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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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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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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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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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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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Role of Ferrostatin-1 prevent high glucose-induced Ferroptosis of renal tubular epithelial cells WU Zi-yu, LIN Yan, LIANG Yuan-qi, GUO Tai-lin Chinese Journal of Blood Purification    2023, 22 (09): 679-684.   DOI: 10.3969/j.issn.1671-4091.2023.09.010 Abstract （111）      PDF（pc） （774KB）（523）       Knowledge map    Objective To investigate the role of Ferrostatin-1(Fer-1) in high glucose-induced ferroptosis of renal tubular epithelial cells. Method (1) 24 DBA/2J mice were randomly divided into 4 groups: normal control group, Fer-1 intervention group, DM model group, DM + Fer-1 intervention group with 6 mice in each group. According to the body weight of mice, DBA/2J mice were injected intraperitoneally with freshly prepared Streptozocin at a dose of 40 mg / kg for 5 days to establish DM model. Fer-1 intervention group and DM+Fer-1 intervention group were given intraperitoneal injection of Fer-1 (2.5μmol/kg) every day for 12 weeks after modeling.. The control group and DM Group were intraperitoneally injected with the same volume of normal saline for 12 weeks. The expression levels of activated glutathione peroxidase 4(GPX4)and solute carrier family 7 A11(SLC7A11)were detected by Western blotting, and the expression and localization of GPX4 in renal tissue were detected by immunohistochemistry.(2) Human renal tubular epithelial cells (HK-2) were stimulated with high glucose (30 mmol/L) , and treated with 200 nm Fer-1. The expression of ferroptosis signaling in renal tubular epithelial cells was detected by Western blotting and immunofluorescence staining. Results  Compared with the normal control group, the levels of Fe2+and Malondialdehyde (MDA) in the kidney of DM model group were significantly up-regulated, glutathione (GSH) was significantly down-regulated ( t=35.073、15.732 and 4.954 respectively，all P ＜ 0.001) , and the protein expression levels of GPX4 and SLC7A11, which were related to ferroptosis, were significantly up-regulated (t=12.432 and 5.484；P=0.006 and 0.003) . Compared with the DM model group, the levels of Fe2+ and MDA in the kidney of DM +Fer-1 intervention group were down-regulated, while GSH was up-regulated (t=14.503、4.675 and 7.124； all P＜0.001) . The protein expression levels of GPX4 and SLC7A11 were up-regulated (t =4.573 and 27.942；P= 0.039 and 0.001) . In addition, high glucose could induce the expression levels of ferroptosis related proteins GPX4 and SLC7A11 in HK-2 cells cultured in vitro to decrease significantly ( t=12.433 and 7.716；P=0.006 and 0.019) , the expression levels of GPX4 and SLC7A11 were significantly increased by Fer-1(t=5.136 and 5.043；P=0.035 and 0.037) . Conclusions  Inhibition of ferroptosis in renal tubular epithelial cells induced by high glucose may be a new strategy to prevent the progression of DM. 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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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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A study on the combination of roxadustat and erythropoietin in the treatment of anemia in maintenance hemodialysis patients with kidney transplant failure LIU Xu, ZHANG Ai-hua, DIAO Zong-li, HUANG Hong-dong, LIU Wen-hu Chinese Journal of Blood Purification    2023, 22 (09): 649-652.   DOI: 10.3969/j.issn.1671-4091.2023.09.003 Abstract （180）      PDF（pc） （450KB）（438）       Knowledge map    Objective  To observe the efficacy of roxadustat combined with erythropoietin (EPO) in the treatment of anemia in maintenance hemodialysis (MHD) patients with kidney transplant failure.  Method   A retrospective analysis was conducted on MHD patients with low EPO response and kidney transplant failure at Beijing Friendship Hospital affiliated to Capital Medical University during the period from June 2021 to December 2022. Some of the patients were treated with roxadustat combined with EPO. Changes of hemoglobin (Hb) and the compliance rate of Hb before and after the combination treatment were analyzed. Their physical and activity status were evaluated using the Eastern Cooperative Oncology Group (ECOG) scoring standards. The dosage of the two drugs and the adverse drug reactions were recorded.  Result  A total of 34 MHD patients with kidney transplant failure were enrolled in this study, including 23 cases in the combined roxadustat treatment group and 11 cases in the control group. There were no statistically differences in age, gender, dialysis age, dry weight and BMI between the two groups. In the combined roxadustat group, Hb increased from (97.91±15.47) g/L before treatment to (111.61±11.95) g/L after treatment (t=-4.499, P＜0.001); the HB level before treatment was lower than the HB level of 117.09±4.30g/L in the control group (t=-5.515, P＜0.001), but the HB level after the treatment had no statistical difference with the HB level of （117.09±4.30） g/L in the control group (t=-1.131, P=0.266); the compliance rate of Hb increased from 30.4% to 65.2% (χ2=7.265, P=0.017); and the ECOG scoring indicated that their physical and activity status improved (Z= -2.238, P=0.025). The dosage of roxadustat was 150mg/week in 16 patients and 300mg/week in 7 patients. In the combined roxadustat group, EPO dosage decreased from (14956.52±7351.43) U/week before the treatment to （7478.26±4066.15） U/week after the treatment (t=6.927, P＜0.001); the EPO dosage before treatment was higher than that of （10 727.27±2 412.09） U/week in the control group (t=2.493,P=0.018), but the EPO dosage after treatment was lower than that of （10727.27±2412.09） U/week in the control group (t=-3.290, P=0.002). No significant adverse reactions were observed in the combination therapy of roxadustat and EPO.  Conclusion  The combination therapy of roxadustat and EPO is safe and effective in MHD patients with lower EPO response and kidney transplant failure. 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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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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Clinical practice of grading management scheme for hyperkalemia in chronic kidney disease patients LIU Fang-fang, LOU Xiao-ping, WANG Wen-jiao, ZHANG Tong-tong, ZHENG Xiao, CHEN Jie, LI Zheng-yan Chinese Journal of Blood Purification    2023, 22 (06): 467-471.   DOI: 10.3969/j.issn.1671-4091.2023.06.015 Abstract （142）      PDF（pc） （436KB）（400）       Knowledge map    Objective   This paper is to explore the effects of risk grading management scheme on chronic renal disease patients with hyperkalemia.  Method  A total of 90 patients with chronic kidney disease in the First Affiliated Hospital of Zhengzhou University were selected as the research objects. They were randomly divided into control group and experimental group and 45 cases in each group. The control group was given routine nursing care, while the experimental group was used the risk grading management program in addition to routine nursing care. The incidence and the cognitive level of hyperkalemia, the medication compliance and diet compliance for hyperkalemia were compared before and after intervention between the two groups.  Results   The incidence of hyperkalemia was significantly lower in experimental group than in control group (c2=4.444,P=0.035); the cognition of hyperkalemia risks (t=-7.071, P<0.001), the medication compliance (t=          -3.081, P=0.004) and the diet compliance (t=-8.785, P<0.001) were also higher in experimental group than in control group.  Conclusion   The application of risk grading management scheme on patients can reduce the incidence of hyperkalemia, improve the cognitive level and help patients develop good behaviors of medication and diet compliance, to reduce the occurrence of adverse events. Reference | Related Articles | Metrics

