• Journal of Korean Clinical Nursing Research
• /
• v.22 no.3
• /
• pp.359-367
• /
• 2016

Purpose: The purpose of this study was to examine the effects of physical, psychological, and social factors on the health status of patients undergoing hemodialysis using longitudinal data. Methods: Two surveys were conducted within a period of two-year. A total of 75 patients participated in both surveys. Eight variables including symptoms, treatment belief, hope, meaning-focused coping, family support, friend/peer support, healthcare provider support, and health status were measured. Data were analyzed by paired t-test, Pearson's correlation coefficients, and hierarchical multiple regressions. Results: The mean age of the participants was 47.31 and the average duration of dialysis was 8.27 years. There was no difference in scores on perceived health status between the two year-interval surveys. The two-year follow-up on perceived health status was correlated with baseline perceived health status, friend/peer support, meaning-focused coping, hope, and symptoms. As the result of the regression analysis, friends/peer support (${\beta}=.31$, p=.013) and baseline perceived health status (${\beta}=.30$, p=.020) were found to be significant predictors of subsequent health status which explained 39.0% of the variance. Conclusion: This study suggests the importance of psychosocial resources for positive health outcomes in patients with a chronic illness. Nursing interventions aimed to provide renal peer support need to be developed and tested.

• Journal of Chest Surgery
• /
• v.53 no.6
• /
• pp.392-399
• /
• 2020

Background: Surgical treatment of empyema thoracis in patients with chronic kidney disease is challenging, and few studies in the literature have evaluated this issue. In this study, we aim to report the surgical outcomes of empyema and to analyze factors predicting perioperative mortality in patients with chronic kidney disease. Methods: This retrospective study included data from 34 patients with chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 ㎡ for 3 or more months) who underwent surgery for empyema between 2012 and 2020. An analysis of demographic characteristics and perioperative variables, including complications, was carried out. Postoperative mortality was the primary outcome measure. Results: Patients' age ranged from 20 to 74 years with a 29-to-5 male-female ratio. The majority (n=19, 55.9%) of patients were in end-stage renal disease (ESRD) requiring maintenance hemodialysis. The mean operative time was 304 minutes and the mean intraoperative blood loss was 562 mL. Postoperative morbidity was observed in 70.5% of patients (n=24). In the subgroup analysis, higher values for operative time, blood loss, intensive care unit stay, and complications were found in ESRD patients. The mortality rate was 38.2% (n=13). In the univariate and multivariate analyses, poor performance status (Eastern Cooperative Oncology Group >2) (p=0.03), ESRD (p=0.02), and late referral (>8 weeks) (p<0.001) significantly affected mortality. Conclusion: ESRD, late referral, and poor functional status were poor prognostic factors predicting postoperative mortality. The decision of surgery should be cautiously assessed given the very high risk of perioperative morbidity and mortality in these patients.

• Journal of Digital Convergence
• /
• v.11 no.12
• /
• pp.607-614
• /
• 2013

This study has been conducted to investigate the effect of self awareness of halitosis on the quality of life related to oral health in patients with chronic renal failure undergoing hemodialysis and use basic data related to oral health of patients with chronic renal failure which is very rare in Korea. In terms of oral symptoms based on awareness of halitosis, there were significant differences in symptoms of teeth pain in the past one month, bleeding gums, symptoms of tongue or cheek pain, dry mouth, In terms of status of oral functions, there were significant differences in discomfort upon chewing foods, difficulty of pronunciation and presence of lost teeth. As the results of analysis of effect of self awareness of halitosis on the quality of life related to oral health in patients with chronic renal failure, it was shown that there were significant effects in psychological discomfort(B=-2.028, p<.01), poor social skills(B=2.596, p<.01) and social disadvantage(B=-2.173, p<.01). Thus, because self awareness of halitosis gives psychologically and socially negative effects, it could be an important factor to patients with renal failure whose number is rapidly increasing.

• Clinical Nutrition Research
• /
• v.11 no.4
• /
• pp.264-276
• /
• 2022

Hemodialysis (HD) patients can experience appetite alterations that affect meals and nutritional status. Few qualitative studies have assessed the chronic impact of HD on the everyday diet. This study aimed to characterise comprehensively the experiences of HD patients adapting to appetite alteration. Semi-structured, face-to-face interviews were conducted in a unit of a tertiary hospital to understand patient experiences with appetite alteration. An interview guide was used to consider adaptive processes developed after reviewing the literature and based on the researchers' clinical experiences. A single researcher conducted all interviews to maintain consistency in data collection. The interview content was analysed using Nvivo 11 based on grounded theory and constant comparison analysis. As a results, the mean age and HD vintage of 14 participants were 60 and 5.8 years, respectively. We developed a self-care model based on HD patient experiences with appetite alteration based on axial and selective coding. Differences in urea sensitivity, taste alteration, and social support could be explained by timing of transitions, life events, and responses to stress. Self-care processes are adapted through the processes of "self-registration" and "self-reconstruction," starting with "disruption." At the stage of adjustment, 4 self-management types were derived based on pattern of self-care: self-initiator, follower, realist, and pessimist. The results of this study provide unique qualitative insight into the lived experiences of HD patients experiencing appetite alteration and their self-care processes. By recognising dietary challenges, health teams can better support HD patients in the transition from dietary education to self-care.

