ObjectiveTo explore the nutritional status of inpatients with chronic kidney disease (CKD) and analyze the factors affecting nutritional risk, to provide theoretical basis for further nutritional support.MethodsConvenience sampling method was adopted to select 719 inpatients with CKD as research subjects in a tertiary hospital in Chengdu, Sichuan Province from January to March 2018. Nutritional Risk Screening 2002 was used for nutritional risk screening, and chi-square test, t test, one-way analysis of variance, and multiple linear regression analysis were used to explore the influencing factors of nutritional risk.ResultsAmong the 719 cases, whose average nutritional risk score was 1.79±1.11, 158 cases had nutritional risk, accounting for 22.0%. There were statistically significant differences in nutritional risk score between patients of age<60 years and ≥60 years, between males and females, between patients with CKD stage 1-3 and stage 4-5, between patients with serum albumin level <30 g/L and ≥30 g/L, and between patients with and without anaemia (P<0.05). The results of multiple linear regression analysis showed that the nutritional risk score of CKD patients was negatively correlated to serum albumin level (P=0.016), positively correlated to age (P<0.001), and higher in females than that in males (P=0.001).ConclusionsInpatients with CKD have a higher nutritional risk, with age, gender and serum albumin as the main influencing factors. Based on the above factors, the medical staff should continue to take targeted intervention measures to assess the nutritional status of CKD inpatients early and conveniently, so as to provide scientific basis for further nutritional support and nutritional nursing.
Studies of evidence-based medicine have provided much important evidence, clarified problems, and guided the clinical practice in the treatment of renal diseases. As examples, several therapeutic problems in renal hypertension, renal anemia and low protein diet for the patients with chronic kidney disease are discussed in this paper.
Chronic kidney disease (CKD) has become an important public health problem that seriously affects the physical and mental health of Chinese people. Nutritional therapy has become one of the important treatments for CKD. Domestic and international guidelines for CKD clinical nutrition therapy have been introduced, and the intake of various nutrients in CKD patients, especially protein intake, has been guided. In recent years, with the continuous development of nutrition assessment and treatment, the content of the guidelines has gradually improved, but some views are still controversial. This article explains the relevant guidelines for the treatment of CKD at home and abroad to provide reference for the clinical nutritional treatment of CKD patients.
Chronic kidney disease (CKD) and hypertension are very common chronic diseases. Active and standardized treatment of hypertension in patients with CKD can not only delay the progress of renal disease, but also reduce the risk of cardiovascular events. In recent years, although the guidelines for hypertension have put forward detailed suggestions for the management of hypertension in CKD patients, there are differences in the recommendation of blood pressure target value for CKD patients. Combined with the latest guidelines, this review interprets the blood pressure measurement methods, diagnostic criteria, antihypertensive targets and drug therapy in patients with CKD.
The incidence of chronic kidney disease is increasing worldwide, which greatly increases the risk of end-stage renal disease. It is particularly important to find out the risk factors for the development and progression of chronic kidney disease. Whether gender is a risk factor for the progression of kidney disease remains controversial with inconsistent results in human cohort studies with diabetic or non-diabetic kidney disease. In most of the studies, women seem to exhibit certain gender advantages. Sex hormones, renal hemodynamics and lifestyle differences may play an important role. The underlying mechanism of gender affecting the progression of kidney disease deserves further exploration. This article reviews the gender differences and possible mechanisms in diabetic and non-diabetic chronic kidney disease, in order to provide reference for future research.
ObjectiveTo investigate the renal impairment and the risk factors of renal impairment in patients with OSA. MethodsData from patients who underwent polysomnography (PSG) in our department from July 2022 to January 2023 were collected, totaling 178 cases. Based on the results of the polysomnography, the patients were divided into an OSA group (145 cases) and a non-OSA group (33 cases). According to the severity of the condition, the OSA group was further divided into mild OSA (21 cases), moderate OSA (28 cases), and severe OSA (96 cases). The Pearson correlation analysis was further conducted to analyze the relationships between serum urea nitrogen (BUN), serum cystatin C (Cys-C) concentrations, and estimated Glomerular Filtration Rate (eGFR) with various risk factors that may influence renal impairment. Moreover, multiple linear regression analysis was used to identify the risk factors affecting BUN, Cys-C, and eGFR. ResultsWhen comparing the two groups, there were statistically significant differences in age, weight, BMI, neck circumference, waist circumference, eGFR、Cys-C、BUN, LSaO2, CT90% (all P<0.05). Univariate analysis of variance was used to compare differences in BUN, Serum creatinine (SCr), Cys-C, and eGFR among patients with mild, moderate, and severe OSA, indicating that differences in eGFR and Cys-C among OSA patients of varying severities were statistically significant. Further analysis with Pearson correlation was conducted to explore the associations between eGFR, BUN, and Cys-C with potential risk factors that may affect renal function. Subsequently, multiple linear regression was utilized, taking these three indices as dependent variables to evaluate risk factors potentially influencing renal dysfunction. The results demonstrated that eGFR was negatively correlated with age, BMI, and CT90% (β=−0.95, P<0.001; β=−1.36, P=0.01; β=−32.64, P<0.001); BUN was positively correlated with CT90% (β=0.22, P=0.01); Cys-C was positively correlated with CT90% (β=0.58, P<0.001. Conclusion Chronic intermittent hypoxia, age, and obesity are risk factors for renal dysfunction in patients with OSA.
