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Chinese Journal of Blood Purification

Chinese Journal of Blood Purification

    20 January 2020, Volume 19 Issue 01 Previous Issue    Next Issue
    How to raise the influence of sci-tech periodicals in the new era#br# ZHANG Qi1,2 #br#
    2020, 19 (01):  1-2.  doi: 10.3969/j.issn.1671-4091.2020.01.001
    Abstract ( 263 )   PDF (326KB) ( 947 )  
    【Abstract】With the entry of socialism with Chinese characteristics into a new era and the rapid development of information technology, sci-tech periodicals have faced new opportunities as well as challenges. Here we used our periodical the Chinese Journal of Blood Purification as an example to explore the ways to improve the influence of sci-tech periodicals, which include the objectives of the journal, the use of digital platform, and training of personnel. Chinese sci-tech periodicals are expected to have more influence through the priorities of right political direction, personnel training, professionalization, authority, diversity, high quality, and fusion media application of the periodicals.
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    Related factors of unscheduled interruption during prolonged intermittent renal replacement therapy
    Xue-Jie LI Xi-zi ZHENG Chong-yan YU Qi-zhuang JIN
    2020, 19 (01):  3-6.  doi: 10.3969/j.issn.1671-4091.2020.01.002
    Abstract ( 320 )   PDF (724KB) ( 623 )  
    【Abstract】Objective To explore the related factors of unscheduled interruption during prolonged intermittent renal replacement therapy (PIRRT). Method The medical records of all patients received PIRRT in the Renal Department of Peking University First Hospital from January 2017 to December 2017 were retrospectively reviewed. Circuit and patient data were collected and analyzed. Result A total of 82 patients with 898 circuits were finally included in this study, in which 259 circuits (28.8%) were considered as unscheduled interruption. Circuit clotting was observed in 212 cases of the unscheduled interruption (81.9%). Compared to the scheduled group, the unscheduled group was more likely not to receive anticoagulation (34.7% vs. 13.3%,
    χ2=71.941, P<0.001), to use femoral vein catheters (68.3% vs. 59.8%, χ2=5.745, P=0.010), and to have higher level of the highest filtration fraction (31.7±5.3% vs. 31.0±4.6%, t=-1.985, P=0.047). There were no significant differences in the education degree of nurses (62.9% vs. 64.9%, χ2=0.304, P=0.318), working years of nurses (3.3 ± 2.0 vs. 3.6 ± 2.1, t=- 0.971, P=0.064), and patient- nurse ratio (1.8 ± 0.7 vs. 1.9 ± 0.8, t=- 1.833, P=0.360) between the two groups. Conclusion The main reason for unscheduled interruption during PIRRT in our dialysis center was circuit clotting caused by inappropriate use of anticoagulation, higher filtration fraction and catheter malfunction. After regular and standardized training, the education degree and working years of nurses had no significant impact on unscheduled interruption.
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    Effects of red blood cell distribution width and neutrophil/lymphocyte ratio on the prognosis of maintenance hemodialysis patients#br#
    2020, 19 (01):  7-11.  doi: 10.3969/j.issn.1671-4091.2020.01.003
    Abstract ( 308 )   PDF (489KB) ( 667 )  
    【Abstract】Objective To explore the red blood cell distribution width (RDW) and neutrophil/lymphocyte ratio (NLR) on the prognosis of maintenance hemodialysis (MHD) patients. Methods Clinical data of the end-stage renal disease (ESRD) patients treated with regular dialysis for more than 3 months and with stable condition in the Hemodialysis Center of the First Affiliated Hospital of Bengbu Medical College from January 1, 2017 to December 31, 2018 were retrospectively analyzed. Patients were divided into two groups based on the difference of RDW, and the general conditions and hematological indicators such as RDW were compared between the two groups. Patients were also divided into two groups based on the presence or absence of adverse events, and their RDW and NLR were compared between the two groups. Kaplan-Meier curve and COX regression model were used to analyze RDW and NLR for independent prediction of prognosis in MHD patients. Results A total of 221 MHD patients with the age of 56.3±13.1 years old and dialysis age of 31.0 (8.0, 58.9) months were included in this study. Adverse events were found in 68 patients, in which 29 cases died and 39 cases had non-fatal events. In the adverse event group, the mean RDW and NLR were higher than those in the non-event and survival group (Z=2.642 and 5.044 respectively; P=0.009 and <0.001 respectively). COX regression analysis showed that time mean RDW (HR=1.300, 95% CI: 1.000～1.691, P=0.049) and
    NLR (HR=1.189, 95% CI: 1.074～1.316, P= 0.001) were the independent risk factors for adverse events in MHD patients. Conclusion Higher time mean RDW and NLR can independently predict the occurrence of adverse events in MHD patients.
