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Structural equation modeling analysis of factors influencing decisional conflict between dialysis modality among end-stage kidney disease patients in Wuhan. 武汉市终末期肾病患者透析方式决策冲突影响因素的结构方程模型分析。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-17 DOI: 10.1186/s12882-024-03805-6
Shiyi Zhang, Jinrui Cui, Xiaoqin Liu, Xifei He, Yulin Xu

Objectives: To explore the influencing factors and relationships associated with decisional conflict of dialysis modality in End-stage kidney disease (ESKD) patients.

Methods: This study was a survey-based cross-sectional investigation conducted on 150 ESKD patients in a third-class hospital in Wuhan. The general information questionnaire, decisional conflict scale, Montreal cognitive assessment, frail scale, perceived social support scale, and brief health literacy screen were used for investigation. SPSS 25.0 was used to compare the differences between the decisional and non-decisional conflict groups, and AMOS 23.0 was used to construct a structural equation model to explore the influencing factors.

Results: The incidence of decisional conflict in 150 ESKD patients was 33.3% (50/150). Binary logistic regression analysis showed that the independent risk factors for decisional conflict of dialysis modality in ESKD patients included monthly household income (OR = 0.184), cognitive function (OR = 7.0), social support (OR = 0.891), health literacy (OR = 0.608), the level of eGFR (OR = 1.488), and the level of cTnI (OR = 9.558). The constructed path analysis model had a good fit (x2/df = 1.499, GFI = 0.957, AGFI = 0.911, NFI = 0.906, CFI = 0.967, RMSEA = 0.055). The path analysis showed that health literacy (0.577) had the greatest impact on the decisional conflict, with a direct effect of 0.480 and an indirect effect of 0.097 through cognitive function and monthly household income. Next was social support, with an effect value of 0.434.

Conclusions: In clinical practice, it is important to enhance the health literacy of patients and their families and to provide advanced education on dialysis plans. Additionally, in managing and planning chronic kidney disease progression and dialysis, it is recommended to regularly and systematically assess cognitive function, particularly before the patient's cognitive impairment worsens or the severity of the disease progresses. Advanced care planning can be established through collaboration between healthcare professionals and patients to ensure appropriate decision-making and management.

Implications for the profession and patient care: This paper finds that the factors that influence and relate to dialysis methods in end-stage renal disease patients help nurses exercise autonomy better, assist patients in reducing their decisional conflict, and improve clinical outcomes.

Patient or public contribution: Patients received a relevant questionnaire survey, and caregivers assisted in conducting the study.

目的探讨终末期肾病(ESKD)患者透析方式决策冲突的影响因素及相关关系:本研究以武汉市某三级甲等医院的 150 名终末期肾脏病(ESKD)患者为调查对象,进行横断面调查。调查采用一般信息问卷、决策冲突量表、蒙特利尔认知评估、体弱量表、感知社会支持量表和简明健康素养筛查。采用 SPSS 25.0 比较决策冲突组和非决策冲突组之间的差异,采用 AMOS 23.0 构建结构方程模型探讨影响因素:150名ESKD患者中决策冲突的发生率为33.3%(50/150)。二元逻辑回归分析显示,ESKD 患者透析方式决策冲突的独立危险因素包括家庭月收入(OR = 0.184)、认知功能(OR = 7.0)、社会支持(OR = 0.891)、健康知识(OR = 0.608)、eGFR 水平(OR = 1.488)和 cTnI 水平(OR = 9.558)。构建的路径分析模型拟合良好(x2/df = 1.499,GFI = 0.957,AGFI = 0.911,NFI = 0.906,CFI = 0.967,RMSEA = 0.055)。路径分析显示,健康素养(0.577)对决策冲突的影响最大,直接影响为 0.480,通过认知功能和家庭月收入的间接影响为 0.097。其次是社会支持,影响值为 0.434:在临床实践中,提高患者及其家属的健康知识水平并提供有关透析计划的高级教育非常重要。此外,在管理和规划慢性肾脏病进展和透析时,建议定期系统地评估认知功能,尤其是在患者认知功能障碍恶化或疾病严重程度进展之前。可以通过医护人员和患者之间的合作来制定晚期护理计划,以确保适当的决策和管理:本文发现,影响终末期肾病患者透析方法并与之相关的因素有助于护士更好地行使自主权,协助患者减少决策冲突,改善临床疗效。患者或公众的贡献:患者收到了相关的问卷调查,护理人员协助开展了这项研究。
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引用次数: 0
Association between serum uric acid variability and mild eGFR decline in Chinese adults: a retrospective cohort study. 中国成年人血清尿酸变异与 eGFR 轻度下降之间的关系:一项回顾性队列研究。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-17 DOI: 10.1186/s12882-024-03814-5
Na Li, Jianrong Wu, Jing Chen, Yajing Cui, Yunjie Teng, Xiaoping Yang

Background: The present retrospective cohort study focused on evaluating the effects of fluctuations in serum uric acid (SUA) on a mildly reduced glomerular filtration rate (eGFR) in a population with a normal eGFR in Urumqi, China.

Methods: A total of 2,154 normal individuals with a normal eGFR were recruited from 2018 to 2021. This study included questionnaire surveys, physical measurements, and blood sampling. We deemed the mildly reduced eGFR to be 60-90 ml·min-1·(1.73 m2)-1. The relationship between changes in SUA levels and the eGFR was assessed.

