Chinese Journal of Blood Purification

20 February 2020, Volume 19 Issue 02 Previous Issue    Next Issue

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Clinical characteristics of peritoneal dialysis-related peritonitis with different outcomes 2020, 19 (02):  77-80.  doi: 10.3969/j.issn.1671-4091.2020.02.002 Abstract ( 355 )   PDF (424KB) ( 931 )   【Abstract】Objective To analyze the clinical characteristics of peritoneal dialysis (PD)-related peritonitis with different outcomes and to explore the risk factors for PD-related peritonitis. Methods We retrospectively analyzed the clinical data of PD patients with PD-related peritonitis hospitalized from Jan. 2004 to Dec. 2018 in The Second Affiliated Hospital of Harbin Medical University. They were divided into cure group and exit group (change to hemodialysis or death). Their clinical characteristics were compared between the two groups. Results A total of 180 PD patients with PD-related peritonitis were included in this study. There were no significant differences in age, gender, smoking history, complications and prevalence of hypokalemia between the two groups. Compared to cure group, patients in exit group had lower plasma albumin (23.48±6.43 g/L vs. 26.84 ± 7.61 g/L, t=2.953, P=0.004) and hemoglobin (87.48 ± 19.34 g/L vs. 93.27 ± 17.50 g/L,t=2.028, P=0.044), higher fungal infection rate, higher referral rate (36.10% vs. 18.50%, χ2=6.747, P=0.009),and longer dialysis age [36.00 (12.66, 50.000) months vs. 24.00 (9.00, 42.00) months, Z=2.368, P=0.018). Multivariate logistic regression showed that longer dialysis age, referral to other department and relapse of peritonitis were the independent predictors for poor prognosis. Conclusion Nutritional status, anemia, referral to other department, relapse of peritonitis and dialysis age were associated with the prognosis in PD patients with peritonitis. Improvement of nutritional status, treatment of anemia will ameliorate the prognosis of PD patients with peritonitis. Metrics

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Relationship between baseline uric acid level and primary peritoneal dialysis- associated peritonitis 2020, 19 (02):  81-84.  doi: 10.3969/j.issn.1671-4091.2020.02.003 Abstract ( 336 )   PDF (397KB) ( 695 )   【Abstract】Objective To investigate the relationship between baseline serum uric acid level and primary peritoneal dialysis-associated peritonitis. Methods Peritoneal dialysis (PD) patients admitted to the Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University for the first time between January 2012 and January 2018 and followed up regularly for a long period of time were recruited in this study. Patients were divided into primary peritonitis group and non- peritonitis group. The relationship between baseline serum uric acid level and other related laboratory indexes was analyzed in the two groups. The level of baseline serum uric acid for the prediction of primary PD-associated peritonitis was evaluated. Results Primary peritonitis occurred in 37.3% of the 130 PD patients. Patients in primary peritonitis group had younger age (t=1.664, P=0.020), higher levels of baseline serum uric acid (t=-6.367, P<0.001) and phosphorus (t=-3.691, P<0.001) and lower hemoglobin (t=2.388, P=0.018), as compared with those in non-peritonitis group. Primary PD- associated peritonitis was positively correlated with baseline levels of serum uric acid(r=0.487, P<0.001) and serum phosphorus (r=0.310, P<0.001), and negatively correlated with hemoglobin(r=-0.206, P=0.018). Univariate regression analysis showed that higher baseline serum uric acid (OR=1.013, 95% CI=1.007~1.018, P<0.001) and lower HGB (OR=0.968, 95% CI=0.938~1.000, P=0.047) were the risk factors for primary PD-associated peritonitis. Multivariate analysis showed that higher baseline serum uric acid (OR=1.014, 95% CI=1.008~ 1.019, P<0.001) lower albumin (OR=0.909, 95% CI= 0.840~0.985, P=0.020) and diabetes (OR=3.808, 95% CI=1.180~ 12.288, P=0.006) were the risk factors for primary PD-associated peritonitis. Conclusions Baseline serum uric acid level was significantly correlated with primary PD-associated peritonitis in continuous PD patients. For end-stage renal disease patients treated with PD, higher baseline serum uric acid level before PD catheterization will be more likely to complicate with primary PD-associated peritonitis. Metrics

