Chinese Journal of Blood Purification

12 February 2023, Volume 22 Issue 02 Previous Issue    Next Issue

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Effect of high-flux hemodialysis on serum hepcidin and hypoxia-inducible factor in maintenance dialysis patients IANG Xiao-lan, LIU Bin 2023, 22 (02):  81-85.  doi: 10.3969/j.issn.1671-4091.2023.02.001 Abstract ( 165 )   PDF (466KB) ( 127 )   Objectives  To investigate the effects of High-Flux Hemodialysis (HFHD) on Serum Hepcidin and Hypoxia Inducible Factor (HIF) in Maintenance Hemodialysis (MHD) Patients.  Methods  Sixty MHD patients in the First People's Hospital of Kunming Blood Purification Center between May 2018 and April 2020 were randomly divided into the HFHD group and the Low Flux Hemodialysis (LFHD) group (30 patients in each group). Pre- and post-dialysis whole blood specimens were collected from both groups at the beginning of the trial, 6 months into the trial, 12 months into the trial, and 18 months into the trial respectively. The differences in serum hepcidin, Hypoxia Inducible Factor (HIF), Interleukin-6 (IL-6), and Tumor necrosis factor-α (TNF-α) were examined and compared between the two groups.  Results   The hepcidin level :  ①There was a statistically significant difference (Z=-2.927,P=0.003) between the HFHD group and the LFHD group [31.5 (21.4, 54.2) vs. 49.1 (36.9, 68.8)] at 18 months. ② There was a statistical difference of serum hepcidin at different time points in the HFHD group (H=50.992,P＜0.001) and the lowest at 18 months. Hypoxia Inducible Factor (HIF): The results were not statistically different (P＞0.05) between the HFHD and LFHD groups at each time point (Z=-1.442，-1.952，-0.834 and -3.152，P=0.149，0.051，0.404 and 0.912) or between different time points of the same group (H=13.212 and 6.369，P=0.808 and 0.095), and no significant trend over time was found. When compared between the two groups, IL-6 and TNF-α were lower in the HFHD group than in the LFHD group at 18 months (Z=-1.996, P=0.046, Z=-4.140,P＜0.001).  Conclusion  The effects of HFHD and LFHD on HIF were not significant. Compared with LFHD, HFHD decreased the levels of hepcidin, the levels of inflammatory factors IL-6 and TNF-α in patients with MHD which probably due to the preferential clearance of serum hepcidin and inflammatory factors by high-flux dialysis membranes, also improved the microinflammatory state in patients, thus reducing the high expression of hepcidin in the liver. Metrics

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Risk factors of arteriovenous fistula dysfunction and relationship with aortic arch calcification YAN Ai-hong, BAO Xiu-qin, ZHANG Qiao-gen 2023, 22 (02):  86-89.  doi: 10.3969/j.issn.1671-4091.2023.02.002 Abstract ( 161 )   PDF (499KB) ( 267 )   Objective  To investigate the risk factors of  (arteriovenous fistula,AVF) dysfunction in MHD patients and the relationship with aortic arch calcification.  Methods  185 patients with MHD by regular follow-up were retrospectively chosen in the period of January 2015 to January 2020. The enrolled patients were divided into calcified group (138 cases) and non-calcified group (47 cases) according to the presence of aortic arch calcification. The clinical characteristics of the two groups were compared and Logistic regression model was used to explore the independent risk factors of AVF dysfunction. The correlation between aortic arch calcification score and AVF dysfunction was analyzed and ROC curve was drawn to evaluate the predict efficacy on AVF dysfunction of aortic arch calcification score.  Results  The age, pulse pressure difference, corrected calcium, blood phosphorus levels and CRP and AVF function loss rate in calcified group were significantly higher than non-calcified group (P＜0.05). The levels of DBP and iPTH in calcified group were significantly lower than non-calcified group (P＜0.05). Univariate and multivariate analysis results of logistic regression models showed that higher corrected calcium level, higher blood phosphorus level, higher CRP and aortic arch calcification were independent risk factors for AVF dysfunction in patients with MHD (P＜0.05). Spearman test showed that aortic arch calcification score was positively correlated with AVF dysfunction (P＜0.05). ROC curve analysis showed that AUC of aortic arch calcification score in predicting of AVF dysfunction was 0.88 (95% CI: 0.83～0.97), the optimal cut-off value was 2 points, and the sensitivity and specificity were 78.41% and 86.33%, respectively.  Conclusion  The AVF dysfunction in patients with MHD was closely related to aortic arch calcification, abnormal calcium and phosphorus levels, and inflammatory cytokine secretion, and the degree of aortic arch calcification can be used to predict the risk of AVF dysfunction.  Metrics

