Metabolic syndrome(Met S) is a term used to denote a combination of selected,widely prevalent cardiovascular disease(CVD)-related risk factors.Despite the ambiguous definition of Met S,it has been clearly associated w...Metabolic syndrome(Met S) is a term used to denote a combination of selected,widely prevalent cardiovascular disease(CVD)-related risk factors.Despite the ambiguous definition of Met S,it has been clearly associated with chronic kidney disease markers including reduced glomerular filtration rate,proteinuria and/or microalbuminuria,and histopathological markers such as tubular atrophy and interstitial fibrosis.However,the etiological role of Met S in chronic kidney disease(CKD) is less clear.The relationship between MetS and CKD is complex and bidirectional,and so is best understood when CKD is viewed as a common progressive illness along the course of which MetS,another common disease,may intervene and contribute.Possible mechanisms of renal injury include insulin resistance and oxidative stress,increased proinflammatory cytokine production,increased connective tissue growth and profibrotic factor production,increased microvascular injury,and renal ischemia.MetS also portends a higher CVD risk at all stages of CKD from early renal insufficiency to end-stage renal disease.Clinical interventions for MetS in the presence of CKD should include a combination of weight reduction,appropriate dietary modification and increase physical activity,plus targeting of individual CVD-related risk factors such as dysglycemia,hypertension,and dyslipidemia while conforming to relevant national societal guidelines.展开更多
Purpose:Patients undergoing maintenance hemodialysis(MHD)have a higher prevalence of cognitive impairment and inferior cognitive performance than the general population,and those with cognitive impairment are at highe...Purpose:Patients undergoing maintenance hemodialysis(MHD)have a higher prevalence of cognitive impairment and inferior cognitive performance than the general population,and those with cognitive impairment are at higher risk of death than those without cognitive impairment.Having diabetes has been associated with an increased risk of cognitive decline in end-stage kidney disease patients treated with peritoneal dialysis or kidney transplant.However,these findings may not extend to the hemodialysis population.Thus,we aim to investigate the relationship between having diabetes and cognitive function in MHD patients.Methods:This was a cross-sectional study.A total of 203 patients treated with MHD from two blood purification centers were enrolled as subjects.The Chinese version of the Montreal Cognitive Assessment(MoCA)was utilized to assess cognitive function.Results:MHD patients with diabetes had a significantly higher prevalence of global cognitive impairment and inferior performance in global cognition,visuospatial/executive function,naming,language,abstraction and orientation tasks compared with those without diabetes.According to the multiple linear analyses,having diabetes was significantly associated with lower global cognitive function,naming,and language scores,withβcoefficients and 95%CIs of-1.30[-2.59,-0.01],-0.25[-0.47,-0.02],and-0.32[-0.58,-0.07],respectively(all P<0.05).Having diabetes could not independently predict an increased risk of global cognitive impairment.Conclusions:In MHD patients,having diabetes is significantly associated with lower cognitive function scores.Medical staff should evaluate early and focus on the decline of cognitive function in MHD patients with diabetes,in order to achieve early diagnosis and earlv intervention.展开更多
目的探讨Roy适应模式对糖尿病肾病(diabetes nephropathy,DN)腹膜透析患者自我感受负担、自我护理能力量表(exercise of self-care agency,ESCA)评分的影响。方法采用随机数字表法将2021年1月—2022年1月解放军陆军第七十三集团军医院...目的探讨Roy适应模式对糖尿病肾病(diabetes nephropathy,DN)腹膜透析患者自我感受负担、自我护理能力量表(exercise of self-care agency,ESCA)评分的影响。方法采用随机数字表法将2021年1月—2022年1月解放军陆军第七十三集团军医院收治的56例DN腹膜透析患者分入两组(各28例)。对照组行常规护理干预,观察组行Roy适应模式干预。比较两组患者护理满意程度,护理前、护理后的自我感受负担量表(self-perceived burden scale,SPBS)评分、ESCA评分、生活质量综合评定问卷-74(generic quality of life inventory-74,GQOLI-74)评分变化。结果护理后两组患者情感因素、身体因素、经济负担等SPBS维度评分及总分均下降,且观察组低于对照组,差异有统计学意义(P<0.05);护理后两组患者自我护理技能、自我护理责任、自我概念、健康知识等维度ESCA评分均升高,且观察组高于对照组,差异有统计学意义(P<0.05);护理后两组患者躯体功能、心理功能、社会功能、物质生活等GQOLI-74维度评分均升高,且观察组高于对照组,差异有统计学意义(P<0.05);观察组护理满意度(96.43%)高于对照组(71.43%),差异有统计学意义(P<0.05)。结论对DN腹膜透析患者实施Roy适应模式护理可有效降低其自我感受负担,提高自我护理能力,且护理满意度高。展开更多
The increasing prevalence of diabetes has led to a growing population of endstage kidney disease(ESKD)patients with diabetes.Currently,kidney transplantation is the best treatment option for ESKD patients;however,it i...The increasing prevalence of diabetes has led to a growing population of endstage kidney disease(ESKD)patients with diabetes.Currently,kidney transplantation is the best treatment option for ESKD patients;however,it is limited by the lack of donors.Therefore,dialysis has become the standard treatment for ESKD patients.However,the optimal dialysis method for diabetic ESKD patients remains controversial.ESKD patients with diabetes often present with complex conditions and numerous complications.Furthermore,these patients face a high risk of infection and technical failure,are more susceptible to malnutrition,have difficulty establishing vascular access,and experience more frequent blood sugar fluctuations than the general population.Therefore,this article reviews nine critical aspects:Survival rate,glucose metabolism disorder,infectious complications,cardiovascular events,residual renal function,quality of life,economic benefits,malnutrition,and volume load.This study aims to assist clinicians in selecting individualized treatment methods by comparing the advantages and disadvantages of hemodialysis and peritoneal dialysis,thereby improving patients’quality of life and survival rates.展开更多
