ABSTRACT
Background@#This is the first clinical study conducted among Asian women using breast implants manufactured by an Asian company. Four-year data regarding the safety and efficacy of BellaGel breast implants have already been published, and we now report 6-year data. @*Methods@#This study was designed to take place over 10 years. It included 103 patients who underwent breast reconstruction or augmentation using BellaGel breast implants. The rates of implant rupture and capsular contracture were measured and analyzed to evaluate the effectiveness of the breast implant. @*Results@#At patients’ 6-year postoperative visits, the implant rupture and capsular contracture rates were 1.15% and 2.30%, respectively. The implant rupture rate was 3.77% among reconstruction cases and 0% among augmentation cases. The capsular contracture rate was 5.66% among reconstruction cases and 0.83% among augmentation cases. @*Conclusions@#The 6-year data from this planned 10-year study suggest that the BellaGel cohesive silicone gel-filled breast implant is an effective and safe medical device that can be used in breast reconstruction and augmentation.
ABSTRACT
This is a case of a 56-year-old man with Castleman disease (CD) who improved after kidney transplantation (KTP). CD is an uncommon lymphoproliferative disorder that was found incidentally on biopsy during dialysis in the current patient and was followed up without further treatment. However, the lesion showed improvement after KTP. Therefore, active KTP can be considered even if CD is one of the lymphoproliferative disorders that can occur as a complication after KTP.
Subject(s)
Humans , Middle Aged , Biopsy , Dialysis , Castleman Disease , Kidney Transplantation , Kidney , Lymphoproliferative Disorders , Renal DialysisABSTRACT
Kidney transplantation (KTP) lowers the mortality and morbidity of patients with end-stage renal disease. Post-transplantation infection and antibody mediated rejection (AMR) are the most common complications. Hepatitis B surface antigen (HBsAg) positive carrier donors and high anti A/B antibody titer ABO incompatible KTP could lead to recipient hepatitis B virus (HBV) infection and AMR. Here, we report a case of successful KTP in a 41-year-old male with a high titer of ABO incompatible and HBsAg positive donor. He underwent seven rounds of plasmapheresis, low dose intravenous immunoglobulin and rituximab treatment to inhibit antibody production and remove antibodies from the serum, after which he was administered anti-viral agent for HBV prophylaxis. The recipient maintained successful allograft function for 6 months after transplantation; therefore, we report that desensitization and anti-viral treatment achieved successful outcome in a 1:512 anti A/B antibody titer ABO incompatible and hepatitis B carrier donor KTP.
Subject(s)
Adult , Humans , Male , Allografts , Antibodies , Antibody Formation , Hepatitis B Surface Antigens , Hepatitis B virus , Hepatitis B , Hepatitis , Immunoglobulins , Kidney Failure, Chronic , Kidney Transplantation , Kidney , Mortality , Plasmapheresis , Rituximab , Tissue DonorsABSTRACT
Transplant renal artery stenosis (TRAS) is an important cause of hypertension, allograft dysfunction, and graft loss. Patient and allograft survival rates are lower in patients with TRAS. Causes of TRAS include acute rejection, cytomegalovirus infection, calcineurin inhibitor toxicity, atherosclerosis of recipient, and/or donor. Technical problems due to surgery are a common cause of early TRAS. A 62-year-old male in end stage renal disease received kidney transplant surgery. There was 5/6 mismatch of human leukocyte antigen and the panel reactive antibody of patient was class I 0% and class II 0%. End to side anastomosis was done between the graft's renal artery and the patient's common iliac artery. His serum creatinine was measured at 6.4 mg/dL before transplantation but his serum creatinine level did not fall below 2.6 mg/dL at 5 days postoperative. His blood pressures was 160/90~180/100 mmHg. There was a significant TRAS (about 80% luminal narrowing) at the arterial anastomosis site on the renal magnetic resonance angiography. We performed percutaneous transluminal angioplasty (PTA) for the stenotic lesion. The balloon angioplasty was done with a 5 mm balloon and low pressure (8 mmHg, nominal pressure was 10 mmHg) at the stenotic lesion. The arterial pressure gradient was 8 mmHg (recipient's common iliac arterial pressure, 147/73 mmHg; poststenotic segmental renal arterial pressure, 139/70 mmHg) just before the balloon angioplasty. After PTA, the arterial pressure gradient became 3 mmHg (recipient's common iliac arterial pressure, 157/66 mmHg; poststenotic segmental renal arterial pressure, 154/65 mmHg). The arterial size and blood flow recovered to within normal range and serum creatinine level was normal after PTA. PTA using low pressure and a small balloon was safe and effective modality in treating early TRAS.