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Clinical observation on the modified pre-flushing method of soaking slowly and rushing fast in heparinfree hemodialysis 2020, 19 (02):  85-87.  doi: 10.3969/j.issn.1671-4091.2020.02.004 Abstract ( 314 )   PDF (364KB) ( 745 )   【Abstract】Objective To discuss clinical application value of the modified pre-flushing method by soaking slowly and rushing fast in heparin-free hemodialysis. Methods A total of 38 patients of heparin-free dialysis in the Blood Purification Center of Tongxiang First People’s Hospital from Jan. 2018 to Mar. 2019 were enrolled in this study. They were randomly divided into two groups. The traditional pre-flushing method of dialyzer and pipeline was used in the group A (n=19), and the modified method of soaking slowly and rushing fast was used in the group B (n=19). The observation period was 4 dialysis sessions for every patient. Blood clotting grade in dialyzer and pipeline, the number of flushing by normal saline, and actual dialysis time were recorded. eKt/V was estimated at the fourth hemodialysis session for every patient. Results Blood clotting in dialyzer and pipeline at 0、II and III grades were better in group B than in group A (t=7.851, 3.437 and 8.774 respectively; P=0.013, 0.009 and ＜0.001 respectively). Normal saline flushing for 0, 1, 3 and ≥4 times were statistically different between group A and B (t=7.602, 8.959, 5.848 and 8.192 respectively; P=0.031, 0.006, 0.024 and 0.018 respectively). The percentage of hemodialysis time greater than or equal to 3h was 87.2% and 97.4% in group A and B respectively (t=6.752, P=0.011). The rate of eKt/V compliant with the standard was 82.1% in group A and 94.8% in group B (t=8.039, P=0.023). Conclusion The modified preflushing method of soaking slowly and rushing fast in heparin-free hemodialysis was simple, inexpensive and safe and did not affect the adequacy of hemodialysis. This method is worthy to be used clinically. Metrics

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Correlation analysis of health literacy and treatment compliance of maintenance hemodialysis patients 2020, 19 (02):  88-91.  doi: 10.3969/j.issn.1671-4091.2020.02.005 Abstract ( 279 )   PDF (385KB) ( 884 )   【Abstract】Objective To explore the correlation between health literacy and treatment compliance of maintenance hemodialysis (MHD) patients in order to provide a theoretical basis for effective management of MHD patients. Methods A total of 240 MHD patients were investigated by convenience sampling method. Correlation analysis was used for data processing. Results The total score of health literacy was 19.36±3.82 in MHD patients, which is lower than the norm in Chinese population (t=-3.968, P＜0.001). The total score of treatment compliance was 96.22±9.32 in the MHD patients, which is higher than the norm in Chinese population (t=9.822, P＜0.001), but the hemodialysis compliance dimension was below the norm in Chinese population (t= -61.225, P＜0.001). There was a positive correlation between health literacy and treatment compliance in MHD patients (r= 0.386, P＜0.001). Conclusion There was a positive correlation between health literacy and treatment compliance in MHD patients. Therefore, health care professions can improve the treatment compliance of MHD patients through enhancing their health literacy. Metrics

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Clinical observation of sodium thiosulfate in the treatment of intractable uremic pruritus 2020, 19 (02):  92-94.  doi: 10.3969/j.issn.1671-4091.2020.02.006 Abstract ( 1013 )   PDF (434KB) ( 1022 )   【Abstract】Objective To observe the efficacy and safety of sodium thiosulfate (STS) in the treatment of uremic pruritus. Methods Sixty patients with uremic pruritus were randomly divided into observation group (n=30) and control group (n=30). The control group was given loratadine 10mg orally once daily, and the observation group was given STS 3.2g intravenously three times a week after dialysis in addition to the loratadine treatment in control group. They were observed for 3 months. The changes of inflammatory index, modified Duo's pruritus score, Pittsburgh sleep quality index (PSQI) score and the incidence of adverse reactions were compared before and after the treatment. Results The total clinical effective rate was 96.70% in the observation group, significantly higher than that (63.30%) in the control group (χ2=10.892, P=0.001). The changes of C- reactive protein (t=15.170, P<0.010), ferritin (t=7.330, P<0.010) and albumin (t=- 9.030, P<0.010) before and after treatment were statistically significant in the observation group; however, the changes of C-reactive protein (t=1.170, P=0.055) and ferritin (t=1.731, P=0.086) before and after treatment did not have statistical significances in the control group. Modified Duo score (intra-group: t=14.480, P<0.001; intergroup: t=- 11.220, P<0.001) and PSQI score (intra- group: t=33.240, P< 0.001; inter- group: t=- 14.480, P<0.001) after the treatment were significantly lower than those before the treatment in the observation group and were also lower than those before treatment in the control group. There was no significant difference in the incidence of adverse reactions between the two groups (χ22=0.218, P=0.640). Conclusions STS combined with anti-allergic therapy is more effective in the treatment of uremic pruritus without serious adverse reactions. Metrics

