Chinese Journal of Blood Purification

12 December 2019, Volume 18 Issue 12 Previous Issue    Next Issue

Select

The changes of abdominal CT image and their influence factors in peritoneal dialysis related peritoneal injury#br# 2019, 18 (12):  809-813.  doi: 10.3969/j.issn.1671-4091.2019.12.001 Abstract ( 399 )   PDF (444KB) ( 652 )   【Abstract】Aim To understand the changes of abdominal CT image and their influence factors in continuous ambulatory peritoneal dialysis (CAPD) patients with peritoneal injury. Methods A total of 173 CAPD patients regularly followed up in our center were subjected to abdominal CT scan. The relationship between the abnormal CT image indices and the clinical indices of age, dialysis age, primary disease, type of peritoneal transport, glucose exposure and number of peritonitis episodes were analyzed in 109 patients who met the criteria of peritoneal injury. Logistic regression was used to evaluate the influence factors for increased thickness of peritoneum and abnormal omental structure as well as the relationship between the number of peritonitis episodes and the increased thickness of peritoneum and abnormal omental structure. Results In the 109 patients with peritoneal injury, 70 had increased thickness of parietal peritoneum (64.22%) and 63 showed abnormal omental structure (57.8%) on abdominal CT scan. Multivariate regression analyses revealed that the episode number and the cumulative score of peritonitis were the independent risk factors for increased thickness of peritoneum and abnormal omental structure. The risk prediction model suggested that the risks of peritoneal thickening and abnormal omental structure increased 4.364 (OR=4.364, 95% CI 1.886～10.098) and 5.393 (OR=5.393, 95% CI 2.204～13.197) times respectively after every episode of peritonitis. Conclusions The increased thickness of parietal peritoneum and abnormal omentum structure were the main imaging features in CAPD patients with progressive peritoneal injury. The major risk factor for progressive peritoneal injury was peritonitis. Abdominal CT scan is useful to comprehensively investigate the characteristics and extent of peritoneal injury and to diagnose peritoneal injury earlier. Metrics

Select

Effect of intradialytic protein- rich meals on nutritional parameters in hemodialysis patients 2019, 18 (12):  813-817.  doi: 10.3969/j.issn.1671-4091.2019.12.002 Abstract ( 412 )   PDF (434KB) ( 776 )   【Abstract】Objective The aim of this study was to evaluate the effect of intradialytic protein-rich meals (egg + milk) on nutritional parameters in maintenance hemodialysis (MHD) patients. Method This was a single center and non-randomized study. Fifty-three patients with hypoalbuminemia (plasma albumin ＜40g/L) were assigned into control group (hemodialysis on Monday, Wednesday and Friday; n=26) or intervention group (hemodialysis on Tuesday, Thursday and Saturday; n=27). The control group received standardized nutritional counseling, and the intervention group received standardized nutritional counseling plus intradialytic protein-rich meal three times a week. They were observed for 3 months. Biochemical and body composition parameters were examined in both groups. Results In the invention group, compared with baseline and control group, serum albumin increased significantly after intervention for 3 months (t/Z=3.493, - 3.851;P＜0.001, ＜0.001). In the intervention group, baseline normalized protein catabolic rate(nPCR) ＜1.0g/(kg •d) was found in 11 patients; at the end of the intervention, nPCR was increased significantly[＞1.0g/(kg•d)] in 7(64%)of them（t=-5.267, P＜0.001). After the intervention, CO2-CP decreased (t=3.667,P=0.001) and blood urea nitrogen increased (t=-2.885,P=0.008) as compared with the baseline values. Conclusions Intradialysis protein-rich meals improved serum albumin level in MHD patients. Metrics

Select

Clinical features and prognosis of active tuberculosis in patients under hemodialysis 2019, 18 (12):  818-821.  doi: 10.3969/j.issn.1671-4091.2019.12.003 Abstract ( 299 )   PDF (415KB) ( 677 )   【Abstract】Objective To investigate the clinical features, diagnosis, treatment and prognosis of active tuberculosis in patients undergoing hemodialysis (HD). Methods The clinical data of 36 HD patients with active tuberculosis and treated in the period from Jan. 1, 2014 to Jan. 1, 2018 in our hospital were studied retrospectively. Their survival rates were expressed using Kaplan-Meier curve. Log-rank test and Cox regression model were used to analyze their prognosis. Results The chief clinical manifestations were fever (58.33%) and extra-pulmonary tuberculosis (72.22%) in the 36 patients. The diagnosis was made by the combination of bacteriological and histological methods in 16 cases (44.44%), and by clinical manifestations and other examinations in 20 patients. Nineteen patients (52.78%) developed the side-effects of anti-tuberculosis drugs, including peripheral neuropathy, retro-bulbar neuritis and digestive disorders. Eleven patients (30.56%) died in the follow- up period from 3 days to 48 months. Univariate analyses showed that albumin ＜35g/L (P=0.011), age ≥60 years (P＜0.005) and comorbidities ≥ 2 (P=0.022) were closely related to unfavorable prognosis. Cox regression analysis showed that age was the independent risk factor for prognosis in HD patients with active tuberculosis (P=0.022). Conclusion There were no specific manifestations in HD patients with active tuberculosis. The incidence of side-effects of anti-tuberculosis drugs was higher and the prognosis was poorer in these patients. Nutritional status, age and comorbidities were the important risk factors for prognosis. Metrics

