Comparative efficacy of traditional Chinese herbal injection for chronic renal failure:A systematic review and network meta-analysis of randomized controlled trials

Objective: To conduct a systematic review and network meta-analysis(NMA) for the comparison of the efficacy and safety of Chinese herbal injection(CHI) combined with Western medicine(WM) and WM monotherapy for chronic renal failure(CRF).Methods: Eight databases were searched from inception to August 30, 2022. Randomized controlled trials(RCTs) regarding the comparison of CHI-WM combination therapy and WM monotherapy were included. Literature search, risk-of-bias assessment, and data extraction were conducted by 2 reviewers independently. NMA was performed by Stata 14.0, R 4.0.4 software, and the latest risk of bias assessment tool 2(RoB 2).Results: A total of 53 RCTs were finally included, involving 4445 participants and 16 CHIs. RoB 2 showed that 2 of these studies had a high risk of bias. Tianqi injection(TQ) + WM was the most effective in reducing serum creatinine(Scr) level. Xingding injection(XD) + WM was the most effective in reducing blood urea nitrogen(BUN) and cystatin C(Cys C) levels. Guhong injection(GH) + WM had the highest endogenous creatinine clearance rate(Ccr). Shuxuetong injection(SXT) + WM was the most effective in improving the clinical effective rate. Danhong injection(DH) + WM resulted in the lowest 24-h urinary protein quantity(24 h-UPQ), while Danshen injection(DS) + WM led to the lowest blood uric acid(UA)level. Shenfu injection(SF) + WM was the most effective in increasing hemoglobin(Hb) level.Conclusion: CHIs-WM combination therapy is more effective than WM monotherapy in treating CRF.Considering all of the indicators, SK + WM may be the optimal treatment option for improving renal function in patients with CRF.

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.

Effects of Shenkang Injection Combined with Hemodialysis on Dialysis Rate and Nutriture in Patients with Chronic Renal Failure

OBJECTIVE: To explore the effects of Shenkang Injection combined with hemodialysis on dialysis rate and nutriture in patients with chronic renal failure (CRF).METHODS: A total of 110 CRF patients admitted in the hospital from January 2016 to January 2018 were randomly divided into 2 groups.The control group was treated with hemodialysis while the observation group was additionally treated with Shenkang Injection on the treatment basis of the control group.They were treated for 4 weeks and reexamined 1 d after the treatment.Renal function,nutriture,dialysis adequacy,oxidative stress level and inflammatory factor level in the 2 groups were determined before and after the treatment,and traditional Chinese medicine (TCM) syndrome score,dialysis rate within 1 week and incidence of adverse reactions during the treatment were counted before and after the treatment.RESULTS: After the treatment,the levels of serum creatinine (Scr) and urea nitrogen (BUN) in the observation group were lower than those in the control group,and the endogenous creatinine clearance rate (Ccr) was higher than that in the control group (P < 0.05).After the treatment,the nutriture in the observation group was better than that in the control group (P < 0.05).After the treatment,the dialysis rate and time average concentration of urea (TACurea) in the observation group were lower than those in the control group,while the overall urea clearance rate (Kt/V) and protein catabolic rate (PCR) were higher than those in the control group (P < 0.05).After the treatment,the TCM syndrome scores in the observation group was lower than that in the control group (P < 0.05) and the level of serum malondialdehyde (MDA) in the observation group was lower than that in the control,while the level of superoxide dismutase (SOD) and total antioxidant capacity (T-AOC) in the observation group were higher than those in the control group (P < 0.05).After the treatment,the levels of inflammatory factors in the observation group were lower than those in the control group (P < 0.05).No serious adverse reactions occurred in the 2 groups.CONCLUSION: Shenkang Injection combined with hemodialysis for the treatment of CRF can effectively improve clinical symptoms and nutriture,and reduce the dialysis rate.