Subject(s)
Humans , Male , Middle Aged , Allografts , Angioplasty , Angioplasty, Balloon , Arterial Pressure , Atherosclerosis , Calcineurin , Creatinine , Cytomegalovirus Infections , Hypertension , Iliac Artery , Kidney , Kidney Failure, Chronic , Kidney Transplantation , Leukocytes , Magnetic Resonance Angiography , Phenobarbital , Reference Values , Renal Artery Obstruction , Renal Artery , Survival Rate , Tissue Donors , TransplantsABSTRACT
Thrombotic microangiopathy (TMA) is a serious complication of solid organ transplantation. Drug-induced TMA is typically caused by immunosuppressants, particularly calcineurin inhibitors. Withdrawing the causative drug can be one of the treatments for TMA. However, the more immunosuppressants are reduced, the more risk of rejection increases. Even if TMA is successfully resolved, the outcomes of patient and graft survival would be worse than expected. Therefore, it is necessary to maintain efficient and safe immunosuppression therapy. We report on a case of de novo TMA after kidney transplantation triggered by tacrolimus and reactivated by sirolimus. Belatacept, a novel CTLA4 Ig fusion protein, was administered for maintenance immunosuppressant with mycophenolate mofetil and prednisolon. The patient had excellent early graft outcome, and there have been no adverse events so far.
Subject(s)
Humans , Abatacept , Calcineurin , Graft Survival , Immunosuppression Therapy , Immunosuppressive Agents , Kidney Transplantation , Kidney , Organ Transplantation , Sirolimus , Tacrolimus , Thrombotic Microangiopathies , TransplantsABSTRACT
BACKGROUND: Although nutritional problems associated with dialysis are well described, nutritional problems after renal transplantation have received little attention. Nutrition interventions play an important role in prevention and management of common health problems associated with renal transplantation such as obesity, hypertension, diabetes, and cardiovascular disease. METHODS: Sixty-four kidney transplant recipients who received post-transplant management at our hospital replied to the questionnaire. The questionnaire included 102 questions on the amount and types of Korean foods that they consumed last week. Nutritional elements of diet in renal transplant patients who consume Korean food were analyzed on the basis of the survey. RESULTS: The mean energy and protein of daily intake were 2,088+/-1,016 kcal and 75.5+/-38.2 g. Patients' diets were generally sufficient, but characterized by deficiencies in vitamin B2, vitamin D, niacin, calcium, and magnesium intake. CONCLUSIONS: Dietary advice is required with regard to intake of some nutritional elements for kidney transplant recipients who consume Korean foods. Their main nutritional problem is obesity after transplantation. Attention should be paid to prevention of nutritional imbalance.
Subject(s)
Humans , Calcium , Cardiovascular Diseases , Dialysis , Diet , Hypertension , Kidney Transplantation , Kidney , Magnesium , Niacin , Obesity , Surveys and Questionnaires , Riboflavin , Transplantation , Vitamin DABSTRACT
Hyperuricemic patients with gouty arthritis or tophi, a serum uric acid concentration of 8.0 mg/dL or higher, and complications should be treated with urate-lowering drugs. Conventionally, allopurinol is used to treat hyperuricemia and gout, but it is necessary to adjust the dosage according to the degree of renal impairment. Uncommonly, allopurinol may have severe or fatal side effects. The non-purine xanthine oxidase inhibitor febuxostat undergoes hepatic metabolism and may require less dose adjustment in association with renal function. It is considered to be an alternative treatment for hyperuricemic patients with chronic kidney disease. Our experience suggests that low-dose febuxostat is a promising alternative to allopurinol for the treatment of gouty arthritis or tophi in peritoneal dialysis patients.
Subject(s)
Humans , Allopurinol , Arthritis, Gouty , Gout , Hyperuricemia , Kidney Failure, Chronic , Metabolism , Peritoneal Dialysis , Peritoneal Dialysis, Continuous Ambulatory , Renal Insufficiency, Chronic , Uric Acid , Xanthine Oxidase , FebuxostatABSTRACT
Pneumocystis jirovecii pneumonia (PCP) can be a life-threatening opportunistic infection after kidney transplantation, occurring most frequently in the first 12 months with the symptoms of dyspnea, cough, fever, and hypoxia. Prophylaxis for PCP is usually applied during the first 3 months to 1 year after transplantation, but late onset incidence of PCP can be detected. We report on a patient who developed PCP 9 years after renal transplantation. The patient showed indolent onset of acute respiratory distress and was treated with trimethoprim-sulfamethoxazole and corticosteroid therapy. Previous rescue treatment of acute cellular rejection with ongoing maintenance of an elevated level of immunosuppressants may have predisposed the patient to PCP.
