Hypercalcemia is a common complication in CAPD patients treated with calcium-containing phosphate binders and using the standard dialysate (SCD) calcium concentration of 3.5mEq/L. We performed a retrospective study in 25 CAPD patients to determine whether a low calcium dialysate (LCD) containing 2.5mEq/L calcium would reduce the incidence of hypercalemia with adequate control of serum inorganic phosphate levels and diminish the need to use aluminum-containing phosphate binders. All patients had previously used SCD before converting to LCD. The incidence of hypercalcemia (more than 2 episodes of corrected serum calcium > or = 10.5mg/dL) tended to be lower after converting to LCDl 0.27 (0-2.76) vs. 0 (0-1.97) episodes/patient-yearl. Intact PTH level increased from 38.8 (0.1-1599.3)pg/mL to 70.6 (9.5-1540.0)pg/mL after conversion, but there was no statistical sifnificance. Serum calcium, inorganic phosphate, alkaline phosphatase and bicarbonate levels did not change after converting to LCD. We were able to reduce aluminum hydroxide dosagel 1.09 (0-10.88) vs. 0 (0-3.26)g/day/patientl and increase calcium carbonate dosage (1.95 0.92 vs. 2.98 2.14g/day/ patient) after conversion significantly (P<0.05). The frequency of peritonitis was similar in LCD and SCD period. In conclusion, low calcium dialysate is useful in diminishing aluminum-containing phosphate binder dosage and increasing calcium carbonate dosage to maintain a similar phosphate value. Its effects on renal osteodystrophy remain to be assessed.
Alkaline Phosphatase ; Aluminum Hydroxide ; Calcium Carbonate ; Calcium* ; Humans ; Hypercalcemia ; Incidence ; Kidney Failure, Chronic ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Renal Osteodystrophy ; Retrospective Studies

To determine the optimal administration route of calcitriol in CAPD patients with secondary hyperparathyroidism, we conducted a prospective study on 33 patients who performed CAPD for more than 6 months an d whose intact parathyroid hormone(iPTH) level was higher than 250pg/mL. The patients were randomized into 3 groups:IP(n=11); 1.0 microgram of calcitriol once daily via intraperitoneal route by overnight retention with dialysate, SC(n=11); 1.0 microgram of calcitriol three times a week via subcutaneous route, and PO (n=11); 1.0 microgram of calcitriol three times a week by ingestion. 11 out of 33 patients(6 in IP, 4 in SC, and 1 in PO) dropped out during the 6-months study period, and 5 among the 6 patients in IP were due to recurrent peritonitis. Biochemical data including calcium, phosphorus, iPTH, alkaline phosphatase, bone-specific alkaline phosphatase, osteocalcin and 1,25(OH)2D3 were measured regularly, and the data of 22 patients who had completed the 6-months study were analyzed. There was a statistically significant decrease in iPTH level(pg/mL) in the three groups after 6-months calcitriol therapy(IP; 812.0+/-276.7 vs. 354.7+/-129.4, PO; 571.8+/-330.7 vs. 159.6+/-192.3, SC; 786.1+/-535.0 vs. 551.8+/-729.9, respectively, P<0.05), but there were no differences in the percentage of decrease in iPTH from baseline values among the three groups. Alkaline phosphatase, bone- specific alkaline phosphatase and osteocalcin also decreased significantly in all three groups(IP; 50.1+/-14.6, 33.5+/-11.6, 52.3+/-10.9% of baseline value; SC; 80.9+/-14.8, 67.4+/-20.80, 54.4+/-11.1% of baseline value; PO; 48.8+/-24.4, 36.6+/-23.5, 54.2+/-11.6% of baseline value, respectively, P<0.05), but they were not different with each other. Among 22 patients who completed the 6-months study, hypercalcemia(Ca>=10.5 mg/dL) occurred in 7 patients(31.8%). IP(2/5, 40%) and SC groups(5/7, 71.4%) had significantly higher incidence of hypercalcemia than PO group(0/10, 0%) (P<0.05). IP group(2/5, 40%) also experienced significantly higher incidence of hyperphosphatemia than SC(1/7, 14.3%) and PO groups(1/10, 10%). Peritonitis occurred significantly more in IP than in SC and PO groups(P<0.05). In conclusion, calcitriol treatment resulted in a significant decrement in iPTH levels in CAPD patients and no significant differences were noted in the iPTH-suppressive effect of calcitriol according to the administration route. Because of higher incidence of peritonitis and hypercalcemia in IP and SQ groups, oral ingestion may be the most optimal route for calcitriol treatment in CAPD patients with secondary hyperparathyroidism.
Alkaline Phosphatase ; Calcitriol* ; Calcium ; Eating ; Humans ; Hypercalcemia ; Hyperparathyroidism, Secondary ; Hyperphosphatemia ; Incidence ; Osteocalcin ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Phosphorus ; Prospective Studies*

