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1.
Wiad Lek ; 74(3 cz 1): 471-474, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33813452

RESUMEN

OBJECTIVE: The aim: To determine informative value of pre-thrombosis, post-thrombosis and anticoagulation factors as well as their correlations for assessment of hemostasis status in patients with stage VD CKD. PATIENTS AND METHODS: Materials and methods: Potential predictors of thrombophilia development as well as their relationships depending on the level of molecular markers of hemostasis were studied in 88 patients with stage VD CKD undergoing long-term hemodialysis with the view to determine their informative value. RESULTS: Results: Accumulation of soluble fibrin (sF) was demonstrated to cause moderate reaction of D-dimer (D-d) being insufficient in the absence of reaction of anticoagulant component of hemostasis. Soluble fibrin levels were found to be associated with D-d concentration (r = 0.39) and functionally inactive prothrombin forms (FIPF) to some extent (r = -0.24). Accumulation of FIPF in individuals with high level of sF implies significant activation of blood coagulation system at the stage prior to thrombin formation. Absence of close relationship between pre- and post-thrombosis indices may be indicative of still preserved potential of anticoagulant component of hemostasis. CONCLUSION: Conclusions: Accumulation of FIPF is an early marker of activation of blood coagulation and possible thrombosis. Levels of sF correlate with pre-thrombosis (fibrinogen, FIPF) and post-thrombosis (D-d) factors being associated with inhibition of anticoagulation processes. Comprehensive study of basic components of hemostasis in patients with VD stage of chronic kidney disease offer broader opportunities in arranging prophylactic measures to prevent thrombophilia.


Asunto(s)
Insuficiencia Renal Crónica , Trombofilia , Trombosis , Biomarcadores , Productos de Degradación de Fibrina-Fibrinógeno , Hemostasis , Humanos , Diálisis Renal , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/terapia , Trombofilia/etiología , Trombosis/etiología
2.
Cardiovasc Diabetol ; 20(1): 75, 2021 03 31.
Artículo en Inglés | MEDLINE | ID: mdl-33789663

RESUMEN

The 6th Cardiovascular Outcome Trial (CVOT) Summit "Cardiovascular and Renal Outcomes 2020" was the first to be held virtually on October 29-30, 2020. As in previous years, this summit served as reference meeting for in-depth discussions on the topic of recently completed and presented major outcome trials. This year, focus was placed on the outcomes of VERTIS-CV, EMPEROR-Reduced, DAPA-CKD, and FIDELIO-DKD. Trial implications for diabetes management and the impact on new treatment algorithms were highlighted for diabetologists, cardiologists, endocrinologists, nephrologists, and general practitioners. Discussion evolved from major outcome trials using SGLT-2 inhibitors for treatment and prevention of heart failure and chronic kidney disease in people with and without diabetes, to additional therapy options for chronic kidney disease with a novel mineralocorticoid receptor antagonist. Furthermore, challenges in diabetes management like COVID-19 and obesity, as well as novel treatment strategies and guidelines, were discussed.The 7th Cardiovascular Outcome Trial Summit will be held virtually on November, 18-19, 2021 ( http://www.cvot.org ).


Asunto(s)
/epidemiología , Enfermedades Cardiovasculares/epidemiología , Ensayos Clínicos como Asunto/métodos , Congresos como Asunto/tendencias , Insuficiencia Renal Crónica/epidemiología , Informe de Investigación/tendencias , /terapia , Enfermedades Cardiovasculares/terapia , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/terapia , Humanos , Riñón/efectos de los fármacos , Riñón/fisiología , Antagonistas de Receptores de Mineralocorticoides/administración & dosificación , Insuficiencia Renal Crónica/terapia , Inhibidores del Cotransportador de Sodio-Glucosa 2/administración & dosificación , Resultado del Tratamiento
3.
Artículo en Inglés | MEDLINE | ID: mdl-33806120

RESUMEN

Both intradialytic and out-of-clinic exercise programs (EP) have been proven to be a safe and effective way to increase fitness levels in end-stage chronic kidney disease (CKD) patients. The actual COVID-19 pandemic situation has forced the suspension of EP offered in hemodialysis centers in many countries; as well as all activities considered as "non-essential" (i.e., sport facilities and fitness centers). Therefore, there is a high risk that movement restrictions would promote physical inactivity and its associated diseases in CKD patients; especially those undergoing domiciliary confinement situations. Given the importance for CKD patients' overall health to maintain exercise levels and reach physical activity recommendations, the aim of this Protocol was to design a personalized, well-structured, multicomponent physical EP that CKD patients can safely follow at home. We also aimed to provide an initial fitness evaluation tool that allows patients to adapt the EP to their fitness level. Current general exercise recommendations for people living with chronic conditions have been analyzed to develop the present home-based EP proposal.


