Blood Purification最新文献

{"title":"Albumin and Platelet Loss during the Application of CytoSorb® in Critically Ill Patients: A post hoc Analysis of the Cyto-SOLVE Trial.","authors":"Clara Isabell Brozat, Michael Zoller, Sandra Frank, Mathias Bruegel, Caroline Gräfe, Diana Rebholz, Michael Paal, Helen Graf, Uwe Liebchen, Christina Scharf","doi":"10.1159/000542009","DOIUrl":"10.1159/000542009","url":null,"abstract":"<p><strong>Introduction: </strong>Adsorption devices like CytoSorb® (CS) are increasingly used in critically ill patients. However, potential adverse effects have not been sufficiently investigated. The aim of this post hoc analysis of the monocentric prospective Cyto-SOLVE study was to examine albumin concentration and platelet count during the application of CS in intensive care unit (ICU) patients with different indications for CS therapy.</p><p><strong>Methods: </strong>Twenty-nine adult ICU patients receiving continuous kidney replacement therapy and CS application for 12 h were included. Albumin concentration and platelet count were measured before, during, and after application. Changes in albumin concentration and platelet count were investigated. Since 10/29 patients were substituted with platelets during CS therapy and 20/29 received albumin, subgroup analysis was performed in patients receiving no platelet concentrate and <20 g albumin substitution during CS application. The dependent sample t test was used to detect significant (p < 0.05) changes over time, and multivariate models were investigated.</p><p><strong>Results: </strong>We observed a significant reduction in platelets (p = 0.005, mean 14 G/L, 95% confidence interval (CI) 4-23 G/L) during CS therapy with an even more pronounced drop in those 19 patients without platelet substitution (p = 0.001, mean 22 G/L, 95% CI 10-34). No significant change was detected in the albumin concentration of all patients. However, a significant albumin decrease was observed in those 17 patients with less than 20 g albumin substitution during CS therapy (p = 0.007, mean 0.17g/dL, 95% CI 0.05-0.29). No other potential covariates for the decrease could be identified in a multivariate model.</p><p><strong>Conclusion: </strong>Since a drop in albumin and platelets occurred during the use of CS, an increased substitution might be necessary. Knowledge of potential side effects is of great importance to prevent harm during the use of extracorporeal procedures. This knowledge should be considered for a reliable risk-benefit assessment in the future.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"93-101"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severely Hyperammonemic Acute Liver Failure due to Paracetamol Overdose: The Impact of High-Intensity Continuous Renal Replacement Therapy.","authors":"Anis Chaba, Stephen Joseph Warrillow, Caleb Fisher, Sofia Spano, Akinori Maeda, Atthaphong Phongphithakchai, Nuttapol Pattamin, Yukiko Hikasa, Nuanprae Kitisin, Scott Warming, Claire Michel, Glenn M Eastwood, Rinaldo Bellomo","doi":"10.1159/000542556","DOIUrl":"10.1159/000542556","url":null,"abstract":"<p><strong>Introduction: </strong>Paracetamol (acetaminophen)-induced acute liver failure (ALF) with severe hyperammonemia (ammonia >100 µmol⋅L-1) is a life-threatening condition. A strategy based on high-intensity continuous renal replacement therapy (CRRT) without early (up to day seven) transplantation may enable clinicians to safely identify which patients can recover and survive and which patients require transplantation.</p><p><strong>Methods: </strong>We conducted a single-center, retrospective cohort study of patients with severely hyperammonemic paracetamol-induced ALF. The primary outcome was early transplant-free survival.