• Journal of Medicine and Life Science
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• v.20 no.3
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• pp.115-125
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• 2023

Arteriovenous fistula flow dysfunction is the leading cause of vascular access thrombosis and loss in patients undergoing hemodialysis. However, data regarding the influence of access flow rate measurements on the long-term outcomes of access are limited. This study aims to identify accesses at a high risk of thrombosis and loss among patients undergoing hemodialysis by measuring the access flow rate and exploring an optimal threshold value for predicting future access thrombosis. We enrolled 220 patients with arteriovenous fistula undergoing hemodialysis. The primary outcome was the occurrence of access thrombosis. Access flow rates were measured monthly using the ultrasound dilution method and were averaged using all measurements from patients with patent access. In patients experienced access thrombosis, those immediately before the thrombosis were selected. Using these data, we calculated the access flow rate threshold for thrombosis occurrence by analyzing the receiver operating characteristic curve, and the patients were divided into two groups according to whether access flow rates were higher or lower than 400 mL/min. During a median follow-up period of 3.1 years, 4,510 access flows were measured (median measurements per patient, 33 times; interquartile range, 11-54). A total of 65 access thromboses and 19 abandonments were observed. Access thrombosis and loss were higher in the lowflow group than in the high-flow group. This study revealed that low access flow rates are strongly associated with access thrombosis occurrence and subsequent loss of arteriovenous fistulas in patients undergoing hemodialysis.

• Journal of Hospice and Palliative Care
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• v.27 no.1
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• pp.1-10
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• 2024

This article underscores the importance of integrating comprehensive palliative care for noncancer patients who are undergoing hemodialysis, with an emphasis on the aging populations in Asian nations such as Taiwan, Japan, the Republic of Korea, and China. As the global demographic landscape shifts towards an aging society and healthcare continues to advance, a marked increase has been observed in patients undergoing hemodialysis who require palliative care. This necessitates an immediate paradigm shift to incorporate this care, addressing the intricate physical, psychosocial, and spiritual challenges faced by these individuals and their families. Numerous challenges impede the provision of effective palliative care, including difficulties in prognosis, delayed referrals, cultural misconceptions, lack of clinician confidence, and insufficient collaboration among healthcare professionals. The article proposes potential solutions, such as targeted training for clinicians, the use of telemedicine to facilitate shared decision-making, and the introduction of time-limited trials for dialysis to overcome these obstacles. The integration of palliative care into routine renal treatment and the promotion of transparent communication among healthcare professionals represent key strategies to enhance the quality of life and end-of-life care for people on hemodialysis. By embracing innovative strategies and fostering collaboration, healthcare providers can deliver more patient-centered, holistic care that meets the complex needs of seriously ill patients within an aging population undergoing hemodialysis.

• Journal of Hospice and Palliative Care
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• v.27 no.1
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• pp.11-20
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• 2024

Purpose: Advance directives (ADs) are legal documents that outline a person's preferences or decisions regarding end-of-life care ahead of time. In Korea, there is insufficient awareness and knowledge about ADs among patients undergoing hemodialysis. This study explored the relationship between perceptions of a good death, knowledge about ADs, and attitudes toward ADs in this patient population. Methods: This cross-sectional survey enrolled 119 hemodialysis patients from a secondary hospital in 2021. The participants completed a self-administered questionnaire, and the data were analyzed using the t-test, analysis of variance, Pearson correlation coefficients, Spearman rank correlation coefficients, and multiple regression analysis. Results: The average score for perceptions of a good death among hemodialysis patients was 2.80 out of 4, with clinical symptoms identified as the most critical factor. The average scores for knowledge about ADs and attitudes toward ADs were 5.69 out of 9 and 2.79 out of 4, respectively. There was a positive correlation between perceptions of a good death and attitudes toward ADs (r=0.34, P<0.001), as well as between knowledge about Ads and attitudes toward ADs (r=0.19, P=0.037). Factors influencing attitudes toward Ads included employment status (β=0.22, P=0.011), education level (β=0.22, P=0.013), and perceptions of a good death (β=0.29, P=0.001), which accounted for 24.8% of the variance in attitudes toward ADs. Conclusion: A positive perception of a good death among patients undergoing hemodialysis was associated with a positive attitude toward ADs. Educational programs are needed to improve individuals' understanding of a good death and encourage the development of end-of-life care plans.

