• 제목/요약/키워드: chronic hemodialysis patients

검색결과 115건 처리시간 0.021초

혈액투석 환자에서 갑상선 초음파의 추적 (Follow-up of thyroid ultrasonography in patients with hemodialysis)

  • 김현정;김보라;서영미;조윤영;백종하;김경영;김수경;우승훈;정정화;정재훈;함종렬
    • Journal of Yeungnam Medical Science
    • /
    • 제34권1호
    • /
    • pp.69-74
    • /
    • 2017
  • Background: Chronic kidney disease is considered a risk factor for thyroid nodules as well as thyroid dysfunction such as hypothyroidism. Among patients on hemodialysis, we assessed the size of thyroid nodule and goiter at baseline and 1 year later with ultrasonography. Methods: We prospectively selected 47 patients with hemodialysis at January 2012 and reviewed their medical records. We checked goiter and thyroid nodules at January 2012 and December 2012. Results: In the hemodialysis patients (n=47), 24 patients (51.1%) had thyroid nodules and 33 patients (70.2%) had goiter at baseline. Parathyroid hormone (PTH) was higher in patients with thyroid nodules ($204.4{\pm}102.9$ vs. $129.9{\pm}93.6pg/mL$, p=0.01). Thyroid ultrasonography was conducted in 29 patients after 1 year. The thickness of the thyroid isthmus increased ($2.8{\pm}1.6$ vs. $3.2{\pm}1.9mm$, p=0.003), but the number of nodules did not change ($1.2{\pm}1.9$ vs. $1.4{\pm}2.0$, p=0.109). PTH was associated with the enlargement of thyroid nodules significantly through logistic regression analysis. Conclusion: Thyroid goiter and nodules in hemodialysis patients were more prevalent than in the general population. PTH influenced the production of thyroid nodules in hemodialysis patients. Regular examination with thyroid ultrasonography and thyroid function test should be considered in hemodialysis patients.

Current treatment status and medical costs for hemodialysis vascular access based on analysis of the Korean Health Insurance Database

  • Lee, Hyung Seok;Ju, Young-Su;Song, Young Rim;Kim, Jwa Kyung;Choi, Sun Ryoung;Joo, Narae;Kim, Hyung Jik;Park, Pyoungju;Kim, Sung Gyun
    • The Korean journal of internal medicine
    • /
    • 제33권6호
    • /
    • pp.1160-1168
    • /
    • 2018
  • Background/Aims: The Republic of Korea is a country where the hemodialysis population is growing rapidly. It is believed that the numbers of treatments related to vascular access-related complications are also increasing. This study investigated the current status of treatment and medical expenses for vascular access in Korean patients on hemodialysis. Methods: This was a descriptive observational study. We inspected the insurance claims of patients with chronic kidney disease who underwent hemodialysis between January 2008 and December 2016. We calculated descriptive statistics of the frequencies and medical expenses of procedures for vascular access. Results: The national medical expenses for access-related treatment were 7.12 billion KRW (equivalent to 6.36 million USD) in 2008, and these expenses increased to 42.12 billion KRW (equivalent to 37.67 million USD) in 2016. The population of hemodialysis patients, the annual frequency of access-related procedures, and the total medical cost for access-related procedures increased by 1.6-, 2.6-, and 5.9-fold, respectively, over the past 9 years. The frequency and costs of access care increased as the number of patients on hemodialysis increased. The increase in vascular access-related costs has largely been driven by increased numbers of percutaneous angioplasty. Conclusions: The increasing proportion of medical costs for percutaneous angioplasty represents a challenge in the management of end-stage renal disease in Korea. It is essential to identify the clinical and physiological aspects as well as anatomical abnormalities before planning angioplasty. A timely surgical correction could be a viable option to control the rapid growth of access-related medical expenses.

