Chinese Journal of Blood Purification

12 June 2022, Volume 21 Issue 06 Previous Issue    Next Issue

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Research advances on portable artificial kidney devices  CHEN Li-ting, SONG Ming-yang, ZHAO Jian-cheng, LI Xue-mei 2022, 21 (06):  385-388.  doi: 10.3969/j.issn.1671-4091.2022.06.001 Abstract ( 1076 )   PDF (1798KB) ( 289 )   The global burden of chronic kidney disease is increasing. In China, the number of dialysis patients is increasing rapidly. Hemodialysis is the most prevalent renal replacement therapy worldwide. Due to the intermittence of hemodialysis and the need for patients to go to the hospital frequently, experts and scholars have been committed to finding more suitable kidney replacement therapy for patients. Portable artificial kidney device is a promising method. This review aims to summarize the research progress of portable artificial kidney devices with mature technology and new artificial kidney devices under development. Metrics

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Advantages and prospects of home hemodialysis GU Wen, ZHOU Yi-jun, NI Zhao-hui 2022, 21 (06):  389-392.  doi: 10.3969/j.issn.1671-4091.2022.06.002 Abstract ( 599 )   PDF (504KB) ( 250 )   Home Hemodialysis (HHD) is one of the methods of renal replacement therapy for patients with end-stage renal disease (ESRD), which is performed in a home environment by patients themselves or with the assistance of others. Although HHD has appeared and is widely used abroad as early as the 1960s, the proportion of HHD fell sharply due to the establishment of a large number of dialysis centers, the emergence of peritoneal dialysis, as well as the changes in reimbursement policies. In recent years, HHD has risen again because of its unique advantages. HHD can not only increase the survival rate of patients and improve the quality of life of patients, but also is of great significance in the context of the COVID-19 epidemic. In April 2020, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine carried out the first case of home hemodialysis in mainland China, filling the gap of HHD in mainland China. With the burgeoning development of the Internet, the establishment of a standardized HHD training system and the continuous enrichment of experience, HHD is supposed to have broader prospects.  Metrics

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The clinical application of modified peritoneal dialysis catheter revision of malfunctioning catheter XIANG Shi-long, ZHANG Xiao-hui, WANG Yao-min, LIU Guang-jun, XIE Xi-shao, HAN Fei, CHEN Jiang-hua 2022, 21 (06):  393-397.  doi: 10.3969/j.issn.1671-4091.2022.06.003 Abstract ( 320 )   PDF (428KB) ( 65 )   Objective To investigate the clinical efficacy of the modified peritoneal dialysis catheter revision technique, and to find a simple, safe and effective operation for patients with malfunctioning catheter. Methods A total of 76 patients with malfunctioning catheter were enrolled, who received the modified peritoneal dialysis catheter revision operation from May 2013 to December 2019 in the First Affiliated Hospital of Zhejiang University. The general condition before and during operation, postoperative complications were observed. Results All patients were managed successfully, with a catheter revision operation time 74.44 ± 25.93 minutes and operative hemorrhage 21.17 ± 2.94 ml. The mean onset time to catheter malfunction was 335.3 ± 556.3 days. Amongst the 76 patients, catheter malposition occurred in 45, omental wrapping in 10, catheter occlusion in 7, catheter malposition with omental wrapping in 10, catheter malposition with occlusion in 3, and 1 case of others. During the follow-up time (38.68 ± 26.76 months), there was only 1patient occurring catheter occlusion after peritonitis and 2 patients with early peritonitis (within 14 days after operation). There was no recurrence of catheter malposition and omental wrapping, and no organ injury, hydrothorax, incision infection and surgery-related tunnel infection. The rate of catheter malfunction was 2.6%, of which were due to dialysate leakage and abdominal wall hernia. Conclusions Our modified peritoneal dialysis catheter revision technique is a simple, safe and effective procedure. This procedure was of less trauma, less complications, minimized or even eliminated the possibility of recurrence of catheter malfunction. It is worthy of clinical application. Metrics

