Chinese Journal of Blood Purification

12 October 2023, Volume 22 Issue 10 Previous Issue    Next Issue

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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) 2023, 22 (10):  721-725.  doi: 10.3969/j.issn.1671-4091.2023.10.001 Abstract ( 553 )   PDF (446KB) ( 457 )   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. Metrics

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Effect of hemodialysis combined with hemoperfusion on blood lipids and micro inflammatory status in uremic patients ZHANG Ning, HE Liang-yu, TAO Yong-yuan, HAN Jing-ming, ZHANG Yan-ping, CAO Ning 2023, 22 (10):  726-729.  doi: 10.3969/j.issn.1671-4091.2023.10.002 Abstract ( 194 )   PDF (507KB) ( 193 )   Objective  To investigate the effects of hemodialysis (HD) combined with hemoperfusion (HP) on blood lipids and micro inflammatory status in uremic patients.  Method  A total of 60 uremic patients undergoing maintenance hemodialysis at the Blood Purification Center of the Northern Theater Command General Hospital from December 2018 to December 2020 were recruited for this study. They were divided using a random number table method into a control group and an experiment group with 30 cases in each group. The patients in the control group received routine hemodialysis, while the patients in the experiment group received hemoperfusion in addition to hemodialysis in the control group. Before treatment and 12 weeks after the treatment, blood samples were collected to observe the changes of total cholesterol (TC), triacylglycerol (TG), high-density lipoprotein (HDL-C), low density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α).  Result  There were no statistical differences in the levels of TC, TG, HDL-C and LDL-C before treatment between the two groups (t=1.582, 0.488, 0.096 and 0.908 respectively; P=0.119, 0.627, 0.924 and 0.368 respectively). After 12 weeks of treatment, the levels of TC, TG and LDL-C were lower in the experiment group than in the control group (t=2.101, 4.308 and 2.521 respectively; P=0.040, <0.001 and 0.014 respectively), while serum HDL-C was higher in the experiment group than in the control group (t=3.408, P=0.001); the improvement of TC, TG, HDL-C and LDL-C levels were better in the experiment group than in the control group (t=3.709, 2.108, 2.336 and 3.401 respectively; P<0.001, 0.039, 0.023 and 0.001 respectively); CRP, IL-6 and TNF-α decreased in both groups (t=3.062, 2.694 and 4.575 respectively; P=0.003, 0.009 and <0.001 respectively), but the levels of improvement were better in the experiment group than in the control group (t=8.574, 7.698 and 9.256 respectively; P<0.001).  Conclusion  The combination of hemodialysis and hemoperfusion can effectively improve the blood lipid metabolism, the clearance of inflammatory factors and the micro inflammatory state in maintenance hemodialysis patients. This method is worthwhile to be widely used clinically. Metrics

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The effect of different plasma adsorption volume in the treatment of hyperbilirubinemia using the double plasma molecular adsorption system YE Hui, LEI Ming, XU Kai-liang, HAN Yao-guo, YUAN Wei-fang, SUN Yu-xia 2023, 22 (10):  730-733.  doi: 10.3969/j.issn.1671-4091.2023.10.003 Abstract ( 114 )   PDF (461KB) ( 33 )   Objective  To observe the clinical effect of different plasma adsorption volume in the treatment of hyperbilirubinemia using the double plasma molecular adsorption system.  Methods  A total of 40 patients with hyperbilirubinemia treated with double plasma molecular adsorption system in the Seventh People's Hospital of Shanghai University of TCM were enrolled in this study. According to the plasma adsorption volume in a single treatment they were divided into groups. Blood routine, coagulation function, C-reactive protein, bilirubin clearance rate and others were compared among groups.  Results  A total of 60 times of double plasma molecular adsorption treatment were performed in the 40 patients, in which 4 times of the treatment were significant effective, 50 times were effective, and 6 times was ineffective, with the total effective rate of 90%. After the treatment, the reduction rate of bilirubin was more significant in the patients using plasma adsorption volume of 1.0～1.4L (group C) or 1.8～2.2L (group E) in a single treatment than in the patients using plasma adsorption volume of 0.6～1.0L (group B) (t=-2.403 and -2.405, P=0.023 and 0.032), and was more significant in group C than in group B (t=-2.068, P=0.048). After the treatment, prothrombin time and activated partial thromboplastin time prolonged (t=-3.662 and -2.828, P=0.001 and 0.008), the international normalized ratio increased (t=-3.092, P=0.004), and plasma fibrinogen (t=4.786, P<0.001), platelet count     (t=4.963, P<0.001) and C-reactive protein decreased (t=3.088, P=0.004).  Conclusion  The double plasma molecular adsorption system reaches the maximum clearance of bilirubin when the plasma adsorption volume ranges between 1.0 to 1.4 L in a single treatment. The efficient of bilirubin clearance can be further increased if the treatment time in the adsorption column is prolonged. It is recommended that the suitable plasma adsorption volume in a single treatment is 3.5～5.5 times of the plasma volume in a patient. Metrics

