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Indonesian Journal of Kidney and Hypertension最新文献

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Vol 2 No 3 (2019): September - December 2019 第二卷第三期(2019):2019年9月至12月
Pub Date : 2019-12-02 DOI: 10.32867/inakidney.v2i3
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引用次数: 0
Effect of a Single Dialysis on Cognitive Function in Chronic Kidney Disease Stage 5 Hemodialysis Patients 单次透析对慢性肾病5期血液透析患者认知功能的影响
Pub Date : 2019-07-31 DOI: 10.32867/INAKIDNEY.V2I2.10
A. R. Hidayat, H. Rasyid, S. Bakri, H. Kasim, S. Syamsuddin, A. Seweng
Abstract Background: The incidence of cognitive impairment (CI) has been widely reported in various studies among chronic kidney disease (CKD) patients. Many factors influence cognitive function including hemodialysis (HD) process itself. There is much evidence that a single HD session brings about changes in the cognitive status of patients, but just a few studies assessing whether cognitive performance varies with dialysis. Aim: To know the effect of single dialysis session on cognitive function in HD patients. Method: Sixty medically stable CKD stage 5 patients on HD maintenance at least for three months were enrolled. Cognitive testing performed thrice, 1-2 hour prior dialysis (T1), 3-4 hour into the session (T2) and 24 hour after the session (T3) using a well-validated neuropsychological test battery, Montreal Cognitive Assessment (MoCA) Indonesian version which assess the domain of cognitive function including visuospatial, executive function, naming, memory, attention, language, abstraction, recall, and orientation. Result: among 60 patients complete testing, mean age 45,45 ± 11,28 years, dialysis vintage 10,12 ± 11,88 months, 44 patients (73,3%) had CI at baseline. Cognitive function decline during dialysis (T2) (MoCA INA score 21,65 to 19,67, p < 0.001) and visuospatial, executive function, attention, language and recall was impaired during dialysis. While cognitive function reached its best 24 hour after dialysis (MoCA INA score 23,65, p < 0.001) and all the domain of cognitive function was improved except naming that didn’t change over the dialysis session. Age and dialysis  adequacy were associated with the decline.      Conclusion: There is effect of a single HD session on global cognitive function where cognitive function was deteriorated during HD and reached its best 24 hour after HD. Keywords: cognitive function, chronic kidney disease, hemodialysis
背景:认知功能障碍(CI)的发生率在慢性肾脏疾病(CKD)患者的各种研究中被广泛报道。许多因素影响认知功能,包括血液透析(HD)过程本身。有很多证据表明,单次透析会改变患者的认知状态,但只有少数研究评估透析是否会改变患者的认知表现。目的:了解单次透析对HD患者认知功能的影响。方法:纳入60例医学上稳定且维持至少3个月的CKD 5期患者。认知测试进行三次,透析前1-2小时(T1)、透析后3-4小时(T2)和透析后24小时(T3),使用经过验证的神经心理学测试,蒙特利尔认知评估(MoCA)印度尼西亚版,评估认知功能领域,包括视觉空间、执行功能、命名、记忆、注意力、语言、抽象、回忆和定向。结果:60例完成检测的患者,平均年龄45、45±11、28岁,透析时间10、12±11、88个月,44例(73.3%)基线CI。透析期间认知功能下降(T2) (MoCA INA评分21、65至19、67,p < 0.001),视觉空间、执行功能、注意力、语言和回忆功能受损。而透析后24小时认知功能达到最佳(MoCA INA评分23、65,p < 0.001),除命名外,所有认知功能领域在透析期间均有改善。年龄和透析充分性与下降有关。结论:单次高清晰度治疗对患者整体认知功能有影响,患者认知功能在高清晰度治疗期间恶化,在高清晰度治疗后24小时达到最佳状态。关键词:认知功能,慢性肾病,血液透析
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引用次数: 0
