Chinese Journal of Blood Purification

12 December 2020, Volume 19 Issue 12 Previous Issue    Next Issue

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Interpretation of ISPD《practice recommendations：Prescribing high-quality goal-directed peritoneal dialysis》 in 2020 Mei /Wang 2020, 19 (12):  793-797.  doi: 10.3969/j.issn.1671-4091.2020.12.001 Abstract ( 669 )   PDF (275KB) ( 1580 )   Metrics

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Application of endotoxin adsorption hemofilter continuous renal replacement therapy in septic shock patients with acute kidney injury 2020, 19 (12):  798-802.  doi: 10.3969/j.issn.1671-4091.2020.12.002 Abstract ( 536 )   PDF (493KB) ( 1082 )   【Abstract】Objective To evaluate the effect of endotoxin adsorption haemofilter continuous renal replacement therapy(CRRT) in patients with septic shock complicated with acute kidney injury(AKI). Methods 20 patients suspected gram-negative septic shock with AKI and treated with CRRT using oXiris filter for 48h were enrolled. 25 patients with the same diagnosis treated with CRRT using regular filter in our center were selected as the control group. The changes of organ function indicators and plasma inflammatory factors in the two groups during the treatment period were observed. Results Compared with the control group, the dosage of norepinephrine, plasma lactate, plasma inflammatory factors levels and the sequential organ failure assessment (SOFA) scores were significantly lower in oXiris group after 48 hours CRRT(P＜0.05). Meanwhile, the whole duration of using vasoactive drugs and CRRT in oXiris group was significantly shorter than controls(P=0.004, P=0.022). But there were no differences in length of hospital and intensive care unit(ICU) stays and mortality between groups. Conclusions Compared with conventional haemofilter, CRRT with oXiris haemofilter is more effective in removing plasma inflammatory factors and improving organ function in patients with septic shock complicated with AKI. Metrics

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Analysis of the timing and effect of CRRT treatment in elderly severe heart failure patients with AKI 2020, 19 (12):  803-806.  doi: 10.3969/j.issn.1671-4091.2020.12.003 Abstract ( 337 )   PDF (444KB) ( 814 )   【Abstract】Objective To explore the correlation between timing of continuous renal replacement therapy (CRRT) and efficacy in elderly patients with severe heart failure complicated with acute renal function injury (AKI). Methods Elderly severe heart failure patients with AKI treated in our hospital from August 2017 to June 2019 were enrolled. Patients were divided into 2 groups according to the timing of CRRT: experimental group (start CRRT Within 6 hours after admission) and control group (start CRRT at 6～12 hours after admission). The mechanical ventilation time, CRRT treatment time, ICU stay length, and mortality (within 14 days and 28 days) of patients were recorded. Meanwhile, patients were monitored for changes in vital signs, serum potassium and sodium level before and after CRRT. Results The treatment time and ICU stay length of patients in the experimental group were shorter than those in the control group (t=4.700 and 3.596,respectively, P=0.001). Meanwhile, the mortality within 28 days of patients in the experimental group was lower than that in the control group (χ2=4.043, P=0.044).However, no significant differences in mechanical ventilation time (t=0.071, P=0.472) and the mortality within 14 days (χ2=0.351,P=0.554) between the two groups. After CRRT, patients in the experimental group had higher heart rate, systolic blood pressure, diastolic blood pressure (t=6.276, 30.561, 10.887, P=0.001) and lower respiratory rate, serum potassium and sodium levels (t=4.224, 3.325, 10.646, P= 0.001) than those in the control group. Conclusion CRRT has good therapeutic effect on elderly patients with severe heart failure complicated with AKI. CRRT can shorten the hospitalization stay length and improve patient’s prognosis, which has good clinical application value. Metrics

