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Clinicopathological manifestations of the renal damage due to cholesterol crystal embolism Chinese Journal of Blood Purification    2022, 21 (01): 15-19.   DOI: 10.3969/j.issn.1671-4091.2022.01.004 Abstract （1902）      PDF（pc） （1550KB）（296）       Knowledge map    【Abstract】Objectives Kidney is frequently involved in cholesterol crystal embolism, but this renal injury is easily to be disregarded and misdiagnosed. Objective To investigate the clinicopathological features, treatment and outcome of the renal injury due to cholesterol crystal embolism. Methods The clinicopathological data of the patients with renal injury due to cholesterol crystal embolism were retrospectively reviewed. Results In this cohort, 10 of the 11 patients had atherosclerosis. The renal injury was induced by interventional therapy in 7 patients and by newly administered warfarin in 2 patients, and occurred spontaneously in 2 patients. Blue toe syndrome was found in 6 patients, and eosinophilia was present in 9 patients. All the patients had proteinuria, and 10 patients had renal insufficiency. Eight patients received renal biopsy. Pathological findings consisted of artery thickening and stenosis with needle-shaped clefts in the occluded vessels, and moderate to severe infiltration of lymphomonocytes and some eosinophils. Ten patients were followed up; renal function was normal in one patient and was insufficient in 9 patients, in which one died, and 8 patients showed no improvement in renal function. At the end of follow-up, 4 patients were dialysis-dependent. Conclusion The clinical manifestation of cholesterol crystal embolism varied. Renal biopsy and pathological examination are required in unexplained acute or subacute renal insufficiency patients complicated with atherosclerosis, interventional therapy, and/or anticoagulant treatment. Related Articles | Metrics

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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）（1140）       Knowledge map    Reference | Related Articles | Metrics

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Sacubitril/valsartan improves cardiac systolic function independently from blood volume management in hemodialysis patients with heart failure Chinese Journal of Blood Purification    2022, 21 (01): 10-14.   DOI: 10.3969/j.issn.1671-4091.2022.01.003 Abstract （1405）      PDF（pc） （499KB）（176）       Knowledge map    【Abstract】Objective To observe the efficacy and safety of sacubitril/valsartan for the treatment of heart failure in maintenance hemodialysis patients. Methods Patients on hemodialysis complicated with chronic cardiac insufficiency and with stably controlled volume status were enrolled. They were treated with sacubitril/valsartan and followed up for 3 months. Before treatment with sacubitril/valsartan (baseline) and during follow- up, biomarkers of heart failure were tested, and volume status was assessed by body composition monitor (BCM). Changes of cardiac structure and function were examined by echocardiography. Results A total of 17 patients were included, while 4 patients withdrew due to drug-related adverse reactions and one due to renal transplantation during follow-up. Left ventricular ejection fraction (LVEF) increased from baseline 54.2±15.8% to endpoint 62.7±10.1% (t=-4.429, P=0.001) and greater improvement was found in patients with declined baseline LVEF (≤55%; t=-6.204, P=0.003), in line with a significant reduction in left ventricular end systolic volume (baseline 109.0±62.7ml vs. endpoint 79.4±52.1ml; t=4.725, P=0.009). In patients with normal LVEF, left ventricular posterior wall thickness decreased significantly (baseline 1.08 ± 0.27cm vs. endpoint 0.99 ± 0.16cm; t=3.176, P=0.025). The endpoints of serum creatinine (t=- 2.856, P=0.016), urea (t=- 3.149, P=0.009) and parathyroid hormone (baseline 328±161pg/ml vs. endpoint 409±191pg/ml; t=-2.230, P=0.048) elevated significantly as compared with the baseline values. Conclusion Sacubitril/valsartan significantly improves cardiac systolic function in hemodialysis patients with heart failure and reduces ventricular wall thickness in patients with normal LVEF. However, this treatment may also induce the increase of creatinine, urea and parathyroid hormone levels. 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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Cardiovascular outcomes with Sacubitril- Valsartan in patients undergoing hemodialysis Chinese Journal of Blood Purification    2021, 20 (12): 809-813.   DOI: 10.3969/j.issn.1671-4091.2021.12.005 Abstract （1146）      PDF（pc） （498KB）（123）       Knowledge map    【Abstract】Objective To explore the cardiovascular outcomes with sacubitril-valsartan in patients undergoing hemodialysis. Methods 13 maintenance hemodialysis (MHD) patients from Peking University People's Hospital were selected, without obvious edema, severe infection or acute cardiovascular events recently. Blood pressure and echocardiography of the patients were recorded. Paired-Samples T test was used to identify the effects of sacubitril-valsartan in MHD patients. Results ①A total of 13 patients on MHD for 99 (14～155) months (8 males and 5 females) were included in this study. ②Compared with baseline levels, left ventricular ejection fractions (LVEF) (43.0 ± 10.2% vs. 60.0 ± 13.9%, t =- 4.769, P＜0.001) were markedly improved after treatment with sacubitril-valsartan. ③ Compared with baseline levels, NT-proBNP levels (25594pg/ml vs. 15325 pg/ml, t = 2.979, P = 0.012) were markedly decreased after treatment with sacubitril-valsartan. ④No serious adverse events occurred. Conclusions Sacubitril-valsartan is effective and safe for MHD patients. 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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The cause of death and its related information in hemodialysis patients in China - enlightenment from the DOPPS study Chinese Journal of Blood Purification    2022, 21 (02): 89-93.   DOI: 10.3969/j.issn.1671-4091.2022.02.005 Abstract （1037）      PDF（pc） （430KB）（681）       Knowledge map    【Abstract】Although hemodialysis (HD) can improve the life expectancy of end stage renal disease (ESRD) patients, the risk of death is still significantly higher in HD patients than in general population. The purpose of this study was to explore the cause of death and its related information in HD patients in the China Dialysis Outcomes and Practice Patterns Study (DOPPS). Methods DOPPS is an international, prospective and observational study. China participated in the DOPPS 5 study (2012～2015) and has completed the follow-up of the cohort. A total of 1,427 patients were enrolled in the China DOPPS 5 study. Their demographics, primary cause of ESKD, comorbidities, dialysis prescription, laboratory examination results, and date, cause and other related information of death were recruited. The primary cause, date and place of death were then defined. Results A total of 1,427 HD patients were enrolled in the China DOPPS 5 study, including 473 cases in Beijing, 454 cases in Guangzhou and 500 cases in Shanghai. The average age of the patients was 59.4+14.9 years old, 55% were males, and 25.1% had diabetes. The mean follow-up period was 1.9 years (1.1, 2.1 years). During the follow-up period, 205 patients died, with the overall mortality of 14.4% and the annual average mortality of 8.8%. In the death patients, the median age was 70 (59, 79) years old, 56.1% were males, and the median dialysis vintage was 2.5 (1.0～5.0) years. The number of death patients in Beijing, Guangzhou and Shanghai were 67, 67 and 71 cases respectively, with the annual average mortality of 7.9%,10.0% and 8.6% respectively. The top three causes of death in HD patients were cerebrovascular events (19.3%, including ischemic stroke), congestive heart failure (18.2%) and pulmonary infection (11.6%); 105 cases died of cardiovascular diseases, accounting for 51.2% of the death patients. There were gender differences in the ranking of the main causes of death. In the died patients, 70.8% died in hospital and 27.0% died at home; HD treatment continued before death in 79.8% patients, and discontinued before death in 20.2%; 62.9% cases received hospice care before death; the risk time of death in a day was within 10pm～6am. Conclusion In the China DOPPS 5 study, the average annual mortality was 8.8%. The main cause of death was cardiovascular events. Among the single cause of death, cerebrovascular events (including ischemic stroke), congestive heart failure and pulmonary infection were the most common causes of death, and the causes of death seemed to be gender different. The terminal stage was present in most death patients, and 1/4 of death happened at home. Without medical intervention, the risk time of death in a day was from late night to early morning. Reference | Related Articles | Metrics

