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Sleep Disturbance and Myocardial Damage in Patients with End-Stage Renal Disease.

Korean Journal of Nephrology.2004;23(5):777-784.

BACKGROUND: Recently, it was suggested that sleep disorders, like sleep apnea and periodic limb movements during sleep, are associated with the cardiovascular complications and outcomes seen in ESRD patients. This study investigated the association between sleep disturbances, including nocturnal hypoxemia, and myocardial damage in ESRD patients. METHODS: We conducted a cross-sectional study of 15 hemodialysis patients (age=50+-8 years, M: F= 11: 4, diabetes=6) who were classified as at high risk of sleep disturbance using the Epworth Sleepiness Scale and Sleep Disorders Questionnaire. Overnight polysomnographic studies were performed in these 15 patients to evaluate sleep parameters. The predialysis serum concentration of cardiac troponin T (cTnT) was measured as a marker of myocardial damage. RESULTS: Apnea+hypopnea index >5, which is a diagnostic criterion of sleep-related breathing disorder, was found in 12 (80%) patients. Several sleep parameters were associated with cTnT concentration. Sleep efficiency and lowest oxygen saturation decreased (p<0.05 and p=0.06, respectively), and average desaturation increased (p<0.05) with increasing cTnT concentration. Spearman's Rho, which was used to assess the relationships between the severity of sleep apnea and clinical parameters, showed that apnea+hypopnea index and oxygen desaturation index were negatively correlated (both p<0.01) with the serum concentration of uric acid. In multivariate analysis, the uric acid concentration was also independently associated with apnea+hypopnea index and oxygen desaturation index. CONCLUSION: Elevated concentration of cTnT was associated with poor sleep efficiency and severe oxygen desaturation during sleep, and the serum concentration of uric acid was lower in patients with severe sleep apnea.
Anoxia ; Cross-Sectional Studies ; Extremities ; Humans ; Kidney Failure, Chronic* ; Multivariate Analysis ; Oxygen ; Renal Dialysis ; Respiration ; Sleep Apnea Syndromes ; Sleep Wake Disorders ; Troponin T ; Uric Acid ; Surveys and Questionnaires

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The Effect of Hemodialysis on Signal-Averaged Electrocardiography (SAECG) in Patients with End-Stage Renal Disease.

Yoon Mi SHIN ; Hye Young KIM ; Jeong Hoon JI ; Ja Chung GOO ; Byeong Uk KIM ; Sung Soon PARK ; Hae Suk HAN ; Soon Kil KWON ; Dong Woon KIM

Korean Journal of Nephrology.2004;23(5):769-776.

BACKGROUND: The presence of late potentials on the signal-averaged electrocardiography (SAECG) is predictive of ventricular tachycardia and sudden cardiac death. We investigated the acute effect of HD on the SAECG in patients with end-stage renal disease (ESRD). METHODS: Twenty HD patients with normal sinus rhythm on a routine ECG were enrolled. SAECGs were recorded immediately before, within 30 minute after, and then 24 hour after the completion of HD. Serum electrolyte, BUN, calcium, echocardiogram and body weight were examined before and after the HD. RESULTS: Positive late potentials on SAECG were detected in 8 patients (40%) before HD, 12 patients (60%) at 30 minute after HD, and 5 patients (25%) at 24 hour after HD. There was a significant change in QRSd (QRS duration) after HD: (110.3+-9.7 msec before HD; 112.3+-9.3 msec at 30 minute after HD; 109.5+-8.6 msec at 24 hour after HD) (p<0.05). The reduction of serum potassium was greater in positive late potential (n=12) than in negative late potential group after HD (n=8) (p<0.05). A significant negative correlation was seen between the changes of dialysis-induced serum total CO2 and QRSd changes (r=-0.534, p<0.05). CONCLUSION: SAECG parameters tended to be aggravated after HD in patient with ESRD. Prolongation of QRSd after HD could be explained by the changes of potassium and bicarbonate.
Body Weight ; Calcium ; Death, Sudden, Cardiac ; Electrocardiography* ; Humans ; Kidney Failure, Chronic* ; Potassium ; Renal Dialysis* ; Tachycardia, Ventricular

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Central Venous Stenosis in Chronic Hemodialysis Patients: The Effect of Percutaneous Angioplasty and Stenting.

