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.
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.
Objective To investigate the correlation between grip strength and subjective cognitive decline (SCD) in maintenance hemodialysis (MHD) patients of different genders. Methods Patients who underwent outpatient MHD in the Wenjiang Hemodialysis Unit, Department of Nephrology, West China Hospital, Sichuan University between March and June 2024 were selected as the research subjects. Multiple linear regression analysis was used to explore the relationship between grip strength and SCD in MHD patients of different genders. Results A total of 171 patients were investigated, with 76 in the non-SCD group and 95 in the SCD group. The results of multiple linear regression analysis showed that educational level (P=0.039), nutritional status (P=0.026), and grip strength (P=0.042) were the influencing factors of SCD in male MHD patients. Work status (P=0.001) and nutritional status (P=0.011) were the influencing factors of SCD in female MHD patients. Conclusions Educational level, nutritional status, and grip strength are influencing factors of SCD in male MHD patients. Work status and nutritional status are influencing factors of SCD in female MHD patients. Grip strength may serve as an indicator for evaluating SCD in male MHD patients.
ObjectiveTo observe the effects of levocarnitine by intravenous injection on nutritional and microinflammatory state in maintenance hemodialysis patients. MethodsBetween October 2010 and October 2011, 62 maintenance hemodialysis (>6 months) patients in our dialysis center were enrolled in this study, and were randomly divided into treatment group (n=32) and control group (n=30). Patients in the treatment group were injected with levocarnitine (1.0 g once) after every dialysis for 3 months, while patients in the control group only accepted routine hemodialysis therapy. Blood biochemical indicators, serum high sensitive C-reactive protein (hs-CRP) were measured and compared at the experiment onset and 3 months later. ResultsAfter treatment with levocarnitine for three months, the average serum levels of albumin (Alb), hemoglobin (Hb), triacylglycerol (TG), high density lipoprotein cholesterol (HDL-C) and hs-CRP, and the conditions of dialysis hypotension, muscular spasm, lacking in strength, and anorexia were significantly different between the two groups (P<0.05). But there was no significant difference in total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) between the two groups (P>0.05). For the control group, after treatment, Alb, Hb and condition of anorexia changed significantly (P<0.05), while TC, TG, LDL-C, HDL-C, hs-CRP, conditions of dialysis hypotension, muscular spasm and lacking of strength did not change (P>0.05); for the treatment group, after treatment, all Alb, Hb, TG, HDL-C, hs-CRP, conditions of dialysis hypotension, muscular spasm, lacking of strength and anorexia changed significantly (P<0.05), while TC and LDL-C did not change obviously (P>0.05). ConclusionLevocarnitine can significantly improve the nutritional and microinflammatory state and better the quality of life in maintenance hemodialysis patients.
Objective To explore the current status of electronic health (eHealth) literacy and online health information seeking behavior of maintenance hemodialysis (MHD) patients, and to explore the relationship between them. Methods MHD patients in the Hemodialysis Center of West China Hospital of Sichuan University between January and April 2022 were selected by convenient sampling method. The patients were investigated with general condition questionnaire, eHealth Literacy Scale and internet health information retrieval behavior questionnaire. According to the score of eHealth literacy, patients were divided into high eHealth literacy group and low eHealth literacy group, to compare the differences between the two groups, and analyze the factors that affected the internet health information retrieval behavior. Results A total of 194 MHD patients were included. Among them, 112 were male and 82 were female. The average score of eHealth literacy was 24.84±9.24. There were 136 cases in low eHealth literacy group, and the average score of eHealth literacy was 20.76±7.91. There were 58 cases in high eHealth literacy group, and the average score of eHealth literacy was 34.36±3.01. Multivariate analysis showed that eHealth literacy and education level were the influencing factors of health information search behavior (P<0.05). Conclusions The overall eHealth literacy of MHD patients is low, and the online health information search means is single and behaviorally inconsistent. It is necessary to improve the eHealth literacy of hemodialysis patients, and at the same time, provide various health information publicity and education for patients with different levels of eHealth literacy, which will help them better carry out disease management.
