Chinese Journal of Blood Purification

12 August 2023, Volume 22 Issue 08 Previous Issue    Next Issue

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Expert consensus on anticoagulation management in chronic kidney disease patients complicated with non-valvular atrial fibrillation The Working Group on Anticoagulation Management of Non-valvular Atrial Fibrillation in Chronic Kidney Disease Patients 2023, 22 (08):  561-573.  doi: 10.3969/j.issn.1671-4091.2023.08.001 Abstract ( 516 )   PDF (782KB) ( 332 )   The incidence of thromboembolic diseases and hemorrhage is high in chronic kidney disease (CKD) patients complicated with non-valvular atrial fibrillation. Nephrologists and cardiologists are facing problems in anticoagulation treatment for these patients. A committee composed of nephrologists, cardiologists and pharmaceutical experts compiled the consensus based on current status of clinical diagnosis and treatment of the disease. According to the data of evidence-based medicine and clinical experiences, this consensus systematically introduces the risk assessment of thromboembolism and bleeding, the timing of starting anticoagulant therapy and the drug of choice, in order to guide and standardize the anticoagulant treatment and to improve clinical diagnosis and treatment of non-valvular atrial fibrillation in CKD patients. Metrics

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Effect of serum HO-1, HIF-1α and FGF23 on vascular calcification in peritoneal dialysis patients CHEN Hui-xia, WANG Wei-wei, DANG Shan, ZHAO Zhan-feng 2023, 22 (08):  574-578.  doi: 10.3969/j.issn.1671-4091.2023.08.002 Abstract ( 85 )   PDF (565KB) ( 18 )   Objective   To investigate the effects of serum heme oxygenase-1 (HO-1), hypoxia inducible factor-1α (HIF-1α) and fibroblast growth factor 23 (FGF23) on vascular calcification in peritoneal dialysis (PD) patients.  Methods   A total of 109 PD patients admitted to The Central Hospital of Jiaozuo Coal Industry (Group) Co., Ltd. from May 2019 to May 2022 were selected. Lateral abdominal plain radiographs were used to detect vascular calcification in the PD patients. According to the presence or absence of abdominal aortic calcification, patients were divided into the calcification group and the non-calcification group. Clinical data and serum HO-1, HIF-1α and FGF23 were compared between the two groups. Logistic regression was used to analyze the influencing factors of abdominal aortic calcification in PD patients. The predictive values of serum HO-1, HIF-1α and FGF23 for abdominal aortic calcification were analyzed by ROC curve.  Results  Serum HO-1 was lower, and serum HIF-1α and FGF23 levels were higher in calcification group than in non-calcification group (t=5.762, 8.176, and 9.382 respectively; P＜0.001). Logistic regression showed that age (OR=1.359, 95% CI 1.048～1.763, P<0.001), serum phosphorus (OR=1.994, 95% CI 1.123～3.539, P＜0.001), HO-1 (OR=0.857, 95% CI 0.762～0.964, P＜0.001), HIF-1α (OR=2.211, 95% CI 1.156～4.228, P＜0.001) and FGF23 (OR=3.916, 95% CI 1.957～7.836, P＜0.001) were the factors affecting the presence of abdominal aortic calcification in PD patients. The AUC predicted by HO-1, HIF-1α, FGF23 and their combination were 0.789, 0.868, 0.902 and 0.972 respectively.  Conclusions   Serum HO-1, HIF-1α and FGF23 levels are the independent influencing factors for abdominal aortic calcification in PD patients. Anyone of the three levels has a predictive value, but their combined has a higher predictive value for the presence of abdominal aortic calcification. Metrics

