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Zinc Acetate Hydrate Supplementation versus Polaprezinc Supplementation for Improving Hypozincemia in Hemodialysis Patients: A Randomized Clinical Trial. 补充醋酸锌水合物与补充安定改善血液透析患者低锌血症的随机临床试验。
IF 2.1 Q3 Medicine Pub Date : 2023-10-05 eCollection Date: 2023-01-01 DOI: 10.1155/2023/2403755
Etsuko Kumagai, Kazuhiro Furumachi, Akihiro Kurihara, Ken Hosokawa, Keiko Hosohata, Shinji Takai

Zinc supplementation may ameliorate zinc deficiency in maintenance hemodialysis patients; however, no standard protocol has been established. This study aimed to investigate the effects of zinc acetate hydrate (ZAH) and polaprezinc (PPZ) as zinc supplements in hemodialysis patients. We enrolled 75 hemodialysis patients with serum zinc levels <60 μg/dL for this study and randomly assigned Zinc supplementation to these 75 patients: 37 received ZAH (50 mg/day), and 38 received PPZ (34 mg/day). Serum zinc levels of both groups were compared every 4 weeks for 1 year. In both groups, serum zinc levels significantly increased at 4-52 weeks. Serum zinc levels were significantly higher in the ZAH group at 4-12 weeks; however, no significant differences were observed between the groups at 16-52 weeks. Adverse events requiring a reduction in the zinc dose, including copper deficiency, occurred significantly more frequently in the ZAH group. In conclusion, PPZ can safely maintain serum zinc levels for 1 year. ZAH provides rapid zinc supplementation but can cause adverse events.

补充锌可以改善维持性血液透析患者的锌缺乏;然而,尚未建立标准协议。本研究旨在探讨醋酸锌水合物(ZAH)和泊拉嗪酮(PPZ)作为血液透析患者锌补充剂的效果。本研究招募了75名血清锌水平为μg/dL的血液透析患者,并将锌补充剂随机分配给这75名患者:37名接受ZAH(50 mg/天),38人接受PPZ(34 mg/天)。每4天比较两组的血清锌水平 1周 年在两组中,血清锌水平在4-52时显著升高 周。ZAH组4-12岁时血清锌水平显著升高 周;然而,在16-52岁时,两组之间没有观察到显著差异 周。需要减少锌剂量的不良事件,包括铜缺乏,在ZAH组中发生的频率明显更高。总之,PPZ可以安全地维持血清锌水平1 年ZAH可以快速补充锌,但会导致不良事件。
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引用次数: 0
Immunophenotypic Characterization of Citrate-Containing A Concentrates in Maintenance Hemodialysis: A Pre-Post Study. 维持性血液透析中含柠檬酸A浓缩物的免疫表型特征:一项前后研究。
IF 2.1 Q3 Medicine Pub Date : 2023-09-27 eCollection Date: 2023-01-01 DOI: 10.1155/2023/7772677
Yuli Shen, Christoph Schmaderer, Andreas Ossadnik, Arianne Hammitzsch, Javier Carbajo-Lozoya, Quirin Bachmann, Vera Bonell, Matthias Christoph Braunisch, Uwe Heemann, Dang Pham, Stephan Kemmner, Georg Lorenz

Introduction: Due to chronic inflammation, maintenance hemodialysis (MHD) patients continue to show excess mortality. Acetate-free citrate-buffered A concentrates could be a way to improve the biocompatibility of the procedure, reduce chronic inflammation, and thus in the long term improve the prognosis of patients.

Methods: Using a pre-post design (3 months of acetate followed by 3 months of citrate-acidified A concentrates in standard bicarbonate-based dialysate hemodialysis, CiaHD) and linear mixed model analysis in 61 stable HD patients, we assessed the impact of CiaHD on counts and phenotypes of peripheral T cells and monocytes by flow cytometry.

Results: Switching to CiaHD left C-reactive protein (CRP) levels and leucocyte counts unaffected. However, CiaHD increased lymphocyte counts ex vivo. Furthermore, we found a decrease in total CD3+CD4+CD69+ ((109/L), mean ± SD: acetate, 0.04 ± 1.0 versus citrate, 0.02 ± 0.01; P = 0.02) activated cells, while the number of CD28+ T cells remained stable. No differences were noted regarding T-cell exhaustion marker expression, CD14+CD16+ monocyte counts, and PMN-MDSCs.

Conclusion: Compared with acetate, CiaHD has a minor impact on lymphocyte counts and CD4+T-cell activation, which was independent of systemic CRP and ionized magnesium, calcium levels, and other dialysis prescription modalities.

