Chinese Journal of Blood Purification

12 January 2024, Volume 23 Issue 01 Previous Issue    Next Issue

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Interpretation on the 2023 clinical practice guidelines of plasma component purification technology from the American Society for Apheresis (9th edition)  WAN Li, WANG Mei 2024, 23 (01):  1-8.  doi: 10.3969/j.issn.1671-4091.2024.01.001 Abstract ( 131 )   PDF (520KB) ( 25 )    In April 2023, the American Society for Apheresis (ASFA) released the 9th edition of guidelines for clinical practice of therapeutic apheresis. Based on published literature, these guidelines define the quality of evidence and the recommended strength of therapeutic apheresis in the treatment of diseases, and discuss the clinical application of therapeutic apheresis in 91 disease (166 indications). This article focuses on the interpretation of clinical multidisciplinary applications of plasma component purification technology, including plasma exchange and immuneadsorption. Metrics

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Study on the influencing factors for cognitive impairment in maintenance hemodialysis patients XIONG Man-ting, CHANG Li-yang, ZHANG Hong-mei 2024, 23 (01):  9-13.  doi: 10.3969/j.issn.1671-4091.2024.01.002 Abstract ( 132 )   PDF (525KB) ( 13 )   Objective To explore the influencing factors for cognitive impairment (CI) in patients with maintenance hemodialysis (MHD).  Methods The MHD patients in the Blood Purification Center of Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medicine University from March to May 2023 were selected as the study subjects by convenient sampling method. Patients were divided into CI group (68 cases) and non-CI group (131 cases) according to the score of the Montreal Basic Cognitive Assessment Scale. General information, dialysis data, laboratory results, comorbidities, sleep status and Ishii score were collected. The influencing factors for CI were analyzed by logistic regression. The predictive value of Ishii score on CI was evaluated by using the receiver operating characteristic (ROC) curve.  Results  A total of 199 MHD patients were included in this study, and 34.2% of the patients had CI. Binary logistic regression showed that older age, higher Ishii score, higher cholesterol level, poor sleep status and lower education level were the independent risk factors for CI (OR=7.694, 3.259, 1.567, 1.085 and 0.318, respectively; 95% CI:2.484～23.830, 1.417～7.494, 1.084～2.265, 1.016～1.159 and 0.148～0.684, respectively; P<0.001, 0.005, 0.017, 0.015 and 0.003, respectively). Further study on the ROC curve of Ishii score showed that the optimal critical values for predicting CI in MHD patients, male and female MHD patients were 98.03, 105.17 and 125.49 points, respectively; the areas under the curve were 0.809, 0.813 and 0.802, respectively; the sensitivities were 85.30%, 80.00%, 68.40%, respectively and the specificities were 63.40%, 72.60%, 79.30%, respectively (P<0.001).  Conclusions  The prevalence of CI in MHD patients is higher. CI is affected by many factors. High Ishii score is an independent risk factor for CI, and is a useful indicator for the prediction of CI in MHD patients. Metrics

