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Association Between Indoxyl Sulfate and Dialysis Initiation and Cardiac Outcomes in Chronic Kidney Disease Patients 硫酸吲哚酚与慢性肾脏病患者透析开始和心脏预后的关系
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2022-03-01 DOI: 10.2147/IJNRD.S354658
K. Takkavatakarn, J. Phannajit, S. Udomkarnjananun, Suri Tangchitthavorngul, P. Chariyavilaskul, P. Sitticharoenchai, K. Praditpornsilpa, S. Eiam‐Ong, P. Susantitaphong
Introduction Indoxyl sulfate, a protein-bound uremic toxin, has been reported as an atherosclerosis and fibrosis accelerator. This study aimed to determine whether serum indoxyl sulfate is associated with cardiac abnormalities, cardiovascular events, and renal progression to dialysis in patients with chronic kidney disease (CKD). Methods The prospective study enrolled 89 patients with CKD stage 3 to 5 patients. Serum biochemistry data and indoxyl sulfate were measured. All patients underwent echocardiographic examination. Global longitudinal strain (GLS) was calculated using two-dimensional speckle tracking. The clinical outcomes including cardiovascular event and dialysis initiation were recorded during a 2-year follow-up. Results Patients were divided into 2 groups based on the median value of serum indoxyl sulfate (low and high indoxyl sulfate groups). Kaplan–Meier analysis revealed that patients with higher indoxyl sulfate (≥6.124 mg/L) were significantly associated with renal progression to dialysis (p < 0.001). There was no significant difference in cardiovascular events between 2 groups (p = 0.082). In addition, serum indoxyl sulfate level was independently associated with GLS (r = 0.62; p = 0.01). The risk of cardiovascular events was significantly higher in patients with impaired GLS (>−16%) (p = 0.015). Conclusion Serum indoxyl sulfate level was a significant predictor for CKD progression to dialysis and was correlated with GLS, a speckle tracking echocardiography parameter representing early LV systolic dysfunction. Furthermore, GLS was associated with cardiovascular events in CKD patients. Serum indoxyl sulfate measurement may help to identify the high dialysis and cardiovascular risk CKD patients beyond traditional risk factors.
引言硫酸吲哚酚是一种结合蛋白的尿毒症毒素,已被报道为动脉粥样硬化和纤维化的促进剂。本研究旨在确定血清硫酸吲哚酚是否与慢性肾脏病(CKD)患者的心脏异常、心血管事件和肾进展至透析有关。方法前瞻性研究纳入89例CKD 3-5期患者。测定血清生化指标和硫酸吲哚酚。所有患者均接受了超声心动图检查。使用二维散斑跟踪计算全局纵向应变(GLS)。在2年的随访中记录了包括心血管事件和透析开始在内的临床结果。结果根据血清硫酸吲哚酚中位值将患者分为2组(硫酸吲哚酚低组和高组)。Kaplan–Meier分析显示,硫酸吲哚酚含量较高(≥6.124 mg/L)的患者与肾透析进展显著相关(p<0.001)。两组之间的心血管事件没有显著差异(p=0.082)。此外,血清硫酸吲哚酚水平与GLS独立相关(r=0.62;p=0.01)。GLS受损患者发生心血管事件的风险显著较高(>−16%)(p=0.015),斑点跟踪超声心动图参数表示早期左心室收缩功能障碍。此外,GLS与CKD患者的心血管事件有关。血清硫酸吲哚酚测定可能有助于识别传统危险因素之外的高透析和心血管风险CKD患者。
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引用次数: 1
Disease-Associated Systemic Complications in Childhood Nephrotic Syndrome: A Systematic Review. 儿童肾病综合征疾病相关系统并发症的系统评价
IF 2.1 Q2 UROLOGY & NEPHROLOGY Pub Date : 2022-02-25 eCollection Date: 2022-01-01 DOI: 10.2147/IJNRD.S351053
Dany Hilmanto, Fitriana Mawardi, Ayuningtyas S Lestari, Ahmedz Widiasta

Introduction: Nephrotic syndrome (NS) is one of the most common childhood kidney diseases. During the active phase, the disease pathogenesis affects various biological functions linked to loss of proteins negatively, which can result in systemic complications. Complications of childhood NS are divided into two categories: disease-associated complications and drug-associated complications. However, complications in pediatric patients with NS, especially disease-associated complications are still limited. Although reported in the literature, information is not comprehensive and needs to be updated. This study aimed to systematically assess systemic complications in children with NS, especially disease-associated complications, to better understand how they impact outcomes.

