Effects of Different Hemodialysis Treatments on Abnormal Mineral and Bone Metabolism in Patients with Chronic Renal Failure

Objective:To investigate the effects of different hemodialysis treatments on abnormal mineral and bone metabolism in patients with chronic renal failure.Methods:A random number table was used to divide 80 patients with chronic renal failure admitted to our hospital from January 2018 to January 2019 into 2 groups,with 40 cases in each group.Group A was treated with low-flux hemodialysis,and group B was treated with high-flux hemodialysis.The related indicators of mineral and bone metabolism of the two groups were compared.Results:Before treatment,the blood calcium,blood phosphorus,intact parathyroid hormone(iPTH),type I procollagen amino terminal peptide(PINP),fibroblast growth factor 23(FGF23),serum creatinine(Scr)indicators of the two groups were compared.The difference was not statistically significant(P>0.05);After treatment,the blood calcium levels of the two groups were higher than before treatment,the blood phosphorus,iPTH,PINP,FGF23,and Scr levels were lower than before treatment,and the blood calcium level of group B was higher than that of group A,while blood phosphorus,iPTH,PINP,FGF23,and Scr levels were lower than group A,the difference was statistically significant(P<0.05).Conclusion:Compared with low-flux hemodialysis,patients with chronic renal failure treated with highflux hemodialysis have better results,which can correct abnormal bone metabolism and improve Scr levels.

The Effect of Glucose Added to the Dialysis Fluid on Blood Pressure, Vasoactive Hormones and Energy Transfer during Hemodialysis in Chronic Renal Failure

Background: Previous studies showed that blood pressure was reduced in patients with chronic renal failure during hemodialysis with glucose added to the dialysis fluid. We wanted to test the hypotheses that blood pressure is reduced in non-diabetic and diabetic dialysis patients, when glucose is added to the dialysis fluid, and that blood pressure changes are caused by changes in plasma concentrations of vasoactive hormones or to vasodilation secondary to an increase in body temperature. Methods: The effect of dialysis with glucose added to the dialysis fluid was measured in three randomized, placebo-controlled, un-blinded and cross-over studies with periods of one week duration. In non-diabetic nephropathy (Study 1, n = 19) and diabetic nephropathy (Study 2, n = 15), we measured blood pressure (BP) and pulse rate (PR), plasma concentrations of glucose (p-Glucose), renin (PRC), angiotensin II (p-AngII), endothelin (p-Endot), insulin (p-Ins), glucagon (p-Glu), and human growth hormone (p-hGH). In non-diabetic nephropathy (Study 3, n = 24), we measured the effect of dialysis with glucose added to the dialysis fluid on energy transport from form the body using body temperature control. Results: Study 1 and 2 showed that BP, PRC, p-AngII, and p-Ins were unchanged, whereas P-Endot increased and P-hGH decreased, in dialysis patients with or without glucose added to the dialysis fluid. In diabetics, a marginal increase in p-Glu was measured during dialysis with glucose, but not without glucose. Study 3 showed that SBP increased significantly using dialysis with temperature control of dialysis fluid compared with no temperature control (145 versus 138 mm Hg). In parallel with the increase in SBP, the energy flux from the patients was significantly higher with temperature control than without. Conclusion: In non-diabetics and diabetics, blood pressure was unchanged during dialysis with glucose added to the dialysis fluid in a short-term study. Vasoactive hormones in plasma were changed in the same way independently of glucose in the dialysis fluid. Systolic blood pressure increased using dialysis with temperature control of dialysis fluid, presumably due to vasoconstriction to prevent or antagonize a fall in body temperature.