</p><p><strong>Results: </strong>We studied 84 patients (median age: 38; female sex: 79 [85%]) over a 12-year period (median ammonia level at ICU admission: 153 µmol⋅L-1; median peak aspartate aminotransferase (AST): 10,029 U⋅L-1; median lactate: 5.0 mmol⋅L-1; and median INR: 4.4) and 55 (65%) with King's College criteria for transplantation. Overall, 87% received high-intensity CRRT (92% in 2020-2023). Median CRRT intensity was 54 mL⋅kg-1⋅hr-1 within the first 48 h and increased by 1.8 mL⋅kg-1⋅hr-1 per year during the study period (p = 0.002). Transplant-free survival to day 7 was 86% in 2011-2023 and 96% in 2020-2023. Overall, only 4 patients were transplanted and only 1 (4%) in 2020-2023. On multivariable Cox analysis, factors independently associated with failure to achieve day seven transplant-free survival were higher APACHE III score (HR = 1.05, 95% CI: 1.02-1.08), higher lactate (HR = 1.27, 95% CI: 1.12-1.44), and lower platelet count at ICU admission (HR = 0.85, 95% CI: 0.78-0.93) and the median effluent dose applied within the first 48 h of ICU admission (HR = 0.67, 95% CI: 0.46-0.98).</p><p><strong>Conclusions: </strong>Early transplant-free survival is achievable in most patients with paracetamol-induced ALF and severe hyperammonemia with a treatment based on high-intensity CRRT. Such transplant-free survival increased over time together with increased CRRT dose.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"111-121"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seraph 100 Hemoperfusion for Management of Severe COVID-19: Assessment of Serum and Plasma Analytes Pre- and Post-Filtration.","authors":"Michael Rouse, Eric R Gann, Joost Brandsma, Victor A Sugiharto, Henry Robertson, Pavol Genzor, Hua-Wei Chen, Mark P Simons, Seth A Schobel, Josh G Chenoweth, Sarah A Jenkins, Danielle V Clark, Jeffrey Della Volpe, Stephen Chitty, Ian M Rivera, Michael Lewis, Caroline Park, Amay Parikh, Pooja Vir, Ian J Stewart, Kathleen P Pratt","doi":"10.1159/000542995","DOIUrl":"10.1159/000542995","url":null,"abstract":"<p><strong>Introduction: </strong>We report an Intervention/outcome study of 33 severe COVID-19 subjects who received Seraph 100 Microbind Affinity Blood Filter (Seraph 100) hemoperfusion therapy (15 survivors, 18 non-survivors) under emergency authorization from the FDA. Our objective was to determine if Seraph 100 hemoperfusion reduces SARS-CoV-2 RNA titers and/or markers of inflammation and/or epi/endothelial damage.</p><p><strong>Methods: </strong>Viral RNA and 78 protein analytes related to endothelial/epithelial damage and/or inflammation were quantified in systemic blood samples from 33 severe COVID-19 subjects collected upon intensive care unit (ICU) admission and then immediately before and after blood passed through the heparin-based Seraph 100 filter at two time points on the first day of hemoperfusion. Viral RNA titers were quantified using droplet digital PCR. Protein analytes were quantified using multiplex/multi-analyte panels on MesoScale Discovery and ProteinSimple Ella platforms.</p><p><strong>Results: </strong>A total of 15/33 subjects had detectable viral RNA in baseline samples (shortly after ICU admission). These initial viremia levels were low, and they did not change uniformly post-perfusion. Five of 55 protein analytes that were upregulated 1.4-120X at ICU admission relative to healthy controls showed significant decreases across the filter during the indicated time points on the first day of hemoperfusion: IP-10/CXCL10, fms-like tyrosine kinase 1, MIG/CXCL9, hepatocyte growth factor (HGF), and receptor for advanced glycosylation end products (RAGE). Paired t tests identified 25 additional analytes that showed significant decreases (p < 0.05) only without Bonferroni correction.</p><p><strong>Conclusion: </strong>Initial freely circulating SARS-CoV-2 RNA levels of ICU-admitted subjects were low or undetectable. The Seraph 100 filter did not significantly reduce viral RNA titers in their plasma. However, multiple circulating proteins with roles in inflammation, endothelial/epithelial damage, and/or angiogenesis decreased significantly across the filter. Larger prospective trials will be required to determine if such transient reductions translate into improved patient outcomes. However, this study did not demonstrate a direct reduction of free SARS-CoV-2 viral RNA by the Seraph 100.