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Influence of Podocyte Injury on the Development of Class IV Lupus Nephritis. 荚膜细胞损伤对四级狼疮性肾炎发展的影响
IF 2.1 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-04 eCollection Date: 2024-01-01 DOI: 10.2147/IJNRD.S473616
Cyntia Camilo Franco Borges Zago, Bruna de Freitas Oliveira, Giovanna Uehara, Ana Laura Carvalho da Silva, Laura Penna Rocha, Fabiano Bichuette Custódio, Liliane Silvano Araújo, Crislaine Aparecida da Silva, Marlene Antônia Reis, Juliana Reis Machado

Purpose: In the kidneys, Systemic Lupus Erythematosus leads to Lupus Nephritis (LN), a form of glomerulonephritis. There is evidence that patients with LN may present activation of specific pathways for podocyte injury. This injury can occur through different mechanisms such as loss of podocyte adhesion to the glomerular basement membrane, cell death or dedifferentiation. Podocyturia with consequent podocytopenia has been described in some nephropathies such as LN, highlighting the importance of studying podocyte injuries in this condition. Evaluating in situ morphological characteristics of podocytes becomes relevant for a better understanding of the processes involved in their pathogenesis. This study investigated podocytes in different classes of LN in renal biopsies performed by the Kidney Research Center at the Federal University of Triângulo Mineiro.

Patients and methods: Twenty control cases and 29 biopsy cases diagnosed with LN were selected, divided according to the histopathological classes of the disease. Podocyte density was assessed through immunohistochemistry for Wilms tumor 1 protein and the evaluation of foot process effacement was performed by transmission electron microscopy.

Results: Podocyte density was lower in the LN and this reduction was observed in all analyzed classes when compared to the control group. More foot process effacement was observed in the LN group, with more effacement in classes I/II and class IV compared to the control group. The class IV group showed more foot process effacement than the class III group and presented higher proteinuria levels compared to the classes I/II group. A strong, positive, and significant correlation was observed between the activity index and foot process effacement in the class IV group.

Conclusion: Podocytes play an important role in the development of LN, and possibly, injuries to these cells are more closely related to the inflammatory/diffuse proliferative cellular process developed in class IV LN.

目的:在肾脏中,系统性红斑狼疮会导致狼疮性肾炎(LN),这是一种肾小球肾炎。有证据表明,狼疮肾炎患者可能会出现荚膜细胞损伤的特定途径激活。这种损伤可通过不同的机制发生,如荚膜细胞失去与肾小球基底膜的粘附力、细胞死亡或脱分化。一些肾病(如淋巴结核)中出现了荚膜细胞尿和随之而来的荚膜细胞减少症,这凸显了研究这种情况下荚膜细胞损伤的重要性。评估荚膜细胞的原位形态特征有助于更好地了解其发病过程。本研究调查了 Triângulo Mineiro 联邦大学肾脏研究中心进行的肾活检中不同类型 LN 中的荚膜细胞:研究选择了 20 例对照病例和 29 例确诊为 LN 的活检病例,并根据疾病的组织病理学分类进行了划分。通过Wilms肿瘤1蛋白的免疫组织化学方法评估荚膜细胞密度,并通过透射电子显微镜评估足突脱出情况:结果:与对照组相比,淋巴结核患者的荚膜细胞密度较低,而且在所有分析级别中都能观察到这种降低。与对照组相比,LN 组观察到更多的足突脱出,I/II 级和 IV 级脱出更多。与 I/II 级组相比,IV 级组比 III 级组有更多的足突脱出,蛋白尿水平也更高。在 IV 级组,观察到活动指数和足突脱出之间存在较强的正相关性:结论:荚膜细胞在 LN 的形成过程中起着重要作用,这些细胞的损伤可能与 IV 级 LN 的炎症/弥漫性增生细胞过程有更密切的关系。
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引用次数: 0
Simplified Creatinine Index as Predictor of Malnutrition in Stage 5 Chronic Kidney Disease Patients on Maintenance Haemodialysis. 简化肌酐指数作为维持性血液透析的 5 期慢性肾病患者营养不良的预测指标。
IF 2.1 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-07-29 eCollection Date: 2024-01-01 DOI: 10.2147/IJNRD.S465294
Ria Bandiara, Davin Takaryanto, Rizky Andhika, Afiatin Makmun, Rudi Supriyadi, Lilik Sukesi

Background: Malnutrition inflammation score (MIS) is an instrument for assessing the nutritional status of stage 5 CKD patients, while simplified creatinine index (SCI) is used to assess muscle mass indirectly.

