Clinical nephrology最新文献

{"title":"Application of the extended technology acceptance model to explore clinician likelihood to use robotics in rehabilitation.","authors":"Marlena Klaic, Justin Fong, Vincent Crocher, Katie Davies, Kim Brock, Emma Sutton, Denny Oetomo, Ying Tan, Mary P Galea","doi":"10.1080/17483107.2022.2060356","DOIUrl":"10.1080/17483107.2022.2060356","url":null,"abstract":"<p><strong>Purpose: </strong>Evidence suggests that patients with upper limb impairment following a stroke do not receive recommended amounts of motor practice. Robotics provide a potential solution to address this gap, but clinical adoption is low. The aim of this study was to utilize the technology acceptance model as a framework to identify factors influencing clinician adoption of robotic devices into practice.</p><p><strong>Materials and method: </strong>Mixed methods including survey data and focus group discussions with allied health clinicians whose primary caseload was rehabilitation of the neurologically impaired upper limb. Surveys based on the technology acceptance measure were completed pre/post exposure to and use of a robotic device. Focus groups discussions based on the theory of planned behaviour were conducted at the conclusion of the study.</p><p><strong>Results: </strong>A total of 34 rehabilitation clinicians completed the surveys with pre-implementation data indicating that rehabilitation clinicians perceive robotic devices as complex to use, which influenced intention to use such devices in practice. The focus groups found that lack of experience and time to learn influenced confidence to implement robotic devices into practice.</p><p><strong>Conclusion: </strong>This study found that perceived usefulness and perceived ease of use of a robotic device in clinical rehabilitation can be improved through experience, training and embedded technological support. However, training and embedded support are not routinely offered, suggesting there is a discordance between current implementation and the learning needs of rehabilitation clinicians.IMPLICATIONS FOR REHABILITATIONPatients do not receive adequate amounts of upper limb motor practice following a stroke, and although robotic devices have the potential to address this gap, clinical adoption is low.The technology acceptance model identified that clinicians perceive robotic devices to be complex to use with current implementation efforts failing to consider their training needs.Implementation adoption of robotic devices in rehabilitation should be supported with adequate training and technological support if sustainable practice change is to be achieved.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":"75 Suppl 1 1","pages":"52-59"},"PeriodicalIF":2.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90828066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The reasons for comparative effectiveness clinical trials of arteriovenous fistula versus graft strategy in older adults on hemodialysis with a catheter.","authors":"Mariana Murea, Michael Allon","doi":"10.5414/CN111227","DOIUrl":"10.5414/CN111227","url":null,"abstract":"<p><p>Clinicians and patients are guided by observational studies to make one of the most consequential decisions for patients with advanced kidney disease: the selection of the \"right\" hemodialysis vascular access. More than a decade ago, a call for randomized clinical trials was made to equitably compare clinical outcomes between arteriovenous (AV) fistulas (AVFs) and AV grafts (AVGs). Mounting evidence suggests that trade-offs between AVF- and AVGrelated outcomes are context dependent. In this article, we summarize four streams of evidence that collectively underpin the burden of equipoise between the two types of AV access in older adults with comorbidities who are on hemodialysis with a central venous catheter.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"243-248"},"PeriodicalIF":1.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50157219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and pathological correlation between urinary exosome miR-223 and IgAN patients.","authors":"Jianling Song,&nbsp;Xinfang Qin,&nbsp;Hong Li,&nbsp;Guxiang Huang,&nbsp;Huixin Bi","doi":"10.5414/CN110810","DOIUrl":"10.5414/CN110810","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the association between urine exosome miR-223 and clinical markers with pathological severity of IgA nephropathy (IgAN) in order to offer a new perspective for the evaluation of IgAN patients.