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Observation on the anticoagulant efficacy and blood concentration of nafamostat mesylate in hemodialysis AO Guang-yu, HUANG Lan, CHEN Ting-yu, LI Han-yu, CHEN Min 2023, 22 (08):  579-583.  doi: 10.3969/j.issn.1671-4091.2023.08.003 Abstract ( 758 )   PDF (414KB) ( 113 )   Objective To explore the safety and effectiveness of nafamostat mesylate (NM) as an anticoagulant for hemodialysis, and its impact on the systemic coagulation function in patients undergoing maintenance hemodialysis (MHD).  Methods A prospective study was conducted on 12 MHD patients at the Department of Nephrology, The First People's Hospital of Chengdu from January to September 2022. Blood samples were collected at various time points: before dialysis at the arterial end, during dialysis (1h, 2h, 3h and 4h) and 15 minutes post-dialysis at the sites before the filter, after the filter and at the arterial end. NM concentration and activated clotting time (ACT) were measured in these blood samples.  Results At the time points of 1h, 2h, 3h and 4h during dialysis, the ACT values showed significant differences in the blood samples before the filter, after the filter and from arterial end (F=21.899, 27.464, 8.264 and 8.162 respectively; P<0.001, <0.001, =0.001 and =0.001 respectively); the ACT values of different sites at the same time point showed that the ACT value of arterial end was the lowest, followed by the value after filter and then the value before filter. At the time points of 1h, 2h, 3h and 4h during dialysis, the NM blood concentrations were significantly different in the blood samples before the filter, after the filter and from arterial end (F=46.547, 20.059, 16.582 and 16.687 respectively; P <0.001); the NM blood concentrations of different sites at the same time point showed that the NM blood concentration of arterial end was the lowest, followed by the value after filter and then the value before filter.  Conclusion Nafamostat mesylate effectively serves as an anticoagulant in the extracorporeal circulation during hemodialysis. It possesses the characteristics of high dialysis clearance rate and rapid metabolism in the body with a minimal impact on systemic coagulation status. It is a new choice of anticoagulant for patients undergoing hemodialysis with high risk of bleeding. Metrics

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The predictive value of extracellular fluid/intracellular fluid ratio combined with geriatric nutritional risk index for long-term survival in elderly hemodialysis patients GAN Jing-xian, XU Jia, RUAN Jun-ying, HONG Qi-jun 2023, 22 (08):  584-589.  doi: 10.3969/j.issn.1671-4091.2023.08.004 Abstract ( 79 )   PDF (551KB) ( 14 )   Objective  To investigate the relationship between extracellular fluid/intracellular fluid ratio (ECF/ICF) and geriatric nutritional risk index (GNRI) in the elderly, and to determine the predictive value of ECF/ICF combined with GNRI for all-cause mortality in maintenance hemodialysis (MHD) patients.   Methods The medical records of 486 MHD patients treated in Taizhou Central Hospital from October 2010 to October 2015 and subjected to routine biologic resistance (BIA) body composition examination were retrospectively analyzed. Their demographic and clinical data and ECF/ICF were retrieved from the medical records, and their GNRI was calculated by a basic formula. Based on the median of GNRI [94.53 (84.22, 99.17)] and the median of ECF/ICF [0.56(0.41, 0.87)], the patients were first divided into high GNRI (≥94.53) group and low GNRI (< median) group, high ECF/ICF group (≥0.56) group and low ECF/ICF (< median) group; four subgroups were further derived: G1, patients with high GNRI and low ECF/ICF; G2, patients with low GNRI and low ECF/ICF; G3, patients with high GNRI and high ECF/ICF; G4, patients with low GNRI and high ECF/ICF.  Results  Multivariate linear regression showed that ECF/ICF was independently correlated with GNRI (β=-0.247, P=0.001). The 7-year survival rates in G1, G2, G3 and G4 groups were 74.4%, 57.6%, 38.7% and 20.9%, respectively (Log rank: χ2=28.845, P<0.001). Multivariate COX proportional hazard regression showed that the adjusted HR for all-cause mortality in G2, G3 and G4 were 8.73 (95% CI 3.62～47.72), 16.27 (95% CI 6.42～64.33) and 20.32 (95% CI 11.38～73.26) respectively using G1 as a reference. After adding GNRI, ECF/ICF, and the combination of GNRI and ICF into the basic model, the C index of death risk model was improved from 0.714 to 0.743, 0.813, and 0.831.  Conclusions   ECF/ICF was independently correlated with GNRI, and both of which were the strong predictors for all-cause mortality in MHD patients. The combination of GNRI and ECF/ICF improved the ability to predict mortality outcomes. We therefore recommend that GNRI and ECF/ICF should be included in routine evaluation of MHD patients. Metrics

