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Observation on the anticoagulant efficacy and blood concentration of nafamostat mesylate in hemodialysis AO Guang-yu, HUANG Lan, CHEN Ting-yu, LI Han-yu, CHEN Min Chinese Journal of Blood Purification    2023, 22 (08): 579-583.   DOI: 10.3969/j.issn.1671-4091.2023.08.003 Abstract （849）      PDF（pc） （414KB）（307）       Knowledge map    Objective To explore the safety and effectiveness of nafamostat mesylate (NM) as an anticoagulant for hemodialysis, and its impact on the systemic coagulation function in patients undergoing maintenance hemodialysis (MHD).  Methods A prospective study was conducted on 12 MHD patients at the Department of Nephrology, The First People's Hospital of Chengdu from January to September 2022. Blood samples were collected at various time points: before dialysis at the arterial end, during dialysis (1h, 2h, 3h and 4h) and 15 minutes post-dialysis at the sites before the filter, after the filter and at the arterial end. NM concentration and activated clotting time (ACT) were measured in these blood samples.  Results At the time points of 1h, 2h, 3h and 4h during dialysis, the ACT values showed significant differences in the blood samples before the filter, after the filter and from arterial end (F=21.899, 27.464, 8.264 and 8.162 respectively; P<0.001, <0.001, =0.001 and =0.001 respectively); the ACT values of different sites at the same time point showed that the ACT value of arterial end was the lowest, followed by the value after filter and then the value before filter. At the time points of 1h, 2h, 3h and 4h during dialysis, the NM blood concentrations were significantly different in the blood samples before the filter, after the filter and from arterial end (F=46.547, 20.059, 16.582 and 16.687 respectively; P <0.001); the NM blood concentrations of different sites at the same time point showed that the NM blood concentration of arterial end was the lowest, followed by the value after filter and then the value before filter.  Conclusion Nafamostat mesylate effectively serves as an anticoagulant in the extracorporeal circulation during hemodialysis. It possesses the characteristics of high dialysis clearance rate and rapid metabolism in the body with a minimal impact on systemic coagulation status. It is a new choice of anticoagulant for patients undergoing hemodialysis with high risk of bleeding. Reference | Related Articles | Metrics

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Research report on the development of China's hemodialysis Chinese Hospital Association Blood Purification Center Branch Chinese Journal of Blood Purification    2024, 23 (05): 321-329.   DOI: 10.3969/j.issn.1671-4091.2024.05.001 Abstract （793）      PDF（pc） （506KB）（278）       Knowledge map    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 Related Articles | Metrics

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Expert consensus on anticoagulation management in chronic kidney disease patients complicated with non-valvular atrial fibrillation The Working Group on Anticoagulation Management of Non-valvular Atrial Fibrillation in Chronic Kidney Disease Patients Chinese Journal of Blood Purification    2023, 22 (08): 561-573.   DOI: 10.3969/j.issn.1671-4091.2023.08.001 Abstract （673）      PDF（pc） （782KB）（708）       Knowledge map    The incidence of thromboembolic diseases and hemorrhage is high in chronic kidney disease (CKD) patients complicated with non-valvular atrial fibrillation. Nephrologists and cardiologists are facing problems in anticoagulation treatment for these patients. A committee composed of nephrologists, cardiologists and pharmaceutical experts compiled the consensus based on current status of clinical diagnosis and treatment of the disease. According to the data of evidence-based medicine and clinical experiences, this consensus systematically introduces the risk assessment of thromboembolism and bleeding, the timing of starting anticoagulant therapy and the drug of choice, in order to guide and standardize the anticoagulant treatment and to improve clinical diagnosis and treatment of non-valvular atrial fibrillation in CKD patients. Reference | Related Articles | Metrics