Doctor-led intensive diet education on health-related quality of life in patients with chronic renal failure and hyperphosphatemia

BACKGROUND Secondary hyperparathyroidism,renal osteodystrophy,and cardiovascular adverse events can occur if long-term hyperphosphatemia is not corrected,leading to the adverse prognosis of patients with chronic renal failure.Besides the use of phosphorus binders,clinical control measures for hyperphosphatemia in these patients should also incorporate diet control.AIM To observe doctor-led intensive diet education effects on health-related quality of life in patients with chronic renal failure and hyperphosphatemia.METHODS We assessed 120 patients with hyperphosphatemia and chronic renal failure on hemodialysis admitted to our hospital(July 2018 to March 2020).The control group(n=60)was given routine nursing guidance,and the observation group(n=60)was given doctor-led intensive diet education.The changes in EQ-5D-3L scores,disease-related knowledge,and compliance scores before intervention and 3 and 6 mo after intervention in the two groups were recorded.The levels of serum parathyroid hormone(iPTH),calcium(Ca),phosphorus(P),calciumphosphorus product(Ca×P),serum creatinine(Scr),and blood urea nitrogen(BUN)before intervention and 3 and 6 mo after intervention in the two groups were assessed along with patient satisfaction.RESULTS There was no significant difference in blood iPTH,Ca,P,Ca×P,Scr,or BUN levels between the groups before intervention.After 3 and 6 mo of intervention,the blood iPTH,Ca,P,and Ca×P levels in the two groups decreased gradually(P<0.05),but there were no significant differences in Scr or BUN.The blood iPTH,Ca,P,and Ca×P levels in the observation group were lower than those in the control group(P<0.05).The satisfaction rate in the observation group after 3 mo was 93.33%and after 6,90.00%,which was high compared with the 80.00%and 71.67%,respectively,in the control group(P<0.05).There was no significant difference in EQ-5D-3L score between the two groups before intervention.After 3 and 6 mo of intervention,the visual analogue scale score of the two groups increased gradually(P<0.05);and the scores of action ability,self-care,daily activities,pain and discomfort,and anxiety and depression decreased gradually(P<0.05).The overall EQ-5D-3L score in the observation group was better than that in the control group(P<0.05).There was no significant difference in diseaserelated knowledge or compliance scores between the groups before intervention.After 3 and 6 mo of intervention,the scores of disease,diet,and medication knowledge and compliance in the two groups increased gradually(P<0.05).The scores of disease-related knowledge and compliance were higher in the observation group than in the control group(P<0.05).CONCLUSION Doctor-led intensive diet education can improve patient satisfaction and the quality of life in patients with chronic renal failure and hyperphosphatemia and promote low-phosphorus diet behavior.

Evaluation of Thyroid Hormones Levels in Libyan Patients with Chronic Renal Failure before and after Maintenance Hemodialy

Data from recent studies revealed that kidney diseases might affect the thyroid function in various ways. A variety of alterations in thyroid hormone levels and metabolism have also been reported in patients with chronic renal failure (CRF) in some studied population. In addition, it was reported that serum levels of both T3 and T4 might alter immediately after a hemodialysis (HD) treatment than before. Therefore, this study was aimed to investigate the level of triiodothyronine (T3) and thyroxine (T4) in CRF Libyan patients before and after HD. This study was carried out on 46 CRF patients (30 males and 16 females) with a mean age of 47.46 ± 15.75 years. These patients were treated at the hemodialysis unit of Educational Central Zelitin Hospital, Zelitin, Libya. None of these patients apparently have any thyroid problems and no history of drug intake that may affect thyroid function. Blood samples were taken from each patient to measure serum levels of T3 and T4, before and after HD. In addition, the effects of several variables including age, gender, body mass index (BMI), presence of both hypertension and, diabetes mellitus and duration of kidney dialysis on serum levels of T3 and T4 before and after HD were also studied. After HD, there was a statistically significant increase in the serum levels of T3, T4. The age, gender, BMI, duration of kidney dialysis and the presence of hypertension and diabetes mellitus did not have any significant effect on the serum level of T3 and T4 before and after HD. However, the serum levels of T3 and T4 were still in the normal range in these examined patients either before or after HD. From these findings, it can be concluded that these CRF patients may be in a euthyroid state, because the serum levels of T3 and T4 were in the normal range. In addition, HD was seemed to improve the T3 and T4 thyroid hormone concentrations, suggesting that HD might activate the secretion of thyroid gland and catabolism. The other variables did not play any role in thyroid hormone levels in these patients either before or after HD. It is highly recommended that large scale evaluation of thyroid hormone levels in Libyan CRF patients is performed by more patients, especially elderly patients.

