Chinese Journal of Blood Purification

12 November 2024, Volume 23 Issue 11 Previous Issue    Next Issue

Select

A mesh meta-analysis of the effect of non-drug intervention on restless leg syndrome in hemodialysis patients WANG Pan, XIAO Jun-nan, XIA Yu-xiao, ZHANG Bin, HUANG Bing-luan, FENG Xiu-li 2024, 23 (11):  801-806.  doi: 10.3969/j.issn.1671-4091.2024.11.001 Abstract ( 143 )   PDF (682KB) ( 17 )   Objective  To comprehensively evaluate the effect of non-drug intervention on the symptoms of restless legs syndrome (RLS) in hemodialysis patients, and to provide references for selecting the best intervention measures.   Methods  Randomized controlled studies on the effects of different non-drug interventions on RLS in hemodialysis patients were searched by computer in PubMed, Embase, Web of Science, Cochrane, CNKI, VIP, Wanfang and Biomedical Literature Service System from the establishment of the database to May 2023. Two researchers independently screened the literature, extracted data, and evaluated literature quality. Stata 17.0 software was used to perform mesh meta-analysis.   Results  A total of 21 studies were included, with a total sample size of 1,183 cases. The results of mesh meta-analysis showed that cold dialysate was the best choice for improving RLS symptoms in hemodialysis patients. Cold dialysate combined with foot bath using traditional Chinese medicine and acupressure (SMD=-13.23～95% CI:   -25.15～-1.32), acupressure application (SMD=-18.20～95% CI: -30.06～-6.34), exercise training during dialysis (SMD=-12.47～95% CI: -21.68～-3.27), auricular-point compression therapy (SMD=-17.07～95% CI: -29.30～-4.84), foot reflexology (SMD=-11.84～95% CI: -22.02～-1.66), infrared light therapy (SMD =  -18.16～95% CI: -30.07～-6.25), acupuncture therapy (SMD=18.91, 95% CI: 7.06, 30.77), and acupressure (SMD=17.91, 95% CI: 4.65～31.16) also had the statistical differences (P＜0.017).   Conclusion   Among the non-drug interventions, cold dialysate can improve RLS symptoms in hemodialysis patients, and the intervention of RLS can be managed according to patient tolerance. Metrics

Select

Correlation analysis of 25-hydroxyvitamin D3 with chronic kidney disease-associated pruritus in dialysis patients JI Bo-fan, CHEN Jing-jing, MA Xue-jie, ZHANG Xiao-liang, TANG Ri-ning 2024, 23 (11):  807-812.  doi: 10.3969/j.issn.1671-4091.2024.11.002 Abstract ( 164 )   PDF (613KB) ( 21 )   Objective  To investigate the association between 25-hydroxyvitamin D3 [25(OH)D3] and chronic kidney disease-associated pruritus (CKD-aP) in patients on maintenance hemodialysis (MHD) or peritoneal dialysis (PD), and the predictive value of 25(OH)D3 level for CKD-aP in dialysis patients. Methods  In this single-center, cross-sectional study, patients with MHD, or PD treatment from 1 January 2022 to 31 December 2022 in the Zhongda Hospital, affiliated with Southeast University were selected as subjects. Based on the absence of CKD-aP, the patients were divided into the non-pruritus and pruritus groups, then compare the clinical data and 25(OH)D3 level between the two groups. The pruritus group further divided into mild and moderate-to-severe pruritus based on the pruritus score. Then we compared the 25(OH)D3 levels in the general population, MHD, and PD patients in different itching severity groups. The ROC curve was used to analyze the clinical value of 25(OH)D3 in predicting the occurrence of CKD-aP in dialysis patients.  Results  A total of 331 dialysis patients were included, including 238 patients with MHD and 93 patients with PD. The prevalence of CKD-aP was 56.5%, 58.4% and 51.6%, respectively. The 25(OH)D3 in the pruritus group of MHD and PD patients was lower than that in the non-pruritus group (MHD: 13.490 (10.140, 17.980) vs. 18.900 (10.910, 24.630), Z=-3.538, P<0.001; PD: 7.215 (4.843, 11.875) vs. 12.090 (6.630, 15.240), Z=-3.075, P=0.002). Further analysis showed that There were statistically differences in 25(OH)D3 among no pruritus group, mild pruritus group, and moderate to severe pruritus group (total population: H=28.823 P<0.001; MHD: H=25.137 P<0.001; PD: H=12.228 P=0.002). 25(OH)D3 decreased with the increase of pruritus in the total population and MHD patients (P<0.05). The 25(OH)D3 in the non-pruritus group was higher than that in the mild pruritus group (P=0.015) and the moderate-to-severe pruritus group (P=0.003), and there was no significant difference in 25(OH)D3 between the mild pruritus group and the moderate-to-severe pruritus group (P=0.081). The results of multivariate logistic regression analysis showed that white blood cell count (OR=1.257, 95% CI: 1.033～1.529, P=0.022), serum phosphorus (OR=2.277, 95% CI: 1.215～4.268, P=0.010), parathyroid hormone (OR=1.002, 95% CI: 1.000～1.003, P=0.018), β2-microglobulin (OR=1.039, 95% CI: 1.007～1.073, P=0.017) were risk factors for CKD-aP in MHD patients, and serum phosphorus (OR=4.613, 95% CI: 1.354～15.719,P=0.015) and hypersensitive C-reactive protein (OR=1.192, 95% CI: 1.019～1.395, P=0.028) were risk factors for CKD-aP in PD patients. 25(OH)D3 was a protective factor for CKD-aP in patients with MHD and PD (MHD: OR=0.937, 95% CI: 0.901～0.975, P=0.001. PD: OR=0.909, 95% CI: 0.830～0.995, P=0.038). The ROC curve showed that the predicted AUC was 0.635 when the 25(OH)D3<18.835 ng/ml in MHD patients and 0.685 when the 25(OH)D3<10.545 ng/ml in PD patients.  Conclusions  Lower 25(OH)D3 may play an important role in CKD-aP in dialysis patients. Moreover, 25(OH)D3 level has certain clinical value in predicting the occurrence of CKD-aP in dialysis patients. Metrics

