Chinese Journal of Blood Purification

12 January 2025, Volume 24 Issue 01 Previous Issue    Next Issue

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Chinese expert consensus on guiding self-management for patients with renal anemia (2024) Work Group for Chinese Expert Consensus on Guiding Self-Management for Patients with Renal Anemia 2025, 24 (01):  1-12.  doi: 10.3969/j.issn.1671-4091.2025.01.001 Abstract ( 298 )   PDF (910KB) ( 20 )   Renal anemia is a common complication of chronic kidney disease (CKD), which not only seriously affects the life quality of CKD patients, but also significantly increases the risk of cardiovascular events and death. Self-management of patients with renal anemia obviously affects the treatment outcome and prognosis of the patients. At present, there is still a lack of standardized guidance for patients' self-management. The target of this consensus is for the medical staff to guide the self-management of patients with renal anemia. It is jointly written by experts in nephrology, blood purification, nursing, hematology, pharmacy, and public health, and supplies the latest evidence-based medicine and clinical experience for medical staff to guide patients with renal anemia holding self-management. The consensus content includes assessing and establishing necessary knowledge reserves for patients, consultation and follow up on time, rational drug use, lifestyle guidance, monitoring and avoiding aggravating factors, shared decision making and self-management evaluation. Multi-dimensional standardization guidance is provided for self-management of patients with renal anemia, aiming to further improve their self-management level, enhance the compliance rate of renal anemia in China, and improve prognosis. Metrics

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Development of a nomogram-based risk  prediction model for extracorporeal circulation failure children on continuous renal replacement therapy#br# QUAN Zi-lin, YIN Yan, CUI Dong-mei, ZHAO Li-yan, WANG Fang-yuan, WANG Juan, HE Wen-jing, HU Yu-hang, CHEN Cheng, LIANG Qi-zhen, SONG LI 2025, 24 (01):  13-17.  doi: 10.3969/j.issn.1671-4091.2025.01.002 Abstract ( 71 )   PDF (689KB) ( 2 )   Objective  This study aimed to investigate the factors influencing extracorporeal circulation failure during continuous renal replacement therapy (CRRT) in pediatric patients and to develop and validate a predictive model.  Methods  A retrospective analysis was conducted on data from 370 pediatric patients who received CRRT at Guangdong Provincial People's Hospital between 2014 and 2021. Patients were divided into failure and non-failure groups based on the occurrence of extracorporeal circulation failure within 24 hours of CRRT initiation. Through the application of the Lasso regression regularization method and clinical judgement, the key variables associated with extracorporeal circulatory failure were identified and selected. These variables were then incorporated into a multivariate logistic regression analysis to identify independent risk factors, leading to the construction of a predictive model.  Results  The final predictive model was based on body weight (OR=0.932, 95% CI: 0.910～0.954, P＜0.001), mean ultrafiltration rate (OR=1.012, 95% CI: 1.007～1.017, P＜0.001), insufficient blood flow (OR=26.535, 95% CI: 12.507～56.297, P＜0.001), and lactate levels (OR=1.095, 95% CI: 1.014～1.183, P=0.021). The area under the receiver operating characteristic (ROC) curve for the model was 0.891 (85.61%～92.48%). Calibration curves and clinical decision curves indicated that the model has good predictive capability and clinical utility.  Conclusion  Low body weight, high mean ultrafiltration rate, insufficient blood flow, and elevated lactate levels are independent risk factors for extracorporeal circulation failure within 24 hours of CRRT in pediatric patients. The predictive model based on these factors demonstrates high predictive accuracy. Metrics