Study on the occurrence and influencing factors of gastrointestinal symptoms in hemodialysis patients with uremia

BACKGROUND Gastrointestinal symptoms are common in patients with uremia undergoing hemodialysis,and these symptoms seriously affect patients'prognosis.AIM To assess the occurrence and factors influencing gastrointestinal symptoms in patients with uremia undergoing hemodialysis.METHODS We retrospectively selected 98 patients with uremia who underwent regular hemo-dialysis treatment in the blood purification center of our hospital from December 2022 to December 2023.The gastrointestinal symptoms and scores of each dimension were evaluated using the Gastrointestinal Symptom Grading Scale(GSRS).Patients were divided into gastrointestinal symptoms and no gastrointestinal symptom groups according to whether they had gastrointestinal symptoms.The factors that may affect gastrointestinal symptoms were identified by single-factor analysis.Multiple logistic regression analysis was performed to identify independent risk factors for gastrointestinal symptoms.RESULTS Gastrointestinal symptoms included indigestion,constipation,reflux,diarrhea,abdominal pain,and eating disorders,and the total average GSRS score was 1.35±0.47.This study showed that age,number of tablets,dialysis time,glucocorticoid,parathyroid hormone(PTH),combined diabetes mellitus and C-reactive protein(CRP)were independent risk factors for gastrointestinal symptoms in patients with uremia undergoing hemodialysis,whereas body mass index(BMI),hemoglobin(Hb),and urea clearance index were independent protective factors(P<0.05).CONCLUSION Gastrointestinal symptoms are mostly mild in patients with uremia undergoing hemodialysis,most commonly including dyspepsia,eating disorders,and gastroesophageal reflux.The independent influencing factors mainly include the BMI,age,number of pills taken,dialysis time,urea clearance index,Hb,use of glucocorticoids,and thyroid hormone level.PTH,CRP,and diabetes are clinically related factors influencing the occurrence of gastrointestinal symptoms,and targeted prevention can be performed.

Health-related quality of life and coping strategies of patients on hemodialysis in selected hospitals in Ilorin,Kwara state,Nigeria

Objective:The study assessed the quality of life(QoL)and coping strategies of patients on hemodialysis in selected hospitals in Ilorin,Kwara State.Methods:The study was a descriptive cross-sectional design using a quantitative strategy.A multistage sampling technique was adopted to select 80 participants.The data were collected using an adapted questionnaire including four sections:sociodemographic characteristics,hemodialysis stressor scale consisting of four stressors,Jaloweic Coping Scale consisting of eight coping strategies,and QoL consisting of four items.The data were analyzed using SPSS version 23.Results:Findings from the study revealed that 50%of the participants were between the ages of 18 and 39 years,40%of the participants have been on hemodialysis for 1-2 years,whereas 52.5%had hypertension as a comorbidity.A total of 12.5%,63.8%,and 23.8%of the respondents were categorized as experiencing low,moderate,and high stress due to hemodialysis,respectively.QoL of the respondents revealed that 49.4%had no problem in self-care dimension.Average monthly income(χ^(2)=16.36,P=0.04)was observed to be significantly associated with coping strategies,whereas religion(χ^(2)=11.14,P=0.03)and frequency of hemodialysis(χ^(2)=10.26,P=0.04)were significantly associated with coping helpfulness.Conclusion:All participants experienced stress at varying degrees.Hemodialysis results in marked changes in the quality of patients’life,since it includes a number of modifications and restrictions,which affects patients’health functioning.This study revealed a wide range of information on the psychological and physiological stressors of people under hemodialysis.

Hematological Alterations in an Eastern Sudanese Chronic Kidney Disease Patient Population

