Chinese Journal of Blood Purification

12 October 2011, Volume 10 Issue 10 Previous Issue    Next Issue

专题

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New challenges and points of view to the build up of arteriovenous fistulas ZHANG Pan;YE Chao-yang 2011, 10 (10):  523-526.  Abstract ( 266 )   HTML ( 0 )   PDF (181KB) ( 361 )   Metrics

临床研究

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The influence of the length of chronic central venous catheter on catheter dysfunction in hemodialysis patients YANG Tao;ZHANG Li-hong;ZHAN Shen;LI Da-sheng;WANG Yu-zhu 2011, 10 (10):  527-530.  doi: 10.3969/j.issn.1671-4091.2011.10.00 Abstract ( 525 )   HTML ( 1 )   PDF (214KB) ( 237 )   Objective To investigate catheter dysfunction in relation to the length of chronic central venous catheter in hemodialysis patients, and to explore the factors relating to the dysfunction. Methods We recruited 231 end stage renal disease patients inserted a catheter into right internal jugular veins for vascular access. X-ray chest film was taken to determine the catheter tip position. They were then assigned into 3 groups (36 cm, 40 cm, or 45cm groups) based on the catheter length placed in the body. Their age, body height, hemoglobin (Hb), platelet (Plt), activated partial thromboplastin time (APTT), albumin (Alb) and disease history such as diabetes mellitus and coronary heart disease were collected. Arrhythmia during dialysis using the catheter was also recorded. Catheter dysfunction rate was compared among the 3 groups. Logistic regression was used to evaluate the factors relating to catheter dysfunction. Results Blood flow during hemodialysis was 254.4±30.6ml/min, 257.7±23.1ml/min and 253.0±28.0ml/min in the 36cm, 40cm and 45cm groups (P=0.603), respectively. Statistical difference in catheter dysfunction rate was not found among the 3 groups (P=0.715) nor between the patients with the catheter tip in atrium and those outside the atrium (P=0.280). Logistic regression indicated that hemoglobin, albumin and body height were the factors relating to catheter dysfunction in hemodialysis patients with the odds ratio of 1.037 (P=0.002), 0.922 ((P=0.041) and 0.910 (P=0.002), respectively. Conclusion Hemoglobin, albumin and body height are the influence factors on catheter dysfunction, but catheter length is unrelated to catheter dysfunction in hemodialysis patients Metrics

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Distribution and complications of native arteriovenous fistulas in maintenance hemodialysis patients GONG Li;HUANG Jie- bo;ZANG Xiu-juan;CHEN Lei;WANG Jing;YU Qing 2011, 10 (10):  531-534.  Abstract ( 283 )   HTML ( 0 )   PDF (228KB) ( 436 )   Metrics

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The influence of systemic anticoagulation with warfarin between dialysis sessions on survival in hemodialysis patients with long-term indwelling catheters LONG Chun-jiao;LI Yuan-ming;SUN Yong-chao;WANG Lu-fang;PENG Lan;XIE Hui-le;WU Kun 2011, 10 (10):  535-537.  doi: R318.16 R512.6 Abstract ( 334 )   HTML ( 1 )   PDF (217KB) ( 211 )   Objective Long-term indwelling catheter is an alternative approach for vascular access in hemodialysis patients. However, complications such as thromboses and infections often lead to catheter dysfunction. To investigate the effect of anticoagulation on catheter patency, we used warfarin between dialysis sessions in hemodialysis patients with tunneled, cuffed and indwelling catheters in right internal jugular vein. Method In a cohort of 309 hemodialysis patients implanted with cuffed dual-lumen catheters in right jugular vein as vascular access, 144 patients took adjusted doses of warfarin between dialysis sessions, and the remaining 165 cases without anticoagulation medication were served as controls. Catheter patency and infection rate were monitored. The study end point arrived when their blood flow during a dialysis session became <200ml/min, they had refractory catheter infection, or their observation period reached to 36 months. Results The average survival period of catheter was significantly longer in anticoagulant group than in control group (31.8±0.9 months vs. 22.0±1.2 months, P＜0.01). Moreover, patients in anticoagulant group had a higher 3-year patency rate (82.6% vs 51.5%, P = 0.003) and a lower catheter infection rate (5.6% vs 14.5%, P＜0.05). Conclusion Warfarin is effective in extending catheter patency period and lowering local infection rate. Metrics