Jeong Min YOON ; Ha Hun SONG ; Young Ok KIM ; Young Soo KIM ; Yoon Kyung CHANG ; Hyung Wook KIM ; Ho Cheol SONG ; Sun Ae YOON ; Suk Young KIM ; Euy Jin CHOI ; Yoon Sik CHANG ; Byung Kee BANG

Korean Journal of Nephrology.2004;23(5):763-768.

BACKGROUND: Central venous stenosis in chronic hemodialysis patients occurs in about 17% of all venous stenosis and it is associated with central vein catheterization. We evaluated the effect of percutaneous angioplasty and stenting in the treatment of central venous stenosis in hemodialysis patients. METHODS: We retrospectively investigated medical records of total 31 dialysis patients who had central venous stenosis. We reviewed the causes of central venous stenosis, clinical manifestations, venographic findings, and patency rate of radiological intervention. RESULTS: Of the total 31 patients, 28 patients had past history of central vein catheterization ipsilateral to vascular access. Mean duration of the catheterization was 32+-14 days. Venography showed complete obstruction of central vein (n=14) and stenosis (n=17). The site of venous lesion was right subclavian vein (n=11), innominate vein (n=9), left subclavian vein (n=7), and superior vena cava (n=14). total 30 procedures of angioplasty with or without stenting were performed in 26 of 31 patients. Initial success rate was 96.1% and there was no severe complication such as rupture or bleeding. The primary patency rate at 6, 12, 24, and 48 month after the procedure was 87.3%, 75.6%, 67.9%, 65.4%, respectively. The cumulative patency rate at the same time point was 96.0%, 90.6%, 74.0%, 72.8%, respectively. CONCLUSION: Our data suggest that angioplasty with or without stenting is safe and effective in the treatment of central venous stenosis in hemodialysis patients.
Angioplasty* ; Arteriovenous Fistula ; Brachiocephalic Veins ; Catheterization ; Catheters ; Constriction, Pathologic* ; Dialysis ; Hemorrhage ; Humans ; Medical Records ; Phlebography ; Renal Dialysis* ; Retrospective Studies ; Rupture ; Stents* ; Subclavian Vein ; Veins ; Vena Cava, Superior

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The Effect of Catheter Revision on Intractable Exit Site Infection in CAPD Patients.

Tae Woo KIM ; Jun Young DO ; Sung Hyun LEE ; Dong Un BAE ; Kyu Hyang JO ; Jong Won PARK ; Kyung Woo YOON

Korean Journal of Nephrology.2004;23(5):753-762.

BACKGROUND: Continuous ambulatory peritoneal dialysis (CAPD) is an important method of renal replacement therapy in chronic renal failure, and reduction of dialysis-associated complication is essential to successful peritoneal dialysis. But catheter related infection is a major cause of catheter loss and transferring to hemodialysis. We use an unique catheter revision method for the treatment of intractable exit-site/tunnel infection in CAPD patients. METHODS: We reviewed 322 CAPD patients on the ESI/TI from May 1995 to January 2003 at Yeungnam University Hospital. Forty-four patients had exit-site infection more than one times. Prevalence of exit-site infection, kinds of causative micro- organism and results of catheter revision were analyzed retrospectively. RESULTS: Total follow-up was 5, 834 patient months. ESI occurred on 141 occasions in 44 patients out of 322 patients and cumulative incidence of ESI was 1 per 41.4 patient months. We started empiric antibiotic therapy with oral penicillinase- resistant penicillin and quinolones, thereafter adjusted antibiotics according to the results of culture and sensitivity. The most common organism responsible for ESI was Staphylococcus aureus (MSSA, 34.8%), followed by Pseudomonas aeruginosa (25.5%). Nineteen patients had to be treated with catheter revision to control intractable ESI/TI. With analysis of ten patients who showed relapsed ESI after catheter revision, 5 patients improved with antibiotic therapy and 3 patients improved with additional secondary revision, but remaining 2 patients showed removal of peritoneal catheter to treat combined peritonitis. CONCLUSION: Catheter revision technique can be regarded as an effective alternative method to treat intractable exit site/tunnel infection before removal of catheter in CAPD patients.
Anti-Bacterial Agents ; Catheters* ; Follow-Up Studies ; Humans ; Incidence ; Kidney Failure, Chronic ; Penicillins ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Prevalence ; Pseudomonas aeruginosa ; Quinolones ; Renal Dialysis ; Renal Replacement Therapy ; Retrospective Studies ; Staphylococcus aureus

