Chinese Journal of Blood Purification

12 March 2023, Volume 22 Issue 03 Previous Issue    Next Issue

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Research and Application Progress of Long acting Erythropoietin LIU Ai-chun, WEI Tao 2023, 22 (03):  161-163.  doi: 10.3969/j.issn.1671-4091.2023.03.001 Abstract ( 208 )   PDF (342KB) ( 216 )   China has a large number of patients with renal anemia and tumor anemia after radiotherapy and chemotherapy. Long acting erythropoietin (EPO) has the advantages of long half-life and high biological activity. It can reduce the frequency and dose of administration, improve patient compliance and improve the effect of anemia treatment. This paper summarizes the design scheme, advantages and application prospects of long-acting EPO in order to provide a theoretical basis for promoting the wide application of long-acting EPO in China. Metrics

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Research progress of cardiorenal anemia syndrome ZHONG Zhong, CHEN Wei 2023, 22 (03):  164-167,172.  doi: 10.3969/j.issn.1671-4091.2023.03.002 Abstract ( 232 )   PDF (378KB) ( 328 )   There is a close interaction between the heart and the kidney. Cardiorenal syndrome encompasses a spectrum of disorders involving both the heart and kidney in which acute or chronic dysfunction in one organ may induce acute or chronic dysfunction in the other organ. Anemia is very common in patients with both chronic kidney disease and heart failure. They interact and promote each other, forming a vicious circle, so they called the term cardiorenal anemia syndrome (CRAS). The occurrence of CRAS is mainly related to erythropoietin deficiency, iron deficiency, oxidative stress, inflammation response, and abnormal bone mineral metabolism. Patients with CRAS require comprehensive management, not only to control anemia, but also to actively treat heart failure, kidney injury and other comorbidities. Currently, the treatment of CRAS mainly focuses on erythropoietin and iron supplementation and the use of new hypoxia-inducible factor prolyl hydroxylase inhibitors. However, there are still many unresolved problems regarding the treatment of CRAS, and more randomized controlled studies with large samples are needed to provide evidence-based medicine results in the future. Metrics

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Investigation on the treatment status of infectious diseases in hemodialysis patients complicated with blood-borne infectious diseases ZHAO Na-xin, DONG Qing-hua, ZENG Zhi-li, LIU Hai-yan, REN Wen-wen, XIANG Pan 2023, 22 (03):  168-172.  doi: 10.3969/j.issn.1671-4091.2023.03.003 Abstract ( 130 )   PDF (379KB) ( 21 )   Objectives  To investigate the status of infectious disease treatment in maintenance hemodialysis (MHD) patients with blood-borne infectious diseases.  Methods  The treatment data of infectious disease in MHD patients with hepatitis B virus (HBV), hepatitis C virus(HCV), human immunodeficiency virus (HIV), or  treponema pallidum (TP) infection in Beijing Ditan Hospital by August 2022 were collected. And the data of viral load or tolulized red unheated serum test (TRUST) were summarized.  Results  A total of 55 patients were enrolled, including 40 males (72.7%). The average age was 57.4 (±11.1) years. There were 27 patients with HBV infection. 16 (59.26%) patients have received anti-HBV treatment, and 9 (33.33%) patients with HBV infection have serum HBV-DNA higher than the detection limit. There were 9 patients with HCV infection, and 6 (66.67%) patients had received or were receiving anti-HCV treatment. Serum HCV-RNA was not detected in all patients with HCV infection. There were 21 patients with TP infection, including 2 patients with HBV co-infection and 2 patients with HIV co-infection. TRUST turned negative in 2 patients without any treatment, and the remaining 19 (90.48%) patients had been treated with penicillin, and 5 (23.81%) patients had high titer of TRUST. There were 2 HIV-infected patients, all of whom had received antiviral treatment(ART), and their serum HIV-RNA could not be detected. One of them had severe drug-induced hepatitis after the initial ART.  Conclusions  The treatment of infectious diseases among MHD patients with blood-borne infectious diseases needs to be further optimized. Multi-disciplinary communication and cooperation are needed to take safe and effective measures to minimize the infectivity of blood. Metrics

