• Nutrition Research and Practice
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• v.3 no.3
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• pp.247-252
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• 2009

The present study was to investigate the nutritional status and factors related to malnutrition in end-stage renal disease (ESRD) patients requiring hemodialysis (HD) in South Korea. Subjects were ESRD outpatients from general hospitals or HD centers in Seoul referred to the dialysis clinic for maintenance HD care. A total of 110 patients (46 men and 64 women; mean ages $58.6{\pm}1.0y$) were eligible for this study. The family history of chronic renal failure (CRF) was considered positive if a patient reported having either a first-degree or second-degree relative with CRF. Malnutrition was defined as a triceps skinfold thickness or mid-ann muscle circumference below the fifth percentile for age and sex and forty-seven of the 110 patients were malnourished. Almost all (94%) patients had anemia (hemoglobin: <13 g/dL for men and <12 g/dL for women). Energy intake was below the recommended intake levels of energy [30-35 kcal/kg ideal body weight (IBW)] and protein (1.2 g/kg IBW) in 60% of patients. The duration of HD was longer in malnourished HD patients (P=0.0095). Malnutrition was more prevalent in women (P=0.0014), those who never smoked (P=0.0007), nondiabetic patients (P=0.0113), and patients with bone diseases (P=0.0427), adequate HD (spKt/$V{\geq}1.2$) (P=0.0178), and those with a family history of CRF (P=0.0255). Multiple logistic regression was used to examine the relationship between malnutrition and potential risk factors. After adjusting for age, sex, and other putative risk factors for malnutrition, the OR for malnutrition was greater in HD patients with a family history of CRF (OR, 3.290; 95% CI, $1.003{sim}10.793$). Active nutrition monitoring is needed to improve the nutritional status of HD patients. A family history of CRF may be an independent risk factor for malnutrition in Korean HD patients. A follow-up study is needed to investigate whether there is a causal relationship between a family history of CRF and malnutrition in Korean ESRD patients.

• Journal of Korean Academy of Nursing
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• v.30 no.3
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• pp.791-798
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• 2000

The hemodialysis patients with chronic renal disease have experienced negative emotions, especially depression among with physical, social, and psychological changes. Based upon a stress-coping theory, group imago psychotherapy which can induce effective coping through self awareness and positive emotional responses is implemented to the hemodialysis patients. The effects of the imago psychotherapy in regards to comfort and depression are studied here. Group imago psychotherapy was performed on forty-three subjects(twenty subjects in the experimental group and twenty-three subjects in the control group). The results of the study were as follows. After being given group imago psychotherapy, the comfort scores of the experimental group were significantly higher than those of the control group (F=15.33, p= .003). Moreover, after being given treatment, the depression scores of the experimental group were significantly lower than those of the control group (F=9.14. p=.0044). Specifically, the scores on comfort in the experimental group under emotion-focused coping style were significantly higher than those of the control group (F=18.59, p= .0002). The mean difference on comfort scores in the experimental group under problem - focused coping style was higher than that of the control group. But their scores were not significant (F=0.19, p= .6729). The scores on depression in the experimental group under emotion-focused coping style were significantly lower than those of the control group (F=14.62, p= .0006). The mean difference on depression scores in the experimental group under problem - focused coping style was much lower than that of the control group. But their scores were not significant (F=0.31, p=.5947). There was a significant positive correlation between comfort and depression variables. After group imago psychotherapy the hemodialysis patients recognized positive changes in emotional reponses, self awareness, self control, ease of mind, and felt overall more relaxed. Imago psychotherapy is a nursing intervention which as this study has shown can improve to comfort. The results of this study can be applied to general nursing practices. In the view of holistic nursing, the development of the nursing practice combined with imago psychotherapy will contribute to the enlargement of the nursing field with conventional nursing practices.

• Journal of muscle and joint health
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• v.30 no.1
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• pp.25-35
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• 2023

Purpose: This study was conducted to examine the effects of ethyl chloride spray during arteriovenous fistula puncture on pain, depression, and noncompliance in hemodialysis patients. Methods: This study used a randomized controlled trial design on adults with chronic renal failure who received hemodialysis treatment through arteriovenous fistula. Ethyl chloride spray was applied to 20 subjects in the experimental group during arteriovenous fistula puncture, and a placebo spray was applied to 20 subjects in the control group; the intervention was conducted 12 times for 4 weeks. A total of 33 participants were used in the final analysis. The outcomes were measured using the face pain rating scale, Center for Epidemiological Studies Depression Scale (CES-D), and modified United States Renal Data System tools. Results: As a result of the pre-homogeneity test between the two groups, it was confirmed that the sexes were not homogeneous. Therefore, sex was treated as a covariate and analyzed. Puncture pain was significantly reduced in the experimental group (p<.001). However there was no significant difference between the groups in depression and noncompliance. Conclusion: Ethyl chloride spray was convenient and effective pain management intervention for both hemodialysis patients and medical staff.