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Epidemiological study on the incidence of malignant tumors in maintenance hemodialysis patients in Hebei Province ZHOU Wei, SHI Ning-ning, JIN Jing-jing, CHENG Mei-juan, XU Jin-sheng 2022, 21 (06):  398-402.  doi: 10.3969/j.issn.1671-4091.2022.06.004 Abstract ( 194 )   PDF (681KB) ( 111 )   Objective To investigate the incidence of malignant tumors in maintenance hemodialysis (MHD) patients in Hebei province.  Methods  A total of 20,035 subjects were extracted from the National Blood Purification Case Information Registration System before the date of December 31, 2019 according to the inclusion and exclusion criteria of this study. The time of first dialysis was recorded, and the occurrence of malignant tumors in these patients was described.  Results  The standardized morbidity rate of malignant tumors was 247.9/100,000/year in the general population in Hebei Province. In the 20,035 MHD patients, a total of 113 patients were found to have newly diagnosed malignant tumors, with a standardized incidence of malignant tumors of 278.8/100,000/year; the risk of genitourinary malignancies was 1.7 times higher than that in the general population (Z=3.540, P=0.004); the standard cumulative incidence of malignancy was higher in non-diabetic patients than in diabetic patients (0.22% vs. 0.16%, χ²=340.245, P＜0.001), and was higher in women than in men (0.22% vs. 0.17%, χ²=215.845, P＜0.001).  Conclusion  The incidence of malignant tumor in the MHD patients was obviously higher than that in the general population in Hebei Province, especially the incidence of genitourinary malignancies. Therefore, monitoring of genitourinary malignancies is required to improve the quality of life and prognosis of MHD patients. Metrics

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The relationship between serum triglyceride glucose index and coronary artery calcification in dialysis patients  ANG Zhi-juan, LI Huan, LIU Gui-ling 2022, 21 (06):  403-407.  doi: 10.3969/j.issn.1671-4091.2022.06.005 Abstract ( 292 )   PDF (497KB) ( 70 )   Objective  To investigate the relationship between triglyceride glucose (TyG) index and coronary artery calcification (CAC) in dialysis patients, and to analyze the risk factors for CAC.  Methods  The dialysis patients hospitalized in the Nephrology Department, the Second Affiliated Hospital of Anhui Medical University from October 2019 to March 2021 were recruited. Their general clinical data and laboratory results were collected, and CAC of the patients was examined by multi-layer spiral computed tomography (MSCT). They were then divided into CAC group and non-CAC group according to the MSCT findings. These indexes were compared between the two groups. Binary logistic regression analysis and ROC curve were used to assess the predictive value of TyG index for CAC in dialysis patients.  Results  A total of 286 dialysis patients (219 hemodialysis and 67 peritoneal dialysis) were included in this study, in which 157 were in CAC group and 129 in non-CAC group. Age, dialysis age, CRP, TyG index and intact parathyroid hormone (iPTH) were significantly higher in CAC group than in non-CAC group (Z=-7.642, -5.226, -5.152, -3.460 and -1.989, respectively; P＜0.001, ＜0.001, ＜0.001, =0.001 and =0.047, respectively). Spearman correlation analysis showed a positive correlation between CAC and age, dialysis age, CRP, iPTH and TyG index (r=0.453, 0.310, 0.305, 0.118 and 0.326, respectively; P＜0.001,＜0.001,＜0.001, =0.047 and ＜0.001, respectively). Binary logistic regression analysis found that age (OR=1.085, 95% CI: 1.060~1.111, P< 0.001), dialysis age (OR=1.010, 95% CI: 1.004~1.017, P<0.001), CRP (OR=1.060, 95% CI: 1.021~1.102, P=0.003), and TyG index (OR=2.309, 95% CI: 1.370~3.892, P=0.002) were the risk factors for CAC. ROC curve analysis showed that TyG index associated with age had the greatest predictive value for the occurrence of CAC in dialysis patients, and the area under the curve was 0.807 (95% CI: 0.756～0.857, P＜0.001).  Conclusion  Age, dialysis age, CRP and TyG index are the independent risk factors for CAC in dialysis patients. TyG index associated with age has a better predictive value for the occurrence of CAC in dialysis patients. Metrics

