Chinese Journal of Blood Purification

12 June 2023, Volume 22 Issue 06 Previous Issue    Next Issue

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Associations between hyperhomocysteinemia and cardiac structure in maintenance hemodialysis  patients HUANG Jia, LEI Juan-juan, LI Han, WANG Shi-xiang 2023, 22 (06):  401-405.  doi: 10.3969/j.issn.1671-4091.2023.06.001 Abstract ( 151 )   PDF (463KB) ( 33 )   Associations between hyperhomocysteinemia and cardiac structure in maintenance hemodialysis  patients   HUANG Jia1, LEI Juan-juan1, LI Han1, WANG Shi-xiang1    1Department of Nephrology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China Corresponding author: LI Han, Email: hanli@ccmu.edu.cn 【Abstract】Objective  To investigate the associations between hyperhomocysteinemia and cardiac structure in maintenance hemodialysis patients (MHD). Methods  176 MHD patients in Beijing Chao-Yang Hospital Affiliated to Capital Medical University from January 2014 to December 2021 were analyzed retrospectively. Patients whose plasma homocysteine (Hcy) ≤30μmol/L were divided into the normal-mild group, and whose plasma Hcy＞30μmol/L were divided into moderate-severe groups. The indexes of left ventricular by cardiac ultrasound were compared between the 2 groups, and the correlation between plasma Hcy and left ventricular indexes was analyzed. We also explored whether there was an interaction between plasma Hcy and other risk factors of cardiovascular disease on left ventricular structural and functional.  Results  74 patients were enrolled in the normal-mild group, and 102 patients were enrolled in the moderate-severe group. There were significant differences in left ventricular end-diastolic dimension (LVDd) (Z=-2.569, P=0.010), left ventricular end-systolic dimension (LVDs) (Z=-2.813, P=0.005), ventricular septal thickness (IVST) (Z=-3.389, P=0.001), left ventricular posterior wall thickness (LVPWT) (Z=-2.463, P=0.014) and the peak of early diastolic flow velocity E /the peak of atrial flow velocity A (Z=-3.483, P＜0.001) between normal mild-group and moderate-severe group. Plasma Hcy level was negatively correlated with LVDd (r=-0.206, P=0.006), LVDs (r=-0.190, P=0.011) and E/A (r=-0.234, P=0.002), positively correlated with IVST (r=0.356, P＜0.001) and LVPWT (r=0.243, P=0.001). Multiple regression analysis showed that plasma Hcy level was correlated with LVDd  (β=-0.263, P＜0.001), LVDs  (β=-0.223, P=0.004), IVST (β=0.294, P＜0.001), LVPWT   (β=0.244, P=0.002) independently. Plasma Hcy level interacted with body mass index (BMI) (β=0.405, P＜0.001) on IVST；Plasma Hcy level interacted with gender (β=-0.164, P=0.038), BMI (β=0.386, P＜0.001) and systolic blood pressure (SBP) (β=0.225, P=0.004) on LVPWT.  Conclusion  Hyperhomocysteinemia was an independent risk factor for cardiac structure changes in MHD patients, and there was an interaction between blood Hcy level and gender, BMI, and SBP before dialysis on cardiac structure changes. 【Key word】Maintenance hemodialysis; Homocysteine; Cardiac structure Metrics