Methods: We conducted a systematic search of several databases: BioMed Central Pediatrics, PubMed, Google Scholar, the National Library of Medicine, Cochrane Library, CINAHL/EBSCO, British Medical Journal, Science Direct, Scopus, and Elsevier's ClinicalKey. We followed the PRISMA guidelines to plan, conduct, and report this review. We used the Joanna Briggs Institute's critical appraisal tools for assuring the quality of the journal articles that were chosen.

Results: Eleven articles concerning complications in childhood NS were analyzed. Systemic disease-associated complications in covered were cardiovascular complications, infections, thyroid-hormone complication, kidney complications, and oral health complications.

Conclusion: NS is marked by heavy proteinuria, hypoalbuminemia, edema, and hyperlipidemia, which can result in systemic disease-associated complications. Cardiovascular complications, infections, thyroid-hormone complications, kidney complications, and oral health complications are the main systemic complications in childhood NS. It is essential that health-care providers prevent these complications for proper maintenance of patients' health.

引言肾病综合征是儿童最常见的肾脏疾病之一。在活动期,疾病的发病机制会对与蛋白质损失相关的各种生物功能产生负面影响,从而导致全身并发症。儿童NS的并发症分为两类:疾病相关并发症和药物相关并发症。然而,NS患儿的并发症,尤其是与疾病相关的并发症仍然有限。尽管文献中有报道,但信息并不全面,需要更新。本研究旨在系统评估NS儿童的全身并发症,特别是与疾病相关的并发症,以更好地了解它们如何影响结果。方法我们对几个数据库进行了系统搜索:BioMed Central Pediatrics、PubMed、Google Scholar、国家医学图书馆、Cochrane图书馆、CINAHL/EBSCO、British Medical Journal、Science Direct、Scopus和Elsevier’s ClinicalKey。我们遵循PRISMA指南来规划、执行和报告此次审查。我们使用乔安娜·布里格斯研究所的关键评估工具来确保所选期刊文章的质量。结果分析了11篇关于儿童NS并发症的文章。涵盖的系统性疾病相关并发症包括心血管并发症、感染、甲状腺激素并发症、肾脏并发症和口腔健康并发症。结论NS以大量蛋白尿、低蛋白血症、水肿和高脂血症为特征,可导致系统性疾病相关并发症。心血管并发症、感染、甲状腺激素并发症、肾脏并发症和口腔健康并发症是儿童NS的主要全身并发症。医疗保健提供者必须预防这些并发症,以适当维护患者的健康。
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引用次数: 0
Influences of Financial Strains Over the Life Course Before Initiating Hemodialysis on Health Outcomes Among Older Japanese Patients: A Retrospective Study in Japan 开始血液透析前生活过程中的经济压力对日本老年患者健康结果的影响:一项在日本的回顾性研究
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2022-02-01 DOI: 10.2147/IJNRD.S352174
H. Sugisawa, Y. Shimizu, T. Kumagai, K. Shishido, T. Shinoda
Purpose This study analyzed the influence of financial strains over the life course before initiating hemodialysis on the health outcomes of older Japanese patients. This study was limited to financial strains over the life course before initiating hemodialysis to eliminate the influence of financial strains resulting from resignation from paid jobs. We examined which of the four life course models—pathway, latent, social mobility, and accumulation—were appropriate to describe the influences of financial strains over the life course on older patients’ health. Patients and Methods Data were obtained from a cross-sectional survey of 6,644 outpatients in dialysis facilities across Japan. We selected participants aged 60 years and older at the time of the survey. Numbers of dialysis complications, activities of daily living (ADL) disability, and depressive symptoms were selected as health outcomes. Benchmark periods over the life course were constructed in three parts: less than 18 years (childhood), 18–35 years (young adults), and 35–50 years (middle-aged). We retrospectively measured financial strains over the life course. Results Pathway models best described the influence of financial strains over the life course on the three types of health outcomes. Experiences of financial strains as young adults had a direct influence on ADL disability of older patients. This result supports latent models. Social mobility models (upward and downward mobility) and accumulation models explained the number of dialysis complications, ADL disability, and depressive symptoms in older patients. Conclusion These results suggest that socioeconomic disadvantages over the life course before initiating hemodialysis were significantly associated with health outcomes in older patients.
