Chinese Journal of Blood Purification

12 November 2018, Volume 17 Issue 11 Previous Issue    Next Issue

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A cross-sectional study on the prevalence of atrial fibrillation in hemodialysis patients 2018, 17 (11):  721-726.  doi: 10.3969/j.issn.1671-4091.2018.11.001 Abstract ( 454 )   PDF (544KB) ( 655 )   【Abstract】Objective Atrial fibrillation (AF) is a common arrhythmia in hemodialysis patients and its prevalence is higher in hemodialysis patients than in general population. Cross-sectional and cohort studies reported that the prevalence of AF in hemodialysis patients was between 2.8% and 27%. The purpose of this study was to investigate the prevalence of AF, its related risk factors and treatment in patients in the two hemodialysis centers of our hospital. Methods A total of 305 patients with long-term hemodialysis were recruited in the two hemodialysis centers of our hospital. They accepted electrocardiogram (ECG) examination. We collected their medical information including demographic data, clinical diagnosis, comorbidity, smoking and drinking history. Atrial fibrillation was determined by ECG or previous diagnostic history. We then calculated the prevalence of AF and compared the differences between the groups with AF and without AF. The factors associated with AF were analyzed by logistic regression. CHA2DS2-VASc score was used for patients with AF. Results The overall prevalence of AF was 9.8%, in which 73.3% were paroxysmal AF and 26.7% were persistent AF. The prevalence of AF was 9.0% in the hemodialysis center in emergency department and 11.7% in the Third Inpatient Department of our hospital. There are differences in age, coronary heart disease, myocardial infarction and vascular disease between patients with AF and without AF. The prevalence of AF increased with age. In AF patients, 6.7% patients were younger than 55 years old, 23.3% were between 55～64 years old, 26.7% aged between 65～74 years old, and 43.3% aged ≥75 years old. Multivariate analyses showed that AF was independently associated with age (odds ratio: 1.042 per year increase, 95% CI: 1.006～1.078, P= 0.020) and vascular diseases (OR=3.854, 95% CI 1.358～10.942, P=0.011). Thirteen AF patients accepted anticoagulant and antiplatelet therapy and the treatment rate was 43.3%. Conclusions The prevalence of AF was associated with older age and vascular diseases. The rate of standard anticoagulant therapy was lower in this cohort of patients. Metrics

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Continuous quality improvement decreased the rate of peritonitis in a peritoneal dialysis center 2018, 17 (11):  727-730.  doi: 10.3969/j.issn.1671-4091.2018.11.002 Abstract ( 231 )   PDF (418KB) ( 630 )   【Abstract】Objective To decrease the peritonitis rate in peritoneal dialysis (PD) patients through the continuous quality improvement (CQI) program, and to analyze the characteristics and outcome of peritonitis in PD patients. Methods We adopted the four-step (PDCA) method, i.e., plan, do, check, act, to design and perform the measures for reducing the prevalence of peritonitis. Eighty-six PD patients were enrolled as control group not using CQI program, and 102 PD patients were recruited as observation group using CQI program. These PD patients were treated in the Peritoneal Dialysis Center, Department of Nephrology, Tongxiang First People's Hospital. The prevalence, clinical characteristics and outcome of peritonitis were compared between the two groups. Results Compared to control group, peritonitis reduced from 0.2093 episodes per year to 0.0980 episodes per year (c2=4.557, P=0.033) in observation group, and Gram-positive bacteria peritonitis reduced from 0.1385 episodes per year to 0.0490 episodes per year (c2=4.424, P=0.035). Peritonitis due to incorrect manipulation of liquid change reduced from 0.1163 episodes per year to 0.0392 episodes per year (c2= 4.020, P=0.045). Conclusion CQI program decreased the peritonitis due to incorrect manipulation of liquid change and the rate of PD-related peritonitis especially the rate of Gram-positive bacteria peritonitis. Metrics

