Chinese Journal of Blood Purification

12 September 2022, Volume 21 Issue 09 Previous Issue    Next Issue

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Calciphylaxis, calcific uremic arteriolopathy or others ZUO Li 2022, 21 (09):  625-627.  doi: 10.3969/j.issn.1671-4091.2022.09.001 Abstract ( 232 )   PDF (362KB) ( 51 )   Calciphylaxis is often used by nephrologist to describe a kind of painful skin dry gangrene in some uremic patients. The underlining mechanisms of the skin gangrene is attributed to arterial smooth muscle cells active transformation to osteoblast-like cells, and medium layer calcification, lumen thrombosis and obstruction followed. But when the word calciphylaxis created, it had nothing to do with arterial medium layer calcification. It then was renamed as calcific uremic arteriolopathy. But, calciphylaxis, with the above-mentioned meaning, can also occurred in patients without uremia; never the less, it can also be detected in larger arteries outside organs. It seems now that calcific uremic arteriolopathy is also not a proper name for this condition. Then, what is the proper name for this skin change with medium layer calcification as underlining mechanism? Metrics

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Calciphylaxis is a misnomer and the Chinese translation of calciphylaxis is also a wrong name Yangming Cao 2022, 21 (09):  628-632.  doi: 10.3969/j.issn.1671-4091.2022.09.002 Abstract ( 213 )   PDF (609KB) ( 136 )   This review article explains that the term calciphylaxis originated from an animal model studying dermatomyositis in 1961. Shortly, it was borrowed to explain the calcification syndrome found in chronic kidney disease patients. But calciphylaxis in animal model and the calcification syndrome in kidney patients have different pathogenesis and different pathological findings. Obviously calciphylaxis is a misnomer for kidney patients. Therefore, calcific uremic arteriolopathy (CUA) was proposed to explain the calcification syndrome in kidney patients. However, this syndrome can also occur in patients without kidney failure, including patients with normal kidney function, which will make CUA not suitable for such patients. Therefore,recently we proposed the term“calcific arteriolopathy”to more accurately describe this calcification syndrome in patients with normal kidney function as well as those with kidney diseases. We also shared our experience in diagnosing CUA. For comparison, Martorell HYTILU (hypertensive ischemic leg ulcer), a diagnosis not commonly made in many countries, is reviewed. Apparently HYTILU and calciphylaxis are the same entity. In addition, we also points out that the term calciphylaxis is the combination of calcium and anaphylaxis, while  while “钙化防御” “ (calcification defense”)is obviously from the combination of calcium and prophylaxis. In other words, the previous translator mistook anaphylaxis for prophylaxis. Therefore calcific arteriolopathy is a better term to describe the syndrome and is easier to be translated into Chinese. Metrics

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Influence of Roxadustat on blood pressure in peritoneal dialysis patients ZHAO Yu- chao, ZHAO Huiping, WU Bei, ZHU Li, LU Li-xia, ZUO Li, WANG Mei 2022, 21 (09):  633-637.  doi: 10.3969/j.issn.1671-4091.2022.09.003 Abstract ( 475 )   PDF (415KB) ( 54 )   Objective To assess the influence of Roxadustat on blood pressure in peritoneal dialysis (PD) patients through a retrospective, self-controlled cohort study. (PD) patients through a retrospective, self-controlled cohort study. Methods PD Patients who were treated with Roxadustat for at least 4 months, and were treated with rHuEPO for at least 1 year before the application of Roxadustat were enrolled in this study. Baseline clinical data and the clinical data of each month after the application of Roxadustat were collected for a total of 4 months. Clinical data of patients during the same period of 1 year ago when patients were treated with rHuEPO were also collected. Compare the differences between baseline and after taking Roxadustat, and the difference between Roxadustat phase and rHuEPO phase. Results A total of 38 PD patients were enrolled in the study. Systolic blood pressure (SBP) at baseline was 144.6±18.5 mmHg, after taking Roxadustat for 1 month, 2 months, 3 months and 4 months, SBP was 139.2±17.5 mmHg, 134.3±15.9 mmHg, 137.4±16.9 mmHg and 137.2±14.5 mmHg respectively. SBP decreased after taking Roxadustat compared with baseline (1 month：t was 2.285, P was 0.028；2 month: t was 3.408, P was 0.002；3 month t was 2.223，3 month P was 0.032；4 month t was 2.521，P was 0.030 respectively). There were no significant differences in defined daily dose of anti- hypertensive drugs after Roxadustat treatment compared with baseline. Conclusion After switching rHuEPO to Roxadustat, hypertension caused by rHuEPO can be avoided after excluding factors that may affect blood pressure in PD patients, such as season, volume, and dose of antihypertensive drugs. Metrics