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Effect of sodium thiosulfate combined with hemoperfusion on uremic pruritus and oxidative stress in maintenance hemodialysis patients  Chinese Journal of Blood Purification    2022, 21 (01): 33-37.   DOI: 10.3969/j.issn.1671-4091.2022.01.008 Abstract （1035）      PDF（pc） （508KB）（184）       Knowledge map    【Abstract】Objective To observe the effect of sodium thiosulfate combined with hemoperfusion on refractory pruritus and oxidative stress in maintenance hemodialysis (MHD) patients. Methods A total of 70 MHD patients with refractory pruritus treated in the Hemodialysis Center, Shanghai Jing’an District Zhabei Central Hospital during January 2019 to December 2020 were enrolled in this study. They were randomly divided into three groups: group A (sodium thiosulfate group), group B (hemoperfusion group) and group C (sodium thiosulfate combined with hemoperfusion group). Patients in group A received hemodialysis three times a week, and 3.2g sodium thiosulfate was intravenously injected before every dialysis; those in group B received hemodialysis twice a week and hemodialysis combined with hemoperfusion once a week; those in group C used the dialysis protocols in group B as well as intravenous 3.2g sodium thiosulfate before every dialysis for 3 months. Serum creatinine (SCR), urea nitrogen (BUN), calcium (Ca), phosphorus (P), β2-micro-globulin (β2-MG), parathyroid hormone (PTH), C-reactive protein (CRP), glutathione peroxidase (GSHPx), superoxide dismutase (SOD) and malondialdehyde (MDA) were measured before and after 3 months treatment. Pittsburgh sleep quality index (PSQI) and visual analogue scale (VAS) were used before and after 3 months treatment to evaluate the efficacy and safety of the treatment. Results Serum P, β2-MG and PTH in group B and group C were lower after the treatment than those before the treatment, and were lower than those in group A after the treatment (Serum P, in group B and group C: t=2.829 and 4.226, P=0.010 and <0.001; between group B and group C: F=3.191 and P=0.041. Serum β2-MG, in group B and group C: t=2.363 and 2.575, P=0.027 and 0.017; between group B and group C: F=4.658 and P=0.013. Serum PTH, in group B and group C: t=2.715 and 5.856, P=0.008 and <0.001; between group B and group C: F=13.738 and P<0.001). Serum GSHPx and SOD in group A and group C were higher after the treatment than those before the treatment, and were higher than those in group B during the same period (Serum GSHPx, in group A and group C: t=-2.247 and - 5.387, P=0.035 and <0.001; between group A and group C: F=15.577 and P<0.001. Serum SOD, in group A and group C: t=-2.300 and -5.122, P=0.031 and <0.001; between group A and group C: F=8.308 and P=0.001). Serum MDA decreased significantly (in group A and group C: t=5.630 and 7.904, P<0.001; between group A and group C: F=26.116 and P<0.001). PSQI score and VAS score lowered after 3 months treatment compared to those before treatment in the three groups (PSQI score in groups A, B and C: t=4.739, 4.761 and 8.803 respectively, P<0.001; VAS score in groups A, B and C: t=15.087, 11.682 and 17.310 respectively, P<0. 001). PSQI and VAS scores lowered more in group C than in group A and group B during the same period (For PSQI score and VAS score: F=15.049 and 8.670, P<0.001). After 3 months treatment, the effective rates were 54.2%, 47.8% and 78.3% in group A, group B and group C, respectively, higher in group C than in groups A and B (χ2=4.956, P=0.026). Conclusions Sodium thiosulfate combined with hemoperfusion was safe and effective for MHD patients with refractory pruritus. Sodium thiosulfate has antioxidant effect, which may alleviate uremic pruritus. Reference | 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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The technology and application status of hemodiafiltration Chinese Journal of Blood Purification    2021, 20 (10): 649-653.   DOI: 10.3969/j.issn.1671-4091.2021.10.001 Abstract （835）      PDF（pc） （515KB）（674）       Knowledge map    【Abstract】Hemodiafiltration has gradually become a common renal replacement therapy. The solute removal method in the hemodiafiltration process includes both diffusion and convection, which can simultaneously achieve the effective removal of small molecules and medium and large molecular weight toxins. Recent reports from China and international researches show that the total number of patients using online hemodiafiltration therapy is gradually increasing. According to the current research and clinical application situation, the clinical experience and practice mode in the Asia-Pacific region are different from those in Europe, and specific studies are needed to be carried out according to the actual situation. In this paper, we reviewed the technical requirements, clinical researches and application status of hemodiafiltration in this article. Reference | Related Articles | Metrics