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    Analysis of frailty related factors in elderly maintenance hemodialysis patients
    2020, 19 (01):  12-16.  doi: 10.3969/j.issn.1671-4091.2020.01.004
    Abstract ( 361 )   PDF (472KB) ( 686 )  
    【Abstract】Objective The purpose of this study was to explore the factors relating to frailty in elderly maintenance hemodialysis (MHD) patients. Method A total of 92 patients with regular MHD in the First Hospital of Shanxi Medical University from April 2017 to April 2019 were recruited. Frailty scores were estimated by a frailty symptom scale. The patients were then divided into non-frailty group, pre-frailty group and frailty group according to the frailty scores. General conditions, laboratory indicators and depression status of the patients were analyzed and compared between the groups. Spearman rank correlation analysis was used to evaluate the correlation between frailty scores and other indicators. Multivariate logistic regression analysis was conducted to analyze the risk factors for frailty in elderly MHD patients. Result Among the 92 elderly MHD patients, 32 cases were in the non-frailty group (34.78%), 29 cases in the pre-frailty group (31.52%), and 31 cases in the frailty group (33.70%). Age (F=23.094 P＜0.001), dialysis age (F=11.405, P=0.003), hemoglobin (F=16.327, P<0.001), serum levels of albumin (F=15.347, P＜0.001), prealbumin (F=6.759, P=0.002), C- reactive protein (CRP) (F=7.851, P=0.001), 25- hydroxyvitamin D (F=18.367, P<0.001), urea (F=5.017, P=0.009) and creatinine (F=4.985, P=0.009), and depression (χ2=10.549, P=0.005) were statistically significant between the three groups. Frailty scores were positively correlated with C- reactive protein (r=0.327, P= 0.001),urea(r=0.285, P=0.006), creatinine (r=0.322,P=0.002) and depression (r=0.503, P<0.001), and were negatively correlated with dialysis age (r=- 0.468, P＜0.001), hemoglobin (r=- 0.533, P＜0.001), serum albumin (r=0.281, P=0.007) and serum 25-hydroxyvitamin D (r=0.524, P<0.001). Dialysis age (OR= 11.000, 95% CI=0.888～0.970, P=0.001), hemoglobin (OR=13.189, 95% CI=0.803～0.936, P<0.001), serum levels of albumin (OR=8.158, 95% CI=0.591～0.907, P=0.004), C- reactive protein (OR=6.650, 95% CI= 1.099～2.002, P=0.010) and 25- hydroxyvitamin D (OR=16.392, 95% CI=0.666～0.868, P<0.001), and depression (OR=3.939, 95% CI=1.015～10.457, P=0.047) were the influencing factors for frailty in elderly MHD patients. Conclusion The prevalence of frailty was higher in elderly MHD patients. Frailty was related to hemoglobin, serum levels of albumin, CRP and 25-hydroxyvitamin D, depression and dialysis vintage.
