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Development and Validation of a Treatment Algorithm for Osteoarthritis Pain Management in Patients With End-Stage Kidney Disease Undergoing Hemodialysis. 血液透析终末期肾病患者骨关节炎疼痛治疗算法的开发与验证。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-05-13 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241249365
Mai Mohsen, Jordanne Feldberg, Angelina Abbaticchio, S Vanita Jassal, Marisa Battistella
<p><strong>Background: </strong>Although osteoarthritis is common in the hemodialysis population and leads to poor health outcomes, pain management is challenged by the absence of clinical guidance. A treatment algorithm was developed and validated to aid hemodialysis clinicians in managing osteoarthritis pain.</p><p><strong>Objective: </strong>The objective was to develop and validate a treatment algorithm for managing osteoarthritis pain in patients undergoing hemodialysis.</p><p><strong>Design: </strong>A validation study was conducted based on Lynn's method for content validation.</p><p><strong>Setting: </strong>To develop and validate a treatment algorithm, interviews were conducted virtually by the primary researcher with clinicians from various institutions across the Greater Toronto and Hamilton Area in Ontario.</p><p><strong>Patients: </strong>The treatment algorithm was developed and validated for the management of osteoarthritis pain in patients on hemodialysis. Patients were not involved in the development or validation of the tool.</p><p><strong>Measurements: </strong>The algorithm was measured for content and face validity. Content validity was measured by calculating the content validity index of each component (I-CVI) of the algorithm and the overall scale validity index (S-CVI). Face validity was assessed by calculating the percentage of positive responses to the face validity statements.</p><p><strong>Methods: </strong>A draft algorithm was developed based on literature searches and expert opinion and validated by interviewing nephrology and pain management clinicians. Through consecutive rounds of 1:1 interviews, content and face validity were assessed by asking participants to rate the relevance of each component of the algorithm and indicate their level of agreeability with a series of statements. Following each round, the I-CVI of the algorithm as well as the S-CVI was calculated and the percentage of positive responses to the statements was determined. The research team revised the algorithm in response to the findings. The final algorithm provides a stepwise approach to the non-pharmacologic and pharmacologic management of pain, including topical, oral, and opioid use.</p><p><strong>Results: </strong>A total of 18 clinicians from 7 institutions across the Greater Toronto and Hamilton Area were interviewed (10 pharmacists, 5 nurse practitioners, and 3 physicians). The average S-CVI of the algorithm across all 3 rounds was 0.93. At least 78% of participants provided positive responses to the face validity statements.</p><p><strong>Limitations: </strong>An algorithm was developed based on input from clinicians working in the province of Ontario, limiting the generalizability of the algorithm across provinces. In addition, the algorithm did not include the perspectives of primary care providers or patients/caregivers.</p><p><strong>Conclusions: </strong>An algorithm for the management of osteoarthritis pain in the hemodialysis
背景:虽然骨关节炎在血液透析人群中很常见,并导致不良的健康后果,但由于缺乏临床指导,疼痛管理面临挑战。我们开发并验证了一种治疗算法,以帮助血液透析临床医生管理骨关节炎疼痛:目的:开发并验证一种治疗算法,用于治疗血液透析患者的骨关节炎疼痛:设计:根据林恩内容验证法进行验证研究:为了开发和验证治疗算法,主要研究人员对安大略省大多伦多和汉密尔顿地区不同机构的临床医生进行了虚拟访谈:该治疗算法是针对血液透析患者骨关节炎疼痛的治疗而开发和验证的。患者并未参与该工具的开发或验证:对算法的内容效度和表面效度进行了测量。内容效度通过计算算法各组成部分的内容效度指数(I-CVI)和总体量表效度指数(S-CVI)来衡量。表面效度则通过计算对表面效度陈述的正面回答的百分比来评估:方法:根据文献检索和专家意见制定了算法草案,并通过采访肾病学和疼痛治疗临床医生进行验证。通过连续几轮 1:1 的访谈,要求参与者对算法中每个组成部分的相关性进行评分,并指出他们对一系列声明的同意程度,从而对内容效度和表面效度进行评估。每轮访谈结束后,都会计算算法的 I-CVI 和 S-CVI,并确定对陈述作出积极回应的百分比。研究小组根据研究结果对算法进行了修订。最终算法为非药物和药物治疗疼痛提供了一个循序渐进的方法,包括局部、口服和阿片类药物的使用:结果:来自大多伦多和汉密尔顿地区 7 家机构的 18 名临床医生(10 名药剂师、5 名执业护士和 3 名医生)接受了访谈。在所有 3 轮访谈中,算法的平均 S-CVI 为 0.93。至少 78% 的参与者对表面效度声明做出了积极回应:算法是根据安大略省临床医生的意见开发的,因此限制了算法在各省之间的通用性。此外,该算法并未纳入初级保健提供者或患者/护理者的观点:通过专家评审,制定并验证了血液透析人群骨关节炎疼痛管理算法,以规范实践,鼓励临床医生使用循证治疗并解决疼痛的社会心理症状。由于该算法具有高度的内容效度和表面效度,因此可改善血液透析患者的骨关节炎疼痛管理。未来的研究将评估该算法在不同血液透析环境中的实施情况。
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引用次数: 0
"Weighing the Pros and Cons of Everything": A Qualitative Descriptive Study Exploring Perspectives About Living Donor Kidney Transplantation From Parents of Chinese Canadian Pediatric Patients With Chronic Kidney Disease. "权衡利弊":加拿大华裔小儿慢性肾脏病患者家长对活体肾移植的看法的定性描述研究》。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-05-10 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241249872
Sarah J Pol, Enid K Selkirk, Alameen Damer, Istvan Mucsi, Susan Abbey, Beth Edwards, Kenneth Fung, Jagbir Gill, Paula Neves, Suk Yin Ng, Rulan S Parekh, Linda Wright, Minglin Wu, Samantha J Anthony
<p><strong>Background: </strong>As of 2021, more than 6000 children and youth in Canada were living with end-stage kidney disease (ESKD), for which kidney transplantation is considered the preferred treatment by health professionals. Research shows that living donor kidney transplantation (LDKT) has superior allograft and recipient survival compared to deceased donor kidney transplantation (DDKT). However, in a pediatric setting, the choice of LDKT or DDKT is a summative consideration of factors weighed carefully by the patient's family, health care team, and patient. Decision-making surrounding transplantation may be more complex for racial and ethnic minorities as culturally specific values and beliefs are interwoven within dominant understandings and concepts of health and accepted models of health care. For example, Chinese Canadians have an increased risk of ESKD, yet reduced access to LDKT compared to White patients, despite being the largest visible minority population in Canada.</p><p><strong>Objective: </strong>The objective of this qualitative study is to deepen our understandings of the decision-making process surrounding DDKT versus LDKT among parents of Chinese Canadian pediatric patients with chronic kidney disease (CKD).</p><p><strong>Design: </strong>Qualitative descriptive study design.</p><p><strong>Setting: </strong>The Nephrology Program at The Hospital for Sick Children in Toronto, Canada.</p><p><strong>Participants: </strong>Caregivers of Chinese Canadian patients with CKD, 18 years of age or older, and who spoke English, Cantonese, or Mandarin.</p><p><strong>Methods: </strong>One-on-one, semistructured interviews were conducted virtually, by a member of the research team and were audio-recorded and transcribed verbatim. Thematic analysis was used to explore participants' shared experience.</p><p><strong>Results: </strong>Seven interviews were conducted with 6 mothers and 1 father of 6 Chinese Canadian pediatric patients with CKD: 4 patients had undergone a kidney transplant, and 2 were not yet listed for transplant. Analysis of data highlighted that cultural influences affected whether parents shared with others about their child's illness and experience. The cultural understanding that it is inappropriate to burden others contributed to the creation of an isolating experience for participants. Cultural influences also impacted whether parents asked others to be a living donor as participants articulated this would place a physical burden on the living donor (e.g., potential risk to their health) and an emotional burden on the participant as they would be indebted to a willing donor. Ultimately, parents' decision to choose DDKT or LDKT for their patient-child was a result of evaluating both options carefully and within an understanding that the ideal treatment choice reflected what was best for all family members.</p><p><strong>Limitations: </strong>Findings reflect experiences of a small sample from a single recruitment si
