Chinese Journal of Blood Purification

12 March 2022, Volume 21 Issue 03 Previous Issue    Next Issue

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Obstructive sleep apnea and chronic kidney disease 2022, 21 (03):  145-148.  doi: 10.3969/j.issn.1671-4091.2022.03.001 Abstract ( 188 )   PDF (387KB) ( 92 )   【Abstract】Obstructive sleep apnea (OSA) is regarded as an independent risk factor for chronic kidney disease and is highly prevalent among patients with chronic kidney disease (CKD). In recent years, increasing evidence has demonstrated a bidirectional relationship between obstructive sleep apnea and chronic kidney disease. Therefore, a comprehensive understanding of the relationship and early intervention could alleviate symptoms of OSA and potentially prevent or delay CKD progression, which ultimately allows for improvement of quality of life. This review mainly focuses on the bidirectional relationship between OSA and CKD, including the epidemiology, pathogenesis, and treatment strategies. Metrics

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A review of factorial and risk analysis for hyperkalemia in hemodialysis patients 2022, 21 (03):  149-152.  doi: 10.3969/j.issn.1671-4091.2022.03.002 Abstract ( 336 )   PDF (397KB) ( 281 )   【Abstract】Patients with end-stage renal disease (ESRD) on maintenance hemodialysis have a high incidence of hyperkalemia, and with the deterioration of renal function, the risk of recurrence of hyperkalemia gradually increases. Many factors, including inappropriate dialysis, concomitant use of drugs that raise serum potassium, and certain medical conditions, increase the risk of hyperkalemia in dialysis patients. Hyperkalemia in dialysis patients is closely related to its poor prognosis, not only increasing the risk of death, but also increasing the number of emergency department visits and hospitalizations, and medical costs. Therefore, for HD patients with recurrent hyperkalemia, attention should be paid to the comprehensive management of serum potassium levels, including restriction of high potassium diet, adequate dialysis treatment, avoidance of drugs that increase serum potassium, and rational use of potassium-lowering drugs. Metrics

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Effect of peritonitis frequency on survival of peritoneal dialysis patients 2022, 21 (03):  153-157.  doi: 10.3969/j.issn.1671-4091.2022.03.003 Abstract ( 173 )   PDF (504KB) ( 76 )   【Abstract】Objective To investigate the effect of peritonitis frequency on survival rate of peritoneal dialysis patients. Methods The subjects were adult patients with end- stage renal disease (aged ≥ 18 years) newly admitted to peritoneal dialysis from January 2006 to April 2014. They were followed up till December 2020. COX regression model was used to analyze the related factors of all-cause death. The patients were divided into three groups according to the frequency of peritonitis: group A (＜0.2 episode/ year), Group B(0.2～0.5 episode/year), and Group C (＞0.5 episode/year). Kaplan-Meier survival analysis and COX regression model were used to analyze the survival rate of the three groups. Results A total of 221 peritoneal dialysis patients were enrolled. After multivariate COX regression, the patients' age (HR=1.058, 95% CI 1.040～1.076，P＜0.001), Charlson complication index (HR=1.274, 95% CI 1.107～1.466, P = 0.001), time-averaged iPTH (HR=0.998, 95% CI 0.996～0.999, P=0.001) and the frequency of peritonitis (HR=3.301, 95% CI 2.098～5.196,P＜0.001) were independent risk factors for predicting death. The overall survival rate was different among the three groups (χ2=99.473，P＜0.001). The risk of death in group C was higher than that in group A (HR=2.022, 95% CI 1.184～3.452, P=0.010), and group B (HR=3.450, 95% CI 1.723～6.906, P＜0.001). But the risk of death was no difference between group A and group B (HR=1.013, 95% CI 0.621～1.652, P=0.958). Conclusion The frequency of peritonitis can affect the survival of patients with peritoneal dialysis. However, there is a threshold for its impact: when the frequency of peritonitis exceeds 0.5 episode/year, the risk of death increases. Metrics

