Chinese Journal of Blood Purification

12 July 2023, Volume 22 Issue 07 Previous Issue    Next Issue

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Consideration of the supervision of hemoperfusion device ZHAN Na, ZOU Yan-guo, LI Dan, QIANG Yi-ning, ZENG Zhu 2023, 22 (07):  481-483.  doi: 10.3969/j.issn.1671-4091.2023.07.001 Abstract ( 283 )   PDF (354KB) ( 489 )   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. Metrics

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Diagnostic value of shear wave elastic ultrasound imaging for tibial neuropathy in CKD5 patients undergoing maintenance hemodialysis LIU Guo-an, YU Li-ping, LAI Jiang-qiong 2023, 22 (07):  484-487.  doi: 10.3969/j.issn.1671-4091.2023.07.002 Abstract ( 113 )   PDF (509KB) ( 35 )   KD 5 patients undergoing maintenance hemodialysis(CKD5D). Methods  A retrospective study was conducted on 80 patients with maintenance hemodialysis and 32 healthy controls who underwent electrophysiological examinations in the 910th Hospital of Joint Logistics Support Force of the Chinese People’s Liberation Army from January 2021 to December 2022. According to the electrophysiological examination results of the tibial nerve, 80 patients with CKD5D were divided into the neuropathic group (n=50) and the non-neuropathic group (n=30). Clinical information and Young's modulus (E) of the tibial nerve measured by SWE were collected. The ROC curves were conducted to assess the value of Young's modulus of the tibial nerve in predicting tibial neuropathy. Results  Compared with the non-neuropathic group and the control group, the blood sodium level in the neuropathic group was lower (F=5.360, P=0.023), and the blood potassium (F=7.081, P=0.007) and triglyceride levels (F=5.491, P=0.021) were higher. Compared with the non-neuropathic group, the dialysis time in the neuropathic group was longer (F=23.516, P＜0.001). The E value in the neuropathy group was higher than that in the non-neuropathy group and the healthy control group, while the E value in the non-neuropathy group was higher than that in the healthy control group (t=9.709, P＜0.001). The optimal E-threshold for diagnosis of peroneal neuropathy was 48.36 kPa, and the area under the curve was 0.899. At this time, the sensitivity was 84.0%; the specificity was 86.0%; the positive predictive value was 81.1%; and the negative predictive value was 88.1%. Conclusion  SWE has a high value in the diagnosis of peroneal neuropathy in patients with CKD5D and is worth further research and promotion in the future. 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 2023, 22 (07):  488-492.  doi: 10.3969/j.issn.1671-4091.2023.07.003 Abstract ( 161 )   PDF (529KB) ( 217 )   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. Metrics

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Effect of the start time of blood purification therapy and the selection of filter on short-term prognosis of the patients with sepsis CHEN Xi, WAN Hong-zhe, WU Shuo, ZHANG Li 2023, 22 (07):  493-497.  doi: 10.3969/j.issn.1671-4091.2023.07.004 Abstract ( 209 )   PDF (522KB) ( 183 )   Objective  To investigate the effect of starting time of blood purification therapy and selection of filter on short-term prognosis of patients with sepsis. Methods:We retrospectively collected Patients with sepsis who received blood purification treatment in the First Affiliated Hospital of Xinjiang Medical University .Single factor analysis was collected on the index line on the start day.ROC curve was used to compare the prediction effect of each index, and the optimal threshold value was determined and grouped to analyze the 28d mortality rate with AN69/oXiris was analyzed in the higher/lower groups with different cut-off values. P＜0.05 was considered statistically significant. Results:Among the 66 patients, 31 died within 28 days of admission. Univariate analysis showed that aCCI, NEWS, SOFA, APACHE II(OR value was 1.380, 1.213, 1.141, 1.079; 95%CI was 1.035-1.838, 1.062-1.386, 1.005-1.297, 1.017-1.144; and P value was 0.028, 0.005, 0.042, 0.012) was the risk factor for death within 28 days; Scr(OR=0.994;95%CI=0.991-0.998;P=0.001) was a protective factor for death within 28 days; The AUC vaule of aCCI, NEWS, SOFA, APACHE II and Scr were 0.674, 0.698, 0.657, 0.679 and 0.736. 95%CI were 0.543-0.806、0.572-0.824、0.521-0.793、0.548-0.811、0.614-0.858, and the optimal cut-off values were 3.5, 14.5, 11.5, 19.5 and 418.98. In the low-aCCI group, 28d mortality was lower in patients treated with oXiris(χ2=4.572，P=0.032). Conclusion: 1. Patients with sepsis at the start of blood purification therapy had higher risk of death within 28 days with aCCI score above 3.5, NEWS score above 14.5, SOFA score above 11.5, APACHE II score above 19.5, and Scr score below 418.98μmol/L. 2. In sepsis patients with low aCCI, oXiris treatment compared with AN69 membrane material can reduce the 28d mortality of sepsis patients. 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 2023, 22 (07):  498-502.  doi: 10.3969/j.issn.1671-4091.2023.07.005 Abstract ( 162 )   PDF (425KB) ( 289 )   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. Metrics

