Chinese Journal of Blood Purification

12 December 2024, Volume 23 Issue 12 Previous Issue    Next Issue

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Expert consensus on standardized operating procedures of ultrasound-guided percutaneous transluminal angioplasty of arteriovenous access The Working Group on Vascular Access 2024, 23 (12):  881-890.  doi: 10.3969/j.issn.1671-4091.2024.12.001 Abstract ( 558 )   PDF (682KB) ( 33 )   Stenosis and occlusion are common complications of arteriovenous access, and percutaneous transluminal angioplasty is the first-line treatment for these complication. In recent years, ultrasound-guided percutaneous transluminal angioplasty is gradually being developed in China. However, there is currently a lack of uniformity in treatment concepts and technical operations among various units. Some doctors may not grasp the details properly, or use equipment in a standardized way, which may result in unsatisfactory treatment outcomes and a higher incidence of procedure-related complications. Meanwhile, there are still many units in need of adopting this technology. Given these issues, this expert consensus compiled by the Vascular Access Expert Committee of the Blood Purification Center Branch of the Chinese Hospital Association, combined evidence-based medicine and clinical practice experience, systematically introduced the standardized operation procedures for ultrasound-guided percutaneous transluminal angioplasty of arteriovenous access. The aim of this consensus is to promote, standardize, and improve the performance of ultrasound-guided arteriovenous access percutaneous transluminal angioplasty, benefiting hemodialysis patients in our country. Metrics

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Interpretation of the standard YY 0793.2-2023 “Preparation and Quality Management of Fluids for Hemodialysis and Related Therapies; part 2: Water for Hemodialysis and Related Therapies” XU Su-hua, LIU Guo-guang, HUANG Qi-yu, XU Chao-sheng, CHEN Hua-yan, HUANG Min-ju 2024, 23 (12):  891-895.  doi: 10.3969/j.issn.1671-4091.2024.12.002 Abstract ( 297 )   PDF (529KB) ( 24 )   The standard YY 0793.2-2023 “Preparation and Quality Management of Fluids for Hemodialysis and Related Therapies; part 2: Water for Hemodialysis and Related Therapies” was released on November 22, 2023, and will be implemented from December 1, 2026. This article compares this standard with the standards YY 0572-2015 and ISO 23500-3:2019, and interprets the differences in several important clauses, including the scope of application, quality requirements, microbiological requirements and their detection methods, chemical pollutants requirements and their detection methods. Ultimately, it will help relevant enterprises understand and apply this standard. Metrics

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Meta-analysis of the efficacy of a new generation of intravenous calcimimetic agent in the treatment of secondary hyperparathyroidism ZHANG Ju-hong, LI Ying 2024, 23 (12):  896-900.  doi: 10.3969/j.issn.1671-4091.2024.12.003 Abstract ( 177 )   PDF (755KB) ( 8 )   Objective  To evaluate the efficacy and adverse reactions of etelcalcetide in the treatment of secondary hyperparathyroidism in hemodialysis patients.  Methods  Randomized controlled trials  or cohort studies on Etelcalcetide in the treatment of secondary hyperparathyroidism (SHPT) in dialysis patients published before May 2024 were searched in CNKI, Wanfang Database, PubMed, Embase and Cochrane library. Meta-analysis was performed by the software RevMan 5.0.  Results  A total of 14 articles were included, including 15 experiments, with a total sample size of 9628 cases. Meta-analysis showed that Etelcalcetide was more effective in reducing PTH level by 30% than the control group (Blank control group: RR=8.440, 95% CI: 6.515～10.935, P＜0.001; Cinacalcet group: RR=1.131, 95% CI:1.040～1.229, P= 0.004; Vitamin D receptor agonist group: RR=4.272, 95% CI: 2.259～8.081, P< 0.001), improving serum phosphate compliance rate (RR=1.122, 95% CI: 1.049～1.205, P=0.001) and decreasing the level of serum fibroblast growth factor (FGF-23) (treatment time < 1 year: MD=-0.563, 95% CI: -0.713～-0.413, P<0.001 ; treatment duration ≥1 year: MD=-2.108, 95% CI: -2.405～-1.812, P < 0.001), while no statistical differences in the rate of serum calcium compliance (RR=0.910, 95% CI: 0.778～1.064, P=0.240) and drug persistence (RR=1.439, 95% CI: 0.903～2.292, P=0.120). In terms of adverse events, the incidence of symptomatic hypocalcemia was higher in Etelcalcetide group than in control group (RR=2.890，95% CI：1.915～4.361, P＜0.001), and the incidence of nausea in Etelcalcetide group was higher than that in blank control group (RR=1.747, 95% CI: 1.150～2.652, P=0.009), which was lower than that in oral medication group (RR=0.769, 95% CI: 0.611～0.969, P=0.030), while no significant difference in the incidence of vomiting. Conclusion  Etelcalcetide, a new generation of intravenous calcimimetic agent, has more advantages in reducing PTH level, improving hyperphosphatemia and reducing FGF-23 level, but it increased the incidence of hypocalcemia.  Metrics

