Chinese Journal of Blood Purification

12 April 2022, Volume 21 Issue 04 Previous Issue    Next Issue

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Gender-specific association between serum CHI3L1 and abdominal aortic calcification in peritoneal dialysis patients  2022, 21 (04):  225-230.  doi: 10.3969/j.issn.1671-4091.2022.04.001 Abstract ( 221 )   PDF (552KB) ( 52 )   【Abstract】Objective To investigate the association between serum chitinase-3-like protein 1(CHI3L1) and vascular calcification in peritoneal dialysis (PD) patients of different genders. Methods In this cross-sectional study, a total of 116 patients with chronic renal failure treated with PD over 6 months were recruited. Lateral plain X-ray films of abdomen were used to evaluate the abdominal aortic calcification (AAC) score according to the Kauppila scoring system. Patients were divided into the low AAC score group (AAC score＜4) and the high AAC score group (AAC score≥4). Demographic data and laboratory measurements were collected. Bioelectrical impedance analysis was applied to examine the body composition of these PD patients. Serum CHI3L1 was measured by enzyme-linked immunosorbent assay. Results Fifty- six males and 60 females were recruited. The mean age was 57.0±13.7 years and 61 patients (52.6%) had an AAC score≥4. Serum CHI3L1 of the female patients was significantly higher than that of the male patients (Z=− 3.435，P=0.001). Among male patients, there was a trend that serum CHI3L1 of the high AAC score group was higher than that of the low AAC score group, but the result was not significant (285.9±100.3ng/ml versus. 238.4±106.8ng/ml，t=−1.701,P=0.095). Among female patients, serum CHI3L1 of the high AAC score group was significantly higher than that of the low AAC score group [437.7(314.2,459.2) ng/ml versus. 273.4 (177.6,368.6)ng/ml，Z=−3.600，P＜0.001]. Serum CHI3L1 was positively correlated with the AAC score in the female patients (r=0.590, P＜0.001), but not in the male patients (r=0.194, P=0.155). Multivariate logistic regression analysis showed that serum CHI3L1 (OR=1.012, 95% CI 1.005～1.019, P=0.001) and serum phosphate (＞1.45mmol/L or not) (OR=5.596, 95%CI 1 .345～23.278, P=0.018) were independent related factors of high AAC score (AAC score ≥4) in the female patients. However, age (OR=1.138, 95% CI 1.026～1.262, P= 0.014), diastolic blood pressure (OR=0.927, 95%CI 0.861～0.997, P=0.042), serum high-sensitivity C-reactive protein (OR=1.169, 95%CI 1.003～1.361, P=0.046), and skeletal muscle mass (OR=0.829, 95% CI 0.696～0.987, P=0.035) were the independent related factors of high AAC score (AAC score ≥4) in the male patients. Conclusions There are gender differences in the correlation between serum CHI3L1 and AAC among PD patients. Higher serumCHI3L1 is an independent marker of AAC score in female but not male PD patients. Metrics

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Serum BNP, CysC, KIM-1 Levels in Patients with Type I CRS and Correlation with AKI and Diagnostic Value 2022, 21 (04):  231-234.  doi: 10.3969/j.issn.1671-4091.2022.04.002 Abstract ( 110 )   PDF (459KB) ( 167 )   【Abstract】Objective To investigate the levels of serum brain natriuretic peptide (BNP), serum cystatin C (CysC) and kidney injury molecule (KIM-1) in patients with type I cardiorenal syndrome (CRS), and explore the relationship between these factors and acute kidney injury (AKI). Methods 211 patients with acute heart failure admitted to our hospital between March 2017 and March 2020 were recruited. Among them, 89 patients with AKI were in the observation group, and 122 patients without AKI were in the control group. According to the severity of kidney injury, the observation group was divided into three subgroups: mild group (n=28), moderate group (n=46), and severe group (n=15). The levels of serum BNP, CysC and KIM-1 were tested in all patients. Pearson correlation analysis was used to analyze the correlation between serum BNP, CysC, KIM-1 levels and AKI. The receiver operating characteristic curve (ROC) was used to evaluate the predictive value of serum BNP, CysC, and KIM- 1 for type I CRS AKI. Results The serum BNP [(1124.36±765.61 ng/L)], CysC [(1.81±0.59 mg/L)] and KIM-1[(157.89±16.59 ng/L)] levels in the observation group were higher than that in the control group [(816.56±631.25)ng/L, (0.92± 0.08)mg/L, [(136.52±13.43)ng/L] (t=3.195, 16.470, 10.328, P=0.001,＜0.001, ＜0.001)]. In the observation group, the serum BNP(1453.65 ± 668.92)ng/L, (1135.13 ± 459.31)ng/L], CysC [(2.37 ± 0.63)mg/L, (1.86 ± 0.51)mg/L] and KIM- 1[(179.86) ±17.12)ng/L,(158.21±15.56)ng/L] in the severe and moderate subgroups were higher than the mild subgroup [(930.26 ± 356.45)ng/L, (1.43 ± 0.46)mg/L, (145.58 ± 14.27)ng/L], and the serum BNP [(1453.65 ±668.92)ng/L], CysC [(2.37±0.63)mg/L] and KIM-1 [(179.86±17.12)ng/L] levels in the severe subgroup were higher than that in the moderate subgroup [(1135.13±459.31)ng/L, (1.86±0.51)mg/L, (158.21±15.56)ng/L (F= 1.956, 12.546, 12.165, P=0.034, 0.009, 0.011)]. Pearson analysis showed that serum BNP, CysC and KIM-1 levels were positively correlated with serum creatinine (Scr) (r=0.713, r=0.727, r=0.715, P＜0.001). ROC curve analysis showed that the AUC of serum BNP for predictive of type I CRS AKI was 0.716 (95% CI: 0.603 to 0.830, P=0.001); the AUC of serum CysC for predictive of type I CRS AKI was 0.792 (95% CI: 0.698 to 0.897, P＜0.001); the AUC of serum KIM-1 for predictive of type I CRS AKI was 0.749 (95% CI: 0.641～0.857, P＜0.001) ; the AUC of the combined index predictive of type I CRS AKI was 0.880 (95% CI: 0.804～0.955, P＜0.001). Conclusion The serum levels of BNP, CysC and KIM-1 were all increased in patients with type I CRS. Serum BNP, CysC, KIM-1 levels are closely related to the severity of AKI, and can be used as indicators to reflect the severity of type I CRS. The combination of serum BNP, CysC and KIM-1 has important value in the prediction of type I CRS AKI. Metrics

