Chinese Journal of Blood Purification

12 July 2020, Volume 19 Issue 07 Previous Issue    Next Issue

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Recent progress in urgent-start peritoneal dialysis 2020, 19 (07):  433-436.  doi: 10.3969/j.issn.1671-4091.2020.07.001 Abstract ( 391 )   PDF (367KB) ( 1121 )   【Abstract】End stage renal disease (ESRD) has become an important public health problem worldwide. The insidious progress of ESRD often leads to the requirement of urgent-start dialysis when admitted to hospitals. Currently, hemodialysis with central vein catheterization is still the most commonly used method of urgent-start dialysis. However, this method has the risks of catheter- related infection, bacteremia, thrombosis and other complications with higher medical expenses. Due to the continuous progress of automated peritoneal dialysis technology, the interest to urgent-start peritoneal dialysis(PD) increases in recent years. Most studies show that urgent-start PD is safe, effective, favorable to health economics, and worthy of widely used. Metrics

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Application of automatic Peritoneal Dialysis in urgent-start Peritoneal Dialysis 2020, 19 (07):  437-439.  doi: 10.3969/j.issn.1671-4091.2020.07.002 Abstract ( 259 )   PDF (315KB) ( 971 )   Metrics

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Dietary survey and nutritional status of the patients with continuous ambulatory peritoneal dialysis 2020, 19 (07):  440-444.  doi: 10.3969/j.issn.1671-4091.2020.07.003 Abstract ( 343 )   PDF (386KB) ( 695 )   【Abstract】Objective To investigate food and nutritional intake in the patients with continuous ambulatory peritoneal dialysis (CAPD) so as to provide scientific evidences for nutrition intervention in these patients. Methods A retrospective survey of diet in 24 hours was performed in 70 CAPD patients. Based on the daily protein intake (DPI), they were divided into group I [normal DPI group, DPI ≥1.08 g/(kg·d)] and group II [DPI insufficient group, DPI <1.08 g/(kg · d)]. Dietary survey and nutritional status were evaluated in the two groups. Results The incidence of insufficient DPI was 77.1% (54 cases) in the 70 CAPD patients. The intakes of cereals, vegetables, meat and poultry were significantly higher in group I than in group II (Z=-3.089, -2.088 and -3.465 respectively; P=0.002, 0.037 and 0.001 respectively). The daily energy intake (DEI) and DPI were significantly higher in group I than in group II (t=4.400 and 8.562 respectively; P<0.001). The intakes of dietary protein and animal protein were significantly higher in group I than in group II (t=6.171 and 5.246 respectively; P<0.001), while the intake of plant protein was significantly lower in group I than in group II (t=3.387, P=0.001). The intakes of vitamins A, B1, B2, C and PP were significantly higher in group I than in group II (t=2.841, 4.821, 4.314, 2.480 and 5.109 respectively; P=0.006, <0.001, <0.001, 0.016 and <0.001 respectively). The intakes of potassium, sodium, calcium, magnesium, iron, manganese, zine, copper, phosphorus and selenium were significantly higher in group I than in group II (t=5.003, 2.500, 2.593, 4.359, 5.660, 3.443, 5.721, 4.480, 5.789 and 3.065 respectively; P<0.001, 0.016, 0.012, <0.001, <0.001, 0.001,<0.001, <0.001, <0.001 and 0.003 respectively). Conclusions Lower dietary intake in CAPD patients was common, and protein intake was much lower than the recommended amount. The dietary nutritional status was worse in group II than in group I. Effective measures of nutritional education and individualized dietary instructions should be taken to improve the nutritional status in CAPD patients. Metrics

