Chinese Journal of Blood Purification

12 July 2024, Volume 23 Issue 07 Previous Issue    Next Issue

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Comprehensive management of encapsulating peritoneal sclerosis in peritoneal dialysis patients: chinese expert consensus Chinese Expert Consensus Working Group on Comprehensive Management of Encapsulating Peritoneal Sclerosis in Peritoneal Dialysis Patients 2024, 23 (07):  481-493.  doi: 10.3969/j.issn.1671-4091.2024.07.001 Abstract ( 278 )   PDF (1423KB) ( 119 )   Encapsulation Peritoneal Sclerosis (EPS) is a rare and serious complication in long-term peritoneal dialysis patients, with poor prognosis and high mortality rate. EPS is a chronic and insidious disease that often difficult to identify in its early stages. It is characterized by progressive and extensive fibrotic thickening of the peritoneum, peritoneal sclerosis，which causes progressive obstruction and encapsulation of the bowel. Till now, the pathogenesis of EPS remains uncertain. Early detection and timely intervention can effectively prevent the progression of EPS, and multidisciplinary combination treatment is needed. However, EPS has not been widely recognized in China, especially for doctors in primary hospitals, which can easily lead to missed diagnosis or misdiagnosis. In order to guide physician to comprehensively understand the pathogenesis, clinical characteristics, and prevention and treatment strategies of EPS in peritoneal dialysis (PD) patients, identify EPS risk factors, diagnose and treat EPS early so as to delay its progression, the Blood Purification Center Branch of Chinese Hospital Association organized experts in the field of peritoneal dialysis in China to develop this expert consensus. Metrics

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Research on factors affecting peritoneal water transport and solute transport function in peritoneal dialysis patients ZHANG Meng-qin, XU Xiao, DONG Jie 2024, 23 (07):  494-499,509.  doi: 10.3969/j.issn.1671-4091.2024.07.002 Abstract ( 132 )   PDF (493KB) ( 23 )   Objective  To explore the factors affecting the long-term trends of peritoneal water transport and solute transport in incident peritoneal dialysis patients.  Methods   Incident peritoneal dialysis patients were recruited at Peking University First Hospital from January 1, 2016, to April 30, 2019. Baseline data including demographics, clinical biochemistry, dialysis prescription, and dialysis adequacy and transport test were collected. Spearman's correlation analysis was used to explore the factors affecting patients' baseline ultrafiltration per glucose load and 24-hour dialysate-to-plasma creatinine ratio (24h D/P Cr). Factors that influenced the trends of patients' ultrafiltration per glucose load and 24h D/P Cr were analyzed using mixed linear modeling. Results A total of 197 incident peritoneal dialysis patients who were clinically stable were included in this study. A positive correlation between continuous dialysis (r=0.227, P=0.001), baseline exposure of glucose (r=0.140, P=0.049) and baseline 24h D/P Cr was observed. Cardiovascular disease (r=0.144, P=0.043), new-onset peritonitis (r=0.168, P=0.018), and baseline exposure of glucose at baseline (r=0.252, P＜0.001) were positively correlated with baseline ultrafiltration per glucose load. In contrast, baseline blood albumin (r=-0.192, P=0.007) and renal Kt/V (r=-0.340, P＜0.001) showed a negative correlation with ultrafiltration per glucose load. A gradual increasing trend in ultrafiltration per glucose load (t=-4.196，P＜0.001) was observed in our peritoneal dialysis patients using mixed linear modeling but was not associated with age, gender, diabetes, cardiovascular disease, Charlson comorbidity score, baseline hemoglobin, baseline blood albumin, baseline hypersensitive C-reactive protein (hs-CRP), baseline diastolic blood pressure, baseline systolic blood pressure, new-onset peritonitis, intermittent or continuous dialysis, baseline renal Kt/V, and aquaporin-1 (AQP1) promoter genotype (P>0.050). Meanwhile, 24h D/P Cr remained relatively stable (t=-1.486，P=0.138) during follow-up.  Conclusion  This study demonstrated that an increasing trend in ultrafiltration per glucose load and a stable trend in 24h D/P Cr were observed in our incident peritoneal dialysis patients, which may be associated with our incremental dialysis and glucose-sparing strategies. This supported that peritoneal membrane function in peritoneal dialysis patients is influenced by a combination of environmental and genetic factors. Metrics

