Chinese Journal of Blood Purification

12 January 2023, Volume 22 Issue 1 Previous Issue    Next Issue

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Regional multicenter investigation of anemia and iron status in maintenance hemodialysis patients XING Jie, WANG Gui-hua, ZHANG Liu-ping, XIE Qing-lei, LU Wen, CHEN Feng-ling, FANG Ya-xiang, HE Wei-ming, DING Hong, WANG De-guang, PAN You-wen, JIN Wei-min, LI Yu-dan, LIU Jian-jing, WEI Shan-zhai, FANG Li-ming, CHEN Xiao-lan, ZHANG Xiao-liang 2023, 22 (1):  1-6.  doi: 10.3969/j.issn.1671-4091.2023.01.001 Abstract ( 150 )   PDF (1468KB) ( 68 )   Objective This study intended to conduct a cross-sectional survey of anemia and iron status distribution characteristics and drug use in regional maintenance hemodialysis patients to clarify the relationship between relevant indicators and provide data support for the development of optimal anemia management strategies. Methods Twelve blood purification centers in three provinces including Jiangsu Province, Anhui Province and Jiangxi Province were selected. Maintenance hemodialysis patients from September 2021 to December 2021 were included. General demographic data and laboratory parameters before dialysis were collected. Relevant analysis methods were used to describe hemoglobin (Hb) reaching standards, anemia and iron status distribution characteristics of multicenter maintenance hemodialysis patients, and to explore the related factors affecting the control rate of Hb. Results A total of 1814 patients who met the criteria were included in this study, including 1116 males and 698 females, with a mean age of 58.0±14.0 years. The overall control rate of Hb was 48.5%, and the Hb distribution and control rate were significantly different among the sub-centers (P < 0.001). The vast majority of patients had serum ferritin (SF) < 200 μg/L and 2% had SF more than 1000 μg/L. Transferrin Saturation (TSAT) ranged from 20-49% in 64.8% of patients. For every 1% change in TSAT, the OR of Hb reaching target was 1.029 (P=0.023, 95% CI=1.004-1.055). Conclusion The overall control rate of Hb of sample units was not satisfactory, most patients had moderate or slight iron reserve, and very few patients had iron overload. There were significant differences in Hb and iron status distribution characteristics among sub-centers. TSAT was an independent protective factor for good control rate of Hb. Metrics

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The Value of serum LncRNA NEAT1 in Predicting Acute Kidney Injury in Patients with Sepsis LI Sha, HU Ming-liang, WANG Li 2023, 22 (1):  7-10.  doi: 10.3969/j.issn.1671-4091.2023.01.002 Abstract ( 57 )   PDF (425KB) ( 42 )   Objective  To investigate the value of serum LncRNA NEAT1 in predicting acute kidney injury (AKI) in patients with sepsis.  Methods  A total of 163 cases of patients with sepsis admitted to the Department of Intensive Care Medicine in our hospital were selected from May 2018 to May 2021. The expression of nuclear enriched abundant transcript 1 (NEAT1) in the serum was detected by using qRT-PCR. The value of the expression of NEAT1 in the serum in predicting the occurrence of AKI in patients with sepsis was analyzed by using receiver operating characteristic curve(ROC).   Results   Among 163 cases of patients with sepsis, 67 cases occurred AKI (AKI group), with an incidence rate of 41.10%, and the rest seemed as the control group. The differences of the time from onset to intensive care unit (ICU) admission, sequential organ failure assessment (SOFA) score, serum creatinine(Scr), lactate, estimated glomerular filtration rate(eGFR), plasma infusion and red blood cell (RBC) infusion between the two groups were statistically significant (t=8.698, P＜0.001; t =8.134, P＜0.001; t=13.978, P＜0.001; t=2.383, P=0.018; t=4.177, P＜0.001; t=6.609, P＜0.001 and t=2.453, P=0.015). The relative expression level of NEAT1 in the serum in the AKI group was 1.90±0.26, which was higher than 1.46±0.32 in the control group, and the difference was statistically significant (t=9.314, P＜0.001). Logistic regression analysis showed that Scr, plasma infusion and the expression of NEAT1 were risk factors for AKI occurring in patients with sepsis (OR=1.263, 95% CI=1.052～1.515, P=0.012; OR=1.063, 95% CI=1.007～1.122, P=0.026; OR=4.897, 95% CI=1.392～17.233, P=0.013). ROC curve analysis results showed that the area under the curve of the expression of NEAT1 in serum for predicting the occurrence of AKI in patients with sepsis was 0.853 (95% CI: 0.796～0.910). When the expression level of NEAT1 in serum was 1.60, the sensitivity was 88.06%, and the specificity was 64.58%.  Conclusion  The expression level of NEAT1 in the serum of patients with sepsis complicated with AKI is increased. It is a risk factor for AKI occurring in patients with sepsis, and it has certain predictive value for the occurrence of AKI in patients. Metrics