Purpose: This study aims to analyse the correlation between SCI and MIS, as well as determine the SCI cut-off value as a predictor of malnutrition in stage 5 CKD patients on maintenance HD.

Methods: This research was an analytical observational study with a cross-sectional study approach. The 132 research subjects were stage 5 CKD patients at the HD Unit of RSUP Dr. Hasan Sadikin Bandung. The research used the Rank-Spearman test with SPSS for correlative bivariate analysis. The area under the curve (AUC) on the receiver operating characteristic (ROC) curve was analysed to find the SCI cut-off value as a predictor of malnutrition in stage 5 CKD patients.

Results: Sixty-three subjects (47.7%) were classified as good nutrition and 69 subjects (52.3%) as poor nutrition. The average SCI value in this study was 24.5 mg/kg/day ± SD 3.2 mg/kg/day, with a median MIS value was 6. This study showed a significant negative correlation between SCI and MIS (r = -0.586, p < 0.001). The optimal SCI cut-off from the ROC curve analysis value was ≤ 24.53 mg/kg/day (sensitivity = 76.8%; specificity = 79.4%).

Conclusion: A negative correlation existed between SCI and MIS, with an SCI value ≤ 24.53 indicating poor nutritional status in stage 5 CKD patients on maintenance HD. SCI can be used as a predictor of malnutrition at a lower cost and easier.

背景:目的:本研究旨在分析简化肌酐指数(SCI)和营养炎症评分(MIS)之间的相关性,并确定简化肌酐指数的临界值,以预测接受维持性 HD 治疗的 5 期 CKD 患者的营养不良状况:本研究是一项分析性观察研究,采用横断面研究方法。132名研究对象是万隆哈桑-萨迪金博士医疗中心(RSUP Dr. Hasan Sadikin Bandung)血液透析室的5期CKD患者。研究使用 SPSS 的 Rank-Spearman 检验进行相关的双变量分析。通过分析接收者操作特征曲线(ROC)上的曲线下面积(AUC),找出预测 5 期 CKD 患者营养不良的 SCI 临界值:63名受试者(47.7%)被归类为营养良好,69名受试者(52.3%)被归类为营养不良。本研究的 SCI 平均值为 24.5 毫克/千克/天(± SD 3.2 毫克/千克/天),MIS 中位值为 6。本研究显示 SCI 与 MIS 之间存在显著负相关(r = -0.586,p <0.001)。从 ROC 曲线分析值来看,最佳 SCI 临界值≤ 24.53 毫克/千克/天(灵敏度 = 76.8%;特异性 = 79.4%):SCI与MIS之间存在负相关,SCI值≤24.53表明维持性HD治疗的5期CKD患者营养状况较差。SCI可作为营养不良的预测指标,成本更低,操作更简单。
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引用次数: 0
Comparative Analysis of Logistic Regression, Gradient Boosted Trees, SVM, and Random Forest Algorithms for Prediction of Acute Kidney Injury Requiring Dialysis After Cardiac Surgery. 逻辑回归、梯度提升树、SVM 和随机森林算法在预测心脏手术后需要透析的急性肾损伤方面的比较分析。
IF 2.1 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-07-24 eCollection Date: 2024-01-01 DOI: 10.2147/IJNRD.S461028
Evi Diana Omar, Hasnah Mat, Ainil Zafirah Abd Karim, Ridwan Sanaudi, Fairol H Ibrahim, Mohd Azahadi Omar, Muhd Zulfadli Hafiz Ismail, Vivek Jason Jayaraj, Bak Leong Goh

Purpose: This study aimed to identify the best-performing algorithm for predicting Acute Kidney Injury (AKI) necessitating dialysis following cardiac surgery.

