目的:免疫球蛋白A肾病(immunoglobulin A nephropathy,IgAN)是最常见的肾病类型之一,肾移植手术是终末期肾病最有效的治疗手段。本研究旨在分析成人IgA肾病肾移植的临床疗效,探讨IgA肾病肾移植围手术期及中远期的有效性与安全性。方法:...目的:免疫球蛋白A肾病(immunoglobulin A nephropathy,IgAN)是最常见的肾病类型之一,肾移植手术是终末期肾病最有效的治疗手段。本研究旨在分析成人IgA肾病肾移植的临床疗效,探讨IgA肾病肾移植围手术期及中远期的有效性与安全性。方法:回顾性纳入2018年1月至2022年1月中南大学湘雅二医院实施的所有81例成人IgA肾病肾移植的临床资料和随访数据。受者年龄(34.1±9.9)岁,其中男性47例(58.0%),体重指数为(20.8±3.2)kg/m2,人白细胞抗原错配数为(3.5±1.2)个。总结受者肾移植手术后第1、5、7天以及出院时的估算肾小球滤过率(estimated glomerular filtration rate,eGFR)及每日24 h尿量情况,综合评估其移植肾恢复情况以及并发症发生情况。评估随访第6、12、24、36、48个月的eGFR、尿蛋白、尿隐血等指标。结果:随访(25.7±15.8)个月。围手术期所有患者均未发生原发性移植肾无功能,51例(62.9%)患者属于移植物功能立即恢复,16例(19.8%)患者属于移植物功能缓慢恢复,两者占总数的82.7%;14例患者出现了移植物功能延迟恢复,占17.3%。共发生19例围手术期并发症,包括急性排斥反应9例、尿瘘5例、双下肢血管血栓1例、淋巴瘘4例。随访第6、12、24、36及48个月的eGFR分别为(65.3±22.9)、(67.6±23.0)、(64.3±21.8)、(65.9±24.7)及(68.7±31.2)mL/(min·1.73 m2)。中长期随访eGFR均保持较高水平,最长随访至56个月,eGFR波动仍较小;末次随访尿蛋白阳性率与尿隐血阳性率较低。移植肾IgAN复发4例,占总患者的4.94%,未出现严重肾功能不全。3例患者因重症肺炎、排斥反应、移植肾结石出现移植肾失功能,总体移植肾存活率达95%以上,随访至2022年1月所有患者存活率100%。结论:成人IgAN肾病肾移植近期效果显著,受者受益明显,中远期效果良好,IgAN复发率较低,且很少引起严重肾功能损害。展开更多
Objective:Compared with long-term renal replacement therapy,kidney transplantation is the ideal treatment for end-stage renal disease(ESRD),significantly extending patient life and improving quality of life.Kidney tra...Objective:Compared with long-term renal replacement therapy,kidney transplantation is the ideal treatment for end-stage renal disease(ESRD),significantly extending patient life and improving quality of life.Kidney transplant patients need to adhere to lifelong immunosuppressive medication regimens,but their medication adherence is generally poor compared with other organ transplant recipients.Medication adherence is closely related to medication literacy and psychological status,yet related studies are limited.This study aims to investigate the current status of medication adherence,inner strength,and medication literacy in kidney transplant patients,analyze the relationships among these 3 factors,and explore the mediating role of inner strength in the relationship between medication literacy and medication adherence.Methods:A cross-sectional survey was conducted from March to October 2023 involving 421 patients aged≥18 years who visited kidney transplantation outpatient clinics at 4 tertiary hospitals in Hunan Province.The inner strength,medication literacy,and medication adherence of kidney transplant patients were investigated using the Inner Strength Scale(ISS),the Chinese version of the Medication Literacy Assessment in Spanish and English(MedLitRxSE),and the Chinese version of the Morisky Medication Adherence Scale-8(C-MMAS-8),respectively.Univariate analysis was performed to examine the effects of demographic and clinical data on medication adherence.Correlation analysis was conducted to explore the relationships among medication literacy,medication adherence,and inner strength.Significant variables from univariate and correlation analyses were further analyzed using multiple linear regression,and the mediating effect of inner strength was explored.Results:Among the 421 questionnaires collected,408 were valid,with an effective rate of 96.91%.The scores of C-MMAS-8,MedLitRxSE,and ISS were 6.64±1.16,100.63±14.67,and 8.47±4.03,respectively.Among the 408 patients,only 86(21.08%)patients had a high level of medication adherence,whereas 230(56.37%)patients had a medium level of medication adherence,and 92(22.55%)patients had poor medication adherence.Univariate analysis indicated that the kidney transplant patients’age,marital status,education levels,years since their kidney transplant operation,number of hospitalizations after the kidney transplant,and adverse drug reactions showed significant differences in medication adherence(all P<0.05).Correlation analysis showed that inner strength positively correlated with both medication literacy(r=0.183,P<0.001)and medication adherence(r=0.201,P<0.001).Additionally,there was a positive correlation between medication adherence and medication literacy(r=0.236,P<0.001).Inner strength accounted for 13.22%of the total effect in the mediating role between medication literacy and medication adherence.Conclusion:The level of medication adherence among kidney transplant patients needs improvement,and targeted intervention measures are essential.Inner strength mediates the relationship between medication literacy and medication adherence in these patients.Healthcare professionals should focus on enhancing medication literacy and supporting patients’inner strength to improve medication adherence.展开更多