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Associations between geriatric nutritional risk index and clinical characteristics in maintenance hemodialysis patients WANG Wei, SHI Rui, LI Xiu-yong, BAI You-wei, LIU Zhi, LIANG Shao-qin, CHEN Lei, TANG Xiao-fei, LI Ji, GUO Yu-wen, YUAN Liang, WANG De-guang 2023, 22 (02):  90-94.  doi: 10.3969/j.issn.1671-4091.2023.02.003 Abstract ( 145 )   PDF (534KB) ( 244 )   Objective To evaluate the associated between Geriatric Nutritional Risk Index (GNRI) and clinical characteristics in maintenance hemodialysis (MHD) patients.  Methods  Two thousand six hundred and seventy-eight patients in MHD were recruited. Clinical characteristics of the patients were collected. We divided patients into the highest GNRI group (>98), considered to have no risk of malnutrition, the high GNRI group (92≤GNRI≤98), considered to have a low risk of malnutrition, median GNRI group (82≤GNRI＜92), considered to have a median risk of malnutrition, and low GNRI group (＜82), considered to have a high risk of malnutrition. Pearson correlation analyses and multiple linear regression analyses were conducted.  Results  One thousand and eighty-four patients (40.3%) were at risk of malnutrition. Pearson analysis showed that age (r=-0.101, P＜0.001) and hypersensitive c reactive protein (hsCRP) (r=-0.195, P=0.002) were negatively correlated with GNRI. Hemoglobin (r=0.266, P＜0.001), serum creatinine (r=0.225, P＜0.001),  triglyceride (r=0.147, P＜0.001), low density lipoprotein (r=0.089, P＜0.001), cholesterol (r=0.060, P=0.002), serum magnesium (r=0.113, P＜0.001), serum phosphorus (r=0.127, P＜0.001), parathyroid hormone (r=0.051, P=0.008) were positively correlated with GNRI. Multivariate logistic regression analysis shown that serum creatinine (β=0.070, P＜0.001), triglyceride (β=0.070, P＜0.001) and low density lipoprotein (β=0.034, P=0.009) were significantly associated with GNRI.  Conclusions  GNRI may be a reasonable indicator for assessment and monitoring of nutritional status in MHD patients.  Metrics

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The relationship between C-reactive protein to albumin ratio, alkaline phosphatase to albumin ratio and coronary artery calcification in patients with chronic kidney disease at the 3~5 stage HONG Ying, ZHU Yu-yu, WANG De-guang 2023, 22 (02):  95-99.  doi: 10.3969/j.issn.1671-4091.2023.02.004 Abstract ( 115 )   PDF (489KB) ( 34 )   Objectives  To analyze the risk factors of coronary artery calcification (CAC) in chronic kidney disease (CKD) patients at the 3~5 stage, and to investigate the value of C-reactive protein to albumin ratio (CAR) and alkaline phosphatase to albumin ratio (APAR) in the prediction of CAC.  Methods  This was a cross-sectional and retrospective study on the 175 CKD patients at 3~5 stage. According to the CAC score, the patients were divided no CAC group (CAC score 0~10, n=88), and CAC group (CAC score ≥11, n=87). The differences of CAR and APAR were analyzed between the two groups. Spearman correlation was used to analyze the correlation between CAR, APAR and CAC. Binary logistic regression was used to analyze the risk factors of CAC. The receiver operating characteristic (ROC) curve was used to explore the values of CAR and APAR in the prediction of CAC.  Results  The detection rate of CAC was 49.7% in the 175 CKD patients at 3~5 stage. Spearman correlation analysis showed that CAC was positively correlated with CAR (r=0.416,     P<0.001) and APAR (r=0.226, P=0.003). Binary logistic regression analysis showed that age (OR=1.047, 95% CI: 1.012~1.083, P=0.007), diabetes (OR=0.132, 95% CI: 0.038~0.456, P=0.001), CAR(OR=16.332, 95% CI:2.415~110.447, P=0.004), and APAR (OR=1.500, 95% CI: 1.043~2.155, P=0.029) were the independent risk factors for CAC. ROC curve showed that the area under the curve were 0.765 (95% CI: 0.695~0.835, P<0.001) and 0.648 (95% CI: 25 0.567~0.730, P=0.001) for the prediction of CAC by CAR and APAR respectively.  Conclusion  ①The higher the values of CAR and APAR, the heavier the severity of coronary artery disease in the CKD patients at 3~5 stage. ②CAR and APAR can be used as the predictors for the severity of coronary artery disease in CKD patients at 3~5 stage. Metrics

