Chinese Journal of Blood Purification

12 May 2018, Volume 17 Issue 05 Previous Issue    Next Issue

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Factors that affect the survival at early stage in patients on peritoneal dialysis 2018, 17 (05):  289-292.  doi: 10.3969/j.issn.1671-4091.2018.05.001 Abstract ( 421 )   PDF (462KB) ( 698 )   【Abstract】Objective To investigate the survival status within one year and the factors that affect the prognosis in patients on peritoneal dialysis (PD). Methods In this retrospective cohort study, patients who started PD during Jan. 1, 2006 to Dec. 31, 2014 were included. Cox regression model was used to estimate the factors that affect early survival of the patients. Results We recruited 608 patients, in which 63 patients died within one year and 545 patients rmained alive. Cox regression analysis showed that age (HR 1.047, 95% Cl 1.024～1.071, P＜0.001), hypoalbuminemia (HR 0.900, 95% Cl 0.854～0.949, P＜0.001), urine volume (HR 0.999, 95% Cl 0.998～1.000, P=0.003), bedridden (HR 2.112, 95% Cl 1.148-3.885, P=0.016) and amputation history (HR 10.927, 95% CI 1.407～84.846, P=0.022) were associated with higher mortality rate, and regular clinic visit pre-dialysis (HR 0.422, 95% Cl 0.242～0.737, P=0.002) was associated with lower mortality rate. Conclusions Regular clinic visit pre-dialysis was associated with better outcome. Patients with advanced age, bedridden status, amputation history, hypoalbuminemia and oliguria were associated with poor outcomes Metrics

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The overexpression of Klotho gene on the expression of vascular endothelial growth factor in kidney of acute kidney injury mice 2018, 17 (05):  293-298.  doi: 10.3969/j.issn.1671-4091.2018.05.002 Abstract ( 353 )   PDF (1782KB) ( 598 )   【Abstract】Objective To investigate the overexpression of Klotho gene on the expression of renal vascular endothelial growth factor (VEGF) in order to explore the protective role of Klotho on acute kidney injury (AKI) in mice. Methods Mouse bone marrow mesenchymal stem cells (BMSCs) were infected with the recombinant lentivirus to efficiently and stably express Klotho (BMSCs-Klotho), and those infected with the parent lentivirus was used as the control (BMSCs-EV). AKI model was established by intramuscular injection of 50% glycerol to the interior side of both legs to induce rhabdomyolysis in mice. Thirty male C57BL/6 mice were randomly and equally divided into 5 groups: normal control group (Ctrl group), AKI with PBS intervention (AKI+PBS group), AKI with BMSCs-Klotho intervention (AKI+BMSCs-Klotho group), AKI with BMSCs- EV intervention (AKI+BMSCs-EV group), and AKI with BMSCs intervention (AKI+BMSCs group). Mice were treated with the intervention after AKI for 6 hours, and were sacrificed after the intervention for 3 days. Serum creatinine (Scr) and blood urea nitrogen (BUN) were measured by routine biochemical methods, and the expression of VEGF in kidney was assayed by immunohistochemistry and immunoblot. Results Scr and BUN levels increased in AKI+PBS group, AKI+BMSCs-Klotho group, AKI+BMSCs-EV group and AKI+ BMSCs group as compared to those in Ctrl group (for Scr, F=370.705, P＜0.001, P＜0.001, P＜0.001 and P＜0.001, respectively; for BUN, F=307.656, P＜0.001, P＜0.001, P＜0.001 and P＜0.001, respectively). Scr and BUN levels were lower in AKI+BMSCs-Klotho group than in AKI+PBS group, AKI+BMSCs-EV group and AKI+BMSCs group (for Scr, P＜0.001, P＜0.001 and P＜0.001, respectively; for BUN, P＜0.001, P＜0.001 and P＜0.001, respectively). The expression of VEGF in kidney as assayed by immunoblot and immunohistochemistry was significantly lower in AKI+PBS group than in Ctrl groups (P＜0.001). The expression of VEGF in kidney was significantly higher in AKI+BMSCs-Klotho group than in AKI+PBS group, AKI+BMSCs-EV group and AKI+BMSCs group (for immunoblot, P＜0.001, P＜0.001 and P＜0.001, respectively; for immunohistochemistry, P＜0.001, P＜0.001 and P＜0.001, respectively), but had no statistical significance between AKI+BMSCs-Klotho group and Ctrl group (for immunoblot, P=0.884; for immunohistochemistry, P= 0.809). Conclusion Klotho has a protective effect on AKI through up-regulation of VEGF in kidney in mice. Metrics