Results: (1) During the 3-year follow-up period, 433 individuals (20.10%) presented mildly reduced eGFR. (2) After stratification by the degree to which uric acid changed into five groups, the group showing the greatest change in uric acid concentration had significantly lower eGFR values than the other four groups. As the uric acid concentration (ΔSUA) increased, the degree of mild eGFR reduction (ΔeGFR) also increased (P < 0.05). When classified into five groups by the degree of eGFR change (ΔeGFR), analysis of variance revealed no statistically significant differences between baseline SUA and follow-up SUA (P > 0.05). Pearson correlation analysis showed a negative correlation between ΔSUA and ΔeGFR (r = -0.211, P < 0.01). (3) Multifactorial logistic regression, in which the endpoint event was an eGFR decreasing to 60 to 90 ml·min-1·(1.73 m2)-1, revealed that the ΔSUA was a risk factor that independently predicted a reduced eGFR (OR = 1.347, P < 0.001).

Conclusion: In people with a normal eGFR in Urumqi, a high SUA level is associated with a mild reduction in the eGFR.

研究背景本回顾性队列研究主要评估中国乌鲁木齐市eGFR正常人群中血清尿酸(SUA)波动对肾小球滤过率(eGFR)轻度降低的影响:2018年至2021年,共招募了2154名eGFR正常的正常人。本研究包括问卷调查、体格测量和血液采样。我们将轻度降低的 eGFR 视为 60-90 ml-min-1-(1.73 m2)-1。结果:(1)在 3 年的随访期间,有 433 人(20.10%)出现 eGFR 轻度降低。(2)按尿酸变化程度分为五组后,尿酸浓度变化最大的一组的 eGFR 值明显低于其他四组。随着尿酸浓度(ΔSUA)的增加,eGFR 的轻度降低程度(ΔeGFR)也随之增加(P 0.05)。皮尔逊相关性分析表明,ΔSUA 与 ΔeGFR 之间呈负相关(r = -0.211,P -1-(1.73 m2)-1),表明ΔSUA 是独立预测 eGFR 降低的一个风险因素(OR = 1.347,P 结论:ΔSUA 与 eGFR 之间呈负相关(r = -0.211,P -1-(1.73 m2)-1):在乌鲁木齐,eGFR 正常的人群中,SUA 水平高与 eGFR 轻度降低有关。
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引用次数: 0
Predictive value of stress hyperglycemia ratio on one-year mortality in chronic kidney disease patients admitted to intensive care unit. 压力性高血糖比率对重症监护室慢性肾病患者一年死亡率的预测价值。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-17 DOI: 10.1186/s12882-024-03823-4
Shuoyan An, Zixiang Ye, Wuqiang Che, Yanxiang Gao, Jingyi Ren, Jiahui Li, Jingang Zheng

Background: Stress Hyperglycemia Ratio (SHR) reflects the acute blood glucose variation in critically ill conditions. However, its prognostic value in chronic kidney disease (CKD) remains understudied. This study aimed to investigate the association between SHR and one-year mortality in CKD patients hospitalized in the Intensive Care Unit (ICU).

Methods: Patients with diagnosis of CKD in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were enrolled. Incidence of all-cause mortality within one-year follow-up was used as the primary endpoint.

Results: 1825 CKD patients were included in the study. A "U-shaped" relationship between SHR and one-year mortality as identified using multivariate restricted cubic spline (RCS) analysis. Then study population were categorized into three groups: Group 1 (SHR < 0.70), Group 2 (0.70 ≤ SHR ≤ 0.95) and Group 3 (SHR > 0.95). Group 2 showed significantly better one-year outcomes compared to the other two groups (p = 0.0031). This survival benefit persisted across subgroup analyses stratified by age, sex, CKD stage, anemia and various clinical conditions.

Conclusion: SHR proved to be a meaningful biomarker for predicting one-year mortality in ICU-admitted CKD patients, with a "U-shaped" correlation. The identification of the optimal SHR range (0.70-0.95) provided clinicians with a valuable tool for detecting high-risk populations.

背景:应激性高血糖比值(SHR)反映了危重病人的急性血糖变化。然而,其在慢性肾脏病(CKD)中的预后价值仍未得到充分研究。本研究旨在调查在重症监护室(ICU)住院的 CKD 患者的 SHR 与一年死亡率之间的关系:方法:研究人员招募了重症监护医学信息市场(MIMIC-IV)数据库中诊断为 CKD 的患者。结果:1825 名 CKD 患者被纳入 MIMIC-IV 数据库:研究共纳入了 1825 名慢性肾脏病患者。通过多变量限制立方样条曲线(RCS)分析发现,SHR与一年死亡率之间存在 "U "型关系。随后,研究对象被分为三组:第 1 组(SHR 0.95)。与其他两组相比,第 2 组的一年生存率明显更高(p = 0.0031)。根据年龄、性别、慢性肾脏病分期、贫血和各种临床状况进行亚组分析后,这种生存获益依然存在:事实证明,SHR 是预测入住 ICU 的 CKD 患者一年死亡率的有效生物标志物,其相关性呈 "U "形。最佳 SHR 范围(0.70-0.95)的确定为临床医生检测高危人群提供了宝贵的工具。
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引用次数: 0
Associations between leisure time, non-leisure time physical activity, and kidney function in Japanese adults: a cross-sectional study. 日本成年人闲暇时间、非闲暇时间体育活动与肾功能之间的关系:一项横断面研究。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-16 DOI: 10.1186/s12882-024-03813-6
Ippei Chiba, Naoki Nakaya, Mana Kogure, Rieko Hatanaka, Kumi Nakaya, Sayuri Tokioka, Tomohiro Nakamura, Satoshi Nagaie, Soichi Ogishima, Taku Obara, Toshimi Sato, Nobuo Fuse, Yoko Izumi, Shinichi Kuriyama, Atsushi Hozawa

Background: Chronic kidney disease (CKD) contributes to decreased life expectancy. We examined the association between leisure-time physical activity (LTPA), non-leisure-time physical activity (non-LTPA) and kidney function.