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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 the classification of clinical application for replacement fluids used in continuous renal replacement therapy The Expert Group of Zhongguancun Nephrology & Blood Purification Innovation Alliance (NBPIA) Chinese Journal of Blood Purification    2023, 22 (10): 721-725.   DOI: 10.3969/j.issn.1671-4091.2023.10.001 Abstract （553）      PDF（pc） （446KB）（457）       Knowledge map    Continuous renal replacement therapy (CRRT) is especially suitable for critically ill patients with unstable clinical conditions among the various extracorporeal blood purification therapies. CRRT enables continuous and slow removal of water and solutes and improvement of metabolic imbalances, and at the same time, stabilizing hemodynamics and facilitating the restoration of kidney function. The selection and optimal combination of replacement fluids based on patient conditions and treatment goals play a pivotal role in the safe and effective performance of CRRT. In the past, the type and quality of replacement fluids proposed in the clinical guidelines, expert consensus and operational protocols from China and foreign countries have been recommended. However, these recommendations are quite different from the preparation and supply of replacement fluids currently used in clinical practice. The establishment of a standardized and practical classification of replacement fluids are required for clinically rational application of replacement fluids and for healthcare professionals to develop effective fluid management and anticoagulation strategies. Based on the three rules, i.e., featuring the present situation of clinical practice, enabling quick clinical decision-making, and reflecting the future technology advances, the expert group of Zhongguancun Nephrology & Blood Purification Innovation Alliance (NBPIA) proposed an expert consensus on the classification of clinical application of replacement fluids for CRRT. This consensus combines clinical evidences and practical experiences, suggests the classification method for replacement fluids according to preparation method, base composition and mixing method, and recommends the classification system and clinical use of replacement fluids for CRRT, in order to improve the clinical use of replacement fluids, the quality evaluation, the standardized management, and the overall quality of CRRT in China. 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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Perioperative Management of New-built Autogenous Arteriovenous Fistula: Chinese Expert Consensus Expert Consensus Work Group of Nephrology and Blood Purification Chinese Journal of Blood Purification    2023, 22 (12): 881-890.   DOI: 10.3969/j.issn.1671-4091.2023.12.001 Abstract （453）      PDF（pc） （583KB）（402）       Knowledge map    Autogenous arteriovenous fistula (AVF) is the first choice for vascular access in hemodialysis patients. Detailed evaluation and planning for a new AVF before the surgery, meticulous manipulation during surgery, and close monitoring and exercise guidance after the surgery must be carried out. These processes need mutual interaction and collaboration between doctors and patients. Healthcare education should begin before the use of AVF for hemodialysis. The Expert Consensus Work Group of Nephrology and Blood Purification, Beijing Perioperative Medicine Study Society based on the guidelines, consensus and evidence-based medical data from China and foreign countries and combined with the clinical experiences of the members in this group proposes this consensus to provide suggestions and comments about the perioperative management of AVF. 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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The proposal and significance of cardiovascular-kidney-metabolic syndrome WANG Fang-yu, GAO Yue-ming, DENG Zhen-ling, WANG Yue Chinese Journal of Blood Purification    2024, 23 (05): 368-371.   DOI: 10.3969/j.issn.1671-4091.2024.05.011 Abstract （379）      PDF（pc） （407KB）（308）       Knowledge map    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. Reference | Related Articles | Metrics

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The new classification of uremic toxins LI Chao, WEI Tao Chinese Journal of Blood Purification    2023, 22 (11): 801-805,815.   DOI: 10.3969/j.issn.1671-4091.2023.11.001 Abstract （362）      PDF（pc） （521KB）（697）       Knowledge map    ?The retention and increase of uremic toxin will lead to a series of uremic symptoms, which will affect many systems of the whole body, and lead to the decline of patients' quality of life and high mortality. In 2003, the European Uremic Working Group classified uremic toxins into three groups according to their physical chemistry properties: water-soluble small molecule compounds, protein-binding compounds, and middle molecule compounds. With the new understanding of uremic solutes, the new data of sources and the development of hemodialysis methods and membrane materials, the previous classification can not fully adapt to the new progress in the field of blood purification. Accordingly, in november-december 2020, Claudio R, as president of the General Assembly, convened an expert meeting and prepared an expert consensus that provided new insights into the definition and classification of uremic toxin  tails the expert group's consensus recommendations for new definitions and more clinically oriented new classifications of uremic toxins. Related Articles | Metrics

