ObjectiveTo explore the role of arteriovenous axillary loop graft (AVALG) on chest for establishing hemodialysis access in patients with chronic renal failure. MethodsA retrospective analysis was made on the clinical data of 12 patients with chronic renal failure who underwent an AVALG on chest for hemodialysis access between December 2010 and May 2014. There were 2 males and 10 females with an average age of 65.25 years (range, 46-75 years). The main causes were chronic glomerulonephritis in 6 cases, diabetic nephropathy in 4 cases, and both kidney resection because of urinary tract tumors in 2 cases. The disease duration was 2-12 years (mean, 6 years). The 12 patients all underwent 5-14 times (mean, 7 times) failed prior vascular accesses [arteriovenous fistula (AVF）and arteriovenous graft (AVG)] leading to exhaustion of venous access sites on the upper extremities. ResultsThe AVALG on chest were functionally useful for hemodialysis access, 2-3 times per week, and the blood flow was 250-350 mL/minute; the average time for the first dialysis was 48 days (range, 42-93 days). All patients were followed up 12-54 months (mean, 20.92 months). There was no death during perioperative period. The primary patency rates at 6 and 12 months were 91.7% and 83.3% respectively, and the secondary patency rates at 6 and 12 months were both 100%. After operation, infection (1 case), thrombosis (2 cases), bleeding (2 cases), and swollen (1 case) occurred, which were all cured after corresponding treatment. ConclusionAVALG on chest is a supplementary option for chronic renal failure patients with inadequate upper extremity venous access sites after repeat occlusion.
Objective To analyze the research hotspots and trends in the field of hyperkalemia in hemodialysis patients at home and abroad, and to provide reference for the research and prevention and control of hyperkalemia in hemodialysis patients. Methods China National Knowledge Infrastructure (CNKI) and Web of Science databases were searched by computer for literature about the hyperkalemia in hemodialysis patients published between January 1995 and January 2023. The included literature was analyzed using visualization analysis tools for visualization, including high-frequency keywords, keyword co-occurrence map, keyword emergence intensity and keyword time series prediction. Results A total of 10 275 articles were included. Among them, there were 10 036 articles from web of science and 239 articles from CNKI. The number of articles in this research field showed a trend of steady increase year by year. The United States was in a leading position in the research and development in this field, followed by China. At the same time, the research in this field presents the characteristics of multidisciplinary integration. The development trends of research hotspots in the next 5 years were risk and health education research. Conclusions The number of research articles related to hyperkalemia in hemodialysis patients is gradually increasing. Multidisciplinary approach and integration is a research hotspot and frontier in the development of hyperkalemia in hemodialysis patients both domestically and internationally.
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).
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.
Objective To understand the cognition and acceptance of community hemodialysis centers among hemodialysis patients in Yangzhou, and to provide theoretical basis for the development of community hemodialysis centers. Methods A cluster random sampling method was used to select 400 maintenance hemodialysis patients treated in various areas of Yangzhou in April 2021 for a questionnaire survey to analyze the influencing factors of patients’ medical treatment behavior. Results A total of 390 valid questionnaires were recovered, with an effective recovery rate of 97.50%. Among the patients, 40.51% were very concerned about the construction of hemodialysis centers in the community, 56.67% understood the relevant policies, and 56.92% of the patients were willing to choose the community for dialysis treatment. The results of logistic regression analysis showed that the main factors affecting whether patients choose community for hemodialysis treatment include the patients’ residence [Jiangdu vs. Guangling: odds ratio (OR)=7.183, 95% confidence interval (CI) (2.010, 25.674), P=0.002; Gaoyou vs. Guangling: OR=22.512, 95%CI (7.201, 70.373), P<0.001; Yizheng vs. Guangling: OR=25.137, 95%CI (7.636, 82.744), P<0.001; Baoying vs. Guangling: OR=23.784, 95%CI (7.795, 72.569), P<0.001], degree of concern [some concern vs. very concerned: OR=0.267, 95 %CI (0.137, 0.521), P<0.001; not very concerned vs. very concerned: OR=0.062, 95%CI (0.023, 0.168), P<0.001; not concerned vs. very concerned: OR=0.101, 95% CI (0.023, 0.439), P=0.002], awareness [somewhat know vs. know very well: OR=0.025, 95%CI (0.002, 0.318), P=0.004; don’t know very well vs. know very well: OR=0.035, 95%CI (0.003, 0.439), P=0.009; don’t know vs. know very well: OR=0.006, 95%CI (0.000, 0.084), P<0.001]. Conclusions Hemodialysis patients in Yangzhou have a low level of awareness and acceptance of community-based hemodialysis centers. The patients’ residence, degree of attention and awareness of community-based hemodialysis center directly affect whether they choose the community for treatment. The relevant departments and medical institutions can start from the factors that affect patients’ choice of medical treatment, further strengthen the publicity of community dialysis, optimize the allocation of medical resources, and improve the capacity of community health services.
