慢性肾脏病（CKD）现状、争议与研究前景

慢性肾脏病（Chronic Kidney Disease,CKD）及分期于2002年在美国肾脏病基金会（NKF）组织撰写的肾脏病／透析的临床实践指南（KDOQI）（AJKD,2002,39：51～226）中正式提出,并于2004年、     

高尿酸血症与老年慢性肾脏病(CKD)患者肾功能的相关性

目的 探索高尿酸血症与老年慢性肾脏病(CKD)患者肾功能的相关性。方法 研究以东莞常安医院收治的106例老年慢性肾脏病患者为研究对象,患者于2015年10月-2019年10月时间段入院,按照患者尿酸值将患者划分两组,血尿酸高(≥420μmol/L)患者划分为观察组(53例),血尿酸低(<420μmol/L)患者划分为对照组(53例),观察两组患者血压指标与相关的临床症状指标。结果 观察组患者血压指标(舒张压、收缩压)相比对照组差异较为明显,存在对比价值(P<0.05)。两组患者糖化血红蛋白指标无对比意义(P>0.05)。观察组患者三酰甘油、总胆固醇指标相比对照组差异较大,有统计学意义(P<0.05)。两组患者血红蛋白、尿蛋白指标差异无统计学意义(P>0.05);观察组患者白蛋白、白细胞、血肌酐指标相比对照组差异显著,有统计学意义(P<0.05)。观察组患者eGFR、BMI指标差异明显,存在统计学意义(P<0.05)。结论 CKD患者肾功能与尿酸存在明显的关联性,二者存在负相关,伴高尿酸血症是临床CKD患者预后不良的常见独立危险因素。     

昆明市铁路职工慢性肾脏病流行病学分析

目的研究云南省昆明市铁路系统职工慢性肾脏病(CKD)的患病情况及相关危险因素。方法在昆明市铁路系统职工中采用分层整群抽样方法,共抽取1 204人,进行CKD及相关危险因素问卷调查、体格检查和血尿检测。结果在资料完整的1 103人中,经过人口年龄、性别构成比校正后,白蛋白尿患病率为6.94%;血尿患病率为7.56%;肾功能下降患病率为1.83%,CKD患病率为14.61%;多因素Logistic回归分析结果显示,高血压、糖尿病、高脂血症、高尿酸血症、年龄和性别是白蛋白尿的独立危险因素;高血压、高尿酸血症、性别和年龄是肾功能下降的独立危险因素;性别是血尿的独立危险因素。结论昆明市铁路系统职工CKD的患病情况与中国其他大城市及发达国家基本相似。     

慢性肾脏病与性别差异的相关性分析

慢性肾脏病已成为全球性疾病,是世界前20大死因之一,其给患者及卫生部门均带来了沉重的负担。目前已有资料证明很多疾病存在性别差异,在肾脏健康的各个方面也存在着性别差异。本文将从流行病学、危险因素、转归三个角度分析慢性肾脏病的性别差异。     

慢性肾脏病的流行病学研究进展

慢性肾脏疾病(CRD)已成为全球范围严重影响人类健康的主要疾病之一,具有患病率高、知晓率低、治疗费用高、以及死亡率高等特点.近年来,国内外已经进行了较大规模的CKD筛查和流行病学研究,在CKD的发病率、检测方法及危险因素等方面有了更深刻的认识.本文对CKD的定义和分期、发病率、检测方法、危险因素及病因等方面的研究进展进行综述,指导并服务于临床医疗工作.     

