Chinese Journal of Blood Purification

12 May 2024, Volume 23 Issue 05 Previous Issue   

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Research report on the development of China's hemodialysis Chinese Hospital Association Blood Purification Center Branch 2024, 23 (05):  321-329.  doi: 10.3969/j.issn.1671-4091.2024.05.001 Abstract ( 92 )   Research report on the development of China's hemodialysis   Chinese Hospital Association Blood Purification Center Branch    Corresponding author: WEI Tao, Email: weitao63@163.com  【Abstract】Objective To investigate the current situation of hemodialysis in mainland China and provide references for the future national medical policies.  Methods  The number of maintenance hemodialysis patients and hemodialysis centers, as well as the manufacturing of hemodialysis industry were investigated in 31 provinces in mainland China using the methods of questionnaire survey, on-site survey and literature review.  Results  By the end of 2022, there were a total of 850, 809 maintenance hemodialysis patients and 7, 399 dialysis centers in mainland China. 26.1% of the hemodialysis centers belonged to tertiary hospitals, 61.6% belonged to secondary hospitals, and 8.5% belonged to primary hospitals or unclassified hospitals and 3.8% were not categorized. Public hospitals account for 84.9% of the hemodialysis centers, while private hospitals account for 15.1%. There were 30 registered blood purification equipment manufacturing companies in mainland China, including 12 foreign companies and 18 domestic companies, with Fresenius having the highest market share of 38%. There were 48 dialyzer manufacturing companies, including 17 foreign companies and 31 domestic companies, with Weigao having the highest market share of 30%. There were 14 manufacturers of hemoperfusion cartridge, including 3 foreign companies and 11 domestic companies, with Jianfan having the highest market share of 74%. There were 35 manufacturers of hemodialysis tubing, including 5 foreign companies and 30 domestic companies, with Weigao having the highest market share of 23%. There were 23 manufacturers of fistula puncture needles, with Nipro having the highest market share of 40%. There were 39 manufacturers of dialysate or hemodialysis dry powder. There were 31 manufacturers of water disposal equipment for hemodialysis, including 5 foreign companies and 26 domestic companies.  Conclusion  There are a large number of maintenance hemodialysis patients in mainland China. However, the hemodialysis centers are relatively insufficient and mainly distributed in secondary and tertiary hospitals, indicating enormous potential for the future development of hemodialysis. On the other hand, the core products of hemodialysis, such as dialysis equipment and dialyzers, rely mainly on foreign companies. Domestic companies should improve technology to be more competitive in the future. 【Key words】Hemodialysis; Current development; Survey; Market analysis Metrics

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Significance of macrophage migration inhibitory factor in the early diagnosis and prognostic assessment of sepsis-induced acute kidney injury DING Wen-sen, WANG Hai-bo, ZHANG Qiang, WANG Xiao-ran, ZHOU Min, ZHANG Wei, CHEN Rong-rong 2024, 23 (05):  330-333.  doi: 10.3969/j.issn.1671-4091.2024.05.002 Abstract ( 20 )   Objective  To explore the significance of macrophage migration inhibitory factor (MIF) in the early diagnosis and prognostic assessment of acute kidney injury (AKI) due to sepsis. Methods  A total of 121 patients with sepsis admitted to our hospital from July 2017 to May 2023 were retrospectively selected. The serum MIF levels at the time of admission to the intensive care unit were detected by enzyme-linked immunosorbent assay. Patient’s clinical and laboratory measurements and 28day mortality data were collected. Parameters in both the AKI and non-AKI groups were compared, and the ability of MIF to identify septic patients with or without comorbid AKI and with or without death within 28 days was clarified by the receiver-operating characteristics (ROC) curve. Results  Seventy-three (60.33%) of the included patients had combined AKI. MIF levels were significantly higher in patients in the AKI group than that in the non-AKI group [(6.82±1.58)ng/ml vs. (4.83±1.19)ng/ml, t=7.883, P＜0.001], and in the 28-day mortality group than those who survived 28 days [(7.33±1.74)ng/ml vs. (5.62±1.52)ng/ml, t=5.092, P＜0.001]. The results of multivariate binary logistic regression showed that MIF level (OR=3.240, 95% CI:1.114～11.549, P=0.023) was an independent risk factor for comorbid AKI in patients with sepsis. The area under the curve for MIF to identify AKI occurrence and 28day mortality in patients with sepsis were 0.85 and 0.80, respectively.  Conclusion    Elevated MIF level is a risk factor for comorbid AKI and poor short-term prognosis in patients with sepsis, which warrants clinical attention. Metrics