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Feasibility of the surgery unrelated to peritoneal dialysis in peritoneal dialysis patients WU Bei, ZHAO Hui-ping, TANG Yi-fang, LU Li-xia, QIAO Jie, ZUO Li, WANG Mei 2023, 22 (03):  173-176.  doi: 10.3969/j.issn.1671-4091.2023.03.004 Abstract ( 96 )   PDF (414KB) ( 31 )   Objective The purpose of this study was to explore the feasibility and the perioperative management of surgical treatment due to concomitant diseases in patients with maintenance peritoneal dialysis (MPD).  Methods All peritoneal dialysis patients treated in Peking University People's Hospital from March 2006 to May 2021 were enrolled in this study, and the surgical operation records were reviewed for retrospective study. General information of the operation, levels of hemoglobin, electrolyte, renal function, blood pressure and others before and after the operation for 1-3 days, and surgical complications were recruited. Perioperative management and dialysis program were then explored in the MPD patients.  Results  In the 513 MPD patients, 72 (14.0%) patients required 96 operations for various concomitant diseases, and 71 operations involved in 11 departments were analyzed in this study. Hemoglobin (100.15±14.95 vs. 106.15±14.95 g/L, t=3.436, P=0.001), serum albumin (32.45±5.14 vs. 34.99±5.14, t=3.362, P=0.002) and carbon dioxide binding capacity (25.30±3.66 vs. 27.04±2.76, t=4.205, P＜0.001) decreased but still within the target ranges after the operations as compared with those before the operations. Blood pressure and serum potassium had no changes after the operations. Patients used general anesthesia had a higher probability (58.3%) of switching to continuous renal replacement therapy (CRRT) or hemodialysis during perioperative period than those used local anesthesia and intra-spinal anesthesia. Antibiotics were routinely used in 18 operations, and iodine contrast agent was used in 25 operations. Postoperative peritonitis occurred in 2 cases. The prognosis was better in most cases except that one patient died within one week after the operation.  Conclusion  There are higher risks in MPD patients undertaking surgical operation. However, most patients tolerate the surgery if perioperative management is appropriately arranged. Management of perioperative period, especially the adjustment of dialysis program, must be emphasized to help patients safely go through the perioperative period. Metrics

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The predictive value of serum D-dimer level on treatment failure of peritoneal dialysis-associated peritonitis MENG Ran, XU Jian, CHEN Xiao-li, LIU Gui-ling 2023, 22 (03):  177-181.  doi: 10.3969/j.issn.1671-4091.2023.03.005 Abstract ( 95 )   PDF (447KB) ( 36 )   Objective  To investigate the predictive value of plasma D-dimer on the treatment failure of peritoneal dialysis-associated peritonitis (PDAP).  Methods  The clinical data of 161 patients diagnosed with PDAP were retrospectively analyzed. They were divided into cured group and treatment failure group according to the treatment effect. The clinical data were compared between the two groups. Logistic regression was used to analyze the risk factors for the treatment failure of PDAP. Receiver operating characteristic curve (ROC) was used to analyze the predictive value of the risk factors for the treatment failure.  Results Serum albumin (t=3.359, P=0.002) and the first episode of PDAP (χ2=6.155, P=0.013) were significantly higher in the cured group than in the treatment failure group, while dialysis duration (Z=-3.314, P=0.001), leukocyte count in effluent dialysate at the 3rd day (Z=-3.951, P＜0.001), hs-CRP (Z=-3.093, P=0.002), procalcitonin (PCT, Z=-2.344, P=0.019), fibrinogen (Z=-2.197, P=0.024) and D-dimer (Z=-4.152, P＜0.001) were significantly lower in the cured group than in the treatment failure group. Univariate logistic regression showed that longer dialysis duration (OR=1.025, 95% CI:1.011～1.039, P＜0.001), higher hs-CRP (OR=1.007, 95% CI:1.002～1.012, P=0.008), higher PCT (OR=1.018, 95% CI:1.002～1.034, P=0.029), higher fibrinogen (OR=1.568, 95% CI:1.052～2.336, P=0.027), higher D-dimer (OR=1.523, 95% CI:1.165～1.991, P=0.002) and lower serum albumin (OR=0.915, 95% CI:0.840～0.997, P=0.043) were the risk factors for treatment failure of PDAP. Multivariate logistic analysis showed that longer dialysis duration (OR=1.023, 95% CI:1.008～1.039, P=0.003) and higher D-dimer (OR=1.419, 95% CI:1.064～1.893, P=0.017) were the independent risk factors for treatment failure of PDAP. ROC curve showed that D-dimer level to predict the treatment failure of PDAP had the area under the curve of 0.801, the sensitivity of 72.2% and the specificity of 76.2%, better than the levels of hs-CRP, PCT, fibrinogen and serum albumin to predict the treatment failure.  Conclusions Longer peritoneal dialysis duration and higher D-dimer before treatment were independently correlated with the treatment failure of PDAP. Plasma D-dimer level was a better indicator to predict treatment failure of PDAP. Metrics

