Chinese Journal of Blood Purification

12 May 2012, Volume 11 Issue 05 Previous Issue    Next Issue

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Current status of dialysis therapy in Shanghai (results from Shanghai Renal Registry, 2011) ZHANG Wei-ming;QIAN Jia-qi 2012, 11 (05):  233-236.  doi: 10.3969/j.issn.1671-4091.2012.05.00 Abstract ( 442 )   HTML ( 3 )   PDF (193KB) ( 621 )   【Abstract】Objective This report is based on the data (up to December 31, 2010) from Shanghai Renal Registry Network. Our aim is to explore the current status of dialysis in Shanghai.  Methods Data are collected from Shanghai Renal Registry Network in 2010. All of dialysis centers (n=63) in Shanghai enter the registry system.  Results The incidence of new dialysis patients was 1621 (114.8 patients per million), of which 75.8% were on hemodialysis (HD) and 24.2% on peritoneal dialysis (PD). The point prevalence of dialysis patients on Dec 31, 2010 is 10508 (744.0 patients per million), of which 80.6% were on hemodialysis (HD) and 19.4% on peritoneal dialysis (PD). The main cause for end stage renal disease (ESRD) is chronic glomerulonephritis. However, the incidence of diabetes is increasing from 17.2% to 19.5% within four years, and account for the second major cause for ESRD. Death rate is decreased from 8.4% in 2006 to 4.6% in 2010. Dialysis adequacy, hepatitis infection control and anemia treatment are improved.  Conclusions Dialysis population is continuously growing during recently years in Shanghai. Chronic glomerulonephritis is the main cause for ESRD patients. The main dialysis modality for ESRD patients is hemodialysis in Shanghai Metrics

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Analysis of related factors for seasonal variation of serum albumin in patients on peritoneal dialysis LI Yan-jun;ZUO Li;GAN Hong-bing;DONG Jie 2012, 11 (05):  237-240.  doi: 10.3969/j.issn.1671-4091.2012.05.00 Abstract ( 300 )   HTML ( 0 )   PDF (220KB) ( 165 )   【Abstract】Objectives To observe the seasonal variation of serum albumin in peritoneal dialysis patients, and to analyze its related factors including dietary protein intake and protein loss. Methods We enrolled 41 clinically stable patients on peritoneal dialysis in our Peritoneal Dialysis Center between Sep. 2006 and Aug. 2007. Serum albumin, dietary protein intake and protein loss through urine and dialysate were recorded every one to two months, and the average values in the four seasons were calculated. Results Forty-one patients with the age of 59.69±14.23 yrs and with the dialysis duration of 35.85 months (6-104 month) were enrolled. The seasonal variation of serum albumin was obtained after adjusted for age, sex, dialysis duration, protein intake and total protein loss, with the nadir value in summer (35.45±0.38g/l) and peak value in winter (37.19±0.39g/l; P＜0.001, compared with the value in summer). There were no significant differences in the changes of dietary protein intake and total protein loss throughout the year. Next, we divided patients into two groups according to the median of age. The seasonal variation of serum albumin was more obvious in lower age group (age ≤ 62 years) than in elder age group (P＜0.05), and the differences in serum albumin in cold and warm season were 2.35g/l and 1.20g/l, respectively. Conclusions The seasonal variation of serum albumin in peritoneal dialysis can not be explained by the changes of dietary protein intake and protein loss. The extent of seasonal variation in serum albumin was more obvious in patients less than 62 yrs. The mechanism underlying these phenomena remains to be further explored. Metrics

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Ultrafiltration capacity and peritoneal fluid kinetics in continuous ambulatory peritoneal dialysis patients ZHE Xing-wei;LUO Jie;LIU Zhen-hua;BAI Yun-kai;XIONG Li-yan;DAN Yi-sheng;CHENG Lei;TIAN Xing-kui;WANG Tao 2012, 11 (05):  241-244.  Abstract ( 244 )   HTML ( 0 )   PDF (314KB) ( 185 )   【Abstract】Objective Volume control is critical for peritoneal dialysis. Although peritoneal equilibration test (PET) has been used to clarify the peritoneal membrane characteristics, it is unable to adequately predict peritoneal fluid removal and appropriately optimize the dwelling time. In the present study, we applied computer simulation and performed a more detailed evaluation of the fluid kinetics in patients with different ultrafiltration (UF) capacity.  Methods Patients who used three to four exchanges of 2.5% glucose dialysate per day (poor UF capacity group) and patients who used three to four exchanges of 1.5% glucose dialysate per day (good UF capacity group) to achieve adequate amount of peritoneal fluid removal were included in the present analysis. All included patients were asked to record appropriately their dialysis exchanges for assessment of their peritoneal fluid transport characteristics.  Results Seventeen continuous ambulatory peritoneal dialysis patients were selected in the present study, nine in poor UF capacity group and eight in good UF capacity group. Patients in poor UF capacity group had significantly higher daily glucose exposure (p＜0.01), higher dialysate-to-plasma ratio of creatinine (D/P creatinine) (p＜0.05) values, and higher peritoneal fluid absorption rate (Ke) (P＜0.01), as compared to patients with good UF capacity. Conclusions Our results suggest that patients with poor UF capacity have significantly higher peritoneal small solute transport rate, and more importantly, higher peritoneal fluid absorption rate as compared to patients with good UF capacity. Metrics