背景:截至 2021 年,加拿大有 6000 多名儿童和青少年患有终末期肾病 (ESKD),医疗专业人员认为肾移植是治疗终末期肾病的首选方法。研究表明,活体肾移植(LDKT)的异体移植物存活率和受体存活率均优于死体肾移植(DDKT)。然而,在儿科环境中,选择 LDKT 还是 DDKT 是由患者家属、医疗团队和患者仔细权衡各种因素后做出的综合考虑。对于少数种族和少数族裔来说,围绕移植的决策可能更为复杂,因为在主流的健康理解和概念以及公认的医疗模式中,交织着特定的文化价值观和信仰。例如,华裔加拿大人罹患 ESKD 的风险更高,但与白人患者相比,他们获得 LDKT 的机会却更少,尽管他们是加拿大最大的有色人种:本定性研究旨在加深我们对加拿大华裔儿科慢性肾脏病(CKD)患者父母围绕 DDKT 与 LDKT 的决策过程的理解:设计:定性描述研究设计:地点:加拿大多伦多病童医院肾脏科:加拿大华裔 CKD 患者的护理人员,年龄在 18 岁或以上,会讲英语、粤语或普通话:由研究小组的一名成员通过虚拟方式进行一对一的半结构化访谈,并进行录音和逐字记录。采用主题分析法探讨参与者的共同经历:对 6 名患有慢性肾脏病的加拿大籍华裔儿科患者的 6 名母亲和 1 名父亲进行了 7 次访谈,其中 4 名患者已接受肾移植,2 名患者尚未列入移植名单。数据分析结果表明,文化因素影响了父母是否与他人分享孩子的病情和经历。文化上认为给他人增加负担是不合适的,这导致了参与者的孤独感。文化影响还影响了父母是否要求他人成为活体捐献者,因为参与者明确表示,这将给活体捐献者带来身体负担(例如,对其健康的潜在风险),同时也会给参与者带来情感负担,因为他们会对自愿捐献者有所亏欠。最终,父母决定为他们的患儿选择 DDKT 或 LDKT,是在仔细评估了两种方案后做出的决定,他们认为理想的治疗选择反映了对所有家庭成员都是最好的:研究结果反映了来自单一招募地点的小样本的经验,这可能会限制研究结果的可推广性:本研究中的家长认为,他们能够获得必要的循证信息,从而在为孩子选择 DDKT 还是 LDKT 的问题上做出明智的决定。在参与者的叙述中,他们感觉到自己在家人和朋友的文化社区中被孤立了,而参与者提出的从更多的支持中获益的建议可能会指引未来的研究方向。从业人员可以为家庭提供直接和间接的支持,同时认识到文化价值观和以家庭为中心的护理对家庭决策的重要性。我们需要建立可访问的虚拟社会支持平台,以增加父母从具有相似经历的父母那里获得文化中介同伴支持的感觉。
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引用次数: 0
From Prophecy to Plate: How to Actualize a Planetary Menu for Kidney Disease Nutrition. 从预言到餐桌:如何实现肾病营养行星菜单。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-05-06 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241244965
Dani Renouf, Michelle M Y Wong
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引用次数: 0
Pathways for Diagnosing and Treating CKD-Associated Pruritus: A Narrative Review. 诊断和治疗慢性肾脏病相关瘙痒症的途径:叙述性综述。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-04-25 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241238808
Claudio Rigatto, David Collister, Alexandre Granger-Vallée, Louis Girard, Jay Hingwala, Angelo Karaboyas, Adeera Levin, Philip McFarlane, Ron Pisoni, Bhanu Prasad, Normand Proulx, Daniel Schwartz, Manish Sood, Rita Suri, Karthik Tennankore
<p><strong>Purpose of review: </strong>Chronic kidney disease (CKD)-associated pruritus is a common, persistent, and distressing itch experienced by patients across the CKD spectrum. Although the disorder is associated with adverse outcomes and poor health-related quality of life, it remains underdiagnosed and undertreated. The purpose of this narrative review is to offer health care providers guidance on how to effectively identify, assess, and treat patients with CKD-associated pruritus, with the goal of reducing symptom burden and improving patient-important outcomes, such as quality of life (QoL).</p><p><strong>Sources of information: </strong>A panel of nephrologists and researchers from across Canada and the United States was assembled to develop this narrative review based on the best available data, current treatment guidelines, and their clinical experiences.</p><p><strong>Methods: </strong>A panel of nephrologists who actively care for patients with pruritus receiving dialysis from across Canada was assembled. Two researchers from the United States were also included based on their expertise in the diagnosis and management of CKD-associated pruritus. Throughout Spring 2023, the panel met to discuss key topics in the identification, assessment, and management of CKD-associated pruritus. Panel members subsequently developed summaries of the pertinent information based on the best available data, current treatment guidelines, and added information on their own clinical experiences. In all cases, approval of the article was sought and achieved through discussion.</p><p><strong>Key findings: </strong>This narrative review provides pragmatic guidance addressing: (1) methods for screening CKD-associated pruritus, (2) assessing severity, (3) management of CKD-associated pruritus, and (4) suggested areas for future research. The panel developed a 3-pillar framework for proactive assessment and severity scoring in CKD-aP: systematic screening for CKD-associated pruritus (pillar 1), assessment of pruritus intensity (pillar 2), and understanding the impact of CKD-associated pruritus on the patient's QoL (pillar 3). Management of CKD-associated pruritus can include ensuring optimization of dialysis adequacy, achieving mineral metabolism targets (ie, calcium, phosphate, and parathyroid hormone). However, treatment of CKD-associated pruritus usually requires additional interventions. Patients, regardless of CKD-associated pruritus severity, should be counseled on adequate skin hydration and other non-pharmacological strategies to reduce pruritus. Antihistamines should be avoided in favor of evidence-based treatments, such as difelikefalin and gabapentin.</p><p><strong>Limitations: </strong>A formal systematic review (SR) of the literature was not undertaken, although published SRs were reviewed. The possibility for bias based on the experts' own clinical experiences may have occurred. Key takeaways are based on the current available evidence, of which
综述目的:慢性肾脏病(CKD)相关性瘙痒症是慢性肾脏病患者常见的一种持续性瘙痒症。虽然这种疾病与不良后果和健康相关生活质量低下有关,但仍然诊断不足、治疗不足。本综述旨在为医疗服务提供者提供如何有效识别、评估和治疗 CKD 相关瘙痒症患者的指导,以减轻症状负担并改善患者的重要预后,如生活质量(QoL):我们组建了一个由来自加拿大和美国的肾病专家和研究人员组成的小组,根据现有的最佳数据、现行治疗指南和他们的临床经验编写了这篇叙述性综述:方法:由加拿大各地积极治疗接受透析治疗的瘙痒症患者的肾病专家组成了一个小组。此外,还有两名来自美国的研究人员,他们在诊断和治疗慢性肾功能衰竭相关瘙痒症方面具有专长。在整个 2023 年春季,专家小组开会讨论了有关 CKD 相关性瘙痒症的识别、评估和管理的关键议题。随后,专家组成员根据现有的最佳数据、当前的治疗指南,并结合自身的临床经验,编写了相关信息的摘要。在所有情况下,文章均通过讨论获得批准:这篇叙事性综述针对以下方面提供了务实的指导:(1)筛查 CKD 相关瘙痒症的方法;(2)评估严重程度;(3)CKD 相关瘙痒症的管理;以及(4)未来研究的建议领域。专家小组为 CKD-aP 的主动评估和严重程度评分制定了一个三支柱框架:系统筛查 CKD 相关性瘙痒症(第一支柱)、评估瘙痒强度(第二支柱)、了解 CKD 相关性瘙痒症对患者 QoL 的影响(第三支柱)。对慢性肾脏病相关性瘙痒症的管理可包括确保透析充分性的优化、实现矿物质代谢目标(即钙、磷酸盐和甲状旁腺激素)。然而,治疗慢性肾功能衰竭相关性瘙痒症通常需要额外的干预措施。无论 CKD 相关性瘙痒症的严重程度如何,都应指导患者适当补充皮肤水分,并采取其他非药物策略来减轻瘙痒。应避免使用抗组胺药,而应采用循证疗法,如地非司酮和加巴喷丁:尽管对已发表的文献进行了回顾,但并未对文献进行正式的系统回顾(SR)。专家自身的临床经验可能会产生偏差。主要启示基于目前可用的证据,其中缺乏头对头临床试验:这项工作得到了大冢加拿大制药公司(加拿大地匹福林的进口商和分销商)的正常拨款资助。LiV Medical Education Agency Inc.提供了后勤和编辑支持。