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Observation on the efficacy of oXiris hemofilter in the treatment of severe burn complicated with sepsis and acute kidney injury PENG Jia-nan, LUAN Feng-wu, ZHAO Li-hong, CHEN Meng-hua, ZHANG Ting 2023, 22 (06):  406-409.  doi: 10.3969/j.issn.1671-4091.2023.06.002 Abstract ( 159 )   PDF (436KB) ( 63 )   Objective  To explore the efficacy of oXiris hemofilter in the treatment of severe burn patients complicated with sepsis and acute kidney injury.  Method  The clinical data of 5 patients with severe burn complicated with sepsis and acute kidney injury treated with continuous venovenous hemofiltration (CVVHDF) with oXiris hemofiltration in the hemodialysis center of General Hospital of Ningxia Medical University from May 2018 to February 2021 were retrospectively analyzed. The changes in general vital signs (body temperature, MAP, heart rate, respiration, urine volume, etc.), blood routine, blood gas analysis, and biochemical indexes were observed in 5 patients before and 24 hours after CVVHDF treatment with oXiris hemofiltration, and the Sequential Organ Failure Assessment (SOFA) score was calculated respectively.  Results  ①In the following 24 hours after CVVHDF with oXiris hemofiltration, compared with before treatment, the urine volume of 24 hours (Z=-2.069, P=0.039), the platelets count (t=-3.977, P =0.001) were increased, and the serum sodium level (t=2.652, P =0.016) and the SOFA score (t=4.265, P＜0.001) was decreased. The indexes of body temperature(t=-0.258, P=0.799), MAP (t=0.168, P=0.868), heart rate(t=1.057, P=0.304), respiration     (t=0.481, P=0.636), PH(t=1.304, P=0.208), WBC (t=-1.616, P=0.123), serum bilirubin(t=0.560, P=0.582), serum creatinine (t=0.755, P=0.459) were improved, but there was no significant difference before and after treatment. ②The 28-day survival rate of these patients was 60%.  Conclusions  CVVHDF therapy with oXiris hemofiltration can improve coagulation function, promote the recovery of kidney function, reduce SOFA score in severe burn patients complicated by sepsis and acute kidney injury. Metrics

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Serum FT3 levels, sleep, and anxiety status in maintenance hemodialysis patients: a mediation effect analysis study LI Mao-xue, LONG Mu-yang, LIU Yun, ZHONG Xiao-shi, LIU Yan 2023, 22 (06):  410-414.  doi: 10.3969/j.issn.1671-4091.2023.06.003 Abstract ( 106 )   PDF (447KB) ( 72 )   Objective  To investigate the relationship between serum FT3 level and anxiety state in maintenance hemodialysis (MHD) patients.  Methods  This was a single-center and cross-sectional study. Patients who underwent MHD in our center in September 2021 were enrolled. Demographic data, routine blood biochemical examination, and serum free triiodothyronine (FT3) before dialysis sessions were tested, and the anxiety status of the patients was evaluated by the Hamilton Anxiety Scale (HAMA). According to the anxiety scale score, patients were divided into the without anxiety status group (total score＜7 points) and with anxiety status group (total score≥7 points). Multivariate binary Logistic regression was used to analyze the independent factors associated with anxiety risk, and software (Empower Stats 3.0) was used to analyze causal mediating effects among variables.  Results  A total of 120 MHD patients were enrolled in this study, including 66 patients in the anxiety status group and 54 patients in the control group. Spearman analyses showed that the levels of serum FT3 negatively correlated with the sleep score (r=-0.277, P=0.002). Multivariate binary logistic regression analysis showed that low serum FT3 level in MHD patients in our center was independent associated with anxiety status (OR=3.167，95% CI：1.144～8.772, P=0.027), but when sleep score was included in the models, the association between the serum FT3 and anxiety status disappeared (OR=0.842，95% CI：0.812～8.051, P=0.109). Mediation analysis showed that 47.6% of the effect of serum FT3 on anxiety state was mediated through sleep disturbance (P=0.004). Metrics

