Chinese Journal of Blood Purification

12 April 2023, Volume 22 Issue 04 Previous Issue    Next Issue

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Application of Angiotensin Receptor-Neprilysin Inhibitor in Chronic Kidney Disease Patients: Chinese Expert Consensus Chinese Expert Group Consensus on Application of Angiotensin Receptor-Neprilysin Inhibitor in Chronic Kidney Disease Patients 2023, 22 (04):  241-253.  doi: 10.3969/j.issn.1671-4091.2023.04.001 Abstract ( 470 )   PDF (572KB) ( 345 )   Chronic kidney disease (CKD) is a global public health problem, and cardiovascular disease is the most common cause of death in patients with CKD. The incidence and prevalence of cardiovascular events during the early stages of CKD increases significantly with a decline in renal function. More than 50% of dialysis patients die from cardiovascular disease. Therefore, developing effective methods to control risk factors and improve prognosis of cardiovascular disease is the primary focus during the diagnosis and treatment of CKD. For example, the Systolic blood pressure intervention trial (SPRINT) study demonstrated that CKD drugs are effective in reducing cardiovascular and cerebrovascular events by controlling blood pressure. Uncontrolled blood pressure not only increases the risk of these events but also accelerates the progression of CKD. Recent studies have repeatedly confirmed that the first and so far the only angiotensin receptor–neprilysin inhibitor (ARNI) sacubitril/valsartan can reduce blood pressure more effectively than renin–angiotensin system inhibitors and improve the prognosis of heart failure in patients with CKD. Here, to better guide the application of ARNI in patients with CKD, and reduce the occurrence of cardiovascular events，we formulate a consensus based on clinical evidence and experience. Metrics

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The levels of serum GRP78 and BMP2 in maintenance hemodialysis patients and their correlation with vascular calcification XU Jian-nan, WANG Shu-ming, ZHANG Jian-xin, WANG Yue-hua, KANG Jing-yue, LIU Chang 2023, 22 (04):  254-258.  doi: 10.3969/j.issn.1671-4091.2023.04.002 Abstract ( 211 )   PDF (469KB) ( 29 )   Objective  To explore the levels of serum glucose regulatory protein 78 (GRP78) and bone morphogenetic protein 2 (BMP2) in patients with maintenance hemodialysis (MHD) and their correlation with vascular calcification (VC).  Methods  During April 2020 to May 2022, 112 patients with MHD admitted to Sanhe Yanjiao Fuhe first hospital were selected as the study objects. Clinical data were collected, serum GRP78 and BMP2 levels were detected, and the incidence of VC was counted; the correlation between serum GRP78 and BMP2 levels in MHD patients, serum GRP78 and BMP2 levels in VC patients and general clinical data were analyzed, and the risk factors of VC in MHD patients.  Results  Among the 112 patients included, 52 had mild to moderate calcification (mild and moderate calcification group), 21 patients had severe calcification (severe calcification group), 39 patients did not develop VC (non-calcification group); There were significantly differences in age, proportion of diabetes, albumin (Alb), hemoglobin (Hb), blood phosphorus, serum calcium, calcium phosphorus product, intact parathyroid hormone (iPTH), serum GRP78, BMP2 levels among the non-calcification group, mild and moderate calcification group, severe calcification group (F/c2=38.987, 20.187, 34.952, 43.411, 34.541, 11.572, 48.522, 598.639, 123.029, 259.490, all P<0.001); there was a positive correlation between serum GRP78 and BMP2 in MHD patients (r=0.490, P<0.001); the level of serum GRP78 in VC patients was positively correlated with age, diabetes, blood phosphorus, blood calcium, calcium phosphorus product and iPTH (r=0.581, 0.339, 0.516, 0.534, 0.611, 0.513, all P<0.001), and negatively correlated with Alb and Hb (r=-0.302, -0.296, P=0.005, 0.007); the level of serum BMP2 in VC patients was positively correlated with age, diabetes, blood phosphorus, blood calcium, calcium phosphorus product and iPTH (r=0.524, 0.415, 0.535, 0.547, 0.602, 0.498, all P<0.001), and negatively correlated with Alb and Hb (r=-0.298, -0.284, P=0.008, 0.011); age, calcium phosphorus product, iPTH, GRP78 and BMP2 were the risk factors of VC in MHD patients (OR values are 3.009, 4.321, 4.719, 6.679, 6.237 respectively; 95% CI were 1.337～6.774, 1.634～11.423, 1.693～13.153, 1.951～22.871, 1.962～19.824 respectively; P values were 0.008, 0.003, 0.003, 0.002, 0.002 respectively).  Conclusion  The serum levels of GRP78 and BMP2 in MHD patients are related to the occurrence and condition of VC, the elevated levels of GRP78 and BMP2 are risk factors for the occurrence of VC. 【Key words】 Maintenance hemodialysis; Glucose regulatory protein 78; Bone morphogenetic protein 2; Vascular calcification Metrics