Select

Multivariate prediction of cardiovascular disease risk in maintenance hemodialysis patients XIONG Rui-fang, XU Zhuo-jia 2024, 23 (11):  813-817.  doi: 10.3969/j.issn.1671-4091.2024.11.003 Abstract ( 103 )   PDF (456KB) ( 3 )   Objective   Explore the predictive value of mean platelet volume (MPV), neutrophil to lymphocyte ratio (NLR) combined with C-reactive protein (CRP) for cardiovascular disease (CVD) in maintenance hemodialysis (MHD) patients.  Method  Selecting patients diagnosed with uremia and undergoing MHD in nephrology department of Civil Aviation General Hospital from August 2018 to June 2023, patients were divided into survival group and cardiovascular death group based on the occurrence of cardiovascular death events. Demographic data including age, gender, body mass index (BMI), dialysis age and laboratory data (blood routine, biochemical routine) were collected. Independent risk factors were identified by using on logistic regression analysis, and receiver operator characteristic (ROC) curves were used for predictive performance analysis.  Result  A total of 267 patients were included, including 228 of survival group and 39 of cardiovascular death group.1. There were no statistically significant difference in general data such as age  (t= -1.835, P=0.068), gender (χ2=3.515, P=0.061), BMI (t=1.971, P=0.051), and dialysis age (t=-1.092, P=0.062) between the two groups. 2. MPV [11.30(10.4, 12.6)] fL, NLR [6.75(4.8, 12.7)], and CRP [15.80(5.8, 64.5)]mg/L in cardiovascular death event group were significantly higher than survival group (Z/t values were     -7.456, -5.340, -5.416, respectively, all P＜0.001). While albumin (ALB), creatinine (Cr), calcium (Ca), phosphorus (P), and hemoglobin (Hb) were significantly lower than survival group (Z/t values were 5.968, 5.168, 4.375,    -3.552, -2.052, and P were ＜0.001, ＜0.001, ＜0.001, 0.040, 0.039, respectively). 3. Elevated levels of MPV (OR=7.182, 95% CI：2.974 ～17.348, P＜0.001)、NLR (OR=1.203, 95% CI：1.015 ～1.427, P=0.033)、CRP (OR=1.127, 95% CI：1.098 ～1.258, P=0.042) and decreased levels of Hb (OR=1.062, 95% CI：1.007～1.319, P=0.027)、Ca (OR=0.006, 95% CI：0.000～0.184,P=0.003) were independent risk factors for cardiovascular death in MHD patients. 4. ROC curve analysis indicated MPV (AUC= 0.881, 95% CI：0.821～0.940, P＜0.001), NLR (AUC= 0.764, 95% CI：0.668～0.860, P＜0.001), CRP (AUC= 0.778, 95% CI：0.677～0.878, P＜0.001), and their combined factors (including MPV, NLR, and CRP) have predictive value for cardiovascular death events in MHD patients, and the area under the curve (AUC) of combined factors was higher than the single indicator (AUC=0.931, 95% CI: 0.882～0.980, P＜0.001).  Conclusion  Elevated MPV, NLR, CRP, and decreased Hb and Ca were independent risk factors for cardiovascular death in MHD patients. MPV, NLR, CRP, and their combined factors have a predictive value for cardiovascular death events in MHD patients, and the predictive value of their combined factors has greater clinical guidance significance. Metrics

