Chinese Journal of Blood Purification

12 June 2024, Volume 23 Issue 06 Previous Issue    Next Issue

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Interpretation of Sepsis Associated Acute Kidney Injury: Consensus Report of 28th ADQI TANG You-li, ZHANG Ling 2024, 23 (06):  401-405.  doi: 10.3969/j.issn.1671-4091.2024.06.001 Abstract ( 218 )   PDF (485KB) ( 57 )   《Sepsis-associated acute kidney injury(SA-AKI):28th Acute Disease Quality Initiative workgroup: The ADQI Consensus Report》(hereinafter referred to as Consensus) was published in February 2023. The consensus covers six parts of clinical definition and epidemiology, pathophysiology, the impact of fluid management strategies, the role of biomarkers in risk stratification and diagnostic treatment guidance, extracorporeal blood purification and innovative therapies, and SA-AKI in pediatric patients, totaling 34 articles of consensus. This consensus is the first global ADQI expert consensus on SA-AKI,and provides a more accurate direction and framework for the diagnosis and treatment of SA-AKI. This article interprets the main points of adults in the first 5 parts of the consensus, and shares the application experience of West China Hospital of Sichuan University in SA-AKI blood purification, which can provide reference for medical workers in the diagnosis and treatment of SA-AKI. Metrics

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The Effect of peritoneal dialysis fluid with neutral pH and low GDPs on CA125 level in peritoneal dialysispatients JIA Yu-xia, SUN Yong-he, WEI Xiao-fei, NIU Yong-qin, ZHANG Kun 2024, 23 (06):  406-409.  doi: 10.3969/j.issn.1671-4091.2024.06.002 Abstract ( 161 )   PDF (426KB) ( 19 )   Objective  To evaluate the effect of neutral pH and low glucose degradation products (glucose degradation products, GDPs) on CA125 in peritoneal dialysis (peritoneal dialysis,PD) patients. Methods Continuous ambulatory peritoneal dialysis  patients were enrolled. These patients were initially dialyzed with standard calcium peritoneal dialysis solution, followed by 6 months of dialysis with neutral pH and low GDPs peritoneal dialysis solution. Compare the concentrations of CA125 in the exudate and serum, ultrafiltration volume, and whether there is dialysis pain of these patients when using standard PD fluid (group A) and after using neutral pH and low GDPs PD fluid (group B).  Results  A total of 44 PD patients were included, including 24 males and 20 females. Compared with group A, group B had higher effluent CA125 (t=2.266, P=0.029), serum CA125 (t=2.575, P=0.014), peritoneal dialysis ultrafiltration (Z=5.052, P <0.001), and lower hemoglobin (t=2.208, P=0.033), calcium (t=2.843, P=0.007), and phosphorus (t=2.094, P=0.042).  Conclusion  The peritoneal dialysis fluid with neutral pH, low GDPs can increase the CA125 level in peritoneal dialysis patients, which indirectly indicates the reduced damage of peritoneal mesothelial cells. Metrics

