Chinese Journal of Blood Purification

12 February 2024, Volume 23 Issue 02 Previous Issue    Next Issue

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Interpretation of the 2023 International Society for Peritoneal Dialysis guideline recommendations for prevention and treatment of peritoneal dialysis catheter-related infection CHENG Shui-qin, YU Le, ZHANG Zhi-hong, YU Yu-sheng 2024, 23 (02):  81-85.  doi: 10.3969/j.issn.1671-4091.2024.02.001 Abstract ( 108 )   PDF (519KB) ( 10 )   Peritoneal dialysis (PD) catheter-related infection is a serious complication in PD patients, being an important risk factor for drawing out of PD catheter and peritonitis and affecting prognosis of the PD patients. In May 2023, the International Society for Peritoneal Dialysis (ISPD) updated the guideline recommendations for PD catheter-related infection, revised and clarified the definition and classification of PD catheter exit site infection (ESI) and tunnel infection. A new target that overall PD catheter ESI rate should be less than 0.4 episodes per year was established. The specific recommendation for prevention and treatment of PD catheter-related infections was provided, and the research direction of PD catheter-related infections was proposed. In this review, we present an interpretation on this guideline. Metrics

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Current situation and influencing factors of oral frailty in maintenance hemodialysis patients DOU Jun-kai, LI Li, MEI Yan, YANG Liang, LIU Huan, SHI Xue-zhi 2024, 23 (02):  86-90.  doi: 10.3969/j.issn.1671-4091.2024.02.002 Abstract ( 83 )   PDF (534KB) ( 8 )   Objective To investigate the current status of oral frailty in maintenance hemodialysis (MHD) patients and to explore its influencing factors.  Method  The convenient sampling method was used to select patients from the Hemodialysis Center of Lu'an Hospital of Anhui Medical University in the period from October 2022 to June 2023. This survey was conducted using a general information questionnaire, an oral frailty index-8, a simplified nutritional appetite questionnaire, and an age-charlson comorbidity index (aCCI).  Results The incidence of oral frailty in the 238 MHD patients was 41.2%. Binary logistic regression showed that educational level (OR=0.591, 95% CI:0.400～0.875, P=0.009), grip strength (OR=0.922, 95% CI:0.880～0.967, P=0.001), aCCI score (OR=1.820, 95% CI:1.498～2.212, P＜0.001), and simplified nutritional appetite survey scale score (OR=0.895, 95% CI: 0.803～0.998, P=0.046) were the influencing factors for oral frailty in MHD patients.  Conclusion  The prevalence of oral frailty is relatively high in MHD patients. Medical professionals should pay attention to the oral health problems in MHD patients and develop targeted intervention measures based on their conditions. Metrics

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The predictive value of baseline systemic inflammatory response index for the occurrence and prognosis of peritoneal dialysis-related peritonitis LIN Ru, MA Ya-nan, ZHANG Jin-jin, WANG Rui-feng, LIU Gui-ling 2024, 23 (02):  91-96.  doi: 10.3969/j.issn.1671-4091.2024.02.003 Abstract ( 47 )   PDF (480KB) ( 9 )   Objective  To investigate the predictive value of baseline systemic inflammatory response index (SIRI) for peritoneal dialysis-associated peritonitis (PDAP) in peritoneal dialysis (PD) patients.  Methods  A total of 140 patients undergoing PD catheterization in the Second Affiliated Hospital of Anhui Medical University from January 2014 to December 2020 were retrospectively analyzed. They were divided into peritonitis group and non-peritonitis group according to the presence or absence of PDAP. General clinical data and laboratory indexes were compared between the two groups. Binary logistic regression was used to analyze the risk factors for PDAP, and receiver operating characteristic (ROC) curve was used to evaluate the predictive value of baseline SIRI for the occurrence of PDAP. According to the prognosis in peritonitis group, the patients were further divided into a successful treatment group and an ineffective treatment group; the risk factors for peritonitis treatment failure were then analyzed.  Results  SIRI (Z=-4.347, P<0.001), white blood cell count (Z=-3.590, P<0.001), serum phosphorus (Z=-5.499, P<0.001), serum alkaline phosphatase (Z=-2.452, P=0.014), and total cholesterol (Z=-2.195, P=0.028) were significantly higher in the peritonitis group than in the non-peritonitis group. Multivariate logistic regression showed that higher SIRI (OR=2.084, 95% CI: 1.054～4.121, P=0.035), higher serum phosphorus (OR=11.826, 95% CI: 4.204～33.262, P<0.001) and higher serum alkaline phosphatase (OR=1.010, 95% CI: 1.002～1.019, P=0.022) were the risk factors for PDAP. ROC curve showed that the area under the curve of SIRI was 0.720, with the sensitivity of 69.2% and specificity of 67%. Higher baseline SIRI level (OR=0.446, 96% CI: 0.208～0.959, P=0.039) was a risk factor for treatment failure of PDAP.  Conclusions The baseline SIRI is associated with the risk of PDAP in PD patients, and is a good predictive indicator for the occurrence and prognosis of PDAP. Metrics

