• 문화기술의 융합
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• 제4권4호
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• pp.11-20
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• 2018

본 연구는 저온투석 적용이 혈액투석환자의 투석안정성, 피로감, 소양증과 투석적절도에 미치는 효과를 규명하기 위하여 시도되었다. 연구설계는 비동등성 대조군 전후 설계를 이용한 유사실험 연구이며, 연구대상자는 B시에 소재한 G 종합병원에 혈액투석을 받는 환자로 저온투석 간호중재를 적용한 실험군 25명, 대조군 25명으로 총 50명을 선정하였다. 결과인 제1가설은 "저온투석요법군과 일반투석요법군은 시간의 경과에 따라 투석안정성에 차이가 있을 것이다"는 수축기압만 지지되었다(p=.023). 제2가설은 "저온투석요법군과 일반투석요법군은 시간의 경과에 따라 피로감에 차이가 있을 것이다"는 지지되었다(p<.001). 제3가설은 "저온투석요법군과 일반투석요법군은 시간의 경과에 따라 소양증에 차이가 있을 것이다"는 기각되었다. 제4가설은 "저온투석요법군과 일반투석요법군은 시간의 경과에 따라 투석적절도에 차이가 없을 것이다"는 지지되어 같은 효과로 나타났다. 결론은 혈액투석환자의 투석안정성, 피로감에 대한 관리 방법으로 저온투석 적용시 효과가 있는 것으로 보인다.

• 간호행정학회지
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• 제5권2호
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• pp.297-316
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• 1999

The purpose of this study is searching for hemodialysis nursing bahaviors by hemodialysis room nurses and analyzing them. Then, it estimates hemodialysis nursing costs and obtains basic data for development of proper nursing costs. First, it searched for hemodialysis nursing behaviors at a tertiary hospital hemodialysis room in Seoul and classified them. After the content validity was verified by 6 experts, Tool of hemodialysis nursing behaviors was developed. patients who recived hemodialysis were classified by dialysis patient classification tool. The searcher observed hemodialysis nursing behaviors applied to classified patients per 5 minutes. Then hemodialysis nursing hours spent to classified patients were calculated respectively. The direct expenditures and indirect expenditures were estimated. Ultimately, hemodialysis nursing costs were estimated. The results of the study were as follows ; 1. hemodialysis nursing behaviors were grouped by the same knowledge and skills. then, the content validity of them was verified by evaluation tool of nursing intervention classification by expert groups. They consisted of 9 hemodialysis activity domains and 71 hemodialysis nursing behaviors. The predialysis activity domain included 15 nursing behaviors, the activity domain of start-dialysis included 12 nursing behaviors, the activity domain of during- dialysis included 9 nursing behaviors, the activity domain of finish-dialysis included 5 nursing behaviors, the activity domain of after-dialysis included 5 nursing behaviors, the nursing documentation & undertaking and transfering included 5 nursing behaviors, the supply, drug, equipment & environment management activity domain included 7 nursing behaviors, the patient emotional support & education activity domain included 4 nursing behaviors, the emergency activity domain included 9 nursing behaviors. 2. The acute hemodialysis nursing hours were 106.42 minutes per a dialysis and the chroni hemodialysis nursing hours were 72.23 minutes per a dialysis. 3. The direct expenditure was 11.971 won per hour and indirect expenditure was 288won. 4. Finally, the cost of acute hemodialysis was 21,745 won and that of chronic hemodialysis was 14,759 won. By search of hemodialysis nursing behaviors, they will be used as hemodialysis nursing care standard and will be tended toward high qualitative care. Estimation of hemodialysis nursing costs will be used as fundamental data for development of proper nursing costs.

• 가정∙방문간호학회지
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• 제16권2호
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• pp.98-107
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• 2009

Purpose: The objective of this study was to identify the effects of a telephone follow-up program on patient compliance, urea kinetic modeling and incidence of infection in patients with continuous ambulatory peritoneal dialysis (CAPD). Method: A pretest-posttest design with a nonequivalent control group was used to examine the effects of a telephone follow-up program for 12 weeks in a group of 39 CAPD patients. The telephone follow-up group of 17 patients received telephone follow-up 10 min once a week for 1 month and 10 min twice a month for 2 months during 12 weeks compared to control group of 22 who patients received usual care. Results: The telephone follow-up group showed no significant changes in patient compliance and urea kinetic modeling, although patients with CAPD receiving a telephone follow-up showed reduced incidence of exit site infection during the intervention compared with the control group. Conclusion: Telephone follow-up program for CAPD patients may decrease the incidence of exit site infection. Future studies with a larger sample be done utilizing diet and exercise reinforcement program combined with telephone follow-up as a nursing intervention for patients with CAPD.

