BACKGROUND Diabetic nephropathy(DN)is frequently seen in the development of diabetes mellitus,and its pathogenic factors are complicated.Its current treatment is controversial,and there is a lack of a relevant efficac...BACKGROUND Diabetic nephropathy(DN)is frequently seen in the development of diabetes mellitus,and its pathogenic factors are complicated.Its current treatment is controversial,and there is a lack of a relevant efficacy prediction model.AIM To determine the effects of paricalcitol combined with hemodiafiltration on bonemetabolism-related indexes in patients with DN and chronic renal failure(CRF),and to construct an efficacy prediction model.METHODS We retrospectively analyzed 422 patients with DN and CRF treated in Cangzhou Central Hospital between May 2020 and May 2022.We selected 94 patients who met the inclusion and exclusion criteria.Patients were assigned to a dialysis group(n=45)and a joint group(n=49)in relation to therapeutic regimen.The clinical efficacy of the two groups was compared after treatment.The changes in laboratory indexes after treatment were evaluated,and the two groups were compared for the incidence of adverse reactions.The predictive value of laboratory indexes on the clinical efficacy on patients was analyzed.RESULTS The dialysis group showed a notably worse improvement in clinical efficacy than the joint group(P=0.017).After treatment,the joint group showed notably lower serum levels of serum creatinine,uric acid(UA)and blood urea nitrogen(BUN)than the dialysis group(P<0.05).After treatment,the joint group had lower serum levels of phosphorus,procollagen type I amino-terminal propeptide(PINP)and intact parathyroid hormone than the dialysis group,but a higher calcium level(P<0.001).Both groups had a similar incidence of adverse reactions(P>0.05).According to least absolute shrinkage and selection operator regression analysis,UA,BUN,phosphorus and PINP were related to treatment efficacy.According to further comparison,the non-improvement group had higher risk scores than the improvement group(P<0.0001),and the area under the curve of the risk score in efficacy prediction was 0.945.CONCLUSION For treatment of CRF and DN,combined paricalcitol and hemodiafiltration can deliver higher clinical efficacy and improve the bone metabolism of patients,with good safety.展开更多
Introduction: Correct adjustment of dry weight after hemodialysis (HD) with no signs of hypervolemia is important. Intradialytic hypotension (IDH) is the most common complication during HD. IDH occurs in 15% to 30% an...Introduction: Correct adjustment of dry weight after hemodialysis (HD) with no signs of hypervolemia is important. Intradialytic hypotension (IDH) is the most common complication during HD. IDH occurs in 15% to 30% and possibly in up to 50% of dialysis sessions. IDH augments mortality essentially due to chronic overhydration and the inability to reach the proper dry weight. On-line hemodiafiltration (ol-HDF) has been reported to reduce the frequency of IDH. The aim of this study was to assess the effect of ol-HDF on hemodynamic stability and dry weight adjustment compared with low-flux HD. Methods: IDH-prone HD patients at our center were enrolled. This study was designed as a crossover trial with two phases (A arm: low-flux HD for 8 weeks followed by ol-HDF for 8 weeks vs. B arm: ol-HDF for 8 weeks followed by low-flux HD for 8 weeks) and two treatment arms (ol-HDF vs. low-flux HD), each phase lasting 8 weeks. We measured the proportion of body water using a body composition monitor (BCM). Results: In a comparison of the systolic blood pressure (SBP) and diastolic blood pressure (DBP) reductions from the baseline blood pressure between the HD and ol-HDF groups, statistically significant differences were observed only in the SBP of the B arm (SBP: HD vs. HDF, -9.83 ± 6.64 