Complexity and Management of Chronic Kidney Disease

Chronic Kidney Disease (CKD) is ongoing damage of the kidneys, which affects their ability to filter the blood the way they should. Worldwide CKD is considered as the 16th leading cause of death and affects 8% - 16% of the population. CKD often goes unnoticed and is revealed as an incidental finding. Healthcare providers diagnose the condition as CKD based on persistent abnormal kidney function tests revealing kidney damage markers > 3 months, urine albumin creatinine ratio (UACR) > or equal to 30 mg/g per 24 hours, and GFR < 60 mL/min/1.73m2. In this article, we have discussed chronic kidney disease in terms of kidney physiology, chronic kidney disease pathophysiology, etiology, diagnosis, signs and symptoms, and management.

Prediction of mortality among patients with chronic kidney disease:A systematic review

BACKGROUND Chronic kidney disease(CKD)is a common medical condition that is increasing in prevalence.Existing published evidence has revealed through regression analyses that several clinical characteristics are associated with mortality in CKD patients.However,the predictive accuracies of these risk factors for mortality have not been clearly demonstrated.AIM To demonstrate the accuracy of mortality predictive factors in CKD patients by utilizing the area under the receiver operating characteristic(ROC)curve(AUC)analysis.METHODS We searched Ovid MEDLINE,EMBASE,and the Cochrane Library for eligible articles through January 2021.Studies were included based on the following criteria:(1)Study nature was observational or conference abstract;(2)Study populations involved patients with non-transplant CKD at any CKD stage severity;and(3)Predictive factors for mortality were presented with AUC analysis and its associated 95%confidence interval(CI).AUC of 0.70-0.79 is considered acceptable,0.80-0.89 is considered excellent,and more than 0.90 is considered outstanding.RESULTS Of 1759 citations,a total of 18 studies(n=14579)were included in this systematic review.Eight hundred thirty two patients had non-dialysis CKD,and 13747 patients had dialysis-dependent CKD(2160 patients on hemodialysis,370 patients on peritoneal dialysis,and 11217 patients on non-differentiated dialysis modality).Of 24 mortality predictive factors,none were deemed outstanding for mortality prediction.A total of seven predictive factors[N-terminal pro-brain natriuretic peptide(NT-proBNP),BNP,soluble urokinase plasminogen activator receptor(suPAR),augmentation index,left atrial reservoir strain,C-reactive protein,and systolic pulmonary artery pressure]were identified as excellent.Seventeen predictive factors were in the acceptable range,which we classified into the following subgroups:predictors for the non-dialysis population,echocardiographic factors,comorbidities,and miscellaneous.CONCLUSION Several factors were found to predict mortality in CKD patients.Echocardiography is an important tool for mortality prognostication in CKD patients by evaluating left atrial reservoir strain,systolic pulmonary artery pressure,diastolic function,and left ventricular mass index.

Hepatitis C and kidney disease:An overview and approach to management

Hepatitis C infection and chronic kidney disease are major health burden worldwide. Hepatitis C infection is associated with a wide range of extra-hepatic manifestations in various organs including the kidneys. A strong association between hepatitis C and chronickidney disease has come to light. Hemodialysis in supporting the end stage renal disease patients unfortunately carries a risk for hepatitis C infection. Despite much improvement in the care of this group of patients,the prevalence of hepatitis C infection in hemodialysis patients is still higher than the general population. Hepatitis C infection has a negative effect on the survival of hemodialysis and renal transplant patients. Treatment of hepatitis C in end stage renal disease patients using conventional or pegylated interferon with or without ribavirin remains a clinical challenge with low response rate,high dropout rate due to poor tolerability and many unmet needs. The approval of new direct acting antiviral agents for hepatitis C may dramatically change the treatment approach in hepatitis C infected patients with mild to moderate renal impairment. However it remains to be confirmed if the newer Hepatitis C therapies are safe in individuals with severe renal impairment. This review article discusses the relationship between hepatitis C and chronic kidney disease,describe the various types of renal diseases associated with hepatitis C and the newer as well as the existing treatments for hepatitis C in the context of this subpopulation of hepatitis C patients.

