Chinese Journal of Blood Purification

12 March 2021, Volume 20 Issue 03 Previous Issue    Next Issue

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The prevalence and risk factors of hyperkalemia in Chinese hemodialysis patients based on the China Dialysis Outcomes and Practice Patterns Study 2021, 20 (03):  145-150.  Abstract ( 686 )   PDF (577KB) ( 1046 )   【Abstract】Objective Hyperkalemia is a common complication in patients with end stage renal disease due to impaired renal potassium excretion. Higher pre-dialysis serum potassium may cause heart rhythm disturbances and even fatal cardiac arrest. This study assessed the prevalence of hyperkalemia in hemodialysis (HD) patients based on the China Dialysis Outcomes and Practice Patterns Study (DOPPS), and explored the independent risk factors of hyperkalemia in HD patients. Methods DOPPS is an international prospective and observational study. China participates in the DOPPS5 (2012～2015) and has completed the follow-up study of the cohort. A total of 1,427 HD patients included in the China DOPPS5. We recruited their pre-dialysis serum potassium and clinical data, and divided them into normal potassium group and hyperkalemia group (serum potassium ≥5.5mmol/L). Their demographic information, laboratory data and dialysis prescriptions were compared between the two groups. The independent risk factors for hyperkalemia were explored using multivariate logistic regression analysis. Results A total of 1,339 HD patients were enrolled in this study, with an average age of 59.4±14.9 years, 54.4% males, and an average dialysis vintage of 2.6 (0.9, 5.3) years. Hyperkalemia was detected in 345 patients (25.8%), of which 13.3% were mild hyperkalemia, 7.6% were moderate hyperkalemia, and 4.9% were severe hyperkalemia. Among the three cities involved in this study, the HD patients in Beijing had the highest rate of hyperkalemia (31.8%), followed by Guangzhou (26.0%) and Shanghai (19.3%) (χ2=18.580, P＜0.001). There were significant differences in age (t=2.610, P=0.009), gender (χ2=4.059, P=0.007), BMI (t=-2.680, P=0.008), dialysis adequacy (t=4.280, P＜0.001), dialysis frequency (χ2=21.548, P＜0.001), serum albumin (t=6.071, P＜0.001), and serum phosphorus (t=7.083, P＜0.001) between normal potassium group and hyperkalemia group. Multivariate logistic regression showed that higher BMI (OR: 1.040, 95% CI: 1.004～1.077, P=0.027), female gender (OR:1.201, 95% CI: 1.023～2.547, P=0.026), potassium concentration in dialysate≥2.5mEq/L (compared to <2.5mEq/L) (OR: 1.194, 95% CI:1.028～1.386, P=0.020), lower dialysis adequacy (stdKt/V<2) (OR: 1.336, 95% CI: 1.170～1.527, P＜0.001), dialysis frequency＜3 times per week (OR: 1.332, 95% CI: 1.150～1.544, P＜0.001), higher serum albumin (OR: 1.815, 95% CI: 1.294～2.547, P＜0.001) and higher serum phosphorus (OR: 1.231, 95% CI: 1.153～1.316, P＜0.001) were the independent risk factors for hyperkalemia in HD patients (P＜0.05). Conclusion The China DOPPS5 of hyperkalemia in HD patients found that hyperkalemia was detected in 25.8% HD patients. Among the three cities involved in this study, the HD patients in Beijing had the highest rate of hyperkalemia (31.8%), followed by Guangzhou (26.0%) and Shanghai (19.3%). Higher BMI, female gender, dialysate potassium concentration≥2.5mEq/L, stdKt/V＜2, dialysis frequency＜3 times per week, higher serum albumin and phosphorus levels were the independent risk factors for hyperkalemia in HD patients. Metrics