</p><p><strong>Materials and methods: </strong>Western blotting and transmission electron microscopy were used to identify the exosomes collected and isolated from subjects' urine. qRT-PCR was then performed to determine the expression level of miR-223. Following that, the relationship between miR-223 expression, clinical markers, and the severity of pathology in IgAN patients was examined.</p><p><strong>Results: </strong>(1) Urine can be used to isolate exosomes since its marker protein was visible by Western blotting, and its size and structure were observable using transmission electron microscopy. (2) Expression levels of miR-223 in urinary exosomes were much higher in IgAN patients than in healthy subjects, and these were also positively correlated with creatinine (Cr) (rho = 0.396; p = 0.006), blood urea nitrogen (BUN) (rho = 0.371; p = 0.011), 24-hour urinary microalbumin (24hU-mALB) (rho = 0.341; p = 0.036), mesangial cell proliferation (rho = 0.359; p = 0.014), glomerular segmental sclerosis (rho = 0.417; p = 0.004), cell/fibroblast crescents (rho = 0.612; p = 0.000), glomerulosclerosis, and renal interstitial fibrosis (rho = 0.331; p = 0.025).</p><p><strong>Conclusion: </strong>In urine exosomes, miR-223 might be considered a non-invasive biomarker for the assessment of IgAN disease progression.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"209-215"},"PeriodicalIF":1.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10158396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of canagliflozin in non-diabetic obese patients with albuminuria: A randomized, double-blind, placebo-controlled trial.","authors":"Primploy Greeviroj, Pongpratch Puapatanakul, Jeerath Phannajit, Kullaya Takkavatakarn, Wonngarm Kittanamongkolchai, Patchaya Boonchaya-Anant, Pisut Katavetin, Kearkiat Praditpornsilpa, Somchai Eiam-Ong, Paweena Susantitaphong","doi":"10.5414/CN111143","DOIUrl":"10.5414/CN111143","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose co-transporter 2 inhibitor (SGLT2i) has been shown to improve renal outcomes in both diabetic and non-diabetic kidney disease. However, the effect of SGLT2i on renal outcomes in patients with non-diabetic obesity is still not established.</p><p><strong>Materials and methods: </strong>In this double-blind, randomized controlled trial, we assigned non-diabetic patients with body mass index (BMI) ≥ 25 kg/m², persistent 24-hour urine albumin-creatinine ratio (UACR) ≥ 10 mg/gCr, and estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73m², who had been treated with renin-angiotensin system blockade, to canagliflozin 100 mg daily or placebo for 24 weeks. The reduction in UACR and eGFR at 12 and 24 weeks were explored. (Thai Clinical Trials Registry 20190203003).</p><p><strong>Results: </strong>Of 247 non-diabetic obese patients screened, 32 patients met inclusion criteria and underwent randomization. The median baseline of UACR was 69.1 mg/gCr. There were no statistically significant differences in albuminuria reduction between the groups at 12 weeks and 24 weeks. The estimated GFR in the canagliflozin group decreased significantly from baseline at 12 weeks (-5.39 mL/min/1.73m²; 95% CI -9.81 to -0.97; p = 0.017) but not at 24 weeks (-1.16 mL/min/1.73m²; 95% CI -5.58 to 3.26; p = 0.66), and there was no significant change from baseline in the placebo group at both 12 and 24 weeks.</p><p><strong>Conclusion: </strong>Canagliflozin 100 mg daily was well tolerated but did not significantly reduce UACR in non-diabetic obese patients with microalbuminuria. However, a significant temporary decline in eGFR might reflect a subtle reduction in glomerular hyperfiltration.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":" ","pages":"224-230"},"PeriodicalIF":1.1,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10171654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The drivers of non-adherence to albuminuria testing guidelines and the clinical and economic impact of not identifying chronic kidney disease.","authors":"Franziska Groehl, Antonio Garreta-Rufas, Kimberley Meredith, James Harris, Peter Rossing, F D Richard Hobbs, Christoph Wanner","doi":"10.5414/CN111106","DOIUrl":"10.5414/CN111106","url":null,"abstract":"<p><strong>Background: </strong>Regular monitoring is required to ensure that patients who have, or are at risk of, chronic kidney disease (CKD) receive appropriate management. Guidelines recommend regular testing of estimated glomerular filtration rate (GFR) and albuminuria. However, evidence suggests that albuminuria testing rates, specifically urine albumin-to-creatinine ratio (UACR), are suboptimal.