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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 Medicine 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 Medicine 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
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 Medicine 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
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 Medicine 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
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 Medicine 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
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 Medicine 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
Hyperkalemia and the Use of New Potassium Binders a Single Center Experience from Vestfold Norway (The PotBind Study). 高钾血症和新型钾结合剂的使用——来自挪威Vestfold的单中心经验(PotBind研究)。
IF 2 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.2147/IJNRD.S401623
Thea Bjune, Thea Bjerkestrand Bøe, Stig Arne Kjellevold, Kristian Heldal, Sadollah Abedini

Purpose: Hyperkalemia is a common metabolic complication of chronic kidney disease (CKD) and is associated with several serious adverse events. We aimed to treat/prevent hyperkalemia using the new of potassium-binders, allowing maintained renin-angiotensin-aldosterone system inhibitors (RAASi) treatment in proteinuric CKD and/or congestive heart failure (CHF) patients.

Patients and methods: We conducted a retrospective cohort study in long-term users of potassium binders for chronic hyperkalemia. Patients aged 18 years and older, treated with potassium-binders and who met the reimbursement criteria and indication for RAASi treatment were included.

Results: Fifty-seven percent of the patients were males and mean age was 65 years. During the study period, no patients were admitted to hospital due to hyperkalemia after initiation of potassium binders. Potassium maximum values were significantly lower after treatment. Few patients reported major side effects, and discontinuation was mostly due to normokalemia. We found no significant changes in bicarbonate, serum creatinine or GFR stage after starting potassium binder treatment. All patients on RAASi treatment before initiating potassium-binders were retained on RAASi treatment.

Conclusion: New potassium binders in clinical practice are an easy and safe treatment with few side effects and good tolerance, that significantly lowers the risk of hyperkalemia. Furthermore, and most importantly, patients can be maintained on RAASi treatment.

目的:高钾血症是慢性肾脏疾病(CKD)常见的代谢并发症,并与一些严重的不良事件相关。我们的目标是使用新的钾结合剂治疗/预防高钾血症,允许维持肾素-血管紧张素-醛固酮系统抑制剂(RAASi)治疗蛋白尿CKD和/或充血性心力衰竭(CHF)患者。患者和方法:我们对长期使用钾结合剂治疗慢性高钾血症的患者进行了回顾性队列研究。患者年龄在18岁及以上,接受钾结合剂治疗,符合RAASi治疗的报销标准和适应症。结果:57%的患者为男性,平均年龄65岁。在研究期间,没有患者在使用钾结合剂后因高钾血症而入院。处理后钾最大值显著降低。很少有患者报告严重的副作用,停药主要是由于正常血钾。我们发现在开始钾结合剂治疗后,碳酸氢盐、血清肌酐或GFR分期没有显著变化。所有在开始钾结合剂治疗前接受RAASi治疗的患者都保留了RAASi治疗。结论:临床应用的新型钾结合剂治疗方法简便、安全、副作用少、耐受性好,可显著降低高钾血症的发生风险。此外,最重要的是,患者可以维持RAASi治疗。
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引用次数: 1
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 Medicine 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。
{"title":"Time to Diabetic Nephropathy and its Predictors Among Diabetic Patients Treated in Wolaita and Dawuro Zone Hospitals, Ethiopia: A Retrospective Cohort Study.","authors":"Tiwabwork Tekalign,&nbsp;Mistire Teshome Guta,&nbsp;Nefsu Awoke,&nbsp;Tesfaye Yitna Chichiabellu,&nbsp;Mengistu Meskele,&nbsp;Gubay Anteneh,&nbsp;Tilahun Saol Tura,&nbsp;Shimelash Bitew Workie","doi":"10.2147/IJNRD.S396574","DOIUrl":"https://doi.org/10.2147/IJNRD.S396574","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methodology: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f0/e7/ijnrd-16-163.PMC10275322.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9716278","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
Survival Rates in Elderly Patients on Continuous Ambulatory Peritoneal Dialysis. 老年患者持续非卧床腹膜透析的生存率。
IF 2 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.2147/IJNRD.S397555
Bach Nguyen, Quynh Thi Huong Bui, Phuong Que Tran

Purpose: The present study aimed at evaluating the survival rate, its associated factors, and the causes of death in elderly patients undergoing continuous ambulatory peritoneal dialysis (CAPD) in Vietnam.