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    The effect of baseline parathyroid hormone level on the prognosis of peritoneal dialysis patients
    2020, 19 (01):  17-20.  doi: 10.3969/j.issn.1671-4091.2020.01.005
    Abstract ( 277 )   PDF (470KB) ( 615 )  
    【Abstract】Objective The purpose of this study was to investigate the changes of serum intact parathyroid hormone (iPTH) and its related factors in incident peritoneal dialysis (PD) patients, and to assess its impact on long-term survival of PD patients. Methods Clinical data were analyzed for all adult chronic renal failure patients initiating PD therapy. According to the iPTH level, patients were divided into four groups: group A (iPTH ＜150pg/ml), group B (iPTH 150~300pg/ml), group C (iPTH 300~ 600 pg/ml), and group D (iPTH ≥600pg/ml). Variance analysis and χ2 test were used to compare the clinical and laboratory data of the four groups. Multiple linear regression was used to screen the risk factors for baseline iPTH level. Cox regression model was used to analyze the factors for survival rate. Kaplan-Meier survival analysis and Cox regression model were used to compare the survival rate of the four groups. Results This study enrolled 222 patients, in which baseline iPTH <150 pg/ml accounted for 43.7% of the patients. The patients with baseline iPTH <150 pg/ml had the characteristics of older age (F=6.235, P<0.001), higher incidence of diabetes mellitus (F=16.277, P=0.001), more complications (F=4.348, P=0.005), and higher eGFR (F= 5.699, P=0.001). However, multiple linear regression revealed that only age (β =- 8.700, P＜0.001) and diabetes mellitus
    (β=145.400, P=0.012) had the independent effects on baseline iPTH level. Kaplan- Meier survival curve showed that the survival rate was different among the four groups (P=0.002). Multivariate COX regression showed that only age (β=0.066, P< 0.001) was the independent risk factor for predicting mortality, and baseline iPTH level (P=0.507) could not independently predict mortality. Conclusion The incident PD patients with older age and diabetes mellitus were more likely to have lower baseline iPTH. However, baseline iPTH level could not independently predict mortality.
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    Clinical analysis of peritoneal dialysis tube implantation and complications in children with renal failure
    2020, 19 (01):  21-24.  doi: 10.3969/j.issn.1671-4091.2020.01.006
    Abstract ( 328 )   PDF (438KB) ( 604 )  
    【Abstract】Objective To improve the method of peritoneal dialysis catheterization in children in order to reduce the postoperative complications and to increase the efficiency of peritoneal dialysis (PD). Methods The children undergoing PD catheterization in the Department of Pediatric Surgery, Peking University First Hospital from January 2015 to December 2018 were retrospectively reviewed. Results A total of 51 cases were enrolled in this study. According to the method of catheterization, they were divided into unresected omentum group (n=23) and partial resected omentum group (n=28). In unresected omentum group, the catheter was inserted into abdominal cavity through a distance of abdominal wall in right rectus abdominis; postoperative occlusion of the tube was found in 5 cases (21.74%). In partial resected omentum group, the catheters were placed using the same method and the omentum was partially removed; no postoperative occlusion of the tube was found and no secondary operation was required. The difference in catheter occlusion was statistically significant between the two groups (χ2=6.749,P=0.009). No postoperative infection occurred in both groups. Conclusion The PD catheter inserted into abdominal cavity through a distance of abdominal wall in right rectus abdominis and partial removal of omentum can significantly reduce the postoperative complications and the requirement for secondary operation, facilitating the PD management in children.