Select

Performance evaluation of two different dilution modes during continuous veno-venous hemodiafiltration 2019, 18 (12):  822-825.  doi: 10.3969/j.issn.1671-4091.2019.12.004 Abstract ( 302 )   PDF (389KB) ( 677 )   【Abstract】Objective To investigate the effect of two different dilution modes during continuous venovenous hemodiafiltration (CVVHDF). Method Twenty patients who received CVVHDF with PRISMAFLEX V8.0 machine in West China Hospital were randomly assigned to pre- and post-dilution or total post-dilution, and then crossed over with each other. The life span of extracorporeal circuit and other performance metrics were compared between the two groups. Result During the treatment, there were no statistically significant differences in the changes of coagulation function indicators (t=0.654, P=0.521). There was no statistically significant difference in the frequency of blood pump suspension caused by alarm of venous pressure (t=0.539, P=0.232) and arterial pressure (t=0.705, P=0.415) per hour between the two groups. The average service life of extracorporeal circulation pipeline in the post-dilution treatment mode was 28.80±16.85 h, which was shorter than 40.25±20.32 h in the post-dilution treatment mode, and the difference was statistically significant (t=3.712, P=0.001). There were no statistically significant differences in the clearance efficiency of creatinine (t=-0.669, P=0.512) and urea (t=0.030, P=0.977) between the two groups. Conclusion Compared with post-dilution mode, pre- and post-dilution can effectively prolong the life-span of extracorporeal circuit during CVVHDF, and should be recommended in clinical practice. Metrics

Select

Long-term survival analysis of maintenance hemodialysis patients 2019, 18 (12):  826-829.  doi: 10.3969/j.issn.1671-4091.2019.12.005 Abstract ( 540 )   PDF (374KB) ( 961 )   【Abstract】Objective Through the analysis of multiple related factors in maintenance hemodialysis (MHD) patients in a single center, the factors affecting long-term survival were evaluated for the improvement of survival rate and quality of life in MHD patients. Methods We retrospectively analyzed clinical records of 235 patients treated with MHD for more than 3 months in the Blood Purification Center, the Second Hospital of Shanxi Medical University between January 2010 and December 2017 to explore the impact of related factors on survival of MHD patients. Results Among the 235 MHD patients, 133 were males and 102 were females. The survival rate was 93.7% in one year, 81.4% in three years, 76.2% in five years and 16.4% in ten years. The longest survival patient lasted MHD for 252 months and still survived well. Older age at the first dialysis (RR=1.03, P＜0.001), diabetic nephropathy (RR=2.24, P＜0.001), dialysis frequency <2 times per week (RR=2.34, P＜0.001) and higher blood phosphorus before dialysis (RR=1.34, P＜0.001) increased the risk of death in MHD patients. Autologous arteriovenous fistula beginning from the first vascular access (RR=0.78, P＜0.001), urea clearance index (Kt/V) >1.2 (RR=0.72, P＜0.001) and higher hemoglobin (RR=0.76, P＜ 0.001) and albumin levels (RR=0.61, P＜0.001) decreased the risk of death in MHD patients. Conclusion As the hemodialysis treatment prolonged, the long-term survival rate declined gradually. Older age at the first dialysis, diabetic nephropathy and high levels of blood phosphorus before dialysis were the risk factors for survival. Autologous arteriovenous fistula used earlier, better dialysis adequacy and higher hemoglobin and albumin levels were the protection factors for survival in MHD patients. Metrics