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Changes of serum FGF-23 and sST2 levels and their predictive value for cardiac valve calcification in elderly patients with end-stage renal disease on hemodialysis WANG Wei, XU Chang-sheng, HUO Yu-zhang, MA Da 2023, 22 (02):  100-104.  doi: 10.3969/j.issn.1671-4091.2023.02.005 Abstract ( 93 )   PDF (471KB) ( 50 )   Objective  To explore serum levels of fibroblast growth factor-23 (FGF-23) and soluble growth stimulation expressed gene 2 (sST2) in the prediction of heart valve calcification in elderly patients with end-stage renal disease (ESRD) on hemodialysis.  Methods  A total of 106 elderly ESRD patients on hemodialysis admitted to the Seventh Affiliated Hospital of Xinjiang Medical University from June 2018 to June 2021 were recruited as the observation group, and a total of 106 healthy individuals for physical check-up were recruited as the control group. Serum FGF-23 and sST2 levels were compared between the two groups. The observation group was followed up until January 2022, and the incidence of heart valve calcification in this group was then calculated. The influencing factors for heart valve calcification and the interaction of FGF-23 and sST2 in the pathogenesis of heart valve calcification were analyzed. The values of FGF-23 and sST2 in predicting heart valve calcification were then evaluated.  Results Serum FGF-23 and sST2 levels were higher in the observation group than in the control group (t=35.539 and 45.748, P＜0.001). Higher expressions of FGF-23 and sST2 increased the risk of heart valve calcification (OR=4.539 and 4.265, 95% CI：2.527~8.154 and 2.008~9.057, P＜0.001). After adjusting for confounding factors, there was a positive interaction between FGF-23 and sST2 on the occurrence of cardiac valve calcification. The synergistic effect was 2.631 times higher than the sum of the effects of the two individually (SI=2.631). The area under the curve (AUC) of combined FGF-23 and sST2 was greater than that of FGF-23 or sST2 for the prediction of heart valve calcification (AUC=0.851, 95% CI：0.767~0.913, P＜0.001).   Conclusion  Serum FGF-23 and sST2 levels abnormally increased in elderly ESRD patients on hemodialysis. The effects of FGF-23 and sST2 were synergistic in the pathogenesis of heart valve calcification, and combination of the two can efficiently improve the prediction of heart valve calcification. Metrics