• 대한영양사협회학술지
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• 제12권4호
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• pp.411-431
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• 2006

The purpose of this study was to assess the frequently consumed dish consumption frequencies of continuous ambulatory peritoneal dialysis(CAPD) patients with osteopenia and develop recipes to improve bone mineral density of CAPD. The subjects were 96 CAPD patients with osteopenia(male 39, female 57) (osteopenia group) and 45 CAPD patients with normal BMD(male 24, female 21), matched with key variables(normal group). Fifty dishes(foods) that most frequently consumed were determined and food consumption frequency for each dish(food) for two groups were compared. Osteopenia group showed lower consumption frequency for ice-cream but higher frequency in apple. Of the 50 most frequently consumed dishes(foods), 20 dishes assessed as safe and recommendable for CAPD patients with osteopenia based on the contents of protein and mineral were selected : white boiled rice, white gruel, beef soup, steamed cabbage, roasted dried laver, fried egg, roasted bean-curd, cooked and seasoned bean sprouts, corn-starch jelly, cheese, ice-cream, orange juice, apple, grape, peach, peanut, raw lettuce, raw cucumber, and injulmi rice cake. wenty eight new dishes with modified recipes were developed for CAPD patients. Protein and mineral contents were analyzed for frequently consumed 17 dishes, assessed as modification of recipes are needed. The recipes were modified to decrease P, Na and K contents and to increase protein and Ca contents. Twenty dishes(foods) selected as having reasonable protein and mineral contents ratio or 28 newly developed dishes modified with protein and mineral contents or ratio would be helpful for nutrition education or counseling for CAPD patients with osteopenia. Dishes(foods) suggested in this study would also be useful for all CAPD patients for preventing osteoporosis.

• 한국임상약학회지
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• 제26권2호
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• pp.97-106
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• 2016

Background: Sevelamer is associated with reduced complications of chronic kidney disease-mineral bone disorder (CKD-MBD) resulted from hyperphosphatemia, which may contribute mortality, in CKD patients with dialysis. So far clinical outcomes of sevelamer on mortality and risk of cardiovascular mortality related to CKD-MBD are debating. Purpose of this study was to evaluate the effectiveness of sevelamer HCl on mortality of secondary hyperparathyroidism (SHPT), risk of cardiovascular mortality and, frequency of osteopathy in end stage renal disease (ESRD) patients with dialysis. Methods: We retrospectively reviewed the electronic medical records of 536 patients with ESRD, who were admitted for moderate to severe SHPT, for 36 months. 75 patients who met inclusion criteria were evaluated for the efficacy of sevelamer (mean serum iPTH = 487.5 pg/mL). Results: Sevelamer intervention was not associated with increased three-year survival time compared with non-sevelamers group [average survival month: 30.4 months in sevelamer group, 26.8 months in non-sevelamer group, p = 0.463]. Sevelamer intervention was not associated with significant mortality benefit and cardiovascular mortality benefit as compared to non-sevelamer group [sevelamer group: non-sevelamer group, all-cause mortality (iPTH > 600 pg/mL): 14.3% (1/34): 20% (1/41) p = 0.962, OR = 0.935, 95% CI, 0.058-14.98, heart disease mortality: 6.67% (2/30): 0% (0/32) p = 0.138]. Sevelamer was not associated with significantly lower cumulative incidence of osteopathy compared to non-sevelamer group (sevelamer group: non-sevelamer group, 5.9% (2/34):9.8% (4/41); p = 0.538; OR = 0.578; 95% CI, 0.099-3.367). Conclusion: Sevelamer was not associated with decreased all-cause mortality and risk of cardiovascular mortality compared to non-sevelamer group in ESRD patients with SHPT.

• 한국산학기술학회논문지
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• 제16권10호
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• pp.6495-6503
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• 2015

본 연구는 혈액투석환자의 이행 수준을 파악하고 이행과 생리적 지표, 건강관련 삶의 질 간의 관계를 조사하였다. 지역 투석의원 27곳에서 220명의 혈액투석환자로부터 자료를 수집하였다. 이행은 투석 간 체중증가, 혈중 칼륨과 인과 함께 환자역할행위이행 도구로 측정하였고 건강관련 삶의 질은 MOS-SF 12로 측정하였다. 자료는 서술통계, t-test, ANOVA, 피어슨 상관계수로 분석하였다. 이행의 평균 점수는 4점을 기준으로 2.92점이었고, 전체 15개 이행 항목 중 투석스케줄 지키기에서 가장 높은 점수를 보였다. 이행 수준은 연령, 결혼상태, 투석기간에 따라 유의한 차이가 있었으며, 이행 항목 중에서 복약, 감염관리, 수면, 야채와 과일섭취가 건강관련 삶의 질과 유의한 상관관계를 보였다. 본 연구결과는 혈액투석환자의 삶의 질을 향상시키기 위해 환자중심 접근이 도움이 될 것임을 시사한다. 건강돌봄제공자들은 환자에게 중요한 이행을 확인하고 환자의 가치와 우선순위를 고려함으로써 환자들의 입장을 이해할 필요가 있다.

