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Observation on the anticoagulant efficacy and blood concentration of nafamostat mesylate in hemodialysis AO Guang-yu, HUANG Lan, CHEN Ting-yu, LI Han-yu, CHEN Min Chinese Journal of Blood Purification    2023, 22 (08): 579-583.   DOI: 10.3969/j.issn.1671-4091.2023.08.003 Abstract （754）      PDF（pc） （414KB）（98）       Knowledge map    Objective To explore the safety and effectiveness of nafamostat mesylate (NM) as an anticoagulant for hemodialysis, and its impact on the systemic coagulation function in patients undergoing maintenance hemodialysis (MHD).  Methods A prospective study was conducted on 12 MHD patients at the Department of Nephrology, The First People's Hospital of Chengdu from January to September 2022. Blood samples were collected at various time points: before dialysis at the arterial end, during dialysis (1h, 2h, 3h and 4h) and 15 minutes post-dialysis at the sites before the filter, after the filter and at the arterial end. NM concentration and activated clotting time (ACT) were measured in these blood samples.  Results At the time points of 1h, 2h, 3h and 4h during dialysis, the ACT values showed significant differences in the blood samples before the filter, after the filter and from arterial end (F=21.899, 27.464, 8.264 and 8.162 respectively; P<0.001, <0.001, =0.001 and =0.001 respectively); the ACT values of different sites at the same time point showed that the ACT value of arterial end was the lowest, followed by the value after filter and then the value before filter. At the time points of 1h, 2h, 3h and 4h during dialysis, the NM blood concentrations were significantly different in the blood samples before the filter, after the filter and from arterial end (F=46.547, 20.059, 16.582 and 16.687 respectively; P <0.001); the NM blood concentrations of different sites at the same time point showed that the NM blood concentration of arterial end was the lowest, followed by the value after filter and then the value before filter.  Conclusion Nafamostat mesylate effectively serves as an anticoagulant in the extracorporeal circulation during hemodialysis. It possesses the characteristics of high dialysis clearance rate and rapid metabolism in the body with a minimal impact on systemic coagulation status. It is a new choice of anticoagulant for patients undergoing hemodialysis with high risk of bleeding. Reference | Related Articles | Metrics

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Expert consensus on anticoagulation management in chronic kidney disease patients complicated with non-valvular atrial fibrillation The Working Group on Anticoagulation Management of Non-valvular Atrial Fibrillation in Chronic Kidney Disease Patients Chinese Journal of Blood Purification    2023, 22 (08): 561-573.   DOI: 10.3969/j.issn.1671-4091.2023.08.001 Abstract （509）      PDF（pc） （782KB）（311）       Knowledge map    The incidence of thromboembolic diseases and hemorrhage is high in chronic kidney disease (CKD) patients complicated with non-valvular atrial fibrillation. Nephrologists and cardiologists are facing problems in anticoagulation treatment for these patients. A committee composed of nephrologists, cardiologists and pharmaceutical experts compiled the consensus based on current status of clinical diagnosis and treatment of the disease. According to the data of evidence-based medicine and clinical experiences, this consensus systematically introduces the risk assessment of thromboembolism and bleeding, the timing of starting anticoagulant therapy and the drug of choice, in order to guide and standardize the anticoagulant treatment and to improve clinical diagnosis and treatment of non-valvular atrial fibrillation in CKD patients. Reference | Related Articles | Metrics

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Expert consensus on the classification of clinical application for replacement fluids used in continuous renal replacement therapy The Expert Group of Zhongguancun Nephrology & Blood Purification Innovation Alliance (NBPIA) Chinese Journal of Blood Purification    2023, 22 (10): 721-725.   DOI: 10.3969/j.issn.1671-4091.2023.10.001 Abstract （364）      PDF（pc） （446KB）（150）       Knowledge map    Continuous renal replacement therapy (CRRT) is especially suitable for critically ill patients with unstable clinical conditions among the various extracorporeal blood purification therapies. CRRT enables continuous and slow removal of water and solutes and improvement of metabolic imbalances, and at the same time, stabilizing hemodynamics and facilitating the restoration of kidney function. The selection and optimal combination of replacement fluids based on patient conditions and treatment goals play a pivotal role in the safe and effective performance of CRRT. In the past, the type and quality of replacement fluids proposed in the clinical guidelines, expert consensus and operational protocols from China and foreign countries have been recommended. However, these recommendations are quite different from the preparation and supply of replacement fluids currently used in clinical practice. The establishment of a standardized and practical classification of replacement fluids are required for clinically rational application of replacement fluids and for healthcare professionals to develop effective fluid management and anticoagulation strategies. Based on the three rules, i.e., featuring the present situation of clinical practice, enabling quick clinical decision-making, and reflecting the future technology advances, the expert group of Zhongguancun Nephrology & Blood Purification Innovation Alliance (NBPIA) proposed an expert consensus on the classification of clinical application of replacement fluids for CRRT. This consensus combines clinical evidences and practical experiences, suggests the classification method for replacement fluids according to preparation method, base composition and mixing method, and recommends the classification system and clinical use of replacement fluids for CRRT, in order to improve the clinical use of replacement fluids, the quality evaluation, the standardized management, and the overall quality of CRRT in China. Related Articles | Metrics

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Perioperative Management of New-built Autogenous Arteriovenous Fistula: Chinese Expert Consensus Expert Consensus Work Group of Nephrology and Blood Purification Chinese Journal of Blood Purification    2023, 22 (12): 881-890.   DOI: 10.3969/j.issn.1671-4091.2023.12.001 Abstract （312）      PDF（pc） （583KB）（38）       Knowledge map    Autogenous arteriovenous fistula (AVF) is the first choice for vascular access in hemodialysis patients. Detailed evaluation and planning for a new AVF before the surgery, meticulous manipulation during surgery, and close monitoring and exercise guidance after the surgery must be carried out. These processes need mutual interaction and collaboration between doctors and patients. Healthcare education should begin before the use of AVF for hemodialysis. The Expert Consensus Work Group of Nephrology and Blood Purification, Beijing Perioperative Medicine Study Society based on the guidelines, consensus and evidence-based medical data from China and foreign countries and combined with the clinical experiences of the members in this group proposes this consensus to provide suggestions and comments about the perioperative management of AVF. Related Articles | Metrics

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Consideration of the supervision of hemoperfusion device ZHAN Na, ZOU Yan-guo, LI Dan, QIANG Yi-ning, ZENG Zhu Chinese Journal of Blood Purification    2023, 22 (07): 481-483.   DOI: 10.3969/j.issn.1671-4091.2023.07.001 Abstract （218）      PDF（pc） （354KB）（170）       Knowledge map    Hemoperfusion device is widely used in the treatment of renal failure, liver failure, poisoning, autoimmune diseases, et al. This article tends to introduce the common registration problems and difficulties of these hemoperfusion devices from the perspective of medical device registration supervision. Reference | Related Articles | Metrics

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The new classification of uremic toxins LI Chao, WEI Tao Chinese Journal of Blood Purification    2023, 22 (11): 801-805,815.   DOI: 10.3969/j.issn.1671-4091.2023.11.001 Abstract （214）      PDF（pc） （521KB）（92）       Knowledge map    ?The retention and increase of uremic toxin will lead to a series of uremic symptoms, which will affect many systems of the whole body, and lead to the decline of patients' quality of life and high mortality. In 2003, the European Uremic Working Group classified uremic toxins into three groups according to their physical chemistry properties: water-soluble small molecule compounds, protein-binding compounds, and middle molecule compounds. With the new understanding of uremic solutes, the new data of sources and the development of hemodialysis methods and membrane materials, the previous classification can not fully adapt to the new progress in the field of blood purification. Accordingly, in november-december 2020, Claudio R, as president of the General Assembly, convened an expert meeting and prepared an expert consensus that provided new insights into the definition and classification of uremic toxin  tails the expert group's consensus recommendations for new definitions and more clinically oriented new classifications of uremic toxins. Related Articles | Metrics

