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Primary Care Providers Barriers, Comfort and Awareness in Follow-up Care of Acute Kidney Injury Patients: A Comprehensive Survey on Current Practices. 初级保健提供者在急性肾损伤患者随访护理中的障碍、舒适度和意识:当前做法综合调查。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-12-13 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241304517
Jean-Maxime Côté, William Beaubien-Souligny, Lauriane Hamel, Josée Bouchard

Background: Patients who experienced acute kidney injury (AKI) may benefit from dedicated care following hospital discharge. Most of these patients will be followed by primary care providers. There is a lack of data on current practices and comfort for these care providers when offering post-AKI care.

Objective: We surveyed nurse practitioners and family physicians to assess their awareness, perceptions, practice patterns and comfort regarding post-AKI care.

Design/setting: We distributed a web-based self-administered survey among clinicians from the Province of Quebec. We asked about their awareness and perceptions on how AKI should be disclosed and followed, the barriers encountered regarding the process of care following hospital discharge, and their level of comfort and expertise in offering dedicated post-AKI care. The survey integrated direct and scenario-based questions and was conducted from December 2022 to April 2023.

Participants: We distributed the survey to practicing family physicians and nurse practitioners through the mailing list of the Fédération des Médecins Omnipraticiens du Québec, and the Association des infirmières praticiennes spécialisées du Québec, respectively. No incentives were provided.

Methods: We conducted descriptive analyses and used chi-squared analysis to compare responses between family physicians and nurse practitioners and between hospital-based and cabinet-based practice.

Results: The survey was opened by 779 potential participants. Of these, the response rate was 9% (70/779). Most participants were family physicians (79%) and dedicated 70% (±32) of their time in community outpatient clinics. Participants reported that 59% (±20) of all patients seen daily had at least 1 risk factor for AKI, whereas they estimated that 21% (±12) of recently discharged patients suffered from an AKI episode. The lack of awareness by the patient and lack of details on the discharge summary were the barriers most frequently reported impacting the overall process of care at follow-up. Most nurse practitioners (60%) and 33% of family physicians reported at least some levels of discomfort and lack of expertise when offering post-AKI.

Limitations: The generalizability of our study is limited by its response rate. However, this is comparable with typical response rates seen in electronic surveys. The distribution was limited to a single province of Canada.

Conclusions: We reported significant barriers regarding the hospital-to-community transition of care in patients who experienced AKI and the suboptimal comfort and expertise of primary care providers when offering dedicated post-AKI care. This reflects the need to improve communication, collaboration, and AKI training with primary care providers.

背景:急性肾损伤(AKI)患者出院后可能会受益于专门的护理。这些患者中的大多数将由初级保健提供者随访。目前还缺乏有关这些医疗服务提供者在提供 AKI 后护理时的做法和舒适度的数据:我们对执业护士和家庭医生进行了调查,以评估他们对 AKI 后护理的认识、看法、实践模式和舒适度:我们向魁北克省的临床医生发放了一份基于网络的自填式调查问卷。我们询问了他们对如何披露和跟踪 AKI 的认识和看法、出院后护理过程中遇到的障碍,以及他们在提供 AKI 后专门护理方面的舒适度和专业知识水平。调查综合了直接问题和情景问题,调查时间为 2022 年 12 月至 2023 年 4 月:我们分别通过魁北克全科医师联合会和魁北克专科护士协会的邮件列表向执业家庭医生和执业护士发放了调查问卷。没有提供任何奖励:我们进行了描述性分析,并使用卡方分析比较了家庭医生和执业护士之间以及医院执业和内阁执业之间的回复情况:779 名潜在参与者打开了调查问卷。其中,回复率为 9%(70/779)。大多数参与者是家庭医生(79%),70%(±32)的时间在社区门诊工作。参与者报告说,在每天接诊的所有患者中,59%(±20)的患者至少有一个导致 AKI 的危险因素,而他们估计最近出院的患者中有 21%(±12)的患者曾发生过 AKI。患者缺乏意识和出院摘要缺乏细节是影响随访护理整体流程的最常见障碍。大多数执业护士(60%)和 33% 的家庭医生表示,在提供 AKI 后护理时至少会有一定程度的不适和缺乏专业知识:我们研究的推广性受到了回复率的限制。然而,这与电子调查中的典型回复率相当。调查范围仅限于加拿大的一个省:我们报告了经历过 AKI 的患者在从医院到社区的护理过渡中遇到的重大障碍,以及初级医疗服务提供者在提供专门的 AKI 后护理时的舒适度和专业知识不够理想。这反映出需要加强与初级医疗服务提供者的沟通、合作和 AKI 培训。
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引用次数: 0
Randomized Trials Using Provincial Health Numbers for Group Assignment. 使用省健康号码进行分组分配的随机试验。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-12-06 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241304510
Amit X Garg, Stephanie N Dixon, Charlotte Ma, Erika Basile, Bin Luo, Magda Nunes De Melo, Amber O Molnar, Naveen Poonai, Michael J Schull, Samuel A Silver, Jessica M Sontrop, Merrick Zwarenstein, Pavel Roshanov

Purpose: Using data from Ontario, Canada, this report shows how provincial government-assigned health card numbers can be used for individual-level randomization in large pragmatic trials. We describe how health card numbers are assigned and analyze the distribution of health card digits in a trial setting. We then provide an example of how they can be used for randomization and discuss the methodological and practical considerations of the approach.

Key findings: In Ontario, Canada, health card numbers are randomly generated and assigned without regard to the applicant's characteristics. The number is a 10-digit string connected with hyphens followed by a version code (ie, 1234-567-890-XX). The number is unique to each individual and assigned for life. Before assignment, some numbers within the 10 digits are altered using proprietary business rules. We demonstrate how to use certain digits for individual-level randomization and provide an example of how we will use the tenth digit for randomization in a large new trial of different dialysate bicarbonate concentrations. While this approach has many practical and methodological advantages, it does not allow for stratification. Before using this approach, teams should consider if it will affect the integrity of the randomization and the trial, which will be influenced by the setting and the type of intervention tested.