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Construction of predictive model for cognitive decline in maintenance hemodialysis patients based on LASSO regression FAN Wei, WEN Ping, SHAO Li-na, CUI Ying, ZHANG Jin 2023, 22 (04):  259-263.  doi: 10.3969/j.issn.1671-4091.2023.04.003 Abstract ( 140 )   PDF (655KB) ( 58 )   Objective  To construct a predictive model based on LASSO regression for maintenance hemodialysis (MHD) patients with cognitive decline.  Methods  100 patients treated with MHD in Yixing People's Hospital from March 2016 to March 2021 were prospectively included. The patients were classified into a cognitive impairment (CI) group (MocA＜26) and a non-CI group (MocA≥26) using the Montreal cognitive assessment (MocA) scale. General and clinical data were collected. Characteristic factors related to CI in MHD patients with non-zero coefficients were screened by LASSO regression. Lasso-Logistics regression model was constructed and receiver operating characteristic curve (ROC) was drawn to evaluate the model effectiveness. Data rows of 71 MHD patients were selected for external verification.  Results  There were 62 patients in CI group and 38 patients in non-CI group, respectively. LASSO regression showed that age, dialysis vintage, diabetes mellitus (OR=1.673, 95%CI:0.150～18.661,P=0.676), higher sensitive C-reactive protein(hs-CRP), triglyceride, total cholesterol, serum albumin and serum calcium were significantly correlated with the occurrence of CI in MHD patients. Logistic regression analysis showed that age (OR=1.135, 95%CI:1.041～1.238, P=0.004), dialysis vintage (OR=1.138, 95%CI :1.012～1.279, P=0.031), hs-CRP (OR=2.394, 95%CI:1.158～4.950, P=2.394), serum albumin (OR=0.759, 95%CI: 0.593～0.971,P=0.028) were risk factors for CI in MHD patients. Lasso-logistics regression model predicted that the AUC of CI occurrence in MHD patients was 0.892 (95%CI: 0.813～0.945). External verification showed that the area under the curve (AUC) was 0.899 (95%CI: 0.0.804～0.958), and the Youden index J was 0.713.   Conclusion  Age, dialysis vintage, hs-CRP and lower albumin were significantly correlated with the incidence of CI in MHD patients, and the established prediction model could better predict the incidence of CI in MHD patients.  Metrics

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Analysis of related risk factors for restless legs syndrome in maintenance hemodialysis patients LI Tuan-jie, JIN Xin, YU Ze-ying, LI Xu 2023, 22 (04):  264-268.  doi: 10.3969/j.issn.1671-4091.2023.04.004 Abstract ( 178 )   PDF (519KB) ( 95 )   Objective  To explore the risk factors for restless legs syndrome (RLS) in patients with maintenance hemodialysis (MHD).  Methods  The clinical data of 169 MHD patients treated in the hemodialysis unit of Shihezi People's Hospital from June 2021 to July 2022 were recruited. Clinical parameters were compared between group A (with RLS) and group B (without RLS). The correlations between the clinical data and RLS were analyzed by univariate logistic regression and multivariate logistic regression.  Results  A total of 169 MHD patients were included in this study, and 66 patients had RLS with a RLS prevalence of 39.05%.  Comparisons of clinical data showed that age  (t=-2.297, P=0.022), dialysis age  (t=-2.938, P=0.003), hemoglobin (t=-2.205, P=0.027), serum creatinine (t=3.309, P=0.001), blood phosphorus (t=5.732, P=0.002), blood magnesium (t=-4.070, P＜0.001), serum iron (t=-3.545, P＜0.001), PTH (t=-4.038, P＜0.001), β2-microglobulin (t=-3.655, P＜0.001) and ferritin (t=-2.291, P=0.022) were statistically different between group A and group B. Univariate logistic regression found that age (OR=0.976, 95% CI 0.952~1.000, P=0.046), dialysis age (OR=1.019, 95% CI 1.009~1.029, P<0.001), hemoglobin (OR=0.976, 95% CI 0.957~0.995, P=0.012), blood magnesium (OR=13.134, 95% CI 2.561~67.366, P=0.002), PTH (OR=1.002, 95% CI 1.001~1.003, P=0.001), β2-microglobulin (OR=1.008, 95% CI 1.002~1.013, P=0.010) and ferritin (OR=0.998, 95% CI 0.996~1.000, P=0.015) were associated with the presence of RLS. Multivariate logistic regression showed that longer dialysis age (β=1.414, P=0.048), higher PTH (β=0.012, P=0.035), higher β2-micrglobulin (β=0.013, P=0.014) and lower ferritin (β=-0.091, P=0.004) were the independent risk factors for RLS in MHD patients. Additionally, MHD patients with RLS were more likely to complicate with sleep disorders, anxiety and depression.  Conclusion RLS is a common complication in MHD patients. Longer dialysis, increased PTH and β2-microglobulin, and iron deficiency may relate to the occurrence of RLS in MHD patients. RLS patients are more likely to have sleep disorders, anxiety and depression. Metrics