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Vascular access investigation in a hemodialysis center in Shanghai CHENG Ye;LIN Yue-yong;YE Chaoyang;RONG Shu;CHEN Jing;MEI Chang-lin 2011, 10 (10):  538-541.  doi: 10.3969/j.issn.1671-4091.2011.10.00 Abstract ( 291 )   HTML ( 0 )   PDF (335KB) ( 562 )   Objective To retrospectively investigate vascular access (VA) in hemodialysis patients in our hemodialysis center. Method We recruited 1102 patients in this center in 2010, of whom 667 were incident patients, and 435 were prevalent patients. Their VA types were recorded. Autologous arteriovenous fistula (AVF) used in maintenance hemodialysis patients and the primary diseases in patients with long-term indwelling catheterization were analyzed. SPSS software was used for the statistical analyses. Results In the 667 incident patients for VA, 81.26% of them used provisional catheter, 4.2% long-term cuffed catheter, and 14.54% AVF. In the 435 prevalent patients, 83.91% of them used AVF, 13.56% long-term cuffed catheter, 1.84% provisional catheter, and 0.69% graft vessel. The radio-cephalic anastomosis was the most common site for AVF. We treated complications from AVF in 173 cases (15.7%). The complications seen in these patients included thrombosis (72.25%), arterial steal syndrome (14.45%), stenosis at anastomosis site (8.67%), and extremity edema (4.62%). The average infection rate in patients with long-term cuffed catheters was 0.07/1,000 catheterization days. Conclusion In incident patients, provisional catheters were frequently performed. In maintenance hemodialysis patients, autologous AVF was frequently seen, and artificial vessel graft for VA was less recommended. Prevention of complications from AVF has been an important issue in clinical practice. Metrics

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Effects of arteriovenous fistula at elbow and wrist on left ventricular structure in maintenance hemodialysis patients HUANG Jie-bo;WANG Jing;CHEN Lei;ZHANG Zheng;YU Qing 2011, 10 (10):  542-544.  doi: 10.3969/j.issn.1671-4091.2011.10.00 Abstract ( 200 )   HTML ( 0 )   PDF (220KB) ( 353 )   Objective To study the effect of arteriovenous fistulas at elbow and at wrist on left ventricular structure in maintenance hemodialysis patients. Methods A total of 46 maintenance hemodialysis patients during October 2007 to January 2011 were enrolled in this study. Arteriovenous fistula was created at elbow in 14 cases (elbow group), and at wrist in 32 cases (wrist group). Left ventricular ejection fraction (EF), shortening fraction (FS), left atrium internal dimension (LAD), aortic root internal dimension (AAo), left ventricular end diastolic internal dimension (LVDd), left ventricular end systolic internal dimension (LVDs), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), pump controlled blood flow (Qb)，left ventricular mass index(LVMI)，relative wall thickness (RWI) and E/A were compared between the two groups. Results LAD was lower in wrist group than in elbow group (40.59±4.72 vs 42.07±9.17, P＜0.05). There were no significant differences in FS, AAo, LVDd, LVDs, IVST, LVPWT, LVM, LVMI and Qb (P>0.05) nor in left ventricular function between the two groups (P>0.05). Conclusion The effects of the two kinds of arteriovenous fistula on left cardiac structure are similar. Elbow arteriovenous fistula does not account for the high risk factor for high output cardiac failure among maintenance hemodialysis patients. Therefore, elbow arteriovenous fistula is a reasonable alternative vascular access when wrist arteriovenous fistula is difficult to be made in maintenance hemodialysis patients. Metrics

