Download Nephrology and renal replacement therapy in South Korea: A brief

Nephrol Dial Transplant (1996) 11: 979-981
Nephrology
Dialysis
Transplantation
DialysisI Transplantation News
Nephrology and renal replacement therapy in South Korea:
A brief report on the Korean Society of Nephrology and
Korean Society of Transplantation
Myung-Jae Kim
Department Internal Medicine, Kyung-Hee University Medical Center, Seoul, Korea
The history of nephrology in Korea
The forerunner of the Korean Society of Nephrology
was a loose organization established in 1975 by several
senior nephrologists, urologists, and pathologists to
organize on a monthly basis seminars covering diverse
topics and discussing renal cases. In June 1980, the
Korean Society of Nephrology was founded. It is an
official academic society under the auspices of the
Korean Federation of Medical Societies. The Korean
Society of Transplantation was established in May
1969. Haemodialysis was first introduced into Korea
in 1952 by an American Army physician, Paul Teschan,
in the battle area during the Korean war. The technique
was introduced to treat the victims amongst UN troops
of so called haemorrhagic fever with renal syndrome
(HFRS). Korean haemorrhagic fever is caused by
infection with the Hantan virus. In 1965, Korean army
doctors performed the first haemodialysis on Korean
soldiers in the Soodo Army Hospital in Seoul. In
October 1969 thefirsthaemodialysis center for civilians
was opened at Seoul National Hospital by Dr
Siwhang Kim.
Percutaneous needle renal biopsy was first introduced to Korea by Scandinavian doctors in 1960 and
the first needle renal biopsy was performed in 1965 at
Seoul National University Hospital by a Korean doctor.
The first successful renal transplantation in Korea
was performed in March 1969 in the Catholic Medical
College, St Mary Hospital, where a 33-year-old printer
received a kidney from a living related donor by Dr
Yong-Kak Lee.
ists. This comprises 100 physicians recognized by the
subspecialty board of the Korean Society of Internal
Medicine as well as 50 pediatric nephrologists who
have no official recognition as subspecialists. Korea
has 34 Medical Schools which graduate around 4000
students annually.
Renal transplantation is currently performed in 33
Korean centers and the number of surgeons with
special expertise in renal transplantation is around 60.
The Korean Society of Nephrology has around 400
registered members and the Korean Society of
Transplantation around 300, all of whom are M.D.'s.
Incidence and prevalence of end-stage renal disease
The number of patients newly admitted annually
for dialysis and transplantation was 4553 (104,6/
million/year) in 1992 and 4443 (98.6/million/year) in
1993.
Dialysis activities in Korea
In 1992, a total of 3083 (70.8/million/year) were newly
admitted for haemodialysis treatment, 705 (16.2/
million/year) for CAPD and 765 (17.6/million/year)
for renal transplantation. In 1993, the respective figures
were 3035 (70.8/million/year) for haemodialysis, 731.
In 1993, the total number of dialysis centers throughout the country was 135. Forty of these were located
in Seoul (population 11 million), 15 in Pusan, 10 in
Taegu, three in Inchon, four in Kwangju, eight in
Taegon, 10 in the Kyungi province, seven in the
Kangwon province, three in the Southern
Basic demographic data
Choongchang province, five in the Northern
The population of South Korea is 44,85 million with Choongchang province, six in the Southern Chonla
an annual growth rate of 1.65% Korea has currently province, four in the Northern Chonla province, 10 in
55 000 doctors of whom 150 are specialized nephrolog- the Southern Kyongsang province, eight in the
Northern Kyongsang province and one on Cheju
island.
Correspondence and offprint requests to: Myung-Jae Kim, M.D,
In 1993, the total number of dialysis machines used
Ph.D, Department of Internal Medicine, Kyung-Hee University
Medical Center, Seoul 130-702, Korea.
in South Korea was 1705 (37.8/million).
