Hemodialysis Patients In Korea Research Articles

Importance of dialysis specialists in early mortality in elderly hemodialysis patients: a multicenter retrospective cohort study

The early mortality rate in elderly patients undergoing hemodialysis is more than twice that in young patients, requiring more specialized healthcare. We investigated whether the number of professional dialysis specialists affected early mortality in elderly patients undergoing hemodialysis. This multicenter retrospective cohort study analyzed data from 1860 patients aged ≥ 70 years who started hemodialysis between January 2010 and December 2017. Study regions included Seoul, Gyeonggi-do, Gangwon-do, Daejeon/Chungcheong-do, Daegu/Gyeongsangbuk-do, and Busan/Ulsan/Gyeongsangnam-do. The number of patients undergoing hemodialysis per dialysis specialist was calculated using registered data from each hemodialysis center. Early mortality was defined as death within 6 months of hemodialysis initiation. Gangwon-do (28.3%) and Seoul (14.5%) showed the highest and lowest early mortality rate, respectively. Similarly, Gangwon-do (64.6) and Seoul (43.9) had the highest and lowest number of patients per dialysis specialist, respectively. Relatively consistent results were observed for the regional rankings of early mortality rate and number of patients per dialysis specialist. Multivariate Cox regression analysis—adjusted for previously known significant risk factors—revealed that the number of patients per dialysis specialist was an independent risk factor for early mortality (hazard ratio: 1.031, p < 0.001). This study underscores the growing need for dialysis specialists for elderly hemodialysis patients in Korea.

The effectiveness of structured educational programs for hemodialysis patients in Korea: an integrated literature review

Purpose: The purpose of this study was to provide evidence for future research by analyzing the contents, delivery methods, and educational effects of educational programs for hemodialysis patients. Methods: A literature review was conducted in the following order: problem identification, literature search and data collection, data evaluation, data analysis, and data presentation. In total, 936 documents were retrieved from the search, and 24 documents were finally included in this study. Results: The contents of the educational programs were comprehensive hemodialysis-related knowledge education in seven studies, exercise-related education in 10 studies, diet-related education in four studies, drug-related education in one study, and complex education in two studies. The delivery methods were pamphlets in six studies, audio-visual materials in four studies, direct guidance by researchers in six studies, and multiple methods in seven studies. The effects of the educational program were divided into physical indicators, emotional indicators, and knowledge and performance related to hemodialysis. Sixteen out of 20 articles using physical indicators showed significant outcomes, and 10 out of 12 articles using emotional indicators derived positive results. Hemodialysis-related knowledge and performance were measured in eight and 10 studies, respectively, and meaningful results were found in six studies for knowledge and seven studies for performance. Conclusion: Future research will require the development of a systematic and standardized educational program with comprehensive content that can be provided to all hemodialysis patients, as well as a highly accessible education delivery method to enhance the effectiveness of education.

Burden, Depression, and Awareness of Information on Safety Behavior in Korean Hemodialysis Patients during the COVID-19 Pandemic.

The purpose of this study was to investigate the relationships among burden, depression, awareness of information (AIC), and safety behavior among hemodialysis patients in Korea during the COVID-19 pandemic. The study participants included 149 patients who received hemodialysis at seven general hospitals in Korea between January and February 2021. A structured questionnaire was used to survey their levels of burden, depression, AIC, adherent safety behavior (ASB), and dysfunctional safety behavior (DSB). The study results showed that the influencing factors of ASB for COVID-19 were AIC (β = 0.265, p < 0.001), the burden of “not receiving hemodialysis on time” (β = 0.233, p = 0.008), and the burden of “social exclusion of hemodialysis patients” (β = 0.186, p = 0.032). The influencing factors of DSB were the burden of “social exclusion of hemodialysis patients” (β = 0.258, p = 0.003) and AIC (β = 0.217, p = 0.004). As the COVID-19 pandemic continues, the latest evidence-based information must be provided to hemodialysis patients to promote self-care and prevention behavior that encourages ASB and discourages DSB.

Trends in the incidence and prevalence of end-stage renal disease with hemodialysis in entire Korean population: A nationwide population-based study.

