ObjectiveTo preliminarily explore the effect of Osteoporosis Self-assessment Tool for Asians (OSTA) and Fracture Risk Assessment Tool (FRAX) on predicting osteoporosis and osteoporosis fracture in postmenopausal patients with maintenance hemodialysis (MHD).MethodsThirty-six postmenopausal patients undergoing MHD from August 2017 to October 2018 in Hemodialysis Center of Nephrology Department, West China Hospital of Sichuan University were selected. Relevant data such as age, height, and weight were collected. OSTA index and the 10-year probability of major osteoporotic fractures and 10-year probability of hip fractures of FRAX score were calculated. Bone mineral densities (BMD) of the hip and lumbar spine were measured by dual energy X-ray absorptiometry (DXA) at the same time. The value of OSTA index and FRAX scale in evaluating the risk of osteoporosis predicated on T value ≤−2.5 determined by DXA BMD and fracture in postmenopausal patients with MHD were analyzed.ResultsThe DXA BMD of the 36 patients showed that 50.0% (18/36) had a T value≤−2.5, and 30.6% (11/36) had a fracture history. BMD in postmenopausal patients with MHD was negatively correlated with FRAX score (model without BMD values), and positively correlated with OSTA index. The sensitivity and specificity of OSTA in the prediction of osteoporosis were 94.4% and 61.1%, respectively; and the sensitivity and specificity of FRAX (the model without BMD values) in the prediction of osteoporosis were 88.9% and 50.0%, respectively. The FRAX score with or without BMD had the same clinical value in predicting osteoporosis.ConclusionsPostmenopausal MHD patients have a higher risk of osteoporosis and fracture. Both OSTA index and FRAX scale can predict osteoporosis risk among postmenopausal MHD patients, and the FRAX scale with or without BMD has the same clinical value in predicting osteoporosis risk. In clinical work, for primary hospitals and dialysis centers lacking DXA, preliminary screening of osteoporosis in MHD patients can be performed with OSTA and FRAX scales.
ObjectiveTo investigate the effect of 24-week intradialytic progressive resistance exercise on hemoglobin and iron metabolism in maintenance hemodialysis (MHD) patients.MethodsFrom April to May 2019, 62 MHD patients were enrolled and randomly assigned into exercise group (n=31) and control group (n=31). Both groups of patients received regular routine hemodialysis, on that basis, patients in the exercise group completed intradialytic resistance exercise three times per week for 24 weeks. Each exercise included 8-10 muscle groups (grasping the grip ring with both hands, flexion and extension of the elbows and shoulders on the non-vascular side and lower limbs with sandbag), 3 sets of 15 repetitions with a rest of 1-2 min between 2 sets. Exercise began with a low load, the sandbag weight was gradually increased, and the Borg score was aimed to be 11-13 points after exercise. Hemoglobin, serum ferritin, transferrin saturation, serum creatinine, high-sensitivity C-reactive protein, urea clearance index, recombinant human erythropoietin (rHuEPO) dosage at baseline and after 24 weeks, as well as the cumulative iron supplement dose and hemoglobin variation of the two groups during the study period were evaluated.ResultsThere were 20 patients in the exercise group and 30 ones in the control group who completed the study. After 24 weeks of progressive resistance exercise, the medium (lower quartile, upper quartile) of the amount of rHuEPO in the exercise group decreased from 6 000 (6 000, 9 000) U/week to 6 000 (4 500, 7 125) U/week (Z=−2.599, P=0.009), while that in the control group had no statistically significant difference (Z=−1.340, P=0.180); there was no statistically difference in hemoglobin, hemoglobin coefficient of variation, serum ferritin, transferrin saturation, or 24-week cumulative iron supplementation between the two groups.ConclusionIntradialytic progressive resistance exercise can reduce the amount of rHuEPO in MHD patients, which is benefitial to optimizing the management of hemoglobin.