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Association between monocyte to lymphocyte ratio and all-cause death in maintenance hemodialysis patients DENG Meng-yuan, WANG Jian-gang, LIU Xin-yu 2023, 22 (03):  182-186.  doi: 10.3969/j.issn.1671-4091.2023.03.006 Abstract ( 171 )   PDF (585KB) ( 44 )   Objectives To investigate the relationship between monocyte-lymphocyte ratio (MLR) and all-cause mortality in patients with maintenance hemodialysis (MHD).  Methods This was a single-centered, retrospective and cohort study. Baseline clinical data and laboratory parameters were collected from the patients with end-stage renal disease (ESRD) and treated with MHD at the Department of Blood Purification, Nanyang Central Hospital from January 2020 to January 2022. All patients were followed up until August 2022. The relationship between MLR and all-cause mortality was analyzed in the MHD patients.  Results A total of 259 patients were enrolled in the study, including 55.2% males and with an average age of 57.0±13.9 years old. The median follow-up time was 22.0 (11.0, 27.0) months, and all-cause death occurred in 62 (23.9%) patients until the end of follow-up. Univariate Cox regression analysis showed that MLR (HR=6.251, 95% CI：2.654~14.723, P＜0.001), neutrophil/lymphocyte ratio (HR=1.119, 95% CI：1.057~1.184, P＜0.001), and systemic immune inflammatory index (HR=1.001, 95% CI：1.000~1.001, P＜0.001) were the risk factors for all-cause mortality in the MHD patients. Multivariate Cox regression analysis showed that MLR was independently correlated with the risk of all-cause mortality after adjusting the confounding factors (HR=4.81, 95% CI：1.32~17.53, P=0.017). Subgroup analysis showed that MLR as a risk factor for all-cause mortality in MHD patients was stable in different populations. Kaplan-Meier survival curve showed a gradual decrease of survival along with the increase of MLR (Log-rank test c2=12.248, P=0.007).  Conclusion  The increase of MLR is an independent risk factor for all-cause mortality in MHD patients, and is closely related to the survival rate of MHD patients. Metrics

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Prevalence of apparent treatment resistant hypertension in non-dialysis patients with chronic kidney disease: a meta-analysis LIU Dan-yang, GONG Ni-rong, ZHANG Guang-qing, SHI Sheng-ying, LIN Yan-hong, YANG Cong, AI Jun 2023, 22 (03):  187-192.  doi: 10.3969/j.issn.1671-4091.2023.03.007 Abstract ( 99 )   PDF (975KB) ( 50 )   Objective  To systematically review the prevalence of apparent treatment resistant hypertension (aTRH) in non-dialysis patients with chronic kidney disease (CKD).  Methods  Chinese and English databases were searched for observational studies on the prevalence of aTRH in non-dialysis patients with CKD. According to the American Heart Association (AHA) criteria, aTRH was defined as AHA-1 and AHA-2. Stata 15.0 was used for the meta-analysis of overall and staged prevalence of CKD under different aTRH definitions.  Results A total of 14 studies were included. The overall prevalence of aTRH in CKD patients was 27.1% (ES=0.271, 95% CI: 0.220~0.321, P＜0.001). Under AHA-1 definition, the prevalence of aTRH in CKD1-5 patients was 20.6% (ES=0.206, 95% CI: 0.105~0.307, P＜0.001), and the prevalence of aTRH in CKD3-5 patients was 29.5% (ES=0.295, 95% CI: 0.224~0.366, P＜0.001). Under AHA-2 definition, the prevalence of aTRH in CKD1-5 patients was 30.4% (ES=0.304, 95% CI: 0.178~0.430, P＜0.001). The prevalence of aTRH in CKD patients increased with the decrease of glomerular filtration rate in all original studies.  Conclusion The prevalence of aTRH in non-dialysis CKD patients is high and increases with the progression of renal injury. More attention should be paid to aTRH in CKD patients.  Metrics