Methods: This was a cross-sectional study including 32 162 community-dwelling adults aged ≥ 20 years from the Tohoku Medical MegaBank community-based cohort study. Kidney function was evaluated using cystatin C-based estimated glomerular filtration rate (eGFR) as well as self-reported LTPA and non-LTPA. CKD was defined as either eGFR decline (≤ 60 mL/min/1.73 m2) or presence of albuminuria (albumin-creatinine ≥ 30 mg/g). The association between domain-specific physical activity and kidney function, and CKD prevalence was examined using multivariable-adjusted ordinary least squares and modified Poisson models.

Results: The mean eGFR was 98.1 (± 13.2) mL/min/1.73 m2. 3 185 (9.9%) participants were classified as having CKD. The mean LTPA and non-LTPA levels were 2.9 (± 4.2) and 16.6 (± 14.2) METs-hour/day, respectively. For LTPA, in the adjusted model, the quartile groups with higher levels had a higher kidney function (β, 0.36; 95% confidence intervals [CI], [0.06, 0.66]; p = 0.019 for the 2nd quartile, β, 0.82; 95% CI, [0.51, 1.14]; p < 0.001 for the 3rd quartile, and β, 1.16; 95% CI, [0.83, 1.49]; p < 0.001 for the 4th quartile), whereas there were no apparent associations for prevalence of CKD. For non-LTPA, 4th quartile was associated with decreased eGFR (β, -0.42; 95% CI, [-0.72, -0.11]; p = 0.007) and higher prevalence of CKD prevalence (Prevalence ratio, 1.12; 95% CI, [1.02, 1.24]; p = 0.022). These associations with kidney function remained consistent in the subgroup analyses divided by demographic and biological variables.

Conclusions: We observed a positive association between higher LTPA levels and better kidney function, but not association with CKD prevalence. In contrast, higher non-LTPA was negatively associated with both kidney function and CKD prevalence. These findings suggest that promoting LTPA is beneficial for kidney function.

背景:慢性肾脏病(CKD)会导致预期寿命缩短。我们研究了闲暇时间体育活动(LTPA)、非闲暇时间体育活动(Non-LTPA)与肾功能之间的关系:这是一项横断面研究,包括来自东北医疗 MegaBank 社区队列研究的 32 162 名年龄≥ 20 岁的社区成年人。采用基于胱抑素 C 的肾小球滤过率(eGFR)估算值以及自我报告的长程肾衰竭和非长程肾衰竭来评估肾功能。eGFR 下降(≤ 60 mL/min/1.73 m2)或出现白蛋白尿(白蛋白-肌酐≥ 30 mg/g)即为慢性肾功能衰竭。采用多变量调整普通最小二乘法和修正泊松模型研究了特定领域体力活动与肾功能和慢性肾功能衰竭患病率之间的关系:平均 eGFR 为 98.1 (± 13.2) mL/min/1.73 m2。3 185 人(9.9%)被归类为患有慢性肾功能衰竭。LTPA和非LTPA的平均水平分别为2.9 (± 4.2) METs-小时/天和16.6 (± 14.2) METs-小时/天。在调整模型中,LTPA 水平较高的四分位组肾功能较好(β,0.36;95% 置信区间 [CI],[0.06, 0.66];第 2 个四分位组 p = 0.019,β,0.82;95% 置信区间 [CI],[0.51, 1.14];p):我们观察到,LTPA 水平越高,肾功能越好,但与 CKD 患病率无关。相反,较高的非LTPA水平与肾功能和慢性肾脏病患病率均呈负相关。这些研究结果表明,促进 LTPA 对肾功能有益。
{"title":"Associations between leisure time, non-leisure time physical activity, and kidney function in Japanese adults: a cross-sectional study.","authors":"Ippei Chiba, Naoki Nakaya, Mana Kogure, Rieko Hatanaka, Kumi Nakaya, Sayuri Tokioka, Tomohiro Nakamura, Satoshi Nagaie, Soichi Ogishima, Taku Obara, Toshimi Sato, Nobuo Fuse, Yoko Izumi, Shinichi Kuriyama, Atsushi Hozawa","doi":"10.1186/s12882-024-03813-6","DOIUrl":"10.1186/s12882-024-03813-6","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) contributes to decreased life expectancy. We examined the association between leisure-time physical activity (LTPA), non-leisure-time physical activity (non-LTPA) and kidney function.</p><p><strong>Methods: </strong>This was a cross-sectional study including 32 162 community-dwelling adults aged ≥ 20 years from the Tohoku Medical MegaBank community-based cohort study. Kidney function was evaluated using cystatin C-based estimated glomerular filtration rate (eGFR) as well as self-reported LTPA and non-LTPA. CKD was defined as either eGFR decline (≤ 60 mL/min/1.73 m<sup>2</sup>) or presence of albuminuria (albumin-creatinine ≥ 30 mg/g). The association between domain-specific physical activity and kidney function, and CKD prevalence was examined using multivariable-adjusted ordinary least squares and modified Poisson models.</p><p><strong>Results: </strong>The mean eGFR was 98.1 (± 13.2) mL/min/1.73 m<sup>2</sup>. 3 185 (9.9%) participants were classified as having CKD. The mean LTPA and non-LTPA levels were 2.9 (± 4.2) and 16.6 (± 14.2) METs-hour/day, respectively. For LTPA, in the adjusted model, the quartile groups with higher levels had a higher kidney function (β, 0.36; 95% confidence intervals [CI], [0.06, 0.66]; p = 0.019 for the 2nd quartile, β, 0.82; 95% CI, [0.51, 1.14]; p < 0.001 for the 3rd quartile, and β, 1.16; 95% CI, [0.83, 1.49]; p < 0.001 for the 4th quartile), whereas there were no apparent associations for prevalence of CKD. For non-LTPA, 4th quartile was associated with decreased eGFR (β, -0.42; 95% CI, [-0.72, -0.11]; p = 0.007) and higher prevalence of CKD prevalence (Prevalence ratio, 1.12; 95% CI, [1.02, 1.24]; p = 0.022). These associations with kidney function remained consistent in the subgroup analyses divided by demographic and biological variables.</p><p><strong>Conclusions: </strong>We observed a positive association between higher LTPA levels and better kidney function, but not association with CKD prevalence. In contrast, higher non-LTPA was negatively associated with both kidney function and CKD prevalence. These findings suggest that promoting LTPA is beneficial for kidney function.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"25 1","pages":"354"},"PeriodicalIF":2.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457914","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
Bioelectrical impedance analysis-derived phase angle predicts possible Sarcopenia in patients on maintenance hemodialysis: a retrospective study. 生物电阻抗分析得出的相位角可预测维持性血液透析患者可能出现的肌少症:一项回顾性研究。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-16 DOI: 10.1186/s12882-024-03787-5
Ying Zeng, Yang Chen, Yujie Yang, Ying Qiu, Ping Fu, Huaihong Yuan

