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Dialysis modality, humoral response to vaccine, and SARS-CoV-2 infection risk: Comparative prospective evaluation. 透析方式、对疫苗的体液反应和严重急性呼吸系统综合征冠状病毒2型感染风险:比较前瞻性评估。
IF 1.6 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-09-01 Epub Date: 2023-04-12 DOI: 10.1111/sdi.13155
Alon Bnaya, Naomi Nacasch, Yael Einbinder, Linda Shavit, Daniel Erez, Moshe Shashar, Ayelet Grupper, Sydney Benchetrit, Ori Wand, Keren Cohen-Hagai

Background: COVID-19 vaccinations have a central role in decreasing severe SARS-CoV-2 disease complications. This study investigated the long-term humoral immune response to BNT162b2 vaccine among hemodialysis (HD) versus peritoneal dialysis (PD) patients, and their relative risk for COVID-19 infection.

Methods: This prospective, observational study included maintenance HD and PD patients who had received at least two BNT162b2 vaccine doses. Levels of antibodies targeting SARS-CoV-2 spike protein were measured 6 and 12 months after the first vaccine dose, and 2-3 weeks after the third and fourth vaccine doses. Patients were divided according to dialysis modality (HD or PD). Humoral response was evaluated at different time points among different vaccine regimens (two vs. three vs. four doses of vaccine). An adjusted multivariate model was used to assess cumulative risk for SARS-CoV-2 infection.

Results: Eighty-seven HD and 36 PD patients were included. Among them, 106 (86%) received at least three vaccine doses. Both HD and PD patients demonstrated marked increases in humoral response 2-3 weeks after the third dose (mean anti-S antibody increased from 452 ± 501 AU/mL to 19,556 ± 14,949 AU/mL, p < 0.001). By 6 months after the third dose, antibody titers had declined significantly (mean anti-S antibody 9841 ± 10,493 AU/mL, p < 0.001). HD patients had higher risk for SARS-CoV-2 infection than PD patients (OR 4.4 [95% CI 1.4-13.6], p = 0.006). In multivariate analysis, the most important predictor for SARS-CoV-2 infection was dialysis modality.

Conclusion: This study found a high antibody response rate after the third and fourth doses of BNT162b2 vaccine among dialysis patients. Hemodialysis as dialysis modality is an important predictor of COVID-19 infection, despite similar humoral responses to vaccine in peritoneal dialysis.

背景:新冠肺炎疫苗接种在减少严重的SARS-CoV-2疾病并发症方面发挥着核心作用。本研究调查了血液透析(HD)和腹膜透析(PD)患者对BNT162b2疫苗的长期体液免疫反应,以及他们感染新冠肺炎的相对风险。方法:这项前瞻性观察性研究包括至少接种了两剂BNT162b2疫苗的维持性HD和PD患者。测量了针对严重急性呼吸系统综合征冠状病毒2型刺突蛋白的抗体水平6和12 第一剂疫苗接种后数月,以及2-3 第三剂和第四剂疫苗接种后数周。根据透析方式(HD或PD)对患者进行分组。在不同的疫苗方案(两剂疫苗、三剂疫苗和四剂疫苗)的不同时间点评估体液反应。使用调整后的多变量模型来评估严重急性呼吸系统综合征冠状病毒2型感染的累积风险。结果:包括87例HD和36例PD患者。其中,106人(86%)至少接种了三剂疫苗。HD和PD患者的体液反应均明显增加2-3 第三剂后数周(平均抗S抗体从452增加 ± 501 AU/mL至19556 ± 14949 AU/mL,p 结论:本研究发现透析患者接种第三剂和第四剂BNT162b2疫苗后抗体应答率较高。尽管腹膜透析中对疫苗有类似的体液反应,但血液透析作为透析方式是新冠肺炎感染的重要预测因素。
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引用次数: 0
Computational fluid dynamics simulation of hemodynamic changes in a hemodialysis patient with central venous stenosis treated with stent. 支架治疗中心静脉狭窄血液透析患者血液动力学变化的计算流体动力学模拟。
IF 1.6 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-09-01 Epub Date: 2023-08-07 DOI: 10.1111/sdi.13170
Biyun Teng, Qining Fu, Zhe Wang

We comment on the recently published to investigate hemodynamic changes in central venous stenosis patients before and after stent placement. Through the evidence, we believe that the boundary conditions in computational models and simulations of this study are incorrect in three points.