Select

Clinical comparative study on the therapeutic effect of cellulose triacetate membrane or polysulfone membrane dialyzers with sodium thiosulfate on uremic pruritus in hemodialysis patients WANG Huan, WANG Lin, BAO Qing-hai 2024, 23 (11):  818-822.  doi: 10.3969/j.issn.1671-4091.2024.11.004 Abstract ( 115 )   PDF (504KB) ( 3 )   To compare the clinical therapeutic efficacy of cellulose triacetate (CTA) and polysulfone (PS) dialyzers in combination with sodium thiosulfate (STS) in alleviating skin pruritus symptoms among patients undergoing maintenance hemodialysis (MHD).  Methods  A total of 60 patients who received blood purification treatment and had a pruritus visual analogue scale (VAS) score ≥7 in the Second Blood Purification Center of Shengjing Hospital of China Medical University from June 2022 to June 2023 were enrolled. Based on random number allocation, patients were divided into the PS+STS group and the CTA+STS group, with 30 patients in each group. After 6 months of intervention, differences between the two groups were compared in terms of serum calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH), complement C3, immunoglobulin E (IgE), beta-2 microglobulin (β2-MG), pruritus severity, sleep quality, micro-inflammatory markers (including high-sensitivity C-reactive protein (Hs-CRP), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α)), oxidative stress markers (including superoxide dismutase (SOD), malondialdehyde (MDA), and glutathione peroxidase (GSH-Px)), overall effective rate, and adverse reactions.  Results   Compared to the PS+STS group, patients in the CTA+STS group exhibited significant reduction in serum P, C3, IgE, VAS scores for pruritus, Pittsburgh Sleep Quality Index (PSQI) scores, and micro-inflammatory markers (Hs-CRP and IL-1β) (P: t=3.045, P=0.004; C3: t=2.746, P=0.008; IgE: t=3.327, P=0.002; VAS: t=2.088, P=0.041; PSQI:        t=2.154, P=0.035; Hs-CRP: t=2.772, P=0.008; IL-1β: t=2.546, P=0.014). Additionally, oxidative stress markers (SOD, MDA and GSH-Px) improved significantly (SOD: t=2.065, P=0.043; MDA: t=2.121, P=0.038; GSH-Px: t=2.091, P=0.041), and the overall effective rate was significantly higher (Z=7.690, P=0.021).  Conclusion  Compared to PS combined with STS, CTA combined with STS can effectively reduce serum P, C3, and IgE levels in MHD patients with pruritus, improve micro-inflammatory status and oxidative stress imbalance, thereby significantly alleviating skin pruritus symptoms and ultimately enhancing patients' quality of life. Metrics

Select

The influencing factors for sarcopenia and sarcopenic obesity in maintenance hemodialysis patients CHEN Ya-li, DING Ning, DIAO Zong-li 2024, 23 (11):  823-827.  doi: 10.3969/j.issn.1671-4091.2024.11.005 Abstract ( 110 )   PDF (542KB) ( 246 )   Objective To analyze the prevalence and the risk factors for sarcopenia and sarcopenic obesity in patients undergoing maintenance hemodialysis (MHD).  Methods  A total of 107 patients undergoing MHD at the Department of Nephrology, Beijing Friendship Hospital, Capital Medical University from January 2023 to January 2024 were enrolled in this study. Univariate and multivariate regressions were conducted for the analysis of sarcopenia in MHD patients. Based on body fat percentage (≥30% for males and ≥ 40% for females), the patients were divided into sarcopenic obesity group and non-sarcopenic obesity group. Clinical data were compared between patient groups.  Results  The prevalence of sarcopenia in MHD patients was 33.6%. Compared to non-sarcopenia patients, the sarcopenia patients had older age (t=2.426, P=0.009), lower body mass index (BMI) (t=-3.541, P=0.001), higher prevalence rates of diabetes (χ²=4.466, P=0.035) and coronary artery disease (χ²=4.306, P=0.038), and higher modified quantitative subjective global assessment (MQSGA) scores (Z=-6.192, P＜0.001). Logistic regression showed that hemodialysis with diffusion and filtration (HDF) (OR=0.167, 95% CI:0.041～0.683, P=0.01) and higher BMI (OR=0.234, 95% CI: 0.074～0.736, P=0.013) were the protective factors against sarcopenia, while higher volume load (OR=4.951, 95% CI: 1.030～23.790, P=0.046) and higher MQSGA scores (OR=10.794, 95% CI: 3.060～38.071, P=0.000) were the risk factors for sarcopenia in MHD patients. The prevalence of sarcopenic obesity in MHD patients was 15.9%. Compared to non-sarcopenic obesity patients, the sarcopenia patients had a lower BMI (F=2.433, P=0.007), a higher body fat percentage (F=-5.661, P=0.007), a lower proportion of HDF (χ²=8.758, P=0.003), and a higher neutrophil to lymphocyte ratio (NLR) (F=-1.008, P=0.006).   Conclusion  The prevalence rates of sarcopenia and sarcopenic obesity are higher in MHD patients. Early identification and effective management of the abnormalities should be conducted for MHD patients with sarcopenia or sarcopenic obesity. Metrics

