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The Protective Activity of Withania somnifera Against Mercuric Chloride (HgCl2)-Induced Renal Toxicity in Male Rats. 睡茄对氯化汞(HgCl2)引起的雄性大鼠肾毒性的保护作用
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-10-28 eCollection Date: 2024-01-01 DOI: 10.1155/2024/8023989
Haddad A El Rabey, Samar M Rezk, Aseel Abusaber, Rwaah Khlabi, Ayah H Alhawiti, Romana M Algorayed, Nadia Bakry

The purpose of this study was to test the protective effect of Withania somnifera (WS) against the harmful effects of mercuric chloride (HgCl2)-induced kidney failure at the histological, biochemical, and immune levels in Wistar rats. The study assessed the biochemical and immunological changes in five groups (n = 6): Group 1 (G1) was the negative control, and the other rats received a single subcutaneous dose of HgCl2 (2.5 mg/kg in 0.5 mL of 0.9% saline solution) and randomly divided into 4 groups. Group 2 (G2) was the positive control and left without treatment. Groups 3, 4, and 5 (G3, G4, and G5) were treated with different doses of WS root powder for 30 days. The HgCl2-positive group showed significant signs of renal toxicity as reflected by increased levels of kidney function parameters (blood urea nitrogen, urea, and creatinine), inflammatory biomarkers, immunological indices (SDF-1, IL-6, NGAL, and KIM-1), and oxidative stress (SOD, TAC, CAT, GSH, and MDA). The positive group rats also showed drastic pathological changes in renal tissues. Different doses of WS treatment significantly reduced the levels of all biochemical markers and decreased pathological damage to the kidney tissues. The antioxidant, phenolic, and flavonoid constituents of WS root powder helped protect rats' kidneys against HgCl2-induced kidney toxicity in male rats.

本研究旨在从组织学、生化和免疫学层面测试薇甘菊(WS)对氯化汞(HgCl2)诱导的 Wistar 大鼠肾衰竭的保护作用。研究评估了五组(n = 6)大鼠的生化和免疫学变化:第 1 组(G1)为阴性对照组,其他大鼠接受单剂量氯化汞皮下注射(2.5 毫克/千克溶于 0.5 毫升 0.9% 生理盐水),并随机分为 4 组。第 2 组(G2)为阳性对照,不做任何处理。第 3、4 和 5 组(G3、G4 和 G5)使用不同剂量的 WS 根粉治疗 30 天。HgCl2 阳性组的肾功能参数(血尿素氮、尿素和肌酐)、炎症生物标志物、免疫学指标(SDF-1、IL-6、NGAL 和 KIM-1)和氧化应激(SOD、TAC、CAT、GSH 和 MDA)水平升高,反映了肾毒性的显著迹象。阳性组大鼠的肾组织也出现了急剧的病理变化。不同剂量的 WS 治疗明显降低了所有生化指标的水平,减少了肾组织的病理损伤。WS 根粉中的抗氧化剂、酚类和类黄酮成分有助于保护雄性大鼠的肾脏免受 HgCl2 引起的肾毒性的影响。
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引用次数: 0
Key Performance Indicators of Secondary Health Care in Chronic Kidney Disease: Experience in Public and Private Services in the State of São Paulo, Brazil. 慢性肾脏病二级医疗保健的关键绩效指标:巴西圣保罗州公共和私营服务机构的经验。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-10-26 eCollection Date: 2024-01-01 DOI: 10.1155/2024/5401633
Farid Samaan, Cristiane Akemi Vicente, Luiz Antônio Coutinho Pais, Gianna Mastroianni Kirsztajn, Ricardo Sesso

Introduction: The objective of this study was to evaluate quality indicators of secondary health care in chronic kidney disease (CKD). Methods: This retrospective longitudinal study was conducted in an outpatient medical nephrology clinic of the Brazilian Unified Health System (UHS) and a multidisciplinary outpatient clinic of a private health plan (PHP). The inclusion criteria were age ≥ 18 years, ≥ 3 medical appointments, and follow-up time ≥ 6 months. Results: Compared to PHP patients (n = 183), UHS patients (n = 276) were older (63.4 vs. 59.7 years, p=0.04), had more arterial hypertension (AH) (91.7% vs. 84.7%, p=0.02) and dyslipidemia (58.3 vs. 38.3%, p < 0.01), and had a lower estimated baseline glomerular filtration rate (eGFR) (29.9 [21.5-42.0] vs. 39.1 [28.6-54.8] mL/min/1.73 m2, p < 0.01). Compared to PHP patients, UHS patients had a lower percentage of diabetics with glycated hemoglobin < 7.5% (46.1% vs. 61.2%, p=0.03), fewer people with potassium < 5.5 mEq/L (90.4% vs. 95.6%, p=0.04), and fewer referrals for hemodialysis with functioning arteriovenous fistula (AVF) (9.1% vs. 54.3%, p < 0.01). The percentages of people with hypertension and blood pressure < 140 × 90 mmHg were similar between the UHS and PHP groups (59.7% vs. 66.7%; p=0.17), as was the percentage of people with parathyroid hormone control (85.6% vs. 84.8%; p=0.83), dyslipidemia and LDL-cholesterol < 100 mg/dL (38.3% vs. 49.3%; p=0.13), phosphorus < 4.5 mg/dL (78.5% vs. 72.0%; p=0.16), and 25-OH-vitamin-D > 30 ng/mL (28.4% vs. 36.5%; p=0.11). The crude reduction in eGFR was greater in the UHS group than in PHP (2.3 [-0.1; 5.9] vs. 1.1 [-1.9; 4.6] mL/min/1.73 m2; p < 0.01). In the multivariate linear mixed-effects model, UHS patients also showed faster CKD progression over time than PHS ones (group effect, p < 0.01; time effect, p < 0.01; interaction, p < 0.01). Conclusions: Quality of care for patients with CKD can be improved through both services, and multidisciplinary care may have a positive impact on the control of comorbidities, the progression of CKD, and the planning of the initiation of hemodialysis.