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Combined diagnostic value of NLR, PLR and Lp-PLA2 for protein energy consumption in maintenance hemodialysis patients LI Zhao-ting, JU Ping-ping, ZOU Chun-bo 2024, 23 (05):  334-337,363.  doi: 10.3969/j.issn.1671-4091.2024.05.003 Abstract ( 44 )   Objective  To investigate the value of neutrophil/lymphocyte ratio (NLR), Platelet/lymphocyte ratio (PLR) and serum lipoprotein phospholipase A2 (Lp-PLA2) in the diagnosis of protein energy wasting in patients undergoing maintenance hemodialysis (MHD).  Methods   Clinical data of 327 patients with end stage renal disease (ESRD) who received MHD treatment in Taizhou People's Hospital were collected. According to the International Society of Renal Nutrition and metabolism the patients with MHD who developed PEW were divided into PEW and non-PEW groups. The application values of NLR, PLR, and serum Lp-PLA2 in the diagnosis of PEW in MHD patients were compared.  Results  In the PEW group, Body Mass Index (BMI) (Z=-5.358, P＜0.001), albumin (Z=-8.147, P＜0.001), prealbumin (Z=-5.363, P＜0.001), total cholesterol (Z=-2.297, P =0.022), creatinine (Z=-4.168, P＜0.001), uric acid (t=-2.326, P =0.020) levels were significantly lower than those in non-Pew group, age (Z=-2.753, P=0.006), NLR (Z=-5.588, NLR (Z=-5.588, P=0.020), and NLR (Z=-4.168, P＜0.001) were significantly lower than those in non-Pew group, P＜0.001), PLR (Z=-4.672, P＜0.001) and Lp-PLA2 (t=-9.269, P＜0.001) levels were significantly higher than those in non-Pew group. The results of multivariate binary Logistic stepwise regression equation analysis showed that NLR (OR=1.094,95% CI:1.004～1.192,P=0.041), PLR (OR=1.021, 95% CI:1.009～1.033,＜0.001), Lp-PLA2 (OR=1.085, 95% CI:1.056～1.114, P＜0.001) levels were independent risk factors for PEW in hemodialysis patients. NLR (95% CI:0.631～0.756, P＜0.001), PLR (95%CI: 0.597～0.726, P＜0.001), Lp-PLA2 (95% CI:0.735～0.841, P＜0.001), NLR combined PLR (95% CI:0.631～0.756, P＜0.001) 0.650～0.775, P＜0.001), NLR combined with Lp-PLA2 (95% CI: 0.800～0.889, P＜0.001), PLR combined with Lp-PLA2 (95% CI: 0.782～0.875, P＜0.001), NLR combined with PLR and Lp-PLA2 (95% CI: 0.809～0.895, P＜0.001) area under ROC curve were 0.693, 0.662, 0.788, 0.713, 0.844, 0.829, 0.852, respectively. NLR, PLR, Lp-PLA2 all had certain diagnostic value for the occurrence of PEW in MHD patients. The area under ROC curve was 0.852 (95% CI: 0.809～0.895, P＜0.001) when the three combined, indicating the maximum diagnostic efficiency.  Conclusion  NLR, PLR and serum Lp-PLA2 levels can be used as reference indicators for PEW in MHD patients, and strengthening the joint monitoring of NLR, PLR and serum Lp-PLA2 levels can provide intervention evidence for the diagnosis and treatment of PEW. Metrics