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The effectiveness and safety of combined use of erythropoietin and low dose Roxadustat in the treatment of renal anemia in hemodialysis patients 2022, 21 (03):  158-161.  doi: 10.3969/j.issn.1671-4091.2022.03.004 Abstract ( 329 )   PDF (395KB) ( 251 )   【Abstract】Objective To investigate the effectiveness and safety of erythropoietin (EPO) combined with low dose Roxadustat in hemodialysis patients whose hemoglobin (Hb) levels remained below the target range under EPO therapy. Methods The hemodialysis patients treated in Peking University Third Hospital from January 2020 to September 2021 and having renal anemia not to be reversed to the target range by EPO were retrospectively reviewed. Their EPO dose could not be further increased because of the already higher EPO dose they took, the possible side-effects of high EPO dose, or the unaffordable cost of Roxadustat of the patients. The changes of Hb level, doses of EPO and Roxadustat, dialysis regimens, iron supplements, ultrasensitive C-reactive protein (us-CRP), intact parathyroid hormone (iPTH), acidosis (CO2CP), and others before the combined therapy and after 6 months of the therapy were analyzed. Results A total of 38 patients received combined therapy. The Hb gradually decreased in the 6 months before the addition of Roxadustat compared with the 3 months and the 0 months (t=6.689, 4.910, respectively，both P<0.001). EPO dose did not change significantly (t=-1.686, -1.937, P=0.102, 0.088, respectively). Transferrin saturation (TSAT) and ferritin (SF) were in the target range. After the combination therapy with low-dose Roxadustat [(211.9 ±12.5) mg/week] for 1, 3 and 6 months, the dose of EPO had no significant change compared with month 0 (t=0.583, -1.303, - 1.402, P=0.563, 0.201, 0.180). Hb gradually increased at 1, 3 and 6 months after combined treatment (t=-4.788, -5.162, -5.910, respectively. P<0.001 in all). TSAT decreased slightly without statistically significance (t=1.967, P=0.064); SF decreased significantly (t=2.259, P=0.037). Before and after the combined therapy, dialysis regimen and intravenous iron dose had no changes; us-CRP, iPTH, and CO2CP levels also had no changes (t=-1.989, -1.743 and 0.946 respectively; P=0.427, 0.464 and 0.352 respectively). No adverse events were found during the combined therapy. Conclusion For hemodialysis patients who cannot maintain the Hb target with EPO alone, combined use of low-dose Roxadustat is safe and effective. Metrics

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Relationship between post-dialytic overhydration and long-term prognosis in maintenance hemodialysis patients 2022, 21 (03):  162-166.  doi: 10.3969/j.issn.1671-4091.2022.03.005 Abstract ( 196 )   PDF (459KB) ( 86 )   【Abstract】Objective To explore the role of post-dialytic overhydration (OH) determined by bioelectrical impedance technique in the prediction of all- cause death in maintenance hemodialysis (MHD) patients. Methods A total of 117 MHD patients without edema from Peking University People's Hospital were recruited for the observation. Their total body water (TBW), extracellular water (ECW), intracellular water (ICW), fat mass and muscle mass after dialysis were measured by bioelectrical impedance analyzer. The ECW/TBW ratio higher than that of normal upper limit after hemodialysis was defined as post-dialytic OH. Blood pressure, laboratory tests and echocardiography were recorded. The primary endpoint was all-cause death in the follow-up period of 4 years. Multivariate COX regression analysis was conducted to explore the predictive effect of post-dialytic OH on all-cause death in MHD patients using all-cause death as the dependent variable, post-dialytic OH as the independent variable, and statistically significant variables in univariate analysis and clinically significant variables in previous studies as the correction variables. Results ①A total of 117 patients (73 males and 44 females, average age 58±15 years old) on MHD for 67 (39, 120) months were included in this study. They were followed up for 4 years, and 21 cases died (17.9%) and 96 cases survived in the follow-up period. ②Multivariate COX regression analysis showed that post-dialytic OH was an independent risk factor for all-cause death (HR=17.459, 95% CI 2.801～108.832, P=0.002) in MHD patients after adjusting for a variety of factors. Conclusions Post-dialytic ECW/TBW ratio was a sensitive biomarker of volume status in MHD patients without evident edema. Post-dialytic OH was an independent risk factors for all-cause death in MHD patients. Therefore, volume management should be carefully conducted in MHD patients. Metrics