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A survey research on risk events during the survival of regular hemodialysis patients 2021, 20 (03):  151-156.  doi: 10.3969/j.issn.1671-4091.2021.03.002 Abstract ( 338 )   PDF (659KB) ( 1059 )   【Abstract】Objective To analyze the major risk events and the influencing factors of maintenance hemodialysis patients(MHD)in the Lanzhou University Second Hospital hemodialysis center. Methods MHD patients were included in the hemodialysis center of Lanzhou university second hospital from July 2014 to July 2019. Results 168 patients were enrolled, including 63.10% males. The most common major risk events occurred in MHD patients were cardiovascular and cerebrovascular events (17.04%), vascular access problems (17.04%), followed by pulmonary infection (14.38%). Patients in the cardio-cerebrovascular event group were older (Z=-2.489, P=0.013),with hogher proportion of catheter with cuff (CVC)(c2=5.080,P=0.024), and with lower hemoglobin (Hb) (t=2.465,P=0.015), blood urea nitrogen (BUN) (t=2.736,P=0.007), serum creatinine (Scr) (Z=- 3.067,P=0.002), and total cholesterol(TC) (t=2.291,P=0.023). Patients in the lung infection group were older (Z=-2.272,P=0.023), with higher proportion of CVC (c2=10.510, P=0.001),and with lower Hb (Z=-2.418,P=0.016) and serum albumin(ALB) (Z=-2.087,P=0.037). In the vascular access event group, the proportion of females was higher (c2=11.191,P=0.001) ,the proportion of CVC was higher (c2=38.768,P＜0.001), and Hb (t=2.551,P=0.012),BUN (t=2.210,P=0.028),Scr (Z=-2.408,P=0.016) levels were lower. In the severe anemia group, the proportion of females was higher (c2=12.196, P＜0.001),the proportion of CVC was higher (c2=11.419,P=0.001), and the levels of Hb (t=5.048, P＜0.001), Scr (Z=-3.643, P＜0.001), ALB (Z=-2.324, P=0.020) and serum phosphate (P) (t=2.821, P= 0.005) were lower. Multivariate Logistic regression analysis indicated that in MHD patients, TC (OR=0.685,95% CI:0.481～0.977, P=0.037) was an independent risk factor for cardio-cerebrovascular diseases. CVC was an independent risk of pulmonary infection (OR=2.948,95% CI:1.248～6.961,P=0.014) and vascular access problems (OR=11.164, 95% CI:4.125～30.219, P＜0.001) in MHD patients. High intact parathyroid hormone (iPTH) level was a risk factor for severe anemia in MHD patients (OR=1.001,95% CI:1.000～1.002, P=0.013). Conclusion We need pay more attention to the cardiocerebrovascular and pulmonary health problems in MHD patients. It is recommended that if there are no special issues, the arteriovenous fistulas should be the first choice for MHD patients. In addition, we need to pay more attention to the choice of vascular access and the monitoring of anemia in female patients. Metrics

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Analysis of the relationship between neutrophils-to-lymphocytes ratio, nutritional status and abdominal aortic calcification in hemodialysis patients  2021, 20 (03):  157-160.  doi: 10.3969/j.issn.1671-4091.2021.03.003 Abstract ( 392 )   PDF (413KB) ( 886 )   【Abstract】Objective To investigate the relationship between neutrophils-lymphocytes ratio (NLR), nutritional status and abdominal aortic calcification (AAC) in maintenance hemodialysis (MHD) patients, and to analyze the risk factors of AAC. Methods MHD patients treated in the Blood Purification Center of the Affiliated Hospital of Xuzhou Medical University from 2019 to 2020 were selected. The clinical data and laboratory examination results of patients were collected, and the AAC of patients was examined by abdominal lateral X-ray film. The geriatric nutritional risk index (GNRI) was used to evaluate patients’nutritional status. According to whether abdominal aortic calcification occured, the patients were divided into non- calcification group and calcification group. The differences of indices between the two groups were compared, and binary Logistic regression analysis was used to explore the risk factors of AAC. Results A total of 72 patients with MHD were included, divided into calcification group (n= 37) and non-calcification group (n=35). Compared with the non-calcified group, patients in calcification group were older, with higher proportion of diabetes mellitus, and with higher parathyroid hormone (PTH), C-creative protein (CRP) and NLR, lower albumin, GNRI (P＜0.05). Correlation analysis showed that AAC was positively correlated with age, PTH, CRP and NLR, but negatively correlated with Alb and GNRI (P＜0.05). Logistic regression analysis showed that age, diabetes mellitus, lower albumin and higher NLR were independent risk factors for abdominal aortic calcification.Conclusions NLR and malnutrition status are associated with AAC in patients with MHD. Old age, diabetes mellitus, lower albumin and higher NLR are independent risk factors for abdominal aortic calcification. Metrics