基金This work was supported by the Natural Science Foundation of Hunan Province,China (2024JJ9201)。
文摘Objective:Compared with long-term renal replacement therapy,kidney transplantation is the ideal treatment for end-stage renal disease(ESRD),significantly extending patient life and improving quality of life.Kidney transplant patients need to adhere to lifelong immunosuppressive medication regimens,but their medication adherence is generally poor compared with other organ transplant recipients.Medication adherence is closely related to medication literacy and psychological status,yet related studies are limited.This study aims to investigate the current status of medication adherence,inner strength,and medication literacy in kidney transplant patients,analyze the relationships among these 3 factors,and explore the mediating role of inner strength in the relationship between medication literacy and medication adherence.Methods:A cross-sectional survey was conducted from March to October 2023 involving 421 patients aged≥18 years who visited kidney transplantation outpatient clinics at 4 tertiary hospitals in Hunan Province.The inner strength,medication literacy,and medication adherence of kidney transplant patients were investigated using the Inner Strength Scale(ISS),the Chinese version of the Medication Literacy Assessment in Spanish and English(MedLitRxSE),and the Chinese version of the Morisky Medication Adherence Scale-8(C-MMAS-8),respectively.Univariate analysis was performed to examine the effects of demographic and clinical data on medication adherence.Correlation analysis was conducted to explore the relationships among medication literacy,medication adherence,and inner strength.Significant variables from univariate and correlation analyses were further analyzed using multiple linear regression,and the mediating effect of inner strength was explored.Results:Among the 421 questionnaires collected,408 were valid,with an effective rate of 96.91%.The scores of C-MMAS-8,MedLitRxSE,and ISS were 6.64±1.16,100.63±14.67,and 8.47±4.03,respectively.Among the 408 patients,only 86(21.08%)patients had a high level of medication adherence,whereas 230(56.37%)patients had a medium level of medication adherence,and 92(22.55%)patients had poor medication adherence.Univariate analysis indicated that the kidney transplant patients’age,marital status,education levels,years since their kidney transplant operation,number of hospitalizations after the kidney transplant,and adverse drug reactions showed significant differences in medication adherence(all P<0.05).Correlation analysis showed that inner strength positively correlated with both medication literacy(r=0.183,P<0.001)and medication adherence(r=0.201,P<0.001).Additionally,there was a positive correlation between medication adherence and medication literacy(r=0.236,P<0.001).Inner strength accounted for 13.22%of the total effect in the mediating role between medication literacy and medication adherence.Conclusion:The level of medication adherence among kidney transplant patients needs improvement,and targeted intervention measures are essential.Inner strength mediates the relationship between medication literacy and medication adherence in these patients.Healthcare professionals should focus on enhancing medication literacy and supporting patients’inner strength to improve medication adherence.
