Chinese Journal of Blood Purification

12 February 2012, Volume 11 Issue 2 Previous Issue    Next Issue

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Retrospective and prospective view of hemodialyis JI Da-xi;XU Bin 2012, 11 (2):  59-63.  Abstract ( 253 )   HTML ( 0 )   PDF (201KB) ( 472 )   Metrics

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The effects of comorbid conditions on inflammation, nutritional status and outcomes in peritoneal dialysis patients ZHOU Xiao-ling;HAN Qing-feng;SHI Junbo;NIE Jiandong;SUN Linghua 2012, 11 (2):  64-67.  doi: 10.3969/j.issn.1671-4091.2012.01.00 Abstract ( 350 )   HTML ( 2 )   PDF (327KB) ( 339 )   【Abstract】Objective To investigate the impact of comorbid conditions on inflammation, nutritional status and outcomes in peritoneal dialysis patients. Method A total 202 peritoneal dialysis patients were studied. Pre-dialysis and post-dialysis comorbid and their outcomes were recorded. Patients were then grouped into high comorbid group, low comorbid group and non comorbid group based on the Charlson Comorbidity Index (CCI). Inflammation, nutritional status and outcomes were compared among the groups.  Result Patients with higher CCI score showed worse malnutrition condition evaluated by SGA, lower serum albumin level, and higher serum CRP (P＜0.05). Kaplan-Meier survival analysis revealed a significant difference in cumulative survival rate among the 3 groups, and the cumulative survival rates were lower in CCI high group and CCI low group than in CCI zero group (χ2=37.048, P＜0.05). Cox regression analysis revealed that CCI, age, SGA and percentage of LBM were independent prognostic indicators (χ2=9.872, 5.836, 7.816 and 15.051, respectively, P＜0.05).  Conclusion Peritoneal dialysis patients with comorbid conditions may accompany with systemic inflammation and malnutrition during peritoneal dialysis, which may explain the increased mortality. Metrics

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The expression of peripheral blood CD36 and its clinical significance in patients with chronic kidney disease FANG Yan;ZHANG Yu;QIAN Jia-qi;DAI Hui-li;WANG Qin;MOU Shan;NI Zhao-hui;YAN Yu-cheng 2012, 11 (2):  68-72.  doi: 10.3969/j.issn.1671-4091.2012.01.00 Abstract ( 243 )   HTML ( 0 )   PDF (249KB) ( 137 )   【Abstract】Objective To investigate the expression of peripheral blood CD36 level, its influence factors, and its clinical significance in patients with chronic kidney disease. Methods A total of 77 chronic kidney disease (CKD) patients and 10 healthy subjects were included in this study. Clinical data was collected. Blood tests, echocardiogram and carotid artery ultrasound were taken. The number of CD36+ cells in whole blood was determined by a flow cytometer and compared among patients with CKD stage 1～3, Stage 4～5 and healthy subjects. Its correlations with lipid, inflammation indices, carotid plaques and left ventricular hypertrophy were analyzed.  Results The CD36+ level was significantly higher in patients at CKD stage 1～3 and CKD stage 4～5 than in control subjects (476.73±191.41×105/L, 1463.61±592.90×105/L and 68.55±12.73×105/L, respectively, P＜0.01), and was significantly higher in patients at CKD stage 4～5 than in patients at CKD stage 1～3 (P＜0.01). The CD36+ level was significantly higher in patients with left ventricular hypertrophy than in those without left ventricular hypertrophy (1255.07±704.20×105/L vs. 805.34±586.20×105 / L, P＜0.05). Multiple regression analysis showed that the CD36+ level in whole blood was an independent risk factor for carotid artery plaque (β=0.295, P=0.010). Multiple linear regression analysis showed that eGFR (β= -0.301, P＜0.01) and triglyceride (β= -0.294, P＜0.01) were the stronger independent determinants of the CD36+ level.  Conclusion The CD36+ level in whole blood was elevated in CKD patients. The increase of CD36+ level was closely associated with renal function deterioration and dyslipidemia, and might relate to left ventricular hypertrophy and atherosclerosis. Metrics

