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Better health-related quality of life is associated with prolonged survival and reduced hospitalization risk among dialysis-dependent chronic kidney disease patients: a historical cohort study. 透析依赖型慢性肾病患者提高健康相关生活质量与延长生存期和降低住院风险有关:一项历史队列研究。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-31 DOI: 10.1186/s12882-024-03835-0
Abraham Rincon Bello, Jasmine Ion Titapiccolo, Isabel Berdud Godoy, Diana J C Samaniego, Sofia Ortego Perez, Alicia Sobrino Perez, Kateryna Shkolenko, Stefano Stuard, Luca Neri, Maria Eva Baró Salvador

Rationale & objective: End-stage kidney disease (ESKD) negatively affects patients' physical, emotional, and social functioning. Furthermore, adjustment to dialysis require substantial lifestyle changes that may further impact on patients physical and emotional well-being. However, the relationship between Health-Related Quality of life impairment with future adverse outcomes in dialysis is not well characterized. Our study aims to investigate the relationship between Health-Related Quality of Life (HRQoL) and patients' survival and hospitalization rates within a large European dialysis network.

Methods: A historical cohort study was conducted to evaluate association of HRQoL with hospitalization and mortality rates over a 12-month follow-up period. Patients responded to a self-administered survey as part of a Continuous Quality Improvement Program implemented in clinics affiliated with the Spanish FMC-Nephrocare organization. Health-Related Quality of Life (HRQoL) was measured with the KDQOL-36. Potential confounders included socio-demographic characteristics, comorbidities, biochemical parameters, dialysis treatment. We used Cox's Proportional Hazard regression to assess the hazard of death and Logistic Regression to assess the likelihood of hospital admissions during 12-month follow-up period.

Results: A total of 2280 (51.5%) completed the self-administrated survey, and 1838 patients met the inclusion/exclusion criteria of the study. Higher HRQoL scores were associated with significantly lower mortality and hospitalization risk. Risk estimates were robust to adjustment for potential confounders.

Conclusions: Several dimensions of HRQoL are associated with patient-centered outcomes (i.e., mortality and hospitalizations at 1 year). Patient-Reported Outcomes contribute unique pieces of information characterizing patients' health. Residual confounding cannot be fully ruled out; moreover, the high attrition rate could result in selection bias, which may limit the generalizability of the findings to a broader population.

理由与目标:终末期肾病(ESKD)会对患者的身体、情绪和社会功能产生负面影响。此外,适应透析需要大量改变生活方式,这可能会进一步影响患者的身体和情绪健康。然而,透析过程中与健康相关的生活质量损害与未来不良后果之间的关系尚未得到很好的描述。我们的研究旨在调查欧洲一个大型透析网络中与健康相关的生活质量(HRQoL)与患者生存率和住院率之间的关系:方法:我们进行了一项历史队列研究,以评估 12 个月随访期内 HRQoL 与住院率和死亡率之间的关系。作为西班牙 FMC-Nephrocare 组织下属诊所实施的持续质量改进计划的一部分,患者对一项自填式调查做出了答复。与健康相关的生活质量(HRQoL)通过KDQOL-36进行测量。潜在的混杂因素包括社会人口特征、合并症、生化指标和透析治疗。我们采用 Cox 比例危险度回归评估死亡危险度,采用 Logistic 回归评估 12 个月随访期间入院的可能性:共有 2280 名患者(51.5%)完成了自我管理调查,1838 名患者符合研究的纳入/排除标准。HRQoL 评分越高,死亡率和住院风险越低。对潜在的混杂因素进行调整后,风险估计值是稳健的:结论:几个方面的 HRQoL 与以患者为中心的结果(即 1 年的死亡率和住院率)相关。患者报告的结果提供了描述患者健康状况的独特信息。不能完全排除残余混杂因素;此外,高自然减员率可能会导致选择偏差,这可能会限制研究结果在更广泛人群中的推广。
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引用次数: 0
Carotid plaque thickness predicts cardiovascular events and death in patients with chronic kidney disease. 颈动脉斑块厚度可预测慢性肾病患者的心血管事件和死亡。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-31 DOI: 10.1186/s12882-024-03831-4
Sasha S Bjergfelt, Ida M H Sørensen, Laerke Urbak, Klaus F Kofoed, Theis Lange, Bo Feldt-Rasmussen, Henrik Sillesen, Christina Christoffersen, Susanne Bro

Background: Classical risk scoring systems underestimate the risk of cardiovascular disease in chronic kidney disease (CKD). Coronary artery calcium score (CACS) has improved prediction of cardiovascular events in patients with CKD. The maximal carotid plaque thickness (cPTmax) measured in ultrasound scans of the carotid arteries has demonstrated similar predictive value as CACS in the general population. This is the first study to investigate whether cPTmax can predict cardiovascular events in CKD and to compare the predictive value of cPTmax and CACS in CKD.

