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Chinese Journal of Blood Purification

    12 June 2011, Volume 10 Issue 6 Previous Issue    Next Issue
    专题
    Major research issues on continuous kidney replacement therapy in the treatment of acute kidney injury
    JI Da-xi
    2011, 10 (6):  291-293. 
    Abstract ( 379 )   HTML ( 0 )   PDF (149KB) ( 246 )  
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    The debate about therapeutic dosage in continuous kidney replacement therapy for acute kidney injury
    BAO Jin-fang;YUAN Wei-jie
    2011, 10 (6):  294-295. 
    Abstract ( 350 )   HTML ( 0 )   PDF (139KB) ( 282 )  
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    Research progress in sustained slow and low efficient hemodialysis for the treatment of acute renal failure
    ZHANG Ting;CHEN Men-hua
    2011, 10 (6):  296-297. 
    Abstract ( 363 )   HTML ( 0 )   PDF (125KB) ( 363 )  
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    临床研究
    The risk factors and the acute physiology and chronic health evaluation (APACHE) scores in post-operation patients treated with continuous renal replacement therapy
    XU Jing;SHEN Ping-yan;MA Xiao-bo;CHEN Xiao-nong;ZHANG Wen
    2011, 10 (6):  298-301. 
    Abstract ( 408 )   HTML ( 0 )   PDF (236KB) ( 169 )  
    Objective To investigate the risk factors relating to prognosis and to evaluate the clinical situation using APACHE scores in critical patients after surgery and treated with continuous renal replacement therapy (CRRT). Subjects and methods Patients after surgery and treated with CRRT were recruited from several departments in Shanghai Ruijin Hospital affiliated to Shanghai JiaoTong University, School of Medicine during the period of 2004-2007. Their APACHE II and III scores were estimated within 24 hours before CRRT, and their risk coefficient of mortality was also assessed. The software SPSS 15.0 was used for statistical evaluation. Measurement data were shown as X±S, Chi-square test was used for ratio comparison, and one sample t test was used for comparison among groups. P<0.05 was considered to be significant. Multinomial logistic regression was applied to explore the risk factors. Results A total of 86 post-operation patients under CRRT were studied, with the age of 62.2±16.2yrs, 57 males and 29 females, and 54 patients treated in ICU. Thirty-three cases underwent heart surgery including valvular surgery 13 cases and coronary arterial surgery 19 cases, and all of them were complicated with surgery-related acute kidney injury. Twenty-three cases had operations pertinent to general surgery, 18 cases treated with transplantation operations including liver transplantation 16 cases and renal transplantation 2 cases, 6 cases underwent thoracic operation including esophageal operation and pulmonectomy, and 7 cases had operations due to trauma including neurosurgery 5 cases and other operations 2 cases. Of them 29 cases survived, with the mortality rate of 66.3%. The average APACHE II score was 26.3±7.2 in the 86 cases, in which the score was 23.0±5.8 in survival cases and was 27.9±7.3 in dead cases (P<0.01). The average APACHE III score was 67.4±18.0 in the 86 cases, in which the score was 60.0±14.8 in survival cases and was 71.2±18.4 in dead cases (P<0.01). Logistic regression analysis showed that mechanical ventilation (P=0.000) and multiple organ dysfunction syndrome (P=0.033) were the risk factors for the mortality in patients after surgery and treated with CRRT. Conclusion The prognosis of the patients after surgery and treated with CRRT is closely related to APACHE score, with the higher mortality rate in patients with higher score. APACHE score may be useful for the early prediction of mortality in these patients. One of the two APACHE scoring systems is sufficient for the prediction. Patients complicated with multiple organ dysfunction syndrome or treated with mechanical ventilation are at higher risk of mortality

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    Predictive power of three Severity Scoring Systems and AKI classification on prognosis of acute kidney injury patients treated with continuous renal replacement therapy
    SHENG Xiao-hua;JIAN Gui-hua;WANG Nian-song;GAO Xu-ping;XUE Qin;YAN Yan;YU Gang;ZHANG Xiao-guang;CUI Yong-ping;FAN Ying;LI Jun-hui.
    2011, 10 (6):  302-305. 
