Chinese Journal of Blood Purification

12 September 2023, Volume 22 Issue 09 Previous Issue    Next Issue

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Common problems in supervision of the hemodialysis devices for single-use HAN Na, ZOU Yan-guo, LI Dan, QIANG Yi-ning 2023, 22 (09):  641-643.  doi: 10.3969/j.issn.1671-4091.2023.09.001 Abstract ( 100 )   PDF (405KB) ( 39 )   Hemodialysis devices for single use are used to remove harmful substances and excessive water in blood by diffusion, ultrafiltration and convection, playing a key role in renal replacement therapy. It can also be used in the adjunct treatment for patients with drug overdose and toxicosis. However, some problems and defects exist in the documents recently submitted to the Center for Medical Device Evaluation for registration. This article attempts to make a brief analysis on these problems from the perspective of registration and supervision of the medical devices. Metrics

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Updated points of the American Society for Apheresis: The Ninth Special Issue Guidelines for Therapeutic Apheresis HUANG Yu-min, WU Bu-yun 2023, 22 (09):  644-648.  doi: 10.3969/j.issn.1671-4091.2023.09.002 Abstract ( 134 )   PDF (493KB) ( 93 )   Therapeutic apheresis separates different blood components using blood separation techniques, which is a non-pharmacological treatment to remove toxins, antibodies and other substances from the body. In the ninth edition of American Society for Apheresis Guidelines, seven new disease indications, nine new indications for diseases, and changes of evidence level of eight older indications have been added compared to the eighth edition. This article provides a brief review of the updated guidelines. Metrics

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A study on the combination of roxadustat and erythropoietin in the treatment of anemia in maintenance hemodialysis patients with kidney transplant failure LIU Xu, ZHANG Ai-hua, DIAO Zong-li, HUANG Hong-dong, LIU Wen-hu 2023, 22 (09):  649-652.  doi: 10.3969/j.issn.1671-4091.2023.09.003 Abstract ( 110 )   PDF (450KB) ( 137 )   Objective  To observe the efficacy of roxadustat combined with erythropoietin (EPO) in the treatment of anemia in maintenance hemodialysis (MHD) patients with kidney transplant failure.  Method   A retrospective analysis was conducted on MHD patients with low EPO response and kidney transplant failure at Beijing Friendship Hospital affiliated to Capital Medical University during the period from June 2021 to December 2022. Some of the patients were treated with roxadustat combined with EPO. Changes of hemoglobin (Hb) and the compliance rate of Hb before and after the combination treatment were analyzed. Their physical and activity status were evaluated using the Eastern Cooperative Oncology Group (ECOG) scoring standards. The dosage of the two drugs and the adverse drug reactions were recorded.  Result  A total of 34 MHD patients with kidney transplant failure were enrolled in this study, including 23 cases in the combined roxadustat treatment group and 11 cases in the control group. There were no statistically differences in age, gender, dialysis age, dry weight and BMI between the two groups. In the combined roxadustat group, Hb increased from (97.91±15.47) g/L before treatment to (111.61±11.95) g/L after treatment (t=-4.499, P＜0.001); the HB level before treatment was lower than the HB level of 117.09±4.30g/L in the control group (t=-5.515, P＜0.001), but the HB level after the treatment had no statistical difference with the HB level of （117.09±4.30） g/L in the control group (t=-1.131, P=0.266); the compliance rate of Hb increased from 30.4% to 65.2% (χ2=7.265, P=0.017); and the ECOG scoring indicated that their physical and activity status improved (Z= -2.238, P=0.025). The dosage of roxadustat was 150mg/week in 16 patients and 300mg/week in 7 patients. In the combined roxadustat group, EPO dosage decreased from (14956.52±7351.43) U/week before the treatment to （7478.26±4066.15） U/week after the treatment (t=6.927, P＜0.001); the EPO dosage before treatment was higher than that of （10 727.27±2 412.09） U/week in the control group (t=2.493,P=0.018), but the EPO dosage after treatment was lower than that of （10727.27±2412.09） U/week in the control group (t=-3.290, P=0.002). No significant adverse reactions were observed in the combination therapy of roxadustat and EPO.  Conclusion  The combination therapy of roxadustat and EPO is safe and effective in MHD patients with lower EPO response and kidney transplant failure. Metrics