Background: Chronic Kidney Disease (CKD), associated with a slow and progressive loss of kidney function over a period of several years, is an important clinical disaster with an increasing rate of morbidity and mortality especially in the least developed countries. Many hematological parameters are thought to alter dramatically during the course of the disease. These include white blood cells, red blood cells, and platelets. Methods: We tried, retrospectively, to evaluate the peripheral blood hematological alterations in a group of patients undergoing hemodialysis in an eastern Sudan dialysis center to add local medical information. Results: Anemia (Low hemoglobin and hematocrit) was detected in 94% of the patients’ group. Mean Erythrocyte count (3.32vs.4.76 (×109/L)), Hemoglobin concentration (9.4vs.13 (g/dl)), Hematocrit (28.7vs.38.7 (L/L)) and platelet count (296 vs. 238 (×109/L)) were significantly lower in the patients’ group than in the control group (P-values Conclusion: Five out of eight studied parameters (Red cell count, hemoglobin, hematocrit, mean cell hemoglobin concentration, and platelets count) have shown a significant alteration in CKD patients. As the complete blood count (CBC) test is the most utilized test in clinical laboratory practice, these alterations may be considered as early indicators for CKD. Furthermore, all patients with CKD must be routinely checked for these alterations.

Dental implant treatment for renal failure patients on dialysis:a clinical guideline

Chronic kidney disease （CKD） is a worldwide public health problem that is growing in prevalence and is associated with severe complications. During the progression of the disease, a majority of CKD patients suffer oral complications. Dental implants are currently the most reliable and successful treatment for missing teeth. However, due to complications of CKD such as infections, bone lesions, bleeding risks, and altered drug metabolism, dental implant treatment for renal failure patients on dialysis is more challenging. In this review, we have summarized the characteristics of CKD and previous publications regarding dental treatments for renal failure patients. In addition, we discuss our recent research results and clinical experience in order to provide dental implant practitioners with a clinical guideline for dental implant treatment for renal failure patients undergoing hemodialysis.

Epidemiological Profile of Chronic Hemodialysis Patients in Ouagadougou

Goal: By describing the epidemiology of chronic hemodialysis patients in the single hemodialysis unit of Burkina Faso, we want to contribute to the prevention and improvement of chronic renal failure management (CRF) in this country. Patients and Methods: A descriptive cross-sectional study was conducted in the hemodialysis unit of the University Hospital Center Yalgado Ouedraogo (UHC-YO) during the period from February 12 to May 15, 2015. The patients who started hemodialysis in this unit and were treated for at least three months were included in this study. The sociodemographic and clinical data were collected. The statistical significance was defined for a probability (p ≤ 0.05). Results: One hundred and seventy-two patients (71.2% of the 240 patients of the unit) have been included. The sex ratio was 1.6. The average age was 45.2 ± 12.4 years old. The presumed causes of CRF have been identified in 134 cases (77.9%). The most frequent were hypertensive nephropathy (65 cases;48.5%), chronic glomerulonephritis (41 cases;30.6%;including 11 viral origin and 16 with history of recurrent otorhinolaryngologic infections and/or urinary schistosomiasis). Hemodialysis began in an emergency context in 118 cases (68.6%). The average duration of hemodialysis was 29.4 ± 28.4 months. Conclusion: The main suspected causes of CRF were hypertension and chronic glomerulonephritis. The origin of the latter seemed more often infectious. Prevention of CRF in Burkina Faso should be focused on that of hypertension and infectious diseases.

高通量血液透析联合血液透析滤过序贯治疗慢性肾衰竭的临床效果及对钙磷代谢、预后的影响

目的分析高通量血液透析(HFHD)联合血液透析滤过(HDF)序贯治疗慢性肾衰竭(CRF)的临床效果。方法选取2020年1月至12月我院接收的90例CRF患者为研究对象,随机将其分为常规组(45例,常规HFHD治疗)和联合组(45例,HFHD联合HDF序贯治疗)。比较两组的治疗效果。结果联合组的治疗总有效率高于常规组(P<0.05)。治疗后,联合组的血尿素氮(BUN)、血肌酐(Scr)、甲状旁腺素(PTH)及β2-微球蛋白(β2-MG)水平低于常规组,内生肌酐清除率(Ccr)显著高于常规组(P<0.05)。治疗后,联合组的钙(Ca)水平高于常规组,磷(P)、成纤维细胞生长因子-23(FGF-23)、镁(Mg)、降钙素(CT)及碱性磷酸酶(ALP)水平低于常规组,差异具有统计学意义(P<0.05)。治疗后,联合组的肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)及白细胞介素-8(IL-8)水平低于常规组,白细胞介素-10(IL-10)水平高于常规组,差异具有统计学意义(P<0.05)。联合组的不良反应总发生率低于常规组,差异具有统计学意义(P<0.05)。结论HFHD联合HDF序贯治疗CRF可取得理想的效果。