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Construction and validation of a prediction model for the risk of intradialytic hypotension in maintenance hemodialysis patients GUO Xue-mei, ZHU Zhen-nan, LUO Jia-yi, ZHANG He-ping, JING Jian-ying 2022, 21 (06):  408-412.  doi: 10.3969/j.issn.1671-4091.2022.06.006 Abstract ( 335 )   PDF (511KB) ( 368 )   Objective  To investigate the influencing factors for intradialytic hypotension (IDH) in maintenance hemodialysis (MHD) patients, then to construct a risk prediction model and to evaluate the prediction effect of this model.  Methods  A total of 222 MHD patients in the Blood Purification Center of The Affiliated Hospital of North Sichuan Medical College from September 2020 to August 2021 were enrolled in this study as the study subjects. They were randomly divided into modeling group and modeling validation group in the patient number ratio of 6:4. Patients in the modeling group were further divided into IDH group and non-IDH group based on the definition of IDH in the National Kidney Foundation Kidney Disease Prognostic Quality Guidelines. Univariate analysis was used to analyze the risk factors for IDH. Multivariate logistic regression analysis was performed to obtain the factors with P<0.05 for construction of the risk prediction model. Hosmer-Lemeshow test model was used to test the goodness of fit of the model. ROC curve was used to examine the predictive value of the model. The effectiveness of the constructed model was then evaluated in the modeling validation group.  Results  The incidence of IDH was 40.09% in the MDH patients. Predialysis systolic blood pressure (OR=0.959, 95% CI=0.932~0.988, P=0.005), hemoglobin (OR=0.962, 95% CI=0.929~0.996, P=0.030), magnesium (OR=79.558, 95% CI=2.644~2393.594, P=0.012), diabetes (OR=16.066, 95% CI=4.914~52.530, P<0.001), and hypertension (OR=5.221, 95% CI=1.661~16.409, P=0.005) were the influencing factors for IDH. Hosmer-Lemeshow test gave the result of P=0.718. When the optimal cut-off value was set at 0.436, the area under the ROC curve (AUC) was 0.922, the sensitivity was 0.83 and the specificity was 0.887. The Youden index was 0.717, and the correct rate of practical application was 83.15%.  Conclusion The model we constructed can better predict the risk of IDH in MDH patients and provides a reference for clinicians to evaluate IDH in MHD patients. Metrics

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The factors affecting the duration of continuous renal replacement therapy in acute kidney injury patients and the construction of a model for prediction of the duration EN Si-fang, LIU Ying, WANG Yun 2022, 21 (06):  413-417.  doi: 10.3969/j.issn.1671-4091.2022.06.007 Abstract ( 178 )   PDF (577KB) ( 328 )   To analyze the influencing factors for the duration of continuous renal replacement therapy (CRRT) in the treatment of acute kidney injury (AKI) patients, and to establish a model to predict the duration of CRRT in AKI patients.  Methods  A total of 102 AKI patients treated in the Intensive Care Unit (ICU) of Jiangsu Province Hospital from April 2018 to January 2020 were retrospectively analyzed. They were divided into <6 days group and ≥6 days group based on the median duration of CRRT [6.0 (2.3, 10.4) d]. Univariate analysis and binary logistic regression were used to find out the independent influencing factors for CRRT duration. The R software was then used to construct a prediction nomogram model, and the prediction value of this model was evaluated.  Results  Among the 102 AKI patients, 53 cases were in the <6 days group and 49 cases were in the ≥6 days group. Univariate analysis indicated that α1-MG (t=2.009,          P=0.047), β2-MG (t=2.402, P=0.018), Scr (t=2.395, P=0.019) and neutrophil gelatinase-associated lipocalin (NGAL; t=2.030, P=0.045) were lower in the <6 days group than in the ≥6 days, while mean arterial pressure (MAP; t=2.425, P=0.017) and urine volume (t=2.058, P=0.042) were higher in the <6 days group than in the ≥6 days. Binary logistic regression showed that urine volume (OR=1.131, 95% CI: 1.017~1.024), NGAL (OR=0.987, 95% CI: 0.982~0.993), α1-MG (OR=0.860, 95% CI: 0.767~0.976) and β2-MG (OR=0.755, 95% CI: 0.572~0.996) were the independent predictors for CRRT duration in AKI patients (P<0.05). The C-index of the nomogram model was 0.894 (95% CI: 0.723~0.896). The calibration curve showed that the average absolute error of prediction possibility was 0.029, indicating a better discrimination and accuracy of the prediction model.  Conclusion  The nomogram model constructed on the differences of urine volume, NGAL, α1-MG and β2-MG can better predict the duration of CRRT in AKI patients, and provide useful references for CRRT treatment in AKI patients. Metrics