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Application effect evaluation of closed plasma return in double plasma molecular adsorption system (DPMAS) Treatment: A prospective randomized controlled study WANG Bei-bei, ZHOU Sheng-yu, ZHAO Yuan, LIN Li, SUN Xian-kun, WANG Fang, ZHANG Ling, CHEN Zhi-wen 2025, 24 (01):  18-22.  doi: 10.3969/j.issn.1671-4091.2025.01.003 Abstract ( 100 )   PDF (635KB) ( 2 )   Objective  To evaluate the application effect of closed plasma reinfusion in the treatment of patients with double plasma molecular absorption system (DPMAS).   Methods  A total of 60 patients who underwent DPMAS treatment in our hospital from May 2021 to February 2023 were selected and randomly divided into three groups: non-reinfusion group, closed plasma reinfusion 400 ml group, and closed plasma reinfusion 600 ml group, with 20 patients in each group. The loss of albumin after the completion of DPMAS treatment and the change in bilirubin levels in the blood before and after plasma reinfusion in the closed plasma reinfusion groups were compared.  Results  After DPMAS treatment and reinfusion, the remaining albumin levels in different locations of the three groups were significantly different (bilirubin adsorber: 11.9(10.4, 13.0)g vs. 1.2 (1.0, 1.5)g vs. 0.8(0.6, 0.9)g, H=49.266, P<0.001). hemoperfusion device: 11.9 (10.4, 13.0) g vs. 4.0 (3.7, 5.2) g vs. 1.3(1.1, 2.0)g, H=52.477, P<0.001). extracorporeal circuit: 11.9(10.4,13.0)g vs. 9.0(7.9,10.0)g vs. 3.2(2.2, 3.8)g, H=46.787, P<0.001). The average albumin loss was also significantly different [11.9(10.4, 13.0)g vs. 4.7(4.3, 5.3)g vs. 1.8(1.4, 2.0)g, H=52.465, P<0.001]. In the closed plasma reinfusion groups (400 ml and 600 ml), no statistically significant difference was observed in bilirubin levels before [(236.21±98.31) vs. (224.07±64.63)mmol/L, t=-0.461, P=0.647] and after reinfusion [(233.83±99.98) vs. (220.04±66.67)mmol/L, t=-0.513, P=0.611].  Conclusion  Closed plasma reinfusion can not only reduce the loss of albumin in patients but also does not increase the risk of bilirubin shedding. Metrics

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Application value of musculoskeletal ultrasound in the evaluation of sarcopenia in maintenance hemodialysis patients TAO Ying, FANG Yu, JI Xiao-jing, MOU Hong-bin, JIAO Cheng 2025, 24 (01):  23-26.  doi: 10.3969/j.issn.1671-4091.2025.01.004 Abstract ( 80 )   PDF (517KB) ( 5 )   Objective  To investigate the application value of musculoskeletal ultrasound in the evaluation of sarcopenia in maintenance hemodialysis patients. Methods  237 patients with maintenance hemodialysis in the Blood Purification Center of Northern Jiangsu People’s Hospital were selected as the study objects. The grip strength and skeletal muscle index were measured, and the gastrocnemius muscle thickness was measured by ultrasound. Patents were into male and female group. The relationship between gastrocnemius thickness and diagnostic indicators of sarcopenia was analyzed, and the optimal cutoff value of gastrocnemius thickness was analyzed by the receiver operating characteristic (ROC) curves.  Results  The thickness of gastrocnemius was significantly correlated with sarcopenia in maintenance hemodialysis patients. The gastrocnemius muscle thickness was positively correlated with grip strength and skeletal muscle index in general, male and female groups，General (r=0.570, 0.520, P＜0.001); Male group (r=0.631, 0.535, P＜0.001); Female group (r=0.251, 0.356, P=0.017, 0.001). Compared with non-sarcopenia patients, the thickness of gastrocnemius in patients with sarcopenia was significantly reduced. Compared with the non-sarcopenia group, the gastrocnemius muscle thickness was reduced in the male group (t=8.975, P＜0.001) and the female group (t=4.725, P＜0.001). The ROC curves of subjects with sarcopenia predicted by gastrocnemius thickness in maintenance hemodialysis patients of different genders showed that: the area under the curve (AUC), optimal cut-off value, specificity and sensitivity of male group were 0.903, 15.3, 0.882 and 0.823, respectively. The area under the curve, optimal cut-off value, specificity and sensitivity of female suite were 0.868, 14.1, 0.750 and 0.857. Conclusion  Gastrocnemius thickness was positively correlated with grip strength and skeletal muscle index in maintenance hemodialysis patients. If the thickness of gastrocnemius muscle is less than 15.3mm in males and less than 14.1mm in females, it indicates that patients may develop sarcopenia. Clinical staff can use musculoskeletal ultrasound for early screening of sarcopenia in maintenance hemodialysis patients, and make early intervention to improve the quality of life of patients. Metrics