Patients and methods: The dataset encompassed patient data from a tertiary cardiothoracic center in Malaysia between 2011 and 2015, sourced from electronic health records. Extensive preprocessing and feature selection ensured data quality and relevance. Four machine learning algorithms were applied: Logistic Regression, Gradient Boosted Trees, Support Vector Machine, and Random Forest. The dataset was split into training and validation sets and the hyperparameters were tuned. Accuracy, Area Under the ROC Curve (AUC), precision, F-measure, sensitivity, and specificity were some of the evaluation criteria. Ethical guidelines for data use and patient privacy were rigorously followed throughout the study.

Results: With the highest accuracy (88.66%), AUC (94.61%), and sensitivity (91.30%), Gradient Boosted Trees emerged as the top performance. Random Forest displayed strong AUC (94.78%) and accuracy (87.39%). In contrast, the Support Vector Machine showed higher sensitivity (98.57%) with lower specificity (59.55%), but lower accuracy (79.02%) and precision (70.81%). Sensitivity (87.70%) and specificity (87.05%) were maintained in balance via Logistic Regression.

Conclusion: These findings imply that Gradient Boosted Trees and Random Forest might be an effective method for identifying patients who would develop AKI following heart surgery. However specific goals, sensitivity/specificity trade-offs, and consideration of the practical ramifications should all be considered when choosing an algorithm.

目的:本研究旨在确定预测心脏手术后需要透析的急性肾损伤(AKI)的最佳算法:数据集包括马来西亚一家三级心胸中心 2011 年至 2015 年间的患者数据,数据来源于电子健康记录。广泛的预处理和特征选择确保了数据的质量和相关性。应用了四种机器学习算法:逻辑回归、梯度提升树、支持向量机和随机森林。数据集被分成训练集和验证集,并对超参数进行了调整。评估标准包括准确度、ROC 曲线下面积(AUC)、精确度、F 值、灵敏度和特异性。整个研究过程严格遵守了数据使用和患者隐私的伦理准则:梯度提升树的准确率(88.66%)、AUC(94.61%)和灵敏度(91.30%)最高,表现最佳。随机森林的 AUC(94.78%)和准确率(87.39%)都很高。相比之下,支持向量机的灵敏度(98.57%)较高,特异度(59.55%)较低,但准确度(79.02%)和精确度(70.81%)较低。通过逻辑回归,灵敏度(87.70%)和特异度(87.05%)保持平衡:这些研究结果表明,梯度提升树和随机森林可能是识别心脏手术后发生 AKI 患者的有效方法。不过,在选择算法时应考虑具体目标、灵敏度/特异性权衡以及实际影响。
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引用次数: 0
Causes of Chronic Kidney Disease and Their Associations with Cardiovascular Risk and Disease in a Sub-Saharan Low-Income Population. 撒哈拉以南低收入人群慢性肾脏病的病因及其与心血管风险和疾病的关系。
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-06-12 eCollection Date: 2024-01-01 DOI: 10.2147/IJNRD.S463751
Nkosingiphile Matthew Sandile Twala, Grace Tade, Patrick Hector Dessein, Gloria Teckie

Introduction: The causes of chronic kidney disease (CKD) in people living in Sub-Saharan Africa await identification. Also, whether cardiovascular risk and disease extent differ among patients with different CKD etiologies is uncertain.

Methods: In this prospective cross-sectional study, we examined the presumed causes of chronic kidney disease (CKD) and their relationships with cardiovascular risk and disease in 743 consecutive patients from a sub-Saharan low-income population.

Results: Hypertensive nephropathy (HNP) (60.2%), diabetic nephropathy (DNP) (24.4%), HIV associated CKD (20.0%) and glomerular disease (13.6%) comprised the major CKD etiologies upon enrolment at the hospital nephrology clinic. Pulse pressure was larger in patients with concurrent HNP and DNP than in those with HNP only (p<0.001). Pulse pressure and systolic blood pressure were larger in HNP or/and DNP patients than those with HIV associated CKD and glomerular disease (p=0.04 to <0.001). Cardiovascular disease was more prevalent in patients with HNP and concurrent HNP and DNP than those from other etiologic categories (p<0.05). HNP and DNP were associated with pulsatile pressures (pulse pressure and systolic blood pressure) independent of one another (p<0.01). In adjusted product of coefficient mediation analysis, mean arterial or distending pressure accounted fully for the potential impact of HNP on pulsatile pressures (103.9-115.7%) but not for that of DNP on the respective pressures (-2.0%-(-)7.5%).