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A study on the relationship between serum chitinase 3-like protein 1 and prognosis in hemodialysis patients BI Shu-hong, GAO Yue-ming, SU Chun-yan, WANG Yue, TANG Wen, HE Lian, ZHANG Ai-Hua 2024, 23 (07):  500-504.  doi: 10.3969/j.issn.1671-4091.2024.07.003 Abstract ( 82 )   PDF (534KB) ( 10 )   Objective  This study aimed to determine the relationship bewteen serum Chitinase 3-like Protein 1 (CHI3L1) and the mortality of patients with end-stage renal disease (ESRD) on haemodialysis (HD) and to evaluate the prognostic value of serum CHI3L1.  Methods  It was a prospective cohort study of kidney failure patients on HD at Peking University Third Hospital in September 2014 and were followed up until December 2023. Baseline serum CHI3L1 levels were measured using enzyme-linked immunosorbent assay (ELISA), then patients were divided into two groups (high-CHI3L1 group and low-CHI3L1 group) based on median CHI3L1. Overall survival and cardiovascular mortality were analyzed by the Kaplan-Meier method. The restricted cubic spline (RCS) curve was used to model and depict the relationship between baseline CHI3L1 and the risk of all-cause mortality in HD patients. The influence of CHI3L1 on outcome was analyzed using Cox regression method.  Results  109 prevalent patients were enrolled. The follow-up period was 80.0 (38.2, 113.2) months. Kaplan-Meier survival analysis showed that all-cause mortality of patients in high-CHI3L1 group was significantly higher than that in low-CHI3L1 group (χ2=4.720, P=0.030), and there was no significant difference in cardiovascular mortality between these two groups (χ2=1.954, P=0.162). When CHI3L1≥199.8 ng/ml, all-cause mortality significantly increased with the increase of CHI3L1 level (HR=1.747; 95% CI: 1.035～2.947, P =0.037). COX regression analysis showed that older age (HR=1.029, 95% CI：1.001～1.056, P =0.040), longer dialysis vintage (HR=2.251, 95% CI：1.310～3.868, P=0.003), higher systolic blood pressure (HR=1.022, 95% CI：1.008～1.036, P=0.002) and lower serum creatinine level (HR=0.13, 595% CI：0.064～0.28, P＜0.001) were independent risk factors for all-cause mortality. After adjusting these factors, high CHI3L1 remained to be an independent predict factor for all-cause mortality in HD patients (HR=1.963, 95% CI: 1.010-3.813, P=0.047).   Conclusions   The study suggested that all-cause mortality of HD patients in high-CHI3L1 group was significantly higher than that of patients in low-CHI3L1 group. Serum CHI3L1 was independently associated with all-cause mortality in HD patients. Metrics

