Efficacy of Protocol-based Erythropoietin Administration in Chronic Hemodialysis Patients / 대한신장학회잡지

BACKGROUND: Anemia is a major contributor to morbidity and mortality in chronic renal failure patients. The benefits of anemia correction using recombinant human erythropoietin (Epo) are well established but because of high cost, several studies increasing the efficacy of it were described. The objective of this study was to evaluate the efficacy of an anemia management protocol using subcutaneous Epo and intravenous iron therapy. METHODS: We enrolled seventy-eight maintenance hemodialysis patients for at least 3 months from January 2000 to November 2002. They received a practice of anemia correction in two other settings. One (control) group performed an irregular administration of Epo and iron, the other (protocol) group performed a regular administration according to anemia management protocol. Clinical and laboratory parameters were analyzed. Dosage of Epo and IV iron were compared. RESULTS: Thirty-one patients in control group and forty-seven patients in protocol group were enrolled. There were no significant differences between two groups in age, gender, existence of diabetic mellitus, vintage of hemodialysis, use of angiotensin-converting enzyme inhibitor, BUN, prealbumin, parathyroid hormone and Kt/Vurea. Mean arterial pressure, creatinine and albumin were significantly lower and hematocrit was significantly higher and well-maintained on the target level in protocol group. There were no significant differences in serum iron, transferrin saturation, ferritin but total iron binding capacity was significantly lower in protocol group. Doses of erythropoietin and IV iron showed no significant differences between two groups. CONCLUSION: The protocol based erythropoietin administration was more efficient in achieving target hematocrit without increment of dosage of erythropoietin and intravenous iron and side effect of hypertension.

Adequacy of Individualized Heparinization during Hemodialysis / 대한신장학회잡지

BACKGROUND: Most chronic hemodialysis units select heparin doses on an empirical basis. Too little heparin causes clotting in the extracorporeal circuit and too much heparin may lead to excessive bleeding. We conducted a prospective, randomized, repeated cross over study to evaluate the effect of two different heparin regimens. The empirical standard dose regimen (empirical heparinization, EH) was used for all patients, and the individualized dose regimen (individualized heparinization, IH) determined by measuring the activated clotting time (ACT) was performed for more adequate heparinization during hemodialysis. METHODS: Twenty-four outpatients with systemic heparinization who had been on hemodialysis for more than 3 months were enrolled. In both METHODS, anticoagulation was achieved with a loading dose and a continuous infusion of heparin. Each regimens were prescribed alternately, and repeated after 2 weeks later. The study evaluated pre-post dialytic Hgb, Hct, Platelet and predialytic albumin, heparin loading dose and infusion rate, ACT, total blood compartment volume (TBCV), visible blood clots, bleeding, pre-post dialytic and next predialytic BUN, predialytic Cr, URR, Kt/Vurea. RESULTS: Twenty-two patients were analyzed in this study. Pre-post dialytic Hgb, Hct, Platelet and predialytic albumin, heparin loading dose were not significantly different between two methods. But heparin infusion rate were significantly increased in individualized heparinization than in empirical heparinization. Activated clotting times were prolonged and maintained adequately in individualized heparinization during hemodialysis. The loss of TBCV and visible blood clots were significantly decreased in individualized heparinization than in empirical heparinization. There was no bleeding complication in two methods. Pre-post and next predialytic BUN, predialytic Cr, URR, Kt/Vurea were not significantly different between two methods.0.CONCIUSION: We concluded that the individualized heparinization can maintain adequate anticoagulation than the empirical heparinization without any other problems and compromising the delivery dose of dialysis.

