Chinese Journal of Blood Purification

22 November 2023, Volume 22 Issue 11 Previous Issue    Next Issue

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The new classification of uremic toxins LI Chao, WEI Tao 2023, 22 (11):  801-805,815.  doi: 10.3969/j.issn.1671-4091.2023.11.001 Abstract ( 217 )   PDF (521KB) ( 109 )   ?The retention and increase of uremic toxin will lead to a series of uremic symptoms, which will affect many systems of the whole body, and lead to the decline of patients' quality of life and high mortality. In 2003, the European Uremic Working Group classified uremic toxins into three groups according to their physical chemistry properties: water-soluble small molecule compounds, protein-binding compounds, and middle molecule compounds. With the new understanding of uremic solutes, the new data of sources and the development of hemodialysis methods and membrane materials, the previous classification can not fully adapt to the new progress in the field of blood purification. Accordingly, in november-december 2020, Claudio R, as president of the General Assembly, convened an expert meeting and prepared an expert consensus that provided new insights into the definition and classification of uremic toxin  tails the expert group's consensus recommendations for new definitions and more clinically oriented new classifications of uremic toxins. Metrics

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Effect of calcium ion concentration in peritoneal dialysate on peritoneal fibrosis and endoplasmic reticulum stress of peritoneal dialysis patients GUO Bao-zhu, CHENG Jin-xiu, JIN Xin, HE Yu-tao, SUN Xian-min 2023, 22 (11):  805-809.  doi: 10.3969/j.issn.1671-4091.2023.11.002 Abstract ( 62 )   PDF (563KB) ( 82 )   Objective  To study the effect of calcium ion concentration in peritoneal dialysate on peritoneal fibrosis, epithelial mesenchymal transition (EMT) and endoplasmic reticulum stress (ERS) of peritoneal dialysis patients.  Method   A randomized controlled study was conducted on patients who underwent continuous non-bedridden peritoneal dialysis using standard calcium peritoneal dialysate. They were divided into low calcium group and control group. Patients in low calcium group switched to low calcium peritoneal dialysate while those in the control group continued to use the peritoneal dialysate with standard calcium concentration. The enrollment time point was set at 0 month and the end of the experiment was set after 6 months. Their clinical data at the time of enrollment were recorded. The outflow dialysates at 0 and 6 months were collected to measure the contents of transforming growth factors-β1 (TGF-β1), fibronectin (FN) and collagen-I (Col-I), and the expression levels of E-cadherin, N-cadherin, ZO-1, α-smooth muscle actin (α-SMA), CCAAT enhancer binding protein homologous protein (CHOP), phosphorylated protein kinase R-like endoplasmic reticulum kinase (p-PERK), phosphorylated eukaryotic translation initiation factor 2 α (p-eIF2α) and transcription activating factor 4 (ATF4).  Results  A total of 49 patients were enrolled, including 24 in low calcium group and 25 in control group. After 6 months of treatment, the contents of TGF-β1, FN, Col-I and the expression levels of α-SMA, N-cadherin, p-PERK, p-eIF2α, ATF4 and CHOP were lower in low calcium group than in control group  (t=4.599, 2.161, 6.557, 9.357, 8.565, 8.634, 7.518, 8.842 and 10.989 respectively; P＜0.001, =0.036, ＜0.001, ＜0.001, ＜0.001, ＜0.001, ＜0.001, ＜0.001 and ＜0.001 respectively), while the expression levels of E-cadherin and ZO-1were higher in low calcium group than in control group (t=16.684 and 22.273; P＜0.001 and＜0.001).  Conclusion  Low calcium dialysate can alleviate peritoneal fibrosis, of which the molecular mechanism may relate to the inhibition of EMT and ERS by low calcium dialysate. Metrics

