Objective To describe the status of hope,self-efficacy,and self-management in patients with chronic kidney disease(CKD)(stages 1-3)and to explore the interactions between these three variables.Methods Herth Hope Index,self-efficacy scale,and CKD self-management instrument were used to evaluate the patients with CKD(stages 1-3)in PUMC Hospital(=153). Structural equation modeling was used to establish the structural equation model of hope,self-efficacy,and self-management.Results The median score of hope was 40.0(36.0,44.5),and 85.0% of patients were in higher level of hope. The median score of self-efficacy was 8.3(7.1,9.4)and the overall score of self-management was 89.0±13.4. There were no significant differences in level of hope and self-management among patients with different age,gender,marital status,educational level,course of disease,and CKD stages(all >0.05). Age and marriage status were significantly associated with self-efficacy. Self-efficacy was significantly higher in >65 years group than in other age groups(<0.05)and was significantly higher in married group than in single group(<0.05).The level of hope had direct effect on self-efficacy(=0.67,<0.05)and self-management(=0.46,<0.05).Conclusions The levels of hope,self-efficacy,and self-management are high in patients with CKD(stages 1-3). Hope directly affects the self-efficacy and self-management of these patients.
Hope ; Humans ; Renal Insufficiency, Chronic ; psychology ; therapy ; Self Efficacy ; Self-Management

This review article is intended to show and understand psychosocial factors in patients with chronic kidney disease (CKD) including end-stage renal disease (ESRD) on renal replacement therapy. These patients suffered from many psychosocial factors such as depression, sleep disorder, and chronic pain, etc. The prevalence of major depression or a defined psychiatric illness in ESRD patients is not clearly defined, but is roughly estimated between 5% and 50%. Unfortunately many sufferers do not seek treatment, and of those who do, significant numbers are improperly diagnosed or are not appropriately treated. They should be managed by psychiatric medication and interview, because depression could affect medical outcomes in ESRD patients through several mechanisms. Sleep disorders are common in ESRD patients treated with dialysis and are associated with patients' perceptions of quality of life, assessed by diverse measures, as well as depressive mood. Although pain has been considered as a problem for ESRD patients for more than 20 years, few studies exist on this subject. Pain appears to be an undervalued problem for ESRD patients. These psychosocial factors could affect morbidity, mortality and life quality in CKD and ESRD patients. The physicians, especially managing CKD patients, need to consider these factors.
Chronic Pain ; Depression ; Dialysis ; Dyssomnias ; Humans ; Kidney Failure, Chronic ; Mortality ; Prevalence ; Psychology* ; Quality of Life ; Renal Insufficiency, Chronic* ; Renal Replacement Therapy ; Sleep Wake Disorders

BACKGROUND AND OBJECTIVES: The sense of smell plays an important role in the quality of life. Loss of smell is common in the elderly and it results from respiratory diseases, certain disease states (Alzheimer disease, chronic renal failure (CRF), multiple sclerosis), medications, and surgical interventions. Many studies have shown a declining odor perception in the CRF patients. The objectives of the present study were to test odor identification ability in patients with CRF and the effect of hemodialysis on olfactory recognition, and to examine the possible correlations between smell identification test score and various clinical parameters. MATERIALS AND METHOD: We performed a case-control study comparing the Cross- Cultural Smell Identification Test (CC-SIT) scores of CRF patients with hemodialysis, and those without hemodialysis, and age-sex matched healthy controls. RESULTS: Healthy controls had significantly high CC-SIT scores compared to those of CRF patients without hemodialysis. No significant differences were observed in the CC-SIT scores between CRF patients with hemodialysis and healthy controls and in CRF patients before and after the hemodialysis session. No significant positive correlation was found between CC-SIT score and creatinine clearance in the dialysis group. CONCLUSION: Acute removal of uremic toxins by hemodialysis does not correct olfactory disturbances. Odor perception is severly impaired in patients with CRF and is related to the degree of renal impairment.
Aged ; Case-Control Studies ; Creatinine ; Dialysis ; Humans ; Identification (Psychology) ; Kidney ; Kidney Failure, Chronic* ; Odors ; Quality of Life ; Renal Dialysis* ; Renal Insufficiency, Chronic ; Smell