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Clinical study on the improvement of protein depletion in hemodialysis patients by the intervention of oral nutritional supplement  WANG Yu,  ZHAO Qing, LUO Yong-bing, FENG Xiao-ran,  ZHANG Feng-ping,  YU Xiao-yu, LIU Fei-yan, XU Jian-hua, WU Guo-qing, CHEN Qin-kai 2023, 22 (1):  11-16.  doi: 10.3969/j.issn.1671-4091.2023.01.003 Abstract ( 377 )   PDF (629KB) ( 192 )   Objectives: To investigate the improvement of protein-energy wasting (PEW) in hemodialysis patients after supplementation with Lexineng nutritional supplements. Methods: A total of 90 patients who had been on maintenance haemodialysis for more than 3 months and met the diagnosis of PEW in the hemodialysis units of 6 hospitals in Jiangxi Province were collected and randomly divided into a control group and a test group of 45 patients each. After the patients were given dietary instructions, the corresponding number of calories in the test group was replaced by one can of Lexineng supplement daily for 3 months. Changes in body mass index, laboratory parameters such as haemoglobin and albumin and assessment of safety effects were observed in both groups before and after 3 months of treatment with Lexineng supplementation.Results:A total of 90 patients were included in the study and 84 patients (41 in the control group and 43 in the trial group) eventually completed the trial as required, of whom 47 (55.95%) were male and the mean age was (61.6±11.39) years. The mean mineral intake levels were similar and the differences in the indicators between the two groups were not significant (p>0.05). After 3 months of the trial, the results showed that the changes in body measurements such as weight (Wt) and BMI in the control group were not significant compared to those before the trial (p>0.05), while the Wt、BMI increased significantly and the subjective global assessment (SGA) decreased significantly in the trial group (p<0.05). Serum albumin (Alb) and haemoglobin increased in both groups compared to the pre-test, with Alb and haemoglobin increasing more significantly in the test group (p<0.001), and albumin and haemoglobin were significantly higher compared to the control group (p<0.05); Leukodystrophy was also significant in reducing serum creatinine levels and increasing serum calcium concentrations (p<0.05), and was able to reduce blood glucose levels without increasing the fat burden.Conclusion: Sustained supplementation with Lexineng on maintenance hemodialysis is effective in improving PEW symptoms and other complications in haemodialysis patients in many ways. Metrics

