BACKGROUND: The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China. METHODS: This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences. RESULTS: Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [ n  = 278] vs . 43.7% [ n  = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs . 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses. CONCLUSION This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.
Humans ; Percutaneous Coronary Intervention/methods* ; Male ; Female ; Coronary Artery Disease/drug therapy* ; Retrospective Studies ; Renal Dialysis/methods* ; Middle Aged ; Aged ; China ; Proportional Hazards Models ; Treatment Outcome

This study establishes a high-performance liquid chromatography (HPLC) method for the determination of acetate content in hemodialysis solutions and dialysis concentrates. In this study, Synergi Polar-RP column is utilized. Phosphate buffered saline (50 mmol/L, pH=2.5) is used as a mobile phase. The flow rate is 1.0 mL/min. The wavelength of detection is 212 nm. Results show that the linear relationship of acetate is good in the range of 0.1~20 mmol/L, r =0.999 9 and the spike recoveries are from 98.9%~99.5%, RSD<0.5% ( n=3). This method can easily and accurately determine the acetate content in hemodialysis solutions and dialysis concentrates, and can be applied to quality control in the production and use of such products.
Chromatography, High Pressure Liquid/methods* ; Acetates/analysis* ; Hemodialysis Solutions/analysis* ; Dialysis Solutions/analysis* ; Renal Dialysis

Traditional Chinese medicine(TCM) compound preparations have complex compositions. As a widely used TCM injection, Shuganning Injection, its in vivo processes are not yet fully understood. Determining the plasma protein binding rate is of great significance for pharmacokinetic and pharmacodynamic studies. In this experiment, the equilibrium dialysis method combined with UPLC-MS/MS technology was used to determine the plasma protein binding rates of 10 components, including p-hydroxyacetophenone, caffeic acid, baicalein, oroxylin A, geniposide, baicalin, cynaroside, oroxylin A-7-O-β-D-glucuronide, scutellarin, and hyperoside, in Shuganning Injection in rat and human plasma to provide a theoretical basis for further elucidating the in vivo processes of Shuganning Injection and guiding clinical medication. The results showed that, except for baicalein and geniposide, the plasma protein binding rates of the other eight components were higher in human plasma than in rat plasma, and there were interspecies differences. In human plasma, except for geniposide, caffeic acid, and baicalin, the plasma protein binding rates of the remaining seven components were above 80%, with baicalein and oroxylin A exceeding 90%. All components exhibit a high level of binding to plasma proteins, with the exception of geniposide.
Rats ; Humans ; Animals ; Tandem Mass Spectrometry/methods* ; Chromatography, Liquid/methods* ; Rats, Sprague-Dawley ; Liquid Chromatography-Mass Spectrometry ; Protein Binding ; Renal Dialysis ; Drugs, Chinese Herbal ; Blood Proteins ; Chromatography, High Pressure Liquid/methods*

INTRODUCTION: In patients with end-stage kidney disease (ESKD) suitable for peritoneal dialysis (PD), PD should ideally be planned and initiated electively (planned-start PD). If patients present late, some centres initiate PD immediately with an urgent-start PD strategy. However, as urgent-start PD is resource intensive, we evaluated another strategy where patients first undergo emergent haemodialysis (HD), followed by early PD catheter insertion, and switch to PD 48-72 hours after PD catheter insertion (early-start PD). Conventionally, late-presenting patients are often started on HD, followed by deferred PD catheter insertion before switching to PD≥14 days after catheter insertion (deferred start PD). METHODS: This is a retrospective study of new ESKD patients, comparing the planned-start, early-start and deferred-start PD strategies. Outcomes within 1 year of dialysis initiation were studied. RESULTS: Of 148 patients, 57 (38.5%) patients had planned-start, 23 (15.5%) early-start and 68 (45.9%) deferred-start PD. Baseline biochemical parameters were similar except for a lower serum urea with planned-start PD. No significant differences were seen in the primary outcomes of technique and patient survival across all 3 subgroups. Compared to planned-start PD, early-start PD had a shorter time to catheter migration (hazard ratio [HR] 14.13, 95% confidence interval [CI] 1.65-121.04, P=0.016) while deferred-start PD has a shorter time to first peritonitis (HR 2.49, 95% CI 1.03-6.01, P=0.043) and first hospital admission (HR 2.03, 95% CI 1.35-3.07, P=0.001). CONCLUSION Planned-start PD is the best PD initiation strategy. However, if this is not possible, early-start PD is a viable alternative. Catheter migration may be more frequent with early-start PD but does not appear to impact technique survival.
Female ; Humans ; Kidney Failure, Chronic/therapy* ; Male ; Peritoneal Dialysis/methods* ; Renal Dialysis ; Retrospective Studies ; Time Factors

