Chinese Journal of Blood Purification

12 August 2011, Volume 10 Issue 8 Previous Issue    Next Issue

临床研究

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Accuracy of prediction equations for resting energy expenditure in hemodialysis patients JIANG Ying;LI Jiu-hong;ZHU Sheng-lang;ZHANG Jun;CHEN Lu;CHANG Ju-ping 2011, 10 (8):  404-411.  doi: 10.3969/j.issn.1671-4091.2011.06.00 Abstract ( 399 )   HTML ( 0 )   PDF (289KB) ( 173 )   Objective Equations are frequently used to predict resting energy expenditure (REE) in clinical settings. This study aimed to evaluate the accuracy of the eight prediction equations for REE by using Bland-Altman method in a population of end-stage renal disease (ESRD) patients on maintenance hemodialysis (MHD). Methods In a total of 53 ESRD patients on MHD, REE was measured by indirect calorimetry, and then compared with the values calculated from the eight prediction equations suggested by the Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU), Schofield, Harris-Benedict, Owen, Mifflin, Cunningham, Liu, and Hong Jia. Agreement between the REE from indirect calorimetry and the values calculated from the prediction equations was assessed by Spearman correlation, paired t-test, Bland-Altman method and the percentage of individual coincidence. Results The measured REE was 1460±398kcal/day. There were significant discrepancies between the measured REE and the values predicted from Mifflin, Liu, and Hong Jia equations (P<0.05), among which that predicted from Hong Jia equation (240±321kcal/day) was found to have the maximal deviation from the measured REE. There were no significant discrepancies between the measured REE and the values predicted from FAO/WHO/UNU, Schofield, Harris-Benedict, Owen and Cunningham equations (P>0.05), among which the value from Schofield equation (6±293kcal/day) showed the minimal deviation from the measured REE. When Bland-Altman method was used to calculate the 95% limits of agreement, however, the agreement between the measured REE and the values predicted from the 8 equations was very weak. The REE predicted from Schofield equation showed the smallest bias (the low limit was -580±137kcal/day, and the high limit was 592±137kcal/day) and the greatest percentage of individual coincidence (41.5%). Conclusion No equation can be used to accurately predict REE. We therefore recommend indirect calorimetry as the method for determining REE in MHD patients. Schofield equation appears to be the most reliable one among the eight equations. We can use this equation when indirect calorimetry is unavailable. Metrics

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Effect of fluid overload on the prognosis of children receiving continuous renal replacement therapy after cardiac surgery ZHENG Jun-bo;YE Ming;YU Kai-jiang;WANG Hong-liang;JIANG Xue-song;ZHOU Jing 2011, 10 (8):  412-415.  doi: 10.3969/j.issn.1671-4091.2011.06.00 Abstract ( 301 )   HTML ( 0 )   PDF (204KB) ( 171 )   Objective To evaluate the effect of fluid overload on the prognosis of children receiving continuous renal replacement therapy (CRRT) after cardiac surgery. Methods We collected 48 children receiving CRRT after cardiac operation from June 2005 to June 2010. Fluid overload in the period from admission to ICU to initiation of CRRT was expressed as: [total fluid intake (L) – total fluid output (L)] / [body weight at admission to ICU (kg)] x 100%. The patients were divided into two groups: fluid overload ＜10% group and fluid overload ≥10% group. Their clinical manifestations and outcomes were recorded and analyzed. Results In the 48 cases, 26 cases (54.2%) were found to have fluid overload <10%, and 22 cases (45.8%) to have fluid overload ≥10%. The mortality rate was significantly higher in children with fluid overload ≥10% (14/22; 63.6%) than in those with fluid overload ＜10% (9/26; 34.6%). Multivariate logistic regression analysis demonstrated that the degree of fluid overload was significantly correlated with the mortality rate (OR=1.05; 95%CI=1.02-1.08). Conclusions The prognosis of the children receiving CRRT after cardiac surgery correlates to the degree of fluid overload. Appropriate fluid management before CRRT may improve the prognosis. Metrics

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Epidemiology of contrast-induced nephropathy after computerized tomography BAO Jing;WU Weizhen;DU Xiangke;WANG Mei 2011, 10 (8):  416-420.  doi: 10.3969/j.issn.1671-4091.2011.06.00 Abstract ( 295 )   HTML ( 0 )   PDF (228KB) ( 211 )   Objective To investigate the prevalence of contrast-induced nephropathy (CIN) in patients using intravenous contrast medium for CT examination, and to explore the risk factors relating to CIN. Methods Inpatients with CT examination in Peking University People’s Hospital from January 2010 to June 2010 were studied retrospectively. We investigated the prevalence of CIN, and the risk factors for CIN were also characterized by using univariate and multifactor regression analyses. Results A total of 261 patients were involved in this study, of whom 7.7% patients developed CIN. Comparing with non-CIN group, CIN group showed higher rates of hypotension and liver cirrhosis. Multifactor regression analysis demonstrated that hypotension was the independent risk factor for CIN. Conclusion CIN was not uncommon in inpatients using low osmolarity contrast medium for CT examination. Hypotension was recognized as the independent risk factor after controlling the factors of renal function and contrast medium dose. Metrics