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The value of triglycerides-glucose index in the evaluation of abdominal aortic calcification in maintenance hemodialysis patients LI Xin-yu, WANG Xue-rong,  YUAN Liang, BAO Ting, WANG De-guang 2023, 22 (1):  17-21.  doi: 10.3969/j.issn.1671-4091.2023.01.004 Abstract ( 170 )   PDF (488KB) ( 208 )   Objective  To explore the value of triglycerides-glucose (TyG) index in the evaluation of abdominal aortic calcification (AAC) in maintenance hemodialysis (MHD) patients.  Method  The MHD patients hospitalized in the Nephrology Department of the Second Affiliated Hospital of Anhui Medical University were enrolled in this study. Their clinical data and biochemical parameters were recruited and the AAC scores was evaluated by abdominal lateral X-ray film. Based on AAC score, the patients were divided into non-AAC group and AAC group. The correlation between AAC score and clinical parameters were analyzed to explore the value of TyG index in the evaluation of AAC.   Results  In the 130 MHD patients enrolled in this study, AAC was found in 67 patients (51.5%), in which 36.2% had moderate to severe AAC. Compared with non-AAC group, age (t= -3.642, P<0.001), dialysis age  (t= -2.458,  P=0.015), BMI (Z=3.776, P<0.001), neutrophil count (Z=2.041, P=0.041), total cholesterol (Z=2.364, P=0.018), triglyceride (Z=6.802, P<0.001), C-reative protein (Z=2.113, P=0.035) and TyG index (Z=7.247, P<0.001) were higher in AAC group. AAC score was positively correlated with age, BMI, total cholesterol, triglyceride, C-creative protein and TyG index (r=0.299, 0.274, 0.223, 0.640, 0.234 and 0.667 respectively;  P=0.001,  0.002,  0.013, <0.001, 0.014 and <0.001 respectively). Logistic regression analysis showed that age (OR=1.060, 95% CI : 1.001～1.122, P=0.046), dialysis age (OR=1.027, 95% CI:1.012～1.042, P<.001), BMI (OR=0.163, 95% CI: 11.016～1.331, P=0.028),  and TyG index (OR=133.874, 95% CI: 18.833 ～ 951.649,  P<0.001)  were the independent risk factors for AAC in MHD patients. The area under receiver operating characteristic (ROC) curve of TyG index for AAC was 0.871,with the cutoff point of 8.58, sensitivity of 80.0%,   and specificity of 84.1% (95% CI:  0.812~0.931, P<0.001).   Conclusion  The incidence of AAC is high in MHD patients. TyG index is correlated with AAC, and has a better predictive value for AAC in MHD patients. Metrics

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The diagnostic value of pentraxin3 (PTX3) in peritoneal dialysis-related peritonitis  KE Ying, ZHENG Xiao-jun, LI Qing-yun, CUI Tong-xia, ZHU Wei-ping 2023, 22 (1):  22-26.  doi: 10.3969/j.issn.1671-4091.2023.01.005 Abstract ( 149 )   PDF (496KB) ( 38 )   Objective  To explore the diagnostic value of pentraxin3 (PTX3) in peritoneal dialysis-related peritonitis (PDRP).   Methods  A total of 31 patients with PDRP and 58 patients without PDRP on normal peritoneal dialysis and hospitalized in the Nephrology Department, The Fifth Hospital of Sun Yat-sen University from January 2020 to June 2021 were recruited as the study subjects. Peritoneal effluent (PE) of the study subjects was collected and PTX3 in PE (pPTX3) was assayed in batches by enzyme-linked immunosorbent assay. The clinical data and pPTX3 of the study subjects were statistically analyzed.  Results  The expression level of pPTX3 in the PDRP group was significantly higher than that in the non-PDRP group (Z=-7.314, P＜0.001). Compared with blood contents of white blood cells, procalcitonin, lymphocyte to monocyte ratio and hypersensitive C-reactive protein, pPTX3 is more effective for the diagnosis of PDRP (area under the cure =0.972, 95% CI: 0.913～0.995, P<0.0001). There was no significant difference in pPTX3 and leukocytes in PE (AUC=0.991,95% CI: 0.943～1.000, P＜0.0001) for the diagnosis of PDRP (Z=1.161, P=0.246). Pathogens in PE were positive in 24 of the 31 patients with PDRP, of which 15 patients were Gram-positive bacterial infections and 9 patients were Gram-negative bacterial infections. pPTX3 was significantly higher in the patients with Gram-negative bacterial infections than in those with Gram-positive bacterial infections (Z=            -2.684, P=0.005). PE was collected at the 1st, 3rd, 5th, 9th and 13th day of treatment in 18 of the 31 patients with PDRP; in the 14 patients whose PDRP were cured, the pPTX3-treatment time curve gradually went downward and infinitely approached the X axis at the 11th day; in the 4 patients whose PDRP could not be cured, the pPTX3-treatment time curve gradually went downward from the 1st day to the 5th day then remained at this level after the 5th day.   Conclusions  pPTX3 is an effective biomarker for the diagnosis of PDRP, and may also be useful for the differentiation of Gram-negative bacterial infection from Gram-positive bacterial infection and for the evaluation of therapeutic efficacy and prognosis of PDRP. Metrics

