• The Korean Journal of Nuclear Medicine
• /
• v.35 no.1
• /
• pp.81-82
• /
• 2001

A 47-year-old man with end-stage renal disease due to diabetic nephropathy underwent a peritoneal scintigraphy to evaluate the cause of recently developed scrotal swelling. Two liters of dialysate mixed with 111 MBq of Tc-99m sulfur colloid were administered into the peritoneal cavity via the dialysis catheter. Various anterior images of the abdomen and pelvis were obtained at 15 min, 2 hr and 4 hr after the tracer instillation. At 15 min, anterior images of the abdomen and pelvis demonstrated linear tracts of activity through both inguinal canals, which were more prominent in the right side (A). Images at 2 hr revealed a passage of the radioactive fluid into the right hemiscrotum. At the same time, there was a considerable accumulation of activity in the right inguinal canal (B). In the delayed image, there was a progressive accumulation of activity in the inguinal canals and a prominent passage of the tracer into the scrotum (C). Both abdominal and inguinal hernias are commonly associated with continuous ambulatory peritoneal dialysis (CAPD). Overall incidence of CAPD-induced hernia ranges from 2.7% to 25%.$^{1)}$ Inguinal hernias were frequently manifested as scrotal swelling. Leakages of dialysate fluid into the scrotum has been noted in CAPD patients with scrotal swelling, with or without clinical findings of inguinal hernia.$^{1,2)}$ In the present case, the right side had leakage from a clinical inguinal hernia and the left side, leakage from a subclinial inguinal hernia. A subclinical inguinal hernia was easily demonstrable with peritoneal scintigraphy. Peritoneal scintigraphy is extremely helpful in the evaluation of scrotal swelling in a patient on CAPD.

• Korean Journal of Clinical Pharmacy
• /
• v.23 no.2
• /
• pp.142-150
• /
• 2013

Background: Secondary hyperparathyroidism (SHPT) is common in patients with chronic kidney disease, affecting most of those who are receiving dialysis. Cinacalcet, a novel calcimimetic, targets the calcium-sensing receptor to lower PTH levels in dialysis patients. Objective: This study aimed to assess efficacy, safety and appropriateness of use of cinacalcet in dialysis patients. Method: This retrospective study was performed on total 24 cases with identified intact parathyroid hormone (iPTH), serum calcium and phosphorus levels before and 4 weeks after cinacalcet initiation at a teaching hospital from July 1st, 2011 to October 31st, 2012. Results: Cinacalcet decreased iPTH by 19% from baseline after 4weeks treatment and it was statistically significant (p<0.001). Cinacalcet also significantly decreased iPTH levels regardless of dialysis modality (hemodialysis group versus peritoneal dialysis group) and severity of SHPT (iPTH 300-800 pg/ml group versus iPTH >800 pg/ml group). Serum calcium, phosphorus and Ca x P levels were decreased without statistical significance. Gastrointestinal events, headache and hypocalcemia were the most common side effects. Monitoring for iPTH and serum calcium was not performed appropriately. 43.7% patients initiated cinacalcet therapy at serum calcium level< 9.0 mg/dl. Conclusion: In conclusion, cinacalcet lowers parathyroid hormone levels with no serious side effects. However, it is required to avoid cinacalcet treatment in patients with low serum calcium levels and monitor iPTH and serum calcium levels during cinacalcet administration.