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The application value of urinary calprotectin in adult patients with acute kidney injury YAO Qian, KONG Chao, ZHANG Kun-ying, QIN Li-li, SUN Xuan, WU Sheng-qin 2023, 22 (03):  193-197.  doi: 10.3969/j.issn.1671-4091.2023.03.008 Abstract ( 145 )   PDF (678KB) ( 27 )   Objective  To explore the application value of urinary calprotectin in adult acute kidney injury (AKI) by observing urinary calprotectin concentration in adult AKI patients and healthy people.  Methods  Fifty patients with AKI (AKI group) and 30 healthy people (healthy control group) were selected to determine the indexes of urinary calprotectin, serum creatinine, blood urea nitrogen, urinary kidney injury molecule-1 (KIM-1), blood albumin and hemoglobin. General clinical data and laboratory indexes were compared between the two groups. ROC curve was used to analyze the predictive value of urinary calprotectin for adult AKI.  Results  Urinary calprotectin, urinary KIM-1, serum creatinine and blood urea nitrogen were higher in AKI group than in healthy control group (t=10.113, 9.152, 11.119 and 9.049 respectively; P＜0.001). Urinary calprotectin was positively correlated with serum creatinine (r=0.794, P＜0.001), urea nitrogen (r=0.462, P=0.001) and urinary KIM-1 (r=0.409, P=0.003), and was negatively correlated with serum albumin (r=-0.620, P=0.042) and hemoglobin (r=-0.289, P＜0.001) in AKI group. When the diagnostic limit of urinary calprotectin for adult AKI was set at 55.17ng/ml, the area under the ROC curve was 0.747 (95% CI: 0. 641～0.853), with the sensitivity of 62.0% and specificity of 90.0%.  Conclusion  Urinary calprotectin concentration was significantly increased, and was positively correlated with serum creatinine, blood urea nitrogen and urinary KIM-1 levels in adult AKI patients. The sensitivity and specificity of urinary calprotectin for the diagnosis of adult AKI are higher. Therefore, urinary calprotectin has an important clinical value in the prediction and evaluation of therapeutic effect and recovery process in adult AKI patients. Metrics

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The present status of the clinical prediction models for autologous arteriovenous fistula in hemodialysis patients ZHANG Yi-ye, YAN Yan 2023, 22 (03):  198-201.  doi: 10.3969/j.issn.1671-4091.2023.03.009 Abstract ( 167 )   PDF (360KB) ( 195 )   Autologous arteriovenous fistula (AVF) is the first choice of vascular access for maintenance hemodialysis (MHD) patients. However, the rates of AVF immaturity and dysfunction are very high. Therefore, accurate evaluation of the prognosis of AVF after operation is helpful to optimize the treatment and improve the prognosis of MHD patients. In recent years, the clinical prediction models (CPMs) have been widely used for the evaluation of AVF. In the current review, we summarize the current research status of CPMs for AVF in MHD patients. Metrics

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Research progresses in the prediction model of intradialytic hypotension WANG Ze-min, SHAO Guo-jian, ZHENG Yue-nan, PAN Lu-lu, ZHENG Yi-yi 2023, 22 (03):  202-205,220.  doi: 10.3969/j.issn.1671-4091.2023.03.010 Abstract ( 197 )   PDF (413KB) ( 394 )   Maintenance hemodialysis (MHD) is an important renal replacement therapy for end-stage renal disease. Intradialytic hypotension (IDH) is a common complication in MDH patients. IDH may cause many adverse events and affect the quality of life and the prognosis of the patients. The discovery of high-risk factors for IDH is essential to the early identification of IDH. The IDH prediction models integrate multiple risk factors, can better predict the occurrence of IDH, and thereby improve the prognosis of MHD patients. This article discusses and summarizes the definition of IDH, risk factors for IDH, the types of prediction models, and the prediction models of IDH in China and foreign countries, in order to provide references for the construction of suitable prediction models for IDH. Metrics

