Mediating role of social support in dysphoria,despondency,and quality of life in patients undergoing maintenance hemodialysis

BACKGROUND Dysphoria and despondency are prevalent psychological issues in patients undergoing Maintenance Hemodialysis(MHD)that significantly affect their quality of life(QOL).High levels of social support can significantly improve the physical and mental well-being of patients undergoing MHD.Currently,there is limited research on how social support mediates the relationship between dysphoria,despondency,and overall QOL in patients undergoing MHD.It is imperative to investigate this mediating effect to mitigate dysphoria and despondency in patients undergoing MHD,ultimately enhancing their overall QOL.AIM To investigate the mediating role of social support in relationships between dysphoria,despondency,and QOL among patients undergoing MHD.METHODS Participants comprised 289 patients undergoing MHD,who were selected using a random sampling approach.The Social Support Rating Scale,Self-Rating Anxiety Scale,Self-Rating Depression Scale,and QOL Scale were administered.Correlation analysis was performed to examine the associations between social support,dysphoria,despondency,and QOL in patients undergoing MHD.To assess the mediating impact of social support on dysphoria,despondency,and QOL in patients undergoing MHD,a bootstrap method was applied.RESULTS Significant correlations among social support,dysphoria,despondency,and quality in patients undergoing MHD were observed(all P<0.01).Dysphoria and despondency negatively correlated with social support and QOL(P<0.01).Dysphoria and despondency had negative predictive impacts on the QOL of patients undergoing MHD(P<0.05).The direct effect of dysphoria on QOL was statistically significant(P<0.05).Social support mediated the relationship between dysphoria and QOL,and this mediating effect was significant(P<0.05).Similarly,the direct effect of despondency on QOL was significant(P<0.05).Moreover,social support played a mediating role between despondency and QOL,with a significant mediating effect(P<0.05).CONCLUSION These findings suggest that social support plays a significant mediating role in the relationship between dysphoria,despondency,and QOL in patients undergoing MHD.

Analysis of current status of and barriers to exercise participation among patients on maintenance hemodialysis

Objective:The objective of this study was to analyze the current status of barriers to exercise participation(EP)among patients on maintenance hemodialysis(MHD).Materials and Methods:A cross-sectional study was conducted on 277 outpatients undergoing MHD in 2 tertiary first-class hospitals in Beijing from February 2023 to June 2023 who were selected using convenience sampling method.The data of patients on MHD were collected using the general information questionnaire,Physical Activity Rating Scale,Exercise Benefits/Barriers Scale(EBBS),and Exercise Self-Efficacy Scale(ESES).The relationship between EP and barriers to EP was analyzed through univariate and multivariate linear regression models.Results:Patients on MHD had a low exercise volume score of 13.71±0.68 points and a medium EBBS score of 63.36±0.40 points.Multivariate logistic analysis showed that exercise volume was significantly related to the following four aspects,including low monthly household income per capita(odds ratio[OR]=86.741,95%confidence interval[CI][1.164-6.465],P=0.042),primary underlying disease of diabetic nephropathy(OR=45.993,95%CI[1.353-1.564],P=0.033),the belief that“fatigue in lower extremities hinders exercise”(OR=4.697,95%CI[1.127-19.585],P=0.034),and the belief that“physical exercise bringing optimistic and positive life attitude”(OR=0.074,95%CI[0.007-0.830],P=0.035).Conclusions:Since patients on MHD had low physical exercise volume,the health-care provider should pay more attention on the controllable factors that affect the EP of patients on MHD.Therefore,feasible and effective intervention measures can be formulated based on ESES in clinical nursing.

Construction and verification of a model for predicting fall risk in patients with maintenance hemodialysis

Objective:To construct a risk prediction model for fall in patients with maintenance hemodialysis(MHD)and to verify the prediction effect of the model.Methods:From June 2020 to December 2020,307 patients who underwent MHD in a tertiary hospital in Chengdu were divided into a fall group(32 cases)and a non-fall group(275 cases).Logistic regression analysis model was used to establish the influencing factors of the subjects.Hosmer–Lemeshow and receiver operating characteristic(ROC)curve were used to test the goodness of fit and predictive effect of the model,and 104 patients were again included in the application research of the model.Results:The risk factors for fall were history of falls in the past year(OR=3.951),dialysis-related hypotension(OR=6.949),time up and go(TUG)test(OR=4.630),serum albumin(OR=0.661),frailty(OR=7.770),and fasting blood glucose(OR=1.141).Hosmer–Lemeshow test was P=0.475;the area under the ROC curve was 0.907;the Youden index was 0.642;the sensitivity was 0.843;and the specificity was 0.799.Conclusions:The risk prediction model constructed in this study has a good effect and can provide references for clinical screening of fall risks in patients with MHD.

