Current Opinion in Nephrology and Hypertension最新文献_第6页

Infection prevention in home dialysis. 家庭透析中的感染预防。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-01-01 Epub Date: 2024-10-14 DOI: 10.1097/MNH.0000000000001032

Muthana Al Sahlawi, Christopher T Chan, Jeffrey Perl

{"title":"Infection prevention in home dialysis.","authors":"Muthana Al Sahlawi, Christopher T Chan, Jeffrey Perl","doi":"10.1097/MNH.0000000000001032","DOIUrl":"10.1097/MNH.0000000000001032","url":null,"abstract":"Purpose of review: Among patients with kidney failure, home dialysis modalities, including peritoneal dialysis (PD) and home hemodialysis (HHD) provide several individual and healthcare system benefits over in-center hemodialysis (HD). Infection remains a major source of morbidity and mortality in this population, and a core outcome of critical importance to patients, caregivers, and kidney health professionals. This narrative review provides evidence-based measures for infection prevention among individuals receiving home dialysis, with a particular emphasis on dialysis and access-related infections.Recent findings: Patient and care partner education and training is an important and major theme for infection prevention in home dialysis. In PD, identifying and managing modifiable risk factors for infections such as hypokalemia, constipation, use of gastric acid suppressants, and domestic pets, along with the use of antimicrobial prophylaxis, when indicated, can substantially reduce peritonitis risk. Reducing the use of central venous catheters (CVC), and duration of CVC dependence is the most effective means of prevention of HD access-related bloodstream infections in individuals receiving HHD. For arteriovenous fistula cannulation, rope ladder technique is associated with lower risk of infection compared to buttonhole cannulation.Summary: Developing and instituting a well structured and evidence-based patient training and education program within home dialysis units is the most important measure in preventing and reducing dialysis and access-related infections. Kidney care providers should be familiar with different infection risk factors among individuals receiving home dialysis.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"95-103"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evolving indications and management patterns in heart - kidney transplantation. 心肾移植术不断演变的适应症和管理模式。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-01-01 Epub Date: 2024-11-05 DOI: 10.1097/MNH.0000000000001042

Frederick M Lang, Veli K Topkara

{"title":"Evolving indications and management patterns in heart - kidney transplantation.","authors":"Frederick M Lang, Veli K Topkara","doi":"10.1097/MNH.0000000000001042","DOIUrl":"10.1097/MNH.0000000000001042","url":null,"abstract":"Purpose of review: Dual heart - kidney transplantation (HKT) is an increasingly utilized option for patients with end-stage heart failure and impaired renal function. In 2023, the United Network for Organ Sharing (UNOS) formalized indications for simultaneous heart - kidney transplantation (SHKT) and kidney-after-heart transplantation (KAHT). In light of this landmark effort, we review the evolution in HKT indications, outcomes after SHKT and KAHT in various patient populations, novel considerations in pre and posttransplant management, and areas for future research.Recent findings: The UNOS policy was borne out of retrospective outcome studies suggesting that SHKT is superior to single-organ heart transplantation (HT) in select patients with sufficiently severe renal impairment. KAHT utilization continues to evolve, providing a helpful safety net for HT recipients with irreversible worsening of renal function. Time-limited pretransplant device trials are useful for identifying optimal candidates for HKT, and calcineurin inhibitor-sparing regimens can preserve posttransplant renal function. Explorations into artificial intelligence algorithms and biomarker technology represent interesting future opportunities.Summary: Recent studies have refined selection and management of dual HKT recipients. The new UNOS policies now provide helpful standardization to the field. Rapid innovation to date has made dual HKT an exciting therapeutic strategy for patients with few options left.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"16-22"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Bringing the end-stage kidney disease life plan home. 把终末期肾病的生活计划带回家。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-01-01 Epub Date: 2024-11-28 DOI: 10.1097/MNH.0000000000001029

Ankur D Shah

引用次数: 0

Recent advances in peritoneal dialysis catheter placement: the association between method of insertion, operator, and prior abdominal surgery and outcomes. 腹膜透析导管置入术的最新进展：置入方法、操作者和先前腹部手术与结果之间的关联。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-01-01 Epub Date: 2024-10-04 DOI: 10.1097/MNH.0000000000001031

