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Acute Kidney Injury in Neonates Admitted to a Low-Resource Neonatal Intensive Care Unit in Lusaka, Zambia. 赞比亚卢萨卡一家资源匮乏的新生儿重症监护室收治的新生儿急性肾损伤。
IF 1.6 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-07-25 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241263160
Mavis Chishala, Sylvia Machona-Muyunda, Chisambo Mwaba

Background: Neonatal acute kidney injury (nAKI) has been reported to be common among neonates admitted to the Neonatal Intensive Care Unit (NICU) and is associated with increased mortality and prolonged duration of hospital stay. However, data on this entity from sub-Saharan Africa are scanty.

Objectives: This study aimed to assess the burden, risk factors, and short-term outcomes of nAKI in neonates admitted to a low-resource NICU in Zambia.

Design: The design of the study is a prospective cohort study.

Setting: The setting of this study was the NICU at the Women and Newborn Hospital of the University Teaching Hospitals (WNBH-UTHs).

Patients: In total, 322 neonates who were admitted to the NICU between November 2021 and December 2022.

Methods: A serum creatinine was determined on all patients at admission (within 24 hours), at 72 hours and day 7. The modified neonatal Kidney Disease: Improving Global Outcome (KDIGO) Criteria were used to define nAKI. Data were extracted using a predesigned form and analyzed using SPSS. A P-value less than .05 was considered statistically significant.

Results: The prevalence of nAKI was 13.7% (44/322). On multivariable regression analysis, antepartum hemorrhage (adjusted odds ratio [AOR] 5.58; 95% confidence interval [CI]: [1.62-19.13], P = .007), vomiting in the neonate (AOR 5.76; 95% CI: [1.10-30.32], P = .04), history of use of unit second-line antibiotics, meropenem (AOR 4.37; 95% CI: [1.97-9.69], P < .001), and ciprofloxacin (AOR 4.53; 95% CI: [1.22-16.84], P = .02) were associated with increased risk of nAKI. Acute kidney injury (AKI) was significantly associated with longer length of hospital stay and higher mortality (P < .05).

Limitations: The study did not use the urine output criteria to define nAKI and this may have led to an underestimation of nAKI prevalence. Additionally, kidney, ureter, and bladder ultrasound was not performed on any of the study participants.

Conclusion: AKI is common in neonates admitted to the NICU at WNBH-UTHs, and it is associated with a higher risk of mortality and prolonged length of hospital stay. Further studies among the various NICU sub-populations are needed to better characterize risks and outcomes.

背景:据报道,新生儿急性肾损伤(NAKI)在新生儿重症监护室(NICU)收治的新生儿中很常见,与死亡率增加和住院时间延长有关。然而,撒哈拉以南非洲地区有关该疾病的数据却很少:本研究旨在评估赞比亚一家资源匮乏的新生儿重症监护室收治的新生儿患纳克病的负担、风险因素和短期疗效:研究设计为前瞻性队列研究:研究地点:大学教学医院妇女和新生儿医院(WNBH-UTHs)的新生儿重症监护室:患者:2021年11月至2022年12月期间入住新生儿重症监护室的322名新生儿:所有患者在入院时(24 小时内)、72 小时和第 7 天均测定了血清肌酐。方法:对所有患者在入院时(24 小时内)、72 小时和第 7 天进行血清肌酐测定:改善总体预后 (KDIGO) 标准来定义 nAKI。使用预先设计的表格提取数据,并使用 SPSS 进行分析。P值小于0.05为具有统计学意义:nAKI 的发生率为 13.7%(44/322)。经多变量回归分析,产前出血(调整赔率[AOR]5.58;95% 置信区间[CI]:[1.62-19.13],P = .007)、新生儿呕吐(AOR 5.76;95% CI:[1.10-30.32],P = .04)、二线抗生素美罗培南使用史(AOR 4.37;95% CI:[1.97-9.69],P = .02)与发生 nAKI 的风险增加有关。急性肾损伤(AKI)与住院时间延长和死亡率升高密切相关(P 限制:该研究没有使用尿量标准来定义 nAKI,这可能导致 nAKI 发生率被低估。此外,没有对任何研究参与者进行肾脏、输尿管和膀胱超声检查:结论:AKI在西北卡罗来纳州立大学附属医院新生儿重症监护室收治的新生儿中很常见,它与较高的死亡风险和较长的住院时间有关。需要对新生儿重症监护病房的不同亚群进行进一步研究,以更好地确定风险和结果。
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引用次数: 0
The Correlation of MicroRNA-21 With the Nephrin, Podocin, and Urinary Albumin-Creatinine Ratio in Patients With Type 2 Diabetes and Albuminuria: A Cross-Sectional Study. MicroRNA-21与2型糖尿病和白蛋白尿患者的肾素、Podocin和尿白蛋白-肌酐比值的相关性:一项横断面研究
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-06-17 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241260948
Pringgodigdo Nugroho, Tri Hadi Susanto, Maruhum Bonar, Aulia Rizka, Aida Lydia, Soekamto Koesno, Pradana Soewondo, Hamzah Shatri, Carissa Cornelia Chundiawan, Fidel Hermanto

Background: Diabetic kidney disease (DKD) is the most common and deranging microvascular complication of diabetes mellitus (DM). Podocytopathy is a key component of glomerular damage in DKD. Micro RNA-21 (miRNA-21) is an epigenetic regulator that plays a role in podocyte damage; however, the results of previous studies have not resolved the controversy about the role of miRNA-21 in the pathogenesis of DKD.

Objective: The objective was to investigate the correlation between miRNA-21 levels and urinary nephrin, podocin, and urinary albumin-creatinine ratio (UACR) in patients with type 2 DM and albuminuria.

Design: This is a cross-sectional study.

Setting: This study was carried out in internal medicine outpatient clinic of Cipto Mangunkusumo Hospital Jakarta, Indonesia.

Patients: This study consisted of 42 adults with type 2 DM and albuminuria.

Measurements: The measurements include (1) Serum miRNA-21; (2) urinary podocin, nephrin, and albumin-creatinine ratio; and (3) serum miRNA-21 correlated to urinary podocin, nephrin, and albumin-creatinine ratio.

