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Peritoneal Dialysis Patient Training Program to Enhance independence and Prevent Complications: A Scoping Review. 腹膜透析患者培训计划,以提高独立性和预防并发症:范围界定综述。
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2023-09-11 eCollection Date: 2023-01-01 DOI: 10.2147/IJNRD.S414447
Toni Rahmat Jaelani, Kusman Ibrahim, Jonny Jonny, Sri Hartati Pratiwi, Hartiah Haroen, Nursiswati Nursiswati, Bunga Pinandhita Ramadhani

Background: Peritoneal dialysis (PD) training is essential to ensure patient independence and prevent life-threatening complications, such as peritonitis. The International Society for Peritoneal Dialysis (ISPD) recommends that every PD unit worldwide implement local PD training programs with the goal of improving self-care capabilities. This scoping review aims to give an overview of recent literature and recommendations on PD training programs aiming to improve the quality of care and outcomes for PD patients.

Methods: The literature search was conducted using the PC (Population, Concept) approach. The population of interest in this study is PD patients, and the study concept is the PD training program. Several databases were used to conduct the literature search, including PubMed, Science Direct, and CINAHL. The search process began from July 2022 until January 2023. The inclusion criteria for the search included research articles and recommendations.

Results: The search yielded 22 articles recommending training programs lasting from 5-8 days, with 1-3-hour sessions and a nurse-to-patient ratio of 1:1. A cumulative training time of 15 hours or more is recommended to enhance patient independence and reduce peritonitis rates. Home-based or in-unit PD training, conducted by experienced nurses using adult learning strategies, has shown significant value in improving self-care and preventing peritonitis. Evaluating training outcomes should encompass knowledge, skills, and attitudes, and the impact on peritonitis rates. Training programs should be flexible and consider physiological and psychosocial barriers to achieving the best results.

Conclusion: There are a variety of strategies for dialysis training concerning duration, session length, patient-to-trainer ratio, timing, methods, location, compliance, and the need for retraining. More evidence is needed to assess the impact of PD patient training programs on self-care capabilities and peritonitis incidence. Future studies should investigate the effects of training programs on compliance, self-efficacy, and patient and nurse perspectives.

背景:腹膜透析(PD)培训对于确保患者独立性和预防危及生命的并发症(如腹膜炎)至关重要。国际腹膜透析学会(ISPD)建议全球每个PD单位实施当地PD培训计划,以提高自我护理能力。本范围综述旨在概述最近关于PD培训计划的文献和建议,旨在提高PD患者的护理质量和结果。方法:文献检索采用PC(Population,Concept)方法。本研究感兴趣的人群是帕金森病患者,研究概念是帕金森病训练计划。几个数据库被用来进行文献检索,包括PubMed、Science Direct和CINAHL。搜索过程从2022年7月开始,一直持续到2023年1月。搜索的入选标准包括研究文章和推荐。结果:搜索产生了22篇文章,推荐持续5-8天的培训计划,培训时间为1-3小时,护士与患者的比例为1:1。建议累计训练时间为15小时或更长,以增强患者的独立性并降低腹膜炎发生率。由经验丰富的护士使用成人学习策略进行的家庭或单位PD培训,在改善自我护理和预防腹膜炎方面显示出重要价值。评估培训结果应包括知识、技能和态度,以及对腹膜炎发生率的影响。培训计划应具有灵活性,并考虑到实现最佳结果的生理和心理障碍。结论:透析培训有多种策略,包括持续时间、课程长度、患者与培训师的比例、时间、方法、地点、依从性和再培训的必要性。需要更多的证据来评估帕金森病患者培训计划对自我护理能力和腹膜炎发病率的影响。未来的研究应该调查培训计划对依从性、自我效能感以及患者和护士观点的影响。
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引用次数: 0
The Assessment of Male Erectile Dysfunction Characteristics in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis and Hemodialysis Using the International Index of Erectile Function (IIEF-5) Combined with Hospital Anxiety and Depression Scales. 使用国际勃起功能指数(IIEF-5)结合医院焦虑和抑郁量表评估连续卧床腹膜透析和血液透析患者的男性勃起功能障碍特征。
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2023-05-05 eCollection Date: 2023-01-01 DOI: 10.2147/IJNRD.S402540
Syah Mirsya Warli, Mohammad Taufiq Alamsyah, Alwi Thamrin Nasution, Dhirajaya Dharma Kadar, Ginanda Putra Siregar, Fauriski Febrian Prapiska

Purpose: To determine the differences in mean scores of erectile dysfunctions (EDs) assessed by the International Index of Erectile Function (IIEF-5) questionnaire between patients with chronic kidney disease (CKD) undergoing hemodialysis and patients undergoing continuous ambulatory peritoneal dialysis (CAPD).