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Reliability and validity of Chinese version of SF-36 scale for quality of life evaluation in automated peritoneal dialysis and continuous ambulatory peritoneal dialysis patients 2020, 19 (07):  445-448.  doi: 10.3969/j.issn.1671-4091.2020.07.004 Abstract ( 316 )   PDF (407KB) ( 637 )   【Abstract】Objective Based on the data from new peritoneal dialysis patient treated in the Department of Nephrology, Xinqiao Hospital of Army Medical University, multidimensional analyses on patients with automated peritoneal dialysis (APD) or continuous ambulatory peritoneal dialysis (CAPD) were performed by using the SF-36 quality of life questionnaire. Methods Purpose sampling method was used to investigate the peritoneal dialysis patients treated in the Department of Nephrology, the Second Hospital of PLA Military Medical University in the period from January 2018 to June 2019 by using the questionnaire of SF-36 scale. A total of 241 valid questionnaires were received, including 135 questionnaires from APD group and 106 from CAPD group. Their reliability and the dimensions of collective validity, discriminant validity and structural validity were comprehensively analyzed to obtain the results of social regression in the two groups of patients. Results The overall Cronbach's α coefficients were 0.93 and 0.92 in APD group and CAPD group respectively, with better internal consistency reliability in both groups. The success rates of collective validity of the samples were 83% and 93%, and the success rates of discrimination validity tests were 96% and 98% in APD group (n=135) and CAPD group (n=106) respectively. Both groups had better collective validity and discrimination validity (Cronbach’s α=0.93 and 0.92, P=0.034 and 0.025 in APD group and CAPD group respectively). For standard validity, the rank correlation coefficient calculated by the standard and scale scores of the samples in APD group was 0.593, greater than 0.403 in CAPD group (P=0.320 and 0.300 respectively), suggesting that SF-36 scale has better standard correlation validity used in APD group. For structural validity, the t-test of the unstandardized factor load coefficients demonstrated that the load coefficients were statistically significant at >0.1 level in both groups (P=0.017 and 0.030 for APD group and CAPD group respectively), indicating that the designed entries in the scale are informative for both groups. Conclusion The SF-36 scale has good reliability and validity for statistical analysis of quality of life in peritoneal dialysis patients, and the internal reliability and standard correlation validity are better for APD group than for CAPD group, suggesting that social function and emotional state are better in APD patients than in CAPD patients. Metrics

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The clinical investigation of peritonitis associated with Povidone- iodine minicap 2020, 19 (07):  449-453.  doi: 10.3969/j.issn.1671-4091.2020.07.005 Abstract ( 344 )   PDF (552KB) ( 759 )   【Abstract】Objective To investigate the relationship between Providone-iodine minicap and peritonitis through the etiology and clinical course analyses of the 3 cases with perioperative peritoneal dialysis (PD) associated peritonitis. Methods The etiology of perioperative peritonitis was scrutinized. To analyze the relationship between the brand A of Povidone-iodine minicap and peritonitis, we compared the antibacterial effects of different brands of Povidone-iodine minicaps using in vitro bacterial inhibition tests, and investigated the incidence, clinical characteristics and prognosis of peritonitis in patients treated with different brands of Povidone-iodine minicaps in this Peritoneal Dialysis Center. Results The possibilities of contamination during the operation of surgery operation and PD manipulation leading to the peritonitis were excluded in the 3 cases with perioperative PD associated peritonitis; the relationship between Povidone-iodine minicap and peritonitis was then suspected. In vitro bacterial inhibition tests found that the antibacterial effect of brand A was weaker than brands B and C. The peritonitis recovered after change of the Povidone-iodine minicap brand A to that of brand B. The incidence of peritonitis was higher in the patients using Povidone- iodine minicap brand A than those using that of brand B in the 89 PD patients (c2=20.578, P<0.001). The clinical peritonitis characteristics of Povidone-iodine minicap associated peritonitis were mild symptoms, negative bacterial culture of the peritoneal exudate, and poor effect of conventional antibacterial infection treatment, without other etiological factors. Conclusion It is necessary to pay attention to the abnormal quality of peritoneal dialysis products as the possible cause of peritonitis when the common causes for peritonitis have been excluded. Metrics

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Studies on surgical methods for renal hyperparathyroidism accompanied with thyroid cancer 2020, 19 (07):  454-457.  doi: 10.3969/j.issn.1671-4091.2020.07.006 Abstract ( 273 )   PDF (385KB) ( 660 )   【Abstract】Objective To explore the choice of surgical methods for renal hyperparathyroidism complicated with thyroid carcinoma. Methods The clinical data including preoperative diagnosis, surgical methods, pathological results and laboratory examinations of the patients with renal hyperparathyroidism complicated with thyroid cancer treated in the Thyroid and Breast Surgery of the 960th Hospital of the People’s Liberation Army from February 2012 to August 2019 were retrospectively analyzed. The patients were followed up for 2～90 months (median follow-up period 60 months). The improvement of clinical symptoms and recurrence were observed. Results In the 480 patients with renal hyperparathyroidism undergoing parathyroidectomy, 16 (3.3%) were found to accompany with thyroid cancer. Surgery was successfully performed in 15 cases, and one case underwent re-operation. Pathologically, all of the 16 thyroid cancer samples were papillary thyroid carcinoma. Total thyroidectomy was performed in the 16 cases, 12 of them received central lymphadenectomy and 2 of them received lateral cervical lymph node dissection. A total of 62 parathyroid glands were resected. The clinical symptoms of the patients relieved after operation, and the related biochemical indexes improved or became normal compared with those before the operation. No recurrence occurred during followup. Conclusion Patients with renal hyperparathyroidism should carefully assess the character of the thyroid lesions before operation. The best surgical effect can be obtained by accurate and appropriate design of the operation area. Metrics