BACKGROUND The number of end-stage renal disease patients with diabetes mellitus(DM)who are undergoing peritoneal dialysis is increasing.Peritoneal dialysis-associated peritonitis(PDAP)is a serious complication of per...BACKGROUND The number of end-stage renal disease patients with diabetes mellitus(DM)who are undergoing peritoneal dialysis is increasing.Peritoneal dialysis-associated peritonitis(PDAP)is a serious complication of peritoneal dialysis leading to technical failure and increased mortality in patients undergoing peritoneal dialysis.The profile of clinical symptoms,distribution of pathogenic organisms,and response of PDAP to medical management in the subset of end-stage renal disease patients with DM have not been reported previously.Discrepant results have been found in long-term prognostic outcomes of PDAP in patients with DM.We inferred that DM is associated with bad outcomes in PDAP patients.AIM To compare the clinical features and outcomes of PDAP between patients with DM and those without.METHODS In this multicenter retrospective cohort study,we enrolled patients who had at least one episode of PDAP during the study period.The patients were followed for a median of 31.1 mo.They were divided into a DM group and a non-DM group.Clinical features,therapeutic outcomes,and long-term prognostic outcomes were compared between the two groups.Risk factors associated with therapeutic outcomes of PDAP were analyzed using multivariable logistic regression.A Cox proportional hazards model was constructed to examine the influence of DM on patient survival and incidence of technical failure.RESULTS Overall,373 episodes occurred in the DM group(n=214)and 692 episodes occurred in the non-DM group(n=395).The rates of abdominal pain and fever were similar in the two groups(P>0.05).The DM group had more infections with coagulase-negative Staphylococcus and less infections with Escherichia coli(E.coli)as compared to the non-DM group(P<0.05).Multivariate logistic regression analysis revealed no association between the presence of diabetes and rates of complete cure,catheter removal,PDAP-related death,or relapse of PDAP(P>0.05).Patients in the DM group were older and had a higher burden of cardiovascular disease,with lower level of ser展开更多
文摘Metabolic syndrome(Met S) is a term used to denote a combination of selected,widely prevalent cardiovascular disease(CVD)-related risk factors.Despite the ambiguous definition of Met S,it has been clearly associated with chronic kidney disease markers including reduced glomerular filtration rate,proteinuria and/or microalbuminuria,and histopathological markers such as tubular atrophy and interstitial fibrosis.However,the etiological role of Met S in chronic kidney disease(CKD) is less clear.The relationship between MetS and CKD is complex and bidirectional,and so is best understood when CKD is viewed as a common progressive illness along the course of which MetS,another common disease,may intervene and contribute.Possible mechanisms of renal injury include insulin resistance and oxidative stress,increased proinflammatory cytokine production,increased connective tissue growth and profibrotic factor production,increased microvascular injury,and renal ischemia.MetS also portends a higher CVD risk at all stages of CKD from early renal insufficiency to end-stage renal disease.Clinical interventions for MetS in the presence of CKD should include a combination of weight reduction,appropriate dietary modification and increase physical activity,plus targeting of individual CVD-related risk factors such as dysglycemia,hypertension,and dyslipidemia while conforming to relevant national societal guidelines.
基金This study was in part supported by the project of Nanjing Medical Science and Technology Development Foundation(YKK17231).
文摘Purpose:Patients undergoing maintenance hemodialysis(MHD)have a higher prevalence of cognitive impairment and inferior cognitive performance than the general population,and those with cognitive impairment are at higher risk of death than those without cognitive impairment.Having diabetes has been associated with an increased risk of cognitive decline in end-stage kidney disease patients treated with peritoneal dialysis or kidney transplant.However,these findings may not extend to the hemodialysis population.Thus,we aim to investigate the relationship between having diabetes and cognitive function in MHD patients.Methods:This was a cross-sectional study.A total of 203 patients treated with MHD from two blood purification centers were enrolled as subjects.The Chinese version of the Montreal Cognitive Assessment(MoCA)was utilized to assess cognitive function.Results:MHD patients with diabetes had a significantly higher prevalence of global cognitive impairment and inferior performance in global cognition,visuospatial/executive function,naming,language,abstraction and orientation tasks compared with those without diabetes.According to the multiple linear analyses,having diabetes was significantly associated with lower global cognitive function,naming,and language scores,withβcoefficients and 95%CIs of-1.30[-2.59,-0.01],-0.25[-0.47,-0.02],and-0.32[-0.58,-0.07],respectively(all P<0.05).Having diabetes could not independently predict an increased risk of global cognitive impairment.Conclusions:In MHD patients,having diabetes is significantly associated with lower cognitive function scores.Medical staff should evaluate early and focus on the decline of cognitive function in MHD patients with diabetes,in order to achieve early diagnosis and earlv intervention.