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Relationship between serum FGF-2 and FGF-23 levels and renal function and its prognosis in sepsis patients with acute kidney injury and treated by continuous renal replacement therapy LIN Ru, MA Ya-nan, ZHANG Jin-jin, WANG Rui-feng, LIU Gui-ling 2024, 23 (02):  97-101.  doi: 10.3969/j.issn.1671-4091.2024.02.004 Abstract ( 37 )   PDF (575KB) ( 9 )   Objective  To analyze the relationship between serum fibroblast growth factor (FGF)-2 and FGF-23 levels and renal function and its short-term prognosis in sepsis patients with acute kidney injury (AKI) and treated by continuous renal replacement therapy (CRRT).  Methods  A total of 157 sepsis patients complicated with AKI and treated by CRRT were enrolled in this study. Serum FGF-2 and FGF-23 levels were compared among patients with different AKI stage. Patients were divided into survival group and death group according to the prognosis at day 28. Serum FGF-2 and FGF-23 levels and renal function indexes were compared between the two groups, and the correlations were analyzed. The predictive value of serum FGF-2 and FGF-23 levels for short-term prognosis of AKI was evaluated.  Results  In patients with AKI Ⅲ, serum FGF-2 level was lower and serum FGF-23 level was higher, as compared those with AKI Ⅱ (t=20.149 and -8.060, P＜0.001). Serum FGF-23, creatinine (Scr) and cystatin C levels were higher in the death group than in the survival group, while serum FGF-2 and eGFR were lower in the death group than in the survival group  (t=-12.051, -17.462, -5.881, 25.990 and 15.997 respectively; P＜0.001). Pearson correlation analysis showed that serum FGF-2 was negatively correlated with Scr and cystatin C, and positively correlated with eGFR   (r=-0.511, -0.449 and 0.606 respectively; P＜0.001, 0.002 and ＜0.001 respectively). Serum FGF-23 was positively correlated with Scr and cystatin C, and negatively correlated with eGFR (r=0.610, 0.522, -0.654 respectively; P＜0.001). The predictive value of combined application of serum FGF-2 and FGF-23 levels was higher than that of the two indicators applied individually (Z=2.120 and 2.034, P=0.034 and 0.042).   Conclusion  Serum FGF-2 level is significantly reduced and FGF-23 level is significantly increased in sepsis patients with AKI. The lower serum FGF-2 level and higher serum FGF-23 level are associated with the decreased renal function and poor short-term prognosis. Simultaneous use of serum FGF-2 and FGF-23 levels improves the prediction value for short-term prognosis in sepsis patients with AKI. Metrics