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    The impact of motivational interview on self-management ability and quality of life in maintenance hemodialysis patients #br#
    2020, 19 (01):  25-28.  doi: 10.3969/j.issn.1671-4091.2020.01.007
    Abstract ( 234 )   PDF (427KB) ( 659 )  
    【Abstract】Objective To investigate the impact of motivational interview on self-management ability and quality of life in maintenance hemodialysis (MHD) patients. Methods A total of 100 MHD patients were recruited in a top-level hospital in Hangzhou city. According to the duration of hemodialysis, the patients were divided into the intervention group (n=50) and the control group (n=50). The control group adopted the traditional health education method, and the intervention group received the motivational interview. Self-management scale and kidney disease specific questionnaire were used to evaluate their self-management ability and quality of life before intervention and after the intervention for 6 months. Results In the scores of selfmanagement ability, partnership, problem solving, emotional processing, self-care and total score were statistically higher in the intervention group than in the control group (t=20.131, 13.645, 12.213, 15.012 and 17.043 respectively; P=0.021,0.012, 0.023, 0.001 and 0.004 respectively). In the scores of quality of life, somatic symptoms, fatigue, relationship with others and total score were statistically higher in the intervention group than in the control group (t=10.586, 3.560, 3.959 and 4.574 respectively; P=0.001, 0.001, 0.001 and 0.001 respectively). Conclusion Motivational interview can improve the self- management ability and quality of life in MHD patients.
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    The clinical value of preoperative color Dopppler ultrasound examination of wrist blood vessels for the prediction of arteriovenous fistula maturation#br#
    2020, 19 (01):  29-32.  doi: 10.3969/j.issn.1671-4091.2020.01.008
    Abstract ( 391 )   PDF (478KB) ( 746 )  
    【Abstract】Objective The aim of this study was to assess the accuracy of pre-operative ultrasound examination for predicting maturation of wrist radio-cephalic arteriovenous fistula (RCAVF). Methods A total of 135 patients with the first operation of RCAVF performed from August 2016 to January 2019 were enrolled in this study. Ultrasound examination for the preparation of RCAVF was conducted before the operation. RCAVF maturation was defined as the successful cannulation of fistula with two needles, delivery of blood at a flow rate >200 ml/min and blood access via fistula for at least six consecutive sessions. A comparative analysis was performed for RCAVF outcomes. Results There were ninety-nine wrist RCAVF in the patency group, twenty-four in the dysfunctional group, and twelve cases died or changed to kidney transplantation. The RCAVF patency rate was 81% at 12 months and 77% at 24 months and 32 months. Binary logistic regression analysis suggested that preoperative cephalic vein internal diameter measured by ultrasound examination was an independent risk factor for RCAVF patency (OR= 4.05, 95% CI: 1.49~11.01, P=0.006). ROC curve analysis showed that the area under the curve of the cephalic vein diameter was 0.707, and the optimal threshold was 2.075 mm. Conclusion Preoperative ultrasonography for the preparation of RCAVF showed that internal diameter of the cephalic vein was the best predictor for RCAVF patency.
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    The steal blood phenomenon and flow distribution of newly created arteriovenous radial- cephalic wrist fistula#br#
    2020, 19 (01):  33-36.  doi: 10.3969/j.issn.1671-4091.2020.01.009
    Abstract ( 288 )   PDF (373KB) ( 764 )  
    【Abstract】Objective The newly created arteriovenous radial- cephalic wrist fistula was observed by Doppler ultrasonography and the blood flow and steal blood phenomenon were recorded, in order to investigate the correlation between blood flow distribution in the fistula and steal blood phenomenon. Methods Forty-four patients with end-to-side radial-cephalic wrist fistula operation for 2～6 weeks were recruited in this study. Doppler ultrasonography was used to measure the blood flow in proximal radial artery, distal radial artery and cephalic vein of the fistula. Steal blood phenomenon was evaluated by color Doppler ultrasonography. According to the steal blood phenomenon, the patients were divided into retrograde flow in the distal radial
    artery group (groupⅠ) and antegrade flow in the distal radial artery group (groupⅡ). The blood flow in the proximal and distal radial arteries and cephalic vein of the fistula were compared between the two groups. Results Retrograde flow in the distal radial artery was found in 35 patients (group I) with the steal blood phenomenon rate of 79.5%. Antegrade flow in the distal radial artery was found in 9 patients (group II). The blood flow in the proximal radial arteries of anastomosis orifice was significantly higher in groupⅡ than in group Ⅰ (t=- 2.899, P=0.006). In contrast, the blood flow in the distal radial arteries of anastomosis orifice were significantly lower in groupⅡ than in groupⅠ (t=2.040, P=0.048). The mean blood flow in the cephalic veins had no statistical difference between group II and group I (452.22±170.50 ml/min vs. 500.31±191.49 ml/min; t=0.680, P= 0.500). In the 35 patients with retrograde flow in the distal radial artery (group I), one patient developed dialysis access induced ischemia syndrome, and the blood flow in the distal radial artery was higher than that in the proximal radial artery of anastomosis orifice. Conclusion Steal blood phenomenon is frequently found in arteriovenous fistula. Retrograde flow in the distal radial arteries (steal blood phenomenon) is critical for the maturation of arteriovenous fistula.