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Clinical use of the new type long-term cuffed Palindrome catheter in hemodialysis patients LI Ming-xu,ZHANG Zhi-yong,YU Yong-wu,CHEN Hong,LI Xin-xin,LI Hong-yan,MA Jun-hong,DONG Zhen,ZHOU Chun-hua 2012, 11 (2):  73-76.  doi: 10.3969/j.issn.1671-4091.2012.02.00 Abstract ( 400 )   HTML ( 4 )   PDF (235KB) ( 586 )   【Abstract】 Objective To compared dialysis adequacy, catheter function and complications among hemodialysis patients using the new type long-term dialysis catheter of Palindrome, those using permcath long-term dialysis catheter, and those using arteriovenous fistulas as the vascular access. Methods A total of 43 cases using Permcath long-term dialysis catheter with complete clinical data was assigned as Permcath group, 49 cases using Palindrome catheter with complete clinical data as Palindrome group, and 56 cases using arteriovenous fistula (AVF) with complete clinical data as AVF group. Their urea clearance (Kt/V), urea reduction rate (URR), the largest blood flow, catheter-related infection, catheter thrombosis formation, and the patency rate in a year were observed.  Results The maximum blood flow velocity was significantly higher in Palindrome group than in Permcath group. The rate of patients using long-term dialysis catheters as blood access was finally 49.2%, but was only 17.4% at the earlier dialysis course. Secondary kidney damages (metabolic disease, hypertension, ischemic nephropathy, etc.) accounted for 73.1% patients to use long-term dialysis catheters, and only 51.5% patients to use AVF (t= 13.064, P=0.000). Kt/V, URR and the catheter patency rate in a year were better in Palindrome group than in Permcath group (P=0.02, 0.007, 0.021, respectively), but were similar between Palindrome group and AVF group. Blood access related infection was higher in Palindrome group than in AVF group (χ2=4.5946, P=0.032). The prevalence of thrombosis was 30.6% in Palindrome group, lower than that in Permcath group (48.8%, χ2=7.8125, P=0.005), and higher than that in AVF group (5.4%, χ2=5.9019, P=0.015).  Conclusion The effects of long-term Palindrome dialysis catheter on maximum blood flow, dialysis adequacy and one year patency rate were superior to Permcath catheter, and were similar to AVF. However, Palindrome catheter had higher prevalence of infection and thrombosis. Therefore, long-term Palindrome dialysis catheter can be used as the better complement but not the best approach for blood access in patients on maintenance hemodialysis. Metrics

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The effect of antibiotic lock therapy with vancomycin on central venous catheter-related bloodstream staphylococcus aureus infection HUANG Zhi-fang;YANG Ai-jun;ZHANG Chi-bing;LUN Li-de. 2012, 11 (2):  77-80.  doi: 10.3969/j.issn.1671-4091.2012.02.00 Abstract ( 610 )   HTML ( 1 )   PDF (308KB) ( 258 )   【Abstract】 Objective To investigate the effect of vancomycin to lock catheter on central venous catheter-related bloodstream infection (CRBSI) due to staphylococcus aureus. Methods A total of 20 patients with CRBSI due to staphylococcus aureus in our center were included in this study. All patients were used long-term central venous catheter for hemodialysis. Antibiotic lock therapy alternately with vancomycin and heparin every 6 hours was used for catheter salvage. In addition to antibiotic lock therapy, systemic vancomycin therapy was administered to all patients. Results   The percentage of diabetic nephropathy was higher in CRBSI group than in control group (45% vs. 19.6%, χ2=4.73, P＜0.05). Of the 20 patients with CRBSI, 14 patients recovered by using the antibiotic lock therapy (70%), and the catheters were successfully salvaged; the remaining 6 patients did not respond to the therapy, of whom 5 underwent catheter removal and one died of infective endocarditis. Serum hemoglobin (96.5±19.2 g/L vs. 92.2±22.1 g/L, t=2.4, P＜0.05) and albumin (35.6±3.8 g/L vs. 32.7±4.2 g/L, t =2.3, P＜0.05) levels were higher in responsive group than in no-responsive group.  Conclusion Antibiotic lock therapy alternately with vancomycin and heparin can effectively reduce catheter removal rate caused by CRBSI due to staphylococcus aureus. Metrics

