• Journal of Veterinary Clinics
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• v.23 no.3
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• pp.320-324
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• 2006

The purpose of the present study was to compare pulsatile type(Twin Pulse Life Support; TPLS) with rotary type hemodialyzer(AK95) in order to reduce the dialysis time and to improve dialysis effect. Three healthy dogs(about 30 kg BW) were used. Experimental renal failure was induced by the ligation of bilateral renal artery. A pair of catheters were implanted in jugular vein for dialysis. Daily investigated parameters included clinical signs such as vomiting, fecal appearance and activity, and also laboratory data such as PCV, TP, BUN and creatinine. Hemodialysis was started above 90 mg/100 ml BUN level and, laboratory data were measured every an hour for 4 hours. Heparin was administered 300 IU/Kg before dialysis and 150 IU/Kg via IV route every 90 minutes during dialysis. Clinical signs after induction renal failure were shown severe vomiting, anorexia, diarrhea, mucous feces, ataxia, dilated pupil and episcleral hyperemia. The average of BUN value decreased hourly $99{\pm}12.1,\;84{\pm}12.2,\;72{\pm}8.0,\;58{\pm}7.1,\;48{\pm}5.2,\;and\;39{\pm}3.2mg/100ml$ by hemodialysis. The average of creatinine value decreased $7.8{\pm}0.61,\;6.4{\pm}0.40,\;5.3{\pm}0.42,\;4.5{\pm}0.23,\;4.0{\pm}0.41,\;and\;3.4{\pm}0.42mg/100ml$ according to hemodialysis an hour. There are not significantly differences BUN, creatinine, PCV and TP values between pulsatile and rotary type hemodialysis. These results suggested that effects of hemodialysis with Pulsatile type(TPLS) are not significantly difference as compared with hemodialysis of rotary type(AK95). Further research is needed in order to estimate the influence of cardiovascular and pulmonary system in hemodialysis of pulsatile type.

• Journal of Chest Surgery
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• v.12 no.4
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• pp.371-378
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• 1979

The authors have performed operations on vascular system of 108 cases from 1972 through 1979, and analyzed the diseases, surgical procedures and results. They were 1. Arterial system; 45 cases P.D.A. : 20 Occlusive diseases : 13 Coarctation of aorta : 4 Aneurysm : 4 A-V fistula : 2 Trauma : 2 2. Venous system; 6 cases Esophageal varix : 4 S.V.C. syndrome : 1 Varicose vein : 1 3. Arteriovenous shunt for hemodialysis; 57 cases Of the arterial diseases, the worst results came from Burger`s disease. For the bleeding esophageal varices, we have performed ligations of varices or collateral circulations rather than emergency splenorenal shunt with good results. External A-V shunt for hemodialysis had much more complications than the A-V fistula.

• Journal of Chest Surgery
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• v.29 no.9
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• pp.1028-1030
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• 1996

Arteriovenous fistula Is the most widely used mean of vascular access for long-term hemodialysis in patients with end-stage renal disease. Lymphangioma associated with arteriovenous fistula is very rare, seemed to be developed from Iymphatic fluid accumulation. Lymphangioma is benign neoplasm, arises de hobo or secondary to surge y or irradiation, and affects almost any part of the body served by the Lwphasic system. Treatment of choise for Iymphangioma Is surgical excision. We repo$\ulcorner$t a case of procedure using Gore-Tex graft between left brachial artery and cephalic vein for vascular access of hemodialysis in 59 year old female, with successful surgical removal.

• Journal of Korean Clinical Nursing Research
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• v.14 no.1
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• pp.161-172
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• 2008

Purpose: This study was to classify patient severity score for hemodialysis patients. Method: The subject of this study was 1,575 patients. To study the severity of the patients, we used t-test and ANOVA. The congruity was measured by Kappa coefficient and the severity in each medical facility was analyzed by ANOVA. Result: The results showed that there was a significant difference according to the levels of medical center (F=171.187, p<.0001). Categorizing the severity of the patients in each medical facility, group II and III of the secondary medical institution had higher ratio than the primary medical institution. There was not a single patient coming under group IV in both of the primary or secondary medical institutions. However, the tertiary medical institutions had more subjects in group II and III than the primary and secondary medical institutions. The group IV with the highest severity had 11 patients(1.5%), demonstrating that the tertiary medical institution had higher severity patients than the primary or secondary medical institutions. Conclusion: The results of this study appropriately reflects the repayment system of medical expenses by the government. Also, it provides the fundamental information to develop nursing fee system taken into account of the systemic differences among the primary, secondary and tertiary medical institutions.