基于沃森人文关怀理论的人性化护理在慢性肾衰竭血液透析患者中的应用

目的分析基于沃森人文关怀理论的人性化护理干预在慢性肾衰竭血液透析患者中的应用效果。方法回顾性研究,采集2021年6月至2023年2月于郑州市第七人民医院接受常规护理的75例慢性肾衰竭血液透析患者的病历资料,纳入对照组;采集医院同期接受基于沃森人文关怀理论的人性化护理的75例慢性肾衰竭血液透析患者的病历资料,纳入观察组。比较两组心理状态[焦虑自评量表(SAS)、抑郁自评量表(SDS)评分]、主观幸福感[总体幸福感量表(GWB)评分]、自护能力[自我护理能力测定量表(ESCA)评分]以及护理满意度。结果护理后,观察组心理状态评分低于对照组,主观幸福感、自护能力、护理满意度均高于对照组(P<0.05)。结论基于沃森人文关怀理论的人性化护理可以调节慢性肾衰竭血液透析患者的心理状态,提高主观幸福感和自护能力,且患者护理满意度更高。

慢性肾衰竭血液透析患者IL-13、FGF23、SOST水平变化与血管钙化的关系

目的分析慢性肾衰竭(chronic renalfailure,CRF)血液透析患者血清白介素13(interleukin-13,IL-13)、成纤维细胞生长因子23(fibroblast growthfactor 23,FGF23)、骨硬化蛋白(sclerostin,SOST)水平变化与血管钙化的关系。方法纳入2021年1月至2022年12月郑州大学第一附属医院收治的126例行维持性血液透析(maintenance hemodialysis,MHD)的CRF患者临床资料,所有患者使用X线正位片及腹部平片观察血管钙化情况,采用Adragao钙化评分法,分为0分(无钙化)、1~3分(轻度钙化)、4~6分(中度钙化)、7~8分(重度钙化),使用受试者工作特征(receiver operatingcharacteristic,ROC)曲线评估血清IL-13、FGF23、SOST对患者血管钙化的诊断价值,并使用Pearson相关系数评估存在血管钙化者的血管钙化评分与血清IL-13、FGF23、SOST的相关性。结果行MHD治疗的CRF患者中,合并血管钙化者且有糖尿病患病史的比例高于无血管钙化者(P<0.05),血清IL-13、FGF23、SOST水平均高于无血管钙化者(P<0.05)。ROC曲线分析显示,血清IL-13、FGF23、SOST对MHD治疗的CRF患者血管钙化的诊断均具有价值(AUC_(IL-13)=0.827,P<0.05;AUC_(FGF2)=0.781,P<0.05;AUC_(SOST)=0.746,P<0.05),且3项联合诊断价值更高(AUC=0.906,P<0.05)。重度血管钙化者血清IL-13、FGF23、SOST水平显著高于中度钙化与轻度钙化者(P<0.05),中度钙化者高于轻度钙化者(P<0.05);Pearson相关系数分析显示,合并血管钙化患者的血管钙化评分与血清IL-13、FGF23、SOST均呈正相关(r_(IL-13)=0.532,P<0.05;r_(FGF23)=0.504,P<0.05;r_(SOST)=0.511,P<0.05)。结论IL-13、FGF23、SOST可能参与了MHD治疗的CRF患者血管钙化发生、发展过程,监测三者血清水平变化具有重要的临床诊疗价值。

循证护理对慢性肾衰竭血液透析患者遵医行为、自我护理能力及生活质量的影响

目的 了解为慢性肾衰竭血液透析患者提供循证护理对其遵医行为、自我护理能力及生活质量的影响,确定循证护理的临床应用价值。方法 选择2021年5月—2022年5月60例在本院接受治疗且成功出院并具有一定典型的慢性肾衰竭血液透析患者,按照入院时间将其排序,随后打乱进行随机抽取,将其全部纳入观察组与对照组,每组30例。对照组实施常规护理,真实记录护理前后的各项数据。观察组实施循证护理,同时也记录护理前后的各项数据。最后处理两组的各项数据,确定可比较后分析两组的整体预后情况。结果 护理前,两组的各项数据比较无显著差异;护理后,相较于对照组,观察组无论是遵医行为还是自我护理能力、生活质量皆更为优异(P<0.05)。结论 在慢性肾衰竭血液透析患者中应用循证护理干预效果更佳,可以通过有针对性的举措改善患者的遵医行为,提高自我护理水平和生活质量,是一种行之有效的护理干预模式,值得广泛应用于临床。

