Most Down Articles

Published in last 1 year| In last 2 years| In last 3 years| All| Most Downloaded in Recent Month | Most Downloaded in Recent Year|

Published in last 1 year

Please wait a minute...


For Selected: Download Citations EndNote Reference Manager ProCite BibTeX RefWorks Toggle Thumbnails

Select

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

Select

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

Select

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

Select

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

Select

Efficacy of drug-coated balloon in the treatment of venous stenosis in hemodialysis access HUO Gui-jun, ZENG Yu-qi, TAO Zhi-hong, ZHANG qin, YAO Zhi-chao, ZHOU Da-yong Chinese Journal of Blood Purification    2024, 23 (06): 457-461.   DOI: 10.3969/j.issn.1671-4091.2024.06.013 Abstract （126）      PDF（pc） （584KB）（59）       Knowledge map    Objective To compare the safety and efficacy of drug-coated balloon angioplasty (DCBA) and conventional balloon angioplasty (CBA) in the treatment of venous stenosis in arteriovenous fistula (AVF) for hemodialysis access.  Methods  A retrospective analysis was conducted on the clinical data of 152 hemodialysis patients with AVF stenosis and treated at Suzhou Municipal Hospital from November 2020 to April 2022. Based on the treatment method, they were divided into the drug-coated balloon (DCB) group (n=62) and the conventional balloon (CB) group (n=90). Kaplan-Meier curve was used to assess re-stenosis rate of the target lesion in both groups. Primary patency of the target lesion (TLPP) was compared after the operation for 6 months.  Results  All patients achieved technical and clinical success, and completed follow-up observation. There were no statistical differences in baseline characteristics between the two groups (P>0.05). Kaplan-Meier survival analysis and log-rank test indicated that DCBA significantly prolonged the patency of AVF. TLPP after 6 months showed that the DCB group had higher patency rate compared to the CB group (OR=1.935, 95% CI:1.173～3.193, P=0.017).  Conclusion  Our research results indicate that DCBA improves the primary patency rate of AVFs better than CBA in hemodialysis patients, and DCBA also reduces the need for re-intervention of the target lesion. Therefore, DCBA is an effective and safe method for treatment of AVF stenosis. Reference | Related Articles | Metrics

Select

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

Select

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

Select

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

Select

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

Select

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

Select

Construction of a core competence evaluation index system for nurses specializing in continuous renal replacement therapy XU Xian-rong, ZHU Ya-mei, WANG Mi, XU Jing, YE Ya-jun, CAO Shi-qi, WU Bu-yun, MAO Hui-juan Chinese Journal of Blood Purification    2024, 23 (08): 630-635.   DOI: 10.3969/j.issn.1671-4091.2024.08.013 Abstract （117）      PDF（pc） （501KB）（35）       Knowledge map    Objective  To construct a core competency evaluation index system for nurses specializing in continuous renal replacement therapy (CRRT).  Methods   The first draft of core competence evaluation indexes for CRRT nurses was formulated by referring to domestic and international literature and after discussion in the research group. The second round of consultation with 16 experts was conducted from June to August 2023 by using the Delphi method, to complete the screening and modification of the indexes and to determine the weights of the indexes.   Results  The finalized core competency evaluation indicators for CRRT nurses included 7 first-level indicators (professional theoretical knowledge, professional practical ability, critical thinking ability, communication and coordination ability, management ability, professional development ability, and professional humanistic literacy ability), 27 second-level indicators, and 112 third-level indicators. The effective response rate of the two rounds of expert consultation was 100%, and the expert authority coefficient was 0.912. The Kendall harmony coefficients of the first-, second-, and third-level indicators of the second round of correspondence were 0.399, 0.278, and 0.208, respectively, and the results of the correspondence were all P<0.001.  Conclusion  The constructed core competency evaluation indexes for CRRT specialized nurses are scientific, rational, comprehensive, and professional. This evaluation index system can be used for the training and evaluation of CRRT specialized nurses. Reference | Related Articles | Metrics