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"200-210"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum.","authors":"","doi":"10.1159/000541558","DOIUrl":"10.1159/000541558","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"81"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11835227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"100 Years of Dialysis at University Hospital Giessen.","authors":"Faeq Husain-Syed, Ulrike Enke, Friedrich Lübbecke, Winfried Fassbinder, Friedrich Grimminger, Horst-Walter Birk","doi":"10.1159/000543874","DOIUrl":"10.1159/000543874","url":null,"abstract":"","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"211-217"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduction of Waste Mass in Used Hemodialysis Circuits by Quality Control Circle Activity.","authors":"YingYan Liang, Ni Xu, YongXiao Zhang, MeiXia Wu, QiuQin Ding, Jing Yin, JieEr Guo, QiongQiong Yang, Hao Li, XiaoMei Li","doi":"10.1159/000545400","DOIUrl":"10.1159/000545400","url":null,"abstract":"<p><strong>Introduction: </strong>The improvement of waste management constitutes a critical component of green nephrology initiatives. Hemodialysis circuits represent a substantial proportion of medical waste generated in dialysis units, yet standardized industry protocols for optimizing the disposal of discarded hemodialysis circuits remain underdeveloped. This study aimed to validate the effectiveness of Quality Control Circle (QCC) methodology in reducing the total mass of discarded hemodialysis circuits.</p><p><strong>Methods: </strong>A multidisciplinary QCC task force was established with the explicitly defined objective: \"reduce residual fluid volume in discarded hemodialysis circuits.\" The QCC methodology was systematically implemented to drive process improvements. Residual fluid mass from decommissioned hemodialysis circuits served as the primary quality metric, with comparative analyses conducted pre- and post-intervention.</p><p><strong>Results: </strong>Implementation of QCC interventions resulted in a 29.7% reduction in mean circuit mass, decreasing from 0.64 ± 0.015 kg to 0.45 ± 0.012 kg (p < 0.01) across the sampled hemodialysis apparatus.</p><p><strong>Conclusion: </strong>The implementation of QCC activities has significantly reduced residual waste from hemodialysis circuits, leading to environmental conservation and lower waste disposal costs. QCC serves as an effective management tool for hemodialysis units to promote the concept of green nephrology.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"264-271"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Dialysis on Structural Brain Connectivity in Patients with End-Stage Renal Disease.","authors":"Byeongo Choi, Chang Min Heo, Jiyae Yi, Dong Ah Lee, Yoo Jin Lee, Sihyung Park, Yang Wook Kim, Junghae Ko, Bong Soo Park, Kang Min Park","doi":"10.1159/000541239","DOIUrl":"10.1159/000541239","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with end-stage renal disease (ESRD) are known to have reduced structural and functional brain connectivity in the brain regions associated with cognitive function. However, the effect of dialysis on brain connectivity remains unclear. This study aimed to evaluate the effects of dialysis on structural brain connectivity in patients with ESRD.</p><p><strong>Methods: </strong>This prospective study included 20 patients with ESRD in the pre-dialysis stage and 35 healthy controls. The patients underwent T2-weighted and three-dimensional T1-weighted magnetic resonance imaging before and 3 months after dialysis initiation. Moreover, the cortical thickness was calculated. We applied graph theoretical analysis to calculate the structural covariance network based on cortical thickness. We compared the cortical thickness and structural covariance network of patients with ESRD in the pre-dialysis stage with those of healthy controls and with those of patients with ESRD in the post-dialysis stage.</p><p><strong>Results: </strong>The mean cortical thickness in both hemispheres was lower in patients with ESRD in the pre-dialysis stage than in healthy controls (2.296 vs. 2.354, p = 0.030; 2.282 vs. 2.362, p = 0.004, respectively) and was higher in patients with ESRD in the post-dialysis stage than in those in the pre-dialysis stage (2.333 vs. 2.296, p = 0.001; 2.322 vs. 2.282, p = 0.002, respectively). Analysis of the structural covariance network revealed that the assortative coefficient was lower in patients with ESRD in the pre-dialysis stage than in healthy controls (-0.062 vs. -0.031, p = 0.029) and was higher in patients with ESRD in the post-dialysis stage than in those in the pre-dialysis stage (-0.002 vs. -0.062, p = 0.042).