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Low triiodothyronine syndrome correlated with residual renal function and survival in patients undergoing maintenance peritoneal dialysis 2020, 19 (02):  95-98.  doi: 10.3969/j.issn.1671-4091.2020.02.007 Abstract ( 391 )   PDF (516KB) ( 694 )   【Abstract】Objective To examine the correlation of low triiodothyronine (T3) syndrome with residual renal function and survival in patients undergoing maintenance peritoneal dialysis (PD). Methods Baseline data including thyroid hormone tests were recruited from PD patients treated in our Hospital in April 2009, and a seven- year follow- up was conducted. The relationship between serum free T3 (FT3) and renal Kt/V (rKt/V) was explored using one-way ANOVA and linear regression analysis, and Cox proportional hazards modeling was used to explore the association between serum FT3 and all-cause mortality. Results A total of 125 subjects were included in this study, of whom 34 patients (27.2%) presented with low T3 syndrome. In the patients with the highest rKt/V, serum FT3 was higher (F=12.779, P<0.001) and the prevalence of low T3 syndrome was the lowest (14.3%, χ2=10.175, P=0.038) as compared with the other two groups. Univariate regression analysis revealed that the level of serum FT3 was positively correlated with rKt/V (r=0.270, P=0.002), protein equivalent of nitrogen appearance (PNA) (r=0.217, P= 0.016), hemoglobin (HGB) (r=0.183, P=0.044) and serum albumin (ALB) (r=0.424, P<0.001), and was negatively correlated with serum C-reactive protein (CRP) (r=-0.311, P<0.001) and age (r=-0.346, P<0.001). Multivariate regression analysis showed that rKt/V remained the independent influencing factor on serum FT3 level after adjusting sex, age, serum ALB, CRP, HGB and PNA (β=0.284, P=0.004). Cox regression analysis showed that serum FT3 remained to be an independent predict factor for all-cause mortality in PD patients after adjusting sex, age, HGB, PNA, serum ALB, CRP and rKt/V (HR 0.303, 95% CI 0.103～0.889, P=0.030). Conclusions Our study demonstrates that the presence of serum FT3 syndrome is closely associated with residual renal function and that serum FT3 can independently predict death risk in PD patients. Metrics

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Clinical observation of treatment of CAPD with heart failure by APD 2020, 19 (02):  99-102.  doi: 10.3969/j.issn.1671-4091.2020.02.008 Abstract ( 300 )   PDF (380KB) ( 822 )   【Abstract】Objective To study the effect of APD on Heart failure (HF) in CAPD patients. Methods 44 patients were included in this study from August 1, 2016 to July 31, 2018. All patients had been treated with CAPD before they came to our center and were treated with APD in the hospital. The ultrafiltration volume, urine volume, body mass, blood pressure, serological index and HF grade (NYHA grade) were recorded before and after treatment. Results Of the 44 patients, peritoneal dialysis UF was significantly increased when receiving APD compared to CAPD (t=-15.448，P＜0.001),and LHF class was significantly decreased 4 days after receiving APD (Z=- 7.582，P＜0.001).Body weights had significantly decreased 4 days after treatment with APD (t=11.411，P＜0.001).Blood pressure was well controlled 4 days after treatment with APD (SBP 11.713，P＜0.001；DBP t= 8.407，P＜0.001). After 4 days of APD treatment, serum creatinine, BUN and NTproBNP levels were significantly lower than those before treatment, and the difference was statistically significant (t=7.891，P＜0.001). Conclusions CAPD patients is easily associated with heart failure caused by volume overload, APD can effectively improve the acute heart failure symptoms, improve LHF, increase the ultrafiltration, and reduce serum creatinine, blood urea nitrogen, systolic blood pressure. It may be an effective way to treat CAPD patients with heart failure. Metrics