Asunto(s)
Fallo Renal Crónico , Insuficiencia Renal Crónica , Humanos , Fallo Renal Crónico/terapia , Pandemias , Insuficiencia Renal Crónica/terapia
4.
Iran J Kidney Dis ; 1(2): 155-158, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33764327

RESUMEN

A 22-year old man underwent kidney transplant two years ago. Following fever and cough, epigastric pain, convulsion, vomiting and PO intolerance he had been brought to the emergency room. During evaluation in addition to pulmonary involvement with SARS-COVID-19, brain, stomach and pancreas involvements with COVID-19 infection also were detected. Hemodialysis and specific treatments were initiated. After 16 days he could be discharged ultimately.


Asunto(s)
/complicaciones , Trasplante de Riñón , Diálisis Renal , Insuficiencia Renal Crónica/terapia , Receptores de Trasplantes , /terapia , Humanos , Masculino , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/virología , Adulto Joven
5.
Pol Merkur Lekarski ; 49(289): 13-18, 2021 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-33713086

RESUMEN

Introduction of the definition and classification of chronic kidney disease (CKD) according to the KDOQI guidelines in 2002 served as a turning point in nephrology. On one hand, the new definition has allowed for the standardization of terminology, on the other hand, however, it has led to a rapid growth in CKD diagnoses. Another issue is the strengthening of the assumption, that diagnosis of CKD is associated with further progressive kidney dysfunction until reaching the end stage renal disease (ESRD). Clinical practice, however, provides evidence that not all patients diagnosed with CKD reach ESRD and eventually require renal replacement therapy (RRT), and in many cases CKD does not progress. AIM: The aim of the study was to assess practical information for a clinician provided by eGFR and its changes during the follow-up of a patient as regards the RRT prognosis and mortality risk. MATERIALS AND METHODS: The study group consisted of patients with CKD treated in the regional outpatient clinic. Progression was assessed by determining a linear trend line for eGFR results. Based on its course and the value of the coefficient of determination R2, four types of eGFR trajectories were identified: linear progression type (G2), nonlinear progression type (G1), improvement type (G3), undetermined eGFR change type (G4). RESULTS: The study group consisted of 65 patients 58.5% females, age mean 69 ± 12.8 years. The mean annual eGFR change in the entire group was -1.67±11.7 ml/min/1.73m2/year. During the study, 6.2% of patients began RRT (hemodialysis), and 9.2% died. Despite the evident tendency towards higher mortality in the group characterized by progression (G1+G2) as compared to the group without progression (G3+G4), the difference did not reach statistical significance (p=0.617). However, the comparison of groups with the baseline eGFR value above and below 45 ml/min/1.73 m2 differentiated the two groups that statistically differed in mortality (p=0.044). CONCLUSIONS: The baseline eGFR was not a significant predictor of future renal outcomes (ESRD, RRT). However, eGFR below 45 ml/min/ 1.73m2 was associated with a significantly higher mortality risk (p=0.036). Moreover, the groups with the fastest and with improved eGFR were characterized by the highest mortality.


Asunto(s)
Fallo Renal Crónico , Insuficiencia Renal Crónica , Anciano , Anciano de 80 o más Años , Progresión de la Enfermedad , Receptores ErbB , Femenino , Tasa de Filtración Glomerular , Humanos , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Pronóstico , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/terapia , Terapia de Reemplazo Renal
6.
Pol Merkur Lekarski ; 49(289): 60-63, 2021 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-33713096

