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Efficacy and safety analysis of ambrisentan treatment for IgA nephropathy LI Bing-zhe, SHI Su-fang, ZHU Li, ZHOU Xu-jie, LIU Li-jun, LYU Ji-cheng, ZHANG Hong Chinese Journal of Blood Purification    2024, 23 (10): 741-746.   DOI: 10.3969/j.issn.1671-4091.2024.10.003 Abstract （570）      PDF（pc） （530KB）（58）       Knowledge map    Background  The efficacy of endothelin receptor antagonists (ERA) in reducing proteinuria in patients with IgA nephropathy (IgAN) has been validated in phase III clinical trials. Ambrisentan, as a selective ERA receptor antagonist, protects the kidneys by antagonizing endothelin. Our study aimed to investigate the efficacy and safety of ambrisentan in patients with IgAN.  Methods  Medical records and follow-up data of IgAN patients treated with ambrisentan in our hospital from November 2022 to December 2023 were collected. Follow-up assessments were conducted at weeks 4, 8, and 12. The primary outcomes were 24-hour urinary protein, 24-hour urinary protein change rate estimated glomerular filtration rate (eGFR), and drug safety monitoring.  Results  A total of 147 IgAN patients were included in the study. The baseline 24h urinary protein level was 1.16 [0.74,1.99] g/day. Compared to baseline, the urinary protein level was 0.7 (0.38 to 1.32) g/day at week 4, with a reduction of 40.5%, Z=-8.157,P＜0.001. At week 8, the urinary protein level was 0.60 (0.43 to 1.44) g/day, with a reduction of 40.25%, Z=-5.866, P＜0.001. At week 12, the urinary protein level was 0.66 (0.43 to 1.43) g/day, with a reduction of 38.9%, Z=-5.238, P＜0.001.There was no significant difference in the rate of 24h UP reduction among subgroups stratified by gender, eGFR, or concomitant medication including steroids, immunosuppressants, and Renin-Angiotensin-Aldosterone System inhibitor (RAASi). eGFR remained stable during the 12-week follow-up period. Ambrisentan was well tolerated in the follow-up patients, with two patients discontinuing treatment due to edema or impaired liver function. Conclusion Ambrisentan can reduce proteinuria in patients with IgAN and is well tolerated. Reference | Related Articles | Metrics

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Expert consensus on standardized operating procedures of ultrasound-guided percutaneous transluminal angioplasty of arteriovenous access The Working Group on Vascular Access Chinese Journal of Blood Purification    2024, 23 (12): 881-890.   DOI: 10.3969/j.issn.1671-4091.2024.12.001 Abstract （558）      PDF（pc） （682KB）（33）       Knowledge map    Stenosis and occlusion are common complications of arteriovenous access, and percutaneous transluminal angioplasty is the first-line treatment for these complication. In recent years, ultrasound-guided percutaneous transluminal angioplasty is gradually being developed in China. However, there is currently a lack of uniformity in treatment concepts and technical operations among various units. Some doctors may not grasp the details properly, or use equipment in a standardized way, which may result in unsatisfactory treatment outcomes and a higher incidence of procedure-related complications. Meanwhile, there are still many units in need of adopting this technology. Given these issues, this expert consensus compiled by the Vascular Access Expert Committee of the Blood Purification Center Branch of the Chinese Hospital Association, combined evidence-based medicine and clinical practice experience, systematically introduced the standardized operation procedures for ultrasound-guided percutaneous transluminal angioplasty of arteriovenous access. The aim of this consensus is to promote, standardize, and improve the performance of ultrasound-guided arteriovenous access percutaneous transluminal angioplasty, benefiting hemodialysis patients in our country. Reference | Related Articles | Metrics

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Expert consensus on management of chronic kidney disease associated cardiomyopathy Work group of expert consensus on management of chronic kidney disease associated cardiomyopathy Chinese Journal of Blood Purification    2024, 23 (08): 561-580.   DOI: 10.3969/j.issn.1671-4091.2024.08.001 Abstract （520）      PDF（pc） （1043KB）（154）       Knowledge map    The incidence of chronic kidney disease (CKD) associated cardiomyopathy is high, which seriously affects the prognosis of patients. The comprehensive management of such patients is a challenge for both nephrologists and cardiologists. Based on the current status of diagnosis and treatment, this expert consensus is jointly written by an expert consensus writing committee composed of experts in nephrology, cardiology, pharmacy and radiology. Based on evidence-based medicine and clinical experience, this consensus systematically introduces the definition, risk factors, pathogenesis, diagnosis, screening, comprehensive management (lifestyle, blood pressure, anemia, chronic kidney disease-mineral and bone disorder, renal replacement therapy) and prevention of CKD associated cardiomyopathy. The purpose of this expert consensus is to guide and standardize the management of CKD associated cardiomyopathy, and to improve the understanding and clinical diagnosis and treatment. Related Articles | Metrics

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Consensus of Chinese experts on the treatment of secondary hyperparathyroidism in maintenance hemodialysis patients with calcimimetics(2024 edition) Expert consensus working group on the treatment of secondary hyperparathyroidism in maintenance hemodialysis patients with calcimimetics Chinese Journal of Blood Purification    2024, 23 (10): 721-735.   DOI: 10.3969/j.issn.1671-4091.2024.10.001 Abstract （402）      PDF（pc） （735KB）（95）       Knowledge map    Secondary hyperparathyroidism (SHPT) is a critical clinical manifestation of chronic kidney disease-mineral and bone disorder (CKD-MBD), significantly impacting the prognosis of maintenance hemodialysis patients. Calcimimetics activate the calcium-sensing receptor (CaSR), effectively reducing parathyroid hormone (PTH) levels without increasing the risks of hypercalcemia and vascular calcification. To standardize and optimize the use of calcimimetics in SHPT treatment, this consensus was developed through a systematic literature review, integrating with clinical practices and expert experiences in China, following the principles of ‘evidence-based first, consensus supplementary, experience as reference’. Utilizing the nominal group technique, 14 recommendations were established, covering the timing of drug administration, clinical efficacy, use in special populations, combination therapy, and clinical safety of calcimimetics in SHPT treatment. The consensus also provides detailed guidelines on the utilization, monitoring indicators, and management of adverse reactions of calcimimetics, providing scientific guidance for clinicians in various medical institutions to improve treatment outcomes and patient prognosis. Reference | Related Articles | Metrics

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Chinese expert consensus on guiding self-management for patients with renal anemia (2024) Work Group for Chinese Expert Consensus on Guiding Self-Management for Patients with Renal Anemia Chinese Journal of Blood Purification    2025, 24 (01): 1-12.   DOI: 10.3969/j.issn.1671-4091.2025.01.001 Abstract （298）      PDF（pc） （910KB）（20）       Knowledge map    Renal anemia is a common complication of chronic kidney disease (CKD), which not only seriously affects the life quality of CKD patients, but also significantly increases the risk of cardiovascular events and death. Self-management of patients with renal anemia obviously affects the treatment outcome and prognosis of the patients. At present, there is still a lack of standardized guidance for patients' self-management. The target of this consensus is for the medical staff to guide the self-management of patients with renal anemia. It is jointly written by experts in nephrology, blood purification, nursing, hematology, pharmacy, and public health, and supplies the latest evidence-based medicine and clinical experience for medical staff to guide patients with renal anemia holding self-management. The consensus content includes assessing and establishing necessary knowledge reserves for patients, consultation and follow up on time, rational drug use, lifestyle guidance, monitoring and avoiding aggravating factors, shared decision making and self-management evaluation. Multi-dimensional standardization guidance is provided for self-management of patients with renal anemia, aiming to further improve their self-management level, enhance the compliance rate of renal anemia in China, and improve prognosis. Related Articles | Metrics

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Interpretation of the standard YY 0793.2-2023 “Preparation and Quality Management of Fluids for Hemodialysis and Related Therapies; part 2: Water for Hemodialysis and Related Therapies” XU Su-hua, LIU Guo-guang, HUANG Qi-yu, XU Chao-sheng, CHEN Hua-yan, HUANG Min-ju Chinese Journal of Blood Purification    2024, 23 (12): 891-895.   DOI: 10.3969/j.issn.1671-4091.2024.12.002 Abstract （297）      PDF（pc） （529KB）（24）       Knowledge map    The standard YY 0793.2-2023 “Preparation and Quality Management of Fluids for Hemodialysis and Related Therapies; part 2: Water for Hemodialysis and Related Therapies” was released on November 22, 2023, and will be implemented from December 1, 2026. This article compares this standard with the standards YY 0572-2015 and ISO 23500-3:2019, and interprets the differences in several important clauses, including the scope of application, quality requirements, microbiological requirements and their detection methods, chemical pollutants requirements and their detection methods. Ultimately, it will help relevant enterprises understand and apply this standard. Reference | Related Articles | Metrics

