지속성 복막투석의 동물 모델에서 복막휴식이 용질 수송과 복막 섬유화에 미치는 영향

김석재(Seog Jae Kim),김용림(Yong Lim Kim),조동규(Dong Kyu Cho),김용진(Yong Jin Kim),김준홍(Jun Hong Kim),김성호(Sung Ho Kim),김찬덕(Chan Duck Kim),남직화(Jick Hwa Nam) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.3

N/A Ultrafiltration failure has been known as a major cause of dropout from long-term peritoneal dialysis and is often related to peritoneal hyperpermeability. This can be explained in part by progressive peritoneal fibrosis. The present experiment has been under- taken to evaluate the effects of peritoneal rest on peritoneal transport and morphology in rat model of peritoneal dialysis. Twenty-four male rats(Sprague-Dawley, 250-300g) were used and divided into three groups : group 1 (control, n=6) without dialysis, group 2(n=9) sacrificed immediately after 3 weeks of dialysis, and group 3 (n=9) sacrificed after 4 weeks of peritoneal rest after 3 weeks of dialysis. Peritoneal dialysis was performed twice a day with 25mL of 3.86% dextrose solution for 3 weeks. Peritonitis was induced by supplementing lipopolysaccharide(5μg/mL) in the dialysis fluid on days 8, 10 and 12 of peritoneal dialysis. Peritoneal equilibration tests were performed before dialysis and repeated on the 4th and 8th week of dialysis. Mor-phometric analysis of the peritoneal membrane and immunohistochemistry for collagen type I and type III were done in tissue specimens obtained at the time of sacrifice. The D/Do ratio for glucose at two hours in groups 2 and 3 at the beginning of week 4 were signifi-cantly lower than baseline value, indicating increase in the peritoneal penneability to glucose after 3 weeks of dialysis. D/Do in group 3 at the beginning of week 8, after 4 weeks of peritoneal rest, was significantly higher than at week 4. The drained dialysate volumes in groups 2 and 3 at week 4 were significantly lower than at baseline; however, The drained dialysate volume in group 3 at week 8 was significantly greater than at week 4. The thickness of the parietal peritoneal membraoe in group 2 and 3 were significantly greater than in group 1. Severity of the thickness of the parietal peritoneal membrane in group 3 was not much than that of group 2(group 1, 11.4±7.6; group 2, 37.5±18.4; group 3, 21.4±12.1 pm). Histologically, the thickened peritoneum in group 2 showed a monolayer of mesothelial cells and under-lying multilayer of curled collagen bundles. Mononu-ciear cells and fibroblasts were embedded in these collagen layers and capillary proliferation was present. Immunohistochemistry for collagen type I and Z demonstrated that the distribution of collagen type llI was richer than that of collagen l in group 2 at fibrotic area of submesothelial region. These findings were decreased in group 3. Ultrastructural examination of the peritoneum showed thicker fibrotic zone and the activated fibro-blasts in group 2 compared to group 1 and 3. Meso-thelial cells were plump and the number of meso-thelial microvilli was decreased in group 2. Nucleus was enlarged and irregular. Intracytoplasmic orga-nelles were also richer than those of group I or 3. In conclusion, peritoneal rest improves ultrafil- tration in rats by decreasing the hyperpermeability of glucose and also reduces the degree of peritoneal fibrosis. These data suggest that dialysis-induced changes in peritoneal transport and morphology are reversible under the condition of peritoneal rest in this experimental model.

