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Development and validation of a prediction model for people with mild chronic kidney disease in Japanese individuals. 日本轻度慢性肾病患者预测模型的开发与验证。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-09 DOI: 10.1186/s12882-024-03786-6
Takahiro Miki, Toshiya Sakoda, Kojiro Yamamoto, Kento Takeyama, Yuta Hagiwara, Takahiro Imaizumi

Background: Chronic kidney disease (CKD) poses significant health risks due to its asymptomatic nature in early stages and its association with increased cardiovascular and kidney events. Early detection and management are critical for improving outcomes.

Objective: This study aimed to develop and validate a prediction model for hospitalization for ischemic heart disease (IHD) or cerebrovascular disease (CVD) and major kidney events in Japanese individuals with mild CKD using readily available health check and prescription data.

Methods: A retrospective cohort study was conducted using data from approximately 850,000 individuals in the PREVENT Inc. database, collected between April 2013 and April 2023. Cox proportional hazard regression models were utilized to derive and validate risk scores for hospitalization for IHD/CVD and major kidney events, incorporating traditional risk factors and CKD-specific variables. Model performance was assessed using the concordance index (c-index) and 5-fold cross-validation.

Results: A total of 40,351 individuals were included. Key predictors included age, sex, diabetes, hypertension, and lipid levels for hospitalization for IHD/CVD and major kidney events. Age significantly increased the risk score for both hospitalization for IHD/CVD and major kidney events. The baseline 5-year survival rates are 0.99 for hospitalization for IHD/CVD and major kidney events are 0.99. The developed risk models demonstrated predictive ability, with mean c-indexes of 0.75 for hospitalization for IHD/CVD and 0.69 for major kidney events.

Conclusions: This prediction model offers a practical tool for early identification of Japanese individuals with mild CKD at risk for hospitalization for IHD/CVD and major kidney events, facilitating timely interventions to improve patient outcomes and reduce healthcare costs. The models stratified patients into risk categories, enabling identification of those at higher risk for adverse events. Further clinical validation is required.

背景:慢性肾脏病(CKD)早期无症状,且与心血管和肾脏事件增加有关,因此对健康构成重大风险。早期发现和管理对改善预后至关重要:本研究旨在利用现成的健康检查和处方数据,开发并验证日本轻度 CKD 患者因缺血性心脏病(IHD)或脑血管疾病(CVD)住院以及重大肾脏事件的预测模型:利用 PREVENT 公司数据库中 2013 年 4 月至 2023 年 4 月期间收集的约 85 万人的数据,开展了一项回顾性队列研究。利用 Cox 比例危险回归模型,结合传统风险因素和慢性肾脏病特异性变量,得出并验证了因 IHD/CVD 和重大肾脏事件住院的风险评分。使用一致性指数(c-index)和 5 倍交叉验证来评估模型性能:结果:共纳入 40351 人。主要预测因素包括年龄、性别、糖尿病、高血压和血脂水平。年龄明显增加了因高血压/心血管疾病住院和重大肾脏事件的风险评分。因 IHD/CVD 和重大肾脏事件住院的基线 5 年生存率分别为 0.99 和 0.99。所开发的风险模型具有预测能力,IHD/CVD 住院的平均 c 指数为 0.75,重大肾脏事件的平均 c 指数为 0.69:该预测模型提供了一种实用工具,可用于早期识别日本轻度慢性肾脏病患者因 IHD/CVD 和重大肾脏事件住院的风险,便于及时采取干预措施,改善患者预后并降低医疗成本。这些模型将患者分为不同的风险类别,从而识别出不良事件的高风险人群。还需要进一步的临床验证。
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引用次数: 0
Vision transformer introduces a new vitality to the classification of renal pathology. 视觉转换器为肾脏病理分类注入了新的活力。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-09 DOI: 10.1186/s12882-024-03800-x
Ji Zhang, Jia Dan Lu, Bo Chen, ShuFang Pan, LingWei Jin, Yu Zheng, Min Pan

Recent advancements in computer vision within the field of artificial intelligence (AI) have made significant inroads into the medical domain. However, the application of AI for classifying renal pathology remains challenging due to the subtle variations in multiple renal pathological classifications. Vision Transformers (ViT), an adaptation of the Transformer model for image recognition, have demonstrated superior capabilities in capturing global features and providing greater explainability. In our study, we developed a ViT model using a diverse set of stained renal histopathology images to evaluate its effectiveness in classifying renal pathology. A total of 1861 whole slide images (WSI) stained with HE, MASSON, PAS, and PASM were collected from 635 patients. Renal tissue images were then extracted, tiled, and categorized into 14 classes on the basis of renal pathology. We employed the classic ViT model from the Timm library, utilizing images sized 384 × 384 pixels with 16 × 16 pixel patches, to train the classification model. A comparative analysis was conducted to evaluate the performance of the ViT model against traditional convolutional neural network (CNN) models. The results indicated that the ViT model demonstrated superior recognition ability (accuracy: 0.96-0.99). Furthermore, we visualized the identification process of the ViT models to investigate potentially significant pathological ultrastructures. Our study demonstrated that ViT models outperformed CNN models in accurately classifying renal pathology. Additionally, ViT models are able to focus on specific, significant structures within renal histopathology, which could be crucial for identifying novel and meaningful pathological features in the diagnosis and treatment of renal disease.

近年来,人工智能(AI)领域的计算机视觉技术取得了长足进步,在医疗领域也取得了重大进展。然而,由于多种肾脏病理分类存在细微差别,将人工智能应用于肾脏病理分类仍具有挑战性。视觉变换器(ViT)是图像识别变换器模型的一种改良,在捕捉全局特征和提供更高的可解释性方面表现出了卓越的能力。在我们的研究中,我们使用一组不同的染色肾组织病理学图像开发了一个 ViT 模型,以评估其在肾病理学分类中的有效性。我们从 635 名患者中收集了 1861 张用 HE、MASSON、PAS 和 PASM 染色的全切片图像(WSI)。然后提取、平铺肾组织图像,并根据肾脏病理分为 14 类。我们采用了 Timm 库中的经典 ViT 模型,利用大小为 384 × 384 像素的图像和 16 × 16 像素的斑块来训练分类模型。我们进行了对比分析,以评估 ViT 模型与传统卷积神经网络 (CNN) 模型的性能。结果表明,ViT 模型的识别能力更强(准确率:0.96-0.99)。此外,我们还将 ViT 模型的识别过程可视化,以研究潜在的重要病理超微结构。我们的研究表明,在对肾脏病理进行准确分类方面,ViT 模型优于 CNN 模型。此外,ViT 模型还能关注肾脏组织病理学中特定的、重要的结构,这对于在诊断和治疗肾脏疾病时识别新的、有意义的病理特征至关重要。
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引用次数: 0
Apixaban dosing in hemodialysis - can drug level monitoring mitigate controversies? 血液透析中的阿哌沙班剂量--药物浓度监测能否缓解争议?
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-09 DOI: 10.1186/s12882-024-03782-w
Simeon Schietzel, Andreas Limacher, Matthias B Moor, Cecilia Czerlau, Uyen Huynh-Do, Bruno Vogt, Fabienne Aregger, Dominik E Uehlinger

Background: Inconsistent study results and contradictory recommendations from health authorities regarding the use of apixaban in patients on hemodialysis have generated considerable uncertainty among clinicians, making investigations of appropriate dosing an unmet need.