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Relationship between abnormal bone mass and long- term outcomes in peritoneal dialysis patients 2022, 21 (03):  167-171.  doi: 10.3969/j.issn.1671-4091.2022.03.006 Abstract ( 132 )   PDF (465KB) ( 105 )   【Abstract】Objective To investigate the determinant factors for abnormal bone mass and the relationship between abnormal bone mass and long- term outcomes in peritoneal dialysis (PD) patients. Methods Bone mineral density was assessed by dual-energy x-ray absorptiometry. Clinical data and laboratory indices of the PD patients were collected. The time and cause of fracture or death were documented. The determinant factors of bone density and the relationship between bone density and all-cause mortality and cardiovascular mortality were analyzed in the PD patients. Results A total of 74 PD (average age 60.9±14.1 years old, 38 females) patients were enrolled in the study, with a median follow-up period of 59.5 (27.8, 98.0) months. During the follow-up period, 52 patients died, of which 26 died of cardiovascular events, and 5 had fractures. The rate of abnormal bone mass diagnosed by lumbar spine examination and that by femur examination were significant different (χ2=17.697, P＜0.001). Low BMI (OR=0.666, 95% CI 0.508～0.874, P=0.003) and advanced age (OR=1.065, 95% CI 1.007～1.126, P=0.027) were the independent risk factors for femoral abnormal bone mass. Multivariate COX regression analysis revealed that abnormal femoral bone mass increased the risk of cardiovascular mortality for 2.58 times (HR=3.582, 95% CI 1.193～10.760, P=0.023). Conclusion Abnormal femoral bone mass is an independent predictor for the risk of cardiovascular mortality in PD patients. Metrics

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The correlation of phase angle with sarcopenia and its diagnostic value in maintenance hemodialysis patients 2022, 21 (03):  172-176.  doi: 10.3969/j.issn.1671-4091.2022.03.007 Abstract ( 177 )   PDF (559KB) ( 99 )   【Abstract】Objective This study aimed to analyze the correlation between phase angle measured by bioelectrical impedance method and sarcopenia in maintenance hemodialysis (MHD) patients and to explore the role of phase angle in sarcopenia. Methods We enrolled 346 MHD patients with regular dialysis in this study. Their relevant data were collected. Multivariate linear regression was used to analyze the influencing factors for phase angle in MHD patients. Receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the predictive value of phase angle for sarcopenia. Results Multivariate linear regression showed that the phase angle was linear with age, albumin, fat free mass, skeletal muscle mass index, handgrip strength, gait speed (B=- 0.192, 0.180, 0.889, 0.978, 0.212 and 0.210 respectively; P＜0.05). The best cutoff value of phase angle for sarcopenia was 4.67° , with the AUC of 0.823, the sensitivity of 86.7%, and the specificity of 67.4% (P＜0.001). Conclusions This study found that phase angle was closely related to sarcopenia component in MHD patients, and was an important predictor for sarcopenia. As a simple and convenient clinical index, phase angle can provide objective reference for early diagnosis of sarcopenia in MHD patients. Metrics

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Effect of phosphate clearance on serum phosphate and clinical prognosis in peritoneal dialysis patients 2022, 21 (03):  177-181.  doi: 10.3969/j.issn.1671-4091.2022.03.008 Abstract ( 143 )   PDF (720KB) ( 67 )   【Abstract】Objective To investigate the effect of phosphate clearance on serum phosphate and prognosis in primary peritoneal dialysis patients (PD) with different peritoneal transport status. Methods The patients who were primarily treated with PD and regularly followed up for more than 3 months in a single center were involved in this cross-sectional study. Their blood laboratory results in the first month of PD were collected, and their PD adequacy and peritoneal membrane function were evaluated. Serum phosphate, phosphate clearances by peritoneum and kidney, and clinical outcome were compared among PD patients with different levels of peritoneal transport functions. Results A total of 504 PD patients were enrolled in this study. Serum phosphate in the first month of PD was lower in the high peritoneal transport patients than in the low average peritoneal transport patients (F=5.452, P=0.020) and low peritoneal transport patients (F=9.441, P=0.003). The peritoneal phosphate clearance was positively related to the 4-hour creatinine D/P ratio (r=0.280, P ＜0.001) and dialysis dose (r=0.452 P＜0.001), and was negatively related to the urinary phosphate clearance (r=-0.205, P=0.020), serum phosphate (r=-0.332 P＜0.001), and glomerular filtration rate (r=0.229, P=0.004). ROC curve for the prediction of hyperphosphatemia by peritoneal phosphate clearance rate showed that the area under the curve (AUC) was 0.682 (95% CI 0.584～0.723, P＜0.001) and the cut-off value was set at 28.75 L/W; ROC curve for the prediction of hyperphosphatemia by nPCR in low average peritoneal transport patients and low peritoneal transport patients showed that the AUC was 0.660 (95% CI 0.577～0.742, P=0.001) and the cut- off value was set at 1.026 g/kg/d. COX survival model showed that older age (OR=1.055, 95% CI 1.003～1.193, P＜0.001), and hypoalbuminemia in the first month of PD (OR=0.907, 95% CI 0.871～0.945, P=0.001) were the independent risk factors for death in all PD patients, and that low urinary phosphate clearance rate was the risk factor for death (OR=0.430, 95%CI 0.213～0.866, P=0.018) only in PD patients with lower peritoneal transport function. Conclusion ①The lower the peritoneal transport function, the lower the peritoneal phosphate clearance rate and the higher the serum phosphate level. ② Low urinary phosphate clearance was the independent risk factor for all-cause mortality in PD patients with low peritoneal transport function and low average peritoneal transport function. Metrics

