目的对比羟氯喹(hydroxychloroquine,HCQ)和螺内酯在充分肾素-血管紧张素-醛固酮系统抑制剂(renin-angiotensin-aldosterone system inhibitors,RAASi)治疗的基础上对IgA肾病(immunoglobin A nephropathy)患者的疗效和安全性。方法采用...目的对比羟氯喹(hydroxychloroquine,HCQ)和螺内酯在充分肾素-血管紧张素-醛固酮系统抑制剂(renin-angiotensin-aldosterone system inhibitors,RAASi)治疗的基础上对IgA肾病(immunoglobin A nephropathy)患者的疗效和安全性。方法采用前瞻性、非随机对照研究,纳入2019年4月至2021年3月陆军军医大学第二附属医院肾内科门诊原发性IgA肾病患者172例,其中男性56例,女性116例,年龄(37.5±10.7)岁,分为HCQ组(n=104)和双RAASi组(n=68),均随访6个月。比较两组患者随访期间尿蛋白肌酐比值(UPCR)下降率和肾小球滤过率(eGFR)下降率,以及亚组分析探讨激素或免疫抑制剂对治疗的影响。结果与双RAASi组比较,HCQ组基线血肌酐平均水平更高,eGFR更低,Lee氏分级中Ⅲ~Ⅳ比例更高,差异有统计学意义(P<0.05)。随访6个月,两组UPCR下降率相当(-54.7%vs-52.0%,P=0.551),而HCQ组的eGFR下降率显著低于双RAASi组(-3.3%vs-11.5%,P<0.01)。进一步评价激素或免疫抑制剂对两组治疗的影响,采用亚组分析发现,HCQ和螺内酯对降尿蛋白无显著差异,但对于入组前和入组后全程未使用激素或免疫抑制剂的人群,入组前未使用激素或免疫抑制剂但入组后加用的人群,以及入组前和入组后全程使用激素或免疫抑制剂的人群,HCQ组在随访第6个月时的eGFR下降率显著低于双RAASi组(P<0.05)。在随访过程中两组均未观察到严重不良事件。结论在充分RAASi治疗的基础上尿蛋白不达标的IgA肾病患者,HCQ和螺内酯控制尿蛋白水平效果相当,无严重不良事件,但HCQ在eGFR保护作用显著优于螺内酯。展开更多
Objective Variations are present in common clinical practices regarding best practice in managing hyperkalaemia(HK),there is therefore a need to establish a multi-specialty approach to optimal renin angiotension-aldos...Objective Variations are present in common clinical practices regarding best practice in managing hyperkalaemia(HK),there is therefore a need to establish a multi-specialty approach to optimal renin angiotension-aldosterone system inhibitors(RAASi)usage and HK management in patients with chronic kidney disease(CKD)&heart failure(HF).This study aimed to establish a multi-speciality approach to the optimal use of RAASi and the management of HK in patients with CKD and HF.Methods A steering expert group of cardiology and nephrology experts across China were convened to discuss challenges to HK management through a nominal group technique.The group then created a list of 41 statements for a consensus questionnaire,which was distributed for a further survey in extended panel group of cardiologists and nephrologists across China.Consensus was assessed using a modified Delphi technique,with agreement defined as"strong"(≥75%and<90%)and"very strong"(≥90%).The steering group,data collection,and analysis were aided by an independent facilitator.Results A total of 150 responses from 21 provinces across China were recruited in the survey.Respondents were comprised of an even split(n=75,50%)between cardiologists and nephrologists.All 41 statements achieved the 75%consensus agreement threshold,of which 27 statements attained very strong consensus(≥90%agreement)and 14 attained strong consensus(agreement between 75%and 90%).Conclusion Based on the agreement levels from respondents,the steering group agreed a set of recommendations intended to improve patient outcomes in the use of RAASi therapy and HK management in China.展开更多
文摘目的对比羟氯喹(hydroxychloroquine,HCQ)和螺内酯在充分肾素-血管紧张素-醛固酮系统抑制剂(renin-angiotensin-aldosterone system inhibitors,RAASi)治疗的基础上对IgA肾病(immunoglobin A nephropathy)患者的疗效和安全性。方法采用前瞻性、非随机对照研究,纳入2019年4月至2021年3月陆军军医大学第二附属医院肾内科门诊原发性IgA肾病患者172例,其中男性56例,女性116例,年龄(37.5±10.7)岁,分为HCQ组(n=104)和双RAASi组(n=68),均随访6个月。比较两组患者随访期间尿蛋白肌酐比值(UPCR)下降率和肾小球滤过率(eGFR)下降率,以及亚组分析探讨激素或免疫抑制剂对治疗的影响。结果与双RAASi组比较,HCQ组基线血肌酐平均水平更高,eGFR更低,Lee氏分级中Ⅲ~Ⅳ比例更高,差异有统计学意义(P<0.05)。随访6个月,两组UPCR下降率相当(-54.7%vs-52.0%,P=0.551),而HCQ组的eGFR下降率显著低于双RAASi组(-3.3%vs-11.5%,P<0.01)。进一步评价激素或免疫抑制剂对两组治疗的影响,采用亚组分析发现,HCQ和螺内酯对降尿蛋白无显著差异,但对于入组前和入组后全程未使用激素或免疫抑制剂的人群,入组前未使用激素或免疫抑制剂但入组后加用的人群,以及入组前和入组后全程使用激素或免疫抑制剂的人群,HCQ组在随访第6个月时的eGFR下降率显著低于双RAASi组(P<0.05)。在随访过程中两组均未观察到严重不良事件。结论在充分RAASi治疗的基础上尿蛋白不达标的IgA肾病患者,HCQ和螺内酯控制尿蛋白水平效果相当,无严重不良事件,但HCQ在eGFR保护作用显著优于螺内酯。
文摘Objective Variations are present in common clinical practices regarding best practice in managing hyperkalaemia(HK),there is therefore a need to establish a multi-specialty approach to optimal renin angiotension-aldosterone system inhibitors(RAASi)usage and HK management in patients with chronic kidney disease(CKD)&heart failure(HF).This study aimed to establish a multi-speciality approach to the optimal use of RAASi and the management of HK in patients with CKD and HF.Methods A steering expert group of cardiology and nephrology experts across China were convened to discuss challenges to HK management through a nominal group technique.The group then created a list of 41 statements for a consensus questionnaire,which was distributed for a further survey in extended panel group of cardiologists and nephrologists across China.Consensus was assessed using a modified Delphi technique,with agreement defined as"strong"(≥75%and<90%)and"very strong"(≥90%).The steering group,data collection,and analysis were aided by an independent facilitator.Results A total of 150 responses from 21 provinces across China were recruited in the survey.Respondents were comprised of an even split(n=75,50%)between cardiologists and nephrologists.All 41 statements achieved the 75%consensus agreement threshold,of which 27 statements attained very strong consensus(≥90%agreement)and 14 attained strong consensus(agreement between 75%and 90%).Conclusion Based on the agreement levels from respondents,the steering group agreed a set of recommendations intended to improve patient outcomes in the use of RAASi therapy and HK management in China.