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A comparative study on the association of all-cause mortality with different definitions of intradialytic hypotension CAO Hu-nan, FAN Rui, KONG Ling, CHENG Shui-qin, CHEN Yi-hong, LV Gui-lan 2022, 21 (09):  638-643.  doi: 10.3969/j.issn.1671-4091.2022.09.004 Abstract ( 266 )   PDF (626KB) ( 42 )   Objective To compare the association between intradialytic hypotension (IDH) using different definitions and all- cause mortality in maintenance hemodialysis (MHD) patients. Methods Data from 407 patients were retrospectively analyzed. The K-M curves based on the 9 different definitions were established, and the cutoff value for the incidence of IDH with maximum difference in the K-M curve was used to distinguish frequent IDH from non-frequent IDH. Cox proportional hazard regression model was conducted to compare the correlation between frequent IDH and all-cause mortality. C-index, Akaike Information Criterion(AIC), Net Reclassification Index (NRI) and Integrated Discrimination Improvement (IDI) were used to evaluate efficiency and quality of the model. Finally, the dose-response effect between the frequency of IDH and allcause mortality was explored by strict cubic spline regression. Results A total of 198,883 dialysis data were collected during the 56-month follow-up period, and 35 patients (8.6%) died with an average death rate of 2.6 per 100 person-years. The proportion of never having IDH using an IDH definition ranged from 0% to 46.4%, and the average incidence of IDH ranged from 0.7% to 46.0%. After adjusting for confounding variables, frequent IDH that defined by the British Kidney Association (UKKA) guidelines was significantly associated with all-cause mortality (HR=6.762, 95% CI:3.272～13.977, P＜0.001). The C-index, AIC, NRI and IDI of the model were 0.749, 380.957, 0.381 and 0.093 respectively; there was a significant non-linear relationship between the frequency of IDH and the risk of all- cause mortality (Wald χ2=3.875, P=0.049). Conclusion IDH is common, and its incidence varies using different definitions. Redefinition of IDH may reduce the variation. Using the UKKA guidelines, the risk of all-cause mortality increased with the frequency of IDH. Frequent IDH was significantly associated with all-cause mortality, which is closely related to clinical practice to reveal the association between IDH and all-cause mortality. Metrics