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Relationship between serum metabolomics and stenosis in autologous arteriovenous fistula in maintenance hemodialysis patients LIAO Lu, ZOU Li-ting, FU Meng-ru, YAN yan, XIAO Jun 2023, 22 (03):  206-209.  doi: 10.3969/j.issn.1671-4091.2023.03.011 Abstract ( 104 )   PDF (450KB) ( 197 )   With the increasing incidence of chronic kidney disease (CKD) stage 5, the number of patients with maintenance hemodialysis (HD) is increasing. Autogenous Arteriovenous fistula (AVF) is the preferred method for long-term vascular access in HD patients. AVF stenosis is the main cause of AVF dysfunction in HD patients, and its mechanism has not been fully elucidated. CKD5 patients often cause various related complications due to changes in the types and concentrations of blood metabolites. The application of metabolomics technology has revealed various metabolic disorders in CKD patients. This article analyzes the correlation between abnormal blood metabolomics and AVF stenosis in CKD patients, hoping to provide new ideas for elucidating the mechanism of AVF stenosis and prevention and treatment of AVF stenosis Metrics

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Analysis of radiation dose during interventional procedure for hemodialysis access CHEN Zhi-chun, WANG Ying, HU Rong-rong, HU Yan, FAN Xiao-hong, LIU Bing-yan, XIA Jing-hua 2023, 22 (03):  210-213.  doi: 10.3969/j.issn.1671-4091.2023.03.012 Abstract ( 145 )   PDF (393KB) ( 64 )   Objective   To investigate the dose of radiation exposure during the common interventional radiologic procedures for blood access and to evaluate its risks.  Methods  Data of the adults treated with interventional radiologic procedure for hemodialysis access between December 2020 and August 2022 were retrospectively analyzed. Fluoroscopy time (T), frames (F), dose area product (DAP), and cumulative does (CD) were recorded, and peak skin dose (PSD) was calculated. Standard statistical assessments were employed for the analyses.  Results A total of 408 patients were collected, including 6 procedure types of tunneled cuffed central venous catheter placement (TCC placement) 223, arteriovenous fistula-percutaneous transluminal angioplasty (AVF-PTA) 95,arteriovenous graft-PTA(AVG-PTA)28, arteriovenous graft-thrombectomy (AVG-thrombectomy) 27, tunneled cuffed central venous catheter replacement + central vein-PTA (TCC replacement+CV-PTA) 14, and central vein-PTA(CV-PTA) 21; the median PSD was 1.43(0.60,5.28), 6.33(3.94,9.91), 6.41(2.66,13.09), 7.38 (4.23,10.86), 30.52(19.08,52.73), and 60.64(36.17,79.92) mGy respectively; the median DAP was 0.63(0.27,2.26), 4.02(2.57,6.49), 4.21(1.74,8.53), 4.27(2.72,7.13), 13.51(8.44, 29.30), and 26.84(18.02, 35.37) Gy·cm² respectively.  Conclusions   Most interventional radiologic procedures for hemodialysis access were the exposure of low or medium radiation doses. Radiation exposure doses in central venous intervention procedures were significantly higher than those in peripheral vascular intervention procedures. Metrics

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Incidence and risk factors for catheter-related bloodstream infections in hemodialysis through tunneled central venous catheters: a systematic review and meta-analysis DOU Xin-man, XIE Qi, ZHANG Li-hong, ZHONG Juan-ping, WANG Xing-lei 2023, 22 (03):  214-220.  doi: 10.3969/j.issn.1671-4091.2023.03.013 Abstract ( 146 )   PDF (860KB) ( 170 )   Objective To systematically review the incidence and risk factors for catheter-related bloodstream infection (CRBSI) in hemodialysis patients undergoing tunneled central venous catheterization.  Methods  PubMed, Web of science, Embase, Cochrane Library, CBM, WanFang Data, VIP and CNKI databases from the establishment of the database to September 2022 were searched for clinical studies about the incidence and/or risk factors of CRBSI. R software (version 4.1.2) was used for meta-analysis of single-group rate and risk factors.  Results   A total of 21 studies were included, including 6,758 patients undergoing hemodialysis through tunneled central venous catheters. Meta-analysis showed that the pooled incidence of CRBSI was 14.5%, the incidence was 28.9% in European population (95% CI：16.2%～43.5%), and the incidence was 26.3% from case-control study (95% CI：14.1%～40.7%). The incidence was 22.2% (95% CI：14.5%, 31.0%) in patients aged≥60 years, and 28.2% (95% CI：2.5%～67.2%) in patients with catheterization duration of >24 months. Age≥60 years old (OR=1.85, 95% CI：1.29～2.64), albumin <30g/L (OR=2.12, 95% CI：1.40～3.22), femoral vein catheterization (OR=2.17, 95% CI：1.24～3.80), diabetes mellitus (OR=1.82, 95% CI：1.37～2.40), and catheterization period≥4 weeks (OR=2.04, 95% CI：1.22～3.41) were the important risk factors for CRBSI in hemodialysis patients undergoing tunneled central venous catheterization.  Conclusion The incidence of CRBSI is higher in patients undergoing hemodialysis through tunneled central venous catheter. Age≥60 years, albumin <30g/L, femoral vein catheterization, diabetes mellitus, catheterization period≥4 weeks are the important risk factors for CRBSI. Metrics