RESUMEN

Cystinuria is the genetic condition for the increased excretion of cystine in the urine. Patients mainly suffer from afflictions related to the presence and passage of kidney stones. The currently available treatment methods include conservative treatment based on increased fluid intake, appropriate diet, medications and urological procedures. The causal treatment has not yet been invented. A CASE REPORT: A patient case was described whose first symptomatic kidney stones appeared after the second year of life. Urinary cystine excretion was significantly increased - 25,431 µmol/1g creatinine (norm: 167-333 µmol/1g creatinine), which was also shown, but lower, in both parents of the patient. Despite the early initiation of therapy including low sodium diet, abundant hydration, alkalization, captopril and compliance with stringent restrictions, the level of urinary cystine excretion was still not within the normal range. There have been many modifications to the therapy and dose increases of drugs, but without visible results. The patient underwent several urological procedures, including: ESWL (Extracorporeal shock wave lithotripsy), URSL (Ureteroscopic lithotripsy), PCNL (Percutaneous nephrolithotomy) and open surgery to remove cystine deposits that were still produced in the kidneys. In addition, for many years the disease was complicated by recurrent urinary tract infections, underweight and lesions like epithelial metaplasia in the bladder. Renal parameters were repeatedly examined. Elevated results such as: serum creatinine 0.9 mg/dl, cystatin C concentration 1.10 mg/l, albumin-creatinine index 0.197, creatinine clearance 50.7 ml/min /1.73 m2 and eGFR 73 ml/min/1.73 m2 allowed for the diagnosis of chronic kidney disease before the age of 18. After many years of conservative treatment, only the introduction of thiopronine, still little known in Poland, reduced the level of cystine excreted in the urine. The inclusion of the drug reduced the tendency to produce kidney stones, which allowed to inhibit the progression of renal failure. CONCLUSIONS: Despite many years of research and modern drugs, cystinuria is still a disease with which patients are associated for the rest of their lives. The ongoing research, along with attempts to understand the genetic and epigenetic mechanisms responsible for the emergence of mutations in the main genes causing the disease and the course of the disease, gives hope for finding a method of causal treatment for cystinuria.


Asunto(s)
Cistinuria , Cálculos Renales , Litotricia , Insuficiencia Renal Crónica , Cistinuria/complicaciones , Cistinuria/terapia , Humanos , Cálculos Renales/terapia , Polonia , Insuficiencia Renal Crónica/etiología , Insuficiencia Renal Crónica/terapia
7.
Ann Intern Med ; 174(3): JC26, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33646846

RESUMEN

SOURCE CITATION: Navaneethan SD, Zoungas S, Caramori ML, et al. Diabetes management in chronic kidney disease: synopsis of the 2020 KDIGO Clinical Practice Guideline. Ann Intern Med. 2020. [Epub ahead of print]. 33166222.


Asunto(s)
Diabetes Mellitus , Insuficiencia Renal Crónica , Diabetes Mellitus/tratamiento farmacológico , Humanos , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/terapia
8.
Inquiry ; 58: 46958021997337, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33682514

RESUMEN

The coronavirus disease pandemic has created a crisis for patients with chronic kidney disease, as far as getting treatment facilities are concerned. The crisis is more intense in developing countries where the health system is more vulnerable due to poor infrastructures and insufficient health professionals. Bangladesh, being a developing nation, is also facing similar challenges to provide sufficient services to patients with chronic kidney disease. In this short report, we have discussed the challenges and barriers non-COVID chronic kidney disease patients are facing in terms of healthcare access along with getting proper medical interventions and suggested probable strategies to minimize the suffering.


Asunto(s)
/epidemiología , Accesibilidad a los Servicios de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/organización & administración , Insuficiencia Renal Crónica/terapia , Telemedicina/organización & administración , Bangladesh , Países en Desarrollo , Humanos , Servicios Preventivos de Salud/organización & administración , Índice de Severidad de la Enfermedad
9.
Medicine (Baltimore) ; 100(8): e24882, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33663116

RESUMEN

INTRODUCTION: Our aim was to evaluate the safety and efficacy of low-dose mineralocorticoid receptor antagonists (MRAs) in dialysis patients. METHODS: We systematically searched PubMed, EMBASE, and Cochrane libraries for clinical trials on the use of MRAs in dialysis patients. Review Manager 5.3 software was used to analyze relevant data and evaluate the quality of evidence. RESULTS: We identified nine randomized controlled trials including 1128 chronic dialysis patients. In terms of safety, when hyperkalemia was defined as serum potassium level ≥5.5 mmol/L, low-dose MRAs were significantly associated with hyperkalemia (relative risk [RR] 1.76, 95% confidence intervals [CI] 1.07-2.89, P = .02); however, when hyperkalemia was defined as serum potassium level ≥6.0 mmol/L or serum potassium level ≥6.5 mmol/L, no significant association was observed between low-dose MRAs and hyperkalemia (RR 1.40, 95% CI 0.83-2.37, P = .20; RR 1.98, 95% CI 0.91-4.30, P = .09, respectively). Use of low-dose MRAs can reduce cardiovascular mortality by 54% compared with the control group (0.46, 95% CI 0.28-0.76, P = .003). Similarly, the RR of all-cause mortality for the low-dose MRAs group was 0.48 (95% CI 0.33-0.72, P = .0003). CONCLUSION: Low-dose MRAs may benefit dialysis patients without significantly increasing moderate to severe hyperkalemia.


