Outcomes after percutaneous coronary interventions in patients with chronic kidney disease

Introduction Chronic kidney disease (CKD) is a significant contributor to cardiovascular morbidity and mortality.Patients with CKD are known to have a greater prevalence of cardiovascular disease than the general population,1 and patients with concurrent CKD and coronary artery disease (CAD) have greater mortality than patients without CKD.2-4 The rate of cardiovascular mortality is approximately 50%,five to 10 times higher than the general population.

Awareness of Chronic Kidney Disease among Patients Attending Tertiary Care Hospital in Bangladesh

Background: Patients with chronic kidney disease (CKD) are at increased risk of morbidity & mortality. Educational interventions aimed at empowering patients are successful in chronic disease management including CKD. Objective: To explore the awareness regarding CKD among patients attending in a tertiary care hospital in Bangladesh. Methodology: This was a descriptive observational study, which includes 100 adult patients attending the department of Medicine in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2013 to June 2013. Data were collected on a pre-tested questionnaire by face-to-face interview to investigate awareness toward: 1) basic knowledge of personal health;2) perceptions of factors increasing the risk of CKD;3) knowledge of therapies to slow CKD progression;4) perceptions of CKD increasing the risk of other medical conditions and 5) demographic information. Main outcome variables were demographic parameters, socio-economic status and awareness about chronic kidney disease. Data were analyzed and compared by statistical tests. Results: Almost one third (32.0%) respondents were in 3rd decade and male to female ratio was 1:1.5. Majority (43.0%) patients came from lower-middle income family. In all age groups, the majority (60%) respondents had low knowledge of CKD. Among the study population, 44.0% believe that smoking increases risk of CKD;42.0% believe that restricting salt intake reduces the progression of CKD;34.0% mention that CKD increases the risk for hypertension and 82.0% mention that renal transplantation is the treatment of choice in CKD. Among the participants, 32.8% had knowledge of increasing risk factor of CKD, 30.8% had knowledge of the method of slow progression of CKD, 30.3% had knowledge of conditions for increase risk of CKD and 41.7% respondent had knowledge of treatment of CKD. Conclusion: Most of the study participants had inadequate knowledge of CKD. Lack of CKD screening and educational programs have contributed to the inadequate patient knowledge about the condition.

Quality of Life of Chronic Haemodialytic Patients at Cotonou Teaching Hospital (BENIN)

Introduction: The objectives of this work were to assess haemodialytic patients’ quality of life (QoL) and to identify factors affecting this QoL. Patients and Methods: It was a three (03) month monocentric and transversal study (from October 24, 2011 to January 27, 2012) conducted in the haemodialysis unit at Hubert Koutoukou Maga Teaching Hospital (CNHU-HKM) in Cotonou. Patients included were residents of Benin, aged 18 years and above, chronic haemodialysis in this unit for over 3 months, and willfully gave their consent. Quality of life was evaluated using questionnaire on Kidney Disease Quality of Life Short-Form French version 1.2 (KDQoL-SF 36). Epidemiological data, nephropathy etiologies and purification parametres were recorded in patients files. Data statistical analysis was performed using SPSS software 11.5. Results: In total 131 patients were involved in the study. The average age was 50.27 ± 12.17 years with a sex ratio of 1.69. Nephroangiosclerosis was the 1st cause. Most patients 128 (97.71 %) received two haemodialysis sessions on weekly basis. The Average Overall Score (AOS) based respectively on SF 36 and KDQoL was 48.55 and 58.55. The average of both SF 36 and KDQoL AOS was 53.55. Factors affecting hemodialytic patients quality of life were vitality, limitations related to mental health and physical condition, burden of kidney disease, effect of the disease on daily life and occupational status. The study revealed that: Patients education level was correlated with vitality

Advanced Oxidation Protein Products Regulate the Pharmacokinetics of Aloe-emodin,Emodin,Rhein,and Chrysophanol in Chronic Kidney Disease Rats