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Chinese Journal of Blood Purification    2021, 20 (11): 721-727.   DOI: 10.3969/j.issn.1671-4091.2021.11.001 Abstract （834）      PDF（pc） （395KB）（701）    PDF（mobile） （395KB）（43）    Knowledge map    Reference | Related Articles | Metrics

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Effect of IV3000 dressing on the prevention of early catheter-related infection in peritoneal dialysis patients Chinese Journal of Blood Purification    2021, 20 (07): 498-500.   DOI: 10.3969/j.issn.1671-4091.2021.07.016 Abstract （761）      PDF（pc） （397KB）（345）       Knowledge map    【Abstract】Objective To investigate the effect of IV3000 dressing on the prevention of early catheter-related infection in peritoneal dialysis (PD) patients. Methods A total of 43 patients with peritoneal dialysis catheters were randomly divided into experimental group or control group. The experimental group used IV3000 dressing for catheter outlet nursing, and the control group used 3L wound dressing. The exit site score, catheter-related infection, skin abnormalities, comfort degree of the patients, dressing integrity, dressing exchange frequency, and expense of the dressing were compared after the treatment for 6 weeks between the two groups. Results Compared with the control group, the experimental group had lower exit site score (Z=-4.644, P<0.001), lower catheter-related infection rate (x2=8.419, P=0.016), lower skin abnormality rate (x2=23.872, P＜0.001), less dressing exchange frequency (t=-16.321, P＜0.001), better comfort degree of the patients (x2=14.614, P＜0.001) and higher dressing integrity (x2=21.428, P＜0.001). The expense of the dressing was similar between the two groups (t=-1.453, P=0.154). Conclusion IV3000 dressing used in the early nursing of peritoneal dialysis catheter outlet had a better effect on the prevention of catheter-related infection and unplanned dressing exchange. IV3000 dressing was relatively comfortable and safe, and can be widely used clinically. Reference | 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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Current situation and Prospect of blood purification standards Yuqing Chen Chinese Journal of Blood Purification    2021, 20 (06): 361-364.   DOI: 10.3969/j.issn.1671-4091.2021.06.001 Abstract （734）      PDF（pc） （356KB）（962）       Knowledge map    【Abstract】Blood purification is an important treatment for chronic kidney disease. Due to the requirement for safety and quality, various standardized operation documents have emerged. In recent years, with the development of our national standardization field, more and more medical workers realized that the field of blood purification requires a series of standards. The standardization and standard system construction in the field of blood purification will guarantee the safety of blood purification better, continuously improve the management level and medical quality of blood purification, and contributes to improving the prognosis of uremic patients. The Chinese standard of blood purification is still a new thing, and many practitioners in this field do not fully understand it. This review mainly introduces the related concepts of standards, the current standards of blood purification in China, and future development prospects. Reference | Related Articles | Metrics

