Chinese Journal of Blood Purification

12 March 2024, Volume 23 Issue 03 Previous Issue    Next Issue

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How to assess the microcirculation status of critically ill patients? SUN Xue-feng 2024, 23 (03):  161-164.  doi: 10.3969/j.issn.1671-4091.2024.03.001 Abstract ( 48 )   Accurate assessment of microcirculation status in critically ill patients is of great value in guiding clinical decisions on fluid resuscitation, the use of vasoactive medications, and renal replacement therapy. This article introduces the common methods, effects and precautions for evaluation of microcirculation status in these patients based on evidence-based evidence, aiming to provide guidance to diagnose microcirculation disorders in time and improve treatment levels. Metrics

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Screening and predictive value of serum markers related to coronary artery calcification in peritoneal dialysis patients CHENG Hong-juan, WU Xiao-rong, ZHOU Wei, ZENG Ming 2024, 23 (03):  165-169.  doi: 10.3969/j.issn.1671-4091.2024.03.002 Abstract ( 45 )   Objective  To observe the clinical features of coronary artery calcification (CAC) in peritoneal dialysis (PD) patients, to find out serological markers for evaluating CAC, and to estimate their application values for the diagnosis of CAC.  Methods  The PD patients treated during March 2022 to March 2023 in the Department of Nephrology, Nanjing Gaochun People's Hospital were recruited for this study. Their clinical data were collected, laboratory examinations were improved, and serum sclerostin, dephospho-uncarboxylated matrix glaprotein (dp-ucMGP) and soluble growth stimulation expressed gene 2 (sST2) were dtermined by ELISA. Spiral CT was used to assess the coronary artery calcification score (CACS). According to CACS, patients were then divided into non-calcified group (CACS=0), mild calcified group (0＜CACS＜100), moderate calcified group (100≤CACS≤400) and severe calcified group (CACS>400). Clinical data and serum indexes were compared among the four groups, and the serological markers were then screened for evaluating CAC.  Results  The prevalence of CAC was 67.96% (70 cases) in a total of 103 PD patients. There were statistical differences in age (F=9.644, P＜0.001), dialysis age (F=8.141, P=0.043), cardiovascular disease rate (F=8.424, P=0.038), total Kt/V (F=3.775, P=0.013), alkaline phosphatase (F=7.909, P=0.048), sclerostin (F=31.513, P＜0.001), dp-ucMGP (F=24.188, P＜0.001), sST2 (F=8.691, P=0.034), and B-type natriuretic peptide precursor (F=13.922, P=0.003) among the four groups. Multivariate logistic regression showed that older age (OR=1.192, 95% CI：1.070～1.327, P=0.001), low Kt/V (OR=0.006, 95% CI：0.000～0.418, P=0.018), higher sclerotin (OR=1.826, 95% CI：1.194～2.792, P=0.006), and higher dp-ucMGP (OR=1.990, 95% CI：1.235～3.207, P=0.005) were the independent risk factors for CAC. ROC curve analysis showed that the areas under the curve of serum sclerostin, dp-ucMGP  and their combined for predicting CAC in PD patients were 0.817 (95% CI: 0.715～0.919, P＜0.001), 0.797 (95% CI：0.705～0.889, P＜0.001), and 0.855 (95% CI：0.776～0.935, P＜0.001) respectively.  Conclusion Serum sclerostin and dp-ucMGP levels are potentially sensitive serological markers for predicting CAC in PD patients, having important value for clinical application. Metrics

