Chinese Journal of Blood Purification

12 September 2024, Volume 23 Issue 09 Previous Issue    Next Issue

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Interpretation of the standard YY 0793.3-2023 preparation and quality management of fluids for haemodialysis and related therapies-part 3: Concentrates for haemodialysis and related therapies XU Su-hua, LUO Qing-feng, LIU Guo-guang, HUANG Qi-yu, HUANG Min-ju 2024, 23 (09):  641-645.  doi: 10.3969/j.issn.1671-4091.2024.09.001 Abstract ( 186 )   PDF (497KB) ( 36 )   YY 0793.3-2023《Preparation and Quality Control of fluids for hemodialysis and related Therapeutics - Part 3: Concentrates for hemodialysis and related Therapeutics》 will come into force on July 1, 2025. This article compares YY 0793.3-2023 with YY 0598-2015 and ISO 23500-4:2019, and interprets the differences in some important clauses, including the scope of application of the standard, requirements for chemical raw materials, solute concentration and testing methods, microbial limits and testing methods, pH value, pH value and solute concentration of online use of B dry powder, ultimately helping relevant enterprises understand and apply the standard. Metrics

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Effects of pre-dialysis chronic kidney disease management on hospitalization costs in one year and long-term mortality in maintenance hemodialysis patients YU Shu , JIA Jue , WANG Tao-tao , XU Feng-lan , Gui Lan-lan , HUA Qin , HE Jian-qiang 2024, 23 (09):  646-650.  doi: 10.3969/j.issn.1671-4091.2024.09.002 Abstract ( 138 )   PDF (528KB) ( 16 )   Objective  To further explore whether the management of chronic kidney disease (CKD) before dialysis has a long-term effect in the period after hemodialysis, so as to contribute to the better promotion of CKD management from the perspective of economics and demography.  Methods  This study enrolled 70 patients with initial hemodialysis from the CKD Outpatient Clinic (management group, group M) and 142 patients with initial hemodialysis from the Nephrology Clinic (non-management group, group NM) in the Affiliated Hospital of Jiangsu University in the period from March 2015 to March 2018. The patients were followed up for 5 years, and the hospitalization and expenses at the initial of dialysis and within 1 year after dialysis, as well as the death at 1 year and 5 years after dialysis were compared between the two groups, and the influence of various factors on all-cause death was analyzed.  Results  When starting dialysis, the total hospitalization cost per capita in group NM was significantly higher than that in the group M (t=-3.100，P=0.002). The total hospitalization cost per capita in group M was significantly lower than that in the group NM within 1 year after dialysis (t=-2.269, P=0.024), this is mainly due to a decrease in the cost of medicines, tests, treatments, surgeries and blood transfusions. Multiple linear regression found that CKD management was independently associated with a reduction in total inpatient costs per patient, whether unadjusted, adjusted for age and sex, adjusted for comorbidities, adjusted for baseline laboratory measures at hemodialysis starting, or adjusted for vascular access at hemodialysis initiation, at the time of initiation of dialysis and within one year after initiation of dialysis (Dialysis start-up β=0.386, 0.392, 0.392, 0.359, 0.248，P＜0.001, ＜0.001, ＜0.001, ＜0.001,  =0.018, respectively; Within 1 year of dialysis β=0.151, 0.154, 0.148, 0.168, 0.343，P=0.028, 0.025, 0.038, 0.021, 0.002,  respectively). Kaplan-Meier analysis showed that the 5-year cumulative survival rate difference was statistically significant (χ2=3.947, P=0.047). The results of multivariate analysis showed that age and diabetes mellitus were independent risk factors for all-cause death (HR=1.042, 0.390,95% CI: 1.021～1.062, 0.226～0.671, P＜0.001, 0.001), while pre-dialysis CKD management was protective factor for all-cause death (HR=0.503, 95% CI: 0.295～0.857, P=0.012).  Conclusions   Pre-dialysis CKD management has a legacy effect on post-dialysis economic outcomes and can improve the long-term prognosis of maintenance hemodialysis patients, we should pay more attention to diabetes and elderly patients in CKD management. Metrics