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The Influence of Different Frequency of Hemoperfusion on Protein-energy Wasting of Maintenance Hemodialysis Patients  The Influence of Different Frequency of Hemoperfusion on Protein-energy Wasting of Maintenance Hemodialysis Patients 2024, 23 (06):  410-416.  doi: 10.3969/j.issn.1671-4091.2024.06.003 Abstract ( 194 )   PDF (586KB) ( 26 )   The Influence of Different Frequency of Hemoperfusion on Protein-energy Wasting of Maintenance Hemodialysis Patients   YIN Yi-fang1,MOU Jiao1,YANG Ying1,TANG Jian-ying1    1Department of Nephrology and Urology Center,University Town Hospital Affiliated to Chongqing Medical University, Chongqing 400715,China Corresponding author: TANG Jian-ying, Email:800273@hospital.cqmu.edu.cn 【Abstract】Objective  To investigate the impact of different hemoperfusion (HP) frequencies on protein-energy wasting (PEW) in patients undergoing maintenance hemodialysis (MHD).  Methods Eighty patients were included and divided based on HP treatment frequency into four groups: no HP (group A), monthly HP (group B), bi-monthly HP (group C) and weekly HP (group D) , with 20 patients in each group. All patients were followed up for six months, then the prevalence of PEW, malnutrition-inflammation score (MIS), and related serum biochemical indicators were analyzed before and after treatment.   Results   Before treatment, there were no significant differences (P＞0.05) in MIS scores (F=2.194, P=0.096),  the prevalence of PEW (χ2=0.579, P=0.901), level of pre-albumin (PA) (F=0.258, P=0.855), albumin (Alb) (F=0.187, P=0.905), parathyroid hormone (PTH) (F=0.780, P=0.509), hemoglobin(Hb)(F=1.823，P=0.150), β2-microglobulin (β2-MG) (F=1.833, P=0.148), and C-Reactive protein (CRP) (F=0.432, P=0.731) among the four groups. After treatment, there were 15 patients who withdrew from the trial in Group D. The group C had lower levels of MIS score (C-A: t=4.391, P＜0.001;  C-B: t=-2.871,  P=0.006),  PTH (C-A: t=4.098, P=0.001; C-B: t=-2.551,     P=0.047),β2-MG (C-A: t=5.688, P＜0.001; C-B: t=-3.207, P=0.002), CRP (C-A:t=4.293, P＜0.001; C-B:     t=-2.843, P=0.006) compared with group A and B); and higher level of PA(C-A: t=-3.177, P=0.002; C-B:      t=2.196, P=0.032). Alb (C-A: t=-5.540, P＜0.001; C-B: t=2.196, P=0.010) than Groups A and B. Group C had higher level of Hb (t=-3.733, P＜0.001) than group A, and  no significant difference with group B (t=1.451,  P=0.152). The prevalence of PEW in group C (χ2=6.465, P=0.011) was significantly lower than group A, but there was no significant difference between group A and group B (χ2=2.506, P=0.113).  Conclusion   Bimonthly HP treatment can obviously improve the nutritional status of patients with MHD and reduce the prevalence of PEW. Metrics

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Impact of dialysis adequacy on blood pressure variability and vascular calcification in patients undergoing maintenance hemodialysis YOU Nu-jia, XIONG Yu-qin, LIU Yao, MA Qiu, LIAO Ruo-xi, WU Ling, LING Zi-ying, YU Yang 2024, 23 (06):  416-420.  doi: 10.3969/j.issn.1671-4091.2024.06.004 Abstract ( 130 )   PDF (513KB) ( 23 )   Objective To explore the relationships between dialysis adequacy and cardiovascular structure and function in patients with maintenance hemodialysis (MHD).  Methods  Clinical data with respect to blood biochemical examinations, vascular calcification and 12 consecutive dialysis treatments were retrospectively collected for patients receiving hemodialysis more than three months. Adequate dialysis was defined as the urea reduction rate (URR)≥65% and single-pool urea clearance (spKt/V)1.2. Blood pressure variability (BPV) metrics including the difference in maximum and minimum BPs (△BP) and average real variation (ARV) were calculated, and multivariate regression analyses were conducted.  Results  A total of 90 Chinese MHD outpatients were included, with the mean age of 59.8±17.4 years and the median dialysis vintage of 28.3(12.3～46.8) months. Patients with inadequate dialysis (45 patients) had higher intradialysis systolic ΔBP (27.9±6.6 vs. 25.1±6.5 mmHg, t=-2.035, P=0.045) and systolic BP-ARV [SBP-ARV (13.4 ± 3.4) vs. (11.9 ± 3.2)mmHg, t=-2.228, P=0.028] and greater coronary artery calcification score [CACs, 461.0(96.0～1741.0) vs. 99.5(1.0～1329.0), t=-2.045, P=0.041] than those with adequate dialysis (45 patients). Age (β=0.305, P=0.003), coronary heart disease (β= -0.255, P=0.014) and spKt/V (β= -0.290, P=0.006) were significantly correlated with intradialysis SBP-ARV; diabetes mellitus (OR= 6.048, 95% CI:1.168～31.330, P=0.032), low serum albumin levels (OR=0.817, 95% CI:0.681～0.982, P=0.031) and spKt/V (OR=0.886, 95% CI:0.786～0.998, P=0.047) were found to be independent risk factors for CACs≥400.Conclusions Inadequate dialysis was strongly associated with elevated intradialysis BPV and increased risk of severe coronary artery calcification in MHD patients. Metrics