Correlation between Urinary Cyclophilin A and Urinary Albumin Levels on Diabetic Kidney Disease 尿亲环蛋白A与尿白蛋白水平与糖尿病肾病的相关性
Pub Date : 2019-07-31 DOI: 10.32867/INAKIDNEY.V2I2.29
Harnavi Harun, Rangga Lunesia, Syaiful Azmi
Introduction: Diabetic kidney disease (DKD) is a complication of diabetes mellitus characterized by albuminuria persisting within 3 to 6 months, the earliest clinical evidence is microalbuminuria (30-299 mg/24hours or 20-199 ug/i). Cyclophilin A (Cyp A) is an 18 k-Da 165-amino acid long cytosolic protein also known as peptidylprolyl isomerase A. In DN, hyperglycemia will cause Cyp A secretion by human kidney-2 (HK-2) cells from PTEC and mesangial-13 cells (MES-13) and causes kidney damage. Material and Methods: This study was an analytic observational, cross sectional study conducted at the clinic and inpatient internal medicine installation at dr. M. Djamil General Hospital Padang  for 6 months. Samples were selected by consecutive sampling, as many as 60 people with post prandial blood glucose > 180 mg/dl and urinary albumin > 30 mg/24 hours and met the inclusion and exclusion criteria. The samples were examined for urinary Cyp A and albumin levels. Results: The mean level of urinary Cyp A in patients with DKD is 4.96 (2.03) ng/ml. Median urinary albumin levels in DKD patients is 287.89 (30.79-394.57) mg/24 hours. Correlation analysis between urinary Cyp A and albumin levels showed a significant (p < 0.05) with a positive and strong correlation (r = 0.776) in DKD patients. Conclusion: There was an increase of urinary Cyp A and urinary albumin levels, with a positive and strong correlation between them in DKD patients. Keywords: Urinary Cyclophilin A, urinary albumin, diabetic kidney disease
简介:糖尿病肾病(DKD)是以蛋白尿为特征的糖尿病并发症,病程持续3 ~ 6个月,临床最早表现为微量蛋白尿(30 ~ 299 mg/24h或20 ~ 199 ug/i)。嗜环蛋白A (Cyclophilin A, Cyp A)是一种18 k-Da的165个氨基酸长的细胞质蛋白,也被称为肽基脯氨酸异构酶A。在DN中,高血糖会导致人肾-2 (HK-2)细胞从PTEC和系膜-13细胞(mes13)分泌Cyp A,造成肾脏损害。材料和方法:本研究是一项分析性观察性横断面研究,在巴东M. Djamil综合医院的临床和住院内科装置进行了为期6个月的研究。通过连续取样,选取餐后血糖> 180 mg/dl、尿白蛋白> 30 mg/24小时符合纳入和排除标准的60人。检测样本的尿A型血和白蛋白水平。结果:DKD患者尿Cyp A平均水平为4.96 (2.03)ng/ml。DKD患者尿白蛋白水平中位数为287.89 (30.79-394.57)mg/24小时。尿Cyp A与白蛋白水平的相关性分析显示,DKD患者尿Cyp A与白蛋白水平的相关性显著(p < 0.05),呈强正相关(r = 0.776)。结论:DKD患者尿Cyp A和尿白蛋白水平升高,两者呈强正相关。关键词:尿亲环蛋白A,尿白蛋白,糖尿病肾病
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引用次数: 3
Survival Rate of Living Related Kidney Transplant Patients in Surabaya 泗水市活体亲属肾移植患者的存活率
Pub Date : 2019-07-31 DOI: 10.32867/INAKIDNEY.V2I2.27
Decsa Medika, Aditiawardana Aditiawardana, Pranawa Pranawa, D. Santoso, W. Widodo, Chandra Irwanadi Mohani
Abstract Background The survival outcome of transplant patients have improved in the past three decades. The short and long term survival of graft and patients are still being widely studied. Many factors affect the survival rate such as age, gender, diabetes mellitus, and immunosuppressive therapy. Objective The study aim to provide patients’ survival rates 1, 3, and 5 years after transplant. Methods The study used descriptive approach on 67 kidney transplant patients undergoing outpatient