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The association between serum 25-hydroxyvitamin D and inflammatory markers in maintenance hemodialysis patients LUO Chun-lei, BIAN Xue-yan, BAO Ling-ling, XU Qing-qing, JI Chun-yang 2023, 22 (10):  734-738,748.  doi: 10.3969/j.issn.1671-4091.2023.10.004 Abstract ( 137 )   PDF (597KB) ( 96 )   Objective  To investigate the relationship between serum 25-hydroxyvitamin D (25(OH)D) level and novel inflammatory markers in maintenance hemodialysis (MHD) patients.   Methods  A total of 153 MHD patients were enrolled in this study. Patients were divided into three groups according to the serum 25(OH)D level: 25(OH)D deficiency group (serum 25(OH)D＜20ng/ml, n=50), 25(OH)D insufficiency group (serum 25(OH)D 20～30ng/ml, n=57), and 25(OH)D normal group (serum 25(OH)D >30ng/ml, n=46). The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), monocyte to high-density lipoprotein cholesterol ratio (MHR) and C-reactive protein to albumin ratio (CAR) were calculated. Spearman correlation analysis and linear regression analysis were used to define differences of the parameters among groups.  Results The three groups showed statistical differences of age (F=4.061, P=0.019), diabetes (c2=6.982, P=0.030), diastolic blood pressure (F=3.200, P=0.044), serum albumin (F=8.744, P＜0.001), serum creatinine (F=3.844, P=0.024), total cholesterol (F=3.392, P=0.036), low-density lipoprotein cholesterol (F=3.296, P=0.040), NLR (F=5.633, P=0.004), MLR (F=7.569, P=0.001) and MHR (F=4.568, P=0.012). Serum 25(OH)D level was negatively correlated with age (r=−0.261, P=0.001), NLR (r=−0.261, P=0.001), MLR (r=−0.302, P<0.001), MHR (r=−0.256, P=0.002) and CAR (r=−0.179, P=0.029), and was positively correlated with diastolic blood pressure (r=0.227, P=0.005), albumin (r=0.207, P＜0.001), creatinine (r=0.288, P＜0.001), calcium (r=0.161, P=0.048), phosphorus (r=0.164, P=0.044), total cholesterol (r=0.241, P=0.004) and low-density lipoprotein cholesterol (r=0.241, P=0.004). Multivariate linear regression revealed that male gender (β=3.445, P=0.033), diabetes (β=-4.233, P=0.014), diastolic blood pressure (β=0.158, P=0.013), albumin (β=0.584, P=0.013), NLR (β=-1.351, P=0.001) and MHR (β=-6.894, P=0.032) were independently associated with serum 25(OH)D level.  Conclusions Serum 25(OH)D level is negatively correlated with NLR, MLR, MHR and CAR, in which NLR and MHR are independently correlated with serum 25(OH)D levels. Serum 25(OH)D level is closely related to the inflammatory status in MHD patients. Metrics

