Executive summary of the Korean Society of Nephrology 2021 clinical practice guideline for optimal hemodialysis treatment

The Korean Society of Nephrology (KSN) has published a clinical practice guideline (CPG) document for maintenance hemodialysis (HD). The document, 2021 Clinical Practice Guideline on Optimal HD Treatment, is based on an extensive evidence-oriented review of the benefits of preparation, initiation, and maintenance therapy for HD, with the participation of representative experts from the KSN under the methodologists’ support for guideline development. It was intended to help clinicians participating in HD treatment make safer and more effective clinical decisions by providing user-friendly guidelines. We hope that this CPG will be meaningful as a recommendation in practice, but not on a regulatory rule basis, as different approaches and treatments may be used by health care providers depending on the individual patient’s condition. This CPG consists of eight sections and 15 key questions. Each begins with statements that are graded by the strength of recommendations and quality of the evidence. Each statement is followed by a summary of the evidence supporting the recommendations. There are also a link to full-text documents and lists of the most important reports so that the readers can read further (most of this is available online).

BNT162b2 mRNA COVID-19 vaccine adverse reactions needing medical support: a vaccine center experience

Objective@#The coronavirus disease 2019 (COVID-19) pandemic has not yet been controlled and herd immunity through vaccination against COVID-19 has been considered the best option to prevent the spread of COVID-19 worldwide. We encountered several patients in our emergency department presenting with adverse reactions after COVID-19 vaccinations. Hence, we investigated the clinical characteristics of patients with adverse reactions after vaccination. @*Methods@#In South Korea, 10,510 doses of the BNT162b2 mRNA COVID-19 vaccine was administered to 5,304 medical staff. To investigate adverse reactions, we reviewed the case report forms from the vaccination centers and the medical charts from the date of first dose administration until two weeks after the last planned second dose. @*Results@#A total of 187 cases, out of the 10,510, experienced adverse reactions and these were more common in females. Dizziness (44.4%), nausea and vomiting (28.3%), and fever (24.1%) were the most reported adverse reactions. Immediate adverse reactions included dizziness, nausea, and vomiting, palpitation, sensory changes, and delayed adverse reactions included fever, myalgia, headache, nausea, and vomiting. The delayed reactions of fever and myalgia were significantly more common after the second, rather than after the first dose (P<0.01 and P=0.03, respectively). One case of anaphylaxis was reported. All adverse reactions improved after conservative care. @*Conclusion@#Our findings show diverse adverse reactions to the BNT162b2 mRNA COVID-19 vaccine, but none of them required hospitalization. However, since this vaccine has been manufactured using a newly developed technique, more research focused on the clinical significance of the adverse reactions is necessary.

Executive Summary of the Korean Society of Nephrology 2021 Clinical Practice Guideline for Optimal Hemodialysis Treatment

The Korean Society of Nephrology (KSN) has published a clinical practice guideline (CPG) document for maintenance hemodialysis (HD). The document, 2021 Clinical Practice Guideline on Optimal HD Treatment, is based on an extensive evidence-oriented review of the benefits of preparation, initiation, and maintenance therapy for HD, with the participation of representative experts from the KSN under the methodologists’ support for guideline development. It was intended to help clinicians participating in HD treatment make safer and more effective clinical decisions by providing user-friendly guidelines. We hope that this CPG will be meaningful as a recommendation in practice, but not on a regulatory rule basis, as different approaches and treatments may be used by health care providers depending on the individual patient’s condition. This CPG consists of eight sections and 15 key questions. Each begins with statements that are graded by the strength of recommendations and quality of the evidence. Each statement is followed by a summary of the evidence supporting the recommendations. There is also a link to full-text documents and lists of the most important reports so that the readers can read further (most of this is available online).

Relationship between Decreased Estimated Glomerular Filtration Rate and Sarcopenic Obesity among Postmenopausal Women: Korea National Health and Nutrition Examination Survey (2008–2011) / 가정의학회지