Relapsing peritonitis are major limitation of CAPD, a common reason for discontinuation of this form of therapy. Inappropriate treatment of previous peritonitis often leads to relapsing peritonitis, especially in patients with catheter-related infections. Although a multitude of therapeutic approaches have been tried, there is a controversy over the optimal antimicrobial treatment. The purposes of this study were: 1) to analyze the causative pathogen; 2) to determine the appropriate treatment regimen and duration; and 3) to evaluate the role of catheter replacement in recurrent peritonitis. Follow-up data were obtained in 43 CAPD patients who experienced 104 episodes of reucrrent peritonitis. 1) Among 104 episodes of recurrent peritonitis, 70 (67%) were culture-positive. The distribution of isolates was as follows : coagulase negative Staphylococci, 39 (38%); Enterococcus, 9 (9%); Staphylococcus aureus, 8 (8%); Pseudomonas, 4 (4%); Serratia, 4 (4%); Xanthomonas, 3 (3%); Klebsiella, 2 (2%); and fungus, 1 (1%). 2) Peritonitis recurred in 46 (50%) and did not recur in the other 46 (50%) of the 92 catheter- maintained peritonitis. After catheters were removed in 12 patients, new catheters were inserted in 3 patients without any more peritonitis. 3) There was no significant difference of recurrence between Gram-positive and Gram-negative peritonitis (56 vs. 50%). 4) Five (29%) of 17 peritonitis treated with vancomycin and amikacin, and 22 (73%) of 30 peritonitis treated with cefazolin and tobramycin experienced recurrence. Compared with cefazolin, initial therapy with vancomycin decreased the recurrence rate (P<0.05). 5) In Gram-positive and Gram-negative peritonitis, there was no reduction of recurrence in peritonitis treated for more than 2 weeks (63 vs. 51%, 40 vs. 60%). In coagulase negative Staphylococcal peritonitis, treatment for more than 2 weeks reduced the recurrence without statistical significance (59 vs. 30%, P=0.10). 6) In Gram-positive and Gram-negative peritonitis, there was no reduction of recurrence in peritonitis treated for more than 10 days after resolution (59 vs. 53%, 40 vs. 69%). In coagulase negative Staphylococcal peritonitis, treatment more than 10 days after resolution reduced the recurrence without statistical significance (50 vs. 26%, P=0.08). In conclusion, treatment with vancomycin and a longer treatment duration seem to be beneficial in relapsing CAPD peritonitis. Moreover, removal and replacement of catheter should be considered in cases unresponsive to antibiotic treatment.
Amikacin ; Catheter-Related Infections ; Catheters ; Cefazolin ; Coagulase ; Enterococcus ; Follow-Up Studies ; Fungi ; Humans ; Klebsiella ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Pseudomonas ; Recurrence ; Serratia ; Staphylococcus aureus ; Tobramycin ; Vancomycin ; Xanthomonas

