Rov Qab Los Ntawm Lub Raum Ua Haujlwm Tom Qab Dialysis Pib Hauv Cov Me Nyuam Thiab Cov Neeg Laus hauv Teb Chaws Asmeskas: Kev Kawm Rov Qab Los Ntawm Tebchaws Meskas Cov Ntaub Ntawv Raum Cov Ntaub Ntawv

Hu rau: Audrey Hu Whatsapp / hp: 0086 13880143964 Email:audrey.hu@wecistanche.com

Elaine Ku et al

Abstract

Keeb kwm

Tsawg tsis paub txog yam cuam tshuam nrog kev rov qab los ntawmraummuaj nuj nqi-thiab rov qab mus rau kev lim ntshav ywj pheej-lossis ib ntus kev hloov pauv hauv lub sijhawm rov qab los tom qab pib kev lim ntshav tawm sab nraud hauv Tebchaws Meskas. Kev nkag siab txog cov yam ntxwv ntawm cov tib neeg uas tuaj yeem muaj peev xwm rov qab ua haujlwm ntawm lub raum tuaj yeem txhawb kev paub txog cov xwm txheej zoo li no. Lub hom phiaj ntawm txoj kev tshawb no yog txhawm rau txiav txim siab txog yam cuam tshuam nrog kev rov ua haujlwm ntawm lub raum hauv cov menyuam yaus piv nrog cov neeg laus pib lim ntshav hauv Asmeskas.

Cov txheej txheem thiab kev tshawb pom

Peb txiav txim siab yam cuam tshuam nrog kev rov qab los ntawmraummuaj nuj nqi-txhais tias muaj sia nyob thiab kev txiav tsis tu ncua ntawm kev lim ntshav rau lub sijhawm {{{0}}}hnub-hauv cov menyuam yaus thiab cov neeg laus uas tau pib kho ntshav lim ntshav nruab nrab ntawm 1996 thiab 2015 raws li United States Renal Data System(USRDS ) ua raws li 2016 nyob rau hauv kev tshawb fawb rov qab. Peb kuj tau tshuaj xyuas qhov sib txawv ntawm lub cev hauv cov nqi rov qab los ntawm 2 xyoo dhau los hauv pawg neeg no. Ntawm 1,968,253 tus neeg suav nrog hauv txoj kev tshawb no, lub hnub nyoog nruab nrab yog 62.6 ± 15.8 xyoo, thiab 44 feem pua ​​​​yog poj niam. Zuag qhia tag nrho, 4 feem pua ​​​​ntawm cov neeg laus (83,302/1,953,881) thiab 4 feem pua ​​​​ntawm cov menyuam yaus (547/14,372) pib lim ntshav hauv qhov chaw kho mob sab nraud tau rov qab ua haujlwm rau lub raum hauv 1 xyoos. Ntawm cov neeg uas rov zoo, lub sijhawm nruab nrab ntawm kev rov zoo yog 73 hnub (interquartile range [IQR] 43–131) hauv cov neeg laus thiab 100 hnub (IQR 56–189) hauv cov menyuam yaus. Kev suav nyiaj rau qhov kev pheej hmoo sib tw ntawm kev tuag, cov menyuam yaus tsis tshua muaj peev xwm rov qab ua haujlwm rau lub raum piv nrog cov neeg laus (sub-hazard ratio [sub-HR] 0.81; 95 feem pua ​​​​CI 0.74–0.89, p-value<0.001; point="" estimates=""><1 indicating="" increased="" risk="" for="" a="" negative="" outcome).="" non-hispanic="" black="" (nhb)="" adults="" were="" less="" likely="" to="" recover="" compared="" with="" non-hispanic="" white="" (nhw)="" adults,="" but="" these="" racial="" differences="" were="" not="" observed="" in="" children.="" of="" note,="" a="" steady="" increase="" in="" the="" incidence="" of="" recovery="" of="" kidney="" function="" was="" noted="" initially="" in="" adults="" and="" children="" between="" 1996="" and="" 2010,="" but="" this="" trend="" declined="" thereafter.="" the="" diagnoses="" associated="" with="" the="" highest="" recovery="" rates="" of="" recovery="" were="" acute="" tubular="" necrosis="" (atn)="" and="" acute="" interstitial="" nephritis="" (ain)="" in="" both="" adults="" and="" children,="" where="" 25%–40%="" of="" patients="" recovered="" kidney="" function="" depending="" on="" the="" calendar="" year="" of="" dialysis="" initiation.="" limitations="" to="" our="" study="" include="" the="" potential="" for="" residual="" confounding="" to="" be="" present="" given="" the="" observational="" nature="" of="" our="">

Cov lus xaus

Hauv txoj kev tshawb no, peb tau pom tias kev txiav tawm ntawm cov neeg mob ntshav qab zib tsis tu ncua vim qhov rov zoo tau tshwm sim hauv 4 feem pua ​​​​ntawm cov neeg mob uas muaj qhov kawg.raumkab mob(ESKD) thiab muaj ntau dua ntawm cov neeg uas muaj ATN lossis AIN ua rau lawvraumkab mob. Thaum cov nqi rov qab tau nce pib, tsis kam pib xyoo 2010. Cov kev tshawb fawb ntxiv yog xav tau kom nkag siab tias yuav ua li cas thiaj paub zoo tshaj thiab txhawb kev rov qab los rau cov neeg mob uas nws muaj peev xwm txiav tsis ua kom lim ntshav siab hauv qhov chaw kho mob sab nraud.

Cistanche deserticola tiv thaivraumkab mob, nyem qhov no kom tau txais cov qauv

Taw qhia

Cov neeg mob mob hnyavraumraug mob(AKI) nyob rau hauv qhov teeb meem ntawm kev mob los yog mus pw hauv tsev kho mob feem ntau yuav tsum tau pib dialysis acutely [1–3]. Ib feem ntau ntawm cov neeg mob no yuav muaj sia nyob lawv qhov chaw pw hauv tsev kho mob thawj zaug thiab raug tso tawm mus rau qhov chaw kho mob sab nraud nrog cov kev cai rau kev lim ntshav txuas ntxiv [4–7]. Txawm li cas los xij, subsets ntawm cov neeg mob sab nraud tuaj yeem muaj peev xwm rov zoo txausraummuaj nuj nqikom nws thiaj li txiav tsis tu ncua kev lim ntshav. Cov kev tshawb fawb ua ntej tau tshaj tawm tias kwv yees li 40 feem pua ​​​​ntawm cov neeg mob uas pib lim ntshav tom qab AKI thiab txuas ntxiv rau kev lim ntshav tom qab lub tsev kho mob tau rov zoo txaus hauv 1 xyoo [8]. Txawm hais tias nyob rau hauv cov neeg mob uas muaj kab mob raum mob ntev (CKD) uas tsis tshwm sim los raug kev thuam hnyav ua ntej pib lim ntshav, qhov kev txiav txim siab pib lim ntshav yuav ua raws li cov yam ntxwv uas tsis tas li (xws li kev ua tsis zoo rau kev noj zaub mov tsis zoo lossis kev thauj mus los tsis zoo. rau cov kws kho mob rau kev saib xyuas ze), yog li txawm tias cov neeg mob tsis xav tias yuav muaj qhov tsis zoo ntawm lub raum kev ua haujlwm tuaj yeem rov zoo txaus rau lub raum ua haujlwm kom tswj tau qhov homeostasis thiab txiav kev lim ntshav txawm tias tus kab mob uas tau pom zoo raws li kab mob raum kawg (ESKD) [ 9].

Muab qhov kev txhawb siab loj zuj zus los txo qhov ntev ntawm kev mus pw hauv tsev kho mob [10] thiab kev them nyiaj txoj cai hloov pauv hauv kaum xyoo dhau los nyob ib puag ncig AKI thiab ESKD kev saib xyuas [11,12], kev hloov pauv ntawm lub raum rov qab rau hauv cov neeg mob ntshav qab zib sab nraud tau tshwm sim [11,13 ]. Tsis tas li ntawd, qhov kev xav mus rau qhov pib ntawm kev lim ntshav ntawm qhov nce siab dua qhov kwv yees glomerular pom tus nqi (eGFR; thiab muaj peev xwm ua ntej kev lim ntshav yog qhia kiag li) nyob rau 2 xyoo dhau los hauv Tebchaws Meskas [14–17] tej zaum yuav ua rau muaj qhov tshwm sim uas muaj feem cuam tshuam. ntawm cov neeg mob uas pib lim ntshav tom qab "rov qab" los ntawm kev lim ntshav; Qhov tshwm sim no kuj tseem tuaj yeem cuam tshuam rau cov neeg mob uas tau lim ntshav-yuav tsum tau AKI. Cov qauv mus rau kev pib lim ntshav ua ntej tau raug pom txawm tias tau tshaj tawm qhov kev sim loj hauv xyoo 2010 uas pom tias tsis muaj txiaj ntsig zoo los ntawm kev pib ua ntej ntawm kev lim ntshav [14]. Txawm li cas los xij, ib sab ntawm cov kev tshawb fawb ib leeg tau tsom mus rau cov neeg laus cov neeg laus [3,18,19], qhov tshwm sim thiab kev kwv yees ntawm kev rov qab los.raummuaj nuj nqitom qab kev pib kho mob rau tus neeg mob sab nraud rau cov neeg laus thiab cov menyuam yaus tsis tau piav qhia zoo nyob rau hauv lub tebchaws.