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Expression changes of Nrf2 and NQO1 in peripheral mononuclear cells and TNF-α and IL-6 in serum in uremic hemodialysis patients 2018, 17 (05):  299-303.  doi: 10.3969/j.issn.1671-4091.2018.05.003 Abstract ( 408 )   PDF (470KB) ( 536 )   【Abstract】Objective To analyze the expression changes of nuclear factor E2 related factor 2 (Nrf2) and quinone oxidoreductase (NQO1) in peripheral mononuclear cells and tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) in serum in uremic hemodialysis patients. Methods A total of 46 uremic patients treated with hemodialysis for more than 6 months in our hospital from June 2015 to August 2017 were recruited as the dialysis group, and 37 newly diagnosed uremic patients were enrolled as the non-dialysis group. In addition, 25 healthy subjects were recruited as the healthy group. Hemoglobin (Hb), serum TNF-α, IL-6, albumin (Alb), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), and the mRNA and protein levels of Nrf2 and NQO1 in mononuclear cells were assayed. These laboratory results in dialysis group were compared with those in non-dialysis group and healthy group. Results Serum TNF-α, IL-6, TC, and LDL-C were significantly higher in dialysis group and non-dialysis group than in healthy group (For TNF-α, t=6.937, P＜0.001 in dialysis group; t=8.462, P＜0.001 in non- dialysis group. For IL- 6, t=8.068, P＜0.001 in dialysis group; t=8.937, P＜0.001 in non- dialysis group. For TC, t=2.301, P=0.024 in dialysis group; t=4.338, P＜0.001 in non-dialysis group. For LDL-C, t=4.489, P＜0.001 in dialysis group; t=7.032, P＜0.001 in non-dialysis group). Serum Alb and Hb were significantly lower in dialysis group and non- dialysis group than in healthy group (For Alb, t=6.040, P＜0.001 in dialysis group; t=4.266, P＜0.001 in non- dialysis group. For Hb, t=3.859, P＜0.001 in dialysis group; t=2.478, P=0.016 in non-dialysis group). Serum TNF-α, IL-6, TC, LDL-C, Alb and Hb were significantly lower in dialysis group than in non- dialysis group (For TNF-α, t=2.205, P=0.030. For IL-6, t=2.327, P=0.022. For TC, t=2.123, P=0.037. For LDL-C, t=2.106, P=0.038. For Alb, t=2.357, P=0.021. For Hb, t=2.179, P=0.032). The relative mRNA levels of Nrf2 and NQO1 in peripheral mononuclear cells were significantly lower in dialysis group and non-dialysis group than in healthy group (For Nrf2, t=9.525, P＜0.001 in dialysis group; t=7.858, P＜0.001 in non-dialysis group. For NQO1, t=7.517, P＜0.001 in dialysis group; t=9.046, P＜0.001 in non-dialysis group), and were significantly lower in dialysis group than in non-dialysis group (For Nrf2, t=2.612, P=0.011. For NQO1, t=2.523, P=0.014). The relative protein levels of Nrf2 and NQO1 in peripheral mononuclear cells were significantly lower in dialysis group and non-dialysis group than in healthy group (For Nrf2, t=7.345, P＜0.001 in dialysis group; t=6.107, P＜0.001 in non- dialysis group. For NQO1, t=6.247, P＜0.001 in dialysis group; t=7.689, P＜0.001 in non- dialysis group), and were significantly lower in dialysis group than in non-dialysis group (For Nrf2, t=2.351, P=0.021. For NQO1, t=2.207, P=0.030). In dialysis group, serum TNF-α and IL-6 were negatively correlated with Alb and Hb (For TNF-α/Alb, r=-0.672, P＜0.001. For IL-6/Alb, r=-0.654, P＜0.001. For TNF-α/Hb, r=-0.521, P=0.001. For IL-6/Hb, r=-0.537, P＜0.001), positively correlated with TC and LDL-C (For TNF-α/TC, r=0.574, P＜0.001. For IL- 6/TC, r=0.412, P=0.005. For TNF- α/LDL- C, r= 0.618, P＜0.001. For IL- 6/LDL- C, r=0.622, P＜0.001), and negatively correlated with the expression of Nrf2 and NQO1 (For TNF- α/ Nrf2, r=-0.726, P＜0.001. For IL-6/ Nrf2, r=-0.732, P＜0.001. For TNF-α/ NQO1, r=-0.714, P＜0.001. For IL-6/ NQO1, r=- 0.721, P＜0.001). In dialysis group, the expression level of Nrf2 was positively correlated with that of NQO1 (r= 0.691, P＜0.001). Conclusion In uremic patients, the endogenous antioxidant capacity was reduced and the body was in an inflammation status. These abnormalities were resulted from malnutrition, lipid metabolism disturbances and anemia. Metrics