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The correlation between hyperphosphatemia and cognitive impairment in continuous ambulatory peritoneal dialysis patients YAN Shao-bo, PEI Hua-ying, ZHANG Mai, SUN Xiao-yu, YANG Ya-qi, ZHANG Li-min, LU Su-yu 2023, 22 (09):  653-657,684.  doi: 10.3969/j.issn.1671-4091.2023.09.004 Abstract ( 96 )   PDF (691KB) ( 26 )   Objective  To investigate the association between hyperphosphatemia and cognitive impairment in patients on continuous ambulatory peritoneal dialysis (CAPD).  Methods  This is a single-centered study recruited a total of 312 CAPD patients from the Second Hospital of Hebei Medical University in the period of January 2021 to December 2022. Their general cognitive function was examined using the Montreal Cognitive Assessment (MoCA), and their executive function was assessed by Test A (Trail-Making Test forms A, TA).  Results were statistically processed by SPSS 26.0.  Results  ①Among the 312 CAPD patients, the prevalence of cognitive impairment was 36.9%. ②Univariate correlation analysis showed that hyperphosphatemia (OR=2.333, 95% CI：1.456～3.736, P＜0.001) and age (OR=0.830, 95% CI：1.076～1.135, P＜0.001) were correlated with general cognitive function, and serum albumin (OR=0.869, 95% CI：0.770～0.982,       P=0.024) and age (OR=1.073, 95% CI：1.024～1.124, P=0.003) were correlated with executive function. There were no significant correlation between serum levels of calcium (OR=0.218, 95% CI：0.048～0.999, P=0.050) and iPTH (OR=1.000, 95% CI：0.999～1.001, P=0.484) and general cognitive and executive functions. ③Multivariate regression analysis suggested that hyperphosphatemia was significantly associated with cognitive impairment (95% CI：3.272～17.741, P＜0.001) after adjustments for demographic, clinical and laboratory confounding factors. The incidence of cognitive impairment in CAPD patients with hyperphosphatemia was 7.62 times higher than that in the patients without hyperphosphatemia. ④ ROC curve indicated that when blood phosphorus was set at 1.66mmol/L, the maximum value of Youdon index was 0.30, the sensitivity was 75.7%, and the specificity was 54.10%.  Conclusions   In CAPD patients, serum phosphorus level affects general cognition of the patients, and hyperphosphatemia is an independent risk factor for cognitive impairment in CAPD patients. If serum phosphorus level increases to >1.66 mmol/L, the risk of cognitive impairment increases significantly. Metrics

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The effect of incremental hemodialysis on dialysis adequacy: a meta-analysis WANG Shun, ZHANG Li, YANG Wen-jun, WANG Shi-han, MAIERZIYA Usman, WUERGULI Abdukadir, LU Chen 2023, 22 (09):  658-662.  doi: 10.3969/j.issn.1671-4091.2023.09.005 Abstract ( 84 )   PDF (1012KB) ( 38 )   Objective  To investigate the effect of incremental hemodialysis on dialysis adequacy and patient prognosis through meta-analysis.  Methods  A comprehensive literature search was conducted in PubMed, Web of Science, Cochrane library, China National Knowledge Infrastructure (CNKI), Wanfang database (WanFang), and VIP database (VIP). Meta-analysis was undertaken using the software Review Manager version 5.4.  Results  Six articles were finally included according to the inclusion and exclusion criteria. There were no statistical differences in dialysis adequacy (MD=-0.19, 95% C1：-0.62～0.24, Z=0.88, P=0.38) and mortality rate (MD=0.48, 95% C1： 0.06～4.24, Z=0.65, P=0.51) between conventional hemodialysis and incremental hemodialysis. Conclusions  Incremental hemodialysis had no influences on dialysis adequacy and mortality, as compared with those of conventional hemodialysis. Therefore, incremental hemodialysis is an ideal mode of hemodialysis for patients with residual renal function. Metrics

