Chinese Journal of Blood Purification

12 August 2022, Volume 21 Issue 08 Previous Issue    Next Issue

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Clinical Practice Recommendation for Arteriovenous Access Thrombosis Treatment WANG Yu-zhu, ZHANG Li-hong, ZHAN Shen 2022, 21 (08):  545-459,568.  doi: 10.3969/j.issn.1671-4091.2022.08.001 Abstract ( 472 )   PDF (476KB) ( 471 )   Vascular access is the lifeline of maintenance hemodialysis patients. Arteriovenous fistula is the preferred vascular access, but it is prone to thrombosis which resulting in loss of fistula. Also, thrombosis is associated with hospitalization and all-cause mortality in maintenance hemodialysis patients. The establishment of vascular access and the treatment of complications in our country have made great progress in recent years, but there is a lack of systematic and standardized understanding of preoperative assessment, indications, method selection, technical points, and complication prevention for arteriovenous fistula thrombosis treatment. In view of this, the Department of Nephrology of Beijing Haidian Hospital drafted this recommendation with reference to relevant domestic and foreign literatures and a large amount of practical experience in our center, aiming to provide reference for nephrologists to standardize thrombosis treatment. Metrics

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The relationship between inflammatory state and anemia in maintenance hemodialysis patients with renal allograft failure  LIU Xu, ZHANG Ai-hua, DIAO Zong-li, LIU Wen-hu 2022, 21 (08):  550-553.  doi: 10.3969/j.issn.1671-4091.2022.08.002 Abstract ( 170 )   PDF (397KB) ( 60 )   Objective  To observe the indexes of inflammation and anemia in maintenance hemodialysis patients with kidney transplant failure (KTF), and to provide clinical basis for improving the therapeutic effect. Methods Fifty-four maintenance hemodialysis patients with kidney transplant failure were included in Beijing Friendship Hospital and other fifty-four hemodialysis patients who had not undergone kidney transplantation were selected as controls. The demographic data of the patients, the results of blood cell counts, the dosage of erythropoietin (EPO) were recorded, and neutrophil to lymphocyte ratio(NLR), platelet to lymphocyte ratio(PLR), lymphocyte to monocyte ratio(LMR) and EPO resistance index was calculated, and the setup of patients’ databases for statistical analysis of the clinical data.  Results  There was no significant difference in age (t=-1.095, P=0.276), gender (χ2=0.983, P=0.321), and the duration of dialysis (t=1.634, P=0.105) between the two groups. There was significant difference in the number of eosinophils [(0.21±0.21)×109/L vs. (0.43±0.54)×109/L, t=-2.639, P=0.010], NLR [(4.14±1.92) vs. (3.47±1.18) , t=2.156, P=0.033], LMR [(2.78±0.80) vs. (3.51±1.18), t=-3.794, P=0.005] between the two groups. There was no statistical difference in the dosage of EPO between the two groups (Z=-1.611, P=0.107). The median ERI of the KTF group was 13.59 (7.21, 20.37), which was higher than that of the control group, which was 9.12 (5.75, 13.48), and the difference was statistically significant (Z=-2.515, P=0.012). The patients' ERI was positively correlated with PLR (r=0.247, P=0.010), and negatively correlated with LMR (r=-0.217, P=0.024), which was statistically significant.  Conclusion  Hemodialysis patients with kidney transplant failure have a hyper-inflammatory state, which may be one of the influence factors leading to EPO resistance. Metrics

