Chinese Journal of Blood Purification

12 October 2022, Volume 21 Issue 10 Previous Issue    Next Issue

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Application of inotropic agents in patients with chronic kidney disease accompanied by decompensated heart failure SUN Xuefeng 2022, 21 (10):  705-708.  doi: 10.3969/j.issn.1671-4091.2022.10.001 Abstract ( 222 )   PDF (455KB) ( 63 )   Inotropic agents are commonly used in the treatment of decompensated heart failure, but there is still no guidance on how to choose and apply them in patients with chronic kidney disease (CKD). Based on evidence-based medicine, this paper introduces the pharmacological effects of different kinds of inotropic agents and evaluated the benefits and risks of them in the treatment decompensated heart failure in CKD patients. This papers aim is to provide reference for clinicians in rational application of inotropic agents.  Metrics

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Preferred strategy for dialysis in older adults ZHAO Wei-hong, WEI Lu 2022, 21 (10):  709-712.  doi: 10.3969/j.issn.1671-4091.2022.10.002 Abstract ( 183 )   PDF (609KB) ( 106 )   aging is a growing public health problem. The number of older adults with end stage renal disease (ESRD) is rising dramatically. Epidemiological surveys in China found that the fastest growing number of dialysis patients are the elderly. Older adults with ESRD face not only the threat of deteriorating kidney function, but also the effects of aging, frailty, and comorbidities. This review discussed the issues related to dialysis in older adults, including assessing whether elderly ESRD patients are suitable for dialysis, whether dialysis meet the overall goals of patients, frailty and cognitive impairment in older dialysis patients, the choice of dialysis methods in older adults, and the decision points of dialysis vascular access. Metrics

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Research Progress on the effect of iodine contrast media on residual renal function in dialysis patients   KIM Hanna, ZHAO Hui-ping, WANG Mei 2022, 21 (10):  713-718.  doi: 10.3969/j.issn.1671-4091.2022.10.003 Abstract ( 209 )   PDF (421KB) ( 59 )   Residual renal function (RRF) is closely associated with increased survival in dialysis patients. Avoiding the factors aggravating renal injury is the main strategy to protect RRF of dialysis patients. With the continuous extension of dialysis duration，more patients are involved in vascular interventional examination and treatment. The application of iodine contrast media (ICM) may lead to acute kidney injury (AKI). However, how does ICM affect the RRF of dialysis patients? This paper reviews the research progress of the effect of ICM on RRF in dialysis patients. Metrics

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The relationship between the dynamic changes of nutritional status and the symptoms of pruritus and sleep disturbance in peritoneal dialysis patients  WANG Xiao-pei, LV Jing, LIANG Chang-na, LI Zhao, LU Wan-hong 2022, 21 (10):  719-723.  doi: 10.3969/j.issn.1671-4091.2022.10.004 Abstract ( 200 )   PDF (853KB) ( 33 )   Objective  To investigate the influence of serum albumin changes on sleep quality and uremic pruritus in peritoneal dialysis (PD) patients.   Methods   Pittsburgh Sleep Quality Index (PSQI) and Four-Item Itch Questionnaire (FIIQ) were used to assess sleep quality and pruritus in the 166 PD patients regularly followed up in our PD center. Their clinical data and laboratory results were recruited. According to the changes of serum albumin level before PD (ALB0) and after PD (ALB1), the PD patients were divided into four groups: group A, normal albumin group (both ALB0 and ALB1 ≥35g/L); group B, elevated albumin group (ALB0＜35g/L, and ALB1≥35g/L); group C, persistent low protein group (both ALB0 and ALB1＜35g/L); group D, decreased albumin group (ALB0≥35g/L, and ALB1＜35g/L). Sleep disturbance, itching and other clinical parameters were compared among the groups.   Results   ①There were 63 patients in group A, 47 in group B, 38 in group C, and 18 in group D. Age (F=8.490, P＜0.001), dialysis duration (F=2.266, P=0.043), CRP (F=4.051, P=0.025) and the incidence of diabetes (χ²=28.160, P＜0.001) were significantly different among the four groups. ②The mean PSQI sleep score in group D was higher than that in group A (H=9.037, P=0.022) and group B (H=6.806, P=0.033); the mean PSQI sleep score in group C was higher than that in group A (H=3.269, P=0.049) and group B (H=3.503, P=0.045); the mean PSQI sleep score had no difference between group D and group C (H=23.458, P=0.459). The pruritus score in group D was significantly higher than that in groups A, B and C (P=0.001, 0.003 and 0.006 respectively). The incidence of sleep disorder in group D was 55.6%, significantly higher than that in groups A, B and C (P ＜0.05). The incidence of pruritus in group D was 64.7%, also significantly higher than that in groups A, B and C (P＜0.05). ③Logistic regression showed that decreased serum albumin after PD was an independent risk factor for pruritus (OR=3.886, 95% CI :1.132～13.333, P=0.031) and sleep disorder (OR=4.682, 95% CI 1.466～14.958, P=0.009).  Conclusion  ①PD patients with diabetes, older age, longer dialysis duration and micro-inflammatory state are prone to suffer from malnutrition or to negatively affect the nutritional status. ②Deterioration of nutritional status leads to the risk of sleep disorders and pruritus in PD patients. Metrics

