关键词: 血液透析, 质控指标, 达标率, 血管通路

Abstract: Objective To analyze the quality of hemodialysis services in 2018 to 2023 in Nanning city, Guangxi Zhuang Autonomous Region. The hemodialysis units were classified into urban group and county group based on their geographical location. Comparisons of hemodialysis service quality between the two groups demonstrate the current status of developmental differences across urban and county regions, from which strategies targeting the differences can then be organized to enhance the overall hemodialysis quality throughout the city.  Methods  Baseline data, quality control indicators including blood pressure, hemoglobin (Hb), intact parathyroid hormone (iPTH), blood calcium (Ca), blood phosphorus (P), albumin (Alb), vascular access type and common complications, and compliance rates assessed according to the "Standard Operating Procedures for Blood Purification, 2021 Edition" during 2018-2023 were recruited from the hemodialysis units in Nanning city. The differences in hemodialysis service quality were compared between the hemodialysis units in urban and county regions.  Results  ①From 2018 to 2023, the number of hemodialysis units in Nanning city increased from 19 to 35, dialysis machines from 358 to 1,015, qualified physicians from 65 to 146, qualified nurses from 155 to 464, and qualified technicians from 19 to 39. The number of maintenance hemodialysis patients rose from 2,231 to 5,148, and treatment sessions increased from 200,801 to 569,935.    ②Since 2019, the number of dialysis machines, patient number and treatment sessions were higher in the county group than those in the urban group. For resource allocation and workload, the ratios of patients per physician (Z=-6.570, P<0.001), patients per nurse (Z=-2.286, P=0.022), treatment sessions per physician (Z=   -6.270, P<0.001) and treatment sessions per nurse (Z=-3.084, P=0.002) were higher in the county group than those in the urban group. ③For management of quality control indicators, the monitoring  rates of blood pressure (t=-0.339, P=0.704), Hb (t=-1.662, P=0.158), Alb (t=-0.975, P=0.373), blood Ca (t=0.750, P=0.485 ) and blood P (t=-0.440, P=0.676), and the compliance rates of blood pressure (t=-1.221, P=0.227), Hb (t=-0.406, P=0.699) and Alb (t=1.017, P=0.356) had no differences between urban group and county group; but the monitoring rate of iPTH (t=3.384, P=0.019) and the compliance rates of iPTH (t=3.547, P=0.016), blood Ca (t=3.048, P=0.029) and blood P (t=3.836, P=0.012) were higher in urban group than those in county group; the use rate of autogenous arteriovenous fistula (t=-5.077, P=0.004) was higher in county group than that in urban group.  Conclusion  During 2018 to 2023, hemodialysis quality increased significantly in Nanning city, in which hemodialysis quality developed faster in the county regions than urban regions, but the medical staff working in county regions bore more working burdens. Therefore, the number of medical staff should be increased and the management of chronic kidney disease-mineral and bone disorder should be improved in county regions.

Key words: Hemodialysis, Quality control indicator, Compliance rate, Vascular access