Methods: The Spearman bivariate analysis to assess the correlation of miRNA-21 with nephrin, podocin, and UACR.

Results: The mean relative expression of miRNA-21 was 0.069 (0.024), the median for nephrin, podocin, and UACR was 35.5 (15.75-51.25) ng/mL, 0.516 (0.442-0.545) ng/mL, and 150 (94.56-335.75) ng/mL, respectively. A correlation between miRNA-21 and nephrin was observed (r = 0.598; P < .0001). There was a correlation between miRNA-21 and UACR (r = 0.604; P < .0001). No correlation was found between miRNA-21 and podocin.

Limitations: A lack of non-DM and non-albuminuric control population and small sample size. We could not exclude concurrent disease, and all other potential confounding variables, particularly those related to inflammation.

Conclusions: The miRNA-21 can be considered an early biomarker for podocytopathy and albuminuria in DM, highlighting its potential for early diagnostic and therapeutic interventions. Further research is required to confirm these findings and explore their clinical applications, which could significantly alter management strategies for DKD.

背景:糖尿病肾病(DKD)是糖尿病(DM)最常见、最严重的微血管并发症。荚膜细胞病变是糖尿病肾病肾小球损害的关键组成部分。微RNA-21(miRNA-21)是一种表观遗传调节因子,在荚膜细胞损伤中发挥作用;然而,以往的研究结果并未解决有关miRNA-21在DKD发病机制中作用的争议:目的:研究2型DM和白蛋白尿患者的miRNA-21水平与尿肾素、荚膜蛋白和尿白蛋白-肌酐比值(UACR)之间的相关性:设计:这是一项横断面研究:本研究在印度尼西亚雅加达 Cipto Mangunkusumo 医院内科门诊进行:研究对象:42 名患有 2 型糖尿病和白蛋白尿的成年人:测量项目包括:(1)血清 miRNA-21;(2)尿荚膜蛋白、肾素和白蛋白-肌酐比值;(3)血清 miRNA-21 与尿荚膜蛋白、肾素和白蛋白-肌酐比值的相关性:方法:采用Spearman双变量分析评估miRNA-21与肾素、荚膜蛋白和尿蛋白-肌酐比值的相关性:结果:miRNA-21的平均相对表达量为0.069(0.024),肾素、荚膜素和UACR的中位数分别为35.5(15.75-51.25)纳克/毫升、0.516(0.442-0.545)纳克/毫升和150(94.56-335.75)纳克/毫升。miRNA-21 与肾素之间存在相关性(r = 0.598;P < .0001)。miRNA-21 与 UACR 存在相关性(r = 0.604;P < .0001)。miRNA-21 与 podocin 之间没有相关性:局限性:缺乏非糖尿病和非白蛋白尿对照人群,样本量较小。我们无法排除并发症和所有其他潜在的混杂变量,尤其是与炎症相关的变量:结论:miRNA-21可被视为DM患者荚膜细胞病变和白蛋白尿的早期生物标志物,它具有早期诊断和治疗干预的潜力。需要进一步的研究来证实这些发现并探索其临床应用,这可能会大大改变 DKD 的管理策略。
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引用次数: 0
Thymoquinone Nanoparticles (TQ-NPs) in Kidney Toxicity Induced by Ehrlich Ascites Carcinoma (EAC): An In Vivo Study. 胸腺醌纳米颗粒(TQ-NPs)在艾氏腹水癌(EAC)诱导的肾脏毒性中的作用:体内研究。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-06-10 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241258812
Zakaria Eltahir, Maha Ibrahim, Muniera Y Mohieldeen, Ammar Bayoumi, Samia M Ahmed

Background: Cisplatin (Cis) is potent chemotherapy used to treating already many different types of cancer; however, it is found to correlate with nephrotoxicity and other adverse health consequences. Thymoquinone (TQ) is an antioxidant and anti-inflammatory molecule that may defend against the consequences of different chemotherapies. Thymoquinone uses, although, are negatively impacted by its weak solubility and inadequate biological availability.

Objectives: This investigation examined the efficacy of a new nanoparticle (NP) absorbing TQ in an Ehrlich Ascites Carcinoma (EAC) mice model to address its low solubility, enhance its bioavailability, and protect against Cis-induced nephrotoxicity.

Methods: Following 4 treatment groups were included in this research: (1) control, (2) EAC, (3) EAC + Cis + Thymoquinone nanoparticle (TQ-NP) treated, and (4) EAC + Cis-treated.

Results: The study revealed that TQ-NP was efficacious in avoiding Cis-induced kidney problems in EAC mice, as well as restoring kidney function and pathology. Thymoquinone nanoparticle considerably reduced Cis-induced oxidative damage in renal tissue by augmenting antioxidant levels. According to tumor weight and histological investigation results, TQ-NP did not impair Cis's anticancer efficacy.

Conclusion: Thymoquinone nanoparticle might be used as a potential drug along with Cis anticancer therapy to reduce nephrotoxicity and other side effects while maintaining Cis anticancer properties.

背景:顺铂(Cis)是一种强效化疗药物,可用于治疗多种不同类型的癌症;然而,人们发现它与肾毒性和其他不良健康后果有关。胸腺醌(TQ)是一种抗氧化剂和抗炎分子,可以抵御不同化疗的后果。不过,胸腺醌的使用受到其弱溶解性和生物可用性不足的负面影响:本研究考察了一种新型纳米粒子(NP)吸收胸腺醌在艾氏腹水癌(EAC)小鼠模型中的疗效,以解决其溶解度低的问题,提高其生物利用度,并防止顺式疗法引起的肾毒性:研究包括以下 4 个处理组:(1) 对照组;(2) EAC;(3) EAC + Cis + 胸腺醌纳米粒子(TQ-NP)处理组;(4) EAC + Cis 处理组:研究结果表明,TQ-NP能有效避免Cis诱导的EAC小鼠肾脏问题,并能恢复肾脏功能和病理变化。胸腺醌纳米粒子通过提高抗氧化剂水平,大大减少了顺式诱导的肾组织氧化损伤。根据肿瘤重量和组织学检查结果,TQ-NP并未损害Cis的抗癌功效:结论:胸腺醌纳米粒子可作为一种潜在的药物,与顺式抗癌疗法一起使用,在保持顺式抗癌特性的同时,减少肾毒性和其他副作用。
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引用次数: 0
Association of Glomerular Filtration Rate Decline With Clinical Outcomes in a Population With Type 2 Diabetes. 2 型糖尿病患者肾小球滤过率下降与临床结果的关系
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-06-10 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241255781
Scott W Klarenbach, David Collister, Natasha Wiebe, Aminu Bello, Stephanie Thompson, Neesh Pannu

Background: While historical rate of decline in kidney function is informally used by clinicians to estimate risk of future adverse clinical outcomes especially kidney failure, in people with type 2 diabetes the epidemiology and independent association of historical eGFR slope on risk is not well described.