Subject(s)
Humans , Hypoxia , Cough , Dyspnea , Fever , Immunosuppressive Agents , Incidence , Kidney Transplantation , Opportunistic Infections , Pneumocystis carinii , Pneumocystis , Pneumonia , Transplantation , Trimethoprim, Sulfamethoxazole Drug CombinationABSTRACT
Transplant renal artery stenosis (TRAS) is a common surgical complication after kidney transplantation (KTP) and is the cause of allograft dysfunction. TRAS is a potentially curable cause of refractory hypertension and allograft dysfunction which accounts for approximately 1% to 5% of cases of post-transplant hypertension. Acute cellular rejection (ACR) is also common after KTP, which is the main cause of allograft dysfunction. Although the incidence of ACR has declined with the advent of new immunosuppressive drugs, it is still around 15% worldwide. Although each disease is frequently seen individually, seeing both together is rare. A 42-year-old man with end stage renal disease underwent KTP, and the donor was his younger brother. Four months after KTP, his serum creatinine was increased to 2.1 mg/dL, and renal biopsy showed interstitial lymphocytic infiltration and tubulitis. With the diagnosis of acute T-cell mediated rejection, steroid pulsing therapy was started, but it was resisted. Therefore thymoglobulin 60 mg (1 mg/kg/day) was administered for 6 days, but serum creatinine was 1.8 mg/dL. Abdomen magnetic resonance angiography showed TRAS, stenosis at the anastomosis site and lobar artery in the lower pole. Percutaneous transluminal angiography was performed successfully. After balloon angioplasty, the stenotic lesion showed a normal size and blood flow. The patient's renal function returned to normal levels and he is currently being followed up for 9 months.
Subject(s)
Adult , Humans , Abdomen , Allografts , Angiography , Angioplasty, Balloon , Arteries , Biopsy , Constriction, Pathologic , Creatinine , Diagnosis , Hypertension , Incidence , Kidney Failure, Chronic , Kidney Transplantation , Magnetic Resonance Angiography , Renal Artery Obstruction , Renal Artery , Siblings , T-Lymphocytes , Tissue Donors , TransplantationABSTRACT
Intrathoracic omental herniation through the esophageal hiatus is extremely rare. Here, we report a case of a 57-year-old male with continuous ambulatory peritoneal dialysis (CAPD) who was admitted to our hospital after experiencing nausea and abdominal discomfort for 3 days. Computed tomography (CT) revealed a fatty mass, extended continuously through the esophageal hiatus into the thoracic cavity. Laparoscopic surgery revealed an omental herniation through the esophageal hiatus. There was no herniation of the stomach or intestines. Peritoneal dialysis was resumed six weeks later. This is a report of omental herniation through the esophageal hiatus in a patient with CAPD.
Subject(s)
Humans , Male , Middle Aged , Hernia , Intestines , Laparoscopy , Nausea , Omentum , Peritoneal Dialysis , Peritoneal Dialysis, Continuous Ambulatory , Stomach , Thoracic CavityABSTRACT
Conversion of immunosuppressants to sirolimus, an inhibitor of mammalian target of rapamycin, is a useful treatment option for prevention of the adverse events of immunosuppressants such as calcineurin inhibitor in renal transplantation recipients. In addition, sirolimus has been improving the quality of life and increasing the survival of patients with renal transplantation by decreasing immunosuppression-related malignancies, particularly skin cancer. However, complete remission of skin squamous cell carcinoma after renal transplantation only by conversion to sirolimus has not been well reported, although its preventive effect on skin cancer is well known. We report on a 72-year-old male with squamous cell carcinoma in his nasal cavity consequent to renal transplantation, which was treated completely with the conversion of cyclosporine to sirolimus without surgical removal or chemotherapy.
