Renal Failure最新文献

Background: This study aimed to investigate the impact of a comprehensive nursing intervention targeting high water and salt intake on blood pressure and volume burden in patients with chronic renal failure.

Method: From January 2020 to January 2023, 120 patients diagnosed with chronic renal failure were treated at our hospital. Participants were randomly allocated to either a control group (n = 60) receiving standard dietary education or an observation group (n = 60) receiving intensive water-salt diet nursing intervention alongside standard education. Blood pressure, volume load, and related parameters were compared after a 6-month observation period.

Result: Both groups exhibited reduced systolic and diastolic blood pressure post-intervention (p < 0.05). The observation group demonstrated a significantly lower extracellular water-to-total body water ratio (ECW/TBW) compared to the control group (p < 0.05). The observation group also showed higher 24-hour urine volume (p < 0.05), hemoglobin levels, creatinine clearance rates (p < 0.05), and treatment compliance (p < 0.05), alongside a lower complication rate (3.33% vs. 13.33%; χ² = 3.927, p < 0.05). A negative correlation was observed between the Therapeutic Intervention Scoring System (TISS) scale and post-intervention blood pressure/volume load (r = -2.924, -2.184; p < 0.05).

Conclusion: Intensive water-salt diet nursing interventions effectively control blood pressure, reduce volume load, and mitigate complications in chronic renal failure patients. This approach should be widely implemented in clinical practice.

Objective: The mortality rate of patients undergoing maintenance hemodialysis (MHD) remains high. The C-reactive protein-albumin-lymphocyte (CALLY) index is a novel biomarker that reflects inflammation, nutritional and immune status, all merged into one single derived parameter. No study has yet linked the CALLY index to survival in hemodialysis. This study aims to explore the correlation between the CALLY index and mortality in MHD patients, and develop and validate a nomogram to estimate the likelihood of death in this population.

Methods: This retrospective cohort study collected data from 436 patients and they were divided into survival group (n = 335) and non-survival group (n = 101). Multivariate logistic regression analysis was used to screen factors associated with death, and nomograms were developed to estimate the risk of death in MHD patients. The discrimination and calibration of nomograms were validated using the area under the receiver operating characteristic (ROC) curve (AUC) and calibration curve. In the study, stratification analysis and covariate adjustment were conducted to explore the correlation between the CALLY index and the mortality of MHD patients.

Results: In the final model, logistic regression showed that the CALLY index, creatinine, triglycerides, dialysis duration, absolute neutrophil count, blood urea nitrogen, sodium and ferritin were variables associated with mortality in MHD patients. A nomogram was developed to assess the risk of death in MHD patients. The AUC of the model was 0.821 (95% CI: 0.778-0.861). The results of stratified analysis and calibration model showed that the CALLY index was a protective factor for maintaining the mortality of MHD patients.

Conclusions: The CALLY index is closely related to the mortality of MHD patients. A nomogram constructed based on CALLY index can effectively evaluate the mortality risk of MHD patients.

Background: Acute kidney injury (AKI) is a common complication in heart failure (HF) patients. Patients with heart failure who experience renal injury tend to have a poor prognosis. The objective of this study is to examine the correlation between the occurrence of AKI in heart failure patients and different mean arterial pressure (MAP) trajectories, with the goal of improving early identification and intervention for AKI.

Methods: A retrospective study was conducted on patients with heart failure using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV). We utilized the group-based trajectory modeling (GBTM) method to classify the 24-hour MAP change trajectories in heart failure patients. The occurrence of AKI within the first 7 days of intensive care unit (ICU) admission was considered the outcome. The impact of MAP trajectories on AKI occurrence in heart failure patients was analyzed using Cox proportional hazards models, competing risk models, and doubly robust estimation methods.

Results: A cohort of 8,502 HF patients was analyzed, with their 24-hour MAP trajectories categorized into five groups: Low MAP group (Class 1), Medium MAP group (Class 2), Low-medium MAP group (Class 3), High-to-low MAP group (Class 4), and High MAP group (Class 5). The results from the doubly robust analysis revealed that Class 4 exhibited a significantly increased AKI risk than Class 3 (HR 1.284, 95% CI 1.085-1.521, p = 0.003; HR 1.271, 95% CI 1.074-1.505, p = 0.005). Conversely, the risks of Class 2 were significantly lower than those of Class 3 (HR 0.846, 95% CI 0.745-0.960, p = 0.009; HR 0.879, 95% CI 0.774-0.998, p = 0.047).