简介本研究旨在评估慢性肾脏病(CKD)二级医疗保健的质量指标。研究方法这项回顾性纵向研究在巴西统一医疗系统(UHS)的一家肾脏病门诊部和一家私人医疗计划(PHP)的多学科门诊部进行。纳入标准为年龄≥ 18 岁,就诊次数≥ 3 次,随访时间≥ 6 个月。结果与 PHP 患者(人数 = 183)相比,UHS 患者(人数 = 276)年龄更大(63.4 岁对 59.7 岁,P=0.04),动脉高血压(AH)(91.7% 对 84.7%,P=0.02)和血脂异常(58.3% 对 38.3%,P<0.01),基线肾小球滤过率(eGFR)估计值较低(29.9 [21.5-42.0] 对 39.1 [28.6-54.8] mL/min/1.73 m2,P<0.01)。与 PHP 患者相比,UHS 患者中糖化血红蛋白小于 7.5% 的糖尿病患者比例较低(46.1% vs. 61.2%,p=0.03),血钾小于 5.5 mEq/L 的人数较少(90.4% vs. 95.6%,p=0.04),转诊进行血液透析且动静脉瘘 (AVF) 功能正常的人数较少(9.1% vs. 54.3%,p < 0.01)。高血压和血压 < 140 × 90 mmHg 患者的百分比在 UHS 组和 PHP 组之间相似(59.7% vs. 66.7%;P=0.17),甲状旁腺激素控制患者的百分比也相似(85.6% vs. 84.8%;P=0.01)。6% vs. 84.8%; p=0.83)、血脂异常和低密度脂蛋白胆固醇 < 100 mg/dL (38.3% vs. 49.3%; p=0.13)、磷 < 4.5 mg/dL (78.5% vs. 72.0%; p=0.16)、25-OH-维生素-D > 30 ng/mL (28.4% vs. 36.5%; p=0.11)。UHS 组 eGFR 的粗略下降幅度大于 PHP 组(2.3 [-0.1; 5.9] vs. 1.1 [-1.9; 4.6] mL/min/1.73 m2; p <0.01)。在多变量线性混合效应模型中,随着时间的推移,UHS 患者的 CKD 进展速度也快于 PHS 患者(组别效应,p < 0.01;时间效应,p < 0.01;交互效应,p < 0.01)。结论通过这两种服务可以提高对 CKD 患者的护理质量,多学科护理可能会对合并症的控制、CKD 的进展以及血液透析的启动规划产生积极影响。
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引用次数: 0
Matrix Gla Protein and Nitric Oxide Synthase-3 Genetic Variants in Chronic Kidney Disease and Their Relation with Cardiovascular Risk. 慢性肾脏病中的基质la蛋白和一氧化氮合成酶-3基因变异及其与心血管风险的关系
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-08-30 eCollection Date: 2024-01-01 DOI: 10.1155/2024/3850055
G Priyadarshini, Sreejith Parameswaran, Jayaprakash Sahoo, Sandhiya Selvarajan, Ananthakrishnan Ramesh, Medha Rajappa

Background: Chronic kidney disease (CKD) is defined by gradual deterioration of renal parenchyma and decline of functioning nephrons. The risk of cardiovascular events is drastically increased in patients with CKD. This complicated link of CKD and cardiovascular disease (CVD) is not well understood till date.

Objective: We aim to study the influence of genetic variants of matrix Gla protein (MGP) gene rs1800801, rs1800802, and rs4236 and nitric oxide synthase-3 (NOS3) gene rs1799983 and rs2070744 on the risk of CKD and its associated cardiovascular comorbidity in South Indian Tamils.

Methods: One hundred and eighty-five CKD patients and 185 controls were recruited in this research. Flow-mediated dilatation (FMD) of brachial artery was measured ultrasonically. Circulating levels of MGP and nitric oxide (NO) were measured by ELISA. Genotyping was done by real-time PCR.

