Chinese Journal of Blood Purification

12 December 2021, Volume 20 Issue 12 Previous Issue    Next Issue

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Recent advances in the management of hyperkalemia in patients on maintenance hemodialysis 2021, 20 (12):  793-796.  doi: 10.3969/j.issn.1671-4091.2021.12.001 Abstract ( 616 )   PDF (461KB) ( 425 )   【Abstract】Patients on maintenance hemodialysis (MHD) are prone to have hyperkalemia due to the severe impairment of renal function. The complications of diabetes, hypertension and hear failure in MHD patients further increase the risk of hyperkalemia. Hyperkalemia seriously affects their prognosis, so that maintenance of serum potassium within normal range is essential to improving their clinical outcomes. Recent studies on hemodialysis and dietary management add more explorations to the prevention and treatment of hyperkalemia. The presence of sodium zirconium cyclosilicate and patiromer in the market contributes new therapeutic options to the intervention of hyperkalemia. Given that the incidence of hyperkalemia is higher and the disease burden is heavier in MHD patients in China, this article aims to review the recent advances in the management of hyperkalemia in MHD patients. Metrics

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Application of local citrate anticoagulation in continuous renal replacement therapy 2021, 20 (12):  797-800.  doi: 10.3969/j.issn.1671-4091.2021.12.002 Abstract ( 386 )   PDF (401KB) ( 218 )   【Abstract】Anticoagulation in extracorporeal circulation is an important step for successful implementation of continuous renal replacement therapy (CRRT). Inappropriate anticoagulation regimen will cause blood coagulation in extracorporeal circulation, blood loss, hypercoagulation status or thromboembolic diseases, which are life-threatening in severe cases. Regional citrate anticoagulation (RCA) with its advantages of effective anticoagulation and lower bleeding risk is widely used in CRRT, especially for patients with bleeding risk. However, there are no standard protocols yet for clinical application. This article briefly introduces the technical essentials and precautions of RCA for its better use in CRRT. Metrics

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Comparison of the advantages and disadvantages of several continuous renal replacement therapy technologies 2021, 20 (12):  801-804.  doi: 10.3969/j.issn.1671-4091.2021.12.003 Abstract ( 595 )   PDF (469KB) ( 515 )   【Abstract】Continuous renal replacement therapy (CRRT) has the roles of ultrafiltration to remove excess water, convection to clear medium and small molecular solutes, and adsorption to eliminate inflammatory mediators. The therapeutic models of CRRT are developed progressively, such as continuous venous-venous hemofiltration (CVVH), continuous venous- venous hemodiafiltration (CVVHDF), high- volume hemofiltration (HVHF), continuous plasma filtration adsorption (CPFA), and slow continuous ultrafiltration (SCUF). CVVH is the most commonly used model, usually as an adjuvant method for refractory heart failure, severe acute pancreatitis, rhabdomyolysis, and many others; CVVHDF has been widely used for the treatment of sepsis; HVHF is a treatment often for severe sepsis and septic shock; CPFA can be used in severe inflammatory response syndrome and sepsis; SCUF is often used in patients with refractory heart failure, edema, and overload of extracellular fluid volume. Every CRRT technology has its own characteristics, and the selection of therapeutic model and dosage must be individualized based on clinical situation of the patient. Metrics

