Chinese Journal of Blood Purification

12 August 2018, Volume 17 Issue 08 Previous Issue    Next Issue

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Risk factors for cardio- and cerebro- vascular disease in peritoneal dialysis patients 2018, 17 (08):  505-507.  doi: 10.3969/j.issn.1671-4091.2018.08.001 Abstract ( 383 )   PDF (326KB) ( 677 )   【Abstract】Cardio- and cerebro-vascular disease is a primary cause of death in peritoneal dialysis (PD) patients. A variety of risk factors are involved in the pathogenesis of cardio- and cerebro-vascular disease in PD patients. These risk factors can be classified into three categories: ①poor lifestyles, including lack of physical activity, high salt diet, and smoking; ②uremic complications or comorbidities, including hypertension, diabetes, inflammatory status, protein-energy wasting, anemia, chronic kidney disease-mineral bone disease, hypokalemia, and hyperlipidemia; and ③inadequate peritoneal dialysis, including decreased residual renal function, and volume overload. These risk factors should be effectively prevented and managed in PD patients based on the guide of multi-disciplinary clinical practice and the characteristics of PD. Metrics

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Recent advances in the diagnosis and treatment of peritoneal dialysis-related peritonitis 2018, 17 (08):  508-513.  doi: 10.3969/j.issn.1671-4091.2018.08.002 Abstract ( 402 )   PDF (452KB) ( 1138 )   【Abstract】Peritoneal dialysis (PD) is one of the renal replacement therapies for patients with end-stage renal disease (ESRD). Peritonitis is a common and serious complication and a major cause for PD failure, transfer to hemodialysis, and death in PD patients. Accurate diagnosis and treatment of peritonitis in time is essential to cure this complication and to recover PD treatment for the patients. This article introduces the recent advances in diagnosis and treatment of PD-related peritonitis, based on the latest Peritonitis Recommendations on Prevention and Treatment Updated in 2016 by the International Association for Peritoneal Dialysis (ISPD) and recent literature. Metrics

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Relationship between body fluid distribution, blood pressure and left ventricular hypertrophy before and after hemodialysis sessions in maintenance hemodialysis patients 2018, 17 (08):  514-518.  doi: 10.3969/j.issn.1671-4091.2018.08.003 Abstract ( 399 )   PDF (437KB) ( 549 )   【Abstract】Objective To explore the relationship between body fluid distribution, blood pressure and left ventricular hypertrophy (LVH) before and after hemodialysis sessions in maintenance hemodialysis (MHD) patients by using bioelectrical impedance technique. Methods A total of 99 MHD patients without obvious edema, recent severe infection and heart failure were recruited from Peking University People's Hospital. The total body water (TBW), extracellular water (ECW) and intracellular water (ICW) before and after dialysis were measured by a bioelectrical impedance analyzer. Blood pressure and echocardiography of the patients were recorded. Logistics regression analysis was used to identify risk factors for hypertension and LVH. Results ①A total of 99 MHD patients (60 males and 39 females) with the dialysis vintage of 63 (39.00～118.00) months were enrolled in this study. ② In patients reached dry body weight after dialysis by clinical evaluation, 22.2% of them were still overloaded by bioelectrical impedance analysis. ③ΔECW was positively and closely correlated to ultrafiltration volume (r=0.822, P＜0.001); ΔTBW was positively correlated to ultrafiltration volume (r=0.594, P＜0.001); while ΔICW only had a weak correlation to ultrafiltration volume (r=0.210, P=0.037). ④ECW/TBW before dialysis (P=0.023, OR=1.187, 95% CI 1.024～1.377), ECW/TBW after dialysis (P=0.019, OR=1.156, 95% CI 1.024～1.306), and intact parathyroid hormone (iPTH) (P=0.021, OR=1.005, 95% CI 1.001～1.010) were the risk factors for hypertension before dialysis. ⑤ECW/body weight after dialysis (P=0.041, OR=1.196, 95% CI 1.007～1.420), female (P=0.026, OR=0.358, 95% CI 0.145～ 0.882), iPTH (P=0.014, OR=1.004, 95% CI 1.001～1.006), and hypertension before dialysis (P=0.045, OR=3.177, 95% CI 1.026～9.842) were significantly correlated to LVH. The weight gain rate in the interphase of hemodialysis sessions was higher in LVH group than in non-LVH group (4.45±1.68 vs. 3.86± 1.50, t=1.859,P= 0.066). Conclusions Volume overload is an independent risk factor for hypertension and LVH in MHD patients. The higher weight gain rate in the interphase of hemodialysis sessions may associate with LVH. Metrics