© 1996 European Dialysis and Transplant Association-European Renal Association
980
Myung-Jae Kim
In 1993, the total number of patients receiving
dialysis was 8.423, 78.5% of whom received haemodialysis and 21.5% of whom received CAPD (Table 1).
CAPD has been available in Korea since March 1981.
The procedure is carried out with a domestic bag,
lines, and peritoneal solution. These items are now
also provided by a number of foreign companies.
Table 1. Living dialysis and transplant patients
Year
HD
CAPD
Transplant
Total
1986
1987
1988
1989
1990
1991
1992
1993
1,335 (32.6)
2,087 (49.7)
3,012 (74.0)
3,574 (85.2)
4,311 (101.8)
4,860(111.7)
5,890(135.3)
6,611 (146.7)
573(13.9)
683(16.5)
1,058(25.2)
932(22.2)
1,130(26.7)
1,392(32.0)
1,599(36.7)
1,812(40.2)
621 (15.1)
916(14.7)
982(23.4)
1,438(34.3)
1,866(44.1)
2,376(54.6)
2,862 (65.8)
3,574 (79.3)
2,534
3,405
5,142
5,944
7,307
8,628
10,351
11,997
(61.7)
(81.0)
(122.7)
(141.8)
(172.6)
(198.3)
(237.8)
(266.1)
( ) : Number of patients per million population.
Table 2. Annual intake of new patients
Year
HD
CAPD
Transplant
Total
1986
1987
1988
1989
1990
1991
1992
1993
670(16.3)
1,276 (30.4)
1,516(36.2)
2,008 (47.9)
2,418(57.1)
2,524 (58.0)
3,083 (70.8)
3,035 (67.3)
287 (7.0)
321 (7.6)
375 (8.9)
572(13.6)
530(12.5)
617(14.2)
705 (16.2)
731 (16.2)
221 (5.4)
242 (5.8)
428 (10.2)
581 (13.9)
624(14.7)
672(15.4)
765 (17.6)
677(15.0)
1,173
1,839
2,319
3,161
3,572
3,813
4,553
4,443
(28.7)
(43.8)
(55.3)
(75.4)
(84.3)
(87.6)
(104.6)
(98.6)
( ) : Number of patients per million population.
Domestic cuprophane haemodialyser and blood lines
were first manufactured and supplied to the dialysis
centers in 1986.
Transplantation activities in Korea
In 1992 765 (17.5/million/year) renal transplants were
performed. The respective figure was 677 (15.0/
million/year) in 1993.
From 1969 to 1993 a total of 4747 kidneys was
transplanted in Korea. Table 5 gives a breakdown.
At the end of 1993, 3574 grafts maintained adequate
renal function. Of the 677 transplantations performed
in 1993, 12 were second grafts, 15 concerned pediatric
patients and 10 concerned patients with diabetic
nephropathy.
Renal transplantation is performed in 33 centers.
Korea has six centers for liver transplantation, four
centers for heart transplantation and one center only
for pancreas transplantation as of 1994. The Korean
government plans to introduce a national organ sharing system. In recognition of the transplant activities,
the Fourth Congress of the Asian Transplantation
Society is held in Seoul in August 1995.
Table 6 gives some information concerning organ
transplantation in Korea.