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Comprehensive management of encapsulating peritoneal sclerosis in peritoneal dialysis patients: chinese expert consensus Chinese Expert Consensus Working Group on Comprehensive Management of Encapsulating Peritoneal Sclerosis in Peritoneal Dialysis Patients Chinese Journal of Blood Purification    2024, 23 (07): 481-493.   DOI: 10.3969/j.issn.1671-4091.2024.07.001 Abstract （278）      PDF（pc） （1423KB）（119）       Knowledge map    Encapsulation Peritoneal Sclerosis (EPS) is a rare and serious complication in long-term peritoneal dialysis patients, with poor prognosis and high mortality rate. EPS is a chronic and insidious disease that often difficult to identify in its early stages. It is characterized by progressive and extensive fibrotic thickening of the peritoneum, peritoneal sclerosis，which causes progressive obstruction and encapsulation of the bowel. Till now, the pathogenesis of EPS remains uncertain. Early detection and timely intervention can effectively prevent the progression of EPS, and multidisciplinary combination treatment is needed. However, EPS has not been widely recognized in China, especially for doctors in primary hospitals, which can easily lead to missed diagnosis or misdiagnosis. In order to guide physician to comprehensively understand the pathogenesis, clinical characteristics, and prevention and treatment strategies of EPS in peritoneal dialysis (PD) patients, identify EPS risk factors, diagnose and treat EPS early so as to delay its progression, the Blood Purification Center Branch of Chinese Hospital Association organized experts in the field of peritoneal dialysis in China to develop this expert consensus. Related Articles | Metrics

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Research advances in  the mechanism of autogenous arteriovenous fistula stenosis LIANG Xin-yi, WANG Tao-xia, LIU Xiao-li, RONG Dan, CAI Xiao-bei, LI Gui-ying Chinese Journal of Blood Purification    2024, 23 (08): 609-611,640.   DOI: 10.3969/j.issn.1671-4091.2024.08.008 Abstract （233）      PDF（pc） （506KB）（114）       Knowledge map    Autogenous arteriovenous fistula (AVF) is the vascular access most commonly used for hemodialysis (HD) patients. In clinical practice, the prevalence of AVF stenosis is 4.6% to 10.8%. Therefore, exploring the mechanism of AVF stenosis is of vital significance to prolong the blood the access period of AVF and to improve the quality of life in HD patients. This article briefly introduces the autogenous AVF stenosis and its classification, and summarizes the research progresses in the mechanism of AVF stenosis, including vascular smooth muscle cell proliferation, platelet aggregation and thrombus formation, inflammatory reaction, hemodynamic shear force, hypoxia, immune system, genetics and individual differences. The presence of AVF stenosis is the interaction results of multiple factors. A deep understanding of these mechanisms contributes to the development of effective diagnostic and therapeutic strategies to increase the patency rate of AVF in HD patients. Related Articles | Metrics

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Chinese expert consensus on hemodialysis arteriovenous graft nursing（1st edition） Chinese Expert Consensus working group on Hemodialysis Arteriovenous Graft Chinese Journal of Blood Purification    2025, 24 (02): 89-107.   DOI: 10.3969/j.issn.1671-4091.2025.02.001 Abstract （229）            Knowledge map    The application of arteriovenous graft in hemodialysis treatment is becoming more and more common. Clinical nursing staff have an urgent need for specialized nursing standard operation and management of arteriovenous graft. With reference to domestic and foreign literature, combined with practical experience in clinical application, we developed the 'Chinese. Expert Consensus on Hemodialysis Arteriovenous Graft Nursing' from eight dimensions: establishment of arteriovenous graft, perioperative nursing and follow-up monitoring, puncture preparation, safe puncture, puncture complications, monitoring reports, reports of nursing events, and patient education, This consensus is the first expert consensus to guide the nursing operation and management of hemodialysis arteriovenous graft in China. Reference | Related Articles | Metrics

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Interpretation of Sepsis Associated Acute Kidney Injury: Consensus Report of 28th ADQI TANG You-li, ZHANG Ling Chinese Journal of Blood Purification    2024, 23 (06): 401-405.   DOI: 10.3969/j.issn.1671-4091.2024.06.001 Abstract （218）      PDF（pc） （485KB）（57）       Knowledge map    《Sepsis-associated acute kidney injury(SA-AKI):28th Acute Disease Quality Initiative workgroup: The ADQI Consensus Report》(hereinafter referred to as Consensus) was published in February 2023. The consensus covers six parts of clinical definition and epidemiology, pathophysiology, the impact of fluid management strategies, the role of biomarkers in risk stratification and diagnostic treatment guidance, extracorporeal blood purification and innovative therapies, and SA-AKI in pediatric patients, totaling 34 articles of consensus. This consensus is the first global ADQI expert consensus on SA-AKI,and provides a more accurate direction and framework for the diagnosis and treatment of SA-AKI. This article interprets the main points of adults in the first 5 parts of the consensus, and shares the application experience of West China Hospital of Sichuan University in SA-AKI blood purification, which can provide reference for medical workers in the diagnosis and treatment of SA-AKI. Related Articles | Metrics

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The relationship between hemoglobin fluctuations and cardio-cerebrovascular events in dialysis patients treated with roxadustat WANG Wen-bo, CHENG Hong, BIAN Wei-jing, YANG Min, XU Xiao-yi, YE Nan, XU Feng-bo, CHEN Wen-mei, CHEN Lan, WANG Guo-qin Chinese Journal of Blood Purification    2024, 23 (07): 505-509.   DOI: 10.3969/j.issn.1671-4091.2024.07.004 Abstract （214）      PDF（pc） （513KB）（8）       Knowledge map    Objective  This study aimed to investigate the relationship between fluctuations in hemoglobin levels and cardio-cerebrovascular events in dialysis patients initially treated with Roxadustat.  Methods  Dialysis patients who were initially treated with Roxadustat at Beijing Anzhen Hospital from June 2020 to May 2022 were selected and treated for 12 months. They were divided into low hemoglobin coefficient of variation group and high hemoglobin coefficient of variation group according to the mean hemoglobin variability coefficient. The relationship between fluctuations in hemoglobin levels and cardio-cerebrovascular events during the treatment period was observed. According to the mean value of hemoglobin acquired target rate the patients were divided into a high hemoglobin acquired target rate subgroup and a low hemoglobin acquired target rate subgroup, and the effect of hemoglobin variation rate on cardio-cerebrovascular events was analyzed separately in the two subgroups, and the interaction P value was calculated.   Results  A total of 77 patients were enrolled. Among these patients, 55 patients were treated with Roxadustat alone and 22 patients were treated with erythropoietin. During the 12-month treatment period, the low hemoglobin coefficient of variation (n=39) after hemoglobin compliance rate was higher than the high hemoglobin coefficient of variation group (n=38) (Z=-5.570, P=0.001), while the proportion of cardiovascular and cerebrovascular events was significantly lower than the high hemoglobin coefficient of variation group (23.08% vs. 55.26%, χ2=          -1.408, P=0.024). Kaplan-Meier analysis showed that the incidence of cardio-cerebrovascular events in the high hemoglobin coefficient of variation group was significantly higher than that in the low hemoglobin coefficient of variation group (χ2=5.012, P=0.025). The results of the multivariate Cox regression analysis showed that the hemoglobin variation coefficient was an independent risk factor for cardio-cerebrovascular events (OR=2.935, 95% CI:1.157～7.446, P=0.023). The results of the subgroups showed that regardless of whether the hemoglobin acquired target rate was high or low, a high hemoglobin variation coefficient would increase the risk of cardio-cerebrovascular events in patients (chi-squareed=1.51, interaction P=0.244).  Conclusion  When using Roxadustat to treat anemia in maintenance dialysis patients, high hemoglobin variation coefficient may increase the risk of cardiovascular and cerebrovascular events in patients.  Reference | Related Articles | Metrics

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The characteristics and management of hyperkalemia in patients on maintenance hemodialysis WANG Yu-rou, GUO Sheng-jie, YUAN Li-ying Chinese Journal of Blood Purification    2024, 23 (10): 767-770.   DOI: 10.3969/j.issn.1671-4091.2024.10.008 Abstract （197）      PDF（pc） （443KB）（33）       Knowledge map    Hyperkalemia is frequently seen in patients on maintenance hemodialysis (MHD). Patients with slight hyperkalemia may have no obvious symptoms, but severe hyperkalemia can cause cardiac arrest, fatal arrhythmia, ventilator paralysis and other complications, seriously affecting survival and prognosis of the MHD patients. This article aims to review the characteristics and management of hyperkalemia in MHD patients. Reference | Related Articles | Metrics