引言:由于慢性炎症,维持性血液透析(MHD)患者继续表现出超额死亡率。不含醋酸盐的柠檬酸缓冲A浓缩物可以改善手术的生物相容性,减少慢性炎症,从而从长远来看改善患者的预后。方法:采用前后设计(3 醋酸几个月后3个月 在标准碳酸氢盐透析液血液透析(CiaHD)中的柠檬酸酸化A浓缩物的月数)和线性混合模型分析中,我们通过流式细胞术评估了CiaHD对外周T细胞和单核细胞计数和表型的影响。结果:改用CiaHD后,C反应蛋白(CRP)水平和白细胞计数未受影响。然而,CiaHD增加了离体淋巴细胞计数。此外,我们发现总CD3+CD4+CD69+((109/L),平均 ± SD:乙酸盐,0.04 ± 1.0相对于柠檬酸盐,0.02 ± 0.01;P = 0.02)活化的细胞而CD28+T细胞的数量保持稳定。在T细胞耗竭标志物表达、CD14+CD16+单核细胞计数和PMN-MDSCs方面没有发现差异。结论:与醋酸盐相比,CiaHD对淋巴细胞计数和CD4+T细胞活化的影响较小,这与全身CRP和电离镁、钙水平以及其他透析处方模式无关。
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引用次数: 0
Comparison of Three Glomerular Filtration Rate Estimating Equations with 24-Hour Urine Creatinine Clearance Measurement in Potential Living Kidney Donors. 三种肾小球滤过率估算公式与 24 小时尿液肌酐清除率测量在潜在活体肾脏捐献者中的比较
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-06-15 eCollection Date: 2023-01-01 DOI: 10.1155/2023/2022641
Fernando Giron-Luque, Andrea Garcia-Lopez, Yenny Baez-Suarez, Nasly Patino-Jaramillo

Background: The accuracy of the measurement of renal function in potential living kidney donors (PLKD) is essential. The direct measurement of glomerular filtration rate (mGFR) has been considered the "gold standard." The estimated GFR (eGFR) with 24-hour urinary creatinine clearance (CrCl) is frequently used because of its availability. We aim to evaluate the correlation and agreement of eGFR using serum-based creatinine formulas (Cockcroft-Gault, MDRD, and CKD-EPI) and the eGFR based on 24-hour urinary CrCl to evaluate kidney function in PLKD.

Methods: We evaluated the kidney function in 799 PLKD using 24-hour urinary CrCl method and compared the correlation and agreement with the eGFR based on creatinine formulas (Cockcroft-Gault, MDRD, and CKD-EPI). We calculated the mean bias (difference), precision (SD of this difference), accuracy, and performed Bland-Altman plots.

Results: A total of 799 PLKD were analyzed. The age of the PLKD ranged from 18 to 73 years. Weak to mild correlation was observed between 24-hour urinary CrCl and all formulas (ranged from 0.31 to 0.49). The three equations underestimated the GFR. Using the Bland-Altman graphic, we observed that the CKD-EPI was the least scattered and most precise; however, mean bias and the interval range (limits of agreement) of all formulas were too big to assume equivalence between 24-hour urinary CrCl method and eGFR based on creatinine. Results of mean bias were similar when comparing the three equations in patients with CrCl GFR <60. However, the accuracy of all formulas was better for the female group and the youngest individuals (≤40 years old).

Conclusion: In this PLKD cohort, of all the three equations, the CKD-EPI was the least scattered and most precise. However, the correlation and the level of agreement between the three equations and 24-hour urinary CrCl were too low to assume the equivalence.

背景:潜在活体肾脏捐献者(PLKD)肾功能测量的准确性至关重要。直接测量肾小球滤过率(mGFR)一直被认为是 "黄金标准"。估算的肾小球滤过率(eGFR)和 24 小时尿肌酐清除率(CrCl)因其可用性而经常被使用。我们旨在评估使用基于血清的肌酐公式(Cockcroft-Gault、MDRD 和 CKD-EPI)计算的 eGFR 与基于 24 小时尿液 CrCl 的 eGFR 在评估 PLKD 肾功能时的相关性和一致性:我们使用 24 小时尿 CrCl 法评估了 799 例 PLKD 的肾功能,并比较了与基于肌酐公式(Cockcroft-Gault、MDRD 和 CKD-EPI)的 eGFR 的相关性和一致性。我们计算了平均偏差(差值)、精确度(差值的 SD 值)和准确度,并绘制了 Bland-Altman 图:结果:共分析了 799 例 PLKD。PLKD的年龄从18岁到73岁不等。观察发现,24 小时尿 CrCl 与所有公式之间存在微弱至轻度的相关性(从 0.31 到 0.49 不等)。三种公式都低估了肾小球滤过率。通过使用 Bland-Altman 图形,我们观察到 CKD-EPI 的分散性最小且最精确;然而,所有公式的平均偏差和间隔范围(一致性限制)都过大,因此无法假设 24 小时尿 CrCl 方法与基于肌酐的 eGFR 之间具有等效性。在比较 CrCl GFR 患者的三种公式时,平均偏差结果相似:在该 PLKD 队列中,在所有三种方程中,CKD-EPI 的偏差最小且最精确。但是,这三种方程与 24 小时尿 CrCl 之间的相关性和一致程度太低,因此不能假定其等效性。
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引用次数: 0
Magnetic Resonance Visibility, Artifacts, and Overall Safety of the Self-Locating Peritoneal Dialysis Catheter with a Tungsten Tip. 带钨尖头的自定位腹膜透析导管的磁共振可见度、伪影和总体安全性。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-01-24 eCollection Date: 2023-01-01 DOI: 10.1155/2023/7901413
Maurizio Gallieni, Umberto G Rossi, Massimo Tonolini, Andrea Ianniello, Roberta Miglio, Gianmarco Sabiu, Maurizio Cariati