vs. -4.62 ± 1.61 mmHg, p = 0.036;DBP: HD vs. HDF, -3.29 ± 4.05 vs. -1.86 ± 1.49 mmHg, p = 0.261). Neither the mean of the interdialytic body weight gains nor the frequency of IDH was different between the A and B arms (p = 0.817 and p = 0.562, respectively). In terms of dialysis modality, there were no significant differences in the amount of overhydration between the conventional HD and ol-HDF groups during the two study phases, as measured by the BCM (A arm: p = 0.875, B arm: p = 0.655). Conclusion: Our study did not show a better benefit of ol-HDF to reach the dry weight compared with low-flux HD in IDH-prone patients.展开更多
目的观察一种新型血液透析技术—内源性再输注血液透析滤过(hemodiafiltration with endogenous reinfusion,HFR)对缓解血液透析患者瘙痒症状的效果。方法行前后对照研究,比较患者HFR治疗前、后瘙痒症状、睡眠质量、生活质量和相关实验...目的观察一种新型血液透析技术—内源性再输注血液透析滤过(hemodiafiltration with endogenous reinfusion,HFR)对缓解血液透析患者瘙痒症状的效果。方法行前后对照研究,比较患者HFR治疗前、后瘙痒症状、睡眠质量、生活质量和相关实验室检查指标。结果HFR治疗前、后瘙痒严重程度(Z=-2.023,P=0.043)、睡眠质量(t=7.318,P<0.001)和生活质量(t=4.804,P=0.003)差异均有统计学意义。结论HFR治疗在一定程度上可减轻尿毒症患者的瘙痒症状,改善其睡眠质量和生活质量。展开更多
目的更新维持性血液透析患者衰弱影响因素的系统评价,为制订维持性血液透析患者衰弱早期识别和干预方案提供参考。方法检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Cochrane Library、Web of Science、CINAHL、Embase...目的更新维持性血液透析患者衰弱影响因素的系统评价,为制订维持性血液透析患者衰弱早期识别和干预方案提供参考。方法检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Cochrane Library、Web of Science、CINAHL、Embase数据库,从建库至2023年11月22日有关维持性血液透析患者衰弱影响因素的所有文献及其参考文献,由2名研究者按照标准独立筛选文献、提取资料和评价文献质量。本研究采用Stata 15.0软件对衰弱影响因素进行Meta分析。结果共纳入23篇文献,样本量为8644例。Meta分析结果显示,年龄、性别、糖尿病、周围血管疾病、心脏疾病、脑血管疾病、合并症、吸烟史、糖尿病肾病、跌倒史、抑郁、睡眠质量评分、营养评分、血红蛋白是衰弱的危险因素;血清白蛋白、日常活动能力评分、握力、体型标准是衰弱的保护因素(P<0.05)。体型偏瘦、运动锻炼、甲状旁腺激素和透析充分性与衰弱无关(P>0.05)。结论维持性血液透析患者衰弱影响因素较多,未来的研究可参考本研究结果,早期识别衰弱的高危人群,制订衰弱的干预方案,及早进行干预,改善患者的不良结局,提高患者的生存质量。展开更多
文摘BACKGROUND Diabetic nephropathy(DN)is frequently seen in the development of diabetes mellitus,and its pathogenic factors are complicated.Its current treatment is controversial,and there is a lack of a relevant efficacy prediction model.AIM To determine the effects of paricalcitol combined with hemodiafiltration on bonemetabolism-related indexes in patients with DN and chronic renal failure(CRF),and to construct an efficacy prediction model.METHODS We retrospectively analyzed 422 patients with DN and CRF treated in Cangzhou Central Hospital between May 2020 and May 2022.We selected 94 patients who met the inclusion and exclusion criteria.Patients were assigned to a dialysis group(n=45)and a joint group(n=49)in relation to therapeutic regimen.The clinical efficacy of the two groups was compared after treatment.The changes in laboratory indexes after treatment were evaluated,and the two groups were compared for the incidence of adverse reactions.The predictive value of laboratory indexes on the clinical efficacy on patients was analyzed.RESULTS The dialysis group showed a notably worse improvement in clinical efficacy than the joint group(P=0.017).After treatment,the joint group showed notably lower serum levels of serum creatinine,uric acid(UA)and blood urea nitrogen(BUN)than the dialysis group(P<0.05).After treatment,the joint group had lower serum levels of phosphorus,procollagen type I amino-terminal propeptide(PINP)and intact parathyroid hormone than the dialysis group,but a higher calcium level(P<0.001).Both groups had a similar incidence of adverse reactions(P>0.05).According to least absolute shrinkage and selection operator regression analysis,UA,BUN,phosphorus and PINP were related to treatment efficacy.According to further comparison,the non-improvement group had higher risk scores than the improvement group(P<0.0001),and the area under the curve of the risk score in efficacy prediction was 0.945.CONCLUSION For treatment of CRF and DN,combined paricalcitol and hemodiafiltration can deliver higher clinical efficacy and improve the bone metabolism of patients,with good safety.