文摘目的探讨Roy适应模式对糖尿病肾病(diabetes nephropathy,DN)腹膜透析患者自我感受负担、自我护理能力量表(exercise of self-care agency,ESCA)评分的影响。方法采用随机数字表法将2021年1月—2022年1月解放军陆军第七十三集团军医院收治的56例DN腹膜透析患者分入两组(各28例)。对照组行常规护理干预,观察组行Roy适应模式干预。比较两组患者护理满意程度,护理前、护理后的自我感受负担量表(self-perceived burden scale,SPBS)评分、ESCA评分、生活质量综合评定问卷-74(generic quality of life inventory-74,GQOLI-74)评分变化。结果护理后两组患者情感因素、身体因素、经济负担等SPBS维度评分及总分均下降,且观察组低于对照组,差异有统计学意义(P<0.05);护理后两组患者自我护理技能、自我护理责任、自我概念、健康知识等维度ESCA评分均升高,且观察组高于对照组,差异有统计学意义(P<0.05);护理后两组患者躯体功能、心理功能、社会功能、物质生活等GQOLI-74维度评分均升高,且观察组高于对照组,差异有统计学意义(P<0.05);观察组护理满意度(96.43%)高于对照组(71.43%),差异有统计学意义(P<0.05)。结论对DN腹膜透析患者实施Roy适应模式护理可有效降低其自我感受负担,提高自我护理能力,且护理满意度高。
基金Supported by Science and Technology Department of Jilin Province,No.YDZJ202201ZYTS110 and No.20200201352JC.
文摘The increasing prevalence of diabetes has led to a growing population of endstage kidney disease(ESKD)patients with diabetes.Currently,kidney transplantation is the best treatment option for ESKD patients;however,it is limited by the lack of donors.Therefore,dialysis has become the standard treatment for ESKD patients.However,the optimal dialysis method for diabetic ESKD patients remains controversial.ESKD patients with diabetes often present with complex conditions and numerous complications.Furthermore,these patients face a high risk of infection and technical failure,are more susceptible to malnutrition,have difficulty establishing vascular access,and experience more frequent blood sugar fluctuations than the general population.Therefore,this article reviews nine critical aspects:Survival rate,glucose metabolism disorder,infectious complications,cardiovascular events,residual renal function,quality of life,economic benefits,malnutrition,and volume load.This study aims to assist clinicians in selecting individualized treatment methods by comparing the advantages and disadvantages of hemodialysis and peritoneal dialysis,thereby improving patients’quality of life and survival rates.
文摘BACKGROUND The number of end-stage renal disease patients with diabetes mellitus(DM)who are undergoing peritoneal dialysis is increasing.Peritoneal dialysis-associated peritonitis(PDAP)is a serious complication of peritoneal dialysis leading to technical failure and increased mortality in patients undergoing peritoneal dialysis.The profile of clinical symptoms,distribution of pathogenic organisms,and response of PDAP to medical management in the subset of end-stage renal disease patients with DM have not been reported previously.Discrepant results have been found in long-term prognostic outcomes of PDAP in patients with DM.We inferred that DM is associated with bad outcomes in PDAP patients.AIM To compare the clinical features and outcomes of PDAP between patients with DM and those without.METHODS In this multicenter retrospective cohort study,we enrolled patients who had at least one episode of PDAP during the study period.The patients were followed for a median of 31.1 mo.They were divided into a DM group and a non-DM group.Clinical features,therapeutic outcomes,and long-term prognostic outcomes were compared between the two groups.Risk factors associated with therapeutic outcomes of PDAP were analyzed using multivariable logistic regression.A Cox proportional hazards model was constructed to examine the influence of DM on patient survival and incidence of technical failure.RESULTS Overall,373 episodes occurred in the DM group(n=214)and 692 episodes occurred in the non-DM group(n=395).The rates of abdominal pain and fever were similar in the two groups(P>0.05).The DM group had more infections with coagulase-negative Staphylococcus and less infections with Escherichia coli(E.coli)as compared to the non-DM group(P<0.05).Multivariate logistic regression analysis revealed no association between the presence of diabetes and rates of complete cure,catheter removal,PDAP-related death,or relapse of PDAP(P>0.05).Patients in the DM group were older and had a higher burden of cardiovascular disease,with lower level of ser
