Chronic kidney disease (CKD) has been highlighted as one of the most important public health problems due to sharply climbing incidence and prevalence. To efficiently attenuate the disease burden and improve the disease management, not only active and effective treatment should be administrated, but also comprehensive follow-up nursing management with innovative and evolving spirits should be implemented. Thus dynamic changes of diseases could be acquired in time and patients are under appropriate medical instruction as soon as possible. This editorial is based on quickly developing medical big data resources and advanced internet techniques, from both aspects of patients and health care providers, briefly talking about integrated management strategy of CKD and its future development in China.
目的:觀察抗菌素聯合療法結合BMP紅外光治療宮頸糜爛的療效和作用機理。方法:用抗菌素職合療法結合BMP紅外光治療宮頸糜爛92例與83例單用BMP紅外光作對比。結果:治療組痊愈率97.83%,對照組為73.49%,兩組比較有顯著性差異(Plt;0.005)。治療組副反應明顯低于對照組,創面愈合時間與對照組比較有顯著性差異(Plt;0.005)。結論:抗菌素聯合治療法結合BMP紅外光治療宮頸糜爛能提高治愈率,減少副反應,加速創面愈合。
Acute kidney injury (AKI) is a common critical illness in clinical practice, with complex etiologies, acute onset, and rapid progression. It not only significantly increases the mortality rate of patients, but also may progress to chronic kidney disease. Currently, its incidence remains high, and improving early diagnosis rate and treatment efficacy is a major clinical challenge. Artificial intelligence (AI), with its powerful data processing and analysis capabilities, is developing rapidly in medical field, providing new ideas for disease diagnosis and treatment, and showing great potential in revolutionizing the early diagnosis, condition assessment, and treatment decision-making models in the AKI field. This article will review the application progress of AI in AKI prediction, condition assessment, and treatment decision-making, so as to provide references for clinicians and promote the further application and development of AI in the AKI field.
The patency of vascular access is of great significance to hemodialysis patients. Combining with guidelines and literature associated with vascular access for dialysis in recent years, the authors interpret the effectiveness and limitations of prophylactic drug strategies, including using fish oil, anticoagulation, anti-platelet, lipid-lowering agents, etc., in order to promote the proper use of these agents in clinical practice, and improve the effect of prophylaxis and treatment of vascular access dysfunction.
Objective To investigate the risk factors of high peritoneal transport characteristics in patients with end-stage renal disease undergoing initial continuous ambulatory peritoneal dialysis. Method The clinical data of continuous ambulatory peritoneal dialysis patients who underwent initial peritoneal dialysis and catheterization in the Department of Nephrology, West China Hospital of Sichuan University from January 2011 to December 2017 and completed the peritoneal equilibration test were collected retrospectively. According to the ratio of dialysate to plasma ratio for creatinine at 4 hour [D/Pcr (4h)] in the standard peritoneal equilibration test, the patients were divided into 4 groups (low transport, low average transport, high average transport and high transport). Spearman correlation analysis was used to analyze the related factors of D/Pcr (4h). The risk factors of high peritoneal transport characteristics were analyzed by ordered multi classification logistic regression. Results A total of 647 patients were included. The average age of the patients was (45.85±14.03) years, and the average D/Pcr (4h) was 0.67±0.12. Among them, there were 89 cases (13.76%) in the high transport group, 280 cases (43.28%) in the high average transport group, 234 cases (36.17%) in the low average transport group and 44 cases (6.80%) in the low transport group. Diabetic patients with D/Pcr (4h) were higher than those without diabetes mellitus (0.72±0.12 vs. 0.66±0.12; t=?4.005, P<0.001). Correlation analysis showed that age and 24-h urine volume were positively correlated with D/Pcr (4h); serum albumin, triglyceride, potassium, calcium, magnesium, phosphorus, hemoglobin, serum uric acid and creatinine were negatively correlated with D/Pcr (4h); body surface area (BSA), high sensitivity C-reactive protein, ferritin, cholesterol, sodium, intact parathyroid hormone and estimated giomerular filtration rate had no correlation with D/Pcr (4h). Regression analysis showed that serum albumin [odds ratio (OR)=0.842, 95% confidence interval (CI) (0.809, 0.877), P<0.001], serum uric acid [OR=0.996, 95%CI (0.994, 0.998), P<0.001], magnesium [OR=0.389, 95%CI (0.156, 0.965), P=0.042], BSA [OR=3.916, 95%CI (1.121, 13.680), P=0.032] were correlated with the incidence of peritoneal high transport characteristics. Conclusion Low serum albumin, high BSA, low magnesium and low serum uric acid were independent risk factors for high transport characteristics in initial PD patients.