文摘Introduction: Correct adjustment of dry weight after hemodialysis (HD) with no signs of hypervolemia is important. Intradialytic hypotension (IDH) is the most common complication during HD. IDH occurs in 15% to 30% and possibly in up to 50% of dialysis sessions. IDH augments mortality essentially due to chronic overhydration and the inability to reach the proper dry weight. On-line hemodiafiltration (ol-HDF) has been reported to reduce the frequency of IDH. The aim of this study was to assess the effect of ol-HDF on hemodynamic stability and dry weight adjustment compared with low-flux HD. Methods: IDH-prone HD patients at our center were enrolled. This study was designed as a crossover trial with two phases (A arm: low-flux HD for 8 weeks followed by ol-HDF for 8 weeks vs. B arm: ol-HDF for 8 weeks followed by low-flux HD for 8 weeks) and two treatment arms (ol-HDF vs. low-flux HD), each phase lasting 8 weeks. We measured the proportion of body water using a body composition monitor (BCM). Results: In a comparison of the systolic blood pressure (SBP) and diastolic blood pressure (DBP) reductions from the baseline blood pressure between the HD and ol-HDF groups, statistically significant differences were observed only in the SBP of the B arm (SBP: HD vs. HDF, -9.83 ± 6.64 vs. -4.62 ± 1.61 mmHg, p = 0.036;DBP: HD vs. HDF, -3.29 ± 4.05 vs. -1.86 ± 1.49 mmHg, p = 0.261). Neither the mean of the interdialytic body weight gains nor the frequency of IDH was different between the A and B arms (p = 0.817 and p = 0.562, respectively). In terms of dialysis modality, there were no significant differences in the amount of overhydration between the conventional HD and ol-HDF groups during the two study phases, as measured by the BCM (A arm: p = 0.875, B arm: p = 0.655). Conclusion: Our study did not show a better benefit of ol-HDF to reach the dry weight compared with low-flux HD in IDH-prone patients.
文摘目的观察一种新型血液透析技术—内源性再输注血液透析滤过(hemodiafiltration with endogenous reinfusion,HFR)对缓解血液透析患者瘙痒症状的效果。方法行前后对照研究,比较患者HFR治疗前、后瘙痒症状、睡眠质量、生活质量和相关实验室检查指标。结果HFR治疗前、后瘙痒严重程度(Z=-2.023,P=0.043)、睡眠质量(t=7.318,P<0.001)和生活质量(t=4.804,P=0.003)差异均有统计学意义。结论HFR治疗在一定程度上可减轻尿毒症患者的瘙痒症状,改善其睡眠质量和生活质量。
文摘目的更新维持性血液透析患者衰弱影响因素的系统评价,为制订维持性血液透析患者衰弱早期识别和干预方案提供参考。方法检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Cochrane Library、Web of Science、CINAHL、Embase数据库,从建库至2023年11月22日有关维持性血液透析患者衰弱影响因素的所有文献及其参考文献,由2名研究者按照标准独立筛选文献、提取资料和评价文献质量。本研究采用Stata 15.0软件对衰弱影响因素进行Meta分析。结果共纳入23篇文献,样本量为8644例。Meta分析结果显示,年龄、性别、糖尿病、周围血管疾病、心脏疾病、脑血管疾病、合并症、吸烟史、糖尿病肾病、跌倒史、抑郁、睡眠质量评分、营养评分、血红蛋白是衰弱的危险因素;血清白蛋白、日常活动能力评分、握力、体型标准是衰弱的保护因素(P<0.05)。体型偏瘦、运动锻炼、甲状旁腺激素和透析充分性与衰弱无关(P>0.05)。结论维持性血液透析患者衰弱影响因素较多,未来的研究可参考本研究结果,早期识别衰弱的高危人群,制订衰弱的干预方案,及早进行干预,改善患者的不良结局,提高患者的生存质量。
文摘血液透析滤过(hemodiafiltration,HDF)结合了弥散与对流的溶质清除方式,以更好地清除较大分子量的尿毒症毒素。该治疗模式是否可以为需要肾脏替代治疗的终末期肾病(end-stage renal disease,ESRD)患者带来长期生存获益一直存有争议,近期高剂量HDF与高通量血液透析的比较(comparison of high-dose hemodiafiltration with high-flux hemodialysis,CONVINCE)研究结果的发表或将成为该争议终结的里程碑。本综述系统梳理了HDF临床获益的证据以及高容量HDF实现的重要影响因素和阶梯式实现方案。