• The Korean Society of Law and Medicine
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• v.21 no.1
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• pp.69-105
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• 2020

In the health care system, medical fee payment is a very important and basic factor. The National Health Insurance Act adopted a contract system, and the content of the contract is to be determined the unit price per relative value scale. Accordingly, in the National Health Insurance system, the costs of health care benefits are adjusted each year according to inflation or changes in economic conditions. On the other hand, in the Medical Care Assistance system, the Medical Care Assistance Act does not prescribe the method of determining the medical payment, and all matters are delegated to the Minister of Health and Welfare. Accordingly, the Minister has adopted a fixed-payment system for hemodialysis treatment since 2001. A constitutional petition was filed in 2017 against this fixed-payment system, and the Constitutional Court rejected the petition in 2020. In this study, we examine the meaning and content of the medical fee payment system, focusing on the above constitutional petition case, and present three principles as constitutional limits on the system. The first of its principles is the principle of legality, the second is the principle of prohibition of comprehensive delegation, and the third is the principle of proportionality. From that point of view, There are many unconstitutional elements in the fixed-payment system on hemodialysis.

• Journal of Nutrition and Health
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• v.35 no.5
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• pp.544-557
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• 2002

This study was performed to evaluate the quality of nutrient intakes of the hemodialysis patients (26 men and 23 women) according to the socioeconomic status by 3-day dietary recall in Daejeon city and Chungnam area, Korea. Mean age of the subjects was 50.7 yrs and BMI was 22.0 $\pm$ 0.4 kg/$m^2$. Education level was divided into two groups ($\leq$ 9 years： LE group, 9 years： HE group), and monthly family income level was divided into three groups (< 500,000 won: LI group, 500,000-1,499,999 won: MI group, $\geq$ 1,500,000 won : HI group). The data were analyzed by Student t-test and Oneway ANOVA using SPSS 9.0 version at p < 0.05 level. Intakes of energy, carbohydrates, cholesterol, potassium, thiamin and riboflavin were significantly higher in HE group than in LE group (p < 0.05). Intakes of all the nutrients except protein and phosphorus were less than Korean RDA, and INQs (Index of Nutritional Quality) of most nutrients were lower than 1.0 but cholesterol, phosphorus. thiamin and niacin being over 1.0 in HE group. MAR (Mean adequacy ratio) of all the nutrients (e.g., energy, protein, calcium, phosphorus, iron, vitamin A, vitamin C, thiamin, riboflavin and niacin) was significantly higher in HE group (0.61 $\pm$ 0.04) than in LE group (0.48 $\pm$ 0.03) at p = 0.036. Intakes of energy, protein (total, animal and plant), fat, cholesterol, potassium, calcium, phosphorus, iron, vitamin A, thiamin and riboflavin were also significantly higher in HI group than in LI and MI group (p < 0.05). Daily intakes of most nutrients were less than Korean RDA except protein ed phosphorus in HI poop, and INQs of thiamin, niacin and phosphorus were higher than 1.0, while those of calcium, iron, vitamin A and riboflavin were lower than 1.0. MAR of energy and 9 nutrients was significantly higher in HI group (0.70 $\pm$ 0.04) than in LI group (0. 56 0.04) and MI poop (0.47 $\pm$ 0.03) at p = 0.000. In conclusion, quality of nutrient intakes, especially energy and protein, was significantly influenced by socioeconomic status such as education and monthly income (p < 0.05). This result suggests that it would be very helpful to develop nutritional education programs considering hemodialysis patients' education levels, and to improve public supports (e.g., medical insurance system, low-rate lease system of dialysis equipments, etc.) focusing on the patients' family income levels f3r their better nutrition and health.

• Kidney Research and Clinical Practice
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• v.37 no.4
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• pp.393-403
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• 2018

Background: This study compared nutritional parameters in hemodialysis (HD) subjects and controls using bioimpedance analysis (BIA) and investigated how BIA components changed before and after HD. Methods: This cross-sectional study included 147 subjects on maintenance HD from two hospitals and 298 propensity score-matched controls from one healthcare center. BIA was performed pre- and post-HD at mid-week dialysis sessions. Results: Extracellular water/total body water (ECW/TBW) and waist-hip ratio were higher in the HD patients; the other variables were higher in the control group. The cardiothoracic ratio correlated best with overhydration (r = 0.425, P < 0.01) in HD subjects. Blood pressure, hemoglobin, creatinine, and uric acid positively correlated with the lean tissue index in controls; however, most of these nutritional markers did not show significant correlations in HD subjects. Normal hydrated weight was predicted to be higher in the pre-HD than post-HD measurements. Predicted ultrafiltration (UF) volume difference based on pre- and post-HD ECW/TBW and measured UF volume difference showed a close correlation ($r^2=0.924$, P < 0.01). Remarkably, the leg phase angle increased in the post-HD period. Conclusion: The estimated normal hydrated weight using ECW/TBW can be a good marker for determining dry weight. HD subjects had higher ECW/TBW but most nutritional indices were inferior to those of controls. It was possible to predict UF volume differences using BIA, but the post-HD increase in leg phase angle, a nutritional marker, must be interpreted with caution.