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The correlation between free mtDNA in outflow dialysate and peritoneal micro-inflammation in patients undergoing peritoneal dialysis QIU Jie-shan, JI Li-jun, WANG Yan-xiang, WANG Dan-ping, CHEN Jing-jing, FANG Shen-shen 2023, 22 (10):  739-743.  doi: 10.3969/j.issn.1671-4091.2023.10.005 Abstract ( 108 )   PDF (536KB) ( 52 )   Objective  To investigate the relationship between free mitochondrial DNA (mtDNA) level in outflow dialysate and chronic peritoneum inflammation in patients undergoing peritoneal dialysis (PD).  Methods  A total of 85 patients with PD for more than 6 months were enrolled and divided into group A (using dialysate with 1.5% glucose) and group B (using dialysate with 2.5% or 4.25% glucose more than twice a day). Blood samples were collected and serum biochemical parameters were tested. The outflow dialysate was collected to measure interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-18 (IL-18) and free mtDNA in the fluid. The differences of these parameters were compared between the two groups. The correlation between mtDNA in outflow dialysate and clinical parameters was analyzed. Multivariate regression was used to define the risk factors for mtDNA in dialysate.  Results  PD duration was longer (t=-2.206, P=0.030) and serum albumin was lower (t=2.635, P=0.010) in group B than in group A. IL-6, TNF-α, IL-1β, IL-18 and free mtDNA in the dialysate were significantly higher in group B than in group A           (t=-4.835, -6.557, -2.395, -2.318 and -3.920 respectively; P<0.001, <0.001, =0.019, =0.023 and <0.001 respectively). Free mtDNA level in the dialysate was positively correlated with the levels of IL-6, TNF-α, IL-1β and IL-18 in dialysate and PD duration (r=0.721, 0.418, 0.771, 0.634 and 0.240 respectively; P＜0.001, <0.001,    <0.001 and =0.03 respectively), and was negatively correlated with serum Alb (r=-0.319, P＜0.01). Multivariate linear regression showed that higher glucose concentration in dialysate (β=0.358, P=0.005), longer PD duration (β=0.292, P=0.000) and lower serum Alb concentration (β=-0.272, P=0.027) were the risk factors for higher free mtDNA in outflow dialysate.  Conclusion  Elevated mtDNA in outflow dialysate is associated with chronic micro-inflammatory status of the peritoneum in PD patients. Higher glucose concentration in dialysate, longer PD duration and lower serum Alb concentration are the risk factors for higher free mtDNA in outflow dialysate. Metrics

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Clinical study of urea clearance K as an important index affecting the adequacy of dialysis in hemodialysis patients ZHANG Hong-li, ZHU Qiang, LIAO Yong-ping, TIAN Chong, GAO Ning 2023, 22 (10):  744-748.  doi: 10.3969/j.issn.1671-4091.2023.10.006 Abstract ( 148 )   PDF (538KB) ( 98 )   Objective  Through online clearance monitoring (OCM), the quantitative relationship among the changes of urea clearance (K), its influencing factors and dialysis adequacy during dialysis processes are discussed.  Methods   A total of 152 maintenance hemodialysis patients were investigated. The K value during a hemodialysis session was recorded by OCM every hour. ANOVA of repeated measurements was used to explore the rule of K change during hemodialysis. Multivariate linear regression was used to explore the influencing factors for average K value. Results  The K value decreased linearly with time during a hemodialysis session (F=447.552, P＜0.001 ). The K value was positively correlated with blood flow rate (BFR) (β=0.706, 95% CI：0.403～0.526, P＜0.001) and ultrafiltrate coefficient (β=0.183, 95% CI：0.074～0.223, P＜0.001), and was negatively correlated with haematocrit (HCT) (β=-0.242, 95% CI：-0.877～-0.405, P＜0.001) and age (β=-0.106, 95% CI：-0.209～-0.011, P=0.030). We also found that there was a significant correlation between the difference of K value and three times of dry body weight and the dialysis adequacy of Kt/V (Pearson correlation analysis, r=0.808, P＜0.001).  Conclusion   The K value decreases linearly and slowly during a hemodialysis session. The ways to increase K value include the increase of BFR, the use of high-flux dialyzer, and the maintenance of HCT within 33～36%. We infer that the K value should be more than three times of the dry body weight to obtain a standard level of dialysis adequacy. Metrics