{"title":"Pathways for Diagnosing and Treating CKD-Associated Pruritus: A Narrative Review.","authors":"Claudio Rigatto, David Collister, Alexandre Granger-Vallée, Louis Girard, Jay Hingwala, Angelo Karaboyas, Adeera Levin, Philip McFarlane, Ron Pisoni, Bhanu Prasad, Normand Proulx, Daniel Schwartz, Manish Sood, Rita Suri, Karthik Tennankore","doi":"10.1177/20543581241238808","DOIUrl":"https://doi.org/10.1177/20543581241238808","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose of review: &lt;/strong&gt;Chronic kidney disease (CKD)-associated pruritus is a common, persistent, and distressing itch experienced by patients across the CKD spectrum. Although the disorder is associated with adverse outcomes and poor health-related quality of life, it remains underdiagnosed and undertreated. The purpose of this narrative review is to offer health care providers guidance on how to effectively identify, assess, and treat patients with CKD-associated pruritus, with the goal of reducing symptom burden and improving patient-important outcomes, such as quality of life (QoL).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Sources of information: &lt;/strong&gt;A panel of nephrologists and researchers from across Canada and the United States was assembled to develop this narrative review based on the best available data, current treatment guidelines, and their clinical experiences.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A panel of nephrologists who actively care for patients with pruritus receiving dialysis from across Canada was assembled. Two researchers from the United States were also included based on their expertise in the diagnosis and management of CKD-associated pruritus. Throughout Spring 2023, the panel met to discuss key topics in the identification, assessment, and management of CKD-associated pruritus. Panel members subsequently developed summaries of the pertinent information based on the best available data, current treatment guidelines, and added information on their own clinical experiences. In all cases, approval of the article was sought and achieved through discussion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key findings: &lt;/strong&gt;This narrative review provides pragmatic guidance addressing: (1) methods for screening CKD-associated pruritus, (2) assessing severity, (3) management of CKD-associated pruritus, and (4) suggested areas for future research. The panel developed a 3-pillar framework for proactive assessment and severity scoring in CKD-aP: systematic screening for CKD-associated pruritus (pillar 1), assessment of pruritus intensity (pillar 2), and understanding the impact of CKD-associated pruritus on the patient's QoL (pillar 3). Management of CKD-associated pruritus can include ensuring optimization of dialysis adequacy, achieving mineral metabolism targets (ie, calcium, phosphate, and parathyroid hormone). However, treatment of CKD-associated pruritus usually requires additional interventions. Patients, regardless of CKD-associated pruritus severity, should be counseled on adequate skin hydration and other non-pharmacological strategies to reduce pruritus. Antihistamines should be avoided in favor of evidence-based treatments, such as difelikefalin and gabapentin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;A formal systematic review (SR) of the literature was not undertaken, although published SRs were reviewed. The possibility for bias based on the experts' own clinical experiences may have occurred. Key takeaways are based on the current available evidence, of which","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241238808"},"PeriodicalIF":1.7,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11047256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854340","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
Perceptions and Information-Seeking Behavior Regarding COVID-19 Vaccination Among Patients With Chronic Kidney Disease in 2023: A Cross-Sectional Survey. 2023 年慢性肾病患者对接种 COVID-19 疫苗的看法和信息查询行为:一项横断面调查。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-04-15 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241242550
Omosomi Enilama, Cynthia MacDonald, Pearl Thompson, Umair Khan, Selina Allu, Mary Beaucage, Kevin Yau, Matthew J Oliver, Michelle A Hladunewich, Adeera Levin
<p><strong>Background: </strong>People living with chronic kidney disease (CKD) face an increased risk of severe outcomes such as hospitalization or death from COVID-19. COVID-19 vaccination is a vital approach to mitigate the risk and severity of infection in patients with CKD. Limited information exists regarding the factors that shape COVID-19 vaccine uptake, including health information-seeking behavior and perceptions, within the CKD population.</p><p><strong>Objective: </strong>The objectives were to describe among CKD patients, (1) health information-seeking behavior on COVID-19, (2) their capacity to comprehend and trust COVID-19 information from different sources, and (3) their perceptions concerning COVID-19 infection and vaccination.</p><p><strong>Design/setting: </strong>Cross-sectional web-based survey administered in British Columbia and Ontario from February 17, 2023, to April 17, 2023.</p><p><strong>Participants: </strong>Chronic kidney disease G3b-5D patients and kidney transplant recipients (CKD G1T-5T) enrolled in a longitudinal COVID-19 vaccine serology study.</p><p><strong>Methods and measurements: </strong>The survey consisted of a questionnaire that included demographic and clinical data, perceived susceptibility of contracting COVID-19, the ability to collect, understand, and trust information on COVID-19, as well as perceptions regarding COVID-19 vaccination. Descriptive statistics were used to present the data with values expressed as count (%) and chi square tests were performed with a significance level set at <i>P</i> ≤ .05. A content analysis was performed on one open-ended response regarding respondents' questions surrounding COVID-19 infection and vaccination.</p><p><strong>Results: </strong>Among the 902 patients who received the survey via email, 201 completed the survey, resulting in a response rate of 22%. The median age was 64 years old (IQR 53-74), 48% were male, 51% were university educated, 32% were on kidney replacement therapies, and 57% had received ≥5 COVID-19 vaccine doses. 65% of respondents reported that they had sought out COVID-19-related information in the last 12 months, with 91% and 84% expressing having understood and trusted the information they received, respectively. Those with a higher number of COVID-19 vaccine doses were associated with having sought out (<i>P</i> =.017), comprehended (<i>P</i> < .001), and trusted (<i>P</i> =. 005) COVID-19-related information. Female sex was associated with expressing more concern about contracting COVID-19 (<i>P</i> = .011). Most respondents strongly agreed to statements regarding the benefits of COVID-19 vaccination. Respondents' questions about COVID-19 infection and vaccination centered on 4 major themes: COVID-19 vaccination strategy, vaccine effectiveness, vaccine safety, and the impact of COVID-19 infection and vaccination on kidney health.</p><p><strong>Limitations: </strong>This survey was administered within the Canadian health care context to
背景:慢性肾脏病(CKD)患者因感染 COVID-19 而导致住院或死亡等严重后果的风险增加。接种 COVID-19 疫苗是降低 CKD 患者感染风险和严重程度的重要方法。有关影响 CKD 患者接种 COVID-19 疫苗的因素(包括健康信息寻求行为和认知)的信息十分有限:目的:描述慢性肾脏病患者(1)寻求 COVID-19 健康信息的行为,(2)理解和信任来自不同来源的 COVID-19 信息的能力,以及(3)他们对 COVID-19 感染和疫苗接种的看法:横断面网络调查,于 2023 年 2 月 17 日至 2023 年 4 月 17 日在不列颠哥伦比亚省和安大略省进行:参加 COVID-19 疫苗血清学纵向研究的慢性肾脏病 G3b-5D 患者和肾移植受者(CKD G1T-5T):调查内容包括人口统计学和临床数据、感染 COVID-19 的易感性、收集、理解和信任 COVID-19 信息的能力以及对接种 COVID-19 疫苗的看法。数据采用描述性统计,数值以计数(%)表示,并进行卡方检验,显著性水平设定为 P≤ .05。对受访者提出的有关 COVID-19 感染和疫苗接种的问题进行了内容分析:在通过电子邮件收到调查问卷的 902 名患者中,有 201 人完成了调查问卷,回复率为 22%。中位年龄为 64 岁(IQR 53-74),48% 为男性,51% 接受过大学教育,32% 接受过肾脏替代疗法,57% 接种过≥5 剂 COVID-19 疫苗。65%的受访者称他们在过去12个月中寻求过与COVID-19相关的信息,91%和84%的受访者分别表示理解和信任他们所获得的信息。接种 COVID-19 疫苗次数较多的受访者与曾寻求 (P=.017)、理解 (P < .001) 和信任 (P =. 005) COVID-19 相关信息有关。女性性别与对感染 COVID-19 表示更多担忧有关(P = .011)。大多数受访者非常同意有关接种 COVID-19 疫苗益处的说法。受访者关于 COVID-19 感染和疫苗接种的问题主要集中在 4 个主题上:COVID-19疫苗接种策略、疫苗有效性、疫苗安全性以及COVID-19感染和疫苗接种对肾脏健康的影响:本调查是在加拿大医疗保健范围内对至少接种过一次 COVID-19 疫苗的慢性肾脏病患者进行的。未采集参与者的种族/族裔:结论:在这项针对慢性肾脏病患者的调查中,COVID-19 的信息寻求行为很高,几乎所有受访者都了解并信任他们所获得的信息。对 COVID-19 疫苗和加强剂的看法大多是正面的。