Background: The prevalence of possible sarcopenia is notably high among maintenance hemodialysis (MHD) patients. Possible sarcopenia, defined as a decrease in muscle strength and/or somatic function, is an early and reversible condition between non-sarcopenic and sarcopenia, and early recognition and intervention for possible sarcopenia is important for preventing adverse outcomes and improving the quality of life of these patients. This study aimed to establish a simple and effective model for screening and identifying MHD patients at high risk of possible sarcopenia by using 50 kHz-Whole Body Phase Angle (PhA), with a specific focus on gender differences.

Methods: This prospective cross-sectional study was conducted from September to December 2023 at the Wenjiang Hemodialysis Center in the Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China. A total of 244 MHD patients, including 130 males and 114 females, were enrolled. Data were collected prospectively, including demographic information and physical measurements. All participants provided informed consent before enrollment. Measurements were taken post-dialysis to ensure consistency. The whole-body phase angle was measured using the InBody S10 device, grip strength was measured using an electronic grip strength tester, and physical function was assessed by the Short Physical Performance Battery (SPPB). The Skeletal Muscle Index (SMI) was also calculated.

Results: A total of 244 patients receiving hemodialysis were enrolled in this study. Among these, 109 patients were categorized as non-sarcopenic, 111 as having possible sarcopenia, and 24 as sarcopenic. The prevalence of sarcopenia among MHD patients is 9.8%, while the prevalence of possible sarcopenia is 45.5%. The receiver operating characteristic (ROC) curve analysis showed that for male patients, the AUC of PhA for predicting possible sarcopenia was 0.798, with a sensitivity of 80.36%, specificity of 69.70%, and a cutoff value of 6.20°. For female patients, the AUC of PhA was 0.701, with a sensitivity of 70.91% and specificity of 62.79%, and a cutoff value of 5.70°.

Conclusions: PhA may be a useful and simple predictor of the risk of possible sarcopenia in MHD patients, and more research is needed to further promote the use of PhA in possible sarcopenia.