The Effect of Seated Baduanjin Exercise on Psychological State, Fatigue Symptoms, and Quality of Life in Maintenance Hemodialysis Patients

Objective:To evaluate the intervention effects of seated Baduanjin exercise on patients undergoing maintenance hemodialysis(MHD).Methods:A total of 108 MHD patients admitted between July 2022 and July 2023 were selected.They were randomly assigned into two groups:the experimental group,with 55 patients,who received seated Baduanjin exercise combined with leg exercises during dialysis;and the control group,with 53 patients,who only performed leg exercises during dialysis.The psychological state,fatigue symptoms,quality of life,and sleep quality scores were compared between the two groups,and exercise endurance was recorded.Results:After the intervention,the psychological state scores in the experimental group were lower than those in the control group,the fatigue symptom scores were lower,the quality of life scores were higher,the sleep quality scores were lower,and the exercise endurance was higher(P<0.05).Conclusion:Seated Baduanjin exercise can improve the negative psychological state and fatigue symptoms of MHD patients,enhance their quality of life and sleep quality,and effectively increase their exercise endurance.

Evaluation of the Application Effect of Psychological Nursing Intervention on Maintenance Hemodialysis Patients with Uremia

Objective:To evaluate the application effect of psychological nursing intervention on maintenance hemodialysis(MHD)patients with uremia.Methods:Sixty cases of uremic patients admitted to the hospital between May 2023 and May 2024 were selected for MHD treatment and divided using the random number table method into 30 cases in each group.The observation group implemented psychological nursing intervention,while the reference group received conventional nursing intervention,after which the nursing effects were compared.Results:After nursing,the psychological state score of the observation group was lower than that of the reference group;the treatment compliance of the observation group was higher than that of the reference group;the self-care ability score of the observation group was higher than that of the reference group,and the quality-of-life score of the observation group was higher than that of the reference group(P<0.05).Conclusion:Psychological nursing intervention for uremic MHD patients can improve their negative psychology,enhance treatment compliance,and comprehensively improve patients’self-care ability and quality of life.

Effect of Jianpi Wenshen Granules on the Nutritional Control Status Score in Elderly Patients Undergoing Maintenance Hemodialysis

Objective:To explore the effect of Jianpi Wenshen Granules on the Controlling Nutritional Status(CONUT)score in elderly patients undergoing maintenance hemodialysis.Methods:Seventy elderly outpatients undergoing maintenance hemodialysis from January 2023 to January 2024 at the Blood Purification Centers of Taizhou Traditional Chinese Medicine Hospital and Taizhou Second People’s Hospital were selected as the study subjects.The patients were randomly divided into two groups:the study group and the control group,with 35 patients in each group.Both groups received maintenance hemodialysis,while the control group received only conventional Western medicine treatment,and the study group was additionally treated with Jianpi Wenshen Granules.The changes in biochemical and inflammatory markers before and after treatment were compared between the two groups.The nutritional status of the patients was assessed using the Controlling Nutritional Status(CONUT)score,and detailed statistics were gathered on anemia and albumin levels in both groups.Results:After treatment,the CONUT score in the study group significantly decreased compared to the control group,showing a significant correlation(P<0.05).Albumin and hemoglobin levels significantly increased,with a notable difference(P<0.05).There were no significant differences in alanine aminotransferase and aspartate aminotransferase levels between the two groups before and after treatment(P>0.05).Conclusion:In elderly patients undergoing maintenance hemodialysis,Jianpi Wenshen Granules improve the CONUT score and enhance nutritional status,demonstrating potential for clinical application and promotion.