Chronic kidney disease (CKD) has become a global public health problem because of its high prevalence, low awareness, poor prognosis, and high medical costs. Effective follow-up management can facilitate timely adjustment of the treatment of the CKD patients and delay the disease progression. The application of internet of things (IoT) technology in dynamic monitoring and telemedicine is helpful for the self-management of patients with chronic diseases, and can provide convenient, intelligent, and humanized medical and health services. In the future, with the rapid growth of demands of CKD management and innovations in information technology, new medical IoT industry will accelerate the intelligent development of CKD management. Multi-disciplinary and multi-industrial collaboration should be promoted to solve current challenges, such as evaluation of actual effectiveness, the system design and construction, and the accessibility of intelligent healthcare services, to ensure that IoT products can improve clinical outcomes, reduce medical expenditure, and lower disease burden.
Acute kidney injury (AKI) is characterized by a rapid decrease in renal function caused by different etiologies and can involve multiple organs and systems. AKI is a potentially reversible disease. However, it can also progress to chronic kidney disease (CKD) without proper treatment. The concept of acute kidney disease (AKD) is recently recommended as a derivative between AKI and CKD. At present, AKI still lacks specific drug treatment; therefore prevention and early diagnosis are crucial in AKI management. Due to the heterogeneity of the pathogenesis, the epidemiological features of AKI vary across nations and regions, so the strategies for prevention and control are different. This papers reports new progress of epidemiological features of AKI in different countries, so as to provide reference for assessing the disease burden and formulating public health policies.
ObjectiveTo compare dialysis catheter function and complications according to catheter site in patients undergoing hemopurification.MethodsLiteratures were searched from PubMed, Medline, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Data, and VIP Database according to the inclusion and exclusion criteria. Publication years of these literatures ranged from April 1998 to April 2018. Meta-analysis was performed with RevMan 5.3 software. The odds ratio (OR) and 95% confidence intervals (CI) were calculated for uncontinuous outcomes, and the weighted mean difference (WMD) and 95%CI were calculated for continuous outcomes. The incidence of catheter related infection, other complications and patients outcome were compared between different sites for dialysis vascular access.ResultsA total of 9 articles were included, including 2 randomized controlled trials and 7 observational clinical studies, and 5 220 adult patients undergoing renal replacement therapy. Meta-analysis showed that there was no significant difference in incidences of catheter colonization or catheter-related bloodstream infection, as well as arterial puncture, local thrombosis, catheter dysfunction and spontaneous catheter withdrawal, between femoral and non-femoral (jugular or subclavian) catheterization (P≥0.05). Whereas the incidence of bleeding and local hematoma was lower in femoral catheterization [OR=0.44, 95%CI (0.23, 0.82), P=0.009], and the duration of catheters was shorter in femoral catheterization [WMD=–1.40 d, 95%CI (–2.17, –0.62) d, P=0.000 4]. The blood flow rate, filters clotting incidence and patients intensive case unit mortality were similar in different catheterization.ConclusionsIn patients undergoing renal replacement therapy, the bleeding and local hematoma incidence is lower in femoral catheterization but the duration of catheters is shorter. Nevertheless the patients have similar clinical outcome. This result may provide reference for clinical decision-making.
The presence of thrombus on the surface of blood-contacting biomaterials in clinical practice can significantly impact both the longevity of the biomaterials and the overall survival prognosis of patients. The administration of anticoagulant and antiplatelet medications may heighten the risk of systemic bleeding. Developing biomaterials with anti-thrombogenetic properties and enabling localized anti-thrombosis may offer a solution to these challenges. The development strategies for anti-thrombogenetic biomaterials can be categorized into three main approaches based on the mechanisms of thrombus formation on biomaterial surfaces: altering physical and chemical properties, designing coatings containing or releasing active substances, and promoting endothelialization. However, due to the intricate and interconnected nature of these mechanisms, biomaterials constructed using a single approach may not effectively prevent thrombus formation. The collaborative intervention of various mechanisms can facilitate the development of biomaterials with enhanced blood compatibility.