Results: We observed a significant difference in the distribution of TT and CT genotypes of NOS3 (rs2070744), indicating an increase in the risk of CKD. NO level was significantly decreased in CKD cases than controls. We also found a significant difference in the distribution of TTA and CCG haplotypes of MGP polymorphisms (1-rs4236; 2-rs1800801; 3-rs1800802) between the groups, indicating an increase in the risk of CKD. CT genotype of MGP (rs4236) and CT genotype of NOS3 (rs2070744) variants were found to be associated with decreased FMD, indicating endothelial dysfunction, the harbinger of CVD.

Conclusion: We conclude that genetic variants of MGP and NOS3 enhance the risk of CKD and its associated cardiovascular comorbidity in South Indian Tamils.

背景:慢性肾脏病(CKD)是指肾实质逐渐恶化,肾小球功能衰退。慢性肾脏病患者发生心血管事件的风险大大增加。迄今为止,人们对 CKD 与心血管疾病(CVD)之间的复杂联系还不甚了解:我们旨在研究南印度泰米尔人基质格拉蛋白(MGP)基因 rs1800801、rs1800802 和 rs4236 以及一氧化氮合酶-3(NOS3)基因 rs1799983 和 rs2070744 的遗传变异对 CKD 风险及其相关心血管合并症的影响:本研究招募了 185 名 CKD 患者和 185 名对照组。用超声波测量了肱动脉的血流介导扩张(FMD)。用酶联免疫吸附法测定循环中 MGP 和一氧化氮(NO)的水平。通过实时 PCR 进行基因分型:结果:我们观察到 NOS3(rs2070744)的 TT 和 CT 基因型分布存在明显差异,表明患慢性肾脏病的风险增加。与对照组相比,CKD 病例的 NO 水平明显下降。我们还发现,MGP 多态性(1-rs4236;2-rs1800801;3-rs1800802)的 TTA 和 CCG 单倍型的分布在各组间存在明显差异,表明 CKD 风险增加。MGP的CT基因型(rs4236)和NOS3的CT基因型(rs2070744)变异与FMD下降有关,表明内皮功能障碍是心血管疾病的先兆:我们得出的结论是,MGP 和 NOS3 基因变异会增加南印度泰米尔人患慢性肾脏病及其相关心血管并发症的风险。
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引用次数: 0
Renal Manifestations of IgG4-Related Disease: A Concise Review. IgG4 相关疾病的肾脏表现:简明综述。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-06-24 eCollection Date: 2024-01-01 DOI: 10.1155/2024/4421589
Shahrukh T Towheed, Wayel Zanjir, Kevin Yi Mi Ren, Jocelyn Garland, Marie Clements-Baker

IgG4-related disease (IgG4-RD) is an immune-mediated disorder marked by fibro-inflammatory masses that can infiltrate multiple organ systems. Due to its relatively recent discovery and limited understanding of its pathophysiology, IgG4-related disease may be difficult to recognize and is consequently potentially underdiagnosed. Renal involvement is becoming regarded as one of the key features of this disease. To date, the most well-recognized renal complication of IgG4-related disease is tubulointerstitial nephritis, but membranous glomerulonephritis, renal masses, and retroperitoneal fibrosis have also been reported. This concise review has two objectives. First, it will briefly encapsulate the history, epidemiology, and presentation of IgG4-related disease. Second, it will examine the reported renal manifestations of IgG4-related disease, exploring the relevant histology, imaging, clinical features, and treatment considerations. This synthesis will be highly relevant for nephrologists, rheumatologists, general internists, and renal pathologists to raise awareness and help improve early recognition of IgG4-related kidney disease (IgG4-RKD).

IgG4 相关疾病(IgG4-RD)是一种免疫介导的疾病,其特征是可浸润多个器官系统的纤维炎性肿块。由于 IgG4 相关疾病是最近才被发现的,而且人们对其病理生理学的了解有限,因此可能难以识别,进而导致诊断不足。肾脏受累逐渐被认为是这种疾病的主要特征之一。迄今为止,IgG4 相关疾病最公认的肾脏并发症是肾小管间质性肾炎,但膜性肾小球肾炎、肾肿块和腹膜后纤维化也有报道。这篇简明扼要的综述有两个目的。首先,它将简要概述 IgG4 相关疾病的病史、流行病学和表现。其次,它将研究已报道的 IgG4 相关疾病的肾脏表现,探讨相关的组织学、影像学、临床特征和治疗注意事项。本综述对肾脏病学家、风湿病学家、普通内科医生和肾脏病理学家具有重要意义,有助于提高对 IgG4 相关肾脏疾病(IgG4-RKD)的认识和早期识别能力。
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引用次数: 0
Bacteremia and Mortality among Patients with Nontunneled and Tunneled Catheters for Hemodialysis. 血液透析非隧道式和隧道式导管患者的菌血症和死亡率。
IF 2.1 Q3 Medicine Pub Date : 2024-02-06 eCollection Date: 2024-01-01 DOI: 10.1155/2024/3292667
Carla Santos De Lima, Flora Braga Vaz, Rodrigo Peixoto Campos

Introduction: Central venous catheters for hemodialysis (HD) can be nontunneled catheters (NTC) or tunneled catheters (TC). Bacteremia and dysfunction are complications that can impact morbidity and mortality. We decided to compare the rates of bacteremia and dysfunction between NTC and TC and patient survival 90 days after catheter insertion.