我们对最近发表的研究中心静脉狭窄患者支架置入前后血液动力学变化的研究发表了评论。通过证据,我们认为本研究的计算模型和模拟中的边界条件在三点上是不正确的。
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引用次数: 0
Novel method for laparoscopic rectus sheath tunneling with Lin's tube in peritoneal dialysis catheter implantation. 腹腔镜下林氏管穿管腹膜透析导管植入术的新方法。
IF 1.6 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-09-01 Epub Date: 2023-08-02 DOI: 10.1111/sdi.13165
Yuntzu Chang, Wei-Jung Chang, Huang Cheng-Yen, Ping-Fang Chiu, Kuo-Hua Lin

Laparoscopic implantation of a catheter through rectus sheath tunnel minimizes the risks of catheter failure and reduces some complications like catheter migration, hernias, and leaks. We described a novel method for laparoscopic catheter rectus sheath tunneling using an aspiration tube and a silk tie (Lin's tube). This material is easily available and yields a small fascial defect with an equivalent cannula size to minimize tissue disruption. The technique is feasible, reproducible and it may reduce the risks of postoperative leakage and hemorrhage.

腹腔镜下通过直肌鞘隧道植入导管可最大限度地降低导管故障的风险,并减少一些并发症,如导管移位、疝和渗漏。我们描述了一种使用抽吸管和丝线扎带(林氏管)进行腹腔镜导管直肌鞘穿管的新方法。这种材料很容易获得,并产生具有同等套管尺寸的小筋膜缺损,以最大限度地减少组织破坏。该技术可行,可重复使用,可降低术后渗漏和出血的风险。
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引用次数: 0
Neutrophil reactive oxygen formation, bacterial infections and mortality in malnourished hemodialysis patients: Evaluation of clinical outcomes. 营养不良血液透析患者中性粒细胞活性氧形成、细菌感染和死亡率:临床结果评估。
IF 1.6 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-09-01 Epub Date: 2023-07-09 DOI: 10.1111/sdi.13168
Hadar Mudrik-Zohar, Danny Alon, Naomi Nacasch, Aviad Sternschuss, Meidad Greenberg, Sydney Benchetrit, Ronit Gavrieli, Tali Zitman-Gal, Keren Cohen-Hagai

Introduction: Patients with end stage kidney disease undergoing maintenance hemodialysis (MHD) are prone to malnutrition and infections.

Objective: The objective of this study was to evaluate the effect of polymorphonuclear (PMN) cell dysfunction on clinical outcomes of MHD patients, in association with nutritional status.

Methods: This prospective study investigated 39 MHD patients by evaluating the oxidative activity of their PMN cells using Phorbol 12-Myristate-13-Acetate (PMA) stimulation. Blood samples were taken from each participant at dialysis initiation. Demographics, laboratory data, and clinical outcomes during a 24-month follow-up period were obtained from electronic medical records.

Results: Phagocytic activity was described in percentiles of mean fluorescence intensity (MFI) of PMA levels. There were no differences in comorbidities between patients with low or high MFI-PMA percentiles. Patients in the lowest (25th) MFI-PMA percentile (N = 10) had poorer nutritional status and more frequent severe infections compared to the other 29 patients (4.3 ± 3.4 events versus 2 ± 2.2 events, p = 0.017). Furthermore, they had more frequent hospitalizations (>3) due to infections (70% versus 41%, p = 0.073) and their mortality rate was higher (80% versus 31%, p = 0.007). The odds ratio for all-cause mortality was 8.85. In multivariate analysis, the MFI-PMA percentile and ischemic heart disease were the strongest predictors of all-cause mortality (p = 0.02 and p = 0.005, respectively).