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Analysis of clinical features of the patients using decremented peritoneal dialysis JIN Li, WANG Xiao-pei, LU Wan-hong, LYU Jing 2024, 23 (01):  14-17.  doi: 10.3969/j.issn.1671-4091.2024.01.003 Abstract ( 44 )   PDF (440KB) ( 13 )   Objective We have observed that the volume of dialysate exchange for peritoneal dialysis (PD) can be started at a full dose, and then is gradually reduced and maintained at a lower dose (dialysate≤4 L/day) in a small group of PD patients. This study analyzes the clinical characteristics of these patients and discusses the feasibility and safety of decremented PD. Methods  Patients who initiated PD between January 2012 to December 2018 in our PD center and satisfied the criterion of decremented PD (maintained the PD at ≤4L/day for >6 months) were included in this study. Acute kidney injury, lupus nephritis, vasculitis, and obstructive nephropathy were excluded in these patients. Baseline renal function and urinary volume were collected. Residual renal function (RRF) and peritoneal permeability were calculated at baseline (within one month of PD), before the decrement (the time before decrement to 4 L/day), and after the decrement (maintenance of ≤4L/day for 6 months). Results A total of 19 patients were included, including 11 females and 8 males with a mean age of 49.87±20.53 years. The median estimating glomerular filtration rate (eGFR) before PD was 6.87 (4.98, 9.44) ml/min1.73m2. The primary renal diseases were chronic glomerulonephritis (8 case) diabetic nephropathy (3 cases), hypertensive renal impairment (3 cases), interstitial nephritis (3 cases), and IgA nephropathy/purpura nephritis (2 cases). The initial dialysate dose was 6L/day in 16 patients and 8L/day in 3 patients. The median period from the beginning to <4L/day was 5.33 (4.57, 14.20) months, and the median period to maintain the decremented PD was 22.17 (13.13, 45.80) months. RRF was 4.95±2.04 ml/min at baseline, and increased to 7.85±2.78 mL/min after PD but before decremented PD (F=10.284, P=0.005). Urinary volume also increased before decremented PD as compared with that at baseline (F=7.374, P=0.015). Total urea clearance (tKt/V) and total creatinine clearance (tCCr) had no differences between the values before decremented PD and after decremented PD for 6 months (F=3.436 and 0.015, P=0.082 and 0.904).  Conclusion  In a small group of PD patients, RRF can be slightly increased after adequate PD. In this group of patients, it is feasible and safe to gradually reduce the dialysate dose and maintain at a lower dose of PD. Metrics

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Case study on the hemodiafiltration with endogenous reinfusion to relieve pruritus symptoms in hemodialysis patients LIU Peng-cheng, SONG Kai, ZENG Ying, MA Qin, HU Dong-yan, TAN Li-ping, JIANG Xiao-mei 2024, 23 (01):  18-21.  doi: 10.3969/j.issn.1671-4091.2024.01.004 Abstract ( 77 )   PDF (468KB) ( 21 )   Objectives To observe the effect of the new hemodialysis technology- hemodiafiltration with endogenous reinfusion (HFR) in the treatment of pruritus in patients undergoing hemodialysis.  Methods Clinical controlled studies including pruritus symptoms, quality of sleep, quality of life and laboratory tests were performed before and after HFR.  Results There were significant differences in severity of itching (Z=-2.023, P=0.043), quality of sleep (t=7.318, P＜0.001) and quality of life (t=4.804, P=0.003) before and after HFR treatment (P<0.05).  Conclusion  HFR can reduce the pruritus symptoms in a short period of time, and improve the quality of sleep and quality of life in uremic patients. Metrics

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Clinical study on donor-specific antibodies in haploid matched hematopoietic stem cell transplantation treated by dual-membrane filtration plasma exchange combined with desensitization WANG Zeng-sheng, NIE Yu-ling, LANG Tao, ZHANG Xiao-yan, LIN Si-ying, WANG Xiao-min, MAO Min 2024, 23 (01):  22-25.  doi: 10.3969/j.issn.1671-4091.2024.01.005 Abstract ( 80 )   PDF (459KB) ( 11 )   Objective To investigate and analyze the efficacy of dual-membrane filtration plasma exchange (DFPP) combined with desensitization therapy in the treatment of donor-specific antibodies (DSA) in haploid matched hematopoietic stem cell transplantation patients.  Methods  The DSA-positive patients were desensitized with DFPP, intravenous immunoglobulin (IVIG) and rituximab. The DSA levels before and after transplantation were measured. The incidence of implantation and graft-versus-host disease (GVHD) were evaluated and analyzed.  Results  Seven of the eight DSA patients received stable implantation of donor cells with the chimerism rate of 100%, and one patient had poor platelet implantation. After desensitization with DFPP, IVIG and rituximab, the mean fluorescence intensity (MFI) reduced to 3911±2499 (t=2.101, P＜0.000); 3 of the 8 patients turned to be weak positive. The MFI reduced further to 907±997 after stem cell reinfusion for 3 days, significantly lower than that before stem cell reinfusion (t=2.145, P=0.002). Only one of the 8 patients developed severe acute GVHD.  Conclusion Dual-membrane filtration plasma exchange combined with the desensitization therapy of high dose IVIG and rituximab can reduce the level of DSA and promote the implantation of donor stem cells. Metrics

