Chinese Journal of Blood Purification

12 March 2011, Volume 10 Issue 3 Previous Issue    Next Issue

临床研究

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Active charcoal combined with zhubarb containing preparation as an adjuvant measure to control hyperphosphatemia in patients on dialysis CHENG Xu-yang;CAI Mei-shun;CUI Tai-gen;HE Lian;BAI Xia-feng;WU Lei-yun;DONG Jie;WANG Mi;LIU Jing;ZHU Ning;GUO Wei-ya;QIAO Song;ZHAO Hui-ping;XU Rong;ZUO Li;WANG Mei 2011, 10 (3):  119-124.  doi: 10.3969/j.issn.1671-4091.2011.03.00 Abstract ( 1147 )   HTML ( 0 )   PDF (261KB) ( 665 )   Objectives To evaluate the efficacy of active charcoal combined with rhubarb containing preparation in refractory hyperphosphatemia in patients on dialysis. Methods This was a multi-center, prospective and cross-over study. Patients on hemodialysis or peritoneal dialysis with stable disease condition but with hyperphosphatemia (serum phosphate > 1.78mmol/L) that could not be successfully controlled by conventional methods were selected. Patients were randomly assigned into 2 groups. Patients in therapy group received Aixite 1.5g with meal three times per day, and Shenshuaining, a composite preparation containing rhubarb, 4 pills three times per day. Dose of Shenshuaining was increased or decreased depending on patients’ gastrointestinal symptoms. Patients’ diet habit and other therapies remained unchanged. After 1 month, patients in treatment group were changed to control group, and those in control group to treatment group. Patients were then followed up for another 1 month. Changes of serum phosphate, albumin and hemoglobin between treatment group and control group were compared using paired t test. Results Fifty patients from 6 dialysis facilities were selected, of whom 24 patients were males, and 15 patients were on peritoneal dialysis. The average age and vintage were 56±13 and 4.9±3.1 years, respectively. Three patients were not included in the final analysis: one lost our follow-up, one had diarrhea before the treatment, and one took food unstably. The treatment decreased serum phosphate by about 0.35±0.67mmol/L (P=0.0010, compared with that of control group). Serum phosphate level lowered to <1.78mmol/L in 36.2% patients. Serum calcium and iPTH levels did not alter during the treatment period. Diarrhea happened in 3 patients and constipation in 3 patients, and the symptoms released after adjustment of Shenshuaining dose. Conclusions Active charcoal combined with rhubarb containing preparation is effective as an adjuvant measure in control of hyperphosphatemia in patients on dialysis, and provides a new approach for the treatment of hyperphosphatemia. Because the short observation period and small sample size, further study is needed to find out the long term benefits and risks of this regimen. Metrics

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The application of FX60 dialyser on chronic complications in maintenance hemodialysis patients LI Yue-hong;XIAO Ming;WANG Ru;YAN Yu;TAN Min;WANG Mei 2011, 10 (3):  125-128.  doi: 10.3969/j.issn.1671-4091.2011.03.00 Abstract ( 958 )   HTML ( 0 )   PDF (223KB) ( 317 )   Objective To investigate the application of FX60 dialyser on chronic complications in maintenance hemodialysis patients. Methods A total of 30 patients aged from 28 to 78 years old and on hemodialysis for more than 2 years were switched to FX60 dialyzer for hemodialysis for one year. Their clinical and biochemical indicators, including blood pressure, hemoglobin, albumin, intact parathyroid hormone (iPTH), calcium, lipids, calcium and phosphorus product, Kt/V and β2-MG clearance rate, were obtained before and after the application of FX60 dialyser. Results After the dialysis with FX60 dialyser for one year, hemoglobin increased from 103.9±18.1g/l to 111.8±11.5g/l (P＜0.05), iPTH declined from 525.2±695.6pg/ml to 437.3±417.2pg/ml (P＜0.05), mean arterial blood pressure lowered from 106.1±7.5mmHg to 104.5±7.3mmHg (P＜0.05), and high-density lipoprotein (HDL) increased from 0.91±0.27mmol/l to 1.02±0.28mmol/l (P<0.05). There were no significant differences in clearance rates for small molecules between low-flux dialysis and high-flux dialysis. β2-MG clearance rate was 35.9±3.8% after one dialysis session using FX60 dialyzer. Conclusion High-flux hemodialysis with FX60 dialyser effectively improves β2-MG clearance, renal anemia, hypertension, and secondary hyperparathyroidism in maintenance hemodialysis patients. Metrics