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Predictive value of blood urea nitrogen/creatinine ratio for frailty in maintenance hemodialysis patients MA Cai-hong, GAO Huan-ling, SHANG Chun-e, LI Hong-mei, YANG Yu-lin, CHEN Ling 2024, 23 (06):  421-425.  doi: 10.3969/j.issn.1671-4091.2024.06.005 Abstract ( 153 )   PDF (536KB) ( 14 )   Objective To explore the predictive value of blood urea nitrogen/creatinine ratio (BUN/Cr) for frailty in maintenance hemodialysis (MHD) patients.  Methods  This study was a single centered and cross-sectional study that included 247 patients undergoing MHD treatment in a tertiary hospital in Shanxi province from May 2022 to November 2023. They were divided based on the score of FRAIL scoring system (FRAIL: fatigue, resistance, ambulation, illness, and loss of weight) into two groups, frailty group (FRAIL score≥3, n=101) and non-frailty group (FRAIL score ≤2, n=146). Their relevant information was collected. Univariate and binary logistic regression were used to find out the influencing factors for frailty in the MHD patients. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of BUN/Cr for frailty in MHD patients.  Results  Age, dialysis age, C-reactive protein, blood urea nitrogen and BUN/Cr were higher in frail group than in non-frail group (t/χ2/Z=9.042, -4.612, -2.649, 3.096 and 14.724 respectively; P＜0.001, ＜0.001, 0.008, 0.002 and ＜0.001 respectively). Body mass index, hemoglobin, serum albumin, creatinine, and urea clearance index were lower in frail group than in non-frail group (t/χ2/Z= -2.294,  -2.769,   -8.936, -13.126 and -5.097 respectively; P=0.022, 0.006, ＜0.001, ＜0.001 and ＜0.001 respectively). Binary logistic regression demonstrated that age (OR=1.060, 95% CI: 1.015～1.107, P=0.009), dialysis age (OR=1.283, 95% CI:1.022～1.612, P=0.032), serum albumin (OR=0.841, 95% CI: 0.748～0.945, P=0.004), C-reactive protein (OR=1.641, 95% CI: 1.039～2.591, P=0.033), urea clearance index (OR=0.013, 95% CI: 0.001～0.251, P=0.004), and BUN/Cr (OR=3.478, 95% CI: 1.455～8.310, P=0.005) were the independent risk factors for frailty in the MHD patients. ROC curve suggested that the optimal value of BUN/Cr for the diagnosis of frailty in MHD patients was 9.42, with the area under the curve of 0.929 (95% CI: 0.896～0.962, P＜0.001).  Conclusion  BUN/Cr has a better prediction value for the presence of frailty in MHD patients. It also provides a new perspective for medical professionals to identify frailty. Metrics

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The progression of abdominal aortic calcification and its risk factors in maintenance hemodialysis patients CHEN Tian-yi, ZHANG Dong-liang 2024, 23 (06):  426-430.  doi: 10.3969/j.issn.1671-4091.2024.06.006 Abstract ( 137 )   PDF (796KB) ( 13 )   Objective To investigate the progression of abdominal aortic calcification (AAC) and its risk factors in maintenance hemodialysis (MHD) patients.  Methods  Forty-seven MHD patients treated in Beijing Jishuitan Hospital from December 2019 to April 2022 were enrolled in this study. Two lumbar quantitative CT images performed during the follow-up period were retrospectively reviewed; 8 slices were sequentially extracted, and AAC score was obtained by the Image J software. According to the average annual AAC-growth, the patients were divided into slow progression group (n=23) and rapid progression group (n=24), and then analyzed using univariate and multivariate regression methods.  Results  The median follow-up time was 2.15(2.14, 2.20) years, and 95.74% of the patients had the progression of AAC. The median baseline AAC score was 59.55 (20.03, 122.46), and the median follow- up AAC score was 78.25(31.93,141.92). Compared with the slow progression group, the rate of smoking (χ2=6.715, P=0.010), baseline AAC score (Z=-3.629, P＜0.001), time averaged serum phosphorus (t=-3.538, P=0.001), time averaged calcium and phosphorus product (t=-3.173, P=0.003), and time averaged intact parathyroid hormone (t=-3.060, P=0.004) were significantly higher, and the durations of oral sevelamer carbonate (Z=-2.122, P=0.034) and cinacalcet hydrochloride (Z=    -2.880, P=0.004) were significantly longer in the rapid progression group. Multivariate logistic regression showed that baseline AAC score (OR=1.020, 95% CI: 1.006～1.035, P=0.005) and time averaged serum phosphorus (OR=115.585, 95% CI: 3.412～3915.747, P=0.008) were the risk factors for rapid progression of AAC in MHD patients.  Conclusion  AAC progresses rapidly in MHD patients. Higher baseline AAC score and hyperphosphatemia were the risk factors for rapid AAC progression in MHD patients. Metrics

