitary-hypothalamic region, and VATS associated open lung biopsy.

Coexistence of Membranous Glomerulonephritis and IgA Nephropathy in a Patient with Psoriasis Vulgaris / 대한신장학회잡지

A 17-year-old man with psoriasis developed albuminuria and microscopic hematuria. Renal biopsy revealed a glomerulonephritis with features of both membranous glomerulonephritis and IgA nephropathy. Histologically the glomeruli exhibited variable degree of mesangial expansion and hypercellularity, three of which showed segmental hyalinosis and/or sclerosis. Direct immunofluorescence demonstrated granular IgG-bearing deposits along the peripheral glomerular capillaries and IgA deposits in the mesangium. His urinary abnormalities persisted after the remission of skin lesion induced by PUVA treatment. It suggests that although the psoriasis may induce the renal lesion, it is insufficient to treat only the skin lesion for clinical improvement of glomerulonephritis after the renal lesion is already established.

Plasma Total Homocysteine Concentrations in Patients with Chronic Renal Failure / 대한신장학회잡지

Hyperhomocysteinemia, an independent risk factor of vascular disease, is common in patients with chronic renal failure(CRF) patients including dialysis patients. We measured fasting plasma concentrations of total homocysteine(tHcy) by high-performance liquid chromatography in 114 chronic renal patients and 37 healthy controls. The CRF patients were divided into four groups : chronic renal failure with serum creatinine >1.4mg/dl and creatinine clearance >10ml/min(CRF group, n=27), non-dialyzed ESRD patients with creatinine clearance <10ml/min(ESRD group, n=38), patients on maintenance hemodialysis(HD group, n=20) and patients on continuous ambulatory peritoneal dialysis(PD group, n=29). Mean(+/-SD) tHcy in each of CRF(14.2+/-5.6micromol/L), ESRD(21.6+/-14.1micromol/L), HD(21.0+/-9.2micromol/L) and PD(17.2+/-7.7micromol/L) group was significantly higher than that in controls(9.0+/-3.1micromol/L, P=0.001). In 87 ESRD, HD and PD patients, mean(SD) tHcy in 45 patients who received routine folate supplementation (1mg/day) was lower(17.5+/-8.3micromol/L) than that in 42 patients without supplementation(22.6+/-13.4micromol/ L, P=0.03), but was higher than that in controls (9.13.1micromol/L, P=0.001). In conclusion, hyperhomocysteinemia was present in patients with varying degree of chronic renal failure and increased in parallel with progression or renal failure.

Anticardiolipin Antibody (ACA) and Lupus Anticoagulant (LA): Association with Vascular Access Occlusion in Hemodialysis (HD) Patients / 대한내과학회지

