Journal of Nephrology最新文献

Background: This umbrella review aimed to synthesise the existing evidence on sleep disturbances and sleep disorders in the adult chronic kidney disease (CKD) population.

Methods: A systematic search across five electronic databases. Reviews were grouped according to aspects of sleep and the focus of the review. The JBI critical appraisal checklist was used for quality assessment, and Preferred Reporting Items for Overviews of Reviews (PRIOR) guideline was used for reporting. The protocol was registered in the international registry PROSPERO (CRD42024527039).

Results: We identified 50 reviews covering three main aspects of sleep (sleep apnoea, restless legs syndrome and other sleep disturbances) across five focus areas (prevalence, interventions, health outcomes, determinants of sleep and patient experience). Most reviews reported on sleep disturbances (72%, 36 reviews) and focused on interventions (58%, 29 reviews). In contrast, evidence on sleep determinants and patient experience was limited. A high prevalence of sleep apnoea (49%), restless legs syndrome (27.2%) and other sleep disturbances (55%) was reported. Non-pharmacological interventions, including aromatherapy, dialysis, muscle relaxation, yoga, music, and nurse-led management, were found to improve sleep. However, this evidence was based on a single meta-analysis with few primary studies.

Conclusions: Despite the growing number of reviews on interventions to improve sleep, the evidence for their effectiveness is limited by the small number of primary studies and the high degree of overlap between reviews. Further research is needed to identify effective interventions. Additionally, qualitative studies exploring patients' perspectives on sleep are essential, as evidence in this area remains scarce.

A 3.5-year-old girl with genetically proven distal renal tubular acidosis presented with lethargy, after numerous episodes of vomiting and poor feeding. Laboratory investigations revealed severe metabolic acidosis, hypokalemia and a serum ammonia level of 515 mmol/L (normal range: 19-50 mmol/L). Despite treatment with sodium bicarbonate, potassium supplementation, sodium benzoate and carglumic acid, her condition required hemodialysis, which resulted in rapid improvement in clinical and metabolic parameters. Hyperammonemia in distal renal tubular acidosis results from impaired ammonium excretion and increased ammoniagenesis due to hypokalemia and chronic metabolic acidosis, particularly during metabolic decompensation. This case had the highest ever reported serum ammonia level in distal renal tubular acidosis with encephalopathic findings, necessitating hemodialysis treatment. Routine monitoring of serum ammonia levels in distal renal tubular acidosis patients during metabolic stress is essential.

Background: Assisted reproductive technology (ART) has significantly increased the rate of conception and live births in women with fertility problems. Having a kidney disease negatively affects a woman's reproductive health, making infertility a significant concern, and women with chronic kidney disease (CKD) are increasingly seeking treatment with assisted reproductive technology. The side effects of assisted reproductive technology are not fully known and its impact on kidney function, especially if a woman has undergone repeated treatments, is likewise not known.

Methods: This case series gathers all consecutive patients who were followed by the Mansoura University Hospital's Obstetric Nephrology Service or were admitted to its Nephrology and Gynecology Department during pregnancy with a diagnosis of acute or chronic kidney function impairment after conceiving with an assisted reproductive technology method, in the period from 2021 to 2024.

Results: Of the approximately 150 pregnancies referred to the Obstetric Nephrology Clinic, 6 were referred for acute or acute-on-chronic kidney function impairment, or nephrotic syndrome after conceiving via assisted reproductive technology. In one patient, CKD was overlooked and later progressed to kidney failure; one had probable CKD, but discontinued follow-up before confirmation; and one had a kidney malformation, diagnosed during pregnancy. All presented with early or very early severe hypertension and proteinuria, before 20 weeks, while preeclampsia and the hypertensive disorders of pregnancy are conventionally defined as developing after 20 weeks of gestation. Three had complete recovery postpartum, one progressed to kidney failure, while two were lost to follow-up.