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Prognostic factors of dialysis age in patients with maintenance peritoneal dialysis LIANG Ru-lian, WEN Yue-qiang, WANG Nian-song, WU Xian-feng 2024, 23 (12):  901-905,919.  doi: 10.3969/j.issn.1671-4091.2024.12.004 Abstract ( 135 )   PDF (549KB) ( 7 )   Objective  The prognostic factors of dialysis vintage in patients on maintenance peritoneal dialysis were analyzed.  Methods  The clinical data of 571 patients on maintenance peritoneal dialysis (PD) in Evergreen Tree Nephrology Association (ETNA) Peritoneal dialysis database from November 2005 to May 2020 were analyzed retrospectively. The survival rate and technical survival rate were calculated, and the risk factors influencing prognosis were analyzed. PD patients were divided into long dialysis vintage group (≥60 months) and short dialysis vintage group (<60 months), and the prognosis of the patients in different dialysis vintage groups and the risk factors affecting dialysis vintage were analyzed.  Results  The 1-,2-,3-,5- and 10- year cumulative survival rates of the 571 PD patients were 94%, 88.8%, 80.9%,70.3% and 49.8%. The cumulative technical survival rates were 94%, 88.8%,80.8%,69.3% and 39.2%, respectively. COX Multivariate regression analysis showed that chronic obstructive pulmonary disease (COPD) history (HR=3.39, 95% CI: 1.054～10.576, P=0.040), elevated Low-Density lipoprotein cholesterol (LDL-c) (HR=1.222, 95% CI: 1.032～1.447, P=0.020) and pulmonary infection (HR=1.568, 95% CI: 1.252～1.965, P＜0.001) were independent risk factors of death in PD patients (P＜0.05). Logistic regression analysis showed that Smoking (OR=0.349，95% CI: 0.139～0.873，P=0.024), elevated intact parathyroid hormone(iPTH) (OR=0.999, 95% CI: 0.998～1.000, P=0.048)and low urine volume (OR=1.001, 95% CI: 1.000～1.001, P＜0.001) were independent risk factors of technical failure.  Conclusion  Smoking, elevated iPTH and low urine volume are independent risk factors of technical failure. Smoking cessation, rational reduction of iPTH and protection of residual renal function can prolong patients' dialysis vintage. Metrics