血液透析联合解毒泄浊方治疗慢性肾功能衰竭的临床效果分析

目的分析临床上血液透析联合解毒泄浊方治疗慢性肾功能衰竭的效果。方法选择2022年1月—2023年3月本院收治的120例慢性肾功能衰竭患者为研究对象,随机将其分为观察组和对照组,每组60例。对照组接受血液透析治疗,观察组在对照组的基础上进行解毒泄浊方治疗。3个月后观察两组患者的临床效果、炎症因子及肾功能指标改善情况。结果观察组治疗有效率高于对照组(P<0.05)。治疗后,观察组各项炎症因子(IL-6、CRP、TNF-ɑ)水平均明显低于对照组(P<0.05);观察组Cr、BUN水平明显低于对照组,CCR水平明显高于对照组(P<0.05)。结论血液透析联合解毒泄浊方治疗慢性肾功能衰竭效果显著,安全可靠,值得推广使用。

补肾活血法联合血液透析治疗慢性肾衰竭的Meta分析

[目的]对补肾活血法联合血液透析治疗慢性肾衰竭的文献进行Meta分析。[方法]计算机检索中国期刊全文数据库(CNKI)、万方数据库知识服务平台(WangFang)、Pubmed、EmBase等数据库,筛选补肾活血法联合血液透析治疗慢性肾功能不全的随机对照试验,检索时间为自建库起至2022年9月7日。运用Cochrane风险偏倚评估工具进行文献质量评价,应用Review Manager 5.3软件进行Meta分析,使用Stata14.0软件进行Egger检验,以评估发表偏倚,若存在发表偏倚则进一步运用非参数剪补法评估偏倚对结果的影响。运用GRADEprofiler3.6软件对本研究涉及结局指标进行证据质量评价。[结果]纳入14篇相关研究文献,共1316例患者,试验组660例,对照组656例。Meta分析结果显示,补肾活血法联合血液透析在降低血肌酐(Scr)、尿素氮(BUN)水平、中医证候积分方面优于单纯血液透析组,提高肌酐清除率(Ccr)、有效率方面联合组优于单纯血液透析组,差异具有统计学意义,但证据质量有待提高。两组的不良反应发生率未见统计学差异。发表偏倚检验及非参数剪布法结果提示血Scr、BUN指标存在偏倚,但偏倚结果对结果未造成影响。[结论]研究证明补肾活血法联合血液透析治疗慢性肾衰竭疗效显著,可以降低Scr、BUN、中医证候积分,提高Ccr水平,且未见不良反应增加。但需要更多高质量、大规模的研究来进一步验证。