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Correlation between serum Sclerostin level and vascular calcification in maintenance hemodialysis patients 2020, 19 (02):  103-107.  doi: 10.3969/j.issn.1671-4091.2020.02.009 Abstract ( 317 )   PDF (499KB) ( 786 )   【Abstract】Objective To investigate the relationship between serum sclerostin and the degree of abdominal aortic calcification in patients undergoing maintenance hemodialysis(MHD). Methods 150 MHD patients in our hospital's nephropathy center were selected as subjects, Collect patient demographic data and clinical data, Including diabetes and residual urine volume, urine volume <200ml is considered as no residual renal function (RRF), Serum Sclerostin and bone specific alkalinephosphatase(BsAP) levels from 150 cases of MHD patients were measured by ELISA. Abdominal aortic calcification (AAC) was detected by lateral radiographs of the abdomen and AAC scores were performed. Analysis of the relationship between Sclerostin level and iPTH, BsAP and a AAC in patients with MHD. Results 1. The incidence of abdominal aortic calcification in patients with MHD was 74%. The patients were divided into calcified group and non-calcified group according to the presence or absence of AAC. The results showed that the sclerostin, kt/v in the calcified group was significantly lower than that in the non- calcified group (t=6.694, P<0.001). Age（t=- 5.250，P<0.001）, dialysis age (t=-4.356，P<0.001), iPTH(t=-2.926，P<0.001), serum alkaline phosphatase (t=-3.877，P<0.001), BsAP (t=-4.654，P<0.001)were higher than those without calcification (P<0.05). There were no significant differences in gender (t=2.345，P=0.126), serum calcium (t=- 0.262，P=0.794) and phosphorus (t= 0.096，P=0.923) between the two groups (P＞ 0.05). 2. Logistic regression analysis of risk factors for vascular calcification in patients with MHD: Age (OR=1.134, 95% CI, 1.059～1.224, P<0.001), dialysis age (OR=1.006, 95% CI, 1.006- 1.075, P= 0.019), RRF(OR=0.150, 95%CI, 0.027～0.818, P=0.028), Diabetes (OR=8.199, 95% CI, 1.316～51.073, P=0.024), iPTH (OR= 1.009, 95% CI, 1.001～1.017,P=0.035) , Kt/V(OR=0.030, 95% CI, 0.001～0.652, P=0.026), Sclerostin (OR=0.985, 95% CI, 0.976～0.994, P=0.002), BsAP(OR=1.295, 95% CI) , 1.037～1.618, P=0.023) were statistically significant. Conclusion The incidence of vascular calcification were higher in MHD patients.Agedness,Long-dialysis, diabetes, higher iPTH, and higher BsAP are risk factors for vascular calcification in patients with MHD,but RRF, Sclerostin, and Kt/V are protective factors for vascular calcification in patients with MHD. Metrics

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Development of a clinical nomogram for predicting cardiovascular events in maintenance hemodialysis patients 2020, 19 (02):  108-112.  doi: 10.3969/j.issn.1671-4091.2020.02.010 Abstract ( 237 )   PDF (587KB) ( 849 )   【Abstract】Objective To investigate the influencing factors for cardiovascular events in maintenance hemodialysis (MHD) patients, and to construct a clinical nomogram risk predictive model. Methods A total of 229 patients with maintenance hemodialysis, who admitted into Wenzhou Integrated Traditional Chinese and Western Medicine Hospital during May 2014 to March 2017, were analyzed retrospectively. The major adverse events of the cardiovascular disease were tracked. A nomogram was developed on the results of the multivariate Cox model. Results Four risk factors were found by COX regression model , including age ≥60 years (HR=2.80; 95% CI:1.56～5.01; P<0.001）, the history of cardiovascular disease (HR=2.08; 95% CI:1.07～4.07;P=0.032) , dialysis age≥36 months (HR=2.36;95% CI:1.25～4.44; P=0.008) , and QT interval dispersion. ≥63ms (HR=2.14;95% CI:1.20～3.82; P=0.010). The initial concordance index（C-index）of nomogram was 0.719（95% CI:0.652～0.786）, and C-index of nomogram was 0.722（95% CI:0.656～0.788）after 1 000 times of internal validation. Hosmer-Lemeshow statistic（χ2＝8.124, P=0.632） Conclusion The nomogram based on the related factors could accurately predict cardiovascular events in maintenance hemodialysis (MHD) patients. Metrics