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Correlation between hypersensitive C reactive protein to albumin ratio and abdominal aortic calcification and all-cause death in maintenance hemodialysis patients SU Kai-jie, CAO Qian-ying, LI Zhong-xin 2024, 23 (12):  906-909,933.  doi: 10.3969/j.issn.1671-4091.2024.12.005 Abstract ( 146 )   PDF (633KB) ( 8 )   Objective  To explore the relationship between high sensitivity C reactive protein to albumin ratio (CAR) and abdominal aortic calcification and all-cause death in patients with maintenance hemodialysis (MHD).  Methods  Patients with MHD who were treated in the Blood Purification Center of Beijing Luhe Hospital affiliated to Capital Medical University from January 2023 to February 2024 were selected. The basic information and laboratory data after 3 months of regular dialysis treatment were collected in the enrolled patients, as well as the data of abdominal aortic calcification and all-cause death. The correlation between CAR and abdominal aortic calcification was analyzed. The diagnostic value of CAR for calcification was analyzed by receiver operating characteristic curve (ROC), and the relationship between CAR and all-cause death was analyzed by logistic regression.  Results  A total of 204 patients were enrolled, including 155 patients (75.98%) with abdominal aortic calcification, and 11 patients (5.39%) with death. CAR in abdominal aorta calcification group was significantly higher than that in non-calcification group (Z=3.105, P=0.002), spearman correlation analysis showed that CAR was positively correlated with abdominal aorta calcification (r=0.218, P=0.002). The CAR cutoff value was 0.02mg/g for abdominal aorta calcification, the sensitivity and specificity were 92.9% and 36.7%, respectively, with an area under the curve of 0.647 (95% CI: 0.554～0.741, P=0.002). Logistic regression analysis showed that age, dialysis age and HbAlc were independent risk factors for abdominal aortic calcification (OR=1.074, 1.015, 1.881; 95% CI:1.040～1.110, 1.007～1.024, 1.188～2.978; P＜0.001, ＜0.001, =0.001) , and that CAR was an independent risk factor for all-cause death (OR=5.393, 95% CI:1.089～26.699, P=0.039).  Conclusion  CAR is positively correlated with abdominal aorta calcification, CAR is helpful for the diagnosis of abdominal aorta calcification, and CAR is an independent risk factor for all-cause death. Metrics

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The relationship between cumulative fluid balance and prognosis after continuous renal replacement therapy in patients with severe acute pancreatitis CHEN Yong-kang, DAI Xiao-rong, YAN Kun-feng, CHEN Lei 2024, 23 (12):  910-914.  doi: 10.3969/j.issn.1671-4091.2024.12.006 Abstract ( 95 )   PDF (901KB) ( 6 )   Objective  To explore the relationship between cumulative fluid balance (CFB) and prognosis after continuous renal replacement therapy (CRRT) in patients with severe acute pancreatitis (SAP).  Methods  A total of 248 SAP patients treated in our hospital from March 2020 to March 2023 were selected as the research subjects. Computer-generated random number method was used to divide them into a training set (n=165) and a validation set (n=83) in a 2:1 ratio. According to the prognosis of CRRT patients in the training set, they were divided into a survival group (n=113) and a death group (n=52). General information and CFB within 7 days after treatment were compared between the two groups. The influencing factors for mortality in SAP patients after CRRT treatment and the dose relationship between CFB3 and patient survival after treatment were analyzed.  Results  After 7 days of treatment, the death group had higher levels of CFB3 (t=126.906, P=0.263), CFB4 (t=149.141, P=0.409), CFB5 (t=163.673, P＜0.001), CFB6 (t=158.426, P＜0.001), and CFB7 (t=373.539, P＜0.001) compared to the survival group. Multivariate Cox regression analysis showed that total duration of CRRT during hospitalization (HR=2.864, 95% CI:1.042～4.057, P=0.034), procalcitonin (PCT) (HR=3.628, 95% CI:2.605～5.231, P=0.016), and CFB3 (HR=2.743, 95% CI:1.536～3.967, P=0.008) were the independent risk factors for mortality in SAP patients after CRRT treatment, while albumin (ALB) (HR=0.726, 95% CI:0.532～0.965, P=0.024) was a protective factor. The top 4 factors that affect the prognosis of SAP patients were CFB3, total duration of CRRT during hospitalization, ALB and PCT. Restrictive cubic spline model analysis showed that there was no non-linear dose-response relationship between CFB3 and the risk of death after CRRT treatment in SAP patients, regardless of gender.  Conclusion  Excessive CFB after CRRT in SAP patients can increase the risk of death, and CFB3 is an independent risk factor for poor prognosis.  Metrics

