Chinese Journal of Blood Purification

12 November 2020, Volume 19 Issue 11 Previous Issue    Next Issue

Select

Prediction of readmission within 30 days in maintenance dialysis patients using scoring system developed from electronic health record data in Yinzhou, China 2020, 19 (11):  721-725.  doi: 10.3969/j.issn.1671-4091.2020.11.001 Abstract ( 337 )   PDF (609KB) ( 852 )   【Abstract】Objective Readmission within 30 days after hospital discharge is an important indicator for disease prognosis and health care quality. This study aims to explore risk factors associated with 30-day readmission in maintenance dialysis patients and to build score sheets for risk prediction. Methods Data were taken from patients receiving maintenance dialysis and discharged from hospitals located in Yinzhou, Ningbo, between January 2010 and January 2020. Age, sex, hospitalization records and diagnoses on discharge were collected. The outcome was the readmission within 30 days after discharge of the index hospitalization. The index hospitalization was arbitrarily selected when there were multiple hospitalizations for a patient. Charles Comorbidity Index (CCI) was calculated as an indicator of multi- comorbidities status. All patients had 2 scores due to their status of dialysis. COX proportional hazard regression model was utilized to explore the potential risk factors. Score sheets were developed to predict readmission from the β-coefficients of COX proportional hazards model. Results Among the 1614 patients, 348 (21.56%) had a 30-day hospital readmission.Multivariable- adjusted Cox proportional hazard model showed that higher CCI (CCI 3~4 vs. CCI 2, HR=1.257, 95% CI: 0.917~1.724; CCI ≥5 vs. CCI2, HR=1.848, 95%CI:1.374~2.486), more hospitalizations in the prior 6 months (HR=1.576, 95% CI: 1.471~1.688), inpatient days (HR=1.010, 95%CI:1.001~1.020), peritoneal dialysis (HR= 1.505, 95%CI: 1.207~1.876). These variables were used to build score sheets to predict the readmission risk. Conclusions CCI, multiple hospitalizations in the prior 6 months, inpatient days and peritoneal dialysis were associated with 30-day readmission in patients receiving maintenance dialysis, and could be used for risk prediction. Metrics

Select

Epidemiology and treatment pattern of hyperkalemia among outpatients in China: a descriptive study using an administrative database in China  2020, 19 (11):  726-729.  doi: 10.3969/j.issn.1671-4091.2020.11.002 Abstract ( 950 )   PDF (392KB) ( 1329 )   【Abstract】Objectives The aim of this study was to evaluate the proportion of hyperkalemia, rates of the diagnosis and treatment, and rate of retesting for hyperkalemia among outpatients in China. Methods Data were derived from Beijing Data Center for Rational Use of Drugs. Patients who accessed outpatient services (aged ≥18 years old) with record(s) of serum potassium (S-K) between Jan. 1st, 2015 and Dec. 31st, 2017 were included. The data about laboratory test, diagnosis and treatment were analyzed. The main outcomes including proportion of hyperkalemia patients, diagnosis rate, treatment rate and S-K retesting rate were analyzed. The geographic and seasonal distributions of the outcomes were examined. Results A total of 2,997,634 patients with at least one S-K record were analyzed. Among these patients, 115,826 (3.86%) experienced hyperkalemia (S-K＞5.0mmol/L). In patients with chronic kidney disease, heart failure, diabetes mellitus and hypertension, the rates of patients who experienced hyperkalemia were 22.89%, 12.54%, 7.11% and 6.51%, respectively. In outpatients, the overall rate of hyperkalemia was 2.53%. In patients with hyperkalemia, the overall hyperkalemia treatment rate was 8.69%, and the overall retesting rate within 7 days was 11.41%. Conclusions Hyperkalemia is an abnormality not rare in adult outpatients in China. The rate and severity of hyperkalemia were higher in patients with chronic kidney disease, heart failure, hypertension and diabetes compared to those in the overall outpatients. However, the rates of diagnosis, treatment and retesting for hyperkalemia in outpatients were insufficient, suggesting that the recognition and management of hyperkalemia in outpatients should be emphasized. Metrics

