Chinese Journal of Blood Purification

12 June 2012, Volume 11 Issue 06 Previous Issue    Next Issue

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KCNMB1 gene E65K is associated with eGFR in males from a community-based Chinese cohort HAN Jia;LIU Ying;WANG Fang;ZHANG Lu-xia;CHEN Yu-qing 2012, 11 (06):  235-238.  Abstract ( 302 )   HTML ( 0 )   PDF (216KB) ( 179 )   Metrics

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Issues should be concerned about in elderly patients on maintenance hemodialysis JIA Qiang 2012, 11 (06):  291-292.  Abstract ( 343 )   HTML ( 0 )   Metrics

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Intensive ultrafiltration on hypertension in elderly hemodialysis patients DENG Ying-hui;WANG Jun-mei;LIN Na;JIA Qiang 2012, 11 (06):  293-297.  doi: 10.3969/j.issn.1671-4091.2012.06.00 Abstract ( 396 )   HTML ( 0 )   PDF (208KB) ( 433 )   【Abstract】 Objective To investigate whether additional ultrafiltration to further reduce dry body weight improves blood pressure (BP) control among elderly hemodialysis patients with hypertension. Methods Thirty-four aged maintenance hemodialysis (MHD) patients with hypertension were divided into control and ultrafiltration groups. In control group, conventional dialysis dose and ultrafiltration volume were used. In ultrafiltration group, reduction of dry body weight to a minimal tolerable level was gradually achieved by slightly increasing ultrafiltration volume. After 28 weeks, dry body weight and BP were compared between the two groups. Results In control group and ultrafiltration group at the baseline condition, dry body weight was 64.81±13.26 kg and 64.49±13.83 kg (t=0.508, P=0.618), systolic BP was 155.12±13.77 mmHg and 155.47±9.92 mmHg (t= 0.086, P=0.932), and diastolic BP was 78.59±11.41 mmHg and 78.71±10.96 mmHg (t=0.031, P= 0.976), respectively, without significant differences between the two groups. In control group and ultrafiltration group after the treatment for 28 weeks, dry body weight was 65.56±13.75 kg and 62.22±13.34 kg (reduced by 0.36±1.12 kg and 2.27±1.03 kg), systolic BP before dialysis session was 155.29±12.73 mmHg and 139.82±4.14 mmHg (reduced by 0.53±4.57 mmHg and 14.29±10.55 mmHg), and diastolic BP before dialysis session was 79.12±9.84 mmHg and 68.24±3.57 mmHg (reduced by 0.53±4.57 mmHg and 9.00±9.46 mmHg), respectively. Patients in ultrafiltration group showed more reduction in dry body weight (t=3.785, P=0.002), systolic BP (t=4.767, P=0.000), and diastolic BP (t=4.298, P=0.000) than those in control group. Conclusion The decrease of dry body weight through intensive ultrafiltration is an effective approach to improve BP control in elderly hemodialysis patients with hypertension. Metrics

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Survival analysis of elderly patients on maintenance hemodialysis LV Wen-Lv;TENG Jie;ZOU Jian-Zhou;Zhong Yi-Hong;DING Xiao-Qiang 2012, 11 (06):  298-302.  doi: 10.3969/j.issn.1671-4091.2012.06.00 Abstract ( 564 )   HTML ( 0 )   【Abstract】 Objective To perform survival analysis and to explore the main risk factors affecting survival in elderly patients on maintenance hemodialysis (MHD). Methods Incident patients with end stage of renal disease starting hemodialysis between 1 January 2005 and 31 December 2009 and followed up through 31 December 2010 were enrolled in this retrospective cohort study. Survival analysis was performed using Kaplan-Meier method and Cox regression model.  Results A total of 131 patients were included in this study. The median follow-up period was 25 months (14-41 months) from initiation of dialysis, and 52 patients died in the follow-up period. The median survival time was 48 months (37.72-58.28 months). The main causes of death were congestive heart failure, infection and cerebrovascular disease. In the death cases, the age when dialysis began was older. More patients were found to have congestive heart failure and cerebrovascular disease history before dialysis, Charlson co-morbidity index (CCI) ≥5, catheters for hemodialysis vascular access, and dialysis due to heart failure. The estimated glomerular filtration rate (eGFR) at the initiation of dialysis increased significantly. The proportion of patients with CCI=3-4 was lower. In addition, urine volume, serum creatinine and serum albumin at initiation of dialysis were significantly lower than the survival cases. Kaplan-Meier survival curve revealed that the 1-year, 2-year, 3-year, 4-year and 5-year survival rate of elderly MHD patients was 80.9%, 74.6%, 63.2%, 48.0% and 33.9%, respectively. Cox regression model indicated that older age (HR=1.070, 95% CI 1.015-1.127, P<0.05), history of cerebrovascular accident before dialysis (HR=2.052, 95% CI 1.035-4.068, P<0.05), history of congestive heart failure before dialysis (HR=1.888, 95% CI 1.029-3.463, P<0.05), CCI ≥5 before dialysis (HR=2.675, 95% CI 1.323-5.411, P<0.05) and lower serum albumin at initiation of dialysis (HR=0.949, 95% CI 0.901-0.999, P<0.05) were the main risk factors for survival of elderly MHD patients.  Conclusions The main causes of death in elderly MHD patients were cardiovascular disease, infection and cerebrovascular disease. Older age, malnutrition status, and co-morbidities at initiation of dialysis may be the main risk factors for survival of elderly MHD patients. Metrics