혈액투석 중인 만성 신부전증 환자에서의 불면증에 대한 연구 (Insomnia in Patients with Chronic Renal Failure on Hemodialysis)

  • 김경률;양창국;한홍무
    • 수면정신생리
    • /
    • 제6권2호
    • /
    • pp.126-132
    • /
    • 1999
  • 목 적: 저자들은 본 연구에서 혈액투석 중인 환자들을 대상으로 불면증의 빈도, 불면증 환자들의 특성, 신체적 그리고 심인적인 증상들과의 상관관계, 수면에 대한 믿음과 태도 등을 조사하여 향후 진료에 도움을 주고자 하였다. 방 법: 부산시내 소재 4개의 혈액투석실에서 혈액투석을 받고 있는 만성 신부전증 환자 153명(남 87명, 여 66명)을 대상으로 저자들이 본 연구에 알맞게 개발한 수면관련 설문지, 벡 우울증 척도, 스필버거 상태-특성 불안 척도를 이용하여 환자들의 증상을 조사하였다. 결 과: 전체 153명의 혈액투석 환자 중 65.4%인 100명이 불면증을 호소하였다. 연령, 남녀비, 교육정도, 결혼상태, 평균 혈액투석 기간, 그리고 혈청 알부민을 제외한 조사된 혈액화학검사 소견들은 불면증군과 비불면증군 사이에 차이가 없었다. 불면증군은 비불면증군에 비해 유의하게 BDI 점수와 투석전 수축기 혈압이 높았고 혈청 알부민치는 더 낮았다. 또, 시각유도척도법을 이용한 두 군간의 주관적인 고통에 대한 조사에서 불면증군은 슬픔, 불안, 걱정, 피부 소양증, 그리고 일상생활에서의 기능장애 등의 주관적인 고통을 비불면증군보다 유의하게 더 많이 호소하고 있었다. 불면증의 심한 정도가 불량한 신체적 건강상태, 피부 소양증, 그리고 골관절 통증 등의 신체적 증상, 슬픔, 불안, 걱정 등의 심인적인 증상, 그리고 낮 동안의 졸음과 일상생활에서의 기능장애와 유의한 혈액투석 중인 만성 신부전증 환자에서의 불면증 132 상관관계가 있었다. 또, 불면증군은 비불면증군에 비해 수면에 대한 비기능적인 믿음이 더 많았다. 결 론: 혈액투석을 받고 있는 말기 신부전증 환자들은 일반 인구에 비해 불면증이 흔하였고, 이들 중 불면을 호소하는 환자들은 대조군에 비해 심인적인 증상과 신체증상 그리고 일상생활에서의 기능저하를 더 호소하였고, 수면에 대한 비기능적인 믿음이 많았다. 그리고 불면증의 심한 정도는 이러한 요인들과 밀접한 관계가 있었다. 이상의 요인들을 고려하여 수면장애를 개선한다면 이들 환자들의 진료에 도움을 주어 치료 순응도와 삶의 질을 높일 수 있으리라고 생각한다.

  • PDF

만성 신부전증 환자에서의 동정맥루조성술 (Clinical Analysis of Arteriovenous Fistula Formation for CRF Patiients)

  • 김응중;이영;박진석
    • Journal of Chest Surgery
    • /
    • 제27권8호
    • /
    • pp.669-676
    • /
    • 1994
  • Because the number of patients who require maintenance hemodialysis is increasing in number recently, angioaccess has become important to many vascular surgeons participating in the management of such patients.The authors created 269 arteriovenous fistulas[AVF] for angioaccess in 229 patients with chronic renal failure[CRF] at the Department of Thoracic and Cardiovascular Surgery in Chungnam National University Hospital during the period from August 1990 to March 1993. We analyzed the results of 260 operations for 220 patients except 9 patients who were lost during the follow up period. We performed snuffbox AVF in 171 cases, classic radiocephalic AVF in 46 cases, direct AVF at other site in 5 cases, forearm Gore-Tex AVF in 29 cases, and upper arm Gore-Tex AVF in 9 cases. We experienced 13 cases of operative failures, 11 cases of early complications, and 60 cases of late complications including obstructions during follow-up period. The 1 year, 2 year and 3 year patency rates of snuffbox AVF[Group 1], classic radiocephalic AVF[Group 2], and Gore-Tex AVF[Group 3] are like followings; 89, 84, 76% in group 1, 84, 75, 68% in group 2, and 79, 66, 55% in group 3. It showed a statistically significant difference between group 1, 2 and group 3.