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The value of serum CRP/ALB, IL-22 and heparin binding protein for early prediction of infection in chronic renal failure patients undergoing hemodialysis YANG Mei, GUO Zong-lin, REN Ting-ting 2024, 23 (12):  915-919.  doi: 10.3969/j.issn.1671-4091.2024.12.007 Abstract ( 96 )   PDF (583KB) ( 4 )   Objective  To investigate the value of serum C-reactive protein (CRP)/albumin (ALB), interleukin-22 (IL-22) and heparin binding protein (HBP) for the early prediction of infection in chronic renal failure (CRF) patients undergoing hemodialysis.  Methods  A total of 113 CRF patients undergoing hemodialysis in Chengdu Sixth People's Hospital from January 2021 to June 2023 were selected as the research subjects. They were divided into an infection group (26 cases) and a non-infection group (87 cases) based on whether they had an infection in hospital within 6 months of dialysis. The levels of serum CRP/ALB, IL-22 and HBP were compared between the two groups, and the value of serum CRP/ALB, IL-22 and HBP levels for the prediction of infection in CRF patients undergoing hemodialysis were then analyzed.  Results  In the infection group, the levels of serum CRP, CRP/ALB, IL-22 and HBP were higher (t=3.880, 5.228, 5.454 and 5.246 respectively; P<0.001) and the level of ALB was lower (t=5.291, P<0.001) as compared those with the non-infection group. Serum CRP/ALB, IL-22 and HBP were positively correlated with the infection probability score (IPS) (r=0.811, 0.791 and 0.826 respectively; 95% CI：0.704～0.935, 0.683～0.917 and 0.718～0.951 respectively; P<0.001). The area under the curve (AUC) of serum CRP/ALB, IL-22 and HBP for predicting infection in CRF patients undergoing hemodialysis were 0.752 (95% CI: 0.662～0.828), 0.811 (95% CI: 0.727～0.879), and 0.800 (95% CI: 0.714～0.869) respectively. The risk of infection in the patients with positive expression of serum CRP/ALB, IL-22 and HBP was 4.232 times (95% CI: 2.158～8.299), 5.854 times (95% CI: 2.558～13.395) and 6.049 times (95% CI: 2.803～13.056) respectively, higher than that in the patients with negative expressions (all P<0.001). The AUC of combined serum CRP/ALB, IL-22 and HBP to predict infection in the patients was 0.927 (95% CI: 0.863～0.968), greater than the AUCs of the three indicators separately (Z=2.565, 2.435 and 2.079 respectively; P=0.010, 0.015 and 0.038 respectively), with the sensitivity of 88.46% and the specificity of 80.46%.  Conclusion  Serum CRP/ALB, IL-22 and HBP are significantly correlated with the possibility of concurrent infection in CRF patients undergoing hemodialysis. They can effectively predict the risk of infection, especially when combination of the three indicators is used for the prediction. Metrics

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The role and mechanism of SOCS1 gene in high glucose-induced epithelial-mesenchymal transformation of peritoneal mesothelial cells in mice HAN Xiao-li, WANG Jia-wei, WEI Zhi-feng, WANG Lin-lin, GUO Bao-zhu, CAO Yan-chun, JIN Yu-jie, LIU Sheng-jun 2024, 23 (12):  920-925.  doi: 10.3969/j.issn.1671-4091.2024.12.008 Abstract ( 76 )   PDF (761KB) ( 5 )   Objective  To investigate the role and mechanism of the suppressor of cytokine signaling 1 (SOCS1) gene in high glucose-induced epithelial-mesenchymal transformation (EMT) of peritoneal mesothelial cells in mice.  Methods  Mouse peritoneal mesothelial cells were cultured and divided into 6 groups: the control group was treated with routine medium; cells cultured in the medium containing 1.5% (83 mmol/L), 2.5% (139 mmol/L) and 4.25% (236 mmol/L) D-glucose formed the 1.5% group, 2.5% group and 4.25% group; cells transfected with negative control plasmid and cultured in the medium containing 2.5% glucose formed the 2.5%+NC plasmid group; cells transfected with SOCS1 plasmid and cultured in the medium containing 2.5% glucose formed the 2.5%+SOCS1 plasmid group. After the treatment for 24h, proliferation, migration and invasion number of the cells, mRNA expression levels of SOCS1, E-cadherin, N-cadherin and α-SMA, and JAK1/STAT1 and JAK2/STAT3 signaling pathways were detected.  Results  In 4.25% group, the proliferation level of peritoneal mesothelial cells was lower than that in control group (t=5.051, P=0.002). In 1.5%, 2.5% and 4.25% groups, the mRNA expression levels of E-cadherin and SOCS1 in peritoneal mesothelial cells were lower than those in control group (E-cadherin mRNA: t=2.774, 7.310 and 9.7813; P=0.032, ＜0.001 and ＜0.001. SOCS1 mRNA: t=2.544, 6.996 and 10.733; P=0.044, ＜0.001 and ＜0.001), while mRNA expression levels of N-cadherin and α-SMA in peritoneal mesothelial cells were higher than those in control group (N-cadherin mRNA: t=2.825, 5.121 and 7.207; P=0.030, ＜0.001 and ＜0.001. α-SMA mRNA: t=2.527, 4.807 and 6.950; P=0.045, 0.003 and ＜0.001). In 2.5%+SOCS1 plasmid group, JAK1/STAT1 and JAK2/STAT3 signaling pathways in peritoneal mesothelium cells were inhibited, the mRNA and protein expression levels of SOCS1 and the mRNA expression level of E-cadherin were higher than those in 2.5% group and 2.5%+NC plasmid group (SOCS1 mRNA: t=9.435 and 9.737, P＜0.001; SOCS1 protein: t=9.761 and 9.138, P＜0.001; E-cadherin mRNA: t=7.690 and 7.132, P＜0.001), and the number of cell migration and invasion and the mRNA expression levels of N-cadherin and α-SMA were lower than those in 2.5% group and 2.5%+NC plasmid group (t=7.350 and 8.456, P＜0.001; t=8.562 and 7.697, P＜0.001; t=4.574 and 4.865, P=0.004 and 0.003; t=3.467 and 3.036, P=0.013, 0.023).  Conclusion Overexpression of SOCS1 gene inhibits high glucose-induced EMT of peritoneal mesothelial cells in mice, which is related to the inhibition of JAK1/STAT1 and JAK2/STAT3 signaling pathways. Metrics