• Korean Journal of Adult Nursing
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• v.12 no.1
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• pp.88-98
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• 2000

Hemodialysis(HD)-associated hypotension is a frequent complication, but it is difficult to manage. Until now, several maneuvers have been tried to prevent the HD-associated hypotension. Of these, the sodium content of dialysate was regarded as an important factor for maintaining blood pressure during HD. In this study, we evaluated the effect of hypertonic dialysate on blood pressure, interdialytic weight gain and the incidence of thirst. The study was done for 6 weeks successively with 3 different groups. Each patient was dialysed with 3 different dialysates for 2 weeks: Group I(Conventional HD: sodium concentration: 137 mEq/L), Group II(Hypertonic HD: 147 mEq/L) and Group III (Sequential HD: from 147 to 140 mEq/L). Hemodynamic parameters(blood pressure, pulse rate and ultrafiltration rate), biochemical parameters(hematocrits, blood urea nitrogen, creatinine, osmolality, sodium, potassium, chloride, fasting blood sugar) and complications (interdialytic weight gain & thirsty sensation) were compared among 3 groups. The results were as follows: 1. Decline of systolic blood pressure and diastolic blood pressure at the time of a 3 hour check during hemodialysis was lower in the Group II than Group I and III (p=0.002; p=0.012). and decline of diastolic blood pressure at the time of a 4 hour check during hemodialysis was lower in the Group II and III than Group I (p=0.04). 2. Incidence of hypotensive episodes during dialysis was significantly lower in Group II than group I (p=0.0287). 3. The ultrafiltration in Group III at the time of 1 hour, 2 hour and 3 hour check during hemodialysis was higher than that in Group I and II at the time of 1 hour, 2 hour and 3 hour check during hemodialysis respectively (p=0.0001; p=0.0001; p=0.0004). 4. Interdialytic weight gain was higher in Group I($3.1{\pm}0.8$) than Group I($2.8{\pm}0.8$) and III ($2.9{\pm}0.9$) (p=0.0422). 5. Hematologic and biochemical results were not significantly different among 3 Groups. 6. Frequency of thirst was different in Group I, II and III, $0.05{\pm}0.12$, $0.41{\pm}0.24$and $0.22{\pm}0.29$ respectively (p=0.0259). The results suggest that hypertonic HD was effective in preventing HD-associated hypotension but interdialytic weight gain and thirst sensations were increased as compared with a conventional method. In this situation, sequential HD seems to be an alternative method to minimizes the side effect of hypertonic HD.

• Anxiety and mood
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• v.2 no.2
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• pp.128-135
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• 2006

Objective : In this study, we investigated the prevalence of depression and its impact on the healthrelated Quality of life (HRQoL) of the patients with End-Stage Renal Disease (ESRD) on Hemodialysis. Method : The Quality of life (QOL) of patients was evaluated by HRQoL Questionnaire, "Medical Outcome Survey 36-Item Short Form Health Survey Korean Version (SF-36-K)". The patients on Hemodialysis in ESRD, were chosen from the hemodialytic room at Wonkwang University and Jeongeup-Asan Hospital. The number of patients was 95 (64 from Wonkwang University Hospital and 31 from Jeongeup-Asan Hospital) and all of them were above 19 years old. We performed various investigations to find a statistical correlations between HRQoL and physical & psychosocial factors such as the demographic characteristics, clinical characteristics (hemoglobin level and albumin level etc), and the score of Beck's depressive inventory (BDI). Results : The HRQoL value of patients on hemodialysis in ESRD is far poorer than the HRQoL reference value of Koreans and Americans, who are in normal healthly. The prevalence of depressive symptoms by BDI of the ESRD patients on hemodialysis is 68.6%, and age and depression have negative correlations with HRQoL of the patients. However, education level, serum albumin level, and social support have positive correlations with HRQoL. The patient group with depression has significantly poorer HRQoL than the group without depression. Conclusion : The HRQoL of ESRD patients on hemodialysis is not good in both physical and mental aspects. The prevalence of depression is very high and depression has negative impact of HRQoL of patients. Based on our study, it is essential to accompany with therapeutic Strategy to improve the HRQoL of ESRD patients on hemodialysis.

• The Korean Journal of Medicine
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• v.93 no.6
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• pp.548-555
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• 2018

Background/Aims: Assessment of fluid status in hemodialysis patents is very important. Overhydration in hemodialysis is associated with generalized edema, cardiovascular complications, and hypertension. The aim of this study was to determine the factors correlated with mortality of hemodialysis patients, assessing body muscle mass and fluid status using bioelectrical impedance analysis (BIA). Methods: This study enrolled 93 patients who underwent hemodialysis between January 2010 and May 2015 at CHA Bundang Medical Center. Medical records of enrollees up to June 2017 were reviewed retrospectively. These included laboratory results (serum albumin, C-reactive protein [CRP], lipid profile, etc.) and BIA data (extracellular water, intracellular water, total body water, soft lean mass, fat free mass, skeletal muscle mass, etc.). Results: Eleven of 93 patients had expired by May 2017. Among the surviving subjects, mean age was younger, CRP levels were lower, albumin levels were higher, and extracellular water/total body water (ECW/TBW) ratios were lower than in the expired patient group. Kaplan-Meier survival analysis revealed that overhydration (ECW/TBW > 0.4) was associated with higher mortality. Conclusions: In hemodialysis patients, overhydration is an important factor in mortality, and BIA could be a reliable modality in its assessment. We suggest that, for hemodialysis patients, overhydration is more of a risk factor for mortality than is muscle wasting.