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Influence of interdialytic weight gain variation on prognosis in maintenance hemodialysis patients WU Jia-jun, HE Hai-dong, WANG Hua, SUN Wei-qian, TANG YU-yan, TONG Yi-jing, XU Xu-dong 2022, 21 (09):  644-649.  doi: 10.3969/j.issn.1671-4091.2022.09.005 Abstract ( 167 )   PDF (538KB) ( 58 )   Objective To observe the influence of interdialytic weight gain (IDWG) variation on prognosis in maintenance hemodialysis (MHD) patients. Methods The general information, laboratory indicators and patient outcomes of 229 MHD patients during October 2018 to October 2021 were recruited from the Department of Nephrology, Minhang Hospital, Fudan University. According to the interdialytic weight gain coefficient of variation (IDWG-CV), patients were divided into three groups: high IDWG variation group (IDWG-CV average of 0.617), moderate IDWG variation group (IDWG-CV average of 0.345) and low IDWG variation group (IDWG-CV average of 0.231). The relationship between IDWG-CV and all-cause mortality and cardiovascular disease mortality was analyzed. Results In the 229 MHD patients, the mean age was 61.79±14.47 years, the mean age of dialysis was 58.93±21.10 months (95% CI: 56.187～61.682), and 55 patients (24%) died, among which 24 patients (10.5%) died of cardiovascular diseases. The all-cause mortality in the high IDWG variation group was higher than that in the moderate and low IDWG variation groups but without statistical significance (31.6% vs. 24.7% vs. 15.8%, χ2=5.219, P=0.074). The cardiovascular disease mortality in the high IDWG variation group was also higher than that in the moderate and low IDWG variation groups (18.4% vs. 9.1% vs. 3.9%, χ2=8.724, P=0.013). Subgroup of the patients based on whether IDWG variation of the patient was in the target range showed that all-cause mortality and cardiovascular disease mortality were higher in the patients with higher IDWG variation out of the target range than in the patients in other 5 groups (For all- cause mortality: 51.4% vs. 14.6%, 40.0%, 17.3%, 33.3% and 6.1%; χ2=22.351, 2.030, 11.379, 0.765 and 11.831; P＜0.001, 0.154, 0.001, 0.382 and 0.001. For cardiovascular disease mortality: 31.4% vs. 7.3%, 16.0%, 5.8%, 3.7% and 4.1%; χ2=11.672, 7.506, 10.201, 1.851 and 7.305; P=0.001, 0.006, 0.001, 0.174 and 0.007). COX regression showed that advanced age (HR=2.365, 95% CI: 1.160～4.822, P=0.018), oliguria (HR=0.525, 95% CI: 0.284～0.972, P=0.040), hypoproteinemia (HR=0.291, 95% CI: 0.162～0.522, P＜0.001) and higher IDWG (HR=3.385, 95% CI: 1.909～6.002, P＜0.001) were the independent risk factors for all- cause mortality in MHD patients; hypoproteinemia (HR=0.223, 95% CI: 0.087～ 0.575, P=0.002) and higher IDWG (HR=3.318, 95% CI: 1.387～7.940, P=0.007) were the independent risk factors for cardiovascular disease mortality in MHD patients. Kaplan-Meier survival analysis showed that the patients with IDWG variation not in the target range had higher all-cause mortality and cardiovascular disease mortality than those with IDWG variation in the target range (χ2=26.570 and 10.423, P＜0.001 and 0.001). The patients with higher IDWG variation had higher all-cause mortality and cardiovascular disease mortality than those with moderate and low IDWG variation (χ2=7.116 and 10.097, P=0.028 and 0.006).  Conclusions MHD patients with higher IDWG variation have higher all-cause mortality and cardiovascular disease mortality. Patients with higher IDWG variation out of the target range have a higher mortality. Control of the IDWG variation within the target range and with low IDWG variation may be beneficial in improving survival rate in MHD patients. Metrics

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Clinical efficacy of sacubitril/valsartan in maintenance hemodialysis patients with heart failure LU Hai-feng, XU Dan-ping, PENG Wang-ying, DONG Yang, WANG Nian-song, SHENG Xiao-hua 2022, 21 (09):  650-654.  doi: 10.3969/j.issn.1671-4091.2022.09.006 Abstract ( 457 )   PDF (403KB) ( 59 )   Objective  To investigate the clinical efficacy of sacubitril/valsartan in maintenance hemodialysis (MHD) patients with heart failure.  Methods  A retrospective cohort study was performed in the MHD patients with heart failure treated in Sixth People's Hospital Affiliated to Shanghai Jiao Tong University from January 1, 2020, to July 31, 2021. Patients who took the medicine for more than 3 months were included in this study. Clinical data, demographic characteristics, laboratory indicators, echocardiography, adverse response of the treatment, and endpoint events were recorded.  Results  A total of 54 patients were enrolled and followed up for 3 months. Sacubitril/valsartan treatment significantly reduced NT-proBNP (15213.15±12110.44 vs. 7823.21±7457.71ng/L, t=7.053, P＜0.001), interventricular septal thickness dimension (IVSTd; 10.24±1.81 vs. 9.79±1.96mm, t=2.557, P=0.013), left ventricular posterior wall thickness dimension (LVPWTd; 10.04±1.69 vs. 9.44±1.61mm, t=2.728, P=0.009), left ventricular mass index (LVMI; 126.30±42.79 vs. 113.81±34.74g/m2, t=3.059, P=0.003), systolic blood pressure (SBP; 160.46±16.43 vs. 139.19±15.21mmHg, t=12.381, P＜0.001) and diastolic blood pressure (DBP; 79.57±11.97 vs. 69.67±10.43mmHg, t=7.070, P＜0.001). Meanwhile, left ventricular ejection fraction (LVEF) increased after three months of the treatment (55.76±8.30% to 60.02±6.18%, t=-4.323, P＜0.001). There were no significant differences in dry body mass (t=0.465, P=0.644), body mass gain (t=0.350, P=0.728), ultrafiltration (t=-0.019, P=0.985), parathyroid hormone (PTH, t=-1.660, P=0.103), serum creatinine (Scr, t=-1.452, P=0.152), Kalium (K, t=-1.806, P=0.077), Natrium (Na, t=0.400, P=0.690), Calcium (Ca, t=-1.376,  P=0.175), Phosphorus (P, t=-0.193, P=0.848), hemoglobin (HGB, t=-0.710, P=0.481) and albumin (ALB, t=-1.823, P=0.074) before and after the treatment.  Conclusion  Sacubitril/valsartan could effectively and safely relieve the clinical symptom of heart failure, improve cardiac function indicators, reduce left ventricular hypertrophy, reverse left ventricular remodeling, and lower blood pressure in MHD patients with heart failure. Metrics