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Efficacy and safety of expanded hemodialysis in hemodialysis patients: a meta-analysis DING Hong-yun, JIANG An-ya, YAN Hua-xian, ZHOU Zu-lian 2024, 23 (03):  170-176.  doi: 10.3969/j.issn.1671-4091.2024.03.003 Abstract ( 49 )   Objective  To systematically evaluate the efficacy and safety of expanded hemodialysis (HDx) in hemodialysis (HD) patients.  Methods  Pubmed, Embase, Cochrane Library, Web of science, CNKI, Wanfang and VIP databases were searched from the establishment of the database to September 2022 for clinical and prospective studies on HDx intervention in HD patients. The quality of the included literature was evaluated according to the risk bias assessment of the Cochrane Collaboration Network. Meta-analysis was performed using RevMan5.3 software.  Results Twenty trials including 846 HD patients were enrolled for the analyses. They were divided into HDx group, HD group and hemodiafiltration (HDF) group. The Kt/V value in HDx group was significantly higher than that in HD group (MD=0.052, 95% CI: 0.012～0.092, P=0.012), but there was no significant difference between HDx group and HDF group (MD=-0.012, 95% CI: -0.118～0.094, P=0.828). The clearance rate of β2 microglobulin (β2-MG) in HDx group was significantly higher than that in HD group (MD=6.542, 95% CI: 3.411～9.672, P< 0.001), and was lower than that in HDF group (MD=-3.733, 95% CI: -5.262～-2.203, P<0.001). The clearance of human immunoglobulin κ free light chain (κFLC) and human immunoglobulin λ free light chain (λFLC) in HDx group was significantly higher than that in HD group (κFLC: MD=15.793, 95% CI: 9.912～21.647, P<0.001; λFLC: MD=22.412, 95% CI: 18.282～26.542, P<0.001), but was similar to that in HDF group (κFLC: MD=-2.224, 95% CI: -5.408～0.961, P=0.171; λFLC: MD=0.417, 95% CI: -7.945～8.779, P=0.922). Serum albumin (ALB) loss in HDx group was higher than that in HD group, and there was no difference between HDX group and HDF group (HD: MD=2.010, 95%  CI: 1.327～2.692, P＜0.001;  HDF:MD=0.050,  95% CI: -1.626~1.726, P=0.953). The incidence of adverse events showed no significant difference between the HDx group and both the HD and HDF groups (HD: MD=0.624, 95% CI: 0.365～1.066, P=0.084; HDF:MD=0.860, 95% CI: 0.726～1.020, P=0. 141).  Conclusion  HDx increased the clearance of medium and large molecular weight uremia toxins, and is preferable for patients with unsatisfactory vascular access. Metrics

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Comparison of the application of domestic BLT-D800 and imported Braun Dialog+ hemofiltration machines LI Qi, LI Xiao-ying, ZHANG Qing-hua, ZHANG Zhong-qin 2024, 23 (03):  177-180.  doi: 10.3969/j.issn.1671-4091.2024.03.004 Abstract ( 48 )   Objective To investigate the performance of domestic Biolight D800 hemofiltration machine (BLT-D800 Guangdong Biolight Meditech CO., China).  Method  This was a randomized controlled study, using the imported Braun Dialog+ hemofiltration machine (B. Braun Avitum AG, Germany) as the control. A total of 120 patients undergoing maintenance hemodialysis (MHD) at the Blood Purification Center, Guizhou Hospital of Beijing Jishuitan Hospital were recruited for this study. They were divided into 2 groups (n=60/group) by a random number table method. Patients in each group were treated with hemodialysis (HD) 3 times/week and post diluted hemodiafiltration (HDF) once/month. Dialysis complications, treatment effects, dialysate for the machine and other indicators were observed during HDF.  Result  The ratios of hypotension, hypertension, muscle cramp, and choking sensation in chest were similar between the two groups (χ2=0.178, 0.934, 0.167 and 0.164 respectively; P=0.677, 0.358, 0.666 and 0.873 respectively). After HDF treatment, Kt/V, urea reduction rate (URR) and serum β2 microglobulin (β2-MG) were also similar between the two groups (t=     -0.426, 0.165 and 0.046 respectively; P=0.381, 0.692 and 0.833 respectively). Ultrafiltration error was statistically higher in the control group (t=-14.956, P＜0.001).  Conclusion  The domestic BLT-D800 hemofiltration machine is stable for blood purification performance, and is capable to carry out HDF safely and effectively. Metrics