Select

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

Select

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

Select

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

Select

Analysis of social avoidance and distress in maintenance hemodialysis patients and its influencing factors CAI Yun, KONG Ling Chinese Journal of Blood Purification    2024, 23 (07): 557-560.   DOI: 10.3969/j.issn.1671-4091.2024.07.015 Abstract （110）      PDF（pc） （452KB）（31）       Knowledge map    Objective  To investigate the current situation of social avoidance and distress in maintenance hemodialysis (MHD) patients and to analyze its influencing factors.  Method  A total of 246 MHD patients treated in the Blood Purification Center of Eastern Theater Command General Hospital from September 2023 to December 2023 were selected as the investigation subjects. General information questionnaire, social avoidance and distress scale, social impact scale and perceived social support rating scale were used to the investigation.  Results  The score of social avoidance and distress in the MHD patients was 12.02±6.70, which was in the middle level. Univariate and multivariate linear regression analyses showed that gender (β=0.278, P<0.001), per capita monthly family income (β=-0.168, P<0.001), self-care ability (β=-0.133, P=0.005), number of complications (β=0.161, P=0.001), total score of stigma (β=0.344, P<0.001) and total score of perceived social support (β=-0.257, P<0.001) were the main influencing factors for social avoidance and distress.  Conclusion  The social avoidance and distress in MHD patients are at a moderate level. Medical staff should provide targeted interventions for patients according to the relevant influencing factors, so as to reduce their social avoidance and distress level and help patients better return to society. Reference | Related Articles | Metrics

Select

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

Select

Analysis of the risk factors for recurrence of juxta-anastomotic stenosis in wrist arteriovenous fistula after percutaneous transluminal angioplasty: a single-center prospective cohort study YAO Guo-ming, HU Ri-hong, YANG Yuan-yuan, HUANG Jia-li, OU Fei, CHEN Hong-yu Chinese Journal of Blood Purification    2024, 23 (07): 546-551.   DOI: 10.3969/j.issn.1671-4091.2024.07.013 Abstract （98）      PDF（pc） （532KB）（29）       Knowledge map    Objective  This study aimed to explore the risk factors for restenosis of the juxta-anastomotic stenosis in radial-cephalic arteriovenous fistula (RC-AVF) after primary percutaneous transluminal angioplasty (PTA).  Methods  A single-center prospective study was conducted, to analyze the patients with arteriovenous fistula (AVF) undergoing PTA treatment between January, 2021 and June 2022. Their demographics, lesional characteristics, technical factors, and auxiliary examination results were collected. Risk factors for restenosis after PTA were evaluated using univariate and multivariable analyses.  Results  A total of 114 patients with RC-AVF successfully completed the first PTA treatment with a technical success rate of 95.0% (114/120), and 112 patients finished follow-up the primary assistant patency time was 512.15±226.32 days, and the secondary patency time was 554.88±205.67 days. After PTA for 90, 180, 360, and 540 days, the primary patency rates were 94.6%, 81.3%, 56.1%, and 33.3%, respectively; the primary assistant patency rates were 97.3%, 95.5%, 85.1%, and 70.1%, respectively; the secondary patency rates were 100%, 100%, 95.7%, and 85.7%, respectively. Cox regression analysis showed that balloon diameter (HR=0.62，95% CI: 0.43～0.89, P=0.009) was the independent predicting factor for primary patency loss after PTA. ROC curve analysis showed an AUC area of 0.614 (95% CI: 0.510～0.718, P=0.037) and a critical value of 6.0 mm. Stenosis length (HR=1.04, 95% CI: 1.02～1.07, P<0.001) and stenosis number (HR=3.73, 95% CI: 1.32～10.54, P=0.013) were the independent predicting factors for primary assistant patency loss after PTA, with AUC areas of 0.686 (95% CI: 0.543～0.838, P=0.009) and 0.685 (95% CI: 0.559～0.810, P=0.010), critical values of 17.5 mm and 2.   Conclusions Restenosis of the juxta-anastomotic venous stenosis in RC-AVF after primary PTA remains high. Balloon diameter is closely related to the restenosis after PTA. The use of a balloon with a maximum diameter <6 mm is an independent predictor for primary patency loss after PTA. Longer stenosis (≥17.5 mm) and stenosis number ≥2 are the independent predictors for primary assistant patency loss after PTA.  Reference | Related Articles | Metrics