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The relationship between serum albumin / CRP levels and prognosis in maintenance hemodialysis patients ZHANG Yan-jing;WU Hua;CHEN Xian-guang;CHAI Yi 2011, 10 (8):  420-425.  doi: 10.3969/j.issn.1671-4091.2011.08.00 Abstract ( 666 )   HTML ( 0 )   PDF (259KB) ( 407 )   Objective To summarize serum albumin and C-reactive protein (CRP) levels in hemodialysis patients treated in Beijing Hospital in 2008, and to analyze their effect on patients’ prognosis. Methods We summarized serum albumin and CRP levels in 93 hemodialysis patients treated in Beijing Hospital in 2008. The patients were divided into four groups based on their serum albumin and CRP levels. Mortality rate and cause of death before the end of 2010 in each group were recorded, and a survival curve was then derived. Results (a) Patients’ serum albumin level improved following treatment. At the beginning and the end of 2008, serum albumin level was 38.42±2.81g/L and 39.41±2.77g/L (P=0.002), respectively. Serum albumin level was higher in male patients than in female patients. At the end of 2008, serum albumin was 39.56±3.26g/L in male patients and was 39.24±2.12g/L in female patients, and the level was in the normal range in 91.0% patients. The percentage of normal serum albumin was higher in the patient group of <60 years old than in the group of >60 years old (χ2=6.746，P=0.014). (b) Serum CRP level decreased following hemodialysis. At the beginning and the end of 2008, serum CRP level was 0.53±0.46mg/dL and 0.38±0.20mg/dL, respectively (t=2.276, P＜0.05). Serum CRP correlated negatively with serum albumin (r=-0.238, P＜0.01). The major causes of death in this cohort were septic shock and cardiac-cerebro-vascular diseases (82.3%). Survival analysis demonstrated that the mortality rate was 66.7% in the group with abnormal albumin and CRP levels, 50.0% in the group with abnormal albumin level, and 18.8% in the group with abnormal CRP level (χ2=72.563，P=0.000). Conclusions Patients’ serum albumin level improved following hemodialysis. Serum albumin level was higher in male patients than in female patients. The percentage of normal serum albumin was higher in the patient group of <60 years old than in the group of >60 years old. Serum CRP correlated negatively with serum albumin. Mortality rate was higher in patients with hypoalbuminemia and higher serum CRP. Metrics

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Telmisartan improves micro-inflammation and oxidative stress in patients with maintenance hemodialysis YAO Li;WEI Dan-dan;GE Dan-mei;WEI Min;GENG Ye;FENG Mao-ling;WANG Li-ning 2011, 10 (8):  426-428.  doi: 10.3969/j.issn.1671-4091.2011.08.00 Abstract ( 487 )   HTML ( 0 )   PDF (207KB) ( 352 )   Objective To evaluate the effect of telmisartan on micro-inflammation and oxidative stress in maintenance hemodialysis (MHD) patients. Methods Sixty stable MHD patients and 30 healthy volunteers (control) were involved in this study. The MHD patients were randomly divided into telmisartan treatment group (group T; n=30) or non-telmisartan treatment group (group NT; n=30). Patients in group T took telmisartan at a dose of 80mg per day for 24 weeks. Plasma high-sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor (TNF-a), lipid peroxide malondialdehyde (MDA), serum prealbumin (PA), and serum albumin (Alb) were measured before telmisartan treatment and after the treatment for 24 weeks. Results When comparisons were performed between MHD patients and healthy controls, plasma levels of hs-CRP (8.1±2.6 vs. 1.5±0.7mg/L), IL-6 (349.0±52.4 vs. 53.6±15.0ng/L), TNF-a (8.1±2.12 vs. 2.1±0.8ng/L) and MDA (7.3±3.2 vs. 3.5±0.9μmol/L) were significantly higher in MHD patients, and serum PA (20.6±7.3 vs. 28.4±4.0mg/dL) was significantly lower in MHD patients than in healthy controls (P＜0.05, respectively). When comparisons were conducted between group T and group NT, plasma levels of hs-CRP (5.6±1.8 vs. 8.2±2.8mg/L), IL-6 (218.6±45.9 vs. 363.0±67.4ng/L), TNF-a (5.3±1.7 vs. 8.7±2.3ng/L) and MDA (4.6±2.3 vs. 7.5±3.7μmol/L) were significantly lower, and serum PA (25.3±6.7 vs. 20.0±7.7mg/dL) was significantly higher in group T after telmisartan treatment for 24 weeks than in group NT (P＜0.05, respectively). Conclusion Telmisartan improves micro-inflammation, oxidative stress and malnutrition in MHD patients. Metrics