Renal artery stenosis may be a cause of hypertension and a potential contributor to progressive renal insufficiency. However, the prevalence of renal artery disease in a general population is poorly defined. The purposes of this study were to evaluate the prevalence of angiographically-determined renal artery narrowing in a patient population undergoing routine cardiac catheterization, and to identify the risk factors for renal artery stenosis. After left ventriculography, abdominal aortography was performed to screen for the presence of renal artery stenosis. A total of 427 patients (274 males, 153 females) were studied and the mean age was 59 years. Renal artery narrowing was identified in 10.5% of patients. Significant (> or = 50% diameter narrowing) renal artery stenosis was found in 24 patients (5.6%) and insignificant stenosis was found in 21 patients (4.9%). Significant unilateral stenosis was present in 4.2% of patients and bilateral stenosis was present in 1.4%. The stem of the renal artery was a more common site of stenosis in 62.2% of patients than in the ostium (37.8%), but the severity of stenosis was not significantly different according to the site of stenosis. By univariate and multivariate logistic regression analysis, the association of clinical variables with renal artery stenosis was assessed. Multivariable predictors included age, hypertension and peripheral vascular disease (p < 0.05). The variables such as sex, smoking history, hyperlipidemia, renal insufficiency, as well as the presence of obesity, severity of coronary heart disease and D.M., were not associated. In conclusion, the prevalence of angiographically-determined renal artery narrowing in a patient population undergoing cardiac catheterization is 10.5%. Old age, hypertension and evidence of peripheral vascular disease represent the predictors of renal artery stenosis.
Adult ; Aged ; Female ; Heart Catheterization* ; Human ; Hypertension/etiology ; Male ; Middle Age ; Multivariate Analysis ; Prevalence ; Renal Artery Obstruction/etiology ; Renal Artery Obstruction/epidemiology* ; Risk Factors

In order to evaluate the peritoneal transport characteristics in Korean non-diabetic and diabetic end- stage renal disease patients, peritoneal equilibration test(PET) proposed by Twardowski et al. were performed on patients who had been on continuous ambulatory peritoneal dialysis(CAPD) for 2 to 6 months. The results were as follows : 1) Fifty four patients(including 24 diabetics) on CAPD were studied with a mean age of 48.7 years. And male/female ratio was 1 : 1.08. 2) In non-diabetics, the dialysate to dialysate prior to infusion ratio for glucose(D/D0 glu) at 2-, and 4-hour dwell times were 0.61+/-0.09, and 0.39+/-0.10, and the dialysate-to-plasma ratio for creatinine (D/P cr) at 2-, and 4-hour dwell times were 0.40+/-0.11, 0.63+/-0.12, respectively. 3) In diabetic patients, D/D0 glu at 2-, and 4- hour dwell times were 0.60+/-0.09, 0.39+/-0.08, respectively, and D/P cr at same dwell times were 0.50+/-0.08, and 0.71+/-0.08, which were significantly higher than in non-diabetics(p<0.05). 4) According to the two-hour plasma glucose concentration, diabetic patients were subdivided into hyperglycemic(>or=150mg/dL) and normoglycemic(<150mg/ dL) patients. The values of D/Pcr at 2-, and 4-hour dwell times in hyper-glycemic patients were signficantly higher than in non-diabetic patients (D2/P2 cr : 0.50+/-0.09 vs. 0.40+/-0.11, D4/P4 cr : 0.72+/-0.07 vs 0.63+/-0.12, respectively, p<0.05). 5) Net ultrafiltration did not differ between any of subgroups. 6) In non-diabetic patients, the ranges of D4/P4 cr and D4/D0 glu for high, high average, low average, and low transporters were defined as D4/P4 cr : 0.87-0.75, 0.75-0.63, 0.63-0.51, 0.51-0.39, D4/D0 glu : 0.19-0.29 0.29-0.39, 0.39-0.49, 0.49-0.59, respectively, which were remarkably simliar as suggested by Twardowski et al. In conclusion, the creatinine and glucose transfers assessed by dialysate-plasma ratio of creatinine and glucose are remarkably similar between Korean and North American patients. And the creatinine transport rate in Korean diabetic patient is higher than non-diabetic patient while ultrafiltration is achievable in non-diabetic patient.
Blood Glucose ; Creatinine ; Glucose ; Humans ; Peritoneal Dialysis, Continuous Ambulatory* ; Ultrafiltration

