BACKGROUND: Exit site/tunnel infection causes con-siderable morbidity and technique failure in CAPD patients. We presently use a unique revision method for the treatment of refractory ESl/TI in CAPD patients and mupirocin prophylaxis for high risk patients. MTEHODS: We reviewed one hundred-thirty nine CAPD patients about the ESI/TI from Qctober 1993 to February 1999 at Yeungnam University Hospital. At the beginning of the ESI, we usually started medications with rifampicin and ciprofloxacin and then changed the antibiotics according to the sensitivity test. If the ESI had persisted and there were TI symptoms(purulent discharge, abscess lesion around exit site), we performed catheter revision(external cuff shaving, disinfection around tunnel and new exit site on opposit direction) with a combination of proper antibiotics. We applied local mupirocin ointment at the exit site three times per week to the 34 patients who had the risk of ESI starting from October 1998. RESULTS: The total follow-up was 2401 patient months (pt.mon). ESI occurred on 105 occasions in 36 out of 139 patients, and peritonitis occurred on 112 occasions in 67 out of 139 patients. Cumulative incidence of ESI and peritonitis was 1 per 23.0 pt.mon and 1 per 21.6 pt.mon. The most common organism responsible for ESI was Staphylococcus aureus (26 of 54 isolated cases, 43%), followed by Methicillin resistant S. aureus (MRSA)(13 cases, 24%). Seven patients (5: MRSA, 2: Pseudomonas) had to be treated with a revision to control infection. Three patients experienced ESI relapse after revision. One of them improved with antibiotics, while another needed a second revision and the remaining required catheter removal due to persistent MRSA infection with reinsertion at the same time. But, there was no more ESI in these 3 patients who were received management to relapse (The mean duration : 14.0 months) The rates of ESI were more reduced after using mupirocin than before (l per 12.7 vs 34.0 pt.mon, p<0.01). CONCLUSION: In summary, revision technique can be regarded as an effective method for refractory ESI/TI before catheter removal. Also local mupirocin ointment can play a significant role in the prevention of ESI.
Abscess ; Anti-Bacterial Agents ; Catheters* ; Ciprofloxacin ; Disinfection ; Follow-Up Studies ; Humans ; Incidence ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Mupirocin* ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Recurrence ; Rifampin ; Staphylococcus aureus

Peritonitis is one of the major complication of continuous ambulatory peritoneal dialysis (CAPD) and the most common cause of hospital admission and for termination of peritoneal dialysis. We retrospectively analyzed the incidences and causative organisms of CAPD peritonitis according to season/month of the year under the hypothesis that climate factors, increased temperature and humidity, may changes the incidences and causative organisms of peritonitis. There were a few studies about this issue and in most cases the result was inconclusive because of the limitation in the limited range of climate factors such as temperature and humidity. Wide annual differences of temperature (-3.4-25.4 degrees C) and humidity (61-81%) may affect the rate of peritonitis episode in the area where the current study was performed. Data from 80 patients(49 male, 31 female), with a mean age 48.3+/-14.5 years and mean CAPD period 14.0+/-9.0 months, followed from September 1996 to July 1999, were reviewed. Fifty-three cases of peritonitis were found in 1,123 patient-months, a rate of 0.56 episode/patients- year, and 0.047 episode/patient-month. The months in which the incidence of peritonitis above average was March (5.05%), May(7.96%), July (10.8%), August (6.25%), September (6.06%). The incidence of peritonitis was the lowest in November (1.31%). The incidence in hot season (May-September : average temperature for three years 21.9degrees C, humidity 74%) was 0.065 episodes/patient-month, which was significantly higher than in cold season (October-February : 5.9degrees C, 64.4%)(p<0.05). Average temperature for three years in the study area was 13.2degrees C with maximal temperature of 25.4degrees C (August) and minimal of -3.4 degrees C (January). Average humidity for three years in the study area was 68.4% with maximal humidity of 81% (July) and minimal of 61% (April). The incidence of peritonitis paralleled with temperature and humidity, highest in July (0.080/pt-month) and lowest in November (0.013/pt-month) and were directly correlated with temperature (r=0.53, p<0.05) and humidity (r=0.59, p<0.05). Among 53 episodes of peritonitis, gram positive peritonitis, gram negative peritonitis and culture negative peritonitis were 36.9%, 15.0% and 45.2%, respectively. From March to August, gram positive peritonitis was 50% and culture negative peritonitis was 42.4%. From September to February, culture-negative peritonitis was 52.9% and gram negative peritonitis organisms was 29.4%. In contrast to gram positive organisms which showed increased in hot weather, gram negative organisms showed uniform distribution throughout the year. There were no significant monthly differences in peritoneal fluid WBC count on admission and negative conversion period of that. Our data suggest that high temperature and humidity can adversely affect the incidence of CAPD peritonitis and may change the distribution of causative organisms.
Ascitic Fluid ; Climate* ; Humans ; Humidity ; Incidence ; Male ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis* ; Retrospective Studies ; Seasons ; Weather