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A study on the correlation between serum magnesium level and mortality in maintenance hemodialysis patients HOU Miao, PENG Qiong-yao, TANG Ming, ZHANG Ke-qin, LIU Ling 2023, 22 (1):  27-31.  doi: 10.3969/j.issn.1671-4091.2023.01.006 Abstract ( 147 )   PDF (581KB) ( 233 )   Objective  To explore the correlation between serum magnesium level and all-cause mortality, cardio-cerebrovascular mortality and non-cardio-cerebrovascular mortality in maintenance hemodialysis (MHD) patients.  Methods  Patients who underwent MHD in The Second Affiliated Hospital of Chongqing Medical University from January 1, 2014 to January 1, 2020 were enrolled in this study. The baseline data before dialysis and clinical follow-up data every 3 months after dialysis were collected and analyzed. The patients were grouped by the quartile of average serum magnesium value: Q1 (Mg≤0.98mmol/L), Q2 (Mg>0.98≤1.06mmol/L), Q3 (Mg >1.06 ≤1.13mmol/L), Q4 (Mg >1.13mmol/L). Combined with the Restricted Cubic Spline model, Q2 and Q3 were combined into Qi group (Mg >0.98 ≤1.13mmol/L), and Q1 and Q4 were combined into Qo group. Kaplan-Meier method was used to survival analysis. COX regression model was used to analyze the influencing factors for mortality.   Results  A total of 182 MHD patients were enrolled, including 46 patients in group Q1, 45 patients in group Q2, 46 patients in group Q3, and 45 patients in group Q4. Kaplan-Meier survival analysis showed that there was a statistical difference in total survival rate among the four groups (Log-rank χ2=9.024, P=0.029). There were statistical differences in total survival rate and non-cardio-cerebrovascular survival rate between groups Qi and Qo (Log-rank  χ2=8.892, P=0.003; Log-rank χ2=7.385, P=0.007). Cox regression model found that the risk of all-cause mortality and non-cardio-cerebrovascular mortality increased in patients in group Qo when patients in group Qi were used as the controls. After adjusting for confounders, the risk of all-cause mortality in the Qo group increased by 88.7%, as compared with that in the Qi group (HR=1.887, 95% CI： 1.012～3.519, P=0.046).  Conclusions  This study found that serum magnesium level was associated with all-cause mortality in MHD patients. Our results also suggest that the all-cause mortality is lower in patients with the serum magnesium between 0.98 and 1.13mmol/L. Metrics