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Exploring HD+HP in patients with secondary hyperparathyroidism based on inflammatory-nutritional, cardiovascular adverse events XU Hai-ping, GUAN Jun-rong, WANG Ping, WANG Hong-run, KANG Su-zhi 2023, 22 (07):  503-507.  doi: 10.3969/j.issn.1671-4091.2023.07.006 Abstract ( 144 )   PDF (461KB) ( 179 )   Objective  To investigate the effect of HA resin haemoperfusion (HP) + haemodialysis (HD) on inflammatory-nutritional status and adverse cardiovascular events in patients with secondary hyperparathyroidism (SHPT).  Methods   800 patients with SHPT from June 2021 to June 2022 were selected for the prospective study and grouped by random number table method, 400 patients in each group. The control group was treated with conventional haemodialysis (HD) 3 times a week and the observation group was treated with conventional HD+HP 3 times a week. The clinical efficacy and small molecular indicators [blood phosphorus, serum calcium, alkaline phosphatase (ALP)], medium and large molecular indicators [intact parathyroid hormone (iPTH), β2-microglobulin (β2- MG), cystatin C (CysC)], nutritional status [serum albumin (ALB), prealbumin (PA), transferrin (TRF)], inflammation level [interleukin-1 (IL-1), C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6)] and cardiovascular events.  Results  The total effective rate of the observation group was 93.25% higher than that of the control group 77.25% (χ2=40.718, P=0.000); there was no significant difference between the two groups in terms of ALP, blood phosphorus and blood calcium levels after treatment (t=1.017, 1.305, 0.603, P=0.309, 0.192, 0.547);After treatment, the levels of iPTH, CysC, and β2-MG were lower in the observation group than in the control group, and the levels of ALB, PA, and TRF were higher than in the control group (t=42.160, 21.114, 20.480, 28.321, 33.596, 37.387, all P＜0.001); compared with the control group after treatment, the levels of IL-6, CRP, TNF-α, and IL-1 levels were lower in the observation group compared to the control group after treatment (t=17.164, 16.131, 8.024, 21.639, all P＜0.001); The incidence of cardiovascular events was lower in the observation group at 4.75% than in the control group at 10.50% (χ2=9.388, P=0.002). Conclusion HP combined with HD treatment can improve the scavenging effect of small molecules, macromolecules and other toxic substances, maintain the nutritional and metabolic balance of the body, improve the state of excessive inflammatory response, and reduce the occurrence of cardiovascular events, thereby improving the therapeutic effect, which is worthy of clinical promotion. Metrics