Background@#Previous studies have shown that body composition is associated with chronic kidney disease (CKD), and perimenopause is associated with increased fat mass and decreased lean body mass. Muscle wasting is common among patients with CKD. Sarcopenic obesity (SO) refers to excess adiposity with decreased muscle mass. However, little is known about the relationship between SO and renal function decline. Here, we identified the relationship between SO and decreased estimated glomerular filtration rate (eGFR) in postmenopausal women. @*Methods@#We conducted a cross-sectional study based on the data from the Korea National Health and Nutrition Examination Survey (2008–2011). We analyzed 4,560 postmenopausal women who underwent dual energy X-ray absorptiometry. Sarcopenia was defined based on weight-adjusted appendicular skeletal muscle mass. Obesity was defined based on body mass index. The eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Subjects were classified into four groups: normal, obese, sarcopenic, and sarcopenic obese. Logistic regression analysis was performed to examine the association between SO and decreased eGFR. The results were adjusted for variable confounders. @*Results@#In the unadjusted model, the odds ratio (OR) of decreased eGFR for SO was 1.67 (95% confidence interval [CI], 1.23–2.26). The obese and sarcopenic groups had ORs of 0.67 (95% CI, 0.44–1.03) and 0.70 (95% CI, 0.44–1.10), respectively. After controlling for confounding variables, there was also a significant association between SO and decreased eGFR (adjusted OR, 1.48; 95% Cl, 1.05–2.07). @*Conclusion@#SO was independently associated with decreased eGFR in postmenopausal Korean women.

Appropriateness of rabies post-exposure prophylaxis in pediatric patients visiting the emergency department due to animal bite

Purpose@#To study the appropriateness of rabies post-exposure prophylaxis (rPEP) for children with animal bite who visited the emergency department (ED). @*Methods@#The study enrolled children younger than 18 years with animal bite who visited the National Medical Center ED between January 2014 and October 2017. The children’ electronic medical records were retrospectively reviewed. Data for analysis included age, sex, body parts bitten by animals, species of animals, regions where animal bites occurred, history of recent antibiotics therapy and tetanus vaccination, and justification by the 2017 Guidelines for Rabies Control in Korea and implementation of rPEP. In children who underwent unjustified rPEP or did not undergo justified one, we recorded their guardians’ opinion for or against rPEP. @*Results@#Of the 63 enrolled children, rPEP was justified for 38 children by the Korean guidelines. Of the 38 children, 35 actually underwent rPEP. Among the remaining 3 children, 2 did not undergo the prophylaxis as per the guardians’ requests. Among the 25 children whose rPEP was not justified, 8 underwent the prophylaxis. Of these 8 children, 7 did based on the guardians’ requests. @*Conclusion@#In this study, inappropriate rPEP was usually affected by the guardians’ requests, regardless of the criteria for such prophylaxis. Thus, their requests for or against rPEP should be discussed with emergency physicians who are aware of the relevant criteria to prevent occurrence of rabies or unnecessary use of medical resources.

Factors Influencing Electronic Cigarette Use for Smoking Cessation among Adolescents in South Korea: The 13th Korea Youth Risk Behavior Web-Based Survey

BACKGROUND@#This study used the data of Korea Youth Risk Behavior Web-based Survey (KYRBS) to confirm the relationship between electronic cigarette use for smoking cessation among Korean adolescents and demographic, health behavior, and school-life factors.@*METHODS@#Data were taken from the 13th KYRBS in 2017. In this study on 62,276 adolescents, characteristics of 1,244 electronic cigarette users were compared with those of non-electronic cigarette users. The 1,244 adolescent electronic cigarette users were evaluated for characteristics related to smoking cessation. Among the related characteristics, demographic factors comprised sex, grade, economic status, weekly allowance, and residence type. Health status-related factors comprised physical activity, lifetime drinking experience, smoking amount, subjective health perception, and stress perception. School characteristics included school type, academic performance, and smoking cessation education. Chi-square test and logistic regression analysis were performed using complex sample analysis.@*RESULTS@#The proportion of current electronic cigarette users was 2.2% (boys, 3.3%; girls, 0.9%). Of the 41.5% of cigarette users willing to quit smoking, 11% used electronic cigarettes for this purpose. Among the electronic cigarette users, characteristics related to smoking cessation were grade, weekly allowance, and residence type, but logistic regression analysis revealed that increases in grade (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.21–3.35) and living with family (OR, 4.17; 95% CI, 1.89–9.18) were associated with smoking cessation.@*CONCLUSIONS@#According to the 13th KYRBS in 2017, adolescents were likely to use electronic cigarette for smoking cessation when they are older and live with their families.