Meta analysis on the effectiveness of auricular therapy combined with modern medicine in the treatment of depression/anxiety disorders in maintenance hemodialysis patients

Objective:We used meta-analysis to explore the clinical efficacy of auricular point therapy combined with modern medicine in improving depression/anxiety in maintenance hemodialysis patients.Methods:We searched CNKI,Wanfang,Weipu,CBM,The Cochrane Library,PubMed,Web of Science,Embase through computer to build a randomized controlled trials of auricular therapy combined with modern medicine in the treatment of depression/anxiety disorders in China and abroad since 2022.Two evaluators independently screened the studies,extracted and cross-checked the key data in the studies independently after determining the included studies,and then evaluated the quality of the studies respectively.Finally,we used RevMan 5.3 platform for statistical processing of data.Results:This meta-analysis included a total of 12 clinical randomized controlled trials,including a total of 899 patients.The results showed that the observation group was more effective in reducing the scores of Hamilton Anxiety Scale,self rating Anxiety Scale,self rating Depression Scale,Pittsburgh sleep quality index score of maintenance hemodialysis patients.In addition,there was no statistical difference between the observation group and the control group in improving the total clinical effective rate.Conclusion:The observation group has a more obvious effect on the improvement of anxiety or depression in maintenance hemodialysis patients.However,due to the limitation of the quantity and quality of the included studies,the real efficacy of auricular therapy combined with modern medicine in improving anxiety or depression disorder after maintenance hemodialysis still needs to be supported by more carefully designed and standardized multi-center,large-sample clinical studies.

Association between serum cartilage oligomeric matrix protein and coronary artery calcification in maintenance hemodialysis patients

Background Coronary artery calcification(CAC)is common in end-stage renal disease(ESRD)patients,and the extent of CAC is closely related to cardiovascular outcomes in ESRD patients.Cartilage oligomeric matrix protein(COMP),as a component of the vascular matrix,has been found to be an inhibitor of arterial calcification in basic studies.However,there is no clinical research on the correlation between COMP and CAC in maintenance hemodialysis(MHD)patients.The aim of this study was to explore the relationship between serum COMP levels and CAC and cardiovascular events in MHD patients.Methods Serum COMP levels were compared between 54 MHD patients and 66 healthy people.MHD patients were then divided into three groups according to the tertiles of the concentration of COMP level and were followed up for major adverse cardiac events(MACEs),which were defined as a combined end point of new onset angina pectoris,nonfatal myocardial infarction,heart failure,coronary artery revascularization,hospitalization due to angina pectoris and all-cause deaths.The CAC score was calculated based on computed tomography scans.Results The serum COMP level in MHD patients was significantly higher than that in the general population[984.23(248.43-1902.61)ng/mL vs.219.01(97.26-821.92)ng/mL,P<0.01].Serum COMP levels were positively correlated with CAC(r=0.313,P=0.021)and serum parathyroid hormone in MHD patients(r=0.359,P<0.01).Linear regression suggested that after adjusting for age,fasting blood glucose(Glu)and glycosylated hemoglobin(HbAlc),CAC score was an independent predictor in the final model for COMP level(β=0.424,t=3.130,P<0.01).The receiver operating characteristic(ROC)curve showed that COMP≥994 mg/mL had 68.0%sensitivity and 72.4%specificity for the prediction of severe CAC[area under the curve(AUC):0.674,P=0.030,95%CI:0.526-0.882].After a median follow-up of 16 months(8-24 months),there was no difference in the incidence rate of MACEs between the upper,middle and lower serum COMP groups.Conclusions Our study found that MHD patients have higher levels of circulating COMP than controls.The serum COMP level is positively correlated with CAC score and could be used as a biomarker of severe CAC in MHD patients.However,there is no obvious correlation between serum COMP levels and the incidence of cardiovascular events.

Effects of Lanthanum Carbonate on Vascular Calcification in Elderly Maintenance Hemodialysis Patients

