Chinese Journal of Blood Purification

12 June 2021, Volume 20 Issue 06 Previous Issue    Next Issue

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Current situation and Prospect of blood purification standards Yuqing Chen 2021, 20 (06):  361-364.  doi: 10.3969/j.issn.1671-4091.2021.06.001 Abstract ( 734 )   PDF (356KB) ( 962 )   【Abstract】Blood purification is an important treatment for chronic kidney disease. Due to the requirement for safety and quality, various standardized operation documents have emerged. In recent years, with the development of our national standardization field, more and more medical workers realized that the field of blood purification requires a series of standards. The standardization and standard system construction in the field of blood purification will guarantee the safety of blood purification better, continuously improve the management level and medical quality of blood purification, and contributes to improving the prognosis of uremic patients. The Chinese standard of blood purification is still a new thing, and many practitioners in this field do not fully understand it. This review mainly introduces the related concepts of standards, the current standards of blood purification in China, and future development prospects. Metrics

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Brief introduction of technical review of citric acid disinfectant 2021, 20 (06):  365-366.  doi: 10.3969/j.issn.1671-4091.2021.06.02 Abstract ( 295 )   PDF (308KB) ( 603 )   【Abstract】With the popularization of hemodialysis-related treatments, the amount of citric acid disinfectant used in hemodialysis equipment has increased significantly. To further standardize the key points of its quality evaluation and help enterprises in research and production, this article summarizes recent technical review principles and requirements by regulations and national standards. It provides an overview of the key points of citric acid disinfectant review for departments of production, technical review and others. Metrics

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Comparison of clinical characteristics and all-cause mortality of different vascular access types in maintenance hemodialysis patients 2021, 20 (06):  367-372.  doi: 10.3969/j.issn.1671-4091.2021.06.003 Abstract ( 467 )   PDF (687KB) ( 571 )   【Abstract】Objective To compare the clinical characteristics and all-cause mortality of maintenance hemodialysis (MHD) patients with different vascular access types. Methods A retrospective collection of 310 MHD patients started receiving MHD in affiliated Zhongshan Hospital of Dalian University from May 31, 2010 to December 31, 2016. The follow-up deadline was July 31, 2020. The endpoint events were all-cause death, complications of vascular access, and cardiovascular and cerebrovascular events. The differences in clinical data, laboratory indexes, cardiac ultrasound parameters, and all-cause mortality rate of patients in the autogenous arteriovenous fistula (AVF) group and the tunnel- cuffed catheter (TCC) group were compared. Results A total of 310 MHD patients were enrolled, with 184 males (59.4%), and the mean age was 65.69±13.11 years old. The age of starting dialysis and the primary cause of end-stage renal disease were different between groups (t=- 3.134, P=0.002;χ2=11.792, P=0.007). Compare with the AVF group, patients in the TCC group with a higher rate of anemia (χ2=5.120，P=0.024) and a lower rate of pulmonary hypertension (χ2=4.696, P=0.030). The incidence of pathway complications and cardiovascular death was not statistically significant (P>0.05). After 50.00 (25.00, 73.25) months of follow-up, 219 patients died. The independent risk factors of all-cause death including male gender (HR=1.384, 95% CI:1.042～1.839, P=0.025), the age of starting dialysis (HR=1.036, 95% CI: 1.023～1.049, P=0.001), the history of cardiovascular disease (HR=1.698, 95% CI: 1.244～2.318, P=0.001), use catheter (HR= 2.264, 95% CI:1.703～3.009, P=0.001), diabetic nephropathy (HR=1.734, 95% CI:1.322～2.275, P=0.001). Conclusion Patients in the TCC group with a higher rate of anemia and a lower rate of pulmonary hypertension. Use catheter, the age of starting dialysis, history of cardiovascular disease, and diabetic nephropathy were independent risk factors of all-cause death in our MHD patients. Metrics

