• 임상간호연구
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• 제19권1호
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• pp.45-56
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• 2013

Purpose: The purpose of this study is to identify the effect of low sodium dialysate (LSD) rather than conventional dialysate on interdialytic weight gain (IWG), blood pressure (BP), and intradialytic side-effects (ISEs) in patients on maintenance hemodialysis (HD). Methods: The study was performed in 43 patients, who were treated in the university hospital over 8 weeks. Each participant's serum sodium set point was measured using dialysate sodium 140 mEq/L during the first 4 weeks. For the next 4 weeks dialysate sodium concentrate (134,136,and138 mEq/L) was provided to each participant but only to an experimental group (EG) (n=22) based on the individual set point, although 140 mEq/L dialysate was given to all of the control group (CG) (n=21). Consequently, outcomes including IWG, BP, and ISE were evaluated. Results: In EG, difference of pre-HD SBP (p=.047) and post-HD serum sodium (p=.006) were significantly decreased compared to CG. Also, ISEs was not more frequent in EG. However, the differences were not statistically significant, IWG (kg & %), pre-HD DBP, post-HD SBP & DBP, and serum osmolality in EG. Conclusion: Individual application of LSD in patients on maintenance hemodialysis is beneficial to decrease pre-HD SBP and post-HD serum sodium without increasing ISE. Therefore, LSD can be better treatment than conventional dialysate.

• 성인간호학회지
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• 제12권1호
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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.

• 한국임상수의학회지
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• 제23권3호
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• pp.267-271
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• 2006

The present study was performed to clarity the effect of hemodialysis(HD) on acute renal failure induced by bilateral ligation of the ureter. HB was applied on 48 hours(1st HD) and 72 hours(2nd HD) after ligation of the ureter, respectively. Clinical signs including nausea, vomiting, diarrhea and depression were observed in all cases(6 heads), however, those symptoms were much improved after HD. Hematological values including WBC, PCV and PLT were increased after ligation of the ureter, however, those values were decreased by HD without significance, compared with those of before HD. In addition, serum BUN, creatinine, Ca and P levels were increased after ligation of the ureter, however, BUN(p<0.05), creatinine(p<0.05) and P(p<0.05) were significantly decreased by HD, compared with before HD, respectively. Considering above findings, it was thought that HD was effective for improvement of clinical symptoms of dogs with induced acute renal failure.

• Journal of Nutrition and Health
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• 제34권8호
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• pp.920-928
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• 2001

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 chronic HD patients. We investigated the nutritional parameters of 50 Korean HD patients(mean age: 46.9 $\pm$ 10.3y, men : 23, women : 27) by measuring anthropometric and biochemical blood indices and assessing food intake using 24-h recall method. Also we administered two questionnaires, one for assessing nutritional knowledge about renal disease and dietary therapy, the other for measuring dietary habits related to dietary therapy. According to the distribution of BMI, 21.3% of HD patients were underweight. The hematological values of HD patients, such as plasma hemoglobin, hematocrit, and total lymphocyte count were below the normal range. The serum cholesterol levels were 133.2 $\pm$ 30.5mg/dl. HD patients took energy and protein only 77.5% and 83.1%, respectively, of their RDA. There were significantly positive correlations between nutritional knowledge and intake of nutrients, such as energy, fat, cholesterol, iron, potassium, vitamin B$_1$, vitamin B$_2$, and niacin. Also, there was a significantly positive correlation between nutritional knowledge and dietary habits(r = 0.317, p < 0.05). In conclusion, Korean HD patients showed mild malnutrition and suboptimal nutrition intake. It can be postulated that the dietary intake can be increased by nutrition education improving nutritional knowledge and correcting the dietary habits of HD patients.

• Clinical and Experimental Pediatrics
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• 제50권10호
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• pp.938-947
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• 2007

Many dialysis modalities such as peritoneal dialysis (PD), hemodialysis (HD) and continuous hemofiltration or hemodialysis (CRRT) are available for the management of pediatric patients with acute renal failure (ARF). PD is a relatively simple, inexpensive modality and can be used in hemodynamically unstable patients. But, it may not be the optimal therapy for patients with severe volume overload or life threatening hyperkalemia. HD is the preferred modality for the treatment of severe volume overload, severe hyperkalemia, but it needs vascular access. Improvements in the HD equipment have allowed HD to be performend in small children. Recents technological improvements in CRRT therapies have enabled pediatric patients who are less stable to be treated. CRRT is becoming the preferred method of acute therapy in pediatric intensive care units. A sound knowledge of the underlying principles of dialysis and awareness of recent technological advancements in differnet dialysis modalities will hopefully result in improved management of children with ARF.

• Kidney Research and Clinical Practice
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• 제37권4호
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• pp.393-403
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• 2018

Background: This study compared nutritional parameters in hemodialysis (HD) subjects and controls using bioimpedance analysis (BIA) and investigated how BIA components changed before and after HD. Methods: This cross-sectional study included 147 subjects on maintenance HD from two hospitals and 298 propensity score-matched controls from one healthcare center. BIA was performed pre- and post-HD at mid-week dialysis sessions. Results: Extracellular water/total body water (ECW/TBW) and waist-hip ratio were higher in the HD patients; the other variables were higher in the control group. The cardiothoracic ratio correlated best with overhydration (r = 0.425, P < 0.01) in HD subjects. Blood pressure, hemoglobin, creatinine, and uric acid positively correlated with the lean tissue index in controls; however, most of these nutritional markers did not show significant correlations in HD subjects. Normal hydrated weight was predicted to be higher in the pre-HD than post-HD measurements. Predicted ultrafiltration (UF) volume difference based on pre- and post-HD ECW/TBW and measured UF volume difference showed a close correlation ($r^2=0.924$, P < 0.01). Remarkably, the leg phase angle increased in the post-HD period. Conclusion: The estimated normal hydrated weight using ECW/TBW can be a good marker for determining dry weight. HD subjects had higher ECW/TBW but most nutritional indices were inferior to those of controls. It was possible to predict UF volume differences using BIA, but the post-HD increase in leg phase angle, a nutritional marker, must be interpreted with caution.