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Construction of a risk prediction model for abdominal aortic calcification in maintenance hemodialysis patients SHAO Feng, WANG Xiao-qi, YUAN Dan, LIU Cong-hui, LIAN Xiao-ying, LI Zhong-xin 2025, 24 (01):  27-30,53.  doi: 10.3969/j.issn.1671-4091.2025.01.005 Abstract ( 74 )   PDF (582KB) ( 5 )   Objective To study the correlation between the values of plasma atherosclerotic index (AIP) and lymphocyte/monocyte ratio (LMR) and the presence of abdominal aortic calcification (AAC) in maintenance hemodialysis (MHD) patients, from which a risk prediction model of AAC was then constructed.  Methods  This was a cross-sectional study. Clinical data of the MHD patients treated in our hospital from May 1, 2023 to April 30, 2024 were retrospectively analyzed. Univariate and multivariate logistic regression analyses were applied to determine the risk factors for ACC, from which a column chart was constructed and internally validated.  Results A total of 158 MHD patients were enrolled in this study. They were divided into AAC group (n=106) and non-AAC group (n=52). Age (F=1.325, P＜0.001), corrected serum calcium (F=0.343, P=0.016), AIP (F=8.726, P=0.003) and rate of diabetes history (F=9.287, P=0.002) were higher in AAC group than in non-AAC group; dialysis age (F=3.681, P=0.007), blood albumin (F=3.287, P=0.002), blood phosphorus (F=0.344, P=0.018), and LMR (F=1.824, P=0.022) were lower in AAC group than in non-AAC group. Multivariate logistic regression found that older age (OR=1.071, 95% CI: 1.034～1.108, P＜0.001), diabetes (OR=3.346, 95% CI: 1.428～7.843, P=0.005), high AIP (OR=1.176, 95% CI: 1.041～1.33, P=0.009) and low LMR (OR=0.777, 95% CI: 0.614～0.983, P=0.036) were the independent risk factors for AAC in MHD patients. A column chart was then constructed and the C-index of 0.834 (95% CI: 0.769～0.899) was calculated, indicating a better discriminative ability of the column chart model. A calibration curve was drawn, and the absolute error between simulated curve and actual curve was 0.029, indicating a strong consistency of the model.  Conclusions  Older age, diabetes, higher AIP and lower LMR are the independent risk factors for AAC in MHD patients. The risk prediction model based on age, diabetes, AIP and LMR has a better prediction efficiency. Metrics

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Prospective study of calcium-containing dialysate and replacement fluid with simplified citrate anticoagulation technique in continuous renal replacement treatment QIANG Jing-ya, TANG Xue, WANG Fang, WANG Bei-bei, CHEN Fang, CHEN Zhi-wen, ZHANG Ling 2025, 24 (01):  31-34.  doi: 10.3969/j.issn.1671-4091.2025.01.006 Abstract ( 78 )   PDF (490KB) ( 3 )   Objective To observe the effectiveness and safety of calcium-containing dialysate and replacement fluid with regional citrate anticoagulation in continuous renal replacement treatment (CRRT).  Methods  We prospectively recruited the patients treated with CRRT in West China Hospital of Sichuan University during January 2020 to December 2021. They were treated with the model of continuous veno-venous hemodiafiltration (CVVHDF) using citrate anticoagulation method. Blood access used the cuffed catheter in internal jugular vein or femoral vein. The initial blood flow was 150 ml/min, the rate of calcium-containing dialysate and replacement fluid was 1,000 ml/h, and 4% sodium citrate solution was pumped at the initial rate of 180 ml/h. Calcium ion was measured before and after the filtration at 0h, 6h, 12h, 24h and 48h. Lifespan of the extracorporeal circulation pipeline, treatment parameters and complications were collected. Results  A total of 28 patients were enrolled in this study, including 44 times of extracorporeal circulation pipeline and 42 times of scheduled CRRT. The average lifespan of the extracorporeal circulation pipeline was 44.0±24.6h, including the lifespan of <24h in 11 cases (26.2%), 24h ～ ＜48h in 13 cases (31.0%), and 48h ～≤72h in 18 cases (42.9%). There were no significant differences in the levels of calcium ion before filtration at 6h (t=0.612, P=0.969), 12h (t=0.456, P=0.625), 24h (t=0.848, P=0.298) and 48h (t=0.411, P=0.415), as compared with the baseline level at 0h. There were also no significant differences in the levels of calcium ion after filtration at 6h (t=0.294, P=0.774), 12h (t=0.246, P=0.405), 24h (t=0.191, P=0.853) and 48h (t=0.059, P=0.955), as compared with the level at 0h. Metabolic alkalosis was found in one patient (2.3%), and citric acid accumulation was found in one patient (2.3%).  Conclusion  The calcium-containing dialysate and replacement fluid with regional citrate anticoagulation for CRRT is effective and safe, and is suitable for the use of CRRT equipment with integrated citrate anticoagulation system. This method is worthy of further clinical application. Metrics

