ObjectiveTo study and analyze the clinical characteristics, treatment and prognosis of chronic kidney disease (CKD) patients with tuberculosis.MethodsThe cases of CKD with tuberculosis treated in respiratory department, nephrology department and infection department of the Affiliated Hospital of Southwest Medical University during January 2014 to December 2018 and followed up for at least half a year were collected as the study subjects. The clinical characteristics of CKD patients with tuberculosis and to observe the treatment, prognosis and adverse reactions were analyzed.ResultsA total of 74 patients were enrolled in the analysis, including 51 males (68.91%) and 23 females (31.08%), and with a mean age of (52.1±15.5) years. The use rate of immunosuppress drug in CKD G1\G2\G3 stage was very high (100%, 100%, 70%, respectively), and patients in G5 stage had the highest TB infection by 49 cases. There were 58 cases of pulmonary tuberculosis, which was the main form of tuberculosis. Extrapulmonary tuberculosis was very common too, and there were 40 cases including 29 cases of lymph node tuberculosis. Among 53 cases of acid fast bacilli smear, 8 cases were positive; lung biopsy positive in 1; lymph node biopsy was positive in 5 cases; 53 cases were initially treated and 21 cases were retreated. The main symptoms of 74 patients were emaciation (33 cases), fever (30 cases), and fatigue (25 cases); the common symptoms of 58 patients with pulmonary tuberculosis were cough and expectoration (41 cases). Pulmonary tuberculosis mainly infected the upper field of lung (39 cases). The most common imaging features was patchy shadow in 17 cases, followed by single or multiple nodules in 15 cases. The number of cases with lymph node enlargement in drainage area, pleural effusion, and pleural thickening were 36, 34 and 24, respectively. The sensitivity of tuberculosis interferon-gamma release assays (TB-IGRA), tuberculosis polymerase chain reaction (TB-PCR) and Mycobacterium tuberculosis protein chip was 79.6%, 18.8% and 61.7%, respectively. After tuberculosis treatments, 51 cases were successful, 14 cases failed, 5 cases died, and 4 cases could not be evaluated. Sixteen cases had serious and typical adverse reactions, including 12 cases of drug-induced liver injury, and 11 cases of treatment failure due to these serious adverse reactions.ConclusionsThe incidence rate of tuberculosis is high in CKD patients and the clinical manifestations are atypical. Pulmonary tuberculosis is the main form of tuberculosis, extrapulmonary tuberculosis is very common and mainly lymph node tuberculosis. The sensitivity of TB-IGRA, TB-PCR and Mycobacterium tuberculosis protein chip detection are lower than that of common patients. The success rate of tuberculosis treatment in CKD patients is low, the adverse reaction rate is high, and the adverse reactions are the main causes of treatment failure.
The patency of vascular access is of great significance to hemodialysis patients. Combining with guidelines and literature associated with vascular access for dialysis in recent years, the authors interpret the effectiveness and limitations of prophylactic drug strategies, including using fish oil, anticoagulation, anti-platelet, lipid-lowering agents, etc., in order to promote the proper use of these agents in clinical practice, and improve the effect of prophylaxis and treatment of vascular access dysfunction.
Chronic kidney disease (CKD) has been highlighted as one of the most important public health problems due to sharply climbing incidence and prevalence. To efficiently attenuate the disease burden and improve the disease management, not only active and effective treatment should be administrated, but also comprehensive follow-up nursing management with innovative and evolving spirits should be implemented. Thus dynamic changes of diseases could be acquired in time and patients are under appropriate medical instruction as soon as possible. This editorial is based on quickly developing medical big data resources and advanced internet techniques, from both aspects of patients and health care providers, briefly talking about integrated management strategy of CKD and its future development in China.
Objective
To explore the hormone medication compliance in children with chronic kidney disease (CKD) and analyze its influencing factors.
Methods
Between May and December 2013, 96 children were investigated by questionnaires about medication compliance when they were out of the hospital. Then we analyzed the influencing factors for medication compliance. All the data were analyzed by SPSS 19.0 software.
Results
Of these 96 children, medication nonadherence accounted for 52% (50). The main guardian, educational level of the father, educational level of the mother, residence, duration of illness, time of hospitalization, and understanding of the treatment plan played significant roles in causing different medication compliance among these children (P＜0.05). Logistic regression analysis showed that duration of illness [OR=2.204, 95%CI (1.253, 3.875), P=0.006], residence [OR=2.615, 95%CI (1.0 23, 6.687), P=0.045] and the mother’s educational level [OR=0.147, 95%CI (0.028, 0.788), P=0.025] were the independent factors for medication compliance.