Patients and methods: This is an analytic observational study with a cross-sectional design that was conducted from June to December 2022 at the Urology Center of Haji Adam Malik General Hospital and Rasyida Kidney Specialized Hospital. The sample of this study were male CKD-patients who underwent regular hemodialysis (HD) and who underwent CAPD, and met the inclusion and exclusion criteria. Psychological disorders experienced during therapy session are considered as risk factors and assessed via the Hospital Anxiety and Depression Scale (HADS). These disorders assessment was used to evaluate the severity of the patients' anxiety and depressive symptoms. Statistical data analysis was carried out.

Results: Both groups had HADS-A and HADS-D scores with an average <7, classified as normal anxiety and depression. Most of the patients in the HD group had mild-to-moderate ED (28.6%), while in the CAPD group had mild severity of ED (38.1%). There were no significant differences in severity of ED between patients undergoing HD and CAPD (p > 0.05). However, there was a significant difference in ED scores (IIEF-5) between patients undergoing HD and those with CAPD (p < 0.05), in which patients in the CAPD group had a higher IIEF-5 score. In addition, there was a significant positive correlation with moderate strength (p<0.001; r=0.494) between anxiety disorders and ED disorders in patients undergoing HD and CAPD, whereas there is no significant correlation between depressive disorders and ED conditions (p > 0.05).

Conclusion: There was a significant difference in IIEF-5 scores between patients undergoing HD and CAPD.

目的:通过国际勃起功能指数(IIEF-5)问卷评估接受血液透析的慢性肾脏疾病(CKD)患者和接受连续性非卧床腹膜透析(CAPD)的患者勃起功能障碍(ED)平均得分的差异。患者和方法:这是一项分析性观察性研究,采用横断面设计,于2022年6月至12月在哈吉亚当·马利克综合医院泌尿外科中心和Rasyida肾脏专科医院进行。本研究的样本为男性CKD患者,他们接受了定期血液透析(HD)和CAPD,并符合纳入和排除标准。治疗期间出现的心理障碍被视为危险因素,并通过医院焦虑和抑郁量表(HADS)进行评估。这些障碍评估用于评估患者焦虑和抑郁症状的严重程度。进行了统计数据分析。结果:两组患者均有HADS-A和HADS-D评分(平均0.05)。然而,HD患者和CAPD患者的ED评分(IIEF-5)存在显著差异(p<0.05),其中CAPD组患者的IIEF-5评分较高。此外,HD和CAPD患者的焦虑障碍与ED障碍与中等强度呈正相关(pr=0.494),而抑郁障碍与ED状况无显著相关性(p>0.05)。
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引用次数: 0
Can Oral Zinc Supplementation Reduce Relapses in Childhood Steroid-Sensitive Nephrotic Syndrome? A Systematic Review. 口服补锌能减少儿童类固醇敏感性肾病综合征的复发吗?系统评价。
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2023-04-20 eCollection Date: 2023-01-01 DOI: 10.2147/IJNRD.S403699
Ngozi R Mbanefo, Samuel N Uwaezuoke, Chizoma I Eneh, Chioma L Odimegwu, Ugo N Chikani, Uzoamaka V Muoneke, Charles E Nwolisa, Kenneth E Odo, Francis N Ogbuka, Anthony T Akwue

Introduction: Frequent relapses and steroid dependence are common treatment challenges of steroid-sensitive nephrotic syndrome (SSNS) in children. Acute respiratory infection (ARI) is the most frequently reported trigger of relapse. Given the role of zinc supplementation in preventing ARI, some studies show that this targeted intervention may reduce relapses in childhood SSNS.

Aim: This systematic review aimed to determine if oral zinc supplementation can significantly reduce relapses in this disease.

