• Biomedical Science Letters
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• v.23 no.3
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• pp.185-193
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• 2017

Malnutrition is common and the major risk factor of mortality of end stage renal disease (ESRD) patients. The aim of this study is to assess nutritional status of malnutrition patients on dialysis by various methods and compare nutritional parameters of continuous ambulatory peritoneal dialysis (CAPD) patients with hemodialysis patients. 137 patients on dialysis from April 2009 to July 2013 were enrolled. Nutritional parameters of 66 CAPD and 71 hemodialysis patients were investigated by anthropometry, biochemical study, diet analysis and questionnaires. Malnutrition patients were selected by body mass index (BMI), serum albumin and pre-albumin based on International Society of Renal Nutrition and Metabolism (ISRNM) diagnostic criteria for protein-energy wasting and compared with non-malnutrition patients. In comparison of CAPD and hemodialysis patients, most anthropometric values showed no significant difference except total body water (TBW). TBW was lower in CAPD patients (P=0.024). Although serum albumin was slightly higher in hemodialysis patients (P=0.047), pre-albumin were significantly higher in CAPD patients (P=0.000). Serum blood urea nitrogen (BUN) was higher in hemodialysis patients (P=0.000). In diet analysis, Total calorie (P=0.000) and total cholesterol (P=0.012) intakes were higher in CAPD patients. Mean subjective global assessment (SGA) grade was higher in CAPD patients (P=0.003). Several nutritional parameters of CAPD patients were better than hemodialysis patients implying more intensive therapeutic approach may be needed for hemodialysis patients. We have to understand multiple factors contributing malnutrition of ESRD patients and individualized therapeutic approach is needed.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.5 no.2
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• pp.313-323
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• 1998

This study was a descriptive research on the level of self-care available to continous ambulatory peritoneal dialysis patients (hereinafter referred to as 'CAPD patient') related to the specific area of infection management. The method employed for the collection of data was a modified instrument of the self-care survey essentially based on Young Sook Choi's instrument. The relevant data was collected from september 1, 1996 to september 30, 1996. The subjects were provided with an open-ended question regarding the reasons behind why they did not seek self-care. The answers provided about self-care compliance were analyzed by SPSS for frequency, percentage, mean, t-test, ANOVA. Reasons for non-compliance were analyzed by content analysis. The results of the study were as follows : 1. The percentage of patients engaging in self-care were according to the following self performed tasks : preparation of dialysis : 30.58 points Dialysate exchange procedures : 49.40 points - Two bag type : 50.50 points - Spike type : 48.80 points - Neo type : 48.90 points Catheter exit site care : 25.13 points More specifically, in relation to the preparation of dialysis as referred to above, those patients engaging in self care was relatively high with respect to the cleaning of the dialysis before use and for the preservation of peritosol. However, in dialysate exchange procedures, data revealed that those patients engaging in self-care are relatively low with respect to putting on a mask during the performance of peritosol exchange. Similary in peritosol exchange procedure and catheter exit care, low levels of self-care performance were found in the area of putting on a mask during the peritosol exchange procedures and catheter line testing procedures, respectively. 2. In general characteristics, there appeared to be no distinction in self-care compliance among CAPD patients. 3. The main reasons for non-compliance were based in the following factor : intellectual, attitude, enviromental surrounding and physical. As a result of the foregoing finding, nurses should provide adequate assistance to promote self-care compliance by CAPD patients by checking the preparation of dialysis, dialysate exchange procedure, and catheter exit site care which recieved low point in this research.

• 대한임상약리학회:학술대회논문집
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• 1992.11a
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• pp.22-22
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• 1992

• Journal of Korean Academy of Nursing
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• v.26 no.2
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• pp.304-319
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• 1996

It is important to evaluate nutritional status of elderly patients receiving dialysis, since wasting and malnutrition are their common problems. This study aims at assessing their nutritional status by the type and duration of dialysis. The nutritional status such as somatic fat and protein storage was evaluated with anthropometric measure including weight/height ratio, triceps skinfold thickness and midarm muscle circumference. It was also measured with albumin, transferrin, C3 and IGF-1 and calorie and protein intakes. The general clinical condition of patients was evaluated with the severity of uremia and metabolic acidosis. which were measured through the levels of serum urea, creatinine and bicarbonateion. The data were analyzed by using t-test, ANOVA, Wilcoxon-rank sums test, Scheffe test, Kruskal-Wallis test and Pearson correlation coefficients. The results are following : 1. There was no significant difference in the calorie and protein intakes by the type and duration of dialysis received. 2. As for the anthropometric measures, no significant difference was found by the type of dialysis in body mass index triceps skinfold thickness and midarm muscle circumference. Yet these anthropometric measures differed significantly by the duration of dialysis in those elderly patients receiving hemodialysis(HD group), but this finding was not found in those receiving continuous ambulatory peritoneal dialysis(CAPD). 3. Regarding the indicators of uremia and metabolic acidosis, blood urea nitrogen(BUN) and creatinine were lower in the CAPD group than in the HD group, whereas bicarbonate ion was higher in the CAPD group than in the HD group, with no statistical significance. In the HD group, creatinine increased significantly with the increase of the duration of dialysis. 4. Serum trasferrin and C3 were significantly higher in the CAPD group than in the HD group. However. each of biochemical indices did not show statistical significance by the duration of dialysis in both HD and CAPD groups. 5. Anthropometric measures were significantly associated with dietary intake. Significant correlations were observed between biocarbonate ion, BUN and creatinine. In addition, the correlations between serum protein and albumin and between transferrin and C3 were statistically significant. Yet, IGF-1 revealed no significant correlation with other nutritional indices. The above findings indicate that there were no difference in nutritional status measured with protein and calorie intakes between the type and duration of dialysis, but CAPD seems to benefit correcting uremia and metabolic acidosis than HD. Studies of dietary management for dialysis patients need to be pursued in order to improved the quality of aged patients receiving dialysis.