Select

The observation of hemoglobin variation in anemic hemodialysis patients treated with darbepoetin alfa XIONG Jian, JI Dong-yun, LIU Ping-ping, CHEN Lei Chinese Journal of Blood Purification    2024, 23 (06): 441-444.   DOI: 10.3969/j.issn.1671-4091.2024.06.009 Abstract （128）      PDF（pc） （521KB）（27）       Knowledge map    Objective  To investigate the efficacy of darbepoetin alfa for the treatment of anemia and its effect on hemoglobin variation in hemodialysis patients.  Methods  A total of 38 stable hemodialysis patients treated in Hefei Jin'nan Kidney Disease Specialized Hospital from August 2022 to September 2023 were selected and randomly divided into two groups, observation group (n=19; 2 dropped out) received darbepoetin alfa treatment, and control group (n=19) received conventional short-acting erythropoiesis stimulating agent treatment. The study consisted of a correction phase and a maintenance phase, with assays of hemoglobin and biochemical indicators monthly, and iron metabolism indicators at 0 and 5th months. Independent samples t-test was used to compare hemoglobin levels before and after treatment between the two groups. Paired t-test was used for before-after self-control comparisons in each group. Repeated measures analysis was performed to examine the trend of hemoglobin change in both groups over time. Chi-square test was used for adverse event analysis.  Results  There was no significant difference in pretreatment hemoglobin level between the two groups (t=0.174, P=0.863). Post-treatment hemoglobin level also had no significant difference (t=0.809, P=0.425). No significant differences in adverse events (heart failure events, P=1.000; fistula occlusion,          P=1.000) were found between the two groups. During the correction phase, the observation group showed a more pronounced and stable hemoglobin increase (F=3.624, P=0.034).  Conclusion  Darbepoetin alfa has the safety and efficacy comparable to those of short-acting erythropoiesis stimulating agents, and can maintain hemoglobin at a stable increase level with less variability. Reference | Related Articles | Metrics

Select

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

Select

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

Select

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

Select

Study on the occurrence and influencing factors of furuncle around the exit of peritoneal dialysis catheter MEN Chun-cui, LU Li-xia, QIAO Jie, CHU Xin-xin, HE Yu-ting, WU Bei, ZHAO Hui-ping, WANGmei Chinese Journal of Blood Purification    2024, 23 (06): 474-479.   DOI: 10.3969/j.issn.1671-4091.2024.06.017 Abstract （100）      PDF（pc） （588KB）（24）       Knowledge map    Objective  To explore the occurrence and influencing factors of furuncle around exit of peritoneal dialysis (PD) catheters.  Methods  The PD patients who were followed up regularly from September 2011 to September 2017 in the Department of Nephrology, Peking University People’s Hospital were selected. The occurrence of furuncle and related clinical data were reviewed and analyzed.  Results  A total of 183 PD patients were enrolled in this study, 88 (48.1%) were male, the average age was 59.8±13.8 years, and the median PD duration was 27 (15, 51) months. Thirty-six episodes of furuncle around exit of PD catheter occurred in 23 (12.6%) patients (0.05 episodes/patient-year). The most common site of furuncle was at 6 to 9 o'clock position around PD catheters (14 episodes, 38.9%). In terms of complications, 4 episodes of furuncle (11.1%) were complicated with exit-site infection and/or tunnel infection, but without peritonitis. Logistic regression analysis showed that shorter PD duration (OR=0.969, 95% CI: 0.941～0.998, P=0.039), diabetes mellitus (OR=3.014, 95% CI: 1.050～8.651, P=0.040) and higher serum C-reactive protein (OR=1.154, 95% CI: 1.065～1.251, P<0.001) were the independent risk factors for occurrence of furuncle around exit of PD catheters. Binary logistic regression found that diabetes mellitus (OR=5.513, 95% CI: 1.029～29.536, P=0.046) and C-reactive protein (OR=1.103, 95% CI: 1.016～1.197, P=0.019) were the independent risk factors for frequent furuncle occurrence around exit of PD catheters.  Conclusions  Furuncle around exit of PD catheters is not uncommon in PD patients, and may develop into exit-site infection and/or tunnel infection. The patients with diabetes mellitus, shorter PD duration and higher level of C-reactive protein should be paid attention to the presence of furuncle around the exit, and should be given corresponding education to prevent exit-site infection and tunnel infection. Related Articles | Metrics