Methods: We searched the PubMed and Google Scholar electronic databases for interventional and observational analytical studies without limiting their year or language of publication. We selected studies with primary data that met our inclusion criteria, screened their titles and abstracts, and removed duplicates. We used a preconceived structured form to extract data items from selected studies and conducted a quality assessment of randomized controlled trials (RCTs) and non-randomized studies with the Cochrane collaboration tool and the Newcastle Ottawa Scale, respectively. We qualitatively synthesized the extracted data to validate the review's objective.

Results: Eight full-text articles were selected, comprising four RCTs and four observational analytical studies. Two of the RCTs had a high risk of bias in three parameters of the Cochrane collaboration tool, while three non-randomized studies had low methodological quality. A total of 621 pediatric patients with SSNS were investigated in the eight studies: six participants dropped out in one study. Three RCTs indicate that zinc supplementation may lead to sustained remission or reduction in relapse rate. Similarly, three observational analytical studies suggest a significant relationship between reduced serum zinc levels and disease severity.

Conclusion: Despite the association of zinc deficiency with increased morbidity in SSNS and the reduction of relapse rates with zinc supplementation, there is no robust evidence to recommend its use as a therapeutic adjunct. We recommend more adequately-powered RCTs to strengthen the current evidence.

引言:经常复发和类固醇依赖是儿童类固醇敏感肾病综合征(SSNS)常见的治疗挑战。急性呼吸道感染(ARI)是最常见的复发诱因。鉴于补锌在预防ARI中的作用,一些研究表明,这种有针对性的干预措施可以减少儿童SSNS的复发。目的:本系统综述旨在确定口服补锌是否可以显著减少该疾病的复发。方法:我们在PubMed和Google Scholar电子数据库中搜索干预和观察性分析研究,不限制其发表年份或语言。我们选择了具有符合纳入标准的原始数据的研究,筛选了它们的标题和摘要,并删除了重复项。我们使用先入为主的结构化形式从选定的研究中提取数据项,并分别使用Cochrane协作工具和Newcastle Ottawa量表对随机对照试验(RCT)和非随机研究进行质量评估。我们对提取的数据进行了定性综合,以验证审查的目的。结果:选择了8篇全文文章,包括4项随机对照试验和4项观察性分析研究。其中两项随机对照试验在Cochrane协作工具的三个参数中存在高偏倚风险,而三项非随机研究的方法学质量较低。在八项研究中,共调查了621名患有SSNS的儿科患者:在一项研究中有6名参与者退出。三项随机对照试验表明,补充锌可能导致持续缓解或降低复发率。同样,三项观察性分析研究表明,血清锌水平降低与疾病严重程度之间存在显著关系。结论:尽管缺锌与SSNS发病率的增加以及补充锌可降低复发率有关,但没有强有力的证据推荐将其用作治疗辅助药物。我们建议进行更充分的随机对照试验,以加强现有证据。
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引用次数: 0
Emerging Role of Sodium-Glucose Co-Transporter 2 Inhibitors for the Treatment of Chronic Kidney Disease. 钠-葡萄糖协同转运体 2 抑制剂在治疗慢性肾病方面的新作用。
IF 2.1 Q2 UROLOGY & NEPHROLOGY Pub Date : 2023-02-21 eCollection Date: 2023-01-01 DOI: 10.2147/IJNRD.S387262
Rey Isidto, Romina Danguilan, Oscar Naidas, Russell Vilanueva, Mel-Hatra Arakama, Layla Marie Paraiso

Chronic kidney disease is one of the leading causes of morbidity and mortality in the Philippines. It is associated with a growing health burden as many patients progress to end-stage renal disease. Until recently, therapeutic options for the management of chronic kidney disease were limited. Sodium-glucose co-transporter 2 inhibitors offer an alternative therapeutic approach for patients with chronic kidney disease. Several trials have shown renal benefits with sodium-glucose co-transporter 2 inhibitors in patients with cardiovascular disease with and without type 2 diabetes and across a range of estimated glomerular filtration rate levels. In the Philippines, the sodium-glucose co-transporter 2 inhibitors dapagliflozin and canagliflozin are approved for the prevention of new and worsening nephropathy in type 2 diabetes. With emerging treatment options, an urgent need exists for guidance on the management of chronic kidney disease within the Philippines. In this review, we focus on the putative renal-protective mechanisms of sodium-glucose co-transporter 2 inhibitors, including effects on tubuloglomerular feedback, albuminuria, endothelial function, erythropoiesis, uric acid levels, renal oxygen demand, and hypoxia. Furthermore, we discuss the findings of recent large clinical trials using sodium-glucose co-transporter 2 inhibitors in patients with chronic kidney disease and diabetic kidney disease, summarize safety aspects, and outline the practical management of patients with chronic kidney disease in the Philippines.