Objective: Determine the association of eGFR slope and risk of clinically important outcomes.

Design setting and patients: Observational population-based cohort with type 2 diabetes in Alberta.

Measurement and methods: An Alberta population-based cohort with type 2 diabetes was assembled, characterized, and observed over 1 year (2018) for clinical outcomes of ESKD, first myocardial infarction, first stroke, heart failure, and disease-specific and all-cause hospitalization and mortality. Kidney function was defined using KDIGO criteria using the most recent eGFR and albuminuria measured in the preceding 18 months; annual eGFR slope utilized measurements in the 3 years prior and was parameterized using three methods (percentiles, and linear term with and without missingness indicator). Demographics, laboratory results, medications, and comorbid conditions using validated definitions were described. In addition to descriptive analysis, odds ratios from fully adjusted logistic models regressing outcomes on eGFR slope are reported; the marginal risk of clinical outcomes was also determined.

Results: Among 336 376 participants with type 2 diabetes, the median annual eGFR slope was -0.41 mL/min/1.73 m2 (IQR -1.67, 0.62). In fully adjusted models, eGFR slope was independently associated with many adverse clinical outcomes; among those with ≤10th percentile of slope (median -4.71 mL/min/1.73 m2) the OR of kidney failure was 2.22 (95% CI 1.75, 2.82), new stroke 1.23 (1.08, 1.40), heart failure 1.42 (1.27, 1.59), MI 0.98 (0.77, 1.23) all-cause hospitalization 1.31 (1.26, 1.36) and all-cause mortality 1.56 (1.44, 1.68). For every -1 mL/min/1.73 m2 in eGFR slope, the OR of outcomes ranged from 1.01 (0.98, 1.05 for new MI) to 1.09 (1.08, 1.10 for all-cause mortality); findings were significant for 10 of the 13 outcomes considered.

Limitations: Causality cannot be established with this study design.

Conclusions: These findings support consideration of the rate of eGFR decline in risk stratification and may inform clinicians and policymakers to optimize treatment and inform health care system planning.

背景:虽然临床医生非正式地使用肾功能的历史下降率来估计未来不良临床结局(尤其是肾衰竭)的风险,但在 2 型糖尿病患者中,eGFR 历史斜率的流行病学和与风险的独立关联尚未得到很好的描述:确定 eGFR 斜率与临床重要结果风险的关系:艾伯塔省 2 型糖尿病人群观察性队列:对艾伯塔省 2 型糖尿病人群队列进行了组建、特征描述,并对 ESKD、首次心肌梗死、首次中风、心力衰竭、疾病特异性和全因住院及死亡率等临床结局进行了为期 1 年(2018 年)的观察。肾功能根据 KDIGO 标准定义,采用前 18 个月测量的最新 eGFR 和白蛋白尿;年度 eGFR 斜率采用前 3 年的测量值,并使用三种方法(百分位数、带或不带遗漏指标的线性项)进行参数化。此外,还对人口统计学、实验室结果、药物和合并症进行了描述,并使用了经过验证的定义。除描述性分析外,还报告了根据 eGFR 斜率对结果进行回归的完全调整逻辑模型得出的几率;还确定了临床结果的边际风险:在 336 376 名 2 型糖尿病患者中,eGFR 年斜率中位数为-0.41 mL/min/1.73 m2(IQR-1.67, 0.62)。在完全调整模型中,eGFR斜率与许多不良临床结果独立相关;在斜率≤第10百分位数的人群中(中位数为-4.71 mL/min/1.73 m2),肾衰竭的OR值为2.22 (95% CI 1.75, 2.82),新发中风 1.23 (1.08, 1.40),心力衰竭 1.42 (1.27, 1.59),心肌梗死 0.98 (0.77, 1.23),全因住院 1.31 (1.26, 1.36),全因死亡率 1.56 (1.44, 1.68)。eGFR 坡度每增加 -1 mL/min/1.73 m2,结果的 OR 值从 1.01(新发心肌梗死为 0.98,1.05)到 1.09(全因死亡率为 1.08,1.10)不等;在考虑的 13 项结果中,有 10 项结果具有显著性:局限性:该研究设计无法确定因果关系:这些研究结果支持在进行风险分层时考虑 eGFR 的下降率,可为临床医生和政策制定者提供优化治疗和医疗保健系统规划的信息。
{"title":"Association of Glomerular Filtration Rate Decline With Clinical Outcomes in a Population With Type 2 Diabetes.","authors":"Scott W Klarenbach, David Collister, Natasha Wiebe, Aminu Bello, Stephanie Thompson, Neesh Pannu","doi":"10.1177/20543581241255781","DOIUrl":"10.1177/20543581241255781","url":null,"abstract":"<p><strong>Background: </strong>While historical rate of decline in kidney function is informally used by clinicians to estimate risk of future adverse clinical outcomes especially kidney failure, in people with type 2 diabetes the epidemiology and independent association of historical eGFR slope on risk is not well described.</p><p><strong>Objective: </strong>Determine the association of eGFR slope and risk of clinically important outcomes.</p><p><strong>Design setting and patients: </strong>Observational population-based cohort with type 2 diabetes in Alberta.</p><p><strong>Measurement and methods: </strong>An Alberta population-based cohort with type 2 diabetes was assembled, characterized, and observed over 1 year (2018) for clinical outcomes of ESKD, first myocardial infarction, first stroke, heart failure, and disease-specific and all-cause hospitalization and mortality. Kidney function was defined using KDIGO criteria using the most recent eGFR and albuminuria measured in the preceding 18 months; annual eGFR slope utilized measurements in the 3 years prior and was parameterized using three methods (percentiles, and linear term with and without missingness indicator). Demographics, laboratory results, medications, and comorbid conditions using validated definitions were described. In addition to descriptive analysis, odds ratios from fully adjusted logistic models regressing outcomes on eGFR slope are reported; the marginal risk of clinical outcomes was also determined.</p><p><strong>Results: </strong>Among 336 376 participants with type 2 diabetes, the median annual eGFR slope was -0.41 mL/min/1.73 m<sup>2</sup> (IQR -1.67, 0.62). In fully adjusted models, eGFR slope was independently associated with many adverse clinical outcomes; among those with ≤10th percentile of slope (median -4.71 mL/min/1.73 m<sup>2</sup>) the OR of kidney failure was 2.22 (95% CI 1.75, 2.82), new stroke 1.23 (1.08, 1.40), heart failure 1.42 (1.27, 1.59), MI 0.98 (0.77, 1.23) all-cause hospitalization 1.31 (1.26, 1.36) and all-cause mortality 1.56 (1.44, 1.68). For every -1 mL/min/1.73 m<sup>2</sup> in eGFR slope, the OR of outcomes ranged from 1.01 (0.98, 1.05 for new MI) to 1.09 (1.08, 1.10 for all-cause mortality); findings were significant for 10 of the 13 outcomes considered.</p><p><strong>Limitations: </strong>Causality cannot be established with this study design.</p><p><strong>Conclusions: </strong>These findings support consideration of the rate of eGFR decline in risk stratification and may inform clinicians and policymakers to optimize treatment and inform health care system planning.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241255781"},"PeriodicalIF":1.7,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11163929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141300079","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
Opportunities for Improving the Transplant Assessment and Education Process in British Columbia: Patient and Health Care Provider Perspective. 改善不列颠哥伦比亚省移植评估和教育过程的机会:患者和医疗服务提供者的视角。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-05-31 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241256735
Oshorenua Aiyegbusi, Sharon Gradin, Yanchini Rajmohan, Bingyue Zhu, Alexandra Romann, Helen Chiu, Jagbir Gill, Olwyn Johnston, Micheli Bevilacqua

