Purpose: This study is to identify how the meaning in life, depression, and social support influences the suicidal ideation of old adult hemodialysis patients. Methods: A cross-sectional design was used. A descriptive correlative study was conducted through an organized and structured self-administrated questionnaire survey for 120 sampled old adult renal dialysis patients. The collected data were analyzed by t-tests, ANOVA, Pearson's correlation coefficient, and multiple linear regression analysis using the Stata 13.0 program. Results: The suicidal ideation of participants was positively correlated with the meaning in life, and social support, and the depression was negatively correlated with the suicidal ideation. Significant factors influencing the suicidal ideation included the meaning in life, depression, social support, age, caregiver, monthly income, and smoking. These factors explained 68% of the variance. Conclusion The depression of old adult hemodialysis patients was a major risk factor that increased suicidal ideation, and the meaning in life and social support was a protective factor that reduced the suicidal ideation. These results suggest that health professionals should provide old adult hemodialysis patients with proper management of suicidal ideation, and depression as well as its meaning in life, and social support.

PURPOSE: Automated peritoneal dialysis (APD) is increasingly used due to freedom from daytime exchanges and flexibility of prescription. In this study, we compared APD with continuous ambulatory peritoneal dialysis (CAPD) to assess the influence of mode of PD on various measures of clinical performance. METHODS: We followed 26 APD patients prospectively over a 12-month period and compared them with 16 CAPD patients in whom examinations of dialysis dose and residual renal function (RRF) at least twice during the 1st one year after dialysis were done. Weekly Kt/V urea (Kt/V) and standard creatinine clearance (SCCr) of PD, and RRF (24hr urine creatinine clearance) were measured at 1st month, 6th month and 12th month after start of dialysis. In addition, serial biochemical tests were analyzed every three months during this period. RESULTS: No statistically significant differences in baseline characteristics, RRF, SCCr and Kt/V were observed between APD and CAPD patients. Serum concentrations of bicarbonate, hemoglobin, and calcium tended to be higher in the APD group and actually serum bicarbonate levels at 9 months, calcium levels at 12 months and hemoglobin levels at 6 and 9 months were significantly higher in APD patients (p<0.05). There was no significant difference in serum sodium concentrations and peritonitis rate between the two groups. CONCLUSION: No significant differences were observed between APD and CAPD in Kt/V, SCCr and RRF for one year after start of PD. APD, however, may be advantageous in improving several biochemical markers such as blood levels of hemoglobin, bicarbonate, and calcium compared to CAPD.
Biochemistry ; Biomarkers ; Calcium ; Creatinine ; Dialysis ; Diphosphonates ; Freedom ; Hemoglobins ; Humans ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Pliability ; Prescriptions ; Prospective Studies ; Sodium ; Urea

PURPOSE: The purpose of this study is to evaluate the costs and benefits of individual home visiting health care using secondary data and literature review. METHODS: The total number of subjects was 1,008,837. A specific program was classified into disease management, care of infant, child and women, or elderly care. The costs and effects of a program were identified from a societal perspective, and the effects were converted into monetary terms or benefits. The total cost was calculated in the way that medical expenses, travel costs and productivity losses were offset by the decrease in benefits and thus only the program budget was included in the total cost. RESULTS: The total program cost was 47.6 billion won per year and the total annual benefit was estimated at 435.6 billion won. The benefits of arthritis management were the biggest among disease management programs. The net benefit was 388.0 billion won per year and the benefit/cost ratio was 9.16. CONCLUSION: Home visiting health care was validated to be economically effective. It made a positive contribution to improving the health status of vulnerable populations and reducing medical expenses. These results suggest that home visiting care should be extended more broadly to vulnerable populations.
Aged ; Arthritis ; Budgets ; Child ; Cost-Benefit Analysis* ; Delivery of Health Care* ; Disease Management ; Efficiency ; Female ; House Calls* ; Humans ; Infant ; Vulnerable Populations

This is the first reported case of a kidney transplant patient in Korea who developed cytomegalovirus and Nocardia pulmonary coinfection simultaneously with cytomegalovirus nephropathy. The patient had a history of end stage renal disease on peritoneal dialysis, diabetes mellitus and pulmonary tuberculosis. He underwent unrelated living kidney transplantation in China. About 5 months after transplantation, he developed high fever and rising serum creatinine for which he was admitted to hospital. Chest CT revealed consolidation in the left upper lung field and lung biopsy showed CMV infected bronchiolitis obliterans with organizing pneumonia. Culture of lung biopsy tissue grew Nocardia farcinica. In addition, he was found to have CMV infection in kidney tissue with positive CMV antigen assay of blood. This case emphasizes that CMV infection, through its effect on systemic immunity, may increase the risk of other opportunistic infection.
Biopsy ; Bronchiolitis Obliterans ; China ; Coinfection ; Creatinine ; Cytomegalovirus ; Diabetes Mellitus ; Fever ; Humans ; Kidney ; Kidney Failure, Chronic ; Kidney Transplantation ; Korea ; Lung ; Nocardia ; Opportunistic Infections ; Peritoneal Dialysis ; Pneumonia ; Thorax ; Transplants ; Tuberculosis, Pulmonary