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Visual analysis of current research status of peritoneal dialysis based on VOSviewer 2021, 20 (03):  161-165.  doi: 10.3969/j.issn.1671-4091.2021.03.004 Abstract ( 397 )   PDF (2277KB) ( 915 )   【Abstract】Objective To evaluate the current research status and research hotspots of peritoneal dialysis in the past decade. Methods In the Science Citation Index Expanded database of the Web of Science, this study applied the relevant researches on peritoneal dialysis from 2010 to 2019 to extract and analyze according to journals, authors, research institutions, keywords by bibliometrics and VOSviewer software. We analyzed the hotspots and development history of the research field of peritoneal dialysis by visual display. Results A total of 6,864 studies were retrieved. In general, the output of peritoneal dialysis research has fluctuated in the past decade. Number of studies on peritoneal dialysis ranked top 1 country is the United States, and the publication volume, journal distribution, frequency of citations, H index and fund-funded output of peritoneal dialysis research in the United States are all ranked in the forefront. The research on peritoneal dialysis is developing rapidly in China, and the research institutions and authors are mainly concentrated in our country. But domestic research institutions have little cooperation with related international institutions, and the cooperation between research authors is relatively scattered. The hotspots of peritoneal dialysis research mainly focus on the evaluation of treatment prognosis, pathological mechanisms, complications, dialysis quality and quality of life. Conclusions Using bibliometric methods，we can get a clearer and more intuitive understanding of the current of global research status and hotspots of peritoneal dialysis. Metrics

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Effects of exercise therapy on microinflammation and hyperhomocysteinemia in maintenance hemodialysis patients 2021, 20 (03):  166-170.  doi: 10.3969/j.issn.1671-4091.2021.03.005 Abstract ( 342 )   PDF (520KB) ( 914 )   【Abstract】Objective To investigate the effects of exercise therapy on microinflammatory status and hyperhomocysteinemia (HHcy) in maintenance hemodialysis (MHD) patients. Methods A total of 90 MHD patients were enrolled in this study. They were randomly divided into exercise group and control group. Patients in the exercise group performed an intradialytic exercise program for 20～35 minutes during the first 2 hours in a dialysis session, and the intradialytic exercise was carried out 3 dialysis sessions per week for 6 months. Serum interleukin- 6 (IL- 6), procalcitonin (PCT), C- reactive protein (CRP) and homocysteine (Hcy) levels were measured in both groups before the treatment and after the treatment for 6 months. Results The levels of IL-6, PCT, CRP and Hcy in the exercise group were lower than those in the control group after 6 months, and the differences were statistically significant (P<0.05). In the exercise group, the levels of IL-6, PCT, CRP and Hcy decreased after 6 months of exercise compared with those before exercise, and the differences were statistically significant (P<0.05). Conclusions Intradialytic exercise therapy had significant effects on microinflammation and HHcy in MHD patients. Metrics

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The outcome and its influencing factors of peritoneal dialysis patients with type 2 diabetes mellitus 2021, 20 (03):  171-175.  doi: 10.3969/j.issn.1671-4091.2021.03.006 Abstract ( 284 )   PDF (554KB) ( 874 )   【Abstract】Objective To evaluate the outcome and its influence factors of peritoneal dialysis (PD) patients complicated with type 2 diabetes mellitus. Methods The PD patients diagnosed with type 2 diabetes at the beginning of PD and treated in our center from May 1, 2015 to May 1, 2020 were enrolled in this study. Their clinical data and outcome information were collected. The end-point events were analyzed and the influence factors for the withdrawal of PD were then identified. Results A total of 113 eligible subjects were recruited, including 70 males (61.95%) and 43 females (38.05%) with an average age of 60 (54, 68) years old and an average PD period of 27 (15, 48) months. Defined end events that led to the withdrawal of PD developed in 47 patients (41.59%), of which 17 cases (15.4%) died and 30 cases (26.55%) transferred to hemodialysis. Univariate and multivariate COX analyses showed that obesity (HR=2.131, 95% CI:1.123～4.045, P=0.021) and the time of starting PD (HR=1.863, 95% CI: 0.872～3.243, P=0.055) were the independent risk factors for survival of the PD patients. In the survival analysis, the median PD duration was 50 (25, 123) months in the 113 patients; the median PD duration was 42 (20, 71) months in obese patients, significantly shorter than that of 85 (34, 123) months in non-obese patients (c2=5.750, P=0.016). The median PD duration was 73 (33, 120) months in late dialysis patients, significantly longer than that of 41 (20, 58) months in nonlate dialysis patients (c2= 4.501, P=0.034). Conclusion Obese PD patients with type 2 diabetes have a relatively high risk of withdrawal from PD. Metrics