Select

Clinical observation of mixed dilution hemodiafiltration in maintenance hemodialysis patients TENG Shao-hua, LI Xiao-ying, LI Qi 2024, 23 (11):  828-832,843.  doi: 10.3969/j.issn.1671-4091.2024.11.006 Abstract ( 120 )   PDF (524KB) ( 12 )   Objective To observe the effect of mixed predilution and postdilution hemodiafiltration (mixed-HDF) on solute removal in maintenance hemodialysis (MHD) patients.  Methods  Ten MHD patients who met the inclusion and exclusion criteria were selected in this self-cross-control study. They were treated with conventional hemodialysis (HD) three times a week and HDF once a month. Each hemodialysis lasted 4 hours. HDF was performed in the order of predilution hemodiafiltration (pre-HDF), postdilution hemodiafiltration (post-HDF), and mixed-HDF. According to the distribution of pre-displacement fluid volume and post-displacement fluid volume, the mixed-HDF was divided into 2:1 mixed-HDF group, 1.5:1 mixed-HDF group and 1:1 mixed-HDF group. Blood samples before and after the treatment were collected to observe the changes of blood routine, blood urea nitrogen (BUN), serum creatinine (Scr), phosphorus (Phos), β2-microglobulin       (β2-MG) and parathyroid hormone (PTH) before and after the hemodialysis. Adverse reactions during treatment including blood pressure change, muscle spasm, and coagulation in dialyzer and extracorporeal circulation circuit were observed.  Results  The 10 MHD patients completed the 5 different modalities of HDF treatment. The BUN clearance rates of 2:1, 1.5:1, and 1:1 mixed-HDF had no significant differences with the BUN clearance rates of pre-HDF (t=-0.576, 1.150 and 0.215 respectively; P=0.290, 0.140 and 0.417 respectively) and post-HDF (t=-1.054, 0.243 and -1.168 respectively; P=0.161, 0.407 and 0.136 respectively). The Scr clearance rate was higher in 1:1 mixed-HDF than in 2:1 mixed-HDF (t=1.893, P=0.047). The clearance rate of Phos was significantly higher in 1:1 mixed-HDF than in pre-HDF (t=2.171, P=0.029), but had no significant differences as compared with the rates of 2:1 and 1.5:1 mixed-HDF with the rates of pre-HDF (t=1.677 and 1.734; P=0.064 and 0.058) and post-HDF (t=0.735 and 0.545; P=0.240 and 0.300). The clearance rate of β2-MG was significantly higher in 1.5:1 mixed-HDF than in post-HDF (t=3.314, P=0.005), but had no significant differences as compared the rates of 2:1 and 1:1 mixed-HDF with the rates of pre-HDF (t=1.218 and 0.879; P=0.127 and 0.201) and post-HDF (t=1.235 and 0.837; P=0.124 and 0.212). The clearance rate of PTH was higher in 1.5:1 mixed-HDF than in post-HDF (t=1.870, P=0.047), but had no significant differences as compared the rates of 2:1 and 1:1 mixed-HDF with the rates of pre-HDF (t=-0.672 and -0.833; P=0.259 and 0.213) and post-HDF (t=1.479 and 0.974; P=0.087 and 0.178).  Conclusion  Mixed-HDF has the ability of efficient clearance of small molecule solutes as well as medium and large molecule solutes. For clearance of small molecule solutes, mixed-HDF has the similar efficiency as pre-HDF and post-HDF; for clearance of medium and large molecule solutes, mixed-HDF has the efficiencies higher than pre-HDF and post-HDF. Metrics