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The value of albumin to C-reactive protein ratio, red blood cell distribution width, and serum uric acid in evaluating the prognosis of maintenance hemodialysis patients  2021, 20 (06):  373-377.  doi: 10.3969/j.issn.1671-4091.2021.06.004 Abstract ( 443 )   PDF (707KB) ( 592 )   【Abstract】Objective To predict prognosis of the end stage renal disease (ESRD) patients with maintenance hemodialysis (MHD) by using albumin/C-reactive protein ratio (ALB/CRP), red blood cell distribution width (RDW), serum uric acid (SUA) and integration of the three indicators. Methods A total of 265 ESRD patients treated with MHD in the First Affiliated Hospital of Air Force Medical University were enrolled in this study. After 6 months of MHD, they were divided into death group (n=31) and survival group (n=234) according to their survival status. Clinical data, and ALB/CRP, RDW and SUA levels were compared between the two groups. Logistic regression was conducted to analyze the prognostic factors. Receiver operating characteristic curve (ROC) was used to estimate the prognostic values of the three indicators and the integrated value of the three indicators. Results Among the 265 ESRD patients, 31 died in the 6 months of MHD, with a mortality rate of 11.70%. After 3 months and 5 months of MHD, ALB/CRP and SUA were significantly decreased, and RDW was significantly increased in both groups; ALB/CRP and SUA were lower (F=18.261, 20.608, P＜0.001) and RDW was higher (F=16.256, P＜0.001) in the death group than in the survival group; the changes of ALB/CRP (OR=0.507, 95% CI: 0.315～0.817; OR=0.610, 95% CI: 0.405～0.918), SUA (OR= 0.391, 95% CI: 1.264～1.417; OR=0.445, 95% CI: 0.205～0.964) and RDW (OR=1.338, 95% CI: 1.264～ 1.417; OR=1.439, 95% CI: 1.355～1.529) were the influencing factors for prognosis of the ESRD patients with MHD (P＜0.001); After 3 and 5 months of MHD, the area under the curve (AUC) of ALB/CRP, RDW and SUA levels to predict prognosis of the ESRD patients with MHD was＞0.7; after 5 months of MHD, the AUC of the integrated value of the three indicators to predict prognosis became bigger (0.890). Conclusion ALB/CRP, RDW and SUA are significantly correlated with the prognosis of ESRD patients with MHD. The integration of the 3 indicators has a higher value to predict prognosis of these patients. Metrics

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Effect of blood pressure variability on cardiovascular events in maintenance hemodialysis patients complicated with hypertension  2021, 20 (06):  378-381.  doi: 10.3969/j.issn.1671-4091.2021.06.005 Abstract ( 406 )   PDF (444KB) ( 569 )   【Abstract】Objective To investigate the effect of blood pressure variability (BPV) on cardiovascular events in end-stage renal disease (ESRD) patients on maintenance hemodialysis (MHD) and complicated with hypertension. Methods A total of 89 ESRD patients treated with MHD in our hospital from January 2017 to January 2018 were enrolled as the MHD group, and 100 healthy volunteers for physical examination in our hospital during the same period were recruited as the normal control group. The two BPV parameters, standard deviation of 24h mean systolic blood pressure (24hSBP- SD) and 24h mean diastolic blood pressure (24hDBP-SD), were examined and compared between the two groups. According to the presence or absence of cardiovascular events during the follow-up period, the MHD patients were further divided into cardiovascular event subgroup (n=32) and non-cardiovascular event subgroup (n=57). Clinical data were analyzed by univariate and multivariate regression methods to evaluate the influencing factors for cardiovascular events in MHD patients. Results The 24hSBP- SD and 24hDBP- SD were 19.341 ± 2.765 mmHg and 10.102 ±1.758mmHg respectively in the MHD group, significantly higher than 11.852 ± 1.927mmHg and 6.824 ± 0.892 mmHg respectively in the normal control group (t=21.844 and 16.401, P＜0.001). Age, 24hSBP-SD, 24HDBP-SD and Hb were 67.571±8.542 years, 22.435±3.094mmHg, 12.042±1.857mmHg and 107.341±13.284g/L respectively in the cardiovascular event subgroup, and were 59.125±7.432 years, 18.017±2.385 mmHg, 8.765±0.929mmHg and 115.092±14.745g/L respectively in the non- cardiovascular event subgroup (t=4.391、7.537、11.179、2.464，P=0.008、＜0.001、＜0.001、0.016). Logistic regression analysis found that older age, higher 24HHBP-SD and 24HDBP-SD were the risk factors for cardiovascular events in MHD patients, while higher Hb level was the protective factor for cardiovascular events (OR=1.943, 2.509, 2.741 and 0.564 respectively; P=0.012, 0.007, 0.000 and 0.018 respectively). Receiver operating characteristic (ROC) curve showed that the sensitivity and specificity were 84.21% and 59.38% respectively when the cut- off value of 24h SBP-SD was set at 20.73mmHg; the sensitivity and specificity were 71.93% and 71.88% respectively, when the cut-off value of 24hDBP-SD was set at 10.59 mmHg. Conclusion BPV was increased in end-stage renal disease patients on MHD and complicated with hypertension. Higher BPV was the risk factor for cardiovascular events. BPV parameters measured earlier may be useful for the prediction of cardiovascular events. Metrics