  • PDF

혈액투석 4마리 개의 증례에서 투석적절성 평가 (Clinical Hemodialysis Cases with Estimation of the Adequacy in Four Dogs)

  • 이창민;임채영;김승곤;강민희;박희명
    • 한국임상수의학회지
    • /
    • 제32권5호
    • /
    • pp.436-439
    • /
    • 2015
  • 급성 또는 급성 악화 신장 손상으로 혈액투석을 위해 4마리의 개가 내원하였다. 모든 증례에는 난치성의 구토, 식욕 부진, 설사, 침울 등을 포함하는 요독증 증후군을 가지고 있었다. 기존의 일반적인 치료를 받았으나, 치료적 반응은 없었으며 심한 임상증상은 남아있었다. 4마리의 증례에서 간헐적 혈액투석(IHD)이 실시 되었다. 본 논문은 혈액투석을 실시한 4마리의 환자의 임상증상과 생화학적 특징을 Kt/V로 나타나는 투석 적절성에 대하여 기술하였다. 본 논문은 개에서의 혈액투석 치료의 표준화의 설정에 도움이 되기 위하여 실제 증례에서 투석 적절성을 평가하였다.

혈액투석환자의 영적 안녕에 관한 연구 (A Study on Spiritual Well-being of Hemodialysis Patients)

  • 김정남;홍외현
    • 대한간호학회지
    • /
    • 제28권4호
    • /
    • pp.1036-1046
    • /
    • 1998
  • The purpose of this study was to investigate the spiritual well-being of hemodialysis patients and the correlation between spiritual well-being and demographic characteristics and disease related characteristics. The subjects for this study were 98 patients who were diagnosed as having chronic renal failure and were being treated at the hemodialysis units of three hospitals located in Seoul, Pusan and Taegu, Korea. Data were collected from October 27 1997 to November 15, 1997 by an investigator interviewing with a structured questionnaire. Palautizion and Ellison(1982)'s spiritual well-being scale was used after some modification. The results of this study are as follows ; To analyze the differences between demographic characteristics, spiritual well-being, and disease characteristics and the spiritual well-being, T-test and ANOVA were used. 1. There were statistically significant differences in spiritual well-being for the demographic characteristics of age (p=0.0145) religious affiliation(p=0.0001) and level of education(p=0.04). 2. There were statistically significant differences in spiritual well-being for the disease characteristics perceived health status (p=0.0014) and vigor(p=0.01) 3. The mean score for spiritual well-being in hemodialysis patients was 57.10 of a possible range of 22-88. Among the components of spiritual well-being, the mean score for religions well-being was 27.01 of a possible range 11-44, and for existential well-being 30.09 of a possible range of 11-44. 4. Correlation between general characteristics and spiritual well-being showed that there were significantly positive correlations for level of education(p=0.0036), perceived health status(p=0.0001), vigor(p=0.0036) and religion(p=0.0004)

  • PDF

혈액투석 환자의 자기관리 수행도와 이에 영향을 미치는 요인 (Self-Care and Associating Factors in Hemodialysis Patients)