    Abstract ( 705 )   HTML ( 1 )   PDF (139KB) ( 361 )  
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    Comparison of continuous veno-venous hemofiltration and sustained low-efficiency daily dialysis for the treatment of critical patients with acute kidney injury
    WANG Fang;HE Qiang;HONG Da-qing;PU Lei;ZHANG Yue;WANG li.
    2011, 10 (6):  306-309.  doi: 10.3969/j.issn.1671-4091.2011.06.00
    Abstract ( 941 )   HTML ( 0 )   PDF (210KB) ( 513 )  
    Objective To observe the effectiveness and safety of continuous veno-venous hemofiltration (CVVH) and sustained low-efficiency daily dialysis (SLEDD) in critical patients with acute kidney injury (AKI). Method We retrospectively analyzed 41 AKI patients treated with CVVH (n=18) or SLEDDD (n=23) in the 2 ICUs in this hospital. Data for analysis included gender, age, primary disease, APACHEⅡ score, number of dysfunction organs, AKI classification, blood purification modality and dose, vascular access, and anticoagulant used. Results There were no differences in age, gender, number of failure organs and AKI classification between CVVH and SLEDDD groups (P>0.05). APACHE Ⅱ score was significantly higher in CVVH group than in SLEDD group (P =0.03). Hemodynamic instability was found in 52.6% in CVVH group (a total of 128 times of CVVH in 23 cases) and 47.3% in SLEDD group (a total of 87 days in 18 cases; P>0.05). Electrolyte concentrations had no significant differences before and after the dialysis in the two groups (P>0.05). More anticoagulants were used in CVVH group than in SLEDD group (P<0.01). Daily ultrafiltration volume, water uptake and excretion were significantly higher in CVVH group than in SLEDD group (P<0.01), so as the service time, working time at night and money expense (P<0.01). Conclusion SLEDD can be conducted in a shorter period of time, using less anticoagulant and at a lower cost, while brings similar effects as CVVH.
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    The relationship between plasma 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels and the factors affecting the levels in patients with chronic kidney disease at stage 3-5 and without dialysis
    YU Yuan;Wang Mi;Wang Mei
    2011, 10 (6):  310-314.  doi: 10.3969/j.issn.1671-4091.2011.06.00
    Abstract ( 374 )   HTML ( 0 )   PDF (248KB) ( 330 )  
    Objectives To observe the plasma levels of 25(OH)D and 1,25(OH)2D in patients with chronic kidney disease (CKD) at stages 3~5 and without dialysis, and to explore the association between 25(OH)D and 1,25(OH)2D levels and the factors affecting the levels. Methods Serum 25(OH)D and 1,25(OH)2D were detected by radioimmunoassay. Serum calcium, phosphorous, alkaline phosphatase, creatinine, albumin, hepatic function parameters, glucose were measured by an automatic biochemical analyzer. The association between 25(OH)D and 1,25(OH)2D levels and the factors affecting the levels were assayed by correlation analyses. The independent factors relating to 25(OH)D level and 1,25(OH)2D level were estimated by multiple linear regression analyses. Results Eighty-two CKD patients at stage 3~5 and without dialysis were enrolled in this study. Their average level of 25(OH)D level was 8.81ng/ml (0.34-37.69ng/ml) and 1,25(OH)2D was 17.14pg/ml (1.10-65.40pg/ml). The prevalence of 25(OH)D insufficiency and deficiency were 15.0% and 81.3%, respectively, and that of 1,25(OH)2D deficiency was 44.0%. In patients at different stages, discrepancies in serum level and deficiency prevalence were insignificant to 25(OH)D (P=0.903; X2=0.343, P=0.842), but were statistically significant to 1,25(OH)2D (P=0.000; X2=20.384, P=0.000). Pearson’s correlation analyses revealed that serum albumin and 24h urine protein positively correlated with serum 25(OH)D, eGFR positively correlated with serum 1,25(OH)2D, and diabetes and serum phosphorous negatively correlated with serum 1,25(OH)2D. Multiple linear regression analyses demonstrated that serum albumin was the independent factor affecting serum 25(OH)D level, and serum 25(OH)D and eGFR were the independent factors affecting serum 1,25(OH)2D level. Conclusions 25(OH)D and 1,25(OH)2D deficiencies were frequently found in CKD patients at stages 3~5. Serum 25(OH)D correlated significantly with serum 1,25(OH)2D. Serum albumin was the predictor for 25(OH)D level. Serum 25(OH)D and eGFR were the independent factors affecting serum 1,25(OH)2D.
