Chinese Journal of Blood Purification

12 October 2019, Volume 18 Issue 10 Previous Issue    Next Issue

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The developmental history of peritoneal dialysis in China in the 70 years 2019, 18 (10):  661-663.  doi: 10.3969/j.issn.1671-4091.2019.10.001 Abstract ( 844 )   PDF (391KB) ( 1788 )   【Abstract】There are about 1,000,000～2,000,000 patients with end-stage renal disease (ESRD) in China, which consumes huge medical resources and results in great economic burden to the society. Peritoneal dialysis (PD) has the advantages of convenience, safe, effective and home treatment, becoming one of the alternative treatment methods suitable for ESRD patients in China. The number of registered PD patients increases nearly 20 times from 4,380 in 1999 to 86,264 by the end of 2018. With the improvement of dialysis registration system, the widespread utilization of standard PD operating protocols, and the increase of high- quality clinical studies on PD in China, we have achieved continuous advances in PD quality, large experiences in treatment and management of PD, and excellent reputations about the treatment of PD in the international community. Metrics

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The effects of calcium and phosphorus metabolism on heart failure of maintenance peritoneal dialysis patients#br# 2019, 18 (10):  664-668.  doi: 10.3969/j.issn.1671-4091.2019.10.002 Abstract ( 264 )   PDF (415KB) ( 685 )   【Abstract】Objective To investigate the levels of serum calcium, serum phosphorus and iPTH to influence and predict the heart failure (HF) in maintenance peritoneal dialysis (MPD) patients. Methods A total of 322 MPD patients treated in our hospitals from January 2014 to October 2018 were recruited in this retrospective and multicenter clinical study. Based on morning fasting serum phosphate level (Pi), patients were divided into high phosphorus group (Pi≥1.6mmol/L, n=143), low phosphorus group (Pi ≤0.8mmol/L, n=21) and normal phosphorus group (0.8mmol/L＜ Pi ＜1.6mmol/L, n=158). They were followed up for more than 3 months, and the presence of HF events was recorded. Clinical data, peritoneal dialysis indices, laboratory examinations and echocardiographic parameters were compared between the 3 groups. The correlation of calcium/phosphorus metabolism and other clinical parameters with HF was analyzed. The effect of calcium/phosphorus metabolism on survival of the MPD patients with HF was assessed by Kaplan-Meier curve method. Multivariate logistic regression model was used to evaluate the risk factors for HF in MPD patients. SPSS20.0 was used for the statistical analyses, and P<0.05 was considered to be statistically significant. Results ①HF was found in 179 cases within the follow-up period of 25.46±16.98 months. The prevalence of HF was higher in high phosphorus group (69.2% ) than in low phosphorus group (4.8% ) and normal phosphorus group (50.0%) (F=17.386, P=0.016). ②There were statistical differences in dialysis age (F=202.706, P=0.009) and serum albumin (F=84.193, P=0.020) between the 3 groups. ③ Kaplan- Meier curve method revealed that MPD patients with low calcium, high phosphorus and high iPTH were at high risk of HF (P=0.002). ④ Multivariate logistic regression model found that higher serum phosphorus and iPTH were the risk factors for HF in MPD patients (OR=1.231 and 1.003 respectively; 95% CI=1.023～4.634 and 1.000～1.006 respectively; P=0.004 and 0.030 respectively). Conclusions Higher levels of serum phosphorus and iPTH are the independent risk factors for HF in MPD patients, and MPD patients with lower serum calcium accompanied by higher levels of phosphorus and higher iPTH will have higher risk of HF. Therefore, treatment for the disorders of calcium and phosphorus metabolism is an essential method for the prevention of HF in MPD patients. Metrics