Select

The relationship between the expression CCR5 mRNA in peripheral blood gamma delta T cells and the prognosis of maintenance hemodialysis patients LI Xiao-li, ZHU Jiang, WANG Qi-qi, ZHANG Qing-juan, YUAN Zi-jing 2024, 23 (11):  833-838.  doi: 10.3969/j.issn.1671-4091.2024.11.007 Abstract ( 78 )   PDF (624KB) ( 4 )   Objective   To investigate the relationship between the expression of CC chemokine receptor 5 (CCR5) mRNA in peripheral γδ T cells and the prognosis of maintenance hemodialysis (MHD) patients.  Methods  A total of 191 MHD patients (MHD group) and a total of 109 healthy subjects (control group) in Jiangning Hospital Affiliated to Nanjing Medical University in the period from January 2018 to December 2020 were recruited in this study. Laboratory indexes and CCR5 mRNA expression in peripheral γδ T cells were examined. After 3 years of follow-up, the MHD patients were divided into survival group (n=160) and death group (n=31). The correlation of CCR5 mRNA in peripheral γδ T cells with age, dialysis age, hemoglobin (Hb), albumin (ALB), hypersensitive C-reactive protein (hs-CRP) and tumor necrosis factor (TNF)-α were analyzed. The factors affecting the 3-year survival of MHD patients, and the predictive value of CCR5 mRNA in peripheral γδ T cells for 3-year survival in MHD patients were evaluated.  Results  Compared with control group, Hb, ALB and blood calcium decreased significantly (t=10.172, 4.702 and 7.702 respectively; P<0.001), while blood phosphorus, serum creatinine, blood urea nitrogen, intact parathyroid hormone, hs-CRP, TNF-α and CCR5 mRNA in peripheral γδ T cells increased significantly (t=20.196, 77.626, 52.291, 80.126, 42.637, 46.766 and 57.854 respectively; P<0.001) in MHD group. In death group, age, dialysis age, hs-CRP, TNF-α, CCR5 mRNA in peripheral γδ T cells increased significantly (t=4.525, 13.841, 14.991, 20.662 and 54.229 respectively; P<0.001), while Hb and ALB decreased significantly (t=8.783 and 15.190; P<0.001), as compared those in survival group. In MHD patients, CCR5 mRNA in peripheral γδ T cells was positively correlated with age, dialysis age, hs-CRP and TNF-α (r=0.448, 0.463, 0.567 and 0.405 respectively; P<0.001), and negatively correlated with Hb and ALB (r=-0.502 and -0.491; P<0.001). Age (HR=2.250, 95% CI: 1.228～4.123, P=0.009), dialysis age (HR=3.196, 95% CI: 1.454～7.028, P=0.004), hs-CRP (HR=3.717, 95% CI: 1.876～7.367, P<0.001), TNF-α (HR=2.497, 95% CI: 1.193～5.227, P=0.015) and CCR5 mRNA in peripheral γδ T cells (HR=2.358, 95% CI: 1.439～3.865, P=0.001) were the independent risk factors, while Hb (HR=0.401, 95% CI: 0.204～0.787, P=0.008) and ALB (HR=0.456, 95% CI: 0.241～0.862, P=0.016) were the independent protective factors for 3-year survival in MHD patients. The area under curve of CCR5 mRNA in peripheral γδ T cells for predicting 3-year survival in MHD patients was 0.927, with the sensitivity of 85.71% and the specificity of 93.96%.  Conclusions The expression of CCR5 mRNA in peripheral blood γδT cells is higher in MHD patients, and has a predictive value for 3-year survival in MHD patients. Metrics

Select

Research advances in the clinical application of adsorption-based extracorporeal life support technology LIU Huan, ZHOU Jin-hua 2024, 23 (11):  839-843.  doi: 10.3969/j.issn.1671-4091.2024.11.008 Abstract ( 113 )   PDF (519KB) ( 4 )   The progresses in extracorporeal life support technology have brought new options for the treatment of critical illnesses. The extracorporeal life support technology of extracorporeal membrane oxygenation (ECMO) has significantly increased survival rate of the patients. However, ECMO may also have problems, such as organ damage caused by the inflammatory cytokine storm. The presence of extracorporeal life support with adsorption technology (ECLSA) may overcome these problems. ECLSA combines blood perfusion and extracorporeal life support technology to remove harmful substances such as inflammatory mediators, thus improving inflammation response and enhancing survival rate of the patients. ECLSA shows great potential in the treatment of critical illnesses. This article provides an overview of the progresses in the clinical application of ECLSA. Metrics