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The influence factors for left ventricular diastolic dysfunction in peritoneal dialysis patients 2018, 17 (11):  731-734.  doi: 10.3969/j.issn.1671-4091.2018.11.003 Abstract ( 264 )   PDF (405KB) ( 764 )   【Abstract】Objective To investigate the status of left ventricular diastolic function and to explore the influence factors for left ventricular diastolic dysfunction in patients with maintenance peritoneal dialysis (PD). Methods Cardiac diastolic function was evaluated by color Doppler ultrasound. In the 130 PD patients, 123 patients were diagnosed with grade I or grade II left ventricular diastolic dysfunction according to the findings of color Doppler ultrasound. Demographic characteristics, clinical and laboratory indicators were compared between patients with grade I and grade II left ventricular diastolic dysfunction to analyze the risk factors for left ventricular diastolic dysfunction. Results The prevalence of left ventricular diastolic dysfunction was 94.6%, in which 35.4% were grade II diastolic dysfunction. Body mass index (BMI) (t=- 2.058, P=0.042), blood phosphorus (t=-2.699, P=0.008) and brain natriuretic peptide (BNP) (t=-2.588, P=0.011) were significantly different between the PD patients with grade II and grade I diastolic dysfunction. Logistic regression analysis found that higher levels of BMI (OR=1.316, 95% CI: 1.117～1.550, P=0.001), total cholesterol (OR=2.034, 95% CI: 1.153～3.588, P=0.014), serum phosphorus (OR=3.855, 95% CI: 1.477～10.059, P =0.006) and BNP (OR=1.003, 95% CI: 1.001～1.004, P=0.003) were the risk factors for left ventricular diastolic dysfunction. Conclusions Left ventricular diastolic dysfunction occurred in most PD patients. Higher levels of BMI, total cholesterol, serum phosphorus and BNP were the risk factors for left ventricular diastolic function. Metrics

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Relationship between increased left ventricular mass index and decreased cognitive function in endstage renal disease patients 2018, 17 (11):  735-738.  doi: 10.3969/j.issn.1671-4091.2018.11.004 Abstract ( 303 )   PDF (403KB) ( 590 )   【Abstract】To investigate the relationship between increased left ventricular mass index (LVMI) and other risk factors and decreased cognitive function in end- stage renal disease (ESRD) patients. Methodology We recruited 39 chronic kidney disease patients at stage 5 without dialysis and hospitalized in the Department of nephrology, the first affiliated Hospital of Xi'an Jiaotong University in the period from June 2016 to December 2017. Patient's demographic data, color Doppler echocardiography findings, neuropsychological scale (the Montreal cognitive scale, MoCA) to evaluate the overall cognition function, and the executive function score (connection test A) were collected. Correlation analysis and multivariate regression were conducted to analyze their demographic data, cardiac color Doppler ultrasound findings and cognitive function scores. Results ①The correlation analysis between demographic data and cognitive score showed that age was positively correlated with connection test A score (r=0.335, P=0.037); education level and serum calcium were negatively correlated with connection test A score (r=-0.546 and -0.358 respectively, P=0.001 and 0.025 respectively) and were positively correlated with MoCA score (r=0.593 and 0.349 respectively, P=0.001 and 0.030 respectively); cystatin C was negatively correlated with MoCA score (r=-0.398, P=0.012). ②The correlation between left ventricular diameter and function and cognitive score showed that LVMI was positively correlated with connection test A score (r=0.471, P=0.003) and negatively correlated with MoCA score (r=-0.332, P=0.039).③Multivariate stepwise regression analysis showed that education level and LVMI were closely related to the decrease of executive function in ESRD patients (t=-3.891 and 3.238 respectively, P=0.001 and 0.003 respectively); education level, cystatin C and LVMI were closely related to the decrease of overall cognitive function in ESRD patients (t=0.516, -1.496 and -0.022 respectively, P=0.001, 0.004 and 0.021 respectively). Conclusion Many factors affect the cognitive function, and increased LVMI may closely relate to the decreased cognitive function in ESRD patients. Metrics