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The relationship between serum proliferation-inducing ligand level and sepsis-induced acute kidney injury WANG Ya-jing,  LIU Qian,  YAN Wen-wen,  WANG Xiao-xiao 2023, 22 (1):  32-35.  doi: 10.3969/j.issn.1671-4091.2023.01.007 Abstract ( 88 )   PDF (514KB) ( 33 )   Objective  To explore the relationship between serum a proliferation-inducing ligand (APRIL) level and sepsis-induced acute kidney injury.  Methods  A total of 106 patients with sepsis admitted to Baoding First Central Hospital from October 2020 to October 2021 were selected. Fasting venous serum samples were collected from patients at admission, and serum APRIL was measured by enzyme-linked immunosorbent assay. According to the median serum APRIL level of 13.42 (7.38, 19.65) μg/L, the patients were divided into high APRIL group (n=43) and low APRIL group (n=63). The relationship between serum APRIL level and sepsis-induced acute kidney injury was analyzed.  Results  Gender, age, white blood cell count, C-reactive protein, procalcitonin, cystatin C, creatinine clearance rate, APACHE Ⅱscore, mechanical ventilation, renal replacement therapy, and serum APRIL level were significantly different between high APRIL group and low APRIL group (χ2=4.068, t=2.678, 2.746, 9.816, 18.915, 12.515, 6.021, 10.130, 19.063, 9.012 and 3.176 respectively; P≤0.05, 0.044, 0.009, 0.007, <0.001, <0.001, <0.001, <0.001, <0.001, 0.003 and <0.001 respectively). The incidence of acute kidney injury was 39.53% in high APRIL group and was 19.05% in low APRIL group ( χ2=5.398, P=0.000), suggesting that serum APRIL level is correlated with    sepsis-induced acute kidney injury. Multivariate logistic regression showed that cystatin C (OR=1.906, 95%  CI:1.219～2.980,  P=0.005), increased creatinine clearance rate (OR=2.067, 95% CI 1.271～3.360, P=0.003), APACHE Ⅱscore≥12(OR=6.290,95% CI 2.671～14.813, P ＜0.001), and increased serum APRIL (OR=6.848,  95% CI 2.510～18.681, P＜0.001) were the independent influencing factors for sepsis-induced acute kidney injury.   Conclusion   The increased serum APRIL in patients with sepsis-induced acute kidney injury is an important risk factor for these patients. Higher serum APRIL is closely related to the occurrence of acute kidney injury in sepsis patients. Metrics

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Study on the improvement of hemolysis test method for dialyzer XU Jian-xia, FU Bu-fang, FU Hai-yang 2023, 22 (1):  36-39,43.  doi: 10.3969/j.issn.1671-4091.2023.01.008 Abstract ( 107 )   PDF (464KB) ( 71 )   Objective  The current hemolysis test method is optimized to identify the dialyzers having adverse events.  Methods  The existed hemolysis test method was optimized from two aspects. On the one hand, the static contact time between the hollow fiber and the red blood cell suspension was increased from 60 min to 100 min, and on the other hand, the dynamic contact was added, i.e., the hollow fiber was slid 20 times in the red blood cell suspension after the static contact. Two dialyzers having adverse events and three other dialyzers were tested for hemolysis using the modified method.  Results  The hemolysis rate of the 2 dialyzers having adverse events was much higher than that of the other 3 dialyzers. The improved hemolysis test method can identify 2 dialyzers with adverse events.  Conclusion  The optimized hemolysis test method is useful to pick out the high-risk dialyzers. Metrics

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Research progress in the family management level of children with maintenance hemodialysis SUN Chao-nan,  ZHANG Rong-zhi 2023, 22 (1):  40-43.  doi: 10.3969/j.issn.1671-4091.2023.01.009 Abstract ( 87 )   PDF (390KB) ( 291 )   The level of family management in children with maintenance hemodialysis (MHD) is closely related to their quality of life. This paper reviews the status quo, common research tools, influencing factors and interventions of family management level in MHD children based on the ecological systems theory, aiming to provide bases for clinical decision-making and disease management of MHD children and to improve their negative emotions and the quality of life. Metrics

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Novel factors involved in chronic kidney disease-mineral and bone disorder (CKD-MBD)  GUO Xin,  FANG Jing-ai,  WANG Rui-hua,  ZHANG Xiao-dong,   LIU Wen-yuan,  CHANG Qin-tao 2023, 22 (1):  44-47.  doi: 10.3969/j.issn.1671-4091.2023.01.010 Abstract ( 105 )   PDF (406KB) ( 144 )   Many biological factors are involved in the occurrence and development of chronic kidney disease-mineral and bone disorder (CKD-MBD). In addition to the classic parathyroid hormone (PTH)/vitamin D axis theory, recent studies have found that fibroblast growth factor 23, FGF23/Klotho, dentin matrix protein 1 (DMP1), secretory protein DicKKOPF-1 (DKK1) and sclerostin are also directly or indirectly involved in the progression of CKD-MBD. This paper reviews the latest research on these factors. Metrics

