1.Clinical Usefulness of Bioimpedance for Tailored Therapy in Hemodialysis Patients.
Wookyung CHUNG ; Ho Jun CHIN ; Sejoong KIM
Korean Journal of Nephrology 2011;30(6):573-574
No abstract available.
Humans
;
Renal Dialysis
2.Atherosclerotic Renovascular Hypertension : Lessons from Recent Clinical Studies.
Electrolytes & Blood Pressure 2010;8(2):87-91
Atherosclerotic renovascular hypertension is a form of secondary hypertension due to renal artery stenosis. After the introduction of medical therapy such as with statins and angiotensin blocking agents, it has been considered a very slowly progressive disease. In the 1990s, surgical methods were compared to radiological intervention and showed no additional benefits. Recent clinical data also demonstrate that in cases of relatively stable atherosclerotic renovascular disease, medical therapy is as effective as other interventions with regard to patient outcomes. In this paper the recent clinical outcomes are reviewed.
Angiotensins
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Atherosclerosis
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Humans
;
Hypertension
;
Hypertension, Renovascular
;
Renal Artery Obstruction
3.Vitamin D, and Kidney Disease.
Hyung Soo KIM ; Wookyung CHUNG ; Sejoong KIM
Electrolytes & Blood Pressure 2011;9(1):1-6
Mineral metabolism abnormalities, such as low 1,25-dihydroxyvitamin D (1,25(OH)2D) and elevated parathyroid hormone (PTH), are common at even higher glomerular filtration rate than previously described. Levels of 25-hydroxyvitamin D (25(OH)D) show an inverse correlation with those of intact PTH and phosphorus. Studies of the general population found much higher all-cause and cardiovascular (CV) mortality for patients with lower levels of vitamin D; this finding suggests that low 25(OH)D level is a risk factor and predictive of CV events in patients without chronic kidney disease (CKD). 25(OH)D/1,25(OH)2D becomes deficient with progression of CKD. Additionally, studies of dialysis patients have found an association of vitamin D deficiency with increased mortality. Restoration of the physiology of vitamin D receptor activation should be essential therapy for CKD patients.
Dialysis
;
Glomerular Filtration Rate
;
Humans
;
Kidney
;
Kidney Diseases
;
Parathyroid Hormone
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Phosphorus
;
Receptors, Calcitriol
;
Renal Insufficiency, Chronic
;
Risk Factors
;
Vitamin D
;
Vitamin D Deficiency
;
Vitamins
4.De Novo Hypokalemia in Incident Peritoneal Dialysis Patients: A 1-Year Observational Study.
Ji Yong JUNG ; Jae Hyun CHANG ; Hyun Hee LEE ; Wookyung CHUNG ; Sejoong KIM
Electrolytes & Blood Pressure 2009;7(2):73-78
Hypokalemia occurs frequently in patients undergoing peritoneal dialysis (PD). However, the therapeutic strategy may differ from that of non-PD-related hypokalemia. We investigated clinical features and related factors of de novo hypokalemia in incident PD patients. We retrospectively enrolled 82 normokalemic patients starting PD at Gachon University Gil Hospital, Korea. The patients were divided into hypokalemia (K+<3.5 mEq/L) and normokalemia (3.5 mEq/L< or =K+<5.5 mEq/L) groups based on the plasma potassium levels at month 13, and then clinical parameters including peritoneal function and adequacy tests and biochemical parameters were compared. Eight patients who showed hyperkalemia (K+> or =5.5 mEq/L) at month 13 were excluded from our analyses. The incidence of hypokalemia in PD patients was 7.3% in a year. The de novo hypokalemia (n=6) and normokalemia (n=68) groups had no significant differences in baseline characteristics. The serum albumin levels and normalized protein equivalent of nitrogen appearance (nPNA) at month 1 were not significantly different between the two groups. At month 13, on the other hand, serum albumin levels and nPNA were significantly lower in the hypokalemia group (P=0.014; P=0.006, respectively). Kt/Vurea, residual renal function, dialysate-peritoneal creatinine ratio, and glucose load were not significantly different between the two groups. Hypokalemia occurring after initiation of PD may largely be associated with poor nutritional status.
