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OBJECTIVE To compare the effects of roxadustat and recombination human erythropoietin （rHuEPO） on coronary artery calcification in maintenance hemodialysis （MHD） patients. METHODS In retrospective analysis， MHD patients prescribed roxadustat in the Blood Purification Center of the First Affiliated Hospital of Chongqing Medical University from April 2019 to June 2021 were selected as the ROX group （56 patients）， and MHD patients prescribed rHuEPO during the same period were selected as the EPO group （60 patients）， and follow-up observation was conducted for 12 months. The differences in laboratory index， coronary artery calcification score （CACS）， and cardiac ultrasound parameters before and after treatment as well as the occurrence of cardiac and cerebrovascular adverse events during follow-up period were compared between the two groups. RESULTS There was no statistical difference in CACS between the two groups before and after treatment （P＞0.05）； but the difference of CACS in the ROX group was significantly lower than the EPO group （P＜0.05）. There was no statistically significant difference in cardiac ultrasound parameters and laboratory indexes between the two groups before and after treatment （P＜0.05）. The incidence of apoplexy and myocardial infarction in the ROX group was lower than that in the EPO group （P＜0.05）， and there was no statistically significant difference in the incidence of hospitalization due to heart failure between the two groups （P＞0.05）. CONCLUSIONS Compared with rHuEPO， roxadustat may have a positive effect on delaying coronary artery calcification in MHD patients and may be beneficial in reducing the incidence of myocardial infarction and apoplexy in MHD patients.
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Objective:To investigate the development and influencing factors of frailty in elderly patients on maintenance hemodialysis.Methods:A cross-sectional survey involved 146 elderly patients on maintenance hemodialysis at the blood purification department of the First Affiliated Hospital of Xi'an Jiaotong University.A self-designed demographic questionnaire was used to collect general information of patients, the Simple Physical Performance Scale(SPPB)was used to assess physical function, the 5-item SARC-F was used as a tool for rapid screening of sarcopenia, and the Hospital Anxiety and Depression Scale(HADS)was used for screening of anxiety and depression.The FRAIL scale was used for frailty assessment and participants were divided into a no frailty group, a pre-frailty group and a frailty group according to different frailty scores.Relevant influencing factors of frailty were analyzed.Results:Among 146 hemodialysis patients, 33(22.6%)were in the non-frailty group, 86(58.9%)in the pre-frailty group, and 27(18.5%)in the frailty group.Univariate analysis showed that there were statistically significant differences in sex( χ2=6.220, P=0.045), age( F=5.197, P=0.007), body type( χ2=31.927, P<0.001), SARC-F score( χ2=24.283, P<0.001)and SPPB score( χ2=26.773, P<0.001)between different groups.There were 3 patients(9.4%)at high risk for sarcopenia in the no frailty group, 13 patients(40.6%)at high risk for sarcopenia in the pre-frailty group, and 16 patients(50%)at high risk for sarcopenia in the frailty group, and differences in the occurrence of sarcopenia between the different subgroups of frailty were statistically significant( χ2=27.496, P<0.001). Multifactorial Logistic regression analysis showed that age, ( OR=1.04, 95% CI: 0.99-1.08, P=0.049), sex( OR=0.39, 95% CI: 0.17-0.87, P=0.021), body size( OR=0.07, 95% CI: 0.01-0.50, P=0.008), SARC-F( OR=0.14, 95% CI: 0.05-0.38, P<0.001)were independent influencing factors of frailty in elderly maintenance hemodialysis patients( P<0.05). Conclusions:The incidence of frailty is high in elderly patients on maintenance hemodialysis, and the development of frailty is affected by age, body mass index and sarcopenia.
