在发生腹膜透析患者中影响功能残留的因素:系统性审查和元分析
Dan Zhou1,2,3, Hong Lei4, Shuran Wu1
1Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
Renal failure
|November 30, 2023
概括
男性性别,更高的BMI,SBP,糖尿病,腹膜炎,蛋白尿和高增加腹膜透析患者的残留功能损失风险. 年龄较大,白蛋白和基线RKF具有保护作用.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 内部医学 内部医学
- 透析是通过透析进行的.
背景情况:
- 脏残留功能 (RKF) 对腹腔透析 (PD) 患者的生存和生活质量至关重要.
- 了解影响RKF衰减和损失的因素对于优化PD患者的治疗结果至关重要.
研究的目的:
- 系统地识别和量化与腹透析患者残留功能衰退和损失相关的风险和保护因素.
- 为临床管理策略提供基于证据的见解,旨在保护PD患者的RKF.
主要方法:
- 对队列和横截面研究进行了全面的元分析,使用来自多个数据库的数据,直到2023年1月31日.
- 随机效应模型被用于从多变量分析中汇总风险估计和95%置信区间 (CI).
- 进行了敏感性和子组分析,以解决研究异质性的问题.
主要成果:
- 确定了RKF下降/损失的重大风险因素:男性性别,较高的BMI,高的SBP,糖尿病,腹膜炎,蛋白尿和血清含量增加.
- 确定了重要的保护因素:年龄较大,血清白蛋白较高,每周足够的Kt/V尿素,足够的基线尿量 (UV) 和较高的基线RKF.
- 利尿剂使用,自动腹腔透析 (APD) 和基线RKF在此元分析中没有显示对RKF下降有显著影响.
结论:
- 男性性别,肥胖,高血压,糖尿病,腹膜炎,蛋白尿和高血症与PD患者的RKF损失风险增加有关.
- 高龄,良好的营养状况 (血清白蛋白),足够的透析剂量 (Kt/V尿素),足够的尿量和保存的基线RKF与更好的RKF保存有关.
- 这些发现突出了临床医生在治疗PD患者时应考虑的关键可修改和不可修改的因素,以保持残留功能.
相关概念视频
01:17Factors Affecting Renal Clearance: Renal Impairment
99
Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
99
01:11Renal Failure: Dose Adjustments
95
In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
95
01:27Dialysis
322
Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
322
01:31Factors Affecting Renal Clearance: Drug's Physicochemical Properties and Plasma Levels
238
Renal clearance of a drug is influenced by various factors, including its physicochemical properties and plasma levels. These factors play a significant role in determining how efficiently the kidneys eliminate a drug.
One important factor is the drug's molecular size. The kidneys readily excrete smaller molecules below 300 Daltons (Da). On the other hand, molecules weighing between 300 and 500 Da are excreted through both urine and bile. Larger molecules above 500 Da tend to be excreted...
One important factor is the drug's molecular size. The kidneys readily excrete smaller molecules below 300 Daltons (Da). On the other hand, molecules weighing between 300 and 500 Da are excreted through both urine and bile. Larger molecules above 500 Da tend to be excreted...
238
01:22Renal Drug Excretion: Effect of Urine pH, Flow Rate, and Drug pKa
179
The pH of urine, the drug's pKa, and the urine flow rate are vital parameters for drug reabsorption and excretion. Urinary pH varies between 4.6 and 8.0 and is influenced by diet, drug intake, and the patient's pathophysiology. It affects a drug's ionization state and reabsorption. For instance, carbohydrate-rich food produces alkaline urine promoting drug excretion, while proteins and certain medications like ascorbic acid lead to acidic urine enhancing reabsorption.
The pKa of a...
The pKa of a...
179
01:09Factors Affecting Renal Clearance: Drug Distribution and Drug Interactions
138
Renal clearance plays a pivotal role in drug elimination from the body and can be influenced by drug distribution and interactions. Understanding these factors is crucial in pharmacology as they impact the effectiveness and duration of drug therapy.
One important factor is the relationship between renal clearance and the apparent volume of distribution. Renal clearance tends to be inversely proportional to the apparent volume of distribution. Drugs with an extensive distribution volume or those...
One important factor is the relationship between renal clearance and the apparent volume of distribution. Renal clearance tends to be inversely proportional to the apparent volume of distribution. Drugs with an extensive distribution volume or those...
138