Chinese Journal of Blood Purification

21 August 2021, Volume 20 Issue 08 Previous Issue    Next Issue

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The application and challenge of shared decision making in peritoneal dialysis field 2021, 20 (08):  505-508.  doi: 10.3969/j.issn.1671-4091.2021.08.001 Abstract ( 231 )   PDF (296KB) ( 548 )   Metrics

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Recent progress of cognitive impairment in patients with chronic kidney disease 2021, 20 (08):  509-511.  doi: 10.3969/j.issn.1671-4091.2021.08.002 Abstract ( 273 )   PDF (233KB) ( 547 )   Metrics

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GNRI can predict the outcomes of maintenance hemodialysis patients—a meta- analysis 2021, 20 (08):  516-520.  doi: 10.3969/j.issn.1671-4091.2021.08.004 Abstract ( 342 )   PDF (1174KB) ( 438 )   【Abstract】Objective As a common nutritional risk screening tool, the Geriatric Nutritional Risk Index (GNRI) has been used to assess nutritional status under various pathological conditions. We evaluated the correlation between GNRI and the prognosis of maintenance hemodialysis patients by a systematic review and meta-analysis. Methods Relevant articles were collected by searching web of science, PubMed, EMBASE, Cochrane Library, CNKI and Wanfang medical database. The outcomes were all-cause mortality, cardiovascular mortality and cardiovascular events in maintenance hemodialysis patients. The deadline for the search was November 2020. Use Review Manager 5.3 to pool hazard ratio (HR) and 95% confidence interval (CI) and other related information. Results A total of 20 studies involving 10162 patients were included. The results of meta-analysis showed that the GNRI (as continuous variable) had statistical significance with all-cause mortality risk and cardiovascular mortality of maintenance hemodialysis patients, but no statistical significance with cardiovascular events (HR=0.96, 95% CI：0.94～0.98, P< 0.001; HR=0.94, 95%CI：0.91～0.98, P< 0.001); (HR=0.96, 95% CI：0.86～1.08, P＝0.510). As a binary variable, GNRI had statistical significance with allcause mortality and cardiovascular mortality in maintenance hemodialysis patients (HR=2.13, 95% CI：1.84～2.46, P < 0.001) and (HR=2.00, 95% CI：1.04～3.88, P=0.040). Conclusion GNRI is related to all-cause mortality and cardiovascular mortality in maintenance hemodialysis patients. GNRI can be used as a predictor of adverse outcomes in maintenance hemodialysis patients. Metrics

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Influential factors analysis of the efficacy of plasma exchange in hyperlipidemic pancreatitis patients 2021, 20 (08):  521-524.  doi: 10.3969/j.issn.1671-4091.2021.08.005 Abstract ( 302 )   PDF (455KB) ( 449 )   【Abstract】Objective To identify the risk factors on the efficacy of plasma exchange in hyperlipidemic pancreatitis patients by Logistic regression. Methods We retrospectively analyzed the clinical data of 58 hyperlipidemic pancreatitis patients who underwent plasma exchange treatment in the Blood Purification Center of Shantou Central Hospital from January 2015 to December 2020. According to the comparison of the abdominal CT results both before and after the plasma exchange, enrolled patients were divided into improved group and progressed group. Compare the clinical data between the two groups. Logistic regression analysis was performed to analyze the risk factors which affected the imaging progression of hyperlipidemic pancreatitis patients. Results 58 patients recruited in this study, including 47 males and 11 females, mean age was 39.0 ± 8.8 years. There was a significant difference in the TG level of patients before and after plasma exchange treatment (16.7±4.3 mmol/L vs. 6.6±2.8 mmol/L, t= 19.524, P＜0.001). The post-treatment abdominal CT results showed 28 cases (48.3%) in the improved group and 30 cases (51.7%) in the progressed group. Compared with patients in the imaging improvement group, patients in the imaging progressed group had higher serum glucose (t=2.406, P=0.019), a higher proportion of serum amylase＞300 U/L (χ2=4.459, P=0.035), a higher proportion of Balthazar CT grade D/E (χ2=4.351, P=0.037), and higher TG after treatment (t=2.441, P=0.018). Multivariate Logistic regression analysis showed that the independent risk factors affecting the imaging progression of hyperlipidemic pancreatitis included serum amylase＞300u/L (OR=3.781, 95% CI：1.124～12.723, P=0.032), and post- treatment TG (OR= 1.309, 95% CI：1.040-1.646，P=0.022). Conclusion Plasma exchange can significantly reduce the level of blood lipid, and the independent risk factors affecting the imaging progression of hyperlipidemic pancreatitis include serum amylase and post-treatment TG. Metrics