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Activation of NLRP3/IL-1β signaling pathway is associated with reduction of HDL-C in patients with maintenance hemodialysis 2022, 21 (04):  235-239.  doi: 10.3969/j.issn.1671-4091.2022.04.003 Abstract ( 137 )   PDF (526KB) ( 78 )   【Abstract】Objective To investigate the relationship between of Nod-like receptor protein 3/interleukin-1β (NLRP3/IL-1β) signaling pathway activation and blood high-density lipoprotein cholesterol (HDL-C) level and atherosclerosis (AS) in patients with maintenance hemodialysis (MHD). Methods A total of 83 patients who underwent MHD were collected as the study group, and 20 healthy individuals as the control group. Their biochemical indexes, HDL-C, serum IL-1β, interleukin-18 (IL-18) and NLRP3 mRNA were assayed, and the carotid intima-media thickness (IMT) was measured. The differences of these results were compared between the two groups. The correlations between HDL-C and NLRP3 mRNA, carotid artery IMT and NLRP3 mRNA, and IL-1β and IL-18 were analyzed respectively. The risk factors affecting HDL-C level and carotid IMT in MHD patients were explored. Results HDL-C level was lower in MHD patients than in the control group (t=-7.048，P<0.001), while carotid IMT value was higher in MHD patients than in the control group (t=2.634，P<0.001). HDL- C was negatively correlated with NLRP3 mRNA (r=- 0.682, P<0.001), IL- 1β (r=-0.537, P<0.01) and IL-18 (r=-0.426, P<0.01). Carotid artery IMT was positively correlated with NLRP3 mRNA (r=0.521, P<0.001), IL-1β (r=0.569, P<0.001) and IL-18 (r=0.674, P<0.001). Hence, the activation of NLRP3 mRNA was the risk factor for low HDL-C level (B=-0.390, P<0.001), while the activation of NLRP3 mRNA (B=0.069, P<0.001) and IL-18 signals (B=0.002, P< 0.001) and the decrease of HDL-C (B=-0.106, P<0.001) were the risk factors for the increase of carotid IMT in MHD patients. Conclusion NLRP3/IL-1β signal pathway is involved in the decrease of blood HDL-C level and the thickening of carotid artery IMT in MHD patients. Metrics

