Kidney and dialysis最新文献_第7页

Physical Activity Behaviour in Solid Organ Transplant Recipients: Proposal of Theory-Driven Physical Activity Interventions 实体器官移植受者的身体活动行为:理论驱动的身体活动干预建议

Kidney and dialysis

Pub Date : 2022-06-07 DOI: 10.3390/kidneydial2020029

S. Leunis, M. Vandecruys, V. Cornelissen, A. V. Van Craenenbroeck, S. D. De Geest, D. Monbaliu, S. De Smet

Physical inactivity is highly prevalent after solid organ transplantation and leads to unfavourable outcomes. This review aimed to understand posttransplant physical activity behaviour and propose physical activity interventions. Michie’s Behavioural Change Wheel was applied, in which the Context and Implementation of Complex Interventions framework, the Capability-Opportunity-Motivation and Behaviour model, and the Theoretical Domains Framework were embedded. Various contextual factors were found to modulate physical activity behaviour. Promising strategies to promote long-term physical activity included (i) tailoring of physical activity programs to patients’ abilities and preferences; (ii) incitement of intrinsic and autonomous motivation to change; (iii) SMART goals setting (e.g., Specific, Measurable, Achievable, Realistic, Timebound), (iv) autonomy-supportive co-design of action plans; (v) foster new habit formation; (vi) self-monitoring of physical activity; (vii) follow-up opportunities for evaluation and adjustment; (viii) education of transplant recipients, healthcare providers, and the patients’ social network; (iv) improvement of self-efficacy through incremental successes, verbal persuasion, peer modelling, and awareness of exercise-related bodily signals; (x) providing physical activity opportunity within patients’ social and environmental setting; (xi) encouragement and support from patients’ social network and healthcare providers; and (xii) governmental action that alleviates financial barriers and restructures the physical environment to promote physical activity. These new insights may contribute to physical activity program development for transplantation recipients.

缺乏身体活动在实体器官移植后非常普遍，并导致不利的结果。本综述旨在了解移植后的身体活动行为并提出身体活动干预措施。运用Michie行为改变轮，嵌入复杂干预的情境与实施框架、能力-机会-动机与行为模型和理论领域框架。研究发现，各种背景因素可以调节身体活动行为。促进长期体育活动的有希望的策略包括(i)根据患者的能力和偏好量身定制体育活动计划;(ii)激发内在和自主的改变动机;(iii) SMART目标设定(例如，具体的、可衡量的、可实现的、现实的、有时限的);(iv)自主支持的行动计划协同设计;(五)培养新习惯;(vi)身体活动的自我监测;评价和调整的后续机会;(八)对移植受者、医疗保健提供者和患者的社会网络进行教育;(iv)透过渐进式的成功、言语说服、同伴示范及觉察与运动有关的身体信号，提高自我效能感;(x)在患者的社会和环境环境中提供身体活动的机会;(十一)患者社交网络和保健提供者的鼓励和支持;(xii)缓解财政障碍和重构自然环境以促进体育活动的政府行动。这些新的见解可能有助于移植受者的身体活动计划的发展。

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引用次数: 4

Seeking out SDGs in Dialysis Medicine—Selected Articles from the JSDT Conference, Yokohama 2022 在透析医学中寻找可持续发展目标——JSDT会议文章选集，横滨2022

Kidney and dialysis

Pub Date : 2022-06-02 DOI: 10.3390/kidneydial2020028

Ken Tsuchiya

The 67th Annual Meeting of the Japanese Society for Dialysis Therapy (JSDT) was held in Yokohama City from 1 to3 July, 2022 [...]