Creatinine
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Glucose
;
Hand
;
Humans
;
Hyperkalemia
;
Hypokalemia
;
Incidence
;
Korea
;
Nitrogen
;
Nutritional Status
;
Peritoneal Dialysis
;
Plasma
;
Potassium
;
Retrospective Studies
;
Serum Albumin
5.Adipsic Hypernatremia after Clipping of a Ruptured Aneurysm in the Anterior Communicating Artery:A Case Report
Won Ki KIM ; Taeho LEE ; Ae Jin KIM ; Han RO ; Jae Hyun CHANG ; Hyun Hee LEE ; Wookyung CHUNG ; Ji Young JUNG
Electrolytes & Blood Pressure 2021;19(2):56-60
Adipsia is a rare disorder that occurs due to damage to the osmoreceptor and not feeling thirst despite hyperosmolality. Adipsic hypernatremia can occur when there is damage to the anterior communicating artery that supplies blood to osmoreceptors, and the level of arginine vasopressin secretion varies widely. A 37-year-old woman, suffering from severe headache, was consulted to the nephrology department for hypernatremia and polyuria after clipping of a ruptured aneurysm in the anterior communicating artery. Despite her hypernatremic hyperosmolar state, she denied thirst and did not drink spontaneously. She was diagnosed adipsic hypernatremia by evaluating the osmoregulatory and baroregulatory function tests.Because adipsic hypernatremia is caused by not enough drinking water even for hyperosmolality due to the lack of thirst stimulus, the strategies of treatment are that setting the target body weight when serum osmolality is normal and have the patient drink water until patient reach the target body weight. Adipsic hypernatremia should be considered to be a rare complication of subarachnoid hemorrhage associated with an anterior communicating artery aneurysm.
6.Serum calcification propensity and its association with biochemical parameters and bone mineral density in hemodialysis patients
Hyunsook KIM ; Ae Jin KIM ; Han RO ; Jae Hyun CHANG ; Hyun Hee LEE ; Wookyung CHUNG ; Ji Yong JUNG
Kidney Research and Clinical Practice 2023;42(2):262-271
T50 is a novel serum-based marker that assesses the propensity for calcification in serum. A shorter T50 indicates a greater propensity to calcify and has been associated with cardiovascular disease and mortality among patients with chronic kidney disease. The factors associated with T50 and the correlation between T50 and bone mineral density (BMD) are unknown in hemodialysis (HD) patients. Methods: This cross-sectional study included 184 patients undergoing HD. Individuals were grouped into tertiles of T50 to compare the demographic and disease indicators of the tertiles. Linear regression was used to evaluate the association between T50 and hip and spinal BMD in a multivariate model. Results: Mineral and inflammatory parameters, including serum phosphate (r = –0.156, p = 0.04), albumin (r = 0.289, p < 0.001), and high-sensitivity C-reactive protein (r = –0.224, p = 0.003) levels, were associated with T50. We found a weak association between T50 and BMD in the total hip area in the unadjusted model (β = 0.030, p = 0.04) but did not find a statistically significant association with the total hip (β = 0.017, p = 0.12), femoral neck (β = –0.001, p = 0.96), or spinal BMD (β = 0.019, p = 0.33) in multivariable-adjusted models. Conclusion: T50 was moderately associated with mineral and inflammatory parameters but did not conclusively establish an association with BMD in HD patients. Broad-scale future studies should determine whether T50 can provide insights into BMD beyond traditional risk factors in this population.
7.De novo Hyponatremia in Patients Undergoing Peritoneal Dialysis: A 12-month Observational Study.
Hyun Hee LEE ; Soo Jung CHOI ; Heon Nam LEE ; Sun Young NA ; Jae Hyun CHANG ; Wookyung CHUNG ; Sejoong KIM
Korean Journal of Nephrology 2010;29(1):31-37
PURPOSE: Hyponatremia occurs infrequently in patients undergoing peritoneal dialysis (PD). Nevertheless, one must understand its pathophysiology, since the therapeutic strategy differs from that of non- PD-related hyponatremia. This study examined the clinical features of hyponatremia in PD and evaluated the factors that may contribute to its development. METHODS: We retrospectively enrolled 51 normonatremic PD patients at Gachon University Gil Hospital, South Korea. Using the plasma sodium levels at month 13, the patients were divided into hyponatremia (Na+ <135 mEq/L) and normonatremia (Na+ > or = 135 mEq/L) groups. Then, the clinical variables of these patients were examined, including peritoneal function and adequacy tests, and biochemical parameters. RESULTS: The de novo hyponatremia (n=8) and normonatremia (n=43) groups had no significant differences in baseline characteristics. At month 1, the serum albumin was lower in the hyponatremia group (p=0.022). In the peritoneal equilibration test analysis, the dialysate-to-plasma ratio for creatinine (D/ P(Cr)) measured after 13 months differed significantly between the two groups (p=0.007), while the maximum dip in sodium did not differ. No significant differences were observed in the normalized protein equivalent of nitrogen appearance, Kt/V, or residual renal function. CONCLUSION: Our data suggest that the development of hyponatremia is associated with a lower initial serum albumin level and increased D/P(Cr) in patients undergoing PD. Therefore, the serum sodium levels should be monitored more carefully in these patients.
Creatinine
;
Humans
;
Hyponatremia
;
Nitrogen
;
Peritoneal Dialysis
;
Plasma
;
Republic of Korea
;
Retrospective Studies
;
Serum Albumin
;
Sodium
8.Volume Control by Using the Body Composition Monitor in a Puerperal Patient on Hemodialysis.