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Renal recovery in peritoneal dialysis patient – a single center cohort study Chinese Journal of Blood Purification    2021, 20 (11): 728-731.   DOI: 10.3969/j.issn.1671-4091.2021.11.002 Abstract （704）      PDF（pc） （427KB）（215）       Knowledge map    【Abstract】Objective Peritoneal dialysis (PD) is mostly used as a long term renal replacement therapy for end stage renal disease (ESRD). Data from the dialysis registration systems of various countries shown that a certain number of patients experience renal recovery after on peritoneal dialysis for a while. However, the characteristics of these patients are far from clear. This paper is to explore the characteristics of these patients. Methods This is a single center cohort study. The long term PD patients in our center were followed up until death or withdraw PD. We analyzed the characteristics of the patients who start PD for ESRD and withdraw PD for renal function recovery. Results There were 1623 patients started PD between June, 1986 to January, 2018 in our PD center. 10 patients (including 6 males; mean age: 56±22) were included in the analysis. 8 of the 10 patients started PD after their first presenting in nephrology clinic. The time phase from renal replacement therapy until renal recovery was between 60 to 634 days (medium (quartiles): 343 (142, 467) days). Most of these patients had anemia, hypocalcemia, and hyperphosphatemia when they started PD, and some had decreased urine output, but the kidney size was generally preserved in most cases. Conclusions A few patients diagnosed with ESRD at the beginning of dialysis may still have renal function recovery after a considerable period of replacement therapy, especially in those without clear past disease history and with preserved kidney size. It is important recognize these patients and protect residual renal function and avoid renal damage factors. Related Articles | Metrics

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Application of anti-Xa factor activity assay in low molecular weight heparin anticoagulation in hemodialysis patients  WANG Zhen-xing, XU Leng-nan, FU Pei-jie, DANG Xin, MAO Yong-hui Chinese Journal of Blood Purification    2022, 21 (05): 365-368.   DOI: 10.3969/j.issn.1671-4091.2022.05.014 Abstract （703）      PDF（pc） （398KB）（213）       Knowledge map    Low molecular weight heparin (LMWH) is one of the commonly used anticoagulants. Its anticoagulation effect and bleeding risk are often monitored by the anti-Xa factor activity. Appropriate anti-Xa factor activity range is also recommended in clinical guidelines. As for hemodialysis patients using LMWH, there is no consensus about the target range of anti-Xa factor activity. This review mainly discusses the value of anti-Xa factor activity assay in LMWH anticoagulation for hemodialysis and the recent progresses in its specific monitoring strategies. 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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Clinical features, diagnosis and treatment of pleuroperitoneal communication in peritoneal dialysis patients Chinese Journal of Blood Purification    2022, 21 (02): 85-88.   DOI: 10.3969/j.issn.1671-4091.2022.02.004 Abstract （675）      PDF（pc） （455KB）（115）       Knowledge map    【Abstract】Objective To explore the clinical features, diagnosis and treatment of pleuroperitoneal communication in peritoneal dialysis (PD) patients. Methods The PD patients diagnosed with pleuroperitoneal communication during January 1, 2006 to September 30, 2021 and treated in the PD Center of Peking University People's Hospital were enrolled in this study. General information, PD procedures, symptoms and signs, laboratory results, diagnosis methods, treatment and outcome were collected and analyzed. Results ①Five PD patients with pleuroperitoneal communication were diagnosed with the incidence of 0.96%. ②Pleuroperitoneal communication occurred in the period of increasing dialysate dwelling dose during the first 3~13 weeks of PD and at the right side in all of the 5 cases. Four of the five cases were females. Female, older age and low body surface area may be the risk factors. The major clinical manifestations included chest tightness, dyspnea and decreased ultrafiltration volume. ③ Chest X-ray revealed moderate to large pleural effusion in right side. Glucose concentration in pleural fluid higher than that in blood, methylene blue injected into abdominal cavity, and CT peritoneography were the methods to confirm the diagnosis. ④Once diagnosed, PD should be interrupted immediately and changed to hemodialysis temporarily or permanently. In some cases, PD may be continued beginning from lower dialysate dwelling dose and gradual increase of the dose to reconstitute the long- term PD. Conclusions Pleuroperitoneal communication is a rare complication of PD, frequently occurring in the period of increasing dialysate dwelling dose at the early stage of PD. CT peritoneography has been the most simple and effective diagnosis method. After diagnosis, PD should be switched to hemodialysis temporarily or permanently, or reconstituted starting from lower dialysate dwelling dose and gradual increase of the dose. If possible, surgical treatment is an effective measure for this complication. To prevent the occurrence of pleuroperitoneal communication in PD patients with the risk factors, symptoms and signs relating to pleuroperitoneal communication and changes of intraperitoneal pressure should be closely monitored in the period of increasing dialysate dose at the early stage of PD, and the dialysate dwelling dose should be reduced when necessary. Related Articles | Metrics