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The correlation between systemic inflammatory response index (SIRI) and cardiovascular events in hemodialysis patients CHEN Jian-hua, CHEN Lin-qing, CAO Ai-qin, ZHONG Hao-wen, ZHANG Meng-bi, SU Xiao-yan 2023, 22 (09):  663-667.  doi: 10.3969/j.issn.1671-4091.2023.09.006 Abstract ( 68 )   PDF (540KB) ( 102 )   Objective  To investigate the correlation between the systemic inflammatory response index (SIRI) and cardiovascular events in patients on hemodialysis (HD).  Methods  The basic clinical information, blood routine and laboratory examination results were collected and analyzed in patients treated with regularly HD for more than 3 months in Dongguan Tungwah Hospital in the period of January 2019 to January 2021.  Results  The SIRI level was significantly higher in the cardiovascular event group than in the non-cardiovascular event group (Z=-3.558, P＜0.001). Patients in the cardiovascular event group had a higher proportion of previous cardiovascular disease, older age (χ2=-3.901, P＜0.001), and higher levels of white blood cell count (t=-3.104, P=0.002), red blood cell distribution width (t=-2.746, P=0.006), neutrophil count (t=-3.117, P=0.002), monocyte count (t=-2.492, P=0.013), triglycerides (Z=-2.508, P=0.012), C-reactive protein (Z=-2.035, P=0.042), monocyte-to-lymphocyte ratio (MLR) (Z=-2.552, P=0.011), and neutrophil-to-lymphocyte ratio (NLR) (Z= -2.277, P=0.023). COX risk proportional model analysis showed that higher SIRI level was an independent risk factor for cardiovascular events in HD patients (HR=2.307, 95% CI:1.236～4.305, P=0.009). ROC analysis showed that the area under the curve (AUC) of SIRI, MLR, and NLR were 0.676, 0.626, and 0.612, respectively, and the Youden indices were 0.326, 0.202, and 0.178, respectively, with the optimal cut-off values of 1.15, 0.35, and 4.98 respectively, sensitivity of 87.23%, 70.21%, and 40.43% respectively, and specificity of 45.31%, 50.00%, and 77.34%, respectively.  Conclusion  SIRI is an independent risk factor for cardiovascular events in HD patients. Metrics

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The value of intravascular ultrasonography in the diagnosis and treatment of central venous diseases in maintenance hemodialysis patients ZHOU Ya, DONG Xin-xin, ZHU Gui-zhen, YAN Guo-sheng, MA Xu, ZHANG Hong-tao 2023, 22 (09):  668-671.  doi: 10.3969/j.issn.1671-4091.2023.09.007 Abstract ( 58 )   PDF (597KB) ( 16 )   Objective  To evaluate the clinical value of intravascular ultrasonography (IVUS) in the diagnosis and treatment of central venous diseases (CVD) in maintenance hemodialysis (MHD) patients.  Methods  Clinical data of the 5 patients with CVD treated in the Department of Nephrology, Henan Provincial People’s Hospital during February first, 2020 to March first, 2021 were recorded. The location and extent of CVD in the 5 patients were diagnosed by digital subtraction angiography (DSA) and IVUS.  Results  There was no significant difference in evaluating the degree of vascular stenosis between DSA and IVUS, but IVUS detected more lesions than DSA. Among the 5 CVD patients, 2 patients had mild stenosis and 3 patients had occlusion of the central vein. DSA detected 6 lesions, and 3 of them were thrombosis. IVUS detected 8 lesions, and 4 of them were thrombosis, 2 of them were aortic compression, one of them was concomitant artery compression, and one of them was caused by vessel distortion.  Conclusions  IVUS is highly sensitive and specific in identifying CVD and  its primary cause, applicable for the management and treatment of CVD. Metrics