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Association between the initial time of artificial liver plasma dialysis filtration intervention and the in-hospital prognosis in patients with hepatitis B-related chronic onset acute liver failure LIN Jian-hui, CHEN Li-xia, LAN Li-qin, LIU Bao-rong, LIN Luan-feng, YU Xiao-ling, LIU Hai-yu 2023, 22 (03):  221-226.  doi: 10.3969/j.issn.1671-4091.2023.03.014 Abstract ( 132 )   PDF (677KB) ( 37 )   Objective  To explore the relationship between the start time of plasma diafiltration (PDF) intervention with artificial liver and the in-hospital prognosis of the patients with hepatitis B-related acute chronic liver failure (HBV-ACLF).  Methods  The patients diagnosed with HBV-ACLF from January 1 2017 to December 31, 2021 were selected and divided into an improved group and a non-improved group according to their in-hospital prognosis. Univariate and multivariate logistic regression analyses were performed using their demographics, baseline laboratory examinations, and in-hospital prognosis of the two groups to obtain the independent influencing factors. Smooth curve fitting was used to explore the correlation between start time of PDF and in-hospital prognosis.  Results  A total of 88 patients were included, with 60 patients in the improved group (68.2%). Univariate logistic regression showed that start time of PDF intervention (OR=1.03,95% CI: 1.01~1.04,P＜0.001), age (OR=1.06, 95% CI:1.02~1.11,P=0.005), baseline blood alanine aminotransferase (OR=1.00, 95% CI:1.00~1.00, P=0.012), and baseline abdominal infection (OR=3.13, 95% CI: 1.20~8.14, P=0.019) were the possible influencing factors for in-hospital prognosis. Multivariate logistic regression showed that the start time of PDF intervention (OR=1.04,95% CI: 1.02~1.05,P＜0.001), age (OR=1.08,95% CI:1.01~1.14, P=0.038), and HBV-ACLF at an early stage (OR=0.13, 95% CI:0.02~0.98,P=0.048) were the independent influencing factors for adverse in-hospital prognosis. There may be a threshold effect between the start time of PDF intervention and adverse in-hospital prognosis. The segmented regression model showed that the optimal threshold was 72 hours, less than 72 hours with the OR=0.75 (95% CI: 0.53~1.05,P=0.089), and more than 72 hours with the OR=1.04(95% CI:1.02~1.06,P＜0.001).  Conclusion  There was a threshold effect between the start time of PDF intervention and the adverse in-hospital prognosis of the patients. Preoperative evaluation and initiation of PDF intervention within 72 hours after the diagnosis of HBV-ACLF may be one of the potential opportunities of clinical treatment. Metrics

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Summary of the best evidence for exit-site care in peritoneal dialysis patients  FENG Chun-yan, LIU Yue, SU Chun-yan 2023, 22 (03):  227-231.  doi: 10.3969/j.issn.1671-4091.2023.03.015 Abstract ( 125 )   PDF (424KB) ( 175 )   Objective To retrieve, evaluate and integrate the best evidence for exit-site care in peritoneal dialysis patients for the guidance of clinical practice.  Methods  We searched the relevant guidelines, systematic reviews, and expert consensuses about the exit-site care. The retrieval period was from the establishment of the databases to June 30, 2022.  Results  A total of 14 articles were enrolled, including 8 guidelines, 2 expert consensuses, one systematical review and 3 cohort studies.  Conclusions  This study summarized the best evidence for exit-site care in peritoneal dialysis and provided the best practice evidence for clinical nursing. Metrics