Conclusions: Low MFI-PMA levels were associated with poor nutritional status and adverse clinical outcomes and might serve as a prognostic biomarker, predicting severe infections and mortality among malnourished MHD patients.

引言:接受维持性血液透析(MHD)的终末期肾病患者容易营养不良和感染。目的:本研究的目的是评估多形核细胞(PMN)功能障碍对MHD患者临床结果的影响,以及与营养状况的关系。方法:本前瞻性研究通过使用佛波醇12-肉豆蔻酸酯-13-乙酸酯(PMA)刺激评估其PMN细胞的氧化活性来调查39名MHD患者。在透析开始时从每个参与者身上采集血样。从电子医疗记录中获得24个月随访期间的人口统计、实验室数据和临床结果。结果:吞噬细胞活性以PMA水平的平均荧光强度(MFI)的百分位数来描述。MFI-PMA百分位数低或高的患者之间的合并症没有差异。MFI-PMA最低(第25)百分位(N = 10) 与其他29名患者相比,营养状况较差,严重感染频率更高(4.3 ± 3.4个事件与2个事件 ± 2.2事件,p = 0.017)。此外,他们因感染而住院的频率更高(>3)(70%对41%,p = 0.073),死亡率较高(80%对31%,p = 0.007)。全因死亡率的比值比为8.85。在多变量分析中,MFI-PMA百分位数和缺血性心脏病是全因死亡率的最强预测因素(p = 0.02和p = 结论:低MFI-PMA水平与不良营养状况和不良临床结果相关,可能作为预后生物标志物,预测营养不良MHD患者的严重感染和死亡率。
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引用次数: 0
Incidence and risk factors of cognitive dysfunction in hemodialysis patients: A systematic review and meta-analysis. 血液透析患者认知功能障碍的发生率和危险因素:一项系统综述和荟萃分析。
IF 1.6 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-09-01 Epub Date: 2023-08-17 DOI: 10.1111/sdi.13171
Jun Liu, Kehong Chen, Jia Chen, Lili Fu, Weiwei Zhang, Jing Lin, Jingfang Wan

Background: The study aims to explore the incidence and risk factors of cognitive dysfunction in hemodialysis patients.

Methods: PubMed, Embase, Cochrane Library, and Web of Science databases were searched for clinical studies on the association between hemodialysis and cognitive dysfunction from the database's inception to 1 December 2022. Two researchers independently completed data extraction and risk of bias assessments for the included studies. All statistical analyses were performed using STATA15.0 software.

Results: Ten studies were included in this meta-analysis, with a total of 5535 hemodialysis patients, that is, 2033 patients with cognitive dysfunction and 3502 patients with normal cognitive function. The Newcastle-Ottawa Scale scores of the included studies were greater than 5. Meta-analysis results suggested that the incidence of cognitive dysfunction in hemodialysis patients was (effect size = 51%, 95% confidence interval [CI] [0.33, 0.69]), and hemodialysis patients with cognitive dysfunction were often older than those with normal cognition (standard mean difference [SMD] = 0.49, 95% CI [0.31, 0.68]). Female gender was a risk factor for cognitive dysfunction in hemodialysis patients (relative risk [RR] = 1.21, 95% CI [1.04, 1.41]); diabetes (RR = 1.33, 95% CI [1.04, 1.71]) and stroke (RR = 1.66, 95% CI [1.08, 2.55]) increased the incidence of cognitive dysfunction in hemodialysis patients.

Conclusions: The most important risk factors for cognitive dysfunction associated with hemodialysis might be female gender, old age, diabetes, and stroke. Close attention should be paid to such patients for early prevention.

