Chinese Journal of Blood Purification

12 May 2023, Volume 22 Issue 05 Previous Issue    Next Issue

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Investigation and analyses on the peritoneal dialysis fees and the reimbursement from medical insurance in Chinese mainland Chinese Hospital Association Blood Purification Center Branch 2023, 22 (05):  321-326.  doi: 10.3969/j.issn.1671-4091.2023.05.001 Abstract ( 1369 )   PDF (485KB) ( 154 )   Objective  To investigate the items and costs of peritoneal dialysis (PD) management and the reimbursement of the expenses by medical insurance in PD patients from different regions in China, in order to reduce the financial burden of the patients and to promote the use of PD through the standard items and prices of PD and the rational rules of reimbursement by medical insurance.  Methods  A self-designed questionnaire on PD items and medical insurance was used to investigate the PD patients in 137 hospitals that provide PD in 30 provinces and big cities in China. Descriptive statistical analysis was performed on the collected data, and Kruskal-Wallis rank sum H test was used to examine the differences among groups.  Results  The nationwide median rates of reimbursement by medical insurance were 80.0 (70.0, 85.0)%, 85.0 (80.0, 90.0)% and 90.0 (80.0, 90.0)% for residents, urban employees, and retired employees, respectively. The monthly expense of continuous ambulatory peritoneal dialysis (CAPD) was significantly lower than that of automated peritoneal dialysis (APD) (H=26.717, P＜0.0001). The monthly reimbursable amount increased with the monthly total expense of CAPD or APD (H=58.367, P＜0.001). The prices of PD varied significantly in different provinces and big cities. The prices of surgical removal of granulation tissue at the outlet, waste bag, removal of polyester cuff in PD tube, and treatment of PD catheter-related tunnel infections had not been set up in 63%, 60%, 50% and 47% provinces and big cities respectively. The commonly used disposable materials necessary for PD safety such as dressing, waste bag and disinfectants could not be reimbursed by medical insurance in 77% provinces and big cities.  Conclusions   This study analyzed the current administration situations of PD management. We therefore recommend that ①the organization and administration of the basic medical insurance system must be continuously reinforced, and the encouragement mechanisms underlying PD services must be improved; ② the prices of PD items should be properly adjusted to support the passions of the hospitals providing high quality of PD services, and ③ the reimbursable PD items are required to be increased to support the safety and quality of PD services. Metrics

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Brief introduction of technical review key points of hemodialyzer LUO Qing-feng, XIAO Li, YANG Yu-xi, CAI Na-na 2023, 22 (05):  327-329.  doi: 10.3969/j.issn.1671-4091.2023.05.002 Abstract ( 121 )   PDF (349KB) ( 180 )   In order to ensure the effectiveness and safety of the hemodialyzer, this paper summarizes the key contents of the pre-marketing technical review of the hemodialyzer from the aspects of risk administration, technical requirements, process research, evaluation of toxic substances, Quality Control System, etc. according to the latest regulations, national/industrial standard terms, and the latest cognitive level. For the reference of professionals in research and development, production, review, supervision and other related fields. Metrics