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Visualization analysis of research hotspots in the field of peritoneal dialysis nursing based on the software of CiteSpace  CHANG Ya-nan, WANG Yong-ni, ZHAO Cai-ping, MA Xiao-qin, SONG Shu-hua, WANG Yan 2023, 22 (03):  232-236.  doi: 10.3969/j.issn.1671-4091.2023.03.016 Abstract ( 114 )   PDF (1156KB) ( 127 )   Objective  To analyze the research hotspots and frontiers of peritoneal dialysis nursing in Web of Science core collection database in recent 10 years.  Methods  The literature about peritoneal dialysis nursing from January 1, 2012 to December 31, 2021 in the Web of Science core collection database was retrieved, and CiteSpace 6.1 software was used for visual analysis.  Results  A total of 1,838 articles were included, involving 113 countries and 516 authors. The overall number of publications on this subject is increasing, and the United States ranks first in the number of publications. The main research institutions were colleges and universities, and close cooperation and communication between institutions have apparently formed a core team. The patients in the field of nursing research were focused on adults and children with end-stage renal disease and acute kidney injury. The intervention measures mainly included self-care and management. Outcome indicators include quality of life, mortality and survival. Qualitative research, remote nursing and humanistic care are the future research trends.  Conclusion a comprehensive understanding of the research hotspots of peritoneal dialysis nursing can provide references to promote peritoneal dialysis nursing in professional clinical nurses. Metrics

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Study on the clinical effect of different drainage methods of hemodialysis machine  WANG Li-qi, SONG Wei, LIU Wen-hu, HUANG Hong-dong, LI Di-shan, ZHANG Yue, LIU Jin-shan 2023, 22 (03):  237-240.  doi: 10.3969/j.issn.1671-4091.2023.03.017 Abstract ( 207 )   PDF (376KB) ( 104 )   Objective   The amount of liquid remaining in the dialyzer and blood purification pipeline is variable with different drainage methods. This study investigated the evacuation effect of different drainage methods on residual waste volume in the dialyzer and blood purification pipeline after the treatment of hemodialysis patients, and explored the safest and effective drainage method to reduce the risks of environmental pollution and infection.  Methods  The dialyzers and blood purification tubes after hemodialysis of 200 cases were selected. In the experimental group, the dialyzers with the drainage method of negative pressure plus positive pressure (blood pump) guided by the manufacturers were used for 150 cases, who were then divided into 3 subgroups (50/each subgroup); positive pressures were provided by the blood pump of 100ml/min, 200ml/min and 300ml/min for the 3 subgroups respectively. In the control group, the dialyzers with the drainage method of negative pressure plus gravity guided by the manufacturers were used for 50 cases. The transmembrane pressure during drainage, drainage time, and residual waste volume (gram) in dialyzer and blood purification pipeline after drainage were compared between experimental group and control group and among the 3 subgroups in the experimental group.  Results   In the experimental group, the evacuation time was shorter (blood pump speed 200ml/min: 1.48 vs. 2.22 min, Z=6.598, P＜0.001; 300ml/min: 0.49 vs. 2.22 min,            Z=10.920, P＜0.001), and the residual waste volume after drainage was lower (blood pump speed 100ml/min: 90.9 vs. 136.4g, Z=8.202, P＜0.001; 200ml/min: 88.9 vs. 136.4 g, Z=8.888, P＜0.001; 300ml/min: 91.9 vs. 136.4 g, Z=7.894, P＜0.001), as compared with those in the control group. In the control group, the transmembrane pressure during drainage was within the safety range not causing membrane rupture set by the manufacturers, and the transmembrane pressure was lower than that in the experimental group (blood pump speed 100ml/min: 359.5 vs. 457.5 mmHg, Z=-3.965, P＜0.001; 200ml/min: 359.5 vs. 476.0 mmHg, Z=-6.945, P＜0.001; 300ml/min: 359.5 vs. 487.5 mmHg, Z=-9.498, P＜0.001). In the subgroup of blood pump speed 300ml/min in the experimental group, the instant transmembrane pressure exceeded the maximal safety value of 500mmHg set by the manufacturers, leading 10% risk of membrane rupture; in the subgroup of blood pump speed 200ml/min, the transmembrane pressure during drainage was within the safety range, and the evacuation time was shorter than that in the 100m/min subgroup, being the safest and efficient drainage pump speed (1.48 vs. 2.21min, Z=6.359, P＜0.001).  Conclusion  Compared with the dialyzers using negative pressure and gravity as the drainage method, the dialyzers using negative pressure and positive pressure (blood pump) as the drainage method had the advantages of shorter evacuation time and lower residual waste volume when the drainage pump speed was set within the pressure not breaking the membrane. Metrics