Background:As accelerators and products of the progression of chronic kidney disease(CKD),advanced oxidation protein products(AOPPs)affect the function of the liver.Huang Gan granules(HGGs)are commonly used to prevent the progression of CKD,but the pharmacokinetics of aloe-emodin,emodin,rhein,and chrysophanol in HGGs in CKD remain unknown.Objective:To investigate the influence and its molecular mechanism of AOPPs on the in vivo pharmacokinetics of aloe-emodin,emodin,rhein,and chrysophanol in HGGs.Methods:We constructed 5/6 nephrectomised(5/6 nx),adenine-induced(adenine)and AOPP-treated rat models.After oral administration of HGG,the concentrations of aloe-emodin,emodin,rhein,and chrysophanol in the plasma samples were detected by high-performance liquid chromatography(HPLC),and their pharmacokinetics were analysed with the PKSolver software.The plasma concentrations of IL-6 and TNF-αare detected by enzyme linked immunosorbent assay(ELISA).The RT-PCR was performed in the HepG2 cells to explore the effect of TNF-αand IL-6 on the mRNA expression of CYP1A2 and CYP3A4.Result:The results showed that the method was suitable for the quantification of four anthraquinones in plasma and excreta samples with satisfactory linear(R R^(2)>0.9931),precision(<9.4%)and accuracy(±10%).In 5/6 nx,adenine and AOPPs-treated rats,the concentrations of TNF-αand IL-6 were increased.In 5/6 nx and adenine rats,the pharmacokinetic parameters(t_(1/2),MRT_(0-∞)and AUC_(0-∞))of aloe-emodin,emodin,rhein,and chryso-phanol were,respectively,significantly increased and correlated with the concentration of AOPPs.In AOPPs-treated rats,the concentration of AOPPs was significantly increased and the pharmacokinetic parameters of four anthraquinones were also increased.Conclusion:In summary,inflammatory cytokine production may be one of the important causes in AOPPs’regulat-ing the pharmacokinetic of aloe-emodin,emodin,rhein,and chrysophanol in the CKD rats.Studies of aloe-emodin,emodin,rhein,and chrysophanol in CKD facilitate the appropriate prescription of HGGs in the clinical.

中晚期慢性肾脏病患者失眠严重指数异质性的潜在剖面分析

目的探究中晚期慢性肾脏病患者失眠严重指数的潜在类别,并分析中晚期慢性肾脏病患者失眠严重指数的预测指标。方法于2023-01~06月采用便利抽样法选取陕西省10所三甲医院的974名中晚期慢性肾脏病患者作为研究对象,采用一般资料调查表和失眠严重指数量表(insomnia severity index scale,ISIS)调查中晚期慢性肾脏病患者的失眠严重状况并进行类别分析,探索不同类别间的区分指标。结果中晚期慢性肾脏病患者失眠严重指数特征可分为3种类别,分别命名为中度失眠组、亚临床失眠组、无失眠症状组,占比依次为63.14%、20.43%、16.43%。年龄>50岁(OR=1.547,P<0.001)、无业(OR=1.051,P=0.023)是中度失眠的预测指标;年龄>50岁(OR=1.974,P<0.001)是亚临床失眠的预测指标。结论中晚期慢性肾脏病患者失眠严重指数存在明显不同的分类特征,护理人员应根据患者失眠的不同分类和人口学特征,给予针对性的护理措施与心理护理策略。

互联网医疗平台中慢性病诊疗医生受欢迎程度影响因素研究

目的 研究互联网医疗平台慢性病医患沟通中医生受欢迎程度的影响因素,并分析医生职称在其中的调节效应。方法 抓取国内典型的互联网医疗平台糖尿病板块共2 184名注册医生的在线参与行为信息,提取变量进行普通线性回归及调节效应分析,对医生受欢迎程度的影响因素进行研究。结果 医生的在线诊疗量(β=0.668)、在线访问量(β=0.741)、医患互动(β=0.831)和专业性(β=0.184)均显著正向影响医生的受欢迎程度;医生职称在上述影响关系中起到调节作用,副主任级别及以上的医师在线访问量和医患互动对其受欢迎程度影响较大,主治医师的在线诊疗量和医患互动对其受欢迎程度影响较大,普通医师的在线诊疗量和在线访问量对其受欢迎程度影响较大。结论 互联网医疗平台中医生的参与行为存在一定差异,医生的参与行为显著正向影响自身的受欢迎程度,不同职称的医生受欢迎程度的影响因素并不相同,可以根据职称的不同采取相应的措施。