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Prospective and self-crossover control study of dialysates containing different calcium concentrations for simplified citric acid anticoagulant hemodialysis WANG Wei, LI Yue-hong, WU Xiang-lan, YANG Hua, LYU Jia-xuan, XU Hui-ying 2023, 22 (09):  672-674.  doi: 10.3969/j.issn.1671-4091.2023.09.008 Abstract ( 101 )   PDF (523KB) ( 24 )   Objective To investigate the effectiveness of different calcium concentrations in dialysate for simplified citric acid anticoagulant hemodialysis.  Methods  A total of 32 hemodialysis patients with high risk of bleeding were treated with 1.25mmol/L (group A) or 1.5 mmol/L (group B) calcium-containing dialysate for 64 times of simplified citric acid anticoagulant hemodialysis by self-crossover control method. Blood free calcium level was measured at different dialysis time points, the pumping speed of citric acid was adjusted, and the dialysis indexes and dialysis adequacy (Kt/V) were recorded.  Results  ①The anticoagulant efficacies of group A and group B were 100% and 93.8% respectively. ②The pumping speed of citric acid in group A was lower than that in group B [(390.9±24.0) ml/h vs.（410.9±20.7）ml/h, t=-3.569, P=0.001]. In group A, the free calcium after the filter at 2 hours of dialysis [(0.66±0.13) mmol/L vs. (0.80±0.12) mmol/L, t=-4.428, P<0.001) and the free calcium before the filter at 4 hours of dialysis [(0.91±0.11) mmol/L vs. (1.00±0.13) mmol/L, t=-2.917, P=0.005) were lower than those in group B. ③There was no significant difference in Kt/V between the two groups [(1.16±0.22) mmol/L vs. (1.18±0.20)mmol/L, t=-0.380, P=0.706].  Conclusion  Dialysate containing calcium 1.5mmol/L can achieve effective anticoagulation with safer blood free calcium concentration, and it may be appropriate for simplified citric acid anticoagulant hemodialysis.  Metrics

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Investigation on the status quo of drug compliance and its influencing factors in peritoneal dialysis patients in a single center by using the MMAS-8 scale ZHOU Xiang,  ZHANG Qing-qing,  JIAYINAXI Azhati,  SUN Yu 2023, 22 (09):  675-678.  doi: 10.3969/j.issn.1671-4091.2023.09.009 Abstract ( 50 )   PDF (504KB) ( 14 )   Objective  To investigate the status quo of drug compliance and the risk factors affecting drug compliance in peritoneal dialysis (PD) patients in a single center.  Methods  The Chinese version of Morisky drug compliance eight-item scale was used to evaluate the drug compliance and its relevant factors in a total of 155 PD patients treated in the Peritoneal Dialysis Center, Department of Nephrology, People's Hospital of Xinjiang Autonomous Region. The receiver operating characteristics (ROC) curve was used to evaluate the predictive ability of logistic regression model.  Results  Good drug compliance was found in 112 PD patients (72.258%), and poor drug compliance was found in 43 PD patients (27.742%). Univariate analyses showed that dialysis age (χ2=9.121, P=0.010), smoking history (χ2=7.504, P=0.006), regional distribution (χ2=5.195, P=0.023) and joint-decision score (t=2.594, P=0.010) significantly affected the differences among groups. Multivariate logistic regression demonstrated that dialysis age (OR=1.011, 95% CI: 1.000~1.022,     P=0.047), regional distribution (OR=2.450, 95% CI: 1.020~5.886, P=0.045) and joint-decision score (OR=1.093, 95% CI: 1.001~1.192, P=0.047) were the main factors affecting drug compliance in PD patients.  ROC curve had a better ability to assess the differentiation performance of the prediction model (AUC=0.685).  Conclusion  The chance of the PD patients to access information based on their resident place and their participation in joint-decision making should be comprehensively evaluated, so as to promote their rational cognition and compliance of the drug therapy, and to provide evidences for professional PD nurses to carry out high-quality and goal-oriented nursing management of PD patients. Metrics