</p><p><strong>Aim: </strong>To assess published evidence relating to the drivers of non-adherence to albuminuria testing guidelines and the impact of not identifying CKD across the course of progression.</p><p><strong>Materials and methods: </strong>A systematic review of five bibliographic databases was conducted, supplemented by hand searches of relevant conference abstracts.</p><p><strong>Results: </strong>One study was identified that reported drivers of non-adherence to albuminuria testing guidelines. The largest barrier was the perception that testing does not impact patient management. Thirteen studies were identified that evaluated the impact of not identifying CKD patients. All included studies analyzed the effect of not identifying worsening CKD severity leading to late referral (LR). 12/13 studies reported only on clinical impact, and 1/13 reported on clinical and economic impact. LR led to higher costs and worse outcomes than early referral, including higher rates of mortality and worsened kidney replacement therapy preparation.</p><p><strong>Conclusion: </strong>This systematic review demonstrates a gap in evidence exploring the drivers of non-adherence to albuminuria testing guidelines and the impact of not identifying patients in the early stages of CKD. Guideline-recommended testing allows timely identification, referral, and treatment for patients with, or at risk of, CKD, providing the best chance of avoiding the worsened outcomes identified in this review.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":"100 4","pages":"145-156"},"PeriodicalIF":1.1,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10548545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10220023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective observational study of purse-string suturing of the anterior rectus fascia for urgent-start peritoneal dialysis.","authors":"Tuncay Sahutoglu,&nbsp;Yadigar Akturk Kus,&nbsp;Halenur Harman,&nbsp;Meral Beyaz","doi":"10.5414/CN111134","DOIUrl":"https://doi.org/10.5414/CN111134","url":null,"abstract":"<p><strong>Introduction: </strong>To assess the efficacy and safety of a consistent percutaneous procedure for peritoneal dialysis (PD) catheter placement in initiating immediate-start PD in patients with end-stage kidney disease (ESKD).</p><p><strong>Materials and methods: </strong>In this single-center prospective observational study, we enrolled patients with ESKD who were willing to undergo long-term PD. Tenckhoff catheters were placed under local anesthesia by a nephrologist, with the inner cuffs pushed underneath the anterior rectus fascia and purse-string sutures applied. Automated PD (APD) and continuous ambulatory PD (CAPD) were started within 1 hour following catheter placement. The primary outcomes were peri-catheter leakage, technique failure, and the need for hemodialysis during admission.</p><p><strong>Results: </strong>APD was initiated in 12 patients, with a median initial dwell volume of 1,350 mL (range 1 - 2 L, 7 exchanges) and CAPD in 8 patients, with a median initial dwell volume of 1,500 mL (range 1 - 1.8 L, 4 exchanges). No cases of peri-catheter leakage, flow restriction, or hemodialysis inception occurred. There were 2 minor complications: 1 case of hemoperitoneum and 1 case of incisional bleeding, both of which were managed conservatively.</p><p><strong>Conclusion: </strong>The use of purse-string suturing of the rectus fascia may allow for the immediate start of PD within 1 hour of catheter placement, with larger dwell volumes and a low risk of complications.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":"100 3","pages":"115-125"},"PeriodicalIF":1.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10047112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary thrombotic microangiopathy following CNI and mTOR inhibitor toxicity after COVID-19 therapy with nirmatrelvir/ritonavir in a kidney transplant patient.","authors":"Johanna Reindl,&nbsp;Martin Busch,&nbsp;Gunter Wolf","doi":"10.5414/CN111178","DOIUrl":"https://doi.org/10.5414/CN111178","url":null,"abstract":"","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":"100 3","pages":"143-144"},"PeriodicalIF":1.