Lub hom phiaj ntawm txoj kev tshawb no yog los txiav txim cov yam ntxwv ntawm cov neeg laus (18 xyoo lossis tshaj saud) lossis cov menyuam yaus (<18 years)="" who="" recovered="" sufficient="">raummuaj nuj nqikom tsis txhob lim ntshav rau yam tsawg kawg 90 hnub tom qab pib kho cov neeg mob sab nraud kho mob lim ntshav raws li UnitedStates Renal Data System (USRDS), lub teb chaws ESKD npe uas ntes txhua tus neeg mob uas tau kho ntshav lim ntshav hauv Asmeskas. Peb kuj tau tshuaj xyuas cov xwm txheej ntawm lub cev nyob rau hauv kev txiav tsis tu ncua ntawm kev saib xyuas kev lim ntshav nyob rau lub sijhawm thiab muab piv cov qauv no rau cov neeg laus thiab menyuam yaus. Peb tau xaiv suav nrog cov neeg laus thiab cov menyuam yaus txhawm rau txhim kho peb txoj kev nkag siab txog qhov sib txawv ntawm cov kab mob etiology, cov qauv kev coj ua, thiab kev sib tw kev pheej hmoo ntawm kev tuag (uas tsis tshua muaj nyob rau hauv cov menyuam yaus uas muaj ESKD) yuav cuam tshuam nrog qhov muaj feem cuam tshuam nrog kev tu ncua kev lim ntshav hauv 1 xyoos. kev pib kho mob hauv cov chaw kho mob sab nraud.

Cistanche: tshuaj ntsuab kho mob raum kab mob

Cov txheej txheem

Tshawb nrhiav cov pejxeem thiab cov ntaub ntawv

Peb tau ua qhov kev tshawb fawb rov qab ntawm txhua tus neeg uas pib mob ntshav qab zib sab nraud thaum lub Ib Hlis 1, 1996, thiab Kaum Ob Hlis 31, 2015, siv cov ntaub ntawv los ntawm USRDS, lub teb chaws ESKD npe. Cov yam ntxwv ntawm pej xeem, tus cwj pwm ua rau ESKD, kev tuav pov hwm, zip code, hnub tim ntawm ESKDonset, thiab haiv neeg thiab haiv neeg (categorized as non-Hispanic white [NHW], Hispanic, non-His panic black [NHB], Asian, los yog lwm yam) ntawm Qhov xwm txheej ESKD tau lees paub los ntawm Lub Chaw rau Medicare & Medicaid Services 2728 (CMS-2728) Daim Ntawv Pov Thawj Kho Mob (MEDEVAC) thiab cov ntaub ntawv PATIENTS hauv USRDS. Zipcode tau siv los txiav txim qhov nruab nrab ntawm tsev neeg cov nyiaj tau los ntawm cov neeg mob cov zej zog siv cov txiaj ntsig los ntawm American Community Survey ntawm 2006 thiab 2010 [20]. Thawj ESKD kev kho mob modality (peritoneal dialysis piv rau hemodialysis) tau txiav txim siab nyob rau thawj hnub pab ESKD raws li RXHIST (kho keeb kwm) cov ntaub ntawv. Peb tau tshuaj xyuas qhov kev sib raug zoo ntawm lub sijhawm nruab nrab ntawm lub xyoo daim ntawv qhia hnub ntawm kev pib lim ntshav thiab rov qab los ntawmraummuaj nuj nqisiv cov cubic splines.

Lub ntsiab lus ntawm kev rov qab los thiab tsis txuas ntxiv ntawm kev saib xyuas kev lim ntshav

Cov neeg mob tau sau npe hauv USRDS tom qab tus kws kho mob tau lees paub lawv qhov xwm txheej ESKD los ntawm kev xa cov ntaub ntawv CMS -2728 MEDEVID uas yuav tsum tau ua hauv 45 hnub ntawm kev pib lim ntshav. Cov ntaub ntawv RXHIST sib sau ua ke cov ntaub ntawv los ntawm Medicare Claims, CROWNWeb (cov ntaub ntawv kev tswj hwm los ntawm Medicare-certified dialysis cov chaw qhia txog kev ntsuas rau CMS), CMS -2728 daim ntawv, CMS Daim Ntawv Ceeb Toom Txog Kev Tuag, thiab Cov Khoom Siv Hauv Paus Hloov Hloov Network Hloov cov ntaub ntawv los hloov kho cov xwm txheej raws li lub sijhawm [21]. Peb tau siv cov ntaub ntawv RXHIST los txheeb xyuas qhov kev kho ESKD thawj zaug, hnub ntawm kev pib lim ntshav ntev, thiab kev hloov pauv hauv kev kho mob suav nrog kev tshem tawm ntawm kev lim ntshav. Txhua tus neeg mob uas muaj CMS-2728 daim ntawv ua tiav tau tsim nyog rau kev suav nrog hauv txoj kev tshawb fawb.

Cov neeg mob tau pom tias tau zoo lawmraumua haujlwm yog tias lawv tau ntsib tag nrho cov hauv qab no: (1) lawv tau sau tseg tias lawv tau zoo lawmraummuaj nuj nqiraws li cov ntaub ntawv RXHIST thiab tsis muaj qhov rov pib lim ntshav hauv 90 hnub ntawm hnub rov qab los; (2) tus neeg mob tsis tuag nyob rau hauv 90 hnub ntawm kev tso tseg kev kho mob dialysis (thiab tej zaum yuav rho tawm los ntawm kev kho mob dialysis); thiab (3) tus neeg mob tsis tau txais ib lub raum hloov hauv 90 hnub tom qab tso tseg kev lim ntshav. Ib lub sijhawm 90-hnub tsis pub lim ntshav yuav tsum tau ua kom rov qab ua tau raws li cov lus txhais raws li USRDS (uas tseem yuav tsum muaj sijhawm 90-hnub ntawm kev lim ntshav ywj pheej) [21]. Cov neeg mob uas tau txais kev hloov pauv txhua lub sijhawm tau raug censored txij li txawm tias rov qab ua haujlwm ntawm lub raum tau tshwm sim tom qab hloov lub raum, nws yuav nyuaj rau kev paub qhov txawv ntawm lub raum ua haujlwm los ntawm kev ua haujlwm allograft.

Kev soj ntsuam tau pib ntawm thawj ntu ntawm kev pib lim ntshav raws li RXHIST cov ntaub ntawv (thiab tsis tas yuav tsum muaj lub sijhawm ua ntej ntawm kev lim ntshav rau kev suav nrog hauv peb txoj kev tshawb fawb) thiab xaus rau hnub ntawm lub raum rov qab, tuag, 365 hnub tom qab kev lim ntshav, lossis kev tswj xyuas censoring hnub (Lub Kaum Ob Hlis 31, 2016). Peb xaiv los tsom rauraumrov qab tau tshwm sim nyob rau hauv 1 xyoo ntawm kev kho mob sab nraud dialysis pib raws li cov nqi rov qab ntawm lub raum ua hauj lwm tom qab ntawd tsawg. Txawm li cas los xij, hauv kev tshuaj ntsuam rhiab heev, peb kuj tau tshuaj xyuas cov kev kwv yees ntawm qhov tshwm sim ntawm kev rov qab los ntawm txhua lub sijhawm thaum kev tshawb nrhiav.

