Chinese Journal of Blood Purification

12 May 2022, Volume 21 Issue 05 Previous Issue    Next Issue

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Research updates on hyperphosphatemia in Chronic kidney disease CHENYa-fei, ZUOL 2022, 21 (05):  305-308.  doi: 10.3969/j.issn.1671-4091.2022.05.001 Abstract ( 558 )   PDF (383KB) ( 524 )   Chronic kidney disease (CKD) is highly prevalent in general population. With the decline of kidney function, the abnormality of phosphorus metabolism is gradually aggravated. In China, hyperphosphatemia in CKD is characterized by high prevalence and low control rate. Hyperphosphatemia is an independent risk factor of CKD progression, secondary hyperparathyroidism, cardiovascular events, and all-cause mortality in CKD patients. Literatures on mechanisms of hyperphosphatemia and its adverse outcomes were reviewed. Metrics

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Progress of peritoneal dialysis catheterization HANQing-feng 2022, 21 (05):  309-311.  doi: 10.3969/j.issn.1671-4091.2022.05.002 Abstract ( 230 )   PDF (457KB) ( 336 )   Peritoneal dialysis catheter is the basic foundation of peritoneal dialysis treatment. Reasonable selection of peritoneal dialysis catheter and standardized peritoneal dialysis tube placement are the keys to ensure its normal function. Current studies have shown that there is no significant difference in complications and outcomes among various peritoneal dialysis catheters, but it should be noted that the coiled-tail peritoneal dialysis catheters may increase the risk of catheter migration. Peritoneal dialysis catheterization methods include open surgical catheterization, percutaneous puncture catheterization, endoscopic / laparoscopic catheterization. Each method has its own advantages and needs to be selected according to the condition of patients and the technology of doctors. Ultrasound and radiation intervention technology can play an auxiliary role in peritoneal dialysis catheterization to ensure the success rate and safety. Advanced laparoscopic peritoneal dialysis catheter insertion can be used in patients with complex complication in the abdominal cavity. Reliable peritoneal dialysis catheterization technology and reasonable peritoneal dialysis prescription are helpful to reduce the occurrence of dialysate leakage in emergency start-up peritoneal dialysis. Metrics

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The Clinical Application of Low-Position Two-Port Laparoscopic Technique for Peritoneal Dialysis Catheterization  ZHANG Xiao-hui, XIANG Shi-long, WANG Yao-min, LIU Guang-jun, JIANG Yan, XIE Xi-shao, HAN Fei, CHEN Jiang-hua 2022, 21 (05):  312-316.  doi: 10.3969/j.issn.1671-4091.2022.05.003 Abstract ( 293 )   PDF (519KB) ( 104 )   Objective  To compare the efficacy and safety of open and low-position two-port laparoscopic technique for peritoneal dialysis catheterization.  Methods  A total of 639 patients with end-stage renal disease were retrospectively analyzed, who received catheter and peritoneal dialysis therapy from June 2016 to December 2019 in the First Affiliated Hospital of Zhejiang University. For the placement of peritoneal dialysis catheters, 147 patients underwent low-position two-port laparoscopic surgery (group A) and 292 patients were by open surgical method (group B). The general condition before operation, perioperative condition, postoperative complications and outcomes were compared between the two groups.  Results   The operation time (t=-21.543, P＜0.001) and hospitalization time (t=-2.398,P=0.017) in group A were shorter than those in group B, while operative hemorrhage (t=-0.011，P=0.991), postoperative pain (t=-1.650，P=0.100), onset time of peritoneal dialysis (t=-0.211，P=0.833)and hospitalization expenses (t=-1.739，P=0.083) showed no difference. the incidence of catheter malposition (χ2=7.516, P=0.006) and bloody effluent (χ2=4.675, P=0.031)in group A were significantly lower than those in group B, while the other complications such as catheter occlusion (χ2=0.762, P=0.383), omentum wrapping (χ2=0.010, P=0.921), dialysate leakage (χ2=0.182, P=0.544), organ injury (χ2=0.299, P=0.770), hernia, hydrothorax (χ2=0.003, P=0.955), and peritonitis (within 2 weeks)   (χ2=0.182, P=0.670)showed no difference. There was no tunnel infection event within 2 weeks in both groups. patients in group A had a favorable catheter technique survival rate compared with  group B (Log-rank         χ2=4.696, P=0.030).  Conclusions   Our low-position two-port laparoscopic technique is a simple and safe procedure. This procedure can shorten the operation time, reduce the possibility of migration, trauma and complications, and improved the catheter technique survival rate without additional costs. This technique is worthy of clinical application.  Metrics