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Changes of serum NRF2 and HO-1 levels in patients with sepsis and their predictive value for the complication of acute kidney injury in these patients XU Ya-nan, LI Li-zhi, SHI Ping, GU Xiao-jun, ZHANG Ning 2023, 22 (11):  810-815.  doi: 10.3969/j.issn.1671-4091.2023.11.003 Abstract ( 57 )   PDF (692KB) ( 83 )   Aim  To investigate the changes of serum levels of nuclear factor E2-related factor 2 (NRF2) and heme oxygenase-1 (HO-1) in patients with sepsis and their predictive value for the complication of acute kidney injury (AKI) in these patients.  Methods  A total of 132 patients with sepsis treated in our hospital from April 2017 to April 2023 were selected as the study group, and a total of 132 healthy subjects with similar age and sex ratios during the same period were selected as the control group. Serum NRF2 and HO-1 levels were tested in both groups. AKI was evaluated in the study group at the first week after admission. The influencing factors of AKI in sepsis patients were analyzed. The nomogram prediction model of AKI in sepsis patients was constructed and the decision curve analysis (DCA) was performed. Results  Serum NRF2 (2.74±0.54 vs. 1.20±0.21) and HO-1 (6.69±1.27 vs. 3.19±0.52) were higher in the study group than in the control group (t=30.537 and 29.302, P<0.001). The incidence of AKI was 45.45% (60/132) in the 132 sepsis patients within one week after admission. With the increase of serum NRF2 and HO-1, a trend towards the decreased of AKI incidence happened (χ2=35.636 and 28.514, P< 0.001). Multivariate logistic regression showed that NRF2 (OR=0.104, 95% CI: 0.023～0.471) and HO-1 (OR=0.341, 95% CI: 0.168～0.691) were the independent protective factors for AKI in sepsis patients, while SOFA score (OR=1.493, 95% CI: 1.128～1.976), procalcitonin (OR=1.277, 95% CI: 1.070～1.523) and white blood cell count (OR=3.030, 95% CI: 1.550～5.921) were the independent risk factors for AKI in sepsis patients (P<0.05). The nomogram prediction model showed that serum NRF2 and HO-1 had higher predictive values for AKI in sepsis patients, and the consistency indexes were 0.769 and 0.751, respectively. DCA showed that in the threshold range of 0.20～0.78, the net benefit rate of combined assessment of AKI in sepsis patients was better than that of NRF2 or HO-1 alone.  Conclusion  Serum NRF2 and HO-1 levels elevate in sepsis patients, and the combined assay of both levels is helpful to predict the risk of AKI. Metrics

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Clinical features and changes of cardiac structure and function in maintenance hemodialysis patients with different NYHA grades LI Zhuan-huan, LIAN You 2023, 22 (11):  816-820.  doi: 10.3969/j.issn.1671-4091.2023.11.004 Abstract ( 54 )   PDF (535KB) ( 85 )   Objective  To analyze the clinical characteristics and changes of cardiac structure and function in maintenance hemodialysis (MHD) patients with different New York Heart Association cardiac function grade (NYHA grade).  Methods  A total of 148 MHD patients were divided into NYHA I group, NYHA II group, NYHA III group and NYHA IV group according to the NYHA classification of their heart function. Clinical data, laboratory indicators and Echocardiography results were collected. Changes of the above indicators were compared in the MHD patients with different NYHA grades.  Results   There were significant differences in weight gain in the hemodialysis period (t=2.057, P=0.049) and systolic blood pressure (t=2.415,       P=0.017) between NYHA III group and NYHA I group. With the increase of NYHA grade, the proportion of heart failure with preserve ejection fraction (HFpEF) patients reduced gradually, and the proportion of patients with heart failure and reduced ejection fraction (HFrEF) increased gradually (χ2=8.517, P=0.046); NT-proBNP and CRP increased gradually, and ALB and Hb decreased gradually, especially in NYHA IV group, with statistical significances among the four groups (χ2=9.465, P=0.009; F=6.745, P=0.048; F=6.235, P=0.037;             F=6.812, P=0.042); left atrial diameter (LA), left ventricular end-diastolic diameter (LVEDd) and the late diastolic peak flow velocity (VA) increased gradually, especially in NYHA IV group, and the differences were statistically significant among the groups (F=6.701, P=0.032; F=6.278, P=0.037; F=6.485, P=0.042); left ventricular ejection fraction (LVEF) decreased gradually, with significant differences among the groups (χ2=58.216, ＜0.000).  Conclusion  MHD patients with NYHA III or IV grade usually show more weight gain and poor blood pressure control during the dialysis period. With the increase of NYHA grade, microinflammatory state, malnutrition and anemia increased gradually, atrial and ventricular diameters increased mainly due to the decrease of diastolic function. Early identification of the decreased diastolic function should combine the values of early diastolic peak velocity (VE) and VA and their dynamic changes rather than limited to the E/A ratio. Metrics

