Chinese Journal of Blood Purification

12 February 2017, Volume 16 Issue 02 Previous Issue    Next Issue

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Targeting renal cell death for acute kidney injury therapy 2017, 16 (02):  73-76.  doi: 10.3969/j.issn.1671-4091.2017.02.001 Abstract ( 279 )   PDF (301KB) ( 335 )   Renal cell death is an important pathological basis for acute kidney injury (AKI). Various forms of renal cell death such as apoptosis and regulated necrosis (including necroptosis, pyroptosis and ferroptosis) are involved in the pathogenesis of AKI. Nowadays, targeting renal cell death for AKI therapy has become a hot issue in this area. This review highlights the mechanisms and roles of different forms of renal cell death in AKI and the recent advances in targeting renal cell death for AKI therapy, in order to provide a new theoretical foundation for the treatment of AKI. Metrics

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Assessment and management of volume capacity in acute kidney injury 2017, 16 (02):  77-79.  doi: 10.3969/j.issn.1671-4091.2017.02.002 Abstract ( 329 )   PDF (291KB) ( 459 )   Acute kidney injury (AKI) is a critical disease in the nephrology department, and has achieved worldwide attention due to its high mortality rate. Pre-renal injuries are the most common factors causing AKI. Negative volume balance in this situation easily results in renal tubular necrosis and accelerates the progress to end-stage renal disease. Maintenance of normal renal perfusion as soon as possible is extremely urgent. On the other hand, volume overload is an independent risk factor for mortality. Therefore, assessment and management of volume capacity in AKI patients must be carried out as early as possible. An effective volume capacity assessment and management strategy is the combination of the initial fluid for resuscitation and the follow-up conservative liquid management. To make renal function back to the baseline values and to reduce patients’mortality, renal replacement therapy (RRT) or conservative control of liquid must be individually planned. Metrics

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Rational use of automated peritoneal dialysis in acute kidney injury patients 2017, 16 (02):  80-82.  doi: 10.3969/j.issn.1671-4091.2017.02.003 Abstract ( 289 )   PDF (474KB) ( 286 )   Peritoneal dialysis (PD) is one of the simple, safe and efficient renal replacement therapies (RRT). Automated peritoneal dialysis (APD) is a new modality of PD which can successfully improve the acute kidney injury (AKI)-induced metabolic, electrolytic and acid-base disturbances and is the first choice for some specific AKI patients. In this article, we discuss the rational use of APD in AKI patients. Metrics

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The timing of renal replacement therapy in acute kidney injury 2017, 16 (02):  83-85.  doi: 10.3969/j.issn.1671-4091.2017.02.004 Abstract ( 248 )   PDF (348KB) ( 404 )   Acute kidney injury (AKI) is a common critical disease, and renal replacement therapy (RRT) has become an important treatment for AKI patients. However, there is no consensus about the optimal timing for RRT. At present, several clinical features including serum creatinine, blood urea nitrogen, urine volume, the time admitted to intensive care unit (ICU) and AKI stage are the factors to determine when RRT should be used. Most clinical studies considered that AKI patients may benefit from early RRT, but others had the opposite conclusion. Large scale, multicenter, prospective, and randomized control trials are needed to find out the optimal time point between early and late RRT for AKI patients. Metrics

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The intensity of continuous renal replacement therapy on the prognosis of cardiac surgery related acute kidney injury patients 2017, 16 (02):  86-90.  doi: 10.3969/j.issn.1671-4091.2017.02.005 Abstract ( 250 )   PDF (488KB) ( 341 )   Objective Acute kidney injury (AKI) is a major complication after cardiac surgery and is an independent risk factor for mortality. However, the optimal intensity of renal replacement therapy for these patients is still controversial. Methods We recruited 151 AKI patients after cardiac surgery and treated with continuous renal replacement therapy (CRRT) during the period from Nov. 2013 to Feb. 2016 and assigned them into 2 groups based on the intensity of CRRT, the high intensity group [35(ml/kg•h), n=78) and the low intensity group [25(ml/kg • h)], n=73). The endpoints of observation were the all- cause mortality within 14, 28 and 90 days and the renal function at the 14th, 28th and 90th days after being grouped. Kaplan- Meier survival curve was used for the analyses. Results The two groups had similar baseline characteristics. There were no significant differences between the two groups in number of death within 14, 28 and 90 days. In high intensity group and low intensity group, the survival rates within 14 days were 63.4% (49/78) and 65.7% (48/73) (χ2=0.591, P=0.442) respectively, the rates within 28 days were 54.5% (43/78) and 55.6% (41/73) (χ2=1.232, P=0.267) respectively, and the rates within 90 days were 45.5% (35/78) and 47.5% (35/73) (χ2=4.560, P=0.094) respectively. The recovery of renal function in survival patients also had no differences between the 2 groups at the 14th, 28th and 90th days. Conclusions In patients with AKI after cardiac surgery, the CRRT intensity of 25 ml/kg/h and 35 ml/kg/h had no differences in mortality within 14, 28 and 90 days and in recovery of renal function in survival patients at the 14th, 28th and 90th days. Metrics