Data on the overall epidemiology and temporal trends of end-stage renal disease (ESRD) requiring hemodialysis in Korea are scarce. We aimed to estimate the prevalence and incidence of ESRD requiring hemodialysis in Korea between 2002 and 2017.Using the National Health Insurance Service database, we analyzed data from the entire Korean population between 2002 and 2017. Hemodialysis patients were identified using rare incurable disease codes (V001) or prescription of medical fee codes of hemodialysis (O7020 and O7021). We only included patients who had been maintained on hemodialysis for more than 90 days from the date of dialysis initiation, to exclude patients who required short-term dialysis for acute kidney injury, conversion to peritoneal dialysis, or kidney transplantation.During the 16-year follow-up, the number of hemodialysis patients in Korea has steadily increased from 11,215 in 2002 to 67,486 in 2017. The mean age of these patients has gradually increased from 55.57 ± 13.31 years in 2002 to 62.13 ± 13.23 years in 2017. In 2017, the crude prevalence rate of hemodialysis was 1303.4 per million population. Overall, the number of men tended to be somewhat higher than that of women, and the proportion of men increased slightly from 55.56% in 2002 to 58.45% in 2017. The proportion of diabetic patients increased rapidly from 23.84% to 47.84%, and the percentage of dyslipidemic patients rose from 18.9% to 86.7%. The number of incident hemodialysis patients increased significantly from 4406 in 2003 to 12,134 in 2014, and then decreased to 8090 in 2017. In the incident cases of hemodialysis, the observed increase in the proportion of male patients and in diabetes and dyslipidemia were similar to that of prevalent patients. The more recent era of hemodialysis initiation, the better 5-year survival rates were observed.The prevalence and incidence of hemodialysis in Korea gradually increased between 2002 and 2017. The proportion of men, and patients with diabetes and dyslipidemia requiring hemodialysis also increased continuously. The survival rate of hemodialysis patients was gradually improving. These findings may serve as a reference for future epidemiological studies on hemodialysis in Korea.

An Alternative View of a Hemodialysis-Life Balance: Life Reorganization of Korean Patients Undergoing Hemodialysis.

Hemodialysis patients in Korea increased 2.3 fold from 2008 to 2018 and continues to rise 7% to 10% annually. Long-term treatment to prevent complications requires understanding patients' hemodialysis-life balance. Our purpose was to explore the process of life reorganization by hemodialysis patients from Korea. Grounded theory methodology was utilized. Participants were hemodialysis patients recruited from four hemodialysis centers in Korea. Data were collected by in-depth individual interviews. Data were analyzed using constant comparative method with theoretical saturation. Participants (n = 14) experienced four phases with transitions. A traditional Korean belief system, the view of blessing-focused destiny promoted a change in perspective from the focus on a life crisis, and thereby, played a role in buffering negative experience. Nurses should assess the cultural individual needs of patients, which change according to each phase of life reorganization, and provide the right care at the right time to increase positive experiences.

P1504RELATIONSHIP OF LOW BODY MASS INDEX AND SURVIVAL IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Malnutrition is common in patients with hemodialysis and major risk factor of mortality. The Korean Society of Nephrology (KSN) collected data of end-stage renal disease registry since 1985. We evaluated whether body mass index (BMI) can affect mortality in patient with hemodialysis. Method From 2004 to 2015, a total of 32,163 patients starting hemodialysis were included. The patients were divide four groups according quartiles of BMI measurement. Results At baseline, mean age was 59.0 ± 14.3 years old, and 60.0% were men. The 5-year mortality of hemodialysis patients was 16.9 % (N=5,435) and ratio of unknown state was 24.9 % (N=7,996). The mean of BMI in each quartiles were 18.2 ± 1.2, 20.8 ± 0.5 22.8 ± 0.6, 26.4 ± 2.6 kg/m2 respectively. The mean of BMI between survivor and non-survivor were different (22.3 ± 3.3 vs. 21.5 ± 3.2 kg/m2). Cox-proportional regression multivariate analysis revealed that the 5-year all-cause mortality was associated with age (HR 1.04, CI 1.03-1.05), diabetes (HR 1.34, CI 1.07-1.7) coronary heart disease or heart failure (HR 1.3, CI 0.9-1.7), 2nd BMI quartile (HR 0.7, CI 0.5-0.9), 3rd BMI quartile (HR 0.6, CI 0.46-0.88), 4th BMI quartile (HR 0.59, CI 0.43-0.82), hypoalbuminemia (HR 2.9, CI 2.3-3.7) and anemia (HR 1.6, CI 1.2-2.0) . Conclusion Higher quartiles of BMI was significantly associated with better survival rate in hemodialysis patients in Korea. Traditional risk factors of malnutrition, such as hypoalbuminemia, anemia were also independent risk factor for mortality. This result suggests that hemodialysis patients needed to nutritional support.

