Chinese Journal of Blood Purification

12 January 2022, Volume 21 Issue 01 Previous Issue    Next Issue

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Research progress in the effect of erythropoiesis stimulants on blood pressure in patients with chronic kidney disease  2022, 21 (01):  1-5.  doi: 10.3969/j.issn.1671-4091.2022.01.001 Abstract ( 462 )   PDF (407KB) ( 265 )   【Abstract】Renal anemia, a common complication relating to the poor prognosis, is mainly caused by erythropoietin (EPO) deficiency and iron deficiency in chronic kidney disease (CKD) patients. The most important medication to treat renal anemia is the erythropoiesis-stimulating agents (ESA), among which the firstgeneration ESA of recombinant human erythropoietin (rHuEPO) is widely used currently. The most common adverse reaction of rHuEPO is hypertension, accounting for about one third of the patients using rHuEPO. Hypoxia inducible factor prolyl hydroxylase inhibitor (HIF-PHI), a new type of ESA, mimics the activation of hypoxia inducible factor (HIF) pathway under hypoxic environment through inhibition of hydroxylation and degradation of HIF and maintenance of HIF level to treat renal anemia. This paper reviews the research progress in the effect of ESAs on blood pressure during the treatment of renal anemia in CKD patients. Metrics

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Treatment of renal anemia 2022, 21 (01):  6-9.  doi: 10.3969/j.issn.1671-4091.2022.01.002 Abstract ( 445 )   PDF (397KB) ( 349 )   【Abstract】Anemia is a common complication and is related to progression of the kidney disease, longterm survival and adverse cardiovascular events in chronic kidney disease patients. Many new drugs can be clinically used to treat the anemia, including hypoxia-inducible factor prolyl hydroxylase inhibitors, new intravenous iron reagents, long-acting erythropoietin, etc. This article summarizes the progresses in the treatment of renal anemia so as to provide the evidence-based methods for clinical management of renal anemia. Metrics

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Sacubitril/valsartan improves cardiac systolic function independently from blood volume management in hemodialysis patients with heart failure 2022, 21 (01):  10-14.  doi: 10.3969/j.issn.1671-4091.2022.01.003 Abstract ( 1405 )   PDF (499KB) ( 176 )   【Abstract】Objective To observe the efficacy and safety of sacubitril/valsartan for the treatment of heart failure in maintenance hemodialysis patients. Methods Patients on hemodialysis complicated with chronic cardiac insufficiency and with stably controlled volume status were enrolled. They were treated with sacubitril/valsartan and followed up for 3 months. Before treatment with sacubitril/valsartan (baseline) and during follow- up, biomarkers of heart failure were tested, and volume status was assessed by body composition monitor (BCM). Changes of cardiac structure and function were examined by echocardiography. Results A total of 17 patients were included, while 4 patients withdrew due to drug-related adverse reactions and one due to renal transplantation during follow-up. Left ventricular ejection fraction (LVEF) increased from baseline 54.2±15.8% to endpoint 62.7±10.1% (t=-4.429, P=0.001) and greater improvement was found in patients with declined baseline LVEF (≤55%; t=-6.204, P=0.003), in line with a significant reduction in left ventricular end systolic volume (baseline 109.0±62.7ml vs. endpoint 79.4±52.1ml; t=4.725, P=0.009). In patients with normal LVEF, left ventricular posterior wall thickness decreased significantly (baseline 1.08 ± 0.27cm vs. endpoint 0.99 ± 0.16cm; t=3.176, P=0.025). The endpoints of serum creatinine (t=- 2.856, P=0.016), urea (t=- 3.149, P=0.009) and parathyroid hormone (baseline 328±161pg/ml vs. endpoint 409±191pg/ml; t=-2.230, P=0.048) elevated significantly as compared with the baseline values. Conclusion Sacubitril/valsartan significantly improves cardiac systolic function in hemodialysis patients with heart failure and reduces ventricular wall thickness in patients with normal LVEF. However, this treatment may also induce the increase of creatinine, urea and parathyroid hormone levels. Metrics