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The effect of low molecular weight heparin as an antioxidant in chronic kidney disease LIU Xiao-yan;ZHONG Yi-hong;DING Xiao-qiang 2011, 10 (3):  129-132.  doi: 10.3969/j.issn.1671-4091.2011.03.00 Abstract ( 484 )   HTML ( 0 )   PDF (237KB) ( 229 )   Objective To identify the anti-oxidative effect of low molecular weight heparin (LMWH) in chronic kidney disease (CKD). Method Forty CKD patients at stage 3-5 were randomly divided into two groups, glutathione (GSH) group (0.9% NaCl 250ml + Glutathione 1.8g/d, intravenous injection for 10 days) and LMWH group (Fraxiparine 0.4ml/d, subcutaneous injection for 10 days). Plasma malondialdehyde (MDA), advanced oxidation protein product (AOPP) and glutathione peroxidase activity (GSH-PX) were measured at the beginning and the end of glutathione or LMWH administration. Results Plasma AOPP decreased and plasma GSH-PX increased significantly after the treatment in both LMWH and GSH groups (P<0.05). The decrease of plasma AOPP was more significant in GSH group than in LMWH group (2.86±0.82 vs. 4.89±0.66μmol/l, P<0.05). After the treatment, plasma MDA did not change significantly in LMWH group, but decreased (5.09±1.44 vs. 4.61±1.30nmol/ml, P<0.05) in GSH group. There were no apparent side effects in both groups. Conclusion LMWH ameliorates oxidative stress state without apparent side effects. The anti-oxidative effect of LMWH is slightly lower than that of GSH. Metrics

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Changes of microinflammatory state in hemodialysis patients using high-flux membrane dialyzer XU Feng-bo;SUN Yi;LIU Hui-lan 2011, 10 (3):  133-135.  doi: 10.3969/j.issn.1671-4091.2011.03.00 Abstract ( 484 )   HTML ( 1 )   PDF (203KB) ( 447 )   Objective This is a prospective and self-controlled study designed to detect whether the microinflammatory state improves in hemodialysis patients using high-flux dialysis. Methods Thirty patients on maintenance low-flux hemodialysis were included in this study. They were then switched the dialyzer from low-flux dialyzer to high-flux F60 or FX60 dialyzer without changes of dialysis prescription. Ultrapure dialysate was used in the dialysis. Serum high sensitivity C-reactive protein (hCRP), interleukin-1 (IL-1), interleukin-6 (IL-6) and albumin were determined after the switch for 0, 6 and 12 months. Results After the switch from low-flux hemodialysis to high-flux hemodialysis for 12 months, serum hCRP and IL-1 remained unchanged. Serum IL-6 was 39.97±41.03ng/L, 36.81±37.09ng/L and 15.17±1.54ng/L (P<0.05) after the switch for 0, 6 and 12 months, respectively. Conclusions Switch from low-flux hemodialysis to high-flux hemodialysis may improve the microinflammatory state in maintenance hemodialysis patients. Metrics