Factors Influencing Electronic Cigarette Use for Smoking Cessation among Adolescents in South Korea: The 13th Korea Youth Risk Behavior Web-Based Survey

BACKGROUND: This study used the data of Korea Youth Risk Behavior Web-based Survey (KYRBS) to confirm the relationship between electronic cigarette use for smoking cessation among Korean adolescents and demographic, health behavior, and school-life factors. METHODS: Data were taken from the 13th KYRBS in 2017. In this study on 62,276 adolescents, characteristics of 1,244 electronic cigarette users were compared with those of non-electronic cigarette users. The 1,244 adolescent electronic cigarette users were evaluated for characteristics related to smoking cessation. Among the related characteristics, demographic factors comprised sex, grade, economic status, weekly allowance, and residence type. Health status-related factors comprised physical activity, lifetime drinking experience, smoking amount, subjective health perception, and stress perception. School characteristics included school type, academic performance, and smoking cessation education. Chi-square test and logistic regression analysis were performed using complex sample analysis. RESULTS: The proportion of current electronic cigarette users was 2.2% (boys, 3.3%; girls, 0.9%). Of the 41.5% of cigarette users willing to quit smoking, 11% used electronic cigarettes for this purpose. Among the electronic cigarette users, characteristics related to smoking cessation were grade, weekly allowance, and residence type, but logistic regression analysis revealed that increases in grade (odds ratio [OR], 2.01; 95% confidence interval [CI], 1.21–3.35) and living with family (OR, 4.17; 95% CI, 1.89–9.18) were associated with smoking cessation. CONCLUSIONS: According to the 13th KYRBS in 2017, adolescents were likely to use electronic cigarette for smoking cessation when they are older and live with their families.

Association between Sarcopenic Obesity and Metabolic Syndrome in Postmenopausal Women: A Cross-sectional Study Based on the Korean National Health and Nutritional Examination Surveys from 2008 to 2011

BACKGROUND: Menopause contributes to an increase in visceral fat mass and a decrease in muscle protein synthesis. Therefore, we performed this study to examine their relationship how effect the changes of body composition as obesity and sarcopenia on metabolic syndrome (MS) as a predictor of cardiovascular disease in postmenopausal women. METHODS: Using data from the Korean National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011, we estimated that 4,183 postmenopausal women underwent dual energy X-ray absorptiometry scans. Sarcopenia was defined as an appendicular skeletal muscle mass divided by body weight that was less than 1 standard deviation below the sex specific mean for the young reference group. After classification into four groups, the results were adjusted with menopausal age and hormonal treatment. The relationship between sarcopenic obesity (SO) and MS in postmenopausal women was analyzed by logistic regression analysis in a complex sampling. RESULTS: In an unadjusted model, the odds ratio (OR) of MS for sarcopenia was 1.94 (95% confidence interval [CI], 1.52-2.49); the obesity group had an OR of 4.55 (95% CI, 3.63-5.71); and distinctly, the SO group had an OR of 6.26 (95% CI, 5.10-7.70). Even though there was controlling for variable adjustment, no definite difference was seen in the results. CONCLUSIONS: Sarcopenia and obesity were associated with MS independent of other metabolic impairment risk factors in both early menopausal and postmenopausal women. The results showed that, in particular, the prevalence of MS has increased more in postmenopausal women compared with previous research.

The Association between Chronic Diseases and Active Patient Participation

BACKGROUND: Active patient participation in health care decision-making can results in better medical outcomes. This study's purpose is to investigate the association between the patient participation and the diseases often encountered in primary care. METHODS: We used the data from the Korean National Health and Nutrition Examination Survey conducted in 2015 which included 4,158 adults aged older than 19 and who had no missing data. The association between the presence of disease or the number of accompanying diseases and the active patient participation in the treatment decision was studied. Logistic regression analysis was conducted using complex sampling design in each sex. RESULTS: After adjusting for confounding variables, the relationship between active patient participation and the diagnosis of hypertension, odds ratio (OR) was 1.95 (95% confidence interval [CI], 1.25-3.04) for men and 1.83 (95% CI, 1.27-2.65) for women. In women diagnosed with diabetes, OR was 0.58 (95% CI, 0.35-0.97). Between active patient participation and increasing number of accompanying diseases have positive tendency but not statistically significant. CONCLUSIONS: This study suggests that active patient participation is related to the diagnosis of hypertension, and the number of accompanying diseases and active patient participation were not significantly associated. This is a rare study related to the active patient participation in the Korean population, that it may be helpful in establishing further relevant research and strategies to increase the patient participation rate.

