Seminars in nephrology最新文献_第9页

Sodium Management in Kidney Disease: Old Stories, New Tricks 肾脏疾病中的钠管理：老故事，新技巧

IF 3.3 3区医学

Seminars in nephrology Pub Date : 2023-03-01 DOI: 10.1016/j.semnephrol.2023.151407

Rengin Elsurer Afsar MD , Baris Afsar MD , Talat Alp Ikizler MD

{"title":"Sodium Management in Kidney Disease: Old Stories, New Tricks","authors":"Rengin Elsurer Afsar MD , Baris Afsar MD , Talat Alp Ikizler MD","doi":"10.1016/j.semnephrol.2023.151407","DOIUrl":"10.1016/j.semnephrol.2023.151407","url":null,"abstract":"<div><p>Excessive dietary sodium intake is associated with an increased risk of hypertension, especially in the setting of chronic kidney disease (CKD). Although implementation of a low-sodium diet in patients with CKD generally is recommended, data supporting the efficacy of this practice is mostly opinion-based. Few controlled studies have investigated the specific association of dietary sodium intake and cardiovascular events and mortality in CKD. Furthermore, in epidemiologic studies, the association of sodium intake with CKD progression, cardiovascular risk, and mortality is not homogeneous, and both low- and high-sodium intake has been associated with adverse health outcomes in different studies. In general, the adverse effects of high dietary sodium intake are more apparent in the setting of advanced CKD. However, there is no established definitive target level of dietary sodium intake in different CKD stages based on glomerular filtration rate and albuminuria/proteinuria. This review discusses the current challenges regarding the rationale of sodium restriction, target levels and assessment of sodium intake, and interventions for sodium restrictions in CKD in relation to clinical outcomes.</p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10111205","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: 1

Introduction: Advances in Nutrition Management in Chronic Kidney Disease 引言：慢性肾脏疾病的营养管理进展。

IF 3.3 3区医学

Seminars in nephrology Pub Date : 2023-03-01 DOI: 10.1016/j.semnephrol.2023.151445

Angela Yee-Moon Wang MD, PhD (Guest Editor)

引用次数: 0

Nutrition in Conservative Kidney Management: From Evidence to Practice 保守肾脏管理中的营养：从证据到实践。

IF 3.3 3区医学

Seminars in nephrology Pub Date : 2023-01-01 DOI: 10.1016/j.semnephrol.2023.151399

Jessica Dawson BHSc, MNutDiet, PhD , Cameron McLean BSc, MSc

引用次数: 0

Introduction: Conservative Kidney Management 引言：保守性肾脏管理。

IF 3.3 3区医学

Seminars in nephrology Pub Date : 2023-01-01 DOI: 10.1016/j.semnephrol.2023.151394

Samantha Gelfand MD (Guest Editor)

引用次数: 0

Dialysis Access Considerations in Kidney Palliative Care 肾脏姑息治疗中透析途径的考虑因素。

IF 3.3 3区医学

Seminars in nephrology Pub Date : 2023-01-01 DOI: 10.1016/j.semnephrol.2023.151397

Samantha L. Gelfand MD , Dirk M. Hentschel MD

{"title":"Dialysis Access Considerations in Kidney Palliative Care","authors":"Samantha L. Gelfand MD , Dirk M. Hentschel MD","doi":"10.1016/j.semnephrol.2023.151397","DOIUrl":"10.1016/j.semnephrol.2023.151397","url":null,"abstract":"<div><p>In this review, we discuss common challenges at the interface between dialysis access planning, prognostication, and patient-centered decision making. Particularly for patients whose survival benefit from dialysis is attenuated by advanced age or other serious illness, knowing the potential complications and anticipated frequency of access procedures is essential for patients and families to be able to conceptualize what life on dialysis will look like. Although starting dialysis with a functioning graft or fistula is associated with reduced infection rates, mortality, hospitalizations, and cost compared with a central venous catheter, these benefits must be weighed against the chance that early access placement in an elderly or seriously ill patient is an unnecessary surgery because the chronic kidney disease never progresses, the patient dies before developing an indication to start dialysis, or, the patient prefers conservative kidney management over dialysis. Kidney palliative care is a growing subspecialty of nephrology focused on helping seriously ill patients navigate complex medical decisions, and may be useful for intensive goals-of-care discussions about treatment and access options for patients with limited anticipated survival because of age or other serious illness.</p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10353142","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

Geriatric Medicine Principles in Conservative Kidney Management: Frailty, Functional Assessments, and Selective Deprescribing 保守性肾脏管理中的老年医学原则：虚弱、功能评估和选择性剥夺。

IF 3.3 3区医学

Seminars in nephrology Pub Date : 2023-01-01 DOI: 10.1016/j.semnephrol.2023.151400

Peter Hedderich DO , Luis Ng Sueng MD , Hesham Shaban MD

引用次数: 0

Conservative Kidney Management in Kidney Transplant Populations 肾移植人群的保守性肾脏管理。

IF 3.3 3区医学

Seminars in nephrology Pub Date : 2023-01-01 DOI: 10.1016/j.semnephrol.2023.151401

Naoka Murakami MD, PhD , Amanda J. Reich PhD, MPH , Martha Pavlakis MD , Joshua R. Lakin MD