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Effect of chronic kidney disease management on the disease progression and dialysis initiation in diabetic kidney disease patients YU Shu, JIA Jue, WANG Tao-tao, XU Feng-lan, GUI Lan-lan, HUA Qin, HE Jian-qiang 2023, 22 (06):  415-420.  doi: 10.3969/j.issn.1671-4091.2023.06.004 Abstract ( 98 )   PDF (456KB) ( 156 )   Objective  To evaluate the influence of chronic kidney disease (CKD) outpatient management on the disease progression and dialysis initiation in diabetic kidney disease (DKD) patients, so as to provide a basis for continuous improvement of the multidisciplinary management of CKD outpatients and DKD patients. Methods This study enrolled 92 DKD patients with initial hemodialysis from the CKD Outpatient Clinic (management group, group M) and 94 DKD patients with initial hemodialysis from the Nephrology Clinic (non-management group, group NM) in the Affiliated Hospital of Jiangsu University in the period from June 2015 to June 2021. Biochemical indexes, vascular access, hospitalization and renal function changes were compared between the two groups at the first dialysis. The impact of various factors on disease progression was evaluated by Cox regression analysis.  Results  At dialysis entry, systolic blood pressure, estimated glomerular filtration rate (eGFR), and serum whole parathyroid hormone were significantly lower in group M than in group NM (t=-3.352, -1.196 and -1.995 respectively; P=0.001, 0.047 and 0.047 respectively), and hemoglobin, serum creatinine and albumin were significantly higher in group M than in group NM (t=2.320, 2.189 and 2.102 respectively; P=0.021, 0.030 and 0.037 respectively); vascular access, emergent dialysis and the ratio of first induced dialysis at the first dialysis were significantly different between the two groups (c2=19.573, 16.396 and 16.969 respectively; P＜0.001). Kaplan-Meier survival analysis showed that the median disease course entering dialysis was significantly longer in group M than in group NM (t=2.239, P=0.21). Multivariate regression analysis showed that age, diabetic retinopathy, urinary microalbumin/creatinine were the risk factor for DKD progression (HR=1.020, 0.554 and 1.000 respectively, 95% CI: 1.003~1.038, 0.405~0.757 and 1.000~1.000 respectively; P=0.019, ＜0.001 and ＜0.001 respectively). CKD management and treatment with angiotensin converting enzyme inhibitors (ACEI)/angiotensin II receptor blocker (ARB) could postpone the DKD progression.  Conclusion  CKD management can significantly delay the progression of DKD. In outpatient management, early screening of diabetic retinopathy, management of urinary protein, and early use of ACEI/ARB medications are helpful to delay the DKD progression. Metrics

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Analysis of intradialytic blood glucose change and hypoglycemia in maintenance hemodialysis patients HAN Yu, QU Zhi-jie, FENG Wen-yuan, LI Wen, MIAO Li-ning, SUN Jing 2023, 22 (06):  421-425.  doi: 10.3969/j.issn.1671-4091.2023.06.005 Abstract ( 191 )   PDF (447KB) ( 76 )   Objectives  To analyze the rules and influencing factors of intradialytic blood glucose change and hypoglycemia, and to explore the effect of glucose-containing dialysate (GCD) on intradialytic hypoglycemia.  Methods  The maintenance hemodialysis (MHD) patients treated in the Blood Purification Center, The Second Hospital of Jilin University from December 2021 to December 2022 were enrolled in this study. They were routinely treated with glucose-free dialysate (GFD), and then switched to GCD containing 5.5mmol/L glucose. Blood glucose was assayed at 0, 1st， 2nd, 3rd hour and the end of last session of hemodialysis with GFD, and of the 4th session of hemodialysis with GCD.  Intradialytic blood glucose changes and hypoglycemia were compared between the MHD patients with and without diabetes. Univariate and multivariate logistic regression were used to analyze the influencing factors for intradialytic hypoglycemia in MHD patients with diabetes.   Results  A total of 232 MHD patients were enrolled in this study, including 102 in diabetes group and 130 in non-diabetes group. When they were dialyzed with GFD, hypoglycemia occurred in 21 cases in diabetes group (3 episodes of hypoglycemia occurred during dialysis after 0~2 hour and 21 episodes occurred during dialysis after 2 hours to end of the session), and in 6 cases in non-diabetes group (6 episodes occurred during dialysis after 2 hours to end of the session). Asymptomatic hypoglycemia accounted for 79.17% and 83.33% of the hypoglycemia in diabetes group and non-diabetes group respectively. The incidences of hypoglycemia were 20.59 % and 4.62% in diabetes group and non-diabetes group respectively (c2=14.180, P＜0.001). After the hemodialysis switched to GCD, hypoglycemia occurred in one case (0.98%) in diabetes group, significantly lower than the incidence of 20.59 % when GFD was used (P＜0.001); no hypoglycemia occurred in non-diabetes group. Pre-dialytic blood glucose≥10mmol/L (OR=0.185, 95% CI 0.054~0.636, P=0.007) and withdrawal of hypoglycemic medications on dialysis day (OR=0.226, 95% CI 0.073~0.707, P=0.011) were the protective factors for intradialytic hypoglycemia, while diabetes course≥20 years (OR=3.280, 95% CI 1.046~10.286,P=0.042) was the risk factor for intradialytic hypoglycemia. Conclusion   The last 2 hours of a dialysis session is the period when hypoglycemia, especially asymptomatic hypoglycemia, frequently occurs. GCD with a glucose concentration of 5.5mmol/L can effectively reduce the prevalence of hypoglycemia. Diabetes course ≥20 years is the risk factor for intradialytic hypoglycemia; withdrawal of hypoglycemic medications on dialysis day and pre-dialytic blood glucose ≥10mmol/L are the protective factors for intradialytic hypoglycemia. Metrics

