Chinese Journal of Blood Purification

12 April 2012, Volume 11 Issue 04 Previous Issue    Next Issue

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Comments on the annual report from Beijing Blood Purification Quality Control and Upgrade Center Expert Group of Beijing Blood Purification Quality Control and Upgrade Center 2012, 11 (04):  175-178.  Abstract ( 209 )   HTML ( 0 )   PDF (211KB) ( 161 )   Metrics

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Serum 25-hydroxyvitamin D level and its related factors in maintenance peritoneal dialysis patients ZHAO Hui-ping;WU Bei;SUI Zhun;LU Lix-ia;QIAO Jie;WU Xiang-lan;WANG Mei 2012, 11 (04):  179-183.  doi: 10.3969/j.issn.1671-4091.2012.03.00 Abstract ( 215 )   HTML ( 0 )   PDF (233KB) ( 142 )   【Abstract】 Objective To examine the prevalence of 25-hydroxyvitamin D (25(OH)D) deficiency and insufficiency in CKD patients at stage 5 and on maintenance peritoneal dialysis (PD) and to evaluate the factors relating to serum 25(OH)D level, so as to provide useful bases for appropriate therapy. Methods We recruited 101 maintenance PD patients with stable status and to be regularly followed up for at least three months at the Department of Nephrology, Peking University People’s Hospital from December 2010 to February (winter) 2011. Serum 25(OH)D level was measured by ELISA. Patients’ general data were recorded. Serum 25(OH)D level and the parameters of mineral metabolism (serum albumin corrected calcium, phosphorus, intact parathyroid hormone and bone-specific alkaline phosphatase), nutritional index (serum albumin and body mass index), hemoglobin, serum creatinine, residual renal function, total urea clearance (Kt/V), and total creatinine clearance were determined. Multiple linear regression analysis was used to assess the factors relating to serum 25(OH)D level. Results A total of 101 PD patients (49 males and 52 females with a mean age of 61.8±14.1 years) were enrolled in this study. Their average PD duration was 25.9±21.7 months. Their major primary disease was diabetic nephropathy, accounting for 40.6% of the patients. Their average serum 25(OH)D was 9.92±2.44ng/ml (5.6-17.83ng/ml). Vitamin D insufficiency was found in 3.96% (4/101) patients, and vitamin D deficiency in 96.04% (97/101) patients. Serum 25(OH)D were significantly lower in PD patients with diabetes than in those without diabetes (P＜0.05). Multiple linear regression analysis demonstrated that outdoor activities (β= 0.223, P= 0.026), serum albumin corrected calcium level (β= 0.203, P=0.048) and residual renal function (β=0.267, P=0.012) were the independent factors relating to 25(OH)D level. Conclusions Vitamin D deficiency/insufficiency is frequently found in CKD patients at stage 5 undergoing PD in winter in northern China. Hypocalcemia, loss of residual renal function, and less outdoor activities are the independent risk factors relating to vitamin D deficiency/insufficiency. Vitamin D supplement of appropriate dose should be given as early as possible o these patients. Metrics

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The value of physical fitness for the prediction of mortality in maintenance hemodialysis patients HANG Lu;YOU Li-ming;ZHENG Jing;LIANG Yan-yi;CHEN Nian-chang;LI Ying-na;LI Fo-lan;LV Shao-fen 2012, 11 (04):  184-188.  doi: 10.3969/j.issn.1671-4091.2012.03.00 Abstract ( 196 )   HTML ( 0 )   PDF (266KB) ( 140 )   【Abstract】 Objective To explore the predictive value of physical fitness to mortality among MHD patients. Methods We used the convenience sampling method to recruit 317 patients from 5 major hospitals in Guangzhou city. The Human Activity Profile (HAP) was used to assess physical fitness among MHD patients. Conclusion Physical fitness can be used to predict the mortality among MHD patients. Patients with higher physical fitness will have higher survival rate. Accordingly, it is necessary to assess physical fitness and provide health instructions about physical activities to lower the mortality in MHD patients. Metrics

