• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.7
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• pp.589-598
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• 2019

This study was conducted to build a structural equation model explaining factors that affect hemodialysis patients' quality of life to test the goodness of fit of the model and identify directly and indirectly significant paths. To accomplish this, 230 patients receiving hemodialysis registered at study hospitals in G Metropolitan City and M City were randomly selected, and 201 were used in the final analysis. Data were collected using a self reporting questionnaire from February 1 to March 31, 2014. SPSS WIN 18.0 was used for descriptive statistics and correlation analysis of the general characteristics and for reliability analysis of the research tools. In addition, AMOS 18.0 was used for confirmatory factor analysis of latent variables, to determine the goodness of fit of the hypothetic model, and hypotheses testing. The results of this study were as follows: the fit of the modified model was 41.32, GFI = .96, AGFI = .92, RMR = .04, NFI = .96, CFI = .91 and TLI = .95. Twelve out of the 22 research hypotheses that were improved and improved were statistically significant. The results indicated that hemodialysis patients' quality of life was influenced directly by self-efficacy, depression, and self-care behavior, and indirectly by sleep disturbance, stress, fatigue, and family support. These variables explained 58.6% of the variation in quality of life. Overall, these findings suggest that nursing interventions for hemodialysis patients require strategies for managing patient depression and for increasing self-efficacy and self-care behavior to improve quality of life.

• Journal of Chest Surgery
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• v.53 no.6
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• pp.417-419
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• 2020

Surgeons avoid creating arteriovenous fistulae in obese patients owing to deep vessels, cannulation complications, and inconsistent outcomes. We describe placing an arteriovenous polytetrafluoroethylene (PTFE) graft between the brachial artery and axillary vein to avoid these complications. A 39-year-old super-obese woman with end-stage renal disease had undergone several hemodialysis access procedures on both arms. We traced the course of the arteriovenous graft course with the patient sitting and lying down. The ideal course was more accurate with the patient sitting; thus, the patient sat when the course was drawn, before lying on the operating bed. The PTFE graft was placed between the right brachial artery and axillary vein, according to the course in the opposite arm. No anastomotic dehiscence or pseudoaneurysm has taken place during 2 years of follow-up. In super-obese patients, the ideal course for arteriovenous grafts should be drawn while they are sitting, avoiding skin folds. This tip could avoid anastomotic dehiscence and pseudoaneurysm between the axillary vein and a PTFE graft.

• Korean Journal of Head & Neck Oncology
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• v.23 no.2
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• pp.153-156
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• 2007

Objectives : We study the feasibility and pharmacokinetics of cisplatin concurrent chemoradiation for advanced head and neck cancer patient undergoing hemodialysis. Materials and Methods : A 57-year old male with end stage renal disease developed stage III external auditory canal cancer. Complete resection surgery was done. Postoperative 6 months, local recurrence was occurred. Despite excision and adjuvant radiotherapy, local tumor was recurred. We decided to treat a cisplatin concurrent chemoradiotherapy. Cisplatin was administered at a dose of $20mg/m^2$ for 30 min. Hemodialysis was started 30 min after completion of the cisplatin infusion and performed for 4 hours. Hemodialysis was performed on day 3 and 5 of chemotherapy. Plasma samples were collected at specified times after administration of cisplatin. Result : At the end of the third cycle of cisplatin concurrent chemoradiotherapy, the tumor size was markedly decreased. The maximum plasma concentrations of plasma platinum and free platinum were 0.74 and $0.37{\mu}g/ml$ respectively. The area under the curve of plasma platinum and free platinum were 94.7 and $11.3{\mu}g{\cdot}h/ml$ respectively. Conclusion : We report a case of Cisplatin concurrent chemoradiation for hemodialysis patient with advanced head and neck cancer and suggest full dose cisplatin concurrent chemoradiotherpay is tolerable for these patients.

• 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.

• Journal of The Korean Dental Society of Anesthesiology
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• v.3 no.2 s.5
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• pp.98-102
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• 2003

Patients in end-stage renal disease (ESRD) and chronic renal failure present a number of challenges to the anesthesiologist. They may be chronically iii and debilitated and have the potential for multiorgan dysfunction. A 65-year-old male patient with ESRD was scheduled for oral cancer surgery under general anesthesia. He was in regular hemodialysis three times a week and secondary hypertension with left ventricular hypertrophy was accompanied. He also had chronic metabolic acidosis and hyperkalemia. The day after hemodialysis, general anesthesia was carried out. Uneventful anesthetic induction using thiopental and vecuronium and nasotracheal intubation were carried out. General anesthesia was maintained with isoflurane for 9 hours. During the anesthesia, he did not have any problem but persistently increasing serum potassium level. After anesthetic emergence, he was transferred to intensive care unit for mechanical ventilation. So we report this successful case of anesthetic management in a patient with ESRD for oral cancer surgery, which massive bleeding and long anesthetic time were inevitable in, from the preoperative preparation to anesthetic emergence.