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Clinical study on red blood cell lifespan and its influencing factors in maintenance hemodialysis patients DU Wen-hui, YAN Guo-sheng, WANG Meng-fan, ZHOU Ya, WAN Jing-yi, ZHANG Hong-tao 2024, 23 (01):  26-29.  doi: 10.3969/j.issn.1671-4091.2024.01.006 Abstract ( 51 )   PDF (510KB) ( 16 )   Objective To investigate red blood cell lifespan and its influencing factors in maintenance hemodialysis (MHD) patients. Methods The MHD patients treated in the Blood Purification Center of Henan Provincial People's Hospital from February 2023 to May 2023 were selected as the research subjects. Their general data and clinical indicators were collected. Red blood cell lifespan was measured by carbon monoxide (CO) exhalation method. The patients were then divided into normal red blood cell lifespan group and shortened red blood cell lifespan group. The incidence of shortened red blood cell lifespan, and the influencing factors for red blood cell lifespan were analyzed. Clinical parameters were compared between the two groups.  Results ①A total of 83 MHD patients were enrolled, with the gender ratio of 67.47% males (56 cases), mean age of 51.55±10.08 years, and mean dialysis age of 45.80±28.20 months. Diabetic nephropathy accounted for 37.34% of the primary renal diseases. ②Red blood cell lifespan ranged from 29 to 126 days, with an average of 60.83±29.66 days. Shortened red blood cell lifespan was found in 49 cases (59.03%). ③Multivariate linear regression showed that serum albumin (β=0.163, P=0.048), neutrophil/lymphocyte ratio (β=-0.284, P=0.044) and PTH (β=-0.054, P=0.018) were the independent influencing factors for red blood cell lifespan.  Conclusion The mean red blood cell lifespan becomes shortened in MHD patients. The red blood cell lifespan is independently correlated with serum albumin, neutrophil/lymphocyte ratio and serum parathyroid hormone. Metrics

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Diagnostic value of triglyceride-glucose index and brain-derived neurotrophic factor for sarcopenia in non-diabetic maintenance hemodialysis patients SHI Qing-bo, FAN Fan 2024, 23 (01):  30-34.  doi: 10.3969/j.issn.1671-4091.2024.01.007 Abstract ( 37 )   PDF (530KB) ( 10 )   Objective To investigate the diagnostic value of triglyceride-glucose index (TyG) and brain-derived neurotrophic factor (BDNF) for sarcopenia in non-diabetic maintenance hemodialysis (MHD) patients.  Methods  A total of 126 MHD patients admitted to our hospital from January 2021 to January 2023 were recruited as the research subjects. According to the diagnostic criteria revised by the Asian Sarcopenia Working Group (AWGS) in 2019, the incidence of sarcopenia was calculated and analyzed. Serum levels of triglyceride, glucose and BDNF were assayed, and TyG was calculated. Pearson correlation was used to evaluate the correlations between the biomarkers of TyG and BDNF and the sarcopenia indexes of skeletal muscle mass index (SMI), grip strength and walking speed. Multivariate logistic regression was conducted to analyze the influencing factors for sarcopenia in MHD patients. The receiver operating characteristic (ROC) curve was established to assess the values of TyG and BDNF for the diagnosis of sarcopenia in MHD patients.  Results Thirty-nine MHD patients (30.95%) were complicated with sarcopenia. Compared with non-sarcopenia group, TyG was higher (t=7.974, P＜0.001) and BDNF was lower in sarcopenia group (t=14.699, P＜0.001). In sarcopenia group, TyG was negatively correlated with SMI, grip strength and walking speed (r=-0.365, -0.319 and -0.452 respectively; P<0.001), while BDNF was positively correlated with SMI, grip strength and walking speed (r=0.326, 0.275 and 0.395 respectively; P<0.001, =0.003, <0.001 respectively). Older age (OR=1.861, 95% CI：1.040～3.330, P=0.019) and higher TyG (OR=2.050, 95% CI：1.049～4.008, P=0.015) were the risk factors for sarcopenia in MHD patients, while higher albumin (OR=0.694, 95% CI：0.515～0.935, P=0.008) and higher BDNF (OR=0.630, 95% CI：0.430～0.923, P=0.010) were the protective factors for sarcopenia in MHD patients. The areas under the curve using TyG or BDNF for the diagnosis of sarcopenia were 0.740 (95% CI：0.654～0.814, P<0.001) and 0.727 (95% CI：0.641～0.803, P<0.001) respectively; the area under the curve using both TyG and BDNF for the diagnosis of sarcopenia was 0.939 (95% CI：0.882～0.974, P<0.001), higher than those using TyG and BDNF individually for the diagnosis (Z=4.075 and 4.241, P<0.001).  Conclusion  The increase of TyG and the decrease of serum BDNF are associated with sarcopenia in MHD patients. The combination of TyG and BDNF can improve the risk assessment of sarcopenia in MHD patients. Metrics