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Observation of extracorporal administration of the anticoagulant nafamostat mesylate in hemodialysis patients with high bleeding risk YANG Zhen-hua, CHEN Qiu-xin, LI Qian-yu, PAN Xiao-ting, WANG Lu, CHEN Yu, CHEN Xiao-nong, MA Xiao-bo Chinese Journal of Blood Purification    2024, 23 (09): 651-654,662.   DOI: 10.3969/j.issn.1671-4091.2024.09.003 Abstract （197）      PDF（pc） （696KB）（19）       Knowledge map    Objective  To investigate the safety and efficacy of nafamostat mesylate in hemodialysis (HD) patients with high bleeding risk.   Methods   A total of 60 patients with high bleeding risk undergoing HD treated in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2023 to August 2023 were randomly divided into anticoagulant group (nafamostat mesylate group) and no anticoagulant group, with 30 cases in each group. The efficacy and safety of HD were compared between the two groups.  Results  In the anticoagulant group, the use time of cardiopulmonary bypass pipeline was longer (t=5.118, P＜0.001), the average service life of dialyzer was longer (t=4.691, P＜0.001), the number of venous pressure alarm intervention was less (χ2=4.691, P＜0.010), the effective rate of grade 0-1 anticoagulation was higher (χ2=24.300, P＜0.001), the single chamber model urea clearance index (spkt/v) was higher (t=17.456, P＜0.010), and no transmembrane pressure alarm intervention and dialyzer replacement happened. In the anticoagulant group, the activated partial thromboplastin time (APTT), thrombin time (TT), prothrombin time (PT), international normalized ratio (INR), fibrinogen (FG) and fibrin degradation products (FDP) had no significant differences in the samples from blood pipeline before heparin pump (blood collection point A) before HD, during HD at 1h, 2h, 3h, and end of HD, and in the sample from contralateral limb without autologous arteriovenous fistula (blood collection point C) after HD for 15min (F= 0.132, 1.708, 0.025, 1.394, 0.849 and 0.993 respectively; P=0.985, 0.135, 1.000, 0.229, 1.106 and 0.424 respectively). The activated clotting time (ACT) showed no significant difference in the samples from the blood pipeline behind the dialyzer (blood collection point B) during HD at 1h, 2h, 3h, and end of HD (F=0.297, P=0.914). No adverse events including allergic reaction, hyperkalemia, bleeding, arrhythmia occurred in the two groups.   Conclusion   Nafamostat mesylate has better efficacy and safety used as an anticoagulant for HD in patients with high bleeding risk. Reference | Related Articles | Metrics

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Recent advances in coagulation mechanism and anticoagulation strategy of extracorporeal circulation in blood purification HE Xi-mei, WAN Li-ping, LI Tian, WANG Xue-liang, YUAN Shu-ting, XI Chun-sheng Chinese Journal of Blood Purification    2024, 23 (10): 771-774.   DOI: 10.3969/j.issn.1671-4091.2024.10.009 Abstract （196）      PDF（pc） （622KB）（54）       Knowledge map    Blood purification is an important treatment modality to clear toxins and other wastes from the body and to maintain electrolyte and acid-base balance, critical for patients’ survival and quality of life. However, blood quickly develops a coagulation reaction when it contacts filters and tubes, which lowers the adequacy of hemodialysis or even interrupts the hemodialysis. This reaction may also trigger the activation of coagulation system, leading to consumption of clotting factors, immune-inflammatory reactions, filter blockage, bleeding, thrombus formation, and other coagulation-related complications. With the advances of blood purification technology, the mechanisms of coagulation in the extracorporeal circulation and the effective anticoagulation strategies have been widely investigated. This review comprehensively summarizes the recent advances in the mechanisms of blood coagulation on equipment surfaces, and also briefly reviews the recent advances in inhibition of coagulation pathways, modification or engineering of membrane surfaces, and improvement of extracorporeal circuits. Reference | Related Articles | Metrics

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The Influence of Different Frequency of Hemoperfusion on Protein-energy Wasting of Maintenance Hemodialysis Patients  The Influence of Different Frequency of Hemoperfusion on Protein-energy Wasting of Maintenance Hemodialysis Patients Chinese Journal of Blood Purification    2024, 23 (06): 410-416.   DOI: 10.3969/j.issn.1671-4091.2024.06.003 Abstract （194）      PDF（pc） （586KB）（26）       Knowledge map    The Influence of Different Frequency of Hemoperfusion on Protein-energy Wasting of Maintenance Hemodialysis Patients   YIN Yi-fang1,MOU Jiao1,YANG Ying1,TANG Jian-ying1    1Department of Nephrology and Urology Center,University Town Hospital Affiliated to Chongqing Medical University, Chongqing 400715,China Corresponding author: TANG Jian-ying, Email:800273@hospital.cqmu.edu.cn 【Abstract】Objective  To investigate the impact of different hemoperfusion (HP) frequencies on protein-energy wasting (PEW) in patients undergoing maintenance hemodialysis (MHD).  Methods Eighty patients were included and divided based on HP treatment frequency into four groups: no HP (group A), monthly HP (group B), bi-monthly HP (group C) and weekly HP (group D) , with 20 patients in each group. All patients were followed up for six months, then the prevalence of PEW, malnutrition-inflammation score (MIS), and related serum biochemical indicators were analyzed before and after treatment.   Results   Before treatment, there were no significant differences (P＞0.05) in MIS scores (F=2.194, P=0.096),  the prevalence of PEW (χ2=0.579, P=0.901), level of pre-albumin (PA) (F=0.258, P=0.855), albumin (Alb) (F=0.187, P=0.905), parathyroid hormone (PTH) (F=0.780, P=0.509), hemoglobin(Hb)(F=1.823，P=0.150), β2-microglobulin (β2-MG) (F=1.833, P=0.148), and C-Reactive protein (CRP) (F=0.432, P=0.731) among the four groups. After treatment, there were 15 patients who withdrew from the trial in Group D. The group C had lower levels of MIS score (C-A: t=4.391, P＜0.001;  C-B: t=-2.871,  P=0.006),  PTH (C-A: t=4.098, P=0.001; C-B: t=-2.551,     P=0.047),β2-MG (C-A: t=5.688, P＜0.001; C-B: t=-3.207, P=0.002), CRP (C-A:t=4.293, P＜0.001; C-B:     t=-2.843, P=0.006) compared with group A and B); and higher level of PA(C-A: t=-3.177, P=0.002; C-B:      t=2.196, P=0.032). Alb (C-A: t=-5.540, P＜0.001; C-B: t=2.196, P=0.010) than Groups A and B. Group C had higher level of Hb (t=-3.733, P＜0.001) than group A, and  no significant difference with group B (t=1.451,  P=0.152). The prevalence of PEW in group C (χ2=6.465, P=0.011) was significantly lower than group A, but there was no significant difference between group A and group B (χ2=2.506, P=0.113).  Conclusion   Bimonthly HP treatment can obviously improve the nutritional status of patients with MHD and reduce the prevalence of PEW. Reference | Related Articles | Metrics

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Interpretation of the standard YY 0793.3-2023 preparation and quality management of fluids for haemodialysis and related therapies-part 3: Concentrates for haemodialysis and related therapies XU Su-hua, LUO Qing-feng, LIU Guo-guang, HUANG Qi-yu, HUANG Min-ju Chinese Journal of Blood Purification    2024, 23 (09): 641-645.   DOI: 10.3969/j.issn.1671-4091.2024.09.001 Abstract （186）      PDF（pc） （497KB）（36）       Knowledge map    YY 0793.3-2023《Preparation and Quality Control of fluids for hemodialysis and related Therapeutics - Part 3: Concentrates for hemodialysis and related Therapeutics》 will come into force on July 1, 2025. This article compares YY 0793.3-2023 with YY 0598-2015 and ISO 23500-4:2019, and interprets the differences in some important clauses, including the scope of application of the standard, requirements for chemical raw materials, solute concentration and testing methods, microbial limits and testing methods, pH value, pH value and solute concentration of online use of B dry powder, ultimately helping relevant enterprises understand and apply the standard. Reference | Related Articles | Metrics

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Meta-analysis of the efficacy of a new generation of intravenous calcimimetic agent in the treatment of secondary hyperparathyroidism ZHANG Ju-hong, LI Ying Chinese Journal of Blood Purification    2024, 23 (12): 896-900.   DOI: 10.3969/j.issn.1671-4091.2024.12.003 Abstract （177）      PDF（pc） （755KB）（8）       Knowledge map    Objective  To evaluate the efficacy and adverse reactions of etelcalcetide in the treatment of secondary hyperparathyroidism in hemodialysis patients.  Methods  Randomized controlled trials  or cohort studies on Etelcalcetide in the treatment of secondary hyperparathyroidism (SHPT) in dialysis patients published before May 2024 were searched in CNKI, Wanfang Database, PubMed, Embase and Cochrane library. Meta-analysis was performed by the software RevMan 5.0.  Results  A total of 14 articles were included, including 15 experiments, with a total sample size of 9628 cases. Meta-analysis showed that Etelcalcetide was more effective in reducing PTH level by 30% than the control group (Blank control group: RR=8.440, 95% CI: 6.515～10.935, P＜0.001; Cinacalcet group: RR=1.131, 95% CI:1.040～1.229, P= 0.004; Vitamin D receptor agonist group: RR=4.272, 95% CI: 2.259～8.081, P< 0.001), improving serum phosphate compliance rate (RR=1.122, 95% CI: 1.049～1.205, P=0.001) and decreasing the level of serum fibroblast growth factor (FGF-23) (treatment time < 1 year: MD=-0.563, 95% CI: -0.713～-0.413, P<0.001 ; treatment duration ≥1 year: MD=-2.108, 95% CI: -2.405～-1.812, P < 0.001), while no statistical differences in the rate of serum calcium compliance (RR=0.910, 95% CI: 0.778～1.064, P=0.240) and drug persistence (RR=1.439, 95% CI: 0.903～2.292, P=0.120). In terms of adverse events, the incidence of symptomatic hypocalcemia was higher in Etelcalcetide group than in control group (RR=2.890，95% CI：1.915～4.361, P＜0.001), and the incidence of nausea in Etelcalcetide group was higher than that in blank control group (RR=1.747, 95% CI: 1.150～2.652, P=0.009), which was lower than that in oral medication group (RR=0.769, 95% CI: 0.611～0.969, P=0.030), while no significant difference in the incidence of vomiting. Conclusion  Etelcalcetide, a new generation of intravenous calcimimetic agent, has more advantages in reducing PTH level, improving hyperphosphatemia and reducing FGF-23 level, but it increased the incidence of hypocalcemia.  Reference | Related Articles | Metrics