Robert R Quinn, Matthew J Oliver

{"title":"Recent advances in peritoneal dialysis catheter placement: the association between method of insertion, operator, and prior abdominal surgery and outcomes.","authors":"Robert R Quinn, Matthew J Oliver","doi":"10.1097/MNH.0000000000001031","DOIUrl":"10.1097/MNH.0000000000001031","url":null,"abstract":"Purpose of review: Peritoneal dialysis (PD) is associated with comparable outcomes to hemodialysis and is much less expensive to provide in most parts of the world. A well functioning PD catheter is required, but complications are frequent, and while there are guidelines for the placement and care of a PD access, they are based on low-quality evidence.Recent findings: Data reporting the outcomes of percutaneous, as compared to surgical pathways for placement of catheters and the role of operator type in determining outcomes are examined. The impact of prior abdominal procedures on patient selection and the prognostic importance of the presence of adhesions at the time of catheter insertion are reviewed.Summary: There are conflicting data about the relative merits of percutaneous as compared to surgical placement of catheters that may relate to differences in patient selection, operator experience, or operator volume. Prior abdominal procedures are not associated with worse PD catheter outcomes and likely should not influence patient selection, except in exceptional circumstances. Finally, the presence of adhesions is associated with a higher risk of complications. However, even in the presence of adhesions, the termination of PD therapy and need for re-intervention occurs in <20% of patients.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"85-89"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Implementing novel diagnostic and therapeutic strategies to improve population health outcomes and equity in kidney disease, dialysis therapies, and transplantation. 实施新的诊断和治疗策略，以改善人口健康结果和肾脏疾病、透析治疗和移植的公平性。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-01-01 Epub Date: 2024-11-28 DOI: 10.1097/MNH.0000000000001036

Ekamol Tantisattamo, Ramy M Hanna, Kamyar Kalantar-Zadeh

引用次数: 0

Diagnostic and therapeutic challenges in implementing hypertension management after kidney transplantation. 肾移植后实施高血压管理的诊断和治疗挑战。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-01-01 Epub Date: 2024-11-08 DOI: 10.1097/MNH.0000000000001045

Ekamol Tantisattamo, Antoney J Ferrey, Uttam G Reddy, Robert R Redfield, Hirohito Ichii, Fawaz Al Ammary, Wei Ling Lau

{"title":"Diagnostic and therapeutic challenges in implementing hypertension management after kidney transplantation.","authors":"Ekamol Tantisattamo, Antoney J Ferrey, Uttam G Reddy, Robert R Redfield, Hirohito Ichii, Fawaz Al Ammary, Wei Ling Lau","doi":"10.1097/MNH.0000000000001045","DOIUrl":"10.1097/MNH.0000000000001045","url":null,"abstract":"Purpose of review: Evidence for blood pressure (BP) measurement and hypertension management in kidney transplant recipients (KTR) remains lacking.Recent findings: Accurate BP measurement technique is a critical component of hypertension management, and 24-h ambulatory BP monitoring remains the gold standard for diagnosis of hypertension in KTR. BP target at different periods posttransplant is uncertain, but likely higher than that in nontransplant patients given factors related to long-standing uremic milieu and kidney transplantation such as vascular calcification altering transplant renal hemodynamic and allograft perfusion and immunosuppression. Dividing BP target into immediate, early, and late posttransplant periods can guide differential diagnoses of hypertension and BP control with a target SBP less than 160 mmHg in general and BP 115-135/65-85 mmHg for adult KTR receiving pediatric kidneys during the immediate posttransplant period, 130/80 mmHg during early and late posttransplant periods. Calcium channel blockers were shown to have favorable graft outcomes. Novel antihypertensive medications for resistant and refractory hypertension and device-based therapies are limited due to KTR's ineligibility for participating in clinical trials.Summary: In KTR, BP measurement and monitoring practice should follow the standard clinical practice guideline for nontransplant patients by considering posttransplant factors and immunosuppressive state. Novel treatment options required further studies.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"4-15"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Incremental hemodialysis transition in veterans and nonveterans with kidney failure. 肾功能衰竭的退伍军人和非退伍军人的渐进式血液透析过渡。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-01-01 Epub Date: 2024-11-18 DOI: 10.1097/MNH.0000000000001040

Connie M Rhee, Csaba P Kovesdy, Mark Unruh, Susan Crowley, David Geller, David S Goldfarb, Jeffrey Kraut, Mandana Rastegar, Ian R Rifkin, Kamyar Kalantar-Zadeh