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Increased serum sclerostin and dickkopf-1 levels are associated with coronary artery calcification in peritoneal dialysis patients  CHEN Jin-yan, WANG Xiao-yue, DU Ya-jing, LI Ping-hai, HU Yong 2022, 21 (10):  724-728,784.  doi: 10.3969/j.issn.1671-4091.2022.10.005 Abstract ( 146 )   PDF (491KB) ( 281 )   Objective  To analyze the relationship between serum sclerostin and dickkopf-1 (DKK-1) levels and coronary artery calcification (CAC) in peritoneal dialysis (PD) patients. Methods A total of 110 patients with continuous ambulatory peritoneal dialysis (CAPD) or daytime ambulatory peritoneal dialysis (DAPD) for more than 3 months were prospectively recruited. The coronary calcification score (CaCS) was calculated using the Agatston score from multi-slice spiral CT. Serum sclerostin and Dkk-1 were measured using ELISA. Logistic regression analysis was used to determine the risk factor for CAC in PD patients. Receiver operating characteristic (ROC) curve was applied to evaluate the predictive value of sclerostin and DKK-1 levels for CAC.  Results  CAC was found in 72 (64.9%) patients, of which 23 CAC patients (27.3%) had higher CaCS, and 49 CAC patients (37.6%) had lower CaCS. Serum sclerostin and DKK-1 levels were positively correlated with moderate to severe CaCS (ρ=0.733, P＜0.001; ρ=0.796, P＜0.001). Logistic regression showed that higher serum sclerostin level (OR＝1.052, 95% CI:1.005～1.102, P=0.021) and higher DKK-1 level (OR=1.180, 95% CI:1.040～1.339, P=0.005) were the independent risk factors for CAC in PD patients. When the cut-off value of serum sclerostin was set at 240pg/ml, the area under curve (AUC) was 0.940 (95% CI:0.899～0.981, P＜0.001), the accuracy was 0.833 and the specificity was 0.974; when the cut-off value of serum DDK-1 was set at 37.05μg/ml, the area under curve (AUC) was 0.960 (95% CI 0.927～0.993, P＜0.001), the accuracy was 0.875 and the specificity was 0.949.  Conclusion  Higher serum sclerostin and DKK-1 levels are significantly associated with CAC in PD patients. Serum sclerostin and DKK-1 may play important roles in the pathogenesis of CAC in PD patients. Metrics