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The correlation between serum vitamin K2 and abdominal aortic calcification in patients with chronic kidney disease at stage 3～5 CHEN Tian-hao, HUANG Zheng, WAN Hua, ZHAO Ping, SHI You-shan, SHI Xiao-jun, FANG Dan-dan, CHONG Xiao-feng, XU Chuan-yin 2024, 23 (03):  181-185.  doi: 10.3969/j.issn.1671-4091.2024.03.005 Abstract ( 34 )   Objective  To investigate the correlation between serum vitamin K2 (VitK2) and abdominal aortic calcification (AAC) in patients with chronic kidney disease (CKD) at stage 3～5, and to analyze the risk factors for vascular calcification (VC), so as to provide new ideas for diagnosis, treatment, and control of VC.  Methods   A total of 178 CKD patients at stage 3～5 and hospitalized in the Department of Nephrology, Tianchang People’s Hospital from September 2020 to May 2023 were recruited as the study subjects. Lumbar lateral X-ray examination was used to determine AAC, by which patients were assigned into calcification group or control group. VitK2 and its related indexes were compared between the two groups. Binary logistic regression was used to analyze the independent influencing factors for AAC. The correlation between VitK2 and AAC was then discussed.  Results  There were 104 cases (59 males and 45 females) in calcification group, with an average age of 67.58±11.90 years, and there were 74 cases (54 males and 20 females) in control group, with an average age of 52.86±14.17 years. The overall calcification rate was 58.43%. Compared with control group, estimated glomerular filtration rate (eGFR) (Z=1.974, P=0.041), VitK2 (Z=3.765, P=0.025) and serum uric acid decreased (t=2.373, P=0.022), and serum 25-hydroxyvitamin D3 (Z=2.077, P=0.042) and CRP (Z=3.214, P=0.001) increased in calcification group. Multivariate regression showed that VitK2 (OR=0.425, 95% CI:0.146～0.617, P=0.005), eGFR (OR=0.854, 95% CI:0.814～0.886, P=0.023) and age (OR=1.123, 95% CI:1.075～1.176, P=0.001) were the independent influencing factors for AAC. The equation from regression model was ln[P/(1-P)]=-2.657+0.122×age-0.166×eGFR-0.866×VitK2. Correlation analysis showed that AAC was negatively correlated with VitK2 (r=-0.253, P=0.034) and eGFR (r= -0.263, P=0.005), and was positively correlated with age (r=0.343, P=0.001), CRP (r=0.241, P=0.001) and intact parathyroid hormone (r=0.191, P=0.011).   Conclusion   Serum VitK2 is correlated with AAC. Serum VitK2, eGFR and age are the independent influencing factors for AAC. Serum VitK2 level can be used as an important reference marker for prediction of VC. Metrics

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Observation of short-term potassium-lowering effect of sodium zirconium cyclosilicate in patients with hyperkalemia HUANG Zhen-xing, WANG Yu-ying, GAO Xin-ying, LIU Xiao-yong 2024, 23 (03):  186-188.  doi: 10.3969/j.issn.1671-4091.2024.03.006 Abstract ( 39 )   Objective  To observe the short-term potassium-lowering effect and adverse reactions of sodium zirconium cyclosilicate dispersion in patients with hyperkalemia.  Methods  The clinical data of 50 inpatients with hyperkalemia who received sodium zirconium cyclosilicate dispersion at Xining City First People's Hospital from November 2020 to March 2022 were collected and retrospectively analyzed for the potassium-lowering effects after 2 hours and 8 hours post-medication as well as any adverse drug reactions.  Results  Blood potassium levels after 2 hours and 8 hours post-medication were significantly lower than those before medication (t=10.034 and 14.654, P＜0.001), while there were no significant differences in blood sodium, calcium, magnesium, CO2CP, ALT, and AST levels before and after medication (P>0.05). Scatter plot analysis showed a linear positive correlation between the degree of decrease in blood potassium at 2 hours and 8 hours post-medication and the pre-medication blood potassium levels (r=0.298 and 0.579, P=0.038 and ＜0.001). There was no statistically significant difference in the degree of potassium reduction between the group with GFR ≤15ml/min and the group with＞15 ml/min at both 2 hours and 8 hours post-medication (t=-1.452 and 1.594, P=0.153 and 0.118). During treatment, two patients experienced mild nausea after taking the drug.   Conclusion  Sodium zirconium cylcosilicate dispersion can safely and effectively reduce blood potassium levels within 2-8 hours in patients with hyperkalemia without severe adverse reactions. Metrics