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Clinical significance of respiratory variation rate of inferior vena cava in volume management for early continuous renal replacement therapy in patients with sepsis SUN Li, YANG Yu-Fang, ZHAO Qun 2024, 23 (06):  431-435.  doi: 10.3969/j.issn.1671-4091.2024.06.007 Abstract ( 92 )   PDF (477KB) ( 7 )   Objective  To explore the application of respiratory variability of inferior vena cava diameter for early volume management of continuous renal replacement therapy (CRRT) in sepsis shock patients.   Methods The sepsis patients hospitalized in the Intensive Care Unit (ICU) of the Second Hospital of Jiaxing City and planned to be treated with CRRT were selected as the research objects. They were randomly divided into control group and ultrasound group. In the ultrasound group, the respiratory variation rate of inferior vena cava diameter was monitored by ultrasound to guide fluid management during CRRT. General data of the patients were collected, and the hemodynamics and blood gas indexes of the two groups were compared before CRRT and 24, 48 and 72 hours after CRRT. Clinical prognosis indexes of the two groups were analyzed.   Result   A total of 60 patients were enrolled in this study, including 30 in the control group and 30 in the ultrasound group. There were no significant differences in the general clinical data between the two groups (P＞0.05). Compared with the control group, the dose of vasoactive drugs and the central venous pressure were lower (F=1.255 and 18.618, P＜0.001) in the early stage of CRRT of the ultrasound group. In addition in the ultrasound group, the prognostic indicators showed that the durations of CRRT and vasoactive drug treatment were shorter (t=3.103 and 4.775, P=0.004 and ＜0.001),  and the rate of withdrawal from CRRT at the 28th day was higher (χ2=4.593, P=0.032).  Conclusion  The use of ultrasound to monitor the respiratory variation rate of inferior vena cava diameter can guide the early volume management of CRRT in septic patients, so that the early hemodynamic indexes and the clinical prognosis are improved in these patients Metrics

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Correlation between serum 25 hydroxyvitamin D level and handgrip strength and pinch strength in maintenance hemodialysis patients YANG Ya-qi, LIU Lin, LIN Qi-ting, LIU Yun, TAN Rong-shao, LIU Yan 2024, 23 (06):  436-440.  doi: 10.3969/j.issn.1671-4091.2024.06.008 Abstract ( 109 )   PDF (506KB) ( 16 )   Objectives To investigate the correlation between serum 25 hydroxyvitamin D [25(OH)D] level and handgrip strength (HGS) and pinch strength (PS) in maintenance hemodialysis (MHD) patients.  Method  This was a single-center and cross-sectional study. Patients undergoing MHD in the month of March 2021 in our Hemodialysis Center were enrolled in this study. Demographic data of the patients were collected. Routine blood counts, serum biochemical parameters and 25(OH)D levels (by electrochemiluminescence immunoassay) were determined before dialysis. HGS and PS were measured using a dynamometer. Patients were categorized into 25(OH)D normal, 25(OH)D insufficient, and 25(OH)D deficient groups based on 25(OH)D levels. Differences in these indexes were compared among the 3 groups. Spearman correlation analysis and linear regression were applied to evaluate the correlation between 25(OH)D level and HGS and PS.  Results  A total of 126 MHD patients were included in this study; 28 patients (22.22%) in the normal 25(OH)D group, 42 patients (33.33%) in the insufficient group, and 56 patients (44.44%) in the deficient group. Spearman correlation analysis suggested that serum 25(OH)D level was positively correlated with HGS (r=0.289, P=0.001) and PS (r=0.289, P=0.001). After adjusting for relevant confounders, multivariate linear regression showed that lower serum 25(OH)D level was independently associated with lower HGS (β=0.199, 95% CI:0.058～0.341, P=0.006) and PS (β=0.052, 95% CI：0.017～0.087, P=0.004).   Conclusion  Reduced serum 25(OH)D level was an independent factor for reduced HGS and PS in MHD patients. Metrics