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The effect of heparin saline used for catheter locking after heparin-free dialysis on coagulation parameters in patients with high bleeding risk CHEN Feng-kun;LI Ji-jun;CHEN Pu;ZHAO Chang-zheng;GONG Hong-ying;YAO Dong-fang 2012, 11 (05):  245-248.  doi: 10.3969/j.issn.1671-4091.2012.05.00 Abstract ( 244 )   HTML ( 0 )   PDF (221KB) ( 321 )   【Abstract】 Objective To understand the effect of heparin saline for catheter locking after heparin-free dialysis on patients with bleeding risk by comparison of coagulation parameters before and after heparin-free dialysis and after heparin saline filling in catheter for 30 minutes with the baseline data in non-dialysis days.  Method A total of 26 patients were treated with heparin-free dialysis in our department from June to September, 2011. Their catheters were fully filled with 1:1 heparin saline (3,125U/ml) according to the volume marked on them. The coagulation parameters in non-dialysis days were recorded as the baseline data, and blood samples were taken at the time points of 5 minutes after starting dialysis, after dialysis but before catheter locking, and 30 minutes after catheter-locking. Results Activated partial thromboplastin time (APTT) at the 4 time points mentioned above were 28.75 (26.60-31.63), 32.65 (28.30-54.03), 28.25 (26.53-32.03), and 47.90 (35.80-199.65) seconds, respectively. There were no differences between the data after dialysis but before catheter locking and at baseline condition. However, the values after starting dialysis for 5 minutes and after filling the catheter with heparin saline for 30 minutes were longer than the baseline value (P=0.0003 and 0.0001, respectively), and their median values were also longer than the baseline value by 13.6% and 66.7%, respectively. After filling the catheters with heparin saline, other parameters including prothrombin time (PT) and international normalized ratio (INR) were longer than the values before heparin saline filling the catheters (P≤0.0001). Conclusion The effect of routine heparin-free dialysis on coagulation parameters is trivial. However, 1:1 heparin saline for locking the catheters leads to a significant increase of APTT beginning from starting dialysis to a certain period of time after dialysis. Therefore, heparin saline used for locking catheters may increase bleeding potentials in patients with higher bleeding risk. Metrics

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The effect of long session hemodialysis on sleep quality in maintenance hemodialysis patients DAI Wen-di;ZHANG Dong-liang;LIU Wen-hu. 2012, 11 (05):  249-251.  doi: 10.3969/j.issn.1671-4091.2012.05.00 Abstract ( 268 )   HTML ( 0 )   PDF (181KB) ( 190 )   【Abstract】 Objective To investigate the sleep quality in patients on maintenance hemodialysis of long session hemodialysis. Methods sleep quality was evaluated using the Athens Insomnia Scale (AIS), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS). Forty patients on maintenance hemodialysis were equally divided into two groups according to their scores of sleep quality: hemodialysis (HD) group, and long session hemodialysis (LSHD) group. In HD group, hemodialysis was performed 4h a session and three times a week. In LSHD group, hemodialysis was delivered 8h a session and three times a week. The test lasted for 6 months. Results Kt/V was significant higher in LSHD group than in HD group (P＜0.05). Significant differences in PSQI, ESS scores were found between the two groups.  Conclusion Sleep disorder is very common in hemodialysis patients. Increase of hemodialysis dose can improve sleep quality. Metrics