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Clinical study on micro-inflammatory state in maintenance hemodialysis patients WEI Dan-dan;YAO Li;JIAO Ya-bin;LIU Mei-na;WANG Li-ning 2011, 10 (3):  136-139.  doi: 10.3969/j.issn.1671-4091.2011.03.00 Abstract ( 984 )   HTML ( 0 )   PDF (221KB) ( 705 )   Objective To investigate the micro-inflammatory state and its related factors in maintenance hemodialysis (MHD) patients. Methods We recruited 51 MHD patients with chronic renal failure (MHD group), and 29 healthy volunteers (control group). Their micro-inflammation indicators, including serum C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), were assayed and compared between the 2 groups. Serum creatinine (Scr), blood urea nitrogen (BUN), hemoglobin (Hb), transferrin (TRF), serum albumin (ALB), bicarbonate ions (HCO3-), serum parathyroid hormone (PTH) and other related indicators were also determined in MHD group, and correlation analyses were made among biochemical parameters. We subdivided the patients in MHD group into ACEI/ARB(+) group and ACEI/ARB(-) group based on whether angiotensin-converting enzyme inhibitor II/angiotensin II receptor 1 blockers (ACEI/ARB) were used in these patients. We then compared CRP, IL-6 and TNF-α between the 2 subgroups. Results (a) When comparisons were made between MHD group and control group, serum CRP (8.88±8.46mg/L vs. 0.8±0.2mg/L, P＜0.01), IL-6 (10.57±5.25pg/ml vs. 1.70±0.43pg/ml, P＜0.01) and TNF-α (30.55±12.84pg/ml vs. 11.36±3.14pg/ml, P＜0.01) were significantly increased in MHD group. (b) Correlation analyses within MHD group disclosed that serum CRP positively correlated with IL-6 (r = 0.526, P＜0.01), TNF-α (r = 0.511, P＜0.01), BUN (r = 0.279, P＜0.05), Scr (r = 0.287, P＜0.05), PTH (r=0.341, P＜0.05) and dialysis age (r = 0.298, P＜0.05), negatively correlated with the nutritional status indicators of serum ALB (r= -0.573, P＜0.05) and TRF (r= -0.46, P＜0.01), as well as HCO3- (r = - 0.479, P＜0.01), but did not correlate with Hb and patients’ age. (c) We compared 15 patients taking ACEI/ARB for more than 3 months in the ACEI/ARB(+) subgroup and 14 patients in the ACEI/ARB(-) subgroup. When comparisons were made between ACEI/ARB(+) subgroup and ACEI/ARB(-) subgroup, serum CRP (0.55±0.32mg/L vs. 10.07±9.34mg/L, P＜0.05), IL-6 (9.66±4.53pg/ml vs. 14.24±6.69pg/ml, P＜0.05) and TNF-α (26.36±11.25pg/ml vs. 38.35±16.46pg/ml, P＜0.05) were reduced in ACEI/ARB(+) subgroup, but age, gender and dialysis age had no significant differences between the two subgroups. Conclusions (a) Higher levels of serum CRP, IL-6 and TNF-α suggest the existence of micro-inflammatory state in MHD patients. Serum CRP is a better marker for micro-inflammatory state, and its level correlated with dialysis age, serum PTH and HCO3-. (b) Micro-inflammatory state has an important impact on nutritional status in MHD patients. (c) ACEI/ARB medications improve the micro-inflammatory state. Metrics

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Calcium supplement after parathyroidectomy with forearm autograft in uremic patients LI Ming-xin;Liu Ling;XUE Jun;Li Hai-ming;Chen Jing;Ding Feng;LU Fu-ming;GU Yong;Hao Chuan-ming 2011, 10 (3):  140-142.  doi: 10.3969/j.issn.1671-4091.2011.03.00 Abstract ( 642 )   HTML ( 1 )   PDF (212KB) ( 418 )   【Abstract】 Objective To resolve the problems of calcium supplement after parathyroidectomy with forearm autograft in uremic patients. Methodology Fifteen uremic patients who received the operation had their serum concentration of calcium monitored, and the amount of calcium supplement was adjusted based on serum calcium to maintain the serum calcium within the range of 1.8 to 2.5mmol/L. Results The average serum calcium was 2.235±0.082mmol/L within the 2 weeks after the operation. The cumulative amount of calcium supplement within the 2 weeks after the operation (CaSUM) was 48.2±17.9g. To maintain 1mmol/L serum calcium, the average calcium supplement in the 2 weeks after the operation (CaAVG) was 29.1±14.9 mg/day/kg. CaSUM positively correlated to the weight of parathyroid (R=0.910, P=0.038), but did not relate to the duration time of hyperparathyroidism (T), body weight, serum alkaline phosphatase (AKP), normalized protein catabolic rate (nPCR), and the first day serum intact PTH (iPTH) after the operation. CaAVG positively related to the T (R=1, P=0.041), but negatively related to the first day serum iPTH after the operation (R= -1, P=0.002). Conclusion The amount of calcium supplement after parathyroidectomy with forearm autograft correlates to parathyroid weight, the duration time of hyperparathyroidism, and the first day serum iPTH after the operation. Metrics