Summary： The effect of lanthanum carbonate on abdominal aortic calcification （AAC） in the elderly maintenance hemodialysis （MHD） patients was investigated. Fifty-four cases subjected to routine MHD complicated with skin pruritus admitted to our hospital were selected and randomly divided into case group （n=28） and control group （n=26）. The control group was given routine MHD alone. The case group was given lanthanum carbonate additionally on the basis of routine MHD. The changes of itching degrees at first and third month, and serum calcium, phosphorus, calcium-phosphorus products, intact parathyroid hormone （iPTH） levels and AAC scores at third month after treatments were compared be- tween the two groups. The correlation between calcium-phosphorus products and AAC scores was also analyzed. There was no significant difference in the baseline of blood urea nitrogen （BUN）, serum creatinine （Scr）, uric acid, albumin, hemoglobin, C reactive protein （CRP）, low density lipoprotein （LDL）, high density lipoprotein （HDL）, triglyceride, total cholesterol between case group and control group （P〉0.05 for all）. There was also no significant difference in the baseline itching scores between the case group and the control group （P〉0.05）. At 1st and 3rd month after treatment, the itching scores in the case group were 14.2±3.2 and 10.5±2.3, respectively, which were significantly lower than the baseline and those in the control group （P〈0.05 for all）. At 1 st and 3rd month after treatment, the itching scores in the control group were 23.6v5.9 and 24.8±6.3, respectively, which were significantly higher than the baseline （P〈0.05）. There was no significant difference in the baseline of serum calcium, phos- phorus, calcium-phosphorus products, iPTH levels between the case group and control group （P〉0.05）. At 3rd month after treatment, serum phosphorus, calcium-phosphorus products and iPTH levels in the case group were decreased significantly as compared with the baseline （P〈0.05）, and the serum calcium, phosphorus, calcium-phosphorus products, and iPTH levels were statistically decreased as compared with those in the control group （P〈0.05）. The AAC scores showed statistically significant difference between the case group and the control group （P〈0.05）. The serum phosphorus and AAC scores showed a positive correlation in both two groups. It was suggested that the administration of lanthanum carbon- ate in the elderly MHD patients can effectively relieve itching, and simultaneously reduce serum phos- phorus and iPTH levels, resulting in the attenuation of vascular calcification.

Current status and influencing factors of post-traumatic growth in maintenance hemodialysis

Objective:To study the post-traumatic growth level and influencing factors in patients with maintenance hemodialysis.Methods:A total of 179 patients receiving maintenance hemodialysis from a third-level grade A hospital in Tianjin,China were investigated using Post-traumatic Growth Inventory(PTGI),Perceived Social Support Scale,and Medical Coping Modes Questionnaire.Results:The total score for the PTGI was 53.73±16.45.Multiple linear regression analysis showed that social support,coping style,marital status,and family income significantly influenced the post-traumatic growth level in patients undergoing maintenance hemodialysis.These factors explained 41.4%of the variance.Conclusion:Medical staff should help patients under maintenance hemodialysis to fulfill their potentials by boosting the level of social support and to effectively cope with internal conflicts.In addition,nursing staff should provide relevant psychological health education to patients to improve their post-traumatic growth.

The effect of Levocarnitine on nutritional status and lipid metabolism during long-term maintenance hemodialysis

Objective To investigate the effect of Levocarnitine on lipid metabolism and nutritional status of maintenance hemodialysis(MHD)patients and possible mechanism.Methods A total of 40 MHD patients [mean age(53.5±7.1)years] who underwent normal hemodialysis more than 6 months were randomly classified into two groups,Levocarnitine supplemented group(LS-G)(n=20;Levocarnitine supplementation after each normal hemodialysis session,at a dose of 1.0 g/day by intravenous administration)and control group(C-G)(n=20;normal hemodialysis).Before treatment,one month and three months after treatment we respectively measured or observed the following items,the tolerance to hemodialysis,carnitine level in plasma,C-reactive protein,IL-6,TNF-α,percentage of neutrophil,and some relevant nutritional parameters,such as lipid profile,transferrin,total protein,albumin and prealbumin levels.Comparative analysis was conducted between the two groups.Results In LS-G three months after treatment,the levels of carnitine,hemoglobin,and prealbumin in plasma were significantly increased(P<0.05),but C-reactive protein,neutrophil percentage,low-density lipoprotein and triglyceride were significantly decreased(P<0.05)in contrast to those in C-G and before treatment.Transferrin,total protein,and albumin were elevated in LS-G,with no statistical significance.Conclusion There was a significant improvement of lipid metabolism and nutritional status for the long-term maintenance hemodialysis patients with Levocarnitine supplementation.And this improvement is related to the decrease of inflammatory factors.

