Chinese Journal of Blood Purification

12 April 2024, Volume 23 Issue 04 Previous Issue   

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Evidence of benefits and achievement of high-volume hemodiafiltration DU Hui, ZUO Li 2024, 23 (04):  241-244,289.  doi: 10.3969/j.issn.1671-4091.2024.04.001 Abstract ( 61 )   Hemodiafiltration(HDF)works by combining diffusive and convective solute removal to provide a greater removal of larger molecular weight uremic toxins. The recent publication of the CONVINCE study might be a milestone in ending the controversy over whether this treatment modality can provide long-term survival benefits for patients with end-stage renal disease(ESRD)requiring renal replacement therapy. This review gives a brief overview of the current evidence for the clinical benefits of HDF as well as the important factors and stepwise protocols for high-volume HDF achievements. Metrics

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A preliminary clinical exploration of extracorporeal carbon dioxide removal therapy in the treatment of type Ⅱ respiratory failure WAN Jing-yi, LU Yang, HU Jun-kai, MA Xu, YAN Guo-sheng, ZHANG Hong-tao 2024, 23 (04):  245-249.  doi: 10.3969/j.issn.1671-4091.2024.04.002 Abstract ( 30 )   Objective  To investigate the clinical efficacy of extracorporeal carbon dioxide removal (ECCO2R) therapy in patients with continuous renal replacement therapy combined with type Ⅱ respiratory failure. Methods  A retrospective analysis were performed, including 11 CRRT patients with type Ⅱ respiratory failure treated with ECCO2R in the intensive care unit (ICU) and 11 not treated CRRT patients with type Ⅱ respiratory failure as the control group from December 2020 to July 2022.  The results of blood gas analyses were collected from the patients before the treatment and 24 hours after the treatment. The changes in arterial blood carbon dioxide partial pressure (PaCO2), pH (acid-base), arterial blood oxygen partial pressure (PaO2), base remaining (BE), bicarbonate (HCO3-), and lactic acid (Lac) were compared between before and after the treatment.  Results Compared with the control group, PaCO2 was higher in the intervention group before the application of ECCO2R treatment (Z=2.988, P=0.002), but there was no significantly difference after the treatment (Z=-0.230, P=0.847). 24 hours after the application of ECCO2R treatment, pH (t=-3.656,  P=0.002), BE (t=3.185, P= 0.001), HCO3- (t=2.791, P=0.004), and Lac (Z=-2.397, P=0.016) were higher than in the control group. After the application of ECCO2R, pH was significantly higher (t=-2.948, P=0.008) and PaCO2 was significantly lower (Z=-3.447, P＜0.001) than before treatment in the intervention group. And there was no statistically significant change in PaO2 and hemodynamic parameters before and after treatment.  Conclusion  ECCO2R corrects hypercapnia in CRRT patients with type Ⅱ respiratory failure, but whether it has benefits to prognosis still requires large-scale clinical research. Metrics

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Clinical observation of oXiris-endotoxin adsorption technique in the treatment of ESRD patients with  HUANG He-ben, LYU Jun-rui, GUO Qiong-qiong, LI Wen-tian, SUN Yu-xin, WANG Jun-xia 2024, 23 (04):  250-255.  doi: 10.3969/j.issn.1671-4091.2024.04.003 Abstract ( 35 )   Objective  To investigate the efficacy of oXiris-endotoxin adsorption technique in the treatment of end-stage renal disease (ESRD) complicated with sepsis.   Methods  A total of 41 patients with ESRD complicated with sepsis who were hospitalized in the First Affiliated Hospital of Henan University of Science and Technology from January 1, 2021 to July 30, 2023 were enrolled. Among these patients, 22 are in the oXiris filter treatment group, and the other 19 patietns are in the group treated by continuous veno-venous hemofiltration (CVVH) combined with Hemoperfusion (HP). In-hospital mortality, length of stay in ICU, length of mechanical ventilation, length of continuous renal replacement therapy, number of patients with mechanical ventilation, number of filter and Acute Physiology and Chronic Health Evaluation (Apache-II), Norepinephrine (NE) dosage and laboratory test results at the beginning of and after hemopurification treatment were compared between the two groups.  Results  The mechanical ventilation duration in oXiris group was significantly shorter than that in CVVH+HP group (Z= -3.749, P=0.001). After treatment, APACHE-II (t=-4.481,    P=0.001), NE dosage (t=-2.036, P=0.049), C-reactive protein, procalcitonin (Z=-2.850, P=0.004), interleukin-6 (Z=-2.512, P=0.012) in oXiris group were significantly lower than those in CVVH+HP group.  Conclusion  oXiris-endotoxin adsorption technique can effectively reduce inflammatory factors in ESRD patients with sepsis, and it’s effect is better than CVVH+HP treatment; which has good value of clinical application. Metrics