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    A study on dysfunction of the upper limbs with arteriovenous fistula and its influence factors in maintenance hemodialysis patients#br#
    2020, 19 (01):  37-40.  doi: 10.3969/j.issn.1671-4091.2020.01.0
    Abstract ( 318 )   PDF (435KB) ( 609 )  
    【Abstract】Objective To evaluate the function of upper limbs with arteriovenous fistula (AVF) and its related factors in patients with maintenance hemodialysis (MHD). Methods A total of 67 MHD patients with regular hemodialysis for more than 3 months in Beijing Boai Hospital of China Rehabilitation Research Center were enrolled to evaluate the upper limb functions, including grip strength, pinch force, wrist motion and simple test for evaluating hand function (STEF). Results ①Grip strength: Grip strength of the upper limbs with AVF was lower than that of the upper limbs without AVF (24.22±12.54 vs. 26.05±11.01N, t=- 2.075,
    P=0.042). Multivariate linear regression analysis showed that age, albumin and abnormal passive dorsal extension of the upper limbs with AVF were the independent risk factors for grip strength of the upper limbs with AVF (standardization coefficient β=-0.364, 0.408 and -0.231 respectively; P=0.002, 0.001 and 0.044 respectively). AVF was an independent risk factor for grip strength of dominant hand (standardization coefficient β=-0.345; P=0.006). ② Pinch force: Pinch force of the upper limbs withAVF had no significant difference with that of the upper limbs withoutAVF(thumb-forefinger: 6.24±3.78 vs. 6.19±2.13N, t=0.104, P=0.918; thumb-middle finger: 4.69 ± 1.70 vs. 4.83 ± 1.57N, t=- 0.820, P=0.417; thumb- ring finger: 2.97 ± 1.35 vs. 3.10 ± 0.99N, t=-0.808, P=0.423). ③Wrist motion: The proportion of abnormal passive palmar curvature on the AVF side was higher than that on the non-AVF side (38.6% vs. 19.3%, c2=5.160, P=0.023). ④STEF: There were no significant
    differences in the proportion of abnormal scoring (6% vs. 9%, c2=0.437, P=0.509), gross motor score (49 vs. 47, Z=-1.371, P=0.170), fine motor score (49 vs. 48, Z=-1.126, P=0.260) and total score (96 vs. 96, Z=- 1.285, P=0.199) between the upper limbs with AVF and those without AVF. Conclusion Compared with non-AVF limbs, the upper limbs with AVF have lower grip strength and abnormal passive palmar curvature in MHD patients. These dysfunctions have to be concerned by clinicians. Early intervention for the dysfunctions of grasp movement, and palmar curvature, dorsal extension and rotation of wrist joint on the AVF side should be carried out in order to improve quality of life and movement ability of MHD patients.
