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 diseases (CKD) with long duration and a variety of complications have caused great physical and psychological problems for patients, and the overall quality of life of patients is low. Taijiquan, as a traditional Chinese techniques project, is beneficial to improving cardiopulmonary function, enhancing lower limb muscle strength, and reducing cardiovascular and cerebrovascular risks. We summarized the latest progress in clinical research concerning taijiquan as exercise rehabilitation for patients with CKD, aiming to promote the clinical application of taijiquan and other traditional exercises in the rehabilitation process of CKD patients and improve the overall quality of life of CKD patients.
End-stage renal disease is a late complication of chronic kidney disease (CKD) and one of the leading causes of high mortality worldwide. Over the years, the impacts of gut microbiota and their associated uremic toxins on kidney diseases through the intricate “gut-kidney axis” have been extensively studied. However, translation of microbiome-related omics results into specific mechanisms is still a significant challenge. In this paper, we review the interaction between gut microbiome and blood purification, as well as the current microbiota-based therapies in CKD. Additionally, the current sequencing technologies and progresses in the gut microbiome research are also discussed.
Patients with atrial fibrillation complicated with kidney disease have a high risk of stroke and bleeding, and have some limitations or contraindications to oral anticoagulants. Left atrial appendage closure has been used as an alternative to oral anticoagulation in patients with atrial fibrillation, but its efficacy and safety in patients with atrial fibrillation and chronic kidney disease need to be further confirmed. This paper intends to review the research progress of left atrial appendage occlusion in patients with atrial fibrillation complicated with chronic renal insufficiency.
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.
Objective To compare the infection characteristics and pathogen resistance between dialysis and non-dialysis patients with chronic kidney disease (CKD) in West China Hospital of Sichuan University, and provide a reference for clinical diagnosis and treatment. Methods The clinical data of CKD patients with non-repeated etiological evidence admitted to West China Hospital of Sichuan University between January 2010 and December 2021 were retrospectively analyzed. The patients were divided into dialysis group and non-dialysis group according to treatment methods. The infection characteristics and pathogen resistance of the two groups were analyzed by WHONET 5.6 and SPSS 23 softwares. Results A total of 1387 patients with CKD with positive etiology were included, excluding coagulase-negative Staphylococcus, which was common contamination pathogens of bloodstream infections. There were 527 patients in the dialysis group and 860 patients in the non-dialysis group in this study. There was no significant difference in gender between the two groups (P>0.05). There were significant differences in age, disease stage and specimen type between the two groups (P<0.01). The pathogenic bacteria samples of dialysis patients were mainly blood (25.81%) and dialysate (44.02%), and Staphylococcus aureus was the main pathogenic bacteria. In the non-dialysis group, sputum (49.88%) and urine (35.47%) were the main contents. In main Gram-positive pathogens, there were high resistance rates to penicillin and cephalosporin, and high sensitive rates to vancomycin and linezolid. In Gram-negative pathogenic bacteria, there were high resistance rates to penicillins, the first generation cephalosporins and the third generation cephalosporins, and high sensitive rates to β-lactamase inhibitor compound preparation, the fourth generation cephalosporins and other antibiotics. Conclusions CKD patients are easy to be complicated with infections. In clinical practice, it is necessary to pay attention to pathogen culture results, and selectively use antibiotics based on drug sensitivity results. At the same time, medical staff in hemodialysis centers should pay attention to aseptic operation and hand hygiene to reduce the risk of concurrent infection in dialysis patients.