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The correlation between calciprotein particles and coronary calcification in patients with chronic kidney disease at G3~5D stage CHEN Yu-rou, WANG Shu-ting, LIAO Cheng-chun, YE Chao-yang 2024, 23 (01):  35-40.  doi: 10.3969/j.issn.1671-4091.2024.01.008 Abstract ( 64 )   PDF (682KB) ( 26 )   Objectives  To analyze the correlation between calciprotein particles (CPPs) and coronary calcification in chronic kidney disease (CKD) G3～5D patients, and to discuss the predictive value and influencing factors of CPPs for coronary calcification in both hemodialysis (HD) and non-HD patients.  Method This single-centered and cross-sectional survey study enrolled 75 CKD G3～5D patients. Based on CKD stage and coronary artery calcification score (CACS), the patients were divided into calcification group and non-calcification group to compare the differences of CPPs at different CKD stages between the two groups. The risk and protective factors for calcification in CKD G3～5 (non-dialysis) patients were assessed using bivariate logistic regression. The correlation between CPPs and degrees of coronary calcification in HD patients was evaluated using Kruskal-Wallis test and Pearson chi square test. The influencing factors for CPPs in CKD G3～5D patients with calcification were investigated using univariate linear regression.  Result  For CKD G3～5 (non-dialysis) patients, bivariate logistic regression showed that CPPs (increased per SD) were the independent protective factors for coronary calcification; an increase of one SD (10.20) of CPPs was associated with a 73.4% reduction in coronary calcification risk (OR: 0.266, 95% CI: 0.077～0.916, P=0.036). Kruskal-Wallis test showed that CPPs increased with the increase of CACS (H=6.557, P=0.037), and CACS increased with the increase of CPPs (H=7.440, P=0.024). Pearson chi square test demonstrated that the proportion of HD patients with CACS >100 was more in the middle and high CPPs groups than that in the low CPPs group, and the ratios of calcification degrees were statistically different among the 3 CPPs groups (χ2=9.800， P=0.044). Univariate linear regression showed a negative correlation between CPPs and eGFR-EPI (β=-0.424,  P=0.004) and positive correlations between CPPs and serum levels of Scr (β=0.453, P＜0.001) and calcium (β=0.328, P=0.014) in CKD G3～5D patients with coronary calcification.  Conclusion  In CKD G3～5 (non-dialysis) patients, CPPs are the protective factors for coronary calcification. In contrast in HD patients, higher CPPs implies severer coronary calcification. Serum levels of eGFR-EPI, Scr and calcium are the potential factors for CPPs changes in CKD G3～5D patients with coronary calcification. Metrics