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Correlation analysis between whole blood trace elements and parathyroid hormone level in maintenance hemodialysis patients  2021, 20 (03):  176-180.  doi: 10.3969/j.issn.1671-4091.2021.03.007 Abstract ( 302 )   PDF (442KB) ( 838 )   【Abstract】Objectives To investigate the correlation between whole blood trace elements and serum parathyroid hormone (PTH) in maintenance hemodialysis (MHD) patients. Method This was a cross-section and singlEcenter study. A total of 153 MHD patients treated during September 2019 in our center were enrolled in this study. Their clinical data and drug usage were collected. Laboratory parameters and blood trace elements were measured before dialysis. According to serum PTH level, patients were divided into high PTH group (PTH≥300pg/ml, n=46) and the low PTH group (PTH<300pg/ml, n=107). Clinical characteristics were compared between the two groups. Univariate and multivariate logistic regressions were utilized to analyze the factors relating to the high PTH level. Results Compared with the patients in the low PTH group, those in the high PTH group had higher prEdialysis levels of serum calcium, phosphorus, creatinine, alkaline phosphatase, albumin, prealbumin, ferritin and whole blood lead, but had no significant differences in other trace elements. Multivariate binary logistic regression showed that higher levels of serum calcium and phosphorus, use of calcitriol and blood lead>44.3μg/L were independently correlated with the higher serum PTH. Conclusion Whole blood lead >44.3μg/L was independently correlated with the serum PTH≥300pg/ml in MHD patients. Metrics

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Study on the repeatability of infiltration ultrasound and contact ultrasound examinations in measuring cephalic vein diameter 2021, 20 (03):  181-184.  doi: 10.3969/j.issn.1671-4091.2021.03.008 Abstract ( 287 )   PDF (503KB) ( 883 )   【Abstract】Objective To evaluate the repeatability of infiltration and contact ultrasound examinations in measuring cephalic vein diameter. Methods Thirty-nine patients were subjected to radial artery-cephalic vein internal fistula angioplasty in left forearm in University-Town Hospital of Chongqing Medical University. Before the surgery, their cephalic vein diameters were measured using infiltration ultrasound and contact ultrasound methods at the same position and at different time points by two professional physicians working in the ultrasonic diagnosis field for more than 10 years. Interclass correlation coefficient (ICC) was used to evaluate the intra- and inter-group consistency of the measurement. Bland-Altman plot analysis was performed to rEevaluate the repeatability. Results The intra- and inter- group consistency of the measurements were quite satisfactory using infiltration ultrasound, with the ICC values of 0.968 (95% CI : 0.939～0.983, P＜0.001) and 0.960 (95% CI : 0.924～0.979, P＜0.001) respectively. The intra- and inter-group consistency of the measurements were 0.718 (95% CI: 0.521～0.843, P<0.001) and 0.692 (95% CI: 0.482～0.827, P＜0.001) respectively using contact ultrasound. In the Bland- Altman cephalic vein diameter scattergrams of intra- and intergroups, the points falling within the 95% LIMITS of agreement (LOA) were 97% in infiltration ultrasound group, and were 94% in contact ultrasound group. The two-dimensional images of cephalic vein, including the structure of proximal field, the anterior wall and intracavitary structure, were clearer in infiltration ultrasound group. Additionally, infiltration ultrasound had the advantages of bigger examination field and simultaneous display of cephalic vein and radial artery. Conclusion The repeatability of cephalic vein diameter measurement and the two-dimensional images of cephalic vein including the structure of proximal field and the scanning scope were better using infiltration ultrasound than using contact ultrasound. Therefore, infiltration ultra-sound is a preferential method for cephalic vein diameter measurement before radial artery-cephalic vein internal fistula angioplasty. Metrics