OBJECTIVES: Anticardiolipin antibody (ACA) and lupus anticoagulant (LA) are acquired antiphospholipid antibodies (APAs), which are regarded as important risk factors far vascular thrombosis and recurrent fetal loss. Although the clinical relevance of APAs in dialysis patients is uncertain, recent studies have suggested that APAs are involved in bioincompatibility and thrombogenic complications in hemadialysis (HD) patients. METHOD: We performed a cross sectional study of ACA and LA in 50 stable HD patients and their 68 vascular accesses (52 native arteriovenous fistulae and 16 synthetic arterovenous grafts), with the analysis of factors associated with the presence of APAs and the retrospective evaluation of vascular access occlusion (VAO). LA was assessed by platelet neutralization method whereas IgG-ACA was measured by a solid phase ELISA. Values higher than 23GPLU/ml (IgG phospholipid units) were considered to be positive for IgG-ACA and positive values for LA was more than 8 seconds in prolongation of the clotting time with human platelet lysate. Vascular access survival was assessed by Kaplan- Meier method, RESULTS: The mean age of the subject (M:F 21:29) was 46 years and the mean duration of hemodialysis was 49 months. The frequency of VAO in entire subjects was 0.45+/-0.98 episodes/patient year. The median value of IgG-ACA was 16.0 GPLU/ml with a distribution from 2.7 to 46.1GPLU/ ml. The median titer of I.A was 4.5 (3.1-45.6) seconds. Fourteen patients (28%) were found to have at least one episode of VAO. In spite of comparable clinical and biochemical data according to the presence of VAO, the titers of IgG-ACA (13.6+/-7.7 vs, 20.3+/-8.7GPLIJ/ml, P<0.05) and LA (4.5+/-2.9 vs. 11.7 +/-12.6sec, P<0.05) were significantly higher in VAO group. Six out of 50 patients(12%) had an increased titer of IgG-ACA and LA was found in 11 patients(22%). No patients were positive for ACA and LA simultaneously. There was no significant difference in sex, etiology of ESRD, diabetic status, the dosage of heparin during HD or the amount of erythropoietin administered according to the presence of APAs. We could not find any significant correlation between the titer of APAs and age, duration of dialysis, blood pressure, platelet count and biochemical parameters. In the patients with positive ACA, the frequency of VAO was 1.05+/-0.12 episodes/patient year, which was significantly higher than patients without ACA (0.33+/-0.17 episodes/ patient year, P<0.05). In the patients with the presence of LA(1.06+/-0.43 vs. 0.12+/-0.06 episodes/ patients year, P<0.01). The median vascular access survival time in IgG-ACA positive patients (32.7 months) was significantly decreased compared to 66.8 months in IgG-ACA negative group. CONCLUSION: Our data suggest that the presence of APAs (ACA and/or LA) affects the event-free vascular access survival in HD patients. Therefore the evaluation of APAs status have to be included in the diagnostic strategies for the patients with recurrent VAO. Further studies are necessary to explore the pharmacologic intervention method to decrease APAs and prevent VAO in HD patients.

Plasma Exchange with Cryosupernatant in the Patient with Refractory Hemolytic Uremic Syndrome / 대한신장학회잡지

Many patients with Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome(TTP-HUS) satisfactorily respond to plasma exchange. Some patients, however, respond either not at all or only transiently and incompletely. In the refractory case, endothelial cell-derived unusually large von Willebrand factor multimers(ULvWFM) have an important role in the formation of microthrombi. As the ULvWFM may be removed in the cryoprecipitate, we reason the plasma depleted of cryoprecipitate(the plasma cryosupernatant) should be considered for effectiveness in the treatment of refractory TTP- HUS. We experienced a 48 year old woman presented with diarrhea, jaundice and oliguria. She had microangiopathic hemolytic anemia, renal impairment, platelets of 21,000/mm3 and LDH 3,258U/L. She had not improved after plasma exchange with fresh frozen plasma(FFP)(1.5 plasma volumeX7 days). On hospital day 8, her HUS had not responded, platelets of 37,000/mm3 and LDH 1,588U/L. Substitution of cryosupernatant for FFP was associated with prompt increased in the platelet count to normal and complete resolution of HUS. Therefore. the cryosupernatant fraction of plasma should be considered as an alternative to whole FFP for plasma exchange if there is continuing platelet consumption and microvascular thrombosis in spite of intensive conventional plasma therapy.

Hemodialysis Using Heparin Bound Hemophan in Chronic Dialysis Patients with High Risk of Bleeding / 대한신장학회잡지