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The sequential therapy of sustained low efficiency dialysis and intermittent hemodialysis in uremic patients with diabetes mellitus  XIA Yu-lian, LI Xiang-lian, MO Li-wen, ZENG Yan, XIAO Dan, ZHANG Fan, LI Yi, CHENG Cai-juan, CHENG Yue 2022, 21 (09):  655-658.  doi: 10.3969/j.issn.1671-4091.2022.09.007 Abstract ( 227 )   PDF (400KB) ( 209 )   Objective  To observe the efficacy of the sequential therapy of sustained low efficiency dialysis (SLED) and intermittent hemodialysis (IHD) in uremic patients with diabetes mellitus, and to explore better and practical hemodialysis treatment model.  Methods  Uremic patients with diabetes mellitus who were undergoing maintenance hemodialysis for more than 3 months were enrolled in this study. The patients were divided into sequential group (IHD twice a week and SLED once a week) and conventional group (IHD 3 times a week). Blood pressure, blood pressure variability, dialysis dehydration, BNP, Kt/V and urea reduction ratio (URR) were compared between the two groups.  Results  There were 10 patients in the sequential group and 24 patients in the conventional group. Systolic blood pressure (SBP) before dialysis (t=-1.053,     P=0.300), diastolic blood pressure (DBP) before dialysis  (t=-1.020, P=0.315),  SBP at 2 hours of dialysis  (t= -1.861, P=0.072), DBP at 2 hours of dialysis (t=-1.227, P=0.229), SBP after dialysis (t=-1.901, P= 0.066), DBP after dialysis (t=-0.945, P=0.354), systolic blood pressure standard deviation (SBP_SD) between dialysis (t=-1.784, P=0.084), and DBP_SD between dialysis (t=-1.530, P=0.136) showed no statistical significances between the two groups. The variability of systolic blood pressure during follow up period (SBP_SD before dialysis) was significantly lower in the sequential group than in the conventional group (t=-2.166，P=0.038); Kt/V (t=2.878, P=0.007) and URR (t=2.643, P=0.013) were higher in the sequential group than in the conventional group.  Conclusion  Compared with conventional IHD, the sequential therapy of SLED and IHD can better control the blood pressure variation between dialysis, ensure the stability of hemodynamics, and improve the adequacy of dialysis. Metrics

