ObjectiveTo study the differences in body composition between maintenance hemodialysis (MHD) patients with reduced muscle mass and the ones with normal muscle mass by bioelectrical impedance analysis, and explore the influencing factors.MethodsA total of 122 patients undergoing MHD in the hemodialysis center of a general hospital between September 2018 and May 2019 were selected as the research subjects. According to the relative skeletal muscle mass index, they were divided into the muscle loss group and the normal muscle mass group. Their general conditions, post-dialysis body composition, and serum albumin were collected to analyze the differences between the two groups, and a multiple stepwise logistic regression analysis was carried out.ResultsAmong the included subjects, 53 patients had normal muscle mass and 69 patients had muscle mass loss. The post-dialysis body weight, muscle-related indexes, intracellular water, extracellular water (ECW), total body water (TBW), protein, minerals, body cell mass, bone mineral content, body mass index, arm circumference, and arm muscle circumference in the normal muscle mass group were higher than those in the muscle loss group (P<0.05); the percentage of ECW/TBW in the normal muscle mass group was lower than that in the muscle loss group (P<0.05). The multiple stepwise logistic regression analysis showed that the post-dialysis weight [odds ratio (OR)=0.679, 95% confidence interval (CI) (0.535, 0.862), P=0.001] was a protective factor from losing muscle in MHD patients, and the high ECW/TBW [OR=6.926, 95%CI (1.014, 47.280), P=0.048], low body cell mass [OR=57.707, 95%CI (6.927, 480.761), P<0.001], low bone mineral content [OR=9.743, 95%CI (1.220, 77.831, P=0.032], and arm circumference [OR=2.183, 95%CI (1.004, 4.749), P=0.049] were risk factors for muscle loss in MHD patients.ConclusionsMHD patients have a high incidence of muscle loss. It is necessary to monitor the changes of their body composition, especially those who with low post-dialysis body weight, lack of bone minerals and body cells, excessive ECW/TBW, and increased arm circumference after hemodialysis. Both nutritional interventions and exercise interventions should be performed timely and routinely to prevent the occurrence of sarcopenia.
During the medical rescue after Wenchuan earthquake, based on the design and implementation of the management process of blood purification equipment, we gave the top priority to those patients with post-disaster crush syndrome to ensure their hemodialytic treatment. Through strict management of blood purification technology, the outcomes of these patients have been fundamentally improved and the incidence of complications was substantially reduced. Safe and effective hemodialytic treatment have been administered to 77 patients with crush syndrome (813 case-times).
Objective To investigate the therapeutic effect of continuous renal replacement therapy (CRRT) plus hemoperfusion (HP) on patients with diabetes and uremic encephalopathy. Methods Fifty-five patients with diabetes and uremic encephalopathy from January 2010 to December 2017 were retrospectively collected in this study and divided into CRRT plus HP (CRRT+HP) group (n=28) and hemodialysis (HD) plus HP (HD+HP) group (n=27). The changes of vital signs, related biochemical indicators before and after treatment and curative effects were compared between the two groups. Results The two groups were comparable in general. No significant differences were found in blood pressure or heart rate before and after treatment between the two groups (P>0.05). The incidence of hypotension events in CRRT+HP group was significantly lower than that in HD+HP group (P<0.05), and the effective rate of cardiac function improvement in CRRT+HP group was significantly higher than that in HD+HP group (P<0.05). After treatment, the blood urea nitrogen, creatinine, parathyroid hormone, β2-microglobulin, phosphorus, C-reactive protein and brain natriuretic peptide in the two groups were significantly decreased than those before treatment (P<0.05). Parathyroid hormone, β2-microglobulin, C-reactive protein and brain natriuretic peptide were significantly decreased in CRRT+HP group as compared with those in HD+HP group (P<0.05). The remission rate of uremic encephalopathy in CRRT+HP group was significantly higher than that in HD+HP group (P<0.05). Conclusions As compared with HD+HP pattern, CRRT+HP pattern is more stable in the hemodynamics, and more effective in the improvement of heart failure and the clearance of inflammatory mediators, middle molecular and macromolecular substances associated with uremic encephalopathy. CRRT+HP pattern is suitable for the treatment of patients with diabetes and uremic encephalopathy.