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Application of small animal models in the study of vascular access for hemodialysis QIN Yu, DU Jing, ZHAO Zhan-yun Chinese Journal of Blood Purification    2023, 22 (06): 446-449.   DOI: 10.3969/j.issn.1671-4091.2023.06.010 Abstract （178）      PDF（pc） （388KB）（359）       Knowledge map    Vascular access for hemodialysis patients includes arteriovenous fistula (AVF), arteriovenous graft (AVG) and central venous catheter (CVC), but all the vascular access methods have the problem of dysfunction. The mechanism of blood access failure is unclear. Animal model can be helpful to understand the causes of vascular access failure. Small animal model has the advantages of easy to use and less expensive, suitable for the molecular study of blood access failure. This review introduces several small animal models as well as the research status and characteristics of the small animal models for the study of blood access failure. 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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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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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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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）（300）       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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Effect of chronic kidney disease management on the disease progression and dialysis initiation in diabetic kidney disease patients YU Shu, JIA Jue, WANG Tao-tao, XU Feng-lan, GUI Lan-lan, HUA Qin, HE Jian-qiang Chinese Journal of Blood Purification    2023, 22 (06): 415-420.   DOI: 10.3969/j.issn.1671-4091.2023.06.004 Abstract （155）      PDF（pc） （456KB）（299）       Knowledge map    Objective  To evaluate the influence of chronic kidney disease (CKD) outpatient management on the disease progression and dialysis initiation in diabetic kidney disease (DKD) patients, so as to provide a basis for continuous improvement of the multidisciplinary management of CKD outpatients and DKD patients. Methods This study enrolled 92 DKD patients with initial hemodialysis from the CKD Outpatient Clinic (management group, group M) and 94 DKD patients with initial hemodialysis from the Nephrology Clinic (non-management group, group NM) in the Affiliated Hospital of Jiangsu University in the period from June 2015 to June 2021. Biochemical indexes, vascular access, hospitalization and renal function changes were compared between the two groups at the first dialysis. The impact of various factors on disease progression was evaluated by Cox regression analysis.  Results  At dialysis entry, systolic blood pressure, estimated glomerular filtration rate (eGFR), and serum whole parathyroid hormone were significantly lower in group M than in group NM (t=-3.352, -1.196 and -1.995 respectively; P=0.001, 0.047 and 0.047 respectively), and hemoglobin, serum creatinine and albumin were significantly higher in group M than in group NM (t=2.320, 2.189 and 2.102 respectively; P=0.021, 0.030 and 0.037 respectively); vascular access, emergent dialysis and the ratio of first induced dialysis at the first dialysis were significantly different between the two groups (c2=19.573, 16.396 and 16.969 respectively; P＜0.001). Kaplan-Meier survival analysis showed that the median disease course entering dialysis was significantly longer in group M than in group NM (t=2.239, P=0.21). Multivariate regression analysis showed that age, diabetic retinopathy, urinary microalbumin/creatinine were the risk factor for DKD progression (HR=1.020, 0.554 and 1.000 respectively, 95% CI: 1.003~1.038, 0.405~0.757 and 1.000~1.000 respectively; P=0.019, ＜0.001 and ＜0.001 respectively). CKD management and treatment with angiotensin converting enzyme inhibitors (ACEI)/angiotensin II receptor blocker (ARB) could postpone the DKD progression.  Conclusion  CKD management can significantly delay the progression of DKD. In outpatient management, early screening of diabetic retinopathy, management of urinary protein, and early use of ACEI/ARB medications are helpful to delay the DKD progression. Reference | Related Articles | Metrics

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Correlation between controlled nutritional status (CONUT) score and prognosis of peritoneal dialysis-associated peritonitis patients MA Ya-nan, LIN Ru, MENG Ran, LIU Gui-ling Chinese Journal of Blood Purification    2023, 22 (07): 512-515.   DOI: 10.3969/j.issn.1671-4091.2023.07.008 Abstract （138）      PDF（pc） （389KB）（290）       Knowledge map    Objective  To investigate the predictive value of the controlling nutrition status (CONUT) score for the prognosis of peritoneal dialysis-associated peritonitis (PDAP) after treatment.  Method A total of 161 patients with PDAP were divided into a cured group and a treatment failure group base on their treatment effect. Their clinical data were compared. Logistic regression was used to analyze the correlation between CONUT score and treatment effect. ROC curve was used to analyze the predictive value of CONUT score on prognosis of the patients after treatment.  Result  Dialysis age (Z=-3.027, P=0.002), hs-CRP (Z=-2.608, P=009) and CONUT score (Z=-3.161, P=0.002) were higher and albumin (t=2.158, P=0.032) was lower in the treatment failure group as compare with those in the cured group. Univariate logistic regression showed that dialysis age (OR=1.025, 95% CI: 1.011～1.039, P=0.001), hs-CRP (OR=1.006, 95% CI:1.000～1.011, P=0.038), albumin (OR=0.906, 95% CI: 0.827～0.933, P=0.035) and CONUT score (OR=1.529, 95% CI: 1.150～2.039, P=0.004) were the risk factors for poor prognosis of PDAP. Multivariate logistic regression showed that dialysis age (OR=1.024, 95% CI: 1.008～1.039, P=0.002) and CONUT score (OR=1.613, 95% CI:1.058～2.459, P=0.026) were the independent risk factors for poor prognosis of PDAP. ROC curve showed that dialysis age (months) combined with CONUT score had the greatest predictive value for the prognosis of PDAP, and the area under the curve was 0.802 (95% CI: 0.682～0.921, P<0.001).  Conclusion  Longer dialysis age (months) and higher CONUT score are the independent risk factors for poor prognosis of PDAP. Dialysis age (months) combined with CONUT score is highly predictive for the prognosis of PDAP patients after treatment. Reference | Related Articles | Metrics

