Chinese Journal of Blood Purification

12 April 2011, Volume 10 Issue 4 Previous Issue    Next Issue

专家述评

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The clinical application and the novel principles of high volume hemofiltration GONG De-hua;JI Da-xi 2011, 10 (4):  175-177.  Abstract ( 584 )   HTML ( 1 )   PDF (144KB) ( 446 )   Metrics

临床研究

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The clinical significance of changes in serum IL-6, IL-8 and TNF-?in maintenance hemodialysis patients SONG Jie;LI Hui;ZHANG Xiao-dong;SHI Li-hua;LI Ying 2011, 10 (4):  178-180.  doi: 10.3969/j.issn.1671-4091.2011.04.00 Abstract ( 773 )   HTML ( 2 )   PDF (201KB) ( 564 )   【Abstract】 Objective To observe the changes of serum IL-6, IL-8 and TNF-α and their clinical significance in maintenance hemodialysis patients. Methods We selected 80 uremic patients undergoing maintenance hemodialysis (MHD group) during April 2009 to June 2010 in the Blood Purification Center, Department of Nephrology, the Affiliated Hospital of Chinese People’s Armed Police Forces Medical College, and 20 healthy individuals as the normal control (control group). Their serum IL-6, IL-8, TNF-α, albumin (ALB), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), creatinine (Cr) and blood urea nitrogen (BUN) were measured. Results Serum levels of IL-6, IL-8, TNF-α, TC and LDL-C were significantly higher in MHD patients than in control group (P<0.01), and ALB was significantly lower in MHD group. Correlation analysis indicated that IL-6, IL-8 and TNF-α were negatively correlated with ALB, and were positively correlated with TC and LDL-C in MHD patients. Conclusion Microinflammatory status existed in MHD patients, possibly relating to the malnutrition and dyslipidemia in these patients. Metrics

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Effects of continuous blood purification therapy on early induced gut mucosal dysfunction in patients with severe acute pancreatitis ZHANG Jian-bin;GAN Hua;MIN Xiao-ying;ZHOU Ying;LUO Xiang-feng;XU Le;JIANG Zhi-min;GUO Zhi-yong;LIU Fei-yan 2011, 10 (4):  181-184.  doi: 10.3969/j.issn.1671-4091.2011.04.00 Abstract ( 476 )   HTML ( 0 )   PDF (317KB) ( 270 )   【Abstract】 Objective Early gut mucosal dysfunction is one of the critical pathophysiological disorders in patients with severe acute pancreatitis (SAP). To investigate the effects of continuous blood purification on SAP induced gut mucosal dysfunction, we conducted a prospective study in 26 patients with SAP. Method All patients were treated with continuous veno-venous hemofiltration (CVVH) for 24 hours. Permeability of the epithelial monolayer, serum concentrations of diamine oxidase (DAO), D-lactate and endotoxin were used as the markers for the assessment of epithelial function. Blood samples were taken from the patients at 0, 6, 12 and 24h during CVVH. Serum DAO, D-lactate and endotoxin were determined by spectrophotometry. Monolayer Caco-2 cells incubated with patient’s serum were used as the model to assess SAP-induced epithelial permeability changes by measuring their trans-epithelial electric resistance (TEER). Expression and distribution of actin in the cells were observed by immunofluorescence. Result The Acute Physiology and Chronic Healthy Evaluation (APACHE) Ⅱ score was significantly improved after CVVH. Compared with the normal controls, SAP patients showed the increase of serum DAO, D-lactate, endotoxin and epithelial permeability. Peripheral filament bands in the cells became blurred, with loose cell-cell junctions. After CVVH, serum DAO, D-lactate and epithelial permeability decreased, and the organization of actin improved in all patients. Conclusion Early gut mucosal dysfunction is present in SAP patients. CVVH improves patients’ general conditions as well as their gut mucosal dysfunction, probably resulting from the clearance of over-expressed pro-inflammation cytokines and reorganization of actin in epithelial cells. Metrics