Background: There are several steps patients and their health care providers must navigate to access kidney transplantation in British Columbia (BC).

Objective: We explored perceptions and experiences with the pretransplant process across BC to determine where process improvements can be made to enhance access to transplantation.

Design: Anonymous surveys were sent online and via post to health care providers (including nephrologists, registered nurses, and coordinators) and patients across BC.

Setting: Kidney care clinics, transplant regional clinics, and provincial transplant centers in BC.

Measurements: Surveys included Likert scale questions on the current pretransplant process and transplant education available in BC. The health provider survey focused on understanding the pretransplant process, knowledge, roles, and communication while the patient survey focused on patient education and experience of the pretransplant processes.

Results: A total of 100 health care providers and 146 patients responded. Seventy-six percent of health care providers understood their role and responsibility in the pretransplant process, while only 47% understood others' roles in the process. Fifty-nine percent of health care respondents felt adequately supported by the provincial donor and transplant teams. Seventy-one percent of registered nurses and 92% of nephrologists understood transplant eligibility. About 68% and 77% of nurses and nephrologists, respectively, reported having enough knowledge to discuss living donation with patients. Fifty percent of patients had received transplant education, of which 60% had a good grasp of the pretransplant clinical processes. Sixty-three percent felt their respective kidney teams had provided enough advice and tools to support them in finding a living donor. Fifty percent of patients reported feeling up to date with their status in the evaluation process.

Limitations: This analysis was conducted between December 2021 and June 2022 and may need to account for practice changes that occurred during the COVID-19 pandemic. Responses are from a selection of health care providers, thus acknowledging a risk of selection bias. Furthermore, we are not able to verify patients who reported receiving formal transplant education from their health care providers.

Conclusions: Exploring these themes suggests communication with regional clinics and transplant centers can be improved. In addition, patient and staff education can benefit from education on kidney transplantation and the pretransplant clinical processes. Our findings provide opportunities to develop strategies to actively address modifiable barriers in a patient's kidney transplantation journey.