Vitamin D levels in subjects with or without chronic kidney disease among Veterans with diabetes in North East United States

AIM To evaluate the prevalence of vitamin D deficiency and its relation to diabetes and kidney disease in Veterans residing in the North East United States(VISN 2). METHODS In this retrospective study, we used data from the computerized patient record system at Stratton Veterans Administration Medical Center at Albany, NY(VHA) for those patients who had 25-hydroxyvitamin D levels and 1,25(OH) vitamin D levels measured between 2007 and 2010. We collected demographic information including age, sex, body mass index and race; clinical data including diabetes, hypertension and CAD; and laboratory data including calcium, creatinine and parathyroid hormone(PTH)(intact). Vitamin D deficiency is defined as a serum 25-hydroxyvitamin D level of less than 20 ng/mL(50 nmol/L), and insufficiency is defined as a serum 25-hydroxyvitamin D level of 20 to 30 ng/mL(50 to 75 nmol/L). RESULTS Data was available for approximately 68000 subjects. We identified 64144 subjects for analysis after exclusion of duplicates. Among them, 27098 had diabetes. Themean age of subjects with diabetes was 68 ± 11 with a mean body mass index(BMI) of 32 ± 7 and duration of diabetes of 5.6 ± 3.2 years. The mean 25(OH) vitamin D level among subjects with diabetes was 27 ± 11.6. There was no significant difference in 25(OH) vitamin D levels between subjects with diabetes and glomerular filtration rate(e-GFR) < 60 compared to those with e-GFR ≥ 60. As expected, subjects with e-GFR < 60 had significantly lower 1,25(OH) vitamin D levels and significantly elevated PTH-intact. Of the 64144 subjects, 580 had end-stage renal disease. Of those, 407 had diabetes and 173 did not. Vitamin D levels in both groups were in the insufficiency range and there was no significant difference irrespective of presence or absence of diabetes. Subjects with vitamin D levels less than 20 ng/mL had a higher BMI and elevated PTH, and higher HbA 1C levels compared to those with vitamin D levels more than 20 ng/mL. CONCLUSION We conclude that we need to keep a close eye on vitamin D levels in subjects with mild chronic kidney disease as well as those with moderate control of diabetes.

Impact of sustained virologic response on chronic kidney disease progression in hepatitis C

AIM To determine how sustained virological response at 12 wk(SVR12) with direct acting antivirals(DAAs) for the treatment of hepatitis C virus(HCV) infection affects chronic kidney disease(CKD) progression. METHODS A retrospective analysis was performed in patients aged ≥ 18 years treated for HCV with DAAs at the VA Greater Los Angeles Healthcare System from 2014-2016. The treatment group was compared to patients with HCV from 2011-2013 who did not undergo HCV treatment, prior to the introduction of DAAs; the control group was matched to the study group in terms of age, gender, and ethnicity. Analysis of variance and co-variance was performed to compare means between SVR12 subgroups adjusting for co-variates.RESULTS Five hundred and twenty-three patients were evaluated. When comparing the rate of change in estimated glomerular filtration rate(e GFR) one-year after HCV treatment to one-year before treatment, patients who achieved SVR12 had a decline in GFR of 3.1 m L/min ± 0.75 m L/min per 1.73 m^2 compared to a decline in e GFR of 11.0 m L/min ± 2.81 m L/min per 1.73 m^2 in patients who did not achieve SVR12(P = 0.002). There were no significant clinical differences between patients who achieved SVR12 compared to those who did not in terms of cirrhosis, treatment course, treatment experience, CKD stage prior to treatment, diuretic use or other co-morbidities. The decline in e GFR in those with untreated HCV over 2 years was 2.8 m L/min ± 1.0 m L/min per 1.73 m^2, which was not significantly different from the e GFR decline noted in HCV-treated patients who achieved SVR12(P = 0.43).CONCLUSION Patients who achieve SVR12 have a lesser decline in renal function, but viral eradication in itself may not be associated improvement in renal disease progression.