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Clinical and multi-center research on hepatitis C infection in hemodialysis patients ZHANG Xiao-li;ZHU Bei;YU Rong-bin;ZHAO Wei-hong 2011, 10 (8):  429-432.  doi: 10.3969/j.issn.1671-4091.2011.08.00 Abstract ( 378 )   HTML ( 0 )   PDF (208KB) ( 154 )   Objective The aim of this study was to investigate the incidence of hepatitis C virus (HCV) infection and the risk factors for the infection in maintenance hemodialysis (HD) patients from multiple centers in Jiangsu province. We also measured serum aminotransferase level in these patients. Methods Clinical data of these patients, including demographical information, history of blood transfusion and kidney transplantation, were recorded. Liver biochemistry tests including alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured. Anti-HCV antibody was assayed by enzyme-linked immunosorbent assay (ELISA), and HCV-RNA was detected by real-time polymerase chain reaction (RT-PCR) method. Results (a) Positive anti-HCV antibody was found in 22.1% (176/796) HD patients, and HCV-RNA was found in 80.7% (142/176) patients with positive anti-HCV antibody. (b) Univariate analysis of HCV infected and non-HCV infected patients indicated that the HCV infection was associated with longer duration on hemodialysis (7.13±4.60 vs. 2.73±3.01 year, P＜0.001), blood transfusion (64.2% vs. 45.5%, P＜0.001), dialyzer reuse (51.3% vs. 7.9%, P＜0.001) and kidney transplantation (11.0% vs. 3.5%, P=0.003). Moreover, logistic analysis revealed that longer duration on hemodialysis (OR=1.38, 95% CI=1.24-1.53, P＜0.001) and dialyzer reuse history (OR=10.91, 95% CI=5.52-21.55, P＜0.001) were the independent risk factors for HCV infection. (c) Despite the normal range of average aminotransferase level in HCV infected patients, the average aminotransferase level and the rate of abnormal aminotransferase level were significantly higher in HCV infected patients than in non-HCV infected patients. Conclusions (a) HCV-RNA detection is required in HD patients with positive anti-HCV antibody for the estimation of HCV activity. (b) Serum aminotransferase level may be an insensitive marker for the diagnosis of HCV infection in HD patients, but is useful for the evaluation of hepatitis activity and hepatocytic injury. (c) Comprehensive interventions should be taken to control HCV transmission in HD patients. Metrics

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Clinical study on dialysis adequacy and complications using long-term indwelling cuffed tunneled catheter for blood access in maintenance hemodialysis patients YU Yong-wu;LI Ming-xv;ZHOU Chun-hua;ZHANG Zhi-yong;MA Jun-hong;YU Jun-rong 2011, 10 (8):  433-436.  doi: 10.3969/j.issn.1671-4091.2011.08.00 Abstract ( 451 )   HTML ( 0 )   PDF (221KB) ( 279 )   Objective　To compare dialysis adequacy and complications between hemodialysis patients using cuffed tunneled catheter (CTC) and those using arteriovenous fistula for blood access, and to find out a relatively ideal vascular access approach. Methods Patients subjected to an operation of long-term hemodialysis access between July 2006 and July 2007 were enrolled in this study. Dialysis adequacy and complications after the operation were compared in patients using vascular access of arteriovenous fistula (AVF) (n=40) and those using CTC in an internal jugular vein (n=39) in a follow-up period of 36-48 months. Results The duration of using AVF and CTC for blood access was 29.75±10.26 months and 21.48±7.74 months, respectively. Laboratory variables were indifferent between the two groups (P>0.05), except serum phosphorus. Maximal blood flow, blood access usage duration, Kt/V, urea reduction ratio and EF were significantly higher in patients using AVF than in those using CTC (P<0.05). The prevalence of catheter infection, thrombus and death were significantly higher in patients using CTC group (P<0.05). Conclusions Although the prevalence of adverse events was higher in patients using CTC, they still obtained the same dialysis adequacy as those using AVF. CTC is an optimal and alternative vascular access for maintenance hemodialysis patients Metrics