Method: Two hundred patients with CKD stage 3 from the Copenhagen CKD Cohort underwent ultrasound scanning of the carotid arteries. The assessment consisted of locating plaque and measuring the thickest part of the plaque, cPTmax. Based on the distribution of cPTmax, the participants were divided into 3 groups: No plaques, cPTmax 1.0-1.9 mm and cPTmax > 1.9 mm (median cPTmax = 1.9 mm among patients with plaques). To measure CACS, 175 of the patients underwent a non-contrast CT scan of the coronary arteries. The follow-up time spanned between the ultrasound scan and a predefined end-date or the time of first event, defined as a composite of major cardiovascular events or death of any cause (MACE).

Results: The median follow-up time was 5.4 years during which 45 patients (22.5%) developed MACE. In a Cox-regression adjusted for classical cardiovascular risk factors, patients with cPTmax > 1.9 mm had a significantly increased hazard ratio of MACE (HR 3.2, CI: 1.1-9.3), p = 0.031) compared to patients without plaques. C-statistics was used to evaluate models for predicting MACE. The improvement in C-statistics was similar for the two models including classical cardiovascular risk factors plus cPTmax (0.247, CI: 0.181-0.312) and CACS (0.243, CI: 0.172-0.315), respectively, when compared to a model only controlled for time since baseline (a Cox model with no covariates).

Conclusion: Our results indicate that cPTmax may be useful for predicting MACE in CKD. cPTmax and CACS showed similar ability to predict MACE.

背景:传统的风险评分系统低估了慢性肾脏病(CKD)患者罹患心血管疾病的风险。冠状动脉钙化评分(CACS)提高了对慢性肾脏病患者心血管事件的预测能力。在普通人群中,通过颈动脉超声扫描测量的最大颈动脉斑块厚度(cPTmax)具有与 CACS 相似的预测价值。这是首次研究 cPTmax 能否预测慢性肾脏病患者的心血管事件,并比较 cPTmax 和 CACS 在慢性肾脏病患者中的预测价值:方法:哥本哈根 CKD 队列中的 200 名 CKD 3 期患者接受了颈动脉超声波扫描。评估包括定位斑块并测量斑块最厚的部分,即 cPTmax。根据 cPTmax 的分布,参与者被分为三组:无斑块组、cPTmax 1.0-1.9 mm 组和 cPTmax > 1.9 mm 组(有斑块患者的 cPTmax 中位数 = 1.9 mm)。为了测量 CACS,175 名患者接受了冠状动脉非对比 CT 扫描。随访时间从超声扫描到预定的结束日期或首次事件发生时间之间,首次事件发生时间定义为主要心血管事件或任何原因死亡(MACE)的复合时间:中位随访时间为5.4年,期间有45名患者(22.5%)发生了MACE。在对传统心血管风险因素进行调整后的 Cox 回归中,与无斑块患者相比,cPTmax > 1.9 mm 的患者发生 MACE 的危险比显著增加(HR 3.2,CI:1.1-9.3,p = 0.031)。C统计量用于评估预测MACE的模型。与仅控制自基线以来时间的模型(无协变量的Cox模型)相比,包括经典心血管风险因素加cPTmax(0.247,CI:0.181-0.312)和CACS(0.243,CI:0.172-0.315)的两个模型的C统计量的改善情况相似:我们的研究结果表明,cPTmax 可用于预测慢性肾脏病患者的 MACE。
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引用次数: 0
The prognostic role of activation of the complement pathways in the progression of advanced IgA nephropathy to end-stage renal disease. 补体途径激活在晚期 IgA 肾病发展为终末期肾病过程中的预后作用。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-30 DOI: 10.1186/s12882-024-03832-3
Ying Wang, Shimin Jiang, Dingxin Di, Guming Zou, Hongmei Gao, Shunlai Shang, Wenge Li

Introduction: The role of complement system in late stage of IgA nephropathy (IgAN) remains unknown. We therefore investigated the effects of complement system on worsening kidney function in advanced (stage 4 CKD) IgAN.

Methods: Renal specimens of 69 IgAN patients who underwent renal biopsy during stage 4 CKD between 2010 and 2021, were stained using immunofluorescence (IF) and immunohistochemistry (IHC) for glomerular complement components. The primary outcome was progression to end-stage renal disease (ESRD). Associations of complement components with baseline clinicopathological characteristics and outcomes were assessed using multivariable Cox regression and Spearman analyses.