P1496TRENDS IN THE INCIDENCE AND PREVALENCE OF END-STAGE RENAL DISEASE PATIENTS WITH HEMODIALYSIS IN ENTIRE KOREAN POPULATION: A NATIONWIDE POPULATION-BASED STUDY

Abstract Background and Aims Data on the epidemiology and temporal trends of end-stage renal disease (ESRD) with hemodialysis are not well established in the entire Korean population. We aimed to estimate the incidence and prevalence of ESRD with hemodialysis in Korea between 2002 and 2017. Method Using the National Health Insurance Service database, we analyzed entire Korean population from 2002 to 2017. Hemodialysis patients was identified by using rare incurable disease codes (V001) or prescription of medical fee code of hemodialysis (O7020, O7021). We only included patients who have been maintained hemodialysis more than 90 days from the date of dialysis initiation to exclude short-term dialysis due to acute kidney injury or patients who converted to peritoneal dialysis or kidney transplantation. Results During the 16-year follow-up, the number of hemodialysis patients in Korea has steadily increased from 11,251 in 2002 to 67,486 in 2017. The mean age of hemodialysis patients has gradually increased from 55.57±13.31 years in 2002 to 62.13±13.23 years in 2017. Overall, the number of men tended to be somewhat higher than that of women, and the proportion of men increased slightly from 55.56% in 2002 to 58.45% in 2017. The proportion of diabetic patients increased rapidly from 23.84% to 47.84%, and the percentage of hyperlipidemic patients rose from 18.9% to 86.7%, while the percentage of hypertensive patients did not show a significant increase. The number of incident hemodialysis patients increased significantly from 4,406 in 2003 to 12,134 in 2014 and then decreased to 8,090 in 2017. In the incident patients, the increase in the proportion of male patients and the increase in diabetes and hyperlipidemia were observed in similar manner with prevalent patients. Conclusion The incidence and prevalence of hemodialysis in Korea gradually increased from 2002 to 2017. The proportion of men, diabetes and hyperlipidemia among patients with hemodialysis also increased continuously. These findings may contribute as groundwork for epidemiological studies of hemodialysis in Korea.

The Effectiveness of Stress Intervention Program for Hemodialysis Patients in Korea: A meta-analysis

The Effectiveness of Stress Intervention Program for Hemodialysis Patients in Korea: A meta-analysis

Validity and Reliability of the Korean Version of the Dialysis Symptom Index for Hemodialysis Patients.

Hemodialysis patients experience physical and psychosocial symptoms caused by comorbid illnesses, treatment-related side effects, lifestyle alteration, and the psychosocial impacts of living with end-stage renal disease. The Dialysis Symptom Index (DSI) is the most frequently used instrument to assess symptoms of chronic kidney disease and end-stage renal disease in patients. The aims of this study were to develop the Korean version of the DSI, to verify the reliability and validity of the developed tool, and to use the tool to evaluate the symptoms of hemodialysis patients in Korea. A methodological study was performed on 230 hemodialysis patients from three hospitals who agreed to participate in the study from October 1 to 30, 2015. The Symptom Checklist-90-Revised was used to verify the convergent validity, whereas the total score of Kidney Disease Quality of Life Questionnaire-Short Form, Version 1.3, was used to verify the divergent validity. Data were analyzed using descriptive analysis, Cronbach's alpha, confirmatory factor analysis, and Pearson's correlation analysis. The internal consistency reliability of the Korean DSI assessed by Cronbach's alpha was .90. The Korean DSI showed a high positive correlation coefficient of .80 with symptom severity using the Symptom Checklist-90-Revised, which confirmed the convergent validity. Finally, the correlation coefficient with the quality of life of the participants using the Kidney Disease Quality of Life Questionnaire-Short Form, Version 1.3, was -.68, which confirmed the divergent validity. This study developed the Korean version of the DSI and verified its validity and reliability. The Korean version of the DSI showed good properties and may be used to assess the symptoms of hemodialysis patients. Nurses may use this self-report tool to better understand and help relieve the prevalence and severity of symptoms in hemodialysis patients in Korea.