Methods: We analyzed pre-dialysis apixaban drug levels from a tertiary care dialysis unit, comparing 2.5 mg once versus twice daily dosing. We applied mixed-effects models including dialysis modality, adjusted standard Kt/V, ultrafiltration, and dialyzer characteristics. We included an exploratory analysis of bleeding events and compared the drug levels of our dialysis patients to those from non-CKD reference populations taking the standard dose of 5 mg twice daily.

Results: We analyzed 143 drug levels from 24 patients. Mean (SD) age at first drug level measurement was 64.7 (15.9) years (50 % female), median (IQR) follow-up was 12.5 (5.5 - 21) months. For the apixaban 2.5 mg once and twice daily groups, median (IQR) drug levels were 54.4 (< 40 - 72.1) and 71.3 (48.8 - 104.1) ng/mL respectively (P < 0.001). Levels were below the detection limit in 30 % (with 2.5 mg once daily) and 14 % (with 2.5 mg twice daily) respectively. Only dosing group (twice versus once daily) was independently associated with higher drug levels (P = 0.002). Follow-up did not suggest accumulation. The 95th percentile of drug levels did not exceed those of non-CKD populations taking 5 mg twice daily. Median (IQR) drug levels before a bleeding (8 episodes) were higher than those without a subsequent bleeding: 111.6 (83.1 - 129.3) versus 54.8 (< 40 - 77.1) ng/mL (P < 0.001). Concomitant antiplatelet therapy was used in 86% of those with bleeding events versus 6% without bleeding events (P < 0.001).

Conclusions: Drug monitoring may be a contributory tool to increase patient safety. Despite non-existing target ranges, drug levels on both edges of the spectrum (e.g. below detectability or beyond the 95th percentiles of reference populations) may improve decision-making in highly individualized risk-benefit analyses.

背景:关于血液透析患者使用阿哌沙班的研究结果不一致,卫生部门的建议也相互矛盾,这给临床医生带来了很大的不确定性,因此对适当剂量的研究成为一项尚未满足的需求:我们分析了一家三级医疗透析单位透析前的阿哌沙班药物水平,比较了 2.5 毫克每日一次和每日两次的剂量。我们采用了混合效应模型,包括透析方式、调整后的标准 Kt/V、超滤和透析器特征。我们对出血事件进行了探索性分析,并将透析患者的药物水平与每日两次服用 5 毫克标准剂量的非 CKD 参考人群的药物水平进行了比较:我们分析了 24 名患者的 143 种药物水平。首次测量药物浓度时的平均(标清)年龄为 64.7(15.9)岁(50% 为女性),随访时间的中位数(IQR)为 12.5(5.5 - 21)个月。阿哌沙班 2.5 毫克每日一次组和每日两次组的药物浓度中位数(IQR)分别为 54.4(< 40 - 72.1)纳克/毫升和 71.3(48.8 - 104.1)纳克/毫升(P < 0.001)。药物水平低于检测限的比例分别为 30%(2.5 毫克,每天一次)和 14%(2.5 毫克,每天两次)。只有给药组别(每天两次与每天一次)与较高的药物浓度有独立关联(P = 0.002)。随访结果未显示药物蓄积。药物浓度的第 95 百分位数未超过每天两次、每次 5 毫克的非慢性阻塞性肺病患者。出血(8 次)前的药物浓度中位数(IQR)高于未发生出血的药物浓度中位数(IQR):111.6(83.1 - 129.3)纳克/毫升对 54.8(< 40 - 77.1)纳克/毫升(P < 0.001)。在发生出血事件的患者中,86%的患者同时使用了抗血小板疗法,而在未发生出血事件的患者中,只有6%的患者同时使用了抗血小板疗法(P < 0.001):结论:药物监测是提高患者安全性的有效工具。尽管不存在目标范围,但药物水平的两个边缘(如低于可检测水平或超过参考人群的第95百分位数)可改善高度个体化的风险-效益分析决策。
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引用次数: 0
Quality of life and social reinsertion of patients on maintenance haemodialysis in four government funded hospitals in Cameroon. 喀麦隆四家政府资助医院维持性血液透析患者的生活质量和重新融入社会的情况。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-08 DOI: 10.1186/s12882-024-03778-6
Denis Georges Teuwafeu, Mervis Sehbing, Marie-Patrice Halle, Maimouna Mahamat, Hermine Fouda, Gloria Ashuntantang

Background: Reduced quality of life is associated with shorter survival in chronic illnesses. However, the health-related quality of life (HRQOL) and social reinsertion of patients on maintenance haemodialysis is much more underappreciated in resource-limited countries such as Cameroon.

Method: A hospital-based cross-sectional study was carried out from February 22nd to May 20th, 2022, in 4 government-funded haemodialysis centres in three randomly selected regions of Cameroon. Patients received twice-weekly dialysis sessions. Social reinsertion and HRQOL were assessed using a structured questionnaire and the kidney disease quality of life instrument (KDQOL-36™). HRQOL scores < 50 were categorized as low, while scores > 50 reflected better HRQOL. Data were analysed using the software statistical package for Social Sciences version 25.0. Statistical significance was set at a p value < 0.05.

Results: The study included 434 patients. The mean age was 48.33 (13.55) years, 65.7% (285/434) were male, 62.3% (269/434) had no monthly income, and the mean dialysis vintage was 3.74 (3.83) years. The mean HRQOL score was 44.34 (9.77), and 76.2% (325/434) had HRQOL scores < 50). Overall HRQOL was associated with older age (aOR: 2.344, CI 1.089-5.04). After the initiation of maintenance haemodialysis, 67.1% (49/73) of students dropped out of school. The main reason for school absenteeism and unemployment was physical insufficiency, with 82.4% (19/24) and 52.4% (75/144), respectively. There were no promotions or marriages after initiation; 51% (221/434) of relationships with relatives and friends were affected negatively, while 83.3% (66/79) of those of marriageable ages could not find suitors. The social participation score was poor in 61.5% (267/434) of participants. There was an association between low QOL and social participation (p = 0.009).