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A single-center study of online hemodiafiltration with different frequency to improve quality of life in maintenance hemodialysis patients SUN Yan-ling, XIE Hua, WANG Jin-ling, XIAO Kun, FENG Qing, LIN Hong-li 2023, 22 (11):  821-825,860.  doi: 10.3969/j.issn.1671-4091.2023.11.005 Abstract ( 109 )   PDF (598KB) ( 89 )   Objective  To explore the effect of online hemodiafiltration (OL-HDF) once a week and thrice a week on quality of life in patients with maintenance hemodialysis (MHD).  Methods   Patients who received OL-HDF in Dalian Renal Care Hospital from January 1, 2022 to September 30, 2022 were selected and divided into OL-HDF once a week group and OL-HDF thrice a week group; according to the dialysis age in OL-HDF thrice a week group, dialysis age was matched at a ratio of 1:2. The Kidney Disease Quality of Life short Form (SF-36) was applied. The quality of life was assessed by kidney disease component summary (KDCS), physical component summary (PCS) and mental component summary (MCS). Lean tissue index (LTI) was measured by body composition monitor (BCM). Clinical indicators including quality of life scores, LTI, renal function and β2 microglobulin at baseline and after 6 months were compared between the two groups.  Results  A total of 102 MHD patients were included in this study, including 68 patients in OL-HDF once a week group and 34 patients in OL-HDF thrice a week group. Comparison of the indicator changes at baseline and after 6 months in the two groups revealed that KDCS score had no change (t=0.754, P=0.453), the sleep assessment in KDCS was better (t=3.082, P=0.003), the scores of PCS and MCS had no changes (t=  -0.515 and -1/513, P=0.608 and 0.133), and the general health assessment in PCS was better (t=2.442, P=0.016) in OL-HDF thrice a week group, as compared those in OL-HDF once a week group. Changes of the indicators after 6 months showed that hemoglobin (F=6.682, P=0.011), albumin (F=12.294, P=0.001) and LTI (F=7.898, P=0.007) were higher, β2 microglobulin was lower (25.15±3.26mg/L vs. 26.96±5.15mg/L; F=4.710, P=0.032), and spKt/V was higher (1.31±0.21 vs. 1.19±0.15; F=11.975, P=0.001) in OL-HDF thrice a week group, as compared those in OL-HDF once a week group.  Conclusions  OL-HDF treatment thrice a week improves the sleep and nutritional status in MHD patients, probably due to the better dialysis adequacy in these patients. Metrics

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The influencing factors and prognosis value of lung B-line formation examined by ultrasonography in peritoneal dialysis patients WU Xu, SHEN Si-ping, WU Wei-fei, FAN De-yong, LU Min-hui 2023, 22 (11):  826-830.  doi: 10.3969/j.issn.1671-4091.2023.11.006 Abstract ( 76 )   PDF (532KB) ( 23 )   Objective  To investigate the influencing factors of lung ultrasound B-line formation and its prognosis value in peritoneal dialysis (PD) patients.  Methods  A total of 200 PD patients regularly followed up in the Nephrology Department of Huzhou Central Hospital were selected and divided into mild group, moderate group and severe group according to the number of lung ultrasound B-lines. Their relevant data were collected, and they were follow-up for 19 (15, 24) months.  Results  Multivariate linear regression showed that the number of lung ultrasound B-lines was correlated with systolic blood pressure (β=0.090, P=0.003), diastolic blood pressure (β=0.201, P＜0.001), ultrafiltration volume (β=−0.010, P=0.017), hemoglobin (β=−0.112, P=0.026), blood brain natriuretic peptide (BNP; β=0.008, P＜0.001) and pulmonary artery systolic blood pressure (β=0.294, P=0.006). Multivariate Cox regression showed that the number of lung ultrasound B-lines (OR=1.109, 95% CI:1.019～1.208, P=0.017), cardiac functional grade (OR=4.290, 95% CI: 1.564～11.771, P=0.005) and BNP (OR=1.001, 95% CI: 1.000～1.002, P=0.003) were the independent risk factors for cardiovascular disease in PD patients. Kaplan-Meier survival analysis showed that the median survival periods could not be calculated in mild group (n=95), and were 29 and 21 months in moderate group (n=68) and severe group (n=37) respectively; the overall survival period was different among the three groups (χ2=16.384, P＜0.001).  Conclusion  The formation of lung B-line examined by ultrasonography is influenced by many factors in PD patients. The number of lung ultrasound B-lines is an independent risk factor for cardiovascular disease, and is also associated with the prognosis of PD patients. Metrics