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The effect of ulinastatin combined with continuous blood purification in the treatment of severe sepsis and its influence on microcirculation indexes, plasma polysaccharide coating level and prognosis 2022, 21 (03):  182-185.  doi: 10.3969/j.issn.1671-4091.2022.03.009 Abstract ( 174 )   PDF (438KB) ( 58 )   【Abstract】Objective To investigate the effect of ulinastatin combined with continuous blood purification (CBP) in the treatment of severe sepsis and its effects on microcirculation indexes, plasma polysaccharide coating level and prognosis. Methods A total of 130 patients with severe sepsis treated in our hospital from August 2017 to January 2020 were divided into observation group (Ulinastatin+CBP, n=78) and control group (CBP, n=52). The disease improvement indexes, microcirculation indexes and plasma polysaccharide coating level before and after the treatment were compared between the two groups. The incidence of complications and 28-day mortality in the two groups were recorded to evaluate their prognosis. Results Compared with the control group, the scores of sequential organ failure assessment (t=7.835, P＜0.001), acute physiology and chronic health status II (t=8.264, P＜0.001), total sublingual vascular density (t=8.101, P＜0.001), sublingual perfusion vascular density (t=3.905, P＜0.001), plasma hyaluronic acid (t=2.216, P=0.028), plasma multi ligand proteoglycan- 1 (t=6.792, P＜0.001), plasma heparan sulfate (t=3.457, P=0.001), serum procalcitonin (t=2.994, P=0.003), serum interleukin-6 (t=9.003, P＜0.001) and serum interleukin-17 (t=6.414, P＜0.001) decreased significantly in the observation group after the treatment; the proportion of sublingual perfusion vessels (t=4.739, P＜0.001) and sublingual flow index (t=2.467, P=0.015) were higher in the observation group; the hospitalization period was shorter (t=2.219, P=0.028) and the 28-day mortality (χ2=4.670, P=0.031) was lower in the observation group. Conclusion CBP treatment combined with the administration of ulinastatin can improve the microcirculation state, alleviate the inflammatory reaction, inhibit the degradation of plasma polysaccharide, and significantly improve the short-term and long-term prognosis of the patients with severe sepsis. Metrics