Effect of peritoneal dialysis on inflammatory factors, nutritional index and renal function in patients with chronic renal failure

Objective:To explore the effect of peritoneal dialysis on inflammatory factors, nutritional index and renal function indexes in patients with chronic renal failure, and to provide help for clinical treatment of patients with chronic renal failure. Methods:80 cases of chronic renal failure patients in our hospital were selected as the study group, given peritoneal dialysis treatment;80 healthy people during the same period in our hospital selected as the normal group. The inflammatory factors [C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α(TNF-α) and IL-8], renal function indices [BUN (Urea nitrogen) and SCR (serum creatinine)] and nutritional index [PA (prealbumin), Hb (hemoglobin), ALB (albumin) and TF (Transferrin)] levels were detected in healthy population and patients with chronic renal failure patients before and after treatment of 1 and 30 d, and the relative significance was analyzed. Results:Compared with the normal group, the inflammatory factors (CRP, IL-6, TNF-αand IL-8) and renal function indices (BUN and SCR) of patients with chronic renal failure in study group increased significantly and nutritional indexes (TF, PA and ALB) decreased significantly (P<0.05). The inflammatory factors (CRP, IL-6, TNF-αand IL-8), nutritional index (TF, PA and ALB) and renal function indices (BUN and SCR) of patients with chronic renal failure by peritoneal dialysis in the treatment of 1 d in research group were significantly lower than the level before treatment, and Hb was significantly higher than that before treatment (P<0.05). After 30 d of dialysis, inflammatory factors (CRP, IL-6, TNF-αand IL-8), nutritional index (TF, PA and ALB) and renal function indices (BUN and SCR) decreased further and Hb increased further (P<0.05). Conclusions:Peritoneal dialysis can improve the inflammatory factors levels of patients with chronic renal failure, reduce the renal function index, and can affect the nutritional index of patients, and has important significance in clinical treatment of patients with chronic renal failure.

Effect of adjuvant salvia miltiorrhiza and ligustrazine therapy on renal function, renal blood perfusion as well as CTGF and TGF-β1 content in patients with chronic renal failure

Objective:To analyze the effect of adjuvant salvia miltiorrhiza and ligustrazine therapy on renal function, renal blood perfusion as well as connective tissue growth factor (CTGF) and transforming growth factor (TGF)-β1 content in patients with chronic renal failure.Methods:80 patients with chronic renal insufficiency treated in our hospital between March 2013 and March 2016 were selected for study and randomly divided into observation group (n=40) and control group (n=40). Control group received conventional therapy and observation group received conventional + adjuvant salvia miltiorrhiza and ligustrazine therapy. After 3 months of treatment, differences in renal function indexes, illness-related indexes, renal blood perfusion, CTGF and TGF-β1 content, and so on of two groups of patients were determined. Results: After 3 months of treatment, serum urea nitrogen (BUN), serum creatinine (Scr),β2 microglobulin (β2-MG), intermedin (IMD), fibroblast growth factor 23 (FGF23), cystatin C (CysC), CTGF and TGF-β1 content as well as 24 h urine albumin excretion rate (UAER) level in urine of observation group were significantly lower than those of control group (P<0.05) while glomerular filtration rate (GFR) level and serum adiponectin (APN) content were significantly higher than those of control group (P<0.05);renal perfusion parameters renal cortex Tmax (ATc) and medulla Tmax (ATm) levels of observation group were significantly lower than those of control group while cortex peak intensity change (ΔAc), medulla peak intensity change (ΔAm) and peak intensity (PI) levels were significantly higher than those of control group.Conclusions:Adjuvant salvia miltiorrhiza and ligustrazine therapy can effectively control the overall condition of patients with chronic renal failure, and plays a positive role in improving renal function and increasing renal blood perfusion.

Effects of alprostadil combined with Bailing Capsule on residual renal function, renal hemodynamics, immune indexes and nutritional status in patients with chronic renal failure