{"title":"Conservative Kidney Management in Kidney Transplant Populations","authors":"Naoka Murakami MD, PhD , Amanda J. Reich PhD, MPH , Martha Pavlakis MD , Joshua R. Lakin MD","doi":"10.1016/j.semnephrol.2023.151401","DOIUrl":"10.1016/j.semnephrol.2023.151401","url":null,"abstract":"<div><p>Conservative kidney management (CKM) has been increasingly accepted as a therapeutic option for seriously ill patients with advanced chronic kidney disease. CKM is active medical management of advanced chronic kidney disease without dialysis, with a focus on delaying the worsening of kidney disease and minimizing symptom burden. CKM may be considered a suitable option for kidney transplant recipients with poorly functioning and declining allografts, defined as patients with low estimated glomerular filtration rate (<20 mL/min per 1.73 m<sup>2</sup>) who are approaching allograft failure. CKM may be a fitting option for transplant patients facing high morbidity and mortality with or without dialysis resumption, and it should be offered as a choice for this patient population. In this review, we describe clinical considerations in caring for patients with poorly functioning and declining kidney allografts, especially the unique decision-making process around kidney replacement therapies. We discuss ways to incorporate CKM as an option for these patients. We also discuss financial and policy considerations in providing CKM for this population. Patients with poorly functioning and declining kidney allografts should be supported throughout transitions of care by an interprofessional and multidisciplinary team attuned to their unique challenges. Further research on when, who, and how to integrate CKM into existing care structures for patients with poorly functioning and declining kidney allografts is needed.</p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10543459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9883559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Conservative Kidney Management: When, Why, and For Whom? 保守肾脏管理：何时、为什么、为谁？

IF 3.3 3区医学

Seminars in nephrology Pub Date : 2023-01-01 DOI: 10.1016/j.semnephrol.2023.151395

Kelly Chenlei Li MBBS, FRACP, FAChPM, M(Bioeth), Mark Ashley Brown MBBS, MD, FRACP

{"title":"Conservative Kidney Management: When, Why, and For Whom?","authors":"Kelly Chenlei Li MBBS, FRACP, FAChPM, M(Bioeth), Mark Ashley Brown MBBS, MD, FRACP","doi":"10.1016/j.semnephrol.2023.151395","DOIUrl":"10.1016/j.semnephrol.2023.151395","url":null,"abstract":"<div><p>Deciding between dialysis and conservative kidney management (CKM) in an elderly or seriously ill person with kidney failure is complex and requires shared decision making. Patients and families look to their nephrologist to provide an individualized recommendation that aligns with patient-centered goals. For a balanced and considered decision to be made, dialysis should not be the default and nephrologists need to be familiar with relevant prognostic information including survival, symptom burden, functional trajectory, and quality of life with dialysis and with CKM. CKM is a holistic, proactive, and multidisciplinary treatment for kidney failure. For some elderly comorbid patients, CKM improves symptom burden and aligns with quality-of-life goals, with modest or no loss of longevity. CKM can be provided by a nephrologist alone but ideally is managed through partnership with a dedicated supportive or palliative care service embedded within the nephrology practice. Treatment decisions are best discussed early in the disease trajectory and occur over many consultations, and nephrologists should be upskilled in communication to better support patients and families in these important conversations. Nephrologists should remain actively involved in their patients’ care through to end-of-life care.</p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9848822","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

Hospice Care in Conservative Kidney Management 保守肾脏管理中的临终关怀。

IF 3.3 3区医学

Seminars in nephrology Pub Date : 2023-01-01 DOI: 10.1016/j.semnephrol.2023.151398

Alexandra E. Bursic MD , Jane O. Schell MD

引用次数: 0

Teaching Conservative Kidney Management and Other Palliative Care Skills in Nephrology Fellowships 在肾病学奖学金中教授保守性肾脏管理和其他姑息治疗技能。

IF 3.3 3区医学

Seminars in nephrology Pub Date : 2023-01-01 DOI: 10.1016/j.semnephrol.2023.151396

Amanda K. Leonberg-Yoo MD, MS , Scott J. Gilbert MD

{"title":"Teaching Conservative Kidney Management and Other Palliative Care Skills in Nephrology Fellowships","authors":"Amanda K. Leonberg-Yoo MD, MS , Scott J. Gilbert MD","doi":"10.1016/j.semnephrol.2023.151396","DOIUrl":"10.1016/j.semnephrol.2023.151396","url":null,"abstract":"<div><p>Offering and providing effective conservative kidney management (CKM) for patients with end-stage kidney disease who do not want dialysis is a foundational skill that all nephrology fellows should learn during fellowship training. However, the current educational landscape in fellowship training programs is sparse and is not recognized currently as a skill within the Accreditation Council for Graduate Medical Education (ACGME) guidelines. Moreover, there is no standardized curriculum, methods of assessment of this learning objective, and no structure for implementation within general and subspecialty nephrology training programs. In this article, we discuss the current educational resources available for fellowship training programs, including interactive communication skills workshops such as NephroTalk, that address core concepts of CKM and assess communication skills and attitudes of trainees. Additional assessment tools should be prioritized when developing a CKM curriculum, including assessment of symptom management and medical knowledge acquisition. We propose that the ACGME nephrology milestones specifically highlight CKM as an important component within the ACGME nephrology milestones, thus ensuring that trainees understand how and when to offer CKM (knowledge), implement it effectively (skills), and conceptualize it as an appropriate course for patients in a number of varied situations (attitudes). We also outline a subspecialty pathway for palliative nephrology, to align with the recent American Society of Nephrology Task Force Recommendation to provide subspecialty training beyond core competencies, for those interested in pursuit of advanced training that ultimately can shape the CKM landscape in education and policy making.</p></div>","PeriodicalId":21756,"journal":{"name":"Seminars in nephrology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9987901","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