背景:在维持性血液透析(MHD)患者中,可能出现的 "肌肉疏松症 "发病率很高。可能的肌肉疏松症定义为肌肉力量和/或躯体功能下降,是介于非肌肉疏松症和肌肉疏松症之间的一种早期可逆情况,早期识别和干预可能的肌肉疏松症对于预防不良后果和改善这些患者的生活质量非常重要。本研究旨在利用 50 kHz 全身相位角(PhA)建立一个简单有效的模型,用于筛查和识别可能患有肌少症的高危 MHD 患者,并特别关注性别差异:这项前瞻性横断面研究于 2023 年 9 月至 12 月在中国成都四川大学华西医院肾内科温江血液透析中心进行。共纳入 244 名血液透析患者,包括 130 名男性和 114 名女性。前瞻性收集数据,包括人口统计学信息和体格测量。所有参与者在入组前均已知情同意。透析后进行测量以确保一致性。全身相位角使用 InBody S10 设备进行测量,握力使用电子握力测试仪进行测量,身体功能通过短期体能测试(SPPB)进行评估。此外,还计算了骨骼肌指数(SMI):共有 244 名接受血液透析的患者参与了这项研究。其中,109 名患者被归类为非肌肉疏松症患者,111 名患者被归类为可能患有肌肉疏松症,24 名患者被归类为肌肉疏松症患者。肌肉疏松症患者的发病率为 9.8%,而可能患有肌肉疏松症的发病率为 45.5%。接收器操作特征曲线(ROC)分析显示,对于男性患者,PhA 预测可能肌少症的 AUC 为 0.798,灵敏度为 80.36%,特异度为 69.70%,临界值为 6.20°。对于女性患者,PhA 的 AUC 为 0.701,灵敏度为 70.91%,特异度为 62.79%,临界值为 5.70°:PhA可能是预测MHD患者可能出现肌少症风险的一个有用而简单的指标,需要更多的研究来进一步促进PhA在可能出现的肌少症中的应用。
{"title":"Bioelectrical impedance analysis-derived phase angle predicts possible Sarcopenia in patients on maintenance hemodialysis: a retrospective study.","authors":"Ying Zeng, Yang Chen, Yujie Yang, Ying Qiu, Ping Fu, Huaihong Yuan","doi":"10.1186/s12882-024-03787-5","DOIUrl":"https://doi.org/10.1186/s12882-024-03787-5","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of possible sarcopenia is notably high among maintenance hemodialysis (MHD) patients. Possible sarcopenia, defined as a decrease in muscle strength and/or somatic function, is an early and reversible condition between non-sarcopenic and sarcopenia, and early recognition and intervention for possible sarcopenia is important for preventing adverse outcomes and improving the quality of life of these patients. This study aimed to establish a simple and effective model for screening and identifying MHD patients at high risk of possible sarcopenia by using 50 kHz-Whole Body Phase Angle (PhA), with a specific focus on gender differences.</p><p><strong>Methods: </strong>This prospective cross-sectional study was conducted from September to December 2023 at the Wenjiang Hemodialysis Center in the Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China. A total of 244 MHD patients, including 130 males and 114 females, were enrolled. Data were collected prospectively, including demographic information and physical measurements. All participants provided informed consent before enrollment. Measurements were taken post-dialysis to ensure consistency. The whole-body phase angle was measured using the InBody S10 device, grip strength was measured using an electronic grip strength tester, and physical function was assessed by the Short Physical Performance Battery (SPPB). The Skeletal Muscle Index (SMI) was also calculated.</p><p><strong>Results: </strong>A total of 244 patients receiving hemodialysis were enrolled in this study. Among these, 109 patients were categorized as non-sarcopenic, 111 as having possible sarcopenia, and 24 as sarcopenic. The prevalence of sarcopenia among MHD patients is 9.8%, while the prevalence of possible sarcopenia is 45.5%. The receiver operating characteristic (ROC) curve analysis showed that for male patients, the AUC of PhA for predicting possible sarcopenia was 0.798, with a sensitivity of 80.36%, specificity of 69.70%, and a cutoff value of 6.20°. For female patients, the AUC of PhA was 0.701, with a sensitivity of 70.91% and specificity of 62.79%, and a cutoff value of 5.70°.</p><p><strong>Conclusions: </strong>PhA may be a useful and simple predictor of the risk of possible sarcopenia in MHD patients, and more research is needed to further promote the use of PhA in possible sarcopenia.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":"25 1","pages":"357"},"PeriodicalIF":2.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457915","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
Artificial intelligence and predictive models for early detection of acute kidney injury: transforming clinical practice. 用于早期检测急性肾损伤的人工智能和预测模型:改变临床实践。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-16 DOI: 10.1186/s12882-024-03793-7
Tu T Tran, Giae Yun, Sejoong Kim

Acute kidney injury (AKI) presents a significant clinical challenge due to its rapid progression to kidney failure, resulting in serious complications such as electrolyte imbalances, fluid overload, and the potential need for renal replacement therapy. Early detection and prediction of AKI can improve patient outcomes through timely interventions. This review was conducted as a narrative literature review, aiming to explore state-of-the-art models for early detection and prediction of AKI. We conducted a comprehensive review of findings from various studies, highlighting their strengths, limitations, and practical considerations for implementation in healthcare settings. We highlight the potential benefits and challenges of their integration into routine clinical care and emphasize the importance of establishing robust early-detection systems before the introduction of artificial intelligence (AI)-assisted prediction models. Advances in AI for AKI detection and prediction are examined, addressing their clinical applicability, challenges, and opportunities for routine implementation.

急性肾损伤(AKI)是一项重大的临床挑战,因为它会迅速发展为肾衰竭,导致电解质失衡、体液超负荷等严重并发症,并可能需要进行肾脏替代治疗。早期发现和预测 AKI 可通过及时干预改善患者预后。本综述以叙述性文献综述的形式进行,旨在探索早期检测和预测 AKI 的最先进模型。我们对各种研究结果进行了全面回顾,强调了它们的优势、局限性以及在医疗机构实施时的实际考虑因素。我们强调了将其纳入常规临床护理的潜在益处和挑战,并强调了在引入人工智能(AI)辅助预测模型之前建立强大的早期检测系统的重要性。我们研究了人工智能在 AKI 检测和预测方面的进展,探讨了其临床适用性、挑战以及常规实施的机遇。
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引用次数: 0
Chronic kidney disease in Kuwait: a multicenter study of two cohorts with different levels of access to public healthcare. 科威特的慢性肾脏病:对两组享有不同程度公共医疗保健的人群进行的多中心研究。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-16 DOI: 10.1186/s12882-024-03794-6
Ali AlSahow, Anas AlYousef, Nasser AlSabti, Bassam AlHelal, Heba AlRajab, Ahmed AlQallaf, Yousif Bahbahani, Abdulrahman AlKandari, Ahmad Mazroue, Noha Dewidar, Gamal Nessim, Ahmad Atef Mekky, Mohamed Sherif, Hesham Zamel, Ahmed Abdalla, Rajeev Kumar

Introduction: Kuwait has a large expatriate community who experience both restricted access to public health services and lower income than Kuwaiti citizens. Given these conditions, we examined differences in characteristics and management of chronic kidney disease (CKD) between Kuwaitis and expatriates.

Methods: Clinical and laboratory data for adult CKD Stages 3-5 not on dialysis (CKD 3-5 ND) patients with native kidneys attending nephrology clinics in all Ministry of Health hospitals collected from January 1, 2022, to December 31, 2022. Cohort was then divided into Kuwaiti patients and expatriates patients for comparison.