Conclusion: HNP is by far the most prevalent presumed cause of CKD in this African population. Cardiovascular risk and disease differ markedly across CKD etiological categories.

导言:撒哈拉以南非洲地区居民患慢性肾脏病(CKD)的原因尚待查明。此外,不同病因的慢性肾脏病患者的心血管风险和疾病程度是否存在差异也尚不确定:在这项前瞻性横断面研究中,我们对来自撒哈拉以南地区低收入人群的 743 名连续患者的慢性肾病(CKD)推测病因及其与心血管风险和疾病的关系进行了研究:高血压肾病(HNP)(60.2%)、糖尿病肾病(DNP)(24.4%)、艾滋病相关慢性肾脏病(HIV associated CKD)(20.0%)和肾小球疾病(13.6%)是医院肾脏病门诊登记的主要慢性肾脏病病因。同时患有 HNP 和 DNP 的患者的脉压比仅患有 HNP 的患者的脉压要大(p 结论:HNP 是目前最常见的慢性肾脏疾病:迄今为止,HNP 是非洲人群中最常见的慢性肾功能衰竭假定病因。不同病因的 CKD 患者的心血管风险和疾病有明显不同。
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引用次数: 0
Retrospective Study on the Efficacy and Safety of Dulaglutide in Patients with Diabetes and Moderate-Advanced Chronic Kidney Disease. 杜拉鲁肽对糖尿病和中晚期慢性肾病患者疗效和安全性的回顾性研究
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-05-28 eCollection Date: 2024-01-01 DOI: 10.2147/IJNRD.S450772
Sriya Kosaraju, Rong M Zhang
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引用次数: 0
Hyperphosphatemia in Chronic Kidney Disease: The Search for New Treatment Paradigms and the Role of Tenapanor. 慢性肾病中的高磷血症:寻找新的治疗范例和特纳帕诺的作用。
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-05-28 eCollection Date: 2024-01-01 DOI: 10.2147/IJNRD.S385826
Valeria Cernaro, Elisa Longhitano, Chiara Casuscelli, Luigi Peritore, Domenico Santoro

Hyperphosphataemia represents a significant challenge in the management of chronic kidney disease, exerting a pronounced influence on the pathogenesis of cardiovascular complications and mineral bone disorders. Traditional approaches to address hyperphosphataemia involve implementing dietary phosphate restrictions, administering phosphate binders, and, in cases of end-stage renal disease, resorting to dialysis. Unfortunately, these interventions frequently prove inadequate in maintaining phosphate levels within recommended ranges. Additionally, commonly employed pharmacological agents are not immune to eliciting adverse events, thereby limiting their prescription and therapeutic adherence. There is a growing focus on exploring novel therapeutic strategies in this context. The current discussion centres on tenapanor, a pharmacological agent predominantly acting as a selective inhibitor of sodium/hydrogen exchanger isoform 3 (NHE3). Its mechanism of action involves modulating tight junctions, resulting in reduced sodium absorption and intestinal paracellular permeability to phosphate. Furthermore, tenapanor downregulates sodium-dependent phosphate 2b transport protein (NaPi2b) expression, thereby impeding active transcellular phosphate transport. Clinical trials have elucidated the efficacy and safety profile of tenapanor. This evidence hints at a potential paradigm shift in the management of hyperphosphataemia. However, the burgeoning optimism surrounding tenapanor warrants tempered enthusiasm, as further research remains indispensable. The imperative lies in meticulously delineating its efficacy and safety contours within the crucible of clinical practice. In this review, we synthesize the intricate interplay between hyperphosphataemia and Chronic Kidney Disease-Mineral Bone Disorder, and we discuss the existing pharmacological interventions for hyperphosphataemia and explore emerging treatment paradigms that offer novel perspectives in managing elevated phosphate levels in CKD patients.