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Relationship between high ankle-brachial index and cardiovascular events in patients on peritoneal dialysis 2018, 17 (05):  304-307.  doi: 10.3969/j.issn.1671-4091.2018.05.004 Abstract ( 464 )   PDF (530KB) ( 578 )   【Abstract】Objective To investigate the relationship between high ankle-brachial index (ABI) and major adverse cardiovascular events (MACE) in patients on peritoneal dialysis (PD). Methods A total of 98 chronic kidney disease patients treated with PD over 3 months were recruited. Baseline characteristics, ABI, Framingham cardiovascular risk factors and other laboratory measurements were collected and analyzed. Results Patients were divided into two subgroups according to ABI value. Among these participants, 33 participants (one-side or two-sides ABI＞1.3) were assigned in high ABI group and the other 65 participants (0.9＜two-sides ABI＜1.3) were assigned in normal ABI group. Twenty-eight patients suffered MACE. PD patients with high ABI had higher incidence of MACE than those with normal ABI (15/33 vs. 13/65, P=0.008). Compared with normal ABI group, patients in high ABI group had significantly higher dialysis age, blood pressure, serum calcium, ischemia modified albumin (IMA) and high sensitivity C-reactive protein (hs-CRP), and lower serum albumin, residual GFR (rGFR) and 24h urine volume. According to Framingham cardiovascular risk factors, all of the PD patients could be divided into three groups: cardiovascular disease (CVD) 0~1 group (36 participants with 0~1 Framingham cardiovascular risk factor), CVD 2~3 group (40 participants with 2~3 Framingham cardiovascular risk factors), CVD 4 group (22 participants with more than 4 Framingham cardiovascular risk factors). The prevalence of high ABI was statistically different among the three groups (19.444%, 27.500% and 68.181%; chi square=15.676, P=0.000). Logistic regression analysis showed that dialysis age, serum calcium, IMA level and hs-CRP level were the independent risk factors for high ABI. Conclusions High ABI was closely related to cardiovascular events in PD patients. Dialysis age, serum calcium, oxidative stress and inflammation were the most important factors for high ABI. Metrics

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Recent advances in the factors relating to hepcidin and renal anemia 2018, 17 (05):  308-312.  doi: 10.3969/j.issn.1671-4091.2018.05.005 Abstract ( 399 )   PDF (467KB) ( 592 )   【Abstract】The global incidence of chronic kidney disease (CKD) is as high as 8~16%. Anemia is one of the main complications in CKD patients. Factors causing renal anemia include erythropoietin deficiency, iron deficiency, blood loss, inflammation, vitamin D deficiency, hepcidin, secondary hyperparathyroidism and obesity, in which erythropoietin and iron deficiencies are the main causes for renal anemia. Therefore erythropoiesis stimulator and iron supplementation are two important therapies for renal anemia. Recent studies have found that hepcidin is closely related to renal anemia and is possibly related to iron state, inflammatory state and glomerular filtration rate. Hepcidin plays an important role in the regulation of functional iron deficiency. This article reviews the factors relating to hepcidin and renal anemia, and provides a basis for clinical treatment and study of renal anemia. Metrics

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Research progress of polymorphism in vitamin D receptor (VDR) gene and parathyroid hormone 2018, 17 (05):  313-316.  doi: 10.3969/j.issn.1671-4091.2018.05.006 Abstract ( 510 )   PDF (370KB) ( 571 )   【Abstract】Low transport bone disease, one of the most common types of bone disease in dialysis patients with end-stage renal disease, is characterized by low level of parathyroid hormone (PTH). The possible causes of low transport osteopathy include relative deficiency of PTH, iatrogenic factors, older age, diabetes mellitus, acidosis, etc. Studies have shown that PTH level is associated with the polymorphisms in vitamin D receptor (VDR) gene. VDR has four polymorphic loci, and BsmI polymorphism is related to PTH level in hemodialysis patients. "B" allele may be one of the causes of low PTH level in hemodialysis patients. Metrics