Select

The impact of lactate on circuit clotting in regional citrate anticoagulation continuous renal replacement therapy DUAN Peng-cheng, LU Mu-rong, YU Ting-ting, ZHOU Li-zhen, WANG Shuang-shuang, CHEN Wei-yan, YU Hong-jing Chinese Journal of Blood Purification    2024, 23 (08): 586-589,595.   DOI: 10.3969/j.issn.1671-4091.2024.08.003 Abstract （84）      PDF（pc） （556KB）（24）       Knowledge map    Objective  This retrospective study aimed to identify factors contributing to clotting within 48 hours in circuits of continuous renal replacement therapy (CRRT) using regional citrate anticoagulation (RCA). Methods  Data from the intensive care unit of the Second Affiliated Hospital of Guangzhou Medical University between June 2021 and July 2023 were analyzed. Circuits were categorized into clotting and non-clotting groups based on 48-hour clotting occurrence. COX regression analysis was performed to identify clotting risk factors. Results A total of 114 patients with 179 sets of CRRT circuits and corresponding data were included in the study. Among them, clotting within 48 hours of initiation was observed in 105 cases, while 74 cases did not experience clotting within 48 hours. Venous pressure (HR=1.008, 95% CI: 1.0～1.016, P=0.045)and lactate level ≥2 mmol/L (HR=1.517, 95% CI：1.009～2.280, P=0.045) were identified as independent risk factors for circuit clotting within 48 hours of CRRT. On the other hand, citrate dose ≥3.2 mmol/L (HR=0.461, 95% CI：0.312～0.682, P＜0.001) was identified as a protective factor. Conclusion  In continuous renal replacement therapy using regional citrate anticoagulation, high venous pressure, increased platelet count, and elevated lactate levels were associated with increased clotting risk within 48 hours. Pre-filling circuits adequately and optimizing catheter positioning before CRRT initiation are recommended. Managing patients with high lactate levels and impaired tissue perfusion through fluid resuscitation can reduce clotting risk. Reference | Related Articles | Metrics

Select

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

Select

Impact of dialysis adequacy on blood pressure variability and vascular calcification in patients undergoing maintenance hemodialysis YOU Nu-jia, XIONG Yu-qin, LIU Yao, MA Qiu, LIAO Ruo-xi, WU Ling, LING Zi-ying, YU Yang Chinese Journal of Blood Purification    2024, 23 (06): 416-420.   DOI: 10.3969/j.issn.1671-4091.2024.06.004 Abstract （130）      PDF（pc） （513KB）（23）       Knowledge map    Objective To explore the relationships between dialysis adequacy and cardiovascular structure and function in patients with maintenance hemodialysis (MHD).  Methods  Clinical data with respect to blood biochemical examinations, vascular calcification and 12 consecutive dialysis treatments were retrospectively collected for patients receiving hemodialysis more than three months. Adequate dialysis was defined as the urea reduction rate (URR)≥65% and single-pool urea clearance (spKt/V)1.2. Blood pressure variability (BPV) metrics including the difference in maximum and minimum BPs (△BP) and average real variation (ARV) were calculated, and multivariate regression analyses were conducted.  Results  A total of 90 Chinese MHD outpatients were included, with the mean age of 59.8±17.4 years and the median dialysis vintage of 28.3(12.3～46.8) months. Patients with inadequate dialysis (45 patients) had higher intradialysis systolic ΔBP (27.9±6.6 vs. 25.1±6.5 mmHg, t=-2.035, P=0.045) and systolic BP-ARV [SBP-ARV (13.4 ± 3.4) vs. (11.9 ± 3.2)mmHg, t=-2.228, P=0.028] and greater coronary artery calcification score [CACs, 461.0(96.0～1741.0) vs. 99.5(1.0～1329.0), t=-2.045, P=0.041] than those with adequate dialysis (45 patients). Age (β=0.305, P=0.003), coronary heart disease (β= -0.255, P=0.014) and spKt/V (β= -0.290, P=0.006) were significantly correlated with intradialysis SBP-ARV; diabetes mellitus (OR= 6.048, 95% CI:1.168～31.330, P=0.032), low serum albumin levels (OR=0.817, 95% CI:0.681～0.982, P=0.031) and spKt/V (OR=0.886, 95% CI:0.786～0.998, P=0.047) were found to be independent risk factors for CACs≥400.Conclusions Inadequate dialysis was strongly associated with elevated intradialysis BPV and increased risk of severe coronary artery calcification in MHD patients. Reference | Related Articles | Metrics