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Correlation between vitamin D level and cardiac function in hemodialysis patients  2021, 20 (06):  382-386.  doi: 10.3969/j.issn.1671-4091.2021.06.006 Abstract ( 287 )   PDF (650KB) ( 575 )   【Abstract】Objective To investigate the relationship between serum 25-hydroxyvitamin D (25(OH)D) level and cardiovascular function in hemodialysis patients. Methods This was a cross-sectional study. Serum 25(OH)D levels were determined from 109 hemodialysis patients treated in the Dialysis Center of the PLA Strategic Support Force Medical Center. Clinical data and cardiac ultrasound results of the 109 hemodialysis patients were collected. Correlation and multivariate regression analyses were used to evaluate the relationship between serum 25(OH)D level and cardiovascular function. Results The average value of 25(OH)D was 50.39±22.74 nmol/L in the hemodialysis patients, in which 65 patients (59.6%) were identified as 25(OH)D deficient (≤50nmol/L). By comparing between 25(OH)D normal group and 25(OH)D deficient group, there were no significant differences in B-type natriuretic peptide (BNP), high- sensitivity C-reactive protein (hs-CRP), intact parathyroid hormone (iPTH), hemoglobin, left ventricular mass (LVM), left ventricular mass index (LVMI), ejection fraction (EF), fraction shortening (FS), left ventricular internal dimensions at end-diastole (LVIDd), posterior wall thickness at end- diastole (PWTd), septal wall thickness at end- diastole (SWTd), left ventricular end diastolic diameter (LVED), systolic left ventricular volume (LVES) and the ratio of mitralwave E peak velocity to A peak velocity (e/a), but there was a significant difference in the ratio mitral-wave E peak velocity to mitral annulus velocity E’(e/e ́) (t=2.495, P=0.001). Spearman analysis showed that 25(OH) D was negatively correlated with e/e ́ (r=-0.272, P=0.004). Multivariate regression showed that 25(OH)D was an independent correlation factor for e/e´(β=-0.115, 95% CI: -0.129～-0.009, P=0.010). Conclusions Serum 25(OH)D level was lower in maintenance hemodialysis patients. 25(OH)D level was independently and negatively correlated with left ventricular diastolic function. Metrics

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Advances in the application of regional citrate anticoagulation in intermittent hemodialysis 2021, 20 (06):  387-390.  doi: 10.3969/j.issn.1671-4091.2021.06.007 Abstract ( 422 )   PDF (392KB) ( 661 )   【Abstract】In recent years, regional citrate anticoagulation (RCA) has been used increasingly in intermittent hemodialysis due to its unique advantages for patients with high risk of bleeding or active bleeding. In this paper, we review and analyze the application of RCA in intermittent hemodialysis in China and foreign countries in recent years, so as to provide a reference for its popularization. Metrics

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Protein energy wasting in hemodialysis patients evaluated by bioelectrical impedance 2021, 20 (06):  391-394.  doi: 10.3969/j.issn.1671-4091.2021.06.008 Abstract ( 296 )   PDF (372KB) ( 554 )   【Abstract】Bioelectrical impedance is a non- invasive, cheap, safe, and maneuverable technology that displays the electrical characteristics and the rule of electrical changes in biological tissues and organs to reflect biomedical information about human physiological and pathological conditions. Currently, bioelectrical impedance has been widely used in research and clinical practice to measure human body components, such as hydration situation, non-fatty substances and fatty substances, useful for the assessment of body fluid capacity and nutritional status, the early diagnosis of disease and the supervision of disease status during therapeutic period. This article reviews the use of bioelectrical impedance for the evaluation of protein energy wasting in hemodialysis patients, allowing early detection and intervention of the abnormality, and management of hemodialysis patients to reduce hospitalization rate and mortality rate. Metrics

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Enlightenment?from?ISPD guidelines?to nursing of?peritoneal dialysis 2021, 20 (06):  398-400.  doi: 10.3969/j.issn.1671-4091.2021.06.010 Abstract ( 259 )   PDF (298KB) ( 836 )   Metrics