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Comparison of the modified quantitative subjective global assessment (MQSGA) and the malnutritioninflammation score (MIS) for the evaluation of nutritional status in elderly maintenance hemodialysis patients 2018, 17 (08):  519-522.  doi: 10.3969/j.issn.1671-4091.2018.08.004 Abstract ( 444 )   PDF (416KB) ( 629 )   【Abstract】Objective To compare the accuracy of modified quantitative subjective global assessment (MQSGA) and malnutrition-inflammation score (MIS) for the evaluation of nutritional status and the prediction of cardio- and cerebro-vascular events in elderly maintenance hemodialysis (MHD) patients. Methods A total of 236 MHD patients treated in the period from January 2014 to December 2016 were enrolled in this study. Patients were on MHD for more than 3 months and over 60 years old. MQSGA and MIS were performed for these patients. Clinical data and laboratory test results were collected. Body mass index (BMI), skin fold thickness of upper arm, skin fold thickness of triceps muscle, upper arm circumference and upper arm muscle circumference were measured. The correlation of these parameters with MQSGA and MS was analyzed. The effectiveness of MQSGA and MS for the evaluation of malnutrition-inflammation status was compared. Clinical data were compared between patients with cardio- and cerebro-vascular events and those without cardio- and cerebro-vascular events. Multivariate logistic regression was used to analyze the relationshipbetween the scores from different nutrition evaluation method and cardio- and cerebro-vascular events. Results This study enrolled 236 MHD patients (138 males and 108 females, average age 73.4±7.6 years, and MHD duration 35.1±14.2 months). The proportion of malnutrition in this cohort was 64.4% by MQSGA and was 65.8% by MIS (χ2=0.150, P=0.699). Except for the skin fold thickness of triceps muscle, the absolute values of correlation coefficient for nutrition and inflammatory indexes were higher from MIS than from MQSGA, suggesting that MIS is better than MQSGA for the evaluation of nutritional status in elderly MHD patients. The levels of MIS score (Z=2.641, P＜0.001), MQSGA (Z=2.012, P＜0.001), pre-albumin (t=2.951, P= 0.002), and C reactive protein (Z=2.715, P＜0.001) were significantly higher in patients with cardio- and cerebro-vascular events than in those without cardio- and cerebro-vascular events. Multivariate logistic regression showed that the relative risk (RR) of cardio- and cerebro-vascular events from MQSGA (RR=1.516, 95% CI 1.109-2.001, P=0.005) was significantly lower than that from MIS (RR=2.563, 95% CI 1.561～5.211, P=0.003), suggesting that MIS is more valuable than MQSGA in predicting the risk of cardio- and cerebro-vascular events in elderly MHD patients. Conclusion MIS was better than MQSGA for the evaluation of nutritional status and the prediction of cardiovascular events in elderly MHD patients. Metrics