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Analysis of risk factors in Maintenance hemodialysis patients with Left ventricular diastolic dysfunction YU Dan-xia, HUANG Hong, QIU Qiang 2024, 23 (03):  189-192.  doi: 10.3969/j.issn.1671-4091.2024.03.007 Abstract ( 41 )   Objective  To explore risk factors of left ventricular diastolic dysfunction (LVDD) in maintenance hemodialysis patients.  Methods  This study was a retrospective study. One hundred maintenance hemodialysis patients in Blood purification Center of Beijing shunyi district hospital were enrolled. According to the results of doppler echocardiography，the early diastolic flow-velocity peak (Ve) and the diastolic flow-velocity peak (Va) were measured at the mitral annulus on the four-chamber apical view of the heart，and the ratio of Ve to Va was calculated. LVDD was defined as Ve/Va＜1. According to the diagnostic criteria, patients were divided into the LVDD group and the normal group. General information and biochemical index was collected and compared between groups，and logistic regression analysis was used to explore the risk factors of LVDD in maintenance hemodialysis patients.  Results   ①In the LVDD group，the rate of diabetic nephropathy patients was higher than that in the control group (χ2=4.332，P=0.024). ②There was significant increases in the levels of systolic blood pressure (t=6.443, P=0.033), calcium-phosphorus product (t=5.419, P=0.043) and C-reactive protein (t=5.107, P=0.036) in the LVDD group，and a significant decrease in the level of serum albumin (t=6.759，P=0.008). ③Logistic regression analysis showed that systolic blood pressure was an independent risk factor of LVDD (OR=1.245，95% CI: 0.987～1.008，P=0.001)，and the albumin serves as a protective factor (OR=2.061，95% CI: 0.091～1.239, P=0.037).  Conclusions  Diabetic nephropathy, systolic blood pressure, malnutrition, calcium-phosphorus product and C-reactive protein are associated with the prevalence of LVDD in maintenance hemodialysis patients. Meanwhile, SBP and serum albumin may be the important independent risk factors of LVDD in maintenance hemodialysis patients. Metrics

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Research progress on the prognostic influence of net ultrafiltration intensity in critically ill patients receiving continuous renal replacement therapy TANG You-li, YANG Ying-ying, ZHANG Ling 2024, 23 (03):  193-196.  doi: 10.3969/j.issn.1671-4091.2024.03.008 Abstract ( 44 )   Net ultrafiltration (UFNET) during continuous renal replacement therapy (CRRT) is often used to treat fluid overload (FO) in critically ill patients, but the effect of UFNET intensity on the prognosis of critically ill patients remains unclear. This article reviews the effects of FO on critically ill patients and the effects of different levels of UFNET on organ function, mortality, dialysis dependence, and potential tools that may be used to guide the adjustment of UFNET to draw clinicians' attention to the optimal UFNET intensity during CRRT treatment. Metrics

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Advances in the diagnosis and treatment of encapsulated peritoneal sclerosis in peritoneal dialysis patients LOU Fang-fang, LIU Xiao-yi, XIE Chao, KONG Yao-zhong 2024, 23 (03):  197-199,218.  doi: 10.3969/j.issn.1671-4091.2024.03.009 Abstract ( 35 )   Peritoneal dialysis (PD) is now widely used in the long-term treatment of patients with end stage renal disease (ESRD). Encapsulating peritoneal sclerosis (EPS) is a rare and serious complication of long-term PD patients with a high morbidity and mortality rate. The clinical symptoms of EPS mainly include irregular, persistent or frequent gastrointestinal obstruction symptoms often accompanied by severe abdominal pain, nausea, and vomiting. Imaging mostly shows progressive fibrotic thickening and sclerosis of the peritoneum, leading to intestinal encapsulation and followed by partial or complete intestinal obstruction. The purpose of this review is to introduce the pathogenesis of EPS and the progress of its diagnosis and treatment. Metrics