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Risk factors of pre-dialysis chronic hyponatremia in maintenance hemodialysis patients ZHANGZhoucang, CHANGJing-jing, CUIZheng, ZHENGLi-ren, WANGMei 2022, 21 (05):  317-321.  doi: 10.3969/j.issn.1671-4091.2022.05.004 Abstract ( 274 )   PDF (479KB) ( 230 )   Objective  To explore the risk factors of pre-dialysis chronic hyponatremia in maintenance hemodialysis (MHD) patients.  Methods  We retrospectively analyzed the 152 MHD patients treated in the Blood Purification Center of Peking University International Hospital from August 2017 to June 2020. Their blood sodium, glucose, albumin, alkaline phosphatase, and other laboratory results were measured before dialysis every 1-3 months, and the time-averaged values including time-averaged serum sodium (TASNa) were calculated. Bioimpedance analysis (BIA) was also measured every 1-3 months, and the indexes including overhydration (OH), extracellular water, intracellular water (ICW), and lean tissue index (LTI) were recorded. The patients were then divided into two groups based on the TASNa, hyponatremia (TASNa≤135mmol/L) and normonatremia (135＜ TASNa ＜145 mmol /L). The differences between the two groups were compared by independent sample t-test or chi square test, and the risk factors for pre-dialysis chronic hyponatremia were analyzed by binary logistic regression.  Results  The prevalence of hyponatremia based on TASNa was 23.7%, and the prevalence of hyponatremia adjusted by blood glucose was 9.9%. Compared with the normonatremia group, the hyponatremia group had a higher proportion of diabetes (c2=27.134, P＜0.001), and higher levels of clinic systolic blood pressure (t=2.175, P=0.031), blood glucose  (t=6.408, P＜0.001) and OH         (t=2.930,  P=0.004) in the hyponatremia group, while serum creatinine (t=-4.008, P＜0.001), blood urea nitrogen(t=-2.169, P=0.032), chloride (t=-7.898, P＜0.001), prealbumin (t=-3.692, P＜0.001), albumin (t=-2.170,   P=0.032), phosphorus (t=-2.476, P=0.014), uric acid (t=-2.168, P=0.032), effective plasma osmolality (t=        -3.737, P=0.001), ICW (t=-2.113, P=0.038) and LTI (t=-3.180, P=0.002) were lower in the hyponatremia group. Binary logistic regression showed that hyperglycemia (OR=1.409, 95% CI: 1.245～1.593, P＜0.001), elevated serum alkaline phosphatase (OR=1.010, 95% CI: 1.001～1.019, P=0.034) and decreased LTI (OR=0.809, 95% CI: 0.659-0.993, P=0.042) were the risk factors for pre-dialysis chronic hyponatremia in MHD patients.  Conclusion  pre-dialysis chronic hyponatremia is common in MHD patients. Hyperglycemia, elevated serum alkaline phosphatase and malnutrition are the risk factors for pre-dialysis chronic hyponatremia. Metrics

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Study on red blood cell lifespan and its influencing factors in patients with maintenance peritoneal dialysis ZHAO Yu-chao, ZHAO Hui-ping, WU Bei, LU Li-xia, BAI Li, ZUO Li, WANG Mei 2022, 21 (05):  322-325.  doi: 10.3969/j.issn.1671-4091.2022.05.005 Abstract ( 242 )   PDF (492KB) ( 170 )   Objective   To study red blood cell (RBC) lifespan in patients with maintenance peritoneal dialysis (PD) and to explore the related factors of RBC lifespan, so as to provide the evidences for a rational treatment.  Methods   The PD patients with stable status and regularly followed up for at least 3 months in the Department of Nephrology, Peking University People’s Hospital from June to August, 2021 were enrolled in this study. RBC lifespan was determined by CO breath test. Their general data, laboratory results, anemia index and anemia treatment were recorded. SPSS 22.0 software was used for statistical analysis. Multivariate linear regression was used to analyze the related factors for RBC lifespan.  Results  ①A total of 32 PD patients (17 males and 15 females, with a mean age of 57.42±11.03 years) were enrolled in this study. The average PD duration was 34.0 (20.25, 104.25) months. The major primary disease was chronic glomerulonephritis, accounting for 46.9% of the PD patients. ②The RBC lifespan of PD patients ranged from 44 days to132 days, with an average of 79.45±24.98 days. ③Multivariate linear regression analysis demonstrated that serum albumin (β=3.269, P=0.010), serum creatinine (β=0.045, P=0.037), and the presence of diabetes (β=-19.702, P=0.041) were the independent factors relating to RBC lifespan.  Conclusion  The shortened RBC lifespan in PD patients is independently related to low serum albumin, low serum creatinine level and diabetes mellitus. Treatment aimed at these factors are required. Metrics