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    High mobility group box protein-1 correlating with microinflammation and endothelial dysfunction in patients on chronic intermittent hemodialysis
    GU Li-jie;ZHU Nan;YUAN Wei-jie;WANG Ling;CHEN Sheng;ZHANG Zheng
    2011, 10 (6):  315-318.  doi: 10.3969/j.issn.1671-4091.2011.06.00
    Abstract ( 724 )   HTML ( 0 )   PDF (257KB) ( 448 )  
    Objective High mobility group box protein-1 (HMGB1) is a newly recognized molecule behaving as an important extracellular mediator in systemic inflammation. Systemic inflammation results in endothelial cell activation and vascular injury. In the present study, we determined serum HMGB1 level in patients on maintenance hemodialysis (MHD), and assessed the HMGB1 level in association with microinflammation biomarkers and endothelial dysfunction. Methods During the period of March 2009 through April 2009, 89 patients (46 male, 43 female, mean age 56.54±10.72 years) with end stage renal dysfunction on MHD (for 65.2±54.7 months) as well as 31 healthy volunteers were investigated. Their disease status was stable, and they had no evidence of vascular disease and/or active infection. Serum levels of HMGB1, TNF-α, sVCAM1 and E-selectin were measured by ELISA. Results Serum HMGB1 in patients was 5.10±1.93μg/L, significantly higher than that in healthy volunteers (2.20±0.31μg/L, n=31). Serum HMGB1 positively correlated with TNF-α (r=0.711, P<0.01), IL-6 (r=0.804, P<0.01), soluble vascular cell adhesion molecule 1 (sVCAM1) (r=0.454, P<0.01), and E-selectin (r=0.601, P<0.01), but negatively correlated with Hb (r=-0.26, P=0.013) and Alb (r=-0.372, P<0.01). Serum HMGB1 did not correlate with total cholesterol, triglyceride and blood glucose. Conclusions Higher serum HMGB1 was frequently found in MHD patients, probably reflecting the vascular endothelial injury in these patients. Therefore, serum HMGB1 may be used clinically as a microinflammation biomarker in MHD patients.
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    Reaction time and its influencing factors in peritoneal dialysis patients
    CHEN Jun-yi;TANG Wen;CHEN Wei-ming;ZHANG Wen-yu;WANG Tao
    2011, 10 (6):  319-323.  doi: 10.3969/j.issn.1671-4091.2011.06.00
    Abstract ( 445 )   HTML ( 0 )  
    Objective To investigate the possible factors affecting the reaction time (RT) in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods A total of 103 CAPD patients from a single center were enrolled in this cross-sectional study. RT in CAPD patients was measured by a standard method, and their clinical data were also collected. Data comparison between groups was performed using one-way ANOVA. Simple correlation analysis and multiple linear regression analysis were used to explore the relationship between RT and other factors in CAPD patients. Results RT was longer in CAPD patients than in healthy people. Multiple linear regression analysis showed that age (P =0.049), education level (P =0.008), handgrip strength (P =0.011) and history of cardiovascular and/or cerebrovascular diseases (P =0.049) were the independent factors relating to RT values in CAPD patients (R2adj =0.326, P<0.05). Conclusions RT is longer in CAPD patients than in healthy people. Age, education level, nutrition status, history of cardiovascular and/or cerebrovascular diseases are the factors influencing RT value in CAPD patients. Therefore, lagged RT may have impact on rehabilitation in these patients.