肢体运动训练对老年中重度COPD患者肺功能和生活质量改善的影响

目的:分析老年中重度慢性阻塞性肺疾病(COPD)患者实施肢体运动训练对患者肺功能、生活质量改善的影响。方法:本研究选取2021年1月-2022年12月我院收治的58例中重度COPD患者为研究对象,根据随机数字表法将其分为研究组与对照组。研究组(n=29)采用常规干预联合肢体运动训练,对照组(n=29)采用常规干预。结果:干预前,2组肺功能、生活质量、呼吸困难程度、运动耐力以及血气指标比较,组间差异无统计学意义(P>0.05);干预后,研究组患者用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、FEV1/FVC均大于对照组,最大呼气中段平均流量多于对照组,日常生活活动能力、社会活动能力及抑郁症状、焦虑症状评分均低于对照组,呼吸困难程度评分低于对照组,6分钟步行距离长于对照组,动脉血氧分压、血氧饱和度高于对照组,动脉二氧化碳分压低于对照组,组间差异有统计学意义(P<0.05)。结论:老年中重度COPD患者实施肢体运动训练,不仅仅可以更好改善患者的肺功能和生活质量,同时也提高了患者的运动耐力,促进了患者各项血气指标的恢复。

Management of Chronic Kidney Disease in China Calls for The Implementation of Expert Patient Program with Traditional Chinese Medical Interventions

Chronic kidney disease was closely related with unhealthy lifestyle;therefore a strategy focused both on daily life and medical process,like the Expert Patients Program,was of great value in the prevention and treatment of chronic kidney disease.In China,however,obstacles still existed in the process of implementing the program.Adding traditional Chinese medical interventions to the program assisted both patients and physicians to understand and to accept this new trend in management of chronic disease better.The combination with traditional Chinese medical interventions showed a solution for successfully implementing the Expert Patients Program and provided a new strategy for prevention and control of chronic kidney disease.

PRELIMINARY RESULTS OF VALIDATION OF A NEW PATIENT-REPORTED OUTCOME INSTRUMENT FOR ADVANCED CHRONIC KIDNEY DISEASE

The uremic symptoms of advanced chronic kidney disease(CKD)can severely impair physical function,psychological health and social life.Some patients,especially for the older,chose conservative kidney management(CKM)and Traditional Chinese medicine(TCM)but not dialysis in this stage.To measure the patients-reported outcome(PRO)from these people,Advanced Chronic Kidney

中晚期慢性肾脏病患者成纤维细胞生长因子23水平与颈动脉粥样硬化的关系

目的探讨中晚期慢性肾脏病（CKD）患者成纤维细胞生长因子23（FGF23）水平与颈动脉粥样硬化的相关性。方法收集我院中晚期慢性肾脏病患者共计120例,分为3组,其中CKD非透析组患者（3-5期）30例、腹膜透析组患者30例、血液透析组患者60例;另外选择年龄、性别匹配的20例健康体检者为健康对照组。比较中晚期慢性肾脏病患者与健康人群FGF23水平的差别,以及3组之间的差别。同时将中晚期CKD患者分为颈动脉粥样硬化组和无颈动脉粥样硬化组,比较两组临床有关参数及FGF23水平的变化,探讨FGF23水平与颈动脉粥样硬化的相关性,分析其临床意义。结果中晚期CKD患者颈动脉粥样硬化发生率较高（59/120,49.2%）。颈动脉粥样硬化组血清FGF23水平明显高于无颈动脉粥样硬化组（P〈0.01）;中晚期CKD患者血清FGF23水平显著高于健康对照组（P〈0.01）;中晚期CKD患者3组人群比较,透析患者FGF23水平高于非透析的CKD 3-5期患者（P〈0.05）;血液透析患者的FGF23水平又显著高于腹膜透析患者（P〈0.01）。中晚期CKD患者FGF23水平与颈动脉内膜中层厚度呈正相关（r=0.68,P〈0.05）,多因素分析显示,FGF23水平是中晚期慢性肾脏病患者发生颈动脉粥样硬化的独立危险因素。结论血清FGF23水平与中晚期CKD患者颈动脉粥样硬化的发生相关,FGF23在颈动脉粥样硬化的发生发展中可能起着重要作用。FGF23可能成为预测CKD患者发生心血管疾病和死亡风险性增高的更敏感的标志物之一。