</p><p><strong>Conclusion: </strong>We observed differences in the cortical thickness and structural covariance networks before and after dialysis in patients with ESRD. This indicates that dialysis affects structural brain connectivity, contributing to the understanding of the pathophysiological mechanism of cognitive function alterations resulting from dialysis in patients with ESRD.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"28-36"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Method to Monitor Arteriovenous Fistula Maturation: Impact on Catheter Residence Time.","authors":"Laura Rosales Merlo, Xiaoling Ye, Hanjie Zhang, Brenda Chan, Marilou Mateo, Seth Johnson, Frank M van der Sande, Jeroen P Kooman, Peter Kotanko","doi":"10.1159/000540306","DOIUrl":"10.1159/000540306","url":null,"abstract":"<p><strong>Introduction: </strong>Arteriovenous fistula (AVF) maturation assessment is essential to reduce venous catheter residence. We introduced central venous oxygen saturation (ScvO2) and estimated upper body blood flow (eUBBF) to monitor newly created fistula maturation and recorded catheter time in patients with and without ScvO2-based fistula maturation.</p><p><strong>Methods: </strong>From 2017 to 2019, we conducted a multicenter quality improvement project (QIP) in hemodialysis patients with the explicit goal to shorten catheter residence time post-AVF creation through ScvO2-based maturation monitoring. In patients with a catheter as vascular access, we tracked ScvO2 and eUBBF pre- and post-AVF creation. The primary outcome was catheter residence time post-AVF creation. We compared catheter residence time post-AVF creation between QIP patients and controls. One control group comprised concurrent patients; a second control group comprised historic controls (2014-2016). We conducted Kaplan-Meier analysis and constructed a Cox proportional hazards model with variables adjustment to assess time-to-catheter removal.</p><p><strong>Results: </strong>The QIP group comprised 44 patients (59 ± 17 years), the concurrent control group 48 patients (59 ± 16 years), the historic control group 57 patients (58 ± 15 years). Six-month post-AVF creation, the fraction of non-censored patients with catheter in place was 21% in the QIP cohort, 67% in the concurrent control group, and 68% in the historic control group. In unadjusted and adjusted analysis, catheter residence time post-fistula creation was shorter in QIP patients compared to either control groups (p < 0.001).</p><p><strong>Conclusion: </strong>ScvO2-based assessment of fistula maturation is associated with shorter catheter residence post-AVF creation.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"44-53"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142341001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemoperfusion with the HA330/HA380 Cartridge in Intensive Care Settings: A State-Of-The-Art Review.","authors":"Yupei Li, Mei Han, Mei Yang, Baihai Su","doi":"10.1159/000542469","DOIUrl":"10.1159/000542469","url":null,"abstract":"<p><strong>Background: </strong>Hemoperfusion with the HA330/HA380 cartridge has markedly evolved during the past decade and has thus been widely used in intensive care settings to treat critical or hyperinflammatory illnesses. Numerous clinical studies have demonstrated that HA330/HA380 hemoperfusion might mitigate systemic inflammatory response syndrome and organ dysfunction in ICU patients by removing inflammatory mediators and metabolic toxins from the blood. However, there is currently lacking a systematic evaluation on the safety and efficacy of HA330/HA380 hemoperfusion in intensive care settings.