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Research on the burden of cardiovascular disease in hemodialysis patients in China WANG Yan, ZHAO Xin-ju, WEI Tao Chinese Journal of Blood Purification    2024, 23 (10): 736-740.   DOI: 10.3969/j.issn.1671-4091.2024.10.002 Abstract （172）      PDF（pc） （459KB）（21）       Knowledge map    Objective  The aim of this study was to investigate the burden of cardiovascular disease (CVD) in hemodialysis (HD) patients in China, so as to provide evidences for conducting a multicenter study on CVD in the future.  Methods  The HD Working Group of the HD Branch of the Chinese Hospital Association developed a questionnaire, and pushed the questionnaire through Questionnaire Star to the medical staff of HD centers in China from 2024.1.11-2024.1.18 to investigate the prevalence of CVDs and the screening status. Results A total of 186 valid questionnaires were collected, covering 19 provinces, 4 autonomous regions and 4 municipalities. Coronary artery disease and vascular calcification were the most common types of CVD in HD patients, with the proportion of prevalence exceeding 40% in 55.9% and 62.4% of HD centers, respectively; followed by ischemic stroke, with relatively low proportions of atrial fibrillation and cerebral hemorrhage. In 68.6% of HD centers, the annual mortality rate of patients was less than 10%. In terms of CVD screening, 58.6% of HD centers performed echocardiography for patients once a year, but only 25 (13.4%) arranged for lateral abdominal plain films for patients once a year, and only 15 (8.1%) HD centers performed pulse wave velocity for patients once a year. What’s more, 39.8% of HD centers considered patient compliance to be poor, and 83.3% of medical staff were willing to participate in studies related to the burden of CVD in HD patients.  Conclusion  The proportion of HD patients with CVD is high in China, especially coronary artery disease and vascular calcification, but numerous HD centers failed to conduct regular CVD screening, and patient compliance was poor. CVD screening and management should be strengthened in the future to reduce the burden of CVD disease in HD patients. Reference | Related Articles | Metrics

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Summary of best evidence for the management of thirst symptoms in hemodialysis patients JIANG Hai-long, LI Chang, GAI Ying, GENG Xiao-ting, ZHANG Chi, LI Shu-ying Chinese Journal of Blood Purification    2024, 23 (09): 716-720.   DOI: 10.3969/j.issn.1671-4091.2024.09.018 Abstract （171）      PDF（pc） （484KB）（35）       Knowledge map    Objective  To evaluate and summarize the best evidence for the management of thirst symptoms in hemodialysis patients, and to provide evidence-based data for clinical practice.  Method  We systematically searched domestic and foreign computerized decision support systems, guideline websites, databases, and websites of professional associations relating to the management of thirst symptoms in hemodialysis patients from establishment of the databases to November 2023. AGREE II, JBI  and CASE evaluation tools were used to evaluate the quality of the included literature and to summarize the evidence of the literature that meets the requirements.  Result  A total of 12 articles were included, including one guideline, one evidence summary, 3 systematic reviews, and 7 randomized controlled trials.   Conclusion  This study summarizes the best evidence for the management of thirst symptoms in hemodialysis patients and provides a scientific basis of clinical practice for healthcare professionals. Reference | Related Articles | Metrics

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To explore the clinical characteristics of upper extremity arterial calcification in maintenance hemodialysis patients WANG Chen, XU Yuan-kai, YANG Yan-li, LI Wen, RUAN Lin, ZHANG Li-hong Chinese Journal of Blood Purification    2024, 23 (09): 659-662.   DOI: 10.3969/j.issn.1671-4091.2024.09.005 Abstract （166）      PDF（pc） （752KB）（17）       Knowledge map    Objective  To investigate the distribution characteristics of forearm artery calcification in maintenance hemodialysis patients and its correlation with vascular access.   Methods   Patients who received regular hemodialysis treatment in the Blood Purification Center of the First Hospital of Hebei Medical University from January 2023 to July 2023 were selected. Clinical data were collected. Doppler ultrasound was used to examine the radial artery and ulnar artery of both upper limbs, and the calcification score was recorded.  Results  A total of 118 patients were included. The overall prevalence of radial artery and ulnar artery calcification: the prevalence of ulnar artery calcification on the non-fistula side was higher than that of radial artery calcification (P=0.029), with a statistical difference. There were no significant difference of the prevalence of calcification between the ulnar artery and radial artery (P=0.557). In addition, the prevalence of calcification on the internal fistula side of the radial artery was significantly higher than that on the non-internal fistula side (P=0.015). The prevalence of calcification was no significant difference between ulnar artery fistula side and non-fistula side (P=0.405). The prevalence of calcification in different segments of the radial artery and ulnar artery: the prevalence of calcification in the distal segment of the radial artery and ulnar artery was higher than that in the proximal segment, regardless of the internal fistula side or the non-internal fistula side (P =0.001；P＜0.001；P＜0.001；P＜0.001). Comparison of the severity of vascular calcification: the degree of calcification in the ulnar artery was more severe than that in the radial artery (χ2=14.524, P=0.024), the difference was statistically significant. The calcification degree of the ulnar artery on the non-fistula side was more severe than that of the radial artery (χ2=17.522, P=0.004), and the difference was statistically significant. The degree of calcification of the radial artery in the fistula side was more severe than that in the non-fistula side (χ2=12.943, P=0.044). The severity of ulnar artery calcification on the fistula side was basically the same as that on the non-fistula side (χ2=6.733, P=0.346).  Conclusions   The prevalence and severity of vascular calcification in the distal segment of the upper extremity artery in maintenance hemodialysis patients are higher than those in the proximal segment, and the ulnar artery may be more susceptible to calcification. Reference | Related Articles | Metrics

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The efficacy and safety of sodium thiosulfate in the treatment of pruritus in maintenance hemodialysis patients BAO Hong-da, JIAN Gui-hua, GUO Yong-ping, LIU Kun, ZHANG Li-ming, WANG Ying-deng, YU Chen, ZOU Jian-zhou, ZHANG Lei, ZHANG Ran, FAN Qiu-ling, CHEN Shun-jie, MA Jun, WANG Xiao-xia, WANG Qin, WANG Nian-song, JIANG Geng-ru Chinese Journal of Blood Purification    2025, 24 (01): 35-39.   DOI: 10.3969/j.issn.1671-4091.2025.01.007 Abstract （163）      PDF（pc） （636KB）（7）       Knowledge map    Objective To observe and compare the efficacy and safety of different doses of sodium thiosulfate for the treatment of pruritus in maintenance hemodialysis (MHD) patients.  Methods  A total of 126 MHD patients with pruritus from 11 general hospitals in Shanghai during January 2020 to December 2022 were included in this study. They were randomly divided into three groups. The dose of sodium thiosulfate was 1.92g in group 1, 3.20g in group 2, and 4.48g in group 3. The treatment period lasted 8 weeks. Clinical effects and safety including pruritus score, biochemical indicators and adverse reactions were observed and compared between the groups.  Results Compared with the pruritus scores 5 days before the treatment and 8 weeks after the treatment, the decreases of pruritus score were 18.6±1.91 to 12.8±3.03, 19.0±2.80 to 11.3±3.40 and 19.6±3.64 to 10.9±3.75 in group 1 (n=72), 2 (n=79) and 3 (n=75) respectively; the extent of decrease were statistically significant among the 3 groups (F=2.735, P=0.046), and the extent of score decrease was greater in group 3 than in group 1 (score difference=-1.352, 95% CI: -2.645～-0.060, P=0.041). No adverse reactions such as allergic reactions, rash and hypotension were found during the observation period. Multivariate analysis showed that compared with group 1 the slope of pruritus score 5 days before the treatment and 8 weeks after the treatment in group 3 showed β= -1.650 (95% CI: -3.046～-0.253, P=0.021).  Conclusion  Sodium thiosulfate can effectively relieve the pruritus symptoms in MHD patients, and the effect is enhanced with increase of the dose. No obvious adverse reactions were found. This treatment is therefore safe and effective. Related Articles | Metrics

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Leukemia patients with severe iron overload and treated with double filtration plasmapheresis: report of two cases and review of the literature SONG Yi-Fan, CHEN Li-ting, ZHANG Chao, REN Ye-ping, WANG Qin Chinese Journal of Blood Purification    2024, 23 (11): 878-880.   DOI: 10.3969/j.issn.1671-4091.2024.11.016 Abstract （161）      PDF（pc） （441KB）（12）       Knowledge map    We report two leukemia patients with severe iron overload and successfully treated with double filtration plasmapheresis (DFPP). After the treatment, serum ferritin reduced significantly without any severe complications. We suggest that DFPP is a fast and efficient therapy to remove ferritin, and can be used in severe iron overload patients with poor response or intolerance to drug treatment.  Reference | Related Articles | Metrics

