维持性血液透析患者缺血性脑卒中发生的影响因素及预后分析

目的探讨维持性血液透析（MHD）患者缺血性脑卒中的危险因素及影响其预后的因素。方法在我院2004年1月至2008年12月行MHD治疗的216例患者中,选择发生缺血性脑卒中的患者25例,为脑卒中组;选择同期无脑卒中者42例,为非脑卒中组。比较2组患者临床及生化指标。Logistic回归分析MHD患者缺血性脑卒中发生的危险因素,同时分析脑卒中组患者的转归。结果（1）脑卒中组年龄、收缩压（SBP）、脉压（PP）、脉压指数（PPI）、进入MHD后平均动脉压（MAP）的增加值、尿酸（UA）、C反应蛋白（CRP）、纤维蛋白原、总胆固醇（TC）／高密度脂蛋白胆固醇（HDLC）比值以及合并高血压、糖尿病的比例均高于非脑卒中组,而血压控制满意率、血清白蛋白（Alb）、HDL-C低于非脑卒中组,差异均有统计学意义（P〈0．05）;（2）Logistic回归分析表明,合并糖尿病、SBP、PPI、Alb、TC／HDL-C比值（0分别为1．265、1．032、1．655、0．625和3．087,P〈0．05）是MHD患者并发缺血性脑卒中的危险因素;（3）脑卒中组死亡7例,存活18例,死亡组年龄、透析龄、合并糖尿病的比例高于存活组,血红蛋白、Alb低于存活组,差异均有统计学意义（P〈0．05）。结论MHD患者缺血性脑卒中的发生与高血压、糖脂代谢紊乱、营养不良和炎症状态有关。纠正贫血、改善透析质量以纠正营养不良一炎症状态可能改善透析合并脑卒中患者的预后。     

Association of serum magnesium level with all-cause mortality in maintenance hemodialysis patients

Objective To investigate the association of serum magnesium (Mg) level with all-cause mortality in maintenance hemodialysis patients. Methods A multicenter retrospective cohort study was conducted in seven hemodialysis centers of Guizhou province. The adult outpatients who underwent hemodialysis for more than 3 months were included from June 2015 to June 2016. Demographics, baseline clinical and laboratory test results were collected. All patients were followed up until June 30, 2018. Patients were divided into 4 groups according to their baseline serum Mg levels (interquartile range). Kaplan-Meier method was used to compare the survival rates of the four group. Cox regression model was used to analyze the association of Mg with all-cause mortality. Logistic regression was used to analyze the influencing factors of low Mg level. Results A total of 868 hemodialysis dialysis patients with baseline Mg data were enrolled in this study, with age of (55.47±16.17) years old, among whom 59.4% were male. There were 11 (1.3%) patients with hypomagnesemia (Mg＜0.7 mmol/L), 432(49.8%) patients with hypermagnesemia (Mg＞1.05 mmol/L), and 16(1.8%) patients with Mg＞2.0 mmol/L. Median Mg was 1.05 mmol/L and interquartile range was 0.95-1.24 mmol/L. The comparison between Mg quartile groups showed that the difference in age, hemoglobin, serum albumin, serum calcium, parathyroid hormone (PTH), serum creatinine, uric acid and urea nitrogen was statistically significant (all P＜0.05). After a median follow-up of 24 months, 207 patients died. Kaplan-Meier curves showed higher all-cause mortality in patients with Mg≤0.95 mmol/L (Q1 group) (Log-rank test χ2=15.11, P=0.002). However, after adjusting for age, comorbidities and biochemical indicators(especially albumin), there was no statistically significant difference in the hazard ratio for all-cause death among the four groups. Multiple logistic regression analysis results showed that low serum albumin (OR=0.946, 95%CI 0.913-0.979, P=0.002) and low serum uric acid (OR=0.994, 95%CI 0.992-0.997, P＜0.001) were the risk factors for baseline Mg≤0.95 mmol/L. Conclusions Hypomagnesemia is rare in MHD patients, while hypermagnesemia is more common. Baseline serum Mg≤0.95 mmol/L in MHD patients is correlated with increased risk of all-cause death, but it may be not an independent risk factor. Baseline serum Mg≤0.95 mmol/L that occurred is associated with low levels of albumin and serum uric acid.     