Subject(s)
Aged , Humans , Male , Calcineurin , Carcinoma, Squamous Cell , Cyclosporine , Drug Therapy , Immunosuppressive Agents , Kidney Transplantation , Nasal Cavity , Quality of Life , Sirolimus , Skin , Skin NeoplasmsABSTRACT
Tuberous sclerosis complex (TSC) is a neurocutaneous disease characterized by the formation of hamartomas in multiple organs. TSC can show lesions including facial angiofibroma, shagreen patch on the skin, cortical tuber, subependymal nodule, astrocytoma in the brain, cardiac rhabdomyoma, and renal angiomyolipoma. In particular, renal angiomyolipoma may be a cause of end-stage renal disease (ESRD). On the other hand, sirolimus has regulatory effects on cellular growth and proliferation via its inhibitory effect on a protein, mammalian target of rapamycin. We report on a case of an 18-year-old male who underwent renal transplantation due to ESRD induced by TSC. Sirolimus played a role in successful treatment of TSC and effective immunosuppression for transplantation.
Subject(s)
Adolescent , Humans , Male , Angiofibroma , Angiomyolipoma , Astrocytoma , Brain , Hamartoma , Hand , Immunosuppression Therapy , Kidney Failure, Chronic , Kidney Transplantation , Rhabdomyoma , Sirolimus , Skin , Tuberous SclerosisABSTRACT
Acute antibody-mediated rejection is the major cause of graft failure in the early stage of kidney transplantation. Preoperative treatment and early diagnosis of acute rejection is very important to prevent graft loss in sensitized patients. High panel reactive antibody (PRA) means a likelihood of acute rejection, and the recipient of high PRA needs adequate pretreatment for kidney transplantation. However, there is not sufficient time and chances for desensitization in deceased kidney transplants. We report a successful renal transplant outcome in a 47-year-old-woman with high PRA levels (Class I 97.5%, Class II 36.7%). The cross match was negative on the CDC (ELISA) and flowcytometric methods. Plasma exchange was performed on the recipient before transplantation (fresh frozen plasma replacement, 1.3 plasma volume) and immediately after plasma exchange she was given 200 mg of rituximab. She received basiliximab and methyl prednisolone induction therapy and was maintained on steroids, mycophenolate mofetil, and tacrolimus. Graft function was normal immediately after transplantation, but decreased urinary output and elevated serum creatinine was noted on POD 5. On POD 6, a graft biopsy revealed acute cellular rejection (Type IIa) and antibody-mediated rejection (Type II). On 9~13 days after transplantation, additional plasma exchange was performed every other day, and steroid pulse therapy was performed 3 times. After normalization of urinary output and serum creatinine, the patient was discharged and is being followed up on. In conclusion, immunologically careful preparation and pretransplant treatment may be needed on the negative cross match in cadaveric kidney recipients with high levels of PRA.
Subject(s)
Humans , Antibodies, Monoclonal , Antibodies, Monoclonal, Murine-Derived , Biopsy , Cadaver , Creatinine , Early Diagnosis , Graft Rejection , Immunization , Kidney , Kidney Transplantation , Mycophenolic Acid , Plasma , Plasma Exchange , Prednisolone , Recombinant Fusion Proteins , Rejection, Psychology , Rituximab , Steroids , Tacrolimus , Tissue Donors , TransplantsABSTRACT
BACKGROUND/AIMS: Heart rate variability (HRV) is a method for evaluation of autonomic nervous system activity by expressing the balance of sympathetic and parasympathetic tones. Some studies of HRV in patients with end-stage renal disease (ESRD) have been performed in Korea. However, few have examined kidney transplantation (KT) patients. Therefore, we investigated autonomic nervous system activity by means of HRV in patients with KT due to ESRD. METHODS: We compared the pattern of cardiac sympathetic and parasympathetic activity by time- and frequency-domain analysis of HRV with 24-h Holter monitoring of 23 KT and 56 dialysis patients. Patients underwent KT between January, 2008 and June, 2011. RESULTS: The mean ages of KT and dialysis patients were 54.2 +/- 12.3 and 53.7 +/- 12.6 years, respectively. The KT group showed increased time- and frequency-domain HRV (including HRV index), very low frequency (VLF), means and standard deviations of all normal R-R intervals for all 5-min segments of the entire recording (SDNNi), low frequency (LF), LF in normalized units (LF norm), and LF to high-frequency power ratio, compared with the dialysis group. CONCLUSIONS: Autonomic tone in patients with KT is higher than that in patients with ESRD on dialysis.