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Vitamin levels of elderly patients with continuous ambulatory peritoneal dialysis ZHOU Qi, YU Jian-peng, WANG Hai-yan, WANG Tie-yun, DU Jun, ZHAO Li-fang, LAI Xue-li 2022, 21 (08):  554-558.  Abstract ( 129 )   PDF (450KB) ( 160 )   Objective  To investigate vitamin levels of elderly patients with continuous ambulatory peritoneal dialysis and clinical significance of vitamin status, and to provide proper reference for nutritional intervention.  Methods  Totally, 242 patients undergoing continuous ambulatory peritoneal dialysis at Peritoneal Dialysis Center of Changhai Hospital from March 2019 to March 2021 were selected as subjects, with their age and sex recorded. The patients were divided into the elderly group and the non-elderly group. Vitamin levels and some other laboratory test results of these two groups were examined and compared. The correlation coefficient between vitamin levels and biochemical indicators of the elderly was also calculated.  Results  The serum creatinine levels (t=-6.989，P＜0.001), urea nitrogen levels (t=-2.044，P=0.042) and parathyroid hormone levels (t=-2.048，P=0.042) in the elderly group were lower than those in the non-elderly group. The levels of vitamin A (t=-2.629，P=0.009), vitamin B1(t=-2.115，P=0.035) and vitamin B9 (t=-2.250，P=0.025) in the elderly group were lower than those in the non-elderly group. Vitamin A (r=-0.223，P=0.036)and vitamin B6 levels (r=-0.270，P=0.011) were negatively correlated with age. Vitamin C (r=0.421，P＜0.001)and vitamin E (r=0.265，P=0.013)levels were positively correlated with hemoglobin levels. Vitamin B9 levels were positively correlated with triglyceride levels (r=0.218，P=0.042). And vitamin B2 levels were positively correlated with ferritin levels (r=0.217，P=0.043). The deficiency rates of vitamin A (χ2=5.826，P=0.016), vitamin B2 (χ2=20.823，P＜0.001) and vitamin B12 (χ2=8.150，P=0.004) in the elderly group were significantly higher than those in the non-elderly group.  Conclusion Vitamin deficiency is common in elderly patients with peritoneal dialysis and vitamin levels are associated with some clinical tests and examination indicators. It is necessary to monitor the vitamin levels of elderly patients and supplement them in time. Metrics

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The risk factors of severe hypocalcemia in patients with renal secondary hyperparathyroidism after parathyroidectomy  CHEN Dan, ZHAO Wen-man, WANG Xue-rong, WANG De-guang 2022, 21 (08):  559-563.  doi: doi:10.3969/j.issn.1671-4091.2022.08.004 Abstract ( 118 )   PDF (406KB) ( 132 )   Objective  To explore the risk factors of severe hypocalcemia in patients with renal secondary hyperparathyroidism (SHPT) after parathyroidectomy (PTX).  Methods A retrospective study was conducted on 784 patients with renal SHPT who underwent total parathyroidectomy and autologous transplantation (TPTX+AT) or total parathyroidectomy (TPTX). Patients were divided into severe hypocalcemia group (corrected serum calcium ＜1.8 mmol/L) and non-severe hypocalcemia group (corrected serum calcium ≥1.8 mmol/L) according to the serum calcium level at the first day after operation.  Results  There were 214 cases (27.3%) with severe hypocalcemia at the first day after PTX. Age (t=5.648, P＜0.001), dialysis age>5years  (Z=7.199, P=0.007), peritoneal dialysis (c2=4.985, P=0.026), preoperative hypocalcemia (c2=6.241, P=0.012), preoperative parathyroid hormone (PTH) level (Z=-8.902, P＜0.001), preoperative alkaline phosphatase (ALP) level (Z=-10.230, P＜0.001) and postoperative serum phosphorus reached the standard level (c2=3.988, P=0.046) were different between severe hypocalcemia group and non-severe hypocalcemia group. Multivariate logistic regression showed that younger age (OR=0.963, 95% CI 0.945~0.980, P＜0.001), preoperative hypocalcemia (OR=1.930, 95% CI 1.120~3.327, P=0.018), preoperative higher PTH level (OR=1.0004, 95% CI 1.000~1.001, P=0.016) and preoperative higher ALP level (OR=1.001, 95% CI 1.000~1.001, P=0.001) were the independent risk factors of severe hypocalcemia in renal SHPT patients after PTX.  Conclusion  Patients with younger age, preoperative hypocalcemia, higher preoperative ALP, and higher preoperative PTH level are more likely to develop severe hypocalcemia after TPTX+AT or TPTX. Metrics