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Correlation of QT dispersion with ventricular arrhythmias and its influencing factors in maintenance hemodialysis patients LIU Xin-yu;ZOU He-qun;LI Yong-qiang;WANG Xiao-hong;LI bin;ZHANG Ying. 2011, 10 (10):  545-547.  doi: 10.3969/j.issn.1671-4091.2011.10.00 Abstract ( 209 )   HTML ( 0 )   PDF (210KB) ( 178 )   Objective To investigate the change of QT dispersion (QTd) in 60 patients with uremia undergoing maintenance hemodialysis (MHD), the relationship between QTd and ventricular arrhythmia in MHD patients, and the factors relating to QTd. Methods 12-lead ECG was conducted in 60 MHD patients before and after dialysis, and their QTds were calculated. Clinical observation, laboratory examinations and statistical analysis were performed. Results Before hemodialysis, QTd values were higher in patients with ventricular arrhythmias than those without ventricular arrhythmias (P＜0.01). QTd values became higher after hemodialysis (P＜0.01). Regression analysis showed that the magnitude of QTd increase positively correlated with the magnitude of K+ and HCO3- concentration changes (r=0.67, P＜0.01, and r=0.79, P＜0.01, respectively) after hemodialysis. Conclusion QTd value may relate to the presence of ventricular arrhythmias in MHD patients. QTd increases further after hemodialysis, probably resulting from the rapid change of serum K+ concentration and rapid correction of acidosis. Metrics

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Endogenous glucocorticoids and insulin resistance induced protein-energy wasting in hemodialysis patients XU Ye;WANG Hui-ling;LU Shi;ZHANG Jin-yuan. 2011, 10 (10):  548-551.  doi: 10.3969/j.issn.1671-4091.2011.10.00 Abstract ( 254 )   HTML ( 0 )   PDF (229KB) ( 222 )   Objective The protein-energy wasting (PEW) often complicates with hemodialysis, resulting in a poorer life quality and a higher mortality in these patients. This clinical research studied the relationship between PEW and endogenous glucocorticoids (eGC) level and insulin resistance in maintenance hemodialysis patients (MHD). Methods A total of 70 MHD patients with malnutrition based on the modified quantitative subjective global assessment (MQSGA) score over 10 were selected, and 30 healthy adults were used as controls. We measured their biochemical parameters, body mass index (BMI) and anthropometry data. Fasting venous serum corticosterone before hemodialysis was measured by EIA. Fasting serum insulin was measured by ELISA, and insulin resistance was calculated by HOMA-IR. The correlation between nutritional parameters and corticosterone and HOMA-IR was analyzed. Results The MQSGA score of the 70 MHD patients was 12.97±2.36. Their body weight, BMI, triceps skinfold (TSF) and mid-arm circumference (MAC), as well as total serum protein and serum albumin, were all lower than those of the controls. Serum corticosterone was significantly increased compared with controls (10.82±14.52ng/L vs 2.35±3.68ng/L, P＜0.01). Fasting insulin significantly increased in MHD patients (25.2±9.9mmol/L vs 6.4±1.3mmol/L, P＜0.001), so did the HOMA-IR level (5.3±2.70 vs 1.39±0.49, P＜0.001). Spearman correlation analysis demonstrated that eGC was positively correlated to MQSGA (r=0.684, P＜0.001), and negatively correlated to MAC and mid-arm muscle circumference (MAMC). Fasting insulin and HOMA-IR levels were positively correlated to MAC, MAMC and serum triglycerides. Conclusions MHD patients with PEW are characterized by lower BMI, loss of muscle mass, but their serum albumin may still remain within normal range. The high levels of eGC and insulin resistance may relate to PEW status in MHD patients. Metrics