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Role of Ferrostatin-1 prevent high glucose-induced Ferroptosis of renal tubular epithelial cells WU Zi-yu, LIN Yan, LIANG Yuan-qi, GUO Tai-lin 2023, 22 (09):  679-684.  doi: 10.3969/j.issn.1671-4091.2023.09.010 Abstract ( 57 )   PDF (774KB) ( 38 )   Objective To investigate the role of Ferrostatin-1(Fer-1) in high glucose-induced ferroptosis of renal tubular epithelial cells. Method (1) 24 DBA/2J mice were randomly divided into 4 groups: normal control group, Fer-1 intervention group, DM model group, DM + Fer-1 intervention group with 6 mice in each group. According to the body weight of mice, DBA/2J mice were injected intraperitoneally with freshly prepared Streptozocin at a dose of 40 mg / kg for 5 days to establish DM model. Fer-1 intervention group and DM+Fer-1 intervention group were given intraperitoneal injection of Fer-1 (2.5μmol/kg) every day for 12 weeks after modeling.. The control group and DM Group were intraperitoneally injected with the same volume of normal saline for 12 weeks. The expression levels of activated glutathione peroxidase 4(GPX4)and solute carrier family 7 A11(SLC7A11)were detected by Western blotting, and the expression and localization of GPX4 in renal tissue were detected by immunohistochemistry.(2) Human renal tubular epithelial cells (HK-2) were stimulated with high glucose (30 mmol/L) , and treated with 200 nm Fer-1. The expression of ferroptosis signaling in renal tubular epithelial cells was detected by Western blotting and immunofluorescence staining. Results  Compared with the normal control group, the levels of Fe2+and Malondialdehyde (MDA) in the kidney of DM model group were significantly up-regulated, glutathione (GSH) was significantly down-regulated ( t=35.073、15.732 and 4.954 respectively，all P ＜ 0.001) , and the protein expression levels of GPX4 and SLC7A11, which were related to ferroptosis, were significantly up-regulated (t=12.432 and 5.484；P=0.006 and 0.003) . Compared with the DM model group, the levels of Fe2+ and MDA in the kidney of DM +Fer-1 intervention group were down-regulated, while GSH was up-regulated (t=14.503、4.675 and 7.124； all P＜0.001) . The protein expression levels of GPX4 and SLC7A11 were up-regulated (t =4.573 and 27.942；P= 0.039 and 0.001) . In addition, high glucose could induce the expression levels of ferroptosis related proteins GPX4 and SLC7A11 in HK-2 cells cultured in vitro to decrease significantly ( t=12.433 and 7.716；P=0.006 and 0.019) , the expression levels of GPX4 and SLC7A11 were significantly increased by Fer-1(t=5.136 and 5.043；P=0.035 and 0.037) . Conclusions  Inhibition of ferroptosis in renal tubular epithelial cells induced by high glucose may be a new strategy to prevent the progression of DM. Metrics

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The research progresses in fibroblast growth factor 23 on renal anemia ZHANG Zhi-yan, CHANG Qin-tao 2023, 22 (09):  685-689.  doi: 10.3969/j.issn.1671-4091.2023.09.011 Abstract ( 57 )   PDF (478KB) ( 34 )   Chronic kidney disease (CKD) is a global public health problem with an increasing incidence year by year. It is characterized by insidious onset and hard to be noticed at the beginning. With the gradual loss of kidney function, a variety of acute and chronic complications follow, including electrolyte disorders, heart failure, anemia, mineral metabolism disorders, and others. Recent studies have shown that fibroblast growth factor 23 (FGF23) is involved not only in the regulation of mineral metabolism, but also in iron deficiency, inflammation, and the functions of erythropoietin and hypoxia-inducible factor. Anemia is a potent driver of FGF23, and FGF23 is negatively correlated with erythropoiesis in CKD patients. A comprehensive understanding of the regulatory mechanism of FGF23 is helpful for the treatment of renal anemia. Metrics

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Research progresses in mesenchymal stem cells to delay peritoneal fibrosis ZHANG Qing-ru, LIU Xiao-yu, LU Xue-hong 2023, 22 (09):  690-694.  doi: 10.3969/j.issn.1671-4091.2023.09.012 Abstract ( 64 )   PDF (563KB) ( 26 )   Peritoneal dialysis (PD) is one of the kidney replacement treatments and plays an irreplaceable role in the treatment of end-stage renal failure patients. However, long-term PD can affect the function and structure of the peritoneum. Peritoneal fibrosis is a serious complication in long-term PD patients, leading to ultrafiltration failure and interruption of PD. In recent years, mesenchymal stem cells (MSCs) have become an innovative research field with clinical application potential due to their multi-directional differentiation potential, immunomodulatory and tissue repair abilities. Recent studies have shown that MSCs can ameliorate peritoneal fibrosis by regulating inflammation, repairing damage, and inhibiting epithelial-mesenchymal transformation (EMT) of the peritoneal mesenchymal cells. This article reviews the mechanism, research progresses and difficulties of MSCs used for delaying peritoneal fibrosis. Metrics