血清胱抑素C和超敏C反应蛋白对维持性血液透析患者3年生存情况的影响分析

目的 探讨血清胱抑素C(Cys-C)与超敏C反应蛋白(hs-CRP)水平对维持性血液透析(MHD)患者3年生存情况的影响。方法 选择2011年4月—2020年10月在南通大学第二附属医院就诊的358例慢性肾衰竭患者为研究对象,所有患者均接受MHD。记录患者一般临床资料、透析前实验室检查指标、透析后3个月超声心动图指标。随访患者透析3年后生存情况,比较存活患者和死亡患者的一般临床资料、透析前实验室检查指标以及透析后3个月的超声心动图指标。采用单因素和多因素Cox回归分析筛选MHD患者3年生存情况的影响因素。结果 3年随访时,302例MHD患者中203例存活,99例死亡。存活患者与死亡患者的年龄、原发疾病、糖尿病情况、充血性心力衰竭情况、他汀类药物使用、抗血小板药物使用、利尿药使用、透析方式、谷氨酰转移酶(GGT)、碱性磷酸酶(AKP)、总胆红素(TBIL)、β_(2)-微球蛋白(β_(2)-MG)、肌酐(Cr)、估算肾小球滤过率(eGFR)、低密度脂蛋白胆固醇(LDL-C)、超敏C反应蛋白(hs-CRP)和血清磷(P)水平比较,差异均有统计学意义(P<0.05或P<0.01)。单因素Cox回归分析结果显示,MHD患者年龄、原发疾病(糖尿病肾病、高血压肾病、多囊肾、其他)、合并症(糖尿病、充血性心力衰竭、其他心血管疾病)、药物使用情况(他汀类药物、抗血小板药物)、透析方式(血液透析滤过、血液透析+血液灌注)、实验室检查指标[GGT、AKP、TBIL、总胆汁酸(TBA)、白蛋白(ALB)、Cr、Cys-C、eGFR、载脂蛋白A(APO-A)、hs-CRP]均是MHD患者3年生存率的影响因素;多因素Cox回归模型分析结果显示,年龄、原发疾病、其他心血管疾病、透析方式、AKP、ALB、TBIL、Cys-C和hs-CRP是慢性肾衰竭患者生存情况的重要影响因素(P<0.05)。结论 慢性肾衰竭患者MHD治疗前血清Cys-C和hs-CRP水平可能与透析治疗3年生存情况有关,高血清Cys-C可能降低患者临床预后不良风险,而高血清hs-CRP可能增高患者临床预后不良风险。

血清Hcy、hs-CRP表达与慢性肾衰竭透析患者发生心律失常的相关性

目的分析血清同型半胱氨酸(Hcy)、超敏C-反应蛋白(hs-CRP)水平与慢性肾衰竭(CRF)透析患者发生心律失常的相关性。方法回顾性分析2021年1月至2023年6月接受透析治疗且发生心律失常的60例CRF患者病历资料作为发生组,同期纳入接受透析治疗且未发生心律失常的60例CRF患者病历资料作为未发生组。收集发生组和未发生组临床资料,检测血清Hcy、hs-CRP等实验室指标,重点分析血清Hcy、hs-CRP与CRF患者发生心律失常的关系。结果发生组的血清Hcy、hs-CRP及血钾水平高于未发生组(P<0.05);点二列相关性结果显示,血清Hcy、hs-CRP及血钾水平与CRF透析患者发生心律失常呈正相关(r>0,P<0.05);多元Logistic回归分析结果显示,CRF透析患者血清Hcy、hs-CRP及血钾水平高是患者发生心律失常的危险因素(OR>1,P<0.05)。结论血清Hcy、hs-CRP水平与CRF透析患者发生心律失常存在一定的关系,且二者水平升高可增加患者心律失常发病风险。

百令胶囊在行血液透析的慢性肾功能衰竭患者中的应用价值

目的探究慢性肾功能衰竭患者接受百令胶囊的治疗效果。方法选取2021年9月—2023年10月于江苏大学附属武进医院(徐州医科大学武进临床学院)门诊行维持血液透析治疗的112例慢性肾功能衰竭患者为研究对象,按照治疗方法的不同分为对照组和观察组,各56例。对照组血液透析期间采用常规西医治疗,观察组在对照组治疗基础上联合百令胶囊治疗。对比两组肾功能[尿素氮(blood urea nitrogen,BUN)、残余肾功能(residual renal function,RRF)、透析超滤量(Kt/V)]、炎性指标[肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)]、营养指标[总蛋白(total protein,TP)、血清白蛋白(bovine serum albumin,Alb)、前白蛋白(prealbumin,PA)]水平。结果治疗后,观察组BUN、TNF-α、IL-6、hs-CRP水平均低于对照组,RRF、Kt/V水平均高于对照组,差异有统计学意义(P均<0.05)。治疗后,观察组TP为(72.13±5.54)g/L、Alb为(41.77±2.86)g/L、PA为(522.57±68.39)mg/L,均高于对照组的(69.85±5.27)g/L、(40.29±2.03)g/L、(498.52±53.26)mg/L,差异有统计学意义(t=2.231、3.158、2.076,P均<0.05)。结论百令胶囊可以改善血液透析慢性肾功能衰竭患者的肾功能、炎性指标及营养水平。

