Chronic renal failure

慢性肾功能衰竭
  • 文章类型: Journal Article
    背景:GOAL集群随机对照试验(NCT04538157)正在进行中,调查老年综合评估(CGA)对虚弱的慢性肾脏病(CKD)老年人的影响。主要结果是在3个月时达到患者确定的目标,使用目标达成缩放过程进行评估。该协议需要一个专门的过程评估,将与主要试验一起进行,调查执行问题,可能影响干预成功的影响机制和环境因素。此过程评估将提供新的见解,以了解CGA如何以及为什么可能对患有CKD的虚弱老年人有益,并在考虑如何将这种复杂的干预措施应用于临床实践时提供指导。
    方法:本过程评估方案遵循医学研究委员会的指导和公布的关于成组随机试验评估的指导。将采用混合方法学方法,使用作为主要试验的一部分收集的数据和专门为过程评估收集的数据。招聘和过程数据将包括现场可行性调查,筛选所有站点的日志和站点问题登记册,以及与干预和控制站点的会议记录。编辑的CGA字母将进行描述性和定性分析。大约60个半结构化访谈将通过定性方法使用反身主题分析进行分析,以解释主义观点为基础的归纳和演绎方法。定性分析将根据报告定性研究指南的综合标准进行报告。还将遵循《质量改进标准卓越报告指南》。
    背景:已通过MetroSouth人类研究伦理委员会(HREC/2020/QMS/62883)获得伦理批准。传播将通过同行评审的期刊进行,并通过中央协调中心促进对试验参与者的反馈。
    背景:NCT04538157。
    BACKGROUND: The GOAL Cluster Randomised Controlled Trial (NCT04538157) is now underway, investigating the impact of comprehensive geriatric assessment (CGA) for frail older people with chronic kidney disease (CKD). The primary outcome is the attainment of patient-identified goals at 3 months, assessed using the goal attainment scaling process. The protocol requires a dedicated process evaluation that will occur alongside the main trial, to investigate issues of implementation, mechanisms of impact and contextual factors that may influence intervention success. This process evaluation will offer novel insights into how and why CGA might be beneficial for frail older adults with CKD and provide guidance when considering how to implement this complex intervention into clinical practice.
    METHODS: This process evaluation protocol follows guidance from the Medical Research Council and published guidance specific for the evaluation of cluster-randomised trials. A mixed methodological approach will be taken using data collected as part of the main trial and data collected specifically for the process evaluation. Recruitment and process data will include site feasibility surveys, screening logs and site issues registers from all sites, and minutes of meetings with intervention and control sites. Redacted CGA letters will be analysed both descriptively and qualitatively. Approximately 60 semistructured interviews will be analysed with a qualitative approach using a reflexive thematic analysis, with both inductive and deductive approaches underpinned by an interpretivist perspective. Qualitative analyses will be reported according to the Consolidated criteria for Reporting Qualitative research guidelines. The Standards for Quality Improvement Reporting Excellence guidelines will also be followed.
    BACKGROUND: Ethics approval has been granted through Metro South Human Research Ethics Committee (HREC/2020/QMS/62883). Dissemination will occur through peer-reviewed journals and feedback to trial participants will be facilitated through the central coordinating centre.
    BACKGROUND: NCT04538157.