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he relationship between high frequency dialysis related intradialytic hypotension and post-dialysis lactic acid level in maintenance hemodialysis patients#br# 2019, 18 (10):  669-672.  doi: 10.3969/j.issn.1671-4091.2019.10.003 Abstract ( 284 )   PDF (405KB) ( 704 )   【Abstract】Objective To study the relationship between high frequency dialysis related intradialytic hypotension (IDH) and post-dialysis lactic acid level in maintenance hemodialysis (MHD) patients. Methods A total of 115 patients with regular MHD were enrolled in this study. These patients were treated in the Department of Blood Purification, Beijing Chao-Yang Hospital, Capital Medical University during the period from January 1st, 2018 to January 1st, 2019. According to the prevalence of high frequency dialysis related IDH in the 3 months of dialysis period, they were divided into observation group (the prevalence ≥30%) and control group (the prevalence <30%). Their clinical and laboratory data were recorded. Independent sample t test was used to investigate the relationships between the blood gas changes before and after dialysis and the pre- dialytic blood routine, renal function, ions, uric acid, blood sugar and C-reactive protein in observation group and control group. Binary logistic regression was used to analyze the important factors influencing the high frequency dialysis related IDH. Receiver operating characteristic (ROC) curve was used to evaluate the value of lactic acid for the diagnosis of high frequency dialysis related IDH. P＜0.05 was considered to be statistically significant. Results Patients with high- frequency dialysis related IDH accounted for 23.48% (27/115) of the patients. Compared with those in control group, mean hemoglobin concentration of red blood cells was lower (321.670±10.144g/L vs. 328.659±10.974g/L, t=-2.944, P=0.004), red blood cell distribution width (RDW-CV) was higher (14.496±1.535% vs. 13.686±0.945%, t=2.594, P=0.014), and post-dialysis lactic acid was higher (1.881±0.627mmol/L vs. 1.437±0.7mmol/L, t=2.949, P=0.004) in observation group. Binary logistic regression showed that the higher levels of red blood cell distribution width and post- dialysis lactic acid were the risk factors for high- frequency dialysis related IDH (OR=1.630, 95% CI 1.046～2.539, P=0.031; OR=2.364, 95% CI 1.237～4.517, P=0.009). ROC curve demonstrated that the area under the curve (AUC) of lactic acid was 0.721 (95% CI 0.605～0.837, P=0.001). Conclusions The increase of post-dialysis lactic acid is an important risk factor for high frequency dialysis related IDH and is valuable for the prediction of the IDH. Metrics

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Effect of the vascular access type at the beginning of dialysis on five-year survival rate of dialysis patients 2019, 18 (10):  673-676.  doi: 10.3969/j.issn.1671-4091.2019.10.004 Abstract ( 228 )   PDF (419KB) ( 759 )   【Abstract】Objective To investigate whether the use of arteriovenous fistula (AVF) at the beginning of dialysis can improve the 5-year survival rate of patients with end-stage renal disease. Methods The patients undergoing maintenance hemodialysis (MHD) at the Blood Purification Center of Guangdong Provincial People's Hospital from January 1, 2013 to August 31, 2018 were enrolled in this prospective cohort study. According to the type of vascular access at the beginning of dialysis and whether the central venous catheter was changed to AVF/graft, they were divided into three groups: AVF group, central venous catheter to internal fistula group, and long-term/temporary catheterization group. The primary outcome indicator of the three groups was the 5-year mortality rate. Results A total of 360 patients (197 males; the average age of 61.1±16.0 years) were enrolled; 113 patients (37.2%) had diabetic nephropathy. The first type of blood access was autologous AVF in 129 cases (35.8%), arteriovenous grafts (AVG) in 9 cases (2.5%), long-term catheterization in 16 cases (4.4%), and temporary catheterization in 206 cases (57.2%). The 5-year mortality rate of AVF group, central venous catheter to internal fistula group and long- term/temporary catheterization group were: 10/138 (7.2%), 9/138 (6.5%) and 12/84 (14.3%) respectively (χ2=80.966, P=0.116). In central venous catheter to internal fistula group, the median interval between central venous catheterization and establishment of an AVF was 47 (11-86) days. Survival analysis showed that the use of AVF at the beginning of dialysis could significantly improve the 5-year survival rate (Z=2.625, P=0.008). Multivariate analysis showed a higher mortality rate in patients with long-term/temporal catheterization (HR=4.992, 95% CI=1.224～14.84, P=0.025). Conclusions The use of AVF/graft at the beginning of dialysis can significantly improve the 5-year survival rate of patients with end-stage renal disease. Metrics