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Clinical study on the impact of peritoneal dialysis associated peritonitis on cardiovascular events LI Ping, CAI Ming-yu, HOU Shi-hui, KUI Kai-zhen, YANG Jie 2024, 23 (01):  41-45.  doi: 10.3969/j.issn.1671-4091.2024.01.009 Abstract ( 63 )   PDF (485KB) ( 13 )   Aim  To clarify whether peritoneal dialysis associated peritonitis is a risk factor for cardiovascular events in peritoneal dialysis (PD) patients.  Methods  The patients undergoing PD treatment in our peritoneal dialysis center were retrospectively analyzed. They were divided into peritonitis group and non-peritonitis group based on whether they had experienced the peritonitis. Their baseline demographic and clinical data were recruited. The occurrence of peritonitis and cardiovascular events were collected in follow-up study. Regression model was used to analyze the relationship between peritonitis and cardiovascular events.  Results A total of 772 PD patients were included in this study, including 458 (59.3%) in the non-peritonitis group and 314 (40.6%) in the peritonitis group. During the follow-up period, cardiovascular events happened in 187 patients (24.2%), of which 88 patients (47.1%) presented the cardiovascular events after the onset of peritonitis and the median time from the onset of peritonitis to cardiovascular events was 10.3 (1.4, 30.0) months. In the 88 patients having cardiovascular events after peritonitis, 20 patients (22.7%) experienced cardiovascular events within 30 days after peritonitis and 68 patients (77.3%) experienced cardiovascular events beyond 30 days after peritonitis. In the peritonitis group, cardiovascular events happened in 107 patients (34.1%), of which 88 patients (82.2%) had early onset of peritonitis and 19 patients (17.8%) did not; in the non-peritonitis group, cardiovascular events happened in 80 cases (17.5%). Therefore, the risk of cardiovascular events in PD patients was higher in PD patients with peritonitis episodes (OR 2.442, 95% CI：1.746～3.416, P＜0.001). After adjusting for age, diabetes and eGFR, the risk of cardiovascular events after peritonitis remained higher (2.434, 95% CI：1.736～3.412, P＜0.001).  Conclusions   Peritoneal dialysis associated peritonitis is a risk factor for cardiovascular events in PD patients. Metrics

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Recent advances in the risk factors for arteriosclerosis and the prevention and management of arteriosclerosis in maintenance hemodialysis patients HU Qing-fang, SUN Yan-yan 2024, 23 (01):  46-49.  doi: 10.3969/j.issn.1671-4091.2024.01.010 Abstract ( 59 )   PDF (426KB) ( 9 )   Arteriosclerosis is a serious and slowly developing vascular lesion, and is frequently detected in end stage kidney disease (ESRD) patients in recent years. It triggers the progression of cardiovascular and cerebrovascular diseases, profoundly affecting prognosis of the patients and even leading to death. The clinical manifestations of arteriosclerosis are usually insidious and easily to be neglected in hemodialysis patients. In this paper we introduce the recent advances in the risk factors, prevention and treatment of arteriosclerosis in maintenance hemodialysis patients, in order to prevent the occurrence of arteriosclerosis and improve the prognosis of these patients. Metrics

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Research progresses in the intraoperative parathyroid hormone determination during the operation for secondary hyperparathyroidism LIAN Li-xin, GAO Wen-chao, LI Tong-chang, Lyu Wen-chao, LI Xiao-yang, QI Ming 2024, 23 (01):  50-52.  doi: 10.3969/j.issn.1671-4091.2024.01.011 Abstract ( 44 )   PDF (416KB) ( 22 )   Parathyroidectomy can effectively treat the secondary hyperparathyroidism (SHPT). However, complete resection of the parathyroid glands during operation is often impossible due to the anatomical and physiological characteristics of parathyroid glands. Thereby the risk of short-term or long-term recurrence increases. Intraoperative parathyroid hormone (ioPTH) determination has been proven to be of great value in improving effectiveness and safety of the surgery and in reducing the recurrence and complications after the surgery. However, there is no consensus on determination standard. This paper aims to review the research progresses and current status of ioPTH during parathyroidectomy surgery for SHPT and to provide more theoretical bases and research targets for SHPT surgery. Metrics