Implications: Using provincial government-assigned health card numbers for pragmatic randomized trials appears viable, but the merits must be carefully considered on a trial-by-trial basis. The approach can streamline and reduce the cost of conducting such trials.

目的:使用来自加拿大安大略省的数据,本报告展示了省政府分配的健康卡号如何在大型实用试验中用于个人水平的随机化。我们描述了健康卡号是如何分配的,并分析了健康卡号在试验设置中的分布。然后,我们提供了一个如何将它们用于随机化的例子,并讨论了该方法的方法学和实际考虑。主要发现:在加拿大安大略省,健康卡号码是随机生成和分配的,而不考虑申请人的特征。该号码是一个由连字符连接的10位字符串,后跟一个版本代码(例如,1234-567-890-XX)。这个号码对每个人来说都是独一无二的,并且是终身分配的。在分配之前,使用专有业务规则更改10位数内的一些数字。我们演示了如何使用某些数字进行个体水平的随机化,并提供了一个例子,说明我们将如何在不同碳酸氢盐透析液浓度的大型新试验中使用第十位数进行随机化。虽然这种方法有许多实际和方法上的优点,但它不允许分层。在使用这种方法之前,团队应该考虑它是否会影响随机化和试验的完整性,这将受到环境和干预测试类型的影响。启示:在实用的随机试验中使用省政府指定的健康卡号似乎是可行的,但必须在逐个试验的基础上仔细考虑其优点。这种方法可以简化并降低进行此类试验的成本。
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引用次数: 0
The Use of Autologous Omentum Transposition as a Therapeutic Intervention to Reduce the Complication of Ischemia/Reperfusion Injuries in a Rat Model. 自体大网膜转位治疗大鼠缺血/再灌注损伤并发症的研究
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-28 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241300773
Amirreza Shamshirgaran, Abdolreza Mohammadi, Parisa Zahmatkesh, Gholamreza Mesbah, Fateme Guitynavard, Zahra Saffarian, Alireza Khajavi, Leonardo Oliveira Reis, Seyed Mohammad Kazem Aghamir

Background: Ischemia/reperfusion injury (IRI) causes cellular dysfunction and death in organs like the kidney, heart, and brain. It involves energy depletion during ischemia and oxidative stress, inflammation, and apoptosis during reperfusion. Kidney IRI often leads to acute kidney injury (AKI) in various clinical scenarios. The omentum, an adipose tissue with healing properties, has been used to treat injuries in different organs.

Objective: This study aimed to assess the omentum's healing effects on reducing IRI's adverse effects after renal ischemia in Wistar rats.

Method: A total number of 36 male Wistar rats were used in a study on IRI-induced AKI. Rats were divided into 6 groups of normal kidneys wrapped with omentum "Sham-1" and "Sham-2," ischemic kidney wrapped with omentum as "OMT-1" and "OMT-2," and ischemic kidney without omentum as "Control-1" and "Control-2." Ischemia was induced by clamping the left renal artery for 45 minutes. The omentum was transposed onto the injured kidney in "OMT" group. After sacrifice at weeks 4 and 8, kidney histology and blood samples were analyzed for kidney function markers.

Results: On the first day after surgery, there was an immediate increase in creatinine and blood urea nitrogen (BUN) levels, which then decreased by day 28. Both OMT groups showed significantly lower levels of creatinine and BUN compared to Control groups on day 1, but after 28 days differences were not statistically significant. Histological analysis using H&E and Masson's trichrome staining revealed significantly higher levels of inflammatory cell infiltration and hyperemia in the OMT groups. However, fibrosis and glomerular shrinkage were higher in the Control groups.

Conclusion: Using an omental flap significantly prevented fibrosis within the renal parenchyma, slow down the AKI progression, and potentially serving as a promising therapeutic strategy for kidney dysfunction.

背景:缺血/再灌注损伤(IRI)可引起肾、心、脑等器官的细胞功能障碍和死亡。它包括缺血和氧化应激时的能量消耗、再灌注时的炎症和细胞凋亡。在各种临床情况下,肾IRI常导致急性肾损伤(AKI)。网膜是一种具有愈合特性的脂肪组织,已被用于治疗不同器官的损伤。目的:探讨大网膜对Wistar大鼠肾缺血后IRI不良反应的修复作用。方法:采用雄性Wistar大鼠36只,对急性脑损伤(AKI)进行研究。将大鼠分为6组,正常肾包网膜“Sham-1”和“Sham-2”组,缺血肾包网膜“OMT-1”和“OMT-2”组,缺血肾不包网膜“Control-1”和“Control-2”组。左肾动脉夹持缺血45分钟。“OMT”组将大网膜转置到损伤肾上。在第4周和第8周献祭后,分析肾脏组织学和血液样本的肾功能标志物。结果:术后第1天肌酐和血尿素氮(BUN)水平立即升高,第28天下降。与对照组相比,OMT组在第1天的肌酐和BUN水平均显著降低,但28天后差异无统计学意义。H&E和Masson三色染色的组织学分析显示,OMT组炎症细胞浸润和充血水平明显升高。然而,对照组的纤维化和肾小球收缩更大。结论:使用大网膜皮瓣可显著防止肾实质纤维化,减缓AKI的进展,并可能作为肾功能障碍的一种有前景的治疗策略。
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引用次数: 0
Brentuximab-Induced Acute Interstitial Nephritis: A Case Report. 布托昔单抗诱发急性间质性肾炎:病例报告。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-25 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241300766
Matthew Patterson, Pouneh Dokouhaki, Chance S Dumaine, Rebecca MacKay, Davina J Tai