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Effects of CVVH combined with HA330 hemoperfusion on serum HMGB1, hs-CRP and procalcitonin levels and 28-day mortality in post-traumatic sepsis patients with acute kidney injury  LIANG Wen-sheng, WU Wei, WANG Min 2022, 21 (05):  326-330.  doi: 10.3969/j.issn.1671-4091.2022.05.006 Abstract ( 168 )   PDF (514KB) ( 81 )   Objective  To investigate the effects of continuous veno-venous hemofiltration (CVVH) combined with HA330 hemoperfusion (HP) on serum high mobility group protein 1 (HMGB1), high-sensitivity C-reactive protein (hs-CRP), procalcitonin (PCT) and 28-day mortality in post-traumatic sepsis patients with acute kidney injury (AKI).   Methods  A total of 86 patients with post-traumatic sepsis and AKI treated during February 2020 to March 2021 in Guangzhou Red Cross Hospital Affiliated to Jinan University were retrospectively analyzed. They were divided into CVVH group (43 cases) and HP group (43 cases) according to whether the patient agreed to receive HA330 hemoperfusion treatment. CVVH group received CVVH treatment, and HP group was treated with the HA330 hemoperfusion device on the basis of CVVH. Blood creatinine (Scr), blood urea nitrogen (BUN), serum levels of HMGB1, hs-CRP and PCT, and scores of APACHE Ⅱ and sequential organ failure assessment (SOFA) were recruited from both groups before treatment and after the treatment for 3 and 5 days. 24-hour urine volume and 28-day mortality were recorded.  Results  After treatment for 3 days and 5 days, the urine volume increased more in HP group than in CVVH group (for 3 days:  t=-8.158, P＜0.001; for 5 days: t=-12.954, P＜0.001). Serum levels of Scr, BUN, PCT, hs-CRP and HMGB1, and scores of APACHE Ⅱ and SOFA were significantly lower in HP group than in CVVH group (for 3 days:  t=9.698, 3.313, 7.739, 7.266, 2.549, 7.340 and 3.556 respectively, P<0.001, =0.001, <0.001, <0.001, =0.006,  <0.001 and <0.001 respectively; for 5 days: t=7.189, 2.385, 14.583, 5.676, 2.797, 11.238 and 6.964 respectively, P<0.001, =0.010, <0.001, <0.001, =0.003, <0.001 and <0.001 respectively). The hospitalization days and mechanical ventilation days were lower in HP group than in CVVH group (for hospitalization days: 12.37±5.11 vs. 20.69±5.04 days, t=9.324, P＜0.001; for mechanical ventilation days: 9.36±2.47 vs. 14.09±2.85 days, t=8.224, P＜0.001). Patients with SOFA score <8 had a lower 28-day mortality rate (5.00% vs. 23.26%, χ2=8.444, P=0.004).  Conclusion  CVVH combined with HA for the treatment of post-traumatic sepsis patients with AKI can significantly reduce the inflammation responses, promote the recovery of renal function, and reduce the 28-day mortality with better therapeutic effects. Metrics