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Current status and influencing factors of fluid intake behavior in maintenance hemodialysis patients    ZHANG Yan, JIANG Hui-li, ZHANG Hui-zhu, WU Li 2024, 23 (04):  256-260.  doi: 10.3969/j.issn.1671-4091.2024.04.004 Abstract ( 26 )   Objective   To investigate the current status and influencing factors of fluid intake behavior in maintenance hemodialysis (MHD) patients.  Methods  A total of 205 MHD patients treated in The Central Hospital Affiliated to Shandong First Medical University from Jan. to Dec. 2021 were recruited by the convenience sampling method. Their health belief and knowledge level were evaluated by using the Liquid Intake Health Belief Scale and Knowledge Level Questionnaire. The influencing factors for fluid intake behavior were then analyzed.  Results   In the 205 MHD patients, fluid intake behaved in the stage of unintention in 21 patients (10.2%), intention in 42 patients(20.5%), preparation in 43 patients(21.0%), action in 73 patients(35.6%), and maintenance in 26 patients(12.7%). When age, fluid intake self-efficacy, and knowledge level increased by one unit, the likelihood of progression to a higher stage of fluid intake behavior increased by 3.7%(OR=1.037,95% CI：1.010～1.065,P=0.007),18.7% (OR=1.187, 95% CI：1.142～1.234,P＜0.001), and 8.0%(OR=1.080,95% CI：1.006～1.160, P=0.033) respectively. When the average interdialytic weight gain decreased by one kilogram, the likelihood of progression to a higher stage of fluid intake behavior increased by 51.0%(OR=0.490,95% CI： 0.330～0.727,P＜0.001).  Conclusion   Age, average interdialytic weight gain, self-efficacy of fluid intake and knowledge level are the influencing factors for fluid intake behavior in MHD patients. Metrics

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Association between dietary potassium intake and risk of mortality，CKD progression in chronic kidney disease patients: A systematic review and dose-response meta-analysis FENG Qian, ZHU Meng-xia, LI Shu-xian, QI Shi-kun, HAN Xiao-wei 2024, 23 (04):  261-266.  doi: 10.3969/j.issn.1671-4091.2024.04.005 Abstract ( 24 )   Objective  To systematically review the dose-response relationship between dietary potassium intake and risk of mortality, CKD progression in chronic kidney disease patients.  Methods  PubMed, The Cochrane Library, EM-base, Web of Science, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect studies about dietary potassium intake and risk of mortality, CKD progression in patients with CKD from inception to August 2023. Two reviewers screened literature, extracted data and assessed the quality of included studies independently. Meta-analysis was performed by using R4.2, and the dose-response relationship was analyzed by using restricted cubic spline function and generalized least squares estimation.  Results  A total of 14 studies involving 53694 patients were included. The results of meta-analysis showed that no significant association between potassium intake and mortality in CKD patients (RR=0.875, 95% CI:0.746～1.027, P=0.100). Dose-response meta-analysis showed an L-shaped association between potassium intake and mortality in CKD patients (non-linear test P=0.010), while there was no significant non-linear trend between potassium intake and CKD progression (non-linear test  P=0.226). The linear trend results showed that for every unit increase in potassium intake in CKD patients, the risk of CKD progression was reduced by 21.6% (RR=0.784,95% CI:0.625～0.983, P=0.031).  Conclusion   Current evidence suggests that potassium intake in CKD patients should not be excessively restricted. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusion. Metrics