Conclusion: The HRQOL of patients on maintenance haemodialysis is greatly reduced, especially their physical health status. Older age was a determinant of low QOL. Additionally, social reinsertion remains poor due to adverse changes that occur to these patients and their families after dialysis initiation.

Clinical trial number: Not applicable.

背景:生活质量下降与慢性病患者的生存期缩短有关。然而,在喀麦隆等资源有限的国家,维持性血液透析患者的健康相关生活质量(HRQOL)和重新融入社会的问题远未得到重视:方法:2022 年 2 月 22 日至 5 月 20 日,在喀麦隆随机选择的三个地区的 4 家政府资助的血液透析中心开展了一项基于医院的横断面研究。患者每周接受两次透析。采用结构化问卷和肾脏病生活质量工具(KDQOL-36™)对患者的社会融入和 HRQOL 进行评估。HRQOL 得分为 50 分,表示 HRQOL 较好。数据使用社会科学统计软件包 25.0 版进行分析。统计显著性以 p 值为标准:研究共纳入 434 名患者。平均年龄为 48.33(13.55)岁,65.7%(285/434)为男性,62.3%(269/434)无月收入,平均透析年限为 3.74(3.83)年。平均 HRQOL 得分为 44.34 (9.77),76.2%(325/434)的 HRQOL 得分为结论:维持性血液透析患者的 HRQOL 大大降低,尤其是他们的身体健康状况。高龄是导致患者生活质量低的一个因素。此外,由于这些患者及其家庭在开始透析后发生的不利变化,他们的社会融入程度仍然很低:临床试验编号:不适用。
{"title":"Quality of life and social reinsertion of patients on maintenance haemodialysis in four government funded hospitals in Cameroon.","authors":"Denis Georges Teuwafeu, Mervis Sehbing, Marie-Patrice Halle, Maimouna Mahamat, Hermine Fouda, Gloria Ashuntantang","doi":"10.1186/s12882-024-03778-6","DOIUrl":"10.1186/s12882-024-03778-6","url":null,"abstract":"<p><strong>Background: </strong>Reduced quality of life is associated with shorter survival in chronic illnesses. However, the health-related quality of life (HRQOL) and social reinsertion of patients on maintenance haemodialysis is much more underappreciated in resource-limited countries such as Cameroon.</p><p><strong>Method: </strong>A hospital-based cross-sectional study was carried out from February 22nd to May 20th, 2022, in 4 government-funded haemodialysis centres in three randomly selected regions of Cameroon. Patients received twice-weekly dialysis sessions. Social reinsertion and HRQOL were assessed using a structured questionnaire and the kidney disease quality of life instrument (KDQOL-36™). HRQOL scores < 50 were categorized as low, while scores > 50 reflected better HRQOL. Data were analysed using the software statistical package for Social Sciences version 25.0. Statistical significance was set at a p value < 0.05.</p><p><strong>Results: </strong>The study included 434 patients. The mean age was 48.33 (13.55) years, 65.7% (285/434) were male, 62.3% (269/434) had no monthly income, and the mean dialysis vintage was 3.74 (3.83) years. The mean HRQOL score was 44.34 (9.77), and 76.2% (325/434) had HRQOL scores < 50). Overall HRQOL was associated with older age (aOR: 2.344, CI 1.089-5.04). After the initiation of maintenance haemodialysis, 67.1% (49/73) of students dropped out of school. The main reason for school absenteeism and unemployment was physical insufficiency, with 82.4% (19/24) and 52.4% (75/144), respectively. There were no promotions or marriages after initiation; 51% (221/434) of relationships with relatives and friends were affected negatively, while 83.3% (66/79) of those of marriageable ages could not find suitors. The social participation score was poor in 61.5% (267/434) of participants. There was an association between low QOL and social participation (p = 0.009).</p><p><strong>Conclusion: </strong>The HRQOL of patients on maintenance haemodialysis is greatly reduced, especially their physical health status. Older age was a determinant of low QOL. Additionally, social reinsertion remains poor due to adverse changes that occur to these patients and their families after dialysis initiation.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11459710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387912","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
Short- and long-term outcomes in critically ill patients with primary glomerular disease: a case‒control study. 原发性肾小球疾病重症患者的短期和长期预后:一项病例对照研究。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-08 DOI: 10.1186/s12882-024-03766-w
Nicoli Ferri Revoredo Coutinho, Alexandre Braga Libório

Introduction: Glomerular diseases, encompassing primary and secondary forms, pose significant morbidity and mortality risks. Despite their impact, little is known about critically ill patients with primary glomerulopathy admitted to the intensive care unit (ICU).

Methods: We conducted a case‒control study of patients with primary glomerulopathy using the Medical Information Mart for Intensive Care IV database. Demographic, clinical, and outcome data were collected. Logistic regression and mediation analysis were performed to identify predictors of hospital and long-term mortality.

Results: Among 50,920 patients, 307 with primary glomerulopathy were included. Infectious and cardiovascular-related causes were the main reasons for ICU admission, with sepsis being diagnosed in more than half of the patients during their ICU stay. The hospital mortality rate was similar to that of the control group, with a long-term mortality rate of 29.0% three years post-ICU discharge. Reduced urine output and serum albumin were identified as independent predictors of hospital mortality, while serum albumin and the Charlson comorbidity index were significantly associated with long-term mortality. Notably, although acute kidney injury was frequent, it was not significantly associated with mortality. Additionally, reduced urine output mediates nearly 25% of the association between serum albumin and hospital mortality.

Conclusion: Critically ill patients with primary glomerulopathy exhibit unique characteristics and outcomes. Although hospital mortality was comparable to that of the control group, long-term mortality remained high. The serum albumin concentration and Charlson Comorbidity Index score emerged as robust predictors of long-term mortality, highlighting the importance of comprehensive risk assessment in this population. The lack of an association between acute kidney injury and mortality suggests the need for further research to understand the complex interplay of factors influencing outcomes in this patient population.