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Analysis of the influencing factors for bone mineral density measured by quantitative ultrasound examination in patients with maintenance hemodialysis 2020, 19 (07):  458-461.  doi: 10.3969/j.issn.1671-4091.2020.07.007 Abstract ( 235 )   PDF (458KB) ( 688 )   【Abstract】Objective To analyze the relationship between bone mineral density and the related clinical parameters, and to explore the risk factors for osteoporosis in maintenance hemodialysis (MHD) patients. Methods A total of 102 MHD patients treated in the Department of Nephrology, Baoji People's Hospital were retrospectively analyzed. Bone mineral density (BMD) of calcaneus was measured by quantitative ultrasound examination and expressed as T score. According to T score, the patients were divided into three groups: normal bone mass group (T score ≥-1.0), reduced bone mass group (-2.5＜ T score ＜-1.0), and osteoporosis (T score ≤-2.5) group. Clinical parameters were compared among the three groups. The correlation between T score and clinical parameters was analyzed. Results Among the 102 MHD patients, 41 patients (40.2%) were divided into osteoporosis group, 50 patients (49.0%) in reduced bone mass group, and 11 patients (10.8%) in normal bone mass group. There were statistical differences in age (F=5.054, P=0.032), 25-hydroxyvitamin D level (F=18.131, P=0.009) and the index of osteoporosis self-assessment tool for Asians (OSTA) (F=5.714, P=0.043) among the three groups. Pearson correlation analysis showed that T score was negatively correlated with age (r=-0.412, P=0.033) and positively correlated with 25-hydroxyvitamin D level (r=0.596, P= 0.021) and OSTA index (r=0.387, P=0.046). Multivariate stepwise regression analysis showed that 25-hydroxyvitamin D level was the main factor affecting T score of BMD (t=6.214, P＜0.001). Conclusions The incidence of osteoporosis was higher in MHD patients. The main risk factor for osteoporosis was 25-hydroxyvitamin D insufficiency. Metrics

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Relationship between serum levels of fibroblast growth factor-23 and soluble klotho and cardiac valve calcification in maintenance hemodialysis patients 2020, 19 (07):  462-465.  doi: 10.3969/j.issn.1671-4091.2020.07.008 Abstract ( 289 )   PDF (565KB) ( 819 )   【Abstract】Objective To explore the relationship between serum levels of fibroblast growth factor- 23(FGF- 23) and soluble klotho (sKL) and cardiac valve calcification (CVC) in maintenance hemodialysis (MHD) patients. Methods A total of 100 MHD patients treated in the Blood Purification Center of Laigang Hospital were enrolled in this study as the observation group. The serum concentrations of FGF-23 and sKL were measured by enzyme-linked immunosorbent assay. CVC was detected by color Doppler ultrasonography. Results The incidence of CVC and serum level of FGF-23 were higher in observation group than in control group (t=8.820 and 16.642 respectively; P<0.001), while serum level of sKL was lower in observation group than in control group (t= -2.583, P=0.012). The higher levels of serum phosphorus and serum FGF-23 were the independent risk factors for CVC in MHD patients (OR = 2.375 and 1.642 respectively; 95% CI = 1.527 ～ 3.884 and 1.232 ~ 1.912 respectively; P<0.001 and 0.023 respectively). The higher level of sKL was a protective factor for CVC (OR=0.334, 95% CI=0.044~0.621, P＜0.05). Conclusion Serum levels of FGF-23 and sKL were the independent influencing factors for CVC in MHD patients. Therefore, combined detection of serum FGF-23 and sKL can be used to predict CVC in MHD patients. Metrics