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Individual factors contributing to the intercity patient mobility for chronic kidney diseases in China WANG Fu-lin, YANG Chao, LI Peng-fei, WEN Feng-yu, ZHANG Lu-xia 2023, 22 (05):  330-334.  doi: 10.3969/j.issn.1671-4091.2023.05.003 Abstract ( 106 )   PDF (490KB) ( 242 )   Objective  To explore the individual-level influencing factors of intercity mobility among adult patients with chronic kidney diseases (CKD) in China.  Methods   Based on a national hospitalization database of CKD inpatients from 2013 to 2018, descriptive statistics analysis and logistic regression were used to characterize the patient mobility for CKD and analyze the influencing factors.  Results  The overall proportion of intercity patient mobility for CKD was 17.73% in our study. There were significant differences in intercity mobility among patients with different causes of CKD (χ2=33582.873 P＜0.001). In addition, the proportion of patient mobility was higher in rural area compared to urban (29.40% for rural and 12.30% for urban), especially for the intra-province mobility (24.69% for rural while 9.38% for urban). Other individual characteristics including age, sex, marriage, medical insurance and occupation also affect the mobility of CKD inpatients. To be specific, there is a decreasing tendency for intercity mobility with patients getting older (OR=0.982, 95% CI: 0.981～0.982, P＜0.001); female patients are less likely to have intercity mobility behaviors than male patients (OR=0.934, 95%CI: 0.926～0.941, P＜0.001); married patients are more likely to seek medical treatment across cities than unmarried patients (OR=1.045, 95%CI: 1.028～1.061, P＜0.001); compared to patients with Urban Residents Basic Medical Insurance, patients with the New Rural Cooperative Medical Insurance have higher tendency for intercity mobility (OR=2.616, 95% CI: 2.585～2.647, P＜0.001)；in term of the patients’  occupation, taking workers as a reference, the professional and technical staff is more likely to have intercity mobility medical behaviors (OR=1.519, 95% CI: 1.473～1.566, P＜0.001), while retired patients are less likely to do so (OR=0.894, 95%CI: 0.874～0.914, P＜0.001).  Conclusions  There is a high mobility proportion of CKD inpatients in China, and the impact of non-medical factors on patient mobility should not be ignored. The results indicated that it is necessary to strength the guidance for reasonable medical behaviors on the basis of optimizing the layout of renal specialist resources. Metrics

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Changes in peritoneal transport function and its influence on cardiovascular events in peritoneal dialysis patients YAN Qi-qi, LIU Gui-ling, WANG Rui-feng, LI Dan-dan 2023, 22 (05):  335-338.  doi: 10.3969/j.issn.1671-4091.2023.05.004 Abstract ( 99 )   PDF (444KB) ( 28 )   Objective  To investigate the changes in peritoneal transport function and its influence on cardiovascular events (CVE) in peritoneal dialysis (PD) patients.  Method  A total of 114 patients who started PD in the Second Hospital of Anhui Medical University from 1 January 2014 to 31 December 2019 were involved and followed until the occurrence of CVE, change to hemodialysis or kidney transplantation, loss to follow-up, death, or till the study termination date (31 December 2021). According to the changes in dialysate to plasma ratio of creatinine at 4h(4hD/Pcr), all participants were divided into increased (n=70) or decreased (n=44) groups. Compared the occurrence of CVE between the two groups and used the COX regression to explore the influencing factors of CVE in PD patients.  Results  In patients with baseline peritoneal transport functions were low transporters, 4hD/Pcr tended to increase in the first two years, low average transporters increased in the first year, and both high and high average transporters showed a decreasing trend in the first two years. The patients in increased group were significantly younger than the decreased group (t=2.396, P=0.018). A total of 44 (38.6%) patients developed CVE during a mean follow-up of 40.5 months. Among them, 22 (31.4%) were in the increase group and 22 (50%) were in the decrease group. The cumulative proportion of CVE-free in the increased group was higher than that in the decreased group (χ2=4.000, P=0.046). Multivariate Cox regression analysis showed that the changes in 4hD/Pcr (HR=0.093, 95%CI: 0.013～0.662, P=0.018) and diabetes mellitus (HR=2.824, 95%CI: 1.441～5.535, P=0.002) were independent influencing factors for the occurrence of CVE in PD patients. Conclusion   PD patients with decreased 4hD/Pcr have a high risk of CVE.  Metrics