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Efficacy and cost- effectiveness analyses of hyperparathyroidism treated with parathyroidectomy or drugs in secondary hyperparathyroidism patients  2022, 21 (04):  240-243.  doi: 10.3969/j.issn.1671-4091.2022.04.004 Abstract ( 461 )   PDF (438KB) ( 73 )   【Abstract】Objective To observe the efficacy and cost- effectiveness of secondary hyperparathyroidism treated with parathyroidectomy (PTx) or drugs for one year. Methods Patients with secondary hyperparathyroidism who underwent PTx and those with similar baseline who underwent drug therapy in Yuxi People's Hospital from January 2017 to December 2020 were retrospectively reviewed. Blood biochemical values, improvement of clinical symptoms, total medical expenses, cost-effectiveness analysis, scores of the quality of life, and treatment satisfaction were collected in PTx patients and drug treatment patients after the treatments for one year. Results A total of 24 secondary hyperparathyroidism patients were eligible for the analyses. ①Serum iPTH and alkaline phosphatase levels decreased more in the PTX group than in the drug therapy group after the treatment for 3, 6 and 12 months (for iPTH: t=4.046, 2.218 and 2.934 respectively, P=0.001, 0.038 and 0.008 respectively; for alkaline phosphatase: t=- 0.437, 0.962 and 2.536 respectively, P=0.666, 0.348 and 0.026 respectively); the effective iPTH decrease rate was higher in the PTx group than in the drug therapy group (P=0.037). ② The compliant rates of serum calcium and phosphorus had no significant differences between the two groups after the treatments for 3, 6 and 12 months (for serum calcium: P=0.684, 0.214 and 0.155 respectively; for serum phosphorus: P=0.667, 0.680 and 0.680 respectively). ③The improvement rate of bone pain was higher in the PTX group than in the drug therapy group (P=0.030). ④The total medical expenses in the follow-up period of one year were similar in the two groups (3.523±1.138 vs. 4.303±1.088 × 103 yuan, t=-1.723, P=0.099). The cost-effectiveness ratio was 6.04 in the drug therapy group, and was 4.30 in the PTx group, indicating the superiority of PTx to drug therapy. The incremental cost- effectiveness ratio showed that every secondary hyperparathyroidism patient effectively treated by PTX required an additional cost of 18,700 yuan as compared with the expenses of drug treated patients. ⑤The scores of treatment satisfaction, general health status, energy, and body pain were better in the PTX group than in the drug therapy group (t=-4.834, -2.275, -2.169 and -3.555 respectively; P<0.001, 0.033, 0.041 and 0.004 respectively). Conclusion PTx can effectively reduce the levels of iPTH and alkaline phosphatase and relieve bone pain, and is superior to drug therapy in terms of treatment satisfaction and quality of life. There was no significant difference in treatment cost between the two groups within one year, but surgical treatment was more cost-effective. For patients with higher iPTH, PTx may be superior to drug therapy. Metrics

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The effect of probiotics on intestinal microbiota and quality of life in MHD patients with chronic constipation 2022, 21 (04):  244-248.  doi: 10.3969/j.issn.1671-4091.2022.04.005 Abstract ( 594 )   PDF (478KB) ( 344 )   【abstract】Objective To explore the effects of probiotics to treat chronic constipation on intestinal microbiota and quality of life in maintenance hemodialysis (MHD) patients. Methods Ninety patients were randomly divided into probiotic group (n=45) and control group (n=45). The patient assessment of constipation quality of life questionnaire (PAC- QOL), intestinal microbiota, serum inflammatory factors and renal function indicators were detected and analyzed before the treatment and after the treatment for one month. Results ①After the treatment, Scr, BUN, and UA decreased in both groups (control group: t=7.933, 13.190 and 4.176 respectively, P<0.001; probiotic group: t=7.721, 12.722 and 5.948 respectively, P<0.001); BUN was lower in probiotic group than in control group (t=3.217, P=0.002), but Scr and UA had no statistical significances between the two groups (t=0.003 and 0.258, P=0.997 and 0.776). ②After the treatment, the numbers of intestinal bifidobacteria and lactobacilli increased and E. coli and enterococci decreased in both groups, with the changes more prominent in probiotic group than in control group (t=-9.367, -22.573, 35.796, and 6.124 respectively, P<0.001). In control group after the treatment, the number of bifidobacteria had no significant change (t=1.984, P=0.054), but intestinal lactobacilli increased and E. coli and enterococci decreased (t=-4.239, 6.633 and 7.466 respectively, P<0.001); In probiotic group after the treatment, the increase of intestinal bifidobacteria and lactobacilli and decrease of E. coli and enterococci were statistically significant (t=- 10.759, - 30.592, 37.157 and 9.010 respectively, P<0.001). ③ Serum IL- 6 and CRP decreased after the treatment in both groups (t=122.371 and 3.489, P<0.001), with the decrease more in probiotic group. ④After the treatment PAC-QOL improved in the domains of body discomfort, psychological and social inadaptation, worrying and anxiety, satisfaction score, and total score in both groups (t=24.216, 13.26, 34.175, 49.925 and 34.553 respectively, P<0.001), with the improvements more in probiotic group. Conclusion Probiotics can be beneficial in improving the intestinal microbiota imbalance and the micro-inflammatory state but had no obvious effect on renal function in MHD patients with chronic constipation. Probiotics can also reduce the PAC-QOL score and improve the chronic constipation symptoms in these patients. Metrics

