• Journal of Korean Biological Nursing Science
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• 제12권2호
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• pp.114-126
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• 2010

Purpose: To examine the levels of the disease-related knowledge and educational demands of pre-dialysis, chronic renal failure patients at different GFRs and stages. Methods: This study used a cross-sectional survey and aimed at 116 pre-dialysis, chronic renal failure patients, who were registered and received regular treatment from December 1 to December 31, 2009 at the nephrology departments of tertiary medical centers in Seoul. Stages were classified into Stage 3, 4 and 5 depending on GFR ranges. To measure the levels of knowledge and educational demands, the tool, which were first invented by Young Ae Lim (1996) and then modified by Hyo Sun Lim (2005) to adjust the knowledge and educational demands measuring tool for hemodialysis patients to pre-dialysis patients with chronic renal failure, was used. Collected data was analyzed with the SPSS WIN 12.0 program (average, standard deviation, Pearson's correlation coefficient, t-test and ANOVA). Results: There was a significant difference in the disease-related knowledge levels of the subjects at each stage (F=24.41, p=.000). The Scheffe post hoc test confirmed that patients at higher stages had higher levels of knowledge of their disease. Also, although the results showed that patients at higher stages had higher educational demands, there was no significant difference among the groups (F=1.259, p=.288). Conclusion: As patients have different levels of knowledge of the disease and educational demands depending on their stages, it is important to develop and use a systematic education program that reflects the demands and levels of patients at each stage in order to help pre-dialysis patients with chronic renal failure with self-management and improve their quality of life.

• 대한간호학회지
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• 제42권5호
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• pp.699-708
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• 2012

Purpose: This study was designed to test structural equation modeling of the quality of life of pre-dialysis patients, in order to provide guidelines for the development of interventions and strategies to improve the quality of life of patients with Chronic Kidney Disease (CKD). Methods: Participants were patients who visited the nephrology outpatient department of a tertiary hospital located in Seoul. Data on demographic factors, social support, nutritional status, physical factors and biobehavioral factors and quality of life were collected between March 4 and March 31, 2011. Results: In the final analysis 208 patients were included. Of the patients 42% were in a malnourished state. Anxious or depressed patients accounted for 62.0%, 72.6%, respectively. Model fit indices for the hypothetical model were in good agreement with the recommended levels (GFI=.94 and CFI=.99). Quality of life in pre-dialysis patients with CKD was significantly affected by demographic factors, social support, nutritional status, physical factors and biobehavioral factors. Biobehavioral factors had the strongest and most direct influence on quality of life of patients with CKD. Conclusion: In order to improve the quality of life in pre-dialysis patients with CKD, comprehensive interventions are necessary to assess and manage biobehavioral factors, physical factors and nutritional status.

• Journal of Korean Biological Nursing Science
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• 제15권2호
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• pp.82-89
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• 2013

Purpose: To examine the quality of life in pre-dialysis patients with chronic kidney disease. Methods: The subjects were 91 patients who visited the nephrology outpatient department of a tertiary hospital located in Seoul. Data on demographic and clinical characteristics, and quality of life (QOL) were collected between July 19 and 23, 2010. The relationship between QOL and various Stages of dependence on glomerular filtration rates (GFRs) and factors related to QOL were investigated. Collected data was analyzed with the SPSS WIN 12.0 program. Results: There was a significant difference in the quality of life of the subjects in different stages (F=18.12, p<.001). The Scheffe post hoc test confirmed that patients at higher stages had a lower level quality of life. In addition, GFRs, uremic symptoms, gender and age predicted value accounted for 38.5% of the variance on QOL (F=25.09, p<.001). Conclusion: Strategies to develop a systematic management program for improving QOL of pre-dialysis patients are urgently needed.

• 성인간호학회지
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• 제27권5호
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• pp.505-514
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• 2015

Purpose: The purpose of this study was to examine their levels of knowledge of the kidney, self-efficacy, and kidney function in pre-dialysis patients with chronic renal insufficiency. Methods: A total of 142 pre-dialysis patients with chronic renal insufficiency were recruited from a nephrology clinic of a hospital in Korea. Participants' knowledge of the kidney, self-efficacy, and kidney function were measured, and the correlations between these factors were computed. Results: The levels of knowledge of the kidney were moderate, with a mean score of $12.30{\pm}5.35$. Knowledge level was significantly correlated with age, education level, occupation, income, physical symptoms, and information resources (p<.05). The mean score for self-efficacy was $6.06{\pm}2.00$. Self-efficacy was significantly associated with patients' age, education level, occupation, income, cigarette use, and information resources (p<.05). The mean score for kidney function was $35.66{\pm}18.68mL/min/1.73m^2$. Kidney function was significantly correlated with use of medications and drinking behavior (p<.05). Knowledge of the kidney was significantly correlated with self-efficacy (r=.31, p<.001), but not with kidney function. There was a significant correlation between self-efficacy and kidney function (r=.30, p<.001). Multiple regression analysis revealed that self-efficacy and drinking behavior accounted for 11% of the variance in kidney function of pre-dialysis patients with chronic renal insufficiency. Conclusion: Nursing interventions are necessary to increase self-efficacy among pre-dialysis patients with chronic renal insufficiency in order to maintain their kidney function.