PURPOSE: Chronic kidney disease (CKD) is a condition characterized by the gradual loss of kidney function over time. Self-management programs have been widely applied to chronic disease education programs, which are designed to delay deteriorating kidney functions, preclude depression, and improve quality of life. This study aims to analyze effectiveness of self-management programs in bettering CKD patients' eGFR, mitigating depression symptoms and improving quality of life in randomized control or clinical trials. METHODS: Using key terms, a search was conducted in English-language, peer-reviewed journals on CKD that were published between 2002 and 2014 on databases including CINAHL, Cochrane Library, MEDLINE. The measurable variables included CKD patients' eGFR, depression, and quality of life. Random and fixed effects meta analysis were applied with standard error and correlation based measure of effect size. RESULTS: Eight studies met the inclusion criteria. A self-management program significantly impacted CKD patients' depression and mental quality-of-life dimensions, with an effect size of .29 [95% confidence interval (CI) (0.07, 0.53)] and −.42 [95% CI (−0.75, −0.10)]. However, the intervention of a self-management program had no significant effect on patients' eGFR as well as physical quality-of-life dimensions, with effect sizes of .06 [95% CI (−0.69, 0.81)] and −.16 [95% CI (−0.81, 0.50)]. CONCLUSIONS: Self-management programs of patients with chronic kidney disease can improve the depression and mental quality of life. Aside from providing more objective evidence-based results, this study provides a reference for clinical health care personnel who tend to patients with CKD.
Cognitive Therapy/methods ; Depressive Disorder/*etiology/therapy ; Glomerular Filtration Rate/*physiology ; Humans ; *Quality of Life ; Randomized Controlled Trials as Topic ; Renal Insufficiency, Chronic/physiopathology/psychology/*therapy ; Self Care/*methods

PURPOSE: Metabolic syndrome (MS) has been identified as a causal risk factor for cardiovascular disease, stroke, and cardiovascular mortality. Recent studies have suggested a possible relation between MS and renal function. The aim of this study was to evaluate the influence of MS on renal function. MATERIALS AND METHODS: We analyzed 12,348 healthy Koreans who underwent a general health checkup. MS was defined as 3 or more of the criteria according to the National Cholesterol Education Program Adult Treatment Panel guidelines III (NCEP ATP III). The glomerular filtration rate (GFR) was estimated by the redefined Modification of Diet in Renal Disease formula. Chronic kidney disease (CKD) was categorized into 3 categories according to the Kidney Disease: Improving Global Outcomes guidelines; I: GFR> or =90 ml/min, II: 60-89 ml/min, III: 30-59 ml/min. RESULTS: The overall proportion with MS was 19.3%. Compared with populations without MS, those with MS showed a significantly decreased GFR. The prevalence of CKD increased with the number of MS components, and it was prominent in the group of males over 40 years of age. In multivariate analyses using age, sex, and individual MS components, age (odds ratio [OR]=20.40; 95% CI: 10.81-38.49), sex (OR=1.98; 95% CI: 1.51-2.60), and obesity (OR=1.48; 95% CI: 1.13-1.93) were strongly associated with CKD. CONCLUSIONS: This study showed that MS is a significant determinant of CKD. Handling of correctable factors such as obesity may be considered one of the preventive modalities against the development of CKD.
Adenosine Triphosphate ; Adult ; Cardiovascular Diseases ; Cholesterol ; Diet ; Glomerular Filtration Rate ; Handling (Psychology) ; Humans ; Kidney ; Male ; Multivariate Analysis ; Obesity ; Prevalence ; Renal Insufficiency, Chronic ; Risk Factors ; Stroke