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The correlation between irisin and sarcopenia in maintenance hemodialysis patients 2019, 18 (10):  677-680.  doi: 10.3969/j.issn.1671-4091.2019.10.005 Abstract ( 236 )   PDF (495KB) ( 648 )   【Abstract】Objective The aim of this study was to determine the relationship between serum Irisin level and survival rate in maintenance hemodialysis (MHD) patients and the effect of irisin on autophagy in myoblasts. This study was expected to provide an evidence of irisin useful for the treatment of sarcopenia. Design and Method A total of 180 MHD were recruited in this study. Based on the common recognition about the diagnosis of sarcopenia from Asia Working Groups for Sarcopenia (AWGS) in 2014, patients were divided into sarcopenia group and non-sarcopenia group. Serum irisin was determined by ELISA, and the relationship between serum Irisin and survival rate of the patients was then analyzed. The expression of autophagy related genes in murine C2C12 myoblasts induced with indoxyl sulfate (IS) were assayed by western blot, and the effect of Irisin on autophagy in myoblasts was then evaluated. Results Serum irisin was significantly lower in sarcopenia group than in non-sarcopenia group (t=-4.802, P<0.001). Mortality rate was higher in patients with lower serum Irisin than in those with higher serum irisin after the follow-up study for 3 years (χ2=7.865, P=0.010). The autophage related proteins of Atg-3, Atg-12 and Beclin-1 increased significantly in IS induced C2C12 myoblasts, and these changes could be ameliorated by the elevation of Irisin concentration. Conclusions The mortality rate was higher in MHD patients with lower serum Irisin level. Irisin ameliorated the autopahge in IS induced myoblasts. Metrics

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Characteristics and risk factors of the pain after peritoneal dialysis catheter implantation 2019, 18 (10):  681-684.  doi: 10.3969/j.issn.1671-4091.2019.10.006 Abstract ( 718 )   PDF (438KB) ( 662 )   【Abstract】Objective The aim of this study was to explore the characteristics and risk factors of the pain after peritoneal dialysis (PD) catheter implantation. Methods The end-stage renal disease patients undergoing PD catheter implantation in our hospital from January to December 2016 were recruited in this study. Numerical Rating Scale (NRS) was used to evaluate the pain. Patients were divided into three groups according to their pain score: mild, moderate and severe pain groups. Their demographic and clinical data were also collected. Results A total of 118 patients who received peritoneal dialysis catheter insertion in our center were enrolled in this study. Ninety (76.3%) patients had moderate to severe pain. Compared with mild pain group, patients in moderate and severe pain groups had younger age (F=5.602, P=0.005), longer time of postoperative pain (χ2=24.613, P＜0.001), and higher proportion of pain caused by postoperative activity (χ2=11.080, P=0.004). A higher proportion of the patients in severe pain group had active omentum during operation (χ2=5.943, P=0.024). Multivariate logistic analysis showed that younger age (OR=0.96, 95% CI 0.93～0.99, P=0.011), catheter exit-site pain (OR=3.08, 95% CI 1.14～8.36, P=0.027) and pain caused by postoperative activity (OR=3.04, 95% CI 1.12～8.24, P=0.029) were the independent risk factors for postoperative moderate to severe pain. Conclusions The incidence of moderate to severe pain was 76.3% in patients after PD catheter insertion. The analysis of the characteristics and risk factors of the pain is useful for the search of appropriate measures to relieve the pain. Metrics