Polymorphism of Renalase Gene in Patients of Chronic Kidney Disease

Introduction: Chronic kidney disease (CKD) is an important public health problem. Early detection and treatment is a key factor for prevention of its complications. Hypertensive nephrosclerosis is a subtype of CKD which has a poor correlation between hypertension and development of nephropathy, implying role of genetic factors or epigenetic factors. The knowledge regarding genetic factors is limited. Renalase is a novel hormone with its gene on chromosome 10, which secretes flavin adenine dinucleotide dependent amine oxidase. Renalase metabolizes circulating catecholamines and modulates blood pressure and cardiac function. Recently, two single nucleotide polymorphisms of renalase gene rs2576178 GG and rs2296545 CC have been linked to essential hypertension. The SNPrs2296545 CC is also shown to be associated with cardiac hypertrophy, dysfunction and ischemia. The association of these two single nucleotide polymorphisms with hypertensive nephrosclerosis has not been investigated. Methods: We designed a case-control study to investigate whether the two known renalase gene polymorphisms rs2576178 and rs2296545 are associated with CKD particularly hypertensive nephrosclerosis. We genotyped these two polymorphisms in 287 subjects from North Indian population (106 CKD cases and 181 controls). Results: Comparison shows that subjects with hypertensive nephrosclerosis had higher frequencies of rs2296545 Callele than the healthy controls (0.63 versus 0.47, p 0.02). The odds ratio for rs2296545 CC genotype in hypertensive nephrosclerosis were 2.55 (95% CI, 1.03 to 6.42;p = 0.02) (CC versus GG) and 2.11(95% CI, 1.01 to 4.42;p = 0.03) (CC versus CG + GG) compared to controls. Conclusion: These findings may provide novel insight into the role of additional genomic regions as susceptibility gene in the pathophysiology of hypertensive nephrosclerosis. Further, to account for geoethnic variation, studies on heterogeneous populations involving a larger sample size are required. The correlation between this structural change and actual levels of the enzyme or the activity are required to strengthen this association as well as to be clinically applicable.

Insignificant small can still be mighty: Trend of chronic kidney disease in Nigeria

The global burden of chronic kidney diseases(CKDs)kept increasing,and it is a leading cause of mortality and morbidity rate in most African countries.The burden of CKD is felt more in developing countries where there is no adequate social security system or health insurance to meet the huge financial demands the disease places on its sufferers and their families.It is also noted that this disease affects the economically productive age group unlike in developed countries where the elderly are more affected.The prevalence of CKD was found to be highly related to age,gender,hypertension,obesity,history of diabetes mellitus,use of herbal medicines,and prolonged use of nonsteroidal anti-inflammatory drugs in Nigeria.The majority of CKD cases were not clinically recognized promptly,mainly because of the lack of patients’awareness about CKD and associated risk factors.Therefore,health awareness should be intensified by the nurses on lifestyle modification by individuals at risk of CKD,prompt management,good compliance with prescribed medications,avoidance of self-medication,and indiscriminate use of over-the-counter drugs.In addition to that,nurses also need to advocate for regular population screening,and efforts should be made at all levels of care to reduce the negative impact of the disease and complications on the patients.

Prevalence of Chronic Kidney Disease in Relatives of Chronic Hemodialysis Patients

Objectives: To estimate the prevalence of chronic kidney disease (CKD) in first and second degree relatives of Hemodialysis patients. Background: Early detection and intervention of chronic kidney disease (CKD) may prevent or delay the progression and achieve improved patient outcomes. Family members of end-stage renal disease (ESRD) patients are considered as a high-risk population for CKD. The aim of this work is to screen and estimate the prevalence of chronic kidney disease in first and second degree relatives of hemodialysis patients. Methods: This is an observational prospective study carried out in Nephrology Unit, Internal Medicine Department, Menoufia University Hospital during January 2019 to January 2020. First and second degree relatives of ESRD were included. Relatives with known CKD risk factors or relative to ESRD with known hereditary disease were excluded. Serum creatinine and estimated eGFR, albumin creatinine ratio (ACR) and abdominal ultrasound were done twice with 3 months apart to screen for CKD. Results: 321 persons from first and second degree relatives of chronic hemodialysis patients were included. CKD prevalence was 5.6% Comparison between CKD group and non CKD showed no statistically significant difference as regard age, Gender, Smoking, BMI, and degree of relatives. There were highly significant difference between the studied groups as regard serum creatinine, bloodurea, eGFR and ACR. Relatives of ESRD patients of unknown etiology showed highly significant difference to develop CKD (44.4%) compared to non CKD group 11.5% with P value < 0.0001. Conclusions: Prevalence of CKD in relatives—without any CKD risk factors—to ESRD was 5.6%. Family members of ESRD should be screened for CKD, especially relatives to ESRD of unknown etiology.