{"title":"Incremental hemodialysis transition in veterans and nonveterans with kidney failure.","authors":"Connie M Rhee, Csaba P Kovesdy, Mark Unruh, Susan Crowley, David Geller, David S Goldfarb, Jeffrey Kraut, Mandana Rastegar, Ian R Rifkin, Kamyar Kalantar-Zadeh","doi":"10.1097/MNH.0000000000001040","DOIUrl":"https://doi.org/10.1097/MNH.0000000000001040","url":null,"abstract":"Purpose of review: Initiation of hemodialysis treatment with a thrice-weekly prescription is currently the standard of care irrespective of patients' residual kidney function (RKF), comorbidities, and preferences.Recent findings: Each year ∼12 000 Veterans with advanced kidney disease progress to end-stage kidney disease (ESKD) requiring dialysis and comprise greater than 10% of the US incident ESKD population. Dialysis is costly and is associated with impaired health-related quality of life (HRQOL) and high mortality risk, especially in the first year of treatment. Evidence suggests an incremental dialysis transition using twice-weekly hemodialysis provides various benefits, including more dialysis-free time, longer RKF preservation, less vascular access damage, and lower patient burden. Pragmatic studies are needed to inform the efficacy and safety of incremental hemodialysis as a personalized dialysis regimen, and could inform its consideration as a conservation strategy during times of supply shortages. Broadly implementing twice-weekly hemodialysis could also potentially allow more Veterans to receive care within VA-based dialysis units. The VA IncHVets Trial is a pragmatic, multicenter, randomized controlled trial comparing the efficacy and safety of twice-weekly incremental vs. thrice-weekly hemodialysis among Veterans transitioning to ESKD.Summary: Further research is needed to determine whether incremental hemodialysis is well tolerated, effective, and facilitates a more favorable transition to dialysis.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":"34 1","pages":"33-40"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Updated diagnostic and therapeutic management for membranous nephropathy. 膜性肾病的最新诊断和治疗方法。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-01-01 Epub Date: 2024-11-07 DOI: 10.1097/MNH.0000000000001039

Fernando Caravaca-Fontán, Federico Yandian, Fernando C Fervenza

{"title":"Updated diagnostic and therapeutic management for membranous nephropathy.","authors":"Fernando Caravaca-Fontán, Federico Yandian, Fernando C Fervenza","doi":"10.1097/MNH.0000000000001039","DOIUrl":"10.1097/MNH.0000000000001039","url":null,"abstract":"Purpose of review: Pioneering contributions in membranous nephropathy over the last decade have greatly enhanced our comprehension of its pathogenesis, diagnosis, and treatments, igniting renewed interest in this entity. This review provides an updated perspective on the diagnosis and therapeutic management of membranous nephropathy.Recent findings: The identification of antiphospholipase A2 receptor (PLA2R) antibodies in 50-80% of membranous nephropathy patients was a key breakthrough. High or increasing PLA2R antibody levels are linked to persistent nephrotic syndrome and the need for targeted treatment. Given the high specificity of PLA2R antibodies, a kidney biopsy may not be required for pure nephrotic syndrome cases with no comorbidities. Over the years, various target antigens and associated conditions have been identified in membranous nephropathy patients, leading to a reclassification of membranous nephropathy. Treatment approaches vary based on baseline characteristics and changes in proteinuria and PLA2R titers. Rituximab has emerged as the first-line therapy for most patients without severe risk factors, with other emerging therapies under development.Summary: Advances in the diagnosis and treatment of membranous nephropathy have moved the management towards a more precision-based approach, though further studies and new therapies are needed for a comprehensive management strategy.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"23-32"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Automation and innovation in home hemodialysis machines. 家用血液透析机的自动化和创新。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2025-01-01 Epub Date: 2024-10-29 DOI: 10.1097/MNH.0000000000001033

Osama El Shamy, James A Sloand

{"title":"Automation and innovation in home hemodialysis machines.","authors":"Osama El Shamy, James A Sloand","doi":"10.1097/MNH.0000000000001033","DOIUrl":"10.1097/MNH.0000000000001033","url":null,"abstract":"Purpose of review: In this review, we discuss the timeline of innovation and technologic development in home hemodialysis (HHD) in the United States and the legislative approvals that accompanied them.Recent findings: The most recently FDA-approved home hemodialysis devices provide features that include on-demand and batch dialysate generation, access disconnect for venous needle dislodgement, touchscreen interface with visual and auditory prompts and animations, drop-in sterilized cartridges with prestrung tubing, hot water disinfection of tubing allowing extended-use, dialysate flow rates as high as 500 ml/min, as well as remote treatment monitoring capabilities. Furthermore, wearable/portable dialysis devices are currently under development to simplify dialysis delivery to patients with end-stage kidney disease.Summary: Home hemodialysis devices providing longitudinal hemodialysis across different clinical settings, virtual reality headsets for more personalized training, automated patient support, as well as wearable device development and innovations give hope for a future where home hemodialysis is more accessible and seamless.","PeriodicalId":10960,"journal":{"name":"Current Opinion in Nephrology and Hypertension","volume":" ","pages":"90-94"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Population Health Strategies for Health Equity in Chronic Kidney Disease Management: Retraction. 慢性肾脏疾病管理中健康公平的人口健康策略：撤回。

IF 2.2 3区医学

Current Opinion in Nephrology and Hypertension Pub Date : 2024-12-10 DOI: 10.1097/MNH.0000000000001055

引用次数: 0