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A control study on the dialyzers with cellulose triacetate membrane and with polysulfone membrane for maintenance hemodialysis patients 2018, 17 (08):  523-528.  doi: 10.3969/j.issn.1671-4091.2018.08.005 Abstract ( 657 )   PDF (468KB) ( 1017 )   【Abstract】Background With the continuous development and optimization of dialysis membrane materials, polysulfone (PS) as the third generation of dialysis membrane has replaced cellulose triacetate (CTA) and dominated the market because of its better biocompatibility. However, we found that the hypersensitivity to PS could be remitted by the application of CTA in clinical practice. Objective To compare the differences in toxin removal, hematological change and biocompatibility in maintenance hemodialysis (MHD) patients using CTA dialyzer and PS dialyzer. Methods A total of 60 MHD patients treated in the Second Blood Purification Center, Shengjing Hospital, Chinese Medical University from June 2017 to September 2017 were enrolled in this study. They were randomly divided into group CTA and group PS (n=30/each group). They were treated with regular hemodialysis of 4 hours/time and 3 times/week for 2 months. The clearances of creatinine (CR), blood urea nitrogen (BUN) and serum phosphorus (P), the changes of hemoglobin (Hb), platelet (PLT)and white blood cell (WBC), and the differences of C-reactive protein (CRP), IgE, complement 3 (C3), vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) were compared between group CTA and group PS. Results Age (t=-0.735, P=0.465), gender (c2=2.410, P=0.120), dialysis age (t=0.336, P=0.738) and primary diseases (c2=3.817, P=0.701) had no statistical differences between the two groups. Before the hemodialysis with CTA dialyzer and PS dialyzer, there were no statistical differences in all of the parameters between the two groups (P＞0.05). After application of CTA dialyzer and PS dialyzer for 2 months, ①there were no statistical differences in CR, BUN and P, nor in the changes of the above indicators between the two groups (P＞0.05); ② there was a statistical difference in Hb change between the two groups (t=-2.282, P=0.027), with better improvement of anemia in group CTA; ③ there was a statistical difference in PLT (t=2.947, P=0.005) between the two groups, with slighter change in group CTA than in group PS (t=2.219, P=0.031); and ④there were no statistical significances in WBC, VCAM-1, ICAM-1, IgE, CRP and C3 between the two groups (P＞0.05). Conclusion ①There were no significant difference in the clearances of small molecule toxins such as CR, BUN and P between CTA dialyzer and PS dialyzer. ② CTA was better than PS in the improvement of anemia. ③ The effect on PLT was less in group CTA than in group PS. ④ There were no differences in inflammation and allergy factors, complement system, and biocompatibility in MHD patients using CTA dialyzer and PS dialyzer. Metrics

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The advantages of pre-dialysis management in chronic kidney disease outpatient clinic in maintenance hemodialysis patients 2018, 17 (08):  529-533.  doi: 10.3969/j.issn.1671-4091.2018.08.006 Abstract ( 272 )   PDF (469KB) ( 626 )   【Abstract】Objective To evaluate the advantages of pre-dialysis management in chronic kidney disease (CKD) outpatient clinic in maintenance hemodialysis (MHD) patients and to provide the bases for CKD patient treatment in outpatient clinic. Methods This was a retrospective single center study, which enrolled 39 initial hemodialysis patients managed in our CKD outpatient clinic (management group, group M) and 142 initial hemodialysis patients without management in CKD outpatient clinic (non-management group, group NM) in the period from March 2015 to June 2017. Their vascular access methods and laboratory indices at the beginning of hemodialysis were compared. Results A total of 181 patients were enrolled in this study. The mean age was 60.6±15.3 years and 111 patients (61.3%) were male. There were no significant differences in gender, age, cause of CKD, and comorbidities between the two groups. At the initiation of hemodialysis, lower blood pressure [(146.1±14.2) mmHg vs. (160.3±28.8) mmHg, t=4.297, P＜0.001), serum phosphorus [(1.7±0.4) mmol/L vs. (2.0±0.6) ml/min, t=3.486, P=0.010] and iPTH [(270.7±157.1) pg/ml vs. (342.7±286.4) pg/ml, t=2.070, P=0.040], and higher hemoglobin [(88.8±17.2) g/L vs. (75.5±17.3) g/L, t=-4.253, P＜0.001] and eGFR [(7.0±2.3) ml/min vs. (5.5±3.1) ml/min, t=0.906, P =0.020] were found in group M as compared with those in group NM. Five patients (3.5%) used arteriovenous fistula (AVF) and 137 (96.5%) patients used central venous catheter (CVC) as the blood access in group NM, while 29 patients (74.4%) used AVF, 2 patients (5.1%) used tunneled cuffed catheter and 8 patients (20.5%) used CVC as the blood access in group M. The blood access methods were significantly different between the two groups (χ2=110.815, P＜0.001). Conclusions Pre-dialysis management for CKD patients improved their blood pressure, anemia, and renal bone disease at the initiation of hemodialysis, resulting in a better status at the time when hemodialysis was initiated. Pre- dialysis management also increased the use of planned blood access methods and decreased the use of temporary catheterization for blood access. Metrics