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Evaluation of malnutrition and inflammation after total parathyroidectomy in maintenance hemodialysis patients 2020, 19 (12):  807-810.  doi: 10.3969/j.issn.1671-4091.2020.12.004 Abstract ( 533 )   PDF (432KB) ( 948 )   【Abstract】Objective Evaluation of malnutrition and inflammation after parathyroidectomy in 23 patients with maintenance hemodialysis(MHD). Methods 23 MHD patients with parathyroidectomy were enrolled. Then, we observed the changes of dry weight, serum calcium, phosphate, intact parathyroid hormone (iPTH), hemoglobin, hematocrit, serum albumin, total iron binding capacity, and Malnutrtion- inflammation score (MIS) was calculated at 12 months after parathyroidectomy. Results Compared with condition before parathyroidectomy, patients’dry weight, hemoglobin, hematocrit and serum albumin increased significantly at 12 months after parathyroidectomy [(52.2±5.41)kg vs.(57.5±6.6)kg, t=-2.964, P=0.005;(89.5±8.3)g/L vs.(102.5±7.1)g/L, t=- 5.716, P=0.000; (31.1±3.1)% vs. (38.7±4.1)%, t=- 6.975, P＜0.001; (31.2±4.2)g/L vs. (40.2±4.7)g/L, t=-6.865, P=0.000]. The levels of calcium, phosphate and iPTH decreased significantly [(2.85±0.17) vs. (2.10±0.42)mmol/L, t=7.871, P＜0.001; (1.99±0.26) vs. (1.13±0.17)mmol/L, t=13.432, P＜0.001;(1536.0±252.0) vs. (144.4±41.9)ng/L, t=26.136, P＜0.001]. Meanwhile, the level of C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and MIS decreased significantly at 12 months after parathyroidectomy [(10.2±1.8)ng/dl vs. (4.1±1.2)ng/dl, t=13.583, P＜0.001; (65.8±16.7) pg/ml vs. (42.6±13.9)pg/ml, t=5.125, P＜0.001; (49.6±13.7)pg/ml, vs. (34.6±8.517)pg/ml, P＜0.001; (11.80±2.43)scores vs. (6.35±2.50)scores, t=7.480, P＜0.001). Conclusion Total parathyroidectomy can effectively improve the status of malnutrition and inflammation in MHD patients. Further, these will be beneficial to improve the quality of life in MHD patients with secondary hyperparathyroidism. Metrics

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Analysis of the factors influencing the targeted hemoglobin level in peritoneal dialysis patients 2020, 19 (12):  811-815.  doi: 10.3969/j.issn.1671-4091.2020.12.005 Abstract ( 470 )   PDF (430KB) ( 1051 )   【Abstract】Objective To investigate the risk factors influencing peritoneal dialysis (PD) patients to reach the target hemoglobin (Hb) level. Methods PD patients treated in the General Hospital of Ningxia Medical University during the period from May 2003 to October 2015 and followed up for more than one year were retrospectively analyzed. Based on the Hb level at the end of follow-up period, they were divided into targeted group (Hb≥110g/L) and non-targeted group (Hb＜110g/L); patients in the non-targeted group were further divided into mild anemia subgroup (90g/L≤ Hb <110g/L) and moderate or severe anemia subgroup (Hb＜90 g/ L). The risk factors influencing peritoneal dialysis (PD) patients to reach the target Hb level were obtained through the comparison of clinical characteristics between targeted group and non-targeted group and between the two subgroups. Results ①A total of 267 PD patients were enrolled in this study. In this cohort of PD patients, 59.93% were males, the mean age was 52 years old, the median PD vintage was 37 months, the mean follow-up period was 37(21,61) months, the baseline mean Hb level was 80.16± 14.89g/L, and 50.30% of the patients reached the targeted Hb level. ②Patients in non-targeted group had younger age, longer PD vintage, lower rGFR, lower baseline Hb level, higher iPTH level, lower Kt/V and lower erythropoietin dose, as compared with those in the patients in targeted group (t/Z=2.894, -3.757, 4.400, 6.833, 2.364, 3.992 and 1.396 respectively; P=0.004,＜0.001,＜0.001,＜0.001, 0.019,＜0.001 and 0.041 respectively). ③Patients in mild ane-mia subgroup had younger age, longer PD vintage, lower baseline Hb level, rGFR, Kt/V and erythropoietin dose, and higher iPTH as compared with those in the patients in targeted group (t/Z=2.021, - 2.768, 6.193, 2.515, 3.729, -2.336 and -2.312 respectively; P=0.044, 0.006, ＜0.001, 0.013, ＜0.001, 0.019 and 0.021 respectively); similar results could also be found when the comparisons were made between moderate or severe anemia subgroup and targeted group. ④ Multivariate logistic regression analysis showed that female (OR= 0.416, P=0.021), younger age (OR=1.019, P=0.003), inadequate dialysis (OR=0.285, P＜0.001) and hypoalbuminemia(OR=0.942,P=0.027)were the independent risk factors for unable to reach the target Hb level. Conclusions Female, younger age, inadequate dialysis and hypoalbuminemia were the independent risk factors for failure to reach the target Hb level. Metrics