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陶 英 薛 军 陈 烨 TAO Ying;XUE Jun;CHEN Ye 2011, 10 (3):  143-145.  doi: 10.3969/j.issn.1671-4091.2011.03.00 Abstract ( 485 )   HTML ( 0 )   PDF (197KB) ( 220 )   【Abstract】 Objective To study the effect of hemodiafiltration on micro-inflammation and cardiac function in maintenance hemodialysis patients complicated with heart failure. Methods Fifty patients with uremic anemia and heart failure were divided into hemodiafiltration (HDF) group (n=25) and hemodialysis (HD) group (n=25). Patients in the 2 groups were treated with similar cardiotonic agents. Serum CRP, IL-6 and TNF-α were measured by immunoturbidimetry or ELISA method before the treatment and after treatment for 3 months. Their left ventricular diastolic diameter (LVDd), LVDs, interventricular septal thickness (IVST) and left ventricular ejection fraction (LVEF) were measured by echocardiogram. Result In HDF and HD groups before treatment, serum CRP, IL-6 and TNF-α were much higher than those in control group, the left ventricular end-diastolic dimension (LVEDd) and IVST increased, and the LVEF decreased remarkably (P<0.05). After the treatment, the significant amelioration rate and total effective rate were higher in HDF group than in HD group. Serum CRP, IL-6 and TNF-α decreased significantly in HDF group, but they were still higher in HD group. LVEF increased, and LVDd, LVDs and IVST decreased in HDF group, but these parameters unchanged in HD group after the treatment (P>0.05). Conclusion Cardiac function decreases apparently in hemodialysis patients complicated with heart failure. Long-term HDF removes inflammatory factors efficiently, improves cardiac function, and achieves a higher effective rate. Metrics

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Impact of pain on the quality of life in long-term hemodialysis patients LU Yan;CHEN Li-meng;XIA Jing-hua;SUN Yang;LI Xue-mei 2011, 10 (3):  146-148.  doi: 10.3969/j.issn.1671-4091.2011.03.00 Abstract ( 972 )   HTML ( 1 )   PDF (197KB) ( 332 )   【Abstract】 Objective To study the association between pain and life quality in patients with long-term hemodialysis. Methods A total of 33 patients with hemodialysis for more than 5 years from Peking Union Medical College Hospital were selected. The mean age of these patients was 60.7±9.6 years old. The average HD period was 9.5±3.9（5-17）years. The general conditions and biochemical data were collected. Brief Pain Inventory evaluated the pain. SF-36 scales assessed their life quality. Results 75.8% patients had chronic pain. The usually affected parts were shoulder (51.5%), knee (36.4%), wrist (18.2%) and hip (15.2%). The average pain scale was 3.7±1.9 (numerical scale 0-10). 24.2% patients were receiving anti-inflammatory drugs. There were no demographic, serological, and dialysis-related predictors for pain (such as age, primary disease, hemodialysis period, KT/V, Ca, P, PTH and Hb). Patients who complained of pain got less scaled scores of SF-36 (P<0.05). Conclusion Pain was a significant problem for long-term HD patients and affected the quality of life. Nephrologists should pay more attention on it. Metrics