</p><p><strong>Summary: </strong>We searched the PubMed database, Chinese Clinical Trial Registry, and <ext-link ext-link-type=\"uri\" xlink:href=\"http://ClinicalTrials.gov\" xmlns:xlink=\"http://www.w3.org/1999/xlink\">ClinicalTrials.gov</ext-link> for articles published from inception to June 20, 2024 (updated on September 10, 2024) to perform a state-of-the-art review of HA330/HA380 hemoperfusion in daily critical care practice. We discuss the basic technique characteristics and ex vivo investigations of the HA330/HA380 cartridge and summarize the latest clinical evidence regarding the use of HA330/HA380 hemoperfusion for the treatment of sepsis, severe COVID-19, cardiac surgery, acute pancreatitis, liver failure, and blunt trauma. Ex vivo studies suggest that the HA330/HA380 cartridge demonstrates satisfactory biocompatibility and substantial adsorption capacity for inflammatory cytokines, such as interleukin-6, interleukin-10, and tumor necrosis factor-α. Small-scale clinical studies indicate that HA330/HA380 hemoperfusion may help reduce plasma levels of inflammatory mediators, alleviate organ dysfunction, and improve survival in some critically ill patients with sepsis, severe COVID-19, acute pancreatitis, and blunt trauma.</p><p><strong>Key messages: </strong>(i) The HA330/HA380 cartridge contains abundant, coated, biocompatible sorbent beads made of styrene-divinylbenzene copolymers. (ii) HA330/HA380 hemoperfusion, with or without combined continuous renal replacement therapy, is a promising treatment option for some critically ill patients by removing proinflammatory mediators and alleviating organ dysfunction. (iii) The HA330/HA380 cartridge may adversely adsorb antibiotics, and appropriate antibiotic dosing adjustment and plasma drug level monitoring is recommended. (iv) There are currently numerous ongoing clinical trials evaluating the safety and efficacy of HA330/HA380 hemoperfusion in critically ill patients who develop sepsis or undergo cardiopulmonary bypass, which will certainly sharpen our future practice of HA330/HA380 hemoperfusion in ICU.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"122-137"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy of Ultrasound-Guided Selective Nerve Block in the Endovascular Treatment of Arteriovenous Fistulas.","authors":"Jing Wen, Shen Zhan, Yuzhu Wang, Lihong Zhang, Han Li","doi":"10.1159/000543827","DOIUrl":"10.1159/000543827","url":null,"abstract":"<p><strong>Introduction: </strong>Delivering requisite anesthesia for endovascular treatment of dysfunctional arteriovenous fistulas (AVFs) under a targeted nerve block can achieve reasonable analgesia. We evaluated the efficacy and safety of ultrasound-guided selective nerve block (SNB) during percutaneous transluminal angioplasty (PTA) of dysfunctional arteriovenous access.</p><p><strong>Methods: </strong>Two hundred forty-six patients with dysfunctional radiocephalic AVF undergoing PTA were enrolled in this prospective, randomized controlled trial at the Department of Nephrology, Haidian Hospital, Peking University Third Hospital from June 1, 2022, to August 31, 2023. The patients were randomized into either the SNB group (SNB group, n = 123) or the local infiltration anesthesia group (LA group, n = 123). A visual analog scale (VAS) from no pain (= 0) to worst pain possible (= 10) was used to assess the pain intensity. Patient and operator satisfaction were graded from 0 to 2: 0, not satisfied at all; 1, partially satisfied; 2, satisfied. The AVF patency at 1 and 3 months after PTA was also evaluated.</p><p><strong>Results: </strong>Compared with the LA group, the SNB group had significantly lower VAS scores (Z = -7.193, p < 0.001) and required fewer additional anesthetics during the operation (χ2 = -4.847, p = 0.028). Patient and operator satisfaction were significantly higher in the SNB group (p < 0.05). Eight patients in the SNB group encountered grade 3 motor paralysis after the operation, and they all recovered within 60 min. There was no significant difference in primary patency rates of the fistula between the two groups either at 1 month or 3 months after the operation (p > 0.05).</p><p><strong>Conclusion: </strong>Compared with LA, ultrasound-guided SNB has advantages over the LA during endovascular treatment of dysfunctional hemodialysis (HD) fistulas. It can provide safe and efficient analgesia with excellent procedural satisfaction in HD patients.</p>","PeriodicalId":8953,"journal":{"name":"Blood Purification","volume":" ","pages":"240-249"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}