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The effects of intradialytic exercise on athletic ability and dialysis adequacy in maintenance hemodialysis patients: a meta-analysis 2021, 20 (08):  525-530.  doi: 10.3969/j.issn.1671-4091.2021.08.006 Abstract ( 401 )   PDF (759KB) ( 458 )   【Abstract】Objective To systematically evaluate the effects of intradialytic exercise on athletic ability and dialysis adequacy in maintenance hemodialysis (MHD) patients. Methods The databases of PubMed, Embase, Web of science, Cochrane Library, CNKI, VIP and WanFang were retrieved from the establishment of the database to July 2020 for the randomized controlled trials of intradialytic exercise. Two investigators screened the literature according to the inclusion and exclusion criteria. After data extraction and quality assessment, the software of RevMan 5.3 was used for meta-analysis. Results A total of 22 studies which included 1,057 participants were analyzed. Meta-analysis showed that the intradialytic exercise group had better outcomes than the control group in 6-minute walk distance (MD=69.070, 95% CI 54.710~83.440, P＜0.001), 10 sit- to- stand- to- sit cycles (SMD=- 0.770, 95% CI~1.170~- 0.380, P＜0.001), peak oxygen uptake (VO2peak) (SMD=0.460, 95% CI 0.070~0.850, P=0.020), and Kt/V (MD=0.090, 95% CI 0.020~0.170, P=0.010). Conclusion Intradialytic exercise can enhance athletic ability and improve dialysis adequacy in MHD patients. Metrics

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The interaction between intraperitoneal pressure and peritoneal transport function in peritoneal dialysis patients 2021, 20 (08):  531-535.  doi: 10.3969/j.issn.1671-4091.2021.08.007 Abstract ( 354 )   PDF (448KB) ( 441 )   【Abstract】Objectives To explore the interaction between intraperitoneal pressure (IPP) and peritoneal transport function changes in peritoneal dialysis (PD) patients. Methods A total of 50 PD patients undergoing peritoneal equilibration test (PET) in the Second Affiliated Hospital, Harbin Medical University during August 2020 to January 2021 were enrolled in this study. Their clinical data were recruited. They were divided into groups based on the results of IPP and PET and the creatinine ratio of dialysate (4 hours)/plasma (D/Pcr). Clinical data and laboratory results were compared between groups. Correlation analyses were also carried out. Results ①BMI (F=12.442, P=0.023), waist circumference (F=14.090, P=0.001) and D/Pcr (F=4.582, P=0.037) were significantly higher in the high IPP group than in the moderate high IPP but within range group and the low IPP but within normal range group. In addition, BMI (F=3.226, P=0.033) and IPP (F=8.816, P=0.018) were significantly higher in the high transport group than in the high average transport group, the low average transport group and the low transport group. ②Spearman correlation analysis showed that IPP was positively correlated with body weight (r=0.766, P=0.002), BMI(r=0.849, P=0.023), D/Pcr (r=0.658, P=0.037) and waist circumference (r=0.855,P=0.001); D/Pcr was positively correlated with BMI (r=0.636, P=0.033), IPP (r=0.647, P=0.018) and was negatively correlation with HDL (r=-0.121, P=0.013). ③Logistic regression analysis showed that BMI (OR=0.083, 95% CI: 0.485~0.924, P=0.043), body weight (OR=0.796, 95% CI: 0.669~ 946, P=0.010) and waist circumference (OR=0.717, 95% CI: 0.544~0.945, P=0.018) were the independent risk factors for high IPP; BMI (OR=0.696, 95% CI: 0.495~0.979, P=0.037), body weight (OR=0.918,95% CI：0.843~1.000, P=0.049) and IPP (OR=0.728, 95% CI：0.524 ~ 1.010, P=0.047) were the independent risk factors for peritoneal transport function. Conclusions ① IPP and peritoneal transport function were closely related and affected each other. ②BMI, waist circumference and body weight may be the indicators for predicting IPP in PD patients; BMI, IPP and body weight may be used as the indicators for predicting peritoneal transport type in PD patients. Metrics