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Correlation between frailty and nutritional status in patients undergoing peritoneal dialysis CHEN Jing-jing, YI Chun-yan, LIN Jian-xiong, MAO Hai-ping, YANG Xiao 2023, 22 (11):  831-835.  doi: 10.3969/j.issn.1671-4091.2023.11.007 Abstract ( 53 )   PDF (496KB) ( 80 )   Objective  To investigate the relationship between frailty and body composition and nutritional status in maintenance peritoneal dialysis (PD) patients.  Methods   A cross-sectional survey of PD patients with regular follow-up in a single center was conducted. Clinical frailty scale was used to evaluate the physical function of the patients, and the Inbody720 (Biospace) bioelectrical impedance meter was used to determine the body composition of the patients. The demographic and clinical data of the patients were collected. The influencing factors for frailty in PD patients were analyzed.  Results  A total of 528 PD patients were included, of which 127 (24.1%) had frailty. Compared with the non-frailty group, frailty patients had higher body fat mass (t=4.148, P＜0.001), obesity degree (t=2.629, P=0.009), body mass index (t=2.389, P=0.017) and edema index (t=6.588, P＜0.001), and lower bone mineral mass (t= -2.417, P=0.016), skeletal muscle mass (t=-3.706, P＜0.001), intracellular fluid volume (t=-3.714, P＜0.001), total fluid volume (t=-2.947, P=0.003), lean body mass index (t=-2.245, P=0.025), serum total protein (t =-2.486, P=0.013), albumin (t=-6.329, P＜0.001) and prealbumin (t=-7.638, P＜0.001). Multivariate binary logistic regression analysis showed that older age (OR=1.130, 95% CI: 1.076～1.186, P＜0.001), higher Charlson comorbidities score (OR=1.599, 95% CI:1.206～2.119, P＜0.001), higher systolic blood pressure (OR=1.043, 95% CI:1.017～1.070, P＜0.001), lower diastolic blood pressure (OR=0.939, 95% CI: 0.898～0.981, P=0.005) and lower serum albumin (OR=0.858, 95% CI: 0.780～0.944,P=0.002) were the independent risk factor for frailty in PD patients.  Conclusions The incidence of frailty in PD patients was 24.1%. Lean body mass index, obesity degree and edema index were correlated with frailty. Nutritional status, older age, comorbidities and blood pressure were the independent influencing factors for frailty in PD patients. Metrics

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Development of a risk prediction model for food aspiration during hemodialysis sessions in elderly patients with maintenance hemodialysis WANG Jiao, WANG Yi-na, JIANG Ying, BIAN Chun, SUN Wen-juan, WEI Xue-feng 2023, 22 (11):  836-840.  doi: 10.3969/j.issn.1671-4091.2023.11.008 Abstract ( 50 )   PDF (657KB) ( 83 )   Objective   To explore the risk factors for food aspiration during hemodialysis sessions in patients on maintenance hemodialysis (MHD) and to develop a prediction model for the aspiration risk.  Method  A total of 220 MHD patients over 60 years old and treated in a tertiary hospital in Wuxi city were enrolled in this study. Least Absolute Selection and Shrinkage Operator (LASSO) regression analysis was used to select predictors. Multivariate logistic regression was applied to build the risk prediction model, which was also shown as nomogram. Receiver operating characteristic curve (ROC curve) and calibration curve were used to assess the discrimination and calibration abilities of the model.  Results   History of stroke (OR=9.460, 95% CI: 3.218～27.813, P<0.001), pneumonia (OR=6.499, 95% CI: 1.912～22.096, P=0.003), sedative and hypnotic drugs (OR=5.978, 95% CI: 1.323～27.005, P=0.020), drugs for chronic kidney disease-mineral and bone disorder (CKD-MBD; OR=3.069, 95% CI: 1.074～8.773, P=0.036), oxygen saturation <95% (OR=11.545, 95% CI: 3.932～33.901, P＜0.001) and non-solid food (OR=0.253, 95% CI: 0.078～0.826, P=0.023) were the independent risk factors for food aspiration in MHD patients (P＜0.05). The area under curve (AUC) of the ROC curve was 0.917 (95% CI: 0.879～0.955, P＜0.001). The consistency and benefit of the model evaluated by calibration and decision curves obtained better results.  Conclusion  This model has satisfactory effects that provides references for nurses to identify high-risk patients and implement preventive measures. Metrics