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The relationship between bone markers and coronary artery calcification in patients on maintenance hemodialysis ZHOU Li-na, DONG Shao-shao, ZHANG Sheng-ze, WANG Mu-dan, ZHU Yuan, HUANG Wen 2023, 22 (02):  105-109.  doi: 10.3969/j.issn.1671-4091.2023.02.006 Abstract ( 169 )   PDF (457KB) ( 106 )   Objective To investigate the relationship between bone markers and coronary artery calcification (CAC) in patients on maintenance hemodialysis (MHD), and to explore the influencing factors for bone markers in these patients.  Methods  A total of 88 MHD patients treated in Wenzhou People's Hospital were recruited. They were divided into CAC group (n=59) and non-CAC group (n=29) based on the CAC score. General clinical data, biochemical results including the inflammation indicators of serum amyloid A protein (SAA), high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6), and the bone markers of alkaline phosphatase (ALP), N-terminal osteocalcin (N-MID), type 1 collagen cross-linking β-C terminal peptide (β-CTX) and procollagen type 1 N-terminal propeptide (PINP) were recorded. These biochemical parameters were compared between the two groups to evaluate the relationship between bone markers and CAC and the risk factors for CAC.  Results  ①The bone markers were higher in CAC group than in non-CAC group [N-MID: 174.34±88.44 vs. 120.59±76.32, t=2.182, P=0.034; β-CTX: 2.58±0.99 vs. 1.74±1.0, t=2.912, P=0.005; ALP: 95 (59.0~489.00) vs. 83.5 (47.0~129.0), t=2.480, P=0.017], suggesting the presence of higher turnover osteopathy in CAC group.  ②Correlation analyses found that PINP was positively correlated with the inflammation indicators of hs-CRP (r=0.438, P=0.001), IL-6 (r=0.357, P=0.028) and SAA (r=0.298, P=0.038); parathyroid hormone (PTH) was positively correlated with β-CTX (r=0.588, P=0.000), N-MID (r=0.463, P=0.001), PINP (r=0.369, P=0.007), and PINP/β-CTX (r=0.364, P=0.009); β2-microglobulin (β2-MG) was positively correlated with N-MID (r=0.389, P=0.005), PINP (r=0.360, P＜0.010) and PINP/β-CTX (r=0.383, P=0.006); and low-/high-density lipoprotein ratio (LHR) was positively correlated with β-CTX (r=0.340, P=0.010).      ③Binary logistic regression demonstrated that β-CTX was an independent risk factor for CAC (OR=3.433, 95% CI: 1.51~7.78, P=0.003).  Conclusion  Bone markers are implicated in the pathogenesis of CAC. The bone marker of β-CTX can be used as an independent factor for the prediction of CAC. Bone markers are correlated with inflammatory factors, PTH, LHR and β2-MG, and they may collectively participate in the formation of CAC through affecting bone metabolism in MHD patients. Metrics

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Establishment of a nomogram model for individualized prediction of thirst risk in maintenance hemodialysis patients JI Jie, XU Yi-lin, LIU Jun, ZHONG Li-li, LU Yi-Xian, YANG Yi-Jing 2023, 22 (02):  110-113,118.  doi: 10.3969/j.issn.1671-4091.2023.02.007 Abstract ( 115 )   PDF (563KB) ( 79 )   Objective  To construct an individualized nomogram model for predicting the risk of thirst in maintenance hemodialysis (MHD) patients.  Methods  A convenience sampling survey method was performed to select 200 MHD patients admitted to the Blood Purification Center of Huai'an Second People's Hospital from May 2021 to May 2022. A self-made questionnaire and the dialysis thirst inventory (DTI) were used for the investigation. According to the score of DTI scale, the 200 MHD patients were grouped into thirst group (DTI≥16 points, n=36) and non-thirst group (DTI ＜16 points, n=164). Logistic regression was used to identify the risk factors for thirst in MHD patients; R software was used to construct a nomogram model for predicting the risk of thirst in MHD patients. The ROC curve and calibration curve were used to verify efficiency of the nomogram model.  Results   Logistic regression showed that diabetes history (OR=3.174, 95% CI:1.033~9.750, P=0.044), xerostomia inventory (XI) score (OR=1.331, 95% CI : 1.201~1.475, P＜0.001), and interdialysis weight gain rate (IDWG%) (OR=4.417, 95% CI: 2.054~9.497, P＜0.001) were the independent risk factors for thirst in MHD patients. The above three risk prediction indexes were used to construct a column graph model for predicting thirst risk in MHD patients. The verification results showed that the area under the ROC curve was 0.897 (95% CI: 0.840~0.953), the slope of the calibration curve was close to 1, and the H-L goodness-of-fit test χ2=8.830 and P=0.357.  Conclusion   The nomogram model constructed based on the three indicators of diabetes history, XI score and IDWG% has better predictive performance on thirst risk in MHD patients. Metrics