Background: The self-locating peritoneal dialysis (PD) catheter, contains a tungsten tip. The effects of magnetic resonance (MR) on the catheter were evaluated, emphasizing its MR signal, artifacts, ferromagnetism, and possible heating production during the MR sequences.

Methods: The catheter was studied in an ex vivo model using a 1.5T MR system and placed into a plastic box containing saline solution. Acquisitions on coronal and axial planes were obtained on fast gradient-echo T1-weighted and fast spin-echo T2-weighted. In vivo abdominal MR exams were also carried out.

Results: Overall, the catheter had good visibility. In all sequences, an extensive paramagnetic blooming artifact was detected at the level of the tip tungsten ballast, with a circular artifact of 5 cm in diameter. The catheter showed no magnetic deflection, rotation, or movements during all MR sequences. After imaging, the temperature of the saline solution did not change compared to the basal measurement. Patients safely underwent abdominal MR.

Conclusions: The results point to the possibility of safely performing MR in PD patients carrying the self-locating catheter. The self-locating PD catheter is stable when subjected to a 1.5T MR system. However, it creates some visual interference, preventing an accurate study of the tissues surrounding the tungsten tip.

背景:自定位腹膜透析(PD)导管含有钨尖端。我们评估了磁共振(MR)对导管的影响,重点是导管的磁共振信号、伪影、铁磁性以及在磁共振序列中可能产生的热量:使用 1.5T 磁共振系统在体外模型中对导管进行了研究,并将其放入一个装有生理盐水的塑料盒中。通过快速梯度回波 T1 加权和快速自旋回波 T2 加权对冠状面和轴向进行采集。此外,还进行了活体腹部磁共振检查:总体而言,导管的可见度良好。在所有序列中,在尖端钨压载水平检测到广泛的顺磁性发花伪影,直径为 5 厘米的圆形伪影。在所有磁共振序列中,导管均未出现磁偏转、旋转或移动。成像后,生理盐水的温度与基础测量值相比没有变化。患者安全地接受了腹部磁共振成像:结果表明,携带自定位导管的腹腔镜前列腺增生症患者可以安全地进行磁共振成像。当使用 1.5T 磁共振系统时,自定位 PD 导管是稳定的。然而,它产生了一些视觉干扰,妨碍了对钨尖周围组织的准确研究。
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引用次数: 0
Efficacy and Safety of Bedside Removal of Tunnelled Hemodialysis Catheter by Noninterventional Nephrologists among Adult Patients in the King Abdulaziz University Hospital Hemodialysis Centre in Jeddah: A Retrospective Cohort Study. 吉达阿卜杜勒阿齐兹国王大学医院血液透析中心非介入性肾脏科医师床边取出隧道式血液透析导管的有效性和安全性:一项回顾性队列研究
IF 2.1 Q3 Medicine Pub Date : 2023-01-01 DOI: 10.1155/2023/6905528
Abdullah Kashgary, Razan A Almuhyawi, Reem R Alhijri, Aseel M Ba Durayq, Wed B Alnagrani, Arwa J Alharbi, Hamidah M Al Khalaf, Haya S Obaid, Ahmed Zaky Fadel, Mostafa Abdelsalam

This study aimed to assess the efficacy and safety of bedside removal of tunnelled hemodialysis catheter (TDC) by noninterventional nephrologists among adult patients. It is a retrospective study that involved 53 patients from March 2020 to February 2022 at the King Abdulaziz University Hospital (KAUH) Hemodialysis Centre in Jeddah, Saudi Arabia. Of the 53 participants, 60.4% were male and 40.6% female, and their mean age was 50.94 ± 18.89 years. The most common comorbidities were hypertension (HTN) in 47 (88.7%), diabetes mellitus (DM) in 24 (45.3%), and DM and HTN together in 23 (43.4%) patients. The most common site of TDC removal was the right internal jugular vein (77.4%). In 84.9% of the cases, the TDC was removed as an inpatient procedure, and in the majority of the cases (64.2%), the TDC was removed by a noninterventional nephrologist. The most common reasons for TDC removal were sepsis or clinical concerns for infection (64.2%) and TDC not needed (20.8%) due to recovery of the renal function or access maturation. Most patients (96.2%) suffered no complications; only one of 34 (%) patients with catheter removal by a noninterventional nephrologist had bleeding, which required more observation and monitoring before discharge on the same day. Our study revealed that the bedside TDC removal was well tolerated with a minimal complication rate.