The Relationship between Smoking and Suicidal Behavior in Korean Adolescents: 12th Korea Youth Risk Behavior Web-based Survey

BACKGROUND: Suicide is the first leading cause of death among teenagers in Korea, and smoking is reported to be one of the risk factors for suicide. The purpose of this study is to investigate the relationship between smoking and smoking amount and suicidal behavior using data from the Korea Youth Risk Behavior Web-based Survey (KYRBS). METHODS: Using the 12th KYRBS 2016, we surveyed smoking, smoking amount, suicidal ideation, suicidal planning, and suicidal attempt of adolescents. And a total of 65,528 respondents were divided into current smoker, former smokers, and non-smoker, and 4,012 smokers were classified into ≤9 cigarettes/day group, 10–19 cigarettes/day group, and ≥20 cigarettes/day group according to the amount of smokers. We analyzed the relationship between smoking and smoking amount and suicidal ideation, suicidal planning, and suicidal attempt using multivariate logistic regression analysis. RESULTS: As a result of adjusting for all confounding variables, the current smoker has an odds ratio of 1.143 (confidence interval 1.020–1.281) with suicidal ideation compared to non-smoker and the odds ratio of suicidal planning and suicidal attempt is also statistically significant, respectively. And the odds ratio of all suicidal behaviors was significantly higher in ≥20 cigarettes/day group than in ≤9 cigarettes/day group, respectively. CONCLUSIONS: We found that smoking and smoking amount was related to suicidal ideation, suicidal planning, and suicidal attempts in adolescents. Therefore, suicidal prevention strategies considering this relationship should be established.

Secular Trends for Body-shape Perception, Weight-loss Efforts, and Weight-loss Behaviors in Korean Adults Using the Korea National Health and Nutrition Examination Survey from 2001 to 2014

BACKGROUND: The objective of study was to investigate secular trends for body-shape perception, weight-loss efforts, and weight-loss behaviors from 2001 to 2014 in Korean adults and factors related to those weight-related attitude. METHODS: Self-reported body-shape perception, weight-loss efforts, and weight-loss behaviors were used in 26,480 men and 35,051 women aged 19 or older using the Korean National Health and Nutrition Survey from 2001 to 2014 (from 2005 to 2014 for weight-loss behaviors). Multivariable logistic regression analysis was conducted using complex sampling design in each sex. RESULTS: Body-shape misperception tended to decrease from 2001 to 2014 and weight-loss efforts tended to increase over the period in all subjects, whereas unhealthy weight-loss behaviors tended to increase over the period in women. In multivariable logistic regression model, body-shape misperception in men was inversely associated with survey year, while positively associated with age and weight status. In women, body-shape misperception was inversely associated with survey year, education, and income, while positively associated with age and weight status. Weight-loss efforts in both sexes were inversely associated with age, while positively associated with survey year, education, income, and weight status. Healthy weight-loss behaviors were positively associated with education but inversely associated with age in men. In women, those behaviors were positively associated with education and weight status, while inversely associated with survey year. CONCLUSIONS: We found decreased body-shape misperception and increased weight-loss efforts in Korean men and women from 2001 to 2014, and decreased healthy weight-loss behaviors in women from 2005 to 2014.

Association between Obesity and Neighborhood Socioeconomic Status in Korean Adolescents Based on the 2013 Korea Youth Risk Behavior Web-Based Survey / 가정의학회지

BACKGROUND: An increase in the obese adolescent population is being recognized as a serious medical and social problem. The present study aimed to examine the association between neighborhood socioeconomic status (SES) and obesity in Korean adolescents based on total available resources and local social inequality models. METHODS: The present study used data from the 2013 Korea Youth Risk Behavior Web-based Survey in analyzing 72,438 Korean adolescents aged 12-18. The analysis investigated obesity odds ratio (OR) according to neighborhood SES adjusted for age and individual SES indices, which included family affluence scale (FAS), education level of parents, cohabitation with parents, and weekly allowance. Obesity OR was investigated according to neighborhood SES by FAS, and according to FAS by neighborhood SES. RESULTS: After adjusting for age and individual SES variables, there was no significant association between neighborhood SES and adolescent obesity for either boys or girls. However, girls in the high FAS group showed a pattern of lower neighborhood SES being associated with a significant increase in risk of obesity; in the high neighborhood SES group, boys showed a pattern of higher FAS being associated with a significant increase in risk of obesity, whereas girls show a pattern of decrease. CONCLUSION: Although limited, the present study demonstrated that some girl groups exhibited a pattern of lower neighborhood SES being associated with an increase in risk of obesity, as well as a gender-based difference in risk of obesity by individual SES. Therefore, measures to prevent adolescent obesity should be established with consideration for differences in risk according to individual and neighborhood SES.