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On-line down-regulation of bicarbonate concentration in dialysate to prevent metabolic alkalosis in hemodialysis patients with regional citrate anticoagulation XI Chun-sheng, LIU Tong-cun, LIU Fei, FANG Chun-tian 2023, 22 (04):  269-272.  doi: 10.3969/j.issn.1671-4091.2023.04.005 Abstract ( 233 )   PDF (425KB) ( 39 )   Objective  To investigate the effects of lower on-line bicarbonate concentration in dialysate to prevent metabolic alkalosis in hemodialysis (HD) patients using regional citrate anticoagulation (RCA).  Methods  The HD patients at a high risk of bleeding, having the criteria for RCA and treated in the 940th Hospital of Joint Logistics Support Force of Chinese PLA between April 2022 and August 2022 were enrolled in this study. Patients with metabolic acidosis before HD were excluded. They were then divided into two groups, conventional concentration group (dialysate bicarbonate=31.3mmol/L, n=15) and lower concentration group (dialysate bicarbonate=29.3mmol/L, n=15). The alterations of blood pH and HCO3- before and after HD were compared between the two groups.  Results  Before HD, there were no differences in clinical data, HD parameters, and levels of blood pH, HCO3- and Na+ between the two groups. In the conventional concentration group, blood pH and HCO3- were higher at the end of HD than those at the beginning of HD (7.48±0.03 vs. 7.39±0.04 and 27.50±1.93 vs. 23.57±1.13; t=6.971，5.407,P＜0.001), and 33% of the patients had metabolic alkalosis after HD. In the lower concentration group, blood pH was statistically different before and after HD (7.42±0.04 vs. 7.39±0.02, t=2.877, P=0.008), HCO3- had no difference (25.50±1.86 vs. 23.00±1.40, t=0.956，P=0.347), and no patient had the blood pH≥7.50 after HD. At the end of HD, the increased values of blood pH and HCO3- were significantly higher in the conventional concentration group than in the lower concentration group (0.07±0.02 vs. 0.04±0.03 and 4.00±1.1 vs. 1.10±0.88; t=3.223，7.756,P=0.003,＜0.001); the presence of metabolic alkalosis was significantly different between the two groups (33% vs. 0, χ2=4.375,P=0.036). The changes of blood Na+ level before and after HD had no statistical difference between the two groups (136.82±1.78 vs. 136.46±3.76 and 137.69±1.68 vs. 138.60±1.92;t=0.335、1.382，P=0.740、0.178).  Conclusions  For patients without metabolic acidosis before HD, down-regulation of bicarbonate concentration in dialysate may prevent the HD patients with RCA from metabolic alkalosis. Metrics