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The use of Roxadustat to replace recombinant human erythropoietin in the treatment of renal anemia in maintenance dialysis patients   LI Lu, YIN Zhong-cheng, FENG Jin-hong, YANG Jing, QIU Xiao-nan, ZHANG Ying 2022, 21 (08):  564-568.  doi: doi:10.3969/j.issn.1671-4091.2022.08.005 Abstract ( 287 )   PDF (450KB) ( 101 )   Objective  To observe the use of Roxadustat to replace recombinant human erythropoietin (rhEPO) in the treatment of renal anemia in maintenance dialysis (MHD) patients.  Methods  Twenty-one MHD patients complicated with renal anemia and treated in The Affiliated Hospital of Xuzhou Medical University during August 2020 to October 2021 were enrolled in this study. They were treated with rhEPO using the dose based on body mass and anemia degree for at least 3 months, but their hemoglobin continued to be <100g/L. Roxadustat was then used to replace rhEPO therapy. They were followed up for an average period of 24 weeks. Their clinical indicators were compared before and after Roxadustat therapy.  Results  After 4, 8, 12, 16, 20 and 24 weeks of Roxadustat therapy, RBC count, hemoglobin and RBC specific volume became higher(F=10.290, 9.053 and 9.858 respectively;P＜0.001); reticulocyte count increased beginning from the 4th week, and the differences were statistically significant at the 8th, 12th and 24th weeks (F=6.031, P＜0.001) as compared with that before the Roxadustat therapy; total iron binding capacity increased after 12 and 24 weeks of Roxadustat therapy (F=9.336, P=0.002); total cholesterol and low density lipoprotein decreased (F=14.200 and 12.090; P＜0.001). After Roxadustat therapy, reticulocyte percentage, hemoglobin content in reticulocytes, immature reticulocyte ratio, serum iron, ferritin, transferrin saturation and erythropoietin (EPO) level remained unchanged as compared with those before Roxadustat therapy (F=0.881, 3.067, 0.476, 3.629, 2.783 and 1.910, and t=-1.020 respectively; P=0.421, 0.057, 0.679, 0.067, 0.093, 0.158 and 0.315 respectively).  Conclusions In MHD patients complicated with renal anemia and poor responses to rhEPO treatment, Roxadustat can effectively improve anemia and lipid metabolism, with less adverse reactions. Metrics

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Evaluation of continuous renal replacement therapy in neonates with acute renal injury  SUN Yi-fan, CHU Xiao-yun, WENG Bo-wen, HONG Wen-chao, GONG Xiao-hui, CAI Cheng 2022, 21 (08):  569-572.  doi: 10.3969/j.issn.1671-4091.2022.08.006 Abstract ( 159 )   PDF (454KB) ( 196 )   Objective  To investigate the efficacy and safety of continuous renal replacement therapy(CRRT) in neonates with acute kidney injury(AKI).  Method  The AKI neonates treated with CRRT and admitted to our department from January 2015 to October 2021 were enrolled. Serum creatinine(Scr), blood urea nitrogen(BUN), urine output and the use of vasoactive drugs were analyzed at the three time points (before treatment, after 12-24 hours and at the end of the treatment). The complications and prognosis were also observed. Result A total of 12 neonates were involved, including 9 males and 3 females with gestational age of (36.6±3.0) weeks and birth weight of (2765.4±697.6)g. The primary diseases included birth asphyxia (7 cases), pneumonia (one case), congenital omphalocele (one case), congenital jejunal atresia (one case), neonatal septicemia (one case) and meconium aspiration syndrome (one case). Their median age was 3 (1, 4.8) days, and the operation time was (73.5±59.5) h. Finally, 4 patients survived, one patient was given up, and 7 patients died. There was no significant difference in age between cured neonates and those who died or were given up (Z=-0.352, P=0.725). The complications included electrolyte imbalance (8 cases), thrombocytopenia (5 cases) and tube blockage (3 cases). Compared with those before CRRT, BUN was significantly decreased 12～24h after CRRT (Z=-2.118, P=0.034), BUN showed a downward trend at the end of treatment, but the difference was not statistically significant (Z=-1.257, P=0.232); Scr levels were significantly decreased (t=4.528,  P=0.001; t=3.372, P=0.006) and the urine output was significantly increased (Z=-2.670, P=0.008; Z=-2.937, P=0.003) after 12～24 hours of CRRT and at the end of CRRT. Eleven neonates were treated with vasoactive drugs before CRRT; after 12～24 hours of CRRT, one patient stopped using vasoactive drugs and 6 patients reduced the dosage; at the end of CRRT, 5 patients stopped using vasoactive drugs, and 3 patients reduced the dosage.  Conclusion  The application of CRRT in neonates with AKI is effective and safe, and the complications was controllable. Metrics