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Comparison of quality of life in renal transplantation and peritoneal dialysis patients: a case-control study JIN San-li;PANG Dong;YANG Ping;HU Jing-min;WANG Xiao-yue;ZHANG Xie;GENG Yan;LU Qian 2012, 11 (2):  81-84.  doi: 10.3969/j.issn.1671-4091.2012.02.00 Abstract ( 266 )   HTML ( 0 )   PDF (224KB) ( 260 )   【Abstract】 Objective To compare the quality of life between renal transplantation (RT) and peritoneal dialysis (PD) patients. Methods A case-control study was used, matching sex, age, education level, employment, means of payment and renal replacement therapy duration in two groups. 58 pairs were selected to fill out Short Form 36 Health Survey Questionnaire (SF-36) which was used to evaluate their quality of life.  Results There were no significant differences in physical component summary and mental component summary between two groups. Physical functioning (t=3.060, P=0.003), general health (t=2.579, P=0.011) and vitality (t=2.610, P=0.011) of RT patients were higher than those of PD patients, whereas role-physical (z=3.917, P=0.000) was lower than PD patients.  Conclusions There was no significant difference in the overall quality of life between two groups. High-quality disease management would benefit to improve the quality of life. We should pay more attention to the disease management, especially for RT patients. Metrics

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Multi-detector computed tomography venography in the assessment of dysfunction of tunneled hemodialysis central vein catheters CUI Tian-lei;LI Zhen-lin;Zeng Xiao-qian;YANG Ying-ying;FU Ping 2012, 11 (2):  85-87.  doi: 10.3969/j.issn.1671-4091.2012.02.00 Abstract ( 188 )   HTML ( 3 )   PDF (199KB) ( 170 )   【Abstract】Objective To evaluate the value of multi-detector computed tomography venography (MDCTV) in the assessment of tunneled hemodialysis central vein catheters (TCCs) dysfunction. 　Method A total of 31 patients who had TCCs dysfunction without abnormality found by X-ray and ultrasound were enrolled. MDCTV was conducted to observe the position of catheters and to detect central venous stenosis, thrombosis, and fibrin sheath formation. Proper intervention was given according to MDCTV results.　Results MDCTV found catheter malposition in 10 cases, central venous stenosis in 5 cases, central venous thrombosis in 4 cases, fibrin sheath formation in 7 cases, and negative in 5 cases. The blood flow on hemodialysis reached over 300ml/min after proper interventions given.  Conclusion MDCTV provided a valuable way to evaluate dysfunction of TCCs. Metrics

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Clinical comparison between heat and chemical disinfection for dialysis water supply system JIAO Yan;BAI Ying;FAN De-lun;WANG Hong-Xia 2012, 11 (2):  102-103.  doi: 10.3969/j.issn.1671-4091.2012.02.00 Abstract ( 244 )   HTML ( 0 )   PDF (196KB) ( 331 )   【Abstract】 Objective To investigate the effect of different kind of disinfections for dialysis water supplying system. Methods We tested and compared the amount of bacteria and endotoxin in water by using the chemical (formaldehyde) disinfection, and heat sterilization with the heat frequencies of once every day, every 3 days and every week.  Results The amount of bacteria and endotoxin were 38.90±36.32 CFU/ml and 0.42±0.38 EU/ml, respectively, in water with heat sterilization, and were 42.67±39.04 CFU/ml and 0.42±0.38 EU/ml, respectively, in water with chemical disinfection, without statistical differences in amount of bacteria and endotoxin between the two methods. The amount of bacteria and endotoxin were 38.27±37.11 CFU/ml and 0.42±0.38 EU/ml, respectively, in water with heat sterilization once a day, 39.11±34.18 CFU/ml and 0.39±0.35 EU/ml, respectively, in water with heat sterilization once every 3 days, and 42.08±39.87 CFU/ml and 0.42±0.41 EU/ml, respectively, once every week, without statistical differences in amount of bacteria and endotoxin among the three methods. Conclusion It is effective and simple for dialysis water supply system to use heat sterilization combined with intermittent formaldehyde chemical disinfection. Metrics