Methods: Retrospective cohort to evaluate catheters inserted between January 2011 and December 2020 in a tertiary hospital. Catheters in patients with end-stage chronic kidney disease were included. Patients with acute kidney injury, catheters that lasted less than three HD sessions, and patients who died within one week after insertion were excluded. Bacteremia and dysfunction rates, bacteremia-free survival, and dysfunction-free survival were investigated. Multivariable analysis was performed using a Cox proportional hazards regression model for patient survival at 90 days.

Results: 670 catheters were analyzed in 287 patients, 422 NTC (63%), and 248 TC (37%). The rates of confirmed bacteremia per 1,000 catheter-days were 1.19 for NTC and 0.20 for TC (p < 0.0001). The confirmed or possible bacteremia rates were 2.27 and 0.37 per 1,000 catheter-days for NTC and TC, respectively (p < 0.0001). The dysfunction rates were 3.96 and 0.86 for NTC and TC, respectively (p < 0.0001). Patient survival at 90 days was higher in the TC group than the NTC group (96.8% vs. 89.1%; p < 0.0001).

Conclusion: We found lower rates of bacteremia and dysfunction for TC and demonstrated that using NTC affects patient mortality.

导言:用于血液透析(HD)的中心静脉导管可以是非隧道式导管(NTC)或隧道式导管(TC)。菌血症和功能障碍是会影响发病率和死亡率的并发症。我们决定比较 NTC 和 TC 的菌血症和功能障碍发生率以及导管插入后 90 天的患者存活率:方法:对一家三级医院 2011 年 1 月至 2020 年 12 月期间插入的导管进行回顾性队列评估。纳入了终末期慢性肾病患者的导管。急性肾损伤患者、导管持续时间少于三次血液透析疗程的患者以及插入导管后一周内死亡的患者除外。对菌血症和功能障碍发生率、无菌血症存活率和无功能障碍存活率进行了调查。使用 Cox 比例危险回归模型对患者 90 天的存活率进行了多变量分析:对 287 名患者的 670 根导管进行了分析,其中 422 根为 NTC 导管(占 63%),248 根为 TC 导管(占 37%)。每 1,000 个导管日中,NTC 和 TC 的确诊菌血症率分别为 1.19 和 0.20(P < 0.0001)。NTC 和 TC 的确诊或可能菌血症率分别为每 1,000 导管日 2.27 例和 0.37 例(P < 0.0001)。NTC 和 TC 的功能障碍率分别为 3.96 和 0.86(P < 0.0001)。TC组患者的90天存活率高于NTC组(96.8% vs. 89.1%;p < 0.0001):我们发现 TC 的菌血症和功能障碍发生率较低,并证明使用 NTC 会影响患者死亡率。
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引用次数: 0
The Prevalence and Risk Factors of Hyperkalemia in the Outpatient Setting 门诊患者高钾血症的患病率和风险因素
IF 2.1 Q3 Medicine Pub Date : 2024-01-22 DOI: 10.1155/2024/5694131
Chadapa Sevamontree, Supreeya Jintajirapan, Pran Phakdeekitcharoen, B. Phakdeekitcharoen
Background. Hyperkalemia is a life-threatening condition in outpatient and emergency departments. Hyperkalemia is associated with more events of major adverse cardiovascular diseases, hospitalization, and death. The aim of this study is to study and assess the prevalence and risk factors for developing hyperkalemia within the Thai population. Method. A cross-sectional observational study of 3,299 unique adult patients (≥18 years) in one calendar year (2021) with at least 1 valid serum potassium (SK) test was conducted in the outpatient department of medicine. Hyperkalemia was determined as SK ≥5.8 mmol/L without hemolysis or technical error. Clinical data and laboratory tests were collected for analysis of risk factors. Result. 