第67届日本透析治疗学会(JSDT)年会于2022年7月1日至3日在横滨市举行[…]

引用次数: 0

Next Steps for Intradialytic Cycling Research 分析内循环研究的下一步

Kidney and dialysis

Pub Date : 2022-06-02 DOI: 10.3390/kidneydial2020027

A. King, K. Wilund

Hemodialysis patients typically have extremely low physical activity levels, which contributes to poor physical function and quality of life (QOL). Numerous studies show that exercise, intradialytic cycling in particular, may improve physical and cardiovascular function and QOL. But there are also significant inconsistencies in the literature, and the benefits in many studies are modest. This may be due in part to methodological limitations in intradialytic cycling trials, including small sample sizes, short interventions, low volume, and intensity of exercise prescriptions, and/or low retention and protocol adherence rates. The goal of this review is twofold. First, we summarize the current literature on intradialytic cycling in HD patients, highlighting benefits and concerns noted in several recently published trials that were among the most robust and clinically relevant trials conducted to date. Second, we will consider strategies for moving forward with exercise and physical activity interventions in HD, including promoting intradialytic cycling as a core component of a more patient-centric and comprehensive strategy that helps progress patients towards standard physical activity guidelines. We urge researchers and exercise professionals to consider intradialytic cycling as a valuable component of a comprehensive patient-centered, lifestyle intervention, as opposed to a stand-alone exercise prescription.

血液透析患者通常身体活动水平极低，这导致身体功能和生活质量（QOL）较差。大量研究表明，运动，尤其是透析内循环，可以改善身体和心血管功能以及生活质量。但文献中也存在显著的不一致性，许多研究的益处都不大。这可能部分是由于透析内循环试验的方法限制，包括样本量小、干预时间短、运动处方量和强度低，和/或保留率和方案遵守率低。这次审查的目的有两个。首先，我们总结了目前关于HD患者透析内循环的文献，强调了最近发表的几项试验中注意到的益处和担忧，这些试验是迄今为止进行的最有力和临床相关的试验之一。其次，我们将考虑推进HD运动和体育活动干预的策略，包括促进透析内循环，将其作为更以患者为中心和全面的策略的核心组成部分，帮助患者实现标准体育活动指南。我们敦促研究人员和运动专业人士将透析内循环视为以患者为中心的全面生活方式干预的一个有价值的组成部分，而不是单独的运动处方。

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引用次数: 1

The Pathophysiological Basis of Diabetic Kidney Protection by Inhibition of SGLT2 and SGLT1. 抑制SGLT2和SGLT1对糖尿病肾保护的病理生理基础。

Kidney and dialysis

Pub Date : 2022-06-01 Epub Date: 2022-06-18 DOI: 10.3390/kidneydial2020032

Yuji Oe, Volker Vallon

SGLT2 inhibitors can protect the kidneys of patients with and without type 2 diabetes mellitus and slow the progression towards end-stage kidney disease. Blocking tubular SGLT2 and spilling glucose into the urine, which triggers a metabolic counter-regulation similar to fasting, provides unique benefits, not only as an anti-hyperglycemic strategy. These include a low hypoglycemia risk and a shift from carbohydrate to lipid utilization and mild ketogenesis, thereby reducing body weight and providing an additional energy source. SGLT2 inhibitors counteract hyperreabsorption in the early proximal tubule, which acutely lowers glomerular pressure and filtration and thereby reduces the physical stress on the filtration barrier, the filtration of tubule-toxic compounds, and the oxygen demand for tubular reabsorption. This improves cortical oxygenation, which, together with lesser tubular gluco-toxicity and improved mitochondrial function and autophagy, can reduce pro-inflammatory, pro-senescence, and pro-fibrotic signaling and preserve tubular function and GFR in the long-term. By shifting transport downstream, SGLT2 inhibitors more equally distribute the transport burden along the nephron and may mimic systemic hypoxia to stimulate erythropoiesis, which improves oxygen delivery to the kidney and other organs. SGLT1 inhibition improves glucose homeostasis by delaying intestinal glucose absorption and by increasing the release of gastrointestinal incretins. Combined SGLT1 and SGLT2 inhibition has additive effects on renal glucose excretion and blood glucose control. SGLT1 in the macula densa senses luminal glucose, which affects glomerular hemodynamics and has implications for blood pressure control. More studies are needed to better define the therapeutic potential of SGLT1 inhibition to protect the kidney, alone or in combination with SGLT2 inhibition.