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Observation of extracorporal administration of the anticoagulant nafamostat mesylate in hemodialysis patients with high bleeding risk YANG Zhen-hua, CHEN Qiu-xin, LI Qian-yu, PAN Xiao-ting, WANG Lu, CHEN Yu, CHEN Xiao-nong, MA Xiao-bo 2024, 23 (09):  651-654,662.  doi: 10.3969/j.issn.1671-4091.2024.09.003 Abstract ( 197 )   PDF (696KB) ( 19 )   Objective  To investigate the safety and efficacy of nafamostat mesylate in hemodialysis (HD) patients with high bleeding risk.   Methods   A total of 60 patients with high bleeding risk undergoing HD treated in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2023 to August 2023 were randomly divided into anticoagulant group (nafamostat mesylate group) and no anticoagulant group, with 30 cases in each group. The efficacy and safety of HD were compared between the two groups.  Results  In the anticoagulant group, the use time of cardiopulmonary bypass pipeline was longer (t=5.118, P＜0.001), the average service life of dialyzer was longer (t=4.691, P＜0.001), the number of venous pressure alarm intervention was less (χ2=4.691, P＜0.010), the effective rate of grade 0-1 anticoagulation was higher (χ2=24.300, P＜0.001), the single chamber model urea clearance index (spkt/v) was higher (t=17.456, P＜0.010), and no transmembrane pressure alarm intervention and dialyzer replacement happened. In the anticoagulant group, the activated partial thromboplastin time (APTT), thrombin time (TT), prothrombin time (PT), international normalized ratio (INR), fibrinogen (FG) and fibrin degradation products (FDP) had no significant differences in the samples from blood pipeline before heparin pump (blood collection point A) before HD, during HD at 1h, 2h, 3h, and end of HD, and in the sample from contralateral limb without autologous arteriovenous fistula (blood collection point C) after HD for 15min (F= 0.132, 1.708, 0.025, 1.394, 0.849 and 0.993 respectively; P=0.985, 0.135, 1.000, 0.229, 1.106 and 0.424 respectively). The activated clotting time (ACT) showed no significant difference in the samples from the blood pipeline behind the dialyzer (blood collection point B) during HD at 1h, 2h, 3h, and end of HD (F=0.297, P=0.914). No adverse events including allergic reaction, hyperkalemia, bleeding, arrhythmia occurred in the two groups.   Conclusion   Nafamostat mesylate has better efficacy and safety used as an anticoagulant for HD in patients with high bleeding risk. Metrics

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Study on the efficacy and safety of double plasma molecular adsorption system in different length of treatment time ZHOU Sheng-yu, ZHANG Ling, YANG Ying-ying, CHEN Zhi-wen, QIANG Jing-ya, ZHAO yuan 2024, 23 (09):  655-658.  doi: 10.3969/j.issn.1671-4091.2024.09.004 Abstract ( 125 )   PDF (471KB) ( 14 )   Objective  To discuss the efficacy and safety of double plasma molecular adsorption system (DPMAS) in the different length of treatment time.   Methods   This is a prospective cohort study, including patients who received DPMAS treatment in West China Hospital of Sichuan University from September 2022 to December 2023.They were divided into 2h, 3h and 4h groups according to the actual treatment time, to analyze changes in the proportion of bilirubin clearance, coagulation function, albumin and platelet levels, and the incidence of coagulation events before and after treatment in different groups of patients.  Results  A total of 99 patients with liver failure were included, including 136 treatments. Proportion of bilirubin decline before and after treatment: The 2h group was (24.05 ± 8.95)%, the 3h group was (27.98±10.83)%, and the 4h group was (30.44 ± 8.81)%, with statistical differences (F=4.607, P=0.012). There was a statistically significant difference (t=-3.296, P=0.001) in the proportion of bilirubin decrease between the 2h and 4h groups and no statistically significant difference between the 2h and 3h groups (t=1.783, P=0.078), and the 3h and 4h groups (t=-1.244, P=0.216). There were no significant differences in the changes of activated partial thromboplastin time (APTT) (F=1.994, P=0.369), albumin (F=2.411, P=0.300), platelet (F=3.736, P=0.369) and incidence of coagulation events (χ２=0.856, P=0.746) among different treatment time groups. The decrease ratio of bilirubin in different periods: in the 4h group (25.35±5.92) % in 0～2h, (3.29±3.29) % in 2～3h, (1.8±3.99) % in 3～4h, in the 3h group (24.02±10.31) % in 0～2h, and (3.96±3.91) % in 2～3h.  Conclusion  This study validated the effectiveness and safety of DPMAS treatment. The bilirubin clearance ratio showed the highest trend in the first 2 hours and gradually decreased over time. Compared with the 2-hour treatment group, the proportion of bilirubin decrease before and after treatment was significantly increased in the 3-hour and 4-hour treatment groups. At the same time, there were no significant differences in APTT, albumin, and coagulation event incidence among the groups. Therefore, this study suggests that the single treatment time of DPMAS should be guaranteed to be at least 2h, and can be extended to 4h. Metrics