Clinical characteristics and risk factors of infection-related hospitalization in maintenance hemodialysis patients

Objective To explore the clinical characteristics and risk factors of maintenance hemodialysis (MHD) patients combined with infection-related hospitalization. Methods Patients with MHD from December 1, 2013 to February 28, 2018 were retrospectively selected and then followed up for at least 1 year until February 28, 2019. Baseline data including demographic and clinical data of patients were collected. According to whether the infection-related hospitalization occurred, patients were divided into infection group and non-infection group. The clinical characteristics and related factors were compared between the two groups. Logistic regression model was used to analyze the influencing factors. Results A total of 392 patients were included in the study. Two hundred and fifty-five cases were males, accounting for 65.1%. The age was (59.39±15.28) years old. The infection rate of diabetic kidney disease patients was the highest (32.2%). The main site of infection was the lung, accounting for 78.4%, which was far higher than the catheter-related infection in the second position. After infection, quinolones and cephalosporins were often the preferred drugs. Compared with the non-infection group, the infection group had older age [(62.96±15.16) years vs (57.98±15.12) years, t=-2.607, P=0.004], higher proportion of comorbid diabetes (45.9% vs 32.4%, χ2=6.334, P=0.012) and previous smoking history (30.6% vs 18.5%, χ2=6.831, P=0.009), longer time of first dialysis stay [13.0(9.0, 18.0) d vs 12.0(9.0, 17.5) d, Z=3.659, P=0.001] and lower hemoglobin [(74.43±19.93) g/L vs (79.06±17.10) g/L, t=1.612, P=0.022] , albumin [(32.63±5.33) g/L vs (33.99±6.14) g/L, t=2.062, P=0.029] and red blood cell count [2.53×1012/L (2.06×1012/L, 3.06×1012/L) vs 2.68×1012/L(2.28×1012/L, 3.07×1012/L), Z=2.118, P=0.034]. Multivariate logistic analysis found that older age (every 1 year, OR=1.016, 95%CI 1.003-1.030, P=0.017) and longer hospital stay at first dialysis (every 1 d, OR=1.047, 95%CI 1.014-1.080, P=0.008) were independent risk factors, and higher hemoglobin (every 1 g/L, OR=0.987, 95%CI 0.975-0.999, P=0.033) was a protective factor for infection-related hospitalization in MHD patients. Conclusions MHD patients with diabetic kidney disease have the highest infection incidence. The incidence of pulmonary infection is much higher than other types of infection such as catheter-related infection, urinary tract infection and sepsis. Aging and low hemoglobin are risk factors for MHD patients to prone to co-infection.     

Clinical and prognostic analysis of pulmonary hypertension in maintenance hemodialysis patients

Objective To investigate the related factors and prognosis of pulmonary hypertension (PAH) in hemodialysis (HD) patients for early diagnosis and intervention of PAH. Methods A retrospective cohort study was conducted in 183 long?term hemodialysis patients with complete follow?up data from January 1, 2010 to December 30, 2015 from the blood purification center of the Third Affiliated Hospital of Sun Yat?sen University. The follow?up deadline was December 30, 2017, and the endpoints were death and cardiovascular events. The clinical data, laboratory examinations, cardiac color Doppler ultrasound parameters and prognosis of patients with and without PAH were compared. Multivariate logistic regression was used to analyze the risk factors for PAH in HD patients. The survival rates were calculated by Kaplan?Meier method, and the survival curves were compared by Log?rank test between the two groups. A multivariate Cox proportional hazard regression model was used to examine the association between PAH and all?cause mortality in HD patients. Results Of the 183 hemodialysis patients, 79(43.2%) were female, 104(56.8%) were male, and the age was (56.1±16.9) years, of which 72(39.3%) were complicated with PAH. Compared with the non?PAH group, patients in the PAH group was older and had a longer duration of dialysis (both P＜0.05). The left atrial diameter (P=0.002) and the proportion of valvular calcification (P=0.004) were significantly higher in the PAH group than that in the non?PAH group. Logistic regression analysis showed increased age (OR=1.027, 95% CI 1.001-1.053, P=0.041) and increased duration of dialysis (OR=1.129, 95% CI 1.004-1.269, P=0.042) were risk factors for PAH in HD patients. After a median follow?up of 27.8 months, Kaplan?Meier survival analysis showed that all?cause mortality was higher in the PAH group than that in the non?PAH group (χ2=5.636, P=0.018). The main cause of death in two groups was cardiovascular event. After adjusting for age, diabetes mellitus, duration of dialysis, valvular calcification, and hypertension, Cox regression showed that PAH increased the risk of all?cause mortality in HD patients (HR=1.894, 95% CI 1.083-3.313, P=0.025). Conclusions HD patients complicated with PAH are more common and the prognosis is poor. Increased age and increased duration of dialysis may be risk factors for PAH in HD patients. Regular color Doppler echocardiography is helpful for early detection and diagnosis of PAH.     