The Relationship between Daily Sodium Intake and Obesity in Korean Adults

BACKGROUND: World health organization (WHO) recommended daily sodium intake less than 2 g. To assess the validity of WHO recommendation, we investigated the relationship between daily sodium intake and obesity. METHODS: A total of 14,694 participants aged > or =19 years who had no missing data for nutrition, chronic disease, health behavior, economic status and laboratory findings from the 5th Korean National Health and Nutrition Examination Survey (KNHANES-V), which was performed from 2010 to 2012. Obesity was defined as having a body mass index of 25 kg/m2 or higher. Daily sodium intake was calculated from 24 hour recall and divided into five categories ( or =8 g). The association between daily sodium intake and obesity was analyzed using multiple logistic regressions. RESULTS: Higher sodium intake in men had an increased risk of obesity with odds ratios (ORs) of 1.27 for 2-4 g intake (95% confidence interval [CI], 0.97-1.67), 1.40 for 4-6 g intake (95% CI, 1.07-1.85), 1.41 for 6-8 g intake (95% CI, 1.05-1.89), and 1.61 for > or =8 g intake (95% CI, 1.19-2.18), compared to men with less than 2 g intake, after adjusting for confounding factors. The P value for trend of ORs in each group for men was 0.020. In women, compared to the lesser than 2 g intake, only > or =8 g intake group had an OR of 1.28 (95% CI, 1.02-1.62) without showing significant P for trend (P value for trend=0.221) CONCLUSIONS: We found that sodium intake more than 2 g per day was independently related to the increased risk of obesity in men. Therefore, to minimize the risk of obesity, we suggest taking sodium less than 2 g per day.

Surgical Strategy for Colonic Intussusception Caused by a Giant Colonic Lipoma: A Report of Two Cases and a Review of the Literature

A colon lipoma is a remarkably rare tumor. In most cases, the tumors are asymptomatic and small in size, need to be differentiated from malignant tumors, and do not need any special treatment. Selection of the right surgical strategy depends on the status of bowel, as well as the size and the location of tumor. We encountered two patients with giant submucosal lipomas that had induced intussusceptions: one with a lipoma in the transverse colon and the other with a lipoma in the ascending colon. The diagnoses were made by using histological examinations. We report the clinical features, diagnoses, and treatments of, as well as our experience with, these two uncommon cases, and we present a review of the literature on this subject.

Hyalinizing Trabecular Tumor (HTT) of Thyroid: Two Case Report / 대한내분비외과학회지

Hyalinizing trabecular tumor (HTT), a type of thyroid lesion, was first reported by Carney in 1987 and has since been reported continuously. Due to its histological non-specificity, HTT can be misdiagnosed as papillary thyroid cancer or medullary thyroid cancer. For this reason, over treatment might occur; for example, total thyroidectomy and lymphadenectomy. Diagnosis and treatment is a challenge because there is still controversy regarding HTT characters. We report on two cases. One patient was a 48-year-old female and the other was a 46-year-old female. Both patients complained of a thyroid mass and were diagnosed as HTT.

The Relationship between Body Fat Percent and Bone Mineral Density in Korean Adolescents: The Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-1), 2010 / 가정의학회지

BACKGROUND: The relationships of total and regional body fat percent with bone mineral density (BMD) in Korean adolescents were examined using the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-1), 2010. METHODS: Body fat percent at whole body (WBFP), trunk (TBFP), and extremities (both upper and lower extremities fat mass/body weight, EBFP), ratio of trunk fat mass to extremities fat mass (TEFR), and BMD at whole body, total femur, and lumbar spine were measured by dual energy X-ray absorptiometry in a population-based sample of 433 boys and 362 girls, aged 12 to 18 years. The analyses were conducted using linear regression analysis with complex sampling design. RESULTS: After adjusting for confounders such as age, height, weight, serum 25-(OH) vitamin D concentration, energy intake, calcium intake, physical activity, and menarche status for girls, WBFP, TBFP, and EBFP were inversely associated with whole and regional BMD in both sexes (P < 0.05). TEFR was positively associated with whole and regional BMD in boys after adjusting for confounders, while it was negatively associated in girls (P < 0.05). However, the associations were non-significant when bone mass-free lean mass was adjusted instead of bodyweight except for a positive association between TEFR and BMD in boys. CONCLUSION: In Korean adolescents, total and regional body fat percent is not independently associated with BMD after adjusting for bone mass-free lean mass but higher fat in trunk as compared to extremities may be protective for BMD in boys.