Objective:To investigate the clinical efficacy and safety of alprostadil combined with Bailing Capsule in the treatment of chronic renal failure,and the influence of alprostadil combined with Bailing Capsule on residual renal function,renal hemodynamics,immune indexes and nutritional status.Methods 86 patients with chronic renal failure(CRF)hospitalized in Wuhan integrated traditional Chinese and Western Medicine Hospital Affiliated to Tongji Medical College of Huazhong University of science and technology from January 2018 to June 2019 were selected as the study objects.They were randomly divided into control group and case group with 43 cases in each group.Two groups were given peritoneal dialysis treatment,the control group was given bailing capsule,the case group was given alprostadil injection on the basis of the control group.To observe the clinical effect of the two groups before and after treatment,and the changes of residual renal function,renal hemodynamics,immune index and nutritional status.Results The total effective rate of the case group was 97.68%,higher than 83.73%of the control group,the difference was statistically significant(P<0.05).After treatment,the levels of bun,SCR,GFR,24h urinary protein quantity,resistance index,CRP,IL-6,TNF,CD8+and SGA in the two groups were lower than those before treatment;the levels of renal blood flow,RRF,CD3+,CD4+,ALB,PA,TRF and Hb were higher than those before treatment;moreover,the improvement of serum inflammatory cytokines,residual renal function and renal hemodynamic indexes,immune indexes and nutritional status in the case group were significant The difference was statistically significant(P<0.05).The incidence of adverse reactions in the control group was 16.28%,higher than 6.98%in the case group,with no significant difference(P>0.05).Conclusion Alprostadil combined with Bailing capsule can significantly improve the residual renal function,hemodynamics,immune index,reduce the degree of inflammatory response in patients with chronic renal failure.

Clinical Study of Trilogy Detoxicating Therapy Combined with Routine Western Medicine on Patients with Chronic Renal Failure

Objective： To investigate the mechanism of Trilogy Detoxicating Therapy in treating patients with chronic renal failure （CRF）. Methods： A total of 142 patients were assigned to the Trilogy Detoxicating Therapy group （the treatment group, 82 patients） and the Western medicine treatment group （the control group, 60 patients）. All of the patients were treated with NovoNorm 1 mg and metformin hydrochloride tablets 0.15 g thrice per day for lowering the blood glucose, as well as Perindopril 4 mg twice daily for lowering blood pressure, recombinant human erythropoietin 2 000 U and a hypodermic injection thrice a week for rectifying anemia, 30 days as one course of treatment, and all patients were treated for two courses. Patients in the treatment group were treated with the Trilogy Detoxicating Therapy [dispersing the five-zang （脏） organs, expelling toxins through colonic dialysis and skin dialysis fumigation] in addition to the aforementioned drugs. Parameters observed and recorded in the study included renal function [serum creatinine （SCr）, blood urea nitrogen （BUN）], blood lipids [triglyceride （TG）, total cholesterol （TC）, low-density lipoprotein C （LDL-C）, high-density lipoprotein C （HDL-C）], plasma total protein （TP）, hemoglobin （Hb）, serum interleukin-6 （IL-6）, and tumor necrosis factor-α （TNF-α） before and after the treatment. Results： After two courses of treatment, the levels of SCr, BUN, TG, TC, LDL-C, serum IL-6 and TNF-α decreased significantly, meanwhile HDL-C increased in the treatment group （P〈0.05 or P〈0.01）. In contrast, no obvious changes of the above mentioned items occurred in the control group. In both groups, the levels of TP and Hb were significantly elevated （P〈0.05 or P〈0.01）, but the changes were more obvious in the treatment group （P〈0.01）. Conclusion： Trilogy Detoxicating Therapy played a therapeutic role on patients with CRF possibly through lowering the levels of blood lipids, serum IL-6 and TNF- α.

Parathyroidectomy in Chronic Haemodialysis in the Nephrology and Haemodialysis Department at the University Hospital Center of Point G in Bamako, Mali

Introduction: Secondary hyperparathyroidism is a common complication in chronic hemodialysis patients. It is characterized by hypersecretion of parathormone by the parathyroid glands to maintain phosphocalcium homeostasis in response to hypocalcemia, lowering of 1.25 dihydroxy vitamin D3 and hyperphosphatemia. Objective: To analyze the results of parathyroidectomy (PTX) in cases of secondary hyperparathyroidism (HPTS), report the post-operative course and early and late complications. Patients and Methods: We conducted a retrospective study of ten (10) patients with chronic renal failure operated on at the CHU of Point G over a 32-month period, from January 1, 2016 to August 31, 2019. We analyzed the clinical, biological, radiological and histological parameters of the thyroid glands. Results: We have collected 33 cases of secondary hyperparathyroidism. Ten (10) patients met the inclusion criteria. They were 45 years old on average, seven (7) women and three (3) men, in dialysis for an average of 6.8 years before parathyroidectomy. Half of the initial kidney disease was of vascular origin (HTA). No cases of diabetic nephropathy were identified. Symptoms were in order of frequency: bone pain (60%), paresthesia (50%), functional impotence of the lower limbs (50%). Radiological signs included demineralisation (5 out of 6 cases) and brown tumour associated with a fracture (1 out of 6 cases). The most frequent indication for parathyroidectomy (100%) was persistence despite treatment of a serum PTH concentration above 1000 pg/ml. Subtotal PTX (7/8) was performed after cervical ultrasound in all patients. Histological analysis of the parathyroid glands showed adenoma (60%) and hyperplasia in 40% of cases. The evolution was marked by a progressive reduction of the parathormone level over twelve (12) months, without achieving normalization. This could be related to sub-dialysis (generator failure with reduction of dialysis time). There were no cases of complications or mortality. Conclusion: Parathyroidectomy is an effective treatment to curb hypersecretion of parathyroid hormone. Despite this satisfactory result, the management of phosphocalcic abnormalities in renal failure remains an ongoing concern.