Conclusions
According to the survey, hormone medication compliance in children with chronic kidney disease is not satisfying. We should strengthen the health education in children and their parents, and adopt specific interventions to enhance the medication compliance so as to effectively control the disease and delay the progression.
ObjectiveTo collect the nutrition data in patients with chronic kidney disease (CKD) from stage 1 to 4 and provide the basis for further intervention by analyzing the specific problems of the patients.
MethodsA total of 132 CKD patients from stage 1 to 4 were enrolled between December 2012 and December 2013. Nutritionists used inbodyS10ww as a body composition analyzer to test the patients. The data from inbodyS10ww and laboratory indexes were analyzed on marasmus, overweight and obesity, risk of malnutrition, malnutrition, anemia and hypoalbuminemia.
ResultsThe percentage of marasmus in those CKD patients was 3.0%, overweight and obesity was 39.4%, the risk of malnutrition was 22.7%, malnutrition was 19.7%, anemia was 34.1%, and hypoalbuminemia was 9.8%.
ConclusionOur search shows that combining the application of anthropometry and laboratory indexes can evaluate the nutritional status of patients with CKD. The most common nutritional problems in CKD patients include malnutrition, overweight and obesity, risk of malnutrition, and anemia. As for hypoalbuminemia, it is low in early CKD patients.
The incidence of chronic kidney disease is on the rise and has become an important factor affecting global public health issues. The intake of sweet beverage remains high worldwide, which has been proved to be related to chronic health problems such as obesity, type 2 diabetes, some cancers and cardiovascular diseases. In recent years, some studies have found that a higher intake of sweet beverage is associated with chronic kidney disease and its risk factors. This article mainly reviews the current research status and potential mechanisms of the correlation between different types of sweet beverages and risk of chronic kidney disease.
Objective To investigate the nutritional status of hospitalized patients with chronic kidney disease (CKD), analyze the influencing factors, and construct a predictive model to provide a localized theoretical basis and more convenient risk prediction indicators and models for clinical nutrition support and intervention treatment of CKD patients in China. Methods Convenience sampling was used to select hospitalized CKD patients from Department of Nephrology, West China Hospital, Sichuan University, from January to October 2019. General information questionnaires, the Nutritional Risk Screening 2002 scale, and the Huaxi Emotional-distress Index questionnaire were used for data collection. Single factor analyses and multiple logistic regression analysis were conducted to explore the risk factors for malnutrition in CKD hospitalized patients. A predictive model was established and evaluated using receiver operating characteristic (ROC) curve analysis and bootstrap resampling. Results A total of 1059 valid copies of questionnaires were collected out of 1118 distributed. Among the 1059 CKD hospitalized patients, 207 cases (19.5%) were identified as having nutritional risk. The multiple logistic regression analysis showed that CKD stage [odds ratio (OR)=1.874, 95% confidence interval (CI) (1.631, 2.152), P<0.001], age [OR=1.015, 95%CI (1.003, 1.028), P=0.018], and the Huaxi Emotional-distress Index [OR=1.024, 95%CI (1.002, 1.048), P=0.033] were independent risk factors for malnutrition in CKD hospitalized patients, while serum albumin [OR=0.880, 95%CI (0.854, 0.907), P<0.001] was an independent protective factor. The evaluation of the multiple logistic regression analysis predictive model showed a concordance index of 0.977, standard deviation of 0.021, and P<0.05. The area under the ROC curve was 0.977. Conclusions The prevalence of malnutrition is relatively high among CKD hospitalized patients. CKD stage, age, psychological status, and serum albumin are influencing factors for malnutrition in CKD hospitalized patients. The multiple logistic regression model based on the above indicators demonstrates good predictive performance and is expected to provide assistance for early nutritional intervention to improve the clinical outcomes and quality of life for CKD patients with malnutrition in China.