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The Effect of peritoneal dialysis fluid with neutral pH and low GDPs on CA125 level in peritoneal dialysispatients JIA Yu-xia, SUN Yong-he, WEI Xiao-fei, NIU Yong-qin, ZHANG Kun Chinese Journal of Blood Purification    2024, 23 (06): 406-409.   DOI: 10.3969/j.issn.1671-4091.2024.06.002 Abstract （161）      PDF（pc） （426KB）（19）       Knowledge map    Objective  To evaluate the effect of neutral pH and low glucose degradation products (glucose degradation products, GDPs) on CA125 in peritoneal dialysis (peritoneal dialysis,PD) patients. Methods Continuous ambulatory peritoneal dialysis  patients were enrolled. These patients were initially dialyzed with standard calcium peritoneal dialysis solution, followed by 6 months of dialysis with neutral pH and low GDPs peritoneal dialysis solution. Compare the concentrations of CA125 in the exudate and serum, ultrafiltration volume, and whether there is dialysis pain of these patients when using standard PD fluid (group A) and after using neutral pH and low GDPs PD fluid (group B).  Results  A total of 44 PD patients were included, including 24 males and 20 females. Compared with group A, group B had higher effluent CA125 (t=2.266, P=0.029), serum CA125 (t=2.575, P=0.014), peritoneal dialysis ultrafiltration (Z=5.052, P <0.001), and lower hemoglobin (t=2.208, P=0.033), calcium (t=2.843, P=0.007), and phosphorus (t=2.094, P=0.042).  Conclusion  The peritoneal dialysis fluid with neutral pH, low GDPs can increase the CA125 level in peritoneal dialysis patients, which indirectly indicates the reduced damage of peritoneal mesothelial cells. Related Articles | Metrics

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Predictive value of blood urea nitrogen/creatinine ratio for frailty in maintenance hemodialysis patients MA Cai-hong, GAO Huan-ling, SHANG Chun-e, LI Hong-mei, YANG Yu-lin, CHEN Ling Chinese Journal of Blood Purification    2024, 23 (06): 421-425.   DOI: 10.3969/j.issn.1671-4091.2024.06.005 Abstract （153）      PDF（pc） （536KB）（14）       Knowledge map    Objective To explore the predictive value of blood urea nitrogen/creatinine ratio (BUN/Cr) for frailty in maintenance hemodialysis (MHD) patients.  Methods  This study was a single centered and cross-sectional study that included 247 patients undergoing MHD treatment in a tertiary hospital in Shanxi province from May 2022 to November 2023. They were divided based on the score of FRAIL scoring system (FRAIL: fatigue, resistance, ambulation, illness, and loss of weight) into two groups, frailty group (FRAIL score≥3, n=101) and non-frailty group (FRAIL score ≤2, n=146). Their relevant information was collected. Univariate and binary logistic regression were used to find out the influencing factors for frailty in the MHD patients. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of BUN/Cr for frailty in MHD patients.  Results  Age, dialysis age, C-reactive protein, blood urea nitrogen and BUN/Cr were higher in frail group than in non-frail group (t/χ2/Z=9.042, -4.612, -2.649, 3.096 and 14.724 respectively; P＜0.001, ＜0.001, 0.008, 0.002 and ＜0.001 respectively). Body mass index, hemoglobin, serum albumin, creatinine, and urea clearance index were lower in frail group than in non-frail group (t/χ2/Z= -2.294,  -2.769,   -8.936, -13.126 and -5.097 respectively; P=0.022, 0.006, ＜0.001, ＜0.001 and ＜0.001 respectively). Binary logistic regression demonstrated that age (OR=1.060, 95% CI: 1.015～1.107, P=0.009), dialysis age (OR=1.283, 95% CI:1.022～1.612, P=0.032), serum albumin (OR=0.841, 95% CI: 0.748～0.945, P=0.004), C-reactive protein (OR=1.641, 95% CI: 1.039～2.591, P=0.033), urea clearance index (OR=0.013, 95% CI: 0.001～0.251, P=0.004), and BUN/Cr (OR=3.478, 95% CI: 1.455～8.310, P=0.005) were the independent risk factors for frailty in the MHD patients. ROC curve suggested that the optimal value of BUN/Cr for the diagnosis of frailty in MHD patients was 9.42, with the area under the curve of 0.929 (95% CI: 0.896～0.962, P＜0.001).  Conclusion  BUN/Cr has a better prediction value for the presence of frailty in MHD patients. It also provides a new perspective for medical professionals to identify frailty. Related Articles | Metrics

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Investigation on the social rehabilitation in young and middle-aged maintenance hemodialysis patients and analysis on the influencing factors for social function degradation before and after dialysis REN Jiao-jiao, GUO Hong-ping, XUE Fu-ping, LAN Jie, FAN Ji-xiang, LU Xu, LI Jing, WANG Li-hua Chinese Journal of Blood Purification    2024, 23 (07): 510-514.   DOI: 10.3969/j.issn.1671-4091.2024.07.005 Abstract （153）      PDF（pc） （541KB）（26）       Knowledge map    Objective  This study aims to investigate the current status of social rehabilitation and the quality of life, and to explore the factors influencing the degree of social function degradation after dialysis in young and middle-aged maintenance hemodialysis (MHD) patients.  Methods  The young and middle-aged MHD patients treated in the Second Hospital of Shanxi Medical University were taken as the study subjects. Cross-sectional and retrospective survey methods were used to collect patients' data. The Kidney Disease Quality of Life Scale (KDQOL-SFTM 1.3) and Social Disability Screening Schedule (SDSS) were used for evaluation of the patients. Patients were divided into the group with insignificant social function degradation and the group with significant social function degradation based on the median value of SDSS score difference before and after MHD. Univariate analysis and binary logistic regression analysis were used to investigate the influencing factors for social function deterioration in young and middle-aged MHD patients.   Results  ①In the 112 MHD cases included in this study, 42 cases (37.50%) were at the social rehabilitation level 3 and 70 cases (62.50%) at the social rehabilitation level 4. The quality of life score was higher in the patients at the social rehabilitation level 4 than those at the social rehabilitation level 3 (t= -2.554, P=0.012),  but statistical differences were only in the domains of impact of kidney disease (t=2.185, P=0.031), work status (t=3.203, P=0.002), social quality (t=2.117, P=0.037), emotional function  (t=2.700, P=0.008) and social function (t=2.349, P=0.021). ②Shorter dialysis age (OR=3.031, 95% CI：1.192～7.706, P=0.020), fatigue symptom (OR=7.574, 95% CI：1.829～31.367, P=0.005), comorbid anxiety and (or) depression problems (OR=3.765, 95% CI：1.120～12.658, P=0.032), and higher morbidity stigma score (OR=1.303, 95% CI：1.104～1.537, P=0.002) were the independent risk factors for social function deterioration in young and middle-aged MHD patients.  Conclusions  ① Higher levels of social rehabilitation and quality of life were found in young and middle-aged MHD patients; ②Patients with shorter dialysis age, comorbid symptoms of fatigue, anxiety and (or) depression, and high morbid stigma score were prone to have significant social dysfunction. The psychological and emotional problems should be emphasized clinically in young and middle-aged MHD patients. Reference | Related Articles | Metrics