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Effect of dynamic changes of nutritional risk index on the mortality in elderly hemodialysis patients    HUANG Pei-pei, ZHANG Jing, HU Dan-xiang, HUANG Qiang-wei 2022, 21 (06):  418-422.  doi: 10.3969/j.issn.1671-4091.2022.06.008 Abstract ( 152 )   PDF (615KB) ( 71 )   bjective   To evaluate the relationship between annual changes in geriatric nutritional risk index (ΔGNRI) and all-cause mortality and cardiovascular mortality in elderly patients undergoing maintenance hemodialysis (MHD).  Methods   A total of 398 elderly patients who received hemodialysis in our hospital from October 2010 to July 2013 were retrospectively analyzed. Demographic and clinical data of the patients were collected, and ΔGNRI was calculated from the difference between GNRI at baseline and the value after one year. Patients were then divided into four groups: G1 group, GNRI ≥91.2 and ΔGNRI ≥0%; G2 group: GNRI ≥91.2 and ΔGNRI < 0%; G3 group, GNRI ＜91.2 and ΔGNRI ≥0%; G4 group, GNRI ＜91.2 and ΔGNRI ＜0%. The correlation between ΔGNRI and baseline GNRI was examined. The differences in all-cause mortality and cardiovascular mortality among the four groups were analyzed. The adjusted hazard ratio (aHR) and 95% confidence interval (CI) of mortality were calculated by multivariate Cox regression model.  Results  The median ΔGNRI was 0.16 (0.07, 0.46). ΔGNRI was negatively correlated with baseline GNRI  (ρ=0.199, P=0.005). During a follow-up period of 3.7 (1.9, 6.9) years, 108 patients died. Baseline GNRI < 91.2 [aHR 95% CI: 2.59 (1.54~4.33), P<0.001] and ΔGNRI < 0% [aHR 95% CI: 2.33 (1.32~4.32), P=0.003] were the independent predictors for all-cause mortality. The 10-year survival rates in G1, G2, G3 and G4 groups were 69.8%, 43.2%, 39.9% and 19.2%, respectively (log rank test: χ2=18.654, P<0.001). With G1 group as the reference, the aHR for all-cause mortality in G4 group was 3.88 (95% CI : 1.62~9.48, P=0.003).  Conclusions Annual changes in GNRI (ΔGNRI) were negatively correlated with baseline, and can accurately predict all-cause mortality and cardiovascular mortality in MHD patients. Metrics

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Study on the relationship between peritoneal pressure and early leakage of peritoneal dialysis LIU Si-yuan, SHANG Yu, JI Tian-rong, ZHANG Wei, LI Yan, YANG Xiao-jun, KONG Fan-wu 2022, 21 (06):  423-427.  doi: 10.3969/j.issn.1671-4091.2022.06.009 Abstract ( 186 )   PDF (474KB) ( 114 )   To investigate the relationship between intraperitoneal pressure (IPP) and early leakage of peritoneal dialysis (PD) in PD patients.  Methods   A total of 60 patients undergoing PD catheterization for first time during October 2020 to September 2021 at the Department of Nephrology, The Second Affiliated Hospital of Harbin Medical University were prospectively analyzed. Their clinical data were collected and then divided into groups according to the IPP after infusion of 2,000ml dialysate and the presence or absence of leakage. Clinical indicators were compared among the groups and correlation analysis was performed.  Results   ①Body weight (F=6.205, P=0.001), body mass index (BMI) (F=16.008, P<0.001), abdominal circumference (F=9.561, P<0.001), body surface area (BSA) (F=4.048, P=0.011), serum creatinine        (K=8.266, P=0.041), blood eosinophil number (K=9.855, P=0.020) and leakage (χ2=17.304, P=0.001) were significantly different among the groups with different IPP (P<0.05). The IPP values at the intraperitoneal dialysate volume (IPV) of 500ml, 1,000ml and 2,000ml were higher in the leakage group than in the non-leakage group (Z=-2.599, 4.216 and -3.025 respectively； P=0.009, <0.001 and =0.002 respectively). The ratio of females was higher in the leakage group than in the non-leakage group (χ2=5.875, P=0.015)； blood eosinophil number was lower in the leakage group (Z=-2.377, P=0.017).  ②Spearman rank correlation analysis showed that IPP was positively correlated with body weight (r=0.479, P<0.001), BMI (r=0.665, P<0.001), BSA(r=0.383, P=0.002), abdominal circumference (r=0.569, P<0.001), IPV (r=0.537, P<0.001), IPV/BMI(r=0.354, P<0.001), IPV/BSA (r=0.436, P<0.001) and leakage (r=0.370, P=0.004), negatively correlated with blood eosinophil number (r=-0.304, P=0.018), and had no correlation with serum creatinine (r=0.082, P=0.539). The presence of leakage was positively correlated with the IPP values at the IPV of 500ml (r=0.338, P=0.008),      1 000mL (r=0.394, P=0.002) and 2 000ml (r=0.394, P=0.002), and negatively correlated with blood eosinophil number(r= -0.309, P=0.016).  ③Logistic regression analysis showed that body weight (OR=2.570, 95% CI: 1.448~4.561, P=0.001), BMI (OR=2.115, 95% CI: 1.415~3.159, P<0.001), abdominal circumference (OR=1.205, 95%  CI: 1.073~1.353, P=0.002) and BSA (OR=1.046, 95% CI: 1.010~1.083, P=0.012) were the independent risk factors for IPP； gender (OR=9.739, 95% CI: 1.134~83.674, P=0.038) and IPP values at the IPV of 500ml (OR=1.535, 95% CI: 1.120~2.104, P=0.008), 1 000ml (OR=1.606, 95% CI: 1.173~2.198, P=0.003) and 2 000ml (OR=1.564, 95% CI: 1.164~2.102, P=0.003) were the independent risk factors for leakage.  Conclusions  Body mass, BMI, abdominal circumference and BSA can be used as the clinical indicators to predict IPP in patients with PD at early stage. In these PD patients, women are more prone to have early leakage than men. IPP is closely related to the early leakage, and the increase of IPP is one of the important factors leading to early leakage. Metrics