背景:本研究旨在探讨血液透析患者认知功能障碍的发生率和危险因素。方法:检索PubMed、Embase、Cochrane Library和Web of Science数据库,从数据库成立到2022年12月1日,对血液透析与认知功能障碍之间的关系进行临床研究。两名研究人员独立完成了纳入研究的数据提取和偏倚风险评估。所有统计分析均使用STATA15.0软件进行。结果:本荟萃分析纳入了10项研究,共有5535名血液透析患者,即2033名认知功能障碍患者和3502名认知功能正常患者。纳入研究的纽卡斯尔-渥太华量表得分大于5。荟萃分析结果表明,血液透析患者认知功能障碍的发生率为(效应大小 = 51%,95%置信区间[CI][0.33,0.69]),患有认知功能障碍的血液透析患者通常比认知正常的患者年龄大(标准平均差[SMD] = 0.49,95%CI[0.31,0.68])。女性是血液透析患者认知功能障碍的危险因素(相对风险[RR] = 1.21,95%CI[1.04,1.41]);糖尿病(RR = 1.33,95%可信区间[1.04,1.71])和中风(RR = 1.66,95%可信区间[1.08,2.55])增加了血液透析患者认知功能障碍的发生率。结论:与血液透析相关的认知功能障碍最重要的危险因素可能是女性、老年、糖尿病和中风。应密切关注此类患者,以便及早预防。
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引用次数: 0
Manual compression technique improves the success rate in the treatment of thrombosed aneurysmal arteriovenous fistula: A single-center experience. 手工加压技术提高血栓性动脉瘤动静脉瘘治疗的成功率:单中心经验。
IF 1.6 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-09-01 DOI: 10.1111/sdi.13127
Cheng-Yu Ko, Li-Ying Yu, Po-Wei Chen, Chih-Chang Ko, Tian-Xi Lin, Cheng-Han Lee, Ping-Yen Liu, Hsien-Yuan Chang

Objective: Endovascular intervention for thrombosed aneurysmal arteriovenous fistula (AVF) is still a challenge. Manual compression technique (MCT)-assisted angioplasty may be helpful, but there is no evidence or data to support it.

Methods: From January 2018 to May 2021, patients with thrombosed aneurysmal AVFs were retrospectively enrolled. The patients were separated into the MCT group or the traditional group according to the procedure received. Technical failure, clinical failure, 90-day patency, and safety were analyzed.

Results: A total of 159 cases (64 ± 12 years old, 60% male) were enrolled, of which 87 cases received MCT and 72 underwent traditional angioplasty. No technical failure was observed in the MCT group, while five technical failures were observed in the traditional group (0% vs. 7%, p = 0.02). There were no differences in the clinical failure rate (3% vs. 7%, p = 0.30), 90-day patency rate, or procedure time between the MCT group and the traditional group. There was no symptomatic pulmonary embolism or other complication in the two groups.

Conclusion: MCT is a low-cost, less invasive, and safe procedure for thrombosed aneurysmal AVF, and it achieves a higher technical success rate than traditional angioplasty.