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The relationship between hemoglobin fluctuations and cardio-cerebrovascular events in dialysis patients treated with roxadustat WANG Wen-bo, CHENG Hong, BIAN Wei-jing, YANG Min, XU Xiao-yi, YE Nan, XU Feng-bo, CHEN Wen-mei, CHEN Lan, WANG Guo-qin 2024, 23 (07):  505-509.  doi: 10.3969/j.issn.1671-4091.2024.07.004 Abstract ( 214 )   PDF (513KB) ( 8 )   Objective  This study aimed to investigate the relationship between fluctuations in hemoglobin levels and cardio-cerebrovascular events in dialysis patients initially treated with Roxadustat.  Methods  Dialysis patients who were initially treated with Roxadustat at Beijing Anzhen Hospital from June 2020 to May 2022 were selected and treated for 12 months. They were divided into low hemoglobin coefficient of variation group and high hemoglobin coefficient of variation group according to the mean hemoglobin variability coefficient. The relationship between fluctuations in hemoglobin levels and cardio-cerebrovascular events during the treatment period was observed. According to the mean value of hemoglobin acquired target rate the patients were divided into a high hemoglobin acquired target rate subgroup and a low hemoglobin acquired target rate subgroup, and the effect of hemoglobin variation rate on cardio-cerebrovascular events was analyzed separately in the two subgroups, and the interaction P value was calculated.   Results  A total of 77 patients were enrolled. Among these patients, 55 patients were treated with Roxadustat alone and 22 patients were treated with erythropoietin. During the 12-month treatment period, the low hemoglobin coefficient of variation (n=39) after hemoglobin compliance rate was higher than the high hemoglobin coefficient of variation group (n=38) (Z=-5.570, P=0.001), while the proportion of cardiovascular and cerebrovascular events was significantly lower than the high hemoglobin coefficient of variation group (23.08% vs. 55.26%, χ2=          -1.408, P=0.024). Kaplan-Meier analysis showed that the incidence of cardio-cerebrovascular events in the high hemoglobin coefficient of variation group was significantly higher than that in the low hemoglobin coefficient of variation group (χ2=5.012, P=0.025). The results of the multivariate Cox regression analysis showed that the hemoglobin variation coefficient was an independent risk factor for cardio-cerebrovascular events (OR=2.935, 95% CI:1.157～7.446, P=0.023). The results of the subgroups showed that regardless of whether the hemoglobin acquired target rate was high or low, a high hemoglobin variation coefficient would increase the risk of cardio-cerebrovascular events in patients (chi-squareed=1.51, interaction P=0.244).  Conclusion  When using Roxadustat to treat anemia in maintenance dialysis patients, high hemoglobin variation coefficient may increase the risk of cardiovascular and cerebrovascular events in patients.  Metrics

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Investigation on the social rehabilitation in young and middle-aged maintenance hemodialysis patients and analysis on the influencing factors for social function degradation before and after dialysis REN Jiao-jiao, GUO Hong-ping, XUE Fu-ping, LAN Jie, FAN Ji-xiang, LU Xu, LI Jing, WANG Li-hua 2024, 23 (07):  510-514.  doi: 10.3969/j.issn.1671-4091.2024.07.005 Abstract ( 153 )   PDF (541KB) ( 26 )   Objective  This study aims to investigate the current status of social rehabilitation and the quality of life, and to explore the factors influencing the degree of social function degradation after dialysis in young and middle-aged maintenance hemodialysis (MHD) patients.  Methods  The young and middle-aged MHD patients treated in the Second Hospital of Shanxi Medical University were taken as the study subjects. Cross-sectional and retrospective survey methods were used to collect patients' data. The Kidney Disease Quality of Life Scale (KDQOL-SFTM 1.3) and Social Disability Screening Schedule (SDSS) were used for evaluation of the patients. Patients were divided into the group with insignificant social function degradation and the group with significant social function degradation based on the median value of SDSS score difference before and after MHD. Univariate analysis and binary logistic regression analysis were used to investigate the influencing factors for social function deterioration in young and middle-aged MHD patients.   Results  ①In the 112 MHD cases included in this study, 42 cases (37.50%) were at the social rehabilitation level 3 and 70 cases (62.50%) at the social rehabilitation level 4. The quality of life score was higher in the patients at the social rehabilitation level 4 than those at the social rehabilitation level 3 (t= -2.554, P=0.012),  but statistical differences were only in the domains of impact of kidney disease (t=2.185, P=0.031), work status (t=3.203, P=0.002), social quality (t=2.117, P=0.037), emotional function  (t=2.700, P=0.008) and social function (t=2.349, P=0.021). ②Shorter dialysis age (OR=3.031, 95% CI：1.192～7.706, P=0.020), fatigue symptom (OR=7.574, 95% CI：1.829～31.367, P=0.005), comorbid anxiety and (or) depression problems (OR=3.765, 95% CI：1.120～12.658, P=0.032), and higher morbidity stigma score (OR=1.303, 95% CI：1.104～1.537, P=0.002) were the independent risk factors for social function deterioration in young and middle-aged MHD patients.  Conclusions  ① Higher levels of social rehabilitation and quality of life were found in young and middle-aged MHD patients; ②Patients with shorter dialysis age, comorbid symptoms of fatigue, anxiety and (or) depression, and high morbid stigma score were prone to have significant social dysfunction. The psychological and emotional problems should be emphasized clinically in young and middle-aged MHD patients. Metrics