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Efficacy of air wave pressure therapy in preventing hemodialysis-associated muscle cramps  ZHAO Ying SHEN Bo 2022, 21 (08):  573-575.  doi: 10.3969/j.issn.1671-4091.2022.08.007 Abstract ( 161 )   PDF (391KB) ( 71 )   Objective  To explore the role of air wave pressure therapy in the prevention of hemodialysis-associated muscle cramps.  Methods A total of 47 patients with three or more hemodialysis-associated muscle cramps occurring within one month during the monitoring period and treated in the Blood Purification Center of Shaoxing Second Hospital were divided into the observation group (24 cases) and the control group (23 cases). The control group was treated with routine hemodialysis. The observation group was treated with routine hemodialysis plus air wave pressure. The occurrence of muscle cramps and hypotension were compared between the two groups.  Results  Compared with the control group, the incidence of hemodialysis-associated muscle cramps (14.5% vs. 26.2%; χ2=12.797, P＜0.001), and the mean modified Ashworth score (1.31±0.51 vs. 1.79±0.71; t=-4.006, P＜0.001) were lower in the observation group; the incidence of hypotension (13.2% vs. 23.2%; χ2=10.107, P=0.001) and the mean decrease of blood pressure (22.66±2.45 vs. 25.28±3.75 mmHg; t=-4.429, P＜0.001) were also lower in the observation group.  Conclusion Air wave pressure therapy can reduce the incidence and the degree of hemodialysis-associated muscle cramps and hypotension. Metrics

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Clinical investigation of regional citrate anticoagulation continuous venovenous hemodiafiltration with calcium-containing dialysate and replacement solution  XI Chun-sheng, LIU Tong-cun, CAI Rui-lian, ZHANG Meng, FANG Chun-tian, LIU Fei, WEI Yu-shen, WANG Jin-han 2022, 21 (08):  576-579.  doi: 10.3969/j.issn.1671-4091.2022.08.008 Abstract ( 316 )   PDF (434KB) ( 154 )   Objective  To investigate and evaluate the efficacy and safety of regional citrate anticoagulation continuous venovenous hemodiafiltration (RCA-CVVHDF) with calcium-containing dialysate and replacement solution.  Methods  The efficacy and safety of RCA-CVVHDF with calcium-containing dialysate and replacement solution performed in The 940th Hospital of Joint Logistics Support Force of Chinese PLA between Jul 1, 2021 and December 31, 2021 were retrospectively studied. Their CVVHDF operational characteristics, circuit outcomes and new-onset metabolic complications after RCA-CVVHDF with calcium-containing dialysate and replacement solution were analyzed.  Results   A total of 56 patients, 139 filters and 213 days of CRRT were analyzed. In the 56 patients, 43 were males (76.5%) and 13 were females (23.5%), with the average age of 59.6±20.8 years old (18-99 years old) The median filter life was 35±23h (6～72h), and filter life ≤24h, 25～48h, 49～72h and ≥72h were found in 37.4%, 34.5%, 17.3% and 10.8% respectively of the filters. Mild-to-moderate hypocalcemia and hyponatremia were observed in 18.0 and 5.0 per 100 CRRT days, respectively, but severe hypocalcemia, hyponatremia and any types of hypercalcemia and hypernatremia were not observed. Citrate accumulation was observed in 2.0 per 100 CRRT days, and metabolic acidosis occurred in 8.0 per 100 CRRT days. Conclusions   Under close monitoring, RCA-CVVHDF with calcium-containing dialysate and replacement solution can be effective and safe. This method is worth for further clinical practice. Metrics