Brentuximab vedotin is a combination monoclonal antibody to anti-CD30 conjugated to the anti-tubulin agent monomethyl auristatin E. It is approved for the treatment of mycosis fungoides, Hodgkin's lymphoma, and systemic anaplastic large cell lymphoma. Brentuximab has been associated with a number of potential adverse reactions; however, reports of renal complications are rare. A 73-year-old male with mycosis fungoides was admitted to hospital with acute kidney injury following his third cycle of brentuximab. The patient's serum creatinine (SCr) was 122 µmol/L with an estimated glomerular filtration rate (eGFR) of 58 mL/min/1.73 m2 at baseline. Following brentuximab, his SCr peaked at 1073 µmol/L over a 4-week period. Acute interstitial nephritis (AIN) was diagnosed after other causes of acute kidney injury were ruled out and subsequently confirmed on kidney biopsy. The patient was started on prednisone 50 mg daily. This was continued for 3 weeks, followed by a 5-week taper. The patient's SCr decreased to 156 µmol/L by completion of the prednisone taper. He was not rechallenged with brentuximab. A kidney biopsy confirmed AIN in keeping with injury from an immune checkpoint inhibitor (ICI). However, brentuximab is not an ICI. The AIN from ICIs typically has tubulointerstitial inflammatory infiltrate comprised of T lymphocytes such as the case presented here. Therefore, this represents both a novel histopathologic finding in AIN from a non-ICI medication and a rare complication of brentuximab, previously only presented in abstract form.

布伦妥昔单抗(Brentuximab vedotin)是一种抗CD30单克隆抗体与抗微管蛋白制剂单甲基奥司他丁E结合的复方制剂,已被批准用于治疗真菌病、霍奇金淋巴瘤和全身性无性大细胞淋巴瘤。布伦妥昔单抗与许多潜在的不良反应有关,但肾脏并发症的报道很少见。一名患有真菌病的 73 岁男性患者在使用布伦妥昔单抗第三个周期后因急性肾损伤入院。患者的血清肌酐(SCr)为 122 µmol/L,基线估计肾小球滤过率(eGFR)为 58 mL/min/1.73 m2。使用布伦妥昔单抗后,他的血肌酐(SCr)在四周内达到峰值 1073 µmol/L。在排除了导致急性肾损伤的其他原因后,他被诊断为急性间质性肾炎(AIN),随后肾活检证实了这一诊断。患者开始服用泼尼松,每天 50 毫克。持续用药 3 周,然后减量 5 周。泼尼松减量结束后,患者的 SCr 降至 156 µmol/L。他没有再接受布伦妥昔单抗治疗。肾活检证实,AIN 与免疫检查点抑制剂(ICI)的损伤一致。然而,布伦妥昔单抗并不是一种 ICI。ICI 引起的 AIN 通常会出现由 T 淋巴细胞组成的肾小管间质炎症浸润,本病例就是如此。因此,这既是非 ICI 药物所致 AIN 的一种新的组织病理学发现,也是布伦妥昔单抗的一种罕见并发症,以前仅以摘要形式出现过。
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引用次数: 0
Single Center Experience With Sodium-Glucose Co-Transporter-2 Inhibitors (SGLT2i) in Kidney Transplant Recipients With Diabetes. 糖尿病肾移植受者使用钠-葡萄糖协同转运体-2 抑制剂 (SGLT2i) 的单中心经验。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-11 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241293202
Albi Angjeli, Tess Montada-Atin, Rosane Nisenbaum, Niki Dacouris, Michelle Nash, G V Ramesh Prasad, Jeffrey Zaltzman
<p><strong>Background: </strong>Sodium-glucose co-tranporter-2 inhibitors have been shown to be safe and effective in patients with type 2 diabetes for improving glycemia. Furthermore large, randomized control trials have shown cardiovascular and renal benefits. However, limited safety and efficacy data is available in kidney transplant patients with diabetes.</p><p><strong>Objective: </strong>To investigate the safety and efficacy of SGLT2i use on stability of renal function in adult kidney transplant recipients (KTR) with type 2 diabetes mellitus (DM2) or New Onset Diabetes After Transplantation (NODAT).</p><p><strong>Design: </strong>We performed a single center, retrospective cohort study pre- and post-SGLT2i exposure.</p><p><strong>Patients: </strong>Adults with DM2 or NODAT who received a living or deceased kidney transplant (Tx) and started on an SGLT2i post-Tx were reviewed. Patients who had type 1 diabetes were excluded.</p><p><strong>Measurements and methods: </strong>The baseline was the SGLT2i start date. We reviewed available data from 24 months (M) before and after SGLT2i initiation. The primary endpoints were the effects of SGLT2i use on stability of renal function using serum creatinine and eGFR, change in urine albumin excretion(uACR), and glycosylated hemoglobin (A1C). Secondary endpoints compared blood pressure, body mass index and adverse reactions at baseline and quarterly after SGLT2i initiation.</p><p><strong>Results: </strong>125 KTRs were included in cohort: NODAT (52, 42%), DM2 (73, 58%); female (33, 27%); mean age at Tx 55 years (25-75); LD (56, 45%), DD (69, 55%); mean duration of Tx (6.8 years, 0.1-42.5); study follow-up (1.8 years, 0.3-4.9).The mean eGFR remained stable pre-SGLT2i at 64.6 mL/min/1.73m<sup>2</sup>, vs post at 64.3 mL/min/1.73m<sup>2</sup>. There was no difference in mean A1C after SGLT2i initiation. The slope of uACR using natural log transformation pre-SGLT2i compared with post-SGLT2i slope reduced from +0.7 (0.03, 0.11) to -0.04 (-0.01, -0.35) mg/mmol/3mths (<i>P</i> = .002). The risk of developing new genital mycotic infections among all patients was 4% (95% CI 1.3%-9.1%) While there was no significant difference in UTI before (13.6%) and after (12%) SGLT2i use (<i>P</i> = .68), there was a higher risk of UTI seen in patients with a previous history of UTI (23.5%) vs no previous history (10.2%) post initiation. There was no significant increase in AKI pre 8%, post 10.4%, <i>P</i> = .51. There was a single DKA event pre- and post-SGLT2.</p><p><strong>Limitations: </strong>The limitations of this study include its retrospective nonrandomized nature.</p><p><strong>Conclusion: </strong>In this retrospective analysis, SGLT2i use in KTR appears to be safe and efficacious with stable renal function and glycemic control, alongside improvements in uACR. There was a low risk of new genital yeast infections after SGLT2i start. UTI occurrence was higher in patients with a previous history of UTI compared with
背景:钠-葡萄糖共转运体-2 抑制剂已被证明对改善 2 型糖尿病患者的血糖安全有效。此外,大型随机对照试验也显示了对心血管和肾脏的益处。然而,肾移植糖尿病患者使用该药的安全性和疗效数据有限:研究 SGLT2i 对患有 2 型糖尿病(DM2)或移植后新发糖尿病(NODAT)的成年肾移植受者(KTR)肾功能稳定性的安全性和有效性:我们在SGLT2i暴露前后进行了一项单中心回顾性队列研究:我们对接受活体或死体肾移植(Tx)并在移植后开始服用 SGLT2i 的 DM2 或 NODAT 成人患者进行了回顾性研究。不包括1型糖尿病患者:基线为开始使用 SGLT2i 的日期。我们回顾了开始使用 SGLT2i 之前和之后 24 个月(M)的可用数据。主要终点是使用 SGLT2i 对血清肌酐和 eGFR 肾功能稳定性的影响、尿白蛋白排泄量(uACR)的变化以及糖化血红蛋白(A1C)。次要终点比较了基线和开始使用 SGLT2i 后每季度的血压、体重指数和不良反应:结果:125 名 KTR 纳入队列:NODAT(52,42%),DM2(73,58%);女性(33,27%);平均治疗年龄 55 岁(25-75);LD(56,45%),DD(69,55%);平均治疗时间(6.SGLT2i治疗前的平均eGFR稳定在64.6 mL/min/1.73m2,治疗后为64.3 mL/min/1.73m2。使用 SGLT2i 后,平均 A1C 没有差异。SGLT2i前与SGLT2i后相比,采用自然对数转换的uACR斜率从+0.7 (0.03, 0.11) mg/mmol/3月降至-0.04 (-0.01, -0.35)mg/mmol/3月(P = .002)。虽然使用 SGLT2i 之前(13.6%)和之后(12%)的 UTI 没有显著差异(P = .68),但在开始使用后,有 UTI 既往史(23.5%)和无 UTI 既往史(10.2%)的患者发生 UTI 的风险更高。AKI 在启动前为 8%,启动后为 10.4%,P = 0.51。SGLT前后均发生过一次DKA事件2:本研究的局限性包括其回顾性非随机性质:在这项回顾性分析中,SGLT2i 用于 KTR 似乎安全有效,肾功能和血糖控制稳定,uACR 也有所改善。开始使用 SGLT2i 后,发生新的生殖器酵母感染的风险较低。与无尿毒症病史的患者相比,有尿毒症病史的患者发生尿毒症的几率更高。
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引用次数: 0
COVID-19 and Acute Kidney Injury Outcomes in Hospitalized Patients Following SARS-CoV-2 Vaccination: A Case-Control Study. COVID-19 与接种 SARS-CoV-2 疫苗后住院患者的急性肾损伤结果:病例对照研究
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-10 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241297369
Froylan D Martínez-Sánchez, Luis A Bastida-Castro, José L Torres-Cuevas, Julio A Vasquez-Vasquez, Alejandra Diaz-Jarquin, Rafael Moreno-Novales, Joana Balderas-Juarez, Mauricio A Salinas-Ramírez, Jose L Hernández-Castillo, Erika K Tenorio-Aguirre