Select

Research on the construction and performance of a joint care mode for automated peritoneal dialysis patients based on a remote monitoring system 2020, 19 (11):  730-733.  doi: 10.3969/j.issn.1671-4091.2020.11.003 Abstract ( 278 )   PDF (443KB) ( 722 )   【Abstract】Objective To establish a joint care mode for automated peritoneal dialysis (APD) patients based on a remote monitoring system and to analyze its application effects. Methods This was a prospective cohort study which recruits the end stage renal disease (ESRD) patients treated in the Peritoneal Dialysis Center of the Department of Nephrology, the Second Affiliated Hospital of PLA Military Medical University from June 1, 2018 to January 31, 2019. The patients with continuous ambulatory peritoneal dialysis (CAPD) and treated with routine follow-up mode were used as the control group; the APD patients with the joint care mode based on a remote monitoring system were used as the observation group. Complications and compliance of Kt/V were compared between the two groups. Social re-participation and sleep quality were compared between the two groups using the self-made general questionnaire and the sleep quality scale, medical outcomes study sleep scale (MOS-SS). Results In the follow-up period until February 2020, the rate of fulltime social re-participation was 74.58% in the APD group, higher than 5.13% in the CAPD group (χ2=71.180, P=0.000). However, there were no statistical significances in peritonitis, exit infection, mechanical complications, withdrawal from the treatment, emergent hospitalization and compliance of Kt/V between the two groups (χ2= 0.162, 0.154, 0.643, 0.167, 0.548 and 0.651 respectively; P=0.687, 0.215, 0.423, 0.683, 0.459 and 0.983 respectively), neither in self-reported overall sleep quality including sleep disturbance, sleep adequacy, daytime mental state, snoring, breath shortness after wakening, sleep volume and overall sleep score (χ2=0.042, 2.311, 0.752, 0.429, 0.548, 0.173 and 1.086 respectively; P= 0.839, 0.131, 0.388, 0.513, 0.460, 0.678 and 0.269 respectively). Conclusion The joint care mode for APD patients based on the remote monitoring system can improve their social re-participation and sleep quality, achieve the complication occurrence and dialysis effect similar to those in CAPD patients, and is worthy of promotion in clinical practice. Metrics

Select

Fungal peritonitis in peritoneal dialysis patients: retrospective analysis of 24 cases 2020, 19 (11):  734-737.  doi: 10.3969/j.issn.1671-4091.2020.11.004 Abstract ( 474 )   PDF (401KB) ( 789 )   【Abstract】Objective To explore the clinical characteristics of fungal peritonitis (FP) in peritoneal dialysis (PD) patients. Methods We retrospectively reviewed the FP episodes (FP group) diagnosed from January 2010 to December 2019 in Hangzhou Hospital of Traditional Chinese Medicine. Their demographic data and clinical information including temperature, heart rate, blood pressure, white blood cells, hemoglobin, hypersensitive C-reactive protein, serum albumin, serum potassium, white blood cell count in dialysis effluent fluid and culture results of peritoneal fluid were recruited. PD patients diagnosed with bacterial peritonitis (BP group) and matched in a ratio of 1:4 were used as the controls. Results There were 24 FP episodes including 8 males and 16 females with an average age of 62.5 (53.5, 69.5) years and an average PD duration of 65.50 (27.75, 96.25) months, and accounting for 4.43% (24/542) of hospitalized PD-associated peritonitis in the same period. Ten patients were treated with antibiotics 4 weeks before the onset of FP, and 20 patients had a history of peritonitis. A total of 25 strains of fungi were isolated from the 24 FP patients, including C. parapsilosis 9 strains, C. albicans 6 strains, C. glabrata 4 strains, and non-candida species 3 strains. Single fungal infection was found in 19 FP patients and mixed infection was detected in 5 cases including 4 cases of mixed fungal and bacterial infection and one case of mixed two fungal strains infection. Compared to BP group, FP group had a different gender ratio and a longer disease course. Peritoneal catheters were removed in 22 cases, and removal of the peritoneal catheters was refused by the patients in 2 cases. Surgical exploration was performed in 12 cases. Six patients (25%) discharged from the hospital due to exacerbation, one case was re-catheterized for PD after extubation for 3 weeks, and the rest of the patients were changed to hemodialysis. Conclusions FP is a severe complication of PD. FP is frequently complicated with hypokalemia and hypoalbuminemia, a higher withdrawal rate and an unfavorable outcome. C. parapsilosis and C. albicans were the main pathogens in this series of FP patients. Metrics