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The effect of conditioned medium from human umbilical cord mesenchymal stem cells on high glucoseinduced epithelial-mesenchymal transition (EMT) in human peritoneal mesothelial cells and its underlying#br# mechanism#br# 2020, 19 (07):  466-470.  doi: 10.3969/j.issn.1671-4091.2020.07.009 Abstract ( 198 )   PDF (979KB) ( 727 )   【Abstract】Objective To explore the effect of conditioned medium (CM) from human umbilical cord mesenchymal stem cells (hUC- MSCs) on high glucose (HG)- induced epithelial- mesenchymal transition (EMT) in human peritoneal mesothelium cells (HPMCs) and its underlying mechanism. Methods The effect of HG and mesenchymal stem cells conditioned medium (MSC-CM) on HPMCs proliferation was detected by CCK-8. HPMCs were divided into three groups: control group, HG group and CM group. Morphology changes of HPMCs were observed under microscope. The expressions of E- cadherin, vimentin, α-SMA and β- catenin in HPMCs was detected by western blot. Results HG reduced the proliferation of HPMCs, and MSC-CM promoted the proliferation of HPMCs. Compared to control group, most HPMCs in HG group became spindle shape, and MSC-CM could alleviate the morphological changes of HPMCs. Compared to control group, HG treatment reduced the expression level of E-cadherin (0.730±0.049 vs. 0.934±0.008, t=7.166, P=0.002), and increased the expression levels of vimentin and α-SMA (vimentin: 0.897 ± 0.037 vs. 0.645± 0.110, t=3.748, P=0.020; α-SMA: 1.120±0.083 vs. 0.829±0.122, t=3.430, P=0.027), while MSC-CM significantly increased the expression of E-cadherin, and decreased the expressions of vimentin and α-SMA (E-cad-herin: 0.894 ± 0.055 vs. 0.730±0.049, t=3.865, P=0.018; vimentin: 0.737 ± 0.046 vs. 0.897 ± 0.037, t=4.657, P=0.010; α-SMA: 0.808±0.036 vs. 1.120± 0.083, t=6.000, P=0.004). Meanwhile, HG increased the expression of β-catenin in HPMCs (0.842±0.059 vs. 0.664±0.071, t= 3.341, P=0.029), while MSC-CM reduced the expression of β-catenin compared with HG group (0.613±0.086 vs. 0.842±0.059, t=3.808, P=0.019). Conclusions CM from hUC-MSCs attenuate high glucose-induced EMT by down-regulation of Wnt/β-catenin pathway in HPMCs.. Metrics

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A study on the clinical therapeutic effect of endovascular treatment of thrombosis in artificial vascular dialysis access 2020, 19 (07):  476-477.  doi: 10.3969/j.issn.1671-4091.2020.07.011 Abstract ( 202 )   PDF (228KB) ( 852 )   Metrics

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Management strategy for the 27 cases with arteriovenous graft infections 2020, 19 (07):  478-481.  doi: 10.3969/j.issn.1671-4091.2020.07.012 Abstract ( 287 )   PDF (345KB) ( 785 )   【Abstract】Objective To summarize the management experience and strategy for the 27 cases with arteriovenous graft (AVG) infections. Methods Clinical data of the 27 patients (11 male cases and 16 female cases) with AVG infections during the period from January 2015 to January 2019 were retrospectively analyzed. The AVGs located in forearm in 16 cases, in upper arm in 7 cases, and in lower limbs in 4 cases. Whole segment infections of the AVG were found in 8 cases, whole segment infections of the AVG with anastomotic pseudoaneurysm in 3 cases, local infections of the AVG in 15 cases, and local infection of the AVG with steal syndrome in one case. Treatments of the 27 cases included total resection of the AVG with artery reconstruction (13 cases), subtotal resection of the AVG (2 cases), partial resection of the AVG with new graft bypass (11 cases), and partial resection of the AVG with new graft bypass and proximal arterialization of inflow artery (one case). Results All the 27 patients achieved technical success (technical success rate was 100%). No patient died in the peri- operative period. All patients were followed up for an average of 18.3 (12～29) months. During the follow-up period, local infection of the AVG in left upper arm occurred in one case; after subtotal resection of the AVG for two months, rupture of the infected anastomotic orifice at the arterial end of artificial blood vessel and pseudoaneurysm formation in left axillary artery appeared in this case, and the left axillary artery was repaired by autologous basilic vein bypass. One case with local infection of the AVG was treated with partial resection of the AVG with new graft bypass; after the treatment for 8 months, local infection and occlusion of the graft occurred again, and the infected graft was completely resected. Ischemia at the anastomotic orifices and limbs and its related complications (total graft resection) and relapse of graft infec-tions (graft preserved) were not found in other cases. Conclusion Right management strategy should be adopted according to the types of infected AVG. In principle, the AVG should be preserved as much as possible. The aseptic operation during the operation and the subsequent aseptic technique during the puncture process are essential to reduce the incidence of AVG infections. Metrics