ObjectiveTo systematically review the pharmacoeconomics of hemodialysis and peritoneal dialysis in patients with end-stage renal disease. MethodsCRD, NICE, CADTH, HITAP, NECA, IWIQG, ISPOR, PubMed, EMbase, CNKI, and WanFang Data databases were electronically searched to collect pharmacoeconomic studies on the hemodialysis and peritoneal dialysis in the treatment of end-stage renal disease from inception to December 2020. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, the conclusions of research models, pharmacoeconomic evaluation results, and sensitivity analysis were summarized. ResultsA total of 15 pharmacoeconomic studies were included, among which 9 studies used the Markov state transition model, and 6 were observational studies. From the perspective of health outcomes, peritoneal dialysis had cost-effectiveness advantages over hemodialysis in the treatment of end-stage renal disease under the condition of a clear threshold. ConclusionsCurrent evidence shows that compared with hemodialysis, peritoneal dialysis has certain cost-effectiveness advantages in the treatment of end-stage renal disease. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
ObjectiveTo explore the risk factors for central venous catheter (CVC)-related infections and its Countermeasures, as CVC is an important vascular access for blood purification and is widely used in clinical applications, but catheter-related infection is one of the common severe complications. MethodsWe retrospectively analyzed the clinical data of 725 patients with complicated infections of indwelling center venous double lumen catheter treated between January 2009 and December 2012. ResultsAmong all 725 cases, 15 had catheter-related infection. There were one case of subcutaneous tunnel infection (staphylococcus aureus by the secretion culture, negative for blood culture), and 14 cases of positive blood culture including 9 staphylococcus aureus cases, 3 escherichia coli cases, 1 colorless bacillus case and 1 stenotrophomonas maltophilia case. Eight cases were cured by antibiotic therapy while antibiotics were invalid in the other 7 cases resulting in tube withdrawing. ConclusionThe central venous catheter-related infections are related to medical service ability, catheter indwelling position, indwelling time, hemodialysis adequacy, patients' general condition and personal hygiene. Taking relative measures in view of each factor is the key to prevent infections.
ObjectiveTo examine the prevalence of fatigue and analyze its related factors in patients undertaking maintenance hemodialysis. MethodsA total of 235 patients undertaking maintenance hemodialysis in West China Hospital were investigated from January to February 2013. The measures used in the study included Piper Fatigue Scale Revised and socio-demographic questionnaire. ResultsThe prevalence of fatigue in hemodialysis patients was 83.4%. The rates of severe fatigue, moderate fatigue and low fatigue were 10.2%, 43.0% and 30.2%, respectively. The findings of univariate analysis indicated that patients with different age and sleep situation, with or without complications, with or without fatigue after dialysis reported different total fatigue scores. ConclusionThe prevalence of fatigue is high in hemodialysis patients. Aged 60 years and above, with complications, poor sleep quality were significant factors related to fatigue in patients with hemodialysis.
ObjectiveTo summarize and improve the nursing skills of medication for hemodialysis patients. MethodsWe observed and took nursing measures for adverse medication events in 280 hemodialysis patients treated in our dialysis center from July 2013 to December 2013, and actively prevented all kinds of complications caused by medications. ResultsIn this group of patients, 26 had adverse drug events. Five patients with bleeding after central venous catheter indwelling were cured by changing the dressings. One patient had heparin induced thrombocytopenia, and the complication disappeared after the use of non-heparin hemodialysis. One patient had urokinase allergic reaction, and the complication disappeared by cardio-pulmonary resuscitation. One patient had EPO associated pure red cell aplastic anemia, and the patient did not suffer from it any more by changing the EPO. Two patients with high blood pressure recovered to normal by reducing the use of blood for rHuePO. One had allergic reaction for Iron Dextran Injection and was successfully treated by ICU. Six patients with severe reactive hypoglycemia were corrected quickly by intravenous injection of 50% glucose injection. One patient with adverse reaction to levocarnitine was cured by lowering the frequency of medication to one time per week. Two patients had flu-like symptoms after the use of biological agents were cured by stoppage of the medicine. ConclusionAdverse drug effect should be carefully observed, and patients' education and nursing skills of medical workers should be improved to ensure the medication safety of hemodialysis patients.
