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Song W, Wu L, Sun C, Kong X, Wang H. New-onset atrial fibrillation following arteriovenous fistula increases adverse clinical events in dialysis patients with end-stage renal disease. Front Cardiovasc Med 2024; 11:1386304. [PMID: 38682103 PMCID: PMC11045994 DOI: 10.3389/fcvm.2024.1386304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/18/2024] [Indexed: 05/01/2024] Open
Abstract
Background End-stage renal disease (ESRD) patients have a high potential cardiovascular burden, and cardiovascular disease (CVD) is the leading cause of death in maintenance haemodialysis (MHD) patients. Arteriovenous fistula (AVF) is the preferred vascular access for MHD patients, but AVF significantly affects the haemodynamics of the cardiovascular system, leading to or exacerbating CVD, including atrial fibrillation (AF). This study aimed to evaluate the impact of AVF on cardiac function, especially of the left atrium (LA), in patients with ESRD and to further explore the relationship between AVF establishment and the occurrence of AF. Methods We selected 1,107 ESRD patients on haemodialysis using AVF and 550 patients with tunneled-cuffed catheters (TCC) admitted between January 2016 and December 2022 for follow-up to compare the rate of AF between the two groups. A total of 153 patients in the AVF group with complete information (clinical data, echocardiographic and biochemical indices, and other data) were enrolled and retrospectively analysed for risk factors for the development of AF and were followed up for adverse clinical outcomes (including all-cause death, cardiac death, readmission due to heart failure, and stroke). Results The incidence of new-onset AF was higher in the AVF group than the TCC group after dialysis access was established (16.30% vs. 5.08%, P < 0.001). Echocardiography showed that the LA anteroposterior diameter increased (P < 0.001) and the incidence of AF increased from 11.76% to 26.14% (P = 0.001) after AVF establishment. Multivariate logistic regression analysis showed that age and LA enlargement were independent risk factors for new-onset AF after AVF establishment (P < 0.05). Adverse clinical outcomes were more common in patients with AF than in patients without AF (P < 0.001). Multivariate Cox risk regression analysis suggested that new-onset AF (HR = 4.08, 95% CI: 2.00-8.34, P < 0.001) and left ventricular systolic dysfunction (HR = 2.42, 95% CI: 1.20-4.88, P = 0.01) after AVF establishment were independent risk factors for adverse clinical outcomes. Conclusion LA enlargement after AVF establishment is associated with a significant increase in the incidence of AF, in addition, AF which is as an important influential factor in patients with MHD combined other systemic diseases might increase adverse clinical events. Clinical Trial Registration (NCT06199609).
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Affiliation(s)
- Wenhui Song
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Lizhou Wu
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Chong Sun
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Xianglei Kong
- Department of Nephrology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Nephrology, Jinan, China
| | - Haiyan Wang
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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Ertuglu LA, Deger SM, Alsouqi A, Hung A, Gamboa J, Mambungu C, Sha F, Siew E, Abumrad NN, Ikizler TA. A randomized controlled pilot trial of anakinra and pioglitazone for protein metabolism in patients on maintenance haemodialysis. J Cachexia Sarcopenia Muscle 2024; 15:401-411. [PMID: 38178557 PMCID: PMC10834322 DOI: 10.1002/jcsm.13395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/17/2023] [Accepted: 11/02/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Chronic inflammation and insulin resistance are highly prevalent in patients on maintenance haemodialysis (MHD) and are strongly associated with protein energy wasting. We conducted a pilot, randomized, placebo-controlled trial of recombinant human interleukin-1 receptor antagonist (IL-1ra) and pioglitazone to explore the safety, feasibility and efficacy for insulin-mediated protein metabolism in patients undergoing MHD. METHODS Twenty-four patients were randomized to receive IL-1ra, pioglitazone or placebo for 12 weeks. Changes in serum inflammatory markers and insulin-mediated protein synthesis, breakdown and net balance in the whole-body and skeletal muscle compartments were assessed using hyperinsulinaemic-hyperaminoacidemic clamp technique at baseline and Week 12. RESULTS Among 24 patients, median (interquartile range) age was 51 (40, 61), 79% were African American and 21% had diabetes mellitus. All patients initiated on intervention completed the study, and no serious adverse events were observed. There was a statistically significant decrease in serum high-sensitivity C-reactive protein in the pioglitazone group compared with placebo, but not in the IL-1ra group. No significant differences in the changes of whole-body or skeletal muscle protein synthesis, breakdown and net balance were found between the groups. CONCLUSIONS In this pilot study, there were no statistically significant effects of 12 weeks of IL-1ra or pioglitazone on protein metabolism in patients on MHD. CLINICALTRIALS gov registration: NCT02278562.