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Treatment of RANKL inhibitor in chronic kidney disease patients ZHANG Dong-liang, SHI Dan, CHEN Tian-y 2023, 22 (1):  48-51.  doi: 10.3969/j.issn.1671-4091.2023.01.011 Abstract ( 160 )   PDF (427KB) ( 75 )   Chronic kidney disease-mineral and bone disorders (CKD-MBD) are common and serious complications in patients with CKD.  Denosumab (DMab) is an inhibitor of the receptor activator of nuclear factor-kappa B ligand (RANKL) used for the treatment of postmenopausal osteoporosis. It has been applied clinically for male or female CKD patients with or without dialysis. DMab used in the treatment of CKD-MBD may produce the effects on bone metabolism biomarkers, bone mass, and vascular calcification. Here we review the safety and efficacy of DMab in CKD patients and summarize the clinical experience of the RANKL inhibitor in the treatment of CKD-MBD. Metrics

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Investigation on calprotectin as a new target for the diagnosis and treatment of peritoneal dialyis-related peritoneal fibrosis RUAN Yi-lin, XU Tian, REN Hong 2023, 22 (1):  52-55.  doi: 10.3969/j.issn.1671-4091.2023.01.012 Abstract ( 95 )   PDF (407KB) ( 137 )   Calprotectin (S100A8/A9) is a Ca2+ binding protein in the S100 protein family, having a wide range of biological activities and serving as a biomarker for many diseases. Peritoneal dialysis-related peritoneal fibrosis is one of the common complications in peritoneal dialysis (PD) patients. Many studies have recently proved that S100A8/A9 plays an important part in the development of peritoneal fibrosis. Our previous study also confirms that S100A8/A9 is up-regulated in peritoneal fibrosis and down-regulated after inhibition of peritoneal fibrosis. This article discusses the prospect of S100A8/A9 as a new target for the diagnosis and treatment of peritoneal fibrosis. Metrics

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Effect of temporary central venous catheterization on long-term survival of the arteriovenous fistula HE Xiao-ting,  ZHANG Wen,  YANG Xiao-ying,  LIU Ping 2023, 22 (1):  56-60,72.  doi: 10.3969/j.issn.1671-4091.2023.01.013 Abstract ( 121 )   PDF (520KB) ( 179 )   Objective  The purpose of this study was to analyze the effect of temporary central venous catheterization (CVC) on long-term survival of the arteriovenous fistula (AVF).  Methods  We retrospectively collected the general information and laboratory examinations of hemodialysis patients treated in The Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Traditional Chinese Medicine. AVF primary patency time, AVF primary functional patency time, the time from AVF creation to first puncture, and the duration of temporary CVC were recorded. Logistic regression was used to analyze the association between temporary CVC and survival of AVF. Kaplan-Meier survival analysis was used to compare AVF primary patency rate and AVF primary functional patency rate between the CVC group and the non-CVC group, as well as among the three groups of patients with the CVC duration of ≤42 days, 43～89 days, and≥90 days.  Results  A total of 174 patients met the criteria for inclusion in this study. The average age was 58.38±15.35 years old, 57 cases (32.76%) were females, and 68 cases (39.08%) were complicated with diabetes. The time from AVF creation to first puncture, AVF primary patency time and AVF primary functional patency time increased significantly in the non-CVC group, as compared with those in CVC group  (Z= -3.523, -2.064 and -1.965 respectively; P＜0.001, =0.039 and 0.049 respectively). Both univariate binary and multivariate binary logistic regression showed that temporary CVC was associated with AVF survival rate (OR=1.012 and 1.012; 95% CI: 1.000～1.024 and 1.000～1.025; P=0.041 and 0.043). Among the three groups of patients with temporary CVC duration of ≤42 days, 43～89 days, and ≥90 days, AVF primary patency rate and AVF primary functional patency rate were statistically different (χ2=6.354 and 6.926; P=0.042 and 0.031); hemoglobin, hematocrit, urea nitrogen, serum creatinine, the time from AVF creation to first puncture, AVF primary patency time, and AVF primary functional patency time were also statistically different  (F/H=3.222, 5.672, 6.830, 9.366, 49.628, 10.543 and 11.762 respectively; P=0.043, 0.004, 0.001, 0.009, ＜0.001, 0.005 and 0.003 respectively).   Conclusion  This study shows that the time of temporary CVC is correlated to the long-term survival rate of AVF. The long-term survival rate of AVF, AVF primary patency time, and AVF primary functional patency were higher and longer in the group with temporary CVC time ≤42 days. Therefore, temporary CVC should be removed as early as possible when conditions permit. Metrics