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Cardiac dysfunction and Related factors in Patients with Hemodialysis Treatment for more than Twenty Years  2021, 20 (12):  805-808.  doi: 10.3969/j.issn.1671-4091.2021.12.004 Abstract ( 498 )   PDF (460KB) ( 305 )   【Abstract】objective To investigate the cardiac dysfunction characteristics and related factors in patients with sufficient hemodialysis. Methods Patients who have been treated with sufficient hemodialysis for more than 20 years in China-Japan Friendship Hospital were selected for this study. The general clinical data, laboratory and imaging results of these patients are collected for analysis. Results In the total of 20 patients, the dialysis vintage ranges from 20 to 34 years. About 75% of these patients' left ventricular systolic function remains within the normal range; about 35% of them have suffered different degrees of left ventricular systolic dysfunction (LVDD); and about 70% of them have suffered valve degenerative changes and regurgitation. More than 35% of them have also suffered left atrial enlargement, left ventricular hypertrophy, abnormal ventricular wall movement, pericardial effusion and other cardiac damages. Biochemical results showed that the serum cardiac injury markers such as high-sensitivity troponin T(HS cTnT), high-sensitivity troponin I (HS cTnI), B-type natriuretic peptide(BNP)and N-terminal natriuretic peptide precursor (NT Pro BNP) increased significantly in about 50% of the patients. Spearman correlation analysis shows that age is positively related to LVDD(β=0.583，P=0.07), but there is no specific correlation between heart disease and dialysis vintage, the usage of low- molecular weight heparin, ACEI /ARB drugs, whether combined hemodialysis with filtration and hemoperfusion therapy. Conclusions With the increase of age and dialysis vintage, although the left ventricular systolic function could be maintained at a normal level in most patients, they still suffer from extensive cardiac structure damage and decreased left ventricular diastolic function. Metrics

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Cardiovascular outcomes with Sacubitril- Valsartan in patients undergoing hemodialysis 2021, 20 (12):  809-813.  doi: 10.3969/j.issn.1671-4091.2021.12.005 Abstract ( 1147 )   PDF (498KB) ( 123 )   【Abstract】Objective To explore the cardiovascular outcomes with sacubitril-valsartan in patients undergoing hemodialysis. Methods 13 maintenance hemodialysis (MHD) patients from Peking University People's Hospital were selected, without obvious edema, severe infection or acute cardiovascular events recently. Blood pressure and echocardiography of the patients were recorded. Paired-Samples T test was used to identify the effects of sacubitril-valsartan in MHD patients. Results ①A total of 13 patients on MHD for 99 (14～155) months (8 males and 5 females) were included in this study. ②Compared with baseline levels, left ventricular ejection fractions (LVEF) (43.0 ± 10.2% vs. 60.0 ± 13.9%, t =- 4.769, P＜0.001) were markedly improved after treatment with sacubitril-valsartan. ③ Compared with baseline levels, NT-proBNP levels (25594pg/ml vs. 15325 pg/ml, t = 2.979, P = 0.012) were markedly decreased after treatment with sacubitril-valsartan. ④No serious adverse events occurred. Conclusions Sacubitril-valsartan is effective and safe for MHD patients. Metrics

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Role of neutrophil-lymphocyte ratio in evaluating abdominal aortic calcification and prognosis in maintenance hemodialysis patients  2021, 20 (12):  814-818.  doi: 10.3969/j.issn.1671-4091.2021.12.006 Abstract ( 409 )   PDF (545KB) ( 170 )   【Abstract】Objective The purpose of this study was to investigate the relationship between neutrophillymphocyte ratio(NLR) and abdominal aortic calcification (AAC) and prognosis in maintenance hemodialysis (MHD)patients. Methods The general conditions and clinical indexes of 115 MHD patients were collected. AAC was evaluated by abdominal lateral X-ray plain film. According to the abdominal aortic calcification score (AACS), the patients were divided into no or mild calcification group and moderate to severe calcification group. Logistic regression was used to analyze the risk factors of moderate to severe AAC in MHD patients. Kaplan-Meier survival method was used to analyze the difference of survival rate in patients with different levels of NLR, and COX proportional hazards model was used to analyze the risk factors of all- cause death and cardiovascular death in MHD patients. Results The mean age of 115 MHD patients was 57.8 ±13.9 years, the median dialysis vintage was 82.0 (29.0, 122.0) months, and the median AACS was 4.0 (0.0, 11.0). There were 62 cases (53.9%) in the non or mild calcification group and 53 cases (46.1%) in the moderate to severe calcification group. Logistic regression analysis showed that high NLR level was an independent risk factor for moderate to severe AAC. The median follow-up time was 72 (68, 75) months. At the end of follow- up, there were 23 all- cause deaths (20%), including 17 CVD deaths (14.8%). Kaplan- Meier analysis showed that all-cause death and cardiovascular death in patients with high NLR level were significantly higher than those with low NLR level (all-cause mortality: χ2= 4.219, P = 0.040；cardiovascular death: χ2 = 5.383, P=0.020). Multivariate COX regression analysis showed that NLR was an independent risk factor for allcause death and CVD death in MHD patients (all-cause death：HR = 1.191, 95% CI: 1.033～1.372, P=0.016; cardiovascular death：HR=1.212, 95% CI: 1.015～1.448,P=0.034). Conclusions NLR can be used as an independent predictor of moderate to severe AAC, all-cause death and cardiovascular death in MHD patients. Metrics