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Affiliation(s)
- Lale A Ertuglu
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Serpil Muge Deger
- Department of Nephrology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Aseel Alsouqi
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
- Now with Department of Medicine, Division of Hematology and Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Adriana Hung
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center Kidney Disease, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Administration Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Jorge Gamboa
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cindy Mambungu
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center Kidney Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Feng Sha
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center Kidney Disease, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edward Siew
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center Kidney Disease, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Administration Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Naji N Abumrad
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - T Alp Ikizler
- Department of Medicine, Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Center Kidney Disease, Vanderbilt University Medical Center, Nashville, TN, USA
- Veterans Administration Tennessee Valley Healthcare System, Nashville, TN, USA
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Nizami AA, Mustafa W, Qadir M, Shahzad M, Iqbal H, Ali A, Jadoon SK, Akbar A, Tasneem S, Saleem Khan M. Risk Factors of Cardiovascular and Cerebrovascular Events in Patients With Uraemia Complicated With Hypertension During Maintenance Haemodialysis Treatment. Cureus 2024; 16:e53411. [PMID: 38435216 PMCID: PMC10908417 DOI: 10.7759/cureus.53411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION This study aimed to investigate the risk factors associated with major adverse cardiovascular (group of events that affect heart and blood vessels) and cerebrovascular (events affecting blood vessels supplying the brain) events (MACCE) in patients with uraemia complicated with hypertension who required maintenance haemodialysis (MHD) treatment. METHODOLOGY Clinical data and laboratory indicators of 156 uraemia patients complicated with hypertension were collected and retrospectively analysed. The patients were admitted to a tertiary care hospital (Abbas Institute of Medical Sciences AIMS) in Muzaffarabad, Pakistan, from February 2018 to February 2022. The data was collected through consecutive sampling and patients were recruited after following the inclusion and exclusion criteria. RESULTS Eighty-one out of 156 patients were not complicated with MACCE, and 75 patients were complicated with MACCE during the MHD treatment cycle, with an incidence of 48.08%. Compared to the non-MACCE group, the MACCE group's diabetes, body mass growth rate, triglyceride (TG), NT-proBNP, standard deviation and coefficient of variance for systolic and diastolic blood pressure (SBP-SD, SBP-CV, DBP-SD, and DBP-CV) showed significant differences (P<0.05) between the groups. Diabetes, body mass growth rate, TG, NT-proBNP, SBP-SD, SBP-CV, DBP-SD, and DBP-CV with odds ratios of 3.074, 3.202, 2.188, 2.512, 2.357, 2.431, 2.299, and 2.062 respectively were risk factors for MACCE in uraemia patients with hypertension. CONCLUSION From the results of this study, we inferred that patients with uraemia and hypertension complicated by MACCE in the treatment cycle of MHD were related to diabetes, body mass growth rate, TG, NT-proBNP, SBP-SD, SBP-CV, DBP-SD, and DBP-CV.
