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A multicenter randomized controlled study of nafamostat mesylate for anticoagulation therapy on hemodialysis ZHUANG Bing, YE Hong, CAO Hong-di, BIAN Xue-qin, ZHONG Hua, LUO Yuan, PENG Kan-fu, SHI Hui, YANG Jun-wei Chinese Journal of Blood Purification    2022, 21 (10): 739-743.   DOI: 10.3969/j.issn.1671-4091.2022.10.008 Abstract （1670）      PDF（pc） （499KB）（381）       Knowledge map    Objective To observe the safety and efficacy of nafamostat mesylate for anticoagulation in maintenance hemodialysis patients. Methods Patients on hemodialysis were randomly divided into two groups, nafamostat mesylate for injection group and sodium heparin injection group, respectively. The safety and efficacy of nafamostat were evaluated.Results The anticoagulation efficiency of nafamostat mesylate for injection group and sodium heparin injection group was 97.2% and 98.2%, respectively (χ2=0.000，P=0.992); The effect of nafamostat mesylate for injection group on activated clotting time (ACT) during dialysis was less than that of sodium heparin injection group.The ACT values at the arterial side of the two groups were significantly different (1h, t=-15.333, P＜0.001; 2h, Z=-10.317, P＜0.001; 3h,t=-12.733, P＜0.001; the end of dialysis, Z=-6.796, P＜0.001),the venous side of the two groups were significant statistical differences in ACT values(1h, t=-17.833, P<0.001; 2h, t=-15.604, P＜0.001; 3h, Z=-10.066, P＜0.001; the end of dialysis,Z=-4.399, P＜0.001);After the end of hemodialysis, the nafamostat mesylate group for injection had less effect on activated partial thromboplastin time (Z=-4.971, P＜0.001) and thrombin time (Z =5.770, P＜0.001) than the heparin sodium injection group ; The incidence of adverse reactions in nafamostat mesylate for injection group was lower than heparin sodium injection group (χ2=15.239，P＜0.001). Conclusion The anticoagulant effect of nafamostat mesylate is non-inferior to sodium heparin , and the incidence of adverse reactions is lower.It could be used safely and effectively in the anticoagulation of hemodialysis. Reference | Related Articles | Metrics

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Guideline on the management of hyperkalemia in maintenance hemodialysi patients in China Expert group of guideline on the management of hyperkalemia in maintenance hemodialysis patients in China Chinese Journal of Blood Purification    2022, 21 (增刊): 1-16.   DOI: 10.3969/j.issn.1671-4091.2022.S.001 Abstract （1461）      PDF（pc） （905KB）（1141）       Knowledge map    Reference | Related Articles | Metrics

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Progresses in the application of nafamostat mesylate for anticoagulation during continuous renal replacement therapy  SUN Xian-kun WANG Fang, CHEN Zhi-wen, ZHANG Ling Chinese Journal of Blood Purification    2022, 21 (11): 827-830.   DOI: 10.3969/j.issn.1671-4091.2022.11.009 Abstract （1382）      PDF（pc） （351KB）（402）       Knowledge map    The anticoagulants currently used may have contraindications and side effects, therefore continuous renal replacement therapy without anticoagulation is still common. Nafamostat mesylate has a short half-life, which may help critically ill patients avoid bleeding during blood purification. In Korea and Japan, Nafamostat mesylate is frequently utilized for anticoagulation in extracorporeal circulation line. However, there are no consensuses about the fundamental anticoagulant prescription, effective dose and monitoring strategy of the drug. Here we review the anticoagulation mechanism of nafamostat mesylate in patients on continuous renal replacement therapy, method of use, anticoagulation effect and limitations, so as to give a reference for future studies. Reference | Related Articles | Metrics

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Investigation and analyses on the peritoneal dialysis fees and the reimbursement from medical insurance in Chinese mainland Chinese Hospital Association Blood Purification Center Branch Chinese Journal of Blood Purification    2023, 22 (05): 321-326.   DOI: 10.3969/j.issn.1671-4091.2023.05.001 Abstract （1369）      PDF（pc） （485KB）（154）       Knowledge map    Objective  To investigate the items and costs of peritoneal dialysis (PD) management and the reimbursement of the expenses by medical insurance in PD patients from different regions in China, in order to reduce the financial burden of the patients and to promote the use of PD through the standard items and prices of PD and the rational rules of reimbursement by medical insurance.  Methods  A self-designed questionnaire on PD items and medical insurance was used to investigate the PD patients in 137 hospitals that provide PD in 30 provinces and big cities in China. Descriptive statistical analysis was performed on the collected data, and Kruskal-Wallis rank sum H test was used to examine the differences among groups.  Results  The nationwide median rates of reimbursement by medical insurance were 80.0 (70.0, 85.0)%, 85.0 (80.0, 90.0)% and 90.0 (80.0, 90.0)% for residents, urban employees, and retired employees, respectively. The monthly expense of continuous ambulatory peritoneal dialysis (CAPD) was significantly lower than that of automated peritoneal dialysis (APD) (H=26.717, P＜0.0001). The monthly reimbursable amount increased with the monthly total expense of CAPD or APD (H=58.367, P＜0.001). The prices of PD varied significantly in different provinces and big cities. The prices of surgical removal of granulation tissue at the outlet, waste bag, removal of polyester cuff in PD tube, and treatment of PD catheter-related tunnel infections had not been set up in 63%, 60%, 50% and 47% provinces and big cities respectively. The commonly used disposable materials necessary for PD safety such as dressing, waste bag and disinfectants could not be reimbursed by medical insurance in 77% provinces and big cities.  Conclusions   This study analyzed the current administration situations of PD management. We therefore recommend that ①the organization and administration of the basic medical insurance system must be continuously reinforced, and the encouragement mechanisms underlying PD services must be improved; ② the prices of PD items should be properly adjusted to support the passions of the hospitals providing high quality of PD services, and ③ the reimbursable PD items are required to be increased to support the safety and quality of PD services. Reference | Related Articles | Metrics

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Research advances on portable artificial kidney devices  CHEN Li-ting, SONG Ming-yang, ZHAO Jian-cheng, LI Xue-mei Chinese Journal of Blood Purification    2022, 21 (06): 385-388.   DOI: 10.3969/j.issn.1671-4091.2022.06.001 Abstract （1076）      PDF（pc） （1798KB）（289）       Knowledge map    The global burden of chronic kidney disease is increasing. In China, the number of dialysis patients is increasing rapidly. Hemodialysis is the most prevalent renal replacement therapy worldwide. Due to the intermittence of hemodialysis and the need for patients to go to the hospital frequently, experts and scholars have been committed to finding more suitable kidney replacement therapy for patients. Portable artificial kidney device is a promising method. This review aims to summarize the research progress of portable artificial kidney devices with mature technology and new artificial kidney devices under development. Related Articles | Metrics

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Clinical practice guideline for use of iron on anemia in chronic kidney disease Committee of clinical practice guideline for use of iron on anemia in chronic kidney disease Chinese Journal of Blood Purification    2022, 21 (增刊): 17-40.   DOI: 10.3969/j.issn.1671-4091.2022.S.002 Abstract （883）      PDF（pc） （1508KB）（1386）       Knowledge map    Related Articles | Metrics