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Efficacy of Paricalcitol in the treatment of hemodialysis patients with secondary hyperparathyroidism and the characteristic changes of iPTH and abdominal aortic calcfication score after the treatment for 12 weeks LIU Yin, ZHAO Bin, LIU Li-fang, HU Pu-ping, YANG Tao 2023, 22 (07):  508-511,528.  doi: 10.3969/j.issn.1671-4091.2023.07.007 Abstract ( 225 )   PDF (486KB) ( 157 )   Objectives  To investigate the clinical efficacy of Paricalcitol in the treatment of maintenance hemodialysis (MHD) patients with secondary hyperparathyroidism (SHPT), and to analyze the correlation between iPTH level and abdominal aortic calcification (AAC) score.  Methods   A total of 40 MHD patients (24 males and 16 females) with SHPT and received regular hemodialysis at the Hemodialysis Clinic of Beijing Haidian Hospital from April 2019 to June 2020 were included in the study. Intravenous Paricalcitol was administered for 12 weeks in addition to the MHD. AAC score and serum calcium, phosphorus and intact parathyroid hormone (iPTH) were compared before and after Paricalcitol treatment for 12 weeks to assess its clinical efficacy. The relationship between iPTH level and AAC was assessed after the treatment for 12 months.  Results After Paricalcitol treatment for 12 weeks, serum phosphorus and iPTH levels were significantly lower than those before treatment (phosphorus: t=2.192, P=0.047; iPTH: t=3.026, P=0.014); serum calcium was higher than that before treatment (t=4.188, P=0.001), but remained within the normal range (2.1～2.5 mmol/L); the overall effective rate of lowering serum iPTH was 95%. Patients with severe AAC had higher serum iPTH, while those with moderate to mild AAC had relatively lower serum iPTH; the differences in serum iPTH among the severe, moderate and mild AAC groups were statistically significant (F=150.400, P＜0.001). After the treatment for 12 months, AAC scores were lower than the baseline levels, but the score differences had no statistical significance (t=0.504, P=0.617).  Conclusions  Paricalcitol significantly reduced serum iPTH and phosphate levels in MHD patients, and calcium level remained stable within the normal range. Severe AAC may relate to the higher serum iPTH in MHD patients. 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 2023, 22 (07):  512-515.  doi: 10.3969/j.issn.1671-4091.2023.07.008 Abstract ( 138 )   PDF (389KB) ( 290 )   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. Metrics

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Timeliness and dose-effectiveness of exosomes in the treatment of peritoneal dialysis-associated peritoneal fibrosis in mice  WANG Xiao-yue, YU Fang, CAI Qing-li, LUO Jia, CHEN Juan, BO Li-hua, CHEN Jia, HE Ya-ni, CHEN Ke-hong 2023, 22 (07):  516-521.  doi: 10.3969/j.issn.1671-4091.2023.07.009 Abstract ( 154 )   PDF (1371KB) ( 42 )   Objective  To investigate the therapeutic effect of different doses of exosomes derived from bone marrow mesenchymal stem cells (BMSCs) on peritoneal fibrosis, and to find out the optimal therapeutic dose and timing of BMSCs exosome therapy.  Methods  A mouse model of peritoneal fibrosis induced by high concentration of glucose in peritoneal dialysate was established and divided into the normal control group, exosome group, peritoneal fibrosis group and peritoneal fibrosis + exosome group. The exosome group was treated by giving exosomes at 6 time points and 4 different exosome doses to determine the optimal therapeutic dose and timing.  Results  Pathological changes of peritoneal fibrosis in the mouse model induced by high concentration of glucose in peritoneal dialysate were observed at the 28th day and became worse with prolongation of the treatment, suggesting that the BMSCs exosome therapy may be preferable from the 28th day. Administration of the exomes at the 28th day, peritoneal thickness and collagen I expression had no differences between the exomes 50 μg/kg and 100 μg/kg groups (t=0.540, P=0.705; t=1.031, P=0.360) but peritoneal fibrosis alleviated significantly in exomes 200 μg/kg and 400 μg/kg groups (t=5.071, P=0.005; t=5.226, P=0.005), as compared with those in the peritoneal fibrosis group. However, there was no significant difference in improvement of peritoneal fibrosis between exomes 200 μg/kg group and 400 μg/kg group (t=1.540, P=0.280). These results suggested that exomes 200 μg/kg may be the optimal dosage of peritoneal fibrosis therapy. Further exploration of the timing of exosome therapy showed that peritoneal thickening could be significantly reduced by the exosome therapy at the 28th day or at the 35th day (t=4.608, P=0.007; t=4.608,  P=0.007), and exosome therapy at the 28th day plus at the 35th day was more effective than the single treatment at the 28th day or at the 35th day (t=5.730, P=0.003; t=5.730, P=0.003). These results suggested that the optimal exosome therapy was given at the 28th day plus at the 35th day for mouse peritoneal fibrosis model.  Conclusion  This study showed that the optimal treatment time of BMSCs exosomes for peritoneal fibrosis mice model was preferable at the 28th day plus at the 35th day, and the optimal dose was 200 μg/kg. Metrics