  • 전진호;강혜경
    • 보건교육건강증진학회지
    • /
    • 제16권1호
    • /
    • pp.149-166
    • /
    • 1999
  • Self-care and the performance of their own role might be important for the prevention of complications and improvement of quality of life in hemodialysis patients with chronic renal failure(CRF). To improve well-being and quality of life for the patients, the author estimated the level of self-care and associating factors through a questionnaire. The information was composed of the knowledge for hemodialysis and renal disease, the level of self-care, health belief, supports from the family, disease-related stresses, personal characteristics, medical history, relationships with medical personnel, etc. The data was gathered from 126 hemodialysis patients who were undergoing hemodialysis in one university hospital and five hospitals in Kyungsangnam-Do area from December 1997 to January 1998, and was analyzed by PC SAS program(version 6.12) with the level of significance($\alpha$=0.05). The mean age of subjects was 47.0$\pm$13.5years with no significant difference in gender distribution. The mean duration of hemodialysis was 39.0 months, and their frequencies of hemodialysis were more than three times per week(77.0%). Only 21.4% had the specific education on hemodialysis and CRF. In the level which was expressed as the score out of 100, the mean of knowledge was 90.7$\pm$9.1 and the mean of self-care was 73.9$\pm$12.7, that means, they only partially carried their knowledge into practice. They showed a significant correlation between knowledge and health belief($\gamma$=0.282); self-care and health belief($\gamma$=0.357), family supports and knowledge($\gamma$=0.221), self-care($\gamma$=0.402), health belief($\gamma$=0.431); and health belief and stress($\gamma$=-0.361). Age, religion, marrital status, education, and relationships with medical personnel showed positive correlations, and smoking showed negative correlation with self-care. In the multiple regression with the level of self-care as dependent variable, and each of the characeristics as independent variables, supports from the family($\beta$=6.615=0.158), the experience of disease specific education($\beta$=4.959), relationships with medical personnel($\beta$=6.615), current smoking($\beta$=-6.986), and current drinking ($\beta$=-7.095) were detected as significant factors. The value of R-square was 34%. In summary, to promote the level self-care and to improve the well beings and Quality of life for the hemodialysis patients, it would be emphasized that they terminate smoking and drinking, and it would be recommended that the education programs and supports from the family be strengthened. And, because there was a considerable difference between the level of knowledge and self-care, it would also be emphasized to propose the education programs which focused on execution. In addition to that, there is a need to improve relationships between the patients and medical personnel through positive changes in the attitudes of the medical personnel.

  • PDF

혈액투석환자의 피로에 대한 개념분석 : 혼종모형 (Concept Analysis of Fatigue in Hemodialysis Patients Based on Hybrid Model)

  • 서남숙;강승자;김재희
    • 한국산학기술학회논문지
    • /
    • 제18권7호
    • /
    • pp.688-698
    • /
    • 2017
  • 본 연구는 개념분석의 혼종모형을 기반으로 혈액투석환자의 피로에 대한 개념적 정의와 특성을 확인하기 위해 수행되었다. 연구방법은 혼종모형의 3가지 단계를 적용하여 문헌고찰을 통한 이론적 단계, 개념의 주 속성과 지표를 조사하는데 사용되는데 현장 작업 단계에서 데이터는 질적 조사를 포함한 관찰 및 인터뷰를 통해 수집한 현장작업 단계, 자료들을 종합적으로 분석하는 최종분석 단계를 적용하여 개념의 주 속성과 지표를 조사하였다. 연구대상은 광주 2개 병원의 혈액투석 센터에서 혈액투석을 받고 있는 환자 10명이었다. 연구결과, 혈액투석환자의 피로 개념은 신체 활동, 정서적 기분, 사회적 역할, 인지적 반영의 네 가지 차원으로 구분되었다. 혈액투석환자의 피로에 대한 정의는 '말기신부전으로 인한 요독증과 반복적인 혈액투석으로 야기되는 에너지 수준의 감소와 제한된 기능에 대해 신체적 활동, 정서적 기분, 사회적 역할, 인지적 반영 차원에서 인식하고 대처하는 과정 중에 일상적으로 경험하는 주관적인 느낌'으로 나타났다. 본 연구에서 혈액투석환자의 피로의 속성 및 정의를 규명함으로서 도출된 혈액투석환자의 피로개념의 네 가지 차원과 특성을 고려하여 효율적인 간호중재 프로그램을 개발하는데 기초자료로 사용되리라 사료된다.

Plasma Neutrophil Gelatinase-Associated Lipocalin as a Marker of Tubular Damage in Diabetic Nephropathy