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Exercise management combined with paricalciferol increases serum Klotho and improves secondary hyperparathyroidism ZOU Chun-bo, SU Ting-ting, ZHANG Shu-yan, LIU Hai-fei, ZHANG Yu 2023, 22 (02):  114-118.  doi: 10.3969/j.issn.1671-4091.2023.02.008 Abstract ( 135 )   PDF (454KB) ( 51 )   Objectives To investigate the clinical efficacy of exercise management combined with paricalcitol on secondary hyperparathyroidism (SHPT) and on the fibroblast growth factor 23 (FGF23)-Klotho axis in maintenance hemodialysis (MHD) patients  Methods  Forty MHD patients were randomly divided into drug group (using paricalcitol) and combined group (using exercise combined with paricalcitol). Serum calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH), alkaline phosphatase (ALP), FGF23 and Klotho were compared between the two groups before treatment, and after treatment for 12 weeks and 24 weeks.  Results Along with the increase of treatment time, serum P and iPTH were lower in combined group than in drug group (F=4.614 and 4.144; P=0.038 and 0.049), Klotho increased in combined group (F=27.744; P=0.007), and serum Ca, ALP and FGF23 had no differences between the two groups (F=0.004, 0.379 and 0.115 respectively; P=0.070, 0.542 and 0.501 respectively). Before the treatment and after the treatment for 12 and 24 weeks, serum P, iPTH and ALP in the two groups showed statistical differences and decrease trend at the three time points (F=31.395, 60.159 and 38.469 respectively; P<0.001), while serum Ca and Klotho in the two groups revealed statistical differences and increase trend at the three time points (F=21.368 and 5.268; P<0.001); there were reciprocal effects between serum levels of P, Ca, iPTH, ALP and Klotho in the two groups and treatment period (F=6.013, 0.208, 5.321, 4.618 and 5.813 respectively; P=0.008, 0.013, 0.013, 0.028 and 0.013 respectively), but serum FGF23 in the two groups and treatment period did not have such reciprocal effect (F=2.637, P=0.645).  Conclusions  Exercise combined with paricalciferol increased serum Klotho level and decreased serum P and iPTH levels, through which the progressive course of SHPT can be controlled. Metrics

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Factors influencing the increase of peritoneal solute transport rate in peritoneal dialysis patients  WU Bei, ZHAO Hui-ping, LU Li-xia, QIAO Jie, CHU Xin-xin, MEN Chun-cui, HE Yu-ting, WANG Mei 2023, 22 (02):  119-122.  doi: 10.3969/j.issn.1671-4091.2023.02.009 Abstract ( 92 )   PDF (417KB) ( 34 )   Objective  The purpose of this study was to find out the independent factors influencing the increase of peritoneal solute transport rate (PSTR) in peritoneal dialysis (PD) patients by retrospective analysis.  Methods  The PD patients were the adults (≥18 years old) with end-stage renal disease who had undergone PD in Peking University People's Hospital and had subjected to two peritoneal balance tests from June 2017 to June 2022. According to the changes of PSTR, the patients were divided into two groups: PSTR ascending group and PSTR descending group. Independent sample T test, rank sum test or chi square test was used to compare the differences in demographic data, dialysis program, medication and laboratory indicators between the two groups. Logistic regression (input method) was used to detect the independent risk factors relating to the increase of PSTR.  Results  This study enrolled a total of 80 PD patients, of which 48 (60%) were in the PSTR ascending group and 32 (40%) in the PSTR descending group. The PSTR ascending group had the characteristics of longer dialysis age (Z=-2.642, P=0.008), lower baseline PSTR (t=-3.215, P=0.002), and higher proportion of patients using continuous PD (χ2=3.879, P=0.049), as compared those in the PSTR descending group. Logistic regression showed that dialysis age (OR=0.975, 95% CI 0.959~0.991, P=0.002) and baseline PSTR (OR=21 455.039, 95% CI 43.218~10 651 164.480, P=0.002) had the independent effects on the increase of PSTR, and that whether continuous PD was used or not (OR=2.442, 95% CI 0.734~8.130, P=0.146) was not an independent risk factor for the increase of PSTR.  Conclusion  Patients with longer dialysis age, lower baseline PSTR and continuous PD mode are more likely to have increased PSTR. However, continuous PD mode is not an independent risk factor for the increase of PSTR. Metrics