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Analysis of intradialytic blood glucose change and hypoglycemia in maintenance hemodialysis patients HAN Yu, QU Zhi-jie, FENG Wen-yuan, LI Wen, MIAO Li-ning, SUN Jing Chinese Journal of Blood Purification    2023, 22 (06): 421-425.   DOI: 10.3969/j.issn.1671-4091.2023.06.005 Abstract （188）      PDF（pc） （447KB）（70）       Knowledge map    Objectives  To analyze the rules and influencing factors of intradialytic blood glucose change and hypoglycemia, and to explore the effect of glucose-containing dialysate (GCD) on intradialytic hypoglycemia.  Methods  The maintenance hemodialysis (MHD) patients treated in the Blood Purification Center, The Second Hospital of Jilin University from December 2021 to December 2022 were enrolled in this study. They were routinely treated with glucose-free dialysate (GFD), and then switched to GCD containing 5.5mmol/L glucose. Blood glucose was assayed at 0, 1st， 2nd, 3rd hour and the end of last session of hemodialysis with GFD, and of the 4th session of hemodialysis with GCD.  Intradialytic blood glucose changes and hypoglycemia were compared between the MHD patients with and without diabetes. Univariate and multivariate logistic regression were used to analyze the influencing factors for intradialytic hypoglycemia in MHD patients with diabetes.   Results  A total of 232 MHD patients were enrolled in this study, including 102 in diabetes group and 130 in non-diabetes group. When they were dialyzed with GFD, hypoglycemia occurred in 21 cases in diabetes group (3 episodes of hypoglycemia occurred during dialysis after 0~2 hour and 21 episodes occurred during dialysis after 2 hours to end of the session), and in 6 cases in non-diabetes group (6 episodes occurred during dialysis after 2 hours to end of the session). Asymptomatic hypoglycemia accounted for 79.17% and 83.33% of the hypoglycemia in diabetes group and non-diabetes group respectively. The incidences of hypoglycemia were 20.59 % and 4.62% in diabetes group and non-diabetes group respectively (c2=14.180, P＜0.001). After the hemodialysis switched to GCD, hypoglycemia occurred in one case (0.98%) in diabetes group, significantly lower than the incidence of 20.59 % when GFD was used (P＜0.001); no hypoglycemia occurred in non-diabetes group. Pre-dialytic blood glucose≥10mmol/L (OR=0.185, 95% CI 0.054~0.636, P=0.007) and withdrawal of hypoglycemic medications on dialysis day (OR=0.226, 95% CI 0.073~0.707, P=0.011) were the protective factors for intradialytic hypoglycemia, while diabetes course≥20 years (OR=3.280, 95% CI 1.046~10.286,P=0.042) was the risk factor for intradialytic hypoglycemia. Conclusion   The last 2 hours of a dialysis session is the period when hypoglycemia, especially asymptomatic hypoglycemia, frequently occurs. GCD with a glucose concentration of 5.5mmol/L can effectively reduce the prevalence of hypoglycemia. Diabetes course ≥20 years is the risk factor for intradialytic hypoglycemia; withdrawal of hypoglycemic medications on dialysis day and pre-dialytic blood glucose ≥10mmol/L are the protective factors for intradialytic hypoglycemia. Reference | Related Articles | Metrics

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Observation on the efficacy of oXiris hemofilter in the treatment of severe burn complicated with sepsis and acute kidney injury PENG Jia-nan, LUAN Feng-wu, ZHAO Li-hong, CHEN Meng-hua, ZHANG Ting Chinese Journal of Blood Purification    2023, 22 (06): 406-409.   DOI: 10.3969/j.issn.1671-4091.2023.06.002 Abstract （157）      PDF（pc） （436KB）（38）       Knowledge map    Objective  To explore the efficacy of oXiris hemofilter in the treatment of severe burn patients complicated with sepsis and acute kidney injury.  Method  The clinical data of 5 patients with severe burn complicated with sepsis and acute kidney injury treated with continuous venovenous hemofiltration (CVVHDF) with oXiris hemofiltration in the hemodialysis center of General Hospital of Ningxia Medical University from May 2018 to February 2021 were retrospectively analyzed. The changes in general vital signs (body temperature, MAP, heart rate, respiration, urine volume, etc.), blood routine, blood gas analysis, and biochemical indexes were observed in 5 patients before and 24 hours after CVVHDF treatment with oXiris hemofiltration, and the Sequential Organ Failure Assessment (SOFA) score was calculated respectively.  Results  ①In the following 24 hours after CVVHDF with oXiris hemofiltration, compared with before treatment, the urine volume of 24 hours (Z=-2.069, P=0.039), the platelets count (t=-3.977, P =0.001) were increased, and the serum sodium level (t=2.652, P =0.016) and the SOFA score (t=4.265, P＜0.001) was decreased. The indexes of body temperature(t=-0.258, P=0.799), MAP (t=0.168, P=0.868), heart rate(t=1.057, P=0.304), respiration     (t=0.481, P=0.636), PH(t=1.304, P=0.208), WBC (t=-1.616, P=0.123), serum bilirubin(t=0.560, P=0.582), serum creatinine (t=0.755, P=0.459) were improved, but there was no significant difference before and after treatment. ②The 28-day survival rate of these patients was 60%.  Conclusions  CVVHDF therapy with oXiris hemofiltration can improve coagulation function, promote the recovery of kidney function, reduce SOFA score in severe burn patients complicated by sepsis and acute kidney injury. Reference | Related Articles | Metrics

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Iron therapy for iron deficiency anemia in chronic kidney disease TANG Wen-jiao, LIAO Ruo-xi Chinese Journal of Blood Purification    2023, 22 (06): 438-441.   DOI: 10.3969/j.issn.1671-4091.2023.06.008 Abstract （157）      PDF（pc） （366KB）（210）       Knowledge map    Renal anemia is a common complication of chronic kidney disease (CKD). Iron deficiency is highly prevalent in patients with CKD. On the other hand, CKD patients are vulnerable to iron overload due to long-term iron supplement. Serum transferrin and transferrin saturation are traditionally used in the evaluation of iron status. However, due to the chronic inflammation in CKD patients, these biomarkers can not reflect iron status accurately. Oral and intravenous iron therapy both show advantages and disadvantages in anemia treatment. New iron agents bring new choices for iron therapy in renal anemia, while their efficacy needs further studies. Reference | Related Articles | Metrics

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Research trends in artificial intelligence applied to hemodialysis: visualization analysis based on VOSviewer LIU Jia-li, HU Shen-ling, ZHOU Pei-ru, MO Hong-qiang, HUANG Jie-wei, HU Bo Chinese Journal of Blood Purification    2023, 22 (08): 633-637.   DOI: 10.3969/j.issn.1671-4091.2023.08.015 Abstract （154）      PDF（pc） （907KB）（151）       Knowledge map    Objective To investigate the current research status and development trend of artificial intelligence (AI) applied to hemodialysis.  Methods  We searched the literature in the field of AI applied to hemodialysis indexed by SCI-EXPANDED and SSCI in the Web of Science Core Collection database from the establishment of the database to March 29, 2023. We applied the bibliometric research method and VOSviewer software to visualize and present the countries, research institutions, journals, authors, and keywords.  Results  A total of 98 articles and 5 reviews were enrolled in the analysis. In the past 20 years, the application of AI to the field of hemodialysis has shown an overall and rising trend. The country with the most publications was China (n=37), and the institution with the most publications was Fresenius Medical Care (n=16). Hemodialysis outcomes, influencing factors, and complication prediction models are the current and future frontier of research trends in this field.  Conclusion Using bibliometrics and VOSviewer software for analysis can visualize the current status of research and cutting-edge hotspots in the field and provide a reference basis for further research in the future. Reference | Related Articles | Metrics

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Associations between hyperhomocysteinemia and cardiac structure in maintenance hemodialysis  patients HUANG Jia, LEI Juan-juan, LI Han, WANG Shi-xiang Chinese Journal of Blood Purification    2023, 22 (06): 401-405.   DOI: 10.3969/j.issn.1671-4091.2023.06.001 Abstract （149）      PDF（pc） （463KB）（31）       Knowledge map    Associations between hyperhomocysteinemia and cardiac structure in maintenance hemodialysis  patients   HUANG Jia1, LEI Juan-juan1, LI Han1, WANG Shi-xiang1    1Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China Corresponding author: LI Han, Email: hanli@ccmu.edu.cn 【Abstract】Objective  To investigate the associations between hyperhomocysteinemia and cardiac structure in maintenance hemodialysis patients (MHD). Methods  176 MHD patients in Beijing Chao-Yang Hospital Affiliated to Capital Medical University from January 2014 to December 2021 were analyzed retrospectively. Patients whose plasma homocysteine (Hcy) ≤30μmol/L were divided into the normal-mild group, and whose plasma Hcy＞30μmol/L were divided into moderate-severe groups. The indexes of left ventricular by cardiac ultrasound were compared between the 2 groups, and the correlation between plasma Hcy and left ventricular indexes was analyzed. We also explored whether there was an interaction between plasma Hcy and other risk factors of cardiovascular disease on left ventricular structural and functional.  Results  74 patients were enrolled in the normal-mild group, and 102 patients were enrolled in the moderate-severe group. There were significant differences in left ventricular end-diastolic dimension (LVDd) (Z=-2.569, P=0.010), left ventricular end-systolic dimension (LVDs) (Z=-2.813, P=0.005), ventricular septal thickness (IVST) (Z=-3.389, P=0.001), left ventricular posterior wall thickness (LVPWT) (Z=-2.463, P=0.014) and the peak of early diastolic flow velocity E /the peak of atrial flow velocity A (Z=-3.483, P＜0.001) between normal mild-group and moderate-severe group. Plasma Hcy level was negatively correlated with LVDd (r=-0.206, P=0.006), LVDs (r=-0.190, P=0.011) and E/A (r=-0.234, P=0.002), positively correlated with IVST (r=0.356, P＜0.001) and LVPWT (r=0.243, P=0.001). Multiple regression analysis showed that plasma Hcy level was correlated with LVDd  (β=-0.263, P＜0.001), LVDs  (β=-0.223, P=0.004), IVST (β=0.294, P＜0.001), LVPWT   (β=0.244, P=0.002) independently. Plasma Hcy level interacted with body mass index (BMI) (β=0.405, P＜0.001) on IVST；Plasma Hcy level interacted with gender (β=-0.164, P=0.038), BMI (β=0.386, P＜0.001) and systolic blood pressure (SBP) (β=0.225, P=0.004) on LVPWT.  Conclusion  Hyperhomocysteinemia was an independent risk factor for cardiac structure changes in MHD patients, and there was an interaction between blood Hcy level and gender, BMI, and SBP before dialysis on cardiac structure changes. 【Key word】Maintenance hemodialysis; Homocysteine; Cardiac structure Related Articles | Metrics

