Cardiovascular Disease (CVD) is the main complication and the most important cause of death in CKD patients. As the disease progresses, the incidence of cardiovascular disease in CKD patients gradually increases, especially in End-Stage Renal Disease (ESRD) patients receiving dialysis treatment, where the prevalence of cardiovascular disease reaches its highest level. Currently, there is a lack of a simple and reliable tool to assess the cardiac function status and predict the risk of cardiovascular events in patients on maintenance dialysis. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a widely used patient-reported outcomes measurement tool for assessing health-related quality of life in heart failure patients. It has been shown that KCCQ scores not only reflect the underlying undiagnosed symptoms of heart failure in CKD patients, but also have a strong correlation with prognosis. However, there is currently insufficient clinical evidence to confirm the value of the KCCQ in patients on maintenance dialysis.
Investigators will perform a prospective, single-center, observational study to collect the changing trend of KCCQ scores at baseline and during the observation periods in maintenance dialysis patients, to analyze the association between the scores and the occurrence of long-term cardiovascular events and all-cause mortality. The aim is to construct a predictive model of KCCQ scores to provide a reference basis for clinical management of this high-risk group, so as to optimize the diagnosis and treatment of heart failure in dialysis patients and improve their cardiovascular outcomes.

开始日期2024-07-01

申办/合作机构

深圳市第二人民医院

DRKS00033428 / RecruitingN/AIIT

Aging and dialysis: geriatric assessment in hemodialysis patients 65y and older - ALDIA

开始日期2024-05-03

申办/合作机构-

100 项与慢性肾病，V期相关的临床结果

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100 项与慢性肾病，V期相关的转化医学

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0 项与慢性肾病，V期相关的专利（医药）

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328

项与慢性肾病，V期相关的文献（医药）

2024-08-26·Cureus

Dialysis Disequilibrium Syndrome With Cerebral Edema in an Adult Patient Following the Initial Dialysis Session

Article

作者: Patel, Sahil M ; Murray, Kenny J ; Venkatesan, Varshini

Dialysis is a common treatment for removing toxins, electrolytes, and excess fluids due to impaired kidney function. A rare but life-threatening complication that can arise is dialysis disequilibrium syndrome (DDS) with cerebral edema. DDS is characterized by a range of neurological symptoms that may occur following dialysis. Its incidence is not well-established because it often presents with nonspecific symptoms, making diagnosis challenging. Here, we present a case of a 64-year-old female with a history of hypertension and chronic kidney disease stage 5, who sought evaluation for nausea and vomiting with coffee-ground emesis that began three weeks prior. Despite an initial blood transfusion stabilizing her hemoglobin with no further hematemesis, she developed DDS with cerebral edema after her first dialysis session. The condition was managed with 3% hypertonic saline, which quickly resolved both her cerebral edema and neurological symptoms. She tolerated subsequent dialysis sessions without complications and was discharged with a follow-up arranged with nephrology and an outpatient dialysis chair. This case report reviews the clinical features, risk factors, pathophysiology, management, and treatment goals for DDS. In patients commencing dialysis, particular attention should be given to preventing DDS, especially in those with elevated blood urea nitrogen levels above 100 mg/dL. Prompt recognition and treatment are crucial to balance the osmotic gradient and prevent severe outcomes, such as cerebral edema and death.

2024-08-01·Pediatric Nephrology

Idiopathic nephrotic syndrome in Syrian children: clinicopathological spectrum, treatment, and outcomes