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The effects of combined aerobic-resistance training on dialysis adequacy and quality of life in maintenance hemodialysis patients QI Qi-ge, ZHAO Jian-rong Chinese Journal of Blood Purification    2023, 22 (07): 498-502.   DOI: 10.3969/j.issn.1671-4091.2023.07.005 Abstract （162）      PDF（pc） （425KB）（289）       Knowledge map    Objective To explore the effect of combined aerobic-resistance training on dialysis adequacy and quality of life in maintenance hemodialysis (MHD) patients.  Methods  A total of 40 MHD patients treated in Blood Purification Center of the Affiliated Hospital of Inner Mongolia Medical University from June 2021 to June 2022 were recruited as the study subjects. Their hemodialysis age was≥3 months. They were divided into the test group (n=20) and the control group (n=20) by random number table method. Patients in the control group were given routine treatment, including diet guidance, drug treatment and hemodialysis; those in the test group were asked to perform combined aerobic-resistance training three times a week and 45 minutes each time for 24 weeks during the dialysis period in addition to the routine treatment. Blood urea nitrogen, calculated the urea clearance index (Kt/V) and urea reduction rate (URR) before and after the intervention were collected to estimate their dialysis adequacy. Changes of the short form 36 questionnaire (SF-36) before and after the intervention were used to compare the quality of life between the two groups.  Results  After the execirse intervention for 24 weeks, Kt/V, URR, general health status (GH), physical function (PF), vitality (VT), mental health (MH) and total score of SF-36 were significantly higher in the test group than in the control group (t=2.435, 2.218, 2.675, 2.798, 3.188, 2.197 and 4.251 respectively; P=0.020, 0.033, 0.011, 0.008, 0.003, 0.034 and <0.001 respectively). In the test group after the exercise training for 24 weeks, Kt/V, URR, GH, PF, VT and total SF-36 score became significantly higher than their baseline levels (t=-2.880,          -7.543, -6.168, -3.587, -7.009 and -7.521 respectively; P=0.010, <0.001, <0.001, 0.002, <0.001 and <0.001 respectively).  Conclusion  Combined aerobic-resistance training can improve the dialysis adequacy and quality of life in MHD patients. 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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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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The correlation between systemic inflammatory response index (SIRI) and cardiovascular events in hemodialysis patients CHEN Jian-hua, CHEN Lin-qing, CAO Ai-qin, ZHONG Hao-wen, ZHANG Meng-bi, SU Xiao-yan Chinese Journal of Blood Purification    2023, 22 (09): 663-667.   DOI: 10.3969/j.issn.1671-4091.2023.09.006 Abstract （134）      PDF（pc） （540KB）（240）       Knowledge map    Objective  To investigate the correlation between the systemic inflammatory response index (SIRI) and cardiovascular events in patients on hemodialysis (HD).  Methods  The basic clinical information, blood routine and laboratory examination results were collected and analyzed in patients treated with regularly HD for more than 3 months in Dongguan Tungwah Hospital in the period of January 2019 to January 2021.  Results  The SIRI level was significantly higher in the cardiovascular event group than in the non-cardiovascular event group (Z=-3.558, P＜0.001). Patients in the cardiovascular event group had a higher proportion of previous cardiovascular disease, older age (χ2=-3.901, P＜0.001), and higher levels of white blood cell count (t=-3.104, P=0.002), red blood cell distribution width (t=-2.746, P=0.006), neutrophil count (t=-3.117, P=0.002), monocyte count (t=-2.492, P=0.013), triglycerides (Z=-2.508, P=0.012), C-reactive protein (Z=-2.035, P=0.042), monocyte-to-lymphocyte ratio (MLR) (Z=-2.552, P=0.011), and neutrophil-to-lymphocyte ratio (NLR) (Z= -2.277, P=0.023). COX risk proportional model analysis showed that higher SIRI level was an independent risk factor for cardiovascular events in HD patients (HR=2.307, 95% CI:1.236～4.305, P=0.009). ROC analysis showed that the area under the curve (AUC) of SIRI, MLR, and NLR were 0.676, 0.626, and 0.612, respectively, and the Youden indices were 0.326, 0.202, and 0.178, respectively, with the optimal cut-off values of 1.15, 0.35, and 4.98 respectively, sensitivity of 87.23%, 70.21%, and 40.43% respectively, and specificity of 45.31%, 50.00%, and 77.34%, respectively.  Conclusion  SIRI is an independent risk factor for cardiovascular events in HD patients. Reference | Related Articles | Metrics