• Journal of Korean Biological Nursing Science
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• 제21권3호
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• pp.169-177
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• 2019

Purpose: The purpose of this paper was to identify blood pressure, interdialytic weight gain, thirst and intradialytic discomfort in subjects after applying individual low-sodium dialysis fluid (1,2,3 mEq/L) to hemodialysis patients for 12 weeks. Methods: This study was a non-equivalent pre-post design. For 12 weeks, dialysate concentration was maintained at 1 mEq/L or 2 mEq/L or 3 mEq/L based on average sodium concentration of each individual, and the difference was compared after applying individually. Results: Change in blood pressure significantly decreased in the group where in pre-hemodialysis systolic pressure decreased the gradient of sodium concentration in serum sodium and dialysis solution by 2mEq/L. Interdialytic weight gain, and thirst showed significant decrease in all three groups. But in all three groups, intradialytic discomfort among dialysis showed no significant changes. Conclusion: Although application of low sodium dialysis fluid showed no change in intradialytic discomfort, lowered blood pressure, thirst, and interdialytic weight gain, which could be used for individual showing increased interdialytic weight gain and increased blood pressure. There is need for continued study on this.

• 중환자간호학회지
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• 제16권3호
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• pp.34-47
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• 2023

Purpose : Exercise may prevent the worsening of chronic kidney disease (CKD) and progression of cardiovascular diseases in patients with CKD. This review aims to identify the best type of exercise modality and summarizes the beneficial effects of exercise on physical and renal function among older adults with pre-dialysis CKD. Methods : A systematic search of PubMed, Embase, CINAHL, Cochrane Library, Web of Science, SCOPUS, and domestic database was performed for randomized controlled trials (RCTs) assessing the effect of exercise intervention on older adults with pre-dialysis CKD published until February 2023. A random-effects meta-analysis was conducted. The risk of bias was assessed using a Cochrane tool for assessing the risk of bias in RCTs (RoB 2.0). Results : The systematic review included 11 RCTs (n = 591, average age 60.2-76), of which 8 could be included for meta-analysis. Exercise was significant in increasing peak oxygen consumption and knee muscle strength among physical functions, and also in improving glomerular filtration rate among kidney functions. Conclusion : Exercise has beneficial effects on physical and renal function among older adults with pre-dialysis CKD. In the future, it is necessary to verify the effectiveness of exercise by subdividing it by type, intensity, duration, and delivery.

• 대한의생명과학회지
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• 제23권3호
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• pp.185-193
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• 2017

Malnutrition is common and the major risk factor of mortality of end stage renal disease (ESRD) patients. The aim of this study is to assess nutritional status of malnutrition patients on dialysis by various methods and compare nutritional parameters of continuous ambulatory peritoneal dialysis (CAPD) patients with hemodialysis patients. 137 patients on dialysis from April 2009 to July 2013 were enrolled. Nutritional parameters of 66 CAPD and 71 hemodialysis patients were investigated by anthropometry, biochemical study, diet analysis and questionnaires. Malnutrition patients were selected by body mass index (BMI), serum albumin and pre-albumin based on International Society of Renal Nutrition and Metabolism (ISRNM) diagnostic criteria for protein-energy wasting and compared with non-malnutrition patients. In comparison of CAPD and hemodialysis patients, most anthropometric values showed no significant difference except total body water (TBW). TBW was lower in CAPD patients (P=0.024). Although serum albumin was slightly higher in hemodialysis patients (P=0.047), pre-albumin were significantly higher in CAPD patients (P=0.000). Serum blood urea nitrogen (BUN) was higher in hemodialysis patients (P=0.000). In diet analysis, Total calorie (P=0.000) and total cholesterol (P=0.012) intakes were higher in CAPD patients. Mean subjective global assessment (SGA) grade was higher in CAPD patients (P=0.003). Several nutritional parameters of CAPD patients were better than hemodialysis patients implying more intensive therapeutic approach may be needed for hemodialysis patients. We have to understand multiple factors contributing malnutrition of ESRD patients and individualized therapeutic approach is needed.