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New progresses in dialysis water treatment system technology LIU Zhu-qing 2024, 23 (12):  926-929.  doi: 10.3969/j.issn.1671-4091.2024.12.009 Abstract ( 128 )   PDF (670KB) ( 5 )   Dialysis water is an indispensable consumable reagent in the process of hemodialysis. Strict quality control of dialysis water and the equipment with high performance and function are required. This paper summarizes the latest progress in dialysis water treatment system and describes the technical update and development of pretreatment, reverse osmosis system and transportation system, which will be helpful for medical staff and technical engineers freshly entering in this field.  Metrics

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Research progress of antiphospholipid antibody in the autologous arteriovenous fistula-related complications in hemodialysis patients LI Tian, WU Yang, WANG Xue-liang, YUAN Shu-ting, HE Xi-mei, WAN Li-ping, XI Chun-sheng 2024, 23 (12):  930-933.  doi: 10.3969/j.issn.1671-4091.2024.12.010 Abstract ( 130 )   PDF (584KB) ( 5 )   Hemodialysis (HD) is one of the most commonly used blood purification techniques for critically ill patients, but it will inevitably lead to many complications due to various factors. Among them, complications related to arteriovenous fistula (AVF) are one of the important causes for treatment failure and death in HD patients. Some studies have found that persistently positive antiphospholipid antibody (aPL) is commonly present in HD patients, which may be involved in the AVF-related complications. This paper summarizes the current research progress of aPL in AVF-related complications in HD patients, in order to improve the prognosis of HD patients with AVF-related complications and to provide bases for the prevention, monitoring and treatment of the complications. Metrics

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Factor analysis of restenosis after coronary stent implantation in maintenance hemodialysis patients SHI Ke, JIA Ning 2024, 23 (12):  934-937.  doi: 10.3969/j.issn.1671-4091.2024.12.011 Abstract ( 109 )   PDF (482KB) ( 4 )   Cardiovascular disease remains the most common complication in maintenance hemodialysis (MHD) patients. In recent years, a significant proportion of dialysis patients have received percutaneous coronary intervention (PCI). An increasing number of MHD patients are being diagnosed with in-stent restenosis after coronary stent implantation. This article reviews the unique risk factors of this special group and the influencing factors and treatment strategies of coronary in-stent restenosis. Metrics