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Recent advances in the management of hyperkalemia in patients on maintenance hemodialysis Chinese Journal of Blood Purification    2021, 20 (12): 793-796.   DOI: 10.3969/j.issn.1671-4091.2021.12.001 Abstract （616）      PDF（pc） （461KB）（425）       Knowledge map    【Abstract】Patients on maintenance hemodialysis (MHD) are prone to have hyperkalemia due to the severe impairment of renal function. The complications of diabetes, hypertension and hear failure in MHD patients further increase the risk of hyperkalemia. Hyperkalemia seriously affects their prognosis, so that maintenance of serum potassium within normal range is essential to improving their clinical outcomes. Recent studies on hemodialysis and dietary management add more explorations to the prevention and treatment of hyperkalemia. The presence of sodium zirconium cyclosilicate and patiromer in the market contributes new therapeutic options to the intervention of hyperkalemia. Given that the incidence of hyperkalemia is higher and the disease burden is heavier in MHD patients in China, this article aims to review the recent advances in the management of hyperkalemia in MHD patients. 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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Home hemodialysis machine technology: a global overview Chinese Journal of Blood Purification    2022, 21 (02): 73-76.   DOI: 10.3969/j.issn.1671-4091.2022.02.001 Abstract （598）      PDF（pc） （1299KB）（319）       Knowledge map    【Abstract】At present, there are only few cases of home hemodialysis in Chinese mainland, and the machines uses are traditional dialysis machine. In Europe and America, most home hemodialysis patients use the machines specially designed for home dialysis, which are more compact and easy to operate. This paper will briefly describe the home dialysis machine and related technologies that have been used abroad. Reference | Related Articles | Metrics

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Comparison of the advantages and disadvantages of several continuous renal replacement therapy technologies Chinese Journal of Blood Purification    2021, 20 (12): 801-804.   DOI: 10.3969/j.issn.1671-4091.2021.12.003 Abstract （595）      PDF（pc） （469KB）（515）       Knowledge map    【Abstract】Continuous renal replacement therapy (CRRT) has the roles of ultrafiltration to remove excess water, convection to clear medium and small molecular solutes, and adsorption to eliminate inflammatory mediators. The therapeutic models of CRRT are developed progressively, such as continuous venous-venous hemofiltration (CVVH), continuous venous- venous hemodiafiltration (CVVHDF), high- volume hemofiltration (HVHF), continuous plasma filtration adsorption (CPFA), and slow continuous ultrafiltration (SCUF). CVVH is the most commonly used model, usually as an adjuvant method for refractory heart failure, severe acute pancreatitis, rhabdomyolysis, and many others; CVVHDF has been widely used for the treatment of sepsis; HVHF is a treatment often for severe sepsis and septic shock; CPFA can be used in severe inflammatory response syndrome and sepsis; SCUF is often used in patients with refractory heart failure, edema, and overload of extracellular fluid volume. Every CRRT technology has its own characteristics, and the selection of therapeutic model and dosage must be individualized based on clinical situation of the patient. Reference | Related Articles | Metrics

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The effect of probiotics on intestinal microbiota and quality of life in MHD patients with chronic constipation Chinese Journal of Blood Purification    2022, 21 (04): 244-248.   DOI: 10.3969/j.issn.1671-4091.2022.04.005 Abstract （594）      PDF（pc） （478KB）（344）       Knowledge map    【abstract】Objective To explore the effects of probiotics to treat chronic constipation on intestinal microbiota and quality of life in maintenance hemodialysis (MHD) patients. Methods Ninety patients were randomly divided into probiotic group (n=45) and control group (n=45). The patient assessment of constipation quality of life questionnaire (PAC- QOL), intestinal microbiota, serum inflammatory factors and renal function indicators were detected and analyzed before the treatment and after the treatment for one month. Results ①After the treatment, Scr, BUN, and UA decreased in both groups (control group: t=7.933, 13.190 and 4.176 respectively, P<0.001; probiotic group: t=7.721, 12.722 and 5.948 respectively, P<0.001); BUN was lower in probiotic group than in control group (t=3.217, P=0.002), but Scr and UA had no statistical significances between the two groups (t=0.003 and 0.258, P=0.997 and 0.776). ②After the treatment, the numbers of intestinal bifidobacteria and lactobacilli increased and E. coli and enterococci decreased in both groups, with the changes more prominent in probiotic group than in control group (t=-9.367, -22.573, 35.796, and 6.124 respectively, P<0.001). In control group after the treatment, the number of bifidobacteria had no significant change (t=1.984, P=0.054), but intestinal lactobacilli increased and E. coli and enterococci decreased (t=-4.239, 6.633 and 7.466 respectively, P<0.001); In probiotic group after the treatment, the increase of intestinal bifidobacteria and lactobacilli and decrease of E. coli and enterococci were statistically significant (t=- 10.759, - 30.592, 37.157 and 9.010 respectively, P<0.001). ③ Serum IL- 6 and CRP decreased after the treatment in both groups (t=122.371 and 3.489, P<0.001), with the decrease more in probiotic group. ④After the treatment PAC-QOL improved in the domains of body discomfort, psychological and social inadaptation, worrying and anxiety, satisfaction score, and total score in both groups (t=24.216, 13.26, 34.175, 49.925 and 34.553 respectively, P<0.001), with the improvements more in probiotic group. Conclusion Probiotics can be beneficial in improving the intestinal microbiota imbalance and the micro-inflammatory state but had no obvious effect on renal function in MHD patients with chronic constipation. Probiotics can also reduce the PAC-QOL score and improve the chronic constipation symptoms in these patients. Reference | Related Articles | Metrics

