American Journal of Kidney Diseases最新文献

Rationale & objective: Observational studies suggest that uromodulin, produced by the kidneys, is associated with a reduced the risk of upper urinary tract infections, but inferences are limited by potential confounding factors. This study sought to explore further the validity of this association using Mendelian randomization.

Study design: Two-sample Mendelian randomization study.

Setting & participants: The study included 29,315 and 13,956 participants from 18 cohorts of mainly European ancestry with measured urinary and serum uromodulin, respectively, and 3,873 and 512,608 participants from the UK Biobank, the Trøndelag Health Study (HUNT), or the Michigan Genomic Initiative with and without upper urinary tract infections.

Exposures: We identified uncorrelated (r²< 0.01) single nucleotide polymorphisms strongly associated (p<5 x 10^-6) with urinary and serum uromodulin from the above-mentioned two genome-wide association studies. Both studies accounted for kidney function.

Outcomes: Genetic associations for the risk of upper urinary tract infections extracted from the above-mentioned independent genome-wide association study.

Analytical approach: Inverse-variance weighted and sensitivity analyses were performed. The strength of each genetic instrument was estimated using the F statistic RESULTS: A one standard deviation increase in genetically predicted urinary uromodulin was associated with an odds ratio (OR) for upper urinary tract infections of 0.80 (95% confidence interval 0.67 to 0.95; p = 0.01). For serum uromodulin, a one standard deviation increase was associated with an odds ratio of 0.95 (95% confidence interval 0.89 to 1.01, p = 0.12). The results were consistent across the sensitivity analyses.

Limitations: Analyses could only be performed on participants of predominantly European ancestry, potentially decreasing the generalizability of our findings.

Conclusions: This two-sample Mendelian randomization study found that increased levels of genetically predicted urinary uromodulin were associated with a reduced risk of upper urinary tract infections. A similar trend was observed for serum uromodulin. These findings support the hypothesis that uromodulin may have a protective role against upper urinary tract infections.

Rationale & objective: Patients on hemodialysis using a central venous catheter (CVC) are often advised not to shower due to infection risk. This study aimed to assess practices and attitudes of patients and healthcare providers about showering with CVCs.

Study design: Survey study.

Setting & participants: Online survey administered to members of the Canadian Society of Nephrology (CSN, n=972) and two international professional societies (convenience sample). Pen and paper survey administered to patients on maintenance hemodialysis with CVCs able to comprehend English from two hemodialysis programs in Ontario, Canada that advise patients not to shower (St Joseph's Healthcare Hamilton [SJHH], n=119, and University Health Network, Toronto [number of patients asked to complete surveys unavailable]).

Analytical approach: Descriptive statistics.

Results: 304 healthcare provider respondents (CSN response rate 26%). The most common recommendations were strongly against or against showering (45%). Catheter-related bacteremia (CRB) was ranked as the most important outcome (60%). Most respondents (53%) thought that a well conducted prospective cohort study demonstrating improvement in a patient reported outcome with no obvious increase in CRB would reduce the frequency of advice to avoid showering. There were 89 patient respondents (SJHH response rate 45%); 69% were currently showering, and 74% reported "strongly agree" or "agree" to the statement "I want to shower". Prevention of infection was most important to patients in terms of catheter care (78%). 35% of patients would be willing to participate in a shower study.

Limitations: Low response rate. Response rate unavailable from Toronto dialysis units. Exclusion of non-English-speaking patients.

Conclusions: There is variability in personal hygiene recommendations to patients with CVCs, highlighting the need for high quality evidence in this area. A rigorous prospective study examining patient-reported outcomes and CVC-related infections is needed prior to recommending to patients with a CVC that showering is safe.

Rationale & objective: Spousal caregivers participate extensively in the care of patients with kidney failure. Although previous studies suggested that these caregivers experience a high burden, a comprehensive understanding of the determinants of this burden and strategies to alleviate it are needed. Therefore, this study sought to explore the contributing and alleviating determinants of burden in spousal caregivers of patients with kidney failure.

Study design: A qualitative interview study with 15 spousal caregivers.

Setting & participants: Dutch-speaking, adult spousal caregivers were recruited and interviewed by the Dutch Kidney Patients Association for the Kidney Decision Aid.

Analytical approach: A directed qualitative content analysis using the stress-appraisal model of caregiver burden as a framework to inform a disease-specific model on spousal caregiver burden for kidney failure that characterizes the impact of care provision on all aspects of spousal caregivers' lives, the burden associated with it, and possible mitigating factors.

Results: Providing care for patients with kidney failure is complex and burdensome for spousal caregivers and results in many lifestyle changes, which is largely caused by kidney failure-specific tasks and the shifting responsibility for daily life tasks. Spouses identified disease-specific determinants of burden including the impact of kidney disease on afflicted spouses as well as the associated caregiver tasks, e.g., adjusting to dietary restriction and attending dialysis appointments. Dialysis options (e.g., the choice for home or in-center dialysis) were kidney failure-specific moderators of burden. Support of spousal caregivers by healthcare providers plays a key role in preventing overburdening.

Limitations: Potential limited transferability owing to the study of only Dutch-speaking spouses willing to be interviewed and videotaped.

Conclusions: This comprehensive overview of the contributing and alleviating determinants of burden experienced by spousal caregivers of patients with kidney failure highlights four principal areas; 1) personal and relational, 2) social environment, 3) healthcare, and 4) work and legislation, in which such burdens occur and may be alleviated.