Results: During a median follow-up of 18.0 months, 26 (37.7%) patients progressed to ESRD and none died. C1q and C3 deposition were detected in 12 and 66 patients, respectively. Higher eGFR [hazards ratio (HR), 0.852, 95% confidence interval (CI), 0.756-0.959; P = 0.008], higher C3 intensity (HR, 2.955, 95%CI, 1.063-8.220; P = 0.038) and T1-2 score (HR, 2.576, 95%CI, 1.205-5.576, P = 0.015) were predictive of time to ESRD in CKD 4 stage IgAN. Significant expressions of C1q (P = 0.005), C4d (P < 0.001), factor B (P < 0.001), C3 (P = 0.042) and C5b-9 (P = 0.004) were identified in ESRD group than in non-ESRD group by IHC, while MBL expression was low. Although they were not associated with baseline 24 h-UP, higher factor B and C1q expressions were both correlated with a lower baseline eGFR (P < 0.001 and = 0.04, respectively) and the deterioration of kidney function during follow-up (P = 0.046 and 0.015, respectively).

Conclusion: Complement deposition in IgAN patients with stage 4 CKD portends a faster deterioration of kidney function. Activation of classical and alternative complement pathways plays a major role in this stage.

导言:补体系统在晚期IgA肾病(IgAN)中的作用尚不清楚。因此,我们研究了补体系统对晚期(CKD 第 4 阶段)IgAN 肾功能恶化的影响:方法:采用免疫荧光(IF)和免疫组织化学(IHC)方法对 2010 年至 2021 年期间接受肾活检的 69 例 CKD 4 期 IgAN 患者的肾脏标本进行肾小球补体成分染色。主要结果是终末期肾病(ESRD)的进展。采用多变量 Cox 回归和 Spearman 分析评估了补体成分与基线临床病理特征和预后的关系:在中位随访 18.0 个月期间,26 例(37.7%)患者进展为 ESRD,无一例死亡。分别有 12 名和 66 名患者检测到 C1q 和 C3 沉积。较高的 eGFR [危险比 (HR),0.852,95% 置信区间 (CI),0.756-0.959;P = 0.008]、较高的 C3 强度(HR,2.955,95%CI,1.063-8.220;P = 0.038)和 T1-2 评分(HR,2.576,95%CI,1.205-5.576,P = 0.015)可预测 CKD 4 期 IgAN 患者发生 ESRD 的时间。C1q(P = 0.005)、C4d(PCKD 4 期 IgAN 患者体内的补体沉积预示着肾功能会加速恶化。经典补体和替代补体途径的激活在这一阶段起着重要作用。
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引用次数: 0
Prevalence and severity of sarcopenia in patients on maintenance hemodialysis: a cross-sectional study. 维持性血液透析患者肌肉疏松症的患病率和严重程度:一项横断面研究。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-29 DOI: 10.1186/s12882-024-03836-z
Yujie Yang, Ying Zeng, Wenmei Lv, Ping Fu, Huaihong Yuan

Background: Sarcopenia, the progressive loss of muscle mass and strength, is common among patients with chronic kidney disease, especially those on maintenance hemodialysis. This condition often arises from factors like reduced physical activity and metabolic changes associated with chronic kidney disease. This study aims to assess the prevalence and severity of sarcopenia in patients on maintenance hemodialysis (MHD), focusing on probable sarcopenia and its correlations with physical activity, body mass index, and inorganic phosphorus levels.

Methods: This cross-sectional study involved 220 patients on MHD who visited to West China Hospital of Sichuan University between February and April 2023. The demographic data, body measurements, and laboratory results were retrospectively collected. Sarcopenia was assessed using the 2019 criteria from the Asian Working Group and the European Working Group on Sarcopenia in Older People, and physical activity was measured via the International Physical Activity Questionnaire.

Results: Of the study participants, 141 (64.1%) were diagnosed with probable [110 (50.0%) or confirmed sarcopenia [31 (14.1%)], including 22 (10%) with severe sarcopenia. Multivariable logistic regression analysis revealed that physical activity (International Physical Activity Questionnaire score, OR = 0.998, 95% CI: 0.998-0.999, P < 0.001), body mass index (OR = 0.868, 95% CI: 0.788-0.957, P = 0.004), and inorganic phosphorus levels (OR = 0.513, 95% CI: 0.270-0.975, P = 0.042) independently influenced the likelihood of sarcopenia. Within the sarcopenic group, physical activity and BMI significantly correlated with the condition's severity.

Conclusion: The prevalence of probable or confirmed sarcopenia in patients on MHD is significant. Factors such as physical activity, body mass index, and inorganic phosphorus levels are independently associated the presence and severity of sarcopenia in this population.

Trial registration: Chinese Clinical Trial Registry (ChiCTR2100051111), registered on 2021-09-13.