Patients and methods: This is a retrospective, observational study conducted among patients aged ≥65 years who underwent CAPD at Thong Nhat Hospital, Ho Chi Minh City, Vietnam, from April 2012 to December 2020. The Kaplan-Meier method was used to calculate the cumulative survival rate, and the Log rank test was used to analyze the factors associated with the survival rate of patients.

Results: This study enrolled a total of 68 patients with a mean age of 71.93 ± 7.44 years at the initiation of CAPD. The most common complication among kidney failure patients was diabetic nephropathy (39.71%). The rate of concomitant cardiovascular diseases was 58.82%. The average survival rate was 45.59 ± 4.01 months. Peritonitis was the most common factor causing death (31.25%), followed by cardiovascular diseases (28.12%) and malnutrition (25%). The factors that impacted the survival rate included concomitant cardiovascular diseases, low serum albumin (<35 g/dL), and an indication of CAPD due to exhausted vascular access for hemodialysis at baseline. The main factor associated with a shorter survival time was concomitant cardiovascular diseases.

Conclusion: It is necessary to improve the survival time beyond 5 years for elderly patients undergoing CAPD, especially for those with concomitant cardiovascular diseases. Besides the prevention of peritonitis, adequate measures to protect from cardiovascular diseases and malnutrition will reduce the mortality rate in patients on CAPD.

目的:本研究旨在评估越南接受连续动态腹膜透析(CAPD)的老年患者的生存率、相关因素和死亡原因。患者和方法:这是一项回顾性观察性研究,研究对象为2012年4月至2020年12月在越南胡志明市通艺医院接受CAPD治疗的年龄≥65岁的患者。累积生存率采用Kaplan-Meier法计算,Log rank检验分析影响患者生存率的相关因素。结果:本研究共纳入68例患者,CAPD开始时的平均年龄为71.93±7.44岁。肾衰竭患者最常见的并发症是糖尿病肾病(39.71%)。合并心血管疾病的发生率为58.82%。平均生存率为45.59±4.01个月。最常见的死亡原因是腹膜炎(31.25%),其次是心血管疾病(28.12%)和营养不良(25%)。影响生存率的因素包括合并心血管疾病、血清白蛋白水平低(结论:老年CAPD患者,特别是合并心血管疾病的患者,有必要提高5年以上的生存时间。除了预防腹膜炎外,预防心血管疾病和营养不良的适当措施将降低CAPD患者的死亡率。
{"title":"Survival Rates in Elderly Patients on Continuous Ambulatory Peritoneal Dialysis.","authors":"Bach Nguyen,&nbsp;Quynh Thi Huong Bui,&nbsp;Phuong Que Tran","doi":"10.2147/IJNRD.S397555","DOIUrl":"https://doi.org/10.2147/IJNRD.S397555","url":null,"abstract":"<p><strong>Purpose: </strong>The present study aimed at evaluating the survival rate, its associated factors, and the causes of death in elderly patients undergoing continuous ambulatory peritoneal dialysis (CAPD) in Vietnam.</p><p><strong>Patients and methods: </strong>This is a retrospective, observational study conducted among patients aged ≥65 years who underwent CAPD at Thong Nhat Hospital, Ho Chi Minh City, Vietnam, from April 2012 to December 2020. The Kaplan-Meier method was used to calculate the cumulative survival rate, and the Log rank test was used to analyze the factors associated with the survival rate of patients.</p><p><strong>Results: </strong>This study enrolled a total of 68 patients with a mean age of 71.93 ± 7.44 years at the initiation of CAPD. The most common complication among kidney failure patients was diabetic nephropathy (39.71%). The rate of concomitant cardiovascular diseases was 58.82%. The average survival rate was 45.59 ± 4.01 months. Peritonitis was the most common factor causing death (31.25%), followed by cardiovascular diseases (28.12%) and malnutrition (25%). The factors that impacted the survival rate included concomitant cardiovascular diseases, low serum albumin (<35 g/dL), and an indication of CAPD due to exhausted vascular access for hemodialysis at baseline. The main factor associated with a shorter survival time was concomitant cardiovascular diseases.</p><p><strong>Conclusion: </strong>It is necessary to improve the survival time beyond 5 years for elderly patients undergoing CAPD, especially for those with concomitant cardiovascular diseases. Besides the prevention of peritonitis, adequate measures to protect from cardiovascular diseases and malnutrition will reduce the mortality rate in patients on CAPD.</p>","PeriodicalId":14181,"journal":{"name":"International Journal of Nephrology and Renovascular Disease","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c9/29/ijnrd-16-131.PMC10122850.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9438018","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
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International Journal of Nephrology and Renovascular Disease
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