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Study on the relationship between variation of clinic blood pressure and residual renal function in patients with peritoneal dialysis 2021, 20 (12):  819-822.  doi: 10.3969/j.issn.1671-4091.2021.12.007 Abstract ( 351 )   PDF (502KB) ( 141 )   【Abstract】Objective Blood pressure variation is closely related to cardiovascular and cerebrovascular events. Nevertheless, the relationship between the variation of blood pressure measured at clinic and the residual renal function and prognosis of the peritoneal dialysis (PD) patients was rarely studied. Methods A total of 515 PD patients were enrolled in this study. They were followed up regularly, and their clinical indicators and laboratory test results during the follow-up period were collected. According to the interquartile mean arterial pressure variation values (3.85, 9.43, 12.4, 16.4, and 48.8), the enrolled patients were divided into four groups: low variation group (3.85～9.43), low average variation group (9.43～12.4), high average variation group (12.4～16.4), and high variation group (16.4～48.8); patient with a boundary value was arranged into the next group. Clinical and laboratory data were compared among the four groups. Results There were significant differences among low variation group, low average variation group, high average variation group and high variation group in serum albumin (37.6±4.5g/l, 37.0±5.4g/l, 36.8± 5.3g/l and 34.8±5.2g/l respectively; F=5.385, P＜0.001), initial urine volume [699.0 (504.0, 1000.0)ml, 671.0 (407.0, 946.0)ml, 611.0 (493.5, 784.0)ml and 494.0 (296.0, 794.5)ml respectively; H=16.222, P=0.001], average urine volume in the followup period [706.8 (501.0, 913.9)ml, 657.7 (510.7, 844.4)ml, 559.2 (430.8, 754.4)ml and 487.6 (333.4, 748.9)ml respectively; H=25.209, P＜0.001], peritoneal Kt/V [1.10 (0.90, 1.50), 1.14 (0.81, 1.48), 1.18 (0.92, 1.59) and 1.32 (0.98, 1.69) respectively; H=13.147, P=0.004], and residual kidney Kt/V [0.90 (0.40, 1.30), 0.75 (0.50, 1.08), 0.69 (0.30, 1.16) and 0.56 (0.25, 0.88) respectively; H=21.384, P＜0.001]. Spearman's correlation analysis showed a negative correlation between blood pressure variation and average urine volume (β=-0.230, P＜0.001). Conclusion In PD patients, serum albumin and residual urine volume were closely related to the clinic blood pressure variation. PD patients with low blood pressure variation usually had higher residual urine volume and better nutritional status and will directly relate to their long-term prognosis. Metrics

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Expert consensus on construction of the renal rehabilitation system in hemodialysis centers 2021, 20 (12):  823-829.  doi: 10.3969/j.issn.1671-4091.2021.12.008 Abstract ( 480 )   PDF (470KB) ( 295 )   【Abstract】Maintenance hemodialysis (MHD) patients are usually present with decreased physical abilities and abnormal psychological and cognitive functions of various degrees along with the extension of dialysis age, seriously affecting the quality of life and greatly raising the burdens on the families and society. The implementation of the renal rehabilitation system is a major strategy to minimize the dysfunctions and enables MHD patients to achieve the best occupational potentials, functional status and quality of life. However, the renal rehabilitation system set in hemodialysis centers is currently at the primary stage and has not been widely launched yet. This expert consensus elaborates on the definition of renal rehabilitation and the required personnel, place, equipment, service content and quality control, providing a theoretical basis and a clinical guidance for the creation of renal rehabilitation system in hemodialysis centers. Metrics