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Analysis of intradialytic blood glucose change and hypoglycemia in maintenance hemodialysis patients HAN Yu, QU Zhi-jie, FENG Wen-yuan, LI Wen, MIAO Li-ning, SUN Jing Chinese Journal of Blood Purification    2023, 22 (06): 421-425.   DOI: 10.3969/j.issn.1671-4091.2023.06.005 Abstract （331）      PDF（pc） （447KB）（153）       Knowledge map    Objectives  To analyze the rules and influencing factors of intradialytic blood glucose change and hypoglycemia, and to explore the effect of glucose-containing dialysate (GCD) on intradialytic hypoglycemia.  Methods  The maintenance hemodialysis (MHD) patients treated in the Blood Purification Center, The Second Hospital of Jilin University from December 2021 to December 2022 were enrolled in this study. They were routinely treated with glucose-free dialysate (GFD), and then switched to GCD containing 5.5mmol/L glucose. Blood glucose was assayed at 0, 1st， 2nd, 3rd hour and the end of last session of hemodialysis with GFD, and of the 4th session of hemodialysis with GCD.  Intradialytic blood glucose changes and hypoglycemia were compared between the MHD patients with and without diabetes. Univariate and multivariate logistic regression were used to analyze the influencing factors for intradialytic hypoglycemia in MHD patients with diabetes.   Results  A total of 232 MHD patients were enrolled in this study, including 102 in diabetes group and 130 in non-diabetes group. When they were dialyzed with GFD, hypoglycemia occurred in 21 cases in diabetes group (3 episodes of hypoglycemia occurred during dialysis after 0~2 hour and 21 episodes occurred during dialysis after 2 hours to end of the session), and in 6 cases in non-diabetes group (6 episodes occurred during dialysis after 2 hours to end of the session). Asymptomatic hypoglycemia accounted for 79.17% and 83.33% of the hypoglycemia in diabetes group and non-diabetes group respectively. The incidences of hypoglycemia were 20.59 % and 4.62% in diabetes group and non-diabetes group respectively (c2=14.180, P＜0.001). After the hemodialysis switched to GCD, hypoglycemia occurred in one case (0.98%) in diabetes group, significantly lower than the incidence of 20.59 % when GFD was used (P＜0.001); no hypoglycemia occurred in non-diabetes group. Pre-dialytic blood glucose≥10mmol/L (OR=0.185, 95% CI 0.054~0.636, P=0.007) and withdrawal of hypoglycemic medications on dialysis day (OR=0.226, 95% CI 0.073~0.707, P=0.011) were the protective factors for intradialytic hypoglycemia, while diabetes course≥20 years (OR=3.280, 95% CI 1.046~10.286,P=0.042) was the risk factor for intradialytic hypoglycemia. Conclusion   The last 2 hours of a dialysis session is the period when hypoglycemia, especially asymptomatic hypoglycemia, frequently occurs. GCD with a glucose concentration of 5.5mmol/L can effectively reduce the prevalence of hypoglycemia. Diabetes course ≥20 years is the risk factor for intradialytic hypoglycemia; withdrawal of hypoglycemic medications on dialysis day and pre-dialytic blood glucose ≥10mmol/L are the protective factors for intradialytic hypoglycemia. Reference | Related Articles | Metrics

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Interpretation on the 2023 clinical practice guidelines of plasma component purification technology from the American Society for Apheresis (9th edition)  WAN Li, WANG Mei Chinese Journal of Blood Purification    2024, 23 (01): 1-8.   DOI: 10.3969/j.issn.1671-4091.2024.01.001 Abstract （319）      PDF（pc） （520KB）（306）       Knowledge map     In April 2023, the American Society for Apheresis (ASFA) released the 9th edition of guidelines for clinical practice of therapeutic apheresis. Based on published literature, these guidelines define the quality of evidence and the recommended strength of therapeutic apheresis in the treatment of diseases, and discuss the clinical application of therapeutic apheresis in 91 disease (166 indications). This article focuses on the interpretation of clinical multidisciplinary applications of plasma component purification technology, including plasma exchange and immuneadsorption. Reference | Related Articles | Metrics