{"title":"Perceptions and Information-Seeking Behavior Regarding COVID-19 Vaccination Among Patients With Chronic Kidney Disease in 2023: A Cross-Sectional Survey.","authors":"Omosomi Enilama, Cynthia MacDonald, Pearl Thompson, Umair Khan, Selina Allu, Mary Beaucage, Kevin Yau, Matthew J Oliver, Michelle A Hladunewich, Adeera Levin","doi":"10.1177/20543581241242550","DOIUrl":"https://doi.org/10.1177/20543581241242550","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;People living with chronic kidney disease (CKD) face an increased risk of severe outcomes such as hospitalization or death from COVID-19. COVID-19 vaccination is a vital approach to mitigate the risk and severity of infection in patients with CKD. Limited information exists regarding the factors that shape COVID-19 vaccine uptake, including health information-seeking behavior and perceptions, within the CKD population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objectives were to describe among CKD patients, (1) health information-seeking behavior on COVID-19, (2) their capacity to comprehend and trust COVID-19 information from different sources, and (3) their perceptions concerning COVID-19 infection and vaccination.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design/setting: &lt;/strong&gt;Cross-sectional web-based survey administered in British Columbia and Ontario from February 17, 2023, to April 17, 2023.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Chronic kidney disease G3b-5D patients and kidney transplant recipients (CKD G1T-5T) enrolled in a longitudinal COVID-19 vaccine serology study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods and measurements: &lt;/strong&gt;The survey consisted of a questionnaire that included demographic and clinical data, perceived susceptibility of contracting COVID-19, the ability to collect, understand, and trust information on COVID-19, as well as perceptions regarding COVID-19 vaccination. Descriptive statistics were used to present the data with values expressed as count (%) and chi square tests were performed with a significance level set at &lt;i&gt;P&lt;/i&gt; ≤ .05. A content analysis was performed on one open-ended response regarding respondents' questions surrounding COVID-19 infection and vaccination.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 902 patients who received the survey via email, 201 completed the survey, resulting in a response rate of 22%. The median age was 64 years old (IQR 53-74), 48% were male, 51% were university educated, 32% were on kidney replacement therapies, and 57% had received ≥5 COVID-19 vaccine doses. 65% of respondents reported that they had sought out COVID-19-related information in the last 12 months, with 91% and 84% expressing having understood and trusted the information they received, respectively. Those with a higher number of COVID-19 vaccine doses were associated with having sought out (&lt;i&gt;P&lt;/i&gt; =.017), comprehended (&lt;i&gt;P&lt;/i&gt; &lt; .001), and trusted (&lt;i&gt;P&lt;/i&gt; =. 005) COVID-19-related information. Female sex was associated with expressing more concern about contracting COVID-19 (&lt;i&gt;P&lt;/i&gt; = .011). Most respondents strongly agreed to statements regarding the benefits of COVID-19 vaccination. Respondents' questions about COVID-19 infection and vaccination centered on 4 major themes: COVID-19 vaccination strategy, vaccine effectiveness, vaccine safety, and the impact of COVID-19 infection and vaccination on kidney health.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This survey was administered within the Canadian health care context to","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241242550"},"PeriodicalIF":1.7,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11020724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859806","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
Reclassification of Genetic Testing Results: A Case Report Demonstrating the Need for Structured Re-Evaluation of Genetic Findings. 基因检测结果的重新分类:一份证明有必要对基因检测结果进行结构化再评估的病例报告。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-04-14 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241242562
Clara Schott, Samantha Colaiacovo, Cadence Baker, Matthew A Weir, Dervla M Connaughton
<p><strong>Rationale: </strong>Alport Syndrome (AS) is a progressive genetic condition characterized by chronic kidney disease (CKD), hearing loss, and eye abnormalities. It is caused by mutations in the genes <i>COL4A3, COL4A4</i>, and <i>COL4A5</i>. Heterozygous mutations in <i>COL4A4</i> and <i>COL4A3</i> cause autosomal dominant Alport Syndrome (ADAS), and a spectrum of phenotypes ranging from asymptomatic hematuria to CKD, with variable extra-renal features. In the past, heterozygous mutations in these genes were thought to be benign, however recent studies show that about 30% of patients can progress to CKD, and 15% can progress to end stage kidney disease (ESKD).</p><p><strong>Presenting concerns: </strong>We present a case of a woman who was noted to have microscopic hematuria pre-living kidney donation. Genetic testing revealed a heterozygous variant of uncertain significance (VUS) in the <i>COL4A4</i> gene. VUSs are medically nonactionable findings and data show that VUSs can be detected in 41% of all patients who undergo clinical genetic testing. VUSs frustrate clinicians and patients alike. Although they cannot be used in medical decision-making, data suggest that reanalysis can result in the reclassification of a VUS over time.</p><p><strong>Diagnosis: </strong>Post-donation, the index patient had a higher than anticipated rise in serum creatinine, raising a concern for possible intrinsic kidney disease. Kidney biopsy was deemed high risk in the setting of a unilateral kidney thereby limiting possible diagnostic intervention to determine the cause of disease.</p><p><strong>Intervention: </strong>Re-evaluation of prior genetic testing results and reassessment of the previously identified VUS in <i>COL4A4</i> was performed 5-years post-donation. These analyses, along with the addition of new phenotypic data and extended pedigree data, resulted in the reclassification of the previously identified VUS to a likely pathogenic variant.</p><p><strong>Outcomes: </strong>This case demonstrates the importance of structured, periodic re-evaluation of genetic testing results. With the ever-changing landscape of genetics in medicine, the interpretation of a VUS can be dynamic and therefore warrant caution in living kidney donor evaluations. Studies have shown that about 10% of VUSs can be upgraded to a pathogenic classification after an 18- to 36-month interval. Structured re-evaluation of genomic testing results has not yet been integrated into clinical practice and poses a unique challenge in living kidney donation.</p><p><strong>Novel findings: </strong>This case report highlights the variability of the ADAS phenotype caused by pathogenic heterozygous variants in the type 4 collagen genes. It supports the nomenclature change from a benign hematuria phenotype to ADAS, particularly when additional risk factors such as proteinuria, focal segmental glomerulosclerosis or glomerular basement membrane changes on kidney biopsy are present, or as in thi