Background: Acute kidney injury (AKI) is a frequent complication associated with severe COVID-19 and has been linked to increased mortality. While vaccination against SARS-CoV-2 has shown effectiveness in reducing severe COVID-19 outcomes, its impact on the development of AKI among hospitalized patients remains unclear.

Objective: To evaluate the effect of SARS-CoV-2 vaccination on the incidence and severity of AKI and 28-day mortality among hospitalized patients with severe COVID-19.

Design: Retrospective case-control study.

Setting: Conducted at the Internal Medicine Department of Hospital General Dr. Manuel Gea González, Mexico, from April 2020 to December 2021.

Patients: 413 patients over 18 with confirmed severe COVID-19 were included. Patients were categorized based on their vaccination status before COVID-19 infection.

Measurements: Key outcomes included the incidence of AKI, progression to AKI stage 3, and 28-day mortality. AKI was defined according to the KDIGO criteria.

Methods: Data were analyzed using univariate and logistic regression models to assess the association between vaccination status and the studied outcomes. Covariates included age, sex, BMI, type 2 diabetes, hypertension, and inflammatory markers.

Results: Among the 413 patients, 70% developed AKI, with a median hospital stay of 10 days (range 6-17). Vaccinated patients had a significantly lower incidence of AKI compared with nonvaccinated patients (48.7% vs 74.9%; P < .001). After adjusting for confounding factors, vaccination was associated with lower odds of AKI (OR: 0.252, 95% CI: 0.140-0.452), AKI stage 3 (OR: 0.448, 95% CI: 0.205-0.981), and 28-day mortality (OR: 0.187, 95% CI: 0.064-0.544).

Limitations: As a single-center retrospective study, generalizability is limited. In addition, vaccination data were obtained from medical records, and the completeness of vaccination could not be independently verified.

Conclusions: SARS-CoV-2 vaccination was independently associated with a reduced risk of AKI, AKI stage 3, and 28-day mortality in hospitalized patients with severe COVID-19. These findings highlight the potential protective effects of vaccination against severe kidney complications in this population.