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Elevated level of plasma proprotein convertase subtilisin/kexin 9 is a risk factor for cardiovascular disease death in maintenance hemodialysis patients QIAO Juan, ZHOU Yuan-yuan, MIAO Han 2022, 21 (10):  729-733.  doi: 10.3969/j.issn.1671-4091.2022.10.006 Abstract ( 190 )   PDF (446KB) ( 37 )   Objective  To analyze the relationship between plasma proprotein convertase subtilisin/kexin 9 (PCSK9) level and cardiovascular disease (CVD) death in maintenance hemodialysis (MHD) patients.  Methods A total of 84 MHD patients treated in Lianyungang First People's Hospital from Jan 2019 to Dec 2020 were recruited as the research subjects. A total of 84 healthy volunteers from health examinations in the same period were recruited as the healthy control group. The relationship between plasma PCSK9 level and clinical and laboratory indexes was analyzed by Spearson correlation. The risk factors for CVD death in MHD patients were analyzed by multivariate logistic regression. The predictive value of plasma PCSK9 level for CVD death in MHD patients was assessed by ROC curve.  Results  The plasma PCSK9 level was significantly higher in MHD group than in healthy control group  (t=8.775, P＜0.001). In the MHD patients, plasma PCSK9 level was significantly lower in the survival patients than in the patients died of CVD (t=7.638, P＜0.001). Plasma PCSK9 level was negatively correlated with Kt/V, albumin and high-density lipoprotein cholesterol (r=-0.421, -0.402 and -0.387 respectively; P<0.001, <0.001 and=0.001 respectively), and was positively correlated with low-density lipoprotein cholesterol, total cholesterol, triglyceride and leukocyte count        (r=0.355, 0.395, 0.324 and 0.399 respectively; P=0.006, <0.001, =0.011 and <0.001 respectively). High plasma PCSK9 level was the independent risk factors for CVD death in MHD patients (OR=2.054, 95% CI: 1.421～6.293, P=0.002). The AUC of plasma PCSK9 level for predicting CVD death in MHD patients was 0.822 (95% CI: 0.711～0.904) with the sensitivity of 79.26% and the specificity of 72.55% when the cut-off value was set at 255.65ng/mL  Conclusion  Plasma PCSK9 level increases significantly in MHD patients, especially in those died of CVD. Plasma PCSK9 level is an independent risk factor for CVD death in MHD patients, and also has the predictive value for CVD death in MHD patients. Metrics

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Clinical study of intra-abdominal pressure in patients with peritoneal dialysis  SHANG Yu, LIU Si-yuan, YANG Xiao-jun, LI Yan, JI Tian-rong, KONG Fan-wu 2022, 21 (10):  734-738.  doi: 10.3969/j.issn.1671-4091.2022.10.007 Abstract ( 200 )   PDF (448KB) ( 42 )   Objective  To investigate the factors relating to the variation of intra-abdominal pressure (IAP) in patients undergoing peritoneal dialysis (PD) and to explore the effect of IAP on PD therapy.  Methods  A total of 35 patients newly treated with PD were used as a study cohort. The Durand method was used to determine IAP. IAP was measured at the 3rd day after the surgery and after 6 months at a stable PD stage. The dialysate volume (PDV) was 2000mL when IAP was measured. Based on the mean IAP of 12.27±2.37 cmH2O at the stable PD stage, the patients were divided into group I (IAP ＜12.27cmH2O) and group II (IAP≥12.27cmH2O).  Results   ①The IAP at the 3rd day after the surgery was significantly higher than that at the stable stage (t=14.766, P＜0.001);  ②Body weight (t=-2.990, P=0.005), body mass index (BMI) (t= -3.838, P=0.001), and body surface area (BSA) (t=-2.277, P=0.029) were lower in group I than in group II, while total Kt/V (t=2.582, P=0.014), total Ccr (t=-2.450, P=0.014), residual kidney Kt/V (t=2.875, P=0.007), residual kidney Ccr (t=-2.583, P=0.009), and dialysis adequacy rate (P=0.044) were higher in group I than in group II.  ③Correlation analysis showed that BMI was positively correlated with the IAP after the surgery for 3 days  (r=0.558, P＜0.001) and after the operation for 6 months (r=0.688, P＜0.001). Linear regression obtained two equations: the IAP after the surgery for 3 days=0.425×BMI＋4.975 (r2=0.311, P＜0.001), and the IAP after the operation for 6 months=0.548×BMI-0.245 (r2=0.473, P＜0.001). ④ The IAP was significantly lower in the patients with adequate PD than in those with inadequate PD patients (t=-2.156, P=0.038).   Conclusion   ①IAP is significantly lower in the PD patients after the surgery for 6 months at a stable PD stage than in those after the surgery for 3 days. ②IAP variability is related to the characteristics of the patients, in which BMI is a factor closely related to the level of IAP. ③IAP is also closely related to the residual renal function of the patient. Maintaining IAP at a relatively low level will facilitate a higher dialysis efficacy at the early stages of PD. Metrics