慢性肾病是菲律宾发病和死亡的主要原因之一。随着许多患者发展为终末期肾病,慢性肾病带来的健康负担日益加重。直到最近,治疗慢性肾脏病的方法还很有限。钠-葡萄糖共转运体 2 抑制剂为慢性肾病患者提供了另一种治疗方法。多项试验表明,钠-葡萄糖协同转运体 2 抑制剂对患有心血管疾病、伴有或不伴有 2 型糖尿病的患者,以及各种估计肾小球滤过率水平的患者都有肾脏方面的益处。在菲律宾,钠-葡萄糖协同转运体 2 抑制剂达帕格列净(dapagliflozin)和卡那格列净(canagliflozin)已被批准用于预防 2 型糖尿病肾病的复发和恶化。随着治疗方案的不断涌现,菲律宾急需慢性肾病管理指南。在本综述中,我们将重点讨论钠-葡萄糖协同转运体 2 抑制剂的肾脏保护机制,包括对肾小管反馈、白蛋白尿、内皮功能、红细胞生成、尿酸水平、肾需氧量和缺氧的影响。此外,我们还讨论了近期在慢性肾病和糖尿病肾病患者中使用钠-葡萄糖协同转运体 2 抑制剂的大型临床试验结果,总结了安全性方面的问题,并概述了菲律宾慢性肾病患者的实际管理方法。
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引用次数: 0
Acute Kidney Injury Among Admitted COVID-19 Patients in Addis Ababa, Ethiopia. 埃塞俄比亚亚的斯亚贝巴入院的COVID-19患者急性肾损伤
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01 DOI: 10.2147/IJNRD.S402946
Tigist Kefyalew Goffe, Zewdie Aderaw Alemu, Tadios Niguss Derese, Yohannes Bayou Tilahun, Robel Bayou Tilahun

Background: Although diffuse alveolar damage and respiratory failure are the most common symptoms of coronavirus disease 2019, other organ involvement, such as the kidney, has been reported. The incidence of acute kidney injury in COVID-19 patients has been reported to vary greatly. In this study, we look at the magnitude and risk factors for acute kidney injury in COVID-19 patients in Ethiopia, a developing country.

Methods: A hospital-based retrospective cross-sectional study design was conducted among admitted COVID-19 patients at Eka Kotebe general hospital and Saint Peter COVID-19 treatment center by reviewing data from September 2020 to September 2021. A random sampling technique with proportional size allocation was used to select a total sample of 402 patients (225 from Eka Kotebe and 177 from St. Peter). Secondary data was collected from patient medical records using a standard, pre-tested data collection checklist using the Kobo toolbox, which was then exported to SPSS version 25.0 for analysis. The association between dependent and independent variables was analyzed using binary logistic regression. A statistical significance test was declared at a p value of <=0.05 with a 95% confidence interval.

Results: A total of 402 patient charts were reviewed, and the proportion of patients with acute kidney injury was found to be 18.9%. After adjusting for potential confounders, age<=35 years (AOR = 0.23, 95% CI = 0.07-0.72), female gender (AOR = 0.51, 95% CI = 0.28-0.94), and isolation type ICU (AOR = 5.11, 95% CI = 1.44-18.06) were significantly associated with acute kidney injury.

Conclusion: Acute kidney injury is a common complication in hospitalized COVID-19 patients. The prevalence of acute kidney injury in this study was 18.9%. Age, gender, and type of isolation were the factors that had a significant association with acute kidney injury. Clinicians and other concerned parties should provide more care to ICU patients and COVID-19 patients who are older.