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Correlation analysis of 25-hydroxyvitamin D3 with chronic kidney disease-associated pruritus in dialysis patients JI Bo-fan, CHEN Jing-jing, MA Xue-jie, ZHANG Xiao-liang, TANG Ri-ning Chinese Journal of Blood Purification    2024, 23 (11): 807-812.   DOI: 10.3969/j.issn.1671-4091.2024.11.002 Abstract （150）      PDF（pc） （613KB）（11）       Knowledge map    Objective  To investigate the association between 25-hydroxyvitamin D3 [25(OH)D3] and chronic kidney disease-associated pruritus (CKD-aP) in patients on maintenance hemodialysis (MHD) or peritoneal dialysis (PD), and the predictive value of 25(OH)D3 level for CKD-aP in dialysis patients. Methods  In this single-center, cross-sectional study, patients with MHD, or PD treatment from 1 January 2022 to 31 December 2022 in the Zhongda Hospital, affiliated with Southeast University were selected as subjects. Based on the absence of CKD-aP, the patients were divided into the non-pruritus and pruritus groups, then compare the clinical data and 25(OH)D3 level between the two groups. The pruritus group further divided into mild and moderate-to-severe pruritus based on the pruritus score. Then we compared the 25(OH)D3 levels in the general population, MHD, and PD patients in different itching severity groups. The ROC curve was used to analyze the clinical value of 25(OH)D3 in predicting the occurrence of CKD-aP in dialysis patients.  Results  A total of 331 dialysis patients were included, including 238 patients with MHD and 93 patients with PD. The prevalence of CKD-aP was 56.5%, 58.4% and 51.6%, respectively. The 25(OH)D3 in the pruritus group of MHD and PD patients was lower than that in the non-pruritus group (MHD: 13.490 (10.140, 17.980) vs. 18.900 (10.910, 24.630), Z=-3.538, P<0.001; PD: 7.215 (4.843, 11.875) vs. 12.090 (6.630, 15.240), Z=-3.075, P=0.002). Further analysis showed that There were statistically differences in 25(OH)D3 among no pruritus group, mild pruritus group, and moderate to severe pruritus group (total population: H=28.823 P<0.001; MHD: H=25.137 P<0.001; PD: H=12.228 P=0.002). 25(OH)D3 decreased with the increase of pruritus in the total population and MHD patients (P<0.05). The 25(OH)D3 in the non-pruritus group was higher than that in the mild pruritus group (P=0.015) and the moderate-to-severe pruritus group (P=0.003), and there was no significant difference in 25(OH)D3 between the mild pruritus group and the moderate-to-severe pruritus group (P=0.081). The results of multivariate logistic regression analysis showed that white blood cell count (OR=1.257, 95% CI: 1.033～1.529, P=0.022), serum phosphorus (OR=2.277, 95% CI: 1.215～4.268, P=0.010), parathyroid hormone (OR=1.002, 95% CI: 1.000～1.003, P=0.018), β2-microglobulin (OR=1.039, 95% CI: 1.007～1.073, P=0.017) were risk factors for CKD-aP in MHD patients, and serum phosphorus (OR=4.613, 95% CI: 1.354～15.719,P=0.015) and hypersensitive C-reactive protein (OR=1.192, 95% CI: 1.019～1.395, P=0.028) were risk factors for CKD-aP in PD patients. 25(OH)D3 was a protective factor for CKD-aP in patients with MHD and PD (MHD: OR=0.937, 95% CI: 0.901～0.975, P=0.001. PD: OR=0.909, 95% CI: 0.830～0.995, P=0.038). The ROC curve showed that the predicted AUC was 0.635 when the 25(OH)D3<18.835 ng/ml in MHD patients and 0.685 when the 25(OH)D3<10.545 ng/ml in PD patients.  Conclusions  Lower 25(OH)D3 may play an important role in CKD-aP in dialysis patients. Moreover, 25(OH)D3 level has certain clinical value in predicting the occurrence of CKD-aP in dialysis patients. Reference | Related Articles | Metrics

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Evidence summary for ultrasound-guided autogenous arteriovenous fistula puncture TANG Si-kai, CHEN Lin, ZHANG Ying-jun, HE Li, CHEN Hui, LIU Li, SHI Mei, ZHENG Hao-tian Chinese Journal of Blood Purification    2024, 23 (11): 859-863.   DOI: 10.3969/j.issn.1671-4091.2024.11.012 Abstract （149）      PDF（pc） （469KB）（27）       Knowledge map    Objective  To search, evaluate and summarize the best evidence for ultrasound-guided autogenous arteriovenous fistula (AVF) puncture.  Methods  A systematic search of databases for evidence on ultrasound-guided autogenous AVF puncture in maintenance hemodialysis patients was performed, with literature types including clinical guidelines, systematic evaluations, expert consensus, randomized controlled trials and others. The time frame for the search was January 2013 to November 2023. An evidence-based team performed literature screening and quality assessment, and extracted and summarized the evidence.  Results  A total of 21 publications were screened, including 5 guidelines, 3 expert consensus, one systematic evaluation, 10 randomized controlled trials, and 2 cross-sectional studies. Twenty-five pieces of the evidence were summarized in six areas: concepts related to ultrasound-guided fistula puncture, ultrasound-based vascular assessment, preparation and methods, post-puncture observation, and ultrasound-related training.  Conclusion The summarized best evidence for ultrasound-guided fistula puncture can be used as a guideline and norm for clinical caregivers to increase puncture success rate, reduce puncture-related complications, and ensure patient safety. Reference | Related Articles | Metrics

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Research progresses in blood perfusion joint continuous renal replacement therapy in rhabdomyolysis-induced acute kidney injury ZHOU Xiao-chun, YANG Ying-ying, FU Ping Chinese Journal of Blood Purification    2024, 23 (07): 534-537.   DOI: 10.3969/j.issn.1671-4091.2024.07.010 Abstract （147）      PDF（pc） （478KB）（31）       Knowledge map    Rhabdomyolysis (RM) is a multifactorial clinical syndrome of skeletal muscle injury and release of its breakdown products into the circulation. Acute kidney injury (AKI) is a common complication of RM, which is mainly related to myoglobin occlusion of renal tubules and its direct nephrotoxic effects, and others. RM-induced AKI has a low cure rate and high mortality. Previous studies have shown that continuous renal replacement therapy (CRRT) combined with hemoperfusion (HP) can be effective in treating RM-induced AKI. This article provides a review of CRRT combined with HP in the treatment of RM-induced AKI with the aim to provide a reference for clinical therapeutic decision-making and possible follow-up studies. Reference | Related Articles | Metrics

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Correlation between hypersensitive C reactive protein to albumin ratio and abdominal aortic calcification and all-cause death in maintenance hemodialysis patients SU Kai-jie, CAO Qian-ying, LI Zhong-xin Chinese Journal of Blood Purification    2024, 23 (12): 906-909,933.   DOI: 10.3969/j.issn.1671-4091.2024.12.005 Abstract （146）      PDF（pc） （633KB）（8）       Knowledge map    Objective  To explore the relationship between high sensitivity C reactive protein to albumin ratio (CAR) and abdominal aortic calcification and all-cause death in patients with maintenance hemodialysis (MHD).  Methods  Patients with MHD who were treated in the Blood Purification Center of Beijing Luhe Hospital affiliated to Capital Medical University from January 2023 to February 2024 were selected. The basic information and laboratory data after 3 months of regular dialysis treatment were collected in the enrolled patients, as well as the data of abdominal aortic calcification and all-cause death. The correlation between CAR and abdominal aortic calcification was analyzed. The diagnostic value of CAR for calcification was analyzed by receiver operating characteristic curve (ROC), and the relationship between CAR and all-cause death was analyzed by logistic regression.  Results  A total of 204 patients were enrolled, including 155 patients (75.98%) with abdominal aortic calcification, and 11 patients (5.39%) with death. CAR in abdominal aorta calcification group was significantly higher than that in non-calcification group (Z=3.105, P=0.002), spearman correlation analysis showed that CAR was positively correlated with abdominal aorta calcification (r=0.218, P=0.002). The CAR cutoff value was 0.02mg/g for abdominal aorta calcification, the sensitivity and specificity were 92.9% and 36.7%, respectively, with an area under the curve of 0.647 (95% CI: 0.554～0.741, P=0.002). Logistic regression analysis showed that age, dialysis age and HbAlc were independent risk factors for abdominal aortic calcification (OR=1.074, 1.015, 1.881; 95% CI:1.040～1.110, 1.007～1.024, 1.188～2.978; P＜0.001, ＜0.001, =0.001) , and that CAR was an independent risk factor for all-cause death (OR=5.393, 95% CI:1.089～26.699, P=0.039).  Conclusion  CAR is positively correlated with abdominal aorta calcification, CAR is helpful for the diagnosis of abdominal aorta calcification, and CAR is an independent risk factor for all-cause death. Related Articles | Metrics

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Research progress in the citrate-based replacement fluids for continuous renal replacement therapy TONG Shuang, LIN Qiao-xuan, WANG Min-min, WANG Lei Chinese Journal of Blood Purification    2025, 24 (01): 49-53.   DOI: 10.3969/j.issn.1671-4091.2025.01.010 Abstract （140）      PDF（pc） （811KB）（7）       Knowledge map    Anticoagulation strategy ensures filter patency and delivery of an adequate continuous renal replacement therapy (CRRT) dose. Most guidelines recommend the regional citrate anticoagulation (RCA) as the first-line method for patients requiring CRRT. Previous use of the traditional regional citrate anticoagulation had several drawbacks such as complex operation, risks of acid-base imbalance and metabolic disorders, leading to the restriction of its clinical applications. By contrast, citrate-based replacement fluids solve these deficiencies. This article reviews the research progress in citrate-based replacement fluids from point of view of  anticoagulation effectiveness, treatment efficiency and security. Reference | Related Articles | Metrics

