Chinese Journal of Blood Purification

12 January 2011, Volume 10 Issue 1 Previous Issue    Next Issue

专题

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Hybrid renal replacement therapy: its clinical applications and future progression WANG Zhi-gang 2011, 10 (1):  1-4.  Abstract ( 337 )   HTML ( 0 )   PDF (164KB) ( 304 )   Metrics

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The conception and advantages of hybrid renal replacement therapy ZHU Yi-Lin;CHEN Jiang-hua 2011, 10 (1):  5-6.  Abstract ( 357 )   HTML ( 0 )   PDF (116KB) ( 415 )   Metrics

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The clinical application of hybrid renal replacement therapy FU Ping;ZHANG Ling 2011, 10 (1):  7-9.  Abstract ( 350 )   HTML ( 0 )   PDF (146KB) ( 395 )   Metrics

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Hybrid renal replacementtherapy in acute pulmonary edema with acute kidney injury following multiple wasp stings ZHANG Ling;CAO Yu;FU Ping;SHI Yun-ying;YANG Ying-ying;CHEN Zhi-wen;LIN Li 2011, 10 (1):  10-14.  Abstract ( 386 )   HTML ( 0 )   PDF (340KB) ( 475 )   Metrics

临床研究

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The research of effectiveness of hybrid renal replacement on severe snake bite patients CHENG Jun-zhang;HU Shou-liang;LU Hong-zhu;LIU Jun-cheng;YUAN Fan-li. 2011, 10 (1):  15-17.  doi: 10.3969/j.issn.1671-4091.2011..00 Abstract ( 1136 )   HTML ( 0 )   PDF (206KB) ( 472 )   Objective The aim of this study is to investigate the effect of hybrid renal replacement treatment (HRRT) on acute pulmonary edema (APE) with acute kidney injury (AKI) following multiple wasp stings. Methods We designed a prospective study which enrolled nine patients who developed APE with AKI after multiple wasp stings between 2007 and 2010 in West China Hospital. HRRT included continuous venous-venous hemofiltration (CVVH), plasmapheresis (PE) and sustained low-efficiency dialysis (SLED). CVVH was performed for at least 72h with Baxter Accura or B. Braun Diapact CRRT machine and B. Braun Diacap Acute M hemofilter. Hemofiltration was accomplished using predilution bicarbonate replacement fluid at the rate of 3000ml/h and citrate or low-molecular-weight heparin (LMWH) for anticoagulation, with blood flow rates of 180 to 250 ml/min. PE was performed on the 1st and 2nd day after admission to hospital respectively (dose: fresh frozen plasma 2000 to 2500ml each time), then was replaced with SLED as patients in stable condition (dose: 150ml/min, for 10 to 12 hours every other day). Meanwhile, other therapeutic measures, such as regional wash and wet compress with normal saline around wounds, glucocorticoids therapy, hepatic function protection and nutritional support, were applied. Erythropoietin injection, as well as albumin and blood transfusion, were also carried out when necessary. Results One patient died unexpectedly 2h after admission to hospital. Autopsy, done 8h after sudden death, showed that the main cause of death was multiple organ failure due to the massive wasp envenomation. The other eight patients had a sharp improvement in oxygenation index after HRRT therapy, with obvious amelioration of APE as CT scan showed after an average span of 5.3±2.6 days. Among them, five ventilator dependent patients successfully weaned from mechanical ventilation 2 to 7 days after that. All the patients had distinct decrease in BNP, CK, myoglobin (Myo) and LDH after initiation of HRRT. They progressed to the commence of diuretic phase, renal function recovery and Myo decreasing to normal at 18±7d, 29±12d and 37±21d after admission to hospital, respectively. No organ dysfunction was found after an average follow-up span of 92±68 days. Conclusion We conclude that the coalition of APE and AKI is a severe complication of multiple wasp stings, and active HRRT therapy (CVVH+PE+SLED) as early intervention can bring significant benefits. Metrics