Kev kwv yees ntawm kev rov ua haujlwm ntawm lub raum

Peb thawj zaug tshuaj xyuas cov yam ntxwv ntawm cov neeg mob uas rov ua haujlwm rau lub raum hauv cov menyuam yaus piv nrog cov neeg laus. Cov yam ntxwv ntawm kev txaus siab suav nrog hnub nyoog (raws li 6- pawg sib txawv), poj niam txiv neej, haiv neeg, hom kev tuav pov hwm, thawj qhov ua rau ESKD, cov nyiaj tau los nruab nrab ntawm cov neeg nyob ib puag ncig, kev kho tus neeg mob thawj zaug (hemodialysis lossis peritoneal dialysis), lub sijhawm daim ntawv qhia hnub (sib faib ua 5-xyoo ib ntus), thaj tsam ntawm Teb Chaws Asmeskas (West, Northeast, South, thiab Midwest), thiab cov nyiaj tau los nruab nrab ntawm cov zej zog. Tom ntej no, peb siv cov qauv Fine thiab Grey los tshuaj xyuas cov kev kwv yees ntawm kev rov qab los ntawm lub raum ua haujlwm nrog rau cov neeg sib tw sib txawv uas tau teev tseg saum toj no hauv ob qho tib si tsis hloov pauv thiab ntau yam kev ntsuas. Cov qauv sib txawv muaj xws li covariates uas tau teev tseg saum toj no thiab cov kab mob sib kis nrog rau cov kab mob plawv, mob plawv, plawv tsis ua hauj lwm, kub siab, ntshav qab zib, kab mob peripheral vascular, mob stroke, haus luam yeeb, thiab siv tshuaj raws li qhia hauv CMS -2728 daim ntawv. Hauv cov qauv no, lub sijhawm tau pib los ntawm thawj zaug kev kho mob rau tus neeg mob sab nraud (thiab peb tsis xav kom cov neeg mob muaj tsawg kawg 90 hnub ntawm kev lim ntshav kom suav nrog rau kev kawm), kev tuag raug kho raws li kev sib tw, thiab kev soj ntsuam tau raug censored. ntawm kev hloov pauv lossis kev tswj hwm ntawm 1 xyoos tom qab kev kho mob ntshav qab zib thawj zaug. Piv txwv li, kev phom sij<1 in="" these="" models="" indicate="" negative="" outcomes="" (lower="" likelihood="" of="" recovery="" of="" kidney="" function)="" in="" this="" study.="" for="" these="" models,="" we="" included="" both="" adults="" and="" children="" in="" the="" same="" model="" so="" that="" comparisons="" could="" be="" made="" across="" the="" entire="" age="" spectrum.="" we="" also="" compared="" children=""><18 years)="" and="" adults="" (18years="" or="" older)="" as="" a="" 2-category="" predictor="" to="" determine="" the="" overall="" risk="" of="" recovery="" in="" univariable="" and="" multivariable="" analysis,="" adjusted="" for="" the="" same="" covariates="" as="" described="">

Tom ntej no, peb tau sim rau qhov sib txawv ntawm cov kev koom tes ntawm ntau yam yam ntxwv thiab kev phom sij ntawm kev rov qab los ntawm cov menyuam yaus thiab cov neeg laus los ntawm kev sim kev sib cuam tshuam ntawm kev sib deev, haiv neeg, ua rau mob raum, kev kho mob thawj zaug, hom kev tuav pov hwm, cov nyiaj tau los nruab nrab, daim ntawv qhia hnub xyoo ntawm kev lim ntshav, thiab cheeb tsam hauv Teb Chaws Asmeskas nrog hnub nyoog thaum lub sij hawm pib lim ntshav (<18 years="" versus="" ≥18years)="" in="" unadjusted="" models.="" for="" factors="" where="" we="" found="" statistically="" significant="" interactions(p="" <="" 0.05),="" we="" then="" repeated="" our="" fine="" and="" gray="" analyses="" stratified="" by="" whether="" the="" patient="" was="" a="" child="" or="" an="" adult="" at="" the="" time="" of="" dialysis="" initiation="" to="" understand="" how="" these="" factors="" differed="" among="" these="" populations="" in="" their="" association="" with="" recovery.="" we="" did="" not="" test="" for="" interactions="" between="" comorbidities="" given="" the="" low="" prevalence="" of="" comorbid="" conditions="" in="" the="" pediatric="">

Cov pab pawg neeg soj ntsuam ntawm cov kev kuaj mob nrog cov nqi siab ntawm kev rov ua haujlwm ntawm lub raum

Peb tau txheeb xyuas cov txiaj ntsig ntawm ESKD nrog qhov siab tshaj plaws ntawm kev rov ua haujlwm ntawm lub raum rau cov menyuam yaus thiab cov neeg laus. Rau txhua qhov kev kuaj mob no, peb tau txiav txim siab lub sijhawm nruab nrab ntawm kev rov qab los ntawm cov menyuam yaus thiab cov neeg laus sib cais ntawm cov neeg uas rov qab ua haujlwm rau lub raum thiab cov feem pua ​​​​ntawm cov neeg rov qab los ntawm 30, 90, thiab 180 hnub ntawm kev soj ntsuam.

Temporal tiam sis nyob rau hauv lub rov qab ntawm lub raum ua hauj lwm

Txhawm rau tshuaj xyuas cov xwm txheej ntawm lub cev hauv kev rov ua haujlwm ntawm lub raum, peb tau ua qauv lub sijhawm raws li qhov cubic spline nrog pob qhov rooj ntawm 2000, 2004, 2008, thiab 2012 hauv cov qauv kab rov tav uas qhov tshwm sim yog qhov nruab nrab feem pua ​​​​ntawm cov neeg mob uas zoo li qub hauv 1 xyoo ntawm kev pib lim ntshav. . Peb tau ua cov kev tshuaj ntsuam no nyias nyias rau cov menyuam yaus thiab cov neeg laus thiab cov neeg mob ESKD uas yog los ntawm cov mob hnyav tubular necrosis (ATN) lossis mob nephritis (AIN) uas yog 2 qhov kev kuaj mob uas muaj kev rov zoo siab tshaj plaws hauv cov menyuam yaus thiab cov neeg laus.

Tom ntej no, peb rov hais dua peb cov qauv regression nrog lub sij hawm raws li lub cubic spline thiab rov qab los raws li qhov tshwm sim, tab sis stratified peb cov qauv los ntawm seb tus neeg mob pib dialysis ntxov (10 mL / min / 1.73 m2) piv rau lig (<10 ml/min/1.73="" m2)="" in="" adults="" and="" children="" separately.="" we="" determined="" the="" egfr="" at="" dialysis="" initiation="" using="" the="" creatinine-based="" ckd-epi="" equation="" in="" adults="" [22]="" and="" schwartz="" equation="" [23]="" in="" children.="" serum="" creatinine="" is="" routinely="" reported="" on="" the="" cms-2728="" form,="" which="" asks="" providers="" to="" certify="" the="" latest="" creatinine="" value="" within="" 45="" days="" prior="" to="" the="" most="" recent="" episode="" of="" dialysis="" initiation.="" for="" egfr="" determination,="" any="" serum="" creatinine="" reported="" more="" than="" 7="" days="" after="" dialysis="" initiation="" was="" set="" as="">

Lub Tsev Kawm Ntawv Qib Siab California San Francisco Institutional Review Board txiav txim siab qhov kev tshawb fawb no tsis yog tib neeg kev tshawb fawb thiab zam qhov yuav tsum tau muaj kev pom zoo rau kev ncaj ncees. Kev tshuaj xyuas tau ua nyob rau hauv STATA 16 (Stata, Texas, US) thiab txheeb xyuas los ntawm tus kws tshuaj ntsuam cais siv SAS 9.4 (SAS Institute, North Carolina, US). Vim muaj kev ncua sij hawm khiav rau qee qhov kev ntsuam xyuas, peb siv txoj hauv kev ua kom muaj txiaj ntsig zoo dua los ua qhov kev sib tw kev pheej hmoo. Qhov no suav nrog kev ua cov ntaub ntawv ua ntej, suav cov qhov hnyav ntawm lub sijhawm, thiab siv cov qauv Cox proportional kev phom sij uas suav nrog qhov hnyav [24,25].