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The analysis of balloon pressure during percutaneous transluminal angioplasty for hemodialysis access stenosis#br# Chinese Journal of Blood Purification    2021, 20 (09): 624-627.   DOI: 10.3969/j.issn.1671-4091.2021.09.012 Abstract （591）      PDF（pc） （436KB）（231）       Knowledge map    【Abstract】Objective To investigate the balloon pressure required during percutaneous transluminal angioplasty (PTA) in the treatment of hemodialysis access stenosis at different locations. Methods Patients with hemodialysis access stenosis and received PTA in Jinshan Hemodialysis Access Center, the First Affiliated Hospital of Chongqing Medical University during April 2020 to September 2020 were enrolled in this study. Demographic and surgical data were collected. The balloon pressure used at different positions was analyzed. Results A total of 259 patients (102 males and 157 females) were enrolled. They had 300 stenosis lesions including 242 in arteriovenous fistulas and 58 in arteriovenous grafts. The clinical success rate was 100% (300/300), the surgical success rate was 98.7% (296/300), and the incidence of surgical complications was 7.333%, including 13 cases of hematoma and 9 cases of vascular rupture. The total mean balloon pressure was 16.693±6.237 atm, and 58.34% (175/300) of the patients used the pressure of >14 atm for full dilation of the lesions. There was no significant difference in pressure required for full dilation between arteriovenous fistulas and arteriovenous grafts, and among different lesion sites in arteriovenous grafts. However, the mean balloon pressure for lesions in juxta-anastomotic sites of arteriovenous fistulas was 18.467±5.706 atm, significantly higher than that for lesions in puncture area (t=2.070, P=0.040) and outflow vein (t=4.969, P<0.001). Conclusion The hemodialysis access stenosis requires higher pressure during PTA to achieve full dilation, and the pressure required at different lesion sites is different. According to these characteristics, appropriate selection of balloon makes the endovascular intervention economical and efficient. 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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Research updates on hyperphosphatemia in Chronic kidney disease CHENYa-fei, ZUOL Chinese Journal of Blood Purification    2022, 21 (05): 305-308.   DOI: 10.3969/j.issn.1671-4091.2022.05.001 Abstract （558）      PDF（pc） （383KB）（524）       Knowledge map    Chronic kidney disease (CKD) is highly prevalent in general population. With the decline of kidney function, the abnormality of phosphorus metabolism is gradually aggravated. In China, hyperphosphatemia in CKD is characterized by high prevalence and low control rate. Hyperphosphatemia is an independent risk factor of CKD progression, secondary hyperparathyroidism, cardiovascular events, and all-cause mortality in CKD patients. Literatures on mechanisms of hyperphosphatemia and its adverse outcomes were reviewed. Related Articles | Metrics