An increased serum C-reactive protein(sCRP) has been demonstrated to be an independent marker of mortality in hemodialysis patients, but predictive role of sCRP in CAPD patients is not clear. To evaluate the predictive value of the single baseline sCRP as a marker of mortality, we performed a cross-sectional study involving 105 CAPD patients and have followed these patients for 2 years. The mean age was 49 years; the male to female ratio was 0.9:1; mean CAPD duration was 43.5 months; 11.4% of patients had diabetes and 9.5% of patients had cardiovascular disease. Patients were divided into two groups based on sCRP level: normal sCRP group(n=92, sCRP0.8mg/dl). The mean sCRP levels were 0.15+/-0.17 mg/dl and 4.25+/-5.04mg/dl, respectively(P<0.05). In increased sCRP group, there were more diabetic patients(30.7 vs. 8.6%, P<0.05), and serum albumin level was significantly lower compared to normal sCRP group(3.5+/-0.6 vs. 3.9+/-0.5g/dl, P<0.05). Other biochemical, urea kinetic and anthropometric data showed no difference between the two groups. Two- year patient survival rate was significantly lower in increased sCRP group than normal sCRP group(66.7 vs. 94.1%, P=0.001) although there was no significant difference in technique failure, peritonitis rate and hospitalized days between the two groups. By Cox proportional hazards analysis, independent predictors of mortality were cardiovascular disease (relative risk, RR=8.96, P<0.005), increased sCRP level(RR=1.19, P<0.05) and high hematocrit(RR=1.18, P<0.05). Serum CRP was negatively correlated with serum albumin(r=-0.20, P<0.05) and positively correlated with the presence of diabetes mellitus(r=0.31, P=0.001) by stepwise multiple regression analysis. In conclusion, sCRP at enrollment appears to be an independent predictor of 2-year patient survival in CAPD patients.
C-Reactive Protein* ; Cardiovascular Diseases ; Cross-Sectional Studies ; Female ; Humans ; Male ; Mortality* ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Renal Dialysis ; Serum Albumin ; Survival Rate ; Urea

PURPOSE: Many studies have proposed predictive models for type 2 diabetes mellitus (T2DM). However, these predictive models have several limitations, such as user convenience and reproducibility. The purpose of this study was to develop a T2DM predictive model using electronic medical records (EMRs) and machine learning and to compare the performance of this model with traditional statistical methods. MATERIALS AND METHODS: In this study, a total of available 8454 patients who had no history of diabetes and were treated at the cardiovascular center of Korea University Guro Hospital were enrolled. All subjects completed 5 years of follow up. The prevalence of T2DM during follow up was 4.78% (404/8454). A total of 28 variables were extracted from the EMRs. In order to verify the cross-validation test according to the prediction model, logistic regression (LR), linear discriminant analysis (LDA), quadratic discriminant analysis (QDA), and K-nearest neighbor (KNN) algorithm models were generated. The LR model was considered as the existing statistical analysis method. RESULTS: All predictive models maintained a change within the standard deviation of area under the curve (AUC) < 0.01 in the analysis after a 10-fold cross-validation test. Among all predictive models, the LR learning model showed the highest prediction performance, with an AUC of 0.78. However, compared to the LR model, the LDA, QDA, and KNN models did not show a statistically significant difference. CONCLUSION: We successfully developed and verified a T2DM prediction system using machine learning and an EMR database, and it predicted the 5-year occurrence of T2DM similarly to with a traditional prediction model. In further study, it is necessary to apply and verify the prediction model through clinical research.
Area Under Curve ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Electronic Health Records ; Follow-Up Studies ; Humans ; Korea ; Learning ; Logistic Models ; Machine Learning ; Methods ; Prevalence

To determine the prevalence and clinical relevance of HGV infection in dialysis patients, we performed a cross-sectional study of 61 HD patients and 79 Continuous Ambulatory Peritoneal Dialysis (CAPD) patients. HGV-RNA was identified by reverse-transcription (RT) polymerase chain reaction (PCR) assay with primers from the 5'-untranslated region of the viral genome. The prevalence of HGV infection was similar in HD and CAPD patients (9.8% vs. 12.7%), while that of HCV infection was significantly higher in HD patients compared to CAPD patients (16.4% vs. 1.3%, p < 0.05). The mean age (49.2 +/- 13.4 vs. 46.7 +/- 13.0 years), male to female ratio (2.4:1 vs. 1.3:1), history of transfusion (62.3% vs. 49.4%), history of hepatitis (27.9% vs. 26.6%), mean ALT level during the previous 6 months (22.4 +/- 37.9 vs. 14.0 +/- 7.4 IU/L), and the prevalence of HBsAg (8.2% vs. 6.3%) showed no difference between HD and CAPD patients. In both HD and CAPD patients, the presence of HGV RNA was not related to age, sex, duration of dialysis, history of transfusion, history of hepatitis, or to the presence of HBV or HCV markers. There was no significant difference in the clinical and biochemical data between patients with isolated HGV infection (n = 12) and patients without viremia (n = 106). The clinical feature of patients coinfected with HGV and HBV (n = 2), or HGV and HCV (n = 2) seemed to be similar to those of patients with isolated HBV (n = 8) or HCV (n = 9) infection. In conclusion, the prevalence of HGV infection was not different between HD and CAPD patients, and HGV infections did not seem to be associated with clinically significant hepatitis. The routes of HGV transmission, other than transfusion or contamination during HD procedure, were suspected.
Female ; Hepatitis Agents, GB*/genetics ; Hepatitis C/genetics ; Hepatitis C-Like Viruses/genetics ; Hepatitis, Viral, Human/virology ; Hepatitis, Viral, Human/genetics ; Hepatitis, Viral, Human/etiology* ; Human ; Male ; Middle Age ; Peritoneal Dialysis, Continuous Ambulatory/adverse effects* ; Prevalence ; RNA, Viral/analysis ; Renal Dialysis/adverse effects* ; Viremia/genetics