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Association between blood copper-zinc ratio and cognitive impairment in maintenance hemodialysis patients LIU Xue-qing, GUO Mei-qian, GAO Xue-ping, XU Yong, CHEN Xiao-ling, ZHENG Dong-hui 2024, 23 (07):  515-519.  doi: 10.3969/j.issn.1671-4091.2024.07.006 Abstract ( 99 )   PDF (607KB) ( 11 )   Objective To explore the relationship between blood copper-zinc ratio and cognitive impairment (CI) in maintenance hemodialysis (MHD) patients.  Methods A total of 130 MHD patients treated in the hemodialysis center of Huai'an Hospital Affiliated to Xuzhou Medical University between March 2022 and September 2023 were enrolled in this study. Their clinical data were collected. Based on the Montreal Cognitive Assessment (MoCA) score, the patients were divided into CI group (n=55) and normal cognitive group (n=75). Inductively coupled plasma mass spectrometry was used to measure blood zinc and copper levels. Baseline clinical and laboratory data were compared between the two groups. The correlation between copper-zinc ratio and MoCA score, the independent influence factors for the presence of CI, and the predictive value of copper-zinc ratio for CI in MHD patients were analyzed.  Results  Compared to the normal cognitive group, patients in the CI group had older age (t=-6.161, P<0.001), higher percentage of diabetics (c2=4.240, P=0.039), longer dialysis age (Z=-2.131, P=0.033), and higher levels of high sensitivity C-reactive protein (Z=-2.691, P=0.007), blood copper (Z=-4.272, P<0.001) and copper-zinc ratio (Z=-5.539, P<0.001), less years of education (Z=-4.227, P<0.001), and lower levels of creatinine (t=2.002, P=0.047), hemoglobin (t=5.948, P<0.001), albumin (Z=-5.519, P<0.001) and blood zinc (t=4.872, P<0.001). Spearman correlation analysis showed a negative correlation between MoCA score and the blood copper-zinc ratio (r=-0.509, P<0.001). Multivariate logistic regression analysis found that copper-zinc ratio (OR=1.449, 95% CI: 1.017～1.344) and age (OR=1.068, 95% CI: 1.002～1.138) were the independent risk factors for CI in MHD patients, while albumin (OR=0.746, 95% CI: 0.616～0.904) and hemoglobin (OR=0.945, 95% CI: 0.906～0.987) were the independent protective factors for CI (P<0.05). ROC curve analysis showed that the area under the curve of the copper-zinc ratio for predicting the presence of CI in MHD patients was 0.785 (95% CI: 0.704～0.866, P<0.001) and the optimal cut-off value was 0.15, at which the sensitivity and specificity were 74.5% and 76.0%, respectively.  Conclusion  Higher blood copper-zinc ratio is an independent risk factor for the development of CI in MHD patients.  Blood copper-zinc ratio is useful for the prediction of CI in MHD patients. Metrics