高磷血症是慢性肾脏病治疗过程中的一项重大挑战,对心血管并发症和矿物质骨骼紊乱的发病机制有明显影响。解决高磷血症的传统方法包括限制饮食中的磷酸盐、使用磷酸盐结合剂,以及在终末期肾病患者中采用透析治疗。遗憾的是,这些干预措施往往不足以将磷酸盐水平维持在推荐范围内。此外,常用的药物也难免会引起不良反应,从而限制了处方和治疗的依从性。在这种情况下,人们越来越重视探索新型治疗策略。目前的讨论集中在替那潘诺上,这是一种主要作为钠/氢交换器同工酶 3(NHE3)选择性抑制剂的药剂。其作用机制包括调节紧密连接,从而减少钠的吸收和肠道旁细胞对磷酸盐的通透性。此外,替那帕诺还会下调钠依赖性磷酸盐 2b 转运蛋白(NaPi2b)的表达,从而阻碍磷酸盐的跨细胞转运。临床试验阐明了替那帕诺的疗效和安全性。这些证据表明,高磷血症的治疗模式有可能发生转变。然而,围绕替那帕诺的乐观情绪正在迅速升温,这需要适度的热情,因为进一步的研究仍然不可或缺。当务之急是在临床实践的严苛条件下仔细界定其疗效和安全性。在这篇综述中,我们总结了高磷血症与慢性肾脏病-矿物质骨病之间错综复杂的相互作用,讨论了现有的高磷血症药物干预措施,并探讨了新出现的治疗范例,这些范例为控制慢性肾脏病患者体内磷酸盐水平升高提供了新的视角。
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引用次数: 0
Anti-SARS-CoV-2 Spike Antibody Response to the Fourth Dose of BNT162b2 mRNA COVID-19 Vaccine and Associated Factors in Japanese Hemodialysis Patients. 日本血液透析患者对第四剂 BNT162b2 mRNA COVID-19 疫苗的抗 SARS-CoV-2 尖峰抗体反应及相关因素。
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-05-17 eCollection Date: 2024-01-01 DOI: 10.2147/IJNRD.S452964
Keiji Hirai, Masako Shimotashiro, Toshiaki Okumura, Susumu Ookawara, Yoshiyuki Morishita

Background: We assessed the anti-SARS-CoV-2 spike antibody response to four doses of BNT162b2 mRNA COVID-19 vaccine in Japanese hemodialysis patients and determined factors associated with the anti-SARS-CoV-2 spike antibody titer after the fourth dose.

Methods: Fifty-one patients were enrolled in this single-center, prospective, longitudinal study. Change in anti-SARS-CoV-2 spike antibody titers between after the second and fourth doses were evaluated. Multiple linear regression analysis was used to identify factors associated with the anti-SARS-CoV-2 spike antibody titer after the fourth dose.

Results: The anti-SARS-CoV-2 spike antibody titer was higher 4 weeks after the fourth dose compared with 4 weeks after the third dose (30,000 [interquartile range (IQR), 14,000-56,000] vs 18,000 [IQR, 11,000-32,500] AU/mL, p<0.001) and 4 weeks after the second dose (vs 2896 [IQR, 1110-4358] AU/mL, p<0.001). Hypoxia-inducible factor prolyl hydroxylase inhibitor use (standard coefficient [β]=0.217, p=0.011), and the log-anti-SARS-CoV-2 spike antibody titer 1 week before the fourth dose (β=0.810, p<0.001) were correlated with the log-anti-SARS-CoV-2 spike antibody titer 4 weeks after the fourth dose, whereas only the log-anti-SARS-CoV-2 spike antibody titer 1 week before the fourth dose (β=0.677, p<0.001) was correlated with the log-anti-SARS-CoV-2 spike antibody titer 12 weeks after the fourth dose.

Conclusion: Hypoxia-inducible factor prolyl hydroxylase inhibitor use and the anti-SARS-CoV-2 spike antibody titer before the fourth dose were associated with the anti-SARS-CoV-2 spike antibody titer after the fourth dose in Japanese hemodialysis patients.