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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 （758）      PDF（pc） （414KB）（113）       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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PENG Kai-yue   HAN Qing-feng ENG Kai-yue, HAN Qing-feng Chinese Journal of Blood Purification    2022, 21 (08): 595-598.   DOI: doi:10.3969/j.issn.1671-4091.2022.08.013 Abstract （678）      PDF（pc） （403KB）（160）       Knowledge map    codextrin through a mechanism resembling ‘colloid’ osmosis forms effective ultrafiltration during the long dwelling phase of peritoneal dialysate. On the basis of the classic icodextrin dialysate-based treatment regimen, a variety of treatment schedules suitable for different clinical conditions have been developed, such as single daily use of icodextrin dialysate, twice daily use of icodextrin dialysate, and icodextrin combined with glucose peritoneal dialysate. Icodextrin dialysate can help control chronic heart failure and improve or maintain ventricular structure. The treatment regimen based on icodextrin dialysate will effectively improve our peritoneal dialysis treatment.  Reference | Related Articles | Metrics

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Advantages and prospects of home hemodialysis GU Wen, ZHOU Yi-jun, NI Zhao-hui Chinese Journal of Blood Purification    2022, 21 (06): 389-392.   DOI: 10.3969/j.issn.1671-4091.2022.06.002 Abstract （599）      PDF（pc） （504KB）（250）       Knowledge map    Home Hemodialysis (HHD) is one of the methods of renal replacement therapy for patients with end-stage renal disease (ESRD), which is performed in a home environment by patients themselves or with the assistance of others. Although HHD has appeared and is widely used abroad as early as the 1960s, the proportion of HHD fell sharply due to the establishment of a large number of dialysis centers, the emergence of peritoneal dialysis, as well as the changes in reimbursement policies. In recent years, HHD has risen again because of its unique advantages. HHD can not only increase the survival rate of patients and improve the quality of life of patients, but also is of great significance in the context of the COVID-19 epidemic. In April 2020, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine carried out the first case of home hemodialysis in mainland China, filling the gap of HHD in mainland China. With the burgeoning development of the Internet, the establishment of a standardized HHD training system and the continuous enrichment of experience, HHD is supposed to have broader prospects.  Reference | Related Articles | Metrics

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A clinical comparison on high-flux dialyzers with different membranes during a single hemodialysis treatment  CONG Hui, MU Chang-jun, SONG Xu-hong, YU Ya-nan, XU Yan-hua, JI Wei-ling Chinese Journal of Blood Purification    2022, 21 (10): 780-784.   DOI: 10.3969/j.issn.1671-4091.2022.10.017 Abstract （573）      PDF（pc） （446KB）（181）       Knowledge map    ackground  High-flux hemodialysis has been widely used and has the advantages of improved clearance of uremic toxins and efficient removal of extra body fluid due to the hollow fiber membranes with a high ultrafiltration coefficient.  Objective   The present paper aims to investigate the clinical performance of two high-flux dialyzers, one equipped with polysulfone membranes (HF15 from Weigo), and the other equipped with cellulose triacetate membranes (FB-150U, short for 150U, from Nipro). Clearance efficiency of uremic toxins and the biocompatibility in a single hemodialysis session were compared between the two types of high-flux dialyzers.  Methods   A total of 20 patients treated with maintenance hemodialysis for more than 3 months were recruited from Weigao Blood Purification Center and were divided into two groups, HF15 Group (n=10) and 150U Group (n=10). Blood samples were collected right before the dialysis treatment, 15min and 60min during the treatment, and right after the treatment. The reduction ratio and clearance rate of uremic toxins as well as changes of blood cells and complement factor (C3a) were compared between the two groups.  Results   Age, sex, body weight and dialysis age were similar between two groups. Before the dialysis session, baseline parameters including treatment blood flow, small and medium molecule toxins, blood cells and complement factors had no significant differences between the two groups (P≥0.05). After the high-flux hemodialysis treatment for 4 hours, the reduction ratios and clearance rates of small molecule toxins (blood urea nitrogen, creatinine and phosphorus) had no significant differences between the two groups (For reduction ratios: t=0.932, 1.799 and 0.878 respectively; P=0.379, 0.052 and 0.299 respectively. For clearance rates: t=-1.892, 1.500 and -2.211 respectively; P=0.091, 0.168 and 0.056 respectively); HF15 group had higher reduction ratio (t=7.821, P＜0.001) and clearance rate (t=2.686, P=0.013) of the middle molecular toxin β2 microglobulin than 150U group. Variations of blood cells and C3a during the hemodialysis session had no statistical significances between two groups.  Conclusions   During a single high-flux hemodialysis session, HF15 group had higher clearance rates of uremic toxins than 150U group, with equal biocompatibility between the two groups. 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 （516）      PDF（pc） （782KB）（332）       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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Influence of Roxadustat on blood pressure in peritoneal dialysis patients ZHAO Yu- chao, ZHAO Huiping, WU Bei, ZHU Li, LU Li-xia, ZUO Li, WANG Mei Chinese Journal of Blood Purification    2022, 21 (09): 633-637.   DOI: 10.3969/j.issn.1671-4091.2022.09.003 Abstract （475）      PDF（pc） （415KB）（54）       Knowledge map    Objective To assess the influence of Roxadustat on blood pressure in peritoneal dialysis (PD) patients through a retrospective, self-controlled cohort study. (PD) patients through a retrospective, self-controlled cohort study. Methods PD Patients who were treated with Roxadustat for at least 4 months, and were treated with rHuEPO for at least 1 year before the application of Roxadustat were enrolled in this study. Baseline clinical data and the clinical data of each month after the application of Roxadustat were collected for a total of 4 months. Clinical data of patients during the same period of 1 year ago when patients were treated with rHuEPO were also collected. Compare the differences between baseline and after taking Roxadustat, and the difference between Roxadustat phase and rHuEPO phase. Results A total of 38 PD patients were enrolled in the study. Systolic blood pressure (SBP) at baseline was 144.6±18.5 mmHg, after taking Roxadustat for 1 month, 2 months, 3 months and 4 months, SBP was 139.2±17.5 mmHg, 134.3±15.9 mmHg, 137.4±16.9 mmHg and 137.2±14.5 mmHg respectively. SBP decreased after taking Roxadustat compared with baseline (1 month：t was 2.285, P was 0.028；2 month: t was 3.408, P was 0.002；3 month t was 2.223，3 month P was 0.032；4 month t was 2.521，P was 0.030 respectively). There were no significant differences in defined daily dose of anti- hypertensive drugs after Roxadustat treatment compared with baseline. Conclusion After switching rHuEPO to Roxadustat, hypertension caused by rHuEPO can be avoided after excluding factors that may affect blood pressure in PD patients, such as season, volume, and dose of antihypertensive drugs. Related Articles | Metrics

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Clinical Practice Recommendation for Arteriovenous Access Thrombosis Treatment WANG Yu-zhu, ZHANG Li-hong, ZHAN Shen Chinese Journal of Blood Purification    2022, 21 (08): 545-459,568.   DOI: 10.3969/j.issn.1671-4091.2022.08.001 Abstract （472）      PDF（pc） （476KB）（472）       Knowledge map    Vascular access is the lifeline of maintenance hemodialysis patients. Arteriovenous fistula is the preferred vascular access, but it is prone to thrombosis which resulting in loss of fistula. Also, thrombosis is associated with hospitalization and all-cause mortality in maintenance hemodialysis patients. The establishment of vascular access and the treatment of complications in our country have made great progress in recent years, but there is a lack of systematic and standardized understanding of preoperative assessment, indications, method selection, technical points, and complication prevention for arteriovenous fistula thrombosis treatment. In view of this, the Department of Nephrology of Beijing Haidian Hospital drafted this recommendation with reference to relevant domestic and foreign literatures and a large amount of practical experience in our center, aiming to provide reference for nephrologists to standardize thrombosis treatment. Reference | Related Articles | Metrics