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Clinical characteristics and related factors of abdominal aorta and cardiac valve calcification in end stage renal disease patients  Chinese Journal of Blood Purification    2021, 20 (07): 460-464.   DOI: 10.3969/j.issn.1671-4091.2021.07.007 Abstract （528）      PDF（pc） （437KB）（491）       Knowledge map    【Abstract】Objective To assess the status and related factors of abdominal aorta calcification (AAC) and cardiac valve calcification (CVC) in end stage renal disease (ESRD) patients. Methods A total of 277 ESRD patients admitted to the Department of Nephrology, Cangzhou Central Hospital from October, 2019 to December, 2020 were enrolled in this study. They were divided into AAC group and non-AAC group, CVC group and non-CVC group, AAC and CVC group and non-AAC and non-CVC group, based on AAC score and CVC status. Clinical characteristics and related factors were compared among the groups. Results The rates of elderly, female, diabetes, coronary atherosclerotic heart disease (CHD), peritoneal dialysis (PD), CVC and higher C-reactive protein (CRP) level were significantly higher in AAC group than in non-AAC group (P＜0.001, ＜0.001, =0.002, =0.001, =0.042, ＜0.001 and =0.005 respectively). More elderly, diabetes, CHD, and higher diastolic blood pressure, mean arterial pressure, platelet and AAC score were found in CVC group (P＜0.001,＜0.001,＜0.001,＜0.001, =0.001, =0.006 and ＜0.001 respectively). The rates of elderly, diabetes, CHD, higher diastolic blood pressure, higher serum phosphorus increased in AAC and CVC groups (P＜0.001, ＜0.001, ＜0.001, ＜0.001 and =0.001 respectively). Multivariate logistic regression showed that age and dialysis were the independent risk factors for AAC, that age, white blood cell, history of diabetes and CHD, and AAC score were the independent risk factors for CVC, and that age and PD were the independent risk factors for both AAC and CVC. Conclusions AAC and CVC were clinically correlated. However, clinical characteristics and related factors of the two vascular calcifications were different. Active prevention, treatment and individualized management are required. 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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Cardiac dysfunction and Related factors in Patients with Hemodialysis Treatment for more than Twenty Years  Chinese Journal of Blood Purification    2021, 20 (12): 805-808.   DOI: 10.3969/j.issn.1671-4091.2021.12.004 Abstract （498）      PDF（pc） （460KB）（305）       Knowledge map    【Abstract】objective To investigate the cardiac dysfunction characteristics and related factors in patients with sufficient hemodialysis. Methods Patients who have been treated with sufficient hemodialysis for more than 20 years in China-Japan Friendship Hospital were selected for this study. The general clinical data, laboratory and imaging results of these patients are collected for analysis. Results In the total of 20 patients, the dialysis vintage ranges from 20 to 34 years. About 75% of these patients' left ventricular systolic function remains within the normal range; about 35% of them have suffered different degrees of left ventricular systolic dysfunction (LVDD); and about 70% of them have suffered valve degenerative changes and regurgitation. More than 35% of them have also suffered left atrial enlargement, left ventricular hypertrophy, abnormal ventricular wall movement, pericardial effusion and other cardiac damages. Biochemical results showed that the serum cardiac injury markers such as high-sensitivity troponin T(HS cTnT), high-sensitivity troponin I (HS cTnI), B-type natriuretic peptide(BNP)and N-terminal natriuretic peptide precursor (NT Pro BNP) increased significantly in about 50% of the patients. Spearman correlation analysis shows that age is positively related to LVDD(β=0.583，P=0.07), but there is no specific correlation between heart disease and dialysis vintage, the usage of low- molecular weight heparin, ACEI /ARB drugs, whether combined hemodialysis with filtration and hemoperfusion therapy. Conclusions With the increase of age and dialysis vintage, although the left ventricular systolic function could be maintained at a normal level in most patients, they still suffer from extensive cardiac structure damage and decreased left ventricular diastolic function. Reference | Related Articles | Metrics

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Observation of clinical efficacy of hemofiltration adsorption Chinese Journal of Blood Purification    2021, 20 (09): 637-639.   DOI: 10.3969/j.issn.1671-4091.2021.09.016 Abstract （486）      PDF（pc） （431KB）（247）       Knowledge map    【Abstract】Objective To observe the efficacy of hemodiafiltration with endogenous reinfusion (HFR) in maintenance hemodialysis (MHD) patients. Methods A total of 20 MHD patients were collected from Blood Purification Center, Zhongda Hospital Affiliated to Southeast University. After hemodialysis (HD) treatment for 4 weeks as the washout period, they were treated with the HD-HFR-HD mode as the three times of dialysis in a week for 4 weeks. Blood pressure, β2-microglobulin, C-reactive protein and inflammatory cytokines were examined before and after the HFR treatment. Dialysis adequacy and fatigue were observed in the HD and HFR treatment periods. Results Blood pressure was stable before and after HFR treatment. β2-microglobulin (t=1.557, P=0.040) decreased significantly. C-reactive protein (t=0.152, P=0.945), interleukin-2 (t=0.074, P=0.866), interleukin-6 (t=0.392, P=0.619), tumor necrosis factor-α (t=2.042, P=0.068) were also reduced but without statistical significance. After HFR, dialysis adequacy had no significant change (t=0.815, P=0.431), but fatigue score decreased significantly (t=3.834, P=0.001) as compared with those after HD. Conclusion Compared with HD, HFR significantly alleviates the microinflammatory status of the patients but without difference in dialysis adequacy. Related Articles | Metrics

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Expert consensus on construction of the renal rehabilitation system in hemodialysis centers Chinese Journal of Blood Purification    2021, 20 (12): 823-829.   DOI: 10.3969/j.issn.1671-4091.2021.12.008 Abstract （480）      PDF（pc） （470KB）（294）       Knowledge map    【Abstract】Maintenance hemodialysis (MHD) patients are usually present with decreased physical abilities and abnormal psychological and cognitive functions of various degrees along with the extension of dialysis age, seriously affecting the quality of life and greatly raising the burdens on the families and society. The implementation of the renal rehabilitation system is a major strategy to minimize the dysfunctions and enables MHD patients to achieve the best occupational potentials, functional status and quality of life. However, the renal rehabilitation system set in hemodialysis centers is currently at the primary stage and has not been widely launched yet. This expert consensus elaborates on the definition of renal rehabilitation and the required personnel, place, equipment, service content and quality control, providing a theoretical basis and a clinical guidance for the creation of renal rehabilitation system in hemodialysis centers. Reference | Related Articles | Metrics