基础研究

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The effects of lipopolysaccharide on the expression of inflammatory factors interleukin 15 and interleukin 6 and malondialdehyde in rat peritoneal mesothelial cells PENG Xia;MA Jian-fei;LI Cheng-cheng;FAN Yi;HUO Ai-jing 2011, 10 (3):  149-153.  doi: 10.3969/j.issn.1671-4091.2011.03.00 Abstract ( 457 )   HTML ( 0 )   PDF (261KB) ( 206 )   【Abstract】 Objective To observe the effects of lipopolysaccharide (LPS) on the expression of inflammatory factors interleukin 15 (IL-15) and interleukin 6 (IL-6) and malondialdehyde (MDA) in rat peritoneal mesothelial cells (RPMCs). Methods RPMCs were isolated and cultured using trypsin, and then identified. RPMCs at passage 3 were used in the experiment. The cells were divided into (i) normal control group; (ii) LPS dose/time group, LPS 1mg/L, 10mg/L or 100mg/L treated for 6 hours or 12 hours; (iii) LPS time group, LPS 10mg/L treated for 3, 6, 12 and 24 hours. IL-15 mRNA was measured by real-time RT-PCR. IL-15 and IL-6 were assayed by ELISA. MDA were determined by thiobarbituric acid method. Results IL-6, IL-15 and its mRNAs, and MDA were significantly increased in a dose-dependent manner and/or a concentration-dependent manner in the groups treated with LPS (p<0.05, compared with those of the control group). Conclusion IL-15 may be involved in the pathological processes of peritoneal dialysis-related peritonitis. LPS can up-regulate the expression of IL-15, IL-6 and MDA in RPMCs, possibly relating to the peritonitis and oxidative stress. Metrics

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The influences of calcium on proliferation, daminification and fibronectin synthesis in human peritoneal mesothelial cells PENG Xiang;LIU Fu-you;LI Jun;LING Guang-hui;et al. 2011, 10 (3):  154-159.  doi: 10.3969/j.issn.1671-4091.2011.03.00 Abstract ( 463 )   HTML ( 0 )   PDF (365KB) ( 250 )   【Abstract】 Objective To investigate the influences of various concentrations of calcium on human peritoneal mesothelial cells (HPMCs) proliferation, damnification and interstitial fibrosis in vitro and in vivo. Methods HPMCs were cultured in the media containing calcium 0, 0.25, 0.75, 1.25, 1.75 or 2.25mmol/L for 12h or 48h. The proliferation of HPMCs was assessed by tetrazolium salt colorimetry assay (MTT assay), and the damage of HPMCs was evaluated by measuring LDH in the medium. Fibronectin (FN) in cytoplasm of HPMCs was determined by western blotting. For clinical observations, a self-controlled study was conducted in 47 patients on peritoneal dialysis using the dialysis fluid PD4 (1.25mmol/L calcium, Baxter) for 18.5±11.74 months. The patients were then treated with the dialysis fluid PD2 (1.75mmol/L calcium, other components are the same as PD4, Baxter) for 4 weeks without any other changes in their therapies. Patients were examined after the dialysis using PD2 fluid for 1, 2, 3 and 4 weeks. FN and LDH in peritoneal effluent were measured by enzyme linked immunosorbent assay (ELISA), and CA125 was detected by electrochemiluminescence assay (ECLA). We also assayed patients’ serum Ca, P, and intact parathyroid hormone (iPTH). Results Calcium in culture media correlated to the proliferation of HPMCs in concentration- and time- dependent manners, with the most promotion effect at 1.75mmol/L calcium. Calcium in culture media also correlated to the increase of LDH in peritoneal effluents in a time-dependent manner, with the least impact on LDH at 1.25mmol/L calcium (P＜0.05), and to the increase of FN in cells in concentration- and time-dependent manners. In peritoneal dialysis patients after switch to PD2 fluid, LDH in peritoneal effluents increased significantly in a time-dependent manner. In those after the switch for 4 weeks, LDH and FN reached to the highest values (P＜0.01), CA125 decreased to the lowest level (P＜0.01), serum calcium was higher than that of control group (P＜0.05), serum phosphorus was lower than that of control group (P＜0.05), and iPTH remained unchanged (P>0.05). Conclusions Our in vivo and in vitro studies demonstrate that higher calcium concentration in peritoneal dialysis fluid at 1.75mmol/L stimulates HPMCs proliferation, injures HPMCs, and up-regulates FN expression in HPMCs. Physiological calcium concentration in peritoneal dialysis fluid at 1.25mmol/L protects the peritoneum from fibrosis. Metrics

护理园地

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Investigation on the mental health of hemodialysis nurses and influencing factors LUO Shi-xiang 2011, 10 (3):  168-170.  Abstract ( 410 )   HTML ( 0 )   PDF (177KB) ( 291 )   Metrics