维持性血液透析患者心脏结构功能的危险因素分析

目的探讨影响维持性血液透析（MHD）患者心脏结构功能的危险因素。方法选择MHD患者153例,超声心动图测定心脏各项指标,并计算左心室心肌重量指数（LVMI）。生存函数乘积限（Kaplan-Meier）分析观察LVMI对患者预后的影响,分析影响LVMI的危险因素关系。结果153例MHD患者中,84例（占55．2％）患者存在左心室肥厚。多元回归结果显示超滤量（UF）和血红蛋白是影响左心室肥厚的独立危险因素。每周3次透析与每周2次透析的患者左心室肥厚的发生率分别为59．3％和52．1％。Kaplan-Meier生存分析显示左心室肥厚患者的5、10和15年生存率分为78．3％、54．3％和36．2％。结论MHD患者存在较高的左心室肥厚发生率,UF、血红蛋白与左心室肥厚相关,预防患者左心室肥厚可能有助于提高患者生存率。     

Relationship between ultrafiltration rate and cardiovascular death in maintenance hemodialysis patients

Objective To investigate the relationship between ultrafiltration rate (UFR) and cardiovascular death in maintenance hemodialysis patients. Methods This retrospective study observed adult hemodialysis patients treated in Kidney Disease Center, the First Affiliated Hospital, College of Medicine, Zhejiang University during January 2010 to December 2015 and the follow-up were finished at April 2017. Patients were averagely divided into 3 groups according to their UFR. Their clinic characteristics were collected, the survival rate and death related factors were analyzed by Kaplan-Meier (Log-rank test) method and Logistic regression. Results Totally 2184 patients (male 1370, 62.7%) were enrolled, the age was 53.39±16.47. The UFR was (8.88±3.05) ml?h-1?kg-1. During the 7 years' follow-up, 168 patients died, of whom 58 cases (34.5%) died due to the cardiovascular events. Chi-square test showed that there were significant differences in death causes among the high, middle and low UFR group (χ2=12.584, P＜0.01), and the mortality rate of cardiovascular events in high UFR group was significantly higher than that in low (χ2=10.861, P= 0.010) and middle UFR group ( χ2=4.671, P=0.031). Kaplan-Meier survival curve showed that the difference of the survival rates in the 3 groups was statistically significant (Log-rank test χ2=23.394, P＜0.001). Cox regression analysis showed that high UFR (UFR≥10.95 ml?h-1?kg-1), old age (＞60 years old), and low left ventricular ejection fraction (LVEF, ≤50%) were independent risk factors of cardiovascular death. Conclusions High UFR level, old age and low LVEF are independent risk factors of cardiovascular death in hemodialysis patients. Maintaining low UFR level is beneficial to reduce cardiovascular mortality in hemodialysis patients.     

Clinical characteristic and correlative factors of maintenance hemodialysis patients with restless legs syndrome

Objective To explore the prevalence and the correlative factors of restless legs syndrome (RLS) in maintenance hemodialysis (MHD) patients. Methods The basic information and clinical laboratory results of 307 MHD patients were collected. The international RLS study group (IRLSSG) diagnostic criteria were applied to assess the presence and the severity of RLS. Binary logistic analysis was used for exploring correlative factors of RLS. Results The prevalence of RLS was 12.1% in the MHD patients, with 73.0% patients having mild-to-moderate symptoms and 83.8% having chronic RLS. There was no significant difference between MHD patients with and without RLS in age, gender, dialysis age, daily urine, Kt/V, history of smoking, drinking, hemoglobin, serum creatinine, urea nitrogen, uric acid, calcium, phosphorus, magnesium, potassium, intact parathyroid hormone (iPTH), prealbumin, albumin and alkaline phosphatase. But the frequency of daily exercise in RLS group is significantly lower than that in non-RLS group (Z=-4.114, P＜0.001). Logistic regression analysis showed that daily exercise was a correlative factor of RLS (B=-2.203, OR=0.111, 95%CI 0.033-0.371, P＜0.001). Conclusions RLS is a common complication in MHD patients, with chronic state and mild-to-moderate symptoms. RLS is correlated with daily exercise, which may be a scientific approach to treat or prevent this disease.     