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Effect of peritoneal transport function on long-term prognosis of peritoneal dialysis patients IU Ying, ZHANG Qing-yan, JIANG Chun-ming, SUN Cheng, XU Peng-fei, ZHANG Miao 2022, 21 (05):  331-335.  doi: 10.3969/j.issn.1671-4091.2022.05.007 Abstract ( 230 )   PDF (487KB) ( 266 )   Objective  To evaluate the effects of baseline and changes of peritoneal transport characteristics on the prognosis of peritoneal dialysis (PD) patients.  Methods  Patients who started PD in the period from January 1, 2006 to December 30, 2019 and continued PD for more than 3 months in the Department of Nephrology of Nanjing Drum Tower Hospital were included in this study. They were divided into 4 groups according to the baseline dialysate/plasma creatinine (D/Pcr) ratio. Their clinical characteristics, trends of peritoneal transport changes, risk factors for death, and technique failure were analyzed.  Results   A total of 323 PD patients were enrolled in this study, including 70 patients in low transport (L) group, 135 in low average transport (LA) group, 101 in high average transport (HA) group, and 17 in high transport (H) group. Multinomial logistic regression model revealed that male (OR=1.529, 95% CI 1.003~2.330, P=0.049) and low albumin (OR=0.910, 95% CI 0.869~0.952, P＜0.001) were the risk factors for baseline high peritoneal transport status. The survival rate in H group was significantly lower than that in L group (c2=3.953, P=0.047), LA group (c2=4.355, P=0.037) and HA group (c2=9.359, P=0.002). There was no significant difference in technique survival rate among the four groups (c2=0.107, P=0.991). The D/Pcr ratio remained stable in the first 5 years and then presented a slight upward trend. The peritoneal transport status of the four groups had a tendency of centrality with time, i.e., peritoneal transport decreased in higher transport groups and increased in lower transport groups. Multivariate Cox regression analyses showed that age (OR=1.053, 95% CI 1.026~1.082, P＜0.001), Charlson’s comorbidity index (OR=1.630, 95% CI 1.307~2.032, P＜0.001) and baseline high transport (OR=3.280, 95% CI 1.109~9.699, P=0.032) were the independent risk factors for all-cause mortality, and male (OR=1.851, 95% CI 1.123~3.052, P=0.016), C-reactive protein (OR=1.008, 95% CI 1.001~1.015, P=0.025) and peritonitis (OR=2.312, 95% CI 1.430~3.739, P＜0.001) were the independent risk factors for technique failure.  Conclusions  The baseline high peritoneal transport status was an independent risk factors for mortality. Male and low albumin were the determinant factors for baseline high peritoneal transport. The D/Pcr ratio remained stable in the first 5 years and then presented a slight upward trend. The peritoneal transport status of the four groups had a tendency of centrality with time. Metrics

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Long-term efficacy of cinacalcet in maintenance hemodialysis patients with different iPTH levels         FAN Xiao-yan, YANG Liu, YU Yong-wu, ZHANG Ling 2022, 21 (05):  336-340.  doi: 10.3969/j.issn.1671-4091.2022.05.008 Abstract ( 297 )   PDF (486KB) ( 193 )   bjective  To evaluate the long-term efficacy of cinacalcet in hemodialysis patients with different levels of intact parathyroid hormone (iPTH) and secondary hyperparathyroidism (SHPT), so as to provide the information for clinical treatment of hemodialysis patients with SHPT.  Methods  A total of 47 SHPT patients treated during May 2010 to August 2019 online by Dr. Zhang Ling on “Well-known Doctor Online” as well as in the Hemodialysis Center, Department of Nephrology, Beijing Chuiyangliu Hospital were retrospectively analyzed. According to the baseline iPTH value, they were divided into two groups: <800pg/ml (group A) and ≥800pg/ml (group B). After cinacalcet therapy for 12 months, differences in serum calcium, phosphorus and iPTH were analyzed between the two groups. A decrease of iPTH ≥50% was defined as significant effective, and a decrease of iPTH≥30% was defined as effective.  Results  There were no differences in baseline indicators except iPTH level and the number of enlarged parathyroid glands by ultrasound examination between the two groups. Along with the cinacalcet treatment time, the compliance rate of serum calcium was higher in group A than in group B at the 6th month of the treatment (χ2=3.632, P=0.029) and had no difference between the two groups at the 12th month of the treatment (χ2=1.362, P=0.243); the compliance rate of serum phosphorus increased gradually, but had no statistical difference between the two groups at the 6th month and 12th month of the treatment (χ2=5.158 and 6.000, respectively; P=0.076 and 0.050, respectively); the mean iPTH value decreased significantly in both groups at the 6th month and 12th month of the treatment (Z=-2.728 and -1.852, respectively; P=0.003, 0.032), and there were no statistical differences in significant effective rate and effective rate between the two groups at the 6th month and 12th month of the treatment (χ2=0.011, 0.084, 0.869 and 0.254, respectively; P=0.917, 0.772, 0.351 and 0.614, respectively). The rate of iPTH decreased to ≤250pg/ml was higher in group A than in group B at the 6th month of the treatment (χ2=5.887, P=0.015) but had no difference between the two groups at the 12th month of the treatment (χ2=0.510, P=0.475).  Conclusion  Cinacalcet was effective in hemodialysis patients with different iPTH levels. The patients with iPTH <800pg/ml were more likely to reach the compliance level. Those with iPTH≥800pg/ml could also reach the compliance level with the extension of treatment course, suggesting that long-term use of cinacalcet can be beneficial even if parathyroid surgery was not available Metrics