Conclusions: The 24-hour MAP trajectory in HF patients influences the risk of AKI. A rapid decrease in MAP (Class 4) is associated with a higher AKI risk, while maintaining MAP at a moderate level (Class 2) significantly reduces this risk. Therefore, closely monitoring MAP changes is crucial for preventing AKI in HF.

Background: Obesity is a recognized risk factor for chronic kidney disease (CKD), but whether weight change is associated with CKD remains unclear. This research aimed to investigate the relationship between weight change patterns across adulthood and the risk of CKD.

Methods: Data for 34,187 adults participating in the National Health and Nutrition Examination Survey 1999-2020 were analyzed. The weight change patterns of participants were assessed across different time intervals, including transitions from obesity to non-obesity, non-obesity to obesity, and remaining stable obesity. Absolute weight changes were also analyzed, categorizing participants into various weight gain and loss groups. Furthermore, stratified analyses were conducted to explore potential interactions between age, sex, and smoking status about CKD risk.

Results: The study found that individuals transitioning from obesity to non-obesity, non-obesity to obesity, and remaining stable obesity had an elevated risk of developing CKD throughout adulthood compared to those maintaining stable non-obesity weight patterns. Moreover, a J-shaped or U-shaped relationship was observed between CKD risk and absolute weight changes, with both extreme weight gain (≥20 kg) and substantial weight loss (>2.5 kg) associated with increased CKD risk. Stratified analyses revealed that age and sex played significant roles in these associations, with stronger effects observed among participants under 60 years at baseline.

Conclusions: This study underscores the link between weight change across adulthood and the risk of CKD. Maintaining a stable weight and avoiding extreme weight fluctuations may reduce CKD risk. These insights can be considered when developing CKD prevention and management strategies.

Studies have reported that immunoglobulin G (IgG) "deposited" in the basement membrane of renal tubules is associated with tubulointerstitial damage in patients with diabetic kidney disease (DKD). Our previous study found that renal tubular epithelial cells (RTECs) can express and secrete IgG (RTEC-IgG) which may be associated with fibrosis. The present study aimed to explore the role of RTEC-IgG in renal tubulointerstitial fibrosis (TIF) in DKD. The results showed that RTEC-IgG expression was up-regulated in the renal tubulointerstitium of DKD patients and was associated with worse kidney function, more severe anemia, and higher interstitial fibrosis and tubular atrophy (IFTA) scores, and positively correlated with tubular epithelial mesenchymal transition (EMT) and TIF. IgG expression was also enhanced in the renal tubulointerstitium of DKD mice, which was positively correlated with TIF. High glucose induced an over expression of IgG in human renal tubular epithelial cells, and knockdown of IgG with siRNA relieved the expression of α-smooth muscle actin (SMA), collagen IV, fibronectin, and transforming growth factor (TGF)-β1 under high glucose conditions. In conclusion, our study suggests that RTEC-IgG is involved in the development of DKD by promoting EMT and interstitial fibrosis via TGF-β1.

Background: Impaired renal function (IRF) is associated with an elevated risk of major adverse renal events (MARE). However, the relationship between age-adapted estimated glomerular filtration rate (eGFR) criteria and in-hospital MARE has not been extensively studied in critically ill patients. Furthermore, the impact of eGFR trajectory changes on in-hospital MARE in this patient population remains underexplored.

Methods: In this study, we analyzed data from 7,423 critically ill patients using version 2.2 of the Medical Information Mart for Intensive Care IV database. Based on the age-adapted eGFR criteria, renal function status was classified as impaired renal function (IRF), subclinical impairment of renal function (SIRF), and normal renal function (NRF).

Results: There were 2,438 patients (32.8%) of in-hospital MARE. The incidence of MARE and their individual endpoint components was higher in patients with SIRF and IRF than in patients with NRF. Group-based trajectory modeling revealed that, compared with patients with other renal function status, patients with SIRF demonstrated the most significant decline in eGFR as well as the highest risk of MARE based on the results of the low-level-to-decline trajectory. Additionally, a trend toward an increased risk of MARE was observed in patients with SIRF and IRF, particularly among younger patients, when compared with those with NRF.