• Journal of Nutrition and Health
• /
• v.36 no.4
• /
• pp.397-404
• /
• 2003

The present study was designed to compare the nutritional status of hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients. Subjects were 58 HD patients (male/female = 29/29) and 33 CAPD patients (male/female = 23/10) undergoing dialysis treatment in Artificial Kidney Unit of Chonbuk National University Hospital. For nutritional assessment, %IBW (ideal body weight), %TSF (tricep skin fold), %MAC (mid arm circumference), %MAMC (mid arm muscle circumference), serum albumin, serum transferrin, TLC (total lymphocyte count), SGA (subjective global assessment) and estimated energy and protein intakes by 1-month food frequency method were used. Between HD and CAPD group, mean age (50 $\pm$ 12 vs. 52 $\pm$ 12 yr), dialysis durations (37 $\pm$ 36 vs. 30 $\pm$ 26 mon), dietary energy intakes (28.3 $\pm$ 9.0 vs. 28.8 $\pm$ 8.6 kcal/kg/day), dietary protein intakes (1.1 $\pm$ 0.4 vs. 1.2 $\pm$ 0.3 g/kg/day) and incidence of co-morbid conditions (69.0% vs. 69.7%) were not significantly different. Data by using SGA showed a higher incidence of malnutrition in CAPD patients (45.6%) than in HD patients (36.2%). %IBW (p < 0.001), %TSF (p < 0.001) and %MAC (p < 0.001) were higher in CAPD patients than were in HD patients. But serum albumin (p < 0.001) and transferrin (p < 0.001) were significantly lower in CAPD patients than were in HD patients. A higher incidence of malnutrition was shown in CAPD Patients than in HD Patients due to different dialysis type. A significant finding was that CAPD showed protein deficient malnutrition and HD did calorie deficient malnutrition. It suggests that an adequate dietary intake considering dialysis type prevents a prevalence of malnutrition.

• Childhood Kidney Diseases
• /
• v.11 no.1
• /
• pp.41-50
• /
• 2007

Purpose : Dialysis in children with chronic renal failure presents with many difficulies. The purpose of this study is to find an improved method in chronic dialysis in infants and children less than 2 years of age by analyzing the experience with 10 cases. Methods : A retrospective review of the medical records of 10 patients(6 boys and 4 girls) was conducted. The patients had chronic renal failure and underwent chronic dialysis at Samsung medical center from March 1999 to February 2007. Results : At Initiation of dialysis, the median age was 3 months old(22 days-20 months), the median body weight was 3.75 kg(2.2-10.3 kg), and the median serum creatinine level was 4.3 mg/dL(2.0-11.4 mg/dL). The median duration of dialysis was 29.5 months(3-62 months). Dysplastic kidney disease was the most common underlying renal disease. Two patients were treated with hemodialysis, 4 patients with peritoneal dialysis, and 4 patients eventually switched dialysis modality. Nine of the 10 patients took erythropoietin and anti-hypertensive drugs. At the end of the follow up period, 1 patient received kidney transplantation, 2 patients died due to sepsis, and 5 patients were treated with peritoneal dialysis. Two patients were lost to follow up. The most common complication of dialysis was infection. Achieving vascular access and maintaining proper catheter function were the most important factors in treating patients with hemodialysis. The growth status of patients was aggravated after 6 month of dialysis but improved after 1 year of dialysis. Patients showed better growth on peritoneal dialysis than hemodialysis. Conclusion : Chronic dialysis can be performed successfully in infants and children under 2 years of age. Vascular access was the main limitation of hemodialysis, and infection was the common problem in both hemodialysis and peritoneal dialysis. To improve the patients survival rate and quality of life, major efforts should be directed toward the prevention of infection and preservation of catheter function. (J Korean Soc Pediatr Nephrol 2007;11:41-50)

• Kidney Research and Clinical Practice
• /
• v.37 no.4
• /
• pp.404-413
• /
• 2018