单县老年人群慢性肾脏病流行病学调查

目的 调查老年体检人群慢性肾脏病流行病学特点并探讨患病影响因素,为老年人群防治慢性肾脏病提供参考依据。方法 以2019年5月至2020年10月于山东省单县某医院进行健康体检的≥60岁人群作为研究对象进行问卷调查及肾功能筛查,从体检报告管理系统中提取相关血生化检测结果,对尿常规及尿沉渣、血肌酐检查存在异常者进行跟踪随访,3个月后完成相关指标的复查判断是否为慢性肾脏病。采用描述流行病学分析方法对单县老年体检人群慢性肾脏病患病 情况进行分析,并采用单、多因素分析方法对该人群慢性肾病患病影响因素进行分析。结果 纳入研究5 482名≥60岁体检人群,检出慢性肾脏病569例,患病率为10.4%,检出蛋白尿178例（31.3%）、血尿437例（76.8%）、肾功能下降392例（68.9%）,其中CKD 1期126例（22.1%）、CKD 2期249例（43.8%）、CKD 3期188例（33.0%）、CKD 4期6例（1.1%）。多因素Logistic回归分析显示女性（OR=1.960）、年龄70~79岁（OR=1.420）、糖尿病（OR=1.536）、高血压（OR=1.618）、高脂血症（OR=2.504）、高尿酸血症（OR=3.108）是老年体检人群慢性肾脏病患病的危险因素。结论 单县≥60岁体检人群慢性肾脏病患病率较高,了解并掌握老年人群慢性肾脏病流行特点及患病影响因素,针对性采取有效的防治措施,有利于减少慢性肾脏病发生、延缓疾病发展。     

宁波市成年人群的慢性肾脏病流行病学调查

目的了解宁波市成人慢性肾脏病(CKD)患病率及相关危险因素。方法采用多阶段分层整群随机抽样法随机抽取宁波市18岁以上常住居民2 296人,进行CKD及相关危险因素的问卷调查、体格检查及实验室检查。经人口年龄、性别校正后计算CKD患病率,分别采用t检验及χ2检验进行计量及计数数据比较,采用logistic回归分析CKD相关危险因素。结果本次调查有效样本2 110例,经人口年龄、性别校正后,CKD总患病率9.81%,主要集中在CKD早期(82.87%),知晓率11.11%。CKD患病与年龄呈正相关(r=0.254,P=0.000);且女性的CKD患病率显著高于男性(χ2=22.618,P=0.000)。多因素logistic回归结果显示,年龄、女性、糖尿病、高尿酸血症和高血压是CKD的独立危险因素。高脂血症与体质指数与CKD的发生无关。结论宁波市成人CKD总患病率9.81%,知晓率11.11%。年龄、女性、糖尿病、高尿酸血症和高血压是CKD的独立危险因素。     

慢性肾脏病管理发展现状分析和探讨

了解国内各医疗机构对慢性肾脏病采取的管理措施和治疗手段以及总结的经验。     

小心慢性肾脏病来偷袭

长久以来，医学界一直以为肾脏病的发病率不到1％，但就在最近,美国大规模的调查发现，竟然有8％～10％的人存在肾脏病问题。平均每10个人中,就有一个肾脏病人。同样,在江苏省人民医院均体检中心，近几年也发现临床有8.5％的人存在肾脏病问题。     

慢性肾脏病患者的铝中毒

慢性肾脏病患者铝的排泌异常常导致铝在体内的蓄积,透析液中的铝可通过透析膜直接进入人体造成透析患者体内铝的蓄积,均可表现为铝中毒的各种综合征。由于铝具有极大的破坏性并且铝中毒治疗困难,临床上很有必要及时发现并预防各种类型的铝中毒综合征。就慢性肾脏病患者的铝中毒作一简述。     

Chronic kidney disease and socio-economic status: a cross sectional study

ABSTRACT

Objective: This cross-sectional study investigated the relationship between individual-level markers of disadvantage, renal function and cardio-metabolic risk within an Indigenous population characterised by a heavy burden of chronic kidney disease and disadvantage.

Design: Using data from 20 Indigenous communities across Australia, an aggregate socio-economic status (SES) score was created from individual-level socio-economic variables reported by participants. Logistic regression was used to assess the association of individual-level socio-economic variables and the SES score with kidney function (an estimated glomerular function rate (eGFR) cut-point of <60?ml/min/1.73?m²) as well as clinical indicators of cardio-metabolic risk.