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A cross-sectional study on the prevalence and risk factors of maintenance hemodialysis-associated sarcopenia 2021, 20 (08):  536-539.  doi: 10.3969/j.issn.1671-4091.2021.08.008 Abstract ( 332 )   PDF (455KB) ( 508 )   【Abstract】Objective To study the prevalence and risk factors of maintenance hemodialysis (MHD)-associated sarcopenia. Methods A total of 359 MHD patients were enrolled in this study. Clinical data of the patients were collected. Muscle mass, strength and muscle function were tested. Subjects were divided into sarcopenia group and non-sarcopenia group, and the prevalence and risk factors of sarcopenia were then analyzed. Results The 359 MHD patients were divided into the sarcopenia group (n=83) and the non-sarcopenia group (n=276). The prevalence of MHD-associated sarcopenia in the patients was 23.1%. Multivariate logistic regression analysis showed that age (OR=1.962, 95% CI=1.264~3.044, P=0.003), malnutrition (OR=2.697, 95% CI=1.283~5.669, P=0.009) and depression (OR=1.707, 95% CI=1.116~2.611, P=0.014) were the independent risk factors for sarcopenia, and BMI (OR=0.040, 95% CI=0.015~0.108, P＜0.001) was a protective factor for sarcopenia. Conclusion The prevalence of MHD-associated sarcopenia was 23.1%. Age, malnutrition and depression were the independent risk factors for sarcopenia, and BMI was a protective factor for sarcopenia. Metrics

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Relationship between serum levels of miR-155 and programmed cell death 4 (PDCD4) and disorder of calcium and phosphorus metabolism in maintenance hemodialysis patients 2021, 20 (08):  540-545.  doi: 10.3969/j.issn.1671-4091.2021.08.009 Abstract ( 336 )   PDF (558KB) ( 406 )   【Abstract】Objective To investigate the relationship between serum levels of microRNA- 155 (miR-155) and programmed cell death 4(PDCD4) and disorder of calcium and phosphorus metabolism in maintenance hemodialysis (MHD) patients. Methods A total of 86 MHD patients treated during September 2018 to October 2020 in Yanjiao People's Hospital of Sanhe City for more than 3 months and with stable conditions were recruited as the study group, and 80 healthy people for physical check-up in our hospital were selected as the control group. Serum PDCD4 and high-sensitivity C-reactive protein (hs-CRP) were assayed by ELISA, hemoglobin and serum albumin, calcium, phosphorus and intact parathyroid hormone (iPTH) were detected by automatic biochemical analyzer, and serum miR-155 was determined by fluorescence quantitative PCR. General information of the patients was analyzed. Serum miR-155 and PDCD4 levels were compared between the study group and the control group. The MHD patients were further divided into subgroups based on age, dialysis vintage and dialysis frequency, and serum miR-155 and PDCD4 levels were then compared among the subgroups. The MHD could be further grouped into the high expression group and the low expression group based on their average serum miR-155 and PDCD4 levels; calcium and phosphorus metabolism were then analyzed between the two groups. Logistic regression analysis was used to evaluate the risk factors for calcium and phosphorus metabolism disorder in MHD patients. Results Serum albumin was significantly lower in the study group than in the control group (t=8.848, P<0.001), but serum phosphorus, iPTH, hs-CRP, miR-155, and PDCD4 levels were significantly higher in the study group than in the control group (t=10.491, 3.578, 10.988, 16.298 and 19.419 respectively; P<0.001). Serum miR-155 and PDCD4 levels were higher in the MHD patients with age ≥60 years, dialysis vintage ≥3 years and dialysis frequency >2 times/week than those with age <60 years, dialysis vintage <3 years and dialysis frequency 2 times/week (t=13.723, 7.773, 4.846, 15.740, 10.206 and 5.154, respectively; P<0.001). The compliance rates of serum calcium, phosphorus and iPTH were lower in the high expression group than in the low expression group. The expression levels of miR- 155 and PDCD4 were correlated with the serum levels of calcium, phosphorus and iPTH (Z=21.333, 7.898, 7.407, 15.712, 9.234 and 7.899, respectively; P <0.001, 0.019, 0.025, <0.001, 0.010 and 0.019, respectively). Multivariate logistic regression analysis showed that serum albumin (OR=2.431, 95% CI: 1.38～ 4.258, P=0.002), miR-155 (OR=2.715, 95% CI: 1.433～5.144, P=0.002) and PDCD4 (OR=2.629, 95% CI:1.429～4.836, P=0.002) were the independent risk factors for calcium and phosphorus metabolism disorder in MHD patients (P<0.05). Conclusion Serum miR-155 and PDCD4 levels were correlated with calcium and phosphorus metabolism and iPTH in MHD patients. High serum levels of miR-155 and PDCD4 were the independent risk factors for calcium and phosphorus metabolism disorder in MHD patients. Metrics