Clinical Observastion on 30 Cases of Chronic Renal Failure Trested with Shentekang Capsule(肾特康胶囊) and Peritoneal Dialysis

Objective: To evaluate the effect of Shentekang Capsule (STKC) combined with peritonealdialysis (PD) in treating chronic renal failure (CRF). Methods: With single-blind, parallel control and random method, 60 cases of CRF patients were equally divided into 2 groups: (1 ) STKC group treated with combined therapy of STKC and PD; (2 ) control group treated with PD alone. The course of treatment were 1~ 2 months for both groups. Clinical manifestations, blood urea nitrogen, serum creatinine, total protein and hemoglobin were observed before and after the treatment. Results: Blood urea nitrogen decreased in both groups after treat ment as compared with that before treatment significantly (P< 0. 05), but no obvious difference was found be tween blood urea nitrogen levels of the two groups (P > 0. 05 ). However, levels of serum total protein and hemoglobin of the STKC group after treatment were higher than those of the control group (P < 0. 01 ). Clinical manifestation in STKC group also showed more improvement after treatment than that in the control group.Conclusion: STKC could improve nutritional state and quality of CRF patient's life treated with PD.

Renal Replacement Therapy in Qatar—Past, Present and Future

The economic development of Qatar alongside the resultant lifestyle changes in the last few decades has contributed to increasing rates of obesity, diabetes mellitus and hypertension with consequent increased incidence and prevalence of chronic kidney disease and end-stage-renal-disease (ESRD). This article describes renal replacement therapy (RRT) services in Qatar and their evolution in response to challenges posed by the growth of ESRD with reference to regional and international data. It covers the history of RRT, highlighting significant advances in chronological order, as well as providing an overview of the current status of RRT in the multicultural and socioeconomically diverse society that inhabits Qatar. Finally, it casts a glance into the future, predicting how RRT services will further evolve to address the current limitations.

Severe mental disorders following anti-retroviral treatment in a patient on peritoneal dialysis: A case report and literature review

BACKGROUND Antiviral drugs are widely used in populations with viral infection caused by immunologic inadequacy.Because these drugs are mainly metabolized by the kidneys,patients with renal failure undergoing renal replacement therapy are prone to drug adverse effects and poisoning.Severe neurotoxicity caused by antiviral drugs is a rare but life-threatening complication.CASE SUMMARY This study reported one male patient on peritoneal dialysis who suffered from severe mental disorders after receiving an overdose of acyclovir and valacyclovir for the treatment of herpes zoster.The literature review suggested that hemodialysis is better than peritoneal dialysis to clear acyclovir from the circulation.The patient died after his consciousness deteriorated despite peritoneal dialysis and continuous blood purification.CONCLUSION This case emphasizes cautiousness when using anti-retroviral drugs in patients with uremia.Hemodialysis is optimal method to remove the drugs.

