People with diabetes and chronic kidney disease (CKD) are at high risk for kidney failure, atherosclerotic cardiovascular disease, heart failure, and premature mortality. The American Diabetes Association (ADA) and the Kidney Disease: Improving Global Outcomes (KDIGO) established joint group, and integration of evidence-based recommendations for diabetes management in patients with CKD in accordance with the ADA 2022 standards of medical care in diabetes and KDIGO 2022 Clinical Practice Guideline for Diabetes Management in CKD, and to form the Diabetes Management in Chronic Kidney Disease: a Consensus Report by the ADA and KDIGO. The consensus not only re-emphasizes the published guidelines for screening and diagnosis of CKD, glycemia monitoring, lifestyle therapies, treatment goals, and pharmacologic management, but also specifically emphasizes the importance of comprehensive care in which pharmacotherapy based on a foundation of healthy lifestyle. The consensus states seven core recommendations which provide specific guidance for the use of renin-angiotensin system inhibitors, metformin, sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide 1 receptor agonists, and a nonsteroidal mineral corticoid receptor antagonist. These areas of consensus provide clear direction for implementation of care to improve clinical outcomes of people with diabetes and CKD. Focusing on the main contents of the consensus, we interpreted main recommendations in order to provide concise and practical guidance for clinicians, to achieve the goal of improving the prognosis of patients with diabetes mellitus complicated with CKD.
In recent years, panelists from the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) have conducted a systematic review of studies about sarcopenic obesity (SO) . Then in February 2022, ESPEN and EASO jointly released the Definition and Diagnostic Criteria for Sarcopenic Obesity, in which the definition and diagnosis of SO were detailed, aiming to reach expert consensus on a definition and diagnostic criteria for SO, thereby providing a reference for researchers and clinicians to facilitate the development of prevention and treatment of SO. We primarily interpreted the definition and diagnostic procedure (including screening, diagnosis and staging with proposed implementation method and relevant parameters) for SO in the Definition and Diagnostic Criteria for Sarcopenic Obesity, providing Chinese medical workers with guidance for coping with SO.
Peritoneal dialysis (PD) patients generally have low level of physical activity and poor physical functions. Maintaining good physical function has always been a health concern of PD patients. However, there has been no consensus on how to carry out physical activity/exercise intervention and to maintain good physical function in PD patients. Practice recommendations of Physical Activity and Exercise in Peritoneal Dialysis (hereinafter referred to as PAEPD) , the first global practice recommendations on physical activity and exercise in PD patients, were released by International Society for Peritoneal Dialysis (ISPD) and the Global Renal Exercise Network (GREX) in February 2022. In accordance with the physical activity and exercise in Chinese PD patients, after reviewing the PAEPD and other relevant international recommendations, we performed a clinical interpretation of PAEPD in detail, towards addressing the concerns of clinical healthcare workers and PD patients in China: timing of exercise and activity, and volume of intraabdominal fluid recommended during physical activity, core strengthening, potential symptoms and adverse events related to activity and exercise, and individualized activity and exercise. All this will provide clinical healthcare workers with guidance on the management of physical activity and exercise in PD patients.
Nephrolithiasis in pregnancy is a common non-obstetric indication for hospital admission in obstetric patients, which is often associated with pain, nausea, vomiting, decreased renal function, urinary infection and other symptoms, and improper treatment for which will lead to abortion, premature delivery and other adverse pregnancy outcomes. In response, a multi-disciplinary team from a single academic medical center in the United States was assembled to create the management of nephrolithiasis in pregnancy: multi-disciplinary guidelines from an academic medical center to standardize the care for obstetric patients presenting with suspected nephrolithiasis. A total of 10 guideline statements were constructed, including four for guiding diagnosis and imaging, and six for guiding clinical treatment. It is noteworthy that compared with relevant Chinese guidelines, the guidelines provide practice-based evidence that proves the safety and effectiveness of low-dose non-contrast CT scan preferably used when condition changes and diagnostic uncertainty exists. This paper offers an in-depth interpretation of the above-mentioned contents in the guidelines.
Cushing's disease, the most common cause of endogenous Cushing's syndrome, is hypercortisolemia caused by adrenocorticotropic hormone-secreting pituitary adenoma. Patients may present clinical symptoms such as moon face, buffalo back, central obesity and metabolic disorders due to the persistence of hypercortisolemia. Accurate diagnosis, appropriate treatment and follow-up of Cushing's disease are vitally important. Based on recent evidence, the Pituitary Society published the Consensus on Diagnosis and Management of Cushing's Disease: a Guideline Update in December 2021, with updates in screening and diagnosis procedures, postoperative monitoring, medical therapies and radiotherapy, and complication management. This article interprets the medical therapies recommended in the consensus, which will be helpful for general practitioners and specialists to standardize the diagnosis and treatment of Cushing's disease.
Pituitary adenomas usually cause damage to the gonadal axis, leading to a decrease in fertility in female patients. As pituitary gland enlarges during pregnancy, the hormone secretion of the gonadal axis changes accordingly. Therefore, it is particularly important to standardizedly manage pregnant women with pituitary adenomas. To this end, the European Society of Endocrinology (ESE) published Clinical Practice Guideline on Functioning and Non-functioning Pituitary Adenomas in Pregnancy in August 2021, which details the timing and methods selection of diagnosis and treatment of pituitary adenomas from preconception to postpartum in terms of size, location, and endocrine function of adenomas. We interpreted this guideline and summarized its main points, with a view to providing practical guidance for Chinese clinicians to manage such patients based on relevant clinical evidence and patient characteristics in China.
Asthma is a serious health problem affecting people of all ages worldwide. To address asthma, the Global Initiative for Asthma Expert Group published the Global Strategy for Asthma Management and Prevention in 1995, and an updated version (GINA 2022) with new evidence being incorporated, on the World Asthma Day, May 3, 2022. Asthma prevalence is increasing but is unsatisfactorily controlled generally in China. We mainly interpreted the update points in the GINA 2022, discussed the management of asthma during the COVID-19 pandemic, and assessed the significance of the GINA 2022 for the diagnosis and treatment of asthma in China.
Cushing disease, the most common cause of endogenous Cushing's syndrome characterized by hypercortisolemia, is a clinical syndrome caused by adrenocorticotropic hormone (ACTH) ——secreting pituitary adenomas. The excessive secretion of ACTH in Cushing's disease stimulates bilateral adrenal hyperplasia and causes hypercortisolemia, which can lead to a series of severe clinical syndromes such as electrolyte imbalance, glucose and lipid metabolism disorders, involving multiple organs and systems in the body. The clinical symptoms of Cushing's disease are complex and diverse, and its diagnosis and treatment are extremely challenging. In December 2021, the International Pituitary Society released the Consensus on Diagnosis and Management of Cushing's Disease: a Guideline Update, which focuses on the complications and comorbidities of Cushing's disease, such as hypercoagulability, cardiovascular disease, metabolic bone disease, growth hormone deficiency and infection, etc.; discusses the application of the latest evidence in clinical practice, with a particular focus on new treatment and screening options, diagnostic algorithms, and best practices for preventing disease recurrence. Based on the latest evidence-based medical evidence, this article focuses on the interpretation of Cushing's disease——related laboratory examinations, imaging examinations, diagnosis and treatment management procedures, and recurrence monitoring discussed in the Consensus on Diagnosis and Management of Cushing's Disease: a Guideline Update, in order to improve the general practitioners and specialists'understanding of this syndrome and improve the prognosis of patients with Cushing's disease.