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A prospective cohort study of bleeding risk in hemodialysis and peritoneal dialysis patients XU Shui-ying, SHAO Li-ping 2022, 21 (06):  428-431.  doi: 10.3969/j.issn.1671-4091.2022.06.010 Abstract ( 207 )   PDF (472KB) ( 55 )   Objective  To compare the risk of severe bleeding events in hemodialysis (HD) patients and peritoneal dialysis (PD) patients.  Methods  A total of 1,745 patients with end-stage renal disease (ESRD) who started dialysis treatment in Pinghu Hospital of Traditional Chinese Medicine from June 2013 to July 2018 were prospectively recruited. Patients were divided into HD group (n=1,211, 69.4%) and PD group (n=534, 30.6%) according to the dialysis method. They were followed up for 3 years. Demographic and clinical data were collected. Bleeding event was defined as the bleeding leading to hospitalization or death within the follow-up period of 3 years. Kaplan-Meier curve and log-rank test were used to compare the incidence of bleeding event between the two groups within the follow-up period of 3 years. Cox regression analysis with time-dependent independent variables was used to calculate the risk ratio (HR) and 95% confidence interval (95% CI) of bleeding events in HD and PD groups after adjusting for covariates.  Results  During the 3 years of follow-up, 183 patients had a first bleeding event within a median of 2.2 years (P25: 1.0, P75: 3.0). Of these bleeding patients, 144 received HD and 39 received PD in the baseline period. The cumulative incidence of bleeding event was 15.5% in HD group and 9.7% in PD group (log rank test: χ2=5.872, P=0.013). Cox regression analysis with time-dependent independent variables and after adjusting for confounding factors showed that the adjusted HR for bleeding risk in HD patients was 1.6 (95% CI: 1.2~2.5, P=0.014) as compared with PD patients; the adjusted HR of bleeding risk in HD patients taking antithrombotic drugs was 2.0 (95% CI: 1.3~3.8, P=0.002) as compared with the PD patients without antithrombotic drug treatment; the adjusted HR of bleeding risk in HD patients with cardiovascular complications was 1.9 (95% CI: 1.3~3.1, P=0.022) as compared with the PD patients without cardiovascular complications; the adjusted HR of bleeding risk in HD patients with previous bleeding history was 3.2 (95% CI: 2.0~5.8, P＜0.001) as compared with the PD patients without previous bleeding history.  Conclusions   The risk of bleeding event in HD patients was 1.6 times higher than that in PD patients. HD patients who received antithrombotic therapy, had cardiovascular disease, and had a history of bleeding were at a higher risk of severe bleeding. Metrics