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The observation of hemoglobin variation in anemic hemodialysis patients treated with darbepoetin alfa XIONG Jian, JI Dong-yun, LIU Ping-ping, CHEN Lei 2024, 23 (06):  441-444.  doi: 10.3969/j.issn.1671-4091.2024.06.009 Abstract ( 128 )   PDF (521KB) ( 27 )   Objective  To investigate the efficacy of darbepoetin alfa for the treatment of anemia and its effect on hemoglobin variation in hemodialysis patients.  Methods  A total of 38 stable hemodialysis patients treated in Hefei Jin'nan Kidney Disease Specialized Hospital from August 2022 to September 2023 were selected and randomly divided into two groups, observation group (n=19; 2 dropped out) received darbepoetin alfa treatment, and control group (n=19) received conventional short-acting erythropoiesis stimulating agent treatment. The study consisted of a correction phase and a maintenance phase, with assays of hemoglobin and biochemical indicators monthly, and iron metabolism indicators at 0 and 5th months. Independent samples t-test was used to compare hemoglobin levels before and after treatment between the two groups. Paired t-test was used for before-after self-control comparisons in each group. Repeated measures analysis was performed to examine the trend of hemoglobin change in both groups over time. Chi-square test was used for adverse event analysis.  Results  There was no significant difference in pretreatment hemoglobin level between the two groups (t=0.174, P=0.863). Post-treatment hemoglobin level also had no significant difference (t=0.809, P=0.425). No significant differences in adverse events (heart failure events, P=1.000; fistula occlusion,          P=1.000) were found between the two groups. During the correction phase, the observation group showed a more pronounced and stable hemoglobin increase (F=3.624, P=0.034).  Conclusion  Darbepoetin alfa has the safety and efficacy comparable to those of short-acting erythropoiesis stimulating agents, and can maintain hemoglobin at a stable increase level with less variability. Metrics

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The benefits and risks of essential trace elements in hemodialysis patients HU Rui, LIU Yan, LIU Yun 2024, 23 (06):  445-448.  doi: 10.3969/j.issn.1671-4091.2024.06.010 Abstract ( 133 )   PDF (473KB) ( 16 )   Kidney is an important organ for metabolism of trace elements in human body. In end-stage renal disease (ESRD) patients, changes in trace element levels in whole blood, serum or plasma may occur due to reduced food intake, abnormal function of intestinal absorption, decreased renal excretion capacity, and metabolic alterations resulting from renal failure. Additionally, hemodialysis patients face an even greater risk of trace element deficiency or excess due to the differences in dialysis clearance and quality of dialysis water. The abnormal metabolism of trace elements is associated with risks of various complications, hospitalization and mortality among hemodialysis patients. Therefore, the study of trace elements in hemodialysis patients is of clinical importance.  Metrics

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Research progresses in the relationship between exosomal non-coding RNA and ultrafiltration failure in peritoneal dialysis CHEN Xiao-xiao, WANG Lu-lu, HU Shuang-shuang, MA Dong-hong 2024, 23 (06):  449-452.  doi: 10.3969/j.issn.1671-4091.2024.06.011 Abstract ( 97 )   PDF (501KB) ( 10 )   Exosome is a nanoscale extracellular vesicle, which has recently attracted great attentions for the usefulness in clinical diagnosis and treatment both in China and in foreign countries. Non-coding RNA (ncRNA) includes tiny RNA, circular RNA, and long non-coding RNA, and others. ncRNA can be passively released during cellular and tissue damages, and binds to lipoproteins or circulates in various body fluids by exosome. This review focuses on the research progresses in exosomal ncRNA during ultrafiltration failure in peritoneal dialysis, in order to identify potential treatment methods and biomarkers for the clinical evaluation and prevention of ultrafiltration failure.  Metrics