Resistant hypertension is defined as when the blood pressure cannot be reduced to below 140/90 mmHg in patients who are adhering to an adequate and appropriate triple drug regimen that includes a diuretic, in near full doses. Before changing or increasing the antihypertensive medication, several factors should be checked. A careful evaluation of the patient's adherence to therapy and adequate measurement of blood pressure are needed to exclude pseudoresistance secondary to poor medical adherence or white coat hypertension. Patients should be asked regularly about medications or substances that could interfere with blood pressure control. Successful treatment requires the identification of causes and a reversal of life style factors contributing to treatment resistance. Diabetes, chronic kidney disease, nonsteroidal anti-inflammatory drugs, high salt intake, obesity, and alcohol abuse are frequent causes of uncontrolled hypertension in Korea. The diagnosis and appropriate treatment of secondary hypertension is also needed. When multiple medications are used, vasodilators are the most commonly used antihypertensive drugs that cause subsequent fluid retention or sympathetic tone elevation. Adequate, effective, and sufficient diuresis and catecholamine suppression are needed for patients who do not respond to several vasodilators.
Alcoholism ; Antihypertensive Agents ; Blood Pressure ; Diuresis ; Humans ; Hypertension ; Korea ; Life Style ; Obesity ; Renal Insufficiency, Chronic ; Retention (Psychology) ; Vasodilator Agents ; White Coat Hypertension

PURPOSE: Indoxyl sulfate and p-cresyl sulfate are important protein-bound uremic retention solutes whose levels can be partially reduced by renal replacement therapy. These solutes originate from intestinal bacterial protein fermentation and are associated with cardiovascular outcomes and chronic kidney disease progression. The aims of this study were to investigate the levels of indoxyl sulfate and p-cresyl sulfate as well as the effect of probiotics on reducing the levels of uremic toxins in pediatric patients on dialysis. METHODS: We enrolled 20 pediatric patients undergoing chronic dialysis; 16 patients completed the study. The patients underwent a 12-week regimen of VSL#3, a high-concentration probiotic preparation, and the serum levels of indoxyl sulfate and p-cresyl sulfate were measured before treatment and at 4, 8, and 12 weeks after the regimen by using fluorescence liquid chromatography. To assess the normal range of indoxyl sulfate and p-cresyl sulfate we enrolled the 16 children with normal glomerular filtration rate who had visited an outpatient clinic for asymptomatic microscopic hematuria that had been detected by a school screening in August 2011. RESULTS: The baseline serum levels of indoxyl sulfate and p-cresyl sulfate in the patients on chronic dialysis were significantly higher than those in the children with microscopic hematuria. The baseline serum levels of p-cresyl sulfate in the peritoneal dialysis group were significantly higher than those in the hemodialysis group. There were no significant changes in the levels of these uremic solutes after 12-week VSL#3 treatment in the patients on chronic dialysis. CONCLUSION: The levels of the uremic toxins p-cresyl sulfate and indoxyl sulfate are highly elevated in pediatric patients on dialysis, but there was no significant effect by probiotics on the reduction of uremic toxins in pediatric dialysis patients. Therefore, studies for other medical intervention to reduce uremic toxins are also necessary in pediatric patients on dialysis.
Ambulatory Care Facilities ; Bacterial Proteins ; Child ; Chromatography, Liquid ; Dialysis ; Fermentation ; Fluorescence ; Glomerular Filtration Rate ; Hematuria ; Humans ; Indican ; Indoles ; Mass Screening ; Peritoneal Dialysis ; Probiotics ; Reference Values ; Renal Dialysis ; Renal Insufficiency, Chronic ; Renal Replacement Therapy ; Retention (Psychology)

Coexisting end stage liver disease (ESLD) and end stage renal disease (ESRD) for a patient on dialysis is a standard indication for a combined liver-kidney transplantation (CLKT). A survival advantage after CLKT has been verified in liver transplant candidates with significant kidney dysfunction due to chronic kidney disease (CKD) or acute kidney injury (AKI). The severity (glomerular filtration rate (GFR) < or =30 mL/min) and duration (more than 8~12 weeks) of kidney dysfunction are strong determinants for the selection of CLKT candidates. The CLKT patient survival rate is superior to that of liver transplant alone in candidates with a serum creatinine >2.0 mg/dL or who are on dialysis. Because of the immunological modulation effect of the liver graft, post-transplant CLTX results in a lower incidence of acute rejection and higher long-term censored graft survival rate in kidney transplant recipients. Despite the advantages of CLKT, the CLKT waiting list is extremely rare in Korea (0.80%, 67/3,717, from recent Korean Network for Organ Sharing (KONOS) data on March 2010). The narrow indications for CLKT (only ESRD candidates on dialysis are accepted for CLKT) and inferior ranking of CLKT for kidney allocation is a pitfall of the multi-organ allocation rule in KONOS.
Acute Kidney Injury ; Creatinine ; Dialysis ; End Stage Liver Disease ; Filtration ; Graft Survival ; Humans ; Imidazoles ; Incidence ; Kidney ; Kidney Failure, Chronic ; Korea ; Liver ; Nitro Compounds ; Rejection (Psychology) ; Renal Insufficiency, Chronic ; Survival Rate ; Transplants ; Waiting Lists