背景:在不列颠哥伦比亚省(BC 省),患者及其医疗服务提供者必须经过几个步骤才能获得肾移植:我们探讨了不列颠哥伦比亚省各地对移植前流程的看法和经验,以确定在哪些方面可以改进流程,从而提高移植的可及性:设计:向不列颠哥伦比亚省的医疗服务提供者(包括肾病专家、注册护士和协调员)和患者发送在线和邮寄匿名调查问卷:地点:不列颠哥伦比亚省的肾脏护理诊所、移植区域诊所和省级移植中心:调查内容包括有关不列颠哥伦比亚省现有移植前流程和移植教育的李克特量表问题。医疗服务提供者调查的重点是了解移植前流程、知识、角色和沟通,而患者调查的重点是患者对移植前流程的教育和体验:共有 100 名医疗服务提供者和 146 名患者参与了调查。76%的医疗服务提供者了解自己在移植前流程中的角色和责任,而只有 47% 的医疗服务提供者了解其他人在流程中的角色。59%的医疗服务提供者认为他们得到了省级捐赠者和移植团队的充分支持。71%的注册护士和 92% 的肾科医生了解移植资格。分别约有 68% 和 77% 的护士和肾科医生表示,他们有足够的知识与患者讨论活体捐献。50%的患者接受过移植教育,其中60%的患者很好地掌握了移植前的临床流程。63%的患者认为他们各自的肾脏团队提供了足够的建议和工具来支持他们寻找活体捐献者。50%的患者表示在评估过程中了解到自己的最新状况:这项分析是在 2021 年 12 月至 2022 年 6 月期间进行的,可能需要考虑到 COVID-19 大流行期间发生的实践变化。答复来自部分医疗服务提供者,因此存在选择偏差的风险。此外,我们无法核实那些报告说从医疗服务提供者那里接受过正规移植教育的患者:对这些主题的探讨表明,与地区诊所和移植中心的沟通可以得到改善。此外,肾移植和移植前临床流程方面的教育也能使患者和医护人员从中受益。我们的研究结果为制定策略,积极解决患者肾移植过程中可改变的障碍提供了机会。
{"title":"Opportunities for Improving the Transplant Assessment and Education Process in British Columbia: Patient and Health Care Provider Perspective.","authors":"Oshorenua Aiyegbusi, Sharon Gradin, Yanchini Rajmohan, Bingyue Zhu, Alexandra Romann, Helen Chiu, Jagbir Gill, Olwyn Johnston, Micheli Bevilacqua","doi":"10.1177/20543581241256735","DOIUrl":"10.1177/20543581241256735","url":null,"abstract":"<p><strong>Background: </strong>There are several steps patients and their health care providers must navigate to access kidney transplantation in British Columbia (BC).</p><p><strong>Objective: </strong>We explored perceptions and experiences with the pretransplant process across BC to determine where process improvements can be made to enhance access to transplantation.</p><p><strong>Design: </strong>Anonymous surveys were sent online and via post to health care providers (including nephrologists, registered nurses, and coordinators) and patients across BC.</p><p><strong>Setting: </strong>Kidney care clinics, transplant regional clinics, and provincial transplant centers in BC.</p><p><strong>Measurements: </strong>Surveys included Likert scale questions on the current pretransplant process and transplant education available in BC. The health provider survey focused on understanding the pretransplant process, knowledge, roles, and communication while the patient survey focused on patient education and experience of the pretransplant processes.</p><p><strong>Results: </strong>A total of 100 health care providers and 146 patients responded. Seventy-six percent of health care providers understood their role and responsibility in the pretransplant process, while only 47% understood others' roles in the process. Fifty-nine percent of health care respondents felt adequately supported by the provincial donor and transplant teams. Seventy-one percent of registered nurses and 92% of nephrologists understood transplant eligibility. About 68% and 77% of nurses and nephrologists, respectively, reported having enough knowledge to discuss living donation with patients. Fifty percent of patients had received transplant education, of which 60% had a good grasp of the pretransplant clinical processes. Sixty-three percent felt their respective kidney teams had provided enough advice and tools to support them in finding a living donor. Fifty percent of patients reported feeling up to date with their status in the evaluation process.</p><p><strong>Limitations: </strong>This analysis was conducted between December 2021 and June 2022 and may need to account for practice changes that occurred during the COVID-19 pandemic. Responses are from a selection of health care providers, thus acknowledging a risk of selection bias. Furthermore, we are not able to verify patients who reported receiving formal transplant education from their health care providers.</p><p><strong>Conclusions: </strong>Exploring these themes suggests communication with regional clinics and transplant centers can be improved. In addition, patient and staff education can benefit from education on kidney transplantation and the pretransplant clinical processes. Our findings provide opportunities to develop strategies to actively address modifiable barriers in a patient's kidney transplantation journey.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241256735"},"PeriodicalIF":1.7,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11143851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141198857","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
Association Between the Dialysate Bicarbonate and the Pre-dialysis Serum Bicarbonate Concentration in Maintenance Hemodialysis: A Retrospective Cohort Study. 维持性血液透析中透析液碳酸氢盐与透析前血清碳酸氢盐浓度之间的关系:回顾性队列研究。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-05-30 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241256774
Amber O Molnar, Lauren Killin, Sarah Bota, Eric McArthur, Stephanie N Dixon, Amit X Garg, Claire Harris, Stephanie Thompson, Karthik Tennankore, Peter G Blake, Clara Bohm, Jennifer MacRae, Samuel A Silver

Background: It is unclear whether the use of higher dialysate bicarbonate concentrations is associated with clinically relevant changes in the pre-dialysis serum bicarbonate concentration.

Objective: The objective is to examine the association between the dialysate bicarbonate prescription and the pre-dialysis serum bicarbonate concentration.

Design: This is a retrospective cohort study.

Setting: The study was performed using linked administrative health care databases in Ontario, Canada.

Patients: Prevalent adults receiving maintenance in-center hemodialysis as of April 1, 2020 (n = 5414) were included.

Measurements: Patients were grouped into the following dialysate bicarbonate categories at the dialysis center-level: individualized (adjustment based on pre-dialysis serum bicarbonate concentration) or standardized (>90% of patients received the same dialysate bicarbonate concentration). The standardized category was stratified by concentration: 35, 36 to 37, and ≥38 mmol/L. The primary outcome was the mean outpatient pre-dialysis serum bicarbonate concentration at the patient level.

Methods: We examined the association between dialysate bicarbonate category and pre-dialysis serum bicarbonate using an adjusted linear mixed model.

Results: All dialysate bicarbonate categories had a mean pre-dialysis serum bicarbonate concentration within the normal range. In the individualized category, 91% achieved a pre-dialysis serum bicarbonate ≥22 mmol/L, compared to 87% in the standardized category. Patients in the standardized category tended to have a serum bicarbonate that was 0.25 (95% confidence interval [CI] = -0.93, 0.43) mmol/L lower than patients in the individualized category. Relative to patients in the 35 mmol/L category, patients in the 36 to 37 and ≥38 mmol/L categories tended to have a serum bicarbonate that was 0.70 (95% CI = -0.30, 1.70) mmol/L and 0.87 (95% CI = 0.14, 1.60) mmol/L higher, respectively. There was no effect modification by age, sex, or history of chronic lung disease.

Limitations: We could not directly confirm that all laboratory measurements were pre-dialysis. Data on prescribed dialysate bicarbonate concentrations for individual dialysis sessions were not available, which may have led to some misclassification, and adherence to a practice of individualization could not be measured. Residual confounding is possible.

Conclusions: We found no significant difference in the pre-dialysis serum bicarbonate concentration irrespective of whether an individualized or standardized dialysate bicarbonate was used. Dialysate bicarbonate concentrations ≥38 mmol/L (vs 35 mmol/L) may increase the pre-dialysis serum bicarbonate concentration by 0.9 mmol/L.