Multicenter study on the influencing factors of interdialysis blood pressure variability in maintenance hemodialysis patients

Objective To assess the influencing factors of interdialysis blood pressure variability (BPV) in maintenance hemodialysis (MHD) patients from Pearl River Delta, and provide clinically useful information for the prevention and treatment of BPV. Methods MHD patients in 10 hemodialysis centers from Pearl River Delta were enrolled and analyzed retrospectively. According to the quartile of interdialysis systolic blood pressure-coefficient of variation (SBP-CV), patients were divided into four groups, and clinical data, biochemical indicators and drug use were compared among 4 groups. Binary logistic regression analysis was used to analyze the associated factors of interdialysis BPV. Results A total of 1010 MHD patients (612 males and 398 females) with the age of (56.3±13.9) years were enrolled in this study. Their dialysis duration was (48.4±36.1) months, and the median of interdialysis SBP-CV was 8.07% (5.72%, 11.34%). According to the quartile of SBP-CV, the patients were divided into four groups: low BPV group (SBP-CV≤5.72%, 253 cases), middle BPV group (5.72%＜SBP-CV≤8.07%, 252 cases), high BPV group (8.07%＜SBP-CV≤11.34%, 253 cases) and extremely high BPV group (SBP-CV＞11.34%, 252 cases), and the dialysis duration, diabetes, ultrafiltration, interdialysis weight gain rate (IDWGR), serum calcium and the proportion of calcium channel antagonist used in the 4 groups were significantly different (all P＜0.05). Logistic multiple regression analysis showed that high IDWGR (OR=1.216, 95%CI 1.108-1.435, P＜0.001) was an independent risk factors for interdialysis BPV in MHD patients, while high ultrafiltration volume (OR=0.436, 95%CI 0.330-0.575, P＜0.001) and calcium channel antagonists used (OR=0.686, 95%CI 0.477-0.986, P=0.042) were independent protective factors. Conclusion High IDWGR is an independent risk factor for interdialysis BPV in MHD patients, while high ultrafiltration volume and calcium channel antagonists used are protective factors for interdialysis BPV in MHD patients.     

Association of intradialytic hypotension and 5-year mortality in maintaining hemodialysis patients

Objective To assess the risk factors of intradialytic-hypotension (IDH) and the prognosis of IDH among maintenance hemodialysis (MHD) patients for the prevention and treatment of IDH. Methods 276 MHD patients were enrolled during Jan. 2009 to Mar. 2009. Intradialytic blood pressure was monitored during a 3-month period. IDH was defined as an event characterized by a sudden drop in systolic BP more than 20 mmHg or in mean artery pressure (MAP) more than 10 mmHg associated with clinical events and need for interventions. Dialysis-related information was collected. Kaplan-Meier method, log-rank test, logistic regression and Cox regression analyses were performed to examine the association between IDH and survival, using a follow-up through 31 May 2014. Results A total of 276 patients were recruited. The incidence rate of IDH was 40.9%. 163 patients with no-IDH (＜1/10 hypotensive events/3 months) served as controls. 113 patients with IDH (≥1/10 hypotensive events/3 months) were identified among all 276 patients. Multivariate logistic regression analysis showed that age, ultrafiltration rate, gender, serum NT-proBNP, serum albumin and aortic rool inside dimension (AoRD) were associated with IDH among MHD patients. During the 5-year follow-up, 74 patients died, with a mortality rate 5.2 per 100 person-year. Kaplan-Meier survival curve showed significant difference of overall and CV mortality rates between 2 groups. The multivariate Cox regression model indicated that IDH increased the risk of death (HR=1.572, 95%CI 1.077-2.293, P=0.019). So did the rise of LVMI (HR=1.010, 95%CI 1.009-1.085, P=0.020). Conclusion Elderly, female, high ultrafiltration rate, high level of serum NT-proBNP, hypoalbuminemia and shorter AoRD are independent risk factors for IDH among MHD patients. LVMI can predict the outcome of MHD patients. Intradialytic hypotension is an independent risk factor for long-term mortality in MHD patients.     