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The dysfunction of upper limb at the arteriovenous fistula or graft side and its influencing factors in maintenance hemodialysis patients WANG Xin-xin, SUN Chao, LI Shuang, ZHENG Han-xu, GU Guo-yan, SONG Xiao-du, YU Hai-yan, YIN Yong-mei, WU Hai-hong, TIAN Xin, GUAN Yue-hong, SHANG Yun-xiao, ZHAO Shuang, HUANG Fu-biao, MA Ying-chun 2024, 23 (01):  53-56, 61.  doi: 10.3969/j.issn.1671-4091.2024.01.012 Abstract ( 51 )   PDF (561KB) ( 14 )   Objective To evaluate the function of both upper limbs in right-handed maintenance hemodialysis (MHD) patients with arteriovenous fistula or graft for blood access, and to understand the influence of arteriovenous fistula or graft on upper limb function and the factors influencing the limb function at arteriovenous fistula or graft side.  Method  This was a cross-sectional study. Right-handed patients with arteriovenous fistula or graft from six hemodialysis centers in Beijing were enrolled. Demographic, biochemical data and upper limb function indexes including grip strength, range of joint motion, and Simple Test for Evaluating Hand Function (STEF) were collected. t test or non-parametric test was used to compare the upper limb function of arteriovenous fistula or graft side and non-fistula or graft side. Multivariate linear regression was used to analyze the influencing factors for grip strength at the arteriovenous fistula or graft limb side in MHD patients.  Results  A total of 90 MHD patients were enrolled, 51(56.7%) of the patients were males, the mean age was 59.63±10.60 years, and the median dialysis vintage was 62.50(24.00, 113.00) months. The grip strength of non-fistula or graft side was higher than that of fistula or graft side (23.03±10.77 vs. 20.66±10.52, t=-5.133, P＜0.001). Multivariate linear regression demonstrated that the grip strength at fistula or graft side was positively correlated to serum creatinine (β=0.353, P＜0.001) and cognitive function (β=0.223, P=0.006), and was negatively correlated to urea clearance index (Kt/V) (β=-0.235, P=0.007). The grip strength at fistula or graft side was higher in males than in females (β=-0.253, P=0.004). The motion range of carpal joint turned to ulnar side was greater in the non-fistula or graft limb than that in the fistula or graft limb (32.85±10.81 vs. 29.92±9.46, t=-2.814, P=0.006). In the STEF tests, the operation time for large ball (8.17±1.78 vs. 7.99±1.78，t=2.327，P=0.021), large disc (7.29±1.91 vs. 7.02±1.84，t=2.472，P=0.015) and cloth  (7.36±2.06 vs. 7.13±1.84，t=2.688，P=0.008) were longer in the fistula or graft side than those in the non-fistula or graft side, with the differences reached statistical significances (P＜0.05).  Conclusions  The grip strength, range of joint motion and flexibility were decreased in the fistula or graft side. The factors affecting the grip strength in fistula or graft side included gender, serum creatinine, Kt/V and cognitive function. Metrics