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Meta analysis of the effects of hemoperfusion combined with hemofiltration on inflammatory mediators and prognosis in sepsis WU Li-hong, WANG Lin-hua, LUO Li, SHI Da-zhi 2024, 23 (05):  338-341.  doi: 10.3969/j.issn.1671-4091.2024.05.004 Abstract ( 26 )   Objective  To evaluate the impact of hemoperfusion combined with hemofiltration on inflammatory mediators and prognosis in sepsis through meta-analysis.  Method  A comprehensive literature search was conducted using PubMed, Web of Science, MedLine, China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database to collect randomized controlled trials of blood perfusion combined with blood filtration for the treatment of sepsis (observation group treated with blood perfusion combined with blood filtration, control group treated with pure blood filtration). The search was conducted from the establishment of the database until June 30, 2023. Meta-analysis was conducted by using RevMan 5.4 software, and funnel plots were used to analyze the publication bias of various studies.  Results   A total of 19 articles were included, including 1322 patients. Meta-analysis showed that compared to the control group, the observation group had a lower level of C-reactive protein (SMD=-1.60, 95% CI：-2.02～-1.18, P＜0.001), and a lower level of tumor necrosis factor-α (SMD=-1.60, 95% CI：-1.77～ -1.43, P＜0.001), a lower level of interleukin-6 (SMD=-1.29, 95% CI：-1.43～--1.14, P＜0.001), a lower level of sequential organ failure scores (SMD= -0.74, 95% CI：-0.98, -0.51, P＜0.001), and decreased mortality rates (RR=0.50, 95% CI：0.39～ 0.65, P＜0.001).  Conclusion  The combination of hemoperfusion and hemofiltration therapy can downregulate the inflammatory mediators in sepsis, reduce SOFA scores and mortality, and improve prognosis. Metrics

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Relationship between phase angle and cardiac structure and function in maintenance hemodialysis patients HUANG Xi, MA Liang-yan, HUANG Yan, WANG Jing, WANG Jing-fu 2024, 23 (05):  342-346.  doi: 10.3969/j.issn.1671-4091.2024.05.005 Abstract ( 9 )   Objective To explore the relationship between phase angle (PA) and cardiac structure and function in patients with maintenance hemodialysis (MHD).  Methods  A total of 109 patients undergoing MHD in Department of Nephrology, The Affiliated Hospital of Chengde Medical College from January 2023 to June 2023 were included in this study. General information, biochemical results, cardiac ultrasonography, nutritional score, and PA from body composition analyses were recruited. Patients were then divided into low PA group (54 patients) and high PA group (55 patients). Clinical characteristics were compared between the two groups. Univariate and multifactorial regression analyses were used to analyze the differences in cardiac structure and function between the two groups.  Results  The left atrium diameter (t=2.625, P=0.010), early diastolic mitral orifice peak velocity/early diastolic mitral ring motion velocity (E/E') ratio (Z=2.036, P=0.042), cardiac valve insufficiency (χ2=4.650, P=0.031) and cardiac valve calcification ratio (χ2=12.660, P＜0.001) were significantly increased in low PA group as compared with those  in high PA group. Univariate linear regression showed that low PA was correlated with left atrium diameter and E/E' ratio (β=3.086 and 2.789, P=0.010 and 0.028). Multifactor linear regression showed that low PA was independently correlated with left atrium diameter (β=3.404, P=0.009). Univariate logistic regression found that the risks of cardiac valve insufficiency (OR=2.442, 95% CI：1.075～5.546, P=0.030) and cardiac valve calcification (OR=4.190, 95% CI：1.870～9.393, P＜0.001) increased with low PA. Multivariate logistic regression found that low PA was the independent risk factor for cardiac valve calcification (OR=2.770, 95% CI：1.042～7.364, P=0.041).  Conclusion   Low PA is associated with enlarged left atrium diameter, increased E/E' ratio, cardiac valve calcification and cardiac valve insufficiency in MHD patients, and is the independent risk factor for left atrium diameter and cardiac valve calcification in MHD patients. Metrics