目的本研究分析了开始血液透析前生活过程中的经济压力对日本老年患者健康结果的影响。这项研究仅限于在开始血液透析之前的整个生命过程中的经济压力,以消除因辞职而导致的经济压力的影响。我们研究了四种生命过程模型中的哪一种——途径、潜在、社会流动和积累——适合描述生命过程中经济压力对老年患者健康的影响。患者和方法数据来自对日本各地透析机构6644名门诊患者的横断面调查。我们选择了调查时年龄在60岁及以上的参与者。透析并发症、日常生活能力(ADL)残疾和抑郁症状的数量被选为健康结果。生命历程的基准期分为三个部分:18岁以下(儿童)、18-35岁(年轻人)和35-50岁(中年人)。我们回顾性地衡量了整个人生过程中的财务压力。结果Pathway模型最好地描述了生活过程中的经济压力对三种类型的健康结果的影响。年轻人的经济压力对老年患者的ADL残疾有直接影响。这一结果支持了潜在的模型。社会流动性模型(向上和向下流动性)和累积模型解释了老年患者透析并发症、ADL残疾和抑郁症状的数量。结论这些结果表明,在开始血液透析前的整个生命过程中,社会经济劣势与老年患者的健康结果显著相关。
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引用次数: 1
The Lived Experience of Primary Family Caregivers of Patients on Hemodialysis Treatment in Southern Ethiopia: A Phenomenological Study 埃塞俄比亚南部血液透析治疗患者的主要家庭照顾者的生活经验:现象学研究
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2022-02-01 DOI: 10.2147/IJNRD.S353191
Amene Abebe, Aseb Kinfe Arba, Kebreab Paulos, Wogayehu Abera, Temesgen Sidamo, Shimelis Shiferaw, Zinabu Abraham, D. Baza, Banchialem Nega, Selamawit Woldeyohannes
Background Primary family caregivers of hemodialysis patients are the “hidden patients” who shoulder extraordinary care burdens. However, there is a dearth of studies in Ethiopia. The purpose of this study was to explore the lived experience of primary family caregivers of hemodialysis patients in Southern Ethiopia. Methods Qualitative phenomenological study design was employed in February 2021. A homogeneous purposive sampling technique was applied to select study participants. An in-depth interview using an interview guide and field notes were used to collect the required data. All interviews were recorded using a digital audio recorder. Data coding was assisted by Open code software version 4.03. Inductive thematic analysis was used to develop the emerged themes and sub-themes using Colaizzi’s 1978 seven-step phenomenological analysis method. The themes and sub-themes are described in detail in the respective heading and sub-headings. Results A total of twelve participants were involved in the present study. Bio-psychological experience, socio-economic impact, and healthcare provider-primary family caregiver relationships are the major themes that emerged from the data. The emotional responses, coping mechanisms, consequences on the family caregivers’ health, care fatigue, lifestyle change, economic burden, impact on social responsibility, social support, the role of the primary family caregiver, and trust and confidence in the service providers are the sub-themes defining primary family caregivers caring experience. Conclusion In this study, emotional instabilities and reactions, care fatigue, distortion of caregiver’s health, multiple economic and social damages are the major challenges faced by primary family caregivers.
背景血液透析患者的初级家庭照顾者是“隐性患者”,承担着巨大的护理负担。然而,埃塞俄比亚缺乏相关研究。本研究的目的是探讨在埃塞俄比亚南部血液透析患者的主要家庭照顾者的生活经验。方法于2021年2月采用定性现象学研究设计。采用均匀的有目的抽样技术来选择研究参与者。使用访谈指南和现场笔记进行深度访谈以收集所需数据。所有访谈均使用数字录音机进行录音。数据编码由Open code软件4.03版本辅助。运用Colaizzi 1978年提出的七步现象学分析方法,运用归纳性主位分析方法对出现的主位和次主位进行分析。主题和子主题在各自的标题和子标题中有详细的描述。结果本研究共纳入12名受试者。生物心理经验、社会经济影响和医疗保健提供者-主要家庭照顾者关系是数据中出现的主要主题。情绪反应、应对机制、对家庭照顾者健康的影响、照顾疲劳、生活方式改变、经济负担、对社会责任的影响、社会支持、家庭主要照顾者的角色、对服务提供者的信任和信心是定义家庭主要照顾者照顾体验的子主题。结论在本研究中,情绪不稳定和反应、照顾疲劳、照顾者健康扭曲、多重经济和社会损害是家庭初级照顾者面临的主要挑战。
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引用次数: 4
Obstacles to Early Diagnosis and Treatment of Pruritus in Patients with Chronic Kidney Disease: Current Perspectives. 慢性肾病患者瘙痒症早期诊断和治疗的障碍:目前的观点。
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2022-01-01 DOI: 10.2147/IJNRD.S294147
Chandra Mauli Jha, Hormaz Dara Dastoor, Natrajan Gopalakrishnan, Stephen Geoffrey Holt