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A multicenter randomized controlled study of nafamostat mesylate for anticoagulation therapy on hemodialysis ZHUANG Bing, YE Hong, CAO Hong-di, BIAN Xue-qin, ZHONG Hua, LUO Yuan, PENG Kan-fu, SHI Hui, YANG Jun-wei 2022, 21 (10):  739-743.  doi: 10.3969/j.issn.1671-4091.2022.10.008 Abstract ( 1670 )   PDF (499KB) ( 381 )   Objective To observe the safety and efficacy of nafamostat mesylate for anticoagulation in maintenance hemodialysis patients. Methods Patients on hemodialysis were randomly divided into two groups, nafamostat mesylate for injection group and sodium heparin injection group, respectively. The safety and efficacy of nafamostat were evaluated.Results The anticoagulation efficiency of nafamostat mesylate for injection group and sodium heparin injection group was 97.2% and 98.2%, respectively (χ2=0.000，P=0.992); The effect of nafamostat mesylate for injection group on activated clotting time (ACT) during dialysis was less than that of sodium heparin injection group.The ACT values at the arterial side of the two groups were significantly different (1h, t=-15.333, P＜0.001; 2h, Z=-10.317, P＜0.001; 3h,t=-12.733, P＜0.001; the end of dialysis, Z=-6.796, P＜0.001),the venous side of the two groups were significant statistical differences in ACT values(1h, t=-17.833, P<0.001; 2h, t=-15.604, P＜0.001; 3h, Z=-10.066, P＜0.001; the end of dialysis,Z=-4.399, P＜0.001);After the end of hemodialysis, the nafamostat mesylate group for injection had less effect on activated partial thromboplastin time (Z=-4.971, P＜0.001) and thrombin time (Z =5.770, P＜0.001) than the heparin sodium injection group ; The incidence of adverse reactions in nafamostat mesylate for injection group was lower than heparin sodium injection group (χ2=15.239，P＜0.001). Conclusion The anticoagulant effect of nafamostat mesylate is non-inferior to sodium heparin , and the incidence of adverse reactions is lower.It could be used safely and effectively in the anticoagulation of hemodialysis. Metrics

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Relationship between sarcopenia and levels of homocysteine, irisin and malnutrition-inflammation score in maintenance hemodialysis patients  BAO Qun, YAN Yan, DING Xiu-he 2022, 21 (10):  744-748.  doi: 10.3969/j.issn.1671-4091.2022.10.009 Abstract ( 240 )   PDF (563KB) ( 202 )   Objective  To explore the correlation between sarcopenia and the levels of  homocysteine (Hcy), irisin and malnutrition-inflammation score (MIS) in maintenance hemodialysis (MHD) patients.  Methods  A total of 206 MHD patients treated in the Blood Purification Center of Jinan Eighth People’s Hospital from June 2019 to October 2021 were selected as the research subjects. Sarcopenia was diagnosed by handgrip strength, walking speed, and limb skeletal muscle mass index (ASMI). Serum levels of Hcy and irisin were measured by enzyme-linked immunosorbent assay. Nutrition-inflammation was assessed using the MIS scale. A nomogram model was constructed based on the multivariate logistic regression results.  Results Among the 206 MHD patients, 56 (27.2％) were diagnosed with sarcopenia. Logistic regression showed that dialysis age, combined cognitive dysfunction, Hcy and MIS were the independent risk factors for the development of sarcopenia in MHD patients (OR=1.423, 1.718, 1.728 and 2.104 respectively; 95% CI :1.111~1.820, 1.222~2.223, 1.348~2.446 and 1.424~3.442 respectively; P=0.038, 0.021, 0.026 and＜0.001 respectively). Irisin was an independent protective factor for sarcopenia in MHD patients (OR=0.488, 95% CI :0.089~0.762, P＜0.001). The prediction nomogram model constructed based on the above analyses and using Bootstrap internal verification indicates that this model has good accuracy and discrimination, with the C-index index of 0.822 (95% CI :0.734~0.887).  Conclusion  Higher MIS and elevated serum Hcy were the independent risk factors for sarcopenia in MHD patients. Elevated serum irisin was an independent protective factor for sarcopenia in MHD patients. The prediction nomogram model based on the independent influencing factors is useful to improve the predictive ability of sarcopenia complicated in MHD patients. Metrics