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    The time for initiation of hemodialysis in chronic renal failure patients and its trends
    HONG Xiao-shi;QIN Dan-ping;CHEN Wen-xuan;LIU Yan
    2011, 10 (6):  324-327.  doi: 10.3969/j.issn.1671-4091.2011.06.00
    Abstract ( 813 )   HTML ( 0 )   PDF (211KB) ( 361 )  
    Objective To analysis the time for initiation of hemodialysis in chronic renal failure patients and its trends. Methods A retrospective study was performed in 144 patients newly treated with hemodialysis in Guangzhou Red-Cross Hospital during Jan. 1, 2007 to Dec. 31, 2009. The biochemical parameters just before the first dialysis session were retrieved, including blood urea nitrogen, serum albumin, and serum creatinine, from which glomerular filtration rate (GFR) was then calculated. Results In the 144 patients, the mean GFR at the time for initiation of hemodialysis was 6.01±0.59 ml/min·1.73m2. The initial mean GFR was >10ml/min·1.73m2 in 9 patients, 5 to 10ml/min·1.73m2 in 74 patients, and <5ml/min·1.73m2 in 61 patients. Diabetic patients had higher initial GFR than non-diabetic patients (7.41±0.47 vs. 5.22±0.44, t=28.49, P<0.05). The trend of higher GFP at the initiation of hemodialysis became evident over time in chronic renal failure patients. Conclusion In our hemodialysis center, the initiation of hemodialysis was often delayed to the situation much lower than the requirements suggested by K/DOQI guidelines, especially in non-diabetic patients. The difference in the ability to tolerate uremia between diabetic and non-diabetic patients needs to be further investigated.
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    The choice of operation pattern for arteriovenous fistula in hemodialysis patients
    QI You-fei;XIAO Zhan-xiang
    2011, 10 (6):  328-330.  doi: 10.3969/j.issn.1671-4091.2011.06.00
    Abstract ( 786 )   HTML ( 0 )   PDF (200KB) ( 279 )  
    Objective To investigate the clinical application and the choice of operation pattern for arteriovenous fistula (AVF) in hemodialysis patients. Methods AVFs of various operation patterns were established in 322 hemodialysis patients. The AVF pattern depended on the vascular condition before the operation. Time span for operation manipulation, successful rate, duration for AVF maturation, average blood flow during dialysis, and complications were compared among AVFs of various operation patterns. Results A total of 380 AVF operations were performed in the 322 patients, of which 39 cases had snuffbox fistulas with the patency rate of 92.3%, 280 cases had forearm typical fistulas with the patency rate of 92.9%, 52 cases contained artificial graft fistulas with the patency rate of 98.1%, and 4 cases failed to establish an AVF. Conclusion Every operation pattern of AFV has advantages as well as disadvantages. The choice of AFV operation pattern depends on patient’s vascular condition. Appropriate selection of AVF operation pattern will extend the vascular access function.
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    Research on relationship between mineral disorders and vascular calcification in maintenance hemodialysis patients
    WANG Li;WU Shu-kun;HONG Da-qing;HE Qiang;PU Lei;WANG Zheng-tong;WANG Jun-run;LIU Zhang-suo
    2011, 10 (6):  331-334. 
    Abstract ( 772 )   HTML ( 0 )   PDF (230KB) ( 192 )  
    Objective To study the relationship between mineral metabolic disorders and vascular calcification in maintenance hemodialysis (MHD) patients. Methods A total of 91 MHD patients in our dialysis center were enrolled, and their serum calcium, phosphorous, intact PTH (iPTH), 1-84 PTH, 25(OH)D and ALP were measured. X-ray examinations of hands, pelvis and lateral lumbar spine were applied to evaluate vascular calcification. One-way ANOVA and Student-Newman-Keuls were used to compare the differences in quantitative data. Pearson correlation was used to study correlation between two parameters. Result Twenty-two patients scored 0 without vascular calcification, 38 patients scored 1~3 with mild degree of vascular calcification, 20 patients scored 4~6 with moderate degree of vascular calcification, and 11 patients scored 7~10 with severe degree of vascular calcification. The prevalence of vascular calcification was 75.8%. Serum iPTH was higher in severe calcification group than in the other 3 groups (p<0.05), and serum ALP was the highest in severe calcification group. There was a positive correlation between iPTH and calcification score (r0.323, P0.003), a positive correlation between ALP and calcification score (r0.359, P0.007), a negative correlation between 25(OH)D and iPTH (r-0.207, P0.012), a positive correlation between 1-84 PTH and iPTH, and a positive correlation between PTH and ALP (r0.729, P0.000/r0.215, P0.041). There were no differences in calcium, phosphorus, calcium × phosphorus product, 25(OH)D and 1-84 PTH among the 4 groups. Conclusions Mineral metabolic disorders are common in MHD patients, and they may contribute to vascular calcification. Further study is needed to find out whether appropriate control of mineral metabolic disorder can improve or delay the process of vascular calcification.