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The safety and efficacy of argatroban and low-molecular-weight heparin in hemodialysis: A meta analysis 2018, 17 (08):  534-538.  doi: 10.3969/j.issn.1671-4091.2018.08.007 Abstract ( 438 )   PDF (1500KB) ( 704 )   【Abstract】Objective To evaluate the safety and efficacy of argatroban and low-molecular-weight heparin (LMWH) in hemodialysis. Method PubMed, EMBASE, Cochrane library, CNKI, and Wanfang were searched for randomized controlled trials for argatroban and LMWH in hemodialysis. RevMan5.3 was used to perform statistical analyses. Result A total of 6 studies were enrolled, including 467 patients (236 in argatroban group, 231 in LMWH group). Meta analysis showed that argatroban group and LMWH group had no significant differences in clotting events in extracorporeal circuit during hemodialysis (RR=0.740, 95% CI0.470～1.150, P=0.180); platelet counts were significantly higher in argatroban group than in LMWH group (MD=20.000, 95% CI 10.120～29.870, P＜0.001), bleeding rate during hemodialysis was significantly lower in argatroban group than in LMWH group (RR=0.220, 95% CI 0.070～0.680, P=0.009); and the ligature time for puncture site was significantly shorter in argatroban group than in LMWH group (MD=-1.350, 95% CI -1.850～-0.840, P＜0.001). Conclusion The ratio of clotting events in extracorporeal circuit during hemodialysis was similar between argatroban group and LMWH group. Argatroban seems safer than LMWH in less influence on PLT, lower bleeding rate and shorter ligature time for puncture site. Metrics

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The application of intelligent handheld ultrasound diagnostic instrument for difficult puncture of arteriovenous arteriovenous fistula 2018, 17 (08):  539-541.  doi: 10.3969/j.issn.1671-4091.2018.08.008 Abstract ( 335 )   PDF (372KB) ( 785 )   【Abstract】Objective To explore the application of intelligent handheld ultrasound diagnostic instrument for the diagnosis of arteriovenous fistula (AVF) status in maintenance hemodialysis (MHD) patients. Methods We recruited 22 MHD patients with complicated AVF treated between October 2016 and December 2016 in the Hemodialysis Center of our hospital as the control group, and 17 MHD patients with complicated AVF treated between October 2017 and December 2017 in this center as the observation group. The AVF puncture for blood access for the two groups of patients was performed by experienced nurses. For patients in the control group, traditional puncture method, i.e. observation first and then blind puncture of the AVF was adopted; for those in the observation group, evaluation, position, marking and puncture of the AVF were conducted by using a intelligent handheld ultrasound diagnostic instrument. The success rate of AVF puncture, pain score, and the rate of puncture-related complications were compared between the two groups. Results The success rate of puncture was 88.77% in the control group and 94.57% in the observation group (χ2=20.609, P＜0.001). The pain score of the observation group was 3.51±2.03, significantly lower than that of the control group 5.07±2.38 (t=3.833, P＜0.001). Subcutaneous hematoma (χ2=17.762, P＜0.001), bleeding at puncture site (χ2=27.333, P＜0.001), and induration at puncture site (χ2=21.056, P＜0.001) were alsolower in the observation group than in the control group. Conclusion AVF puncture with the help of intelligent handheld ultrasound diagnostic instrument can improve the success rate of AVF puncture, alleviate pain, and reduce the AVF puncture-related complications. Metrics