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The relationship between systemic immunoinflammatory index and treatment failure of peritoneal dialysis-associated peritonitis BAO Ling-ling, HUANG Jian-cheng, ZHANG Ai-wei, LUO Chun-lei, BAO Si-zeng, BIAN Xue-yan 2023, 22 (11):  841-845.  doi: 10.3969/j.issn.1671-4091.2023.11.009 Abstract ( 43 )   PDF (526KB) ( 78 )   Objective   To explore the relationship between systemic immunoinflammation index (SII) and treatment failure of peritoneal dialysis-associated peritonitis (PDAP).  Methods  The clinical data of PDAP patients treated in the Peritoneal Dialysis Center of the First Affiliated Hospital of Ningbo University from January 2015 to December 2022 were retrospectively analyzed. They were divided into successful treatment group and failed treatment group according to the treatment results. The baseline clinical and laboratory data were compared between the two groups. Logistic regression was used to evaluate the relationship between SII and PDAP treatment failure. Receiver operating characteristic curve (ROC curve) was used to analyze the predictive value of SII for PDAP treatment failure.  Results   This study recruited 87 patients with PDAP, in which 60 (69.0%) were males,  and 63 patients were in the successful treatment group and 24 patients were in the failed treatment group. Compared with the successful treatment group, patients in the failed treatment group had older age (t=-2.643, P=0.010), lower albumin (t=2.189, P=0.031), lower prealbumin ( t=2.189, P=0.031), higher hypersensitive C-reactive protein (Z=-2.821, P=0.005) and higher SII level (Z=-2.934, P=0.003). Multivariate logistic regression demonstrated that higher SII was the independent factor for treatment failure of PDAP (OR=1.001, 95% CI：1.000～1.002, P=0.047). ROC curve results showed that the area under the curve of SII for predicting treatment failure of PDAP was 0.704 (95% CI：0.579～0.829, P=0.003); when the optimal cut-off SII value was set at 2463.23, the sensitivity was 46.0% and the specificity was 92.1%.  Conclusion High SII is independently associated with treatment failure of PDAP. Therefore, SII can be used as a better biomarker to predict treatment failure of PDAP. Metrics