Objective To summarize our experience of cardiovascular surgery for patients dependent on dialysis, and evaluate its safety and efficacy.?Methods?Clinical data of 10 consecutive patients dependent on maintenance dialysis underwent cardiovascular operations between Dec. 2004 and April 2011 in Peking Union Medical College Hospital were analyzed retrospectively. There were 6 male and 4 female patients, aged between 23 to 71 （57.6±13.2） years. They were put on dialysis 3-98 （25.2±30.6） months prior to operation due to diabetic nephropathy in 6 patients, chronic glomerulitis in 3 patients and systemic lupus erythemus in 1 patient, and 8 were dependent on hemodialysis and 2 on peritoneal dialysis. Five patients underwent coronary artery bypass grafting, one underwent Bentall procedure，two underwent aortic valve replacement, one underwent mitral valve replacement, and one underwent superior vena cava thrombectomy and patch repair. Patients underwent dialysis on the day before elective operation, followed by continuous ultra-filtration during cardiopulmonary bypass, and then bedside heparin-free continuous veno-venous hyperfiltration-dialysis started 5-32 hours after the operation. Conventional peritoneal dialysis or hemodialysis was resumed 4-7 days after operation.?Results?All operations were successfully completed. Cardiopulmonary bypass time was （125.8±33.5）minutes, aortic clamp time was（77.2±25.5） minutes. One in-hospital death occurred due to septic shock after deep chest wound infection. One patient underwent re-exploration due to pericardial temponade to achieve hemostasis. Three patients experienced atrial fibrillation and were all converted to sinus rhythm by amiodarone. Nine patients recovered to discharge and were followed-up for 8-76 months. Two late deaths occurred due to intracranial hemorrhage and liver carcinoma respectively. Seven survived patients were all in New York Heart Association grade II functional class, and none of them experience major advertent cardiac events related to grafts or prosthetic valve. One patient switched to hemodialysis 14 months after discharge due to peritonitis.Conclusion?Cardiovascular surgery can be practiced in patients dependent on maintenance hemodialysis or peritoneal dialysis with appropriate peri-operative management, so that symptoms can be relieved and quality of life improved.
ObjectiveTo evaluate the safety and efficacy of local sodium citrate anticoagulation for routine hemodialysis in high-risk patients with hemorrhage.MethodsA total of 150 patients who were admitted to West China Hospital from October 2018 to March 2019 for routine hemodialysis treatment with high-risk bleeding were selected as study objects. The patients were divided into without heparin anticoagulation group (group A) and with 4% sodium citrate anticoagulation group (group B) by random number table method, with 75 cases in each group. Biochemical indicators, serum calcium ion concentration, local anticoagulation safety index of citrate and dialysis adequacy index, blood coagulation in dialyzer and tube during dialysis wre observed in the two groups.ResultsThe coagulation events in group B were significantly lower than those in group A (Z=–4.889, P<0.001), and the urea clearance index in group B was higher than that in group A [(1.26±0.12) vs. (0.73±0.13) L/(min·1.73 m2); t=22.418, P<0.05]. There was a significant difference in the changes of urea nitrogen [(3.53±1.05) vs.(3.12±1.11) mmol/L; t=2.323, P=0.021] 24 hours after dialysis; other indicators showed no statistically significant difference (P>0.05). After the filter, serum calcium ion concentrations in group B at different time points were lower than those in group A [2 hours: (0.52±0.07) vs. (0.64±0.08) mmol/L; 4 hours: (0.56±0.09) vs.(0.63±0.09) mmol/L; t=5.198, 0.525, P<0.001], and the coagulation time was higher in group B than that in group A [2 hours: (172.56±14.78) vs. (151.45±19.81) s; 4 hours: (168.45±16.48) vs. (152.88±16.54) s; t=7.396, 5.775, P<0.001]. None of the patients had dialysis-related adverse events.ConclusionFour percent sodium citrate is effective and safe in anticoagulation therapy for hemodialysis patients, and it can reduce the risk of coagulation in dialyzer and ensure the adequacy of maintenance hemodialysis.
Hemodialysis, serving as a crucial renal replacement therapy for patients with end-stage kidney disease, has consistently prioritized the optimization of dialysate composition in clinical practice. The application of glucose-containing dialysate has undergone a conceptual evolution from its initial role in osmotic regulation to its current recognition as a multifunctional systemic modulator. Accumulating evidence demonstrates that glucose-containing dialysate exhibits distinctive clinical advantages in maintaining glycemic and hemodynamic stability while reducing heart rate variability among hemodialysis patients. Nevertheless, existing studies present certain limitations, including relatively small sample sizes and insufficient evaluation of long-term prognostic indicators. Consequently, future investigations should emphasize large-scale, multicenter clinical trials with extended follow-up periods to further substantiate the therapeutic benefits of glucose-containing dialysate in clinical practice.