背景:尽管弥漫性肺泡损伤和呼吸衰竭是2019冠状病毒病最常见的症状,但也有报道称会累及肾脏等其他器官。据报道,COVID-19患者急性肾损伤的发生率差异很大。在这项研究中,我们研究了发展中国家埃塞俄比亚COVID-19患者急性肾损伤的程度和危险因素。方法:采用基于医院的回顾性横断面研究设计,对2020年9月至2021年9月在Eka Kotebe总医院和圣彼得COVID-19治疗中心住院的COVID-19患者进行回顾性研究。采用比例大小分配的随机抽样技术,共选取402例患者(Eka Kotebe医院225例,St. Peter医院177例)。使用Kobo工具箱使用标准的、预先测试的数据收集清单从患者病历中收集次要数据,然后导出到SPSS 25.0版本进行分析。因变量与自变量之间的关系采用二元逻辑回归分析。结果p值为:共审阅402份患者病历,发现急性肾损伤患者比例为18.9%。结论:急性肾损伤是COVID-19住院患者常见的并发症。本研究急性肾损伤发生率为18.9%。年龄、性别和隔离类型是与急性肾损伤显著相关的因素。临床医生和其他有关方面应该为ICU患者和年龄较大的COVID-19患者提供更多的护理。
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引用次数: 0
Prevention of Intradialytic Hypotension in Hemodialysis Patients: Current Challenges and Future Prospects. 预防血液透析患者的分析性低血压:当前的挑战和未来的展望。
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01 DOI: 10.2147/IJNRD.S245621
Seyed Mehrdad Hamrahian, Salem Vilayet, Johann Herberth, Tibor Fülöp

Intradialytic hypotension, defined as rapid decrease in systolic blood pressure of greater than or equal to 20 mmHg or in mean arterial pressure of greater than or equal to 10 mmHg that results in end-organ ischemia and requires countermeasures such as ultrafiltration reduction or saline infusion to increase blood pressure to improve patient's symptoms, is a known complication of hemodialysis and is associated with several potential adverse outcomes. Its pathogenesis is complex and involves both patient-related factors such as age and comorbidities, as well as factors related to the dialysis prescription itself. Key factors include the need for volume removal during hemodialysis and a suboptimal vascular response which compromises the ability to compensate for acute intravascular volume loss. Inadequate vascular refill, incorrect assessment or unaccounted changes of target weight, acute illnesses and medication interference are further potential contributors. Intradialytic hypotension can lead to compromised tissue perfusion and end-organ damage, both acutely and over time, resulting in repetitive injuries. To address these problems, a careful assessment of subjective symptoms, minimizing interdialytic weight gains, individualizing dialysis prescription and adjusting the dialysis procedure based on patients' risk factors can mitigate negative outcomes.

分析性低血压,定义为收缩压迅速下降大于或等于20mmhg或平均动脉压大于或等于10mmhg,导致终末器官缺血,需要采取超滤减少或生理盐水输注等措施来升高血压以改善患者症状,是已知的血液透析并发症,并与几种潜在的不良后果相关。其发病机制复杂,既涉及年龄、合并症等患者相关因素,也涉及透析处方本身相关因素。关键因素包括在血液透析过程中需要清除容量和不理想的血管反应,这损害了补偿急性血管内容量损失的能力。血管充盈不足、不正确的评估或不明原因的目标体重变化、急性疾病和药物干扰是进一步的潜在因素。急性期和长期性低血压可导致组织灌注受损和终末器官损伤,导致重复性损伤。为了解决这些问题,仔细评估主观症状,尽量减少透析期间体重增加,个性化透析处方和根据患者的危险因素调整透析程序可以减轻负面结果。
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引用次数: 1
Low-Intensity Extracorporeal Shockwave Therapy (LI-ESWT) in Renal Diseases: A Review of Animal and Human Studies. 低强度体外冲击波治疗肾脏疾病:动物和人类研究综述
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01 DOI: 10.2147/IJNRD.S389219
Sune Moeller Skov-Jeppesen, Nicky Anúel Petersen, Knud Bonnet Yderstraede, Boye L Jensen, Claus Bistrup, Lars Lund

Background: Low-intensity extracorporeal shockwave therapy (LI-ESWT) has been suggested as a treatment for vascular diseases such as ischemic heart disease, diabetic foot ulcers, and erectile dysfunction. Primarily, LI-ESWT is known for its ability to stimulate angiogenesis and activation of stem cells in target tissues. Application of LI-ESWT in chronic progressive renal diseases is a novel area. The aim of the present review was to summarize available data on the effects of LI-ESWT used in the setting of renal diseases.