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A cross-sectional analysis of vascular access in maintenance hemodialysis patients in a large single center in Tibet SUOLANG Qu-zhen, A Yong, LI Guo-liang, CUI Zhuan, TANG Wen 2024, 23 (06):  453-456.  doi: 10.3969/j.issn.1671-4091.2024.06.012 Abstract ( 100 )   PDF (488KB) ( 21 )   Objective A cross-sectional analysis of vascular access for hemodialysis in a large hemodialysis center in Tibet.  Methods Patients undergoing maintenance hemodialysis (MHD) in the Blood Purification Center, the People's Hospital of Tibet Autonomous Region from December 2021 to December 2022 were recruited for the analysis. Demographic characteristics, primary disease, dialysis vintage, the first and current vascular access modality were collected.  Results  A total of 194 MHD patients were included in the analysis. Vascular access used temporary central venous catheter, tunnel-cuffed catheter (TCC), arteriovenous graft (AVG) and arteriovenous fistula (AVF) for the first dialysis access were found in 66(34.0%), 88(45.4%), 2(1.0%), and 38(19.6%) patients, respectively. Forty-seven patients (24.2%) completed the AVF construction surgery before dialysis. In the patients with AVF surgery before dialysis, there were more male patients (83% vs. 68%, χ²=3.919, P=0.048), more patients with a college education or above (53.2% vs. 21.1%, χ²=17.875, P<0.001), and more patients using AVF or AVG as the vascular access (97.9% vs. 86.4%, χ²=4.860, P=0.029), as compared with those without AVF surgery before dialysis. AVF, AVG and TCC were used as the vascular access for MHD in 86.6%, 2.6% and 10.8%, respectively, of all MHD patients. Compared with the patients using non-TCC access, TCC as the vascular access was usually found in patients with older age (58.3±15.0 vs. 51.7±13.8, t=2.039, P=0.043) and less likely to have glomerulonephritis as the cause of renal failure (23.8% vs. 47.4%, χ²=4.213, P=0.040). Patients with temporary central venous catheter as the initial vascular access (n=66) were more likely to use TCC for MHD (19.7% vs. 6.3%, χ²=8.157, P=0.007), as compared with the patients using other vascular access (n=128).  Conclusion  AVF as the vascular access for MHD in this center was 86.6%, compliant with the requirement of the guidelines. However, the use of TCC was 10.8%, slightly higher than the requirement of the guidelines. Improvement of technology and pre-dialysis education are warranted to reduce the use of TCC for MHD. Metrics

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Efficacy of drug-coated balloon in the treatment of venous stenosis in hemodialysis access HUO Gui-jun, ZENG Yu-qi, TAO Zhi-hong, ZHANG qin, YAO Zhi-chao, ZHOU Da-yong 2024, 23 (06):  457-461.  doi: 10.3969/j.issn.1671-4091.2024.06.013 Abstract ( 126 )   PDF (584KB) ( 59 )   Objective To compare the safety and efficacy of drug-coated balloon angioplasty (DCBA) and conventional balloon angioplasty (CBA) in the treatment of venous stenosis in arteriovenous fistula (AVF) for hemodialysis access.  Methods  A retrospective analysis was conducted on the clinical data of 152 hemodialysis patients with AVF stenosis and treated at Suzhou Municipal Hospital from November 2020 to April 2022. Based on the treatment method, they were divided into the drug-coated balloon (DCB) group (n=62) and the conventional balloon (CB) group (n=90). Kaplan-Meier curve was used to assess re-stenosis rate of the target lesion in both groups. Primary patency of the target lesion (TLPP) was compared after the operation for 6 months.  Results  All patients achieved technical and clinical success, and completed follow-up observation. There were no statistical differences in baseline characteristics between the two groups (P>0.05). Kaplan-Meier survival analysis and log-rank test indicated that DCBA significantly prolonged the patency of AVF. TLPP after 6 months showed that the DCB group had higher patency rate compared to the CB group (OR=1.935, 95% CI:1.173～3.193, P=0.017).  Conclusion  Our research results indicate that DCBA improves the primary patency rate of AVFs better than CBA in hemodialysis patients, and DCBA also reduces the need for re-intervention of the target lesion. Therefore, DCBA is an effective and safe method for treatment of AVF stenosis. Metrics