2,971 patients (131 hyperkalemia and 2,840 control) were eligible. The annual prevalence of hyperkalemia was 4.41%. The mean ages of patients were 66.5 years in the hyperkalemia group and 55.9 years in the control group. Increasing age had a positive association (r = 0.220, p<0.001) to risk of hyperkalemia, whereas the estimated glomerular filtration rate (eGFR) had an inverse association with SK level (r = −0.398, p<0.001). The risk factors for hyperkalemia were patients with age ≥65 years (odds ratio, 2.106; 95% CI, 1.399, 3.171; p<0.001), presence of diabetes mellitus (DM, odds ratio, 1.541; 95% CI, 1.030, 2.306; p=0.036), chronic kidney disease (CKD) stage ≥3 (odds ratio, 14.885; 95% CI, 8.112, 27.313; p<0.001), hemodialysis treatment (odds ratio, 10.170; 95% CI, 5.858, 17.657; p<0.001), and usage of renin-angiotensin-aldosterone system inhibitors (RAASi, odds ratio, 2.256; 95% CI, 1.440, 3.536; p<0.001). Conclusion. The risk factors contributing to hyperkalemia were patients with older age, DM, CKD, hemodialysis treatment, and usage of RAASi. Although the usage of RAASi is proven to be a cardiovascular advantage in the elderly, DM, and CKD patients, careful monitoring of SK is strongly advised to optimize patient care.
背景。在门诊和急诊中,高钾血症是一种危及生命的疾病。高钾血症与更多的主要不良心血管疾病、住院和死亡事件有关。本研究旨在研究和评估泰国人口中高钾血症的患病率和风险因素。研究方法在医学门诊部对一个日历年(2021 年)内至少进行过一次有效血清钾(SK)检测的 3299 名成年患者(≥18 岁)进行横断面观察研究。SK≥5.8 mmol/L,且无溶血或技术误差,即为高钾血症。收集临床数据和实验室检测结果以分析风险因素。结果2 971 名患者(131 名高钾血症患者和 2 840 名对照组患者)符合条件。高钾血症的年发病率为 4.41%。高钾血症组患者的平均年龄为 66.5 岁,对照组为 55.9 岁。年龄的增加与高钾血症风险呈正相关(r = 0.220,p<0.001),而估计肾小球滤过率(eGFR)与 SK 水平呈反相关(r = -0.398,p<0.001)。高钾血症的风险因素包括:年龄≥65 岁(几率比为 2.106;95% CI 为 1.399,3.171;p<0.001)、患有糖尿病(DM,几率比为 1.541;95% CI 为 1.030,2.306;p=0.036)、慢性肾脏病(CKD)≥3 期(几率比为 14.885;95% CI 为 1.030,2.306;p=0.036)。885;95% CI,8.112,27.313;P<0.001)、血液透析治疗(几率比,10.170;95% CI,5.858,17.657;P<0.001)和使用肾素-血管紧张素-醛固酮系统抑制剂(RAASi,几率比,2.256;95% CI,1.440,3.536;P<0.001)。结论导致高钾血症的风险因素包括患者年龄较大、患有糖尿病、慢性肾脏病、接受血液透析治疗以及使用 RAASi。尽管使用 RAASi 被证明对老年人、DM 和 CKD 患者的心血管有利,但仍强烈建议对 SK 进行仔细监测,以优化患者护理。
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引用次数: 0
Endovascular versus Surgical Lower Extremity Revascularization among Patients with Chronic Kidney Disease 慢性肾病患者下肢血管重建的血管内治疗与外科治疗对比
IF 2.1 Q3 Medicine Pub Date : 2023-12-16 DOI: 10.1155/2023/5586060
Qingzheng Chen, Jialin Han, Gomathy Parvathinathan, E. Ross, Margaret R. Stedman, Tara I. Chang
Introduction. Patients with chronic kidney disease (CKD) have a high prevalence of peripheral artery disease. How best to manage lower extremity peripheral artery disease remains unclear in this patient population. We therefore sought to compare the outcomes after endovascular versus surgical lower extremity revascularization among patients with CKD. Methods. We used data from Optum’s de-identifed Clinformatics® Data Mart Database, a nationwide database of commercially insured persons in the United States to study patients with CKD who underwent lower extremity endovascular or surgical revascularization. We used inverse probability of treatment weighting to balance covariates. We employed proportional hazard regression to study the primary outcome of major adverse limb events (MALE), defined as a repeat revascularization or amputation. We also studied each of these events separately and death from any cause. Results. In our cohort, 60,057 patients underwent endovascular revascularization and 9,338 patients underwent surgical revascularization. Endovascular revascularization compared with surgical revascularization was associated with a higher adjusted hazard of MALE (hazard ratio (HR) 1.52; 95% confidence interval (CI) 1.46–1.59). Endovascular revascularization was also associated with a higher adjusted hazard of repeat revascularization (HR 1.65; 95% CI 1.57–1.72) but a lower adjusted risk of amputation (HR 