• Journal of Nutrition and Health
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• v.39 no.7
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• pp.624-640
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• 2006

Dialysis patients are at risk of malnutrition not only because of losses of nutrients during peritoneal dialysis but also because of anorexia that results in inadequate nutrient intakes. The aim of this study was to estimate the nutritional status of 154 patients receiving continuous ambulatory peritoneal dialysis (CAPD), especially focused on protein-energy malnutrition and vitamin and mineral status. The mean age of the subjects was $5.12\;{\pm}\;12.4\;y$ with educational years of $12.3\;{\pm}\;0.4\;y$ for male and $9.6\;{\pm}\;0.4\;y$ for female. The mean duration of dialysis was $22.7\;{\pm}\;21.7\;mo$. The causes of renal failure included diabetes (32.7), chronic glomerulonephritis (15.0%), and hypertension (8.5%). The main complications associated with chronic renal failure were hypertension (86.1%), diabetes (35.4%) and liver disease (9.0%). The mean daily energy intake was $1216.8\;{\pm}\;457.3\;kcal$ and increased to $1509.2\;{\pm}\;457.2\;kcal$ when added with the energy from dextrose in dialysate. The latter was still much lower than estimated energy requirement but energy intake per kg of body weight (28.1 kcal/1 g) was within the range of that recommended for CAPD patients' diet therapy (25 - 30 kcal/kg). The average daily intake of protein was $49.2\;{\pm}\;25.1\;g$ with 37.6% of the patients showing their intakes less than Estimated Average Requirement. The average protein intake per kg of weight was 0.9 g/kg, which is less than that recommended for CAPD patients (1.2-1.5g/kg) with mean serum albumin level $3.2\;{\pm}\;0.5\;g/dl$. The proportion of the patients with dietary calcium intake less than EAR was 90.9%, but when added with supplementary calcium (phosphorus binder), most patients showed their total calcium intake between EAR and UL. Fifty percent of the patients were observed with dietary iron intake less than EAR, however most patients revealed their total iron intake with supplementation above UL. The addition of folic acid with supplementation increased mean total folic intake to $1126.0\;{\pm}\;152.4\;{\mu}g$ and ninety eight percent of the subjects showed their total folic acid intake above UL. The prevalence of anemia was 83.1 % assessed with hemoglobin level, even with high intakes of iron with supplementation. Thirty four percent of the patients showed their fasting blood glucose was not under control $(\geq\;126\;mg/dl)$ even with medication or insulin probably due to dextrose from dialysate. The mean blood lipid levels were within the reference levels of hyperlipidemia, but with 72.1 % of the patients showing lower HDL-C. In conclusion, Fairly large proportion of the patients were observed with protein malnutrition with low intake of protein and serum albumin level. Few patients showed their vitamins and minerals intake less than EAR with supplementation. For iron and folic acid, their intakes were increased to above UL for large proportion of he patients. However, more than eighty percent of the patients were still anemic associated with decreased renal function. The serum blood glucose and lipid level were not under control for some patients with medication. It seems that supplementation and medications that patients are taking should be considered for dietary consulting of CAPD patients.

• Childhood Kidney Diseases
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• v.12 no.2
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• pp.245-249
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• 2008

Peritonitis is one of the major complications of CAPD(continuous ambulatory peritoneal dialysis). Recently, multidrug-resistant organisms, such as vancomycin-resistant enterococcus(VRE) have been rarely reported by the pathogen as of CAPD-associated peritonitis. But, there is limited information on choices of effective therapy for VRE peritonitis in patients undergoing CAPD. We present a pediatric case of successful treatment of CAPD-associated peritonitis due to VRE with linezolid, and review of the literature.