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Correlation of peripheral blood CD4+/CD8+, neutrophil gelatinase-associated lipocalin (NGAL) and serum amyloid A protein (SAA) to bacterial infection and their diagnostic value in elderly patients with chronic renal failure undergoing hemodialysis MO FANG-ni, HU Ji-yang, LI Li 2024, 23 (02):  102-105,124.  doi: 10.3969/j.issn.1671-4091.2024.02.005 Abstract ( 34 )   PDF (541KB) ( 8 )   Objective To study the correlation of peripheral blood CD4+/CD8+, human neutrophil gelatinase-associated lipocalin (NGAL) and serum amyloid A protein (SAA) to bacterial infection and their diagnostic value in elderly patients with chronic renal failure (CRF) undergoing maintenance hemodialysis (MHD).  Methods  This was a cross-sectional study, which enrolled the elderly CRF patients treated with MHD in the hospital between October 2019 and October 2021. They were divided into infected group (n=61) and non-infected group (n=104) according to the presence or absence of bacterial infection. Blood CD4+/CD8+, NGAL and SAA were measured and compared between the two groups. Logistic regression model was established to analyze the relationship between the three blood indicators and bacterial infection in elderly CRF patients undergoing MHD. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of the three blood indicators.  Results  In infected group, CD8+ (28.54±2.48% vs. 27.61±2.09%, t=2.573, P=0.011), NGAL [(203.85±39.46)ng/ml vs. (149.71±26.84)ng/ml, t=6.670, P<0.001] and SAA [(21.83±4.75)ng/ml vs. (15.37±3.38)ng/ml, t=10.116, P<0.001] were higher, while CD4+ [(38.27±4.86)% vs. (45.18±5.13)%,    t=8.514, P<0.001] and CD4+/CD8+ (1.26±0.42 vs. 1.57±0.53, t=3.904, P<0.001) were lower, as compared with those in non-infected group. After adjusting age, gender and dialysis age (The dependent variable assignment was set at 1 in infected group and at 0 in non-infected group), logistic regression results showed that CD4+/CD8+ (OR=0.586, 95% CI: 0.440～0.780, P<0.001), NGAL (OR=1.324, 95% CI: 1.149～1.525, P<0.001) and SAA (OR=1.419, 95% CI: 1.251～1.610, P<0.001) were closely related to bacterial infection in elderly CRF patients undergoing MHD (P<0.05). Receiver operating characteristic (ROC) curve displayed that the area under curve (AUC) values of CD4+/CD8+, NGAL and SAA for the diagnosis of bacterial infection were 0.576, 0.738 and 0.838 respectively, with the sensitivities of 54.10%, 62.30% and 77.05% respectively, and the specificities of 63.46%, 83.65% and 77.88% respectively. Logistic regression model for comprehensive application of the three indicators was established and showed the AUC, sensitivity and specificity were 0.886, 85.25% and 79.81% respectively.  Conclusion  In elderly CRF patients undergoing MHD, the levels of peripheral blood CD4+/CD8+, NGAL and SAA were closely related to bacterial infection. Therefore, assays of CD4+/CD8+, NGAL and SAA can provide references for accurate and early diagnosis of bacterial infection. Metrics