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Application of Angiotensin Receptor-Neprilysin Inhibitor in Chronic Kidney Disease Patients: Chinese Expert Consensus Chinese Expert Group Consensus on Application of Angiotensin Receptor-Neprilysin Inhibitor in Chronic Kidney Disease Patients Chinese Journal of Blood Purification    2023, 22 (04): 241-253.   DOI: 10.3969/j.issn.1671-4091.2023.04.001 Abstract （470）      PDF（pc） （572KB）（345）       Knowledge map    Chronic kidney disease (CKD) is a global public health problem, and cardiovascular disease is the most common cause of death in patients with CKD. The incidence and prevalence of cardiovascular events during the early stages of CKD increases significantly with a decline in renal function. More than 50% of dialysis patients die from cardiovascular disease. Therefore, developing effective methods to control risk factors and improve prognosis of cardiovascular disease is the primary focus during the diagnosis and treatment of CKD. For example, the Systolic blood pressure intervention trial (SPRINT) study demonstrated that CKD drugs are effective in reducing cardiovascular and cerebrovascular events by controlling blood pressure. Uncontrolled blood pressure not only increases the risk of these events but also accelerates the progression of CKD. Recent studies have repeatedly confirmed that the first and so far the only angiotensin receptor–neprilysin inhibitor (ARNI) sacubitril/valsartan can reduce blood pressure more effectively than renin–angiotensin system inhibitors and improve the prognosis of heart failure in patients with CKD. Here, to better guide the application of ARNI in patients with CKD, and reduce the occurrence of cardiovascular events，we formulate a consensus based on clinical evidence and experience. Reference | Related Articles | Metrics

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A study on the status of anorexia and its influencing factors in maintenance hemodialysis patients BU Zhao-wen, ZHONG Yue-huan, LI Na, ZHOU Bin, DING Yi-mei Chinese Journal of Blood Purification    2022, 21 (11): 858-861.   DOI: 10.3969/j.issn.1671-4091.2022.11.015 Abstract （465）      PDF（pc） （485KB）（284）       Knowledge map    Objective To investigate the status of anorexia and its influencing factors in maintenance hemodialysis (MHD) patients.  Methods  A total of 168 MHD patients were recruited from the Blood Purification Center, Gansu Provincial Hospital from November 2021 to January 2022. The self-designed general condition questionnaire, visual analog score of appetite (VAS), self-rating sleep status scale (SPSS), self-rating anxiety scale (SAS), self-rating depression scale (SDS), and international physical activity questionnaire (short volume in Chinese version, IPAQ) were used for the investigation. Univariate analysis and binary logistic regression were performed to analyze the influencing factors.  Results  The incidence of anorexia was 32.1% in the 168 MHD patients. Binary logistics regression showed that gender (OR=0.323, 95% CI 0.119~0.879, P=0.027), constipation (OR=2.929, 95% CI 1.204~7.125, P=0.018), urea clearance index (OR=0.027, 95% CI 0.002~0.435, P=0.011), SPSS score (OR=1.081, 95% CI 1.01~1.156, P=0.024), and physical activity level (OR=0.134, 95% CI 0.049~0.0.364, P＜0.001) were the influencing factors for the diminished appetite in MHD patients.  Conclusion   Anorexia was found in about one third of the MHD patients. Patients’ constipation, urea clearance index, physical activity level and SPSS score were the influencing factors for anorexia. Reference | Related Articles | Metrics

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Expert consensus on the specialized nursing operation of hemoperfusion combined with hemodialysis Blood Purification Committee of Chinese Nursing Association (This consensus was written by MA Zhi-fang, XIANG Jing, XIA Jing-hua, XIAO Guang-hui, FU Xia, SHEN Hua-juan, HE Shan, CHEN Jing, TONG Hui, GAO Ju-lin, YUE Xiao-hong, JIAO Jian-mei, ZHU Han-yu) Chinese Journal of Blood Purification    2023, 22 (05): 364-368,380.   DOI: 10.3969/j.issn.1671-4091.2023.05.010 Abstract （462）      PDF（pc） （556KB）（512）       Knowledge map    Combined hemoperfusion (HP) and hemodialysis (HD) (combined artificial kidney) is increasingly used for the treatment of end-stage renal disease (ESRD). Clinical nursing staff have an urgent need for the specialized nursing operation of combined artificial kidney. The expert group of the Blood Purification Professional Committee of the Chinese Nursing Association, referring to the domestic and foreign literature and combining the clinical application experience, has formulated the “Expert Consensus on Specialized Nursing Operation of Hemoperfusion Combined with Hemodialysis” that contains seven aspects: pipeline selection, heparinization of hemoperfusion, pre-flushing process, blood transfusion operation, blood return operation, observation and treatment, and pressure monitoring. This is the first expert consensus to guide the combined artificial kidney treatment and nursing operation in China, in order to provide a valuable reference for clinical nursing staff to implement the nursing operation of combined artificial kidney treatment. Reference | Related Articles | Metrics

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Clinical efficacy of sacubitril/valsartan in maintenance hemodialysis patients with heart failure LU Hai-feng, XU Dan-ping, PENG Wang-ying, DONG Yang, WANG Nian-song, SHENG Xiao-hua Chinese Journal of Blood Purification    2022, 21 (09): 650-654.   DOI: 10.3969/j.issn.1671-4091.2022.09.006 Abstract （457）      PDF（pc） （403KB）（59）       Knowledge map    Objective  To investigate the clinical efficacy of sacubitril/valsartan in maintenance hemodialysis (MHD) patients with heart failure.  Methods  A retrospective cohort study was performed in the MHD patients with heart failure treated in Sixth People's Hospital Affiliated to Shanghai Jiao Tong University from January 1, 2020, to July 31, 2021. Patients who took the medicine for more than 3 months were included in this study. Clinical data, demographic characteristics, laboratory indicators, echocardiography, adverse response of the treatment, and endpoint events were recorded.  Results  A total of 54 patients were enrolled and followed up for 3 months. Sacubitril/valsartan treatment significantly reduced NT-proBNP (15213.15±12110.44 vs. 7823.21±7457.71ng/L, t=7.053, P＜0.001), interventricular septal thickness dimension (IVSTd; 10.24±1.81 vs. 9.79±1.96mm, t=2.557, P=0.013), left ventricular posterior wall thickness dimension (LVPWTd; 10.04±1.69 vs. 9.44±1.61mm, t=2.728, P=0.009), left ventricular mass index (LVMI; 126.30±42.79 vs. 113.81±34.74g/m2, t=3.059, P=0.003), systolic blood pressure (SBP; 160.46±16.43 vs. 139.19±15.21mmHg, t=12.381, P＜0.001) and diastolic blood pressure (DBP; 79.57±11.97 vs. 69.67±10.43mmHg, t=7.070, P＜0.001). Meanwhile, left ventricular ejection fraction (LVEF) increased after three months of the treatment (55.76±8.30% to 60.02±6.18%, t=-4.323, P＜0.001). There were no significant differences in dry body mass (t=0.465, P=0.644), body mass gain (t=0.350, P=0.728), ultrafiltration (t=-0.019, P=0.985), parathyroid hormone (PTH, t=-1.660, P=0.103), serum creatinine (Scr, t=-1.452, P=0.152), Kalium (K, t=-1.806, P=0.077), Natrium (Na, t=0.400, P=0.690), Calcium (Ca, t=-1.376,  P=0.175), Phosphorus (P, t=-0.193, P=0.848), hemoglobin (HGB, t=-0.710, P=0.481) and albumin (ALB, t=-1.823, P=0.074) before and after the treatment.  Conclusion  Sacubitril/valsartan could effectively and safely relieve the clinical symptom of heart failure, improve cardiac function indicators, reduce left ventricular hypertrophy, reverse left ventricular remodeling, and lower blood pressure in MHD patients with heart failure. Reference | Related Articles | Metrics

