Chinese Journal of Blood Purification

12 February 2021, Volume 20 Issue 02 Previous Issue    Next Issue

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Study on the relationship between lung function and body fluid state in hemodialysis patients with endstage renal disease  2021, 20 (02):  73-76.  doi: 10.3969/j.issn.1671-4091.2021.02.001 Abstract ( 353 )   PDF (407KB) ( 844 )   【Abstract】Objective To explore the relationship between fluid status and lung function in hemodialysis patients with end-stage renal disease (ESRD). Methods From April to October 2019, 54 ESRD patients receiving hemodialysis in the blood purification center of our hospital were enrolled. Respiratory function was measured before and after hemodialysis, and overhydration (OH), extracellular water (ECW), and OH/ECW% were measured using the DSM-BIA method. OH/ECW＞7% is considered overhydration. Results The levels of FVC, FVC% and FEV1 were significantly increased after hemodialysis. In terms of BIA parameters, patients’OH/ECW% after dialysis was statistically lower than that before dialysis (t value: 2.213, 2.389, 2.327 and 15.117, respectively，P value: 0.030,0.019, 0 .022 and＜0.001, respectively). Overhydration was seen in 15 patients (27.8%). The FVC, FVC%, FEV1, FEV1%, FEF25-75, FEF25-75%, PEFR and PEFR% in the overhydration group were all lower than those in the non-overhydration group, and the differences were statistically significant(t value: 4.740, 5.131, 4.902, 6.226, 4.263, 3.668, 2.904 and 3.694, respectively，P value:＜0.001,＜0.001,＜0.001,＜0.001, ＜0.001,＜0.001, 0.005 and＜0.001, respectively). OH/ECW was negatively correlated with FVC, FVC%, FEV1, FEV1%, FEF25-75, FEF25-75%, PEFR and PEFR% (r value:–0.411, –0.530, –0.395, – 0.491,–0.307,–0.272,–0.302and–0.425, respectively，P value: 0.002, ＜0.001, 0.003, ＜0.001, 0.024, 0.047, 0.027 and 0.001, respectively). Stepwise multiple linear regression model showed that increases in male and ultrafiltration were independently associated with higher FVC (Standard Beta value: 0.341 and 0.218 respectively，P value: 0.002 and 0.040 respectively), while increases in age and OH/ECW% were independently associated with lower FVC (Standard Beta value:–0.419 and -0.314 respectively, P value:＜0.001 and 0.002 respectively). Conclusion Overhydration is significantly related to respiratory dysfunction in ESRD patients who undergoing hemodialysis. Hemodialysis has a significant treatment to improve lung function, which may be due to the relief of overhydration after hemodialysis. Metrics

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Analysis of risk factors of coronary artery calcification and its relation with iron metabolism in patients with chronic kidney disease stage 3～5  2021, 20 (02):  77-81.  doi: 10.3969/j.issn.1671-4091.2021.02.002 Abstract ( 421 )   PDF (454KB) ( 753 )   【Abstract】Objective To evaluate the risk factors of coronary artery calcification (CAC) in patients with chronic kidney disease (CKD) stage 3～5 and the relationship between iron metabolism indices and CAC. Methods One hundred and sixty-two patients with CKD stage 3～5 in the Department of Nephrology of the Second Hospital of Anhui Medical University were recruited. Clinical data and laboratory indices were collected. Serum iron, ferritin, transferrin and total iron binding capacity (TIBC) were examined, and transferrin saturation (TSAT) was calculated. Ferrin> 800 μg/L and/or TSAT> 50% were defined as iron overload. The coronary artery calcification score (CACs) was measured by multi-slice spiral computed tomography. According to CACs>10, patients were divided into calcification group and non-calcification group. To investigate the correlation between iron metabolism and CAC, and to explore the predictive value of risk factors on CAC. Result Ninety-two patients (56.8%) had CAC. Transferrin and TIBC were negatively correlated with CACs (r=-0.293, -0.253, P < 0.001, 0.001, respectively). Binary logistic regression analysis showed that old age(OR=1.050, 95% CI=1.013～1.088, P=0.007), diabetes (OR=4.712, 95% CI=1.445～15.371, P=0.010), higher neutrophil- lymphocyte (NLR) (OR=1.253, 95% CI=1.025～1.533, P=0.028), higher blood phosphorus (OR=3.981, 95% CI=1.791～8.849, P=0.001), and lower transferrin (OR=0.130, 95% CI=0.044～0.378, P< 0.001) were independent risk factors of CAC.ROC curve showed that the area under the curve of combined prediction of CAC by age, diabetes, NLR, blood phosphorus and transferrin was 0.828 (95% CI 0.766～0.891, P<0.001), the sensitivity was 79.3%, and the specificity was 75.7%. Conclusion The incidence of CAC was high in patients with CKD stage 3～5. Old age, diabetes, hyperphosphatemia, high NLR and decreased blood transferrin level are independent risk factors of CAC. The combined indicator including the above risk factors has good predictive value for the occurrence of CAC. Metrics