PURPOSE: Disturbances of mineral metabolism are common during the course of chronic kidney disease (CKD) and may lead to serious and debilitating complications unless properly treated. The purpose of this study is to quantify the prevalence of secondary hyperparathyroidism and vitamin D deficiency in non-dialysed chronic kidney disease 3, 4, and 5 in Korea. METHODS: This study included patients who had documented eGFR<60 mL/min/1.73m2 and non-dialysed and had not received any vitamin D compounds. eGFR was calculated by simplified MDRD (Modification of Diet in Renal Disease study) equation. Blood samples were collected for serum creatinine, calcium, phosphate, intact PTH and vitamin D metabolites between May 2006 and April 2007. RESULTS: According to K/DOQI guideline, the prevalence of hyperparathyroidism was 46.9% (15/32) in stage 3 (iPTH>70 pg/mL),45.9% (17/37) in stage 4 (iPTH>110 pg/mL) and 20.5% (9/44) in stage 5 patients (iPTH>300 pg/mL). The prevalence of 25-hydroxyvitamin D deficiency (25(OH)D3<15 ng/mL) was 86.2% (25/29) in stage 3, 75.7% (28/37) in stage 4 and 88.4% (38/43) in stage 5. There was a negative correlation between eGFR and intact PTH (r=-0.531, p=0.000) and a positive correlation between eGFR and 1,25-dihydroxyvitamin D (r=0.587, p=0.000). Conclusions: So far as non-dialysed CKD patients in Korea are concerned, quantification of the prevalence of abnormality of intact PTH and vitamin D deficiency has been described in this study. More research should be conducted in the future in a prospective, multi-center community cohort study, of which subjects include the early stages like CKD 1 and 2.
Calcium ; Cohort Studies ; Creatinine ; Diet ; Glomerular Filtration Rate ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Secondary ; Kidney Failure, Chronic ; Korea ; Parathyroid Hormone ; Prevalence ; Renal Insufficiency, Chronic ; Vitamin D ; Vitamin D Deficiency ; Vitamins

PURPOSE: Homeless patients usually live outside and are therefore frequently exposed to injury and tetanus infection. Thus, after visits to an emergency department (ED) due to injury, homeless patients need to be vaccinated for the prevention of tetanus infection with tetanus immunoglobulin regardless of tetanus antibody titer or previous vaccination history. Because the exact history of previous tetanus vaccination in homeless patients is unclear, the tetanus antibody titer between homeless patients and general patients was assessed. METHODS: Subjects who visited the ED after injury from October 2008 to February 2010 were enrolled. All participants answered questions on age, gender, previous vaccination or prophylaxis history, and military service. The Tetanus Immunoglobulin G ELISA (Enzyme-linked immunosorbent assay) method was used for the analysis of serum samples. Propensity score-matched analysis was used to control for age, gender, previous vaccination or prophylaxis history, and military service. RESULTS: A total of 1325 samples were analyzed. There was 83 samples from homeless patients and 1242 samples from general patients. After matched analysis using the propensity score, 56 subjects were matched. The geometric mean titer of tetanus antibody was 0.204+/-0.392 IU/mL in homeless patients and 0.105+/-0.143 IU/mL in general patients (p=0.078). The proportion of patients with a safe tetanus antibody titer was 66.1 percent of homeless patients and 23.2 percent of general patients (p<0.001). CONCLUSION: Homeless patients had a higher mean titer and a statistically higher proportion had a safe titer compared to general patients.
Emergencies ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoglobulin G ; Immunoglobulins ; Methods ; Military Personnel ; Propensity Score ; Tetanus* ; Vaccination

PURPOSE: Homeless patients usually live outside and are therefore frequently exposed to injury and tetanus infection. Thus, after visits to an emergency department (ED) due to injury, homeless patients need to be vaccinated for the prevention of tetanus infection with tetanus immunoglobulin regardless of tetanus antibody titer or previous vaccination history. Because the exact history of previous tetanus vaccination in homeless patients is unclear, the tetanus antibody titer between homeless patients and general patients was assessed. METHODS: Subjects who visited the ED after injury from October 2008 to February 2010 were enrolled. All participants answered questions on age, gender, previous vaccination or prophylaxis history, and military service. The Tetanus Immunoglobulin G ELISA (Enzyme-linked immunosorbent assay) method was used for the analysis of serum samples. Propensity score-matched analysis was used to control for age, gender, previous vaccination or prophylaxis history, and military service. RESULTS: A total of 1325 samples were analyzed. There was 83 samples from homeless patients and 1242 samples from general patients. After matched analysis using the propensity score, 56 subjects were matched. The geometric mean titer of tetanus antibody was 0.204+/-0.392 IU/mL in homeless patients and 0.105+/-0.143 IU/mL in general patients (p=0.078). The proportion of patients with a safe tetanus antibody titer was 66.1 percent of homeless patients and 23.2 percent of general patients (p<0.001). CONCLUSION: Homeless patients had a higher mean titer and a statistically higher proportion had a safe titer compared to general patients.
Emergencies ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunoglobulin G ; Immunoglobulins ; Methods ; Military Personnel ; Propensity Score ; Tetanus* ; Vaccination