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  • 文章类型: Journal Article
    背景:胃肠道症状在尿毒症患者血液透析中很常见,这些症状严重影响患者的预后。
    目的:评估尿毒症血液透析患者消化道症状的发生情况及其影响因素。
    方法:回顾性选择2022年12月至2023年12月在我院血液净化中心接受常规血液透析治疗的尿毒症患者98例。采用胃肠道症状评分量表(GSRS)对胃肠道症状及各维度评分进行评价。根据患者是否有胃肠道症状分为胃肠道症状组和无胃肠道症状组。通过单因素分析确定可能影响胃肠道症状的因素。采用多因素logistic回归分析确定胃肠道症状的独立危险因素。
    结果:胃肠道症状包括消化不良,便秘,反流,腹泻,腹痛,和饮食失调,GSRS总平均得分为1.35±0.47。这项研究表明,年龄,片剂的数量,透析时间,糖皮质激素,甲状旁腺激素(PTH),合并糖尿病和C反应蛋白(CRP)是尿毒症血液透析患者胃肠道症状的独立危险因素,而体重指数(BMI),血红蛋白(Hb),尿素清除指数为独立保护因素(P<0.05)。
    结论:尿毒症血液透析患者的胃肠道症状大多轻微,最常见的包括消化不良,饮食失调,胃食管反流.独立影响因素主要包括BMI,年龄,服用的药片数量,透析时间,尿素清除指数,Hb,使用糖皮质激素,甲状腺激素水平.PTH,CRP,和糖尿病是影响胃肠道症状发生的临床相关因素,可以进行有针对性的预防。
    BACKGROUND: Gastrointestinal symptoms are common in patients with uremia undergoing hemodialysis, and these symptoms seriously affect patients\' prognosis.
    OBJECTIVE: 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 hemodialysis 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).
    CONCLUSIONS: 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.
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  • 文章类型: Journal Article
    目的:由于人口老龄化,慢性肾脏病(CKD)的发病率正在增加,导致透析和肾移植的需求增加,这可能是昂贵的。目前的研究尚不清楚居住环境与CKD患病率或其相关危险因素之间的关系。这项研究探讨了台湾CKD患病率和危险因素的城乡差异。我们的发现将有助于了解CKD的分布和设计更有效的预防计划。
    方法:这项基于社区的横断面研究使用了肾脏价值评估意识和提升计划,其中涉及CKD诊断和治疗的早期筛查和健康教育。CKD患病率和危险因素,包括饮酒,比较了城市和农村地区的吸烟和槟榔咀嚼。
    方法:根据人口密度确定城市化水平,教育,年龄,农业人口和医疗资源。
    方法:共纳入来自26个城市和15个农村乡镇的7786名参与者。
    结果:农村地区的CKD患病率(29.2%)明显高于城市地区(10.8%),代表2.7倍差异(p<0.0001)。包括糖尿病在内的危险因素(农村和城市:21.7%和11.0%),高血压(59.0%vs39.9%),高尿酸血症(36.7%vs18.6%),饮酒(29.0%vs19.5%),吸烟(15.9%对12.0%),在农村地区,槟榔咀嚼(12.6%vs2.8%)和肥胖(33.6%vs19.4%)明显更高(p<0.0001)。
    结论:农村地区的CKD患病率是城市地区的三倍。尽管超过99%的国民健康保险覆盖率,居住地区之间CKD患病率存在差异。有针对性的干预措施和进一步的研究对于解决这些差异和加强不同环境下的CKD管理至关重要。
    OBJECTIVE: The incidence of chronic kidney disease (CKD) is increasing owing to the ageing population, resulting in an increased demand for dialysis and kidney transplantation, which can be costly. Current research lacks clarity regarding the relationship between residence setting and CKD prevalence or its related risk factors. This study explored the urban-rural disparities in CKD prevalence and risk factors in Taiwan. Our findings will aid the understanding of the distribution of CKD and the design of more effective prevention programmes.
    METHODS: This cross-sectional community-based study used the Renal Value Evaluation Awareness and Lift programme, which involves early screening and health education for CKD diagnosis and treatment. CKD prevalence and risk factors including alcohol consumption, smoking and betel nut chewing were compared between urban and rural areas.
    METHODS: Urbanisation levels were determined based on population density, education, age, agricultural population and medical resources.
    METHODS: A total of 7786 participants from 26 urban and 15 rural townships were included.
    RESULTS: The prevalence of CKD was significantly higher in rural (29.2%) than urban (10.8%) areas, representing a 2.7-fold difference (p<0.0001). Risk factors including diabetes (rural vs urban: 21.7% and 11.0%), hypertension (59.0% vs 39.9%), hyperuricaemia (36.7% vs 18.6%), alcohol consumption (29.0% vs 19.5%), smoking (15.9% vs 12.0%), betel nut chewing (12.6% vs 2.8%) and obesity (33.6% vs 19.4%) were significantly higher (p<0.0001) in rural areas.