Background: Dynapenic obesity and sarcopenic obesity increase cardiovascular disease (CVD) and mortality in nonuremic patients. The present study was designed to determine the prevalence of dynapenic obesity and sarcopenic obesity and their associations with CVD risk factors in peritoneal dialysis (PD) patients. Methods: All eligible PD patients in Tehran peritoneal dialysis centers were included in this cross-sectional study. Skeletal muscle mass and fat mass were assessed using bioelectrical impedance analysis. Muscle strength and physical performance were determined using hand grip strength and a 4-meter walk gait speed test, respectively. In addition, a 5-mL blood sample was obtained from each patient. Results: The prevalence of dynapenic obesity and sarcopenic obesity were 11.4% and 3.8% in PD patients, respectively. Serum high-sensitive C-reactive protein (hs-CRP), soluble intercellular adhesion molecule type 1, triglyceride, total cholesterol, and low-density lipoprotein cholesterol were significantly higher in PD patients with dynapenic obesity than in dynapenic nonobese and nondynapenic nonobese patients. Similarly, serum concentrations of CVD risk factors in PD patients with sarcopenic obesity were higher than in nonsarcopenic nonobese patients, but these differences were statistically significant only for serum hs-CRP and triglyceride. In addition, muscle strength and skeletal muscle mass percentage were negatively associated with markers of inflammation and dyslipidemia, whereas body fat percentage was positively associated with these CVD risk factors. Conclusion: This study indicates that although the prevalence of dynapenic obesity and sarcopenic obesity are relatively low in PD patients, these disorders may be associated with CVD risk factors.

• Advances in pediatric surgery
• /
• v.15 no.2
• /
• pp.141-148
• /
• 2009

Peritoneal dialysis (PD) has been utilized for the children with end stage renal disease. Nevertheless, it is thought to promote inguinal hernia by increasing intraabdominal pressure. To investigate the clinical characteristics of inguinal hernia in children on PD, 155 cases of PD in children between January 1996 and June 2007 at Seoul National University Children's Hospital were reviewed retrospectively. Inguinal hernia developed in 16 cases (10.3 %, M:F=8:8). Hernia occurrence was not correlated to age. Eleven cases (69 %) of inguinal hernia developed in first 6 months after initiation of PD. All inguinal hernias were surgically repaired. No complications occurred related to inguinal hernia or surgery. Recurrent hernia developed in 1 patient (6.3 %) of 2 cases who had PD postoperatively on the day of surgery. In conclusion, inguinal hernia developed more frequently with children on PD than general population (3.5~5 %). The rate of hernia development was highest within the first 6 months following initiation of PD. After repair of hernia, we recommend to discontinue PD immediate postoperatively to prevent recurrence.

• Clinical and Experimental Pediatrics
• /
• v.56 no.7
• /
• pp.308-311
• /
• 2013

In this report, we present a pediatric case of severe symptomatic hypermagnesemia resulting from the use of magnesium oxide as a laxative in a child undergoing continuous cyclic peritoneal dialysis for end-stage renal disease. The patient showed abnormal electrocardiography (ECG) findings, such as tall T waves, a widened QRS complex, and irregular conduction, which were initially misdiagnosed as hyperkalemia; later, the correct diagnosis of hypermagnesemia was obtained. Emergent hemodialysis successfully returned the serum magnesium concentration to normal without complications. When abnormal ECG changes are detected in patients with renal failure, hypermagnesemia should be considered.

• Advances in pediatric surgery
• /
• v.9 no.2
• /
• pp.77-80
• /
• 2003

Continuous Ambulatory Peritoneal Dialysis (CAPD) has now become an established form of renal replacement therapy in children. Despite of technical improvements, there are various complications in CAPD. We reviewed medical records of children who received CAPD at Seoul National University Children's Hospital in the period between May 1991 and June 2002. Ninety-three procedures of CAPD catheter insertion in 70 patients were included in this study. Complication rate was 64.5%, and CAPD catheter related peritonitis was most common. In conclusion, CAPD catheter related peritonitis develops in considerable number of pediatric patients. Although the peritonitis could be treated with empirical antibiotics therapy, further investigation to prevent complication is required.

• Proceedings of the Korean Biophysical Society Conference
• /
• 2001.06a
• /
• pp.65-65
• /
• 2001

We have recently demonstrated that high glucose (50 mM D-glucose) upregulates fibronectin mRNA expression and protein synthesis by human peritoneal mesothelial cells (HPMC) through activation of protein kinase C (PKC) and suggested that this may lead to progressive peritoneal fibrosis during a long-term peritoneal dialysis (PD) using glucose as an osmotic agent.(omitted)

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