treatment from 1996 to 2016. The data collected was analyzed using SPSS with the Kaplan-Meier curve to observe the survival rate. Result The survival rate of patients in 1, 3, and 5 years were 100%, 97%, and 94% respectively. The survival rate in geriatric and non-geriatric patients in the first year post-transplantation was both 100%, the third year post-transplantation survival rate were 100% and 94.7%, and the five year post-transplantation survival rate were 100% and 89.5%. The 1, 3, and 5 year survival rate for male and female patients were both 100%, 96.3% vs 100%, and 92.6% vs 100% respectively. Compared to their non-diabetic counterparts, diabetic patients’ survival rate in 1, 3, and 5 years were both 100%, 96.5% vs 100%, and 93% vs 100% respectively. The survival rate of patients receiving tacrolimus vs cyclosporine were both 100% in the first year, 97.1% vs 97% in the third year, and 97.1% vs 90.9% in the fifth year after transplant. Conclusion The survival rate of kidney transplant patients in 1, 3, and 5 year after transplant were 100%, 97%, and 94%. Factors linked to higher survival rate were geriatric patients, female gender, diabetes, and the use of cyclosporine in the immunosuppressant therapy regimen.   Keyword: kidney transplantation, survival
摘要背景在过去的三十年中,移植患者的生存预后有所改善。移植物和患者的短期和长期生存仍在广泛研究中。影响生存率的因素有年龄、性别、糖尿病、免疫抑制治疗等。目的了解移植后患者1年、3年和5年的生存率。方法对1996 - 2016年门诊肾移植患者67例进行描述性分析。收集的数据用SPSS统计软件进行分析,采用Kaplan-Meier曲线观察生存率。结果1年、3年、5年生存率分别为100%、97%、94%。老年和非老年患者移植后1年生存率均为100%,移植后3年生存率分别为100%和94.7%,移植后5年生存率分别为100%和89.5%。男、女患者1、3、5年生存率分别为100%、96.3%对100%、92.6%对100%。与非糖尿病患者相比,糖尿病患者1年、3年和5年的生存率分别为100%、96.5%对100%、93%对100%。移植后第一年他克莫司与环孢素的生存率均为100%,第三年为97.1% vs 97%,第5年为97.1% vs 90.9%。结论肾移植患者术后1、3、5年生存率分别为100%、97%、94%。与较高生存率相关的因素有老年患者、女性、糖尿病以及在免疫抑制剂治疗方案中使用环孢素。关键词:肾移植;生存
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引用次数: 0
Angioplasty in CKD patients with immature AV fistula: A Case Report 血管成形术治疗CKD伴未成熟房室瘘1例报告
Pub Date : 2019-07-31 DOI: 10.32867/INAKIDNEY.V2I2.19
Atma Gunawan, Sulih Ngutamani, Achmad Rifai, N. Nursamsu
Arteriovenous fistula has been preferred to other vascular access for dialysis due to better patient outcome for morbidity and mortality. However, AVF failure is quite prevalent. One of the cause for AVF failure is due to venous stenosis, diagnosed through Doppler ultrasound and venography. Angioplasty is one of the methods that can be used to repair and salvage an immature AVF. In this report, a 59 year old female patient was diagnosed with CKD with a long history diabetes mellitus type 2 and admitted for routine hemodialysis. An AVF was created on her radiocephalic vein, and upon evaluation was found to not mature properly. Doppler ultrasound examination showed fistula diameter of 3 mm and volume flow of 160 ml/min, whereas venography showed stenosis in radiocephalic fistula. Balloon angioplasty was then performed with balloon diameter of 4 mm and balloon pressure of 10, 15, and 20 atm for three minutes each. After the procedure, the fistula exhibit dilatation with minimum residual stenosis and adequate as vascular access for hemodialysis.