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The investigation of hemodialysis duration in hemodialysis patients in Beijing area, 2008 CHEN Feng-kun;LI Ji-jun 2011, 10 (4):  185-188.  doi: 10.3969/j.issn.1671-4091.2011.04.00 Abstract ( 764 )   HTML ( 0 )   PDF (208KB) ( 302 )   【Abstract】 Objective To understand the epidemiological characteristics of hemodialysis (HD) patients through analyzing the HD duration-related data registered in 109 HD units in Beijing area, 2008. Methods Based on the registered HD duration from 7040 cases in these HD units in 2008, we carried out stratified analyses on HD duration according to sex, age, and the age when dialysis was first given (ADF), and primary disease. Results Rank sum test demonstrated that the orders of HD duration were females longer than males, patients of 0-40 years old longer than those of 41-60 years old, and patients of 41-60 years old longer than those of >60 years old. In addition, HD duration correlated with ADF, with the HD duration in patients of 41-60 years old longer than those of 0-40 years old, and the shortest duration in patients >60 years old. In comparison with the data in 2007, the order changes of HD duration in 2008 became significant in the stratification of age, but not in the stratification of ADF. In regard to several primary diseases with larger number of HD patients, diabetes was associated with the shortest HD duration. Conclusion HD duration correlated to gender, age, ADF and primary disease. Factors affecting more patients enrolled in HD treatment or with shorter HD duration were male gender, younger or older ADF, and diabetes. Metrics

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Relationship between acquired immune disturbances and parathyroid hormone levels in end stage renal disease patients WANG Hai-yun;CHEN Li-meng;LI Xue-mei;QIU Zhi-feng;TAO Jian-ling;QIU Ling;XU hong;ZHOU Zi-juan;LI Tai-sheng;LI Xue-wang 2011, 10 (4):  189-193.  doi: 10.3969/j.issn.1671-4091.2011.04.00 Abstract ( 475 )   HTML ( 0 )   PDF (241KB) ( 310 )   【Abstract】 Objective The clinical relevance of altered lymphocyte function to uremic toxins, such as higher parathyroid hormone (PTH), is not well understood. We studied the changes of B- and T-cellular immunity in end stage renal disease (ESRD) patients with hemodialysis (HD), and evaluated the relationship between T-lymphocyte function and plasma PTH level. Methods Blood cell analysis was conducted in 257 ESRD patients. Patients were divided into 3 groups based on treatment and PTH level: chronic kidney disease (CKD) patients without dialysis (n=20), HD patients with higher PTH (>300pg/ml, n=12), and HD patients with lower PTH (<300 pg/ml, n=11). Lymphocyte subsets were quantified in the 3 groups using monoclonal antibodies and flow cytometry. Analysis of variance (ANOVA) and Pearson correlation analysis using SPSS version 10.0 were performed to test the differences between the 3 groups. Results (a) The percentage of Lymphocytes decreased in 47.5% (122/257) ESRD patients, but the white blood cell count decreased in only 3.9% of the 257 patients. (b) When comparisons were made between ESRD patients with HD and CKD patients without HD, lymphocyte count (1367.4±650.4 vs. 1942.3±856.3, P<0.05), CD19+ B-cells (114.0±88.2 vs. 229.3±143.3, p<0.001), and CD3+ T-cells (1035.9±497.4 vs. 1483.4±674.1, P<0.05) were lower in ESRD patients with HD, in association with the lower percentage and cell count of CD4+ T-cells, CD8+ T-cells and CD28+ cells. (c) CD19+ cells decreased significantly in HD patients with lower PTH (<300 pg/ml). Conclusion T-cell and B-cell functions are abnormal in ESRD patients with HD. Serum PTH level may affect B-cell function. Metrics