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Affiliation(s)
| | - Waqar Mustafa
- Cardiology, Combined Military Hospital, Muzaffarabad, PAK
| | - Mamoon Qadir
- Cardiology, Federal Government Polyclinic, Islamabad, PAK
| | - Maria Shahzad
- Cardiology, Federal Government Polyclinic, Islamabad, PAK
| | - Hamid Iqbal
- Cardiology, Federal Government Polyclinic, Islamabad, PAK
| | - Anwar Ali
- Cardiology, Kulsum International Hospital, Islamabad, PAK
| | | | - Amna Akbar
- Emergency and Accident, District Headquarters Hospital, Muzaffarabad, PAK
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Chen X, Wang M, Niu J, Ma J, Qian J, Ni L, Cheng P, You H, Chen J. Plasma Aβ 42:Aβ 40 ratio as a biomarker for cognitive impairment in haemodialysis patients: a multicentre study. Clin Kidney J 2023; 16:2129-2140. [PMID: 37915896 PMCID: PMC10616443 DOI: 10.1093/ckj/sfad173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Indexed: 11/03/2023] Open
Abstract
Background Mild cognitive impairment (MCI) and dementia are more prevalent in patients undergoing haemodialysis (HD). Although the cerebrospinal fluid amyloid beta (Aβ) and tau (τ) have proven to be valid biomarkers for the diagnosis of Alzheimer's disease (AD) in the general population, the roles of plasma Aβ and τ for the diagnosis of cognitive impairment in HD patients remain unknown. Methods We conducted a cross-sectional study including patients receiving HD in three hospitals in Shanghai. All patients completed the Montreal Cognitive Assessment-Basic (MoCA-B). To validate the effectiveness of the MoCA-B score for screening MCI, a subset group underwent neuropsychological batteries. Serum proteomes were compared in HD patients with normal cognitive function and dementia. Plasma Aβ42, Aβ40 and total τ were measured using a single molecule array. Results A total of 311 HD patients were enrolled (mean age 63 years, 55% male). The best cut-off score of MoCA-B for differentiating MCI and normal cognition was 24, with an area under the curve of 0.94. Serum proteomics revealed that neurodegenerative pathways related to AD were enriched in HD patients with dementia. The plasma Aβ42:Aβ40 ratio was significantly reduced in patients with MCI and dementia and was independently associated with cognitive function after adjusting for age, sex and education levels. Conclusions We validated the MoCA-B as an optimal cognitive function screening instrument for MCI in HD patients. The plasma Aβ42:Aβ40 ratio was a potential biomarker in distinguishing normal cognition, MCI and dementia in HD populations.
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Affiliation(s)
- Xujiao Chen
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mengjing Wang
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianying Niu
- Division of Nephrology, Fifth People's Hospital Fudan University, Shanghai, China
| | - Jun Ma
- Division of Nephrology, Jingan District Centre Hospital of Shanghai, Shanghai, China
| | - Jing Qian
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Ni
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ping Cheng
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Huaizhou You
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jing Chen
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Cao T, An R, Wang Y, Lei J, Liang J, Wan Q. Risk factors and prevalence of cognitive impairment in maintenance haemodialysis patients: A systematic review and meta-analysis of observational studies. J Adv Nurs 2023; 79:3691-3706. [PMID: 37357980 DOI: 10.1111/jan.15746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/25/2023] [Accepted: 06/10/2023] [Indexed: 06/27/2023]
Abstract
AIMS To systematically identify the risk factors for cognitive impairment in maintenance haemodialysis patients and to assess its prevalence in included studies. DESIGN Systematic review and meta-analysis about observational studies. DATA SOURCES Systematic search of seven databases, including PubMed, Web of Science, Scope, Wanfang Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Weipu Chinese Science and Technology Journal Database, from inception until October 2021. REVIEW METHODS Observational studies reporting the risk factors for cognitive impairment in maintenance haemodialysis patients in English and Chinese language were included. Meta-analysis was performed to identify risk factors and prevalence of cognitive impairment in maintenance haemodialysis patients with STATA 15.0 software. RESULTS Overall, 37 eligible studies encompassing 129,849 cases were included. The risk factors with statistical significance after meta-analysis were older age, female sex, fewer years of education, hypertension, diabetes, cerebrovascular accident, multiple comorbid conditions, systolic blood pressure variability, arterial stiffness and low haemoglobin and albumin level. The overall prevalence of cognitive impairment in maintenance haemodialysis patients was 49.1%. CONCLUSION The current analysis indicated a high prevalence of cognitive impairment in maintenance haemodialysis patients. Eleven risk factors for cognitive impairment in maintenance haemodialysis patients were identified, among which more attention should be paid to modifiable factors such as cardiovascular disease risk factors and specific kidney and dialysis-related factors. IMPACT This paper provides an updated estimate of the pooled prevalence of cognitive impairment in maintenance haemodialysis patients. Identification of risk factors associated with cognitive impairment may assist in developing targeted prevention strategies for maintenance haemodialysis patients at high risk. NO PATIENT OR PUBLIC CONTRIBUTION This study was a systematic review completed by the authors in accordance with relevant guidelines and processes and did not include the participation of patients, service users, caregivers or the general public.