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Application of gabapentin in the treatment of hemodialysis patients  LI Qing-lei, MENG Jian-zhong Chinese Journal of Blood Purification    2022, 21 (09): 664-667.   DOI: 10.3969/j.issn.1671-4091.2022.09.009 Abstract （422）      PDF（pc） （384KB）（276）       Knowledge map    With the higher prevalence and the longer survival of uremia patients in our country, the shortage of hemodialysis professionals prevails and accounts for the insufficiency of hemodialysis technologies in basic communities. The advanced assistant dialysis measures, such as high flux hemodialysis, hemoperfusion and drugs of expensive prices, are hardly to be adopted in several areas due to the different health insurance policies, causing dialysis inadequacy and hemodialysis complications in many patients in these areas. Gabapentin (GBP) has a better therapeutic effect in the treatment of many hemodialysis complications. We therefore searched the databases of PubMed and CNKI for the studies in recent years about GBP in the treatment of hemodialysis complications, including uremic pruritus, restless legs syndrome and uremic peripheral neuralgia. In this paper, we try to provide the therapeutic strategies against hemodialysis complications by using GBP for hemodialysis professionals. Reference | Related Articles | Metrics

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Research progress in vascular calcification of arteriovenous fistula HU Meng-hong, ZHAO Guang-ben, YU Chang-qing, CHEN Ji-lin, LIN Hong-li Chinese Journal of Blood Purification    2022, 21 (11): 823-826.   DOI: 10.3969/j.issn.1671-4091.2022.11.008 Abstract （401）      PDF（pc） （336KB）（256）       Knowledge map    Arteriovenous fistula (AVF) is the optimal vascular access for maintenance hemodialysis (MHD) patients. Vascular calcification (VC) is one of the important causes of AVF dysfunction, increasing the risks of dialysis inadequacy and death in the patients. Vascular calcification of AFV is a complicated process, resulting from the combined effects of pro-calcification factors and calcification inhibition factors, such as hemodynamic changes, calcium and phosphorus metabolism dysfunction, inflammation, oxidative stress, and others. In this paper, the epidemiological characteristics, pathophysiology, pathogenesis, and prevention of AVF vascular calcification are summarized. Related Articles | Metrics

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Clinical study on the improvement of protein depletion in hemodialysis patients by the intervention of oral nutritional supplement  WANG Yu,  ZHAO Qing, LUO Yong-bing, FENG Xiao-ran,  ZHANG Feng-ping,  YU Xiao-yu, LIU Fei-yan, XU Jian-hua, WU Guo-qing, CHEN Qin-kai Chinese Journal of Blood Purification    2023, 22 (1): 11-16.   DOI: 10.3969/j.issn.1671-4091.2023.01.003 Abstract （377）      PDF（pc） （629KB）（192）       Knowledge map    Objectives: To investigate the improvement of protein-energy wasting (PEW) in hemodialysis patients after supplementation with Lexineng nutritional supplements. Methods: A total of 90 patients who had been on maintenance haemodialysis for more than 3 months and met the diagnosis of PEW in the hemodialysis units of 6 hospitals in Jiangxi Province were collected and randomly divided into a control group and a test group of 45 patients each. After the patients were given dietary instructions, the corresponding number of calories in the test group was replaced by one can of Lexineng supplement daily for 3 months. Changes in body mass index, laboratory parameters such as haemoglobin and albumin and assessment of safety effects were observed in both groups before and after 3 months of treatment with Lexineng supplementation.Results:A total of 90 patients were included in the study and 84 patients (41 in the control group and 43 in the trial group) eventually completed the trial as required, of whom 47 (55.95%) were male and the mean age was (61.6±11.39) years. The mean mineral intake levels were similar and the differences in the indicators between the two groups were not significant (p>0.05). After 3 months of the trial, the results showed that the changes in body measurements such as weight (Wt) and BMI in the control group were not significant compared to those before the trial (p>0.05), while the Wt、BMI increased significantly and the subjective global assessment (SGA) decreased significantly in the trial group (p<0.05). Serum albumin (Alb) and haemoglobin increased in both groups compared to the pre-test, with Alb and haemoglobin increasing more significantly in the test group (p<0.001), and albumin and haemoglobin were significantly higher compared to the control group (p<0.05); Leukodystrophy was also significant in reducing serum creatinine levels and increasing serum calcium concentrations (p<0.05), and was able to reduce blood glucose levels without increasing the fat burden.Conclusion: Sustained supplementation with Lexineng on maintenance hemodialysis is effective in improving PEW symptoms and other complications in haemodialysis patients in many ways. Reference | Related Articles | Metrics

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Current situation and influencing factors of thirst in maintenance hemodialysis patients  CHEN Wen-si, ZHANG Hong-mei Chinese Journal of Blood Purification    2023, 22 (1): 64-67.   DOI: 10.3969/j.issn.1671-4091.2023.01.015 Abstract （372）      PDF（pc） （421KB）（188）       Knowledge map    Objective  To investigate the present situation and influencing factors of the thirst sensation in maintenance hemodialysis (MHD) patients.  Methods  A total of 369 MHD patients in the Hemodialysis Center, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Traditional Chinese Medical University between February to May 2022 were investigated by convenient sampling method. The general information questionnaire, simplified xerostomia inventory and dialysis thirst inventory were used. The saliva secretion volume at baseline without stimulation was measured.  Results  The average score of dialysis thirst inventory in the 369 MHD patients was 14.80±3.19; 64.5% were mild thirst (10～15 scores), 26.0% were moderate thirst (16～20 scores), and 9.5% were severe thirst (21～25 scores); thirst (dialysis thirst inventory score ≥16) was found in 35.5% of the 369 MHD patients. The average score of simplified xerostomia inventory was 12.46±2.51 in the 369 MHD patients. The baseline and unstimulated saliva secretion volume was 0.21 (0.09, 0.35) ml/min. Logistic regression analysis showed that average ultrafiltration volume (OR=1.001, 95% CI:1.000～1.002, P=0.002), score of simplified xerostomia inventory (OR=3.186, 95% CI: 2.458～4.131, P＜0.001) and degree of salty taste (OR=0.440, 95% CI: 0.209～0.930, P=0.031) were the main influencing factors for thirst in MHD patients.   Conclusion   Thirst is a common symptom that disturbs MHD patients, and is affected by many factors. Thirst in MHD patients justifies to be concerned by the medical professionals that take care of them. Intervention of thirst based on the clinical conditions of the MHD patients is required. 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 （367）      PDF（pc） （446KB）（168）       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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Construction and validation of a prediction model for the risk of intradialytic hypotension in maintenance hemodialysis patients GUO Xue-mei, ZHU Zhen-nan, LUO Jia-yi, ZHANG He-ping, JING Jian-ying Chinese Journal of Blood Purification    2022, 21 (06): 408-412.   DOI: 10.3969/j.issn.1671-4091.2022.06.006 Abstract （335）      PDF（pc） （511KB）（368）       Knowledge map    Objective  To investigate the influencing factors for intradialytic hypotension (IDH) in maintenance hemodialysis (MHD) patients, then to construct a risk prediction model and to evaluate the prediction effect of this model.  Methods  A total of 222 MHD patients in the Blood Purification Center of The Affiliated Hospital of North Sichuan Medical College from September 2020 to August 2021 were enrolled in this study as the study subjects. They were randomly divided into modeling group and modeling validation group in the patient number ratio of 6:4. Patients in the modeling group were further divided into IDH group and non-IDH group based on the definition of IDH in the National Kidney Foundation Kidney Disease Prognostic Quality Guidelines. Univariate analysis was used to analyze the risk factors for IDH. Multivariate logistic regression analysis was performed to obtain the factors with P<0.05 for construction of the risk prediction model. Hosmer-Lemeshow test model was used to test the goodness of fit of the model. ROC curve was used to examine the predictive value of the model. The effectiveness of the constructed model was then evaluated in the modeling validation group.  Results  The incidence of IDH was 40.09% in the MDH patients. Predialysis systolic blood pressure (OR=0.959, 95% CI=0.932~0.988, P=0.005), hemoglobin (OR=0.962, 95% CI=0.929~0.996, P=0.030), magnesium (OR=79.558, 95% CI=2.644~2393.594, P=0.012), diabetes (OR=16.066, 95% CI=4.914~52.530, P<0.001), and hypertension (OR=5.221, 95% CI=1.661~16.409, P=0.005) were the influencing factors for IDH. Hosmer-Lemeshow test gave the result of P=0.718. When the optimal cut-off value was set at 0.436, the area under the ROC curve (AUC) was 0.922, the sensitivity was 0.83 and the specificity was 0.887. The Youden index was 0.717, and the correct rate of practical application was 83.15%.  Conclusion The model we constructed can better predict the risk of IDH in MDH patients and provides a reference for clinicians to evaluate IDH in MHD patients. Reference | Related Articles | Metrics