• Journal of Trauma and Injury
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• v.34 no.4
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• pp.299-304
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• 2021

Atypical hemolytic uremic syndrome (aHUS) is a rare, progressive, life-threatening condition of thrombotic microangiopathy characterized by thrombocytopenia, microangiopathic hemolytic anemia, and renal impairment. The mechanisms underlying aHUS remain unclear. Herein, we present the first case in the literature of aHUS after a traumatic injury. A 55-year-old male visited the emergency department after a traumatic injury caused by a tree limb. Abdominal computed tomography revealed a rectal wall defect with significant air density in the perirectal space and preperitoneum, implying rectal perforation. Due to the absence of intraperitoneal intestinal perforation, we performed diverting sigmoid loop colostomy. An additional intermittent simple repair was performed due to perianal and anal injuries. One day postoperatively, his urine output abruptly decreased and serum creatinine level increased. His platelet level decreased, and a spiking fever occurred after 2 days. The patient was diagnosed with acute renal failure secondary to aHUS and was treated with fresh frozen plasma replacement. Continuous renal replacement therapy (CRRT) was also started for oliguria and uremic symptoms. The patient received CRRT for 3 days and intermittent hemodialysis thereafter. After hemodialysis and subsequent supportive treatment, his urine output and renal function improved. The hemolytic anemia and thrombocytopenia also gradually improved. Dialysis was terminated on day 22 of admission and the patient was discharged after recovery. This case suggests that that a traumatic event can trigger aHUS, which should be considered in patients who have thrombocytopenia and acute renal failure with microangiopathic hemolytic anemia. Early diagnosis and appropriate management are critical for favorable outcomes.

• Journal of the Korean Society of Radiology
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• v.84 no.2
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• pp.477-482
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• 2023

The subclavian vein is an uncommon route for tunneled hemodialysis catheter (tHDC) placement because of its potency for future dialysis access. However, when favored access routes have been exhausted because of repeated catheterization or limited life expectancy, the subclavian vein can be used for urgent hemodialysis. A subclavian catheterization has a technical problem. The subclavian vein often forms a right angle with the vena cava, and advancing stiff peel-away sheath can cause a vascular injury. However, raising the patient's arm can alter the position of the guidewire and, therefore, change the angle of the vein favorable for tHDC placement. Herein, we report two patients who underwent subclavian catheterization; one experienced an injury to the superior vena cava after undergoing the conventional procedure, whereas the other patient with raised arm during the catheterization procedure had safe catheter placement.

• Journal of the Korea Convergence Society
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• v.10 no.5
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• pp.385-395
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• 2019

This was a descriptive study to investigate the effect of social support and resilience on sick role behaviors of hemodialysis patients, and aims to provide base data on nursing intervention programs for improving the sick role behaviors of hemodialysis patients. The study subjects was patients with chronic kidney disease undergoing hemodialysis treatment at a general hospital in D city. The final analysis has been made on 131 questionnaires. The average of social support score was $3.93{\pm}0.84$, and resilience score was $2.67{\pm}0.80$. At last sick role behavior score was $3.99{\pm}0.80$. According to the analysis on the correlations among the study subjects' social support, resilience and sick-role behaviors, the social support had statistically and significantly positive correlation. In regression analysis, frequency of dialysis, social support and resilience have appeared to be the variables influencing sick role behavior, and the explanatory power of this model is 44.0%.

• Journal of Nutrition and Health
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• v.22 no.1
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• pp.32-35
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• 1989

Serum lipid peroxide levels in 25 chronic renal failure patients undergoing hemodialysis were examined by determining TBA reaction with spectrofluorometry. The lipid peroxide levels, 208.9$\pm$88.4nmol/ml, in the patient group was significantly higher than 152.4$\pm$43.9nmol/ml of 48 control healthy subjects. It is likely that the elevated serum lipid peroxide levels can play a role in increasing tendency of hemorrhage and incidence of atherosclerosis in chronic renal failure patients.

• Journal of Korean Academy of Nursing
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• v.46 no.4
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• pp.598-609
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• 2016

Purpose: The purpose of this study was to examine effects of a dietary program based on self-efficacy theory on dietary adherence, physical status and quality of life (QoL) in hemodialysis patients. Methods: A non-equivalent control group pre-post test design was used. The intervention group received the dietary program for 8 weeks from August 4 to September 26, 2014. The control group received only usual care. Results: ANCOVA showed that dietary adherence (F=64.75, p <.001) was significantly different between the two groups. Serum albumin (F=12.13, p =.001), interdialytic weight gain (F=56.97, p <.001), calories (F=15.80, p <.001) as physical status indices were significantly different, but serum potassium (F=2.69, p =.106) and serum phosphorus (F=1.08, p =.303) showed no significant difference between the two groups. In terms of health-related QoL, the physical component scale (F=10.05, p =.002) and the mental component scale (F=16.66, p <.001) were significantly different between the two groups. In addition, in terms of diet related QoL, diet level (F=35.33, p <.001) and satisfaction level (F=15.57, p <.001) were significantly different between the two groups, but dietary impact level (F=1.23, p =.271) was not significantly different. Conclusion: Findings show that the dietary program based on self-efficacy theory is an effective nursing intervention program to improve adherence to diet, and to maintain physical status and QoL for hemodialysis patients.