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Serum level of procalcitonin and its diagnostic value for infections in maintenance hemodialysis patients ZHAO Shu-yin, LI Ping, LIANG Xian-hui 2023, 22 (05):  339-343.  doi: 10.3969/j.issn.1671-4091.2023.05.005 Abstract ( 116 )   PDF (440KB) ( 51 )   Objective   To explore the level and influencing factors of serum procalcitonin (PCT) in maintenance hemodialysis (MHD) patients, and to evaluate the diagnostic value of PCT for infections in MHD patients.  Methods  A total of 500 MHD patients without clinical infection were selected in this cross-sectional study. They were further stratified according to serum PCT level. The influencing factors for the higher serum PCT in MHD patients were investigated by inter-group comparison, univariate and multivariate logistic regression analyses. Additionally, a total of 115 MHD patients with clinical infections were recruited. The optimal cut-off value of serum PCT for the diagnosis of infections in the MHD patients was determined by receiver operating characteristic (ROC) curve and the area under the curve (AUC).  Results   Compared with non-infected groups,serum PCT was significantly elevated in patients in the infected group (Z=-14.204, P＜0.001). Logistic regression showed that catheters as the dialysis access (OR=2.142, 95% CI:1.282~3.579, P=0.004), male (OR=1.517, 95% CI: 1.036~2.221, P=0.032), hemoglobin＜110g/L (OR=1.792, 95% CI 1.225~2.623, P=0.003), blood phosphorus≥1.78mmol/L (OR=1.608, 95% CI:1.079~2.379, P=0.020) and parathyroid hormone >300pg/ml (OR=1.693, 95% CI:1.156~2.479, P=0.007) were the independent risk factors for higher serum PCT level in MHD patients. When the cut-off value of serum PCT was set at 0.851ng/ml, the sensitivity and specificity of PCT to predict infections in MHD patients were 85.2% and 87.2% respectively, with the AUC of 0.924 (95% CI 0.896~0.953).  Conclusions  Serum PCT is significantly increased in MHD patients. We recommend a higher diagnostic threshold of serum PCT for the clinical diagnosis of infections in MHD patients. Metrics

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A multicenter clinical study of maintenance hemodialysis patients using the dialyzer with cellulose triacetate membrane or polysulfone membrane CHEN Chen, ZHANG Chen, ZHOU Guang-yu, ZHOU Hua, LI De-tian, ZHENG Hua, WANG Wen-qiu, WANG Zhe 2023, 22 (05):  344-348.  doi: 10.3969/j.issn.1671-4091.2023.05.006 Abstract ( 214 )   PDF (441KB) ( 46 )   Objective   To compare the differences of biocompatibility and solute removal ability in maintenance hemodialysis (MHD) patients using the dialyzer with cellulose triacetate (CTA) membrane and in those using the dialyzer with polysulfone (PS) membrane. Methods   The MHD patients were divided into a PS membrane group and a CTA membrane group according to the clinical responses whether or not they tolerated the PS membrane dialyzer. The effects of the two dialyzers on serum phosphorus (P), blood urea nitrogen (BUN), β2-microglobulin (β2-MG), parathyroid hormone (PTH), complement, IgE, TNF-α,  interleukin-6 (IL-6),  platelet (PLT), hemoglobin (Hb), calculate urea removal rate (URR) and spKt /V were compared before and after the first dialysis session and after the hemodialysis for 12 months.  Results   After the first dialysis session, the difference of serum TNF-α was less (Z= -2.491, P=0.013) and the difference of serum β2-MG was more (Z=-2.039, P=0.041) in PS membrane group than in CTA membrane group. After the hemodialysis for 12 months, the differences of P (Z=-2.096, P=0.036), BUN (Z=-2.038, P=0.042), and spKt /V (t =-2.147, P=0.049) were statistically different between the two groups; the difference of P was more in PS membrane group than in CTA membrane group (t =0.114, P=0.041).  Conclusions   After the first dialysis session, serum TNF-α increased in PS membrane group, suggesting the better biocompatibility of CTA membrane dialyzer; the clearance of β2-MG was better in CTA membrane group than in PS membrane group. After the hemodialysis for 12 months, the biocompatibility became similar in both groups, spKt /V reached the standard level in CTA membrane group, and the clearances of P and BUN were better in CTA membrane group than in PS membrane group.  Metrics