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Comparison of different anesthesia approaches for relieving pain during endovascular treatment of arteriovenous fistulas 2021, 20 (12):  830-834.  doi: 10.3969/j.issn.1671-4091.2021.12.009 Abstract ( 361 )   PDF (520KB) ( 132 )   【Abstract】Objective To observe the efficacy of different anesthesia approaches for relieving pain during endovascular treatment of arteriovenous fistula in patients with end-stage renal disease so as to guide the rational choice of anesthesia methods for this operation. Method A total of 190 patients undergoing percutaneous transluminal balloon angioplasty (PTA) for arteriovenous fistulas at the Renal Department of Haidian Hospital from October 2019 to April 2020 were enrolled in this study and divided into three groups: control group (n=62), local infiltration anesthesia group (n=72) and selective nerve block group (n=56). After operation, Visual Analogue Scale (VAS) was used to evaluate the degree of pain during PTA and the satisfaction in patients and surgeons. The patients were followed up until December 2020 to observe patency of the fistulas. Result The median pain scores were 3 (0～8), 3 (0～10) and 7 (3～10) in selective nerve block group, local infiltration anesthesia group and control group respectively (F=42.656, P＜0.001). The satisfaction with pain management in patients and surgeons was significant different among the three groups (c2=42.656 and 33.859 respectively, P＜0.001). The primary patency rates after operation for 1, 3, 6 and 12 months were 98.1%, 81.8%, 54.5% and 32.7% respectively in selective nerve block group, 95.8%, 94.4%, 69.4% and 47.2% respectively in local infiltration anesthesia group, and 98.3%, 83.3%, 56.7% and 25.0% respectively in control group; the primary patency rates among the three groups were similar after the operation for one month (c2=0.907, P=0.736), 3 months (c2=5.603, P=0.065) and 6 months (c2=3.594, P=0.166), but were statistically different after the operation for 12 months (c2=7.355, P= 0.025). Conclusion Selective nerve block and local infiltration anesthesia approaches can provide effective and safe analgesia during endovascular treatment of arteriovenous fistulas with better patients’satisfaction and short-term primary patency rate. Metrics

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Investigation of vascular access status in elderly maintenance hemodialysis patients in Bengbu area 2021, 20 (12):  835-838.  doi: 10.3969/j.issn.1671-4091.2021.12.010 Abstract ( 301 )   PDF (441KB) ( 96 )   【Abstract】Objective To investigate the vascular access situation in elderly maintenance hemodialysis(MHD) patients in Bengbu area. Methods A total of 130 MHD patients over 60 years old were enrolled as the elderly group, and a total of 162 MHD patients less than 60 years old were recruited as the non-elderly group. The distribution of vascular access methods at the beginning of hemodialysis and during MHD period were compared between the two groups. Clinical data in elderly group were compared between the patients using internal fistulas and those using venous catheters. Results Of the vascular access methods in elderly group, arteriovenous fistula (AVF) accounted for 62.3%, arteriovenous graft (AVG) for 0.8%, and tunneled cuffed catheter (TCC) for 36.9%. The proportion of using provisional venous catheter as vascular access at first was relatively high in both elderly group and non-elderly group, and was higher in elderly group than in non-elderly group (χ2=18.945, P＜0.001). The proportion of using AVF as vascular access at first was higher in non-elderly group than in elderly group (χ2=17.505, P＜0.001). The proportion of using TCC as vascular access was higher in elderly group than in non-elderly (χ2=27.930, P＜0.001). In elderly group, the concentrations of hemoglobin and albumin were higher in the patients with AVF than those with TCC (t=-7.712 and -6.323 respectively; P＜0.001); the ratio of diabetes and the concentrations of serum hsCRP and creatinine were lower in the patients with AVF than those with TCC (t=14.857, -3.172 and 4.626 respectively, P＜0.001, P=0.002 and P=0.033 respectively). Conclusion The constituents of vascular access methods for elderly MHD patients in Bengbu area were unsatisfactory to the targets recommended by the Expert Consensus on Vascular Access in China. The proportion of using AVF at the beginning of hemodialysis and during MHD was lower, while this vascular access method has less effects on microinflammatory state, nutritional status and anemia of the patients. Therefore, AVF should be adopted as the first choice of vascular access, on which individualized management can then be taken. Metrics