Chronic kidney disease-associated pruritus (CKD-aP) is a common condition amongst patients with advanced chronic kidney disease (CKD). Several studies have confirmed that more than four out of ten early-stage CKD patients suffer from this condition, while its prevalence among CKD patients on dialysis reaches up to seven out of ten. It is noted to be associated with other disabling symptoms and serious outcomes. It has significant impact on sleep, mood, daily activities, and quality of life of CKD patients, and increased mortality risk of patients on hemodialysis. The Dialysis Outcomes and Practice Patterns Study found 17% higher mortality among patients with moderate to extreme pruritus compared with patients with no or mild pruritus. Despite its high prevalence, ill-effect, and suffering associated with it, CKD-aP remains surprisingly under-reported on the patient's part and under-recognized by the healthcare team. Even upon being noticed, it remains unattended and poorly treated. Its etiopathogenesis is complex and not fully understood. Many treatment options are available but good quality evidence about most of those is absent, and to date, only two medications are approved for use in this condition. While a validated guideline is very much required for the benefit of the patients and caretakers, further research on several aspects of this issue is required.

慢性肾脏疾病相关性瘙痒(CKD- ap)是晚期慢性肾脏疾病(CKD)患者的常见疾病。几项研究已经证实,超过四成的早期CKD患者患有这种疾病,而在透析的CKD患者中,其患病率高达七成。注意到它与其他致残症状和严重后果有关。它对CKD患者的睡眠、情绪、日常活动和生活质量有显著影响,并增加血液透析患者的死亡风险。透析结果和实践模式研究发现,中度至重度瘙痒患者的死亡率比无或轻度瘙痒患者高17%。尽管CKD-aP的患病率高,不良影响和痛苦,但令人惊讶的是,CKD-aP在患者方面的报道和医疗团队的认识都不足。即使被注意到,它仍然无人看管,待遇也很差。其发病机制复杂,尚不完全清楚。有许多治疗方案可供选择,但其中大多数缺乏高质量的证据,迄今为止,只有两种药物被批准用于这种情况。虽然非常需要一个有效的指导方针,以使患者和护理人员受益,但需要对这个问题的几个方面进行进一步的研究。
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引用次数: 0
Lung Ultrasound Estimates the Overhydration and Benefits Blood Pressure Control in Normal or Mild Symptomatic Hemodialysis Patients. 肺超声评估正常或轻度症状血液透析患者的过度水合作用和血压控制。
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2022-01-01 DOI: 10.2147/IJNRD.S374569
Akeatit Trirattanapikul, Sawinee Kongpetch, Eakalak Lukkanalikitkul, Anucha Ahooja, Patamapon Seesuk, Amod Sharma, Sirirat Anutrakulchai

Introduction: Lung ultrasound (LUS) is used for dry weight guidance by assessment of pulmonary congestion in hemodialysis (HD) patients. The aim of this study was to estimate amounts of accumulated fluid by total LUS scores (TLUSS), which were scarcely reported in HD patients who were normal or had a mild functional abnormality. In addition, the correlations between the LUS score of each area and TLUSS were determined to suggest fewer specific areas valuable to shorten the examination time of LUS.

Methods: This cohort study was conducted in adult HD patients who have New York Heart Association Classes I-II. LUS and multifrequency bioimpedance (BIA) were performed at baseline and the individual prescribed dry weight was set. Then each LUS was conducted at 28 areas of bilateral intercostal spaces and calculated as TLUSS weekly for eight weeks in which dry weight was adjusted. The second BIA was also measured at week eight. The difference of pre-HD weight and target weight (weight gain; WG) represented the amount of fluid accumulation.