Mortality rate of COVID-19 infection in end stage kidney disease patients on maintenance hemodialysis:A systematic review and meta-analysis

BACKGROUND Coronavirus disease 2019(COVID-19)has been the most talked-about disease of the past few years.Patients with significant comorbidities have been at particular risk of adverse outcomes.This study looked at the outcomes and risk factors for adverse outcomes among patients on chronic hemodialysis for end-stage renal disease,a group of patients known to be particularly susceptible to infectious complications.AIM To assess outcomes and risk factors for adverse outcomes of COVID-19 infection among patients on chronic hemodialysis.METHODS We searched PubMed/MEDLINE,EMBASE,Reference Citation Analysis(https://www.referencecitationanalysis.com/)and Web of Science databases for relevant terms and imported the results into the Covidence platform.From there,studies were assessed in two stages for relevance and quality,and data from studies that satisfied all the requirements were extracted into a spreadsheet.The data was then analyzed descriptively and statistically.RESULTS Of the 920 studies identified through the initial database search,only 17 were included in the final analysis.The studies included in the analysis were mostly carried out during the first wave.We found that COVID-19 incidence among patients on hemodialysis was significant,over 10%in some studies.Those who developed COVID-19 infection were most likely going to be hospitalized,and over 1 in 5 died from the infection.Intensive care unit admission rate was lower than the infection lethality rate.Biochemical abnormalities and dyspnea were generally reported to be associated with adverse outcomes.CONCLUSION This systematic review confirms that patients on chronic hemodialysis are very high-risk individuals for COVID-19 infections,and a significant proportion was infected during the first wave.Their prognosis is overall much worse than in the general population,and every effort needs to be made to decrease their exposure.

Occult hepatitis C virus infection is more common than hepatitis B infection in maintenance hemodialysis patients

Patients of end stage renal disease on maintenance hemodialysis were enrolled to study the prevalence of occult and dual hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and non-occult hepatitis B and C virus infection. One hundred and two patients were enrolled. Thirty patients had HCV infection, three of them were positive in anti-HCV. So, 27 (90%) of HCV-positive patients had occult HCV infection. Eleven (11%) patients had HBV infection. Five patients were positive in anti-HBc or HBV-DNA, but negative in HBsAg (occult HBV infection). Three (3%) patients had dual HBV and HCV infection. None of the patients showed changes in viral markers during the follow-up of 8 mo on average (1-12 mo).

Effects of progressive muscle relaxation therapy on Maintenance hemodialysis patients:a systematic review and meta-analysis

Objective:This study aimed to evaluate the effects of progressive relaxation therapy on patients with maintenance hemodialysis.Methods:A literature search was performed using PubMed,Embase,Cochrane Library,China National Knowledge Infrastructure,and Wanfang Data from inception to July 2020.Randomized controlled trials on the use of progressive muscle relaxation therapy in maintenance hemodialysis patients were selected.The primary outcomes were the depression and anxiety.Secondary outcomes included fatigue and sleep.Two reviewers proceeded study selection and quality assessment of included trials and performed heterogeneity of included studies before meta-analysis.Results:A total of 8 studies,which comprised a total of 668 participants were included in the final meta-analysis.The results showed that progressive muscle relaxation therapy could reduce the depression of patients(MD=-5.11,95%CI:-6.74 to-3.48,P<0.001),reduce the anxiety(SMD=-1.27,95%CI:-1.73 to-0.82,P<0.001),relieve fatigue symptoms(MD=-0.87,95%CI:-1.20 to-0.53,P<0.001),improve the sleep quality(MD=-1.69,95%CI:-1.95 to-1.42,P<0.001).Conclusion:Progressive muscle relaxation therapy has positive effects on depression,anxiety,fatigue and sleep quality in patients with maintenance hemodialysis.While concurrent evidence is insufficient,and further studies of high quality are needed to strengthen the conclusion.

The status of caregiver burden and influencing factors among family caregivers in maintenance hemodialysis patients

Objective: To investigate the status of caregiver burden and influencing factors among family caregivers in maintenance hemodialysis (MHD) patients under the background of coronavirus disease 2019, and to provide references for nursing intervention. Methods: From May to August 2020, 237 convenient samples were recruited from the Hemodialysis Centers of The Renmin Hospital of Wuhan University and Zhongnan Hospital of Wuhan University. Questionnaires were conducted with the General Information Questionnaire, Zarit Burden Interview (ZBI), Sense of Coherence-13 (SOC-13) and Perceived Social Support Scale (PSSS). Multiple linear regression was used to analyze the influencing factors of caregiver burden. Results: The score of ZBI among the caregivers was (36.05 ± 14.09). The ZBI of family caregivers was negatively correlated with SOC-13 and PSSS (P < 0.01). Multiple regression results showed that professional status of MHD patients, activity of MHD patients, comprehensibility, manageability and other support were the main influencing factors of their caregiver burden (P < 0.01), which explained 44.4% of the variance. Conclusion: The caregiver burden among family caregivers of MHD patients was above average under the background of COVID-19, which indicated that they felt more burden in the process of caring. Medical staff could give targeted support and guidance in combination with their influencing factors to reduce their caregiver burden further.