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Comparison of the resting energy expenditure in peritoneal dialysis and hemodialysis patients  FU Gang, XU Xiao, GUO Shan-shan, WANG Yu-zh, DONG Jie, LIU Wen-hu 2022, 21 (10):  749-753.  doi: 10.3969/j.issn.1671-4091.2022.10.010 Abstract ( 205 )   PDF (427KB) ( 46 )   Objective  We aimed to compare the resting energy expenditure (REE) between peritoneal dialysis (PD) patients and hemodialysis (HD) patients.  Methods   This cross-sectional study enrolled 105 PD patients and 35 HD patients who were clinically stable from two tertiary hospitals in Beijing. Their REE was measured by indirect calorimetry.  Results   The mean age of the patients was 52.5±11.9 years old, and the body weight was 68.6±15.1kg, 57.7% being man and 43.6% having diabetes. The REE was 1432.6±339.4 kcal in HD patients and was 1334.6±271.8 kcal in PD patients, without significant difference between PD and HD patients (P=0.086). REE was positively correlated with height (r=0.399/0.574, P=0.018/＜0.001), weight (r=0.756/0.730, P＜0.001), male (r=0.481/0.582, P=0.003/＜0.001), grip strength (r=0.584/0.551, P＜0.001) and lean body mass (r=0.674/0.677, P＜0.001), negatively correlated with age (r=-0.432/-0.254, P=0.010/0.009), dialysis age (r=-0.356/-0.289, P=0.036/0.003) and urea clearance (Kt/V) (r=-0.786/-0.326, P＜0.001/0.002) in both HD and PD patients.  Conclusions  There was no significant difference in REE level between HD and PD patients. Metrics

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Research progress in the effects of indoxyl sulfate on chronic kidney disease and its complications    YANG Jing-yu, FANG Jing-ai, ZHANG Xiao-dong, LIU Wen-yuan, ZHANG Zi-yuan, HU Ya-ling 2022, 21 (10):  754-757.  doi: 10.3969/j.issn.1671-4091.2022.10.011 Abstract ( 291 )   PDF (388KB) ( 305 )   Indoxyl sulfate (IS) is a uremic toxin of intestinal origin. Recent studies have shown that the accumulation of IS in the body will not only lead to the progression of chronic kidney disease (CKD), but also participate in the progression of cardiovascular disease, sarcopenia, cognitive impairment, osteopathy and anemia in CKD patients, thus reducing the quality of life and survival rate of CKD patients. This paper reviews the studies relating to the effects of IS on CKD and its complications in recent years, in order to provide new ideas for the prevention and intervention of CKD. Metrics

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Advances in the study of Klotho protein in acute transplanted kidney injury  HU Wei-wei, ZHANG Wen-jun, ZHOU Xiao-chun, WANG Jian-qin 2022, 21 (10):  758-761.  doi: 10.3969/j.issn.1671-4091.2022.10.012 Abstract ( 154 )   PDF (372KB) ( 86 )   Acute kidney injury (AKI) is a primary complication of renal transplantation and is reversely proportional to the survival rate of renal transplantation. Ischemia-reperfusion injury after renal transplantation is the most important cause of AKI. Due to the shortage of donors, the use of aging kidneys from expanded criteria donors became increased and the incidence of AKI in kidney transplantation is increasing year by year, resulting in the lower rate of long-term survival of transplanted kidney. Many intervention measures to increase the survival rate of transplanted kidney have been tested so far. Klotho protein is a pleiotropic protein expressed in kidney, functions as an anti-aging factor, and may protect the kidney from ischemic injury through multiple mechanisms. Studies about the relationship between Klotho protein and AKI are present in recent years, while studies about Klotho protein relating to renal transplantation are scarce. Whether Klotho protein plays a protective role in allogeneic renal transplantation remains controversial. Studies on the roles of Klotho protein in renal transplantation and its impact on outcomes of renal transplantation are required, to explore an alternative way for the prevention of AKI in allogeneic renal transplantation. Metrics