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The efficacy of double filtration plasmapheresis in patients with severe hypertriglyceridemic acute pancreatitis ZHANG Hui, GE Yun, WU Yun-long, HUANG Man 2023, 22 (10):  749-753.  doi: 10.3969/j.issn.1671-4091.2023.10.007 Abstract ( 156 )   PDF (498KB) ( 48 )   Objective  To compare the effects of double filtration plasmapheresis (DFPP), DFPP + insulin and insulin in the treatment of patients with severe hypertriglyceridemic acute pancreatitis (HTG-AP).  Methods  A total of 62 patients with HTG-AP were divided into three groups: DFPP group, DFPP + insulin group and insulin group. Their basic clinical information and laboratory test results were analyzed. One-way ANOVA or Kruskal-Wallis test was used for analyses of quantitative data, and Chi-square test or Fisher test was used for analyses of numerical data. Multivariate linear regression was used to identify the factors affecting disease severity of the patients.  Results  BMI (F=4.414, P=0.016), medical expenses (K=35.923, P<0.001), days in ICU (K=46.105, P＜0.001), and the sequential organ failure assessment (SOFA) score (K=9.089, P=0.011) and APACHE II scores (K=12.059, P=0.002) were statistically different between DFPP + insulin group and the other two groups. Serum triglyceride level had no difference before treatment between DFPP group and insulin group (K=-2.136, P=0.098), but reduced to 5.65mmol/L after the treatment in DFPP group and became statistically different with the serum triglyceride level in insulin group (K=25.508, P<0.001). Multivariate linear regression showed that the disease severity was independently associated with serum cholesterol (β=0.320, P=0.005), procalcitonin (β=0.243, P=0.042), D dimer (β=0.385, P=0.001), blood glucose (β=0.251, P=0.050), diabetes mellitus (β=-0.284, P=0.008) and age (β=0.302, P=0.007) at admission. Conclusions  DFPP treatment is effective to reduce triglyceride in patients with severe HTG-AP. Metrics

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Cross-sectional survey of the distribution of optic nerve sheath diameter by ultrasound measurement in patients on maintenance hemodialysis LUO Hui-chang, SONG Li, YIN Yan, QUAN Zi-lin, CUI Dong-mei, ZHAO Li-yan, CHEN Cheng 2023, 22 (10):  754-758.  doi: 10.3969/j.issn.1671-4091.2023.10.008 Abstract ( 120 )   PDF (885KB) ( 64 )   Objectives  This is a cross-sectional survey to observe the distribution of optic nerve sheath diameter (ONSD) by ultrasound measurement in maintenance hemodialysis (MHD) patients.  Method  The MHD patients treated in the period from September to October 2022 were recruited. Ultrasound examination of both eyes was performed by one examiner. The ONSD of an eye was measured from the longitudinal and transverse eye sections 3mm after the bulb, and the two values were then averaged.  Results  A total of 206 MHD patients were enrolled, with the mean age of 60.2±14.3 years, the mean dialysis age of 62.5 (26.0～113.0) months, and 80.6% female patients (166 cases). Diabetic nephropathy was found in 71 cases (34.5%), and coronary heart disease was found in 40 cases (19.4%). The average ONSD was higher in males than in females (t=3.180, P=0.002). The average ONSD of left eyes was greater in males than in females (t=-3.399, P=0.001). The average ONSD of both eyes increased significantly in MHD patients with diabetes, as compared with those without diabetes (t=-3.824, P＜0.001). In contrast, the average ONSD of both eyes had no differences between the MHD patients with and without coronary heart disease (t=-1.064, P=0.289).  Conclusion  The distribution of ONSD is closely related to gender and the diabetic nephropathy in MHD patients. Clinically, the left side ONSD is significantly higher than that of right side in male patients with diabetic nephropathy.  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 2023, 22 (10):  759-762.  doi: 10.3969/j.issn.1671-4091.2023.10.009 Abstract ( 205 )   PDF (458KB) ( 263 )   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. Metrics