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Study on the relationship between intestinal barrier function and the ratio of peripheral neutrophil to lymphocyte in peritoneal dialysis patients ZHANG Yan-yu, LI Dan-dan, CHEN Xiao-li, LIU Gui-ling 2022, 21 (05):  341-345.  doi: 10.3969/j.issn.1671-4091.2022.05.009 Abstract ( 148 )   PDF (484KB) ( 227 )   Objective  To investigate the relationship between intestinal barrier and the ratio of peripheral neutrophil to lymphocyte (NLR) in peritoneal dialysis (PD) patients.  Methods  The PD patients treated and regularly followed up in the Department of Nephrology, the Second Hospital of Anhui Medical University during September 2016 to August 2020 were enrolled in this study as the PD group. The chronic kidney disease patients at the stage 3～5 without dialysis and regularly followed up in our outpatient clinic during the same period were recruited as the CKD group. Clinical data, gastrointestinal symptoms and laboratory indices were collected. Intestinal barrier function was evaluated by serum diamine oxidase (DAO), d-lactic acid and bacterial endotoxin assays. Multivariate linear regression model was used to analyze the relationship between NLR and serum levels of DAO, d-lactic acid and bacterial endotoxin in the two groups.  Results  There were 121 cases in PD group and 69 cases in CKD group. At least one gastrointestinal symptom was present in 73 patients (60.3%) in PD group and 37 patients (53.6%) in CKD group. The NLR was significantly higher in PD group than in CKD group (Z=2.223, P=0.026). Serum d-lactic acid and bacterial endotoxin were significantly higher in PD group than in CKD group (Z=2.323 and 5.519 respectively, P=0.020 and＜0.001 respectively). Multivariate regression analysis showed that NLR in PD group was positively correlated with bacterial endotoxin (β=0.308, P=0.003), but not with DAO (β=-0.154, P=0.108), d-lactic acid (β=0.173, P=0.068) and age (β=-0.177, P=0.058); while NLR in CKD group was positively correlated with age (β=0.311, P=0.012) but not statistically correlated with serum d-lactic acid (β=0.162, P=0.197), bacterial endotoxin (β=0.234,           P=0.072) and DAO (β=-0.160, P=0.224).  Conclusion  Gastrointestinal symptoms were present in most PD patients. Serum d-lactic acid and bacterial endotoxin were higher in PD patients than in non-dialysis CKD patients, and bacterial endotoxin was positively correlated with NLR in PD patients, suggesting that intestinal barrier function may affect the inflammatory responses in PD patients. Metrics

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The influencing factors for intradialytic hypotension in diabetic patients with maintenance hemodialysis   YAO Wei-hua, DIAO Zong-li, LI Xia, LI Jing, LIU Wen-hu 2022, 21 (05):  346-349.  doi: 10.3969/j.issn.1671-4091.2022.05.010 Abstract ( 334 )   PDF (504KB) ( 130 )   Objectives  To explore the influencing factors for intradialytic hypotension (IDH) in diabetic patients with maintenance hemodialysis (MHD).  Methods  A total of 140 diabetic patients on MHD during January 2017 to December 2019 were recruited from three hemodialysis centers in Beijing. They were divided into two group: IDH group (IDH episodes in more than 30% of dialysis sessions), and non-IDH group (IDH episodes in less than 30% dialysis sessions). Their clinical and laboratory data were collected and the potential impact factors for IDH were evaluated.  Results  There were 101 cases in IDH group and 39 case in non-IDH group. Logistic regression analysis showed that ultrafiltration rate (OR=1.229, 95% CI 1.017~1.487, P=0.033) and pre-hemodialysis systolic blood pressure (OR=1.048, 95% CI 1.013~1.083, P=0.007) were the independent influencing factors for IDH. ROC for the prediction of IDH demonstrated that the threshold of pre-hemodialysis systolic blood pressure was 159mmHg (AUC=0.702, 95% CI 0.604~0.801, P<0.001) and the threshold of ultrafiltration rate was 9.5ml/h/kg (AUC=0.657, 95% CI 0.551~0.762, P=0.004).  Conclusions   Pre-hemodialysis systolic blood pressure and ultrafiltration rate were the risk factors for IDH in diabetic patients with MHD. Metrics