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Efficacy of ultrasound-guided radiofrequency ablation in the treatment of hyperparathyroidism secondary to chronic kidney disease and its possible injury to recurrent laryngeal nerve ZHAO Xin-ping, WANG Jun-xia 2023, 22 (08):  590-593.  doi: 10.3969/j.issn.1671-4091.2023.08.005 Abstract ( 51 )   PDF (437KB) ( 66 )   Objective  To investigate ultrasound-guided radiofrequency ablation (RFA) in the treatment of secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) patients and its possible injury to recurrent laryngeal nerve.  Methods A total of 18 CKD patients with SHPT and admitted to the Blood Purification Center of Department of Nephrology, The First Affiliated Hospital of Henan University of Science and Technology from September 2020 to February 2022 were selected as the research subjects. Venous blood was collected before RFA and after RFA for one day, 7 days, one month, 3 months and 6 months to assay serum intact parathyroid hormone (iPTH), phosphorus, calcium and alkaline phosphatase (ALP). Their bone pain, skin pruritus, muscle strength grade and other complications were recorded.  Results  After RFA for one day, 7 days, one month, 3 months and 6 months, serum calcium, phosphorus, iPTH and ALP decreased as compared with those before RFA (calcium: F=38.637, P＜0.001; phosphate: F=44.175, P＜0.001; iPTH: F=369.836, P＜0.001; ALP: F=29.954, P＜0.001). Within 7 days after RFA, serum calcium decreased to the lowest (χ2=5.532, P=0.016, compared with those before RFA), and serum calcium increased and stabilized after supplement of calcium to the patients. After RFA, bone pain, blurred vision and pruritus relieved significantly, and muscle strength grade increased (vision: F=9.076, P＜0.001; pruritus: F=439.309, P＜0.001; muscle: F=3.755, P＜0.001). Six of the 18 patients (33.33%) had hypocalcemia of different degrees. Recurrent laryngeal nerve injury occurred in 5 patients (27.78%). Higher serum iPTH recurred but without symptoms and neck pain in 3 patients (16.67%).  Conclusion Ultrasound-guided RFA is effective for the treatment of SHPT in CKD patients. It can relieve bone pain, pruritus and improve muscle strength, with higher safety. Metrics

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Relationship between osteocalcin level in peripheral blood and abdominal aortic calcification in maintenance hemodialysis patients GUO Ling, AN Zhi-feng, SONG Jie 2023, 22 (08):  594-598.  doi: 10.3969/j.issn.1671-4091.2023.08.006 Abstract ( 63 )   PDF (474KB) ( 22 )   Objective To study the relationship between serum osteocalcin level and abdominal aortic calcification in patients with maintenance hemodialysis (MHD).  Methods An observational and cross-sectional study was conducted to collect the clinical data of 220 MHD patients admitted to the Blood Purification Center, Characteristic Medical Center of PAPF from January 2020 to December 2022. Abdominal aortic calcification scores (AACs) were evaluated using the Kauppila Calcification Score method. The patients were then divided into no or mild abdominal aortic calcification group (AACs ≤4, n=114) and significant abdominal aortic calcification group (AACs＞4,n=106). Pearson correlation analysis was used to analyze serum osteocalcin and other parameters affecting bone metabolism. Multivariate logistic regression was used to analyze the independent risk factors for significant abdominal aortic calcification.  Results  The average serum osteocalcin level was 231.56 (25.92, 361.33) ng/ml in the 220 patients. After stratification according to the age of MHD patients, serum osteocalcin was higher than the reference range in both male and female patients of all age groups. Patients in the no or mild abdominal aortic calcification group had the characteristics of younger age (t=9.783, P＜0.001), shorter dialysis age (t=1.251, P=0.038), males more than females (χ2=31.022, P＜0.001), less having diabetes history (χ2=119.216, P＜0.001), and lower serum osteocalcin (t=6.481, P=0.029), as compared those in the significant abdominal aortic calcification group. Pearson correlation analysis showed that serum osteocalcin was positively correlated with serum phosphorus (r=0.511, P=0.001), total parathyroid hormone (r=0.594, P=0.001), FGF23 (r=0.485, P=0.003), and AACs score (r=0.413, P=0.0201), while negatively correlated with age (r=-0.356, P=0.039). Multivariate logistic regression analysis showed that age (OR=1.151, 95% CI 1.021～1.297, P=0.024) and osteocalcin (OR=1.235, 95% CI 1.068～1.427, P=0.003) were the independent risk factors for significant abdominal aortic calcification.  Conclusion  Higher serum osteocalcin was present in MHD patients, and higher serum osteocalcin was an independent risk factor for abdominal aortic calcification. Metrics