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Research trends in artificial intelligence applied to hemodialysis: visualization analysis based on VOSviewer LIU Jia-li, HU Shen-ling, ZHOU Pei-ru, MO Hong-qiang, HUANG Jie-wei, HU Bo Chinese Journal of Blood Purification    2023, 22 (08): 633-637.   DOI: 10.3969/j.issn.1671-4091.2023.08.015 Abstract （299）      PDF（pc） （907KB）（678）       Knowledge map    Objective To investigate the current research status and development trend of artificial intelligence (AI) applied to hemodialysis.  Methods  We searched the literature in the field of AI applied to hemodialysis indexed by SCI-EXPANDED and SSCI in the Web of Science Core Collection database from the establishment of the database to March 29, 2023. We applied the bibliometric research method and VOSviewer software to visualize and present the countries, research institutions, journals, authors, and keywords.  Results  A total of 98 articles and 5 reviews were enrolled in the analysis. In the past 20 years, the application of AI to the field of hemodialysis has shown an overall and rising trend. The country with the most publications was China (n=37), and the institution with the most publications was Fresenius Medical Care (n=16). Hemodialysis outcomes, influencing factors, and complication prediction models are the current and future frontier of research trends in this field.  Conclusion Using bibliometrics and VOSviewer software for analysis can visualize the current status of research and cutting-edge hotspots in the field and provide a reference basis for further research in the future. 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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Consideration of the supervision of hemoperfusion device ZHAN Na, ZOU Yan-guo, LI Dan, QIANG Yi-ning, ZENG Zhu Chinese Journal of Blood Purification    2023, 22 (07): 481-483.   DOI: 10.3969/j.issn.1671-4091.2023.07.001 Abstract （283）      PDF（pc） （354KB）（489）       Knowledge map    Hemoperfusion device is widely used in the treatment of renal failure, liver failure, poisoning, autoimmune diseases, et al. This article tends to introduce the common registration problems and difficulties of these hemoperfusion devices from the perspective of medical device registration supervision. 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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Interpretation of the 2023 International Society for Peritoneal Dialysis guideline recommendations for prevention and treatment of peritoneal dialysis catheter-related infection CHENG Shui-qin, YU Le, ZHANG Zhi-hong, YU Yu-sheng Chinese Journal of Blood Purification    2024, 23 (02): 81-85.   DOI: 10.3969/j.issn.1671-4091.2024.02.001 Abstract （255）      PDF（pc） （519KB）（303）       Knowledge map    Peritoneal dialysis (PD) catheter-related infection is a serious complication in PD patients, being an important risk factor for drawing out of PD catheter and peritonitis and affecting prognosis of the PD patients. In May 2023, the International Society for Peritoneal Dialysis (ISPD) updated the guideline recommendations for PD catheter-related infection, revised and clarified the definition and classification of PD catheter exit site infection (ESI) and tunnel infection. A new target that overall PD catheter ESI rate should be less than 0.4 episodes per year was established. The specific recommendation for prevention and treatment of PD catheter-related infections was provided, and the research direction of PD catheter-related infections was proposed. In this review, we present an interpretation on this guideline. Reference | Related Articles | Metrics

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Iron therapy for iron deficiency anemia in chronic kidney disease TANG Wen-jiao, LIAO Ruo-xi Chinese Journal of Blood Purification    2023, 22 (06): 438-441.   DOI: 10.3969/j.issn.1671-4091.2023.06.008 Abstract （245）      PDF（pc） （366KB）（569）       Knowledge map    Renal anemia is a common complication of chronic kidney disease (CKD). Iron deficiency is highly prevalent in patients with CKD. On the other hand, CKD patients are vulnerable to iron overload due to long-term iron supplement. Serum transferrin and transferrin saturation are traditionally used in the evaluation of iron status. However, due to the chronic inflammation in CKD patients, these biomarkers can not reflect iron status accurately. Oral and intravenous iron therapy both show advantages and disadvantages in anemia treatment. New iron agents bring new choices for iron therapy in renal anemia, while their efficacy needs further studies. Reference | Related Articles | Metrics

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Evidence-based practice of exercise rehabilitation in maintenance hemodialysis patients ZHAN Xuan, GUO Yue-yue, ZHOU Kou-xiang, CHEN Ting-ting, BO Xiang-min, LIU Sheng-feng Chinese Journal of Blood Purification    2023, 22 (06): 472-476.   DOI: 10.3969/j.issn.1671-4091.2023.06.016 Abstract （242）      PDF（pc） （449KB）（788）       Knowledge map    Objective   To implement evidence-based practice based on the evidences from exercise rehabilitation in maintenance hemodialysis (MHD) patients, and to validate the role of exercise rehabilitation in improving physical function, exercise tolerance, and quality of life in MHD patients.  Methods  The evidence-based continuous quality improvement model was used as the research framework, and an evidence-based program for exercise rehabilitation in MHD patients was conducted from January to December 2021 through evidence acquisition, status review and evidence introduction. A total of 80 MHD patients hospitalized in the Department of Nephrology, Jiangsu Provincial Hospital of Traditional Chinese Medicine from January to March 2022 were then recruited and randomly divided into experimental group (n=40) and control group (n=40). After the exercise intervention, the muscle mass, muscle strength, 6-minute walking test, and quality of life were compared between the two groups. The awareness of sport rehabilitation evidence in medical staff was also compared before and after the evidence-based practice.  Results   Nine pieces of evidences were finally included, with a total of seven reviewed indicators. After exercise intervention, muscle mass (t=-3.302, P<0.01), muscle strength (t=-2.825, P<0.001), and 6-minute walking (t=-5.529, P<0.001) increased more in experimental group than in control group. The total scores of each dimension in the Health Survey Short Form increased more in experimental group than in control group (P<0.05). The awareness rate of sport rehabilitation evidence among medical staff increased by 40.74% before and after evidence-based practice, which has a statistical significance (P<0.001).  Conclusion  The evidence-based exercise rehabilitation practice can improve the body function, exercise endurance and quality of life in MHD patients. Reference | Related Articles | Metrics