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Prediction and evaluation of intradialytic hypotension risk in 3,906 hemodialysis patients by a nomogram model  HE Xin, ZHAN Ya, ZHANG Hong, HONG Da-qing, LI Gui-sen, 2022, 21 (05):  350-355.  doi: 10.3969/j.issn.1671-4091.2022.05.011 Abstract ( 281 )   PDF (1266KB) ( 117 )   Objective Intradialytic hypotension (IDH) is one of the most common complications in hemodialysis. The purpose of this study was to predict the risk of IDH in hemodialysis patients by constructing a nomogram model.  Methods  The hemodialysis patients in Sichuan Provincial People's Hospital from 2014 to 2020 was included in this study. Their basic information, laboratory examinations and dialysis treatment records were collected. A multivariate logistic regression model was designed, and the nomogram model was constructed using R language program to predict the risk of IDH. The receiver operating characteristic curve (ROC) and calibration curves were used to investigate and evaluate the discrimination and calibration of the model, while the decision curve analysis was used to evaluate its clinical validity.  Results  A total of 3,906 patients and 314,534 dialysis records were included. After regression analysis, age (OR=1.016, 95% CI 1.015~1.017, P＜0.001), gender (male OR=1.280, 95% CI：1.268~1.282, P＜0.001), pre-dialysis systolic blood pressure (＜90mmHg OR=7.242, 95% CI：6.376~8.156, P＜0.001;>140mmHg OR=2.656, 95% CI：2.345~2.996, P＜0.001), pre-dialysis diastolic blood pressure (＜60mmHg OR=3.772, 95% CI：3.596~3.883, P＜0.001;    ＞90mmHg OR=1.741, 95% CI：1.707~1.783, P＜0.001), heart rate (＜60/min OR=2.314, 95% CI：2.173~2.461, P＜0.001; >100/min OR=1.456, 95% CI：1.397~1.514, P＜0.001), preliminary ultrafiltration volume (OR=1.350, 95% CI：1.336~1.362, P＜0.001), hemoglobin (OR=1.001, 95% CI：1.001~1.002, P＜0.001) and blood calcium (＜2.25mmol/L OR=1.270, 95% CI：1.211~1.339, P＜0.001; ＞2.75mmol/L OR=1.087, 95% CI 1.068~1.102, P＜0.001) were identified and input into the nomogram. The nomogram shows better discrimination. The area under the receiver operating characteristic (ROC) curve of the training set is 0.729 (95% CI 0.727~0.732), and the internal verification C-index is 0.730; the area under the ROC curve of the test set is 0.727 (95% CI 0.724~0.731). The calibration curve of IDH probability shows the consistency between the predicted probability of nomogram and the actual probability.  Conclusion  The nomogram model constructed in this study can be used to identify the patients with high-risk of IDH and to help clinicians make personalized diagnosis and treatment interventions for IDH, indicating that this nomogram model may have clinical utilities. Metrics

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Study on the mechanism of stenosis caused by abnormal intimal hyperplasia and shear stress change in arteriovenous fistula failure  ZHANG Yan-zi, SUI Xiao-lu, XU Yun-peng, ZHANG Ai-sha, XIE Ting-fei, CHEN Ji-hong 2022, 21 (05):  356-360.  doi: 10.3969/j.issn.1671-4091.2022.05.012 Abstract ( 155 )   PDF (1113KB) ( 330 )   Objective   To reveal the rules of vascular intima and shear force changes in the autologous arteriovenous fistula failure.  Methods   C57BL/6 mice were divided into sham operation group (n=20) and surgical group (n=20). The operation group were subjected to a microsurgery to establish an internal arteriovenous fistula between carotid artery and jugular vein, while the sham group did not have the fistula. The examination indicators after the surgery included  ①hemodynamics: arterial pressure, heart rate, blood flow velocity and shear stress value; ②histopathology: thickness of the venous wall by HE staining, mucopolysaccharide in vascular wall by PAS staining, damage of reticular fibers in vascular wall by Gomori silver staining, damage of elastic fibers in vascular wall by aldehyde-fuchsin elastic fiber staining, and changes of vascular endothelial cells by CD31 and CD34 immunostaining.  Results   ①Hemodynamics: Compared with the sham group, the inner diameter of the carotid artery shrank, and the vascular shear stress increased significantly (t=-6.840, P<0.001) in the operation group. ②Histopathology: In the operation group, pathological findings included thickened wall and narrowed lumen of the vein by HE staining, increased neutral mucopolysaccharide by PAS staining, evident fibrosis by Gomori silver staining, proliferation and disarrangement of elastic fibers by aldehyde-fuchsin elastic fiber staining, and interrupted endothelial cell layer by proliferated fibrous tissues in CD31 and CD34 immunostaining.  Conclusion  After arteriovenous fistula surgery, the increased shear stress in the fistula, the intimal hyperplasia, the proliferation and disarrangement of fibrous tissues and the infiltration of inflammatory cells lead to the thickness of the vessel wall and the stenosis of the vessel lumen, which account for the failure of autologous arteriovenous fistula in maintenance hemodialysis patients. Metrics