Asunto(s)
Antagonistas de Receptores de Mineralocorticoides/administración & dosificación , Diálisis Renal/métodos , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/prevención & control , Humanos , Hiperpotasemia/inducido químicamente , Antagonistas de Receptores de Mineralocorticoides/efectos adversos , Antagonistas de Receptores de Mineralocorticoides/farmacología , Ensayos Clínicos Controlados Aleatorios como Asunto , Insuficiencia Renal Crónica/terapia
10.
BMC Med Inform Decis Mak ; 21(1): 34, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33522934

RESUMEN

BACKGROUND AND OBJECTIVES: Internet-based technologies play an increasingly important role in the management and outcome of patients with chronic kidney disease (CKD). The healthcare system is currently flooded with digital innovations and internet-based technologies as a consequence of the coronavirus disease 2019 (COVID-19) pandemic. However, information about the attitude of German CKD-patients with access to online tools towards the use of remote, internet-based interactions such as video conferencing, email, electronic medical records and apps in general and for health issues in particular, are missing. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: To address the use, habits and willingness of CKD patients in handling internet-based technologies we conducted a nationwide cross-sectional questionnaire survey in adults with CKD. RESULTS: We used 380 questionnaires from adult CKD patients (47.6% on dialysis, 43.7% transplanted and 8.7% CKD before renal replacement therapy) for analysis. Of these 18.9% denied using the internet at all (nonusers). Nonusers were significantly older (74.4 years, SD 11.4) than users (54.5 years, SD 14.5, p < 0.001), had a lower educational level than users (≥ 12 years: 6.9% versus 47.1%, p < 0.001) and were more often on dialysis. Within the group of internet users only a minority (2.6%) was using video conferencing with their physician, only 11.7% stated that they were using email to report symptoms and 26.6% were using the internet to schedule appointments. Slightly more than one-third of internet users (35.1%) are concerned that their personal medical data are not safe when submitted via the internet. CONCLUSIONS: Within our group of German CKD-patients we found that almost one out of five patients, especially older patients and patients with a lower educational level, did not use the internet at all. The majority of internet users reported in our survey that they have not used internet-based technologies within a medical context so far, but are willing to consider it. Therefore, it seems to be important to introduce and teach motivated CKD-patients the use and benefits of simple and safe internet-based health care technologies.


Asunto(s)
Prioridad del Paciente , Insuficiencia Renal Crónica , Telemedicina , Adolescente , Adulto , Anciano , Estudios Transversales , Femenino , Alemania/epidemiología , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Prioridad del Paciente/estadística & datos numéricos , Insuficiencia Renal Crónica/terapia , Telemedicina/estadística & datos numéricos , Adulto Joven
11.
J Med Case Rep ; 15(1): 95, 2021 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-33627186