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Effect of hyperkalemia on electrocardiographic stability of hemodialysis patients Burenqiqige, LIU Li, CHEN Er-dong, CHEN Yu-qing 2023, 22 (09):  695-697.  doi: 10.3969/j.issn.1671-4091.2023.09.013 Abstract ( 91 )   PDF (384KB) ( 85 )   Hyperkalemia is a common complication of maintenance hemodialysis (MHD) patients. When blood potassium concentration increases, it will not only change the gradient of potassium concentration inside and outside the cells and break the electrical stability of myocardial cells, but will also promote massive and rapid shift of potassium ions between serum and dialysate and inside and outside the cells during dialysis. These factors may increase the risk of arrhythmia in MHD patients. Therefore, it is very important to treat hyperkalemia in time and choose the best potassium prescription of dialysate. This review discusses the influence of hyperkalemia and dialysis treatment on electrocardiographic stability of hemodialysis patients and related treatment measures. Metrics

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Ultrasound guided percutaneous balloon dilatation applied to the treatment of vascular access stenosis WANG Qing 2023, 22 (09):  698-700,714.  doi: 10.3969/j.issn.1671-4091.2023.09.014 Abstract ( 63 )   PDF (467KB) ( 18 )   Objective  To explore the ultrasound guided percutaneous balloon dilatation applied to the treatment of arteriovenous internal fistula (AVF) stenosis for blood access.  Methods  A total of 82 patients with AVF stenosis treated with surgical intervention in Xishui County Traditional Chinese Medicine Hospital of Huanggang City during January 2018 to September 2022 were enrolled in this study. They were randomly divided into experiment group and control group based on the order of case number. Ultrasound guided percutaneous balloon dilatation was performed in the experiment group, and percutaneous thrombectomy was used for the control group. Patent of the AVF, restenosis of the AVF, complication of the surgical intervention and related clinical indicators were compared between the two groups.  Results  In the experiment group, patent rates of the AVF were 90.24%, 85.36% and 80.47% after the operation for 3 months, 6 months and 12 months respectively, higher than those in the control group (χ2=3.998, 4.232 and 4.661 respectively; P=0.046, 0.040 and 0.031 respectively); restenosis rates of the AVF were 2.44%, 7.32% and 14.63% after the operation for 3 months, 6 months and 12 months respectively, lower than those in the control group (χ2=3.905, 4.479 and 5.185 respectively; P=0.048, 0.034 and 0.023 respectively); complication rate of the intervention was 2.44%, lower than that in the control group (χ2=3.905, P=0.048); after ultrasound guided percutaneous balloon dilatation intervention, the internal diameter at the previous stenosis site, blood access volume and blood flow were greater than those in the control group (t=12.425, 5.391 and 7.875 respectively; P＜0.001).  Conclusion  Ultrasound guided percutaneous balloon dilatation for the treatment of AVF stenosis and occlusion has the advantages of higher success and safety rates, real-time to display the patency and multi-angle images, and disappearance of AVF tremor after the intervention. Therefore, this method is worth to be widely used clinically.  Metrics