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Correlation between red blood cell distribution width and intradialytic hypotension 2018, 17 (11):  739-742.  doi: 10.3969/j.issn.1671-4091.2018.11.005 Abstract ( 368 )   PDF (461KB) ( 610 )   【Abstract】Objective To explore the relationship between red blood cell distribution width (RDW) and intradialytic hypotension (IDH). Methods A total of 238 cases of maintenance hemodialysis patients treated in the hemodialysis center of our hospital during January 1st, 2017～June 1st, 2018 were recruited as research subjects. According to the presence or absence of IDH, they were divided into observation group (50 cases) and control group (188 cases). IDH and RDW were recorded in the two groups. Independent sample t test was used to investigate the relationship between IDH and RDW, hemoglobin, age, gender, total cholesterol, low density lipoprotein (LDL), phosphorus, calcium, parathyroid hormone, etc. Multivariate logistic regression was used to analyze the independent influence factors for IDH. The receiver operating characteristic curve (ROC curve) was obtained to evaluate the diagnostic value of RDW for IDH. P<0.05 was considered to be statistically significant. Results There were significant differences in gender (t=10.024, P=0.002), age (t=4.875, P=0.000), RDW (t=5.673, P=0.000), total cholesterol (t=3.065, P=0.002) and LDL (t=2.787, P=0.006) between the two groups. After correction of IDH, RDW became lower but still had statistically significance (t=5.805, P＜0.001). The ROC curve showed that RDW had a predictive effect for IDH (AUC=0.869, 95% CI 0.791～0.926, OR=1.249). Conclusions The increase of RDW is an important risk factor as well as a better predictive index for IDH. Metrics

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The effect of depression and anxiety on quality of life in maintenance hemodialysis patients 2018, 17 (11):  743-747.  doi: 10.3969/j.issn.1671-4091.2018.11.006 Abstract ( 379 )   PDF (449KB) ( 798 )   【Abstract】Objective To investigate the prevalence of anxiety and depression and their effects on quality of life in maintenance hemodialysis (MHD) patients. Methods MHD patients treated in the Dialysis Unit of Sichuan Provincial Ziyang People’s Hospital from Jan. 2017 to Dec. 2017 were enrolled in this cross-sectional study. Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS) and KDQOL-SFTM Questionnaire were used to assess anxiety, depression and quality of life in MHD patients. Results ①A total of 124 MHD patients were enrolled in this study. The prevalence of anxiety, depression and comorbid depression and anxiety were 16.13%, 36.29% and 10.48% respectively. ②The MHD patients without anxiety/depression had better performance than those with anxiety/depression (P<0.05), and those with comorbid depression and anxiety had lower performance than those without anxiety, depression or comorbid depression and anxiety. ③The scores of SAS and SDS were negative correlated with KDTA score and SF-36 score (P＜0.05). Conclusion The prevalence of anxiety, depression and comorbid anxiety and depression were 16.13%, 36.29% and 10.48% respectively in the MHD patients treated in the hemodialysis center of Sichuan Provincial Ziyang People’s Hospital. Anxiety and depression impair the quality of life in MHD patients, especially in those with comorbid anxiety and depression. Metrics

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Establishment of symptom group in maintenance hemodialysis patients and its correlation with quality of life 2018, 17 (11):  748-752.  doi: 10.3969/j.issn.1671-4091.2018.11.007 Abstract ( 279 )   PDF (434KB) ( 622 )   【Abstract】Objective To determine the type of symptom group in maintenance hemodialysis (MHD)patients by factor analysis method and to analyze its correlation with patients' quality of life. Methods A total of 183 MHD patients were enrolled in this study. Their demographic data were collected. Symptoms and quality of life were evaluated by dialysis symptom assessment scale and concise health status scale (SF-36). Symptom groups were extracted by the factor analysis method. The relationship between symptom group and quality of life was analyzed by Pearson correlation analysis, and the relationship between quality of life and different symptom groups was analyzed by multivariate linear regression. Results MHD patients were plagued by various symptoms. The highest frequency of symptom was fatigue (123, 67.21%), followed by itching (116, 63.39%) and dry skin (103, 56.28%); the highest severity of symptom was itching (3.54±0.89), followed by dry skin (3.46±0.92) and sleep difficulty (3.38±0.82); the most troublesome symptom was fatigue(4.41± 0.76), followed by itching (4.37±1.03) and sleep difficulty (3.94±1.11). The total score of quality of life in the MHD patients was 62.48±9.82 points, being a medium level. Five symptoms groups can be delineated in MHD patients, i.e., disease feeling, emotion, digestive tract, cardiopulmonary system, and water and electrolyte. The symptom group was negatively correlated with quality of life (r=-0.646, P=0.039 for disease feeling; r=-0.603, P=0.028 for emotion; r=-0.583, P=0.036 for digestive tract; r=-0.571, P=0.035 for cardiopulmonary system; r=-0.629, P=0.046 for water and electrolyte). Disease feeling group (β= 4.562, P=0.000), emotional symptom group (β=3.871, P=0.000) and water and electrolyte symptom group (β=2.693, P=0.000) were the most important factors negatively affecting quality of life in MHD patients. Conclusion MHD patients have various symptoms, which disturb them and affect quality of life. We should seek out an efficient, comprehensive and individualized management model based on the characteristics of the symptom group to improve the quality of life of MHD patients. Metrics