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Study on the relationship between uncertainty in illness, depression and hope in patients with maintenance hemodialysis 2020, 19 (02):  113-115.  doi: 10.3969/j.issn.1671-4091.2020.02.011 Abstract ( 196 )   PDF (369KB) ( 740 )   【Abstract】Objective To investigate the status of uncertainty in illness with maintenance hemodialysis (MHD) and its relationship with depression and hope. Methods Self-made questionnaire, Chinese version of Mishel disease uncertainty scale, depression self-rating scale, and Herth hope scale were used to investigate 180 MHD patients who met the inclusion criteria. Results The average total scores were 74.23±7.64 for Chinese version of Mishel disease uncertainty scale, 53.04±9.59 for depression self-rating scale, and 32.33±3.05 for Herth hope scale. The total score of uncertainty in illness was positively correlated with the total score of depression (r=0.429, P<0.001), and was negatively correlated with the total score of hope (r=-0.348, P<0.001). Multiple linear regression analysis showed that the level of depression could positively predict the level of uncertainty in illness (β=0.170, P<0.001), and the level of hope could negatively predict the level of uncertainty in illness (β=-0.398, P<0.001). Conclusions MHD patients had a higher level of uncertainty in illness, which was related to the levels of depression and hope. Metrics

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A cross-sectional survey of long-term vascular access in 1,550 patients with maintenance hemodialysis in Deyang area 2020, 19 (02):  116-119.  doi: 10.3969/j.issn.1671-4091.2020.02.012 Abstract ( 262 )   PDF (677KB) ( 969 )   【Abstract】Objective To investigate the current status of long-term vascular access in maintenance hemodialysis (MHD) patients in Deyang area. Method A cross-sectional survey was conducted to investigate the long-term vascular access of 1,550 MHD patients from 14 hemodialysis centers in Deyang area in the period from June 1 to June 30, 2018. Their basic information and vascular access methods were recruited. Results This study enrolled a total of 1,550 MHD patients including 1,405 cases of arteriovenous fistula (AVF,90.65%), 136 cases of tunneled cuffed catheter (8.77%) and 9 cases of arteriovenous graft (0.58%). The average service time ofAVF, tunneled cuffed catheter and arteriovenous graft were 46.27±36.11 months, 28.69±21.32 months and 27.99±15.27 months respectively. The blood flow of most vascular access was in the range of 200～300ml/min. AVF located left side in 1,019 patients (72.53%) and located right side in 386 patients (27.47%). The most common type of AVF was wrist radio-cephalic fistula (97.51%) and end-to-side anastomosis (98.08%). Conclusion AVF was the most common long- term vascular access among MHD patients in Deyang area. We should make effort to lower the proportion of patients using central venous catheter for blood access. The application of arteriovenous graft can reduce the use of central venous catheter. Metrics

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Clinical efficacy of percutaneous transluminal angioplasty to promote arteriovenous fistula maturation 2020, 19 (02):  120-123.  doi: 10.3969/j.issn.1671-4091.2020.02.013 Abstract ( 305 )   PDF (429KB) ( 825 )   【Abstract】Objective To evaluate the efficacy and safety of percutaneous transluminal angioplasty (PTA) to promote arteriovenous fistula (AVF) maturation. Methods A total of 23 patients with immature AVF in the period from Jan 2017 to May 2018 underwent PTA to promote AVF maturation at the 6th week after AVF surgery. The changes of hemodynamics in AVF after PTA for 24h were measured by Doppler ultrasonography, and the primary patency rate was observed. Results Of the 23 patients with immature AVF, 19 (82.60%) patients had type I AVF stenosis. Clinical and anatomic success of PTA were 100%. The inner diameter and blood flow at the stenosis increased significantly after PTA for 24 hours as compared with those before PTA (t= -31.630 and -27.557 respectively; P< 0.001 and < 0.001 respectively). The primary patency rates were 94.4%, 87.2% and 78.5% after PTA for 3 months, 6 months and 12 months respectively. No serious adverse complications occurred. Conclusion PTA was safe and effective to promote AVF maturation with a higher primary patency rate. Metrics

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The application of automated peritoneal dialysis in the volume management of continuous peritoneal dialysis patients 2020, 19 (02):  124-126.  doi: 10.3969/j.issn.1671-4091.2020.02.014 Abstract ( 221 )   PDF (382KB) ( 709 )   【Abstract】Peritoneal dialysis (PD) is a principal renal replacement therapy. Sufficient fluid removal is an important target of PD. Inadequate fluid removal can lead to volume overload, which may endanger live of the PD patients. However, volume overload is still very common in PD patients. Automated peritoneal dialysis (APD) is a new type of PD, which can achieve enough peritoneal ultrafiltration through frequent exchange and short dwells in night time, thus improving the prognosis of PD patients with volume overload. This paper is a systematic review focusing on the epidemiology of volume overload, the adverse effects of volume overload, and the application of APD in PD patients with volume overload. Metrics