    CONCLUSIONS: The prevalence of CKD is three times higher in rural versus urban areas. Despite >99% National Health Insurance coverage, disparities in CKD prevalence persist between residential areas. Targeted interventions and further studies are crucial for addressing these disparities and enhancing CKD management across different settings.
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  • 文章类型: Journal Article
    目的:非恶性胸腔积液(NMPE)常见于住院患者。NMPE住院患者的数据很少,影响预后的因素尚不清楚。
    方法:这是一项回顾性队列研究。
    方法:我们根据电子病历对2018年至2021年中国人民解放军总医院收治的住院患者(n=86645)进行了回顾性队列研究。在入院期间,对4934例通过胸部放射学检查(CT或X射线)证实有积液而未诊断为恶性肿瘤的受试者进行了观察。采用Logistic回归分析与院内死亡相关的器官损害和其他因素。根据实验室指标对患者进行聚类,并研究了聚类结果与结果之间的关联。
    结果:本研究的结果是住院死亡率。
    结果:在4934例患者中,在100个不同的诊断组中,心力衰竭+肺炎+肾功能不全是最常见的(15.12%).318名(6.4%)患者在住院期间死亡。肺(OR3.70,95%CI2.42至5.89),肾损害(OR2.88,95%CI2.14~3.90)和心脏损害(1.80,95%CI1.29~2.55)与住院死亡率相关.实验室指标的分层聚类(估计的肾小球滤过率,白细胞计数,血小板计数,血红蛋白,N末端B型利钠肽原,血清白蛋白)证明了区分住院死亡高风险患者的能力。
    结论:合并症和多器官功能衰竭是NMPE患者的突出特征,这增加了院内死亡的风险,并建议对特定的合并症模式进行综合干预。
    OBJECTIVE: Non-malignant pleural effusions (NMPE) are common in hospitalised patients. Data on NMPE inpatients are scarce and the factors influencing the prognosis are unknown.
    METHODS: This was a retrospective cohort study.
    METHODS: We conducted a retrospective cohort of inpatients (n=86 645) admitted to the Chinese PLA General Hospital from 2018 to 2021, based on electronic medical records. The observations of 4934 subjects with effusions confirmed by chest radiological tests (CT or X-ray) without a diagnosis of malignancy were followed during admission. Logistic regression was used to analyse organ damage and other factors associated with in-hospital death. Patients were clustered according to their laboratory indicators, and the association between the clustering results and outcomes was studied.
    RESULTS: The outcome of this study was in-hospital mortality.
    RESULTS: Among 4934 patients, heart failure + pneumonia + renal dysfunction was the most common (15.12%) among 100 different diagnostic groups. 318 (6.4%) patients died during hospitalisation. Lung (OR 3.70, 95% CI 2.42 to 5.89), kidney (OR 2.88, 95% CI 2.14 to 3.90) and heart (1.80, 95% CI 1.29 to 2.55) damage were associated with in-hospital mortality. Hierarchical clustering of laboratory indicators (estimated glomerular filtration rate, white blood cell count, platelet count, haemoglobin, N-terminal pro-B-type natriuretic peptide, serum albumin) demonstrated the ability to discriminate patients at high risk of in-hospital death.
    CONCLUSIONS: Comorbidities and multiorgan failure are the prominent characteristics of NMPE patients, which increase the risk of in-hospital mortality, and comprehensive intervention for specific comorbidity patterns is suggested.
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  • 文章类型: Journal Article
    背景:了解沙特阿拉伯(SA)肾透析的使用趋势至关重要,因为它提供了肾脏护理的总体概述。肾透析的实践有助于识别挑战,机遇,以及在提供服务方面需要改进的潜在领域。
    目的:这项研究通过探索肾透析中心的数量,调查了SA中肾透析服务的利用情况。血液透析机(HD),和腹膜透析患者。
    方法:本研究的数据集来自统计总局(GaStat)和卫生部(MoH)之间的合作,关注2021年各卫生部门肾透析中心和患者的指标。使用MSExcel365和IBMSPSS版本29进行分析,并结合了多元回归技术。卫生部门被视为因变量。同时,血液透析(HD)机器的数量以及HD和腹膜透析患者的数量被认为是独立变量.