Results: We collected data from 2,610 patients (eGFR: 30.8 ml/min/1.73m2; age: 62.6 years; males: 56.7%; Kuwaitis: 62.1%). Kuwaitis were older (63.94 vs. 60.3 years, p < 0.001), with lower mean eGFR (30.4 vs. 31.5 ml/min/1.73m2, p = 0.052) than non-Kuwaitis, however, Kuwaitis had lower mean blood pressure (137.2/76.5 vs. 139.1/78.9 mmHg, p = 0.006), lower HbA1c in diabetics (7.59 vs. 7.82%, p = 0.010), and better lipid profile despite higher body mass indexes (29.6 vs. 28.9 kg/m2, p = 0.002). Both groups had high diabetes mellitus and hypertension rates. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) were used in only 22.6% and renin-angiotensin-aldosterone system inhibitors (RAASi) in only 46.2%.

Conclusion: CKD 3-5 ND is caused by diabetes mellitus in 56.6% of cases, and the majority have hypertension. In our study, non-Kuwaitis had higher eGFR; however, restricted public healthcare access and lower income can lead to an unhealthy diet and suboptimal care, which may cause higher blood pressure, higher HbA1c, and a higher dyslipidemia rate. RAASi and SGLT2i utilization must increase to combat CKD, and antihypertensive selection must improve.

导言:科威特有一个庞大的外籍社区,他们在享受公共卫生服务方面受到限制,而且收入低于科威特公民。鉴于这些情况,我们研究了科威特人和外籍人士在慢性肾脏病(CKD)的特征和管理方面的差异:收集了 2022 年 1 月 1 日至 2022 年 12 月 31 日期间在卫生部所有医院肾脏科门诊就诊的本地肾脏的成年 CKD 3-5 期非透析(CKD 3-5 ND)患者的临床和实验室数据。然后将群组分为科威特患者和外籍患者进行比较:我们收集了 2610 名患者的数据(eGFR:30.8 毫升/分钟/1.73 平方米;年龄:62.6 岁;男性:56.7%;科威特人:62.1%)。科威特人比非科威特人年龄大(63.94 岁对 60.3 岁,P 2,P = 0.052),但科威特人的平均血压较低(137.2/76.5 对 139.1/78.9 mmHg,P = 0.006),糖尿病患者的 HbA1c 较低(7.59 对 7.82%,P = 0.010),血脂状况较好,尽管体重指数较高(29.6 对 28.9 kg/m2,P = 0.002)。两组的糖尿病和高血压发病率都很高。只有22.6%的患者使用钠-葡萄糖共转运体2抑制剂(SGLT2i),只有46.2%的患者使用肾素-血管紧张素-醛固酮系统抑制剂(RAASi):结论:56.6%的 CKD 3-5 ND 病例是由糖尿病引起的,大多数人患有高血压。在我们的研究中,非科威特人的 eGFR 较高;然而,公共医疗服务的限制和较低的收入会导致不健康的饮食和不理想的护理,这可能会导致较高的血压、较高的 HbA1c 和较高的血脂异常率。必须提高 RAASi 和 SGLT2i 的使用率以防治 CKD,同时必须改进降压药的选择。
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引用次数: 0
Significance of intrarenal vascular lesions in Ig A nephropathy prognosis. 肾内血管病变在 Ig A 肾病预后中的意义。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-16 DOI: 10.1186/s12882-024-03803-8
Hyeon Tae Yang, Tae In Park, Yong-Jin Kim, Mee-Seon Kim, Sun-Hee Park, Jeong-Hoon Lim, Yoo Na Kang, DongJa Kim, Man-Hoon Han

Background: Immunoglobulin A nephropathy (IgAN) is the predominant primary glomerulonephritis globally and remains a subject of active research with a focus on understanding its course and prognosis. Although vascular lesions are associated with IgAN, the current histopathological grading systems do not consider intrarenal vascular lesions when predicting patient prognosis. Therefore, this retrospective study conducted at Kyungpook National University Hospital between October 2016 and December 2021, aimed to elucidate the significance of intrarenal vascular lesions in IgAN by comparing the clinical data of patients with and without such lesions.

Methods: Data of patients with biopsy-confirmed primary IgAN between October 2016 and June 2021 at Kyungpook National University Hospital (Daegu, South Korea) were collected, and their medical records were reviewed. All slides from these 138 cases were independently pathologically reviewed by two nephropathologists (Y. J. K. and M. S. K.) using light microscope. The vascular lesions included in this study were fibrous intimal thickening, arteriolar wall thickening, and arteriolar hyalinosis. All cases were reviewed according to the Oxford Classification of IgA Nephropathy (2016) and Haas classification.

Results: Of the 138 patients, 88 exhibited at least one intrarenal vascular lesion. Patients with arteriolar wall thickening demonstrated a reduced estimated glomerular filtration rate (eGFR), elevated serum creatinine level and urine protein-to-creatinine ratio, an increased proportion of global glomerulosclerosis, and a higher histologic grade of interstitial fibrosis and tubular atrophy at the time of biopsy.

Conclusion: Arteriolar wall thickening in IgAN are associated with reduced eGFR and global glomerulosclerosis. Moreover, reduced eGFR and global glomerulosclerosis are correlated with the progression to end-stage renal disease. Although the direct correlation between vascular lesions and end-stage renal disease is not entirely clear, a marginally significant association (log-rank test, p = 0.06) was observed with arterial wall thickening. This study suggests the potential importance of vascular lesions in the prognosis of IgAN, encouraging further investigation using larger cohort studies to establish a clearer association.