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Ultrasonography for the prediction of PTA on intimal proliferative stenosis in autogenous arteriovenous fistula WU Zheng-hua, CHEN Hua, REN Xiang, ZHANG Yu-dan, TONG Xu-nan, WANG Zhen-xing 2022, 21 (10):  762-765.  doi: 10.3969/j.issn.1671-4091.2022.10.013 Abstract ( 151 )   PDF (1015KB) ( 61 )   Objective   To investigate ultrasound examination in the prediction of percutaneous transluminal angioplasty (PTA) on hyperplastic stenosis in autogenous arteriovenous fistula (AVF).   Methods   A total of 60 patients with AVF stenosis due to intimal hyperplasia and treated with ultrasound-guided PTA in Shanxi Bethune Hospital and Shanxi Second People’s Provincial Hospital were recruited for analyses. They were divided into 3 groups based on the intimal thickness measured by preoperative ultrasonography: mild group (intimal thickness ≥0.5mm and ＜1.0mm), moderate group (intimal thickness≥1.0mm and ≤1.5mm), and severe group (intimal thickness ≥1.5mm). The relationship between intimal thickness and postoperative effect and relapse was evaluated.  Results   Preoperative vascular diameter (F=12.806, P＜0.001), postoperative vascular diameter (F=44.935, P<0.001), previous PTA times (F=11.243, P＜0.001), preoperative vascular inner diameter (F=12.806, P＜0.001), postoperative vascular inner diameter (F=44.935, P＜0.001), preoperative blood flow (F=17.486, P＜0.001), postoperative blood flow (F=37.244, P＜0.001), and relapse time (F=49.434, P＜0.001) were significantly different among the 3 groups. The patency rates after PTA for 6 months in mild group were 100% and 84.6%, higher than those in moderate group (χ2=22.652, P＜0.001) and severe group (χ2=27.754, P＜0.001). Age, previous PTA times and preoperative intimal thickness were independently correlated with the relapse time of postoperative AVF stenosis (β=-0.169, -0.618 and -2.933 respectively; P=0.042, 0.028, and＜0.001 respectively).  Conclusion The age of patients, number of previous PTA and thickness of intima are the independent risk factors for relapse time after PTA. Metrics

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The value of brachial artery blood flow parameters assessed by color Doppler ultrasonography in the diagnosis of autologous arteriovenous fistula complicated with cephalic venous anastomotic stenosis  XU Cui-ping, YANG Zeng-di, CHENG Jin-jing, LI Jun, WANG Jun, TONG Qing-ping 2022, 21 (10):  766-769.  doi: 10.3969/j.issn.1671-4091.2022.10.014 Abstract ( 186 )   PDF (944KB) ( 101 )   Objective  To investigate brachial artery blood flow parameters assessed by color Doppler ultrasonography in the diagnosis of autologous arteriovenous fistula (AVF) complicated with cephalic vein anastomotic stenosis.  Methods  Ultrasonography was performed in 96 maintenance hemodialysis (MHD) patients with AVF. They were divided into cephalic vein anastomotic stenosis group (n=37) and non-stenosis group (n=59). Color Doppler ultrasonography was used to measure brachial artery time-averaged mean velocity (TAMV), pulsatile index (PI), resistance index (RI), peak systolic velocity (PSV), and end-diastolic velocity (EDV). These parameters were compared between the two groups. Receiver operating characteristic curve (ROC) was used to evaluate the value of brachial artery blood flow parameters in the diagnosis of AVF complicated with cephalic venous anastomotic stenosis.  Results  There were no significant differences in brachial artery diameter and RI between the two groups (P＞0.05). Brachial artery blood flow, TAMV, PSV, and EDV in the stenosis group were lower than those in the non-stenosis group, and PI in the stenosis group was higher than that in the non-stenosis group (t=12.747, 5.018, 4.377, 5.563 and 9.082 respectively; P＜0.001). ROC curve showed that brachial artery blood flow had the highest value in the diagnosis of AVF complicated with cephalic venous anastomotic stenosis, the area under curve (AUC) was 0.852 (95% CI 0.769~0.936, P＜0.001), the sensitivity was 56.76%, and the specificity was 94.59%; the AUCs of EDV, PSV, TAMV and PI were 0.764 (95% CI 0.650～0.877, P＜0.001), 0.756 (95% CI 0.640～0.872, P＜0.001), 0.701 (95% CI 0.583～0.818, P=0.003), and 0.654 (95% CI 0.518～0.790, P=0.023) respectively.   Conclusion   Monitoring of brachial artery blood flow parameters by color Doppler ultrasonography is of great value in predicting AVF complicated with cephalic venous anastomotic stenosis. Metrics