Article

作者: Wannous, Hala

BACKGROUNDIdiopathic nephrotic syndrome (INS) is the most common glomerular disease in children. We performed this study to report histopathological findings, the correlation between clinical and histopathological features, and the response to steroids and other immunosuppressive drugs and outcomes in Syrian children with INS.METHODSA single-center retrospective observational cohort study was conducted at Children's University Hospital in Damascus, and included all patients aged 1-14 years, admitted from January 2013 to December 2022, with INS and who underwent kidney biopsy.RESULTSThe study included 109 patients, with a male/female ratio of 1.13:1, and a median age of 5 years with interquartile range (2.8-10). The main indication of kidney biopsy was steroid-resistant nephrotic syndrome (SRNS) (57.8%). The main histopathological patterns were minimal change disease (MCD) (45%) and focal segmental glomerulosclerosis (FSGS) (37.6%). FSGS was the most common histopathological pattern in SRNS (44.3%). In SRNS, we used calcineurin inhibitors to induce remission. Tacrolimus was used in 49 patients with response rate (complete remission of proteinuria) of 69.4% and cyclosporine in 20 patients with response rate of 50%. In steroid-dependent nephrotic syndrome (SDNS), we used mycophenolate mofetil (MMF) and cyclophosphamide to prevent relapses; MMF was used in 9 patients with response rate (maintaining sustained remission) of 89% and cyclophosphamide in 3 patients with response rate of 66.7%. Rituximab was used in four patients with FSGS, two SRNS patients and two SDNS patients, with sustained remission rate of 100%. Fifteen patients (13.7%) progressed to chronic kidney disease stage 5. Of them, 7 patients had FSGS and 8 patients had focal and global glomerulosclerosis;14 of them were steroid-resistant and one patient was steroid-dependent with persistent relapses. The most common outcome was sustained remission (47%) in MCD and frequent relapses (31.7%) in FSGS.CONCLUSIONSFSGS was the most common histopathological pattern in idiopathic SRNS and had the worst prognosis. Calcineurin inhibitors could be an effective therapy to induce complete remission in SRNS. Rituximab may be an effective treatment to achieve sustained remission in SDNS and frequently relapsing NS and may have a potential role in SRNS with further studies required.

2024-07-01·Hemodialysis International

Evaluation of hepatosteatosis and gallstone disease in patients with chronic kidney disease

Article

作者: Karahan, Doğu ; Şahin, İdris

AbstractIntroductionThe prevalence rates of hepatosteatosis and gallstones are increasing owing to the multifactorial causes of chronic kidney disease, and the prevalence may change with the availability of different forms of renal replacement therapy. We aimed to determine the incidence or prevalence rates of hepatosteatosis, cholelithiasis, and acute cholecystitis in patients with chronic kidney disease and compare them between renal replacement therapy modalities.MethodsA total of 270 patients (90 with chronic kidney disease stages III–V, 90 undergoing peritoneal dialysis, and 90 undergoing hemodialysis) were included and categorized into the pre‐dialysis, hemodialysis, and peritoneal dialysis groups. The patients were questioned about previous gallbladder surgeries and chronic diseases. The results of abdominal ultrasonography, tomography, and magnetic resonance imaging were retrospectively evaluated with respect to the findings on the hepatobiliary system. Hepatosteatosis and cholelithiasis were diagnosed by expert radiologists on the basis of abdominal ultrasonography, tomography, and magnetic resonance imaging findings. The prevalence rates of hepatosteatosis, cholelithiasis, and other liver findings were compared between the groups.FindingsHepatosteatosis and cholelithiasis were detected in 16.7% and 21.5% of the 270 cases, respectively. Hepatosteatosis was present in 17.8%, 25.6%, and 6.7% of patients in the pre‐dialysis, hemodialysis, and peritoneal dialysis groups, respectively. The prevalence of hepatosteatosis was significantly higher in patients undergoing hemodialysis than in patients undergoing peritoneal dialysis (p = 0.002). However, no statistically significant difference was found between the peritoneal dialysis and pre‐dialysis groups or between the hemodialysis and pre‐dialysis groups (p >0.05). The prevalence rates of cholelithiasis were 15.6%, 28.9%, and 20.0%, in the pre‐dialysis, hemodialysis, and peritoneal dialysis groups, respectively, and there were no statistically significant differences among the groups. The incidence of acute cholecystitis was significantly higher in the hemodialysis group than in the pre‐dialysis group (p = 0.006).DiscussionOur study showed that the hepatobiliary system is frequently affected in chronic kidney disease and that the findings may differ depending on the renal replacement therapy modality.