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Affiliation(s)
- Ting Cao
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- School of Nursing, Peking University, Beijing, China
| | - Ran An
- School of Nursing, Peking University, Beijing, China
| | - Ying Wang
- Center of Blood Purification, Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Juan Lei
- Center of Blood Purification, Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Junqing Liang
- Center of Blood Purification, Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Qiaoqin Wan
- School of Nursing, Peking University, Beijing, China
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Ye L, Tang X, Zhang H, Ge S, Yin L, Zhou Y, Chang J. Prevalence and risk factors of pre-frailty and frailty in maintenance haemodialysis patients in China: A cross-sectional Study. J Adv Nurs 2023; 79:3522-3534. [PMID: 37186471 DOI: 10.1111/jan.15676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/07/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023]
Abstract
AIMS To examine the prevalence and risk factors of pre-frailty and frailty in maintenance haemodialysis patients in China. DESIGN A cross-sectional study. METHOD From January to July 2017, using the convenience sampling method, a total of 503 maintenance haemodialysis patients from six hospitals in Lianyungang, China, were recruited for this study. The participants' socio-demographic, lifestyle factors and health information were assessed using a general information questionnaire. Frailty was evaluated based on the Fried frailty phenotype. Multi-categorical logistic regression was performed to examine factors associated with pre-frailty and frailty in this population, including age, sex, living alone, employment, educational level, body mass index, per capita monthly household income, smoking status, exercise status, primary diagnosis, dialysis age, frequency of dialysis, vascular access, congestive heart failure, other cardiac diseases, cerebrovascular disease, peripheral blood diseases, pain, albumin level and haemoglobin level. RESULTS Among the 503 participants with an average age of 53.02 years (standard deviation 14.99), 178 had pre-frailty (35.3%) and were mostly young and middle-aged. The prevalence of pre-frailty among participants <60 years old was more than 40%. Regression analysis showed that lack of exercise, dialysis age ≤12 months, congestive heart failure and other cardiac diseases were positively associated with pre-frailty. Two hundred and eighteen participants were frail (43.3%), most of whom were aged ≥60. The prevalence of frailty in participants ≥60 was 71.4%. Regression analysis showed that advanced age, being female, obesity, low per capita monthly household income, lack of exercise, diabetes as the primary disease, dialysis age ≤12 months, congestive heart failure, other cardiac diseases, pain and low albumin level, were positively associated with frailty. In addition, more than half of the participants hardly exercised (64.6%), while lack of exercise was a risk factor for pre-frailty and frailty. A third of the participants had pain (33.4%), while pain was an independent risk factor for pre-frailty and frailty in these participants. CONCLUSION Pre-frailty and frailty are common in patients with maintenance haemodialysis. Most of the elderly maintenance haemodialysis patients are frail, and most of the young and middle-aged patients are pre-frail. Clinicians should actively screen the pre-frailty and frailty among patients with maintenance haemodialysis, especially those with dialysis age ≤12 months. Many factors affect pre-frailty and frailty in this population. Tailored intervention measures should be designed and implemented based on these factors, giving priority to exercise guidance and pain management for patients to help them prevent or reverse pre-frailty and frailty.
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Affiliation(s)
- Liqin Ye
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Xianping Tang
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Hailin Zhang
- Department of Nursing, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Jiangsu, Lianyungang, China
| | - Song Ge
- Department of Natural Sciences/Nursing, University of Houston-Downtown, Texas, Houston, USA
| | - Lixia Yin
- Department of Nursing, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Jiangsu, Lianyungang, China
| | - Ying Zhou
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Jian Chang
- Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Nursing, Shanghai, China
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Mondal M, Islam MN, Ullah A, Haque MR, Rahman M, Bosak L, Rahman MF, Zaman SR, Rahman MM. Clinical manifestations and outcomes of COVID-19 in maintenance hemodialysis patients of a high infectious epidemic country: a prospective cross-sectional study. Ann Med Surg (Lond) 2023; 85:4293-4299. [PMID: 37663710 PMCID: PMC10473334 DOI: 10.1097/ms9.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/01/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction The outbreak of COVID-19 poses great challenges for patients on maintenance haemodialysis. Here, we reported the clinical characteristics and laboratory features of maintenance haemodialysis (MHD) patients with COVID-19 in Bangladesh. Methods Altogether, 67 MHD patients were enroled in the study from two dedicated tertiary-level hospitals for COVID-19 after the prospective cross-sectional execution of selection criteria. Data were collected from medical records and interviews. Different statistical analysis was carried out in the data analysis. Results The mean age was 55.0±9.9 years, with 40 males (59.7%). The mean dialysis duration was 23.4±11.5 months. The most common symptoms were fever (82.1%), cough (53.7%), and shortness of breath (55.2%), while the common comorbid condition was hypertension (98.5%), followed by diabetes (56.7%). Among MHD patients, 52.2% to 79.1% suffered from severe to critical COVID-19, 48 patients (71.6%) had 26-75% lung involvement on high resolution computed tomography of the chest, 23 patients (34.3%) did not survive, 20 patients (29.9%) were admitted to ICU, and nine patients (13.4%) needed mechanical ventilation. Patients who did not survive were significantly older (mean age: 63.0 vs. 50.86 years, P=0.0001), had significantly higher cardiovascular risk factors (69.6% vs. 43.2%, P=0.04), severe shortness of breath (82.6% vs. 40.9%, P=0.0001), and longer hospital stays (mean days: 17.9 vs. 13.0, P=0,0001) compared to the survivor group. The white blood cell count, C-reactive protein, lactate dehydrogenase, pro-calcitonin, and thrombocytopenia were significantly (P<0.0001) higher, while the albumin level was significantly lower (P=0.0001) in non-survivor compared to patients who survived. Conclusion Maintenance haemodialysis patients had severe to critical COVID-19 and had a higher risk of non-survival if they were older and had comorbidities such as hypertension and diabetes. Therefore, MHD patients with COVID-19 need close monitoring to improve their outcomes.