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Lower serum zinc level was independently associated with left ventricular diastolic dysfunction in maintenance hemodialysis patients LIU Hui-ru, ZHOU Yuan-yuan, QIAO Juan, SHI Jun-jun 2023, 22 (02):  123-127.  doi: 10.3969/j.issn.1671-4091.2023.02.010 Abstract ( 91 )   PDF (512KB) ( 35 )   Objective To study the relationship between serum zinc level and left ventricular diastolic dysfunction (LVDD) in patients with maintenance hemodialysis (MHD), and to explore the feasibility of serum zinc for early prediction of LVDD in MHD patients.  Methods  This was a single centered and cross-sectional study. A total of 96 MHD patients in the Blood Purification Center of Lianyungang First People's Hospital from Jun 2018 to Dec 2020 were recruited as the research objects. Serum zinc level was measured by flame atomic absorption spectrometry. According to the results of echocardiography, the patients were divided into LVDD group (n=52) and non-LVDD group (n=44). The clinical data, laboratory indexes and echocardiographic parameters were compared between LVDD group and non-LVDD group. The relationship between serum zinc level and other indexes in MHD patients was analyzed by Pearson and Spearman correlation methods. The factors affecting LVDD in MHD patients were analyzed by multivariate logistic regression. The diagnostic value of serum zinc for LVDD in MHD patients was analyzed by ROC.  Results  Serum zinc level in LVDD group was (90.15±10.44) μg/dl, lower than that in non-LVDD group (107.42±11.57) μg/dl, and the difference was statistically significant (t=7.618, P<0.001). Correlation analyses showed that serum zinc level in MHD patients was positively correlated with hemoglobin (r=0.263, P=0.017), and negatively correlated with E/E' (r=-0.447, P<0.001) and left atrial diameter (LAD) (r=-0.243, P=0.028). ROC curve showed that the area under curve (AUC) of serum zinc level in predicting LVDD in MHD patients was 0.817 (95% CI: 0.728~0.892, P=0.015), the predicted cutoff value was 95.85 μg/dL, the sensitivity was 78.44%, and the specificity was 76.02%. Multivariate logistic regression showed that lower serum zinc level was an independent risk factor for LVDD in MHD patients (OR=2.014, 95% CI: 1.414~7.015, P=0.005).  Conclusion  Lower serum zinc level is an independent risk factor for LVDD in MHD patients. Serum zinc may be an effective serological marker for predicting LVDD in MHD patients. Metrics

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The pathogenesis and treatment of sarcopenia in end-stage renal disease patients on maintenance dialysis WAN Li, WANG Mei 2023, 22 (02):  128-132.  doi: 10.3969/j.issn.1671-4091.2023.02.011 Abstract ( 230 )   PDF (407KB) ( 141 )   Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass, strength and function. End-stage renal disease (ESRD) patients are at a higher risk of accelerated muscle wasting due to the renal diseases itself, various complications, dialysis treatment and reduced activity from dialysis treatment. The incidence of sarcopenia is higher in dialysis patients and the mortality will be increased in dialysis patients with sarcopenia, highlighting the great importance of early prevention, detection and treatment of muscle wasting. In this article, we summarize the pathogenesis, diagnosis and treatment of sarcopenia in ESRD patients on maintenance dialysis. Metrics

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Exploration of the role of plant-based diet based on the dietary pattern for cardiovascular disease in patients with peritoneal dialysis DU Ya-ting, FANG Lv-gui, RAO Xiang-rong 2023, 22 (02):  133-135,140.  doi: 10.3969/j.issn.1671-4091.2023.02.012 Abstract ( 88 )   PDF (379KB) ( 52 )   Cardiovascular disease (CVD) is the main cause of death in chronic kidney disease patients with peritoneal dialysis (PD). To explore the rationality of plant-based diet based on the dietary pattern for prevention and treatment of CVD, we analyze the possible adverse effects of plant-based diet on PD patients. More attention should be paid to the application of plant-based diet, and intervention studies should be conducted to unveil the risks and benefits of plant-based diet in PD patients. Metrics