Select

The development of a risk prediction model for volume overload in patients with peritoneal dialysis 2020, 19 (11):  738-741.  doi: 10.3969/j.issn.1671-4091.2020.11.005 Abstract ( 534 )   PDF (418KB) ( 864 )   【Abstract】Objective To explore the independent risk factors for volume overload, and to develop a risk prediction model for volume overload in patients with peritoneal dialysis (PD). Methods A total of 129 PD patients treated in the period from January to December 2019 were recruited in this study. Overhydration (OH) value was assessed by multiple-frequency bioelectrical impedance. OH >2.5 L (n=81) was assigned as volume overload, and OH ≤2.5L (n=48) as normal volume status. Clinical manifestations were compared between the two groups. Results Compare with the normal volume patient group, systolic blood pressure, total water (TBW), extracellular water (ECW) and intracellular water (ICW) were significantly higher (P<0.05), while serum albumin and residual urine volume were significantly lower in the volume overload group (P<0.05). Logistic regression analysis found that urine volume (β =0.001, OR=1.001, 95% Cl 1.001- 1.002, P=0.001), systolic blood pressure (β=-1.320, OR=0.966, 95% Cl 0.938-0.994, P=0.019), and serum albumin (β=0.176, OR=1.193, 95% Cl 1.088- 1.308, P=0.000) were the independent risk factors for volume load. The ROC curve showed that AUC=0.845, the most approximate index=0.539, the predictive sensitivity=90.1%, the specificity=62.5%, and the total coincidence rate=73.6%. Conclusion Urine volume, systolic blood pressure and serum albumin were the independent risk factors for volume overload in PD patients. Metrics

Select

Risk factors for vascular calcification in maintenance hemodialysis patients 2020, 19 (11):  742-746.  doi: 10.3969/j.issn.1671-4091.2020.11.006 Abstract ( 530 )   PDF (453KB) ( 962 )   【Abstract】Objective To investigate the prevalence and the influencing factors involved in vascular calcification (VC) in maintenance hemodialysis (MHD) patients. Method A total of 154 patients treated with MHD at the Department of Blood Purification, the First Affiliated Hospital of Xi'an Jiaotong University were enrolled in this study. Demographics data at baseline were collected. Malnutrition-inflammation complex syndrome (MICS) was evaluated using the nutrition inflammatory score (MIS). Laboratory examinations including hypersensitive C-reactive protein (hs-CRP), calcium (Ca2+), phosphorus (P), albumin (ALB), parathyroid hormone (PTH) and serum vitamin K2 were conducted. Patients were divided into two groups based on the presence or absence of abdominal aortic calcification assessed by lateral lumbar radiography. Results ①The rate of VC was 48.7%. All of the patients with VC had different degrees of MICS; MIS score was significantly higher in VC group than in non-VC group (8.27±3.52 vs. 5.56±3.07, t=-5.095, P＜0.001), and MIS score increased along with the increase of VC rate (χ2=21.673, P＜0.001). ②The mean value of serum vitamin K2 in this cohort of MHD patients was 1.88±0.38nmol/L, and the level was significantly lower in VC group than in non-VC group (1.77±0.39 vs. 1.97±0.35nmol/L, t=2.473, P=0.016). ③Multivariate regression analysis indicated that age (OR=1.165, 95% CI 1.055～1.286, P＜0.001) and MICS (OR=1.440, 95% CI 1.009～1.910, P=0.045) were the risk factors for VC, and serum vitamin K2 was the protective factor for VC (OR=0.062, 95% CI 0.007～0.559, P=0.013) after corrections of dialysis age, Ca2 +xP product, 25-(OH) D3 and the history of coronary arteriosclerosis heart disease. Conclusion The incidence of VC in MHD patients is higher than that in the general population. Older age and malnutrition-microinflammatory state are the independent risk factors for VC in MHD patients, and increase of serum vitamin K2 is a favorable factor for the prevention of VC. Metrics