The primary site for a hemodialysis catheter insertion is the right internal jugular vein (IJV) followed by the left IJV and subclavian vein. In cases when veins of the upper extremities are exhausted, femoral veins are an alternative insertion location. Femoral catheter insertions should only be used for short periods because of the increased risk of infection. There is a percutaneous technique to recanalize occluded central veins for hemodialysis catheter insertion. We experienced success with a cut-down method for permcath through a completely occluded IJV. We, therefore, find surgical recanalization to be better than percutaneous method in terms of cost and safety.
Catheters ; Femoral Vein ; Humans ; Jugular Veins ; Methods ; Renal Dialysis ; Subclavian Vein ; Upper Extremity ; Veins

PURPOSE: The purpose of this was to compare effects of application of the skin stimulation method and topical anesthetic cream on pain, heart rate variability and satisfaction according to nursing intervention methods during arteriovenous fistula puncture in chronic renal failure hemodialysis patients. METHODS: This study was a crossover design. Participants were 36 patients with chronic renal failure receiving hemodialysis treatment. Two forms of intervention were applied to participants, and then pain and heart rate variability were measured during the puncture. RESULTS: There were no statistically significant differences according to each treatment in vein pain and artery pain. Also, there were no statistically significant differences according to each treatment in stress index, sympathetic activity (LF), parasympathetic activity (HF) and sympathetic activity/parasympathetic activity (LF/HF ratio). Satisfaction with application of skin stimulation method was statistically higher than that of topical anesthetic cream application. CONCLUSION: This suggests that application of the skin stimulation method complements disadvantages of topical anesthetic cream application and demonstrates possibility of application as a nursing intervention method which can be conveniently used by nurses in clinical practice.
Arteries ; Arteriovenous Fistula ; Complement System Proteins ; Cross-Over Studies ; Heart Rate ; Heart ; Humans ; Kidney Failure, Chronic ; Methods ; Nursing ; Punctures ; Renal Dialysis ; Skin ; Veins

The End-stage Renal Disease Registry Committee of the Korean Society of Nephrology collects data on the dialysis therapy in Korea through an internet-based registry program and reports it annually. In this article, the method and clinical implications of the mortality hazard ratio analyses of various clinical parameters in the 2017 registry report have been described, with the inclusion of data on four additional parameters. The mortality risk based on clinical parameters was analyzed only for hemodialysis patients. The number of registered patients with laboratory data was 13,943 (8,446 male and 5,497 female patients), and death was reported in 3,139 patients. Analysis of the effects of various clinical parameters on mortality was performed using non-linear Cox proportional hazard model with the R statistics program. For all clinical parameters, univariate and adjusted multivariate hazard ratio analyses were performed. Analysis of the mortality hazard ratio showed that low body mass index, low hemoglobin, low serum albumin, low serum phosphorus, and low urea reduction ratio were associated with a significantly increased mortality risk, whereas paradoxically high serum creatinine levels were associated with low mortality risk.
Body Mass Index ; Creatinine ; Dialysis ; Female ; Humans ; Kidney Failure, Chronic ; Korea ; Male ; Methods ; Mortality ; Nephrology ; Phosphorus ; Proportional Hazards Models ; Renal Dialysis ; Serum Albumin ; Urea