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    Microbiological and clinical characteristics of tunnelled and cuffed hemodialysis catheter-related bloodstream infections: analyses of 55 cases #br#
    2020, 19 (01):  41-44.  doi: 10.3969/j.issn.1671-4091.2020.01.011
    Abstract ( 300 )   PDF (428KB) ( 642 )  
    【Abstract】Objective To investigate microbiological and clinical characteristics of tunnelled and cuffed hemodialysis catheter- related bloodstream infections (CRBSIs). Methods The medical records of all patients with confirmed CRBSIs diagnosed in Peking University First Hospital from August 2008 to August 2018 were retrospectively reviewed, and 55 cases with CRBSIs were enrolled. Clinical and microbiological data were collected and analyzed. Results Fever, exit-site infection, tunnel infection and catheter dysfunction were observed in 100%, 21.8%, 7.3% and 20.0% respectively of the cases. The positive rates of blood cultures from peripheral blood (100% vs. 81.5% , P=0.047) and blood within catheters (93.3% vs. 81.5% , P=0.028) before antimicrobial therapy were significantly higher than those after antimicrobial therapy. There were 77 positive cultures that yielded 45.5% Gram-positive, 53.2% Gram-negative and 1.3% fungal isolates. The most common organism isolated was methicillin-resistant staphylococcus aureus (MRSA,19.5%). Conclusion Standardized collection of specimens is essential for the diagnosis of CRBSIs. Gram-negative isolates accounted for most tunnelled CRBSIs in our center. For patients with suspected CRBSIs, the empirical antibiotic regimen should include agents actively against both MRSA and Gram-negative bacteria.

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    Hemoglobin concentration change and its related factors in maintenance hemodialysis patients with different method of vascular access#br#
    2020, 19 (01):  45-48.  doi: 10.3969/j.issn.1671-4091.2020.01.012
    Abstract ( 261 )   PDF (422KB) ( 666 )  
    【Abstract】Objective To compare the difference of hemoglobin concentration (HB) and its related factors among maintenance hemodialysis (MHD) patients with two methods of vascular access (AVF and non-AVF) in Wuhan district. Methods The MHD patients from 40 dialysis units in Wuhan district were recruited as the research objects. Their general clinical information and biochemical indicators were collected. A total of 3,792 patients were enrolled in this study and divided into AVF group and non-AVF group. HB and other parameters were compared between the two groups. The effect of vascular access method on HB was then analyzed. Result ①The median value of spKt/V was significantly higher in AVF group than in non-AVF group (χ2=3.358, P=0.001). ②The average levels of HB, ALB, BUN and Ca were significantly higher in AVF group than in non- AVF group (t= 5.522, 13.297, 11.51 and 2.895 respectively; P＜0.001, ＜0.001, ＜0.001 and 0.004 respectively); while the average levels of Cr, P and logarithm value of PTH were significantly lower in AVF group than in non-AVF group (t=- 17.720, - 8.309 and - 3.773 respectively; P＜0.001, ＜0.001 and ＜0.001 respectively). ③ Pearson correlation analysis showed that HB was positively correlated with ALB (r=0.268, P＜0.001) and Ca (r=0.117, P＜0.001) and negatively correlated with P (r=-0.077, P=0.008) and logarithm value of PTH (r=-0.061, P=0.002) in AVF group; HB was negatively correlated with ALB (r=0.301, P＜0.001) and Cr (r=-0.131, P=0.006) in non-AVF group. ④The proportion of anemia (HB＜100g/L) was lower in AVF group than in non-AVF group (32.2% vs. 39.1%, χ2=16.043, P＜0.001). ⑤Logistic regression model after correcting various confounded factors showed that the risk of anemia in MHD patients with AVF was 19.5% lower than that in patients without AVF (OR=0.805, 95% CI 0.752～0.956, P=0.043). Conclusion HB level was higher and the risk of anemia was lower in MHD patients using AVF as blood access, as compared to those using the blood access routes other than AVF.