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Effects on the early postoperative juxta-anastomotic venous inflammatory response and intimal hyperplasia in arteriovenous fistula in rabbits constructed with the no⁃touch technique to dissect the veins ZHANG Chun-hua, JIAO Zi-zhao, AN Chuan-guo, JI Ning, DING Le-xin, YUAN Ya-li, CHEN Ping-ping, LI Feng-lou 2023, 22 (09):  701-705.  doi: 10.3969/j.issn.1671-4091.2023.09.015 Abstract ( 52 )   PDF (911KB) ( 11 )   Objective To investigate the effects on the early postoperative juxta-anastomotic venous inflammatory response and intimal hyperplasia of arteriovenous fistula (AVF) in rabbits constructed with the no⁃touch technique (NTT) to dissect veins.  Methods  Twenty-four male rabbits were randomly divided into conventional technique (CT) group and NTT group, with 12 rabbits in each group. AVFs were constructed with CT to dissect the veins in CT group, and with NTT to dissect veins in NTT group. At the 7th day after the operation, the juxta-anastomotic veins of AVFs were randomly collected in 6 rabbits from each group. The mRNA expressions of toll-like receptor 4 (TLR4), nuclear factor⁃κB p65 (NF⁃κB p65), tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in the juxta-anastomotic veins were measured by quantitative reverse transcription PCR. At the 21st day after the operation, juxta-anastomotic veins of AVFs were collected in the remaining 6 rabbits from each group, the intimal thickness and the ratio of intima-media thickness were measured after hematoxylin-eosin staining, and the expression of proliferating cell nuclear antigen (PCNA) in the intima was detected by immunohistochemistry.  Results  The intimal thickness and intima-media thickness ratio of juxta-anastomotic veins were 23.7±3.1μm and 26.5±2.3% respectively in the CT group, significantly higher than those of（19.5±2.2）μm and 22.7±1.9% in the NTT group  (t=2.726 and 3.145 respectively; P=0.021 and 0.010 respectively). The positive expression rate of PCNA in the intimal cells of juxta-anastomotic veins was 20.2±2.3% in the CT group, significantly higher than that of 15.2±1.8% in the NTT group (t=4.242, P=0.002). The relative mRNA expressions of TLR4, NF⁃κB p65, TNF-α and IL-1β of juxta-anastomotic veins in the CT group were also significantly higher than those in the NTT group (t=13.457, 12.116, 9.693 and 9.678 respectively; P＜0.001).  Conclusions   Compared with CT, dissection of veins using NTT for the construction AVF in rabbits could attenuate the early postoperative juxta-anastomotic venous inflammatory response and intimal hyperplasia. Metrics

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Association between abdominal aortic calcification and immaturation of autogenousarteriovenous fistula in patients with end-stage renal disease LI Ting, WANG Xiu-feng, ZHAO Yu-jie, GUAN Lin-meng, WANG Hui, SHAO Xiao-lin, YANG Jun 2023, 22 (09):  706-709.  doi: 10.3969/j.issn.1671-4091.2023.09.016 Abstract ( 79 )   PDF (521KB) ( 12 )   Objective  To explore the relationship between abdominal aortic calcification (AAC) and poor maturation of autologous arteriovenous fistula (AVF), and the influencing factors for poor maturation of AVF.  Methods  Patients with chronic kidney disease (CKD) at stage 5 and undergoing AVF construction for the first time at the First Affiliated Hospital of Xinxiang Medical university from October 2021 to October 2022 were enrolled in this study. Their general clinical data, hematological findings, AAC score, and preoperative and postoperative ultrasound examination results were collected. Patients were then divided into immature group and mature group according to physical examination, clinical use, and color Doppler ultrasound results after AVF surgery. Multivariate logistic regression was used to analyze the influencing factors for poor maturation of AVF.  Results  A total of 160 patients were included, with the age of 49.78±14.17 years old and 67.5% of males. There were statistically significant differences in age (t=4.078, P＜0.001), diabetes history (χ 2=4.050, P=0.044), AAC score (t=7.056, P＜0.001) and iPTH (t=2.151, P=0.035) between the two groups. Univariate logistic regression showed that age (OR=1.102, 95% CI 1.042～1.166, P=0.001), diabetes history (OR=2.807, 95% CI 1.010～7.803, P=0.048), AAC score (OR=1.559, 95% CI 1.269～1.915, P＜0.001) and iPTH (OR=1.002, 95% CI 1.000～1.005, P=0.040) were associated with poor maturation of AVF. Multivariate logistic regression showed that age (OR=1.073, 95% CI 1.007～1.142, P=0.030) and AAC score (OR=1.478, 95% CI 1.197～1.825, P＜0.001) were the independent influencing factors for poor maturation of AVF in CKD patients at stage 5.  Conclusions  Our study demonstrates that age and AAC score were the independent influencing factors for poor maturation of AVF. Therefore, age and AAC score should be considered in the evaluation of AVF maturation after operation. Metrics