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Clinicopathological manifestations of the renal damage due to cholesterol crystal embolism 2022, 21 (01):  15-19.  doi: 10.3969/j.issn.1671-4091.2022.01.004 Abstract ( 1902 )   PDF (1550KB) ( 296 )   【Abstract】Objectives Kidney is frequently involved in cholesterol crystal embolism, but this renal injury is easily to be disregarded and misdiagnosed. Objective To investigate the clinicopathological features, treatment and outcome of the renal injury due to cholesterol crystal embolism. Methods The clinicopathological data of the patients with renal injury due to cholesterol crystal embolism were retrospectively reviewed. Results In this cohort, 10 of the 11 patients had atherosclerosis. The renal injury was induced by interventional therapy in 7 patients and by newly administered warfarin in 2 patients, and occurred spontaneously in 2 patients. Blue toe syndrome was found in 6 patients, and eosinophilia was present in 9 patients. All the patients had proteinuria, and 10 patients had renal insufficiency. Eight patients received renal biopsy. Pathological findings consisted of artery thickening and stenosis with needle-shaped clefts in the occluded vessels, and moderate to severe infiltration of lymphomonocytes and some eosinophils. Ten patients were followed up; renal function was normal in one patient and was insufficient in 9 patients, in which one died, and 8 patients showed no improvement in renal function. At the end of follow-up, 4 patients were dialysis-dependent. Conclusion The clinical manifestation of cholesterol crystal embolism varied. Renal biopsy and pathological examination are required in unexplained acute or subacute renal insufficiency patients complicated with atherosclerosis, interventional therapy, and/or anticoagulant treatment. Metrics

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Relationship between hopelessness and sarcopenia in maintenance hemodialysis patients 2022, 21 (01):  20-24.  doi: 10.3969/j.issn.1671-4091.2022.01.005 Abstract ( 291 )   PDF (455KB) ( 162 )   【Abstract】Objective To analyze the relationship between hopelessness and sarcopenia in maintenance hemodialysis (MHD) patients and to provide the references for early prevention and intervention of sarcopenia. Methods A survey was conducted in 308 MHD patients treated in a blood purification center in a tertiary hospital in Qingdao by convenience sampling. General information questionnaire, modified quantitative subjective global assessment (MQSGA) questionnaire and Beck hopelessness scale (BHS) were used for the investigation. Sarcopenia was diagnosed by physical examination. Multivariate logistic regression analysis was performed to analyze the effect of hopelessness on sarcopenia. Results Of the 308 respondents, 78 (25.3%) had sarcopenia and the BHS score was 4.0 (1.0, 8.0). BHS ＞3 defining the presence of hopelessness was found in 155 (50.3%) respondents. BHS ＞3 before the inclusion of confounders was a risk factor for sarcopenia in MHD patients (OR=3.656, 95% CI: 2.079～6.429, P＜0.001). On the basis of this model and after inclusion of the independent variables of gender, age, duration of hemodialysis, with or without diabetes and MQSGA score, BHS ＞3 was still a risk factor for sarcopenia in MHD patients (adjusted OR=2.372, 95% CI: 1.227～4.588, P＜0.001). Conclusion Hopelessness is an independent risk factor for sarcopenia in MHD patients. Medical staff should pay attention to the prevention of sarcopenia in MHD patients with BHS＞3. Metrics

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The relationship between aquaporin 1, transforming growth factor-β1, vascular endothelial growth factor and peritoneal transport function in continuous ambulatory peritoneal dialysis patients 2022, 21 (01):  25-28.  doi: 10.3969/j.issn.1671-4091.2022.01.006 Abstract ( 282 )   PDF (491KB) ( 100 )   【Abstract】Objective To investigate the relationship between the molecules of aquaporin 1 (AQP1), transforming growth factor- β1 (TGF-β1) and vascular endothelial growth factor (VEGF) and the peritoneal transport function in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods A total of 40 CAPD patients treated in the First Affiliated Hospital of Xinxiang Medical University were enrolled in this study. The levels of AQP1, TGF-β1 and VEGF in serum and 4-hour peritoneal dialysis effluent (PDE) were measured. The CAPD patients were divided into groups according to the characteristics of peritoneal transport function, dialysis duration and ultrafiltration volume. The relationship between peritoneal transport function and the levels of AQP1, TGF-β1, VEGF and biochemical markers were analyzed. Result ①Daily ultrafiltration volume and serum urea nitrogen were significantly lower in the high-high-average peritoneal transporter (H-HA) group than in the low-low-average peritoneal transporter (L-LA) group (t=2.420, P=0.020; t=2.478, P=0.018). ②In H-HA group, TGF-β1 in serum and PDE were higher than those in L-LA group (t=- 2.719, P=0.010; t=- 3.407, P=0.002), VEGF in serum and PDE were higher than those in L-LA group (t=- 2.977, P=0.005; t=- 2.553, P=0.015), but AQP1 in PDE was lower than that in L-LA group (t=2.391,P=0.022). ③In long-term dialysis group, TGF-β1 and VEGF in serum were higher than those in short-term dialysis group (F=4.025, P=0.026; F=4.197, P=0.023); VEGF in PDE was higher than that in short-term dialysis group (F=4.547, P=0.017). AQP1 in serum was lower in mid-term and long-term dialysis group than in short-term dialysis group (H=9.504, P=0.009). ④Correlation analyses showed that ultrafiltration volume was positively correlated with AQP1 in PDE (r=0.776, P＜0.001), and was negatively correlated with TGF-β1 and VEGF in PDE (r= -0.825, P＜0.001; r=-0.385, P=0.014). ⑤Logistic regression analyses found that AQP1 in PDE was a protective factor for ultrafiltration (OR=0.514, 95% CI 0.280～0.946, P=0.033). Conclusion Higher TGF-β1 and VEGF in serum and PDE were present in long-term dialysis patients, and lower ultrafiltration volume was present in high-high-average peritoneal transporter (H-HA) patients, suggesting that peritoneal fibrosis and vessel proliferation may result in the increase of solute transportation and the decrease of ultrafiltration volume. AQP1 in PDE was a protective factor for ultrafiltration in CAPD patients. Metrics