SGLT2抑制剂可以保护2型糖尿病患者和非2型糖尿病患者的肾脏，减缓终末期肾病的进展。阻断管状SGLT2并将葡萄糖溢出到尿液中，这触发了类似于禁食的代谢反调节，提供了独特的益处，不仅是一种抗高血糖策略。这些包括低血糖风险，从碳水化合物到脂质利用的转变和轻度的生酮，从而减轻体重并提供额外的能量来源。SGLT2抑制剂对抗早期近端小管的高重吸收，从而急剧降低肾小球压力和滤过，从而减少滤过屏障的物理应激、小管毒性化合物的过滤和小管重吸收的需氧量。这改善了皮质氧合，减少了小管糖毒性，改善了线粒体功能和自噬，可以减少促炎、促衰老和促纤维化信号，长期保持小管功能和GFR。通过向下游转移运输，SGLT2抑制剂更均匀地沿肾元分配运输负担，并可能模拟全身性缺氧刺激红细胞生成，从而改善肾和其他器官的氧气输送。抑制SGLT1通过延缓肠道葡萄糖吸收和增加胃肠道肠促胰岛素的释放来改善葡萄糖稳态。联合抑制SGLT1和SGLT2对肾糖排泄和血糖控制具有加性作用。黄斑致密区SGLT1感知腔内葡萄糖，影响肾小球血流动力学并影响血压控制。需要更多的研究来更好地确定SGLT1抑制单独或联合SGLT2抑制保护肾脏的治疗潜力。

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引用次数: 1

The Role of Exercise Training in Delaying Kidney Function Decline in Non-Dialysis-Dependent Chronic Kidney Disease 运动训练在延缓非透析依赖性慢性肾脏病肾功能下降中的作用

Kidney and dialysis

Pub Date : 2022-05-25 DOI: 10.3390/kidneydial2020026

M. Davies, A. Sandoo, J. Macdonald

Chronic Kidney Disease (CKD) is a progressive condition characterised by declining eGFR and associated, particularly in advanced stages, with increased morbidity and cardiovascular mortality. Current treatment options for delaying disease progression are limited to a small number of pharmacological agents. Considering that rates of kidney function decline are greater in patients with lower levels of habitual physical activity, there is interest in the potential benefits of structured exercise training in delaying CKD progression. This discursive review summarises the current state-of-play in this field of research by critically analysing the published systematic reviews of randomised controlled trials of structured exercise training in the non-dialysis CKD population. Several issues are highlighted that hamper definite conclusions as to the therapeutic effectiveness of exercise training for this purpose. However, following an overview of the pathophysiology and risk factors for kidney function decline, several potential mechanisms explaining how exercise training may benefit CKD progression are offered. Finally, suggestions for future research in this area are made. The review concludes that there is a need for further research on the effectiveness of exercise before it can be recommended as part of routine care for the purpose of delaying CKD progression. Exercise can be recommended, however, to individual patients because of a potential benefit to kidney function, and definite benefits to other outcomes such as quality of life, with no apparent evidence of harm.

慢性肾脏病（CKD）是一种进展性疾病，其特征是eGFR下降，并与发病率和心血管死亡率增加有关，尤其是在晚期。目前用于延缓疾病进展的治疗选择仅限于少量药物。考虑到习惯性体力活动水平较低的患者肾功能下降率更高，人们对结构化运动训练在延缓CKD进展方面的潜在益处感兴趣。本综述通过批判性分析已发表的非透析CKD人群结构化运动训练随机对照试验的系统综述，总结了该研究领域的现状。强调了几个问题，这些问题阻碍了关于为此目的进行运动训练的治疗效果的明确结论。然而，在概述了肾功能下降的病理生理学和危险因素后，提供了几种解释运动训练如何有益于CKD进展的潜在机制。最后，对今后该领域的研究提出了建议。该综述得出结论，在建议将运动作为常规护理的一部分以延缓CKD进展之前，有必要对运动的有效性进行进一步研究。然而，可以向个别患者推荐运动，因为运动对肾功能有潜在益处，对生活质量等其他结果也有明确益处，但没有明显的危害证据。

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引用次数: 2

Targeted Non-Pharmacological Interventions for People Living with Frailty and Chronic Kidney Disease 针对虚弱和慢性肾脏疾病患者的非药物干预