Methods: We systematically searched PubMed, Medline, and Embase databases for relevant studies. Our review included the results from preclinical animal experiments and clinical research.

Results: Eleven animal studies and one clinical study were included in the review. In the animal studies, LI-ESWT was used for the treatment of hypertensive nephropathy (n=1), diabetic nephropathy (n=1), or various types of ischemic renal injury (ie, artery occlusion, reperfusion injury) (n=9). The clinical study was conducted in a single-arm cohort as a Phase 1 study with patients having diabetic nephropathy. In animal studies, the application of LI-ESWT was associated with several effects: LI-ESWT led to increased VEGF and endothelial cell proliferation and improved vascularity and perfusion of the kidney tissue. LI-ESWT reduced renal inflammation and fibrosis. LI-ESWT caused only mild side effects in the clinical study, and, similarly, there were no signs of kidney injury after LI-ESWT in the animal studies.

Conclusion: LI-ESWT, as a non-invasive treatment, reduces the pathological manifestations (inflammation, capillary rarefaction, fibrosis, decreased perfusion) associated with certain types of renal disease. The efficacy of renal LI-ESWT needs to be confirmed in randomized clinical trials.

背景:低强度体外冲击波疗法(LI-ESWT)已被建议用于血管疾病的治疗,如缺血性心脏病、糖尿病足溃疡和勃起功能障碍。首先,LI-ESWT以其刺激靶组织血管生成和干细胞激活的能力而闻名。LI-ESWT在慢性进行性肾脏疾病中的应用是一个新的领域。本综述的目的是总结LI-ESWT在肾脏疾病治疗中的作用。方法:系统检索PubMed、Medline和Embase数据库,查找相关研究。我们的综述包括临床前动物实验和临床研究的结果。结果:综述纳入了11项动物研究和1项临床研究。在动物实验中,LI-ESWT被用于治疗高血压肾病(n=1)、糖尿病肾病(n=1)或各种类型的缺血性肾损伤(即动脉闭塞、再灌注损伤)(n=9)。该临床研究在单臂队列中进行,作为糖尿病肾病患者的1期研究。在动物实验中,LI-ESWT的应用与以下几个效应相关:LI-ESWT导致VEGF和内皮细胞增殖增加,改善肾组织的血管和灌注。LI-ESWT减轻肾脏炎症和纤维化。LI-ESWT在临床研究中只产生了轻微的副作用,同样,在动物研究中LI-ESWT后也没有出现肾脏损伤的迹象。结论:LI-ESWT作为一种无创治疗方法,可减轻某些类型肾脏疾病的病理表现(炎症、毛细血管稀疏、纤维化、灌注减少)。肾用LI-ESWT的疗效有待随机临床试验证实。
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引用次数: 1
The Integral Role of Chloride & With-No-Lysine Kinases in Cell Volume Regulation & Hypertension. 氯和无赖氨酸激酶在细胞体积调节和高血压中的整体作用。
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01 DOI: 10.2147/IJNRD.S417766
Ioannis Koulouridis, Efstathios Koulouridis

Chloride anions are the most abundant in humans. For many years, it has been believed that chloride is simply a counterion of all other cations, ensuring the electroneutrality of the extracellular space. Recent data suggests that chloride anions possess a broad spectrum of important activities that regulate vital cellular functions. It is now evident that, apart from its contribution to the electroneutrality of the extracellular space, it acts as an osmole and contributes to extracellular and intracellular volume regulation. Its anionic charge also contributes to the generation of cell membrane potential. The most interesting action of chloride anions is their ability to regulate the activity of with-no-lysine kinases, which in turn regulate the activity of sodium chloride and potassium chloride cotransporters and govern the reabsorption of salt and excretion of potassium by nephron epithelia. Chloride anions seem to play a crucial role in cell functions, such as cell volume regulation, sodium reabsorption in the distal nephron, potassium balance, and sodium sensitivity, which lead to hypertension. All of these functions are accomplished on a molecular level via complicated metabolic pathways, many of which remain poorly defined. We attempted to elucidate some of these pathways in light of recent advances in our knowledge, obtained mainly from experimental studies.