背景:我们评估了日本血液透析患者接种四剂 BNT162b2 mRNA COVID-19 疫苗后的抗 SARS-CoV-2 尖峰抗体反应,并确定了与第四剂后抗 SARS-CoV-2 尖峰抗体滴度相关的因素:这项单中心前瞻性纵向研究共纳入了 51 名患者。评估了第二次和第四次用药后抗 SARS-CoV-2 尖峰抗体滴度的变化。采用多元线性回归分析确定与第四剂后抗SARS-CoV-2尖峰抗体滴度相关的因素:结果:与第三剂后 4 周相比,第四剂后 4 周的抗 SARS-CoV-2 棘峰抗体滴度更高(30,000 [四分位数间距(IQR),14,000-56,000] vs 18,000 [四分位数间距(IQR),11,000-32,500] AU/mL,pConclusion):日本血液透析患者使用低氧诱导因子脯氨酰羟化酶抑制剂和第四次用药前的抗 SARS-CoV-2 棘峰抗体滴度与第四次用药后的抗 SARS-CoV-2 棘峰抗体滴度有关。
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引用次数: 0
Hospital-Acquired Acute Kidney Injury in Non-Critical Medical Patients in a Developing Country Tertiary Hospital: Incidence and Predictors. 发展中国家三级医院非危重内科病人的医院获得性急性肾损伤:发病率和预测因素。
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-04-25 eCollection Date: 2024-01-01 DOI: 10.2147/IJNRD.S454987
Nahom Dessalegn Mekonnen, Tigist Workneh Leulseged, Buure Ayderuss Hassen, Kidus Haile Yemaneberhan, Helen Surafeal Berhe, Nebiat Adane Mera, Anteneh Abera Beyene, Lidiya Zenebe Getachew, Birukti Gebreyohannes Habtezgi, Feven Negasi Abriha

Background: Acute kidney injury (AKI) is a frequent complication in critical patients, leading to a worse prognosis. Although its consequences are worse among critical patients, AKI is also associated with less favorable outcomes in non-critical patients. Therefore, understanding the magnitude of the problem in these patients is crucial, yet there is a scarcity of evidence in non-critical settings, especially in resource limited countries. Hence, the study aimed at determining the incidence and predictors of hospital acquired acute kidney injury (HAAKI) in non-critical medical patients who were admitted at a large tertiary hospital in Ethiopia.

Methods: A retrospective chart review study was conducted from September 25, 2022 to January 20, 2023 among 232 hospitalized non-critical medical patients admitted to St. Paul's Hospital Millennium Medical College between January 2020 and January 2022. The incidence of HAAKI was estimated using incidence density per total person day (PD) observation of the study participants. To identify predictors of HAAKI, a log binomial regression model was fitted at a p value of ≤0.05. The magnitude of association was measured using adjusted relative risk (ARR) with its 95% CI.

Results: During the median follow-up duration of 11 days (IQR, 6-19 days), the incidence of HAAKI was estimated to be 6.0 per 100 PD (95% CI = 5.5 to 7.2). Significant predictors of HAAKI were found to be having type 2 diabetes mellitus (ARR = 2.36, 95% CI = 1.03, 5.39, p-value=0.042), and taking vancomycin (ARR = 3.04, 95% CI = 1.38, 6.72, p-value=0.006) and proton pump inhibitors (ARR = 3.80, 95% CI = 1.34,10.82, p-value=0.012).

Conclusion: HAAKI is a common complication in hospitalized non-critical medical patients, and is associated with a common medical condition and commonly prescribed medications. Therefore, it is important to remain vigilant in the prevention and timely identification of these cases and to establish a system of rational prescribing habits.