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Correlation between first dialysis serum albumin level and prognosis in maintenance hemodialysis patients MA Rong, MAO Nan, XIAO Xiang, XIE Chun-peng, FENG Ya Chinese Journal of Blood Purification    2025, 24 (02): 108-112.   DOI: 10.3969/j.issn.1671-4091.2025.02.002 Abstract （140）            Knowledge map    Objective  This study aimed to explore the clinical characteristics of first dialysis serum albumin (ALB) level in patients with maintenance hemodialysis (MHD) and its influence on prognosis, and to analyze the value in predicting all-cause death in patients with MHD.  Methods  A retrospective analysis was performed in the Blood Purification Center from January 20009 to October 2022, and 1000 patients with MHD were finally included. The demographic and clinical characteristics of the patients were collected. The study endpoint was all-cause death. The optimal cut-off point of ALB is obtained by using R software. The patients were divided into groups (high ALB group and low ALB group) according to the ALB cut-off value. The clinical characteristics of patients with different ALB levels and the correlation between ALB and clinical indicators were analyzed, and the influence of ALB on the prognosis of MHD patients was evaluated. Results ALB and hemoglobin (r=0.176, P<0.001), Kt/V (r=0.217, P<0.001), URR (r=0.192, P<0.001), blood creatinine (r=0.259, P<0.001), blood calcium (r=0.225, P<0.001), blood phosphorus (r=0.225, P<0.001), PTH (r=0.196, P<0.001) are positively correlated, and negatively correlated with age (r=-0.147, P=0.001), C-reactive protein (r=-0.279, P<0.001), and glucose (r=-0.145, P<0.001). During the follow-up period, 164 patients (16.40%) died, age (HR=1.022, 95% CI: 1.010～1.034, P<0.001, PTH (HR=0.999, 95% CI: 0.998～1.000, P=0.046), urea clearance index, urea reduction rate, and ALB level is an independent predictor of mortality in MHD patients (HR=0.940, 95% CI: 0.904～0.977, P=0.002). Conclusion Low ALB level on first dialysis is an independent risk factor of all-cause death in MHD patients. MHD patients with ALB level above 39.8g/L on first dialysis have a better prognosis. Clinicians should pay attention to the ALB level of MHD patients on first dialysis. The higher the ALB level of MHD patients on first dialysis, the lower the risk of all-cause death. Reference | Related Articles | Metrics

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Effects of pre-dialysis chronic kidney disease management on hospitalization costs in one year and long-term mortality in maintenance hemodialysis patients YU Shu , JIA Jue , WANG Tao-tao , XU Feng-lan , Gui Lan-lan , HUA Qin , HE Jian-qiang Chinese Journal of Blood Purification    2024, 23 (09): 646-650.   DOI: 10.3969/j.issn.1671-4091.2024.09.002 Abstract （138）      PDF（pc） （528KB）（16）       Knowledge map    Objective  To further explore whether the management of chronic kidney disease (CKD) before dialysis has a long-term effect in the period after hemodialysis, so as to contribute to the better promotion of CKD management from the perspective of economics and demography.  Methods  This study enrolled 70 patients with initial hemodialysis from the CKD Outpatient Clinic (management group, group M) and 142 patients with initial hemodialysis from the Nephrology Clinic (non-management group, group NM) in the Affiliated Hospital of Jiangsu University in the period from March 2015 to March 2018. The patients were followed up for 5 years, and the hospitalization and expenses at the initial of dialysis and within 1 year after dialysis, as well as the death at 1 year and 5 years after dialysis were compared between the two groups, and the influence of various factors on all-cause death was analyzed.  Results  When starting dialysis, the total hospitalization cost per capita in group NM was significantly higher than that in the group M (t=-3.100，P=0.002). The total hospitalization cost per capita in group M was significantly lower than that in the group NM within 1 year after dialysis (t=-2.269, P=0.024), this is mainly due to a decrease in the cost of medicines, tests, treatments, surgeries and blood transfusions. Multiple linear regression found that CKD management was independently associated with a reduction in total inpatient costs per patient, whether unadjusted, adjusted for age and sex, adjusted for comorbidities, adjusted for baseline laboratory measures at hemodialysis starting, or adjusted for vascular access at hemodialysis initiation, at the time of initiation of dialysis and within one year after initiation of dialysis (Dialysis start-up β=0.386, 0.392, 0.392, 0.359, 0.248，P＜0.001, ＜0.001, ＜0.001, ＜0.001,  =0.018, respectively; Within 1 year of dialysis β=0.151, 0.154, 0.148, 0.168, 0.343，P=0.028, 0.025, 0.038, 0.021, 0.002,  respectively). Kaplan-Meier analysis showed that the 5-year cumulative survival rate difference was statistically significant (χ2=3.947, P=0.047). The results of multivariate analysis showed that age and diabetes mellitus were independent risk factors for all-cause death (HR=1.042, 0.390,95% CI: 1.021～1.062, 0.226～0.671, P＜0.001, 0.001), while pre-dialysis CKD management was protective factor for all-cause death (HR=0.503, 95% CI: 0.295～0.857, P=0.012).  Conclusions   Pre-dialysis CKD management has a legacy effect on post-dialysis economic outcomes and can improve the long-term prognosis of maintenance hemodialysis patients, we should pay more attention to diabetes and elderly patients in CKD management. Reference | Related Articles | Metrics

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The progression of abdominal aortic calcification and its risk factors in maintenance hemodialysis patients CHEN Tian-yi, ZHANG Dong-liang Chinese Journal of Blood Purification    2024, 23 (06): 426-430.   DOI: 10.3969/j.issn.1671-4091.2024.06.006 Abstract （137）      PDF（pc） （796KB）（13）       Knowledge map    Objective To investigate the progression of abdominal aortic calcification (AAC) and its risk factors in maintenance hemodialysis (MHD) patients.  Methods  Forty-seven MHD patients treated in Beijing Jishuitan Hospital from December 2019 to April 2022 were enrolled in this study. Two lumbar quantitative CT images performed during the follow-up period were retrospectively reviewed; 8 slices were sequentially extracted, and AAC score was obtained by the Image J software. According to the average annual AAC-growth, the patients were divided into slow progression group (n=23) and rapid progression group (n=24), and then analyzed using univariate and multivariate regression methods.  Results  The median follow-up time was 2.15(2.14, 2.20) years, and 95.74% of the patients had the progression of AAC. The median baseline AAC score was 59.55 (20.03, 122.46), and the median follow- up AAC score was 78.25(31.93,141.92). Compared with the slow progression group, the rate of smoking (χ2=6.715, P=0.010), baseline AAC score (Z=-3.629, P＜0.001), time averaged serum phosphorus (t=-3.538, P=0.001), time averaged calcium and phosphorus product (t=-3.173, P=0.003), and time averaged intact parathyroid hormone (t=-3.060, P=0.004) were significantly higher, and the durations of oral sevelamer carbonate (Z=-2.122, P=0.034) and cinacalcet hydrochloride (Z=    -2.880, P=0.004) were significantly longer in the rapid progression group. Multivariate logistic regression showed that baseline AAC score (OR=1.020, 95% CI: 1.006～1.035, P=0.005) and time averaged serum phosphorus (OR=115.585, 95% CI: 3.412～3915.747, P=0.008) were the risk factors for rapid progression of AAC in MHD patients.  Conclusion  AAC progresses rapidly in MHD patients. Higher baseline AAC score and hyperphosphatemia were the risk factors for rapid AAC progression in MHD patients. Reference | Related Articles | Metrics

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Prognostic factors of dialysis age in patients with maintenance peritoneal dialysis LIANG Ru-lian, WEN Yue-qiang, WANG Nian-song, WU Xian-feng Chinese Journal of Blood Purification    2024, 23 (12): 901-905,919.   DOI: 10.3969/j.issn.1671-4091.2024.12.004 Abstract （135）      PDF（pc） （549KB）（7）       Knowledge map    Objective  The prognostic factors of dialysis vintage in patients on maintenance peritoneal dialysis were analyzed.  Methods  The clinical data of 571 patients on maintenance peritoneal dialysis (PD) in Evergreen Tree Nephrology Association (ETNA) Peritoneal dialysis database from November 2005 to May 2020 were analyzed retrospectively. The survival rate and technical survival rate were calculated, and the risk factors influencing prognosis were analyzed. PD patients were divided into long dialysis vintage group (≥60 months) and short dialysis vintage group (<60 months), and the prognosis of the patients in different dialysis vintage groups and the risk factors affecting dialysis vintage were analyzed.  Results  The 1-,2-,3-,5- and 10- year cumulative survival rates of the 571 PD patients were 94%, 88.8%, 80.9%,70.3% and 49.8%. The cumulative technical survival rates were 94%, 88.8%,80.8%,69.3% and 39.2%, respectively. COX Multivariate regression analysis showed that chronic obstructive pulmonary disease (COPD) history (HR=3.39, 95% CI: 1.054～10.576, P=0.040), elevated Low-Density lipoprotein cholesterol (LDL-c) (HR=1.222, 95% CI: 1.032～1.447, P=0.020) and pulmonary infection (HR=1.568, 95% CI: 1.252～1.965, P＜0.001) were independent risk factors of death in PD patients (P＜0.05). Logistic regression analysis showed that Smoking (OR=0.349，95% CI: 0.139～0.873，P=0.024), elevated intact parathyroid hormone(iPTH) (OR=0.999, 95% CI: 0.998～1.000, P=0.048)and low urine volume (OR=1.001, 95% CI: 1.000～1.001, P＜0.001) were independent risk factors of technical failure.  Conclusion  Smoking, elevated iPTH and low urine volume are independent risk factors of technical failure. Smoking cessation, rational reduction of iPTH and protection of residual renal function can prolong patients' dialysis vintage. Reference | Related Articles | Metrics