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Comparison of the clinical application of Acuseal artificial vessel and expanded polytetrafluoroethylene artificial vessel  ANG Ke, HE Lan-lan, WANG Xiao-ping 2022, 21 (10):  770-774.  doi: 10.3969/j.issn.1671-4091.2022.10.015 Abstract ( 140 )   PDF (461KB) ( 73 )   Objectives   To compare the clinical application of Acuseal artificial blood vessel and expanded polytetrafluoroethylene artificial vessel (ePTFE) as the arteriovenous graft (AVG) for hemodialysis access so as to provide reference for clinical use.   Methods   A retrospective study was performed on 61 patients undergoing AVG surgery in the Department of Nephrology, Jinan Central Hospital from December 2019 to December 2020. They were divided into observation group (Acuseal group) and control group (ePTFE group) according to the type of artificial blood vessel used. The first puncture time of internal fistula, the use of central venous catheter (CVC), patency rate and complications after the operation for one year were compared between the two groups.  Results  The surgery time was different between observation group and control group (U=279.000, P=0.024). The first puncture time were 4 (3, 6) days and 31 (30, 39) days after the surgery in observation group and control group respectively. CVC indwelling period was different (U=167.000, P＜0.001), but the rate of CVC used was similar (χ2=0.000, P=1.000) between the two groups. The primary patency rate after 6 months was 54.5% in observation group and was 66.7% in control group (χ2=0.934, P=0.334), and the rate after 12 months was 22.7% in observation group and was 38.5% in control group (χ2=1.984, P=0.159), without statistical significances between the two groups. The cumulative patency rate after 6 months was 90.9% in observation group and was 100% in control group (χ2=3.629, P=0.057), and the rate after 12 months was 81.8% in observation group and was 94.9% in control group (χ2=2.758, P=0.097), also without statistical significances between the two groups. Postoperative complications were similar between the two groups. The artificial vessel in observation group was completely removed if it was infected.  Conclusion  Acuseal artificial blood vessel allows early puncture and has similar patency rate. However, due to the difficulties in surgery, the removal of the whole dialysis pathway after infection leading to the use of CVC, the AVG using Acuseal artificial blood vessel should be carefully weighed in clinical practice. Metrics