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Evidence summary about the management of adult patients with peritoneal dialysis CAO Pei-ye, ZHAO Hui-ping, WU Bei, LU Li-xia, CHU Xin-xin, QIAO Jie, MEN Chun-cui, HE Yu-ting Chinese Journal of Blood Purification    2023, 22 (07): 551-556.   DOI: 10.3969/j.issn.1671-4091.2023.07.017 Abstract （189）      PDF（pc） （439KB）（232）       Knowledge map    Objective  To search, summarize, integrate and evaluate the available evidences about the management of adult patients with peritoneal dialysis, so as to provide evidence-based references for clinical medical staff.  Methods  The websites of Registered Nurses’ Association of Ontario, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, National Guideline Clearinghouse, NGC, Guidelines International Network, Medlive.cn, British Medical Journal Best-practice, UpToDate, Cochrane Library, Joanna Briggs Institute Library, PubMed, Embase, ciNAHL, Web of Science, CNKI and Wanfang database were searched by computer; the British Renal Association and the International Society for Peritoneal Dialysis websites were also searched in order to collect the literature on the management of adult patients with peritoneal dialysis. The retrieval period was from the establishment of database to March 2022. The JBI evidence appraisal and recommendation system was used to evaluate the quality and evidence level of the included literature.  Results  A total of 11 articles were included, including 4 guidelines, 2 expert consensus, 2 evidence summaries, and 3 randomized controlled trials. Twenty-four evidences were summarized from five aspects: diet and nutrition management, exercise management, capacity management, complication prevention and management, and continuous nursing.  Conclusion  This study summarizes the best evidences about the management of adult patients with peritoneal dialysis, which has practical and scientific values, and provides evidence-based references for clinical medical staff to comprehensively control and manage the patients with peritoneal dialysis. Reference | Related Articles | Metrics

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Current insights into the role of indoxyl sulfate in renal anemia LIU Yu-xiu, BAI Feng-xia, YANG Ji-feng, GAO Yan, JIANG Rui-jian, ZHANG Hai-song Chinese Journal of Blood Purification    2023, 22 (06): 450-452.   DOI: 10.3969/j.issn.1671-4091.2023.06.011 Abstract （143）      PDF（pc） （448KB）（225）       Knowledge map    The higher incidence of chronic kidney disease (CKD) has currently become a worldwide and major public health problem. Many complications associated with CKD patients greatly influence their hospitalization rate, quality of life and survival rate. Anemia is a common complication of CKD, and is an independent risk factor for cardiovascular and cerebrovascular complications in CKD patients. Longstanding anemia will cause heart overload, left ventricular hypertrophy, heart failure, higher hospitalization rate, and increased mortality rate. Indoxyl sulfate (IS) is an important protein-bound uremic toxin, accumulating in the body at the early stage of CKD. IS promotes the progression and complications of CKD through various pathways. Here we focus on the role of IS in renal anemia based on the recent studies that IS may also be involved in renal anemia. Related Articles | Metrics

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Advances in the application of medium cut-off membrane and expanded hemodialysis JIANG Ran, WU Bu-yun Chinese Journal of Blood Purification    2023, 22 (11): 856-860.   DOI: 10.3969/j.issn.1671-4091.2023.11.013 Abstract （188）      PDF（pc） （521KB）（223）       Knowledge map    Medium Cut-Off Membrane has been an important evolution in the field of hemodialysis for the past years. Its advantages are mainly reflected in the significant improvement of the clearance of large medium molecular uremia toxins at the moment, more and more relevant clinical trials are being revolved to verify the clinical feasibility and long-term benefits. The nomenclature and theoretical advantages of medium cut-off membrane, and related technologies of Expanded Hemodialysis as well as its clinical applications were briefly described below. Related Articles | Metrics

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Risk factors for ischemic stroke in maintenance hemodialysis patients: a meta-analysis WANG Bing-jie, LIANG Qi, CHEN Yu, ZHANG Chun-mei Chinese Journal of Blood Purification    2023, 22 (10): 794-798.   DOI: 10.3969/j.issn.1671-4091.2023.10.017 Abstract （104）      PDF（pc） （542KB）（219）       Knowledge map    Objective To systematically summarise the factors influencing the occurrence of ischaemic stroke (IS) in maintenance haemodialysis (MHD) patients. Methods Relevant literature from CNKI, Wanfangdata, VIP, CBM, PubMed, EMbase, The Cochrane Library, and web of science databases were searched, all from the time of database creation to February 2023. Two investigators independently screened the literature, extracted information, and evaluated the literature for quality, and Meta-analysis was performed using RevMan 5.3 software. Results A total of 14 cohort studies with a sample size of 6,876 cases were included, and the quality of the literature was high. 14 studies identified a total of 6 risk factors and 1 protective factor, and the effect of history of IS and diabetic nephropathy on the development of IS in MHD patients was inconclusive. meta-analysis results showed that age (HR=1.04, 95% CI:1.03 to 1.06), diabetes (HR= 1.88, 95% CI:1.38 to 2.58), history of atrial fibrillation (HR=2.71, 95% CI:1.73 to 4.27), history of cerebrovascular disease (HR=4.97, 95% CI:3.16 to 7.82), NT-proBNP (HR=4.43, 95% CI:1.66 to 11.80), serum phosphate (HR= 0.57, 95%CI:0.44 to 0.74), and platelet count (HR=1.01, 95%CI:1.00 to 1.02) were influential factors in the development of IS in MHD patients. Conclusions Healthcare professionals can identify people at risk for IS in MHD patients based on these factors and intervene early to improve the quality of life of MHD patients. Reference | Related Articles | Metrics