Select

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

Select

Efficacy of axillary brachial plexus block for analgesia during percutaneous transluminal angioplasty for dialysis access JIA Cheng-bo, CAI Qing-li, JIANG Yan Chinese Journal of Blood Purification    2024, 23 (07): 542-545.   DOI: 10.3969/j.issn.1671-4091.2024.07.012 Abstract （105）      PDF（pc） （523KB）（22）       Knowledge map    Objective  To investigate the efficacy of trans-axillary approach of brachial plexus nerve block for percutaneous transluminal angioplasty (PTA) in hemodialysis patients.   Methods  A total of 60 patients treated with PTA due to autologous arteriovenous fistula stenosis in the Department of Nephrology of Qiqihar Jianhua Hospital from December 2020 to December 2021 were enrolled in this study. They were divided into control group (local infiltration anesthesia, n=30) and brachial plexus block group (axillary approach of brachial plexus block, n=30). After the operation, pain score, pain management satisfaction, operation time, surgical and anesthetic complications, stenosis of the internal fistula, and primary patency rate of the internal fistula were assessed.   Results The visual analogue scale (VAS) of the control group was higher than that of the brachial plexus block group (t=2.571, P=0.011). The brachial plexus block group had a higher pain management satisfaction score (t=-5.305, P<0.001). There was no statistical difference in operation time between the two groups (t=-0.270, P=0.788). In the control group, two patients with arterial lesions presented with arterial spasm during operation, which was relieved by stopping endoluminal manipulation and medication treatment. No surgical and anesthesia complications occurred in the brachial plexus block group. There were statistical differences before and after the surgery in diameter of fistula stenosis (t=-52.789 and -44.140, P＜0.001), natural blood flow in internal fistula (t=-16.741 and -19.528, P＜0.001) and blood flow during dialysis (t=-8.776 and -9.550, P＜0.001) both in the control group and the brachial plexus block group. However, there were no significant differences after PTA in diameter of fistula stenosis (t=0.374, P=0.710), natural blood flow in internal fistula (t=1.017, P=0.313), and blood flow during dialysis (t=-1.181, P=0.242) between the two groups. The primary patency rates after PTA for 1, 3, 6, and 12 months were 93%, 87%, 54%, and 21% respectively in the control group, and were 93%, 90%, 61%, and 25% respectively in the brachial plexus block group, without statistical significances between the two groups (Log Rank: c2=0.307, P=0.579). The primary patency rates in the two groups were also compared monthly in January (c2=0.001, P=0.970), March (c2=0.213, P=0.644), June (c2=0.283, P=0.595) and December (c2=0.087, P=0.768), without statistical differences between the two groups.  Conclusion  Brachial plexus block anesthesia provides safe and effective analgesia during PTA for the treatment of arteriovenous fistula stenosis in dialysis patients, with higher patient satisfaction than local infiltration anesthesia, and has no effect on the 12-month primary patency rate. Reference | Related Articles | Metrics

Select

Effects of intradialytic aerobic exercise on survival status and quality of life in patients undergoing maintenance hemodialysis: a meta-analysis GUO Zhuang-zhuang, YU Liang, YANG Jia-hui, LI Ling-ling, XU Wei, ZHU Ya-mei Chinese Journal of Blood Purification    2024, 23 (10): 790-794.   DOI: 10.3969/j.issn.1671-4091.2024.10.013 Abstract （125）      PDF（pc） （517KB）（22）       Knowledge map    Objective  To assess the impact of intradialytic aerobic exercise on survival status and quality of life among maintenance hemodialysis patients. Methods  A systematic literature search for randomized controlled trials on intradialytic aerobic exercise was performed in PubMed, EMBASE, MEDLINE, Google Scholar, Cochrane Library, Wanfang, VIP and China National Knowledge Infrastructure (CNKI) from inception until October first, 2023. The Jadad scale was used to perform quality assessment. The Stata 12.0 software was used to perform meta-analysis.  Results  A total of 30 studies were included. Meta-analysis showed that intradialytic hypotension (OR=0.410, 95% CI:0.181～0.930, P=0.033), restless legs syndrome (WMD= -4.661, 95% CI:-5.331～-3.992, P＜0.001), 60-second sit-to-stand test (WMD=3.075, 95% CI:1.367～4.783, P＜0.001), 5-repetition sit-to-stand test (WMD=-1.447, 95% CI:-2.716～-0.237, P=0.020), 10-repetition sit-to-stand test (WMD=-4.630, 95% CI:-7.41～-1.849, P=0.001), 6-minute walk distance (WMD=44.903, 95% CI:32.651～57.155, P＜0.001), hand grip strength (WMD=6.207, 95% CI:3.368～9.046, P＜0.001), single pool clearance index (WMD=0.095, 95% CI:0.051～0.140, P＜0.001), urea reduction ratio (WMD=4.820, 95% CI:3.565～6.075, P＜0.001) and life quality scores were improved in the patients with intradialytic aerobic exercise group as compared to the patients using conventional care group. Subgroup analysis suggested that the dialysis adequacy, 60-second sit-to-stand test and 6-minute walking distance improved more in the long-term intervention group than in the short-term intervention group.  Conclusions  Intradialytic aerobic exercise can improve survival status and quality of life in hemodialysis patients, and the effectiveness becomes better in the patients with longer term of the intervention. Reference | Related Articles | Metrics