Mechanical Complications of Peritoneal Dialysis

Introduction: The key to a successful chronic peritoneal dialysis is a permanent and safe access to the peritoneal cavity. The mechanical complications of peritoneal dialysis (MCPD) are a major cause of the failure of the technique. The aim of the study was to define the prevalence of peritoneal dialysis (PD) mechanical catheter complications, to determine the time and the factors associated with their occurring. Materials and Methods: A retrospective study was conducted between January 2009 and January 2014 at the nephrology, dialysis and renal transplants department of Ibn Sina university hospital in Rabat. We included all patients who were on peritoneal dialysis and presented mechanical complications. These mechanical catheter complications are represented by catheter migration or obstruction, inguinal or umbilical hernias, early and late peritoneal dialysate leakage, subcutaneous cuff extrusion and hemoperitoneum. Results: MCPD were noted in 23 of the 62 patients (37% of cases). Onset time of complications was 24.8 ± 18.9 months [3 - 60 months]. Among these complications, we noted a catheter migration (65.2%), postoperative hematoma (21.7%), cracking or perforation of catheter (17.4%), epiploic aspiration (17.4%), sleeve externalization (17.4%), catheter obstruction (13%), hemoperitoneum (13%), hernia (22%;13% umbilical and 8.7% inguinal), early dialysate leakage (13%), and pleuroperitoneal leakage (8.7%). The average age of our patients was 54.9 ± 15.5 years [21 - 81 years old], with a male predominance and a sex ratio of 2.28. The average body mass index (BMI) was 25.4 kg/m2. Diabetic patients represent 48.7% of our series. In our study, MCPD represent 13% of causes of transfer to hemodialysis (HD). Conclusion: Prevention of MCPD remains crucial. It is based on good patient education on hygiene and handling errors but also periodic retraining of patients and caregivers.

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。

影响慢性肾衰竭CRRT患者细菌感染发生的独立危险因素分析

目的 探讨影响慢性肾衰竭连续肾脏替代疗法(CRRT)患者发生细菌感染的独立危险因素。方法 回顾性分析2019年12月~2022年12月在运城市中心医院进行CRRT治疗的1 000例慢性肾衰竭患者。记录发生细菌感染的患者例数,分析细菌感染病原菌分布状况。将细菌感染患者267例设为观察组,余下未感染患者733例设为对照组,比较两组基线资料,并将有差异的指标纳入二元logistic回归分析,得到影响慢性肾衰竭CRRT患者出现细菌感染的独立危险因素。结果 1 000例慢性肾衰竭CRRT治疗患者,共发生细菌感染267例(观察组),发生率为26.70%;未发生细菌感染733例(对照组)。两组患者年龄、治疗时间、体质量指数(BMI)、合并糖尿病、糖尿病肾病、合并心力衰竭、留置静脉导管、血红蛋白(Hb)及血清白蛋白差异比较具有统计学意义(χ^(2)=8.123、5.463、8.631、5.043、8.898、8.052、4.861、8.658、4.803,P<0.05)。多因素logistic回归分析结果显示,≥65岁、≥1年治疗时间、BMI <20 kg/m2、合并糖尿病、合并心力衰竭、留置静脉导管、糖尿病肾病、Hb <70 g/L及血清白蛋白<30 g/L为影响慢性肾衰竭患者CRRT治疗过程中出现细菌感染的独立危险因素(P<0.05)。结论 慢性肾衰竭CRRT患者年龄、治疗时间、BMI、合并糖尿病与心力衰竭、留置静脉导管、糖尿病肾病、Hb及血清白蛋白均可影响细菌感染的发生,临床应针对上述危险因素构建干预方案,预防细菌感染。

慢性肾功能衰竭腹膜透析患者发生肾性贫血的风险及其预测模型构建

目的探究慢性肾功能衰竭(CRF)腹膜透析患者发生肾性贫血的风险,并建立风险预测模型。方法回顾性分析2018年7月至2021年6月吉安市中心人民医院收治的106例行腹膜透析CRF患者的临床资料,根据肾性贫血发生情况分为肾性贫血组与未发生肾性贫血组,各53例。比较两组肾性贫血相关因子水平[红细胞计数(RBC)、血红蛋白(Hb)、白蛋白(Alb)、C反应蛋白(CRP)、转铁蛋白(TRF)、转铁蛋白饱和度(TSAT)、血清总铁结合力(TIBC)、不饱和铁结合力(UIBC)],Logistic回归分析腹膜透析患者发生肾性贫血的危险因素,建立预测模型并评估其预测效能。结果肾性贫血组RBC、Hb、Alb、CRP、TRF、TSAT、TIBC、UIBC水平均低于未发生肾性贫血组,差异有统计学意义(P<0.05)。Logistic回归分析显示,TRF、TIBC、UIBC是发生肾性贫血的危险因素(P<0.05),ROC曲线显示AUC分别为0.815、0.919和0.826。肾性贫血风险预测模型验证结果显示,74例患者TRF、TIBC、UIBC的准确度为85.1%、86.5%、89.2%。结论TRF、TIBC、UIBC是发生肾性贫血的危险因素,且风险预测模型对肾性贫血发生预测效能较好。