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Relationship between fibroblast growth factor-23 in peripheral blood and cardiovascular events in maintenance hemodialysis patients LI Kai-long;CHEN Jing;ZHANG Ying;WANG Yan;LI Kai-bin;HE Ya-ni 2011, 10 (4):  194-197.  doi: 10.3969/j.issn.1671-4091.2011.04.00 Abstract ( 561 )   HTML ( 0 )   PDF (207KB) ( 420 )   【Abstract】 Objective To study the relationship between fibroblast growth factor-23 (FGF-23) in peripheral blood and cardiovascular complications in patients on maintenance hemodialysis (MHD). Methods A total of 155 patients with chronic kidney disease (CKD) at stage 5 treated in this hemodialysis center from Oct. 2006 to Feb. 2010 were enrolled in the study, and the study was lasted for 6 months. Patients were divided into cardiovascular event group or non-cardiovascular event group. The 2 groups were compared in gender, age, primary disease for CKD, blood pressure control, hemoglobin level, nutritional status, dialysis modality and drugs used. Serum phosphorus (P), calcium (Ca), intact parathyroid hormone (iPTH), FGF-23 and plasma 1,25(OH)2D3 levels were determined before and after the study. Results FGF-23 levels in peripheral blood were significantly higher in cardiovascular event group than in non-cardiovascular event group (P<0.001). Correlation analysis indicated that the FGF-23 levels in peripheral blood correlated significantly with the cardiovascular events in MHD patients (P<0.001). Hemofiltration (HF) time was obviously longer in non-cardiovascular event group than in cardiovascular event group (P< 0.001). In non-cardiovascular event group, serum P, iPTH, and FGF-23 were lower at the end of the study, as compared with those at the beginning of the study (P< 0.001). At the end of the study, serum P, iPTH, and FGF-23 also reduced in cardiovascular event group, as compared with those in non-cardiovascular event group (P< 0.001). Conclusion FGF23 levels in peripheral blood correlate significantly with cardiovascular events in MHD patients, suggesting that FGF-23 level in peripheral blood may be used as an early warning indicator for cardiovascular events in MHD patients. HF has the better abilities to excrete P, iPTH and FGF-23. Hemodialysis combined with HF effectively reduce the cardiovascular events in MHD patients. Metrics

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The effects of urokinase in the treatment of acute thrombosis in arterio-venous graft GUO Xiang-jiang;ZHAO Yi-ping;SHI Ya-xue;YE Meng;SUN Min-li;ZHANG Hao;ZHANG Ji-wei. 2011, 10 (4):  198-200.  doi: 10.3969/j.issn.1671-4091.2011.04.00 Abstract ( 528 )   HTML ( 0 )   PDF (203KB) ( 654 )   【Abstract】 Objectives To summarize the experience to treat acute thrombosis in arterio-venous graft by thrombolysis using urokinase. Methods Thrombolysis was used as the first step to treat thrombosis in arterio-venous graft by puncture into the graft near the arterial end and continuous infusion of urokinase. Results We observed 20 cases with acute thrombosis in arterio-venous graft, of whom the mean age was 61.42±13.30 yrs, 6 cases were males and 14 cases were females. The arterio-venous grafts were established for 1 month to 8 years, and the thrombosis was detected within 6 days. Thrombolysis was successful in 14 cases (70%), with the mean thrombolysis duration of 10.73±5.94 hrs and mean urokinase dose of 817,500±400,100 units. The successful rate was closely related to the status of the venous outflow. Conclusions Thrombolysis by local continuous infusion of urokinase is a simple, safe and effective method. It facilitates other intervention techniques, and avoids the complications from catheterization or graft reconstruction for vascular access. Therefore, this method may become the first choice for the management of thrombosis in arterio-venous graft. Metrics

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Clinical investigation of continuous veno-venous hemofiltration on refractory heart failure and clearance of inflammatory mediators HUANG Jie-ping;DENG Xing-jiang;HE Jian-fa;LI Li;HE Min;ZHANG Kui-zheng;LI Jie-zhen 2011, 10 (4):  201-203.  doi: 10.3969/j.issn.1671-4091.2011.04.00 Abstract ( 503 )   HTML ( 0 )   PDF (209KB) ( 263 )   【Abstract】Objective To investigate the effects of continuous veno-venous hemofiltration (CVVH) on the levels of inflammatory mediators in patients with refractory heart failure. Methods Nineteen patients fulfilled the criteria of refractory heart failure were recruited in this study. A single lumen catheter was indwelled into the right femoral vein, and CVVH was performed. Blood biochemical markers including electrolytes, urea nitrogen (BUN), creatinine (Cr) and plasma inflammatory mediators were measured at 0, 1, 2, 4, 6 and 8h following CVVH. Plasma inflammatory mediators were measured by ELISA. Results BUN, Cr and serum K+ levels decreased significantly following CVVH (P<0.05). Plasma tumor necrosis factor-α (TNF-α), (IL-6) and (IL-8) decreased gradually. Left ventricular ejection fraction (LVEF) and cardiac index (CI) were also evaluated. Conclusion CVVH removes many inflammatory mediators in blood, and lowers the elevated blood biochemical markers including BUN, Cr and serum K+ in patients with refractory heart failure. CVVH is effective to refractory heart failure and its complications, such as severe edema, electrolyte disturbances and acid base imbalances. Metrics

