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Chinese Journal of Blood Purification

Chinese Journal of Blood Purification

    12 September 2025, Volume 24 Issue 09 Previous Issue   
    Expert consensus on the selection of blood purification modalities (2025 edition)
    The Working Group of the Expert Consensus on Blood Purification Modality Selection
    2025, 24 (09):  705-725.  doi: 10.3969/j.issn.1671-4091.2025.09.001
    Abstract ( 206 )  
    The "Expert Consensus on the Selection of Blood Purification Modalities" was first published in 2019. After six years of accumulating evidence-based medical updates and clinical practice validation, and to accommodate advancements in blood purification technology and evolving diagnostic and treatment standards, a comprehensively revised edition is now formally released. This updated consensus, authored by 39 nephrology and blood purification experts, integrates evidence-based medicine and clinical experience to propose 26 recommendations providing guidance for selecting blood purification modalities. It     covers the assessment of hemodialysis adequacy and details the indications, advantages, limitations, and precautions for various commonly used blood purification modalities, including low-efficiency hemodialysis, low-flux hemodialysis, high-flux hemodialysis, hemodiafiltration, hemofiltration, isolated ultrafiltration, and hemoadsorption. This consensus offers comprehensive and systematic guidance for blood purification practitioners, aiming to further standardize hemodialysis management, enhance quality control, and improve long-term patient outcomes.
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    Research on the construction of Nomogram model for risk prediction of heart failure in maintenance hemodialysis
    LIU Qiu-yan, YAN Xian-li, ZHANG Yue
    2025, 24 (09):  726-731.  doi: 10.3969/j.issn.1671-4091.2025.09.002
    Abstract ( 15 )  
    Objective  To construct a nomogram model for predicting the risk of heart failure in patients undergoing maintenance hemodialysis (MHD). Methods  The medical records of MHD patients at the Third People's Hospital of Henan Province from September 2020 to July 2023 were retrospectively analyzed. The patients were divided into a model group and a validation group in a 2:1 ratio. The model group was further categprized into concurrent group and non-concurrent group based on the occurrence of heart failure. Risk factors for heart failure was screened through Logistic regression analysis, and a risk prediction nomogram model was constructed and validated.  Results  A total of 312 patients were included, and they were including 208 in the model group and 104 in the validation group. Among the patients in the model group, 68 cases had concurrent heart failure (32.69%). Logistic regression analysis of the model group data showed that hypertension (OR=2.046, 95% CI: 1.229～3.406, P=0.007), dialysis age (OR=2.809, 95% CI: 1.524～5.179, P＜0.001), N-terminal pro-brain natriuretic peptide (NT-proBNP) (OR=3.572, 95% CI: 1.852～6.887, P＜0.001), creatine kinase isoenzyme (CK-MB) (OR=3.384, 95% CI: 1.786～6.411, P＜0.001), hemoglobin (Hb) (OR=0.446, 95% CI: 0.256～0.777, P=0.005), red cell volume distribution width (RDW) (OR=2.989, 95% CI: 1.603～5.575, P＜0.001), blood phosphorus (OR=2.438, 95% CI: 1.359～4.371, P=0.003), C-reactive protein (CRP) (OR=3.174, 95% CI: 1.685～5.978, P＜0.001), uric acid (UA) (OR=2.591, 95% CI: 1.419～4.729, P＜0.001) and procalcitonin (PCT) (OR=3.951, 95% CI: 2.021～7.724, P＜0.001) were all independent risk factors for heart failure in MHD patients. In the nomogram model, the calibration curves of the model group and validation group showed that the calibration curve of this model had good consistency with the ideal curve, and the consistency index of them were 0.836 (95% CI:0.783～0.882) and 0.827 (95% CI:0.764～0.873), respectively. The area under the curve for predicting heart failure in the model group and validation group were 0.843 (95% CI:0.786～0.889) and 0.835 (95% CI:0.750～0.901), respectively. The model group and the validation group could obtain net benefits when the threshold probability were 0～0.88 and 0～0.90.  Conclusion  Hypertension, dialysis vintage, NT-proBNP, CK-MB, hemoglobin, RDW, serum phosphorus, CRP, uric acid and PCT are independent risk factors for heart failure in MHD patients. The Nomogram model incorporating these factors exhibits strong predictive accuracy and clinical applicability.