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Objective:To investigate distinct trahectories of demoralization of maintenance hemodialysis patients in young and middle-aged adults, and analyze the factors that affect the trajectory category, so as to provides reference for formulating individualized intervention strategies.Methods:This study was a cross-sectional survey. From April 2020 to April 2021, young and middle-aged maintenance hemodialysis patients fromShangyu People′s Hospital were collected by convenience sampling method and conducted 4-time follow-up investigation. The survey tools included general information questionnaire, Demoralization Scale Mandarin Version (DS-MV) and Experiences in Close Relationship Scale-Short Form (ECR-S). Latent class growth model was used to identify trajectory patterns of demoralization, Logistic regression was used to identify predictors of demoralization trajectories.Results:Totally, 105 patients were enrolled in the present study. Three distinct trajectories were identified and named as "table high level group" 24 cases, "slow reduction group" 39 cases and "continuous reduction group" 42 cases. Univariate analysis showed that age, occupational status, average income per person in family, number of comorbidities, attachment anxiety scores were related to the category of demoralization trajectories ( F = 15.92, χ2 values were 9.16-15.95, all P<0.05). Multivariate Logistic regression analysis showed that age, occupational status, average income per person in family, number of comorbidities, and attachment anxiety scores were important predictors of patterns of demoralization trajectories in young and middle-aged maintenance hemodialysis patients. Conclusions:This study identified three distinct demoralization trajectories in young and middle-aged maintenance hemodialysis patients, clinical nursing should formulate individualized intervention strategies according to the types of patients′ delirium trajectories.
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ObjectiveTo investigate the distribution of traditional Chinese medicine （TCM） syndrome types and influencing factors of protein-energy wasting （PEW） in chronic kidney disease （CKD） undergoing maintenance hemodialysis （MHD）. MethodsAccording to diagnostic criteria， 164 patients with MHD were divided into PEW group and non-PEW group. The clinical data of all patients were collected， including general information such as gender， age， height and weight， disease characteristics such as course， cormobidity， and haemodialysis duration， laboratory indicators such as blood routine， liver function， renal function， electrolyte， blood lipid， grip strength， and the four examinations. Logistic regression analysis was used to find the influencing factors of PEW by taking the clinical indicators with significant differences between the two groups （P＜0.05） as the independent variables， diagnosis of PEW as the dependent variable， and normal values as the reference. ResultsOut of 164 patients with MHD， there were 96 （58.5%） cases in PEW group and 68 cases （41.5%） in non-PEW group. Compared to the non-PEW group，PEW group had increased age， ratios of bedrest， deep vein preservation， edema， and low grip strength， percentages of comorbidities type 2 diabetes， cardiovascular and cerebrovascular diseases，infections and anemia， and levels of alanine aminotransferase and permine amin aminotransferase， as well as decreased body mass index， self-care ratio，internal arteriovenous fistula， red blood cell count， hemoglobin， serum total protein， serum albumin levels （P＜0.05）. The PEW group had significantly higher frequency of poor appetite and digestion， abdominal distension， fear of cold and preference of warmth， weak breathing and fatigue， poor appetite， oliguria， nausea and vomiting than non-PEW group （P＜0.05）. The incidence of both yin and yang deficiency syndrome and damp-turbidity syndrome were significantly higher in the PEW group than the non-PEW group， while that of liver-kidney yin deficiency syndrome and stirring of wind syndrome were lower （P＜0.05）. Logistic regression analysis showed that low BMI （＜22 kg/m2）， inability to take care of oneself， low grip strength，low serum albumin （＜38 g/L）， infection， older age， fear of cold and cold limbs，and poor appetite were the risk factors of PEW in patients undergoing MHD （P＜0.05）. ConclusionThe root syndrome of MHD-PEW patients is both yin and yang deficiency， concurrent with damp-turbidity syndrome. Low BMI， low serum albumin， infection and older age may be the influencing factors of PEW in patients undergoing MHD.
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Objective:To investigate the status of anticipatory grief among the main caregivers of maintenance hemodialysis patients, and to analyze its influencing factors.Methods:From April 2021 to July 2021, the main caregivers of 180 patients undergoing maintenance hemodialysis in Xiangdong Hospital Affiliated to Hunan Normal University and Liling Traditional Chinese Medicine Hospital in Hunan Province, were selected by convenience sampling method for the research object. The survey was carried out using the General Information Questionnaire, the Anticipatory Grief Scale and the Zarit Caregiver Burden Interview, multiple linear regression was used to analyze the influencing factors of anticipatory grief in the main caregivers of maintenance hemodialysis patients.Results:The total score of Anticipatory Grief Scale in the main caregivers of maintenance hemodialysis patients was 84.43±12.02, and the total score of Zarit Caregiver Burden Interview was 24.92 ± 7.98, which were positively correlated ( r = 0.557, P<0.01).In the multiple linear regression analysis, the caregiver ′s education level, age, gender, care burden and per capita monthly income and the patient ′s age were the influencing factors of anticipatory grief for the main caregivers of maintenance hemodialysis patients ( t values were -5.54-8.75, all P<0.05), which could explain 54.1% of the total variance. Conclusions:The anticipatory grief of the main caregivers of maintenance hemodialysis patients is at a relatively serious level. Medical care should pay more attention to the caregivers and their sadness in their communication, so as to detect problems in time, so as to take targeted measures to the current situation, which is effective to improve their level of grief and improve the quality of care.