• Journal of Preventive Medicine and Public Health
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• v.39 no.2
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• pp.149-158
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• 2006

Objectives : We wanted to evaluate the economic value of a pharmaceutical product, Kremezin, for treating patients with chronic renal failure (CRF) by estimating the amount of cost savings due to its effect for delaying the initiation of dialysis treatments. Methods : We defined a conventional treatment for CRF accompanied by Kremezin therapy as 'the treatment group' and only conventional treatment as 'the alternative group.' The types of costs included were direct medical and nonmedical costs and costs of productivity loss. The information on the effect of Kremezin was obtained from the results of earlier clinical studies. Cost information was derived from the administrative data for 20 hemodialysis and 20 peritoneal dialysis patients from one tertiary care hospital, and also from the administrative data of 10 hemodialysis patients from one free-standing dialysis center. Per-capita cost savings resulting from Kremezin therapy were separately estimated for the cases with delay for the onset of hemodialysis and the cases with immediate performance of peritoneal dialysis. By computing the weighted average for the cases of hemodialysis and peritoneal dialysis, the expected per-capita cost savings of a patient with CRF was obtained. Using a discount rate of 5%, future cost savings were converted to the present value. Results : The present value of cumulative cost savings per patient with CRF from the societal perspective would be $18,555,000{\sim}29,410,000$ Won or $72,104,000{\sim}112,523,000$ Won if Kremezin delays the initiation of dialysis by 1 or 4 years. Conclusions : The estimated amount of cost savings resulting from treating CRF patients with Kremezin confirms that its effect for delaying the onset of dialysis treatments has a considerable economic value.

• The Korean Journal of Nuclear Medicine
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• v.19 no.2
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• pp.43-50
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• 1985

With the improvement of hemodialysis, the course of the disease in patient with endstage renal disease has been clearly improved. Nevertheless, among several shortcomings to our present mode of renal replacement therapy, cardiovascular complications have been the leading cause of morbidity and mortality. Several factors such as anemia, arteriovenous shunting of blood, intermittent extracorporeal circulation and hypertension may be contributing. But little is known about the quantitative cardiac hemodynamic characteristics occurred during hemodialysis. The purpose of this study is to observe the sequential hemodynamic changes before, during and after the hemodialysis and to investigate reliable parameters in the detection of ventricular dysfunction. In the present study, equilibrium radionuclide cardiac angiography was performed and left and right ventricular volume indices, ejection phase indices of both ventricular, performance were measured in the 16 stable patients with chronic renal failure treated with maintenance hemodialysis sequentially i.e. before, during (early and late phase) and after the hemodialysis. The results obtained were as follows; 1) The indices of the left ventricular function were not changed during the hemodialysis but increased after the hemodialysis. 2) The indices of the right ventricular function(EF, SVI) were significantly decreased in the early phase (15, 30 minutes after starting extracorporeal circulation) but recovered after the hemodialysis. 3) The ratio of right ventricular to left ventricular ejection fraction was significantly decreased in the early phase and the lung volume indices were significantly increased at the same phase. As a conclusion, hemodialysis improves left ventricular function maybe due to increased contractility, and effects on the right ventricular function maybe due to the increased lung volume in the early phase of hemodialysis.

• Anxiety and mood
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• v.9 no.1
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• pp.38-44
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• 2013

Objective : The end-stage renal disease patients who shared fear of death, functional impairment due to hemodialysis are vulnerable to depression, anxiety and other mental problems. It is possible that their psychiatric characteristics and related autonomic nervous functions have some differences depending on their age. We purpose to find the differences of psychiatric characteristics and related autonomic nervous functions between adult and elderly hemodialysis patients. Methods : Our subjects are end-stage renal disease hemodialysis patients composed of 39 adults (<65 years) and 24 seniors (${\geq}65$ years). Outcome measures included the 17-item Hamilton Rating Scale for Depression, The Hamilton Rating Scale for Anxiety, The Apathy Evaluation Scale and Mini-International Neuropsychiatric Interview by clinician. And subjects fulfilled self-report scale, The Positive thinking scale and The Snaith-Hamilton Pleasure Scale. The autonomic nervous functions are measured by heart rate variability. Results : There are no significant differences in demographic factors between two groups. The 17-item Hamilton Rating Scale for Depression, The Hamilton Rating Scale for Anxiety, The Apathy Evaluation Scale, The Snaith-Hamilton Pleasure Scale and autonomic nervous functions are also not different. But only positive thinking scale is higher in adult hemodialysis group than the elderly (F=5.395, p=0.024). Conclusion : This study compared depression, anxiety and autonomic nervous functions between adult and senior hemodialysis patients. There are no significant differences in psychiatric characteristics and autonomic nervous functions between two groups except positive thinking traits. Senior patients endured their chronic disease similar to adult patients did in spite of their old age. This result suggests that elderly's higher positive thinking traits affect their endurances about the negative situations.