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Management of patients with diabetic end⁃stage renal disease on peritoneal dialysis LIU Chen-xi, XIA Ming, LIU Hong 2024, 23 (03):  200-203.  doi: 10.3969/j.issn.1671-4091.2024.03.010 Abstract ( 36 )   The prognosis and quality of life remain poor in diabetic end⁃stage renal disease patients on peritoneal dialysis. This paper reviews current obstacles, dialysis prescription, glycemia control measurements, and other management strategies, aiming to provide references for clinical work and research. Metrics

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Risk predictive models for catheter-associated bloodstream infection in hemodialysis patients: a systematic review ZHANG Wei, ZHAO Ruo-bing, ZHOU Yan, HE Jian-qiang, PEI Kun, LIU Xi-yang 2024, 23 (03):  204-208.  doi: 10.3969/j.issn.1671-4091.2024.03.011 Abstract ( 38 )   Objective  To systematically evaluate the risk prediction model for catheter-related bloodstream infection in hemodialysis patients and to provide references for selecting appropriate prediction models or developing new models.  Methods  We searched related literature in CINAHL, PubMed, Web of Science, Cochrane Library, Embase, Wanfang database, CNKI, VIP website, China and Chinese biomedical literature database from establishing the database to October 1, 2023. Two investigators independently screened the literature, extracted data, and analyzed the risk of bias and applicability of included literature using the prediction model risk of bias assessment tool (PROBAST).  Results  A total of seven articles were included. Age, combined diabetes, serum albumin level, hand hygiene and catheter retention time were the major predictors for catheter-related bloodstream infection. The area under the curve was 0.734 to 0.889, from which four models were calibrated. All studies were well applicable but had a risk of bias.  Conclusion  The risk prediction models of catheter-related bloodstream infection in hemodialysis patients have better prediction performance, but with higher risks of bias caused by methodological defects, such as improper processing of missing data, variable selection without appropriate methods, no mention of blindness, and others. Therefore, they cannot be directly applied in clinical practice yet. In the future, the existed models should be verified in-depth and extensively by prospective studies using large sample and multiple population to develop prediction models with excellent predictive performance and simple use. Metrics

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Construction of risk prediction model for thrombosis in autogenous arteriovenous fistula in maintenance hemodialysis patients JIN Xiao-yu, LI Jing-shu, WU Feng-ru, LIU Lu-ning, FAN Yu-ying 2024, 23 (03):  209-213.  doi: 10.3969/j.issn.1671-4091.2024.03.012 Abstract ( 53 )   Objective  To construct a risk prediction model for thrombosis in autogenous arteriovenous fistula (AVF) based on machine learning, and to verify the model.  Methods  A total of 270 patients undergoing maintenance hemodialysis (MHD) in Hemodialysis Center, The Second Affiliated Hospital of Harbin Medical University from March 2020 to December 2021 were recruited as the study subjects. Logistic regression and random forest were used to construct the models. Receiver operating characteristic curve and area under the curve (AUC) were plotted for each model. AUC, accuracy, specificity, sensitivity and F1-score were used to evaluate the models.  Results  Among 270 MHD patients, 105 cases (38.89%) were in AVF thrombosis group and 165 cases (61.11%) in non-AVF thrombosis group. The seven risk factors of smoking history (OR=2.992, 95% CI: 1.306～6.854, P=0.010), hypertension history (OR=12.376, 95% CI: 3.432～44.624, P<0.001), diabetes history (OR=7.477, 95% CI: 2.887～19.360, P<0.001), hyperlipidemia history (OR=6.947, 95% CI: 2.733～17.659, P<0.001), coronary heart disease history (OR=12.894, 95% CI: 4.827～34.439, P<0.001), puncture point compression time (OR=1.132, 95% CI: 1.053～1.217, P=0.010), and triglyceride (OR=1.322, 95% CI: 1.005～1.741, P=0.046) were used to construct risk prediction models. The area under the curve of random forest prediction model was 0.944, and that of logistic regression model was 0.895 (Z=1.688, P=0.092).  Conclusion  Smoking history, hypertension history, diabetes history, hyperlipidemia history, coronary heart disease history, puncture point compression time and triacylglycerol are high risk factors for thrombosis in AVF in MHD patients. The two models based on the seven risk factors have good predictive performance and can be complementary each other. Metrics