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Effectiveness of different frequency of hemodiafiltration combined with high flux hemodialysis in the treatment of end-stage renal disease YANG Zheng-rong, LIN Miao, CAO Fang 2024, 23 (04):  267-271.  doi: 10.3969/j.issn.1671-4091.2024.04.006 Abstract ( 38 )   Objective  To investigate the effect of different frequency of hemodiafiltration combined with high flux hemodialysis (HFHD) in the treatment of patients with end-stage renal (ESRD) disease.  Methods  A total of 108 ESRD patients treated in Fujian Provincial Hospital from January 2019 to August 2022 were retrospectively studied. They were treated with hemodiafiltration combined with HFHD, and divided according to the frequency of hemodiafiltration into low frequency group (n=36, hemodiafiltration once per month), medium frequency group (n=36, hemodiafiltration twice per month), and high frequency group (n=36, hemodiafiltration thrice per month). The treatment lasted for 6 months. The adequacy of dialysis (including Kt/V, β2-microglobulin clearance rate and urea reduction rate), residual renal function (including urine volume, residual renal Kt/V and residual renal creatinine clearance rate), nutritional status (including serum total protein, prealbumin  and albumin), inflammatory factors (including interleukin-6, tumor necrosis factor-α and C-reactive protein), and complications were compared among the three groups.  Results  After 6 months of the treatment, the total urea clearance index (Kt/V), β2-microglobulin clearance rate, and urea reduction rate(URR) were statistically different among the three groups (F=33.410, 27.559 and 35.226 respectively; P＜0.001); residual renal function, urine volume, residual renal Kt/V, and residual renal creatinine clearance rate were different among the three groups (F=34.159, 27.911, 25.084 and 23.342 respectively;P＜0.001); serum total protein, prealbumin  and albumin, interleukin-6, tumor necrosis factor-α and C-reactive protein were also different among the three groups (F=28.404, 39.842, 25.968, 41.864, 25.074 and 39.240 respectively,P＜0.001); the incidence of complications was higher in the high frequency group than in the medium frequency and low frequency groups (χ2=8.826, P=0.012).  Conclusion  Different frequency of hemodiafiltration combined with HFHD can improve the dialysis adequacy, residual renal function, and nutritional status in ESRD patients, with the higher frequency of hemodiafiltration being more effective. It can also reduce the expression of inflammatory factors. However, the incidence of complications remains higher. Metrics

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Influencing factors and interventional measures for cognitive frailty in patients on maintenance hemodialysis YI Zi-han, ZOU Zhao-hua, CHENG Xin-jie, XU Xing-ying, ZHOU Na, LUO Huan, QING Wei 2024, 23 (04):  272-276.  doi: 10.3969/j.issn.1671-4091.2024.04.007 Abstract ( 25 )   Objective  This study aimed to investigate the current status of cognitive frailty (CF) in maintenance hemodialysis (MHD) patients and to analyze the influencing factors for CF.  Methods  A total of 258 MHD patients from July to October 2022 were recruited by a convenient sampling method. CF was assessed using the Montreal cognitive assessment (MoCA), frailty phenotype assessment, and clinical dementia rating (CDR) scale. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for CF. A CF risk prediction model was then developed, and a nomogram was constructed. The performance of the nomogram was assessed using area under the curve and calibration plots.  Results  The prevalence of CF in the surveyed MHD patients was 16.67%. Multivariate logistic regression revealed that the calf muscle circumference (OR=0.938, 95% CI:0.883～0.996,P=0.038), five-times-sit-to-stand test (OR=1.098,95% CI:1.023～1.178,P=0.009), the sarcopenia screening scale of SARC-F score (OR=0.938,95% CI:0.883～0.996,P=0.038), and the geriatric depression scale of GDS-15 score (OR=0.938,95% CI:0.883～0.996,P=0.038) were the independent factors influencing CF in MHD patients. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for CF, and a CF risk prediction model and a nomogram were then developed. The performance assessment of the nomogram showed that the area under the curve was 0.842 (95% CI:0.779～0.905) and the Hosmer and Lemeshow goodness of fit test was c2=5.163 and P=0.740.  Conclusion  The prevalence of CF is high in MHD patients. Healthcare professionals should prioritize the sarcopenia and depression screening and the related somatic measures to enable early identification and intervention of CF, thus delaying the onset and progression of CF in MHD patients. Metrics