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Affiliation(s)
- Mina Mondal
- Department of Nephrology, Khulna Medical College, Khulna
| | | | | | | | - Motiur Rahman
- Kalkini Upzilla Health Complex, Kalkini, Madaripur, Bangladesh
| | - Liza Bosak
- Basic Science Division, World University of Bangladesh
| | - Md. Foyzur Rahman
- Department of Community Medicine, National Institute of Preventive and Social Medicine (NIPSOM)
| | | | - Mohammad Meshbahur Rahman
- Department of Biostatistics, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka
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Xie C, Li L, Li Y. "Alive Day is the Day": A Qualitative Study of Experiences of Learned Helplessness in Maintenance Haemodialysis Patients. Risk Manag Healthc Policy 2023; 16:231-245. [PMID: 36815199 PMCID: PMC9939906 DOI: 10.2147/rmhp.s401205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
Background Learned helplessness (LH) is a common psychological phenomenon among chronic disease patients. However, LH remains underrecognized in the context of maintenance haemodialysis (MHD) patients. This qualitative study is the first study of this topic to be conducted in a Chinese cultural context, and its purpose is to explore the LH experiences of MHD patients and to highlight their interpretations of LH. Methods We employed a qualitative research design. A purposive sampling method was used to recruit participants. The sample size was determined by data saturation. Data were obtained from MHD patients in a blood purification centre located in Hunan Province, China. Data were collected from June to September 2022. The researchers conducted in-depth, semistructured interviews with participants after obtaining informed consent. Texts were transcribed verbatim from the audio recordings of these interviews. Data processing and analysis were based on Giorgi's phenomenological approach. Results Twenty-two respondents completed the interviews (aged 29-75 years, including ten females and twelve males). Four themes emerged from the interviews: (1) triggers of helplessness (hope is gone; witnessing renal friends' helplessness; out of control; nothing works); (2) being tied down (limitation; perceived loss; social isolation; giving in); (3) I am just a loser (self-image disorder; low self-concept; negative attitudes; guilt; abandonment); (4) alive day is the day (fatalism; my duty; downwards comparison). Conclusion The study reveals that multiple stressors drive MHD patients' LH. These salient phenomena demonstrate the importance of recognizing MHD patients' LH. We suggest that support services should be developed alongside a framework that addresses MHD patients' LH from the beginning of treatment.