由于患者发病率和死亡率较低,动静脉瘘优于其他血管透析途径。然而,AVF失败是相当普遍的。AVF衰竭的原因之一是由于静脉狭窄,通过多普勒超声和静脉造影诊断。血管成形术是一种可用于修复和挽救未成熟AVF的方法。本文报道一名59岁女性慢性肾病患者,长期患有2型糖尿病,接受常规血液透析治疗。在她的放射性头静脉上创建了一个AVF,经评估发现未正常成熟。多普勒超声检查显示瘘道直径3mm,容积流量160 ml/min,静脉造影显示放射性头瘘狭窄。然后进行球囊血管成形术,球囊直径为4mm,球囊压力分别为10、15和20 atm,各3分钟。手术后,瘘管扩张,残余狭窄最小,足以作为血液透析的血管通道。
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引用次数: 1
Incidence and Risk Factors of Cardio-Cerebrovascular Event, Hospitalization, and Mortality in Patients Undergoing Regular Hemodialysis 定期血液透析患者心脑血管事件、住院和死亡率的发生率和危险因素
Pub Date : 2019-07-31 DOI: 10.32867/INAKIDNEY.V2I2.18
I. Mahendra, Y. Kandarini, I. Widiana
Background: CKD patients undergoing regular HD experience high rate of hospitalization and mortality compared with general population. The main contributing factors were cardiovascular event and infection. In Indonesia, there has been no comprehensive and representative data available. This study aims to discover the incidence and risk factors of cardio-cerebrovascular events, hospitalization and mortality, as well as the survival rate among patients undergoing regular HD at Sanglah general hospital Denpasar.   Methods: The study was an analytic retrospective cohort study conducted in Sanglah general hospital Denpasar from July 1st to December 31st 2017. Inclusion criteria were patients with CKD stage-5, ≥ 18 years old, and have undergone regular HD for at least 3 months. Patients with malignancy and requiring elective hospitalization were excluded. The Kaplan-Meier method was used to calculate the cumulative survival rate, and the log-rank test was used for extracting the risk factors that influenced the survival rate. Multivariate Cox regression analysis was used to test contributing risk factors towards composite outcomes (cardio-cerebrovascular events, hospitalization and mortality) and mortality outcome. The risk factors contributors were declared with a value of relative risk and odds ratio adjusted with the confidence interval (CI) 95%, the level of significance (α) was specified in the value of p<0.05.   Results: The composite outcome incidence of 222 subject within 6 months (184 days) was 18.09% and mortality outcome was 8.11%, with cardiovascular event was a major cause (56%) of mortality outcome. Risk factors significantly contributed on composite outcome related to etiology (p=0.03) as follows: 1) Diabetic nephropathy (OR=1.33; CI 95% 0.16-11.06); 2) Hypertensive nephrosclerosis (OR=0.98; CI 95% 0.11 - 8.47); 3) Chronic pyelonephritis (OR=0.36; CI 95% 0.05 – 2.74); 4) Chronic Glomerulonephritis (OR=0.23; CI 95% 0.02 – 2.66) and AV fistula (+) (OR=0.37; CI 95% 0.17 – 0.77; p=0.01). Whereas risk factors significantly contributed on mortality outcome related to AV fistula (+) (OR=0.46; CI 95% 0.23 - 0.92; p=0.028) and age < 52 years old (OR=0.51; CI 95% 0.26 to 0.99; p=0.047). The cumulative survival rate (composite outcome) was 165.83±3.57 days with the cumulative survival rate (mortality outcome) was 177.34±2.00 days.   Conclusion: This study concluded that the incidence of mortality outcome was 8.11% within 6 months (184 days), with cardiovascular event was a major cause (56%), risk factors significantly contributed on mortality outcomes were AV fistula and age, whereas the cumulative survival rate (mortality outcome) was 177.34±2.00 days.