背景:急性肾损伤(AKI)是与严重 COVID-19 相关的常见并发症,并与死亡率增加有关。尽管接种 SARS-CoV-2 疫苗在减少严重 COVID-19 结果方面显示出了有效性,但其对住院患者发生急性肾损伤的影响仍不明确:目的:评估接种 SARS-CoV-2 疫苗对重症 COVID-19 住院患者 AKI 发生率和严重程度以及 28 天死亡率的影响:设计:回顾性病例对照研究:2020 年 4 月至 2021 年 12 月在墨西哥 Manuel Gea González 总医院内科进行:共纳入 413 名 18 岁以上确诊患有严重 COVID-19 的患者。根据感染 COVID-19 前的疫苗接种情况对患者进行分类:主要结果包括 AKI 发生率、AKI 进展至 3 期以及 28 天死亡率。AKI根据KDIGO标准定义:采用单变量和逻辑回归模型对数据进行分析,以评估疫苗接种情况与研究结果之间的关联。协变量包括年龄、性别、体重指数、2 型糖尿病、高血压和炎症指标:在413名患者中,70%发生了AKI,中位住院时间为10天(6-17天不等)。与未接种疫苗的患者相比,接种疫苗的患者发生 AKI 的比例明显较低(48.7% vs 74.9%;P < .001)。调整混杂因素后,接种疫苗与较低的 AKI(OR:0.252,95% CI:0.140-0.452)、AKI 3 期(OR:0.448,95% CI:0.205-0.981)和 28 天死亡率(OR:0.187,95% CI:0.064-0.544)相关:局限性:这是一项单中心回顾性研究,可推广性有限。此外,疫苗接种数据来自医疗记录,无法独立核实疫苗接种的完整性:结论:SARS-CoV-2 疫苗接种与严重 COVID-19 住院患者发生 AKI、AKI 3 期和 28 天死亡率的风险降低有独立关联。这些发现凸显了接种疫苗对该人群严重肾脏并发症的潜在保护作用。
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引用次数: 0
Prevalence, Characteristics, and Outcomes of People With A High Body Mass Index Across the Kidney Disease Spectrum: A Population-Based Cohort Study. 高体重指数肾病患者的患病率、特征和预后:一项基于人群的队列研究。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-10 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241293199
Gurleen Sahi, Jennifer Reid, Louise Moist, Michael Chiu, Amanda Vinson, Saverio Stranges, Kyla Naylor, Yunxu Zhu, Kristin K Clemens
<p><strong>Background: </strong>Obesity has a major impact on health and health care, particularly in those with chronic kidney disease (CKD).</p><p><strong>Objective: </strong>The objective was to describe the prevalence, characteristics, and outcomes of people living with CKD and obesity (defined by a body mass index [BMI] ≥30 kg/m<sup>2</sup>) in Canada.</p><p><strong>Design: </strong>Population-based cohort study using linked administrative health data (ICES).</p><p><strong>Patients: </strong>Adults aged 18 year and older with CKD G1-5D who had a height and weight recorded during a visit to an academic hospital in London Ontario Canada, between January 2010 and December 2019.</p><p><strong>Measures: </strong>CKD as defined by CKD 3A or higher. BMI as defined by weight kg/m<sup>2</sup>.</p><p><strong>Methods: </strong>As a primary interest, we described the percentage of patients with CKD across different BMI categories (<25 kg/m<sup>2</sup>, BMI 25-29.9 kg/m<sup>2</sup>, and BMI ≥30 kg/m<sup>2</sup>), as well as their demographic and clinical profiles. As secondary interests, we followed patients until January 1, 2022 to summarize: (1) the percentage with CKD G3 who had kidney disease progression (50% decline from baseline estimated glomerular filtration rate [eGFR]) by BMI category, (2) the percentage with CKD G3-4 who developed kidney failure (initiation of maintenance dialysis or an eGFR of <15 mL/min/1.73 m<sup>2</sup>) by BMI category, (3) the percentage with CKD G4-G5D who received a kidney transplant by BMI category, and (4) post-transplant outcomes in those transplanted over the study period, by BMI category. We performed similar analyses across CKD risk categories.</p><p><strong>Results: </strong>Of the 198 151 patients included, the percentage with obesity defined by a BMI ≥30 kg/m<sup>2</sup> increased from CKD G1 to CKD G4 (ie, 37% of those with CKD G1 had a BMI ≥30 kg/m<sup>2</sup> vs 40.9% of CKD G4). In CKD G5D and CKD T, the prevalence of high BMI appeared to drop (only ~38% had a BMI ≥30 kg/m<sup>2</sup> across groups). Across CKD categories, those with a BMI ≥30 kg/m<sup>2</sup> appeared to have more comorbidities, use more health care resources, and have more socioeconomic disparities than those with lower BMIs. Although secondary outcome events were limited, those with G3-4 with a BMI ≥30 kg/m<sup>2</sup> appeared to have a higher risk of CKD progression and those with CKD G5D with BMI ≥30 kg/m<sup>2</sup> were less likely to receive transplant over the study period. Interestingly those transplanted with a BMI ≥30 kg/m<sup>2</sup> appeared to have fewer post-transplant complications. We also observed an "obesity-paradox" in the risk of mortality, with high BMI appearing protective, particularly in the end stages of kidney disease.</p><p><strong>Limitations: </strong>We used BMI to capture obesity in this study but recognize its limitations as a measure of body composition. Secondary outcomes were descriptive and unadjusted