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The value of coagulation index combined with serum MCP-1 in predicting acute kidney injury in patients with chronic kidney disease ZUO Jun-qiu, YU Yan-yan, ZHOU Hong-xia, PENG Hong-mei, LIU Xiu-juan 2024, 23 (04):  277-281.  doi: 10.3969/j.issn.1671-4091.2024.04.008 Abstract ( 16 )   Objective  To explore the predictive value of coagulation markers combined with serum monocyte chemotaxis protein-1 (MCP-1)  for acute kidney injury(AKI)in patients with chronic kidney disease(CKD).  Methods   A total of 155 CKD patients were admitted to our hospital from January 2021 to June 2023, among which 40 patients had AKI. Clinical data, coagulation indices and serum MCP-1 were compared between the 40 patients with AKI and the 115 CKD patients without AKI. The important risk factors for the presence of AKI and the value of coagulation indices combined with serum MCP-1 for the prediction of AKI in CKD patients was explored.  Results   Thrombin time (TT), activated partial thrombin time (APTT), prothrombin time(PT)and serum MCP-1 were higher in AKI group than in non-AKI group (t=20.506,20.551,21.120 and 16.230 respectively; P＜0.001); fibrinogen(FIB)was lower in AKI group than in non-AKI group (t=8.441,P＜0.001). The presence of AKI was not related to age, sex, body mass index (BMI) and diabetes mellitus (t=0.521, 0.760, 0.648 and 2.399 respectively; P=0.477, 0.383, 0.341 and 0.121 respectively), but was related to diastolic blood pressure, systolic blood pressure, serum uric acid, fasting blood glucose, total cholesterol(TC),serum creatinine(Scr), triglyceride(TAG), hyperlipidemia and hypertension (t=15.681, 12.942, 11.694, 6.914, 12.836, 8.392, 9.724, 14.856 and 11.372 respectively; P＜0.001). Multivariate logistic regression using the presence of AKI as the dependent variable and the factors with P values＜0.05 described above as the independent variables demonstrated that systolic blood pressure, diastolic blood pressure, fasting blood glucose, blood uric acid, TC, TAG, Scr, hypertension, hyperlipidemia, PT, TT, FIB, APTT and MCP-1 were the main risk factors for AKI in CKD patients (OR value=3490, 3.357, 3.050, 2.980, 3.264, 2.861, 3.287, 2.939, 3.466, 9.196, 3.350, 3.281, 2.974 and 3.404 respectively; 95% CI： 2.210～4.770, 1.947～4.767, 1.862～4.238, 1.838～4.122, 2.104～4.424, 1.751～3.971, 2.065～4.510, 1.813～4.065, 2.416～4.516, 1.982～4.410, 2.082～4.618, 2.103～4.459, 1.780～4.168 and 2.092～4.716 respectively; P=0.002, 0.004, 0.005, 0.002, ＜0.001, ＜0.001, ＜0.001, 0.007, 0.002, ＜0.001, ＜0.001, ＜0.001, ＜0.001 and ＜0.001 respectively).   Conclusion   The levels of TT, APTT, PT, FIB and MCP-1 are related to the occurrence of AKI,  and have the ability to predict the occurrence of AKI in CKD patients. Metrics

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Clinical investigation of prolonged intermittent renal replacement therapy to substitute for maintenance hemodialysis XI Chun-sheng, WANG Jin-han, CAI Rui-lian, FANG Chun-tian, XIAO Liao-yuan, LIU Fei, GAO Jian 2024, 23 (04):  282-285.  doi: 10.3969/j.issn.1671-4091.2024.04.009 Abstract ( 38 )   Objective  To investigation the efficacy and safety of prolonged intermittent renal replacement therapy (PIRRT) to substitute for maintenance hemodialysis (MHD).  Methods  Clinical data of the patients treated with renal replacement therapy in the 940th Hospital of Joint Logistics Support Force of Chinese PLA between Oct. 2022 to Mar. 2023, at which quarantine procedures were carried out for the epidemic of coronavirus 2019 disease, were retrospectively studied. The patients undergoing pre- and post-dilution of accelerated venovenous hemofiltration (AVVH) were divided into two groups according to the dialysis dose: low-dose group [25～30ml/(kg·h)] and high-dose group [50～60ml/(kg·h)]. Treatment parameters for the first PIRRT, serum levels of urea, K+, PO4 and carbon dioxide at the beginning and end of PIRRT, estimated urea reduction rate (URR), spKt/V, and complications occurring during and after PIRRT were collected and compared between the two groups.  Results  There were no significant differences in age, sex ratio, dry body weight and hemoglobin (t=1.388, 0.459, 0.479 and 0.913 respectively, P=0.085, 0.498, 0.683 and 0.818 respectively) between low-dose group (n=31) and high-dose group (n=36). Blood flow rate of PIRRT, treatment dose and filter fraction were significantly higher in high-dose group than in low-dose group (t =14.535, 39.358 and 7.304 respectively, P＜0.001); while total net ultrafiltration had no difference between the two groups (t =1.076, P=0.857). Serum K+, PO4, and carbon dioxide were corrected to normal ranges at the end of PIRRT in both groups. URR and spKt/V were significant higher in high-dose group than in low-dose group (t=12.039 and 5.145, P<0.001). No complications were observed during and after PIRRT.  Conclusions   PIRRT can effectively correct volume overload, electrolyte abnormalities and acid-base imbalance. High-dose PIRRT is more effective than low-dose PIRRT in removal of uremic toxins, and is well tolerated by the patients and suitable to substitute for MHD. Metrics

