Chinese Journal of Blood Purification

12 March 2012, Volume 11 Issue 3 Previous Issue    Next Issue

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The target of anti-hypertension therapy for maintenance hemodialysis patients: the present research situation ZHANG Yu-ran;YUAN Wei-jie 2012, 11 (3):  117-120.  Abstract ( 266 )   HTML ( 0 )   PDF (137KB) ( 151 )   Metrics

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The impact of amlodipine besylate combination with benazepril on blood pressure and blood pressure variability in peritoneal dialysis patients ZHONG Wen-qi; YANG Lin; Ni Na;LI Bing-xin;XIA Jin-biao;WU Jun-zhu 2012, 11 (3):  121-123.  doi: 10.3969/j.issn.1671-4091.2012.03.00 Abstract ( 508 )   HTML ( 0 )   PDF (208KB) ( 333 )   【Abstract】 Objective To observe the impact of amlodipine besylate combination with benazepril on blood pressure and blood pressure variability in peritoneal dialysis patients. Methods A total of 145 peritoneal dialysis patients with hypertension were divided into two groups: treatment group (n=80) and control group (n=65). The treatment group was treated with amlodipine besylate and benazepril, and the control group with nifedipine sustained release tablet and benazepril. Follow-up of the patients lasted 24 months beginning from the treatment for one month. Comparisons were made for changes of blood pressure, blood pressure variability, and cardiovascular events including cardiac failure, acute coronary syndrome and sudden death between the two groups.  Results In the two groups, blood pressure and blood pressure variability were significantly decreased after the treatment (P＜0.01). Blood pressure variability was significantly lower in the treatment group than in the control group (P＜0.01), but the change of blood pressure was statistically insignificant between the two groups (P>0.05). The prevalence of cardiovascular events and cardiovascular mortality rate were significantly lower in the treatment group than in the control group (P＜0.01). Conclusion Amlodipine besylate combined with benazepril or nifedipine sustained release tablet combined with benazepril can efficiently control blood pressure in peritoneal dialysis patients. However, amlodipine besylate combination with benazepril was more effective in lowering blood pressure variability and thus the prevalence of cardiovascular events and cardiovascular mortality rate. Metrics

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Impact of nutritional status on prognosis in Chinese hemodialysis patients SHI Jun-bao;ZHU Ning;TIAN Xin-kui;ZHENG Dan-xia;WANG Yue 2012, 11 (3):  124-127.  doi: 10.3969/j.issn.1671-4091.2012.03.00 Abstract ( 261 )   HTML ( 1 )   PDF (217KB) ( 329 )   【Abstract】 Objective The aims of this study were to observe nutritional status in hemodialysis (HD) patients, and to evaluate the impact of different nutritional parameters on their prognosis.  Subjects and methods We recruited 97 HD patients with clinically stable state and treated in the HD Center of Peking University Third Hospital during the period from January to June, 2006. Subjective global assessment (SGA), dietary protein intake, biochemistry and anthropometry parameters were collected. They were followed up for 36 months, and outcomes including survival, discontinuing dialysis or death were recorded.  Results During the 36 months of follow-up period, 3 patents were treated with kidney transplantation, one patient changed to peritoneal dialysis, 23 patients died, and 27 patients (28%) withdrew from dialysis. Malnourished patients had significantly higher mortality than well nourished patients (P =0.000). SGA, albumin, dietary protein intake, serum cholesterol, and body-weight index were the independent prognostic risk factors. Area under the ROC curve of SGA was 0.76, and SGA was the best prognostic marker. Results Malnourished HD patients had significantly higher mortality than well nourished patients. SGA, albumin, dietary protein intake, serum cholesterol, and body-weight index were independently associated with mortality. SGA is the most effective prognostic marker, and is simple for nutrition assessment in maintenance hemodialysis patients. Metrics

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Clinical application of below-the-elbow arterio-venous fistulas GUO Xiang-jiang;SHI Ya-xue;ZHANG Hao;LIANG Wei;ZHAO Yi-ping;ZHANG Lan;XUE Guan-hua;ZHANG Ji-wei;ZHANG Bai-gen. 2012, 11 (3):  128-130.  doi: 10.3969/j.issn.1671-4091.2012.03.00 Abstract ( 243 )   HTML ( 0 )   PDF (186KB) ( 182 )   【Abstract】Objectives To summarize our experience about the operation method for below-the-elbow arterio-venous fistulas (BEAVFs) and its clinical effects. Methods We retrospectively analyzed the maturation, patency and complications of the BEAVFs performed between October 2005 and December 2010 in this department. Results A total of 62 cases (41 males and 21 females; mean age 56.06±17.83 yrs) were treated with the anastomosis of proximal radial (or ulnar) artery and the median cubital vein (or its perforator vein). BEAVFs were successfully established in all patients without complications including hematoma, wound infection, high output cardiac failure, steal blood syndrome and perioperative mortality. The BEAVFs were functionally useful for hemodialysis access after the operation for 1-2 months. After the operation for one and two years, the patent rate was 98.1% and 96.3%, respectively. Conclusions BEAVF is a new method better than the brachial artery in-flow AVF. This method has the advantages of less injury, heart failure, steal blood syndrome and arm edema, a longer and straight conduit for vascular access, and a high patency rate. Metrics