背景:慢性肾病合并常规HD患者的住院率和死亡率高于普通人群。主要影响因素为心血管事件和感染。在印度尼西亚,没有全面和有代表性的数据。本研究旨在了解登巴萨Sanglah总医院普通HD患者的心脑血管事件发生率、危险因素、住院率、死亡率及生存率。方法:采用分析回顾性队列研究,于2017年7月1日至12月31日在登巴萨Sanglah总医院进行。入选标准为CKD 5期患者,年龄≥18岁,接受常规HD治疗至少3个月。排除恶性肿瘤和需要选择性住院的患者。采用Kaplan-Meier法计算累积生存率,采用log-rank检验提取影响生存率的危险因素。多因素Cox回归分析用于检验复合结局(心脑血管事件、住院和死亡率)和死亡率结局的相关危险因素。危险因素以相对危险度值表示,优势比以置信区间(CI) 95%调整,p<0.05表示显著性水平(α)。结果:222例患者6个月(184 d)内综合结局发生率为18.09%,死亡结局发生率为8.11%,其中心血管事件是死亡结局的主要原因(56%)。以下危险因素对病因相关的综合结局有显著影响(p=0.03): 1)糖尿病肾病(OR=1.33;Ci 95% 0.16-11.06);2)高血压性肾硬化(OR=0.98;Ci 95% 0.11 - 8.47);3)慢性肾盂肾炎(OR=0.36;Ci 95% 0.05 - 2.74);4)慢性肾小球肾炎(OR=0.23;CI 95% 0.02 - 2.66)和房室瘘(+)(OR=0.37;Ci 95% 0.17 - 0.77;p = 0.01)。鉴于危险因素显著影响与房室瘘相关的死亡率(+)(OR=0.46;Ci 95% 0.23 - 0.92;p=0.028),年龄< 52岁(OR=0.51;可信区间95% 0.26 ~ 0.99;p = 0.047)。累计生存率(综合结局)为165.83±3.57 d,累计生存率(死亡结局)为177.34±2.00 d。结论:6个月(184天)内死亡结局发生率为8.11%,心血管事件为主要原因(56%),影响死亡结局的危险因素为房室瘘和年龄,累计生存率(死亡结局)为177.34±2.00天。
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引用次数: 1
Correlation of Glycated Albumin and Glycated Hemoglobin with Glycemic Control in Patients with Diabetic Chronic Kidney Disease on Hemodialysis 糖化白蛋白和糖化血红蛋白与糖尿病慢性肾病血液透析患者血糖控制的相关性
Pub Date : 2019-04-01 DOI: 10.32867/INAKIDNEY.V2I1.22
Z. Ali, Rostika Dewi, Alwi Shahab, Irsan Saleh
Background and aims. Diabetes mellitus (DM) is the most common cause of end-stage renal disease (ESRD) worldwide and is the primary etiology of ESRD in Indonesia. It is estimated that there are 10 million patients with DM in Indonesia and about 25-40% of diabetics develop diabetic nephropathy (DN) within 25 years. Poor glycemic control is associated with increased mortality in a large observational study among diabetics on hemodialysis. Glycated hemoglobin, or known as HbA1c, was the currently recommended biomarker to monitor long-term glycemic control in diabetes mellitus guideline. However, it becomes underestimated in patients with DN on hemodialysis (DN-HD), because of 20- 50% reduction of erythrocyte lifespan, clinical use of iron therapy, and effects of recombinant human erythropoietin. Glycated albumin (GA), ketoamine formed via a non-enzymatic glycation reaction of serum albumin, is free from interference by erythrocyte lifespan or erythropoietin therapy and subsequently can be used as an alternative biomarker to monitor glycemic control in DN-HD. As albumin has a half-life of only 14-21 days* compared to Hb 60-100 days in well ESKD patients, thus GA may provide a better reflection of recent diabetic control than HbA1c. The aim of this study was to analyze the correlation between GA and HbA1c with glycemic control in DN-HD. Methods The study was an analytical observational study with a cross-sectional design. The subjects were consecutive patients with DN-HD who visited Hemodialysis Unit at Mohammad Hoesin General Hospital Palembang during August-November 2014. The glycemic control index was determined by the average value of 2 times a week pre-HD random blood glucose for 4 weeks (aRBG). Results. The subjects were 25 patients with an average age of 56.16±7.49 years old. The average value of GA was 26.94±7.74%. GA was strongly correlated with aRBG with r=0.776; p=0.000. After correcting for age, sex, and BMI, the correlations became significantly very strong (r=0.809, p <0.001). The simple linear regression for the relationship between GA and aRBG was aRBG=4,62×GA+42.74 (R2=0.602, P<0.001), estimating that a 1% increase of GA was associated with 4.62mg/dL increase of aRBG. After correcting for age, sex, & BMI, the correlations between HbA1c and aRBG were significant (r=0.852, p<0.001). Conclusion. GA was strongly correlated with glycemic control in patients with DN-HD and HbA1c was correlated better.