• Journal of The Korean Society of Clinical Toxicology
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• v.2 no.2
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• pp.129-132
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• 2004

Ethylene glycol poisoning can cause profound morbidity and is almost universally fatal if untreated. Central nervous system depression, pulmonary edema, and acute oligulic renal failure with crystalluria are among the most commonly encountered complication of ingestion. Ingestion of ethylene glycol may be an important contributor in patients with metabolic acidosis and subsequent renal failure. The diagnosis of ethylene glycol poisoning is based on nonspecific clinical symptoms and signs and indirect and direct laboratory measurement of ethylene glycol. As a result, diagnosis and treatment sometimes can be delayed. We describe 52-year-old man who visited to emergency department with mental change of unknown origin. The patient has high anion gap metabolic acidosis and renal failure due to ingestion of antifreeze that contained ethylene glycol. We used hemodialysis for elimination technique. The patient was discharged with minimal complication.

• Korea Journal of Hospital Management
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• v.18 no.2
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• pp.81-103
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• 2013

This study is to research cost accounting practice and to analyze propriety of patients' medical payment in artificiality kidney center. The researched cost datum of the year 2012 are as follows. - Hemodialysis medical treatment was reimbursed as much as 158,001 won in case of health insured patients, but payed-off as much as 135,810 won. - The average figure of the total hospitals and clinic center is 1,603,303 won, and one time cost of hemodialysis treatment is 154,487 won. Optimal treatment pay are suggested as follows. First, Regardless of the notified classification from MOHW(Ministry of Health and Welfare), 136,000 won of fixed price payment classification needs to be reclassified by patients, severity and tobe rearranged by fixed price payment system of hospitals. Second, Fixed payment code notified by the Ministry of Health and Welfare is recommended to be simplifies and to reflect according to contents of the medical treatment rendered to patients. Third, Establishment of artificial kidney center has to be risk managed because of its huge investment. Fourth, Cost analysis model has to be maintained as basis together with appropriate application of conversion index model mixed with SGR model.

• Quality Improvement in Health Care
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• v.7 no.2
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• pp.204-216
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• 2000

Background : There has been a concern that the quality of care provided to end-stage renal disease (ESRD) patients in the United States may not be as good as recommended. This paper illustrates a composite measure to assess, the quality of care received by ESRD patients undergoing in-center hemodialysis by incorporating outcomes for 4 major treatment areas. The 4 treatment areas are: dialysis treatments, anemia control, nutritional management, and blood pressure control. Methods : The major data source for the study was the United States Renal Data System (USRDS) Dialysis Morbidity and Mortality Study Wave 1 (DMMS-1) d Sixteen categories of a composite quality indicator were constructed by combining 4 dichotomous variables (16=2*2*2*2). representing the optimal vs. less than optimal level of outcome for each of the 4 treatment outcome measure respectively. Optimal outcome level for each treatment area was defined based on the recommendation from the National Kidney Foundation: (a) delivered dialysis doses (Kt/V) ${\geq}$ 1.2; (b) hematocrit level ${\geq}$ 30%; (c) serum albumin concentration ${\geq}$ 3.8g/dl ; and (d) blood pressure of <140 / <90mmHg. The 16 quality indicator were ranked according to their relative quality weights, which were estimated from its association with the relative risk of survival, adjusting for patient's baseline severity and dialysis facility characteristics. Results : Out of the entire sample of 2,179 patients, only 229 (10%) meet th recommended outcome levels for all 4 treatment areas. Overall, the study patients were distributed evenly over the 16 quality indicators, indicating a great variation in the quality of ESRD care. It appears that the rank of the 16 quality-indicators is driven by serum albumin concentration, suggesting that serum albumin concentration may be the most powerful predictor of ESRD patient survival among the 4 outcome measures. Conclusion : The developed quality indicator has the advantage of describin a range of care for dialysis patients and thus providing a more complete picture of care as compared to previous studies that have focused on only single or few components of the ESRD care.