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Clinical study on the relationship between stage of chronic kidney disease, parathyroid hormone and urinary phosphorus excretion fraction DU Chen-lu, WANG Qing-hua, ZHU Hui-min, JIAO Xia, LIANG Qi-Chen, ZUO Li 2023, 22 (08):  599-603.  doi: 10.3969/j.issn.1671-4091.2023.08.007 Abstract ( 91 )   PDF (452KB) ( 18 )   Objective  To investigate the control target of intact parathyroid hormone (iPTH) level in patients with non-dialysis-dependent chronic kidney disease (CKD).  Methods  The CKD patients with complete blood and urine biochemical results, not received renal replacement therapy and treated in the Outpatient/Inpatient Sections, Department of Nephrology, Peking University People's Hospital from March 2016 to October 2022 were recruited. The relationship between estimated glomerular filtration rate (eGFR), iPTH and fraction excretion of phosphate (FEP) in these patients were investigated. By using the segment function in R language, the iPTH-FEP fitting curve is depicted to find out the truncate point that FEP increases no longer with the increase of iPTH.  Results  A total of 125 subjects were enrolled in this study. When eGFR was <60 ml / min·1.73m2, iPTH and FEP levels gradually increased with the decline of renal function. When iPTH >114.74pg/ml, FEP no longer increased.  Conclusion  When iPTH increased to more than 114.74pg/ml in non-dialysis-dependent CKD patients, the ability to promote renal excretion of phosphorus reached the maximum. Metrics

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The impact of residual renal function on nutritional status and quality of life in maintenance hemodialysis patients LI Shuang-shuang, YAN Jian-jun, NING Yong, PAN Hao 2023, 22 (08):  603-607.  doi: 10.3969/j.issn.1671-4091.2023.08.008 Abstract ( 91 )   PDF (432KB) ( 15 )   Objective To analyze the effects of residual renal function (RRF) on nutritional status and quality of life in maintenance hemodialysis (MHD) patients.  Methods  A total of 67 MHD patients were selected and divided into RRF group with urine volume ≥ 200 ml/d within 24h before dialysis and non-RRF group without urine volume < 200 ml/d. The clinical data of the two groups were collected and analyzed. Plasma albumin, prealbumin and skeletal muscle index were compared between the two groups. Patients in the two groups were further subdivided into young subgroup (18～＜45 years old), middle-age subgroup (45～60 years old) and elderly subgroup (≥60 years old). The MOS 36 item Short Form Health Survey (SF-36) was used to evaluate the quality of life of the subgroups.  Results  ①The plasma prealbumin level (t=2.167, P=0.034) and skeletal muscle index (t=4.131, P＜0.001) were better in the RRF group than in the non-RRF group. ②The SF-36 scores of physiological function (t=4.781, P＜0.001 for young subgroups; t=2.306, P=0.036 for elderly subgroups), emotional function (t=3.606, P=0.005 for young subgroups; t=2.542, P=0.023 for elderly subgroups), mental health (t=2.621, P=0.026 for young subgroups;   t=2.518, P=0.024 for elderly subgroups), energy (t=4.111, P=0.002 for young subgroups; t=2.165, P=0.0473 for elderly subgroups) and social function (t=3.308, P=0.008 for young subgroups; t=2.136, P=0.049 for elderly subgroups) were higher, and the scores of physical pain (t=3.400, P=0.007 for young subgroups; t=2.439, P=0.028 for elderly subgroups) were lower in the young and elderly subgroups of the RRF group than in the young and elderly subgroups of the non-RRF group. The SF-36 scores of mental health (t=2.513, P=0.027), energy (t=2.521, P=0.034) and social functioning (t=4.781, P=0.031) were higher, and the physical pain scores (t=2.449, P=0.025) were lower in the middle-age subgroup of the RRF group than in the middle-age subgroup of the non-RRF group.  Conclusion  The nutritional status was better in MHD patients with RRF. RRF can elevate the quality of life of all aspects in young and elderly people, but has limited influence on the quality of life in middle-age people. Metrics