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Effectiveness comparison of the five screening tools for sarcopenia in maintenance hemodialysis patients  WANG Kai-xuan, SUN Yan, CUI Chao, WANG Si-yi, SHI Xin-ru, LIU Zhi-mei 2023, 22 (04):  273-277.  doi: 10.3969/j.issn.1671-4091.2023.04.006 Abstract ( 191 )   PDF (497KB) ( 45 )   Objective To compare the application effect of five screening tools for sarcopenia in maintenance hemodialysis (MHD) patients. Methods A survey was conducted in 340 patients who received MHD treatment in blood purification centre of Qingdao municipal hospital by convenience sampling from October 2020 to April 2021. Strength, assistance with walking, rise from a chair, climb stairs and falls (SARC-F) questionnaire, SARC-F combined with calf circumference (SARC-CalF) questionnaire, SARC-F adding elderly and body mass index information (SARC-F+EBM) questionnaire, mini sarcopenia risk assessment-7 items (MSRA-7) questionnaire, mini sarcopenia risk assessment-5 items (MSRA-5) questionnaire were used for screening. Receiver operating characteristic curve was drawn and the area under the curve (AUC) was calculated using SPSS 22.0 and MedCalc 19.6 software. The optimal cut-off value of five screening tools were determined according to the Yoden index. The performance indicators of five screening tools at the original cut-off value and the optimal cut-off value were calculated respectively. Results Eighty-four (24.71%) MHD patients were diagnosed as sarcopenia. AUC of five screening tools in MHD patients ranged from 0.759 to 0.872. The AUC of SARC-CalF questionnaire was larger than that of SARC-F questionnaire (Z2.506, P0.012), SARC-F+EBM questionnaire (Z3.451, P0.001), MSRA-7 questionnaire (Z2.841, P0.005), MSRA-5 questionnaire (Z2.248, P0.025). Furthermore, its sensitivity (78.57%) and specificity (89.84%) were high with the optimal cut-off value being 11 points. Conclusion SARC-CalF questionnaire has the highest accuracy of all screening tools and has high sensitivity and specificity at the optimal cut-off value, so it is more suitable for being used to screening the risk of sarcopenia in MHD patients than the other four screening tools. Metrics

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Relationship between the levels of serum procalcitonin and red blood cell distribution width and the pathogen species in peritoneal dialysis-related peritonitis  XU Jian, MENG Ran, LIU Gui-ling 2023, 22 (04):  278-282.  doi: 10.3969/j.issn.1671-4091.2023.04.007 Abstract ( 135 )   PDF (490KB) ( 106 )   Objective  To explore the relationship between the levels of serum procalcitonin (PCT) and red blood cell distribution width (RDW) and the pathogen species in peritoneal dialysis-associated peritonitis (PDAP).  Methods  A total of 87 cases with PDAP treated in the Nephrology Department, the Second Affiliated Hospital of Anhui Medical University from January 2018 to January 2022 were retrospectively analyzed. According to the bacterial culture results of outflow dialysate, patients were divided into Gram-negative bacterial infection group (G- group, n=24) and Gram-positive bacterial infection group (G+ group, n=63). Clinical data and laboratory indexes were compared between the two groups. Logistic regression was used to analyze the risk factors for G- bacterial PDAP. ROC curve was used to assess the predictive value of serum PCT and RDW for G- bacterial PDAP.  Results  The predominant species was Staphylococcus epidermidis (36.51%) in the G+ group, and was Escherichia coli (41.67%) in the G- group. The number of nucleated cells (Z=-2.745, P=0.006) and percentage of multinucleated cells in the outflow dialysate (Z=-0.273, P=0.005), serum PCT (Z =-4.345, P＜0.001), serum C-reactive protein (Z=-2.859, P=0.004), RDW (Z=-2.908, P=0.004) and fibrinogen (t=-2.602, P=0.011) were significantly higher in G- group than in G+ group, while serum cholesterol (t=2.091, P=0.040) was significantly lower in G- group than in G+ group. Multivariate logistic regression demonstrated that higher serum PCT (OR=1.034, 95% CI 1.001~1.069, P=0.045) and higher RDW (OR=1.499, 95% CI 1.037~2.167, P=0.031) were the independent risk factors for G- bacterial PDAP. ROC curve showed that serum PCT combined with RDW had the greatest predictive value for the presence of G- bacterial PDAP, with the area under the curve of 0.815 (95% CI 0.717~0.890, P＜0.001).  Conclusion  Higher levels of serum PCT and RDW are the independent risk factors for G- bacterial PDAP. Serum PCT combined with RDW had a better predictive value for the presence of G- bacterial PDAP. Metrics