风险防控质控护理在慢性肾衰竭腹膜透析患者中的应用效果

目的:观察风险防控质控护理在慢性肾衰竭(CRF)腹膜透析患者中的应用效果。方法:选取2018年6月至2020年6月该院收治的70例CRF腹膜透析患者进行前瞻性研究,按照随机数字表法将其分为观察组和对照组各35例。对照组实施常规护理,观察组在对照组基础上实施风险防控质控护理。比较两组护理前后营养指标[总蛋白(TP)、血红蛋白(Hb)、白蛋白(ALB)]水平、生命质量[肾脏病生活质量简表(KDQOL-SF)]评分、负性情绪[焦虑自评量表(SAS)、抑郁自评量表(SDS)]评分,以及并发症发生率。结果:护理后,观察组TP、Hb、ALB水平和KDQOL-SF评分均高于对照组,差异有统计学意义(P<0.05);观察组SAS、SDS评分均低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为8.57%(3/35),低于对照组的40.00%(14/35),差异有统计学意义(P<0.05)。结论:风险防控质控护理应用于CRF腹膜透析患者可提高营养指标水平和生命质量评分,降低负性情绪评分和并发症发生率,效果优于常规护理。

4R理念循证路径对慢性肾衰竭腹膜透析患者的应用效果

目的 观察4R理念循证路径对慢性肾衰竭(CRF)腹膜透析患者肾小球滤过率及远期生活质量的影响。方法 前瞻性招募2022年4月至2023年10月郑州大学第一附属医院接受腹膜透析的慢性肾衰竭患者,共84例。通过计算机随机数法简单抽样分组为观察组和常规组,每组42例。常规组接受肾病内科常规护理方式,观察组接受4R理念模式循证护理路径干预,两组持续护理干预2个月。比较两组临床有效率、肾病生活质量短表(KDQOL-SF)、贝克抑郁量表(BDI-Ⅱ)、并发症发生率、患者满意度评分。结果 观察组临床治疗有效率高于对照组(P<0.05)。护理后两组KDQOL-SF量表得分较治疗前升高,且观察组得分高于对照组(P<0.05)。两组护理后BDI-Ⅱ量表得分较护理前降低,观察组BDI-Ⅱ得分低于对照组(P<0.05)。观察组并发症发生率低于对照组(P=0.013)。观察组患者满意度评分(91.17±10.55)高于对照组(84.54±8.54)(P=0.019)。结论 4R理念循证路径可改善CRF腹膜透析患者治疗有效率,提高生活质量及护理满意度,降低不良反应发生率。

腹膜透析CRF患者自我管理行为与心理韧性、社会支持关系

目的:分析腹膜透析(PD)慢性肾衰竭(CRF)患者自我管理行为与心理韧性、社会支持的关系。方法:对行PD的88例CRF患者进行自我管理量表、Connor-Davidsion韧性量表(CD-RISC)、社会支持评定量表(SSRS)调查,分析自我管理行为与心理韧性、社会支持的关系。结果:PD-CRF患者自我管理量表评分与CD-RISC、SSRS评分呈正相关(P<0.05),且心理韧性、社会支持是PD-CRF患者自我管理行为的影响因素(P<0.05)。结论:自我管理行为与心理韧性、社会支持有关,加强社会支持和提高心理韧性有助于提高PD-CRF患者自我管理行为。