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Affiliation(s)
- Chunyan Xie
- Clinical Nursing Teaching and Research Section, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410011, People’s Republic of China,Xiangya Nursing School of Central South University, Changsha, Hunan Province, 410013, People’s Republic of China
| | - Li Li
- Xiangya Nursing School of Central South University, Changsha, Hunan Province, 410013, People’s Republic of China,The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830011, People’s Republic of China
| | - Yamin Li
- Clinical Nursing Teaching and Research Section, the Second Xiangya Hospital of Central South University, Changsha, Hunan Province, 410011, People’s Republic of China,Correspondence: Yamin Li, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China, Email
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Xie C, Li L, Li Y. Trajectories of Learned Helplessness in Maintenance Haemodialysis Patients and Their Predictive Effects on Self-Management: A Latent Growth Mixture Modeling Approach. Psychol Res Behav Manag 2023; 16:351-361. [PMID: 36798876 PMCID: PMC9926927 DOI: 10.2147/prbm.s401380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/03/2023] [Indexed: 02/11/2023] Open
Abstract
Background Learned helplessness (LH) is an essential psychological factor influencing maintenance haemodialysis (MHD) patients' health behaviour and is closely related to prognosis of the disease. This study aimed to identify potential trajectories of LH in MHD patients and assess their predictive role in self-management. Methods This study was conducted in strict compliance with national laws, the Declaration of Istanbul, and the Declaration of Helsinki. A total of 347 MHD patients at a blood purification centre in Hunan Province, China, were selected as the study population. Four longitudinal surveys (baseline and second/fourth/sixth month after baseline) were conducted using the General Information Questionnaire for MHD patients, the Chinese version of the Learned Helplessness Scale for MHD patients, and the Self-Management Scale for Haemodialysis. Latent growth mixture model (LGMM) analysis was used to identify LH trajectories, and their predictors were analysed using multinomial logistic regression. The predictive role of LH trajectory on self-management was analysed using linear regression. Results This study identified three LH trajectories in MHD patients, named the "high-decreasing group" (57.9%), "low-increasing group" (21.3%), and "low-stability group" (20.7%). The results of the univariate analysis showed that sex (χ2=33.777, P < 0.001), age (χ2=10.605, P<0.05), and subjective social status (SSS) (χ2=12.43, P<0.01) were associated with LH trajectory classes. Multinomial logistic regression further demonstrated that gender, age, and SSS were predictors of different LH trajectories. The intercept and slope of the overall LH trajectory were negatively correlated with self-management (β=-0.273, P<0.001; β=-0.234, P<0.01). Conclusion MHD patients show three different LH trajectories. The initial level and developmental rate of LH can negatively predict future self-management. It is necessary to screen MHD patients' LH and develop targeted interventions for them with different LH trajectories at specific stages.
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Affiliation(s)
- Chunyan Xie
- Clinical Nursing Teaching and Research Section, the Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China,XiangYa Nursing School, Central South University, Changsha, People’s Republic of China
| | - Li Li
- XiangYa Nursing School, Central South University, Changsha, People’s Republic of China,The First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Yamin Li
- Clinical Nursing Teaching and Research Section, the Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China,Correspondence: Yamin Li, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, People’s Republic of China, Email
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Zhu Z, Li P, Chai D, Luan W. Correlation Between the Frailty of Elderly Patients on Regular Haemodialysis and the Quality of Life of Their Family Caregivers: A Cross-Sectional Evaluation. J Multidiscip Healthc 2022; 15:2321-2330. [PMID: 36259072 PMCID: PMC9572479 DOI: 10.2147/jmdh.s384699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the correlation between the frailty status of elderly patients on regular haemodialysis and the quality of life of their family caregivers. Methods 90 elderly patients with regular haemodialysis and 90 family caregivers of the respective patients were selected from January 2020 to April 2021. The influencing factors of the caregivers' quality of life and correlation between patient debility and caregiver quality of life were analyzed by general information questionnaire, Tilburg debility index scale, self-care ability scale, family caregiver-related quality-of-life scale and social support scale. Results The quality of life of the family caregivers of elderly patients on regular haemodialysis is at the medium level (4.50 ± 2.96). Multiple linear stepwise regression analysis shows that the ability of patients to take care of themselves, the degree of patients' weaknesses, whether they care for non-dialysis patients, the time to care for patients, social support and the type of current residence have significant impacts on the quality of life of the caregivers (p < 0.001). Variance analysis showed that the fitting degree of linear regression equation is relatively high, and the regression equation is significant (F = 9.195, p < 0.001, R = 0.595, R2 = 0.315). The quality of life of caregivers is positively correlated with the ability of the patients to take care of themselves, the length of care, social support and type of current residence (p < 0.05). The degree of weakness in patients is negatively correlated with taking care of non-regular dialysis patients (p < 0.05). Conclusion The ability of patients to take care of themselves, the degree of weakness of the patients, social support and the type of current residence are the influencing factors of the burden on the family caregivers of maintenance haemodialysis patients.