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Correlation between 25-hydroxyvitamin D level and vascular calcification in dialysis patients  SHENG Yu-ping, MA Xiao-ying, YANG Xing-meng, ZHANG Hao-ran, WANG Na, XU Hai-ping, SUN Fu-yun 2022, 21 (09):  659-663,680.  doi: 10.3969/j.issn.1671-4091.2022.09.008 Abstract ( 201 )   PDF (969KB) ( 147 )   Objective  To observe 25-hydroxyvitamin D [25(OH)D] evel and abdominal aortic calcification (AAC) in dialysis patients, and to investigate the relationship between 25(OH)D level and vascular calcification (VC).  Methods   We enrolled 100 dialysis patients from Cangzhou Central Hospital in this study. Their clinical laboratory data were collected. Abdominal lateral radiographic image was performed to evaluate AAC and to calculate AAC score (AACs). Spearman correlation analysis was used to analyze the relationship between 25(OH)D level and AACs. Logistic regression was used to analyze the risk factors for AAC. Receiver operating curve (ROC) was used to evaluate the accuracy of 25(OH)D level for the prediction of AAC.  Results   Among the 100 dialysis patients, the incidence of vitamin D deficiency was 61% and the incidence of AAC was 72%. 25(OH)D level was negatively correlated with the degree of AAC (r=-0.605, P＜0.001). Logistic regression showed that age (OR=1.067, 95% CI: 1.025～1.207, P=0.013), 25(OH)D level (OR=0.889, 95% CI: 0.819～0.971, P=0.011) and dialysis modality (OR=0.977, 95% CI: 0.802～0.964, P=0.038) were the independent influence factors for the occurrence of AAC. ROC showed that when the cut-off value of 25(OH)D level for the prediction of AAC was set at 13.8ng/ml, the curve under the area was 0.721(95% CI: 0.589～0.853, P=0.001), with the sensitivity of 63.9%, the specificity of 60.7%, and Yoden index of 0.246.  Conclusion   25(OH)D level is negatively correlated with VC in dialysis patients. Low 25(OH)D level is one of the independent risk factors for VC. Monitoring 25(OH)D level in dialysis patients may be useful for the prediction of VC risk. Metrics

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Application of gabapentin in the treatment of hemodialysis patients  LI Qing-lei, MENG Jian-zhong 2022, 21 (09):  664-667.  doi: 10.3969/j.issn.1671-4091.2022.09.009 Abstract ( 422 )   PDF (384KB) ( 276 )   With the higher prevalence and the longer survival of uremia patients in our country, the shortage of hemodialysis professionals prevails and accounts for the insufficiency of hemodialysis technologies in basic communities. The advanced assistant dialysis measures, such as high flux hemodialysis, hemoperfusion and drugs of expensive prices, are hardly to be adopted in several areas due to the different health insurance policies, causing dialysis inadequacy and hemodialysis complications in many patients in these areas. Gabapentin (GBP) has a better therapeutic effect in the treatment of many hemodialysis complications. We therefore searched the databases of PubMed and CNKI for the studies in recent years about GBP in the treatment of hemodialysis complications, including uremic pruritus, restless legs syndrome and uremic peripheral neuralgia. In this paper, we try to provide the therapeutic strategies against hemodialysis complications by using GBP for hemodialysis professionals. Metrics

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Clinical characteristics and treatment of specific skin diseases in maintenance hemodialysis patients     LI Yu-mei, SHI Jun-bao 2022, 21 (09):  668-671.  doi: 10.3969/j.issn.1671-4091.2022.09.010 Abstract ( 233 )   PDF (387KB) ( 116 )   There are many complications in maintenance hemodialysis patients. In addition to the well-known dialysis-related complications, the awareness of rare skin diseases in hemodialysis patients has been increasing in recent years, such as acquired perforating dermatosis, nephrogenic systemic fibrosis, porphyria cutanea tarda, pseudoporphyria, calciphylaxis, and others. The causes of specific skin diseases complicated with hemodialysis are complex, the clinical manifestations are different, and the treatment measures are also different. Early identification, correct diagnosis, timely prevention and treatment of these specific skin diseases can effectively improve quality of life and prognosis of hemodialysis patients. Metrics

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Recent progress in the diagnosis and treatment of central vein stenosis in hemodialysis patients LIU Ying-ting, ZHANG Jing, ZHANG Sheng-nan, JIAN Xun, HU Shi-de, LI Jing 2022, 21 (09):  672-675.  doi: 10.3969/j.issn.1671-4091.2022.09.011 Abstract ( 300 )   PDF (382KB) ( 193 )   Hemodialysis access is severely affected by central vein stenosis (CVS) in hemodialysis patients. Therefore, the diagnosis and treatment of CVS are of great importance. Early and accurate diagnosis of CVS is the premise of effective treatment that benefits the patients. This article gives a review about the diagnosis and treatment of CVS in hemodialysis patients for clinical reference. Metrics

