Hong Kong Journal of Nephrology最新文献

With the increase in epidemic proportions of diabetes worldwide, the number of patients who will require renal replacement therapy (RRT) will be a great challenge to the health infrastructures of developing countries such as Nigeria. Because those mostly affected are in the economically productive age group, a vicious circle is established whereby those who keep the economy going are the same people affected. Secondary and tertiary care of chronic kidney disease involving RRT would exact disproportionate toll on the income of patients in the developing world where patients pay out of pocket for their own care. Whilst there is an increase in the number of facilities offering RRT, there is no commensurate sustainability of care either by the patients themselves or even by the government. The level of unemployment is increasing. Kidney transplantation is out of reach in addition to the cost of post-transplant care, which includes hospitalization and immunosuppressive medications. Most of the end-stage kidney disease patients who enlisted in our dialysis program were unable to get or sustain adequate hemodialysis. The data also showed that more men were dialyzed at our facilities over the period under review and the age distribution has not changed much over the decade. From this dismal picture in the last decade emerges a series of questions as to why this is so and what must be done to increase access to RRT. Prudent fund management and cost containment, local manufacture of dialysis materials and nongovernmental sources of funding are means of driving down the cost of dialysis. In countries where drugs and equipment for health services are locally manufactured, such as India and other countries, the cost of health care is more affordable than in countries such as Nigeria where these are imported.

在全世界，糖尿病的盛行率與日俱增，然而對於發展中國家如尼日利亞，基礎醫療架構並不足以應付患者對腎置換療法 (RRT) 的需求。本地民眾必須自費支付自身的醫療費用，但其收入水平遠不足以負擔慢性腎病二級與三級照護所需的 RRT。即使目前 RRT 設施已有所增加，但無論是患者或政府均難以維持治療的長期實施。此外，腎臟移植所需的資源在本地更是相當之有限。在被我們納入透析計劃的末期腎病 (ESKD) 患者間，大多數並未能接受足夠或持續的透析治療。過去十年間，在我們設施內接受透析的病人中，年齡分佈大致穩定，且男性佔較多數。目前，我們正研究如何能促進 RRT 普及實施的方案。透過謹慎的理財與成本控制、透析物料的本土生產、及非政府資金的運用，透析的相關費用可望得以降低。目前，發展中國家如尼日利亞的藥物與醫療器材大多仰賴進口，因此相關物資的本土生產是降低醫療成本的可行方案。

Chronic alcohol use and gallstones are the most frequent causes of acute pancreatitis (AP), a life-threatening medical emergency. Above-normal calcium levels in these patients indicate potential malignancy or hyperparathyroidism (HPT). Whereas primary HPT has been associated with AP, tertiary HPT has seldom been linked with AP. Herein we present a case of peritoneal dialysis presenting with recurrent AP and incidental pancreatic duct calcification due to tertiary HPT.

急性胰炎是致命的緊急疾病,最常見的病因為長期飲酒及膽結石。當這些病人的血鈣過高,意味著癌症或副甲狀腺功能亢進的可能性。急性胰炎可能與原發性副甲狀腺功能亢進有關,但鮮少見於三發性副甲狀腺功能亢進患者。以下是一宗三發性副甲狀腺功能亢進所致復發性急性胰炎的個案,患者為腹膜透析接受者,並以偶發性胰管鈣化呈現。

Background/Purpose

The employment status of peritoneal-dialysis patients could have been related to selection bias. This study examined the employment rate and associated factors in a population with peritoneal-dialysis-first policy.

Methods

We performed a single-center cross-sectional survey on the employment status of prevalent peritoneal-dialysis patients between January and September 2013 in Hong Kong.

Results

The survey included 383 prevalent peritoneal-dialysis patients, with 128 of them in the labor force. Among the patients in the labor force, the employment rates were 65.8% and 18.9% for automated peritoneal-dialysis patients and continuous-ambulatory-peritoneal-dialysis patients, respectively, whereas 39.1% of patients in the labor force had expressed that they were able to work, but were unemployed. In adjusted analysis, the use of automated peritoneal dialysis (adjusted odds ratio of 7.93; 95% confidence interval 2.92–21.74) was independently associated with employment, whereas older age was associated with lower likelihood of employment (adjusted odds ratio of 0.53 for each 10 years old; 95% confidence interval 0.38–0.72).

Conclusion

The employment rate in peritoneal-dialysis patients is very low when compared to that in the general population. Patients on automated peritoneal dialysis were more likely to be employed.

背景

腹膜透析患者就業狀況的研究，有可能會受到選擇性偏倚的影響。這項調查 是在一個採納了 é腹膜透析第一û 政策的地區，進行就業率及其相關因素的研究。

方法

在2013年1月至9月期間，我們在香港一個腹膜透析中心對現存的腹膜透析患者的就業狀況進行了一次橫斷面調查。

結果

本次調查包括383名現存的腹膜透析患者，其中有128人被納入勞動力人口。在勞動力人口的患者中，自動腹膜透析的使用者就業率為65.8 %，連續性家居腹膜透析的使用者就業率為18.9 % 。另一方面，39.1%的勞動力人口患者，表示他們有能力工作，但並未受僱用。在調整後的分析，使用自動腹膜透析與就業率有獨立關聯，另外，較年長的患者與較低就業率有關聯。

結論

相比一般香港人，腹膜透析患者的就業率非常低。自動腹膜透析的患用者較易就業。

Staphylococcal immunoglobulin A (IgA)-dominant infection-related glomerulonephritis (IgA-IRGN) is an emerging clinical entity seen in immunocompromised hosts. Antibiotics are the mainstay of treatment and the role of steroids is controversial. We present a review of literature and our recommendations on the use of steroids in the management of IgA-IRGN.

近年來，葡萄球菌感染相關的 IgA 型腎小球腎炎 (IgA-IRGN) 逐漸被世人認識，通常發生於免疫機能不全的病人，治療以抗生素療法為主，類固醇的角色則仍然存有爭議。以下我們將回顧 IgA-IRGN 的相關文獻，並對此病的臨床處置作出建議。