Select

Research progresses in extracorporeal membrane oxygenation (ECMO) combined with continuous renal replacement therapy (CRRT) for adult patients YUAN Shu-ting, WANG Xue-liang, LI Tian, HE Xi-mei, WAN Li-ping, XI Chun-sheng 2024, 23 (11):  844-848.  doi: 10.3969/j.issn.1671-4091.2024.11.009 Abstract ( 143 )   PDF (613KB) ( 17 )   Extracorporeal membrane oxygenation (ECMO) is mainly used in clinical practice to support cardiac insufficiency and/or respiratory insufficiency, and is a key technology for the treatment of severe and intractable heart failure and respiratory failure. During ECMO, fluid overload is frequently an indication for renal replacement therapy, and continuous renal replacement therapy (CRRT) is the commonly used modality. In patients on ECMO treatment, CRRT can be run in parallel with ECMO through different vascular access, or series connection in ECMO circuit. Anticoagulation for ECMO is usually with systemic heparin, but for CRRT circuit several methods can be used, such as no anticoagulation, addition of filtered heparin or local citrate anticoagulation. CRRT in combination with ECMO can be considered as a form of multi-organ supportive therapy, but this approach needs to be optimized in terms of timing, settings, anticoagulation, prescribing, and delivery. This review summarizes the implications of ECMO plus CRRT in adults, the timing of CRRT initiation, CRRT prescribing, circuit connection and prognosis in order to provide references for clinicians to treat the patients with appropriate indications. Metrics

Select

Identification of ferroptosis-related genes in the mechanisms of arteriovenous fistula maturation based on bioinformatics analysis JIN Ai-lian, WANG Huan 2024, 23 (11):  849-853,858.  doi: 10.3969/j.issn.1671-4091.2024.11.010 Abstract ( 172 )   PDF (1293KB) ( 5 )   Objective  Arteriovenous fistula (AVF) is currently the preferred vascular pathway for hemodialysis patients, but the low maturity rate seriously affects the treatment of end-stage renal disease patients. The molecular mechanisms that affect the maturation of AVF are not fully understood yet.  Methods  The gene expression profiles of the AVF vascular tissue (GSE220796 and GSE119296) were downloaded from the Gene Expression Omnibus (GEO) database and the ferroptosis-related genes (FRGs) were obtained from the FerrDb database. We identified differentially expressed FRGs, performed functional enrichment analysis, constructed protein-protein interaction (PPI) network, and identified hub genes. Receiver operator characteristic (ROC) curve was used to analyze the diagnostic efficacy. We also investigated the potential biological mechanisms of hypoxia-inducible factor-1 alpha (HIF1A) through immune cell infiltration analysis, transcription factor prediction, and competitive endogenous RNA (ceRNA) network construction. Results  A total of 70 differentially expressed FRGs were identified (45 upregulated genes and 25 downregulated genes). Functional enrichment analysis suggested that the response to nutrient level, cell response to low oxygen level, regulation of smooth muscle cell proliferation and forkhead box protein O (FoxO) signaling pathway were involved in the processes of AVF maturation. HIF1A was one of the 10 important hub genes and up-expressed in mature AVF vascular tissue. ROC curve analysis showed that area under the curve (AUC) value of HIF1A was 0.926 for diagnosing AVF maturation. HIF1A was found to be positively correlated with activated dendritic cells (r=0.663, P=0.003) and activated mast cells (r=0.644, P=0.004) in AVF vascular tissue. Forkhead box protein M1 (FOXM1) was predicted to be a transcription factor regulating HIF1A expression, and a ceRNA network containing 71 long non-coding RNA (lncRNAs), 62 microRNAs (miRNAs), and one messenger RNA (mRNA) was successfully constructed.  Conclusion  Our study elucidates the presence of ferroptosis in vascular tissues during AVF maturation, and HIF1A is a potential biomarker for AVF maturation. This study provides a theoretical basis that HIF1A may be a therapeutic target to improve AVF maturity. Metrics