Analysis of post-dialysis fatigue in maintenance hemodialysis patients

Objective To analysis the post-dialysis fatigue status of maintenance hemodialysis patients, explore the influencing factors in these patients and propose effective interventions. Methods One hundred and twenty maintenance hemodialysis patients in Department of Nephrology, Second Affiliated Hospital of Nanjing Medical University were enrolled. Clinical data were obtained by questionnaires. Biochemical changes before and post hemodialysis were recorded. The serum concentrations of hemoglobin, albumin, electrolyte, bicarbonate and lactic acid were collected for analysis. Results One hundred and nine (90.8%) effective questionnaires were collected, in which more than half of patients claimed to experience post-dialysis fatigue. Time to recover from hemodialysis (TIRD) was different: the median (interquartile range) time was 2.00(0.00, 3.00) hours. In the study, 30.3% patients reported no fatigue after hemodialysis. Recovery time in 35.8% patients was more than 30 minutes to 2 hours, 22.0% was 3 to 4 hours, 11.0% was 5 to 12 hours, 0.9% patients took longer time to recover from a dialysis session. According to the recovery time, these patients were divided into three groups. Among the three groups, the ultrafiltration, the serum sodium and lactic acid after dialysis showed significant difference. It was showed by the unconditional logistic regression analysis that ultrafiltration (OR=2.35, 95%CI 1.44-3.83), serum sodium (OR=0.75, 95%CI 0.65-0.88) , lactic acid (OR=3.16, 95%CI 1.32-7.55) were associated of TIRD. Conclusions The incidence of post-dialysis fatigue is high. Most of the patients require more rest or sleep immediately after dialysis. The level of lactic acid is a significant influencing factor of the fatigue of patients. TIRD is correlated with the elevation of lactic acid during the dialysis process, and more attention should be paid to post-dialysis fatigue.     

急性卒中后肺炎的危险因素分析

目的探讨急性卒中后肺炎的独立危险因素。方法对2009年7月1日-2011年6月30日在上海交通大学附属第一人民医院和同济大学附属东方医院住院治疗的545例急性卒中患者进行肺炎发生的相关危险因素分析。先做单因素分析,筛选出影响急性卒中后肺炎发生的相关危险因素。根据单因素分析结果及相关专业知识,拟合多因素非条件Logistic回归模型,调整相关的混杂因子,找出影响急性卒中后肺炎发生的独立危险因素。结果急性卒中后肺炎的发生率为11．0％（60／545）。年龄≥80岁（OR=6．024,95％CI：1．923～18．868,P=0．002）、出血性卒中（OR=3．546,95％CI：1．266～9．901,P=0．016）、卧床（OR=4．295,95％C1：1．642～11．233,P=0．003）、基线Glasgow昏迷量表48分（OR=5．127,95％CI：1．377～19．090,P=0．015）、基线Ba~hel指数〈50分（OR=8．403,95％CI：1．468～47．619,P=0．017）、营养不良（OR=10．625,95％CI：3．260～34．631,P=0．000）和基线空腹血糖≥7．0mmol／L（OR=10．000,95％CI：3．115～32．258,P=0．000）为急性卒中后肺炎的独立危险因素,而早期康复治疗是急性卒中后肺炎的保护因素（OR=0．159,95％CI：0．055～0．466,P=0．001）。结论急性卒中后肺炎发生率高,危险因素多,采取综合性干预措施有助于早期识别及防治惫件卒中后肺炎．     