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Application of ultrasound gel pad during the ultrasound examination of autologous arteriovenous fistula stenosis LUO Wei-yuan, HUANG Jin-hang, XIE Yan-hua, LIU Pei-jun, XIE Yu-huan 2023, 22 (1):  61-63.  doi: 10.3969/j.issn.1671-4091.2023.01.014 Abstract ( 148 )   PDF (610KB) ( 106 )   Objective  To investigate the value of ultrasound gel pad during the ultrasound examination of autologous arteriovenous fistula (AVF) stenosis.  Methods  A total of 31 patients with AVF and venous access stenosis were subjected to ultrasound examination of the blood vessels in the upper extremity. The residual diameter of stenosis was measured using different transaudient medium: ultrasound gel pad and coupant. The repeatability and correlation with brachial artery blood flow were evaluated.   Results  All of the 31 cases had end-to-side anastomosis of radial artery-cephalic vein fistula in wrist. The stenosis located in the venous end of the fistula in 4 cases, and located in the forearm segment of cephalic vein in 27 cases. The residual diameter at the stenosis site was 1.41±0.45 mm measured with couplant, and was 1.89±0.53 mm measured with ultrasound gel pad, the difference was statistically significant (t=-3.806, P<0.001). The inter-observer correlation coefficient (ICC) with couplant was 0.887 (95% CI: 0.761~0.946, P<0.001), and was 0.974 (95% CI: 0.948~0.988,  P<0.001) with ultrasound gel pad.  The brachial artery flow measured by Doppler was 381.29±159.77 ml/min. The residual diameter of stenosis measured with couplant was significantly correlated with brachial artery flow (r=0.765, P<0.001). The measurement with ultrasound gel pad was also significantly correlated with brachial artery flow (r=0.817, P<0.001).   Conclusion  When vascular ultrasonography was performed in patients with AVF and venous access stenosis, ultrasound gel pad can reduce the compression deformities of the veins. Ultrasonography of AVF stenosis using ultrasound gel pad has a better repeatability and a better correlation with brachial artery blood flow than those using couplant. Metrics

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Current situation and influencing factors of thirst in maintenance hemodialysis patients  CHEN Wen-si, ZHANG Hong-mei 2023, 22 (1):  64-67.  doi: 10.3969/j.issn.1671-4091.2023.01.015 Abstract ( 372 )   PDF (421KB) ( 188 )   Objective  To investigate the present situation and influencing factors of the thirst sensation in maintenance hemodialysis (MHD) patients.  Methods  A total of 369 MHD patients in the Hemodialysis Center, Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Traditional Chinese Medical University between February to May 2022 were investigated by convenient sampling method. The general information questionnaire, simplified xerostomia inventory and dialysis thirst inventory were used. The saliva secretion volume at baseline without stimulation was measured.  Results  The average score of dialysis thirst inventory in the 369 MHD patients was 14.80±3.19; 64.5% were mild thirst (10～15 scores), 26.0% were moderate thirst (16～20 scores), and 9.5% were severe thirst (21～25 scores); thirst (dialysis thirst inventory score ≥16) was found in 35.5% of the 369 MHD patients. The average score of simplified xerostomia inventory was 12.46±2.51 in the 369 MHD patients. The baseline and unstimulated saliva secretion volume was 0.21 (0.09, 0.35) ml/min. Logistic regression analysis showed that average ultrafiltration volume (OR=1.001, 95% CI:1.000～1.002, P=0.002), score of simplified xerostomia inventory (OR=3.186, 95% CI: 2.458～4.131, P＜0.001) and degree of salty taste (OR=0.440, 95% CI: 0.209～0.930, P=0.031) were the main influencing factors for thirst in MHD patients.   Conclusion   Thirst is a common symptom that disturbs MHD patients, and is affected by many factors. Thirst in MHD patients justifies to be concerned by the medical professionals that take care of them. Intervention of thirst based on the clinical conditions of the MHD patients is required. Metrics