基础研究

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Expressions of CD80 and CD86 in renal tissue and their correlation to interstitial kidney lesion MU Su-hong;JI Ying;ZHAO Shi-lei;MA Jing;SUI Man-shu;XIE Ru-juan 2011, 10 (4):  204-207.  doi: 10.3969/j.issn.1671-4091.2011.04.00 Abstract ( 528 )   HTML ( 1 )   PDF (424KB) ( 285 )   【Abstract】Objective Glomerulonephritis (GN) is a major cause of end-stage renal failure in China. Tubulointerstitial cell infiltration is involved in the tissue destruction and therefore in renal dysfunction. The infiltration cells in renal tissue are mostly T lym¬phocytes and monocytes/macrophages. Activation of T-cells requires costimulatory signals through binding of CD28 receptor with cognate ligands (CD80 and CD86) located on antigen-presenting cells (APC). The aim of this study was to define the mechanisms by which CD80 and CD86 regulate the development of primary glomerulonephritis. Methods Eighty-nine patients with primary glomerulonephritis were studied. Tubulointerstitial lesions were divided into grade 1 to grade 4 (negative to severe tissue damage) by using Katafuchi scale. The expression of CD80 and CD86 in renal tissues was detected by immunohistochemical methods. Results The expression and distribution patterns of CD80 and CD86 were different in patients with primary glomerulonephritis. CD86 was expressed extensively in glomerulus, periglomerular area, tubular epithelial cells, and peritubular interstitium, while CD80 was ex¬pressed only in some tubular epithelial cells and peritubular interstitium. Moreover, the percent¬age of CD80+ and CD86+ cells in peritubular interstitium showed a tendency to increase with tubulointerstitial damage (r=0.741, P<0.001; r=0.736, P<0.001, respectively). The expression of CD80 and CD86 significantly correlated with the amount of 24-hour proteinuria and creatinine clearance. Conclusion This study clearly shows that the increase of CD80 and CD86 expression with the progression of tubulointerstitial lesion may play an important role in primary glomerulonephritis. The expression of CD80 and CD86 correlates with renal function at the time of biopsy. The costimulatory molecules CD80 and CD86 may involve in the pathogenesis of primary glomerulonephritis. Metrics

护理园地

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A survey of the practice of hand hygiene among nurses in a hemodialysis center WU Xiang-lan;TAN Min;ZHAO Hui-ping;LEI Juan;WANG Ying;YANG Hong-jie 2011, 10 (4):  216-218.  Abstract ( 820 )   HTML ( 0 )   PDF (209KB) ( 259 )   【Abstract】Objective To improve the administration and the quality of hand hygiene, we evaluated the present situation of hand hygiene in nurses working in the hemodialysis center of Peking University People’s Hospital. Methods (a) We observed without notice the processes of hand hygiene including wash hands and wear gloves in nursing staff members and the situation of hand hygiene when they were working for the patients for continuous hemodialysis. (b) We also counted colonies on bacterial cultures for their hands to monitor the effect of the hand hygiene procedures. Results (a) Fifteen nurses were investigated. The qualified rate of hand washing procedures was 91.75% before they entered into the working area, was 100% after they contacted the patients, and was 99.66% during glove exchanges. The rate of required amount of hand lotion used during hand washing was 42.61%. The correct rate of washing position was 61.86%, and the rate of required time for washing was 63.57%. The correct rate of hand drying method was 86.25%. The correct rate of glove exchange procedure was 99.66% when change services from one to another patient. The intact rate of gloves was 97.25%. (b) The total colony amount of hand bacterial culture <10cfu/cm2, consistent with the standard in “Quality Control Standard for Hemodialysis, Beijing, 2001” was found in 90.67% nurses. Logistic regression analysis showed that the amount of liquid soap used and hand drying method were the independent factors for hand hygiene quality. Conclusion The nursing staff in hemodialysis units must understand the importance of hand washing, the procedures of hand washing, and the situation to change gloves. The qualified rate of hand hygiene was relatively high in this study, but several shortages existed in implementation of routine hand hygiene procedures. Therefore, the importance of hand hygiene in the quality control of hemodialysis should be re-emphasized. In addition, hand washing facilities such as hand drying sets should be examined routinely. Metrics