• 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.

• 한국임상약학회지
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• 제24권3호
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• pp.206-212
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• 2014

Objectives: This was to evaluate the current usage of three erythropoietin stimulating agents (ESA) and their efficacy for management of anemia in peritoneal dialysis (PD) patients with chronic kidney disease. Methods: It was a retrospective comparative study through review of electronic medical records of chronic kidney disease patients undergoing PD at a tertiary teaching hospital from January 1998 to June 2013. Results: Average administration frequency was 1.66 times/week in EPO group, 0.75 times/week in DA group, and 0.19 times/week in MPG-EPO group. At the first 4 weeks, there were significant differences in mean hemoglobin levels between EPO and DA groups ($9.25{\pm}1.28g/dL$, $10.02{\pm}0.95g/dL$ each, p = 0.018) and also in hemoglobin response rates (10.0%, 45.2% each, p = 0.008), but since after 4 week, there had been no significant differences. There also showed no significant differences in achievement of hemoglobin target between the two groups. When converted to MPG-EPO in EPO/DA groups, there showed a slight increase in hemoglobin levels of both groups. MPG-EPO was the highest compared with two other drugs by the average cost based on the average weekly dose. Conclusion: EPO, DA, and MPG-EPO showed similar effects in treatment of anemia of PD patients based on hemoglobin target range (11.0~12.0 g/dL) which NFK-K/DOQI guidelines suggest. Though the average cost of MPG-EPO was higher than the other two drugs, the number of PD patients using MPG-EPO has increased and it is thought that long half-life and low administration frequency of MPG-EPO have improved the compliance of PD patients who have to self-administrate.

• 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.

• Journal of Nutrition and Health
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• 제39권7호
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• pp.624-640
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• 2006

Dialysis patients are at risk of malnutrition not only because of losses of nutrients during peritoneal dialysis but also because of anorexia that results in inadequate nutrient intakes. The aim of this study was to estimate the nutritional status of 154 patients receiving continuous ambulatory peritoneal dialysis (CAPD), especially focused on protein-energy malnutrition and vitamin and mineral status. The mean age of the subjects was $5.12\;{\pm}\;12.4\;y$ with educational years of $12.3\;{\pm}\;0.4\;y$ for male and $9.6\;{\pm}\;0.4\;y$ for female. The mean duration of dialysis was $22.7\;{\pm}\;21.7\;mo$. The causes of renal failure included diabetes (32.7), chronic glomerulonephritis (15.0%), and hypertension (8.5%). The main complications associated with chronic renal failure were hypertension (86.1%), diabetes (35.4%) and liver disease (9.0%). The mean daily energy intake was $1216.8\;{\pm}\;457.3\;kcal$ and increased to $1509.2\;{\pm}\;457.2\;kcal$ when added with the energy from dextrose in dialysate. The latter was still much lower than estimated energy requirement but energy intake per kg of body weight (28.1 kcal/1 g) was within the range of that recommended for CAPD patients' diet therapy (25 - 30 kcal/kg). The average daily intake of protein was $49.2\;{\pm}\;25.1\;g$ with 37.6% of the patients showing their intakes less than Estimated Average Requirement. The average protein intake per kg of weight was 0.9 g/kg, which is less than that recommended for CAPD patients (1.2-1.5g/kg) with mean serum albumin level $3.2\;{\pm}\;0.5\;g/dl$. The proportion of the patients with dietary calcium intake less than EAR was 90.9%, but when added with supplementary calcium (phosphorus binder), most patients showed their total calcium intake between EAR and UL. Fifty percent of the patients were observed with dietary iron intake less than EAR, however most patients revealed their total iron intake with supplementation above UL. The addition of folic acid with supplementation increased mean total folic intake to $1126.0\;{\pm}\;152.4\;{\mu}g$ and ninety eight percent of the subjects showed their total folic acid intake above UL. The prevalence of anemia was 83.1 % assessed with hemoglobin level, even with high intakes of iron with supplementation. Thirty four percent of the patients showed their fasting blood glucose was not under control $(\geq\;126\;mg/dl)$ even with medication or insulin probably due to dextrose from dialysate. The mean blood lipid levels were within the reference levels of hyperlipidemia, but with 72.1 % of the patients showing lower HDL-C. In conclusion, Fairly large proportion of the patients were observed with protein malnutrition with low intake of protein and serum albumin level. Few patients showed their vitamins and minerals intake less than EAR with supplementation. For iron and folic acid, their intakes were increased to above UL for large proportion of he patients. However, more than eighty percent of the patients were still anemic associated with decreased renal function. The serum blood glucose and lipid level were not under control for some patients with medication. It seems that supplementation and medications that patients are taking should be considered for dietary consulting of CAPD patients.