Chinese Journal of Blood Purification

12 September 2018, Volume 17 Issue 09 Previous Issue    Next Issue

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The analysis of factors relating to volume overload in maintenance hemodialysis patients 2018, 17 (09):  577-582.  doi: 10.3969/j.issn.1671-4091.2018.09.001 Abstract ( 469 )   PDF (491KB) ( 627 )   【Abstract】Objective To investigate volume overload status before and after dialysis, and to analyze the factors relating to overhydration before dialysis in maintenance hemodialysis (MHD) patients. Methods The MHD patients treated in Hangzhou Traditional Chinese Medical Hospital from December 2017 to April 2018 were enrolled in this study. Clinical data and biochemical results were recruited. The hydration status index, i.e. overhydration (OH) value, was measured by using bioimpedance spectroscopy. Multivariate linear regression was used to analyze the independent factors associated with overhydration. Results Atotal of 196MHD patients were enrolled in this study. Before dialysis, 52 (27%) of the patients were of normal volume (-1.1L ≤ OH ≤ 1.1L); 144 (73%) of the patients were overhydrated (OH ＞1.1L), in which 89 (45%) patients were moderate volume overloaded (1.1L＜OH≤2.5L), 55 (28%) patients were severe volume overloaded (OH＞2.5L). After dialysis, 29 patients (15%) were still volume overloaded. Correlation study showed that gender (r=-0.322, P＜0.001), diabetes (r=0.432, P＜0.001), cardiovascular disease (r=0.346, P＜0.001), hypertension (r=0.166, P=0.020), Chalson comorbidity index (r=0.433, P＜0.001), systolic pressure (r= 0.266, P＜0.001), hemoglobin (r=-0.210, P=0.003), serum albumin (r=-0.211, P=0.003), fasting blood glucose (r=0.397, P＜0.001), urea clearance index (r=-0.287, P＜0.001), and high sensitive C reactive protein (r=0.202, P=0.005) were associated with OH value. Multivariate linear regression analyses showed that male (β=-0.580, P=0.001), diabetes (β=0.949, P＜0.001), cardiovascular disease (β=0.632, P=0.001), higher systolic pressure (β=0.014, P＜0.001), lower serumalbumin (β=-0.062, P=0.007), and lower fat tissue index (β=-0.073, P=0.003) were the independent factors relating to the increase of OH before dialysis. Conclusion Overhydration is frequently seen inMHD patients before dialysis. In this cohort of MHD patients, 73% patients were overhydrated and 28% patients were severely volume overloaded before dialysis. Therefore more attention should be paid to the volume overload status inMHD patients, especially in males and those with hypertension, diabetes, cardiovascular disease, lower serum albumin and lower fat tissue index. After dialysis, the volume overload status improved significantly in most patients and remained in 15% MHD patients. Metrics