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To explore the clinical characteristics of upper extremity arterial calcification in maintenance hemodialysis patients WANG Chen, XU Yuan-kai, YANG Yan-li, LI Wen, RUAN Lin, ZHANG Li-hong 2024, 23 (09):  659-662.  doi: 10.3969/j.issn.1671-4091.2024.09.005 Abstract ( 166 )   PDF (752KB) ( 17 )   Objective  To investigate the distribution characteristics of forearm artery calcification in maintenance hemodialysis patients and its correlation with vascular access.   Methods   Patients who received regular hemodialysis treatment in the Blood Purification Center of the First Hospital of Hebei Medical University from January 2023 to July 2023 were selected. Clinical data were collected. Doppler ultrasound was used to examine the radial artery and ulnar artery of both upper limbs, and the calcification score was recorded.  Results  A total of 118 patients were included. The overall prevalence of radial artery and ulnar artery calcification: the prevalence of ulnar artery calcification on the non-fistula side was higher than that of radial artery calcification (P=0.029), with a statistical difference. There were no significant difference of the prevalence of calcification between the ulnar artery and radial artery (P=0.557). In addition, the prevalence of calcification on the internal fistula side of the radial artery was significantly higher than that on the non-internal fistula side (P=0.015). The prevalence of calcification was no significant difference between ulnar artery fistula side and non-fistula side (P=0.405). The prevalence of calcification in different segments of the radial artery and ulnar artery: the prevalence of calcification in the distal segment of the radial artery and ulnar artery was higher than that in the proximal segment, regardless of the internal fistula side or the non-internal fistula side (P =0.001；P＜0.001；P＜0.001；P＜0.001). Comparison of the severity of vascular calcification: the degree of calcification in the ulnar artery was more severe than that in the radial artery (χ2=14.524, P=0.024), the difference was statistically significant. The calcification degree of the ulnar artery on the non-fistula side was more severe than that of the radial artery (χ2=17.522, P=0.004), and the difference was statistically significant. The degree of calcification of the radial artery in the fistula side was more severe than that in the non-fistula side (χ2=12.943, P=0.044). The severity of ulnar artery calcification on the fistula side was basically the same as that on the non-fistula side (χ2=6.733, P=0.346).  Conclusions   The prevalence and severity of vascular calcification in the distal segment of the upper extremity artery in maintenance hemodialysis patients are higher than those in the proximal segment, and the ulnar artery may be more susceptible to calcification. Metrics

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Correlation between visceral adipose tissue area and clinical efficacy of double filtered plasma exchange in patients with hyperlipidemic pancreatitis LIU Duan, ZHONG Yi-xia, ZENG Pan, WANG Xiao-juan 2024, 23 (09):  663-667.  doi: 10.3969/j.issn.1671-4091.2024.09.006 Abstract ( 89 )   PDF (573KB) ( 4 )   Objective   To investigate the correlation between the visceral adipose tissue area (VFA) and the clinical efficacy of double filtered plasma exchange (DFPP) in patients with hyperlipidemic pancreatitis (HLAP).  Methods   A total of 225 patients with HLAP treated with DFPP in First People's Hospital of Zigong City from January 2020 to December 2022 were selected and divided into effective group (n=180) and ineffective group (n=45) according to the clinical efficacy. General clinical data and VFA were compared between the two groups. Multivariate logistic regression was used to analyze the influencing factors for the ineffective outcomes. The dose-response relating to VFA level and the probability of ineffective treatment was analyzed. Based on the influencing factors, a prediction model was established and verified.  Results  Drinking history (OR=3.603, 95% CI: 2.577～4.868, P=0.018), high BMI (OR=2.407, 95% CI: 1.381～3.672, P=0.016), high APACHE Ⅱ score (OR=3.087, 95% CI:2.061～4.352,P=0.026), high fasting plasma glucose (FPG) (OR=1.313, 95% CI: 1.007～2.578, P=0.009), high total cholesterol (TC) (OR=2.511, 95% CI: 1.485～3.776, P=0.025), high triglycerides (TG) (OR=4.885, 95% CI: 3.859～6.150, P=0.035), high LDL-C (OR=3.165, 95% CI: 2.139～4.430, P=0.010), low HDL-C (OR=4.163, 95% CI: 3.137～5.428, P=0.011), high IL-6 (OR=2.117, 95% CI: 1.091～3.382, P=0.006), high IL-8 (OR=3.115, 95% CI: 2.089～4.380, P=0.023), high C-reactive protein (CRP) (OR=1.975, 95% CI: 1.049～3.240, P=0.035), high procalcitonin (PCT) (OR=3.665, 95% CI: 2.639～4.930, P=0.036), high blood amylase (OR=4.547, 95% CI: 3.521～5.812, P=0.041), high blood lipase (OR=2.229, 95% CI: 1.203～3.494, P=0.043), and large VFA (OR=2.827, 95% CI: 1.801～4.092, P=0.031) were the influential factors for efficacy. Dose-response relationship analysis showed that with the increase of VFA, the probability of clinical ineffective treatment increased as well. The regression equation was P=1/[1+exp(-3.265+1.282×drinking history+0.878×BMI+1.127×APACHE Ⅱ score +0.272×FPG+0.921×TC+1.586×TG+1.152×LDL-C+1.426×HDL-C+0.750×IL-6+1.136×IL-8+0.681×CRP+1.299×PCT+1.514×blood amylase+0.802×blood lipase+1.039×VFA)].   Conclusion  In HLAP patients, VFA is significantly correlated with the clinical efficacy of DFPP, and the probability of clinical non-efficacy is gradually increased along with the increase of VFA. Metrics