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Analysis of the risk factors for left atrial enlargement and its impact on prognosis in chronic kidney disease LYU Tao, LI Wen, YAO Zheng, WU Lei-yun, ZHANG Ai-hua 2024, 23 (02):  106-110.  doi: 10.3969/j.issn.1671-4091.2024.02.006 Abstract ( 42 )   PDF (549KB) ( 7 )   [Abstract] Objective To analyze the risk factors, prevalence and prognostic effects of left atrial enlargement (LAE) in non-dialysis patients with chronic kidney disease （CKD）.Methods From January 2018 to December 2019, patients with stage 1 to 5 CKD who had not initiated dialysis and were hospitalized in the Department of Nephrology, Xuanwu Hospital of Capital Medical University and underwent echocardiography were selected and divided into LAE group and non-LAE group according to the diagnostic criteria of LAE. The demographic and biochemical data of patients were collected. The follow-up period ended November, 2021, and all-cause death or lost follow-up were the end point event. Results Among of the 524 patients with CKD, 299 had LAE （ 57.06%，299 / 524). The results of multivariate Logistic regression analysis showed that pre-existing chronic cardiovascular disease (OR = 3.365,95% CI 1.896-5970, P <0.001), hyperlipidemia (OR = 1.845,95% CI 1.042-3.265, P=0.036) and hypocalcemia (OR = 0.273,95% CI 0.082-0.912, P <0.035) were independent influencing factors for LAE in CKD patients. CKD patients with LAE had lower survival rate than those without LAE by Kaplan-Meier analysis(Log-rankχ2=13.093，P＜0.001）whereas the multivariate Cox regression analysis showed that age (Exp (B) =1.036,95%CI 1.011~1.062, P=0.005) and combined chronic cardiovascular disease (Exp (B) =2.175,95%CI 1.133~4.176, P=0.020) were independent risk factors for all-cause death in patients with chronic kidney diseases. Conclusions Prevalence of LAE is more than 50% of patients with stages 1 to 5 CKD. Chronic cardiovascular disease, hyperlipidemia and low blood calcium were independent risk factors for CKD patients with LAE, LAE increase risk all-cause death of CKD but it is not an independent risk factors for all-cause death in non-dialysis CKD patients. Metrics

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Predictive value of aortic calcification index in peri-dialysis period for long-term survival in maintenance hemodialysis patients ZHUANG Feng, WANG Ying-deng 2024, 23 (02):  111-115.  doi: 10.3969/j.issn.1671-4091.2024.02.007 Abstract ( 46 )   PDF (540KB) ( 7 )   Objective   To observe the incidence and mortality of adverse cardiovascular events in maintenance hemodialysis (MHD) patients with different aortic calcification index (ACI), and to explore the relationship between ACI and adverse cardiovascular events and mortality in patients during peri-dialysis period.  Method  The MHD patients beginning dialysis at the Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine from July 2014 to June 2018 were recruited. They were divided into high calcification group (ACI≥10%) and low calcification group (0≤ACI <10%) based on the first ACI examination. Long-term survival rate and incidence of adverse cardiovascular and cerebrovascular events were observed in the two groups of patients.  Result  This study enrolled a total of 82 patients, of which 73 cases (89%) had various degrees of aortic calcification, including 38 patients with ACI≥10% in the high calcification group. A total of 37 patients (45.1%) died at the end of follow-up; 15 cases (40.54%) died of infection and 12 cases, 32.43% died of adverse cardiovascular events, being the main causes of death. Multivariate linear regression showed that older age (β=0.214, 95% CI:1.107～1.386, P＜0.001) and history of cardiovascular and cerebrovascular diseases (β=-0.087, 95% CI: 0.203～4.128, P=0.039) were associated with higher ACI. After follow-up for 60 months, the survival rates were 78.2% and 57.3% in low ACI group and high ACI group respectively (OR=0.359, 95% CI:0.186～0.694, P=0.002). Both univariate and multivariate Cox regression analyses showed a significant correlation between high ACI and higher 5-year mortality in dialysis patients (univariate regression, HR=1.024, 95% CI:1.003～1.045, P=0.025; multivariate regression, HR=1.103, 95% CI:0.965～1.201, P=0.039). Multivariate COX analysis also showed that ACI≥10% was the risk factor for adverse cardiovascular and cerebrovascular events (HR=3.935, 95% CI:1.427～10.850, P=0.008) and death (HR=6.242, 95% CI:0.937～41.583, P=0.050) in dialysis patients.  Conclusion  Higher ACI in peri-dialysis period is related to the long-term survival rate and adverse cardiovascular events in MHD patients. The abnormal mineral bone metabolism and vascular calcification should be monitored earlier in CKD patients, and early intervention to these abnormalities may prolong their dialysis survival period. Metrics