Comparison of Blood Pressure Control and Left Ventricular Hypertrophy in Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD)

( Jong Soon Jang ),( Soon Kil Kwon ),( Hye Young Kim ) 대한전해질학회 2011 Electrolytes & Blood Pressure Vol.9 No.1

This study aimed to investigate the influence of different peritoneal dialysis regimens on blood pressure control, the diurnal pattern of blood pressure and left ventricular hypertrophy in patients on peritoneal dialysis. Forty-four patients undergoing peritoneal dialysis were enrolled into the study. Patients were treated with different regimens of peritoneal dialysis: 26 patients on continuous ambulatory peritoneal dialysis (CAPD) and 18 patients on automated peritoneal dialysis (APD). All patients performed 24-hour ambulatory blood pressure monitoring (ABPM) and echocardiography. Echocardiography was performed for measurement of cardiac parameters and calculation of left ventricular mass index (LVMI). There were no significant differences in average of systolic and diastolic blood pressure during 24-hour, daytime, and nighttime between CAPD and APD groups. There were no significant differences in diurnal variation of blood pressure, systolic and diastolic blood pressure load, and LVMI between CAPD and APD groups. LVMI was associated with 24 hour systolic blood pressure load (r = 0.311, P < 0.05) and daytime systolic blood pressure load (r = 0.360, P < 0.05). In conclusion, this study found that there is no difference in blood pressure control, diurnal variation of blood pressure and left ventricular hypertrophy between CAPD and APD patients. The different peritoneal dialysis regimens might not influence blood pressure control and diurnal variation of blood pressure in patients on peritoneal dialysis.

장기 복막투석 동물 모델에서 물수송체의 역할

박민선(MS Park),차정호(JH Cha),김진(J Kim),(Soren Nielsen) 대한신장학회 2000 Kidney Research and Clinical Practice Vol.19 No.2

N/A Sufficient fluid removal is vital to renal replace-ment therapy in end-stage renal failure patients. Aquaporins are integral membrane proteins and the primary water channels that allow water transport only. Type 1, 3 and 4 aquaporins were found in peritoneal capillary walls and peritoneal mesothelial cells. Approximately 5096 of total amount of free water transported during peritoneal dialysis is through aquaporins. Ultrafiltration failure and fluid overload are found in some of long-term continous ambulatory peritoneal dialysis(CAPI3) patients and are major causes of withdrawl from CAPD. Long- term use of high glucose containing dialysis solutions, and functional and morphological changes of aquaporins were suggested as possible mechanisms of ultrafiltration failure. However, a direct relation between alterations of aquaporins in the peritoneum and ultrafiltration failure in long-term CAPD has not been reported yet. In this study peritoneal aquaporins and ultrafiltration were evaluated after long-term peritoneal exposure to high glucose containing dialy- sis solutions in rats. Sprague-Dawley rats with normal kidney func- tions were used. Twenty five milliliter of 4.25% glucose containing dialysis solutions were injected into the peritoneal cavity twice a day for 12 weeks in 13 rats(dialysis-group). The other 13 rats were used without intraperitoneal injection as controls (control-group). One rat from each group died during the study was excluded. After 12 weeks of intraperitoneal injection, a 2 hour peritoneal transport study was done in 9 rats from each group. To calculate intraperitoneal fluid absorption rate, (131)I labelled human serum albumin(RISA) was used as a volume marker. Mesenteries were taken from the remaining three rats from each group for immuno-histochemistry for aquaporin type l. Intraperitoneal volume after 2 hour dialysis was significantly lower in dialysis-group than in control-group(33.7±3.6 vs 39.4±6.1mL, p<0,05). The peri- toneal fluid absorption rate was significamtly higher in dialysis-group than in contml-group(0,070±0.051 vs 0.049±0.016 mL/min, p<0.05). Dg'P> srxlium was signifieantly higher in dialysis-group than in con- trol-group(0.890±0.014 vs 0.856±0.038, p<0.05).D₂P₂urea and D2/D0 glucose did not differ between the two groups. Immunohistochemistry revealed that aquaporin type 1 was strongly stained in the me-sentery capillary walls in control-group, while it was almost disappeared in dialysis-group. In conclusion, long-term use of high glucose containing dialysis solutions decreased aquaporin type 1 population in the peritoneum and ultrafil-tration volume. Increased peritoneal fluid absorption rate is also in part responsible for decreased ultra- filtration volume after long-term use of dialysie solutions.