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Value of 99mTc-MIBI SPECT/CT combined with ultrasonography in preoperative localization of parathyroid glands in secondary hyperparathyroidism 2022, 21 (01):  29-32.  doi: 10.3969/j.issn.1671-4091.2022.01.007 Abstract ( 260 )   PDF (658KB) ( 145 )   【Abstract】Objective To evaluate the value of 99m technetium-methoxyisobutyl isonitrile (99mTc-MIBI) and single photon emission computed tomography (SPECT/CT) combined with color Doppler ultrasound in the localization of parathyroid glands in secondary hyperparathyroidism (SHPT). Methods A retrospective analysis was conducted on 442 SHPT patients (264 males and 178 females; 16～71 years old, average 45.87± 1.16 years old) from January 2010 to December 2020 treated in the Department of Thyroid and Breast Surgery, The 960th Hospital of PLA Joint Logistics Support Force (General Hospital of Jinan Military Region). Preoperative high-frequency ultrasonography and 99mTc-MIBI SPECT/CT were performed in SHPT patients to localize the parathyroid glands. With postoperative pathological diagnosis as the standard, the localization value of parathyroid glands in SHPT using 99mTc-MIBI SPECT/CT, ultrasonography and their combination was evaluated. Results A total of 1,703 parathyroid glands were removed in 442 patients, in which 6 patients underwent the first operation to remove 5 parathyroid glands, 32 patients underwent the second operation, 3 patients underwent the third operation, and one patient underwent the fourth operation. The detection rates by 99mTc-MIBI SPECT/CT fusion imaging and ultrasonography were 87.25% and 60.24%, respectively, in primary parathyroidectomy, and were 91.67% and 64.58% , respectively, in reoperation parathyroidectomy (χ2=311.785, P=0.000). The localization ability was higher by 99mTc-MIBI SPECT/CT fusion imaging than by ultrasonography. The localization rates of 99mTc-MIBI SPECT/CT combined with ultrasonography before primary parathyroidectomy and reoperation parathyroidectomy were 90.15% and 91.67%, respectively(χ2=5.143, P=0.023), higher than those of 99mTc-MIBI SPECT/CT fusion imaging or ultrasonography alone. Conclusion Preoperative 99mTc-MIBI SPECT/CT fusion imaging combined with high frequency ultrasonography can accurately localize the parathyroid glands in SHPT patients. Combined use of the two methods was better than use of one method, especially for preoperative localization of the parathyroid glands in persistent and recurrent SHT. Metrics