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The efficacy and safety of sodium thiosulfate in the treatment of pruritus in maintenance hemodialysis patients BAO Hong-da, JIAN Gui-hua, GUO Yong-ping, LIU Kun, ZHANG Li-ming, WANG Ying-deng, YU Chen, ZOU Jian-zhou, ZHANG Lei, ZHANG Ran, FAN Qiu-ling, CHEN Shun-jie, MA Jun, WANG Xiao-xia, WANG Qin, WANG Nian-song, JIANG Geng-ru 2025, 24 (01):  35-39.  doi: 10.3969/j.issn.1671-4091.2025.01.007 Abstract ( 163 )   PDF (636KB) ( 7 )   Objective To observe and compare the efficacy and safety of different doses of sodium thiosulfate for the treatment of pruritus in maintenance hemodialysis (MHD) patients.  Methods  A total of 126 MHD patients with pruritus from 11 general hospitals in Shanghai during January 2020 to December 2022 were included in this study. They were randomly divided into three groups. The dose of sodium thiosulfate was 1.92g in group 1, 3.20g in group 2, and 4.48g in group 3. The treatment period lasted 8 weeks. Clinical effects and safety including pruritus score, biochemical indicators and adverse reactions were observed and compared between the groups.  Results Compared with the pruritus scores 5 days before the treatment and 8 weeks after the treatment, the decreases of pruritus score were 18.6±1.91 to 12.8±3.03, 19.0±2.80 to 11.3±3.40 and 19.6±3.64 to 10.9±3.75 in group 1 (n=72), 2 (n=79) and 3 (n=75) respectively; the extent of decrease were statistically significant among the 3 groups (F=2.735, P=0.046), and the extent of score decrease was greater in group 3 than in group 1 (score difference=-1.352, 95% CI: -2.645～-0.060, P=0.041). No adverse reactions such as allergic reactions, rash and hypotension were found during the observation period. Multivariate analysis showed that compared with group 1 the slope of pruritus score 5 days before the treatment and 8 weeks after the treatment in group 3 showed β= -1.650 (95% CI: -3.046～-0.253, P=0.021).  Conclusion  Sodium thiosulfate can effectively relieve the pruritus symptoms in MHD patients, and the effect is enhanced with increase of the dose. No obvious adverse reactions were found. This treatment is therefore safe and effective. Metrics

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Effect and significance of blood purification on ZO-1 and Occludin expressions in intestinal tissue of small pigs with severe heatstroke#br# CHANG Lin-yu, FAN Wen-wen, ZHANG Jing, NI Jun 2025, 24 (01):  40-43.  doi: 10.3969/j.issn.1671-4091.2025.01.008 Abstract ( 65 )   PDF (649KB) ( 1 )   Objective To observe the effect of blood purification on the expressions of ZO-1 (zonula occludens-1) and Occludin in intestinal tissue of small pigs with severe heatstroke.  Methods  A model of severe heatstroke in small pigs was constructed, and the intestinaql function was evaluated before and after blood purification intervention. According to the random number table method, the animals were divided into three groups: control group (n=6), blank control treatment was performed; model group (n=6), a model of heatstroke was established; intervention group (n=6), treated with blood purification. Pathological changes of intestinal tissue were observed using H-E staining. Chiu's score was used to assess the damage of intestinal tissue. Immunohistochemistry was used to observe the expressions of ZO-1 and Occludin in intestinal tissue.  Results  Reduced congestion and edema and relatively complete mucosa structure were found in intervention group, as compared with those in model group. Chiu's score was statistically different among the 3 groups (F=44.245, P<0.001). The expression levels of ZO-1 and Occludin were also statistically different among the 3 groups (ZO-1: F=152.477, P<0.001; Occludin: F=40.360, P<0.001).  Conclusion  Blood purification can be protective against intestinal injury due to heatstroke in small pigs, probably relating to the upregulation of ZO-1 and Occludin expressions. Metrics