    结果:大约275个肾透析中心,超过8000台高清机器,20440例HD患者,从两种资源中统计了1,861例腹膜患者。研究结果表明,卫生部门与几个肾透析中心和腹膜透析患者之间存在负相关关系,如在多元回归分析中p<0.05所示。
    结论:肾透析中心的数量影响HD机的可用性,影响HD和腹膜透析患者的数量。大多数国家患者更喜欢卫生部,而不是其他半政府和私营部门,对于非沙特人,反之亦然。
    BACKGROUND: Understanding the trend of utilization of renal dialysis in Saudi Arabia (SA) is fundamental as it provides a general overview of renal care. The practice of renal dialysis assists in identifying challenges, opportunities, and potential areas for improvement in the provision of the services.
    OBJECTIVE: This research investigated the utilization of renal dialysis services in SA by exploring the number of renal dialysis centers, hemodialysis machines (HD), and peritoneodialysis patients.
    METHODS: The dataset for this study was derived from a collaboration between the General Authority of Statistics (GaStat) and the Ministry of Health (MoH), focusing on indicators for renal dialysis centers and patients across health sectors in 2021. Analysis was conducted using MS Excel 365 and IBM SPSS Version 29, incorporating multiple regression techniques. The health sector was treated as the dependent variable. At the same time, the number of hemodialysis (HD) machines and the counts of HD and peritoneal dialysis patients were considered independent variables.
    RESULTS: Around 275 renal dialysis centers, over 8000 HD machines, 20,440 HD patients, and 1,861 peritoneal patients were tallied from two resources. The findings revealed a negative relationship between the health sector and several renal dialysis centers and peritoneodialysis patients, as demonstrated by p < 0.05 in multiple regression analysis.
    CONCLUSIONS: The number of renal dialysis centers influences the availability of HD machines, affecting the number of HD and peritoneodialysis patients. Most national patients preferred MoH over other semi-governmental and private sectors, and vice versa for non-Saudis.
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  • 文章类型: Journal Article
    背景:慢性肾脏疾病(CKD)是巴基斯坦的主要健康问题之一,对接受血液透析的个体的身心健康产生显着影响。医疗保健专业人员特别关注的是血液透析对居住在该国农村地区的CKD患者的生活的潜在不利影响。本研究将从患者及其家庭照顾者的角度探讨和描述接受血液透析的CKD患者的生活经历和需求。
    方法:将使用先验现象学研究设计。参与者将从三级医院的透析中心通过基于特定纳入标准的目的抽样招募。深入的非结构化访谈,观察和文件分析将是数据收集的方法。在访谈转录后,将使用Colaizzi的方法对数据进行分析。
    背景:该研究已获得ShifaTameer-e-Millat大学机构审查委员会(IRB)的批准,巴基斯坦(IRB#0307-23)并从研究医院的管理部门获得书面许可。在给予书面和口头同意之前,所有参与者都将获得有关研究的详细信息.参与者将保持在任何时候退出研究的自由。将确保参与者的保密。研究结果将传播给重要的利益相关者,并在科学论文和会议记录中发表。
    BACKGROUND: Chronic kidney disease (CKD) is one of the major health issues in Pakistan, exerting notable effects on both the physical and mental well-being of individuals undergoing haemodialysis. Of particular concern to healthcare professionals is the potential adverse influence of haemodialysis on the lives of patients with CKD residing in rural areas of the country. This study will explore and describe the lived experiences and needs of patients with CKD receiving haemodialysis from the perspectives of patients and their family caregivers.