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Ten-Year Study of Bacteremia in Hemodialysis Patients in a Single Center.

Yoo Na KANG ; Sun Ae YOON ; Jae Cheol KWON ; Ji Young KANG ; Tae Woo KIM ; Mi Jung SHIN ; Young Soo KIM ; Dong Gun LEE ; Young Ok KIM ; Yoon Sik CHANG ; Byung Kee BANG

Korean Journal of Nephrology.2004;23(5):746-752.

BACKGROUND: The incidence of infection in patients on chronic hemodialysis in higher than that of the general population. Infection is known to be a major cause of morbidity and mortality in these patients. The vascular access is important for hemodialysis, but infection through this route is the most common source of bacteremia and can be lethal to the patients. Despite the high morbidity and mortality of bacteremia in patients on chronic hemodialysis, the clinical characteristics of bacteremia in hemodialysis patients is rarely reported yet in Korea. METHODS: We included 696 hemodialysis patients from January 1993 to December 2003 at Uijongbu St. Mary's Hospital. We investigated incidence, source, causative organisms, clinical manifestations, complication and mortality of bacteremia. We compared clinical factors, morbidity and mortality between arteriovenous fistula and central venous catheter groups. RESULTS: Total 52 cases of bacteremia occurred in 43 patients. The major source of infection was vascular access (48%) and staphylococcus aureus was most common. Major complications were septic shock (9.6%), pneumonia (9.6%), infective endocarditis (3.8%), aortic pseudoaneurysm (1.9%). Nine patients died from septic shock (n=4), aspiration pneumonia (n=2), hypoxic brain injury (n=1), gastrointestinal bleeding (n=1), and rupture of aortic pseudoaneurysm. Central venous catheter group (n= 22) had higher incidences of vascular access as a source of infection (81.8% vs 23.3%, p<0.001) and staphylococcus as a causative organism (77.2% vs 50.0%, p=0.042) than arteriovenous group. CONCLUSION: This data showed that bacteremia caused high incidence of fatal complications and mortality. Therefore, careful management of vascular access as well as early detection of bacteremia is an important factor for the prevention of infection and proper antibiotic therapy should be started early.
Aneurysm, False ; Arteriovenous Fistula ; Bacteremia* ; Brain Injuries ; Catheterization, Central Venous ; Central Venous Catheters ; Endocarditis ; Hemorrhage ; Humans ; Incidence ; Korea ; Mortality ; Pneumonia ; Pneumonia, Aspiration ; Renal Dialysis* ; Rupture ; Shock, Septic ; Staphylococcus ; Staphylococcus aureus

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Clinical Characteristics of Nephrotic Syndrome Associated with Malignancy.

Jung Tak PARK ; Joo Seong KIM ; Hyung Jong KIM ; Dong Ryeol RYU ; Tae Hyun YOO ; Hoon Young CHOI ; Jung Eun LEE ; Taeik CHANG ; Seung Chul LEE ; Hyeon Joo JEONG ; Kyu Hun CHOI ; Ho Yung LEE ; Dae Suk HAN ; Shin Wook KANG

Korean Journal of Nephrology.2004;23(5):738-745.