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The feasibility and application value of the through and through technique in hemodialysis patients with central venous occlusive disease ZHU Hong-jiang, QU Chang-zheng, ZHAO Peng-peng, FU Yan-bo, YAN Feng 2024, 23 (06):  462-465,479.  doi: 10.3969/j.issn.1671-4091.2024.06.014 Abstract ( 105 )   PDF (534KB) ( 14 )   Objective  To evaluate the feasibility and application value of the through and through technique in the treatment of central venous occlusion in hemodialysis patients.  Methods A retrospective analysis was conducted on 17 hemodialysis patients with central venous occlusion and undergoing vascular intervention surgery at the hospital from January 2020 to June 2023. Sharp recanalization technique or " needle-wire " technique was used to establish a traction wire pathway, followed by balloon dilation or balloon dilation combined with stent implantation. Surgical success rate, incidence of complications, and postoperative patency rate were recorded.  Results  Among the 17 patients, one patient experienced vessel perforation during wire recanalization, resulting in surgical failure, while the remaining 16 cases achieved surgical success with a success rate of 94.12%. There were no bleeding, mediastinal hematoma, cardiac tamponade, or central venous rupture during the manipulations, and no surgical-related deaths occurred. All 16 patients who had successful surgery were able to undergo normal hemodialysis, and the swelling in the upper limbs and face significantly subsided. The follow-up period ranged from 6 to 25 months, with a median follow-up time of 13.5(8.0,15.0) months. The primary patency rates after the operation for 6 months and one year were 93.75% and 75.00%, respectively. No stent displacement occurred during the follow-up period.  Conclusion  The through and through technique has shown significant efficacy with a high success rate and a low incidence of complications in the treatment of central venous occlusion in hemodialysis patients, suggesting its clinical applicability. Metrics

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Clinical application and effect assessment of hemodialysis infection control behavior monitoring system using computer vision in a hemodialysis center FU En-qin, GAN Tie-er, HU Shou-ci, ZHENG Yue, ZHANG Ling-li 2024, 23 (06):  466-469.  doi: 10.3969/j.issn.1671-4091.2024.06.015 Abstract ( 109 )   PDF (474KB) ( 11 )   Objective  To evaluate the recognition of key and standard behaviors for infection prevention, the consistency with the effects of manual monitoring, and the clinical effects of the hemodialysis infection prevention and control monitoring system using computer vision.  Methods We randomly recruited 198 nurse-manipulations in the nurses responsible for the connecting to and disconnecting from the dialyzers in the hemodialysis center from September to December 2022 as the research objects. Systematic and real-time recordings for standard behaviors were set as the computer group, and manual review of the systematic video recordings for standard behaviors were defined as the manual group. The key behaviors systematically recorded during connecting to and disconnecting from the dialyzers before and after use of the system in a nurse were divided into behaviors before the intervention and behaviors after the intervention. The first-grade operation indexes and the second-grade indexes  were used to examine the consistency of standard recognition between computer group and manual group. The standard rates of the key behaviors recorded during connecting to and disconnecting from the dialyzers in the same nurse were compared before and after use of the system.  Results  A total of 198 nurse-manipulations during connecting to and disconnecting from the dialyzers were observed. Comparing the first-grade indexes between the two groups found that there was a strong consistency in the recognition of standard internal fistula/catheter connecting to and disconnecting from the dialyzers (kappa value of internal fistula connecting to the dialyzers =0.718; kappa value of internal fistula disconnecting from the dialyzers =0.714; kappa value of catheter connecting to the dialyzers =0.788; kappa value of catheter disconnecting from the dialyzers=0.712). Comparing the second-grade indexes between the two groups found that a less consistency in the recognition of catheter disconnection (kappa value=0.173), an average consistency in wearing gloves (kappa value =0.243) and catheter connection (kappa value =0.305), and a moderate consistency in internal fistula/catheter disinfection (kappa value =0.556) and hand hygiene execution (kappa value =0.590). After the intervention, standard disinfection manipulations during connecting to dialyzers (χ2=8.156, P=0.004), waiting time (χ2=30.462, P<0.001), hand hygiene (χ2=21.023, P<0.001) and standard rate of access evaluation (χ2=23.522, P < 0.001) were better in the computer group than in the control group; the standard rates of wearing gloves (χ2=1.823, P=0.177) and tubes connecting to the dialyzers (χ2=0.410,           P=0.520) had no statistical differences. After the intervention, the standard rates of disinfection for disconnecting from the dialyzers (χ2=4.444, P=0.035) and hand hygiene execution (χ2=17.770, P<0.001) were better in the computer group than in the control group; but the standard rates of wearing gloves (χ2=1.309, P=0.253), catheter disconnections (χ2=3.220, P=0.073) and waiting time (χ2=2.254, P=0.133) had no statistical differences between the two groups.  Conclusion  Hemodialysis infection prevention and control monitoring system using computer vision can record and recognize the standard manipulations of nurses during connecting to and disconnecting from the dialyzers, which is relatively consistent with the results of manual observation. This system increases the standard rates of key behaviors for infection control during connecting to and disconnecting from the dialyzers, and prevents the hemodialysis-related infection events from occurrence. Metrics