Kidney and dialysis

Pub Date : 2022-05-20 DOI: 10.3390/kidneydial2020025

J. Mayes, H. Young, R. Blacklock, C. Lightfoot, J. Chilcot, A. Nixon

Frailty is highly prevalent within people living with chronic kidney disease (CKD) and is associated with the increased risk of falls, hospitalisation, and mortality. Alongside this, individuals with CKD report a high incidence of depression and reduced quality of life. The identification of frailty within nephrology clinics is needed to establish comprehensive management plans to improve clinical outcomes and quality of life for people with CKD. Current research exploring the role of non-pharmacological management has primarily focussed on exercise and physical activity interventions in the frail CKD population. However, there is a growing evidence base and interest in this area. This review provides an up-to-date overview of the literature into frailty assessment in CKD and subsequent non-pharmacological treatment approaches.

虚弱在慢性肾脏疾病(CKD)患者中非常普遍，并与跌倒、住院和死亡风险增加有关。除此之外，CKD患者报告抑郁症的发病率很高，生活质量下降。需要在肾内科诊所中识别虚弱，以建立全面的管理计划，以改善CKD患者的临床结果和生活质量。目前探索非药物管理作用的研究主要集中在虚弱CKD人群的运动和体育活动干预上。然而，在这一领域有越来越多的证据基础和兴趣。这篇综述提供了最新的文献综述衰弱评估在CKD和随后的非药物治疗方法。

引用次数: 4

Assessment of Function Limitations in People with Chronic Kidney Disease for Implementation in Clinical Practice 慢性肾脏疾病患者功能限制的临床评估

Kidney and dialysis

Pub Date : 2022-05-04 DOI: 10.3390/kidneydial2020024

P. Koufaki

Chronic Kidney Disease (CKD) is a global health problem and a significant contributor to mortality, morbidity and disability from non-communicable diseases (NCD). The current consensus amongst researchers in the field of renal rehabilitation and healthcare practitioners involved in the management of people with CKD, is that physical dysfunction and inactivity are severe and prevalent in all ages and CKD stages compared to normative data. The negative impact of CKD on independence is cumulative, and health interventions and policies should target prevention of deterioration of kidney function and its consequences for physical frailty, disability and ultimately, quality of life. Accurate and feasible assessment of physical function is key for supporting the clinical implementation of current clinical care management guidelines. This overview, therefore, presents the rationale and some key scientific evidence to support the recommendation of physical function measurement tools that reflect function limitations for immediate implementation in clinical practice. Measurement property characteristics of the proposed measurement tools are also summarised in order to support health and exercise professionals in selecting the right tool and in interpreting and evaluating the measured outcomes.

慢性肾脏疾病(CKD)是一个全球性的健康问题，也是非传染性疾病(NCD)导致死亡、发病率和残疾的重要原因。目前肾脏康复领域的研究人员和参与CKD患者管理的医疗从业人员的共识是，与规范数据相比，身体功能障碍和缺乏活动在所有年龄和CKD阶段都是严重和普遍的。CKD对独立性的负面影响是累积的，健康干预和政策应以预防肾功能恶化及其对身体虚弱、残疾和最终生活质量的影响为目标。准确和可行的身体功能评估是支持当前临床护理管理指南的临床实施的关键。因此，本综述提出了基本原理和一些关键的科学证据，以支持在临床实践中立即实施反映功能限制的物理功能测量工具的建议。还总结了拟议测量工具的测量属性特征，以支持健康和运动专业人员选择正确的工具并解释和评估测量结果。

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引用次数: 3

Constipation in Chronic Kidney Disease: It Is Time to Bridge the Gap 慢性肾脏疾病便秘:是时候弥合差距了