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Interpretation of the KDOQI Clinical Practice Guideline for Vascular Access, 2019 version 2020, 19 (07):  482-491.  doi: 10.3969/j.issn.1671-4091.2020.07.013 Abstract ( 1245 )   PDF (468KB) ( 1875 )   【Abstract】In April 2020, the American National Kidney Foundation made a major update to the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guideline for Vascular Access, and carried out various treatments for the survival plan of end-stage renal disease patients, including the life plan of end-stage renal disease patients, the selection of vascular access, and the new methods for handling specific complications. This article interprets this guideline according to the conditions of our country, helps doctors and patients make decisions on the treatment mode and vascular access for end-stage renal disease, and brings directional suggestions for subsequent research. Metrics

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Research on the different attitudes of hemodialysis patients and their family members to community hemodialysis in Chengdu 2020, 19 (07):  492-495.  doi: 10.3969/j.issn.1671-4091.2020.07.014 Abstract ( 339 )   PDF (404KB) ( 753 )   【Abstract】Objective To understand the difference in the attitude of hemodialysis patients and their families towards hemodialysis in community in Chengdu. Methods A total of 673 hemodialysis patients and 386 family members from 11 hospitals in Chengdu were selected for the study. Results Only 17.1% of patients and 21.2% of family members had heard of "community hemodialysis", and there was no significant difference between patients and their family members (c2=2.798, P=0.094). The scores of self-assessed "necessities for establishing a community hemodialysis center" and "acceptance of treatment in a community hemodialysis center" were lower in patients than in their families (2.14±1.11 vs. 2.32±1.07; 1.76±1.22 vs. 2.03± 1.18), and the differences were statistically significant (t=-2.577, P=0.010; t=-3.440, P=0.001). In terms of the type of community hemodialysis centers, the acceptance scores of community hemodialysis centers jointly established by public hospitals and communities, community health centers alone, public hospitals and enterprises, and by enterprises alone were higher in family members than in patients (2.08±1.18 vs. 2.39±1.12; 1.77± 1.09 vs. 2.17±1.11; 1.85±1.10 vs. 2.16±1.11; 1.68±1.08 vs. 1.99±1.13). The differences were statistically significant (t=-4.258, P<0.001; t=-5.811, P<0.001; t=-4.472, P<0.001; t=-4.388, P<0.001). Conclusion The awareness and acceptance of community hemodialysis are low in patients and their families in Chengdu. Family members believe that it is necessary to establish a community hemodialysis center, with higher acceptance of community hemodialysis and different types of community hemodialysis centers than patients. The attitudes to community hemodialysis prompt government departments and public hospital institutions to cooperate with each other, design effective measures, strengthen the education and guidance of community dialysis, improve the awareness of patients and family members on community dialysis, and reduce the burden of medical care to family members. Metrics

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Investigation on the status quo of physical ability in maintenance hemodialysis patients and its influencing factors 2020, 19 (07):  496-499.  doi: 10.3969/j.issn.1671-4091.2020.07.015 Abstract ( 276 )   PDF (405KB) ( 855 )   【Abstract】Objective To assess the physical fitness level and to determine the important predictors for physical fitness level in maintenance hemodialysis (MHD) patients. Methods This study included 103 MHD patients treated in West China Hospital of Sichuan University, and investigated their general data and physical fitness levels including six-minute walking test, grip strength and Berg balance scale. Results The physical ability decreased significantly in MHD patients. The total distance of 6- minute walking test was 424.64 ±91.45m, the grip strength was 24.97±8.55kg, and the score of Berg balance scale was 50.90±5.76. Multivariate linear regression showed that sleep disorder (β=-0.365, P=0.001) was the independent risk factor for 6-minute walking test; age (β= -0.431, P=0.000) and BMI (β=0.301, P=0.002) were the independent risk factors for grip strength; age (β=-0.280, P=0.013) and diabetes (β=-0.275, P=0.023) were the independent risk factors for balance ability. Conclusion The physical fitness level reduced in MHD patients. Early recognition of risk factors for physical fitness level, multi-disciplinary cooperation, and maintenance and promotion of physical fitness level are important measures to improve their quality of life and return to society. Metrics