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Comparison of the three different dilution methods used in continuous veno- venous hemofiltration 2022, 21 (03):  186-190.  doi: 10.3969/j.issn.1671-4091.2022.03.010 Abstract ( 149 )   PDF (459KB) ( 95 )   【Abstract】Objective To compare the efficacy of the three different dilution methods in continuous veno-venous hemofiltration (CVVH) mode. Methods A total of 90 patients treated with CVVH and hospitalized in the Emergency Intensive Care Unit of our hospital between January 2018 and August 2020 were retrospectively studied. According to the dilution method, they were equally divided into post-dilution group, preand post-dilution group, and pre-dilution group. The filter usage period, small molecule removal effect, ICU residence time and mortality were compared between the 3 groups. Results There were no statistical differences in gender (c2=0.287, P=0.866), age (F=0.555, P=0.576), APACHE (acute physiology and chronic health evaluation) II score (F=0.800, P=0.453), anticoagulation method (F=0.480, P=0.787) and diagnosis (c2=2.702, P=0.997) among the 3 groups. The average filter usage periods were 18.70±9.64 hours, 20.81±9.78 hours and 25.83±12.45 hours in post-dilution group, pre- and post-dilution group and pre-dilution group respectively (F=3.515, P=0.034), and the average filter usage period was longer in pre- dilution group than in post- dilution group (t=7.130, P=0.012). In terms of small molecule removal effect, there were no statistical differences in serum urea (F=0.065, P=0.937), creatinine (F=0.347, P=0.708), lactic acid (F=0.112, P=0.894), hemoglobin (F=0.187, P=0.830) and platelet (F=1.826, P=0.167) before the treatment among the 3 groups. After the treatment for 8 hours, serum urea was different among the 3 groups (F=4.831, P=0.010), and was lower in post-dilution group than in pre-dilution group (t=5.512, P=0.003). Serum creatinine level was different among the 3 groups (F=3.666, P=0.030), and was lower in post- dilution group and pre- and post- dilution group than in pre-dilution group (t=59.960 and 46.590, P=0.012 and 0.048). There were no significant differences in serum lactic acid among the 3 groups (F=0.535, P=0.587). The ICU residence time was different among the 3 groups (F=3.625, P=0.031), with the longest in post-dilution group. The 28-day mortality rates were 10% (3 cases), 10% (3 cases), and 13.3% (4 cases) in post-dilution group, pre- and post-dilution group and pre-dilution group respectively, without statistical significances among the 3 groups (c2=0.225, P=0.894). Conclusions In CVVH, the pre-dilution method had the advantages of longer filter usage period and shorter ICU residence time of the patients, while the post-dilution and pre- and post-dilution methods had better effects on removal of small molecules such as urea and creatinine than pre-dilution method. Metrics

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Research progress in the removal of indoxyl sulfate by blood purification 2022, 21 (03):  191-193.  doi: 10.3969/j.issn.1671-4091.2022.03.011 Abstract ( 425 )   PDF (377KB) ( 243 )   【Abstract】Indoxyl sulfate (IS), a typical uremia toxin, is the product of tryptophan decomposed by intestinal flora and then by a series of metabolic processes. Its binding rate with plasma albumin was more than 90%. In chronic kidney disease (CKD), IS cannot be effectively secreted and excreted through the impaired renal tubules. More evidences have shown that IS plays a key role in the presence and development of uremic complications and is also related to the prognosis of uremic patients. Therefore, the clearance of IS is particularly important. Here we summarize the recent advances in the clearance of IS by blood purification. Metrics

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Research progress in the relationship between calciprotein particles and vascular calcification in chronic kidney disease patients 2022, 21 (03):  194-197.  doi: 10.3969/j.issn.1671-4091.2022.03.012 Abstract ( 266 )   PDF (386KB) ( 249 )   【Abstract】Serum calciprotein particles (CPPs) are present in the form of colloidal nanoparticles in serum and have become a novel biological marker for chronic kidney disease-mineral and bone disorder (CKDMBD). CPPS are now intrigued by its involvement in the pathogenesis of vascular calcification in CKD patients. This article reviews the basic structure and biological activities of CPPs as well as the relationship between CPPs and vascular calcification, so as to provide a new diagnostic marker and therapeutic target for vascular calcification in CKD patients. Metrics

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Advances in the clinical practice of therapeutic plasma exchange in pregnant women Dong-Liang Zhang 2022, 21 (03):  198-201.  doi: 10.3969/j.issn.1671-4091.2022.03.013 Abstract ( 148 )   PDF (401KB) ( 75 )   【Abstract】Therapeutic plasma exchange (TPE) achieves the treatment purpose by separating and removing the soluble pathogenic substances in plasma and supplementing fluid, electrolytes, plasma components by replacement fluid. Red cell alloimmunization, thrombotic microangiopathy, autoimmune diseases, and lipids disorders in pregnant women are the indications considered to use TPE. The present article reviews the indications and side effects of TPE, in order to provide references useful for clinical practice of this therapeutic method. Metrics