    METHODS: Transcendental phenomenological research design will be used. Participants will be recruited from the dialysis centre of a tertiary hospital through purposive sampling based on specific inclusion criteria. In-depth unstructured interviews, observation and document analysis will be the methods for data collection. Data will be analysed using Colaizzi\'s approach following the transcription of the interviews.
    BACKGROUND: The study has been approved by the Institutional Review Board (IRB) of Shifa Tameer-e-Millat University, Pakistan (IRB # 0307-23) and written permission was obtained from the administration of the study hospital. Before giving written and verbal consent, all participants will receive detailed information about the study. Participants will maintain the freedom to withdraw from the study at any point. Confidentiality of the participants will be ensured. The study findings will be disseminated to important stakeholders and published in scientific papers and conference proceedings.
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  • 文章类型: Journal Article
    目的:确定慢性肾脏病(CKD)诊断和预防其不良后果的机会窗口,并量化此类预防的潜在人群收益。
    方法:观察性,2015年1月1日至2020年12月31日期间对瑞典斯德哥尔摩和斯科恩地区居民进行的全人群研究。
    方法:根据电子健康记录中的CKD生物标志物的实验室测量,所有在医疗保健中尚未诊断为CKD但患有CKD的患者。
    方法:我们评估了在医疗保健中接受CKD后续诊断的患者人群的比例,使用指南指导的药物治疗(他汀类药物,肾素-血管紧张素-醛固酮系统抑制剂(RAASi)和/或钠-葡萄糖协同转运蛋白-2抑制剂(SGLT2i))和经历不良结局(全因死亡率,心血管死亡或主要不良心血管事件(MACE)。在研究人群的未治疗亚组中,使用指南指导的药物治疗模拟评估了预防CKD不良结局的可能性。
    结果:我们在研究期间确认了99382例CKD患者未确诊。5年后,只有33%的人在医疗保健中接受了CKD的后续诊断。使用他汀类药物或RAASI的比例与未使用他汀类药物或RAASI的比例相似,不管他们的CKD有多先进。SGLT2i的使用可以忽略不计。在最佳治疗的模拟中,21870例死亡中的22%,14310例心血管死亡中的27%和22224例MACE中的39%是可以避免的,如果每个没有使用实验室确认的CKD指定药物的患者都接受指导的CKD药物治疗。
    结论:虽然我们注意到在这个庞大的当代人群中CKD的诊断和治疗不足,我们还发现,通过早期接受指南指导的药物治疗,可以改善CKD结局并减轻其负担.
    OBJECTIVE: Identify the windows of opportunity for the diagnosis of chronic kidney disease (CKD) and the prevention of its adverse outcomes and quantify the potential population gains of such prevention.
    METHODS: Observational, population-wide study of residents in the Stockholm and Skåne regions of Sweden between 1 January 2015 and 31 December 2020.
    METHODS: All patients who did not yet have a diagnosis of CKD in healthcare but had CKD according to laboratory measurements of CKD biomarkers available in electronic health records.
    METHODS: We assessed the proportions of the patient population that received a subsequent diagnosis of CKD in healthcare, that used guideline-directed pharmacological therapy (statins, renin-angiotensin aldosterone system inhibitors (RAASi) and/or sodium-glucose cotransporter-2 inhibitors (SGLT2i)) and that experienced adverse outcomes (all-cause mortality, cardiovascular mortality or major adverse cardiovascular events (MACE)). The potential to prevent adverse outcomes in CKD was assessed using simulations of guideline-directed pharmacological therapy in untreated subsets of the study population.
    RESULTS: We identified 99 382 patients with undiagnosed CKD during the study period. Only 33% of those received a subsequent diagnosis of CKD in healthcare after 5 years. The proportion that used statins or RAASi was of similar size to the proportion that didn\'t, regardless of how advanced their CKD was. The use of SGLT2i was negligible. In simulations of optimal treatment, 22% of the 21 870 deaths, 27% of the 14 310 cardiovascular deaths and 39% of the 22 224 MACE could have been avoided if every patient who did not use an indicated medication for their laboratory-confirmed CKD was treated with guideline-directed pharmacological therapy for CKD.