만성신부전 환자에서 장기간 투석요법 전후의 Insulin-like Growth Factor 및 Insulin-like Growth Factor Binding Proteins 의 변화

이경훈(Kyoung Hoon Lee),문치영(Chi Young Moon),김원(Won Kim),이대열(Dae Yeol Lee),박성광(Sung Kwang Park),강성귀(Sung Kyew Kang) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.2

N/A The insulin-like growth factor-I(IGF-I) is a hormone that has growth stimulation and metabolic effects. Insulin-like growth factor binding proteins (IGFBPs) were known to be the most important factors that affect bioavailability of IGF. Thereby, the changes of IGFBPs may affect the bioavailability of IGF-I. Because growth hormone/IGF system may be affected by dialysis therapy, the changes of GH, IGF-1, IGFBPs levels after dialysis therapy can affect the bioavailability of IGF. To evaluate the changes of serum levels of IGF-I and IGFBP-3 after long-term dialysis therapy, we measured the serum IGF-I and IGFBP-3 levels in the patients on hemodialysis and on peritoneal dialysis. Eight: patients undergoing peritoneal dialysis, 10 patients undergoing hemodialysis, and age-matched 10 normal control patients were studied. In patients on hemodialysis, the mean serum level of IGF-I before hemodialysis was 90.6±9.0ng/mL, and after long-term hemodialysis was 130.9±31.0ng/ mL. The mean serum level of IGFBP-3 before hemodialysis was 14,549±7,815 μg/L, and after longterm hemodialysis was 5,726±883 μg/L. There were no significant changes of serum IGF-I and IGFBP-3 levels after long-term hemodialysis therapy. In patients on peritoneal dialysis, the mean serum level of IGF-I before peritoneal dialysis was 169.8±20.5ng/ mL, and after long-term peritoneal dialysis was 242.6±37.6ng/mL. The mean serum level of IGFBP- 3 before peritoneal dialysis was 10,272±885 μg/L, and after ling-term peritoneal dialysis was 8,604±1,721 μg/L. There were no significant changes of serum IGF-I and IGFBP-3 levels after long-term peritoneal dialysis. We found that the level of IGF-1 before hemodialysis was lower then that of normal control group and the level of IGFBP-3 before hemodialysis or peritoneal dialysis was higher then that of normal control group. Our results suggested that the blood levels of growth hormone, IGF-I and IGFBP-3 may not be significantly affected by long-term dialysis therapy.

복막투석환자의 우울 관련요인

이정림,유병철,임학,이용환 고신대학교 의과대학 2010 고신대학교 의과대학 학술지 Vol.25 No.2

Background: To access the related factors of depression and to provide the basic data for psychologic problems in patients with peritoneal dialysis. Method: We conducted questionnaire survey using Hamilton depression scale from July to August, 2008. Data were collected from 67 peritoneal dialysis patients who diagnosed end-stage renal disease. Depression was defined over 17 points by Hamilton depression scale. Data analysis were performed with t-test, ANOVA and multiple regression analysis using SAS (ver 9.1). Result: Hamilton depression scale score of patients with peritoneal dialysis was 10.4 ± 5.95 and the prevalence of depression was 28.3%(19/67). The related factors of depression scale in patients with peritoneal dialysis were level of education and health status after peritoneal dialysis. Conclusion: More than quadrant of patients with peritoneal dialysis were suspected depression. In order to prevent depression in patients with peritoneal dialysis, education programs considering their intellectual status and health promotion programs of peritoneal dialysis patients are needed.