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Effect Investigation of Non-dialysis CKD Patients with Multidisciplinary Care 2021, 20 (02):  82-85.  doi: 10.3969/j.issn.1671-4091.2021.02.003 Abstract ( 272 )   PDF (713KB) ( 750 )   【Abstract】Objective To investigate the effect of multidisciplinary care (MDC) on renal outcome in CKD patients. Methods This is a prospective cohort study in a single center. Patients with CKD stage 1～5 without renal replacement treatments were followed up regularly in department of nephrology of the Second Hospital of Lanzhou University. Patients were divided into receiving MDC support (intervention group, IG) and physician care alone(control group,CG) according to their wishes. Clinical and laboratory data were collected． The primary renal endpoint is the diagnosis of ESRD and the secondary renal endpoint is 50% increase in serum creatinine. Results A total of 781 patients were enrolled in the final analysis, with 373 patients(92%) of IG and 408 patients (81%) of CG. After the enrollment of 2 years, eGFR decreasing were significantly slower in IG than that in CG(t2=- 2.606，P=0.009). Patients in the IG has a higher proportion of blood pressure≤130/80mmHg (c2=24.408, P＜0.001), a higher rate of serum Ca within 2.1～-2.5mmol/L (c2=4.630, P=0.031) and a higher rate of Hb level≥110g/L (c2=3.576, P=0.048). The MDC reduced the incidence of ESRD (HR,0.448; 95% CI, 0.306-0.656; P＜0.001). Subgroup analysis shown that men gender [HR,0.314 (0.188～0.524), P=0.018], without diabetes [HR, 0.649 (0.414～1.015), P=0.024] and CKD 1～3a group [HR, 0.015 (0.001～0.431), P= 0.031] had lower incident of ESRD. Conclusions MDC management can effectively delay the progress of CKD and improve the compliance rate of indicators. Metrics

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Effect of continuous renal replacement therapy on elderly patients with refractory heart failure and its effect on serum factor levels  2021, 20 (02):  86-89.  doi: 10.3969/j.issn.1671-4091.2021.02.004 Abstract ( 241 )   PDF (445KB) ( 746 )   【Abstract】Objective To investigate the effect of continuous renal replacement therapy (CRRT) in the treatment of elderly patients with refractory heart failure and its effect on serum levels of C reactive protein (CRP), galectin-3 (Gal-3), N-terminal pro-brain natriuretic peptide (NT-proBNP), heart fatty acid binding protein (H-FABP) and Nexilin. Methods We recruited 84 elderly patients with refractory heart failure admitted to our hospital from June 2016 to February 2018, and randomly divided them into study group (n=42) and control group (n=42). While all patients received the conventional treatment, patients in study group were also treated with CRRT. Left ventricular ejection fraction(LVEF), stroke volume(SV), left ventricular end-diastolic diameter (LVEDD), maximum mitral flow velocity E-peak/A-peak (E/A), serum levels of CRP, Gal-3, NTproBNP, H-FABP and Nexilin, and clinical effects were compared before and after CRRT between the two groups. Results After the treatment, LVEF, SV and E/A became higher in study group than in control group (t=3.081, 4.131 and 3.043 respectively; P=0.003, 0.000 and 0.003 respectively); LVEDD and the serum levels of CPP, Gal-3, NT-proBNP, H-FABP and Nexilin were lower in study group than in control group (t=-3.520, -7.468, -6.315, -5.008, -4.133 and -5.361 respectively; P=0.001, 0.001,＜0.001,＜0.001,＜0.001 and＜0.001 respectively). Clinical effects were also better in study group than in control group(Z=-2.012, P=0.044). Conclusion CRRT is better than the conventional therapy in the treatment of elderly patients with refractory heart failure. CRRT can also significantly reduce the serum levels of CRP, Gal-3, NT-proBNP, H-FABP and Nexilin. Metrics