RESUMEN

BACKGROUND: We report a high-risk case of a coronavirus disease 19 (COVID-19)-positive patient with comorbidities including diabetes mellitus (DM), hypertension (HTN), hypothyroidism and chronic kidney disease (CKD), treated successfully using an integrative therapy plan based on Ayurveda and Yoga, along with government-mandated compulsory modern western medicine (MWM) treatment. Recently, some evidence has been emerging on the use of Ayurveda for treatment of COVID-19. The classical texts of Ayurvedic medicine such as Charaka Samhita and Sushruta Samhita contain descriptions of pandemics of similar proportions and describe them as Janapadoddhvansa, meaning the destruction of communities, along with their causes and treatment. CASE PRESENTATION: The case reported herein is a 55-year-old man from Delhi, India, with confirmed (tested) COVID-19, who first took MWM for 7 days before seeking integrative therapy. The patient has comorbidities including DM, HTN, hypothyroidism and CKD and had developed symptoms including fever (which was resolved by the time integrative therapy was started), sore throat, dry cough, body aches, weakness, bad taste and smell, and heaviness in the abdomen. Based on the patient's symptoms and comorbidities, a treatment plan including Ayurvedic medicines, Yoga protocol, dietary recommendations and lifestyle modifications was prescribed by a registered Ayurveda doctor and a Yoga consultant. The patient started experiencing improvement in all the symptoms within 2 days after starting the treatment; he reported approximately [Formula: see text] relief from the symptoms after 5 days, and almost complete relief within 9 days. Also, the blood sugar levels (both fasting blood sugar [FBS] and postprandial blood sugar [PPBS]) exhibited significant improvement after 5 days, and decreased to within the normal range within 12 days. Besides relief in symptoms, the patient's real-time reverse transcription polymerase chain reaction (RT-PCR) test done on the 19th day returned negative results. CONCLUSIONS: Integrative therapy was found to be effective in mitigating the symptoms of COVID-19 in this patient with multiple comorbidities. Moreover, a significant improvement in blood sugar levels (not under control with modern medicine) was also achieved. Integrative therapy based on the classical texts of Ayurveda and Yoga may offer a promising and scalable treatment option for COVID-19 patients. A case series or a suitably designed randomized controlled trial is needed to assess its efficacy.


Asunto(s)
/terapia , Medicina Integral/métodos , Medicina Ayurvédica/métodos , Yoga , /complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/terapia , Humanos , Hipertensión/complicaciones , Hipertensión/terapia , Hipotiroidismo/complicaciones , Hipotiroidismo/terapia , Masculino , Persona de Mediana Edad , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/terapia , Resultado del Tratamiento
12.
Rev Infirm ; 70(268): 16-19, 2021 Feb.
Artículo en Francés | MEDLINE | ID: mdl-33608088

RESUMEN

Chronic kidney disease affects approximately 3 million people in France. The number of patients suffering from chronic kidney failure treated by dialysis or transplantation, which stood at around 90,000 at the end of 2018, is increasing constantly. In recent years, there have been improvements in the current management of this pathology and a reform in the financing of follow-up care.


Asunto(s)
Insuficiencia Renal Crónica , Francia , Humanos , Insuficiencia Renal Crónica/terapia
13.
High Blood Press Cardiovasc Prev ; 28(2): 159-165, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33548022

RESUMEN

INTRODUCTION: It is unclear whether the increased risk associated with diabetes in patients on dialysis is due to diabetes or a consequence of associated cardiovascular disease (CVD). AIM: The purpose of this work was to answer the question: do diabetes and CVD have a similar impact on the incidence of cardiovascular events in patients undergoing maintenance hemodialysis? METHODS: A prespecified protocol was used to prospectively evaluate and follow up 310 diabetic patients on hemodialysis without clinical evidence of CVD and 395 nondiabetic patients with CVD. Endpoint was the incidence of composite CV events and coronary events. RESULTS: The incidence of composite CV events (log-rank = 0.540) and coronary events (log-rank = 0.400) did not differ between groups. Because of the potential influence of occult CVD in patients with diabetes, we repeated the analysis excluding subjects with altered ejection fraction, a myocardial perfusion scan defect, and coronary artery disease in the group of patients with diabetes. Again we found no difference between groups (log-rank = 0.657). CONCLUSION: In patients on hemodialysis, diabetes and CVD carry similar risks for CV events. These results are congruent with the diabetes mellitus-CVD equivalence risk concept reported in the general population.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus/epidemiología , Diálisis Renal , Insuficiencia Renal Crónica/terapia , Anciano , Enfermedades Cardiovasculares/diagnóstico , Diabetes Mellitus/diagnóstico , Femenino , Humanos , Incidencia , Italia , Masculino , Persona de Mediana Edad , Pronóstico , Diálisis Renal/efectos adversos , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/epidemiología , Estudios Retrospectivos , Medición de Riesgo
14.
Cochrane Database Syst Rev ; 2: CD013109, 2021 02 15.
Artículo en Inglés | MEDLINE | ID: mdl-33586138