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Recent advances in non-drug management of pregnancy in women with end stage renal disease DING Jian-ping 2023, 22 (04):  283-286.  doi: 10.3969/j.issn.1671-4091.2023.04.008 Abstract ( 102 )   PDF (381KB) ( 55 )   Non-drug management of pregnant women with end stage renal disease (ESRD) includes volume management, blood pressure management, nutrition management, prenatal consultation, pregnancy monitoring and postpartum guidance. This article summarizes the influencing factors, non-drug management, and the current status of non-drug management for pregnant ESRD women in China and foreign countries, to provide a reference for the management of pregnant ESRD women. Metrics

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Recent progresses in the application of new techniques relating to arteriovenous fistuloplasty            LI Jie, HOU Guo-cun 2023, 22 (04):  287-291.  doi: 10.3969/j.issn.1671-4091.2023.04.009 Abstract ( 229 )   PDF (763KB) ( 315 )   Arteriovenous fistula is the preferable vascular access method for renal failure patient to initiate hemodialysis, and becomes a lifeline of these patients. Since the first successful anastomosis of radial artery-cephalic vein in 1962, many surgical methods, auxiliary devices and methods to promote the maturation of arteriovenous fistula have been developed and widely used. This article reviews the progresses of arteriovenous fistulaplasty to facilitate clinicians with more options for vascular access surgery. Metrics

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Research progresses in the pH-neutral, low-glucose degradation product dialysates for peritoneal dialysis  WU Hai-shan, MAO Hai-ping, CHEN Wei, YANG Xiao 2023, 22 (04):  292-295.  doi: 10.3969/j.issn.1671-4091.2023.04.010 Abstract ( 193 )   PDF (359KB) ( 65 )   Conventional glucose-based peritoneal dialysates with higher glucose concentrations, high glucose degradation products, advanced glycation end products and lower pH have been recognized as bio-incompatible, affecting peritoneal dialysis efficacy and leading to technique failure. pH-neutral, low-glucose degradation product dialysates are relatively biocompatible, and are thought to be superior to the conventional dialysates especially in long-term use of peritoneal dialysis. In this paper, we review the recent advances in pH-neutral, low-glucose degradation product dialysates on the residual renal function, peritoneal function, peritonitis rate, patient and technique survival, and peritoneum pathology in peritoneal dialysis patients. Metrics

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Endovascular Intervention for Refractory Dialysis-Related Subclavian Vein Occlusion CHEN Qin, SUN Ji-bo, SHEN Xi, CUI Tian-lei 2023, 22 (04):  296-301.  doi: 10.3969/j.issn.1671-4091.2023.04.011 Abstract ( 110 )   PDF (654KB) ( 83 )   Objective   To investigate the efficacy and safety of endovascular intervention for refractory subclavian vein occlusion (SVO) in hemodialysis patients.  Methods  Clinical data of the 24 patients failed to recanalize the SVO using standard guidewire and catheter techniques between June 2019 and June 2021 in our department were retrospectively studied. They were categorized into two groups: 12 patients in group 1 undergone percutaneous transluminal venoplasty (PTV) via a blunt impingement technique, and 12 patients in group 2 undergone sharp needle recanalization. Technical success rate, fluoroscopy time in the procedure, perioperative complications, and patency rate were evaluated retrospectively.  Result  Comparison of the two groups reveals no significant difference in success rate (100% vs. 91.67%, Fisher exact test, P=0.400). The operation time (76.08±11.72min vs. 90.67±9.61min, t=3.333, P=0.003) and complication rate (8.34% vs. 58.34%, P=0.027) were significantly less in group 1 than in group 2 (P＜0.05). Mean occlusion length was significantly longer in group 2 than in group 1 (34.0±6.82mm vs. 25±6.99mm, t=3.191, P=0.004). A higher percentage of calcified lesions was found in group 2 (58.33% vs. 16.67%, P=0.019). During follow-up (median 12 months), the primary patency rates were 83.3% in group 1 and 75.0% in group 2 after the operation for 6 months, and were 58.3% in group 1 and 50.0% in group 2 after the operation for 12 months. There was no statistically significant difference in patency rate between the two groups (c2=0.682, P=0.409).  Conclusion  It is effective and safe for interventionalists to use the blunt impingement technique to treat chronic SVO refractory to traditional procedures. The sharp needle recanalization method can be used as supplementary means. Metrics