CAPD may have many negative impacts on nutritional status. Protein and caloric malnutrition are highly prevalent in chronic CAPD patients. In order to evaluate the relationship between nutritional and dialysis adequacy of long-term CAPD patients, twenty patients treated for aver 5 years on CAPD, with a mean age of 50.5+/-12.2 years and dialysis duration of 82.6+/-19.5 months(range 60-116) were studied. Fourteen of the twenty patients(70%) had no residual renal function(RRF). In these twenty patients the mean weekly Kt/Vurea and Ccr were 1.85+/-0.24 and 58.110.8L/week/1.73m2 with the median body surface area(BSA) of 1.61m2. Female(n=7) patients had lower BSA(1A7 vs 1.69m2), TBW(27.7 vs 35.6L), and higher serum albumin (4.01 vs 3.41g/dL), weekly Kt/Vurea(2.02 vs 1.76) than male(n=13) patients. Six patients had nPCR0.9 and nPCR was negatively correlated with age(r=-0.53, p<0.05), BSA(r=-0.54, p<0.05) and positively correlated with serum albumin(r=0.53, p<0.05). Serum albumin was not changed during 5 years of CAPD. Fourteen patients were well nourished and six patients were mild to moderately malnourished on SGA score. Fourteen of the twenty patients had normal serum albumin(> or =3.5g/dL) and 6 had hypoalbuminemia(<3.5g/dL). Serum albumin was positively correlated with nPCR(r=0.53, p<0.05) and negatively with BSA(r=-0.6S, p<0.001) and total body water (TBW)(r=-0.69, p<0.001). Hypoalbuminemia patients had high peritoneal membrane transport characteristics(24h D/Pcr 0.84 vs 0.74, p<0.05). Four patients had weekly Kt/Vurea>2.0 and Kt/Vurea was negatively correlated with BSA(r=-0.61, p<0.001). In conclusion, for Korean patients on long-term CAPD, small body size is the key for adequate dialysis and nutrition. Low serum albumin levels may be related with high peritoneal transport.
Body Size ; Body Water ; Dialysis* ; Humans ; Hypoalbuminemia ; Malnutrition ; Membranes ; Nutritional Status ; Peritoneal Dialysis, Continuous Ambulatory* ; Serum Albumin

OBJECTIVE: It has been proposed that the contact between blood and dialysis membrane during hemodialysis therapy induces harmful reactions to patients. Membrane biocompatibility is the characteristic that makes less adverse reaction. We tried to compare the biocompatibility between Cuprophane and Polysulfone membranes. MRTHODS: Nine chronic renal failure patients who have undergone maintenance hemrodialysis therapy with Hemophan membrane three times per week were included in this study. Cuprophane membranes were used in the first week: Hemophan membranes in the second week; Polysulfone membranes in the third week. Each membrane was used three times a week. On the day of third dialysis with the Cuprophane membrane(first week) and Polysulfone membrane(third week), serial blood sampling was obtained from the afferent line at hemodialysis initiation, 15 minutes, 30 minutes, 60 minutes, 120 minutes and 30 minutes to measure serum complement activity(C3a, C5a), blood polymorphonuclear leukocyte and platelet count, and arterial oxygen pressure which have been regarded as biocompatibility parameters. The parameters measured during the first week(Cuprophane) and the third week(Polysulfone) were compared to evaluate the difference in biocompatibility of both membranes. RESULTS: 1) C3a desArg In both groups, the level of C3a desArg increased significantly from basal level and the Cuprophane group showed significantly higher level of C3a desArg than that of Polysulfone group. 2) C5a desArg : In both groups, the level of C5a desArg did not increased sigpificantly from basal level. Only at 30 minute after hemodialysis, Cuprophane group showed significantly higher level of C5a desArg than that of Polysulfone group(p=0.037). 3) Polymorphonuclear leukocyte : In both groups, the polymorphonuclear leukocyte counts decreased significantly at 15 minutes and 30 minutes from basal level. The polymorphonuclear leukocyte count was lower in Cuprophane group than that of Polysulfone group at 15 minute after hemodialysis(p=0.001). 4) Platelet: In Cuprophane group, the platelet count was decreased significantly at 15 minute(p=0.004) but there were no difference in platelet counts between the two groups. 5) Arterial oxygen pressure Both group showed no consistent pattern of variation of oxygen pressure and there was no significant difference between the two groups. CONCLUSION: The biocompatibility of Polysulfone membrane was superior to the Cuprophane membrane with respect to the increased activation of complement C3a. decrease of polymorphonuclear leukocyte and decrease of platelet count.
Blood Platelets ; Complement C3a ; Complement System Proteins ; Dialysis ; Humans ; Kidney Failure, Chronic ; Membranes* ; Neutrophils ; Oxygen ; Platelet Count ; Renal Dialysis