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The  geriatric nutritional risk index on the treatment effect of peritoneal dialysis-associated peritonitis in elderly patients YU Long-li, SUI Xiao-ni, LI Yang 2024, 23 (07):  520-523.  doi: 10.3969/j.issn.1671-4091.2024.07.007 Abstract ( 109 )   PDF (536KB) ( 10 )   Objective  To investigate the relationship between geriatric nutritional risk index (GNRI) and treatment effect of peritoneal dialysis-associated peritonitis (PDAP) in elderly patients.  Methods  A total of 147 PDAP patients treated in Qingdao Municipal Hospital from January 2020 to January 2023 were selected as the research subjects. They were divided into a cured group (102 cases) and a failed group (45 cases) based on the treatment outcome of PDAP. GNRI scores and clinical characteristics of the two groups were compared. The relationship between GNRI score and treatment outcome of PDAP patients was analyzed.  Results  There were 102 patients in the cured group and 45 patients in the failed group (including death 25 cases, withdrawal of the tubes 10 cases, and  transferred to other hospitals 10 cases) after the treatment. Compared with the cure group, GNRI score, body mass index (BMI), hemoglobin (Hb) and albumin (ALB) were significantly reduced (t=5.134, 7.517, 2.336 and 3.259 respectively; P＜0.001, ＜0.001, 0.021 and 0.001 respectively), while dialysis age was significantly increased (t=10.924, P=0.000) in the failed treatment group. Multivariate logistic regression analysis showed that lower GNRI score (OR=0.541, 95% CI: 0.335～0.872, P＜0.001), lower serum ALB (OR=0.638, 95% CI: 0.494～0.825, P＜0.001) and longer dialysis age (OR=1.674, 95% CI:1.081～2.591,P＜0.001) were the independent risk predictors for treatment failure of PDAP patients. ROC analysis showed that the area under ROC curve of GNRI score to predict treatment failure of PDAP patients was 0.735, with the sensitivity of 89.55%, the specificity of 75.43%, the Yoden index of 0.649, and the best predictive value of 90.53.   Conclusion   Decreased GNRI score is an independent risk factor for treatment failure of PDAP patients, and is highly efficient for the prediction of treatment failure in PDAP patients. Therefore, early correction of abnormal nutritional status can improve the treatment outcome of PDAP. Metrics

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The risk factors for abdominal aortic calcification in maintenance hemodialysis patients: a Meta-analysis HUANG Xin-ping, QIU Cheng-gao, GUAN Hai-tian, ZHANG Lei, SU Shan, XIE Wan-na, MI Lan-lan 2024, 23 (07):  524-528.  doi: 10.3969/j.issn.1671-4091.2024.07.008 Abstract ( 99 )   PDF (617KB) ( 10 )   Objective  To systematically analyze the risk factors for abdominal aortic calcification (AAC) in Chinese maintenance hemodialysis (MHD) patients.   Methods  PubMed, EMBASE, Web of Science, CNKI, CBM, Wanfang and other databases were searched from establishment of the database to May 2023 by computer to retrieve the literature relating to the risk factors for AAC in Chinese MHD patients. The Newcastle-Ottawa Scale (NOS) and the Agency for Healthcare Research and Quality (AHRQ) were used to evaluate the methodological quality of the literature. Meta-analysis was performed using RevMan5.3 software.  Results  A total of 15 articles were obtained, including 10 Chinese articles and 5 English articles and encompassing 2,848 subjects. The results of Meta-analysis showed that older age (OR=1.080, 95% CI: 1.050～1.110, P<0.001), longer dialysis age (OR=1.020, 95% CI: 1.010～1.040, P=0.008), smoking (OR=1.900, 95% CI: 1.440～2.500, P<0.001), higher body mass index (BMI) (OR=1.200, 95% CI: 1.050～1.110, P=0.001), increased blood calcium (OR=14.140, 95% CI: 7.340～27.260, P<0.001), elevated blood phosphorus (OR=6.010, 95% CI: 2.040～17.750, P=0.001), elevated parathyroid hormone (OR=1.310,95% CI:1.010～1.700,P=0.040), elevated blood magnesium(OR=0.490, 95% CI:0.400～0.590, P<0.001) and decreased 25-hydroxyvitamin D3 (OR=0.760, 95% CI: 0.610～0.950, P=0.020) were the risk factors for AAC in MHD patients.  Conclusion  There are many influencing factors for AAC in MHD patients. We should focus on the high-risk groups and carry out targeted and personalized interventions to delay the progress of AAC in MHD patients. Metrics