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Endovascular intervention on long-term arteriovenous access 2018, 17 (11):  753-756.  doi: 10.3969/j.issn.1671-4091.2018.11.008 Abstract ( 354 )   PDF (365KB) ( 688 )   【Abstract】Hemodialysis is the main renal replacement therapy for patients with end-stage renal disease. Complications of long-term arteriovenous access are the main reason for hospitalization in hemodialysis patients. Percutaneous interventional therapy can be used in poor function or failure of the arteriovenous access due to vein or arterial stenosis, which has the advantages of few trauma and blood loss and retention of limited blood vessel resources. Percutaneous transluminal angioplasty is the initial standard treatment for most dialysis pathway lesions. Percutaneous transluminal stenting has the advantages in dealing with central venous stenosis. Early intervention on malfunctional arteriovenous access is essential for extending the service life of arteriovenous access and improving patients’quality of life. Metrics

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he relationship between draining veins and vein anastomotic stenosis of arteriovenous graft 2018, 17 (11):  757-760.  doi: 10.3969/j.issn.1671-4091.2018.11.009 Abstract ( 351 )   PDF (368KB) ( 742 )   【Abstract】Objective To investigate the role of draining veins in predicting vein anastomotic stenosis of arteriovenous graft (AVG) in patients with end-stage renal disease. Method This is a study regarding 138 cases with AVG at the Renal Department of Haidian Hospital in 2016. Their clinical data including conditions of vessels were collected. Patients were followed up to record the use of graft and its complications. Cox multivariate regression model was used to analyze the relative factors. Result The rate of brachial-cephalic AVG was 54.35% and brachial-median antecubital AVG was 32.61%. Cox multivariate regression analysis showed that the diameter of tourniquet draining vein was the independent risk factor for vein anastomotic stenosis (HR: 0.672, 95% CI: 0.453～0.995, P=0.047). Conclusion The diameter of tourniquet draining vein rather than the diameter of feeding artery and draining vein was significantly associated with vein anastomotic stenosis of AVG, Metrics

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he application of color Doppler ultrasound in evaluating the maturation process of arteriovenous fistula 2018, 17 (11):  761-765.  doi: 10.3969/j.issn.1671-4091.2018.11.010 Abstract ( 430 )   PDF (508KB) ( 601 )   【Abstract】Objective To explore the ultrasonic examination for the evaluation of maturation process of newly established radial- cephalic arteriovenous fistula (RC-AVF) within 24 weeks after surgery. Method In this single center clinical study, RC-AVFs performed from October 2016 to January 2018 were included in this study. Ultrasound follow-up examinations were performed after surgery. Patients were divided into patency group and failure group. The ultrasonic parameters at different follow-up time points were compared. ROC curve was used to analyze the diagnostic value of ultrasonic monitoring parameters. Results The patency rate of RC-AVF at the 24th week was 71.43%. The internal diameter of brachial artery (t=-2.338, P=0.029) and cephalic vein (t=- 4.792, P=0.003) increased gradually within 4 weeks after surgery in patency group, while the changes were not significant between 4th to 24th week (P> 0.050). The internal diameter of cephalic vein and its blood flow were always significantly different between the two groups during the follow-up period (P ＜0.05). When the optimal cut-off value of cephalic vein diameter was set at 4.28mm, the sensitivity and specificity were 81.82% and 86.67% respectively for predicting maturation of AVF and AUC=0.882; when the optimal cut-off value of blood flow in cephalic vein was set at 701.580ml/min, the sensitivity and specificity were 72.73% and 93.33% respectively for predicting maturation of AVF and AUC=0.873. Conclusion The newly established RC-AVF matures rapidly within 4 weeks after surgery. The internal diameter of cephalic vein and its blood flow were the main parameters of RC-AVF maturity. The optimal cut-off values for the diagnosis of RC-AVF maturation were internal diameter of cephalic vein 4.28mm and blood flow in cephalic vein 701.580ml/min respectively. Metrics