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Advances in strategies for diagnosis and treatment of anemia in peritoneal dialysis patients in various countries JIANG Hong , MA Xiao-xiao Chinese Journal of Blood Purification    2022, 21 (12): 865-868.   DOI: 10.3969/j.issn.1671-4091.2022.12.001 Abstract （324）      PDF（pc） （453KB）（193）       Knowledge map    Anemia is an important and common complication of chronic kidney disease. With the progression of chronic kidney disease, the incidence of anemia also increases. However, anemia in patients with different types of dialysis may have different physiology, prevalence, diagnosis, and treatment strategies. This article reviewed the diagnosis and treatment strategies of renal anemia in maintenance dialysis patients.  Reference | Related Articles | Metrics

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The clinical application of modified peritoneal dialysis catheter revision of malfunctioning catheter XIANG Shi-long, ZHANG Xiao-hui, WANG Yao-min, LIU Guang-jun, XIE Xi-shao, HAN Fei, CHEN Jiang-hua Chinese Journal of Blood Purification    2022, 21 (06): 393-397.   DOI: 10.3969/j.issn.1671-4091.2022.06.003 Abstract （320）      PDF（pc） （428KB）（65）       Knowledge map    Objective To investigate the clinical efficacy of the modified peritoneal dialysis catheter revision technique, and to find a simple, safe and effective operation for patients with malfunctioning catheter. Methods A total of 76 patients with malfunctioning catheter were enrolled, who received the modified peritoneal dialysis catheter revision operation from May 2013 to December 2019 in the First Affiliated Hospital of Zhejiang University. The general condition before and during operation, postoperative complications were observed. Results All patients were managed successfully, with a catheter revision operation time 74.44 ± 25.93 minutes and operative hemorrhage 21.17 ± 2.94 ml. The mean onset time to catheter malfunction was 335.3 ± 556.3 days. Amongst the 76 patients, catheter malposition occurred in 45, omental wrapping in 10, catheter occlusion in 7, catheter malposition with omental wrapping in 10, catheter malposition with occlusion in 3, and 1 case of others. During the follow-up time (38.68 ± 26.76 months), there was only 1patient occurring catheter occlusion after peritonitis and 2 patients with early peritonitis (within 14 days after operation). There was no recurrence of catheter malposition and omental wrapping, and no organ injury, hydrothorax, incision infection and surgery-related tunnel infection. The rate of catheter malfunction was 2.6%, of which were due to dialysate leakage and abdominal wall hernia. Conclusions Our modified peritoneal dialysis catheter revision technique is a simple, safe and effective procedure. This procedure was of less trauma, less complications, minimized or even eliminated the possibility of recurrence of catheter malfunction. It is worthy of clinical application. Reference | Related Articles | Metrics

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Clinical investigation of regional citrate anticoagulation continuous venovenous hemodiafiltration with calcium-containing dialysate and replacement solution  XI Chun-sheng, LIU Tong-cun, CAI Rui-lian, ZHANG Meng, FANG Chun-tian, LIU Fei, WEI Yu-shen, WANG Jin-han Chinese Journal of Blood Purification    2022, 21 (08): 576-579.   DOI: 10.3969/j.issn.1671-4091.2022.08.008 Abstract （316）      PDF（pc） （434KB）（154）       Knowledge map    Objective  To investigate and evaluate the efficacy and safety of regional citrate anticoagulation continuous venovenous hemodiafiltration (RCA-CVVHDF) with calcium-containing dialysate and replacement solution.  Methods  The efficacy and safety of RCA-CVVHDF with calcium-containing dialysate and replacement solution performed in The 940th Hospital of Joint Logistics Support Force of Chinese PLA between Jul 1, 2021 and December 31, 2021 were retrospectively studied. Their CVVHDF operational characteristics, circuit outcomes and new-onset metabolic complications after RCA-CVVHDF with calcium-containing dialysate and replacement solution were analyzed.  Results   A total of 56 patients, 139 filters and 213 days of CRRT were analyzed. In the 56 patients, 43 were males (76.5%) and 13 were females (23.5%), with the average age of 59.6±20.8 years old (18-99 years old) The median filter life was 35±23h (6～72h), and filter life ≤24h, 25～48h, 49～72h and ≥72h were found in 37.4%, 34.5%, 17.3% and 10.8% respectively of the filters. Mild-to-moderate hypocalcemia and hyponatremia were observed in 18.0 and 5.0 per 100 CRRT days, respectively, but severe hypocalcemia, hyponatremia and any types of hypercalcemia and hypernatremia were not observed. Citrate accumulation was observed in 2.0 per 100 CRRT days, and metabolic acidosis occurred in 8.0 per 100 CRRT days. Conclusions   Under close monitoring, RCA-CVVHDF with calcium-containing dialysate and replacement solution can be effective and safe. This method is worth for further clinical practice. Reference | 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 （316）      PDF（pc） （583KB）（48）       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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A multi-center clinical research on the occurrence and influencing factors of pruritus in maintenance hemodialysis patients BAO Hong-da, WANG Xiao-xia, ZHANG Li-ming, WANG Ying-deng, ZOU Jian-zhou, FU Peng, MA Jun, LI Jiang-tao, WANG Feng, ZHANG Ran, WANG Nian-song, JIANG Geng-ru Chinese Journal of Blood Purification    2022, 21 (11): 813-817,839.   DOI: 10.3969/j.issn.1671-4091.2022.11.006 Abstract （304）      PDF（pc） （471KB）（164）       Knowledge map    Objective To investigate the incidence, severity and risk factors of pruritus in maintenance hemodialysis (MHD) patients.  Methods  The MHD patients in the nephrology departments of eleven hospitals were enrolled in this study. Patient self-reported pruritus was assessed by the Visual Analog Scale (VAS). The observed indicators included current dialysis scheme, dialysis age, complications, medications, and laboratory tests relating to calcium and phosphorus metabolism.  Results  A total of 1,540 patients were investigated, with 78.7% reporting pruritus, of which 34.2% had moderate to severe pruritus; the overall mean pruritus VAS score was 2.85±2.52. Lower Kt/V (β=-0.562, 95% CI:-0.916～-0.207, P=0.002), use of calcimimetics (β=-1.094, 95% CI: -1.462～-0.725, P＜0.001), HD+HDF protocol (β=0.604, 95% CI:0.119～1.089, P=0.015), HD+HDF+HP protocol (β=0.967, 95% CI:0.453～1.481, P＜0.001), hemodialysis combined with peritoneal dialysis (β=0.989, 95% CI:0.078～1.900, P=0.033), use of calcitriol (β=0.564, 95% CI:0.250～0.877, P＜0.001), use of topical antipruritics (β=2.740, 95% CI:2.052～3.428, P＜0.001), anemia (β=0.575, 95% CI:0.245～0.905, P＜0.001), chronic kidney disease-mineral and bone disease (β=0.841, 95% CI:0.527～1.155, P＜0.001), and higher calcium-phosphorus product (β=1.898, 95% CI:0.645～3.152, P=0.003) were associated with higher risk of pruritus.  Conclusion The higher prevalence of pruritus in MHD patients is mainly associated with the abnormalities of calcium and phosphorus metabolism. Reference | Related Articles | Metrics