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Construction of a prediction model for sleep disorders in maintenance hemodialysis patients based on Lasso-Nomogram model and verification of the model SUN Hai-yun, YIN Pei-ran, QIAN Peng 2024, 23 (07):  529-533.  doi: 10.3969/j.issn.1671-4091.2024.07.009 Abstract ( 104 )   PDF (824KB) ( 4 )   Objective  To construct a prediction model of sleep disorder (SD) in patients with maintenance hemodialysis (MHD) based on Lasso-Nomogram model, and to verify the efficacy of the prediction model.  Methods   A total of 198 patients with chronic renal failure (CRF) who underwent MHD in our hospital were selected and categorized into SD and non-SD groups according to whether SD occurred 6 months after MHD. We compared the clinical data of the two groups, analyzed the influencing factors for SD, and constructed a nomogram prediction model of SD according to the predictive factors.  Results   In the sixth month after MHD, 92 CRF patients developed SD, with the SD incidence of 46.46% (92/198). Logistic analysis showed that age (OR=2.152, 95% CI：1.246～3.718), skin itching (OR=6.209, 95% CI：2.051～18.796), depression (OR=3.715, 95% CI：1.531～9.013), urea clearance index (Kt/V) (OR=0.302, 95% CI：0.154～0.592), blood phosphorus (OR=2.274, 95% CI：1.236～4.185), calcium and phosphorus product (OR=3.210, 95% CI：1.517～6.792), serum copeptin (OR=6.816, 95% CI：2.317～20.048), α-amylase (OR=5.277, 95% CI：1.953～14.257), and 25-(OH)D3 (OR=0.381, 95% CI：0.186～0.780) were the influencing factors for SD (P<0.001). A nomogram prediction model of SD was constructed based on the nine indicators screened by Lasso and logistic analyses. Using this model, the area under the curve (AUC) for the occurrence of SD in CRF patients with MHD was 0.928 (95% CI：0.892～0.963), with the prediction sensitivity and specificity of 81.13% and 90.11% respectively.  Conclusion  This nomogram prediction model of SD in CRF patients with MHD based on the influencing factors for SD has higher predictive efficacy and better clinical effect in predicting SD risk. Metrics

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Research progresses in blood perfusion joint continuous renal replacement therapy in rhabdomyolysis-induced acute kidney injury ZHOU Xiao-chun, YANG Ying-ying, FU Ping 2024, 23 (07):  534-537.  doi: 10.3969/j.issn.1671-4091.2024.07.010 Abstract ( 147 )   PDF (478KB) ( 31 )   Rhabdomyolysis (RM) is a multifactorial clinical syndrome of skeletal muscle injury and release of its breakdown products into the circulation. Acute kidney injury (AKI) is a common complication of RM, which is mainly related to myoglobin occlusion of renal tubules and its direct nephrotoxic effects, and others. RM-induced AKI has a low cure rate and high mortality. Previous studies have shown that continuous renal replacement therapy (CRRT) combined with hemoperfusion (HP) can be effective in treating RM-induced AKI. This article provides a review of CRRT combined with HP in the treatment of RM-induced AKI with the aim to provide a reference for clinical therapeutic decision-making and possible follow-up studies. Metrics

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Research progresses in systemic immune inflammatory index in patients with chronic kidney disease YANG Ya-qi, LIU Yun, LIU Yan 2024, 23 (07):  538-541.  doi: 10.3969/j.issn.1671-4091.2024.07.011 Abstract ( 124 )   PDF (503KB) ( 18 )   Chronic kidney disease (CKD) is a global health problem with a complex pathogenesis characterized by a persistent low-grade inflammatory state. In recent years, the systemic immune inflammatory index (SII) has received widespread attention as a new tool for assessing the inflammatory state. SII can better reflect the systemic inflammation level of the patient, and has been widely used in clinical practice because of its advantages of easy access, low price, and ease of calculation. The purpose of this article is to review the research progresses in SII in CKD patients, to explore the relationship between SII and occurrence and development of CKD, to assess the value of SII in disease monitoring and prognostic assessment, and to provide the useful references for subsequent studies. Metrics