국내 혈액투석 환자의 운동프로그램 효과에 관한 메타분석

국내 혈액투석 환자의 운동프로그램 효과에 관한 메타분석

Validity and Reliability Test of the Korean Version of the Hemodialysis Self-Management Instrument (HDSMI-K)

Objectives The purpose of this methodological study was to evaluate the validity and reliability of the Korean version of the Hemodialysis Self-Management Instrument (HDSMI). Methods Forward-backward translation was performed to develop the Korean version of the HDSMI. The translated scale was pilot tested and then administered to 215 patients with hemodialysis from January to February, 2016. Construct validity using exploratory and confirmatory factor analysis and internal consistency reliability were conducted. Results Through a principal component method of exploratory factor analysis, the original twenty items were analyzed into four factors - problem solving and communication (7 items, 33.8%), fluid and weight control (3, 8.3%), diet and hemodialysis (5, 6.6%), and self-advocacy and emotion control (5, 5.7%), explaining 54.5% of total variance. The four-subscale model was validated by confirmatory factor analysis (χ2/df=2.13, p<0.001, RMR=0.04, GFI=0.86, CFI=0.87, TLI=0.85, RMSEA=0.07). Factor loadings of the four sub-scales ranged from 0.69 to 0.78. Average variance extracted was .80 and construct reliability was 0.94. The Cronbach’s alpha for the total scale was 0.89. Conclusions The Korean version of the Hemodialysis Self-Management Instrument showed acceptable reliability and validity and can be utilized to assess self-management behaviors of hemodialysis patients in Korea. Additional studies are recommended to continue the psychometric evaluation of self-management scale. Key words: Self-management, Renal dialysis, Chronic disease, Validity and reliability, Measures

Overhydration measured by bioimpedance analysis and the survival of patients on maintenance hemodialysis: a single-center study

BackgroundBioimpedance analysis (BIA) helps measuring the constituents of the body noninvasively. Prior studies suggest that BIA-guided fluid assessment helps to predict survival in dialysis patients. We aimed to evaluate the clinical usefulness of BIA for predicting the survival rate of hemodialysis patients in Korea. MethodsWe conducted a single-center retrospective study. All patients were diagnosed with end-stage renal disorder and started maintenance hemodialysis between June 2009 and April 2014. BIA was performed within the 1st week from the start of hemodialysis. The patients were classified into 2 groups based on volume status measured by the body composition monitor (BCM; Fresenius): an overhydrated group [OG; overhydration/extracellular water (OH/ECW) >15%] and a nonoverhydrated group (NOG; OH/ECW ≤15%). ResultsA total of 344 patients met the inclusion criteria. Of these, 252 patients (73.3%) were categorized into the OG and 92 patients (26.7%) into the NOG. Age- and sex-matching patients were selected with a rate of 2:1. Finally, 160 overhydrated patients and 80 nonoverhydrated patients were analyzed. Initial levels of hemoglobin and serum albumin were significantly lower in the OG. During follow-up, 43 patients from the OG and 7 patients from the NOG died (median follow-up duration, 24.0 months). The multivariate-adjusted all-cause mortality was significantly increased in the OG (odds ratio, 2.569; P = 0.033) and older patients (odds ratio, 1.072/y; P < 0.001). No significant difference of all-cause or disease-specific admission rate was observed between the 2 groups. ConclusionThe ratio of OH/ECW volume measured with body composition monitor is related to the overall survival of end-stage renal disorder patients who started maintenance hemodialysis.