背景:免疫球蛋白 A 肾病(IgAN)是全球最主要的原发性肾小球肾炎,其病程和预后一直是积极研究的重点。虽然血管病变与 IgAN 相关,但目前的组织病理学分级系统在预测患者预后时并未考虑肾内血管病变。因此,这项于2016年10月至2021年12月在庆北国立大学医院进行的回顾性研究旨在通过比较有无肾内血管病变患者的临床数据,阐明肾内血管病变在IgAN中的重要性:收集了2016年10月至2021年6月期间在庆北国立大学医院(韩国大邱)经活检确诊的原发性IgAN患者的数据,并审查了他们的病历。两名肾病病理学家(Y. J. K. 和 M. S. K.)使用光学显微镜对这 138 例病例的所有切片进行了独立病理审查。本研究中的血管病变包括纤维内膜增厚、动脉壁增厚和动脉透明变性。所有病例均根据 IgA 肾病牛津分类法(2016 年)和哈斯分类法进行了复查:结果:在138名患者中,88人至少有一处肾内血管病变。动脉壁增厚患者的估计肾小球滤过率(eGFR)降低,血清肌酐水平和尿蛋白肌酐比值升高,肾小球全面硬化的比例增加,活检时组织学上间质纤维化和肾小管萎缩的等级升高:结论:IgAN患者的动脉管壁增厚与eGFR降低和肾小球全面硬化有关。结论:IgAN 患者的动脉壁增厚与 eGFR 降低和肾小球全面硬化有关,而且 eGFR 降低和肾小球全面硬化与终末期肾病的进展相关。虽然血管病变与终末期肾病之间的直接相关性尚不完全清楚,但观察到动脉壁增厚与血管病变之间有轻微的相关性(对数秩检验,p = 0.06)。这项研究表明,血管病变在 IgAN 的预后中具有潜在的重要性,因此需要利用更大规模的队列研究来进一步调查,以建立更明确的关联。
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引用次数: 0
Evaluation of urinary volatile organic compounds as a novel metabolomic biomarker to assess chronic kidney disease progression. 将尿挥发性有机化合物作为一种新型代谢组学生物标记物来评估慢性肾脏病的进展。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-15 DOI: 10.1186/s12882-024-03819-0
Henry H L Wu, Malcolm Possell, Long The Nguyen, Wenbo Peng, Carol A Pollock, Sonia Saad

Background: There is a need to develop accurate and reliable non-invasive methods to evaluate chronic kidney disease (CKD) status and assess disease progression. Given it is recognized that dysregulation in metabolic pathways occur from early CKD, there is a basis in utilizing metabolomic biomarkers to monitor CKD progression. Volatile Organic Compounds (VOCs), a form of metabolomic biomarker, are gaseous products of metabolic processes in organisms which are typically released with greater abundance in disease conditions when there is dysregulation in metabolism. How urinary VOCs reflect the abnormal metabolic profile of patients with CKD status is unknown. Our study aimed to explore this.

Methods: Individuals aged 18-75 years undergoing kidney biopsy were included. Pre-biopsy urine samples were collected. All biopsy samples had an interstitial fibrosis and tubular atrophy (IFTA) grade scored by standardized assessment. Urine supernatant was extracted from residue and sampled for stir bar sorptive extraction followed by Gas chromatography-mass spectrometry (GC-MS) analysis. Post-processing of GC-MS data separated complex mixtures of VOCs based on their volatility and polarity. Mass-to-charge ratios and fragment patterns were measured for individual VOCs identification and quantification. Linear discriminant analysis (LDA) was performed to assess the ability of urinary VOCs in discriminating between IFTA 0 ('no or minimal IFTA' i.e. <10%, IFTA), IFTA 1 ('mild IFTA' i.e. 10-25% IFTA) and IFTA ≥ 2 ('moderate or severe IFTA' i.e. >25% IFTA). Linear regression analysis adjusting for age, sex, estimated glomerular filtration rate, diabetes mellitus (DM) status, and albuminuria was conducted to determine significantly regulated urinary VOCs amongst the groups.

Results: 64 study participants (22 individuals IFTA 0, 15 individuals IFTA 1, 27 individuals IFTA ≥ 2) were included. There were 34 VOCs identified from GC-MS which were statistically associated with correct classification between the IFTA groups, and LDA demonstrated individuals with IFTA 0, IFTA 1 and IFTA ≥ 2 could be significantly separated by their urinary VOCs profile (p < 0.001). Multivariate linear regression analysis reported 4 VOCs significantly upregulated in the IFTA 1 compared to the IFTA 0 group, and 2 VOCs significantly upregulated in the IFTA ≥ 2 compared to the IFTA 1 group (p < 0.05). Significantly upregulated urinary VOCs belonged to one of four functional groups - aldehydes, ketones, hydrocarbons, or alcohols.

Conclusions: We report novel links between urinary VOCs and tubulointerstitial histopathology. Our findings suggest the application of urinary VOCs as a metabolomic biomarker may have a useful clinical role to non-invasively assess CKD status during disease progression.