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The impact of socioeconomic factors on the incidence of hemodialysis in mainland China LI Si-chen, ZHAO De-long, XING Zeng-hui, LIU Chao, CAI Guang-yan, CHEN Xiang-mei, SUN Xue-feng 2024, 23 (05):  347-350.  doi: 10.3969/j.issn.1671-4091.2024.05.006 Abstract ( 17 )   Objective   To identify socioeconomic factors affecting the incidence of hemodialysis in mainland China.  Methods  Data on the incidence of hemodialysis and socioeconomic factors from 2011 to 2020 across 31 provinces in mainland China (excluding Hong Kong, Macao, and Taiwan) were collected from the National Medical Services and Quality Safety Reports and China Statistical Yearbooks, both covering the years from 2012 to 2021. The provinces were categorized into three groups based on their 2011 per capita GDP levels: low (<30,000 RMB), medium (＞30,000 and ＜80,000 RMB), and high (≥80,000 RMB). Risk factors influencing hemodialysis incidence were analyzed, and the prevalence rates of CKD in different countries and regions were compared.  Results  Year and per capita GDP group affect hemodialysis incidence. The incidence rates of hemodialysis in the low and medium per capita GDP groups were significantly higher in 2020 compared to 2011 (t=3.736, P=0.002; t=12.898, P＜0.001). The growth rate of hemodialysis incidence over ten years was significantly higher in the low and medium GDP group than in the high GDP group (F=5.573, P=0.009; F=0.733, P=0.024). The ratio of rural to urban population, the number of hospital beds per thousand people, the number of healthcare professionals per thousand people, and per capita income were the independent factors affecting hemodialysis incidence (B=-10.663, 6.619, 4.223 and -21.561 respectively; β=    -0.172, 0.232, 0.225 and -0.348 respectively; P=0.008, 0.002, 0.011 and 0.004 respectively). Compared to the global level, mainland China had a lower prevalence of CKD stages 3～5 (2.21 vs. 8.10 pmp).  Conclusion  With the growth of medical service capabilities that accompanies socioeconomic development, the incidence of hemodialysis increases; however, the growth rate of hemodialysis incidence in areas with high per capita GDP is significantly slower than that in areas with low and medium per capita GDP Metrics

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Application of metagenomic second-generation sequencing and cytokines in the early diagnosis of peritoneal dialysis-associated peritonitis HE Meng-meng, FU Jiao, YAO Ling, SHAO Xiao-qi, LI Nan, ZHANG Pei 2024, 23 (05):  351-355.  doi: 10.3969/j.issn.1671-4091.2024.05.007 Abstract ( 13 )   【Abstract】Objective To assess the performance of metagenomic second-generation sequencing(mNGS) in early detection of bacterial infection in patients with peritoneal dialysis-related peritonitis and to investigate whether the integration of cytokines and mNGS assay could improve diagnostic accuracy. To construct and evaluate the etiological value of a risk prediction model to differentiate peritoneal dialysis-associated peritonitis (PDAP) caused by different types of bacteria. Methods PDAP patients admitted to the First Affiliated Hospital of Anhui Medical University from 2020 to 2023 were included in this study, and randomly divided into groups based on the results of mNGS and conventional microbiology testing (CMT). The clinical data were simultaneously collected. PD fluids were sent for conventional microbiological test (CMT), mNGS, and cytokine measurement in parallel. Independent predictors were selected by univariate and multivariate Logistics regression analysis, and prognostic nomogram was constructed for G- and G+ related . The accurate and discriminative abilities of the nomogram were evaluated by Objective  To assess metagenomic second-generation sequencing(mNGS) in the early detection of bacterial infection of peritoneal dialysis-related peritonitis(PDAP), to investigate whether mNGS combined with cytokines could improve the diagnostic accuracy, and to construct a risk prediction model to predict PDAP caused by different types of bacteria and its unfavorable outcome.  Methods   PDAP patients admitted to the First Affiliated Hospital of Anhui Medical University from 2020 to 2023 were included in this study. They were randomly divided into groups based on the results of mNGS and conventional microbiology testing (CMT). Their clinical data were collected, and peritoneal dialysis fluids were tested for CMT, mNGS, and cytokine measurement. Univariate and multivariate logistics regression analyses were used to find out the independent predictors, and a nomogram was constructed for the prediction of G- and G+ bacterial related prognosis. Efficacy of the nomogram was evaluated by receiver operating characteristic curve (ROC) and clinical impact curve (CIC).  Results  A total of 50 PDAP patients were included in this study. Peritoneal fluids were tested for pathogens by mNGS in 41 patients, showing higher positive detection rate (82% vs. 76%, P=0.440) and less detection time (23.0h vs. 29.4h, P＜0.001) than CMT. A model to predict the PDAP by different types of bacteria and a nomogram were constructed,  from which we found that IL-10 and IL-6 in peritoneal dialysis fluid, serum procalcitonin and serum C-reactive protein were the most important biomarkers to predict the prognosis of PDAP by different types of bacteria.  Conclusions   mNGS demonstrates its powerful potentials in the early and rapid detection of pathogens of PDAP. Comprehensive use of IL6 and IL10 in peritoneal dialysis fluid, serum procalcitonin, and serum C-reactive protein will increase the accuracy in the interpretation of mNGS results. A risk prediction model constructed based on cytokines can effectively distinguish G- and G+ bacterial PDAP.  Metrics