Select

A cross-sectional analysis of vascular access in maintenance hemodialysis patients in a large single center in Tibet SUOLANG Qu-zhen, A Yong, LI Guo-liang, CUI Zhuan, TANG Wen Chinese Journal of Blood Purification    2024, 23 (06): 453-456.   DOI: 10.3969/j.issn.1671-4091.2024.06.012 Abstract （100）      PDF（pc） （488KB）（21）       Knowledge map    Objective A cross-sectional analysis of vascular access for hemodialysis in a large hemodialysis center in Tibet.  Methods Patients undergoing maintenance hemodialysis (MHD) in the Blood Purification Center, the People's Hospital of Tibet Autonomous Region from December 2021 to December 2022 were recruited for the analysis. Demographic characteristics, primary disease, dialysis vintage, the first and current vascular access modality were collected.  Results  A total of 194 MHD patients were included in the analysis. Vascular access used temporary central venous catheter, tunnel-cuffed catheter (TCC), arteriovenous graft (AVG) and arteriovenous fistula (AVF) for the first dialysis access were found in 66(34.0%), 88(45.4%), 2(1.0%), and 38(19.6%) patients, respectively. Forty-seven patients (24.2%) completed the AVF construction surgery before dialysis. In the patients with AVF surgery before dialysis, there were more male patients (83% vs. 68%, χ²=3.919, P=0.048), more patients with a college education or above (53.2% vs. 21.1%, χ²=17.875, P<0.001), and more patients using AVF or AVG as the vascular access (97.9% vs. 86.4%, χ²=4.860, P=0.029), as compared with those without AVF surgery before dialysis. AVF, AVG and TCC were used as the vascular access for MHD in 86.6%, 2.6% and 10.8%, respectively, of all MHD patients. Compared with the patients using non-TCC access, TCC as the vascular access was usually found in patients with older age (58.3±15.0 vs. 51.7±13.8, t=2.039, P=0.043) and less likely to have glomerulonephritis as the cause of renal failure (23.8% vs. 47.4%, χ²=4.213, P=0.040). Patients with temporary central venous catheter as the initial vascular access (n=66) were more likely to use TCC for MHD (19.7% vs. 6.3%, χ²=8.157, P=0.007), as compared with the patients using other vascular access (n=128).  Conclusion  AVF as the vascular access for MHD in this center was 86.6%, compliant with the requirement of the guidelines. However, the use of TCC was 10.8%, slightly higher than the requirement of the guidelines. Improvement of technology and pre-dialysis education are warranted to reduce the use of TCC for MHD. Reference | Related Articles | Metrics

Select

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

Select

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

Select

The mediating effect of self-perceived burden on empowerment and quality of life in peritoneal dialysis patients ZHANG Ying, SHI Xue-zhi, GUAN Yu-xiang, ZHENG Jing, WANG Chao Chinese Journal of Blood Purification    2024, 23 (08): 636-640.   DOI: 10.3969/j.issn.1671-4091.2024.08.014 Abstract （96）      PDF（pc） （555KB）（20）       Knowledge map    Objective  To investigate the status quo of empowerment, self-perceived burden and quality of life in peritoneal dialysis (PD) patients, and to analyze the mediating effect of self-perceived burden.  Methods  A total of 235 PD patients hospitalized in the First Affiliated Hospital of Anhui University of Chinese Medicine from November 2022 to May 2023 were selected by convenience sampling method as the study objects. Simplified peritoneal dialysis empowerment scale, self-perceived burden scale and kidney disease quality of life scale were used for the investigation. SPSS 26.0 was used to analyze the correlation between empowerment, self-perceived burden, and quality of life. AMOS24.0 was used to establish a structural equation model, and bootstrap method was used to test the model.   Results  The total score of empowerment in PD patients was 22.83±4.20, the total score of self-perceived burden was 33.03±6.18, and the total score of quality of life was 45.35±5.26. The self-perceived burden was negatively correlated with the total score of empowerment (r=-0.401, P<0.001) and the total score of quality of life (r=-0.426, P<0.001). Empowerment ability of the PD patients directly and positively affected the quality of life. Self-perceived burden played a partial mediating role between empowerment and quality of life (β=0.203, P<0.001), and the mediating effect accounted for 27.78% of the total effect.  Conclusion  The empowerment ability and self-perceived burden of the PD patients were in the medium level, and the quality of life was in the lower middle level. The self-perceived burden had a partial mediating effect between the empowerment ability and the quality of life. We suggest that medical staff should strengthen the empowerment education of the patients, stimulate their inner strength, reduce the self-perceived burden of patients, and improve their quality of life. Related Articles | Metrics

