Acute kidney injury (AKI) presents as a sharp decline in renal function caused by a variety of reasons. It is a severe clinical challenge affecting multiple organs and multiple systems, with high mortality. Continuous renal replacement therapy (CRRT) plays an important role in the treatment of AKI. Limited by the lack of evidence, the timing of CRRT for AKI remains ambiguous. This article reviews the definition and grading of AKI, the indication and the timing of initiation/termination of CRRT for AKI .
Acute kidney injury (AKI) is characterized by a rapid decrease in renal function caused by different etiologies and can involve multiple organs and systems. AKI is a potentially reversible disease. However, it can also progress to chronic kidney disease (CKD) without proper treatment. The concept of acute kidney disease (AKD) is recently recommended as a derivative between AKI and CKD. At present, AKI still lacks specific drug treatment; therefore prevention and early diagnosis are crucial in AKI management. Due to the heterogeneity of the pathogenesis, the epidemiological features of AKI vary across nations and regions, so the strategies for prevention and control are different. This papers reports new progress of epidemiological features of AKI in different countries, so as to provide reference for assessing the disease burden and formulating public health policies.
Continuous renal replacement therapy (CRRT) is one of the major treatments for critically ill patients. With the development of information technology, the informatization and artificial intelligent of CRRT has received wide attention, which has promoted the optimization of CRRT in terms of workflow, teaching method as well as scientific research. Benefiting from the big data generated, artificial intelligence is expected to be applied in the precision treatment, quality control, timing of intervention, as well as prognosis assessment in severe AKI, so as to ultimately improve the therapeutic effect of CRRT among critically ill patients. This paper summarizes the information construction of CRRT and the research progress of artificial intelligence, which can be used as a reference for practitioners in kidney disease, critical medicine, emergency medicine and other related fields.
Continuous renal replacement therapy (CRRT) is an important therapy for patients with severe acute kidney injury. With the development of blood purification, the application of CRRT has been beyond the scope of kidney disease and developed into a comprehensive and integrated organ support platform, providing a hybrid treatment of different blood purification techniques. With the advancement of informatization, it is possible to improve the quality of CRRT treatment to formulate individualized and precise treatment based on the specific information of patients. This article will discuss the precise prescription and development prospective of CRRT from three dimensions: anticoagulation, dosage and volume management.
Blood purification, as a critical medical intervention for renal function replacement, metabolic waste clearance, and homeostasis maintenance, relies heavily on the optimization of therapeutic solutions to ensure clinical efficacy. In recent years, significant advancements have been made in the formulation design, biocompatibility, and clinical outcomes of blood purification solutions, driven by progress in clinical medicine and biomedical engineering. This article systematically elaborates on the latest research developments in key therapeutic solutions, including continuous renal replacement therapy replacement fluids, hemodialysis dialysate, hemodialysis catheter lock solutions, and peritoneal dialysate. By synthesizing current evidence, the aim is to offer scientific guidance for clinicians in selecting optimal treatment regimens while exploring future directions and emerging trends in the development of blood purification solutions.
Non-anticoagulated continuous renal replacement therapy (CRRT) is usually the main treatment choice for high-risk bleeding patients due to its good safety. The coagulation and shortened lifespan of extracorporeal circulation circuits are the main challenges faced by non-anticoagulated CRRT, and it is particularly important to explore the factors that affect the lifespan of non-anticoagulated CRRT extracorporeal circulation circuits. This article reviews the optimization strategies for extending the lifespan of non-anticoagulated CRRT extracorporeal circulation circuits, including the selection of vascular access and catheter, as well as the setting of CRRT mode, blood flow rate, circuit flush, and replacement fluid dilution methods. The aim is to provide a reference for practitioners in the field of kidney disease and critical care medicine.
Blood purification is not only an effective treatment for patients with acute and chronic renal failure, but also plays an important role in the rescue of various critically ill patients. The current blood purification devices is relatively bulky and not suitable for use in daily life and disaster rescue sites. Portable blood purification devices can be divided into portable artificial kidney, wearable artificial kidney, implantable artificial kidneys and mobile continuous renal replacement therapy machine, which have not yet been widely applied in clinical practice. In recent years, with the advancement of materials science and computer science, efficient regeneration of dialysate and intelligent operation of equipment have become possible, and portable blood purification devices is also expected to experience rapid development. This article briefly reviews the development history and future research directions of portable blood purification devices.