To evaluate the clinical efficacy and safety of newly developed recombinant human erythropoietin (Epokine(R)), a phase III clinical trial was performed in patients with end-stage renal disease undergoing maintenance hemodialysis. Epokine(R)was given initially at a dosage of 50unit/kg, intravenously, three times a week after each dialysis session and the dosage was adjusted according to the changes in hemoglobin level. Out of total 79 patients who were enrolled initially, data of 64 patients who have completed 12 weeks study period were analyzed. The results were as following: 1) Hemoglobin(g/dL) and hematocrit(%) increased significantly from baseline levels beginning from 2 weeks after Epokine(R) administration. Hemoglobin increased significantly from 6.8+/-0.8 to 10.4+/-1.3 and hematocrit increased significantly from 20.9+/-2.2 to 31.1+/-5.2 after 12 weeks(P<0.05). Corrected reticulocyte count(%) increased significantly from 0.6+/-0.4 to 1.4+/-0.7 after 2 weeks and to 1.3+/-0.6 after 12 weeks(P<0.05). 2) A significant increase in platelet count was observed from 2 weeks after Epokine(R) administration (P<0.05). 3) Serum ferritin and serum iron decreased significantly and total iron binding capacity increased significantly after 2 weeks(P<0.05). 4) The mean of pre-hemodialysis systolic blood pressure(mmHg) increased significantly from 148+/-21 to 154+/-25 at 12 weeks(P<0.05). Also, post-hemodialysis blood pressure(systolic/diastolic) at 12 weeks increased significantly from baseline levels(146+/-28/ 82+/-15 vs. 153+/-25/87+/-14mmHg, P<0.05). 5) Anti-erythropoietin antibody was not detected in all subjects. 6) Side effects observed in this study were similar to those reported by earlier reports. Headache(9 cases), and flu-like syndrome(7 cases) were the most common side effects. These side effects were not severe and disappeared without discontinuation of Epokine(R) administration in most of the patients. In conclusion, Epokine(R) is safe and effective in treating anemia of hemodialysis patients with end stage renal disease.
Anemia ; Dialysis ; Erythropoietin ; Ferritins ; Hematocrit ; Humans* ; Iron ; Kidney Failure, Chronic ; Platelet Count ; Renal Dialysis* ; Reticulocytes

Lupus nephritis is a major cause of morbidity and mortality arising from systemic lupus erythematous. It is generally acknowledged that the presence of diffuse proliferative lupus nephritis(DPLN) is highly predictive of a poor prognosis in terms of renal and patient out- come on survival. The objective of this study was to evaluate the clinicopathologic characteristics, renal out- come according to therapeutic regimen, and prognostic factors of biopsy-proven diffuse proliferative lupus nephritis. Among the biopsy-proven lupus nephritis patients who were admitted to Yonsei University Medical Center from January 1986 to June 1997, 36 patents who were diagnosed DPLN by renal biopsy and treated for at least 6 months and regularly followed-up for at least 12 months were included. We retrospec-tively reviewed the medical recorders. Patients were treated with steroid regimen with or without cyclo-phosphamide. According to the therapeutic response, patients were divided into two groups : a therapeutic response group(n=24), and a therapeutic non-response group Academic Medical Centers ; Biopsy ; Creatinine ; Cyclophosphamide ; Diagnosis ; Follow-Up Studies ; Humans ; Lupus Nephritis* ; Medical Records ; Mortality ; Nephritis ; Prognosis ; Proteinuria ; Survival Rate