Wookyung CHUNG ; Shung Han CHOI ; Jiyoon SUNG ; Eul Sik JUNG ; Dong Su SHIN ; Ji Yong JUNG ; Jae Hyun CHANG ; Hyun Hee LEE ; Seung Ho LEE ; Sejoong KIM
Electrolytes & Blood Pressure 2011;9(2):63-66
Accurate measurement of the volume status in hemodialysis patients is important as it can affect mortality. However, no studies have been conducted regarding volume management in cases where a sudden change of body fluid occurs, such as during puerperium in hemodialysis patients. This report presents a case in which the patient was monitored for her body composition and her volume status was controlled using a body composition monitor (BCM) during the puerperal period. This case suggests that using a BCM for volume management may help maintain hemodynamic stability in patients with a rapidly changing volume status for a short term period, such as during puerperium.
Body Composition
;
Body Fluids
;
Hemodynamics
;
Humans
;
Organothiophosphorus Compounds
;
Postpartum Period
;
Renal Dialysis
9.Liver cirrhosis leads to poorer survival in patients with end-stage renal disease.
Ae Jin KIM ; Hye Jin LIM ; Han RO ; Ji Yong JUNG ; Hyun Hee LEE ; Wookyung CHUNG ; Jae Hyun CHANG
The Korean Journal of Internal Medicine 2016;31(4):730-738
BACKGROUND/AIMS: Liver cirrhosis (LC) is an important problem in patients withend-stage renal disease (ESRD). Few studies have investigated the inf luence ofLC on mortality in patients with ESRD. This study investigated the associationbetween LC and mortality among patients with ESRD and compare mortality betweentwo dialysis modalities. METHODS: Adult patients (≥ 18 years of age) starting dialysis for ESRD were enrolledin the present study from 2000 to 2011. We analyzed 1,069 patients withESRD; of these, 742 patients were undergoing hemodialysis (HD) and 327 patientswere undergoing peritoneal dialysis (PD). RESULTS: The prevalence of LC was 44 of 1,069 patients (4.1%). The cumulative 1-,3-, and 5-year survival rates of noncirrhotic patients were 93%, 83%, and 73%, respectively,whereas the equivalent survival rates of cirrhotic patients were 90%,68%, and 48%, respectively (p = 0.011). After adjustment, LC was an independentrisk factor for death in patients with ESRD. No difference in mortality associatedwith LC was found between the HD and PD subgroups. CONCLUSIONS: Of the patients with ESRD, cirrhotic patients had poorer survivalthan noncirrhotic patients. Among patients with ESRD and LC, survival of patientsundergoing PD may be comparable with that of patients undergoing HD.
Adult
;
Dialysis
;
Humans
;
Kidney Failure, Chronic*
;
Liver Cirrhosis*
;
Liver*
;
Mortality
;
Peritoneal Dialysis
;
Prevalence
;
Renal Dialysis
;
Survival Rate
10.Analysis of factors affecting the delivered dose of hemodialysis in patients on conventional fixed dialysis regimen.
Yeun Sun KIM ; Hyun Hee LEE ; Jong Ho LEE ; Eun Soo KIM ; Kyoung Soon JIN ; Jung Gon KIM ; Seung Min YOO ; Joon Seung LEE ; Wookyung CHUNG ; Kwon Wook JOO
Korean Journal of Medicine 2005;69(5):510-517
BACKGROUND: Although adequate removal of small solutes are essential for effective hemodialysis, many patients are suffering from inadequate delivery of hemodialysis, especially with the conventional fixed regimen of dialysis for 4 hours three times per week. We tried to evaluate actual delivered dose of hemodialysis in patients receiving 4 hours of low-flux hemodialysis, and to analyze factors affecting inadequate delivery of hemodialysis. METHODS: 97 stable maintenance hemodialysis patients who were undergoing 4 hours of hemodialysis thrice weekly were included for analysis. Prescribed dose of dialysis was calculated by Kt/V where K was in vitro urea clearance of dialyzer membrane and V was estimated according to the Watson's formula. Delivered dose of dialysis was calculated according to the Daugirdas equation. To find factors that may impair adequate delivery of hemodialysis, various clinical and technical parameters were analyzed. RESULTS: Prescribed dose of hemodialysis was 1.37+/-0.21, while delivered dose was 1.23+/-0.27, and thus, there was a significant difference (p <0.03). In 45% of the patients, delivered dose was less than 1.2. They were heavier and prescribed dose was low. delta Kt/V (Prescribed dose-Delivered dose) was significantly greater in patients who did not use heparin therapy compared to patients who used heparin. Other parameters such as hypotension, missed treatment, sex, type of vascular access and degree of recirculation were not associated with impaired delivery of hemodialysis.
Dialysis*
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Heparin
;
Humans
;
Hypotension
;
Membranes
;
Renal Dialysis*
;
Urea