Treatment Outcomes and Prognostic Factors for Peritoneal Dialysis Patients Based on Single Center Experience over 18 years / 대한신장학회지

PURPOSE:We investigated the survival rate, factors associated with survival, and peritonitis incidence in PD patients who commenced PD at our center since 1990. METHODS:We investigated 670 patients who started PD between January 1990 and June 2007. Data for sex, age, etiology of ESRD, comorbidities, follow-up duration, cause of death, and peritonitis were analyzed. Kaplan-Meier method was used to determine patient survival and technique survival rate. RESULTS:The most common cause of death was cardiovascular disease, while peritonitis was the main reason for technique failure. The overall incidence of peritonitis between 1995 and 2007 was 0.270 episodes per patient-year, and there was a significant drop of peritonitis rate from 1995-1999 (0.365) to 2000-2007 (0.230). Patient survival after 5 and 10 years was 71.7% and 48.2% respectively. Technique survival after 5 and 10 years was 72.8% and 43.8%. Older age (age 40-59: HR 2.427, p= 0.016; age> or =60: HR 7.397, p or =60: HR 1.791, p=0.025) and higher peritonitis rate (HR 2.361, p<0.001) were the independent risk factors of technique failure. CONCLUSION:The patient survival, technique survival and peritonitis incidence of PD patients in our center showed outcomes comparable to other centers worldwide. Older age, diabetes, and cardiovascular disease were associated with lower patient survival, while older age and higher peritonitis rate were associated with higher technique failure.

Treatment Outcomes and Prognostic Factors for Peritoneal Dialysis Patients Based on Single Center Experience over 18 years / 대한신장학회지

PURPOSE:We investigated the survival rate, factors associated with survival, and peritonitis incidence in PD patients who commenced PD at our center since 1990. METHODS:We investigated 670 patients who started PD between January 1990 and June 2007. Data for sex, age, etiology of ESRD, comorbidities, follow-up duration, cause of death, and peritonitis were analyzed. Kaplan-Meier method was used to determine patient survival and technique survival rate. RESULTS:The most common cause of death was cardiovascular disease, while peritonitis was the main reason for technique failure. The overall incidence of peritonitis between 1995 and 2007 was 0.270 episodes per patient-year, and there was a significant drop of peritonitis rate from 1995-1999 (0.365) to 2000-2007 (0.230). Patient survival after 5 and 10 years was 71.7% and 48.2% respectively. Technique survival after 5 and 10 years was 72.8% and 43.8%. Older age (age 40-59: HR 2.427, p= 0.016; age> or =60: HR 7.397, p or =60: HR 1.791, p=0.025) and higher peritonitis rate (HR 2.361, p<0.001) were the independent risk factors of technique failure. CONCLUSION:The patient survival, technique survival and peritonitis incidence of PD patients in our center showed outcomes comparable to other centers worldwide. Older age, diabetes, and cardiovascular disease were associated with lower patient survival, while older age and higher peritonitis rate were associated with higher technique failure.

A Case of Encapsulating Peritoneal Sclerosis Significantly Improved after Enterolysis / 대한신장학회지

Encapsulating peritoneal sclerosis (EPS) is a rare but fatal complication of continuous ambulatory peritoneal dialysis (CAPD). There are some reports on the effect of immunosuppressant therapy including steroid, but the results have not always been promising. Recently, owing to the advance of surgical techniques, there are some reports of the EPS cases significantly improved after successful surgery. A 30-year old man developed EPS after 9 years of peritoneal dialysis, and switched to hemodialysis. In spite of repetitive conservative management and immunosuppressant therapy, there was no improvement. His body weight decreased from 50 kg to 40 kg (BMI 14.2 kg/m2) due to severe malnutrition, so we decided to perform surgery. Total intestinal enterolysis was done successfully without concomitant enterectomy, and his general condition improved dramatically. Four months after surgery, the serum albumin concentration increased from 3.1 g/dL to 4.3 g/dL, cholesterol from 92 mg/dL to 208 mg/dL, and hemoglobin from 9.2 g/dL to 12.5 g/dL. His body weight increased to 61 kg (BMI 21.6 kg/m2), and there was not any fluid collection or bowel obstruction seen on the abdominal CT scan. We experienced a case of EPS which was significantly improved after enterolysis. We report this case with review of the literature.

