Comparison of Spiritual Needs between Patients with Progressive Terminal Kidney Disease and Their Family Caregivers / 한국호스피스완화의료학회지

Purpose@#The purpose of this study was to compare differences in spiritual needs (SNs) and factors influencing SNs between patients with progressive terminal kidney disease and their family caregivers. @*Methods@#An explorative comparative survey was used to identify the SNs of patients (N=102) with progressive terminal kidney disease undergoing hemodialysis and their family caregivers (N=88) at a general hospital located in Seoul, South Korea. The data were analyzed using descriptive statistics, the chi-square test, the independent t-test, one way analysis of variance, the Scheffé test, and multiple regression with dummy variables. @*Results@#The SNs among family caregivers were higher than in the patient group. SNs were higher among those who were religious in both groups. Loving others was the highest-ranked subdimension in the patient group, followed in descending order by maintaining positive perspective, finding meaning, Reevaluating beliefs and life, asking “why?”, receiving love and spiritual support, preparing for death, and relating to God. In the family group, the corresponding order was maintaining positive perspective, loving others, finding meaning, receiving love and spiritual support, preparing for death, relating to God, and asking “why?”. The factors that had a negative influence on the level of SNs were not being religious in the patient group and having only a middle school level of education in the family group. @*Conclusion@#The results of this study may serve as evidence that spiritual care for non-cancer patients’ family caregivers should be considered as an important part of hospice and palliative care.

Tissue Doppler-derived E/e' ratio as a parameter for assessing diastolic heart failure and as a predictor of mortality in patients with chronic kidney disease

BACKGROUND/AIMS: Diastolic dysfunction occurs frequently in patients with chronic kidney disease (CKD) and is associated with heart failure (HF) or mortality. We investigated whether the ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e' ratio), estimated using tissue Doppler imaging, has prognostic value for cardiovascular morbidity and all-cause mortality in patients with CKD. METHODS: For 186 patients with CKD of stages III to V, we obtained echocardiograms with tissue Doppler imaging. A 5-year follow-up of 136 patients was performed based on hospital records and telephone interviews. The enrolled patients (79 males and 57 females) were categorized into the following CKD subgroups: stage III (n = 25); stage IV (n = 22); and stage V (n = 89). RESULTS: The average follow-up period was 30.45 months and the mean age of the patients was 61.13 years. The mortality rate after 5 years was 60.0%. The causes of death were: sepsis, 21.9%; HF, 16.2%; and sudden death, 15.2%. Age (p = 0.000), increased C-reactive protein level (p = 0.018), and increased E/e' ratio (p = 0.048) were found to correlate with mortality. Age (p = 0.000), decreased ejection fraction (p = 0.003), and increased E/e' ratio (p = 0.045) correlated with cardiovascular event. CONCLUSIONS: The E/e' ratio can predict mortality and cardiovascular events in patients with CKD who have diastolic dysfunction.

Very-Late Onset Diffuse Large B-cell Lymphoma with CD3 Coexpression in a Kidney Transplant Patient / 대한신장학회지

B-lineage non-Hodgkin lymphoma may aberrantly coexpress T-cell markers. In general population, however, cases of diffuse large B-cell lymphomas with CD3 co-expression are rare because the CD3 marker is the most lineage specific T-cell antigen. We report a case of CD3 coexpressed diffuse large B-cell lymphoma in a 47-year-old male patient presented with dyspepsia who had transplanted a kidney 17 years ago. An esophagogastroduodenoscopy displayed an ulcerated mass in the gastric antrum. The pathology of the mass was monomorphic post-transplant lymphoproliferative disorder - specifically, CD20- and CD3-positive diffuse large B-cell lymphoma. Resection of the mass and postop chemotherapy were performed. A follow-up computerized tomography showed disapperance of tumor. No recurrence was observed until 7 month after treatment. Nevertheless, the patient's renal function gradually aggrevated and progressed to end stage renal disease. As far as we know, this is the first case of diffuse large B-cell lymphoma with CD3 coexpression after kidney transplant.

Crohn's Disease in a Patient Undergoing Hemodialysis Caused by IgA Nephropathy / 대한신장학회지

IgA nephropathy is usually localized to the kidney, however, it can accompany systemic disease, including gastrointestinal disease, skin disease, connective tissue disease, and malignant tumor. In some patients with IgA nephropathy which manifested as an extraintestinal symptom of Crohn's disease, recovery of renal function was achieved following treatment of Crohn's disease. The pathophysiology of each disease remains unclear. According to some studies, however, immunological, genetic, and environmental factors may be involved in a complex manner. In patients receiving renal replacement therapy for treatment of renal dysfunction due to IgA nephropathy, occurrence of Crohn's disease as an extrarenal symptom has not been reported. We experienced a case of Crohn's disease which developed in a patient receiving hemodialysis for treatment of end-stage renal disease due to IgA nephropathy.