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Factors for gastrointestinal bleeding in maintenance hemodialysis patients: a meta-analysis LIANG Qi, WANG Bing-jie, LIU Yang, ZHANG Chun-mei 2024, 23 (02):  116-120.  doi: 10.3969/j.issn.1671-4091.2024.02.008 Abstract ( 54 )   PDF (673KB) ( 7 )   Objective  To systematically evaluate the factors for gastrointestinal bleeding in maintenance hemodialysis (MHD) patients and provide a reference for early identification and intervention.  Methods A systematic search of databases, including PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang, VIP and CBM, was carried out to collect the risk factors for gastrointestinal bleeding in MHD patients until October 2022. Meta-analysis was performed by Revman5.3 software.  Results   A total of 16 articles with 154,234 patients were included. Meta-analysis showed that age (HR=1.209, 95% CI: 1.010～1.044, P=0.002), gender (HR=1.210, 95% CI: 1.063～1.377, P=0.004), alcohol consumption (OR=4.272, 95% CI: 1.243～14.679, P=0.020), stimulating diet (OR=4.052, 95% CI: 2.485～6.606, P=0.030), calcium (MD=          -0.241, 95% CI: -0.315～-0.168, P<0.001), platelet count (MD=2.342, 95% CI: 0.140～4.544, P=0.040), prothrombin time (MD=0.704, 95% CI: 0.060～1.348, P=0.030), plasma albumin (MD=-3.842, 95% CI: -6.361～-1.323, P=0.003), hemoglobin (MD=-13.484, 95% CI: -16.496～-10.471, P<0.001), blood creatinine (MD=85.194, 95% CI: 22.716～147.671, P=0.008), blood urea nitrogen (MD=4.540, 95% CI: 0.426～8.653, P=0.030), diabetes mellitus (HR=1.395, 95% CI: 1.257～1.548, P<0.001), liver cirrhosis (HR=1.763, 95% CI: 1.561～1.991, P<0.001), helicobacter pylori infection (OR=4.938, 95% CI: 3.139～7.768, P<0.001), use of non-steroidal anti-inflammatory drugs (HR=1.855, 95% CI: 1.628～2.113, P<0.001), and weekly dialysis time (MD=-1.876, 95% CI: -2.312～-1.440, P<0.001) were the influencing factors for gastrointestinal bleeding in MHD patients.  Conclusion According to the above factors, medical staff can identify the high-risk groups of gastrointestinal bleeding in MHD patients and take intervention measures to reduce the occurrence of gastrointestinal bleeding, improve their medical services, reduce medical costs, and optimize medical resources. Metrics

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Current status and clinical use of modified percutaneous peritoneal dialysis catheterization YANG Yun-xuan, DU Xuan-yi 2024, 23 (02):  121-124.  doi: 10.3969/j.issn.1671-4091.2024.02.009 Abstract ( 63 )   PDF (440KB) ( 4 )   A well-functioning peritoneal dialysis catheter (PDC) is a critical prerequisite for successful peritoneal dialysis (PD) therapy. There is no consensus about the best method for PDC placement. Ultrasound-guided Seldinger percutaneous puncture PD placement is now a well-established technology. However PD can still be terminated due to technical or infectious reasons such as catheter migration, leakage, and peritonitis. Therefore, continuous improvement of catheter placement techniques to increase catheter technical survival is an urgent issue to be solved. This article focuses on the improvement of operation procedures and the advantages of Seldinger percutaneous PDC placement. Metrics

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Research progress in the monitoring of arteriovenous fistula based on artificial intelligence and audio technology WANG Fan-li, XU Yuan-kai, ZHANG Li-hong, YANG Yan-li 2024, 23 (02):  125-129.  doi: 10.3969/j.issn.1671-4091.2024.02.010 Abstract ( 59 )   PDF (578KB) ( 9 )   Hemodialysis is the mainstay of renal replacement therapy for end-stage renal disease, and arteriovenous fistula (AVF) is the preferable method for vascular access recommended by major guidelines. However, repeated AVF failures affect the quality of life of the patients, and increase economic and social burdens. Therefore, continuous assessment of AVF function and early intervention to abnormal AVF is essential. Currently, artificial intelligence has become a hot issue due to the advantages of accurate and quantified results, homogenized and remote diagnosis and treatment, as compared to the physical examination of AVF. In this article, research progresses in AVF acoustic feature and its extraction method, selection of machine learning method, and the development of AVF monitoring system by artificial intelligence are reviewed in order to explore the research pathways and the direction of clinical research. Metrics