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The value of serum TLR4 and HMGB1 in the early diagnosis of acute kidney injury in severely burned patients CHEN Jing-jing 2022, 21 (08):  580-583.  doi: doi:10.3969/j.issn.1671-4091.2022.08.009 Abstract ( 92 )   PDF (430KB) ( 40 )   Objective  To investigate the value of serum Toll-like receptor 4 (TLR4) and high mobility group protein B1 (HMGB1) in the early diagnosis of acute kidney injury (AKI) in severely burned patients.  Methods The clinical data of 45 patients with severe burn treated in Taizhou Hospital of Zhejiang Province from August 2019 to August 2021 were retrospectively analyzed. According to the presence or absence of AKI within one week after burn, they were divided into AKI group (n=20) and non-AKI group (n=25). Their basic data, acute physiology, age and chronic health evaluation II (APACHE II) and sequential organ failure estimation score (SOFA) were collected. Serum TLR4 and HMGB1 were detected by enzyme-linked immunosorbent assay at 24, 48 and 72 days after burn. The working characteristic curve (ROC) and area under the curve (AUC) were used to evaluate the value of serum TLR4 and HMGB1 in the early diagnosis of AKI in severely burned patients. Multivariate logistic regression was used to explore the risk factors for the occurrence of AKI in severely burned patients.  Results  SOFA score, APACHE Ⅱ score and serum Scr were higher in AKI group than in non-AKI group (t=16.839, 4.643 and 7.287 respectively; P＜0.001). Comparing between AKI group and non- AKI group, serum TLR4 levels were 4.12±0.36 vs. 2.33±0.25, 6.22±0.96 vs. 4.02±0.30, and 8.06±1.24 vs. 6.14±1.02 ng/ml after severe burn for 24, 48 and 72h respectively (t=8.076, 9.203 and 5.339 respectively; P＜0.001); serum HMGB1 levels were 9.63±2.28 vs. 6.23±1.20, 12.47±3.16 vs. 8.64±2.36, and 15.20±3.47 vs. 11.15±3.6 pg/ml after severe burn for 24, 48 and 72h respectively (t=4.951, 6.036 and 5.618 respectively; P＜0.001). Serum TLR4 and HMGB1 levels reached the highest at 72 hours after severe burn. ROC analysis showed that the AUC, cut-off value, sensitivity and specificity for serum TLR4 were 0.862, 4.50 ng/ml, 86.5% and 85.4%, respectively, and those for serum HMGB1 were 0.845, 6.22 ng/ml, 83.7% and 80.6%, respectively. The sensitivity and specificity of TLR4 (86.5% and 85.4%) and HMGB1 (83.7% and 80.6%) were higher than those of SOFA score (70.8% and 75.4%) and Scr (72.6% and 77.0%). SOFA score ≥4 points [OR (95% CI)=2.62 (1.40～4.91), P＜0.001], Scr≥133.00 μmol/L [OR (95% CI)=3.45 (1.52-7.89), P＜0.001], TLR4≥4.50 ng/ml [OR (95% CI)=3.87 (1.70～8.80), P＜0.001] and HMGB1≥6.22 pg/ml [OR (95% CI)=4.27 (2.10～8.70), P＜0.001] were the risk factors for AKI in severely burned patients.  Conclusion Serum TLR4 and HMGB1 levels increased in severely burned patients, and increased more in the severely burned patients with AKI. Both can predict AKI in severely burned patients. The two serum levels are expected to be used as biomarkers for the prediction of AKI in severely burned patients. Metrics

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A survey on the willingness to block the genetic disease in the family members of dialysis ADPKD patients  WU Ming-hong, LIU Yue, ZHU Bo-tao, WANG Yue, ZHI Xu, YANG Jie, ZHENG Dan-xia 2022, 21 (08):  584-587.  doi: 10.3969/j.issn.1671-4091.2022.08.010 Abstract ( 136 )   PDF (412KB) ( 57 )   Objective  To investigate the awareness and willingness to block the genetic disease by assisted reproduction technology in the family members of autosomal dominant polycystic kidney disease (ADPKD) patients, and the effect of education about genetic disease and reproductive intervention technology to these family members.  Methods  The ADPKD patients on dialysis were recruited from blood or peritoneal dialysis centers. Their family members aged 18-45 years old were surveyed by questionnaire, and re-surveyed after giving them genetic disease and reproductive intervention education.  Results  The whole questionnaire was completed in 40 family members, in which 18 were males and 22 were females with the mean age of 33.4±6.8 years, and 30 family members were diagnosed as ADPKD patients. After the genetic disease and reproductive intervention education, the awareness of ADPKD knowledge in these family members improved, the awareness rate of early diagnosis before renal cysts increased from 57.5% to 95.0% (c2=15.531, P＜0.001), and that of the possibility to breed healthy offspring by reproductive intervention increased from 55.0% to 92.5% (c2=14.526, P＜0.001). The awareness rate of the polycystic liver, waist pain, and hereditary pattern of ADPKD was >80% before the education. The acceptance rate of genetic testing and preimplantation genetic testing (PGT) was >85%. After the education, the rate of self-assessed understanding about genetic testing increased from 57.5% to 85.0% (c2=7.384, P=0.007), and the rate of self-assessed understanding about PGT increased from 52.5% to 77.5% (c2=5.495, P=0.019).  Conclusion  To effectively block the transmission of ADPKD by reproduction intervention, the advanced genetic counseling education in this study was precisely focused on the family members of dialysis ADPKD patients. Our results provide useful experiences of ADPKD prevention for nephrologists and dialysis nurses.  Metrics