背景:需要开发准确可靠的非侵入性方法来评估慢性肾脏病(CKD)的状态和疾病进展。鉴于人们认识到代谢途径的失调从 CKD 早期就开始出现,因此利用代谢组生物标志物监测 CKD 的进展是有依据的。挥发性有机化合物(VOCs)是代谢组生物标志物的一种形式,是生物体内代谢过程的气态产物,通常在新陈代谢失调的疾病情况下会大量释放。尿液中的挥发性有机化合物如何反映出慢性肾脏病患者代谢异常的情况尚不清楚。我们的研究旨在探讨这一问题:方法:纳入接受肾活检的 18-75 岁个体。收集活检前的尿液样本。所有活检样本均通过标准化评估进行间质纤维化和肾小管萎缩(IFTA)分级。从残留物中提取尿液上清液并取样进行搅拌棒吸附萃取,然后进行气相色谱-质谱(GC-MS)分析。气相色谱-质谱数据的后处理根据挥发性和极性分离出复杂的挥发性有机化合物混合物。通过测量质量电荷比和片段模式来识别和定量单个挥发性有机化合物。进行了线性判别分析(LDA),以评估尿液挥发性有机化合物在区分 IFTA 0("无或极少 IFTA",即 25% IFTA)方面的能力。在对年龄、性别、估计肾小球滤过率、糖尿病(DM)状态和白蛋白尿进行调整后,进行了线性回归分析,以确定各组间显著调节的尿液挥发性有机化合物:共纳入 64 名研究人员(22 人 IFTA 0,15 人 IFTA 1,27 人 IFTA ≥ 2)。通过 GC-MS 鉴定出的 34 种挥发性有机化合物在统计学上与 IFTA 组间的正确分类有关,LDA 表明 IFTA 0、IFTA 1 和 IFTA ≥ 2 的个体可通过其尿液挥发性有机化合物特征显著区分开来(p 结论:我们报告了尿液挥发性有机化合物与 IFTA 组间的新联系:我们报告了尿中挥发性有机化合物与肾小管间质组织病理学之间的新联系。我们的研究结果表明,应用尿液中的挥发性有机化合物作为代谢组学生物标记物,可在疾病进展过程中对 CKD 状态进行非侵入性评估,具有有用的临床作用。
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引用次数: 0
Assisted peritoneal dialysis compared to in-centre hemodialysis - an observational study of outcomes from the Swedish Renal Registry. 辅助腹膜透析与中心内血液透析的比较--瑞典肾脏登记结果观察研究。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-14 DOI: 10.1186/s12882-024-03799-1
Helena Rydell, Mårten Segelmark, Naomi Clyne

Background: In-center hemodialysis (IHD) is the most common dialysis modality. Assisted peritoneal dialysis (assPD) is an option for frail and/or incapacitated patients. Both modalities can be used to alleviate uremic symptoms towards the end of life. There are few studies comparing these modalities. The primary aim is to compare hospital admissions between assPD and IHD. The secondary aim is to compare continuation of the dialysis modality and patient survival.

Methods: Patients > 65 years, registered in the Swedish Renal Registry (SRR) and starting dialysis 2010-2017 were eligible for inclusion. Patients starting on assPD were matched with patients starting on IHD according to sex, Charlson Index, age and date for start of dialysis. Data were collected from SRR and other registries.

Results: During the first year, patients on assPD and IHD had in median one (IQR 0-5.0; 0-4.0) hospitalization (p = 0.412). There was no significant difference after two years, in the annual number of days admitted to hospital, in hospitalizations with cardiovascular or infectious disease diagnoses or continuation of the dialysis modality, respectively. However, patients on assPD had a worse median survival (1.1 years IQR 0.6-2.1; IHD 3.1 years IQR 0.2-5.8; p < 0.001).

Conclusion: In this study patients starting assPD, often as a palliative treatment, showed no difference compared to IHD concerning the number of hospitalizations, number of days in hospital/year or continuation of the dialysis modality. Patients on assPD had a worse survival, which is likely due to residual confounding. Without that, patients on assPD would probably have lower number of hospitalizations. Despite limitations due to the retrospective observational design of the study, the results indicate that assPD is a feasible alternative to IHD when self-care dialysis is not possible and/or IHD too arduous.

背景:中心内血液透析(IHD)是最常见的透析方式。辅助腹膜透析(assPD)是体弱和/或无行为能力患者的一种选择。这两种方式都可用于缓解生命末期的尿毒症症状。对这两种方式进行比较的研究很少。本研究的主要目的是比较急性尿毒症和急性肾功能衰竭患者的入院情况。次要目的是比较透析方式的持续性和患者的存活率:年龄大于 65 岁、在瑞典肾脏登记处 (SRR) 登记并在 2010-2017 年开始透析的患者均符合纳入条件。根据性别、查尔森指数、年龄和开始透析的日期,将开始使用 assPD 的患者与开始使用 IHD 的患者进行配对。数据来自 SRR 和其他登记处:第一年,接受 assPD 和 IHD 治疗的患者住院次数中位数分别为 1 次(IQR 0-5.0; 0-4.0)(p = 0.412)。两年后,在每年住院天数、因心血管疾病或传染病住院或继续使用透析方式方面分别没有明显差异。然而,接受 assPD 的患者的中位生存期较短(1.1 年,IQR 0.6-2.1;IHD 3.1 年,IQR 0.2-5.8;P 结论:在这项研究中,开始接受 assPD 的患者的中位生存期较短,而接受 IHD 的患者的中位生存期较长:在这项研究中,开始使用 assPD(通常作为姑息治疗)的患者在住院次数、每年住院天数或继续透析方式方面与 IHD 相比没有差异。接受assPD治疗的患者生存率较低,这可能是由于残余混杂因素造成的。如果没有这些因素,使用辅助透析的患者住院次数可能会更少。尽管这项研究的回顾性观察设计存在局限性,但研究结果表明,在无法进行自理透析和/或自理透析过于艰苦的情况下,assPD是一种可行的替代性血液透析方法。
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