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Surgical treatment of refractory secondary hyperparathyroidism 2019, 18 (10):  685-688.  doi: 10.3969/j.issn.1671-4091.2019.10.007 Abstract ( 229 )   PDF (428KB) ( 800 )   【Abstract】Objective To compare the efficacy of total parathyroidectomy with forearm-autotransplantation (tPTx + AT) and subtotal parathyroidectomy (sPTx) in patients with secondary hyperparathyroidism (SHPT). Methods We retrospectively analyzed the clinical data of 284 SHPT patients accepted the surgery in our hospital from 2004 to 2018. Preoperative and post-operative serum calcium and PTH were analyzed, and their complication rate and recurrence rate were discussed. Results Postoperative serum calcium (t=11.340, P＜0.001 for tPTx+AT; t= 8.209, P＜0.001 for sPTx) and PTH (t=69.968, P＜0.001 for tPTx+AT; t=67.973, P＜0.001 for sPTx) were significantly lower than those before operation in both groups. Postoperative serum calcium had no difference between the two groups (t=0.491, P=0.636). Serum PTH level after operation for 6 months was statistical different between the two groups (t=2.412, P=0.023). The recurrence rate was 27.3% in sPTx group and was 9.92% in tPTx+AT group (χ2=6.110, P=0.013). Conclusion Both tPTx+AT and sPTx have a significant short-term effect on SHPT. tPTx+AT is more conducive to reduce PTH and lower recurrence rate than sPTx. Severe complications are rare, but recurrence of SHPT is still present in some cases. Metrics

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Predictive value of fibroblast growth factor-23 for the treatment efficacy of secondary hyperparathyroidism in maintenance hemodialysis patients#br# 2019, 18 (10):  689-692.  doi: 10.3969/j.issn.1671-4091.2019.10.008 Abstract ( 230 )   PDF (436KB) ( 621 )   【Abstract】Objective To investigate serum fibroblast growth factor-23 (FGF-23) level for the prediction of treatment efficacy of secondary hyperparathyroidism (SHPT) and to observe serum FGF-23 level for the treatment efficacy prediction of palicalcitol and calcitriol in maintenance hemodialysis (MHD) patients. Methods A total of 177 MHD patients with SHPT recruited from 7 hemodialysis centers of People's Hospital of Xinjiang Uygur Autonomous Region were included in this prospective, multicenter and cohort study. We used high FGF-23 level as the exposure factor, PTH level lower than 40% of the baseline value as the main endpoint event, and the presence of hypercalcemia and hyperphosphatemia as the secondary endpoints events. The endpoint events in patients were observed with the median follow-up period of 7.8 months. Results The prevalence of main endpoint event was lower in the patients with higher FGF-23 level than in those with lower FGF-23 level (25.84% vs. 71.59%, HR=0.74, 95% CI 0.31～0.98, P<0.001). The prevalence of hypercalcemia and hyperphosphatemia were higher in the patients with higher FGF-23 level than in those with lower FGF- 23 level (26.97% vs. 9.09%, HR=0.74, 95% CI 2.65～3.77, P=0.005 for hypercalcemia; 61.80% vs. 38.64%, HR=2.64; 95% CI 2.19～2.86, P=0.025 for hyperphosphatemia). In the patients treated with palicalcitol, the prevalence of main endpoint event was lower in patients with lower FGF-23 level than in those with higher FGF-23 level HR=1.89, 95% CI 1.32-1.98, P＜0.001), and the same was found in patients treated with calcitriol (HR=1.15, 95% CI 1.03-1.29, P=0.039). Conclusion Patients with lower FGF-23 level had better curative effect with the lower prevalence of hypercalcemia and hyperphosphatemia. However, FGF-23 level had no influences on hypercalcemia and hyperphosphatemia in patients treated with calcitriol. Metrics