鲑鱼降钙素对维持性血液透析患者并发高钙血症的疗效观察

目的观察鲑鱼降钙素治疗维持性血液透析（MHD）患者并发高钙血症的疗效。方法对28例MHD患者合并高钙血症者给予鲑鱼降钙素肌肉注射,开始每天1次,连续6d,以后每周2次,透析后使用。疗程12周。以用药前和用药后第2、4、8、12周检测血钙、血磷、钙磷乘积和血全段甲状旁腺素（iPTH）为指标,应用视觉模拟疼痛评分法对骨关节疼痛程度进行定量,并进行统计学分析。结果25例完成观察。治疗后第4周血钙、钙磷乘积均有不同程度降低,与治疗前比较有统计学意义（P〈0．05）;血磷和iPTH也有降低,但与治疗前比较差异无显著性。治疗后第4周,所有患者骨关节疼痛、活动障碍等症状均有不同程度缓解;疗程结束后23例症状基本消失,但治疗前已发生的转移性钙化等现象无变化。结论鲑鱼降钙素治疗MHD患者并发高钙血症,可以有效降低高血钙、钙磷乘积,并能够有效缓解骨关节疼痛症状,近期疗效显著。     

维持性血液透析患者冠心病介入治疗

目的探讨维持性血液透析患者合并冠心病心脏介入治疗的安全性和可行性。方法回顾性分析本院7例血液透析合并冠心病患者在强化透析的基础上应用非离子型低渗造影剂行冠状动脉造影术＋支架植入术的临床资料。结果单支病变3例,多支病变4例,行经皮腔内冠状动脉成形术（PTCA）置放支架1～2个。死亡3例,病情改善4例。此4例术后心绞痛症状改善,肾功能无进一步恶化。结论血液透析患者中合并不稳定心绞痛患者可考虑冠状动脉介入治疗,疗效较好,但对于同时有心肌酶谱升高者预后不良。     

维持性血液透析患者并发真菌感染的危险因素及耐药性分析

目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者并发真菌感染的菌群分布特点、药敏特点以及发生真菌感染的危险因素,为积极预防,临床合理用药提供依据.方法 选取我院肾脏内科2018年1月至2020年3月收治的495例MHD患者为研究对象,根据院内真菌感染的诊断标准,将发生真菌感染的7...     

Clinical significance of neutrophil-lymphocyte ratio in maintenance hemodialysis patients

Objective To explore how neutrophil-lymphocyte ratio (NLR) is related with inflammation and atherosclerosis, and the role of NLR in hospitalization in maintenance hemodialysis (MHD) patients. Methods MHD patients treated in hemodialysis center of Sichuan Provincial People's Hospital from June till November 2013 were enrolled. Patients with severe infection, cardiovascular events and malignant carcinoma were excluded. NLR was determined from complete blood count differential. Clinical parameters such as serum albumin, lipids, intact parathormone, ferritin, C-reactive protein (CRP), 25-(OH) vitamin D, interleukin-6 (IL-6) and alkaline phosphatase (ALP) were collected. Pulse wave velocity (PWV) and ankle-brachial index (ABI) were used to evaluate the arterial stiffness. Spearman analysis was used to evaluate the relationship between NLR and these parameters. All patients were divided into low NLR group (NLR≤3.25) and high NLR group (NLR＞3.25) on the median NLR, and their differences in these indexes were analyzed. During the one-year follow-up, the reasons and rates of hospitalization and survival were analyzed. Results One hundred and thirteen MHD patients including 58 males and 55 females were enrolled with (69±49) dialysis age and (54±15) average age. (1) The NLR was significantly correlated with whole blood count (WBC, r=0.538, P＜0.001), ABIL (r=0.201, P=0.033), ABIR (r=0.235, P=0.012) and total cholesterol (TC, r=-0.414, P＜0.001) and low-density lipoprotein cholesterol (LDL-C, r=-0.378, P＜0.001). (2) Low NLR patients had increased TC, LDL-C and IL-6 as compare with high NLR patients, however decreased ABIL and ABIR (all P＜0.05). (3) Forty one patients were hospitalized 63 times during the follow-up period. Annual hospitalization rate was 558/1000 and the mortality rate was 17.7/1000. (4) NLR in patients at least hospitalized once a year was significantly lower than in patients without hospitalization, while ALP was higher (all P＜0.05). Compared with those in other patients, NLR and hemoglobin (Hb) were significantly lower in patients with hospitalization due to infection, while ALP was higher (all P＜0.05). Conclusions NLR is related with WBC, ABI, TC and LDL-C in MHD patients. Lower NLR may indicate high risk for cardiovascular, atherosclerosis and hospitalization, probably different form non-MHD patients, which needs more studies to verify.     