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Research progress in the effects of autophagy on vascular calcification in chronic kidney disease patients 2018, 17 (05):  321-324.  doi: 10.3969/j.issn.1671-4091.2018.05.008 Abstract ( 470 )   PDF (308KB) ( 525 )   【Abstract】Autophagy is a process through which injured and senescent organelles and macromolecular substances in cells are degraded. Autophagy plays a vital role in cell survival, development and homeostasis of interior environment. Vascular calcification is a common complication of chronic kidney disease, and many studies have demonstrated that autophagy is closely related to the pathogenesis of vascular diseases. In this article we comprehensively review the literature about the effects of autophagy on vascular smooth muscle cells and vascular calcification, intending to understand the mechanism of vascular calcification with respect to autophagy and to provide a novel insight into the treatment of chronic kidney disease. Metrics

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Tunneled dialysis catheter placement through fibrin sheath crevasse for the treatment of catheter dysfunction 2018, 17 (05):  325-328.  doi: 10.3969/j.issn.1671-4091.2018.05.009 Abstract ( 486 )   PDF (1103KB) ( 524 )   【Abstract】Objective To search for a new technique for the management of fibrin sheath in order to improve the treatment of catheter dysfunction in hemodialysis patients. Methods A retrospective analysis was conducted for the 40 hemodialysis patients who failed to establish arteriovenous fistula and underwent indwelling tunneled dialysis catheterization. They had catheter related fibrin sheath and fibrin sheath crevasse confirmed by DSA images that showed outflow of contrast through the fibrous sheath crevasse with normal images of brachiocephalic vein and/or superior vena cava. Catheters were inserted into right atrium via central vein through the fibrin sheath crevasse to avoid wrapping of the catheter by the fibrin sheath in 18 patients, and by means of in situ catheter change in 22 patients. Results After the catheter intervention, the catheters were used for blood access on the next day in both groups and the blood flow reached 250ml/min. After 3 months, the blood access volumes of the two groups were (241±2.92) ml/min and (240±4.18)ml/min, respectively, and the Kt/V values were (1.3±0.05 vs. 1.28±0.04), respectively, without statistical differences between the two groups (P=0.420). After 6 months, blood access volumes in in situ catheter change group and in catheter replacement through fibrous sheath crevasse group were (202±3.74) ml/min and (240±4.47) ml/min, respectively (P=0.020), and Kt/V values were (1.04±0.04) and 1.28±0.03, respectively (P=0.010). No severe complications due to the catheter replacement occurred in all patients. Conclusion Dialysis catheter implantation through fibrous sheath crevasse can safely and effectively correct the dysfunction of dialysis catheter. Metrics