• Journal of Chest Surgery
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• v.23 no.3
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• pp.482-487
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• 1990

The leading cause of death in patients with chronic renal failure is cardiovascular diseases. The problems relevant to cardiac surgery in these patients are occurring more frequently with a growing number of patients at risk. Among these, important risk factors related to uremic patients undergone open heart surgery are fluid and electrolytes imbalance, coagulopathy, increased susceptibility to infection. Since 1968 when Lansing and colleagues reported the first successful aortic valve replacement in patients with chronic renal failure and infective endocarditis, there have been increasing reports of the cardiopulmonary bypass surgery in chronic renal failure patients with acceptable perioperative morbidity and mortality From Jan. 1988 to Nov. 1989 we have experienced four uremic patients necessitating open heart surgery ; one needing a coronary artery bypass graft and the other 3 needed cardiac valve replacement. Based on our observations we would like to suggest followings 1]Intraoperative ultrahemofiltration during C-P bypass thought to be an excellent means for the control of hyperkalemia and fluid balance. 2] The immediate postoperative application of peritoneal dialysis instead of hemodialysis is beneficial in controlling fluid and electrolyte imbalance. 3]The cause of one early postoperative death was not associated to renal failure, rather it was the result of an accidental rupture in the right ventricular wall.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.3
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• pp.1597-1599
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• 2013

Since renal failure causes decrease in tumor marker excretion, use of these markers in cancer care and treatment in patients with renal insufficiency or hemodialysis is controversial. The aim of this study was to investigate differences of serum levels of tumor markers CA15-3, AFP, CA19-9 and CEA in patients with impaired renal function. A total of 100 patients referred to the Tabriz Immam Reza and Amiralmomenin hospital from June 2010 to November 2011 were selected for study. Subjects were divided to 3 groups of healthy, dialysis and renal failure but non hemodialysis cases, the last category being re-grouped based on creatinine clearance. No significant relationship between different groups in serum levels of CEA (P=0.99) and CA19-9 (P=0.29) tumor markers was found. A significant correlation was observed between serum levels of AFP (P<0.001) and CA15-3 (P<0.001) and also a tendency between creatinine clearance and CEA (r=0.05, P=0.625). Creatinine clearance significantly correlated with AFP (P<0.001, r=0.53) and CA15-3 (p=0.00, r=-0.412), but not CA19-9 (P=0.089, r=-0.171). According to results of this study it appears that use of tumor markers in patients with impaired renal function should be performed with special precautions.

• Journal of The Korean Society of Clinical Toxicology
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• v.3 no.2
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• pp.130-134
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• 2005

Lithium is mainly prescribed for manic and depressive disorder, also frequently prescribed for the other diseases such as migraine, cluster headache, alcoholism, and obsessive-compulsive disorder. An acute lithium intoxication occurs in cases of patients ingesting large amount lithium at a time, a chronic lithium intoxication occurs in patients on chronic lithium therapy. Acute or chronic lithium poisoning occurs frequently in case of patients on chronic lithium therapy ingesting larger dose than prescribed. Manifestations of lithium poisoning are various. It is possible nervous, cardiovascular, renal, gastrointestinal and endocrine systems to be involved. Due to intracellular high concentration, mortality rate is high in acute lithium intoxication patients on chronic lithium therapy. We report a case of acutely intoxicated 40-year-old male on chronic lithium therapy. His chief complaints were deterioration and high fever. On his arrival to an emergency department, he was in cardiac arrest. He restored return of spontaneous circultion (ROSC) 5 minutes later after cardiopulmonary cerebral resuscitation (CPCR) and referred to department of internal medicine for hemodialysis. Vigorous treatment was given to the patient, but he was expired at 4th hospital day.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.22 no.1
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• pp.743-750
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• 2021

Purpose: The purpose of this study was to analyze factors affecting the meaning of life in patients on hemodialysis. Methods: The sample consisted of 176 adults diagnosed with chronic kidney disease at hospitals in Seoul and Gyeonggi-do who had been receiving hemodialysis for more than three months. The patients volunteered to participate in the study. Data collection instruments used were the Meaning in Life (ML) scale, Resilience scale, Beck Depression Inventory-II (BDI-II) and Fatigue scale questionnaire. The SAS9.2 version was used for descriptive analysis, independent t-test, one-way ANOVA, Pearson's correlation coefficients and stepwise multiple regression. Results: The mean total item score on the meaning of life scale was 133.68 (total score:180), which was low. There was a significant relationship between the ML scale and resilience, depression, and fatigue. Stepwise multiple regression analysis showed that resilience, religion, depression, and fatigue were predictors of the meaning of life. Conclusion: These results indicate a need to develop nursing interventions to increase resilience and reduce depression and fatigue to promote the meaning of life in patients on hemodialysis.