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Effect of malnutrition-inflammation-atherosclerosis (MIA) syndrome on clinical adverse prognosis among patients with peritoneal dialysis associated peritonitis after recovery QIAO Yu-meng, XU Xiao, DONG Jie 2023, 22 (05):  349-354.  doi: 10.3969/j.issn.1671-4091.2023.05.007 Abstract ( 93 )   PDF (591KB) ( 36 )   Objective  To investigate the effect of malnutrition-inflammation-atherosclerosis (MIA) syndrome on the poor prognosis of patients with peritoneal dialysis associated peritonitis (PDAP) after recovery.  Methods  Clinical data of the patients developed PDAP and then cured in the Peritoneal Dialysis Center of Peking University First Hospital between January 1, 2008 and December 31, 2021 were retrospectively analyzed. These patients were divided into MIA0, MIA1 and MIA ≥2 groups according to whether or not they had cardiovascular disease, serum albumin＜35g/L or C-reactive protein (CRP) >3mg/L within 3 months after recovery from PDAP. With MIA0 group as the reference, multivariate COX proportional risk model and competitive risk model were used to analyze whether MIA score was a predictor of death, transferred to hemodialysis, and recurrent peritonitis.  Results   During the study period, a total of 716 PDAP episodes occurred in 483 patients, of which 397 (82.19%) patients continued to maintain PD after recovery from the first PDAP. Excluding 96 patients with missing data, 301 patients were finally incorporated in this study, including 74 patients (24.58%) in MIA0 group, 112 patients (37.21%) in MIA1 group, and 115 patients (38.21%) in MIA ≥2 group. The results suggested that the patients with higher MIA score had lower albumin level and higher CRP level at baseline (P＜0.05). COX proportional risk model found that death risks of the patients in MIA1 and MIA ≥2 groups increased by 137% (HR 2.369, 95% CI:1.127~4.979, P=0.023) and 448% (HR 5.480, 95% CI:2.590~11.590, P＜0.001), respectively, as compared with that of the patients in MIA0 group. The competitive risk model showed that MIA score had no significant effects on the risks of transferred to hemodialysis and recurrent peritonitis.  Conclusion  MIA syndrome has a continuous adverse effect on patients after recovery from PDAP. The more the items of MIA syndrome, the higher the risk of mortality in the PDAP patients after recovery. Metrics

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Comparison of the outcomes of subtotal parathyroidectomy and total parathyroidectomy plus autotransplantation for tertiary hyperparathyroidism after kidney transplantation LYU Yong, WANG Qiu-yuan, CHENG Jing-ning, ZHANG Ling 2023, 22 (05):  355-358.  doi: 10.3969/j.issn.1671-4091.2023.05.008 Abstract ( 53 )   PDF (368KB) ( 29 )   Objective To compare the therapeutic effects of subtotal parathyroidectomy (STPX) and total parathyroidectomy plus autologous transplantation in forearm (TPX-AT) on tertiary hyperparathyroidism (THPT) in patients with successful kidney transplantation.  Method  The patients with THPT after successful kidney transplantation and receiving STPX or TPX-AT from May 2018 to September 2021 were retrospectively reviewed. Their clinical data including age, sex, dialysis age, type of surgery, final pathological findings, preoperative biochemistry tests (serum calcium, iPTH, phosphorus, alkaline phosphatase, glomerular filtration rate, etc.) and postoperative iPTH at each following time were collected and analyzed.  Result  A total of 18 patients were included in this study, including 8 males and 10 females, with an average age of (45.56±3.46)years and an average dialysis time of (6.70±1.20)years. The patients were divided into STPX group and TPX-AT group, with 9 patients in each group. There were no significant differences in the preoperative values of mean serum calcium, phosphorus, ALP and iPTH between the two groups. At the first postoperative day, iPTH levels decreased to 98.88pg/ml and 39.39pg/ml in STPX group and TPX-AT group, respectively, but without statistical significance between the two groups (t=-1.423, P=0.181). The postoperative cure rates were 55.5% and 77.8% and the iPTH levels after the operation for 6 months were 105.52pg/ml and 151.07pg/ml in STPX group and TPX-AT group, respectively. The overall effective rate of the two groups was 61.1%; the effective rate was 55.5% in STPX group and was 66.7% in TPX-AT group.  Conclusion  The postoperative cure rate was higher in TPX-AT group than that in STPX group. However, the effective rates to THPT after the operation for 6 months were unsatisfactory in both groups. The iPTH level at the first postoperative day may be an indicator for prognosis of the THPT patients. Metrics

