ABSTRACT
Chronic Kidney Disease (CKD) is an escalating global health concern, affecting more than 10 % of the general population worldwide, amounting to over 800 million individuals. One of its major complications for patients is the high prevalence of skin ulcers . This study aims to develop a protocol for ulcer management within the context of a hospital-based dialysis center. The success of this strategy is deeply rooted in the collaboration of a multidisciplinary team, continually enriched by specialist training. The clinical nurse specialist (CNS) in wound care plays a pivotal role in this approach. By employing a systematic methodology, the protocol is tailored to emphasize holistic care for patients diagnosed with end-stage renal disease undergoing hemodialysis. It accentuates the significance of proactive prevention, in-depth patient education, and the immediate identification of early wound signs. The research underscores the necessity to further weave in specialized training for ulcer care, ensuring each hospital visit is maximized for efficiency and effectiveness. Central to this protocol is the understanding that CKD is a growing concern, that the optimal management of ulcers relies heavily on multidisciplinary collaboration, and that an emphasis on prevention, patient education, and timely wound recognition is crucial to enhance patient care and experience.
ABSTRACT
BACKGROUND: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been reported to be associated with inflammation in end-stage renal disease (ESRD) receiving dialysis. However, the value of NLR and PLR in non-dialysis patients with ESRD remains unclear. METHODS: Among 611 non-dialysis patients with ESRD in The First Affiliated Hospital of University of South China (2012-2018), we compared NLR and PLR in patients with high-sensitivity C-reactive protein (hs-CRP) levels of ≤3 mg/L vs. > 3 mg/L. Correlation of NLR and PLR to hs-CRP, PCT, ferritin were analyzed. Receiver operating characteristics (ROC) analysis was used for estimating sensitivity and specificity of NLR and PLR. RESULTS: NLR was higher in the patients with high hs-CRP levels (> 3 mg/L), compared to patients with low hs-CRP levels (≤ 3 mg/L) [5.74 (3.54-9.01) vs. 3.96 (2.86-5.85), p < 0.0001]. Additionally, PLR was higher in high hs-CRP group than in low group [175.28 (116.67-252.26) vs. 140.65 (110.51-235.17), p = 0.022]. In the current study, NLR and PLR were both positively correlated with hs-CRP (rs = 0.377, p = 0.000 for NLR; rs = 0.161, p = 0.001 for PLR), PCT, leukocytes, neutrophils, platelets, and age. NLR or PLR with a cut-off value of 5.07 or 163.80 indicated sensitivity and specificity were 65.67 and 66.37% (AUC = 0.69) or 57.21 and 57.52% (AUC = 0.55), respectively. CONCLUSIONS: NLR or PLR was positively correlated with hs-CRP in non-dialysis patients with ESRD. NLR might be better for identifying inflammation than PLR in this population.
Subject(s)
C-Reactive Protein/analysis , Inflammation/blood , Kidney Failure, Chronic/blood , Lymphocytes , Neutrophils , Platelet Count , Adult , Biomarkers/blood , Female , Humans , Kidney Failure, Chronic/immunology , Leukocyte Count , Male , Middle Aged , ROC Curve , Sensitivity and SpecificityABSTRACT
Objective: To observe the protective effect of Xiao Chaihutang and Wulingsan on residual renal function in patients with maintenance peritoneal dialysis (PD) and investigate its effect on peritoneal fibrosis and microinflammation.Method: The 65 patients with PD who were admitted to our hospital from June 2016 to June 2017 were enrolled in the study, and divided into control group (32 cases) and study group (33 cases) according to the random number table. The control group received routine treatment. The study group received routine treatment+Xiao Chaihutang and Wulingsan. The fasting venous blood was taken before treatment and 3 months after treatment to measure serum creatinine (SCr) and urea nitrogen (BUN). Urine was collected; 24 hour urine volume was recorded; 24 h urine protein (24 h UP) was measured by colorimetry; glomerular filtration rate (eGFR) was calculated; residual renal function (RRF) was expressed with residual renal creatinine clearance. Inflammatory factors were detected by using chemiluminescence, including interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α) levels. Serum Janus Kinase (JAK) 2 as well as signal transducer and activator of transcription (STAT) 3 levels were determined by double antibody sandwich enzyme-linked immunosorbent assay (ELISA). E-cadherin and α-smooth muscle actin (α-SMA) levels were determined by Western blot.Result: Before treatment, there was no significant difference in the residual renal function between two groups. After treatment, the residual renal function of the study group was significantly better than that of control group (PPα in study group were lower than those in control group (PPPα-SMA protein was significantly increased after treatment (Pα-SMA protein after treatment.Conclusion: Xiao Chaihutang and Wulingsan can protect the residual renal function of PD patients, and the mechanism may be related to the improvement of peritoneal fibrosis and the reduction of micro-inflammation of the body, showing a high application value.
ABSTRACT
BACKGROUND: The number of patients with End-Stage Renal Disease (ESRD) has progressively increased in the population. Kidney transplantation is the specific treatment for such patients; however a majority of patients will require hemodialysis before kidney transplantation. The present study aims to investigate using the external jugular vein (EJV) for Permcath placement in these patients. MATERIALS AND METHODS: This descriptive and analytical study was conducted in Alzahra Medical Center, Isfahan, in 2012. Catheters were inserted by cutting down the right EJV. The patency rate and potential complications were studied. The obtained data was analyzed using SPSS 21.0. RESULTS: Out of 45 live patients, within three months of surgery, 40 patients (81.6%) had no complications and dialysis continued through Permcath. Permcath Thrombosis occurred in two patients (4.4%). Catheter infection led to the removal of it in one patient (2.2%) 1.5 months after surgery. And accidental catheter removal occurred in one patient. CONCLUSION: Placement of the permcath in the external jugular vein can be a safe, uncomplicated, and reliable method for patients requiring hemodialysis, and can be a life-saving alternative in patients without accessible internal jugular vein.