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Evidence of benefits and achievement of high-volume hemodiafiltration DU Hui, ZUO Li Chinese Journal of Blood Purification    2024, 23 (04): 241-244,289.   DOI: 10.3969/j.issn.1671-4091.2024.04.001 Abstract （242）      PDF（pc） （538KB）（79）       Knowledge map    Hemodiafiltration(HDF)works by combining diffusive and convective solute removal to provide a greater removal of larger molecular weight uremic toxins. The recent publication of the CONVINCE study might be a milestone in ending the controversy over whether this treatment modality can provide long-term survival benefits for patients with end-stage renal disease(ESRD)requiring renal replacement therapy. This review gives a brief overview of the current evidence for the clinical benefits of HDF as well as the important factors and stepwise protocols for high-volume HDF achievements. Reference | Related Articles | Metrics

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Observation on the efficacy of oXiris hemofilter in the treatment of severe burn complicated with sepsis and acute kidney injury PENG Jia-nan, LUAN Feng-wu, ZHAO Li-hong, CHEN Meng-hua, ZHANG Ting Chinese Journal of Blood Purification    2023, 22 (06): 406-409.   DOI: 10.3969/j.issn.1671-4091.2023.06.002 Abstract （235）      PDF（pc） （436KB）（214）       Knowledge map    Objective  To explore the efficacy of oXiris hemofilter in the treatment of severe burn patients complicated with sepsis and acute kidney injury.  Method  The clinical data of 5 patients with severe burn complicated with sepsis and acute kidney injury treated with continuous venovenous hemofiltration (CVVHDF) with oXiris hemofiltration in the hemodialysis center of General Hospital of Ningxia Medical University from May 2018 to February 2021 were retrospectively analyzed. The changes in general vital signs (body temperature, MAP, heart rate, respiration, urine volume, etc.), blood routine, blood gas analysis, and biochemical indexes were observed in 5 patients before and 24 hours after CVVHDF treatment with oXiris hemofiltration, and the Sequential Organ Failure Assessment (SOFA) score was calculated respectively.  Results  ①In the following 24 hours after CVVHDF with oXiris hemofiltration, compared with before treatment, the urine volume of 24 hours (Z=-2.069, P=0.039), the platelets count (t=-3.977, P =0.001) were increased, and the serum sodium level (t=2.652, P =0.016) and the SOFA score (t=4.265, P＜0.001) was decreased. The indexes of body temperature(t=-0.258, P=0.799), MAP (t=0.168, P=0.868), heart rate(t=1.057, P=0.304), respiration     (t=0.481, P=0.636), PH(t=1.304, P=0.208), WBC (t=-1.616, P=0.123), serum bilirubin(t=0.560, P=0.582), serum creatinine (t=0.755, P=0.459) were improved, but there was no significant difference before and after treatment. ②The 28-day survival rate of these patients was 60%.  Conclusions  CVVHDF therapy with oXiris hemofiltration can improve coagulation function, promote the recovery of kidney function, reduce SOFA score in severe burn patients complicated by sepsis and acute kidney injury. Reference | 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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Efficacy of Paricalcitol in the treatment of hemodialysis patients with secondary hyperparathyroidism and the characteristic changes of iPTH and abdominal aortic calcfication score after the treatment for 12 weeks LIU Yin, ZHAO Bin, LIU Li-fang, HU Pu-ping, YANG Tao Chinese Journal of Blood Purification    2023, 22 (07): 508-511,528.   DOI: 10.3969/j.issn.1671-4091.2023.07.007 Abstract （225）      PDF（pc） （486KB）（157）       Knowledge map    Objectives  To investigate the clinical efficacy of Paricalcitol in the treatment of maintenance hemodialysis (MHD) patients with secondary hyperparathyroidism (SHPT), and to analyze the correlation between iPTH level and abdominal aortic calcification (AAC) score.  Methods   A total of 40 MHD patients (24 males and 16 females) with SHPT and received regular hemodialysis at the Hemodialysis Clinic of Beijing Haidian Hospital from April 2019 to June 2020 were included in the study. Intravenous Paricalcitol was administered for 12 weeks in addition to the MHD. AAC score and serum calcium, phosphorus and intact parathyroid hormone (iPTH) were compared before and after Paricalcitol treatment for 12 weeks to assess its clinical efficacy. The relationship between iPTH level and AAC was assessed after the treatment for 12 months.  Results After Paricalcitol treatment for 12 weeks, serum phosphorus and iPTH levels were significantly lower than those before treatment (phosphorus: t=2.192, P=0.047; iPTH: t=3.026, P=0.014); serum calcium was higher than that before treatment (t=4.188, P=0.001), but remained within the normal range (2.1～2.5 mmol/L); the overall effective rate of lowering serum iPTH was 95%. Patients with severe AAC had higher serum iPTH, while those with moderate to mild AAC had relatively lower serum iPTH; the differences in serum iPTH among the severe, moderate and mild AAC groups were statistically significant (F=150.400, P＜0.001). After the treatment for 12 months, AAC scores were lower than the baseline levels, but the score differences had no statistical significance (t=0.504, P=0.617).  Conclusions  Paricalcitol significantly reduced serum iPTH and phosphate levels in MHD patients, and calcium level remained stable within the normal range. Severe AAC may relate to the higher serum iPTH in MHD patients. Reference | Related Articles | Metrics