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Impact of different degrees of interdialytic weight gain on the dysfunction of autogenous arteriovenous fistula in maintenance hemodialysis patients 2021, 20 (06):  405-409.  doi: 10.3969/j.issn.1671-4091.2021.06.013 Abstract ( 399 )   PDF (473KB) ( 798 )   【Abstract】Objective To explore the effect of interdialytic weight gain (IDWG) on the dysfunction of arteriovenous fistula (AVF) in maintenance hemodialysis (MHD) patients. Methods A total of 577 MHD patients treated in Guangdong Provincial People’s Hospital during the period from 2009 to 2019 were recruited for a retrospective and cohort study. Clinical data of the patients before entering the study were collected. The average IDWG was calculated based on the predialysis body weight and dry weight in every dialysis session in 2009. The observation index was AVF dysfunction. Results The MHD patients were divided into IDWG ≤4% group and IDWG >4% group. The two groups of confounding variables were controlled by propensity score matching method and a total of 414 patients completed 1:1 matching. Before and after the matching, the AVF dysfunction in IDWG >4% group was higher than that in IDWG≤4% group (before matching: 34.2% vs. 65.8%, χ2=5.718, P=0.017; after matching: 14.5% vs. 22.7%, χ2=4.611, P=0.032). Binary logistic regression analysis showed that age (OR=3.393, 95% CI 1.861～6.184, P<0.001), IDWG (OR=1.967, 95% CI 1.157～3.347, P=0.013), serum albumin (OR=1.759, 95% CI 1.034～2.990, P=0.037) and left ventricular mass index (OR=1.008, 95% CI 1.002～1.013, P=0.010) were the independent risk factors for AVF dysfunction. Conclusion IDWG over 4% was an important risk factor for AVF dysfunction in MHD patients, especially in patients >60 years old, and with serum albumin <35g/L and higher left ventricular mass index. Metrics

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Serum fibroblast growth factor-23 (FGF-23) level for predicting radial artery calcification and arteriovenous fistula dysfunction in hemodialysis patients 2021, 20 (06):  410-414.  doi: 10.3969/j.issn.1671-4091.2021.06.013 Abstract ( 123 )   PDF (494KB) ( 257 )   【Abstract】Objective To investigate the relationship between serum fibroblast growth factor-23 (FGF-23) level and radial artery calcification (RAC) and arteriovenous fistula (AVF) dysfunction in hemodialysis patients. Methods This prospective study included 212 maintenance hemodialysis (MHD) patients undergoing AVF surgery. Serum FGF-23 level was measured by ELISA. Clinical and biochemical data were collected. RAC was assayed by hematoxylin- eosin staining. Serum FGF- 23 levels were compared between patient groups, and the prediction effect of serum FGF- 23 level was then evaluated. Results The prevalence of RAC was 57.8% (123/212) in the MHD patients. When the cut-off value of serum FGF-23 level was set at 488.5 ng/ml, the sensitivity and specificity for the diagnosis of RAC were 0.797 and 0.921 respectively. When the cut-off value of serum FGF-23 level was set at 490.9 ng/ml, the sensitivity and specificity for the diagnosis of AVF dysfunction were 0.757 and 0.560 respectively. Conclusion Higher prevalence of RAC was found in end-stage renal disease patients. Serum FGF-23 appears to be a sensitive and specific marker of RAC and AVF dysfunction in hemodialysis patients. Metrics

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The type of vascular access used and its influencing factors in maintenance hemodialysis patients in Bengbu city  2021, 20 (06):  415-419.  doi: 10.3969/j.issn.1671-4091.2021.06.014 Abstract ( 268 )   PDF (436KB) ( 585 )   【Abstract】Objective To study the first and the present type of vascular access and its influencing factors in maintenance hemodialysis (MHD) patients in Bengbu city. Methods A questionnaire survey was conducted among the patients treated with hemodialysis for more than 3 months in the First and Second Affiliated Hospitals of Bengbu Medical College. Clinical data, the type of vascular access, blood flow and complications were then recorded. The distribution of different vascular access types in MHD patients was analyzed. The general conditions were compared between patients using arteriovenous fistula (AVF) and those using central venous catheter (CVC) at the first hemodialysis to obtain the influencing factors for the application of AVF at the first hemodialysis. The complications associated with AVF and their influencing factors in the MHD patients were also analyzed. Results In the 198 MHD patients enrolled in this study, the present use of AVF, tunnel-cuffed catheter (TCC) and arteriovenous graft for vascular access were 88.38%, 9.09% and 2.53% respectively, and the use of AVF, TCC and non-cuffed catheter for vascular access at the first hemodialysis were 29.29%, 12.21% and 58.59% respectively. Patients using AVF at the first hemodialysis had higher education level (high school or above high school level; 51.7% vs. 39.3%, P=0.010) and higher proportion with“medical insurance for employees”(82.8% vs. 66.4%, P=0.038), as compared with those using CVC at the first hemodialysis. Multivariate logistic regression showed that the proportion of using AVF at the first hemodialysis was higher in patients with higher education level (OR=3.046, P=0.007) and“medical insurance for employees”( OR=5.128,P=0.007). Serum calcium (F=0.180, P=0.000), phosphorus (F=21.637, P=0.000), albumin (F=0.028, P=0.021) and triglyceride (F=0.665, P=0.024) were higher in MHD patients using AVF for vascular access with complications than those without complications. Conclusion In this cohort of patients, CVC for vascular access was frequently used at the first hemodialysis, and AVF for vascular access was commonly used at the maintenance hemodialysis period. The better the education level and medical insurance the patients had, the more likely AVF for vascular access at the first hemodialysis they accepted. Higher levels of serum calcium, phosphorus, albumin and triglyceride may be the risk factors for complications in patients using AVF for vascular access. Metrics