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Effect of 5E rehabilitation model(encouragement、education、exercise、employment、evaluation)on micro-inflammatory state and quality of life among patients undergoing hemodialysis ZHENG Meng-lei, SHU Liang-hui 2023, 22 (1):  68-72.  doi: 10.3969/j.issn.1671-4091.2023.01.016 Abstract ( 208 )   PDF (473KB) ( 182 )   Objective  To investigate the effect of 5E rehabilitation model on micro-inflammatory state and quality of life among patients undergoing hemodialysis.  Methods  A total of 120 maintenance hemodialysis patients treated in the Blood Purification Center of Wuxi 9th Hospital Affiliated to Soochow University were selected and randomly divided into control group (n=60) and observation group (n=60). Patients in the control group were conducted conventional nursing, while the observation group conducted 5E rehabilitation model on the basis of conventional nursing. After 6 months of intervention, the level of hs-CRP、TNF-α、IL-6 and malnutrition inflammation score and 36-item short form health survey scores were compared between two groups.   Results  After 6 months of intervention, the levels of hs-CRP、TNF-α、IL-6 and malnutrition-inflammation scores in the observation group were lower than these in the control group respectively(t=2.300,4.959,2.649,2.298,P=0.023,＜0.001,0.009, 0.024). There was no significant difference in the score of SF-36 dimension item of mental health between the observation group and the control group(t=-1.877,P=0.063). Item scores of other dimensions in the observation group were higher than these in the control group (t=-2.527, -3.220,-2.963,0.002,-5.963,4.959,-4.177,P=0.013,0.002,0.004,0.001,＜0.001).  Conclusion  5E rehabilitation model may effectively improve the micro-inflammatory state, nutritional status and quality of life among MHD patients. Metrics

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Establishment and clinical practice of quantitative scoring strategy for hemodialysis quality control and improvement management in Beijing ZHANG Yue,  DIAO Zong-li, GUO Wang, WEI Tao, LIU Wen-hu 2023, 22 (1):  73-78.  doi: 10.3969/j.issn.1671-4091.2023.01.017 Abstract ( 118 )   PDF (1503KB) ( 102 )   Objectives  To establish a practical method to improve compliance of the academic guidelines in dialysis units in Beijing.  Methods  Quantitative scoring strategy was built up based on the practicable clinical parameters and the guidelines from other countries. The rate of compliance with the guidelines and the rate of guideline performance during the period from 2014 to 2020 were calculated using the data from the database in Beijing Blood Purification Quality Control and Improvement Center. The dialysis units were then ranked according to the total scores of compliance rate and guideline performance rate.  Results  Eight clinical parameters were incorporated in the quantitative scoring strategy: hemoglobin, serum albumin, ferritin, calcium, phosphorus, iPTH, URR, and Kt/V. After implementation of the strategy for 5 years, the compliance and performance rates for hemoglobin (from 58.7% to 79.7%, χ2=18.339, P=0.005), serum albumin (from 82.2% to 85.6%,  χ2=0.253, P=0.615), ferritin (from 47.5% to 63.4%,  χ2=8.935, P=0.003), calcium ( χ2=5.113, P=0.024), phosphorus (from 41.7% to 47.6%),  and iPTH (from 28.2% to 35.3%,  χ2=2.037, P=0.153) increased steadily, but URR and Kt/V were slightly reduced in spite of their appropriate guideline performance.  Conclusions  The quantitative scoring strategy is a simple and practicable tool for administration and management of blood purification quality control and improvement. Metrics