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Efficacy of axillary brachial plexus block for analgesia during percutaneous transluminal angioplasty for dialysis access JIA Cheng-bo, CAI Qing-li, JIANG Yan 2024, 23 (07):  542-545.  doi: 10.3969/j.issn.1671-4091.2024.07.012 Abstract ( 105 )   PDF (523KB) ( 22 )   Objective  To investigate the efficacy of trans-axillary approach of brachial plexus nerve block for percutaneous transluminal angioplasty (PTA) in hemodialysis patients.   Methods  A total of 60 patients treated with PTA due to autologous arteriovenous fistula stenosis in the Department of Nephrology of Qiqihar Jianhua Hospital from December 2020 to December 2021 were enrolled in this study. They were divided into control group (local infiltration anesthesia, n=30) and brachial plexus block group (axillary approach of brachial plexus block, n=30). After the operation, pain score, pain management satisfaction, operation time, surgical and anesthetic complications, stenosis of the internal fistula, and primary patency rate of the internal fistula were assessed.   Results The visual analogue scale (VAS) of the control group was higher than that of the brachial plexus block group (t=2.571, P=0.011). The brachial plexus block group had a higher pain management satisfaction score (t=-5.305, P<0.001). There was no statistical difference in operation time between the two groups (t=-0.270, P=0.788). In the control group, two patients with arterial lesions presented with arterial spasm during operation, which was relieved by stopping endoluminal manipulation and medication treatment. No surgical and anesthesia complications occurred in the brachial plexus block group. There were statistical differences before and after the surgery in diameter of fistula stenosis (t=-52.789 and -44.140, P＜0.001), natural blood flow in internal fistula (t=-16.741 and -19.528, P＜0.001) and blood flow during dialysis (t=-8.776 and -9.550, P＜0.001) both in the control group and the brachial plexus block group. However, there were no significant differences after PTA in diameter of fistula stenosis (t=0.374, P=0.710), natural blood flow in internal fistula (t=1.017, P=0.313), and blood flow during dialysis (t=-1.181, P=0.242) between the two groups. The primary patency rates after PTA for 1, 3, 6, and 12 months were 93%, 87%, 54%, and 21% respectively in the control group, and were 93%, 90%, 61%, and 25% respectively in the brachial plexus block group, without statistical significances between the two groups (Log Rank: c2=0.307, P=0.579). The primary patency rates in the two groups were also compared monthly in January (c2=0.001, P=0.970), March (c2=0.213, P=0.644), June (c2=0.283, P=0.595) and December (c2=0.087, P=0.768), without statistical differences between the two groups.  Conclusion  Brachial plexus block anesthesia provides safe and effective analgesia during PTA for the treatment of arteriovenous fistula stenosis in dialysis patients, with higher patient satisfaction than local infiltration anesthesia, and has no effect on the 12-month primary patency rate. Metrics

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Analysis of the risk factors for recurrence of juxta-anastomotic stenosis in wrist arteriovenous fistula after percutaneous transluminal angioplasty: a single-center prospective cohort study YAO Guo-ming, HU Ri-hong, YANG Yuan-yuan, HUANG Jia-li, OU Fei, CHEN Hong-yu 2024, 23 (07):  546-551.  doi: 10.3969/j.issn.1671-4091.2024.07.013 Abstract ( 98 )   PDF (532KB) ( 29 )   Objective  This study aimed to explore the risk factors for restenosis of the juxta-anastomotic stenosis in radial-cephalic arteriovenous fistula (RC-AVF) after primary percutaneous transluminal angioplasty (PTA).  Methods  A single-center prospective study was conducted, to analyze the patients with arteriovenous fistula (AVF) undergoing PTA treatment between January, 2021 and June 2022. Their demographics, lesional characteristics, technical factors, and auxiliary examination results were collected. Risk factors for restenosis after PTA were evaluated using univariate and multivariable analyses.  Results  A total of 114 patients with RC-AVF successfully completed the first PTA treatment with a technical success rate of 95.0% (114/120), and 112 patients finished follow-up the primary assistant patency time was 512.15±226.32 days, and the secondary patency time was 554.88±205.67 days. After PTA for 90, 180, 360, and 540 days, the primary patency rates were 94.6%, 81.3%, 56.1%, and 33.3%, respectively; the primary assistant patency rates were 97.3%, 95.5%, 85.1%, and 70.1%, respectively; the secondary patency rates were 100%, 100%, 95.7%, and 85.7%, respectively. Cox regression analysis showed that balloon diameter (HR=0.62，95% CI: 0.43～0.89, P=0.009) was the independent predicting factor for primary patency loss after PTA. ROC curve analysis showed an AUC area of 0.614 (95% CI: 0.510～0.718, P=0.037) and a critical value of 6.0 mm. Stenosis length (HR=1.04, 95% CI: 1.02～1.07, P<0.001) and stenosis number (HR=3.73, 95% CI: 1.32～10.54, P=0.013) were the independent predicting factors for primary assistant patency loss after PTA, with AUC areas of 0.686 (95% CI: 0.543～0.838, P=0.009) and 0.685 (95% CI: 0.559～0.810, P=0.010), critical values of 17.5 mm and 2.   Conclusions Restenosis of the juxta-anastomotic venous stenosis in RC-AVF after primary PTA remains high. Balloon diameter is closely related to the restenosis after PTA. The use of a balloon with a maximum diameter <6 mm is an independent predictor for primary patency loss after PTA. Longer stenosis (≥17.5 mm) and stenosis number ≥2 are the independent predictors for primary assistant patency loss after PTA.  Metrics