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Construction of a predictive model for risk of frailty in patients with maintenance hemodialysis 2022, 21 (04):  249-252.  doi: 10.3969/j.issn.1671-4091.2022.04.006 Abstract ( 194 )   PDF (512KB) ( 352 )   【Abstract】Objective To analyze the risk factors for frailty in maintenance hemodialysis (MHD) patients, and to construct a prediction model for the risk of frailty so as to provide a reference for the prevention and alleviation of frailty in dialysis patients. Methods Convenient sampling was used to select a total of 145 MHD patients treated in the Blood Purification Clinic of our hospital. Logistic regression was used to construct a risk prediction model. The Hosmer-Lemeshow chi-square test was used to evaluate performance of the model. For the degree of fit, the area under the ROC curve was used to verify the predictive effect of the model. Results This study finally included 6 factors, namely gender (OR=7.385, 95% CI: 4.965～56.529, P=0.045), living style (OR=4.823, 95% CI: 1.138～20.446, P=0.033), nutritional score (OR=0.453, 95% CI: 0.255～0.807, P=0.007), hemoglobin (OR=0.146, 95% CI: 0.015～1.392, P=0.030), Charlson comorbidity index (OR=5.918, 95% CI: 0.465～75.240, P=0.012), and self-care ability score (OR=0.589, 95% CI: 0.551～1.142, P=0.032), to construct a risk prediction model. The results of Hosmer- Lemeshow chi- square test showed a better degree of fit (χ2=6.889, P=0.549) of the prediction model; the AUC under the ROC curve of the prediction model was 0.940 (P<0.001, 95% CI: 0.886～0.973), with the sensitivity of 86.4% and the specificity of 86.0%. Conclusion This prediction model has a better degree of fit and a better prediction effect. It is useful for medical staff to predict frailty in MHD patients earlier and to provide references in planning specific intervention measures. Metrics

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Correlation between serum dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP) and vitamin K2 levels and vascular calcification in patients with chronic kidney disease 2022, 21 (04):  253-257.  doi: 10.3969/j.issn.1671-4091.2022.04.007 Abstract ( 451 )   PDF (547KB) ( 113 )   【Abstract】Objective To investigate the correlation between the levels of serum dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP) and vitamin K2 and the vascular calcification (VC) in patients with chronic kidney disease (CKD). Methods A total of 98 CKD patients and 70 healthy people were recruited as the research subjects. Serum dp-ucMGP and vitamin K2 were measured by ELISA, and VC was detected by color Doppler ultrasound and lateral abdominal X-ray examinations. The correlation between dp-uc- MGP and vitamin K2 levels and the VC was then analyzed. Results Serum dp-ucMGP increased (Z=-7.767, P＜0.001) and vitamin K2 decreased (t=16.006, P＜0.001) in CKD group as compared with those in control group. In CKD patients with VC, parathyroid hormone (PTH), alkaline phosphatase (ALP), dp-ucMGP and patients’age were higher (VC in carotid artery: Z=- 2.231, - 2.831, - 5.739 and - 4.130 respectively; P=0.026, 0.005,＜0.001 and ＜0.001 respectively. VC in abdominal aorta: Z=-2.299, -3.415, -4.637 and -3.317 respectively; P=0.022, 0.001, <0.001 and 0.001 respectively), while serum vitamin K2 was lower, as compared with those in CKD patients without VC (VC in carotid artery: Z=- 3.936, P＜0.001; VC in abdominal aorta: t= 5.423, P＜0.001). Logistic regression analysis showed that age, dp-ucMGP and vitamin K2 were the independent risk factors for VC in CKD patients (VC in carotid artery: OR=1.080, 4.777 and 0.160 respectively;95% CI=1.022～1.142, 2.125～10.740 and 0.035～0.733 respectively; P=0.006, <0.001 and 0.018 respectively. VC in abdominal aorta: OR=1.066, 2.259 and 0.104 respectively; 95% CI=1.012～1.123, 1.182～4.317 and 0.023～0.466 respectively; P=0.016, 0.014 and 0.003 respectively). Correlation analysis showed that serum dp-ucMGP was positively correlated with PTH, ALP and age (rs=0.684, 0.620 and 0.278 respectively, P＜0.001, ＜0.001 and =0.006 respectively), and negatively correlated with serum vitamin K2 (rs=- 0.271, P=0.007). Serum dp-ucMGP was higher in the CKD patients with severe VC than in those with moderate and mild VC, while serum vitamin K2 was lower in the CKD patients with severe VC than in those with mild VC (F=12.378 and 4.478, P<0.001 and =0.017). Conclusion Older age, higher dp-ucMGP and lower vitamin K2 were the independent risk factors for VC in CKD patients. Metrics