背景:肌肉疏松症是慢性肾病患者,尤其是接受维持性血液透析的患者中常见的一种肌肉质量和力量逐渐丧失的症状。这种情况通常是由于体力活动减少以及与慢性肾病相关的新陈代谢变化等因素造成的。本研究旨在评估维持性血液透析(MHD)患者中肌肉疏松症的患病率和严重程度,重点关注可能出现的肌肉疏松症及其与体力活动、体重指数和无机磷水平的相关性:这项横断面研究涉及 2023 年 2 月至 4 月期间在四川大学华西医院就诊的 220 名血液透析患者。研究回顾性地收集了人口统计学数据、身体测量数据和实验室结果。采用亚洲工作组和欧洲老年人肌肉疏松症工作组的2019年标准评估肌肉疏松症,并通过国际体力活动调查问卷测量体力活动:研究参与者中有 141 人(64.1%)被诊断为可能患有[110 人(50.0%)]或确诊患有[31 人(14.1%)]肌肉疏松症,其中 22 人(10%)患有严重的肌肉疏松症。多变量逻辑回归分析表明,体力活动(国际体力活动调查问卷得分,OR = 0.998,95% CI:0.998-0.999,P 结论:体力活动与肌肉疏松症的发病率呈正相关:在接受血液透析治疗的患者中,可能或确诊的肌肉疏松症发病率很高。体力活动、体重指数和无机磷水平等因素与肌肉疏松症的存在和严重程度有独立关联:中国临床试验注册中心(ChiCTR2100051111),注册日期:2021-09-13。
{"title":"Prevalence and severity of sarcopenia in patients on maintenance hemodialysis: a cross-sectional study.","authors":"Yujie Yang, Ying Zeng, Wenmei Lv, Ping Fu, Huaihong Yuan","doi":"10.1186/s12882-024-03836-z","DOIUrl":"10.1186/s12882-024-03836-z","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia, the progressive loss of muscle mass and strength, is common among patients with chronic kidney disease, especially those on maintenance hemodialysis. This condition often arises from factors like reduced physical activity and metabolic changes associated with chronic kidney disease. This study aims to assess the prevalence and severity of sarcopenia in patients on maintenance hemodialysis (MHD), focusing on probable sarcopenia and its correlations with physical activity, body mass index, and inorganic phosphorus levels.</p><p><strong>Methods: </strong>This cross-sectional study involved 220 patients on MHD who visited to West China Hospital of Sichuan University between February and April 2023. The demographic data, body measurements, and laboratory results were retrospectively collected. Sarcopenia was assessed using the 2019 criteria from the Asian Working Group and the European Working Group on Sarcopenia in Older People, and physical activity was measured via the International Physical Activity Questionnaire.</p><p><strong>Results: </strong>Of the study participants, 141 (64.1%) were diagnosed with probable [110 (50.0%) or confirmed sarcopenia [31 (14.1%)], including 22 (10%) with severe sarcopenia. Multivariable logistic regression analysis revealed that physical activity (International Physical Activity Questionnaire score, OR = 0.998, 95% CI: 0.998-0.999, P < 0.001), body mass index (OR = 0.868, 95% CI: 0.788-0.957, P = 0.004), and inorganic phosphorus levels (OR = 0.513, 95% CI: 0.270-0.975, P = 0.042) independently influenced the likelihood of sarcopenia. Within the sarcopenic group, physical activity and BMI significantly correlated with the condition's severity.</p><p><strong>Conclusion: </strong>The prevalence of probable or confirmed sarcopenia in patients on MHD is significant. Factors such as physical activity, body mass index, and inorganic phosphorus levels are independently associated the presence and severity of sarcopenia in this population.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry (ChiCTR2100051111), registered on 2021-09-13.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11520690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Medications for community pharmacists to dose adjust or avoid to enhance prescribing safety in individuals with advanced chronic kidney disease: a scoping review and modified Delphi. 社区药剂师为提高晚期慢性肾脏病患者处方安全性而应调整剂量或避免使用的药物:范围界定综述和改良德尔菲法。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-29 DOI: 10.1186/s12882-024-03829-y
Jo-Anne Wilson, Natalie Ratajczak, Katie Halliday, Marisa Battistella, Heather Naylor, Maneka Sheffield, Judith G Marin, Jennifer Pitman, Natalie Kennie-Kaulbach, Shanna Trenaman, Louise Gillis

Background: Community pharmacists commonly see individuals with chronic kidney disease (CKD) and are in an ideal position to mitigate harm from inappropriate prescribing. We sought to develop a relevant medication list for community pharmacists to dose adjust or avoid in individuals with an estimated glomerular filtration rate (eGFR) below 30 mL/min informed through a scoping review and modified Delphi panel of nephrology, geriatric and primary care pharmacists.

Methods: A scoping review was undertaken to identify higher risk medications common to community pharmacy practice, which require a dose adaptation in individuals with advanced CKD. A 3-round modified Delphi was conducted, informed by the medications identified in our scoping review, to establish consensus on which medications community pharmacists should adjust or avoid in individuals with stage 4 and 5 CKD (non-dialysis).