    CONCLUSIONS: While we noted underdiagnosis and undertreatment of CKD in this large contemporary population, we also identified a substantial realisable potential to improve CKD outcomes and reduce its burden by treating patients early with guideline-directed pharmacological therapy.
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  • 文章类型: Journal Article
    观察性研究和一些实验研究表明,肠道菌群与慢性肾衰竭的发生和进展密切相关。然而,肠道菌群与慢性肾衰竭之间的因果关系尚不清楚.本研究采用双样本孟德尔随机化方法在遗传水平上推断肠道微生物群与慢性肾衰竭之间的因果关系。这项研究旨在确定肠道微生物群是否对慢性肾衰竭的风险有因果关系。旨在为慢性肾功能衰竭的靶向治疗提供新的证据支持。
    使用来自公共MiBioGen和IEUOpenGWAS平台的全基因组关联研究(GWAS)数据,我们进行了双样本孟德尔随机化分析.使用五种不同的方法推断肠道微生物群和慢性肾衰竭之间的因果关系:反向方差加权,MR-Egger,加权中位数,简单模式,和加权模式。该研究纳入了包括多效性和异质性评估的敏感性分析。随后,孟德尔随机化分析的结果对多重检验进行了严格的校正,采用错误发现率方法来提高我们发现的有效性。
    根据逆方差加权法的结果,7个细菌属显示与结果变量慢性肾衰竭显著相关.其中,Ruminococus(gauvreaii组)(OR=0.82,95%CI=0.71-0.94,p=0.004)可能是慢性肾衰竭的保护因素,而埃希氏杆菌属(OR=1.22,95%CI=1.08-1.38,p=0.001),乳球菌(OR=1.1,95%CI=1.02-1.19,p=0.013),Odoribacter(OR=1.23,95%CI=1.03-1.49,p=0.026),肠位(OR=1.14,95%CI=1.00-1.29,p=0.047),真细菌(eligens组)(OR=1.18,95%CI=1.02-1.37,p=0.024),Howardella(OR=1.18,95%CI=1.09-1.28,p<0.001)可能是慢性肾功能衰竭的危险因素。然而,在使用错误发现率对多重比较进行校正后,只有与大肠杆菌-志贺氏菌和Howardella的关联仍然显着,表明其他属具有暗示性关联。敏感性分析未显示任何多效性或异质性。
    我们的孟德尔随机双样本研究表明,埃希氏菌属-志贺氏菌属和霍华德氏菌属是慢性肾衰竭的危险因素,它们可以作为未来治疗干预的潜在目标。然而,确切的作用机制尚不清楚,需要进一步研究以充分阐明其确切作用。
    UNASSIGNED: Observational studies and some experimental investigations have indicated that gut microbiota are closely associated with the incidence and progression of chronic renal failure. However, the causal relationship between gut microbiota and chronic renal failure remains unclear. The present study employs a two-sample Mendelian randomization approach to infer the causal relationship between gut microbiota and chronic renal failure at the genetic level. This research aims to determine whether there is a causal effect of gut microbiota on the risk of chronic renal failure, aiming to provide new evidence to support targeted gut therapy for the treatment of chronic renal failure.
    UNASSIGNED: Employing genome-wide association study (GWAS) data from the public MiBioGen and IEU OpenGWAS platform, a two-sample Mendelian randomization analysis was conducted. The causal relationship between gut microbiota and chronic renal failure was inferred using five different methods: Inverse Variance Weighted, MR-Egger, Weighted Median, Simple Mode, and Weighted Mode. The study incorporated sensitivity analyses that encompassed evaluations for pleiotropy and heterogeneity. Subsequently, the results of the Mendelian randomization analysis underwent a stringent correction for multiple testing, employing the False Discovery Rate method to enhance the validity of our findings.