基于Asp.net的慢性肾脏病分期管理系统的实现与改进

近年来,慢性肾脏病(Chronic Kidney Disease,CKD)的发病率呈逐年增长趋势,且患者对慢性肾脏病的知晓率非常低,以致病情恶化,错过了治疗最佳时机。论文设计并实现了基于Asp.net的慢性肾脏病分期管理系统,从系统设计、系统架构、关键技术及改进、系统运行等方面介绍了实现过程。通过该系统的应用,在临床上能方便医生有效管理患者,并能掌握每个患者疾病的发展情况;同时,能够提高患者对病情的了解,增加患者的知晓率和防治慢性肾脏病的知识。系统对该种疾病的防治有重要的意义。

Diabetic Nephropathy and Management

Chronic kidney disease affects people worldwide. Approximately 1 out of 3 adults with diabetes have kidney disease. Among several etiological factors for CKD, diabetes mellitus (DM) and hypertension are the main factors. These factors not only cause CKD but are also responsible for several complications related to CKD. In this article, we have reviewed Diabetic Nephropathy (DN) in terms of etiology, pathophysiology, diagnosis, management, current guidelines for diabetic nephropathy management, and some of the research study findings. Diabetic nephropathy (DN) is the chief factor for end-stage renal disease (ESRD) development across the globe. The primary cause of DN is Diabetes Mellitus, which is an autoimmune lifestyle disorder having several etiological factors. Checking for urine albuminuria, estimated GFR (eGFR), and blood glucose are unswerving tests for DN diagnosis and subsequent monitoring. Controlling hyperglycemia, blood pressure, and proteinuria are critical in stopping the progression of DKD. Clinical practice and evidence-based medicine demonstrated that early diagnosis followed by treatment can prevent or halt DKD progression.

“患者群”管理联合呼吸训练器在慢性阻塞性肺疾病稳定期患者中的应用效果

目的:探讨“患者群”管理联合呼吸训练器在慢性阻塞性肺疾病稳定期患者中的应用效果。方法:选取2019年1月—2022年7月北京市通州区梨园社区卫生服务中心门诊收治的慢性阻塞性肺疾病稳定期患者66例作为研究对象,以随机数字表法分为试验组、对照组,各33例。对照组进行常规门诊管理,试验组建立“患者群”并联合使用呼吸训练器进行肺康复治疗。比较两组肺功能、干预依从性。结果:干预前,两组第1秒用力呼气容积/预计值%(FEV_(1)%预计值)、FEV_(1)/用力肺活量(FVC)比较,差异无统计学意义(P>0.05);干预后,两组FEV_(1)%预测值、FEV_(1)/FVC均高于干预前,且试验组高于对照组,差异有统计学意义(P<0.05)。干预前,两组Morisky用药依从性量表(MMAS-8)评分比较,差异无统计学意义(P>0.05);干预后,两组MMAS-8评分高于干预前,且试验组高于对照组,差异有统计学意义(P<0.05)。结论:“患者群”管理联合呼吸训练器在慢性阻塞性肺疾病稳定期患者中的应用效果显著,可以改善患者肺功能,提高患者依从性。

稳定期慢性阻塞性肺疾病自我管理干预的证据总结

目的:检索并筛选稳定期慢性阻塞性肺疾病自我管理干预相关证据。方法:系统检索UpToDate、BMJ最佳临床实践、JBI、Cochrane Library、Pubmed、Web of Science、Embase、医脉通、中国知网、CBM、万方、维普等数据库及指南网中关于稳定期慢性阻塞性肺疾病自我管理干预的指南等证据。由2名研究者进行文献质量评价,结合专家会议审核证据并给出级别推荐。结果:共纳入13篇文献,在稳定期COPD自我管理干预目标、干预原则、评估内容、自我管理干预内容、随访教育、应急管理6方面提取并形成23条相关证据。结论:稳定期慢性阻塞性肺疾病病人自我管理干预证据内容丰富,医护人员需根据医院实际,考虑病人意愿,科学制定干预决策,从而改善病人健康状况。

Management recommendations for patients with chronic kidney disease during the novel coronavirus disease 2019(COVID-19)epidemic

COVID-19 has become a pandemic and it has already spread to at least 171 countries/regions.Chronic kidney disease(CKD)is a global public health problem with a total of approximately 850 million patients with CKD worldwide and 119.5 million in China.Severe COVID-19 infection may damage the kidney and cause acute tubular necrosis,leading to proteinuria,hematuria and elevated serum creatinine.Since the SARS-CoV-2 enters the cells by binding to the angiotensin-converting enzyme 2 receptor,some doctors question its ability to increase the risk and severity of developing COVID-19.Neither clinical data nor basic scientific evidence supports this assumption.Therefore,patients who take angiotensin-converting enzyme inhibitor or angiotensin receptor blocker are not advised to change their therapy.Patients with CKD are generally the elderly population suffering from multiple comorbidities.Moreover,some patients with CKD might need to take glucocorticoids and immunosuppressants.Dialysis patients are recurrently exposed to a possible contaminated environment because their routine treatment usually requires three dialysis sessions per week.Considering all the above reasons,patients with CKD are more vulnerable to COVID-19 than the general population.The development of COVID-19 may worsen the impaired kidney function and further lead to rapid deterioration of kidney function and even death.Strict comprehensive protocols should be followed to prevent the spread of COVID-19 among patients with CKD.In this review,we provide some practical management recommendations for health care providers,patients with CKD,dialysis patients and dialysis facilities.