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Value of color Doppler ultrasound for brachial artery flow/brachial artery resistance index to evaluate internal arteriovenous fistula stenosis YAN Bo, YUE Qing-xiong 2023, 22 (04):  302-305.  doi: 10.3969/j.issn.1671-4091.2023.04.012 Abstract ( 103 )   PDF (438KB) ( 242 )   Objective  The resistance index (RI) and blood flow volume (Qa) are two important Doppler ultrasound parameters to identify the stenosis in arteriovenous fistula (AVF). In this study, we aimed to evaluate the diagnostic capability of Qa/RI (Qx) for the early identification of AVF stenosis.  Methods  A total of 184 hemodialysis patients treated in Dalian Municipal Central Hospital were enrolled in this study. Patients were categorized by ultrasound measurement of the vein diameter as stenosis group (diameter <2mm, n=75) or non-stenosis group (diameter ≥2mm, n=109). Clinical data, Qa, RI, and Qx were recorded.  Results  The stenosis and non-stenosis groups were homogeneous in number, sex, BMI and smoking habit. Diabetes (t=0.059, P<0.001), Qa (c2=42.868, P<0.001), RI (c2=42.823, P<0.001) and Qx        (c2=40.919, P<0.001) were different between stenosis group and non-stenosis group. Logistic regression showed that Qx was a valid index for evaluating AVF stenosis (OR=0.997, 95% CI=0.995~0.998, P＜0.001). ROC revealed that Qx was better than RI (AUC Qx-RI, P＜0.001) but Qx and Qa had similar capability (AUC Qa-Qx, P=0.071) for the identification of AVF stenosis.  Conclusions  In hemodialysis patients, Qx was more reliable than RI but Qx and Qa had similar capability for the early identification of AVF stenosis. Metrics

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Observation on the effect of ultrasound-guided arteriovenous fistula puncture training for nurses based on the perspective of patients’ demands XIE Qing-lei, ZHANG Liu-ping, WANG Yue 2023, 22 (04):  306-309.  doi: 10.3969/j.issn.1671-4091.2023.04.013 Abstract ( 124 )   PDF (416KB) ( 60 )   Objective   To observe the effect of ultrasound-guided arteriovenous fistula puncture training for nurses based on the perspective of patients’ demands.   Methods  Thirty-four nurses in the dialysis center were divided into experimental group or control group by convenience sampling method, with 17 in each group. The experimental group used ultrasound-guided arteriovenous fistula puncture training based on patients' demands, while the control group used conventional training methods. Number of patients subjected to the puncture, success rate of first puncture, puncture-related complications, overall success rate of the puncture, master rate of ultrasound-guided puncture training, and number of puncture required by the operation training were observed in the two groups.  Results  A total of 32 nurses were enrolled and completed the study, and 16 in each group. A total of 41 patients were su  bjected to ultrasound-guided puncture, including 28 in the experimental group and 13 in the control group. There was no significant difference in the success rate of first puncture between the two groups (78.6% vs. 76.9%, c2=0.000,  P=1.000). The overall puncture success rate of experimental group was significantly higher than that of control group (96.1% vs. 89.9%, c2=8.242, P=0.004). The master rate of ultrasound-guided puncture training for nurses in experimental group was significantly higher than that in control group (81.3% vs. 43.8%, c2=4.800, P=0.028). The median number of puncture times (interquartile distance) required for nurses to master ultrasound-guided puncture in experimental group was 13.0 (12.0, 14.0), significantly less than that in control group of 16.0 (15.0, 17.0) (Z=-13.000, P＜0.001).  Conclusions  The method of ultrasound-guided arteriovenous fistula puncture training based on patients' needs can significantly improve the overall puncture success rate in hemodialysis patients with difficult vascular access and the training effect of nurses. Metrics