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Research progress in the influence of hemodialysis on diabetic retinopathy DENG Wang-yue, HU Da-jun, LU Bi-yu, DONG Pei 2023, 22 (02):  136-140.  doi: 10.3969/j.issn.1671-4091.2023.02.013 Abstract ( 123 )   PDF (419KB) ( 64 )   Diabetic retinopathy and diabetic nephropathy are two common chronic microvascular complications in diabetic patients. It is reported that diabetic retinopathy and diabetic nephropathy are correlated and can be predicted and influenced each other. Diabetic retinopathy and diabetic nephropathy are hardly to be recognized at the early stage. With the gradual progress of the diseases, the former is present with macular edema, exudation, vitreous hemorrhage, retinal detachment and even blindness, and the latter eventually progresses to end-stage renal disease. Hemodialysis is currently the most useful treatment for blood purification to improve end-stage renal disease. Hemodialysis can improve diabetic visual impairment and nephropathy by eliminating toxins and excess body fluid in end-stage renal disease patients. However, the ability to eliminate reactive oxygen species (ROS) by hemodialysis reduces with the elongation of dialysis age, leading to the aggravation of visual impairment in diabetic retinopathy patients. Therefore, how to accurately assess the extent of the retinopathy and reverse the progression of the retinopathy are essential to prevent visual loss and blindness and to improve the quality of life in hemodialysis patients with diabetic retinopathy. Metrics

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A review of the correlation between nurse staffing and patient outcomes in hemodialysis facilities LI Gui, CAO Li-yun, XU Ying, MENG Li, YU Chong-yan, LIU Yao, TAO Zhen-hui, WANG Jin-wei, WANG Zhen-yu, HUANG Zi-ye, DING Yan-ming 2023, 22 (02):  141-144.  doi: 10.3969/j.issn.1671-4091.2023.02.014 Abstract ( 161 )   PDF (380KB) ( 173 )   Hemodialysis patients and facilities are both gradually increasing every year. How to conduct effective nurse staffing allocation, improve nursing efficiency, guarantee nursing quality, ensure patient safety, and promote patient prognosis has become a critical issue to be solved nowadays. This paper provides an overview of the definition and current status of nurse staffing allocation in hemodialysis facilities, the types and current status of patient outcomes, and the correlation between nurse staffing allocation and patient outcomes in hemodialysis facilities, with the aim of raising the attention of relevant departments and health care managers to nurse staffing allocation and providing references for further relevant studies. Metrics

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Analysis of the causes of filamentous fungi contamination in children's blood purification room during the rainy season and the countermeasures ZHAO Wei, LI Xiao-zhong, DAI Xiao-mei, HONG Zhong-qin 2023, 22 (02):  145-148.  doi: 10.3969/j.issn.1671-4091.2023.02.015 Abstract ( 132 )   PDF (400KB) ( 135 )   During the hot-humid climate in rainy season in the middle and lower regions of Yangtze river, filamentous fungi are easy to grow. The children with severe disease or immunocompromised status treated with blood purification are at high risk of getting nosocomial infection. In June 2021, the Blood Purification Room of Children's Hospital of Soochow University conducted the supervision of monthly microbial culture, and found that filamentous fungi were positive in several dialysis water samples and dialysis solutions, including microbial colony 76 cfu/ml in the initial terminal of the dialysis water from the water treatment room, microbial colony 6 cfu/ml in the dialysis solution from the No.1 dialysis machine, and microbial colony 4 cfu/ml in the dialysis solution from the No.2 dialysis machine. We immediately started an emergency plan, adjusted the dialysis regimen, monitored the inflammation markers and fungal infection indicators, analyzed the causes of filamentous fungi pollution, and revised the disinfection process in the blood purification room during rainy season. The fungal contamination can be effectively eliminated by strictly controlling the disinfection quality, and increasing the disinfection frequency for surfaces, ground, environment, air outlets  in the dialysis room and water treatment room. Metrics