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    基础研究
    Characteristics of intrarenal arteriole lesions and its possible pathogenesis in patients with IgA nephropathy
    KONG Jun;DONG Bao;WANG Mei
    2011, 10 (6):  335-339.  doi: 10.3969/j.issn.1671-4091.2011.06.00
    Abstract ( 415 )   HTML ( 0 )   PDF (744KB) ( 188 )  
    Objective To characterize the intrarenal arteriole lesions and the possible pathogenesis in IgA nephropathy patients with and without hypertension. Methods We retrospectively collected 20 IgA nephropathy patients with mild mesangial hyperplasia or focal hyperplasia associated with intrarenal arteriole lesions. They were divided into two groups: group A with normal blood pressure (n=10), and group B with hypertension (n=10). In addition, 10 non-IgA nephropathy cases with mild mesangial hyperplasia or focal hyperplasa and normal blood pressure were assigned as group C. Clinical and pathological indexes were matched among the 3 groups. Renal biopsy tissues were subject to light microscopy after HE, PASM and Masson staining, immunofluorescence and electron microscopy examinations. Cross section images of arterioles in the slides were taken after staining with PASM. The wall thickness/outer diameter ratio and intima thickness/outer diameter ratio of the arterioles were then measured. AngiotensinⅡ (Ang II), AngiotensinⅡ receptor type I (AT1R) and collagen III in slides were detected by immunohistochemistry. Results The wall thickness/outer diameter ratio and intima thickness/outer diameter ratio of the arterioles were significantly higher in groups A and B than in group C, but were indifferent between group A and B. The expression of AngⅡ and AT1R in renal tissues and arterioles were significantly higher in groups A and B than in group C. AngⅡ expression in renal tissues was significantly higher in group B than in group A, but AngⅡ expression in arterioles and AT1R expression in renal tissues and arterioles were similar between the 2 groups. Collagen III expressed predominantly in arteriolar intima, and was significantly higher in group B than in groups A and C. Positive correlations between wall thickness/outer diameter ratio and AngⅡ expression as well as between intima thickness/outer diameter ratio and the expressions of AngⅡ and AT1R were found in arterioles. Conclusion In IgA nephropathy patients, the intrarenal arteriole lesions did not correlate to hypertention, and the intrarenal rennin-angiotensin system is highly expressed.
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    护理园地
    The cross-sectional study of exit site care and compliance in patients on peritoneal dialysis
    XU Ying;DONG Jie;LU Qian
    2011, 10 (6):  342-345.  doi: 10.3969/j.issn.1671-4091.2011.06.00
    Abstract ( 380 )   HTML ( 0 )   PDF (237KB) ( 336 )  
    Objective We aimed to investigate the actual situation of exit site care in patients on peritoneal dialysis (PD) and to further determine the factors influencing the compliance with exit site care. Methods A total of 210 clinically stable PD patients were enrolled in this study. A self-designed questionnaire was applied to explore patient’s exit site care and the compliance with exit site care. The demographic and biochemistry data were also recorded. Results A total of 87 in the 210 patients performed exit site care independently. The compliance with routine exit site observation was significantly worse compared to other aspects (P<0.001). Diabetes was the independent predictor for poor compliance with routine exit site observation after adjusted for age, gender, hemoglobin, serum albumin, the location and direction of exit site by using logistic multivariate regression analysis (p=0.048). Diabetic PD patients were prone to be elder, poor eye-sighted and malnourished (p<0.05~0.001). They also tended to need assistants to do exit site care compared to non-diabetic PD patients (p<0.001). Conclusion The training of patients needs to be strengthened in the aspect of self-care and routine exit site observation. PD patients, especially diabetic PD patients as well as their fellows or care providers should be involved in the training for exit site care.
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