0.71; CI 0.73–0.89). Patients undergoing endovascular revascularization also had a lower adjusted hazard for death from any cause (0.85; CI 0.82–0.88). Conclusions. In this analysis of patients with CKD undergoing lower extremity revascularization, an endovascular approach was associated with a higher rate of repeated revascularization but a lower risk of subsequent amputation and death compared with surgical revascularization. Multiple factors must be considered when counseling patients with CKD, who have a high burden of comorbid conditions. Clinical trials should include more patients with kidney disease, who are often otherwise excluded from participation, to better understand the most effective treatment strategies for this vulnerable patient population.
简介慢性肾脏病(CKD)患者的外周动脉疾病发病率很高。对于这类患者,如何更好地治疗下肢外周动脉疾病仍不清楚。因此,我们试图比较 CKD 患者接受血管内和外科下肢血运重建术后的疗效。方法。我们使用 Optum 的去标识化 Clinformatics® Data Mart 数据库中的数据对接受下肢血管内或外科血管再通手术的 CKD 患者进行了研究。我们使用治疗反概率加权法来平衡协变量。我们采用比例危险回归法研究了肢体主要不良事件(MALE)这一主要结局,其定义为重复血管再通或截肢。我们还分别研究了这些事件以及任何原因导致的死亡。研究结果在我们的队列中,60,057 名患者接受了血管内血运重建,9,338 名患者接受了外科血运重建。血管内血运重建与手术血运重建相比,调整后的MALE风险更高(风险比(HR)1.52;95% 置信区间(CI)1.46-1.59)。血管内血运重建还与较高的重复血管内血运重建调整后风险(HR 1.65;95% CI 1.57-1.72)相关,但截肢调整后风险较低(HR 0.71;CI 0.73-0.89)。接受血管内再通术的患者因任何原因死亡的调整后风险也较低(0.85;CI 0.82-0.88)。结论在这项对接受下肢血管再通手术的慢性肾脏病患者进行的分析中,与外科血管再通手术相比,血管内治疗与较高的重复血管再通率相关,但随后截肢和死亡的风险较低。慢性肾脏病患者合并症较多,在为他们提供咨询时必须考虑多种因素。临床试验应纳入更多肾病患者,以便更好地了解针对这一弱势患者群体的最有效治疗策略。
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引用次数: 0
The Impact of Hot Ambient Temperature and Prolonged Fasting Duration during Ramadan on Patients with Chronic Kidney Disease: A Literature Review 斋月期间环境温度过高和禁食时间过长对慢性肾病患者的影响:文献综述
IF 2.1 Q3 Medicine Pub Date : 2023-12-09 DOI: 10.1155/2023/2636507
A. Alsahow
The Islamic (lunar) calendar has 11 fewer days each year than the Gregorian (solar) calendar. Consequently, ambient temperatures during the month of Ramadan and the duration of the presunrise-to-sunset fast will change each year. At some point, individuals observing Ramadan will experience prolonged periods of fasting during the hot summer months. In this manuscript, findings published in the English-language medical literature that address the impact of prolonged fasting during the warmer summer months on patients with chronic kidney disease, including dialysis and transplantation patients, are reviewed. This is of particular concern given the accelerated pace of global warming. The limitations of the evidence that is currently available are also discussed, and an approach that might be used to standardize future evaluations of the impact of fasting on kidney health is suggested.
伊斯兰历(阴历)每年比公历(阳历)少11天。因此,斋月期间的环境温度和日出至日落斋戒的持续时间每年都会发生变化。在某些时候,遵守斋月的人将在炎热的夏季经历长时间的禁食。在这篇论文中,对发表在英语医学文献上的研究结果进行了综述,这些研究涉及在温暖的夏季延长禁食对慢性肾脏疾病患者(包括透析和移植患者)的影响。考虑到全球变暖的加速,这一点尤其令人担忧。本文还讨论了现有证据的局限性,并提出了一种可能用于标准化未来禁食对肾脏健康影响评估的方法。
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引用次数: 0
Correlation of the Dietary Protein Intake between Those Estimated from a Short Protein Food-Recall Questionnaire and from 24-Hour Urinary Urea-Nitrogen Excretion in Stages 3-4 Chronic Kidney Disease Patients. 3-4期慢性肾病患者膳食蛋白质摄入量与24小时尿尿素氮排泄量的相关性
IF 2.1 Q3 Medicine Pub Date : 2023-11-22 eCollection Date: 2023-01-01 DOI: 10.1155/2023/9713045
Teerawat Thanachayanont, Methee Chanpitakkul, Akhathai Saetie, Salyaveth Lekagul, Kriang Tungsanga