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Application of modified MILLER operation guided by ultrasound for flow restriction of high-flow autologous arteriovenous fistula in hemodialysis 2022, 21 (03):  202-205.  doi: 10.3969/j.issn.1671-4091.2022.03.014 Abstract ( 254 )   PDF (405KB) ( 214 )   【Abstract】Objective To explore a simple and effective operation to limit the flow of high-flow autogenous arteriovenous fistula (AVF). Methods A total of 12 patients with high-flow AVF treated in the Department of Nephrology, the First Affiliated Hospital of Xiamen University from January 2016 to December 2020 using modified MILLER surgery under ultrasound guidance to limit arterial flow were retrospectively analyzed. These AVFs underwent color Doppler ultrasound examination before operation. During the operation, the core of Terumo 6F vascular sheath was placed on the surface of the proximal artery 2 cm away from the fistula, and the sheath core was looped with a slipknot using a 7-gauge silk thread; there were two ferrules with an average interval of 1cm; color Doppler ultrasound monitors the artery diameter and brachial artery flow at the ferrule, and the tightness of the silk loop was adjusted to make the brachial artery flow within 800-1000 ml/min. Color Doppler ultrasound examination for the AVF was repeated on the day after operation, 3 months after the operation, and half a year after the operation. Results The average diameter of the artery after the operation was significantly reduced compared with that before the operation (t=20.282, P=0.001). The artery diameter at the ferrule was rEexamined after the operation for 3 months and half a year, and the two values had no statistical significance (t=-1.295, -1.342; P=0.209,0.193). The blood flow in the brachial artery after the operation was significantly lower than that before the operation (t=13.923, P=0.001). The postoperative blood flow in the brachial artery was rEexamined after the operation for 3 months and half a year, and the two values had no statistical significance (t=-0.364,-0.806; P=0.719,0.429). Conclusion The modified MILLER operation under ultrasound guidance can accurately adjust the ferrules to effectively limit the flow in highflow AVF. The postoperative blood flow in the AVF was stable. This surgical method is simple, easy to perform, safe, effective, low cost, and worthy of promotion. Metrics

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The diagnosis and treatment of early cannulation arteriovenous graft dissection 2022, 21 (03):  206-208.  doi: 10.3969/j.issn.1671-4091.2022.03.015 Abstract ( 241 )   PDF (1080KB) ( 135 )   【Abstract】Objective To summarize the diagnosis, treatment and clinical effects of different treatment methods for early cannulation arteriovenous graft dissection. Methods The clinical data of 86 patients with arteriovenous graft (AVG) and treated with surgery in our center from August 2017 to December 2020 were retrospectively studied. Their basic information, preoperative ultrasound findings, lesion location, treatment method and follow-up results were statistically analyzed. Results All of the 4 patients with early cannulation AVG dissection were treated with percutaneous transluminal angioplasty(PTA) at first. The technical success rate and clinical success rate were 100%. They were followed up with the median follow-up time of 13.8±8.0 months. The primary patency rates after the surgery for 3 months and 6 months were 50% and 25% respectively. During the follow-up period, all of the 4 patients underwent surgical treatment again; 3 of them were treated with stent graft, and the primary patency rates after stent implantation for 3 months and 6 months were 100%; one of them underwent AVG replacement, and the AVG was patent in the follow- up period of 9 months. Conclusion Dissection is a rare complication in hemodialysis patients with AVG for blood access. PTA results in a patency AVG only a short period of time. Stent graft implantation or AVG replacement achieves a better patency rate and satisfactory treatment effects. Metrics

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The efficacy of thrombus aspiration combined with percutaneous transluminal angioplasty via percutaneous vascular sheath in the treatment of acute thromboembolism in autologous arteriovenous fistula 2022, 21 (03):  209-213.  doi: 10.3969/j.issn.1671-4091.2022.03.016 Abstract ( 134 )   PDF (569KB) ( 197 )   【Abstract】Objective To investigate the efficacy of thrombus aspiration combined with percutaneous transluminal angioplasty (PTA) via percutaneous vascular sheath in the treatment of acute thromboembolism in autologous arteriovenous fistula (AVF). Methods Patients with acute thrombotic occlusion of AVF treated in the Affiliated Hospital of Traditional Chinese Medicine, Southwest Medical University from March 2014 to July 2020 were selected as the research subjects. Their clinical data were recruited retrospectively. They were divided into thrombus aspiration group (thrombus aspiration combined with PTA) and local thrombolysis group (local thrombolysis combined with PTA). Surgical success rate, incidence of postoperative complications and primary patency rate after the treatment for one year were compared between the two groups. The patency rate was evaluated by Kaplan-Meier analysis. Results A total of 61 patients were enrolled in this study, including 28 cases in the thrombus aspiration group and 33 cases in the local thrombolysis group. The anatomical success rate and clinical success rate in the thrombus aspiration group were 100% and 96.4% respectively, higher than those of 96.9% and 90.9% respectively in the local thrombolysis group but without statistical significances (χ2=0.863 and 0.753, P=0.353 and 0.385). The incidence of postoperative complications in the thrombus aspiration group (7.4%) was slightly higher than that in the local thrombolysis group (6.7%) but without statistical significance (χ2=0.029, P=0.865). The primary patency rates after the operation for 3, 6 and 12 months in the thrombus aspiration group were 96.3%, 92.6% and 74.1%, respectively, while those in the local thrombolysis group were 96.7%, 76.7% and 46.7%, respectively; the rates in the two groups were statistically significant (χ2=4.158, P=0.041). Conclusions Thrombus aspiration combined with PTA via percutaneous vascular sheath is a safe and effective method to treat acute thrombotic occlusion of AVF, especially for patients with contraindications of thrombolysis. This method can also prolong the survival time of AVF. Metrics