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Preoperative abdominal aortic calcification score to predict dysfunction of newly-built arteriovenous fistula ZHUANG Feng, XIAN Shu-li, WANG Ying-deng 2022, 21 (09):  676-680.  doi: 10.3969/j.issn.1671-4091.2022.09.012 Abstract ( 193 )   PDF (423KB) ( 160 )   Objective  To observe the relationship between aortic calcification and primary patency rate of autologous internal fistula in maintenance hemodialysis patients, and to explore the possibility of predicting the dysfunction of autologous internal fistula by aortic calcification score.  Methods  A total of 88 patients who underwent autologous arteriovenous fistula and hemodialysis for the first time in our hospital were selected. Their abdominal aortic calcification index (ACI) at the time of internal fistula surgery was recorded. According to the results of ACI, the patients were divided into high calcification group and low calcification group. The primary patency rate of autologous internal fistula within 3 years was observed in the two groups.  Results   Seventy patients (93.33%) had different degrees of aortic calcification, including 35 patients in the high calcification group (ACI ≥10%). During the 3-year follow-up period, a total of 31 patients developed various internal fistula dysfunctions, including thrombosis in 17 cases and internal fistula stenosis in 10 cases. After 12, 24 and 36 months, the primary patency rates of internal fistulas were 92.5%, 85% and 76.9% in low calcification group, and were 88.6%, 68.5% and 45.9% in high calcification group (χ2=7.182, P=0.007). COX regression showed that autologous internal fistula dysfunction was related to ACI (HR=5.788, 95% CI:1.488～22.514, P=0.011).  Conclusions  Higher ACI is related to the dysfunction of autologous arteriovenous fistula within 3 years. Internal fistula function dysfunction should be monitored and treated earlier in patients with higher ACI to prolong the survival of internal fistula. Metrics

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Effects of different types of vascular access on survival of maintenance hemodialysis patients  AN Na, LI Hong, CHEN Ru-man, WANG Chun-li, BAI Ya-fei, XU Ming-zhi, WANG Cui-juan 2022, 21 (09):  681-685.  doi: 10.3969/j.issn.1671-4091.2022.09.013 Abstract ( 162 )   PDF (436KB) ( 136 )   Objective  To investigate the effects of different vascular access types on survival of maintenance hemodialysis (MHD) patients.  Methods  A prospective cohort study was performed, which included 216 MHD patients treated in Hainan Provincial People's Hospital from January 1, 2017 to December 31, 2017. The patients were followed up for 3 years. According to vascular access type, they were divided into 2 groups: autologous arteriovenous fistula (AVF) group and tunneled cuffed catheter (TCC) group. The observation endpoint was all-cause death in the follow-up period of 3 years.  Results  ①In the 216 MHD patients, 86 patients were in the age of ≥60 years, 60 patients (27.8%) had diabetic nephropathy, 132 (61.1%) were males, 55 patients (25.5%) were in the TCC group.  ②The cause of death was similar between the two groups (χ2=0.676, P=0.879). In AVF group, the first cause of death was cardiovascular events (39.5%), followed by infection (30.2%); in TCC group, the first cause of death was infection (39.3%), followed by cardiovascular events (35.7 %). ③The cumulative survival rate in the 3-year follow-up period was higher in AVF group than in TCC group (χ2=9.618, P=0.002). ④ Univariate regression showed that age (OR=2.854, 95% CI 1.766～4.612, P<0.001), dialysis vintage (OR=0.973, 95% CI 0.963～0.983, P<0.001), primary disease (OR=2.296, 95% CI 1.435～3.673, P=0.001), vascular access (OR=2.091, 95% CI 1.294～3.378, P=0.003), albumin (OR=4.281, 95% CI 2.050～8.938, P<0.001) and chest CT findings (OR=0.409, 95% CI 0.255～0.655, P<0.001) were the important factors affecting all-cause death. ⑤ Multivariate Cox regression after correction for primary disease, age, dialysis vintage, hemoglobin, albumin, chest CT findings showed that vascular access was not the independent risk factor for all-cause death in MHD patients (OR=0.921, 95% CI 0.545～1.557, P=0.759); while dialysis vintage (OR=0.976, 95% CI 0.966～0.986, P<0.001), albumin (OR=2.898, 95% CI 1.327～6.330, P=0.008) and chest CT findings (OR=2.060, 95% CI 1.258～3.376, P=0.004) were the independent risk factors for all-cause death in MHD patients.  Conclusions  AVF and TCC as the vascular access types have no direct effect on survival in MHD patients. Active correction of malnutrition, albumin level, lung inflammation as well as chest CT abnormalities may improve the survival of MHD patients Metrics