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    Current state of the assessment method for quality of life and the related determinants in chronic kidney disease patients#br#
    2020, 19 (01):  49-51.  doi: 10.3969/j.issn.1671-4091.2020.01.013
    Abstract ( 478 )   PDF (394KB) ( 995 )  
    【Abstract】Chronic kidney disease (CKD) is a syndrome with progressive deterioration of renal function, multisystemic disorders, and higher morbidity and mortality. Patients with CKD have poor quality of life (QOL) and are often plagued by pain, depression, insomnia and multiple comorbidities, causing great pressure on patients as well as their families and increased burden on socio-economic and public health undertakings. At present, the QOL instruments are commonly used, which can be divided into generic instruments and disease-targeted instruments, each with advantages and disadvantages and often clinically used in combination. The factors affecting the QOL in CKD patients are complicated. This paper provides a review of a variety of QOL I nstruments for CKD patients and the related determinants.
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    Research progress in the influence of different pre-transplant dialysis modalities on the prognosis of renal transplantation #br#
    2020, 19 (01):  52-55.  doi: 10.3969/j.issn.1671-4091.2020.01.014
    Abstract ( 238 )   PDF (390KB) ( 765 )  
    【Abstract】Renal replacement therapy in end stage renal disease patients include dialysis and renal transplantation. Due to the lack of sufficient donor renal organs, patients usually have to undergo a variable time of dialysis before renal transplantation. Whether the pre-transplant dialysis modalities, such as hemodialysis and peritoneal dialysis, the duration of dialysis, and no pre-transplant dialysis, impact on the early and long-term prognosis of renal transplantation remains undetermined. In this review, we will introduce the recent research progress in this issue.
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    The effects of buttonhole versus rope-ladder cannulation on the function of arteriovenous fistulas: a meta-analysis#br#
    2020, 19 (01):  65-69.  doi: 10.3969/j.issn.1671-4091.2020.01.018
    Abstract ( 419 )   PDF (998KB) ( 665 )  
    【Abstract】Objective To analyze the effects of buttonhole cannulation and rope-ladder cannulation on the function of autologous arteriovenous fistula (AVF) in maintenance hemodialysis (MHD) patients, and to select the best puncture method suitable for better use and protection of the AVF. Methods We searched for the literature relating to the influence of buttonhole cannulation and rope-ladder cannulation on MHD patients through PubMed, Cochrane Library, Elsevier, Wiley, CNKI, CBM, VIP, Wan Fang, and other Chinese and foreign databases by computer. Two evaluators independently screened the literature according to the inclusion and exclusion criteria. Methodological quality evaluation was conducted for the selected articles. Meta-analysis was carried out using RevMan5.3 software. Results Nine articles including 757 patients were finally selected.
    Meta-analysis showed that the incidence of infection in the buttonhole cannulation group increased significantly with the increase of time. When the follow-up period lasted ≤6 months, the infection rate in the buttonhole group was 3.42 times higher than that in the rope- ladder group (RR=3.42; 95% CI 0.86, 13.69) but without statistical significance (P=0.080). When the follow-up period lasted >6 months, the infection rate in the buttonhole group increased to 14.43 times higher than that in the rope-ladder group (RR=14.43; 95% CI 3.50, 59.55), and the difference between the two groups was statistically significant (RR=8.33; 95% CI 3.17,21.88; P=0.000). The incidence of vascular stenosis or obstruction was lower in the rope-ladder group than in the buttonhole group (RR=4.64; 95% CI 2.01, 10.72; P=0.000). There were no statistical differences in the incidence
    of hematoma (RR=0.70; 95% CI 0.42, 1.16; P=0.170) and thrombosis (RR=0.83; 95% CI 0.43, 1.58; P=0.570) between the two groups. Conclusion In the puncture for patients with AVF, rope-ladder cannulation method was better than buttonhole cannulation method to reduce long-term complications, and is beneficial to protect AVF and extend service life of the AVF. However, more researches are required to help develop strategies to improve buttonhole cannulation technique rather than to disable it. To better serve the patients with AVF, the advantages of buttonhole cannulation should be used as a supplement of rope-ladder cannulation.
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