The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 337
Poster Session
PS 1335 Nephrology
Home Blood Pressure Monitoring in Hemodialysis Patients
Che Wan Lim1, Dong Jin Oh1 Myongji Hospital, Korea1
Background: Hypertension is common in hemodialysis (HD) patients and contributes to this population’s high risk for cardiovascular morbidity and mortality. Most hy- pertension treatment decisions use BPs obtained in the clinic, while peri-dialytic BP recordings in the clinic are highly variable and poorly reproducible, making treatment decisions diffi cult. Recently, it is shown that home BP are better predictors of mortal- ity than individual pre- or post-HD BP measurements in US. We purposed to examine the relationship between inter-dialytic home BP and pre-HD, intra-dialytic, and post- HD BP in stable HD patients.
Methods:This was a single center cross sectional study from December 2013 to February 2014. HD patients who had been on treatment for longer than 3 months, were included for the study. Hospitalized patients and those with an acute illness were excluded. Patients who had a change in dry weight or antihypertensive drugs within 2 weeks were also excluded. Home BP monitoring was performed over 1 week using the same automatic oscillometric device . Patients were asked to record their BP three times daily Results:Twenty patients (14 male and 6 female) took part in the study. Mean home BP was 140.4±12.1 and 74.7±12.8 mmHg (systolic and diastolic, respectively). Mean pre-HD BP was 151.4±18.6 and 73.8±10.8 mmHg, and post-HD BP was 126.1±17.3 and 68.9±13.8 mmHg, respectively. In the correlation analysis, Home BP was associated with intra-dialytic BP (r=0.479, p-value 0.033 and r=0.568, p-value 0.009, systolic and diastolic respectively). In contrast, pre-HD BP was associated with home BP only for systolic BP (r=0.449, p-value 0.047), and post-HD BP was associated with home BP only for diastolic BP(r=0.563, p-value 0.019).
Conclusions: Home BP was associated with intra-dialytic BP better than pre-HD or post-HD BP. We might have to consider intra-dialytic BP with more attention when managing hypertension in HD patients
PS 1336 Nephrology
Spontaneous Renal Rupture in a Hemodialysis Patient
Jinkyung Park1, Sungho Kim1, Heejin Kim2, Dukhyun Lee1
Department of Internal Medicine, Daegu Fatima Hospital, Korea1, Department of Radiology, Daegu Fati- ma Hospital, Korea2
Spontaneous rupture and bleeding of the kidney is a rare event and caused mostly by renal cell carcinoma, angiomyolipoma, vascular diseases or acquired cystic renal disease. We report a case of spontaneous renal rupture which occurred in 50-year-old woman with end-stage renal disease.
Case: A 50-year-old woman with end-stage renal disease caused by chronic glomer- ulonephritis visited emergency room with severe left fl ank pain. She was on hemodi- alysis for 13 years and had no history of trauma. Computed tomography showed con- siderable hematoma on left pararenal area, atrophy of both kidneys and multiple small renal cysts. Emergent selective renal angiogram was performed and contrast leakage was seen at the upper pole of left kidney. Immediate left renal artery embolization was performed without any complication. The occurrence of acquired cysts in kidneys with primary chronic kidney disease is found in 10-95% of patients, depending on age (more frequent in the elderly), renal function (more frequent in advanced renal fail- ure), and duration of renal failure/dialysis therapy. Clinical complications such as pain, hemorrhage, infection, malignancy, and nephrolithiasis can occur in acquired cystic renal disease. Some studies report that anticoagulant therapy or using heparin during hemodialysis is associated with the risk of cystic rupture and bleeding. The occurrence of spontaneous renal rupture should always be considered on regular hemodialysis patients when unexplained distress or fall of hemoglobin suddenly takes place.
Figure 1. Abdominal CT scans show huge hematoma in left subcapsular and pararenal space. Diffuse renal atrophy and multiple small cysts are seen in both kidneys. The arrows indicate hematoma of ruptured kidney.
PS 1337 Nephrology
The Impact of Pre-Existing Arterial Micro-Calcifi cation of the Vascular Access on Early AVF Failure in Incident Hemodialysis Patients
Su Jin Choi1, Young Soo Kim1, Sun Ae Yoon1, Young Ok Kim1 The Catholic University of Korea, Uijeongbu St. Mary`s Hospital, Korea1
Background: Vascular access micro-calcifi cation found on pathology studies has been reported as a risk factor for cardiovascular morbidity and mortality in HD patients.
However the relationship between arterial micro-calcifi cation (AMiC) detected on pa- thology study and the patency of vascular access has rarely been reported. The aim of this study was to determine the impact of AMiC on the patency of vascular access in HD patients.
Methods: One-hundred six HD patients (Mean age: 59.6 ± 12.9 years, Male/Female:
66/40, Percent of diabetes mellitus: 68.9%) receiving arteriovenous fi stula (AVF) oper- ation were included in this study. We obtained a partial arterial specimen intra-opera- tively and performed pathologic examination by von Kossa staining to identify AMiC.
We investigated early AVF failure (poor maturation or severe stenosis requiring radio- logic intervention or surgical correction within 1 year after the operation) between the patients with AMiC and those without AMiC.
Results: The incidence of AMiC was 38.7% (n = 41) and calcifi cation was found in the medial layer. Early AVF failure occurred in 45 patients (42.5%), and the mean time between the operation and access failure was 4.1 ± 3.1 months. The access failure rate within 1 year after the operation was greater in patients with AMiC than those without AMiC (56.1% vs. 33.8%, P = 0.024). Kaplan-Meier analysis showed that the presence of AMiC signifi cantly increased the risk for AVF failure (Log rank = 4.98, P = 0.026). Presence of AMiC (hazard ratio: 1.994, 95% confi dence interval: 1.024-3.881, P
= 0.042) was an independent risk factor for early AVF failure on Cox regression analy- sis.
Conclusions: This study demonstrated that pre-existing AMiC of the vascular access was associated with early AVF failure in incident HD patients.