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Assessment and analysis of the cognitive and depressive disorders in chronic kidney disease patients 2019, 18 (10):  693-696.  doi: 10.3969/j.issn.1671-4091.2019.10.009 Abstract ( 286 )   PDF (452KB) ( 665 )   【Abstract】Objective To investigate the occurrence and mechanisms of the cognitive and depressive disorders in patients with chronic kidney disease (CKD). Methods According to glomerular filtration rate (eGFR) of the subjects, a total of 179 subjects were divided into healthy control group (eGFR＞90 ml/min/1.73m2), eGFR slight decrease group (30＜eGFR ＜60 ml/min/1.73 m2), and eGFR significant decrease group (eGFR<30 ml/min/1.73 m2). The Mini- mental State Examination (MMSE) and Self- rating Depression Scale (SDS) were used to evaluate the cognitive function and mental state of CKD patients. Brain MRI images were analyzed to calculate the rate of lacunar infarction and white matter demyelination. Results In eGFR slight decrease group and eGFR significant decrease group, the MMSE scores were 26.53±0.41 (c2=3.046, P=0.003) and 23.47±0.94 (c2=6.000, P＜0.000) respectively, and the SDS scores were 39.18±1.55 (c2=2.098, P=0.033) and 45.6±1.93 (c2=9.183, P=0.002), statistically different from the scores in control group. In the patients with cognitive and depressive disorders in eGFR slight decrease group and eGFR significant decrease group, the rates of lacunar infarction were 42.5% (c2=4.482, P=0.034) and 52.5% (c2=10.474, P=0.001) respectively, and the rates of white matter demyelination were 50.0% (c2=4.842, P=0.028) and 65.0% (c2=6.983, P=0.013) respectively, statistically higher than the rates in patients without cognitive or depressive disorders in the two groups. Conclusions The risks for cognitive impairment and depressive disorder were higher in CKD patients, possibly relating to the presence of lacunar infarction and white matter demyelination in these patients. Metrics

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Comparison of flow rate in different bloodlines in dialyzers under negative pressure 2019, 18 (10):  697-700.  doi: 10.3969/j.issn.1671-4091.2019.10.010 Abstract ( 424 )   PDF (433KB) ( 752 )   【Abstract】Objective To compare the flow rate in bloodlines of different dialyzer under negative pressure. Methods In this paper, bloodlines A, B, C and D in 4 brands of dialyzers were selected. Each bloodline ran at the speed of 200 ml/min and 300 ml/min for 5 minutes, and the actual flow rate in each bloodline was measured under different pre-pump negative pressures. Results ①The greater the pre-pump negative pressure was, the lower the actual flow rate became under the same rate setting. ②There was no statistical difference in actual flow rate in different brands of bloodlines under the set conditions of flow rate 200 ml/min and the pressure -20mmHg (F=2.095, P=0.120). In contrast, there was statistical difference in actual flow rate in the bloodlines under the pressure of -100mmHg and -200mmHg (F=4.157 and 11.128 respectively; P=0.014 and ＜0.001 respectively). ③There was statistical difference in actual flow rate in different brands of bloodlines under the rate of 300ml/min and the pressure of -100mmHg and -200mmHg (F=6.861 and 18.748 respectively; P=0.001 and ＜0.001 respectively). Conclusion The negative pre-pump pressure affected the actual flow rate of extracorporeal circulation. The difference of actual flow rate existed among bloodlines of different brands under the same negative pressure conditions. Therefore, the clinical effect of these differences should be further studied. Metrics

