• 기본간호학회지
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• 제3권1호
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• pp.68-80
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• 1996

Long-term hemodialysis(HD) patients manifest various signs of protein and caloric malutrition due to poor intake of nutrients and other causes. Poor nutritional status increases the mortality and morbidity rates in HD patients. Thus, mataintnance of adequate nutritional status has been a major task in taking care of patients receiving HD. This study was to evaluate the nutritional status of HD patients and to clarify the degree of nutritional deficit based on usual dietary intake, anthropometric and biochemical indicators. Sixty HD patients comprised a HD group, while the control group consisted of 60 healthy adults whose age and sex matched those of the HD group. Nutritional status was evaluated by dietrary intake using instant nutritional scale, anthropometric measures, serum protein concentrations and the number of lymphocytes. The data were analyzed by using Chi-square test and unpaired t-test. The results are as follows. 1. Regarding usual dietary intake of HD group. 1) Estimated caloric intake was significantly lower than the recommended daily allowance(RDA) and among them, 35% were taking calories less than 85% of the RDA. 2) Estimated protein intake was significantly higher than the RDA and among them 40% were taking protein more than 115% of the RDA. 3) Estimated fat intake was lower than the RDA. 4) Vitamin A, B, $B_1,\;B_2$, C and niacin in take was lower than the RDA respectively. 5) Estimated ferrous intake was within the normal limit the RDA while estimated calcium intake was higher than the RDA. 6) Both calorie and protein intake were higher for the 10 patients who had been under continuous ambulatory peritoneal dialysis than for the patients under HD from the beginning. 2. Regarding anthropometric measures : 1) Body mass index(BMI), midarm circumference(MAC), and triceps skinfold thickness(TSF) were lower in the HD group than in the control group. 2) Among HD group, 47.1% were within the normal limit of BMI, while 86.7% were within the same limit in the control group. 3) Among HD group, 35.0% were within the normal limit of MAC, while 83.3% were within the same limit in the control group. 4) Among HD group, only 8.3% were normal, 30.3% were mild deficit status of TSF, while 50% were normal and 48.3% were mild deficit status in the control group. 3. Regarding biochemical laboratory tests 1) Albumin, transferrin concentrations and the number of lymphocytes were lower in HD group than in the control group. 2) Among HD group, 98.3% were within the normal limit of albumin concentration and all were within the same limit in the control group. 3) Among HD group, only 11.7% were within the normal limit of transferrin concentration, while 81.7% were within the same limit in the control group. 4) Among HD group, 25% were within the normal limit, while 93.3% were within the same limit in the control group. The above findings suggest that HD patients were in nutritional deficit status. Adequate diet therapy and periodical evaluation of the nutritional status in HD patients are needed. Accordingly, it turned out that anthropometric measures were very reliable parameters and easy to use to evaluate nutritional status. So nurses are encouraged to adopt anthropometric measures to examine nutritional deficit status of HD patients.

• 대한임상독성학회지
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• 제3권1호
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• pp.17-21
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• 2005

Purfose: This study was to observe the phosphamidon reduction rate after haemoperfusion (HP) and Hemodialysis (HD) in vitro. Methods: We started off by measuring the clearance of HD and HP for the phosphamidon in vitro. Phosphamidon was measured hourly by High-pressure liquid chromatography. Results: Phosphamidon clearance was effectiveness in HP and HD. Phosphamidon reduction rate was no difference between HD and HP; $64\%$ versus $91.\%1$ at starting, $82.2\%$ versus $80.2\%$ at 1 hours, $82.2\%$ versus $73.8\%$ at 2 hours, $34.4\%$ versus $14.0\%$ at 3 hours, $14.1\%$ versus $27.4\%$ at 4 hours, $0\%$ versus $3.3\%$ at 5 hours. Conculsion: Extracorporeal elimination of phosphamidon is effective by hemoperfusio and hemodialysis in vitro. We suggest hemoperfusion may be effective in organophsphate intoxication patients.