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Establishment and functional identification of an immortalized human parathyroid cell line JIANG Nan, LI Bo-hou, DENG Shu-ting, YUAN Ye, WU Qiong, WEN Si-chun, CHEN Bai-xi, ZHAO Ze-weng, PENG Si-qi, XIA Yu-bing, TAO Yi-ming, LIU Shuang-xin 2023, 22 (05):  359-363.  doi: 10.3969/j.issn.1671-4091.2023.05.009 Abstract ( 152 )   PDF (650KB) ( 25 )   Objective  To establish an immortalized human parathyroid cell line and to identify its functions.  Methods  SV40 (Simian vacuolating virus 40, SV40) large antigen was introduced into the parathyroid cells by lentivirus infection, and the transfected cells were screened by puromycin. The expressions of parathyroid hormone (PTH), calcium sensitive receptor (CaSR) and glial cells missing homolog 2, (GCM2) mRNAs and proteins in the parathyroid cells were detected by cell morphology, RT-qPCR and immunofluorescence. The reactivity of transfected cells to Ca2+ was detected by cell proliferation assay.  Results  Most of the transfected parathyroid cells were fusiform, with oval nuclei and transparent cytoplasm. RT-qPCR showed that the parathyroid cells expressed CaSR, GCM2 and PTH mRNAs. Immunofluorescence showed that the immortalized parathyroid cell line expressed parathyroid associated proteins of CaSR, GCM2 and PTH. Cell proliferation experiments showed that low calcium could promote the proliferation of parathyroid cells.  Conclusion  An immortalized parathyroid cell line was successfully established in this study, which provides an experimental basis for further exploring the pathogenesis and treatment of secondary hyperparathyroidism. Metrics

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Expert consensus on the specialized nursing operation of hemoperfusion combined with hemodialysis Blood Purification Committee of Chinese Nursing Association (This consensus was written by MA Zhi-fang, XIANG Jing, XIA Jing-hua, XIAO Guang-hui, FU Xia, SHEN Hua-juan, HE Shan, CHEN Jing, TONG Hui, GAO Ju-lin, YUE Xiao-hong, JIAO Jian-mei, ZHU Han-yu) 2023, 22 (05):  364-368,380.  doi: 10.3969/j.issn.1671-4091.2023.05.010 Abstract ( 462 )   PDF (556KB) ( 512 )   Combined hemoperfusion (HP) and hemodialysis (HD) (combined artificial kidney) is increasingly used for the treatment of end-stage renal disease (ESRD). Clinical nursing staff have an urgent need for the specialized nursing operation of combined artificial kidney. The expert group of the Blood Purification Professional Committee of the Chinese Nursing Association, referring to the domestic and foreign literature and combining the clinical application experience, has formulated the “Expert Consensus on Specialized Nursing Operation of Hemoperfusion Combined with Hemodialysis” that contains seven aspects: pipeline selection, heparinization of hemoperfusion, pre-flushing process, blood transfusion operation, blood return operation, observation and treatment, and pressure monitoring. This is the first expert consensus to guide the combined artificial kidney treatment and nursing operation in China, in order to provide a valuable reference for clinical nursing staff to implement the nursing operation of combined artificial kidney treatment. Metrics

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Research progresses in the treatment of sepsis using polymyxin B hemoperfusion immobilized fiber column direct hemoperfusion LIU Huan, ZHAO Guo-liang 2023, 22 (05):  369-372.  doi: 10.3969/j.issn.1671-4091.2023.05.011 Abstract ( 118 )   PDF (396KB) ( 86 )   Endotoxin adsorption therapy with polymyxin B hemoperfusion immobilized fiber column direct hemoperfusion (PMX-DHP) has been used in the treatment of septic shock. Endotoxin is an outer membrane component of Gram-negative bacteria, and plays an important role in the pathogenesis of septic shock. Endotoxin triggers white blood cells, macrophages and endothelial cells to secrete a cascade of signaling mediators including cytokines and nitric oxide, leading to septic shock and multiple organ dysfunction syndrome. PMX-DHP directly adsorbs endotoxin as well as monocytes and monoamides, and reduces blood levels of inflammatory cytokines such as IL-1, IL-6, tumor necrosis factor-α, IL-17A, adhesion molecules, plasminogen activator inhibitor-1, and high mobility group box-1 (HMGB1). PMX-DHP also elevates blood pressure, lowers the dose of vasoactive inotropic drugs, and improves the expression of HLA-DR on monocytes in patients with severe sepsis and septic shock. This article reviews the research progresses in PMX-DHP used in the treatment of septic shock. Metrics