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Observations on long-term therapeutic efficacy of daytime ambulatory peritoneal dialysis and continuous ambulatory peritoneal dialysis ZHANG Zhi-yong;LI Ming-xu;YU Yong-wu;ZHOU Chun-hua. 2012, 11 (3):  131-135.  doi: 10.3969/j.issn.1671-4091.2012.03.00 Abstract ( 244 )   HTML ( 0 )   PDF (243KB) ( 236 )   【Abstract】Objective To compare the long-term therapeutic efficacy in patients with daytime ambulatory peritoneal dialysis (DAPD) and those with traditional continuous ambulatory peritoneal dialysis (CAPD), and to explore the long-term peritoneal dialysis method suitable for Chinese patients.  Method A total of 32 outpatients or inpatients subjected to peritoneal dialysis in our hospital were selected and randomized into group A (n=16) and group B (n=16). Patients in group A were treated with CAPD by using the dialysate 8L/day, four exchanges per day, and dialysate left in abdomen cavity at night. Patients in group B were treated with DAPD by using 8L dialysate at daytime, dialysate exchange every 3-4 hours, and evacuation of dialysate from abdomen at night. Long-term monitoring for the patients was carried out. Thoroughness of dialysis was compared between the two groups, including urea clearance index (Kt/V), creatinine clearance rate (Ccr), nutritional status parameters of subjective global assessment (SGA) and serum albumin (sALB), hemoglobin (Hb), carbon dioxide combining power (CO2CP), serum potassium (K+), serum calcium (Ca2+), serum phosphorus (P-), intact parathyroid hormone (iPTH), mean arterial blood pressure, prevalence of peritoneal infection, number of cases on maintenance dialysis, valid duration (months) of maintenance dialysis, and employment rate. Barthel index (BI) was used for the evaluation of daily life ability, and Hamilton depression rating scale (HAMD) for the evaluation of depression degree. Urinary and ultrafiltration volume were recorded everyday. Data were presented as mean±SD, variance analysis was used for the comparison of mean values, and t-test or χ2 test for the comparison between two groups. P＜0.05 was considered to be statistically significant.  Results Residual urinary volume, ultrafiltration volume, Kt/V (weeks), Ccr, CO2CP, K+, and Ca2+ were statistically insignificant between the two groups (P＞0.05). However, nutritional status, Hb, P-, iPTH, mean arterial blood pressure, prevalence of peritoneal infection, number of cases on maintenance dialysis, valid duration (months) of maintenance dialysis, employment rate, BI, and HAMD were better in group B than in group A (P＜0.05). Conclusion Patients under DAPD had better clinical efficacies than those under CAPD in maintenance dialysis duration, thoroughness of dialysis, nutritional status, blood pressure, prevalence of peritoneal infection, daily life ability, and depression degree, although the dialysate volume used was similar in the two groups. Metrics

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Diagnosis and management of upper extremity edema syndrome in hemodialysis patients SHI Ya-xue;ZHANG Hao;ZHANG Ji-wei;LIANG Wei;YE Meng;ZHAO Yi-ping;HUANG Xiao-zhong;GUO Xiang-jiang;ZHANG Bai-gen 2012, 11 (3):  136-139.  doi: 10.3969/j.issn.1671-4091.2012.03.00 Abstract ( 453 )   HTML ( 0 )   PDF (219KB) ( 255 )   【Abstract】Objectives To summarize the diagnosis and management experiences for upper extremity edema in hemodialysis patients. Methods We retrospectively analyzed 51 cases with upper extremity edema in hemodialysis patients from July 2006 to June 2011 in our department. Their location of the lesion, method of management, and outcomes were summarized. Results There were 31 males and 20 females with the mean age of 60.18±14.38 years (21-88yrs). Their vascular accesses for hemodialysis (28 cases in left and 23 cases in right) lasted 36.35±28.94 months. The symptom occurred for one month to two years. Duplex and venography were used preoperatively, and 50 stenosis or occlusion lesions and one reflux lesion were identified. The symptoms were resolved by surgical revision, angioplasty, stent or closure of the access.  Conclusions The upper extremity edema resulted mainly from venous hypertension in hemodialysis patients. Combined use of duplex and venography were helpful for the diagnosis of location and extent of the lesions. Central venous stenosis or occlusion was the common lesion. Surgical revision is recommended for the superficial venous lesions. For cephalic arch and central vein lesions, angioplasty or stent placement may be the best choice to decrease the surgical trauma, but the long-term patency rate is low. Therefore, careful surveillance must be carried out. Metrics