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EEffect of α- cyanoacrylate extravascular stent on venous intimal hyperplasia in the juxta- anastomotic veins of arteriovenous fistula in rabbits 2021, 20 (08):  546-550.  doi: 10.3969/j.issn.1671-4091.2021.08.010 Abstract ( 231 )   PDF (1061KB) ( 414 )   【Abstract】Objective To observe the effect of extravascular stent coated with α-cyanoacrylate (α-CA) on venous intimal hyperplasia in juxta-anastomotic veins of arteriovenous fistula (AVF) in rabbits. Method Twenty adult male rabbits were randomly divided into control group (n=10) and α-CA group (n=10). AVF was created by end- to- end anastomosis of common carotid artery and common jugular vein in animals of both groups. In the α-CA group, extravascular stent coated with α-CA was applied to the outer surface of juxtaanastomotic vein. Color Doppler ultrasonography was used to examine the diameter and peak systolic flow velocity of the juxta-anastomotic vein immediately after the operation and after the operation for one month. The juxta- anastomotic vein was taken after the operation for one month, the intimal thickness and the ratio of intima/ media thickness were measured after hematoxylin-eosin (HE) staining, and the expression of proliferating cell nuclear antigen (PCNA) and α-smooth muscle actin (α-SMA) were detected by immunohistochemistry. Result After the operation for one month, color Doppler ultrasonography showed that the diameter of juxtaanastomotic vein of AVF was 3.50±0.30 mm in the control group higher than the diameter of 3.22±0.23 mm in the α-CA group (t=2.326, P=0.032); the peak systolic flow velocity in juxta- anastomotic vein of AVF was 512.0±83.6mm/s in the control group, lower than the velocity of 668.6±64.1mm/s in the α-CA group (t=4,701,P＜0.001). H-E staining of the intimal in the juxta-anastomotic vein showed that the intimal thickness was 35.3±6.1μm in the control group, higher than that of 24.8±5.6μm in the α-CA group(t=3.987, P=0.001). Immu-nohistochemistry of the intimal in the juxta- anastomotic vein showed that the positive expression rates of PCNA and α-SMA in the in intimal cells were 20.5±3.9% and 25.9± 4.7% respectively in the control group, higher than those of 14.2±3.1% and 16.5±3.7% respectively in the α-CA group (t=3.993 and 4.948 respectively, P=0.001 and <0.001 respectively). Conclusion Extravascular stent coated with α-cyanoacrylate can prevent juxta-anastomotic vein of the AVF from intimal hyperplasia in rabbits. Metrics