Incidence of cognitive impairment and risk factors associated with prognosis in maintenance hemodialysis patients

Objective To investigate the incidence and prognosis of cognitive impairment and to find out the risk factors associated with the outcome for better understanding and preventing cognitive impairment in maintenance hemodialysis (MHD) patients. Methods The patients who met the criteria as below: MHD patients (≥3 months) in Renji Hospital, Shanghai Jiao Tong University School of Medicine from January 2000 to July 2014, ≥18 years old were enrolled and could carry on the montreal cognitive assessment (MoCA) of voluntary cooperation. According to the score of MoCA, all enrolled patients were divided into two groups: cognitive impairment (MoCA＜26) group and non-cognitive impairment (MoCA≥26) group. The follow-up period was 3 years. There were 130 males, and the incidence, demography data, medical history, hemodialysis data, laboratory examination and prognosis of cognitive impairment in hemodialysis patients were prospectively compared and analyzed. Logistic regression analysis was used to investigate the risk factors of cognitive impairment. Kaplan-Meier survival curve and Cox regression model were used for prognostic analysis. Results A total of 219 MHD patients were enrolled. The incidence of cognitive impairment in MHD patients was 51.6%. There were 130 males, and the ratio of male to female was 1.46∶1. Age was (60.07±12.44) years old and dialysis vintage was (100.79±70.23) months. Compared with non-cognitive impairment group (n=106), patients in cognitive impairment group (n=113) were older, and had higher proportion of education status＜12 years, history of diabetes and anuria (all P＜0.05); however, the post-dialysis systolic pressure, pre-dialysis diastolic pressure, post-dialysis diastolic pressure, platelet and spKt/V were lower (all P＜0.05). Multivariate logistic regression analysis showed that education status＜12 years (OR=3.428, 95%CI 1.919-6.125, P＜0.001), post-dialysis diastolic pressure＜73 mmHg (OR=2.234, 95%CI 1.253-3.984, P=0.006) and spKt/V＜1.72(OR=1.982, 95%CI 1.102-3.564, P=0.022) were the independent risk factors for cognitive impairment in MHD patients. The Kaplan-Meier survival curve analysis showed that the survival rate of patients with cognitive impairment was lower than that of non-cognitive impairment group in MHD patients during 3 years follow-up (χ2=3.977, P=0.046). Multivariate Cox regression analysis showed that cognitive impairment was an independent risk factor for death in MHD patients (RR=2.661, 95%CI 0.967-7.321, P=0.058). Conclusions Cognitive impairment is one of the common complications and an independent risk factor for death in MHD patients. The mortality is high in patients who suffer cognitive impairment. Education status ＜12 years, post-dialysis diastolic pressure＜73 mmHg and spKt/V＜1.72 are the independent risk factors for cognitive impairment in MHD patients.     

维持性血液透析患者结核感染的早期诊断方法比较

目的 探讨维持性血液透析患者早期结核感染的检测方法.方法 纳入维持性血液透析患者64例,对所有患者采用结核菌素皮肤试验（TST）、结核感染T细胞斑点试验（T-SPOT.TB）和结核分枝杆菌抗体3种检测方法进行检测,并结合临床资料分为结核感染组（8例）、潜伏结核感染组（32例）及非结核感染组（24例）,比较3种方法对血液透析患者早期结核感染的检测效果.结果 在结核感染组中,T-SPOT.TB检测诊断结核性疾病的敏感性为87.5％（7/8）;在潜伏结核感染组中,T-SPOT.TB敏感性为87.5％（28/32）,TST敏感性为46.9％（15/32）,结核分枝杆菌抗体阳性敏感性为40.6％ （13/32）,T-SPOT.TB与TST及结核分枝杆菌抗体间比较差异有统计学意义（T-SPOT.TB比结核分枝杆菌抗体：OR=10.2,95％ CI 2.9～ 36.2,P=0.001;T-SPOT.TB比TST：OR=7.0,95％ CI 2.0～24.6,P=0.003）.TST与结核分枝杆菌抗体比较差异无统计学意义.在非结核感染组中T-SPOT.TB和TST特异性高,均为100％,结核分枝杆菌抗体检查特异性为58.3％ （14/24）,前两者与结核分枝杆菌抗体的特异性差异有统计学意义（P=0.001）.结论 T-SPOT.TB对维持性血液透析患者早期结核感染检测敏感性和特异性最好.     