Adequacy of Individualized Heparinization during Hemodialysis / 대한신장학회잡지

BACKGROUND: Most chronic hemodialysis units select heparin doses on an empirical basis. Too little heparin causes clotting in the extracorporeal circuit and too much heparin may lead to excessive bleeding. We conducted a prospective, randomized, repeated cross over study to evaluate the effect of two different heparin regimens. The empirical standard dose regimen (empirical heparinization, EH) was used for all patients, and the individualized dose regimen (individualized heparinization, IH) determined by measuring the activated clotting time (ACT) was performed for more adequate heparinization during hemodialysis. METHODS: Twenty-four outpatients with systemic heparinization who had been on hemodialysis for more than 3 months were enrolled. In both METHODS, anticoagulation was achieved with a loading dose and a continuous infusion of heparin. Each regimens were prescribed alternately, and repeated after 2 weeks later. The study evaluated pre-post dialytic Hgb, Hct, Platelet and predialytic albumin, heparin loading dose and infusion rate, ACT, total blood compartment volume (TBCV), visible blood clots, bleeding, pre-post dialytic and next predialytic BUN, predialytic Cr, URR, Kt/Vurea. RESULTS: Twenty-two patients were analyzed in this study. Pre-post dialytic Hgb, Hct, Platelet and predialytic albumin, heparin loading dose were not significantly different between two methods. But heparin infusion rate were significantly increased in individualized heparinization than in empirical heparinization. Activated clotting times were prolonged and maintained adequately in individualized heparinization during hemodialysis. The loss of TBCV and visible blood clots were significantly decreased in individualized heparinization than in empirical heparinization. There was no bleeding complication in two methods. Pre-post and next predialytic BUN, predialytic Cr, URR, Kt/Vurea were not significantly different between two methods.0.CONCIUSION: We concluded that the individualized heparinization can maintain adequate anticoagulation than the empirical heparinization without any other problems and compromising the delivery dose of dialysis.

Clinical Analysis of Arteriovenous Fistulas for Hemodialysis / 대한흉부외과학회지

BACKGROUND: Proper construction of vascular access and adequate maintenance are essential for the prognosis of the hemodialysis patients. Though arteriovenous fistula using autogenous vessel is the first of choice, the incidence of arteriovenous fistula using artificial graft is gradually increasing. The aim of this study was to analyse the patency rates between autogenous and artificial fistula, among artificial graft types, according to the accompanied disease. MATERIAL AND METHOD: A retrospective study was conducted on 186 patients who underwent 292 arteriovenous fistula operations for hemodialysis at Korea University Guro Hospital between 1996 and 2000. Mean age of the patients was 54.37+/-12.89years, and the male: female ratio 99:87. RESULT: Among 292 operations, there were 156 autogenous fistula and 116 graft fistula. The other 20 operations were thrombectomy, takedown of graft, revision, and balloon dilatation. Patency rates of autogenous fistula were 92.78+/-2.35% at 1 year and 39.03+/-9.08% at 5 years, and those of graft fistula were 96.09+/-2.22% at 1 year and 16.45+/-10.15% at 5 years. However, there was no statistical significance between the two operations. The patients who had hypertension, diabetes or both had no statistical significance in the patency rate compared to that of patients without underlying disease. In addition, the type of graft used did not affect the patency rate. Second operation was needed in 62 patients and third operation in 31 patients, but their patency rate again had no statistical significance compared to that of the first operation. CONCLUSION: The patency of the artificial graft fistula was comparable to the autogenous fistula, but the patency according to types of graft need to be studied further. Furthermore, the underlying diseases did not affect the fistula patency.

The Effect of Gradient Ultrafiltration and High Sodium Dialysate on Reducing Complications During Hemodialysis / 대한신장학회잡지

OBJECTIVE: The objective of this study was to determine whether complications and nursing interventions during hemodialysis could be reduced by using gradient ultrafiltration(GUF) and high sodium dialysate(HSD). METHODS: Thirty outpatients who had been on hemodialysis for more than 3 months were enrolled. Patients received Conventional HD(Na+ 137 mEqX4 hrs, constant UF), GUF(UF 62.5%X2 hrs, UF 37.5 %X2 hrs), HSD(Na+ 145 mEqX2 hrs, Na+ 140 mEqX2 hrs) and HSUF(GUF and HSD). Each methods were prescribed for 2 weeks. The clinical features such as thirst, interdialytic weight gain, postdialytic weight loss and MAP(mean arterial pressure) and the frequency of intradialytic complications and nursing interventions were evaluated. RESULTS: The results were as followings. Interdialytic thirst, weight gain, postdialytic weight loss and MAP(pre/post HD) were not significantly different in each method. On the other hand, there was significant difference between 4 methods in serum sodium, osmolality and Hct. There were significantly fewer episodes of hypotention, muscle cramp and headache when using GUF, HSD and HSUF than CHD. The number of nursing interventions was significantly reduced in GUF, HSD and HSUF than CHD. CONCLUSION: Hemodialysis with gradient ultrafiltration and high sodium dialysate leads fewer complications and nursing interventions, more patient's well being.