Chinese Journal of Blood Purification

12 November 2011, Volume 10 Issue 11 Previous Issue    Next Issue

专家述评

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Correct selection of methods for bacteria culture and residual chlorine measurement in dialysate ZUO Li 2011, 10 (11):  581-582.  Abstract ( 333 )   HTML ( 0 )   PDF (155KB) ( 271 )   Metrics

临床研究

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Comparison of different culture methods for bacterial recovery in dialysis water TIAN Ru;TIAN Ai-hui;ZUO Li. 2011, 10 (11):  583-587.  doi: 10.3969/j.issn.1671-4091.2011.11.00 Abstract ( 628 )   HTML ( 2 )   PDF (286KB) ( 343 )   Objective The sensitivity of the four culture methods for bacteria detection in dialysis water was compared to find out the most sensitive one. Methods A total of 85 samples of dialysis water from a blood purification center in Beijing were collected and detected for bacteria by the four culture methods: method A: Columbia blood agar plate incubated at 37℃ for 48 hours, method B: TSA incubated at 37℃ for 48 hours, method C: R2A incubated at 37℃ for 48 hours, and method D: R2A incubated at 20℃ for 7 days. Tap water was used as positive control and water for injection was used as negative control. Results Among the four methods, the number of bacterial colonies was highest by method D and followed by method C. The results from method C were closely consistent with those from method D. Conclusions Method D is the best method for bacteria detection in dialysis water, which is identical to the method recommended by European Best Practice Guideline. Method C can also be used with similar efficiency. Metrics

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The correlation of autonomic dysfunction and intra-dialytic hypotension in maintenance hemodialysis patients XU Jing;CHENG Xu-yang;JIN Qi-zhuang;CAO Li-yun;LIU Li;ZUO Li 2011, 10 (11):  594-598.  doi: 10.3969/j.issn.1671-4091.2011.11.00 Abstract ( 309 )   HTML ( 0 )   PDF (238KB) ( 372 )   Objective To investigate the correlation between autonomic nervous system dysfunction and intra-dialytic hypotension (IDH) in maintenance hemodialysis (MHD) patients by analyzing the heart rate variability (HRV). Methods Blood pressure changes were recorded and dynamic electrocardiography (Holter) was conducted in 60 MHD patients during a hemodialysis session. Patients were assigned into IDH group or control group. The difference in power spectra of HRV between the two groups was analyzed. The normalized low-frequency (LFn) component of HRV was assumed to be the index of sympathetic activity, and the normalized high-frequency (HFn) component to be the index of parasympathetic activity. The LF/HF ratio then indirectly represents the balance level between sympathetic and vagal activities. A logistic regression model was set up to analyze the value of LFn for the prediction of IDH, using IDH as the outcome variable, and parameters including sex, age, hemodialysis age, diabetes as the primary disease, cardiac index, central blood volume/body weigh ratio, ultrafiltration volume/body weight ratio and LFn before hemodialysis as the prediction variables. Results In control group, LFn and LF/HF ratio elevated continually and gradually in a dialysis session (The median of LFn was 65.47nu at the beginning of hemodialysis, 73.79nu after 210 minutes, P=0.001; The median of LF/HF ratio was 2.17 at the beginning, and 3.98 after 210 minutes, P＜0.001), whereas HFn reduced gradually (The median of HFn was 30.06nu at the beginning and 19.43nu after 210 minutes, P=0.002). In IDH group, however, the above indexes changed inconsistently, and LFn was lower than that of control group in the entire hemodialysis session. Logistic regression model showed that LFn was a predictor for IDH (OR= 0.943, 95%CI=0.894～0.966) after adjustment by the above demographic characteristics and basic clinical situations. Conclusion In MHD patients, the presence of IDH may relate to the incapability of continuous and consistent increase of sympathetic activity along with blood volume reduction during hemodialysis. Decrease of basal sympathetic activity before hemodialysis is an independent risk factor for IDH, suggesting that abnormal autonomic nervous function is one of the important causes leading to IDH. Metrics