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Evidence summary for the management of autologous arteriovenous fistula stenosis after interventional therapy LIU Wang-xing, SHEN Wei, LUO Xun, SHI Wen-jian, PENG Xue-ling, XIE Ping, LIU Dong-ling, HU Zheng-zhong, LI Xin 2024, 23 (12):  938-942.  doi: 10.3969/j.issn.1671-4091.2024.12.012 Abstract ( 124 )   PDF (543KB) ( 7 )   Objective To retrieve and evaluate the relevant evidence about the integrated management of autologous arteriovenous fistula (AVF) stenosis after interventional therapy, and to provide evidence-based data for clinical practice.  Methods  According to the "6S" model system, the evidence about postoperative management of AVF stenosis after interventional therapy was retrieved from computer clinical decision-making system, guideline database, domestic and foreign databases, and websites of relevant professional associations. The retrieval time was ended at February 26, 2024. After independent evaluation of the quality of retrieved documents by four researchers, the evidence was extracted and summarized.  Results  A total of 9 articles were included, including 5 clinical decisions, 3 guidelines and one expert consensus. Twenty-five items of evidence were summarized from five aspects: postoperative evaluation and monitoring, postoperative medication, puncture and maintenance of arteriovenous fistula, prevention and treatment of complications and patient education.  Conclusion This study summarizes the best evidence of postoperative management of AVF stenosis after interventional therapy, having scientific and practical value in that it provides evidence-based information for medical and nursing care staff to scientifically manage the AVF stenosis patients after interventional therapy. Metrics

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Analysis of catheter-related bloodstream infections on seasonal prevalence, pathogen characteristics, and drug sensitivity in maintenance hemodialysis patients ZHANG Yan, GAO Zhi-wei, LIAN Xiu-hua, WANG Zun-song 2024, 23 (12):  943-946.  doi: 10.3969/j.issn.1671-4091.2024.12.013 Abstract ( 104 )   PDF (578KB) ( 1 )   Objective  To analyze the seasonal prevalence, pathogen characteristics, and drug sensitivity of catheter-related blood stream infection (CRBSI) in maintenance hemodialysis (MHD) patients.  Method  A retrospective analysis was conducted on the patients treated with tunnel-cuffed catheter (TCC) insertion surgery for MHD at the Department of Nephrology, The First Affiliated Hospital of Shandong First Medical University from August 2012 to June 2021. CRBSI happened in a total of 62 hospitalized patients, including 48 patients with defined pathogenic bacteria from blood cultures. Their infection season, pathogenic bacterial characteristics and drug sensitivity were analyzed.  Results  CRBSI occurred higher in spring and summer (38 cases, 61.3%) than in autumn and winter (24 cases, 38.7%) (c2=6.323, P=0.012). Gram positive bacteria accounted for 52.9%, and Gram negative bacteria for 45.1%. More than half of the Gram positive bacteria were staphylococcus aureus (63.0%), followed by staphylococcus epidermidis (22.2%). Many types of Gram negative bacteria caused the CRBSI, and Escherichia coli accounted for 21.7% of Gram negative bacteria. Antibiotics sensitive to Gram positive bacteria included vancomycin, teicoplanin, tigecycline, antibiotics with higher resistance rates included penicillin G, erythromycin, and clindamycin. Antibiotics sensitive to gram-negative bacteria included ertapenem, piperacillin/tazobactam, cefoperazone/sulbactam, antibiotics with higher resistance rates included ampicillin and cefazolin.  Conclusion  The incidence of CRBSI is higher in spring and summer. Staphylococcus aureus and staphylococcus epidermidis account for the vast majority of Gram positive bacteria. Many types of Gram negative bacteria are involved in CRBSI, with Escherichia coli being the most common bacterium. When the use of special grade antibiotics is restricted, moxifloxacin combined with piperacillin/tazobactam or cefoperazone/sulbactam can be considered as an empirical antibiotic treatment option for CRBSI. Metrics