  • Kim, So Young;Jeong, Tae-Dong;Lee, Woochang;Chun, Sail;Sunwoo, Sung;Kim, Soon Bae;Min, Won-Ki
    • Annals of Laboratory Medicine
    • /
    • 제38권6호
    • /
    • pp.524-529
    • /
    • 2018
  • Background: An increase in neutrophil gelatinase-associated lipocalin (NGAL) indicates tubular injury. Diabetic nephropathy causes typical changes in the kidney, characterized by glomerulosclerosis and eventual tubular damage. We validated the usefulness of plasma NGAL (pNGAL) as a biomarker of tubular damage in patients with diabetic nephropathy. Methods: We included 376 patients with diabetes mellitus (260 patients with chronic renal insufficiency who had not received hemodialysis and 116 hemodialyzed due to diabetic nephropathy) and 24 healthy controls. Patients with chronic renal insufficiency were divided into three groups according to urinary albumin excretion (UAE) levels. pNGAL levels were measured using the Triage NGAL test (Alere, San Diego, CA, USA) and were compared between groups. We also examined whether pNGAL level was related to the degree of albuminuria and cystatin C-based glomerular filtration rate (GFR). Results: Mean pNGAL levels of the healthy controls, chronic renal insufficiency patients with diabetes mellitus, and hemodialyzed patients were $61.9{\pm}5.3ng/mL$, $93.4{\pm}71.8ng/mL$, and $1,536.9{\pm}554.9ng/mL$, respectively. pNGAL level increased significantly in patients with severe albuminuria (P <0.001) and had a moderate correlation with the degree of albuminuria (r=0.467; P <0.001) and GFR (r=0.519; P <0.001). Multivariate regression analysis showed that the pNGAL level was associated with tubular damage independent of patient age, sex, and GFR. Conclusions: pNGAL level independently reflects the degree of tubular damage in patients with diabetic nephropathy. Measurement of pNGAL, combined with UAE, would enable simultaneous, highly reliable assessments of tubular damage for such patients.

당뇨와 비당뇨 유지 혈액투석 환자의 영양상태와 염증지표의 상관성 비교 (Comparison of Nutritional Status and Inflammational Markers in DM and nonDM Hemodialysis Patients)

  • 김수안;손정민;채동완
    • 대한지역사회영양학회지
    • /
    • 제10권5호
    • /
    • pp.693-699
    • /
    • 2005
  • Protein-calorie malnutrition is common in maintenance dialysis patients. Indeed, diabetic patients with chronic renal failure are considered to be at increased risk of malnutrition. The aim of this study was to compare the nutritional status and markers of inflammation of hemodialysis patients with and without type 2 diabetes. We compared nutritional parameters and C-reactive protein (CRP) as a marker of inflammation in 30 type 2 diabetic patients and age-matched 30 non-diabetic patients with hemodialysis. Serum albumin was significantly lower in patients with type 2 diabetes $(3.45\pm0.43g/dL)$ than in non-diabetic patients $(3.64\pm0.36 g/dL)$ (p<0.05). In contrast, the concentration of serum CRP was significantly higher in type 2 diabetes $(1.42\pm1.8mg/dL)$ (p<0.05). There were significant negative-relationships between serum albumin and CRP level in both diabetic (r=-0.553, p<0.01) and non-diabetic (r=-0.579, p<0.01) patients. In diabetic patients, serum albumin level was significantly correlated with hemoglobin (r = 0.488, p < 0.01) and hematocrit (r=0.386, p < 0.01). Diabetic patients as compared to non-diabetic patients showed a significant (p < 0.01) increased serum triglyceride (TG) $(153.1\pm80.1mg/dL\;vs\;101.6\pm62.4mg/dL)$ and decreased serum HDL cholesterol $(36.89\pm13.48mg/dL\;vs\;47.00\pm14.02mg/dL,\;P<0.05)$. There were significant correlations in the intake of calorie and serum albumin levels in both diabetic (r=0.438, p< 0.05) and non-diabetic (r=0.527, p<0.05) patients. Serum CRP level was negatively correlated with calorie (r= -0.468, p < 0.05), protein (r=-0.520, p < 0.01) and fat intakes (r=-0.403, p < 0.05) in diabetic patients and calorie (r=-0.534, p<0.05) and protein intakes (r=-0.559, p<0.05) in non-diabetic patients. The prevalence of protein malnutrition and the risk factors of cardiovascular disease were significantly higher in type 2 diabetic patients than in non-diabetic hemodialysis patients. Thus, we can suggest that the higher comorbidity and mortality rate in diabetic hemodialysis patients are partially explained by malnutrition and inflammation.