Hemodialysis is a safe and effective treatment for uremic patients but hemodynamic changes during hemodialysis is suggested to be the possible cause of encephalopathy. However, few studies have evaluated the cerebral circulation of and the effects of hemodialysis. Therefore, this study was performed to evaluate the cerebral blood flow by transcranial doppler. The study populations were 12 male patients who ranged in age from 28 to 58 years(mean:57) and were receiving maintenance hernodialysis for 3.8 years(0.5-11.5 years). Mean blood flow velocity(MFV), pulsatility index(PI) and resistance index(RI) were measured in carotid artery(CA), middle cerebral artery(MCA), anterior cerebral artery(ACA) and posterior cerebral artery(PCA) before, during and after hemodialysis. Simultaneously, we also checked variables(body weight, blood pressure, arterial blood gases, hematocrits, and other biochemical parameters) which might affect cerebral blood flow. MFV during(70.5+/-20.3 vs. 60.0+/-211cm/sec) and after(vs. 60.6+/-13.7cm/sec, p<0.01) hemodialysis in CA showed significant reduction as compared to the that of before hemodialysis, but other vessels(MCA, ACA and PCA) showed no significant changes. There were no significant changes in PI and RI before, during and after hemodialysis. Body weight, PaCO(2), blood urea nitrogen and hematocrit changed significantly during and after hemodialysis as compared to those of before hemodialysis, but correlation between changes of MFV and these variables was not observed. Hemodialysis and its associated physiologic changes are not associated with cerebral blood flow, and this result suggests the well-preservation of autoregulation of cerebral blood flow during and after hemodialysis.
Arterial Pressure ; Blood Flow Velocity* ; Blood Urea Nitrogen ; Body Weight ; Gases ; Hematocrit ; Hemodynamics ; Homeostasis ; Humans ; Male ; Renal Dialysis*

Serum C-reactive protein(sCRP) is an acute-phase reactant that exhibiting negative correlation with serum albumin concentration. It was reported that sCRP is an independent predictor of survival in both hemodialysis and peritoneal dialysis patients, and an acute phase inflammation could be preceded by protein catabolism, hypoalbuminemia, anorexia and even atherosclerotic cardiovascular disease. We have evaluated serum biochemical parameters including albumin and prealbumin, Kt/Vurea, nPCR, SGA score, anthropometric parameters and diet history in 30 ESRD patients maintained on chronic hemodialysis subdivided by sCRP concentration. Upon comparing the two subgroups[high CRP group(sCRP >or= 0.4mg/dL), n=15 vs. normal CRP group (sCRP<0.4mg/dL), n=15], high CRP group showed significantly lower levels of hemoglobin(9.3+/- 0.7 vs. 9.8+/-0.6g/L, p<0.05), hematocrit(28.3+/-2.3 vs 29.8+/-1.696, p<0.05), creatinine(9.6+/-3.1 vs. 12.2+/-2.5mg/dL, p<0.05), prealbumin(20.9+/-5.0 vs. 25.8+/-6.4mg/dL, p< 0.05), SGA score(5.0+/-1.2 vs. 5.9+/-0.7, p<0.05), and percent of patients who have higher nPCR than protein intake(85.7 vs. 28.6%, p<0.05). Ferritin was significantly higher in high CRP group(503.1+/-205.7 vs. 323.3+/-186.6, p<0.05). There were no differences in age, sex, duration of hemodialysis, prevalence of diabetic nephropathy and cardiovascular disease, Kt/Vurea, nPCR, residual renal function, amount of protein intake and other nutritional parameters. In conclusion, there was higher probability of malnutrition, anemia and protein catabolism in hemo-dialysis patients with elevated sCRP concentration.
Anemia ; Anorexia ; C-Reactive Protein* ; Cardiovascular Diseases ; Diabetic Nephropathies ; Diet ; Ferritins ; Humans ; Hypoalbuminemia ; Inflammation ; Kidney Failure, Chronic ; Malnutrition ; Metabolism ; Nutritional Status* ; Peritoneal Dialysis ; Prealbumin ; Prevalence ; Renal Dialysis* ; Serum Albumin