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Research advances in the relationship between hypoxia-inducible factor-1α and renal fibrosis YAN Tong, JIA Xin-yan, GUO Ming-hao 2024, 23 (02):  130-133.  doi: 10.3969/j.issn.1671-4091.2024.02.011 Abstract ( 58 )   PDF (702KB) ( 7 )   Renal fibrosis is the common pathological hallmark of various chronic kidney diseases, characterized by progressive accumulation of extracellular matrix (ECM). Hypoxia-inducible factor (HIF) is a key regulator of body’s response to hypoxia. HIF regulates ECM synthesis, epithelial-mesenchymal transition (EMT) and pro-fibrosis signaling pathways. This review summarized the relationship between HIF-1α and renal fibrosis. Metrics

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Study on the application effect of internet-based intelligent gripper to promote maturation of autologous arteriovenous fistula in hemodialysis patients MA Qin, LIU Peng-cheng, JIANG Xiao-mei 2024, 23 (02):  134-137,142.  doi: 10.3969/j.issn.1671-4091.2024.02.012 Abstract ( 40 )   PDF (555KB) ( 7 )   Objective  To study the application effect of internet-based intelligent gripper to promote maturation of autologous arteriovenous fistula (AVF) in hemodialysis patients.  Methods  A total of 40 patients with end-stage renal disease were recruited and assigned to control group that used traditional grip strength exercise training in The Second Affiliated Hospital of Suzhou University during January 2021 to December 2021; a total of 30 patients using the internet-based intelligent gripper strength training were assigned to research group from January 2022 to December 2022. Maturation rate of the AVF, first puncture time, success rate of the first puncture, puncture complication, and compliance with postoperative grip strength exercise training were compared between the two groups. Results After the surgery for 4 weeks, clinical maturation rate (χ²=1.542, P=0.228) and ultrasound maturation rate (χ²=0.420, P=0.517) had no significant differences between the two groups. After the surgery for 8 weeks, clinical maturation rate (χ²=16.324, P<0.001), ultrasound maturation rate (χ²=12.343, P<0.001), venous diameter (t=8.358, P<0.001), and brachial artery flow   (t=8.320, P<0.001) were higher in research group than in control group, and the depth from vein to skin was lower in research group than in control group (t=12.718, P<0.001). In research group, the first use of the AVF was earlier (t=6.665, P<0.001), the success rate of the first puncture was higher (χ²=13.611, P<0.001), the complication rate was lower (χ²=5.605, P=0.018), and the compliance rate with postoperative grip exercise training was higher (χ²=7.805, P=0.005), as compared those with control group.  Conclusion Internet-based intelligent gripper training can shorten the maturation time of AVF, improve the maturation rate of AVF, ensure success rate of the first puncture, reduce the incidence of complications, and improve the compliance with grip exercise training in hemodialysis patients. Metrics