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Effects of different blood purification modalities on prognosis of renal damage induced by arsine poisoning 2018, 17 (09):  583-587.  doi: 10.3969/j.issn.1671-4091.2018.09.002 Abstract ( 291 )   PDF (434KB) ( 648 )   【Abstract】Objective To investigate the effects of continuous venous-venous hemofiltration (CVVH) and hemodialysis (HD) combined with hemoperfusion (HP) on the prognosis of renal injury in patients with arsine poisoning. Methods A total of 40 patients with arsine poisoning treated in the hospital were divided into two groups: control group treated with HD+HP and observation group treated with CVVH+HP in addition to routine management. The duration of clinical symptoms, blood purification and hospitalization were record. The changes of hemolysis and renal function indices, and the arsine content in dialysate and urine at the time of admission and after the treatment were compared between the two groups. Results The average duration of blood purification (t=13.836, P=0.003), hemoglobinuria (t=7.381, P=0.041), fever and chills (t=9.029, P=0.034), jaundice (t=7.903, P=0.039), fatigue, back pain and other clinical symptoms (t=9.623, P=0.022) and hospitalization (t=18.349, P=0.001) were significantly shortened in observation group as compared with those in control group. Serum Hb content decreased after the treatment for one day, and began to rise after the treatment for 3 days. Serum total bilirubin (TBIL) decreased continuously after the treatment. Serum creatinine (Scr) and BUN increased at the first treatment day and then decreased continuously. Analysis of variance showed that the values of serum HB, TBIL, Scr and BUN at the admission were significantly different from those at the 4 time points after the treatment (F=18.591, P=0.006 for serum HB; F=71.855, P<0.001 for serum TBIL; F=154.622, P<0.001 for Scr; F=17.728, P=0.011 for BUN). At the 4 time points after the treatment, the values of serum TBIL, serum HB, Scr and BUN in both control group and observation group were significantly different as compared with those at the admission (for serum TBIL: t=7.664, 6.722, 6.330 and 12.684, P= 0.017, 0.021, 0.024 and 0.006 in control group; t=8.338, 12.564, 14.629 and 7.188, P=0.014, 0.006, 0.005 and 0.019 in observation group; for serum Hb: t=4.382, 4.168, 4.496 and -4.779, P=0.048, 0.044, 0.047 and 0.041 in control group; t=6.416, 4.512, 4.408 and 5.081, P=0.023, 0.046, 0.049 and 0.041 in observation group; for Scr: t=- 11.680, - 12.665, - 5.768 and - 9.846, P=0.007, 0.006, 0.033 and 0.010 in control group; t=- 8.526, -12.814, - 10.596 and 17.928, P=0.013, 0.006, 0.009 and 0.003 in observation group; for BUN: t=- 4.575, -4.509, 4.826 and 6.646, P=0.045, 0.046, 0.04 and 0.031 in control group; t=-4.552, 5.778, 6.269 and 6.744, P=0.046, 0.043, 0.040 and 0.032 in observation group). Furthermore, the values of serum TBIL, serum HB, Scr and BUN at the 4 time points were clinically better in observation group than in control group (for TBIL: t=10.757, 19.228, 3.869 and 6.509, P=0.009, 0.003, 0.023 and 0.018; for serum HB: t=4.375, 3.828, 6.032 and 5.966, P=0.043, 0.048, 0.037 and 0.038; for Scr: t=4.792, 7.105, 5.811 and 6.225, P=0.041, 0.033, 0.037 and 0.035; for BUN: t=4.492, 6.113, 5.708 and 7.116, P=0.048, 0.041, 0.043 and 0.039). After the treatment for 7 days, arsine content in dialysate and urine decreased to normal levels, and were lower in observation group than in control group (arsine in dialysate: F=12.234, P=0.005; arsine in urine: F=10.856, P=0.011). Conclusion The early use of CVVH+HP for blood purification in arsine poisoning patients can quickly remove arsine and its related compounds, shorten the disease course, relieve kidney damage, and improve prognosis of the patients. Metrics