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Association of residual renal function with cognitive function among maintenance hemodialysis patients 2021, 20 (02):  90-94.  doi: 10.3969/j.issn.1671-4091.2021.02.005 Abstract ( 359 )   PDF (443KB) ( 878 )   【Abstract】Objective To explore the risk factors of cognitive dysfunction in maintenance hemodialysis (MHD) patients and the relationship between residual renal function and cognitive dysfunction. Methods A total of 93 MHD patients were enrolled in this study, including 31 patients with residual renal function and 62 patients without residual renal function. All patients received Montreal Cognitive Assessment Basic Scale (MOCA-B) examination and their clinical data were collected. Logistic regression was used to analyze the risk factors of cognitive impairment. Results The mean age of the patients was 61.62±11.90 years old, and 51.6% were males. The MOCA-B score of residual renal function group was significantly higher than that of non-residual renal function group (24.61±3.58 vs. 22.11±5.75; t=-2.360, P=0.020). Multivariate logistic regression analysis showed that age (OR = 0.906, 95% CI: 0.854～0.961; P=0.001), neutrophil percentage (OR=0.865, 95% CI: 0.790～0.948; P=0.002), male (OR= 3.572, 95% CI:1.146～11.136; P=0.028), and residual urine volume (OR=4.243, 95% CI: 1.214～14.827; P=0.024) were the independent risk factors of cognitive impairment. Conclusion Residual renal function is one of the protective factors of cognitive dysfunction. Metrics

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Post-operative acute kidney injury in lung transplant patients: comparing the diagnostic criteria of RIFLE,AKIN and KDIGO  2021, 20 (02):  95-98.  doi: 10.3969/j.issn.1671-4091.2021.02.006 Abstract ( 432 )   PDF (470KB) ( 775 )   【Abstract】Objective The aim of this study was to compare the differences of three diagnostic criteria, RIFLE (risk, injury, failure, loss, end stage renal disease), AKIN (acute kidney injury network), and KDIGO(kidney disease: improving global outcomes), in the assessment of post- operative acute renal kidney injury(AKI) in lung transplant recipients. Methods A total of 101 lung transplant patients treated in China-Japan Friendship Hospital from April 2017 to April 2019 were retrospectively analyzed. Their diagnosis and stage of AKI were conducted using RIFLE, AKIN and KDIGO criteria. The differences in ICU stay days, mechanical ventilation days, extracorporeal membrane oxygenation (ECMO) support days and hospitalization days were compared among the patients with different AKI stages. Receiver operating characteristic curve (ROC) curve was used to compare the accuracy of the 3 criteria in the prediction of one-year mortality. Results The incidence rates of post-operative AKI based on RIFLE, AKIN and KDIGO criteria were 73.2%, 71.6% and 75.3% respectively. There were no statistical differences in ICU stay days (P=0.586, 0.343 and 0.612, respectively), mechanical ventilation days (P=0.358, 0.251 and 0.566, respectively), ECMO support days (P=0.450, 0.888 and 0.605, respectively), and hospitalization days (P=0.878, 0.902 and 0.765, respectively) among the patients with different stages classified by the three AKI diagnostic criteria. The area under the curves (AUCs) of ROC for RIFLE, AKIN and KDIGO to predict one-year mortality after lung transplant were 0.744, 0.710 and 0.765 respectively, in which the AUCs of ROC for AKIN and KDIGO were statistically different (Z=2.009, P=0.044). Conclusions The incidence of AKI after lung transplant varies using the three diagnostic criteria. This study found that KDIGO criterion identified more AKI patients, and had better ability to predict postoperative one-year mortality. Metrics

