Effects of aging, baseline renal function and stage of HIV infection on post‐treatment changes in renal function among HIV ‐infected patients: a retrospective cohort study

HIV Medicine ◽  
2019 ◽  
Vol 20 (9) ◽  
pp. 591-600 ◽  
Author(s):  
Y Ding ◽  
S Duan ◽  
R Ye ◽  
S Yao ◽  
D Cao ◽  
...  
2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Daniel N. A. Ankrah ◽  
Margaret Lartey ◽  
Aukje K. Mantel-Teeuwisse ◽  
Hubert G. M. Leufkens

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e030438
Author(s):  
Eung Hyun Lee ◽  
Su-Hyun Kim ◽  
Jung-ho Shin ◽  
Sung Bin Park ◽  
Byung Hoon Chi ◽  
...  

ObjectiveObstruction release from urolithiasis can be delayed with a lack of suggested time for preventing the deterioration of renal function. The objective of this study was to investigate the effect of obstruction duration, concomitant acute kidney injury (AKI) or acute pyelonephritis (APN) during the obstruction on the prognosis of renal function.DesignRetrospective cohort study.Setting and participants1607 patients from a urolithiasis-related obstructive uropathy cohort, between January 2005 and December 2015.Outcome measuresEstimated glomerular filtration rate (eGFR) decrease ≥30% and/or end-stage renal disease (ESRD), and eGFR decrease ≥50% and/or ESRD, according to obstruction duration, AKI and APN accompanied by obstructive uropathy.ResultsWhen the prognosis was divided by obstruction duration quartile, the longer the obstruction duration the higher the probability of eGFR reduction >50% (p=0.02). In patients with concomitant APN or severe AKI during hospitalisation with obstructive uropathy, an eGFR decrease of >30% and >50% occurred more frequently, compared with others (p<0.001). When we adjusted for sex, age, hypertension, diabetes mellitus, APN, AKI grades and obstruction release >7 days for multivariate analysis, we found that concomitant APN (HR 3.495, 95% CI 1.942 to 6.289, p<0.001), concomitant AKI (HR 3.284, 95% CI 1.354 to 7.965, p=0.009 for AKI stage II; HR 6.425, 95% CI 2.599 to 15.881, p<0.001 for AKI stage III) and an obstruction duration >7 days (HR 1.854, 95% CI 1.095 to 3.140, p=0.001) were independently associated with an eGFR decrease >50%. Tree analysis also showed that AKI grade 3, APN and an obstruction duration >7 days were the most important factors affecting renal outcome.ConclusionsIn patients with urolithiasis-related obstructive uropathy, concomitant APN was strongly associated with deterioration of renal function after obstruction release. The elapsed time to release the obstruction also affected renal function.


CMAJ Open ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. E236-E245
Author(s):  
Ana C. Ulloa ◽  
Cathy Puskas ◽  
Benita Yip ◽  
Wendy Zhang ◽  
Cole Stanley ◽  
...  

2021 ◽  
Author(s):  
Annemiek van Dijke ◽  
Gisela R.M. Emmory-Lijde ◽  
Mathijs Deen