• 한국임상수의학회지
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• 제23권1호
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• pp.36-40
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• 2006

The aim of this study is to clarify the therapeutic effect of hemodialysis (HD) on acute renal failure in dogs experimentally induced by ethylene glycol (EG) ingestion in experiment 1(HD on 12 and 36 hours after EG injestion) and experiment 2(HD on 24 and 48 hours after EG injestion). Clinical signs such as vomiting, depression, ataxia and knuckling were improved on experiment 1 and 2. White blood cell (WBC) and platelets (PLT) were decreased, and packed cell volume (PCV) was increased after hemodialysis, however, no significant differences were observed in experiment 1 and 2. BUN, creatinine and phosphorus was significantly decreased in experiment 1 and 2, respectively. These results suggested that hemodialysis was effective for acute renal failure in dogs induced by EG ingestion.

• 성인간호학회지
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• 제26권6호
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• pp.614-620
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• 2014

Purpose: The purpose of this study was to examine the levels of resilience, depression, and self-esteem of hemodialysis(HD) patients, and to find out the factors influencing resilience. Methods: The subjects of this descriptive correlational study was 83 outpatients in H hospital in Seoul, Korea, who receive hemodialysis regularly. Data was analyzed by SPSS/WIN 18.0 program. Results: The resilience of HD patients were statistically different by gender, job, economical state, most supportive person, and recent condition. Self-esteem had positive correlation, while depression had moderate negative correlation with the resilience of HD patients. In regression analysis, depression had significant explanation power, which accounted for 25.4% of the resilience. Conclusion: The results of this study provide basic data for developing a resilience promoting program. Since health-related conditions of HD patients affect their levels of resilience, individualized assessment and management of complications are necessary. Also, as the resilience is related to family support, activating support groups for HD patients and their spouses would be helpful to promote their resilience.

• Journal of Nutrition and Health
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• 제36권4호
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• pp.397-404
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• 2003

The present study was designed to compare the nutritional status of hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients. Subjects were 58 HD patients (male/female = 29/29) and 33 CAPD patients (male/female = 23/10) undergoing dialysis treatment in Artificial Kidney Unit of Chonbuk National University Hospital. For nutritional assessment, %IBW (ideal body weight), %TSF (tricep skin fold), %MAC (mid arm circumference), %MAMC (mid arm muscle circumference), serum albumin, serum transferrin, TLC (total lymphocyte count), SGA (subjective global assessment) and estimated energy and protein intakes by 1-month food frequency method were used. Between HD and CAPD group, mean age (50 $\pm$ 12 vs. 52 $\pm$ 12 yr), dialysis durations (37 $\pm$ 36 vs. 30 $\pm$ 26 mon), dietary energy intakes (28.3 $\pm$ 9.0 vs. 28.8 $\pm$ 8.6 kcal/kg/day), dietary protein intakes (1.1 $\pm$ 0.4 vs. 1.2 $\pm$ 0.3 g/kg/day) and incidence of co-morbid conditions (69.0% vs. 69.7%) were not significantly different. Data by using SGA showed a higher incidence of malnutrition in CAPD patients (45.6%) than in HD patients (36.2%). %IBW (p < 0.001), %TSF (p < 0.001) and %MAC (p < 0.001) were higher in CAPD patients than were in HD patients. But serum albumin (p < 0.001) and transferrin (p < 0.001) were significantly lower in CAPD patients than were in HD patients. A higher incidence of malnutrition was shown in CAPD Patients than in HD Patients due to different dialysis type. A significant finding was that CAPD showed protein deficient malnutrition and HD did calorie deficient malnutrition. It suggests that an adequate dietary intake considering dialysis type prevents a prevalence of malnutrition.

• 대한지역사회영양학회지
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• 제22권5호
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• pp.426-440
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• 2017

Objectives: The valid assessment of food and nutrients intakes using appropriate dietary intake method is necessary to improve the nutritional status of the hemodialysis (HD) patients. This study was conducted to compare the method between newly developed, semi-quantitative food frequency questionnaire (Semi-FFQ) and 7-day dietary records (7-DRs) for hemodialysis patients. Methods: We conducted both methods on 53 maintenance HD patients in two university hospitals. We calibrated the frequency, portion size and daily intake of 47 food items reported in Semi-FFQ. The food and nutrients intake was compared and the correlation of the two methods was analyzed. Also each nutrient intake was compared to recommended dietary allowance for Korean (KDRIs) and recommended nutrient reference value for HD patients. Results: Energy and energy-yielding nutrients intakes were significantly higher in the two methods (p<0.01). These support the possible reliability between Semi-FFQ and 7-DRs that is similar with regard to most mineral and vitamin intakes. Thus, the Semi-FFQ used in this study for the assessment of nutrient intakes of HD patients can be reliable for the assessment of the nutrient intake along with the 7-DRs. The correlation coefficients were higher for foods consumed daily, such as steamed rice, meat and chicken, bean, egg, milk, coffee and alcohol than for those of foods eaten rarely (p<0.01). Conclusions: The Semi-FFQ used in this study can be a reliable tool for the assessment of the HD patients' nutrient intake along with the 7-DRs, despite its limitations.