• Childhood Kidney Diseases
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• v.9 no.1
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• pp.102-107
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• 2005

With the advent of hemodialysis, the success of renal transplants in the 1960s and the wide use of continuous ambulatory peritoneal dialysis at the end of the 1970s, children with renal failure now enjoy an extended life span. As a result, several children experience renal osteodystrophy and growth retardation. Renal osteodystrophy is induced by phosphorus retention, hypocalcemia, low vitamin D levels and hyperparathyroidism. The pharmacologic interventions are used to prevent bone deformities and to normalize growth velocity. But surgical intervention is required sometimes whorl osteodystrophy is severe and poorly controlled. We report an eight-year-old boy with ctironic renal failure who developed severe bone deformities and needed osteotomy.

• Journal of Nutrition and Health
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• v.31 no.9
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• pp.1422-1432
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• 1998

This study investigated the nutritional status of 32 CAPD patients. Their weight, height, triceps, mid arm circumference were measured and their dietary intake and the blood profiles were evaluated. They were 56.0${\pm}$11.8 years old. Their intake of energy and protein were 78% and 93% of RDA respectively. The energy from dextrose was 376.1${\pm}$83.2kcal. The men's and women's intake of protein was 84.6% and 102.1% of RDA respectively, According to the distribution of BMI, 23.5% of the men and 6.1% of the women were underweight and 5.9% of the men and 20% of the women were overweight. The serum albumin levels of the men and women were 3.30 and 3.71g/41 respectively. However, the average amount of serum ferritin, as a whole, comes within the normal range, which shows that stored iron was not decreased and that their anemia was not caused by iron deficiency. The subjects were divided into three groups according to the level of albumin, and their intakes of nutrients were compared with one another, The group with the high level of albumin showed that energy and protein intake was significantly larger and that BMI was also significantly higher than the other groups. There was a positive correlation between BMI and energy intake. Serum total protein had a positive correlation to energy intake ; hematocrit, to carbohydrate intake. BMI had a positive correlation to energy intake. A relative magnitude of factors affecting albumin level was analyzed by Stepwise multiple regression analysis. Overall results about relative influence of independent variables to dependent variable(albumin) indicated that the blood total protein(p <0.0001) was the most significantly correlated with serum albumin level in all subjects,1311owe4 by creatinine and total cholesterol. (Korean J Nutrition 31(9) : 1422-1432, 1998)

• Journal of Yeungnam Medical Science
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• v.29 no.2
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• pp.102-105
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• 2012

Collapsing glomerulopathy (CG) has become an important cause of end-stage renal disease (ESRD). First delineated from other proteinuric glomerular lesions in the 1980s, CG is now recognized as a common, distinct pattern of proliferative parenchymal injury that portends a rapid loss of renal function and poor responses to empirical therapy. The first cases in the literature trace back to human-immunodeficiency-virus(HIV)-negative patients who underwent biopsy in 1979. A 45-year-old male patient complained of hematuria and proteinuria eight years ago. He showed an abrupt serum creatinine increase from 1.75 to 2.65 mg/dL in the last preceding months. Afterwards, his serum creatinine progressively increased up to 6.82 mg/dL. Moreover, his 24 h urine protein level was determined to have reached 6,171 mg/day, as opposed to 670 mg/day a year earlier. Consequently, renal biopsy was performed, and its result showed collapsing glomerulopathy, compatible with the diagnosis. He has undergone continuous ambulatory peritoneal dialysis as renal replacement therapy. Thus, it is reported herein that a patient clinically diagnosed with chronic kidney disease eight years ago showed a sudden renal-function decrease and was clinicopathologically diagnosed with collapsing glomerulopathy based on the results of his renal biopsy.

• Childhood Kidney Diseases
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• v.1 no.2
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• pp.117-122
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• 1997

Purpose : To clarify the clinical findings, laboratory findings and disease course of EP complicated with CAPD and to find out possible predisposing factors to EP. Methods : The medical records of 34 children who underwent CAPD at our hospital between Jan. '94 and Dec. '96 were retrospectively reviewed. The clinical features and laboratory findings of EP were analyzed, and several parameters were evaluated as predisposing factors of EP. Results : EP developed in 7(21%) out of 34 patients. The major symptom of EP was turbid peritoneal fluid without fever, abdominal pain or disturbance of drainage in all cases. The microbiologic culture studies of the peritoneal fluid resulted negative in all cases. Patients with peripheral blood eosinophilia before insertion of CAPD catheter had higher risk of EP than those without eosinophilia (P=0.002). And peripheral blood eosinophilia, noted after insertion of hemodialysis catheter in cases with previous hemodialysis before CAPD, showed significant correlation with the occurrence of EP (P=0.016), too. However, there was no significant correlation between peripheral blood eosinophilia noted after insertion of CAPD cathter and the occurrence of EP. Identification of eosinophils in peritoneal fluids was more accurate with cytospin analysis. Conclusions : An early and accurate diagnosis of EP in patients with CAPD can prevent unnecessary treatment of antibiotics. Peripheral blood eosinophilia before insertion of CAPD catheter is one of the predisposing factors of EP. And, cytospin analysis of peritoneal fluid is an accurate method for diagnosis of EP.