Conclusions: Critically ill patients with SIRF and IRF had an increased risk of in-hospital MARE. Patients with SIRF experienced the most notable decline in renal function during hospitalization, with the highest risk of MARE noted in this trajectory group. In addition, a trend toward an increased risk of MARE was observed in younger patients. Consequently, active monitoring and timely intervention in younger patients are imperative.

Introduction: The aim of this study is to compare the patency rates of catheter placement via cannulation of right external jugular vein (EJV) versus the right brachiocephalic (BCV) in patients experiencing tunneled-cuffed catheter (TCC) loss.

Method: We conducted a retrospective analysis of 30 patients admitted to our department due to TCC loss. Among them, 11 patients underwent catheter reinsertion via the right EJV, while 19 patients underwent catheter reinsertion via the right BCV. We collected and compared the data of these patients.

Results: In both groups of patients, there were no cases of pneumothorax, severe adjacent artery injury, or mediastinal hematoma observed. The one-year primary patency rates of the catheters in the EVJ group and the BCV group were 54.55% and 36.84%, and the primary patency rates of two years were found to be 27.27% and 21.05% respectively. There was no statistically significant difference in the patency rates at both 1 and 2 years (p = 0.55, p = 0.71).

Conclusion: In the face of patients experiencing TCC loss, the practice of replacing dialysis catheters via the right EJV and right BCV routes emerges as a safe and efficacious alternative strategy. Notably, no difference in catheter patency rates is observed between these divergent access routes.

Background: Curcumin has been shown to inhibit renal fibrosis, but whether curcumin mediates renal fibrosis progression by regulating the circular RNA (circRNA)-related pathway remain unclear.

Methods: TGF-β1 was used to construct renal injury and fibrosis cell model. Cell growth was evaluated by cell counting kit 8 assay, EdU assay and flow cytometry. Fibrosis marker and interleukin 6 signal transducer (IL6ST) protein levels were measured using western bolt analysis. Inflammation factor concentrations were determined by ELISA. Circ_0008925, miR-204-5p and IL6ST expression was assessed by qRT-PCR. Unilateral ureteral obstruction (UUO) mice models were constructed to assess the role of curcumin in vivo.

Results: Curcumin treatment alleviated TGF-β1-induced HK-2 cell apoptosis, inflammation and fibrosis in vitro, as well as relieved renal injury in UUO mice models in vivo. Circ_0008925 was highly expressed in TGF-β1-induced HK-2 cells and its expression was inhibited by curcumin. Circ_0008925 could sponge miR-204-5p to positively regulate IL6ST. The inhibition effect of curcumin on TGF-β1-induced HK-2 cell injury and fibrosis was reversed by circ_0008925 overexpression, miR-204-5p inhibitor or IL6ST upregulation. Besides, circ_0008925 knockdown inhibited TGF-β1-induced HK-2 cell injury and fibrosis by suppressing IL6ST expression.

Conclusion: Curcumin relieved renal fibrosis through regulating circ_0008925/miR-204-5p/IL6ST axis.

Vitexin (VI) is a naturally occurring flavonoid derived from the leaves and seeds of Vitex, recognized for its strong antioxidant properties. This study aims to explore its effects on renal ischemia-reperfusion injury (IRI) and investigate the underlying mechanisms. We utilized hypoxia-reoxygenation (H/R) models with HK-2 cell lines and renal ischemia-reperfusion (I/R) models in mice, applying vitexin preconditioning to assess its influence on renal IRI. Our findings reveal that vitexin mitigated oxidative stress, decreased cell apoptosis, and reduced the expression of renal damage indicators such as kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL), along with an overall improvement in renal function. To further investigate the mechanism, we used network pharmacology and molecular docking techniques to predict potential vitexin targets in renal IRI. Results from Western blotting and immunofluorescence assays indicate that vitexin may promote mitophagy by suppressing the phosphorylation of the pivotal p38 protein in the p38/MAPK signaling pathway, offering protection against renal IRI. The findings indicate that vitexin could potentially be used as a therapeutic agent to alleviate renal IRI.