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Progress in risk assessment and prevention of renal failure in patients with chronic kidney disease 2018, 17 (11):  766-768.  doi: 10.3969/j.issn.1671-4091.2018.11.011 Abstract ( 297 )   PDF (392KB) ( 713 )   【Abstract】The prevention and treatment of chronic kidney disease has become an important public health problem in the world. Delaying the disease progress is the most important issue in the treatment of chronic kidney disease. In this paper, the prevention of renal failure risk for chronic kidney disease, risk assessment tools and preventive measures were reviewed, in order to strengthen risk assessment and prevention of renal failure and to provide references for health education and delaying the disease progress in patients with chronic kidney disease Metrics

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Study on quality control of dialysis water among different hemodialysis centers from different areas 2018, 17 (11):  777-779.  doi: 10.3969/j.issn.1671-4091.2018.11.014 Abstract ( 268 )   PDF (368KB) ( 579 )   【Abstract】Objective To compare the quality of dialysis water and dialysate among different hemodialysis(HD) centers from different areas. Methods The records regarding to quality control of dialysis water and dialysate in 2017 were collected from 43 HD centers located in the 3 areas (ZK, SQ, and CP). A questionnaire survey was conducted in order to analyze the factors for failure to pass quality examinations. Results Three centers from SQ area failed to pass quality examinations in 2017 because of management problems. Eight of the other 40 centers failed to pass the examinations; the dialysate from these centers had bacterial culture (77.50±44.57 CFU/ml vs. 17.52±20.00 CFU/ml, t=5.663, P=0.000) and endotoxin levels (0.276±0.156 EU/ml vs. 0.094±0.063 EU/ml, t=4.893, P=0.000) higher than the standards, as compared with those of the 32 centers passed the quality examinations. There was significant difference in the endotoxin test method among the 3 cities. The ratio of samples examined in other places and those examined by themselves were 12/4 in ZK area, 2/11 in SQ area and 3/8 in CP area (χ2=10.933, P=0.004). All of the centers in ZK and SQ areas did not follow the new standards for quality control of dialysis water. Conclusion There were significant differences in quality control of dialysis water and dialysate among different HD centers. The use of new standards for water and dialysate qualify control should be emphasized. Metrics

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Investigation on the incidence of fall and its related factors in 224 patients with maintenance hemodialysis 2018, 17 (11):  780-784.  doi: 10.3969/j.issn.1671-4091.2018.11.015 Abstract ( 305 )   PDF (443KB) ( 578 )   【Abstract】Objectives To understand the incidence of fall, its characteristics and influence factors in maintenance hemodialysis (MHD) patients in order to provide a reference for nursing strategies. Methods A total of 224 MHD patients treated in the blood purification center of a grade Ⅲ hospital from May 2017 to April 2018 and recruited by convenience sampling method were enrolled in this study. A survey was made to investigate fall number in a year, place, main cause and site of the fall(s), injuries due to the falls, and recovery information. The incidence was calculated and the influence factors were analyzed by multivariate regression. Results The incidence of fall was 20% within a year. The fall occurred frequently in street, at home or in toilet room. The falls may cause severe injuries. The influence factors for falls included older age, longer dialysis period, intradialytic hypotention and lower hemoglobin level. Conclusion The incidence of fall was higher in MHD patient. The falls may cause severe injuries. The assessment and prevention of fall and the nursing for falls should be intensified for the MHD patients with older age, longer dialysis period, intradialytic hypotention and lower hemoglobin level Metrics