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Prediction and evaluation of the risk of cardiac valve calcification in maintenance hemodialysis patients with a nomograph model ZHANG Jia-xin, TANG Wen-wu, XIE Xi-sheng 2023, 22 (06):  426-431,437.  doi: 10.3969/j.issn.1671-4091.2023.06.006 Abstract ( 111 )   PDF (620KB) ( 52 )   Objectives   The risk of cardiac valve calcification (CVC) in patients with maintenance hemodialysis (MHD) was predicted by a nomogram.  Methods   Patients with end-stage kidney disease (ESKD) who received MHD in Nanchong Central Hospital from 2014 to 2022 were included in this study. Basic information, disease information, laboratory and imaging examination data were collected. The risk factors for CVC were analyzed by univariate and multivariate logistic regression analyses, and a nomograph model for predicting the risk of CVC was established using R language software. Bootstrap method was used for the verification. The prediction efficiency of the model was evaluated by the area under the ROC curve, and the accuracy and practicability of the model were evaluated by calibration curve and decision curve analysis (DCA).  Results   A total of 173 MHD patients were included, including 63 CVC patients (36.4%). Multivariate logistic regression analysis showed that age (OR:1.046, 95% CI: 1.016~1.077, P=0.002), serum calcium (OR: 5.181, 95% CI: 1.015~27.252, P=0.042), serum phosphorus (OR:2.401,95% CI:1.177~4.898, P=0.038), diabetes (OR: 2.943, 95% CI: 1.397~6.195, P=0.013) and secondary hyperparathyroidism (OR: 2.844, 95% CI: 1.003~8.082, P=0.041) were the independent risk factors for CVC. The line chart showed good differentiation. The area under ROC curve of the training set was 0.757 (95% CI: 0.735 ~0.763), the internal verification C-index was 0.732, and the area under ROC curve of the test set was 0.700 (95% CI: 0.695~0.714). The calibration curve results show that the actual probability of CVC occurrence was in better agreement with the predicted probability.  Conclusions  The column graph constructed in this study can be used to identify the patient group in high risk of CVC, which may be clinically useful. Metrics

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Effect of peritoneal dialysis on liver failure and its effect on inflammatory cytokines ZHAO Wen-xi, LI Li, ZHANG Xiao-you, DAI Jian-rong, CHEN Hong-yu, ZHANG Li-zhu, JIANG Hong-mei, AI Hui, CHEN Feng, OU Ya-lin , ZHOU Zhu 2023, 22 (06):  432-437.  doi: 10.3969/j.issn.1671-4091.2023.06.007 Abstract ( 90 )   PDF (558KB) ( 27 )   Objective  To observe the clinical efficacy of peritoneal dialysis (PD) on liver failure and its effect on inflammatory cytokines.  Methods This is a retrospective and cohort study, including 56 patients with liver failure, of which 30 patients used PD (PD group) and 26 patients treated with abiotic artificial liver plasma exchange (PE group). The clinical efficacy, alanine aminotransferase (ALT), blood ammonia (AMMO), total bilirubin (TBIL), prothrombin time (INR), serum creatinine (Cr), plasma albumin (ALB), interleukin-6 (IL-6), procalcitonin (PCT), tumor necrosis factor-α (TNF-α) before and after the treatment, and the scores of the model for end-stage liver disease (MELD) and Child-Turotte-Pugh (CTP) were compared between the two groups. The primary end point was all-cause mortality in 90 days. Kaplan-Meier survival curve was plotted.  Results  After the treatment, ALT, AMMO, TBIL, INR, Cr,     IL-6, PCT, TNF-α, and the scores of MELD and CTP improved significantly in both groups as compared with those before treatment (For PD group, Z/t=4.440, 6.084, 7.750, 5.227, 4.947, 11.649, 10.060, 14.596, 5.930 and 6.355 respectively; P<0.001. For PE group, Z/t=4.360, 4.191, 7.972, 3.245, 3.122, 8.404, 10.806, 12.596, 3.949 and 4.466, respectively; P<0.001, <0.001, <0.001, 0.003, 0.004, <0.001, <0.001, <0.001, <0.001 and     <0.001 respectively), and the improvements had no statistical significances between the two groups (F/c2=0.039, 0.488, 0.147, 0.000, 1.407, 0.002, 0.010, 0.027, 54.637 and 3.841 respectively; P=0.844, 0.488, 0.703, 0.991, 0.241, 0.960, 0.920, 0.870, 0.523 and 0.798 respectively). After the treatment, ALB was significantly higher in PE group than in PD group (F=8.061, P=0.005). The overall effectiveness rate after the treatment for 3 months had no statistical significance between the two groups (χ2=0.025,P=0.611), but the expenses were less in PD group than in PE group (Z=13.500,P=0.001).  Conclusion   PD and PE are equally effective in the treatment of liver failure, which is worthy of clinical promotion. Metrics