Select

Serum magnesium and its influencing factors in 126 patients with maintenance hemodialysis 2020, 19 (11):  747-750.  doi: 10.3969/j.issn.1671-4091.2020.11.007 Abstract ( 401 )   PDF (481KB) ( 942 )   【Abstract】Objective The study was to analyze the current situation of serum magnesium (Mg) in maintenance hemodialysis (MHD) patients, the influencing factors for serum Mg level, and the relationship between serum Mg and cardio-cerebrovascular events. Methods We analyzed 126 patients treated with MHD in March 2018 at the Blood Purification Center, the Affiliated Hospital of Nantong University. And they were followed up for 24 months. Results Multivariate logistic regression analysis showed that patients with higher serum albumin (OR=2.020, 95% CI: 1.497～2.727, P＜0.001) and lower high-sensitivity C-reactive protein (OR=0.904, 95% CI: 0.824～0.992, P=0.034) had higher serum Mg level. Multivariate COX proportional hazard analysis showed that lower serum Mg was the independent risk factor for adverse cardio-cerebrovascular events (HR=7.461, 95% CI: 2.005～27.766, P=0.003). Conclusions MHD patients with hypermagnesemia had better nutritional status, lower inflammatory level, and lower risk of cardio-cerebrovascular events than patients with normal serum Mg. Therefore, maintenance of serum Mg at a slightly higher level may be beneficial for MHD patients. Metrics

Select

Clinical characteristics and related factors of coronary artery calcification in peritoneal dialysis and hemodialysis patients 2020, 19 (11):  751-755.  doi: 10.3969/j.issn.1671-4091.2020.11.008 Abstract ( 360 )   PDF (473KB) ( 745 )   【Abstract】Objective To assess the differences about the situation and related factors of coronary artery calcification (CAC) in patients with peritoneal dialysis (PD) and those with hemodialysis (HD). Methods According to age and gender balance, 38 PD patients and 38 HD patients with dialysis age of more than one year were recruited in this study. CAC score was calculated after spiral CT examination. Clinical characteristics, related factors and the differences between PD patients and HD patients were analyzed based on the severity of CAC. Results The prevalence of CAC was similar between the two groups. However, CAC score was significantly lower in PD patients than in HD patients (P=0.003). In PD patients, those with severe CAC had higher rates of cerebrovascular disease (P=0.000) and/or diabetes (P=0.012); those with mild CAC had higher rates of taking vitamin D (P= 0.000) and calcium preparations (P=0.000), and higher levels of low density lipoprotein cholesterol (P=0.000) and total cholesterol (P=0.010). The severity of CAC was negatively correlated with diastolic blood pressure (P=0.000), and positively correlated with dialysate glucose load (P=0.040) and the prevalence of abdominal aortic calcification (P=0.000). Multivariate linear regression showed that CAC score was positively correlated with BMI (P=0.030) and negatively correlated with diastolic blood pressure (P=0.018). In HD patients, the severity of CAC was positively correlated with age (P=0.005) and the prevalence of abdominal aortic calcification (P=0.009). Multivariate linear regression showed that CAC score was positively correlated with BMI (P=0.001), serum calcium (P=0.027) and the prevalence of abdominal aorta calcification (P=0.020). Conclusion Clinical characteristics and risk factors of CAC were different between PD patients and HD patients. Therefore, individualized management is required between the two groups of patients. Metrics

Select

Risk factors for hyperkalemia in secondary hyperparathyroidism after parathyroidectomy 2020, 19 (11):  756-759.  doi: 10.3969/j.issn.1671-4091.2020.11.009 Abstract ( 603 )   PDF (401KB) ( 976 )   【Abstract】Objective Parathyroidectomy (PTX) is the main method to treat secondary hyperparathyroidism (SHPT). However, the risk factors for postoperative hyperkalemia are uncertain. This study was to investigate the risk factors for postoperative hyperkalemia after PTX for SHPT. Methods A total of 53 patients with SHPT undergoing PTX in Changzhou First People’s Hospital from January 2013 to August 2019 were involved in this study. Laboratory examinations including serum K+, Ca2+, alkaline phosphatase, phosphorus and intact parathyroid hormone were conducted before and after PTX. Results In PTX patients, postoperative serum K+ was higher than preoperative level (t=-9.125, P<0.001), and postoperative serum Ca2 + (t=-9.853, P<0.001), phosphorus (t=2.044, P=0.046) and iPTH (Z=-6.334, P<0.001) were lower than the preoperative levels. Postoperative hyperkalemia developed in 28 (52.8%) patients. Preoperative serum K+ level was the independent risk factor for hyperkalemia after PTX in SHPT patients (β=-3.054, P=0.008). The ROC curve showed that the optimal cut- off value for preoperative serum K+ was 4.3mmol/L. Conclusion SHPT patients with higher serum K+ before surgery have a higher risk of hyperkalemia after PTX, Lowering serum K+ below 4.3mmol/L before surgery is useful to reduce the risk of postoperative hyperkalemia. Metrics