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The related factors of hypocalcemia after parathyroidectomy in maintenance dialysis patients 2017, 16 (02):  91-94.  doi: 10.3969/j.issn.1671-4091.2017.02.006 Abstract ( 353 )   PDF (434KB) ( 414 )   Objective To investigate the related factors of hypocalcemia after parathyroidectomy in maintenance dialysis patients. Methods Forty-five patients treated with parathyroidectomy in the period from April, 2010 to November, 2014 were retrospectively studied. Clinical data of the patients before and after the operation were collected. Multivariate regression was conducted to confirm the factors influencing postoperative hypocalcemia. Results Hypocalcemia presented in all cases (100%) after the operation, and 43 cases of them had to treat with intravenous calcium．Using the length of intravenous calcium as the degree of hypocalcemia, univariate reggression showed that age (β=-0.104, P=0.049), preoperative serum calcium (β=-9.923, P=0.018), preoperative alkaline phosphate (ALP) (β=0.003, P=0.010), and the ratio of (postoperative ALP-preoperative ALP)/preoperative ALP (β=2.015, P=0.028) were the factors affecting postoperative hypocalcemia. Conclusions Age, preoperative serum calcium, preoperative ALP and the ratio of (postoperative ALP-preoperative ALP)/preoperative ALP are the factors influencing the hypocalcemia after parathyroidectomy. Metrics

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The associated factors with bone alkaline phosphatase in maintenance hemodialysis patients 2017, 16 (02):  95-99.  doi: 10.3969/j.issn.1671-4091.2017.02.007 Abstract ( 288 )   PDF (517KB) ( 420 )   Objective To analyze serum bone alkaline phosphatase (BAP) level and its associated factors in maintenance hemodialysis (MHD) patients. Methods MHD patients treated in Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine in July 1, 2012, more than 18 years old, and more than 3 months of dialysis vintage were enrolled in this study. Clinical, biochemical, and medication data at baseline were collected. Serum BAP levels were determined by an enzyme-linked immunosorbent assay kit. Results This study recruited 226 MHD patients, of whom 144 were males, median age was 58.00 years (48.00～68.00 years), and median dialysis vintage was 41.00 months (21.00～72.25 months). There was no significant difference in serum BAP level between MHD patients and healthy controls [19.71 (14.85～26.72)U/L vs. 21.32 U/L (19.13～28.84 U/L), P>0.05]. In MHD patients, serum BAP level was significantly higher in females than in males [22.41U/L(16.37～32.01 U/L) vs. 18.65U/L(13.81～24.25U/L), Z=-3.199, P＝0.001]. Spearman correlation analyses showed that parathyroid hormone (r=0.569, P＜0.001), alkaline phosphatase (r=0.687, P＜0.001), uric acid (r=0.133, P=0.045), serum phosphorus (r=0.145, P=0.029) were positively correlated with serum BAP level, and body height (r=-0.173, P=0.010), blood bicarbonate level (r=- 0.158, P=0.017), post- dialysis mean arterial pressure (r=- 0.135, P=0.043) were negatively correlated with serum BAP level. Multivariate logistic regression showed that β-blocker treatment (OR 2.600, 95% CI 1.253～5.395, P=0.010), female (OR 2.693, 95% CI 1.336～5.312 , P= 0.004) and PTH (OR 1.005, 95% CI 1.003～1.007 , P＜0.001) were independently correlated with higher BAP in MHD patients (Forward stepwise, P=0.458, Nagelkerke R square 0.339). Conclusion BAP is a sensitive marker for bone metabolism in MHD patients. Females, patients with β- blocker treatment and higher PTH level may have a higher serum BAP level. Metrics