Results: Ninety-two articles and 88 medications were identified from our scoping review. Of which, 64 were deemed relevant to community pharmacy practice and presented for consideration to 27 panel experts. The panel consisted of Canadian pharmacists practicing in nephrology (66.7%), geriatrics (18.5%) and primary care (14.8%). All participants completed rounds 1 and 2 and 96% completed round 3. At the end of round 3, the top 40 medications to adjust or avoid were identified. All round 3 participants selected metformin, gabapentin, pregabalin, non-steroidal anti-inflammatory drugs, nitrofurantoin, ciprofloxacin and rivaroxaban as the top ranked medications.

Conclusion: Medications eliminated by the kidneys may accumulate and cause harm in individuals with advanced chronic kidney disease. This study provides an expert consensus of the top 40 medications that community pharmacists should collaboratively adjust or avoid to enhance medication safety and prescribing for individuals with an eGFR below 30 mL/min.

背景:社区药剂师通常会为慢性肾脏病 (CKD) 患者提供服务,他们是减轻不当处方造成的伤害的理想人选。我们试图制定一份相关药物清单,供社区药剂师在估计肾小球滤过率(eGFR)低于 30 mL/min 的患者中调整剂量或避免用药:方法:我们进行了一次范围审查,以确定社区药房实践中常见的、需要对晚期慢性肾脏病患者进行剂量调整的高风险药物。根据范围界定审查中确定的药物,我们进行了三轮修改后的德尔菲法,以就社区药剂师应调整或避免对第 4 期和第 5 期慢性肾脏病患者(非透析)使用哪些药物达成共识:从我们的范围界定审查中确定了 92 篇文章和 88 种药物。其中 64 篇文章被认为与社区药学实践相关,并提交给 27 位专家组成员审议。专家小组由加拿大肾脏病学(66.7%)、老年医学(18.5%)和初级保健(14.8%)领域的药剂师组成。所有参与者都完成了第一轮和第二轮,96% 完成了第三轮。第三轮结束时,确定了需要调整或避免使用的前 40 种药物。所有第三轮参与者都选择了二甲双胍、加巴喷丁、普瑞巴林、非甾体抗炎药、硝基呋喃妥因、环丙沙星和利伐沙班作为排名靠前的药物:结论:经肾脏排出的药物可能会在晚期慢性肾病患者体内蓄积并造成危害。本研究提供了专家共识,即社区药剂师应共同调整或避免使用的前 40 种药物,以加强 eGFR 低于 30 毫升/分钟的患者的用药安全和处方。
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引用次数: 0
Correction: Tubulointerstitial nephropathy is the predominant finding in men in a review of more than 3000 renal biopsies over a 10-year period from Sri Lanka. 更正:在对斯里兰卡 10 年间 3000 多例肾活检的审查中发现,男性主要患有肾小管间质性肾病。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-28 DOI: 10.1186/s12882-024-03785-7
Jennifer Pett, Christine Linhart, Nicholas Osborne, Stephen Morrell, Mohammed Fahim, John Knight, Shakila Premaranthne, A W M Wazil, Neelakanthi Ratnatunga, Sulcochana Wijethunga, Shenal Thalgahagoda, Zoltan Endre, Richard Taylor, Nishantha Nanayakkara
{"title":"Correction: Tubulointerstitial nephropathy is the predominant finding in men in a review of more than 3000 renal biopsies over a 10-year period from Sri Lanka.","authors":"Jennifer Pett, Christine Linhart, Nicholas Osborne, Stephen Morrell, Mohammed Fahim, John Knight, Shakila Premaranthne, A W M Wazil, Neelakanthi Ratnatunga, Sulcochana Wijethunga, Shenal Thalgahagoda, Zoltan Endre, Richard Taylor, Nishantha Nanayakkara","doi":"10.1186/s12882-024-03785-7","DOIUrl":"10.1186/s12882-024-03785-7","url":null,"abstract":"","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Unraveling the association between chronic inflammatory demyelinating polyradiculoneuropathy and peritoneal Dialysis. 揭开慢性炎症性脱髓鞘多发性神经病与腹膜透析之间的联系。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-28 DOI: 10.1186/s12882-024-03830-5
Yu-Jen Chen, Ting-Ya Chang, Cheng-Hsu Chen

Background: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare disease seen in the general population and has been reported as showing an increased incidence in the peritoneal dialysis (PD) population, as documented in case reports.