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Application of indwelling needle for AVF buttonhole puncture to establish tunnel for dialysis 2020, 19 (07):  500-502.  doi: 10.3969/j.issn.1671-4091.2020.07.016 Abstract ( 267 )   PDF (413KB) ( 776 )   【Abstract】Objective To explore the application value of indwelling needle for dialysis in the establishment of buttonhole tunnel for autologous arteriovenous fistula (AVF). Methods A total of 67 patients on maintenance hemodialysis (MHD) in the Hemodialysis Center of Shanxi Nuclear Industry 215 Hospital were selected. Thirty-two of the patients with AVFs to establish the buttonhole tunnel of internal fistula using puncture and indwelling needle were assigned in observation group; 35 of the patients with AVFs used traditional sharp needle puncture method to establish internal fistula buttonhole tunnel were assigned in control group. Success time, success rate, one-time success rate of blunt needle insertion, and late local stenosis rate were compared between the two groups. Result Compared to control group, observation group had a short success time (8.54±1.28 vs. 12.65±2.38 days, t=0.65, P=0.001) and a high success rate to establish the internal fistula buttonhole tunnel (84.38% vs. 71.43%, χ2=23.251, P＜0.001). Compared to control group, observation group had a higher success rate of blunt needle insertion after success of the buttonhole tunnel (100% vs. 85.7%, χ2=21.201, P＜0.001) and a lower rate of local stenosis in the later period (100% vs. 85.7%,χ2=21.201, P＜0.001). Conclusions The use of indwelling needles for dialysis to establish an internal fistula vascular buttonhole tunnel is a better method to establish a buttonhole tunnel, with shorter success time, higher success rate, simple operation, and fewer complications. Metrics

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A case report of scrotal tumoral calcinosis in a patient on maintenance hemodialysis 2020, 19 (07):  503-504.  doi: 10.3969/j.issn.1671-4091.2020.07.017 Abstract ( 247 )   PDF (584KB) ( 668 )   Metrics

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Effects of Gracz arteriovenous fistula and indwelling catheter in deep vein on maintenance hemodialysis patients and analysis of the prognostic factors 2020, 19 (07):  471-475.  doi: 10.3969/j.issn.1671-4091.2020.07.010 Abstract ( 324 )   PDF (419KB) ( 769 )   【Abstract】Objective To study the effects of Gracz arteriovenous fistula (AVF) and indwelling catheter in deep vein on dialysis efficiency, cardiac function and renal anemia in maintenance hemodialysis (MHD) patients and analyze the prognostic factors. Methods A total of 132 MHD patients treated in Xingtai Third Hospital from June 2017 to October 2018 were divided into two groups according to the vascular access method: deep vein indwelling catheter group and Gracz AVF group. Cardiac structure by echocardiography and dialysis related indexes were compared between the two groups. The prognostic factors were analyzed by multivariate Cox proportional risk regression model. Results Kt/V, urea reduction rate (URR) and blood flow in vascular access were higher in Gracz AVF group than in deep vein indwelling catheter group (t=5.478, 3.588 and 3.350 respectively; P＜0.001). After establishment of the vascular access for one year, left ventricular enddiastolic internal diameter (LVDd) and inter-ventricular septum end-diastolic thickness (IVSTd) were significantly higher in Gracz AVF group than in deep vein indwelling catheter group (t=2.997 and 4.477; P=0.003 and ＜0.001); the use of EPO increased significantly in deep vein indwelling catheter group (t= 5.080; P＜0.001), while the concentrations of hemoglobin, prealbumin and albumin increased significantly in Gracz AVF group (t=2.643, 7.177 and 4.838 respectively; P=0.009, <0.001, and <0.001 respectively). Multivariate COX proportional risk regression model showed that ejection fraction (EF) (OR=1.980, 95% CI=1.119～3.502, P=0.019), E/A ratio (OR=1.914, 95%CI=1.046～3.500, P=0.035) and parathyroid hormone (OR=2.065, 95% CI=1.275～3.344, P=0.003) were the prognostic factors for MHD patients. Conclusion Gracz AVF for blood access can affect cardiac structure and cardiac function in MHD patients. Indwelling catheter in deep vein for blood access was less effective in improving renal anemia. Serum parathyroid hormone level and evaluation of cardiac structure by echocardiography are valuable for the estimation of prognosis in MHD patients. Metrics