The health insurance system
The national medical insurance system was introduced
in 1979. Since 1989 the entire population is covered by
this insurance system. The insurance system covers
80% of the medical fee for patients with end-stage
renal disease. To reach dialysis session the patient has
Table 3. Primary renal diseases of new haemodialysis patients
Causes
Number of patients (%)
1990
Chronic glomerulonephritis
Histologically not examined
Histologically examined
Diabetic nephropathy
Hypertensive nephrosclerosis
Cystic kidney disease
Renal tuberculosis
Pyelo/interstitial nephritis
Drugs or nephrotic agents
Lupus nephritis
Gouty nephropathy
Hereditary nephropathy
Kidney tumor
Others
Uncertain
Total
1991
1992
1993
197(8.1)
158 (6.5)
35(1.4)
21 (0.9)
46(1.9)
15 (0.6)
9 (0.4)
12 (0.5)
7 (0.3)
2(0.1)
41(1.7)
1,295 (53.6)
668 (27.6)
525(21.7)
143 (5.9)
318(13.2)
233 (9.6)
32(1.3)
26(1.1)
17 (0.7)
17 (0.7)
12(0.5)
8 (0.3)
7 (0.3)
2(0.1)
88 (3.6)
990(41.0)
546 (25.3)
425 (19.7)
121 (5.6)
422(19.5)
333(15.4)
45(2.1)
23(1.1)
27(1.3)
27 (2.4)
17(0.8)
15 (0.7)
7 (0.3)
2(0.1)
88 (4.1)
619 (28.6)
589 (21.4)
419 (15.2)
170(6.1)
530(19.2)
403 (14.6)
40(1.5)
28(1.0)
23 (0.8)
15 (0.5)
38 (1.4)
17 (0.6)
13(10.5)
5 (0.2)
167(6.1)
888 (32.2)
2,418(100.0)
2.416(100.0)
2,160(100.0)
2,757(100.0)
585 (24.2)
Nephrology and renal replacement therapy in South Korea
981
Table 4. Causes of death in haemodialysis patients in 1993
Causes
Number of deaths
Causes
Number of deaths
Cardiac
Myocardial ischemia and infarction
Hyperkalemia
Cardiac arrest, cause unknown
Other cardiac disease
Vascular
Pulmonary embolus
Cerebrovascular accident
Gastointestinal hemorrhage
Other vascular disease
Infection
Pulmonary infection
Septicemia
Tuberculosis
Peritonitis
112
10
11
58
33
68
2
49
5
12
56
12
37
2
5
Liver disease
Liver failure due to hepatitis Bvirus
Liver failure due to other cause
Social
Patient refused further treatment
Suicide
Therapy ceased for other reason
Miscellaneous
Cachexia
Malignant disease
Accident
Uncertain
10
5
5
28
17
5
6
28
11
12
3
179
Total
482
TableS. Demographics of kidney transplantation in 1993
Total number
First graft
Regraft
Pediatric
Diabetes
DST
Mean age
Sex ratio (M/F)
KT recipient birth
677
Donor relat
665
Cadaver
12
Mother
15
Father
Sister
20
17
Brother
35.5
Son
65%/35%
Daughter
6
Spouse
Non-related
Table 6. Present status
(December 31, 1994)
Kidney
Liver
Pancreas
Heart
Academic activities
of
organ
transplantation
27
90
34
51
51
15
10
45
227
in
Korea.
The date of first successful
transplantation
first
Total no. since
operation
No. of
centers
1969
1988
1992
1992
5,656
33
6
1
4
44
12
28
to pay 26 US$. The remaining 80% of the total expenses
are paid by the insurance system to the respective
hospital. The annual income per capita in Korea was
10000 USS in 1995.
To convey an idea of the academic profile of the
Korean Society of Nephrology some information on
the annual congresses is provided. In spring and
autumn two national congresses are held. Since 1982,
the abstracts of the accepted papers are published in
Kidney International.
The society has an official journal, which appears
on a quarter yearly basis since 1986. A number of
international meetings have been sponsored by the
Korean Society of Nephrology. These include (i) the
Seoul Symposium to the 7th International Congress
of Pediatric Nephrology (September 1987, Seoul); (ii)
the Symposium on Virus-Related Renal Diseases
as a satellite to the 11th International Congress of
Nephrology (July 1990, Kyongju); the Third Asian
Symposium of Pediatric Nephrology (June 1991,
Seoul); (iv) 9th Asian Colloquium in Nephrology
(May 1992, Seoul); (v) the 13th Annual Meeting of
the International Society of Blood Purification
(September 1995, Kyongju).
The Korean Society of Transplantation has one
national congress during springtime and edits an official journal with two issues per year since 1980. It
organized the Fourth Congress of the Asian Society of
Transplantation (August 1995, Seoul).