Select

Artery-to-fistula diameter ratio of the arteriovenous fistula as a predictor for vascular access patency after primary percutaneous transluminal angioplasty (PTA)  LUO Xu-yang, YANG Wei, KANG Yu-wei, MA Shi-jie, FAN Yi, DENG Fei 2024, 23 (11):  854-858.  doi: 10.3969/j.issn.1671-4091.2024.11.011 Abstract ( 119 )   PDF (508KB) ( 4 )   Objective To investigate the effect of artery-to-fistula diameter ratio of the arteriovenous fistula (AVF) on vascular access patency in patients after percutaneous transluminal angioplasty (PTA) for one year.  Methods A total of 70 patients with maintenance hemodialysis and met the requirements of the study were selected as the study subjects. They were followed up for 12 months. When the patients needed to treat with PTA or AVF reconstruction due to re-occlusion, follow-up was terminated. According to the primary patency time, they were divided into two groups: group A (n=24, primary patency time ＜12 months) and group B (n=46, primary patency time ≥12 months) to observe their primary patency after PTA. Clinical characteristics of the two groups were collected and compared.  Results  The average age of group A was 72.33 years (range 65.22～79.44), significantly higher than that of group B (58.00 years, range 51.19～64.81). However, the artery-to-fistula diameter ratio of AVF were significantly higher in group A than in group B (t=4.251, P＜0.001). Logistic regression showed that a higher artery-to-fistula diameter ratio of AVF was an independent predictor of restenosis within one year after PTA (OR=0.000, 95% CI: 0.000～0.033, P=0.002). ROC curve analysis showed that the area under the curve (AUC) of the artery-to-fistula diameter ratio of the AVF was 0.788 (95% CI: 0.667～0.909, P＜0.05), and the cut-off value of the artery-to-fistula diameter ratio of the AVF was 0.752. The Youden index was 0.576, the sensitivity was 75.0%, and the specificity was 82.6%.  Conclusion Patients with a higher artery-to-fistula diameter ratio of the AVF after PTA have a higher risk of re-fistula failure within one year. Metrics

Select

Evidence summary for ultrasound-guided autogenous arteriovenous fistula puncture TANG Si-kai, CHEN Lin, ZHANG Ying-jun, HE Li, CHEN Hui, LIU Li, SHI Mei, ZHENG Hao-tian 2024, 23 (11):  859-863.  doi: 10.3969/j.issn.1671-4091.2024.11.012 Abstract ( 174 )   PDF (469KB) ( 40 )   Objective  To search, evaluate and summarize the best evidence for ultrasound-guided autogenous arteriovenous fistula (AVF) puncture.  Methods  A systematic search of databases for evidence on ultrasound-guided autogenous AVF puncture in maintenance hemodialysis patients was performed, with literature types including clinical guidelines, systematic evaluations, expert consensus, randomized controlled trials and others. The time frame for the search was January 2013 to November 2023. An evidence-based team performed literature screening and quality assessment, and extracted and summarized the evidence.  Results  A total of 21 publications were screened, including 5 guidelines, 3 expert consensus, one systematic evaluation, 10 randomized controlled trials, and 2 cross-sectional studies. Twenty-five pieces of the evidence were summarized in six areas: concepts related to ultrasound-guided fistula puncture, ultrasound-based vascular assessment, preparation and methods, post-puncture observation, and ultrasound-related training.  Conclusion The summarized best evidence for ultrasound-guided fistula puncture can be used as a guideline and norm for clinical caregivers to increase puncture success rate, reduce puncture-related complications, and ensure patient safety. Metrics

Select

The survival status of elderly hemodialysis patients and the effect of dialysis pathway on survival      GAO Liang-yun, WANG Yue-lin, HE Lu-chen, LIU Guang-min, LI Xiang-cha 2024, 23 (11):  864-867.  doi: 10.3969/j.issn.1671-4091.2024.11.013 Abstract ( 136 )   PDF (529KB) ( 7 )   Objective  To observe the clinical characteristics of elderly patients (≥60 years old) managed with maintenance hemodialysis (MHD) and to investigate the effect of vascular access type on survival of the patients.  Methods  Patients beginning hemodialysis in the period from January 1, 2017 to December 31, 2021 were recruited as the research subjects. They were followed up until June 31, 2022, and the endpoint was all-cause death in the follow-up period. According to vascular access type, patients were divided into 2 groups: autologous arteriovenous fistula group (AVF group) and tunneled cuffed catheter group (TCC group). Kaplan-Meier method was used to analyze the survival rate. Log-rank test was used to compare the survival rate. Cox regression model was performed to analyze the influencing factors.  Results  A total of 133 elderly MHD patients were included in this study, and 33 patients died. The top three death causes were cardiovascular events, multiple organ failure and malignant tumors. The primary diseases were diabetic nephropathy (45.11%) and chronic glomerulonephritis (44.36%). Among the 133 MHD patients, 72.93% used AVF (AVF group) and 27.07% used TCC (TCC) group as the vascular access. There were differences in age (Z=6.177, P＜0.001), Hb (Z=2.489, P=0.013), blood creatinine (t=2.687, P＜0.001), albumin (Z=2.093, P＜0.001), and hs-CRP (Z=4.872, P＜0.001) between the two groups. After 12, 24, 36 months, the survival rates in AVF group were 93.2%, 84.1% and 71.4% respectively, and the survival rates in TCC group were 74.5%, 53.0% and 37.6% respectively. Log-rank test demonstrated that the survival rate was lower in TCC group than in AVF group (χ2=22.665, P<0.001). Multivariate COX regression indicated that TCC was an independent risk factor for survival in elderly MHD patients (HR=0.420, 95% CI: 0.183～0.963, P=0.040).  Conclusions  In elderly MHD patients, the top there death causes are cardiovascular events, multiple organ failure and malignant tumors, and the main primary diseases are diabetes mellitus and chronic glomerulonephritis. Patients using TCC as the vascular access have a lower survival rate, and TCC for vascular access is an independent risk factor for survival in elderly MHD patients.  Metrics

