Studies of evidence-based medicine have provided much important evidence, clarified problems, and guided the clinical practice in the treatment of renal diseases. As examples, several therapeutic problems in renal hypertension, renal anemia and low protein diet for the patients with chronic kidney disease are discussed in this paper.
Chronic kidney disease (CKD) is now recognized as a worldwide public health challenge, and the incidence rate and hospitalization rate have significantly increased in recent years. Without prompt diagnoses and effective treatment in the early renal function damage of CKD, the symptoms will continue to worsen and eventually develop into end-stage renal disease. Functional imaging techniques such as single photon emission computed tomography (SPECT), contrast-enhanced ultrasound (CEUS), computerized tomography perfusion (CTP), and magnetic resonance perfusion weighted imaging (MR-PWI) could be used to quantitatively analyze renal perfusion and renal filtration function. Their diagnostic values are increasingly evident and have become the research hotspot in evaluating renal function. The aim of this review is to briefly evaluate the research and application advances in the early renal function damage assessment of CKD, so as to raise the efficiency of clinical applications.
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.
ObjectiveTo explore the current status of treatment adherence in patients with chronic kidney disease without dialysis and to analyze its influencing factors.MethodsThe patients who visited the Outpatient Department of Nephrology of West China Hospital of Sichuan University from September to December 2020 were taken as the research objects. Self-designed general information questionnaire, treatment adherence questionnaire, physician-patient communication satisfaction, health information seeking behavior questionnaire, and physician-patient concordance questionnaire were used to investigate, and path analysis was used to explore the influencing factors of treatment adherence.ResultsA total of 203 valid questionnaires were obtained. Treatment adherence score was (21.69±2.42) points, self-reported health status was (2.48±0.91) points, physician-patient concordance was (20.39±2.70) points, physician-patient communication satisfaction was (67.73±5.52) points, and health information seeking behavior was (13.17±2.65) points. Health information seeking behavior (r=0.214, P=0.002), physicians-patient concordance (r=0.494, P<0.001), physician-patient communication satisfaction (r=0.229, P=0.001) were positively correlated with treatment adherence. Self-reported health status was negatively correlated with treatment adherence (r=−0.225, P=0.001). Path analysis showed that physicians-patient concordance was the most influencing factor of treatment adherence (total effect=0.474).ConclusionHealth information-seeking behavior and physicians-patient concordance are important factors affecting treatment adherence in chronic kidney disease patients without dialysis. In order to improve treatment adherence of chronic kidney disease patients, healthcare providers can provide various ways to provide information, which can help make more disease-related health knowledge available to patients. Moreover, healthcare workers should also further explore ways to improve the concordance related to reaching agreement between doctors and patients on medical and treatment options.
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.
The incidence of chronic kidney disease is increasing worldwide, which greatly increases the risk of end-stage renal disease. It is particularly important to find out the risk factors for the development and progression of chronic kidney disease. Whether gender is a risk factor for the progression of kidney disease remains controversial with inconsistent results in human cohort studies with diabetic or non-diabetic kidney disease. In most of the studies, women seem to exhibit certain gender advantages. Sex hormones, renal hemodynamics and lifestyle differences may play an important role. The underlying mechanism of gender affecting the progression of kidney disease deserves further exploration. This article reviews the gender differences and possible mechanisms in diabetic and non-diabetic chronic kidney disease, in order to provide reference for future research.
Objective To develop and validate a prediction model to assess the risk of depression in patients with chronic kidney disease (CKD) based on National Health and Nutrition Examination Survey (NHANES) database. Methods Data on patients with CKD were selected from the NHANES between 2005 and 2018. Participants were randomly divided into a training set and a validation set in a 7∶3 ratio for model development and validation, respectively. Multivariable logistic regression was used in the training set to identify independent risk factors associated with depression in CKD patients, with stepwise selection applied to determine the final predictors. Model performance was assessed using receiver operating characteristic curve (ROC), calibration plots, and decision curve analysis (DCA). Internal validation was performed through bootstrap resampling, and a predictive model was ultimately established. Results A total of 4413 CKD patients were included, including 2112 males (47.86%) and 2301 females (52.14%). Among them, 3089 patients were assigned to the training set and 1324 to the validation set. In the training set, 332 patients (10.75%) presented with depressive symptoms, while 143 patients (10.80%) in the validation set had depressive symptoms. Multivariate logistic regression analysis showed that other hispanic, current smoking, and sleep disorders were risk factors (P＜0.05). Male, middle or high-income, high school grad/ged or above, married or widowed were protective factors (P＜0.05). Finally, 7 variables were included to construct a prediction model, including gender, poverty income ratio, education level, marital status, smoking status, body mass index, and sleep disorders. The ROC curve showed that the AUC=0.773 [95% confidence interval (0.747, 0.799)] in the training set, the internal validation was evaluated by 1000 Bootstrap resampling methods, and the corrected C-index=0.763. The validation set AUC=0.778 [95% confidence interval (0.740, 0.815)], showed good discrimination ability. The calibration curve showed that the model’s predicted probability was highly consistent with the actual occurrence. Decision curve analysis showed that the model provided a significant net benefit for clinical decision-making at a threshold probability of 20%～50%. Conclusions The prediction model constructed in this study can effectively predict the risk of depression in patients with CKD and can provide guidance for early screening and personalized intervention for high-risk groups. However, the external validation and localization of the model still needed further research.