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The efficacy and safety of conscious sedation anesthesia in peritoneal dialysis catheterization 2021, 20 (03):  185-188.  doi: 10.3969/j.issn.1671-4091.2021.03.009 Abstract ( 393 )   PDF (446KB) ( 830 )   【Abstract】Objective To investigate the efficacy and safety of conscious sedation (CS) in the operation of peritoneal dialysis (PD) catheterization. Methods Patients undergoing catherization for PD by surgical incision treated in Peking University International Hospital during the period from January 2017 to May 2020 were enrolled in this study. Patients were divided into two groups according to the anesthesia method: group A, intramuscular injection of pethidine hydrochloride and promethazine hydrochloride before operation combined with local infiltration anesthesia during operation; group B, one of the three analgesics, fentanyl (subgroup B1), sufentanil (subgroup B2) or remifentanil (subgroup B3) intravenously at the beginning of operation for conscious sedation combined with local infiltration anesthesia. Adverse reactions, clinical findings, and peri-operative blood pressure, heart rate and pain score were compared between the two groups. Results A total of 94 patients, 53 cases in group A and 41 cases in group B, were enrolled in this study. There were no differences in demographic data and laboratory examinations between the two groups. The proportion of patients with high anesthesia risk (grade IV) based on the ASA assessment was 58.5% and 68.3% in group A and group B respectively (P=0.330). The proportion of intraoperative pain was lower in group B than in group A (17% vs. 39.6%, P=0.018). There were no significant differences in rate of postoperative pain, resting pain score and exercise pain score between the two groups. Five cases in group A (9.4%) had adverse reactions, including gastrointestinal reactions in 3 cases, hypotension in one case, and consciousness disturbance in one case; two cases in group B (4.8%) had gastrointestinal reactions. However, there was no significant difference in the incidence of overall adverse reactions between the two groups (P=0.395). No significant differences in analgesic effects and gastrointestinal reactions were found among the three subgroups in group B (P> 0.05). Conclusion Patients undergoing PD catheterization are at high risk of anesthesia. Conscious sedation anesthesia had better analgesic effect and safety, complying with the concept of comfortable medical treatment. Metrics

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Research progress in the role of klotho in vascular calcification in chronic kidney disease 2021, 20 (03):  189-192.  doi: 10.3969/j.issn.1671-4091.2021.03.010 Abstract ( 396 )   PDF (380KB) ( 840 )   【Abstract】The incidence of chronic kidney disease (CKD) is increasing progressively. CKD patients are frequently accompanied with bone mineral metabolism disorder (CKD-MBD) along with the decline of renal function. CKD-MBD is mainly manifested by abnormal calcium and phosphorus metabolism, secondary hyperparathyroidism and vascular calcification (VC), leading to the higher incidence of cardiovascular disease and the negative impacts on quality of life and prognosis of the patients. Recent studies have shown that Klotho is an anti-aging gene, which is mainly expressed in kidney and protects kidney through the inhibition of renal fibrosis and regulation of calcium and phosphorus metabolism. This review focuses on recent research progress in the role of Klotho on VC. Metrics

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Research progress in the continuous renal replacement therapy related hypophosphatemia Lin weitong 鑫 张 Yang meng Ma hangxia Wan jingjing 2021, 20 (03):  193-196.  doi: 10.3969/j.issn.1671-4091.2021.03.011 Abstract ( 301 )   PDF (373KB) ( 920 )   【Abstract】A variety of complications may happen in the processes of continuous renal replacement therapy (CRRT). Hypophosphatemia is a CRRT- related complication with higher incidence and serious consequences, and is becoming a critical issue to be solved. This paper reviews the literature about hypophosphatemia in CRRT patients, potential risk factors for CRRT-related hypophosphatemia, correlation of blood phosphorus level with the disease degree and death risks, and suggestions about phosphate supplement strategies and cost-effect analysis, in order to provide the useful information for medical staff to prevent and intervene CRRT-related hypophosphatemia. Metrics