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Research progresses in the TLR4/NF-κB signaling pathway involved in AVF stenosis LAN Zhi-xia, SUN Xiu-li 2023, 22 (05):  373-376.  doi: 10.3969/j.issn.1671-4091.2023.05.012 Abstract ( 65 )   PDF (418KB) ( 15 )   Autologous arteriovenous fistula (AVF) is the preferable vascular access method for hemodialysis (HD), being a critical route for end-stage renal disease (ESRD) patients to maintain their lives. AVF dysfunction increases the hospitalization rate and mortality of ESRD patients. The mechanism of AVF dysfunction has not been fully elucidated, but insufficient vascular remodeling and neointimal hyperplasia have been considered as the main causes of non-thrombotic vascular stenosis. Toll-like receptor 4 (TLR4), an important member in the toll-like receptor family, mediates the proliferation and migration of vascular smooth muscle cells (VSMCs) and deposition of extracellular matrix in AVF wall, leading to intimal hyperplasia and AVF stenosis. Comprehension of TLR4 in the development of AVF dysfunction is closely related to the accurate diagnosis and treatment of AVF dysfunction and maintenance of long-term patency of AVF. Here we summarize the recent progresses in AVF stenosis, its influencing factors, TLR4, and the role of TLR4/NF-κB signal pathway in the pathogenesis of AVF dysfunction. Metrics

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Research advances in the irisin in hemodialysis  AN Guo-sheng, DU Wen-hui, ZHANG Hong-tao 2023, 22 (05):  377-380.  doi: 10.3969/j.issn.1671-4091.2023.05.013 Abstract ( 127 )   PDF (415KB) ( 32 )   risin is a new type of energy metabolism factor. Serum irisin level decreases along with the decline of renal function. Irisin is closely associated with a variety of metabolic diseases and probably with the complications and prognosis of hemodialysis patients. Whether or not serum irisin level has racial and population differences and irisin is a protective factor for hemodialysis patients are currently undetermined. Metrics

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Measurement method of renal uric acid excretion ability in patients with hyperuricemia  LIU Yue, WANG Yue 2023, 22 (05):  381-383.  doi: 10.3969/j.issn.1671-4091.2023.05.014 Abstract ( 79 )   PDF (341KB) ( 147 )   About 90% of the hyperuricemia patients are found to have renal dysfunction of uric acid excretion. Guidelines and consensus from China and foreign countries have recommend that the 24-hour uric acid excretion fraction and/or 24-hour uric acid excretion can be used for assay of renal uric acid excretion ability, clinical classification and drug selection. However, collection of a 24-hour urine sample takes a long time, and the result may not be accurate due to the possible contamination and incomplete sampling during collection and limited urine storage condition. Previous studies have found that uric acid excretion fraction in random urine sample, especially in morning urine sample, is a simple and efficient method, which may replace the 24-hour uric acid excretion method to evaluate renal uric acid excretion function and to guide clinical classification and treatment in hyperuricemia patients. Metrics