背景:目前尚不清楚使用较高浓度的透析液碳酸氢盐是否与透析前血清碳酸氢盐浓度的临床相关变化有关:目的:研究透析液碳酸氢盐处方与透析前血清碳酸氢盐浓度之间的关联:这是一项回顾性队列研究:研究利用加拿大安大略省的行政医疗数据库进行:纳入截至 2020 年 4 月 1 日接受中心内维持性血液透析的成年患者(n = 5414):在透析中心层面将患者分为以下透析液碳酸氢盐类别:个性化(根据透析前血清碳酸氢盐浓度进行调整)或标准化(大于 90% 的患者接受相同的透析液碳酸氢盐浓度)。标准化类别按浓度分层:35、36 至 37 和 ≥38 mmol/L。主要结果是门诊患者透析前血清碳酸氢盐的平均浓度:我们使用调整线性混合模型研究了透析液碳酸氢盐类别与透析前血清碳酸氢盐之间的关系:结果:所有透析液碳酸氢盐类别的透析前血清碳酸氢盐平均浓度均在正常范围内。在个体化类别中,91% 的患者透析前血清碳酸氢盐浓度≥22 mmol/L,而在标准化类别中,这一比例为 87%。标准化组患者的血清碳酸氢盐往往比个体化组患者低 0.25(95% 置信区间 [CI] = -0.93,0.43)毫摩尔/升。相对于 35 mmol/L 类别的患者,36 至 37 mmol/L 和 ≥38 mmol/L 类别患者的血清碳酸氢盐分别倾向于高出 0.70(95% 置信区间 [CI] = -0.30,1.70)mmol/L 和 0.87(95% 置信区间 [CI] = 0.14,1.60)mmol/L。年龄、性别或慢性肺部疾病史均不会对研究结果产生影响:我们无法直接确认所有实验室测量值均为透析前测量值。我们无法直接确认所有实验室测量值均为透析前的数据,也无法获得各透析疗程的透析液碳酸氢盐浓度数据,这可能会导致一些错误分类,同时也无法衡量是否坚持了个体化治疗。结论:我们发现,无论使用个体化还是标准化透析液碳酸氢盐,透析前血清碳酸氢盐浓度均无明显差异。透析液碳酸氢盐浓度≥38 mmol/L(vs 35 mmol/L)可能会使透析前血清碳酸氢盐浓度增加 0.9 mmol/L。
{"title":"Association Between the Dialysate Bicarbonate and the Pre-dialysis Serum Bicarbonate Concentration in Maintenance Hemodialysis: A Retrospective Cohort Study.","authors":"Amber O Molnar, Lauren Killin, Sarah Bota, Eric McArthur, Stephanie N Dixon, Amit X Garg, Claire Harris, Stephanie Thompson, Karthik Tennankore, Peter G Blake, Clara Bohm, Jennifer MacRae, Samuel A Silver","doi":"10.1177/20543581241256774","DOIUrl":"10.1177/20543581241256774","url":null,"abstract":"<p><strong>Background: </strong>It is unclear whether the use of higher dialysate bicarbonate concentrations is associated with clinically relevant changes in the pre-dialysis serum bicarbonate concentration.</p><p><strong>Objective: </strong>The objective is to examine the association between the dialysate bicarbonate prescription and the pre-dialysis serum bicarbonate concentration.</p><p><strong>Design: </strong>This is a retrospective cohort study.</p><p><strong>Setting: </strong>The study was performed using linked administrative health care databases in Ontario, Canada.</p><p><strong>Patients: </strong>Prevalent adults receiving maintenance in-center hemodialysis as of April 1, 2020 (n = 5414) were included.</p><p><strong>Measurements: </strong>Patients were grouped into the following dialysate bicarbonate categories at the dialysis center-level: individualized (adjustment based on pre-dialysis serum bicarbonate concentration) or standardized (>90% of patients received the same dialysate bicarbonate concentration). The standardized category was stratified by concentration: 35, 36 to 37, and ≥38 mmol/L. The primary outcome was the mean outpatient pre-dialysis serum bicarbonate concentration at the patient level.</p><p><strong>Methods: </strong>We examined the association between dialysate bicarbonate category and pre-dialysis serum bicarbonate using an adjusted linear mixed model.</p><p><strong>Results: </strong>All dialysate bicarbonate categories had a mean pre-dialysis serum bicarbonate concentration within the normal range. In the individualized category, 91% achieved a pre-dialysis serum bicarbonate ≥22 mmol/L, compared to 87% in the standardized category. Patients in the standardized category tended to have a serum bicarbonate that was 0.25 (95% confidence interval [CI] = -0.93, 0.43) mmol/L lower than patients in the individualized category. Relative to patients in the 35 mmol/L category, patients in the 36 to 37 and ≥38 mmol/L categories tended to have a serum bicarbonate that was 0.70 (95% CI = -0.30, 1.70) mmol/L and 0.87 (95% CI = 0.14, 1.60) mmol/L higher, respectively. There was no effect modification by age, sex, or history of chronic lung disease.</p><p><strong>Limitations: </strong>We could not directly confirm that all laboratory measurements were pre-dialysis. Data on prescribed dialysate bicarbonate concentrations for individual dialysis sessions were not available, which may have led to some misclassification, and adherence to a practice of individualization could not be measured. Residual confounding is possible.</p><p><strong>Conclusions: </strong>We found no significant difference in the pre-dialysis serum bicarbonate concentration irrespective of whether an individualized or standardized dialysate bicarbonate was used. Dialysate bicarbonate concentrations ≥38 mmol/L (vs 35 mmol/L) may increase the pre-dialysis serum bicarbonate concentration by 0.9 mmol/L.</p>","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241256774"},"PeriodicalIF":1.7,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11141227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141198794","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
Reducing the Frequency of Surveillance Blood Work in Patients Treated With Maintenance Hemodialysis: A Local Quality Improvement Initiative. 减少维持性血液透析患者的血常规监测频率:地方质量改进计划。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-05-28 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241255784
Epsita Shome-Vasanthan, Sophia Chou, Juliya Hemmett, Jennifer MacRae, David Ward, Nathen Gallagher, Huda Al-Wahsh, Elena Qirjazi

Introduction: There is little evidence on the ideal frequency of routine blood work in maintenance dialysis patients to manage complications, including anemia, mineral bone disease (MBD), and hyperkalemia. Recent quality improvement studies from Ontario showed no negative impacts when decreasing the frequency from monthly to every 6 weeks in conventional in-center hemodialysis (ICHD) patients. In December 2020, Alberta Kidney Care-South (AKC-S) reduced the frequency of routine blood work from every 6 weeks to every 8 weeks for ICHD patients.