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Iron therapy for iron deficiency anemia in chronic kidney disease TANG Wen-jiao, LIAO Ruo-xi 2023, 22 (06):  438-441.  doi: 10.3969/j.issn.1671-4091.2023.06.008 Abstract ( 159 )   PDF (366KB) ( 224 )   Renal anemia is a common complication of chronic kidney disease (CKD). Iron deficiency is highly prevalent in patients with CKD. On the other hand, CKD patients are vulnerable to iron overload due to long-term iron supplement. Serum transferrin and transferrin saturation are traditionally used in the evaluation of iron status. However, due to the chronic inflammation in CKD patients, these biomarkers can not reflect iron status accurately. Oral and intravenous iron therapy both show advantages and disadvantages in anemia treatment. New iron agents bring new choices for iron therapy in renal anemia, while their efficacy needs further studies. Metrics

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The role of sympathetic nerve activation in neointimal hyperplasia of autogenous arteriovenous fistula   WANG Qun, LIANG Li-ming, KONG Xiang-lei 2023, 22 (06):  442-445.  doi: 10.3969/j.issn.1671-4091.2023.06.009 Abstract ( 74 )   PDF (376KB) ( 34 )   Autologous arteriovenous fistula (AVF) is the most important route of blood access for hemodialysis, and failure of AVF may seriously limit its clinical application. Stenosis in venous outflow tract is a common cause of AVF failure, pathologically due to the neointimal hyperplasia (NIH). The mechanisms underlying NIH include a series of cascade reactions in local vessels, such as inflammation, oxidative stress and vascular remodeling, leading to vascular stenosis and AVF failure. On the other hand, hyperactive sympathetic nerve function is frequently present in end stage renal disease patients, which may also take part in the occurrence of NIH and AVF dysfunction through several pathways. This review focuses on the possible mechanisms of sympathetic activation to the development of NIH, aiming to provide a new theoretical explanation and a new intervention target for the prevention and treatment of AVF failure. Metrics

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Application of small animal models in the study of vascular access for hemodialysis QIN Yu, DU Jing, ZHAO Zhan-yun 2023, 22 (06):  446-449.  doi: 10.3969/j.issn.1671-4091.2023.06.010 Abstract ( 122 )   PDF (388KB) ( 203 )   Vascular access for hemodialysis patients includes arteriovenous fistula (AVF), arteriovenous graft (AVG) and central venous catheter (CVC), but all the vascular access methods have the problem of dysfunction. The mechanism of blood access failure is unclear. Animal model can be helpful to understand the causes of vascular access failure. Small animal model has the advantages of easy to use and less expensive, suitable for the molecular study of blood access failure. This review introduces several small animal models as well as the research status and characteristics of the small animal models for the study of blood access failure. Metrics

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Current insights into the role of indoxyl sulfate in renal anemia LIU Yu-xiu, BAI Feng-xia, YANG Ji-feng, GAO Yan, JIANG Rui-jian, ZHANG Hai-song 2023, 22 (06):  450-452.  doi: 10.3969/j.issn.1671-4091.2023.06.011 Abstract ( 84 )   PDF (448KB) ( 48 )   The higher incidence of chronic kidney disease (CKD) has currently become a worldwide and major public health problem. Many complications associated with CKD patients greatly influence their hospitalization rate, quality of life and survival rate. Anemia is a common complication of CKD, and is an independent risk factor for cardiovascular and cerebrovascular complications in CKD patients. Longstanding anemia will cause heart overload, left ventricular hypertrophy, heart failure, higher hospitalization rate, and increased mortality rate. Indoxyl sulfate (IS) is an important protein-bound uremic toxin, accumulating in the body at the early stage of CKD. IS promotes the progression and complications of CKD through various pathways. Here we focus on the role of IS in renal anemia based on the recent studies that IS may also be involved in renal anemia. Metrics