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Based on the high risk factors of imbalance syndrome in maintenance hemodialysis patients, a prediction model was constructed and verified WANG Yi-Wang, WANG Lei, CUI Ying Chinese Journal of Blood Purification    2023, 22 (07): 488-492.   DOI: 10.3969/j.issn.1671-4091.2023.07.003 Abstract （161）      PDF（pc） （529KB）（217）       Knowledge map    Objective  To investigate the risk factors for the development of dialysis disequilibrium syndrome (DDS) in patients on maintenance hemodialysis (MHD) and to construct a predictive model. Methods  A total of 321 patients with MHD in our hospital from August 2019 to August 2022 were selected and patients were randomly divided into the training group (n=225) and the internal verification group (n=96) according to the proportion of 7:3. The two groups were divided into the DDS subgroup and the non-DDS subgroup according to the occurrence of DDS. The incidence of imbalance syndrome, demographic characteristics and biochemical indicators of the two groups were analyzed. The logistic regression model and random forest model were constructed based on the data of the training group. Then Parallel internal and external validation was performed in the groups.  Results Univariate analysis showed that in the training and internal validation groups, age (t=32.154, 24.618, both P＜0.001), number of dialysis sessions per week (t=10.632, 8.211, both P＜0.001), epilepsy (χ2=4.647, 7.248, P=0.031, 0.007), hemoglobin (t= 21.366, 15.476, all P＜0.001), cognitive impairment (χ2=4.644, 5.403, P=0.031, 0.020), urea nitrogen (t=21.284, 13.058, all P＜0.001), and albumin (t=13.094, 9.018, all P＜0.001) between the DDS subgroups and the non-DDS subgroup were significant differences (P＜0.05). Logistic regression analysis showed that the number of dialysis sessions per week (OR=6.360, 95% CI: 1.968 to 20.554, P＜0.001), cognitive impairment (OR=8.404, 95% CI: 2.446 to 28.877, P＜0.001), hemoglobin (OR=4.889, 95% CI: 1.436 to 16.645, P＜0.001), albumin (OR=0.596, 95% CI: 0.447 to 0.794, P＜0.001), and urea nitrogen (OR=4.429, 95% CI: 1.879 to 10.441, P＜0.001) were factors influencing the occurrence of DDS in patients (P＜0.05). The top 5 influencing factors for the occurrence of DDS were obtained in the following order: urea nitrogen, cognitive impairment, hemoglobin, albumin, and number of dialysis sessions per week. Based on the above factors, logistic regression models and random forest models for the occurrence of DDS in patients were constructed, and internal validation showed that there was no significant difference between the two models in predicting the AUC of DDS in patients, and external validation showed that there was no significant difference between the two models and the actual results.  Conclusion  The influence of DDS in MHD patients is due to urea nitrogen, cognitive impairment, hemoglobin, albumin, and weekly dialysis times. The prediction model built based on the above factors is reliable and provides a certain reference for clinical treatment identification of DDS. Reference | Related Articles | Metrics

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The relationship between systemic immunoinflammatory index and treatment failure of peritoneal dialysis-associated peritonitis BAO Ling-ling, HUANG Jian-cheng, ZHANG Ai-wei, LUO Chun-lei, BAO Si-zeng, BIAN Xue-yan Chinese Journal of Blood Purification    2023, 22 (11): 841-845.   DOI: 10.3969/j.issn.1671-4091.2023.11.009 Abstract （99）      PDF（pc） （526KB）（216）       Knowledge map    Objective   To explore the relationship between systemic immunoinflammation index (SII) and treatment failure of peritoneal dialysis-associated peritonitis (PDAP).  Methods  The clinical data of PDAP patients treated in the Peritoneal Dialysis Center of the First Affiliated Hospital of Ningbo University from January 2015 to December 2022 were retrospectively analyzed. They were divided into successful treatment group and failed treatment group according to the treatment results. The baseline clinical and laboratory data were compared between the two groups. Logistic regression was used to evaluate the relationship between SII and PDAP treatment failure. Receiver operating characteristic curve (ROC curve) was used to analyze the predictive value of SII for PDAP treatment failure.  Results   This study recruited 87 patients with PDAP, in which 60 (69.0%) were males,  and 63 patients were in the successful treatment group and 24 patients were in the failed treatment group. Compared with the successful treatment group, patients in the failed treatment group had older age (t=-2.643, P=0.010), lower albumin (t=2.189, P=0.031), lower prealbumin ( t=2.189, P=0.031), higher hypersensitive C-reactive protein (Z=-2.821, P=0.005) and higher SII level (Z=-2.934, P=0.003). Multivariate logistic regression demonstrated that higher SII was the independent factor for treatment failure of PDAP (OR=1.001, 95% CI：1.000～1.002, P=0.047). ROC curve results showed that the area under the curve of SII for predicting treatment failure of PDAP was 0.704 (95% CI：0.579～0.829, P=0.003); when the optimal cut-off SII value was set at 2463.23, the sensitivity was 46.0% and the specificity was 92.1%.  Conclusion High SII is independently associated with treatment failure of PDAP. Therefore, SII can be used as a better biomarker to predict treatment failure of PDAP. Reference | Related Articles | Metrics

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Correlation between triglyceride-glucose index and cognitive dysfunction in elderly hemodialysis patients LIN Hui, SHEN Ling-yan, ZHU Ye-hui Chinese Journal of Blood Purification    2023, 22 (11): 846-849.   DOI: 10.3969/j.issn.1671-4091.2023.11.010 Abstract （101）      PDF（pc） （520KB）（214）       Knowledge map    Objective  To investigate the correlation between triglyceride-glucose index (TyG) and cognitive impairment in elderly hemodialysis patients.  Methods  A total of 204 elderly hemodialysis patients from January 2020 to June 2020 were enrolled in this study. According to score of the Montreal Cognitive Assessment (MoCA) Chinese version, patients were divided into a normal group (MoCA score≥26 points, n=67) and an obstacle group (MoCA score <26 points, n=137). Clinical data including TyG were collected from the hospital information management system. Multivariate logistic regression was used to explore the relationship between TyG and cognitive impairment in elderly hemodialysis patients. ROC curve was used to evaluate the predictive ability of TyG for cognitive impairment.  Results  There were no statistical differences in age, gender, hypertension, BMI and TC between the two groups (χ2/t=0.593, 0.496, 0.027, 0.581 and 0.245 respectively; P=0.554, 0.481, 0.869, 0.562 and 0.806 respectively). Diabetes, stroke, dialysis age, education level and TyG were significantly different between normal group and obstacle group (χ2/t=9.566, 23.511, 7.122, 8.058 and 6.003 respectively; P=0.002, <0.001, <0.001, <0.001 and <0.001 respectively). Multivariate logistic regression showed that diabetes (OR=1.713, 95% CI: 1.512～2.013, P<0.001), stroke (OR=2.023, 95% CI: 1.647～2.216, P<0.001), dialysis age (OR=1.527, 95% CI: 1.376～1.786, P<0.001), education level (OR=0.613, 95% CI: 0.472～0.874, P<0.001), and TyG (OR=1.476, 95% CI: 1.309～1.738, P<0.001) were the influencing factors for cognitive dysfunction. ROC curve analysis showed that the area under the curve of cognitive dysfunction in elderly hemodialysis patients predicted by diabetes was 0.774, the area under the curve of cognitive dysfunction in elderly dialysis patients predicted by TyG was 0.855 (95% CI: 0.752～0.957), and the maximum Yodon index was 0.515; when TyG was set at 9 points, the optimal cutoff value was obtained, with the sensitivity of 81.25, and the specificity of 79.12. According to the optimal cutoff value from ROC curve, patients were subdivided into TyG <9 group (n=55) and TyG≥9 group (n=149). The readmission rates were 40.00% (22/55) and 59.73% (89/149) in TyG <9 group and TyG≥9 group respectively (χ2=6.305, P=0.012), and the infection rates were 20.00% (11/55) and 37.11% (59/149) in TyG <9 group and TyG≥9 group respectively (χ2=6.845, P=0.009).  Conclusion  The increase of TyG is an independent risk factor for cognitive dysfunction, and has a better predictive value for cognitive dysfunction in elderly hemodialysis patients. 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 progresses in peritoneal dialysis related animal models FANG Lv-gui, RAO Xiang-rong Chinese Journal of Blood Purification    2023, 22 (11): 850-852.   DOI: 10.3969/j.issn.1671-4091.2023.11.011 Abstract （114）      PDF（pc） （593KB）（205）       Knowledge map    Peritoneal dialysis (PD) related animal models provide important references for improving PD treatment in humans, despite the fact that animal results have to be further studied before they can be used clinically. Currently, PD related models have been established in mice, rats, rabbits, pigs and other animals. These animal models offer valuable information about the mechanisms of PD complications such as peritonitis and peritoneal fibrosis, and also about the development of new dialysates. Reference | Related Articles | Metrics