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Parathyroid dysfunction and its related factors in elderly patients on hemodialysis TIAN Jun;LU Jian-rao;YI Yang; YU Xiu-zhi;GU Bo 2012, 11 (06):  303-306.  doi: 10.3969/j.issn.1671-4091.2012.06.00 Abstract ( 376 )   HTML ( 1 )   PDF (222KB) ( 182 )   【Abstract】 Objective To observe abnormal calcium and phosphorus metabolism, parathyroid dysfunction, and their related factors in elderly maintenance hemodialysis (MHD) patients. Methods A total of 286 MHD patients with stable disease status were recruited from the 455th Hospital of PLA and Shanghai Jing’an District Central Hospital during the period of January 2010 to December 2010. They were divided into two groups: elderly group (≥65 years of age) and non-elderly group (＜65 years of age). Before dialysis, fasting blood specimens were drawn to assay hemoglobin (Hb), serum creatinine (Scr), blood urea nitrogen (BUN), calcium, phosphorus, intact parathyroid hormone (iPTH), high-sensitivity C-reactive protein (hsCRP), albumin (Alb), etc. After dialysis, serum BUN, ultrafiltration volume, body weight change, and dialysis time were recorded. Serum albumin corrected calcium (Ac-Ca) and urea removal index (Kt/V) were then calculated.  Results Elderly MHD patients accounted for 51.4% of the total hemodialysis cases over this observation period. In elderly group, the major causes of renal failure were hypertension (35.4%), followed by chronic glomerulonephritis (21.1%) and diabetes (19.7%). In non-elderly group, the main causes of renal failure were chronic glomerulonephritis (43.2%), followed by diabetes (23.7%) and hypertension (12.2%). When comparison was made between elderly group and non-elderly group, patients in elderly group were found to have shorter dialysis age, less dry body weight, less cases treated with vitamin D and/or calcium, higher systolic pressure, lower diastolic pressure, lower levels of serum BUN, Scr, P, iPTH, Alb and standard protein nitrogen present rate (nPNA), higher hsCRP (present in 55.8% patients, P＜0.05), lower iPTH (＜15 pg/L in 36.7% patients, P＜0.05). However, the differences in levels of Hb, AC-Ca and Kt/V were insignificant between the two groups (P＞0.05). Logistic multiple regression analysis demonstrated that older age, lower levels of plasma phosphorus, albumin and nPNA were the independent risk factors for secondary hypoparathyroidism in elderly MHD patients. Conclusion Most elderly MHD patients were complicated with hypoparathyroidism, which may be related to older age, malnutrition and other factors. Hypoparathyroidism in elderly MHD patients needs to be further studied. Metrics