Select

Study on the effect of different hemodialysis methods on the clearance of indoxyl sulfate in rats 2020, 19 (11):  760-763.  doi: 10.3969/j.issn.1671-4091.2020.11.010 Abstract ( 301 )   PDF (798KB) ( 862 )   【Abstract】Objective To establish a model of rats with high indoxyl sulfate (IS) level and then to study the effect of different dialysis modalities on clearance of IS. Methods Rat model of high IS level was established in 24 male SD rats. They were then divided into control group (n=6), HD (hemodialysis) 4h group (n=6), HD 6h group (n=6) and HDF (hemodiafiltration) group (n= 6). Arterial blood sample was taken every 30 minutes during dialysis. Blood IS concentration was assayed by HPLC. SPSS 24.0 was used for statistical analyses; P<0.05 was considered to be significant. Results ①Establishment of the rat model: IS level decreased significantly [(57.79±16.12)μg/ml vs. (49.26±10.80)μg/ml] after model establishment for 30～60min, then maintained the level (46.48±8.00)μg/ml to 360 min (P=0.178, F=4.858). ②IS level decreased gradually with HD (F=24.719, P＜0.001 for HD group; F=44.086，P＜0.001 for HDF group; F=52.481, P＜0.001 for HD 6h group). The clearance of IS with HDF was significantly higher than that with HD (F=7.567, P=0.020). IS level did not change significantly when HD prolonged from 240 min to 360 min (P= 0.555, 95% CI: -0.777～1.284). Conclusion The rat model of renal insufficiency with significant increase of IS level and the rat model treated with HD or HDF were successfully established. The clearance rate of IS using HDF was significantly higher than that using HD. The clearance ability of HD reached saturation about 4 hours after the treatment, and the clearance ability could not be further increased beyond 4 hours. Metrics

Select

Research progress in H- type hypertension in chronic kidney disease 2020, 19 (11):  768-771.  doi: 10.3969/j.issn.1671-4091.2020.11.012 Abstract ( 351 )   PDF (363KB) ( 866 )   【Abstract】Great difficulties and challenges are encountered in the treatment of chronic kidney disease, and the current treatment is mainly focused on the intervention of the risk factors. H-type hypertension is associated with renal insufficiency and cardiovascular complications in chronic kidney disease patients. This article reviews the definition, epidemiology, relationship between H-type hypertension and chronic kidney disease, and the mechanism that H-type hypertension leads to the progression of chronic kidney disease, in order to improve our understanding about the relationship between H-type hypertension and chronic kidney disease, which may be useful for clinical treatment of hypertension in chronic kidney disease patients. Metrics

Select

Effect of peritoneal transport characteristics on survival rate of diabetic nephropathy patients with peritoneal dialysis 2020, 19 (11):  772-774.  doi: 10.3969/j.issn.1671-4091.2020.11.013 Abstract ( 240 )   PDF (249KB) ( 727 )   Metrics

Select

Interpretation of the consensus about the use of iodinated contrast media in kidney disease patients 2020, 19 (11):  775-778.  doi: 10.3969/j.issn.1671-4091.2020.11.014 Abstract ( 478 )   PDF (376KB) ( 848 )   【Abstract】Acute kidney injury is one of the most common adverse reaction after intravascular administration of contrast media, especially with increased risk in kidney disease patients. How to reduce the risk has always been an important issue in clinical practice. In January 2020, the American College of Radiology and the National Kidney Foundation issued consensus statements about use of iodinated contrast media in patients with kidney disease. These statements update the definition, diagnostic criteria, risk factors, combined use of drugs, preventive measures, special population and other aspects. This paper interprets these statements in association with other guidelines and relevant literature. Metrics