Results: Twenty patients with a mean age of 62.2±14.0 years were enrolled. One hundred and sixty-six LUS were performed in which forty episodes of them were simultaneously measured with BIA. Optimum dry weight adjusted by TLUSS which benefited in mean reductions of blood pressure, and cardiothoracic ratios. WG amounts were significantly correlated with TLUSS (r=0.38), and with extracellular fluid (r=0.35) and overhydration fluid (r=0.39) assessed by BIA. Estimations of mean fluid overload were 2.18 (TLUSS ≤15), 2.72 (TLUSS 16-24), 3.17 (TLUSS 25-33), 3.65 (TLUSS 34-38) and 5.03 (TLUSS ≥39) in liters. The cut-off points of sum scores of 12 specific lung areas represented the none-mild were <8, moderate at 8-16, and severe pulmonary congestions were >16.

Conclusion: TLUSS estimated accumulated fluid useful for volume and blood pressure controls. Performance of LUS in 12 specific lung areas may reduce spending time and support routine uses of LUS in clinical practice.

简介:肺超声(LUS)用于干重指导评估肺充血在血液透析(HD)患者。本研究的目的是通过总LUS评分(TLUSS)来估计积液量,这在正常或轻度功能异常的HD患者中几乎没有报道。此外,测定各区域LUS评分与TLUSS的相关性,提示减少有价值的特定区域,以缩短LUS的检查时间。方法:该队列研究在纽约心脏协会分级为I-II级的成年HD患者中进行。在基线时进行LUS和多频生物阻抗(BIA),并设定个体规定的干重。然后在双侧肋间隙的28个区域进行每个LUS,并计算为每周TLUSS,为期8周,其中干重调整。第二BIA也在第8周测量。hd前体重与目标体重的差异(增重;WG)表示液体积聚量。结果:20例患者入组,平均年龄62.2±14.0岁。共进行了166例LUS,其中40例同时进行BIA测量。通过TLUSS调整的最佳干重有利于血压和心肺比值的平均降低。WG量与TLUSS (r=0.38)、BIA评估细胞外液(r=0.35)和过度水化液(r=0.39)显著相关。平均流体过载估计分别为2.18 (TLUSS≤15)、2.72 (TLUSS 16-24)、3.17 (TLUSS 25-33)、3.65 (TLUSS 34-38)和5.03 (TLUSS≥39)升。代表非轻症的12个特定肺区总评分的分界点为16。结论:TLUSS估计累积的液体有助于控制体积和血压。LUS在12个特定肺区域的表现可以减少花费时间,并支持LUS在临床实践中的常规使用。
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引用次数: 0
Estimates of Chronic Kidney Diseases Associated with Proton-Pump Inhibitors Using a Retrospective Hospital-Based Cohort in Thailand. 泰国一项基于医院的回顾性队列研究对质子泵抑制剂相关慢性肾脏疾病的评估
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2022-01-01 DOI: 10.2147/IJNRD.S389238
Tanavij Pannoi, Chissanupong Promchai, Penjamaporn Apiromruck, Suwikran Wongpraphairot, Chen-Chang Yang, Wen-Chi Pan

Purpose: Potential adverse outcomes of Proton pump inhibitors (PPIs) have increasingly been reported. The potential risks to PPIs include hypomagnesemia and chronic kidney disease (CKD). Unlike a real-world electronic medical record (RW-EMR) with active-comparator design, claim databases and special population cohort with non-user design, using in previous studies, resulted in a wide range of strength of association with indication bias. This study aimed to measure the total effect of association between PPIs use and CKD incidence using Thai RW-EMR.

Patients and methods: A retrospective hospital-based cohort was applied into this study. Electronic medical records and administrative data of out- and inpatient were retrieved from October 1st, 2010 to September 30th, 2017. On-treatment with grace period as well as propensity score matching was used in data analysis. Cox proportional hazard models were applied to evaluate the PPIs-CKD association.