Objective To explore the vascular access infection (VAI) incidence of hemodialysis patients during the the maximum spread of the COVID-19 epidemic (epidemic period) compared with the corresponding period with no local cases of COVID-19 (control period). Methods A single-center, retrospective study was carried out. Adult patients who underwent hemodialysis at the Department of Blood Purification Center, the Affiliated Hospital of Xuzhou Medical University during the epidemic period between December 7, 2022 and February 23, 2023 and the control period between December 7, 2020 and February 23, 2021 were selected. The incidence of local access site infection (LASI) and access related bloodstream infection (ARBSI) in included patients were observed and compared. ResultsA total of 1 401 patients were included. Among them, there were 737 cases during the epidemic period and 664 cases during the control period. There was no statistically significant difference in the age, gender, and duration of catheterization among patients of different periods and pathway types (P>0.05). There was no statistically significant difference in the occurrence of LASI between the epidemic period and the control period (χ2=1.800, P=1.180). There was a statistically significant difference in the occurrence of ARBSI between the epidemic period and the control period [χ2=4.610, relative risk (RR)=2.575, 95% confidence interval (CI) (1.053, 6.298), P=0.032]. There was no statistically significant difference in the incidence of LASI and ARBSI at different stages in patients with arteriovenous fistula and unnel-cuffed catheters (TCC) (P＞0.05). There were statistically significant differences in the incidence of LASI [χ2=4.898, RR=3.832, 95%CI (1.058, 13.885), P=0.027] and ARBSI [χ2=7.150, RR=4.684, 95%CI (1.333, 16.460), P=0.005] among non cuffed catheters (NCC) patients at different stages. TCC patients might experience LASI (P<0.05) during the epidemic period and ARBSI (P<0.05) during the control period compared with the arteriovenous fistula patients; both central venous catheterization and NCC patients might experience LASI and ARBSI during the control period (P<0.05). Conclusion Targeting COVID-19 prevention may be associated with the reduction of vascular access infection in hemodialysis patients, in particular in NCC patients.
The coexistence of cognitive impairment and physical frailty in maintenance hemodialysis (MHD) patients is known as cognitive frailty. It has emerged as a novel complication in MHD patients and increases the risk of adverse outcomes such as falls, fractures, functional impairment and death. Timely intervention can delay or even reverse the development of cognitive frailty to dementia, thereby reducing the risk of adverse outcomes and improving the quality of life of patients. Based on this literature review method, this article summarizes the domestic and foreign research progress on the epidemiology, assessment tools, influencing factors and intervention measures of cognitive frailty in MHD patients, aiming to provide reference for clinical staff to carry out early screening and intervention of cognitive frailty in MHD patients.
ObjectiveTo explore the role of chest wall arteriovenous graft (CWAVG) for establishing hemodialysis access in patients with end-stage renal disease.MethodsA retrospective analysis was made on the clinical data of 12 patients with end-stage renal disease who underwent CWAVG for establishing hemodialysis access between January 2014 and June 2015. There were 3 males and 9 females with an average age of 63.6 years (range, 54-82 years). The renal disease causes were chronic glomerulonephritis in 2 cases, hypertensive renal damage in 4 cases, diabetic nephropathy in 1 case, both kidney resection because of urinary tract tumors in 3 cases, and causes unknown in 2 cases. Hemodialysis time ranged from 1 to 144 months, with an average of 38.4 months. The 12 patients all underwent 1-14 times (mean, 4.2 times) anterior pathway failure in CWAVG, all of which were caused by repeated occlusion of dialysis pathway or poor vascular condition of upper extremity, resulting in the exhaustion of vascular pathway in upper extremity.ResultsAll patients were followed up 30-48 months (mean, 35.4 months). Two patients died, including 1 case of digestive tract hemorrhage, 1 case of heart failure. The other 10 CWAVGs were functionally useful for hemodialysis access about 6 weeks after operations. The primary patency rates at 6, 12, 18, 24, and 30 months were 83.3%, 75.0%, 33.3%, 33.3%, and 16.7%, respectively, and the cumulative patency rates at 6, 12, 18, 24, and 30 months were 83.3%, 75.0%, 50.0%, 33.3%, and 16.7%, respectively. Among 8 cases of CWAVG dysfunction, 6 cases had thrombosis, 1 case had seroma, and 1 case had vertebral artery stealing. Among them, 4 patients underwent hemodialysis using tunneled-cuffed catheter, 3 patients using fistula or graft on other limbs, and 1 patient was not treated with hemodialysis.ConclusionAlthough the long-term patency rate of CWAVG is yet to be further increased by improvement of treatment strategies, but it is still a supplementary option for end-stage renal disease patients with inadequate upper extremity venous access sites.
In the management of diabetic nephropathy patients with hemodialysis, diabetes link nurse (DLN) can realize the continuity of nursing management, simplify the communication between multiple disciplines, and play multiple roles such as relieving patients’ psychology, participating in scientific research and clinical management. In this paper, by introducing the origin and development status of DLN in foreign countries, and summarizing the function and clinical contribution of DLN in the management of diabetic nephropathy hemodialysis patients. This article combines the current development status of DLN in China, to arouse the attention of clinical nursing colleagues, and provide some reference for the management of diabetic nephropathy patients with hemodialysis and the training of DLN in China.