背景和目的。糖尿病(DM)是世界范围内终末期肾病(ESRD)最常见的病因,也是印度尼西亚终末期肾病(ESRD)的主要病因。据估计,印度尼西亚有1000万糖尿病患者,约25-40%的糖尿病患者在25年内发展为糖尿病肾病(DN)。一项针对血液透析患者的大型观察性研究显示,血糖控制不良与死亡率增加有关。糖化血红蛋白(HbA1c)是目前糖尿病指南中推荐的监测长期血糖控制的生物标志物。然而,由于红细胞寿命减少20- 50%,临床使用铁治疗和重组人促红细胞生成素的影响,在血液透析(DN- hd)的DN患者中,它被低估了。糖化白蛋白(GA)是通过血清白蛋白的非酶糖基化反应形成的酮胺,不受红细胞寿命或促红细胞生成素治疗的干扰,因此可以用作监测DN-HD患者血糖控制的替代生物标志物。在ESKD良好的患者中,白蛋白的半衰期仅为14-21天*,而血红蛋白的半衰期为60-100天,因此GA可能比HbA1c更能反映近期糖尿病的控制情况。本研究的目的是分析GA和HbA1c与DN-HD患者血糖控制的相关性。方法采用横断面设计的分析性观察研究。研究对象为2014年8月至11月在巨港穆罕默德·胡辛总医院血液透析科就诊的连续DN-HD患者。血糖控制指数采用每周2次、连续4周的hd前随机血糖(aRBG)平均值测定。结果。患者25例,平均年龄56.16±7.49岁。GA平均值为26.94±7.74%。GA与aRBG呈正相关,r=0.776;p = 0.000。在校正了年龄、性别和BMI后,相关性变得非常强(r=0.809, p <0.001)。GA与aRBG关系的简单线性回归为aRBG=4,62×GA+42.74 (R2=0.602, P<0.001),估计GA升高1%与aRBG升高4.62mg/dL相关。校正年龄、性别和BMI后,HbA1c和aRBG之间的相关性有统计学意义(r=0.852, p<0.001)。结论。GA与DN-HD患者血糖控制密切相关,HbA1c相关性较好。
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引用次数: 0
Settings The Role of Low Blood Glucose Level of Mothers with Severe Preeclampsia in Fetal Growth Restriction: a Mini-Study 重度子痫前期母亲低血糖水平在胎儿生长受限中的作用:一项小型研究
Pub Date : 2019-04-01 DOI: 10.32867/INAKIDNEY.V2I1.24
A. Prameswari
Background. The number of patients with severe preeclampsia continues to increase worldwide. Blood glucose is significantly decreased in severe preeclampsia patients, starting at the sudden onset of high blood pressure. This depicts the state of low placental energy status in preeclampsia patients with intrauterine growth restriction (IUGR), due to either glycolysis or ischemia disorders resulting from decreased maternal placental blood flow. Aim. To observe the relationship between mother’s random blood glucose level with fetal growth restriction complications during acute onset of severe preeclampsia. Methods. A cross-sectional study, random sampling involving twenty-one pregnant women with severe preeclampsia who underwent cesarean section at Permata Bunda Hospital, Malang, Indonesia. Data were taken from medical records, which included: mother’s random blood glucose, blood pressure, proteinuria, and complete blood count. Fetal data includes body weight and length. The data were obtained at the subjects’ initial admission in the emergency room during the acute phase of the preeclampsia. Result. Maternal blood glucose had a negative and significant relationship with systolic blood pressure (r = -0.843, p < 0.0001) and with newborn body weight (r = 0.465, p = 0.034) in the acute onset of severe preeclampsia. Conclusion. The blood glucose level of patients at the acute onset of preeclampsia is inversely correlated with systolic blood pressure. The blood glucose level is also correlated with fetal weight. However, due to the chronic nature of IUGR, future studies should analyze the relationship between blood glucose, blood pressure, and fetal growth through multiple stages of pregnancy
背景。在世界范围内,患有严重子痫前期的患者数量持续增加。严重子痫前期患者的血糖显著降低,始于高血压的突然发作。这描述了子宫内生长受限(IUGR)的子痫前期患者胎盘能量低下的状态,这是由于母体胎盘血流减少引起的糖酵解或缺血紊乱。的目标。观察重度子痫前期急性发作时母亲随机血糖水平与胎儿生长受限并发症的关系。方法。一项横断面研究,随机抽样包括21名在印度尼西亚玛朗Permata Bunda医院接受剖宫产术的严重子痫前期孕妇。数据取自医疗记录,包括:母亲的随机血糖、血压、蛋白尿和全血细胞计数。胎儿资料包括体重和身长。这些数据是在受试者在子痫前期急性期首次入住急诊室时获得的。结果。重度子痫前期急性发作时,母体血糖与收缩压(r = -0.843, p < 0.0001)、新生儿体重(r = 0.465, p = 0.034)呈显著负相关。结论。急性子痫前期患者的血糖水平与收缩压呈负相关。血糖水平也与胎儿体重相关。然而,由于IUGR的慢性性质,未来的研究应通过多个妊娠阶段分析血糖、血压与胎儿生长的关系
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引用次数: 0
Does High Ultrafiltration Volume Correlate to Occurrence of Desaturation in Patients Undergoing Hemodialysis? 高超滤容量是否与血液透析患者发生去饱和有关?