• 한국콘텐츠학회논문지
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• 제14권7호
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• pp.367-375
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• 2014

본 연구의 목적은 투석전 만성신장병 환자에게 적용할 타당성 있고 신뢰도 있는 자가관리 도구를 개발하는 것이다. 일개 병원의 143명의 만성신장병 환자에게 설문 조사를 실시하였다. 문헌고찰을 통해 자가관리 영역과 문항을 구성하고, 탐색적 요인분석을 통해 평가하고 신뢰도를 분석하였다. 5개의 요인이 도출되었고, 각각은 치료지시이행과 파트너십, 식이이행, 문제해결, 건강행위, 정신사회적 건강추구로 명명하였다. 5개의 요인은 총 변량의 51.1%를 설명했다. 각 요인은 신뢰도가 0.64-0.79여서 신뢰할 만했다. 개발된 자가관리 도구는 만성신장병 환자에게는 스스로 관리할 수 있는 지침이 되고, 건강관리 전문가들에게는 환자의 관리상태를 평가하고 중재 프로그램을 개발하는 데 유용하게 사용될 수 있다.

• Journal of Korean Medical Science
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• 제33권53호
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• pp.322.1-322.14
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• 2018

Background: Osteoprotegerin (OPG) plays protective roles against the development of vascular calcification (VC) which greatly contributes to the increased cardiovascular events in patients with chronic kidney disease (CKD). The present study aimed to find the non-traditional, kidney-related cardiovascular risk factors correlated to serum OPG and the effect of serum OPG on the arterial stiffness measured by brachial ankle pulse wave velocity (baPWV) in patients with the pre-dialysis CKD. Methods: We cross-sectionally analyzed the data from the patients in whom baPWV and the serum OPG were measured at the time of enrollment in a prospective pre-dialysis CKD cohort study in Korea. Results: Along with traditional cardiovascular risk factors such as age, diabetes mellitus, pulse pressure, and baPWV, non-traditional, kidney-related factors such as albuminuria, plasma level of hemoglobin, total $CO_2$ content, alkaline phosphatase, and corrected calcium were independent variables for serum OPG in multivariate linear regression. Reciprocally, the serum OPG was positively associated with baPWV in multivariate linear regression. The baPWV in the 3rd and 4th quartile groups of serum OPG were higher than that in the 1st quartile group after adjustments by age, sex and other significant factors for baPWV in linear mixed model. Conclusion: Non-traditional, kidney-related cardiovascular risk factors in addition to traditional cardiovascular risk factors were related to serum level of OPG in CKD. Serum OPG level was significantly related to baPWV. Our study suggests that kidney-related factors involved in CKD-specific pathways for VC play a role in the increased secretion of OPG into circulation in patients with CKD.

• 한국임상수의학회지
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• 제32권5호
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• pp.399-403
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• 2015

복막투석은 혈액에서부터 오는 체액과 노폐물을 교환하는 복강내의 막인 복막을 이용한 투석방법으로, 신부전과 중독증 환자에서의 치료법이다. 본 연구에서는 신부전증 개에서 자동투석기를 이용한 복막투석의 치료효율과 합병증에 대해 평가하였다. 10마리의 개를 대상으로 Swan neck 카테터(Neonatal, Coviden)와 자동 복막투석기를 사용하여 복막투석을 실시하였고, 그 효과는 요소감소율(urea reduction ratio)로 평가하였다. 평균 크레아틴닌 감소율과 평균 요소감소율은 $7.09{\pm}3.84$과 $145.8{\pm}48.5$였다. 평균 투석횟수는 $6{\pm}1$회 였다. 투석치료후 유의성 있는 요소의 감소가 7/10 개에서 관찰되었고, 유의성 있는 크레아틴의 감소가 9/10 개에서 관찰되었다. 요소의 감소율이 크레아틴 감소율보다 더 높게 관찰되었다. 1회 투석당 요소와 크레아틴닌의 감소율은 $0.064{\pm}0.023$과 $0.065{\pm}0.023$이 였다. 본 연구에서의 복막투석에 따른 합병증은 카테터 막힘, 투석액의 피하누출, 패혈성 복막염, 저알부민혈증, 과수화 등이었다. Swan neck 카테터와 자동 복막투석기를 이용한 복막투석은 임상에서 적용 가능하였으며 본 연구를 통하여 성공적인 복막투석의 가능성을 보여주었다. 하지만 합병증을 최소화하기 위해서는 주의 깊은 모니터링이 필요할 것으로 판단된다.