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The clinical value of Bioz.com digital noninvasive hemodynamic monitoring system used in blood purification centers JIA Feng-yu;MENG Jian-zhong;WANG Su-xia;LIU Wen-yuan;JING Ying;GE Yan-ming;YUE Ji;LV Su-yi 2011, 10 (11):  599-601.  doi: 10.3969/j.issn.1671-4091.2011.11.00 Abstract ( 304 )   HTML ( 0 )   PDF (276KB) ( 716 )   Objective Hemodynamic and volume load states are important issues in patients on blood purification. In this study we monitored the hemodynamic status in 235 patients by using the Bioz.com digital noninvasive hemodynamic monitoring system to explore clinical value of this instrument in purification centers. Method A total of 235 hemodialysis patients (65±13 years old) were divided into 3 types: new administers, clinically stable patients and critically ill patients. Hemodynamic variables such as cardiac output (CO), acceleration cardiac index (ACI), thoracic fluid level (TFC) and systemic vascular resistance (SVR) measured by the Bioz.com system were compared with the results from echocardiography and chest X-ray examinations as the golden standards for the same patients and for parallel controls. Results Values of CO and ACI from Bioz.com system were consistent with those from echocardiography. TFC from Bio.com system was positively correlated to the cardio-thoracic ratio from X-ray films and mean arterial pressure (MAP), and SVR was positively correlated to MAP. By using the values from the bio.com system as the therapeutic guidance, maintenance hemodialysis patients showed the decreases of dehydration amount and heart failure frequency, and critically ill patients treated with continuous blood purification displayed lower APACHE Ⅱ score and higher percentage of stable blood pressure period. Conclusion Bioz.com digital noninvasive hemodynamic monitoring system provides multiple, reliable and clinically significant data for determining cardiac function status, volume load capacity, dry body weight and dehydration amount. It is a useful monitoring instrument in the field of blood purification. Metrics

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The effects of the selective cytopheretic device on outcome of severe acute kidney injury: a pilot study ZHOU Ying;XIE Qiong-hong;LIU Jun-feng;XU Zhong-ye;KUANG Ding-wei;YOU Huai-zhou;LAI Ling-yun;GU Yong;HAO Chuan-ming;LIN Shan-yan;DING Feng;H. David Humes 2011, 10 (11):  602-605.  doi: 10.3969/j.issn.1671-4091.2011.11.00 Abstract ( 318 )   HTML ( 0 )   PDF (272KB) ( 221 )   Objectives To evaluate the effect of the selective cytopheretic device (SCD) on outcome of severe acute kidney injury (AKI) requiring renal replacement therapy, and to observe the occurrence of adverse events from application of the device. Methods In this study, acute kidney injury was defined as ischemic or nephrotoxic acute tubular necrosis by clinic diagnosis, with at least one nonrenal organ failure or presence of sepsis at the same time. All subjects received standard intensive care treatment with continuous veno-venous hemofiltration (CVVH) in addition to the SCD treatment. Patients enrolled in the trial were compared with the historical case-matched controls from PICARD study with respect to age and Sequential Organ Failure Assessment (SOFA) score. The primary endpoint was in-hospital all cause mortality. Other observation index included urine output change and the occurrence of adverse events. After adjusting for confounders, the Cox model was used to analyze whether SCD combined with CVVH treatment was better than routine CVVH. Results A total of 9 patients were enrolled. In-hospital all cause mortality of SCD combined with CVVH treatment group was 22.2%, significantly lower than historical case-matched control group (77.8%) (p=0.027). Multiple regression analysis identified treatment with SCD as the only significant variable affecting mortality among age, SOFA score, and average change in urine output (SCD vs. CVVH historical cohort, p=0.0222). Mean total urine output in the 9 subjects receiving SCD treatment increased from a baseline of approximately 500 ml/d to more than 2,000 ml/d by day 7 of treatment. In this study, only a few mild adverse events occurred, and no serious adverse events were reported. Conclusion SCD can regulate the immune response by deactivating leukocytes, and therefore improve in-hospital mortality of patients with AKI. The safety of SCD is favorable. Metrics