目的:血栓性动脉瘤动静脉瘘(AVF)的血管内介入治疗仍是一个挑战。手动加压技术(MCT)辅助血管成形术可能有帮助,但没有证据或数据支持。方法:从2018年1月至2021年5月,回顾性纳入血栓性动脉瘤性avf患者。根据所接受的治疗方法将患者分为MCT组和传统组。分析技术失败、临床失败、90天通畅及安全性。结果:共入组159例(64±12岁,男性占60%),其中行MCT 87例,行传统血管成形术72例。MCT组无技术失败,而传统组有5例技术失败(0% vs. 7%, p = 0.02)。MCT组与传统组在临床失败率(3% vs. 7%, p = 0.30)、90天通畅率或手术时间方面均无差异。两组患者均未出现症状性肺栓塞及其他并发症。结论:MCT是一种低成本、微创、安全的治疗血栓性动脉瘤性AVF的方法,其技术成功率高于传统的血管成形术。
{"title":"Manual compression technique improves the success rate in the treatment of thrombosed aneurysmal arteriovenous fistula: A single-center experience.","authors":"Cheng-Yu Ko,&nbsp;Li-Ying Yu,&nbsp;Po-Wei Chen,&nbsp;Chih-Chang Ko,&nbsp;Tian-Xi Lin,&nbsp;Cheng-Han Lee,&nbsp;Ping-Yen Liu,&nbsp;Hsien-Yuan Chang","doi":"10.1111/sdi.13127","DOIUrl":"https://doi.org/10.1111/sdi.13127","url":null,"abstract":"<p><strong>Objective: </strong>Endovascular intervention for thrombosed aneurysmal arteriovenous fistula (AVF) is still a challenge. Manual compression technique (MCT)-assisted angioplasty may be helpful, but there is no evidence or data to support it.</p><p><strong>Methods: </strong>From January 2018 to May 2021, patients with thrombosed aneurysmal AVFs were retrospectively enrolled. The patients were separated into the MCT group or the traditional group according to the procedure received. Technical failure, clinical failure, 90-day patency, and safety were analyzed.</p><p><strong>Results: </strong>A total of 159 cases (64 ± 12 years old, 60% male) were enrolled, of which 87 cases received MCT and 72 underwent traditional angioplasty. No technical failure was observed in the MCT group, while five technical failures were observed in the traditional group (0% vs. 7%, p = 0.02). There were no differences in the clinical failure rate (3% vs. 7%, p = 0.30), 90-day patency rate, or procedure time between the MCT group and the traditional group. There was no symptomatic pulmonary embolism or other complication in the two groups.</p><p><strong>Conclusion: </strong>MCT is a low-cost, less invasive, and safe procedure for thrombosed aneurysmal AVF, and it achieves a higher technical success rate than traditional angioplasty.</p>","PeriodicalId":21675,"journal":{"name":"Seminars in Dialysis","volume":"36 5","pages":"374-381"},"PeriodicalIF":1.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10510419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Combined aerobic and resistance exercise in maintenance hemodialysis patients: A meta-analysis. 维持性血液透析患者的有氧和阻力联合运动:一项荟萃分析。
IF 1.6 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-07-01 Epub Date: 2023-06-14 DOI: 10.1111/sdi.13162
Yixiu Liu, Xiju Luo, Siyan Deng, Jing Chen, Lu Zhang, Ying Huang, Huagang Hu

Exercise brings many benefits to patients undergoing maintenance hemodialysis (MHD), but the effect of combined aerobic and resistance exercise remains unclear. English and Chinese databases (PubMed, Cochrane Library, Embase, Web of Science, CNKI, VIP, Wan Fang, and CBM) were searched from inception to January 2023 to retrieve qualified randomized controlled trials. The literature selection, data extraction, and risk of bias assessment of included studies were conducted independently by two reviewers. Meta-analysis was performed using RevMan 5.3 software. A total of 23 studies with 1214 participants were included, and 17 of the interventions were conducted during dialysis. Results showed that combined aerobic and resistance exercise (CARE) improved the peak oxygen uptake, six-minute walking test, 60 s sit-to-stand test (STS), 30 s STS, dialysis adequacy, five (out of eight) domains and physical component summary of health-related quality of life (HRQOL) measured by the Medical Outcomes Study Short Form-36, blood pressure, and hemoglobin for MHD patients compared with usual care. No significant changes were found in the mental component summary of HRQOL, C-reactive protein, creatinine, potassium, sodium, calcium, and phosphate. Subgroup analysis showed that intradialytic CARE ameliorated more outcomes, except for handgrip strength and hemoglobin, than non-intradialytic ones. CARE is an effective way to improve physical function, aerobic capacity, dialysis adequacy, and HRQOL for MHD patients. Strategies should be implemented by clinicians and policymakers to motivate patients to do more exercise. Well-designed clinical trials are warranted to explore the effectiveness of non-intradialytic CARE.