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Research progresses in the cognitive impairment in maintenance hemodialysis patients HE Ya-peng, ZHAO Qian, LI Xin, ZHANG Teng, WU Hong-xia Chinese Journal of Blood Purification    2023, 22 (07): 529-532.   DOI: 10.3969/j.issn.1671-4091.2023.07.012 Abstract （221）      PDF（pc） （403KB）（183）       Knowledge map    In view of the prevalence and severity of cognitive impairment in maintenance hemodialysis patients, this article aims to review the research progress in the cognitive impairment in maintenance hemodialysis patients from the aspects of etiology, assessment tools, influencing factors, intervention measures, and others, in order to provide reference for clinical work and research. 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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Effect of the start time of blood purification therapy and the selection of filter on short-term prognosis of the patients with sepsis CHEN Xi, WAN Hong-zhe, WU Shuo, ZHANG Li Chinese Journal of Blood Purification    2023, 22 (07): 493-497.   DOI: 10.3969/j.issn.1671-4091.2023.07.004 Abstract （209）      PDF（pc） （522KB）（183）       Knowledge map    Objective  To investigate the effect of starting time of blood purification therapy and selection of filter on short-term prognosis of patients with sepsis. Methods:We retrospectively collected Patients with sepsis who received blood purification treatment in the First Affiliated Hospital of Xinjiang Medical University .Single factor analysis was collected on the index line on the start day.ROC curve was used to compare the prediction effect of each index, and the optimal threshold value was determined and grouped to analyze the 28d mortality rate with AN69/oXiris was analyzed in the higher/lower groups with different cut-off values. P＜0.05 was considered statistically significant. Results:Among the 66 patients, 31 died within 28 days of admission. Univariate analysis showed that aCCI, NEWS, SOFA, APACHE II(OR value was 1.380, 1.213, 1.141, 1.079; 95%CI was 1.035-1.838, 1.062-1.386, 1.005-1.297, 1.017-1.144; and P value was 0.028, 0.005, 0.042, 0.012) was the risk factor for death within 28 days; Scr(OR=0.994;95%CI=0.991-0.998;P=0.001) was a protective factor for death within 28 days; The AUC vaule of aCCI, NEWS, SOFA, APACHE II and Scr were 0.674, 0.698, 0.657, 0.679 and 0.736. 95%CI were 0.543-0.806、0.572-0.824、0.521-0.793、0.548-0.811、0.614-0.858, and the optimal cut-off values were 3.5, 14.5, 11.5, 19.5 and 418.98. In the low-aCCI group, 28d mortality was lower in patients treated with oXiris(χ2=4.572，P=0.032). Conclusion: 1. Patients with sepsis at the start of blood purification therapy had higher risk of death within 28 days with aCCI score above 3.5, NEWS score above 14.5, SOFA score above 11.5, APACHE II score above 19.5, and Scr score below 418.98μmol/L. 2. In sepsis patients with low aCCI, oXiris treatment compared with AN69 membrane material can reduce the 28d mortality of sepsis patients. Reference | Related Articles | Metrics