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The value of 1-3-β-D glucan and galactomannan detection in the early diagnosis of peritoneal dialysisrelated fungal peritonitis 2020, 19 (12):  816-819.  doi: 10.3969/j.issn.1671-4091.2020.12.006 Abstract ( 339 )   PDF (451KB) ( 891 )   【Abstract】Aim To evaluate the clinical application value of 1- 3- β-D glucan (BG) and galactomannan (GM) detection in the early diagnosis of peritoneal dialysis-related fungal peritonitis. Method The continuous ambulatory peritoneal dialysis (CAPD) patients diagnosed with peritonitis during January 2008 to January 2019 were retrospectively analyzed. In these patients, detections of serum BG and GM were performed in 63 cases. Fungi were detected in ascites in 22 cases; bacteria were found in ascites in 41 cases; we also enrolled 11 cases as the controls. In the 74 cases we analyzed in this study, 38 cases were males and 36 cases were females, with the average age of 50.65±13.31 years and the average dialysis age of 37.08±25.01 months. When the results of serum BG and/or GM tests greater than the borderline values, combined therapy containing fluconazole or voriconazole was issued immediately. The period between admission and initiation of antifungal therapy, hospitalized day, and survival rate within 90 days were recorded. The diagnostic value for fungal peritonitis using BG test, GM test and combined BG and GM tests was assessed by a 4-cell scale method. Results The diagnostic sensitivity, specificity, positive predictive value and negative predictive value for fungal peritonitis were 86.4%, 95.1%, 90.5% and 92.9% respectively by BG test, and were 36.4%, 92.7%, 72.7% and 73.1% respectively by GM test. The diagnostic sensitivity and specificity for fungal peritonitis were 95.5% and 97.6% respectively by combined BG and GM tests. The period between admission and initiation of antifungal therapy was shorter in patients undergoing combined BG and GM tests than in the control cases (15.71± 5.65h vs. 50.18±9.99h, P=0.000); the average hospitalized day was also shorter in patients undergoing combined BG and GM tests than in the control cases (15.64±3.55 days vs. 21.00±4.75 days, P=0.001); the survival rate within 90 days was higher in patients undergoing combined BG and GM tests than in the control cases (95.45% vs. 63.64%; c2=5.515, P=0.019). Conclusion Simultaneous BG and GM tests provide a powerful tool for the early diagnosis of fungal peritonitis with higher sensitivity and specificity, from which antifungal medications can be given earlier, and better prognosis and lower mortality rate can be obtained in patients with PD-related fungal peritonitis. Metrics