    UNASSIGNED: According to the results from the Inverse Variance Weighted method, seven bacterial genera show a significant association with the outcome variable chronic renal failure. Of these, Ruminococcus (gauvreauii group) (OR = 0.82, 95% CI = 0.71-0.94, p = 0.004) may act as a protective factor against chronic renal failure, while the genera Escherichia-Shigella (OR = 1.22, 95% CI = 1.08-1.38, p = 0.001), Lactococcus (OR = 1.1, 95% CI = 1.02-1.19, p = 0.013), Odoribacter (OR = 1.23, 95% CI = 1.03-1.49, p = 0.026), Enterorhabdus (OR = 1.14, 95% CI = 1.00-1.29, p = 0.047), Eubacterium (eligens group) (OR = 1.18, 95% CI = 1.02-1.37, p = 0.024), and Howardella (OR = 1.18, 95% CI = 1.09-1.28, p < 0.001) may be risk factors for chronic renal failure. However, after correction for multiple comparisons using False Discovery Rate, only the associations with Escherichia-Shigella and Howardella remain significant, indicating that the other genera have suggestive associations. Sensitivity analyses did not reveal any pleiotropy or heterogeneity.
    UNASSIGNED: Our two-sample Mendelian randomization study suggests that the genera Escherichia-Shigella and Howardella are risk factors for chronic renal failure, and they may serve as potential targets for future therapeutic interventions. However, the exact mechanisms of action are not yet clear, necessitating further research to elucidate their precise roles fully.
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  • 文章类型: Journal Article
    背景:慢性肾脏病(CKD)需要准确预测肾脏替代疗法(RRT)的启动风险。这项研究开发了深度学习算法(DLA),通过结合病史和处方以及生化研究来预测CKD患者的RRT风险。
    方法:一项多中心回顾性队列研究在香港三家主要医院进行。包括eGFR<30ml/min/1.73m2的CKD患者。使用患者数据创建和训练各种结构的DLA。使用测试集,将DLA预测性能与肾衰竭风险方程(KFRE)进行比较。
    结果:DLA在预测RRT起始风险方面优于KFRE(CNN+LSTM+ANN层ROC-AUC=0.90;CNNROC-AUC=0.91;4变量KFRE:ROC-AUC=0.84;8变量KFRE:ROC-AUC=0.84)。DLA准确预测5年后未编码的肾移植和需要透析的患者,展示了他们捕捉非线性关系的能力。
    结论:DLA可以准确预测CKD患者的RRT风险,超越KFRE等传统方法。合并病史和处方可提高预测性能。虽然我们的研究结果表明,DLA有望改善CKD管理中的患者护理和资源分配,进一步的前瞻性观察研究和随机对照试验是必要的,以充分了解其影响,特别是关于DLA的可解释性,偏置最小化,和过拟合减少。总的来说,我们的研究强调了DLA作为推进CKD管理和预测RRT起始风险的潜在有价值工具的新兴作用.
    BACKGROUND: Chronic kidney disease (CKD) requires accurate prediction of renal replacement therapy (RRT) initiation risk. This study developed deep learning algorithms (DLAs) to predict RRT risk in CKD patients by incorporating medical history and prescriptions in addition to biochemical investigations.
    METHODS: A multi-centre retrospective cohort study was conducted in three major hospitals in Hong Kong. CKD patients with an eGFR < 30ml/min/1.73m2 were included. DLAs of various structures were created and trained using patient data. Using a test set, the DLAs\' predictive performance was compared to Kidney Failure Risk Equation (KFRE).
    RESULTS: DLAs outperformed KFRE in predicting RRT initiation risk (CNN + LSTM + ANN layers ROC-AUC = 0.90; CNN ROC-AUC = 0.91; 4-variable KFRE: ROC-AUC = 0.84; 8-variable KFRE: ROC-AUC = 0.84). DLAs accurately predicted uncoded renal transplants and patients requiring dialysis after 5 years, demonstrating their ability to capture non-linear relationships.