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The influence of various blood purification methods on microinflammatory state in patients with maintenance hemodialysis ZHU Zheng-xi;LU Shao-qiang;LIANG Bi-qin;LU Feng-ling;NONG Cong;HUANG Hui 2011, 10 (1):  18-21.  doi: 10.3969/j.issn.1671-4091.2011..00 Abstract ( 540 )   HTML ( 0 )   PDF (229KB) ( 382 )   Objective To investigate the influence of regular hemodialysis (HD), high-flux hemodialysis (HFD) and hemoperfusion (HP) on microinflammatory state in ESRD patients on maintenance hemodialysis (MHD). Methods We enrolled 48 patients with MHD for more than 6 months in this hospital and divided them randomly into HD group (n=16), HFD group (n=16) and HD+HP group (n=16). Serum CRP, IL-6 and TNF-α were measured by immunoturbidimetry and ELISA in patients before and after the first dialysis session, and after the treatment for 3 months, as well as in 20 healthy volunteers as normal controls. Results (a) Serum CRP, IL-6 and TNF-α were significantly higher in the 3 groups of patients than in normal controls (P<0.001), but had no differences among the 3 groups of patients before the treatment (P >0.05). (b) In HD group, serum CRP, IL-6 and TNF-α increased after first dialysis session and after the treatment for 3 months, but the increases were statistically insignificantly (P>0.05). (c) In HFD group serum CRP, IL-6 and TNF-α decreased after the first dialysis session, but the decreases were statistically insignificant (P> 0.05). After the treatment for 3 months, however, serum IL-6 and TNF-α levels decreased significantly (P<0.05) without change of serum CRP level (P>0.05). (d) In HD+HP group, serum IL-6 and TNF-α decreased after the first dialysis session (P<0.05) without change of serum CRP (P >0.05). After the treatment for 3 months, serum CRP, IL-6 and TNF-α decreased (P<0.01), but were still higher than those of normal control group. (e) After the treatment for 3 months, serum CRP, IL-6 and TNF-α were significantly lower in HD+HP group than in HFD group, and the extent of the decreases was larger in HD+HP group than in HFD group. Conclusions (a) Microinflammation state exists in ESRD patients on MHD. (b) The lowering of patients’ serum CRP, IL-6 and TNF-α and thus the recovery from microinflammatory state can be achieved by HFD and HP, and preferably by HP. (c) Patients’ microinflammatory state can not radically corrected after 3 months treatment, therefore, other measures and longer period of follow-up must be conducted for these patients. Metrics

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Effect of high-flux hemodialysis on insulin resistance in diabetic kidney disease patients with maintenance hemodialysis LIU Xiao-bin;WANG Liang;LIU Bin;SUN Zhu-xing 2011, 10 (1):  22-24.  Abstract ( 208 )   HTML ( 0 )   PDF (198KB) ( 341 )   Metrics

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Analysis of factors affecting pulmonary hypertension in hemodialysis patients HEN Yang;ZHOU Yi-lun;JIANG Wei;YU Ze-xing;LIU Jing;MA Li-jie;SUN Fang;CUI Tai-gen 2011, 10 (1):  25-28.  Abstract ( 237 )   HTML ( 0 )   PDF (212KB) ( 234 )   Metrics

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The correlation of serum adiponectin and leptin to inflammation and dyslipidemia in hemodialysis patients CEN Jun;GU Yi-zheng;WEI Li-li;FU Chun-ming;WANG Xue-ying;WANG Chuan-xiang;YU Jie 2011, 10 (1):  29-32.  doi: 10.3969/j.issn.1671-4091.2011..00 Abstract ( 793 )   HTML ( 0 )   PDF (212KB) ( 200 )   Objective To observe the levels of serum adiponectin (ADPN) and leptin, and their correlations to chronic inflammation and dyslipidemia in patients on maintenance hemodialysis (MHD). Methods We measured serum ADPN, leptin, albumin, serum creatinine, blood urea nitrogen, lipoproteins, C-reactive protein (CRP) in 79 MHD patents and 26 healthy individuals. Their body mass index (BMI) and waist to hip ratio (WHR) were calculated and correlated with serum ADPN and leptin. Results Serum ADPN and leptin were significantly higher in MHD patients than tin healthy individuals (P＜0.01). ADPN was negatively correlated with BMI, WHR, CRP and leptin, and was positively correlated with total cholesterol and high density lipoprotein cholesterol (HDL-C) (P＜0.05). Leptin was positively correlated with age, BMI, WHR and triglycerides, and was negatively correlated with HDL-C (P＜0.05). In patients with chronic inflammation, serum ADPN was lower, but serum leptin was higher. Conclusion Serum ADPN and leptin increased significantly in MHD patients, which closely correlate to chronic inflammation and dyslipidemia. Therefore, the higher serum ADPN and leptin may have important roles in the pathogenesis of cardiocerebral vascular diseases. Metrics