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Affiliation(s)
- Zhu Zhu
- Department of VIP Clinic, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, People’s Republic of China
| | - Ping Li
- Department of Hemodialysis Center, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, People’s Republic of China
| | - Dongxue Chai
- Department of Hemodialysis Center, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, People’s Republic of China
| | - Wei Luan
- Department of VIP Medical Office, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, People’s Republic of China,Correspondence: Wei Luan, Renji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160 of Pujian Road, Pudong District, Shanghai, 200127, People’s Republic of China, Tel/Fax +86 21 6838 3088, Email
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Yang T, Wang S, Zhang X, Liu L, Liu Y, Zhang C. Efficacy of auricular acupressure in maintenance haemodialysis patients: A systematic review and meta-analysis. J Clin Nurs 2021; 31:508-519. [PMID: 34268817 DOI: 10.1111/jocn.15966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 06/22/2021] [Accepted: 06/28/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To systematically evaluate the efficacy of auricular acupressure on sleep disorders, depression, pruritus, xerostomia and daily net weight gain (%) in maintenance haemodialysis patients. BACKGROUND Auricular acupressure has been used for various complications in maintenance haemodialysis patients, such as sleep disorders, depression, pruritus and xerostomia, but the efficacy has not yet been unified. DESIGN Systematic review and meta-analysis. METHODS Randomised controlled trials comparing auricular acupressure intervention with non-AA intervention in maintenance haemodialysis patients were included. We searched English databases (PubMed, Cochrane Library, Embase, Web of Science) and Chinese databases (CNKI, WanFang, CBM and VIP database) from the inception to 27 November 2020. The risk of bias was assessed by the Cochrane risk of bias tool. The RevMan 5.3 software was used to perform the meta-analysis. A descriptive analysis was conducted if the data were high of heterogeneity or could not be meta-analysed. The PRISMA statement was used to report systematic review and meta-analysis. RESULTS A total of 12 RCTs with 805 MHD patients were included. Meta-analysis showed that auricular acupressure had a significant difference for improving sleep disorders (MD = -1.97 points, 95% CI: -2.62 to -1.32, p < .0001), pruritus (MD = -1.55 points, 95% CI: -2.01 to -1.08, p < .0001), and daily net weight gain (%) (MD = -0.29, 95% CI: -0.37 to -0.21, p < .0001). The efficacy of depression and xerostomia were analysed descriptively due to insufficient data. CONCLUSIONS The meta-analysis results indicated that auricular acupressure had a positive efficacy in maintenance haemodialysis patients to improve sleep disorders, pruritus and daily net weight gain (%). But the results should be treated conservatively on account of the low quality of included studies. Future researchers need to conduct more high-quality, large sample, multi-centre randomised controlled studies to provide a solid basis to demonstrate of the efficacy of auricular acupressure in maintenance haemodialysis patients. RELEVANCE TO CLINICAL PRACTICE Auricular acupressure has the advantages of low cost, non-invasive and easy to be accepted by patients. This review suggested that auricular acupressure could be considered a non-pharmacological intervention for maintenance haemodialysis patients. Medical staff could teach maintenance haemodialysis patients auricular acupressure to help them self-manage some complications at home.
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Affiliation(s)
- Ting Yang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shurui Wang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiaohong Zhang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Lirong Liu
- Blood Purification Centre, Southeast University Zhongda Hospital, Nanjin, China
| | - Yanhui Liu
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chunmei Zhang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Yang Y, Ye H, He Q, Zhang X, Yu B, Yang J, Chen J. Association between predialysis hypermagnesaemia and morbidity of uraemic restless legs syndrome in maintenance haemodialysis patients: a retrospective observational study in Zhejiang, China. BMJ Open 2019; 9:e027970. [PMID: 31292178 PMCID: PMC6624039 DOI: 10.1136/bmjopen-2018-027970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The aim of the present study was to determine whether the predialysis serum magnesium level was associated with morbidity of uraemic restless legs syndrome (RLS) in maintenance haemodialysis patients. DESIGN A retrospective observational study of morbidity of uraemic RLS was conducted. SETTING Patients on maintenance haemodialysis three times a week. PARTICIPANTS We reviewed 578 patients receiving maintenance haemodialysis for >1 year as our cohort. OUTCOME MEASURES Uraemic RLS was diagnosed according to International RLS Study Group criteria, and hypermagnesaemia was defined as serum magnesium level >1.02 mmol/L. RESULTS The prevalence of uraemic RLS was 14.4% in our study cohort. Univariate analysis indicated that patients with uraemic RLS differed significantly from non-RLS ones in certain demographic and clinical characteristics, including younger age, longer dialysis duration, higher serum parathyroid hormone level and higher prevalence of predialysis hyperphosphataemia and hypermagnesaemia. Binary logistic-regression model analysis indicated that predialysis hypermagnesaemia was independently associated with uraemic RLS and conferred an increase in morbidity of the syndrome (OR=2.024; 95% CI 1.160 to 3.532; p=0.013). Moreover, we found that dialysis duration and predialysis hyperphosphataemia were independently associated with morbidity of uraemic RLS. CONCLUSIONS Our data indicated that the predialysis serum magnesium level was associated with morbidity of uraemic RLS in maintenance haemodialysis patients and that predialysis hypermagnesaemia might serve as an independent risk factor for the syndrome.