Pub Date : 2019-04-01 DOI: 10.32867/INAKIDNEY.V2I1.21
L. Sen, N. M. Hustrini
Background: Hemodialysis is a metabolically stressful condition for patients that leads to reduced oxygen saturation and tissue perfusion. One of the identified drivers is a high ultrafiltration volume (UFV). Concurrently, central venous oxygen saturation (ScvO2) is a marker for global tissue hypoxia that has been used in cases of sepsis and trauma to guide fluid therapy. In dialysis patients with a central venous catheter (CVC) access ScvO2 is accessible. Here we intend to delineate the relationship of UFV to desaturation during dialysis through the measurement of ScvO2. Methods: PICO was formulated from a clinical case, and a literature search was conducted in Pubmed, Embase, Scopus, and Cochrane. Selected studies were then critically appraised using harm/etiology worksheet from CEBM1 for validity, importance, and applicability. Results: Studies by Harrison, et al., Zhang, et al. and Rotondi, et al. were chosen for answering our PICO. Harrison, et al. reported a relation of r: -0.680, p:0.015 between UFV and ScvO2. While, Zhang, et al. utilized retrospective data of Critline Monitor (CLM) reading of dialysis patients and reported a negative 0.3% slope of ScvO2 over corrected UFV (cUFV). Whilst, Rotondi, et al. demonstrated that in 20 patients separated equally to exclusively dialysis or ultrafiltration and both caused lowering of ScvO2, but only the former was statistically significant. Discussion: The mechanism of relationship may include incapability of plasma refill rate to compensate for the fluid shift during ultrafiltration, resulting in lower cardiac preload and stroke volume which is detrimental in patients who are natively prone to suffer from reflex bradycardia and intradialytic hypotension. Studies have shown that episodes of hypoxemia in dialysis patients translate to worse prognosis. Conclusion: ScvO2 is inversely proportional to UFV. As such, monitoring for ScvO2 in dialysis patients will be beneficial to prevent end-organ ischemia.
背景:血液透析是患者的代谢应激状态,可导致血氧饱和度和组织灌注降低。其中一个确定的驱动因素是高超滤体积(UFV)。同时,中心静脉氧饱和度(ScvO2)是整体组织缺氧的标志,已用于败血症和创伤病例指导液体治疗。在中心静脉导管(CVC)透析患者中,ScvO2是可达的。在这里,我们打算通过测量ScvO2来描述透析期间UFV与去饱和的关系。方法:根据1例临床病例制定PICO,并在Pubmed、Embase、Scopus、Cochrane中进行文献检索。然后使用CEBM1的危害/病因工作表对选定的研究进行有效性、重要性和适用性的严格评估。结果:Harrison等人、Zhang等人和Rotondi等人的研究被选择来回答我们的PICO。Harrison等人报道了UFV和ScvO2之间的关系r: -0.680, p:0.015。而Zhang等人利用透析患者的Critline Monitor (CLM)读数的回顾性数据,报告了ScvO2在校正UFV (cUFV)上的负0.3%斜率。而Rotondi等人证明,在20例患者中,完全透析或超滤均可降低ScvO2,但只有前者具有统计学意义。讨论:这种关系的机制可能包括血浆再充血率不能补偿超滤过程中的液体移位,导致心脏预负荷和每搏容量降低,这对本来就容易发生反射性心动过缓和溶性低血压的患者是有害的。研究表明,透析患者的低氧血症发作会导致更差的预后。结论:ScvO2与UFV成反比。因此,监测透析患者的ScvO2将有助于预防终末器官缺血。
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引用次数: 0
Settings The Role of Methylglyoxal Accumulation on Cognitive Function Impairment of Chronic Hemodialysis Patients: an Observational Study 甲基乙二醛积累在慢性血液透析患者认知功能障碍中的作用:一项观察性研究
Pub Date : 2019-04-01 DOI: 10.32867/INAKIDNEY.V2I1.23
Harnavi Harun, Roslaini Roslaini, Syaiful Azmi, R. Martini
Background: Cognitive function decline is prevalent on routine hemodialysis patients. Many factors contribute to the increased risk of cognitive function impairment, one of them is the accumulation of uremic toxins. Methylglyoxal (MG) has been identified as one of the uremic toxins found in dialysis patients by the European Uremic Toxin Group. It has also been found much higher on CKD patients; over five times higher in non-dialysis CKD and 18-40 times higher in CKD patients on dialysis, and cause impaired cognitive function in rats with diabetes. Aim: To find the correlation between blood MG levels and cognitive function of patients who underwent routine hemodialysis. Methods: This study is an observational cross-sectional study done in Hemodialysis Unit of Dr. M Djamil General Hospital, Padang, West Sumatera, Indonesia. Fifty-seven subjects aged 40-60 years old were included in this study, where the blood MG levels were obtained. Cognitive function was measured using the Mini Mental State Examination (MMSE) questionnaire. Result: Among 57 subjects, 29 (50.8%) were male, and 33 (57.9%) were 50-60 years old. The subjects’ mean methylglyoxal levels were 10.8 (SD ± 3.2) µmol/L. The subjects’ mean MMSE score was 26 (SD ± 1.8), with 35% of the subjects had low ( < 0.001). Conclusion: High levels of methylglyoxal negatively correlates with cognitive function in chronic hemodialysis patients. Future research should include analysis regarding age, gender, hypertension, and other confounding factors.