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Awareness of chronic kidney disease among doctors of non-nephrologists in different levels of hospitals 2017, 16 (02):  100-103.  doi: 10.3969/j.issn.1671-4091.2017.02.008 Abstract ( 244 )   PDF (404KB) ( 361 )   Objective To investigate the awareness of chronic kidney disease (CKD) including the knowledge of concept, clinical manifestation, diagnosis, therapeutic principle, reversible factors and medication in order to help us explore the management mode for CKD. Methods Questionnaire survey was carried out among 304 doctors of non-nephrologists in 12 community hospitals, 10 second-class hospitals and 8 third-class hospitals. The questionnaire survey about CKD included 4 parts: concept and classification, diagnosis, prevention and cure, and aggravation and reversible factors. The awareness of the doctors was classified as“awareness”(more than 80% of the answers were correct),“partial awareness”(40-80% of the answers were correct), and“no awareness”(<40% of the answers were correct). Data were analyzed using the SPSS software. Results Ninety-seven doctors in community hospitals completed the questionnaire survey; for concept and classification of CKD: 25% awareness, 47% partial awareness, and 28% no awareness; for diagnosis of CKD: 22% awareness, 43% partial awareness, and 35% no awareness; for prevention and cure of CKD: 20% awareness, 45% partial awareness, and 35% no awareness; for aggravation and reversible factors of CKD: 17% awareness, 43% partial awareness, and 40% no awareness. Ninety-eight doctors in the second-class hospitals completed the questionnaire survey; for concept and classification of CKD: 38% awareness, 51% partial awareness, and 11% no awareness; for diagnosis of CKD: 25% awareness, 43% partial awareness, and 32% no awareness; for prevention and cure of CKD: 22% awareness, 46% partial awareness, and 32% no awareness; for aggravation and reversible factors of CKD: 16% awareness, 47% partial awareness, and 37% no awareness. One hundred and nine doctors in the third-class hospitals completed the questionnaire survey; for concept and classification of CKD: 39% awareness, 50% partial awareness, and 11% no awareness; for diagnosis of CKD: 25% awareness, 46% partial awareness, and 29% no awareness; for prevention and cure of CKD: 25% awareness, 48% partial awareness, and 27% no awareness; for aggravation and reversible factors of CKD: 16% awareness, 51% partial awareness, and 33% no awareness. The awareness rate about the concept and classification of CKD was significantly higher in the doctors of non-nephrologists working in the second-class hospitals and the third-class hospitals than those working in community hospitals (χ2=9.669, P=0.008, χ2=10.818, P=0.004). Conclusion The awareness rate about CKD concept and classification was lower among doctors of non-nephrologists working in all levels of hospitals. Thos situation is unfavorable to the prevention, treatment, and interruption of disease progression for CKD patients. Therefore, more efforts should be conducted to increase the awareness of CKD in doctors. Metrics

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The relationship between predialysis bicarbonate concentration and clinical characteristics in maintenance hemodialysis patients 2017, 16 (02):  104-107.  doi: 10.3969/j.issn.1671-4091.2017.02.009 Abstract ( 301 )   PDF (384KB) ( 354 )   Objective To explore the relationship between predialysis bicarbonate concentration and clinical characteristics in maintenance hemodialysis (MHD) patients. Methods A total of 291 MHD patients treated in our dialysis center were enrolled in this study. Their dialysis data and routine blood tests were collected. Patients were assigned into 4 groups according to the average bicarbonate concentration before dialysis by a quartile method, and clinical characteristics were then compared among the 4 groups. Pearson's correlation analysis was used to explore the relationship between predialysis bicarbonate concentration and clinical indicators, using predialysis bicarbonate concentrations as the dependent variables. Analysis of variance (ANOVA) was used for the analyses of measurement data, and chi square test was used for the analyses of count data. P＜0.05 was considered to be statistically significant. Results There were differences among the 4 groups in duration of dialysis (F=3.527, P=0.015), ratio of twice weekly dialysis (χ2=3.527, P=0.015), body mass index (BMI) (F=5.000, P=0.002), serum albumin (F=7.336, P＜0.001), serum creatinine (F=4.932, P=0.002), serum calcium (F=2.969, P=0.032), and serum phosphorus (F=13.468, P＜0.001). Pearson's correlation analyses demonstrated that predialysis bicarbonate concentration was negatively correlated with duration of dialysis (r=-0.118, P=0.022), BMI (r=-0.153, P=0.004), serum albumin (r=-0.285, P＜0.001), serum creatinine (r=-0.213, P＜0.001), serum phosphorus (r=-0.378, P＜0.001), and iPTH (r=-0.129, P=0.014), and was positively correlated with serum calcium (r=0.113, P= 0.027) in these MHD patients. Conclusions In MHD patients with stable clearance of solution and similar ratio of required hemoglobin concentration, those with lower predialysis bicarbonate concentration had the characteristics of longer dialysis duration, higher ratio of twice weekly dialysis, larger BMI, higher concentration of serum albumin, creatinine and phosphorus, and lower serum calcium. Metrics