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The cytokine adsorption effect of different hemodialysis filters in patients with hematological tumors and acute tumor lysis syndrome: a single-center retrospective study ZHANG Xiao-pan, SHEN Yao-yao, YOU Bing, CHEN Guang-ren, CHEN Feng-ling 2024, 23 (05):  356-359.  doi: 10.3969/j.issn.1671-4091.224.05.008 Abstract ( 16 )   Objective  To retrospectively study the cytokine adsorption effect of different hemodiafiltration filters on patients with hematologic malignancies who developed acute tumor lysis syndrome.  Methods  This article retrospectively analyzed 57 patients who developed acute tumor lysis syndrome and required continuous renal replacement therapy (CRRT) during their hospitalization in the Department of Hematology, The First Affiliated Hospital of Soochow University from September 2020 to September 2023. Patients were divided into an observation group and a control group based on the filter used for CRRT. The observation group used the AN69-OXIRIS filter, while the control group used the AN69-ST100 filter.  Results  The two filters had basically the same effect of renal replacement therapy. Cytokines of IL-6 (Z=8.937, P＜0.001), IL-1b (t=2.177, P=0.031), IL-10 (t=4.065, P=0.009), IL-17A (t=4.382, P=0.013) and interferon-γ (t=6.812, P=0.002) decreased significantly in observation group, as compared with those in control group.  Conclusion   In patients developed acute tumor lysis syndrome during the treatment of hematologic malignancies, the use of the AN69-OXIRIS filter for CRRT will be more effective on cytokine adsorption and prognosis improvement. Metrics

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Progresses in the study of cognitive impairment and decreased activities of daily living in maintenance hemodialysis patients LI Na, JIANG Hong-ying, BAI Yi-hua, ZHANG Feng, ZHOU Huan 2024, 23 (05):  360-363.  doi: 10.3969/j.issn.1671-4091.2024.05.009 Abstract ( 21 )   Maintenance hemodialysis (MHD) is one of the important measures for treatment and longer survival of the patients with end-stage renal disease. Cognitive impairment (CI) is a common complication of MHD patients. Studies have revealed that CI causes decreased activities of daily living (ADL) in MHD patients. However, CI with decreased ADL in MHD patients are usually neglected by most people. This article analyzes the current status of CI and ADL in MHD patients based on the reports in domestic and foreign literature, and summarizes the pathogenesis of CI and its impact on ADL and the managements to increase ADL abilities in MHD patients. Metrics

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Research progresses in the mechanism of thrombosis in chronic kidney disease and hemodialysis patients XU YA, XIA Yun-feng 2024, 23 (05):  364-367.  doi: 10.3969/j.issn.1671-4091.2024.05.010 Abstract ( 28 )   Kidney injury causes the derangement of homeostasis, which damages endothelial cells, and activates platelets, blood coagulation and fibrinolysis system, leading to a hypercoagulation state to facilitate thrombosis. Thrombosis in arteries and veins is a common and frequent complication of various kidney diseases, seriously affecting the prognosis of patients, especially in patients with nephrotic syndrome, chronic kidney disease and maintenance hemodialysis patients. Understanding the mechanism of thrombosis in various kidney diseases is of great importance for developing anticoagulation regimens and improving patient prognosis. Metrics