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The relationship between serum levels of procalcitonin, endotoxin and C-reactive protein and pathogenic bacteria and prognosis in sepsis patients  The relationship between serum levels of procalcitonin, endotoxin and C-reactive protein and pathogenic bacteria and prognosis in sepsis patients 2022, 21 (06):  432-435.  doi: 10.3969/j.issn.1671-4091.2022.06.011 Abstract ( 268 )   PDF (504KB) ( 118 )   Objective  To explore the relationship between serum levels of procalcitonin (PCT), endotoxin and C-reactive protein (CRP) and pathogens and prognosis in sepsis patients.  Methods  A total of 74 sepsis patients confirmed by positive blood culture between January 2020 and January 2021 were retrospective analyzed. According to blood culture results, they were divided into Gram-negative bacteria group (n=46) and Gram-positive bacteria group (n=28); according to the prognosis at the 28th day after hospitalization, they were divided into survival group (n=55) and death group (n=19). The serum levels of PCT, endotoxin and CRP were compared between Gram-negative bacteria group and Gram-positive bacteria group as well as between survival group and death group. Spearman correlation analysis was used to analyze the correlation between serum levels of PCT, endotoxin and CRP and bacterial pathogens in sepsis patients. The receiver operating characteristic curve (ROC curve) was used to explore the value of serum levels of PCT, endotoxin and CRP for prognosis prediction in sepsis patients.  Results  The serum levels of PCT, endotoxin and CRP were 3.79±0.57ng/ml, 0.60±0.13ng/L and 36.35±4.59mg/L respectively in Gram-negative bacteria group, significantly higher than those of 1.72±0.46ng/ml, 0.18±0.04ng/L and 18.42±3.14mg/L respectively in Gram-positive bacteria group (t=16.251, 16.585 and 18.215 respectively; P<0.001). The mortality rate was 34.78% in Gram-negative bacteria group, higher than that of 10.71% in Gram-positive bacteria group (χ2=5.284, P=0.022). The serum levels of PCT, endotoxin and CRP were (3.41±0.74)ng/ml, (0.55±0.12)ng/L and (35.76±7.21)mg/L respectively in death group, higher than those of (2.34±0.59)ng/ml, (0.38±0.11)ng/L and (27.41±5.08)mg/L respectively in survival group (t=6.374, 5.674 and 5.517 respectively; P<0.001). Spearman correlation analysis showed that the serum levels of PCT, endotoxin and CRP in sepsis patients were negatively correlated with the type of pathogen (r=-0.785, -0.793 and -0.822 respectively; P<0.001). ROC curve showed that serum levels of PCT, endotoxin and CRP were valuable for prognosis prediction in sepsis patients (AUC=0.862, 0.831 and 0.827 respectively; P<0.001), and combination of the three levels was more valuable for the prognosis prediction (AUC=0.911, P<0.001).  Conclusion  The serum levels of PCT, endotoxin and CRP were higher in sepsis patients due to Gram-negative bacterial infection than those due to Gram-negative bacterial infection. Combination of the three serum biomarkers can be used as an adjuvant to predict prognosis in sepsis patients. Metrics

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Efficacy of ultrasound-guided percutaneous transluminal angioplasty in the treatment of thrombosis in autogenous arteriovenous fistula LIU Man-man, XU Li-yun, WANG Sha-sha, CHEN Wei-zhen 2022, 21 (06):  436-440.  doi: 10.3969/j.issn.1671-4091.2022.06.012 Abstract ( 160 )   PDF (847KB) ( 171 )   Objective  To investigate the therapeutic effect of ultrasound-guided percutaneous transluminal angioplasty (PTA) for the treatment of thrombosis in autogenous arteriovenous fistula (AVF).  Method, Patients having thrombosis in AVF and treated with ultrasound-guided PTA or open surgery in the Nephrology Department of Taizhou Hospital of Zhejiang Province during January 2016 to November 2020 were retrospectively analyzed. They were followed up for 12 months. Their clinical data, operation-related conditions and complications were recorded. The primary patency rates and secondary patency rates after 3, 6, 9 and 12 months were observed.  Result  A total of 125 patients with thrombosis in AVF were included in this study, in which 46 patients received ultrasound-guided PTA (PTA group) and 79 patients underwent thrombectomy (surgery group). There were no significant differences in preoperative thrombosis time (t=0.315, P=0.753), anesthesia mode (χ2=2.896, P=0.102), operation time (t=0.183, P=0.885) and success rate (χ2＜0.001, P=1.000) between the two groups. The medical expenses were 14,594.17±4,723.79 yuan in PTA group, significantly higher than that of 6,404.76±5,303.15 yuan in surgery group (t=8.660, P<0.001). There were no significant differences in the primary patency rates after 3 months and 6 months between PTA group and surgery group (after 3 months: 95.65%  vs. 91.14%, χ2=2.016, P=0.156; after 6 months: 78.26% vs. 84.81%, χ2=0.352, P=0.553). The primary patency rates after 9 months and 12 months were significantly lower in PTA group than in surgery group (after 9 months: 63.04% vs. 83.54%, χ2=5.787, P=0.016; after 12 months: 58.70% vs. 82.28%, χ2=7.224, P=0.007). The secondary patency rate after 12 months was 97.8% in PTA group and 96.2% in operation group (χ2=0.186, P=0.667).  Conclusion   In the treatment of patients with thrombosis in AVF, ultrasound-guided PTA is a safe and effective measure, having advantages of prolonged hemodialysis access and saving vascular resources for hemodialysis patients. Metrics