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Advances in the study of bone markers for vascular calcification in chronic renal failure patients  LIAO Sheng-chun, YE Chao-yang 2023, 22 (08):  608-611.  doi: 10.3969/j.issn.1671-4091.2023.08.009 Abstract ( 108 )   PDF (401KB) ( 87 )   Vascular calcification (VC) caused by chronic kidney disease-mineral and bone disorder (CKD-MBD) is an important clinical complication, and contributes to the higher cardiovascular mortality in CKD patients. Bone markers can be detected or even involved in the process of VC. Bone markers play important roles in the study of VC. In this paper, we provide an in-depth study of the mechanism of VC, and review the mutual feedback effects among common bone markers such as parathyroid hormone, 25-hydroxyvitamin D, fibroblast growth factor 23 and Klotho (PTH-25OHVitD-FGF23-Klotho). We also summarize the recent research progresses in osteocalcin (OCN), type I collagen carboxy-terminal peptide β special sequence (β-CTX), and total type I collagen amino-terminal extension peptide (tP1NP). Metrics

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Progresses in the application of drug-coated balloon for hemodialysis access BAO Xue-dong, SHI Ya-xue 2023, 22 (08):  612-615.  doi: 10.3969/j.issn.1671-4091.2023.08.010 Abstract ( 75 )   PDF (370KB) ( 14 )   Hemodialysis access is the lifeline of the patients with end-stage renal disease. Vascular stenosis due to intimal hyperplasia is the main cause of access dysfunction. Percutaneous balloon dilatation angioplasty is an important intervention method to solve the stenosis in access route. In recent years, paclitaxel coated balloon has been used for repair of hemodialysis access, but its clinical and social economy efficacies are often concerned by doctors due to its higher price. This article reviews the recent progresses in the application of drug-coated balloon for hemodialysis access. Metrics

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Recent progresses in the application of L-carnitine in peritoneal dialysis patients LIU Ai-chun, ZHAO Hui-ping, WANG Mei 2023, 22 (08):  616-619.  doi: 10.3969/j.issn.1671-4091.2023.08.011 Abstract ( 85 )   PDF (397KB) ( 53 )   Carnitine is a nonessential amino acid participating in the transport of long-chain fatty acids to mitochondrial matrix for β-oxidation and subsequent energy production. The main sources of carnitine are dietary intake and endogenous synthesis in liver and kidney. Carnitine deficiency occurs in dialysis patients due to reduced dietary intake, lack of endogenous synthesis in kidney and dialysis loss. The symptoms of carnitine deficiency include erythropoiesis stimulating agents (ESAs) resistant anemia, muscle weakness, muscle spasm, hypotension and dyslipidemia. Peritoneal dialysis (PD) as an important renal replacement therapy has the advantages of protecting residual renal function, stabilizing hemodynamics, no need for vascular puncture, and less impact on daily life, and is accepted by most end-stage renal disease (ESRD) patients. This article reviews the relevant studies of L-carnitine in PD patients, and summarizes the characteristics of carnitine, the causes and prevalence of carnitine deficiency in PD patients, and the efficacy of L-carnitine supplementation in PD patients. Metrics