Acute Urinary Retention in a 47-month-old Girl Caused by the Giant Fecaloma / 대한소아소화기영양학회지

We present a case of a 47-month-old female suffering from acute urinary bladder neck obstruction and bilateral hydronephrosis secondary to a fecaloma. Fecaloma is defined as an accumulation of inspissated feces in the colon or rectum giving the appearance of an abdominal mass. A fecaloma can be developed by diverse causes and the causes of the fecaloma in this case were septum reformation after the Duhamel procedure and long-term constipation. Chronic constipation is very common at outpatient clinic. However, acute urinary retention and voiding difficulty caused by fecaloma in the giant Duhamel pouch has never been reported in Korea. We would like to present our case with acute urinary retention due to a fecaloma and suggest that fecaloma might be considered as one of the causes for acute urinary retention, especially in cases with previous Duhamel operation for repair of Hischsprung disease.

Clostridium difficile-associated diarrhea in dialysis patients

BACKGROUND: Dialysis patients have impaired host defense mechanisms and frequently require antibiotics for various infective complications. In this study, we investigated whether dialysis patients have greater risk for Clostridium difficile-associated diarrhea (CDAD). METHODS: During the 4-year study period (2004-2008), 85 patients with CDAD were identified based on a retrospective review of C difficile toxin assay or histology records. Nosocomial diarrheal patients without CDAD were considered as controls (n=403). We assessed the association between renal function and the prevalence and clinical outcomes of CDAD. RESULTS: There was a significant difference in the prevalence rate of chronic kidney disease (CKD) between CDAD and non-CDAD patients (P<0.001). Sixteen patients (18.8%) of the CDAD group were treated with dialysis, whereas 21 patients (5.2%) of the non-CDAD group were treated with dialysis. There was a significant association between renal function and CDAD in patients on dialysis [odds ratio (OR)=4.44, 95% confidence interval (CI) 2.19-8.99, P<0.001], but not in patients with CKD stage 3-5 (OR=1.10, 95% CI 0.63-1.92, P=0.73). In multivariate analysis, CKD stage 5D was an independent risk factor for the development of CDAD (OR=13.36, 95% CI 2.94-60.67, P=0.001). CONCLUSION: Our data indicate that dialysis patients might be at a greater risk of developing CDAD, which suggests that particular attention should be provided to CDAD when antibiotic treatment is administered to dialysis patients.

Clostridium difficile-associated diarrhea in dialysis patients

BACKGROUND: Dialysis patients have impaired host defense mechanisms and frequently require antibiotics for various infective complications. In this study, we investigated whether dialysis patients have greater risk for Clostridium difficile-associated diarrhea (CDAD). METHODS: During the 4-year study period (2004-2008), 85 patients with CDAD were identified based on a retrospective review of C difficile toxin assay or histology records. Nosocomial diarrheal patients without CDAD were considered as controls (n=403). We assessed the association between renal function and the prevalence and clinical outcomes of CDAD. RESULTS: There was a significant difference in the prevalence rate of chronic kidney disease (CKD) between CDAD and non-CDAD patients (P<0.001). Sixteen patients (18.8%) of the CDAD group were treated with dialysis, whereas 21 patients (5.2%) of the non-CDAD group were treated with dialysis. There was a significant association between renal function and CDAD in patients on dialysis [odds ratio (OR)=4.44, 95% confidence interval (CI) 2.19-8.99, P<0.001], but not in patients with CKD stage 3-5 (OR=1.10, 95% CI 0.63-1.92, P=0.73). In multivariate analysis, CKD stage 5D was an independent risk factor for the development of CDAD (OR=13.36, 95% CI 2.94-60.67, P=0.001). CONCLUSION: Our data indicate that dialysis patients might be at a greater risk of developing CDAD, which suggests that particular attention should be provided to CDAD when antibiotic treatment is administered to dialysis patients.

Grayanotoxin Poisoning from Honey: A Case Report

Honey is produced by bees from nectar collected from nearby flowers. Sometimes, honey produced from the Rhododendron species is contaminated by Grayanotoxin (GTX) in Nepal and other countries. There have been reports of GTX intoxication, also known as 'mad honey disease', from honey produced in countries other than Korea. The importation of wild honey has been prohibited by the Korean Food and Drug Administration since 2005, yet it is still distributed within Korea by the occasional tourist. We report a case of GTX intoxication from contaminated honey which included the symptoms of nausea, vomiting, general weakness, dizziness, blurred vision, hypotension and sinus bradycardia. By means of infusion with normal saline and atropine sulfate, the patient's condition fully recovered within 8 hours of hospital admission, and she was discharged without any complications.