Objectives To investigate the disease composition and medical costs of in patients with chronic kidney disease (CKD) in People's Hospital of Xinjiang Uygur Autonomous Region from 2012 to 2017. Methods To retrieve the records of patients with CKD, and to classify the main diagnosis of the first page of the medical record according to the International Classification of Diseases (ICD-10) standard. Data was analyzed using Excel 2010 and SPSS 19.0 software. Results A total of 11 650 CKD patients were included, with a sex ratio of 1.48 to 1. The patients were mainly young and middle-aged, accounting for 75.56%. The top 11 diseases of CKD patients were chronic glomerulonephritis, membranous nephropathy, diabetic nephropathy, IgA nephropathy, hypertensive nephropathy, minimally pathological nephritis, focal segmental glomerulosclerosis, lupus nephritis, Polycystic kidney disease, chronic interstitial nephritis and purpuric nephritis. The per capita hospitalization days of CKD patients was 11.23 days, and the per capita medical expenses was 1.51 million yuan. Significant differences were found in different genders, ethnic groups, age groups, disease composition and CKD staging. The medical expenses of CKD patients were mainly medicine and inspection fees, accounting for 71.35%. Conclusions Inpatients of CKD in the People's Hospital of Xinjiang Uygur Autonomous Region have a heavy disease burden and large difference in their conditions.
The patency of vascular access is of great significance to hemodialysis patients. Combining with guidelines and literature associated with vascular access for dialysis in recent years, the authors interpret the effectiveness and limitations of prophylactic drug strategies, including using fish oil, anticoagulation, anti-platelet, lipid-lowering agents, etc., in order to promote the proper use of these agents in clinical practice, and improve the effect of prophylaxis and treatment of vascular access dysfunction.
ObjectiveTo study and analyze the clinical characteristics, treatment and prognosis of chronic kidney disease (CKD) patients with tuberculosis.MethodsThe cases of CKD with tuberculosis treated in respiratory department, nephrology department and infection department of the Affiliated Hospital of Southwest Medical University during January 2014 to December 2018 and followed up for at least half a year were collected as the study subjects. The clinical characteristics of CKD patients with tuberculosis and to observe the treatment, prognosis and adverse reactions were analyzed.ResultsA total of 74 patients were enrolled in the analysis, including 51 males (68.91%) and 23 females (31.08%), and with a mean age of (52.1±15.5) years. The use rate of immunosuppress drug in CKD G1\G2\G3 stage was very high (100%, 100%, 70%, respectively), and patients in G5 stage had the highest TB infection by 49 cases. There were 58 cases of pulmonary tuberculosis, which was the main form of tuberculosis. Extrapulmonary tuberculosis was very common too, and there were 40 cases including 29 cases of lymph node tuberculosis. Among 53 cases of acid fast bacilli smear, 8 cases were positive; lung biopsy positive in 1; lymph node biopsy was positive in 5 cases; 53 cases were initially treated and 21 cases were retreated. The main symptoms of 74 patients were emaciation (33 cases), fever (30 cases), and fatigue (25 cases); the common symptoms of 58 patients with pulmonary tuberculosis were cough and expectoration (41 cases). Pulmonary tuberculosis mainly infected the upper field of lung (39 cases). The most common imaging features was patchy shadow in 17 cases, followed by single or multiple nodules in 15 cases. The number of cases with lymph node enlargement in drainage area, pleural effusion, and pleural thickening were 36, 34 and 24, respectively. The sensitivity of tuberculosis interferon-gamma release assays (TB-IGRA), tuberculosis polymerase chain reaction (TB-PCR) and Mycobacterium tuberculosis protein chip was 79.6%, 18.8% and 61.7%, respectively. After tuberculosis treatments, 51 cases were successful, 14 cases failed, 5 cases died, and 4 cases could not be evaluated. Sixteen cases had serious and typical adverse reactions, including 12 cases of drug-induced liver injury, and 11 cases of treatment failure due to these serious adverse reactions.ConclusionsThe incidence rate of tuberculosis is high in CKD patients and the clinical manifestations are atypical. Pulmonary tuberculosis is the main form of tuberculosis, extrapulmonary tuberculosis is very common and mainly lymph node tuberculosis. The sensitivity of TB-IGRA, TB-PCR and Mycobacterium tuberculosis protein chip detection are lower than that of common patients. The success rate of tuberculosis treatment in CKD patients is low, the adverse reaction rate is high, and the adverse reactions are the main causes of treatment failure.