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Correlation between different assessment methods for hemodialysis initiation and survival prognosis of hemodialysis patients in a single center 2022, 21 (04):  258-263.  doi: 10.3969/j.issn.1671-4091.2022.04.008 Abstract ( 186 )   PDF (576KB) ( 99 )   【Abstract】Objective To analyze the correlation between the hemodialysis initiation timing assessment using estimated glomerular filtration rate (eGFR) or dialysis initiation based on fuzzy mathematics equation (DIFE) and survival prognosis in patients undergoing maintenance hemodialysis (MHD). Methods A total of 252 MHD patients were divided into early dialysis group, suitable dialysis group and late dialysis group based on eGFR or DIFE assessment method. Their clinical indicators at the beginning of dialysis were compared among the groups, and the relationship between the clinical indicators and survival prognosis was analyzed. Results There were no significant differences in overall survival time among early dialysis group, suitable dialysis group and late dialysis group divided using either eGFR value or DIFE value (χ2=4.059 and 1.162 respectively, P=0.131 and 0.559 respectively). Age (HR=1.041, 95% CI 1.022～1.060, P<0.001), primary etiology of primary glomerulopathy (HR=0.378, 95% CI 0.219～0.653, P<0.001) or diabetic nephropathy (HR=2.092, 95% CI 1.250～3.498, P=0.005), and more than 3 comorbidities (HR=2.591, 95% CI 1.457～4.606, P=0.001) were the factors influencing survival prognosis of the patients. COX multivariate analysis showed that age was an independent risk factor for survival prognosis of the patients divided using either eGFR or DIFE (HR=1.035 and 1.043, respectively; 95% CI 1.013～1.057 and 1.020～1.067, respectively; P=0.001 and <0.001, respectively), and primary etiology of glomerular disease was a protective factor (HR=0.465 and 0.502, respectively; 95% CI 0.246～0.877 and 0.267～0.943, respectively; P=0.018 and 0.032, respectively). Conclusion Hemodialysis initiation time assessment using either eGFR or DIFE has no significant effect on the overall survival prognosis of the patients. It is reasonable to include several indexes into the assessment system of hemodialysis initiation timing after quantifying and assigning their different weights. Metrics

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The value of hemodynamic parameters measured by ultrasound to assess the function of hemodialysis arteriovenous fistula and to predict thrombosis by ROC analysis  2022, 21 (04):  264-268.  doi: 10.3969/j.issn.1671-4091.2022.04.009 Abstract ( 222 )   PDF (640KB) ( 70 )   【Abstract】Objective To explore the value of hemodynamic parameters measured by ultrasound to assess hemodialysis arteriovenous fistula (AVF) function and to predict thrombosis in AVF. Methods A total of 124 hemodialysis patients with autologous AVF from the First People’s Hospital of Zhaoqing City, Guangdong Province were recruited. Ultrasound was used to measure radial artery diameter (RAD), radial volume of blood flow (RVF), cephalic vein diameter (CVD), cephalic venous blood flow (CVF) to assess the maturity of the AVF. The presence of AVF stenosis and thrombosis within 6 weeks after surgery were collected, and then divided the patients into patency group, stenosis group and thrombosis group. The hemodynamic parameters of vascular diameter (D), maximum peak velocity (PSV) and blood flow resistance index (RI) were compared among the three groups to evaluate the predictive value of these parameters for thrombosis. Result The RAD, RVF, and CVD after the operation for 2, 4 and 6 weeks were higher than those before the operation. The RAD, RVF, CVD, and CVF showed a gradual increase over time (F= 170.024, 475.914, 438.537 and 70.986 respectively, P＜0.001). In the 124 patients after surgery for 6 weeks, the patency rate was 71.77%,the incidence of AVF stenosis was 11.29%, and the incidence of thrombosis was 16.94%. There were statistically differences in D, PSV, and RI of the cephalic vein and radial artery among the three groups. (F=30.075, 60.959, 22.278, 24.005, 15.490 and 37.178 respectively, P＜0.001). Logistic multivariate analysis showed that D (OR=0.589 and 0.622, 95% CI: 0.204～0.589 and 0.235～0.622, P<0.001), PSV (OR=0.390 and 0.283, 95% CI: 0.229～0.663 and 0.229～0.663, P<0.001) and RI (OR= 6.371 and 6.739, 95% CI: 1.896～21.407 and 2.418～18.779, P<0.001) of the cephalic vein and radial artery were related to thrombosis in AVF. ROC curve analysis showed that the AUC of combined cephalic vein D, PSV and RI to predict thrombosis was 0.877 (95% CI 0.806～0.929), with the sensitivity of 80.95% and the specificity of 84.47%, higher than the prediction ability using the parameters individually (Z= 5.336, 3.259 and 5.810 respectively, P<0.001, 0.012 and <0.001); the AUC of combined radial artery D, PSV and RI to predict thrombosis was 0.864 (95% CI: 0.791～0.919), with the sensitivity of 76.19% and the specificity of 87.38%, also higher than the prediction ability using the parameters individually (Z=8.006, 5.147 and 7.863 respectively, P< 0.001). Conclusion Ultrasound measurement of RAD, RVF, CVD and CVF can accurately assess the AVF function. The D, PSV and RI of cephalic vein and radial artery can be used as important indicators for predicting thrombosis. The combined use of D, PSV and RI parameters was relatively reliable to predict thrombosis in AVF, providing a basis for the establishment of clinical prevention and treatment measures. Metrics