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Chinese Journal of Blood Purification    2021, 20 (11): 791-792.   DOI: 10.3969/j.issn.1671-4091.2021.11.017 Abstract （477）      PDF（pc） （534KB）（195）       Knowledge map    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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Pre- operativemaintenance hemodialysis reduced the 30-day mortality of severe renal dysfunction patients after cardiac surgery Chinese Journal of Blood Purification    2021, 20 (07): 449-454.   DOI: 10.3969/j.issn.1671-4091.2021.07.005 Abstract （474）      PDF（pc） （458KB）（343）       Knowledge map    【Abstract】Objectives Patients with severe renal dysfunction undergoing cardiac surgery still are associated with many complications and higher mortality. The present study aimed to investigate the relationship between prEoperative maintenance hemodialysis (MHD) and 30-day mortality after cardiac surgery in patients with estimated glomerular filtration rate (eGFR) <30ml/min/1.73m2. Methods A total of 272 severe renal dysfunction patients undergoing cardiac surgery during the period between Jan. 2010 and Oct. 2020 were retrospectively studied. Multivariate COX proportional hazard was used to estimate hazard ratio (HR) and 95% confidence interval (CI) of the risk for 30-day mortality after the surgery. Results In the 272 severe renal dysfunction patients undergoing cardiac surgery, 73.2% were male, the average age was 61.4±9.5years, 85 patients (31.3%) had regular MHD before the surgery, and their 30-days mortality after the surgery was 16.9%. COX regression analyses showed that prEoperative MHD reduced the 30-day mortality (HR=0.399, 95% CI 0.160～0.996, P=0.049), and that rEoperation (HR=4.287, 95% CI 1.717～10.705, P=0.002), lower post-operative left ventricular ejection fraction (LVEF<40%) (HR=3.251, 95% CI 1.581～6.685, P=0.001), more intraoperative blood loss (HR=1.133, 95% CI 1.033～1.242, P=0.008), and longer post-operative ventilator time (HR=1.457, 95% CI 1.230～0.909, P=0.024) were the risk factors for higher 30-day mortality, but male patients (HR= 0.457, 95% CI 0.230～0.909, P=0.024) had a lower risk of mortality. Conclusions Patients with severe renal dysfunction undergoing cardiac surgery were associated with many complications and higher mortality. PrEoperative MHD before cardiac surgery reduced the 30-day mortality. 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）（471）       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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Comparison of clinical characteristics and all-cause mortality of different vascular access types in maintenance hemodialysis patients Chinese Journal of Blood Purification    2021, 20 (06): 367-372.   DOI: 10.3969/j.issn.1671-4091.2021.06.003 Abstract （467）      PDF（pc） （687KB）（571）       Knowledge map    【Abstract】Objective To compare the clinical characteristics and all-cause mortality of maintenance hemodialysis (MHD) patients with different vascular access types. Methods A retrospective collection of 310 MHD patients started receiving MHD in affiliated Zhongshan Hospital of Dalian University from May 31, 2010 to December 31, 2016. The follow-up deadline was July 31, 2020. The endpoint events were all-cause death, complications of vascular access, and cardiovascular and cerebrovascular events. The differences in clinical data, laboratory indexes, cardiac ultrasound parameters, and all-cause mortality rate of patients in the autogenous arteriovenous fistula (AVF) group and the tunnel- cuffed catheter (TCC) group were compared. Results A total of 310 MHD patients were enrolled, with 184 males (59.4%), and the mean age was 65.69±13.11 years old. The age of starting dialysis and the primary cause of end-stage renal disease were different between groups (t=- 3.134, P=0.002;χ2=11.792, P=0.007). Compare with the AVF group, patients in the TCC group with a higher rate of anemia (χ2=5.120，P=0.024) and a lower rate of pulmonary hypertension (χ2=4.696, P=0.030). The incidence of pathway complications and cardiovascular death was not statistically significant (P>0.05). After 50.00 (25.00, 73.25) months of follow-up, 219 patients died. The independent risk factors of all-cause death including male gender (HR=1.384, 95% CI:1.042～1.839, P=0.025), the age of starting dialysis (HR=1.036, 95% CI: 1.023～1.049, P=0.001), the history of cardiovascular disease (HR=1.698, 95% CI: 1.244～2.318, P=0.001), use catheter (HR= 2.264, 95% CI:1.703～3.009, P=0.001), diabetic nephropathy (HR=1.734, 95% CI:1.322～2.275, P=0.001). Conclusion Patients in the TCC group with a higher rate of anemia and a lower rate of pulmonary hypertension. Use catheter, the age of starting dialysis, history of cardiovascular disease, and diabetic nephropathy were independent risk factors of all-cause death in our MHD patients. 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