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Efficacy and safety of HIF proly hydroxylase inhibitors vs. erythropoiesis- stimulating agents in the treatment of renal anemia in dialysis patients: a meta analysis  2021, 20 (02):  99-106.  doi: 10.3969/j.issn.1671-4091.2021.02.007 Abstract ( 386 )   PDF (9350KB) ( 767 )   【Abstract】Objective To compare the efficacy and safety of hypoxia-inducible factor prolyl hydroxylase inhibitors(HIF-PHIs) and erythropoiesis-stimulating agents (ESAs) in the treatment of renal anemia in dialysis-dependent chronic kidney disease (CKD) patients by meta-analysis. Methods We searched the databases of PubMed, Embase, Cochrane library from inception until 15th September, 2020 for randomized controlled trials of HIF-PHIs and ESAs for the treatment of renal anemia in dialysis-dependent CKD patients. Their hemoglobin(Hb) level, iron metabolism parameters and adverse reactions were extracted and analyzed by the software of Review Manager Version 5.3. Results Eight studies comprising a total of 1,512 dialysis-dependent CKD patients with anemia were included in the analysis. No significant differences were found between HIF-PHIs group and ESAs group in terms of hemoglobin level (MD=-0.15, 95% CI: -0.35, 0.05; P=0.14), ferritin level (MD=14.61, 95% CI: -3.80, 33.02, P=0.12) and hepcidin level (MD=-16.46, 95% CI: -37.77, 4.85; P=0.13). However, HIF-PHIs group showed better efficacies in terms of transferrin level (MD=0.27, 95% CI: 0.08, 0.46; P=0.02), serum iron level (MD=3.29, 95% CI: 1.22, 5.37; P＜0.01) and transferrin saturation (MD=4.15, 95% CI: 3.88, 4.42; P＜0.01) as compared with those in ESAs group. There were no differences in adverse reactions between the two groups (OR=1.31, 95% CI: 0.99, 1.74; P=0.06), except the higher nausea rate (OR=1.85, 95% CI: 1.05, 3.27; P=0.03) in HIF-PHIs group than in ESAs group. Conclusion The meta analysis found that the effect and safety of HIF-PHIs were similar to those of ESAs in the treatment of renal anemia in dialysis-dependent CKD patients. Metrics

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Incremental hemodialysis and residual kidney function 2021, 20 (02):  111-114.  doi: 10.3969/j.issn.1671-4091.2021.02.009 Abstract ( 600 )   PDF (404KB) ( 795 )   【Abstract】Residual kidney function plays critical roles in controlling water, electrolyte and acid-base balance and removing small-molecular-weight toxins in patients with end-stage renal disease. Additionally, residual kidney function also has the ability to remove middle-molecular-weight and protein-binding toxins. Endogenous clearance conferred by residual kidney function is significantly associated with survival. Hemodialysis adequacy of the patients with considerable residual kidney function should be evaluated by stdKt/Vurea. Currently, incremental hemodialysis has been attracted more attention because of its benefit of protecting residual kidney function. With incremental hemodialysis the hemodialysis dose is adjusted according to the level of residual kidney function. It has been reported that incremental hemodialysis can improve the quality of life and anemia management, reduce serum β2-microglobulin, alleviate economic burden, and even increase survival rate. However, more evidences are required to support this strategy. Metrics

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Lifestyle and the prognosis of maintenance hemodialysis patients:A literature review 2021, 20 (02):  115-117.  doi: 10.3969/j.issn.1671-4091.2021.02.010 Abstract ( 226 )   PDF (251KB) ( 801 )   Metrics

