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.
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.
Objective To investigate the nutritional status of hospitalized patients with chronic kidney disease (CKD), analyze the influencing factors, and construct a predictive model to provide a localized theoretical basis and more convenient risk prediction indicators and models for clinical nutrition support and intervention treatment of CKD patients in China. Methods Convenience sampling was used to select hospitalized CKD patients from Department of Nephrology, West China Hospital, Sichuan University, from January to October 2019. General information questionnaires, the Nutritional Risk Screening 2002 scale, and the Huaxi Emotional-distress Index questionnaire were used for data collection. Single factor analyses and multiple logistic regression analysis were conducted to explore the risk factors for malnutrition in CKD hospitalized patients. A predictive model was established and evaluated using receiver operating characteristic (ROC) curve analysis and bootstrap resampling. Results A total of 1059 valid copies of questionnaires were collected out of 1118 distributed. Among the 1059 CKD hospitalized patients, 207 cases (19.5%) were identified as having nutritional risk. The multiple logistic regression analysis showed that CKD stage [odds ratio (OR)=1.874, 95% confidence interval (CI) (1.631, 2.152), P<0.001], age [OR=1.015, 95%CI (1.003, 1.028), P=0.018], and the Huaxi Emotional-distress Index [OR=1.024, 95%CI (1.002, 1.048), P=0.033] were independent risk factors for malnutrition in CKD hospitalized patients, while serum albumin [OR=0.880, 95%CI (0.854, 0.907), P<0.001] was an independent protective factor. The evaluation of the multiple logistic regression analysis predictive model showed a concordance index of 0.977, standard deviation of 0.021, and P<0.05. The area under the ROC curve was 0.977. Conclusions The prevalence of malnutrition is relatively high among CKD hospitalized patients. CKD stage, age, psychological status, and serum albumin are influencing factors for malnutrition in CKD hospitalized patients. The multiple logistic regression model based on the above indicators demonstrates good predictive performance and is expected to provide assistance for early nutritional intervention to improve the clinical outcomes and quality of life for CKD patients with malnutrition in China.
ObjectiveTo explore the current status of treatment adherence in patients with chronic kidney disease without dialysis and to analyze its influencing factors.MethodsThe patients who visited the Outpatient Department of Nephrology of West China Hospital of Sichuan University from September to December 2020 were taken as the research objects. Self-designed general information questionnaire, treatment adherence questionnaire, physician-patient communication satisfaction, health information seeking behavior questionnaire, and physician-patient concordance questionnaire were used to investigate, and path analysis was used to explore the influencing factors of treatment adherence.ResultsA total of 203 valid questionnaires were obtained. Treatment adherence score was (21.69±2.42) points, self-reported health status was (2.48±0.91) points, physician-patient concordance was (20.39±2.70) points, physician-patient communication satisfaction was (67.73±5.52) points, and health information seeking behavior was (13.17±2.65) points. Health information seeking behavior (r=0.214, P=0.002), physicians-patient concordance (r=0.494, P<0.001), physician-patient communication satisfaction (r=0.229, P=0.001) were positively correlated with treatment adherence. Self-reported health status was negatively correlated with treatment adherence (r=−0.225, P=0.001). Path analysis showed that physicians-patient concordance was the most influencing factor of treatment adherence (total effect=0.474).ConclusionHealth information-seeking behavior and physicians-patient concordance are important factors affecting treatment adherence in chronic kidney disease patients without dialysis. In order to improve treatment adherence of chronic kidney disease patients, healthcare providers can provide various ways to provide information, which can help make more disease-related health knowledge available to patients. Moreover, healthcare workers should also further explore ways to improve the concordance related to reaching agreement between doctors and patients on medical and treatment options.