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Progress in urea removal technology of wearable dialysis equipment ZHENGRui-long 2022, 21 (05):  361-364.  doi: 10.3969/j.issn.1671-4091.2022.05.013 Abstract ( 340 )   PDF (396KB) ( 187 )   Wearable artificial kidney (WAK) is an evolutionary product of dialysis equipment. The key to develop WAK is to remove uremic solutes from waste dialysis fluid, in which urea is the most difficult uremic solute to be cleared. After investigating the progresses of urea removal technology of WAK in China and foreign countries, this paper reviews the urease urea removal technology, electrooxidation technology and urea adsorption technology. Their principles are briefly introduced, and the urea removal effects in clinical trials of WAK are analyzed. Finally, the advantages and disadvantages of the three technologies are evaluated and prospected. It is expected to provide relevant support and reference information of WAK to the urea removal technology researchers. Metrics

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Application of anti-Xa factor activity assay in low molecular weight heparin anticoagulation in hemodialysis patients  WANG Zhen-xing, XU Leng-nan, FU Pei-jie, DANG Xin, MAO Yong-hui 2022, 21 (05):  365-368.  doi: 10.3969/j.issn.1671-4091.2022.05.014 Abstract ( 703 )   PDF (398KB) ( 213 )   Low molecular weight heparin (LMWH) is one of the commonly used anticoagulants. Its anticoagulation effect and bleeding risk are often monitored by the anti-Xa factor activity. Appropriate anti-Xa factor activity range is also recommended in clinical guidelines. As for hemodialysis patients using LMWH, there is no consensus about the target range of anti-Xa factor activity. This review mainly discusses the value of anti-Xa factor activity assay in LMWH anticoagulation for hemodialysis and the recent progresses in its specific monitoring strategies. Metrics

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Research progress in occult hepatitis B virus infection in hemodialysis patients GAOHan, YANGuosheng, ZHANGHong-tao 2022, 21 (05):  369-372.  doi: 10.3969/j.issn.1671-4091.2022.05.015 Abstract ( 240 )   PDF (385KB) ( 77 )   Hepatitis B virus infection is one of the common diseases threatening hemodialysis patients. Occult hepatitis B virus infection is a type of hepatitis B surface antigen (HBsAg) negative hepatitis B virus infection, which has the potential risk of hepatitis B virus transmission through hemodialysis. Considering the specific significance of occult hepatitis B virus infection（OBI） in a hemodialysis specialty, this article reviews the epidemiology, prevention and control of OBI in hemodialysis patients in order to provide a reference for the management of these dialysis patients. Metrics

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The clinical significance of changes in serum PTH, serum ferritin and Th22/Treg cells in uremic patients with hemodialysis YANZhen-yuan, YANTing, LIUJie, YEFeng, YUYu-lan, DINGXiao-jun, SONGCai-xia 2022, 21 (05):  373-376.  doi: 10.3969/j.issn.1671-4091.2022.05.016 Abstract ( 256 )   PDF (452KB) ( 57 )   Objective   To investigate the clinical significance of changes of serum parathyroid hormone (PTH), serum ferritin (SF) and Th22/Treg cells in uremic patients with hemodialysis.   Methods   A total of 65 uremia patients undergoing hemodialysis from January 2020 to January 2021 and treated in The First People’s Hospital of Jiangxia District Wuhan City were retrospectively reviewed. Their serum PTH, SF and inflammatory factors, and Th22/Treg cells were recorded. The correlation between Th22/Treg cells and serum levels of PTH, SF and inflammatory factors and the predictive value of Th22/Treg cells for micro-inflammatory state in these hemodialysis patients were evaluated.  Results  In uremic patients after hemodialysis for 3 and 6 months, serum SF levels were (132.34±20.77)ng/ml and (201.92±25.80)ng/ml respectively, higher than the serum SF of (85.49±15.34)ng/ml in control group (t=14.628 and 31.273, P=0.001); serum PTH levels were (153.92±15.48)pg/ml and (238.60±19.44)pg/ml respectively, higher than the serum PTH of (30.43±10.95)    ng/ml in control group (t=50.507 and 74.221, P=0.000); Th22 cell ratios were (1.15±0.26)% and (1.35±0.24)%, higher than the ratio of (0.97±0.20)% in control group (t=4.424 and 9.807, P=0.001); Treg cell ratios were (1.46±0.19)% and (1.25±0.19)%, lower than the ratio of 1.86±0.24% in control group (t=10.535 and 17.050, P=0.001).  Conclusion   In uremic patients undergoing hemodialysis, serum PTH, serum SF and Th22 cell ratio increased, while Treg ratio decreased. These abnormalities are related to the micro-inflammatory state of the patients. Th22/Treg may be regarded as the predictor factors for micro-inflammatory state in hemodialysis patients. Metrics