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Research progress in the early screening and evaluation of protein energy wasting in patients with chronic kidney disease CUI Hong-qin, WU Yan-fei, FANG Jing-ai, SUN Yan-yan, LIU Wen-yuan, ZHANG Xiao-dong, CHANG Qin-tao, WANG Rui-hua 2022, 21 (06):  441-444.  doi: 10.3969/j.issn.1671-4091.2022.06.013 Abstract ( 260 )   PDF (401KB) ( 143 )   Protein energy wasting (PEW) is a common complication in patients with chronic kidney disease, especially those treated with maintenance hemodialysis. PEW affects their survival, mortality and quality of life. PEW clinically manifests low serum albumin and prealbumin concentrations, reduced body mass index (BMI), and decreased dietary protein intake. Therefore, early identification and diagnosis of PEW is essential for the prognosis of chronic kidney disease patients. Metrics

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Research progress on the mechanism of peritoneal fi-brosis associated with peritoneal dialysis MA Long-fei, DU Lu, DENG Xi-wen, HU Shuang-shuang, GUO Ming-hao 2022, 21 (06):  445-448,460.  doi: doi:10.3969/j.issn.1671-4091.2022.06.014 Abstract ( 119 )   PDF (447KB) ( 113 )   Peritoneal dialysis (PD) is one of the important renal replacement treatments for end stage renal disease (ESRD). PD improves the patients’ quality of life but also has many complications, in which peritoneal fibrosis (PF) is considered to be the main cause of PD failure. In order to promote the development and application of PD technology and to benefit more ESRD patients, many scholars have conducted researches on the mechanism of PF. This paper reviews the recent achievements in this area. Metrics

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Research progress in the relationship between water channel aquaporin-1 (AQP1) and peritoneal ultrafiltration in peritoneal dialysis ZHOU Sheng-nan, TIAN Na 2022, 21 (06):  449-452.  doi: 10.3969/j.issn.1671-4091.2022.06.015 Abstract ( 146 )   PDF (397KB) ( 64 )   Studies have confirmed that the water channel aquaporin-1 (AQP1) is expressed on peritoneum. AQP1 is considered to be the molecular counterpart of the ultrasmall pore on peritoneum, and plays a fundamental role in transcellular water transport across the peritoneum. The changes of its structure, function or distribution in cells may lead to ultrafiltration failure（UFF）, being one of the main causes for peritoneal dialysis (PD) failure. A common promoter variant in the gene coding AQP1 is associated with the decreased  ultrafiltration（UF）, patient prognosis and technology survival, indicating that genetic factors affect the efficiency of peritoneal ultrafiltration. Factors regulating AQP1 expression include permeability regulation, pharmacological regulation, pH regulation, AQP1 channel activity regulation, and others. Recent studies have found that peritoneal mesothelial cells (PMCs) also express AQP1 and are related to peritoneal ultrafiltration. AQP1 may have other functions such as protecting PMCs and the peritoneum from fibrosis. AQP1 as a regulatory target for the amelioration of ultrafiltration has been recently emphasized, especially regulating AQP1 expression at the gene level and using APQ1-selective medicines. In this review, the research progress in the relationship between AQP1 and peritoneal ultrafiltration in PD is introduced. Metrics

