Comparison of Urea Kinetic Modeling and Indices of Nutrition in Hemodialysis Patients / 대한신장학회잡지

OBJECTIVES: Protein-calorie malnutrition has been shown to be prevalent among patients on long-term hemodialysis(HD) patients. And assessment of nutritional status of HD patients has assumed greater importance because of the association of protein- calorie malnutrition with increasing morbidity and mortality. So we observed the incidence and clinical effect of protein-calorie malnutrition, and we compared the indices of nutrition with dialysis adequacy utilizing urea kinetic modeling in HD patients. METHODS: We performed a cross-sectional study in which eight parameters, based on anthropometry, blood chemistry and subjective symptoms, were scored according to the degree of abnormalities in 48 HD patients. A malnutrition index was derived from these scores. We also performed comparative analysis to identify significant correlations of the indices of urea kinetic modeling with the other parameters of nutritional status. RESULTS: The malnutrition index classified 12(25 %) patients as normal, 28(58%) intermediately malnourished, and 8(17%) as severely malnourished. Malnutrition index showed a significant correlation with the body mass index(BMI), mid-arm circumference(MAC), mid-arm muscle area(MAMA), duration of HD, total lymphocyte count,trnsferrin. The malnutrition index also showed a significant correlation with renal creatinine clearance(Ccr), alkaline phosphatase. However, malnutrition index showed no meaningful correlation with TWR-Kt/V, TW-Kt/V, BUN, cholesterol,calcium, triglyceride. The value of Ccr was significantly lower in the severely malnourished and intermediately group than in the normal group. CONCLUSION: In assessing the nutritional status of HD patients, body weight, MAC, MAMA, duration of HD, total lymphocyte count, transferrin, alkaline phosphatase and Ccr were considered useful parameters. No meaningful relationships between TW-Kt/V and malnutrition index or between NPCR (normalized protein catabolic rate) and malnutrition index were found in this cross-sectional study. As the number of patients with longer duration of HD or negligible Ccr has increased in the malnourished patients, regular monitoring of these parameters, especially TWR-Kt/V and residual renal function may be helpful to assess dialysis adequacy to keep good nutritional status of each HD patient.

Clinical Usefulness of GFR Measurement Using Tc-99m DTPA Renal Scan in Kidney Transplantation Patients / 대한신장학회잡지

In clinical practice, Tc-99m DTPA renal scan has been using for screening for the presence of renal dysfunction to determine the need for early treatment in kidney transplantation patients. We measured glomerular filtration rate(GFR) using Gates method during the routine Tc-99m DTPA renal scan, predicted creatinine clearance estimated by Cockcroft and Gault formula and 24-hour creatinine clearance and compared each other in 88 kidney transplantation patients simultaneously. The range of renal uptake(%) of Tc-99m DTPA was from 1.8% to 10.4% and the correlation between 24-hour creatinine clearance and renal uptake showed Y=7.176X8.975Y=creatinine clearance(ml/min), X=renal uptake(%) and the correlation coefficient was 0.771. The correlation coefficient between GFR (ml/min) using Tc-99m DTPA renal scan and predicted creatinine clearance was 0.765. The correlation coefficient between predicted creatinine clearance and 24-hour creatinine clearance was 0.850. We concluded that the measurement of GFR using Tc-99m DTPA renal scan was clinically useful in kidney transplantation patients with the advantage of simplicity, low expense, opportunity for renal imaging.

Clinical Observation of Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis (HD) patients / 대한내과학회지

OBJECTIVE: The selection of dialysis modalities for end-stage renal disease patient is often a complex decision process involving considerations of efficacy in terms of life maintenance, quality of life, convenience and cost. In order to facilitate informed decisions, we have compared the clinical outcome of CAPD and HD patients. METHODS: From May 1992 to May 1997, we observed the followings: patients` survival rate, the causes of death in CAPD and HD patients, the frequency of CAPD peritonitis, CAPD catheter survival rate and the causes of catheter removal. Patients were categorized in the following ways: DM and non-DM, alive or expired, above and below the age of 60 years, and treatment duration of more or less than 5 years. Six items (serum albumin, serum creatinine, hemoglobin, BMI, NPCR and KT/V) were measured, their values were evaluated and compared with each group using univariated statistics. RESULTS: The total number of patients was 508 (369 CAPD, 139 HD). 58 of them expired during the observation period. The overall 5 year patient survival rate was 81.4% for CAPD, 80.5% for HD, and 57.8% for CAPD with DM and 25% for HD with DM using the Kaplan-Meier method. In the CAPD group, the frequency of peritonitis was 0.52 /pt, yr; the 5 year technical survival of the catheter was 80.5%. 42 (88%) of 48 technical failures of the catheter were removed due to peritonitis. Regardless of the modes of replacement therapy used to treat DM and non-DM groups, the DM patients had longer duration of admission, older age, lower serum albumin and serum creatinine levels , and a lower 5 year patient survival rate than the non-DM group. Death in CAPD and HD was positively correlated with a long duration of admission and old age; CAPD patients who expired had lower serum albumin, smaller BMI and more frequent peritonitis than the surviving group. CONCLUSION: 1. There was no significant difference in the 5 year patient survival rate between CAPD and HD (81.4% in CAPD, 80.5% in HD). 2. DM patients had lower serum albumin, creatinine and BUN levels than non-DM patients. 3. The mortality rate was positively correlated with old age and duration of admission in CAPD and HD ; frequent CAPD peritonitis, lower serum albumin and small BMI in CAPD were also positively correlated with the death rate. 4. The higher the serum albumin and NPCR, the higher the survival rate for CAPD patients. 5. The serum creatinine was lower in patients above 60 years old and in those treated more than 5 years. 6. The DM group had a higher mortality rate than the non-DM group; the DM CAPD group had a higher 5 year survival rate than the DM HD group but it was not statistically significant.

Risk Factors For Subtypes of Cerebrovascular Disease in Korea

With a purpose to difine risk factors of respective subtypes of cerebrovascular disease, a case-control study was performed in 1,251 cases with cerebrovascular disease who were admitted to twelve large institutions over the country during the year of 1988. All cases were subtype-proven by computerized tomography. Three hundred and eighty three patients were selected as control among the patients who were admitted to the same hospitals during the same period. The variables were collected prospectively and the data were processed by univariate and multiple logistic regression analyses and the significance was tested by chi-square methods. In the univariate analysis, female sex, being a physical worker, history of hypertension either treated or not and previous stroke history were significantly related with cerebral hemorrhage. Male sex, being aged 60 or more, living in city area, being a mental worker, history of hypertension either treated or not, history of stroke, being a diabetic and positive family history of stroke were significantly related with cerebral infarction. In multiple logistic regression analysis hypertension and alcohol drinking were strong independent risk factors for cerebral hemorrhage. Hypertension, being aged 60 or more, and living in urban area were also independent risk facrots for cerbral infarction. Of the other variables analyzed, socioeconomic class, smoking history or body mass index did not constitute significnat risks for either cerebral hemorrhage or cerebral infarction.