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Effect of sodium thiosulfate combined with hemoperfusion on uremic pruritus and oxidative stress in maintenance hemodialysis patients  2022, 21 (01):  33-37.  doi: 10.3969/j.issn.1671-4091.2022.01.008 Abstract ( 1035 )   PDF (508KB) ( 184 )   【Abstract】Objective To observe the effect of sodium thiosulfate combined with hemoperfusion on refractory pruritus and oxidative stress in maintenance hemodialysis (MHD) patients. Methods A total of 70 MHD patients with refractory pruritus treated in the Hemodialysis Center, Shanghai Jing’an District Zhabei Central Hospital during January 2019 to December 2020 were enrolled in this study. They were randomly divided into three groups: group A (sodium thiosulfate group), group B (hemoperfusion group) and group C (sodium thiosulfate combined with hemoperfusion group). Patients in group A received hemodialysis three times a week, and 3.2g sodium thiosulfate was intravenously injected before every dialysis; those in group B received hemodialysis twice a week and hemodialysis combined with hemoperfusion once a week; those in group C used the dialysis protocols in group B as well as intravenous 3.2g sodium thiosulfate before every dialysis for 3 months. Serum creatinine (SCR), urea nitrogen (BUN), calcium (Ca), phosphorus (P), β2-micro-globulin (β2-MG), parathyroid hormone (PTH), C-reactive protein (CRP), glutathione peroxidase (GSHPx), superoxide dismutase (SOD) and malondialdehyde (MDA) were measured before and after 3 months treatment. Pittsburgh sleep quality index (PSQI) and visual analogue scale (VAS) were used before and after 3 months treatment to evaluate the efficacy and safety of the treatment. Results Serum P, β2-MG and PTH in group B and group C were lower after the treatment than those before the treatment, and were lower than those in group A after the treatment (Serum P, in group B and group C: t=2.829 and 4.226, P=0.010 and <0.001; between group B and group C: F=3.191 and P=0.041. Serum β2-MG, in group B and group C: t=2.363 and 2.575, P=0.027 and 0.017; between group B and group C: F=4.658 and P=0.013. Serum PTH, in group B and group C: t=2.715 and 5.856, P=0.008 and <0.001; between group B and group C: F=13.738 and P<0.001). Serum GSHPx and SOD in group A and group C were higher after the treatment than those before the treatment, and were higher than those in group B during the same period (Serum GSHPx, in group A and group C: t=-2.247 and - 5.387, P=0.035 and <0.001; between group A and group C: F=15.577 and P<0.001. Serum SOD, in group A and group C: t=-2.300 and -5.122, P=0.031 and <0.001; between group A and group C: F=8.308 and P=0.001). Serum MDA decreased significantly (in group A and group C: t=5.630 and 7.904, P<0.001; between group A and group C: F=26.116 and P<0.001). PSQI score and VAS score lowered after 3 months treatment compared to those before treatment in the three groups (PSQI score in groups A, B and C: t=4.739, 4.761 and 8.803 respectively, P<0.001; VAS score in groups A, B and C: t=15.087, 11.682 and 17.310 respectively, P<0. 001). PSQI and VAS scores lowered more in group C than in group A and group B during the same period (For PSQI score and VAS score: F=15.049 and 8.670, P<0.001). After 3 months treatment, the effective rates were 54.2%, 47.8% and 78.3% in group A, group B and group C, respectively, higher in group C than in groups A and B (χ2=4.956, P=0.026). Conclusions Sodium thiosulfate combined with hemoperfusion was safe and effective for MHD patients with refractory pruritus. Sodium thiosulfate has antioxidant effect, which may alleviate uremic pruritus. Metrics

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The correlation between bone mineral density and cardiac valve calcification in maintenance hemodialysis patients 2022, 21 (01):  38-41.  doi: 10.3969/j.issn.1671-4091.2022.01.009 Abstract ( 295 )   PDF (422KB) ( 109 )   【Abstract】Objective To investigate the relationship between bone mineral density and cardiac valve calcification (CVC) in maintenance hemodialysis (MHD) patients. Method A total of 97 MHD patients admitted to The Second Hospital of Anhui Medical University were enrolled in this study. They were divided into combined CVC group and non-combined CVC group based on the manifestations in echocardiograph. Bone mineral density was compared between the two groups. Binary Logistic regression was conducted to explore the factors for combined CVC. Results Thirty patients had combined CVC in mitral and aortic valves with the prevalence of combined CVC of 30.93%. Bone mineral density was lower in combined CVC group than in non-combined CVC group (t= -3.650, P=0.001). Older age, longer duration and higher neutrophil-lymphocyte ratio (NLR) were present in combined CVC group as compared with those in non-combined CVC group. Serum phosphate and intact parathyroid hormone (iPTH) were higher in combined CVC group than in non-combined CVC group (t=3.580 and 2.465, P=0.001 and 0.016). Binary Logistic regression found that hyperphosphatemia (OR=16.301, P=0.001), higher iPTH (OR=1.002, P=0.004), higher NLR (OR=1.561,P=0.042), and lower bone density (OR=0.003, P=0.010) correlated with the combined CVC in MHD patients. Conclusion Hyperphosphatemia, higher iPTH, higher NLR and lower bone density were the risk factors for combined CVC in MHD patients. Metrics