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Analysis of tunneled central venous catheterization through internal jugular vein in 1,598 cases 2021, 20 (02):  121-125.  doi: 10.3969/j.issn.1671-4091.2021.02.012 Abstract ( 328 )   PDF (403KB) ( 809 )   【Abstract】Objectives To explore the factors relating to success and safety of tunneled central venous catheterization via internal jugular vein. Methods We conducted a retrospective study on patients undergoing tunneled central venous catheterization via internal jugular vein during 2011 to 2019. Demographic information and operation-related data, including location of the catheter, utilization of X-ray examination, cause of catheterization failure, intervention method, cause of intervention failure, and many others were recruited. The main termination point of the study was the rate of successful catheterization and the cause of catherization failure. Results A total of 1,598 patients were included in this study, with the average age of 63.27±11.86 years old, 659 males (41.2%), and X-ray utilization rate of 34.7%. The overall rate of successful catheterization was 95.4% (1,525/1,598). The rates of successful catheterization with and without x- ray examination were 97.8% and 94.2% respectively (χ²=11.292, P=0.001). The rate of successful catheterization via right internal jugular vein was higher than that via left internal jugular vein (96.6% vs. 90.1%; χ²=22,375, P<0.001). In the patients X-ray examination was not used, the rates of successful catheterization via right internal jugularvein and left internal jugular vein were 95.9% and 76.8% respectively (χ²=56,871, P<0.001); while in the patients X-ray examination was used, the rates of successful catheterization via right and left jugular veins had no difference (98.4% vs. 96.8%; χ²=1.424, P=0.233). The causes of catheterization failure included ectopic tip of the catheter (endovascular ectopic or extravascular ectopic tip of the catheter), obstruction of guide wire insertion without the help of X-ray examination, and failure of interventional central vein opening. X-ray was not used in all ectopic catheter tip cases, accounting for 3.3%(34/1,043) of the patients without X-ray examination. In patients without X-ray examination, catheterization failure due to obstruction of guide wire insertion was found in 27 cases. In the 237 cases interventional operation was performed to manage the catheterization failure, the catheterization was finally successful in 225 cases, and was failure in 12 cases. Multivariate logistic regression analysis showed that left internal jugular vein catheterization (OR=1.700, 95% CI: 3.203~9.362, P<0.001) and no X-ray examination during catheterization (OR=1.653, 95% CI: 2.650~10.28, P<0.001) were the independent risk factors for failure of the catheterization. Conclusion The application of X-ray examination can increase the success rate of tunneled central venous catheterization via internal jugular vein. X-ray examination was more advantageous when left internal jugular vein was used for the catheterization Metrics

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Systematic review and meta analysis of the risk factors for thrombosis in arteriovenous fistula 2021, 20 (02):  126-129.  doi: 10.3969/j.issn.1671-4091.2021.02.013 Abstract ( 420 )   PDF (896KB) ( 1053 )   【Abstract】Objective To identify the risk factors for autologous arteriovenous fistula thrombosis (AVFT) in hemodialysis patients, and to explore the clinical data useful for preventing AVFT in hemodialysis patients. Methods We searched Cochrane Library, PubMed, Embase, Web of Science, CNKI, Wanfang Database, Weipu Database and China Biomedical Literature Databases before July 2020 about the risk factors for thrombosis in autologous arteriovenous fistula in hemodialysis patients. The searched information was analyzed by the RevMan 5.3 software. Results A total of 20 articles were included, containing 49 related risk factors. Meta analysis showed that the combined OR values of all risk factors included C-reactive protein 1.16 (95% CI:1.08～1.26, P=0.001), age 1.02 (95% CI: 1.01～1.03, P=0.001), systolic blood pressure 1.12 (95% CI: 1.07～1.19, P<0.001), diabetes mellitus 1.67 (95% CI: 1.33～2.11, P<0.001), female 2.50 (95% CI: 1.83～3.42, P<0.001), and hypotension 5.57 (95% CI: 2.88～10.75, P<0.001). Conclusion C-reactive protein, age, systolic blood pressure, diabetes mellitus, female and hypotension were the risk factors for thrombosis in autologous arteriovenous fistula in hemodialysis patients. Early intervention to the controllable risk factors of AVFT should be emphasized in hemodialysis patients. Metrics

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Effect of different outflow tract selection on short-term patency rate of the artificial arteriovenous graft 2021, 20 (02):  130-133.  doi: 10.3969/j.issn.1671-4091.2021.02.014 Abstract ( 347 )   PDF (421KB) ( 800 )   【Abstract】Objective To investigate the effect of different outflow tract selection on short-term patency rate of the artificial arteriovenous graft (AVG) and its related factors. Methods The end-stage renal disease patients treated in the Department of Vascular Surgery, People’s Hospital of Xinjiang Uygur Autonomous Region for AVG operation during the period from June 2017 to June 2019 were enrolled in this study. Their clinical data were collected. They were divided into group A (n=22) in which superficial veins were used for the outflow tract of AVG, and group B (n=15) in which a deep vein was used for the outflow tract of AVG. The general information and intraoperative data were compared between the two groups and analyzed by t-test and chi square test; the patency rate within 6 months after operation was compared between the two groups and analyzed by Kaplan-Meier survival method; the related risk factors were evaluated by Cox model. Results A total of 37 cases were enrolled in this study. Cephalic vein, basilic vein or median cubital vein was used as the outflow tract of AVG in group A, and the deep vein of brachial vein was used as the outflow tract of AVG in group B. There were no significant differences in general information and intraoperative data between the two groups, except that the type of artificial blood vessels was different (χ2=17.357, P=0.002). There was no significant difference in patency rate within 6 months after operation between the two groups (χ2=0.224, P=0.636). Cox model showed that operation site, gender, graft type, and group A or B were unrelated to the short-term patency rate of AVG (OR=1.265, 1.668, 3.936 and 1.880 respectively; 95% CI=0.241~6.626, 0.315~8.821, 0.657~23.590 and 0.398~8.881 respectively; P=0.781, 0.547, 0.781 and 0.426 respectively). Conclusion The short-term patency rate of the AVG was similar, whether superficial vein or deep vein was used for the outflow tract of AVG. However, large clinical samples are required to confirm this conclusion. Metrics