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Changes of bone metabolic markers in uremic patients with secondary hyperparathyroidism before and after parathyroidectomy 2018, 17 (09):  588-592.  doi: 10.3969/j.issn.1671-4091.2018.09.003 Abstract ( 375 )   PDF (763KB) ( 593 )   【Abstract】Objective To analyze the short-term variation of bone metabolic markers after parathyroidectomy (PTX) and forearm transplantation; to comprehend the pathogenesis and to improve the diagnosis and treatment of metabolic bone disease in uremic patients with secondary hyperparathyroidism (SHPT). Methods A total of 50 patients treated with PTX for intractable SHPT in the First Affiliated Hospital of Nanjing Medical University from July 2015 to January 2016 were enrolled in this study. Their baseline clinical data, bone metabolism markers including serum intact parathyroid hormone (PTH), calcitonin (CT), alkaline phosphatase (ALP), osteocalcin (OC), type I collagen N-terminal peptide (NTX) and type I collagen C-terminal peptide (CTX) before and after PTX for 3 days were retrospectively analyzed. The correlation between bone metabolic markers and changes of bone metabolic markers after PTX were also analyzed. Results Preoperative bone metabolic markers including serum phosphorus (2.10±0.41 mmol/L), iPTH (1861.55±920.21 ng/L), ALP [283.55 (155.53, 721.78) U/L], OC [290.8 (220, 300) ng/ml], CT (89.66±50.83 pg/mL), NTX [6.0 (4.69, 6.00) μg/L], and CTX [1191.5 (860.4, 1200.0) μg/L] were all increased in the patients. Correlation study of the preoperative bone metabolic markers showed that iPTH and ALP (r=0.782, P＜0.001), iPTH and NTX (r=0.758, P＜0.001), ALP and OC (r=0.637, P＜0.001), NTX and CTX (r=0.749, P＜0.001), and OC and NTX (r=0.311,  P =0.03) were positively correlated. After PTX for 3 days, serum iPTH, CT and CTX decreased to 11.30(5.42, 23.40) ng/L, 63.17±44.20pg/mL, and 1.68 (1.28, 2.33) μg/L respectively (P＜0.05, compared to the values before PTX); OC increased to 300 (300, 300) ng/mL (P＜0.01, compared to the value before PTX). Conclusions In uremic patients with severe SHPT, both osteoblasts and osteoclasts were activated, resulting in the hyperactivity of bone formation and resorption. Bone turnover was then increased. In the short-term period after PTX, osteoblast activity increased further and osteoclast activity decreased. Metrics

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The correlation between blood pressure and results of body composition monitor in maintenance hemodialysis patients 2018, 17 (09):  593-597.  doi: 10.3969/j.issn.1671-4091.2018.09.004 Abstract ( 312 )   PDF (572KB) ( 702 )   【Abstract】Object To study the significance of body composition monitor (BCM) for the assessment of blood pressure changes in maintenance hemodialysis (MHD) patients. Methods A total of 126 MHD patients and treated in Renji Hospital Shanghai Jiaotong University School of Medicine and analyzed by BCM were recruited. The values of pre- dialytic overhydration (OH), expected ultrafiltration volume, actual ultrafiltration volume, intradialytic blood pressure change, and interdialytic blood pressure were recorded. Results ①The pre-dialytic OH value was lower in hypotension group than in non-hypotension group (1.48±1.26 vs. 2.13±1.22, P=0.017). The difference between pre-dialytic OH and expected ultrafiltration volume was lower in hypotension group than in non- hypotension group (-2.10±1.23 vs. -1.18±1.19, P=0.001). ②The interdialytic mean artery pressure (MAP) was positively correlated with the pre-dialytic OH value (r=0.301, P=0.003), and was also positively correlated with the difference between pre-dialytic OH value and actual ultrafiltration volume (r=0.227, P=0.028). ③When the difference between pre-dialytic OH value and actual ultrafiltration volume was used to predict the interdialysis hypertension in MHD patients, the area under the ROC curve was 0.681 (0.586～0.776, P=0.001). ④ When the difference between pre-dialytic OH value and expected ultrafiltration volume was used to predict the intradialytic hypotension in MHD patients, the area under the ROC curve was 0.721 (0.607～0.835, P=0.001). Conclusion The difference between pre-dialytic OH value from BCM and the actual ultrafiltration volume can be used to predict the risk of interdialysis hypertension; the difference between pre-dialytic OH value from BCM and the expected ultrafiltration volume can be used to predict the risk of intradialysis hypotension in MHD patients. Metrics