BACKGROUND: Even though there have been many case reports on nephrotic syndrome in patients with malignancy, an overall study on malignancy- associated nephrotic syndrome is rare in Korea. The purpose of this study was to explore the clinical and pathologic findings and clinical course of malignancy-associated nephrotic syndrome. METHODS: From January, 1986 to December, 2003, the medical records of patients with nephrotic syndrome and concomitant malignancy were retrospectively reviewed. RESULTS: Forty-eight patients (2.3%) out of 2, 085 patients with nephrotic syndrome had concomitant malignant disease during the study period. The mean age of patients was 57.9+-1.6 years with sex ratio of 2.4: 1. The most common primary origin of malignancy was liver (8 patients, 16.7%) and lungs (8 patients, 16.7%), and adenocarcinoma (17 patients, 35.4 %) was the leading histologic type of malignancy. There was no significant difference in 24-hour urinary protein excretion among patients grouped by TNM stage. Percutaneous renal biopsy was performed in 26 patients (54.2%), renal pathology revealed membranous nephropathy and minimal change disease in 9 patients (34.6%) each, membranoproliferative glomerulonephritis in 6 (23.1%), and IgA nephropathy in 2 patients (7.7%). When the patients were divided into progression and remission group based on the clinical course of underlying malignancy, there were significantly more patients with improved nephrotic syndrome in the remission group than the progression group (55.0% vs. 0%, p<0.05). CONCLUSION: Malignancy should be considered as a cause of nephrotic syndrome in adults, and the treatment of underlying malignancy may affect the outcome of nephrotic syndrome in patients with malignancy.
Adenocarcinoma ; Adult ; Biopsy ; Glomerulonephritis, IGA ; Glomerulonephritis, Membranoproliferative ; Glomerulonephritis, Membranous ; Humans ; Korea ; Liver ; Lung ; Medical Records ; Nephrosis, Lipoid ; Nephrotic Syndrome* ; Pathology ; Retrospective Studies ; Sex Ratio

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The Effect of PPAR gamma2 Pro12Ala Polymorphism on Diabetic Nephropathy in Type 2 Diabetes.

Dong Min KIM ; Hyun Lee KIM ; Bum Yun KIM ; Byung Chul SHIN ; Jong Hoon CHUNG ; Hak Yeon BAE ; Byung Rae LEE

Korean Journal of Nephrology.2004;23(5):729-737.

BACKGROUND: Recently, the PPAR gamma2 Pro12Ala polymorphism has been associated with type 2 diabetes and diabetic nephropathy. In the present study, we investigated the association between Pro12Ala polymorphism and diabetic nephropathy in korean subjects. METHODS: A total of 180 patients with type 2 diabetes and 100 normal controls were enrolled in this studies. Screening for mutation at codon of PPAR gamma2 were carried out by PCR-RELP analysis. Also, we measured important covariables, such as duration of diabetes, blood pressure, renal function and serum lipids. RESULTS: In PCR-RELP, it showed that there were no difference in the PPAR gamma2 genotype frequencies between diabetic subjects (Pro/Pro: 80.5%, Pro/Ala: 19.5%) and normal controls (88%, 12%). However, it showed that there were significant difference in the PPAR gamma2 genotype frequencies between diabetic subjects with nephropathy (Pro/Pro: 74.5%, Pro/Ala: 25.5%) and diabetic subjects without nephropathy (87.8%, 12.2%) (p=0.040). In diabetic subjects, Pro/Ala genotypes were significantly different from Pro/Pro regarding serum creatinine, 24 hour proteinuria, systolic pressure, and LDL-cholesterol. In diabetic nephropathy, genotypes with Pro/Ala significantly increased serum creatinine (2.7+/-0.41 vs 1.7+/-0.68 mg/dL), 24hour urine protein (median+-SE: 1.9+/-1.02 vs 0.9+/-0.44 g/day), systolic pressure (161+/-27.8 vs 152+/-32.4 mmHg), LDL cholesterol (134+/-30.4 vs 125+/-20.0 mg/dL), and triglyceride (151+/-86.5 vs 135+/-60.9 mg/dL) than genotypes with Pro/Pro. CONCLUSION: Our results suggested that Pro12Ala Polymorphism of the PPAR gamma2 gene may be associated with diabetes with nephropathy in korean patients.
Blood Pressure ; Cholesterol, LDL ; Codon ; Creatinine ; Diabetic Nephropathies* ; Genotype ; Humans ; Mass Screening ; Peroxisome Proliferator-Activated Receptors* ; Proteinuria ; Triglycerides