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The correlation between changes of left ventricular structure and pulmonary hypertension in maintenance hemodialysis patients HE He, YANG Yan-lang 2023, 22 (10):  763-767.  doi: 10.3969/j.issn.1671-4091.2023.10.010 Abstract ( 83 )   PDF (452KB) ( 47 )   Objective  To explore whether left heart structure constitutes a risk factor for pulmonary hypertension (PH), and the relationship between changes of left heart structure and pulmonary artery systolic pressure (PASP) in maintenance hemodialysis (MHD) patients.  Methods   A total of 80 MHD patients aged 18 to 80 years old and treated in The Second Affiliated Hospital of Wannan Medical College between January 2016 and June 2019 were enrolled in this study. PASP >35mmHg measured by echocardiography was diagnosed as HP. Patients were then divided into two groups: PH group (n=31) and non-PH group (49). They were followed up for 1.5 years for their prognosis. Clinical and laboratory data were analyzed by univariate and multivariate regression tests to understand the influencing factors for PASP and the risk factors for PH in MHD patients.  Results   Pearson correlation test showed that PASP was positively correlated with left atrial diameter (r=0.464, P<0.001), left ventricular systolic diameter (r=0.267, P=0.019), inter-dialysis body mass growth rate (r=0.452, P<0.001), total cholesterol (r=0.469, P<0.001), low-density lipoprotein (r=0.270,          P<0.001), and triacylglycerol (r=0.402, P=0.016), and was negatively correlated with left ventricular ejection fraction (r=-0.235, P=0.040), monthly dialysis time (r=-0.469, P<0.001), hemoglobin (r=-0.300, P=0.005), serum albumin (r=-0.792, P<0.001), and elderly nutritional risk assessment index (r=-0.324, P=0.003). Multivariate logistic regression found that left atrial diameter (OR=1.757, 95% CI:1.164~2.653, P=0.007) and inter-dialysis body mass growth rate (OR=1.296, 95% CI:1.074~1.564, P=0.007) were the independent risk factors for PH.  Conclusion  Changes of left heart structure were closely related to PH in MHD patients. Changes of PASP were associated with the changes of left atrial structure, elderly nutritional risk assessment index, inter-dialysis body mass growth rate, monthly dialysis time, and blood lipids. Enlargement left atrial diameter and increase of inter-dialysis body mass growth rate were the independent risk factors for PH in MHD patients. Metrics

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Recent advances in the application of functional magnetic resonance imaging in chronic kidney disease patients complicated with brain damage XU Xia, LIU Min, LIU Chang-hua, BI Guang-yu, XU Dao-liang, WANG Rong 2023, 22 (10):  768-771,793.  doi: 10.3969/j.issn.1671-4091.2023.10.011 Abstract ( 117 )   PDF (468KB) ( 86 )   Chronic kidney disease (CKD) patients are often complicated with brain damages including organic lesions (such as cerebrovascular disease, cerebral white matter change, cerebral atrophy), metabolic abnormalities (such as changes of lipid, calcium and phosphate metabolism), and functional changes (such as early cognitive deficits). These brain damages may gradually progress into cognitive dysfunctions. Studies on brain damage in CKD patients are increased in recent years. Many functional magnetic resonance imaging (fMRI) technologies for the evaluation of brain damages have been developed, such as voxel-based morphometry MRI (VBM-MRI), diffusion tensor imaging MRI (DTI-MRI), magnetic resonance spectroscopy MRI (MRS-MRI), arterial spin labelling MRI (ASL-MRI), blood oxygen level dependent MRI (BOLD-MRI) and vessel wall MRI (vwMRI). This article reviews the research progresses in multimodal fMRI in the assessment of brain damage in CKD patients. Metrics