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The regulatory role of p38 MAPK signaling pathway in the processes of neointimal hyperplasia in dialysis access vessels XIE Chun-he, WANG Bao-xing 2022, 21 (08):  588-591.  doi: 10.3969/j.issn.1671-4091.2022.08.011 Abstract ( 205 )   PDF (381KB) ( 191 )   The p38 mitogen-activated protein kinase (MAPK) signaling pathway is one of the important signaling systems that mediates extracellular to intracellular signaling to regulate a variety of pathophysiological processes such as cell proliferation, migration, differentiation, matrix deposition, inflammation and apoptosis. Hyper- or hypoactivation of this signaling pathway may lead to the development of various diseases, including neointimal hyperplasia-mediated autogenous arteriovenous fistula dysfunction. The p38 MAPK signaling pathway is closely related to neointimal hyperplasia that causes many cardiovascular diseases as well as vascular stenosis after arteriovenous fistulas, bypass grafting and angioplasty operations, resulting in health problems of the patients and even social financial burdens. Based on the role of p38 MAPK signaling pathway in neointimal hyperplasia, modulation of this signaling pathway may be an alternative way for the treatment of neointimal hyperplasia-related diseases. Metrics

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Clinical application of gradual peritoneal dialysis LV Jing 2022, 21 (08):  592-594,598.  doi: 10.3969/j.issn.1671-4091.2022.08.012 Abstract ( 198 )   PDF (406KB) ( 67 )   Gradual peritoneal dialysis (PD) is suitable for patients with better residual renal function. At the initial period, lower than the “full dose” dialysis combined with an appropriate protein diet and water and salt restriction were adopted to achieve the clearance of solute and fluid by both the residual renal and peritoneum. As the residual renal function changes with time, dialysis dose and ultrafiltration volume must be regulated gradually to maintain adequate clearance of solute and fluid. Gradual PD has the advantages of delayed loss of residual renal function, less complications, less medical expenses, and higher quality of life, as compared with the routine PD method. However, whether gradual PD leads to better clinical outcome remains to be identified. The suitable patients for this treatment profile, the schedule of PD dose adjustment, compliance of the patients and safety of gradual PD are yet controversial. Metrics

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PENG Kai-yue   HAN Qing-feng ENG Kai-yue, HAN Qing-feng 2022, 21 (08):  595-598.  doi: doi:10.3969/j.issn.1671-4091.2022.08.013 Abstract ( 678 )   PDF (403KB) ( 160 )   codextrin through a mechanism resembling ‘colloid’ osmosis forms effective ultrafiltration during the long dwelling phase of peritoneal dialysate. On the basis of the classic icodextrin dialysate-based treatment regimen, a variety of treatment schedules suitable for different clinical conditions have been developed, such as single daily use of icodextrin dialysate, twice daily use of icodextrin dialysate, and icodextrin combined with glucose peritoneal dialysate. Icodextrin dialysate can help control chronic heart failure and improve or maintain ventricular structure. The treatment regimen based on icodextrin dialysate will effectively improve our peritoneal dialysis treatment.  Metrics

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Advances in early warning system for acute kidney injury based on artificial intelligence  ZHAO Dan, YU chen, ZHANG Ying-ying 2022, 21 (08):  599-602.  doi: 10.3969/j.issn.1671-4091.2022.08.014 Abstract ( 233 )   PDF (391KB) ( 352 )   Acute kidney injury (AKI) is a common complication in hospitalized patients, and is associated with poor outcomes and higher mortality. Early identifying AKI before function loss is crucial to reverse the injury. Therefore, establishing an early-warning system for AKI is essential for clinicians to make the diagnosis and treatment decisions earlier. With the development of artificial intelligence, a variety of electronic alerts and machine learning-based predictive models to predict the risks of AKI have been developed. In the current review, we summarize the advances in the electronic systems based on artificial intelligence for predicting AKI.  Metrics