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Progress in acute complications of hemodialysis 2020, 19 (02):  127-129.  doi: 10.3969/j.issn.1671-4091.2020.02.015 Abstract ( 230 )   PDF (264KB) ( 1304 )   Metrics

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Effect of diversified education mode on treatment compliance and adverse psychology of patients undergoing maintenance hemodialysis with long-term indwelling polyester double-lumen catheter 2020, 19 (02):  134-137.  doi: 10.3969/j.issn.1671-4091.2020.02.017 Abstract ( 192 )   PDF (426KB) ( 732 )   【Abstract】Objective To study the effect of diversified education mode on treatment compliance and psychological status of patients undergoing maintenance hemodialysis (MHD) using long- term indwelling polyester double-lumen catheter. Methods A total of 100 MHD patients using long-term indwelling polyester double-lumen catheter in the People's Hospital of Dongguan City from July 2016 to July 2018 were enrolled in this study. They were divided into two groups according to the random number table extraction method. Each group contained 50 cases. The observation group adopted diversified education mode, while the control group adopted routine health education. The nursing effect was compared between the two groups. Results The total scores of S-AI and T-AI after intervention were lower than those before intervention in the two groups (observation group: t= 7.858 and 8.790 respectively; P＜0.001; control group: t=3.974 and 5.116 respectively; P=0.003 and 0.001 respectively), and the lowering of S-AI and T-AI scores after intervention were more in the observation group than in the control group (t= 4.389 and 3.550 respectively; P=0.002 and 0.001 respectively). The knowledge of hemodialysis after intervention became better than that before intervention in the two groups (observation group: t=25.525, P＜0.001; control group: t=17.559, P＜0.001), and the improvement degree after intervention was more significant in the observation group than in the control group (t=9.501, P＜0.001). After intervention, catheter infections during catheterization (χ2=4.396, P=0.041), bacterial positive rate (χ2=4.433, P=0.038), thrombosis in catheters (χ2=5.741,P=0.017), treatment compliance (χ2=11.111, P＜0.001) and nursing satisfaction (χ2=21.951, P＜0.001) were statistically different between the two groups. Conclusion Diversified education mode was effective to reduce the incidence of complications during long- term indwelling polyester double-lumen catheterization, improve their self- care consciousness, increase the treatment compliance, and avoid the adverse psychology in MHD patients. Metrics

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Application of FOCUS-PDCA model in the management of intradialytic hypotension in maintenance hemodialysis patients 2020, 19 (02):  138-141.  doi: 10.3969/j.issn.1671-4091.2020.02.018 Abstract ( 263 )   PDF (583KB) ( 875 )   【Abstract】Objective To evaluate the effect of FOCUS-PDCA model in the management of intradialytic hypotension (IDH) in maintenance hemodialysis (MHD) patients. Methods Twenty-two patients with recurrent hypotension during hemodialysis from March to June in 2018 were selected. They were compared themselves before and after the intervention of FOCUS-PDCA for 3 months. The incidences of IDH and dropping out of the hemodialysis session 30 minutes earlier, laboratory indicators and self- rating anxiety scale (SAS) score at baseline and after the intervention of FOCUS-PDCA for 3 months were counted. Results The major causes of IDH were dehydration volume/dry weight＞5%, anti-hypertensive drugs before hemodialysis, meals during hemodialysis and diabetes mellitus. IDH occurred in every period especially after three hours during hemodialysis. The incidences of IDH in 22 patients before and after the intervention of FOCUS-PDCA were 15.73% (45/286) and 6.14% (18/293) respectively (χ2=38.662, P=0.005). After the intervention, the incidence of dropping out of the hemodialysis session 30 minutes earlier decreased (χ2=10.741, P=0.027), Alb and kt/V increased (t=-2.134, P=0.038, t=-2.092, P=0.041), and SAS score decreased (t=4.473, P=0.008). Conclusion The procedures of IDH prevention and control reduced the incidence of IDH and improved the psychological and physiological status in MHD patients. Metrics