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Application of the decision aid protocol for choice of dialysis method in patients with end stage renal disease WANG Xiao-xing, ZHANG Xiao-ya, MIAO Jin-hong, WANG Kan-kan, LEI Yu-tian, YUE Xiao-hong, WANG Pei 2022, 21 (06):  456-460.  doi: 10.3969/j.issn.1671-4091.2022.06.017 Abstract ( 138 )   PDF (437KB) ( 93 )   Objective To investigate the application of the decision aid protocol for choice of dialysis method in patients with end stage renal disease (ESRD).  Methods   The ESRD patients admitted to the dialysis center of our hospital from July to December 2020 were enrolled in this study. Fifty ESRD patients hospitalized in the First Nephrology Ward were randomly recruited as the control group, and 48 ESRD patients admitted in the Fifth Nephrology Ward were randomly enrolled as the intervention group. The control group only received routine nursing, while the intervention group received the choice of dialysis method by the decision aid protocol in addition to routine nursing.  Results  The intervention group actually participated more in treatment decision than the control group (t=16.007, P=0.000). The decision preparation was significantly higher in the intervention group than in the control group (t=10.069, P=0.000). The decision satisfaction was significantly higher in the intervention group than in the control group (t=16.713, P＝0.000).   Conclusion  The choice of dialysis method by the decision aid protocol can effectively improve the actual degree of patient participation, the decision-making preparation and patient satisfaction. Metrics

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Effect of caregiver on catheter exit-site infection in elderly peritoneal dialysis patients  LU Shu-chao, LV Shan, YU Xiao-li, YANG Xiao, LIN Jian-xiong 2022, 21 (06):  461-464.  doi: 10.3969/j.issn.1671-4091.2022.06.018 Abstract ( 140 )   PDF (406KB) ( 133 )   This study was to explore the effect of caregiver on catheter exit-site infection in the incident elderly peritoneal dialysis (PD) patients.  Methods  The relevant data of the PD patients with catheterization at the age of ≥60 years in the PD Center of our hospital from January 2009 to December 2012 were recruited.  Results  A total of 213 incident elderly PD patients were recruited in this study. Their average age was 68.5±6.0 years old, with 51.6% males and 48.8% diabetes. The median follow-up period was 12.0 months. Twenty-eight patients (13.1%) had 30 episodes of exit-site infection with a rate of 80.9 patient-months (0.15 episodes/year/patient). Evaluation of the exit-site caregivers demonstrated that their mean age was 52.7±14.6 years, 41.8% were males, 27.2% patients took care of exit-site themselves, 15.0% patients had inconstant exit-site caregivers, and 10.8% had untrained exit-site caregivers. COX proportional risk regression showed that inconstant exit-site caregivers (HR=2.989, 95% CI: 1.089～8.206; P=0.034), untrained exit-site caregivers (HR=3.829, 95% CI: 1.630～8.994, P=0.002) and follow-up interval ≤3 months at the outpatient clinics (HR=0.389, 95% CI: 0.179～0.845, P=0.017) were the independent risk factors for catheter exit-site infections in the elderly PD patients.  Conclusions  The prevalence of exit-site infection in elderly PD patients was 0.15 episodes/year/patient. Stable caregivers, caregivers receiving standardized training by medical staff, and follow-up interval ≤3 months at the outpatient clinics may reduce the incidence of exit-site infection in incident elderly PD patients. Metrics

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Application of online closed two-way blood re-infusion in hemodiafiltration therapy ZHOU Shi-wen, HE Qing-shi, CHAI Dong-xue, LI Ping 2022, 21 (06):  525-529.  doi: 10.3969/j.issn.1671-4091.2022.06.016 Abstract ( 149 )   PDF (375KB) ( 105 )   Objective  To observe the effects of online closed two-way blood re-infusion at the end of hemodiafiltration therapy.  Methods   A total of 43 patients who received regular hemodialysis treatment in the Blood Purification Center of South Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine from May 1 to August 1 2020 were selected. Three methods of open blood return, closed two-way blood return and online closed two-way blood return were used respectively. Every patient received 8 times of blood return, and the blood return time of the three methods was compared.  Results  The shortest time of blood return was online closed two-way blood return (197.19±3.55)s, followed by open two-way blood return (198.85±4.41)s, and closed two-way blood return (213.74±7.99)s; the difference was statistically significant (F=2.898, P=0.009).  Conclusion   The online closed two-way blood return method is simple and can shorten the blood return time. As the main liquid for blood return, the replacement fluid is reduced to save medical expenses. This method is worthy of clinical promotion. Metrics