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Analysis of the intervention mode under the theory of targeted management in acute renal failure patients on dialysis ZHANG Dan, ZHANG Ying-ying, FU Chen 2023, 22 (02):  149-152.  doi: 10.3969/j.issn.1671-4091.2023.02.016 Abstract ( 100 )   PDF (441KB) ( 62 )   Objective  To explore the value of the intervention mode under the theory of target management in dialysis patients with acute renal failure.  Methods  Using the random number table method, 80 dialysis patients with severe acute renal failure treated in our hospital from 2018 to 2021 were divided into observation group (40 cases) and control group (40 cases). The control group adopted the routine intervention mode, and the observation group adopted the nursing intervention mode under the target management theory. The changes of self-perception health score, self-management ability and complications before and after intervention were compared between the two groups.  Results  After the intervention, the scores of acute physiology and chronic health score (APACHE Ⅱ) and self-perceived burden scale (SPB) were lower in the observation group than in the control group (t=6.275, P=0.001; t=8.064, P=0.001). The self-management abilities (physical activity  t=7.236, P＜0.001; treatment behavior  t=8.841, P＜0.001; social psychological activity t=8.522, P＜0.001; eating behavior t=5.699, P＜0.001) were higher in the observation group than in the control group.  Conclusion  The nursing intervention model based on the target management theory can effectively improve the health status and self-perception, and increase the self-management ability in the patients with acute renal failure in intensive care unit. This nursing intervention mode is worthy of clinical promotion and use. Metrics

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Comfort status and its influencing factors in peritoneal dialysis patients  ZHOU Ting, YI Chun-yan, LIN Jian-xiong, YANG Xiao 2023, 22 (02):  153-157.  doi: 0.3969/j.issn.1671-4091.2023.02.017 Abstract ( 56 )   PDF (434KB) ( 64 )   Objective  This study investigated the comfort status of patients with maintenance peritoneal dialysis (PD) and analyzed its influence factors.  Methods  Convenience sampling was used to select patients with PD who were followed up in the First Affiliated Hospital of Sun Yat-sen University from January 2019 to June 2022. The comfort status of PD patients was evaluated by the self-made comfort scale of PD. Demographic data and clinical data were also collected.  Results  A total of 212 maintenance PD patients were included in this study. Their mean age was 46.5±13.2 years, 56.1% were male, the median duration of PD was 28.6 (10.3,64.0) months, and glomerulonephritis was the primary renal disease in 63.7% of the patients. The total score of comfort scale was 93.2±11.2 points, and the mean score of each dimension item showed that the mean score of physiological dimension was the lowest (3.3±0.5 points), followed by the mean score of psychological dimension and social dimension items (3.5±0.5 points and 3.5±0.5 points respectively); the mean score of environmental dimension item was higher (3.8±0.4 points). Multivariate linear regression showed that older age (β=0.136, P=0.027) and higher level of total creatinine clearance index (β=0.160, P=0.046) were the independent protective factors for the total score of comfort scale.  Conclusions  Clinical nurses should improve the physical discomfort of maintenance PD patients, strengthen psychological nursing and social support in the process of nursing, and pay more attention to the younger patients and patients with lower total creatinine clearance index. Metrics

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Chilaiditi syndrome in a peritoneal dialysis patient ZHU Xiang-gang, CHANG Qing, LI Jun-qiu, CAI Zhen, ZHAO Wen-jing 2023, 22 (02):  158-160.  doi: 10.3969/j.issn.1671-4091.2023.02.018 Abstract ( 138 )   PDF (440KB) ( 154 )   Chilaiditi syndrome is a rare clinical syndrome with complex clinical manifestations and higher misdiagnosis rate. Here we present how we diagnosed and treated a 79-year-old male case on peritoneal dialysis with Chilaiditi syndrome. He had upper abdominal pain for 12 years. He then developed dyspnea after 4 months of peritoneal dialysis. His abdominal CT and MRI showed the image of colon in front of liver. Chilaiditi syndrome was confirmed. The abdominal distension and abdominal pain were alleviated by integrated traditional Chinese medicine with western medicine. We reviewed the literature and introduced the update of diagnosis and treatment about this syndrome. Metrics