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Study on Deviation of Heparin Dosage in Hemodialysis Caused by Equipment Factors 2021, 20 (12):  849-852.  doi: 10.3969/j.issn.1671-4091.2021.12.014 Abstract ( 367 )   PDF (494KB) ( 75 )   【Abstract】Objective To judge and analyze the causes of heparin dosage deviation in hemodialysis from the aspects of dialysis equipment and syringe. Method The speed of heparin pump in dialyzer was set as 1 ml/h, 2ml/h, 5 ml/h, and 10ml/h, respectively. ①The injection flow of heparin pump in dialyzer with different operatingtime was measured without changing the type of syringes. ② The injection flow of heparin pump was measured in the same dialysis machine after applying 6 brands of 20ml disposable medical syringes. Results ①The flow errors of heparin pump in dialyzer with different operating time were all less than ±5%. The measured flow of heparin pump in the dialyzer of group B (running time of 20000h to 35000h,n=6) was lower than the set value at different speed measurement points, which was significantly different from that of group A (running time of 10,000h to 20,000 h, n=6)(1ml/h：t=2.857，P=0.021；2ml/h：t=2.32,P=0.042; 5ml/h: t=3.295, P= 0.007). ②There were significant differences in the detection results of the 6 brands of syringes at the measuring points with different set speeds. (1ml/h:H=16.685，P=0.005；2ml/h：H=18.675， P=0.002，P=0.042;5ml/h: H=21.654，P=0.001；10ml/h：H=19.773，P=0.001). Conclusion In order to ensure accurate and stable operation of heparin pump, daily maintenance and maintenance are very important. When replacing the brand of the syringe, important parameters such as the inner diameter of the syringe should be understood in detail,and the setting parameters in the dialysis machine should be changed in time if they are different from those before. Metrics

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The efficacies of hemodialysis unit construction and quality control management in plateau areas supported by the corresponding cities 2021, 20 (12):  853-856.  doi: 10.3969/j.issn.1671-4091.2021.12.015 Abstract ( 352 )   PDF (446KB) ( 70 )   【Abstract】Objective To summarize the experience of hemodialysis unit construction in Lhasa People's Hospital of Tibet Autonomous Region supported by the medical experts from corresponding cities, and to analyze the quality control of hemodialysis for uremic patients. Methods Several medical experts from hospitals in Beijing were assigned to work in Tibet for professional assistance, medical staff training, and hemodialysis unit construction. They undertook the use of standardized operating procedures (SOP) and related guidelines for blood purification, the establishment of indices for medical service quality surveillance, treatment and health education for the patients, and the setup of patients’databases for statistical analysis of the clinical data. Their working efficacies were assessed regularly. Results In a period of four years, a hemodialysis unit was established and 11 medical professionals in Lhasa were retrained to enable them to perform hemodialysis independently.Atotal of 70 uremic patients were treated with regular hemodialysis under strict control of hemodialysis quality. After the hemodialysis for 3 months, the compliance rate of nutritional status increased from 17.1% to 31.4% (χ2=6.149, P=0.046), serum calcium increased from 1.78 mmol/L to 2.20mmol/L(t=-6.004, P＜0.001), serum phosphate decreased form 2.76mmol/L to 2.18mmol/L (t=6.149, P＜0.001), and PTH decreased from 681.93pg/mL to 461.85pg/mL (t=7.136, P＜0.001). After the hemodialysis for 6 months, the compliance rate of hemoglobin increased from 21.7% to 78.3% (χ2=37.254, P<0.001). Conclusion The assistance scheme from corresponding cities exerted considerable influences on the construction, operation and quality control of hemodialysis units in plateau areas, and is worthwhile to be promoted further. Metrics