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Construction and application of a checklist for the quality improvement of standardized arterio-venous access operation during hemodialysis: a multi-center study  WANG Ying, ZHANG Qiu-yue, LIANG Jun-qing, MA Si-hui, DING Hong, LUO Li, HOU Yu-xia, GUO Ping, YU Hai-yan, PING Jin-chao, PENG Ying, JIANG Xiao-rui, GAN Liang-ying, ZUO Li, WANG Mei 2022, 21 (10):  775-779.  doi: 10.3969/j.issn.1671-4091.2022.10.016 Abstract ( 199 )   PDF (501KB) ( 93 )   Objective  To explore the effect of applying a checklist for the quality improvement of standardized arterio-venous access operation during hemodialysis.  Methods  This was a perspective and multi-center study. A quality control checklist was constructed based on the guidelines for arterio-venous access operation and the related information in the literature. The primary checklist was revised by the procedures of “consultation from experts – revision – preliminary investigation – second revision”. Self-evaluation was then conducted after use of the checklist by the several blood purification centers. The drawbacks of the checklist found by the blood purification centers were corrected through several circles of PDCA process, i.e. plan, do, check and action, to improve the nursing quality. Self-evaluation was conducted again. Paired T test was used to compare the scores from the checklist before and after the improvement. P <0.05 was considered to be statistically significant.   Results   ①The checklist comprised of 10 dimensions and 22 items, including identity identification, doctor's order checking, condition assessment, occupational protection, hand hygiene timing, access puncture and drug injection, safety verification, garbage classification and wiping disinfection, humanistic care, and consumables use, with the full score of 20 points. ②After continuous improvement of the nursing quality of standardized operation, the scores of every dimension in the checklist increased; the total scores were 14.87±3.286 and 17.66±1.973 before and after quality control respectively (t=-3.276, P=0.010), in which the scores of identity identification (score: 0.5) (0.17±0.189 vs. 0.46±0.084; t=-4.529, P =0.001) and hand hygiene timing (score: 4.0) (2.83±0.871 vs. 3.51±0.354; t=-3.127, P=0.012) increased significantly after quality control.  Conclusion  The checklist can promote the improvement of nursing quality in standardized arterio-venous access operation, and can be used as a tool for the management of nursing quality. Metrics

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A clinical comparison on high-flux dialyzers with different membranes during a single hemodialysis treatment  CONG Hui, MU Chang-jun, SONG Xu-hong, YU Ya-nan, XU Yan-hua, JI Wei-ling 2022, 21 (10):  780-784.  doi: 10.3969/j.issn.1671-4091.2022.10.017 Abstract ( 573 )   PDF (446KB) ( 181 )   ackground  High-flux hemodialysis has been widely used and has the advantages of improved clearance of uremic toxins and efficient removal of extra body fluid due to the hollow fiber membranes with a high ultrafiltration coefficient.  Objective   The present paper aims to investigate the clinical performance of two high-flux dialyzers, one equipped with polysulfone membranes (HF15 from Weigo), and the other equipped with cellulose triacetate membranes (FB-150U, short for 150U, from Nipro). Clearance efficiency of uremic toxins and the biocompatibility in a single hemodialysis session were compared between the two types of high-flux dialyzers.  Methods   A total of 20 patients treated with maintenance hemodialysis for more than 3 months were recruited from Weigao Blood Purification Center and were divided into two groups, HF15 Group (n=10) and 150U Group (n=10). Blood samples were collected right before the dialysis treatment, 15min and 60min during the treatment, and right after the treatment. The reduction ratio and clearance rate of uremic toxins as well as changes of blood cells and complement factor (C3a) were compared between the two groups.  Results   Age, sex, body weight and dialysis age were similar between two groups. Before the dialysis session, baseline parameters including treatment blood flow, small and medium molecule toxins, blood cells and complement factors had no significant differences between the two groups (P≥0.05). After the high-flux hemodialysis treatment for 4 hours, the reduction ratios and clearance rates of small molecule toxins (blood urea nitrogen, creatinine and phosphorus) had no significant differences between the two groups (For reduction ratios: t=0.932, 1.799 and 0.878 respectively; P=0.379, 0.052 and 0.299 respectively. For clearance rates: t=-1.892, 1.500 and -2.211 respectively; P=0.091, 0.168 and 0.056 respectively); HF15 group had higher reduction ratio (t=7.821, P＜0.001) and clearance rate (t=2.686, P=0.013) of the middle molecular toxin β2 microglobulin than 150U group. Variations of blood cells and C3a during the hemodialysis session had no statistical significances between two groups.  Conclusions   During a single high-flux hemodialysis session, HF15 group had higher clearance rates of uremic toxins than 150U group, with equal biocompatibility between the two groups. Metrics