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The risk factors for the different types of heart failure in maintenance hemodialysis patients 2018, 17 (09):  598-603.  doi: 10.3969/j.issn.1671-4091.2018.09.005 Abstract ( 349 )   PDF (442KB) ( 542 )   【Abstract】Objective To analyze the risk factors and prevalence of different types of heart failure (HF) in maintenance hemodialysis (MHD) patients with HF. Methods Clinical, laboratory and echocardiographic data of 152 MHD patients with HF were retrospectively analyzed. The risk factors for HF were investigated by comparison of HF with preserve ejection fraction (HFpEF), HF with mid-range of ejection fraction (HFmrEF) and HF with reduced ejection fraction (HFrEF) groups. Multivariate logistic regression and multivariate linear regression analyses were used for the analyses. Results A total of 152 MHD cases with HF were enrolled in this study; 110 of the 152 patients (72.4%) had HFpEF, 16 (10.5%) had HFmrEF, and 26 (17.1%) had HFrEF. Compared to HFpEF group, patients in HFrEF group had higher prevalence of grade Ⅳ HF (χ2=6.369, P=0.041) and lower levels of systolic pressure (SBP, t=3.144, P=0.002), uric acid (UA, t=2.131, P=0.033) and plasma albumin (ALB, t=2.933, P=0.003). Compared to HFpEF and HFmrEF groups, patients in HFrEF group had higher level of hemoglobin (HB) (t=3.211, P=0.001, compared to HFpEF group; t=0.789, P=0.005, compared to HFmrEF group). Compared to HFmrEF and HFrEF groups, patients in HFpEF group had lower levels of left atrium (LA; t=3.055, P=0.002, compare to HFmrEF group; t=2.151, P=0.031, compared to HFrEF group), and left ventricular end diastolic diameter (LVDd; t=5.461, P＜0.001, compared to HFmrEF group; t=4.307, P=0.000, compared to HFrEF group). Multivariate logistic regression displayed that SBP (OR 0.338, 95% CI 0.086～0.263, P=0.000), HB (OR 0.188, 95% CI -0.024～-0.033, P=0.010), and LVDd (OR 0.563, 95% CI -1.421～-0.743, P＜0.000) were the risk factors for left ventricular ejection fraction (LVEF). The risk factors for LVEF were also verified by multivariate linear regression (t=7.906, P=0.004 for SBP; t=-4.191, P=0.025 for HB; t=- 5.582, P=0.011 for LVDd). Conclusions HFpEF was relatively prevalent in MDH patients with HF. Increased SBP, decreased HB and LVDd were the risk factors for HFpEF in MHD patients with HF. Metrics

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Effects of continuous blood purification and infection management on plasma inflammatory mediators and electrolytes in AIDS related systemic inflammatory response syndrome (SIRS) patients complicated with acute renal failure 2018, 17 (09):  604-607.  doi: 10.3969/j.issn.1671-4091.2018.09.006 Abstract ( 292 )   PDF (430KB) ( 619 )   【Abstract】Objective To analyze the effects of continuous blood purification (CBP) and infection management on plasma inflammatory mediators and electrolytes in AIDS patients complicated with systemic inflammatory response syndrome (SIRS) and acute renal failure. Methods A total of 30 AIDS patients complicated with SIRS and acute renal failure treated in our hospital from January 2012 to December 2015 were enrolled in this study. After admission they were closely monitored and treated with the routine management. They were treated with CBP through right jugular vein. The effects of infection management were determined according to the diagnostic criteria for hospital infection, and their therapeutic effects were estimated by comparison of plasma inflammatory mediators before and after the therapy. Results After CBP for 2 hours and 6 hours, plasma TNF-α, IL-6 and IL-10 decreased significantly (P<0.05, for TNF-α, IL-6 and IL-10 at 2 hours and 6 hours); plasma TNF-α, IL-6 and IL-10 decreased further along with the CBP duration. Plasma BUN, K, Na, Cl and glucose decreased after CBP for 2 hours and 6 hours (P＜0.05, for BUN, K, Na, Cl and glucose at 2 hours and 6 hours). Plasma BUN and K after CBP for 6 hours were lower than those after CBP for 2 hours (P＜0.05). In the 30 patients treated with CBP, 11 patients died and 19 patients survived with the survival rate of 63.3%. Conclusion For AIDS patients complicated with SIRS and acute renal failure, nosocomial infections could be reduced significantly through standardized management of nosocomial infections, and their abnormal levels of plasma inflammatory mediators, imbalance of electrolytes, derangement of homeostasis and renal failure could be improved by CBP. Metrics