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Recent progresses in the application of ultrafiltration in cardiorenal syndrome 2021, 20 (08):  551-554.  doi: 10.3969/j.issn.1671-4091.2021.08.011 Abstract ( 197 )   PDF (388KB) ( 466 )   【Abstract】Heart disease and kidney disease are often co- existed and interacted each other clinically. The therapy focused on a single organ is inappropriate to treat the diseases with multiple organ interactions. The concept of cardiorenal syndrome is therefore proposed. In this syndrome, fluid overload and venous congestion are critical issues to be solved, and ultrafiltration may be the best strategy after unresponsiveness of intravenous diuretics. Metrics

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The development of extracorporeal organ support therapy 2021, 20 (08):  555-558.  doi: 10.3969/j.issn.1671-4091.2021.08.012 Abstract ( 451 )   PDF (389KB) ( 641 )   【Abstract】Multiorgan failure is one of the most frequent causes for death in critically ill patients. Extracorporeal organ supports are now available for the treatment of organ failures. For example, renal replacement therapy, extracorporeal membrane oxygenation, extracorporeal CO2 removal (ECCO2R) and extracorporeal liver support have been used as the stand-alone single organ support systems. Considering multiple“crosstalk” interactions between organs, multiple organ support therapy(MOST) can cooperatively support the patients with different organ failures. Combined modules consisting of prEexisted technologies such as renal replacement, albumin-dialysis, ECCO2R and cytokine elimination are the first step to be considered. Integrated platform with the capacity to support multiple organs is expected to be developed. Metrics

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Clinical application of a tunneled cuffed catheter in femoral vein as a transitional blood access pathway in elderly dialysis patients with diabetes 2021, 20 (08):  562-565.  doi: 10.3969/j.issn.1671-4091.2021.08.014 Abstract ( 338 )   PDF (449KB) ( 509 )   【Abstract】Objective To assess the clinical efficacy of a tunneled cuffed catheter in femoral vein as a transitional blood access pathway for hemodialysis in elderly dialysis patients with diabetes. Methods This was a retrospective and cohort study. A total of 99 elderly dialysis patients with diabetes undergoing the establishment of a transitional blood access pathway for hemodialysis in the First Affiliated Hospital of Xiamen University during the period from January 2017 to January 2020 were enrolled in this study. Thirty-eight of the 99 patients used the tunneled cuffed catheter in femoral vein as the semi-permanent blood access pathway (femoral vein group), and 61 patients used various temporary central venous catheters via femoral vein or internal jugular vein (temporary catheter group). Autologous arteriovenous fistula (AVF) surgery was performed within 2 weeks after the catheterization in all patients in the two groups. Dialysis adequacy, catheter patency rate, catheter- related complications, duration of catheter indwelling, and medical expenses before the use of AVF were recorded and compared between the two groups. Results ①The post- dialysis Kt/v values were 1.39±0.05 and 1.25±0.04 (t=21.750, P=0.001) in the femoral vein group and the temporary catheter group respectively, suggesting that the femoral vein group had better dialysis adequacy than the temporary catheter group. ②The catheter patency rates were 94.7% and 80.3% (χ2=4.004, P=0.045) in the femoral vein group and the temporary catheter group respectively, suggesting that the femoral vein group had higher catheter patency rate than the temporary catheter group. ③The rates of catheter complications were 2.6% and 16.4% (χ2=4.690, P=0.037) in the femoral vein group and the temporary catheter group respectively, significantly lower in the femoral vein group than in the temporary catheter group. In femoral vein group, one case had catheterrelated infection and required hospitalization to remove the catheter; in contrast in temporary catheter group, 5 cases had catheter-related infection and 4 cases had catheter occlusion and thrombosis, they required hospitalization to remove the catheters. ④The periods of catheter indwelling were 74.0±8.2 days and 51.7±9.9 days (t=11.630, P=0.001) in the femoral vein group and the temporary catheter group respectively, significantly longer in the femoral vein group than in the temporary catheter group. ⑤The medical expenses before the use of AVF for blood access was similar between the two groups (15636.3 ± 2148.7 vs. 14634.1 ± 4208.1 yuan, t=-2.027, P=0.177). However, the hospitalization days were shorter in the femoral vein group than in the temporary catheter group (8.3±2.7 vs. 10.4±5.1 day, t=1.360, P=0.045). Conclusion Tunneled cuffed catheter in femoral vein as a temporary transitional vascular access pathway was advisable for elderly dialysis patients with diabetes, especially for those with poor vascular conditions and slow maturation of the autologous AVF. This method had the advantages of longer catheter indwelling time, better dialysis adequacy, higher catheter patency rate, lower rate of catheter-related complications and shorter hospitalization period than the method of central venous temporary catheter, without extra medical expenses. Therefore, tunneled cuffed catheter in femoral vein is a better method to replace the central venous temporary catheter used as the transitional vascular access for hemodialysis. Metrics