背景:急性肾损伤(AKI)是危重病人的常见并发症,会导致预后恶化。虽然危重病人的后果更严重,但急性肾损伤也与非危重病人的不良预后有关。因此,了解这些患者的问题严重程度至关重要,但在非危重症环境中,尤其是在资源有限的国家,这方面的证据还很匮乏。因此,本研究旨在确定埃塞俄比亚一家大型三甲医院收治的非危重内科病人医院获得性急性肾损伤(HAAKI)的发病率和预测因素:2022 年 9 月 25 日至 2023 年 1 月 20 日,对圣保罗医院千禧医学院在 2020 年 1 月至 2022 年 1 月期间收治的 232 名住院非危重内科病人进行了回顾性病历研究。HAAKI 的发病率是根据对研究参与者的总人日(PD)观察的发病密度进行估算的。为确定 HAAKI 的预测因素,在 p 值≤0.05 时拟合了对数二项式回归模型。相关性的大小用调整后相对风险(ARR)及其 95% CI 来衡量:结果:在中位 11 天(IQR,6-19 天)的随访时间内,HAAKI 的发生率估计为每 100 个 PD 6.0 例(95% CI = 5.5-7.2 例)。HAKI的重要预测因素包括:2型糖尿病(ARR = 2.36,95% CI = 1.03,5.39,P值=0.042)、服用万古霉素(ARR = 3.04,95% CI = 1.38,6.72,P值=0.006)和质子泵抑制剂(ARR = 3.80,95% CI = 1.34,10.82,P值=0.012):HAAKI 是住院非危重病人的常见并发症,与常见的病情和常用药物有关。因此,必须保持警惕,预防和及时发现这些病例,并建立合理用药习惯制度。
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引用次数: 0
Acute Kidney Injury Prediction Model Using Cystatin-C, Beta-2 Microglobulin, and Neutrophil Gelatinase-Associated Lipocalin Biomarker in Sepsis Patients. 利用胱抑素-C、β-2 微球蛋白和中性粒细胞明胶酶相关脂质体生物标记物的脓毒症患者急性肾损伤预测模型
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-03-28 eCollection Date: 2024-01-01 DOI: 10.2147/IJNRD.S450901
Hani Susianti, Aswoco Andyk Asmoro, Sujarwoto, Wiwi Jaya, Heri Sutanto, Amanda Yuanita Kusdijanto, Kevin Putro Kuwoyo, Kristian Hananto, Matthew Brian Khrisna

Introduction: AKI is a frequent complication in sepsis patients and is estimated to occur in almost half of patients with severe sepsis. However, there is currently no effective therapy for AKI in sepsis. Therefore, the therapeutic approach is focused on prevention. Based on this, there is an opportunity to examine a panel of biomarker models for predicting AKI.

Material and methods: This prospective cohort study analysed the differences in Cystatin C, Beta-2 Microglobulin, and NGAL levels in sepsis patients with AKI and sepsis patients without AKI. The biomarker modelling of AKI prediction was done using machine learning, namely Orange Data Mining. In this study, 130 samples were analysed by machine learning. The parameters used to obtain the biomarker panel were 23 laboratory examination parameters.

Results: This study used SVM and the Naïve Bayes model of machine learning. The SVM model's sensitivity, specificity, NPV, and PPV were 50%, 94.4%, 71.4%, and 87.5%, respectively. For the Naïve Bayes model, the sensitivity, specificity, NPV, and PPV were 83.3%, 77.8%, 87.5%, and 71.4%, respectively.

Discussion: This study's SVM machine learning model has higher AUC and specificity but lower sensitivity. The Naïve Bayes model had better sensitivity; it can be used to predict AKI in sepsis patients.

Conclusion: The Naïve Bayes machine learning model in this study is useful for predicting AKI in sepsis patients.

导言:AKI 是败血症患者经常出现的一种并发症,据估计,几乎一半的严重败血症患者都会出现 AKI。然而,目前还没有治疗脓毒症急性肾损伤的有效方法。因此,治疗方法的重点在于预防。在此基础上,我们有机会研究一组用于预测 AKI 的生物标志物模型:这项前瞻性队列研究分析了有 AKI 的脓毒症患者和无 AKI 的脓毒症患者胱抑素 C、β-2 微球蛋白和 NGAL 水平的差异。预测 AKI 的生物标志物建模是通过机器学习(即 Orange 数据挖掘)完成的。在这项研究中,机器学习分析了 130 个样本。用于获得生物标志物面板的参数是 23 项实验室检查参数:本研究使用了 SVM 和奈夫贝叶斯机器学习模型。SVM 模型的灵敏度、特异性、NPV 和 PPV 分别为 50%、94.4%、71.4% 和 87.5%。Naïve Bayes 模型的灵敏度、特异性、NPV 和 PPV 分别为 83.3%、77.8%、87.5% 和 71.4%:本研究的 SVM 机器学习模型具有较高的 AUC 和特异性,但灵敏度较低。讨论:本研究的 SVM 机器学习模型具有较高的 AUC 和特异性,但灵敏度较低,而 Naïve Bayes 模型的灵敏度较高,可用于预测脓毒症患者的 AKI:结论:本研究中的奈伊夫贝叶斯机器学习模型可用于预测脓毒症患者的 AKI。
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引用次数: 0
Advances in Human-Centered Care to Address Contemporary Unmet Needs in Chronic Dialysis. 推进以人为本的护理,满足当代慢性透析未满足的需求。
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-03-20 eCollection Date: 2024-01-01 DOI: 10.2147/IJNRD.S387598
Sumedh Jayanti, Gopala K Rangan