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TThe infection prevention by soaking the catheter hubs in type I entoiodine before hemodialysis sessions 2018, 17 (08):  542-548.  doi: 10.3969/j.issn.1671-4091.2018.08.009 Abstract ( 352 )   PDF (1847KB) ( 545 )   【Abstract】Purpose The cap of tunneled central venous catheter (TCC) was soaked in type I entoiodine for 3-5 min before use for 2 years and then was switched to routine care procedure without type I entoiodine treatment for 2 years. Catheter-related infection (CRI) was compared in the periods with and without type I entoiodine treatment. Damage of TCCs by disinfectants was also studied. Methods A total of 119 maintenance hemodialysis patients using TCC as the blood access route for more than 3 months were enrolled in this study. During the period from Sept. 1st, 2013 to Aug. 31st, 2015, the catheter caps were soaked in type I entoiodine for 3-5 min and then scrubbed with typeⅠentoiodine for 15-30 sec before connecting tubes. During the period from Sept. 1st, 2015 to Aug. 31st, 2017, the catheter caps of the same patients were treated with the same procedure but without type I entoiodine treatment. CRI was recorded and summarized every 3 months. In addi-tion, 5 groups of TCCs (4 TCCs/each group) were soaked in 75% alcohol, type I entoiodine, type III entoiodine, chlorhexidine alcohol, and normal saline respectively, and observed every day until one of the TCCs was damaged. Results In the soaked group, there were totally 37,246 catheter days, in which exit infection in 17 cases, catheter-related blood infection (CRB) in 5 cases, tunnel infection in 5 cases, and suspected CRB in one case were detected. In non-soaked group, there were totally 35,452 catheter days, in which exit infection in 61 cases, CRB in 12 cases, and tunnel infection in 4 cases were detected. The comparisons of CRI according to seasons were made between the two groups. During the period from July to September, exit infections were lower in soaked group then in non-soaked group (0.16/1,000 catheter days vs. 0.73/1,000 catheter days, χ2= 5.524, P=0.019), and CRIs were also lower in soaked group then in non-soaked group (0.40/1,000 catheter days vs. 0.65/1,000 catheter days, χ2=144.810, P＜0.001). During the period from October to December, exit infections were lower in soaked group then in non-soaked group (0.06/1,000 catheter days vs. 0.50/1,000 catheter days, χ2=6.716, P=0.010), and CRIs were also lower in soaked group then in non-soaked group (0.06/1,000 catheter days vs. 0.65/1,000 catheter days, χ2=9.632, P=0.002). There were no differences in the prevalence of other infections according to seasons between the two groups. The comparisons of CRI in the two years were then made between the two groups. Exit infections were lower in soaked group then in non-soaked group (2.15/1,000 catheter days vs. 4.47/1,000 catheter days, χ2=16.211, P=0.001). However, there were no differences in tunnel infection (0.29/1,000 catheter days vs. 0.37/1,000, χ2=0.308, P=0.741), CRB (0.24/1,000 catheter days vs. 1.49/1,000 catheter days, χ2=1.987, P=0.159), and CRI (2.66/1,000 catheter days vs. 6.32/1,000 catheter days, χ2=11.893, P=0.001) between the two groups. Except for chlorhexidine alcohol and saline, 75% alcohol, type I entoiodine and type III entoiodine, especially 75% alcohol, damaged TCCs after soaked in for 4 days. Conclusion Caps of TCC soaked in type I entoiodine before use could prevent exit infection but not CRB. Scrub the hubs with disinfectant 15- 30 sec and change the caps could effectively prevent CRB. TCCs soaked in disinfectants for long time caused catheter damage. 75% alcohol severely damaged TCCs, and chlorhexidine alcohol mildly damaged TCCs. Metrics

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Application of veno-venous puncture as the temporary vascular access in hemodialysis patients 2018, 17 (08):  549-552.  doi: 10.3969/j.issn.1671-4091.2018.08.010 Abstract ( 417 )   PDF (423KB) ( 815 )   【Abstract】Background At present, patients who do not establish long-term vascular access can only rely on central venous catheter (CVC) as the temporary vascular access for dialysis. However, CVC has an adverse impact on the prognosis of patients. The purpose of this study was to investigate the feasibility of venovenous puncture (VVP) as an alternative for temporary vascular access in incident hemodialysis patients. Methods A total of 66 incident hemodialysis patients treated in Fuzhou General Hospital of Nanjing Military Command during the period from June 2014 to June 2015 were enrolled in this study. Patients were randomly divided into VVP group (n=33) and CVC group (n=33). Dialysis adequacy, access recirculation rate and access complications in a follow-up period of 2 months were observed and compared between the two groups. Results There were no significant differences in spKt/V, eKt/V and urea reduction ratio (URR) between the two groups at 0, 1 and 2 months after dialysis. After 2 months, the access dysfunction rate in VVP group was lower than that in CVC groups (0% vs. 12.12%, χ2=4.192, P=0.041). The dialysis adequacy and vascular access complications rate were similar between the two groups. Conclusion VVP is easy to perform and it can be an alternative choice for temporary vascular access in incident hemodialysis patients. Metrics