【摘要】 目的 了解科研志愿者参与科研活动的现状及满意度，为促进本科生科研能力培养提供决策建议。 方法 以参与四川大学华西临床医学院循证医学中心及多学科综合治疗（MCQ）两项科研志愿者活动的407名同学为调查研究对象，采用自制问卷表进行调查。对数据进行描述性分析和Logistic回归分析。 结果 发放问卷407份，回收有效问卷351份，有效回收率86.24%。80.6%的受访对象对目前参与科研活动现状表示满意。认为限制工作进展的主要因素是缺乏相关基础知识和基本技能（占34.7%）以及缺乏时间（占31.6%）。21.1%的科研活动无固定的组织模式。96.2%的受访对象表示有必要进行活动成果展示。是否有导师指导、是否有知识传授和技能培训以及对活动组织模式是否满意是影响科研志愿者对科研活动满意度的主要因素（P值分别为0.027、0.011和0.000）。 结论 志愿者参与科研活动的满意度总体较高;满意度受到多种因素影响。建立科研志愿者招募体系、完善科研能力培养层次、加强科研团队组织建设、规范管理运作机制、嵌入科研课程并加强科研成果展示有助于提升本科生科研活动的参与率及满意度，对医学本科生科研能力培养具有积极作用。【Abstract】 Objective To study the current status and satisfactory degree of student volunteers’’ participation in scientific research, so as to provide suggestion for improving the scientific research capability of medical undergraduates. Methods Carried out a survey on 407 student volunteers from EBM (Evidence-Based Medicine) and MCQ (Matrix clinical quality) research program in West China Medical School, Sichuan University with self-designed questionnaires.The data was described and analyzed with logistic regression. Results A total of 351 (86.24%) valid questionnaires were retrieved among all the 407 questionnaires assigned.80.6% of the respondents were contented with the current situation of scientific volunteers’ program.34.7% of respondents thought that lack of basic knowledge and skill was the main factor that limited the progress of their research work.While for another 31.6% respondents, the main limited factor was lack of extracurricular time.21.1% of research activities were not operated in a standardized organizational mode.96.2% of the respondents emphasized on the necessity of exhibiting their works and achievements in public.“Tutor’s instructions”, “training on basic knowledge and skills” and “organizational mode” were the main factors which affect the satisfactory degree on scientific volunteer programs (P=0.027, 0.011, and 0.000, respectively) . Conclusion The satisfactory degree of students who participated in scientific volunteer programs is generally satisfying, however affected by various factors. Increase of participation rate in scientific research program can be attributed to factors such as establishment of a scientific volunteer recruitment system, improvement of students’ research capability, standard organizational modes, standard managing and operating mechanism, embed training lessons into courses
After more than 10 years of development and construction, the continuous renal replacement therapy subspecialty of the Department of Nephrology of West China Hospital of Sichuan University has made outstanding achievements in the aspect of continuing education. This article discusses and summarizes the current training measures for continuous renal replacement therapy subspecialized refresher physicians in the Department of Nephrology of West China Hospital of Sichuan University, and introduces the training goals, training measures and training results. The purpose is to provide a summary of experience for the continuing education of continuous renal replacement therapy subspecialized refresher physicians, provide a reference for hospitals that plan to develop continuous renal replacement therapy subspecialized refresher physicians training, and assists in promoting the development of continuous renal replacement therapy subspecialized continuing education in China.
ObjectiveTo compare the incidences of peritoneal dialysis (PD)-associated peritonitis among HIV and non-HIV patients, and to analyze the risk factors of PD-associated peritonitis. MethodsEnd-stage renal disease patients with HIV infection who newly started PD in West China Hospital of Sichuan University from 2012 to 2020 were retrospectively included, and non-HIV PD patients in the same period were included as controls at a ratio of 1 to 4. The risk factors of PD-associated peritonitis were analyzed by univariate analysis and multivariate logistic analysis. Kaplan-Meier survival analysis and COX regression analysis were used to compare the peritonitis-free survival between HIV group and non-HIV group. ResultsA total of 60 PD patients were included. The average follow-up time was 31.2±21.3 months. Peritonitis occurred in 7 HIV patients (58.33%) and 8 non-HIV patients (16.67%). Logistic regression analysis showed that HIV infection (P=0.018) and high platelet (>150×109/L) (P=0.032) were independent risk factors for PD-associated peritonitis. The incidence of PD-associated peritonitis in HIV patients significantly increased (HR=10.944, 95%CI 1.503 to 79.707). Kaplan-Meier survival analysis showed that the 5-year peritonitis-free survival of non-HIV group was significantly higher than that of HIV group (75.7% vs. 31.1%) (P=0.003). Multivariate COX survival analysis showed that the 5-year accumulative risk of peritonitis in HIV PD patients was 5.896 times (95%CI 1.508 to 23.043, P=0.01) higher than that of the non-HIV PD patients. ConclusionHIV infection is an independent risk factor for PD-associated peritonitis.