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Construction of a nomogram model of individualized risk prediction for postoperative arteriovenous fistula dysfunction in hemodialysis patients GONG Chun-chen, WANG Ting-ting, MA Qing, DUAN Su-yan, XU Xian-rong 2024, 23 (03):  214-218.  doi: 10.3969/j.issn.1671-4091.2024.03.013 Abstract ( 36 )   Objective To construct a nomogram model for postoperative arteriovenous fistula (AVF) dysfunction in hemodialysis patients.  Methods  A total of 126 hemodialysis patients undergoing AVF operation in our hospital from July 2021 and July 2023 were taken as the research subjects. They were divided into dysfunction group (n=31) and normal function group (n=95) according to the postoperative AVF function. Their clinical data were collected. The influencing factors for postoperative AVF dysfunction in hemodialysis patients were investigated by logistic stepwise regression analysis. A nomogram model of  risk prediction for postoperative AVF dysfunction in hemodialysis patients was constructed, and its predictive value was evaluated using receiver operating characteristic (ROC) curve. Results  The incidence of AVF dysfunction in the 216 hemodialysis patients was 24.60% (31/126). The ratios of ≥60 years old, diabetes mellitus and hypotension during dialysis, and  the values of platelet count, LDL-C, blood phosphorus, and calcium and phosphorus product were higher in dysfunction group than in normal function group (t/χ2=4.946, 4.527, 10.333, 9.789, 7.164, 16.065, and 18.817 respectively, P=0.026, 0.033,＜0.001,＜0.001,＜0.001,＜0.001 and＜0.001 respectively), while serum albumin was lower in dysfunction group than in normal function group (t=7.997, P＜0.001). Multivariate logistic regression showed that age≥60 years old (OR=2.061, 95% CI: 1.431～2.967, P＜0.001), combined with diabetes mellitus (OR=2.776, 95% CI: 1.814～4.247, P＜0.001), hypotension during dialysis (OR=2.286, 95% CI:1.542～3.390,P＜0.001), higher platelet count (OR=2.499, 95% CI: 1.643～3.802, P＜0.001) and higher calcium and phosphorus product (OR=2.234, 95% CI:1.528～3.268, P＜0.001) were the independent risk factors for postoperative AVF dysfunction in hemodialysis patients. The C-index was 0.738 (95% CI: 0.687～0.789) for predicting postoperative AVF dysfunction in hemodialysis patients. ROC curve for the nomogram to predict postoperative AVF dysfunction in hemodialysis patients showed that the area under the curve (AUC) was 0.792 [95% CI：0.792 (0.741～0.843)], with the specificity of 73.05% and the sensitivity of 78.14% (Z=11.257, P＜0.001). Hosmer-Lemeshow goodness of fit test was 8.746 (P=0.394).  Conclusion  The nomogram based on age, combined diabetes, hypotension, platelet count, calcium and phosphorus product had a higher predictive value for the risk of postoperative AVF dysfunction in hemodialysis patients. Metrics