Kidney and dialysis

Pub Date : 2022-05-03 DOI: 10.3390/kidneydial2020023

C. I. Ramos, F. Nerbass, L. Cuppari

In this narrative review, we briefly describe the general features of constipation, our understanding of its physiopathology, and its diagnosis and treatment, focusing on chronic kidney disease (CKD). Considering that constipation is poorly characterized in CKD, we referred to studies that used the Rome criteria to diagnose constipation in patients to describe a more realistic prevalence based on a standardized tool. A highly variable prevalence of the condition was reported, ranging from 4.5% to 71.7%. The main risk factors associated with constipation reported in these studies were advanced age, low fruit intake, presence of diabetes, and medication use, and the main consequence of constipation in CKD was a worse quality of life. We found a paucity of interventional studies for constipation treatment in CKD; however, in the general population, meta-analyses published in the last decade have reported the beneficial effects of non-pharmacological strategies, which may guide the management of constipated patients with CKD. These strategies include the consumption of fiber, prebiotics, and probiotics, as well as physical exercise and acupuncture. In conclusion, although constipation is a frequent complaint among patients with CKD, there remains a considerable knowledge gap regarding its epidemiology, prognosis, and treatment.

在这篇叙述性的综述中，我们简要地描述了便秘的一般特征，我们对其生理病理的理解，以及它的诊断和治疗，重点是慢性肾脏疾病(CKD)。考虑到CKD中便秘的特征较差，我们参考了使用Rome标准诊断患者便秘的研究，以基于标准化工具描述更现实的患病率。据报道，该疾病的患病率变化很大，从4.5%到71.7%不等。在这些研究中报告的与便秘相关的主要危险因素是高龄、水果摄入量低、存在糖尿病和药物使用，CKD中便秘的主要后果是生活质量下降。我们发现缺乏CKD患者便秘治疗的介入研究;然而，在一般人群中，过去十年发表的荟萃分析报告了非药物策略的有益效果，这可能指导便秘CKD患者的管理。这些策略包括摄入纤维、益生元和益生菌，以及体育锻炼和针灸。总之，尽管便秘是CKD患者的常见主诉，但关于其流行病学、预后和治疗仍有相当大的知识差距。

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引用次数: 2

Lifestyle Interventions in Improving Health Outcomes and Enabling People to Live Well with Kidney Disease 生活方式干预改善健康结果并使肾病患者过上良好生活

Kidney and dialysis

Pub Date : 2022-05-03 DOI: 10.3390/kidneydial2020021

T. Harris

Lifestyle interventions can play an important role in improving patients’ health outcomes and helping them to live well with chronic kidney disease (CKD). The key to living well is ‘life participation’, defined as ‘the ability to do meaningful activities of life including, but not limited to, work, study, family responsibilities, travel, sport, social, and recreational activities’. Pharmaceutical, clinical, and surgical interventions such as dialysis and transplantation can deliver beneficial health outcomes for patients. Yet CKD patients say that the focus of renal appointments is ‘bloods, urine, blood pressure and kidney function’ and their treatment. Little time is provided to discuss non-clinical symptoms or concerns and recommend other treatments, such as lifestyle interventions. There are no highly ranked evidence-based guidelines for lifestyle interventions in CKD due to a historic lack of evidence. Diet advice, for example, is widely requested by patients on the internet and online forums but access to reliable information is highly variable. The lack of patient reported outcome measures (PROMs) is a barrier to monitoring and gathering evidence, but regulatory changes and the efforts of international organisations should soon deliver validated tools for research and guidelines which can be implemented in holistic care pathways. A global call to action to focus on lifestyle interventions is proposed.

生活方式干预可以在改善慢性肾脏疾病(CKD)患者的健康结果和帮助他们更好地生活方面发挥重要作用。幸福生活的关键是“生活参与”，定义为“做有意义的生活活动的能力，包括但不限于工作、学习、家庭责任、旅行、体育、社交和娱乐活动”。药物、临床和手术干预，如透析和移植，可以为患者带来有益的健康结果。然而慢性肾病患者说，肾脏预约的重点是“血液、尿液、血压和肾功能”及其治疗。很少有时间讨论非临床症状或担忧，并推荐其他治疗方法，如生活方式干预。由于历史上缺乏证据，对于CKD的生活方式干预没有高排名的循证指南。例如，患者在互联网和在线论坛上广泛要求提供饮食建议，但获得可靠信息的途径却千差万别。缺乏患者报告的结果测量(PROMs)是监测和收集证据的障碍，但是监管改革和国际组织的努力应该很快提供有效的研究工具和指导方针，这些工具和指导方针可以在整体护理途径中实施。提出了一项全球行动呼吁，重点关注生活方式干预。