Advances in the treatment of kidney failure with chronic dialysis have stagnated over the past three decades, with over 50% of patients still managed by conventional in-hospital haemodialysis. In parallel, the demands of chronic dialysis medical care have changed and evolved due to a growing population that has higher frailty and multimorbidity. Thus, the gap between the needs of kidney failure patients and the healthcare capability to provide effective overall management has widened. To address this problem, healthcare policy has increasingly aligned towards a human-centred approach. The paradigm shift of human-centred approach places patients at the forefront of decision-making processes, ensuring that specific needs are understood and prioritised. Integration of human-centred approaches with patient care has been shown to improve satisfaction and quality of life. The aim of this narrative is to evaluate the current clinical challenges for managing kidney failure for dialysis providers; summarise current experiences and unmet needs of chronic dialysis patients; and finally emphasise how human-centred care has advanced chronic dialysis care. Specific incremental advances include implementation of renal supportive care; home-assisted dialysis; hybrid dialysis; refinements to dialysis methods; whereas emerging advances include portable and wearable dialysis devices and the potential for the integration of artificial intelligence in clinical practice.

过去三十年来,慢性透析治疗肾衰竭的进展停滞不前,50% 以上的患者仍在接受传统的院内血液透析治疗。与此同时,慢性透析医疗护理的需求也在不断变化和发展,这是因为越来越多的人体弱多病。因此,肾衰竭患者的需求与提供有效整体管理的医疗保健能力之间的差距越来越大。为解决这一问题,医疗保健政策越来越倾向于以人为本的方法。以人为本的模式转变将患者置于决策过程的最前沿,确保患者的具体需求得到理解并被优先考虑。事实证明,将以人为本的方法与患者护理相结合,可以提高满意度和生活质量。本叙述旨在评估透析服务提供者目前在管理肾衰竭方面所面临的临床挑战;总结慢性透析患者目前的经验和未满足的需求;最后强调以人为本的护理是如何推进慢性透析护理的。具体的渐进式进展包括肾脏支持护理的实施、家庭辅助透析、混合透析、透析方法的改进;而新兴进展包括便携式和可穿戴透析设备以及将人工智能融入临床实践的潜力。
{"title":"Advances in Human-Centered Care to Address Contemporary Unmet Needs in Chronic Dialysis.","authors":"Sumedh Jayanti, Gopala K Rangan","doi":"10.2147/IJNRD.S387598","DOIUrl":"10.2147/IJNRD.S387598","url":null,"abstract":"<p><p>Advances in the treatment of kidney failure with chronic dialysis have stagnated over the past three decades, with over 50% of patients still managed by conventional in-hospital haemodialysis. In parallel, the demands of chronic dialysis medical care have changed and evolved due to a growing population that has higher frailty and multimorbidity. Thus, the gap between the needs of kidney failure patients and the healthcare capability to provide effective overall management has widened. To address this problem, healthcare policy has increasingly aligned towards a human-centred approach. The paradigm shift of human-centred approach places patients at the forefront of decision-making processes, ensuring that specific needs are understood and prioritised. Integration of human-centred approaches with patient care has been shown to improve satisfaction and quality of life. The aim of this narrative is to evaluate the current clinical challenges for managing kidney failure for dialysis providers; summarise current experiences and unmet needs of chronic dialysis patients; and finally emphasise how human-centred care has advanced chronic dialysis care. Specific incremental advances include implementation of renal supportive care; home-assisted dialysis; hybrid dialysis; refinements to dialysis methods; whereas emerging advances include portable and wearable dialysis devices and the potential for the integration of artificial intelligence in clinical practice.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":"17 ","pages":"91-104"},"PeriodicalIF":2.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10961023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206823","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
期刊
International Journal of Nephrology and Renovascular Disease
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