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The clinical significance of hyperparathyroidism detected by ultrasonography and analysis of its related factors in hemodialysis patients 2017, 16 (02):  108-112.  doi: 10.3969/j.issn.1671-4091.2017.02.010 Abstract ( 305 )   PDF (485KB) ( 413 )   Objective We used ultrasonography to investigate the prevalence of hyperparathyroidism, which was used to analyze the related factors of hyperparathyroidism by the correlation to clinical data and to explore the value of intact parathyroid hormone (iPTH) for the prediction of hyperparathyroidism in maintenance hemodialysis (MHD) patients. Method MHD patients treated in Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine in the period from July 1st, 2015 to Dec. 31st, 2015 were recruited. Their clinical data, gender, primary disease, dialysis vintage, biochemical data and medication at baseline were collected. Parathyroid hyperplasia was detected by Philips iE33 color Doppler sonography system (transducer frequency = 11 MHz). Results This study enrolled 96 MHD patients treated in the period of Jul. 2011 to Dec. 2011. The primary disease was chronic glomerulonephritis in 56 patients (58.3%); 60 (62.5%) patients were males; mean age was 56.2±13.3 years old; and mean dialysis vintage was 75.8±55.6 months. Ultrasonography found parathyroid hyperplasia in 54 (57.3%) patients, of whom 41 (42.7%) patients had left parathyroid hyperplasia, 44 (45.8%) patients had right parathyroid hyperplasia, and 29 (30.2%) patients had bilateral parathyroid hyperplasia. The prevalence of parathyroid hyperplasia was 34.6%, 54.5% and 68.8%(χ2=0.018, P=0.018) in patients with dialysis vintage ＜36 months, 36～72 months and ≥72 months respectively. Patients with parathyroid hyperplasia (n=54) had longer dialysis vintage (t=-3.507, P=0.001), higher serum phosphorus (t=-2.591, P=0.011), higher intact parathyroid hormone (iPTH) (Z=-4.328, P＜0.001) and more patients taking active vitamin D preparations (χ2=11.197, P= 0.001), as compared with those without parathyroid hyperplasia (n=42). Receiver operating characteristic (ROC) curve showed that iPTH level could predict parathyroid hyperplasia (AUC=0.758, P＜0.001, 95% CI 0.661-0.855). When iPTH level was set at 456.9pg/ml, the sensitivity and specificity for parathyroid hyperplasia were 57.4% and 88.1%, respectively. Conclusion Parathyroid hyperplasia is one of the common complications in uremic patients. Ultrasonography is one of the efficient methods to evaluate the parathyroid gland size. Longer dialysis vintage, higher iPTH level, hyperphosphatemia and active vitamin D treatment are associated with parathyroid hyperplasia. Routine parathyroid ultrasonography to evaluate parathyroid size should be carried out when the patient had iPTH ＞400pg/ml. Metrics