氯离子在人体中含量最多。多年来,人们一直认为氯化物只是所有其他阳离子的一个反离子,确保了细胞外空间的电中性。最近的数据表明,氯阴离子具有广泛的重要活动,调节重要的细胞功能。现在很明显,除了它对细胞外空间的电中性的贡献外,它还作为一种渗透剂,有助于细胞外和细胞内的体积调节。它的阴离子电荷也有助于细胞膜电位的产生。氯阴离子最有趣的作用是它们调节无赖氨酸激酶活性的能力,而无赖氨酸激酶反过来调节氯化钠和氯化钾共转运体的活性,并控制肾细胞上皮对盐的重吸收和钾的排泄。氯阴离子似乎在细胞功能中起着至关重要的作用,如细胞体积调节、远端肾元钠重吸收、钾平衡和钠敏感性,从而导致高血压。所有这些功能都是通过复杂的代谢途径在分子水平上完成的,其中许多途径仍然不明确。我们试图阐明这些途径的一些最新进展,在我们的知识,主要是从实验研究中获得的。
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引用次数: 0
Time to Diabetic Nephropathy and its Predictors Among Diabetic Patients Treated in Wolaita and Dawuro Zone Hospitals, Ethiopia: A Retrospective Cohort Study. 埃塞俄比亚Wolaita和Dawuro地区医院治疗的糖尿病患者发生糖尿病肾病的时间及其预测因素:一项回顾性队列研究
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01 DOI: 10.2147/IJNRD.S396574
Tiwabwork Tekalign, Mistire Teshome Guta, Nefsu Awoke, Tesfaye Yitna Chichiabellu, Mengistu Meskele, Gubay Anteneh, Tilahun Saol Tura, Shimelash Bitew Workie

Background: Diabetic kidney disease (DKD) develops in nearly half of patients with type 2 diabetes mellitus (DM) and one-third of those with type 1 DM during their lifetime. The incidence of DKD as a cause of end stage renal disease is increasing each year. So this study aimed to assess the time to develop diabetic nephropathy and predictors among diabetic patients treated in Wolaita zone hospitals.

Methodology: A ten-year retrospective cohort study had conducted among 614 diabetic patients using systematic random sampling in Wolaita and Dawuro zone hospitals. Bivariable and multivariable Cox proportional hazards regression had used to identify the possible associations between variables. Those variables with a p-value of less than 0.25 in bivariable analysis exported to multivariable Cox regression analysis. Finally, variables with p-value less than 0.05 at multivariable Cox regression were considered significantly significant. The Cox-proportional hazard model assumption had checked using the Schoenfeld residual test.

Results: Of the total participants, 93 (15.3%; 95% CI = 12.45-18.14) patients had developed nephropathy in 820,048 people year observation. A mean time to diabetic nephropathy in this study was 189.63 (95% CI, 185.01, 194.25) months. Being illiterate (AHR: 2.21, 95% CI: 1.34-3.66), being hypertensive (AHR: 5.76, 95% CI: 3.39-9.59), and being urban dwellers (AHR: 2.25, 95% CI: 1.34-3.77) increases the hazard of nephropathy.

Conclusion: According to this follow-up study, the overall incidence rate is substantially high over ten year follow-up period. The mean time to develop diabetic nephropathy was sixteen years. Educational status, place of residence, and being hypertensive were the predictors. So stakeholders should work on complication reduction measures and awareness creation of the impact of comorbidities.

