Background Metabolic-associated fatty liver disease (MAFLD), one of the most common liver diseases, is detected in patients with concomitant hepatic steatosis and Type 2 Diabetes (T2D). We looked into the relationship between Fibrosis-4 (FIB-4) index and coronary artery diseases (CAD) in patients with MAFLD, to further look into the efficiency of FIB-4 in screening for CAD among patients with MAFLD. Method In this study, we included 1664 patients with MAFLD (T2D, who also had hepatic steatosis) during 2012–2022 and divided them into 2 groups; CAD and non-CAD. Demographic, Anthropometric indices, liver function tests, lipid profile and FIB-4 index of all patients were evaluated and compared. Result Among the 1644 patients (all have MAFLD), 364(21.4%) had CAD. Patients with MAFLD and CAD were more probable to be hypertensive, have longer duration of diabetes and be older (with p-values < 0.001). After adjustment for confounding factors, in a multivariable logistic regression model, FIB4 showed a significant independent relationship with concomitant MAFLD and CAD. Upper Tertile FIB-4 had an odds ratio of 3.28 (P-value = 0.002) to predict CAD. Furthermore, in Receiver Operating Characteristic (ROC) Curve analysis with the maximum Youden Index, a FIB-4 cut-off of 0.85 (AUC = 0.656, 95% CI 0.618–0.693, P < 0.001) noted to predict CAD in patients with MAFLD. Conclusion This study showed that the FIB-4 score independently correlates with CAD in patients with MAFLD.
Introduction: Quality of sleep is among the factors that affect the improvement of life quality. The previous studies showed that 50%-80% of hemodialysis patients experience sleeping disturbances. Additionally, dialysis patients commonly experience vitamin D deficiency. Objectives: We aimed to determine the impact of vitamin D deficiency therapy on sleep quality of hemodialysis patients. Patients and Methods: Thirty hemodialysis patients with 25-hydroxy vitamin D deficiency and Pittsburgh Sleep Quality Index (PSQI) ≥5 were enrolled in this clinical trial. Patients were treated with 50000-unit vitamin D per week for 12 weeks. After treatment, the PSQI score was recalculated for each patient. Results: Nineteen out of 30 patients (63.3%) were men and 11(36.7%) were women, with a mean age of 56.7 ± 14.3 years. The mean of vitamin D level was 18.61 ± 6.32 ng/mL before treatment and 41.14 ± 9.62 ng/mL after the treatment. The mean of PSQI score at the start of study was 9.97 and after treatment with vitamin D3, it was 9.47 (P > 0.05). Conclusion: Treatment of vitamin D deficiency did not have any effect on the sleep quality according to the PSQI score in hemodialysis patients. Trial registration: This randomized controlled trial was registered in the Iranian Registry of Clinical Trials (identifier: IRCT20200223046593N1; https://en.irct.ir/trial/46126, ethical code; IR.SBMU.RETECH.REC.1397.1277).
Despite calls for integration of palliative care (PC) into the care of patients with chronic kidney disease (CKD) uptake remains low. Interventions that target top priorities in CKD care and address barriers to collaboration are needed. Methods: Our team invited all clinicians working in nephrology and palliative care departments (N ¼ 195) at a large academic health center to participate in an on-line survey designed to capture their perspectives regarding facilitators and barriers to collaboration, and top research and clinical priorities in advanced CKD. Results: Response rate ¼ 48.7% (n¼ 95). Most respondents were registered nurses (65.3%) in nephrology (80%) with over 15 years' experience (40%). Respondents reported being comfortable caring for patients at or near end-of-life yet inadequately trained to provide comprehensive care. They endorsed the importance of advance care planning and collaboration between nephrology and PC teams, yet both rarely happen. Fragmentation of care was perceived as the main barrier to collaboration. Nephrology clinicians cited patient/family resistance to PC while PC clinicians cited nephrologists' resistance, as the next significant barrier. Perceptions regarding collaboration facilitation differed; nephrology clinicians identified patient/family education as the most important facilitator while PC clinicians identified clinician education as the most important facilitator. Top clinical priorities also differed. PC clinicians reported pain/symptom management as taking priority while nephrology clinicians identified caregiver/family support. Developing interventions to support treatment-related decision making was the top research priority for both groups. Conclusions: Additional studies to capture patients' and families' perspectives and examine end-of-life care, which are underway, will provide a comprehensive picture. Results will inform the development of targeted interventions.
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