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Investigating on the effect of structured education on self-care behavior towards arteriovenous fistula in hemodialysis patients 2022, 21 (03):  214-217.  doi: 10.3969/j.issn.1671-4091.2022.03.017 Abstract ( 138 )   PDF (437KB) ( 108 )   【Abstract】Objective To evaluate the effect of structured education on self-care behavior towards arteriovenous fistula (AVF) in hemodialysis patients. Methods The hemodialysis patients were randomly divided into the intervention group (n=48) and the control group (n=41). Patients in the control group received routine nursing, and those in the intervention group were treated with structured education. The self-care behavior towards AVF and satisfaction of the patients were compared before and after the intervention. Results In the control group, the total score of self-care behavior towards AVF (t=1.836, P=0.059), symptom and sign management score (t=1.954, P=0.582) and complication prevention score (t=1.768, P=0.611) had no statistically significances as compared with those before and after the intervention. In the intervention group, the total score of self-care behavior towards AVF (t=4.699, P=0.032), symptom and sign management score (t=3.288, P=0.027) and complication prevention score (t=4.005, P=0.025) were statistically significant as compared with those before and after the intervention. After the intervention, the total score of self- care behavior towards AVF (t=3.847, P=0.013), symptom and sign management score (t=2.589, P=0.027) and complication prevention score (t=3.255, P=0.023) were statistically higher in the intervention group than in the control group; the rate of patient satisfaction was higher in the intervention group than in the control group; the flexibility (c2=6.028, P=0.031), independence (c2=5.745, P=0.025) and diversity (c2=4.321, p=0.032) were also statistically different between the two groups. Conclusion In the health education of self-care behavior for patients with AVF, the structured education has significant effects and can be widely used. Metrics

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The influence of appetite on protein-energy wasting in maintenance dialysis patients 2022, 21 (03):  218-222.  doi: 10.3969/j.issn.1671-4091.2022.03.018 Abstract ( 169 )   PDF (444KB) ( 197 )   【Abstract】Objective To investigate the protein-energy wasting (PEW) status and its correlation with appetite in chronic kidney disease (CKD) patients treated with maintenance dialysis, so as to provide scientific basis for clinical nutrition intervention and management. Methods This study is a cross-sectional study, recruiting participants from three hospitals through a convenient sampling method. The malnutrition inflammation scale and appetite visualization scale were used to investigate the PEW and appetite status. Body composition monitoring, anthropometrics and biochemical examinations were performed to assess patients' nutrition and body composition. Multivariate logistic regression was used to explore the relationship between PEW and appetite. Results A total of 101 maintenance dialysis patients were recruited, and the incidence of PEW was 31.7%. In PEW group, the five dimensions of appetite, the mean score for desire to eat and the amount of food consumed were relatively lower, being 39.41± 26.25 and 31.63±25.67. The satiety score in PEW group was significantly higher than that in non-PEW group (Z=3.136, P=0.002). In addition, the ratio of gastrointestinal symptoms was significantly higher in PEW group (75.0%) than in non-PEW group (43.5%). Multiple logistic regression analysis showed that gastrointestinal symptoms (OR=4.445, P=0.005) and postprandial satiety (OR= 1.023, P=0.012) were the risk factors for PEW. Conclusion Nearly one third of maintenance dialysis patients have PEW. The higher postprandial satiety and higher ratio of gastrointestinal symptoms are the risk factors for PEW. Metrics