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Objective:To understand the knowledge, attitude and behavior of volume management of maintenance hemodialysis patients, so as to provide a basis for standardizing volume management and carrying out refined individual care.Methods:By means of convenience sampling, 608 patients from 4 hospitals who received regular dialysis treatment in Xuzhou and Yancheng hemodialysis rooms in October 2021 were selected as subjects. Patients were surveyed by a self-designed knowledge questionnaires of volume management, Maintenance Hemodialysis Patients′ Capacity Management Behavior Scale and Self-Efficacy Scale. Questionnaires were collected through the questionnaire star.Results:A total of 608 valid questionnaires were collected. The knowledge dimension scored 8.21 ± 2.27 , atitude dimension scored 7.36 ± 2.06 and behavior dimension scored 15.07 ± 4.22. Multiplelinear regression analysis showed that age, dialysis age and self-care ability were predictors of volume management knowledge score ( t=-2.07, 2.35, -3.90, all P<0.05 ). Medical insurance type was a predictor of volume management attitude score ( t=-2.17, P<0.05). Education level was a predictor of volume management behavior score ( t=3.04, P<0.05). Conclusions:The capacity management knowledge and capacity management attitude of maintenance hemodialysis patients is in the medium level, but with poor volume management executive ability. It is suggested that medical staff carry out health education related to volume management according to different characteristics of patients, and effectively improve patients′ volume management ability.
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Objective: Treatment options for patients with rheumatoid arthritis on maintenance hemodialysis with an inadequate response to biologic agents have not been reported. In this report, we describe two patients who achieved remission after treatment with peficitinib.Methods: Two 69- and 85-year-old patients with rheumatoid arthritis on maintenance hemodialysis were previously treated with biologics and started on peficitinib 100 mg/day after the secondary failure of biologics.Discussion: In the two cases presented here, rheumatoid arthritis was almost in remission and there were no adverse events, although the patients were switched to peficitinib after secondary failure of the biologic agents. Among Janus kinase inhibitors, peficitinib has the lowest renal excretion; therefore, its administration in patients on dialysis is not contraindicated according to the package insert in Japan. The use of biologic agents in patients on hemodialysis has been reported to be associated with a high incidence of infections; therefore, care should be taken to avoid infections when administering Janus kinase inhibitors.Conclusion: Janus kinase inhibitors with low renal excretion, such as peficitinib, may be effective in patients with rheumatoid arthritis on maintenance hemodialysis who have an inadequate response to biologic agents.
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【Objective】 To compare the therapeutic effects of low molecular weight heparin sodium and sodium citrate on hemodialysis(HD) patients at high risk of bleeding. 【Method】 A total of 96 patients at high risk of bleeding on maintenance hemodialysis from May 2018 to May 2020 were enrolled and divided randomly into control group(n=48) and observation group(n=48). Patients in control group received systemic anticoagulation with heparin, and patients in observation group adopted regional citrate anticoagulation of in vitro dialyzer. The indexes of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fg), D-dimer, service time of filters and the dialysis efficiency, as well as the complication occurrences of clotting events, bleeding, metabolic alkalosis and hypocalcaemia were compared between the two groups. 【Results】 No significant difference was found in coagulation indicators (ACT, PT, Fg, APPT and D-dimer) before and after hemodialysis in observation group(P>0.05), but those in control group were prolonged significantly (P0.05). The incidence of filter clotting (0.0%), dialyzer pipeline clotting (0.0%) and bleeding (2.1%) in observation group were less than those in control group (8.3%, 6.2%, 14.6%, respectively) (P0.05). 【Conclusion】 Regional anticoagulation with citric acid in vitro is safe for patients on maintenance hemodialysis at high risk of bleeding, and can greatly prolong service time of filters, reduce bleeding and thrombocytopenia rates, bring less effects to coagulation function in vivo.