BACKGROUND: Potential involvement of the angiotensinogen gene(M235T) in the pathogenesis of essential hypertension has been suggested by some investigators. However, an association between M235T gene polymorphism and essential hypertension has been reported by some, but not by others. Since genetic diversity exists among different ethnic population, we addressed the question of whether there is an association between M235T gene polymorphism and essential hypertension in the Korean. METHODS: 100 patients with essential hypertension and 100 control subjects were recruited from outpatients at the Department of Internal Medicine, Soon-chunhyang Hospital, Chunan City. The criteria for hypertension was defined as systolic blood pressure higher than 160mmHg and/or diastolic blood pressure higher than 95mmHg. For detection of the M235T polymorphism at the angiotensinogen locus, the primer sequences were: sense primer : 5'-TGAAGGAG- AAGGTGTCTGCGGGA-3' and antisense primer : 5'- AGGACGGTGCGGTGAGAGTG-3'. The PCR product mixture was exposed to restriction enzyme Tthlll I and then submitted to electrophoresis in polyacrylamide gel. Differences between the molecular variants of the gene in hypertensives and normotensives were compared by using the chi square test. p<0.05 was considered statistically significant. The odds ratio and 95% confidence interval were calculated using Woolf's method. RESULTS: Compared with the control subjects, hypertensives had higher values of three established risk factors for hypertension : age, BMI cholesterol (total and LDL). X analysis showed no difference in the distribution of genotype or allele frequency between the hypertensives and normotensives (chi square=1.14, p=0.29). The crude odds ratio was 0.73 for CC over CT (95% confidence interval 0.41-1.30). The adjusted odds ratio with age, sex, lipid profilcs and BMI was 0.68 for CC over CT (9596 confidence interval 037-1,23). CONCLUSION: The molecular varient M235T of the angiotensinogen gene is not associated with essential hypertension in Korean population.
Angiotensinogen* ; Blood Pressure ; Cholesterol ; Chungcheongnam-do ; Electrophoresis ; Gene Frequency ; Genetic Variation ; Genotype ; Humans ; Hypertension* ; Internal Medicine ; Korea* ; Odds Ratio ; Outpatients ; Polymerase Chain Reaction ; Research Personnel ; Risk Factors

BACKGROUND: We evaluated the distribution of the polymorphisms of apolipoprotein E and angiotensin converting enzyme gene in patients with diabetic nephropathy and also evaluated possible association between the apolipoprotein E carriers and angioten-sin converting enzyme genotypes and intima-media thickness of the common carotid artery. METHODS: Study participants were 92 patients with diabetic nephropathy(50 men and 42 women). Hb(A1C), albuminuria, and lipid status were assessed by standard laboratory techniques ; the apolipoprotein E carriers were assessed by modified amplification refractory mutation system and the angioten-sin converting enzyme genotypes were assessed by polymerase chain reaction. The intima-media thickness was measured by high-resolution ultrasonography. RESULTS: The apolipoprotein E frequencies of patients were E2 8%, E3 76%, and E4 16%. The intima-media thickness varied by apo E groups. E2 group has less common carotid intima-media thickness than E3 and E4 groups(p<0.05). The angiotensin converting enzyme genotypes were distributed as follows ; 35% II, 49% ID, 16% DD. The intima-media thickness value did not differ among patients with various angiotensin converting enzyme genotypes. Multiple logistic regression analysis showed that age and apolipoprotein E genotypes were determinants for the intima-media thickness. CONCLUSION: Our results suggested that apolipoprotein E polymorphism is associated with carotid artery intima-media thickness in diabetic nephropathy. But, we could not find an association between carotid artery intima-media thickness and angiotensin converting enzyme gene polymorphism in diabetic nephropathy.
Albuminuria ; Angiotensins* ; Apolipoproteins E ; Apolipoproteins* ; Carotid Arteries* ; Carotid Artery, Common ; Carotid Intima-Media Thickness ; Diabetic Nephropathies* ; Genotype ; Humans ; Logistic Models ; Male ; Peptidyl-Dipeptidase A* ; Polymerase Chain Reaction ; Ultrasonography*