    CONCLUSIONS: DLAs provide accurate predictions of RRT risk in CKD patients, surpassing traditional methods like KFRE. Incorporating medical history and prescriptions improves prediction performance. While our findings suggest that DLAs hold promise for improving patient care and resource allocation in CKD management, further prospective observational studies and randomized controlled trials are necessary to fully understand their impact, particularly regarding DLA interpretability, bias minimization, and overfitting reduction. Overall, our research underscores the emerging role of DLAs as potentially valuable tools in advancing the management of CKD and predicting RRT initiation risk.
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  • 文章类型: Clinical Trial, Phase IV
    目的:用于治疗高钾血症的传统钾(K+)结合剂是令人不快且耐受性差的。据报道,较新的K+粘合剂耐受性更好;然而,没有发表的数据描述它们的适口性,长期坚持的决定因素。这项研究评估了三种K+粘合剂的适口性和偏好:聚苯乙烯磺酸钠和钙(S/CPS),环硅酸钠锆(SZC)和钙配聚物脱水山梨糖醇(patiromer)。
    方法:第四阶段,随机,参与者失明,交叉研究。参与者被随机分为六个味觉序列之一,使用\'sipandspit\'方法,在完成调查之前,品尝了每个K+活页夹。
    方法:美国17个中心,加拿大和欧盟。
    方法:144名慢性肾病患者,高钾血症和最近没有使用K+粘合剂。
    方法:对于主要(美国)和主要次要(加拿大和欧盟)端点,参与者对适口性属性(味道,纹理,气味和口感)并愿意以0-10的等级服用每种K粘合剂(合理评估)。关于每个属性的感觉,以及每天服用一次产品的想法,使用非语言评估,情绪反应的视觉测量。最后,参与者根据适口性对K+粘合剂进行排序。
    结果:在每个地区,SZC和patiromer在整体适口性方面优于S/CPS(复合口味,纹理,气味和口感),基于理性评价和情绪反应。每天服用该产品对SZC和Patiromer更具吸引力,创造比采用S/CPS的想法更大的接受度。对口感的情绪反应对服用每种产品的感觉影响最大。在每个地区,与patiromer或S/CPS相比,SZC被认为是最优选的K+粘合剂。
    结论:优选更可口的K+结合剂,如SZC和patiromer,可能为提高长期治疗高钾血症的依从性提供机会。
    背景:NCT04566653。
    OBJECTIVE: Traditional potassium (K+) binders for treating hyperkalaemia are unpalatable and poorly tolerated. Newer K+ binders are reportedly better tolerated; however, no published data describe their palatability, a determinant of long-term adherence. This study evaluated the palatability of and preference for three K+ binders: sodium and calcium polystyrene sulfonate (S/CPS), sodium zirconium cyclosilicate (SZC) and calcium patiromer sorbitex (patiromer).
    METHODS: Phase 4, randomised, participant-blinded, cross-over study. Participants were randomised to one of six taste sequences and, using a \'sip and spit\' approach, tasted each K+ binder before completing a survey.
    METHODS: 17 centres across the USA, Canada and European Union.
    METHODS: 144 participants with chronic kidney disease, hyperkalaemia and no recent use of K+ binders.
    METHODS: For the primary (USA) and key secondary (Canada and European Union) endpoints, participants rated palatability attributes (taste, texture, smell and mouthfeel) and willingness to take each K+ binder on a scale of 0-10 (rational evaluation). Feelings about each attribute, and the idea of taking the product once daily, were evaluated using a non-verbal, visual measure of emotional response. Finally, participants ranked the K+ binders according to palatability.
    RESULTS: In each region, SZC and patiromer outperformed S/CPS on overall palatability (a composite of taste, texture, smell and mouthfeel), based on rational evaluation and emotional response. Taking the product once daily was more appealing for SZC and patiromer, creating greater receptivity than the idea of taking S/CPS. The emotional response to mouthfeel had the strongest influence on feelings about taking each product. In each region, a numerically greater proportion of participants ranked SZC as the most preferred K+ binder versus patiromer or S/CPS.
    CONCLUSIONS: Preference for more palatable K+ binders such as SZC and patiromer may provide an opportunity to improve adherence to long-term treatment of hyperkalaemia.
    BACKGROUND: NCT04566653.
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