2세 미만 만성 신부전 환아에서의 만성 투석

손영배,남숙현,곽민정,김수진,진동규,백경훈,Sohn, Young-Bae,Nam, Sook-Hyun,Kwak, Min-Jung,Kim, Su-Jin,Jin, Dong-Kyu,Paik, Kyung-Hoon 대한소아신장학회 2007 Childhood kidney diseases Vol.11 No.1

목적 : 영유아 만성 신부전 환자의 투석은 어른에 비해 여러 가지 면에서 어려움이 있다. 본 연구에서는 2세 미만 영유아에서 만성투석을 시행한 10례에 대한 경험을 고찰하여 보다 나은 투석 치료의 방향을 제시하고자 하였다. 방법 : 1999년 3월부터 2007년 2월까지 삼성서울병원에서 3개월 이상 만성 투석을 시행한 2세 미만의 만성 신부전 환아 10례의 의무기록을 후향적으로 조사하였다. 결과 : 대상 환아의 만성 신부전의 원 질환은 이형성신이 5례로 가장 많았다. 10명의 환아 중 남아는 6명, 여아는 4명이었다. 투석 시작 시 연령의 중간값은 3개월(22일-20개월)이었고 투석 시작 시 체중은 3.75 kg(2.2-10.3 kg)이었다. 투석시작 시 혈청 크레아티닌은 4.3 mg/dL(1.4-11.4 mg/dL)이었다. 투석기간은 29.5개월(3-62개월)이었다. 10명의 환아 중 2명은 혈액투석만 시행하였고, 4명은 복막투석만 시행하였다. 4명은 혈액투석과 복막투석을 모두 시행했다. 10명 중 9명은 적혈구 생성인자(Erythropoietin)를 투여 받았으며 고혈압 조절을 위해 항고혈압제를 복용하였다. 최근 추적관찰에서 1례는 신장 이식을 받았고, 2례는 패혈증으로 사망했으며, 5례는 복막투석 중이고, 2례는 추적관찰 되지 않았다. 투석의 합병증으로 감염이 가장 흔했고, 혈액투석 시 도관 확보 및 유지가 중요했다. 투석 시작 시와 비교해 투석 5개월 후 체중과 신장의 mean SDS 는 악화 되었으나 투석 1년 후에는 호전되었고 복막투석이 혈액투석보다 성장 면에서 유리한 경향을 보였다. 결론 : 2세 미만 영유아에서 만성 투석을 하는 경우 감염을 예방하고 도관을 잘 유지해야 한다. 적절한 영양공급을 통해 성장을 보완하고 보존적 치료를 병행하면 영유아에서 비교적 안전하게 투석치료를 할 수 있고 향후 신 이식이 가능하도록 생존율을 높이고 삶을 질을 호전시킬 수 있을 것으로 기대된다. Purpose : Dialysis in children with chronic renal failure presents with many difficulies. The purpose of this study is to find an improved method in chronic dialysis in infants and children less than 2 years of age by analyzing the experience with 10 cases. Methods : A retrospective review of the medical records of 10 patients(6 boys and 4 girls) was conducted. The patients had chronic renal failure and underwent chronic dialysis at Samsung medical center from March 1999 to February 2007. Results : At Initiation of dialysis, the median age was 3 months old(22 days-20 months), the median body weight was 3.75 kg(2.2-10.3 kg), and the median serum creatinine level was 4.3 mg/dL(2.0-11.4 mg/dL). The median duration of dialysis was 29.5 months(3-62 months). Dysplastic kidney disease was the most common underlying renal disease. Two patients were treated with hemodialysis, 4 patients with peritoneal dialysis, and 4 patients eventually switched dialysis modality. Nine of the 10 patients took erythropoietin and anti-hypertensive drugs. At the end of the follow up period, 1 patient received kidney transplantation, 2 patients died due to sepsis, and 5 patients were treated with peritoneal dialysis. Two patients were lost to follow up. The most common complication of dialysis was infection. Achieving vascular access and maintaining proper catheter function were the most important factors in treating patients with hemodialysis. The growth status of patients was aggravated after 6 month of dialysis but improved after 1 year of dialysis. Patients showed better growth on peritoneal dialysis than hemodialysis. Conclusion : Chronic dialysis can be performed successfully in infants and children under 2 years of age. Vascular access was the main limitation of hemodialysis, and infection was the common problem in both hemodialysis and peritoneal dialysis. To improve the patients survival rate and quality of life, major efforts should be directed toward the prevention of infection and preservation of catheter function. (J Korean Soc Pediatr Nephrol 2007;11:41-50)