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Clinicopathological analysis of type I stenosis of autogenous arteriovenous fistula in uremia patients SONG Wen-jun, LIANG Li-ming, CHEN Qin-lan, KONG Xiang-lei, XU Dong-mei 2023, 22 (06):  453-457.  doi: 10.3969/j.issn.1671-4091.2023.06.012 Abstract ( 121 )   PDF (933KB) ( 65 )   Objective  To investigate the clinicopathological characteristics of type I autologous arteriovenous fistula (AVF) stenosis in uremic patients.  Methods  A total of 39 patients who underwent AVF reconstructive surgery for type I stenosis were enrolled in this study. Their clinical data were collected. The stenotic venous tissue cut during the reconstructive surgery and the venous tissue stored during the first AVF constructive surgery were pathologically compared, including HE and masson staining, and immunohistochemistry using antibodies against CD133, CD31, CD68, CD206, iNOS and CD56 to identify the cell types.  Results  The mean age of the 39 patients was 52.7±4.4 years old, 62% were male, and diabetic kidney disease accounted for 43.6% of the patients. HE and Masson staining of the stenotic venous tissues demonstrated typical neointimal hyperplasia (NIH). Pearson correlation analysis showed that NIH was positively correlated with serum phosphorus (r=0.381, P=0.026) and negative correlated with neutrophil count (r=-0.360, P=0.031), but not with serum calcium (r=-0.269, P=0.097) and parathyroid hormone (r=0.007, P=0.971). Immunohistochemical staining showed that positive staining of CD31, CD133, CD206, iNOS, CD68 and CD56 were found in the NIH area in stenotic venous tissues.  Conclusions   Histopathological staining showed an eccentric NIH in the venous tissues from type I AVF stenosis. The thickness of the intimal layer correlated with serum phosphorus level and neutrophil count. Immunohistochemistry showed the presence of abnormally arranged intimal cells, endothelial progenitor cells, M1 and M2 macrophages, and NK cells in NIH areas. Metrics

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Three-dimensional reconstruction of chest CT to assess the relationship between internal jugular venous catheter location and patency ZHANG Dong-liang, YAN Dong, SHEN Yang-yang, ZHOU Qian, WANG Di, FU Chen 2023, 22 (06):  458-462.  doi: 10.3969/j.issn.1671-4091.2023.06.013 Abstract ( 82 )   PDF (1033KB) ( 24 )   Objectives  To assess the correlation between the tip position of the right internal jugular vein (RIJV) catheter and clinical effects through three-dimensional (3D) reconstruction of chest computer tomography (CT) images.  Methods   This was a single centered, retrospective and cohort study. Chest CT images of the cases with tunneled cuffed catheter (TCC) in RIJV were reviewed. When the tip position of TCC was measured, the convergence of upper edge of the 4th rib and the right border of sternum was defined as the ordinate origin. The patients were divided to group thrombolysis (group T) and group non-thrombolysis (group NT) according to whether thrombolytic therapy for TCC was required. Clinical parameters, the tip position of TCC and outcomes of TCC were analyzed.  Results  A total of 47 patients were enrolled in this study, with 16 (34.04%) patients in group NT and 31 (65.96%) patients in group T. Patients in group NT had younger age (t= -2.860, P=0.006), lower CRP level (Z=-2.627, P=0.009), longer vertical distance from tip of TCC to origin point (t=2.108, P=0.041), and longer length of TCC inside the vessel (t=3.617, P=0.001) as compared with those in group T. Logistic regression showed that age (OR=1.069, 95% CI: 0.997~1.122, P=0.008), CRP (OR=1.270, 95% CI: 1.009~1.598, P=0.030), and the length of TCC inside the vessel (OR=0.967, 95% CI:0.920~0.993, P=0.005) were the independent risk factors for the requirement of thrombolytic therapy. When length of TCC inside the vessel was used to estimate the non-thrombolysis therapy for TCC, the best threshold length was 80.6 mm, the area under the curve of receiver operating characteristic (ROC) curve was 0.784 (95% CI: 0.634~0.931, P=0.002), and both the sensitivity and specificity were 100%. The prevalence of TCC-related infection was significantly higher in group T than in group NT (χ2=0.501, P=0.029).  Conclusion  The length of TCC inside RIJV can be used to estimate the possibility of long-term patency of TCC without thrombolytic therapy. For elder patients or patients with CRP higher than normal level, preventive thrombolysis treatment should be considered to get a longer patency of TCC. Metrics