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The proposal and significance of cardiovascular-kidney-metabolic syndrome WANG Fang-yu, GAO Yue-ming, DENG Zhen-ling, WANG Yue 2024, 23 (05):  368-371.  doi: 10.3969/j.issn.1671-4091.2024.05.011 Abstract ( 12 )   More and more evidence suggest that metabolic syndrome, cardiovascular disease, and chronic kidney disease share the similar physiological and pathological mechanism, with mutual promotion of their unfavorable effects. In Oct. 2023, the American Heart Association (AHA) published a chairman's advisory on cardiovascular-kidney-metabolic syndrome (CKM), in which the definition and stage of CKM syndrome were delineated, and the prediction, screening and management of relevant risks in CKM syndrome were recommended. The proposal of CKM syndrome contributes to the comprehensive and systematic understanding of the relationship among metabolic syndrome, cardiovascular diseases and kidney diseases. The stage of CKM syndrome is helpful for our comprehension on the processes of metabolic abnormalities developing to cardiovascular and kidney diseases, the mutual promotion of cardiovascular and kidney diseases, and the negative feedback effects of cardiovascular and kidney diseases on metabolic abnormalities. The stage of CKM syndrome is also useful for prediction, screening and management of relevant risks in CKM syndrome, and for making guidelines for early prevention, diagnosis and intervention of CKM syndrome. With the progresses in research and our understanding on CKM syndrome, metabolism abnormalities and metabolic diseases caused by unhealthy lifestyle and the resultant cardiovascular and kidney diseases are expected to be diminished. Metrics

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CiteSpace-based bibliometric analysis and text mining of research hotspots on arteriovenous fistula YANG Jian-guo, HE Xi-fei, YAN Jian-jun, ZHANG Zhong-hua, WANG Li-sheng 2024, 23 (05):  372-376.  doi: 10.3969/j.issn.1671-4091.2024.05.012 Abstract ( 24 )   Objective  To analyze the current research status and to find out the research hotspots and frontier of autogenous arteriovenous fistula (AVF).  Methods  CiteSpace literature analysis software was used to analyze, summarize, and organize relevant research literature published in the Web of Science core database in the past 20 years.  Results   A total of 1,460 relevant research articles were included in the final analysis, and the overall publication volume on this topic has shown a slow upward trend. The research hotspots include perioperative management of AVF, pathological and physiological mechanisms of AVF failure, treatment of AVF stenosis, AVF puncture or cannulation, and complications of AVF. The research frontier is mainly focused on multicenter and collaborative research relating to endovascular treatment of AVF stenosis.  Conclusion  The research on AVF in maintenance hemodialysis patients is still in an early development stage. Researchers in the field of vascular access should broaden their research ideas and actively explore new dimensions to provide high-quality evidence-based support for the development and clinical practice of perioperative management and daily maintenance of AVF. Metrics

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The patency rate of forearm radial-cephalic arteriovenous fistula constructed by side-to-side anastomosis in patients with end-stage renal disease ZHANG Su-e, WANG Hai-qing, FAN Xiao-li, ZHAO Zhan-yun, DU Jing 2024, 23 (05):  377-381,386.  doi: 10.3969/j.issn.1671-4091.2024.05.013 Abstract ( 33 )   Objective  To investigate the effect of side-to-side anastomosis technique on the function of forearm autologous arteriovenous fistula (AVF) in end-stage renal disease (ESRD) patients with hemodialysis (HD).  Methods Patients undergoing forearm AVF surgery at the Kidney Disease Medical Center of Weifang People's Hospital from May 2019 to September 2021 were enrolled in this study. They were divided into two groups based on the vascular anastomosis technique, end-to-side anastomosis group and side-to-side anastomosis group. Surgical success rate and postoperative complications were compared between the two groups. COX regression was used to analyze the relationship between various factors and AVF patency. Kaplan-Meier survival analysis was used to analyze the primary patency rate and cumulative patency rate in overall patients and the two groups.  Results  A total of 218 patients were included, with 123 in the end-to-side anastomosis group and 95 in the side-to-side anastomosis group. There were no statistical differences in surgical success rate (χ2=0.017, P=0.897), median AVF blood flow after the operation for 8 weeks (Z=-1.820, P=0.069), and postoperative severe limb swelling (P=0.189) between the two groups. Multifactorial COX proportional risk regression model analysis showed that female was a negative factor for AVF cumulative patency (HR=4.603, 95% CI:1.548～13.770, P=0.006), and AVF side-to-side anastomosis was a positive factor for AVF cumulative patency period as compared with that of end-to-side anastomosis (HR=0.307, 95% CI:0.112～0.845, P=0.022). In overall patients after the operation for 12 and 24 months, the primary AVF patency rates were 73.9% and 57.9% respectively, and the cumulative patency rates were 95.2% and 87.75 respectively. AVF cumulative patency rate was statistically different between the two groups (χ2=4.172, P=0.041), while AVF primary patency rate had no statistical difference (χ2=2.816, P=0.093).  Conclusion   Side-to-side anastomosis for constructing forearm proximal radial-cephalic AVF is a safe and effective operation for HD patients, with better cumulative patency than that of end-to-side anastomosis technique. Metrics