Objective To explore the relationship between 25-hydroxy vitamin D [25(OH)D] and metabolic syndrome (MS) in non-dialysis patients with stage 3–5 chronic kidney disease (CKD). Methods Between January 2014 and May 2015, a total of 61 non-dialysis patients with stage 3–5 CKD were included. The patients’ height, weight, blood lipid, levels of 25(OH)D and serum creatinine were conducted. The relationship between 25(OH)D and MS was analyzed. Results The average level of 25(OH)D was (39.99±17.66) nmol/L. Normal level (≥75 mmol/L) of 25(OH)D was observed in 3.3% (2/61) of the patients, insufficiency of 25(OH)D (≥37.5 nmol/L and <75 nmol/L) was observed in 50.8% (31/61), and deficiency (<37.5 nmol/L) was observed in 45.9% (28/61). The prevalence of MS was 67.2% ( 41/61). The body mass index (BMI), proportion of hypertension, proportion of diabetes mellitus, level of triglyceride in the MS group were higher than those in the non-MS group, while the levels of high-density lipoprotein and 25(OH)D were lower in the MS group than those in the non-MS group, and the differences were statistically significant (P<0.05). The patients’ BMI, proportion of hypertension, level of triglyceride and proportion of MS in the 25(OH)D deficiency group were higher than those in the 25(OH)D non-deficiency group, meanwhile, the level of high-density lopoprotein was lower in the 25(OH)D deficiency group than that in the 25(OH)D non-deficiency group, and the differences were statistically significant (P<0.05). Serum 25(OH)D level was correlated negatively with BMI (r=–0.35, P=0.006) and the level of triglyceride (r=–0.16, P=0.039), and correlated positively with the level of high-density lipoprotein (r=0.18, P=0.026). Conclusions Low level of 25(OH)D and MS are both of high incidence rate in non-dialysis patients with stage 3–5 CKD. 25(OH)D is associated with MS.
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.
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.
Objective To systematically review the effect of allopurinol on renal function in patients with chronic kidney disease (CKD). Methods The PubMed, EMbase, Cochrane Library, WanFang Data, CNKI, and VIP databases were searched for randomized controlled trials (RCTs) of the effect of allopurinol on renal function in patients with CKD. Databases for articles published between establishment of the database and April 28, 2021 were searched. Two evaluators independently screened the literature, extracted data and evaluated the risk of bias of the included studies. RevMan 5.4 was then used for meta-analysis. Results A total of 20 RCTs comprising 2 338 patients were included. The results of meta-analysis showed that compared with the control group, allopurinol substantially reduced the serum uric acid (MD=−2.48, 95%CI −3.08 to −1.89, P<0.01). In addition, the effect of allopurinol on slowing the decline in eGFR was influenced by the serum uric acid concentration. Participants taking allopurinol whose serum uric acid concentrations were maintained at >6 mg/dL showed a slower decline in eGFR (MD=5.03, 95%CI 1.76 to 8.31, P<0.01). However, there was no difference in the decline in eGFR between the two groups when the serum uric acid concentration of the participants was <6 mg/dL. Among participants with CKD and moderate renal dysfunction at baseline, those taking allopurinol showed a slower decline in eGFR than controls (MD=3.33, 95%CI 1.14 to 5.52, P<0.01). A further subgroup analysis showed that those who maintained their serum uric acid concentration above 6 mg/dL experienced a slower decline in eGFR (MD=5.46, 95%CI 2.06 to 8.86, P<0.01). However, when the serum uric acid concentration was <6 mg/dL, there was no difference between the allopurinol and control groups. Moreover, the serum creatinine concentration of the allopurinol group was lower than that of the control group after the intervention (MD=−0.39, 95%CI −0.58 to −0.19), P<0.01). However, there was no significant difference in the incidence of progression to end-stage kidney disease between the two groups (RR=0.96, 95%CI 0.65 to 1.42, P=0.85). Conclusion Allopurinol can substantially reduce serum uric acid and may protect the kidneys of patients with CKD when the serum uric acid concentration is maintained above 6 mg/dL.
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.
ObjectiveTo analyze the trend of chronic kidney disease (CKD) disease burden attributable to metabolic factors in China from 1990 to 2021, and to predict the death of CKD due to metabolic factors in China from 2022 to 2046. MethodsBased on the 2021 Global Burden of Disease Database, this paper collected and sorted out the CKD deaths, disability-adjusted life years (DALYs), premature death lost life years (YLLs), and disability life lost years (YLDs) attributed to metabolic factors by different ages and sexes in China from 1990 to 2021, and used the Joinpoint regression model to systematically evaluate the temporal trends of standardized mortality and standardized DALYs rate. The age-period-cohort (APC) model was used to assess age, period, and cohort effects, and the R software Nordpred package was used to predict future changes in the burden of disease. ResultsCompared with 1990, the mortality rate, DALYs rate, YLLs rate, and YLDs rate attributable to metabolic factors of Chinese residents in 2021 showed an upward trend, and the characteristics of male higher than female, higher age group than lower age group. The primary metabolic factor influencing the disease burden of CKD was hyperglycemia. The results of Joinpoint analysis showed a downward trend in the standardized mortality and standardized DALYs rate of CKD attributed to metabolic factors. The results of age-period-cohort model analysis showed that the age effect of CKD attributed to metabolic factors increased significantly, the period effect increased slowly, and the cohort effect showed a downward trend. ConclusionThe disease burden of CKD attributed to metabolic factors in China is generally on the rise, and men, the elderly, and diabetic patients are the key focus of the disease.