Results: Of all 63,595 participants, a total of 59,477 new PPIs and 4118 Histamine 2-receptor antagonist (H2RA) users were eligible for follow-up. As compared with H2RA, the PPI users were non-elderly and more likely being female. The association of PPIs with CKD was statistically significant (adjusted hazard ratio [HR] = 3.753, 95% CI = 2.385-5.905). The HR were not statistically different by concomitant use PPIs with NSAIDs and by medication possession ratio levels.

Conclusion: The association between PPIs and CKD incidence was statistically significant in this hospital-based cohort. However, self-treatment with over-the-counter PPIs, as well as, smoking, drinking alcohol and body mass index could not be fully retrieved, affecting the estimation of treatment effect.

目的:质子泵抑制剂(PPIs)潜在不良后果的报道越来越多。PPIs的潜在风险包括低镁血症和慢性肾脏疾病(CKD)。与现实世界中采用主动比较设计的电子病历(RW-EMR)不同,索赔数据库和特殊人群队列采用非用户设计,在以前的研究中使用,导致了与适应症偏倚的大范围关联强度。本研究旨在使用泰国RW-EMR测量PPIs使用与CKD发病率之间关联的总效应。患者和方法:本研究采用回顾性医院队列研究。检索2010年10月1日至2017年9月30日门诊和住院患者的电子病历和管理数据。数据分析采用宽限期治疗和倾向评分匹配。采用Cox比例风险模型评价PPIs-CKD的相关性。结果:在所有63,595名参与者中,共有59,477名新PPIs和4118名组胺2受体拮抗剂(H2RA)使用者符合随访条件。与H2RA相比,PPI使用者是非老年人,更可能是女性。ppi与CKD的相关性具有统计学意义(校正风险比[HR] = 3.753, 95% CI = 2.385-5.905)。与非甾体抗炎药同时使用PPIs和药物持有率水平的HR无统计学差异。结论:在这个以医院为基础的队列中,PPIs与CKD发病率之间的关联具有统计学意义。然而,非处方质子泵抑制剂的自我治疗,以及吸烟、饮酒和体重指数无法完全检索,影响了治疗效果的估计。
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引用次数: 1
Supporting Shared Decision-Making and Home Dialysis in End-Stage Kidney Disease. 支持终末期肾脏疾病的共同决策和家庭透析。
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2022-01-01 DOI: 10.2147/IJNRD.S375347
Rebecca Campbell-Montalvo, Huanguang Jia, Ashutosh M Shukla

It has been widely demonstrated that patient education and empowerment, especially involving shared treatment decisions, improve patient outcomes in chronic medical conditions, including chronic kidney disease requiring kidney replacement therapies. Accordingly, regulatory agencies in the US and worldwide recommend shared decision-making for finalizing one's choice of kidney replacement therapy. It is also recognized that the US needs to substantially increase home dialysis utilization to leverage its positive impacts on patient and healthcare cost-related outcomes. This perspective highlights how the routine clinical use of the recommended practice of shared decision-making can exist in synergy with the system's goal for increased home dialysis use. It introduces a pragmatic provider checklist, The Nephrologist's Shared Decision-Making Checklist, grounded in the relevant theories of shared decision-making, and, unlike some research assessments and extant tools, is easy to understand and implement in clinical practice. This qualitative Checklist can help providers ensure that they have co-constructed an SDM experience with the patient and involved caretakers, helping them benefit from the improved outcomes associated with SDM.

已广泛证明,患者教育和赋权,特别是涉及共同治疗决策,可改善慢性疾病患者的治疗结果,包括需要肾脏替代疗法的慢性肾病。因此,美国和世界各地的监管机构建议在最终选择肾脏替代疗法时共同决策。人们还认识到,美国需要大幅增加家庭透析的利用率,以利用其对患者和医疗保健成本相关结果的积极影响。这一观点强调了共同决策的推荐实践的常规临床应用如何与系统增加家庭透析使用的目标协同存在。它介绍了一个实用的提供者清单,即肾脏病专家共享决策清单,该清单以共享决策的相关理论为基础,与一些研究评估和现有工具不同,它易于理解并在临床实践中实施。这个定性检查表可以帮助提供者确保他们与患者和相关护理人员共同构建了SDM经验,帮助他们从SDM相关的改进结果中受益。
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引用次数: 1
Uric Acid, Ferritin, Albumin, Parathyroid Hormone and Gamma-Glutamyl Transferase Concentrations are Associated with Uremic Cardiomyopathy Characteristics in Non-Dialysis and Dialysis Chronic Kidney Disease Patients. 尿酸、铁蛋白、白蛋白、甲状旁腺激素和γ -谷氨酰转移酶浓度与非透析和透析慢性肾病患者尿毒症心肌病特征相关
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2022-01-01 DOI: 10.2147/IJNRD.S389539
Grace Tade, Hon-Chun Hsu, Angela J Woodiwiss, Ferande Peters, Chanel Robinson, Noluntu Dlongolo, Gloria Teckie, Ahmed Solomon, Gavin R Norton, Patrick H Dessein