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Investigation on death events in end-stage renal disease patients undergoing hemodialysis YANG Ji-hong;WU Hua;ZHANG Yan-jing;WANG Song-lan;SUN Ying;LI Zhan;LI Tian-hui 2012, 11 (06):  307-310.  doi: 10.3969/j.issn.1671-4091.2012.06.00 Abstract ( 352 )   HTML ( 0 )   PDF (201KB) ( 266 )   【Abstract】Objective To analyze the characteristics of the maintenance hemodialysis (MHD) patients died in this hospital from January 2005 to December 2011, and to investigate the risk factors relating to the death in elderly MHD patients.  Methods Retrospective study on MHD patients in the period from January 2005 to December 2011 found 83 death cases that had treated with MHD for more than 3 months. The annual number of death cases and mortality rate were then calculated. These cases were divided into 3 groups: middle age group (<60 years of age), elderly group (60 to 79 years of age), and very elderly group (>80 years of age). Demographic features, diabetes, dialysis age and cause of death were analyzed among the three groups.  Results The annual mortality rate in MHD patients from 2005 to 2011 was 11.0%, 10.9%, 8.3%, 8.1%, 10.1%, 8.7% and 6.34%, respectively. Of the 83 death cases, 49 cases were males and 34 cases were females, with the mean age of 71.8±12.0 years (42-94 years). Fourteen cases were in middle age group, 46 cases in elderly group, and 23 cases in very elderly group. Sex difference was insignificant among the three groups. Dialysis age was longer in middle age group, and was shorter in elderly group. Diabetic nephropathy was frequently found in elderly group. The causes of death were different. In middle age group, 50% cases died of cerebral vascular disease, especially cerebral hemorrhage. In very elderly group, 56% cases died of septic shock. In elderly group, death was resulted from various causes, including septic shock, cardiac infarction or heart failure, tumor, malnutrition-inflammation-atherosclerosis syndrome (MIA syndrome) and sudden death (in order of the prevalence rate). Conclusions Most of the death cases in this dialysis center were older than 60 years of age. Diabetes played a role more important than age on the prognosis of MHD patients. Cerebral vascular disease was the major cause of death in middle age patients, and septic shock is the main cause in very elderly patients. The causes leading to death in elderly patients were various, including cardiovascular disease, infection, tumor and MIA syndromeelderly. Metrics

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Time-averaged anxiety scores independently predict the risk for peritoneal dialysis-associated peritonitis CHEN Yong-jun;WANG Huan;XU Ying;XU Rong;DONG Jie 2012, 11 (06):  311-314.  doi: 10.3969/j.issn.1671-4091.2012.06.00 Abstract ( 299 )   HTML ( 1 )   PDF (219KB) ( 204 )   【Abstract】Objectives To explore the impact of depression and anxiety at baseline and during follow-up period on the risk of peritonitis in patients on peritoneal dialysis (PD), and if this impact is confounded by clinical characteristics and co-morbidities. Methods This study included 240 incident patients who started PD between July 2002 and February 2007. All patients were followed up until June 2011. The first episode of peritonitis was viewed as outcome event. Death, transfer to hemodialysis and renal transplantation of the patients were censored. Demographics, biochemical data and residual renal function were collected at the baseline. The Hamilton depression and anxiety scales were repeatedly measured at baseline and after PD for one, two, and three years, to represent baseline and time-averaged depression and anxiety levels.  Results In the 240 incident PD patients, the mean age was 59.2±14.2 years, and 40% patients were males. They were followed up for 51±25 months. Sixty-four patients (26.7%) died during the follow-up period of 34.7 months, and 110 of 240 (45.8%) patients died at the end of study. The median interval from the initiation of PD to the first episode of peritonitis was 31 (18~61) months. Multivariate COX regression analysis indicated that time-averaged anxiety scores were the independent predictors of peritonitis even after adjustment by age, gender, body mass index, education and income levels, hemoglobin, serum albumin, residual renal function, and Charlson index (HR=1.057, with the range of 1.022-1.094, P=0.001). However, neither anxiety nor depression scores at baseline could predict peritonitis risk. Conclusions Time-averaged anxiety scores independently predict the risk for peritonitis. Therefore, we should pay more attention to the anxiety status during the long-term follow-up in patients on PD. Metrics

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Clinical research on cognitive dysfunction by Montreal cognitive assessment and the event-related brain potential P300 in hemodialysis patients HOU Guo-cun; SUN Xiou-li;LI Jing;WU Hong-mei;HAN Xiaowen;LIU Ai-ying;YE Fuli 2012, 11 (06):  315-317.  doi: 10.3969/j.issn.1671-4091.2012.06.00 Abstract ( 322 )   HTML ( 1 )   PDF (189KB) ( 263 )   【Abstract】 Objective To assess the value of the Montreal cognitive assessment (MoCA) and the event-related brain potential P300 in screening mild cognitive impairment (MCI) in maintenance hemodialysis (MHD) patients.  Methods Twenty MHD patients and 20 healthy controls were examined for P300 and cognitive performance by the Chinese version of MoCA. Results MHD patients with MCI had significantly lower scores than the healthy subjects in all MoCA sub-items except for name (t= -1.18, P =0.246) and fixed orientation sub-items (t= -0.38, P=0.70). The latency of P300 was significantly longer, and the amplitude of P300 was significantly lower in MHD patients than in normal subjects (P＜0.01). The latency of P300 was negatively correlated to the sub-item scores of visual spatial and executive function, attention and delayed recall, and the total MoCA score (P＜0.01). The amplitude of P300 was positively correlated to the sub-item scores of visual spatial and executive function, attention and delayed recall, and the total MoCA score (P＜0.01).  Conclusion P300 and MoCA can comprehensively assess MCI in MHD patients, and can help identify sub-clinical cognition damage. Metrics