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he role of lung ultrasonography to evaluate overhydration in maintenance hemodialysis patients 2018, 17 (09):  608-612.  doi: 10.3969/j.issn.1671-4091.2018.09.007 Abstract ( 324 )   PDF (729KB) ( 578 )   【Abstract】Objective The aim of present study was to evaluate the value of lung ultrasonography for the prediction of body fluid volume and heart function. Methods The patients treated in Shanghai Changzheng Hospital during July 2014 to July 2015 were enrolled in this study according to the inclusion criteria. Three different kinds of methods, including lung ultrasonography, bioimpedance spectroscopy and echocardiography, were used to evaluate the prediction value. The examinations were performed 30 minutes before dialysis and after dialysis for 30 minutes. Results Patients were classified into 3 groups according to comet- tail: mild, moderate and severe lung congestion. Compared with the patients in mild and moderate groups, patients in the severe group had worse heart function (c2=25.358, P＜0.001) and edema complication (c2=12.217, P=0.002). A significant reduction of the comet-tail was detected following hemodialysis (Z=-6.176, P＜0.001), and the variation was significantly correlated with ultrafiltration volume (r=0.200, P=0.039). According to the stepwise multiple regression analyses, the ejection fraction (β=-87.138, P=0.014) was an independent element for comet-tail. According to the ROC analysis, lung ultrasonography was highly accurate for the detection of overhydration [AUC: 0.841 (0.758, 0.925)]. Furthermore, the best cut-point of lung comet was 12.5 according to the bioelectrical spectroscopy. Conclusion This study proposes that lung ultrasonography is a potentially reliable method for the estimation of fluid overload and heart failure. Metrics

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A multicenter study on the clinical applicability of a novel tryptone glucose extract agar medium for the detection of bacteria in dialysis water 2018, 17 (09):  613-616.  doi: 10.3969/j.issn.1671-4091.2018.09.008 Abstract ( 310 )   PDF (1056KB) ( 575 )   【Abstract】Objective To identify the clinical applicability of a novel tryptone glucose extract agar (TGEA) medium for the detection of bacteria in dialysis water. Methods Water samples were collected from the four hemodialysis centers at the outlet of water treatment system, backwater point of water treatment system, hemodialysis machine (inlet hose connected to the dialysis machine), and diluted dialysate. Samples were cultured with TGEA medium using spreading method (20 ℃, 168 hours) and TGEA membrane filtration method (20 ℃, 168 hours), and with nutrient agar medium (37 ℃, 48 hours) as the control medium. TGEA medium (20 ℃, 168 hours) was used as a validation medium, and bacterial colonies were counted at the end of the culture. Results The value of log10(colony counts) had no significant differences between the TGEA spreading method, the TGEA membrane filtration method, and the validation medium method, but was higher than that of nutrient agar medium method (F=3.346, P=0.025). The detection rate of bacteria was higher from the three TGEA media than from nutrient agar medium, but P value was greater than 0.05 probably due to the limited sample size (χ2=4.267, P=0.234). Bland-Altman analysis showed that the result from validation medium was consistent with the results from TGEA spreading method and TGEA membrane filtration method. The colony number ratios of validation medium/TGEA spreading method and validation medium/ membrane filtration method were all in the range of 0.5～1.5. Conclusion The novel TGEA medium is well applicable for clinical use. The culture process using the novel TGEA medium is easy to operate in a routine environment. Metrics