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The two methods of urokinase thrombolysis therapy for the treatment of thromboses in the polyester-sheathed catheters semi- permanently indwelling in deep veins 2018, 17 (08):  553-555.  doi: 10.3969/j.issn.1671-4091.2018.08.011 Abstract ( 367 )   PDF (331KB) ( 719 )   【Abstract】Objective To observe the efficacy of the two methods of urokinase (UK) thrombolysis therapy for the treatment of thromboses in the polyester-sheathed catheters semi-permanently indwelling in deep veins. Methods A total of 42 patients with thromboses in the semi-permanent polyester-sheathed catheters in the period from November 2012 to April 2017 were enrolled in this study. They were randomly divided into two groups; group A used a micro-pump to continuously pump in UK for 8h everyday and kept the positive pressure when the outlet was sealed (n=21); group B used suction of the outlet to produce negative pressure in tubes, sucked UK into the tubes by siphon phenomenon, and kept UK in the tube for 30 minutes (n=21). The success rate of thrombolysis, average dialysis blood flow, and complications were compared between the two groups. Results There were no significant differences in the success rate of thrombolysis (85.714% vs. 95.238%;χ2=0.276,P=0.599) and the average blood flow (239.014±32.123 ml/min vs. 244.663±23.834 ml/min; t=0.647,P=0.521) after UK thrombolysis therapy between the 2 groups. After the treatments for one month, the success rate of thrombolysis (52.380% vs. 80.952%; χ2=3.857, P=0.049) and the average blood flow (213.913±49.801 ml/min vs. 243.262±39.652 ml/min; t=2.113, P=0.041) were significantly different between the two groups. There was no significant difference in the average blood flow before therapy and after the therapy for one month both in group A (t=1.941, P=0.059) and group B (t=0.139, P=0.890). Gastrointestinal bleeding in one case and local bleeding in one case were found in group A, but no hemorrhages occurred in group B. Conclusion For the treatment of thrombosis in the polyester-sheathed catheters semi-permanently indwelling in deep veins, UK thrombolysis therapy using negative pressure method was better than that using continuous injection and sealed the outlet at positive pressure in higher success rate of thrombolysis, shorter treatment period, less drug used, lower complication rate, few medical expenses, and less pain. Therefore it is worthwhile to be used clinically. Metrics

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Renal vasculopathy in lupus nephritis 2018, 17 (08):  556-560.  doi: 10.3969/j.issn.1671-4091.2018.08.0012 Abstract ( 301 )   PDF (407KB) ( 901 )   【Abstract】Renal vascular lesions are common in lupus nephritis. There are five major pathological types in renal biopsy samples: vascular immune complex deposits, arteriosclerosis, thrombotic microangiopathy, non-inflammatory necrotizing vasculopathy, and true renal vasculitis. They are correlated with disease activity, renal outcome and therapeutic strategy. The key mechanisms include endothelial cell activation and dysfunction, and immune system disorders. Moreover, mechanism- based individualized therapies for lupus nephritis are required. Metrics

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A procedure for maintenance of dialysis machines 2018, 17 (08):  561-562.  doi: 10.3969/j.issn.1671-4091.2018.08.013 Abstract ( 363 )   PDF (320KB) ( 701 )   【Abstract】Objective We used dialysate flow state for the quick judgment of the fault in dialyzers. Methods We successfully repaired 5 dialyzers by judgment of liquid route status in machines. Our experience shows that normal dialysate flow is an important sign of the machine, and that when alarm appears interruption of dialysate flow must exist. The fault components can then be detected by examination of the key points and possible leak sites along the dialysate flow route. Results Through observation of dialysate flow state, we can quickly and accurately find out the fault part and repair the dialysis machine in time so that the waiting time of the patients is shortened. Conclusion Observation of dialysate flow state to diagnose the dysfunction site in the machine is a useful method for the maintenance of dialyzers. Metrics

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Method and modification of continuous plasma filtration adsorption mode on conventional blood purification equipments 2018, 17 (08):  563-565.  doi: 10.3969/j.issn.1671-4091.2018.08.014 Abstract ( 399 )   PDF (731KB) ( 601 )   【Abstract】Continuous plasma filtration adsorption (CPFA) is a blood purification model that can quickly and extensively remove the solute, suitable for the treatment of a variety of critical diseases. However, only a few patients used CPFA because of the limited equipment. In this paper, two methods and their respective characteristics of CPFA using conventional blood purification equipment are introduced, and one of the methods is improved to make it more suitable for clinical application. Metrics