医护联合专项质控小组质控护理在维持性血液透析患者质量管理中的应用

目的研究医护联合专项质控小组质控护理在维持性血液透析患者质量管理中的应用效果。方法回顾性分析2022年2月至2024年2月中山市人民医院收治的86例维持性血液透析住院患者的临床资料,按照不同护理干预方法将患者分为观察组(n=40)和对照组(n=46)。对照组患者实施常规护理,观察组患者在常规护理基础上实施医护联合专项质控小组质控护理。两组患者均护理至出院。比较两组患者透析治疗完成后的透析充分性[尿素清除率(URR)、尿素清除指数(Kt/V)]、入院时及出院时心理状况[汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)]、入院时及出院时生活质量[健康调查简表(SF-36)],同时比较两组患者出院时的治疗依从性。结果出院时,观察组患者的URR为(58.21±6.22)%,明显低于对照组的(63.49±7.31)%,Kt/V为1.56±0.33,明显高于对照组的0.94±0.19,差异均有统计学意义(P<0.05);观察组患者的HAMD、HAMA评分分别为(8.28±0.40)分、(9.13±0.32)分,明显低于对照组的(19.15±0.82)分、(18.70±0.82)分,差异均有统计学意义(P<0.05);观察组患者的躯体疼痛、生理机能、精力、生理职能、社会功能、精神健康、情感职能、一般健康状况评分分别为(66.13±7.08)分、(80.77±7.93)分、(66.70±8.35)分、(50.35±7.76)分、(65.36±7.28)分、(80.03±8.13)分、(68.48±6.90)分、(62.31±9.14)分,明显高于对照组的(55.63±7.46)分、(69.76±8.38)分、(59.32±8.49)分、(42.47±8.03)分、(59.48±7.55)分、(70.53±8.75)分、(56.21±7.23)分、(54.26±9.47)分,差异均有统计学意义(P<0.05);观察组患者的治疗依从性为95.00%,明显高于对照组的76.09%,差异有统计学意义(P<0.05)。结论医护联合专项质控小组质控护理在维持性血液透析患者护理中的应用效果显著,能有效提高透析充分性,改善透析质量指标,缓解抑郁、焦虑等负性情绪,提高生活质量和依从性,值得临床推广应用。

基于Lasso-Nomogram模型构建维持性血液透析患者睡眠障碍的预测模型

目的基于Lasso-Nomogram模型构建维持性血液透析(maintenance hemodialysis,MHD)患者睡眠障碍(sleep disorder,SD)的预测模型。方法选取苏州大学附属第二医院行MHD的慢性肾衰竭(chronic renal failure,CRF)患者,根据MHD后6个月是否发生SD分为SD组和非SD组。比较2组临床资料,分析SD发生的影响因素,根据预测因素构建SD的Nomogram预测模型。结果198例CRF患者MHD后第6个月92例患者发生SD,SD发生率为46.46%;Logistic分析显示年龄(OR=2.152,95%CI:1.246~3.718,P<0.001)、皮肤瘙痒(OR=6.209,95%CI:2.051~18.796,P<0.001)、抑郁(OR=3.715,95%CI:1.531~9.013,P<0.001)、尿素清除指数(urea clearance index,Kt/V)(OR=0.302,95%CI:0.154~0.592,P<0.001)、血磷(OR=2.274,95%CI:1.236~4.185,P<0.001)、钙磷乘积(OR=3.210,95%CI:1.517~6.792,P<0.001)、血清合肽素(OR=6.816,95%CI:2.317~20.048,P<0.001)、α-淀粉酶(OR=5.277,95%CI:1.953~14.257,P<0.001)、25羟维生素D3(OR=0.381,95%CI:0.186~0.780,P<0.001)均为SD发生的影响因素;根据Lasso、Logistic分析筛选出上述9个指标构建SD的Nomogram预测模型,该模型预测MHD患者发生SD的曲线下面积(AUC)为0.928(95%CI:0.892~0.963),预测敏感度、特异度分别为81.13%、90.11%。结论根据MHD患者发生SD的因素构建Nomogram预测模型,在预测SD发生风险方面具有较高预测效能和良好临床效用。