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Evidence-based practice of exercise rehabilitation in maintenance hemodialysis patients ZHAN Xuan, GUO Yue-yue, ZHOU Kou-xiang, CHEN Ting-ting, BO Xiang-min, LIU Sheng-feng Chinese Journal of Blood Purification    2023, 22 (06): 472-476.   DOI: 10.3969/j.issn.1671-4091.2023.06.016 Abstract （148）      PDF（pc） （449KB）（272）       Knowledge map    Objective   To implement evidence-based practice based on the evidences from exercise rehabilitation in maintenance hemodialysis (MHD) patients, and to validate the role of exercise rehabilitation in improving physical function, exercise tolerance, and quality of life in MHD patients.  Methods  The evidence-based continuous quality improvement model was used as the research framework, and an evidence-based program for exercise rehabilitation in MHD patients was conducted from January to December 2021 through evidence acquisition, status review and evidence introduction. A total of 80 MHD patients hospitalized in the Department of Nephrology, Jiangsu Provincial Hospital of Traditional Chinese Medicine from January to March 2022 were then recruited and randomly divided into experimental group (n=40) and control group (n=40). After the exercise intervention, the muscle mass, muscle strength, 6-minute walking test, and quality of life were compared between the two groups. The awareness of sport rehabilitation evidence in medical staff was also compared before and after the evidence-based practice.  Results   Nine pieces of evidences were finally included, with a total of seven reviewed indicators. After exercise intervention, muscle mass (t=-3.302, P<0.01), muscle strength (t=-2.825, P<0.001), and 6-minute walking (t=-5.529, P<0.001) increased more in experimental group than in control group. The total scores of each dimension in the Health Survey Short Form increased more in experimental group than in control group (P<0.05). The awareness rate of sport rehabilitation evidence among medical staff increased by 40.74% before and after evidence-based practice, which has a statistical significance (P<0.001).  Conclusion  The evidence-based exercise rehabilitation practice can improve the body function, exercise endurance and quality of life in MHD patients. Reference | Related Articles | Metrics

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Effect of the start time of blood purification therapy and the selection of filter on short-term prognosis of the patients with sepsis CHEN Xi, WAN Hong-zhe, WU Shuo, ZHANG Li Chinese Journal of Blood Purification    2023, 22 (07): 493-497.   DOI: 10.3969/j.issn.1671-4091.2023.07.004 Abstract （138）      PDF（pc） （522KB）（67）       Knowledge map    Objective  To investigate the effect of starting time of blood purification therapy and selection of filter on short-term prognosis of patients with sepsis. Methods:We retrospectively collected Patients with sepsis who received blood purification treatment in the First Affiliated Hospital of Xinjiang Medical University .Single factor analysis was collected on the index line on the start day.ROC curve was used to compare the prediction effect of each index, and the optimal threshold value was determined and grouped to analyze the 28d mortality rate with AN69/oXiris was analyzed in the higher/lower groups with different cut-off values. P＜0.05 was considered statistically significant. Results:Among the 66 patients, 31 died within 28 days of admission. Univariate analysis showed that aCCI, NEWS, SOFA, APACHE II(OR value was 1.380, 1.213, 1.141, 1.079; 95%CI was 1.035-1.838, 1.062-1.386, 1.005-1.297, 1.017-1.144; and P value was 0.028, 0.005, 0.042, 0.012) was the risk factor for death within 28 days; Scr(OR=0.994;95%CI=0.991-0.998;P=0.001) was a protective factor for death within 28 days; The AUC vaule of aCCI, NEWS, SOFA, APACHE II and Scr were 0.674, 0.698, 0.657, 0.679 and 0.736. 95%CI were 0.543-0.806、0.572-0.824、0.521-0.793、0.548-0.811、0.614-0.858, and the optimal cut-off values were 3.5, 14.5, 11.5, 19.5 and 418.98. In the low-aCCI group, 28d mortality was lower in patients treated with oXiris(χ2=4.572，P=0.032). Conclusion: 1. Patients with sepsis at the start of blood purification therapy had higher risk of death within 28 days with aCCI score above 3.5, NEWS score above 14.5, SOFA score above 11.5, APACHE II score above 19.5, and Scr score below 418.98μmol/L. 2. In sepsis patients with low aCCI, oXiris treatment compared with AN69 membrane material can reduce the 28d mortality of sepsis patients. Reference | Related Articles | Metrics

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Updated points of the American Society for Apheresis: The Ninth Special Issue Guidelines for Therapeutic Apheresis HUANG Yu-min, WU Bu-yun Chinese Journal of Blood Purification    2023, 22 (09): 644-648.   DOI: 10.3969/j.issn.1671-4091.2023.09.002 Abstract （133）      PDF（pc） （493KB）（79）       Knowledge map    Therapeutic apheresis separates different blood components using blood separation techniques, which is a non-pharmacological treatment to remove toxins, antibodies and other substances from the body. In the ninth edition of American Society for Apheresis Guidelines, seven new disease indications, nine new indications for diseases, and changes of evidence level of eight older indications have been added compared to the eighth edition. This article provides a brief review of the updated guidelines. Reference | Related Articles | Metrics

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Effect of hemodialysis combined with hemoperfusion on blood lipids and micro inflammatory status in uremic patients ZHANG Ning, HE Liang-yu, TAO Yong-yuan, HAN Jing-ming, ZHANG Yan-ping, CAO Ning Chinese Journal of Blood Purification    2023, 22 (10): 726-729.   DOI: 10.3969/j.issn.1671-4091.2023.10.002 Abstract （133）      PDF（pc） （507KB）（41）       Knowledge map    Objective  To investigate the effects of hemodialysis (HD) combined with hemoperfusion (HP) on blood lipids and micro inflammatory status in uremic patients.  Method  A total of 60 uremic patients undergoing maintenance hemodialysis at the Blood Purification Center of the Northern Theater Command General Hospital from December 2018 to December 2020 were recruited for this study. They were divided using a random number table method into a control group and an experiment group with 30 cases in each group. The patients in the control group received routine hemodialysis, while the patients in the experiment group received hemoperfusion in addition to hemodialysis in the control group. Before treatment and 12 weeks after the treatment, blood samples were collected to observe the changes of total cholesterol (TC), triacylglycerol (TG), high-density lipoprotein (HDL-C), low density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α).  Result  There were no statistical differences in the levels of TC, TG, HDL-C and LDL-C before treatment between the two groups (t=1.582, 0.488, 0.096 and 0.908 respectively; P=0.119, 0.627, 0.924 and 0.368 respectively). After 12 weeks of treatment, the levels of TC, TG and LDL-C were lower in the experiment group than in the control group (t=2.101, 4.308 and 2.521 respectively; P=0.040, <0.001 and 0.014 respectively), while serum HDL-C was higher in the experiment group than in the control group (t=3.408, P=0.001); the improvement of TC, TG, HDL-C and LDL-C levels were better in the experiment group than in the control group (t=3.709, 2.108, 2.336 and 3.401 respectively; P<0.001, 0.039, 0.023 and 0.001 respectively); CRP, IL-6 and TNF-α decreased in both groups (t=3.062, 2.694 and 4.575 respectively; P=0.003, 0.009 and <0.001 respectively), but the levels of improvement were better in the experiment group than in the control group (t=8.574, 7.698 and 9.256 respectively; P<0.001).  Conclusion  The combination of hemodialysis and hemoperfusion can effectively improve the blood lipid metabolism, the clearance of inflammatory factors and the micro inflammatory state in maintenance hemodialysis patients. This method is worthwhile to be widely used clinically. Reference | Related Articles | Metrics