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Plasma adsorption treatment for severe lupus nephritis 2017, 16 (02):  113-116.  doi: 10.3969/j.issn.1671-4091.2017.02.011 Abstract ( 216 )   PDF (438KB) ( 361 )   Objective To observe plasma adsorption (PA) for the treatment of severe lupus nephritis. Methods A total of 80 severe lupus nephritis patients confirmed by renal biopsy in the Urology Department of Meizhou City People's Hospital from Jan. 2011 to Dec. 2015 were recruited. They were divided into PA group and immunosuppressive group. Patients in the immunosuppressive group were treated with glucocortocoid and immunosuppressives. Patients in the PA group were treated with PA and immunosuppressives. Biochemical indicators, immune indices, inflammatory factors, and systemic lupus erythematosus disease activity index (SLEDAI score) were observed and compared before and after the treatment for 3 weeks. Results After PA, patients serum creatinine (t=0.377, P=0.021), blood urea nitrogen (t=0.351, P=0.030), and 24 hours urinary protein (t=0.417, P=0.012) decreased significantly. Serum IgG (t=2.553, P＜0.001), erythrocyte sedimentation rate (t=0.507, P=0.001), C-reactive protein (t=2.765, P＜0.001), and SLEDAI score (t=0.444, P=0.003) decreased significantly, as compared those before PA. Serum interleukin 4 (IL-4) (t=3.445, P<0.001), interleukin 6 (IL-6) (t=0.406, P=0.013) and tumor necrosis factor-α (TNF-α) (t=0.401, P=0.011) also decreased significantly. The overall effective rate in PA group was significantly higher than that of immunosuppressive group (χ2=23.667, P＜0.001). Conclusion Immunosuppressives combined with PA can quickly reduce serum antibodies and systemic lupus erythematosus disease activity, and acclerate the recovery from systemic lupus erythematosus. We recommend the use of PA for severe lupus nephritis patients. Metrics

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Value of CT peritoneography in the diagnosis of continuous ambulatory peritoneal dialysis-related hydrothorax 2017, 16 (02):  117-120.  doi: 10.3969/j.issn.1671-4091.2017.02.012 Abstract ( 317 )   PDF (1635KB) ( 388 )   Objective To assess the diagnostic value of CT peritoneography for continuous ambulatory peritoneal dialysis-related hydrothorax. Methods We sequentially recruited patients who were treated with continuous ambulatory peritoneal dialysis (CAPD) and had the complication of hydrothorax during Dec. 2015 to May 2016 in our hospital. Using Philips Brilliance Plus 64 CT scanner, conventional CT scans on thorax and upper abdomen were first performed, and then 50 mL non-ionic contrast medium (Iopamidol) mixed with 2L dialysate were infused into peritoneal cavity via Tenchkoff catheter. CT scans on thorax and upper abdomen were repeated after the infusion for 30 minutes. Images were compared before and after the infusion. The differences in 24h urine volume and ultrafiltration volume before and after CT Peritoneography were compared using paired t test. Results Eighteen out of the 225 follow- up cases were successfully enrolled into this study. Abnormal findings were found in 3 cases, including pleuraperitonum communication (2 cases) and peritonum-mediastinum leakage (one case). There was no statistically differences in 24h urine volume and ultrafiltration volume before and after CT Peritoneography (t= 0.674, P=0.509 for 24h urine volume; t=1.212, P=0.242 for ultrafiltration volume). Conclusion CT peritoneography can provide us with accurate diagnosis of CAPD-related hydrothorax, and reveal anatomical abnormalities regarding location and size, valuable for the pathogenesis and treatment of hydrothorax in CAPD patients. Metrics

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Hemoglobin level and its related factors in patients undergoing peritoneal dialysis 2017, 16 (02):  121-125.  doi: 10.3969/j.issn.1671-4091.2017.02.013 Abstract ( 435 )   PDF (423KB) ( 396 )   Objective To investigate the hemoglobin level and its related factors in patients on peritoneal dialysis (PD). Methods All patients initiated PD in the period from Jan. 2000 to May 2013 in Renji Hospital, Shanghai Jiao Tong University School of Medicine and continued on PD for ≥3 months with complete data were enrolled in this study. Patients were followed up for at least 36 months or until death, transferred to hemodialysis or other centers, or lost of our follow-up. Percentage of patients with hemoglobin 100-120g/L was calculated at predialysis, PD for 1, 6, 12, 24 and 36 months. Multivariate regression analysis was used to determine the related factors for hemoglobin level. Results A total of 521 patients were enrolled in this study. Among them, 256 (49.1%) were males, the mean age was 54.3±14.8 years, and 110 (21.1%) patients had diabetes mellitus. Before PD, the percentage of patients with hemoglobin 100～120g/L was 14.8%, and the percentage increased to 36.3%, 40.7%, 43.8%, 42.1% and 42.6% on PD for 1, 6, 12, 24 and 36 months respectively (P＜0.001). The percentage of patients having targeted hemoglobin level (100～120g/L) was significantly higher after PD as compared with that of before PD (χ2=207.112, P＜0.001 after one month; χ2=230.008, P＜0.001 after 6 months; χ2=189.613, P＜0.001 after 12 months; χ2=162.607, P＜0.001 after 24 months; χ2=168.074, P＜0.001 after 36 months). Multivariate regression analysis showed that phosphorus (β =-0.104, P= 0.023), serum albumin (β=0.167, P＜0.001), fasting blood glucose (β= 0.110, P=0.016), transferrin saturation (β=0.482, P＜0.001) and residual renal function (β=0.127, P=0.006) were the independent factors relating to hemoglobin level on PD for one month, and that transferrin saturation (β=0.494, P＜0.001) and residual renal function (β =0.482, P＜0.001) were the independently factors relating to hemoglobin level on PD for 36 months. Conclusions PD can significantly cause the increase of hemoglobin level, but the percentage of patients having targeted hemoglobin level (100～120g/L) was unsatisfactory. Transferrin saturation and residual renal function were the independent factors affecting the hemoglobin level in PD patients. Metrics