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Study on the influencing factors for cognitive impairment in maintenance hemodialysis patients XIONG Man-ting, CHANG Li-yang, ZHANG Hong-mei Chinese Journal of Blood Purification    2024, 23 (01): 9-13.   DOI: 10.3969/j.issn.1671-4091.2024.01.002 Abstract （208）      PDF（pc） （525KB）（130）       Knowledge map    Objective To explore the influencing factors for cognitive impairment (CI) in patients with maintenance hemodialysis (MHD).  Methods The MHD patients in the Blood Purification Center of Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medicine University from March to May 2023 were selected as the study subjects by convenient sampling method. Patients were divided into CI group (68 cases) and non-CI group (131 cases) according to the score of the Montreal Basic Cognitive Assessment Scale. General information, dialysis data, laboratory results, comorbidities, sleep status and Ishii score were collected. The influencing factors for CI were analyzed by logistic regression. The predictive value of Ishii score on CI was evaluated by using the receiver operating characteristic (ROC) curve.  Results  A total of 199 MHD patients were included in this study, and 34.2% of the patients had CI. Binary logistic regression showed that older age, higher Ishii score, higher cholesterol level, poor sleep status and lower education level were the independent risk factors for CI (OR=7.694, 3.259, 1.567, 1.085 and 0.318, respectively; 95% CI:2.484～23.830, 1.417～7.494, 1.084～2.265, 1.016～1.159 and 0.148～0.684, respectively; P<0.001, 0.005, 0.017, 0.015 and 0.003, respectively). Further study on the ROC curve of Ishii score showed that the optimal critical values for predicting CI in MHD patients, male and female MHD patients were 98.03, 105.17 and 125.49 points, respectively; the areas under the curve were 0.809, 0.813 and 0.802, respectively; the sensitivities were 85.30%, 80.00%, 68.40%, respectively and the specificities were 63.40%, 72.60%, 79.30%, respectively (P<0.001).  Conclusions  The prevalence of CI in MHD patients is higher. CI is affected by many factors. High Ishii score is an independent risk factor for CI, and is a useful indicator for the prediction of CI in MHD patients. Related Articles | Metrics

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A systematic review of the scales for quality of life in end-stage renal disease patients in China WU Dan, ZHANG Bei-bei, LI Yang, XIE Kun, CHEN Bo Chinese Journal of Blood Purification    2023, 22 (10): 759-762.   DOI: 10.3969/j.issn.1671-4091.2023.10.009 Abstract （205）      PDF（pc） （458KB）（263）       Knowledge map    Objective  The currently used scales for the assessment of quality of life in end-stage renal disease (ESRD) patients are systematically reviewed and evaluated, so as to provide references for clinical studies of quality of life in these patients.  Methods  We searched for the scales of quality of life for ESRD patients published in Chinese literature in the CNKI database since 2010. The characteristics and application status of these scales were then assessed.  Results There are 6 quality of life scales for ESRD patients, in which the 36-item short form health survey (SF-36) and the kidney disease quality of life-short form (KDQOL-SF) are widely used. SF-36 is a universal scale with the advantages of smaller size, flexible, and short evaluation time, and its application rate is 63.9%. However, SF-36 lacks the evaluation of kidney disease related quality of life. KDQOL-SF is a specific scale for kidney disease and dialysis patients, but KDQOL-SF has 79 items and takes longer examination time.  Conclusion  The scale for study of the quality of life in ESRD patients should be selected based on the purpose of the study, the sample size, and the compliance degree of the patients. Reference | Related Articles | Metrics

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Research progresses in the use of artificial intelligence for hemodialysis monitoring and complication prediction REN Zhi-jian, LUO Qun, CAI Ke-dan Chinese Journal of Blood Purification    2024, 23 (04): 294-297.   DOI: 10.3969/j.issn.1671-4091.2024.04.012 Abstract （203）      PDF（pc） （470KB）（108）       Knowledge map    The prevalence of end stage renal disease (ESRD) has been steadily increasing, and hemodialysis is a predominant treatment modality for these patients. Recently, a series of artificial intelligence (AI) models including machine learning and deep learning techniques have been successfully developed into the area of hemodialysis research. Compared with the conventional linear models, the AI models can accurately predict complications, evaluate vascular access, manage volume control and estimate prognosis based on the information from hemodialysis patients. AI also has powerful potentials in clinical practice to improve and individualize hemodialysis protocols and to prevent and treat complications. This review summarizes recent the research advances in AI models for monitoring hemodialysis and predicting complications, aiming to support doctors and nurses to improve the quality of life and to prolong the lives of hemodialysis patients. Reference | Related Articles | Metrics