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Interpretation on the 2023 clinical practice guidelines of plasma component purification technology from the American Society for Apheresis (9th edition)  WAN Li, WANG Mei Chinese Journal of Blood Purification    2024, 23 (01): 1-8.   DOI: 10.3969/j.issn.1671-4091.2024.01.001 Abstract （129）      PDF（pc） （520KB）（22）       Knowledge map     In April 2023, the American Society for Apheresis (ASFA) released the 9th edition of guidelines for clinical practice of therapeutic apheresis. Based on published literature, these guidelines define the quality of evidence and the recommended strength of therapeutic apheresis in the treatment of diseases, and discuss the clinical application of therapeutic apheresis in 91 disease (166 indications). This article focuses on the interpretation of clinical multidisciplinary applications of plasma component purification technology, including plasma exchange and immuneadsorption. Reference | Related Articles | Metrics

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Study on the influencing factors for cognitive impairment in maintenance hemodialysis patients XIONG Man-ting, CHANG Li-yang, ZHANG Hong-mei Chinese Journal of Blood Purification    2024, 23 (01): 9-13.   DOI: 10.3969/j.issn.1671-4091.2024.01.002 Abstract （129）      PDF（pc） （525KB）（8）       Knowledge map    Objective To explore the influencing factors for cognitive impairment (CI) in patients with maintenance hemodialysis (MHD).  Methods The MHD patients in the Blood Purification Center of Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medicine University from March to May 2023 were selected as the study subjects by convenient sampling method. Patients were divided into CI group (68 cases) and non-CI group (131 cases) according to the score of the Montreal Basic Cognitive Assessment Scale. General information, dialysis data, laboratory results, comorbidities, sleep status and Ishii score were collected. The influencing factors for CI were analyzed by logistic regression. The predictive value of Ishii score on CI was evaluated by using the receiver operating characteristic (ROC) curve.  Results  A total of 199 MHD patients were included in this study, and 34.2% of the patients had CI. Binary logistic regression showed that older age, higher Ishii score, higher cholesterol level, poor sleep status and lower education level were the independent risk factors for CI (OR=7.694, 3.259, 1.567, 1.085 and 0.318, respectively; 95% CI:2.484～23.830, 1.417～7.494, 1.084～2.265, 1.016～1.159 and 0.148～0.684, respectively; P<0.001, 0.005, 0.017, 0.015 and 0.003, respectively). Further study on the ROC curve of Ishii score showed that the optimal critical values for predicting CI in MHD patients, male and female MHD patients were 98.03, 105.17 and 125.49 points, respectively; the areas under the curve were 0.809, 0.813 and 0.802, respectively; the sensitivities were 85.30%, 80.00%, 68.40%, respectively and the specificities were 63.40%, 72.60%, 79.30%, respectively (P<0.001).  Conclusions  The prevalence of CI in MHD patients is higher. CI is affected by many factors. High Ishii score is an independent risk factor for CI, and is a useful indicator for the prediction of CI in MHD patients. Related Articles | Metrics

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Bacterial thrombus in acral arteries due to spread of arteriovenous fistula thrombosis by manual massage in one case, and review of the literature YANG Yan-li, ZHANG Li-hong, LI Wen, MENG Fu-lei, RUAN Lin Chinese Journal of Blood Purification    2023, 22 (08): 683-640.   DOI: 10.3969/j.issn.1671-4091.2023.08.016 Abstract （127）      PDF（pc） （961KB）（97）       Knowledge map    Autogenous arteriovenous fistula (AVF) thrombosis is a common cause of fistula failure in hemodialysis patients. Manual massage is used for emergency treatment of AVF thrombosis due to its simplicity and convenience, but it can lead to complications such as infection, and thrombus detachment, and even endanger lives. We have treated one case with AVF thrombosis. The bacterial emboli in the limb artery were disseminated due to manual massage, accompanied by multiple metastatic abscesses. This is a rare clinical case we reported here. Reference | Related Articles | Metrics

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Clinicopathological analysis of type I stenosis of autogenous arteriovenous fistula in uremia patients SONG Wen-jun, LIANG Li-ming, CHEN Qin-lan, KONG Xiang-lei, XU Dong-mei Chinese Journal of Blood Purification    2023, 22 (06): 453-457.   DOI: 10.3969/j.issn.1671-4091.2023.06.012 Abstract （119）      PDF（pc） （933KB）（62）       Knowledge map    Objective  To investigate the clinicopathological characteristics of type I autologous arteriovenous fistula (AVF) stenosis in uremic patients.  Methods  A total of 39 patients who underwent AVF reconstructive surgery for type I stenosis were enrolled in this study. Their clinical data were collected. The stenotic venous tissue cut during the reconstructive surgery and the venous tissue stored during the first AVF constructive surgery were pathologically compared, including HE and masson staining, and immunohistochemistry using antibodies against CD133, CD31, CD68, CD206, iNOS and CD56 to identify the cell types.  Results  The mean age of the 39 patients was 52.7±4.4 years old, 62% were male, and diabetic kidney disease accounted for 43.6% of the patients. HE and Masson staining of the stenotic venous tissues demonstrated typical neointimal hyperplasia (NIH). Pearson correlation analysis showed that NIH was positively correlated with serum phosphorus (r=0.381, P=0.026) and negative correlated with neutrophil count (r=-0.360, P=0.031), but not with serum calcium (r=-0.269, P=0.097) and parathyroid hormone (r=0.007, P=0.971). Immunohistochemical staining showed that positive staining of CD31, CD133, CD206, iNOS, CD68 and CD56 were found in the NIH area in stenotic venous tissues.  Conclusions   Histopathological staining showed an eccentric NIH in the venous tissues from type I AVF stenosis. The thickness of the intimal layer correlated with serum phosphorus level and neutrophil count. Immunohistochemistry showed the presence of abnormally arranged intimal cells, endothelial progenitor cells, M1 and M2 macrophages, and NK cells in NIH areas. Reference | Related Articles | Metrics

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Application of small animal models in the study of vascular access for hemodialysis QIN Yu, DU Jing, ZHAO Zhan-yun Chinese Journal of Blood Purification    2023, 22 (06): 446-449.   DOI: 10.3969/j.issn.1671-4091.2023.06.010 Abstract （119）      PDF（pc） （388KB）（192）       Knowledge map    Vascular access for hemodialysis patients includes arteriovenous fistula (AVF), arteriovenous graft (AVG) and central venous catheter (CVC), but all the vascular access methods have the problem of dysfunction. The mechanism of blood access failure is unclear. Animal model can be helpful to understand the causes of vascular access failure. Small animal model has the advantages of easy to use and less expensive, suitable for the molecular study of blood access failure. This review introduces several small animal models as well as the research status and characteristics of the small animal models for the study of blood access failure. Reference | Related Articles | Metrics

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Evidence summary about the management of adult patients with peritoneal dialysis CAO Pei-ye, ZHAO Hui-ping, WU Bei, LU Li-xia, CHU Xin-xin, QIAO Jie, MEN Chun-cui, HE Yu-ting Chinese Journal of Blood Purification    2023, 22 (07): 551-556.   DOI: 10.3969/j.issn.1671-4091.2023.07.017 Abstract （118）      PDF（pc） （439KB）（111）       Knowledge map    Objective  To search, summarize, integrate and evaluate the available evidences about the management of adult patients with peritoneal dialysis, so as to provide evidence-based references for clinical medical staff.  Methods  The websites of Registered Nurses’ Association of Ontario, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, National Guideline Clearinghouse, NGC, Guidelines International Network, Medlive.cn, British Medical Journal Best-practice, UpToDate, Cochrane Library, Joanna Briggs Institute Library, PubMed, Embase, ciNAHL, Web of Science, CNKI and Wanfang database were searched by computer; the British Renal Association and the International Society for Peritoneal Dialysis websites were also searched in order to collect the literature on the management of adult patients with peritoneal dialysis. The retrieval period was from the establishment of database to March 2022. The JBI evidence appraisal and recommendation system was used to evaluate the quality and evidence level of the included literature.  Results  A total of 11 articles were included, including 4 guidelines, 2 expert consensus, 2 evidence summaries, and 3 randomized controlled trials. Twenty-four evidences were summarized from five aspects: diet and nutrition management, exercise management, capacity management, complication prevention and management, and continuous nursing.  Conclusion  This study summarizes the best evidences about the management of adult patients with peritoneal dialysis, which has practical and scientific values, and provides evidence-based references for clinical medical staff to comprehensively control and manage the patients with peritoneal dialysis. Reference | Related Articles | Metrics