【摘要】 目的 探讨细胞角蛋白19的可溶性片段CYFRA21-1在慢性肾脏病（chronic kidney disease，CKD）患者血清中的表达及其临床意义。 方法 2008年10月-2009年4月随机选取45例CKD患者，根据肌酐清除率（creatinine clearance rate，Ccr）的大小分为Ccrlt;15 mL/min组（23例）和Ccrgt;15 mL/min组（22例），并以正常体检者（10例）为正常对照组，肺鳞癌患者（10例）为阳性对照组，每位参与研究者取血后采用酶联免疫吸附法测定血清CYFRA21-1的浓度。 结果 正常对照组、阳性对照组、Ccrgt;15 mL/min组和Ccrlt;15 mL/min组的血清CFRA21-1浓度分别为（1.720±0.535）、（21.010±11.809）、（3.310±1.569）和（5.090±1.306） ng/mL。与正常对照组比较，其余3组的CYFRA21-1浓度均显著升高，有统计学意义（Plt;0.05），且均值大于正常参考值（0~3.3 ng/mL）；Ccrgt;15 mL/min组和Ccrlt;15 mL/min组的CFRA21-1浓度显著低于阳性对照组，有统计学意义（Plt;0.05）；两个实验组间随着Ccr的降低，CYFRA21-1浓度升高，有统计学意义（Plt;0.05）。 结论 CKD患者血清CYFRA21-1水平的升高与肾功能减退存在一定关系，可将其作为临床上预测肾脏纤维化程度的指标。【Abstract】 Objective To discuss the clinical Between significance of cytokeratin 19 fragment (CYFRA21-1) in patients with chronic kidney disease (CKD). Methods From October 2008 to April 2009, 45 inpatients were randomly selected and assigned into three groups according to creatinine clearance rate (Ccr) level: Ccrlt;15 mL/min, Ccrgt;15 mL/min. Ten healthy volunteers were chosen as control group, and other 10 patients with lung squamous cell carcinoma as positive control group. ELISA was used to measure the serum concentration of CYFRA21-1. Results Compared with control group, the serum concentration of CYFRA21-1 in CKD groups and positive control group was elevated (Plt;0.05). As the Ccr decreased, the serum concentration of CYFRA21-1 was elevated (Plt;0.05) in two CKD groups. Conclusion Serum concentration of CYFRA21-1 in CKD patients has a relationship with the renal function decrease, and may be used as an indication of renal interstitial fibrosis (RIF).
The number of clinical practice guidelines for traditional Chinese patent medicine has been increasing recently. However, the quality of guidelines was still low compared to international guidelines. Considering the characteristics of traditional Chinese patent medicine, we suggested the following items should be taken into account when developing traditional Chinese patent medicine guidelines: ensuring the standardized guidelines of traditional Chinese patent medicine research problem is scientific based on reliable evidence; identifying the common questions according to these research problems; understanding the strength of evidence and how to recommend correctly; inviting some experts in other fields to take part in the development of guidelines; paying more attention on the changes of disease burden and the impact of new methods and technologies when developing the guideline; paying more attention to the non-consensus opinions and evidence supporting these opinions; insisting on quality is the priority, while speed is secondary.
ObjectiveTo investigate the health literacy level and its influencing factors among follow-up patients with chronic kidney disease (CKD).MethodsFrom March to August 2018, 248 patients from the CKD Follow-up Management Center, West China Hospital, Sichuan University were included. Basic information questionnaire and chronic diseases health literacy scale were used. Analysis of variance and t test were used in univariate analysis, and multiple linear stepwise regression was used in multivariate analysis, to explore the influencing factors of health literacy score.ResultsThe average health literacy score of the 248 CKD patients (97.24±12.22) were in medium to low level. Listed from high to low, the score of each dimension was: ability to obtain information (4.24±0.50), willingness to improve health (4.17±0.66), competence to communicate and interact with others (3.95±0.59), and willingness to support financially (3.41±1.10). The result of multiple linear stepwise regression showed that whether followed up on time, families’ monthly income per capita, and the patients’ age were independent influencing factors of health literacy score (P<0.05).ConclusionsThe health literacy level of follow-up patients with CKD remains to be improved. Medical personnel should pay attention to whether patients with CKD are followed up on time, make targeted intervention, and improve the self-management of patients so as to delay the disease progress of CKD.
ObjectiveTo investigate the current status and influencing factors of self-care behavior of non-dialysis patients with chronic kidney disease (CKD).MethodsA total of 336 patients with CKD were investigated by a general data questionnaire, the CKD Self-care Behavior Scale, Social Support Scale, Generalized Anxiety Self-assessment Scale, and 9-item Patients Health Questionnaire through WeChat platform, and the influencing factors of self-care behavior were explored by binary logistic regression analysis.ResultsThe median score of self-care behavior of CKD patients without dialysis was 60, and the patients with median and high level of self-care behavior accounted for 97.6%. The score of self-care behavior of CKD patients without dialysis was positively correlated with the total score of social support (r=0.210, P<0.001), objective support score (r=0.127, P=0.020), subjective support score (r=0.195, P<0.001), and social support utilization score (r=0.164, P=0.002), and negatively correlated with the anxiety score (r=–0.132, P=0.015), depression score (r=–0.230, P<0.001), body mass index (r=–0.181, P=0.001), and systolic blood pressure (r=–0.168, P<0.001). The results of binary logistic regression analysis showed that the influencing factors of non-dialysis CKD patients’ self-care behavior were gender [(odds ratio, OR)=2.179, 95% confidence interval, CI (1.134, 4.187), P=0.019], systolic blood pressure [OR=0.967, 95%CI (0.947, 0.987), P=0.002], and depression score [OR=0.844, 95%CI (0.765, 0.931), P=0.001].ConclusionsThe self-care behavior of CKD patients without dialysis is at the median and high level. Healthcare workers can improve the self-care behavior of CKD patients by reducing their negative emotions such as depression, and guiding patients to carry out blood pressure management, to delay the progress of the disease.