Select

Analysis of risk factors for severe hypocalcemia in maintenance hemodialysis patients with secondary hyperparathyroidism after parathyroidectomy#br# 2019, 18 (12):  830-833.  doi: 10.3969/j.issn.1671-4091.2019.12.006 Abstract ( 326 )   PDF (390KB) ( 696 )   【Abstract】Objective To investigate the risk factors for postoperative severe hypocalcemia (SH) in maintenance hemodialysis (MHD) patients with secondary hyperparathyroidism (SHPT) after parathyroidectomy (PTX). Method The clinical data of 59 MHD patients with SHPT and undergoing PTX in Shanghai General Hospital from May 2010 to May 2018 were collected. Based on postoperative serum calcium level, they were divided into group A (with SH) and group B (without SH). Multivariate logistic regression analysis was used to determine the risk factors for postoperative SH. Results Among the 59 patients, hypocalcemia occurred in 49 cases and SH in 32 cases. Multivariate regression analysis showed that preoperative alkaline phosphatase (β= 0.185, P=0.045), preoperative parathyroid hormone (β=0.004, P=0.040) and dry weight (β=0.027, P=0.034) were the risk factors for postoperative SH. Conclusion Preoperative alkaline phosphatase, preoperative parathyroid hormone and dry weight are the risk factors for SH in MHD patients with SHPT after PTX. Metrics

Select

Application of antibacterial dressing containing chlorhexidine gluconate for long- term hemodialysis catheters#br# 2019, 18 (12):  834-836.  doi: 10.3969/j.issn.1671-4091.2019.12.007 Abstract ( 352 )   PDF (398KB) ( 672 )   【Abstract】Objective To investigate the effect of antimicrobial transparent dressing containing chlorhexidine gluconate on the maintenance of long-term hemodialysis catheters. Methods This was a single- center prospective cohort study enrolling 56 patients with long-term catheters. The patients in the observation group were treated with antimicrobial transparent dressing containing chlorhexidine gluconate at the outlet of longterm catheters, and the dressing was replaced once a week. The patients in the control group were given traditional sterile gauze dressing, which was changed three times a week. The length of long-term catheter outside of the outlet was measured and recorded. The rates of catheter-related infection and catheter slippage in the two groups were observed for 12 months. Results Kaplan-Meier survival curve showed that there was no significant difference in catheter-related infection rate between the two groups (log-rank test, P=0.078). The catheter slippage rate was lower in the observation group than in the control group (log-rank test, P=0.040). Conclusion Antimicrobial transparent dressing containing chlorhexidine gluconate can effectively reduce the catheter slippage rate in hemodialysis patients. However, there is no significant difference in catheter-related infection rate between the two groups. Metrics

Select

Analysis of long- term patency in hemodialysis patients with lower extremity arteriovenous grafts 2019, 18 (12):  837-840.  doi: 10.3969/j.issn.1671-4091.2019.12.008 Abstract ( 284 )   PDF (399KB) ( 690 )   【Abstract】Objective To analyze the long-term patency in hemodialysis patients with lower extremity arteriovenous grafts (AVG). Method This was a retrospective analysis including 19 lower extremity AVGs constructed during January 2015 to October 2017. Their primary, assisted primary and secondary patency rates were calculated. The events leading to patency failure were analyzed. The stenosis sites were described. Results A total of 19 patients were enrolled in this study. At the 6th month, 12th month and 24th months, the primary patency rates were 79 %, 63 % and 31 % respectively, the assisted primary patency rates were 100 %, 95 % and 69 % respectively, and the secondary patency rates were all 100 %. Conclusion Lower extremity AVG had lower patency rate, but it still can be optional in patients with unusable upper extremity vein. Metrics

Select

Application of traction for the treatment of stuck tunnel cuffed central venous catheters 2019, 18 (12):  841-843.  doi: 10.3969/j.issn.1671-4091.2019.12.009 Abstract ( 224 )   PDF (415KB) ( 663 )   【Abstract】Objective To summarize the application of traction for removal of stuck tunnel cuffed central venous catheters. Methods The cases of incarcerated tunnel cuffed central venous catheters treated in the Second Hospital of Lanzhou University from 2016 to 2019 were retrospectively reviewed. The traction device for orthopedics was used to obtain fixed and continuous tension on the catheter to broke the fibrous tissue around the catheter and then remove the catheter. Results A total of 10 patients were enrolled. All the incarcerated catheters were successfully removed by traction. During traction, complete postural limitation was unnecessary and patients can get out of bed when required. All cases cooperated well in the treatment. No complications occurred, such as bleeding, arrhythmia and catheter rupture that required special intervention. Conclusion The traction method has the advantages of simplicity, non-invasiveness, low cost, low risk and higher patient acceptance. It is worthy of clinical use. Metrics