Peb txoj kev npaj tshuaj ntsuam xyuas tau teev tseg qhov tseem ceeb thaum lub rooj sib tham ntawm cov kws sau ntawv nrog lub hom phiaj ntawm kev tshuaj xyuas qhov sib txawv ntawm kev rov ua haujlwm ntawm lub raum hauv 1 xyoos ntawm kev pib lim ntshav rau cov neeg laus thiab menyuam yaus. Spline-raws li kev txheeb xyuas los tshuaj xyuas cov xwm txheej ntawm lub cev hauv kev rov qab los ntawm lub raum kev ua haujlwm tau ntxiv tom qab ua tiav cov kev ntsuam xyuas tseem ceeb tau txais kev lees paub tias cov koom haum no tuaj yeem hloov pauv raws sijhawm. Keeb kwm, txoj kev npaj tshuaj ntsuam xyuas tsuas yog tshuaj xyuas kev rov qab ua haujlwm ntawm lub raum hauv 1 xyoos ntawm kev lim ntshav, tab sis raws li qhov kev thov ntawm cov neeg saib xyuas thaum lub sijhawm kho, peb tau txuas ntxiv kev rov qab mus rau qhov kawg ntawm lub sijhawm kawm thiab ntxiv qhov no raws li kev tshuaj xyuas ntxiv. . Txoj kev tshawb no tau tshaj tawm raws li Kev Txhim Kho Kev Tshaj Tawm Txog Kev Tshawb Fawb Kev Tshawb Fawb hauv Kev Kab Mob Kab Mob (STROBE) cov lus qhia (S1 Daim Ntawv Teev Npe).

Cistanche: tiv thaiv mob qog noj ntshav

Cov txiaj ntsig

Kev kwv yees ntawm kev rov ua haujlwm ntawm lub raum hauv cov neeg laus thiab menyuam yaus

Peb tau txheeb xyuas 1,953,881 tus neeg laus uas tau pib lim ntshav tawm sab nraud thaum xyoo 1996 thiab 2015. Zuag qhia tag nrho, lub hnub nyoog nruab nrab ntawm pawg neeg laus yog 63 ± 15.2 xyoo, 44 ​​feem pua ​​​​yog poj niam, 28 feem pua ​​​​yog NHB, thiab 13 feem pua ​​yog neeg Mev. Ntawm cov neeg mob no, 83,302 (4.3 feem pua) rov qab ua haujlwm rau lub raum txaus thiab muaj peev xwm tau txais kev ywj pheej los ntawm kev lim ntshav hauv lub sijhawm 1-xyoo, thiab ntxiv 12,360 (0.6%) cov tib neeg tau rov zoo rau lub raum txaus kom tsis txhob lim ntshav hauv lub sijhawm ntev- lub sij hawm rov qab los ntawm qhov kawg ntawm txoj kev kawm. Ntawm cov kev rov zoo, lub sijhawm nruab nrab ntawm kev rov ua haujlwm ntawm lub raum hauv cov neeg laus yog 73 hnub (interquartile range [IQR] 43 txog 132). Kwv yees li ntawm 22 feem pua ​​​​tau tuag (N=439,552) ua ntej rov ua haujlwm ntawm lub raum hauv lub sijhawm 1- xyoo.

Peb tau txheeb xyuas 14,372 tus menyuam yaus uas pib lim ntshav thaum xyoo 1996 thiab 2015. Zuag qhia tag nrho, lub hnub nyoog nruab nrab ntawm cov menyuam yaus yog 10.3 ± 5.9 xyoo, 45 feem pua ​​​​yog cov ntxhais, 25 feem pua ​​​​yog NHB thiab 27 feem pua ​​yog neeg Mev. Ntawm cov neeg mob no, 547 (3.8 feem pua) rov qab ua haujlwm rau lub raum txaus thiab tau txais kev ywj pheej los ntawm kev lim ntshav hauv lub sijhawm 1- xyoo. Kwv yees li ntawm 4 feem pua ​​​​ntawm cov menyuam yaus tuag (N=586) ua ntej rov ua haujlwm ntawm lub raum hauv lub sijhawm 1- xyoo. Lub sijhawm nruab nrab ntawm kev rov ua haujlwm ntawm lub raum hauv cov menyuam yaus yog 100 [IQR 56 txog 189] hnub yog tias rov ua haujlwm.

Hauv 3 lub hlis ntawm kev lim ntshav, 5.8 feem pua ​​​​ntawm cov menyuam yaus (N=831) thiab 0.5 feem pua ​​​​ntawm cov neeg laus (N=8,790) tau txais kev hloov raum. Hauv 1 xyoos ntawm kev lim ntshav, 30.3 feem pua ​​​​ntawm cov menyuam yaus (N=4,350) thiab 2.4 feem pua ​​​​ntawm cov neeg laus (N=47,201) tau txais kev hloov raum. Kwv yees li ntawm 71 feem pua ​​(N=1,384,412) ntawm cov neeg laus thiab 62 feem pua ​​​​ntawm cov menyuam yaus (N=8,889) tau censored tswj raws li lawv tsis mus txog qhov kawg ntawm kev txaus siab los ntawm 1 xyoo tom qab. Qhov feem pua ​​​​ntawm cov menyuam yaus thiab cov neeg laus uas tau rov qab los ntawm ntau lub sijhawm muaj nyob hauv S1 Fig.

Cov yam ntxwv ntawm cov neeg laus thiab cov menyuam yaus uas rov qab ua haujlwm rau lub raum tau pom nyob rau hauv Table 1. Kev ua tau zoo, feem ntau ntawm cov neeg laus uas rov zoo li qub, feem ntau yuav yog NHW, txiv neej, thiab ntau dua yuav tau pib kho mob sab nraud nrog hemodialysis (piv rau peritoneal dialysis. ) dua li cov neeg uas tsis rov qab ua haujlwm rau lub raum. Qhov zoo, feem ntau ntawm cov menyuam yaus uas rov qab los kuj tseem hluas dua, tab sis feem ntau yuav yog NHB lossis lwm haiv neeg, thiab poj niam (Table 1). Txawm hais tias pib hemodialysis raws li kev kho thawj zaug kuj tseem cuam tshuam nrog kev rov qab zoo dua li pib nrog kev lim ntshav peritoneal hauv cov menyuam yaus, feem ntau ntawm cov menyuam yaus pib mob ntshav qab zib peritoneal dialysis (3.5 feem pua, N=243) rov qab rau lub raum ua haujlwm piv nrog cov neeg laus (1.4. feem pua ​​, N=2,115, Table 1).

Cov pab pawg neeg soj ntsuam ntawm cov kev kuaj mob nrog cov nqi siab ntawm kev rov ua haujlwm ntawm lub raum

Cov laj thawj ua rau mob raum uas muaj qhov tshwm sim ntau tshaj plaws ntawm cov neeg laus yog AIN (33 feem pua ​​​​, N=1,381) thiab ATN (29 feem pua, N=14,380, Table 1). Hauv cov neeg laus nrog cov kev kuaj mob no, lub sijhawm nruab nrab ntawm kev rov qab los ntawm cov neeg uas rov zoo yog 49 [IQR 31 txog 83] thiab 58 [IQR 36 txog 98] hnub, feem.

Cov laj thawj ua rau mob raum ntawm cov menyuam yaus uas muaj kev rov zoo siab tshaj plaws yog ATN (18 feem pua ​​, N=54), AIN (N.<11) followed="" by="" glomerulonephritis="" (5%,="" n="278," table="" 1).="" the="" median="" time="" to="" recovery="" among="" those="" who="" recovered="" with="" these="" diagnoses="" were="" 136="" days="" [iqr="" 48="" to="" 229],="" 32="" days="" [iqr="" 17="" to="" 46],="" and="" 93="" days="" [iqr="" 51="" to="" 176],="">