导言:肾小球疾病,包括原发性和继发性肾小球疾病,对患者的发病率和死亡率都有很大的风险。尽管肾小球疾病影响巨大,但人们对重症监护室(ICU)中患有原发性肾小球疾病的重症患者却知之甚少:方法:我们利用重症监护室医疗信息市场(Medical Information Mart for Intensive Care IV)数据库对原发性肾小球疾病患者进行了病例对照研究。我们收集了人口统计学、临床和结果数据。我们进行了逻辑回归和中介分析,以确定住院死亡率和长期死亡率的预测因素:结果:在 50920 名患者中,有 307 人患有原发性肾小球病。感染和心血管相关原因是患者入住重症监护室的主要原因,其中一半以上的患者在入住重症监护室期间被确诊为败血症。住院死亡率与对照组相似,ICU出院三年后的长期死亡率为29.0%。尿量减少和血清白蛋白被确定为住院死亡率的独立预测因素,而血清白蛋白和夏尔森合并症指数与长期死亡率有显著关联。值得注意的是,虽然急性肾损伤很常见,但与死亡率并无显著关联。此外,尿量减少介导了血清白蛋白与住院死亡率之间近25%的关联:结论:患有原发性肾小球病的重症患者表现出独特的特征和结果。虽然住院死亡率与对照组相当,但长期死亡率仍然很高。血清白蛋白浓度和夏尔森综合症指数评分是预测长期死亡率的有力指标,这凸显了对这一人群进行全面风险评估的重要性。急性肾损伤与死亡率之间缺乏关联,这表明有必要开展进一步研究,以了解影响这类患者预后的各种因素之间复杂的相互作用。
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引用次数: 0
Prevalence and clinical patterns of urolithiasis in sub-saharan Africa: a systematic review and meta-analysis of observational studies. 撒哈拉以南非洲地区尿路结石的发病率和临床模式:观察性研究的系统回顾和荟萃分析。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-08 DOI: 10.1186/s12882-024-03780-y
Altaseb Beyene Kassaw, Mekonnen Belete, Ebrahim Msaye Assefa, Amare Abera Tareke
<p><strong>Background and objective: </strong>Urolithiasis, the presence of stones in the urinary tract, has been linked to various clinical features and reported as a worldwide health concern. Its prevalence varies across different regions as well as populations. Several primary studies have been conducted in Sub-Saharan Africa on the situation. However, their reports are inconsistent. Hence, this review aimed to assess the pooled magnitude of urolithiasis and its clinical patterns among hospital-visiting patients in sub-Saharan Africa.</p><p><strong>Methods: </strong>Online databases such as PubMed, Hinari, the African Journals online database, and Google Scholar were used to comprehensively search articles published until June 28, 2023, about the prevalence and clinical patterns of urolithiasis in Sub-Saharan Africa. All the included studies were conducted at hospital setting. The retrieved data was exported to STATA version 16 for final analysis. A random-effect meta-analysis model was computed to estimate the pooled results. The heterogeneity of the studies was assessed using I<sup>2</sup> and Cochran's Q. Publication bias was examined by observation using funnel plots and statistically by Egger's tests. Subgroup analysis was performed based on the country where the studies have been conducted.</p><p><strong>Result: </strong>A total of 26 articles (11 reported both prevalence and clinical pattern, 5 reported only prevalence, and 10 reported only clinical patterns of urolithiasis) were included in the final systematic review and meta-analysis. The pooled prevalence of urolithiasis among hospital-visiting patients was 9.4% (95% CL = 4.9-14%), with significant heterogeneity. Most of the urolithiasis was located in the kidney, with an estimated pooled proportion of 4.6% (95% CI = 2.7, 6.5), followed by bladder stone-2.0% (95% CI = 0.7, 3.4), ureteral stone-1.8% (95% CI = 0.7, 2.9), and urethral stone-0.2% (95% CI = 0.00, 0.05). The subgroup analysis showed the highest prevalence of urolithiasis was found in Mauritian, 28.1% (95%CI 24.5, 31.7), followed by Ethiopia 18.1%, and the lowest was in Eritrea, 1.0%. A sensitivity analysis using the random-effects model found no influential study on the pooled prevalence of urolithiasis. Evidence of significant publication bias was observed and trim-fill analysis was conducted for adjustment. Accordingly, two missing studies were identified, and after adjustment, the combined prevalence of urolithiasis was estimated to be 10.7%. The study also found that urolithiasis prevalence per gender was 6.3% in males and 2.9% in females. The most common clinical presentation of urolithiasis was flank pain at 58.4% (95% CL=, 45.9, 70.8), followed by low back pain at 45.9% (95% CL=, 23.1, 68.8), and nausea/vomiting at 29.9% (95% CI: 1 1.1, 48.8).</p><p><strong>Conclusion: </strong>The prevalence of urolithiasis in Sub-Sahara African Countries is increasing even though a remarkable regional variation was observed, with
背景和目的:尿路结石是指尿路中存在结石,它与各种临床特征有关,是一个全球关注的健康问题。不同地区和人群的发病率各不相同。在撒哈拉以南非洲地区,已就这一情况开展了多项初步研究。然而,它们的报告并不一致。因此,本综述旨在评估撒哈拉以南非洲地区医院就诊患者中尿路结石的总体发病率及其临床模式:方法:使用 PubMed、Hinari、非洲期刊在线数据库和谷歌学术等在线数据库,全面检索截至 2023 年 6 月 28 日发表的有关撒哈拉以南非洲地区尿路结石发病率和临床模式的文章。所有纳入的研究均在医院环境中进行。检索到的数据被导出到 STATA 16 版本中进行最终分析。计算随机效应荟萃分析模型以估算汇总结果。研究的异质性采用 I2 和 Cochran's Q 进行评估。发表偏倚采用漏斗图观察和 Egger's 检验进行统计分析。根据进行研究的国家进行了分组分析:共有 26 篇文章(11 篇同时报告了尿石症的患病率和临床模式,5 篇仅报告了患病率,10 篇仅报告了临床模式)被纳入最终的系统综述和荟萃分析。在医院就诊的患者中,尿路结石的合计患病率为 9.4%(95% CL = 4.9-14%),存在显著的异质性。大多数尿路结石位于肾脏,估计总比例为 4.6% (95% CI = 2.7, 6.5),其次是膀胱结石-2.0% (95% CI = 0.7, 3.4)、输尿管结石-1.8% (95% CI = 0.7, 2.9)和尿道结石-0.2% (95% CI = 0.00, 0.05)。亚组分析显示,毛里求斯的尿路结石发病率最高,为 28.1%(95%CI 24.5,31.7),其次是埃塞俄比亚的 18.1%,最低的是厄立特里亚的 1.0%。使用随机效应模型进行的敏感性分析发现,没有研究对尿路结石的合计患病率产生影响。有证据表明存在明显的发表偏倚,因此进行了修剪填充分析以进行调整。因此,发现了两项缺失的研究,经过调整后,尿路结石的综合患病率估计为 10.7%。研究还发现,不同性别的尿路结石发病率分别为:男性 6.3%,女性 2.9%。尿路结石最常见的临床表现是侧腹疼痛,占 58.4%(95% CL=,45.9,70.8),其次是腰痛,占 45.9%(95% CL=,23.1,68.8),恶心/呕吐占 29.9%(95% CI:1 1.1,48.8):结论:撒哈拉以南非洲国家的尿路结石发病率正在上升,但地区差异显著,男性发病率高于女性。尿路结石的常见临床表现为侧腹疼痛、腰痛和恶心/呕吐。
{"title":"Prevalence and clinical patterns of urolithiasis in sub-saharan Africa: a systematic review and meta-analysis of observational studies.","authors":"Altaseb Beyene Kassaw, Mekonnen Belete, Ebrahim Msaye Assefa, Amare Abera Tareke","doi":"10.1186/s12882-024-03780-y","DOIUrl":"10.1186/s12882-024-03780-y","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objective: &lt;/strong&gt;Urolithiasis, the presence of stones in the urinary tract, has been linked to various clinical features and reported as a worldwide health concern. Its prevalence varies across different regions as well as populations. Several primary studies have been conducted in Sub-Saharan Africa on the situation. However, their reports are inconsistent. Hence, this review aimed to assess the pooled magnitude of urolithiasis and its clinical patterns among hospital-visiting patients in sub-Saharan Africa.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Online databases such as PubMed, Hinari, the African Journals online database, and Google Scholar were used to comprehensively search articles published until June 28, 2023, about the prevalence and clinical patterns of urolithiasis in Sub-Saharan Africa. All the included studies were conducted at hospital setting. The retrieved data was exported to STATA version 16 for final analysis. A random-effect meta-analysis model was computed to estimate the pooled results. The heterogeneity of the studies was assessed using I&lt;sup&gt;2&lt;/sup&gt; and Cochran's Q. Publication bias was examined by observation using funnel plots and statistically by Egger's tests. Subgroup analysis was performed based on the country where the studies have been conducted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result: &lt;/strong&gt;A total of 26 articles (11 reported both prevalence and clinical pattern, 5 reported only prevalence, and 10 reported only clinical patterns of urolithiasis) were included in the final systematic review and meta-analysis. The pooled prevalence of urolithiasis among hospital-visiting patients was 9.4% (95% CL = 4.9-14%), with significant heterogeneity. Most of the urolithiasis was located in the kidney, with an estimated pooled proportion of 4.6% (95% CI = 2.7, 6.5), followed by bladder stone-2.0% (95% CI = 0.7, 3.4), ureteral stone-1.8% (95% CI = 0.7, 2.9), and urethral stone-0.2% (95% CI = 0.00, 0.05). The subgroup analysis showed the highest prevalence of urolithiasis was found in Mauritian, 28.1% (95%CI 24.5, 31.7), followed by Ethiopia 18.1%, and the lowest was in Eritrea, 1.0%. A sensitivity analysis using the random-effects model found no influential study on the pooled prevalence of urolithiasis. Evidence of significant publication bias was observed and trim-fill analysis was conducted for adjustment. Accordingly, two missing studies were identified, and after adjustment, the combined prevalence of urolithiasis was estimated to be 10.7%. The study also found that urolithiasis prevalence per gender was 6.3% in males and 2.9% in females. The most common clinical presentation of urolithiasis was flank pain at 58.4% (95% CL=, 45.9, 70.8), followed by low back pain at 45.9% (95% CL=, 23.1, 68.8), and nausea/vomiting at 29.9% (95% CI: 1 1.1, 48.8).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The prevalence of urolithiasis in Sub-Sahara African Countries is increasing even though a remarkable regional variation was observed, with","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387911","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
Vitamin D deficiency may increase the risk of acute kidney injury in patients with diabetes and predict a poorer outcome in patients with acute kidney injury. 缺乏维生素 D 可能会增加糖尿病患者发生急性肾损伤的风险,并预示着急性肾损伤患者的预后较差。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-07 DOI: 10.1186/s12882-024-03781-x
Xiao-Hua Li, Yu-Zhen Luo, Man-Qiu Mo, Tian-Yun Gao, Zhen-Hua Yang, Ling Pan