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Strategy and status of nosocomial infection control in hemodialysis centers: experience from Beijing Blood Purification Quality Control and Improvement Center ZHANG Yue, XIANG Jing, WEI Tao, WU Ying-hong, MA Zhi-fang, GUO Wang, DIAO Zong-li, LIU Wen-hu 2022, 21 (09):  686-691,701.  doi: 10.3969/j.issn.1671-4091.2022.09.014 Abstract ( 189 )   PDF (638KB) ( 131 )   Objectives   To establish the strategy for and to understand the present status of nosocomial infection control among hemodialysis units in Beijing.   Methods   The newly customized strategy was built based on the national policy of nosocomial infection control and the standard operating procedure for blood purification under the cooperation of nephrologist, specialists for nosocomial infection control, and experts in medical administration. The investigation consisted of the following 8 fields (including control of 91 risk behaviors): quality certification for units and professionals, structural configuration of hemodialysis units, establishment and implement of management system for infection control, occupational protection and hand hygiene, management for blood borne diseases, implement of infection control measures, infection control for different functional areas, and standardized management for dialyzer re-use. With this system, the status of nosocomial infection control was evaluated by investigating files, examination of staffs on spot, and observing operating procedures among hemodialysis units in Beijing between November 2017 to January 2018.  Results  ①A total of 122 hemodialysis units were investigated. The total score for this inspection was 94.6 (95.0 score for units in grade three hospitals, 93.4 score for units in grade two hospitals, and 90.8 score for units in grade one hospitals). ②Among the 8 fields inspected in this study, the leading three of lower score were structural configuration of hemodialysis units (scored 89.3), establishment and implement of management system for infection control (scored 91.3), and quality certification for units and professionals (scored 92.8). ③In this inspection system, the top three risk behaviors of nosocomial infection control were defect implement of disinfection and isolation procedures (29.5%), inadequate basic installation (26.2%), and risk behaviors in areas of treatment preparation room (26.2%).  Conclusions  Structural configuration of hemodialysis units, establishment and implement of management system for infection control, and infection control for different functional areas are the highest risk fields of nosocomial infection control in hemodialysis units in Beijing. Our study also implies that Blood Purification Quality Control and Improvement Center has to focus on these three fields during inspection and management of quality control and infection control in hemodialysis units. Metrics

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Application of the risk assessment tool for grading management of hyperkalemia in hemodialysis patients  GAO Yu-mei, WU Tao-feng, LIN Li-hua, CAI Hui-lan, QIU Hong, JIN Dong-hua 2022, 21 (09):  692-696.  doi: 10.3969/j.issn.1671-4091.2022.09.015 Abstract ( 174 )   PDF (564KB) ( 379 )   Objective  The aim of this study was to observe the effect of the Chinese hyperkalemia risk assessment tool in maintenance hemodialysis (MHD) patients.   Methods   A total of 280 MHD patients from the three hospitals in the Suzhou New District were enrolled in this study. The control group (n=142) was given routine prevention and treatment methods for hyperkalemia. The experimental group (n=138) used Find, Organize, Clarify, Understand, Select, –Plan, Do, Check, Act (FOCUS-PDCA) model for graded intervention based on the risk level of hyperkalemia. The hyperkalemia related indexes were compared before and after the intervention.  Results  After 24 weeks of intervention, the prevalence of hyperkalemia (13.8% vs. 23.9%, c2=4.722, P=0.030) and blood potassium level (4.44±0.35 vs. 4.58±0.47mmol/l, t=2.850, P=0.005) were significantly lower in the experimental group than in the control group; the dialysis adequacy [1.32(1.22～1.54) vs. 1.24(1.20～1.30), Z=-5.360, P<0.001] and quality of life (63.79±14.59 vs. 56.30±16.29, t=-4.004, P<0.001) were significantly higher in the experimental group than in the control group. After 12, 18 and 24 weeks of intervention, the prevalence of hyperkalemia (36.2% vs. 31.2% vs. 27.5% vs. 13.8%, x2=19.37, P<0.001) and blood potassium level (5.02±0.43 vs. 4.81±0.42 vs. 4.68±0.39 vs. 4.44±0.35 mmol/L, F=51.52, P<0.001) in the experimental group decreased gradually along with the intervention duration. After 24 weeks of intervention, 31 extreme-risk or high-risk patients (22.4%) turned to moderate-risk level (Z=16.326, P=0.001).  Conclusion  Based on the hyperkalemia risk assessment tool, the hierarchical management of MHD patients through FOCUS-PDCA model can significantly reduce potassium level and risk of hyperkalemia, and improve dialysis adequacy and quality of life. This method is worthy of promotion for clinical application. Metrics