Kev kwv yees ntawm kev rov qab los ntawm cov neeg laus piv rau menyuam yaus

Zuag qhia tag nrho, tom qab suav txog qhov sib tw txaus ntshai ntawm kev tuag, cov menyuam yaus tsis tshua muaj peev xwm rov qab los nrog cov neeg laus (tsis muaj kev tshuaj ntsuam xyuas: sub-hazard ratio [sub-HR] 0.95; 95% CI 0 .87 mus rau 1.03; p=0.24; kho cov tshuaj ntsuam xyuas: sub-HR 0.81 [95 feem pua ​​​​CI 0.74 rau {{19} }.89]; p <0.001). xav="" txog="" qhov="" muaj="" hnub="" nyoog="" tag="" nrho,="" kev="" rov="" qab="" zoo="" dua="" yuav="" tshwm="" sim="" hauv="" 0-=""><5-year-old age="" groups="" (sub-hr="" 1.04;="" 95%="" ci="" 0.88="" to="" 1.23,="" p="0.64)," although="" this="" did="" not="" reach="" statistical="" significance,="" and="" less="" likely="" in="" the="" 5-="" to=""><13-year-old (sub-hr="" 0.63;="" 95%="" ci="" 0.52="" to="" 0.76,="" p="" <="" 0.001)="" and="" 13-="" to=""><18-year-old age="" groups="" (sub-hr="" 0.64;="" 95%="" ci="" 0.56="" to="" 0.73,="" p="" <="" 0.001)="" in="" adjusted="" analyses="" (table="" 2).="" female="" sex="" (sub-hr="" 0.98;="" 95%="" ci="" 0.96="" to="" 0.99,="" p="" <="" 0.001),="" nhb="" (sub-hr="" 0.52;="" 95%="" ci="" 0.51="" to="" 0.53,="" p="" <="" 0.001),="" and="" hispanic="" groups="" (sub-hr="" 0.66;95%="" ci="" 0.64="" to="" 0.67;="" p="" <="" 0.001),="" those="" starting="" treatment="" with="" peritoneal="" dialysis="" (sub-hr="" 0.34;="" 95%="" ci="" 0.32="" to="" 0.35,="" p="" <="" 0.001),="" those="" with="" urologic/cystic/congenital="" causes="" of="" kidney="" disease="" (sub-hr="" 0.08;="" 95%="" ci="" 0.08="" to="" 0.09,="" p="" <="" 0.001)="" or="" diabetes="" (sub-hr="" 0.09;="" 95%="" ci="" 0.09="" to="" 0.10,="" p="" <="" 0.001),="" and="" residence="" in="" the="" northeastern="" part="" of="" the="" us="" (sub-hr="" 0.72;="" 95%="" ci="" 0.70="" to="" 0.74,="" p="" <="" 0.001)="" were="" predictors="" associated="" with="" lower="" recovery="" rates="" in="" the="" overall="" population="" in="" multivariable="" models="" (table="" 2).="" similar="" findings="" were="" noted="" in="" sensitivity="" analyses="" when="" we="" extended="" follow-up="" to="" end="" of="" the="" study="" (s1="">

Txawm li cas los xij, qee qhov kev kwv yees ntawm kev rov qab los sib txawv ntawm cov neeg laus thiab cov menyuam yaus (kev pom muaj kev cuam tshuam tau pom) raws li qhia hauv Table 3. Txawm li cas los xij, cov poj niam muaj kev phom sij tsawg dua li cov txiv neej (sub-HR 0.97; 95 feem pua ​​​​CI { {5}}.96 rau 0.99, p < 0.001),="" cov="" ntxhais="" muaj="" kev="" phom="" sij="" ntau="" dua="" li="" cov="" tub="" (sub-hr="" 1.47="" ;="" 95%="" ci="" 1.22="" txog="" 1.76,="" p="">< 0="" 0{{30}}1;="" table="" 2).="" txawm="" hais="" tias="" nhb="" cov="" neeg="" laus="" tsis="" tshua="" muaj="" peev="" xwm="" rov="" qab="" tau="" lub="" raum="" ua="" haujlwm="" ntau="" dua="" li="" cov="" neeg="" laus="" nhw="" (sub-hr="" 0.52;="" 95="" feem="" pua="" ​​​​ci="" 0.51="" rau="" 0.53,="" p="">< {{5{="" {53}}}}.001),="" tsis="" muaj="" qhov="" sib="" txawv="" tseem="" ceeb="" ntawm="" cov="" txiaj="" ntsig="" rov="" qab="" los="" ntawm="" nhb="" thiab="" nhw="" cov="" menyuam="" yaus="" (sub-hr="" 1.00;="" 95="" feem="" pua="" ​​​​ci="" 0.79="" to="" 1.27,="" p="0.98)." pib="" nrog="" kev="" lim="" ntshav="" rau="" tus="" neeg="" mob="" sab="" nraud="" nrog="" peritoneal="" dialysis="" tau="" cuam="" tshuam="" nrog="" kev="" pheej="" hmoo="" ntawm="" kev="" rov="" zoo="" dua="" piv="" nrog="" hemodialysis="" hauv="" ob="" tus="" menyuam="" yaus="" thiab="" cov="" neeg="" laus,="" tab="" sis="" qhov="" tshwm="" sim="" loj="" dua="" rau="" cov="" neeg="" laus="" (sub-hr="" 0.33;="" 95="" feem="" pua="" ​​​​ci="" 0.31="" txog="" 0.34,="" p=""><0.001) piv.="" nrog="" cov="" menyuam="" yaus="" (sub-hr="" 0.65;="" 95="" feem="" pua="" ​​​​ci="" 0.54="" txog="" 0.79,="" p="">< 0.001).="" cov="" kev="" tshawb="" pom="" zoo="" sib="" xws="" tau="" raug="" sau="" tseg="" thaum="" qhov="" txiaj="" ntsig="" ntawm="" kev="" rov="" qab="" tau="" ua="" raws="" mus="" txog="" thaum="" kawg="" ntawm="" txoj="" kev="" tshawb="" fawb="" (s2="">

Lub sijhawm ib ntus hauv kev rov ua haujlwm ntawm lub raum hauv cov neeg laus piv rau menyuam yaus

Thaum peb tau tshuaj xyuas cov xwm txheej ntawm lub cev hauv kev rov ua haujlwm ntawm lub raum ntawm cov neeg laus, kev rov ua haujlwm ntawm lub raum tau pom tias muaj txiaj ntsig zoo hauv xyoo 2010 thiab pib poob qis hauv 5- xyoo dhau los (Fig 1A). Hauv cov menyuam yaus, cov qauv zoo sib xws tau raug suav tias yog qhov zoo, tab sis qhov loj ntawm qhov kev txhim kho ntawm kev rov qab los ua ntej xyoo 2010 yog qhov muaj txiaj ntsig tsawg tshaj li qhov pom hauv cov neeg laus (Daim duab 1B).

Txoj kev rov qab los ntawm lub raum ua haujlwm tau txheeb xyuas qhov sib txawv ntawm cov neeg laus (sub-HR 1.90; 95 feem pua ​​​​CI 1.86 txog 1.95, p < 0.0{="" {51}}1)="" piv="" rau="" cov="" menyuam="" yaus="" (sub-hr="" 1.49;="" 95="" feem="" pua="" ​​​​ci="" 1.15="" txog="" 1.92,="" p="0.002)" hauv="" 2006="" txog="" 2010="" lub="" sijhawm="" (table="" 3)="" nrog="" rau="" hauv="" 2011="" txog="" 2015="" lub="" sijhawm="" (="" sub="" hr="" 1.75;="" 95%="" ci="" 1.71="" txog="" 1.79,="" p=""><0.001 hauv="" cov="" neeg="" laus="" piv="" rau="" sub-hr="" 1.05;="" 95="" feem="" pua="" ​​ci="" 0.80="" txog="" 1.38,="" p="0.73" hauv="" cov="" menyuam="" yaus).="" tshwj="" xeeb,="" cov="" menyuam="" yaus="" nyob="" rau="" hauv="" lub="" sijhawm="" dhau="" los="" no="" 5-="" xyoo="" (2011="" txog="" 2015)="" tsis="" muaj="" kev="" cuam="" tshuam="" ntau="" dua="" ntawm="" kev="" rov="" ua="" haujlwm="" ntawm="" lub="" raum="" (sub-hr="" 1.05;="" 95="" feem="" pua="" ​​​​ci="" 0.80="" txog="" 1.38;="" p="" {{55="" }}.73)="" piv="" nrog="" cov="" menyuam="" yaus="" pib="" lim="" ntshav="" nruab="" nrab="" ntawm="" 1996="" thiab="" 2000="" (tus="" sib="" piv="">

Kev sib raug zoo ntawm lub sijhawm ib ntus hauv kev rov qab los thiab lub sijhawm ntawm kev lim ntshav pib ntawm qhov siab dua piv rau qis dua eGFR

Peb tau tshawb nrhiav qhov zoo dua seb qhov kev hloov ntawm lub cev hauv kev rov ua haujlwm ntawm lub raum yuav txawv ntawm cov neeg uas tau pib lim ntshav ntawm qhov siab dua piv rau qis dua eGFR. Raws li pom nyob rau hauv daim duab 2A thiab 2B, kev rov qab los tau qis dua hauv cov neeg uas muaj eGFR<10 ml/min/="" 1.73="" m2="" at="" dialysis="" initiation="" compared="" with="" those="" with="" earlier="" dialysis="" initiation="" (egfr="" ≥10="" ml/min/1.73="" m2,="" fig="" 2c="" and="" 2d).="" recovery="" rates="" improved="" initially="" for="" adults="" regardless="" of="" whether="" they="" underwent="" early="" or="" late="" initiation="" and="" subsequently="" declined="" over="" time="" as="" seen="" qualitatively="" in="" fig="" 2a="" and="" 2c.="" in="" contrast,="" recovery="" rates="" were="" stably="" low="" for="" children="" who="" started="" dialysis="" late="" and="" did="" not="" improve="" as="" substantially="" over="" time="" compared="" to="" children="" who="" started="" dialysis="" early="" as="" seen="" qualitatively="" in="" fig="" 2b="" and="">