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The effect of joint mobility exercises in dialysis on fatigue symptoms and exercise capacity in maintenance hemodialysis patients LI Lu, WANG Li-mei, QI Jia-hong, YE Li-hui, ZHENG Yuan-hua, ZHANG Chong-ni 2024, 23 (07):  552-556.  doi: 10.3969/j.issn.1671-4091.2024.07.014 Abstract ( 100 )   PDF (524KB) ( 19 )   Objective  To investigate the effects of joint mobility exercises in hemodialysis on maintenance hemodialysis (MHD) patients.  Methods  The MHD patients in the Hemodialysis Center of the First Affiliated Hospital of Nanchang University from April to October 2023 were selected as the research subjects, and patients in Donghu Hospital District and patients in Xianghu Hospital District were randomly selected as the experimental group and the control group. The patients in the control group were given routine care, and the patients in the experimental group were implemented the exercise of joint mobility in dialysis on the basis of routine care. Differences in fatigue scale-14 (FS-14) score, 6-minute walk test (6MWT), 30-second sit-to-stand test (30s-STS), and 36-item short form health survey (SF-36) score before and after the intervention were compared between the two groups.   Results   Before intervention, general information, FS-14 scores, 6MWT, 30s-TST and SF-36 scores had no statistical differences between the two groups (Z=-0.199, t=0.501, 0.278 and 0.484 respectively; P=0.842, 0.618, 0.782 and 0.629 respectively).  Compared with the control group, FS-14 scores were significantly lower (Z=-7.782, P<0.001), and 6MWT, 30s-STS, and SF-36 scores were significantly higher (t=5.812, 6.111 and 2.583 respectively;  P<0.001, <0.001  and =0.012 respectively) after the intervention in the test group.  Conclusion Joint mobility exercises in dialysis can effectively relieve fatigue symptoms and improve exercise capacity and quality of life in MHD patients. Metrics

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Analysis of social avoidance and distress in maintenance hemodialysis patients and its influencing factors CAI Yun, KONG Ling 2024, 23 (07):  557-560.  doi: 10.3969/j.issn.1671-4091.2024.07.015 Abstract ( 110 )   PDF (452KB) ( 31 )   Objective  To investigate the current situation of social avoidance and distress in maintenance hemodialysis (MHD) patients and to analyze its influencing factors.  Method  A total of 246 MHD patients treated in the Blood Purification Center of Eastern Theater Command General Hospital from September 2023 to December 2023 were selected as the investigation subjects. General information questionnaire, social avoidance and distress scale, social impact scale and perceived social support rating scale were used to the investigation.  Results  The score of social avoidance and distress in the MHD patients was 12.02±6.70, which was in the middle level. Univariate and multivariate linear regression analyses showed that gender (β=0.278, P<0.001), per capita monthly family income (β=-0.168, P<0.001), self-care ability (β=-0.133, P=0.005), number of complications (β=0.161, P=0.001), total score of stigma (β=0.344, P<0.001) and total score of perceived social support (β=-0.257, P<0.001) were the main influencing factors for social avoidance and distress.  Conclusion  The social avoidance and distress in MHD patients are at a moderate level. Medical staff should provide targeted interventions for patients according to the relevant influencing factors, so as to reduce their social avoidance and distress level and help patients better return to society. Metrics