Introduction: Circulating uric acid, ferritin, albumin, intact parathyroid hormone and gamma-glutamyl transferase each participate in biochemical reactions that reduce or/and enhance oxidative stress, which is considered the final common pathway through which pathophysiological mechanisms cause uremic cardiomyopathy. We hypothesized that the respective biomarkers may be involved in the development of uremic cardiomyopathy characteristics and can be useful in their identification among chronic kidney disease patients.

Methods: We assessed traditional and non-traditional cardiovascular risk factors including biomarker concentrations and determined central systolic blood pressure using SphygmoCor software and cardiac structure and function by echocardiography in 109 (64 non-dialysis and 45 dialysis) patients. Associations were evaluated in multivariate regression models and receiver operator characteristic (ROC) curve analysis.

Results: Each biomarker concentration was associated with left ventricular mass beyond stroke work and/or inappropriate left ventricular mass in all, non-dialysis and/or dialysis patients. Ferritin, albumin and gamma-glutamyl transferase levels were additionally associated with E/e' in all, non-dialysis and/or dialysis patients. Dialysis status influenced the relationship of uric acid concentrations with inappropriate left ventricular mass and those of gamma-glutamyl transferase levels with left ventricular mass and inappropriate left ventricular mass. In stratified analysis, low uric acid levels were related to inappropriate left ventricular mass in dialysis but not non-dialysis patients (interaction p=0.001) whereas gamma-glutamyl transferase concentrations were associated with left ventricular mass and inappropriate left ventricular mass in non-dialysis but not dialysis patients (interaction p=0.020 to 0.036). In ROC curve analysis, uric acid (area under the curve (AUC)=0.877), ferritin (AUC=0.703) and albumin (AUC=0.728) concentrations effectively discriminated between dialysis patients with and without inappropriate left ventricular hypertrophy, left ventricular hypertrophy, and increased E/e,' respectively.

Conclusion: Uric acid, ferritin, albumin, parathyroid hormone and gamma-glutamyl transferase were associated with uremic cardiomyopathy characteristics and could be useful in their identification. Our findings merit validation in future longitudinal studies.

导论:循环尿酸、铁蛋白、白蛋白、完整甲状旁腺激素和γ -谷氨酰转移酶都参与了减少或/和增强氧化应激的生化反应,这被认为是导致尿毒症心肌病的病理生理机制的最终共同途径。我们假设各自的生物标志物可能参与尿毒症心肌病特征的发展,并可用于慢性肾脏疾病患者的识别。方法:我们对109例(64例非透析患者和45例透析患者)进行传统和非传统心血管危险因素评估,包括生物标志物浓度,使用sphygmoor软件测定中心收缩压,并通过超声心动图测定心脏结构和功能。通过多变量回归模型和receiver operator characteristic (ROC)曲线分析评估相关性。结果:在所有、非透析和/或透析患者中,每种生物标志物浓度与卒中工作以外的左心室质量和/或不适当的左心室质量相关。在所有非透析和/或透析患者中,铁蛋白、白蛋白和γ -谷氨酰转移酶水平也与E/ E '相关。透析状态影响尿酸浓度与不适宜左室质量的关系,影响γ -谷氨酰转移酶水平与不适宜左室质量的关系。在分层分析中,低尿酸水平与透析而非透析患者的左心室质量不适当相关(相互作用p=0.001),而γ -谷氨酰转移酶浓度与非透析而非透析患者的左心室质量和不适当相关(相互作用p=0.020至0.036)。在ROC曲线分析中,尿酸(曲线下面积(AUC)=0.877)、铁蛋白(AUC=0.703)和白蛋白(AUC=0.728)浓度分别能有效区分有和无不适当左室肥厚、左室肥厚、E/ E增高的透析患者。结论:尿酸、铁蛋白、白蛋白、甲状旁腺激素和γ -谷氨酰转移酶与尿毒症心肌病的特征有关,可用于鉴别。我们的发现值得在未来的纵向研究中得到验证。
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引用次数: 2
CHA2DS2-VASc, a Simple Clinical Score Expanding Its Boundaries to Predict Contrast-Induced Acute Kidney Injury After Primary Percutaneous Coronary Interventions. CHA2DS2-VASc,一个简单的临床评分扩大其界限预测造影剂引起的急性肾损伤经皮冠状动脉介入治疗后。
IF 2 Q2 UROLOGY & NEPHROLOGY Pub Date : 2021-12-31 eCollection Date: 2021-01-01 DOI: 10.2147/IJNRD.S347303
Rajesh Kumar, Mahesh Kumar Batra, Sanam Khowaja, Ali Ammar, Ashok Kumar, Jehangir Ali Shah, Jawaid Akbar Sial, Tahir Saghir, Musa Karim