Select

Role of blood magnesium in mineral and bone disorders related to chronic kidney disease BAI Wei-wei, DU Shu-tong, MA Wei-hua, WANG Ya-jing, WANG Na Chinese Journal of Blood Purification    2024, 23 (08): 605-608.   DOI: 10.3969/j.issn.1671-4091.2024.08.007 Abstract （96）      PDF（pc） （422KB）（20）       Knowledge map    Chronic kidney disease (CKD) mineral and bone disorder (CKD-MBD) is a common complication in CKD patients. CKD-MBD as a systemic disease is involved in a variety of mineral and bone metabolism abnormalities such as changes in bone density and bone strength and vascular calcification, contributing to an important impact on quality of life and long-term prognosis of the patients. Although our understanding of the pathogenesis of CKD-MBD has been improved for many years, blood magnesium on the evolution of CKD-MBD has not been appreciated until recent years. Studies have found that blood magnesium and CKD-MBD may be closely related, but the available data remain to be equivocal. Further studies are required to confirm these findings. In this paper, the physiological function of magnesium, the relationship between magnesium and CKD and CKD-MBD, and their interactions are reviewed. We suggest that regulation of blood magnesium level may be a new target for the treatment of CKD-MBD. Reference | Related Articles | Metrics

Select

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

Select

Research progresses in pulmonary hypertension in maintenance hemodialysis patients GU Ya-jing, LIU Li-ting, JIANG Yan, SU Chao-jiang, CHEN Yan, LIU Zong-yang Chinese Journal of Blood Purification    2024, 23 (09): 686-689.   DOI: 10.3969/j.issn.1671-4091.2024.09.011 Abstract （129）      PDF（pc） （461KB）（19）       Knowledge map    Pulmonary hypertension is a clinical disorder characterized by the continuing hyper-resistance of pulmonary vessels. Pulmonary hypertension is frequently encountered in maintenance hemodialysis (MHD) patients with a higher mortality rate. The mechanism of the disorder is yet unknown, and its clinical presentations are insidious. Here we summarize the recent progresses in pulmonary hypertension in MHD patients in China and foreign countries, so as to provide references for early diagnosis and management of pulmonary hypertension in MHD patients. Related Articles | Metrics

Select

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

Select

The effect of joint mobility exercises in dialysis on fatigue symptoms and exercise capacity in maintenance hemodialysis patients LI Lu, WANG Li-mei, QI Jia-hong, YE Li-hui, ZHENG Yuan-hua, ZHANG Chong-ni Chinese Journal of Blood Purification    2024, 23 (07): 552-556.   DOI: 10.3969/j.issn.1671-4091.2024.07.014 Abstract （100）      PDF（pc） （524KB）（19）       Knowledge map    Objective  To investigate the effects of joint mobility exercises in hemodialysis on maintenance hemodialysis (MHD) patients.  Methods  The MHD patients in the Hemodialysis Center of the First Affiliated Hospital of Nanchang University from April to October 2023 were selected as the research subjects, and patients in Donghu Hospital District and patients in Xianghu Hospital District were randomly selected as the experimental group and the control group. The patients in the control group were given routine care, and the patients in the experimental group were implemented the exercise of joint mobility in dialysis on the basis of routine care. Differences in fatigue scale-14 (FS-14) score, 6-minute walk test (6MWT), 30-second sit-to-stand test (30s-STS), and 36-item short form health survey (SF-36) score before and after the intervention were compared between the two groups.   Results   Before intervention, general information, FS-14 scores, 6MWT, 30s-TST and SF-36 scores had no statistical differences between the two groups (Z=-0.199, t=0.501, 0.278 and 0.484 respectively; P=0.842, 0.618, 0.782 and 0.629 respectively).  Compared with the control group, FS-14 scores were significantly lower (Z=-7.782, P<0.001), and 6MWT, 30s-STS, and SF-36 scores were significantly higher (t=5.812, 6.111 and 2.583 respectively;  P<0.001, <0.001  and =0.012 respectively) after the intervention in the test group.  Conclusion Joint mobility exercises in dialysis can effectively relieve fatigue symptoms and improve exercise capacity and quality of life in MHD patients. Reference | Related Articles | Metrics

