• Journal of Nutrition and Health
• /
• 제39권7호
• /
• pp.617-623
• /
• 2006

The mortality and morbidity rate of hemodialysis patients (HD) remain high. Among many factors, protein and calorie malnutrition has been shown to be a major risk factor for increased mortality in the HD patients population. Malnutrition can be caused by insufficient amino acid intake, nutrient losses in dialysate, oxidant stress and muscle catabolism. In this study, we evaluated the association of markers of nutritional status and essential amino acids intake in HD patients. We investigated nutritional status of 41 HD patients (mean age: $64.2\;{\pm}\;11.5\;y$, men: 24, women: 27) by measuring anthropometric, biochemical parameters and food intakes by using 24 hr recall methods. Subject's total energy intake and total protein intake were $1,648.0\;{\pm}\;397.31\;kcal/day,\;79.2\;{\pm}\;27.2\;g/day$:, respectively. The animal protein intake was $42.7\;{\pm}\;22.1\;g/day$, essential amino acids intake was $23.4\;{\pm}\;9.92\;g/day$, and the ratio of essential amino acids to total protein intake was $29.6\;{\pm}\;5.42%$. There were significantly positive correlation between muscle mass and lean body mass with serum creatinine level (r=0.435, p<0.01; r=0.435, p<0,01). There were also significant positive correlation in muscle mass and lean body mass with pre hemodialysis blood urea nitrogen (preHD BUN) (r=0.329, p<0.05; r=0.329, p<0.05). There were no significant correlation in total energy intake and total protein intake per kg ideal body weight (IBW) to muscle mass and lean body mass. However, there were significantly positive correlation between the ratio of essential amino acids and muscle mass and lean body mass (r=0.368, p<0.05; r=0.405, p<0.01). And serum hematocrit concentration was positively correlated with the ratio of essential amino acids (r=0.032, p<0.05). The results of this study indicate that strong associations exist in essential amino acid intakes with malnutrition than total protein intakes in HD patient. In conclusion, specialized nutrition education should be necessary to efficiently improve the quality of protein intakes.

• Journal of Nutrition and Health
• /
• 제35권5호
• /
• pp.544-557
• /
• 2002

This study was performed to evaluate the quality of nutrient intakes of the hemodialysis patients (26 men and 23 women) according to the socioeconomic status by 3-day dietary recall in Daejeon city and Chungnam area, Korea. Mean age of the subjects was 50.7 yrs and BMI was 22.0 $\pm$ 0.4 kg/$m^2$. Education level was divided into two groups ($\leq$ 9 years： LE group, 9 years： HE group), and monthly family income level was divided into three groups (< 500,000 won: LI group, 500,000-1,499,999 won: MI group, $\geq$ 1,500,000 won : HI group). The data were analyzed by Student t-test and Oneway ANOVA using SPSS 9.0 version at p < 0.05 level. Intakes of energy, carbohydrates, cholesterol, potassium, thiamin and riboflavin were significantly higher in HE group than in LE group (p < 0.05). Intakes of all the nutrients except protein and phosphorus were less than Korean RDA, and INQs (Index of Nutritional Quality) of most nutrients were lower than 1.0 but cholesterol, phosphorus. thiamin and niacin being over 1.0 in HE group. MAR (Mean adequacy ratio) of all the nutrients (e.g., energy, protein, calcium, phosphorus, iron, vitamin A, vitamin C, thiamin, riboflavin and niacin) was significantly higher in HE group (0.61 $\pm$ 0.04) than in LE group (0.48 $\pm$ 0.03) at p = 0.036. Intakes of energy, protein (total, animal and plant), fat, cholesterol, potassium, calcium, phosphorus, iron, vitamin A, thiamin and riboflavin were also significantly higher in HI group than in LI and MI group (p < 0.05). Daily intakes of most nutrients were less than Korean RDA except protein ed phosphorus in HI poop, and INQs of thiamin, niacin and phosphorus were higher than 1.0, while those of calcium, iron, vitamin A and riboflavin were lower than 1.0. MAR of energy and 9 nutrients was significantly higher in HI group (0.70 $\pm$ 0.04) than in LI group (0. 56 0.04) and MI poop (0.47 $\pm$ 0.03) at p = 0.000. In conclusion, quality of nutrient intakes, especially energy and protein, was significantly influenced by socioeconomic status such as education and monthly income (p < 0.05). This result suggests that it would be very helpful to develop nutritional education programs considering hemodialysis patients' education levels, and to improve public supports (e.g., medical insurance system, low-rate lease system of dialysis equipments, etc.) focusing on the patients' family income levels f3r their better nutrition and health.