• Journal of Yeungnam Medical Science
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• 제37권3호
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• pp.186-193
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• 2020

Background: Non-tunneled catheters (NTCs) are used for hemodialysis (HD) in many centers in which fluoroscopy is not easily accessed despite high complication rates and conditions requiring long-term HD. Therefore, here we aimed to evaluate the superiority of catheter-related outcomes after the application of tunneled cuffed catheter (TCC) without fluoroscopy versus unconditioned NTC insertion. Methods: We divided the participants into two phases: those receiving NTCs between March 2010 and February 2011 (phase I), and those receiving TCCs or NTCs between March 2011 and February 2012 (phase II). Catheter survival, nurse satisfaction, and reasons for catheter removal were analyzed. Results: Two hundred and sixty patients in phase I and 300 patients in phase II were enrolled in this study. The success rate of TCC insertion was 99.2%. The catheter survival rate in phase I was 65.5% at 1 month, while that in phase II was 74.9% at 1 month (p=0.023). We compared catheter survival between TCCs and NTCs for all periods regardless of phase. The TCC survival rate was higher than the NTC survival rate (p<0.001). Catheter-associated problems led to catheter removal in 97 patients (26.6%) in phase I and 68 patients (18.5%) in phase II (p=0.009). Among 14 HD nurses, all reported being satisfied with manipulation during pre-/post-HD, manupulation during HD, and overall. Eleven HD nurses (78.6%) reported being satisfied with the workload. Conclusion: Compared with unconditional NTC insertion for HD, TCC insertion without fluoroscopy improved the overall catheter survival and nurse satisfaction rates.

• Nutrition Research and Practice
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• 제3권3호
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• pp.247-252
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• 2009

The present study was to investigate the nutritional status and factors related to malnutrition in end-stage renal disease (ESRD) patients requiring hemodialysis (HD) in South Korea. Subjects were ESRD outpatients from general hospitals or HD centers in Seoul referred to the dialysis clinic for maintenance HD care. A total of 110 patients (46 men and 64 women; mean ages $58.6{\pm}1.0y$) were eligible for this study. The family history of chronic renal failure (CRF) was considered positive if a patient reported having either a first-degree or second-degree relative with CRF. Malnutrition was defined as a triceps skinfold thickness or mid-ann muscle circumference below the fifth percentile for age and sex and forty-seven of the 110 patients were malnourished. Almost all (94%) patients had anemia (hemoglobin: <13 g/dL for men and <12 g/dL for women). Energy intake was below the recommended intake levels of energy [30-35 kcal/kg ideal body weight (IBW)] and protein (1.2 g/kg IBW) in 60% of patients. The duration of HD was longer in malnourished HD patients (P=0.0095). Malnutrition was more prevalent in women (P=0.0014), those who never smoked (P=0.0007), nondiabetic patients (P=0.0113), and patients with bone diseases (P=0.0427), adequate HD (spKt/$V{\geq}1.2$) (P=0.0178), and those with a family history of CRF (P=0.0255). Multiple logistic regression was used to examine the relationship between malnutrition and potential risk factors. After adjusting for age, sex, and other putative risk factors for malnutrition, the OR for malnutrition was greater in HD patients with a family history of CRF (OR, 3.290; 95% CI, $1.003{sim}10.793$). Active nutrition monitoring is needed to improve the nutritional status of HD patients. A family history of CRF may be an independent risk factor for malnutrition in Korean HD patients. A follow-up study is needed to investigate whether there is a causal relationship between a family history of CRF and malnutrition in Korean ESRD patients.