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Clinical analysis of refractory stenosis in vascular access treated with a progressive strategy WU Xian , YE Hong, GU Chun-feng, BIAN Xue-qin, LUO Yuan 2024, 23 (01):  57-61.  doi: 10.3969/j.issn.1671-4091.2024.01.013 Abstract ( 62 )   PDF (659KB) ( 18 )   Objective  The efficacy and prognosis of refractory stenosis in vascular access treated with a progressive treatment strategy were evaluated in order to find out suitable and effective approaches to maintain patency of vascular access.  Methods  The patients with stenosis in autologous arteriovenous fistula (AVF) at a higher site in cephalic vein arch and those with stenosis in artificial arteriovenous graft (AVG) at the venous anastomosis area treated with ultrasound-guided percutaneous transluminal angioplasty (PTA) for the first time in the Blood Purification Center of The Second Affiliated Hospital of Nanjing Medical University during the period from June 2020 to June 2021 were retrospectively analyzed. Progressive treatment strategy was used to maintain the patency of blood access for hemodialysis. Their patency and re-intervention rates were followed up for 24 months. The efficacy of progressive treatment strategy was compared to the prognosis of the patients with similar stenosis lesions only treated with PTA in the same blood purification center.  Results  A total of 31 patients having stenosis in AVF at a higher site in cephalic vein arch used the progressive treatment strategy, and 16 patients having the similar stenosis used the high pressure balloon dilation alone. After 24 months of follow-up, there were statistical differences in re-intervention times (t=4.461, P<0.001), average patency period after re-intervention (t=3.550, P<0.001) and PTA assistant patency rate (χ2=5.562, P=0.021) between the two groups. A total of 68 patients having stenosis in AVG at the venous anastomosis area used the progressive treatment strategy, and 58 patients having the similar stenosis used the high pressure balloon dilation alone. After 24 months of follow-up, there were statistical differences in re-intervention times (t=5.094, P<0.001) and average patency period after re-intervention (t=3.251, P=0.002) between the two groups.  Conclusion The progressive treatment strategy used suitable endovascular instruments and surgical approaches step-by-step to treat the refractory stenosis in AVF or AVG gradually. This method increased the patency rate, reduced the re-intervention times, and improved the prognosis of the patients. Metrics

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Establishment and validation of a risk prediction model for complications related to femoral vein catheterization for blood purification in children ZHANG Sheng-hua, JIANG Yu-qiu, LI Yin, SONG Shi-yi, TANG Jing, HU Yan 2024, 23 (01):  62-66.  doi: 10.3969/j.issn.1671-4091.2024.01.014 Abstract ( 36 )   PDF (594KB) ( 10 )   Objective  To establish for the first time a risk prediction model for complications related to femoral vein catheterization for blood purification in children, and to verify the prediction performance.  Methods  A total of 428 children with blood purification via femoral vein in the Pediatric Nephrology Department of West China Second University Hospital in Chengdu from January 2020 to June 2022 were selected. The risk factors for complications related to femoral vein catheterization were analyzed by univariate and multivariate logistic regression, and a risk prediction model presented as a nomogram was then developed. Receiver operating characteristic (ROC) curve and calibration curve were used to assess the discrimination and calibration of the model, and a total of 50 children with femoral vein blood purification and hospitalized in the same hospital from July 2022 to October 2022 were selected to verify the model.  Results  Multivariate regression analysis showed that etiology of renal failure, hypoalbuminemia, dysphoria, lower extremity edema, hypertension, peritoneal effusion, infusion of blood or blood products were the risk factors for femoral vein catheter-related complications in children with blood purification. The area under the ROC curve of the model was 0.794 (95% CI: 0.738～0.851, P<0.001), with the sensitivity of 0.733 and the specificity of 0.725. The maximum Youden index was 0.458, with prediction model’s goodness-of-fit of χ2=3.395 and P=0.907. Model verification results showed that the area under the ROC curve of the model was 0.810 (95% CI: 0.689～0.931, P<0.001) with the sensitivity of 0.739 and the specificity of 0.778.  Conclusion  This model has a satisfactory performance, and provides a reference for nurses to identify high-risk children and implement prevention care. Metrics