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Correlation between triglyceride-glucose index and cognitive dysfunction in elderly hemodialysis patients LIN Hui, SHEN Ling-yan, ZHU Ye-hui 2023, 22 (11):  846-849.  doi: 10.3969/j.issn.1671-4091.2023.11.010 Abstract ( 46 )   PDF (520KB) ( 92 )   Objective  To investigate the correlation between triglyceride-glucose index (TyG) and cognitive impairment in elderly hemodialysis patients.  Methods  A total of 204 elderly hemodialysis patients from January 2020 to June 2020 were enrolled in this study. According to score of the Montreal Cognitive Assessment (MoCA) Chinese version, patients were divided into a normal group (MoCA score≥26 points, n=67) and an obstacle group (MoCA score <26 points, n=137). Clinical data including TyG were collected from the hospital information management system. Multivariate logistic regression was used to explore the relationship between TyG and cognitive impairment in elderly hemodialysis patients. ROC curve was used to evaluate the predictive ability of TyG for cognitive impairment.  Results  There were no statistical differences in age, gender, hypertension, BMI and TC between the two groups (χ2/t=0.593, 0.496, 0.027, 0.581 and 0.245 respectively; P=0.554, 0.481, 0.869, 0.562 and 0.806 respectively). Diabetes, stroke, dialysis age, education level and TyG were significantly different between normal group and obstacle group (χ2/t=9.566, 23.511, 7.122, 8.058 and 6.003 respectively; P=0.002, <0.001, <0.001, <0.001 and <0.001 respectively). Multivariate logistic regression showed that diabetes (OR=1.713, 95% CI: 1.512～2.013, P<0.001), stroke (OR=2.023, 95% CI: 1.647～2.216, P<0.001), dialysis age (OR=1.527, 95% CI: 1.376～1.786, P<0.001), education level (OR=0.613, 95% CI: 0.472～0.874, P<0.001), and TyG (OR=1.476, 95% CI: 1.309～1.738, P<0.001) were the influencing factors for cognitive dysfunction. ROC curve analysis showed that the area under the curve of cognitive dysfunction in elderly hemodialysis patients predicted by diabetes was 0.774, the area under the curve of cognitive dysfunction in elderly dialysis patients predicted by TyG was 0.855 (95% CI: 0.752～0.957), and the maximum Yodon index was 0.515; when TyG was set at 9 points, the optimal cutoff value was obtained, with the sensitivity of 81.25, and the specificity of 79.12. According to the optimal cutoff value from ROC curve, patients were subdivided into TyG <9 group (n=55) and TyG≥9 group (n=149). The readmission rates were 40.00% (22/55) and 59.73% (89/149) in TyG <9 group and TyG≥9 group respectively (χ2=6.305, P=0.012), and the infection rates were 20.00% (11/55) and 37.11% (59/149) in TyG <9 group and TyG≥9 group respectively (χ2=6.845, P=0.009).  Conclusion  The increase of TyG is an independent risk factor for cognitive dysfunction, and has a better predictive value for cognitive dysfunction in elderly hemodialysis patients. Metrics

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Research progresses in peritoneal dialysis related animal models FANG Lv-gui, RAO Xiang-rong 2023, 22 (11):  850-852.  doi: 10.3969/j.issn.1671-4091.2023.11.011 Abstract ( 56 )   PDF (593KB) ( 84 )   Peritoneal dialysis (PD) related animal models provide important references for improving PD treatment in humans, despite the fact that animal results have to be further studied before they can be used clinically. Currently, PD related models have been established in mice, rats, rabbits, pigs and other animals. These animal models offer valuable information about the mechanisms of PD complications such as peritonitis and peritoneal fibrosis, and also about the development of new dialysates. Metrics

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Potential therapeutic approaches to promote the maturation of autologous arteriovenous fistula WANG Xue, YU Wei-min 2023, 22 (11):  853-855.  doi: 10.3969/j.issn.1671-4091.2023.11.012 Abstract ( 63 )   PDF (388KB) ( 78 )   Autogenous arteriovenous fistula (AVF) is the vascular access of choice for hemodialysis. However, primary failure after fistula surgery occurs frequently, mainly in the form of venous neointimal hyperplasia (NIH). As a result, the main challenge to promote AVF maturation is the inhibition of venous NIH to maintain patency of the fistula. This article reviews the pathophysiology of AVF and summarizes the potential therapeutic approaches to inhibit venous NIH in AVF and to promote maturation of the endovascular fistula. Metrics

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Advances in the application of medium cut-off membrane and expanded hemodialysis JIANG Ran, WU Bu-yun 2023, 22 (11):  856-860.  doi: 10.3969/j.issn.1671-4091.2023.11.013 Abstract ( 84 )   PDF (521KB) ( 90 )   Medium Cut-Off Membrane has been an important evolution in the field of hemodialysis for the past years. Its advantages are mainly reflected in the significant improvement of the clearance of large medium molecular uremia toxins at the moment, more and more relevant clinical trials are being revolved to verify the clinical feasibility and long-term benefits. The nomenclature and theoretical advantages of medium cut-off membrane, and related technologies of Expanded Hemodialysis as well as its clinical applications were briefly described below. Metrics