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Affiliation(s)
- Yi Yang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hongying Ye
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Department of Nephrology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Qien He
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Department of Nephrology, Beilun People’s Hospital, Ningbo, China
| | - Xiaohui Zhang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Department of Nephrology, Yiwu Municipal Central Hospital, Yiwu, China
| | - Biying Yu
- Department of Nephrology, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, China
| | - Jingjuan Yang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Department of Nephrology, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Liu L, Liu YP, Wang J, An LW, Jiao JM. Use of a knowledge-attitude-behaviour education programme for Chinese adults undergoing maintenance haemodialysis: Randomized controlled trial. J Int Med Res 2016; 44:557-68. [PMID: 26951842 PMCID: PMC5536721 DOI: 10.1177/0300060515604980] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 08/14/2015] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To investigate the effects of a knowledge-attitude-behaviour health education model on acquisition of disease-related knowledge and self-management behaviour by patients undergoing maintenance haemodialysis. METHODS Patients recently prescribed MHD were randomly assigned to a control group or an intervention group. Control group patients were treated with usual care and general education models. A specialist knowledge-attitude-behaviour health education model was applied to patients in the intervention group. RESULTS Eighty-six patients were included (n = 43 per group). Before intervention, there were no significant between-group differences in disease knowledge and self-management behaviour. After 6 months' intervention, a significant between-group difference in acquisition of disease knowledge was observed. Self-management behaviour scores (control of body mass, reasonable diet, correct drug intake, physical activity, correct fistula care, disease condition monitoring, psychological and social behaviours) for the intervention group were also higher than those for the control group. CONCLUSION These preliminary findings suggest that the knowledge-attitude-behaviour model appears to be a valuable tool for the health education of MHD patients.
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Affiliation(s)
- Li Liu
- Ward 3, Department of Nephrology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yue-Ping Liu
- Department of Hepatopancreatobiliary Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jing Wang
- Blood Purification Centre, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Li-Wei An
- Blood Purification Centre, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jian-Mei Jiao
- Blood Purification Centre, Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Wu Y, He Q, Yin X, He Q, Cao S, Ying G. Effect of individualized exercise during maintenance haemodialysis on exercise capacity and health-related quality of life in patients with uraemia. J Int Med Res 2014; 42:718-27. [PMID: 24781720 DOI: 10.1177/0300060513509037] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 09/22/2013] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the effect of individualized exercise on exercise capacity and health-related quality of life (HRQoL) in uraemic patients during maintenance haemodialysis (MHD). METHODS Patients receiving MHD were divided randomly into a test group, who underwent recumbent cycling exercise during dialysis, and a control group, who performed simple stretching exercises. The same dialysis protocol was used for all study participants. At study start and after 12 weeks, exercise capacity was measured using tests of physical ability; HRQoL was measured using the kidney disease quality of life score (KDQOL-SF™). RESULTS A total of 65 patients were included in the study: 33 in the control group and 32 in the test group. There were no significant differences in patient characteristics between the two groups at baseline. After 12 weeks, there were significant improvements in exercise capacity and in many of the items of the KDQOL-SF™ in the test group compared with the control group. CONCLUSION Individualized exercise during MHD significantly improved the exercise capacity and HRQoL for uraemic patients within a short time period, and could therefore be used as a simple, cost-effective therapeutic approach.
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Affiliation(s)
- Yongyao Wu
- Beilun People's Hospital (Beilun Branch of the First Affiliated Hospital, Zhejiang University School of Medicine), Ningbo, China
| | - Qiang He
- Beilun People's Hospital (Beilun Branch of the First Affiliated Hospital, Zhejiang University School of Medicine), Ningbo, China
| | - Xiaohong Yin
- Beilun People's Hospital (Beilun Branch of the First Affiliated Hospital, Zhejiang University School of Medicine), Ningbo, China
| | - Qien He
- Kidney Disease Centre, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shengsheng Cao
- Kidney Disease Centre, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guanghui Ying
- Kidney Disease Centre, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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