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A Study on the Appropriate Normal Range of Serum Creatinine Level for Koreans.

Jongwoo LEE ; Jungeun KIM ; Inwhee PARK ; Sungyo LIM ; Kyongeun SONG ; Hyunkyong CHO ; Gyutae SHIN ; Heungsoo KIM ; Kwangmin KIM

Korean Journal of Nephrology.2004;23(5):721-728.

BACKGROUND: Early identification and appropriate management of mild chronic renal failure has been increasingly recognized as an important opportunity to delay the progression of renal disease. Many physicians rely on serum creatinine (Scr) as a screening test for renal impairment; however, Scr levels can remain within the normal range even when renal function is significantly impaired in certain group of patients. METHODS: The subjects were 20, 245 persons who were enrolled a regular health check up program, Jan. 1997 to Jun. 2001, at Ajou University Hospital, Korea. We identified GFR below 60 mL/min/1.73 m2 as abnormal and found the percentage of patients with Scr value from 1.1 mg/dL to 1.4 mg/dL and their sex and age distribution, using GFRs calculated by Cockroft-Gault Equation, MDRD Equation, and Kang's Equation. RESULTS: Average Scr was 1.07+-0.13 mg/dL in male and 0.82+-0.11 mg/dL in female. Among 34 University hospital in metro Seoul area, 11 hospital used 1.4 mg/dL as normal upper limit of Scr and 7 hospital used 1.3 mg/dL. Taking normal Scr upper limit as 1.3 or 1.4 mg/dL, the frequency of GFR below 60 mL/min/1.73 m2 was 3.9-50% in males and 75-100% in females, although some differences existed according to the equation used. CONCLUSION: Currently used normal Scr upper limit 1.3, 1.4 mL/dL was found to be much too high and we concluded a downward adjustment is needed and one-time test is not adequate to conclude renal impairment but several regular tests are required.
Age Distribution ; Creatinine* ; Female ; Glomerular Filtration Rate ; Humans ; Kidney Failure, Chronic ; Korea ; Male ; Mass Screening ; Reference Values* ; Seoul

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The Effects of Selective Cyclooxygenase-2 Inhibition in Puromycin Aminonucleoside Nephropathy Rats.

Dong Won LEE ; Jung Min SON ; Jung Hee KIM ; You Seok JEONG ; Soo Bong LEE ; Ihm Soo KWAK

Korean Journal of Nephrology.2004;23(5):714-720.