Methods: We conducted a case-control study using data from the Taichung Veterans General Hospital electric medical record database from the years 2010 to 2023. We defined cases as CIDP with End-stage kidney disease (ESKD) and controls as without CIDP. A logistic regression analysis was used to investigate the association between CIDP and dialysis modality, age, gender, dialysis duration, plasma potassium > 5.5 mEq/L and < 2.5 mEq/L, and intact parathyroid hormone (i-PTH) > 613 pg/mL.

Results: Our findings suggest that PD may be a risk factor in the ESKD population (Odds ratio: 5.125, C.I.: 1.078 ~ 24.372, p = 0.040) according to logistic regression analysis. Dialysis duration, gender, diabetes mellitus, HbA1c > 7%, hypokalemia, hyperkalemia, and hyperparathyroidism did not show an association with CIDP.

Conclusion: There seems to be an association between PD and CIDP in this case-control study. Possible mechanisms may involve systemic inflammation induced by peritoneal dialysate exchange or the content of the dialysate. Further studies are still needed.

背景:慢性炎症性脱髓鞘多发性神经病(CIDP)是一种常见于普通人群的罕见疾病,有病例报告显示其在腹膜透析(PD)人群中的发病率有所增加:我们利用台中荣民总医院电子病历数据库中 2010 年至 2023 年的数据进行了一项病例对照研究。我们将病例定义为伴有终末期肾病(ESKD)的 CIDP,对照组定义为无 CIDP。我们采用逻辑回归分析法研究了CIDP与透析方式、年龄、性别、透析时间、血浆钾>5.5 mEq/L和613 pg/mL之间的关系:我们的研究结果表明,根据逻辑回归分析,透析后血栓形成可能是 ESKD 患者的一个风险因素(Odds ratio:5.125,C.I.:1.078 ~ 24.372,p = 0.040)。透析持续时间、性别、糖尿病、HbA1c > 7%、低钾血症、高钾血症和甲状旁腺功能亢进与 CIDP 无关:结论:在这项病例对照研究中,脊髓灰质炎与脊髓空洞症之间似乎存在关联。结论:在这项病例对照研究中,腹膜透析与脊髓损伤性脊髓炎之间似乎存在关联,可能的机制可能涉及腹膜透析液交换或透析液内容物引起的全身炎症。仍需进一步研究。
{"title":"Unraveling the association between chronic inflammatory demyelinating polyradiculoneuropathy and peritoneal Dialysis.","authors":"Yu-Jen Chen, Ting-Ya Chang, Cheng-Hsu Chen","doi":"10.1186/s12882-024-03830-5","DOIUrl":"10.1186/s12882-024-03830-5","url":null,"abstract":"<p><strong>Background: </strong>Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare disease seen in the general population and has been reported as showing an increased incidence in the peritoneal dialysis (PD) population, as documented in case reports.</p><p><strong>Methods: </strong>We conducted a case-control study using data from the Taichung Veterans General Hospital electric medical record database from the years 2010 to 2023. We defined cases as CIDP with End-stage kidney disease (ESKD) and controls as without CIDP. A logistic regression analysis was used to investigate the association between CIDP and dialysis modality, age, gender, dialysis duration, plasma potassium > 5.5 mEq/L and < 2.5 mEq/L, and intact parathyroid hormone (i-PTH) > 613 pg/mL.</p><p><strong>Results: </strong>Our findings suggest that PD may be a risk factor in the ESKD population (Odds ratio: 5.125, C.I.: 1.078 ~ 24.372, p = 0.040) according to logistic regression analysis. Dialysis duration, gender, diabetes mellitus, HbA1c > 7%, hypokalemia, hyperkalemia, and hyperparathyroidism did not show an association with CIDP.</p><p><strong>Conclusion: </strong>There seems to be an association between PD and CIDP in this case-control study. Possible mechanisms may involve systemic inflammation induced by peritoneal dialysate exchange or the content of the dialysate. Further studies are still needed.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11514778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Emphysematous pyelonephritis caused by Raoultella ornithinolytica: a case report. 气肿性肾盂肾炎(由鸟粪雷菌引起):病例报告。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-27 DOI: 10.1186/s12882-024-03791-9
Meng Sun, Xiaobao Wei, Xinyu Xiang, Ting Zhang, Yiwen Zhang, Jiayi Miao, Juanyu Wei, Wei Cao, Qing Yao, Ling Zhu, Ying Zhou, Liyuan Zhang

Background: Emphysematous pyelonephritis is a rare and severe urinary tract infection that is potentially life-threatening and easily progresses to septic shock. In this report, we present a unique case of emphysematous pyelonephritis caused by Raoultella ornithinolytica.