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Effects of the active form vitamin D on metabolism and kidney cell function in patients with chronic kidney disease GUO Zi-Yi, ZHANG Zi-yuan, FANG Jing-ai 2024, 23 (04):  286-289.  doi: 10.3969/j.issn.1671-4091.2024.04.010 Abstract ( 16 )   Vitamin D is a lipid-soluble steroid derivative. Insufficiency or deficiency of vitamin D in patients with chronic kidney disease (CKD) affects calcium-phosphorus homeostasis, parathyroid hormone (PTH) level and glucose and lipid metabolism, leading to the presence of a series of complications, lower quality of life and reduced survival rate in CKD patients. This article reviews the mechanism of vitamin D on metabolism and kidney cell function in CKD patients to provide bases for the prevention and treatment of CKD and its complications. Metrics

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Research progress in the relationship between hemodialysis-related complications and neutrophil/lymphocyte ratio in hemodialysis patients LI Tian, WU Yang, HE Xi-mei, WAN Li-ping, WANG Xue-liang, YUAN Shu-ting, XI Chun-sheng 2024, 23 (04):  290-293.  doi: 10.3969/j.issn.1671-4091.2024.04.011 Abstract ( 31 )   Currently, neutrophils to lymphocytes ratio(NLR)has been recognized as a new predictive biomarker, and is widely used as a prognostic indicator for cardiovascular diseases, renal diseases, autoimmune diseases and others because it is less traumatic, economic, simple, high sensitive and specific. Hemodialysis (HD) is one of the essential measures for critically ill and end-stage renal disease patients to prolong their lives, but many complications occur inevitably. Early identification and treatment of theses complications are required. Previous studies have found that NLR may have the abilities to recognize and predict HD-related complications. This review summarizes the research progress in NLR changes in HD-related complications, to provide a basis for clinicians to evaluate the presence and prognosis of HD-related complications. Metrics

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Research progresses in the use of artificial intelligence for hemodialysis monitoring and complication prediction REN Zhi-jian, LUO Qun, CAI Ke-dan 2024, 23 (04):  294-297.  doi: 10.3969/j.issn.1671-4091.2024.04.012 Abstract ( 30 )   The prevalence of end stage renal disease (ESRD) has been steadily increasing, and hemodialysis is a predominant treatment modality for these patients. Recently, a series of artificial intelligence (AI) models including machine learning and deep learning techniques have been successfully developed into the area of hemodialysis research. Compared with the conventional linear models, the AI models can accurately predict complications, evaluate vascular access, manage volume control and estimate prognosis based on the information from hemodialysis patients. AI also has powerful potentials in clinical practice to improve and individualize hemodialysis protocols and to prevent and treat complications. This review summarizes recent the research advances in AI models for monitoring hemodialysis and predicting complications, aiming to support doctors and nurses to improve the quality of life and to prolong the lives of hemodialysis patients. Metrics