Select

Effects of integrated doctor-nurse-patient with PDCA management mode on hypocalcemia in maintenance hemodialysis patients#br# 2019, 18 (12):  861-864.  doi: 10.3969/j.issn.1671-4091.2019.12.015 Abstract ( 292 )   PDF (485KB) ( 761 )   【Abstract】Objective To investigate the effects of integrated doctor-nurse-patient with PDCA management mode on hypocalcemia in maintenance hemodialysis (MHD) patients, in order to establish an effective and delicate management mode for MHD patients. Methods The patients treated in Dec. 2017 in our hospital and with dialysis age over three months were enrolled in this study. Their baseline serum calcium, 25-hydroxyvitamin total D3, treatment compliance, satisfaction index were recruited. The integrated doctor-nurse-patient with PDCA management mode was conducted from Jan. 2018, and lasted for one year. These parameters were evaluated again at Dec. 2018. Results A total of 320 patients were enrolled in this study. Serum calcium, 25- hydroxyvitamin total D3 and the incidence of hypocalcemia improved significantly in intervention group as compared with control group (P＜0.05). The awareness of disease state, compliance with medication treatment, compliance with correct drug intake, compliance with periodic blood tests, and satisfaction index also improved significantly in intervention group as compared with control group (P＜0.05). Conclusion The integrated doctor-nurse-patient with PDCA(plan, do, check, act) management mode can effectively improve hypocalcemia, blood purification quality control indicators, patient compliance and satisfaction index in MHD patients. This mode is clinically useful for MHD patients. Metrics

Select

Factors affecting the re- hospitalization due to chronic cardiac insufficiency in patients on continuous ambulatory peritoneal dialysis#br# 2019, 18 (12):  865-868.  doi: 10.3969/j.issn.1671-4091.2019.12.016 Abstract ( 280 )   PDF (396KB) ( 638 )   【Abstract】Objective To explore the risk factors for the re- hospitalization within six months due to chronic cardiac insufficiency in patients on continuous ambulatory peritoneal dialysis (CAPD). Methods We retrospectively analyzed 204 CAPD patients who were diagnosed chronic cardiac insufficiency from January 2017 to December 2018. Log-rank test for univariate analysis and Cox regression model for multivariate analysis were used to explore the cause of re-hospitalization due to chronic cardiac insufficiency in these CAPD patients. Results Re- hospitalization within six months happened in 59 cases with the recurrence rate of 28.92%. There are statistically differences in blood urea nitrogen (c2=3.765, P=0.017), serum pre- albumin (c2=6.021, P=0.001), systolic blood pressure (c2=4.652, P=0.015), diastolic blood pressure (c2=3.623, P=0.018), volume management (c2=6.211, P=0.001), edema degree (c2=6.041, P=0.001) between the two groups. Multivariate Cox regression analyses showed that volume management (95% CI 1.298～2.432, OR=2.003, P= 0.023), serum pre-albumin (95% CI 1.421～2.765, OR=2.112, P=0.001) and edema degree (95% CI1.021～2.002, OR=1.675, P=0.034) were the risk factors for re- admission within six months in CAPD patients. Conclusion Nurses working for CAPD patients should increase their abilities in volume management, improvement of nutritional status and edema classification to reduce the re-admission rate. Metrics

Select

Design and application of the "Hemodialysis Safety Checklist" 2019, 18 (12):  869-871.  doi: 10.3969/j.issn.1671-4091.2019.12.017 Abstract ( 265 )   PDF (432KB) ( 841 )   【Abstract】Objective To design a "Hemodialysis Safety Checklist" for clinical use, in order to standardize the hemodialysis procedure, raise the rate of standardized treatment and nursing operations, and increase the overall safety and nursing quality in hemodialysis center. Methods We first retrospectively analyzed the causes of hemodialysis incidents from 2016 to 2018 in the Hemodialysis Center, Zigong First People's Hospital, Sichuan Province. A primary checklist of“Questionnaire for the Present Performance of Hemodialysis Nursing Operations" was set up following the Hemodialysis Guidelines, using the hemodialysis safety checklists from foreign countries as the references, and taking the present status in Zigong city as the basis. A "Hemodialysis Safety Checklist" was then designed based on the practice results of the“Questionnaire for the Present Performance of Hemodialysis Nursing Operations" and two rounds of consultation from experts using the Delphi method. We inspected the operations for patients before entering the hemodialysis room, and before, during and after hemodialysis according to the checklist in "Hemodialysis Safety Checklist". Results The“Hemodialysis Safety Checklist”contained 24 items in the 4 stages. The research objects, including doctors (n=30) and nurses (n=30) working in hemodialysis centers and maintenance hemodialysis patients (n=30), were recruited from 4 higher level hospitals in Zigong city, Sichuan Province. Their implementation rate was 70.00% before use and 93.33% after use of the "Hemodialysis Safety Checklist". The difference in overall implementation rate was statistically significant (c2=5.455, P=0.020). The satisfaction rate of doctors, nurses and patients increased significantly (c2=4.043, 4.320 and 5.455 respectively; P=0.044, 0.038 and 0.020 respectively). No adverse events occurred. Conclusion The implementation of the "Hemodialysis Safety Checklist" can standardize the nursing operations, raise the application rate of guidelines, and provide reliable safety management and higher quality care for hemodialysis patients. Metrics