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Effects of Feynman learning method on self-management compliance and dialysis adequacy in patients performing peritoneal dialysis at home 2021, 20 (02):  134-137.  doi: 10.3969/j.issn.1671-4091.2021.02.015 Abstract ( 282 )   PDF (407KB) ( 730 )   【Abstract】Objective To explore the effects of Feynman learning method on self-management compliance and dialysis adequacy in patients performing peritoneal dialysis (PD) at home. Methods We recruited 269 (PD) patients performing PD at home and regularly followed-up as the outpatients in the Peritoneal Dialysis Center of our hospital from January 2019 to June 2019. They were divided into research group (n=146) and control group (n=123). Patients in the research group were treated with the Feynman learning method, while those in the control group with the guidance education method. The self-management compliance and dialysis adequacy were compared between the two groups after the treatment for 6 months. Results The total score of diet attitude compliance was higher in the research group than in the control group (85.70±3.13 vs.80.60±5.25, t=4.374, P＜0.001), and so was the total score of diet behavior compliance (73.65 ± 4.02 vs. 69.30± 4.46, t = 3.055, P = 0.007). The incidence of grade 2 and grade 3 edema in the research group was 10.96%, significantly lower than that in the control group (32.52%, χ2= 26.576, P＜ 0.001). The parameters of creatinine clearance (Ccr), compliance rate of Ccr, dialysis adequacy Kt/V value and compliance rate of Kt/V value were all better in the research group than in the control group (67.11 ± 9.65 vs. 58.61 ± 10.77, 76.71% vs. 61.79%, 1.83±0.21 vs. 1.71±0.23 and 65.75% vs. 51.22% respectively; t=3.925, 7.065, 2.623, and χ2=5.834 respectively; P=0.001, 0.011, 0.016 and 0.018 respectively). Conclusion The Feynman learning method can improve self-management compliance and dialysis adequacy in patients performing PD at home. Metrics

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The application of empowerment management in the training of nurses specialized in continuous renal replacement therapy  2021, 20 (02):  138-141.  doi: 10.3969/j.issn.1671-4091.2021.02.016 Abstract ( 266 )   PDF (415KB) ( 955 )   【Abstract】Objective To explore the application of empowerment management in the training of nurses specialized in continuous renal replacement therapy (CRRT). Methods The training of nurses specialized in CRRT was carried out in Hubei General Hospital. Empowerment management was performed in the 49 CRRT specialized nurses passed the examination. Their structural empowerment, psychological empowerment, job satisfaction and emergency handling ability were compared before and after training. Results The scores of structural empowerment (t=4.838, P＜0.001), psychological empowerment (t=2.362, P=0.022) and job satisfaction (t=2.484, P=0.017) increased significantly after training as compared with those before training. However, the impact dimension of psychological empowerment (t=0.259, P=0.797) and the external satisfaction subscale of job satisfaction (t=1.899, P=0.064) showed no significant differences after training as compared with those before training. The emergency handling ability of CRRT specialized nurses improved significantly (X2=4.047, P=0.044). Conclusion Empowerment management combined with training of nurses specialized in CRRT can effectively increase their structural empowerment, psychological empowerment, job satisfaction, and specialized nursing ability levels, and decrease the adverse events during CRRT operation. Therefore, this method is worthwhile to be used in clinical practice. Metrics