Cistanche: tshuaj ntsuab kho mob raum kab mob

Kev sib tham

Ntau tus neeg mob uas pib kho mob ntshav qab zib sab nraud nug txog lawv txoj kev pheej hmoo ntawm kev txiav ntshav lim ntshav dhau sijhawm. Txawm li cas los xij, ob peb txoj kev tshawb fawb tau tsom mus rau kev nkag siab txog qhov tshwm sim, kev kwv yees, thiab lub sijhawm ib ntus ntawm kev rov qab los ntawm cov neeg mob tau txais kev kho mob sab nraud. Hauv txoj kev tshawb no, peb tau tshuaj xyuas qhov tshwm sim ntawm kev rov qab los ntawm lub raum ua haujlwm ntawm cov neeg uas pib kho cov neeg mob ntshav qab zib hauv 2 xyoo dhau los. Peb pom tias tag nrho, 4 feem pua ​​​​ntawm cov pej xeem uas pib mob ntshav qab zib sab nraud tau rov qab ua haujlwm rau lub raum txaus kom tsis tu ncua kev lim ntshav hauv 1 xyoos. Cov nqi rov qab muaj nyob nruab nrab ntawm 10 feem pua ​​​​thiab 15 feem pua ​​​​hauv thawj 30 hnub ntawm kev lim ntshav, tab sis ze li ib nrab ntawm cov neeg mob uas rov qab ua haujlwm hauv lub raum tau ua li ntawd hauv 90 hnub tom qab pib lim ntshav. Qee tus neeg mob tau zoo tom qab 180 hnub ntawm tus neeg mob sab nraud mob ntshav qab zib. Cov neeg laus muaj feem yuav rov zoo thiab ua kom lim ntshav ywj pheej piv nrog cov menyuam yaus, tab sis nyob rau hauv ob qho tib si pej xeem, ATN thiab AIN tau cuam tshuam nrog kev rov zoo siab tshaj plaws, thiab cov nqi rov qab no siab li 25 feem pua ​​​​mus rau 45 feem pua ​​​​nyob ntawm daim ntawv qhia hnub xyoo ntawm kev kawm. . Txawm li cas los xij, tus nqi rov qab sib txawv los ntawm etiology ntawm kab mob raum.

Txawm hais tias peb tau xav tias cov menyuam yaus yuav muaj peev xwm zoo dua rau kev rov qab los ntawm lub raum ua haujlwm vim tias lawv qhov qis dua ntawm cov hnub nyoog muaj feem cuam tshuam txog kev mob nkeeg thiab qhov muaj feem tsawg ntawm CKD ntev, peb pom cov nqi rov qab qis dua hauv cov chaw kho mob sab nraud ntawm cov menyuam yaus piv nrog cov neeg laus. . Qhov sib txawv ntawm cov qauv kev coj ua ntawm cov neeg laus thiab cov kws kho menyuam yaus tuaj yeem piav qhia txog qhov sib txawv ntawm qhov kev pheej hmoo ntawm kev rov qab los ntawm cov neeg laus thiab cov neeg laus. Hauv kev kho menyuam yaus, tej zaum yuav muaj kev nyiam ntau dua los saib xyuas cov neeg mob uas tau lim ntshav-yuav tsum tau AKI hauv qhov chaw kho mob hauv tsev kho mob kom rov zoo (tshwj tsis yog tso cov neeg mob no mus rau cov neeg mob ntshav qab zib), vim nws tuaj yeem nyuaj rau kev txheeb xyuas cov neeg mob ntshav qab zib sab nraud uas txaus siab rau. kho cov menyuam yau (sab nraum cov chaw kawm loj) [26]. Tej zaum kuj tseem yuav muaj kev nyuaj siab tsawg dua rau kev tso me nyuam tawm hauv tsev kho mob mus rau cov neeg mob sab nraud, tshwj xeeb tshaj yog muab qhov nyuaj ntawm ESKD kev saib xyuas hauv qhov chaw kho mob sab nraud thiab kev cob qhia uas yuav tsum tau muaj rau cov neeg zov me nyuam. Tsis tas li ntawd, feem ntau ntawm cov menyuam yaus uas muaj ESKD hauv peb pawg neeg raug kho nrog peritoneal dialysis, uas yog ib qho kev pheej hmoo rau kev tsis zoo ntawm ob tus menyuam yaus thiab cov neeg laus. Vim hais tias peritoneal dialysis catheters tej zaum yuav nyuaj rau qhov chaw thiab tshem tawm tshaj li tunneled hemodialysis catheters, cov kws kho mob tej zaum yuav conservative ntau ntawm kev siv peritoneal dialysis raws li kev kho mob modality tshwj tsis yog cov neeg mob muaj pov thawj muaj zog ntawm cov kab mob kawg. Peb lees paub, txawm li cas los xij, qee lub tsev kho mob menyuam yaus muab kev lim ntshav peritoneal raws li kev kho mob hnyav hauv qhov chaw ntawm AKI (uas tsis tshua muaj tshwm sim hauv cov neeg laus xyaum hauv Asmeskas) [27].

Peb kuj tau sau tseg qhov sib txawv ntawm kev rov qab los ntawm haiv neeg hauv cov neeg laus thiab menyuam yaus. Hauv cov neeg laus, NHB cov tib neeg muaj qhov tshwm sim tsawg dua ntawm kev rov qab los piv nrog NHW cov tib neeg, tab sis qhov kev ntxub ntxaug no tsis tau pom hauv cov menyuam yaus. Nws yog qhov zoo li tias kev lag luam hauv zej zog xws li kev nkag mus rau kev tuav pov hwm thiab kev kho mob niaj hnub ua ntej ESKD tuaj yeem ua rau cov kev soj ntsuam no, vim tias cov menyuam yaus feem ntau muaj kev saib xyuas kev noj qab haus huv thoob ntiaj teb thiab kev nkag mus tau zoo dua [28, 29]. Qhov tsis tu ncua ntawm kev rov qab los ntawm lub raum ua haujlwm tom qab xyoo 2012 yog raws li txoj cai qhia meej uas yuav muaj kev cuam tshuam ntxiv rau kev lees txais cov neeg mob nrog AKI rau kev lim ntshav hauv cov chaw kho mob sab nraud ntawm 2012 thiab 2017. Txawm li cas los xij, kev poob qis hauv kev rov qab pib txawm tias ua ntej pib. ntawm no txoj cai hloov nyob rau hauv 2012, yog vim li cas tsis paub meej. Kev nce zuj zus ntawm cov neeg mob uas tau txais kev lim ntshav tom qab AKI hauv Asmeskas cov pej xeem [30] tau sau tseg dhau sijhawm [21]. Muab kev txhim kho hauv kev muaj sia nyob ntawm cov neeg mob AKI-yuav tsum tau lim ntshav mus rau hauv tsev kho mob [31], nws muaj peev xwm ua tau tias qhov no tau ua rau muaj txiaj ntsig zoo ntawm kev rov ua haujlwm ntawm lub raum mus txog rau xyoo 2010 [11]. Txawm li cas los xij, qhov sib txawv no tseem ceeb ntawm cov neeg pib lim ntshav nrog eGFR siab dua 10 mL / min / 1.73 m2 hauv cov menyuam yaus thiab cov neeg laus. Qhov xwm txheej tsis tshua muaj tshwm sim ntawm CKD kev loj hlob tuaj yeem ua rau qee tus kws kho mob tau txais kev saib xyuas kom pib lim ntshav thaum ntxov, thiab qhov me me ntawm kev rov qab los ntawm cov neeg mob no yuav tsim nyog txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau lim ntshav. Peb lees paub tias txoj cai qhia meej uas tau hais qhia tias cov neeg mob Medicare tau txais kev kho mob ntawm cov neeg mob ntshav qab zib sab nraud hauv Asmeskas rau AKI yuav tsis raug them rov qab rau lawv cov kev kho mob sab nraud raug tso tawm hauv 2012 [11,12]. Qhov kev qhia meej no rau Medicare cov cai them nyiaj yuav ua rau ncua sij hawm tsev kho mob tso tawm ntawm cov neeg mob hauv tsev kho mob uas lwm tus tau npaj rau kev kho mob sab nraud thaum tos kom rov qab ua haujlwm ntawm lub raum thiab tuaj yeem ua rau muaj feem cuam tshuam rau kev txo qis ntawm lub raum kev ua haujlwm hauv cov chaw kho mob tom qab ntawd.