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Research progresses in the cognitive impairment in maintenance hemodialysis patients HE Ya-peng, ZHAO Qian, LI Xin, ZHANG Teng, WU Hong-xia Chinese Journal of Blood Purification    2023, 22 (07): 529-532.   DOI: 10.3969/j.issn.1671-4091.2023.07.012 Abstract （118）      PDF（pc） （403KB）（74）       Knowledge map    In view of the prevalence and severity of cognitive impairment in maintenance hemodialysis patients, this article aims to review the research progress in the cognitive impairment in maintenance hemodialysis patients from the aspects of etiology, assessment tools, influencing factors, intervention measures, and others, in order to provide reference for clinical work and research. Reference | Related Articles | Metrics

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Analysis of the influencing factors for skin itching in uremic hemodialysis patients and construction of a column chart model for prediction analysis U Yao-ling, ZHONG Li-li, ZHOU Fang, GU Hong-ye Chinese Journal of Blood Purification    2023, 22 (12): 896-899.   DOI: 10.3969/j.issn.1671-4091.2023.12.003 Abstract （111）      PDF（pc） （650KB）（42）       Knowledge map    Objective  To explore the influencing factors for skin itching in uremic hemodialysis patients and to construct a column chart model for prediction analysis.  Methods  A total of 162 uremic hemodialysis patients admitted to Huai'an Second People's Hospital (Huai'an Hospital affiliated to Xuzhou Medical University) from July 2020 to December 2022 were recruited as the study subjects. They were grouped into a skin itching group (96 cases) and a non-skin itching group (66 cases) based on the symptom of skin itching. Clinical data were collected from the patients. Logistic regression was applied to analyze the risk factors for skin itching in uremic hemodialysis patients. R software was applied to construct a column chart model, and calibration curve was applied to verify the consistency of the mode. The area under the ROC curve was applied to evaluate the predictive value and discrimination ability of the model.  Results  Ninety-six cases (59.26%) of the 162 uremic hemodialysis patients had pruritus. Univariate analysis showed that diabetes history (χ2=5.569, P=0.018), parathyroid hormone (t=13.510, P<0.001), β2 microglobulin (t=11.836, P<0.001), serum phosphorus (t=10.478, P=0.001) and C-reactive protein (t=13.221, P<0.001) were significantly different between skin itching group and non-skin itching group. Multivariate logistic regression showed that β2 microglobulin (OR=1.451, 95% CI: 1.217～1.731, P<0.001), serum phosphorus (OR=7.455, 95% CI: 1.194～46.533, P=0.032), and C-reactive protein (OR=10.929, 95% CI: 4.086～29.234, P<0.001) were the independent risk factors for itching in uremic hemodialysis patients. The nomogram prediction model had better differentiation (area under ROC curve=0.977, 95% CI:0.956～0.998) and consistency (Hosmer-Lemeshow goodness of fit test, χ2=10.065, P=0.261) abilities.  Conclusion   This study constructs a column chart model for predicting the risk of skin itching in uremic hemodialysis patients based on three risk factors: β2 microglobulin, serum phosphorus, and C-reactive protein. This model has better discrimination and consistency abilities, and is expected to become an important tool for predicting the risk of skin itching in uremic hemodialysis patients. Related Articles | Metrics

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Prediction and evaluation of the risk of cardiac valve calcification in maintenance hemodialysis patients with a nomograph model ZHANG Jia-xin, TANG Wen-wu, XIE Xi-sheng Chinese Journal of Blood Purification    2023, 22 (06): 426-431,437.   DOI: 10.3969/j.issn.1671-4091.2023.06.006 Abstract （109）      PDF（pc） （620KB）（50）       Knowledge map    Objectives   The risk of cardiac valve calcification (CVC) in patients with maintenance hemodialysis (MHD) was predicted by a nomogram.  Methods   Patients with end-stage kidney disease (ESKD) who received MHD in Nanchong Central Hospital from 2014 to 2022 were included in this study. Basic information, disease information, laboratory and imaging examination data were collected. The risk factors for CVC were analyzed by univariate and multivariate logistic regression analyses, and a nomograph model for predicting the risk of CVC was established using R language software. Bootstrap method was used for the verification. The prediction efficiency of the model was evaluated by the area under the ROC curve, and the accuracy and practicability of the model were evaluated by calibration curve and decision curve analysis (DCA).  Results   A total of 173 MHD patients were included, including 63 CVC patients (36.4%). Multivariate logistic regression analysis showed that age (OR:1.046, 95% CI: 1.016~1.077, P=0.002), serum calcium (OR: 5.181, 95% CI: 1.015~27.252, P=0.042), serum phosphorus (OR:2.401,95% CI:1.177~4.898, P=0.038), diabetes (OR: 2.943, 95% CI: 1.397~6.195, P=0.013) and secondary hyperparathyroidism (OR: 2.844, 95% CI: 1.003~8.082, P=0.041) were the independent risk factors for CVC. The line chart showed good differentiation. The area under ROC curve of the training set was 0.757 (95% CI: 0.735 ~0.763), the internal verification C-index was 0.732, and the area under ROC curve of the test set was 0.700 (95% CI: 0.695~0.714). The calibration curve results show that the actual probability of CVC occurrence was in better agreement with the predicted probability.  Conclusions  The column graph constructed in this study can be used to identify the patient group in high risk of CVC, which may be clinically useful. Reference | Related Articles | Metrics

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A study on the combination of roxadustat and erythropoietin in the treatment of anemia in maintenance hemodialysis patients with kidney transplant failure LIU Xu, ZHANG Ai-hua, DIAO Zong-li, HUANG Hong-dong, LIU Wen-hu Chinese Journal of Blood Purification    2023, 22 (09): 649-652.   DOI: 10.3969/j.issn.1671-4091.2023.09.003 Abstract （109）      PDF（pc） （450KB）（128）       Knowledge map    Objective  To observe the efficacy of roxadustat combined with erythropoietin (EPO) in the treatment of anemia in maintenance hemodialysis (MHD) patients with kidney transplant failure.  Method   A retrospective analysis was conducted on MHD patients with low EPO response and kidney transplant failure at Beijing Friendship Hospital affiliated to Capital Medical University during the period from June 2021 to December 2022. Some of the patients were treated with roxadustat combined with EPO. Changes of hemoglobin (Hb) and the compliance rate of Hb before and after the combination treatment were analyzed. Their physical and activity status were evaluated using the Eastern Cooperative Oncology Group (ECOG) scoring standards. The dosage of the two drugs and the adverse drug reactions were recorded.  Result  A total of 34 MHD patients with kidney transplant failure were enrolled in this study, including 23 cases in the combined roxadustat treatment group and 11 cases in the control group. There were no statistically differences in age, gender, dialysis age, dry weight and BMI between the two groups. In the combined roxadustat group, Hb increased from (97.91±15.47) g/L before treatment to (111.61±11.95) g/L after treatment (t=-4.499, P＜0.001); the HB level before treatment was lower than the HB level of 117.09±4.30g/L in the control group (t=-5.515, P＜0.001), but the HB level after the treatment had no statistical difference with the HB level of （117.09±4.30） g/L in the control group (t=-1.131, P=0.266); the compliance rate of Hb increased from 30.4% to 65.2% (χ2=7.265, P=0.017); and the ECOG scoring indicated that their physical and activity status improved (Z= -2.238, P=0.025). The dosage of roxadustat was 150mg/week in 16 patients and 300mg/week in 7 patients. In the combined roxadustat group, EPO dosage decreased from (14956.52±7351.43) U/week before the treatment to （7478.26±4066.15） U/week after the treatment (t=6.927, P＜0.001); the EPO dosage before treatment was higher than that of （10 727.27±2 412.09） U/week in the control group (t=2.493,P=0.018), but the EPO dosage after treatment was lower than that of （10727.27±2412.09） U/week in the control group (t=-3.290, P=0.002). No significant adverse reactions were observed in the combination therapy of roxadustat and EPO.  Conclusion  The combination therapy of roxadustat and EPO is safe and effective in MHD patients with lower EPO response and kidney transplant failure. Reference | Related Articles | Metrics