本研究旨在评估非介入性肾科医师床边取出隧道式血液透析导管(TDC)在成年患者中的有效性和安全性。这是一项回顾性研究,涉及沙特阿拉伯吉达阿卜杜勒阿齐兹国王大学医院(KAUH)血液透析中心2020年3月至2022年2月期间的53名患者。53例患者中男性占60.4%,女性占40.6%,平均年龄50.94±18.89岁。最常见的合并症是高血压(HTN) 47例(88.7%),糖尿病(DM) 24例(45.3%),糖尿病合并HTN 23例(43.4%)。最常见的TDC切除部位为右颈内静脉(77.4%)。在84.9%的病例中,TDC作为住院手术切除,在大多数病例中(64.2%),TDC是由非介入肾病专家切除的。切除TDC最常见的原因是脓毒症或感染的临床问题(64.2%),由于肾功能恢复或通路成熟而不需要TDC(20.8%)。大多数患者(96.2%)无并发症;经非介入性肾科医师取管的34例患者中,仅有1例(%)出现出血,需要在当日出院前进行更多的观察和监测。我们的研究表明,床边TDC切除耐受良好,并发症发生率最低。
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引用次数: 0
Growth Differentiation Factor 15 and Risk of Death in Haemodialysis Patients. 生长分化因子15与血液透析患者死亡风险的关系
IF 2.1 Q3 Medicine Pub Date : 2023-01-01 DOI: 10.1155/2023/5163548
Christelle Calen, Seraina Von Moos, Pietro Cippà, Alexandre Mebazaa, Mattia Arrigo

Aim: Noninvasive identification of haemodialysis patients at high risk of cardiovascular events and death might improve their outcome. Growth differentiation factor 15 is a prognostic biomarker in multiple disease entities, including cardiovascular disease. The aim of this study was to assess the association between plasma GDF-15 and mortality in a cohort of haemodialysis patients.

Methods: Circulating GDF-15 was measured in 30 patients after a regular haemodialysis session, followed by a clinical follow-up for all-cause death. Measurements were performed using the Proseek Multiplex Cardiovascular disease panels (Olink Proteomics AB) and validated using the Elecsys GDF-15 electrochemiluminescence immunoassay on a Cobas E801 analyzer (Roche Diagnostics).

Results: During a median of 38 months, 9 patients (30%) died. Seven deaths occurred in the group of patients with a circulating GDF-15 above the median and two in the group with lower GDF-15. Mortality was significantly higher in patients with circulating GDF-15 levels above the median, log-rankP = 0.044. The performance of circulating GDF-15 to predict long-term mortality has an area under the ROC curve of 0.76, P = 0.028. Prevalence of most relevant comorbidities and the Charlson comorbidity index were similar across the two groups. A high agreement with a correlation among both diagnostic methods was observed (Spearman's rho = 0.83, P < 0.001).

Conclusion: Plasma GDF-15 displays promising prognostic properties for the prediction of long-term survival beyond clinical parameters in patients on maintenance haemodialysis.

目的:无创识别高危心血管事件和死亡的血液透析患者可能改善其预后。生长分化因子15是包括心血管疾病在内的多种疾病的预后生物标志物。本研究的目的是评估血液透析患者血浆GDF-15与死亡率之间的关系。方法:在30例定期血液透析患者中测量循环GDF-15,随后进行全因死亡的临床随访。使用Proseek Multiplex心血管疾病面板(Olink Proteomics AB)进行测量,并在Cobas E801分析仪(罗氏诊断)上使用Elecsys GDF-15电化学发光免疫分析法进行验证。结果:在中位38个月期间,9例(30%)患者死亡。在循环GDF-15高于中位数的患者组中有7例死亡,在GDF-15较低的患者组中有2例死亡。循环GDF-15水平高于中位数的患者死亡率明显更高,log-rankP = 0.044。循环GDF-15预测长期死亡率的ROC曲线下面积为0.76,P = 0.028。两组患者最相关合并症的患病率和Charlson合并症指数相似。观察到两种诊断方法之间高度一致的相关性(Spearman’s rho = 0.83, P < 0.001)。结论:血浆GDF-15在预测维持性血液透析患者超出临床参数的长期生存方面具有良好的预后特性。
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引用次数: 0
Primary Hyperoxaluria Type 1: Clinical, Paraclinical, and Evolutionary Aspects in Adults from One Nephrology Center. 原发性高草酸尿1型:成人的临床、临床旁和进化方面
IF 2.1 Q3 Medicine Pub Date : 2023-01-01 DOI: 10.1155/2023/2874414
Hajji Meriam, Asma Bettaieb, Hayet Kaaroud, Fethi Ben Hamida, Taher Gargeh, Ridha Mrad, Kahena Bouzid, Ezzeddine Abderrahim