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Effect of hemodiafiltration on intestinal injury and Keap1/Nrf2 signaling pathway in an animal model of acute severe pancreatitis#br# XU Hai-ping, LI Xiu-li, BAO Yu, YANG Chen 2025, 24 (01):  44-48.  doi: 10.3969/j.issn.1671-4091.2025.01.009 Abstract ( 53 )   PDF (717KB) ( 1 )   Objective  To investigate the effect of hemodiafiltration (HDF) on the intestinal injury of severe acute pancreatitis (SAP) rats and the Keap1/Nrf2 signaling pathway.  Methods  Sprague-Dawley (SD) rats were randomly divided into sham operation group (n=18), SAP group (n=18) and HDF group (n=18). Open surgery without SAP manipulation was performed in sham operation group, SAP model was performed in SAP group and HDF group, and continuous HDF for 12 hours was conducted immediately after the preparation of SAP model in HDF group. The expressions of apoptotic factors Bax and Bcl-2,  Keap1/Nrf2 signaling pathway-related proteins in intestinal epithelial cells, endotoxin level in plasma of portal vein, and bacterial culture were assayed after the operation.  Results  In SAP group, the expression of Bax in intestinal epithelial cells was higher than that in sham operation group (t=8.083, P=0.001), while the expression of Bcl-2 in intestinal epithelial cells was lower than that in sham operation group (t=4.765, P=0.008); plasma endotoxin of portal vein and positive rates of bacterial culture of pancreas and liver were higher than those in sham operation group (plasma endotoxin at 12h: t=15.110, P＜0.001; at 24h: t=19.050, P＜0.001; at 48h: t=18.330, P＜0.001. positive bacterial culture of pancreas at 12h: t=23.712, P＜0.001; at 24h: t=20.901, P＜0.001; at 48h: t=36.740, P＜0.001. positive bacterial culture of liver at 12h: t=23.983, P＜0.001; at 24h: t=29.692, P＜0.001; at 48h: t=35.694, P＜0.001). In HDF group, the expression of Bcl-2 in intestinal epithelial cells was higher than that in SAP group (t=5.825, P=0.004); the expression of Bax in intestinal epithelial cells, plasma endotoxin of portal vein and positive rates of bacterial culture of pancreas and liver were lower than those in SAP group (Bax: t=6.796, P=0.002. plasma endotoxin at 12h: t=6.235, P=0.003; at 24h: t=12.251, P＜0.001; at 48h: t=12.980, P＜0.001. positive bacterial culture of pancreas at 12h: t=16.470, P＜0.001; at 24h: t=5.950, P=0.004; at 48h: t=15.071, P＜0.001. positive bacterial culture of liver at 12h: t=2.782, P=0.049; at 24h: t=9.790, P＜0.001; at 48h: t=15.172, P＜0.001). In SAP group, the expressions of Keap1 and Nrf2 were lower than those in sham operation group (Keap1: t=11.611, P＜0.001; Nrf2: t=12.241, P＜0.001). In HDF group, the expressions of Keap1 and Nrf2 were higher than those in SAP group (Keap1: t=80.658, P=0.001; Nrf2: t=12.312, P=0.000).  Conclusion  Continuous HDF can improve the permeability of intestinal epithelial cells and intestinal dysfunction, and inhibit endotoxin and bacterial translocation in SAP rats. Metrics

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Research progress in the citrate-based replacement fluids for continuous renal replacement therapy TONG Shuang, LIN Qiao-xuan, WANG Min-min, WANG Lei 2025, 24 (01):  49-53.  doi: 10.3969/j.issn.1671-4091.2025.01.010 Abstract ( 140 )   PDF (811KB) ( 7 )   Anticoagulation strategy ensures filter patency and delivery of an adequate continuous renal replacement therapy (CRRT) dose. Most guidelines recommend the regional citrate anticoagulation (RCA) as the first-line method for patients requiring CRRT. Previous use of the traditional regional citrate anticoagulation had several drawbacks such as complex operation, risks of acid-base imbalance and metabolic disorders, leading to the restriction of its clinical applications. By contrast, citrate-based replacement fluids solve these deficiencies. This article reviews the research progress in citrate-based replacement fluids from point of view of  anticoagulation effectiveness, treatment efficiency and security. Metrics