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    Comparison of the clinical outcomes of single-port laparoscopic versus open peritoneal dialysis catheter placement
    JI Li-qi, MA Zhi-mian, LI Jun, WANG Jiao-jiao, SUI Man-shu, WANG Ming-ao
    2025, 24 (09):  732-736.  doi: 10.3969/j.issn.1671-4091.2025.09.003
    Abstract ( 13 )  
    Objective  Laparoscopic catheterization has the advantages of directly exploring the abdominal cavity and correcting the catheter position. However, conventional techniques typically require 2-3 ports, which may increase the risk of complications such as abdominal wall hernia and dialysate leakage. To address this, we designed a simplified single-port laparoscopic catheterization (SLC) technique.  Methods  30 patients with end-stage renal disease who underwent peritoneal dialysis catheterization at the Department of Nephrology, the First Affiliated Hospital of Harbin Medical University from March 2023 to September 2023 were selected and divided into a SLC group (n=15) and an open surgical catheterization (OSC) group (n=15). The baseline data before surgery, perioperative conditions, postoperative complications, and long-term catheter prognosis of the two groups were compared.  Results  No statistical differences in the baseline data between the two groups of patients. All patients underwent successfully peritoneal dialysis catheters inserted, with good intraoperative status. Compared with the OSC group, the SLC group had a shorter operation time (t=-4.227, P＜0.001) and postoperative hospital stays (Z=-3.124, P=0.001), smaller incisions (Z=-4.864, P＜0.001), and less postoperative pain (t=-3.786, P=0.001), but higher hospitalization costs (t=2.662, P=0.018). By the end of follow-up, 5 cases in the OSC group had bloody peritoneal dialysis fluid, 1 case had early peritonitis with catheter displacement, 1 case had dialysate leakage, and 1 case had catheter blockage, while the SLC group only had 3 cases of bloody peritoneal dialysis fluid, and no other catheter-related complications or infections occurred. The 1-year catheter survival rates for the two groups were 93.3% for the SLC group and 86.7% for the OSC group, respectively.  Conclusion   Single-port laparoscopic peritoneal dialysis catheterization is a feasible and safe technique with advantages including reduced operative time, shorter hospital stays, and fewer complications compared to open surgery.
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    Predictive performance of whole-blood cell-derived inflammatory markers for all-cause death in maintenance hemodialysis patients
    YANG Bin, YANG Yi-nan, GU Xiao-hong, ZHAO Qing-qiong
    2025, 24 (09):  737-741.  doi: 10.3969/j.issn.1671-4091.2025.09.004
    Abstract ( 18 )  
    Objective  To investigate the predictive value of whole blood cell-derived inflammatory indicators for all-cause mortality in maintenance hemodialysis (MHD) patients.  Methods  A total of 335 MHD patients from January 2022 to December 2022 at Guizhou University of Traditional Chinese Medicine Second Affiliated Hospital were included. They were divided into a deceased group (n=53) and a survival group (n=282) based on follow-up outcomes. Levels of inflammatory indicators were compared between groups. Restricted cubic splines (RCS) and logistic regression analyzed associations between inflammatory indicators and mortality risk. Receiver operating characteristic (ROC) curves assessed predictive value.  Results  Patients in the deceased group had higher neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), neutrophil-monocyte to lymphocyte ratio (NMLR), systemic immune inflammatory index (SII), systemic inflammatory response index (SIRI), and platelet/lymphocyte ratio (PLR) than those in the survival group (Z=-5.746, -5.275, -5.784, -4.446, -6.087, -2.222; all P＜0.05). RCS showed nonlinear relationships between SIRI, NLR, MLR, NMLR, PLR, and all-cause mortality (χ²=11.480, 20.440, 17.500, 18.830, 13.540, 10.750; P =0.003, ＜0.001, ＜0.001, ＜0.001, 0.001, 0.005). After adjusting for confounders, logistic regression identified NLR (OR=2.324, 95% CI :1.461～3.698, P＜0.001), SII (OR=2.047, 95%  CI :1.365～3.070, P＜0.001), SIRI (OR=1.623, 95% CI :1.080～2.437, P=0.017), and NMLR (OR=2.302, 95%  CI :1.457～3.636, P＜0.001) as independent risk factors. AUCs for predicting mortality were: NLR 0.822(95% CI :0.756～0.888), NMLR 0.822(95% CI :0.756～0.888), SII 0.817(95% CI :0.750～0885), and SIRI 0.814s    (95% CI :0.747～0881).  Conclusion   NLR, NMLR, SII, and SIRI are significantly associated with the risk of all-cause mortality in MHD patients and can effectively predict mortality risk.