Backgound: People with diabetes are much more likely to develop acute kidney injury (AKI) than people without diabetes. Low 25-hydroxy-vitamin D [25(OH)D] concentrations increased the risk of AKI in specific populations. Few studies have explored the relationship between the 25(OH)D level and AKI in patients with diabetes. We conducted this study to investigate the relationship between the plasma level of 25(OH)D and the risk of AKI in patients with diabetes, and to evaluate whether the 25(OH)D level could be a good prognostic marker for AKI progression.

Methods: A total of 347 patients with diabetes were retrospectively reviewed. The primary endpoint was the first event of AKI. The secondary endpoint is need-of-dialysis. AKI patients were further followed up for 6 months with the composite endpoint of end-stage renal disease (ESRD) or all-cause death. Kaplan-Meier survival analysis and Cox proportional hazards models were used.

Results: During a median follow-up of 12 weeks (12.3 ± 6.7), 105 incident AKI were identified. The middle and high tertiles of baseline 25(OH)D levels were associated with a significantly decreased risk of AKI and dialysis compared to the low tertile group (HR = 0.25, 95% CI 0.14-0.46; HR = 0.24, 95% CI 0.13-0.44, respectively, for AKI; HR = 0.15; 95% CI 0.05-0.46; HR = 0.12; 95% CI 0.03-0.42, respectively, for dialysis). Sensitivity analysis revealed similar trends after excluding participants without history of CKD. Furthermore, AKI patients with 25(OH)D deficiency were associated with a higher risk for ESRD or all-cause death (HR, 4.24; 95% CI, 1.80 to 9.97, P < 0.001).

Conclusion: A low 25 (OH) vitamin D is associated with a higher risk of AKI and dialysis in patients with diabetes. AKI patients with 25(OH)D deficiency were associated with a higher risk for ESRD or all-cause death.