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The role of macrophages in the maturation and dysfunction of autogenous arteriovenous fistula for hemodialysis ZOU Jia-le, CHI Yan-qing 2025, 24 (01):  54-57.  doi: 10.3969/j.issn.1671-4091.2025.01.011 Abstract ( 66 )   PDF (472KB) ( 5 )   Inflammation is known to play a crucial role in both early and late phases of vascular remodeling in arteriovenous fistula (AVF). Macrophages are pivotal immune cells in inflammatory responses and exhibit the ability to polarize into pro-inflammatory (M1) or anti-inflammatory (M2) phenotypes in microenvironment. They play key roles in the initiation, progression and resolution of inflammation and in the modulation of AVF in response to surgical trauma, hemodynamic alterations, hypoxia and hyperlipidemia, thereby impacting the maturation and function of AVF. Currently, serval immunosuppressive agents and statins have been demonstrated to diminish macrophage infiltration, enable to improve AVF patency. Consequently, a comprehensive understanding of the roles of macrophages in AVF vascular remodeling is imperative. The exploration of more effective strategies for macrophage regulation may represent a novel avenue for enhancing maturity and maintaining patency of AVF. Metrics

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Research progress in excessive daytime sleepiness in maintenance hemodialysis patients SHANG Zheng-ying ZOU Xun-liang 2025, 24 (01):  58-60.  doi: 10.3969/j.issn.1671-4091.2025.01.012 Abstract ( 81 )   PDF (451KB) ( 3 )   Excessive daytime sleepiness (EDS) is frequently encountered in maintenance hemodialysis (MHD) patients,  probably resulting from complications, drug side effects, sleep deprivation syndrome, obstructive sleep apnea (OSA) or primary central hypersomnia. Unrecognized and untreated EDS is associated with morbidity and mortality of cardiovascular diseases. Improvement of EDS can prolong the life span and improve the quality of life of the patients. This article reviews recent progresses in the causes, evaluation methods and treatment of EDS in MHD patients, in order to provide a systematic approach for clinicians to assess and manage EDS in MHD patients. Metrics

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Based on network pharmacology and molecular docking to investigate the mechanisms of sacubitril valsartan sodium for the treatment of delayed maturation and stenosis of arteriovenous fistula through inhibition of intimal hyperplasia LI xin, QIN Xin-fang, LAN Xue-hua 2025, 24 (01):  61-65.  doi: 10.3969/j.issn.1671-4091.2025.01.013 Abstract ( 72 )   PDF (676KB) ( 1 )   Objective To explore the mechanisms of sacubitril valsartan sodium (LCZ696) for the treatment of delayed maturation and stenosis of arteriovenous fistula (AVF) through inhibition of intimal hyperplasia using network pharmacology and molecular docking methods.  Methods  The effective component of LCZ696 and its target molecules were obtained from the Chemical Book platform and SwissTarget prediction database. The targets of intimal hyperplasia were collected from GeneCards and Online Mendelian Inheritance in Man databases. Protein-protein interaction database was used to construct protein interaction network. Cytoscape 3.10 core target screening and microbioinformatics platform were used for gene ontology and Kyoto encyclopedia of genes and genomes enrichment analysis. Finally, AutoDockTools 1.5.7 was used to verify the core targets and active components.  Results Two effective components and 80 intersection targets were obtained, including 18 core targets such as epidermal growth factor receptor (EGFR). Enrichment analysis showed that phosphatidylinositol 3-kinase/protein kinase B signaling pathway related to the mechanism of action. Molecular docking showed that the docking body composed of EGFR and core target had strong docking activity and highest stability.  Conclusion Sacubitril valsartan sodium may inhibit the intimal hyperplasia through multi-target and multi-pathway in the treatment of delayed AVF maturation and stenosis, providing theoretical basis and potential research pathways for further study of LCZ696. Metrics

