ObjectiveTo explore the application and effect of clinical nursing pathway based on information-knowledge-attitude-practice (IKPA) theory in percutaneous renal needle biopsy.MethodsThis is a historical control study. A total of 460 patients who underwent percutaneous renal biopsy in West China Hospital of Sichuan University between April and December 2020 were prospectively recruited as the pathway group, and a clinical nursing pathway based on IKAP theory was implemented. By contrast, the data of 617 patients who underwent percutaneous renal biopsy and received routine care in the same hospital between April and December 2019 were retrospectively collected as the control group. The length of hospital stay, hospitalization expenses, the incidences of postoperative complications (macroscopic haematuria, perirenal hematoma, and acute urinary retention), the incidence of postoperative postural hypotension, and the management enrollment rate of chronic kidney disease patients were compared between the two groups.ResultsThe length of hospital stay [median (lower quartile, upper quartile): 8 (7, 11) vs. 8 (7, 12) d] and the hospitalization expenses [median (lower quartile, upper quartile): 7380.50 (6401.86, 8789.21) vs. 8167.00 (6816.50, 10044.50) yuan] were less in the pathway group than those in the control group, the incidences of postoperative macroscopic haematuria (1.52% vs. 6.97%) and perirenal hematoma (2.61% vs. 5.02%) were lower in the pathway group than those in the control group, the management enrollment rate of chronic kidney disease patients was higher in the pathway group than that in the control group (26.09% vs. 6.16%), and the differences between the two groups were statistically significant (P<0.05). The differences in the incidences of acute urinary retention (8.26% vs. 11.18%) and postoperative postural hypotension (0.00% vs. 0.81%) between the two groups were not statistically significant (P>0.05).ConclusionThe application of clinical nursing pathway in percutaneous renal needle biopsy can effectively reduce the length of hospital stay and hospitalization expenses, and improve the management enrollment rate of chronic kidney disease patients.
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.
ObjectiveTo investigate the current status and influencing factors of self-care behavior of non-dialysis patients with chronic kidney disease (CKD).MethodsA total of 336 patients with CKD were investigated by a general data questionnaire, the CKD Self-care Behavior Scale, Social Support Scale, Generalized Anxiety Self-assessment Scale, and 9-item Patients Health Questionnaire through WeChat platform, and the influencing factors of self-care behavior were explored by binary logistic regression analysis.ResultsThe median score of self-care behavior of CKD patients without dialysis was 60, and the patients with median and high level of self-care behavior accounted for 97.6%. The score of self-care behavior of CKD patients without dialysis was positively correlated with the total score of social support (r=0.210, P<0.001), objective support score (r=0.127, P=0.020), subjective support score (r=0.195, P<0.001), and social support utilization score (r=0.164, P=0.002), and negatively correlated with the anxiety score (r=–0.132, P=0.015), depression score (r=–0.230, P<0.001), body mass index (r=–0.181, P=0.001), and systolic blood pressure (r=–0.168, P<0.001). The results of binary logistic regression analysis showed that the influencing factors of non-dialysis CKD patients’ self-care behavior were gender [(odds ratio, OR)=2.179, 95% confidence interval, CI (1.134, 4.187), P=0.019], systolic blood pressure [OR=0.967, 95%CI (0.947, 0.987), P=0.002], and depression score [OR=0.844, 95%CI (0.765, 0.931), P=0.001].ConclusionsThe self-care behavior of CKD patients without dialysis is at the median and high level. Healthcare workers can improve the self-care behavior of CKD patients by reducing their negative emotions such as depression, and guiding patients to carry out blood pressure management, to delay the progress of the disease.