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Value of combined atherogenic index of plasma and non-HDL-cholesterol in predicting vascular access failure in hemodialysis patients MA Li-jie, ZHAO Su-mei, SUN Fang, SUN Qian-mei 2023, 22 (05):  384-388.  doi: 0.3969/j.issn.1671-4091.2023.05.015 Abstract ( 36 )   PDF (494KB) ( 66 )   Objective  To investigate the correlation of atherogenic index of plasma (AIP) and non-high-density lipoprotein cholesterol (non-HDL-C) with the vascular access failure (VAF) in hemodialysis patients, and to evaluate the prediction value of AIP and non-HDL-C for VAF risks.  Methods  A total of 277 patients on maintenance hemodialysis (MHD) with autologous arteriovenous fistula (AVF) treated in the Dialysis Center of Beijing Chaoyang Hospital from January 2017 to December 2021 were recruited. They were divided into VAF group (n=85) and non-VAF group (n=192). AIP, non-HDL-C and clinical characteristics were compared between the two groups. Multivariate COX regression was used to analyze the independent factors for VAF risks. ROC curve was drawn to evaluate the prediction value for VAF risks by AIP and non-HDL-C in MHD patients.  Results  AIP (Z=7.331, P<0.001) and non-HDL-C (Z=6.566, P<0.001) were statistically higher in the VAF group than in the non-VAF group. After adjustment for sex, age, blood creatinine and uric acid, AIP (HR=8.757; 95% CI: 4.134, 18.548; P< 0.001) and non-HDL-C (HR=1.533; 95% CI:1.094, 2.150; P<0.001) remained the independent factors for VAF risks. AUC of the prediction for VAF risks by AIP was 0.776 (95% CI:0.722, 0.831), by non-HDL-C was 0.747 (95% CI:0.690, 0.805), and by combined both was 0.805 (95% CI:0.690, 0.805).  Conclusions  AIP and non-HDL-C are the independent factors for VAF risks. AIP, non-HDL-C or combination of the two have a good predictive value for VAF risks. Metrics

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Investigation and influencing factor analyses on volume management behavior in maintenance hemodialysis patients LIN Ping, GAO Ying, ZHUANG Jian-hong 2023, 22 (05):  389-391,400.  doi: 10.3969/j.issn.1671-4091.2023.05.016 Abstract ( 125 )   PDF (424KB) ( 206 )   Objective To explore the volume management behavior in patients with maintenance hemodialysis (MHD) and its influencing factors.  Methods  A total of 89 patients undergoing MHD treatment in Huzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine from January 2021 to June 2022 were selected by cluster sampling method. General information questionnaire, volume management behavior scale, and general self-efficacy scale were used for the investigation of volume management behavior and its influencing factors.  Results  The 89 MHD patients had a total score of 17.24±2.85 for volume management behavior, including diet management dimension score of 5.12±1.88 and comorbidity monitoring dimension score of 12.12±2.67. Univariate regression showed that dialysis age, educational level, average monthly income per family member, and self-efficacy were related to volume management behavior (t=3.048, 3.643, 4.222 and 3.340 respectively; P=0.003, 0.001, 0.000 and 0.001 respectively), but comorbidities, age, health insurance, gender, job and marital status were unrelated to volume management behavior in MHD patients (t/F=0.973, 1.555, 0.002, 1.111, 0.707 and 0.802 respectively; P=0.333, 0.124, 0.998, 0.333, 0.482 and 0.425 respectively). Multivariate linear regression found that lower literacy, longer dialysis age, lower self-efficacy and lower average monthly income per family member were the independent risk factors for volume management behavior in MHD patients (β=0.126, -2.660, 0.130 and 0.241 respectively; P=0.011, <0.001, =0.014 and <0.001 respectively).  Conclusion   The ability of volume management behavior is insufficient in MHD patients. This behavior is affected by dialysis age, educational level, average monthly income per family member, self-efficacy and the others. Metrics