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The application of guidewire hard tip puncture technique in the treatment of hemodialysis related superior vena cava occlusion 2021, 20 (03):  203-207.  doi: 10.3969/j.issn.1671-4091.2021.03.014 Abstract ( 277 )   PDF (699KB) ( 805 )   【Abstract】Objective To investigate the safety and clinical efficacy of guidewire hard tip puncture technique in the treatment of hemodialysis related superior vena cava occlusion. Methods Clinical data of the 37 patients with hemodialysis-related superior vena cava occlusion and treated with guidewire hard tip puncture for recanalization were retrospectively analyzed. These patients underwent the operation of superior vena cava recanalization and tried to place tunnel-cuffed catheters (TCC). Preoperative and postoperative blood flow in TCC catheter, urea clearance (Kt/V) and urea reduction ratio (URR) were compared. Success rate of the surgical technique, perioperative severe complications and incidence of TCC-related complications were calculated after the operation for 3 months. Results The technical success rate of the surgical treatment was 91.9% (34/37). The rate of severe perioperative complications was 2.7% (1/37). Three patients failed to open the superior vena cava; two patients developed a small mediastinal hematoma and improved after conservative treatment; one patient experienced pericardial tamponade during endovascular manipulation and recovered after draining by pericardiocentesis. Postoperative blood flow in TCC, Kt/V value and urea reduction rate (URR) improved significantly as compared with those before operation. There were no TCC- related complications in the 3 months of follow-up period. Conclusions The guidewire hard tip puncture technology for recanalization of the superior vena cava occlusion was safe and effective. Skilled and cautious surgical operation is the key to successfully rEopen the occlusion. Metrics

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Analysis of the influencing factors for nursing service quality in hemodialysis centers based on Servqual model 2021, 20 (03):  208-212.  doi: 10.3969/j.issn.1671-4091.2021.03.015 Abstract ( 275 )   PDF (449KB) ( 886 )   【Abstract】Objective According to the working characteristics in hemodialysis centers, a model for evaluating nursing quality in hemodialysis centers was established. Nursing quality estimated by the patients was conducted, the influencing factors for nursing quality were analyzed, and the measures to improve nursing quality were then suggested. Methods A total of 540 patients treated in the hemodialysis centers in the three general hospitals in Guizhou province from May to August 2019 were recruited as the subjects for investigation. The self-designed nursing quality evaluation scale was used for the investigation. Multivariate linear regression was used to analyze the influencing factors. Results The perception difference score of nursing quality in the seven dimensions of tangibility, reliability, responsiveness, empathy, safety, transparency and effectiveness showed negative values (t=-21.742, -24.973, -34.006, -34.583, -15.415, -19.542 and -34.289 respectively; P<0.001). Multivariate linear regression found that monthly income >5000 yuan (β=0.644, P<0.001), 61~75 years old (β=0.508, P<0.001) and public medical service (β= -0.145, P=0.011) were the influencing factors for the overall perception difference score of nursing quality in the hemodialysis centers. Conclusion The overall perception of nursing quality in the hemodialysis centers by MHD patients was negative, and was affected by many factors. Therefore, improvement of nursing quality in the hemodialysis centers must be consistent with the various needs from different kinds of MHD patients. Metrics

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Observation of the application effect of cluster nursing mode on rope ladder puncture of arteriovenous internal fistula in hemodialysis patients  2021, 20 (03):  213-216.  doi: 10.3969/j.issn.1671-4091.2021.03.016 Abstract ( 300 )   PDF (462KB) ( 1035 )   【Abstract】Objective To explore the application effect of cluster nursing mode on rope ladder puncture of arteriovenous internal fistula (AVF) in hemodialysis patients. Methods A total of 60 patients with AVF for hemodialysis and admitted to our hospital from January 2017 to January 2020 were recruited as the research subjects. They were divided into control group and experimental group according to the random number table method. All patients were treated with the conventional nursing care, while patients in the experimental group were also treated with the cluster nursing mode. The success rate of first puncture, performance rate of rope ladder puncture, self-care ability of AVF, bleeding rate of AVF, incidence of hemangioma, infection rate at the puncture site, and incidence of thrombosis in AVF were compared between the two groups. Results Rope ladder puncture was used in 95.37% patients in experimental group, higher than 88.53% patients in control group (χ2=128.139, P＜0.001). The score of self- care ability of AVF was (131.97 ± 5.09) in experimental group, higher than (111.97±6.41) in control group (t=13.880, P＜0.001). The success rate of first puncture had no significant difference between the two groups (P>0.05). Complications of rope ladder puncture were lower in experimental group than in control group (P<0.05): blood exudation from AVF not found in experimental group and 8 cases in control group, hemangioma 2 cases in experimental group and 8 cases in control group, infection at puncture site one case in experimental group and 7 cases in control group, and thrombosis in AVF one case in experimental group and 8 cases in control group. Conclusion The application of cluster nursing mode significantly increased the performance rate of rope ladder puncture of AVF and the self-care ability of AVF and decreased the incidence of AVF complications in hemodialysis patients with AVF. Therefore, the cluster nursing mode is worthwhile to be used in clinical practice. Metrics