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Analysis of risk factors and construction of a risk prediction model for the complications of autologous arteriovenous fistula in maintenance hemodialysis patients LI Hong-bo 2023, 22 (11):  861-865.  doi: 10.3969/j.issn.1671-4091.2023.11.014 Abstract ( 90 )   PDF (710KB) ( 95 )   Objective  To analyze the risk factors for complications of autologous arteriovenous fistula (AVF) in maintenance hemodialysis (MHD) patients, and to construct a risk prediction model for the complications.  Method  A retrospective analysis was conducted on the clinical data of 178 MHD patients admitted to Department of Nephrology, The Second Medical Center, PLA General Hospital from March 2021 to March 2023. Patients were divided into a AVF complication group (n=46) and a non-AVF complication group (n=132) based on the complications of stenosis and/or thrombosis in AVF. General data was collected. The independent risk factors for AVF complications in MHD patients were analyzed using univariate and multivariate logistic regression methods, from which a prediction model (R software) was constructed. The receiver operating characteristic (ROC) curve and calibration curve were plotted to evaluate the discrimination and accuracy of the prediction model in predicting the risk of AVF complications in MHD patients.   Results  Among 178 MHD patients, 46 cases were in the AVF complication group accounted for 25.84%, while 132 cases were in the non-AVF complication group accounted for 74.16%. Multivariate regression showed that age >65 years old (OR=1.658, OR 95% CI: 1.267～3.025, P<0.001), education level of junior high school or below (OR=1.543, OR 95% CI: 1.068～2.597, P<0.001), hypotension during dialysis (OR=5.492, OR 95% CI: 2.541～10.597, P<0.001), button puncture method (OR=1.843, OR 95% CI: 1.056～2.819, P<0.001), puncture failure or hematoma formation (OR=2.641, OR 95% CI: 1.273～4.320, P<0.001), platelet count >227.84×109/L (OR=4.413, OR 95% CI: 3.171～9.492, P<0.001) and albumin levels ＜32.83g/L (OR=3.981, OR 95% CI: 2.316～8.873, P<0.001) were the risk factors for AVF complications in MHD patients. ROC curve showed that the area under the curve of nomogram model to predict AVF complications in MHD patients was 0.823 (95% CI: 0.763～0.887), the calibration curve slope was close to 1, and there was no significant difference between the predicted probability and the actual probability (χ2=6.521, P=0.573).  Conclusion  Older age, lower education level, hypotension during dialysis, button puncture method, puncture failure or hematoma formation, higher platelet count, and lower albumin level are the risk factors for AVF complications in MHD patients. The column chart prediction model constructed based on the above risk factors has better discrimination and accuracy abilities. Metrics

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The correlation between abdominal aortic calcification and arteriovenous fistula patency period following percutaneous transluminal angioplasty MA Wei-hua, DU Shu-tong, BAI Wei-wei, WANG Ya-jing, WANG Na 2023, 22 (11):  866-870.  doi: 10.3969/j.issn.1671-4091.2023.11.015 Abstract ( 39 )   PDF (488KB) ( 74 )   Objective   To retrospectively analyze the relationship between abdominal aortic calcification (AAC) and arteriovenous fistula patency period after percutaneous transluminal angioplasty (PTA).  Methods   A total of 120 patients treated with PTA for the first time in Cangzhou People's Hospital from June 2018 to November 2021 were enrolled in this study. Their AAC score at the time of PTA operation were recorded. According to the AAC score, the patients were divided into high AAC group and low AAC group. Their primary AVF patency rate after PTA was followed up for 3 years. The influencing factors for primary AVF patency period after PTA were analyzed.  Results  The primary patency period was significantly shorter in high AAC group than in low AAC group (t =2.358, P=0.020). After 6, 12, 24 and 36 months, the primary AVF patency rates were 93.9%, 84.7%, 67.4% and 53.6% in low AAC group, and were 92.6%, 79.4%, 56.3% and 39.6% in high AAC group (χ2=4.827, P=0.028). Multivariate adjusted COX regression found that AAC score (HR=2.893, 95% CI:1.160～7.212, P=0.023) and AVF age (HR=0.545, 95% CI:0.320～0.928, P=0.026) were significantly associated with AVF dysfunction after PTA.  Conclusions   AAC and AVF age are important predictors for AVF restenosis after PTA. Metrics