Objective To explore the current status of nutritional literacy in maintenance hemodialysis (MHD) patients and analyze its influencing factors. Methods MHD patients in Wenjiang Hemodialysis Center of West China Hospital, Sichuan University between January and April 2022 were selected by convenient sampling method. A questionnaire survey was conducted using the Nutrition Literacy Evaluation Scale for end-stage renal disease dialysis patients, and the current status and influencing factors of nutritional literacy in MHD patients were analyzed. Results A total of 214 patients were included, with an average nutritional literacy score of 19.14±5.78 for MHD patients. Among them, there were 60 cases (28.04%) of highly likely low nutritional literacy, 124 cases (57.94%) of moderate nutritional literacy, and 30 cases (14.02%) of highly likely high nutritional literacy. The correlation test results showed that hemoglobin, albumin, cholesterol, triglyceride, calcium, phosphorus, potassium, creatinine, estimated glomerular filtration rate, and nutritional literacy scores were not correlated. The results of multiple linear stepwise regression analysis showed that education level [non-standardized partial regression coefficient (b)=1.821, 95% confidence interval (CI) (1.143, 2.498), P<0.001], age [b=−2.460, 95%CI (−4.247, −0.672), P=0.007], hypertensive kidney damage [b=2.233, 95%CI (0.428, 4.039), P=0.016] were all factors affecting the nutritional literacy of MHD patients. Conclusions In clinical work, more attention should be paid to MHD patients with low educational level, older age, and more primary diseases. And targeted interventions should be adopted to improve the level of nutritional literacy in order to improve the quality of life of MHD patients.
ObjectiveTo explore the clinical curative effect of high flux hemodialysis on diabetic nephropathy (DN) and impact on patients' insulin resistance (IR). MethodsA total of 96 patients with DN meeting the inclusion criteria treated between January 2013 and January 2014 were selected. The patients were randomly divided in to the observation group and control group with 48 in each. The control group received low flux hemodialysis, while the observation group underwent high flux hemodialysis. Before the treatment and in the first half of the year after the treatment, the clinical renal function and inflammatory indexes, lipid metabolism, and glucose metabolism related markers were recorded, and IR index (HOMA-IR) were calculated and compared. ResultsBefore and after the treatment, the Kt/V showed no significant change in the two groups (P > 0.05). Serum creatinine levels was lower after the treatment compared with that before the treatment in both of the two groups; in the observation group, C-reactive protein, interleukin-6 and tumor necrosis factorαwere significantly lower than those before the treatment and than those in the control group after the treatment (P < 0.05). HOMA-IR and fasting insulin levels in the observation group after the treatment were significantly lower than those before the treatment and than those in the control group after the treatment (P < 0.05). No significant changes of fasting plasma glucose and glycosylated hemoglobin levels in the two groups before and after the treatment in patients were found (P > 0.05). ConclusionHigh flux hemodialysis therapy is effective on DN, which can effectively remove the body and large molecular type of inflammatory mediators, alleviate the micro inflammatory state, improve the IR status and correct the lipid metabolic abnormalities.
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.
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 understand the maintenance hemodialysis (MHD) patients’ intention to exercise rehabilitation and discuss the influencing factors.MethodsFrom January to March 2019, 141 MHD patients’ intention to exercise rehabilitation was investigated by cross-sectional survey, and the influencing factors of MHD patients’ intention to exercise rehabilitation were analyzed by multiple linear stepwise regression.ResultsA total of 141 questionnaires were issued and 139 valid ones were recovered. The mean score of exercise rehabilitation intention of MHD patients was 39.99±9.29, which was in the middle and high level. Age [unstandardized partial regression coefficient (b)=−5.277, 95% confidence interval (CI) (−8.640, −1.915), P=0.002], educational level [b=2.412, 95%CI (1.161, 3.663), P<0.001], and 6-minute walking distance [b=3.526, 95%CI (0.032, 7.021), P=0.048] were the influencing factors of exercise rehabilitation intention of MHD patients.ConclusionMHD patients have high intension to exercise rehabilitation, and special attention should be paid to elderly patients and patients with low education level in clinical work to improve their intension to exercise rehabilitation.