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Application of daytime continuous veno-venous hemodiafiltration for the treatment of sepsis with acute kidney injury patients ZHANG Ting;WANG Yan;A Sheng;CHEN Meng-hua 2011, 10 (11):  606-609.  doi: 10.3969/j.issn.1671-4091.2011.11.00 Abstract ( 406 )   HTML ( 0 )   PDF (227KB) ( 216 )   Objective To evaluate the clinical efficacy of continuous veno-venous hemodiafiltration (CVVHDF) in treating critically ill patients with sepsis and acute renal injury. Methods The clinical features and factors affecting prognosis were retrospectively analyzed in 16 critically ill patients with sepsis and acute renal injury who received daytime CVVHDF in this hospital from Jan. 2009 to Feb. 2009. Patients received this treatment schedule with CVVHDF of 35-40 ml per kilogram of body weight per hour and 1500-2000 ml dialysate per hour. Results Seven patients (43.8%) survived the acute phase of their illness, with APACHE Ⅱ score being 25.4±6.7; whereas nine patients (56.2%) died during the acute phase, with APACHE Ⅱ score being 34.4±4.3. Clinical data, biochemical parameters, mechanical ventilation, characteristics of organ failure, and severity of the illness were analyzed between the two groups. There were significant differences in plasma sodium, urinary volume, number of failure organs and mechanical ventilation between the two groups before CVVHDF treatment (P<0.05). Meanwhile, higher APACHE II score and severer metabolic acidosis were found in the died group. Conclusion Daytime CVVHDF is useful for the decrease of mortality rate in critically ill patients with sepsis and acute renal failure. The prognosis of these patients is correlated to mechanical ventilation, number of affected organs, plasma sodium concentration, metabolic acidosis and APACHE Ⅱ score. Metrics

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Effects of high flux hemodialysis on serum folate and vitamin B12 in maintenance hemodialysis patients YIN Pei;LI Ji-jun;S ONG Yan;ZHAO Chang-zheng;GONG Hong-ying;WANG Jian-hong 2011, 10 (11):  610-612.  doi: 10.3969/j.issn.1671-4091.2011.11.00 Abstract ( 568 )   HTML ( 0 )   PDF (205KB) ( 256 )   Objective This prospective and self-controlled study was designed to detect whether serum folate and vitamin B12 concentration improved in hemodialysis patients treated with high flux dialysis. Methods A total of 30 patients on maintenance low flux hemodialysis were included. After switching to high flux dialysis, dialysis prescription was unchanged except the change of dialyzer. Ultrapure dialysate was implied. Pre-dialysis blood samples were collected for measuring serum folate and vitamin B12. Post-dialysis blood samples were collected at 3 and 6 months after entering this study. Results Serum folate and vitamin B12 remained unchanged during the study process. Serum folate was 5.16±0.87ng/ml, 4.94±0.85ng/ml and 4.75±0.77ng/ml at 0, 3 and 6 months, respectively, of high flux dialysis. However, the declining trend of serum folate after high flux dialysis was statistically insignificant (P＞0.05). Serum vitamin B12 level was 419.13±136.83pg/ml, 414.00±153.16pg/ml and 432.83±139.12pg/m, at 0, 3 and 6 months, respectively, of high flux dialysis (P＞0.05). Therefore, serum folate and vitamin B12 levels were unchanged before and after the dialysis. Conclusions Our results show that shifting from low flux to high flux hemodialysis does not result in the decrease of serum folate and vitamin B12. Metrics