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A single-center study of online hemodiafiltration with different frequency to improve quality of life in maintenance hemodialysis patients SUN Yan-ling, XIE Hua, WANG Jin-ling, XIAO Kun, FENG Qing, LIN Hong-li Chinese Journal of Blood Purification    2023, 22 (11): 821-825,860.   DOI: 10.3969/j.issn.1671-4091.2023.11.005 Abstract （108）      PDF（pc） （598KB）（76）       Knowledge map    Objective  To explore the effect of online hemodiafiltration (OL-HDF) once a week and thrice a week on quality of life in patients with maintenance hemodialysis (MHD).  Methods   Patients who received OL-HDF in Dalian Renal Care Hospital from January 1, 2022 to September 30, 2022 were selected and divided into OL-HDF once a week group and OL-HDF thrice a week group; according to the dialysis age in OL-HDF thrice a week group, dialysis age was matched at a ratio of 1:2. The Kidney Disease Quality of Life short Form (SF-36) was applied. The quality of life was assessed by kidney disease component summary (KDCS), physical component summary (PCS) and mental component summary (MCS). Lean tissue index (LTI) was measured by body composition monitor (BCM). Clinical indicators including quality of life scores, LTI, renal function and β2 microglobulin at baseline and after 6 months were compared between the two groups.  Results  A total of 102 MHD patients were included in this study, including 68 patients in OL-HDF once a week group and 34 patients in OL-HDF thrice a week group. Comparison of the indicator changes at baseline and after 6 months in the two groups revealed that KDCS score had no change (t=0.754, P=0.453), the sleep assessment in KDCS was better (t=3.082, P=0.003), the scores of PCS and MCS had no changes (t=  -0.515 and -1/513, P=0.608 and 0.133), and the general health assessment in PCS was better (t=2.442, P=0.016) in OL-HDF thrice a week group, as compared those in OL-HDF once a week group. Changes of the indicators after 6 months showed that hemoglobin (F=6.682, P=0.011), albumin (F=12.294, P=0.001) and LTI (F=7.898, P=0.007) were higher, β2 microglobulin was lower (25.15±3.26mg/L vs. 26.96±5.15mg/L; F=4.710, P=0.032), and spKt/V was higher (1.31±0.21 vs. 1.19±0.15; F=11.975, P=0.001) in OL-HDF thrice a week group, as compared those in OL-HDF once a week group.  Conclusions  OL-HDF treatment thrice a week improves the sleep and nutritional status in MHD patients, probably due to the better dialysis adequacy in these patients. Reference | Related Articles | Metrics

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Advances in the study of bone markers for vascular calcification in chronic renal failure patients  LIAO Sheng-chun, YE Chao-yang Chinese Journal of Blood Purification    2023, 22 (08): 608-611.   DOI: 10.3969/j.issn.1671-4091.2023.08.009 Abstract （107）      PDF（pc） （401KB）（84）       Knowledge map    Vascular calcification (VC) caused by chronic kidney disease-mineral and bone disorder (CKD-MBD) is an important clinical complication, and contributes to the higher cardiovascular mortality in CKD patients. Bone markers can be detected or even involved in the process of VC. Bone markers play important roles in the study of VC. In this paper, we provide an in-depth study of the mechanism of VC, and review the mutual feedback effects among common bone markers such as parathyroid hormone, 25-hydroxyvitamin D, fibroblast growth factor 23 and Klotho (PTH-25OHVitD-FGF23-Klotho). We also summarize the recent research progresses in osteocalcin (OCN), type I collagen carboxy-terminal peptide β special sequence (β-CTX), and total type I collagen amino-terminal extension peptide (tP1NP). Reference | Related Articles | Metrics

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Efficacy of Paricalcitol in the treatment of hemodialysis patients with secondary hyperparathyroidism and the characteristic changes of iPTH and abdominal aortic calcfication score after the treatment for 12 weeks LIU Yin, ZHAO Bin, LIU Li-fang, HU Pu-ping, YANG Tao Chinese Journal of Blood Purification    2023, 22 (07): 508-511,528.   DOI: 10.3969/j.issn.1671-4091.2023.07.007 Abstract （107）      PDF（pc） （486KB）（50）       Knowledge map    Objectives  To investigate the clinical efficacy of Paricalcitol in the treatment of maintenance hemodialysis (MHD) patients with secondary hyperparathyroidism (SHPT), and to analyze the correlation between iPTH level and abdominal aortic calcification (AAC) score.  Methods   A total of 40 MHD patients (24 males and 16 females) with SHPT and received regular hemodialysis at the Hemodialysis Clinic of Beijing Haidian Hospital from April 2019 to June 2020 were included in the study. Intravenous Paricalcitol was administered for 12 weeks in addition to the MHD. AAC score and serum calcium, phosphorus and intact parathyroid hormone (iPTH) were compared before and after Paricalcitol treatment for 12 weeks to assess its clinical efficacy. The relationship between iPTH level and AAC was assessed after the treatment for 12 months.  Results After Paricalcitol treatment for 12 weeks, serum phosphorus and iPTH levels were significantly lower than those before treatment (phosphorus: t=2.192, P=0.047; iPTH: t=3.026, P=0.014); serum calcium was higher than that before treatment (t=4.188, P=0.001), but remained within the normal range (2.1～2.5 mmol/L); the overall effective rate of lowering serum iPTH was 95%. Patients with severe AAC had higher serum iPTH, while those with moderate to mild AAC had relatively lower serum iPTH; the differences in serum iPTH among the severe, moderate and mild AAC groups were statistically significant (F=150.400, P＜0.001). After the treatment for 12 months, AAC scores were lower than the baseline levels, but the score differences had no statistical significance (t=0.504, P=0.617).  Conclusions  Paricalcitol significantly reduced serum iPTH and phosphate levels in MHD patients, and calcium level remained stable within the normal range. Severe AAC may relate to the higher serum iPTH in MHD patients. Reference | Related Articles | Metrics

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Serum FT3 levels, sleep, and anxiety status in maintenance hemodialysis patients: a mediation effect analysis study LI Mao-xue, LONG Mu-yang, LIU Yun, ZHONG Xiao-shi, LIU Yan Chinese Journal of Blood Purification    2023, 22 (06): 410-414.   DOI: 10.3969/j.issn.1671-4091.2023.06.003 Abstract （104）      PDF（pc） （447KB）（66）       Knowledge map    Objective  To investigate the relationship between serum FT3 level and anxiety state in maintenance hemodialysis (MHD) patients.  Methods  This was a single-center and cross-sectional study. Patients who underwent MHD in our center in September 2021 were enrolled. Demographic data, routine blood biochemical examination, and serum free triiodothyronine (FT3) before dialysis sessions were tested, and the anxiety status of the patients was evaluated by the Hamilton Anxiety Scale (HAMA). According to the anxiety scale score, patients were divided into the without anxiety status group (total score＜7 points) and with anxiety status group (total score≥7 points). Multivariate binary Logistic regression was used to analyze the independent factors associated with anxiety risk, and software (Empower Stats 3.0) was used to analyze causal mediating effects among variables.  Results  A total of 120 MHD patients were enrolled in this study, including 66 patients in the anxiety status group and 54 patients in the control group. Spearman analyses showed that the levels of serum FT3 negatively correlated with the sleep score (r=-0.277, P=0.002). Multivariate binary logistic regression analysis showed that low serum FT3 level in MHD patients in our center was independent associated with anxiety status (OR=3.167，95% CI：1.144～8.772, P=0.027), but when sleep score was included in the models, the association between the serum FT3 and anxiety status disappeared (OR=0.842，95% CI：0.812～8.051, P=0.109). Mediation analysis showed that 47.6% of the effect of serum FT3 on anxiety state was mediated through sleep disturbance (P=0.004). Reference | Related Articles | Metrics

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Interpretation of the 2023 International Society for Peritoneal Dialysis guideline recommendations for prevention and treatment of peritoneal dialysis catheter-related infection CHENG Shui-qin, YU Le, ZHANG Zhi-hong, YU Yu-sheng Chinese Journal of Blood Purification    2024, 23 (02): 81-85.   DOI: 10.3969/j.issn.1671-4091.2024.02.001 Abstract （104）            Knowledge map    Peritoneal dialysis (PD) catheter-related infection is a serious complication in PD patients, being an important risk factor for drawing out of PD catheter and peritonitis and affecting prognosis of the PD patients. In May 2023, the International Society for Peritoneal Dialysis (ISPD) updated the guideline recommendations for PD catheter-related infection, revised and clarified the definition and classification of PD catheter exit site infection (ESI) and tunnel infection. A new target that overall PD catheter ESI rate should be less than 0.4 episodes per year was established. The specific recommendation for prevention and treatment of PD catheter-related infections was provided, and the research direction of PD catheter-related infections was proposed. In this review, we present an interpretation on this guideline. Reference | Related Articles | Metrics