Objective To assess the efficacy and safety of prescribing medicinal charcoal for treatment of adult chronic kidney disease. Methods We searched the Cochrane Controlled Trial Register (The Cochrane Library Issue 1, 2009), MEDLINE (1950 to January 2009), EMbase (1980 to January 2009), and Chinese Biomedical Database (1977 to January 2009) to screen randomized controlled trials (RCTs) concerning use of medicinal charcoal for treatment of adult chronic kidney disease. We evaluated the bias risk of the included RCTs according to the Cochrane Handbook for Systematic Reviews of Interventions Version 4.2.2.The Cochrane Collaboration’s software RevMan 5.0 was used for meta-analysis. Results Seven trials involving 347 patients met the criteria. Meta-analysis showed: (1) Medicinal charcoal was better than routine treatment on the improvement of blood urea nitrogen [MD= –0.69, 95%CI (–1.13, –0.24), P=0.002], serum creatinine [MD= – 0.51, 95%CI (–0.94, – 0.08), P=0.02] and the mean change of glomerular filtration rate per month (Plt;0.001). Compared with routine treatment, medicinal charcoal had similar effects on the improvement of 24 hours urinary protein and the mean change of blood pressure; (2) Compared with placebo, and medicinal charcoal was not superior to placebo in improving the incidence of end stage kidney diseases, serum creatinine, creatinine clearance rate, 24 hour urinary protein (Pgt;0.05); (3) Adverse events with constipation, flatulenceand nausea occurred to medicinal charcoal groups. Conclusion Overall, the evidence is not b enough, and more large, high-quality randomized controlled trials are needed to confirm or refute the available evidence.
ObjectivesTo evaluate the methodological bias and the reliability of the conclusions of systematic reviews (SRs) of lanthanum carbonate in the treatment of chronic kidney disease with hyperphosphatemia.
MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library, PROSPERO, CNKI, CBM, WanFang Data and VIP to collect systematic reviews and meta-analysis about lanthanum carbonate in the treatment of chronic kidney disease with hyperphosphatemia from inception to August 31st, 2016. Two reviewers independently screened literature and extracted data, then AMSTAR tool was used to assess the methodological quality of included studies and the GRADE tool was used to grade the evidence quality of outcome measures included in the SRs.
ResultsA total of eight relevant SRs were included and containing three main outcome measures. The assessment results of AMSTAR tool suggested that:four SRs were of high quality, and the other four were of medium quality. GRADE results showed:for serum phosphorus level, compared with placebo, the quality of the evidence of three SRs were medium, low and very low; compared with calcium carbonate or conventional phosphorus binder, four SRs were low, low, low and very low; compared with sevelamer, one SR was low. For serum calcium level, compared with placebo, the quality of the evidence of three SRs were high, medium and low, respectively; compared with calcium carbonate or conventional phosphorus binder, five SRs were low, low, low, very low and very low; compared with sevelamer, one SR was very low. For serum iPTH level, compared with placebo, the quality of the evidence of three SRs were medium, low and very low; compared with calcium carbonate or conventional phosphorus binder, five SRs were medium, low, low, very low and very low; compared with sevelamer, one SR was low.
ConclusionAt present, methodological quality assessment for the treatment of hyperphosphatemia in chronic kidney disease with lanthanum carbonate is generally not high and the level of evidence for the conclusion is generally low. In drug safety, especially in the occurrence of adverse events of the digestive system is still controversial, and a large amount of high quality experimental is needed to demonstrate the safety of its long-term use. Clinicians need to be cautious in using these evidence to make clinical decisions.
ObjectiveTo explore the nutritional status of inpatients with chronic kidney disease (CKD) and analyze the factors affecting nutritional risk, to provide theoretical basis for further nutritional support.MethodsConvenience sampling method was adopted to select 719 inpatients with CKD as research subjects in a tertiary hospital in Chengdu, Sichuan Province from January to March 2018. Nutritional Risk Screening 2002 was used for nutritional risk screening, and chi-square test, t test, one-way analysis of variance, and multiple linear regression analysis were used to explore the influencing factors of nutritional risk.ResultsAmong the 719 cases, whose average nutritional risk score was 1.79±1.11, 158 cases had nutritional risk, accounting for 22.0%. There were statistically significant differences in nutritional risk score between patients of age<60 years and ≥60 years, between males and females, between patients with CKD stage 1-3 and stage 4-5, between patients with serum albumin level <30 g/L and ≥30 g/L, and between patients with and without anaemia (P<0.05). The results of multiple linear regression analysis showed that the nutritional risk score of CKD patients was negatively correlated to serum albumin level (P=0.016), positively correlated to age (P<0.001), and higher in females than that in males (P=0.001).ConclusionsInpatients with CKD have a higher nutritional risk, with age, gender and serum albumin as the main influencing factors. Based on the above factors, the medical staff should continue to take targeted intervention measures to assess the nutritional status of CKD inpatients early and conveniently, so as to provide scientific basis for further nutritional support and nutritional nursing.