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The application of multidisciplinary, integrative and cooperative exercise therapy in maintenance hemodialysis patients  2021, 20 (06):  420-422.  doi: 10.3969/j.issn.1671-4091.2021.06.015 Abstract ( 304 )   PDF (440KB) ( 609 )   【Abstract】Objective To observe the effect of multidisciplinary, integrative and cooperative exercise therapy in maintenance hemodialysis (MHD) patients. Methods A total of 80 MHD patients treated in Huzhou Traditional Chinese Medicine Hospital affiliated to Zhejiang Chinese Medical University in the period between January 2019 and June 2020 were recruited as the research subjects. They were divided into experimental group (n=40) and control group (n=40) based on the envelope method. Patients in the experiment group were treated with the multidisciplinary, integrative and cooperative exercise therapy, and those in the control group received routine exercise nursing. Clinical parameters after the intervention were compared between the two groups. Results After the intervention, the compliance rate of exercise therapy (χ2=20.313, P＜0.001) and the comprehensive quality of life questionnaire scores of social domain (t=23.994, P＜0.001), material domain (t=22.761, P＜0.001), psychological domain (t=23.451, P＜0.001), and somatic domain (t=21.745, P＜0.001) were significantly higher in the experiment group than in the control group. Conclusion The application of multidisciplinary, integrative and cooperative kinesitherapy in the field of exercise nursing during MHD therapy can significantly improve the compliance rate of kinesitherapy and the quality of life in these patients. Metrics

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Effect of narrative nursing on self-perceived burden and negative emotion in maintenance hemodialysis patients 2021, 20 (06):  423-426.  doi: 10.3969/j.issn.1671-4091.2021.06.016 Abstract ( 346 )   PDF (417KB) ( 827 )   【Abstract】Objective To explore the effect of narrative nursing on self-perceived burden and negative emotion in maintenance hemodialysis (MHD) patients. Methods A total of 82 MHD patients who met the diagnostic standards in the period from August to November 2020 were enrolled in this study. They were randomly divided into experimental group (41 cases) and control group (41 cases). The experimental group was given narrative nursing intervention (concern, understand, response, reflect) for 3 months in addition to the routine nursing, while the control group was given routine nursing only. Self-perceived burden, anxiety and depression were used to evaluate the intervention effect. Results After the intervention, the scores of selfperceived burden and negative emotion were lower than those before the intervention in the experimental group (t=2.837, P=0.003; t=6.230, P=0.002), and were also lower in the experimental group than in the control group (t=-1.892, P=0.039; t=12.339, P=0.002). Conclusion Narrative nursing intervention for MHD patients can reduce their self-perceived burden and negative emotion, thereby improving their mental health. Metrics

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Mediating effect of spiritual needs on social support and medical treatment adherence among patients on hemodialysis 2021, 20 (06):  427-430.  doi: 10.3969/j.issn.1671-4091.2021.06.017 Abstract ( 330 )   PDF (506KB) ( 629 )   【Abstract】Objective To explore the mediating effect of spiritual needs on social support and medical treatment adherence, and to provide references for improving quality of life in maintenance hemodialysis (MHD) patients. Method A total of 171 MHD patients were selected by convenience method. They were investigated using the Medical Treatment Adherence Scale, the Spiritual Needs Scale, and the Social Support Rating Scale. Result The total scores of medical treatment adherence, social support and spiritual needs were 89.51±13.32, 38.36±8.00 and 91.78±14.60 respectively in the MHD patients. The total score of medical treatment adherence was positively corelated with the total score of social support (r=0.204, P=0.005), and the total score of spiritual needs (r=0.184, P=0.018); the total score of social support was positively correlated with the total score of spiritual needs (r=0.207, P=0.008). Spiritual needs played a part of mediating effect between medical treatment adherence and social support, with the mediating effect of 0.203. Conclusion Sufficient spiritual needs carried to MHD patients will enhance their social support and improve their medical treatment adherence. Metrics