Acupoint Selection Standards of Auricular Therapy in the Treatment of Maintenance Hemodialysis Insomnia Based on Data Mining

Background:Insomnia is a high-incidence complication in patients undergoing maintenance hemodialysis(MHD).Auricular therapy can effectively improve sleep with few adverse effects.Acupoint selection affects the impact of auricular therapy.However,there is currently a lack of analysis on the standards of acupoint selection.Our study used data mining technology to investigate the acupoint selection principles and characteristics of auricular therapy for the treatment of MHD-related insomnia.Objective:The objective of the study is to explore the standards of acupoint selection in auricular therapy for the treatment of MHD-related insomnia through data mining technology.Materials and Methods:We searched three English(PubMed,WOS,and Embase)and four Chinese(CNKI,VIP,Wangfang,and CBM)databases for studies on auricular therapy for MHD-related insomnia from self-establishment to November 14,2022.Results:Eighty-one publications were involved,which included 33 acupoints.The most common auricular points in patients with MHD-related insomnia were the Shenmen,heart,and kidney points.More applications involved the visceral,nervous system,and specific acupoints.Five effective clusters and two clusters were obtained through cluster analysis,including specific auricular points for insomnia,such as the multi-dream area,neurasthenia area,deep sleep point,and anterior ear lobe.Complex network analysis showed that the core auricular acupoint combinations for the intervention of MHD-related insomnia were Shenmen with kidney,Shenmen with heart,heart with kidney,heart with Shenmen,and heart and Shenmen with subcortex.Conclusions:The selection of auricular points for the treatment of MHD-related insomnia was guided by the heart theory of traditional Chinese medicine.Clinical treatment attaches importance to the use of the multi-dream area,neurasthenia area,and other acupoints.

Glycated albumin may be a choice, but not an alternative marker of glycated hemoglobin for glycemic control assessment in diabetic patients undergoing maintenance hemodialysis

Background It has been suggested that glycated hemoglobin （HbAlc） underestimate the actual glycemic control levels in maintenance hemodialysis （MHD） patients, because of anemia and the using of erythropoietin （EPO）; it was recommended that glycated albumin （GA） should be an alternative marker. Therefore, the assessment performances of glycemic control were compared between GA and HbAlc in this research by referring to mean plasma glucose （MPG） in diabetes mellitus （DM） patients undergoing MHD or not. Methods MPG was calculated according to the data registered at enrollment and follow-up 2 months later and corresponding HbAlc, albumin （ALB）, GA, etc. were measured in 280 cases. A case-control study for comparing GA and HbAlc was done among the groups of MHD patients with DM （n=88） and without DM （NDM; n=90）, and non-MHD ones with DM （n=102） using MPG for an actual glycemic control standard. Results In these 3 groups, only for DM patients＇ （whether undergoing MHD or not）, GA and HbAlc correlated with MPG significantly （P 〈0.01）. Through linear regression analysis, it could be found that the regression curves of GA almost coincided in MHD and non-MHD patients with DM, because the intercepts （2.418 vs. 2.329） and slopes （0.053 vs. 0.057） were very close to each other. On the contrary, regression curves of HbAlc did not coincide in the two groups, because variance of the slopes （0.036 vs. 0.052） were relatively large. Through comparing receiver operating characteristic （ROC） areas under the curve （AUC）, it could be understood that the assessment performances of GA and HbAlc in MHD patients were lower than those in non-MHD ones, and assessment performance of HbAlc in MHD patients was better than GA （P 〈0.05）. In addition, the effects of Hb and EPO dose on HbAlc, or that of ALB on GA were unobvious in our study. Conclusions Actual glycemic control level in MHD patients with DM may be underestimated by HbAlc, and it could be avoided by GA; however, glycemic evaluating performance of HbAlc may be still better than that of GA. Therefore, HbAlc should not be replaced completely although GA can be used as a choice to monitor glycemic level.