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Efficacy analysis of double plasma molecular adsorption system combined with half-volume plasma exchange in patients with hepatitis B-related acute-on-chronic liver failure ZHAO Yu-jie, LI Ting, GUAN Lin-meng, JIANG Dan-dan, WANG Hui, YANG Jun 2024, 23 (12):  947-951.  doi: 10.3969/j.issn.1671-4091.2024.12.014 Abstract ( 104 )   PDF (574KB) ( 6 )   Objective  To explore the efficacy of double plasma molecular adsorption system combined with half-dose plasma exchange (DPMAS+half-dose PE) in patients with hepatitis B-related acute-on-chronic liver failure.  Methods  A total of 100 patients with liver failure and undergoing artificial liver treatment at the First Affiliated Hospital of Xinxiang Medical University from January 2021 to December 2022 were retrospectively analyzed. Patients were divided into two groups based on the treatment mode: DPMAS+half-dose  PE (49 cases) and plasma exchange (PE) alone (51 cases). Changes of laboratory indicators and 28-day survival rate were compared between the two groups. Kaplan-Meier (K-M) method was used to plot survival curves. Log-rank test was employed to analyze survival difference between groups. Multivariate Cox regression analysis was used to identify the independent factors affecting patient prognosis.  Results  After treatment, levels of CRP [(9.9±4.5)mg/L vs. (12.9±5.0) mg/L], albumin [(27.38±3.94)g/L vs. (31.07±3.35)g/L], direct bilirubin [(102.3±54.9)μmol/L vs. 117.4±43.3)μmol/L] and indirect bilirubin [(69.9±43.4)μmol/L vs. (81.2±34.9)μmol/L] were lower in DPMAS+half-dose PE group than in PE group (t=-3.214, -5.064, -2.007 and -2.310 respectively; P=0.002, ＜0.001, 0.045 and 0.021 respectively). Both groups showed decreases of total bilirubin  (t=   -6.974, P＜0.001; t=-7.693, P＜0.001), direct bilirubin (t=-6.711, P＜0.001; t=-6.649, P＜0.001) indirect bilirubin (t=-7.365, P＜0.001; t=-7.713, P＜0.001), international normalized ratio (Z=-3.509, P=0.002; Z=-4.067, P＜0.001), CRP (t=6.602, P＜0.001; t=5.12, P＜0.001), and interleukin-6 (Z=-5.347, P＜0.001; Z=-4.615, P＜0.001), and increase of prothrombin activity (t=-3.322, P＜0.001; t=-5.201, P＜0.001) after treatment. The 28-day survival rate was higher in DPMAS+half-dose PE group than in PE group (χ2=4.209, P=0.040). Multivariate Cox regression analysis revealed that DPMAS+PE treatment (HR=0.832, 95% CI: 0.685～0.994, P=0.043), complications (HR=4.595, 95% CI:1.328～7.395, P=0.005), model for end-stage liver disease (MELD) score (HR=3.258, 95% CI: 1.247～5.593, P=0.009), and liver failure stage (HR=4.852, 95% CI: 1.352～7.529, P=0.002) were the independent factors affecting patient prognosis.  Conclusion  Both the two treatment modalities can improve liver function and coagulation indicators in the patients. DPMAS+half-dose PE group was superior in 28-day survival rate and can reduce the demand for blood transfusion, being a prognostic protective factor for the patients and worthy of clinical promotion. Metrics

