一位年輕、剛開始洗腎患者，少年時有腦傷留下右手無力後遺症，慣用手是左手，因此自體瘻管就開在右手了。這真的是兩難，右手是無法配合握力來訓練瘻管的狀況，但是左手是他的慣用手也不是開瘻管的首選啊！（倫pt瑋）
結論：還是開在右手，瘻管血流不夠時怎麼辦？只好通血管了
2021年4月19日 星期一
2021年3月29日 星期一
穀類食物和心血管疾病死亡率關係
Associations of cereal grains intake with cardiovascular disease and mortality across 21 countries in Prospective Urban and Rural Epidemiology study: prospective cohort study
BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.m4948 (Published 03 February 2021)
結論：
High intake of refined grains was associated with higher risk of mortality and major cardiovascular
disease events. Globally, lower consumption of refined grains should be considered.
No significant associations were found between intakes of whole grains or white rice and health outcomes.
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看起來要少食低纖類穀物才能減少心血管疾病，但是白米和全穀類相比則無差異。
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We defined refined grains as wheat grain products or flours that have been modified to remove the bran (麥麩) (the aleurone layer) and germ and therefore have a low fibre content. Products in this category are made with refined (white) flour, including white bread, pasta/noodles, breakfast cereals, crackers, and bakery products/desserts containing refined grains. For bakery products and desserts, we counted only the proportion of refined grains. Ready to eat breakfast made from corn was also included in this group.
The whole grains group contained two types of grains. The first was whole grain flours such as those
made from wheat, rye, triticale, oats, barley, maize, finger and pearl millet, sorghum, or buckwheat.
We defined refined grains as wheat grain products or flours that have been modified to remove the bran (麥麩) (the aleurone layer) and germ and therefore have a low fibre content. Products in this category are made with refined (white) flour, including white bread, pasta/noodles, breakfast cereals, crackers, and bakery products/desserts containing refined grains. For bakery products and desserts, we counted only the proportion of refined grains. Ready to eat breakfast made from corn was also included in this group.
The whole grains group contained two types of grains. The first was whole grain flours such as those
made from wheat, rye, triticale, oats, barley, maize, finger and pearl millet, sorghum, or buckwheat.
2021年3月13日 星期六
前析、後析、血液透析過濾 HDF
看起來後析的中大分子清除率也不輸前析，所以繼續用高容量的後析HDF沒錯！
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Acta Nephrologica 34(2): 69-79, 2020
DOI:10.6221/AN.202006_34(2).0003
Comparative Study of the Efficacy of High Volume Predilution Online Hemodiafiltration and High Volume Postdilution Online Hemodiafiltration
Hung-Ping Chen, Chang-Hsu Chen, Paik-Seong Lim
Division of Renal Medicine, Tungs’ Taichung Metroharbor Hospital, Taichung, Taiwan
洗腎、C型肝炎
目前依Anti-HCV Ab做初步的檢查，若陽性再加做HCV RNA，是可行的辦法。
註：這2012年，可能是北榮台東分院疑似C肝爆發所做的分析，非常像現在新冠病毒在做疫調，一步一步拆炸彈！
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Acta Nephrologica 34(3): 136-141, 2020
DOI:10.6221/AN.202009_34(3).0005
Combined Application of the Hepatitis C Virus Serologic Testing and the Nucleic Acid Amplification Testing Simultaneously for HCV Infection Isolation Strategy in Hemodialysis Units
Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
2021年3月8日 星期一
高蛋白飲食會傷害腎臟
#lpd
高蛋白飲食不利於腎臟健康: 釋放禁忌2020
https://academic.oup.com/ndt/article/35/1/1/5614387
1. 有這麼嚴重嗎？吃三明治只吃中間的肉，不敢吃外面的麵包？哈
「We feel compelled to eat only the meat patty of the sandwich and leave behind the bun when eating in front of others, otherwise we may lose credibility among friends and peers. If somebody dares to recommend a ‘low-protein diet’ (LPD) or, even worse, to imply that ‘HPD may cause harm’, then it would be considered a serious aberration to health and a taboo.」
2. 生酮飲食 ?? 為了腎臟好，還是不要試比較好
To save ourselves from an obese and diabetic destiny, we accepted the emerging data suggesting that we can lose weight by eating more protein. Subsequently, high-protein regimens such as the Atkins, Zone, South Beach and Ketogenic diets emerged in which daily protein intake increased to 20–25% or more of the total daily energy intake
高蛋白飲食不利於腎臟健康: 釋放禁忌2020
https://academic.oup.com/ndt/article/35/1/1/5614387
1. 有這麼嚴重嗎？吃三明治只吃中間的肉，不敢吃外面的麵包？哈
「We feel compelled to eat only the meat patty of the sandwich and leave behind the bun when eating in front of others, otherwise we may lose credibility among friends and peers. If somebody dares to recommend a ‘low-protein diet’ (LPD) or, even worse, to imply that ‘HPD may cause harm’, then it would be considered a serious aberration to health and a taboo.」
2. 生酮飲食 ?? 為了腎臟好，還是不要試比較好
To save ourselves from an obese and diabetic destiny, we accepted the emerging data suggesting that we can lose weight by eating more protein. Subsequently, high-protein regimens such as the Atkins, Zone, South Beach and Ketogenic diets emerged in which daily protein intake increased to 20–25% or more of the total daily energy intake
3. 高蛋白飲食短期提高了eGFR，但是長期卻加速了腎功能的喪失。
「It is important to note that persons with higher versus lower DPI >1.2 versus <0.8 g/kg/day had a
higher versus lower eGFR of 82 +/- 18 versus 75 +/- 19 mL/min/1.73 m2, respectively. This makes sense, given that higher protein intake increases GFR in the short term, whereas it accelerates kidney function loss in the long term」
higher versus lower eGFR of 82 +/- 18 versus 75 +/- 19 mL/min/1.73 m2, respectively. This makes sense, given that higher protein intake increases GFR in the short term, whereas it accelerates kidney function loss in the long term」
2021年2月23日 星期二
2021年2月6日 星期六
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