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ZHAN Shen, ZHAO Bin, ZHANG Li-hong, HOU Fang, WANG Yu-zhu ZHAN Shen, ZHAO Bin, ZHANG Li-hong, HOU Fang, WANG Yu-zhu 2022, 21 (08):  603-607.  doi: 10.3969/j.issn.1671-4091.2022.08.015 Abstract ( 277 )   PDF (486KB) ( 298 )   Objective  To evaluate the efficacy and safety of peripheral cutting balloon (PCB) angioplasty in the treatment of stenosis in autogenous arteriovenous fistula (AVF) or arteriovenous graft(AVG). Methods The maintenance hemodialysis patients treated with percutaneous transluminal angioplasty using PCB angioplasty in Beijing Haidian Hospital from September 2019 to September 2020 were retrospectively analyzed. Their clinical and follow-up data, primary patency and primary assisted patency after the operation for 3, 6 and 12 months were recruited.  Results  A total of 107 patients were enrolled in this study, including patients with AVF group (n=76) and those with AVG group (n=31). The technical success rate and clinical success rate were 100% in both groups. The mean pressure of opening stenosis was 8.68±1.20 atm in AVF group, and 9.35±1.66 atm in AVG group (t=-2.037, P=0.058). The primary patency rates after the operation for 3, 6 and 12 months were 85.5%, 57.9% and 42.1% respectively in AVF group, and were 67.7%, 38.7% and 25.8% respectively in AVG group (c2=4.415, P=0.036 after 3 months; c2=0.567, P=0.45 after 6 months; c2=2.499, P=0.114 after 12 months). The primary assisted patency rates after the operation for 6 and 12 months were 65.8% and 72.4% respectively in AVF group, and were 58.1% and 61.3% respectively in AVG group (c2=0.567, P=0.451 after 6 months; c2=1.267, P=0.260 after 12 months). Log-rank test showed that the cumulative patency rate was higher in AVF group than in AVG group (c2=4.338, RR=1.28, P=0.037).  Conclusions  PCB angioplasty is effective and safe in the treatment of hemodialysis access stenosis, and has better effects in AVF group than in AVG group. However, the effects of this method need to be further investigated due to our less patient number and shorter follow-up period. Metrics

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The efficacy of intervention therapy for central venous lesions in hemodialysis patients  XIONG Liang-wei, CUI Tian-lei 2022, 21 (08):  608-612.  doi: 10.3969/j.issn.1671-4091.2022.08.016 Abstract ( 152 )   PDF (406KB) ( 138 )   Objective  To observe the efficacy of intervention for central venous stenosis (CVS) or central venous occlusion(CVO) in maintenance hemodialysis (MHD) patients, and to explore the risk factors for relapse after central venous (CV) recanalization.  Method  A total of 94 cases with CVS or CVO admitted to West China Hospital, Sichuan University between June 2015 and March 2020 were retrospectively studied. They were divided into non-relapse group (n=33) and relapse group(n=61) based on the primary patency in the 18 months after CV recanalization. The average follow-up period was 32.53±11.07 months. The technical success rate of CVO recanalization after CV intervention therapy, and the primary patency rate and secondary patency rate after CV recanalization were evaluated. Cox regression was used to analyze the risk factors for relapse after CV recanalization.  Results  ①Technical success rate of CVO recanalization after CV intervention therapy was 96.23%; ②After CV recanalization for 6, 12, 18 and 24 month, the primary patency rates were 91.50%, 58.50%, 30.90% and 10.60% respectively, and the secondary patency rates were 98.80%, 93.80%, 92.50% and 88.80% respectively; ③Cox regression showed that smaller original vascular diameter at the abnormal CV site (HR=0.81, 95% CI: 0.69～0.94, P=0.006), longer CV lesion (HR=1.06, 95% CI: 1.03～1.08, P<0.001), no stent inserted (HR=0.32, 95% CI: 0.21～0.50, P<0.001), and higher serum calcium (HR=4.35, 95% CI: 1.34～14.13, P=0.014) were the risk factors for relapse after CV recanalization; ④Rank-sum test revealed that the length of CV lesions was longer in stent group(n=60) than in non-stent group (n=34)             (Z= -2.037, P=0.042).  Conclusions  Technical success rate of CVO recanalization after CV intervention therapy was high with controllable risks. Multiple intervention therapies can improve the secondary patency rate of CV recanalization. The smaller original diameter at the CV lesion site, longer CV lesion, and higher serum calcium were the risk factors for relapse after CV recanalization. Stent placement after recanalization of longer CV lesion can improve the primary patency rate. Metrics