Results: The combination of lower education and unemployment was associated with poorer kidney function and higher cardio-metabolic risk factors. Regression models adjusted for age and gender showed that an eGFR?<?60?ml/min/1.73?m² was associated with a low socio-economic score (lowest vs. highest 3.24 [95% CI 1.43–6.97]), remote living (remote vs. highly to moderately accessible 3.24 [95% CI 1.28–8.23]), renting (renting vs. owning/being purchased 5.76[95% CI 1.91–17.33]), unemployment (unemployed vs employed 2.85 [95% CI 1.31–6.19]) and receiving welfare (welfare vs. salary 2.49 [95% CI 1.42–4.37]). A higher aggregate socio-economic score was inversely associated with an eGFR?<?60?ml/min/1.73?m² (0.75 [95% CI 063–0.89]).

Conclusion: This study extends upon our understanding of associations between area-level markers of disadvantage and burden of end stage kidney disease amongst Indigenous populations to a detailed analysis of a range of well-characterised individual-level factors such as overall low socio-economic status, remote living, renting, unemployment and welfare. With the increasing burden of end-stage kidney disease amongst Indigenous people, the underlying socio-economic conditions and social and cultural determinants of health need to be understood at an individual as well as community-level, to develop, implement, target and sustain interventions.     

Chronic kidney disease in adolescents

Chronic kidney disease (CKD) involves a fixed deficit or progressive deterioration in kidney function, producing variable losses of normal physiologic functions. In adolescents, CKD results from a wide range of causes. Because of the broad spectrum of disease, the physician providing primary care to the adolescent must be knowledgeable about findings leading to the diagnosis of CKD and must understand the physiologic basis for therapeutic management. Complications of normal renal function loss include issues of fluid, electrolyte, and acid-base balance, as well as development of anemia, cardiovascular disease, metabolic bone disease, and growth failure. Goals of therapy include anticipation and replacement of lost physiologic functions so that the adolescent can grow and develop normally.     

The accumulation of healthy lifestyle behaviors prevents the incidence of chronic kidney disease (CKD) in middle-aged and older males

Aim

This study was retrospectively designed to evaluate the influence of healthy lifestyle behaviors on the incidence of chronic kidney disease (CKD) during a 5-year follow-up period in middle-aged and older males.

Methods

The subjects included 252 males without a history of cardiovascular disease, stroke, renal dysfunction and/or dialysis treatment who were not taking any medications. Their lifestyle behaviors were evaluated using a standardized self-administered questionnaire and defined as follows: (1) habitual moderate exercise, (2) daily physical activity, (3) fast walking speed, (4) slow eating speed, (5) no late-night dinner, (6) no bedtime snacking and (7) no skipping breakfast. The participants were divided into four categories, which were classified into quartile distributions according to the number of healthy lifestyle behaviors (7–6, 5, 4 and ≤3 groups).

Results

After 5 years, the incidence of CKD [estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m² and/or proteinuria] was observed in 23 subjects (9.1 %). The Kaplan–Meier survival curves showed that the cumulative incidence of CKD significantly decreased according to an increase in the number of healthy lifestyle behaviors (log-rank test: p = 0.003). According to a multivariate analysis, habitual moderate exercise [hazard ratio (HR) 0.20, 95 % confidence of interval (CI) 0.06–0.69, p = 0.011] and no bedtime snacking (HR 0.19, 95 % CI 0.08–0.48, p = 0.004) were significantly associated with the incidence of CKD.

Conclusions

These results suggest that the accumulation of healthy lifestyle behaviors, especially those related to habitual moderate exercise and no bedtime snacking, is considered to be important to reduce the risk of CKD.

Electronic supplementary material

The online version of this article (doi:10.1007/s12199-016-0506-6) contains supplementary material, which is available to authorized users.     

Chronic kidney disease in primary care

It has been estimated that chronic kidney disease (CKD) affects about one in 200 of the population in the UK. There is an increased awareness of the need to identify patients in primary care with CKD at an earlier stage, so that treatments can be initiated to delay progression and prevent complications and appropriate nephrological referral can be made. In this article we will review how measures to identify patients with CKD can improve its management.     