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Effect of higher calcium concentration in dialysate on hemodynamics in intra-dialytic hypotension patients: a cross-over and self-control trial I Zi;YANG Li-chuan;CHEN Lin;CHEN Xiao-lei;SHA Zhao-hui;FU Ping 2012, 11 (3):  140-143.  doi: 10.3969/j.issn.1671-4091.2012.03.00 Abstract ( 238 )   HTML ( 0 )   PDF (288KB) ( 226 )   【Abstract】 Objective Symptomatic intra-dialysis hypotension (IDH) continues to be a common problem. In this study, we investigated the changes in hemodynamic parameters induced by calcium concentration in dialysate in IDH patients.  Methods Single-blinded and crossover design was used. Sixteen maintenance hemodialysis patients with IDH were randomized into two groups, beginning by changing the calcium concentration in dialysate either to 1.25mmol/L or 1.75mmol/L. The first 2-week intervention phase was followed by two-week of wash out with calcium concentration in dialysate as 1.5mmol/L, switching round the calcium concentration compared to the initial randomization, by a second 2-week intervention phase.  Results Fourteen patients finished the trial, and two patients withdrew due to infection. Compared to lower calcium concentration (1.25mmol/L), dialysate with higher calcium concentration elevated mean intradialytic systolic blood pressure (mSBP) (P＜0.05), decreased the maximum difference of SBP (the difference between predialytic SBP and the lowest intradialytic SBP), while the incident of symptomatic IDH and stopping hemodialysis did not decreased significantly. Medium calcium concentration in dialysate did not have any effect on such parameters.  Conclusion Higher calcium concentration in dialysate can partially improve the hemodynamic stability in IDH patients. Multiple-centered clinical trial with larger samples is needed.    Metrics

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Application of Montreal Cognitive Assessment in screening mild cognitive impairment in hemodialysis patients LI Jing;HOU Guo-cun;SUN Xiu-li;WU Hong-mei;LIU Ai-ying 2012, 11 (3):  144-146.  doi: 10.3969/j.issn.1671-4091.2012.03.00 Abstract ( 241 )   HTML ( 0 )   PDF (181KB) ( 235 )   【Abstract】Objective To assess the value of Montreal Cognitive Assessment (MoCA) in screening mild cognitive impairment (MCI) in hemodialysis patients. Methods Twenty hemodialysis patients with MCI and 20 healthy subjects were examined with neuropsychological tests using Mini-mental State Examination (MMSE) and MoCA.  Results The MoCA had a sensitivity of 90% and specificity of 75% for detecting MCI, and the sensitivity and specificity of MMSE were 30% and 95%, respectively. For the MoCA sub-items, hemodialysis patients with MCI had significantly lower scores than the healthy subjects in all cognitive function measures except for name and fixed orientation sub-items (t=-1.18, p=0.246; t=-0.38, p=0.70). In MMSE sub-items, significant differences were found between the two groups in only calculation and delayed recall (t=-4.91, P=0.00; t=-3.87, P=0.00). Conclusions The MoCA is a highly sensitive scale for screening MCI in patients with hemodialysis, which allows comprehensive assessment of patients’ cognitive functions better than the MMSE scale, and thus is worthy of clinical use. Metrics

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Analyses of anxiety symptoms and their correlated factors in maintenance hemodialysis patients ZHANG Jing-yi;FENG Min;KONG Li;XU An-ping 2012, 11 (3):  147-149.  doi: 10.3969/j.issn.1671-4091.2012.03.00 Abstract ( 283 )   HTML ( 0 )   PDF (220KB) ( 155 )   【Abstract】Objectives We investigated the prevalence of anxiety symptoms and their relevant factors in maintenance hemodialysis (MHD) patients, to provide the bases for the development of treatment strategies and the improvement of their life quality.  Methods A cross-sectional study was conducted. Seventy-seven outpatients with MHD, 75 outpatients with chronic kidney disease (CKD), and 80 healthy adults were included in this study. They were asked to fill out the SAS self-reported rating scales. MHD patients’ socio-demographic characteristics, clinical information, and laboratory parameters were also collected. Data were analyzed using SPSS version 13.0 software. Results Based on SAS scores, the prevalence of anxiety in MHD patients (36.4%) and in CKD patients (38.7%) were significantly higher compared to the control group (6.3%; P＜0.001). But there were no significant differences between the MHD group and the CKD group (P＞0.10). In the MHD group, older or lower educated patients seemed more likely to have anxiety symptoms (P＜0.05). From univariate analysis, SAS score correlated positively with age, and negatively with educational level (P＜0.05). From logistic regression analysis, only age correlated with anxiety. The odds ratio was 1.08 (P＜0.05). Conclusions Anxiety symptoms were much common in MHD patients. Older or lower educated MHD patients were more likely to have anxiety symptoms. Age would be the important factor relating to anxiety symptoms. Metrics

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Clinical investigation and analysis in maintenance hemodialysis patients with HBV and HCV infection ONG Hong -leng; PENG Hong-quan; LIN Wan-ping; YAN Ya-yi 2012, 11 (3):  168-170.  Abstract ( 244 )   HTML ( 0 )   PDF (196KB) ( 219 )   Metrics