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    Correlation between serum homocysteine, ferritin and sarcopenia in maintenance hemodialysis patients with chronic kidney disease
    LIU Dan, HUANG Fu-han, YANG Zhen-zhen, LIU Bo
    2025, 24 (09):  742-745.  doi: 10.3969/j.issn.1671-4091.2025.09.005
    Abstract ( 10 )  
    Objective  To investigate the association of serum homocysteine (Hcy) and ferritin (SF) with sarcopenia in maintenance hemodialysis (MHD) patients.  Method  undergoing MHD at Huzhou Central Hospital between January 2023 and January 2024 were retrospectively collected. Patients with sarcopenia (n=40, 32.00%) were assigned to the sarcopenia group, while those without sarcopenia (n=85, 68.00%) comprised the non-sarcopenia group. Baseline characteristics, laboratory parameters, and serum Hcy and SF levels at admission were collected. Logistic regression was used to identify factors influencing sarcopenia in MHD patients.  Results Compared with the non-sarcopenia group, the sarcopenia group showed significantly higher levels of high-sensitivity C-reactive protein (hs-CRP), Hcy and SF (t =4.400, 5.169, 5.650; all P＜0.001) and lower levels of hemoglobin, skeletal muscle mass index, handgrip strength and gait speed (t=4.901, 3.764, 3.300, 3.870; P＜0.001, ＜0.001, 0.001, ＜0.001, respectively). Logistic regression revealed that elevated hs-CRP (OR =2.100, 95% CI:1.313～3.357, P=0.002), Hcy (OR=1.160, 95% CI: 1.073～1.255, P＜0.001) and SF (OR =1.018, 95% CI:1.009～1.027, P＜0.001) were independent risk factors for sarcopenia, whereas higher hemoglobin level (OR=0.930, 95% CI: 0.885～0.978, P=0.004) was a protective factor.  Conclusion   Elevated serum Hcy and SF levels are independent risk factors for sarcopenia in MHD patients..
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    Study on biosafety of dialyzer
    XU Jian-xia, HAO Qing, LIU Kang-bo, ZHAO Dan-mei, WANG Xue-ying, LIU Zi-qi, FU Bu-fang
    2025, 24 (09):  746-752.  doi: 10.3969/j.issn.1671-4091.2025.09.006
    Abstract ( 16 )  
    bjective To establish effective methods for detecting hazardous substances in dialyzers. Method  The industry-standard of hemolysis test and reducing substance assay were optimized: ①the contact time between hollow fibers and red blood cells was prolonged and a dynamic, back-and-forth sliding motion of the fibers in the erythrocyte suspension was introduced; ②the entire dialyzer was exhaustively extracted and, after extraction, fully obtain all the extraction solutions to determine the total amount of reducing substances in the device. The hemolysis rate and reducing substance content of 16 batches of dialyzers were tested by both the standard and optimized protocols; results were compared. After further refinement, the optimized methods were applied to 28 additional  batches of dialyzers to determine hemolysis rate and total reducing substances and to analyze their correlation. In addition, relevant studies on the wavelength band of the maximum absorption peak of the dialyzer extract and the appropriateness of the current extract-collection protocol in biological experiments were also conducted.  Result  The optimized hemolysis test (t=-5.987, P＜ 0.001) and reducing substance content (t=-4.601, P ＜0.001) assay demonstrated higher sensitivity than the standard protocols. With the standard methods, hemolysis rate and reducing substance content levels of the 16 batches of dialyzers were uniformly low; with the optimized methods, hemolysis rate ranged from 0.5 % to 12.2 %, and total reducing substances from 3.8 mL to 90.4 mL. For the 28 batches of dialyzers, hemolysis rate correlated positively with total reducing substances (r=0.478, P=0.013); when total reducing substances exceeded 30 mL, hemolysis rate was ≥5 %. The dialyzer extract showed maximum UV absorbance at 200 nm. After obtaining extract liquid in the common way, a substantial volume of fluid remained inside the hollow fibers.   Conclusion  ①The optimized methods for the reducing substances content and hemolysis rate are effective for quantifying hazardous components. Controlling the total amount of reducing substances can, to a certain extent, achieve the goal of limiting the content of hazardous substances.  ② Industry standard YY0053 needs to be revised: the reducing substance assay and hemolysis rate test should be tightened according to the optimized protocols mentioned in our study. the UV absorbance wavelength should be corrected; and the      extraction procedure for biological tests should specify complete removal of residual fluid from the dialyzer using repeated vacuumassisted aspiration.