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Recent progress in the diagnosis and treatment of central vein stenosis in hemodialysis patients LIU Ying-ting, ZHANG Jing, ZHANG Sheng-nan, JIAN Xun, HU Shi-de, LI Jing Chinese Journal of Blood Purification    2022, 21 (09): 672-675.   DOI: 10.3969/j.issn.1671-4091.2022.09.011 Abstract （300）      PDF（pc） （382KB）（193）       Knowledge map    Hemodialysis access is severely affected by central vein stenosis (CVS) in hemodialysis patients. Therefore, the diagnosis and treatment of CVS are of great importance. Early and accurate diagnosis of CVS is the premise of effective treatment that benefits the patients. This article gives a review about the diagnosis and treatment of CVS in hemodialysis patients for clinical reference. Reference | Related Articles | Metrics

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Reliability and validity of the Uremic Pruritus in Dialysis Patients Scale (Chinese version)  CAO Pei-ye, WANG Ying, LU Jiao-jian, GAN Liang-ying Chinese Journal of Blood Purification    2022, 21 (08): 621-624.   DOI: 10.3969/j.issn.1671-4091.2022.08.019 Abstract （294）      PDF（pc） （420KB）（125）       Knowledge map    Objective   To translate the English version of the Uremic Pruritus in Dialysis Patients Scale (UP-Dial) into Chinese, and to test its reliability and validity.  Methods   According to the Brislin’s translation model, the English version of UP-Dial was subjected to translation, back-translation and cultural adjustment to form the Chinese version of UP-Dial. Reliability and validity of the Chinese UP-Dial were evaluated through investigation among 132 patients in Peking University People’s Hospital.  Results  The Chinese UP-Dial contained 11 items. The exploratory factor analysis extracted 3 common factors, and the cumulative variance contribution rate was 69.981%. The content validity index of the total scale was 0.93. The Chinese UP-Dial and numerical rating scale were highly correlated (r=0.687, P＜0.001). The Cronbach's α coefficient of the total scale was 0.931, and the rest-retest reliability of the total scale was 0.875.  Conclusion  The Chinese version of UP-Dial has better reliability and validity. It can be used to evaluate pruritus in dialysis patients. Reference | Related Articles | Metrics

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The relationship between serum triglyceride glucose index and coronary artery calcification in dialysis patients  ANG Zhi-juan, LI Huan, LIU Gui-ling Chinese Journal of Blood Purification    2022, 21 (06): 403-407.   DOI: 10.3969/j.issn.1671-4091.2022.06.005 Abstract （292）      PDF（pc） （497KB）（70）       Knowledge map    Objective  To investigate the relationship between triglyceride glucose (TyG) index and coronary artery calcification (CAC) in dialysis patients, and to analyze the risk factors for CAC.  Methods  The dialysis patients hospitalized in the Nephrology Department, the Second Affiliated Hospital of Anhui Medical University from October 2019 to March 2021 were recruited. Their general clinical data and laboratory results were collected, and CAC of the patients was examined by multi-layer spiral computed tomography (MSCT). They were then divided into CAC group and non-CAC group according to the MSCT findings. These indexes were compared between the two groups. Binary logistic regression analysis and ROC curve were used to assess the predictive value of TyG index for CAC in dialysis patients.  Results  A total of 286 dialysis patients (219 hemodialysis and 67 peritoneal dialysis) were included in this study, in which 157 were in CAC group and 129 in non-CAC group. Age, dialysis age, CRP, TyG index and intact parathyroid hormone (iPTH) were significantly higher in CAC group than in non-CAC group (Z=-7.642, -5.226, -5.152, -3.460 and -1.989, respectively; P＜0.001, ＜0.001, ＜0.001, =0.001 and =0.047, respectively). Spearman correlation analysis showed a positive correlation between CAC and age, dialysis age, CRP, iPTH and TyG index (r=0.453, 0.310, 0.305, 0.118 and 0.326, respectively; P＜0.001,＜0.001,＜0.001, =0.047 and ＜0.001, respectively). Binary logistic regression analysis found that age (OR=1.085, 95% CI: 1.060~1.111, P< 0.001), dialysis age (OR=1.010, 95% CI: 1.004~1.017, P<0.001), CRP (OR=1.060, 95% CI: 1.021~1.102, P=0.003), and TyG index (OR=2.309, 95% CI: 1.370~3.892, P=0.002) were the risk factors for CAC. ROC curve analysis showed that TyG index associated with age had the greatest predictive value for the occurrence of CAC in dialysis patients, and the area under the curve was 0.807 (95% CI: 0.756～0.857, P＜0.001).  Conclusion  Age, dialysis age, CRP and TyG index are the independent risk factors for CAC in dialysis patients. TyG index associated with age has a better predictive value for the occurrence of CAC in dialysis patients. Reference | Related Articles | Metrics

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Research progress in the effects of indoxyl sulfate on chronic kidney disease and its complications    YANG Jing-yu, FANG Jing-ai, ZHANG Xiao-dong, LIU Wen-yuan, ZHANG Zi-yuan, HU Ya-ling Chinese Journal of Blood Purification    2022, 21 (10): 754-757.   DOI: 10.3969/j.issn.1671-4091.2022.10.011 Abstract （291）      PDF（pc） （388KB）（305）       Knowledge map    Indoxyl sulfate (IS) is a uremic toxin of intestinal origin. Recent studies have shown that the accumulation of IS in the body will not only lead to the progression of chronic kidney disease (CKD), but also participate in the progression of cardiovascular disease, sarcopenia, cognitive impairment, osteopathy and anemia in CKD patients, thus reducing the quality of life and survival rate of CKD patients. This paper reviews the studies relating to the effects of IS on CKD and its complications in recent years, in order to provide new ideas for the prevention and intervention of CKD. Reference | Related Articles | Metrics