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The selection of puncture site after secondary percutaneous transluminal angioplasty on the function of autologous arteriovenous fistula 2022, 21 (04):  269-272.  doi: 10.3969/j.issn.1671-4091.2022.04.010 Abstract ( 282 )   PDF (573KB) ( 62 )   【Abstract】Objective To investigate the selection of puncture site after secondary percutaneous transluminal angioplasty (PTA) on the function of autologous arteriovenous fistula (AVF). Methods A total of 60 patients who underwent secondary PTA for AVF class II stenosis in our hospital were prospectively reviewed. They were randomly divided into experimental group, in which the puncture site was far from the dilated arterial end of the AVF outflow tract after PTA, and control group, in which the puncture site located at the dilated arterial end of the AVF outflow tract after PTA for 2 weeks. They were followed up for 12 months, and their clinical data were collected. AVF pump-controlled blood flow, brachial artery blood flow, diameter of dilated vessel and blood flow in dilated vessel after PTA for 1, 3, 6 and 9 months as well as the survival time of the AVF after PTA were compared between the two groups. Results In experimental group and control group after PTA for 1, 3, 6 and 9 months, AVF pump-controlled blood flow was 230.22±12.29 vs. 227.26±11.28 (t=0.971, P=0.335) after one month, 230.36 ± 21.69 vs. 220.32 ± 20.37 (t=1.800, P= 0.077) after 3 months, 231.32 ± 19.31 vs. 210.42 ± 13.32 (t=4.026, P<0.001) after 6 months, and 231.32 ± 18.21 vs. 206.18 ± 16.22 (t=4.317, P< 0.001) after 9 months; brachial artery blood flow was 1260.62 ± 210.23 vs. 1235.56 ± 218.26 (t=0.452, P= 0.652) after one month, 1132.25±213.28 vs. 1028.34±217.25 (t=1.822, P=0.074) after 3 months, 1088.45±221.18 vs. 936.37± 219.36 (t=2.361, P=0.022) after 6 months, and 967.39± 219.22 vs. 729.61±217.18 (t=3.247, P=0.002) after 9 months; diameter of dilated vessel was 5.55±1.28 vs. 5.33±1.23 (t=0.678, P=0.499) after one month, 5.12 ± 1.36 vs. 4.67 ± 1.02 (t=1.409, P= 0.164) after 3 months, 5.06 ± 1.37 vs. 3.90 ± 1.56 (t=2.714, P=0.009) after 6 months, and 4.86±1.29 vs. 3.83±1.46 (t=2.245, P=0.031) after 9 months; blood flow in dilated vessel was 680.26 ± 38.66 vs. 678.14 ± 36.56 (t=0.218, P= 0.828) after one month, 672.11 ±137.63 vs. 623.23±135.51 (t=1.351, P=0.182) after 3 months, 638.21±135.24 vs. 510.37±131.62 (t=3.274, P= 0.002) after 6 months, and 621.27±136.23 vs. 502.87±132.12 (t=2.625, P=0.012) after 9 months. The AVF pump-controlled flow, brachial blood flow, diameter of dilated vessel, and blood flow in dilated vessel in the two groups had no differences after PTA for one and 3 months, but were significantly different after PTA for 6 and 9 months; The median patency period was similar between the two groups during the follow-up period (9.40 vs. 9.00, χ2=2.316, P=0.128), but had a trend of longer period in experimental group than in control group. Conclusion In patients undergoing secondary PTA for AVF, the puncture site should always be far from the dilated vessel segment to facilitate the repair of endothelial cells and the preservation of function, patency and survival period of the AVF. Metrics

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Research progresses in the phase angle in maintenance hemodialysis 2022, 21 (04):  273-275.  doi: 10.3969/j.issn.1671-4091.2022.04.011 Abstract ( 276 )   PDF (360KB) ( 94 )   【Abstract】Phase angle (PA) is a quantitative marker derived from bioelectrical impedance analysis. PA has the advantages of being objective, convenient and quantifiable, and is now widely used in clinical practice for the management of malnutrition, muscle loss and volume overloading in maintenance hemodialysis patients. This article reviews the current research progresses in PA in maintenance hemodialysis with the aim of guiding clinical management of maintenance hemodialysis patients. Metrics