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Cognitive impairment in long-term maintenance hemodialysis patients LI Jian-jun;SHI Dan. 2011, 10 (11):  613-616.  doi: 10.3969/j.issn.1671-4091.2011.11.00 Abstract ( 291 )   HTML ( 1 )   PDF (237KB) ( 181 )   Objective To assess the cognitive impairment in long-term maintenance hemodialysis patients, and to investigate the risk factors relating to the impairment. Method Case control study was performed in the subjects who were on long-term maintenance hemodialysis and without intracranial organic diseases by head CT and MRI examinations, and in the control subjects who were normal community residents without intracranial lesions confirmed by our medical examination center. Performance on a battery of neuropsychological tests was compared between 42 patients and 46 control subjects. The test battery included tests for memory, executive functions, mental speed, visuospatial abilities, visuoconstructive skills and mini-mental state examinations. Results After adjustment for age, sex, years of education, smoking, systolic blood pressure and serum glucose, subjects with long-term maintenance hemodialysis had significantly lower levels of performance tests for acoustic memory, executive functions (including response inhibition, mental flexibility, concept formation and abstract reasoning, plan, sequence and logistical ability), mental processing speed and visuoconstructive skills (P＜0.001), but tests for visual memory (include modified Rey complex figure immediate memory, long-time delay memory and recognition) and visuospatial abilities showed the results similar to control group (P=0.175, P=0.07, P=0.339; P=0.175). Multiple logistic regression analysis showed that hypertension and anemia were the independent risk factors for cognitive impairment in long-term maintenance hemodialysis patients. Conclusion Compared with control subjects, long-term maintenance hemodialysis patients have extensive neuropsychological performance abnormalities that may closely relate to anemia and hypertension. Metrics

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Association of calcaneal osteopenia with arterial stiffness in hemodialysis patients SUN Fang;YU Ze-xing;LIU Jing;MA Li-jie;SHEN Yang;CUI Tai-gen;GUO Rui-jun;ZHOU Yi-lun 2011, 10 (11):  617-620.  doi: 10.3969/j.issn.1671-4091.2011.11.00 Abstract ( 325 )   HTML ( 0 )   PDF (245KB) ( 266 )   Objective To determine the relationship between estimated calcaneal bone mineral density (BMD) and arterial stiffness in hemodialysis patients. Methods Forty one patients on maintenance hemodialysis were recruited. Estimated calcaneal BMD was measured by a calcaneal quantitative ultrasound instrument. Stiffness index β of the right common carotid artery (CCA) was measured using an ultrasonic phase-locked echo-tracking system (Prosound a10; Aloka, Japan) equipped with a high-resolution real-time 7.5-13 MHz linear scanner. Stiffness index β = [ln (Ps/Pd)]/[(Ds-Dd)/Dd], where Ps and Pd are the brachial systolic and diastolic blood pressures, respectively, and Ds and Dd are the systolic and diastolic inner diameters of CCA, respectively. Serum 25-hydroxyvitamin D3 and intact parathyroid hormone (iPTH) were detected by electrochemiluminescence. Serum calcium, phosphorus, C-reactive protein, albumin, total cholesterol, high density lipoprotein, low density lipoprotein and triglyceride were determined with standard methods. Results The mean age of the patients was 57.0±12.3 years. The mean estimated calcaneal BMD was -2.1±0.8, meaning that 14.6% of the patients had osteoporosis, and 58.5% had osteopenia. Pearson correlation analysis indicated that stiffness index β was negatively correlated with calcaneal BMD (r=-0.453, P=0.002) and 25-hydroxyvitamin D3 (r=-0.337, P=0.031), and was positively correlated with serum phosphorus (r=0.391, P=0.022), mean arterial pressure (r=0.298，P=0.043) and age (r=0.477, P=0.002), but had no correlation with serum calcium, iPTH, C-reactive protein, albumin, and lipids. Multiple stepwise regression analysis showed that age (β=0.311, P=0.008) and calcaneal BMD (β=-0.218，P=0.043) were the independent variables responsible for stiffness index β. Estimated calcaneal BMD was positively correlated with 25-hydroxyvitamin D3 (r=0.315, P=0.049) and negatively correlated with age (r=-0.381, P=0.014) and serum phosphorus (r=-0.323, P=0.046), but had no correlation with serum calcium and iPTH. Conclusion Calcaneal osteopenia is prevalent in hemodialysis patients, and it is independently correlated with carotid arterial stiffness. Metrics