背景:糖尿病患者发生急性肾损伤(AKI)的几率远远高于非糖尿病患者。在特定人群中,25-羟基维生素 D [25(OH)D] 浓度低会增加急性肾损伤的风险。很少有研究探讨 25(OH)D 水平与糖尿病患者 AKI 之间的关系。我们进行了这项研究,以探讨糖尿病患者血浆中 25(OH)D 水平与 AKI 风险之间的关系,并评估 25(OH)D 水平是否可作为 AKI 进展的良好预后标志物:方法: 共对 347 名糖尿病患者进行了回顾性研究。主要终点是首次发生 AKI。次要终点是透析需求。对 AKI 患者进一步随访 6 个月,以终末期肾病 (ESRD) 或全因死亡为综合终点。采用卡普兰-梅耶生存分析和考克斯比例危险模型:中位随访时间为 12 周(12.3 ± 6.7),共发现 105 例 AKI。与低三分位组相比,基线25(OH)D水平的中高三分位组发生AKI和透析的风险显著降低(AKI的HR = 0.25,95% CI 0.14-0.46;HR = 0.24,95% CI 0.13-0.44;透析的HR = 0.15;95% CI 0.05-0.46;HR = 0.12;95% CI 0.03-0.42)。敏感性分析显示,在排除无慢性肾脏病病史的参与者后,趋势相似。此外,25(OH)D 缺乏的 AKI 患者发生 ESRD 或全因死亡的风险较高(HR,4.24;95% CI,1.80-9.97,P 结论):25 (OH) 维生素 D 低与糖尿病患者发生 AKI 和透析的风险较高有关。缺乏 25(OH)D 的 AKI 患者发生 ESRD 或全因死亡的风险更高。
{"title":"Vitamin D deficiency may increase the risk of acute kidney injury in patients with diabetes and predict a poorer outcome in patients with acute kidney injury.","authors":"Xiao-Hua Li, Yu-Zhen Luo, Man-Qiu Mo, Tian-Yun Gao, Zhen-Hua Yang, Ling Pan","doi":"10.1186/s12882-024-03781-x","DOIUrl":"https://doi.org/10.1186/s12882-024-03781-x","url":null,"abstract":"<p><strong>Backgound: </strong>People with diabetes are much more likely to develop acute kidney injury (AKI) than people without diabetes. Low 25-hydroxy-vitamin D [25(OH)D] concentrations increased the risk of AKI in specific populations. Few studies have explored the relationship between the 25(OH)D level and AKI in patients with diabetes. We conducted this study to investigate the relationship between the plasma level of 25(OH)D and the risk of AKI in patients with diabetes, and to evaluate whether the 25(OH)D level could be a good prognostic marker for AKI progression.</p><p><strong>Methods: </strong>A total of 347 patients with diabetes were retrospectively reviewed. The primary endpoint was the first event of AKI. The secondary endpoint is need-of-dialysis. AKI patients were further followed up for 6 months with the composite endpoint of end-stage renal disease (ESRD) or all-cause death. Kaplan-Meier survival analysis and Cox proportional hazards models were used.</p><p><strong>Results: </strong>During a median follow-up of 12 weeks (12.3 ± 6.7), 105 incident AKI were identified. The middle and high tertiles of baseline 25(OH)D levels were associated with a significantly decreased risk of AKI and dialysis compared to the low tertile group (HR = 0.25, 95% CI 0.14-0.46; HR = 0.24, 95% CI 0.13-0.44, respectively, for AKI; HR = 0.15; 95% CI 0.05-0.46; HR = 0.12; 95% CI 0.03-0.42, respectively, for dialysis). Sensitivity analysis revealed similar trends after excluding participants without history of CKD. Furthermore, AKI patients with 25(OH)D deficiency were associated with a higher risk for ESRD or all-cause death (HR, 4.24; 95% CI, 1.80 to 9.97, P < 0.001).</p><p><strong>Conclusion: </strong>A low 25 (OH) vitamin D is associated with a higher risk of AKI and dialysis in patients with diabetes. AKI patients with 25(OH)D deficiency were associated with a higher risk for ESRD or all-cause death.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387915","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
Magnitude of multiple drug use and determinants of vulnerability among chronic kidney disease inpatients in Ethiopia: a multi-center study. 埃塞俄比亚慢性肾病住院病人使用多种药物的程度及其易感性的决定因素:一项多中心研究。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-07 DOI: 10.1186/s12882-024-03773-x
Tirsit Ketsela Zeleke, Rahel Belete Abebe, Samuel Agegnew Wondm, Bantayehu Addis Tegegne

Background: Patients with chronic kidney disease frequently face various nutritional and metabolic problems that necessitate the use of multiple medications. This multiple drug use can lead to several drug-related problems including adverse drug events, hospital admissions, poor medication adherence, harmful drug interactions, inadequate therapeutic outcomes, and death. Despite these challenges, there is a notable lack of studies on the extent of multiple drug use and its determinants among patients with chronic kidney disease in Ethiopia. This study aims to assess the magnitude of multiple drug use and identify the determinants of vulnerability among patients with chronic kidney disease in Ethiopia.

Method: A hospital-based cross-sectional study was conducted among patients with chronic kidney disease. Eligible participants were selected using a simple random sampling technique. Frequency and percentage calculations were performed for categorical variables, while means and standard deviations were used for continuous variables. The chi-square test and t-test were used to compare the proportions and means, respectively. Binary logistic regression was used to identify the determinants of multiple drug use, with statistical significance determined by a p-value of less than 0.05 and a 95% confidence interval. Guidelines and previous literature were utilized to assess the magnitude of multiple drug use.

Results: A total of 230 patients were enrolled, with more than half being male. The overall magnitude of multiple drug use was 83.0%. Diuretics being the most frequently prescribed medication class followed by angiotensin converting enzyme inhibitors. Patients aged 65 years and above (AOR = 4.91 (95% CI 1.60-15.03)), CKD stage five (AOR) = 5.48 (95% CI 1.99-15.09)), and the presence of comorbid conditions (AOR) = 3.53 (95% CI 1.55-8.06)) were significantly associated with multiple drug use.

Conclusion: Chronic kidney disease patients exhibited a high rate of multiple drug use. The presence of comorbid conditions, disease progression and older age are significant determinates of this vulnerability. Health care providers should pay particular attention to these factors to manage and mitigate the risks associated with multiple drug use.