Introduction: Primary hyperoxaluria type 1 (PH1) is a rare and inherited condition of urolithiasis. The aim of our study was to analyze clinical, paraclinical, and evolutionary aspects of PH1 in adult patients in our Nephrology department.

Methods: We conducted a retrospective single-center study between 1990 and 2021. We collected patients followed for PH1 confirmed by genetic study and/or histopathological features of renal biopsy and morphoconstitutional analysis of the calculi.

Results: There were 25 patients with a gender ratio of 1.78. The median age at onset of symptoms was 18 years. A delay in diagnosis more than 10 years was noted in 13 cases. The genetic study found the I244T mutation in 17 cases and 33-34 InsC in 4 cases. A kidney biopsy was performed in 5 cases, on a native kidney in 4 cases and on a graft biopsy in one case. The analysis of calculi was done in 10 cases showing type Ic in 2 cases. After a median follow-up of 13 years (1 year-42 years), 14 patients progressed to end-stage chronic renal failure (ESRD). The univariate study demonstrated a remarkable association with progression to ESRD in our population (44% vs. 56%) RR = 13.32 (adjusted ORs (95% CI): 2.82-62.79) (p < 0.01).

Conclusion: Progression to ESRD was frequent in our series. Early diagnosis and adequate management can delay such an evolution.

原发性高草酸尿1型(PH1)是一种罕见的遗传性尿石症。我们研究的目的是分析我们肾脏病科成年患者PH1的临床、临床旁和进化方面。方法:我们在1990年至2021年间进行了一项回顾性单中心研究。我们收集了经遗传研究和/或肾活检组织病理学特征和结石形态结构分析证实的PH1患者。结果:25例患者,性别比为1.78。出现症状的中位年龄为18岁。13例延误诊断超过10年。遗传研究发现17例患者有I244T突变,4例患者有33-34 InsC突变。5例进行了肾活检,4例进行了原生肾活检,1例进行了移植肾活检。结石分析10例,2例为Ic型。中位随访13年(1 -42年)后,14例患者进展为终末期慢性肾功能衰竭(ESRD)。单因素研究显示,在我们的人群中,与ESRD进展有显著关联(44% vs. 56%) RR = 13.32(调整后的or (95% CI): 2.82-62.79) (p < 0.01)。结论:在我们的研究中,进展为ESRD是很常见的。早期诊断和适当的管理可以延缓这种演变。
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引用次数: 1
Blind Spot in the Radar of MEST-C Score: Type and Severity of Tubulointerstitial Nephritis in IgA Nephropathy. MEST-C评分的盲点:IgA肾病小管间质性肾炎的类型和严重程度。
IF 2.1 Q3 Medicine Pub Date : 2023-01-01 DOI: 10.1155/2023/1060526
Iram Asrar, Mudassar Hussain, Aurangzeb Afzal, Usman Hassan, Sheeba Ishtiaq

Background: The updated version of predictive classification for immunoglobulin A nephropathy (IgAN) prognosis "The Oxford Classification" identifies five histopathological features including mesangial hypercellularity (M), endocapillary proliferation (E), segmental glomerulosclerosis (S), tubular atrophy/interstitial fibrosis (T) and crescents (C), the MEST-C. However, few studies suggest that tubulointerstitial inflammation, which is not included in the MEST-C, is also linked to disease progression and is, consequently, a neglected determinant of prognosis among others. Therefore, there is a need to evaluate this histopathological parameter in patients with IgA nephropathy.

Materials and methods: This cross-sectional descriptive study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan. Data of histopathological and immunofluorescence proven renal biopsies (300) of IgA nephropathy patients from January 2016 through May 2022 were extracted using a convenient sampling technique. Biopsies were histologically reviewed for type and severity of tubulointerstitial inflammation, in addition to the MEST-C score. Renal biopsies of patients who had a history of transplant, autolyzed tissue, no glomeruli on histological examination, and/or a tubular atrophy/interstitial fibrosis score of 2 (T2) in MEST-C scoring were excluded. Data were analyzed using SPSS 20. An association between the variables was analyzed using the chi-square and Fischer exact tests. A p value less than 0.05 was considered statistically significant.