背景:糖尿病肾病(DKD)发生在近一半的2型糖尿病(DM)患者和三分之一的1型糖尿病患者的一生中。作为终末期肾脏疾病的病因之一,DKD的发病率每年都在增加。因此,本研究旨在评估在Wolaita地区医院就诊的糖尿病患者发生糖尿病肾病的时间及其预测因素。方法:采用系统随机抽样的方法,对Wolaita和Dawuro地区医院614例糖尿病患者进行了为期10年的回顾性队列研究。使用双变量和多变量Cox比例风险回归来确定变量之间可能存在的关联。将双变量分析中p值小于0.25的变量导出为多变量Cox回归分析。最后,在多变量Cox回归中,p值小于0.05的变量被认为是显著的。利用Schoenfeld残差检验检验了Cox-proportional hazard model的假设。结果:共93例(15.3%;95% CI = 12.45-18.14)在820048人的年观察中发生肾病。在本研究中,糖尿病肾病发生的平均时间为189.63个月(95% CI, 185.01, 194.25)。文盲(AHR: 2.21, 95% CI: 1.34-3.66)、高血压(AHR: 5.76, 95% CI: 3.39-9.59)和城市居民(AHR: 2.25, 95% CI: 1.34-3.77)增加了肾病的风险。结论:根据本随访研究,在10年随访期间,总体发病率相当高。发展为糖尿病肾病的平均时间为16年。教育程度、居住地和是否患有高血压是预测因素。因此,利益相关者应该致力于减少并发症的措施和对合并症影响的认识。
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引用次数: 1
The Clinical Manifestations and Efficacy of Different Treatments Used for Nephrogenic Systemic Fibrosis: A Systematic Review. 肾源性系统性纤维化不同治疗方法的临床表现及疗效综述。
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2023-01-01 DOI: 10.2147/IJNRD.S392231
Shaheer Farooqi, Afshan Mumtaz, Aabiya Arif, Mehwish Butt, Una Kanor, Samuel Memoh, Mohammad Aadil Qamar, Abubakr Yosufi

Aim: Nephrogenic systemic fibrosis (NSF) is a rare disorder that occurs in association majorly with chronic kidney disease (CKD). The lack of collective quantitative data on its clinical manifestations and the different treatment options' efficacy, call the need for our investigation.

Methods: A systematic review was conducted covering a timeline from inception up to July 2022 without any restrictions. Article screening and data extraction were performed independently on PubMed, Google Scholar, ScienceDirect, and Cochrane Library. The keywords that we used were CKD, NSF, Gadolinium enduced fibrosis, etc; shortlisted articles were assessed for risk of bias. Data were presented as frequencies and percentages, with a confidence interval of 95%. A chi-square test was also done to find significant relationships, with a p-value <0.05 considered significant.

Results: We had 83 patients in this review consisting of 44 (55.7%) females with a mean age of 51.4±14.6 years. Sixty-nine (83.1%) patients had chronic kidney disease predisposition to NSF. Previous exposure to gadolinium-based contrast dyes was seen in 66 (79.5%) patients). The most common symptom in patients was cutaneous lesions in 69 (83.1%) patients. The most used treatments were ultraviolet therapy, renal transplant, and extracorporeal photopheresis; in 13.3% of the patients each. Condition in most patients either improved (67.1%) or remained stable (11.8%). Chi-square testing found that the treatments offered were also seen to be significantly related to outcome (p=0.015).

Conclusion: The findings in this study provide a quantitative measurement of NSF's presentations and treatment efficacies. This serves to make way for researchers to form comprehensive guidelines on the presentation-based treatment of NSF.

目的:肾源性系统性纤维化(NSF)是一种罕见的疾病,主要与慢性肾脏疾病(CKD)相关。缺乏关于其临床表现和不同治疗方案疗效的集体定量数据,需要我们进行研究。方法:系统回顾了从成立到2022年7月的时间,没有任何限制。文章筛选和数据提取分别在PubMed、Google Scholar、ScienceDirect和Cochrane Library进行。我们使用的关键词是CKD、NSF、钆诱导纤维化等;对入围文章进行偏倚风险评估。数据以频率和百分比表示,置信区间为95%。结果:在本综述中,我们有83例患者,其中44例(55.7%)为女性,平均年龄为51.4±14.6岁。69例(83.1%)患者有慢性肾脏疾病NSF易感性。66例(79.5%)患者曾接触过钆造影剂。69例(83.1%)患者以皮肤病变为最常见症状。常用的治疗方法有紫外线治疗、肾移植和体外光疗;在13.3%的患者中。大多数患者病情改善(67.1%)或保持稳定(11.8%)。卡方检验发现,所提供的治疗也与结果显著相关(p=0.015)。结论:本研究结果为NSF的表现和治疗效果提供了定量的测量方法。这为研究人员形成基于表现的NSF治疗的综合指南铺平了道路。
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引用次数: 0
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International Journal of Nephrology and Renovascular Disease
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