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Background: Kidneys play a central role in the regulation of body fluids, electrolytes and acid- base balance. With progressive loss of kidney function, derangements in electrolytes and acid-base inevitably occur and contribute to poor patient outcomes. Timely intervention and effective management will minimize complications and can potentially be lifesaving. Aim: To study the haematological profile in patients of chronic kidney disease (CKD) Stage 5 undergoing haemodialysis and to correlate the relation if any, between the study parameters. Material and Methods: Study was conducted on 60 patients undergoing hemodialysis thrice a week. Complete hemogram, RFT, LFT, serum sodium, potassium, calcium and phosphorus values were obtained and their associations were statistically analysed. Results: Out of 60 patients studied, 20% (n=12) had hemoglobin values <8 g/dl, 36% (n=36) had 8-10 g/dl and 12% (n=12) had ?10 g/dl. 18% (n=11) had mild hyponatremia (130-135 mEq/L), 38% (n=23) had moderate (125-129 mEq/L) and 44% (n=26) had severe (<125 mEq/L) hyponatremia.80% of the study group (n=48) had serum calcium <9 mg/dl and 20% (n=12) had >9 mg/dl. 68% (n=41) of the patients had serum phosphorus >5.5 mg/dl and 32% (n=19) of them had <5.5 mg/dl. There was a significant positive correlation of serum sodium with serum calcium (r=0.752, p=0.0001), serum albumin (p=0.0001), hemoglobin (p=0.0001) and significant negative correlation with serum phosphorus (r=-0.730, p=0.0001), serum uric acid (p=0.003). Conclusion: Anemia, hyponatremia, hyperkalemia, hypocalcemia and hyperphosphatemia are most commonly seen in hemodialysis patients. Appropriate timely intervention can significantly prevent the long-term morbidity in such patients.
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OBJECTIVE：To study influential factors for medication compliance of phosphate binder in patients with maintenance hemodialysis and the effects of pharmacist intervention ，and to improve medication compliance and the effects of disease control. METHODS ：The patients with maintenance hemodialysis who were treated in the blood purification center of our hospital from Jun. to Dec. ，2019 were selected for questionnaire survey. The questionnaires involved general information ， medication compliance of phosphate binder ，disease and medicine related knowledge ，social support ，self-efficacy. The t-test，χ2 test and multivariate Logistic regression analysis were used to analyze influential factors for medication compliance. The patients were randomly divided into pharmaceutical intervention group and non-intervention group. Intervention group were provided with pharmaceutical care for 3 months according to risk factors. Blood phosphorus level and medication compliance was compared between 2 groups. RESULTS ：Totally 298 patients completed the survey （effective recovery rate of 96.1％）. Among them ，163 patients（54.7％）had good adherence to phosphate binder ，while 135 patients（45.3％）had poor compliance. Results of single factor analysis showed that medication compliance of phosphate binder was closely associated with age ，dialysis duration ， parathyroid hormone levels ，total daily dose ，daily dose of phosphate binder ，disease and medicine related knowledge scores ， social support ，self-efficacy（P＜0.05）. Results of multivariate Logistic regression analysis showed that total daily dose ，daily dose of phosphate binder ，disease and medicine related knowledge scores ，social support and self-efficacy were the influential factors for medication compliance （P＜0.05 or P＜0.01）. Medication compliance ，disease control status ，disease and medicine related knowledge score ， social support and self-efficacy in pharmaceutical intervention group were significant improved ， blood phosphorus level was significant lower ，compared with non-intervention group （P＜0.05）. CONCLUSIONS ：Independent risk factors influencing medication compliance of phosphate binder include total daily dose ，daily dose of phosphate binder ，disease and medicine related knowledge scores ，social support and self-efficacy. The patients with maintenance hemodialysis have poor compliance to phosphate binder. Pharmacists should take individualized and targeted intervention measures for the above risk factors，which can effectively improve the medication compliance and disease prognosis of patients.