Select

Visual analysis of Chinese literature on renal dialysis hyperkalemia based on CiteSpace software YANG Liu, HE Wen-wen, LU Hai-tao, DONG Wan, JIA Wan-ning, GAO Li-qian, YANG Chun-xia, HUANG Yan-yan 2024, 23 (11):  868-872.  doi: 10.3969/j.issn.1671-4091.2024.11.014 Abstract ( 96 )   PDF (1686KB) ( 9 )   Objective  To analyze the research status, development trend, research hotspots and frontiers of renal dialysis hyperkalemia in China.  Methods  CiteSpace literature analysis software was used to visually analyze the relevant literature on renal dialysis hyperkalemia collected from CNKI, Wanfang and VIP from 2000 to 2022. The maps were then downloaded for analyses.  Results  A total of 397 relevant research articles were included. The overall number of papers published showed an upward trend. The average annual number of papers published after 2011 (20.4 papers/year) was about twice that in the previous 10 years (12 papers/year). The high-frequency keywords were arrhythmia, diet control, purification equipment, treatment, and drugs related increase of blood potassium in the 10 years before 2010, and became ECG, health education and nursing quality in the 10 years after 2010, Keyword analysis showed that the research hotspots were first aid-related severe arrhythmia, ECG changes, survival time, and the importance of dietary restriction as the intervention measure in the first 10 years, and became health education, quality of care, and monitoring the presence of hypokalemia in the 10 years after 2010. In recent years, multicenter collaboration studies among high-level institutions have revealed the epidemiological characteristics of hyperkalemia; nursing intervention, chronic hyperkalemia and quality of life became the keywords and research frontiers.  Conclusion  In the past 20 years, the research on hyperkalemia in renal dialysis patients has been changed from rescue, diagnosis and treatment to prevention, nursing intervention, and improvement of quality of life. Currently, comprehensive management model is emphasized, including standardizing the treatment process of acute hyperkalemia and the early management of chronic hyperkalemia. In the future, exploring better health education model and promoting caregivers as the main body of intervention will be the hotspots and frontiers of the research on renal dialysis hyperkalemia. Metrics

Select

Effectiveness of decision aids on decision-making for renal replacement therapy in patients with chronic kidney disease: a meta-analysis LI Lin, SHEN Qin, WU Jun-xian 2024, 23 (11):  873-877.  doi: 10.3969/j.issn.1671-4091.2024.11.015 Abstract ( 76 )   PDF (614KB) ( 7 )   Objective  Systematic evaluation of the effectiveness of patient decision aids on decision-making for renal replacement therapy in patients with chronic kidney disease.  Methods  Computerized searches for Web of Science, PubMed, Cochrane Library, Embase, China Knowledge, and Wanfang databases were conducted to obtain literature about decision aids for chronic kidney disease, with a timeframe from the time of construction to December 2023. Data were analyzed using Review Manager 5.4 software.  Results  A total of 12 articles were obtained. Analyses of the articles showed that the use of decision aids can increase patients' decision knowledge (MD=2.29, 95% CI: 1.18～3.39, P<0.001), reduce patients' decision conflict (MD=−0.69, 95% CI: −1.09～−0.29, P<0.001), and improve decision quality.  Conclusion  Decision aids can improve patients' decision-making behavior and enhance decision-making quality. Further studies are needed to assess the assistant effectiveness of decision-making for renal replacement therapy.  Metrics

Select

Leukemia patients with severe iron overload and treated with double filtration plasmapheresis: report of two cases and review of the literature SONG Yi-Fan, CHEN Li-ting, ZHANG Chao, REN Ye-ping, WANG Qin 2024, 23 (11):  878-880.  doi: 10.3969/j.issn.1671-4091.2024.11.016 Abstract ( 178 )   PDF (441KB) ( 14 )   We report two leukemia patients with severe iron overload and successfully treated with double filtration plasmapheresis (DFPP). After the treatment, serum ferritin reduced significantly without any severe complications. We suggest that DFPP is a fast and efficient therapy to remove ferritin, and can be used in severe iron overload patients with poor response or intolerance to drug treatment.  Metrics