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A study on the risk factors for intradialytic-hypotension among maintenance hemodialysis patients YU Jin-bo;ZOU Jian-zhou;LIU Zhong-hua;SHEN Bo;XU Shao-wei;TENG Jie;DING Xiao-qiang 2012, 11 (04):  189-193.  doi: 10.3969/j.issn.1671-4091.2012.03.00 Abstract ( 268 )   HTML ( 2 )   PDF (236KB) ( 316 )   【Abstract】 Objective To assess the risk factors for intradialytic-hypotension (IDH) among maintenance hemodialysis (MHD) patients, and to provide clinically useful information for the prevention and treatment of IDH.  Methods We recruited 293 patients who underwent hemodialysis during Jan. 2009 to Dec. 2010. Intradialytic blood pressure was monitored in a 3-month period. IDH was defined as an event characterized by a sudden drop of systolic BP more than 20mmHg or of mean artery pressure (MAP) more than 10mmHg. Logistic regression analysis was used to assess the risk factors for IDH.  Results The incidence rate of IDH was 39.9%. In the 293 patients, 176 patients with <1/10 IDH events/3 months (defined as non-IDH) were served as controls, 80 patients were found to have ≥1/10 but ≤1/3 IDH events/3 months (occasional IDH), and 37 patients with ＞1/3 IDH events/3 months (frequent IDH). We used ultrafiltration volum/body weight (UFV/W) to correlate with IDH, and the area under the ROC curve (AUC) of IDH was 0.706 (95% CI: 0.64～0.77, P<0.01). When the cut-off value of UFV/W was set at 4.33%, the sensitivity for IDH was 53.2% and the specificity for IDH was 76.5%. Multivariate regression analysis showed that age, ultrafiltration rate, serum NT-proBNP, serum albumin, and serum β2MG were associated with IDH among MHD patients.  Conclusion Elderly, higher ultrafiltration rate, higher levels of serum NT-proBNP and β2MG, and hypoalbuminemia are independent risk factors for IDH among MHD patients. Metrics

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Clinical observation of parathyroidectomy in uremic patients with different degrees of ectopic calcification CAO Hong-di;TANG Bing;SONG Zong-wei;ZHAO Qing-hong;HOU Da-wei;ZHANG Hua;WEN Ping;YE Hong;ZHANG Ping;YANG Jun-wei 2012, 11 (04):  194-197.  doi: 10.3969/j.issn.1671-4091.2012.04.00 Abstract ( 374 )   HTML ( 0 )   PDF (207KB) ( 225 )   【Abstract】Objective To analyze the therapeutic effects of parathyroidectomy (PTX) in uremic patients with secondary hyperparathyroidism (SHPT) and different degrees of ectopic calcification. Methods Patients were divided into two groups: group A without specific image of cardiovascular ectopic calcification, and group B with apparent cardiovascular ectopic calcification on X ray and/or ultrasound examinations. Pre- and post-operation symptoms and signs, iPTH, calcium supplementation protocol, cardiovascular events, as well as other indications were observed.  Results Among the 42 SHPT patients that underwent PTX, 17 were enrolled in group A, and 25 patients in group B. In group A after the operation, pruritus and bone pain symptoms were largely relieved, with stable serum calcium level and without the development of adverse cardiovascular events or cardiovascular calcification; in group B, however, the symptoms relieved also after the operation but recurred in 6 patients, and serum calcium levels were lower than those in group A. Seven patients in group A needed to have intravenous calcium administration for more than 6 months. Two patients died of cardiovascular or cerebrovascular events.  Conclusions The prognosis of SHPT patients after PTX is negatively correlated with the severity of vascular ectopic calcification. PTX may help delay the progress of cardiovascular calcification. Metrics

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Deep venous catheter related fibrin sheath detected by color Doppler ultrasonography: analysis of 28 cases DUAN Qing-qing;ZHANG Li-hong;ZHANG Wen-yun;ZHU Jin;WANG Zi-qiang;WANG Bao-xing;LI Ying 2012, 11 (04):  198-201.  doi: 10.3969/j.issn.1671-4091.2012.03.00 Abstract ( 234 )   HTML ( 0 )   PDF (290KB) ( 222 )   【Abstract】 Objective To explore the iconographic characteristics of deep venous catheter related fibrin sheath using color Doppler ultrasonography. Methods During the period of April 2010 to January 2011, 28 hemodialysis patients with temporary catheter were examined by color Doppler ultrasonography before removing the catheter, and thirteen of them were re-examined after the removing for one month. Results In the 28 patients, 26 (92.9%) showed the development of fibrin sheaths by color Doppler ultrasonography. Fibrin sheath at the puncture site was still found in 13 patients re-examined one month after discontinuing the catheterization. Fibrin sheaths were taken out during pulling out of the catheter in 15 of the 28 (53.6%) patients. Conclusion Color Doppler ultrasonography can obtain specific iconography of fibrin sheath following deep venous catheterization. This relatively simple method is useful for the surveillance of deep venous catheter function, and is suitable for the observation and diagnosis of deep venous catheter related fibrin sheath. Metrics