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Protective effect and mechanism of SIRT1 activator SRT1720 on acute renal injury induced by severe hemorrhagic shock/resuscitation in rats 2022, 21 (01):  42-47.  doi: 10.3969/j.issn.1671-4091.2022.01.010 Abstract ( 228 )   PDF (590KB) ( 68 )   【Abstract】Objective To explore the effect and mechanism of SRT1720, the activator of silent mating type information regulation 2 homolog-1 (SIRT1), on severe hemorrhagic shock/resuscitation-induced acute kidney injury. Methods Rats were divided into control group, model group, SIRT1 activator SRT1720 low (20 mg· kg-1) group, medium (40 mg/kg) group, and high dose (80 mg/kg) group. Rats were then subjected to acute severe hemorrhagic shock/resuscitation to induced acute kidney injury. After establishment of the disease model, equal volume of normal saline was given to the rats in control and model group, and various doses of SRT1720 were given to the rats in SRT1720 low, medium and high groups. Rats were then sacrificed, and their kidney/ body ratio, serum creatinine (SCr), urea nitrogen (BUN), SIRT1 in kidney, signal transducer and activator of transcription 3 (STAT3) mRNA and protein, interleukin-2 (IL-2), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were measured. Results In model group, kidney/body ratio, urinary protein, SCr, BUN, IL- 2, IL- 6, and TNF- α increased as compared with those in control group (t=25.632, 14.524,18.965, 23.654, 23.654, 18.695 and 19.547 respectively, P＜0.001). In SRT1720 low, medium and high groups, kidney/body ratio, urinary protein, SCr, BUN, IL- 2, IL- 6, and TNF-α decreased as compared with those in model group (t=21.526, 19.654, 23.654, 25.148, 32.654, 19.654 and 21.548, respectively, in SRT1720 low group; 25.965, 24.967, 28.741, 30.365, 31.654, 23.654 and 18.475, respectively, in SRT1720 medium group; 26.548, 29.512, 30.248, 24.659, 24.965, 22.698 and 26.985, respectively, in SRT1720 high group; P＜0.001); besides, SRT1720 dose and the lowering of the 7 biomarkers apparently have a dosEresponse relationship (t=38.632, 19.625, 25.847, 27.489, 26.954, 29.547 and 32.685, respectively, compared with those between SRT1720 low and medium groups; 34.489, 32.362, 24.548, 29.654, 28.415, 35.957 and 32.548, respectively, compared with those between SRT1720 medium and high groups; P＜0.001). In model group, renal SIRT1 mRNA and protein decreased (t=38.635 and 32.145; P＜0.001) and STAT3 mRNA and protein increased (t=32.636 and 30.213, P＜0.001) as compared with those in control group. In SRT1720 low, medium and high groups, renal SIRT1 mRNA and protein increased (t=18.965 and 23.147 in SRT1720 low group; 28.476 and 30.216 in SRT1720 medium group; 23.654 and 28.471 in SRT1720 high group; P＜0.001) and STAT3 mRNA and protein decreased (t=22.654 and 25.489 in SRT1720 low group; 29.548 and 33.265 in SRT1720 medium group; 41.326 and 29.635 in SRT1720 high group; P＜0.001) as compared with those in model group; additionally, SRT1720 dose and the changes of the 4 biomarkers apparently have a dosEresponse relationship (t=27.485, 28.459, 30.215 and 29.584, respectively, compared with those between SRT1720 low and medium groups; 29.654, 31.145, 32.159 and 30.269, respectively, compared with those between SRT1720 medium and high groups, P＜0.001). Conclusion The SIRT1 activator SRT1720 can alleviate acute renal injury induced by severe hemorrhagic shock/resuscitation in rats. The mechanisms may be that SRT1720 activates the expression of SIRT1 and inhibits the expression of STAT3 in kidney, through which the expressions of inflammatory mediators are inhibited. Metrics