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Investigation on the nursing operation of hemodialysis installation and pre-flush in China WANG Ying, LIANG Jun-qing, SU Mo, GAO Ju-lin, GOU Jing-qi, GENG Tong-hui, GENG Ye, HOU Xian-tao, LUO Li, LIU Yao, LIU Yong-ling, MAO Jia-yan, SHEN Peng, WU Su-zhen, YANG Jing, YANG Jia-hui, YANG Wun-jun, YUE Xiao-hong, YANG Zhen-hua, ZHOU Lin, ZHU Ya-mei, ZHU Yue-ping, GAN Liang-ying, ZUO Li 2023, 22 (04):  310-315.  doi: 10.3969/j.issn.1671-4091.2023.04.014 Abstract ( 152 )   PDF (475KB) ( 107 )   Objective  To investigate the status quo of hemodialysis installation and pre-flush operation, useful for the forthcoming quality management of clinical nursing operation and specialist training.  Methods This was a nationwide cross-sectional survey. The installation and pre-flush operations were surveyed in the form of video records. Two professionals reviewed the video records according to a scoring scale that was developed by literature review and expert consultation. The scoring tool included four dimensions: time and method of hand hygiene; evaluation and safety check before, during and after operation; installation and connection; and principles of pre-flushing. The scores of each item and each dimension were calculated. Independent sample t test was used to compare the scores among the groups. Professional title of the operators were analyzed by one-way ANOVA. P＜0.05 was considered statistically significant.  Results  ①A total of 270 operation video records were received in this survey, and 229 were valid. There were 66 (28.8%) cases in North China, 3 (1.3%) cases in Northeast China, 23 (10.0%) cases in East China, 5 (2.2%) cases in South China, 71 (31.0%) cases in Central China, 26 (11.4%) cases in Southwest China, and 35 (15.3%) cases in Northwest China. 89 (38.8%) operators were the titles of nurses in charge or above, 111 (48.5%) were nurses, and 29 (12.7%) were primary nurses. In the 229 nurses, 42 (18.3%) were from national blood purification nursing training bases, 113 (49.3%) were from the tertiary hospitals. ②The scoring rates of the four dimensions were: time and method of hand hygiene (76.62%), evaluation and safety check before, during and after operation (78.69%), installation and connection (88.42%), and pre-flush principles (87.75%). ③The total score was higher in the nurses from the tertiary hospitals than in those from non-tertiary hospitals (t=3.918,P＜0.001), and the score was higher in the nurses from teaching bases than in those from non-teaching bases (t=5.540,P＜0.001). There was no significant difference in the total score among different professional titles (F=0.853,P=0.428).  Conclusion  The scoring scale for hemodialysis installation and pre-flushing in this study can help standardize the nursing operation of installation and pre-flushing. Nurses from tertiary hospitals and training bases showed a higher level of the operation. This survey revealed that the application of basic norms/standards for health service professionals was insufficient, mainly in the time and method of hand hygiene, and quality evaluation and safety check before, during and after operation. We recommend that hemodialysis centers should reinforce the operation training for nurses. Metrics

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Study on health-promoting lifestyle and e-health literacy in maintenance hemodialysis patients XIONG Rui, FAN Dan-dan, CHEN Yang, HUANG Pei-xuan, YUAN Huai-hong 2023, 22 (04):  316-320.  doi: 10.3969/j.issn.1671-4091.2023.04.015 Abstract ( 98 )   PDF (430KB) ( 67 )   Objective  To investigate the status quo and influencing factors of health-promoting lifestyle in maintenance hemodialysis (MHD) patients, and to explore its correlation with e-health literacy.  Methods  A total of 141 patients with MHD in the Hemodialysis Center, West China Hospital of Sichuan University from February 2022 to May 2022 were selected as the research subjects. A general information questionnaire, eHealth Literacy Scale (eHEALs), and Revised Health Promoting Lifestyle Profile-Ⅱ (HPLP-ⅡR) were used to conduct a questionnaire survey for the MHD patients.  Results   The score of health promotion lifestyle was 104.00±15.01 points, and the score of e-health literacy was 25.26±8.91 in the MHD patients. Multivariate linear regression showed that educational level (high school diploma β=0.285, P=0.030; university degree or above β=0.388, P=0.003), and e-health literacy (β=0.365, P＜0.001) were the main influencing factors for health promotion lifestyle. Spearman correlation analysis showed a positive correlation between health literacy and health promotion lifestyle (r=0.474, P＜0.001).  Conclusion  The health promotion lifestyle was better, and e-health literacy was in a general level in the MHD patients. There was a positive correlation between health promotion lifestyle and e-health literacy. We should take targeted measures to improve the e-health literacy and healthy lifestyle to promote the quality of life in MHD patients. Metrics