Clinical outcome of percutaneous thrombectomy of dialysis access thrombosis by an interventional nephrologist

BackgroundTraditionally, the treatment of a thrombosed dialysis access in hemodialysis patients in Korea has been primarily performed by vascular surgeons and interventional radiologists. The objective of this study was to evaluate the outcome of percutaneous thrombectomy procedures performed by an interventional nephrologist. MethodsFrom October 2010 to May 2014, 75 consecutive percutaneous thrombectomies were performed on 42 patients treated with maintenance hemodialysis. All percutaneous thrombectomy procedures were performed by an interventional nephrologist in a single hospital in Jeju, Korea. The thrombosed arteriovenous graft and arteriovenous fistula were declotted by thromboaspiration mechanical thrombectomy or pharmacomechanical thrombolysis. Kaplan–Meier survival analysis was performed to analyze the primary and secondary patency after the initial successful thrombectomy. Success and complication rates were identified and compared with the recommendations of the Kidney Disease Dialysis Outcomes Quality Initiative (KDOQI) guideline. ResultsThe overall clinical success rate was 89.3% (67/75). In the successful cases, the postintervention primary (unassisted) patency rates at 30 days, 90 days, and 180 days were 79.9%, 56.6%, and 25.6%, respectively. The secondary patency rates at 30 days, 90 days, and 180 days were 92.2%, 85.7%, and 83.7%, respectively. There were no major complications, and all complications were treated successfully during the procedure. ConclusionThe clinical success rate and primary patency rate at 3 months exceeded the recommendations of the KDOQI guideline, and were comparable to that of other reports. Percutaneous thrombectomy by an interventional nephrologist was safe and effective.

The Influence of Cognitive Coping on Hope, Depression and Satisfaction with Life in Hemodialysis Patients

Purpose: The purpose of the study was to examine the relationships between cognitive coping, hope, depression, and life satisfaction of hemodialysis patients based on the stress-coping model. Methods: For this cross-sectional survey, 142 participants were recruited from 10 local clinics in Seoul and Daegu during 2012-2013. The data collection instruments included the Cognitive Emotion Regulation Questionnaire, the Herth Hope Index, the Hospital Anxiety and Depression Scale, and the Satisfaction with Life Scale. The data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation analysis, and stepwise multiple regression. Results: The cognitive coping scores were significantly related to hope, depression, and life satisfaction. The coping strategies explained 80%, 37%, and 38% of the variances in hope, depression, and life satisfaction, respectively. The most powerful coping strategy was positive refocusing, explaining 73% in hope, 25% in depression, and 25% in life satisfaction. Conclusion: The results of the study indicate that cognitive coping plays an essential role for psychological adaptation of hemodialysis patients. Thus, interventions integrating positive refocusing would help instilling hope of hemodialysis patients in Korea.

Depression and health-related quality of life in maintenance hemodialysis patients

This study was designed to determine the prevalence of depression among hemodialysis (HD) patients from urban hospitals in Korea, to illustrate demographic factors and biomarkers associated with depression and health-related quality of life (HRQOL), and to demonstrate association between depression and HRQOL. For this multicenter, cross-sectional study, 160 HD patients from 3 university teaching hospitals and 3 local dialysis units in Korea were enrolled. Korean Beck's depression inventory and Korean version of Kidney Disease Quality of Life short form, version 1.3 (KDQOL-SFTM 1.3) were used to evaluate depression and quality of life, respectively. Depression was found in 51 out of 160 (31.9%) patients. Old age (> 60 years old), low hemoglobin level (< 10 g/dl), and low economic status were associated with depression, and old age (OR 6.138, p = 0.001) was the most important risk factor among them. Old age, female gender, presence of diabetes mellitus, high comorbidity index score (modified Charlson comorbidity index > or = 6), hypoalbuminemia (< 4.0 g/dl), and high CRP (> 0.5 mg/dl) were common factors associated with decreased HRQOL. Depression and HRQOL showed inverse linear relationship. Moderate to severe depression was common in maintenance HD patients in Korea. Among factors associated with depression and decreased HRQOL, some characteristics are potentially modifiable by social and medical intervention. Further prospective studies are warranted to see whether depression and HRQOL can be improved by modifying these factors.