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Relationship between serum osteoprotegerin and calcification of abdominal aorta in hemodialysis patients HU Yan-qiu, TENG Jian, GONG Xue, XU Xiao-na, WAN Mei-yan 2024, 23 (09):  668-672.  doi: 10.3969/j.issn.1671-4091.2024.09.007 Abstract ( 126 )   PDF (510KB) ( 7 )   bjective  To investigate the relationship between serum periostin (POSTN) and abdominal aortic calcification (AAC) in patients on maintenance hemodialysis (MHD).  Methods   A total of 95 patients treated with MHD for more than 3 months in the Blood Purification Center of Qingdao Municipal Hospital from October 2022 to October 2023 were selected as the study subjects. Clinical data and laboratory results were collected. ELISA was used to detect the serum POSTN level. Lateral abdominal X-ray film was conducted to evaluate AAC and to calculate AAC score. Pearson correlation analysis and univariate and multivariate binary logistic regression models were applied to investigate the risk factors for AAC in MHD patients.  Results   ①Serum POSTN was higher in the MHD patient group than in the healthy control group (Z=-8.744, P＜0.001).  ②Correlation analysis found that serum POSTN level was positively correlated with AAC score (r=0.755, P＜0.001), dialysis age (r=0.622, P＜0.001), parathyroid hormone (r=0.202 P=0.049), β2-microglobulin (r=0.212, P=0.039), and low-density lipoprotein (r=0.233, P=0.023), and was negatively correlated with glomerular filtration rate (r=-0.695, P＜0.001).  ③Results of univariate and multivariate binary logistic regression analyses showed that after adjusting for confounders including dialysis age and parathyroid hormone, serum POSTN was an independent risk factor for occurrence of AAC in MHD patients (OR=1.597, 95% CI: 1.005～2.536, P=0.047).  Conclusion  Serum POSTN level was higher in MHD patients than in healthy population. Higher serum POSTN was associated with AAC in MHD patients. Metrics

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Meta integration of qualitative research on fatigue experience and self-management in hemodialysis patients AO Man, YAO Rui-shan, WANG Hui-ming, YANG Lian-hua, BU Wen-duo, BIAN Ting-ting, CHEN Yuan-yuan, WAN Jia 2024, 23 (09):  673-677.  doi: 10.3969/j.issn.1671-4091.2024.09.008 Abstract ( 126 )   PDF (544KB) ( 12 )   Objective  To systematically evaluate and integrate the qualitative studies on fatigue experience and management in hemodialysis patients.  Methods   Cochrane Library, Web of Science, PubMed, CINAHL, Embase, Scopus, CBM, CNKI, Wanfang, and VIP databases were searched for qualitative studies on the experience and management of fatigue in hemodialysis patients from their inception to December 2023.  Results  A total of 9 articles were included, 38 results were extracted, 10 categories were formed, and 4 integrated results were summarized: hemodialysis patients' cognition of fatigue, the impact of fatigue, patient self-management strategies, fatigue management needs and challenges.   Conclusion  There are obstacles in the management of fatigue in hemodialysis patients, such as cognitive deficiency, negative emotional influence, incomplete self-management strategies, and imprecise interventions. Medical institutions should build diversified management strategies and provide comprehensive support to improve self-management strategies, survival cycle, and quality of life in hemodialysis patients. Metrics