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Efficacy of double filtration plasmapheresis combined with methotrexate in the treatment of rheumatoid arthritis 2020, 19 (12):  820-823.  doi: 10.3969/j.issn.1671-4091.2020.12.007 Abstract ( 412 )   PDF (429KB) ( 1000 )   【Abstract】Objective To explore the efficacy of double filtration plasmapheresis (DFPP) combined with methotrexate (MTX) in the treatment of rheumatoid arthritis (RA). Methods A total of 120 RA cases treated during April 2016 to May 2017 were randomly divided into control group (n=60) and observation group (n=60). Patients in control group were treated with MTX and Leflunomide. The levels of inflammatory factors, Dickkopf-1 (DKK1) and nuclear factor κ-B receptor activation factor ligand (RANKL), and joint symptoms were monitored before and after treatment in the two groups. Results After the treatment, DKK1 (t=4.112, P=0.000) increased; RANKL (t=2.208, P=0.000), IL-6 (t=3.926, P=0.000), TNF-α (t=10.320, P=0.000), RF(t= 35.509,  P=0.000), CRP (t=7.233, P=0.000), ESR (t=42.563, P=0.000), number of painful joints (t=9.603, P=0.000) and swollen joints (t=6.056, P=0.000) decreased in the two groups. The degrees of the changes were greater in observation group than in control group (P<0.05). The total number of the adverse reactions was significantly lower in observation group than in control group (c2=3.159, P=0.047). There were no significant differences in WBC, platelet and albumin between the two groups before and after treatment (P＞0.05). Conclusion DFPP combined with MTX treatment increased serum DKK1, reduced RANKL and inflammatory factors, and improved clinical symptoms. Metrics

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Clinical effect of high flux hemodialysis versus low flux hemodialysis: a meta analysis 2020, 19 (12):  824-828.  doi: 10.3969/j.issn.1671-4091.2020.12.008 Abstract ( 677 )   PDF (675KB) ( 1441 )   【Abstract】Objective To assess the effect of high flux hemodialysis (HFHD) and low flux heamodialysis (LFHD) on end-stage renal disease (ESRD) patients by Meta analysis. Methods The randomized controlled trails (RCTs) and quasi-RCTs which compared HFHD with LFHD in ESRD patients were searched in the PubMed, Embase, Cochrane Library, CNKI and Wanfang electronic databases. RevMan5.3 was used for meta analysis. Results A total of 22 studies were included that involved 7,590 participants with ESRD. Meta analysis results showed that all-cause mortality was lower in the participants using HFHD than in those using LFHD (RR= 0.766, 95% CI: 0.659～0.890, P<0.001). Compared with the LFHD group, the HFHD group showed better outcomes in cardiovascular mortality (RR=0.792, 95% CI: 0.696～0.901, P<0.001), beta-2 microglobulin (MD=-10.235, 95% CI: -12.475～ -7.994, P<0.001), lipid profiles (total cholesterol: MD=-0.244, 95% CI: -0.446～- 0.041, P=0.020; triglycerides: MD=- 0.248, 95% CI: - 0.406～- 0.090, P=0.002) and inflammation markers (SMD=-0.225, 95% CI: -0.340～-0.110, P<0.001). Conclusion Compared the patients using LFHD, ESRD patients using HFHD had lower mortality and cardiovascular mortality with better clearance effects for lipids, middle molecular substances and inflammation factors, bringing more benefits to ESRD patients. Metrics

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Comparison of the clinical characteristics of pulmonary tuberculosis in maintenance hemodialysis patients and in general population 2020, 19 (12):  829-831.  doi: 10.3969/j.issn.1671-4091.2020.12.009 Abstract ( 372 )   PDF (372KB) ( 929 )   【Abstract】Objective To compare the clinical characteristics of pulmonary tuberculosis in maintenance hemodialysis (MHD) patients and in general population. Methods A total of 78 MHD patients complicated with pulmonary tuberculosis admitted to The Sixth People's Hospital of Zhengzhou from January 2017 to May 2019 were retrospectively reviewed as the observation group; a total of 110 pulmonary tuberculosis patients admitted to this hospital in the same period were recruited as the control group. Clinical data were compared between the two groups. Results The clinical symptoms of cough and expectoration (χ2=0.282, P= 0.595), fever (χ2=1.709, P=0.091), night sweating (χ2=1.489, P=0.222), hemoptysis (χ2=0.656, P=0.418), chest stuffy and chest pain (χ2=1.472, P=0.232) and fatigue (χ2=1.374, P=0.241) were similar between the two groups of patients. The laboratory tests of positive tuberculosis antibody rate (χ2=3.910, P=0.048), positive TSPORT rate (χ2=4.034, P=0.045), erythrocyte sedimentation rate (χ2=5.691, P=0.017), rate of acid-fast bacilli in sputum smear (χ2=3.910, P=0.048) and lesion ≥3 lobes (χ2=4.201, P=0.040) were statistically significant between the two groups of patients. The effectiveness of anti- tuberculosis drugs was similar between the two groups of patients (χ2=0.180, P=0.671); however, the adverse reactions of nausea and vomiting (χ2=6.732, P=0.009), blurred vision (χ2=5.930, P=0.015), sleep disturbance (χ2=5.495, P=0.019), finger numbness (χ2=5.585, P=0.018) and liver function impairment (χ2=4.427,P=0.035) were different between the two groups of patients. Conclusion The clinical characteristics and the effectiveness of anti-tuberculosis drugs were similar in MHD patients complicated with pulmonary tuberculosis and in pulmonary tuberculosis patients in general population. However, the rates of adverse reactions to anti-tuberculosis drugs were higher and the hospitalization period was longer in MHD patients with pulmonary tuberculosis. Metrics