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Study on the correlation between TGF-β1/p38 MAPK pathway and arteriovenous fistula dysfunction in diabetic nephropathy patients on maintenance hemodialysis WANG Yu-fu, PENG Hong-ying 2025, 24 (01):  66-70.  doi: 10.3969/j.issn.1671-4091.2025.01.014 Abstract ( 64 )   PDF (646KB) ( 3 )   Objective To study the correlation between TGF-β1/p38 MAPK pathway and arteriovenous fistulas (AVF) dysfunction in diabetic nephropathy (DN) patients on maintenance hemodialysis (MHD).  Methods  The DN patients undergoing AVF construction surgery and MHD in the Affiliated Hospital of Guizhou Medical University from June 2019 to June 2021 were retrospectively analyzed and defined as DN group. The non-diabetic nephropathy patients on MHD were recruited as control 1 group. The non-DN patients with type 2 diabetes were recruited as control 2 group. The levels of TGF-β1 mRNA and p38 MAPK mRNA were compared among the three groups. Logistic regression was used to identify the influencing factors for AVF dysfunction in DN group. ROC curve was used to evaluate the predictive value of TGF-β1 mRNA and p38 MAPK mRNA for AVF  dysfunction. The levels of TGF-β1 and p38 MAPK mRNA were compared in patients with different degrees of aortic arch calcification.  Results  The level of TGF-β1 mRNA was higher in DN group (n=96) than in control 1 group (n=45; t=7.133, P<0.001) and control 2 group (n=42; t=9.929, P<0.001). The level of p38 MAPK mRNA was also higher in DN group (n=96) than in control 1 group (n=96; t=5.983, P<0.001) and control 2 group (n=42; t=8.046, P<0.001). Logistic regression showed that aortic arch calcification (OR=5.020, 95% CI: 2.996～8.413, P<0.001), higher levels of corrected blood calcium (OR=5.080, 95% CI: 3.026～8.527, P<0.001), blood phosphorus (OR=3.523, 95% CI: 2.089～5.943, P<0.001), TGF-β1 mRNA (OR=5.371, 95% CI: 3.197～9.025, P<0.001), and p38 MAPK mRNA (OR=5.636, 95% CI: 3.339～9.513, P<0.001) were the risk factors for AVF dysfunction in DN group. The degree of aortic arch calcification can be classified as grade 0, grade 1, grade 2 and grade 3. The order of TGF-β1 mRNA level was grade 0 < grade 1 < grade 2 < grade 3 (grade 0/grade 1: t=2.219, P=0.033; grade 1/grade 2: t=2.650,        P=0.011; grade 2/grade 3: t=2.523, P=0.015). The order of p38 MAPK mRNA level was also grade 0 < grade 1 < grade 2 < grade 3 (grade 0/grade 1: t=2.530, P<0.001; grade 1/grade 2: t=2.066, P=0.045; grade 2/grade 3: t=2.203, P=0.032). ROC curve showed that the AUC of combined TGF-β1 mRNA and p38 MAPK mRNA to predict AVF dysfunction in DN group was 0.820 (95% CI: 0.732～0.907), with the sensitivity of 80.65%, and specificity of 76.40%.  Conclusion Aortic arch calcification and activation of TGF-β1/p38 MAPK pathway are the independent risk factors for AVF dysfunction in DN patients on MHD. Activation of TGF-β1/p38 MAPK pathway may induce AVF dysfunction by promoting aortic arch calcification. TGF-β1 and p38 MAPK levels have a better value for the prediction of AVF dysfunction. Metrics

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Understanding and discussion of the international standard of dialysis water LUO Li-hua, YE Xiao-yan, WANG Sheng-sheng, YANG Zheng-gen, TANG You-hong, ZHANG Le-yu 2025, 24 (01):  71-74.  doi: 10.3969/j.issn.1671-4091.2025.01.015 Abstract ( 72 )   PDF (492KB) ( 5 )   The current international standard for dialysis water is ISO 23500-3: 2019, “Preparation and quality management of fluids for hemodialysis and related therapies - Part 3: Water for hemodialysis and related therapies”. In this paper we analyzed and discussed the technical requirements from the aspects of sampling and storage, chemical contaminant limits, microbiological limits, and others, in order to better understand the standard for relevant practitioners. Metrics