RESUMEN

BACKGROUND: People with chronic kidney disease (CKD) requiring dialysis are at a particularly high risk of cardiovascular death and morbidity. Several clinical studies suggested that aldosterone antagonists would be a promising treatment option for people undergoing dialysis. However, the clinical efficacy and potential harm of aldosterone antagonists for people with CKD on dialysis has yet to be determined. OBJECTIVES: This review aimed to evaluate the benefits and harms of aldosterone antagonists, both non-selective (spironolactone) and selective (eplerenone), in comparison to control (placebo or standard care) in people with CKD requiring haemodialysis (HD) or peritoneal dialysis (PD). SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 5 August 2020 using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA: We included parallel randomised controlled trials (RCTs), cross-over RCTs, and quasi-RCTs (where group allocation is by a method that is not truly random, such as alternation, assignment based on alternate medical records, date of birth, case record number, or other predictable methods) that compared aldosterone antagonists with placebo or standard care in people with CKD requiring dialysis. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias for included studies. We used a random-effects model meta-analysis to perform a quantitative synthesis of the data. We used the I² statistic to measure heterogeneity among the studies in each analysis. We indicated summary estimates as a risk ratio (RR) for dichotomous outcomes, mean difference (MD) for continuous outcomes, or standardised mean differences (SMD) if different scales were used, with their 95% confidence interval (CI). We assessed the certainty of the evidence for each of the main outcomes using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach. MAIN RESULTS: We included 16 studies (14 parallel RCTs and two cross-over RCTs) involving a total of 1446 participants. Thirteen studies compared spironolactone to placebo or standard care and one study compared eplerenone to a placebo. Most included studies had an unclear or high risk of bias. Compared to control, aldosterone antagonists probably reduced the risk of death (any cause) for people with CKD requiring dialysis (9 studies, 1119 participants: RR 0.45, 95% CI 0.30 to 0.67; I² = 0%; moderate certainty of evidence). Aldosterone antagonist probably decreased the risk of death due to cardiovascular disease (6 studies, 908 participants: RR 0.37, 95% CI 0.22 to 0.64; I² = 0%; moderate certainty of evidence) and cardiovascular and cerebrovascular morbidity (3 studies, 328 participants: RR 0.38, 95% CI 0.18 to 0.76; I² = 0%; moderate certainty of evidence). While aldosterone antagonists probably increased risk of gynaecomastia compared with control (4 studies, 768 participants: RR 5.95, 95% CI 1.93 to 18.3; I² = 0%; moderate certainty of evidence), aldosterone antagonists may make little or no difference to the risk of hyperkalaemia (9 studies, 981 participants: RR 1.41, 95% CI 0.72 to 2.78; I² = 47%; low certainty of evidence). Aldosterone antagonists had a marginal effect on left ventricular mass among participants undergoing dialysis (8 studies, 633 participants: SMD -0.42, 95% CI -0.78 to 0.05; I² = 77%). In people with CKD requiring dialysis received aldosterone antagonists compared to control, there were 72 fewer deaths from all causes per 1000 participants (95% CI 47 to 98) with a number needed to treat for an additional beneficial outcome (NNTB) of 14 (95% CI 10 to 21) and for gynaecomastia were 26 events per 1000 participants (95% CI 15 to 39) with a number need to treat for an additional harmful outcome (NNTH) of 38 (95% CI 26 to 68). AUTHORS' CONCLUSIONS: Based on moderate certainty of the evidence, aldosterone antagonists probably reduces the risk of all-cause and cardiovascular death and probably reduces morbidity due to cardiovascular and cerebrovascular disease in people with CKD requiring dialysis. For the adverse effect of gynaecomastia, the risk was increased compared to control. For this outcome, the absolute risk was lower than the absolute risk of death. It is hoped the three large ongoing studies will provide better certainty of evidence.


Asunto(s)
Antagonistas de Receptores de Mineralocorticoides/uso terapéutico , Diálisis Renal , Insuficiencia Renal Crónica/terapia , Sesgo , Enfermedades Cardiovasculares/inducido químicamente , Causas de Muerte , Trastornos Cerebrovasculares/inducido químicamente , Eplerenona/efectos adversos , Eplerenona/uso terapéutico , Ginecomastia/inducido químicamente , Humanos , Hiperpotasemia/inducido químicamente , Antagonistas de Receptores de Mineralocorticoides/efectos adversos , Placebos/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Insuficiencia Renal Crónica/mortalidad , Espironolactona/efectos adversos , Espironolactona/uso terapéutico
16.
Rev Med Suisse ; 17(727): 389-393, 2021 Feb 24.
Artículo en Francés | MEDLINE | ID: mdl-33625804

RESUMEN

Patients with chronic nephropathies were particularly affected during the COVID-19 pandemic. These patients suffer from multiple comorbidities and some specific treatments may put them at risk towards severe complications. Hemodialysis patients necessitating an in-center hemodialysis maintenance regimen were unable to be confined and despite strict prevention protocols suffered high infection and subsequently fatality rates. Renal transplant patients, because of their immunosuppressive drugs, also represent an at-risk population of acquiring the SARS-CoV-2.


