Research progress of nocturnal hemodialysis / 第二军医大学学报

Hemodialysis is one of the main treatment methods for patients with end stage renal disease (ESRD), and conventional hemodialysis (CHD) is the most widely used one. With the development of dialysis technology, the survival time of hemodialysis patients is significantly prolonged, but the mortality remains high. Nocturnal hemodialysis (NHD) was proposed in 1963 as a new type of dialysis, and it has greatly extended time of dialysis as compared with CHD. NHD has advantages in controlling blood pressure and cardiovascular function, correcting anemia, improving calcium and phosphorus metabolism and nutritional status, and enhancing quality of life of hemodialysis patients.

Investigation and analysis of perceived occupational risk of nurses in nocturnal hemodialysis / 第二军医大学学报

Objective To investigate the occupational risk of nurses in nocturnal hemodialysis (NHD), and to analyze the relevant factors and coping approach to occupational risk. Methods The occupational risk of 25 nurses at conventional hemodialysis (CHD) and 25 nurses at NHD were investigated using Nursing Occupational Risk Assessment Questionnaire. The Likert Scale 5-grade method was used to score the questionnaire, to obtain occupational risk index, and to analyze the relevant risk factors. Results The scores in 3 dimensions, including accidental risk, chemical risk, and ergonomical, psychosocial and organizational risk, in the NHD nurse group were significantly higher than those in the CHD nurse group (P<0.05). The average risk index scores of the harzard of irregular working hours, interpersonal relation disturbance, frequent shift work, overtime, and night shift, and the hazard of understaffing and overworking were in the top 2 of each sub events, and they belonged to the risks which were order not allowed. Conclusion The average risk index of the nurses at NHD is higher than at CHD, and the formative factors are specific. Hospital managers should take active measures to prevent and reduce the occupational risk.

Effect of nocturnal hemodialysis on dialysis complications and tolerability in maintenance hemodialysis patients / 第二军医大学学报

Objective To compare the differences of dialysis complications and tolerability between nocturnal hemodialysis (NHD) and conventional hemodialysis (CHD) patients. Methods Seventy-two NHD and 72 CHD patients from Changzheng Hospital of Second Military Medical University were enrolled in this study. The clinical data were collected and the postdialysis recovery time was recorded. The complications including intradialytic hypotension, postdialytic fatigue, itching, muscle spasms, dizziness, headache, loss of appetite, nausea, vomiting, and sleep disorders, and the mental pressure and daily life (fear of death, worrying about equipment failure, losing freedom, and failing to work) were all investigated using a questionnaire. Results Patients in the NHD group had significantly shortened postdialysis recovery time (P<0.01) and significantly less complications (intradialytic hypotension, postdialytic fatigue, itching, dizziness, headache, loss of appetite, nausea and vomiting) than those in the CHD group (P<0.05, P<0.01). The number of patients who lost freedom significantly was decreased (P<0.01), but the number of patients worrying about equipment failure was significantly increased (P<0.01). Conclusion The NHD patients have less complications associated with hemodialysis than CHD patients, and they also have improved tolerance to maintenance hemodialysis.

Nocturnal hemodialysis reducing mortality risk of maintenance hemodialysis patients / 第二军医大学学报

Objective To compare the difference of mortality risk between patients undergoing nocturnal hemodialysis (NHD) and conventional hemodialysis (CHD) and to explore the related factors of mortality. Methods The study cohort comprised the maintenance hemodialysis patients receiving either NHD (n=111) or CHD (n=722) in Changzheng Hospital of Second Military Medical University from Feb. 2009 to Feb. 2017. The demographic information, clinical characteristics, survival status, causes of death and laboratory examination indexes were obtained from hemodialysis management system. The urea clearance index (Kt/V), hemoglobin, blood phosphorus concentration and mortality were compared between NHD and CHD patients. The multivariate-adjusted Cox model was used to analyze the mortality risk of all patients. Results Compared with the patients receiving CHD, the proportion of male was more in the NHD group, and the baseline age was younger (P3 years (P<0.05). Conclusion NHD can effectively increase the solute clearance, improve anemia and calcium and phosphate metabolism, and thus reduce the mortality risk of maintenance hemodialysis patients.