The incidence of sarcopenia and frailty in maintenance hemodialysis patients are high, and there are often comorbidities, which easily lead to more complications, thus increasing the hospitalization rate and reducing the quality of life of patients. This article reviews the definition, physiological mechanism, incidence and diagnosis, relationship and treatment strategies of sarcopenia and frailty in maintenance hemodialysis patients, in order to better prevent and intervene the occurrence of sarcopenia and frailty and provide a reference for prevention and treatment.
Central venous stenosis is a common complication following long-term dialysis catheter placement in dialysis patients. Generally, percutaneous angioplasty is the treatment of choice, and venous stent implantation should be considered in different situations. However, the venous stent migrating into right atrium is a rare but fatal complication. We presented a patient whose superior vena cava stents migrated into right atrium, resulting in acute tamponade, and exploratory thoracotomy was proceeded.
Objective To evaluate the effects of glucose-containing dialysate versus glucose-free dialysate on blood pressure variability and blood glucose variability in maintenance hemodialysis (MHD) patients and to assess safety. Methods MHD patients from 12 hospitals were enrolled between October 2024 and June 2025. According to the randomized block design, patients were randomly divided into the glucose-containing dialysate group (experimental group) and the glucose-free dialysate group (control group). During hemodialysis sessions, blood pressure were monitored at 0, 1, 2, 3, and 4 hours, and blood glucose was measured at 0, 2, and 4 hours monthly for six consecutive months. Hypotension episodes and hypoglycemic episodes were recorded throughout dialysis. Results A total of 244 MHD patients were included, with 122 in each group. Compared with the control group, the experimental group showed significantly lower systolic blood pressure variability [dialysis for 2 hours: 9.92 (7.92, 12.52) vs. 11.95 (9.45, 15.36) mm Hg (1 mm Hg=0.133 kPa), P<0.001; during the 0-2 hour dialysis period: 2.60 (1.24, 3.97) vs. 3.74 (2.03, 6.52) mm Hg, P=0.011], diastolic blood pressure variability [during the 0-4 hour dialysis period: 3.85 (1.49, 6.69) vs. 4.72 (1.99, 8.46) mm Hg, P<0.001], blood glucose variability [dialysis for 2 hours: 0.16 (0.12, 0.20) vs. 0.18 (0.13, 0.23) mmol/L, P=0.002; dialysis for 4 hours: 0.17 (0.13, 0.22) vs. 0.21 (0.17, 0.26) mmol/L, P<0.001; during the 2-4 hour dialysis period: 0.04 (0.02, 0.08) vs. 0.07 (0.03, 0.10) mmol/L, P=0.004], incidence rates of hypotension (32.9% vs. 33.3%, P=0.005) and incidence rates of hypoglycemia (0.42% vs. 4.02%, P<0.001). Conclusions Glucose-containing dialysate reduces both blood pressure variability and blood glucose variability more effectively than glucose-free dialysate during hemodialysis. Compared with glucose-free dialysate, the glucose-containing dialysate demonstrated a lower incidence of hypotension episodes and hypoglycemic episodes.
Objective To compare the clinical effect of continuous renal replacement therapy (CRRT) and intermittent hemodialysis (IHD) in the treatment of severe acute renal failure (ARF). Methods A hundred patients with severe ARF treated between May 2011 and December 2014 were chosen to be the study subjects. According to the order of admission, they were divided into control group and observation group with 50 patients in each. Patients of the control group underwent IHD, while those in the observation group underwent CRRT. Serum creatinine (Scr), blood urea nitrogen (BUN), endogenous creatinine clearance rate (Ccr), treatment effective rate and survival rate were compared between the two groups before and after the treatment. Results Scr, BUN and Ccr were all improved after treatment in both the two groups. However, Scr, BUN and Ccr in the observation group [(225.1±162.7) μmol/L, (14.2±9.3) mmol/L, (23.4±10.5) mL/min] were significantly better than those in the control group [(588.4±183.6) μmol/L, (29.1±10.4) mmol/L, (15.9±8.2) mL/min]. The treatment effective rate and patients’ survival rate in the observation group were respectively 60% and 70%, both significantly higher than those in the control group (40% and 52%) All the differences were significant (P<0.05). Conclusion CRRT is superior in the treatment of severe ARF with a higher survival rate of the patients, which is worthy of clinical promotion.