Asunto(s)
Fallo Renal Crónico , Insuficiencia Renal Crónica , Humanos , Pandemias , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/terapia
17.
Am J Chin Med ; 49(2): 237-268, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33622213

RESUMEN

Intestinal flora is essential for maintaining host health and plays a unique role in transforming Traditional Chinese Medicine (TCM). TCM, as a bodyguard, has saved countless lives and maintained human health in the long history, especially in this COVID-19 pandemic. Pains of diseases have been removed from the effective TCM therapy, such as TCM preparation, moxibustion, and acupuncture. With the development of life science and technology, the wisdom and foresight of TCM has been more displayed. Furthermore, TCM has been also inherited and developed in innovation to better realize the modernization and globalization. Nowadays, intestinal flora transforming TCM and TCM targeted intestinal flora treating diseases have been important findings in life science. More and more TCM researches showed the significance of intestinal flora. Intestinal flora is also a way to study TCM to elucidate the profound theory of TCM. Processing, compatibility, and properties of TCM are well demonstrated by intestinal flora. Thus, it is no doubt that intestinal flora is a core in TCM study. The interaction between intestinal flora and TCM is so crucial for host health. Therefore, it is necessary to sum up the latest results in time. This paper systematically depicted the profile of TCM and the importance of intestinal flora in host. What is more, we comprehensively summarized and discussed the latest progress of the interplay between TCM and intestinal flora to better reveal the core connotation of TCM.


Asunto(s)
Medicamentos Herbarios Chinos/uso terapéutico , Disbiosis/microbiología , Microbioma Gastrointestinal , Medicina China Tradicional , Enfermedades Autoinmunes/microbiología , Enfermedades Autoinmunes/terapia , Enfermedades Cardiovasculares/microbiología , Enfermedades Cardiovasculares/terapia , Diabetes Mellitus/microbiología , Diabetes Mellitus/terapia , Electroacupuntura , Enfermedades Gastrointestinales/microbiología , Enfermedades Gastrointestinales/terapia , Humanos , Enfermedades Metabólicas/microbiología , Enfermedades Metabólicas/terapia , Neoplasias/microbiología , Neoplasias/terapia , Enfermedad del Hígado Graso no Alcohólico/microbiología , Enfermedad del Hígado Graso no Alcohólico/terapia , Obesidad/microbiología , Obesidad/terapia , Insuficiencia Renal Crónica/microbiología , Insuficiencia Renal Crónica/terapia
18.
Vasc Health Risk Manag ; 17: 1-11, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33442257

RESUMEN

In the general population, the prevalence of moderate and severe chronic kidney disease (CKD) is usually below 5% but this figure is often higher in specific groups of patients such as those with type 2 diabetes. Patients with advanced CKD (CKD stage 3b and 4) are at high or very high cardiovascular risk, and their risk of progressing towards end-stage kidney disease (CKD stage 5) and the need of renal replacement therapy are elevated. Hypertension is a major cause of poor cardiovascular and renal outcomes in severe CKD. Therefore, an adequate control of blood pressure (BP) is mandatory. However, normalizing BP is often challenging in these patients because the clinical management of hypertension in advanced CKD is not well defined and rarely supported by large randomized controlled trials. In the present review, we discuss the characteristics of hypertension in advanced CKD, excluding dialysis, and its management integrating data from recent clinical studies and a pragmatic approach enriched by a long-standing clinical experience.


Asunto(s)
Antihipertensivos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Dieta Saludable , Dieta Hiposódica , Tasa de Filtración Glomerular/efectos de los fármacos , Hipertensión/terapia , Fallo Renal Crónico/prevención & control , Riñón/efectos de los fármacos , Insuficiencia Renal Crónica/terapia , Antihipertensivos/efectos adversos , Humanos , Hipertensión/epidemiología , Hipertensión/fisiopatología , Riñón/fisiopatología , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/fisiopatología , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/fisiopatología , Resultado del Tratamiento
19.
Cochrane Database Syst Rev ; 1: CD012899, 2021 01 27.
Artículo en Inglés | MEDLINE | ID: mdl-33501650