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Research advances in central venous hemodialysis catheter related superior vena cava syndrome 2017, 16 (02):  126-129.  doi: 10.3969/j.issn.1671-4091.2017.02.014 Abstract ( 266 )   PDF (423KB) ( 373 )   Due to the unique anatomic characteristics of superior vena cava and adjacent veins, superior vena cava syndrome (SVCS) was mainly reported in malignancies in earlier cases and studies. With the development of central venous catheter (CVC) indwelling technique for hemodialysis and the concerning about the prognosis and longer vascular access in hemodialysis patients, CVC-induced SVCS has been emphasized in clinical practice. Therefore, it is clinically significant to clarify the prevalence, mechanism, early imaging diagnosis and management strategy of SVCS in hemodialysis patients using CVC for vascular access. Metrics

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Rescue strategies for the dysfunctioning of arteriovenous internal fistula 2017, 16 (02):  130-133.  doi: 10.3969/j.issn.1671-4091.2017.02.015 Abstract ( 400 )   PDF (390KB) ( 663 )   Durable and stable vascular access is the prerequisite for maintenance hemodialysis in uremic patients. Dysfunctioning of arteriovenous fistula affects the quality of life of hemodialysis patients. Physical or thrombolysis treatment can be used as a recanalization method for dysfunctioning fistula at early stage. Interventional or surgical measure has to be used for fistula occlusion for a longer period of time. Therefore, rescue management at the early stage of fistula occlusion increases the chance for recanalization of the fistula, and also alleviates the disease and financial burdens of the patients. This paper summarizes the rescue strategies for dysfunctioning of arteriovenous internal fistula. Metrics

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Observational study on clinical effects of trocar used in hemodialysis 2017, 16 (02):  134-137.  doi: 10.3969/j.issn.1671-4091.2017.02.016 Abstract ( 509 )   PDF (545KB) ( 515 )   Objective To compare the clinical effects on hemodialysis (HD) using trocar and conventional steel puncture needles. Methods A total of 26 patients with arterovenous fistula (AVF) for HD were enrolled in this study. They were randomly divided to 2 groups. Patients in group one used trocar needles and patients in group two used conventional steel needles in the first stage of 6 HD sessions. The puncture needles were exchanged between the two groups in stage 2, which also included 6 HD sessions. HD parameters including treatment blood volume (TBV), ultrafiltration volume (UFV), urine reduction ratio (URR), urea clearance index (Kt/V), effective blood volume (EBV), actual dialysate volume (ADV), ultrafiltration (UFR), pressure of arterial (PA), pressure of venous (PV), transmembrane pressure (TMP) were compared between sessions using the two kinds of needles. Results Kt/V [(1.57±0.37) vs. (1.49±0.34), F= 4.144, P=0.043], EBV [(260.2 ± 45.1)ml/min vs. (251.6 ± 28.6)ml/min, F=13.742, P＜0.001] and PA [(-149.3±55.0)mmHg vs. (-177.7±53.6)mmHg, F=15.048, P＜0.001] were much higher in the HD sessions using trocar needles than in those using conventional steel needles. PV value was less in trocar sessions than in conventional steel needle sessions [(105.8±39.4)mmHg vs. (123.6±38.0)mmHg, F=12.272, P＜0.001]. Conclusion Trocar needles can improve the blood volume access and increase the clearance ratio of urea, as compared with those using conventional steel needles. Metrics