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10071053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An analysis of the relationship of blood pressure and its variability with residual kidney function loss in hemodialysis patients.","authors":"Feiyan Li,&nbsp;Xu He,&nbsp;Yongchao Yang","doi":"10.5414/CN111010","DOIUrl":"https://doi.org/10.5414/CN111010","url":null,"abstract":"<p><strong>Aims: </strong>This study aims to investigate the relationship of blood pressure (BP) and systolic BP (SBP) variability with residual kidney function (RKF) loss in hemodialysis (HD) patients.</p><p><strong>Materials and methods: </strong>The demographic and clinical information and data on RKF loss events in HD patients were collected. The baseline characteristics of the patients were compared among groups according to pre- and postdialysis SBP (< 120, 120 - 139, 140 - 159, and ≥ 160 mmHg) and diastolic BP (DBP) (< 80, 80 - 89, 90 - 99, and ≥ 1 00 mmHg). Participants were divided into two groups based on the mean intradialytic and interdialytic SBP variability. Kaplan-Meier analysis and Cox regression analysis were used to evaluate the risk of RKF loss.</p><p><strong>Results: </strong>A total of 157 participants with an average HD vintage of 35.97 months were included. The group with the lowest predialysis SBP showed the longest duration of residual urine. However, Kaplan-Meier analysis and Cox regression analysis indicated that BP and SBP variability were not independent risk factors for RKF loss. Higher serum albumin levels showed protective effects against RKF loss, and diabetes mellitus (DM) and higher serum calcium were the independent risk factors for RKF loss.</p><p><strong>Conclusion: </strong>BP and SBP variability were not independent risk factors for RKF loss in HD patients. DM, serum albumin, and calcium were independent factors related to RKF loss.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":"100 3","pages":"99-106"},"PeriodicalIF":1.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10053653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"De novo positive hepatitis B surface antigen after hepatitis B vaccination in dialysis patients.","authors":"Amelia Chien-Wei Chao,&nbsp;Winston Wing-Shing Fung,&nbsp;Cheuk Chun Szeto,&nbsp;Kai Ming Chow","doi":"10.5414/CN110937","DOIUrl":"https://doi.org/10.5414/CN110937","url":null,"abstract":"","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":"100 3","pages":"138-139"},"PeriodicalIF":1.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10067856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On the earliest descriptions of the uremic syndrome in medical literature.","authors":"Anirban Ganguli","doi":"10.5414/CN111149","DOIUrl":"https://doi.org/10.5414/CN111149","url":null,"abstract":"<p><p>Uremic syndrome refers to the clinical manifestations of renal failure (acute or chronic) that results from the accumulation of several endogenous toxins normally excreted by the kidneys and can be fatal unless the primary cause is addressed and the toxins removed by dialysis. A historical description of the syndrome is traditionally believed to start in the 18^th - 19^th century through seminal works in the field of experimental medicine. This account, however, ignores the possibility of clinical apperception of this syndrome in ancient medical literatures. The <i>Sushruta Samhita (SS)</i>, a Sanskrit text whose authorship is attributed to the legendary ancient Indian surgeon <i>Sushruta</i> (6^th century BC), is well known for its pioneering descriptions of several surgical procedures, even though its contribution to the fields of internal medicine and especially nephrology is detailed. <i>Prameha</i>, a term that first appears in the <i>SS</i>, and subsequently in later historical Ayurvedic (traditional Indian medicine) texts, denotes a multi-systemic disease syndrome impacting the neurological, cardiac, dermatological, and gastrointestinal systems that is recognized through its intimate association with urinary abnormalities such as hematuria, frothy urine, or glycosuria. This construct is highly consistent with uremic syndrome originating from multiple renal disease processes such as acute glomerulonephritis, nephrotic syndrome, diabetes mellitus, etc. Furthermore, medical treatment of <i>prameha</i>, as detailed in the original text, reflects several recently validated approaches to managing chronic kidney disease, supporting the hypothesis that this historical entity may be one of the earliest descriptions of uremic syndrome in medical history.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":"100 3","pages":"132-137"},"PeriodicalIF":1.1,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10047106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}