Purpose: This secondary data analysis study evaluated the effects of ICT enhanced home-visit nursing in long-term care insurance on health-related quality of life among community-dwelling older adults. Methods: This study included data of 131 older adults who had experienced a pilot service for ICT enhanced home-visit nursing. ICT enhanced home-visit nursing refers to a method of sharing health records and teleconference between a visiting nurse and a doctor during the home-visit nursing services to community-dwelling older adults. Health-related quality of life and influencing factors were analyzed by t-tests, logistic regression analysis using the Stata 17/SE program. Results: After a pilot service for ICT enhanced home-visit nursing, their health-related quality of life increased. The teleconferencing method had a significant effect on the increase in health-related quality of life. Conclusion The findings indicate a pilot service for ICT enhanced home-visit nursing can be applied to the domestic community-based healthcare service model in terms of health management. In the future, the advanced service model of a pilot service for ICT enhanced home-visit nursing in which subjects conduct detailed for each health problem, and a well-designed evaluation system should be developed.

Background and Objectives: Previous studies have reported an association between impaired renal function and poor outcomes after radiofrequency catheter ablation in patients with atrial fibrillation (AF). However, outcomes of cryoballoon ablation (CBA) in patients with renal insufficiency are not fully elucidated. This study aimed to compare outcomes of CBA in AF patients with chronic kidney disease (CKD) versus those without CKD and to assess changes in renal function over 12 months following CBA. Methods: A total of 839 patients (65.1% with non-paroxysmal AF [PAF]) who underwent de novo CBA were prospectively enrolled. We divided patients into two groups based on creatinine clearance rate (CCr) and performed intracardiac echocardiography (ICE)-guided contrast agent-free CBA. Results: In comparison with patients without CKD (CCr >50, n=722), those with CKD (CCr ≤50, n=117) were older and predominantly female, had a lower body mass index, and showed a higher prevalence of heart failure and hypertension. Mean CHA 2 DS 2 -VAS score was significantly higher in CKD group than in non-CKD group. Procedure-related complications were not significantly different between two groups. During a mean follow-up period of 25.4±11.9 months, clinical recurrence occurred in 182 patients (21.7%) and not significantly different between two groups. In multivariate analysis, non-PAF and left atrial size were independent predictors of AF recurrence. CCr levels significantly improved over 12 months after CBA in CKD group. Conclusions ICE-guided contrast-agent-free CBA showed comparable long-term clinical outcomes without increasing procedure-related complications and improvement of renal function over 12 months following CBA in AF patients with CKD.

Background and Objectives: Previous studies have reported an association between impaired renal function and poor outcomes after radiofrequency catheter ablation in patients with atrial fibrillation (AF). However, outcomes of cryoballoon ablation (CBA) in patients with renal insufficiency are not fully elucidated. This study aimed to compare outcomes of CBA in AF patients with chronic kidney disease (CKD) versus those without CKD and to assess changes in renal function over 12 months following CBA. Methods: A total of 839 patients (65.1% with non-paroxysmal AF [PAF]) who underwent de novo CBA were prospectively enrolled. We divided patients into two groups based on creatinine clearance rate (CCr) and performed intracardiac echocardiography (ICE)-guided contrast agent-free CBA. Results: In comparison with patients without CKD (CCr >50, n=722), those with CKD (CCr ≤50, n=117) were older and predominantly female, had a lower body mass index, and showed a higher prevalence of heart failure and hypertension. Mean CHA 2 DS 2 -VAS score was significantly higher in CKD group than in non-CKD group. Procedure-related complications were not significantly different between two groups. During a mean follow-up period of 25.4±11.9 months, clinical recurrence occurred in 182 patients (21.7%) and not significantly different between two groups. In multivariate analysis, non-PAF and left atrial size were independent predictors of AF recurrence. CCr levels significantly improved over 12 months after CBA in CKD group. Conclusions ICE-guided contrast-agent-free CBA showed comparable long-term clinical outcomes without increasing procedure-related complications and improvement of renal function over 12 months following CBA in AF patients with CKD.