• Sleep Medicine and Psychophysiology
• /
• v.14 no.2
• /
• pp.99-106
• /
• 2007

Objective: Restless legs syndrome (RLS) is known to be associated with chronic renal failure (CRF) patients on hemodialysis, however the prevalence of RLS in CRF patients on hemodialysis is variable due to different diagnostic criteria or dialysis technique. A few reports have indicated the association between RLS symptom and lower life quality in CRF patients on hemodialysis. This study aims to investigate the prevalence of RLS and its association with the quality of life in CRF patients of a single dialysis unit in Korea. Methods: A total of 83 Korean CRF patients on hemodialysis in the Korea University Hospital were examined. International Restless Legs Syndrome Study Group (IRLSSG) criteria and International Restless Legs Scale (IRLS) were used to determine the diagnosis and severity of RLS. Questionnaires including Athens Insomnia Scale (AIS), Epworth sleepiness scale (ESS), and Medical Outcome Study Form-36 (SF-36) were administered to all the patients for the assessment of sleep and quality of life. Hamilton Depression Rating Scale (HDRS) and Clinical Global Impression (CGI) were also measured for depression and status of mental illness by psychiatrist. Results: Of the 83 patients, 31 (37.3%) patients were found to have RLS and 43 (51.8%) patients met at least one of the RLS diagnostic criteria. The AIS (t=2.40, p=0.019), ESS (t=2.41, p=0.018), HDRS (t=3.85, p<0.001) and CGI (t=3.52, p=0.001) were higher in the subjects with RLS compared to other subjects. The SF-36 scores were significantly lower in the patients with RLS except physical functioning and bodily pain. Total (p=0.005), physical component (p=0.019), and mental component scores (p=0.019) of SF-36 were significantly lower in patients with more severe RLS symptoms. Conclusion: There was significant relationship between RLS and poor quality of sleep and life. More severe RLS symptom was proven to be an important factor to make a quality of life worsen.

• Journal of Chest Surgery
• /
• v.48 no.3
• /
• pp.193-198
• /
• 2015

Background: Patients on dialysis undergoing surgery belong to a high-risk group. Only a few studies have evaluated the outcome of major thoracic surgical procedures in dialysis patients. We evaluated the outcomes of pulmonary resection for non-small cell lung cancer (NSCLC) in patients on hemodialysis (HD). Methods: Between 2008 and 2013, seven patients on HD underwent pulmonary resection for NSCLC at our institution. We retrospectively reviewed their surgical outcomes and prognoses. Results: The median duration of HD before surgery was 55.0 months. Five patients underwent lobectomy and two patients underwent wedge resection. Postoperative morbidity occurred in three patients, including pulmonary edema combined with pneumonia, cerebral infarction, and delirium. There were no instances of in-hospital mortality, although one patient died of intracranial bleeding 15 days after discharge. During follow-up, three patients (one patient with pathologic stage IIB NSCLC and two patients with pathologic stage IIIA NSCLC) experienced recurrence and died as a result of the progression of the cancer, while the remaining three patients (with pathologic stage I NSCLC) are alive with no evidence of disease. Conclusion: Surgery for NSCLC in HD patients can be performed with acceptable perioperative morbidity. Good medium-term survival in patients with pathologic stage I NSCLC can also be expected. Pulmonary resection seems to be the proper treatment option for dialysis patients with stage I NSCLC.

• Health Policy and Management
• /
• v.16 no.2
• /
• pp.96-116
• /
• 2006

To assess the economic value of pharmaceutical therapy with Kremezin, we investigated the maximum amount of willingness-to-pay (WTP) of patients with chronic renal failure (CRF) for a hypothetical effect of Kremezin in delaying the initiation of dialysis treatments. A face-to-face survey was carried out in a sample of 141 CRF patients from 2 dialysis centers, composed of 82 hemodialysis patients, 38 peritoneal dialysis patients, and 21 non-dialysis CRF patients. Using a bidding game method with a starting point of 320,000 Won, which is the average monthly out-of-pocket payment for dialysis treatment, we asked the study subjects how much they would pay per month to receive Kremezin therapy. The mean out-of-pocket monthly WTP for Kremezin was 310,000, 430,000, and 520,000 Won (p<0.05, repeated one-way ANOVA)) when Kremezin delays the initiation of dialysis treatments by 1, 2, and 4 years. Significant correlation between the respondent's WTP and income $(r=0.266{\sim}0.368,\;p<0.05)$ confirmed the construct validity of the WTP instrument. Regression results showed that patients with a higher education, with diabetes as a major causes of CRF, and undergoing hemodialysis treatments tended to express higher WTP for Kremezin. The economic value of WTP from the perspective of patients varied from 310,000 to 520,000 Won depending on the effect size of Kremezin. The mean WTP was higher than 32,000 Won, only when the hypothetical effect of Kremezin in delaying the initiation of dialysis is for 2 years. This implies that Kremezin might be the preferred choice of therapy by CRF patients if it delays the initiation of dialysis treatment for at least 2 years.