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    High calcium ion concentration regulates epithelial-mesenchymal transition of human peritoneal mesothelial cells via the STAT3 pathway
    HE Yu-tao, GUO Bao-zhu, WEI Zhi-feng, ZHAO Qi, DONG Juan
    2025, 24 (09):  753-758.  doi: 10.3969/j.issn.1671-4091.2025.09.007
    Abstract ( 10 )  
    Objective  To investigate the role and mechanism of high calcium ion concentration in regulating epithelial-mesenchymal transition (EMT) of human peritoneal mesothelial cells through the Janus kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) pathway.  Methods  Human peritoneal mesothelial cells HMrSV5 were cultured and divided into the following groups: control group (Ca2+ 1.25 mmol/L), 1.75 mmol/L Ca2+ group, 2.25 mmol/L Ca2+ group, solvent control group (Ca2+ 1.25 mmol/L, 0.1% dimethyl sulfoxide), 2.25 mmol/L Ca2+ + solvent group (Ca2+ 2.25 mmol/L, 0.1% dimethyl sulfoxide), 2.25 mmol/L Ca2+ + S3I-201 (STAT3 inhibitor) group (Ca2+ 2.25 mmol/L, S3I-201 100 μmol/L), and 2.25 mmol/L Ca2+ + Stattic (STAT3 inhibitor) group (Ca2+ 2.25 mmol/L, Stattic 1.5 μmol/L). After 48 hours of treatment, number of invasive cells, mRNA and protein expression levels of α-smooth muscle actin (α-SMA) and E-cadherin, and phosphorylation levels of JAK1, JAK2, STAT3 and STAT6 were measured.  Results  In 1.75 mmol/L Ca2+ group and 2.25 mmol/L Ca2+ group, number of invasive cells (t=6.901 and 10.870, P＜0.001), α-SMA mRNA (t=5.375 and 9.564, P＜0.001), α-SMA protein (t=7.018 and 10.859, P＜0.001), phosphorylation of JAK2 (t=7.031 and 11.001, P＜0.001) and phosphorylation of STAT3 (t=5.425 and 9.846, P=0.001 and ＜0.001) were significantly higher than those in control group; E-cadherin mRNA (t=4.457 and 10.749, P=0.002 and ＜0.001) and E-cadherin protein (t=6.519 and 11.351, P＜0.001) were lower than those in control group; while phosphorylation levels of JAK1 and STAT6 (F=0.423 and 0.311, P=0.619 and 0.674) had no differences as compared with those of control group. In 2.25 mmol/L Ca2+ + S3I-201 group and 2.25 mmol/L Ca2++ Stattic group, number of invasive cells (t=7.259 and 6.995, P＜0.001), α-SMA mRNA (t=5.230 and 5.851, P=0.001 and ＜0.001),  α-SMA protein (t=7.684 and 7.833, P＜0.001), and phosphorylation of STAT3 (t=6.753 and 8.574, P＜0.001) were lower than those of 2.25 mmol/L Ca2+ + solvent group; E-cadherin mRNA (t=7.500 and 8.173, P＜0.001) and E-cadherin protein (t=13.021 and 9.340, P＜0.001) were higher than those of 2.25 mmol/L Ca2+ + solvent group; while phosphorylation of JAK2 (t=0.754 and 1.091, P=0.473 and 0.307) had no difference as compared with that of 2.25 mmol/L Ca2+ + solvent group.  Conclusion  High Ca2+ concentration activates the signaling pathway via phosphorylation of STAT3 to promote EMT of human peritoneal mesothelial cells.
