Hong Kong Journal of Nephrology最新文献

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。

With over 70% of hemodialysis (HD) patients, aged ≥55 years, having moderate to severe chronic cognitive impairment (CI), in an increasingly aging population, the need to stop this cognitive decline is paramount. CI amongst HD patients raises patient safety concerns, while limiting their ability to understand information such as medical advice and their decision-making ability. Unfortunately, the data available on assessment of cognition in HD patients and interventions utilized remain extremely limited. This paper discusses assessment of cognition, the theories of CI in HD patients, and current literature on cognitive interventions in chronic disease, with many not applicable to the HD population. An encouraging psychological intervention called cognitive stimulation therapy helps improve cognition as well as social skills in CI. This is the first review article discussing the possibility of cognition stimulation during HD which has not been investigated previously. With cognitive stimulation therapy showing improvements in cognition at 6-month follow-up, as well as being recommended by the National Institute for Health and Care Excellence for use in dementia, we suggest the need to study whether this therapy has any effect on cognition in HD patients both in short term, with respect to daily activities and decision making, and in long term, with respect to the possibility of reducing the risk of dementia.

在 55 歲或以上的血液透析 (HD) 病人間, 逾 70% 有中至重度的慢性認知障礙 (CI), 在目前老年化的人口中, 這是必須要解決的問題。在接受 HD 後, CI 可引發病人安全的隱憂, 同時亦限制患者接受資訊如醫囑、及決策的能力。然而, 至今關於 HD 病人認知功能與改善方案的數據仍非常有限。本文探討了認知功能的評估方法、及 CI 發生於 HD 的相關理論, 亦回顧了目前有關慢性病中認知功能改善方案的文獻, 雖然很多並不特定於 HD 病人群。我們注意到一種稱為認知刺激療法 (cognitive stimulation therapy, CST) 的心理治療方案, 可望改善 CI 患者的認知功能和社交技能。本文將首度就這種療法對 HD 病人的效應作出探討。事實上, CST 經證實可於 6 個月期間達到認知功能的改善, 亦是英國 NICE (National Institute for Health and Care Excellence) 建議的失智症療法, 我們認為有需要研究 CST 對 HD 病人認知功能的影響, 不論是在短期 (日常活動及決策能力)、或長期層面 (失智症的預防)。

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。