Venous pressure monitoring is an important indicator for the arteriovenous fistula evaluation. Direct static venous pressure monitoring is recognized as the most accurate way of venous pressure monitoring, which is widely used in the functional monitoring, functional evaluation of arteriovenous fistula, the diagnosis of complications and the evaluation of surgical efficacy. Venous pressure monitoring has obvious advantages and disadvantages, so it is necessary to improve relevant knowledge to correctly guide clinical diagnosis and treatment. In this paper, the study of static venous pressure monitoring of arteriovenous fistula was summarized, in order to improve the understanding of the significance and clinical application of static venous pressure monitoring of arteriovenous fistula.
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.
Maintenance hemodialysis patients face great risk and challenges in the current coronavirus disease 2019 (COVID-19) epidemic, and adequate and reasonable nutrition is an important weapon in the prevention and treatment of COVID-19. Therefore, the Chinese Society of Parenteral and Enteral Nutrition proposed Dietary Expert Advice on Prevention and Treatment of COVID-19 in Hemodialysis Patients for hemodialysis patients. In this paper, the nine pieces of advice on hemodialysis patients’ staple food, intake of high-quality protein, vegetables and fruits, food types and combinations, prevention of virus transmission, fluid intake, nutritional supplements, regular rest and adequate sleep, as well as supplement of anti-inflammatory and antioxidant preparations are interpreted in detail.
Objective To explore the vitamin K level in Chinese maintenance hemodialysis (MHD) patients. Methods MHD patients and healthy subjects from our outpatient clinic were enrolled from 1 to 30 in March 2016. Demographic data was collected. Fasting serum samples from all subjects were collected for biochemistry tests and the measurement of known vitamin K-dependent proteins, i.e. matrix Gla protein (MGP), osteocalcin (OC) and uncarboxylated osteocalcin (ucOC). We also quantified the fraction of ucOC of total OC (%ucOC). Differences of these parameters between the two groups were analyzed. Results We enrolled 70 MHD patients as a test group and 70 healthy subjects as a control group. There was no significant difference in MGP between MHD group and the control group [(4.1±2.2) vs. (4.4±1.0) pg/mL, P=0.441]. The value of %ucOC was significantly higher in the MHD group than that in the control group [(79.3±19.3)% vs. (51.9±13.0)%, P<0.001]. Conclusions Deficiency of vitamin K appears common in Chinese MHD patients. Besides pathological reasons, dietary habit may also contribute to this phenomenon.
Blood pressure variability (BPV) refers to the fluctuations of blood pressure in a certain period of time. In recent years, BPV is becoming a predictive marker for cardiovascular events. Given the hemodynamic and internal environmental change brought by hemodialysis as well as the complex complications, hemodialysis patients always have complex BPV. Nowadays there is no consensus on an optimal standard to evaluate BPV in hemodialysis population. Metrics usually used are as follows: blood pressure change during a certain period of time, standard deviation, coefficient of variation, variation independent of mean, average real variability, weighted mean of daytime and night-time standard deviation, residual derived from generalized linear models, and residual standard deviation. Impact factors of BPV in hemodialysis patients include age, ultrafitration volume, hemodialysis frequency and time length, peripheral vascular disease, serum calcium, antihypertensive drugs and so on. Recent studies showed significant associations between both long-term and short-term BPV with prognosis of hemodialysis patients. This review focuses on the evaluation methods, the influencing factors and the impact on prognosis of BPV.
Objective To investigate the effects and feasibility of regional citrate anticoagulation continuous venous-venous hemodialysis(RCA-CVVHD) in acute hepatic & kidney injury after cardiovascular surgery. Methods Ten patients with acute kidney injury combined with acute hepatic injury after cardiovascular surgery were involved in this study. There were 5 males and 5 females at age of 35-69(58.2±12.7) years. All of them were treated by RCA-CVVHD. Blood samples were collected before treatment, 12 h, 24 h, 48 h, and 72 h after treatment. Results There was no statistical difference between post- and pre-treatment regarding with pH value (7.47±0.12 vs. 7.50±0.06 vs. 7.48±0.04 vs. 7.48±0.03 vs. 7.45±0.05, P>0.05) or BE value (0.91±9.97 mmol/L vs. 2.36±3.92 mmol/L vs. –0.22±3.09 mmol/L vs. 1.87±3.58 mmol/L vs. –1.05±1.12 mmol/L, P>0.05). There was a statistical difference in iCa (1.09±0.09 mmol/L vs. 1.15±0.08 mmol/L vs. 1.17±0.08 mmol/L vs. 1.24±0.09 mmol/L vs. 1.16±0.06 mmol/L), Na+ (149.44±6.84 mmol/L vs. 144.33±3.35 mmol/L vs. 143.13±3.52 mmol/L vs.141.25±5.52 mmol/L vs. 136.71±4.92 mmol/L), and tCa/iCa (2.07±0.11 vs. 2.10±1.12 vs. 2.17±0.69 vs. 2.23±1.05 vs. 2.30±0.11), respectively. Conclusion RCA-CVVHD used in patients with acute hepatic impairment is safe and feasible.
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.
Most patients with end-stage renal disease choose maintenance hemodialysis to prolong survival. The clinical application of exercise therapy has a definite effect on maintenance hemodialysis patients, and can effectively improve their quality of life and promote rehabilitation. Individualized exercise therapy under the guidance of medical professionals has positive effects on patients’ physical and mental rehabilitation. This paper mainly summarizes the status of exercise, factors affecting exercise, exercise therapy, exercise and rehabilitation of maintenance hemodialysis patients, and reviews the impact of exercise therapy on the physical and mental health of maintenance hemodialysis patients, in order to provide some references for clinical intervention and prognosis studies.
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.