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Advances in surgical treatment of secondary hyperparathyroidism 2018, 17 (09):  617-620.  doi: 10.3969/j.issn.1671-4091.2018.09.009 Abstract ( 332 )   PDF (385KB) ( 638 )   【Abstract】With the development of dialysis technology, the incidence of secondary hyperparathyroidism (SHPT) increases significantly due to the longer survival of chronic kidney disease (CKD) patients. SHPT symptoms including skin itching, skeletal deformities and ectopic calcifications in cardiovascular system often severely hurt the quality of life in CKD patients. The main therapy for SHPT is medicine. However, medical treatment may be ineffective for some intractable SHPT patients, leading to relapse of the symptoms and higher medical expenses. Therefore, surgical treatment is necessary in some cases ineffective to drug treatment. The guidelines for chronic kidney disease-mineral and bone disorder (CKD-MBD) propose performing parathyroidectomy (PTX) for these SHPT patients. In this paper we reviewed the recent advances in surgical treatment of SHPT. Metrics

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Prolonged intermittent renal replacement therapy 2018, 17 (09):  621-625.  doi: 10.3969/j.issn.1671-4091.2018.09.010 Abstract ( 466 )   PDF (395KB) ( 788 )   【Abstract】Renal replacement therapy (RRT) has made great progresses since the last century. RRT is now widely used, especially for acute kidney injury. The main modalities of RRT consist of intermittent hemodialysis (IHD), continuous renal replacement therapy (CRRT), peritoneal dialysis (PD), etc. Each of these modalities has its own advantages and disadvantages. The prolonged intermittent renal replacement therapy (PIRRT) emerges in order to improve the efficiency of RRT. As a hybrid RRT, PIRRT combing the efficiency of IHD and the stable hemodynamics of CRRT is able to clear small solutes with an efficacy comparable to IHD and CRRT, and offers the advantages of flexible time for treatment and reduced medical expenses. Consequently, PIRRT has become one of the hotspots in China and other countries. However, due to the lack of clear guidelines, PIRRT is still faced with significant challenges, especially pertaining to appropriate dialysate volume and drug doses. There should be more clinical trials to develop a unified standard for PIRRT in the future. Metrics

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Effect of patient support mode on anxiety and depression in hemodialysis patients 2018, 17 (09):  626-628.  doi: 10.3969/j.issn.1671-4091.2018.09.011 Abstract ( 294 )   PDF (407KB) ( 587 )   【Abstract】Objective To explore the effect of patient support mode on anxiety and depression in patients with initial hemodialysis. Methods Convenient sampling method was used to select 92 patients with initial maintenance hemodialysis (MHD) in the period from November 2015 to November 2017 as the research objects. We then used the random number table to divide these patients into observation group (n=46) and control group (n=46). In control group, patients were treated with routine nursing for MHD patients; in observation group, patients were treated with patient support mode in addition to the routine nursing program. Their anxiety and depression were evaluated before the treatment and after the treatment for 3 months and compared between the two groups. Results After the intervention for 3 months, scores of self-rating anxiety scale (SAS) and self-rating depression scale (SDS) significantly improved in the two groups, and were significantly lower in observation group than in control group (SAS: 37.1 ± 8.4 vs. 44.9 ± 7.5, t=4.747, P＜0.001; SDS: 40.4±7.7 vs. 49.0±6.7, t=5.731, P＜0.001). Conclusions The patient support model can effectively improve the anxiety and depression status and enhance the confidence to actively face dialysis in patients with initial hemodialysis. This model can be widely used clinically. Metrics