运动给接受维持性血液透析(MHD)的患者带来了许多好处,但有氧运动和阻力运动的联合效果尚不清楚。从开始到2023年1月,检索英文和中文数据库(PubMed、Cochrane Library、Embase、Web of Science、CNKI、VIP、Wan Fang和CBM),检索合格的随机对照试验。纳入研究的文献选择、数据提取和偏倚风险评估由两名评审员独立进行。使用RevMan 5.3软件进行荟萃分析。共纳入23项研究,共有1214名参与者,其中17项干预措施是在透析期间进行的。结果表明,有氧和阻力运动(CARE)相结合可以提高峰值摄氧量、6分钟步行测试、60 s坐立式测试(STS),30 与常规护理相比,MHD患者的STS、透析充分性、五个(八个)领域和健康相关生活质量(HRQOL)的物理成分总结(通过医疗结果研究简表36测量)、血压和血红蛋白。HRQOL、C反应蛋白、肌酸酐、钾、钠、钙和磷酸盐的心理成分汇总没有发现显著变化。亚组分析显示,除握力和血红蛋白外,透析内CARE比非透析外改善了更多的结果。CARE是改善MHD患者身体功能、有氧能力、透析充分性和HRQOL的有效方法。临床医生和决策者应该实施策略,激励患者进行更多的锻炼。精心设计的临床试验有助于探索非透析CARE的有效性。
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引用次数: 0
Early start hemodialysis with a catheter may be associated with greater mortality: A propensity score analysis. 早期开始使用导管进行血液透析可能与更高的死亡率相关:倾向评分分析。
IF 1.6 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-07-01 Epub Date: 2023-04-23 DOI: 10.1111/sdi.13157
Gustavo Laham, Gervasio Soler Pujol, Jenny Guzman, Natalia Boccia, Anabel Abib, Carlos H Diaz

Introduction: Deciding when and how to initiate hemodialysis (HD) is still controversial. An early start (ES) seems to show a lack of benefit. "Lead time bias" and comorbidities have been associated with different outcomes in ES groups. On the other hand, it is well accepted that the impact the type of vascular access (VA) has on patient survival. Our aim was to evaluate survival with early start (ES) versus late start (LS) on HD, taking into account the vascular access (VA) used.

Methods: Between 01/1995 and 06/2018, 503 incidental patients initiated HD at our Dialysis Unit. eGFR was estimated by the CKD-EPI equation. Diabetes mellitus (DM), coronary disease (CD), and peripheral vascular disease (PVD) were considered comorbid conditions. According to eGFR and VA, patients were divided into four groups: G1: ES (eGFR > 7 mL/min) with catheter (ES + C), G2: ES with fistula or graft (F/G) (ES + F/G), G3: LS (eGFR< 7 mL/min) with catheter (LS + C), and G4: LS with F/G (LS + F/G). The cut-off value to define ES or LS was based on median eGFR for these 503 patients. We compared patient's survival rates by Kaplan-Meier and log-rank test. The four groups were compared before and after matching with propensity scores (PS). Cox analysis was performed to determine the impact of predictors of mortality.

Results: Median eGFR was 7 (5.3-9.5) mL/min/1.73 m2 , median follow-up time was 30.9 (13-50) months, 52.1% had F/G access at entry, and 46.9% died during the observation period. Among the four groups, the ES + C were significantly older, and there were more diabetics and comorbid conditions, while phosphatemia, iPTH, albumin, and hemoglobin were significantly higher in the LS groups. Before propensity score (PS) matching, the ES + C group had a poor survival rate (p < 0.0001), while LS + F/G access had the best survival. After PS, a total of 180 patients were selected in the same four groups and ES + C kept showing a statistically significant poorer survival. Multivariate analysis revealed that ES + C was an independent predictor of mortality.

Conclusion: In this retrospective study, ES + C on HD was associated with a higher mortality rate than LS. This association persisted after PS matching.