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Research progresses in the prediction models for risks of cardiovascular events in maintenance hemodialysis patients LING Min, WANG Xiao-yi, ZHANG Jin, WANG Ting 2023, 22 (10):  772-775.  doi: 10.3969/j.issn.1671-4091.2023.10.012 Abstract ( 140 )   PDF (415KB) ( 182 )   In this article, we review the prediction models for risks of cardiovascular events in maintenance hemodialysis patients, and summarize the evaluation content, prediction efficiency, scientific bases and limitations of the currently used risk prediction models, so as to provide references for the development of scientific and accurate prediction tools for risks of cardiovascular events in maintenance hemodialysis patients.  Metrics

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Progress in the application of phase angle for cardiac structure and function in end-stage renal disease patients HUANG Xi, WANG Jing-fu 2023, 22 (10):  776-779.  doi: 10.3969/j.issn.1671-4091.2023.10.013 Abstract ( 85 )   PDF (452KB) ( 125 )   Bioelectrical impedance analysis (BIA) is a non-invasive, convenient and quick examination method frequently used in the assessment of volume status of the patients. Phase angle (PA) is a derivative index of BIA, and the significance of PA has been studies and emphasized in recent years. This paper reviews the progresses in the application of PA for changes of cardiac structure and function in end-stage renal disease (ESRD) patients in order to provide references useful for the clinical diagnosis and treatment of ESRD patients. Metrics

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Correlation between radial artery calcification and AVF function by ultrasound examination in maintenance hemodialysis patients WANG Xiao, GUAN Wen-yu, Wang Dan, GAO Qing-zhen 2023, 22 (10):  780-784.  doi: 10.3969/j.issn.1671-4091.2023.10.014 Abstract ( 98 )   PDF (489KB) ( 60 )   Objective  To investigate calcification of the radial artery (RAC) in arteriovenous fistula (AVF) and its effects on function of the AVF by Doppler ultrasound examination in maintenance hemodialysis (MHD) patients.  Methods  The RAC degree of AVF was evaluated by Doppler ultrasound examination, and the patients were then grouped. The ultrasound parameters for the function of AVF were recorded. Clinical data and quality control of the laboratory results were recruited for statistical analyses. Results  A total of 280 patients were enrolled in this study, and 102 patients (36%) of them had various degrees of RAC in AVF. RAC was negatively correlated with radial artery diameter (r=-0.333, P<0.001) and blood flow in AVF (r=-0.257, P<0.001), but not with short-term AVF dysfunction (r=-0.031, P=0.600). Radial artery diameter (H=38.861, P<0.001) and blood flow in AVF (H=24.035, P<0.001) were significantly different among the groups with different degrees of RAC. The radial artery diameter in patients without RAC was statistically different from that in patients with mild, moderate and severe RAC (Z=37.326, 91.820 and 76.524 respectively; P=0.012, <0.001 and <0.001 respectively); the blood flow in AVF in patients without RAC was statistically different from that in patients with moderate and severe RAC (Z=60.696 and 59.501; P=0.024 and <0.001); the comparisons among other groups had no statistical differences (P>0.05). In patients with RAC, gender (χ2=5.258, P=0.022), age (t=-1.975, P=0.049), dialysis age (Z=3.180, P=0.001), anastomosis method (χ2=7.495, P=0.006), diabetes (χ2=13.252, P<0.001), and serum iPTH level (Z=-2.022, P=0.043) were statistical different from those in patients without RAC. Multivariate logistic regression showed that longer dialysis age (OR=1.010, 95% CI:1.004~1.016, P=0.001), diabetes (OR=3.101, 95% CI:1.713~5.615, P<0.001), and higher serum iPTH (OR=1.002, 95% CI:1.000~1.004, P=0.033) were the independent risk factors for RAC in MHD patients. Conclusion  RAC is unrelated to the short-term AVF dysfunction. When RAC progresses, radial artery diameter becomes smaller and blood flow in AVF decreases. Ultrasound examination has better clinical values in the evaluation of RAC and its degree. Metrics