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Objective:To evaluate the effect of aromatherapy on fatigue in maintenance hemodialysis patients.Methods:Searching related domestic and foreign databases from the establishment of the database to September 1st, 2020, included 6 randomized controlled trials of maintenance hemodialysis patients using aromatherapy to relieve fatigue, a total of 435 patients, including 213 in the experimental group and 222 in the control group example. StataMP 16.0 software was used for Meta-analysis.Results:The result of Meta-analysis was SMD=-0.94, 95% CI -1.71, -0.18, and the combined effect size of the two groups was compared, and the difference was statistically significant ( Z value was 2.42, P<0.05). Subgroup analysis using essential oil varieties as indicators showed that the lavender and citrus essential oil mixed group SMD=-1.89, 95% CI -3.22, -0.57, the combined effect size was statistically significant ( Z value was 2.80, P<0.05); The results of subgroup analysis using essential oil measurement as an indicator showed that the 2-drop group SMD=-1.65, 95% CI -2.65, -0.65, and the combined effect size was statistically significant ( Z value was 3.23, P<0.05); The results of subgroup analysis using intervention time as an indicator showed that the 8-week group SMD=-1.23, 95% CI -1.77, -0.70, and the combined effect size was statistically significant ( Z value was 4.51, P<0.05). Conclusions:Aromatherapy can effectively reduce the fatigue level of maintenance hemodialysis patients, and the positive effect of aromatherapy on fatigue is closely related to the type, dosage and intervention time of essential oils.
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Objective:To explore the application effect of self-efficacy theory combined with WeChat health education in patients with maintenance hemodialysis.Methods:Totally 112 patients with regular hemodialysis in Jiaxing Second Hospital from May 2018 to October 2019 were randomly divided into observation group and control group, 56 patients in each group. Conventional health education was used in the control group, while the health education based on the self-efficacy theory was used in the observation group. Awareness rate of health knowledge, incidence of adverse events in hemodialysis, treatment compliance and self-efficacy before and after intervention were recorded.Results:The Awareness rate of health knowledge in the observation group was 89.28% (50/56), which was higher than 69.65% (39/56) of the control group ( χ 2 value was 6.564, P<0.05). After intervention, the scores of dietary adherence, fluid adherence, medication adherence and dialysis scheme adherence in the observation group (29.53±4.74), (21.76±3.83), (26.25±4.64), (17.14±2.83) were higher than those of the control group (26.08±4.45), (18.12±3.66), (22.39±4.42), (14.76±2.69), the difference was statistically significant ( t values were 3.971-5.142, P<0.001); After intervention, the score of General Self-efficacy Scale (GSES) in the observation group (27.43±5.59) was higher than that of the control group (24.06±5.22), with statistical significance ( t value was 3.297, P<0.001). During the intervention, the incidence of adverse events in the observation group was 8.93% (5/56), which was lower than 23.21% (13/56) of the control group ( χ 2 value was 4.236, P<0.05). Conclusion:the self-efficacy theory combined with WeChat health education can promote the self-efficacy of patients with maintenance hemodialysis, improve the level of health knowledge and treatment compliance, and reduce the incidence of vascular access adverse events.
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Objective To investigate and analyze the health literacy and nutritional characteristics of maintenance hemodialysis (MHD) patients with diabetes mellitus in Huizhou, and to analyze its influencing factors. Methods MHD patients with treatment time ≥ 3 mon in Huizhou from January 2016 to December 2019 were enrolled, including 320 patients with diabetic nephropathy and 320 patients with simple nephropathy. Demographic characteristics, health literacy level and nutritional status of all patients were collected to analyze the risk factors affecting the health and nutrition status of patients. Results The proportion of subjects with healthy living habits, nutritional knowledge, health literacy, normal Hb and ALB levels among diabetic nephropathy patients was lower than that of patients with simple nephropathy ( P < 0.05 ). Age ≥ 55 years old, education level below junior high school, irregular living habits, and ignorance of nutrition knowledge were the independent influencing factors for diabetic nephropathy patients without health literacy (P<0.05). Age ≥55 years, dialysis duration ≥5 years, treatment interruption, irregular health habits, and lack of health literacy were independent influencing factors for abnormal nutritional status in diabetic nephropathy patients ( P < 0.05 ). Conclusion The health literacy and nutritional characteristics of MHD patients in Huizhou were worse than those of patients with nephropathy, which were mainly related to age, education level, living habits, and dialysis treatment.