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Effect of high flux hemodialysis on nutrition and lipid metabolism in maintenance hemodialysis patients WANG Bei;WANG Kai. 2012, 11 (05):  252-255.  doi: 10.3969/j.issn.1671-4091.2012.05.00 Abstract ( 231 )   HTML ( 0 )   PDF (225KB) ( 153 )   【Abstract】 Objective To investigate the effect of high flux hemodialysis on nutrition and lipid metabolism in maintenance hemodialysis (MHD) patients. Methods A total of 60 MHD patients were randomly divided into two groups: high flux hemodialysis (HFHD) group, and low flux hemodialysis (LFHD) group. The treatment lasted for 6 months. Changes of the parameters for nutrition and lipid metabolism were observed before and after the treatment in the two groups. Results After 6 months, the Modified Quantitative Subjective Global Assessment score, EPO dose, β2-MG, hsCRP, iPTH, TG and apolipoprotein CIII were significantly lower in HFHD group than in LFHD group, and than in HFHD group before the treatment (P＜0.05), while ALB and IGF-1 were significantly higher (P＜0.05) in HFHD group. Conclusions   High flux hemodialysis can improve nutritional status and dyslipidema in MHD patients. Metrics

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Comparison of dialysis adequacy and access-related complications among hemodialysis patients with different vascular access approaches ZHANG Yong;MENG Xi;HE Wei-mei;CAO Li-yin;YU Yue-ming 2012, 11 (05):  256-258.  doi: 10.3969/j.issn.1671-4091.2012.05.00 Abstract ( 248 )   HTML ( 0 )   PDF (193KB) ( 364 )   【Abstract】Objective To compare the dialysis adequacy and complications in hemodialysis patients with different vascular access, and try to find out an ideal vascular access approach.  Methods Patients who underwent long-term hemodialysis access operation between June, 2009 and June, 2010 in Department of Nephrology General Hospital of PLA were enrolled in this study. Kt/V value and the morbidity of access-related complications were evaluated and compared in a follow-up period of 12 months among patients using vascular access of native arteriovenous fistula (AVF), and cuffed and tunneled catheter (CTC) in an internal jugular vein.  Results In the 74 maintenance hemodialysis patients, 53 cases used native AVF, and 21 cases used CTC as the long-term vascular access for hemodialysis. Patients using native AVF for vascular access were younger, and had lower infection rate than the patients using CTC for the access (P<0.05). Thrombosis rate was lower in AVF group than in the CTC group, but the difference was insignificant (P>0.05).  Conclusion Patients using native AVF for vascular access for hemodialysis were younger, and had lower rate of thrombosis and infection. Therefore, native AVF is preferable for long-term vascular access. When this type of vascular access is difficult to be established, CTC can also be chosen with relatively satisfactory effect of dialysis. Metrics

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Impact of hemodialysis frequency on heart rate variability in patients with end stage of renal disease CHEN Xiao-wan;SHEN Yang;LI Zhi 2012, 11 (05):  259-262.  doi: 10.3969/j.issn.1671-4091.2012.05.00 Abstract ( 245 )   HTML ( 0 )   PDF (203KB) ( 175 )   【Abstract】Aims To explore the impact of hemodialysis and hemodialysis frequency on heart rate variability (HRV) in patients with end stage renal disease.  Methods A total of 107 patients treated with regular hemodialysis were enrolled in this study. They were assigned into 3 groups according to the hemodialysis frequency: Q2d group (once every 2 days), Q3d group (once every 3 days) and Q4d group (once every 4 days). The parameters of HRV were compared between the 3 groups. Results The parameters of HRV were increase after hemodialysis in all patients (P＜0.05), especially in Q2d and Q3d groups (P＜0.01). Analysis of variance showed that there were significant differences in HRV parameters between the 3 groups before and after hemodialysis (P＜0.05). HRV tended downwards when hemodialysis frequency decreased.  Conclusions Long term and adequate hemodialysis may be useful for the improvement of heart autonomic function. Metrics