Introduction: High protein intake may accelerate progression of chronic kidney disease (CKD). Estimation of dietary protein intake (DPI) is indispensable for management of CKD, but to achieve optimum DPI is quite challenging in routine clinical practice. We recently studied a beneficial effect of utilizing integrated care on the management of CKD at the rural community level. In that study, we created a short protein food-recall questionnaire (S-PFRQ) as a working tool to estimate DPI of the CKD patients during home visit by community health personnel. Herein, we reported the initial evaluation of the reliability of S-PFRQ from our previous study.

Objective: We compared the amount of DPI obtained from S-PFRQ with that obtained from protein-equivalent of total nitrogen appearance (PNA).

Methods: In the previous ESCORT-2 study, 914 patients with CKD stage 3 or 4, who were living in the rural area of Thailand, were prospectively followed while receiving integrated care for 36 consecutive months. During home visits by community nurses from subdistrict health centers, dietary food recall was made, recorded in S-PFRQ, and DPI was obtained. Among these, sixty patients were randomly selected, and 24-h urine was collected for urinary urea-N and estimation of PNA. A correlation was made between DPI obtained from S-PFRQ and PNA.

Results: The DPIs derived from S-PFRQ and PNA were 28.8 ± 14.8 and 39.26 ± 17.79 g/day, respectively. The mean difference and 95% CI between the 2 methods was -10.43 (-7.1 to -13.8) g/day, respectively (P < 0.001). Interclass correlation between these 2 methods was 0.24, P = 0.007. The difference between the 2 methods remained constant across different amounts of DPI.

Conclusion: The DPI estimated from S-PFRQ significantly correlated to that from PNA. However, the S-PFRQ method yielded a DPI value which was about 10 g of protein or 25% less than the PNA method. Despite this amount of difference, this S-PFRQ is user-friendly and could be used during field work as an easy and simple tool for DPI estimation in resource-limiting condition.

高蛋白摄入可能加速慢性肾脏疾病(CKD)的进展。膳食蛋白质摄入量(DPI)的估算是CKD治疗中不可缺少的,但在日常临床实践中实现最佳DPI是相当具有挑战性的。我们最近研究了在农村社区一级利用综合护理管理慢性肾病的有益效果。在该研究中,我们创建了一个简短的蛋白质食物召回问卷(S-PFRQ)作为工作工具来估计社区卫生人员家访期间CKD患者的DPI。在此,我们报告了先前研究对S-PFRQ可靠性的初步评估。目的:比较S-PFRQ法与总氮外观蛋白当量法(protein-equivalent of total nitrogen appearance, PNA)的DPI含量。方法:在之前的ESCORT-2研究中,生活在泰国农村地区的914例CKD 3期或4期患者接受了连续36个月的综合护理,并进行了前瞻性随访。在街道卫生中心社区护士家访期间,进行膳食食品召回,记录在S-PFRQ中,并获得DPI。其中随机选取60例患者,采集24 h尿液进行尿尿素氮测定和PNA测定。从S-PFRQ得到的DPI与PNA之间存在相关性。结果:S-PFRQ和PNA的dpi分别为28.8±14.8 g/d和39.26±17.79 g/d。两种方法的平均差异和95% CI分别为-10.43(-7.1至-13.8)g/day (P = 0.007)。两种方法之间的差异在不同的DPI量下保持不变。结论:S-PFRQ与PNA的DPI呈显著相关。然而,S-PFRQ方法得到的DPI值约为10 g蛋白质,比PNA方法少25%。尽管存在如此大的差异,但该S-PFRQ用户友好,可以在资源有限的情况下作为一种简单易用的DPI估计工具在现场工作中使用。
{"title":"Correlation of the Dietary Protein Intake between Those Estimated from a Short Protein Food-Recall Questionnaire and from 24-Hour Urinary Urea-Nitrogen Excretion in Stages 3-4 Chronic Kidney Disease Patients.","authors":"Teerawat Thanachayanont, Methee Chanpitakkul, Akhathai Saetie, Salyaveth Lekagul, Kriang Tungsanga","doi":"10.1155/2023/9713045","DOIUrl":"10.1155/2023/9713045","url":null,"abstract":"<p><strong>Introduction: </strong>High protein intake may accelerate progression of chronic kidney disease (CKD). Estimation of dietary protein intake (DPI) is indispensable for management of CKD, but to achieve optimum DPI is quite challenging in routine clinical practice. We recently studied a beneficial effect of utilizing integrated care on the management of CKD at the rural community level. In that study, we created a short protein food-recall questionnaire (S-PFRQ) as a working tool to estimate DPI of the CKD patients during home visit by community health personnel. Herein, we reported the initial evaluation of the reliability of S-PFRQ from our previous study.</p><p><strong>Objective: </strong>We compared the amount of DPI obtained from S-PFRQ with that obtained from protein-equivalent of total nitrogen appearance (PNA).</p><p><strong>Methods: </strong>In the previous ESCORT-2 study, 914 patients with CKD stage 3 or 4, who were living in the rural area of Thailand, were prospectively followed while receiving integrated care for 36 consecutive months. During home visits by community nurses from subdistrict health centers, dietary food recall was made, recorded in S-PFRQ, and DPI was obtained. Among these, sixty patients were randomly selected, and 24-h urine was collected for urinary urea-N and estimation of PNA. A correlation was made between DPI obtained from S-PFRQ and PNA.</p><p><strong>Results: </strong>The DPIs derived from S-PFRQ and PNA were 28.8 ± 14.8 and 39.26 ± 17.79 g/day, respectively. The mean difference and 95% CI between the 2 methods was -10.43 (-7.1 to -13.8) g/day, respectively (<i>P</i> < 0.001). Interclass correlation between these 2 methods was 0.24, <i>P</i> = 0.007. The difference between the 2 methods remained constant across different amounts of DPI.</p><p><strong>Conclusion: </strong>The DPI estimated from S-PFRQ significantly correlated to that from PNA. However, the S-PFRQ method yielded a DPI value which was about 10 g of protein or 25% less than the PNA method. Despite this amount of difference, this S-PFRQ is user-friendly and could be used during field work as an easy and simple tool for DPI estimation in resource-limiting condition.</p>","PeriodicalId":14177,"journal":{"name":"International Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10686714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138459902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Findings of Cardiovascular Workup of Kidney Transplant Candidates: A Retrospective Study of a Single-Center in Saudi Arabia. 肾移植候选者心血管检查结果:沙特阿拉伯一个单一中心的回顾性研究。
IF 2.1 Q3 Medicine Pub Date : 2023-10-10 eCollection Date: 2023-01-01 DOI: 10.1155/2023/4653069
Ziad Arabi, Mohammed H Tawhari, Haneen S Al Rajih, Talha M Youssouf, Mohamad Y Abdulgadir