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Clinical effect and related factors of urokinase thrombolysis combined with balloon dilatation for the treatment of arteriovenous fistula occlusion due to thromboembolism XIONG Di, ZHOU Ying, WAN Zhen, GONG Zhi-jun 2023, 22 (06):  463-466.  doi: 10.3969/j.issn.1671-4091.2023.06.014 Abstract ( 96 )   PDF (397KB) ( 31 )   Objective  To analyze the clinical effect and related influencing factors of urokinase thrombolysis combined with balloon dilation for the treatment of arteriovenous fistula (AVF) occlusion due to thromboembolism.  Method   The patients with AVF occlusion due to thromboembolism treated in The First Hospital of Nanchang City were retrospectively analyzed. The success rate of the operation and the incidence of complications were collected. Factors that possibly influence the success rate including diabetes, utilized period of the AVF, length of the occlusion in AVF, occlusion time, hemoglobin level and anatomical factors of the AVF were statistically analyzed.  Results   A total of 84 cases were enrolled in this study, of which 69 cases had successful patency of the AVF after the operation with the total success rate of 82.1%. The overall complication rate was 7.1%, and no serious complications occurred. Univariate analysis showed that the success rate of the operation was not related to gender (χ2=0.202, P=0.653), diabetes (χ2=0.387, P=0.534), location of AVF (χ2=0.082, P=0.774), establishment time (χ2=2.889, P=0.089), length of thrombus (χ2=1.445, P=0.229), occlusion period (χ2=0.082, P=0.774) and hemoglobin level (χ2=0.365, P=0.546), but closely related to anatomical factors of the AVF (χ2=29.238, P<0.001). The success rate of the operation was significantly different between the patients with 2 venous outflows (χ2=18.287, P<0.001) or 3 venous outflows (χ2=24.199, P<0.001) and those with one venous outflow, but had no difference between the patients with 2 or 3 venous outflows (χ2=0.002, P=0.967). Multivariate analysis showed that the number of venous outflow of the AVF was an independent risk factor affecting the success rate of the operation (OR=8.296, 95% CI: 2.724~25.267, P<0.001), and the establishment time of fistula was a protective factor affecting the success rate of the operation (OR=0.976, 95% CI: 0.959~0.993, P=0.006).  Conclusions  Urokinase thrombolysis combined with balloon dilation is safe and effective for the treatment of thromboembolism in occluded AVF. The number of venous outflow of the AVF is an independent risk factor, and the establishment time of fistula is a protective factor to affect the success rate of the operation; gender, diabetes, the location of fistula, the length of thrombus, the occlusion period, and the hemoglobin level have no influences on the success rate of the operation. Metrics

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Clinical practice of grading management scheme for hyperkalemia in chronic kidney disease patients LIU Fang-fang, LOU Xiao-ping, WANG Wen-jiao, ZHANG Tong-tong, ZHENG Xiao, CHEN Jie, LI Zheng-yan 2023, 22 (06):  467-471.  doi: 10.3969/j.issn.1671-4091.2023.06.015 Abstract ( 100 )   PDF (436KB) ( 203 )   Objective   This paper is to explore the effects of risk grading management scheme on chronic renal disease patients with hyperkalemia.  Method  A total of 90 patients with chronic kidney disease in the First Affiliated Hospital of Zhengzhou University were selected as the research objects. They were randomly divided into control group and experimental group and 45 cases in each group. The control group was given routine nursing care, while the experimental group was used the risk grading management program in addition to routine nursing care. The incidence and the cognitive level of hyperkalemia, the medication compliance and diet compliance for hyperkalemia were compared before and after intervention between the two groups.  Results   The incidence of hyperkalemia was significantly lower in experimental group than in control group (c2=4.444,P=0.035); the cognition of hyperkalemia risks (t=-7.071, P<0.001), the medication compliance (t=          -3.081, P=0.004) and the diet compliance (t=-8.785, P<0.001) were also higher in experimental group than in control group.  Conclusion   The application of risk grading management scheme on patients can reduce the incidence of hyperkalemia, improve the cognitive level and help patients develop good behaviors of medication and diet compliance, to reduce the occurrence of adverse events. Metrics