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Strategies for blood purification in sepsis ZHANG Qing-qing, HAN Xu-dong Chinese Journal of Blood Purification    2023, 22 (12): 920-924.   DOI: 10.3969/j.issn.1671-4091.2023.12.008 Abstract （103）      PDF（pc） （517KB）（10）       Knowledge map    Sepsis is complicated with dysregulation of immune system to infection, which may lead to life-threatening dysfunction of organs. In the presence of infections, pathogen-associated molecular patterns (PAMPs) initiate inflammatory responses to clear the pathogens, but hyper-activated responses of the immune system may injure the host cells and organs. Damage-associated molecules released by the injured cells amplify the inflammatory responses and may progress to develop a cytokine storm through the damage-associated molecular patterns (DAMPs) pathway. In sepsis, neutrophils shift from potent antimicrobial protectors to destructive mediators to tissues and organs. Blood purification removes the inflammatory mediators as well as the immune cells with adverse functions, and becomes an important approach for the treatment of sepsis. Here we summarize the roles of lipopolysaccharides, cytokines, DAMPs and neutrophils in the pathogenesis of sepsis. We also introduce a series of blood purification methods and their clinical trials targeting the clearance of endotoxins, cytokines, and immune cells at the upstream of inflammatory cascade in sepsis. Related Articles | Metrics

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A systematic review of the scales for quality of life in end-stage renal disease patients in China WU Dan, ZHANG Bei-bei, LI Yang, XIE Kun, CHEN Bo Chinese Journal of Blood Purification    2023, 22 (10): 759-762.   DOI: 10.3969/j.issn.1671-4091.2023.10.009 Abstract （102）      PDF（pc） （458KB）（114）       Knowledge map    Objective  The currently used scales for the assessment of quality of life in end-stage renal disease (ESRD) patients are systematically reviewed and evaluated, so as to provide references for clinical studies of quality of life in these patients.  Methods  We searched for the scales of quality of life for ESRD patients published in Chinese literature in the CNKI database since 2010. The characteristics and application status of these scales were then assessed.  Results There are 6 quality of life scales for ESRD patients, in which the 36-item short form health survey (SF-36) and the kidney disease quality of life-short form (KDQOL-SF) are widely used. SF-36 is a universal scale with the advantages of smaller size, flexible, and short evaluation time, and its application rate is 63.9%. However, SF-36 lacks the evaluation of kidney disease related quality of life. KDQOL-SF is a specific scale for kidney disease and dialysis patients, but KDQOL-SF has 79 items and takes longer examination time.  Conclusion  The scale for study of the quality of life in ESRD patients should be selected based on the purpose of the study, the sample size, and the compliance degree of the patients. Reference | Related Articles | Metrics

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Therapeutic effects of methanol poisoning using the hemodialyzer with a China-made filter and an imported filter ZHAO Ling-shan, XIE De-qiong, ZHANG Chen-li Chinese Journal of Blood Purification    2023, 22 (06): 477-480.   DOI: 10.3969/j.issn.1671-4091.2023.06.017 Abstract （101）      PDF（pc） （391KB）（67）       Knowledge map    Objective  To explore the clinical effect of hemodialysis using the hemodialyzer with a China-made filter (Weigao HF17) and using the hemodialyzer with an imported filter (FX80, Fresenius, Germany) for the treatment of methanol poisoning.  Methods   A total of 25 patients with methanol poisoning treated with hemodialysis in The Second People's Hospital of Yibin City and The Fifth People's Hospital of Yibin City in March 2022 were selected as the research subjects; 9 patients were treated with HF17 hemodialyzer (HF17 group), and 16 patients with FX80 hemodialyzer (FX80 group). Hospitalization days  and changes of blood methanol concentration, pH, base excess (BE) and lactate before and after the hemodialysis were compared between the two groups.  Results   After the treatment, the changes of blood methanol concentration was higher in HF17 group than in FX80 group (t=-3.849, P=0.001); blood pH (FX80 group: t=-6.005, P＜0.001; HF17 group: t=-3.501, P=0.008) and methanol concentration (FX80 group: t=11.045, P＜0.001; HF17 group: t=13.829, P＜0.001) decreased significantly in both groups; blood pH (t=1.461, P=0.158), BE           (t=0.760, P=0.455), lactate (t=-1.276, P=0.215), and hospitalization days (t=-1.925, P=0.067) had no statistical significances between the two groups.  Conclusion   The hemodialyzer equipped with a China-made filter (HF17) and that equipped with an imported filter (FX80) for the treatment of methanol poisoning have the same effects in the clearance of methanol and its toxic metabolites, maintaining acid-base balance, shortening the hospitalization days, and decrease of expenses. Reference | Related Articles | Metrics

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Prospective and self-crossover control study of dialysates containing different calcium concentrations for simplified citric acid anticoagulant hemodialysis WANG Wei, LI Yue-hong, WU Xiang-lan, YANG Hua, LYU Jia-xuan, XU Hui-ying Chinese Journal of Blood Purification    2023, 22 (09): 672-674.   DOI: 10.3969/j.issn.1671-4091.2023.09.008 Abstract （100）      PDF（pc） （523KB）（12）       Knowledge map    Objective To investigate the effectiveness of different calcium concentrations in dialysate for simplified citric acid anticoagulant hemodialysis.  Methods  A total of 32 hemodialysis patients with high risk of bleeding were treated with 1.25mmol/L (group A) or 1.5 mmol/L (group B) calcium-containing dialysate for 64 times of simplified citric acid anticoagulant hemodialysis by self-crossover control method. Blood free calcium level was measured at different dialysis time points, the pumping speed of citric acid was adjusted, and the dialysis indexes and dialysis adequacy (Kt/V) were recorded.  Results  ①The anticoagulant efficacies of group A and group B were 100% and 93.8% respectively. ②The pumping speed of citric acid in group A was lower than that in group B [(390.9±24.0) ml/h vs.（410.9±20.7）ml/h, t=-3.569, P=0.001]. In group A, the free calcium after the filter at 2 hours of dialysis [(0.66±0.13) mmol/L vs. (0.80±0.12) mmol/L, t=-4.428, P<0.001) and the free calcium before the filter at 4 hours of dialysis [(0.91±0.11) mmol/L vs. (1.00±0.13) mmol/L, t=-2.917, P=0.005) were lower than those in group B. ③There was no significant difference in Kt/V between the two groups [(1.16±0.22) mmol/L vs. (1.18±0.20)mmol/L, t=-0.380, P=0.706].  Conclusion  Dialysate containing calcium 1.5mmol/L can achieve effective anticoagulation with safer blood free calcium concentration, and it may be appropriate for simplified citric acid anticoagulant hemodialysis.  Reference | Related Articles | Metrics

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Research progresses in the application of chronic kidney disease management system to manage chronic kidney disease patients ZHUANG Min-ting, YANG Xia-li Chinese Journal of Blood Purification    2023, 22 (07): 525-528.   DOI: 10.3969/j.issn.1671-4091.2023.07.011 Abstract （99）      PDF（pc） （409KB）（32）       Knowledge map    This paper introduces the current management situation of chronic kidney disease (CKD) patients and the application of the chronic kidney disease management system to take care of CKD patients, analyzes the current problems, and looks forward to its future development tendency, so as to provide references for doctors and nurses using the chronic kidney disease management system to manage CKD patients. Reference | Related Articles | Metrics

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Clinical practice of grading management scheme for hyperkalemia in chronic kidney disease patients LIU Fang-fang, LOU Xiao-ping, WANG Wen-jiao, ZHANG Tong-tong, ZHENG Xiao, CHEN Jie, LI Zheng-yan Chinese Journal of Blood Purification    2023, 22 (06): 467-471.   DOI: 10.3969/j.issn.1671-4091.2023.06.015 Abstract （99）      PDF（pc） （436KB）（187）       Knowledge map    Objective   This paper is to explore the effects of risk grading management scheme on chronic renal disease patients with hyperkalemia.  Method  A total of 90 patients with chronic kidney disease in the First Affiliated Hospital of Zhengzhou University were selected as the research objects. They were randomly divided into control group and experimental group and 45 cases in each group. The control group was given routine nursing care, while the experimental group was used the risk grading management program in addition to routine nursing care. The incidence and the cognitive level of hyperkalemia, the medication compliance and diet compliance for hyperkalemia were compared before and after intervention between the two groups.  Results   The incidence of hyperkalemia was significantly lower in experimental group than in control group (c2=4.444,P=0.035); the cognition of hyperkalemia risks (t=-7.071, P<0.001), the medication compliance (t=          -3.081, P=0.004) and the diet compliance (t=-8.785, P<0.001) were also higher in experimental group than in control group.  Conclusion   The application of risk grading management scheme on patients can reduce the incidence of hyperkalemia, improve the cognitive level and help patients develop good behaviors of medication and diet compliance, to reduce the occurrence of adverse events. Reference | Related Articles | Metrics