Association of nutritional status and diet quality in hemodialysis patients

Variety and adequacy of food intake as well as dietary pattern affect nutritional status of hemodialysis (HD) patient's. The aim of this study was to investigate the quality of diet and nutritional status in HD patients and to find out the relationships among the variables. We assessed nutritional status and diet quality of 63 HD patients (age: 55.3 ± 11.9 yrs; men/women ratio: 49.2%/50.8%) using Subjective Global Assessment (SGA) and 3‐day diet recall methods, respectively. Patient's daily energy intake (DEI) and protein intake (DPI) were 21.9 ± 6.7 kcal/BW/day and 0.9 ± 0.3 g/BW/day, respectively. About 70% of HD patients appeared to have lower daily energy and protein intake compared to recommended amount. More than 50% of HD patients had lower intake of vitamin C, B1, B2, niacin, folate, calcium, and zinc below75% of Dietary recommended intakes. Nutrient intakes per 1,000kcal indicated that HD patients had diets that were lower in nutrient density for Vitamin C, B1, B2, folate, and calcium. There was significant positive correlation between DEI and SGA scores (r=0.3, p&lt;0.05). DQI‐I was significantly correlated with DEI, DPI and lean body mass (kg) (r=0.5, p&lt;0.01; r=0.4, p&lt;0.01; r=0.3, p&lt;0.05, respectively). As increased in disease severity measured by End‐Stage Renal Disease Severity Index (ESRD‐SI), FVS score decreased (r=−0.3, p&lt;0.05). The results of this study indicate that HD patients in Korea consumed less calories, protein, vitamin C, B1, B2, folate, and calcium than recommended amount for each nutrient for HD patients. This study also confirmed that nutritional status and disease severity were significantly correlated with dietary quality.Grant Funding Source: ASN

A cross-sectional study comparing the nutritional status of peritoneal dialysis and hemodialysis patients in Korea

Objective: This study was performed to compare the nutritional status of peritoneal dialysis (PD) and hemodialysis (HD) patients in Korea and to validate the nutritional assessment method. Design: For nutritional assessment, we used five nutrition-related indicators, including percentage unplanned weight loss, percentage ideal body weight (IBW), serum albumin, appetite and intake, and any gastrointestinal symptoms affecting intake. A 1-month food frequency interview was conducted by clinical dietitians using food models to estimate energy and protein intake. The validity of the nutritional assessment method was tested by objective measures. Patients/Setting: A cross-sectional study was conducted in our center for 51 PD patients and 169 HD patients who met the study criteria. In the study, HD patients typically underwent dialysis three times per week, and most PD patients performed four 2-L dialysis exchanges every day. Results: Our data showed a higher incidence of malnutrition in PD patients than in HD patients (33% v 18%) and in diabetics than in nondiabetics. Age, height, and dietary energy intake of the two groups were comparable. In PD patients, however, duration of dialysis treatment (23.9 ± 19.1 months v 41.8 ± 31.7 months, P < 0.001) and serum albumin (35.2 ± 5.0 g/L v 39.7 ± 3.4 g/L, P < 0.0001) were significantly lower, whereas percentage IBW (108.1% ± 12.4% v 96.2% ± 11.6%, P < 0.0001) and dietary protein intake (1.12 ± 0.34 g/kg IBW v 0.98 ± 0.31 g/kg IBW, P < 0.05) were significantly higher than in HD patients. In malnourished PD and HD patients, percentage IBW, serum albumin, dietary energy, and protein intake were significantly lower than in well-nourished counterparts. Conclusion: A higher incidence of malnutrition was observed in PD patients than in HD patients. Nutritional profile of PD patients was different from that of HD patients. Higher body weight and lower serum albumin in PD patients did not seem to be related to dietary energy and protein intake. The five nutritional indicators can be used as a simple inexpensive and reliable method for the early detection of malnutrition in dialysis patients.