Conclusion: Severe early-pregnancy kidney impairment after assisted reproductive technology is probably more frequent than previously reported. Assessment of kidney function after assisted reproductive technology should be mandatory, to make it possible for timely specialized kidney care to be given.

Patients with Diabetic Kidney Disease (DKD) suffer from various complications of diabetes mellitus, including autonomic neuropathy. Cardiac autonomic nervous system dysfunction is a common disorder in patients with diabetes mellitus and Chronic Kidney Disease (CKD), and is associated with an increased risk of arrhythmias and cardiovascular morbidity and mortality. Although the effects of exercise training have been thoroughly studied in different patient populations with CKD or diabetes mellitus, few studies have investigated the effects of exercise on cardiac autonomic nervous system activity in patients with DKD. This narrative review aims to summarize the evidence regarding the effects of exercise training on cardiac autonomic nervous system modulation in DKD patients.

Background: Pregnancy on dialysis is a rare and complex event, necessitating careful planning. Nurses play a vital role in the dialysis team, providing essential education and support to patients. This study aimed to explore nurses' knowledge and perspectives regarding pregnancy in dialysis patients.

Methods: An electronic survey was distributed to six dialysis centers in Saudi Arabia, spanning four regions. A total of 127 nurses participated, of whom 88.2% were hemodialysis (HD) nurses and 11.8% were peritoneal dialysis nurses. Survey responses were summarized using descriptive statistics, presented as percentages.

Results: Regarding the impact of kidney failure on reproductive health, only 53.5% of respondents recognized it as a cause of menstrual irregularities. However, 82.7% acknowledged that it reduces fertility, and 89% responded "yes" to the possibility of pregnancy while on dialysis, with 61.4% agreeing that female patients of reproductive age with kidney failure require contraception. Despite known limitations, 63% identified a pregnancy test as the preferred method for pregnancy confirmation. In terms of dialysis modality, 63% believed HD to be associated with a higher likelihood of pregnancy. Additionally, 79.5% selected renal transplantation as a measure to increase the likelihood of pregnancy. Regarding pregnancy risks, 89% agreed it poses both fetal and maternal risks. Finally, only 18.1% reported consistently discussing pregnancy-related topics with reproductive-age patients.

Conclusions: Nurses are essential to patient education in the dialysis setting. This study identifies potential knowledge gaps and proposes a framework of learning objectives on reproductive health to be integrated into nursing training.

Background: Sustained-Low Efficiency Dialysis (SLED) is an increasingly used Kidney Replacement Therapy (KRT) modality in critically ill patients. This study was aimed at evaluating the safety and efficacy of simplified Regional Citrate Anticoagulation (RCA) for SLED using new hemodialysis equipment.

Methods: The 8-hour SLED sessions were performed with a Surdial X Nipro^® hemodialysis machine and a cellulose triacetate filter. A concentrated citrate solution (ACD-A) was infused in predilution with a target circuit citrate concentration of 2.5-3 mmol/L. Blood recalcification in the extracorporeal circuit mainly occurred through the backfiltration phenomenon by dialysis fluid (Ca²⁺ 1.5 mmol/L). Serum citrate levels were directly measured during KRT by enzymatic methods and an extensive daily laboratory workup was performed. Changes in laboratory variables at the end of the SLED sessions were analyzed with mixed-effects linear models for repeated measures.

Results: Eighty-one SLED treatments were performed in 27 patients (APACHE II score 21 ± 6). The prescribed duration was attained for the majority of the treatments (72/81, 88%). No major bleeding episodes or side effects of citrate accumulation occurred. While calcium infusion was needed in 19/81 SLED sessions (23%), phosphate and magnesium supplementation was necessary following about 25% of all SLED sessions.

Conclusions: Our simplified regional citrate anticoagulation protocol for SLED with a new "conventional" dialysis machine resulted safe and effective, also for critically ill patients, ensuring a good match between the prescribed and delivered dialysis dose. Close electrolyte monitoring and early supplementation allowed to tailor the dialysis prescription to the patient's actual needs, while avoiding KRT-related complications.