PURPOSE: This study was a cross-sectional study comparing differences in self-management knowledge, self-management, physiologic indexes, and symptoms experience for two methods of dialysis. METHODS: Participants were 90 patients on hemodialysis and 91 on peritoneal dialysis at A hospital. RESULTS: There was no significant difference between the two groups for knowledge of self-management. A comparison of the categories in the evaluation of self-management showed that patients in the peritoneal dialysis group took better care of their dialysis access route (F=17.61, p < .001) and dialysis schedule (F=4.30, p=.040). The physiologic indexes between the two dialysis groups showed that hemoglobin levels were higher in the hemodialysis group (F=5.28, p=.023). The product of serum calcium and phosphate was higher in the peritoneal dialysis group (F=11.42, p=.001). Serum sodium level was also higher in the peritoneal dialysis group (t=5.36, p < .001) while serum albumin level (t=−3.36, p=.001) and mean arterial blood pressure (t=−2.50, p=.013) were higher in hemodialysis patients. There were no significant differences in the proportion of uncomfortable experiences between the two groups. CONCLUSION: Medical personnel should consider differences in self-management knowledge/self-management, physiologic indexes, and symptoms experience for hemodialysis and peritoneal dialysis populations, and should provide adequate education accordingly and promote behavioral change to improve physiologic indexes and reduce symptoms.
Appointments and Schedules ; Arterial Pressure ; Biomarkers ; Calcium ; Cross-Sectional Studies ; Dialysis* ; Education ; Humans ; Methods* ; Peritoneal Dialysis ; Renal Dialysis ; Self Care* ; Serum Albumin ; Sodium ; Symptom Assessment

PURPOSE: This research is to describe and identify the difficulties of compliance to medical regimen, by implementing interviews with hemodialysis patients. METHODS: The research data was collected from July, 2017 to October, 2017. In-depth interviews were implemented using a semi-structured questionnaire. The data were analyzed by qualitative content analysis method. RESULTS: The fourteen subjects diagnosed with chronic renal failure were attended. The difficulties of adherence to medical regimen that the hemodialysis patients feel consisted of 14 themes and they were categorized into five subjects; ‘Difficulty in practicing self-care’, ‘Repetition of Negative feelings’, ‘Withdrawal of Social activity’, ‘Lack of expertise’, ‘Uncertainty about the future’. CONCLUSION: To facilitate the hemodialysis patients' adherence to medical regimen, the change of their basic life style is required. Also, tailored nursing intervention considering not only their physical characteristics but also their psychological and affective characteristics is required to increase their self-management and adaptation to the disease.
Adult* ; Compliance ; Humans ; Kidney Failure, Chronic ; Life Style ; Methods ; Nursing ; Renal Dialysis* ; Self Care

PURPOSE: This study aimed to explain what are the experiences of patients with renal disease who are just begun hemodialysis in the end-stage. METHODS: The data were collected from February to December in 2017 through individual in-depth interviews using open-ended questions. For data analysis, a phenomenological method suggested by Colaizzi was applied. A total of 8 hemodialysis patients with end-stage renal disease (ESRD) participated in this study. RESULTS: According to the analysis, five theme clusters emerged: ‘I go into darkness’, ‘Being disappearing from others’, ‘Baby bird living with love’, ‘Dawn in darkness’ and ‘A life longing for the absolute’. CONCLUSION: Patients undergoing hemodialysis experienced fear and anxiety at the beginning of hemodialysis. Therefore, counseling and social supports were needed for patients with ESRD in their early stage of hemodialysis. In addition, a multidisciplinary education program should be implemented in the future research. It may help to overcome for the patients who are experiencing complicated health problems in their early stage of hemodialysis treatment.
Anxiety ; Birds ; Counseling ; Education ; Humans ; Kidney Failure, Chronic* ; Methods ; Qualitative Research ; Renal Dialysis* ; Statistics as Topic