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Studies on the chronic risk factors for the dysfunction of mature autogenous arteriovenous fistulas 2018, 17 (05):  329-334.  doi: 10.3969/j.issn.1671-4091.2018.05.010 Abstract ( 438 )   PDF (426KB) ( 721 )   【Abstract】Objective To explore the chronic risk factors for the dysfunction of mature autogenous arteriovenous fistulas (AVFs) in maintenance hemodialysis (MHD) patients through the analyses of their general condition, dialysis index, inflammation and nutritional status. Methods This was a retrospective case-control analysis. A total of 248 MHD patients were recruited from the 404 MHD patients treated in two hemodialysis centers, and divided into dysfunction group (n=53) and patent group (n=195). Clinical data were collected and compared between the two groups in order to find out the risk factors for dysfunction of mature AVFs. Multivariate logistic regression was also used to investigate the independent risk factors for dysfunction of mature AVFs. Results ①There were no significant differences in gender (c2=0.007, P=0.932), AVF age (c2=5.803, P=0.055), initial blood flow in AVF (t=- 1.662, P=0.098), dialysis age (t=0.284, P=0.509), white blood cell count (t '=0.977, P=0.331), serum albumin (t=0.656, P=0.512) and prothrombin time (t=-1.639, P=0.102) between the two groups. ②There were significant differences in primary disease (c2=8.809, P=0.032), high flux dialysis duration (t=- 5.453, P＜0.001), total dialysis duration (t' =- 3.158, P=0.002), C- reactive protein (t=2.325, P=0.021), serum calcium (t=-3.404, P=0.001), serum phosphorus (t'=4.135, P=0.000), calcium-phosphorus product (t'=2.585, P=0.012), serum parathyroid hormone (t'=3.528, P=0.001), serum cholesterol (t=5.951, P＜0.001) and serum triglycerides (t=2.054, P=0.041) between the two groups. ③The risk for dysfunction of mature AVFs was higher in MHD patients with diabetic nephropathy (OR=8.652, 95% CI: 2.111～35.460, P=0.003), hypertension nephropathy (OR=7.300, 95% CI: 1.537～34.672, P=0.012), higher serumphosphorus (OR=6.323, 95% CI: 1.881～21.253, P=0.003), higher parathyroid hormone (OR=1.002, 95% CI:1.001～1.004, P=0.007) and higher serum cholesterol (OR=5.570, 95% CI: 2.598～11.943, P＜0.001), and was lower in those with moderate hypocalcemia (OR=0.066, 95% CI: 0.007～0.611, P=0.017) and longer high flux dialysis period (OR=0.765, 95% CI: 0.666～0.878, P＜0.001). Conclusion ①The related risk factors for the dysfunction of mature AVFs included primary disease, high flux dialysis duration, total dialysis duration, C-reactive protein, serum calcium, serum phosphorus, calcium-phosphorus product, serum parathyroid hormone, serum cholesterol and serum triglycerides. ②The independent risk factors for the dysfunction of mature AVFs included diabetic nephropathy, hypertension nephropathy and calcium, phosphorus and lipid metabolism disturbances. ③ Clinically, increase of high flux dialysis period is useful for the prevention of mature AVF from dysfunctioning. Metrics

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Prevention and treatment of central venous catheterization associated complications for hemodialysis patients: the experience from a single center 2018, 17 (05):  335-338.  doi: 10.3969/j.issn.1671-4091.2018.05.011 Abstract ( 435 )   PDF (379KB) ( 627 )   【Abstract】Objective The present study aimed to summarize the clinical experience about management of central venous catheterization (CVC) associated complications in order to reduce the severe complications. Methods Information about all CVC patients treated in the Hemodialysis Department of Guangdong Provincial Hospital of Chinese Medicine during 2015-2016 in the dataset was analyzed. The information included demographic characteristics, clinical features, unfavorable factors, complications and the outcome of CVC. The unfavorable factors and complications were investigated. Results Totally there were 277 cases having CVC operation. Of them, the operation was unsuccessful at one time in 72 patients (25.99%). The unfavorable factors during the operation included obstruction of guide wire insertion, venous collapse, nervousness of the patient and hematoma. Complications during the operation occurred in 40 cases (14.44%), including puncture of artery, hematoma formation, bleeding at puncture site and misplacement of catheter. All CVCs were successfully operated after appropriate adjustment. In the 3 cases of catheter misplacement, we took the advantages of other examinations and interdisciplinary cooperation to adjust the position of catheters or to establish a new catheterization. Conclusion Obstruction of guide wire insertion, venous collapse, nervousness of the patient and hematoma are unfavorable factors during CVC operation. These should be recognized promptly to prevent associated complications. In case of CVC with complications, X-ray and ultrasonic examinations as well as multidisciplinary consultations are of great helpful to avoid severe adverse events. Metrics

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Relationship between position of the tip and flow rate of the tunneled cuffed catheter in femoral vein 2018, 17 (05):  339-342.  doi: 10.3969/j.issn.1671-4091.2018.05.012 Abstract ( 332 )   PDF (601KB) ( 568 )   【Abstract】Objective To study the relationship between tip position and flow rate of the tunneled cuffed catheter (TCC) in femoral vein. Methodology We selected 215 cases of maintenance hemodialysis patients with TCC in femoral vein. According to X-ray examination, distal tip of the catheter was categorized into group A, group B and group C. Blood flow (ml/min) was recorded within one hour of the first hemodialysis. Blood flow was compared between the groups. Results of Kruskal-Wallis test showed that χ2=11.5, Df=2 and P=0.003. Average blood flow was different between the 3 groups, with 235.3± 25.5ml/min in group A, 249.5 ± 18.1ml/min in group B and 234.7 ± 26.8ml/min in group C. Comparison between the groups using Mann-Whitney U test showed that the difference was statistically significant in group B (P＜0.05). Conclusion Blood flow of the tunneled cuffed catheter in femoral vein was related to the position of the catheter tip. At L3 level, the blood flow was the highest. The most suitable tip position was at L3 level in inferior vena cava. The different flow rate within a group may relate to the anatomical variation of inferior vena cava. Metrics