Case presentation: An 86-year-old man presented with severe back pain of 3 days' duration. He had a history of hypertension and diabetes for more than 20 years, and his infection indicators and serum creatinine were elevated. Abdominal computed tomography revealed an abnormal gas shadow around his right kidney and the anterior edge of his right psoas muscle. Consequently, he was initially diagnosed with emphysematous pyelonephritis. There was no evidence of nephrolithiasis or other anatomical or structural abnormalities that could have precipitated this focal renal infection. Both blood and drainage fluid cultures revealed R. ornithinolytica. After early anti-infection treatment, percutaneous drainage and moderate control of blood glucose, the patient gradually recovered.

Conclusions: Emphysematous pyelonephritis caused by R. ornithinolytica is rare but has a high drug resistance rate potentially and may cause severe infections. Early diagnosis, prompt use of antibiotics that are sensitive to the organism, and decompression drainage could be the key to treatment.

背景:气肿性肾盂肾炎是一种罕见的严重泌尿道感染,有可能危及生命,很容易发展为脓毒性休克。在本报告中,我们介绍了一例由腊肠菌(Raoultella ornithinolytica)引起的气肿性肾盂肾炎:一名 86 岁的男性因持续 3 天的剧烈背痛前来就诊。他有 20 多年的高血压和糖尿病病史,感染指标和血清肌酐均升高。腹部计算机断层扫描显示,他的右肾周围和右腰肌前缘有异常气影。因此,他被初步诊断为气肿性肾盂肾炎。没有证据表明他患有肾结石或其他解剖或结构上的异常,而这些都有可能诱发这种局灶性肾感染。血液和引流液培养均发现了鸟疫杆菌。经过早期抗感染治疗、经皮引流和适度控制血糖后,患者逐渐康复:结论:由鸟疫杆菌引起的气肿性肾盂肾炎非常罕见,但潜在耐药率很高,可能导致严重感染。早期诊断、及时使用对该病原体敏感的抗生素和减压引流可能是治疗的关键。
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引用次数: 0
Short and long-term effects of kidney donation on mineral and bone metabolism. 捐肾对矿物质和骨代谢的短期和长期影响。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-26 DOI: 10.1186/s12882-024-03827-0
Eduardo Jorge Duque, Gustavo Fernandes Ferreira, Ivone Braga Oliveira, Wagner Dominguez, Fabiana Agena, Vanda Jorgetti, Francine Lemos, Myles Wolf, Elias David-Neto, Rosa Maria A Moysés

Background: Living kidney donors (LKD) experience an abrupt decline in glomerular filtration rate (GFR) resulting in abnormalities of mineral and bone metabolism (MBD), and this may have implications for skeletal health. We prospectively studied acute and long term MBD adaptation of LKD from two kidney transplant centers (São Paulo, Brazil and Miami, USA).

Methods: Renal function and MBD parameters longitudinally after kidney donation (baseline - D0, day 1, 14, 180 and 360 post-operatively) were measured in 74 patients (40 y, 73% female, 54% Brazilian). A subset of 20 donors from Brazil were reassessed after 10 years of nephrectomy.

Results: At baseline, Brazilian donors presented lower intact FGF23 (20.8 vs. 80.1 pg/mL, P < 0.01) and higher PTH (47.4 vs. 40.1, P = 0.04) than their US counterparts. GFR decreased to 63% of its baseline levels just after donation but improved 10% during the first year. PTH levels increased on D1, returning to baseline levels on D14, while FGF23 remained higher than baseline over the first year. LKD had a significant reduction of serum phosphate on D1, which returned to baseline levels on D180. A higher fractional excretion of phosphate (FEP) was noted since D14. After 10 years of donation, 20 LKD presented a sustained reduction in GFR (74.8 ± 14mL/min). There was a return to baseline in serum FGF23 [21.8 (18-30) pg/mL] and FEP, accompanied by an increase in serum calcium. PTH remained elevated (57.9 ± 18 pg/mL), whereas serum calcitriol and Klotho were lower than before the donation.

Conclusions: The abrupt decline in kidney mass is associated with an increase in PTH and FGF23 that is not explained by phosphate retention. In a long-term evaluation, LKD showed a sustained drop in GFR, with lower serum calcitriol and Klotho, and higher PTH. The effects of these changes should be investigated in further studies.