Objective To investigate the current status of health promoting lifestyle in maintenance hemodialysis (MHD) patients and to explore its correlation with chronic illness resource utilization. Methods Patients who underwent outpatient MHD in the Hemodialysis Room of the Department of Nephrology, West China Hospital, Sichuan University between January and March 2023 were selected. Patients were surveyed using the General Information Questionnaire, Chronic Illness Resource Survey, and Health Promoting Lifestyle Profile-Ⅱ Revise. Results A total of 158 patients were surveyed. MHD patients scored 103.37±18.52 on health promoting lifestyle, and 68.95±14.14 on chronic illness resource utilization. The Pearson correlation analysis results showed that there was a positive correlation between the chronic illness resource utilization and the total score of health promoting lifestyle in MHD patients (r=0.765, P<0.001), as well as scores in all dimensions (P<0.05). The results of multiple linear regression analysis showed that the main caregivers being parents [non-standardized partial regression coefficient (b)=8.150, 95% confidence interval (CI) (0.804, 15.497), P=0.030], weekly dialysis times [b=10.701, 95%CI (2.787, 18.615), P=0.008], and chronic illness resource utilization [b=0.936, 95%CI (0.800, 1.072), P<0.001] were influencing factors for health promoting lifestyle. Conclusions MHD patients have an average health promoting lifestyle, and ideal chronic illness resource utilization. Hemodialysis nurses can take targeted measures to enhance chronic illness resource utilization and health promoting lifestyle in MHD patients, which can further improve the quality of life of MHD patients.
ObjectiveTo evaluate the screening performance of commonly used renal function indicators for chronic kidney disease (CKD) in subjects of different ages, so as to explore the appropriate screening regimen for Chinese population.MethodsA total of 2 131 adult subjects in Sichuan Orthopaedic Hospital or Mianyang Central Hospital from May 2016 to October 2017 were selected. They were divided into three groups according to age: group A (18–39 years, n=278), group B (40–64 years, n=1 167), and group C (≥65 years, n=686). Serum levels of creatinine (SCr), urea, and cystatin C [CysC; to calculate estimated glomerular filtration rate (eGFR) based on this index], as well as urine levels of albumin, total protein and creatinine were measured, and urine albumin to creatinine ratio (ACR) and urine protein to creatinine ratio (PCR) were calculated respectively. CKD was diagnosed according to the Kidney Disease: Improving Global Outcomes (KDIGO) Guideline (2012 Edition). The receiver-operating characteristic (ROC) curve analysis was finally performed to investigate the diagnostic performance of each indicator for CKD.ResultsThe prevalences of CKD in group A, B, and C were 10.8% (30/278), 16.4% (191/1 167), and 45.8% (314/686), respectively, and the difference among these groups was statistically significant (χ2=233.525, P<0.001). In addition, the levels of the six renal function indicators between CKD and non-CKD subjects also had statistically significant differences in different age groups (P<0 05="" otherwise="" roc="" curve="" analysis="" revealed="" that="" the="" diagnostic="" values="" of="" these="" indicators="" were:="" acr="" or="" pcr=""> eGFR or CysC > serum urea or SCr (AllP<0 05="" except="" that="" egfr="" cysc="" serum="" urea="" and="" scr="" in="" group="" a="" assessed="" the="" similar="" diagnostic="" performance="" among="" the="" three="" indicators="" recommended="" by="" kdigo="" guideline="" the="" diagnostic="" performances="" of="" acr="" and="" pcr="" in="" different="" age="" groups="" were:="" group="" b="" 0="" 915="" 0="" 914=""> group A (0.885, 0.890) > group C (0.841, 0.846), while the diagnostic performance of eGFR was group C (0.807) > group B (0.728) > group A (0.696). The best boundary values of ACR and PCR were lower while the value of eGFR was higher than the corresponding KDIGO recommended medical decision levels.ConclusionsACR is the first choice for screening CKD when the renal function index creatinine is normal. Moreover, eGFR can further improve the diagnostic value, especially in subjects over 65 years old.