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Comparison of different methods for the assessment of nutritional status in maintenance hemodialysis patients ZHANG Yuan;ZHANG Yaling;HONG Daqing;WANG Li 2011, 10 (8):  437-439.  doi: 10.3969/j.issn.1671-4091.2011.08.00 Abstract ( 417 )   HTML ( 1 )   PDF (240KB) ( 331 )   Objective To study the differences of nutritional status in maintenance hemodialysis (MHD) patients assessed by Subjective Global Assessment (SGA), Malnutrition Inflammation Score (MIS) and Mini Nutritional Assessment-Simple Form (MNA-SF). Methods SGA, MIS and MNA-SF were used to assess the nutritional status in 120 MHD patients, and correlations were analyzed among the results from the 3 methods. Receiver operating characteristic (ROC) curve was applied to study the sensitivity and specificity of the 3 methods for the evaluation of malnutrition status. Results A strong correlation existed among SGA, MIS and MNA-SF (P＜0.01). Area under the ROC curve of MNA-SF and MIS was 0.342 and 0.689, respectively, for malnutrition diagnosed by SGA score of ＜25. When the MIS score was >6.5, the sensitivity (70.00%) and specificity (61.70%) was highest. Conclusion MIS is similar to SGA for malnutritional assessment in MHD patients. MNA-SF is unsuitable for this purpose, neither for the assessment in elderly (age ≥60 years) MHD patients. Metrics

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Study on bone metabolism in elderly patients on maintenance hemodialysis due to type II diabetes nephropathy GU Bo;LU Jian-rao;YI Yang;WANG Han-qing;XUAN Yi 2011, 10 (8):  440-443.  doi: 10.3969/j.issn.1671-4091.2011.08.00 Abstract ( 405 )   HTML ( 0 )   PDF (203KB) ( 168 )   Objective To explore the characteristics of bone and calcium-phosphorus metabolism in elderly maintenance hemodialysis (MHD) patients with type II diabetes kidney disease (DKD) or non-DKD. Methods During the period of 2006 to 2010, peripheral blood samples were taken from 90 elderly end-stage renal disease (ESRD) patients due to type II DKD and 120 elderly ESRD patients of non-DKD to measure their plasma levels of osteocalcin (OT), β-crosslaps, parathyroid hormone (iPTH), calcium (Ca), phosphorus (P) and Ca+2 before MHD, and on MHD for 1 year, 3 years and >5 years. Results When comparisons were made for the laboratory parameters taken before MHD, and on MHD for 1 year, 3 years and >5 years, plasma levels of OT, β-crosslaps and iPTH were found to be lower in patients on MHD for 1 year, 3 years and >5 years, especially in those on MHD for 1 year (P＜0.05), than those before MHD; plasma Ca was higher in those on MHD for 1, 3 and >5 years (P＜0.01); plasma P was lower in the patients with DKD and on MHD for 1 year, but was higher in the patients with non-DKD and on MHD for 3 years. When comparisons were conducted between the laboratory parameters from MHD patients with DKD and those with non-DKD, plasma levels of OT, β-crosslaps, iPTH and P were found to be lower in the patients with DKD before MHD and on MHD for 1 and 3 years, especially in those before MHD and on MHD for 3 years (P＜0.05); plasma Ca was indifferent in MHD patients with DKD and those with non-DKD. Conclusions As MHD lasted longer in elderly patients with DKD, they exhibited distinct clinical manifestations and pathogenesis in bone and calcium-phosphorus metabolism. Specific management to these clinical features is usually required. Metrics

护理园地

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Clinical observation of low-molecular-weight heparin in combination treatment of hemodialysis-hemoperfusion TAO Hui-qin;CHEN Jian-min;LIU Jun 2011, 10 (8):  455-457.  Abstract ( 484 )   HTML ( 0 )   PDF (199KB) ( 352 )   Objective To investigate the clinical effect of low-molecular-weight heparin (LMWH) for hemodialysis-hemoperfusion combined therapy. Methods Twenty-five end-stage renal disease patients (14 males and 11 females; mean age: 62.3 years) subjected to hemodialysis-hemoperfusion combined therapy were included. The dose of LMWH was adjusted based on dry body weight. Patients with dry weight <40kg were intravenously given a single bolus of Fraxiparine 0.4ml at the beginning of the treatment, those with dry body weight 40-60kg were intravenously administrated a bolus of Fraxiparine 0.4ml followed by an additional injection of 8mg heparin one hour after the treatment, and those with dry body weight >60kg were intravenously given a bolus of Fraxiparine 0.4ml followed by an additional injection of 12mg heparin one hour after the treatment. Results A total of 352 sessions of hemodialysis-hemoperfusion combined therapy were conducted. The incidence of thrombus in resin hemoperfusion cartridge was 0.28%, and in dialyser was 3.69%. Patients with arteriovenous fistula were treated with the combined therapy for 260 sessions, and those with central venous catheter for 92 sessions; their incidence of thrombus in dialyser was 3.08% and 5.43%, respectively. Hemostasis time was 11.3±5.21 minutes, and no treatment-induced bleeding was found. Conclusions We used dry body weight to optimize the LMWH dosage for hemodialysis-hemoperfusion combined therapy and achieved a better clinical effect, thus providing an alternative anticoagulant approach for hemodialysis-hemoperfusion combined therapy. Metrics