Outcomes of Chronic Peritoneal Dialysis by Various Modalities in Korean Children - A Single Center Study

이성하,백재숙,이현경,한경희,최현진,이범희,조희연,정해일,최용,하일수,Lee, Sung-Ha,Baek, Jae-Suk,Lee, Hyun-Kyung,Han, Kyoung-Hee,Choi, Hyun-Jin,Lee, Bum-Hee,Cho, Hee-Yeon,Cheong, Hae-Il,Choi, Yong,Ha, Il-Soo Korean Society of Pediatric Nephrology 2007 Childhood kidney diseases Vol.11 No.2

목 적 : 단일 기관에서 만성복막투석을 시행 받고 있는 소아 환자를 대상으로 후향적 단면연구를 시행하여 복막투석 방법에 따른 투석 결과의 차이가 있는지에 대하여 연구해 보고자 한다. 방 법 : 단일 기관에서 2004년과 2007년 사이에 복막투석을 시행 받았던 환자들 중 투석 후 3개월에서 15개월 사이에 복막투석 적절도에 대한 평가가 이루어졌던 35명의 환자를 대상으로 하였다. 연구 당시 시행하고 있던 복막투석 방법에 따라 CAPD 군, CCPD 군과 NIPD 군으로 환자들을 분류하였고 각각 17명, 13명, 5명의 환자들이 포함되었다. 각 군 사이에 항고혈압제를 복용하고 있는 환자 수, 체중, 신장 및 일반화학 검사와 혈색소 검사를 포함한 혈액 검사 결과의 차이가 있는지 비교 분석하였다. 투석 및 잔여 신기능을 통한 주간 $Kt/V_{urea}$, Ccr과 초여과양 및 소변량에 대한 비교 분석도 시행하였다. 표준 방법을 통한 복막평형검사를 시행하여 개인의 복막 투과성에 대해서도 알아보았다. 결 과 : 각 군 간에 항고혈압제를 복용하고 있는 환자의 비율, 체중과 신장 Z-score의 월간 변화 및 혈액검사 평균 수치의 차이는 유의하지 않았다. CAPD 군과 CCPD 군에서, 복막투석 및 잔여 신기능을 통한 주간 Kt/Vurea, Ccr 및 수분 배설 의 차이는 없었다. NIPD 군의 복막투석을 통한 주간 Ccr이 다른 두 군에서보다 유의하게 낮았지만, 잔여 신기능을 통한 보상으로 총 주간 Ccr에는 차이가 없었다. 복막 평형 검사 결과 저 투과성(low transporter) 및 저 평균 투과성(low average transporter)으로 분류되었던 환자들을 대상으로 비교하였을 때, CAPD를 통한 주간 Ccr이 CCPD를 통한 주간 Ccr 보다 유의하게 높았다. 결 론 : 본 연구의 결과를 토대로, 소아 만성복막투석 환자들에 있어서 투석 방법은 환자의 선호도에 의하여 자유롭게 선택될 수 있어야 할 것을 제안하는 바이다. 또한 초여과의 실패 및 부적절한 투석으로 투석 방법의 변경이 불가피한 상황에서, 복막 평형 검사는 투석 방법 변경이 적절이 이루어질 수 있도록 도와주는 귀중한 정보를 제공해 줄 것이다. 투석 방법 간의 명확한 비교를 위하여 향후 복막염의 빈도, 영양상태 및 장기간의 성장등 다양한 투석 성적을 비교하는 추가 연구가 필요할 것으로 생각된다. Purpose : A single center cross sectional retrospective study was performed to compare the outcomes of different peritoneal dialysis(PD) modalities in Korean children. Methods : Among children dialyzed with PD between the year 2004 and 2007, 35 children had reliable data on PD adequacy after 3 to 15 months of dialysis. Subjects were grouped by their modalities; 17, 13 and 5 children were on continuous ambulatory PD(CAPD), continuous cyclic PD(CCPD) and nightly intermittent PD(NIPD), respectively. Body weight and height, number of patients taking anti-hypertensives and laboratory data including biochemical and hemoglobin levels were compared. Dialysis adequacy including weekly Kt/Vurea, creatinine clearance (Ccr) and daily water removal were also compared. Patients were sub-grouped by their peritoneal permeability characteristics. Results : The percentage of patients taking anti-hypertensives, monthly change in Z-scores of body weight and height and laboratory data did not differ among the groups. Patients on CAPD and CCPD showed similar dialysis adequacies. Weekly dialytic Ccr was significantly lower in the NIPD group compared to the others. But total Ccr was not different when residual renal function was added. Weekly dialytic Ccr by CAPD was significantly higher than that of CCPD in low and low-average transporters. Conclusion : We propose that modality can be selected flexibly according to the patients' preferences. And peritoneal permeability characteristics provide valuable information for adjusting PD prescriptions in ultrafiltration failure or in inadequate dialysis. Further study of other clinical performance measures should be performed to clarify the comparable outcomes in different PD modalities.