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Current situation and influencing factors of functional exercises for the limb of the arteriovenous fistula side 2021, 20 (08):  566-569.  doi: 10.3969/j.issn.1671-4091.2021.08.015 Abstract ( 369 )   PDF (466KB) ( 666 )   【Abstract】Objective To investigate the present situation and influencing factors of functional exercise for the autogenous arteriovenous fistula(AVF) side limb in maintenance hemodialysis (MHD) patients. Methods A total of 485 MHD patients in one hemodialysis center in Guangzhou, one in Shenzhen and one in Changzhou between August to September 2019 were investigated. Results Exercise for the AVF side limbs was carried out in 250 patients (51.5%), in which 165 patients (34.0%) exercised their limbs through handgrip of soft balls. Multivariate logistic regression analysis showed that patients having one to 3 hobbies had the OR value of 2.024 (95% CI 1.310~3.127) P=0.001and those having more than 3 hobbies had the OR value of 2.156 (95% CI 1.043~4.457) P=0.038 as compare with those having no hobby; patients knowing a little about AVF maintenance had the OR value of 2.024 (95% CI 0.484~8.459)，P=0.334, those knowing much about AVF maintenance had the OR value of 3.160 (95% CI 0.825~12.102)P=0.093, and those knowing all knowledge about AVF maintenance had the OR value of 4.261 (95% CI 1.105 ~ 16.426)P=0.035 as compared with those knowing nothing about AVF maintenance. Conclusion The present situation of functional exercise for the AVF side limb was unsatisfactory. We recommend that health education from nurses about the functional exercise should be emphasized to increase the compliance of functional exercise of the patients, especially for those with less hobbies. Metrics

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Construction of a training program for the nursing ability of perioperative arteriovenous fistula based on the Miller pyramid competency model 2021, 20 (08):  570-574.  doi: 10.3969/j.issn.1671-4091.2021.08.016 Abstract ( 219 )   PDF (464KB) ( 426 )   【Abstract】Objective To construct a training program for the nursing ability of perioperative arteriovenous fistula (AVF) based on the Miller pyramid competency model, so as to promote the nursing ability of perioperative AVF in nurses, improve the nursing quality, and prevent nursing adverse events. Methods Delphi method was used to conduct several rounds of consultation with experts about indicators of the preliminary training program, to construct a complete index system for the nursing ability training program. Results The nursing ability training program, which includes 4 first-class indicators, 12 second-class indicators and 38 third-class indicators, was constructed after two rounds of consultation with experts. The recovery rate of effective questionnaires in two rounds of consultation with experts was more than 97%, and the expert authority coefficient was above 0.85. Conclusion The consultation experts have a better enthusiasm and authority to construct a nursing ability training program for perioperative AVF containing comprehensive topics but with suitable number of items. This program provides a basis for the establishment and application of a nursing training system of internal AVF patients for clinical nurses. Metrics

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Catheter-associated right atrial thrombosis in maintenance hemodialysis patients：a case report and literature review 2021, 20 (08):  575-576.  doi: 10.3969/j.issn.1671-4091.2021.08.017 Abstract ( 215 )   PDF (235KB) ( 469 )   Metrics