基本原理:阿尔波特综合征(AS)是一种渐进性遗传疾病,以慢性肾病(CKD)、听力损失和眼部异常为特征。它是由 COL4A3、COL4A4 和 COL4A5 基因突变引起的。COL4A4 和 COL4A3 基因的杂合子突变会导致常染色体显性阿尔波特综合征(ADAS),表现型从无症状血尿到慢性肾脏病,并伴有不同的肾外特征。过去,这些基因的杂合突变被认为是良性的,但最近的研究表明,约 30% 的患者会发展为慢性肾脏病,15% 的患者会发展为终末期肾脏病(ESKD):我们介绍了一例在活体肾脏捐献前发现有镜下血尿的女性病例。基因检测发现,COL4A4 基因中存在一个意义不确定的杂合变体(VUS)。VUS 是医学上不可操作的结果,数据显示,在所有接受临床基因检测的患者中,有 41% 的人可以检测到 VUS。VUSs 让临床医生和患者都感到沮丧。虽然它们不能用于医疗决策,但数据表明,随着时间的推移,重新分析可对 VUS 进行重新分类:捐献后,指标病人的血清肌酐升幅高于预期,令人担忧可能存在内在肾脏疾病。在单侧肾脏的情况下,肾脏活检被认为是高风险的,从而限制了确定病因的可能诊断干预:干预措施:对先前的基因检测结果进行重新评估,并在捐献 5 年后对先前确定的 COL4A4 中的 VUS 进行重新评估。这些分析,加上新的表型数据和扩展的血统数据,将先前确定的 VUS 重新归类为可能致病的变异体:本病例表明,对基因检测结果进行结构化的定期再评估非常重要。随着医学遗传学的不断变化,对 VUS 的解释也会不断变化,因此在评估活体肾脏捐献者时需要谨慎。研究表明,约有 10% 的 VUS 在间隔 18 至 36 个月后可升级为致病分类。基因组检测结果的结构化再评估尚未纳入临床实践,这对活体肾脏捐献构成了独特的挑战:本病例报告强调了由 4 型胶原基因致病性杂合变异引起的 ADAS 表型的可变性。它支持将良性血尿表型更名为 ADAS,尤其是当出现蛋白尿、局灶节段性肾小球硬化或肾活检肾小球基底膜病变等其他风险因素时,或者像本病例一样,其他家族成员也有患病的证据。
{"title":"Reclassification of Genetic Testing Results: A Case Report Demonstrating the Need for Structured Re-Evaluation of Genetic Findings.","authors":"Clara Schott, Samantha Colaiacovo, Cadence Baker, Matthew A Weir, Dervla M Connaughton","doi":"10.1177/20543581241242562","DOIUrl":"https://doi.org/10.1177/20543581241242562","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Rationale: &lt;/strong&gt;Alport Syndrome (AS) is a progressive genetic condition characterized by chronic kidney disease (CKD), hearing loss, and eye abnormalities. It is caused by mutations in the genes &lt;i&gt;COL4A3, COL4A4&lt;/i&gt;, and &lt;i&gt;COL4A5&lt;/i&gt;. Heterozygous mutations in &lt;i&gt;COL4A4&lt;/i&gt; and &lt;i&gt;COL4A3&lt;/i&gt; cause autosomal dominant Alport Syndrome (ADAS), and a spectrum of phenotypes ranging from asymptomatic hematuria to CKD, with variable extra-renal features. In the past, heterozygous mutations in these genes were thought to be benign, however recent studies show that about 30% of patients can progress to CKD, and 15% can progress to end stage kidney disease (ESKD).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Presenting concerns: &lt;/strong&gt;We present a case of a woman who was noted to have microscopic hematuria pre-living kidney donation. Genetic testing revealed a heterozygous variant of uncertain significance (VUS) in the &lt;i&gt;COL4A4&lt;/i&gt; gene. VUSs are medically nonactionable findings and data show that VUSs can be detected in 41% of all patients who undergo clinical genetic testing. VUSs frustrate clinicians and patients alike. Although they cannot be used in medical decision-making, data suggest that reanalysis can result in the reclassification of a VUS over time.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Diagnosis: &lt;/strong&gt;Post-donation, the index patient had a higher than anticipated rise in serum creatinine, raising a concern for possible intrinsic kidney disease. Kidney biopsy was deemed high risk in the setting of a unilateral kidney thereby limiting possible diagnostic intervention to determine the cause of disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;Re-evaluation of prior genetic testing results and reassessment of the previously identified VUS in &lt;i&gt;COL4A4&lt;/i&gt; was performed 5-years post-donation. These analyses, along with the addition of new phenotypic data and extended pedigree data, resulted in the reclassification of the previously identified VUS to a likely pathogenic variant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes: &lt;/strong&gt;This case demonstrates the importance of structured, periodic re-evaluation of genetic testing results. With the ever-changing landscape of genetics in medicine, the interpretation of a VUS can be dynamic and therefore warrant caution in living kidney donor evaluations. Studies have shown that about 10% of VUSs can be upgraded to a pathogenic classification after an 18- to 36-month interval. Structured re-evaluation of genomic testing results has not yet been integrated into clinical practice and poses a unique challenge in living kidney donation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Novel findings: &lt;/strong&gt;This case report highlights the variability of the ADAS phenotype caused by pathogenic heterozygous variants in the type 4 collagen genes. It supports the nomenclature change from a benign hematuria phenotype to ADAS, particularly when additional risk factors such as proteinuria, focal segmental glomerulosclerosis or glomerular basement membrane changes on kidney biopsy are present, or as in thi","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241242562"},"PeriodicalIF":1.7,"publicationDate":"2024-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11017705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847947","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
Differences in Antihypertensive Medication Prescription Profiles Between 2009 and 2021: A Retrospective Cohort Study of CARTaGENE. 2009 年至 2021 年间抗高血压药物处方概况的差异:CARTaGENE 的回顾性队列研究。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-04-09 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241234729
Victoria Ivensky, Pitchou Zonga, Gabriel Dallaire, Louis-Charles Desbiens, Annie-Claire Nadeau-Fredette, Guy Rousseau, Rémi Goupil

Background: Although blood pressure (BP) control is critical to prevent cardiovascular diseases, hypertension control rates in Canada are in decline.

Objective: To assess this issue, we sought to evaluate the differences in antihypertensive medication prescription profiles in the province of Quebec between 2009 and 2021.

Design: This is a retrospective cohort study.

Setting: We used data from the CARTaGENE population-based cohort linked to administrative health databases.

Patients: Participants with any drug claim in the 6 months prior to the end of follow-up were included.

Measurements: Guideline-recommended antihypertensive drug prescription profiles were assessed at the time of enrollment (2009-2010) and end of follow-up (March 2021).

Methods: Prescriptions practices from the 2 time periods were compared using Pearson's chi-square tests. A sensitivity analysis was performed by excluding participants in which antihypertensive drugs may not have been prescribed solely to treat hypertension (presence of atrial fibrillation/flutter, ischemic heart disease, heart failure, chronic kidney disease, or migraines documented prior to or during follow-up).

Results: Of 8447 participants included in the study, 31.4% and 51.3% filled prescriptions for antihypertensive drugs at the beginning and end of follow-up. In both study periods, guideline-recommended monotherapy was applied in most participants with hypertension (77.9% vs 79.5%, P = .3), whereas optimal 2 and 3-drug combinations were used less frequently (62.0% vs 61.4%, P = .77, 51.9% vs 46.7%, P = .066, respectively). Only the use of long-acting thiazide-like diuretics (9.5% vs 27.7%, P < .001) and spironolactone as a fourth-line agent (8.3% vs 15.9%, P = .054) increased with time but nonetheless remained infrequent. Results were similar in the sensitivity analysis.

Limitations: Specific indication of the prescribed antihypertensive medications and follow-up BP data was not available.

Conclusions: Application of hypertension guidelines for the choice of antihypertensive drugs remains suboptimal, highlighting the need for education initiatives. This may be an important step to raise BP control rates in Canada.