Causes and risk factors for dropout of nocturnal hemodialysis patients / 第二军医大学学报

Objective To explore the causes of nocturnal hemodialysis (NHD) patient dropout and the risk factors for dropout. Methods We collected the clinical data of patients receiving NHD for more than 3 months, of whom 47 patients dropped out and 64 kept receiving NHD from Feb. 2009 to Nov. 2016 in Changzheng Hospital of Second Military Medical University. We investigated the general conditions; and we compared the differences of the blood parameters between the two groups when the patients received NHD for the first time and for the last time, including hemoglobin, platelet, albumin, ferritin, serum calcium, serum phosphorus and parathyroid hormone. We also analyzed the risk factors for NHD dropout or for death using Cox regression analysis model. Results Among 111 patients, 47 patients had withdrawn from NHD, with their average time for NHD being (31.55±20.30) months, and the causes for dropout included death, transferring to other hospitals, turning to conventional hemodialysis (CHD), renal transplantation and others. Univariate Cox regression analysis showed that hypertensive nephropathy (P=0.007, HR=2.913, 95%CI: 1.348-6.293) and diabetic nephropathy (P=0.047, HR=2.401, 95%CI: 1.014-5.685) were risk factors for NHD patient dropout, while chronic nephritis syndrome (P<0.001, HR=0.095, 95%CI 0.046-0.195) was a protective factor; blood albumin (P=0.007, HR=0.904, 95%CI:0.840-0.973) and age (P=0.027, HR=1.052, 95%CI:1.006-1.101) were risk factors for NHD patient dropout. Multivariate Cox regression analysis showed that albumin level (P=0.007, HR=0.911, 95%CI: 0.848-0.991) was an independent risk factor for death in NHD patients. Conclusion Hypertensive nephropathy and diabetic nephropathy are the risk factors for NHD patients dropout, while chronic nephritis syndrome was a protective factor. Low serum albumin level is an independent risk factor for death in NHD patients.

Causes and risk factors for dropout of nocturnal hemodialysis patients / 第二军医大学学报

Objective To explore the causes of nocturnal hemodialysis (NHD) patient dropout and the risk factors for dropout.Methods We collected the clinical data of patients receiving NHD for more than 3 months,of whom 47 patients dropped out and 64 kept receiving NHD from Feb.2009 to Nov.2016 in Changzheng Hospital of Second Military Medical University.We investigated the general conditions;and we compared the differences of the blood parameters between the two groups when the patients received NHD for the first time and for the last time,including hemoglobin,platelet,albumin,ferritin,serum calcium,serum phosphorus and parathyroid hormone.We also analyzed the risk factors for NHD dropout or for death using Cox regression analysis model.Results Among 111 patients,47 patients had withdrawn from NHD,with their average time for NHD being (31.55±20.30) months,and the causes for dropout included death,transferring to other hospitals,turning to conventional hemodialysis (CHD),renal transplantation and others.Univariate Cox regression analysis showed that hypertensive nephropathy (P=0.007,HR=2.913,95％CI:1.348-6.293) and diabetic nephropathy (P=0.047,HR=2.401,95％CI:1.014-5.685) were risk factors for NHD patient dropout,while chronic nephritis syndrome (P＜0.001,HR=0.095,95％CI 0.046-0.195) was a protective factor;blood albumin (P=0.007,HR=0.904,95％CI:0.840-0.973) and age (P=0.027,HR=1.052,95％CI:1.006-1.101) were risk factors for NHD patient dropout.Multivariate Cox regression analysis showed that albumin level (P=0.007,HR=0.911,95％CI:0.848-0.991) was an independent risk factor for death in NHD patients.Conclusion Hypertensive nephropathy and diabetic nephropathy are the risk factors for NHD patients dropout,while chronic nephritis syndrome was a protective factor.Low serum albumin level is an independent risk faetor for death in NHD patients.

Nocturnal hemodialysis reducing mortality risk of maintenance hemodialysis patients / 第二军医大学学报