Objective To observe the expression of hepcidin-ferroportin (FPN) pathway in adenine-induced chronic kidney disease (CKD) rat model and to explore the mechanism of its involvement in renal fibrosis in CKD. Methods A total of 20 6-week-old male SD rats without specific pathogen were selected. The rats were divided into control group and CKD group, with 10 rats in each group, using a simple random method. Rats were sacrificed at the end of the second and sixth weeks after modeling. The levels of serum creatinine (Scr), blood urea nitrogen (BUN) and 24 h urine protein quantification were measured. The pathological changes of rats were observed. The iron content of rat kidney tissue was detected by colorimetric method, and the level of serum hepcidin-25 was detected by enzyme linked immunosorbent assay method in both groups. Immunohistochemistry and reverse transcription-polymerase chain reaction were used to detect the renal protein and mRNA expression of α-smooth muscle actin (α-SMA), collagen type Ⅰ (Col-Ⅰ), FPN1, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), nuclear factor kappa-B (NF-κB) P65. Results Compared with the control group, the levels of Scr, BUN, and 24 h urine protein quantification were higher in the CKD group at the end of the second and sixth weeks of modeling (P<0.05). The results of renal tissue staining showed that the CKD group had obvious glomerular structural disorders, tubular dilation, and interstitial collagen fiber deposition. Compared with the control group, the serum hepcidin-25 level and the iron content of kidney tissues in the CKD group were significantly higher, and correlation analysis suggested that both were positively correlated with the renal function of rats (P<0.05). Compared with the control group, the protein and mRNA expression levels of α-SMA, Col-Ⅰ, HAMP, IL-6, TNF-α, NF-κB P65 were higher (P<0.05), while FPN1 expression was lower in CKD group at the end of the second and sixth weeks of modeling (P<0.05). Correlation analysis results showed that HAMP mRNA expression was positively correlated with α-SMA, Col-Ⅰ, IL-6, TNF-α, and NF-κB p65 (P<0.001), which was negatively correlated with FPN1 mRNA expression (P<0.001). FPN1 mRNA expression was significantly negatively correlated with α-SMA, Col-Ⅰ (P<0.001). Conclusions Ferroptosis may be present in the adenine-induced rat model of CKD, and it may be involved in the process of renal fibrosis through the interaction of HAMP-FPN signaling pathway with the inflammatory response. Serum hepcidin-25 is expected to be a serological marker for the early diagnosis of CKD.
Objective To evaluate the application effect of quality control circle (QCC) in improving the number of cases received in the follow-up management of chronic kidney disease (CKD). Methods The outpatient and inpatient CKD patients who were filed in the CKD follow-up management center of West China Hospital of Sichuan University from March 10 to October 10, 2020 were selected. We analyzed the reasons that affected CKD patients’ willingness to file by carrying out QCC, improved the case collection by establishing standardized processes, broadened the collection channels, established a collective team, strengthened training management and education of CKD patients and their families, so as to increase the number of cases received in CKD follow-up management. Then, we observed the score of active ability of QCC members before and after this activity. Results After the implementation of QCC activities, the number of follow-up cases increased from 8 per month to 15 per month. The target achievement rate was 140%, and the progress rate was 87.5%. The ability of all circle members in the evaluation indicators of team training has been improved. Conclusions QCC activity can effectively improve the number of cases received in CKD follow-up management. It is helpful for the medical staff to provide better disease management for CKD patients.