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Objective@#To explore the effect of extended nursing service on malnutrition in patients undergoing maintenance hemodialysis combined with peritoneal dialysis.@*Methods@#According to the formula, 124 patients with malnutrition in maintenance hemodialysis combined with peritoneal dialysis were divided into intervention group and control group by lottery, 62 in intervention group and 62 in control group. The control group received routine specialist nursing and health education during hospital dialysis, while the intervention group received extended nursing services for 6 months, including telephone follow-up, knowledge lectures and Wechat interaction. The nutritional status of two groups of patients was assessed by modified subjective comprehensive nutrition assessment (MQSGA) one day before the implementation of extended nursing service, three months and six months after the implementation of extended nursing service, and the body mass index(BMI), albumin, prealbumin, hemoglobin, serum calcium and serum phosphorus were measured at the same time.@*Results@#There was no significant difference in nutritional status, BMI and blood index between the two groups before intervention (P > 0.05). After 3 months and 6 months of intervention, MQSGA scores of intervention group were (13.28±3.99), (10.17±3.43) respectively, which were significantly lower than those of control group (15.32±3.52), (14.37±3.73). There were significant differences between the two groups (t=2.946, 6.336, P<0.01). After 3 months and 6 months of intervention, BMI was (18.29±2.27), (20.27±2.09) kg/m2, respectively, which were significantly higher than those of control group (16.41±2.32), (16.49±2.26) kg/m2. The difference between the two groups was significant (t=-4.430, -9.372, P <0.01). After 3 months of intervention, albumin, preaalbumin, hemoglobin, serum calcium, and serum inorganic phosphorus in intervention group were (35.63±4.24) g/L, (277.57±29.52) mg/L, (102.03±11.21) g/L,(2.01±0.19) mmol/L, (1.74±0.37) mmol/L; and the control group were (33.19±4.89) g/L, (216.81±24.06) mg/L, (92.58±13.79) g/L, (1.91±0.21) mmol/L, (2.05±0.49) mmol/L, respectively. After 6 months of intervention, the intervention groups were (41.49±6.14) g/L, (344.60±30.56) mg/L, (111.34±10.09) g/L, (2.28±0.18) mmol/L, (1.45±0.33) mmol/L, the control group were (34.16±4.71) g/L, (218.63±24.85) mg/L, (94.36±11.21) g/L, (1.99±0.24) mmol/L, (1.95±0.41) mmol/L. There were significant differences between the two groups (t=-24.484-7.220, P<0.01).@*Conclusions@#Extended nursing service can significantly improve the nutritional status of patients undergoing maintenance hemodialysis combined with peritoneal dialysis.
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Objective:To discuss influence of addition and subtraction therapy of Zhenwutang to residual renal function （RRF）， nutritional status， dialysis adequacy and quality of life of patients with maintenance hemodialysis （MHD）. Method:One hundred and thirty-six patients were randomly divided into control group （68 cases） and observation group （68 cases） by random number table. Patients in two group got MHD， 3 times/week， 4 h/time， levocarnitine injection （1 g dissolved in 5-10 mL water for injection） after the dialysis， 2-3 min/time， recombinant human erythropoietin injection with subcutaneous injection for 4 weeks， 3 000 U， 3 times/day， valsartan capsules for 3 months， 80 mg/time， 1 time/day. The control group took Manshenning mixture， 35 mL / time， 3 times / day.Patients in observation group added addition and subtraction therapy of Zhenwutang for 3 months， 1 dose/day. Before and after treatment， urea nitrogen （BUN）， creatinine （CR） and 24 hours' urine volume were recorded. And RRF， rate of decrease of RRF and rate of decrease in urine volume were also calculated. Levels of hemoglobin （HB）， albumin （ALB）， prealbumin （PA） and transferrin （TRF） were detected. After treatment， standardized protein metabolism rate （nPCR）， urea clearance index （Kt / V） and glomerular filtration rate （EGFR） were discussed. And improved subjective comprehensive nutrition assessment （SGA）， dialysis related quality of life （kdta） and health survey summary （SF-36） were graded. Six months' follow-up， primary end point event （24 h urine volume ≤ 400 mL） and no residual renal function （24 h urine volume ≤ 400 mL） were recorded. Result:Levels of RRF， Kt/V， nPCR， eGFR， Hb， Alb， PA， TRF and total scores of KDTA and SF-36 in observation group were higher than those in control group （P<0.01）. And score of SGA， rate of decrease of RRF and rate of decrease in urine volume were less than those in control group （P<0.01）.Incidence rate of primary end point event was 27.94%（19/68） lower than 47.06%（32/68） in control group （χ2=5.302， P<0.05）， incidence rate of no residual renal functionwas 17.65%（11/68） lower than 36.76%（25/68） in control group （χ2=6.274， P<0.05）. And BUN and Cr were lower than those in control group （P<0.01）， 24 h urine volume was more than that in control group （P<0.01）. Conclusion:Addition and subtraction therapy of Zhenwutang can maintenance of RRF， improvement of nutritional status， improvement of dialysis adequacy and quality of life of patients .