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A retrospective study on self-sealing graft (Acuseal) versus heparin-bonded graft (Propaten) for prosthetic arteriovenous fistulas#br# 2019, 18 (10):  701-704.  doi: 10.3969/j.issn.1671-4091.2019.10.011 Abstract ( 293 )   PDF (463KB) ( 693 )   【Abstract】Objective To compare the performance of self-sealing vascular access graft (Acuseal) and heparin-bonded graft (Propaten) in hemodialysis applications. Methods The end stage renal disease patients undergoing implantation of prosthetic graft in Haidian Hospital from October 1st, 2016 to December 31st, 2017 were enrolled in this retrospective study. According to the graft type, patients were divided into Acuseal group (observation group) and Propaten group (control group). Early cannulation time, survival rate and access related complications were compared between the two groups. Results There were no statistical differences in age, gender, primary disease, age of dialysis, drugs used, laboratory results and the inner diameter of the anastomotic vessels between observation group (n=45) and control group (n=75). Compared with control group, patients in observation group had shorter early cannulation time (3.0±2.53 days vs. 54.08±23.73 days, P=0.000), lower primary survival rates after 6 months and 12 months (60% and 37.78% vs. 81.33% and 65.33%, P=0.018 and 0.004), lower primary assisted survival rates after 6 months and 12 months (68.89% and 55.56% vs. 94.67% and 82.67%, P=0.00 and 0.001). The cumulative survival rates after 6 months and 12 months in observation group and control group were 91.11% and 88.89% vs. 100% and 94.67% (P=0.293). Access-related complications such as infection, ischemia and pseudoaneurysm were similar in both groups, except 4 cases with layer separation in graft in observation group. Conclusion Acuseal graft allows for early blood access, but its primary survival rate and primary assisted survival rate are lower. The pros and cons should be considered during the selection of prosthetic grafts. Metrics

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Risk factors for autologous arteriovenous fistula dysfunction in hemodailysis patients: a meta analysis 2019, 18 (10):  705-709.  doi: 10.3969/j.issn.1671-4091.2019.10.012 Abstract ( 309 )   PDF (1251KB) ( 1104 )   【Abstract】Objective To explore the risk factors for arteriovenous fistula (AVF) dysfunction in hemodialysis patients in order to provide the basis for early identification of AVF dysfunction. Methods We searched databases including Cochrane Library, PubMed, Medline, Web of Science, CNKI, WanFang Data, and VIP from inception to February 2017 to collect the risk factors for AVF dysfunction in adult patients. RevMan 5.3 software was used for meta-analysis. Results A total of 2,873 cases were included. Meta analysis showed that the combined OR value or MD value (95% CI, P value) of the risk factors for AVF dysfunction were age 4.39(1.43~7.34, P=0.004), combined diabetes 2.53(1.89~3.39, P<0.001), primary diabetic nephropathy 2.2(1.69~3.04, P＜0.001), occurrence of hypotension 2.90 (1.17~7.16, P=0.020), C- reactive protein 15.75(14.51~16.99, P＜0.001), serum phosphorus 0.27(0.22~0.32, P<0.001), parathyroid hormone 93.95(92.21~95.68, P<0.001), hemoglobin -2.5(-3.70~-1.31,  P<0.001), white blood cells (0.08~1.93, P=0.030), and platelet 23.55 (1.10～45.99, P=0.040). Conclusion Older age, diabetes mellitus, diabetic nephropathy as the primary disease, the occurrence of hypotension, and higher levels of C-reactive protein, blood phosphorus, parathyroid hormone, white blood cells and platelet were the risk factors for AVF dysfunction in hemodialysis patients; hemoglobin is a protection factor. Therefore, clinical measures should be focused on the early intervention of the controllable risk factors for AVF dysfunction. Metrics