Nephrogenic systemic fibrosis:A frivolous entity

Gadolinium-based contrast agents(GBCAs)used in magnetic resonance imaging are vital in providing enhanced quality images,essential for diagnosis and treatment.Nephrogenic systemic fibrosis(NSF)with GBCAs has been a deterrent for the physician and has led to avoidance of these agents in patients with impaired kidney function.NSF is a progressive debilitating multisystem condition described classically in patients with renal insufficiency exposed to gadolinium contrast media.It is characterized by an induration and hardening of the skin.NSF is described to first involve the extremities and can imperceptibly involve internal organs.Lack of therapeutic interventions to treat NSF makes it more challenging and warrants deep insight into the pathogenesis,risk factors and treatment strategies.

Prevalence, awareness, treatment, and control of hypertension in the non-dialysis chronic kidney disease patients

Background Data on the epidemiology of hypertension in Chinese non-dialysis chronic kidney disease （CKD） patients are limited.The aim of the present study was to investigate the prevalence,awareness,treatment,and control of hypertension in the non-dialysis CKD patients through a nationwide,multicenter study in China.Methods The survey was performed in 61 tertiary hospitals in 31 provinces,municipalities,and autonomous regions in China （except Hong Kong,Macao,and Taiwan）.Trained physicians collected demographic and clinical data and measured blood pressure （BP） using a standardized protocol.Hypertension was defned as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg,and/or use of antihypertensive medications.BP 〈140/90 mmHg and 〈130/80 mmHg were used as the 2 thresholds of hypertension control.In multivariate logistic regression with adjustment for sex and age,we analyzed the association between CKD stages and uncontrolled hypertension in non-dialysis CKD patients.Results The analysis included 8927 non-dialysis CKD patients.The prevalence,awareness,and treatment of hypertension in non-dialysis CKD patients were 67.3%,85.8%,and 81.0%,respectively.Of hypertensive CKD patients,33.1% and 14.1% had controlled BP to 〈140/90 mmHg and 〈130/80 mmHg,respectively.With successive CKD stages,the prevalence of hypertension in non-dialysis CKD patients increased,but the control of hypertension decreased （P〈0.001）.When the threshold of BP 〈130/80 mmHg was considered,the risk of uncontrolled hypertension in CKD 2,3a,3b,4,and 5 stages increased 1.3,1.4,1.4,2.5,and 4.0 times compared with CKD 1 stage,respectively （P〈0.05）.Using the threshold of 〈140/90 mmHg,the risk of uncontrolled hypertension increased in advanced stages （P〈0.05）.Conclusions The prevalence of hypertension Chinese non-dialysis CKD patients was high,and the hypertension control was suboptimal.With successive CKD stages,the risk of uncontrolled hypertension increased.

慢性阻塞性肺疾病急性加重期规范化管理的应用效果观察

目的:研究慢性阻塞性肺疾病急性加重期规范化管理的应用效果。方法:选出蚌埠医学院第二附属医院2021年2月至2023年3月确诊的78例慢性阻塞性肺疾病患者,分组方式:抽签法,通过常规指导以及药物治疗的患者命名为参照组,通过规范化管理的患者命名为研究组,比较实施效果。结果:依从性结果比较,参照组数据占比(76.92%)明显比研究组数据占比(97.44%)低,2组存在较大差异,P<0.05。治疗前,2组患者的SGQR评分和急性发作次数对比差异不显著,P>0.05;治疗后,研究组患者的评分明显低于参照组,急性发作次数较参照组少,2组差异显著,P<0.05。结论:慢性阻塞性肺疾病急性加重期行规范化管理效果理想,可将患者用药依从性显著提升,临床治疗效果得到明显改善,临床应用价值极高,可广泛推行。