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Clinicopathological analysis of type I stenosis of autogenous arteriovenous fistula in uremia patients SONG Wen-jun, LIANG Li-ming, CHEN Qin-lan, KONG Xiang-lei, XU Dong-mei Chinese Journal of Blood Purification    2023, 22 (06): 453-457.   DOI: 10.3969/j.issn.1671-4091.2023.06.012 Abstract （202）      PDF（pc） （933KB）（176）       Knowledge map    Objective  To investigate the clinicopathological characteristics of type I autologous arteriovenous fistula (AVF) stenosis in uremic patients.  Methods  A total of 39 patients who underwent AVF reconstructive surgery for type I stenosis were enrolled in this study. Their clinical data were collected. The stenotic venous tissue cut during the reconstructive surgery and the venous tissue stored during the first AVF constructive surgery were pathologically compared, including HE and masson staining, and immunohistochemistry using antibodies against CD133, CD31, CD68, CD206, iNOS and CD56 to identify the cell types.  Results  The mean age of the 39 patients was 52.7±4.4 years old, 62% were male, and diabetic kidney disease accounted for 43.6% of the patients. HE and Masson staining of the stenotic venous tissues demonstrated typical neointimal hyperplasia (NIH). Pearson correlation analysis showed that NIH was positively correlated with serum phosphorus (r=0.381, P=0.026) and negative correlated with neutrophil count (r=-0.360, P=0.031), but not with serum calcium (r=-0.269, P=0.097) and parathyroid hormone (r=0.007, P=0.971). Immunohistochemical staining showed that positive staining of CD31, CD133, CD206, iNOS, CD68 and CD56 were found in the NIH area in stenotic venous tissues.  Conclusions   Histopathological staining showed an eccentric NIH in the venous tissues from type I AVF stenosis. The thickness of the intimal layer correlated with serum phosphorus level and neutrophil count. Immunohistochemistry showed the presence of abnormally arranged intimal cells, endothelial progenitor cells, M1 and M2 macrophages, and NK cells in NIH areas. Reference | Related Articles | Metrics

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Updated points of the American Society for Apheresis: The Ninth Special Issue Guidelines for Therapeutic Apheresis HUANG Yu-min, WU Bu-yun Chinese Journal of Blood Purification    2023, 22 (09): 644-648.   DOI: 10.3969/j.issn.1671-4091.2023.09.002 Abstract （202）      PDF（pc） （493KB）（414）       Knowledge map    Therapeutic apheresis separates different blood components using blood separation techniques, which is a non-pharmacological treatment to remove toxins, antibodies and other substances from the body. In the ninth edition of American Society for Apheresis Guidelines, seven new disease indications, nine new indications for diseases, and changes of evidence level of eight older indications have been added compared to the eighth edition. This article provides a brief review of the updated guidelines. Reference | Related Articles | Metrics

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Construction of risk prediction model for thrombosis in autogenous arteriovenous fistula in maintenance hemodialysis patients JIN Xiao-yu, LI Jing-shu, WU Feng-ru, LIU Lu-ning, FAN Yu-ying Chinese Journal of Blood Purification    2024, 23 (03): 209-213.   DOI: 10.3969/j.issn.1671-4091.2024.03.012 Abstract （200）      PDF（pc） （510KB）（132）       Knowledge map    Objective  To construct a risk prediction model for thrombosis in autogenous arteriovenous fistula (AVF) based on machine learning, and to verify the model.  Methods  A total of 270 patients undergoing maintenance hemodialysis (MHD) in Hemodialysis Center, The Second Affiliated Hospital of Harbin Medical University from March 2020 to December 2021 were recruited as the study subjects. Logistic regression and random forest were used to construct the models. Receiver operating characteristic curve and area under the curve (AUC) were plotted for each model. AUC, accuracy, specificity, sensitivity and F1-score were used to evaluate the models.  Results  Among 270 MHD patients, 105 cases (38.89%) were in AVF thrombosis group and 165 cases (61.11%) in non-AVF thrombosis group. The seven risk factors of smoking history (OR=2.992, 95% CI: 1.306～6.854, P=0.010), hypertension history (OR=12.376, 95% CI: 3.432～44.624, P<0.001), diabetes history (OR=7.477, 95% CI: 2.887～19.360, P<0.001), hyperlipidemia history (OR=6.947, 95% CI: 2.733～17.659, P<0.001), coronary heart disease history (OR=12.894, 95% CI: 4.827～34.439, P<0.001), puncture point compression time (OR=1.132, 95% CI: 1.053～1.217, P=0.010), and triglyceride (OR=1.322, 95% CI: 1.005～1.741, P=0.046) were used to construct risk prediction models. The area under the curve of random forest prediction model was 0.944, and that of logistic regression model was 0.895 (Z=1.688, P=0.092).  Conclusion  Smoking history, hypertension history, diabetes history, hyperlipidemia history, coronary heart disease history, puncture point compression time and triacylglycerol are high risk factors for thrombosis in AVF in MHD patients. The two models based on the seven risk factors have good predictive performance and can be complementary each other. 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