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引用次数: 2

Mortality in High-Flux Hemodialysis vs. High-Volume Hemodiafiltration in Colombian Clinical Practice: A Propensity Score Matching Study 哥伦比亚临床实践中高通量血液透析与大容量血液滤过的死亡率:倾向评分匹配研究

Kidney and dialysis

Pub Date : 2022-05-03 DOI: 10.3390/kidneydial2020022

Luis A. Valderrama, L. Barrera, E. Cantor, J. Muñoz, Javier Arango, Carlos Tobon, B. Canaud

Background: The aim was to compare the effects of high-flux hemodialysis (HF-HD) versus high-volume post-dilution hemodiafiltration (HV-HDF) on mortality risk. Methods: Retrospective observational study of prevalent patients on hemodialysis who were followed for two years and treated in 28 kidney centers in Colombia. In this study, we included all adult patients who had been on dialysis for at least 90 days treated with an arteriovenous fistula. They were classified as HF-HD if they underwent this treatment exclusively (100% of time). For HV-HDF, if they received this treatment in more than 90% of the observation period. The primary outcome variable was mortality, and the type of hemodialysis therapy was considered as the exposure variable. Propensity score matching (PSM) and Cox regression models were used to evaluate the effect of dialysis modality on the mortality risk. Results: A total of 2933 patients were analyzed, 2361 patients with HF-HD and 572 with HV-HDF. After PSM, 1010 prevalent patients remained; mortality rate was 14.2% (95% Confidence Interval—CI: 11.3–17.6%) and 5.9% (95%CI: 4.0–8.4%) in HF-HD and HV-HDF group, respectively. HV-HDF therapy was associated with a 55% reduction in mortality compared with the HF-HD group (Hazards ratio-HR: 0.45 [95%CI 0.32–0.64] p < 0.001). Cardiovascular mortality rate was not statistically different between groups (HF-HD: 7.1% (36), HV-HDF: 3.4% (17), HR: 0.51 (95%CI: 0.21–1.28), p: 0.152). However, in patients younger than 60 years, a beneficial effect was observed in favor to HV-HDF therapy with a 79% reduction in cardiovascular mortality risk (HR: 0.21, (95%CI: 0.05–0.79), p: 0.021). Conclusion: After adjustment for different confounders, this study suggests that HV-HDF could reduce all-cause mortality compared to HF-HD therapy in prevalent patients on hemodialysis.

背景:目的是比较高通量血液透析(HF-HD)与高容量稀释后血液滤过(HV-HDF)对死亡风险的影响。方法:对哥伦比亚28个肾脏中心的血液透析流行患者进行为期2年的回顾性观察研究。在这项研究中，我们纳入了所有接受透析至少90天并接受动静脉瘘治疗的成年患者。如果他们只接受这种治疗(100%的时间)，他们被归类为HF-HD。对于HV-HDF，如果他们在90%以上的观察期接受这种治疗。主要结局变量是死亡率，血液透析治疗类型被认为是暴露变量。采用倾向评分匹配(PSM)和Cox回归模型评估透析方式对死亡风险的影响。结果:共分析2933例患者，其中HF-HD患者2361例，HV-HDF患者572例。经PSM后，仍有1010例流行患者;HF-HD组和HV-HDF组的死亡率分别为14.2%(95%可信区间:11.3-17.6%)和5.9%(95%可信区间:4.0-8.4%)。与HF-HD组相比，HV-HDF治疗与死亡率降低55%相关(风险比:0.45 [95%CI 0.32-0.64] p < 0.001)。两组间心血管死亡率无统计学差异(HF-HD: 7.1% (36)， HV-HDF: 3.4% (17)， HR: 0.51 (95%CI: 0.21-1.28)， p: 0.152)。然而，在60岁以下的患者中，观察到有利于HV-HDF治疗的有益效果，心血管死亡风险降低79% (HR: 0.21， (95%CI: 0.05-0.79)， p: 0.021)。结论:在对不同混杂因素进行调整后，本研究表明，在血透流行患者中，与HF-HD治疗相比，HV-HDF可以降低全因死亡率。

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引用次数: 1