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Research progresses in fibroblast growth factor 23 in chronic kidney disease related anemia 2022, 21 (04):  276-279.  doi: 10.3969/j.issn.1671-4091.2022.04.012 Abstract ( 226 )   PDF (446KB) ( 76 )   【Abstract】The incidence of chronic kidney disease (CKD) is high. CKD is insidious at the early stage and may evolve gradually to end-stage renal disease (ESRD), at which patients have to rely on dialysis or kidney transplantation with a heavy financial burden. CKD has become a social and public problem that seriously threatens public health. CKD patients at late stage are often accompanied by various degrees of calcium and phosphorus metabolic disorders, anemia, secondary hyperparathyroidism, cardiovascular disease and others. Many studies have found that fibroblast growth factor 23 (FGF23) is involved in the regulation of calcium and phosphorus metabolism as well as in erythropoiesis in CKD patients. Further studies on FGF23 may bring a breakthrough in the clinical treatment of anemia in CKD patients. Metrics

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Application of vascular superficialization in arteriovenous fistula Yang Jie 2022, 21 (04):  280-283.  doi: 10.3969/j.issn.1671-4091.2022.04.013 Abstract ( 351 )   PDF (405KB) ( 262 )   【Abstract】Vascular superficialization is a surgical operation that places target vessel to the subcutaneous layer. It includes vein superficialization and artery superficialization, which enable hemodialysis access using routine puncture. The methods of vascular superficialization operation include tunnel transposition, direct elevation, minimal incision superficialization technology (MIST), placement of vein window needle guide (Vwing), fat resection and liposuction and others. In this paper, the key points of these surgical methods are described in detail, and the clinical reports about patency rate and complications are reviewed. Metrics

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Application of drug- coated balloons for hemodialysis access 2022, 21 (04):  284-287.  doi: 10.3969/j.issn.1671-4091.2022.04.014 Abstract ( 265 )   PDF (434KB) ( 224 )   【Abstract】Hemodialysis access is a lifeline for end stage renal disease patients. The complications in the access route endanger the patient’s life. Percutaneous transluminal balloon angioplasty is an important manipulation useful for the treatment of arteriove-nous fistula stenosis and thrombosis, which is widely used clinically due to its minimal trauma, repairment of the original route and recovery of is function immediately after the manipulation. However, because of the higher expense of this manipulation, its cost-effectiveness and complications are often concerned by the doctors and patients. This article reviews the recent progresses in the application of drug-coated balloons for hemodialysis access. Metrics

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Comparative study on disinfection effect of the two different disinfection methods for CDDS system 2022, 21 (04):  288-291.  doi: 10.3969/j.issn.1671-4091.2022.04.015 Abstract ( 215 )   PDF (524KB) ( 101 )   【Abstract】Objective To compare the effectiveness and safety of the two different disinfection methods, high concentrations of sodium hypochlorite and peracetic acid with no solution immersion every night, and low concentrations of sodium hypochlorite and peracetic acid with solution immersion every night, and to analyze the advantages of low concentration disinfectant immersion method at night in the disinfection of central dialysis fluid delivery system (CDDS). Methods During the period from November 2017 to November 2019 in the First Medical Center of the General Hospital of the Chinese People's Liberation Army, the CDDS used two disinfection methods, each for 12 months. The levels of bacteria and endotoxin at different sampling points in CDDS and the changes of disinfectant concentration during night immersion were compared between the two disinfection methods to evaluate the effectiveness. The washing time required to the safe residual concentration of the two low disinfectants was measured to evaluate the safety of the disinfection method. Results Compared with the high concentration washing disinfection, the low concentration immersion disinfection at night resulted in the decreases of bacterial colonies (Z=-2.041, P=0.041) and endotoxin (t=4.761, P=0.032) at the outlet of dialysate supply device, and the decreases of bacterial colonies (Z=-2.178, P= 0.029) and endotoxin (t=5.405, P=0.027) at the end of system pipeline. There were no significant differences in the levels of bacteria colonies (Z=-1.069, P=0.285) and endotoxin (t=2.621, P=0.086) at the outlet of dialysis machine between the two disinfection methods. After the disinfectant dwelled in pipeline ever night, the effective concentration of sodium hypochlorite decreased by 15.78% to the concentration of 43mg/L, and peracetic acid decreased by 5.88% to the concentration of 160mg/L. The residual concentrations of the two disinfectants reached safe levels after washing for 14 min and 16 min respectively. Conclusion Night low concentration disinfectant immersion method is safe and effective for CDDS disinfection and can be used clinically. Metrics