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Objective : To explore the correlation between blood pressure fluctuation and chronic kidney disease-mineral and bone disorder (CKD-MBD) in patients with maintenance hemodialysis (MHD). Methods ¡¤ From Jan. 2009 to Apr. 2015, 433 MHD patients in Hemodialysis Center of Renji Hospital, Shanghai Jiao Tong University School of Medicine were included, and their clinical data, treatment parameters during dialysis, lab examination indexes and drug applications were collected. According to the difference value of systolic blood pressure (SBP) during dialysis period, all the patients were divided into high fluctuation group of blood pressure (|△ SBP| ≥ 10 mmHg, n=234) and low fluctua-tion group of blood pressure (|△ SBP|<10 mmHg, n=199). The blood pressure fluctuation and its relationship with dialysis adequacy, bone metabolism indicator and nutrition indicator were analyzed between the two groups. Results ¡¤ Compared with the low fluctuation group of blood pressure, the patients in the high fluctuation group of blood pressure took higher proportion of β receptor blockers and Vit D, higher level of serum P and intact parathyroid hormone (iPTH), higher dialysis age, and lower Kt/V, ultrafiltration volume, body mass index (BMI) and serum albumin (ALB) level (all P<0.05). The blood pressure fluctuation between the patients with different serum P and iPTH levels was statistically significant (all P<0.05). There was no statistically significant difference in blood pressure fluctuation between the patients with different serum Ca levels. Multivariate Logistic regression analysis showed that dialysis age, serum P and iPTH levels were independent risk factors for blood pressure fluctuation of MHD patients, while Kt/V and ALB were protective factors. Con-clusion ¡¤ Blood pressure fluctuation in MHD patients during dialysis period is significantly correlated with CKD-MBD, nutritional status, dialy-sis age and dialysis adequacy.
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Objective: To explore the patterns of cerebral structural abnormalities and cognitive function alterations in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis, and the underlying correlative factors. Methods: Thirty-seven ESRD patients undergoing maintenance hemodialysis without prior stroke in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine were selected. All patients underwent brain magnetic resonance imaging (MRI) and assessment of cognitive function by using Mini-Mental State Examination (MMSE). Patients were divided into lacunar infarction group (n=33) and non-lacunar infarction group (n=4), or white matter hyperintensities (WMH) group (n=14) and non-WMH group (n=23). The difference of demographic characteristics, past history, blood parameter and dialysis adequacy between patients and their controls were analyzed by t test, Mann-Whitney U test, χ2 test and Fisher exact test. Spearman correlation analysis were performed to explore the relationship between clinical features, cerebral structural abnormalities and cognitive function. Results: Nineteen male and eighteen female patients participated in the study. The mean age was (59.4±12.3) years. The incidences of lacunar infarction and WMH were 89.2% and 37.8%, respectively. 24.3% of the participants were diagnosed as cognitive impairment. Patients with lacunar infarction were elder, who had lower level of hemoglobin, hematocrit, serum albumin and serum total protein, while parathyroid hormone (PTH), erythrocyte sedimentation rate, tumor necrosis factor-α and interleukin-6 were elevated. Patients with WMH were also significantly elder, lower in transferrin saturation and higher in PTH. The differences between the two groups were statistically significant (all P<0.05). Spearman correlation analysis showed MMSE score had a negative correlation with age (r=-0.471, P=0.003) and had positive correlations with education status (r=0.355, P=0.031) and hypertension (r=0.358, P=0.030). The study did not find the relationship among lacunar infarction, WMH and MMSE score; however, recall function was found negatively correlated with lacunar infarction (r=-0.357, P=0.030). Conclusion: ESRD patients undergoing maintenance hemodialysis have a high prevalence of cerebrovascular disease and cognitive impairment. Older age, anemia, inflammation status, chronic kidney disease-mineral and bone disorder may be the influencing factors of the cerebral structural abnormalities and cognition decline.