BACKGROUND Background: The prevalence of major depression is very high and it is considered one of the most hindering disorders, associated with a strong social- and financial impact. Despite the effectiveness of traditional cognitive behavioral therapy (CBT), response, improvement, remission and recovery rates are low and relapse percentages are considerably high. This study is the first to investigate the effectiveness of online videoconferencing CBT with smartphone app support in patients with major depression. With this ‘modern’ way of online CBT, we aim to enhance the effectiveness of CBT OBJECTIVE Objective: The objective is to assess the results of online videoconferencing CBT with app-support compared to TAU in patients with depression. To enhance therapy outcome and patient satisfaction for the treatment of depression. METHODS Methods: A retrospective cohort study was conducted in an outpatient treatment center (PsyQ-Parnassia, the Netherlands). Routine Outcome Monitoring (ROM) data was collected from September 2018 to March 2020, at pre- and post-treatment. Seven hundred and seventy patients were included; 40 for psyQ-online and 730 for psyQ-TAU. The primary outcome measure is the symptoms of depression measured with the Quick Inventory of Depressive Symptomatology (QIDS-SR-16; Trivedi et al., 2004). To assess ‘significant change’ in depressive symptoms we compared pre-and post-treatment scores for PsyQ-online group compared with the PsyQ-TAU group. Clinical significant change or remission was defined as ‘going from above the clinical cut-off score at pre-treatment to below the cut-off score’ which equals ‘normalcy’ or ‘no depression’ (in this case below 6) at post-treatment. ‘Reliable change’ was defined as ‘whether people changed sufficiently that the change is unlikely to be due to simple measurement unreliability’. Reliable changes were grouped in four categories: (1) Recovered = reliable and clinical significant change in QIDS-SR-16, (2) Improved = reliable change, without clinical significant change, (3) No change = no reliable change and no clinical significant change, and (4) Deteriorated = negative reliable change in the QIDS-SR-16 (Jakobsen et al., 2017). To investigate patients satisfaction for online psychotherapy when compared to the patients in the PsyQ-TAU group, we used KLANT scores (Huijbrechts et al., 2009). RESULTS Results: The psyQ-online patients showed significantly higher improvement, remission and recovery percentages compared to the psyQ-TAU patients. Online patients were more satisfied with their therapy compared to TAU patients. CONCLUSIONS Conclusion: ‘Significant reduction’ in depressive symptoms and high percentages of ‘improvement’, ‘remission’ and ‘recovery’, can be obtained when performing online cbt with smartphone-application-support for depression. This even enhances CBT-outcome in highly satisfied patients. CLINICALTRIAL n/a


2021 ◽  
Author(s):  
Daiji Nagayama ◽  
Kentaro Fujishiro ◽  
Shinichi Tsuda ◽  
Yasuhiro Watanabe ◽  
Takashi Yamaguchi ◽  
...  

Abstract Background: Abdominal obesity as a risk factor for diagnosing metabolic syndrome (MetS) is conventionally evaluated using waist circumference (WC), although WC does not necessarily reflect visceral adiposity. We aimed to examine whether replacing WC with “A Body Shape Index (ABSI)”, an abdominal obesity index, in MetS diagnosis is useful for predicting renal function decline (RFD). Methods: A retrospective cohort study was conducted in 5438 Japanese urban residents (median age 48 years) who participated in a public health screening program for 4 consecutive years. Systemic arterial stiffness was assessed by cardio-ankle vascular index (CAVI), and high CAVI was defined as CAVI ≥ 9.0. The predictability of the occurrence of RFD (eGFR < 60 mL/min/1.73m 2 ) by replacing high WC with high ABSI (ABSI ≥ 0.080) was examined using three sets of MetS diagnostic criteria: Japanese, International Diabetes Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII). Results: In Japanese and NCEP-ATPIII criteria, MetS diagnosed using ABSI (ABSI-MetS) was associated with significantly higher age-adjusted CAVI compared to non-MetS, whereas MetS diagnosed using WC (WC-MetS) showed no association. Kaplan-Meier analysis of the rate of new-onset RFD over 4 years (total 8.7%) showed remarkable higher rate in subjects with ABSIMetS than in those without (log-rank test p <0.001), but almost no difference between subjects with and without WC-MetS ( p = 0.014-0.617). In Cox analysis including gender, high CAVI and low-density lipoprotein‒cholesterol ≥140 mg/dL as confounders, only ABSI-MetS diagnosed by Japanese criteria contributed independently to the occurrence of RFD (HR = 1.41, p = 0.011). High CAVI was also an independent contributor to the occurrence of RFD. In a subanalysis, ABSI-MetS diagnosed by Japanese criteria contributed significantly to the occurrence of RFD regardless of age or gender, while WC-MetS by Japanese criteria contributed significantly only in older women. Conclusion: In this study, replacing WC with ABSI in MetS diagnostic criteria more efficiently predicted subjects at risk of RFD and arterial stiffening. Further studies are needed to confirm whether MetS diagnosed using ABSI also predicts CVD.


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