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Application of perforating vein fistula in elderly hemodialysis patients with diabetes 2022, 21 (01):  48-50.  doi: 10.3969/j.issn.1671-4091.2022.01.011 Abstract ( 424 )   PDF (626KB) ( 121 )   【Abstract】Objective The purpose of this paper is to assess the establishment methods and clinical application of perforating vein fistula in elderly hemodialysis patients. Methods A retrospective comparison of elderly patients(75.7±8.9years) undergoing primary vascular access surgery using high arteriovenous fistula (n=54) and perforating vein fistula (n=48) was performed over a 3year period. The general data of patients , procedure success rate, fistula maturation time, blood flow during dialysis, postoperative patency rate and complications of patients with different surgical methods were analyzed. Results The two surgical methods have a one-time success rate of 100%. For elderly diabetic dialysis patients, internal fistula failure can occur in the early stage, patency rates were significantly lower in patients withforearm AVF compared to perforating vein AVF (c2= 6.971, P= 0.008). Comparing the non- diabetic patients oftwo group, there were no significant differences in survival rate (c2= 0.668, P= 0.414). The incidence of pseudoaneurysm and heart failurein observation group was significantly lower than in control group (c2= 5.768, 7.761; P= 0.014, 0.007). There were no significant differences between two groups in thrombosisandswollen hand syndrome (c2=0.956, 0.260; P=0.248, 0.698). Conclusion For the elderly patients with poor vascular condition in wrist and forearm, perforating vein fistula operation may have clinically satisfactory efficacies. Metrics

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Relationship between cardiac valve calcification and arteriovenous fistula dysfunction in maintenance hemodialysis patients 2022, 21 (01):  51-54.  doi: 10.3969/j.issn.1671-4091.2022.01.012 Abstract ( 299 )   PDF (487KB) ( 258 )   【Abstract】Objective To evaluate the relationship between cardiac valve calcification (CVC) and failure of arteriovenous fistula (AVF) in patients with maintenance hemodialysis (MHD). Methods A total of 95 MHD patients treated at Beijing Haidian Hospital from June 2019 to December 2020 were recruited. Their clinical data and laboratory results were collected. The extent of CVC by color Doppler ultrasonography was classified into four (none, slight, medium, heavy) grades. Patients were then divided into minor CVC group (patients with none or slight CVC) and severe CVC group (patients with medium or heavy CVC). The association between CVC severity, clinical factors, and failure of AVF was then analyzed by Cox proportional hazard analysis. Results The severity of CVC increased along with the increase of age (t=2.463, P<0.016). Serum phosphate (t=- 4.075, P<0.001) and parathyroid hormone (t=- 3.398, P<0.001) were higher and prealbumin (t= -2.412, P=0.018) was lower in severe CVC group as compared with those in minor CVC group. Multivariate regression analysis showed that severe CVC was the independent risk factor for failure of AVF, and the risk for failure of AVF in severe CVC patients was 4.909 times higher than that in minor CVC patients (OR=4.909, 95% CI：1.972～12.222, P=0.001). Conclusions Older age, higher serum phosphate, parathyroid hormone and TG, and lower serum prealbumin were the risk factors for CVC. Severe CVC can be used to predict the failure of AVF in MHD patients. Metrics

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The types and influencing factors of hemodialysis patients participating in vascular access sharing decision-making  2022, 21 (01):  66-69.  doi: 10.3969/j.issn.1671-4091.2022.01.016 Abstract ( 308 )   PDF (476KB) ( 292 )   【Abstract】Objective To understand the expectation, actual decision-making status and influencing factors of hemodialysis patient participating in vascular access. Methods Patients who chose or changed vascular access for the first time in Henan Provincial People's Hospital from November 2020 to July 2021 were selected as the subjects of the study. Their general information was investigated. The expected decision and actual decision of the patients were evaluated by Control Preference Scale (CPS). The consistency of expected decision and actual decision was analyzed. Univariate and binary logistic regression analyses were used to explore the influencing factors of decision making. Results A total of 202 questionnaires were sent out and 202 were received and valid, with the effective recovery rate of 100%. The consistency between expected decision and actual decision participation of the patients was 0.74. For expected decision- making, 75 cases (37.1%) had good sense and 127 cases (62.9%) had weak sense; for practical decision-making, 52 cases (25.7%) had good consciousness and 150 cases (74.3% ) had weak consciousness. Binary logistic regression analyses showed that age between 35 to 59 years (OR=28.179, 95% CI: 5.451～145.674, P<0.001), high school or technical secondary school education level (OR=0.026, 95% CI: 0.004～0.170, P<0.001), family monthly income>5000 RMB (OR=0.115, 95% CI: 0.032～0.409, P=0.004), and the number of vascular access selection (OR=0.018, 95% CI: 0.002～0.141, P<0.001) were the influential factor for actual decision-making participation of the patients. Conclusion The expected decision participation of vascular access in hemodialysis patients is consistent with the actual decision-making type, and the low consciousness type is dominant in decision- making. To improve the situation of weak awareness of decision- making participation, medical staff should provide intervention programs based on the influencing factors and the decision-making needs of the patients. Metrics