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Investigation on the status of vascular access in maintenance hemodialysis patients in primary hospitals HUI Xin, BIAN Xue-qin, DING Hao, WU Xian, LUO Yuan, XU Fang-fang, ZHANG Ya-qi, WANG Hong-mei, XU Zhi-yu, WANG Ying, YE Hong 2024, 23 (02):  138-142.  doi: 10.3969/j.issn.1671-4091.2024.02.013 Abstract ( 57 )   PDF (520KB) ( 5 )   Objective  To investigate the status of vascular access in maintenance hemodialysis (MHD) patients in primary hospitals.  Methods  This was a multi-center and cross-sectional study, which collected clinical data of the MHD patients in the hemodialysis centers of 15 primary hospitals located in 8 regions in Jiangsu and Anhui provinces from March 2023 to August 2023.  Results  A total of 650 MHD patients who met the criteria were investigated, including 342 males (52.62%) and 308 females (47.38%) with a median dialysis age of 5.48 (2.00, 8.00) years. For blood access of the first hemodialysis, non-cuffed catheter was used in 291 cases (48.10%), and autologous arteriovenous fistula (AVF) was used in 271 cases (44.79%). For current blood access of hemodialysis, autologous AVF was used in 518 cases (85.62%); rope ladder puncture technique on the AVF was used in 100 cases (19.30%), and regional puncture technique was used in 412 cases (79.54%). For blood access in patients with arteriovenous graft, rope ladder puncture technique on the graft was used in 29 cases (90.63%). Vascular stenosis, the main complication of vascular access, occurred in 177 cases (34.17%) in patients with autologous AVF and in 10 cases (31.25%) in those with arteriovenous graft.  Conclusion  The status of vascular access in MHD patients in the hemodialysis centers in primary hospitals meets the expectations of primary hospitals. However, performance of blood access should be further standardized, and personnel training should be reinforced to find out and manage vascular stenosis earlier. Metrics

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Application and complication of the promptly used type of artificial blood vessel for vascular access LIU Cheng, WEN Yu, YANG Xue, LIN Ze-hong, ZHANG Zhen-hua 2024, 23 (02):  143-146.  doi: 10.3969/j.issn.1671-4091.2024.02.014 Abstract ( 36 )   PDF (483KB) ( 6 )   Objective  To study the effect and complication of the promptly used type of artificial blood vessel for vascular access.  Methods  A total of 83 patients undergoing the surgery of artificial blood vessel implement in People’s Hospital of Ziyang during February 2019 to February 2022 were recruited as the research subjects. According to the diameter of outflow vein, they were divided into promptly used type of artificial blood vessel group (diameter of outflow vein >4mm, n=41) and expanded polytetrafluoroethylene (ePTFE) type of artificial blood vessel group (diameter of outflow vein 3～4mm, n=42). They were followed up for 18 months after the surgery. Postoperative patency rate, effectiveness, complication and survival rate were compared between the two groups.  Results  The primary patency rates and secondary patency rates after the surgery for 6, 12 and 18 months had no statistical significances between promptly used type group and ePTFE type group (Primary patency rate: t=1.437, 0.609 and 0.595 respectively; P=0.231, 0.435 and 0.441 respectively. Secondary patency rate: t=2.108, 0.149 and 0.310 respectively; P=0.147, 0.699 and 0.578 respectively). The time of first puncture and the time of dialysis catheter removal after the surgery were shorter in promptly used type group than in ePTFE type group (t=78.386 and 21.491, P<0.001). Postoperative dialysis blood flow and artificial vessel utilization rate were similar between the two groups (t/χ²=0.214 and 0.988, P=0.831 and 0.320). The incidence of postoperative swelling and thrombosis were lower in promptly used type group than in ePTFE type group (χ²=24.418 and 7.540, P＜0.001 and 0.006). The survival rates of the patients after the surgery for 6, 12 and 18 months had no statistical significances between the two groups (χ²=1.037, 0.239 and 0.183 respectively; P=0.309, 0.625 and 0.668 respectively).   Conclusion  The promptly used type of artificial blood vessel for vascular access has the advantages of earlier puncture, higher patency rate, and lower risk of complications, and is worthwhile to be widely used clinically. Metrics