There are some clinical evidences that hepatitis B virus(HBV) infection may cause IgA nephropathy. To evaluate clinical significances and pathogenetic roles of HBV infection in patients with IgA nephropathy, we studied that varius clinical and lab- oratory findings in 172 patients with IgA nephrop-athy as serum hepatitis B surface antigen (HBsAg) positive (19 cases) and negative group (153 cases). The result was as following: 1) The incidence of positive serum HRsAg was 11.0%(19/172 cases) in patients with IgA nephropathy and it was higher than that of the randomized age-sex matched general population(4.1%) but has no significance statistically. 2) There was no significant differences in incidence of hypertension, serum levels of IgA, C3, SGOT, SGFf between HBsAg postive and negative group. 3) The cases of nephrotic range proteinuria (3.5g/ day) was more prevalent in HBsAg positive group (31.6%) than that in negative group(7.2%). significantly (p<0.05). 4) The cases of impaired renal function (serum creatinine more than 1.4mg/dL) were more frequent in HBsAg positive group (42.19%) than that in neg-ative group (13.1%) significantly(p<0.05).
Aspartate Aminotransferases ; Creatinine ; Glomerulonephritis, IGA* ; Hepatitis B Surface Antigens* ; Hepatitis B* ; Hepatitis* ; Humans ; Hypertension ; Immunoglobulin A* ; Incidence ; Prognosis ; Proteinuria

To evaluate the risk factors and clinical characteristics of acute renal failure(ARF) in patients with severe preeclampsia, we retrospectively investigated medical and obstetric histories, clinical and laboratory findings, maternal morbidity, and perinatal outcome between renal insufficiency and normal groups in patients with severe preeclampsia. Of the total 307 patients with severe preeclampsia, ARF occurred in 36 patients and its incidence was 11.7%. ARF developed before labor in 17 patients and postpartum in 19 patients. Oliguria occurred in 13 patients(36.1%) and 3 out of these patients required hemodialysis. Of the 31 patients who was observed for 3 months, renal function did not recover in 3 patients(9.7%). The systolic and diastolic blood pressures in renal insufficiency group(n=36) were higher than those in normal group(systolic:173+/-22 vs 164+/-19mmHg, p<0.02, diastolic:119+/-17 vs 108+/-14mmHg, p<0.01). In addition to degree of blood pressure, this study demonstrated that the risk factors of acute renal failure at admission were history of chronic hypertension, twin pregnancy, hypoalbuminemia, and thrombocytopenia. The incidences of maternal complications such as syndrome of hemolysis, elevated liver enzymes, and low platelets(HELLP syndrome), abruptio placenta, pulmonary edema and perinatal morbidity in renal insufficiency group were higher than those in normal group, respectively. In conclusion, acute renal failure in severe preeclampsia occur frequently in patients with history of chronic hypertension, twin pregnancy, severe hypertension, severe hypoalbuminemia, and thrombocytopenia.
Acute Kidney Injury* ; Blood Pressure ; Hemolysis ; Humans ; Hypertension ; Hypoalbuminemia ; Incidence ; Liver ; Oliguria ; Placenta ; Postpartum Period ; Pre-Eclampsia* ; Pregnancy ; Pregnancy, Twin ; Pulmonary Edema ; Renal Dialysis ; Renal Insufficiency ; Retrospective Studies ; Risk Factors ; Thrombocytopenia