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The influencing factors for the intimal hyperplasia in arteriovenous fistula in patients with buttonhole puncture for hemodialysis ZHAO Xiu-ming, NIU Hong-yan, LIU Jin-feng, SUN Lin, HUANG Li, SONG Yue-xia 2023, 22 (09):  710-714.  doi: 10.3969/j.issn.1671-4091.2023.09.017 Abstract ( 95 )   PDF (610KB) ( 26 )   Objective  To investigate the influencing factors for the intimal hyperplasia in arteriovenous fistula (AVF) in patients with buttonhole puncture for hemodialysis, so as to provide scientific basis for the intervention.  Methods  The patients using buttonhole puncture for hemodialysis in The First People’s Hospital of Changzhou during January 2021 to December 2021 were selected by the convenience sampling method. They were divided into intimal hyperplasia group and normal group as the binary dependent variables, and the general clinical information and relevant indexes of buttonhole puncture were used as the independent variables. Univariate analysis and unconditional logistic regression analysis were used to analyze the influencing factors for intimal hyperplasia. Receiver operating characteristic (ROC) curve was plotted to obtain the optimal critical value for predicting intimal hyperplasia.  Results  The incidence of intimal hyperplasia in the 85 patients using buttonhole puncture was 68.2%. Binary logistic regression showed that use time of the buttonhole (OR=1.059, 95% CI 1.004～1.116, P=0.036), normal vein diameter (OR=0.744, 95% CI 0.589～0.940, P=0.013) and infection (OR=7.460, 95% CI 1.685～33.033, P=0.008) were the influencing factors for intimal hyperplasia in AVF. ROC curve predicted that the optimal critical time for intimal hyperplasia was the use of the buttonhole for 10.5 months.  Conclusion The incidence of intimal hyperplasia in AVF is high at the puncture site of buttonhole, which is closely related to long-term use of the buttonhole, slender diameter of normal vein and infection. Clinical nurses should understand the indications of buttonhole puncture and the relationship between intimal hyperplasia and buttonhole puncture, take early intervention measures, and implement strict monitoring measures to prevent access complications caused by intimal hyperplasia in AVF. Metrics

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A meta-analysis and systematic review of taste alteration in adult patients with chronic kidney disease WU Xia-xin, SHI Yue-xian, FAN Ya-ru, LI Ji-yue 2023, 22 (09):  715-720.  doi: 10.3969/j.issn.1671-4091.2023.09.018 Abstract ( 63 )   PDF (944KB) ( 29 )   Objective  A meta-analysis was performed to analyze the risk of taste alteration and to integrate the prevalence of taste alteration in chronic kidney disease (CKD) patients.  Methods  CNKI, Wanfang Database, PubMed, Embase, and Web of Science were searched from the date of database establishment to January 31, 2023 to collect the studies on taste changes in CKD patients. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias of the included studies. Stata 17.0 software was used for the meta-analysis.  Results  A total of 13 studies were included, including 4,090 patients. The results of meta-analysis showed that the risk odds ratio of CKD patient with taste alteration was 6.262 (95% CI 1.556～25.197), and the overall prevalence of taste alteration in CKD patients was 29.6% (ES=0.296, 95% CI 0.209～0.390). The incidence of taste alteration was 33.5% (ES=0.335, 95% CI 0.285～0.386) in patients with eGFR＜20ml/min/1.73m2, and was 20.0% (ES=0.200, 95% CI 0.047～0.353) in patients with eGFR≥20ml/min/1.73m2. The incidence of taste alteration was 43.3% (ES=0.433, 95% CI -0.058～0.923) screening by objective assessment tools, and was 27.9% (ES=0.279, 95% CI 0.189～0.368) screening by subjective assessment tools. The incidence of taste alteration was 46.4% (ES=0.464, 95% CI 0.125～0.802) reported in developing countries, and was 23.6% (ES=0.236, 95% CI 0.148～0.324) reported in developed countries. Integration of the literature showed that age, sex, nutrition-related blood biochemical markers and gastrointestinal symptoms were related to taste alteration.  Conclusion  CKD patients have a high risk of taste alteration. The reported rate increases with disease progression, and is significant different among countries with different economic levels. The taste alteration affects eating, nutrition, digestion, and others. Clinical evaluation of the taste changes should be carried out by combining subjective and objective assessment tools, especially focusing on the elderly, women and potentially malnourished people, to early identify and intervene the taste changes. Metrics