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Application of cognitive load theory in the management of internal fistula in hemodialysis patients with arteriovenous fistula established for the first time ZHANG Jie-ting, LIANG Yu-ting, LIU Lan-xia 2022, 21 (09):  697-701.  doi: 10.3969/j.issn.1671-4091.2022.09.016 Abstract ( 126 )   PDF (833KB) ( 286 )   bjective  To explore the effect of arteriovenous fistula (AVF) management based on cognitive load theory in maintenance hemodialysis (MHD) patients with AVF established for the first time.  Method  A total of 42 MHD patients who had AVF for the first time from June 2019 to May 2020 were selected as the observation group to implement AVF management based on cognitive load theory; a total of 44 MHD cases with conventional AVF management from June 2018 to may 2019 were taken as the control group.  Result  After the intervention, the AVF related knowledge score was 95 (90.00, 100.00) in the observation group and was 80 (75.00, 85.00) in the control group (Z=-6.709, P<0.001). There was significant difference in compliance behavior between the two groups (χ2=29.951, P<0.001); the complete compliance rate in the observation group was 59.5% and was 6.8% in the control group (χ2=27.185, P<0.001). The success rate of first internal fistula puncture within one year after the operation was 99.7% in the observation group and was 99.4% in the control group (χ2=6.496, P=0.011). The rates of thrombosis and insufficient blood flow within one year after the operation were 7.1% and 2.4% respectively in the observation group and were 22.7% and 13.6% respectively in the control group (χ2=4.067 and 5.726, P= 0.044 and 0.017).  Conclusion  The AVF management model based on cognitive load theory is helpful to improve the quality of health education and the success rate of first internal fistula puncture in MHD patients. Therefore, this management model can reduce the AVF complications and is worthy of promotion in clinical practice. Metrics

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Clinical situation at the first hemodialysis in hypertension patients with stage 5 chronic kidney disease in Mianzhu area   LI Dan-dan, PU Rui, CHEN Chang-yun, QIN Wei, RAO Jian-hui, LUO Xiao-qin, REN Ying, ZHANG Guang-bing 2022, 21 (09):  702-704.  doi: 10.3969/j.issn.1671-4091.2022.09.017 Abstract ( 163 )   PDF (376KB) ( 62 )   Objective  To understand the clinical situation of patients with stage 5 chronic kidney disease (CKD) during the first hemodialysis in Mianzhu area, so as to provide a basis for continuous improvement of CKD management before dialysis.  Methods  A single-center retrospective study was performed, which recruited patients with stage 5 CKD and undergoing first hemodialysis (HD) in Mianzhu People's Hospital from January 2014 to December 2019. They were divided into hypertension group and normal blood pressure group. Their clinical data at the first hemodialysis were recorded. Laboratory indicators, primary renal disease, and dialysis access modality were compared between the two groups.   Results   A total of 185 patients were included in this study. The top 3 primary diseases were chronic glomerulonephritis (79 cases), diabetic nephropathy (61 cases) and hypertensive renal damage (22 cases); the top 3 complications were renal anemia (178 cases), hypertension (171 cases) and renal osteopathy (104 cases). The main reasons for hemodialysis were uremic symptoms, similar in both groups (χ2=2.937, P=0.087). Serum phosphorus was higher in normal blood pressure group than in hypertension group (t=-1.990, P=0.048), while serum high-density lipoprotein cholesterol was lower in the normal blood pressure group than in hypertension group (t=2.070,   P=0.040). Blood access modality had no difference between the two groups (χ2=0.000, P=0.985).  Conclusion  Chronic glomerulonephritis was the most important primary disease in stage 5 CKD patients at first hemodialysis in Mianzhu area. Uremic symptoms were the most common causes for the beginning of hemodialysis. Renal anemia, hypertension, and CKD-mineral and bone disorder (CKD-MBD) were the most common complications in these patients. Metrics