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Early intervention on high phosphorous induced vascular calcification by sodium thiosulfate administration in rats with remnant kidney YU Yi;HUANG Tian. 2012, 11 (05):  263-267.  doi: 10.3969/j.issn.1671-4091.2012.05.00 Abstract ( 224 )   HTML ( 0 )   PDF (347KB) ( 238 )   【Abstract】 Objective To observe the early effect of sodium thiosulfate (STS) on the progression of high phosphorous induced vascular calcification in remnant kidney rats.  Methods  SD rats underwent 5/6 nephrectomy or sham operation. The rats were then fed with high phosphorous or normal diet for 16 weeks. They were divided into 5 groups: (1) rats with sham operation and receiving normal phosphorous diet (SNP, n=7), (2) rats with sham operation rats receiving high phosphorous diet (SHP, n=7), (3) remnant kidney rats receiving normal phosphorous diet (NNP, n=7), (4) remnant kidney rats receiving high phosphorous diet (NHP, n=7), and (5) remnant kidney rats receiving high phosphorous diet and STS (THP, n=7). STS was given intraperitoneally three times a week for 16 weeks. At the 16th week, serum creatinine, urea nitrogen, uric acid, calcium and phosphorus were measured, and thoracic aorta was removed. Vessels were examined for calcification by HE and von kossa staining, and for the expression of Pit-1 and Cbfα1 by immunohistochemistry.  Results  After 16 weeks, urine protein, and serum urea nitrogen, creatinine, uric acid and phosphorus levels were significantly different among the 5 groups (F=19.057, 43,527, 26.688,40.324 and7.676, respectively; P＜0.01). These parameters were higher in NHP group than in SNP, SHP and NNP groups (P＜0.05). HE and von kossa staining showed more evident vascular calcification in NHP group than in SNP, SHP and NNP groups. The expressions of Pit-1 and Cbfα1 were significantly different among the 5 groups (F=8.259 and 5.91, respectively; P＜0.01). Pit-1 and Cbfα1 expressions were significantly higher in NHP group than in SNP group (P＜0.01). The positive area ratios of Pit-1 and Cbfα1 were correlated with serum phosphorus level (r=0.344 and 0.376, respectively; P＜0.05). Serum creatinine, urea nitrogen, uric acid, phosphorus and urine protein levels were significantly lower in THP (STS treatment) group than in NHP group (P＜0.05). Also, the expressions of Pit-1 and Cbfα1 on aorta were significantly lower in SHP group than in NHP group (P＜0.01), while aorta calcification was alleviated partly in SHP group.  Conclusion  We successfully established a vascular calcification model in remnant kidney rats. STS treatment decreased serum phosphate, improved renal function, and delayed the progression of vascular calcification. Its effect is encouraging, but the underlying mechanisms require to be further studied. Metrics

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The changes of epidemiological features in patients on maintenance hemodialysis LAN Lei;WANG Peng;REN Wei;DIAO Xiu-zhu 2012, 11 (05):  280-283.  doi: 10.3969/j.issn.1671-4091.2012.05.00 Abstract ( 261 )   HTML ( 1 )   PDF (192KB) ( 212 )   【Abstract】 Objective To reveal the epidemiological features of patients treated with maintenance hemodialysis (MHD) for the improvement of their therapeutic effect and prognosis. Methods Patients treated with MHD for more than three months during the period of June, 1991 to June, 2011 were retrospectively analyzed. Patients were divided into two groups according to their death time. Their epidemiological features were studied.  Results Epidemiological features in the recent 10 years were compared with those of 10 years ago. (a) MHD due to diabetic nephropathy rose significantly from 15.7% to 24.5% (x2=4.85, P＜0.05). MHD due to hypertensive nephropathy increased from 11.9% to 17.9% (x2=3.97, P＜0.05). On the other hand, MHD due to chronic glomerulonephritis decreased significantly from 44.0% to 38.4% (x2=5.67, P＜0.05), and MHD due to chronic interstitial nephritis decreased from 18.2% to 13.1% (x2=6.89, P＜0.05). (b) The age when MHD started rose significantly from 47.1±14.4 years to 55.6±17.1 years (F=14.97, P＜0.05). The proportion of MHD patients more than 60 years old increased from 40.8% to 49.1% (x2=7.21, P＜0.05), and the proportion of MHD patients less than 30 years old decreased from 19.3% to 15.6% (x2=3.87, P＜0.05). (c) Dialysis age also prolonged significantly from 39.7±13.4 months to 48.6±15.1 months (F=61.93, P＜0.05). MHD patients with dialysis age of more than 60 months rose from 20.1% to 38.9% (x2=18.71, P＜0.05), and MHD patients with dialysis age of less 12 months decreased from 20.5% to 13.2% (x2=3.63, P＜0.05). (d) Vascular access varied in recent 10 years. Autogenous arteriovenous fistula was used for most patients. Long-term central venous catheter and artificial vascular graft fistula were used increasingly. MHD patients using autogenous arteriovenous fistula as the first vascular access increased from 12.5% to 23.2% (x2=7.371, P＜0.05). (e) Death due to cardiovascular and cerebrovascular events increased significantly from 53.5% to 78.2% (x2=29.576, P＜0.05), and infection caused death decreased from 37.1% to 16.6% (x2=23.70, P＜0.05). Conclusion In the recent 10 years, the primary diseases leading to MHD transformed from primary renal diseases to secondary renal diseases, the age when MHD started became older, average dialysis age prolonged, survival rate improved, vascular access approaches became varied, patients using arteriovenous fistula as the first vascular access increased, cardiovascular and cerebrovascular events were the leading causes leading to death, and death due to infection decreased. Metrics