• 재활간호학회지
• /
• 제2권1호
• /
• pp.95-108
• /
• 1999

The purpose of this study was to identify the effect of the humor intervention program, administred to the hemodialysis patient as an adaptive coping mechanism. The research design was non-equivalent control group non-synchronized design. The study method had been done by investigating the experimental group and control group through the questionnaire on 36 patients who had been out patient hemodialysis room at B hospital in Pusan from August 18 to September 15, 1998. The humor intervention program consisted of 1 TV comedy, 1 home video and 1 comedy film. The humor intervention program was provided to the experimental group for 20-30 minute 3 times every other day at hemodialysis room. Dependent variables were measured by Spielberger's State Anxiety Inventory, Zung's Self Rating Depression Scale, Lefcourt & s Humor Coping Scale. The analysis of the collected data had been done for the hemogeneity test in which general characteristics of the experimental group and the control group had been tested by $X^2$-test and the hemogeneity test had been tested by t-test before using the humor intervention program which is for anxiety, depression and coping of humor. To test the hypothesis the t-test had been given for the difference of anxiety, depression and coping of humor between the two groups. The result were summarized as follows : 1. Anxiety score in the experimental group and control group was not significant difference. 2. Depression score in the experimental group and control group was not significant difference. 3. Coping of humor score in the experimental group and control group was not significant difference. In conclusion, even though humor intervention program did not have any efficient effect on hemodialysis patients in reacting to anxiety, depression and coping humor, it caused very positive reactions from patients, and it also reducted anxiety of patients among the experimental group a little bit. If this program could be sufficiently applied ac cording to the character of every patients with a little bit different appliences such as selection of humor intervention program, frequency and period, it will be used as an efficient the humor intervention program.

• 재활간호학회지
• /
• 제5권2호
• /
• pp.166-179
• /
• 2002

The purpose of this study was to the relationship between powerlessness, self-efficacy and quality of life in hemodialysis patients. The subjects were compromised of 198 hemodialysis patients from Pusan, Kyung-Sang Namdo and Kyung-Sang Bukdo 6 hemodialysis clinics. Data were collected by questionnaires from Sep. 19 to Oct. 27, 2001. The instrument used for study were the Powerlessness Behavioral Assessment Tool(Miller, 1983) and self-efficacy developed by Kim, Ju-Hyun(1995) and quality of life developed by Kim, Ok-Soo(1993). Collected data were analyzed by frequency, percentage, mean, standard deviation, t-test, ANOVA, Scheffe test, pearson correlation. The results were as follows. 1. The mean score of powerlessness was $52.41{\pm}6.93$, mean mark $3.28{\pm}0.43$, and the mea score of self-efficacy was $45.44{\pm}7.75$, mean mark $2.87{\pm}0.49$, and the mea score of quality of life was $121.27{\pm}23.81$, mean mark $2.96{\pm}0.58$. 2. There were significant differences in the level of powerlessness according to sex(t=2.148, p=.033), occupation(t=3.682, p=.000), economic status(F=3.094, p=.048), experience of hospitalization (t=-2.002, p=.047). 3. There were significant differences in the level of self-efficacy according to age(F=3.271, p=.013), economic status (F=5.759, p=.004), religion(F=2.667, p=.048), hemodialysis period(F=2.991, p=.032), hemodialysis frequency(t=9.045, p=.003), experience of hospitalization (t=4.40, p=.037). 4. There were significant differences in the level of quality of life according to occupation(t=3.796, p=.053), economic status(F=11.478, p=.000), hemodialysis frequency(t=7.573, p=.006). 5. There were significant negative correlation between powerlessness and self-efficacy (r=- .401, p<.001) powerlessness and quality of life(r=- .562, p<.001). There were significant positive correlation between self-efficacy and quality of life(r= .512, p<.001).