ObjectiveTo investigate the current situation of stress load and professional benefit of hemodialysis nurses during the outbreak period and the remission period of coronavirus disease 2019 (COVID-19) epidemic, and discuss the differences in stress load and professional benefit of hemodialysis nurses between the two periods.MethodsIn February 2020, 119 hemodialysis nurses from three hemodialysis centers in Sichuan Province were selected as the respondents. Using the Stress Overload Scale and the Questionnaire of Nurses’ Perceived Professional Benefits, questionnaire survey was conducted in February 2020 and April 2020, respectively. Paired-sample t test was used for analysis.ResultsA total of 109 valid questionnaires were collected. The scores of stress load of hemodialysis nurses in outbreak period and remission stage were 3.00±1.26 and 2.17±1.16, respectively, of which the scores of event load dimension were 3.49±1.15 and 2.31±1.27, respectively, and the scores of individual vulnerability dimension were 2.59±1.19 and 2.05±1.06, respectively; the professional benefit scores of hemodialysis nurses in outbreak and remission were 4.19±0.83 and 4.21±0.78, respectively. The difference in stress load of the same group of hemodialysis nurses between different time periods was statistically significant (P<0.05), while there was no significant difference in professional benefit (P>0.05).ConclusionsDuring the outbreak of COVID-19 epidemic, the stress load of hemodialysis nurses was ata medium level, and that in the remission stage of COVID-19 epidemic was at a low level; the professional benefit of nurses in the outbreak and remission period was at a high level. The stress load status of hemodialysis nurses was different between different periods of the epidemic. We should take incentive mechanism or targeted psychological intervention measures to improve the professional benefit level of nurses.
The formation of an arteriovenous fistual for dialysis by routine interrupted sutures anastomosing the vein and artery is difficult to perform and time-consuming. A new method, telescopic adhesive anastomosis was studied and applied in 10 hemodialysis patients, who were in need of an arteriovenous fistula. The external diameter of the vessels anastomosed was 2.40 +/- 0.20 mm (radial artery) or 2.40 +/- 0.35 mm (cephalic vein). After thorough debridement of the vascular ends, the arterial end was put in the venous lumen. In order to fix the telescopic vessels, two stitches were applied 180 degrees apart from each other and tied. Each stitch was inserted from vein (penetrating the whole wall) to artery (just through the adventitia and partial thickness of the media vasorum). The distance from the stitch to the edge of the vein was 0.5 mm, and that of the artery was approximated to the external diameter of the vessle. The medical adhesive was then applied for sealing the anastomotic adventitia. Ten seconds were given for the solidification of the adhesive. The patients were followed up for 8 months. The patency rate was 100%, and the rate of blood flow was more than 300 ml/min (measured by ultrasonography). It was shown that this method could be managed easily and quickly, and the so-formed fistula would fulfill the need of hemodialysis.
OBJECTIVE To investigate the clinical application of artificial blood vessel graft for arteriovenous fistulization. METHODS From October 1995 to August 1998, 23 cases with renal failure received PTEF artificial vessels grafting for arteriovenous fistulization in the forearm. The PTFE artificial vessel was 6 mm in diameter, and 40 cm in length. Artificial vessel "U"-shaped loop was formed from elbow incision to wrist incision, and perfused by 20 ml heparin saline. The two ends of artificial vessel were end-to-side anastomosed with superficial cubital vein and cubital artery respectively. RESULTS All of arteriovenous fistulas were successfully formed, and could be performed hemodialysis periodically. The artificial vessels could be punctured repeatedly, and had sufficient volume of blood flow. It had no rejection, no formation of false aneurysm, and no ischemia in arm or exacerbated reflux to heart. CONCLUSION The artificial vessel grafting for arteriovenous fistulization is a safe and convenient technique in clinical practice, especially when there is no autogenous vessels for arteriovenous fistula.
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.
ObjectiveTo compare the quality of life in the early stage of treatment in patients who accepted renal transplantation with those who still were undergoing long-term hemodialysis. MethodsPatients undergoing long-term hemodialysis in December 2011 and adult patients who planned to accept renal transplantation within 6 months were chosen to be our study subjects. The Medical Outcomes Study 36-item Short Form Health Survey Questionnaire (SF-36) was used for the study. After 6 months of following up, they were assessed with the same questionnaire again. Those hemodialysis patients who accepted renal transplantation within this period were divided into the intervention group. The quality of life between the two groups was compared then. ResultsA total of 124 end-stage renal failure patients were involved in our study, in which 79 patients successfully accepted renal transplantation (intervention group) and the other 45 patients who still underwent hemodialysis (control group). No other complications were observed during this period. There was no significant difference in life quality between the two groups before treatment (P>0.05). Six months after the treatment, SF-36 total score and each of the 8 dimension scores for the intervention group were all significantly higher than those for the control group (P<0.05). ConclusionRenal transplantation recipients have a totally better life quality than those who depend on hemodialysis.