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Application of medical and nursing care integrated platform based on remote monitoring in the management of peritoneal dialysis patients at home TIAN Na, LIU Ying, JIANG Xiao-xue, LIU Meng-ai, LIU Da-jun, YUN Yang 2024, 23 (06):  470-473.  doi: 10.3969/j.issn.1671-4091.2024.06.016 Abstract ( 132 )   PDF (582KB) ( 12 )   Objective   To explore the application effect of medical and nursing care integrated platform based on remote monitoring system to follow up peritoneal dialysis (PD) patients.  Methods  Sixty patients undergoing PD and followed up at Shengjing Hospital of China Medical University from June 2017 to May 2020 were selected as the control group, and a total of 60 PD patients followed up from June 2020 to May 2023 were assigned to the observation group. The control group received routine care, while the observation group received the medical and nursing care integrated platform based on remote monitoring system. Medication compliance, complication rate, re-hospitalization and re-examination score were compared between the two groups.  Results  Compared with the control group, medication compliance of patients in the observation group was significantly improved (63.33% vs. 46.67%, χ2=4.062, P=0.044), complication rate was significantly reduced (26.67% vs. 46.67%, χ2=5.167, P=0.023), re-hospitalization rate was lower (23.33% vs. 41.67%, χ2=4.596, P=0.032), and re-examination score was significantly increased (88.13±6.36 vs. 81.32±9.78, t=4.527, P<0.001).  Conclusion   The application of medical and nursing care integrated platform based on remote monitoring system can help PD patients better comply with medications and reduce complications, and can also improve the quality of management to chronic diseases. Metrics

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Study on the occurrence and influencing factors of furuncle around the exit of peritoneal dialysis catheter MEN Chun-cui, LU Li-xia, QIAO Jie, CHU Xin-xin, HE Yu-ting, WU Bei, ZHAO Hui-ping, WANGmei 2024, 23 (06):  474-479.  doi: 10.3969/j.issn.1671-4091.2024.06.017 Abstract ( 100 )   PDF (588KB) ( 24 )   Objective  To explore the occurrence and influencing factors of furuncle around exit of peritoneal dialysis (PD) catheters.  Methods  The PD patients who were followed up regularly from September 2011 to September 2017 in the Department of Nephrology, Peking University People’s Hospital were selected. The occurrence of furuncle and related clinical data were reviewed and analyzed.  Results  A total of 183 PD patients were enrolled in this study, 88 (48.1%) were male, the average age was 59.8±13.8 years, and the median PD duration was 27 (15, 51) months. Thirty-six episodes of furuncle around exit of PD catheter occurred in 23 (12.6%) patients (0.05 episodes/patient-year). The most common site of furuncle was at 6 to 9 o'clock position around PD catheters (14 episodes, 38.9%). In terms of complications, 4 episodes of furuncle (11.1%) were complicated with exit-site infection and/or tunnel infection, but without peritonitis. Logistic regression analysis showed that shorter PD duration (OR=0.969, 95% CI: 0.941～0.998, P=0.039), diabetes mellitus (OR=3.014, 95% CI: 1.050～8.651, P=0.040) and higher serum C-reactive protein (OR=1.154, 95% CI: 1.065～1.251, P<0.001) were the independent risk factors for occurrence of furuncle around exit of PD catheters. Binary logistic regression found that diabetes mellitus (OR=5.513, 95% CI: 1.029～29.536, P=0.046) and C-reactive protein (OR=1.103, 95% CI: 1.016～1.197, P=0.019) were the independent risk factors for frequent furuncle occurrence around exit of PD catheters.  Conclusions  Furuncle around exit of PD catheters is not uncommon in PD patients, and may develop into exit-site infection and/or tunnel infection. The patients with diabetes mellitus, shorter PD duration and higher level of C-reactive protein should be paid attention to the presence of furuncle around the exit, and should be given corresponding education to prevent exit-site infection and tunnel infection. Metrics