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Meta-analysis of the prevalence and influencing factors of frailty in elderly Chinese patients undergoing maintenance hemodialysis XIAO Yu, HU Wan-yue, XING Xin-yue, XIAO Hong-ling, WANG Chen-qi, WU Ya-xuan 2025, 24 (01):  75-79,85.  doi: 10.3969/j.issn.1671-4091.2025.01.016 Abstract ( 94 )   PDF (756KB) ( 7 )   Objective To explore the prevalence of frailty and its influencing factors among elderly maintenance hemodialysis (MHD) patients in China by a meta-analysis, and to provide references for early diagnosis and intervention of the frailty.  Methods  We systematically searched for the databases of Embase, Cochrane Library, PubMed, WOS, CINAHL, SinoMed, CNKI, VIP and WanFang. The search period was from the establishment of the database to April 2024. Meta-analysis was performed using the Stata 15.0 software.  Results  A total of 11 literatures were obtained, containing 1008 patients with frailty in the 2007 elderly MHD patients, and 28 related influencing factors. Meta-analysis found that the prevalence of frailty in elderly MHD patients in China was 48% (95% CI: 37.2%～58.9%). Age (OR=1.163, 95% CI: 1.066～1.269, P=0.001), female (OR=2.143, 95% CI: 1.296～3.543, P=0.003), C-reactive protein (OR=1.331, 95% CI: 1.124～1.576, P=0.001), depression (OR=4.231, 95% CI: 1.524～11.751, P=0.006), complicated with diabetes (OR=3.242, 95% CI: 1.943～5.410, P＜0.001) and complicated with cardiovascular disease (OR=4.066, 95% CI: 2.225～7.430, P＜0.001) were the risk factors for frailty in elderly MHD patients in China. Ability of daily living (OR=0.886, 95% CI: 0.791～0.993, P=0.037) was a protective factor for frailty in elderly MHD patients in China.  Conclusion  The prevalence of frailty in Chinese elderly MHD patients is at a higher level. Clinical staff should pay attention to elderly MHD patients, identify the influence factors for frailty, and take individualized intervention measures, so as to achieve early recognition, prevention, treatment and a higher survival rate. Metrics

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Potential profile analysis of volume management characteristics in maintenance hemodialysis patients     YE Wei, CAO Song-mei, HE Jian-qiang, PEI Kun, WAN Xing-yu 2025, 24 (01):  80-85.  doi: 10.3969/j.issn.1671-4091.2025.01.017 Abstract ( 59 )   PDF (627KB) ( 5 )   Objective  To classify the subgroups of maintenance hemodialysis (MHD) patients based on their volume management capacity characteristics and to analyze the influencing factors.  Methods  The MHD patients treated in the Affiliated Hospital of Jiangsu University Hospital, Zhenjiang Second People's Hospital, and Xingkang Chain Dialysis Center of Zhenjiang Hemodialysis Branch Center from September to November 2023 were recruited by convenience sampling method. General information questionnaire, Volume Management Behavior Scale, Dialysis Thirst Rating Scale, Perceived Social Support Scale, Fluid Intake Compliance Barrier Scale, Fluid Intake Self-Efficacy Scale, and Hemodialysis Knowledge Level Questionnaire were used for the investigation. Latent profile analysis (LPA) was employed to explore the potential typologies of volume management characteristics in MHD patients. Univariate and multinomial logistic regression were used to evaluate the influencing factors.  Result  We recruited 322 MHD patients for this study, of whom 76 (23.6%) were classified as high ability-low barrier, 143 (44.4%) as moderate management ability, and 103 (32.0%) as low ability-high barrier. Logistic regression showed that when the high ability-low barrier patients were used as the reference group, education level of junior high school (OR=6.576, 95% CI: 1.132～38.187, P=0.036; OR=10.671, 95% CI: 2.238～50.882, P=0.003), dialysis duration of 1-5 years (OR=10.777, 95% CI: 2.422～47.966, P=0.002; OR=4.922, 95% CI: 1.457～16.628, P=0.010), diabetes (OR=16.729, 95% CI: 3.312～84.498, P=0.001; OR=5.034, 95% CI: 1.067～23.744, P=0.041), knowledge level (OR=0.405, 95% CI: 0.297～0.551, P＜0.001; OR=0.445, 95% CI: 0.331～0.598, P＜0.001), and social support (OR=0.884, 95% CI: 0.830～0.942, P＜0.001; OR=0.883, 95% CI: 0.832～0.937, P＜0.001) were the influencing factors for latent classes of volume management characteristics in MHD patients.  Conclusion  The volume management characteristics is heterogeneous in MHD patients. Healthcare professionals should identify management issues in different types of patients and implement targeted interventions to increase the patients' volume management capabilities. Metrics