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Risk factors for distal limb ischemia syndrome caused by vascular access CAO Xue-ling, LIAO Jie, YU Li-li 2024, 23 (03):  219-222.  doi: 10.3969/j.issn.1671-4091.2024.03.014 Abstract ( 24 )   Objective  To analyze the risk factors for hemodialysis access-induced distal ischemia (HAIDI) syndrome.  Methods  This study enrolled 70 end-stage renal disease patients undergoing hemodialysis for the first time in Department of Nephrology, Rongxian People's Hospital from May 2025 to May 2022. According to the presence or absence of HAIDI syndrome, they are divided into HAIDI group (n=15) and the non-HAIDI group (n=55). Clinical data were collected and compared between the two groups. Univariate analysis was conducted to find out the potential risk factors for HAIDI syndrome. Binary logistic regression was used to quantify the potential risk factors.  Results  Univariate analysis showed that the ratios of≥60 years of age, female, hypertension history, diabetes, vasculitis, systemic lupus erythematosus, dialysis age more than one year, arteriovenous fistula (AVF) graft, and autologous AVF using brachial artery were higher in HAIDI group than in non-HAIDI group (χ2/t=4.419, 4.272, 4.904, 6.360, 10.972, 7.231, 5.657 and 18.670 respectively; P=0.036, 0.039, 0.027, 0.012, 0.001, 0.007, 0.017 and <0.001 respectively). Binary logistic regression analysis showed that older age, female, hypertension history, diabetes history, vasculitis, systemic lupus erythematosus, longer dialysis age, AVF graft, and AVF of higher position were the risk factors for HAIDI (OR=0.286, 3.353, 0.274, 0.224, 0.051, 0.074, 4.111, 0.055 and 0.049 respectively; 95% CI:0.086～0.954, 1.030～10.920, 0.084～0.895, 0.066～0.755, 0.005～0.500, 0.007～0.775, 1.223～13.818, 0.010～0.303 and 0.007～0.321 respectively; P=0.042, 0.045, 0.032, 0.016, 0.011, 0.030, 0.022, 0.001 and 0.002 respectively).  Conclusion Age, sex, hypertension, diabetes, vasculitis, systemic lupus erythematosus, dialysis age and vascular access type are the risk factors for HAIDI. Prevention and control measures focusing on the patients with these risk  factors will help reduce the occurrence of HAIDI syndrome. Metrics

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Risk factors for early readmission of maintenance hemodialysis patients: a meta-analysis LIANG Qi, WANG Zhi-hu, WANG Bing-jie, LIU Yang, ZHANG Chun-mei 2024, 23 (03):  223-226,231.  doi: 10.3969/j.issn.1671-4091.2024.03.015 Abstract ( 32 )   Objective  To systematically evaluate the risk factors for early readmission of maintenance hemodialysis (MHD) patients, and to provide a reference for early identification and intervention.  Methods  A systematic search for risk factors for early readmission in MHD patients in the databases of PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang, VIP and CBM from establishment of the databases to February 2023 was carried out. Meta-analysis was performed by Revman5.3 software.  Results  A total of 13 articles with 774,826 patients were included. Meta-analysis results showed that female (OR=1.08, 95% CI: 1.05～1.11, P＜0.001), smoking (OR=1.56, 95% CI: 1.09～2.23, P=0.010), alcohol consumption (OR=1.24, 95% CI: 1.04～1.48, P=0.020), medication misuse (OR=1.08, 95% CI: 1.05～1.11, P＜0.001), cerebrovascular disease (OR=1.17, 95% CI: 1.08～1.26, P＜0.001), coronary artery disease (OR=1.27, 95% CI: 1.08～1.49,＜0.001), heart failure (OR=1.28, 95% CI: 1.19～1.37, P＜0.001), diabetes (OR=1.13, 95% CI: 1.06～1.20, P＜0.001), chronic obstructive pulmonary disease (OR=1.20, 95% CI: 1.12～1.28, P＜0.001), Hb (MD=-9.29, 95% CI: -14.06～-4.53, P＜0.001), Alb (MD=-3.51, 95% CI: -4.44～-2.58, P＜0.001) and central venous catheterization (OR=1.25, 95% CI: 1.15～1.37, P＜0.001) were the risk factors for early readmission in MHD patients.   Conclusion  Clinical staff can identify the MHD patients with the risk of early readmission based on the above factors and take interventions to improve their quality of care, reduce healthcare costs and optimize healthcare resources. Metrics