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Effect of education model based on health awareness theory on volume management behavior and dietary compliance in peritoneal dialysis patients CHANGYa-nan, ZHAOCai-ping, MAXiao-qin, WANGLi, WANGYan 2022, 21 (05):  377-380.  doi: 10.3969/j.issn.1671-4091.2022.05.017 Abstract ( 132 )   PDF (392KB) ( 213 )   Objective  To explore the effect of education model based on health awareness theory on volume management behavior and dietary compliance in peritoneal dialysis (PD) patients.  Methods  A total of 129 PD patients in the General Hospital of Ningxia Medical University from January 2019 to May 2020 were enrolled in this study. They were randomly divided into control group and experimental group. The control group received routine health education, and the experimental group received health education model based on health awareness theory in addition to routine health education. The differences of volume management behavior score and diet compliance score were compared between the two groups before and after 3 months of intervention.  Results  Before intervention, there were no significant differences in the total scores of volume management behavior and diet compliance behavior between the two groups; the total score of volume management behavior was (12.53±5.60) vs. (11.75±4.79)(t=0.847, P=0.398), and the total score of dietary compliance behavior was (86.71±10.49) vs. (85.66±8.67) (t=0.615, P=0.540). After three months of intervention, the total scores of volume management behavior and dietary compliance behavior in the experimental group were higher than those in the control group, and the difference was statistically significant; the total score of volume management was (15.73±4.19) vs. (13.51±3.69) (t=3.230, P=0.002, and the total score of dietary compliance behavior was (92.39±7.64) vs. (86.24±7.58), t=4.586, P=0.001.  Conclusion Health education model based on health awareness theory can improve volume management behavior and dietary compliance behavior in PD patients. Metrics

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Fistula cannulation using a 15G needle in maintenance hemodialysis patients: the safety and efficacy  GUAN Yan-ning, HU Na-na, CUI Zheng, WANG Mei, LUO Li 2022, 21 (05):  381-384.  doi: 10.3969/j.issn.1671-4091.2022.05.018 Abstract ( 427 )   PDF (420KB) ( 142 )   Objective To observe the efficacy and safety of fistula cannulation using a 15G needle in maintenance hemodialysis (MHD) patients.  Methods  This was a prospective and self-control study. A total of 26 MHD patients with mature arteriovenous fistula and routine blood flow rate of ≥350ml/min were enrolled in this study. All patients underwent high-flux hemodialysis for 6 continuous sessions, and blood flow rate was set at 350ml/min using a 16G or a 15G puncture needle. During each session, we monitored the effective blood flow rate (EBFR), arterial pressure (AP), venous pressure (VP), transmembrane pressure (TMP), online urea clearance using an online clearance monitor (OCM), and calculated single-chamber urea solute clearance index (spKt/V) by blood sampling. We recorded the impact of 16G and 15G needles on the time of compression (TC) after needle removal, pain score of the patients, and the related adverse events in the follow-up period.  Results  When the pump speed was set at 350ml/min using a 15G puncture needle, EBFR [(322.63±15.41)ml/min vs. (315.36±11.42)ml/min, t=-2.776，P=0.013] and OCM-spKt/V [(1.18±0.13) vs. (1.14±0.14), t=-2.178, P=0.045] were higher than those using a 16G puncture needle; AP [(-129.61±25.71)mmHg vs. (-191.27±20.05)mmHg, t=-8.441, P＜0.001] and VP [(139±11.77)mmHg vs. (167.81±10.23)mmHg, t=8.822, P＜0.001]were significantly lower than those using a 16G puncture needle. The time of compression after the needle removal using a 15G needle was longer than that using a 16G needle [(60.19±23.25) min vs. (54.99±20.51)min, t=3.188, P=0.004]. There was no significant difference in score of pain [(1.56±1.29) vs. (1.93±1.6), t=1.336, P=0.200].  Conclusions  When the blood flow rate was set at ≥350ml/min, the use of a 15G needle can significantly increase the real blood flow compared with that of a 16G needle, thereby improving the dialysis adequacy. There is no significant difference in score of pain, but the time of compression after needle removal was longer in patients using a 15G needle than in those using a 16G needle. Metrics