• 대한유전성대사질환학회지
• /
• 제19권1호
• /
• pp.20-25
• /
• 2019

Very-long-chain acyl-CoA dehydrogenase (VLCAD) 결핍증은 상염색체 열성으로 유전되는 유전성대사질환으로 미토콘드리아에서 장쇄지방산의 산화 장애이다. VLCAD 결핍증의 임상증상은 중증도 및 발현 시기에 따라 심각한 심장 이상을 동반하는 신생아기 발현형, 소아기 발현형, 지발형의 세 가지로 분류할 수 있다. 저자들은 혈장 아실카르니틴 분석과 유전자패널 염기서열분석 방법으로 확진된 성인기 발현형 VLCAD 결핍증 1례를 경험하였기에 보고하고자 한다. 34세 여자가 반복되는 근육통증과 간헐적 횡문근융해증의 병력을 주소로 내원하였다. 환자는 12세에 처음으로 운동 후 횡문근융해증으로 급성 신부전이 발생하여 혈액 투석을 받고 회복하였다. 이후 환자는 장시간의 운동이나 금식 후에 반복적으로 근육통증과 횡문근융해증이 발생하였다. 내원 시 신체 검진과 신경학적 검진은 정상이었다. 내원시 혈장 AST/ALT, Creatinine kinase (CK)는 약간 상승해있었으나, 이전 의무기록에 의하면 횡문근융해증이 있을 당시 AST/ALT, CK는 매우 상승하였다. 환자의 병력을 토대로 지방산대사장애 의심하에 감별진단을 위하여, 유전자 패널 염기서열 분석과 혈장 아실카르니틴 분석을 시행하였다. 혈장 아실카르니틴 분석결과 C14:1 ($1.453{\mu}mol/L$; 참고치, 0.044-0.285)와 C14:2 ($0.323{\mu}mol/L$; 0.032-0.301)가 증가였고, C14 ($0.841{\mu}mol/L$; 0.065-0.920)는 높은 정상이었다. 유전자패널 염기서열분석에서는 ACADVL 유전자에서 두 개의 병원성변이가 이형접합으로 발견되었으며, 이는 Sanger 염기서열 분석으로 확진되었다: c.[1202G>A(;)1349G>A] (p.[(Ser401Asn)(;)(Arg 450His)]). 환자는 생화학적, 유전학적 검사결과를 바탕으로 지발형 VLCAD 결핍증으로 확진되어 저지방식이와 급성 대사장애를 예방하기 위한 영양 교육을 받았다. 경증의 지발형 지방산 대사장애는 임상증상과 생화학적 검사 이상이 간헐적으로 발생하기 때문에 진단이 어렵다. 유전자패널 염기서열 분석은 지방산대사 장애와 같이 임상증상과 원인 유전자 이상이 다양한 대사 이상질환에서 유용한 진단법이 될 수 있다.