背景:慢性肾病患者经常面临各种营养和代谢问题,因此需要使用多种药物。多重用药可导致多种与药物相关的问题,包括药物不良事件、入院、用药依从性差、有害的药物相互作用、治疗效果不佳以及死亡。尽管存在这些挑战,但有关埃塞俄比亚慢性肾病患者多重用药的程度及其决定因素的研究却明显不足。本研究旨在评估埃塞俄比亚慢性肾脏病患者使用多种药物的程度,并确定其脆弱性的决定因素:在慢性肾病患者中开展了一项基于医院的横断面研究。采用简单随机抽样技术选取了符合条件的参与者。分类变量采用频率和百分比计算,连续变量采用平均值和标准差计算。比例和均值的比较分别采用卡方检验和 t 检验。使用二元逻辑回归来确定多重吸毒的决定因素,统计意义由小于 0.05 的 p 值和 95% 的置信区间决定。利用指南和以往文献来评估多重用药的程度:共有 230 名患者入选,其中一半以上为男性。多重用药的总体比例为 83.0%。利尿剂是最常用的处方药,其次是血管紧张素转换酶抑制剂。65 岁及以上患者(AOR = 4.91 (95% CI 1.60-15.03))、慢性肾脏病五期(AOR)= 5.48 (95% CI 1.99-15.09))和合并症(AOR)= 3.53 (95% CI 1.55-8.06))与多重用药显著相关:结论:慢性肾脏病患者的多重用药率很高。结论:慢性肾脏病患者的多重用药率很高,并发症的存在、疾病的进展和年龄的增大是导致这种脆弱性的重要因素。医疗服务提供者应特别关注这些因素,以管理和降低与多重用药相关的风险。
{"title":"Magnitude of multiple drug use and determinants of vulnerability among chronic kidney disease inpatients in Ethiopia: a multi-center study.","authors":"Tirsit Ketsela Zeleke, Rahel Belete Abebe, Samuel Agegnew Wondm, Bantayehu Addis Tegegne","doi":"10.1186/s12882-024-03773-x","DOIUrl":"10.1186/s12882-024-03773-x","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic kidney disease frequently face various nutritional and metabolic problems that necessitate the use of multiple medications. This multiple drug use can lead to several drug-related problems including adverse drug events, hospital admissions, poor medication adherence, harmful drug interactions, inadequate therapeutic outcomes, and death. Despite these challenges, there is a notable lack of studies on the extent of multiple drug use and its determinants among patients with chronic kidney disease in Ethiopia. This study aims to assess the magnitude of multiple drug use and identify the determinants of vulnerability among patients with chronic kidney disease in Ethiopia.</p><p><strong>Method: </strong>A hospital-based cross-sectional study was conducted among patients with chronic kidney disease. Eligible participants were selected using a simple random sampling technique. Frequency and percentage calculations were performed for categorical variables, while means and standard deviations were used for continuous variables. The chi-square test and t-test were used to compare the proportions and means, respectively. Binary logistic regression was used to identify the determinants of multiple drug use, with statistical significance determined by a p-value of less than 0.05 and a 95% confidence interval. Guidelines and previous literature were utilized to assess the magnitude of multiple drug use.</p><p><strong>Results: </strong>A total of 230 patients were enrolled, with more than half being male. The overall magnitude of multiple drug use was 83.0%. Diuretics being the most frequently prescribed medication class followed by angiotensin converting enzyme inhibitors. Patients aged 65 years and above (AOR = 4.91 (95% CI 1.60-15.03)), CKD stage five (AOR) = 5.48 (95% CI 1.99-15.09)), and the presence of comorbid conditions (AOR) = 3.53 (95% CI 1.55-8.06)) were significantly associated with multiple drug use.</p><p><strong>Conclusion: </strong>Chronic kidney disease patients exhibited a high rate of multiple drug use. The presence of comorbid conditions, disease progression and older age are significant determinates of this vulnerability. Health care providers should pay particular attention to these factors to manage and mitigate the risks associated with multiple drug use.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387910","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
Creatinine clearance/eGFR ratio: a simple index for muscle mass related to mortality in ICU patients. 肌酐清除率/eGFR 比值:与重症监护病房患者死亡率相关的肌肉质量简单指数。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-02 DOI: 10.1186/s12882-024-03760-2
Meint Volbeda, Hendrik W Zijlstra, Adrian Post, Jenny E Kootstra-Ros, Peter H J van der Voort, Casper F M Franssen, Maarten W Nijsten

Introduction: In patients admitted to the intensive care unit (ICU), muscle mass is inversely associated with mortality. Although muscle mass can be estimated with 24-h urinary creatinine excretion (UCE), its use for risk prediction in individual patients is limited because age-, sex-, weight- and length-specific reference values for UCE are lacking. The ratio between measured creatinine clearance (mCC) and estimated glomerular filtration rate (eGFR) might circumvent this constraint. The main goal was to assess the association of the mCC/eGFR ratio in ICU patients with all-cause hospital and long-term mortality.

Methods: The mCC/eGFR ratio was determined in patients admitted to our ICU between 2005 and 2021 with KDIGO acute kidney injury (AKI) stage 0-2 and an ICU stay ≥ 24 h. mCC was calculated from UCE and plasma creatinine and indexed to 1.73 m2. mCC/eGFR was analyzed by categorizing patients in mCC/eGFR quartiles and as continuous variable.

Results: Seven thousand five hundred nine patients (mean age 61 ± 15 years; 38% female) were included. In-hospital mortality was 27% in the lowest mCC/eGFR quartile compared to 11% in the highest quartile (P < 0.001). Five-year post-hospital discharge actuarial mortality was 37% in the lowest mCC/eGFR quartile compared to 19% in the highest quartile (P < 0.001). mCC/eGFR ratio as continuous variable was independently associated with in-hospital mortality in multivariable logistic regression (odds ratio: 0.578 (95% CI: 0.465-0.719); P < 0.001). mCC/eGFR ratio as continuous variable was also significantly associated with 5-year post-hospital discharge mortality in Cox regression (hazard ratio: 0.27 (95% CI: 0.22-0.32); P < 0.001).

Conclusions: The mCC/eGFR ratio is associated with both in-hospital and long-term mortality and may be an easily available index of muscle mass in ICU patients.