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    Research progress on the mechanism, prognostic value, diagnosis and treatment of worsing renal function in CRS-1
    SONG Chao, LIN Qiong-zhen
    2025, 24 (09):  759-763.  doi: 10.3969/j.issn.1671-4091.2025.09.008
    Abstract ( 17 )  
    Cardiorenal syndrome type 1 (CRS-1) refers to the pathophysiological syndrome of acute kidney injury (AKI) caused by acute deterioration of cardiac function. It is more common in acute decompensated heart failure (ADHF). AKI in the development of CRS-1 is also known as worsening renal function (WRF). This article reviews the definition, diagnostic criteria, pathogenesis, clinical significance and etiology of WRF in CRS-1, as well as therapeutic strategies for WRF. The aim is to enhance recognition of AKI in CRS-1 and deepen understanding of its pathophysiology, thereby providing a theoretical basis for improving CRS-1 management and patient prognosis.
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    Meta-analysis on the incidence and risk factors of restless legs syndrome in maintenance hemodialysis patients
    ZHENG Min-yao, ZHENG You-wen, CHU Xin, HE Yan
    2025, 24 (09):  764-770.  doi: 10.3969/j.issn.1671-4091.2025.09.009
    Abstract ( 18 )  
    Objective   To conduct a meta-analysis on the incidence and risk factors of restless legs syndrome (RLS) in patients undergoing maintenance hemodialysis (MHD).  Methods  We searched the databases including PubMed, Web of Science, EMbase, the Cochrane Library, SinoMed, CNKI, Wanfang Data, and VIP from inception of the databases to December 2024. Stata 17.0 statistical software was employed for the meta-analysis.  Results  A total of 43 studies were included, with a total sample size of 12,333 patients among whom 2,519 were diagnosed with RLS. Twelve risk factors were identified. Meta-analysis revealed that the incidence of RLS in MHD patients was 24.8% (95% CI:21.1～28.5%). Risk factors for RLS included female gender (OR=1.332, 95% CI:1.231～1.441, P＜0.001), duration of dialysis (OR=1.037, 95% CI: 1.014～1.060, P=0.001), β2-microglobulin (OR=1.160, 95% CI:1.019～1.320, P=0.025), serum phosphorus (OR=1.591, 95% CI: 1.238～2.044, P＜0.001) and serum homocysteine (OR=1.252, 95% CI: 1.135～1.381, P＜0.001). High level of serum vitamin D (OR=0.909, 95% CI: 0.831～0.995, P=0.038) was a protective factor.  Conclusion  The incidence of RLS is relatively high in MHD patients. Healthcare professionals should identify RLS early based on risk factors and implement corresponding preventive measures and intervention strategies to reduce the incidence of RLS to improve patients' quality of life.
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    Application of balloon dilation for small-caliber veins in arteriovenous fistula surgery of diabetic nephropathy patients
    JIANG Qiang, SUN Yu-jun, LONG Huang-zhe, WANG Min, WEN Lan-fang, LIU Wen-wei
    2025, 24 (09):  771-775.  doi: 10.3969/j.issn.1671-4091.2025.09.010
    Abstract ( 13 )  
     Objective  To evaluate the efficacy of balloon dilation, catheter dilation, and hydraulic dilation techniques for small-caliber veins in arteriovenous fistula (AVF) surgery of diabetic nephropathy patients.  Methods  This retrospective study enrolled 97 diabetic nephropathy patients for the  construction of a new AVF at Shaoyang Central Hospital and its East Branch from January 2020 to January 2023. The preoperative cephalic vein diameters (tourniquet applied) were less than 2.5 mm in all patients. Based on intraoperative vein dilation technique, the patients were divided into three groups: balloon dilation group (n=30, using 3～4 mm×80 mm balloon catheter), catheter dilation group (n=35, using 6F urinary catheter), and hydraulic dilation group (n=32, saline hydraulic dilation). AVF patency rate, re-intervention rate, cephalic vein diameter, and brachial artery blood flow immediately after surgery and after surgery for 1, 2 and 12 months were used to assess their outcomes.  