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The mechanism and research advances in the use of no-touch technique to dissect veins during surgery to alleviate early postoperative juxta-anastomotic venous hypoxia and intimal hyperplasia of the arteriovenous fistula CHEN Chao-jin, JIAO Zi-zhao, ZHANG Chun-hua 2023, 22 (08):  620-623.  doi: 10.3969/j.issn.1671-4091.2023.08.012 Abstract ( 83 )   PDF (446KB) ( 15 )    The damage to vasa vasorum caused by dissection of juxta-anastomotic veins during autologous arteriovenous fistula (AVF) surgery and the changes of hemodynamics after AVF construction can lead to early postoperative hypoxia of the juxta-anastomotic venous wall. As a result, hypoxia inducible factors (HIFs) and its downstream signal pathway are activated to induce cell proliferation and collagen deposition in juxta-anastomotic venous wall, and intimal hyperplasia and stenosis are thus produced. During coronary artery bypass surgery, the no-touch technique used for great saphenous vein dissection can reduce the damage to venous vasa vasorum in the venous dissection operation, and the preserved perivenous tissue has external supporting effects to reduce the hemodynamic changes of the vein graft. Therefore, the no-touch technique can alleviate hypoxia and intimal hyperplasia of the vein graft. In recent years, this technology has been applied to vein dissection during AVF surgery, and achieved better clinical results. In this review, we summarize the mechanism and research advances in the use of no touch technique to dissect veins during surgery to alleviate early postoperative juxta-anastomotic venous hypoxia and intimal hyperplasia of the arteriovenous fistula. Metrics

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Effects of different vascular access on neutrophil to lymphocyte ratio in maintenance hemodialysis patients LIU Feng-hua, XU Yan 2023, 22 (08):  624-628.  doi: 10.3969/j.issn.1671-4091.2023.08.013 Abstract ( 68 )   PDF (439KB) ( 51 )   Objective   To analyze the neutrophil to lymphocyte ratio (NLR) in maintenance hemodialysis (MHD) patients using the blood access method of central venous catheterization (CVC) or arterial venous fistula (AVF).  Methods   A   total of 182 MHD patients in our department were enrolled in this study. They were divided into CVC group (n=52) and AVF group (n=130). All of them received routine hemodialysis 3 times a week for at least three months. Changes of blood cells, NLR, serum biochemical indicators, and C-reactive protein (CRP) in the follow-up period of 2 years were compared.  Results   After the follow-up period of 2 years, lymphocyte (χ2=-2.338, P=0.019), NLR (χ2=2.347, P=0.019) and CRP (χ2=2.688, P=0.007) were higher in the CVC group than in the AFV group, and serum albumin and hemoglobin were lower in the CVC group than in the AFV group. Multivariate linear regression showed that NLR was positively correlated with white blood cells (β=0.287, P＜0.001) and platelet count (β=0.944, P＜0.001). Changes of hemoglobin (χ2=2.460, P=0.015) and albumin (χ2=4.101, P<0.001) during the follow-up period of 2 years were more in the CVC group than in the AVF group.  Conclusions   Patients using CVC as the blood access for MHD have higher degrees of microinflammation, NLR, anemia and malnutrition. Metrics