Results: A total of 247/300 biopsies were eligible for inclusion. The mean age at the time of biopsy was 31.90 ± 12.48 with 63.6% in the age group between 21 and 40 years, and 69.6% were male. Tubulointerstitial inflammation was observed in 90.2% cases with 49.4% showing moderate while 4.5% showing severe degree of inflammation. A strong association of both the type and severity of tubulointerstitial inflammation was found with M, E, T, and C scores (p value < 0.05).

Conclusion: The high-frequency and strong statistical association of tubulointerstitial inflammation with the M, E, T, and C scores in our study elucidate its prognostic role in the progression and management of IgA nephropathy.

背景:免疫球蛋白A肾病(IgAN)预后预测分类的最新版本“牛津分类”确定了五种组织病理学特征,包括系膜细胞增多(M)、毛细血管内增生(E)、节段性肾小球硬化(S)、小管萎缩/间质纤维化(T)和新月状(C),即MEST-C。然而,很少有研究表明,未包括在MEST-C中的小管间质炎症也与疾病进展有关,因此是一个被忽视的预后决定因素。因此,有必要对IgA肾病患者的这一组织病理学参数进行评估。材料和方法:本横断面描述性研究在巴基斯坦拉合尔的Shaukat Khanum纪念癌症医院和研究中心进行。使用方便的采样技术提取2016年1月至2022年5月IgA肾病患者(300例)的组织病理学和免疫荧光证实的肾活检数据。除MEST-C评分外,组织学检查活检以确定小管间质炎症的类型和严重程度。排除有移植史、组织自溶、组织学检查无肾小球和/或MEST-C评分为2 (T2)的肾活检患者。数据采用SPSS 20进行分析。使用卡方检验和费舍尔精确检验分析变量之间的关联。p值小于0.05认为有统计学意义。结果:共有247/300例活检符合纳入条件。活检时的平均年龄为31.90±12.48岁,21 ~ 40岁年龄组占63.6%,男性占69.6%。90.2%的患者出现了小管间质性炎症,其中49.4%为中度炎症,4.5%为重度炎症。小管间质炎症的类型和严重程度与M、E、T和C评分有很强的相关性(p值< 0.05)。结论:在我们的研究中,小管间质炎症与M、E、T和C评分之间高频且强的统计学关联阐明了其在IgA肾病进展和治疗中的预后作用。
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引用次数: 2
Effects of Oral Sodium Bicarbonate Supplementation on Protein Metabolism and Inflammation in Iraqi Hemodialysis Patients: An Open-Label Randomized Controlled Trial. 口服碳酸氢钠对伊拉克血液透析患者蛋白质代谢和炎症的影响:一项开放标签随机对照试验。
IF 2.1 Q3 Medicine Pub Date : 2023-01-01 DOI: 10.1155/2023/6657188
Zina A Rasheed, Ban A Al-Hashemi, Ala A Ali

Background: The effect of correcting metabolic acidosis on protein metabolism in hemodialysis patients is controversial.

Objectives: To study the effects of oral sodium bicarbonate on protein metabolism and markers of inflammation in acidotic hemodialysis patients. Patients and Methods. An open-label randomized controlled trial was conducted at a single center. Sixty-six clinically stable adult hemodialysis patients were recruited with an average predialysis serum bicarbonate level of <22 mmol/l and a dialysate bicarbonate concentration of 35 mmol/l. Forty-nine participants have completed the study. Oral sodium bicarbonate tablets of 500 mg were given daily in the intervention group (n = 25) for 12 weeks versus the standard of care in the control group (n = 24). Outcomes compared intervention versus nonintervention in both groups at equivalent time points (0 and 3 months). The clinical data, anthropometry, dialysis adequacy, albumin, normalized protein catabolism rate, blood gas analysis, and bicarbonate were recorded at 0 and 3 months. In addition, muscle mass and handgrip strength were measured. Finally, IL-6 as a marker of inflammation was measured at randomization and three months.

Results: Serum bicarbonate and pH increased significantly from 17.57 ± 3.34 mmol/L to 20.69 ± 2.54 mmol/L and from 7.26 ± 0.06 to 7.34 ± 0.04, respectively (p < 0.0001). Serum albumin was significantly higher in the intervention group at three months than in the control group, 4.11 ± 0.45 vs. 3.79 ± 0.47 (p value 0.011). Serum potassium significantly decreased in the intervention group at three months compared to the control group, 5.00 ± 0.43 mEq/l vs. 5.33 ± 0.63 mEq/l (p value 0.03). Muscle strength expressed as handgrip has improved significantly in the intervention group at three months compared to the control group, 45.01 ± 19.19 vs. 33.93 ± 15.06 (p value 0.03). The IL-6 values were less in the intervention group at 3 months with a p value of 0.01. The interdialytic weight of the intervention group at three months was 2.42 ± 0.64 compared to the 2.20 ± 1.14 control group, but this did not reach statistical significance (p value of 0.4). The composite of (albumin + nPCR) at three months was achieved in 59.18% of the intervention group compared to 14.28% with a p value of 0.01.