Systemic anticoagulation in routine hemodialysis is not desirable in patients with high risk of bleeding. Since heparin can bind to Hemophan, we evaluated the risk of bleeding and efficiency of hemodialysis using heparin bound Hemophan membranes in patients with high risk of bleeding. Heparin solution (1liter, 20IU/ml saline) was recirculated through the Hemophan(Gambro dialyzer, GFS Plus 11) for 1hour while removing saline solution(700ml/hr) by application of transmembrane pressure gradient, followed by a single pass rinse with 1 liter of saline solution. As a pilot study, we performed 17 hemodialyses on 15 chronic dialysis patients with contraindication to systemic anticoagulation. The duration of each dialysis was standardized to 4 hours at blood flow of 200 to 250ml/min. Blood samples were obtained to measure activated partial thromboplastin time (aPTT), and heparin concentrations (HC) before dialysis, at 15min, 60min, 120min after initiation of dialysis and at the end (240min) of dialysis. Dialysis efficiency was assessed by measuring Kt/V and urea clearance of dialyzer (K) by the direct quantification of dialysate urea and then compared with the 25 control dialyses with systemic anticoagulation. We successfully completed all 17 hemodialyses without severe clotting defined as, requiring replacement of the dialyzer and/or the extracorporeal blood lines. There was a slight increase in the aPTT (mean+/-SD, 42.9+/-4.4sec) and HC (0.15+/-0.03IU/ml) taken at 15min from predialysis levels of 36.3+/-6.3sec and 0.11+/-0.03U/ml, respectively. But no increase in aPTT, HC was observed in measurements taken at 60min, 120min, and at the end of dialyses. The value (mean+/-SD) of Kt/V and K was 1.27+/-0.25 and 134+/-19ml/min respectively, which did not differ from those of the control dialyses which was 1.24+/-0.21 and 136+/-13ml/min respectively. We performed 82 hemodialyses using such treated Hemophan on 27 patients for 4 hours basing the result of the pilot study. Clotting of dialyzer necessitating termination of dialysis occurred in 1 dialysis(1.2%) at 150min and clotting in the venous blood lines requiring change of blood lines occurred in 6 dialyses(7.3%) on 4 patients from 180min to 230min after initiation of dialysis. We conclude that the use of heparin bound Hemophan can be a safe and effective technique of hemodialysis with careful monitoring of extracorporeal clotting in patients with high risk of bleeding.

Comparison of Dialysis Efficiency Between Hemodialysis Using Heparin Bound Hemophan and Routine Hemodialysis with Systemic Heparinization / 대한신장학회잡지

Although hemodialysis using heparin bound Hemophan(HBH-HD) has been reported to be a possible modality that can be used in patients at high risk of bleeding, the efficiency of HBH-HD is not certain. To investigate the efficiency of HBH- HD, we compared the total blood compartment volume(TBCV), Kt/V and urea clearance of dialyzer(K) of HBH-HD with those of routine hemodialysis with systemic heparinization(R-HD) in the same patients. HBH-HD was switched to R-HD as soon as the bleeding risk had ceased. Before each HBH-HD, heparin solution(1liter, 20IU/ml saline) was recirculated through the Hemophan(Gambro dialyzer, GFS Plus 11) for 1 hour while removing saline solution(700ml/hr) by applying transmembrane pressure gradient, followed by a single pass rinse with 1 liter of saline solution. Then we performed 10 HBH-HD on 10 patients at risk of bleeding. The dilayzer had to be changed due to severe clotting in one patient during HBH-HD so the comparison of above parameters was possible in 9 patients. The duration of each dialysis was possible in 9 patients. The duration of each dialysis was standardized to 4 hours at blood flow of 200 to 250ml/min. During HBH-HD, there was a slight increase in activated partial thromboplastin time(aPTT)(45.02.6 sec) at 15 min after initiation of dialysis from predialysis level (35.81.3 sec), but no increase in aPTT was observed at 60min, 120min, and the end of dialyses. The loss of TBCV(%) of dialyzers was greater in HBH-HD (174%) than in R-HD(51%). The Kt/V and K of HBH-HD, however, were 1.25+/-0.10 and 143+/-3ml/ min, respectively, which did not differ from those of R-HD which were 1.28+/-0.07 and 145+/-4ml/min, respectively. We conclude that the use of heparin bound Hemophan can be an efficient hemodialysis technique in patients at high risk of bleeding, but clotting of the dialyzer should be observed carefully during hemodialysis(values are mean+/-SE).