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Advances in the application of artificial intelligence for management of arteriovenous fistula in maintenance hemodialysis patients YAO Shi-yan, SHEN Hua-juan, DONG Yong-ze, JIA Yan-qing, ZHAO Meng-jiao Chinese Journal of Blood Purification    2025, 24 (02): 149-152.   DOI: 10.3969/j.issn.1671-4091.2025.02.011 Abstract （134）            Knowledge map    End-stage renal disease has become one of the important public health problems due to its long-term and incurable nature. Maintenance hemodialysis is the most effective renal replacement therapy for patients with end-stage renal disease, and arteriovenous fistula (AVF) is the frequently used blood access for hemodialysis. However, maturation of newly established AVF and maintenance of AVF patency are two critical obstacles required to be solved. Recently, artificial intelligence (AI) has been successfully used in the field of dialysis. AI provides a novel alternative for the management of AVF. This article reviews recent advances in the application of AI for management of AVF dealing with six aspects: decision-making of AVF site, postoperative maturity prediction, functional monitoring, acoustic feature monitoring, thrombosis and stenosis prediction, and aneurysm grading, aiming to provide references for the application of AI for management of AVF in maintenance hemodialysis patients. Reference | Related Articles | Metrics

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The benefits and risks of essential trace elements in hemodialysis patients HU Rui, LIU Yan, LIU Yun Chinese Journal of Blood Purification    2024, 23 (06): 445-448.   DOI: 10.3969/j.issn.1671-4091.2024.06.010 Abstract （133）      PDF（pc） （473KB）（16）       Knowledge map    Kidney is an important organ for metabolism of trace elements in human body. In end-stage renal disease (ESRD) patients, changes in trace element levels in whole blood, serum or plasma may occur due to reduced food intake, abnormal function of intestinal absorption, decreased renal excretion capacity, and metabolic alterations resulting from renal failure. Additionally, hemodialysis patients face an even greater risk of trace element deficiency or excess due to the differences in dialysis clearance and quality of dialysis water. The abnormal metabolism of trace elements is associated with risks of various complications, hospitalization and mortality among hemodialysis patients. Therefore, the study of trace elements in hemodialysis patients is of clinical importance.  Reference | Related Articles | Metrics

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Application of medical and nursing care integrated platform based on remote monitoring in the management of peritoneal dialysis patients at home TIAN Na, LIU Ying, JIANG Xiao-xue, LIU Meng-ai, LIU Da-jun, YUN Yang Chinese Journal of Blood Purification    2024, 23 (06): 470-473.   DOI: 10.3969/j.issn.1671-4091.2024.06.016 Abstract （132）      PDF（pc） （582KB）（12）       Knowledge map    Objective   To explore the application effect of medical and nursing care integrated platform based on remote monitoring system to follow up peritoneal dialysis (PD) patients.  Methods  Sixty patients undergoing PD and followed up at Shengjing Hospital of China Medical University from June 2017 to May 2020 were selected as the control group, and a total of 60 PD patients followed up from June 2020 to May 2023 were assigned to the observation group. The control group received routine care, while the observation group received the medical and nursing care integrated platform based on remote monitoring system. Medication compliance, complication rate, re-hospitalization and re-examination score were compared between the two groups.  Results  Compared with the control group, medication compliance of patients in the observation group was significantly improved (63.33% vs. 46.67%, χ2=4.062, P=0.044), complication rate was significantly reduced (26.67% vs. 46.67%, χ2=5.167, P=0.023), re-hospitalization rate was lower (23.33% vs. 41.67%, χ2=4.596, P=0.032), and re-examination score was significantly increased (88.13±6.36 vs. 81.32±9.78, t=4.527, P<0.001).  Conclusion   The application of medical and nursing care integrated platform based on remote monitoring system can help PD patients better comply with medications and reduce complications, and can also improve the quality of management to chronic diseases. Reference | Related Articles | Metrics

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Research on factors affecting peritoneal water transport and solute transport function in peritoneal dialysis patients ZHANG Meng-qin, XU Xiao, DONG Jie Chinese Journal of Blood Purification    2024, 23 (07): 494-499,509.   DOI: 10.3969/j.issn.1671-4091.2024.07.002 Abstract （132）      PDF（pc） （493KB）（23）       Knowledge map    Objective  To explore the factors affecting the long-term trends of peritoneal water transport and solute transport in incident peritoneal dialysis patients.  Methods   Incident peritoneal dialysis patients were recruited at Peking University First Hospital from January 1, 2016, to April 30, 2019. Baseline data including demographics, clinical biochemistry, dialysis prescription, and dialysis adequacy and transport test were collected. Spearman's correlation analysis was used to explore the factors affecting patients' baseline ultrafiltration per glucose load and 24-hour dialysate-to-plasma creatinine ratio (24h D/P Cr). Factors that influenced the trends of patients' ultrafiltration per glucose load and 24h D/P Cr were analyzed using mixed linear modeling. Results A total of 197 incident peritoneal dialysis patients who were clinically stable were included in this study. A positive correlation between continuous dialysis (r=0.227, P=0.001), baseline exposure of glucose (r=0.140, P=0.049) and baseline 24h D/P Cr was observed. Cardiovascular disease (r=0.144, P=0.043), new-onset peritonitis (r=0.168, P=0.018), and baseline exposure of glucose at baseline (r=0.252, P＜0.001) were positively correlated with baseline ultrafiltration per glucose load. In contrast, baseline blood albumin (r=-0.192, P=0.007) and renal Kt/V (r=-0.340, P＜0.001) showed a negative correlation with ultrafiltration per glucose load. A gradual increasing trend in ultrafiltration per glucose load (t=-4.196，P＜0.001) was observed in our peritoneal dialysis patients using mixed linear modeling but was not associated with age, gender, diabetes, cardiovascular disease, Charlson comorbidity score, baseline hemoglobin, baseline blood albumin, baseline hypersensitive C-reactive protein (hs-CRP), baseline diastolic blood pressure, baseline systolic blood pressure, new-onset peritonitis, intermittent or continuous dialysis, baseline renal Kt/V, and aquaporin-1 (AQP1) promoter genotype (P>0.050). Meanwhile, 24h D/P Cr remained relatively stable (t=-1.486，P=0.138) during follow-up.  Conclusion  This study demonstrated that an increasing trend in ultrafiltration per glucose load and a stable trend in 24h D/P Cr were observed in our incident peritoneal dialysis patients, which may be associated with our incremental dialysis and glucose-sparing strategies. This supported that peritoneal membrane function in peritoneal dialysis patients is influenced by a combination of environmental and genetic factors. Reference | Related Articles | Metrics

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Research progress in job competency training for blood purification nurses ZHANG Yu-jiao, YUAN Jing, NING Yun-feng, YING Jin-ping Chinese Journal of Blood Purification    2024, 23 (09): 683-685,710.   DOI: 10.3969/j.issn.1671-4091.2024.09.010 Abstract （132）      PDF（pc） （504KB）（46）       Knowledge map    Blood purification patients have various primary diseases and may present rapid disease changes or critically ill situations, which need the management by professional nurses with comprehensive competency of higher quality. Training blood purification nurses familiar with a variety of blood purification operations and enable to deal with various clinical problems are then required. Nurses newly working in this field are usually facing many challenges, including the specific skills of nursing operations and the abilities to identify disease changes, quite different from the nursing skills in other departments. Enhanced training of these nurses is an essential step to quickly increase their job competency capable to independently manage blood purification operations and dialysis patients and to support the continuing development of professional nursing in blood purification centers. This article reviews the research advances in the abilities of blood purification nurses. We summarize the importance and present situation of blood purification nurse training in China and foreign countries based on the concept of job competency, in order to provide references for the management and excellence of training new blood purification nurses. Reference | Related Articles | Metrics

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Research progresses in extracorporeal membrane oxygenation (ECMO) combined with continuous renal replacement therapy (CRRT) for adult patients YUAN Shu-ting, WANG Xue-liang, LI Tian, HE Xi-mei, WAN Li-ping, XI Chun-sheng Chinese Journal of Blood Purification    2024, 23 (11): 844-848.   DOI: 10.3969/j.issn.1671-4091.2024.11.009 Abstract （132）      PDF（pc） （613KB）（16）       Knowledge map    Extracorporeal membrane oxygenation (ECMO) is mainly used in clinical practice to support cardiac insufficiency and/or respiratory insufficiency, and is a key technology for the treatment of severe and intractable heart failure and respiratory failure. During ECMO, fluid overload is frequently an indication for renal replacement therapy, and continuous renal replacement therapy (CRRT) is the commonly used modality. In patients on ECMO treatment, CRRT can be run in parallel with ECMO through different vascular access, or series connection in ECMO circuit. Anticoagulation for ECMO is usually with systemic heparin, but for CRRT circuit several methods can be used, such as no anticoagulation, addition of filtered heparin or local citrate anticoagulation. CRRT in combination with ECMO can be considered as a form of multi-organ supportive therapy, but this approach needs to be optimized in terms of timing, settings, anticoagulation, prescribing, and delivery. This review summarizes the implications of ECMO plus CRRT in adults, the timing of CRRT initiation, CRRT prescribing, circuit connection and prognosis in order to provide references for clinicians to treat the patients with appropriate indications. Reference | Related Articles | Metrics