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The efficacy and safety of Sanacide as disinfectant for overnight dwelling disinfection of dialysis machines 2018, 17 (05):  343-345.  doi: 10.3969/j.issn.1671-4091.2018.05.013 Abstract ( 563 )   PDF (435KB) ( 669 )   【Abstract】Objective To evaluate the efficacy and safety of the disinfectant Sanacide for overnight dwelling disinfection of dialysis machines. Methods Five Nikkiso DBB-27 dialysis machines were used for the test. The disinfectant was diluted by 100 times and then used for overnight dwelling disinfection of the machines after daily running. Concentration of the disinfectant was assayed in the disinfection period. Results of Sudan black B, Ponceau 3R and periodic acid-schiff (PAS) staining for water in circuit were compared before and after the disinfection. After disinfection, residual concentration of the disinfectant was measured to evaluate its safety. Contents of endotoxin and bacteria were measured in water at the inlet of the machine during wash the circuit every month and in dialysate before and after the endotoxin filter to evaluate the effectiveness of the disinfectant. Results After 15 min, the effective concentrations of peracetic acid and hydrogen peroxide stabilized at the highest concentration of 190 ppm and 600 ppm, respectively. The residual concentration after disinfection was <0.02 ppm. The endotoxin level and bacterial colonies in water at the inlet of dialysis machine were <0.01 EU/mL and <10 CFU/ml, respectively. The endotoxin level in water before dialysate filter was below the minimum detection accuracy of the instrument, and bacterial colonies were <0.1 CFU/ml. The endotoxin level in water after dialysate filter was below the minimum detection accuracy of the instrument, and the bacterial colonies were 0 CFU/ml. Conclusion It is safe and effective to use Sanacide for overnight dwelling disinfection of dialysis machines. Metrics

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Efficacy of the lock solution containing gentamicin and heparin for the treatment of long-term dialysis catheter related bloodstream infections 2018, 17 (05):  346-351.  doi: 10.3969/j.issn.1671-4091.2018.05.014 Abstract ( 636 )   PDF (537KB) ( 603 )   【Abstract】Objective To observe the efficacy of the lock solution containing gentamicin and heparin for the treatment of catheter-related bloodstream infections (CRBSI). Methods We retrospectively analyzed 95 patients diagnosed with CRBSI in West China Hospital, Sichuan University from January 2011 to September 2016. Two groups were divided according to the component of the lock solution: treatment group (gentamicin 4mg/ml plus heparin 1,000 IU/ml in the lock solution) and control group (piperacillin- tazobactam 125mg/ml plus heparin 1,000 IU/ml in the lock solution). The intravenous antibiotics were the same in the two groups. After 72 hours, fever was used as an indicator for the effectiveness of the treatment protocols. According to the results of drug sensitivity test, the treatment protocols were adjusted in failure cases. Patients remaining to have fever after one week were treated with wire-guided exchange of the catheters. Results A total of 97 eligible patients were enrolled in this study. They had an average age of 59.10±17.54 years and a catheter indwelling time of 24 months (8 months, 39.5 months). Twenty-seven of them (27.83%) had diabetes. The disease duration was longer in control group than in treatment group [19 days (10 days, 30.25 days) vs. 10 days (5 days, 30 days), P=0.037]. The positive rate of blood culture was 46.39%, including 19 strains of Gram-positive bacteria (44.19%), 24 strains of Gram-negative bacteria (55.81%) and 2 strains of fungi. The most common Gram-positive bacteria was Staphylococcus aureus (11 strains, 57.89%), and the most common Gram-negative bacteria was Enterobacter cloacae (6 strains, 25.00%). Three gentamicin resistant strains were isolated in treatment group, and 2 piperacillin-tazobactam resistant strains were isolated in control group. The success rate of catheter salvage was higher in treatment group than in control group (77.33% vs. 54.54%, χ2=4.397, P=0.036). Twenty-six cases (26.80%) were treated with wire-guided exchange of the catheters. All cases were followed up for 3 months, and only 3 cases re-hospitalized due to CRBSI. Conclusions Gentamicin (4mg/ml) + heparin (1,000 IU/ml) in lock solution combined with systemic antibiotics for the treatment of CRBSI was effective.Wire-guided exchange of the catheter was a safe measure for ineffective cases. Metrics