Peb txoj kev tshawb fawb muaj kev coj ua thiab kev cuam tshuam txoj cai. Ua ntej, cov kws kho mob nephrology yuav tsum tau xav txog yav dhau los thiab nquag mus ntsib tus neeg hauv cov chav lim ntshav, kev soj ntsuam xyuas ntau dua ntawm lub raum tsis ua haujlwm, thiab kev hloov pauv hauv cov qauv coj ua (xws li zam dhau ultrafiltration thiab intradialytic hypotension) rau lub subset uas yuav rov zoo. lub raum ua haujlwm [32–34]. Tsis tas li ntawd, kev ntxhov siab ntau zaus los txiav txim siab seb ib tus neeg puas muaj ESKD tuaj yeem ua rau muaj kev faib cov neeg mob tsis raug thiab kev siv cov peev txheej tsis tsim nyog, xws li kev thauj mus los thiab kev tuav pov hwm cov txiaj ntsig uas tuaj yeem nrog kev kuaj mob ntawm ESKD. Txawm hais tias tsis ntev los no txoj cai hloov pauv uas tam sim no tso cai rau kev them nyiaj rov qab ntawm kev lim ntshav rau AKI hauv cov chaw kho mob sab nraud tau cuam tshuam rau lub cev thiab kev coj ua hloov pauv tseem yuav txiav txim siab [34].

Lub zog ntawm peb txoj kev tshawb fawb suav nrog qhov loj ntawm lub teb chaws cohort, cov xwm txheej tam sim no ntawm cov ntaub ntawv, thiab suav nrog cov neeg laus thiab cov menyuam yaus ntau haiv neeg. Peb cov kev soj ntsuam ntawm cov neeg tuaj koom kuj tseem ntev dua li cov kev tshawb fawb ua ntej feem ntau uas yog ib qho kev tshawb fawb hauv ib qho chaw thiab tej zaum yuav muaj cov ntaub ntawv txwv tsis pub ntev tshaj ntawm cov neeg mob tom qab pib lim ntshav hauv qhov chaw kho mob sab nraud. Cov kev txwv muaj xws li cov ntaub ntawv tsis raug thiab cov ntaub ntawv ploj lawm los ntawm CMS -2728 cov ntaub ntawv uas tej zaum yuav ua rau muaj peev xwm ua kom tsis zoo ntawm kev kwv yees ntawm kev rov qab los thiab tsis muaj cov ntaub ntawv nyob ib puag ncig seb cov tshuaj nephrotoxic tau siv tom qab AKI uas tuaj yeem ncua sijhawm rov qab rau lub raum ua haujlwm. Peb tsis muaj cov ntaub ntawv tseem ceeb nyob ib puag ncig kev saib xyuas cov neeg mob ua ntej pib lim ntshav, thiab peb tsis tuaj yeem hais meej meej seb cov neeg mob puas muaj lub hauv paus CKD thiab tom qab tsim AKI lossis qhov tseeb ntawm lub raum kev ua haujlwm ua ntej pib lim ntshav. Peb ntseeg tias peb cov neeg kawm suav nrog cov neeg mob uas muaj AKI hnyav dua uas txuas ntxiv mus rau kev lim ntshav hauv qhov chaw kho mob sab nraud, thiab yog li peb cov txiaj ntsig tsis ua rau cov neeg mob uas tau tsim AKI thiab rov ua haujlwm rau lub raum ua ntej tawm hauv tsev kho mob lossis rau cov neeg mob hauv lwm lub tebchaws uas tau lim ntshav. kev saib xyuas yuav txawv ntawm qhov ntawd hauv Asmeskas. Peb kuj lees paub tias kev hloov pauv rau kev saib xyuas cov neeg mob AKI tej zaum yuav tshwm sim nrog cov kev hloov pauv tsis ntev los no nyob ib puag ncig kev them nyiaj rov qab rau kev lim ntshav ntawm cov neeg mob AKI, uas tuaj yeem txwv qhov kev siv tau ntawm peb qhov kev tshawb pom tom qab hloov txoj cai no. Thaum kawg, muab qhov kev soj ntsuam ntawm peb cov ntaub ntawv, residual confounding tej zaum yuav muaj.

Hauv kev xaus, peb nco ntsoov tias kev rov ua haujlwm ntawm lub raum txaus rau kev txiav tawm ntawm cov neeg mob ntshav qab zib tsis tu ncua tshwm sim hauv 4 feem pua ​​​​ntawm cov neeg mob uas tau sau tseg tias muaj ESKD. Kev soj ntsuam ze ntawm cov neeg mob hauv thawj 6 lub hlis ntawm kev pib lim ntshav yuav ua tau zoo, tshwj xeeb tshaj yog cov neeg muaj ATN, AIN, lossis cov menyuam yaus, glomerulonephritis. Cov kev tshawb fawb ntxiv yog xav tau kom nkag siab txog yam uas tuaj yeem txhim kho txoj hauv kev zoo ntawm lub raum ua haujlwm hauv qhov chaw kho mob sab nraud, thiab cov tswv yim xav tau los ua kom muaj peev xwm ua kom rov zoo.

Cistanche: tshuaj ntsuab kho mob raum kab mob

Cov ntaub ntawv

1. Gautam SC, Brooks CH, Balogun RA, Xin W, Ma JZ, Abdel-Rahman EM. Kev kwv yees thiab cov txiaj ntsig ntawm Kev Kho Mob Tom Tsev Kho Mob Dialysis Dependent mob raum mob. Nephron. 2015; 131(3):185–90 : kuv. HTTPS:// doi.org/10.1159/000441607 PMID: 26524288 NWS

2. Kellum JA, Lameire N. Kev kuaj mob, kev ntsuam xyuas, thiab kev tswj cov mob raum raug mob: KDIGO cov ntsiab lus (Part 1). Crit Care. 2013; 17(1:204) Xee 17. https://doi.org/10.1186/cc11454 PMID: 23394211 ib

3. Pajewski R, Gipson P, Heung M. Cov kws kho mob tom tsev kho mob rov qab ua haujlwm ntawm lub raum ntawm cov neeg mob uas mob raum raug mob uas yuav tsum tau lim ntshav. Hemodial Int. 2018; 22(1):66–73 : kuv. https://doi.org/10. 1111/HDI.12545 PMID: 28296033

4. Chu JK, Folkert VW. Lub raum ua haujlwm rov qab rau cov neeg mob ntshav qab zib ntev. Semin Dial. 2010; 23(6):606–13. https://doi.org/10.1111/j.1525-139X.2010.00769.x PMID: 21166875

5. Rottembourg J, Issad B, Allouache M, Jacobs C. Rov qab ua haujlwm ntawm lub raum hauv cov neeg mob kho los ntawm CAPD. Adv Perit Dial. Xyoo 1989; 5:63–6. PIB: 2577429

6. Schiffl H. Lub raum rov qab los ntawm tus mob tubular necrosis xav tau kev kho lub raum hloov: ib qho kev kawm yav tom ntej hauv cov neeg mob hnyav. Nephrol Dial Hloov. 2006; 21(5):1248–52 : kuv. https://doi.org/10.1093/ndt/ gfk069 PMID: 16449291 ib

7. Macdonald JA, McDonald SP, Hawley CM, Rosman J, Brown F, Wiggins KJ, et al. Kev rov ua haujlwm ntawm lub raum hauv lub raum tsis ua haujlwm kawg - kev sib piv ntawm peritoneal dialysis thiab hemodialysis. Nephrol Dial Hloov. 2009; 24(9):2825–31 : kuv. https://doi.org/10.1093/ndt/gfp216 PMID: 19443649 ib

8. Pajewski R, Gipson P, Heung M. Kev kwv yees ntawm kev kho mob tom tsev kho mob rov qab los ntawm lub raum ua haujlwm ntawm

cov neeg mob uas mob raum raug mob yuav tsum tau dialysis. Hemodial Int. 2017. https://doi.org/10.1111/hdi. 12545 PIB: 28296033

9. Pawg Saib Xyuas Kev Ncaj Ncees thiab Kev Ncaj Ncees. Dub-dawb tsis sib xws hauv kev kho mob. JAMA. Xyoo 1990; 263 (17): 2344–6. https://doi.org/10.1001/jama.1990.03440170066038 PMID: 2182918 ib