• 대한간호학회지
• /
• 제11권2호
• /
• pp.83-104
• /
• 1981

Hemodialysis is essential treatment for the chronic renal failure patient's long-term cure and for the patient management before and after kidney transplantation. It sustains the endstage renal failure patient's life which didn't get well despite strict regimen and furthermore it becomes an essential treatment to maintain civil life. Bursing implementation in hemodialysis may affect the significant effect on patient's life. The purpose of this study was to obtain the basic data to solve the hypotension problem encountable to patient and the blood loss problem affecting hemodialysis patient'a anemic states by incomplete rinsing of blood in coil through all process of hemodialysis. The subjects for this study were 44 patients treated hemodialysis 691 times in the hemodialysis unit, The .data was collected at Gang Nam 51. Mary's Hospital from January 1, 1981 to April 30, 1981 by using the direct observation method and the clinical laboratory test for laboratory data and body weight and was analysed by the use of analysis of Chi-square, t-test and anlysis of varience. The results obtained an follows; A. On clinical laboratory data and other data by dialysis Procedure. The average initial body weight was 2.37 ± 0.97kg, and average body weight after every dialysis was 2.33 ± 0.9kg. The subject's average hemoglobin was 7.05±1.93gm/dl and average hematocrit was 20.84± 3.82%. Average initial blood pressure was 174.03±23,75mmHg and after dialysis was 158.45±25.08mmHg. The subject's average blood ion due to blood sample for laboratory data was 32.78±13.49cc/ month. The subject's average blood replacement for blood complementation was 1.31 ±0.88 pint/ month for every patient. B. On the hypotensive state and the coping approaches occurrence rate of hypotension was 28.08%. It was 194 cases among 691 times. 1. In degrees of initial blood pressure, the most 36.6% was in the group of 150-179mmHg, and in degrees of hypotension during dialysis, the most 28.9% in the group of 40-50mmHg, especially if the initial blood pressure was under 180mmHg, 59.8% clinical symptoms appeared in the group of“above 20mmHg of hypotension”. If initial blood pressure was above 180mmHg, 34.2% of clinical symptoms were appeared in the group of“above 40mmHg of hypotension”. These tendencies showed the higher initial blood pressure and the stronger degree of hypotension, these results showed statistically singificant differences. (P=0.0000) 2. Of the occuring times of hypotension,“after 3 hrs”were 29.4%, the longer the dialyzing procedure, the stronger degree of hypotension ann these showed statistically significant differences. (P=0.0142). 3. Of the dispersion of symptoms observed, sweat and flush were 43.3%, and Yawning, and dizziness 37.6%. These were the important symptoms implying hypotension during hemodialysis accordingly. Strages of procedures in coping with hypotension were as follows ; 45.9% were recovered by reducing the blood flow rate from 200cc/min to 1 00cc/min, and by reducing venous pressure to 0-30mmHg. 33.51% were recovered by controling (adjusting) blood flow rate and by infusion of 300cc of 0,9% Normal saline. 4.1% were recovered by infusion of over 300cc of 0.9% normal saline. 3.6% by substituting Nor-epinephiine, 5.7% by substituting blood transfusion, and 7,2% by substituting Albumin were recovered. And the stronger the degree of symptoms observed in hypotention, the more the treatments required for recovery and these showed statistically significant differences (P=0.0000). C. On the effects of the changes of blood pressure and osmolality by albumin and hemofiltration. 1. Changes of blood pressure in the group which didn't required treatment in hypotension and the group required treatment, were averaged 21.5mmHg and 44.82mmHg. So the difference in the latter was bigger than the former and these showed statistically significant difference (P=0.002). On the changes of osmolality, average mean were 12.65mOsm, and 17.57mOsm. So the difference was bigger in the latter than in the former but these not showed statistically significance (P=0.323). 2. Changes of blood pressure in the group infused albumin and in the group didn't required treatment in hypotension, were averaged 30mmHg and 21.5mmHg. So there was no significant differences and it showed no statistical significance (P=0.503). Changes of osmolality were averaged 5.63mOsm and 12.65mOsm. So the difference was smaller in the former but these was no stitistical significance (P=0.287). Changes of blood pressure in the group infused Albumin and in the group required treatment in hypotension were averaged 30mmHg and 44.82mmHg. So the difference was smaller in the former but there is no significant difference (P=0.061). Changes of osmolality were averaged 8.63mOsm, and 17.59mOsm. So the difference were smaller in the former but these not showed statistically significance (P=0.093). 3. Changes of blood pressure in the group iutplemented hemofiltration and in the Uoup didn't required treatment in hypotension were averaged 22mmHg and 21.5mmHg. So there was no significant differences and also these showed no statistical significance (P=0.320). Changes of osmolality were averaged 0.4mOsm and 12.65mOsm. So the difference was smaller in the former but these not showed statistical significance（P=0.199). Changes of blood pressure in the group implemented hemofiltration and in the group required treatment in hypotension were averaged 22mmHg and 44.82mmHg. So the difference was smatter in the former and these showed statistically significant differences (P=0.035). Changes of osmolality were averaged 0.4mOsm and 17.59mOsm. So the difference was smaller in the former but these not showed statistical significance (P=0.086). D. On the changes of body weight, and blood pressure, between the group of hemofiltration and hemodialysis. 1, Changes of body weight in the group implemented hemofiltration and hemodialysis were averaged 3.340 and 3.320. So there was no significant differences and these showed no statistically significant difference, (P=0.185) but standard deviation of body weight averaged in comparison with standard difference of body weight was statistically significant difference (P=0.0000). Change of blood Pressure in the group implemented hemofiltration and hemodialysis were averaged 17.81mmHg and 19.47mmHg. So there was no significant differences and these showed no statistically significant difference (P=0.119), But in comparison with standard deviation about difference of blood pressure was statistically significant difference. (P=0.0000). E. On the blood infusion method in coil after hemodialysis and residual blood losing method in coil. 1, On comparing and analysing Hct of residual blood in coil by factors influencing blood infusion method. Infusion method of saline 200cc reduced residual blood in coil after the quantitative comparison of Saline Occ, 50cc, 100cc, 200cc and the differences showed statistical significance (p < 0.001). Shaking Coil method reduced residual blood in Coil in comparison of Shaking Coil method and Non-Shaking Coil method this showed statistically significant difference (P < 0.05). Adjusting pressure in Coil at OmmHg method reduced residual blood in Coil in comparison of adjusting pressure in Coil at OmmHg and 200mmHg, and this showed statistically significant difference (P < 0.001). 2. Comparing blood infusion method divided into 10 methods in Coil with every factor respectively, there was seldom difference in group of choosing Saline 100cc infusion between Coil at OmmHg. The measured quantity of blood loss was averaged 13.49cc. Shaking Coil method in case of choosing saline 50cc infusion while adjusting pressure in coil at OmmHg was the most effective to reduce residual blood. The measured quantity of blood loss was averaged 15.18cc.