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Construction of a clustered nursing strategy for non-cuffed catheter based on multi-criteria decision analysis method REN Yu-shen, CHEN Na, WANG Xiao-ping, QUAN Yue, NI Wei-lian, XIANG Yang, CHANG Pan, TIAN Li 2024, 23 (02):  147-151.  doi: 10.3969/j.issn.1671-4091.2024.02.015 Abstract ( 39 )   PDF (486KB) ( 5 )   Objective  To construct a clustered nursing strategy for tunnel-free and non-cuffed catheter (NCC) in hemodialysis (HD) patients using multi-criteria decision analysis (MCDA) method.  Methods  We systematically searched for relevant literature on NCC nursing from the National Guidelines Library of the United States, the International Guidelines Collaboration Network, the Ontario Registered Nurses Association, the China Medical Association Guidelines Network, Pubmed, Embase, Medline databases, Cochrane Library, CNKI, VIP, Wanfang, and the China Biomedical Literature Database. The search period is from January 2010 to July 2022. Ten experts in the fields of hemodialysis, vascular access, and infection control used MCDA method to form a NCC cluster nursing strategy, which was preliminarily applied to verify its clinical feasibility.  Results  The authority coefficient of the 10 consultation experts was 0.88. Based on the ranking of scores from high to low, 8 optimized nursing strategies were formed, namely sterile technology (590.45), care of the catheter outlet area (587.65), flushing tube care (585.25), sealing care (582.75), replacement and selection of dressing (574.83), tubing operation (573.85), maintenance evaluation (573.40), and catheter joint care (573.12).  Conclusions  The NCC cluster nursing strategy constructed using MCDA science is clinically practicable and will be continuously optimized after use to improve patient quality of life. Metrics

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Application of experiential diet management in peritoneal dialysis patients CHEN Jie, DU Wen-ting, LIU Fang-fang, WU Su-hang 2024, 23 (02):  152-156.  doi: 10.3969/j.issn.1671-4091.2024.02.016 Abstract ( 48 )   PDF (487KB) ( 6 )   Objective  To investigate the effect of experiential diet management on dietary compliance and nutritional status of peritoneal dialysis (PD) patients.  Methods  The subjects were PD patients from Department of Nephrology, the First Affiliated Hospital of Zhengzhou University.  They were randomly assigned to the intervention group (experiential diet management group) and the control group (routine diet management group) by using the random number table method.  Results  A total of 97 patients were enrolled in the study, including 48 in the intervention group and 49 in the control group. Dietary knowledge, dietary compliance attitude, dietary compliance behavior and incidence of malnutrition were compared between the two groups before intervention, at discharge from the hospital, 3 months after discharge, and 6 months after discharge, and the differences were statistically significant (P<0.05).  Conclusion  Experiential diet management allows the patients to simulate and experience various scenarios of diet management and to increase the sense of participation, thereby improving patients' knowledge level, diet compliance, diet structure, and nutritional status. Metrics

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Current status of nutritional literacy and its influencing factors in maintenance hemodialysis patients LI Yi, MENG Qing-lan, HAO Jian, ZHANG Li-juan, ZHU Ting, XI Xiao-yan, WU Su-zhen 2024, 23 (02):  157-160.  doi: 10.3969/j.issn.1671-4091.2024.02.017 Abstract ( 58 )   PDF (482KB) ( 6 )   Objective  To explore the current situation and influencing factors of nutritional literacy in maintenance hemodialysis (MHD) patients.  Methods  A total of 200 MHD patients treated in the Hemodialysis Center, The Affiliated Hospital of Inner Mongolia Medical University from April 2023 to June 2023 were recruited in this study. General Information Questionnaire, Social Support Rating Scale, Self-Management Scale for Hemodialysis Patients, and Nutritional Literacy Evaluation Scale for Hemodialysis Patients were used as the questionnaires to the MHD patients.  Results  The nutritional literacy score of MHD patients was 19.99±3.72. Multivariate linear regression analyses showed that gender (β=0.142, P=0.003), literacy level    (β=0.188, P=0.001), mode of residence (β=0.112, P=0.020), daily urine output (β=0.249, P＜0.001), dialysis age (β=0.193, P=0.001), primary disease (diabetes) (β=-0.144, P=0.005), social support (β=0.113, P=0.032), and self-management (β=0.449, P＜0.001) were the influencing factors for nutritional literacy in MHD patients (P<0.001).  Conclusion  The level of nutritional literacy in MHD patients is at an intermediate level, and further improvement is required. Metrics