• Journal of Nutrition and Health
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• v.36 no.7
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• pp.749-758
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• 2003

Malnutrition is a common problem in patients undergoing maintenance hemodialysis (HD) and compromised food intake is an important cause. Malnutrition is one of the important factors influencing mortality in these patients. This study was conducted to evaluate the effectiveness of nutrition education at improving nutritional status of 23 Korean HD patients (mean : 48.6 $\pm$ 10.4 years, men : 8, women : 15). Anthropometric indices, nutrient intakes, and biochemical blood indices were measured before and after a 6-month nutrition education intervention. Anthropometric indices such as percent ideal body weight [PIBW (%)], body fat, body mass index (BMI), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC), and calculated arm muscle area (CAMA) of subjects were within the normal range and not changed by nutrition education. Subjective global assessment (SGA) was significantly increased (p < 0.05) after nutrition education. Intake of total energy, carbohydrate, lipid, Ca, and vitamin B1 was increased significantly (p < 0.05) but intake of phosphorus, potassium, and sodium was decreased (p < 0.05). The serum concentrations of albumin, total protein, and Ca were significantly increased (p < 0.05), but levels of P and K were decreased (p < 0.05) after the intervention. These findings suggest that nutrition education for HD patients can be effective for positively changing nutrient intakes, leading to improvements in blood indices and nutritional status.

• Journal of Nutrition and Health
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• v.33 no.2
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• pp.179-185
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• 2000

This study investigated the nutritional status of 33 hemodialysis patients. Their weight, height, triceps and mid-arm circumference were measured and their dietary intake and blood profiles evaluated. The subjects were 57.1$\pm$11.9 years old. The energy intakes of men and women were 61% and 68% of RDA, respectively. The men and women's intake of protein was 0.93g/IBWkg/d and 0.99g/IBWkg/d, respectively. According to the distribution of BMI, 22.2% of the men and 73.3% of the women were underweight. A total of 5.6% of the men were overweight, versus none of the women. The serum albumin levels of the men and women were 3.56 and 3.52g/dl, respectively. The serum cholesterol levels of the men and women were 134.1 and 148.5mg/dl, respectively. The subjects were divided into three groups according to the level of albumin, and their intakes of nutrients were compared with one another. The group with high levels of albumin did not show higher energy and protein intake than the other groups but the serum total protein level was significantly higher. When the nutritional status of the patients was evaluated by weight and serum albumin level, 6.0% of them showed kwashiorkor-type malnutrition and 75.8% of them showed mild malnutrition.

• Journal of Korean Clinical Nursing Research
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• v.21 no.1
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• pp.116-126
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• 2015

Purpose: The purpose of this study was to examine the relationship between social support (family, healthcare provider, friends/peer), treatment belief, hope, and health status in patients on hemodialysis, and to identify direct and indirect effects of the variables on patients' health status. Methods: The self-regulation model was used to establish a path model. Data were collected from 240 patients. Multidimensional Scale of Perceived Social Support, Revised Illness Perception Questionnaire, Herth Hope Index, and Medical Outcomes Study Short Form-12 were used. Data were analyzed using the SPSS and AMOS programs. Results: The model was supported by fit statistics ($x^2=3.33$, p=.343, GFI .995, RMSEA .021, AGFI .968, NFI .986, CFI .999, TLI .993). Family and friends/peer support showed a significant direct influence on hope, while healthcare provider support directly influenced treatment belief. Social support, treatment belief, and hope directly and indirectly influenced health status, explaining 28.7% of the variance. Conclusion: These results show mechanisms underlying connections between social support and health status by demonstrating impact of social support and showing treatment belief and hope as mediators between social context and outcomes. To promote health of patients on hemodialysis, it is necessary for patient, family, healthcare professional, and friends to collaborate.

• Tuberculosis and Respiratory Diseases
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• v.82 no.2
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• pp.166-172
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• 2019

Background: The purpose of this study was to determine whether components of the ProVent model can predict the high medical costs in Korean patients requiring at least 21 days of mechanical ventilation (prolonged mechanical ventilation [PMV]). Methods: Retrospective data from 302 patients (61.6% male; median age, 63.0 years) who had received PMV in the past 5 years were analyzed. To determine the relationship between medical cost per patient and components of the ProVent model, we collected the following data on day 21 of mechanical ventilation (MV): age, blood platelet count, requirement for hemodialysis, and requirement for vasopressors. Results: The mortality rate in the intensive care unit (ICU) was 31.5%. The average medical costs per patient during ICU and total hospital (ICU and general ward) stay were 35,105 and 41,110 US dollars (USD), respectively. The following components of the ProVent model were associated with higher medical costs during ICU stay: age <50 years (average 42,731 USD vs. 33,710 USD, p=0.001), thrombocytopenia on day 21 of MV (36,237 USD vs. 34,783 USD, p=0.009), and requirement for hemodialysis on day 21 of MV (57,864 USD vs. 33,509 USD, p<0.001). As the number of these three components increased, a positive correlation was found betweeen medical costs and ICU stay based on the Pearson's correlation coefficient (${\gamma}$) (${\gamma}=0.367$, p<0.001). Conclusion: The ProVent model can be used to predict high medical costs in PMV patients during ICU stay. The highest medical costs were for patients who required hemodialysis on day 21 of MV.