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Effects of the active form vitamin D on metabolism and kidney cell function in patients with chronic kidney disease GUO Zi-Yi, ZHANG Zi-yuan, FANG Jing-ai Chinese Journal of Blood Purification    2024, 23 (04): 286-289.   DOI: 10.3969/j.issn.1671-4091.2024.04.010 Abstract （120）      PDF（pc） （472KB）（205）       Knowledge map    Vitamin D is a lipid-soluble steroid derivative. Insufficiency or deficiency of vitamin D in patients with chronic kidney disease (CKD) affects calcium-phosphorus homeostasis, parathyroid hormone (PTH) level and glucose and lipid metabolism, leading to the presence of a series of complications, lower quality of life and reduced survival rate in CKD patients. This article reviews the mechanism of vitamin D on metabolism and kidney cell function in CKD patients to provide bases for the prevention and treatment of CKD and its complications. Reference | Related Articles | Metrics

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Analysis of risk factors and construction of a risk prediction model for the complications of autologous arteriovenous fistula in maintenance hemodialysis patients LI Hong-bo Chinese Journal of Blood Purification    2023, 22 (11): 861-865.   DOI: 10.3969/j.issn.1671-4091.2023.11.014 Abstract （160）      PDF（pc） （710KB）（204）       Knowledge map    Objective  To analyze the risk factors for complications of autologous arteriovenous fistula (AVF) in maintenance hemodialysis (MHD) patients, and to construct a risk prediction model for the complications.  Method  A retrospective analysis was conducted on the clinical data of 178 MHD patients admitted to Department of Nephrology, The Second Medical Center, PLA General Hospital from March 2021 to March 2023. Patients were divided into a AVF complication group (n=46) and a non-AVF complication group (n=132) based on the complications of stenosis and/or thrombosis in AVF. General data was collected. The independent risk factors for AVF complications in MHD patients were analyzed using univariate and multivariate logistic regression methods, from which a prediction model (R software) was constructed. The receiver operating characteristic (ROC) curve and calibration curve were plotted to evaluate the discrimination and accuracy of the prediction model in predicting the risk of AVF complications in MHD patients.   Results  Among 178 MHD patients, 46 cases were in the AVF complication group accounted for 25.84%, while 132 cases were in the non-AVF complication group accounted for 74.16%. Multivariate regression showed that age >65 years old (OR=1.658, OR 95% CI: 1.267～3.025, P<0.001), education level of junior high school or below (OR=1.543, OR 95% CI: 1.068～2.597, P<0.001), hypotension during dialysis (OR=5.492, OR 95% CI: 2.541～10.597, P<0.001), button puncture method (OR=1.843, OR 95% CI: 1.056～2.819, P<0.001), puncture failure or hematoma formation (OR=2.641, OR 95% CI: 1.273～4.320, P<0.001), platelet count >227.84×109/L (OR=4.413, OR 95% CI: 3.171～9.492, P<0.001) and albumin levels ＜32.83g/L (OR=3.981, OR 95% CI: 2.316～8.873, P<0.001) were the risk factors for AVF complications in MHD patients. ROC curve showed that the area under the curve of nomogram model to predict AVF complications in MHD patients was 0.823 (95% CI: 0.763～0.887), the calibration curve slope was close to 1, and there was no significant difference between the predicted probability and the actual probability (χ2=6.521, P=0.573).  Conclusion  Older age, lower education level, hypotension during dialysis, button puncture method, puncture failure or hematoma formation, higher platelet count, and lower albumin level are the risk factors for AVF complications in MHD patients. The column chart prediction model constructed based on the above risk factors has better discrimination and accuracy abilities. Related Articles | Metrics