Effect of long intermittent hemodialysis on improving dialysis adequacy of maintenance hemodialysis patients

Background With the increase in hemodialysis （HD） patients, the blood dialysis patient＇s quality of life （QoL） and long- term survival are still a challenge for clinicians. Recent studies have found that most of the HD patients have sleep disorders, which have a certain correlation with long-term survival and QoL. But there are few studies of Chinese in this field. This study aimed to investigate whether increasing the dialysis dose can improve sleep quality, so we treated HD patients on long intermittent hemodialysis （LIHD）. Methods Forty patients who were treated by conventional HD at the Beijing Friendship Hospital Blood Purification Center were offered the option of LIHD. The patients＇ laboratory data, medication use, and questionnaire answers were analyzed. Conventional HD was delivered thrice weekly with 4 hours per treatment, and LIHD was delivered thrice weekly with 8 hours per treatment. The study lasted 6 months. Questionnaires included sleep quality survey and QoL SF-36; the former includes the Athens Insomnia Scale, Pittsburgh Sleep Quality Index （PSQI）, and Epworth Sleepiness Scale （ESS）. Results After conversion to LIHD the dialysis efficiency （K~/V） significantly increased than before （P 〈0.05） and clearance rate of urea nitrogen also increased from 67 to 78% （P 〈0.01）. After conversion, median values for Hb increased from 108.95 to 126.55 g/L （P 〈0.01）; albumin increased from 38.85 to 40,05 g/L （P 〈0.01）. Phosphorus decreased from 2.69 to 1.54 mmol/L （P 〈0.01）, but there was no alteration in blood calcium; phosphorus and calcium-phosphate product levels were under more control, but parathyroid hormone （iPTH） level did not change after conversion to LIHD. After conversion, blood pressure （BP） was better controlled than before and the mean number of antihypertensive drugs prescribed declined from 2.9 to 0.5 （P 〈0.01）. There was a significant reduction in the use of erythropoietin-stimulating agent of 5250 U/w （P 〈0.01）. Sleep quality significantly improved in the 2 months after conversion to LIHD, and the PSQI score decreased from 10.80 to 5.45 and the ESS score decreased from 12.05 to 5.30 （P 〈0.01）. However, sleep quality started to decline after 2 months on LIHD. QoL SF-36 score increased from 410.92 to 592.53 （P 〈0.01）. Conclusion LIHD offers an effective improvement in dialysis adequacy for Chinese maintenance HD patients, but it improves sleep quality only briefly which may be related to loss of serum calcium and parathyroid dysfunction.

Analysis of the parathyroid function in maintenance hemodialysis patients from Changchun, China

Objective: To evaluate the parathyroid function in maintenance hemodialysis patients from 4 hemodialysis centers and to analyze the cause of the dysfunction.Methods: This cross-sectional study included patients with chronic renal disease undergoing maintenance hemodialysis treatment at 4 hemodialysis centers in Changchun, China, between March 2014 and August 2015. A total of 337 patients were asked to complete a questionnaire including their name, gender, age, hemodialysis duration, the use of calcium carbonate and vitamin D3 supplements, health education status, hemofiltration frequency, appetite, and education level. Serum intact parathyroid hormone (iPTH), phosphorus, total calcium, blood urea nitrogen (BUN), and creatinine (Cre) levels were obtained from clinical information. Patients with iPTH data were divided into 2 groups:Normal group:the patients with an iPTH level<100 pg/ml (28 subjects);Abnormal group:the patients with an iPTH level>100 pg/ml (136 subjects). Intergroup differences were analyzed using the t-test. The enumeration data were analyzed by the x2 test.Results: The iPTH levels were not monitored for 173 maintenance hemodialysis patients (51.3%) but for 164 patients (48.7%). Of the 164 patients, 28 (17.1%) had a normal serum iPTH level, while the other 136 (82.9%) had an abnormal iPTH level. The maintenance hemodialysis duration and phosphorus levels in the Abnormal group were higher than those in the Normal group (P<0.05). The appetites of patients in the Abnormal group were better than those of patients in the Normal group (P<0.05). Conclusions: A lower proportion of patients on hemodialysis had a normal iPTH level. The phosphorus levels of patients on hemodialysis should be controlled via dietary interventions.

Application of KDQOL-SF^(TM) 1.3 version in evaluating quality of life of maintenance hemodialysis patients in multiple centers

Objective To understand the quality of life(QOL)and its influencing factors in maintenance hemodialysis patients(hemodialysis maintenance,MHD),and to provide theoretical basis for improving QOL of patients.Methods A cross-sectional study was conducted in the blood purification centre in 8 hospitals in Hefei,and patients’clinical data were collected.KDQOL-SF self-ad-