成纤维细胞生长因子23可预测慢性肾脏病中晚期患者冠状动脉钙化的发生及不良预后

目的探讨成纤维细胞生长因子23（fibroblast growth factor-23,FGF23）与慢性肾脏病（chronic kidney disease,CKD）患者冠状动脉钙化发生和预后的关系。方法入选2010年4月-12月上海交通大学医学院附属仁济医院肾脏科CKD非透析（CKD 3-5期）、腹膜透析和血液透析患者共150例,分析FGF23浓度与冠脉钙化的关系。并对这些患者进行为期（35±3）个月的随访,记录心血管和死亡事件。结果 CKD中晚期患者血清FGF23水平显著高于健康对照组（P〈0.01）。血清FGF23水平与冠脉钙化分数（CaS）之间呈显著正相关（r=0.177,P〈0.05）。Logistic回归分析显示年龄、透析龄和FGF23水平是CKD中晚期患者发生冠脉钙化的独立危险因素。Kaplan-Meier生存曲线提示FGF23水平较高的患者CVD发生率（P〈0.01）及全因死亡率（P〈0.05）显著高于FGF23水平较低的患者。Cox回归分析显示FGF23≥675.8pg/ml和冠脉明显钙化（冠脉CaS〉400）是患者发生CVD的独立危险因素。而FGF23水平和冠脉明显钙化（冠脉CaS〉400）是患者全因死亡的独立危险因素。结论 CKD中晚期患者的血清FGF23水平较普通人群显著增高,FGF23与CKD中晚期患者的冠脉钙化发生及不良预后可能相关。

沙美特罗/氟替卡松治疗老年中重度慢性阻塞性肺疾病

目的:观察沙美特罗/氟替卡松吸入治疗老年中重度慢性阻塞性肺疾病的疗效。方法:选取老年中重度慢性阻塞性肺疾病患者140例,随机分为观察组和对照组各70例。对照组给予吸入沙丁胺醇气雾剂治疗,观察组给予吸入沙美特罗/氟替卡松治疗。比较两组患者治疗后的各项肺功能指标、动脉血气指标及不良反应发生情况。结果:观察组的FEV1、FVC及FEV1/FVC优于对照组;PaO_(2)高于对照组、PaCO_(2)低于对照组(P<0.05)。两组不良反应发生情况差异无统计学意义(P>0.05)。结论:老年中重度慢性阻塞性肺疾病给予吸入沙美特罗/氟替卡松治疗效果较好,可改善患者各项临床指标,且不良反应发生率较低。

不同机械通气模式对合并轻中度慢性阻塞性肺疾病老年患者腹腔镜下胆囊切除术后肺氧合功能的影响

目的比较不同机械通气模式对合并轻中度慢性阻塞性肺疾病(COPD)老年患者腹腔镜下胆囊切除术后肺氧合功能的影响。方法选择择期全身麻醉下行腹腔镜下胆囊切除术的合并轻中度COPD的90例老年患者,将其随机分成容量控制通气(VCV)组、压力控制通气(PCV)组和压力控制容量保证通气(PCV-VG)组,每组30例。3组患者术中采用相应的机械通气模式进行呼吸调控。比较3组患者的术中输液量、术中尿量、术中出血量、机械通气时间及拔除气管导管时间;记录3组患者麻醉前(T_(0))、拔除气管导管后30 min(T_(1))、术后第1天(T_(2))、术后第2天(T_(3))的心率、平均动脉压(MAP)、氧合指数及PaCO_(2)。结果3组患者的机械通气时间、术中输液量、术中出血量及术中尿量比较,差异均无统计学意义(均P>0.05);PCV组和PCV-VG组的拔除气管导管时间均短于VCV组(均P<0.05),而PCV组与PCV-VG组的拔除气管导管时间差异无统计学意义(P>0.05)。3组患者的MAP、心率、氧合指数及PaCO_(2)比较,差异均无统计学意义(均P>0.05);3组患者的MAP、心率及氧合指数均有随时间变化的趋势(均P<0.05),PaCO_(2)无随时间变化的趋势(P>0.05),其中3组患者T_(1)时的MAP和心率均高于T_(0)时,VCV组患者T_(1)、T_(2)时的氧合指数均低于T_(0)时,而PCV组和PCV-VG组患者T_(1)时的氧合指数均低于T_(0)时(均P<0.05);3组患者的MAP、心率及PaCO_(2)的分组与时间均无交互效应(均P>0.05),氧合指数的分组与时间有交互效应(P<0.05)。结论术中采用PCV模式或PCV-VG模式进行机械通气有利于合并轻中度COPD老年患者腹腔镜下胆囊切除术后肺氧合功能的恢复。