背景:活体肾脏捐献者(LKD)的肾小球滤过率(GFR)会突然下降,导致矿物质和骨代谢(MBD)异常,这可能会对骨骼健康产生影响。我们对两个肾移植中心(巴西圣保罗和美国迈阿密)的 LKD 患者的急性和长期 MBD 适应性进行了前瞻性研究:方法:测量了 74 名患者(40 岁,73% 为女性,54% 为巴西人)捐肾后纵向肾功能和 MBD 参数(基线 - D0、术后第 1 天、第 14 天、第 180 天和第 360 天)。肾切除术 10 年后,对来自巴西的 20 名捐献者进行了重新评估:结果:基线时,巴西捐献者的完整 FGF23 较低(20.8 对 80.1 pg/mL,P 结论:巴西捐献者的完整 FGF23 较高:肾脏质量的突然下降与 PTH 和 FGF23 的增加有关,而磷酸盐潴留无法解释这一现象。在长期评估中,LKD 的 GFR 持续下降,血清降钙素三醇和 Klotho 降低,PTH 升高。这些变化的影响应在进一步的研究中进行调查。
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引用次数: 0
Assessment of myeloid response and iron status among Sudanese pediatric ESKD on hemodialysis through reticulocyte parameters and β-globin mRNA expression. 通过网织红细胞参数和β-球蛋白mRNA表达评估接受血液透析的苏丹小儿ESKD患者的骨髓反应和铁状况。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-26 DOI: 10.1186/s12882-024-03806-5
Abier Abdelaziz Makkawi Abdelrahman, Ahmed Ibrahim Marzouk, Osama Ali Altayeb, Eman Abbas Fadul, Mugtaba Osman, Nahla Allam, Nadia Madani Mohammed Ahmed, Nazik Elmalaika Obaid Seid Ahmed Husain

Background: Sudanese children with End-Stage Kidney Disease (ESKD) often show limited improvement in hemoglobin levels despite treatment with recombinant human erythropoietin (rHuEPO). This study aims to assess the response to rHuEPO therapy by analyzing β-globin mRNA expression and reticulocyte parameters. Additionally, it classifies anemia among Sudanese pediatric patients based on iron status, considering age and gender as biological markers for evaluating treatment response.

Methods: A prospective observational cohort study was conducted from January 2019 to February 2020 in Khartoum, Sudan, involving 45 anemic children aged 2 to 15 years diagnosed with ESKD. The treatment protocol included rHuEPO injections and maintenance hemodialysis. Laboratory assessments consisted of complete blood count (CBC), absolute reticulocyte count, ferritin, and transferrin measurements. β-globin mRNA expression was quantified using reverse transcription polymerase chain reaction (RT-PCR), and reticulocyte parameters, including Reticulocyte Hemoglobin Content (CHr), percentage of hypochromic reticulocytes (HYPO%), and Immature Reticulocyte Fraction (IRF), were measured via flow cytometry.

Results: Significant variations in hemoglobin levels were observed across different age groups (p = 0.011). Gender analysis revealed a significant association with IRF, showing a lower IRF in male patients (p = 0.017). However, there were no significant differences in hemoglobin levels between genders (p = 0.999). β-globin mRNA expression showed considerable variability, with a strong positive correlation with hemoglobin levels (r = 0.875, p < 0.0001).

Conclusion: Age and gender significantly influence treatment responses in children with ESKD, highlighting the need to consider growth physiology in anemia management. This study underscores the variability in β-globin mRNA expression and its association with Flow Cytometry parameters, demonstrating their effectiveness in evaluating iron status and guiding rHuEPO dosage.

背景:患有终末期肾病(ESKD)的苏丹儿童尽管接受了重组人促红细胞生成素(rHuEPO)治疗,但血红蛋白水平往往改善有限。本研究旨在通过分析 β-球蛋白 mRNA 表达和网织红细胞参数来评估对 rHuEPO 治疗的反应。此外,该研究还根据铁的状况对苏丹儿科患者的贫血情况进行分类,并将年龄和性别作为评估治疗反应的生物标志物:方法:2019 年 1 月至 2020 年 2 月在苏丹喀土穆开展了一项前瞻性观察性队列研究,涉及 45 名确诊为 ESKD 的 2 至 15 岁贫血儿童。治疗方案包括注射 rHuEPO 和维持性血液透析。实验室评估包括全血细胞计数(CBC)、绝对网织红细胞计数、铁蛋白和转铁蛋白测量。使用反转录聚合酶链反应(RT-PCR)对β-球蛋白mRNA表达进行量化,并通过流式细胞术测量网织红细胞参数,包括网织红细胞血红蛋白含量(CHr)、低色素网织红细胞百分比(HYPO%)和未成熟网织红细胞比例(IRF):结果:不同年龄组的血红蛋白水平差异显著(p = 0.011)。性别分析显示,男性患者的 IRF 较低(p = 0.017)。然而,不同性别之间的血红蛋白水平没有明显差异(p = 0.999)。β- 球蛋白 mRNA 的表达有很大的差异性,与血红蛋白水平有很强的正相关性(r = 0.875,p 结论:β- 球蛋白 mRNA 的表达与血红蛋白水平有很强的正相关性(r = 0.875,p):年龄和性别对 ESKD 患儿的治疗反应有很大影响,这说明在贫血管理中需要考虑生长生理因素。本研究强调了β-球蛋白mRNA表达的可变性及其与流式细胞术参数的关联,证明了它们在评估铁状态和指导rHuEPO剂量方面的有效性。
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引用次数: 0
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