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Evidence-based practice of exercise rehabilitation in maintenance hemodialysis patients ZHAN Xuan, GUO Yue-yue, ZHOU Kou-xiang, CHEN Ting-ting, BO Xiang-min, LIU Sheng-feng 2023, 22 (06):  472-476.  doi: 10.3969/j.issn.1671-4091.2023.06.016 Abstract ( 152 )   PDF (449KB) ( 282 )   Objective   To implement evidence-based practice based on the evidences from exercise rehabilitation in maintenance hemodialysis (MHD) patients, and to validate the role of exercise rehabilitation in improving physical function, exercise tolerance, and quality of life in MHD patients.  Methods  The evidence-based continuous quality improvement model was used as the research framework, and an evidence-based program for exercise rehabilitation in MHD patients was conducted from January to December 2021 through evidence acquisition, status review and evidence introduction. A total of 80 MHD patients hospitalized in the Department of Nephrology, Jiangsu Provincial Hospital of Traditional Chinese Medicine from January to March 2022 were then recruited and randomly divided into experimental group (n=40) and control group (n=40). After the exercise intervention, the muscle mass, muscle strength, 6-minute walking test, and quality of life were compared between the two groups. The awareness of sport rehabilitation evidence in medical staff was also compared before and after the evidence-based practice.  Results   Nine pieces of evidences were finally included, with a total of seven reviewed indicators. After exercise intervention, muscle mass (t=-3.302, P<0.01), muscle strength (t=-2.825, P<0.001), and 6-minute walking (t=-5.529, P<0.001) increased more in experimental group than in control group. The total scores of each dimension in the Health Survey Short Form increased more in experimental group than in control group (P<0.05). The awareness rate of sport rehabilitation evidence among medical staff increased by 40.74% before and after evidence-based practice, which has a statistical significance (P<0.001).  Conclusion  The evidence-based exercise rehabilitation practice can improve the body function, exercise endurance and quality of life in MHD patients. Metrics

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Therapeutic effects of methanol poisoning using the hemodialyzer with a China-made filter and an imported filter ZHAO Ling-shan, XIE De-qiong, ZHANG Chen-li 2023, 22 (06):  477-480.  doi: 10.3969/j.issn.1671-4091.2023.06.017 Abstract ( 102 )   PDF (391KB) ( 78 )   Objective  To explore the clinical effect of hemodialysis using the hemodialyzer with a China-made filter (Weigao HF17) and using the hemodialyzer with an imported filter (FX80, Fresenius, Germany) for the treatment of methanol poisoning.  Methods   A total of 25 patients with methanol poisoning treated with hemodialysis in The Second People's Hospital of Yibin City and The Fifth People's Hospital of Yibin City in March 2022 were selected as the research subjects; 9 patients were treated with HF17 hemodialyzer (HF17 group), and 16 patients with FX80 hemodialyzer (FX80 group). Hospitalization days  and changes of blood methanol concentration, pH, base excess (BE) and lactate before and after the hemodialysis were compared between the two groups.  Results   After the treatment, the changes of blood methanol concentration was higher in HF17 group than in FX80 group (t=-3.849, P=0.001); blood pH (FX80 group: t=-6.005, P＜0.001; HF17 group: t=-3.501, P=0.008) and methanol concentration (FX80 group: t=11.045, P＜0.001; HF17 group: t=13.829, P＜0.001) decreased significantly in both groups; blood pH (t=1.461, P=0.158), BE           (t=0.760, P=0.455), lactate (t=-1.276, P=0.215), and hospitalization days (t=-1.925, P=0.067) had no statistical significances between the two groups.  Conclusion   The hemodialyzer equipped with a China-made filter (HF17) and that equipped with an imported filter (FX80) for the treatment of methanol poisoning have the same effects in the clearance of methanol and its toxic metabolites, maintaining acid-base balance, shortening the hospitalization days, and decrease of expenses. Metrics