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Relationship between serum macrophage migration inhibitory factor and vascular calcification in maintenance hemodialysis patients 2020, 19 (12):  832-836.  doi: 10.3969/j.issn.1671-4091.2020.12.010 Abstract ( 324 )   PDF (537KB) ( 958 )   【Abstract】Objective T o investigate the relationship between serum macrophage migration inhibitory factor (MIF) level and vascular calcification in maintenance hemodialysis (MHD) patients. Methods A total of 98 MHD patients admitted to the First Hospital Affiliated to Harbin Medical University were recruited. They were divided into calcification group (n=64) and non-calcification group (n=34). Their baseline clinical data were collected. The correlations between serum MIF level and abdominal aortic calcification score (AACS), serum interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) levels were analyzed. We also analyzed the influencing factors for vascular calcification, and the predictive values of serum MIF, 25-hydroxyvitaminD (25(OH)D), calcium, phosphorus and intact parathyroid hormone (iPTH) levels for vascular calcification in MHD patients. Results In calcification group, serum 25(OH)D level decreased significantly (t=15.408, P<0.001), while serum calcium, phosphorus, iPTH, MIF, IL- 6 and TNF-α levels increased (t=12.098, 13.384, 24.570, 7.255, 9.694 and 15.567 respectively; P＜0.001) as compared with those in non-calcification group. Serum MIF level was positively correlated with IL- 6 and TNF- α levels and AACS score (r=0.666, 0.693, 0.501; P<0.001). The areas under curves (AUCs) of serum MIF, 25(OH)D, calcium, phosphorus and iPTH for the diagnosis of vascular calcification in MHD patients were 0.841, 0.698, 0.709, 0.665 and 0.716 respectively; the AUC of integrated serum biochemical parameters was 0.919, better than the diagnostic efficiency using single serum biochemical parameter. Conclusions Serum MIF level increased significantly in MHD patients,which is related to the inflammatory state and vascular calcification, and is an independent risk factor for vascular calcification in MHD patients. Integrated estimation of serum MIF, 25(OH)D, calcium, phosphorus and iPTH levels will be more useful for the prediction of vascular calcification in MHD patients. Metrics

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Current situation and treatment of hyperkalemia in patients with chronic kidney disease and heart failure 2020, 19 (12):  837-839.  doi: 10.3969/j.issn.1671-4091.2020.12.011 Abstract ( 425 )   PDF (236KB) ( 1238 )   Metrics

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Depression and cardio- cerebrovascular events in hemodialysis patients 2020, 19 (12):  840-842.  doi: 10.3969/j.issn.1671-4091.2020.12.012 Abstract ( 365 )   PDF (368KB) ( 941 )   【Abstrac】Depression is the most common psychological abnormality in maintenance hemodialysis (MHD) patients, with an incidence rate of 20%～30% in MHD patients. It is a risk factor for cardio-cerebrovascular events and many comorbidities and seriously impair quality of life and prognosis of patients. Cardiocerebrovascular events are common complications and the most common cause of death in MHD patients. We summarized the occurrence of depression and its correlation with cardio-cerebrovascular events in MHD patients as below, hoping to provide reasonable guidance for relevant clinical strategies. Metrics