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The value of Caprini thrombosis risk assessment scale for the prediction of thrombosis events in hemodialysis patients after arteriovenous graft surgery YAO Yao 2024, 23 (05):  382-386.  doi: 10.3969/j.issn.1671-4091.2024.05.014 Abstract ( 14 )   Objective  To explore the value of Caprini thrombosis risk assessment scale for the prediction of thrombosis events and primary patency rate within 6 months after arteriovenous graft (AVG) surgery in hemodialysis patients.  Method  A retrospective study was conducted on patients with end-stage renal disease and subjected to AVG surgery from October 2017 to January 2023. General information, surgical data and postoperative patency within 6 months were collected. Patients were divided by professional nurses into group A (low risk patients), group B (medium risk patients), and group C (high and extremely high risk patients) based on the Caprini score during hospitalization. General and intraoperative data were compared among the three groups. Kaplan-Meier survival curve was used to analyze the patency rate within 6 months after surgery in the three groups of patients. COX model was used to analyze the related risk factors.  Result  A total of 52 patients were recruited in this study, including 30 males and 22 females and with the average age of 54.75±12.68 years old. Age(Z=5.836, P=0.005),D-dimer (Z=4.009, P=0.024),hospitalization day(Z=4.432,P=0.017) and follow-up period (Z=7.155, P=0.002) were statistically different but patency rate within 6 months after the surgery (χ2=1.851, P=0.396) had no difference among the three groups. COX regression demonstrated that age (OR=1.015, 95% CI: 0.943～1.092, P=0.695), hospitalization day (OR=0.970, 95% CI: 0.743～1.265, P=0.820), D-dimer (OR=1.029, 95% CI: 0.594～1.782, P=0.920), and Caprini score (OR=1.969, 95% CI: 0.270～14.367, P=0.504) were not related to postoperative primary patency rate.  Conclusion  The Caprini thrombosis risk assessment scale may lack the objective clinical evidence for evaluating thrombosis events in patients with end-stage renal disease after AVG surgery. Metrics

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Study on the classification of benefit finding and its influencing factors in peritoneal dialysis patients based on latent profile analysis WANG Yong-ni, ZHAO Cai-ping, MA Xiao-qin, CHANG Ya-nan 2024, 23 (05):  387-391.  doi: 10.3969/j.issn.1671-4091.2024.05.015 Abstract ( 19 )   Objective  To explore the potential categories and influencing factors of benefit finding in peritoneal dialysis (PD) patients.  Methods  A total of 308 PD patients who were followed up in the General Hospital of Ningxia Medical University were selected as the study subjects. The general data questionnaire, Benefit Finding Scale, Medical Coping Modes Questionnaire, Perceived Social Support Scale, The Conor-Davidson Resilience Scale and Brief Illness Perception Questionnaire were used for questionnaire survey. Latent profile analysis was used to explore the potential categories of benefit finding in PD patients. Ordinal and multinomial logistic regression analysis was used to explore the influencing factors of each potential category.   Results  The benefit finding of PD patients can be divided into three potential categories: low benefit-family care deficiency group (52.9%), medium benefit-high acceptance group (38.0%) and high benefit-high personal growth group (9.1%). The results of regression analysis showed that the medical coping styles of facing (OR=1.245, 95% CI:1.115～1.390, P＜.001), yielding (OR=1.124, 95% CI:1.039～1.215, P=0.003), avoiding (OR=1.186, 95% CI:1.060～1.326, P=0.003), psychological resilience (OR=1.063, 95% CI:1.033～1.093, P＜0.001) and dialysis age (OR=0.170, 95% CI:0.069～0.413, P＜0.001) were the influencing factors for potential categories of benefit finding in PD patients.  Conclusion   There are obvious differences in the sense of benefit finding among PD patients. Clinical staff should formulate individualized intervention strategies according to different categories and characteristics. Metrics

