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소아복막투석의 현황: 다기관 공동연구 결과보고

Current Status of Children on Peritoneal Dialysis in Korea : A Cross-Sectional Multicenter Study

최용|유기환|박영서|정해일|임형은|하일수|이주훈|백경훈|윤지석
대한소아신장학회 (The Korean Society Of Pediatric Nephrology)|2009.10|Childhood Kidney Diseases (Childhood Kidney diseases)|제13권 제2호|pp. 176-188

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키워드

End-Stage Renal DiseasePeritoneal Dialysis
주제분류소아과학

초록

목 적 : 복막투석요법은 말기 신부전 환아에서 신이식 다음으로 추천되는 신대체 요법으로 현재 말기 신부전 환아들의 장기 생존율 향상으로 복막투석요법 환아 수가 점차 증가하고 있다. 현재 한국 내 복막투석요법 소아에 대한 현황을 파악하고자 이번 연구를 시행하였다. 방 법 : 2008년 5월 국내 4개 대학병원을 대상으로 전자우편 설문조사를 시행하였고 현재 3개월 이상 복막투석 중인 103명의 소아를 대상으로 자료를 분석하였다. 결 과 : 대상 환아 103명의 남녀비는 1.6:1로 남아가 많았고, 평균 연령은 11.5±4.9세(0-19세), 투석시작 전 말기 신부전의 원인 중 원발성 사구체 질환이 34%로 가장 많았다. 복막투석의 형태는 지속적 외래 복막투석법이 42.7%로 가장 많았고, 주간 전체 Kt/V는 2.1± 0.7 (0.3-4.1), 복막평형검사상 저 투과성이 36.8%, 저평균 투과성이 31.6%으로 가장 많은 비율을 차지했다. 체중 표준편차점수(Z-score)는 -1.00± 1.20(-4.54-+2.50), 신장 표준편차점수(Z- score)는 -1.55±1.65(-9.42-+1.87)였고, 성장호르몬은 24.3%에서 투여 중이었다. 38.8%의 환아에서 이완기 혹은 수축기 혈압 95 백분위수 이상의 고혈압을 보였고, 64.0%의 환아가 항고혈압제 투여 중이었다. 평균 혈청 혈색소는 10.5±1.4 g/dL, 평균 혈청 칼슘은 9.7± 0.7 mg/dL, 평균 혈청 인은 5.4± 1.4 mg/dL, 평균 부갑상선 호르몬은 324.2± 342.8 pg/ mL였다. 결 론 : 국내 복막투석요법 소아에서 원발성 사구체 질환이 소아 말기 신부전의 가장 흔한 원인이고, 지속적 외래 복막투석법이 가장 흔히 사용되는 복막투석 형태이며, 복막평형검사상 저 투과성과 저평균 투과성이 가장 많았다. 대부분의 환아가 적절한 신장과 체중을 유지하고 있었으나 저신장 환아의 경우 성장 호르몬 치료가 제대로 이루어지지 않고 있었고 여전히 많은 환아에서 빈혈과 고혈압이 관찰되었다. 혈청 칼슘과 인은 비교적 정상범위를 유지하고 있으나 많은 환아가 이차성 부갑상선 기능 항진증을 보였다.

Abstract

Purpose : Peritoneal dialysis (PD) is the major form of dialysis in use for infants and children with end-stage renal disease (ESRD). The aim of this study was to gain insight into the current status of children on PD in Korea. Methods : In May 2008, questionnaires were sent to the pediatric nephrologists via e-mail. Four centers replied and those data were reviewed. Results : A total of 103 patients were included in this study. Male to female ratio was 1.6:1. Mean age was 11.5± 4.9 years (0-19 years). Primary renal diseases diagnosed were as follows: primary glomerular disease (34%), chronic pyelonephritis-reflux nephropathy (14.6%), systemic disease (9.7%), renal hypoplasia/dysplasia (8.7%), heredofamilial disease (6.8%), vascular disease (3.9%), drug-induced nephropathy (1.0%), and unknown (12.6%). PD modalities were as follows: CAPD (42.7%), CCPD (27.2%), NIPD (11.7%), and Hybrid (18.4%). Weekly total Kt/V was 2.1± 0.7 (0.3- 4.1). Results of peritoneal equilibrium test were as follows: low 36.8%, low average 31.6%, high average 19.7%, and high 11.8%. Z-score for weight was -1.00± 1.20 (-4.54～+2.50). Z-score for height was -1.55± 1.65 (-9.42～+1.87). Growth hormone was administered in 24.3% of patients. Anti-hypertensive drugs were administered in 64.0% of patients. Laboratory findings were as follows: hemoglobin 10.5± 1.4 g/dL, calcium 9.7± 0.7 mg/dL, phosphorus 5.4± 1.4 mg/dL, and parathyroid hormone 324.2± 342.8 pg/mL. Conclusion : Primary glomerular disease was the most common cause of ESRD. CAPD was the most prevalent PD modality. Low and low average peritoneal transport type were common. Growth disturbance were noted in many patients. Some patients had hypertension even with anti- hypertensive drugs. Calcium-phosphorus levels were maintained adequately, but many patients had secondary hyperparathyroidism.

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