背景:尽管控制血压对预防心血管疾病至关重要,但加拿大的高血压控制率却在下降:尽管控制血压对预防心血管疾病至关重要,但加拿大的高血压控制率却在下降:为了评估这一问题,我们试图评估 2009 年至 2021 年期间魁北克省抗高血压药物处方概况的差异:设计:这是一项回顾性队列研究:我们使用了与行政健康数据库相连接的 CARTaGENE 人口队列数据:患者:纳入在随访结束前 6 个月内有任何药物索赔的参与者:方法:评估入组时(2009-2010 年)和随访结束时(2021 年 3 月)指南推荐的降压药处方情况:采用皮尔逊卡方检验比较两个时间段的处方情况。通过排除可能并非仅为治疗高血压而处方降压药的参与者(在随访前或随访期间记录有心房颤动/搏动、缺血性心脏病、心力衰竭、慢性肾病或偏头痛),进行了敏感性分析:在纳入研究的 8447 名参与者中,分别有 31.4% 和 51.3% 的人在随访开始和结束时开具了降压药处方。在两个研究期间,大多数高血压患者都采用了指南推荐的单一疗法(77.9% 对 79.5%,P = .3),而最佳的 2 种和 3 种药物组合的使用频率较低(分别为 62.0% 对 61.4%,P = .77;51.9% 对 46.7%,P = .066)。随着时间的推移,只有长效噻嗪类利尿剂(9.5% vs 27.7%,P < .001)和螺内酯作为四线药物(8.3% vs 15.9%,P = .054)的使用率有所增加,但仍不常见。敏感性分析的结果与此相似:局限性:无法获得处方降压药的具体适应症和随访血压数据:结论:应用高血压指南选择降压药物的效果仍不理想,因此有必要开展教育活动。这可能是提高加拿大血压控制率的重要一步。
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引用次数: 0
Randomized Controlled Trial of the Effect of an Exercise Rehabilitation Program on Symptom Burden in Maintenance Hemodialysis: A Clinical Research Protocol. 运动康复计划对维持性血液透析患者症状负担影响的随机对照试验:临床研究协议》。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-04-03 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241234724
Emilie Ford, Krista Stewart, Eric Garcia, Monica Sharma, Reid Whitlock, Ruth Getachew, Krista Rossum, Todd A Duhamel, Mauro Verrelli, James Zacharias, Paul Komenda, Navdeep Tangri, Claudio Rigatto, Jennifer M MacRae, Clara Bohm
<p><strong>Background: </strong>People receiving hemodialysis experience high symptom burden that contributes to low functional status and poor health-related quality of life. Management of symptoms is a priority for individuals receiving hemodialysis but limited effective treatments exist. There is emerging evidence that exercise programming can improve several common dialysis-related symptoms.</p><p><strong>Objective: </strong>The primary aim of this study is to evaluate the effect of an exercise rehabilitation program on symptom burden in individuals receiving maintenance hemodialysis.</p><p><strong>Design: </strong>Multicenter, randomized controlled, 1:1 parallel, open label, prospective blinded end point trial.</p><p><strong>Setting: </strong>Three facility-based hemodialysis units in Winnipeg, Manitoba, Canada.</p><p><strong>Participants: </strong>Adults aged 18 years or older with end-stage kidney disease receiving facility-based maintenance hemodialysis for more than 3 months, with at least 1 dialysis-related symptom as indicated by the Dialysis Symptom Index (DSI) severity score >0 (n = 150).</p><p><strong>Intervention: </strong>Supervised 26-week exercise rehabilitation program and 60 minutes of cycling during hemodialysis thrice weekly. Exercise intensity and duration were supervised and individualized by the kinesiologist as per participant baseline physical function with gradual progression over the course of the intervention.</p><p><strong>Control: </strong>Usual hemodialysis care (no exercise program).</p><p><strong>Measurements: </strong>Our primary outcome is change in symptom burden at 12 weeks as measured by the DSI severity score. Secondary outcomes include change in modified DSI severity score (includes 10 symptoms most plausible to improve with exercise), change in DSI severity score at 26 and 52 weeks; time to recover post-hemodialysis; health-related quality of life measured using EuroQol (EQ)-5D-5L; physical activity behavior measured by self-report (Godin-Shepherd questionnaire) and triaxial accelerometry; exercise capacity (shuttle walk test); frailty (Fried); self-efficacy for exercise; and 1-year hospitalization and mortality.</p><p><strong>Methods: </strong>Change in primary outcome will be compared between groups by independent 2-tailed <i>t</i> test or Mann-Whitney U test depending on data distribution and using generalized linear mixed models, with study time point as a random effect and adjusted for baseline DSI score. Similarly, change in secondary outcomes will be compared between groups over time using appropriate parametric and nonparametric statistical tests depending on data type and distribution.</p><p><strong>Limitations: </strong>The COVID-19 pandemic restrictions on clinical research at our institution delayed completion of target recruitment and prevented collection of accelerometry and physical function outcome data for 15 months until restrictions were lifted.</p><p><strong>Conclusions: </strong>The
背景:血液透析患者的症状负担很重,导致功能状态低下和健康相关生活质量低下。控制症状是血液透析患者的首要任务,但目前有效的治疗方法有限。有新的证据表明,运动计划可以改善几种常见的透析相关症状:本研究的主要目的是评估运动康复计划对维持性血液透析患者症状负担的影响:多中心、随机对照、1:1 平行、开放标签、前瞻性盲法终点试验:地点:加拿大马尼托巴省温尼伯市的三家血液透析单位:年龄在18岁或18岁以上的终末期肾病患者,接受设施内维持性血液透析3个月以上,至少有1种透析相关症状,透析症状指数(DSI)严重程度大于0分(n=150):干预措施:为期 26 周的运动康复计划和每周三次在血液透析期间进行 60 分钟的自行车运动。运动强度和持续时间由运动学专家根据参与者的基线身体功能进行监督和个性化设计,并在干预过程中逐步推进:对照组:常规血液透析护理(无运动计划):我们的主要结果是 12 周后症状负担的变化,以 DSI 严重程度评分来衡量。次要结果包括修改后的 DSI 严重程度评分(包括 10 个最有可能通过运动改善的症状)的变化、26 周和 52 周时 DSI 严重程度评分的变化、血液透析后恢复时间、使用 EuroQol (EQ)-5D-5L 测量的健康相关生活质量、通过自我报告(Godin-Shepherd 问卷)和三轴加速度测量的身体活动行为、运动能力(穿梭步行测试)、虚弱程度(Fried)、运动自我效能以及 1 年住院时间和死亡率。方法:将根据数据分布情况,使用广义线性混合模型,将研究时间点作为随机效应,并根据基线 DSI 分数进行调整,通过独立的双尾 t 检验或 Mann-Whitney U 检验来比较组间主要结果的变化。同样,将根据数据类型和分布情况,使用适当的参数和非参数统计检验来比较不同组间随时间的次要结果变化:COVID-19大流行对本机构临床研究的限制延迟了目标招募的完成,并在限制解除前的15个月内无法收集加速度计和身体功能结果数据:应用运动康复计划来改善血液透析患者的症状负担可能会改善血液透析患者的常见症状,并在长期内提高生活质量、减少残疾和发病率。重要的是,这项务实的研究采用了标准化的运动干预措施,能够适应基本的身体功能,弥补了血液透析患者临床治疗和我们现有知识中的一个重要缺口。
{"title":"Randomized Controlled Trial of the Effect of an Exercise Rehabilitation Program on Symptom Burden in Maintenance Hemodialysis: A Clinical Research Protocol.","authors":"Emilie Ford, Krista Stewart, Eric Garcia, Monica Sharma, Reid Whitlock, Ruth Getachew, Krista Rossum, Todd A Duhamel, Mauro Verrelli, James Zacharias, Paul Komenda, Navdeep Tangri, Claudio Rigatto, Jennifer M MacRae, Clara Bohm","doi":"10.1177/20543581241234724","DOIUrl":"https://doi.org/10.1177/20543581241234724","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;People receiving hemodialysis experience high symptom burden that contributes to low functional status and poor health-related quality of life. Management of symptoms is a priority for individuals receiving hemodialysis but limited effective treatments exist. There is emerging evidence that exercise programming can improve several common dialysis-related symptoms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The primary aim of this study is to evaluate the effect of an exercise rehabilitation program on symptom burden in individuals receiving maintenance hemodialysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Multicenter, randomized controlled, 1:1 parallel, open label, prospective blinded end point trial.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Three facility-based hemodialysis units in Winnipeg, Manitoba, Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Adults aged 18 years or older with end-stage kidney disease receiving facility-based maintenance hemodialysis for more than 3 months, with at least 1 dialysis-related symptom as indicated by the Dialysis Symptom Index (DSI) severity score &gt;0 (n = 150).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;Supervised 26-week exercise rehabilitation program and 60 minutes of cycling during hemodialysis thrice weekly. Exercise intensity and duration were supervised and individualized by the kinesiologist as per participant baseline physical function with gradual progression over the course of the intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Control: &lt;/strong&gt;Usual hemodialysis care (no exercise program).