3种透析方式对于维持性血液透析患者难治性高血压的疗效观察

目的观察血液透析、血液透析并滤过和血液透析＋血液透析并滤过3种血液净化治疗方法对维持性血液透析患者难治性高血压的临床疗效。方法将60例维持性血液透析患者随机分为3组,即血液透析组、血液透析并滤过组和血液透析＋血液透析并滤过组各20例。血液透析组每周行血液透析治疗3次;血液透析并滤过组每周行血液透析并滤过治疗3次;血液透析＋血液透析并滤过组每周行血液透析治疗2次,血液透析并滤过治疗1次。观察治疗4周和8周后血压的变化。结果血液透析组治疗4周和8周后和治疗前相比,患者血压差异无统计学意义（P〉0．05）;血液透析并滤过组和血液透析＋血液透析并滤过组中,治疗4周后两组血压都较本组治疗前明显下降（P〈0．05）;但两组间比较,差异均无统计学意义（P〉0．05）;治疗8周与治疗4周时相比,两组患者血压均基本保持稳定,没有明显进一步下降,差异无统计学意义（P〉0．05）。结论血液透析＋血液透析并滤过及血液透析并滤过两种血液净化方式均可以有效改善血液透析患者难治性高血压,而且血液透析＋血液透析并滤过比血液透析并滤过方式更为经济。     

维持性血液透析患者外周动脉疾病及危险因素分析

目的通过测量踝肱指数调查维持性血液透析患者下肢外周动脉疾病的患病率及危险因素。方法纳入我院血液净化中心179例维持性血液透析患者,对其进行问卷、体格检查、实验室检查及踝肱指数测量。以任何一侧踝肱指数〈0．90作为下肢外周动脉疾病的诊断标准,分析其患病率及危险因素。结果我院血液净化中心下肢外周动脉疾病的患病率为12．8％（23／179）,男女患病率无差异。年龄大于65岁患者外周动脉疾病患病率为18．9％,低于65岁患者为8．6％。高三酰甘油血症患者外周动脉疾病患病率为18．7％,非高三酰甘油血症患者为7．7％。有脑血管疾病患者比无脑血管疾病患者外周动脉疾病患病率高（33．3％：11．3％,P〈0．05）。Logistic分析显示,年龄（优势比为1．036-1．276,P=0．009）、慢性肾脏病病程（优势比1．003～1．018,P=0．007）、脑血管疾病（优势比2-202．19,P=0．011）为外周动脉疾病的独立危险因素。结论维持性血液透析患者外周血管疾病患病率较高,年龄、慢性肾脏病病程及脑血管疾病史为此人群外周血管疾病的独立危险因素。     

维持性血液透析患者发生急性冠脉综合征的危险因素分析

目的 探讨影响维持性血液透析患者发生急性冠脉综合征（ACS）的危险因素。方法 回顾性分析2015年3月至2018年4月在河北省承德市中心医院和滦平县中医院血液净化中心行维持性血液透析的175例患者的临床资料,根据是否发生ACS分成两组,其中发生ACS患者57例（ACS组）,未发生ACS的118例（非ACS组）。收集患者的性别、年龄、肾衰竭的基础疾病、透析龄、发生ACS前1个月的收缩压、舒张压、脱水量及发生ACS时的血红蛋白（Hb)、C反应蛋白(CRP)、甲状旁腺素(PTH)、血白蛋白(ALB)、血脂、血尿酸(UA)、肺动脉压(PH)等指标进行比较分析;应用多因素的logistic回归分析导致ACS的危险因素。结果 ACS组的男性居多[38例（66.67%）],而房颤病史、透析前的收缩压和舒张压、超流量、红细胞分布宽度（RDW）、血钾（K⁺）低于非ACS组,ALB高于非ACS组,差异均有统计学意义（均P<0.05）。二元logistic回归分析显示：透析前的收缩压≥160 mmHg（OR=3.240,95%CI：1.255～5.367,P<0.05）和超流量≥3 500 mL/次（OR=2.797,95%CI：1.033～4.574,P<0.05）是影响维持性血液透析患者发生ACS的相关影响因素。结论 透析前血压控制不良（收缩压≥160 mmHg）、超流量过大（超流量≥3 500 mL/次）使维持性血液透析患者发生ACS的风险增加。