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Investigation of the empowerment status and its influencing factors in 323 patients with continuous ambulatory peritoneal dialysis ZHANG Ying, SHI Xue-zhi, GUAN Yu-xiang, ZHENG Jing, WANG Chao, XU Juan 2024, 23 (01):  67-70, 74.  doi: 10.3969/j.issn.1671-4091.2024.01.015 Abstract ( 36 )   PDF (561KB) ( 6 )   Objective  To investigate the current status and its influencing factors of empowerment in patients with continuous ambulatory peritoneal dialysis (CAPD).  Methods  A total 323 CAPD patients treated in the First Affiliated Hospital of Anhui University of Chinese Medicine from January 2022 to February 2023 were selected as the research subjects using convenience sampling method. General information questionnaire, the Simplified Peritoneal Dialysis Empowerment Scale, and Kidney Disease Quality of Life Scale were used to carry on the cross-sectional survey. Multivariate stepwise regression was used to analyze the influence factors for empowerment ability in CAPD patients.  Results  The score of the Simplified Peritoneal Dialysis Empowerment Scale in the 323 CAPD patients was 21.82±3.26. Multivariate stepwise regression showed that age (β=-1.543, P=0.030), education level (β=2.631, P=0.012), employment status (β=-3.021, P＜0.001), the main caregiver (β=-3.301, P＜0.001), dialysis age (β=2.498, P＜0.001), 24h ultrafiltration volume (β=1.373, P=0.004), major complications (β=-2.440, P＜0.001), and the quality of life (β=1.527, P＜0.001) were the factors influencing  empowerment ability in CAPD patients, and 62.0% of the total variation were explainable.  Conclusions  The empowerment ability needs to be improved in CAPD patients. Medical staff are required to adopt effective intervention measures to improve their empowerment ability and to help them actively manage the disease themselves, especially for those with older age, low education level, unemployment, non-family members as the main caregivers, low dialysis age, low ultrafiltration volume, and dialysis related peritonitis. Metrics

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Drug informatization management based on the collaboration between doctors and nurses on the compliance with dialysis medications and biochemistry parameters in hemodialysis outpatients CAO Ming-cong, MA Xiao-ying, JIA Ru-fu, WANG Ya-fei, PAN Ke-li, HU Jing 2024, 23 (01):  71-74.  doi: 10.3969/j.issn.1671-4091.2024.01.016 Abstract ( 36 )   PDF (569KB) ( 6 )   Objective  To explore the influence of drug informatization management based on the collaboration between doctors and nurses on the compliance with dialysis medications and biochemistry parameters in hemodialysis outpatients.  Methods  A total of 252 hemodialysis outpatients treated in the Blood Purification Division, Cangzhou Central Hospital from October 2021 to September 2022 were recruited using the convenience sampling method. The routine drug management method was used during October 2021 to March 2022, and the informatization management for dialysis medications based on the collaboration between doctors and nurses was used during April 2022 to September 2022. Paired t-test and paired χ2 test were used to compare the compliance with dialysis medications and biochemical parameters before and after the drug informatization management in hemodialysis patients.  Results  The compliance score of dialysis medications (t=32.563, P<0.001), hemoglobin (χ2=11.021, P=0.001), albumin (χ2=8.481, P=0.004), serum calcium (χ2=24.735, P<0.001), and intact parathyroid hormone (χ2=11.529, P=0.001) improved significantly after drug infomatization management, as compared those before drug infomatization management.  Conclusion  Drug informatization management based on the collaboration between doctors and nurses improves the compliance with dialysis medications and biochemical parameters in hemodialysis patients. This method is worthwhile to be used clinically. Metrics

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Peritonitis secondary to obstructive pyonephrosis in a peritoneal dialysis patient: report of a case and review of the literature WU Xiao-feng, LI Jian-ying, LI Jian-bo, LIN Jian-xiong, LIU Yuan-ying, GUO Qun-ying 2024, 23 (01):  75-77.  doi: 10.3969/j.issn.1671-4091.2024.01.017 Abstract ( 60 )   PDF (448KB) ( 34 )   Peritoneal dialysis (PD)-associated peritonitis is usually caused by contamination of the PD system or infection of exit site. Peritonitis may sometimes be present with gastrointestinal diseases, such as intestinal perforation, ischemic bowel disease or cholecystitis. PD-associated peritonitis due to obstructive pyonephrosis is rarely seen. Here we report the first case of PD-associated peritonitis due to obstructive pyonephrosis in a 72-year-old PD patient in China. He was then subjected to a left-sided percutaneous nephrostomy and nephrectomy without removal of the peritoneal dialysis catheter. No peritonitis relapsed in the next 8 months after the operation. From this case we can draw the experience that PD-associated peritonitis may derive from a focal infection, which is of diagnostic and therapeutic importance. Metrics