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The comparative analysis of Alteplase and Reteplase for thrombolysis treatment in arteriovenous fistula 2018, 17 (09):  629-632.  doi: 10.3969/j.issn.1671-4091.2018.09.012 Abstract ( 343 )   PDF (427KB) ( 589 )   【Abstract】Objective This is a comparative analysis to investigate Alteplase (rt-PA) and Reteplase (r-PA) for thrombolysis treatment in arteriovenous fistula (AVF). Methods A total of 132 patients with the blockage of AVF due to thrombosis and treated in the hospital from January 2015 to February 2018 were recruited in this study. They were assigned into two groups based on the hospitalization day: r-PA group (n=105, treated with r-PA), and rt-PA group (n=27, treated with rt-PA). The re-patency rate, re-patency time and adverse events in the two groups were observed after the treatment. Result There were no significant differences in age, risk factors and the time of thrombolysis treatment between the two groups (P>0.05). The re-patency rate was 81.48% (22/27cases) in rt-PA group, and 78.1% (82/105cases) in r-PA group (χ2=0.147, P=0.701). The re-patency time was longer in rt-PA group than in r-PA group [3.75 (1.75～4.88) vs. 1.50 (1.50～3.23), Z=- 2.135, P=0.033]. Fibrinogen decreased in both groups. The decrease of fibrinogen was within normal range in both groups, but was more in r-PA group than in rt-PA group (1.92±0.88 g/L vs. 2.73±0.88, t=-5.331, P＜0.001]. Patients with minor bleeding were 2/27 in rt-PA group and were 17/105 in r-PA group (χ2=0.726, P=0.394). No bleeding in brain, gastrointestinal tract and any other organs were found in both groups. Conclusion r-PA and rt-PA have similar effect on thrombolysis in AVF. rt-PA has less influence on coagulation and bleeding. Metrics

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Handheld ultrasound examination for real-time guidance on cannulation in patients with a new arteriovenous fistula for hemodialysis: a randomized and prospective comparison with standard cannulation technique 2018, 17 (09):  633-636.  doi: 10.3969/j.issn.1671-4091.2018.09.013 Abstract ( 359 )   PDF (978KB) ( 637 )   【Abstract】Objective To explore the feasibility of handheld ultrasound examination for real- time guidance on cannulation of new arteriovenous fistula (AVF), and to compare its effects to the standard cannulation method. Methods This was a single center, randomized and prospective study comparing the handheld ultrasound examination-guided cannulation to new AVF with the standard cannulation method. Sixty end stage renal disease patients with a new and mature wrist radial-cephalic AVF treated in this hemodialysis center were enrolled in this study. Patients with new AVF received either standard cannulation (control group) or ultrasound guided cannulation (study group) for one week. Cannulation manipulation and complications were observed. Results Baseline data including age, body weight index, gender and comorbidities had no statistical significances between the two groups (P＞0.05). Compared to control group, study group yielded longer assessment time before cannulation (123.2±47.7s vs. 40.4±30.6s;p t=19.145, P＜0.001), longer cannulation time (48.6±20.2s vs. 32.0±30.7s; t=2.556, P=0.011), higher success rate (100.0% vs. 96.5%; χ2=6.393, P=0.011), and lower number of cannulation attempts (1.0 vs. 1.0±0.2; t=6.519, P＜0.001). The puncture injury rate was totally 5.2% in the patients; cannulation injury rate was lower in study group than in control group (2.8% vs. 7.3%; χ2=4.150, P=0.042). Change to catheterization for blood access due to cannulation injury was lower in study group than in control group but without statistical significance (1.1% vs. 5.6%; χ2=2.759, P=0.097). No puncture into arteries and infection due to cannulation were found in both groups. Conclusion Handheld ultrasound examination for real-time guidance on cannulation for new AVF can increase the success rate and decrease the cannulation-related complications. It is a safe and useful method for blood access to be used widely in clinical practice. Metrics