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The effect of blunt needle buttonhole cannulation on the complications of autologous arteriovenous fistula 2018, 17 (05):  352-355.  doi: 10.3969/j.issn.1671-4091.2018.05.015 Abstract ( 416 )   PDF (381KB) ( 744 )   【Abstract】Objective To discuss the effect of different cannulation methods on the complications of autologous arteriovenous fistula and dialysis adequacy. Methods A total of 91 maintenance hemodialysis (MHD) patients with autologous arteriovenous fistula were enrolled in this study. They were divided into group A (n=52, puncturable fistula vessel length ≥5 cm), and group B (n=39, puncturable fistula vessel length ＜5 cm). Patients in group A were subdivided into group A1 (n=26, blunt needle buttonhole cannulation) and group A2 (n=26, rope-ladder cannulation); patients in group B were subdivided into group B1 (n=20, blunt needle buttonhole cannulation) and group B2 (n=19, regional area cannulation). After 12 months, dialysis adequacy, internal fistula vascular stenosis, aneurysm, blood flow, bleeding, hematoma, infection, vascular occlusion were compared between groups A1, A2, B1 and B2. Results There was no statistical difference in dialysis adequacy between group A and group B (P＞0.05). The incidence of vascular stenosis (P=0.009) and blood flow insufficiency (P=0.039) were higher in group A2 than in group A1; the incidence of bleeding extravasation (P=0.007) and aneurysm (P=0.047) were higher in group B2 than in group B1. Conclusion Blunt needle buttonhole cannulation can reduce the incidence of complications including vascular stenosis, aneurysm, blood flow insufficiency and bleeding and ensure dialysis adequacy. So it is a safe and effective cannulation method for AVF with different length of puncturable fistula vessel. Metrics

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Application of rope ladder puncture under the guidance of color Doppler ultrasonography in hemodialysis patients with arteriovenous fistula 2018, 17 (05):  356-359.  doi: 10.3969/j.issn.1671-4091.2018.05.016 Abstract ( 530 )   PDF (752KB) ( 575 )   【Abstract】Objective To investigate the effect of color Doppler ultrasonography on the application of rope ladder puncture for arteriovenous fistula in hemodialysis patients. Methods We recruited 128 hemodialysis patients first using arteriovenous fistula for blood access in the period from January 2017 to June 2017. They were randomly divided into control group and observation group according to the sequence of initial use of arteriovenous fistula. In the control group, the traditional rope ladder method was used. In the observation group, color Doppler ultrasonography was used to draw the rope ladder puncture site. The success rate of once puncture, implementation rate of rope ladder puncture technique, patient satisfaction rate, compliance rate of online clearance monitoring (online Kt/V), moderate pain rate during puncture and fistula complication rate were followed-up for 6 months to analyze the differences between the two methods. Results The satisfaction rate of observation group was higher than that of control group (100% vs. 73%, χ2=10.012, P=0.001). The execution rate in observation group was much higher than that in control group (100% vs. 46%, χ2=16.123, P＜0.001). The online Kt/V compliance rate in observation group was significantly higher than that in control group (95% vs. 80%, χ2=7.479, P=0.008). The incidence of moderate puncture pain (3% vs. 30%, χ2=9.729, P=0.003) and arteriovenous fistula complications (1% vs. 20%, χ2=8.279, P=0.005) in observation group were also much lower than those in control group. There was no significant difference in the success rate of once puncture between the observation group and the control group (97% vs. 96%, χ2=0.187, P=0.657). Conclusion The rope ladder puncture under the guidance of color Doppler ultrasonography can help nurses better manipulate the puncture technique, reduce the vascular complications caused by puncture, ameliorate moderate pain rate of the patients, prolong the service life of the internal fistula, and improve dialysis effect and treatment satisfaction of the patients. Metrics