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Update of intracranial hypertension associated with central vein obstruction in hemodialysis patients TIAN Xin, ZHAN Shen, ZHANG Li-hong, WANG Yu-zhu 2023, 22 (07):  522-524.  doi: 10.3969/j.issn.1671-4091.2023.07.010 Abstract ( 144 )   PDF (347KB) ( 105 )   Central venous obstruction (CVO) is a common complication in hemodialysis patients. CVO can lead to the increase of intracranial venous pressure and obstruction of cerebrospinal fluid reflux and absorption that result in intracranial hypertension. Understanding of the pathogenesis and clinical manifestations of CVO-related intracranial hypertension is useful for the early diagnosis and management of the narrowed central veins, thus achieving better neurological and visual prognoses of the patients. Metrics

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Research progresses in the application of chronic kidney disease management system to manage chronic kidney disease patients ZHUANG Min-ting, YANG Xia-li 2023, 22 (07):  525-528.  doi: 10.3969/j.issn.1671-4091.2023.07.011 Abstract ( 170 )   PDF (409KB) ( 153 )   This paper introduces the current management situation of chronic kidney disease (CKD) patients and the application of the chronic kidney disease management system to take care of CKD patients, analyzes the current problems, and looks forward to its future development tendency, so as to provide references for doctors and nurses using the chronic kidney disease management system to manage CKD patients. Metrics

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Research progresses in the cognitive impairment in maintenance hemodialysis patients HE Ya-peng, ZHAO Qian, LI Xin, ZHANG Teng, WU Hong-xia 2023, 22 (07):  529-532.  doi: 10.3969/j.issn.1671-4091.2023.07.012 Abstract ( 221 )   PDF (403KB) ( 183 )   In view of the prevalence and severity of cognitive impairment in maintenance hemodialysis patients, this article aims to review the research progress in the cognitive impairment in maintenance hemodialysis patients from the aspects of etiology, assessment tools, influencing factors, intervention measures, and others, in order to provide reference for clinical work and research. Metrics

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Research progress of EZH2 in peritoneal dialysis-associated peritoneal fibrosis SUN Shuai, ZHANG Kun-ying, ZHAO Jun 2023, 22 (07):  533-536.  doi: 10.3969/j.issn.1671-4091.2023.07.013 Abstract ( 118 )   PDF (452KB) ( 187 )   Enhancer of zeste homolog 2 (EZH2) is a histone lysine methyltransferase, which induces the silence of target gene by regulating trimethylation of Lys27 in histone 3 (H3K27me3) and plays an important role in peritoneal dialysis-associated peritoneal fibrosis. Studies have shown that EZH2 is highly expressed in the process of peritoneal fibrosis and induces the development of peritoneal fibrosis by promoting epithelial-to-mesenchymal transition (EMT), peritoneal inflammation and angiogenesis. Inhibition of EZH2 can reduce or even partially reverse peritoneal fibrosis. Further study of EZH2 can be helpful to clarify the pathogenesis of peritoneal fibrosis and to find out target treatment for peritoneal fibrosis. Metrics