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Analysis of factors influencing the maturation of autogenous arteriovenous fistula using slender artery based on vascular remodeling YANG Yan-li, XU Yuan-kai, HU Pei-hua, LI Wen, LIU Yong-liang, SUN Li-jun, REN Guang-wei, NIU Zhe-li, ZHANG Jing, RUAN Lin, ZHANG Li-hong 2024, 23 (04):  298-301,316.  doi: 10.3969/j.issn.1671-4091.2024.04.013 Abstract ( 17 )   Objective  To investigate the maturation and long-term patency of arteriovenous fistula (AVF) constructed by slender artery, and to analyze the influencing factors for maturation of the AVF based on the theory of vascular remodeling.   Method   Patients undergoing AVF operation using the radial artery diameter ≤1.5 mm for the construction were selected. The diameters of radial artery and cephalic vein were measured by ultrasound before operation; Blood flow and diameters of cephalic vein and brachial artery were measured after operation for one month. The maturation of AVF was evaluated and follow-up study was conducted for 12 months to analyze the prognosis of AVF established by slender vessels.  Result  Fifty-six patients were included in this study. Before operation, the mean diameter of radial artery was 1.26±0.28 mm, and the smallest diameter of radial artery was 0.5 mm; the average diameter of the cephalic vein after dilatation by tourniquet was 2.72±0.53 mm. AFV maturation progressed naturally without intervention in 40 patients (71.43%), and the AVF maturated after endovascular surgery or surgical reconstruction in 13 (23.21%) of the remaining 16 patients. Regression model showed that radial artery diameter was an independent factor for predicting AVF maturation, and the best critical value for predicting AVF maturation was radial artery diameter ＞1.35 mm. The average follow-up time of the 56 patients was 11.39±5.81 months. After the operation for 3, 6 and 12 months, the primary patency rates were 73.08%, 68.75% and 65.71% respectively and the secondary patency rates were 100%, 97.92% and 100% respectively.  Conclusions  AVF constructed by slender radial artery has a high maturity rate and long-term patency rate. The radial artery diameter over 1.35mm is more likely to mature naturally. Metrics

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Association between CT image-based muscle mass and constipation in maintenance dialysis patients ZHANG Liu-ping, XIE Qing-lei, WANG Yue, LI Meng-ting 2024, 23 (04):  302-306.  doi: 10.3969/j.issn.1671-4091.2024.04.014 Abstract ( 31 )   Objective  Constipation is a common gastrointestinal symptom that is prevalent in dialysis patients. It is well known that many factors affect constipation in dialysis patients, but whether muscle mass affects constipation is unknown. The aim of this study was to explore the relationship between muscle mass and constipation in dialysis patients.  Methods   A total of 428 dialysis patients from three dialysis centers were enrolled in this cross-sectional study. Constipation was assessed by the constipation assessment scale (CAS). Muscle mass was determined using computed tomography (CT) at the L1 vertebral level. Multivariate logistic regression was used to assess the effect of muscle mass on constipation.   Results   A total of 428 dialysis patients were enrolled in the study. The mean age was 56.09±15.17 years, and the prevalence of constipation was 62.38% in dialysis patients. Multivariate logistic regression results showed that dialysis years (OR=0.942,95% CI:0.910～0.976,P＜0.001) and low attenuation muscle (LAM) density (OR=0.825,95% CI:0.771～0.961,P=0.008) were the protective factors influencing constipation, while diabetes history (OR=2.331,95% CI:1.290～4.212,P＜0.001) was a risk factor for constipation. We also performed sex subgroup analyses. In male dialysis patients, a younger dialysis age (OR=0.946,95% CI:0.903～0.990,P=0.017) and a lower LAM density (OR=0.868,95% CI:0.777～0.970,P=0.014) were the risk factors for constipation based on CAS score. In female dialysis patients, a younger dialysis age (OR=0.934,95% CI:0.884～0.987,P=0.015) and a lower LAM density (OR=0.784,95% CI:0.675～0.911,P=0.002) were the risk factors for constipation based on CAS scores.   Conclusions   The present study shows that dialysis patients have a higher incidence of constipation and that LAM density is an independent risk factor for constipation in dialysis patients. Our study provides a new perspective to understand the cause of susceptibility to constipation in dialysis patients. Metrics