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Common problems in supervision of the hemodialysis devices for single-use HAN Na, ZOU Yan-guo, LI Dan, QIANG Yi-ning Chinese Journal of Blood Purification    2023, 22 (09): 641-643.   DOI: 10.3969/j.issn.1671-4091.2023.09.001 Abstract （98）      PDF（pc） （405KB）（38）       Knowledge map    Hemodialysis devices for single use are used to remove harmful substances and excessive water in blood by diffusion, ultrafiltration and convection, playing a key role in renal replacement therapy. It can also be used in the adjunct treatment for patients with drug overdose and toxicosis. However, some problems and defects exist in the documents recently submitted to the Center for Medical Device Evaluation for registration. This article attempts to make a brief analysis on these problems from the perspective of registration and supervision of the medical devices. Reference | Related Articles | Metrics

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Based on the high risk factors of imbalance syndrome in maintenance hemodialysis patients, a prediction model was constructed and verified WANG Yi-Wang, WANG Lei, CUI Ying Chinese Journal of Blood Purification    2023, 22 (07): 488-492.   DOI: 10.3969/j.issn.1671-4091.2023.07.003 Abstract （97）      PDF（pc） （529KB）（25）       Knowledge map    Objective  To investigate the risk factors for the development of dialysis disequilibrium syndrome (DDS) in patients on maintenance hemodialysis (MHD) and to construct a predictive model. Methods  A total of 321 patients with MHD in our hospital from August 2019 to August 2022 were selected and patients were randomly divided into the training group (n=225) and the internal verification group (n=96) according to the proportion of 7:3. The two groups were divided into the DDS subgroup and the non-DDS subgroup according to the occurrence of DDS. The incidence of imbalance syndrome, demographic characteristics and biochemical indicators of the two groups were analyzed. The logistic regression model and random forest model were constructed based on the data of the training group. Then Parallel internal and external validation was performed in the groups.  Results Univariate analysis showed that in the training and internal validation groups, age (t=32.154, 24.618, both P＜0.001), number of dialysis sessions per week (t=10.632, 8.211, both P＜0.001), epilepsy (χ2=4.647, 7.248, P=0.031, 0.007), hemoglobin (t= 21.366, 15.476, all P＜0.001), cognitive impairment (χ2=4.644, 5.403, P=0.031, 0.020), urea nitrogen (t=21.284, 13.058, all P＜0.001), and albumin (t=13.094, 9.018, all P＜0.001) between the DDS subgroups and the non-DDS subgroup were significant differences (P＜0.05). Logistic regression analysis showed that the number of dialysis sessions per week (OR=6.360, 95% CI: 1.968 to 20.554, P＜0.001), cognitive impairment (OR=8.404, 95% CI: 2.446 to 28.877, P＜0.001), hemoglobin (OR=4.889, 95% CI: 1.436 to 16.645, P＜0.001), albumin (OR=0.596, 95% CI: 0.447 to 0.794, P＜0.001), and urea nitrogen (OR=4.429, 95% CI: 1.879 to 10.441, P＜0.001) were factors influencing the occurrence of DDS in patients (P＜0.05). The top 5 influencing factors for the occurrence of DDS were obtained in the following order: urea nitrogen, cognitive impairment, hemoglobin, albumin, and number of dialysis sessions per week. Based on the above factors, logistic regression models and random forest models for the occurrence of DDS in patients were constructed, and internal validation showed that there was no significant difference between the two models in predicting the AUC of DDS in patients, and external validation showed that there was no significant difference between the two models and the actual results.  Conclusion  The influence of DDS in MHD patients is due to urea nitrogen, cognitive impairment, hemoglobin, albumin, and weekly dialysis times. The prediction model built based on the above factors is reliable and provides a certain reference for clinical treatment identification of DDS. Reference | Related Articles | Metrics

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Effect of chronic kidney disease management on the disease progression and dialysis initiation in diabetic kidney disease patients YU Shu, JIA Jue, WANG Tao-tao, XU Feng-lan, GUI Lan-lan, HUA Qin, HE Jian-qiang Chinese Journal of Blood Purification    2023, 22 (06): 415-420.   DOI: 10.3969/j.issn.1671-4091.2023.06.004 Abstract （96）      PDF（pc） （456KB）（152）       Knowledge map    Objective  To evaluate the influence of chronic kidney disease (CKD) outpatient management on the disease progression and dialysis initiation in diabetic kidney disease (DKD) patients, so as to provide a basis for continuous improvement of the multidisciplinary management of CKD outpatients and DKD patients. Methods This study enrolled 92 DKD patients with initial hemodialysis from the CKD Outpatient Clinic (management group, group M) and 94 DKD patients with initial hemodialysis from the Nephrology Clinic (non-management group, group NM) in the Affiliated Hospital of Jiangsu University in the period from June 2015 to June 2021. Biochemical indexes, vascular access, hospitalization and renal function changes were compared between the two groups at the first dialysis. The impact of various factors on disease progression was evaluated by Cox regression analysis.  Results  At dialysis entry, systolic blood pressure, estimated glomerular filtration rate (eGFR), and serum whole parathyroid hormone were significantly lower in group M than in group NM (t=-3.352, -1.196 and -1.995 respectively; P=0.001, 0.047 and 0.047 respectively), and hemoglobin, serum creatinine and albumin were significantly higher in group M than in group NM (t=2.320, 2.189 and 2.102 respectively; P=0.021, 0.030 and 0.037 respectively); vascular access, emergent dialysis and the ratio of first induced dialysis at the first dialysis were significantly different between the two groups (c2=19.573, 16.396 and 16.969 respectively; P＜0.001). Kaplan-Meier survival analysis showed that the median disease course entering dialysis was significantly longer in group M than in group NM (t=2.239, P=0.21). Multivariate regression analysis showed that age, diabetic retinopathy, urinary microalbumin/creatinine were the risk factor for DKD progression (HR=1.020, 0.554 and 1.000 respectively, 95% CI: 1.003~1.038, 0.405~0.757 and 1.000~1.000 respectively; P=0.019, ＜0.001 and ＜0.001 respectively). CKD management and treatment with angiotensin converting enzyme inhibitors (ACEI)/angiotensin II receptor blocker (ARB) could postpone the DKD progression.  Conclusion  CKD management can significantly delay the progression of DKD. In outpatient management, early screening of diabetic retinopathy, management of urinary protein, and early use of ACEI/ARB medications are helpful to delay the DKD progression. Reference | Related Articles | Metrics

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Clinical effect and related factors of urokinase thrombolysis combined with balloon dilatation for the treatment of arteriovenous fistula occlusion due to thromboembolism XIONG Di, ZHOU Ying, WAN Zhen, GONG Zhi-jun Chinese Journal of Blood Purification    2023, 22 (06): 463-466.   DOI: 10.3969/j.issn.1671-4091.2023.06.014 Abstract （95）      PDF（pc） （397KB）（30）       Knowledge map    Objective  To analyze the clinical effect and related influencing factors of urokinase thrombolysis combined with balloon dilation for the treatment of arteriovenous fistula (AVF) occlusion due to thromboembolism.  Method   The patients with AVF occlusion due to thromboembolism treated in The First Hospital of Nanchang City were retrospectively analyzed. The success rate of the operation and the incidence of complications were collected. Factors that possibly influence the success rate including diabetes, utilized period of the AVF, length of the occlusion in AVF, occlusion time, hemoglobin level and anatomical factors of the AVF were statistically analyzed.  Results   A total of 84 cases were enrolled in this study, of which 69 cases had successful patency of the AVF after the operation with the total success rate of 82.1%. The overall complication rate was 7.1%, and no serious complications occurred. Univariate analysis showed that the success rate of the operation was not related to gender (χ2=0.202, P=0.653), diabetes (χ2=0.387, P=0.534), location of AVF (χ2=0.082, P=0.774), establishment time (χ2=2.889, P=0.089), length of thrombus (χ2=1.445, P=0.229), occlusion period (χ2=0.082, P=0.774) and hemoglobin level (χ2=0.365, P=0.546), but closely related to anatomical factors of the AVF (χ2=29.238, P<0.001). The success rate of the operation was significantly different between the patients with 2 venous outflows (χ2=18.287, P<0.001) or 3 venous outflows (χ2=24.199, P<0.001) and those with one venous outflow, but had no difference between the patients with 2 or 3 venous outflows (χ2=0.002, P=0.967). Multivariate analysis showed that the number of venous outflow of the AVF was an independent risk factor affecting the success rate of the operation (OR=8.296, 95% CI: 2.724~25.267, P<0.001), and the establishment time of fistula was a protective factor affecting the success rate of the operation (OR=0.976, 95% CI: 0.959~0.993, P=0.006).  Conclusions  Urokinase thrombolysis combined with balloon dilation is safe and effective for the treatment of thromboembolism in occluded AVF. The number of venous outflow of the AVF is an independent risk factor, and the establishment time of fistula is a protective factor to affect the success rate of the operation; gender, diabetes, the location of fistula, the length of thrombus, the occlusion period, and the hemoglobin level have no influences on the success rate of the operation. Reference | Related Articles | Metrics