Results  Immediate success rates in balloon, catheter, and hydraulic groups were 96.7%, 85.7%, and 84.4%, respectively, without significant difference (χ²=2.799, P=0.133). After 2 months, AVF maturation rate was significantly higher in balloon group (93.3%) than in catheter (68.6%, χ²=6.190, P=0.013) and hydraulic groups (71.9%, χ²=4.885, P=0.027). After 12 months, re-intervention rate was lower in the balloon group (13.3%) than in catheter (40.0%, χ²=5.737, P=0.017) and hydraulic groups (37.5%, χ²=4.723,      P=0.030). Cephalic vein diameter and brachial artery blood flow showed statistically significant differences among groups immediately after surgery and after surgery for one  and two months (Cephalic vein diameter: F=23.994, 21.311 and 17.305 respectively; P＜0.001. Brachial artery blood flow: F=16.425, 14.002 and 12.631 respectively; P＜0.001). Tukey’s post hoc tests revealed that balloon group had significantly greater cephalic vein diameters than catheter (q=6.390, 3.429 and 4.152 respectively; P=0.001, 0.035 and 0.010 respectively) and hydraulic groups (q=6.711, 4.393 and 5.184 respectively; P=0.001, 0.002 and 0.001 respectively), as well as significantly higher brachial artery blood flow than catheter (q=4.180, 2.551 and 2.758 respectively; P=0.001, 0.034 and 0.020 respectively) and hydraulic groups (q=5.533, 3.357 and 3.374 respectively; P=0.001, 0.004 and 0.003 respectively).  Conclusion  Balloon dilation for small-caliber vein dilation during surgery has the advantages of a higher AVF maturation rate and a lower re-intervention rate in diabetic nephropathy hemodialysis patients, which has a prospect of clinical application.
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    Factors influencing the presence of late thrombosis in autogenous arteriovenous fistulas in patients on maintenance haemodialysis
    ZHANG Yan, JIANG Hui-li, LIU Fang, XU Yong-cang, DU Hong-xia
    2025, 24 (09):  776-780.  doi: 10.3969/j.issn.1671-4091.2025.09.011
    Abstract ( 10 )  
     Objective  This study aimed to analyze and explore the factors influencing the presence of late thrombosis in autogenous arteriovenous fistula (AVF) in patients on maintenance hemodialysis (MHD).  Methods  In this cross-sectional study, Clinical data of the patients who received MHD at the Hemodialysis Vascular Access Clinic, The Central Hospital Affiliated to Shandong First Medical University between January 2023 and December 2023 were collected. Patients were divided into a patency group and an obstruction group based on the presence or absence of thrombosis in AVF. Binary logistic regression was used to explore the potential influencing factors.  Results  A total of 521 MHD patients were included in this study, among whom thrombosis in AVF occurred in 252 cases (48.37%). Binary logistic regression analysis showed that compression time for hemostasis (OR=8.145, 95% CI: 3.543～18.727, P＜0.001), fistula functions (including insufficient blood flow during hemodialysis, high venous pressure, and puncture failure) in the latest month (OR=47.404, 95% CI: 11.127～201.949, P＜0.001), pre-dialysis systolic blood pressure (OR=0.971, 95% CI: 0.949～0.993, P=0.011), pre-dialysis diastolic blood pressure (OR=1.111, 95% CI:1.076～1.148, P＜0.001), minimum diastolic blood pressure during hemodialysis (OR= 0.923, 95% CI: 0.886～0.961, P＜0.001), regional cannulation (OR=66.674, 95% CI: 7.505～592.350, P＜0.001), buttonhole cannulation (OR=18.578, 95% CI: 6.154～56.086, P＜0.001), and a history of AVF dysfunction for two or more two times (OR=3.967, 95% CI: 1.614～9.751, P=0.003) were the risk factors influencing the presence of thrombosis in AVF.  Conclusion Compression time for hemostasis ≥30 minutes, AVF dysfunction in the latest month, higher pre-dialysis diastolic blood pressure, and a history of multiple AVF failures were the risk factors for late thrombosis in AVF, while rope ladder cannulation, high pre-dialysis systolic blood pressure, and high minimum diastolic blood pressure during hemodialysis were the protective factors against late thrombosis in AVF.