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Studies on carotid artery atherosclerosis and its related factors in maintenance hemodialysis patients GUO Mei-hua;PI Xiao-ling;XU Qing-fang;FU Li-qian 2012, 11 (06):  318-320.  doi: 10.3969/j.issn.1671-4091.2012.06.00 Abstract ( 289 )   HTML ( 0 )   PDF (200KB) ( 211 )   【Abstract】Objective To understand the formation of carotid artery atherosclerosis (CAS) and its potential causes in maintenance hemodialysis (MHD) patients. Methods We recruited 55 MHD cases and measured their physical dimensions of bilateral carotid arteries by using high resolution ultrasonography. They were then assigned into plaque positive group or plaque negative group. Data were compared between the two groups. Logistic regression analysis was performed to disclose the potential factors leading to plaque generation.  Results Atherosclerotic plaque was found in 69.09% of the 55 MHD cases. The intima-media thickness (IMT) of the carotid arteries was significant larger in plaque positive group than in negative group (P=0.001). Other significant differences between the two groups included age (P=0.000), hemoglobin (Hb) level (P=0.01) and C reactive protein (CRP) level (P=0.002). Logistic regression analysis indicated that older age (β=1.102, P=0.014) and higher CRP level (β=0.138, P=0.026) were the two major contribution factors for atherosclerotic plaque formation.  Conclusions MHD patients have higher potential of CAS. Older age and higher CRP level are the two major risk factors for atherosclerotic plaque formation in carotid artery. Metrics

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Investigation on anxiety and depression and their relevant factors in continuous ambulatory peritoneal dialysis patients LI Qin-jun;ZHANG Chang-ling;ZHANG Shu-guang;WANG Ling 2012, 11 (06):  321-324.  doi: 10.3969/j.issn.1671-4091.2012.06.00 Abstract ( 376 )   HTML ( 0 )   PDF (214KB) ( 255 )   【Abstract】Objective To investigate the incidence of depression and anxiety and their related factors in continuous ambulatory peritoneal dialysis (CAPD) patients, and to evaluate the correlation of depression and anxiety with Engle coefficient, treatment comp1iance, complication, and nutrition status in these patients. Methods Seventy-five outpatients with end-stage renal disease and treated with CAPD were recruited in this cross-sectional study. Their demographic data and primary disease were collected. Patient’s family income was assessed by Engle coefficient. Anxiety and depression were rated by the Hamilton depression rating scale (HAMD) and Hamilton anxiety rating scale (HAMA). Residual renal function was evaluated by creatinine clearance calculated by the MDRD equation. Nutrition status was measured by the subjective global assessment (SGA) in combination with blood biochemical indices. We also estimated their complications by Charlson coefficient, and their activities by EOCG/Karnofsky activity indices. Results In the 75 outpatients recruited from this dialysis center, 28 cases (37.33%) were identified as having depression and/or anxiety symptoms. The occurrence of depression and anxiety symptoms related to the disease status and income level (P＜0.05). CAPD patients with depression or anxiety had less activities, poor compliance, more complications, and higher malnutrition rate. Psychological symptoms correlated negatively with hemoglobin, serum albumin, urea nitrogen and Kt/V (P＜0.01), and positively with nutritional status (P＜0.01). On the other hand, psychological problems significantly affected nutritional status (OR= 3.610, P＜0.05).  Conclusions Inuremic patients on CAPD, depressive and anxious symptoms were frequently encountered. Most CAPD patients with psychological symptoms were associated with malnutrition, poor compliance or other complications. Moreover, psychological symptoms induced the presence of malnutrition. Psychological symptoms related not only to the primary disease and its complications, but also to patient’s income level.  Appropriate treatment of depression and anxiety may be helpful for the effectiveness of peritoneal dialysis in these patients. Metrics