OBJECTIVE: To study the differences in the pregnancy outcomes of severe preeclampsia before 32 weeks of gestation in relation to the latency between admission and delivery. METHODS: We reviewed medical records of 89 pregnant women who were managed in Samsung Medical Center because of severe preeclampsia before 32 weeks of gestation between January 1996 and February 2004. We studied the differences in the management and the neonatal outcomes between the immediate delivery group (admission to delivery < or =2 days) and the expectant management group (admission to delivery>2 days). We excluded maternal renal disease, chronic hypertension, multiple pregnancies, diabetes and placenta previa from this study. RESULTS: 40 women were included in the immediate delivery group and 49 women in the expectant management group. Antenatal corticosteroid was given pregnant women in the expectant management group (89.8% vs. 52.5%, p<0.0001). There was no significant difference in the occurrence of small for gestational age- and prematurity-related complications including neonatal mortality. There was significantly less respiratory distress syndrome in the expectant management group (46.9% vs. 62.5%, p=0.0315). However this difference disappeared when the adjustment was made to the gestational age at delivery (p=0.223). CONCLUSION: The latency period does not seem to alter the neonatal prognosis in severe preeclampsia before 32 weeks of gestation but the gestational age at the delivery, a reflection of the severity of the preeclampsia, seems to be the single most important factor for the occurrence of neonatal respiratory distress syndrome.
Female ; Gestational Age ; Humans ; Hypertension ; Infant ; Infant Mortality ; Latency Period (Psychology) ; Medical Records ; Placenta Previa ; Pre-Eclampsia* ; Pregnancy Outcome ; Pregnancy* ; Pregnancy, Multiple ; Pregnant Women ; Prognosis ; Renal Insufficiency, Chronic ; Respiratory Distress Syndrome, Newborn

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common inherited kidney diseases and a frequent cause of end-stage renal failure. Generally accepted indications of nephrectomy in ADPKD cases are recurrent pyelonephritis, cyst hemorrhage, pain refractory to medical management and massively enlarged kidneys. Although pretransplant nephrectomy has been applied in these patients, evidence of the benefits of this strategy is lacking. METHODS: ADPKD patients transplanted from cadaveric or living donors were reviewed retrospectively regard to posttransplant complications and outcomes. We compared operative time, hospital day, serum creatinine at discharge and at 1year after transplantation, complication, rejection and graft loss. RESULTS: Between February 1995 and March 2008, 24 patients with end stage ADPKD received kidney transplantation at our hospital. 14 patients underwent simultaneous bilateral nephrectomy (Group I), 10 patients underwent pretransplant sequential nephrectomy (Group II). The mean operative time was 5.87+/-1.17, 9.52+/-2.67 hours in Group I and II, respectively (P=0.001). The mean hospital stay was different between Group I and II at 20.8+/-6.0, 42.8+/-17.6 days, respectively (P<0.001). Overall posttransplant complications were more frequent in the sequential nephrectomy (43% vs 80%); however, the difference was not statistically significant. Also about rejection, graft loss, there are no statistically significant differences. CONCLUSIONS: Our data imply that there is no higher morbidity or mortality when performing simultaneous bilateral nephrectomy during renal transplantation in patients with renal failure due to ADPKD. Therefore if bilateral nephrectomy is performed as an adjunct to transplantation, it is tolerable to be done at the same time as renal grafting.
Cadaver ; Creatinine ; Graft Rejection ; Hemorrhage ; Humans ; Kidney ; Kidney Diseases ; Kidney Failure, Chronic ; Kidney Transplantation ; Length of Stay ; Living Donors ; Nephrectomy ; Operative Time ; Polycystic Kidney, Autosomal Dominant ; Pyelonephritis ; Rejection (Psychology) ; Renal Insufficiency ; Retrospective Studies ; Transplants