Optimal peritoneal fluid white blood cell count for diagnosis of peritonitis in peritoneal dialysis patients

Kunin Margarita,Mini Sharon,Abu-Amer Nabil,Beckerman Pazit 대한신장학회 2023 Kidney Research and Clinical Practice Vol.42 No.1

Background: The diagnosis of peritonitis among peritoneal dialysis (PD) patients is based on clinical presentation, dialysis effluentwhite blood cell (WBC) count, and dialysis effluent culture. Peritoneal fluid WBC count is very important in the initial diagnosis of peritonitis.The purpose of this work was to determine the optimal number of peritoneal WBCs with different clinical presentations at admissionto define PD-related peritonitis.Methods: Medical records of chronic PD patients who underwent work-up for suspected peritonitis between 2008 and 2019 were reviewedretrospectively. Results of all peritoneal WBC count tests during this period were collected. Clinical manifestations and follow-up analysis of each peritoneal WBC count were performed.Results: The peritoneal WBC count cutoff of 100/μL recommended by International Society for Peritoneal Dialysis provided specificityof only 35%. Increasing peritoneal WBC count cutoff to 150, 200, and 250/μL provided sensitivity around 98% and gradually increasingspecificity. The chi-square automatic interaction detector model of statistical analysis determined that peritoneal WBC count below230/μL combined with absence of inflammatory markers (fever, increased C-reactive protein) ruled out peritonitis with 99.8%sensitivity. Peritoneal fluid WBC count cutoff of 230/μL provided specificity of 89% and good positive and negative likelihood scoresof 8.3 and 0.03, respectively. Peritoneal fluid polymorphonuclear count has lower discriminating ability for peritonitis compared toperitoneal fluid WBC count.Conclusion: Increasing peritoneal fluid WBC count cutoff to 230/μL in suspected PD-related peritonitis could improve specificity withoutcompromising the sensitivity of the test.