Conclusions: Correcting metabolic acidosis in hemodialysis patients improved serum albumin and nPCR without hypokalemia or significant interdialytic weight gain. This was particularly evident in patients with minimal inflammation with low IL-6 values.

背景:纠正代谢性酸中毒对血液透析患者蛋白质代谢的影响存在争议。目的:探讨口服碳酸氢钠对酸性血液透析患者蛋白质代谢及炎症标志物的影响。患者和方法。在单中心进行开放标签随机对照试验。招募66名临床稳定的成人血液透析患者,透析前平均血清碳酸氢盐水平为n = 25),为期12周,对照组为标准护理(n = 24)。结果比较两组在相同时间点(0和3个月)的干预和不干预。在0和3个月记录临床资料、人体测量、透析充分性、白蛋白、标准化蛋白质分解代谢率、血气分析和碳酸氢盐。此外,还测量了肌肉质量和握力。最后,在随机分组和三个月时测量IL-6作为炎症标志物。结果:血清碳酸氢盐由17.57±3.34 mmol/L升高至20.69±2.54 mmol/L, pH由7.26±0.06升高至7.34±0.04,差异均有统计学意义(p < 0.0001)。干预组3个月时血清白蛋白水平(4.11±0.45比3.79±0.47)明显高于对照组(p值0.011)。干预组3个月时血清钾水平明显低于对照组,分别为5.00±0.43 mEq/l和5.33±0.63 mEq/l (p值0.03)。与对照组相比,干预组在3个月时握力(45.01±19.19)比对照组(33.93±15.06)有明显改善(p值0.03)。干预组在3个月时IL-6值明显低于对照组,p值为0.01。干预组3个月时透析间期体重为2.42±0.64,对照组为2.20±1.14,但差异无统计学意义(p值为0.4)。干预组3个月(白蛋白+ nPCR)复合阳性率为59.18%,干预组为14.28%,p值为0.01。结论:纠正血透患者代谢性酸中毒可改善血清白蛋白和nPCR,且无低钾血症或显著的透析间期体重增加。这在IL-6值较低的轻度炎症患者中尤为明显。
{"title":"Effects of Oral Sodium Bicarbonate Supplementation on Protein Metabolism and Inflammation in Iraqi Hemodialysis Patients: An Open-Label Randomized Controlled Trial.","authors":"Zina A Rasheed,&nbsp;Ban A Al-Hashemi,&nbsp;Ala A Ali","doi":"10.1155/2023/6657188","DOIUrl":"https://doi.org/10.1155/2023/6657188","url":null,"abstract":"<p><strong>Background: </strong>The effect of correcting metabolic acidosis on protein metabolism in hemodialysis patients is controversial.</p><p><strong>Objectives: </strong>To study the effects of oral sodium bicarbonate on protein metabolism and markers of inflammation in acidotic hemodialysis patients. <i>Patients and Methods</i>. An open-label randomized controlled trial was conducted at a single center. Sixty-six clinically stable adult hemodialysis patients were recruited with an average predialysis serum bicarbonate level of <22 mmol/l and a dialysate bicarbonate concentration of 35 mmol/l. Forty-nine participants have completed the study. Oral sodium bicarbonate tablets of 500 mg were given daily in the intervention group (<i>n</i> = 25) for 12 weeks versus the standard of care in the control group (<i>n</i> = 24). Outcomes compared intervention versus nonintervention in both groups at equivalent time points (0 and 3 months). The clinical data, anthropometry, dialysis adequacy, albumin, normalized protein catabolism rate, blood gas analysis, and bicarbonate were recorded at 0 and 3 months. In addition, muscle mass and handgrip strength were measured. Finally, IL-6 as a marker of inflammation was measured at randomization and three months.</p><p><strong>Results: </strong>Serum bicarbonate and pH increased significantly from 17.57 ± 3.34 mmol/L to 20.69 ± 2.54 mmol/L and from 7.26 ± 0.06 to 7.34 ± 0.04, respectively (<i>p</i> < 0.0001). Serum albumin was significantly higher in the intervention group at three months than in the control group, 4.11 ± 0.45 vs. 3.79 ± 0.47 (<i>p</i> value 0.011). Serum potassium significantly decreased in the intervention group at three months compared to the control group, 5.00 ± 0.43 mEq/l vs. 5.33 ± 0.63 mEq/l (<i>p</i> value 0.03). Muscle strength expressed as handgrip has improved significantly in the intervention group at three months compared to the control group, 45.01 ± 19.19 vs. 33.93 ± 15.06 (<i>p</i> value 0.03). The IL-6 values were less in the intervention group at 3 months with a <i>p</i> value of 0.01. The interdialytic weight of the intervention group at three months was 2.42 ± 0.64 compared to the 2.20 ± 1.14 control group, but this did not reach statistical significance (<i>p</i> value of 0.4). The composite of (albumin + nPCR) at three months was achieved in 59.18% of the intervention group compared to 14.28% with a <i>p</i> value of 0.01.</p><p><strong>Conclusions: </strong>Correcting metabolic acidosis in hemodialysis patients improved serum albumin and nPCR without hypokalemia or significant interdialytic weight gain. This was particularly evident in patients with minimal inflammation with low IL-6 values.</p>","PeriodicalId":14177,"journal":{"name":"International Journal of Nephrology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10403331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9943351","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: 1
Somatic Symptoms of Depression Lose Association with Mortality upon Adjustment for Frailty: Analysis from the Fitness Haemodialysis Cohort. 虚弱调整后抑郁的躯体症状丧失与死亡率的关联:来自健康血液透析队列的分析
IF 2.1 Q3 Medicine Pub Date : 2023-01-01 DOI: 10.1155/2023/4518843
Benjamin M Anderson, Muhammad Qasim, Gonzalo Correa, Felicity Evison, Suzy Gallier, Charles J Ferro, Thomas A Jackson, Adnan Sharif