“防控管治”四位一体慢病管理模式在溃疡性结肠炎缓解期的效果评价

目的:运用科室总结创新的“防控管治”四位一体中医慢病管理模式对溃疡性结肠炎(Ulcerative Colitis,UC)缓解期病例进行干预,科学评价该模式对UC缓解期患者疗效、预防复发及其生存质量的效果。方法:采用前瞻性队列研究方法,将确诊为UC缓解期患者60例随机分为两组:对照组单纯给予对维持缓解UC有效的口服药物美沙拉嗪治疗,治疗组在对照组基础上运用“防控管治”四位一体中医特色慢病管理模式进行中医特色慢病管理。疗程均为24周,每4周随访记录,主要观察临床症状疗效、复发率、生活质量、不良反应,以及治疗前后内镜指数和黏膜组织学检查的变化。结果:治疗24周后,治疗组总有效率(90.0%,27/30)高于治疗组(66.7%,20/30)(P<0.05);两组治疗前后内镜Baron评分与改良Mayo评分、病理组织学评分比较证实,治疗组内镜下黏膜愈合情况优于对照组;治疗组复发率(10.0%,3/30)低于对照组(20.0%,6/30)(P<0.05);治疗组治疗后肠道症状、全身症状、情感能力及社会能力各方面均较治疗前有所改善(P<0.05),而对照组只有肠道症状较治疗前改善(P<0.05),证明治疗组在改善生活质量方面优于对照组。结论:“防控管治”四位一体中医慢病管理模式可以有效改善UC缓解期患者的生活质量,降低复发率,提高临床疗效,值得进一步研究并推广运用。

阶段式护理结合改良肾病食物交换份法对慢性肾病腹膜透析患者的影响

目的探讨阶段式护理结合改良肾病食物交换份法对慢性肾病(CKD)腹膜透析患者的影响。方法选择2021年1月至2023年1月河南省人民医院收治的100例CKD腹膜透析患者作为研究象,随机分为对照组与观察组,每组50例,对照组接受阶段式护理,观察组在对照组基础上结合改良肾病食物交换份法,对比两组营养指标、疾病管理能力、情感健康指标[焦虑自评量表(SAS)、抑郁自评量表(SDS)]、肾脏病生活质量简表(KDQOL)、并发症发生率。结果护理前两组营养状况、疾病管理能力评分及SAS、SDS、KDQOL评分对比,差异无统计学意义(P>0.05);护理后观察组营养状况优于对照组,疾病管理能力评分高于对照组,SAS、SDS评分低于对照组,KDQOL评分高于对照组(P<0.05)。干预期间观察组并发症发生率低于对照组(P<0.05)。结论阶段式护理结合改良肾病食物交换份法在CKD腹膜透析患者中应用,可提高其疾病管理能力,改善营养状态及情感健康水平,减少并发症。

慢性肾脏病早期患者自我管理量表的修订

目的 修订台湾版慢性肾脏病早期（1~3期）患者自我管理量表,并检验其结构和信效度,为医务工作者提供测评工具和依据。方法 修订台湾版慢性肾脏病患者早期（1~3期）自我管理量表,进而使用该量表对北京地区2所三甲医院住院和门诊168例慢性肾脏病1~3期患者进行调查,检验量表信、效度。结果 量表的I-CVI指数为0.88~1.0,S-CVI指数为0.92。量表总的Cronbach′sα系数为0.94,分半信度为0.92。探索性因子分析提取了4个因子,能联合解释总变异的60.955%。结论 简体中文版CKD-SM量表总体上具有较好的信度和效度,除遵医维度外各项指标达到测量学要求,适合做我国内地CKD患者自我管理能力的评估和评价工具,使用时建议修改遵医行为维度的表述方式。

慢性肾脏病早期患者自我效能量表的修订与初步应用

目的：修订台湾版慢性肾脏病早期患者自我效能量表；检验其在北京地区慢性肾脏病1～3期患者中应用的效度和信度，建立相应常模。方法通过便利抽样调查了北京地区两所三甲医院住院和门诊168位慢性肾脏病1～3期患者，对量表进行探索性因子分析，分析其各条目与其对应因子的相关性、关联效度，并分析其内部一致性信度和重测信度。结果探索性因子分析得到3个因子；量表的CVI指数为0．91；各条目得分与各因子得分的Pearson相关系数为0．72～0．90（P＜0．01），各因子与总体量表间的相关系数在0．75～0．90（P＜0．01）。量表总体的Cronbach’s alpha系数为0．97；分半信度为0．92，重测信度0．70。患者的自我管理能力标准得分为68．59。结论修订的慢性肾脏病早期患者自我效能量表的信、效度达到测量学要求。北京地区慢性肾脏病患者的疾病自我效能感有待提高。