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A cross-sectional survey of the implementation status of renal rehabilitation in hemodialysis centers in China ZHANG Li, DAI Shan-shan, LIN Ze-hua, YU Hai-yan, SUN Chao, LI Shuang, ZHENG Han-xu, MA Ying-chun 2023, 22 (07):  537-541.  doi: 10.3969/j.issn.1671-4091.2023.07.014 Abstract ( 120 )   PDF (440KB) ( 49 )   Objective  We conducted a questionnaire survey on the implementation status of renal disease rehabilitation (RR) in hemodialysis centers (HDCs) in the hospitals with different technical levels and located in different economical regions in China.  Methods  The unit self-assessment tool (USAT) was used to evaluate the implementation of RR in HDCs in hospitals. USAT has a total score of 100 points, with each "E" subscale of 20 points.  Results  A total of 225 questionnaires were distributed and 189 valid questionnaires were returned in this study, with a return rate of 84.0%. The surveyed HDCs were mainly public and tertiary general hospitals in China. Most of the hospitals were equipped with rehabilitation department (77.0%), but only a few of HDCs were equipped with rehabilitation treatment room (2.1%) and with rehabilitation-related equipment (12.2%). Among the HDCs surveyed, only 8.5% of the HDCs had a total USAT score of ≥60, while more than 20% had a total score of ≤20. HDCs with rehabilitation equipment had higher USAT scores than those without rehabilitation equipment (Z=-3.249, P=0.001). USAT scores did not achieve statistical significances in HDCs located in different economical regions (χ²=1.129, P=0.770) and between general and specialty hospitals (Z=-0.118, P=0.906), public and private hospitals (Z=-0.063, P=0.950), and HDCs with and without a rehabilitation department (Z=-0.904, P=0.366).  Conclusion  The total USAT score is generally low in HDCs in China, and RR remains at a primary stage in China. Metrics

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Effect of controlling nutritional status on late failure of hemodialysis arteriovenous fistula in patients with end-stage renal disease LIU Hai-yan, ZHAO Na-xin, XIANG Pan, REN Wen-wen, ZENG Zhi-li, DONG Qing-hua 2023, 22 (07):  542-545,556.  doi: 10.3969/j.issn.1671-4091.2023.07.015 Abstract ( 163 )   PDF (444KB) ( 39 )   Objective  To investigate the relationship between controlling nutritional status (CONUT) and late arteriovenous fistula (AVF) failure in patients with end-stage renal disease (ESRD).  Methods  The ESRD patients admitted to the Department of Nephrology, Beijing Ditan Hospital Affiliated to Capital Medical University from March 2021 to May 2022 were included in this study. They were divided into normal group, mild group, and moderate and severe group according to the preoperative CONUT score. Baseline data and laboratory indexes before AVF surgery were recorded. The late AVF failure was recorded during the follow-up period of 6 months after the surgery. The effect of CONUT on late AVF failure was analyzed.  Results  A total of 100 patients were enrolled in this study, including 28 cases in the normal group, 50 cases in the mild group and 22 cases in the moderate and severe group. Levels of lymphocyte count (Lym), albumin (ALB), total cholesterol (TC), uric acid (UA) and C-reactive protein (CRP) were different among the three groups (F=7331.645, 82.823, 27.704, 14.530 and 6.128 respectively; P<0.001). The rate of late AVF failure was 31.00 % in the follow-up period of 6 months. The rate of late AVF failure was statistically different among the three groups of patients (χ2=13.363, P=0.001), with higher in moderate and severe group than in normal group (χ2=13.732, P<0.001) and higher in mild group than in normal group (χ2=7.026, P=0.008), but without statistical significance between mild group and moderate to severe group (χ2=2.681, P=0.102). Logistic regression showed that malnutrition (mild: OR=10.321, 95% CI 1.297～81.978, P=0.027; moderate and severe: OR=18.559, 95% CI 1.484～232.091,P=0.023) was a risk factor for late AVF failure in ESRD patients.  Conclusion The late AVF failure in ESRD patients on hemodialysis is related to moderate and severe malnutrition. CONUT scoring is helpful for the screening of the ESRD patients with risk of late AVF failure. Metrics

