Adherence to Chronic Kidney Disease Screening Guidelines Among Patients With Type 2 Diabetes in a US Administrative Claims Database

ObjectiveTo examine the screening rates for kidney damage and function among patients with type 2 diabetes (T2D) and chronic kidney disease stage at diabetes diagnosis using a US administrative claims database.Patients and MethodsThis cohort study used a claims database enriched with laboratory results data. Patients with T2D (defined as 1 inpatient or 2 outpatient claims for diabetes), aged 18 years or older, and with at least 1 year of follow-up enrollment were identified. Patients with type 1 diabetes, kidney disease, or other related conditions at baseline were excluded. We estimated screening rates using laboratory orders for serum creatinine and estimated glomerular filtration rate (eGFR) measurement and urine albumin to creatinine ratio (UACR). Chronic kidney disease severity was reported using the Kidney Disease: Improving Global Outcomes classification based on laboratory results.ResultsA total of 1,881,447 patients with T2D were eligible for analysis. Mean ± SD age was 63.1±13.1 years; 947,150 patients (50.3%) were male. Serum creatinine tests were ordered within 14 days of the index date among 290,722 patients of 622,915 (46.7%) patients with newly-recognized T2D. Overall, 1,595,964 patients (84.8%) had at least one serum creatinine test ordered during the 1-year follow-up period. Fewer patients received a UACR test during follow-up (814,897 [43.3%]). Less than half of all patients with T2D received a laboratory test order for both serum creatinine and urine albumin measurements during the follow-up period.ConclusionPhysicians treating patients with diabetes are selectively adhering to chronic kidney disease screening guidelines, as indicated by high rates of eGFR testing, but less frequent UACR testing. Despite recommendations to monitor both eGFR and UACR, less than half of patients were screened for albuminuria during the 1-year follow-up.     

Mechanical Hemolysis Complicating Transcatheter Interventions for Valvular Heart Disease: JACC State-of-the-Art Review

Mechanical intravascular hemolysis is frequently observed following procedures on heart valves and uncommonly observed in native valvular disease. In most cases, its severity is mild. Nevertheless, it can be clinically significant and even life threatening, requiring multiple blood transfusions and renal replacement therapy. This paper reviews the current knowledge on mechanical intravascular hemolysis in valvular disease, before and after correction, focusing on pathophysiology, approach to diagnosis, and impact of other hematological conditions on the resultant anemia. The importance of a multidisciplinary management is underscored. Laboratory data are provided about subclinical hemolysis that is commonly observed following the implantation of surgical and transcatheter valve prostheses and devices. Finally, clinical scenarios are reviewed and current medical and surgical treatments are discussed, including alternative options for inoperable patients.     

左卡尼汀联合重组人促红素注射液治疗规律透析慢性肾功能衰竭合并贫血患者的临床效果

目的探究左卡尼汀联合重组人促红素注射液治疗规律透析慢性肾功能衰竭合并贫血患者的临床效果。方法选择2017年1月至2020年1月收治的100例规律透析慢性肾功能衰竭合并贫血患者,以计算机随机化法将其分为对照组和试验组,每组50例。对照组给予重组人促红素注射液治疗,试验组给予左卡尼汀与重组人促红素注射液联合治疗。比较两组患者的治疗效果。结果试验组的治疗总有效率为96.00%,高于对照组的80.00%(P<0.05);治疗后,两组患者的MCHC、MCH、MCV、SF、Hb、RBC水平均高于治疗前,且试验组高于对照组(P<0.05);两组患者的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论规律透析慢性肾功能衰竭合并贫血患者接受左卡尼汀与重组人促红素注射液联合治疗,可获得较好的效果,改善贫血相关生化指标水平,且不良反应发生率低,安全有效。     

慢性阻塞性肺疾病合并侵袭性肺曲霉菌病的临床分析

目的探析慢性阻塞性肺疾病合并侵袭性肺曲霉菌病患者的临床特点。方法对医院2018年2月—2019年12月间收治的慢性阻塞性肺疾病合并侵袭性肺曲霉菌病患者24例相关临床数据进行回顾性分析,归纳此类患者的临床特点,以期为以后收治此类患者在诊疗上提供可参考数据。结果慢性阻塞性肺疾病合并侵袭性肺曲霉菌病患者典型临床症状为肺部罗音、呼吸障碍、胸痛、咳嗽咳痰、发热。影像学检查后典型表现为肺部炎性渗出、空洞、结节、实变。经过积极治疗后有8例患者判定为治疗有效。结论收治慢性阻塞性肺疾病合并侵袭性肺曲霉菌病患者应该做到早期阶段准确诊断,积极治疗,是保障预后的重点。