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A single-center study of online hemodiafiltration with different frequency to improve quality of life in maintenance hemodialysis patients SUN Yan-ling, XIE Hua, WANG Jin-ling, XIAO Kun, FENG Qing, LIN Hong-li Chinese Journal of Blood Purification    2023, 22 (11): 821-825,860.   DOI: 10.3969/j.issn.1671-4091.2023.11.005 Abstract （169）      PDF（pc） （598KB）（201）       Knowledge map    Objective  To explore the effect of online hemodiafiltration (OL-HDF) once a week and thrice a week on quality of life in patients with maintenance hemodialysis (MHD).  Methods   Patients who received OL-HDF in Dalian Renal Care Hospital from January 1, 2022 to September 30, 2022 were selected and divided into OL-HDF once a week group and OL-HDF thrice a week group; according to the dialysis age in OL-HDF thrice a week group, dialysis age was matched at a ratio of 1:2. The Kidney Disease Quality of Life short Form (SF-36) was applied. The quality of life was assessed by kidney disease component summary (KDCS), physical component summary (PCS) and mental component summary (MCS). Lean tissue index (LTI) was measured by body composition monitor (BCM). Clinical indicators including quality of life scores, LTI, renal function and β2 microglobulin at baseline and after 6 months were compared between the two groups.  Results  A total of 102 MHD patients were included in this study, including 68 patients in OL-HDF once a week group and 34 patients in OL-HDF thrice a week group. Comparison of the indicator changes at baseline and after 6 months in the two groups revealed that KDCS score had no change (t=0.754, P=0.453), the sleep assessment in KDCS was better (t=3.082, P=0.003), the scores of PCS and MCS had no changes (t=  -0.515 and -1/513, P=0.608 and 0.133), and the general health assessment in PCS was better (t=2.442, P=0.016) in OL-HDF thrice a week group, as compared those in OL-HDF once a week group. Changes of the indicators after 6 months showed that hemoglobin (F=6.682, P=0.011), albumin (F=12.294, P=0.001) and LTI (F=7.898, P=0.007) were higher, β2 microglobulin was lower (25.15±3.26mg/L vs. 26.96±5.15mg/L; F=4.710, P=0.032), and spKt/V was higher (1.31±0.21 vs. 1.19±0.15; F=11.975, P=0.001) in OL-HDF thrice a week group, as compared those in OL-HDF once a week group.  Conclusions  OL-HDF treatment thrice a week improves the sleep and nutritional status in MHD patients, probably due to the better dialysis adequacy in these patients. Reference | Related Articles | Metrics

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Correlation between frailty and nutritional status in patients undergoing peritoneal dialysis CHEN Jing-jing, YI Chun-yan, LIN Jian-xiong, MAO Hai-ping, YANG Xiao Chinese Journal of Blood Purification    2023, 22 (11): 831-835.   DOI: 10.3969/j.issn.1671-4091.2023.11.007 Abstract （111）      PDF（pc） （496KB）（196）       Knowledge map    Objective  To investigate the relationship between frailty and body composition and nutritional status in maintenance peritoneal dialysis (PD) patients.  Methods   A cross-sectional survey of PD patients with regular follow-up in a single center was conducted. Clinical frailty scale was used to evaluate the physical function of the patients, and the Inbody720 (Biospace) bioelectrical impedance meter was used to determine the body composition of the patients. The demographic and clinical data of the patients were collected. The influencing factors for frailty in PD patients were analyzed.  Results  A total of 528 PD patients were included, of which 127 (24.1%) had frailty. Compared with the non-frailty group, frailty patients had higher body fat mass (t=4.148, P＜0.001), obesity degree (t=2.629, P=0.009), body mass index (t=2.389, P=0.017) and edema index (t=6.588, P＜0.001), and lower bone mineral mass (t= -2.417, P=0.016), skeletal muscle mass (t=-3.706, P＜0.001), intracellular fluid volume (t=-3.714, P＜0.001), total fluid volume (t=-2.947, P=0.003), lean body mass index (t=-2.245, P=0.025), serum total protein (t =-2.486, P=0.013), albumin (t=-6.329, P＜0.001) and prealbumin (t=-7.638, P＜0.001). Multivariate binary logistic regression analysis showed that older age (OR=1.130, 95% CI: 1.076～1.186, P＜0.001), higher Charlson comorbidities score (OR=1.599, 95% CI:1.206～2.119, P＜0.001), higher systolic blood pressure (OR=1.043, 95% CI:1.017～1.070, P＜0.001), lower diastolic blood pressure (OR=0.939, 95% CI: 0.898～0.981, P=0.005) and lower serum albumin (OR=0.858, 95% CI: 0.780～0.944,P=0.002) were the independent risk factor for frailty in PD patients.  Conclusions The incidence of frailty in PD patients was 24.1%. Lean body mass index, obesity degree and edema index were correlated with frailty. Nutritional status, older age, comorbidities and blood pressure were the independent influencing factors for frailty in PD patients. Reference | Related Articles | Metrics

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Effect of calcium ion concentration in peritoneal dialysate on peritoneal fibrosis and endoplasmic reticulum stress of peritoneal dialysis patients GUO Bao-zhu, CHENG Jin-xiu, JIN Xin, HE Yu-tao, SUN Xian-min Chinese Journal of Blood Purification    2023, 22 (11): 805-809.   DOI: 10.3969/j.issn.1671-4091.2023.11.002 Abstract （129）      PDF（pc） （563KB）（196）       Knowledge map    Objective  To study the effect of calcium ion concentration in peritoneal dialysate on peritoneal fibrosis, epithelial mesenchymal transition (EMT) and endoplasmic reticulum stress (ERS) of peritoneal dialysis patients.  Method   A randomized controlled study was conducted on patients who underwent continuous non-bedridden peritoneal dialysis using standard calcium peritoneal dialysate. They were divided into low calcium group and control group. Patients in low calcium group switched to low calcium peritoneal dialysate while those in the control group continued to use the peritoneal dialysate with standard calcium concentration. The enrollment time point was set at 0 month and the end of the experiment was set after 6 months. Their clinical data at the time of enrollment were recorded. The outflow dialysates at 0 and 6 months were collected to measure the contents of transforming growth factors-β1 (TGF-β1), fibronectin (FN) and collagen-I (Col-I), and the expression levels of E-cadherin, N-cadherin, ZO-1, α-smooth muscle actin (α-SMA), CCAAT enhancer binding protein homologous protein (CHOP), phosphorylated protein kinase R-like endoplasmic reticulum kinase (p-PERK), phosphorylated eukaryotic translation initiation factor 2 α (p-eIF2α) and transcription activating factor 4 (ATF4).  Results  A total of 49 patients were enrolled, including 24 in low calcium group and 25 in control group. After 6 months of treatment, the contents of TGF-β1, FN, Col-I and the expression levels of α-SMA, N-cadherin, p-PERK, p-eIF2α, ATF4 and CHOP were lower in low calcium group than in control group  (t=4.599, 2.161, 6.557, 9.357, 8.565, 8.634, 7.518, 8.842 and 10.989 respectively; P＜0.001, =0.036, ＜0.001, ＜0.001, ＜0.001, ＜0.001, ＜0.001, ＜0.001 and ＜0.001 respectively), while the expression levels of E-cadherin and ZO-1were higher in low calcium group than in control group (t=16.684 and 22.273; P＜0.001 and＜0.001).  Conclusion  Low calcium dialysate can alleviate peritoneal fibrosis, of which the molecular mechanism may relate to the inhibition of EMT and ERS by low calcium dialysate. Reference | Related Articles | Metrics