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Influence of different dialysis models on plasma endothelin and serum endogenous digitalis-like substance SHEN Dong-bo;ZHANG Jie;ZHOU Xue-zhen;SHEN Li;LI Bing-xian;SUN Ai-li;CHEN Feng-jiao;XIE Guang-lan;HUANG Peng-yu;GUO Jun-li;JIANG Hong-mei 2011, 10 (1):  33-36.  doi: 10.3969/j.issn.1671-4091.2011..00 Abstract ( 451 )   HTML ( 0 )   PDF (243KB) ( 246 )   Objective To investigate the influence of different dialysis models on plasma endothelin (ET) and serum endogenous digitalis-like substance (EDLS) in patients with chronic renal failure. Methods We enrolled 75 maintenance hemodialysis (MHD) patients to assign them randomly and equally into 3 groups: LFHD group in which patients were treated with low-flux hemodialysis, HFHD group in which they were treated with high- flux hemodialysis, and HDF group in which they were treated with hemodiafiltration. We also collected 20 healthy participants as controls. Plasma ET and serum EDLS were measured by radioimmunoassay in MHD patients before and after hemodialysis and controls. Results Plasma ET and serum EDLS were significantly higher in MHD patients than in the healthy controls (P<0.01). In LFHD group after treatment, plasma ET increased from 74.58±11.09pg/ml to 89.97±26.09pg/ml (P<0.01) and serum EDLS decreased from 246.59±25.73pg/ml to 211.96±25.01pg/ml (P<0.01). In HFHD group after treatment, plasma ET increased from 75.27±17.58pg/ml to 80.70±23.83pg/ml but without statistically difference (P>0.05), while serum EDLS decreased from 250.92±28.71pg/ml to 212.56±27.40pg/ml (P<0.01). In HDF group after treatment, plasma ET decreased from 76.66±17.53pg/ml to 68.69±17.48pg/ml (P<0.05), and serum EDLS decreased from 251.17±23.13pg/ml to 210.65±20.60pg/ml (P<0.01). Plasma ET increased in LFHD and HFHD groups after treatment, but decreased in HDF group after treatment (P<0.05, as compared with that in LFHD group). Serum EDLS decreased in LHFD, HFHD and HDF groups, but without statistical differences among the three groups (P>0.05). Conclusions Serum EDLS decreased significantly in LHFD, HFHD and HDF groups. In addition, plasma ET decreased preferably in HDF group. Metrics

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The change of plasma soluble vascular cell adhension molecule-1 in chronic renal failure patients and its significance JIANG Li-ping;HUANG Wen;ZHAI Yan-ling;LIU Ning 2011, 10 (1):  37-40.  doi: 10.3969/j.issn.1671-4091.2011..00 Abstract ( 441 )   HTML ( 0 )   PDF (216KB) ( 179 )   Objective To observe the change of plasma soluble vascular cell adhension molecule-1 (sVCAM-1) and its relationship to C-reactive protein (CRP) and soluble CD40 ligand (sCD40L) in chronic renal failure (CRF) patients, and to explore their potential effects on renal injury and immunodeficiency. Methods We recruited 30 CRF patients without hemodialysis (CRF group) treated in the Department of Nephrology, Beijing TongRen Hospital of Capital Medical University, 30 uremic patients on maintenance hemodialysis for more than 3 months (HD group) treated in the Dialysis Center of this hospital, and 20 healthy volunteers (normal control group) matched with the patients in age and gender. Plasma sVCAM-1 was measured by enzyme linked immunosorbent assay method. The relationship between sVCAM-1 and related factors, and the influence of hemodialysis on plasma sVCAM-1 were analyzed. ANOVA and Pearson correlation analysis were used for statistical analysis. Results Plasma sVCAM-1, CRP and sCD40L were significantly higher in CRF group and HD group than in the control group (P<0.01). Plasma sVCAM-1 and sCD40L were higher in HD group than in CRF group (P<0.05). In CRF group, sVCAM-1 level was positively correlated with CRP and sCD40L (P<0.05), and with serum creatinine (Scr) (P<0.01). In HD group, sVCAM-1 level was positively correlated with CRP (P<0.01), but had no correlations with Scr and sCD40L (P>0.05). After one HD session, plasma sVCAM-1 increased significantly, compared to that before the HD (P<0.01). Conclusion Elevation of plasma sVCAM-1 occurs in CRF patients especially in those on hemodialysis, which may relate to the microinflammatory state and may also be involved in the renal injury and abnormal immune function in these patients. Metrics

护理园地

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Investigation on the surface contamination on hemodialysis machines WANG Ying;TAN Min;WU Xiang-lan;LEI Juan;YAN Yu 2011, 10 (1):  47-49.  doi: 10.3969/j.issn.1671-4091.2011..00 Abstract ( 816 )   HTML ( 0 )   PDF (208KB) ( 226 )   Objects To investigate the differences of the contamination on hemodialyzer surface before and after a hemodialysis session, and before and after the wipe and disinfection following the current administration rules for infection control. Methods The wipe and disinfection procedures defined in the Current Stipulation for Hemodialysis Quality Control were strictly carried out in the hemodialysis center, in which two sessions per hemodialyzer were conducted in a workday. Bacterial cultures were performed for samples taken from the 33 hemodialyzer before hemodialysis sessions in the morning and after the sessions in the afternoon. The bacterial culture results were evaluated following the published standards. Results The overall negative rate was 96.2%. Samples taken before dialysis sessions in the morning and in the afternoon were all negative, while those taken after dialysis sessions before wipe and disinfection were negative in 93.9% samples in the morning and in 90.9% samples in the afternoon. The number of bacterial colonies in samples taken before dialysis sessions was significantly different from that taken after sessions (P＜0.05). Although the number of bacterial colonies had no statistical difference between samples taken before and after the wipe and disinfection procedure, the negative rate reached to 100% after the procedure. Conclusion The wipe and disinfection procedure following the Current Stipulation for Hemodialysis Quality Control and performed between every hemodialysis session was proved to be essential and effective. Metrics