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Objective@#To compare the prevalence of dental caries and periodontal disease in patients with end-stage renal disease treated with maintenance hemodialysis with that in healthy controls and to investigate the relationship between end-stage renal disease, dental caries and periodontal disease.@*Methods @#A total of 82 maintenance hemodialysis patients who met the inclusion criteria were selected as the case group, and 86 healthy persons who underwent oral examination in the physical examination center were selected as the control group. Dental caries and periodontal conditions were examined in the two groups. The dental caries examination was conducted by determining the number of decayed-missing-filled teeth, which was recorded as recommended by the World Health Organization. The periodontal condition parameters included the plaque index, calculus index, bleeding on probing, periodontal pocket depth and clinical attachment loss.@*Results@#The prevalence of dental caries in the case group and healthy control group was 87.8% and 81.4%, respectively, and there was no statistically significant difference between the two groups (P > 0.05). The periodontal indexes, including the plaque index, calculus index, probe bleeding index, periodontal pocket depth and clinical attachment level, in the case group were significantly higher than those in the control group (P < 0.05), and the prevalence of periodontitis in the case group was significantly higher than that in the control group (97.6% vs 88.4%, P < 0.05).@*Conclusion@#The dental caries conditions were comparable between the case group and the control group, but the prevalence and severity of periodontitis were significantly higher in the case group than in the control group.
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ObjectiveCardiovascular disease (CVD) is the main cause of morbidity and mortality in patients with hemodialysis (HD) end-stage renal disease (ESRD). This paper analyzes and discusses the relationship between neutrophils-to-lymphocytes ratio (NLR) and heart valve calcification (CVC) in maintenance hemodialysis (MHD) patients to provide theoretical basis for the prevention and treatment of CVC.MethodsThe demographic data, relevant clinical indicators and laboratory examination results of 135 patients with MHD in the Second Hospital of Anhui Medical University were retrospectively analyzed to calculate the NLR value. Echocardiography was used to detect the incidence of CVC in the patients, and they were divided into calcification group and non-calcification group. The correlation between NLR value and CVC in MHD patients was analyzed, and the independent risk factors of CVC were discussed by using Logistic regression.ResultsAmong the 135 MHD patients, CVC was found in 59 cases (43.7%). Compared with the non-calcification group, patients in the calcification group showed significant increases in age, dialysis age, high-sensitivity c-reactive protein (HsCRP), ALP and NLR, with statistically significant differences (P5.02 (OR=17.709, P=0.046) were independent risk factors for heart valve calcification in MHD patients.ConclusionThe incidence of heart valve calcification is high in MHD patients, and NLR is an independent risk factor for it.
ABSTRACT
Introduction: Viral hepatitis is one of the common causes of chronic liver disease. Hepatitis C is the second most importantcause of chronic viral hepatitis. Globally, an estimated 71 million people have chronic hepatitis C infection. In 2015, there were1.75 million new hepatitis C virus (HCV) infections. Approximately 399,000 people die each year due to HCV-related cirrhosisand hepatocellular carcinoma. Highest numbers of infections are noted in Egypt. South East Asian region countries are alsohaving high prevalence. The prevalence in India is around 1%. In Tripura, blood bank-based study shows prevalence around0.1%. Higher prevalence was seen in patient on maintenance hemodialysis.Objectives: The study was designed to determine. (1) Mode of transmission of hepatitis C in Tripura, (2) To evaluate genotypicpattern of hepatitis C infection in Tripura, (3) To evaluate coinfection with human immune deficiency virus (HIV)/hepatitis B virus (HBV).Materials and Methods: It was a cross-sectional study done on 60 consecutive hepatitis C patients attended the liver clinic ofHepatitis Foundation of Tripura between January 2018 and December 2018.Results: The study reveals that in this group, 65% hepatitis C patients were males and 35% were females and 63.3% patientsare from rural areas whereas 36.7% patients are from urban areas. Study shows that there is shift of age among hepatitis Cpatients from older to the younger group. It was observed that 5% of hepatitis C patients had coinfection with HIV infectionbut no coinfection with HBV. Regarding mode transmission of hepatitis C, 30% are through blood transmission, 20% throughdrug abuse, 16.7% patients through sexual route, 11.6% patients through dialysis, 1.7% prenatal transmission, and 20%remain unknown. Genotype 3 was 75% (3a was found in 55% and 20% were genotype 3b,) and genotype 1 was 25% (21.7%genotype 1a and 3.3% were genotype 1b). In the study group, 18% were in decompensated chronic liver disease.Discussion: The prevalence of HCV infection seems to be increasing among people who inject drugs in Tripura. Malepreponderance in this study may be due to more exposure to drugs among males. Higher prevalence of Hepatitis C amongthe rural people may be due to increase quackery practice in the rural areas.