Clinical Practice Guidelines For Acute Kidney Injury in China

Acute kidney injury (AKI) is the most common critical illness among hospitalized patients and carries a high risk of death. AKI has many causes and complex mechanisms and is characterized by high morbidity, high mortality, and huge harm. Research evidence shows that patients with AKI have a 2.67-fold increased risk of new-onset or progression to chronic kidney disease (CKD), a 4.81-fold increased risk of uremia, a 38% increased risk of cardiovascular events, a 1.80-fold increased risk of death, and a 5-year readmission rate of 32.4%, the global death toll from AKI exceeds 2 million per year, which greatly increases medical and financial costs, places a heavy burden on patient families and society, and has become a serious public health problem worldwide.

Click to Cistanche for kidney disease

At present, the majority of medical workers in China, especially grassroots medical workers, still lack sufficient understanding of the diagnosis and treatment of AKI. There are many blind spots and misunderstandings in the diagnosis, treatment, and prevention of AKI, and the level of diagnosis and treatment is uneven. There is a common problem of insufficient renal function monitoring among hospitalized patients in China. Hospitals of different levels have high rates of missed diagnosis and misdiagnosis of AKI, resulting in poor patient prognosis. Therefore, there is an urgent need to establish diagnostic standards and treatment specifications for AKI in China.

In 2012, the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for Acute Kidney Injury were released, which unified and standardized the definition and staging criteria of AKI, improved the sensitivity of AKI diagnosis, reduced the missed diagnosis rate, and improved the ability to predict critically ill patients. The ability to die. Subsequently, different international academic organizations have successively formulated guidelines for the diagnosis and treatment of AKI, including the "Peritoneal Dialysis Treatment Guidelines for Acute Kidney Injury" formulated by the International Society of Peritoneal Dialysis (ISPD) in 2014, and the French Society of Anesthesia and Intensive Care Medicine in 2016. "Guidelines for the Management of Acute Kidney Injury in the Perioperative and ICU", "Guidelines for the Management of Acute Kidney Injury" developed by the Japanese Society of Nephrology (JSN) in 2016, "Guidelines for the Management of Acute Kidney Injury" developed by the Acute Dialysis Quality Initiative (ADQI) in 2017 Consensus" and the "Acute Kidney Injury Guidelines" released by the British Association of Nephrology (RA) in 2019 have played a guiding role in the diagnosis and treatment of AKI to a certain extent. However, most of the evidence-based medical evidence cited in these guidelines is research results from European and American countries, and there is a lack of epidemiological and randomized controlled trial (RCT) research data on Chinese people. The guidance on the diagnosis and treatment of AKI in Chinese people is based on race, etiology, and composition. Differences in diagnosis and treatment characteristics.

In the past 10 years, Chinese scholars have published a large number of internationally influential epidemiological and RCT studies on the epidemiology, biomarkers, diagnosis, and treatment methods of AKI, and presented Chinese data. However, so far, there are no AKI guidelines formulated by Chinese people to guide the diagnosis and treatment of AKI in China. Based on the above reasons, the National Chronic Kidney Disease Clinical Research Center and the Nephrology Branch of the Chinese Medical Doctor Association gathered national authoritative experts in the field of AKI diagnosis and treatment to follow the internationally accepted grading of recommendations assessment, development, and evaluation. GRADE) grading system, using the development methods and workflow of clinical evidence-based guidelines, the "Clinical Practice Guidelines for Acute Kidney Injury in China" (hereinafter referred to as this guideline) that is suitable for China's national conditions were formulated.

This guideline aims to provide a clinical decision-making basis for Chinese clinicians and related practitioners in the prevention, diagnosis, and treatment of AKI, reduce unnecessary and excessive treatment methods, identify and avoid wrong and harmful treatment strategies, and improve the effectiveness of AKI treatment. Standardization and effectiveness can reduce the disability and mortality rates of AKI patients and reduce the excessive consumption of medical resources.

This guideline focuses on six major clinical issues in the diagnosis and treatment of AKI and systematically introduces the definition and epidemiological characteristics of AKI, diagnosis and monitoring of AKI, non-blood purification treatment of AKI, renal replacement therapy strategies for AKI, diagnosis, and treatment of AKI in special populations, and AKI It aims to systematically standardize the diagnosis and treatment of AKI in China and provide the first comprehensive and systematic guiding document for the diagnosis and treatment of AKI in China.

Introduction to methodology

In order to ensure the scientificity, authority, and impartiality of this guideline, the National Chronic Kidney Disease Clinical Research Center and the Nephrology Branch of the Chinese Medical Doctor Association established a guideline-writing group composed of experts in nephrology, urology, and blood purification, led by Academician Chen Xiangmei Serves as the team leader. The writing team includes experts in clinical medicine, evidence-based medicine, health economics, epidemiology, literature research, and statistics. Clinical issues are collected through literature research, expert consultation, etc. The writing team formulates the formulation through meetings and emails. In order to write a proposal, clinical questions were selected based on the PICO principle.

For major clinical issues such as the definition and epidemiology of AKI, diagnosis and detection of AKI, treatment of AKI, prevention and treatment of AKI in special populations, search Medline, PubMed, Embase, Web of Science, Cochrane Library, Epistemonikos, and Chinese Biomedical Literature Service System, Wanfang Database and CNKI, analyze whether the paper can answer the main clinical questions, and evaluate the evidence level of the paper. The guideline writing expert group evaluates the quality of the papers and comprehensive evidence retrieved from the system. The evaluation tool adopts the GRADE standard, and the guideline grading standard adopts the GRADE grading system.

After evaluating the evidence and discussing its consistency with the clinical problem, the evidence is converted into recommendations. The recommendations should be supported by evidence, and the corresponding evidence sources should be included in the references. Recommended opinions adopt the principle of expert consistency. When there are different expert opinions, the expert opinion with more than 2/3 of the votes will be used. At the same time, current domestic and foreign AKI-related clinical guidelines were used for reference. For case reports that are widely used in clinical practice and expert opinions that have not been verified by systematic research, the expert consensus method is used to form recommendations, and the source is marked as "expert consensus".

The writing team of this guideline stated that during the drafting and revision process of the guideline, they promised not to take part-time jobs for compensation from relevant companies. They did not take the demands of companies into consideration when drafting the guideline and did not disclose the content to relevant manufacturers before it was officially released. From 2020 to 2023, after 5 expert discussions, revision and finalization were carried out, and this guide was jointly compiled.

How Does Cistanche Treat Kidney Disease?

Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.

Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.

Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.

Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.

Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.

Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.

Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.

In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.

In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.