Association of Angiotensin-Converting Enzyme and Angiotensinogen Gene Polymorphisms with Preeclampsia

We tested the hypothesis that angiotensin-converting enzyme (ACE) and angiotensinogen gene polymorphism influence the incidence, development and outcome of preeclampsia. Subjects were recruited from 90 Korean patients with preeclampsia during pregnancy and 98 age-matched controls. After isolation of DNA, polymerase chain reactions (PCR) were carried out to detect polymorphism of the ACE and angiotensinogen. M235T and T174M genotypes of angiotensinogen were determined by digestion with restriction enzyme endonuclease Tth 111-I and NCo I, respectively. The frequency of DD genotype was significantly greater in preeclampsia (0.36) than in controls (0.14) (p<0.05). The frequency of D allele was 0.55 in preeclampsia and 0.40 in controls (p<0.05). There were no differences in the onset of preeclampsia and pregnancy outcomes according to the ACE genotypes. There was no difference in the frequency of a allele of angiotensinogen M235T between the groups (0.79:0.78 in preeclampsia : controls). The frequency of T allele of angiotensinogen T174M gene was slightly increased, but not significantly, in preeclampsia (0.11) than in controls (0.07). In a multivariate analysis, only ACE genotype was associated with the development of preeclampsia (beta=0.27, p=0.05). In conclusion, a molecular variant of ACE, but not angiotensinogen, gene is associated with preeclampsia in Korean women.

The Postpartum Recurrence of Graves'Disease and its Contributing Factors / 대한내분비학회지

BACKGROUND: Pregnancy affects the course of Graves' Disease (GD), and patients who initially maintain euthyroid function into their middle trimester with minimum doses of antithyroid drugs become exacerbated after delivery. Even patients who are completely cured, requiring no treatment during pregnancy, can relapse after delivery. In this study, we examined the postpartum changes in the thyroid functions of patients with GD, and attempted to determine the factors contributing to these changes. METHODS: The study subjects were recruited from pregnant women visiting our outpatient clinic for routine prenatal evaluations. 45 women previously diagnosed with GD, who had been treated and cured with hyperthyroidism, and were no longer taking any thyroid medications, were evaluated for 1 year post delivery. RESULTS: Among 45 patients, 20 (44.4%) developed thyroid disorders following delivery. Postpartum thyroiditis (PPT) developed in 8 patients (17.8%), and GD developed in 12 (26.0%). The onset of the PPT disease 3.1 +/- 1.4 months following delivery, which was significantly earlier than the 6.7 +/- 2.7 months required for the post delivery onset of GD (p=0.003). The TBII values, measured during the thyrotoxic state in each womaen, were negative in women with PPT and positive in 71.4% of women with GD (p=0.030). The duration of treatment for hyperthyroidism prior or pregnancy, the number of recurrences, and the time interval without treatment, were not associated with the development of postpartum thyroid disorders. Whereas, the mean number of past pregnancies for women who developed PPT was 3.9 +/- 2.1, and was significantly higher than the 2.2+/- 1.7 for women developing no thyroid dysfunctions (p=0.044). In 13 women their initial onset of GD occurred within one year postpartum, 7 (53.8%) having had a recurrence, which was significantly higher than in women whose disease onset occurred unrelated to delivery (5 of 32 women: 15.6%). CONCLUSION: Women with GD developed postpartum thyroid dysfunctions in 44.4% of cases. Women whose initial disease onset occurred within one year postpartum had higher recurrences of GD, and women who developed PPT had a history of higher gravidity compared to the euthyroid women postpartum. Therefore, if women with GD develop postpartum thyroid dysfunctions, the diagnosis should be made, and a treatment modality planned, following careful considerations of the patients' past obstetric history, changes in clinical manifestations and the TBII values.

Dyspnea and Palpitation during Pregnancy

OBJECTIVES: Dyspnea and palpitation are common features of pregnancy. While several theories have been put forward to explain the etiology of gestational dyspnea and palpitation, there have been few systemic studies of its incidence, severity and time-course in a group of normal women. METHODS: We interviewed postpartum women, within 3 days after delivery, about dyspnea and palpitation. Separately from this interview, we performed 24-hour ECG monitoring for obstetric patients with palpitation before delivery. RESULTS: The subjects interviewed were 261 women, of whom 37.5 percent and 11.5 percent experienced dyspnea and palpitation, respectively. These symptoms had a tendency to increase to term. The presence of arrhythmias could be documented in only 22% of patients having 24-hour Holter monitoring. CONCLUSION: Dyspnea and palpitation were common among normal pregnant women and had a tendency to increase to term.