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Construction of a risk prediction model for catheter-related infection and treatment strategies of the infection in maintenance hemodialysis patients XIONG Yuan-yuan, ZHONG Fang-ping, PENG Ai-ping, WANG Li, HU Ming-liang 2024, 23 (03):  227-231.  doi: 10.3969/j.issn.1671-4091.2024.03.016 Abstract ( 43 )   Objective   To investigate the influencing factors for catheter-associated infection (CRBSI), to construct a prediction model, and to build up treatment strategies of the injection in patients with maintenance hemodialysis (MHD).  Methods   A total of 204 MHD patients in our hospital were selected as the control subjects. They were divided into infected group (n=63) and non-infected group (n=141). Logistic regression was used to analyze the patients’ clinical data and to construct the model. A new intervention system was then established based on the model, clinical experience and literature reports. In addition, a total of 198 MHD patients were selected as the observation subjects to evaluate the effects of the new intervention system.  Results Diabetes history (OR=2.237, 95% CI: 1.067～5.679, P=0.003), catheter placement time (OR=3.647, 95% CI: 1.326～7.892, P=0.024), frequency of catheter care (OR=6.679, 95% CI: 2.534～16.476, P=0.003), aseptic training rate (OR=2.889, 95% CI: 1.146～6.654, P=0.030) and blood uric acid (OR=2.937, 95% CI: 1.627～8.883, P=0.014) were the independent influencing factors for CRBSI in MHD patients. The model equation was Y=-20.673+1.116×blood uric acid+1.012×aseptic training rate+2.017×catheter care frequency+1.912×catheterization time+1.079×diabetes history. Hosmer and Lemeshow's goodness of fit test equation was used (χ2=10.678, P=0.236). Receiver operating characteristic curve showed that the area under the curve was 0.813, the sensitivity was 89.47%, and the specificity was 63.93%. The incidence of CRBSI and adverse events were lower in the observation group than those in the control group (χ2=3.606 and 32.780; P <0.001).  Conclusion  The prediction model has a better discrimination validity, and the evidence-based systematic nursing intervention system has a better effect on preventing and controlling CRBSI in MHD patients. Metrics

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Bridge symptoms among symptom clusters in maintenance hemodialysis patients: a network analysis     MA Shui-mei, YANG Wen-jun, PA REDANMU·Tuo Huti, HE Fan, LI Yuan-yuan, YAN Ping 2024, 23 (03):  232-236.  doi: 10.3969/j.issn.1671-4091.2024.03.017 Abstract ( 42 )   Objective  To explore the interrelationships among symptom clusters in maintenance hemodialysis (MHD) patients and to identify bridge symptoms among the symptom clusters.  Methods   A total of 480 MHD patients were selected using convenience sampling method. They were investigated by utilizing the dialysis symptom index scale. The network analysis was used to identify bridge symptoms among symptom clusters.  Results  The MHD patients experienced six symptom clusters, namely uremia symptom cluster, gastrointestinal symptom cluster, emotional symptom cluster, skin symptom cluster, water electrolyte symptom cluster, and sexual dysfunction symptom cluster. According to the index of bridge centrality, worrying (rbs=7.946) and dry skin (rbs=7.800) had the highest bridge strength; worrying (rbc=0.331) and feeling sad (rbc=0.322) had the highest bridge closeness; decreased interest in sex (rbb=12.000) and trouble falling asleep (rbb=7.000) had the highest bridge betweenness.  Conclusion  MHD patients are troubled by multiple symptom clusters. Worrying and dry skin are bridge symptoms among different symptom clusters. Accurate intervention of bridge symptoms is beneficial to block the bridging effect between different symptom clusters and improve the efficiency of symptom management. Metrics

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Brucella peritonitis in a patient on peritoneal dialysis: report of a case and review of the literature BAO Hai-jiao, ZHANG Shi-xu, DU Xiang-yun, ZHAO Na, LI Zi 2024, 23 (03):  237-240.  doi: 10.3969/j.issn.1671-4091.2024.03.018 Abstract ( 40 )   Peritonitis is the most common complication in patients undergoing peritoneal dialysis (PD). Peritoneal dialysis-associated peritonitis (PDAP) caused by Brucella species is rare. As well as we know, only 15 patients has been reported previously. Here we report a case of Brucella peritonitis. This patient was successfully treated with both intraperitoneal and prolonged oral antibiotics. We review relevant literature and introduce the diagnosis and treatment of Brucella PDAP from published literature. Metrics