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Problems frequently encountered in the editing of the manuscripts published on Chinese Journal of Blood Purification#br# 2019, 18 (10):  710-712.  doi: 10.3969/j.issn.1671-4091.2019.10.013 Abstract ( 228 )   PDF (352KB) ( 716 )   【Abstract】Objective We analyzed the common problems in the manuscripts that have to be revised by authors at the processing stage in the Editorial Board of Chinese Journal of Blood Purification, in order to improve the formats of the papers, to understand the requirements for submission of manuscripts by authors, and to ensure a high quality of the journal. Methods The causes that lead to the return of the manuscripts for revision by authors at the processing stage in the period from Jan. 2018 to Jun. 2018 were analyzed through online search for the processing courses in the editing system of Chinese Journal of Blood Purification. Results A total of 105 manuscripts were processed for publication in this period; the manuscripts were sent back for revision for a total of 100 times with a total of 216 editing problems, of which the top three were faults in figure and/or table design, word expression and numerical data processing (24.54%), misuse or omitted use of statistics (21.76%), and errors in medical terminology applications (20.37%). Other causes for the revision included wrong reference format (16.20%), the absence of information about the names of authors and/or corresponding authors and their affiliations (10.19%), and manuscripts with inappropriate arrangement of their contents, too more words and out of focus on its objective and conclusion (6.94%). Conclusion Many faults were present in most manuscripts at the time of submission. These manuscripts usually had the shortcomings in design of figures and tables, statistical analyses, expression of medical terminology, and reference format, leading to the return of the manuscript to authors for revision at the processing stage. Therefore, authors are expected to avoid these shortcomings and to improve their writing ability before submission. Staff members in the Editorial Board are ready to help authors find out and correct these shortcomings to pursue a high quality of Chinese Journal of Blood Purification. Metrics

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Application and nursing observation of mixed dilution method in hemodiafiltration treatment in plateau area#br# 2019, 18 (10):  728-730.  doi: 10.3969/j.issn.1671-4091.2019.10.019 Abstract ( 224 )   PDF (412KB) ( 660 )   【Abstract】Objective To observe the application and nursing of mixed dilution method in hemodiafiltration treatment in plateau area. Methods A total of 76 hemodialysis patients were randomly divided into experiment group (mixed dilution method, n=39) and control group (post-dilution method, n=37). The effects of toxin clearance, coagulation in dialyzer, amount of heparin used, alarm frequency, and the subjective comfort degree were compared between the two groups. Reults Blood samples were taken before and after dialysis, and renal function tests were performed. Compared with post- dilution method, mixed dilution method increased the decreased creatinine clearance rate by 25.47%(t=9.706, P=0.024), the decreased urea nitrogen clearance rate by 12.21% (t=5.571, P=0.047), and the decreased β2 microglobulin clearance rate by 14.41% (t=7.669, P= 0.038). By the observation of coagulation grade in dialyzer and the amount of heparin used, the mixed dilution method also showed the advantages of improving coagulation grade in dialyzer and reducing heparin amount used by 50.63% (from 6.32 IU to 3.12 IU; t=25.469, P=0.010). The subjective comfort degree observed by a suitable scale demonstrated that mixed dilution method increased the quality of life score by 38.66% (t=4.444, P=0.035) and appetite score by 37.28% (t=5.845, P=0.042), and decreased sleep quality score by 50.63% (t=25.469, P=0.028) and skin itching degree score by 44.55% (t=15.132, P=0.036). Conclusion With the prerequisite for adequate effect of hemodiafiltration, mixed dilution method is more suitable than post-dilution method for hemodialysis patients in plateau areas. Therefore, this method of hemodiafiltration is useful for clinical use. Metrics

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Establishment of a performance evaluation system for nursing staff working in hemodialysis units based on the balanced scorecard#br# 2019, 18 (10):  731-734.  doi: 10.3969/j.issn.1671-4091.2019.10.020 Abstract ( 194 )   PDF (408KB) ( 757 )   【Abstract】Object To establish a suitable system for performance evaluation of the nursing staff working in hemodialysis units. Method Based on the idea of balanced score card, the Delphi and analytic hierarchy process were adopted to establish the indicator system and to determine the weight of corresponding indicators. Results Two cycles of consultation with experts were performed. The enthusiasm coefficient of the authoritative experts was 95.5%. The indicator system included 4 first level indicators (quality of nurses, satisfaction investigation, work achievement, and study-and-growth), 13 secondary level indicators and 49 tertiary indicators. Conclusion This indicator system is logical, reliable and operable. The evaluation results derived from this indicator system provide a scientific basis for the optimal management of nurses in hemodialysis units. Metrics