我国公立医院法人治理——研究现状与未来展望

中国学术界和实务界对公立医院法人治理问题进行了较有价值的研究和探讨。文章从公立医院法人治理结构的界定、对其他国家和地区公立医院法人治理结构的研究、国内试点公立医院法人治理结构研究及建议等方面对中国相关研究文献进行了系统的梳理,指出了中国当前公立医院法人治理结构研究的问题,指出了有关研究应完善的方向。     

Expert opinion of nephrologists about the effectiveness of low-protein diet in different stages of chronic kidney disease (CKD)

No clinical trials have specifically explored the benefits of low-protein diet in patients with different stages of chronic kidney disease (CKD) 3B. In the absence of RCTs, expert opinion may be a valid surrogate to estimate treatment effectiveness. A questionnaire-based survey of a large sample of nephrologists from Southern Italy was conducted to explore benefits of low-protein diet (LPD) in delaying dialysis entry in different CKD stages. For the case vignettes describing eight different patient profiles with various CKD stages, nephrologists reported expected benefits as time delay of dialysis entry. Information was collected through questionnaires filled by 88 nephrologists from different Southern Italian hospitals. On average, nephrologists estimated the highest delay in starting dialysis due to LPD in stages 3B (15 months) and 3A (14 months), and the lowest for 5 stage (3 months). According to opinion of a large sample of Southern Italian nephrologists, low-protein diet may be more efficacious if started in CKD stage 3B than 4 and 5.     

Epidemiological research in rheumatology: current status and prospects]

Rheumatic diseases are very common and their consequences on both the individuals (leading cause of activity limitation between the age of the 18 and 64 years) and on society (socio-economic costs) are considerable. However, the epidemiology of these diseases remains poorly known. In this paper, a review of the epidemiological data for the most frequent rheumatic diseases (including recent advances) is followed by an analysis of the specific obstacles to epidemiological research in the rheumatology field and by a proposal of possible developments.     

Obesity and Other Nutrition Related Abnormalities in Pre-Dialysis Chronic Kidney Disease (CKD) Participants

Chronic kidney disease (CKD) is increasing in sub-Saharan Africa. Undernutrition has been prevalent amongst end stage CKD patients, with limited data on the prevalence of obesity. The aim of this study was to assess the nutritional status of CKD patients using various methods sensitive to over and under-nutrition. Stage 3 to 5 CKD patients (glomerular filtration rate (GFR) < 60 mL/min/1.73 m²) attending a pre-dialysis clinic in Cape Town, were enrolled. Exclusion criteria included infectious and autoimmune conditions. Sociodemographic, clinical and biochemical data were collected, and anthropometric measurements were performed. Dietary intake was measured with a quantified food frequency questionnaire (FFQ). Statistical Package for the Social Sciences (SPSS) version 26 was used for statistical analysis. Seventy participants, with mean age of 41.8 ± 11.8 years, 52.9% females and 47.1% males were enrolled. Participants enrolled mainly had stage 5 kidney failure. Thirty percent were overweight (21) and 25 (36%) were obese, 22 (60%) of females were overweight and obese, while 13 (39.4%) of males were predominantly normal weight. Abdominal obesity was found in 42 (60%) of participants, mainly in females. Undernutrition prevalence was low at 3%. Dietary assessment showed a high sugar and protein intake. There was a high prevalence of overweight, obesity and abdominal obesity in CKD stage 35 patients, with unhealthy dietary intake and other nutritional abnormalities.     

慢性肾脏病与甲状腺功能减退研究现状

在正常情况下，肾脏在不同类型甲状腺素(thyroxine)的代谢、降解和排泄过程中发挥着重要作用。慢性肾脏病(CKD)患者发生甲状腺功能减退(hypothyroidism)的风险增加，多数呈亚临床表现，以低T3综合征最为常见，表现为血浆游离三碘甲状腺素(FT3)和总三碘甲状腺素(TT3)水平降低，而反式三碘甲状腺素(rT3)、游离甲状腺素(T4)及促甲状腺素(TSH)水平通常正常。低T3综合征最初被认为是慢性疾病的一种适应性反应。目前研究结果显示，低T3综合征是判断CKD患者预后不良的重要指标，可能导致CKD患者肾功能减退，增加患者全因死亡率和心血管疾病发生风险。有关甲状腺素替代治疗，用于CKD合并甲状腺功能减退患者的治疗，迄今尚存在争议。笔者拟就CKD患者甲状腺功能减退风险增加的发生机制，甲状腺功能减退及甲状腺素替代治疗，对CKD患者预后作用的最新研究进展进行阐述。