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The influencing factors and prognosis of sarcopenia in maintenance hemodialysis patients ZHONG Zhi-cong, WU Yi-fan, WEI Lin 2024, 23 (04):  307-312.  doi: 10.3969/j.issn.1671-4091.2024.04.015 Abstract ( 25 )   Objective  To investigate the prevalence, risk factors and survival prognosis of sarcopenia in maintenance hemodialysis(MHD)patients.  Methods  A total of 177 MHD patients from December 2021 to August 2023 were selected as the study objects by convenience sampling method. The incidence of sarcopenia was analyzed, and univariate and multivariate logistic regression analyses were performed to explore the independent influencing factors for sarcopenia. Kaplan-Meier curve was used to analyze the 12-month survival prognosis of MHD patients with and without sarcopenia.   Results   ①In the 177 MHD patients, sarcopenia was found in 65 patients(36.72%) and was not found in 112 patients(63.28%). ②Multivariate logistic regression showed that age (OR=1.078，95% CI:1.030～1.143，P=0.002),dialysis months (OR=1.019, 95% CI:1.008～1.030,P=0.001),diabetes mellitus(OR=4.802,95% CI:1.484～15.603,P=0.009), lower level of physical activity (OR=4.222,95% CI:1.013～17.653，P=0.048) were the independent factors for sarcopenia. ③After 12 months of follow-up, the survival rate of MHD patients with sarcopenia was 69.23% (45/65), and that of the patients without sarcopenia was 89.29% (100/112). Kaplan-Meier survival analysis found that the overall survival rate of non-sarcopenia group was significantly higher than that of sarcopenia group (log-rank test,χ2=11.272,P＜0.001). There was no significant difference in overall survival rate between appendicular skeletal muscle mass index (ASMI) compliant group and non-compliant group (log-rank test, χ2=2.374, P=0.123). The overall survival rate of grip strength compliant group was significantly higher than that of grip strength non-compliant group (log-rank test, χ2=10.086, P=0.001). The overall survival rate in the 5-time sitting-standing test compliant group was significantly higher than that in the non-compliant group (log-rank test, χ2=19.668,P＜0.001).   Conclusion   The prevalence of sarcopenia is higher in MHD patients, and the survival rate in the follow-up period of 12 months is low in in MHD patients with sarcopenia. Medical staff should make early diagnosis of sarcopenia in MHD patients and take effective intervention measures to improve their prognosis. Metrics

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Application and nursing of therapeutic plasma exchange on pediatric renal rheumatic diseases ZHOU Jia, ZHANG Hui, ZHOU Qing, ZHAO Rui, SHEN Xia, LIU Fan, XU Hong, SHEN Qian, FANG Xiao-yan 2024, 23 (04):  313-316.  doi: 10.3969/j.issn.1671-4091.2024.04.016 Abstract ( 22 )   Objective  To analyze the application of therapeutic plasma exchange (TPE) and its complications in pediatric renal rheumatic diseases, and to explore the relevant nursing strategies.  Methods The children undergoing TPE at the Department of Nephrology and Rheumatology, Fudan University Children's Hospital from January 2021 to December 2022 were retrospectively studied. Informed consent was obtained from the family of the patient. Vascular access was established through an internal jugular vein. The Prismaflex blood purification machine was used to perform TPE in a total of 28 times for 9 patients. The primary diseases of the patients, pre- and post-TPE indicators, and the presence of complications were analyzed. Results Complications occurred in the 28 times of TPE for the 9 patients, including allergic reactions 9 times (32.1%), hypocalcemia 9 times (32.1%), hypotension 4 times (14.2%), coagulation in extracorporeal circulation once (3.6%), and catheter malfunction once (3.6%). After appropriate nursing interventions, the complications were resolved, and TPE treatments completed successfully without any other life-threatening events.  Conclusion  In the processes of TPE, clinical efficacy on children with different diseases should be observed, and TPE complications should be monitored and managed by appropriate nursing interventions to minimize the side-effects of complications, and to ensure the safety and efficacy of TPE. Metrics

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Negative impacts of hemodialysis waste on environment and measures for improvement LIU Yang, BI Jun, GUO Dong-hua 2024, 23 (04):  317-320.  doi: 10.3969/j.issn.1671-4091.2024.04.017 Abstract ( 19 )   Hemodialysis(HD)is a primary therapeutic modality for end-stage renal disease. However, large quantities of waste water and medical waste are produced in the dialysis processes. Previous studies have focused on the negative impacts of waste water on environment, but the negative impacts of medical waste and carbon emission by hemodialysis have been rarely discussed. This paper aims to fill this study gap and to explore the improvement measures based on previous research results, in order to promote a green and a sustainable development of HD. Metrics