Subject(s)
Humans , Autonomic Nervous System , Dialysis , Electrocardiography , Electrocardiography, Ambulatory , Heart , Heart Rate , Kidney , Kidney Failure, Chronic , Kidney Transplantation , KoreaABSTRACT
Renal biopsy is an essential diagnostic tool for detecting acute and chronic kidney rejection as well as recurrent and de novo nephropathies in renal allograft recipients. However, a well-known complication of percutaneous renal biopsy is arteriovenous fistula (AVF). Most post-biopsy AVFs are asymptomatic and regress spontaneously but some AVFs result in hypertension, hematuria, and renal insufficiency. Whether post-biopsy AVF superimposed on transplant renal artery stenosis (TRAS) also regresses spontaneously is unknown. We present a case of acute renal insufficiency in a 51-year-old female renal allograft recipient with post-biopsy AVF and TRAS. Percutaneous angioplasty with stent implantation was performed for the TRAS and transcatheter arterial coil embolization therapy applied for AVF. The patient's renal function returned to baseline levels and is currently being followed up for 6 months.
Subject(s)
Female , Humans , Acute Kidney Injury , Angioplasty , Arteriovenous Fistula , Biopsy , Hematuria , Hypertension , Kidney , Rejection, Psychology , Renal Artery , Renal Artery Obstruction , Renal Insufficiency , Stents , Transplantation, Homologous , TransplantsABSTRACT
Acute antibody-mediated rejection (AMR) developing simultaneously with acute cellular rejection has been rarely reported as a long-term complication of renal transplantation, and it can present on top of another chronic pathology affecting the graft. A 51-year-old female patient with chronic kidney disease of unknown etiology received renal transplantation 12 years ago from a living unrelated donor with 3 HLA mismatches. She received induction therapy with methylprednisolone and was maintained on steroids, mycophenolate mofetil and cyclosporine A (CsA). For a period of twelve years post-transplantation, she was clinically and biochemically stable. She presented with a rise in serum creatinine (SCr.) from 1.3 mg/dL to 2.4 mg/dL but did not have proteinuria. Graft biopsy revealed findings suggestive of acute cellular rejection on top of antibody-mediated rejection (type II) and chronic calcineurin inhibitor toxicity. Panel reactive antibody (PRA) test levels were 3.6%, 91.7% for class I and II respectively. The patient was treated with high-dose methylprednisolone for 3 days but serum creatinine was not fully normalised. After 2 weeks from initial methyl-PDS pulse therapy, she received intravenous immunoglobulin, plasma exchange and anti-CD20 (rituximab). Cyclosporine was changed to tacrolimus. She achieved a complete response, and SCr. was maintained at 1.3 mg/dL without proteinuria. Follow-up PRA test levels were 0%, 75% for class I and II. Current therapies have had considerable success in reversing mixed, acute humoral and cellular rejection since it is being identified quickly and treated aggressively. The best use of rituximab to treat AMR should be evaluated in controlled trials using dosing strategies that include longer courses or retreatment schedules.
Subject(s)
Female , Humans , Middle Aged , Antibodies, Monoclonal, Murine-Derived , Appointments and Schedules , Biopsy , Calcineurin , Creatinine , Cyclosporine , Follow-Up Studies , Graft Rejection , Immunoglobulins , Immunoglobulins, Intravenous , Kidney Transplantation , Methylprednisolone , Mycophenolic Acid , Plasma Exchange , Plasmapheresis , Proteinuria , Rejection, Psychology , Renal Insufficiency, Chronic , Retreatment , Rituximab , Steroids , Tacrolimus , Transplants , Unrelated DonorsABSTRACT
BACKGROUND/AIMS: Many studies have reported the correlation between the spot urine protein to creatinine (P/C) ratio and 24-hour urinary protein amounts in patients with glomerulonephritis. This correlation has also been reported in Western patients with kidney transplants, but no prior study has reported on this association in Eastern populations. We compare the correlation between the spot urine P/C ratio and 24-hour urinary protein amounts and the associating factors in Korean patients with kidney transplants. METHODS: The study included 66 patients with kidney transplants from our hospital. The subjects had urine samples evaluated between January 2005 and July 2010. We compared 24-hour urinary protein amounts with a spot urine P/C ratio collected in the morning and analyzed the factors affecting the correlation in each group. RESULTS: The 24-hour urinary protein amounts were 1.31 +/- 1.69 g/day and the spot urine P/C ratio was 1.29 +/- 1.70 in all subjects. A strong positive linear correlation was observed between the 24-hour urinary protein amounts and the spot urine P/C ratio (r = 0.95). The primary factor affecting accurate quantitation of proteinuria using the spot urine P/C ratio was gender (p = 0.003). The spot urine P/C ratio and the 24-hour urinary protein levels were 1.05 +/- 1.51 and 1.26 +/- 1.68 g/day in males (p = 0.005) and 1.57 +/- 1.88 and 1.36 +/- 1.72 g/day in females (p = 0.047), respectively. CONCLUSIONS: We determined that the spot urine P/C ratio provides an accurate estimate of 24-hour urinary protein levels in Korean patients with kidney transplants.