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Reassessment of cardiac troponin T (cTnT) level variation and clinical value during acute myocardial infarction in hemodialysis patients ANG Xiao-xia, SUN Peng, LIU Fang, YU Rui, LU Min, GAO Qing-zhen 2024, 23 (09):  678-682.  doi: 10.3969/j.issn.1671-4091.2024.09.009 Abstract ( 94 )   PDF (506KB) ( 5 )   Objectives  To investigate the variation of serum cardiac troponin T (cTnT) and its clinical value in hemodialysis patients with acute myocardial infarction (AMI).  Methods  We retrospectively studied the cTnT level and its variation trend in hemodialysis patients and normal renal function patients with AMI, to determine the relationship between cTnT level and the degree of AMI, and to predict the rate of recurrent AMI and mortality.  Results   During non-AMI stage, the baseline cTnT level was 147.25 (92.85, 236.65) ng/L in hemodialysis patients, significantly higher than that of 25.0 (15.0, 52.3) ng/L in normal renal function patients (Z=-11.595, P<0.001), and the cut-off value of cTnT  for the diagnosis of AMI was 396.45ng/L. During AMI stage, the peak level of cTnT was 1938.0 ng/L in hemodialysis patients, higher than that of 1036.5ng/L in normal renal function patients (Z=-6.041, P＜0.001); cTnT reached a peak after 4.0 days, with an overall duration of 23.0 days in hemodialysis patients, longer than the values in normal renal function patients (Z=-6.771 and -9.592; P<0.001). Peak cTnT level was positively correlated with ECG ischemia grade in hemodialysis patients (r=0.620, P<0.001). Peak cTnT was positively correlated with AMI recurrence (r=0.907, P<0.001) and all-cause death (r=0.938, P<0.001).  Conclusions   Higher cTnT cutoff value is required for the diagnosis of AMI in hemodialysis patients. Compared with AMI in normal renal function patients, the peak level of cTnT is higher and lasts longer in AMI of hemodialysis patients, but the values can still be useful to reflect the degree of AMI and to predict AMI recurrence and mortality. Metrics

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Research progress in job competency training for blood purification nurses ZHANG Yu-jiao, YUAN Jing, NING Yun-feng, YING Jin-ping 2024, 23 (09):  683-685,710.  doi: 10.3969/j.issn.1671-4091.2024.09.010 Abstract ( 132 )   PDF (504KB) ( 46 )   Blood purification patients have various primary diseases and may present rapid disease changes or critically ill situations, which need the management by professional nurses with comprehensive competency of higher quality. Training blood purification nurses familiar with a variety of blood purification operations and enable to deal with various clinical problems are then required. Nurses newly working in this field are usually facing many challenges, including the specific skills of nursing operations and the abilities to identify disease changes, quite different from the nursing skills in other departments. Enhanced training of these nurses is an essential step to quickly increase their job competency capable to independently manage blood purification operations and dialysis patients and to support the continuing development of professional nursing in blood purification centers. This article reviews the research advances in the abilities of blood purification nurses. We summarize the importance and present situation of blood purification nurse training in China and foreign countries based on the concept of job competency, in order to provide references for the management and excellence of training new blood purification nurses. Metrics

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Research progresses in pulmonary hypertension in maintenance hemodialysis patients GU Ya-jing, LIU Li-ting, JIANG Yan, SU Chao-jiang, CHEN Yan, LIU Zong-yang 2024, 23 (09):  686-689.  doi: 10.3969/j.issn.1671-4091.2024.09.011 Abstract ( 129 )   PDF (461KB) ( 19 )   Pulmonary hypertension is a clinical disorder characterized by the continuing hyper-resistance of pulmonary vessels. Pulmonary hypertension is frequently encountered in maintenance hemodialysis (MHD) patients with a higher mortality rate. The mechanism of the disorder is yet unknown, and its clinical presentations are insidious. Here we summarize the recent progresses in pulmonary hypertension in MHD patients in China and foreign countries, so as to provide references for early diagnosis and management of pulmonary hypertension in MHD patients. Metrics