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Progress towards clinical applications of hemodiafiltration 2020, 19 (12):  843-846.  doi: 10.3969/j.issn.1671-4091.2020.12.013 Abstract ( 599 )   PDF (368KB) ( 1492 )   【Abstract】End-stage renal disease (ESRD) is a global healthcare burden. Hemodiafiltration (HDF)is capable of effective clearance of solutes of low and middle molecular weight by combining diffusion and convection. With the improvement of dialyzer membrane and the progress of ultrafiltration control system and water treatment techniques, HDF is currently an accessible, safe and well- established treatment option. Latest clinical evidence demonstrated that HDF can reduce mortality of ESRD patients by superior solutes clearance and/or cooling effect. Metrics

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Analysis of the risk factors and clinical characteristics of catheter-related infection in hemodialysis patients 2020, 19 (12):  850-854.  doi: 10.3969/j.issn.1671-4091.2020.12.015 Abstract ( 659 )   PDF (465KB) ( 1231 )   【Abstract】Objective To study the risk factors and clinical characteristics of catheter- related blood stream infection (CRBSI) in hemodialysis patients, so as to provide strategies for the prevention and treatment of CRBSI in these patients. Methods A total of 320 patients undergoing hemodialysis using central venous catheters and treated in the Blood Purification Center, Xuzhou Medical University Affiliated Hospital in the period from January 2015 to May 202 were retrospectively analyzed. According to the infection status, they were divided into infected group and non-infected group. Their clinical data and laboratory indicators were recruited to explore the relevant factors for the infections and to analyze the pathogenic bacteria and their drug sensitivities. Results There were 60 cases of CRBSI among 320 patients, the incidence rate was 18.75%. Compared with the non- infected group, femoral vein catheterization in the infected group (χ2=5.585, P=0.016), long- term catheterization (χ2=17.903, P<0.001), and catheterization days ≥28 days (χ2=18.526, P<0.001) ), dialysis time ≥1 year (χ2=35.688, P<0.001), the proportion of people suffering from hypertension (χ2=4.571, P=0.033) were significantly higher than those in the non- infected group, and sodium in the infected group (t=2.635) , P=0.009), chlorine (t=2.978,P=0.003) levels were significantly lower than those in the noninfected group, and the white blood cell count (Z=-4.812, P<0.001), neutrophil to lymphocyte ratio (Neutrophil to lymphocyte ratio, NLR) (Z=-4.953, P<0.001), C-reactive protein (CRP) (Z=-6.399, P<0.001), procalcitonin (PCT) (Z=-9.716, P<0.001), parathyroid hormone (PTH) (Z=-3.002, P=0.003) levels were significantly higher than those of the non-infected group, and the differences were statistically significant (P<0.05 ), Logistic regression showed that femoral vein catheterization [OR=4.483, 95% CI (1.814~11.079), P=0.001], longterm catheterization [OR=4.039, 95% CI(1.636~9.972),P=0.002], The number of days of catheterization ≥28 days [OR=6.636, 95% CI (2.605~16.905), P=0.000] dialysis time ≥1 year [OR=3.016, 95% CI (1.268~ 7.175), P=0.013], NLR [OR=1.065, 95% CI (1.020~1.111), P=0.004], PCT [OR=1.044, 95% CI (1.028~1.061), P= 0.000], PTH [OR=1.003, 95% CI (1.001~1.006), P=0.002] is an independent risk factor for catheter-related infection in hemodialysis patients. The main pathogenic bacteria of infection are Gram-negative bacteria, and the single bacterial species are mainly Staphylococcus aureus and Pseudomonas aeruginosa. During the course of anti-infection treatment, the medication should be adjusted in time according to the results of drug sensitivity. Conclusion Femoral vein catheterization, long-term catheterization, catheterization days≥28 days, dialysis period more than one year, NLR, PCT, and PTH were the risk factors for CRBSI in hemodialysis patients. The main pathogenic bacteria of the infection were Gram- negative bacteria, and the main bacterial species were Staphylococcus aureus and Pseudomonas aeruginosa. The anti-infection medications should be adjusted in time according to the results of drug sensitivity tests. Metrics