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Measurements: &lt;/strong&gt;Our primary outcome is change in symptom burden at 12 weeks as measured by the DSI severity score. Secondary outcomes include change in modified DSI severity score (includes 10 symptoms most plausible to improve with exercise), change in DSI severity score at 26 and 52 weeks; time to recover post-hemodialysis; health-related quality of life measured using EuroQol (EQ)-5D-5L; physical activity behavior measured by self-report (Godin-Shepherd questionnaire) and triaxial accelerometry; exercise capacity (shuttle walk test); frailty (Fried); self-efficacy for exercise; and 1-year hospitalization and mortality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Change in primary outcome will be compared between groups by independent 2-tailed &lt;i&gt;t&lt;/i&gt; test or Mann-Whitney U test depending on data distribution and using generalized linear mixed models, with study time point as a random effect and adjusted for baseline DSI score. Similarly, change in secondary outcomes will be compared between groups over time using appropriate parametric and nonparametric statistical tests depending on data type and distribution.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The COVID-19 pandemic restrictions on clinical research at our institution delayed completion of target recruitment and prevented collection of accelerometry and physical function outcome data for 15 months until restrictions were lifted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The ","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241234724"},"PeriodicalIF":1.7,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10993676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847946","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
The Association Between Intradialytic Symptom Clusters and Recovery Time in Patients Undergoing Maintenance Hemodialysis: An Exploratory Analysis. 维持性血液透析患者析出内症状群与恢复时间之间的关系:探索性分析
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-03-25 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241237322
Arrti A Bhasin, Jennifer M MacRae, Braden Manns, Kelvin C W Leung, Amber O Molnar, Jason W Busse, David Collister, K Scott Brimble, Christian G Rabbat, Jessica Tyrwhitt, Andrea Mazzetti, Michael Walsh
<p><strong>Background: </strong>Individuals receiving hemodialysis often experience concurrent symptoms during treatment and frequently report feeling unwell after dialysis. The degree to which intradialytic symptoms are related, and which specific symptoms may impair health-related quality of life (HRQoL) is uncertain.</p><p><strong>Objectives: </strong>To explore intradialytic symptoms clusters, and the relationship between intradialytic symptom clusters with dialysis treatment recovery time and HRQoL.</p><p><strong>Design/setting: </strong>We conducted a post hoc analysis of a prospective cohort study of 118 prevalent patients receiving hemodialysis in two centers in Calgary, Alberta and Hamilton, Ontario, Canada.</p><p><strong>Participants: </strong>Adults receiving hemodialysis treatment for at least 3 months, not scheduled for a modality change within 6 weeks of study commencement, who could provide informed consent and were able to complete English questionnaires independently or with assistance.</p><p><strong>Methods: </strong>Participants self-reported the presence (1 = <i>none</i> to 5 = <i>very much</i>) of 10 symptoms during each dialysis treatment, the time it took to recover from each treatment, and weekly Kidney Disease Quality of Life 36-Item-Short Form (KDQoL-36) assessments. Principal component analysis identified clusters of intradialytic symptoms. Mixed-effects, ordinal and linear regression examined the association between symptom clusters and recovery time (categorized as 0, >0 to 2, >2 to 6, or >6 hours), and the physical component and mental component scores (PCS and MCS) of the KDQoL-36.</p><p><strong>Results: </strong>One hundred sixteen participants completed 901 intradialytic symptom questionnaires. The most common symptom was lack of energy (56% of treatments). Two intradialytic symptom clusters explained 39% of the total variance of available symptom data. The first cluster included bone or joint pain, muscle cramps, muscle soreness, feeling nervous, and lack of energy. The second cluster included nausea/vomiting, diarrhea and chest pain, and headache. The first cluster (median score: -0.56, 25th to 75th percentile: -1.18 to 0.55) was independently associated with longer recovery time (odds ratio [OR] 1.62 per unit difference in score, 95% confidence interval [CI]: 1.23-2.12) and decreased PCS (-0.72 per unit difference in score, 95% CI: -1.29 to -0.15) and MCS scores (-0.82 per unit difference in score, 95% CI: -1.48 to -0.16), whereas the second cluster was not (OR 1.24, 95% CI: 0.97-1.58; PCS 0.19, 95% CI -0.46 to 0.83; MCS -0.72, 95% CI: -1.50 to 0.06).</p><p><strong>Limitations: </strong>This was an exploratory analysis of a small data set from 2 centers. Further work is needed to externally validate these findings to confirm intradialytic symptom clusters and the generalizability of our findings.</p><p><strong>Conclusions: </strong>Intradialytic symptoms are correlated. The presence of select intradialytic symp
背景:接受血液透析的患者在治疗期间经常会出现并发症状,透析后也经常会感到不适。透析内症状的相关程度以及哪些特定症状可能会损害健康相关生活质量(HRQoL)尚不确定:探讨透析内症状群,以及透析内症状群与透析治疗恢复时间和 HRQoL 之间的关系:我们对在加拿大阿尔伯塔省卡尔加里市和安大略省汉密尔顿市两家中心接受血液透析的 118 名流行病患者的前瞻性队列研究进行了事后分析:接受血液透析治疗至少 3 个月的成人,在研究开始后 6 周内未计划更换透析方式,可提供知情同意书,能够独立或在他人协助下完成英文问卷:参与者自我报告每次透析治疗期间出现的 10 种症状(1 = 无到 5 = 非常多)、每次治疗后恢复所需的时间以及每周的肾病生活质量 36 项短表(KDQoL-36)评估。主成分分析确定了透析内症状群。混合效应、序数和线性回归检验了症状群与恢复时间(分为0小时、>0至2小时、>2至6小时或>6小时)以及KDQoL-36的身体成分和精神成分得分(PCS和MCS)之间的关系:116 名参与者填写了 901 份肾内症状问卷。最常见的症状是乏力(占治疗的 56%)。两个椎管内症状群解释了现有症状数据总方差的 39%。第一个症状群包括骨或关节疼痛、肌肉痉挛、肌肉酸痛、紧张和乏力。第二组包括恶心/呕吐、腹泻、胸痛和头痛。第一组评分(中位数:-0.56,第 25 到 75 百分位数:-1.18 到 0.55)与较长的恢复时间独立相关(评分每单位差异的几率比 [OR] 为 1.62,95% 置信区间 [CI]:1.23-2.12):而第二组则不然(OR 1.24,95% CI:0.97-1.58;PCS 0.19,95% CI -0.46-0.83;MCS -0.72,95% CI:-1.50-0.06):局限性:这是对来自两个中心的小数据集进行的探索性分析。局限性:这是一项来自两个中心的小型数据集的探索性分析,还需要进一步的工作对这些结果进行外部验证,以确认椎管内症状群和我们研究结果的普遍性:结论:椎管内症状具有相关性。结论:透析内症状具有相关性,特定透析内症状的存在可能会延长患者从透析治疗中恢复的时间,并损害患者的 HRQoL。