Objective To compare the difference of mortality risk between patients undergoing nocturnal hemodialysis (NHD) and conventional hemodialysis (CHD) and to explore the related factors of mortality.Methods The study cohort comprised the maintenance hemodialysis patients receiving either NHD (n=111) or CHD (n=722) in Changzheng Hospital of Second Military Medical University from Feb.2009 to Feb.2017.The demographic information,clinical characteristics,survival status,causes of death and laboratory examination indexes were obtained from hemodialysis management system.The urea clearance index (Kt/V),hemoglobin,blood phosphorus concentration and mortality were compared between NHD and CHD patients.The multivariate-adjusted Cox model was used to analyze the mortality risk of all patients.Results Compared with the patients receiving CHD,the proportion of male was more in the NHD group,and the baseline age was younger (P＜0.01) and baseline dialysis vintage was longer (P＜0.01).There was no significant difference in incidences of primary disease and comorbidities,or laboratory examination results.Compared with the CHD group,the levels of Kt/V and hemoglobin in the NHD group were significantly higher (P＜0.01),and the blood phosphorus concentration was significantly lower (P＜0.05).Mortality in the NHD and CHD groups was 3.5 per 100 patients-years and 6.2 per 100 patients-years,respectively.After the adjustment by baseline age,dialysis vintage,gender,and comorbidities,Cox model analysis showed that the mortality risk in the NHD group was lower than in the CHD group (HR=0.67,95％CI:0.39-1.00,P=0.05).Subgroup analysis showed NHD was of more survival benefit for male (P＜0.05),non-diabetic patients (P =0.05) and patients with conventional dialysis vintage ＞3 years (P＜0.05).Conclusion NHD can effectively increase the solute clearance,improve anemia and calcium and phosphate metabolism,and thus reduce the mortality risk of maintenance hemodialysis patients.

Investigation and analysis of perceived occupational risk of nurses in nocturnal hemodialysis / 第二军医大学学报

Objective To investigate the occupational risk of nurses in nocturnal hemodialysis (NHD),and to analyze the relevant factors and coping approach to occupational risk.Methods The occupational risk of 25 nurses at conventional hemodialysis (CHD) and 25 nurses at NHD were investigated using Nursing Occupational Risk Assessment Questionnaire.The Likert Scale 5-grade method was used to score the questionnaire,to obtain occupational risk index,and to analyze the relevant risk factors.Results The scores in 3 dimensions,including accidental risk,chemical risk,and ergonomical,psychosocial and organizational risk,in the NHD nurse group were significantly higher than those in the CHD nurse group (P＜0.05).The average risk index scores of the harzard of irregular working hours,interpersonal relation disturbance,frequent shift work,overtime,and night shift,and the hazard of understaffing and overworking were in the top 2 of each sub events,and they belonged to the risks which were order not allowed.Conclusion The average risk index of the nurses at NHD is higher than at CHD,and the formative factors are specific.Hospital managers should take active measures to prevent and reduce the occupational risk.

Research progress of nocturnal hemodialysis / 第二军医大学学报

Hemodialysis is one of the main treatment methods for patients with end stage renal disease (ESRD),and conventional hemodialysis (CHD) is the most widely used one.With the development of dialysis technology,the survival time of hemodialysis patients is significantly prolonged,but the mortality remains high.Nocturnal hemodialysis (NHD) was proposed in 1963 as a new type of dialysis,and it has greatly extended time of dialysis as compared with CHD.NHD has advantages in controlling blood pressure and cardiovascular function,correcting anemia,improving calcium and phosphorus metabolism and nutritional status,and enhancing quality of life of hemodialysis patients.

Effect of nocturnal hemodialysis on dialysis complications and tolerability in maintenance hemodialysis patients / 第二军医大学学报

Objective To compare the differences of dialysis complications and tolerability between nocturnal hemodialysis (NHD) and conventional hemodialysis (CHD) patients.Methods Seventy-two NHD and 72 CHD patients from Changzheng Hospital of Second Military Medical University were enrolled in this study.The clinical data were collected and the postdialysis recovery time was recorded.The complications including intradialytic hypotension,postdialytic fatigue,itching,muscle spasms,dizziness,headache,loss of appetite,nausea,vomiting,and sleep disorders,and the mental pressure and daily life (fear of death,worrying about equipment failure,losing freedom,and failing to work) were all investigated using a questionnaire.Results Patients in the NHD group had significantly shortened postdialysis recovery time (P ＜ 0.01) and significantly less complications (intradialytic hypotension,postdialytic fatigue,itching,dizziness,headache,loss of appetite,nausea and vomiting) than those in the CHD group (P＜0.05,P＜0.01).The number of patients who lost freedom significantly was decreased (P＜0.01),but the number of patients worrying about equipment failure was significantly increased (P＜0.01).Conclusion The NHD patients have less complications associated with hemodialysis than CHD patients,and they also have improved tolerance to maintenance hemodialysis.