• 정신신체의학
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• 제6권1호
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• pp.59-69
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• 1998

Objectives: This research was performed to know severity of depression and anxiety, the psychopathology of hemodialysis patients and kidney transplantation patients using Minneesota Multiphasic Personality Inventory(MMPI) and Zung's Self-rating Depression Scale (SDS), Zung's Self-rating Anxiety Scale(SAS), MMPI Subscales. Methods: We surveyed 31 hemodialysis patients and 119 kidney transplantation patients. 119 kidney transplantation group(KT) was investigated at ; 1) Before kidney transplantation (KT-1), 2) Three days after kidney transplantation(KT-2), 3) Three weeks after kidney transplantation(KT-3),4) Follow up at OPD(F/U). Results: 1) According to dermographic data, mean age was KT 33.1, HD 42.2, Control 33.1 years old and KT, HD were belonged to lower economic states and lower educational level than Control. 2) In the depression scale for SDS, KT-1 was more depressed than F/U and Control but depression scale was significantly decreased at KT-2 in comparison with HD. In the anxiety scale for SAS, KT-1 was more anxious than Control but anxiety scale was not different within IT subgroups and in comparison with HD. 3) In comparison of MMPI scales, Hs, D, Pt, Ma at KT-1, Pd, Pa, Pt, Ma at KT-2, F, D, Pd, Pt, Pa, Sc, Ma at KT-3, Pt at F/U were more high scores than Control.

• Nutrition Research and Practice
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• 제2권4호
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• pp.301-307
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• 2008

This study was aimed to investigate the nutritional status and the role of diabetes mellitus in hemodialysis (HD) patients. Anthropometric, biochemical, and dietary assessments for HD 110 patients (46 males and 64 females) were conducted. Mean body mass index (BMI) was $22.1\;kg/m^2$ and prevalence of underweight (BMI<$18.5\;kg/m^2$) was 12%. The hypoalbuminemia (<3.5 g/dl) was found in 15.5% of the subject, and hypocholesterolemia (<150 mg/dl) in 46.4%. About half (50.9%) patients had anemia (hemoglobin: <11.0 g/dL). High prevalence of hyperphosphatemia (66.4%) and hyperkalemia (43.5%) was also observed. More than 60 percent of subjects were below the recommended intake levels of energy (30-35 kcal/kg IBW) and protein (1.2 g/kg IBW). The proportions of subjects taking less than estimated average requirements for calcium, vitamin $B_1$, vitamin $B_2$, vitamin C, and folate were more than 50%, whereas, about 20% of the subjects were above the recommended intake of phosphorus and potassium. Diabetes mellitus was the main cause of ESRD (45.5%). The diabetic ESRD patients showed higher HMI and less HD adequacy than nondiabetic patients. Diabetic patients also showed lower HDL-cholesterol levels. Diabetic ESRD patients had less energy from fat and a greater percentage of calories from carbohydrates. In conclusion, active nutrition monitoring is needed to improve the nutritional status of HD patients. A follow-up study is needed to document a causal relation between diabetes and its impact on morbidity and mortality in ESRD patients.

• Journal of Nutrition and Health
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• 제36권7호
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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.

• Nutrition Research and Practice
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• 제10권4호
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• pp.404-410
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• 2016

BACKGROUND/OBJECTIVE: Malnutrition and inflammation are reported as the most powerful predictors of mortality and morbidity in hemodialysis (HD) patients. Diet has a key role in modulating inflammation and dietary inflammatory index (DII) is a new tool for assessment of inflammatory potential of diet. The aim of this study was to evaluate the application of DII on dietary intake of HD patients and examine the associations between DII and malnutrition-inflammation markers. SUBJECTS/METHODS: A total of 105 subjects were recruited for this cross-sectional study. Anthropometric measurements, 3-day dietary recall, and pre-dialysis biochemical parameters were recorded for each subject. Subjective global assessment (SGA), which was previously validated for HD patients, and malnutrition inflammation score (MIS) were used for the diagnosis of protein energy wasting. DII was calculated according to average of 3-day dietary recall data. RESULTS: DII showed significant correlation with reliable malnutrition and inflammation indicators including SGA (r = 0.28, P < 0.01), MIS (r = 0.28, P < 0.01), and serum C-reactive protein (CRP) (r = 0.35, P < 0.001) in HD patients. When the study population was divided into three subgroups according to their DII score, significant increasing trends across the tertiles of DII were observed for SGA score (P = 0.035), serum CRP (P = 0.001), dietary energy (P < 0.001), total fat (P < 0.001), saturated fatty acids (P < 0.001), polyunsaturated fatty acids (P = 0.006), and omega-6 fatty acids (P = 0.01) intakes. CONCLUSION: This study shows that DII is a good tool for assessing the overall inflammatory potential of diet in HD patients.