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Construction and verification of a nomogram model for unplanned disembarkation due to clotting in cardiopulmonary bypass line in patients undergoing maintenance hemodialysis WU Hai-fang, XU Zheng-quan, SHEN Bo 2024, 23 (12):  952-956.  doi: 10.3969/j.issn.1671-4091.2024.12.015 Abstract ( 121 )   PDF (563KB) ( 3 )   Objective  To investigate the influential factors of unplanned disembarkation due to clotting in cardiopulmonary bypass line in maintenance hemodialysis (MHD) patients, and to establish a nomogram model of unplanned disembarkation due to clotting in cardiopulmonary bypass line in MHD patients and to validate the nomogram.  Methods  The MHD patients treated in the General Hospital of Shaoxing Second Hospital from April 2022 to June 2023 were retrospectively studied. They were divided into modeling group and validation group with the ratio of 7:3. The clinical data of the modeling group were collected and were then divided into coagulation subgroup and non-coagulation subgroup according to the presence or absence of clotting in cardiopulmonary bypass line. By comparing the clinical data of the two subgroups, multivariate logistic regression was used to analyze the risk factors for clotting in cardiopulmonary bypass line in the MHD patients, and a nomogram model of clotting in cardiopulmonary bypass line in MHD patients was established and validated.  Results  A total of 286 patients were recruited as the study subjects. They were divided into modeling group (n=200) and verification group (n=86) with the ratio of 7:3. The modeling group were divided into coagulation subgroup (n=38) and non-coagulation subgroup (n=162). The incidence of clotting in cardiopulmonary bypass line in MHD patients was 19%. Hypotension (χ2=4.630, P=0.031), prothrombin time (t=2.392, P=0.018), platelet count (t=3.090, P=0.002), hemodialysis for the first time (χ2=4.935, P=0.026), anticoagulation method (χ2=8.546, P=0.014), treatment time (<8h/d, 8-16h/d, >16h/d) (χ2=9.497, P=0.009), blood flow velocity (<200ml/min, ≥200ml/min) (χ2=5.194, P=0.023) and health education before dialysis (χ2=6.991, P=0.008) were statistically different between the two subgroups. Multivariate logistic regression showed that hypotension (OR=3.160, 95% CI: 1.182～8.447, P=0.022), platelet count (OR=1.081, 95% CI: 1.049～1.115, P<0.001), hemodialysis for the first time (OR=3.354, 95% CI: 1.202～9.359, P=0.021), no anticoagulation used (OR=5.845, 95% CI:1.697～20.132, P=0.005), and lack of health education (OR=6.524, 95% CI: 2.322～18.330, P<0.001) were the independent risk factors for clotting in cardiopulmonary bypass line; longer prothrombin time (OR=0.378, 95% CI:0.261～0.547, P<0.001) and blood flow velocity ≥200 ml/min (OR=0.226, 95% CI:0.081～0.625, P=0.004) were the protective factors for clotting in cardiopulmonary bypass line. For verification of the nomogram, the area under ROC curve was 0.891 (95% CI: 0.835～0.947), a better discrimination ability was identified, the maximum approximate entry value was 0.641, the sensitivity was 0.789, and the specificity was 0.852. The theoretical value of calibration curve was in better agreement with the actual value.  Conclusion  This nomogram model of unplanned disembarkation caused by clotting in cardiopulmonary bypass line in MHD patients shows a better efficiency, and provides a reference for clinical practice.  Metrics

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The therapeutic effect of kinesiology tape on hematomas after arteriovenous fistula puncture in hemodialysis patients SHEN Yang-yang, LI Ying, GAO Yan-jun, WANG Yi, WANG Xiao-fei, ZHANG Li-ping, ZHANG Dong-liang 2024, 23 (12):  957-960.  doi: 10.3969/j.issn.1671-4091.2024.12.016 Abstract ( 110 )   PDF (604KB) ( 3 )   Objective  To investigate the effectiveness of kinesiology tape in the treatment of hematoma after arteriovenous fistula (AVF) puncture in hemodialysis patients.  Methods  A total of 34 patients with hematoma after AVF puncture admitted to the Blood Purification Center of Department of Nephrology, Beijing Jishuitan Hospital, Capital Medical University from January 2022 to March 2024 were included in this study. They were divided into control group and experiment group according to the random number table method. Mucopolysaccharide polysulfate cream combine with hot compress were used in control group, and kinesiology tape was used in experiment group. Visual analog scale (VAS), hardness of the hematoma, fading time of the skin ecchymosis, and the therapeutic effect were compared between two groups.  Results  VAS gradually decreased after 3, 6 and 9 days of the treatment in both groups. VAS was significantly lower in experiment group than in control group after 3 days of the treatment  (t=3.084, P=0.004) and 6 days of the treatment  (Z=  -3.536, P＜0.001). Hardness of the hematoma decreased gradually after 3, 6 and 9 days of the treatment in both groups. Hardness of the hematoma was lower in experiment group than in control group after 3 days of treatment (χ2=6.769, P=0.035). Fading time of the skin ecchymosis was significantly shorter in experiment group than in control group (t=8.161, P＜0.001). After 3 days of treatment, the therapeutic effect was better in experiment group (100%, 16/16) than in control group (72.22%, 13/18; χ2=5.211, P=0.046).  Conclusion  The application of kinesiology tape for the treatment of hematoma after AVF puncture in hemodialysis patients can reduce pain degree and hardness of the hematoma, shorten subsiding time of the skin ecchymosis and hematoma, and improve the therapeutic effect. Metrics