背景:肥胖对健康和医疗保健有重大影响,尤其是对慢性肾脏病(CKD)患者:目的:描述加拿大患有慢性肾脏病和肥胖(定义为体重指数[BMI]≥30 kg/m2)的人群的患病率、特征和结果:设计:基于人群的队列研究,使用关联的行政健康数据(ICES):患者:2010 年 1 月至 2019 年 12 月期间在加拿大安大略省伦敦市一家学术医院就诊并记录了身高和体重的 18 岁及以上 CKD G1-5D 成人:CKD 定义为 CKD 3A 或更高。体重指数以体重 kg/m2 为标准:作为主要兴趣点,我们描述了不同 BMI 类别(2、BMI 25-29.9 kg/m2 和 BMI ≥30 kg/m2)的 CKD 患者比例,以及他们的人口统计学和临床概况。作为次要兴趣,我们对患者进行了跟踪调查,直至 2022 年 1 月 1 日,以总结(1) 按 BMI 分类,CKD G3 患者中肾病进展(估计肾小球滤过率 [eGFR] 比基线下降 50%)的比例;(2) 按 BMI 分类,CKD G3-4 患者中出现肾衰竭(开始维持性透析或 eGFR 为 2)的比例;(3) 按 BMI 分类,CKD G4-G5D 患者中接受肾移植的比例;(4) 按 BMI 分类,研究期间接受移植者的移植后结果。我们对不同的 CKD 风险类别进行了类似的分析:在纳入的 198 151 例患者中,从 CKD G1 到 CKD G4,BMI ≥30 kg/m2 的肥胖患者比例有所增加(即 CKD G1 患者中 37% 的人 BMI ≥30 kg/m2 ,而 CKD G4 患者中 40.9% 的人 BMI ≥30 kg/m2)。在 CKD G5D 和 CKD T 中,高体重指数的发生率似乎有所下降(各组中只有约 38% 的人体重指数≥30 kg/m2)。在所有 CKD 类别中,BMI ≥30 kg/m2 的患者似乎比 BMI 较低的患者有更多的并发症,使用更多的医疗资源,并有更多的社会经济差异。虽然次要结果事件有限,但 BMI ≥30 kg/m2 的 G3-4 患者似乎有更高的 CKD 进展风险,而 BMI ≥30 kg/m2 的 CKD G5D 患者在研究期间接受移植的可能性较低。有趣的是,那些体重指数≥30 kg/m2的移植患者似乎有较少的移植后并发症。我们还观察到死亡率风险中的 "肥胖副作用",高体重指数似乎具有保护作用,尤其是在肾脏疾病的晚期:局限性:在本研究中,我们使用体重指数(BMI)来衡量肥胖程度,但也认识到其作为身体成分衡量标准的局限性。由于样本量较小,次要结果是描述性的,未经调整,可能会受到选择偏差和混杂因素的影响:结论:由高体重指数定义的肥胖在慢性肾脏病患者中非常普遍,患者在健康、医疗保健和社会方面存在差异。未来的研究对于了解 BMI 对 CKD 患者的影响以及如何在 CKD 的各个阶段对 BMI 和肥胖进行个体化管理仍然非常重要。
{"title":"Prevalence, Characteristics, and Outcomes of People With A High Body Mass Index Across the Kidney Disease Spectrum: A Population-Based Cohort Study.","authors":"Gurleen Sahi, Jennifer Reid, Louise Moist, Michael Chiu, Amanda Vinson, Saverio Stranges, Kyla Naylor, Yunxu Zhu, Kristin K Clemens","doi":"10.1177/20543581241293199","DOIUrl":"https://doi.org/10.1177/20543581241293199","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Obesity has a major impact on health and health care, particularly in those with chronic kidney disease (CKD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective was to describe the prevalence, characteristics, and outcomes of people living with CKD and obesity (defined by a body mass index [BMI] ≥30 kg/m&lt;sup&gt;2&lt;/sup&gt;) in Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Population-based cohort study using linked administrative health data (ICES).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients: &lt;/strong&gt;Adults aged 18 year and older with CKD G1-5D who had a height and weight recorded during a visit to an academic hospital in London Ontario Canada, between January 2010 and December 2019.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measures: &lt;/strong&gt;CKD as defined by CKD 3A or higher. BMI as defined by weight kg/m&lt;sup&gt;2&lt;/sup&gt;.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;As a primary interest, we described the percentage of patients with CKD across different BMI categories (&lt;25 kg/m&lt;sup&gt;2&lt;/sup&gt;, BMI 25-29.9 kg/m&lt;sup&gt;2&lt;/sup&gt;, and BMI ≥30 kg/m&lt;sup&gt;2&lt;/sup&gt;), as well as their demographic and clinical profiles. As secondary interests, we followed patients until January 1, 2022 to summarize: (1) the percentage with CKD G3 who had kidney disease progression (50% decline from baseline estimated glomerular filtration rate [eGFR]) by BMI category, (2) the percentage with CKD G3-4 who developed kidney failure (initiation of maintenance dialysis or an eGFR of &lt;15 mL/min/1.73 m&lt;sup&gt;2&lt;/sup&gt;) by BMI category, (3) the percentage with CKD G4-G5D who received a kidney transplant by BMI category, and (4) post-transplant outcomes in those transplanted over the study period, by BMI category. We performed similar analyses across CKD risk categories.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 198 151 patients included, the percentage with obesity defined by a BMI ≥30 kg/m&lt;sup&gt;2&lt;/sup&gt; increased from CKD G1 to CKD G4 (ie, 37% of those with CKD G1 had a BMI ≥30 kg/m&lt;sup&gt;2&lt;/sup&gt; vs 40.9% of CKD G4). In CKD G5D and CKD T, the prevalence of high BMI appeared to drop (only ~38% had a BMI ≥30 kg/m&lt;sup&gt;2&lt;/sup&gt; across groups). Across CKD categories, those with a BMI ≥30 kg/m&lt;sup&gt;2&lt;/sup&gt; appeared to have more comorbidities, use more health care resources, and have more socioeconomic disparities than those with lower BMIs. Although secondary outcome events were limited, those with G3-4 with a BMI ≥30 kg/m&lt;sup&gt;2&lt;/sup&gt; appeared to have a higher risk of CKD progression and those with CKD G5D with BMI ≥30 kg/m&lt;sup&gt;2&lt;/sup&gt; were less likely to receive transplant over the study period. Interestingly those transplanted with a BMI ≥30 kg/m&lt;sup&gt;2&lt;/sup&gt; appeared to have fewer post-transplant complications. We also observed an \"obesity-paradox\" in the risk of mortality, with high BMI appearing protective, particularly in the end stages of kidney disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;We used BMI to capture obesity in this study but recognize its limitations as a measure of body composition. Secondary outcomes were descriptive and unadjusted","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241293199"},"PeriodicalIF":1.6,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142615341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Role of SGLT-2 Inhibitors in Ultrafiltration Failure in Peritoneal Dialysis: A Narrative Review. SGLT-2 抑制剂在腹膜透析超滤失败中的作用:叙述性综述。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-05 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241293500
Magdalena Riedl Khursigara, Ping Liu, Reetinder Kaur, Thomas A Mavrakanas