Introduction: The somatic symptom component of depression is associated with increased hospitalisation and mortality and poorer health-related quality of life (HRQOL). However, the relationship of subsets of depression symptoms with frailty and outcomes is not known. This study aimed to (1) explore the relationship between the Clinical Frailty Scale (CFS) and components of depression and (2) their association with mortality, hospitalisation, and HRQOL in haemodialysis recipients.

Methods: We conducted a prospective cohort study of prevalent haemodialysis recipients, with deep bio-clinical phenotyping including CFS and PHQ-9 somatic (fatigue, poor appetite, and poor sleep) and cognitive component scores. EuroQol EQ-5D summary index assessed HRQOL at the baseline. Electronic linkage to English national administration datasets ensured robust follow-up data for hospitalisation and mortality events. Findings. Somatic (β = 0.067; 95% C.I. 0.029 to 0.104; P < 0.001) and cognitive (β = 0.062; 95% C.I. 0.034 to 0.089; P<0.001) components were associated with increased CFS scores. Both somatic (β = -0.062; 95% C.I. -0.104 to -0.021; P<0.001) and cognitive (β = 0.052; 95% C.I. -0.081 to -0.024; P < 0.001) scores were associated with lower HRQOL. Somatic scores lost mortality association on addition of CFS to the multivariable model (HR1.06; 95% C.I. 0.977 to 1.14; P=0.173). Cognitive symptoms were not associated with mortality. Neither the component score was associated with hospitalisation on multivariable analyses.

Conclusions: Both somatic and cognitive depression symptoms are associated with frailty and poorer HRQOL in haemodialysis recipients but were not associated with mortality or hospitalisation when adjusted for frailty. The risk profile of depression somatic scores may be related to overlap with symptoms of frailty.

抑郁症的躯体症状成分与住院率和死亡率增加以及健康相关生活质量(HRQOL)下降有关。然而,抑郁症状亚群与虚弱和预后的关系尚不清楚。本研究旨在(1)探讨临床虚弱量表(CFS)与血液透析患者抑郁成分之间的关系;(2)CFS与血液透析患者死亡率、住院率和HRQOL的关系。方法:我们对流行的血液透析受者进行了一项前瞻性队列研究,其深层生物临床表型包括CFS和PHQ-9躯体(疲劳、食欲差和睡眠差)和认知成分评分。EuroQol EQ-5D综合指数在基线时评估HRQOL。与英国国家管理数据集的电子链接确保了住院和死亡事件的可靠随访数据。发现。体细胞(β = 0.067;95% C.I. 0.029 ~ 0.104;P < 0.001)和认知能力(β = 0.062;95% C.I. 0.034 ~ 0.089;pβ = -0.062;95% C.I. -0.104 ~ -0.021;pβ = 0.052;95% C.I. -0.081 ~ -0.024;P < 0.001)评分与较低的HRQOL相关。在多变量模型中加入CFS后,躯体评分丧失死亡率(HR1.06;95% ci = 0.977 ~ 1.14;P = 0.173)。认知症状与死亡率无关。在多变量分析中,两项成分得分均与住院率无关。结论:血液透析受者的躯体和认知抑郁症状与虚弱和较差的HRQOL相关,但在调整虚弱因素后与死亡率或住院率无关。抑郁躯体评分的风险特征可能与虚弱症状重叠有关。
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引用次数: 0
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International Journal of Nephrology
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