• Clinical Nutrition Research
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• 제12권2호
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• pp.126-137
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• 2023

Hemodialysis (HD) patients face a common problem of malnutrition due to poor appetite. This study aims to verify the appetite alteration model for malnutrition in HD patients through quantitative data and the International Classification of Functioning, Disability, and Health (ICF) framework. This study uses the Mixed Method-Grounded Theory (MMGT) method to explore various factors and processes affecting malnutrition in HD patients, create a suitable treatment model, and validate it systematically by combining qualitative and quantitative data and procedures. The demographics and medical histories of 14 patients were collected. Based on the theory, the research design is based on expansion and confirmation sequence. The usefulness and cut-off points of the creatinine index (CI) guidelines for malnutrition in HD patients were linked to significant categories of GT and the domain of ICF. The retrospective CIs for 3 months revealed patients with 3 different levels of appetite status at nutrition assessment and 2 levels of uremic removal. In the same way, different levels of dry mouth, functional support, self-efficacy, and self-management were analyzed. Poor appetite, degree of dryness, and degree of taste change negatively affected CI, while self-management, uremic removal, functional support, and self-efficacy positively affected CI. This study identified and validated the essential components of appetite alteration in HD patients. These MM-GT methods can guide the selection of outcome measurements and facilitate the perspective of a holistic approach to self-management and intervention.

• Nutrition Research and Practice
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• 제9권2호
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• pp.158-164
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• 2015

BACKGROUND/OBJECTIVES: Vitamin D deficiency is common in hemodialysis patients. The aim of this study was to identify whether or not sun exposure and dietary vitamin D intake have effects on serum 25-hydroxyvitamin D (25(OH)D) status in hemodialysis (HD) patients. The objective was to identify the main determinants of serum vitamin D status in the study subjects. SUBJECTS/METHODS: A cross-sectional study of 47 HD patients (19 males and 28 females) was performed. We assessed serum 25(OH)D and $1,25(OH)_2D$ levels between August and September 2012 and analyzed the prevalence of vitamin D deficiency in HD patients. To evaluate the determinants of serum 25(OH)D levels, we surveyed dietary vitamin D intake, degree of sun exposure, and outdoor activities. To compare biological variables, serum 25(OH)D was stratified as below 15 ng/ml or above 15 ng/ml. RESULTS: Mean 25(OH)D and $1,25(OH)_2D$ levels were $13.5{\pm}5.8ng/ml$ and $20.6{\pm}11.8pg/ml$, respectively. The proportions of serum 25(OH)D deficiency (< 15 ng/ml), insufficiency (15-< 30 ng/ml), and sufficiency (${\geq}30ng/ml$) in subjects were 72.4%, 23.4%, and 4.3%, respectively. Prevalence of vitamin D deficiency in female patients was 78.6%, whereas that in males was 63.2% (P = 0.046). Vitamin D intake and sun exposure time were not significantly different between the two stratified serum 25(OH)D levels. Dietary intake of vitamin D did not contribute to increased serum 25(OH)D levels in HD patients. The main effective factors affecting serum 25(OH)D status were found to be the sun exposure and active outdoor exercise. CONCLUSIONS: Hypovitaminosis D is common in HD patients and is higher in females than in males. Sun exposure is the most important determinant of serum 25(OH)D status in HD patients.