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Therapeutic dose of continuous hemofiltration contributes to the favorable prognosis of critical rhabdomyolysis MENG Jian-zhong;LI Dan-dan;JIA Feng-yu;ZHOU Chun-hua;LIU Wen-yuan;WANG Su-xia;GEYan-ming;JING Ying;YUE Ji 2011, 10 (10):  552-555.  doi: 10.3969/j.issn.1671-4091.2011.10.00 Abstract ( 250 )   HTML ( 0 )   PDF (239KB) ( 168 )   Objective To investigate the therapeutic dose of continuous hemofiltration in relation to the prognosis of critical rhabdomyolysis (RM). Methods A total of 47 RM patients were randomized into 2 groups: group A (n=26) treated with continuous venovenous hemofiltration (CVVH), and group B (n=21) treated with high volume hemofiltration (HVHF). Serum myoglobin (Mb), biochemistry parameters, tumor necrosis factor-α (TNF-α) and IL-6, and acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score were measured after the treatment for 24 hours. Changes of serum TNF-α after the treatment for 24, 48, 72, 96 and 120 hours were analyzed in association with the prognosis in the 2 groups. Results (a) After the presence of RM for 24～48h, the incidence of critical signs such as hypotension, acute kidney injury (AKI), hyperkalemia and acute respiratory distress syndrome (ARDS) were similar between the 2 groups (P＞0.05). (b) After treatment, APACHEⅡ score improved remarkably in the 2 groups (P＜0.05). Twenty-nine patients (61.70%) progressed into diuresis stage after treatment for 9.3±3.7 days. Eighteen patients (38.29%) showed delayed recovery of renal function, of which the incidence was 50% and 23.81% in group A and B (P＜0.05), respectively. (c) In the patients with delayed recovery of renal function, 12 patients (66.66%) passed through the oliguria stage after 24.2±4.2 days, while the remaining 6 patients (33.33%) died of acute hepatic failure, disseminated intravascular coagulation (DIC), severe craniocerebral injury or superinfection. (d) In patients showing recovery of renal function after the treatment for 24-48 hours, serum TNF-α was significantly lower than that before treatment (P＜0.05). In the dead patient, however, serum TNF-α decreased insignificantly or even increased. The decrease of serum TNF-α occurred earlier for 24 hours in group B than in group A. After the treatment for 120 hours, the clearance of TNF-α was higher in group B than in group A, and the mortality rate was lower in group B than in group A (P＜0.05). Conclusions Delayed recovery of renal function was closely related to the death of the patients. Due to the higher volume exchange of fluid, HVHF can efficiently displace fluid with blood, fluid in lymph system, tissue and intracellular compartments, decrease the concentration of inflammatory mediators in histiocytes, and protect the function of endothelial cells and epithelial cells. HVHF is useful to prevent DIC and multiple organ dysfunction syndrome (MODS), and thus provides the opportunity to reconstruct renal function in critical RM patients. Metrics

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Neutral resin hemoperfusion combined with continuous hemofiltration for the treatment of septic patients with acute kidney injury U Wei;HUANG Zhao;YANG Zhi;WANG Si-rong;CHEN Yu-sheng;YU Xiao-chun;LIU Ji-yun 2011, 10 (10):  556-559.  doi: 10.3969/j.issn.1671-4091.2011.10.00 Abstract ( 270 )   HTML ( 0 )   PDF (221KB) ( 214 )   Object To evaluate clinical effect and safety of neutral resin hemoperfusion combined with continuous hemofiltration for the treatment of septic patients with acute kidney injury (AKI). Method A total of 78 cases were enrolled in this study and were assigned into two groups. In group L (n=32), patients received hemoperfusion (HP) and then hemofiltration. In group S (n=46), patients were treated with hemofiltration. A HP session lasted for 2.5 hours, and HP carried out twice every 24 hours. APCHEⅡ score, PO2/FiO2 (OI), mean arterial pressure (MAP), dopamine dose (DA), serum creatinine (Scr), C-reactive protein (CRP), serum IL-6 and IL-10, hemoglobin (Hb) and platelet (Plt) were measured during the treatment. Result HP was well tolerated without any complication in group L. After the initiation of the treatment for 24h, 48h and 72h, APACHEⅡ score, OI, MAP, DA, Scr, CRP and IL-6 improved significantly than before treatment in the two groups (P＜0.05), but without significant changes in serum IL-10, Hb and Plt. In group L, APCHEⅡ score, OI, MAP, DA, IL-6, CRP and Scr improved better than in group S (P＜0.05). No significant differences in serum IL-10, Hb and Plt were detected between the 2 groups after the treatment. Conclusion Neutral resin hemoperfusion combined with continuous hemofiltration can improve APACHEⅡ score, PO2/FiO2 and MAP, reduce serum levels of CRP, creatinine and IL-6, but had no effects on serum IL-10, hemoglobin and platelet in septic patients with AKI Metrics