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Study on the relationship between the blood pressure and pumped blood flow rate and the blood flow rate in fistula during hemodialysis ZHAO Pei-nan, RUAN Lin, LI Wen, XU Yuan-kai, NIU Zhe-li, YANG Yan-li, ZHANG Li-hong 2023, 22 (08):  629-632.  doi: doi:10.3969/j.issn.1671-4091.2023.08.014 Abstract ( 36 )   PDF (440KB) ( 21 )   Objective  To explore the relationship between the blood pressure and pumped blood flow rate and the blood flow rate in fistula (access flow, Qa) during hemodialysis sessions.  Method  The electronic sphygmomanometer and hand-held Doppler ultrasound apparatus were used to measure blood pressure and Qa before hemodialysis, within 30 minutes of the hemodialysis session at blood flow rate of 200 ml/min, 250 ml/min and 300 ml/min, at the 2nd hour and 4th hour (within 20 minutes before end of the sessions) of the hemodialysis session.  Result  A total of 104 maintenance hemodialysis patients were enrolled in this study. We found that ①Qa and the change rate of mean arterial pressure (MAP) were positively correlated both at the first stage of hemodialysis (0～2nd hours; r=0.447, P<0.001) and the second stage of hemodialysis (2nd～4th hours; r=0.355, P<0.001); ②MAP and Qa were statistically different between the values before dialysis, at the 2nd hour of dialysis, and at the 4th hour of dialysis (F=77.068 and 32.887, P<0.001);  ③MAP decreased by 14.593 mmHg (95% CI 11.613～17.572, P<0.001) and Qa decreased by 105.853 ml/min (95% CI 72.757～138.948, P< 0.001) at the 4th hour of dialysis, as compared those before dialysis; ④the linear fitting between Qa change rate (y) and MAP change rate (x) derived an equation of y=0.75x (P=0.000); and ⑤the difference between Qa and increased pumped blood flow rate had no statistical significance (F=2.352, P=0.099).  Conclusions  During hemodialysis sessions, Qa decreases along with the decrease of MAP; when MAP decreases by 10%, Qa will decrease by 7.5%. Qa is unrelated to the pumped blood flow rate. Metrics

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Research trends in artificial intelligence applied to hemodialysis: visualization analysis based on VOSviewer LIU Jia-li, HU Shen-ling, ZHOU Pei-ru, MO Hong-qiang, HUANG Jie-wei, HU Bo 2023, 22 (08):  633-637.  doi: 10.3969/j.issn.1671-4091.2023.08.015 Abstract ( 157 )   PDF (907KB) ( 176 )   Objective To investigate the current research status and development trend of artificial intelligence (AI) applied to hemodialysis.  Methods  We searched the literature in the field of AI applied to hemodialysis indexed by SCI-EXPANDED and SSCI in the Web of Science Core Collection database from the establishment of the database to March 29, 2023. We applied the bibliometric research method and VOSviewer software to visualize and present the countries, research institutions, journals, authors, and keywords.  Results  A total of 98 articles and 5 reviews were enrolled in the analysis. In the past 20 years, the application of AI to the field of hemodialysis has shown an overall and rising trend. The country with the most publications was China (n=37), and the institution with the most publications was Fresenius Medical Care (n=16). Hemodialysis outcomes, influencing factors, and complication prediction models are the current and future frontier of research trends in this field.  Conclusion Using bibliometrics and VOSviewer software for analysis can visualize the current status of research and cutting-edge hotspots in the field and provide a reference basis for further research in the future. Metrics

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Bacterial thrombus in acral arteries due to spread of arteriovenous fistula thrombosis by manual massage in one case, and review of the literature YANG Yan-li, ZHANG Li-hong, LI Wen, MENG Fu-lei, RUAN Lin 2023, 22 (08):  683-640.  doi: 10.3969/j.issn.1671-4091.2023.08.016 Abstract ( 129 )   PDF (961KB) ( 99 )   Autogenous arteriovenous fistula (AVF) thrombosis is a common cause of fistula failure in hemodialysis patients. Manual massage is used for emergency treatment of AVF thrombosis due to its simplicity and convenience, but it can lead to complications such as infection, and thrombus detachment, and even endanger lives. We have treated one case with AVF thrombosis. The bacterial emboli in the limb artery were disseminated due to manual massage, accompanied by multiple metastatic abscesses. This is a rare clinical case we reported here. Metrics