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Analysis of experiential avoidance and its influencing factors in maintenance hemodialysis patients    LUO Na, DING Shu-zhen 2023, 22 (05):  392-395.  doi: 10.3969/j.issn.1671-4091.2023.05.017 Abstract ( 99 )   PDF (408KB) ( 40 )   Objective To understand the experiential avoidance in maintenance hemodialysis (MHD) patients and to explore its influencing factors so as to provide  theoretical basis for follow-up study.  Methods  A total of 200 MHD patients treated in The First Affiliated Hospital of Dalian Medical University from October 2021 to January 2022 were selected by means of the convenience sampling method. They were assessed by Acceptance Action Questionnaire, Patient Activation Measure 13, Benefit Finding Scale, and General Data Questionnaire. SPSS 26.0 software was used to process the data.  Results  The overall score of experiential avoidance was 23.74±6.356 in the patients (P＜0.050). The overall score of experiential avoidance was negatively correlated with the overall score of activation and the scores of its dimensions (cognition dimension: r=-0.263, P＜0.001; skill dimension: r=-0.464, P＜0.001; action dimension: r=-0.326, P=0.001; faith dimension: r=-0.271, P＜0.001; overall score of activation: r=-0.515, P＜0.001), and the overall score of benefit finding and the scores of its dimensions (acceptance dimension: r=-0.492, P<0.001; family relationship dimension: r= -0.344, P=0.002; world outlook dimension: r=-0.319, P＜0.001; personal growth dimension: r=-0.336, P＜0.001; social relation dimension: r=-0.374, P＜0.001; health dimension: r=-0.348, P＜0.001; overall score of benefit finding: r=-0.544, P<0.001). Multivariate linear regression showed that educational level (β=-0.162, P=0.001), average monthly income per family member (β=-0.124, P＝0.011), hemodialysis year (β=-0.299, P<0.001), hobbies (β=-0.192, P＜0.001), patient activation (β=-0.230, P＜0.001) and benefit finding (β=         -0.311, P＜0.001) were the influencing factors for experiential avoidance.  Conclusion  The status of experiential avoidance in MHD patients was found in a medium level. We should take appropriate measures based on the influencing factors to reduce the level of experiential avoidance and to promote physical and mental health of MHD patients. Metrics

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Characteristics of intimal hyperplasia at the buttonhole puncture segments of arteriovenous fistula and the effect of discontinuing the puncture ZHANG Yao, WANG Xiao, DU Nan-nan, WANG Chen-wei, ZHANG Rui-bin, GAO Qing-zhen 2023, 22 (05):  396-400.  doi: 10.3969/j.issn.1671-4091.2023.05.018 Abstract ( 233 )   PDF (752KB) ( 82 )   Objectives  To study the pathological course of intimal hyperplasia at the blunt needle buttonhole puncture segments of arteriovenous fistula (AVF), analyze the possible pathogenesis of the intimal hyperplasia, and find out the effective intervention measures.  Methods   Doppler ultrasound was used to observe the intimal hyperplasia at the buttonhole puncture segments of AVF, measure the size of the hyperplastic area, and describe its morphological characteristics. Patients with intimal hyperplasia at the buttonhole puncture segment were divided in to continuous use group and discontinuous use group according to whether or not the puncture was continuously used. The changes of intimal hyperplasia at the puncture segments were dynamically observed. Spearman correlation was used to analyze the correlation between intimal hyperplasia and clinical data of the patients.  Results  A total of 39 patients with 82 buttonholes were included in this study. Ultrasound examinations showed that intimal hyperplasia appeared at the anterior and posterior blood vessel walls of the buttonhole puncture segments with various morphological characteristics. At the initial examination, the incidence of intimal hyperplasia at the blunt needle buttonhole puncture segments was 54.9%, significantly higher than the incidence in the traditional sharp needle puncture group (χ2=103.197, P＜0.001). Spearman correlation analysis showed that the intimal hyperplasia at the buttonhole puncture segments was positively correlated with the puncture time (r=0.211, P=0.001). In the continuous use group, the intimal hyperplasia (n=28) aggravated progressively, with significant increase of length, width and thickness of the hyperplastic area after one year (t=-4.030, -3.093 and -2.454 respectively; P＜0.001, =0.005 and 0.021 respectively). While in the discontinuous use group (n＝21), the intimal hyperplasia subsided gradually, with significant decrease of length and width of the hyperplastic area after one year (t=3.140 and 3.084 respectively; P=0.005 and 0.006 respectively).  Conclusions Intimal hyperplasia is liable to occur at the vascular walls of buttonhole puncture segments, and the degree of intimal hyperplasia gradually increases with the prolongation of puncture time. Discontinuing the puncture is an effective measure to alleviate the intimal hyperplasia. Metrics