Purpose of review: Sodium-glucose co-transporter-2 (SGLT-2) inhibitors are glucose lowering agents with protective effects on cardiovascular health and the ability to slow chronic kidney disease (CKD) progression. The benefits of SGLT-2 inhibitors have not been studied in patients with advanced CKD or on maintenance dialysis. Ultrafiltration failure is a common reason for failure of peritoneal dialysis (PD). Glucose transporters, such as SGLT-2, are involved in the progression to ultrafiltration failure, and hence, SGLT-2 inhibitors might be beneficial in patients on PD to prevent ultrafiltration failure.

Source of information: Here, we review data from animal models and ongoing clinical trials of SGLT-2 inhibitors in advanced CKD, as well as considerations for a phase III trial in patients on PD.

Methods: A literature search was conducted and information on clinical trials was obtained from clinicaltrials.gov.

Key findings: Animal models of PD have shown upregulation of glucose transporters in the peritoneal membrane and a potential effect of SGLT-2 inhibitors on glucose absorption and ultrafiltration. Several clinical trials are currently ongoing with SGLT-2 inhibitors in patients on PD. We discuss their study designs and propose a mixed-methods, patient-centered approach to studying SGLT-2 inhibitors in PD patients. We also discuss the potential implications of SGLT-2 inhibitors on people living with kidney failure, especially in remote communities.

综述目的:钠-葡萄糖共转运体-2(SGLT-2)抑制剂是一种降糖药物,对心血管健康具有保护作用,并能延缓慢性肾病(CKD)的进展。目前尚未研究 SGLT-2 抑制剂对晚期 CKD 患者或维持性透析患者的益处。超滤失败是腹膜透析(PD)失败的常见原因。SGLT-2等葡萄糖转运体参与了超滤衰竭的进展,因此,SGLT-2抑制剂可能有利于腹膜透析患者预防超滤衰竭:在此,我们回顾了SGLT-2抑制剂在晚期CKD中的动物模型和正在进行的临床试验数据,以及在PD患者中进行III期试验的考虑因素:方法:进行文献检索,并从 clinicaltrials.gov.cn 获取临床试验信息:主要发现:腹膜透析动物模型显示腹膜葡萄糖转运体上调,SGLT-2抑制剂对葡萄糖吸收和超滤有潜在影响。目前正在进行几项针对腹膜透析患者的 SGLT-2 抑制剂临床试验。我们讨论了它们的研究设计,并提出了一种以患者为中心的混合方法来研究 SGLT-2 抑制剂在帕金森病患者中的应用。我们还讨论了 SGLT-2 抑制剂对肾衰竭患者,尤其是偏远社区患者的潜在影响。
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引用次数: 0
GLP-1 Agonism for Kidney Transplant Recipients: A Narrative Review of Current Evidence and Future Directions Across the Research Spectrum. 肾移植受者的 GLP-1 激动剂:当前证据和未来研究方向综述》。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-10-31 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241290317
Victoria J Riehl-Tonn, Kyle D Medak, Christie Rampersad, Anne MacPhee, Tyrone G Harrison

Purpose of review: Diabetes is the most common cause of kidney disease in individuals that receive a kidney transplant, and those without pre-existing diabetes are at greater risk of developing diabetes following kidney transplant. A class of diabetes treatment medications called glucagon-like peptide-1 receptor agonists (GLP-1RA) has seen recent widespread use for people with diabetes or obesity, with efficacy for improved glycemic control, weight loss, and reduced risk of cardiovascular events. Given these benefits, and indications for use that often co-occur in kidney transplant recipients, use of GLP-1RAs warrants consideration in this population. Therefore, we sought to review the current literature to better understand the mechanisms of action, clinical application, and person-centred considerations of GLP-1RAs in kidney transplant recipients.

Sources of information: Original articles were identified between December 2023 and July 2024 from electronic databases including the Ovid MEDLINE database, PubMed, and Google Scholar using terms "kidney transplant," "GLP-1," "glucagon-like peptide-1 receptor agonist," and "diabetes."

Methods: A comprehensive review of the literature was conducted to explore the relationship between GLP-1RAs and kidney transplant recipients. We reviewed the current state of evidence across the research disciplines of basic or fundamental science, clinical and health services research, and person-centred equity science, and highlighted important knowledge gaps that offer opportunities for future research.

Key findings: Numerous clinical studies have demonstrated the benefit of GLP-1RAs in people with and without diabetic kidney disease, including decreased risk of cardiovascular events. However, there is a paucity of high-quality randomized controlled trials and observational studies analyzing use of GLP-1RAs in kidney transplant recipients. Evidence of benefit in this population is therefore limited to small studies or inferred from research conducted in nontransplant populations. Growing evidence from preclinical and clinical studies may elucidate renoprotective mechanisms of GLP-1RAs and remove barriers to application of these drugs in the transplant recipient population. Individuals who are female, non-white, have lower socioeconomic status, and live in rural communities are at greater risk of diabetes and have lower uptake of GLP-1RAs. There is a need for clinical trials across diverse kidney transplant populations to estimate the efficacy of GLP-1RAs on important health outcomes.

Limitations: The search strategy for this narrative review may not have been sensitive to identify all relevant articles. Our search was limited to English language articles.