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The influencing factors for early failure of arteriovenous fistula in maintenance hemodialysis patients YANG Xiao-lin, ZHUANG Feng, XIAN Shu-li, WANG Ying-deng 2023, 22 (11):  871-875.  doi: 10.3969/j.issn.1671-4091.2023.11.016 Abstract ( 57 )   PDF (542KB) ( 54 )   Objective To explore the risk factors for early dysfunction of arteriovenous fistula (AVF) in maintenance hemodialysis (MHD) patients.  Methods  A total of 128 patients who underwent the first AVF creation surgery from January 2017 to February 2020 in the single center were enrolled in this study. Based on the diagnosis criteria of AVF failure and the AVF patency duration, patients were divided into one-year failure group, one-year non-failure group, 2-year failure group and 2-year non-failure group. The differences in clinical data between failure groups and non-failure groups were retrospectively analyzed.  Results  Multivariate COX regression revealed that lower hemoglobin (OR=4.729, 95% CI: 1.108～20.188, P=0.036), lower platelet (OR=0.980, 95% CI: 0.967～0.993, P=0.003), lower blood glucose (OR=0.665, 95% CI: 0.449～0.986, P=0.042), older age (OR=1.051, 95% CI: 1.001～1.102, P=0.044) and female (OR=6.468, 95% CI: 1.458～28.689, P=0.014) were the risk factors for AVF failure in one year; older age (OR=1.042, 95% CI: 1.001～1.085, P=0.046), lower hemoglobin (OR=0.948, 95% CI: 0.912～0.986, P=0.007), lower platelet (OR=0.986，95% CI: 0.976～0.997, P=0.009) and lower blood glucose (OR=0.632, 95% CI: 0.419～0.953, P=0.029) were the risk factors for AVF failure in two years. Kaplan-Meier survival curve demonstrated that the AVF patency duration was significantly shorter in patients over 60 years old than in those <60 years old (log-rank, c2=6.253, P=0.012), and was shorter in females than in males (log-rank, c2=9.387, P=0.002).  Conclusion Older age, female, lower hemoglobin, lower platelet, and lower blood glucose were the risk factors for early failure of AVF in MHD patients. Metrics

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Study on the influencing factors of mild cognitive impairment in patients with end-stage renal disease - based on logistic and decision tree model ZHANG Hui, ZHOU Zi-juan, YANG Wei, ZOU Hai-ou 2023, 22 (11):  876-880.  doi: 10.3969/j.issn.1671-4091.2023.11.017 Abstract ( 52 )   PDF (613KB) ( 73 )   Objective  To analyze the influencing factors of mild cognitive impairment based on logistic regression and decision tree.  Methods   Patients were selected from three third-class and first-class hospitals in Beijing, who were diagnosed with end-stage renal disease and underwent hemodialysis or peritoneal dialysis. Based on multivariate logistic regression analysis and CHAID algorithm of decision tree, the influencing factors of mild cognitive impairment in patients with end-stage renal disease were analyzed.  Results   A total of 337 patients with end-stage renal disease were included, the incidence of mild cognitive impairment  was 44.2%. The results of multivariate logistic regression analysis showed that compared with patients aged≤44 years, the risk of mild cognitive impairment at≥60 years is higher (OR=5.637, 95% CI: 2.843～11.175, P<0.001). Compared with patients with education for 6 years or less, those with education for 7 to 12 years (OR=0.138, 95% CI: 0.023～0.827, P=0.030) and more than 12 years (OR=0.076, 95% CI: 0.013～0.454, P=0.004) have lower risk of mild cognitive impairment. Patients with diabetes (OR=2.009, 95% CI: 1.147～3.521, P=0.015) and history of cerebrovascular disease (OR=5.039, 95% CI: 2.281～11.129, P＜0.001) are at higher risk of mild cognitive impairment. A total of 6 variables entered the decision tree model, from top to bottom were age, history of cerebrovascular disease, diabetes, time of education, mode of dialysis and creatinine. Both models have high efficiency.  Conclusion   The combination of decision tree model and traditional logistic model can scientifically and fully explore the influencing factors of mild cognitive impairment in patients with end-stage renal disease. The influencing factors are related to the general condition of patients, complicated disease, treatment methods and examination indicators, which should be paid attention to in clinic.  Metrics