Select

Analysis of status quo and relevant factors of disaster preparedness in kidney transplant patients 2020, 19 (11):  779-782.  doi: 10.3969/j.issn.1671-4091.2020.11.015 Abstract ( 273 )   PDF (350KB) ( 698 )   【Abstract】Objective To understand the status of disaster preparedness of kidney transplant patients, and to provide reference for the formulation of relevant interventions. Methods A disaster questionnaire for kidney transplantation was used to investigate 222 kidney transplantation patients in West China Hospital of Sichuan University. An online questionnaire was used to collect data through the "questionnaire star". Results Among the 222 kidney transplant patients, 118(53.20%) had low disaster preparedness, 93 (41.90%) had moderate disaster preparedness, and 11(5.00%) had high disaster preparedness. There were differences among patients of different ages, genders, educational levels and occupations. Patients' ages (r=-0.417, P＜0.001), educational levels (r= -0.351, P＜0.001)and occupations (r=- 0.355,P＜0.001) were negatively correlated with patients' preparedness behaviors, while patients' genders (r=0.288,P＜0.001) were positively correlated with patients' preparedness behaviors. Conclusion The disaster preparedness of kidney transplant patients is in the low level. It is recommended to carry out disaster preparedness training for kidney transplant patients to improve their disaster preparedness. Metrics

Select

Application value of closed loop management of Internet of Things in disposal of medical waste of peritoneal dialysis patients 2020, 19 (11):  783-785.  doi: 10.3969/j.issn.1671-4091.2020.11.016 Abstract ( 192 )   PDF (379KB) ( 652 )   【Abstract】Objective To explore the application value of closed loop management of Internet of Things in disposal of medical waste of peritoneal dialysis (PD) patients at home. Methods A total of 119 PD patients at home were randomly divided into control group (n=61) and intervention group (n=58). Conventional education and guidance were given to the control group, and closed loop management of Internet of Things in addition to the conventional education and guidance were given to the intervention group. The self-designed questionnaire was used to understand the disposal of medical waste by PD patients. The disposal of medical waste before and after the intervention was compared between the two groups. Results In the intervention group, the rate of standardized disposal of medical waste increased from 3.4% before the intervention to 91.4% after the intervention (χ2= 89.327, P<0.001), and the rate of standardized disposal of medical waste was significantly higher in the intervention group than in the control group (χ2=82.338, P<0.001). The recovery rate of PD waste liquid bags in the intervention group increased from 3.47% before intervention to 91.37% after intervention (χ2=86.726, P<0.001). The recovery rate of PD waste liquid bags was significantly higher in the intervention group than in the control group (χ2=76.842, P<0.001). Conclusion The closed loop management of Internet of Things can standardize the behavior of disposal of medical waste in PD patients at home. This method is valuable for practical use, and is the recent trend of medical waste management for PD at home. Metrics

Select

The construction and application of a system for the evaluation of useless hemodialysis machines based on analytical hierarchy process and Delphi methods 2020, 19 (11):  786-789.  doi: 10.3969/j.issn.1671-4091.2020.11.017 Abstract ( 217 )   PDF (379KB) ( 683 )   【Abstract】Purpose To construct a system for the evaluation of useless hemodialysis machines and to improve a decision- making and technological process for the disposal of useless hemodialysis machines. Method Taking the use of hemodialysis machines in Baoji Central Hospital as an example, an evaluation system for obsolescent hemodialysis machines was established by using the analytical hierarchy process (AHP). The weight of all indicators was determined by using the Delphi method. The evaluation criteria were then developed. Total evaluation score of the equipment was calculated, and disposal of the equipment was conducted in sections. Result A total of 34 hemodialysis machines in our hospital were evaluated. Four units were approved to be scrapped, consistent with the content reported by the department. Six sets were ready to be scrapped; the configuration benefit was maximized by changing the functional parameters and use attributes of the equipment. There were 5 sets in normal use; their preventive maintenance needed to be enhanced. There were 18 sets of equipment in better status; daily maintenance is required for their normal performances. Conclusion The application of this evaluation system resolved the problems that were merely formal and unable to be quantified in the evaluation process of useless hemodialysis machines. Objective, systematic and intuitive evaluation of scrapping promotes and guides the whole life cycle management and quality control of the medical equipment. Metrics