     
     
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    Symptom burden and its influencing factors in peritoneal dialysis patients
    LI Na, ZHANG Hai-fen, YU Chen-jie, LIU Ting-ting, LU Yi-na, FANG Wei, GU Ai-ping
    2025, 24 (09):  781-785.  doi: 10.3969/j.issn.1671-4091.2025.09.012
    Abstract ( 13 )  
    Objective  This study investigated the current situation of symptom burden and analyzed the factors affecting symptom burden in peritoneal dialysis (PD) patients.  Methods  A total of 151 PD patients treated from October 2023 to January 2024 were enrolled in this study. Their general data and disease related information were collected. Symptom burden, level of social support and self-efficacy in symptom management were evaluated by the questionnaire surveys of the Chinese version of the dialysis patient symptom burden questionnaire (Dialysis Frequency, Severity, and Symptom Burden Index, DFSSBI), the Social Support Revalued Scale (SSRS), and the Patient-Reported Outcomes Measurement Information System-Self-Efficacy for Managing Symptoms (PROMIS-SEMSX).   Results  The scores of symptom frequency, severity and distress in PD patients were 16.50±13.70, 13.78±11.65 and 17.44±15.40 respectively. The top five items contributing to symptom burden were dry skin with 4(0,7) points, itching with 3(0,6) points, fatigue with 3(0,5) points, dry mouth with 3(0,5) points, and easily awakened with 0(0,5) points. Correlation analysis showed that patients’ self-efficacy in symptom management was negatively associated with total symptom burden score (r=-0.320, P＜0.001) and the dimensions including symptom frequency (r=-0.315, P＜0.001), symptom severity (r=-0.320, P＜0.001), and the extent of symptom distress (r=-0.326, P＜0.001). Multivariate linear regression analysis showed that dialysis duration (β=4.254, P=0.003), number of complications (β=4.406, P=0.006), and symptom management scores (β=-1.108, P＜0.001) were the independent risk factors for symptom burden in PD patients.  Conclusions  Dialysis duration and the number of complications are the objective factors affecting the symptom burden in PD patients. Self-efficacy in symptom management can reduce symptom burden. Therefore, healthcare professionals should focus on the education of self-management knowledge and skills in daily care of PD patients.
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    Analysis of the influencing factors for symptom group disturbance in maintenance hemodialysis patients and establishment and evaluation of the decision tree model
    WANG Ling, ZHU Ya-mei, LYU Xiao-lin, ZHANG Jing, SHAO Yu, GU Yue
    2025, 24 (09):  786-790.  doi: 10.3969/j.issn.1671-4091.2025.09.013
    Abstract ( 18 )  
    Objective To analyze the influencing factors for symptom cluster distress in maintenance hemodialysis (MHD) patients and to construct a decision tree risk prediction model.  Methods A total of 398 MHD patients admitted to the First Affiliated Hospital of Nanjing Medical University from March 2019 to March 2024 were retrospectively reviewed as the study subjects. Their clinical data were recruited. They were then categorized into distress and non-distress groups according to the presence or absence of symptom cluster distress. The risk factors affecting the symptom cluster distress in MHD patients were analyzed using unifactorial and multifactorial logistic regressions. The risk prediction models were constructed using the decision tree model and logistic regression algorithm, and the predictive value of the 2 models for the occurrence of symptom cluster distress in MHD was compared.  Results A total of 398 patients were included, including 106 cases in distress group and 292 cases in non-distress group. Multifactorial logistic analysis showed that monthly income (OR=2.072, 95% CI:1.019～4.211, P=0.044), dialysis time (OR=2.046, 95% CI:1.055～3.970, P=0.034), anxiety and depression (OR=1.990, 95% CI:1.002～3.949, P=0.049), parathyroid hormone (OR=1.241, 95% CI:1.178～1.308, P＜0.001) and blood phosphorus (OR=18.581, 95% CI:5.963～57.897, P＜0.001) were the risk factors for the presence of symptom cluster distress in MHD patients, and hemoglobin (OR=0.947, 95% CI:0.925～0.969, P＜0.001) was a protective factor for the presence of symptom cluster distress in MHD patients. The constructed decision tree model contained 5 variables that divided into 4 levels with 24 nodes, and parathyroid hormone was the main influencing factor. The AUCs of logistic regression model and decision tree model were 0.898 and 0.923, respectively, and the delong test for comparison of the two models was Z=2.240 and P=0.025.  Conclusion   Monthly income, dialysis time, anxiety and depression, parathyroid hormone and blood phosphorus are the risk factors for symptom cluster distress in MHD patients, and hemoglobin is a protective factor. The predictive efficacy of the constructed decision tree risk prediction model was superior to that of the logistic regression model. 
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