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Evidence-based nursing for the hemodialysis patients with high arteriovenous fistula vascular access YANG Jing-yuan;MA Chun-ling;ZHU Gao-feng;YAO Hong 2011, 10 (4):  219-220.  doi: 10.3969/j.issn.1671-4091.2011.04.00 Abstract ( 440 )   HTML ( 0 )   PDF (182KB) ( 325 )   Objective To investigate the effect of evidence-based care on the hemodialysis patients with high arteriovenous fistula vascular access. Method The evidence-based care was performed in 11 hemodialysis patients with brachial artery - cubital vein or brachial artery - high basilic vein arteriovenous fistula vascular access (observation group). We also retrospectively analyzed 11 hemodialysis patients with the implementation of the traditional vascular access care (control group). Results The complications of vascular access was significantly lower in observation group than in control group (P<0.05). Conclusion The evidence-based nursing for the hemodialysis patients with high arteriovenous fistula vascular access facilitates solving the practical problems, so that vascular access complications usually seen in patients with traditional vascular access care are reduced, and the life quality of the patients is improved. This nursing program also promotes the initiative potentials in nurses, enriches their professional knowledge, and enhances their nursing skills for hemodialysis patients. Metrics

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Application of airtight blood re-infusion method to heparin-free hemodialysis DENG Dong-qin;GE Wen-e;JIANG Rui-fen;WEI Xiao-xia;LI Xiao-feng 2011, 10 (4):  221-223.  doi: 10.3969/j.issn.1671-4091.2011.04.00 Abstract ( 1003 )   HTML ( 2 )   PDF (187KB) ( 452 )   【Abstract】 Objective To study whether airtight blood re-infusion method was suitable for the heparin-free hemodialysis. Method Seventy-one patients with hemodialyis (100 dialysis sessions) were enrolled in this study, including 21 patients treated with 50 sessions of heparin-free hemodialysis (experimental group) and 50 maintenance hemodialyis patients with heparin in hemodialysis (control group). Airtight blood re-infusion method was used when the patients met the criteria. The extent of clots in pipeline and dialyzer after airtight blood re-infusion, the operation time for the re-infusion, and the frequency of pressure applied to the re-infusion were observed and compared between the two groups. Result The completion rate of airtight blood re-infusion was significantly lower in experimental group than in control group (P＜0.05). The occurrence of clots in pipeline or dialyzer in airtight blood re-infusion was significantly higher in experimental group than in control group (P＜0.05). However, the operation time for airtight blood re-infusion, and the frequency of pressure applied to the blood re-infusion were insignificant between the 2 groups (P＞0.05). Conclusion Airtight blood re-infusion method can be considered for patients using heparin-free hemodialysis when the presence of clots in pipeline ranks 0 or 1. During the airtight blood re-infusion, blood clotting in pipeline should be always monitored. Metrics

血液净化相关产品与技术

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Discussion on requirements for preclinical and clinical research on single-use hemodialyzers DENG Jie 2011, 10 (4):  224-227.  doi: 10.3969/j.issn.1671-4091.2011.04.00 Abstract ( 488 )   HTML ( 0 )   PDF (215KB) ( 259 )   【Abstract】 This paper discusses preclinical research on hemodialyzers, including standards for hemodialyzer membranes, product control, biological evaluation, process control, and allowable limits for leachable substances. This paper also analyzes the requirements for clinical research on hemodialyzers, the key points to safety and efficacy evaluation of hemodialyzers, and the common questions from clinical researches. Metrics