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Correlation analysis between the arteriovenous fistula infection and the levels of peripheral blood CD4 count and albumin in HIV-positive renal failure patients after arteriovenous fistula surgery XIN Yi, YANG Ting-ting, SONG Xiao-fei, HE Ya-nan 2024, 23 (09):  690-693.  doi: 10.3969/j.issn.1671-4091.2024.09.012 Abstract ( 92 )   PDF (505KB) ( 11 )   Objective  To analyze the correlation between the infection after the arteriovenous fistula (AVF) surgery and the levels of peripheral blood CD4 count and albumin (ALB) in human immunodeficiency virus (HIV)-positive patients with renal failure undergoing hemodialysis.  Methods  A total of 96 patients with HIV-positive and renal failure primarily undergoing AVF surgery for hemodialysis at the Chengdu Public Health Clinical Medical Center from July 2016 to October 2023 were selected as the research subjects. They were divided into an infection group (20 cases) and an non-infected group (76 cases) based on whether they had AVF infection. Logistic regression was used to analyze the factors affecting the occurrence of infection after AVF surgery. Spearman correlation was used to analyze the correlation between peripheral blood CD4 count, ALB level, infection probability score (IPS), and acute physiology and chronic health evaluation II (APACHE II) score. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of peripheral blood CD4 count and ALB for the occurrence of AVF infection after the surgery.  Results  The repeated puncture rate and the rate of allergy at puncture site were 55.00% and 45.00% respectively in the infection group, higher than those of 19.74% and 14.47% respectively in the non-infection group (χ2=9.970 and 7.191; P=0.002 and 0.007). The peripheral blood CD4 count and ALB level were lower in the infected group than in the non-infected group (t=8.073 and 7.092; P=0.001 and 0.001). Repeated puncture at the puncture site (OR=3.552, 95% CI: 1.186～10.637, P=0.001), allergy at puncture site (OR=4.042, 95% CI: 1.245～13.120, P=0.001), peripheral blood CD4 count (OR=0.370, 95% CI: 0.182～0.753, P=0.001), and ALB level (OR=0.356, 95% CI: 0.176～0.720, P=0.001) were the factors affecting the occurrence of infection after the first AVF surgery in HIV-positive renal failure patients undergoing hemodialysis (P＜0.05). In the infection group, patients with CD4 count ＜200 cells/μl had higher IPS and APACHE II scores than those with CD4 count ≥200 cells/μl (t=3.774 and 4.123; P=0.001 and 0.001); patients with ALB ＜30 g/L had higher IPS and APACHE II scores than those with ALB ≥30 g/L (t=3.594 and 4.229; P=0.002 and 0.001); peripheral blood CD4 count and ALB level were negatively correlated with IPS and APACHE II scores  (r=-0.576,  -0.621,        -0.562 and -0.643 respectively; P=0.001, 0.001, 0.001 and 0.001 respectively). The area under the curves of peripheral blood CD4 count and ALB for predicting infection in HIV-positive renal failure patients undergoing hemodialysis after AVF surgery were 0.763 and 0.800 respectively; the area under the curve of combined use of peripheral blood CD4 count and ALB was 0.947, significantly greater than that of individual use of the two factors for the prediction (Z=2.793 and 2.078; P=0.007 and 0.035).  Conclusion  Infection after the first AVF surgery in HIV-positive renal failure patients is closely related to peripheral CD4 count and ALB level. Combined use of peripheral CD4 count and ALB level can provide an important reference to predict AVF infection. Metrics

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Mid- and long-term therapeutic efficacy of surgical treatment for arteriovenous fistula aneurysm XIE Zhan-chang, LIU Min, WANG Wei, YU Kang-min 2024, 23 (09):  694-697.  doi: 10.3969/j.issn.1671-4091.2024.09.013 Abstract ( 119 )   PDF (622KB) ( 7 )   Objective  To investigate the mid- and long-term effects of different surgical methods to resect arteriovenous fistula aneurysm (AVFa) on fistula function. Methods We retrospectively analyzed the clinical data of 36 patients undergoing surgical treatment of AVFa at our center between Feb. 2016 and Feb. 2020. Eighteen patients underwent aneurysmorrhaphy to reshape the new AVF, 13 ineligible patients underwent aneurysm resection with outflow reconstruction to construct a new dialysis pathway, and 5 patients had only aneurysm resection and failed to retain fistula function. All patients were followed up for 36 months.   Results The 18 patients undergoing aneurysmorrhaphy dialyzed with the primary AVF immediately after surgery, with normal AVF function and no recurrence of aneurysm in follow-up study. Of the 13 patients undergoing reconstruction of the outflow tract, 5 had anastomotic stricture in the 36 months period of follow-up. The fistula became patent after PTA treatment and could be used normally. The remaining 5 patients underwent AVFa resection.  Conclusion  Aneurysmorrhaphy is an effective treatment for AVFa in hemodialysis patients, can preserve adequate vascular resources in forearm for hemodialysis, and has satisfactory mid- and long-term patency rates. Metrics