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Risk factors of debilitation in maintenance hemodialysis patients and the effect of exercise combined with nutritional support group intervention 2022, 21 (04):  292-295.  doi: 10.3969/j.issn.1671-4091.2022.04.016 Abstract ( 204 )   PDF (504KB) ( 192 )   【Abstract】Objective To explore the risk factors of debilitation in maintenance hemodialysis (maintenance hemodialysis，MHD) patients and observe the efficacy of exercise combined with nutritional support group intervention. Methods 195 MHD patients who were treated in the hemodialysis center of "the 3rd degree and grade A" hospitals in Nanjing were recruited in this study, and 75 of them were screened according to the weakness diagnostic criteria of Tilburg weakness scale. Then analyze the influencing factors of debilitation in these MHD patients. According to the different intervention methods, these debilitating patients were divided into the following groups: group A included 20 cases of routine nursing intervention; group B included 20 cases of simple exercise intervention, group C included 18 cases of simple nutrition support and group D included 17 cases of exercise combined nutrition intervention. In this study, the effects of debilitating state of patients before and after intervention were compared. Results The multivariate regression analysis shown that, age (or value (95% CI) = 1.041 (1.012～1.183), P=0.008), serum albumin [(OR value (95% CI)=0.841 (0.812～1.192), P =0.001], 25-hydroxyvitamin D [OR value (95%CI) = 0.782 (0.223～0.892), P = 0.018[, nutritional risk assessment score [or value (95% CI) = 1.157 (1.092-～1.523), P ＜ 0.001)], walking speed [OR value (95% CI) = 0.632 (0.191～0.972), P = 0.032] and grip strength [OR value (95% CI) = 0.767 (0.309～0.589), P = 0.026)] were risk factors of debilitation in MHD patients. After different interventions, the mean debilitation scores were decreased in all the groups, and the effect was better in group B, C and D than that in group A (t = 3.956, P ＜ 0.001, t= 3.258, P = 0.002, t= 0.254, P=0.036), and the effect was better in group D than that in group B and C (t = 2.463, P = 0.024, t= 2.421, P = 0.025). Conclusion The occurrence of debilitation in MHD patients was related to age, serum albumin, 25-hydroxyvitamin D, nutritional risk assessment score, walking speed and grip strength. Moreover, nutritional support combined with exercise can effectively improve the debilitation state of MHD patients. Metrics

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Investigation and analysis of symptom distress and quality of life in middle-aged and elderly maintenance hemodialysis patients 2022, 21 (04):  296-299.  doi: 10.3969/j.issn.1671-4091.2022.04.017 Abstract ( 183 )   PDF (463KB) ( 110 )   【Abstract】Objective To explore the status and the correlation of symptom distress and quality of life in middle-aged and elderly maintenance hemodialysis (MHD) patients, and to analyze the influencing factors for symptom distress. Methods A total of 160 MHD patients were recruited by convenience sampling method. The investigation included general information questionnaire, dialysis symptom index and the 12-item short from health survey. Results The overall quality of life score was 37.4±6.8 points, among which physiological health score was 40.3±6.3 points and mental health score was 34.6±6.0 points, all lower than the domestic norm. (t=-34.686, 22.06 and -30.43 respectively, P＜0.001). Symptom distress was negatively correlated with quality of life (r=-0.511, P<0.001). Multiple regression showed that age, residence place, income and number of diseases were the influencing factors for symptom distress (β=1.819, -2.606, -2.128 and 2.055 respectively; P=0.009, 0.021, 0.003 and 0.006 respectively). Conclusion The middle-aged and elderly MHD patients generally experience a variety of uncomfortable symptoms, and their quality of life is relatively low. Different demographic characteristics and disease conditions lead to different levels of symptom distress. Medical staff should design individualized nursing measures according to the specific conditions of the patients to reduce the symptom burden and improve the quality of life of the patients. Metrics

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Construction and application of continuous renal replacement therapy nursing information system 2022, 21 (04):  300-304.  doi: 10.3969/j.issn.1671-4091.2022.04.018 Abstract ( 169 )   PDF (614KB) ( 213 )   【Abstract】Objective The continuous renal replacement therapy (CRRT) nursing information system is designed to solve the problems of clinical nursing record preservation, resource sharing and human cost, and to provide safe and high quality care for patients. Methods The information items required in the CRRT nursing information system were selected by questionnaire survey, literature retrieval and conference discussion. These items were automatically obtained from the hospital information system, analyzed, classified and visualization. The application effect of this system was evaluated by questionnaire survey and quality management. Results The CRRT nursing information system contained 128 items organized into 9 categories, including 16 items of patients' basic information, 20 items of nursing evaluation before CRRT, 6 items of adjustment of medical orders, 17 items of medication orders, 23 items of nursing monitoring during CRRT, 3 items of nursing measures, 20 items of bedside blood gas analyses, 6 items of summary of intake and output volume, 17 items of nursing evaluation after CRRT. Compared with the manual record, the time spent on the CRRT nursing information system shortened significantly (t=29.305, P＜0.001). Conclusion CRRT nursing information system can optimize the CRRT nursing processes, ensure the quality of nursing records, improve work efficiency, and promote scientific research output. Metrics