成纤维细胞生长因子23与慢性肾脏病中晚期患者冠状动脉钙化的关系

目的探讨慢性肾脏病（CKD）中晚期患者血成纤维细胞生长因子23（FGF23）水平与冠状动脉钙化的关系。方法2010年4月至12月我院肾脏科病房、腹透中心、血透中心的CKD非透析（CKD3～5期）、腹膜透析和血液透析患者共150例为对象；年龄、性别匹配的25例健康体检者为对照。收集患者临床和相关生化指标资料。采用酶联免疫法测定血清全段FGF23水平。对人选患者进行冠脉多层螺旋CT（MSCT）检查。分析FGF23水平与CKD中晚期患者冠脉钙化的关系。结果CKD中晚期患者血清FGF23水平显著高于健康对照组1196．46（83．09，355．02）ng／L比27．17（21．63，51．20）ng／L，P〈0．011；透析患者的FGF23水平显著高于非透析患者（P〈0．01）；血透患者的FGF23水平显著高于腹透患者f6048．29（1129．08，34807．45）ng／L比1625．80（602．83，7521．78）ng／L，P〈0．011。CKD中晚期患者冠脉钙化发生率较高（74／130，56．9％），血清FGF23水平与冠脉钙化分数（CaS）呈正相关（r=0．177，P〈0．05）。Logistic回归分析显示年龄（β=0．091，OR=1．095，P〈0．01）、透析龄（β=2．013，OR=7．483，P〈0．05）和FGF23水平（β=0．838，OR=2．311，P〈0．05）是CKD中晚期患者发生冠脉钙化的独立危险因素。冠状动脉钙化的ROC曲线显示，FGF23曲线下面积为0．705（P〈0．01），当检测的截点为786．73ng/L时，其敏感度和特异性分别为62．5％和75．9％；碱性磷酸酶（AKP）的曲线下面积为O．626（P=0．017），当检测的截点为79．75U／L时，其敏感度和特异性分别为84．5％和41．5％。血磷在诊断冠脉钙化时没有统计学意义。结论血清FGF23水平与CKD中晚期患者冠脉钙化发生相关。FGF23作为诊断冠脉钙化的参考指标，其敏感度低于AKP，特异性优于AKP。

肺保护性通气对全麻轻中度COPD老年患者围术期肺部感染的影响

目的探讨肺保护性通气(Lung protective ventilation strategy,LPVS)对全麻手术的轻中度慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)老年患者肺部感染的影响。方法选取2015年1月-2017年12月在医院行择期全麻手术的轻中度COPD老年患者75例,均符合临床诊断标准。根据随机数字表法分为试验组38例(使用LPVS),对照组37例(使用常规通气)。记录麻醉前,术后1、3、5、7d的临床肺部感染评分(Clinical Pulmonary Infection Score,CPIS);麻醉诱导前(T1)、机械通气后1h(T2)、术毕时(T3)、术后12h(T4),取静脉血检测血清炎性因子(IL-6、IL-8)的浓度;观察术后发生肺部炎症的情况。结果两组患者在T1～T4时间点的IL-6和IL-8水平均差异无统计学意义;两组患者T1～T4时间点的各时间点的IL-6和IL-8水平均高于T1时间点(P<0.05);对照组术后1～5d的CPIS评分均高于T1时间点,且高于试验组术后1～5d的CPIS评分(P<0.05);试验组术后共2例患者出现肺部炎症(5.26%),少于对照组的8例(21.62%)(P=0.037)。结论LPVS能够减少行全麻手术的轻中度COPD老年患者术后5d内发生肺部感染的情况,减少炎症发生率;但是不能够抑制老年患者体内的IL-6、IL-8炎症因子浓度,具有一定的临床应用价值。