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The effect of lidocaine aerosol on reducing the pain during real-time ultrasound guided puncture of new autogenous arteriovenous fistula XIAO Guang-hui, ZHANG Wen-di, ZHANG Li-hong, ZHAN Shen, ZHAO Bin, WEN Jing, ZHANG Fan, WANG Yu-zhu 2024, 23 (09):  698-700.  doi: 10.3969/j.issn.1671-4091.2024.09.014 Abstract ( 97 )   PDF (453KB) ( 4 )   Objective   To observe the clinical effect of lidocaine aerosol on reducing the pain during real-time ultrasound guided puncture in hemodialysis patients with new autogenous arteriovenous fistula (AVF).  Methods   A total of 60 maintenance hemodialysis patients undergoing new autogenous AVF puncture in our blood purification center were selected as the research subjects. They were divided by using the random number grouping method into a standard group and a lidocaine aerosol group. The standard group underwent routine real-time ultrasound guided puncture, and the lidocaine aerosol group used lidocaine aerosol locally applied on puncture site 15 minutes before the real-time ultrasound guided puncture. Visual analogue scale (VAS) pain scoring was used to assess the pain level during puncture of the new autogenous AVF in the two groups.  Results  Comparison of the pain score distribution between the two groups found that the pain score was lower in the lidocaine aerosol group than in the standard group (Z=6.783, P＜0.001), and the ratios of no pain and slight pain during the puncture were higher in the lidocaine aerosol group than in the standard group (χ2=60.000, P＜0.001).  Conclusion   Local use of lidocaine aerosol can significantly reduce the pain during real-time ultrasound guided puncture of new autogenous AVF, bringing a better experience of AVF puncture to the maintenance hemodialysis patients. This method can be widely used in clinical practice. Metrics

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Feasibility of arteriovenous fistula function monitoring based on machine learning and audio technology WANG Fan-li, YANG Yan-li, XU Yuan-kai, RUAN Lin, LI Wen, LIU Yong-liang, SUN LI-jun, LEI Ying, LIU Xiao-ming, ZHAO Pei-nan, ZHANG Li-hong 2024, 23 (09):  701-705.  doi: 10.3969/j.issn.1671-4091.2024.09.015 Abstract ( 106 )   PDF (875KB) ( 17 )   Objective To explore the feasibility of using machine learning and audio technology and analyzing the auscultation data from arteriovenous fistula (AVF) to monitor AVF function. Methods A total of 50 patients with AVF stenosis which required percutaneous transluminal angioplasty (PTA) were recruited in this study. Digital sound of the AVF shunt was recorded using a wireless electronic stethoscope before (pre-PTA) and after PTA (post-PTA). The audio files were subsequently converted to spectrograms, and the acoustic signatures were extracted. More than 30 classification learners in MATLAB software were used to analyze the extracted acoustic features, and models to evaluate the AVF function were constructed. Finally, the performance of these models was compared.   Results  One hundred audio files were obtained from the 50 recruited patients and were pooled for the study. In the spectrogram comparison of AVF before PTA and after PTA, the spectrogram before PTA showed a larger high-frequency amplitude. There was a significant difference between the files before and after PTA (Z=-4.721, P＜0.001). The highest and lowest frequencies in a cardiac cycle were significant different before and after PTA, and the difference was greater before PTA than after PTA (Z=-6.169, P＜0.001). Among the models established by more than 30 kinds of classification learners, the model established by efficient linear support vector machine (SVM) and coarse Gaussian SVM had the best performance, with 81.11% accuracy after 5-fold cross validation. The test accuracy of the model constructed by quadratic discrimination, cubic kNN, medium neural network, and double-layer neural network can reach up to 90%.  Conclusions  Spectrum-based machine learning models can predict the saliency narrowness of AVF, so it is feasible to use it for the monitoring of AVF function. The model constructed by efficient linear SVM and rough Gaussian SVM had the best performance in this feasibility study. Metrics