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The clinical effect of no-touch vein separation technique on the construction of forearm radio-cephalic arteriovenous fistula 2018, 17 (09):  637-640.  doi: 10.3969/j.issn.1671-4091.2018.09.014 Abstract ( 298 )   PDF (784KB) ( 618 )   【Abstract】Objective To investigate the clinical effect of no- touch vein separation technique on the construction of forearm radio-cephalic arteriovenous fistula (AVF). Method A total of 118 cases having an operation of forearm radio-cephalic AVF from July 2011 to June 2015 were randomly selected; the operation was performed using standard vein separation technique in 76 cases and using no-touch vein separation technique in 42 cases. Complications, dysfunction rate and patency rate of the AVF in the 24 months of follow-up period were retrospectively analyzed. Result There were no significant differences in age (χ2=0.612, P=0.736), gender (χ2=0.000, P=0.995), primary disease (χ2=0.352, P=0.999), secondary/primary operation ratio (χ2=0.015, P=0.901), distal diameter of cephalic vein (＜2 mm/＞2 mm; χ2=0.001, P=0.978), comorbidities of thrombotic disease and risk factors for thrombosis (χ2=0.829, P=0.991), and the use of anti-platelet drugs (χ2=0.069, P=0.793) and anticoagulation drugs (χ2=0.253, P=0.615) between the two groups. In the 24 months of follow-up period, vascular stenosis (χ2=4.267, P=0.039), pseudoaneurysm (χ2=4.129, P=0.042), thrombosis (χ2=3.895, P=0.048) and dysfunction rate of AVF (χ2=3.944, P=0.047) were lower in the patients using no-touch vein separation technique than in those using standard vein separation technique; postoperative patency rate was higher in the patients using no-touch vein separation technique than in those using standard vein separation technique (c2=4.785, P=0.029). Conclusion Forearm radio-cephalic arteriovenous fistula (AVF) operation using no-touch vein separation technique can reduce the related complications and increase the usefulness term of the AVF. Metrics

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Symptoms and the strategy for symptom management in maintenance hemodialysis patients in Shenzhen area 2018, 17 (09):  643-648.  doi: 10.3969/j.issn.1671-4091.2018.09.016 Abstract ( 324 )   PDF (476KB) ( 584 )   【Abstract】Objective To investigate the symptoms in maintenance hemodialysis (MHD) patients in three tertiary hospitals in Shenzhen, and to put forward the strategies for symptom management based on the presentations of the MHD patients. Methods A total of 368 patients with chronic kidney disease undergoing MHD at outpatient clinics from April 2017 to October 2017 were recruited using a convenient sampling method. General information questionnaire and symptom assessment scale for dialysis were used for a comprehensive investigation of the symptoms in MHD patients. Results The total symptom rate was 81.88% and the rate of various symptoms was 16.44～79.19% in MHD patients. Among the 30 symptoms, different symptoms were different in case number (χ2=631.383, P<0.001), frequency (t=42.651, P<0.001), severity (χ2=1070.703, P<0.001), and annoyances and troubles caused by the symptom (t=101.040, P<0.001). Stratified analyses of the MHD patients with different symptoms showed that gender (χ2=13.288, P=0.003), age (χ2=10.305, P=0.006), dialysis age (χ2=80.144, P＜0.001), dialysis frequency (χ2=48.033, P＜0.001), dialysis mode (χ2=114.949, P＜0.001) and primary kidney disease (χ2=55.068, P＜0.001) were significantly different in these MHD patients. The incidence of dry skin was significantly different, relating to gender (χ2=4.797, P=0.029), age (χ2=46.846, P＜0.001), dialysis age (χ2=52.661, P＜0.001), dialysis frequency (χ2=14.282, P=0.001), dialysis mode (χ2=74.599, P＜0.001), and primary disease (χ2=6.031, P=0.014) of the MHD patients. The inci- dence of pruritus was significantly different, relating to dialysis frequency (χ2=6.200, P=0.045) and dialysis mode (χ2=55.886, P＜0.001) of the MHD patients. The incidence of anxiety was significantly different, relating to age (χ2=13.785, P=0.001) and dialysis age (χ2=27.939, P＜0.001) of the MHD patients. The incidence of sleep difficulty was also significantly different, relating to age (χ2=9.598, P=0.008) and primary disease (χ2=4.585, P=0.032) of the MHD patients. Conclusions The prevalence of symptoms is high in MHD patients. These symptoms are significant different in prevalence rate, severity, and influences on the patients, and are coexistent and correlated. Therefore, the essential approaches to manage symptoms in MHD patients should include symptom assessment, symptom management by multidisciplinary team, drugs and other interventions, and self-management ability. Metrics