{"title":"The Association Between Intradialytic Symptom Clusters and Recovery Time in Patients Undergoing Maintenance Hemodialysis: An Exploratory Analysis.","authors":"Arrti A Bhasin, Jennifer M MacRae, Braden Manns, Kelvin C W Leung, Amber O Molnar, Jason W Busse, David Collister, K Scott Brimble, Christian G Rabbat, Jessica Tyrwhitt, Andrea Mazzetti, Michael Walsh","doi":"10.1177/20543581241237322","DOIUrl":"10.1177/20543581241237322","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Individuals receiving hemodialysis often experience concurrent symptoms during treatment and frequently report feeling unwell after dialysis. The degree to which intradialytic symptoms are related, and which specific symptoms may impair health-related quality of life (HRQoL) is uncertain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;To explore intradialytic symptoms clusters, and the relationship between intradialytic symptom clusters with dialysis treatment recovery time and HRQoL.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design/setting: &lt;/strong&gt;We conducted a post hoc analysis of a prospective cohort study of 118 prevalent patients receiving hemodialysis in two centers in Calgary, Alberta and Hamilton, Ontario, Canada.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Adults receiving hemodialysis treatment for at least 3 months, not scheduled for a modality change within 6 weeks of study commencement, who could provide informed consent and were able to complete English questionnaires independently or with assistance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Participants self-reported the presence (1 = &lt;i&gt;none&lt;/i&gt; to 5 = &lt;i&gt;very much&lt;/i&gt;) of 10 symptoms during each dialysis treatment, the time it took to recover from each treatment, and weekly Kidney Disease Quality of Life 36-Item-Short Form (KDQoL-36) assessments. Principal component analysis identified clusters of intradialytic symptoms. Mixed-effects, ordinal and linear regression examined the association between symptom clusters and recovery time (categorized as 0, &gt;0 to 2, &gt;2 to 6, or &gt;6 hours), and the physical component and mental component scores (PCS and MCS) of the KDQoL-36.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;One hundred sixteen participants completed 901 intradialytic symptom questionnaires. The most common symptom was lack of energy (56% of treatments). Two intradialytic symptom clusters explained 39% of the total variance of available symptom data. The first cluster included bone or joint pain, muscle cramps, muscle soreness, feeling nervous, and lack of energy. The second cluster included nausea/vomiting, diarrhea and chest pain, and headache. The first cluster (median score: -0.56, 25th to 75th percentile: -1.18 to 0.55) was independently associated with longer recovery time (odds ratio [OR] 1.62 per unit difference in score, 95% confidence interval [CI]: 1.23-2.12) and decreased PCS (-0.72 per unit difference in score, 95% CI: -1.29 to -0.15) and MCS scores (-0.82 per unit difference in score, 95% CI: -1.48 to -0.16), whereas the second cluster was not (OR 1.24, 95% CI: 0.97-1.58; PCS 0.19, 95% CI -0.46 to 0.83; MCS -0.72, 95% CI: -1.50 to 0.06).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;This was an exploratory analysis of a small data set from 2 centers. Further work is needed to externally validate these findings to confirm intradialytic symptom clusters and the generalizability of our findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Intradialytic symptoms are correlated. The presence of select intradialytic symp","PeriodicalId":9426,"journal":{"name":"Canadian Journal of Kidney Health and Disease","volume":"11 ","pages":"20543581241237322"},"PeriodicalIF":1.7,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10964465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140292880","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
Impact of the 2021 CKD-EPI eGFR Equation on Kidney Care Referral Criteria in Ontario, Canada: A Population-based Cross-sectional Study. 2021 年 CKD-EPI eGFR 公式对加拿大安大略省肾脏护理转诊标准的影响:基于人口的横断面研究。
IF 1.7 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-03-23 eCollection Date: 2024-01-01 DOI: 10.1177/20543581241229258
Eric McArthur, Graham Smith, Manish M Sood, Peter G Blake, K Scott Brimble, Flory T Muanda, Amit X Garg, Stephanie N Dixon
<p><strong>Background: </strong>In some jurisdictions, individuals become eligible or recommended for referral for different types of kidney care using criteria based on their estimated glomerular filtration rate (eGFR). Historically, GFR was estimated with an equation developed in 2009, which included a Black race term. An updated, race-free equation was developed in 2021. It is unclear how adoption of the 2021 equation will influence the number of individuals meeting referral criteria to receive different types of kidney care.</p><p><strong>Objective: </strong>To develop population-based estimates on how the number of individuals meeting the eGFR-based referral criteria to receive three different types of kidney care (nephrologist consultation, care in a multi-care specialty clinic, kidney transplant evaluation) changes when the 2021 versus 2009 equation is used to calculate eGFR.</p><p><strong>Design: </strong>Population-based, cross-sectional study.</p><p><strong>Setting: </strong>Ontario, Canada's most populous province with 14.2 million residents as of 2021. Less than 5% of Ontario's residents self-identify as being of Black race.</p><p><strong>Patients: </strong>Adults with at least one outpatient serum creatinine measurement in the 2 years prior to December 31, 2021.</p><p><strong>Measurements: </strong>Referral criteria to 3 different types of kidney care: nephrologist consultation, multi-care specialty clinic, and evaluation for a kidney transplant. The eGFR thresholds used to define referral eligibility or recommendation for these kidney health services were based on guidelines from Ontario's provincial renal agency.</p><p><strong>Methods: </strong>The number of individuals meeting referral criteria for the 3 different healthcare services was compared between the 2009 and 2021 equations, restricted to individuals not yet receiving that level of care. As individual-level race data were not available, estimates were repeated, randomly assigning a Black race status to 1%, 5%, and 10% of the population.</p><p><strong>Results: </strong>We had an outpatient serum creatinine measurement available for 1 048 110 adults. Using the 2009 equation, 37 345 individuals met the criteria to be referred to a nephrologist, 10 019 met the criteria to receive care in a multi-care specialty clinic, and 10 178 met the criteria to be referred for kidney transplant evaluation. Corresponding numbers with the 2021 equation (and the percent relative to the 2009 equation) were 26 645 (71.3%), 9009 (89.9%), and 8615 (84.6%) individuals, respectively. These numbers were largely unchanged when Black race was assumed in up to 10% of the population.</p><p><strong>Limitations: </strong>Referral criteria based solely on urine albumin-to-creatinine ratio were not assessed. Self-reported race data were unavailable.</p><p><strong>Conclusions: </strong>For healthcare planning, in regions where a minority of the population is Black, a substantial number of individuals may no
背景:在一些司法管辖区,根据个人的估计肾小球滤过率(eGFR)标准,个人有资格或建议转诊接受不同类型的肾脏治疗。从历史上看,肾小球滤过率是根据 2009 年制定的公式估算的,该公式包含一个黑人种族项。2021 年制定了不含种族因素的最新公式。目前还不清楚 2021 年方程的采用将如何影响符合转诊标准、接受不同类型肾脏治疗的人数:以人群为基础,估算当采用 2021 年方程与 2009 年方程计算 eGFR 时,符合基于 eGFR 的转诊标准以接受三种不同类型肾脏治疗(肾病专家会诊、多种专科诊所治疗、肾移植评估)的人数有何变化:设计:基于人群的横断面研究:安大略省是加拿大人口最多的省份,截至 2021 年共有 1420 万居民。安大略省不到 5%的居民自认为是黑人:患者:在 2021 年 12 月 31 日之前的两年内至少在门诊测量过一次血清肌酐的成年人:3种不同类型肾脏护理的转诊标准:肾科医师会诊、多种护理专科门诊和肾移植评估。用于界定这些肾脏保健服务的转诊资格或建议的 eGFR 临界值是基于安大略省肾脏机构的指南:对 2009 年和 2021 年方程中符合 3 种不同医疗服务转介标准的人数进行了比较,但仅限于尚未接受该级别医疗服务的个人。由于无法获得个人层面的种族数据,因此重复进行了估算,随机为1%、5%和10%的人口分配了黑人种族身份:我们获得了 1 048 110 名成人的门诊血清肌酐测量数据。根据 2009 年的计算公式,37 345 人达到了转诊至肾科医生的标准,10 019 人达到了在综合专科诊所接受治疗的标准,10 178 人达到了接受肾移植评估的标准。采用 2021 年等式的相应人数(以及相对于 2009 年等式的百分比)分别为 26 645 人(71.3%)、9009 人(89.9%)和 8615 人(84.6%)。当假定黑人占总人口的 10%时,这些数字基本保持不变:未评估仅基于尿白蛋白与肌酐比值的转诊标准。无法获得自我报告的种族数据:对于医疗保健规划而言,在黑人占人口少数的地区,采用新的 2021 年 eGFR 方程后,相当多的人可能不再符合不同类型肾脏医疗保健的转诊标准。
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Canadian Journal of Kidney Health and Disease
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