Select

Research progresses in systemic immune inflammatory index in patients with chronic kidney disease YANG Ya-qi, LIU Yun, LIU Yan Chinese Journal of Blood Purification    2024, 23 (07): 538-541.   DOI: 10.3969/j.issn.1671-4091.2024.07.011 Abstract （123）      PDF（pc） （503KB）（18）       Knowledge map    Chronic kidney disease (CKD) is a global health problem with a complex pathogenesis characterized by a persistent low-grade inflammatory state. In recent years, the systemic immune inflammatory index (SII) has received widespread attention as a new tool for assessing the inflammatory state. SII can better reflect the systemic inflammation level of the patient, and has been widely used in clinical practice because of its advantages of easy access, low price, and ease of calculation. The purpose of this article is to review the research progresses in SII in CKD patients, to explore the relationship between SII and occurrence and development of CKD, to assess the value of SII in disease monitoring and prognostic assessment, and to provide the useful references for subsequent studies. Related Articles | Metrics

Select

Investigation on the operational status of point-of-care ultrasound assisted difficult arteriovenous fistula puncture in 18 hospitals ZHANG Jie-ting, LI Jing-hui, ZHAO Dai-xin, WU Yi-fan, LIANG Yu-ting, LI Yin, WEI Shuang Chinese Journal of Blood Purification    2024, 23 (09): 706-710.   DOI: 10.3969/j.issn.1671-4091.2024.09.016 Abstract （93）      PDF（pc） （500KB）（18）       Knowledge map    Objective  To investigate the nursing operation status of point-of-care ultrasound (POCUS) assisted difficult arteriovenous fistula (AVF) puncture in 18 hospitals in order to provide a scientific basis for quality management and specialized training of the clinical nursing operations.  Methods   This was a cross-sectional study. The videos of POCUS assisted difficult AVF puncture operation from the 18 hospitals were examined. A scoring rule for the operation was developed as the scoring basis. Six key steps of the manipulation were extracted for the scoring, including routine evaluation and safety verification, nurse-patient communication, infection control, AVF routine evaluation, ultrasound evaluation, and ultrasound guided puncture. The scores were then statistically analyzed.  Results  The average score of the manipulation on video from the 18 cases was 79.25±10.91. For the six key steps of the manipulation, ratios of the steps with low scores were evaluation and safety verification 55.56%, nurse-patient communication 50.00%, AVF routine evaluation 44.44%, infection control 38.89%, ultrasound evaluation 11.11%, and ultrasound guided puncture 0%. The video duration and the operation score were positively correlated (r=0.717, P=0.001).  Conclusion   The scoring standard for POCUS assistant difficult fistula puncture developed in this study is helpful to standardize this procedure and is worth promoting. Reference | Related Articles | Metrics

Select

Research progress in the assessment tools and influencing factors of somatic frailty in patients with maintenance hemodialysis ZHU Zheng-wei, ZHANG Jian-jun, CAO Hui-ting, SUN Yi-shen, TAO Xing-juan Chinese Journal of Blood Purification    2024, 23 (08): 612-615.   DOI: 10.3969/j.issn.1671-4091.2024.08.009 Abstract （107）      PDF（pc） （461KB）（18）       Knowledge map    Maintenance hemodialysis (MHD) patients are often associated with somatic frailty, which leads to a variety of adverse clinical outcomes and causes significant threats to the quality of life and life safety of the patients. Frailty is a complex syndrome usually involving somatic, cognitive and social aspects, which are interconnected and interacted each other. The incidence of somatic frailty is high, and it is usually associated with cognitive and social frailty. The progression of frailty can be alleviated or reversed, if assessment and intervention are made at an early stage. This paper reviews the assessment tools and influencing factors for somatic frailty, with the aim of providing references for the development of frailty interventions for MHD patients in China. Reference | Related Articles | Metrics