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Long-term result of stent implantation in arteriovenous graft outflow stenosis ZHAO Xia, ZUO Hong-wei, TENG Bi-yun, WANG Zhe, LI Xiang-jie, FU Qi-ning, ZHAO Yu 2023, 22 (07):  546-550.  doi: 10.3969/j.issn.1671-4091.2023.07.016 Abstract ( 114 )   PDF (417KB) ( 154 )   Objective To investigate the long-term prognosis of stent implantation for arteriovenous graft (AVG) outflow stenosis.  Methods  Patients with AVG outflow stenosis and received stent implantation from January 2016 to December 2021 in Jinshan Hemodialysis Access Center, the First Affiliated Hospital of Chongqing Medical University were enrolled in this study. General information were collected, postoperative patency was followed up, and the influence factors for postoperative patency were analyzed.  Results  A total of 71 patients were included with (732.15±428.29) days after AVG creation and (4.17±2.52) times of percutaneous transluminal angioplasty (PTA) before stent implantation. Stent implantation was performed for recurrent stenosis within 3 months after PTA in 59.15% of the patients. The primary patency rates were 84.51%, 63.38%, 39.62% and 24.14%, and the secondary patency rates were 100%, 98.59%, 98.04% and 89.66% after stent implantation for 6 months, 12 months, 24 months and 36 months, respectively. The mean re-intervention times after the first stenting were 0.46, 0.83 and 1.31 times in the first year, second year and third year, respectively. The median re-intervention time was 9.80 months after stenting (0.33～41.53 months, calculated only the cases with re-intervention events during follow-up). Thirty cases developed in-stent edge stenosis, 18 cases developed de novo stenosis at two ends of stent, and 2 cases had AVG thrombosis without stenosis and probably caused by other factors.  Conclusion  Stent implantation is an effective management for AVG outflow stenosis. There are many factors affecting AVG patency, and new stenosis lesions may be induced by stenting itself. Therefore, stenting operation needs to be judged individually. 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 2023, 22 (07):  551-556.  doi: 10.3969/j.issn.1671-4091.2023.07.017 Abstract ( 189 )   PDF (439KB) ( 232 )   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. Metrics

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The use of flushing solution for the non-tunneled catheter after continuous renal replacement therapy (CRRT): a cross-sectional survey LU Hang-chao, QIN Xiang-jun, CUI Dong-mei, ZOU Hui-jian, HE Zhuo-ying, CHEN Quan-yu, LI Kang-ye, QUAN Zi-lin, YIN Yan, CHEN Cheng, SONG Li 2023, 22 (07):  557-560.  doi: 10.3969/j.issn.1671-4091.2023.07.018 Abstract ( 146 )   PDF (407KB) ( 80 )   Objective  This was a cross-sectional study to investigate the use of flushing solutions before locking solution for non-tunneled catheters after continuous renal replacement therapy (CRRT), in order to provide a reference for maintenance and care of the catheters.  Methods A questionnaire survey was conducted using the Wenjuanxing online survey to investigate the 78 hospitals in Guangdong province in order to understand the type and dose of flushing solution and the type of syringe used for non-tunneled catheters after CRRT.  Results A total of 91 questionnaires were collected, and 78 were effective after excluding 13 questionnaires from the same hospitals, with an effective rate of 85.7%. The average age of the nurses conducting CRRT was 33.78±5.97 years, with 19.2% of males and 56.4% having the senior professional titles. Normal saline was the most commonly used solution (97.5%) for flushing after CRRT, while sterilized water for injection was used in two hospitals. The volume of normal saline used for flushing was variable in the hospitals: 5ml in 12 hospitals (14.5%), 10ml in 47 hospitals (56.6%), 15ml in 5 hospitals (6.0%), and 20ml in 19 hospitals (22.9%). The volume of syringe used for flushing was 5ml in one hospital (1.2%), 10ml in 29 hospitals (35.4%), 20ml in 45 hospitals (54.9%), and 30ml in 7 hospitals (8.5%).  Conclusion Normal saline is the main flushing solution for non-tunneled catheters after CRRT, but the volume of normal saline and the type of syringe for the injection are variable in these hospitals. Metrics