审查目的:在接受肾移植的患者中,糖尿病是导致肾脏疾病的最常见原因,而没有糖尿病的患者在接受肾移植后患糖尿病的风险更大。最近,一类名为胰高血糖素样肽-1受体激动剂(GLP-1RA)的糖尿病治疗药物被广泛用于糖尿病或肥胖症患者,其疗效包括改善血糖控制、减轻体重和降低心血管事件风险。鉴于这些益处以及肾移植受者中经常出现的适应症,在这一人群中使用 GLP-1RAs 值得考虑。因此,我们试图回顾目前的文献,以更好地了解 GLP-1RA 在肾移植受者中的作用机制、临床应用以及以人为本的考虑因素:采用 "肾移植"、"GLP-1"、"胰高血糖素样肽-1 受体激动剂 "和 "糖尿病 "等术语,从 Ovid MEDLINE 数据库、PubMed 和 Google Scholar 等电子数据库中查找 2023 年 12 月至 2024 年 7 月间的原创文章:我们对文献进行了全面回顾,以探讨 GLP-1RA 与肾移植受者之间的关系。我们回顾了基础或基本科学、临床和健康服务研究以及以人为本的公平科学等研究学科的证据现状,并强调了为未来研究提供机会的重要知识缺口:大量临床研究表明,GLP-1RAs 可为糖尿病肾病患者或非糖尿病肾病患者带来益处,包括降低心血管事件风险。然而,对肾移植受者使用 GLP-1RA 进行分析的高质量随机对照试验和观察性研究却很少。因此,在这一人群中获益的证据仅限于小型研究,或根据在非移植人群中进行的研究推断。临床前研究和临床研究中越来越多的证据可能会阐明 GLP-1RAs 的肾脏保护机制,并消除这些药物在移植受者人群中应用的障碍。女性、非白人、社会经济地位较低、生活在农村社区的人患糖尿病的风险更大,对 GLP-1RAs 的吸收率也更低。需要对不同的肾移植人群进行临床试验,以评估 GLP-1RA 对重要健康结果的疗效:本综述的搜索策略可能无法识别所有相关文章。我们的搜索仅限于英语文章。
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引用次数: 0
Patient Perspectives of Telemedicine in Outpatient Nephrology Clinics During COVID-19: A Qualitative Study. COVID-19 期间患者对肾脏病门诊远程医疗的看法:定性研究。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-10-28 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241293192
Abdelhady Osman, Seung Heyck Lee, Mateen Noori, Melissa Al-Jaishi, Kerri Gallo, Lori Harwood, Louise Moist

Background: The COVID-19 pandemic notably disrupted care for patients with chronic kidney disease (CKD) care, necessitating a rapid shift to telemedicine. Despite the growing use of telemedicine, the impact of this transition on patients' experiences, particularly in Canada and considering sociocultural factors, remains underexplored. This study aims to investigate patients with CKD perspectives on telemedicine versus in-person care and to offer recommendations for enhancing telemedicine services.

Objective: The objective was to understand patients with CKD views on telemedicine clinics during the pandemic compared to traditional in-person clinics.

Design: This was a qualitative descriptive study employing semi-structured interviews.

Setting: This study was conducted in general nephrology and multidisciplinary kidney care clinics in London, Canada.

Population: The study population was English-speaking patients with CKD with at least one in-person nephrology visit before March 15, 2020, and one telemedicine appointment after March 30, 2020.

Methods: Interviews were conducted using a structured guide, with transcripts analyzed line-by-line by 3 independent reviewers through directed content analysis. Themes were identified and agreed upon through group consensus.

Results: Interviews with 12 participants revealed 5 key themes: (1) convenience; (2) building connection and trust; (3) necessity of in-person care; (4) role of family or caregivers; and (5) preferences for clinic types. Most participants (11/12) valued the convenience of telemedicine, noting similar levels of care compared to in-person visits. However, they found it easier to establish personal connections in face-to-face appointments. Most (8/12) preferred in-person visits if their condition worsened. Overall, a combination of in-person and telemedicine was favored, with a preference for video over telephone.

Limitations: The study's focus on one academic nephrology center in Ontario and predominantly white participants limits broader applicability. Additionally, recall bias may affect the findings due to the interview-based design.

Conclusions: Telemedicine will remain integral to CKD care, with a hybrid model combining in-person and telemedicine preferred. Integrating patient feedback into future telemedicine practices is essential to enhance flexibility, access, and patient satisfaction.

背景:COVID-19 大流行明显扰乱了对慢性肾脏病 (CKD) 患者的护理,因此有必要迅速转向远程医疗。尽管远程医疗的使用越来越多,但这一转变对患者体验的影响,尤其是在加拿大并考虑到社会文化因素,仍未得到充分探讨。本研究旨在调查慢性肾脏病患者对远程医疗与面对面医疗的看法,并为加强远程医疗服务提供建议:目的:了解慢性肾脏病患者对大流行期间远程医疗诊所与传统面对面诊所的看法:这是一项采用半结构化访谈的定性描述性研究:研究在加拿大伦敦的普通肾脏病学和多学科肾脏护理诊所进行:研究对象:2020 年 3 月 15 日之前接受过至少一次肾内科面诊、2020 年 3 月 30 日之后接受过一次远程医疗预约的讲英语的慢性肾脏病患者:采用结构化指南进行访谈,由 3 位独立审稿人通过定向内容分析对访谈记录进行逐行分析。结果:对 12 名参与者的访谈揭示了 5 个主题:对 12 名参与者的访谈揭示了 5 个关键主题:(1) 便捷性;(2) 建立联系和信任;(3) 亲自护理的必要性;(4) 家庭或护理人员的作用;(5) 对诊所类型的偏好。大多数参与者(11/12)重视远程医疗的便利性,并指出远程医疗的护理水平与面对面就诊的护理水平相似。不过,他们认为面对面的预约更容易建立个人联系。如果病情恶化,大多数人(8/12)倾向于亲自到医院就诊。总的来说,他们更倾向于将面诊和远程医疗结合起来,视频比电话更受欢迎:局限性:这项研究的重点是安大略省的一家肾脏病学术中心,参与者主要是白人,这限制了研究的广泛适用性。此外,基于访谈的设计可能会影响研究结果的回忆偏差:结论:远程医疗仍将是慢性肾脏病治疗不可或缺的一部分,最好采用现场和远程医疗相结合的混合模式。将患者的反馈融入未来的远程医疗实践对提高灵活性、可及性和患者满意度至关重要。
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引用次数: 0
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Canadian Journal of Kidney Health and Disease
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