ObjectiveTo observe whether proteinuria is relate to the decline of residual renal function (RRF) in peritoneal dialysis (PD) patients.
MethodsThis is a prospective cohort study including 45 PD patients (underwent PD between January 2011 and January 2013) with a 12-month follow-up. All the patients were divided into 2 groups with respect to the initial proteinuria level: massive proteinuria group A (n=20) and non-massive proteinuria group B (n=25) at baseline. We established regression models to do univariate analysis and multivariate analysis of the relationship between the decline of RRF≥50% of baseline and the indices of age, sex, PD-associated peritonitis, baseliner residual glomerular filtration rate (rGFR), initial proteinuria, and use of ACEI/ARB.
ResultsThe primary outcome (RRF>50% of baseline) at 12 months was 65% in group A, and 80% in group B (P<0.05). Based both on the results of univariate and multivariate Cox regression analysis, non-massive proteinuria and higher rGFR at baseline were factors to protect RRF from decline (P<0.05).
ConclusionThe study demonstrates that massive proteinuria and lower rGFR at baseline may be associated with a rapid decline of RRF in PD patients. Treatment aimed at reducing albuminuria may lead to protect RRF and improve life quality of patients.
Objectives To explore the relationship between diabetic macular edema (DME) classified by different optical coherence tomography (OCT) types and the risk of diabetic nephropathy (DN). MethodsA retrospective clinical study. A total of 304 patients with DME, involving 421 eyes, diagnosed through ophthalmic examinations at Xi'an Third Hospital between August 2019 and December 2024 were included in the study. All affected eyes underwent OCT examination along with laboratory tests including glycated hemoglobin, serum albumin, serum creatinine, glomerular filtration rate, urine albumin-to-creatinine ratio, serum β2-microglobulin, and 24-hour urine protein quantification. Based on OCT imaging characteristics, DME was classified into diffuse retinal thickening (DRT) type, cystoid macular edema (CME) type, and serous retinal detachment (SRD) type, with corresponding group sizes of 96 patients (138 eyes), 102 patients (132 eyes), and 106 patients (151 eyes), respectively. The risk of DN development was categorized as low, moderate, high, or very high risk according to KDIGO guidelines. Intergroup comparisons of renal function-related indicators were performed using nonparametric tests. ResultsThe number of affected eyes classified as low risk for DN in the DRT, CME, and SRD groups were 87, 72, and 63, respectively. The number classified as moderate risk were 23, 23, and 28, respectively. The number classified as high risk were 22, 27, and 35, respectively. The number classified as extremely high risk were 6, 10, and 25, respectively. These differences were statistically significant (χ2=20.359, P=0.002). Serum albumin levels were (44.66±4.89), (43.59±6.41), and (41.31±7.53) g/L, respectively. Serum β2-microglobulin levels were (2.15±1.55), (2.52±2.34), and (4.09±5.57) mg/L, respectively. The 24-hour urine protein quantification was (94.88±64.58), (106.20±75.49), and (151.38±121.88) mg/24 h, respectively. Low serum albumin levels were (32.58±1.84), (31.58±2.13), and (30.15±1.63) g/L, respectively. 24-hour high urine protein levels were (225.15±59.78), (246.96±67.38), and (317.71±96.52) mg/24 h, respectively. High serum β2-microglobulin levels were (5.51±3.03), (7.80±3.63), and (14.60±6.81) mg/L, respectively. The comparison of indicators related to renal function showed that there were statistically significant overall differences among the three groups in serum albumin, serum β2-microglobulin and 24-hour urine protein quantification (χ2=18.367, 18.674, 14.612; P＜0.001). The SRD group presented more significant characteristics of renal function impairment. Its low serum albumin level was lower than that of the DRT and CME groups, while the 24-hour high urine protein quantification and high serum β2-microglobulin level were significantly higher than those of the other two groups, and the differences were statistically significant (χ2=21.587, 21.344, 21.587; P＜0.001). ConclusionDN is an important risk factor for SRD-type DME, and patients with this type often have more severe abnormal markers of renal function impairment.
The prevalence, incidence, and medical expenses of end-stage renal disease (ESRD) is extremely high in Taiwan, China; so decreasing the incidence of ESRD is a major work for kidney disease prevention in Taiwan, China. Current chronic kidney disease (CKD) guideline suggests multidisciplinary team (MDT) care for CKD patient with estimated glomerular filtration rate (eGFR) less than 30 mL/(min·1.73 m2). MDT includes not only nephrologist but also nursing specialty, dietitian, social worker, psychologist, and other professional personnel. The aim of the MDT care is to preserve renal function, decrease complications, provide nutrient support and nephrotoxic drug consultation, establish the concept of renal replacement therapy and preparation for dialysis access, provide the renal transplantation information, and give the psychosocial support. These cares should provide to CKD patients one year before starting renal replacement therapy. The MDT care for CKD could delay the progression from CKD to ESRD, lower the mortality and hospitalization of CKD, slow the renal function decline, provide better medical care and quality of life for patients, and decrease the medical expenditures. Besides, advanced CKD patients receiving MDT care have higher arteriovenous access preparation rate that prevent the additional intervention and hospitalization while starting dialysis. MDT care also decreases the hospitalization costs and medical expenditures, and decrease 3-year mortality rate after dialysis initiation. The further developing MDT care includes: (1) providing personalized renal care and treatment model, and intergraded care by cardiology-nephrology-diabetes-neurology model; (2) new iCKD care with health management platform and care mode combined with communication technology; (3) shared decision making for choice of renal replacement therapy; (4) advance care planning clinic for palliative treatment of ESRD. All MDT care hopes to establish a person-oriented care policy, provides a better quality care model, not only for the patient’s personalized medical care, but also hopes to improve the overall kidney disease care and prevention work. In addition, we can extend the CKD prevention and treatment experience to other countries worldwide.