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Follow-up investigation of sleep quality in maintenance hemodialysis patients in a dialysis center JIA Meng;CHEN Wei;DING Lin;SU Hong;WU Hao;GUO Zhi-yong 2012, 11 (04):  202-205.  doi: 10.3969/j.issn.1671-4091.2012.04.00 Abstract ( 189 )   HTML ( 0 )   PDF (222KB) ( 362 )   【Abstract】 Objective A longitudinal study was performed aimed to evaluate the dynamic change of sleep disturbances and its related factors in maintenance hemodialysis patients treated in this hemodialysis center.  Methods Patients on maintenance hemodialysis for more than 3 months were recruited in this study. Sleep quality evaluation using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) was performed twice with an interval of 15 months. Biochemical parameters were collected as well. Results (a) In the 60 patients completed the sleep quality survey at the first evaluation, the incidence of sleep disturbances was 60% (PSQI＞5) and daytime sleepiness was 58.3% (ESS＞6). (b) In the 60 patients, 55 completed the second sleep quality survey. Sleep disturbances accounted for 89% and daytime sleepiness 87.3% of the 55 patients. After comparing the scores of the two surveys, we found that the increase of PSQI and ESS scores was statistically correlated to the values of iPTH, calcium-phosphate product, CRP and Hb. Conclusion (a) Sleep quality deteriorated along with the increase of dialysis age. (b) This deterioration was related to the values of iPTH, calcium-phosphate product, CRP and Hb. Metrics

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Comparison of blood pressure variability in hemodialysis patients with and without diabetes mellitus LI Xiu-ji;JIANG Li-ping;HUANG Wen. 2012, 11 (04):  206-209.  doi: 10.3969/j.issn.1671-4091.2012.04.00 Abstract ( 179 )   HTML ( 0 )   PDF (216KB) ( 153 )   【Abstract】Objective To investigate the difference of blood pressure variability (BPV) between maintenance hemodialysis (MHD) patients with diabetes mellitus and those without diabetes mellitus.  Methods We recruited 47 MHD patients with stable disease status in the Hemodialysis Center of Beijing Tongren Hospital. They were divided into diabetes group and non-diabetes group. Pre-dialytic and intradialytic mean blood pressure and BPV were compared between the two groups. Standard deviation (SD) and coefficient of variation (CV) were used for the evaluation of BPV.  Results In diabetes group, pre-dialytic levels of plasma albumin and serum creatinine were 41.52±3.84 g/L and 742.41±199.58 μmol/L, respectively, significantly lower than those in non-diabetes group (44.02±3.48 g/L and 1015.26±278.04 μmol/L, respectively; P＜0.05). There were no significant differences in age, ratio of sex, hemoglobin, total calcium, inorganic phosphorus, ultrafiltration volume (UFV), UFV/W, Kt/V, and anti-hypertension treatment between the two groups (P＞0.05). In diabetes group, pre-dialytic mean systolic blood pressure (SBP), SBP-SD, SBP-CV and △SBP were 162±15mmHg, 15.39±5.13mmHg, 9.53±3.14% and 47±15mmHg, respectively, significantly higher than those in non-diabetes group (150±14mmHg, 11.35±4.65mmHg, 7.53±2.90% and 35±13mmHg, respectively; P＜0.05). There were no significant differences in pre-dialytic mean diastolic blood pressure (DBP), DBP-SD and DBP-CV between the two groups (P＞0.05). In diabetes group, intradialytic SBP-SD and SBP-CV were 19.07±6.07mmHg and 13.25±4.08%, respectively, significantly higher than those in non-diabetes group (13.93±3.56mmHg and 9.71±2.65%, respectively; P＜0.05). There were no significant differences in intradialytic mean SBP, mean DBP, DBP-SD and DBP-CV between the two groups (P＞0.05). Conclusion In MHD patients with diabetes, blood pressure control was relatively difficult, and pre-dialytic and intradialytic SBP variability were more extensive. Metrics

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Considerations from the DOPPS study-hemoglobin fluctuation is positively correlated to mortality in dialysis patients CHEN Ya;NI Zhao-hui. 2012, 11 (04):  210-213.  doi: 10.3969/j.issn.1671-4091.2012.04.00 Abstract ( 208 )   HTML ( 1 )   PDF (289KB) ( 234 )   【Abstract】With the progresses of renal anemia administration, many researches recognize that hemoglobin stability is an important index for the treatment and prognosis of renal anemia. Evidences from other countries indicate that hemoglobin instability has a direct relationship with mortality in dialysis and non-dialysis patients. Among these studies, the DOPPS study is worthwhile to be concerned. Here we discuss hemoglobin fluctuation and its related factors, the relationship between hemoglobin fluctuation and patient’s survival and outcome, the ideal target of hemoglobin level, and its clinical significance in dialysis patients especially in hemodialysis patients. Metrics