Objective To observe the expression of hepcidin-ferroportin (FPN) pathway in adenine-induced chronic kidney disease (CKD) rat model and to explore the mechanism of its involvement in renal fibrosis in CKD. Methods A total of 20 6-week-old male SD rats without specific pathogen were selected. The rats were divided into control group and CKD group, with 10 rats in each group, using a simple random method. Rats were sacrificed at the end of the second and sixth weeks after modeling. The levels of serum creatinine (Scr), blood urea nitrogen (BUN) and 24 h urine protein quantification were measured. The pathological changes of rats were observed. The iron content of rat kidney tissue was detected by colorimetric method, and the level of serum hepcidin-25 was detected by enzyme linked immunosorbent assay method in both groups. Immunohistochemistry and reverse transcription-polymerase chain reaction were used to detect the renal protein and mRNA expression of α-smooth muscle actin (α-SMA), collagen type Ⅰ (Col-Ⅰ), FPN1, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), nuclear factor kappa-B (NF-κB) P65. Results Compared with the control group, the levels of Scr, BUN, and 24 h urine protein quantification were higher in the CKD group at the end of the second and sixth weeks of modeling (P<0.05). The results of renal tissue staining showed that the CKD group had obvious glomerular structural disorders, tubular dilation, and interstitial collagen fiber deposition. Compared with the control group, the serum hepcidin-25 level and the iron content of kidney tissues in the CKD group were significantly higher, and correlation analysis suggested that both were positively correlated with the renal function of rats (P<0.05). Compared with the control group, the protein and mRNA expression levels of α-SMA, Col-Ⅰ, HAMP, IL-6, TNF-α, NF-κB P65 were higher (P<0.05), while FPN1 expression was lower in CKD group at the end of the second and sixth weeks of modeling (P<0.05). Correlation analysis results showed that HAMP mRNA expression was positively correlated with α-SMA, Col-Ⅰ, IL-6, TNF-α, and NF-κB p65 (P<0.001), which was negatively correlated with FPN1 mRNA expression (P<0.001). FPN1 mRNA expression was significantly negatively correlated with α-SMA, Col-Ⅰ (P<0.001). Conclusions Ferroptosis may be present in the adenine-induced rat model of CKD, and it may be involved in the process of renal fibrosis through the interaction of HAMP-FPN signaling pathway with the inflammatory response. Serum hepcidin-25 is expected to be a serological marker for the early diagnosis of CKD.
Objective To observe the prognosis of pregnant patients with renal failure who underwent blood purification. Methods Pregnant patients with renal failure undergoing blood purification (hemodialysis or hemofiltration) from January 2009 to February 2017 were included in this study. Clinical data and pregnancy outcome were collected retrospectively. Results A total of 42 patients were enrolled in this study, including 38 with acute renal failure, 3 with chronic progressed renal failure, and 1 with chronic renal failure. There were 5 patients (11.9%) with chronic kidney disease (CKD) before pregnancy, 3 (7.2%) with systemic lupus erythematosus, 24 (54.8%) with hypertension, 5 (11.9%) with acute pancreatitis, and 7 (14.3%) with acute liver failure. In perinatal period, 7 patients (16.7%) died, whose underlying diseases were acute pancreatitis in 2, lupus nephritis in 1, acute hepatic failure in 3, and pulmonary tuberculosis breakout in 1. There were 5 patients with twin pregnancy, and 37 patients with single pregnancy. In the 28 patients with natural pregnancy ending, the live birth rate was 82.1% (23/28), and the live birth rate of twin pregnancy was only 50% (5/10). Twenty-seven patients were followed up, in whom 10 were in end stage of renal disease (ESRD), which was correlated with hypertension (P=0.001), and 3 patients were in CKD 1–4. Renal diseases were completely recovered in 14 patients. New CKD were diagnosed in 8 patients, without any correlated factor. Conclusions For pregnant patients with renal failure undergoing hemodialysis or hemofiltration, the death risk and the dead birth rate are high. Patients with hypertension or pre-existed renal failure have higher risk for ESRD. Some patients are not completely recovered from acute renal failure, with CKD left.
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.
Studies of evidence-based medicine have provided much important evidence, clarified problems, and guided the clinical practice in the treatment of renal diseases. As examples, several therapeutic problems in renal hypertension, renal anemia and low protein diet for the patients with chronic kidney disease are discussed in this paper.