Objective: Promising results of CHA2DS2-VASc score have been reported for the prediction of contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI). However, data of its predictive strength in the context of primary PCI are not available. Therefore, in this study, we have assessed predictive value of CHA2DS2-VASc score for CI-AKI after primary PCI.

Methods: This analytical cross-sectional study was conducted between January 2021 and June 2021 at the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan. Inclusion criteria of the study was consecutive adult patients who had undergone primary PCI. Baseline CHA2DS2-VASc score was calculated, and either a 25% or 0.5 mg/dL increase in post-procedure serum creatinine level as compared to baseline level was categorized as CI-AKI.

Results: A total of 691 patients were included, of which 82.1% (567) were male. CI-AKI after primary PCI was observed in 63 (9.1%) patients, out of which 66.7% (42) of patients had CHA2DS2-VASc score of ≥2. The area under the curve (AUC) for the score was 0.725 [0.662 to 0.788] with a sensitivity and specificity of 66.7% [63.1% to 70.2%] and 66.7% [53.7% to 78.1%], respectively, at a cut-off value of ≥2. In multivariable analysis, left ventricular ejection fraction ≤30% and CHA2DS2-VASc ≥2 were found to be independent predictors with adjusted odds ratios of 2.19 [1.06-4.5] and 2.13 [1.13-4.01], respectively.

Conclusion: CHA2DS2-VASc score has a good predictive value for the prediction of CI-AKI after primary PCI. Criteria of CHA2DS2-VASc ≥2 can be used for the risk stratification of CI-AKI after primary PCI.

目的:CHA2DS2-VASc评分在预测经皮冠状动脉介入治疗(PCI)后造影剂诱导的急性肾损伤(CI-AKI)方面有很好的结果。然而,其在初级PCI背景下的预测强度的数据是不可用的。因此,在本研究中,我们评估了CHA2DS2-VASc评分对初次PCI术后CI-AKI的预测价值。方法:本分析性横断面研究于2021年1月至2021年6月在巴基斯坦卡拉奇国家心血管疾病研究所(NICVD)进行。该研究的纳入标准是连续接受过首次PCI治疗的成年患者。计算基线CHA2DS2-VASc评分,与基线水平相比,术后血清肌酐水平升高25%或0.5 mg/dL被归类为CI-AKI。结果:共纳入691例患者,其中男性567例,占82.1%。63例(9.1%)患者首次PCI后出现CI-AKI,其中66.7%(42例)患者CHA2DS2-VASc评分≥2。该评分的曲线下面积(AUC)为0.725[0.662 ~ 0.788],敏感度为66.7%[63.1% ~ 70.2%],特异度为66.7%[53.7% ~ 78.1%],临界值≥2。在多变量分析中,左室射血分数≤30%和CHA2DS2-VASc≥2是独立的预测因素,调整后的比值比分别为2.19[1.06-4.5]和2.13[1.13-4.01]。结论:CHA2DS2-VASc评分对初次PCI术后CI-AKI的预测有较好的预测价值。CHA2DS2-VASc≥2可作为初次PCI术后CI-AKI的危险分层标准。
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引用次数: 2
期刊
International Journal of Nephrology and Renovascular Disease
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