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Analysis of training effectiveness of multidisciplinary collaborative teaching model based on outcome-based education (OBE) in point-of-care ultrasound (POCUS) technology assisted arteriovenous access management ZHANG Jie-ting, LIANG Yu-ting, LI Jing-hui, ZHAO Dai-xin, LI Yin, WEI Shuang 2024, 23 (05):  392-395.  doi: 10.3969/j.issn.1671-4091.2024.05.016 Abstract ( 15 )   Objective   To explore the training effect of a multidisciplinary collaborative teaching model based on outcome-based education (OBE) concept in point-of-care ultrasound (POCUS) assisted arteriovenous fistula (AVF) management.  Methods   Observation of the training effect consisted of recruiting training targets, adopting a multidisciplinary collaborative teaching model based on OBE to set up a training framework and content for the application of POCUS technology in the management of AVF in hemodialysis patients, implementing training for 70 nurses from 57 hemodialysis centers, and evaluating the effectiveness.  Results   After implementing training, the confidence score of nurses in using POCUS for AVF management was 39.00(38.00, 41.00) points, significantly higher than 21.00(20.00, 25.00) points before training(Z=7.278, P＜0.001). The assessment results show that the pass rate of the assessment was 90.00%, with a total score of 82.50 (69.73, 89.78) points, of which 55.71% were “good”, 34.29% were “moderate”, and 10.00% were “poor”.  Conclusion  Conducting teaching activities based on OBE and multidisciplinary collaboration mode helps hemodialysis nurses to systematically learn POCUS technology in a short period of time, which is worth promoting. Metrics

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A study on oral health status and its influencing factors in hemodialysis patients ZHANG Qing-lai, ZHANG Ying, SUN Qian-mei, JIN Mei-ling, HE Wen-wen 2024, 23 (05):  396-400.  doi: 10.3969/j.issn.1671-4091.2024.05.017 Abstract ( 25 )   Objective  To understand the oral health status in maintenance hemodialysis (MHD) patients, and to explore the impact of patients' demographic characteristics, sleep, water intake, and negative emotion on their oral health status.  Methods  A questionnaire survey was conducted on 1,186 MHD patients conveniently selected from April to August 2023.  Results   ①The oral health status score of MHD patients ranged from 8 to 22 points, with an average of (12.54±2.63) points. ②Univariate analysis showed that marital status (F=4.536, P=0.004), smoking (F=10.768, P<0.001), water consumption (F=10.565, P<0.001), medical expenses (F=5.308, P<0.001), hypercholesterolemia (t=-2.767, P=0.006), and coronary heart disease (t=-2.291, P=0.023) were associated with oral health status of MHD patients, and oral health status of MHD patients was negatively correlated with age (r=-0.068, P<0.05); ③Multivariate analysis showed that anxiety (F=6.7634,  P=0.010), sleep quality (F=9.374, P<0.001), hypercholesterolemia (F=4.197, P=0.041), proportion of medical expenses (F=2.758, P=0.017), smoking (F=4.19, P=0.006), and water intake (F=5.345, P=0.001) had significant effects on oral health.  Conclusion  MHD patients have poor oral health, and hemodialysis nurses should pay attention to the oral health problems of patients and improve the awareness of preventive oral health care for MHD patients. It is suggested to establish multidisciplinary professional teams to manage the existed or potential oral health problems to further improve the overall health status of MHD patients. Metrics