Background: There are limited data about the prevalence of cardiovascular (CV) risk factors and the findings of CV workup among kidney transplant (KTx) recipients (KTRs) in Saudi Arabia.

Methods: A single-center retrospective study of KTRs who underwent KTx from 2017 to 2020 was performed. We reviewed the prevalence of CV risk factors and the results of the pre-KTx CV workup which was derived from the American Heart Association guidelines.

Results: We included 254 KTRs. The mean age was 43.1 ± 15.9 years, and 55.5% were men and 79.5% were living-donor KTRs. Pre-emptive KTx was 9.8%, peritoneal dialysis was 11.8%, and hemodialysis was 78.3% (arteriovenous fistula: 33.1% versus hemodialysis catheter: 66.9%). The mean dialysis vintage was 4.8 ± 3.3 years for deceased-donor KTRs versus 2.4 ± 2.6 years for living-donor KTRs. CV risk factors were hypertension: 76%, diabetes: 40.6% (type 1 : 25.2% versus type 2 : 74.7%), hyperlipidemia (low-density lipoprotein >2.6 mmol/L): 40.2%, coronary artery disease (CAD): 12.6%, smoking: 9.1%, peripheral vascular disease: 2.8%, and cerebral vascular disease: 2.4%. The prevalence of obesity stage 1 was 19.7% and obesity stage 2 was 4%. Left ventricular hypertrophy was present in 38.5%. The ejection fraction was abnormal (<55%) in 22%. Abnormal wall motion was present in 34 patients (13.4%). A cardiac (PET-CT) stress test was conducted on 129 patients (50.8%) which showed abnormal perfusion in 37 patients (28.7%). Out of those who required PET-CT, 18.6% had a coronary artery calcium scoring (CACS) of more than 400, 41.8% had a CACS of zero, 29.4% had a CACS of 1-100, and 14.7% had a CACS of 100-400. Coronary angiogram was required in only 41 patients (16.1%), 12 (29.3%) required coronary interventions, 25 (61%) were treated medically, and 4 (9.8%) did not have any CAD. CT scans of pelvic arteries were performed in 118 patients (46.5%). It showed moderate or severe calcifications in only 7 patients (5.9%), whereas it was normal in 97 patients (82.2%), or it showed only mild calcifications in 14 patients (11.9%).

Conclusion: This study outlines the prevalence of CV risk factors and the findings of the pretransplant CV workup among KTx candidates who underwent KTx. Multicenter national studies will be helpful to validate the generalizability of these findings.

背景:关于沙特阿拉伯肾移植受者心血管(CV)危险因素的患病率和心血管检查结果的数据有限。方法:对2017年至2020年接受KTx的KTR进行单中心回顾性研究。我们回顾了心血管危险因素的患病率和KTx前心血管检查的结果,该检查源自美国心脏协会指南。结果:我们包括254 KTR。平均年龄43.1岁 ± 15.9 55.5%为男性,79.5%为活体供体KTR。先发制人KTx为9.8%,腹膜透析为11.8%,血液透析为78.3%(动静脉瘘:33.1%,而血液透析导管:66.9%)。平均透析年限为4.8 ± 3.3 已故捐赠者KTR的年数与2.4 ± 2.6 活体捐赠者KTR的年数。心血管危险因素为高血压:76%,糖尿病:40.6%(1型 : 25.2%与2型相比 : 74.7%)、高脂血症(低密度脂蛋白>2.6 mmol/L):40.2%,冠状动脉疾病(CAD):12.6%,吸烟:9.1%,外周血管疾病:2.8%,脑血管疾病:2.4%。肥胖1期的患病率为19.7%,肥胖2期为4%。38.5%的患者出现左心室肥大。射血分数异常(结论:本研究概述了接受KTx的KTx候选人中CV危险因素的患病率和移植前CV检查的结果。多中心国家研究将有助于验证这些发现的可推广性。
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引用次数: 0
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International Journal of Nephrology
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