Comparison of heart rate variability between end stage renal disease patients on hemodialysis and hypertensive patients / 대한내과학회지

BACKGROUND/AIMS: Heart rate variability (HRV) can be used to assess the effects of drugs and other interventions, including exercise, respiration, metabolic changes, and psychological or physical stressors, on cardiac autonomic tone. HRV is regulated by the balance of sympathetic and parasympathetic tone. Few studies pertaining to HRV in end stage renal disease (ESRD) patients have been performed in Korea. Thus, autonomic nervous system activity as indicated by HRV was investigated in patients on hemodialysis due to ESRD. METHODS: We compared the pattern of cardiac sympathetic and parasympathetic activity through time- and frequency- domain analyses of HRV with 24-hour Holter monitoring in 30 ESRD patients and 64 hypertensive control subjects. The ESRD patients had undergone hemodialysis therapy at the Bongseng Hospital between January 2006 and June 2007. RESULTS: The mean age of ESRD patients and hypertensive controls was 51.17+/-11.91 and 55.02+/-13.72 years, respectively. In the ESRD group, all time- and frequency-domain HRV measures, including the standard deviation of all normal sinus R-R intervals over 24 hours (SDNN), the HRV index, the very low-frequency (VLF) normalized unit of low-frequency (LFnorm), and the ratio of low-frequency power to high-frequency power (LF/HF), were reduced; the normalized unit of high frequency (HFnorm) was increased in the ESRD patients compared with the control group. CONCLUSION: The autonomic tone in ESRD patients on hemodiaysis was decreased compared with hypertensive patients. The parasympathetic tone in ESRD patients on hemodyalysis was dominant over the sympathetic tone.

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.

A Case of Polyoma Virus(PV) Infection in a Renal Allograft Recipient / 대한신장학회잡지

We report one case of renal PV infection after renal allograft transplantation leading to graft dysfunction. According to prior reports, PV induced interstitial nephritis might be a cause of graft loss. Pathologic findings show varying degrees of interstitial infiltration and tubular degenerative changes, which resemble acute cellular rejection. Therapeutic strategies have not yet been developed. Case ; A 23 years old male underwent renal transplantation from his HLA haploidentical 25 year old sister. His renal function had been good with cyclosporin, steroid and azathioprine until 9 months after transplantation, when his serum creatinine level rose to 2.2mg/dl. The renal biopsy revealed diffuse lymphocyte infiltration in the interstitium and feature of the tubulitis. Also, giant tubular epithelial cells with large, hyperchromic nuclei were present. Despite steroid pulsing and OKT3, renal function progressively de- teriorated. After 10 days of OKT3 therapy, the patient suffered from high fever, dyspnea and general aches. A chest X-ray revealed interstitial infiltration in both lung fields and the cytomegalovirus PCR (polymerase chain reaction) test of serum and blood was positive. Intravenous ganciclorvir was administered and immunosuppressants were tapered. 4 months after admission, he lost his graft function and underwent hemodialysis. The aforementioned renal biopsy was retested immunohistochemically. Nuclear inclusions in renal tubular epithelial cells were shown and these inclusions were reacted positively with PV monoclonal antibodies.

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.