• Tuberculosis and Respiratory Diseases
• /
• v.56 no.1
• /
• pp.77-84
• /
• 2004

Background : We hypothesized that there was a relationship between body weight change and bronchodilator response (BDR) in patients with chronic renal failure (CRF) on hemodialysis (HD). Several mechanisms such as pulmonary edema due to water retention or increased permeability of alveolar capillary may play a important role in pulmonary function impairment and bronchial hyperresponsiveness in patients with CRF on HD. But, no studies have been published concerning BDR in patients with CRF on HD. This study was aimed to know the immediate effect of hemodialysis on pulmonary function and BDR in patients with CRF on HD. Methods : This study included 30 patients with CRF on HD. We collected data including age, sex, height, pretibial and pedal pitting edema, interdialysis weight gain, postdialysis weight loss, underlying diseases, duration of HD, $FEV_1$, FVC, $FEV_1/FVC$, and BDR before and after HD. Results : Interdialysis weight gain of the patients was $3.4{\pm}1.0kg$, and postdialysis weight loss was $3.2{\pm}0.7kg$. Before HD,$FEV_1$, FVC, and $FEV_1/FVC$ of the patients were $89{\pm}22%$, $86{\pm}19%$ of predicted, and $87{\pm}10%$. After bronchodilator inhalation, these parameters were changed to $95{\pm}22%$, $90{\pm}19%$ of predicted, and $88{\pm}9%$ respectively. BDR was positive in 15 patients. After HD, $FEV_1$, FVC, and $FEV_1/FVC$ of the patients were $100{\pm}23%$, $94{\pm}18%$ of predicted, and $88{\pm}11%$. After bronchodilator inhalation, these parameters were changed to $102{\pm}23%$, $96{\pm}18%$ of predicted, and $89{\pm}8%$ respectively. BDR was positive in 9 patients. Conclusion : First, HD increases $FEV_1$, FVC, and $FEV_1/FVC$ but little affects BDR. Second, there is no correlation between postdialysis weight loss and increases in $FEV_1$, FVC, and $FEV_1/FVC$ after HD. Third, there is also no correlation not only between interdialysis weight gain and BDR before HD but between postdialysis weight loss and BDR after HD.

• The Journal of Internal Korean Medicine
• /
• v.44 no.2
• /
• pp.146-157
• /
• 2023

Restless leg syndrome is a nervous system disorder that causes an overpowering urge to move one's legs. Symptoms of restless leg syndrome usually worsen when one tries to fall asleep and can prevent sufficient sleep. Restless leg syndrome is common in patients with chronic kidney failure and can be caused or worsened by chronic kidney failure and hemodialysis. Various medications can treat restless leg syndrome, though the long-term use of medications can cause augmentation and adverse effects. In addition, the use of dopamine agonists is limited in patients with chronic kidney failure. This is because the dose of administration should be controlled for patients with chronic kidney failure, and the treatment effect has not been clearly proven. This study reports the case of a 56-year-old male diagnosed with chronic kidney failure complaining of uncomfortable leg sensations. The patient underwent Korean medicine treatment using Jakyakgamcho-tang. The IRLS, NRS, and AIS scores were evaluation tools during treatment. This study suggested significantly improved symptoms through the individual interventions of Jakyakgamcho-tang in a restless leg syndrome patient with chronic kidney failure.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• v.6 no.2
• /
• pp.192-196
• /
• 2003

Angiodysplasia is the most common vascular abnormality of the gastrointestinal tract and probably the most frequent cause of recurrent lower intestinal bleeding in otherwise healthy elderly patients. Also, it is an important cause of hemorrhage in chronic renal failure observed in up to 19~32% of patients. Bleeding due to gastric angiodysplasia is treated by various endoscopic approaches, including argon and Nd : YAG laser photocoagulation, monopolar or bipolar electrocoagulation, heater probe, injection sclerotherapy, band ligation or hemoclipping. A 15-year-old boy, who had undergone hemodialysis for chronic renal failure for about 10 years, was admitted due to melena and progressive anemia. A gastroduodenoscopy revealed a cherry red and fern-like lesion with oozing on the posterior wall at junction of gastric body and fundus. Endoscopic hemoclipping therapy was performed. However, melena recurred four days later. Argon plasma coagulation and hemoclipping therapy were performed again. Since then, no recurrence of bleeding has been observed.