RESUMEN

BACKGROUND: Patients with chronic kidney disease (CKD) who require urgent initiation of dialysis but without having a permanent dialysis access have traditionally commenced haemodialysis (HD) using a central venous catheter (CVC). However, several studies have reported that urgent initiation of peritoneal dialysis (PD) is a viable alternative option for such patients. OBJECTIVES: This review aimed to examine the benefits and harms of urgent-start PD compared to HD initiated using a CVC in adults and children with CKD requiring long-term kidney replacement therapy. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 25 May 2020 for randomised controlled trials through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. For non-randomised controlled trials, MEDLINE (OVID) (1946 to 11 February 2020) and EMBASE (OVID) (1980 to 11 February 2020) were searched. SELECTION CRITERIA: All randomised controlled trials (RCTs), quasi-RCTs and non-RCTs comparing urgent-start PD to HD initiated using a CVC. DATA COLLECTION AND ANALYSIS: Two authors extracted data and assessed the quality of studies independently. Additional information was obtained from the primary investigators. The estimates of effect were analysed using random-effects model and results were presented as risk ratios (RR) with 95% confidence intervals (CI). The GRADE framework was used to make judgments regarding certainty of the evidence for each outcome. MAIN RESULTS: Overall, seven observational studies (991 participants) were included: three prospective cohort studies and four retrospective cohort studies. All the outcomes except one (bacteraemia) were graded as very low certainty of evidence given that all included studies were observational studies and few events resulting in imprecision, and inconsistent findings. Urgent-start PD may reduce the incidence of catheter-related bacteraemia compared with HD initiated with a CVC (2 studies, 301 participants: RR 0.13, 95% CI 0.04 to 0.41; I2 = 0%; low certainty evidence), which translated into 131 fewer bacteraemia episodes per 1000 (95% CI 89 to 145 fewer). Urgent-start PD has uncertain effects on peritonitis risk (2 studies, 301 participants: RR 1.78, 95% CI 0.23 to 13.62; I2 = 0%; very low certainty evidence), exit-site/tunnel infection (1 study, 419 participants: RR 3.99, 95% CI 1.2 to 12.05; very low certainty evidence), exit-site bleeding (1 study, 178 participants: RR 0.12, 95% CI 0.01 to 2.33; very low certainty evidence), catheter malfunction (2 studies; 597 participants: RR 0.26, 95% CI: 0.07 to 0.91; I2 = 66%; very low certainty evidence), catheter re-adjustment (2 studies, 225 participants: RR: 0.13; 95% CI 0.00 to 18.61; I2 = 92%; very low certainty evidence), technique survival (1 study, 123 participants: RR: 1.18, 95% CI 0.87 to 1.61; very low certainty evidence), or patient survival (5 studies, 820 participants; RR 0.68, 95% CI 0.44 to 1.07; I2 = 0%; very low certainty evidence) compared with HD initiated using a CVC. Two studies using different methods of measurements for hospitalisation reported that hospitalisation was similar although one study reported higher hospitalisation rates in HD initiated using a catheter compared with urgent-start PD. AUTHORS' CONCLUSIONS: Compared with HD initiated using a CVC, urgent-start PD may reduce the risk of bacteraemia and had uncertain effects on other complications of dialysis and technique and patient survival. In summary, there are very few studies directly comparing the outcomes of urgent-start PD and HD initiated using a CVC for patients with CKD who need to commence dialysis urgently. This evidence gap needs to be addressed in future studies.


Asunto(s)
Catéteres Venosos Centrales , Tratamiento de Urgencia/métodos , Diálisis Renal/métodos , Insuficiencia Renal Crónica/terapia , Tiempo de Tratamiento , Bacteriemia/epidemiología , Bacteriemia/prevención & control , Sesgo , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/prevención & control , Tratamiento de Urgencia/efectos adversos , Tratamiento de Urgencia/instrumentación , Tratamiento de Urgencia/mortalidad , Hospitalización/estadística & datos numéricos , Humanos , Estudios Observacionales como Asunto/estadística & datos numéricos , Diálisis Peritoneal/efectos adversos , Diálisis Peritoneal/instrumentación , Diálisis Peritoneal/métodos , Diálisis Peritoneal/mortalidad , Peritonitis/epidemiología , Diálisis Renal/efectos adversos , Diálisis Renal/instrumentación , Diálisis Renal/mortalidad , Insuficiencia Renal Crónica/mortalidad
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