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The comparison of upper limb function between maintenance hemodialysis patients with arteriovenous fistula or arteriovenous graft and healthy adults WANG Xin-xin, SUN Chao, LI Shuang, ZHENG Han-xu, GU Guo-yan, SONG Xiao-duo, YU Hai-yan, YIN Yong-mei, WU Hai-hong, TIAN Xin, GUAN Yue-hong, SHANG Yun-xiao, ZHAO Shuang, HUANG Fu-biao, MA Ying-chun 2023, 22 (10):  785-789.  doi: 10.3969/j.issn.1671-4091.2023.10.015 Abstract ( 99 )   PDF (459KB) ( 30 )   Objective To compare the upper limb function between right-handed maintenance hemodialysis (MHD) patients with arteriovenous fistula (AVF) or AVF graft and healthy adults.  Method  The right-handed MHD patients with AVF or AVF graft for blood access from six hemodialysis centers in Beijing were enrolled in this cross-sectional study. Demographic and biochemical data, grip strength, and the operation time of Simple Test for Evaluating Hand Function (STEF) were collected. t-test was used to compare the upper limb function between MHD patients and healthy adults.  Results  A total of 90 MHD patients were enrolled, 51 patients were males, the mean age was 59.63±10.60 years, and the median dialysis vintage was 62.50 (24.00, 113.00) months. The MHD patients were divided into 8 groups by gender and age. The grip strength of MHD patients vs. healthy adults in the age groups were 35-40 years old (female: 20.27±1.10 vs. 28kg, t=-9.968, P=0.064; male: 25.85±8.38 vs. 45kg, t=-4.998, P=0.038), 41-50 years old (female: 20.37±9.25 vs. 28kg, t=-1.844, P=0.139; male: 27.59±10.43 vs. 43kg, t=-4.433, P=0.002), 51～60 years old (female: 17.99±8.84 vs. 26kg, t=-2.717, P=0.026; male: 25.64±9.04 vs. 40kg, t=-4.205, P=0.006), and 61～70 years old (female: 14.11±9.45 vs. 23kg, t=-3.880, P=0.001; male: 27.41±9.22 vs. 36kg, t=-4.837, P<0.001), indicating grip strength decreased in MHD patients as compared with healthy adults of the same age range. The operation time of each STEF items increased in MHD patients than in Chinese healthy adults (P<0.05).  Conclusions  The grip strength and flexibility were lower in MHD patients with AVF or AVF graft than in healthy people. Metrics

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Analysis of two-year monitoring results of ultraviolet dechlorination device used in hemodialysis water treatment system WANG Yan, TIAN Ai-hui, CHEN Yu-qing 2023, 22 (10):  790-793.  doi: 10.3969/j.issn.1671-4091.2023.10.016 Abstract ( 99 )   PDF (464KB) ( 55 )   Objective To analyze the effect of ultraviolet dechlorination device used in hemodialysis water treatment system. Methods  Twenty groups of ultraviolet dechlorination devices in our hospital were tested in the years of 2022 and 2023. When the ultraviolet dechlorination device was closed, total chlorine concentrations in water supply and after carbon cans were measured. When the ultraviolet dechlorination device was opened, total chlorine concentrations in water supply, after ultraviolet dechlorination device, and after carbon cans were measured. The results were compared and analysed. Results When the ultraviolet dechlorination device was opened, total chlorine in water supply decreased significantly with the average reduction rates of 75.0% and 62.5% in 2022 and 2023 respectively (t=40.825, P<0.001; t=46.483, P<0.001). When the device was opened in 2022 and 2023, total chlorine concentrations at the outlet of activated carbon tanks A1(t=-8.365,   P<0.001; t=-17.474, P<0.001), A2 (t=-6.718, P<0.001; t=-16.905, P<0.001), B1 (t=-8.014, P<0.001; t=-12.212, P<0.001) and B2 (t=-6.162, P<0.001; t=-13.789, P<0.001) decreased significantly, as compared with those when the ultraviolet dechlorination device was closed.  Conclusion  Ultraviolet dechlorination device is effective and can be used in hemodialysis water treatment system. 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 2023, 22 (10):  794-798.  doi: 10.3969/j.issn.1671-4091.2023.10.017 Abstract ( 104 )   PDF (542KB) ( 219 )   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. Metrics