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The use of Roxadustat to replace recombinant human erythropoietin in the treatment of renal anemia in maintenance dialysis patients   LI Lu, YIN Zhong-cheng, FENG Jin-hong, YANG Jing, QIU Xiao-nan, ZHANG Ying Chinese Journal of Blood Purification    2022, 21 (08): 564-568.   DOI: doi:10.3969/j.issn.1671-4091.2022.08.005 Abstract （287）      PDF（pc） （450KB）（101）       Knowledge map    Objective  To observe the use of Roxadustat to replace recombinant human erythropoietin (rhEPO) in the treatment of renal anemia in maintenance dialysis (MHD) patients.  Methods  Twenty-one MHD patients complicated with renal anemia and treated in The Affiliated Hospital of Xuzhou Medical University during August 2020 to October 2021 were enrolled in this study. They were treated with rhEPO using the dose based on body mass and anemia degree for at least 3 months, but their hemoglobin continued to be <100g/L. Roxadustat was then used to replace rhEPO therapy. They were followed up for an average period of 24 weeks. Their clinical indicators were compared before and after Roxadustat therapy.  Results  After 4, 8, 12, 16, 20 and 24 weeks of Roxadustat therapy, RBC count, hemoglobin and RBC specific volume became higher(F=10.290, 9.053 and 9.858 respectively;P＜0.001); reticulocyte count increased beginning from the 4th week, and the differences were statistically significant at the 8th, 12th and 24th weeks (F=6.031, P＜0.001) as compared with that before the Roxadustat therapy; total iron binding capacity increased after 12 and 24 weeks of Roxadustat therapy (F=9.336, P=0.002); total cholesterol and low density lipoprotein decreased (F=14.200 and 12.090; P＜0.001). After Roxadustat therapy, reticulocyte percentage, hemoglobin content in reticulocytes, immature reticulocyte ratio, serum iron, ferritin, transferrin saturation and erythropoietin (EPO) level remained unchanged as compared with those before Roxadustat therapy (F=0.881, 3.067, 0.476, 3.629, 2.783 and 1.910, and t=-1.020 respectively; P=0.421, 0.057, 0.679, 0.067, 0.093, 0.158 and 0.315 respectively).  Conclusions In MHD patients complicated with renal anemia and poor responses to rhEPO treatment, Roxadustat can effectively improve anemia and lipid metabolism, with less adverse reactions. Reference | Related Articles | Metrics

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ZHAN Shen, ZHAO Bin, ZHANG Li-hong, HOU Fang, WANG Yu-zhu ZHAN Shen, ZHAO Bin, ZHANG Li-hong, HOU Fang, WANG Yu-zhu Chinese Journal of Blood Purification    2022, 21 (08): 603-607.   DOI: 10.3969/j.issn.1671-4091.2022.08.015 Abstract （277）      PDF（pc） （486KB）（298）       Knowledge map    Objective  To evaluate the efficacy and safety of peripheral cutting balloon (PCB) angioplasty in the treatment of stenosis in autogenous arteriovenous fistula (AVF) or arteriovenous graft(AVG). Methods The maintenance hemodialysis patients treated with percutaneous transluminal angioplasty using PCB angioplasty in Beijing Haidian Hospital from September 2019 to September 2020 were retrospectively analyzed. Their clinical and follow-up data, primary patency and primary assisted patency after the operation for 3, 6 and 12 months were recruited.  Results  A total of 107 patients were enrolled in this study, including patients with AVF group (n=76) and those with AVG group (n=31). The technical success rate and clinical success rate were 100% in both groups. The mean pressure of opening stenosis was 8.68±1.20 atm in AVF group, and 9.35±1.66 atm in AVG group (t=-2.037, P=0.058). The primary patency rates after the operation for 3, 6 and 12 months were 85.5%, 57.9% and 42.1% respectively in AVF group, and were 67.7%, 38.7% and 25.8% respectively in AVG group (c2=4.415, P=0.036 after 3 months; c2=0.567, P=0.45 after 6 months; c2=2.499, P=0.114 after 12 months). The primary assisted patency rates after the operation for 6 and 12 months were 65.8% and 72.4% respectively in AVF group, and were 58.1% and 61.3% respectively in AVG group (c2=0.567, P=0.451 after 6 months; c2=1.267, P=0.260 after 12 months). Log-rank test showed that the cumulative patency rate was higher in AVF group than in AVG group (c2=4.338, RR=1.28, P=0.037).  Conclusions  PCB angioplasty is effective and safe in the treatment of hemodialysis access stenosis, and has better effects in AVF group than in AVG group. However, the effects of this method need to be further investigated due to our less patient number and shorter follow-up period. Related Articles | Metrics

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TR-350 immunoadsorption used in the neuromyelitis optica spectrum disorders: its clinical effects and#br# nursing methods XIONG Yun- jin, ZHOU Ran, GU Jing, GONG Yong, ZHANG Yin, ZHOU Yi- lun Chinese Journal of Blood Purification    2022, 21 (07): 541-544.   DOI: 10.3969/j.issn.1671-4091.2022.07.017 Abstract （270）      PDF（pc） （407KB）（61）       Knowledge map    Objective To summarize the clinical effects and nursing methods of TR-350 immunoadsorption in treatment of the national rare disease, the neuromyelitis optica spectrum disorders. Methods General situation of the patients, abnormal reactions during treatment, equipment alarm, management and clinical results were collected. Results Visual acuity and nerve function improved significantly after the immunoadsorption treatment. The extended disability status scale (EDSS) reduced from (5.84 ± 2.16) to (4.46 ± 2.13) (t=5.404, P=0.005). The concentration of anti- aquaporin- 4 autoantibody also decreased significantly from (72.14±24.21)μ/ml to (16.72±6.63)μ/ml (t =10.793, P＜0.001). In the 68 cases during treatment, hypotension occurred in one case, catarrh symptoms in 5 cases, equipment alarm in 14 cases, and unplanned termination of the treatment in one case. Conclusions The immunoadsorption effect is obvious but the operation is complicated. Therefore, the operation nurses are required to strictly follow the operation processes, and have the abilities to analyze the cause of equipment alarm and to manage the emergencies to ensure success of the treatment. Reference | Related Articles | Metrics

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The relationship between serum levels of procalcitonin, endotoxin and C-reactive protein and pathogenic bacteria and prognosis in sepsis patients  The relationship between serum levels of procalcitonin, endotoxin and C-reactive protein and pathogenic bacteria and prognosis in sepsis patients Chinese Journal of Blood Purification    2022, 21 (06): 432-435.   DOI: 10.3969/j.issn.1671-4091.2022.06.011 Abstract （268）      PDF（pc） （504KB）（118）       Knowledge map    Objective  To explore the relationship between serum levels of procalcitonin (PCT), endotoxin and C-reactive protein (CRP) and pathogens and prognosis in sepsis patients.  Methods  A total of 74 sepsis patients confirmed by positive blood culture between January 2020 and January 2021 were retrospective analyzed. According to blood culture results, they were divided into Gram-negative bacteria group (n=46) and Gram-positive bacteria group (n=28); according to the prognosis at the 28th day after hospitalization, they were divided into survival group (n=55) and death group (n=19). The serum levels of PCT, endotoxin and CRP were compared between Gram-negative bacteria group and Gram-positive bacteria group as well as between survival group and death group. Spearman correlation analysis was used to analyze the correlation between serum levels of PCT, endotoxin and CRP and bacterial pathogens in sepsis patients. The receiver operating characteristic curve (ROC curve) was used to explore the value of serum levels of PCT, endotoxin and CRP for prognosis prediction in sepsis patients.  Results  The serum levels of PCT, endotoxin and CRP were 3.79±0.57ng/ml, 0.60±0.13ng/L and 36.35±4.59mg/L respectively in Gram-negative bacteria group, significantly higher than those of 1.72±0.46ng/ml, 0.18±0.04ng/L and 18.42±3.14mg/L respectively in Gram-positive bacteria group (t=16.251, 16.585 and 18.215 respectively; P<0.001). The mortality rate was 34.78% in Gram-negative bacteria group, higher than that of 10.71% in Gram-positive bacteria group (χ2=5.284, P=0.022). The serum levels of PCT, endotoxin and CRP were (3.41±0.74)ng/ml, (0.55±0.12)ng/L and (35.76±7.21)mg/L respectively in death group, higher than those of (2.34±0.59)ng/ml, (0.38±0.11)ng/L and (27.41±5.08)mg/L respectively in survival group (t=6.374, 5.674 and 5.517 respectively; P<0.001). Spearman correlation analysis showed that the serum levels of PCT, endotoxin and CRP in sepsis patients were negatively correlated with the type of pathogen (r=-0.785, -0.793 and -0.822 respectively; P<0.001). ROC curve showed that serum levels of PCT, endotoxin and CRP were valuable for prognosis prediction in sepsis patients (AUC=0.862, 0.831 and 0.827 respectively; P<0.001), and combination of the three levels was more valuable for the prognosis prediction (AUC=0.911, P<0.001).  Conclusion  The serum levels of PCT, endotoxin and CRP were higher in sepsis patients due to Gram-negative bacterial infection than those due to Gram-negative bacterial infection. Combination of the three serum biomarkers can be used as an adjuvant to predict prognosis in sepsis patients. Related Articles | Metrics