引言:决定何时以及如何开始血液透析(HD)仍然存在争议。早期启动(ES)似乎显示出缺乏益处。ES组的“提前期偏倚”和合并症与不同的结果相关。另一方面,血管通路(VA)的类型对患者生存的影响是公认的。我们的目的是评估HD早期启动(ES)与晚期启动(LS)的生存率,同时考虑所使用的血管通路(VA)。方法:1995年1月至2018年6月,503名偶发患者在我们的透析室开始HD。eGFR通过CKD-EPI方程估计。糖尿病(DM)、冠状动脉疾病(CD)和外周血管疾病(PVD)被认为是合并症。根据eGFR和VA,患者被分为四组:G1:ES(eGFR>7mL/min)和导管(ES + C) ,G2:ES伴瘘或移植物(F/G)(ES+ F/G),G3:LS(eGFR<7 mL/min),带导管(LS + C) ,和G4:带F/G的LS(LS + F/G)。定义ES或LS的临界值是基于这503名患者的eGFR中位数。我们通过Kaplan-Meier和log-rank检验比较了患者的生存率。四组在匹配倾向评分(PS)前后进行比较。Cox分析用于确定死亡率预测因素的影响。结果:中位eGFR为7(5.3-9.5)mL/min/1.73 m2,中位随访时间为30.9(13-50)个月,52.1%的患者进入F/G通道,46.9%的患者在观察期内死亡。在四组中,ES + C年龄明显较大,糖尿病患者和共病患者较多,而LS组的磷酸盐血症、iPTH、白蛋白和血红蛋白明显较高。在倾向得分(PS)匹配之前,ES + C组生存率低(p 结论:在这项回顾性研究中,ES+ HD上的C与LS相比死亡率更高。这种相关性在PS匹配后持续存在。
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引用次数: 0
The association of cognition with protein energy wasting and synaptic transmission in chronic kidney disease. 慢性肾脏疾病认知与蛋白质能量消耗和突触传递的关系。
IF 1.6 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-07-01 Epub Date: 2023-03-02 DOI: 10.1111/sdi.13146
Xia Yang, Yujun Quan, Erzhong Wu, Yuecheng Jiang, Qian Song, Yue Li, Qian Li, Zhaolin Sun, Jing Yuan, Yan Zha, Xiaoli Cui

Introduction: In recent years, consciousness impairment in patients with end-stage renal disease (ESRD) has been paid more and more attention, but the cause and mechanism of consciousness state change is not clear.

Methods: As the hippocampus played a crucial role in consciousness, we explored the pathological and electrophysiological changes in chronic kidney disease (CKD) mouse hippocampus.

Results: Whole-cell recordings in hippocampal neurons showed that miniature excitatory postsynaptic current (mEPSC) frequency decreased, but the amplitude was unaltered in CKD_8w mice. In addition, α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor-mediated EPSCs (AMPAR-EPSCs) and N-methyl-D-aspartic acid receptor-mediated EPSCs (NMDAR-EPSCs) in hippocampal Schaffer collateral-CA1 synapses displayed a significant decline in CKD_8w mice. Although the ratio of AMPAR-/NMDAR-EPSCs did not change, the paired-pulse ratio (PPR) in CKD_8w mice increased. Intriguingly, the mEPSC frequency and AMPAR-/NMDAR-EPSCs amplitudes were positively associated with body weight, and the mEPSC frequency was negatively correlated with serum creatinine in CKD_8w mice, indicating a potential correlation between cognition and nutritional status in patients with CKD. To confirm the above hypothesis, we collected the clinical data from multiple hemodialysis centers to analyze the correlation between cognition and nutritional status.

Conclusion: Our analysis indicated that protein energy wasting (PEW) was a possible independent risk factor for consciousness dysfunction in maintenance hemodialysis (MHD) patients. Our results provided a more detailed mechanism underlying the cognitive impairment (CI) in ESRD patients at the synaptic level. Last but not least, our results showed that PEW was a probable new independent risk factor for CI in cases with ESRD.