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The effects of adequate hydration and standardized nursing on the prevention of contrast-induced nephropathy after interventional therapy of renal artery stenosis 2018, 17 (08):  566-569.  doi: 10.3969/j.issn.1671-4091.2018.08.015 Abstract ( 254 )   PDF (379KB) ( 675 )   【Abstract】Objective To investigate the effects of adequate hydration and standardized nursing on the prevention of contrast-induced nephropathy (CIN) in patients after interventional therapy of renal artery stenosis (RAS). Methods A total 50 hospitalized patients with atherosclerotic RAS treated with percutaneous transluminal renal angioplasty and stent placement (PTRA+S) in the period from February 2012 to December 2017 were enrolled in this study. Before and after the interventional therapy, patients received adequate hydration and standardized nursing, including preoperative CIN risk assessment, pre- and postoperative psychological care, establishment and maintenance of venous access, bed urination training and urine output monitoring, and observation of postoperative condition. Results Compared with the low-risk group (20 cases), the patients in the moderate and high-risk group (28 and 2 cases, respectively) were older, had higher levels of baseline serum creatinine (SCr), lower levels of estimate of glomerular filtration rate (eGFR), and applied larger doses of contrast agent (P＜0.01), suggesting that CIN occurs more likely in these patients. However, after receiving adequate hydration and standardized nursing, no patient developed CIN in the moderate and high-risk group just as in the low- risk group. Conclusion Adequate hydration can effectively prevent CIN after PTRA+S therapy, and standardized nursing plays an important role in ensuring the quality and effect of hydration. Metrics

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The application and nursing of blunt needle buttonhole puncture in elderly maintenance hemodialysis patients 2018, 17 (08):  570-572.  doi: 10.3969/j.issn.1671-4091.2018.08.016 Abstract ( 332 )   PDF (388KB) ( 620 )   【Abstract】Objective To analyze the application and nursing of blunt needle buttonhole puncture in elderly maintenance hemodialysis (MHD) patients. Methods We recruited 83 elderly MHD patients treated in this hospital during Feb. 2016 to Dec. 2017. Blunt needle buttonhole puncture was used for blood access, and the patients were divided into conventional nursing group (n=41) and specific nursing group (n=42), in which systematic nursing suitable for elderly MHD patients was used. Nursing effects were compared between the two groups. Results The prevalence of puncture complications were lower in the specific nursing group than in the conventional nursing group (7.14% vs. 24.39%, χ2=4.6721, P=0.031). The success rate of blunt needle buttonhole puncture was higher in the specific nursing group than in the conventional nursing group (97.62% vs. 85.37%,χ2 =4.0337, P=0.045). The satisfaction scores and pain scores from elderly MHD patients were statistically different between the two groups (P<0.05). Conclusion The systematic nursing specific for blunt needle buttonhole puncture was effective and alleviated pain sensation in elderly MHD patients. Metrics

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Effects of integration of medical-nursing care on hemodialysis patients with hyperphosphatemia liu sinan 2018, 17 (08):  573-576.  doi: 10.3969/j.issn.1671-4091.2018.08.017 Abstract ( 254 )   PDF (400KB) ( 683 )   【Abstract】Purpose To explore the effects of integration of medical- nursing care on health- related knowledge and serum phosphorus in hemodialysis patients with hyperphosphatemia. Methods This study used a randomized controlled trial with 80 cases randomized into two groups. Results Serum phosphorus of the patients in the intervention group was 1.80±0.16 mmol/L, which was lower than that of the control group (2.06±0.15 mmol/L), and the difference was statistically significant (t=7.498 P＜0.001). In patients in the intervention group, the scores of disease knowledge (94.90 ± 1.45 vs. 92.78 ± 1.46, t=6.156, P＜0.001), diet knowledge (93.53±1.48 vs. 92.15±1.33, t=3.486, P＜0.001), medicine knowledge about hyperphosphatemia (93.90±1.39 vs. 92.45±1.28, t=4.853, P＜0.001), and sports knowledge (92.20±1.22 vs. 91.43±1.30, t=2.732, P=0.008) were higher as compared with those in patients in the control group. Conclusions Integration of medical-nursing care can improve health-related knowledge and reduce serum phosphorus in hemodialysis patients with hyperphosphatemia. Metrics