简介在重症监护病房(ICU)住院的患者中,肌肉质量与死亡率成反比。虽然肌肉质量可通过 24 小时尿肌酐排泄量(UCE)进行估算,但由于缺乏与年龄、性别、体重和身长相关的 UCE 参考值,因此其在个体患者风险预测中的应用受到了限制。测量的肌酐清除率(mCC)和估算的肾小球滤过率(eGFR)之间的比值可能会规避这一限制。主要目的是评估重症监护病房患者的 mCC/eGFR 比值与全因住院死亡率和长期死亡率的关系:根据 UCE 和血浆肌酐计算 mCC,并将其指数化为 1.73 m2。mCC/eGFR 的分析方法是将患者按 mCC/eGFR 四分位进行分类,并将其作为连续变量:共纳入 759 名患者(平均年龄 61 ± 15 岁;38% 为女性)。mCC/eGFR 最低四分位数患者的院内死亡率为 27%,最高四分位数患者的院内死亡率为 11%(PmCC/eGFR 比值与院内死亡率和长期死亡率都有关联,可能是 ICU 患者肌肉质量的一个简便指标。
{"title":"Creatinine clearance/eGFR ratio: a simple index for muscle mass related to mortality in ICU patients.","authors":"Meint Volbeda, Hendrik W Zijlstra, Adrian Post, Jenny E Kootstra-Ros, Peter H J van der Voort, Casper F M Franssen, Maarten W Nijsten","doi":"10.1186/s12882-024-03760-2","DOIUrl":"10.1186/s12882-024-03760-2","url":null,"abstract":"<p><strong>Introduction: </strong>In patients admitted to the intensive care unit (ICU), muscle mass is inversely associated with mortality. Although muscle mass can be estimated with 24-h urinary creatinine excretion (UCE), its use for risk prediction in individual patients is limited because age-, sex-, weight- and length-specific reference values for UCE are lacking. The ratio between measured creatinine clearance (mCC) and estimated glomerular filtration rate (eGFR) might circumvent this constraint. The main goal was to assess the association of the mCC/eGFR ratio in ICU patients with all-cause hospital and long-term mortality.</p><p><strong>Methods: </strong>The mCC/eGFR ratio was determined in patients admitted to our ICU between 2005 and 2021 with KDIGO acute kidney injury (AKI) stage 0-2 and an ICU stay ≥ 24 h. mCC was calculated from UCE and plasma creatinine and indexed to 1.73 m<sup>2</sup>. mCC/eGFR was analyzed by categorizing patients in mCC/eGFR quartiles and as continuous variable.</p><p><strong>Results: </strong>Seven thousand five hundred nine patients (mean age 61 ± 15 years; 38% female) were included. In-hospital mortality was 27% in the lowest mCC/eGFR quartile compared to 11% in the highest quartile (P < 0.001). Five-year post-hospital discharge actuarial mortality was 37% in the lowest mCC/eGFR quartile compared to 19% in the highest quartile (P < 0.001). mCC/eGFR ratio as continuous variable was independently associated with in-hospital mortality in multivariable logistic regression (odds ratio: 0.578 (95% CI: 0.465-0.719); P < 0.001). mCC/eGFR ratio as continuous variable was also significantly associated with 5-year post-hospital discharge mortality in Cox regression (hazard ratio: 0.27 (95% CI: 0.22-0.32); P < 0.001).</p><p><strong>Conclusions: </strong>The mCC/eGFR ratio is associated with both in-hospital and long-term mortality and may be an easily available index of muscle mass in ICU patients.</p>","PeriodicalId":9089,"journal":{"name":"BMC Nephrology","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364339","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
The epidemiology and microbiology of central venous catheter related bloodstream infections among hemodialysis patients in the Philippines: a retrospective cohort study. 菲律宾血液透析患者中心静脉导管相关血流感染的流行病学和微生物学:一项回顾性队列研究。
IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY Pub Date : 2024-10-02 DOI: 10.1186/s12882-024-03776-8
Renz Michael Pasilan, Isabelle Dominique Tomacruz-Amante, Coralie Therese Dimacali

Background: Despite efforts to improve the management of catheter-related bloodstream infections (CRBSI) in literature, temporary CVCs continue to be used for maintenance hemodialysis outside of acute care settings, particularly in the Philippines.

Methods: We conducted a retrospective cohort study to investigate the incidence, outcomes, risk factors, and microbiological patterns of CRBSI among adult kidney disease patients undergoing hemodialysis at the Philippine General Hospital, the country's largest tertiary referral center. We included all adult patients who received a CVC for hemodialysis from January 1, 2018, to August 31, 2019, and followed them for six months to observe the occurrence of CRBSI and its outcomes.

Results: Our study documented a CRBSI incidence rate of 6.72 episodes per 1000 catheter days, with a relapse rate of 5.08%, a reinfection rate of 15.74%, and a mortality rate of 6.09%. On multivariable regression analysis, we identified autoimmune disease, dialysis frequency of > 3 × per week, use of CVC for either blood transfusion or IV medications, renal hypoperfusion, drug-induced nephropathy, and hypertensive kidney disease as significant risk factors for CRBSI. Gram-negative bacteria, including B. cepacia complex, Enterobacter, and Acinetobacter spp, were the most common organisms causing CRBSI. Multidrug-resistant organisms (MDROs) comprised almost half of the isolates (n = 89, 44.5%), with Coagulase-negative Staphylococcus species having the highest proportion among gram-positive organisms and Acinetobacter spp. among gram-negative isolates.

Conclusion: Our findings emphasize the need for more stringent measures and interventions to prevent the propagation of identified pathogens, such as a review of sterile technique and adequate hygiene practices, continued surveillance, and expedited placement and utilization of long-term access for patients on maintenance hemodialysis. Furthermore, CVC use outside of hemodialysis should be discouraged, and common antibiotic regimens such as piperacillin-tazobactam and fluoroquinolones should be reviewed for their low sensitivity patterns among gram-negative isolates. Addressing these issues can improve hemodialysis patients' outcomes and reduce the CRBSI burden in our institution.

背景:尽管文献中努力改善导管相关血流感染(CRBSI)的管理,但临时性 CVC 仍被用于急症护理环境以外的维持性血液透析,尤其是在菲律宾:我们进行了一项回顾性队列研究,调查了在菲律宾最大的三级转诊中心--菲律宾总医院接受血液透析的成年肾病患者中 CRBSI 的发生率、结果、风险因素和微生物模式。我们纳入了2018年1月1日至2019年8月31日期间接受CVC血液透析的所有成年患者,并对他们进行了为期6个月的随访,以观察CRBSI的发生情况及其结果:我们的研究记录显示,每1000导管日CRBSI发生率为6.72次,复发率为5.08%,再感染率为15.74%,死亡率为6.09%。通过多变量回归分析,我们发现自身免疫性疾病、每周透析次数大于 3 次、使用 CVC 输血或静脉注射药物、肾脏灌注不足、药物性肾病和高血压肾病是 CRBSI 的重要风险因素。革兰氏阴性菌(包括复合头孢杆菌、肠杆菌属和醋氨梭菌属)是导致 CRBSI 的最常见细菌。耐多药菌类(MDROs)几乎占到分离菌类的一半(n = 89,44.5%),其中凝固酶阴性葡萄球菌在革兰氏阳性菌中所占比例最高,而不动杆菌属则在革兰氏阴性菌中所占比例最高:我们的研究结果表明,有必要采取更严格的措施和干预措施来防止已确定病原体的传播,如审查无菌技术和适当的卫生习惯、持续监控、加快为维持性血液透析患者安置和使用长期通路。此外,应避免在血液透析之外使用 CVC,并对哌拉西林-他唑巴坦和氟喹诺酮类等常用抗生素方案进行审查,以确定其在革兰氏阴性分离菌中的低敏感性模式。解决这些问题可以改善血液透析患者的治疗效果,减轻本机构的 CRBSI 负担。
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BMC Nephrology
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