10. Kab mob raum Txhim Kho Ntiaj Teb Kev Tshaj Tawm Kev Sau Ntawv Pab Pawg. Tshooj 5: Xa mus rau cov kws kho mob tshwj xeeb thiab cov qauv kev saib xyuas. Volume 3, Issue 1. 2013 [cited 2019 May 16]. p 112-119. Muaj los ntawm: http://www. sciencedirect.com/science/article/pii/S2157171615311059. https://doi.org/10.1038/kisup.2012.68 PMID: 25599001

11. Heung M. Tus neeg mob sab nraud Dialysis rau mob raum mob hnyav: Kev nce qib thiab qhov pitfalls. Am J Raum Dis. Xyoo 2019. https://doi.org/10.1053/j.ajkd.2019.03.431 PMID: 31204193

12. Lub Chaw rau Medicare & Medicaid Services (CMS), HHS. Qhov kev pab cuam Medicare; Kev hloov kho rau cov cai them nqi raws li tus kws kho mob cov nqi teem caij rau xyoo 2004. Txoj cai zaum kawg nrog lub sij hawm tawm tswv yim. Fed Sau npe. 2003; 68:63 195 ib. PIB: 14610760

13. Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, et al. Ib qho Randomized sim ntawm Intensive piv rau Standard Blood-Pressure Control. N Engl J Med. 2015; 373 (22): 2103–16. https://doi. org/10.1056/NEJMoa1511939 PMID:26551272

14. Cooper BA, Branley P, Bulfone L, Collins JF, Craig JC, Fraenkel MB, et al. Ib qho randomized, tswj kev sim ntawm ntxov piv rau lig pib ntawm kev lim ntshav. N Engl J Med. 2010; 363(7):609–19 : kuv. https://doi.org/10. 1056 / NEJ 1000552 PMID: 20581422

15. Ferguson TW, Garg AX, Sood MM, Rigatto C, Chau E, Komenda P, et al. Kev Koom Tes Ntawm Kev Tshaj Tawm ntawm Kev Pib Dialysis Thaum Ntxov thiab Lub Sijhawm Kawg thiab Lub Sijhawm ntawm Dialysis Initiation hauv Canada. JAMA Intern Med. Xyoo 2019. https://doi.org/10.1001/jamainternmed.2019.0489 PMID: 31135821

16. Rosansky SJ, Clark WF, Eggers P, Glassock RJ. Kev pib ntawm kev lim ntshav ntawm GFRs siab dua: Puas yog qhov pom tseeb ntawm kev lim ntshav thaum ntxov muaj teeb meem lossis pab tau? Raum Int. 2009; 76(3): 257–61. https://doi.org/10.1038/ki. 2009.161 PMID: 19455195 PAB

17. Susantitaphong P, Altamimi S, Ashkar M, Balk EM, Stel VS, Wright S, et al. GFR ntawm qhov pib ntawm kev lim ntshav thiab kev tuag hauv CKD: kev tshuaj ntsuam meta. Am J Raum Dis. 2012; 59 (6): 829–40. https://doi.org/10.1053/j. nug.2012.01.015 PMID: 22465328

18. Hickson LJ, Chaudhary S, Williams AW, Dillon JJ, Norby SM, Gregoire JR, et al. Kev kwv yees ntawm tus neeg mob lub raum ua haujlwm rov qab los ntawm cov neeg mob uas pib hemodialysis hauv tsev kho mob. Am J Raum Dis. 2015; 65(4): 592–602. https://doi.org/10.1053/j.ajkd.2014.10.015 PMID: 25500361

19. Hickson LJ, Chaudhary S, Williams AW, Dillon JJ, Norby SM, Gregoire JR, et al. Cov neeg mob ntshav qab zib hauv lub raum ua haujlwm rov qab los ntawm cov neeg mob uas pib hemodialysis hauv tsev kho mob. Am J Raum Dis. 2014. https://doi.org/10.1053/j.ajkd.2014.10.015 PMID: 25500361

20. Pej Xeem Studies Center. Zip Code yam ntxwv: Lub ntsiab lus thiab nruab nrab tsev neeg cov nyiaj tau los University of Michigan: Lub koom haum rau Kev Tshawb Fawb Txog Kev Sib Raug Zoo. 2010 [cited 2017 Feb 10]. Muaj los ntawm: http://www.psc.isr. umich.edu/dis/census/Features/tract2zip/index.html.

21. Teb Chaws Asmeskas Lub Raum Data System. 2018 USRDS cov ntaub ntawv tshaj tawm txhua xyoo: Kev kis kab mob raum hauv Tebchaws Meskas. National Institutes of Health NIDDK.

22. Inker LA, Schmid CH, Tighiouart H, Eckfeldt JH, Feldman HI, Greene T, et al. Kev kwv yees glomerular pom tus nqi los ntawm cov ntshav creatinine thiab cystatin C. N Engl J Med. 2012; 367(1):20–9 : kuv. https://doi.org/10. 1056/11/2020 PMID: 22762315 AB

23. Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, et al. Kev sib npaug tshiab los kwv yees GFR hauv cov menyuam yaus nrog CKD. J Am Soc Nephrol. 2009; 20(3):629–37 : kuv. https://doi.org/10.1681/ASN. 2008030287 PMID:19158356 PAB

24. Kab mob raum: Txhim kho Ntiaj Teb Kev Ua Haujlwm (KDIGO) CKD Pawg Ua Haujlwm. KDIGO 2012 Cov Lus Qhia Txog Kev Kho Mob rau Kev Ntsuam Xyuas thiab Kev Tswj Xyuas Kab Mob Raum Mob. / Levin, Adeera; Stevens, Paul E.; Bilous, Rudy W.; Coresh, Josef; De Francisco, Angel LM.; De Jong, Paul E.; Griffith, Kathryn E.; Hemmelgarn, Brenda R.; Iseki, Kunitoshi; Lamb, Edmund J.; Levey, Andrew S.; Riella, Miguel C.; Shlipak, Michael G.; Wang, Haiyan; Dawb, Colin T. Winearls, Christopher G. [cited 2019 Jun 1]. Muaj los ntawm: https://kdigo.org/guidelines/ckd-evaluation-and-management/.

25. Geskus RB. Kev kwv yees qhov xwm txheej tshwj xeeb thiab cov qauv zoo thiab grey nyob rau hauv ob qho tib si sab laug thiab sab xis censoring. Biometrics. 2011; 67(1):39–49 : kuv. https://doi.org/10.1111/j.1541-0420. 2010.01420.x PMID: 20377575

26. Chand DH, Swartz S, Tuchman S, Valentini RP, Somers MJ. Dialysis hauv Me Nyuam thiab Cov Hluas: Pediatric Nephrology Perspective. Am J Raum Dis. 2017; 69(2):278–{5}} ib. https://doi.org/10.1053/j.ajkd. 09.09.2016 16:27:09 TSI

27. Guzzo I, de Galasso L, Mir S, Bulut IK, Jankauskiene A, Burokiene V, et al. Mob ntshav lim ntshav hauv cov menyuam yaus: cov txiaj ntsig ntawm kev tshawb fawb European. J Nephrol. 2019; 32(3):445–51 : kuv. https://doi.org/10.1007/s40620-019- 00606-1 PMID:30949986

28. Kucirka LM, Grams ME, Lessler J, Hall EC, James N, Massie AB, et al. Kev sib koom ntawm haiv neeg thiab hnub nyoog nrog kev muaj sia nyob ntawm cov neeg mob ntshav qab zib. JAMA. 2011; 306 (6): 620–6. https://doi.org/10.1001/ jama.2011.1127 PMID: 21828325 NWS

29. Rhee CM, Lertdumrongluk P, Streja E, Park J, Moradi H, Lau WL, et al. Kev cuam tshuam ntawm hnub nyoog, haiv neeg, thiab haiv neeg ntawm kev lim ntshav cov neeg mob muaj sia nyob thiab kev hloov pauv raum tsis sib xws. Yog J Nephrol. 2014; 39(3):183–94 : kuv. https://doi.org/10.1159/000358497 PMID: 24556752 ib

30. Hsu RK, McCulloch CE, Dudley RA, Lo LJ, Hsu CY. Lub sijhawm hloov pauv hauv qhov xwm txheej ntawm Dialysis-Yuav tsum tau AKI. J Am Soc Nephrol. 2013; 24(1):37–42 : kuv. https://doi.org/10.1681/ASN.2012080800 PMID: 23222124

31. Brown JR, Rezaee ME, Hisey WM, Cox KC, Matheny ME, Sarnak MJ. Txo cov neeg tuag nrog rau mob raum raug mob yuav tsum tau lim ntshav hauv Tebchaws Meskas. Yog J Nephrol. 2016; 43(4):261–70. https://doi.org/10.1159/000445846 PMID: 27161485 ib