引言:近年来,终末期肾病(ESRD)患者的意识障碍越来越受到重视,但其意识状态变化的原因和机制尚不清楚。方法:由于海马在意识中起着至关重要的作用,我们探讨了慢性肾脏病(CKD)小鼠海马的病理和电生理变化。结果:CKD_8w小鼠海马神经元的全细胞记录显示,微小兴奋性突触后电流(mEPSC)频率降低,但振幅不变。此外,在CKD_8w小鼠中,海马Schaffer侧支-CA1突触中的α-氨基-3-羟基-5-甲基-4-异恶唑-丙酸受体介导的EPSC(AMPAR EPSC)和N-甲基-D-天冬氨酸受体介导EPSC(NMDAR EPSC)表现出显著下降。CKD_8w小鼠的AMPAR-/NMDAR-EPSCs比值没有变化,但成对脉冲比(PPR)增加。有趣的是,在CKD_8w小鼠中,mEPSC频率和AMPAR-/NMDAR-EPSCs振幅与体重呈正相关,mEPSC-频率与血清肌酐呈负相关,这表明CKD患者的认知与营养状况之间存在潜在相关性。为了证实上述假设,我们收集了多个血液透析中心的临床数据,分析了认知与营养状况之间的相关性。结论:蛋白质能量消耗(PEW)可能是维持性血液透析(MHD)患者意识功能障碍的独立危险因素。我们的研究结果在突触水平上提供了ESRD患者认知障碍(CI)的更详细的潜在机制。最后但并非最不重要的是,我们的研究结果表明,PEW可能是ESRD患者CI的一个新的独立风险因素。
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引用次数: 0
Hyponatremia and mortality in patients undergoing maintenance hemodialysis: Systematic review and meta-analysis. 维持性血液透析患者的低钠血症与死亡率:系统综述和荟萃分析。
IF 1.6 4区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2023-07-01 Epub Date: 2023-03-16 DOI: 10.1111/sdi.13140
Takamasa Miyauchi, Hiroki Nishiwaki, Aya Mizukami, Masahiko Yazawa

Introduction: This systematic review and meta-analysis examined the relationship between hyponatremia and worse outcomes in patients undergoing maintenance hemodialysis.

Methods: The MEDLINE, EMBASE, CENTRAL, and Web of Science databases were used to search for relevant articles. The target population was patients on maintenance hemodialysis (those undergoing hemodialysis for ≥60 days). The defined outcomes were death, cardiovascular disease, cognitive decline, and falls. Meta-analysis was performed with a random-effects model of pairwise comparisons of normonatremia and hyponatremia defined for each study, 1-mmol/L increment of sodium analysis, and dose-response analysis using the sodium concentration defined for each study. This study was registered with PROSPERO (registration number CRD42018087667).

Results: Thirteen articles were included. The pairwise analysis revealed that the hazard ratio for all-cause mortality was 1.45 (95% confidence interval, 1.31-1.61). The analysis of 1-mmol/L increment of sodium included six studies with a hazard ratio for all-cause mortality of 0.94 (95% confidence interval, 0.91-0.97) for each 1-mmol/L increase in the serum sodium concentration. In the dose-response analysis, assuming a linear relationship, a sodium increment of 1 mmol/L revealed a hazard ratio for all-cause mortality of 0.97 (95% confidence interval, 0.96-0.98). Other outcomes could not be integrated.

Conclusions: Hyponatremia is associated with all-cause mortality in patients undergoing maintenance hemodialysis. Healthcare providers should pay special attention to even the slightest indication of hyponatremia.

引言:本系统综述和荟萃分析研究了维持性血液透析患者低钠血症与不良预后之间的关系。方法:使用MEDLINE、EMBASE、CENTRAL和Web of Science数据库检索相关文章。目标人群是接受维持性血液透析的患者(那些接受血液透析≥60 天)。定义的结果是死亡、心血管疾病、认知能力下降和跌倒。荟萃分析采用随机效应模型进行,该模型对每项研究中定义的正常钠血症和低钠血症进行成对比较,钠增量为1mol/L,并使用每项研究定义的钠浓度进行剂量反应分析。本研究已在PROSPERO注册(注册号CRD42018087667)。结果:共收录13篇文章。成对分析显示,全因死亡率的危险比为1.45(95%置信区间,1.31-1.61)。钠浓度增加1mmol/L的分析包括6项研究,血清钠浓度每增加1mmol/L,全因死亡的危险比均为0.94(95%置信间隔,0.91-0.97)。在剂量反应分析中,假设呈线性关系,钠增量为1 mmol/L时,全因死亡率的危险比为0.97(95%置信区间,0.96-0.98)。其他结果无法整合。结论:维持性血液透析患者的低钠血症与全因死亡率相关。医疗保健提供者应特别注意哪怕是最轻微的低钠血症迹象。
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Seminars in Dialysis
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