背景:认知功能下降在常规血液透析患者中普遍存在。许多因素导致认知功能障碍的风险增加,其中之一是尿毒症毒素的积累。甲基乙二醛(MG)已被欧洲尿毒症毒素组确定为透析患者尿毒症毒素之一。慢性肾病患者的死亡率也更高;在非透析的CKD患者中高出5倍以上,在透析的CKD患者中高出18-40倍,并导致糖尿病大鼠的认知功能受损。目的:探讨常规血液透析患者血MG水平与认知功能的关系。方法:本研究是在印度尼西亚西苏门答腊巴东Dr. M Djamil总医院血液透析科进行的一项观察性横断面研究。本研究选取了57名年龄在40-60岁之间的受试者,测定了他们的血MG水平。认知功能采用迷你精神状态检查(MMSE)问卷进行测量。结果:57例患者中,男性29例(50.8%),年龄50 ~ 60岁33例(57.9%)。受试者的平均甲基乙二醛水平为10.8 (SD±3.2)µmol/L。受试者MMSE平均评分为26 (SD±1.8)分,35%的受试者MMSE评分较低(< 0.001)。结论:高水平甲基乙二醛与慢性血液透析患者的认知功能呈负相关。未来的研究应包括年龄、性别、高血压和其他混杂因素的分析。
{"title":"Settings The Role of Methylglyoxal Accumulation on Cognitive Function Impairment of Chronic Hemodialysis Patients: an Observational Study","authors":"Harnavi Harun, Roslaini Roslaini, Syaiful Azmi, R. Martini","doi":"10.32867/INAKIDNEY.V2I1.23","DOIUrl":"https://doi.org/10.32867/INAKIDNEY.V2I1.23","url":null,"abstract":"Background: Cognitive function decline is prevalent on routine hemodialysis patients. Many factors contribute to the increased risk of cognitive function impairment, one of them is the accumulation of uremic toxins. Methylglyoxal (MG) has been identified as one of the uremic toxins found in dialysis patients by the European Uremic Toxin Group. It has also been found much higher on CKD patients; over five times higher in non-dialysis CKD and 18-40 times higher in CKD patients on dialysis, and cause impaired cognitive function in rats with diabetes. \u0000Aim: To find the correlation between blood MG levels and cognitive function of patients who underwent routine hemodialysis. \u0000Methods: This study is an observational cross-sectional study done in Hemodialysis Unit of Dr. M Djamil General Hospital, Padang, West Sumatera, Indonesia. Fifty-seven subjects aged 40-60 years old were included in this study, where the blood MG levels were obtained. Cognitive function was measured using the Mini Mental State Examination (MMSE) questionnaire. \u0000Result: Among 57 subjects, 29 (50.8%) were male, and 33 (57.9%) were 50-60 years old. The subjects’ mean methylglyoxal levels were 10.8 (SD ± 3.2) µmol/L. The subjects’ mean MMSE score was 26 (SD ± 1.8), with 35% of the subjects had low ( < 0.001). \u0000Conclusion: High levels of methylglyoxal negatively correlates with cognitive function in chronic hemodialysis patients. Future research should include analysis regarding age, gender, hypertension, and other confounding factors.","PeriodicalId":423107,"journal":{"name":"Indonesian Journal of Kidney and Hypertension","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116047465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Indonesian Journal of Kidney and Hypertension
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