Association between Dialysis Adequacy and Cognition in Patients with Peritoneal Dialysis

Dong Jin Shin,Taehee Kim,Do-Un Jung,Jung-Joon Moon,Dong-Wook Jeon,Sung-Jin Kim,Yeong Hoon Kim,Sun Woo Kang,Yunmi Kim 대한신경정신의학회 2020 PSYCHIATRY INVESTIGATION Vol.17 No.11

Objective Cognition of peritoneal dialysis patients is influenced by various factors including dialysis adequacy such as fractional urea clearance (Kt/V) and relative overhydration (RelOH). This study aimed to discover the potential contribution of dialysis adequacy to cognitive function in patients undergoing peritoneal dialysis. Methods Fifty-nine patients undergoing peritoneal dialysis were recruited. Demographic information, comorbidities, and clinical lab findings were retrospectively collected, and dialysis adequacy was determined by the Kt/V and RelOH calculation. Cognition and depression were measured with Digit Symbol Substitution Test, Hopkins Verbal Learning Test, Wechsler memory scale (spatial span), Wisconsin Card Sorting Test, and Beck’s depression inventory. Partial correlation test was used to explore the correlation of dialysis adequacy with cognitive function. Results RelOH showed significant correlation with some of the Wisconsin Card Sorting test results. The categories achieved showed negative correlation (r=-0.32, p=0.02) and trials to complete first category showed positive correlation (r=0.31, p=0.02) with RelOH. Other tasks showed no significant correlation with RelOH. Kt/V. Conclusion Our study demonstrates that peritoneal dialysis adequacy, measured by RelOH, seems to be significantly correlated with the occurrence of cognitive impairment. The outcome suggests that RelOH may have the potential to clarify the role of cognitive impairment in peritoneal dialysis patients.

복막투석환자의 식이적응경험: 현상학적 연구

이현정,김봉희,강희영 한국산학기술학회 2020 한국산학기술학회논문지 Vol.21 No.11

This paper describes the experience of the dietary adaptation of patients undergoing peritoneal dialysis due to end-stage renal failure by identifying the meanings and structure of the experience. In the research method, the data from nine patients were collected using individual in-depth interviews and analyzed using Colaizzi's phenomenological method. The experience of the dietary adaptation of participants undergoing peritoneal dialysis was organized into four theme-clusters and 15 themes. These four theme-clusters were characterized as follows: 'the double sufferings of peritoneal dialysis process and dietary adaptation', 'vague and ambiguous diet management', 'the hardship of diet management felt by experiencing diet using one's body', and 'realizing the importance of diet management with peritoneal dialysis, resetting one's goal in life'. This paper describes the dietary adaptation process experienced by peritoneal dialysis patients was a process of adhering to a better life, even though it was the double sufferings of peritoneal dialysis process and dietary adaptation. In conclusion, the findings in this study provide a deep understanding of the lived experience of the dietary adaptation in peritoneal dialysis patients and should help in the development of tailored diet interventions for patients on peritoneal dialysis. 본 연구의 목적은 말기신부전증으로 복막투석을 받는 환자의 식이적응 경험의 의미와 구조를 규명하고 기술하는 것이다. 연구 방법으로 Colaizzi의 현상학적 연구방법을 적용한 질적 연구로서, 자료는 G광역시 일개 대학병원을 다니고 있는 복막투석 6개월 이상 된 9명의 환자를 대상으로 심층면담을 통해 수집되었다. 자료 분석을 위해 모든 면담은 녹취되고 필사되었고, Colaizzi의 현상학적 방법을 이용하여 분석하였다. 본 연구결과, 복막투석환자의 식이적응 경험은 네 개의 주제모음과 15개의 주제로 구조화되었다. 네 개의 주제모음은 ‘복막투석과 식이적응의 이중적 고통’, ‘막막하고 답답한 식이조절’, ‘체험하면서 느끼게 된 식이조절의 고됨’, ‘투석과 식이조절 병행의 중요성을 깨닫고 삶의 목표 재설정’이었다. 결론적으로 본 연구를 통해 복막투석환자들이 겪는 현실적인 식이적응과정은 복막투석과 식이요법적응의 이중적 고통으로 삶이 고되었지만, 순응하고 더 나은 삶을 위해 나아가는 과정이었다. 이를 바탕으로 복막투석환자 식이적응의 어려움에 대해 깊이 있게 이해하고, 식이관련 맞춤형 중재연구 개발에 필요한 기초자료로 활용하고자 한다.