Subject(s)
Female , Humans , Male , Creatinine , Glomerulonephritis , Kidney , Kidney Transplantation , Proteinuria , TransplantsABSTRACT
Peritonitis is one of the major complications of continuous ambulatory peritoneal dialysis (CAPD). Multidrug-resistant organisms, including vancomycin-resistant enterococci (VRE), have been reported as pathogens of CAPD-associated peritonitis. The incidence of hospital-associated infections caused by VRE has recently increased. Some drugs, such as linezolid and quinupristin/dalfopristin, have been introduced as treatments of VRE infection. However, there is limited information about the effects of VRE-associated CAPD peritonitis. We present a case of successful treatment of CAPD peritonitis caused by VRE with quinupristin/dalfopristin and include a review of the literature.
Subject(s)
Humans , Acetamides , Incidence , Oxazolidinones , Peritoneal Dialysis, Continuous Ambulatory , Peritonitis , LinezolidABSTRACT
PURPOSE: Quantification of the dialysis dose is an essential element in the management of hemodialysis. The author investigates the reliability of hemodialysis adequacy measured by ionic dialysance (Online clearance monitoring(R), OCM). Because OCM is a non-invasive and instantly accessible method, it could be replaced Kt/V derived from single-pool variable volume urea kinetic model (UKM). METHODS: Kt/V using UKM and OCM were measured simultaneously in 51 patients who have received hemodialysis therapy via arteriovenous fistula. The analysis of the data collected from 186 hemodialysis sessions were performed. RESULTS: Kt/V of conventional hemodialysis, high efficiency hemodialysis and hemodiafiltration measured by UKM were 1.39+/-0.24, 1.41+/-0.23 and 1.53+/-0.17, and by OCM were 1.24+/-0.17, 1.26+/-0.19 and 1.39+/-0.19, respectively. The data of UKM were significantly higher than those of OCM (p=0.00). Also, there were strong positive correlations between UKM and OCM in hemodialysis (r=0.80, p=0.00), high efficiency hemodialysis (r=0.65, p=0.00) and hemodiafiltration (r=0.67, p=0.00). CONCLUSION: The Kt/V using OCM measured by ionic dialysance provided slightly lower data than that of UKM derived from single-pool variable volume urea kinetic model, but it may be a reliable test to evaluate dialysis adequacy in conventional hemodialysis, high efficiency hemodialysis and hemodiafiltration.
Subject(s)
Humans , Arteriovenous Fistula , Dialysis , Hemodiafiltration , Renal Dialysis , UreaABSTRACT
BACKGROUND/AIMS: Heart rate variability (HRV) is regulated by the balance between the sympathetic and parasympathetic tones. HRV can be used to assess the effects of drugs and other interventions on cardiac autonomic tone, including exercise, respiration, metabolic change, and psychological or physical stress. As few studies have examined HRV in end-stage renal disease (ESRD) patients in Korea, we investigated autonomic nervous system activity reflected in HRV in patients on peritoneal dialysis for ESRD. METHODS: We compared the pattern of cardiac sympathetic and parasympathetic activity through time-and frequency-domain analysis of HRV in 20 ESRD patients and 65 hypertensive control subjects using 24-hour Holter monitoring. The patients had been undergoing peritoneal dialysis at the Bongseng Hospital between January 2006 and December 2008. RESULTS: The mean age of the patients and controls was 53.8+/-13.1 and 55.1+/-13.7 years, respectively. In the patient group, all of the time- and frequency-domain HRV measures were reduced compared with the control group, including the HRV index, normalized unit of low-frequency (LF norm), and ratio of low-frequency power to high-frequency power (LF/HF), whereas the normalized unit of high frequency (HF norm) was increased. CONCLUSIONS: Autonomic tone in ESRD patients on peritoneal dialysis is decreased compared with patients with hypertension. The parasympathetic tone in ESRD patients on peritoneal dialysis dominates over the sympathetic tone.