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Investigation on the operational status of point-of-care ultrasound assisted difficult arteriovenous fistula puncture in 18 hospitals ZHANG Jie-ting, LI Jing-hui, ZHAO Dai-xin, WU Yi-fan, LIANG Yu-ting, LI Yin, WEI Shuang 2024, 23 (09):  706-710.  doi: 10.3969/j.issn.1671-4091.2024.09.016 Abstract ( 93 )   PDF (500KB) ( 18 )   Objective  To investigate the nursing operation status of point-of-care ultrasound (POCUS) assisted difficult arteriovenous fistula (AVF) puncture in 18 hospitals in order to provide a scientific basis for quality management and specialized training of the clinical nursing operations.  Methods   This was a cross-sectional study. The videos of POCUS assisted difficult AVF puncture operation from the 18 hospitals were examined. A scoring rule for the operation was developed as the scoring basis. Six key steps of the manipulation were extracted for the scoring, including routine evaluation and safety verification, nurse-patient communication, infection control, AVF routine evaluation, ultrasound evaluation, and ultrasound guided puncture. The scores were then statistically analyzed.  Results  The average score of the manipulation on video from the 18 cases was 79.25±10.91. For the six key steps of the manipulation, ratios of the steps with low scores were evaluation and safety verification 55.56%, nurse-patient communication 50.00%, AVF routine evaluation 44.44%, infection control 38.89%, ultrasound evaluation 11.11%, and ultrasound guided puncture 0%. The video duration and the operation score were positively correlated (r=0.717, P=0.001).  Conclusion   The scoring standard for POCUS assistant difficult fistula puncture developed in this study is helpful to standardize this procedure and is worth promoting. Metrics

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The application value of self-disclosure group intervention in caregivers of peritoneal dialysis patients LI Xiu-mei, ZHANG Hong-mei, LI Xiao-han, ZHANG Ya-li, ZHENG Yan 2024, 23 (09):  711-715.  doi: 10.3969/j.issn.1671-4091.2024.09.017 Abstract ( 104 )   PDF (591KB) ( 6 )   Objective  To explore the effects of self-disclosure group intervention program on the care burden and quality of life of the caregivers for peritoneal dialysis (PD) patients.  Methods  The caregivers of 90 PD patients were selected by convenient method as the study objects. These PD patients admitted to the Peritoneal Dialysis Center of Henan Provincial People's Hospital from February to May 2022, and were equally divided into experimental group and control group. The control group received routine nursing, and the experimental group received routine nursing plus group intervention nursing based on self-disclosure. General information questionnaire, caregiver burden scale, and adult caregiver quality of life questionnaire were used. Results  The repeated measure analysis of variance was used for the analyses. There were statistical differences between the experimental group and the control group in the total score of caregiver burden in the inter-group effect (F=22.135, P＜0.001), the intra-group effect (F=63.601, P＜0.001) and the interaction effect between time and groups (F=162.598, P＜0.001). There were statistically significant differences in the total score of caregivers' quality of life between groups (F=33.414, P＜0.001), within groups (F=76.329, P＜0.001), and interaction effect between time and groups (F=46.482, P＜0.001).  Conclusion  The self-disclosure group intervention program for the caregivers of PD patients can reduce the burden of the caregivers, improve the quality of life of the caregivers, and provide a valuable reference for the medical professionals. Metrics

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Summary of best evidence for the management of thirst symptoms in hemodialysis patients JIANG Hai-long, LI Chang, GAI Ying, GENG Xiao-ting, ZHANG Chi, LI Shu-ying 2024, 23 (09):  716-720.  doi: 10.3969/j.issn.1671-4091.2024.09.018 Abstract ( 171 )   PDF (484KB) ( 35 )   Objective  To evaluate and summarize the best evidence for the management of thirst symptoms in hemodialysis patients, and to provide evidence-based data for clinical practice.  Method  We systematically searched domestic and foreign computerized decision support systems, guideline websites, databases, and websites of professional associations relating to the management of thirst symptoms in hemodialysis patients from establishment of the databases to November 2023. AGREE II, JBI  and CASE evaluation tools were used to evaluate the quality of the included literature and to summarize the evidence of the literature that meets the requirements.  Result  A total of 12 articles were included, including one guideline, one evidence summary, 3 systematic reviews, and 7 randomized controlled trials.   Conclusion  This study summarizes the best evidence for the management of thirst symptoms in hemodialysis patients and provides a scientific basis of clinical practice for healthcare professionals. Metrics