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Efficacy of ultrasound-guided radiofrequency ablation in the treatment of hyperparathyroidism secondary to chronic kidney disease and its possible injury to recurrent laryngeal nerve ZHAO Xin-ping, WANG Jun-xia Chinese Journal of Blood Purification    2023, 22 (08): 590-593.   DOI: 10.3969/j.issn.1671-4091.2023.08.005 Abstract （108）      PDF（pc） （437KB）（196）       Knowledge map    Objective  To investigate ultrasound-guided radiofrequency ablation (RFA) in the treatment of secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) patients and its possible injury to recurrent laryngeal nerve.  Methods A total of 18 CKD patients with SHPT and admitted to the Blood Purification Center of Department of Nephrology, The First Affiliated Hospital of Henan University of Science and Technology from September 2020 to February 2022 were selected as the research subjects. Venous blood was collected before RFA and after RFA for one day, 7 days, one month, 3 months and 6 months to assay serum intact parathyroid hormone (iPTH), phosphorus, calcium and alkaline phosphatase (ALP). Their bone pain, skin pruritus, muscle strength grade and other complications were recorded.  Results  After RFA for one day, 7 days, one month, 3 months and 6 months, serum calcium, phosphorus, iPTH and ALP decreased as compared with those before RFA (calcium: F=38.637, P＜0.001; phosphate: F=44.175, P＜0.001; iPTH: F=369.836, P＜0.001; ALP: F=29.954, P＜0.001). Within 7 days after RFA, serum calcium decreased to the lowest (χ2=5.532, P=0.016, compared with those before RFA), and serum calcium increased and stabilized after supplement of calcium to the patients. After RFA, bone pain, blurred vision and pruritus relieved significantly, and muscle strength grade increased (vision: F=9.076, P＜0.001; pruritus: F=439.309, P＜0.001; muscle: F=3.755, P＜0.001). Six of the 18 patients (33.33%) had hypocalcemia of different degrees. Recurrent laryngeal nerve injury occurred in 5 patients (27.78%). Higher serum iPTH recurred but without symptoms and neck pain in 3 patients (16.67%).  Conclusion Ultrasound-guided RFA is effective for the treatment of SHPT in CKD patients. It can relieve bone pain, pruritus and improve muscle strength, with higher safety. Reference | Related Articles | Metrics

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Effect of hyperkalemia on electrocardiographic stability of hemodialysis patients Burenqiqige, LIU Li, CHEN Er-dong, CHEN Yu-qing Chinese Journal of Blood Purification    2023, 22 (09): 695-697.   DOI: 10.3969/j.issn.1671-4091.2023.09.013 Abstract （155）      PDF（pc） （384KB）（195）       Knowledge map    Hyperkalemia is a common complication of maintenance hemodialysis (MHD) patients. When blood potassium concentration increases, it will not only change the gradient of potassium concentration inside and outside the cells and break the electrical stability of myocardial cells, but will also promote massive and rapid shift of potassium ions between serum and dialysate and inside and outside the cells during dialysis. These factors may increase the risk of arrhythmia in MHD patients. Therefore, it is very important to treat hyperkalemia in time and choose the best potassium prescription of dialysate. This review discusses the influence of hyperkalemia and dialysis treatment on electrocardiographic stability of hemodialysis patients and related treatment measures. Reference | Related Articles | Metrics

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Clinical features and changes of cardiac structure and function in maintenance hemodialysis patients with different NYHA grades LI Zhuan-huan, LIAN You Chinese Journal of Blood Purification    2023, 22 (11): 816-820.   DOI: 10.3969/j.issn.1671-4091.2023.11.004 Abstract （121）      PDF（pc） （535KB）（194）       Knowledge map    Objective  To analyze the clinical characteristics and changes of cardiac structure and function in maintenance hemodialysis (MHD) patients with different New York Heart Association cardiac function grade (NYHA grade).  Methods  A total of 148 MHD patients were divided into NYHA I group, NYHA II group, NYHA III group and NYHA IV group according to the NYHA classification of their heart function. Clinical data, laboratory indicators and Echocardiography results were collected. Changes of the above indicators were compared in the MHD patients with different NYHA grades.  Results   There were significant differences in weight gain in the hemodialysis period (t=2.057, P=0.049) and systolic blood pressure (t=2.415,       P=0.017) between NYHA III group and NYHA I group. With the increase of NYHA grade, the proportion of heart failure with preserve ejection fraction (HFpEF) patients reduced gradually, and the proportion of patients with heart failure and reduced ejection fraction (HFrEF) increased gradually (χ2=8.517, P=0.046); NT-proBNP and CRP increased gradually, and ALB and Hb decreased gradually, especially in NYHA IV group, with statistical significances among the four groups (χ2=9.465, P=0.009; F=6.745, P=0.048; F=6.235, P=0.037;             F=6.812, P=0.042); left atrial diameter (LA), left ventricular end-diastolic diameter (LVEDd) and the late diastolic peak flow velocity (VA) increased gradually, especially in NYHA IV group, and the differences were statistically significant among the groups (F=6.701, P=0.032; F=6.278, P=0.037; F=6.485, P=0.042); left ventricular ejection fraction (LVEF) decreased gradually, with significant differences among the groups (χ2=58.216, ＜0.000).  Conclusion  MHD patients with NYHA III or IV grade usually show more weight gain and poor blood pressure control during the dialysis period. With the increase of NYHA grade, microinflammatory state, malnutrition and anemia increased gradually, atrial and ventricular diameters increased mainly due to the decrease of diastolic function. Early identification of the decreased diastolic function should combine the values of early diastolic peak velocity (VE) and VA and their dynamic changes rather than limited to the E/A ratio. Reference | Related Articles | Metrics