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Clinical application of early cannulation graft FLIXENE™  for hemodialysis patients  WU Chang, MI Lan-hua, SHI Ya-xue, LIU Si-jie, BAO Xue-dong, YU Min, HU Wen-ping 2022, 21 (08):  613-616.  doi: 10.3969/j.issn.1671-4091.2022.08.017 Abstract ( 267 )   PDF (456KB) ( 263 )   Objective  To summarize the preliminary clinical application results of FLIXENE™ (Atrium™, Hudson, NH, USA), an early cannulation artificial vascular graft.  Methods  A total of 48 cases subjected to arteriovenous graft construction using the early cannulation FLIXENE™ vascular graft at the Department of Vascular Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from August 2019 to October 2021 were retrospectively analyzed. The first cannulation time, patency rate and incidence of complications were summarized.  Results   There were 18 males and 30 females, with an average age of 60.06±11.93 years. The arteriovenous graft was established in upper limbs (n=40) or in lower limbs (n=8), with the clinical success rate of 100% and without any perioperative complications. The first cannulation time after operation was 15～336h, with the median time of 20 (18, 22) h. The average follow-up time was 224.77±151.73 days, and the follow-up rate was 100%. Complications included thrombus (2 cases), stenosis (9 cases) and infection (2 cases). No hematoma at puncture site, seroma, pseudoaneurysm, or steal syndrome occurred. After the operation for 3, 6 and 12 months, the primary patency rates were 95.3%, 87.4% and 63.0%, respectively, the primary assisted patency rates were 100%, 97.4%, and 92.2% respectively, and the secondary patency rates were 100%.  Conclusions  The early cannulation FLIXENE™ vascular graft is safe and feasible for early cannulation hemodialysis.  Metrics

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The correlation between seasonal variation and dechlorination performance by activated carbon in the dialysis center  LIU Xiao-hui, YANG Yan, QU Xin-yi, DENG Chuo, TIAN Ai-hui, CHEN Yu-qing 2022, 21 (08):  617-620.  doi: 10.3969/j.issn.1671-4091.2022.08.018 Abstract ( 127 )   PDF (640KB) ( 79 )   Objective To clarify the decisive factors affecting the dechlorination performance in the pretreatment system of dialysis water.  Methods Total chlorine concentration, pH and water temperature were monitored in the 5 samples from tap water at input site, resin tank, carbon tank 1, carbon tank 2 and reverse osmotic water in a total of 235 dialysis days from January to September 2020. Pearson correlation analysis was used to investigate the correlation between total chlorine level behind carbon tank 1 and total chlorine, pH and temperature in tap water. Stepwise linear regression (backward) analysis was used to explore the specific correlation.  Results  The total chlorine behind carbon tank 1 was negatively correlated with tap water temperature (r=-0.936, P<0.001), and positively correlated with pH (r=0.360, P<0.001) and total chlorine (r=0.235, P<0.001) in tap water. Stepwise linear regression analysis showed that tap water temperature was negatively correlated with the total chlorine level behind carbon tank 1 (𝛽=-0.936, P<0.001).  Conclusion  Tap water temperature is the decisive factor affecting the dechlorination performance in the pretreatment system of dialysis water. Seasonal low temperature of tap water affected the dechlorination efficiency by the activated carbon tank in the water pretreatment system. Metrics

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Reliability and validity of the Uremic Pruritus in Dialysis Patients Scale (Chinese version)  CAO Pei-ye, WANG Ying, LU Jiao-jian, GAN Liang-ying 2022, 21 (08):  621-624.  doi: 10.3969/j.issn.1671-4091.2022.08.019 Abstract ( 294 )   PDF (420KB) ( 125 )   Objective   To translate the English version of the Uremic Pruritus in Dialysis Patients Scale (UP-Dial) into Chinese, and to test its reliability and validity.  Methods   According to the Brislin’s translation model, the English version of UP-Dial was subjected to translation, back-translation and cultural adjustment to form the Chinese version of UP-Dial. Reliability and validity of the Chinese UP-Dial were evaluated through investigation among 132 patients in Peking University People’s Hospital.  Results  The Chinese UP-Dial contained 11 items. The exploratory factor analysis extracted 3 common factors, and the cumulative variance contribution rate was 69.981%. The content validity index of the total scale was 0.93. The Chinese UP-Dial and numerical rating scale were highly correlated (r=0.687, P＜0.001). The Cronbach's α coefficient of the total scale was 0.931, and the rest-retest reliability of the total scale was 0.875.  Conclusion  The Chinese version of UP-Dial has better reliability and validity. It can be used to evaluate pruritus in dialysis patients. Metrics