BACKGROUND: It is known that non-steroidal antiinflammatory drugs (NSAIDs) reduce the amount of proteinuria in nephrotic syndrome. It is based on the facts that the NSAIDs block the production of prostaglandins. Therefore selective cyclooxygenase-2 (COX-2) inhibitor may be expected to play a role in reduction of the proteinuria in nephrotic syndrome. METHODS: Twenty-seven Sprague-Dawley rats were divided into 3 groups. After 3 to 5 days of adaptation, we gave puromycin aminonucleoside to groups A and B via intraperitoneal route. The third group C was a normal control group. Selective COX-2 inhibitor was orally given to group A for 2 weeks. Each group was divided again into 3 subgroups by the day of experiment: 1, 14 and 21-day subgroups. We checked the changes in the serum and urine creatinine, albumin concentrations, creatinine clearances, the amount of proteinuria and the pathologic findings. The differences between groups were tested by 2-way ANOVA and Dunnett T-test, and the changes of proteinuria were tested by Repeated measures ANOVA. RESULTS: The changes of 24-hour urine protein excretion were significantly different between three groups (p<0.01). Protein excretion of group A was significantly decreased, especially between 14 and 21 days (p<0.05). The changes of creatinine clearance were significantly different between three groups (p<0.05), between 1 and 21 days (p<0.05). Electron microscopy showed morphological recovery of foot processes after administration of selective COX-2 inhibitor in PAN nephropathy rats (group A). CONCLUSION: It is suggested that selective COX- 2 inhibitors may be effective in reducing proteinuria and protecting the renal function in nephrotic syndrome.
Animals ; Anti-Inflammatory Agents, Non-Steroidal ; Creatinine ; Cyclooxygenase 2* ; Cyclooxygenase Inhibitors ; Foot ; Microscopy, Electron ; Nephrotic Syndrome ; Prostaglandins ; Proteinuria ; Puromycin Aminonucleoside* ; Puromycin* ; Rats* ; Rats, Sprague-Dawley

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Effects of Aminoguanidine on Norepinephrine-Induced Vascular Contraction in Renovascular Hypertensive Rats.

Seok CHOI ; Kyu Bae JUN ; Jae Yeoul JUN ; Pyung Jin YOON ; Jun Soo KIM ; Myung Young KIM ; Hyun Sik MUN ; Cheol Ho YEUM

Korean Journal of Nephrology.2004;23(5):703-713.

BACKGROUND: It has been established that hypertension is characterized by a dysfunctional endothelium. Among the endothelial factors that cause vasorelaxation, nitric oxide has been most widely known, which is synthesized by the enzyme nitric oxide synthase. This study was aimed to evaluate the role of the inducible nitric oxide synthase in chronic two-kidney, one clip (2K1C) hypertensive rats. METHODS: 2K1C hypertension was made by clipping the left renal artery and age- matched rats received a sham treatment served as control. In vitro experiments were preformed on intact and endothelium-denuded isolated thoracic aortic rings from lipopolysaccharide (LPS)-treated rats, in the presence of aminoguanidine alone, considered to be a selective inhibitor of the inducible nitric oxide synthase and of aminoguanidine and the nonselective nitric oxide synthase inhibitor Nomega-nitro-L-arginine (L-NNA). RESULTS: LPS treatment induced a shift to the right of concentration-response curves to norepinephrine in aortic rings with or without endothelium from sham- clipped control rats, while it did not modify in 2K1C hypertensive rats. In aortic rings with endothelium, aminoguanidine caused a significant shift of the norepinephrine concentration-response curve to the left in LPS-treated control rats, but had no effect in hypertensive rats. L-NNA caused an additional shift of the concentration-response curve to norepinephrine in both control and hypertensive rats, although the magnitude was diminished in hypertensive rats. In the endothelium-denuded rings, norepinephrine-induced contractions were enhanced by aminoguanidine in LPS- treated control rats, whereas no significant changes were observed in hypertensive rats. LPS treatment inhibited the relaxation response to acetylcholine in aortic rings from control rats, while it was without effect in hypertensive rats. L-arginine caused a dose-dependent relaxation in endothelium-denuded rings from LPS-treated rats. The relaxation response to L-arginine was attenuated by aminoguanidine in control rats, but no significant changes were noted in hypertensive rats. CONCLUSION: These results provide indirect evidence for an impaired activity of the inducible nitric oxide synthase in 2K1C hypertension, although involvement of an altered activity of constitutive nitric oxide synthase in the endothelium cannot be excluded.
Acetylcholine ; Animals ; Arginine ; Endothelium ; Hypertension ; Nitric Oxide ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type II ; Norepinephrine ; Placebos ; Rats* ; Relaxation ; Renal Artery ; Vasodilation

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