渐进减量的腹膜透析患者临床特征分析

目的临床上观察到少量腹膜透析患者可实现足量起始,逐渐减量,并以小剂量(透析剂量≤4 L/d)维持透析,本研究分析该部分患者的临床特点,探讨渐进减量腹膜透析的可行性及安全性。方法筛选2012年1月—2018年12月于西安交通大学医学院第一附属医院腹膜透析中心置管并符合渐进减量至小剂量透析(以≤4 L/d维持6月以上)的患者,排除急性肾损伤、狼疮性肾炎、血管炎、梗阻性肾病患者。收集其基线肾功、尿量,计算基线(定义为透析1月时)、减量前(指减量至4 L/d前),小剂量维持6月后(指≤4 L/d维持6月时)残余肾功能、腹膜透析充分性。结果共19例患者纳入研究,平均年龄(49.87±20.53)岁,女性11例,男性8例,进入透析时的中位估算肾小球滤过率(estimating glomerular filtration rate,eGFR)为6.87(4.98,9.44)ml/(min·1.73m^(2))。慢性肾小球肾炎8例,糖尿病肾病、高血压肾损害、间质性肾炎各3例、IgA肾病/紫癜性肾炎2例。16例患者起始腹膜透析剂量为6 L/d,3例患者起始剂量为8 L/d。减为小剂量(≤4 L/d)的中位时间为5.33(4.57,14.20)透析月,小剂量维持的中位时间为22.17(13.13,45.80)月。基线时残余肾功能为(4.95±2.04)ml/min,减量前残余肾功能为(7.85±2.78)ml/min,较基线升高(F=10.284,P=0.005)。减量前尿量较基线增加(F=7.374,P=0.015)。小剂量透析维持6月后总尿素清除指数(tKt/V)、总肌酐清除率(total creatinine clearance,tCCr)较减量前无明显变化(F=3.436、0.015,P=0.082、0.904)。结论少量慢性肾衰竭患者经足量透析后残余肾功能较前改善,在该部分患者中小幅渐进减少透析剂量至小剂量维持的方法安全有效。

双罐串联连续血液净化对慢性肾衰竭尿毒症患者血清可溶性转铁蛋白受体和人巨噬细胞趋化蛋白-1水平及生存质量的影响

目的:探讨双罐串联连续血液净化(CRRT)对慢性肾衰竭尿毒症患者血清可溶性转铁蛋白受体(sTfR)和人巨噬细胞趋化蛋白-1(MCP-1)水平及生存质量的影响。方法:选择2022年4月至2023年4月新疆医科大学第一附属医院行血液透析治疗的96例慢性肾衰竭尿毒症患者,随机分为单罐组(CRRT连续血液净化单个灌流器)和双罐串联组(CRRT连续血液净化2个灌流器串联),每组48例。分别于治疗前,治疗后2个月、半年及1年时检测两组患者血清sTfR和MCP-1水平,判断其治疗后皮肤瘙痒缓解程度;分别于治疗前及治疗后72h记录两组白细胞水平、急性生理与慢性健康量表(APACHEⅡ)评分情况。采用中文版欧洲五维量表(CEQ-5D-3L)、视觉模拟量表(VAS)评分,评估两组患者治疗前后生命质量。结果:两组治疗前血清sTfR水平比较差异无统计学意义(P>0.05)。治疗后2个月、半年及1年各时间点,双罐串联组血清sTfR水平均低于单罐组,差异有统计学意义(t=5.089、18.410、41.306,P<0.05);两组治疗前血清MCP-1水平比较,差异无统计学意义(P>0.05)。治疗后2个月、半年及1年各时间点,双罐串联组血清MCP-1水平均低于单罐组,差异有统计学意义(t=8.554、8.019、10.744,P<0.05);两组治疗后原有皮肤瘙痒程度均有所改善,但单罐组缓解程度明显低于双罐串联组,差异有统计学意义(x^(2)=8.540,P<0.05);两组治疗前白细胞、APACHEⅡ评分比较,差异无统计学意义(P>0.05),治疗后72h白细胞、APACHEⅡ评分均降低,且双罐串联组改善程度均优于单罐组,差异有统计学意义(t=5.549、14.781,P<0.05);两组治疗前血清CEQ-5D-3L评分比较,差异无统计学意义(P>0.05)。治疗后2个月、半年及1年各时间点,双罐串联组健康描述系统标准总分均低于单罐组,VAS评分高于单罐组,差异有统计学意义(t健康描述系统标准总分=4.744、5.103、9.418,tVAS评分=3.375、2.866、3.126,P<0.05)。结论:双罐串联连续血液净化可有效降低慢性肾衰竭尿毒症患者血清sTfR,MCP-1水平,缓解皮肤瘙痒程度,提高生存质量,同时还能有效降低白细胞水平,改善APACHEⅡ评分和血常规。