Objective: We aimed to assess the impact of reducing blood work frequency on patient outcomes.

Methods: We compared prevalent AKC-S ICHD patients in 2 cohorts: (1) retrospective control (October 31, 2019-October 31, 2020) and (2) prospective intervention (December 1, 2020-December 1, 2021). Primary outcomes were true frequency of routine blood work, odds of patients being within target for anemia and MBD, and proportion of lab values of hyperkalemia. Furthermore, we compared hospitalizations and mortality.

Results: A total of 972 patients in Calgary's ICHD program were included, 787 in each period (with 602 patients overlapping both cohorts). The frequency of routine blood work decreased from every 39.5 days in the control period to every 54.2 days in the intervention period (P < .01). There was a reduction in the odds of phosphate values in targets (P = .02), and an increase in the odds of labs with hyperkalemia (>6.0 mmol/L) during the intervention period (P = .01). There was no significant change in the odds of being within the accepted targets during the intervention period compared with the control period for hemoglobin, Tsat, calcium, or parathyroid hormone (PTH). Fewer patients were hospitalized during the intervention period and the risk of death decreased as well, although additional factors such as the COVID-19 pandemic may have affected this. A cost-savings of $32 962 occurred from the reduced anemia and MBD blood work during the intervention period.

Conclusions: When ICHD units in Calgary reduced routine blood work frequency from every 6 weeks to 8 weeks, there were no negative impacts on hospitalizations or deaths. A slightly lower proportion of phosphate values were within target, and a 0.7% increase in potassium values greater than 6 mmol/L was demonstrated. Our study suggests that blood work frequency in ICHD dialysis patients may be further reduced to every 8 weeks safely. Ultimately, additional pragmatic trials are needed to identify the optimal frequency of routine blood work.

导言:关于维持性透析患者进行常规血液检查以控制贫血、矿物质骨病 (MBD) 和高钾血症等并发症的理想频率,目前还没有什么证据。安大略省最近进行的质量改进研究表明,将常规中心内血液透析(ICHD)患者的血常规检查频率从每月一次降低到每 6 周一次不会产生负面影响。2020 年 12 月,阿尔伯塔肾脏护理中心南区(AKC-S)将 ICHD 患者的常规血液检查频率从每 6 周一次降至每 8 周一次:我们旨在评估减少血液检查频率对患者预后的影响:我们比较了两个队列中流行的 AKC-S ICHD 患者:(1)回顾性对照组(2019 年 10 月 31 日至 2020 年 10 月 31 日);(2)前瞻性干预组(2020 年 12 月 1 日至 2021 年 12 月 1 日)。主要结果是常规血液检查的真实频率、患者贫血和MBD在目标范围内的几率以及高钾血症实验室值的比例。此外,我们还比较了住院率和死亡率:卡尔加里 ICHD 项目共纳入了 972 名患者,每个阶段均有 787 名患者(其中 602 名患者与两个队列重叠)。常规血液检查的频率从对照组的每 39.5 天一次降至干预组的每 54.2 天一次(P < .01)。在干预期间,磷酸盐值达到目标的几率有所降低(P = .02),而化验出高钾血症(>6.0 mmol/L)的几率有所增加(P = .01)。与对照组相比,干预期间血红蛋白、Tsat、血钙或甲状旁腺激素(PTH)在接受目标范围内的几率没有明显变化。干预期间住院的患者人数减少,死亡风险也有所降低,但 COVID-19 大流行等其他因素可能对此有所影响。在干预期间,由于减少了贫血和 MBD 血液检查,节省了 32 962 美元的成本:当卡尔加里的 ICHD 单位将常规血液检查频率从每 6 周一次减少到 8 周一次时,对住院或死亡人数没有产生负面影响。磷酸盐值在目标范围内的比例略有降低,钾值大于 6 mmol/L 的比例增加了 0.7%。我们的研究表明,可以将 ICHD 透析患者的血液检查频率进一步降低到每 8 周一次,以确保安全。最终,还需要更多的实用性试验来确定常规血液检查的最佳频率。
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引用次数: 0
Hemophagocytic Lymphohistiocytosis in a Remote Kidney Transplant Recipient Triggered by HSV Infection With Complete Recovery: An Educational Case Report. 一名肾移植偏远地区患者因感染 HSV 而引发的嗜血细胞淋巴组织细胞增多症,现已完全康复:教育性病例报告。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-05-23 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241253921
Anjana Gopal, S Joseph Kim

Rationale: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease characterized by excessive immune activation. It is more commonly seen in children but increasingly recognized in adults. Primary HLH relies on a genetic predisposition, whereas secondary HLH develops in the context of infections, malignancies, or autoimmune diseases. Hemophagocytic lymphohistiocytosis has been rarely described in patients on immunosuppressive therapy after kidney transplant. Here, we describe a case of HLH in a patient with a remote history of kidney transplant, triggered by a viral infection.

Presenting concerns: A 45-year-old female, with a kidney transplant in 2009 for IgA nephropathy, presented with fever, vomiting, and back pain of 1-week duration. She was on triple immunosuppression consisting of daily doses of prednisone 5 mg, azathioprine 100 mg, and tacrolimus extended release 1 mg, and a baseline creatinine of 130 µmol/L.

Diagnosis: Initial investigations showed anemia, leukopenia, elevated serum creatinine, transaminitis, and markedly increased ferritin of 67 600 µg/L which prompted a bone marrow biopsy to rule out HLH. The bone marrow showed an increased proportion of CD68+ cells (macrophages) with more than 5 in 1000 hemophagocytic macrophages. Her soluble IL-2 receptor (CD25) level was 3406 pg/mL (606-2299 pg/mL) which was mildly elevated. She fulfilled 4 of the 8 criteria for HLH and with an H score was 223 which suggested a diagnosis of HLH with 96.9% probability. An extensive secondary workup for possible triggers for HLH led to a swab from genital ulcers that was positive for herpes simplex virus (HSV) type 2. The polymerase chain reaction (PCR) in the blood for HSV type 2 was also positive.