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Clinical application of early cannulation graft FLIXENE™  for hemodialysis patients  WU Chang, MI Lan-hua, SHI Ya-xue, LIU Si-jie, BAO Xue-dong, YU Min, HU Wen-ping Chinese Journal of Blood Purification    2022, 21 (08): 613-616.   DOI: 10.3969/j.issn.1671-4091.2022.08.017 Abstract （267）      PDF（pc） （456KB）（263）       Knowledge map    Objective  To summarize the preliminary clinical application results of FLIXENE™ (Atrium™, Hudson, NH, USA), an early cannulation artificial vascular graft.  Methods  A total of 48 cases subjected to arteriovenous graft construction using the early cannulation FLIXENE™ vascular graft at the Department of Vascular Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from August 2019 to October 2021 were retrospectively analyzed. The first cannulation time, patency rate and incidence of complications were summarized.  Results   There were 18 males and 30 females, with an average age of 60.06±11.93 years. The arteriovenous graft was established in upper limbs (n=40) or in lower limbs (n=8), with the clinical success rate of 100% and without any perioperative complications. The first cannulation time after operation was 15～336h, with the median time of 20 (18, 22) h. The average follow-up time was 224.77±151.73 days, and the follow-up rate was 100%. Complications included thrombus (2 cases), stenosis (9 cases) and infection (2 cases). No hematoma at puncture site, seroma, pseudoaneurysm, or steal syndrome occurred. After the operation for 3, 6 and 12 months, the primary patency rates were 95.3%, 87.4% and 63.0%, respectively, the primary assisted patency rates were 100%, 97.4%, and 92.2% respectively, and the secondary patency rates were 100%.  Conclusions  The early cannulation FLIXENE™ vascular graft is safe and feasible for early cannulation hemodialysis.  Related Articles | Metrics

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A comparative study on the association of all-cause mortality with different definitions of intradialytic hypotension CAO Hu-nan, FAN Rui, KONG Ling, CHENG Shui-qin, CHEN Yi-hong, LV Gui-lan Chinese Journal of Blood Purification    2022, 21 (09): 638-643.   DOI: 10.3969/j.issn.1671-4091.2022.09.004 Abstract （266）      PDF（pc） （626KB）（42）       Knowledge map    Objective To compare the association between intradialytic hypotension (IDH) using different definitions and all- cause mortality in maintenance hemodialysis (MHD) patients. Methods Data from 407 patients were retrospectively analyzed. The K-M curves based on the 9 different definitions were established, and the cutoff value for the incidence of IDH with maximum difference in the K-M curve was used to distinguish frequent IDH from non-frequent IDH. Cox proportional hazard regression model was conducted to compare the correlation between frequent IDH and all-cause mortality. C-index, Akaike Information Criterion(AIC), Net Reclassification Index (NRI) and Integrated Discrimination Improvement (IDI) were used to evaluate efficiency and quality of the model. Finally, the dose-response effect between the frequency of IDH and allcause mortality was explored by strict cubic spline regression. Results A total of 198,883 dialysis data were collected during the 56-month follow-up period, and 35 patients (8.6%) died with an average death rate of 2.6 per 100 person-years. The proportion of never having IDH using an IDH definition ranged from 0% to 46.4%, and the average incidence of IDH ranged from 0.7% to 46.0%. After adjusting for confounding variables, frequent IDH that defined by the British Kidney Association (UKKA) guidelines was significantly associated with all-cause mortality (HR=6.762, 95% CI:3.272～13.977, P＜0.001). The C-index, AIC, NRI and IDI of the model were 0.749, 380.957, 0.381 and 0.093 respectively; there was a significant non-linear relationship between the frequency of IDH and the risk of all- cause mortality (Wald χ2=3.875, P=0.049). Conclusion IDH is common, and its incidence varies using different definitions. Redefinition of IDH may reduce the variation. Using the UKKA guidelines, the risk of all-cause mortality increased with the frequency of IDH. Frequent IDH was significantly associated with all-cause mortality, which is closely related to clinical practice to reveal the association between IDH and all-cause mortality. Reference | Related Articles | Metrics

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Research progress in the early screening and evaluation of protein energy wasting in patients with chronic kidney disease CUI Hong-qin, WU Yan-fei, FANG Jing-ai, SUN Yan-yan, LIU Wen-yuan, ZHANG Xiao-dong, CHANG Qin-tao, WANG Rui-hua Chinese Journal of Blood Purification    2022, 21 (06): 441-444.   DOI: 10.3969/j.issn.1671-4091.2022.06.013 Abstract （260）      PDF（pc） （401KB）（143）       Knowledge map    Protein energy wasting (PEW) is a common complication in patients with chronic kidney disease, especially those treated with maintenance hemodialysis. PEW affects their survival, mortality and quality of life. PEW clinically manifests low serum albumin and prealbumin concentrations, reduced body mass index (BMI), and decreased dietary protein intake. Therefore, early identification and diagnosis of PEW is essential for the prognosis of chronic kidney disease patients. Related Articles | Metrics

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Clinical characteristics and prognosis of the first episode of peritoneal dialysis-associated peritonitis in patients with different peritoneal dialysis duration  Chinese Journal of Blood Purification    2022, 21 (11): 790-794.   DOI: 10.3969/j.issn.1671-4091.2022.11.002 Abstract （260）      PDF（pc） （456KB）（101）       Knowledge map    Objectives   To investigate the clinical characteristics and prognosis of peritoneal dialysis-associated peritonitis (PDAP) in patients with different dialysis duration.  Method  A total of 166 peritoneal dialysis (PD) patients who experienced the first episode of PDAP in Peking University People's Hospital from January 2007 to October 2021 were retrospectively reviewed. According to PD duration, patients were divided into long PD duration group (≥60 months), medium PD duration group (36-59 months) and short PD duration group (＜36 months). Clinical characteristics and PDAP prognosis were collected and analyzed. Results  Among 166 patients，83(50%) were male and the mean age was (63.33±12.14) years. The major primary renal diseases were diabetic nephropathy(35.5%).There were 36 patients (21.7%) in long PD duration group. With the extension of PD duration, the proportion of patients with diabetes gradually decreased (62.1%, 45.7%, 30.6%, χ2=11.068, P=0.004), and the treatment failure rate and PDAP-related mortality gradually increased(χ2=10.095、11.171，P=0.005, 0.003). Logistic multivariate regression analysis showed that PD duration was not only independent risk factor for the treatment failure of the first-episode PDAP (OR1.291，95%CI : 1.048～1.591,P=0.016) , but also independent risk factor for first-episode PDAP death (OR: 1.675, 95%CI:1.262～2.222, P＜0.001).   Conclusion   Patients with PD duration of ≥60 months had the highest rate of treatment failure and PDAP-related mortality when they first experienced PDAP. PD duration is an independent risk factor for the first episode of PDAP treatment failure and death. The prevention of peritonitis in PD patients with long PD duration should be actively strengthened. Reference | Related Articles | Metrics