Interventions: Given the diagnosis of HSV type 2 as the putative trigger for HLH, she was started on parenteral acyclovir for 2 weeks followed by oral valacyclovir for 2 more weeks. In the context of infection, the azathioprine was stopped while low-dose steroid and tacrolimus were continued.

Outcomes: With the initiation of treatment for HSV infection, leukopenia, creatinine, and transaminases improved along with ferritin levels. At her 6-month follow-up, her blood counts and liver enzymes had normalized, and ferritin was 566 µg/L.

Teaching points: Hemophagocytic lymphohistiocytosis is a rare disease in kidney transplant recipients with a high mortality rate. It can occur even in remote kidney transplant recipients so a high degree of suspicion is necessary to lead to a prompt diagnosis. Infections are common triggers for secondary HLH. Early identification and treatment of the triggering infection may improve outcomes.

理由:嗜血细胞淋巴组织细胞增多症(HLH)是一种以过度免疫激活为特征的危及生命的疾病。这种疾病多见于儿童,但越来越多的成人也会患上这种疾病。原发性 HLH 依赖于遗传易感性,而继发性 HLH 则在感染、恶性肿瘤或自身免疫性疾病的背景下发病。嗜血细胞淋巴组织细胞增多症很少见于肾移植后接受免疫抑制治疗的患者。在此,我们描述了一例肾移植远期病史患者因病毒感染引发的嗜血细胞性淋巴细胞增多症:一名 45 岁的女性患者于 2009 年因 IgA 肾病接受了肾移植手术,术后出现发热、呕吐和背痛,病程 1 周。诊断:初步检查显示贫血、白细胞减少、血清肌酐升高、转氨酶升高、铁蛋白明显升高(67 600 µg/L),因此需要进行骨髓活检以排除 HLH。骨髓显示 CD68+ 细胞(巨噬细胞)比例增加,嗜血细胞巨噬细胞的比例超过千分之五。她的可溶性IL-2受体(CD25)水平为3406 pg/mL(606-2299 pg/mL),轻度升高。她符合 HLH 8 项标准中的 4 项,H 评分为 223,这表明她被诊断为 HLH 的可能性高达 96.9%。对 HLH 的可能诱因进行了广泛的二次检查,结果发现生殖器溃疡拭子中的 2 型单纯疱疹病毒(HSV)呈阳性。血液中 2 型 HSV 的聚合酶链反应(PCR)也呈阳性:鉴于2型HSV被诊断为HLH的可能诱因,她开始接受为期两周的肠外阿昔洛韦治疗,随后又口服了两周的伐昔洛韦。在感染的情况下,停用硫唑嘌呤,同时继续使用小剂量类固醇和他克莫司:随着HSV感染治疗的开始,白细胞减少症、肌酐和转氨酶以及铁蛋白水平均有所改善。6个月随访时,她的血细胞计数和肝酶已恢复正常,铁蛋白为566微克/升:嗜血细胞淋巴组织细胞增多症是肾移植受者中的一种罕见疾病,死亡率很高。即使是远期肾移植受者也可能发病,因此必须高度怀疑,以便及时诊断。感染是继发性 HLH 的常见诱因。及早发现和治疗诱发感染可改善预后。
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引用次数: 0
Challenges to Implementing Environmentally Sustainable Kidney Care in LMICs: An Opinion Piece. 在低收入和中等收入国家实施环境可持续肾脏护理所面临的挑战:评论文章。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-05-20 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241246835
Divya Bajpai, Workagegnehu Hailu, Peace Bagasha, Onu Ugochi Chika, Ehab Hafiz, Elliot Koranteng Tannor, Eranga Wijewickrama, Robert Kalyesubula, Sabine Karam, Viviane Calice-Silva, Isabelle Ethier, Shaifali Sandal
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引用次数: 0
Mind the Gap in Kidney Care: Translating What We Know Into What We do. 关注肾脏护理中的差距:将我们的知识转化为我们的行动。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-05-17 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241252506
Valerie A Luyckx, Katherine R Tuttle, Dina Abdellatif, Ricardo Correa-Rotter, Winston W S Fung, Agnès Haris, Li-Li Hsiao, Makram Khalife, Latha A Kumaraswami, Fiona Loud, Vasundhara Raghavan, Stefanos Roumeliotis, Marianella Sierra, Ifeoma Ulasi, Bill Wang, Siu-Fai Lui, Vassilios Liakopoulos, Alessandro Balducci

Historically, it takes an average of 17 years to move new treatments from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. The time is now to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions worldwide are diagnosed, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because in the early stages, it is often silent. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary-care level. Many systematic barriers exist, ranging from patient to clinician to health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay.

从历史上看,新疗法从临床证据转化为日常实践平均需要 17 年的时间。鉴于目前已有的高效疗法可以预防或延缓肾病的发生和发展,这个时间太长了。现在是缩小我们所知道的与我们所做的之间差距的时候了。对于高血压和糖尿病等肾脏病常见风险因素的预防和管理,已有明确的指导方针,但全世界只有一小部分肾脏病患者被确诊,接受目标治疗的患者则更少。同样,绝大多数肾病患者都不知道自己的病情,因为在早期阶段,肾病往往是无声无息的。即使在已经确诊的患者中,许多人也没有接受适当的肾病治疗。考虑到肾病恶化、肾衰竭或死亡的严重后果,必须及早开始适当的治疗。必须从初级保健开始,最大限度地利用早期诊断和治疗肾病的机会。从患者到临床医生,从医疗系统到社会因素,存在着许多系统性障碍。为了保护和改善世界各地每个人的肾脏健康,必须认识到这些障碍中的每一个,以便制定和实施可持续的解决方案,不再拖延。
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引用次数: 0
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Canadian Journal of Kidney Health and Disease
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