Chinese Journal of Blood Purification

12 February 2011, Volume 10 Issue 02 Previous Issue    Next Issue

临床研究

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Relationship between fibroblast growth factor-23 in peripheral blood and vascular calcification in maintenance hemodialysis patients LI Kai-long;CHEN Jing;ZHAN Jun;WANG Yan;JING Yu;HE Ya-ni 2011, 10 (02):  59-61.  doi: 10.3969/j.issn.1671-4091.2011.02.00 Abstract ( 577 )   HTML ( 0 )   PDF (204KB) ( 431 )   Objective To study the relationship between plasma FGF-23 level and peripheral vascular calcification (VC) in patients treated with maintenance hemodialysis (MHD). Methods A total of 22 patients treated with maintenance hemodialysisfor for more than 3 years with a wrist primary radial artery-cephalic vein arteriovenous fistula (AVF) as the vascular access were included in this study (MHD group). Samples of radial artery were collected from these patients during the reconstruction of the inadequate AVF. Ten abdominal aorta samples collected from cadaveric kidney donors were used as controls (control group). Von Kossa histochemistry served as the qualitative indicator of VC, and cresolphthalein complexone chemical method served as the quantification of VC. Alkaline phosphatase (ALP) activity assay was performed following the manual of the assay kit, and FGF-23 level was determined by enzyme-linked immunosorbent assay. The relationship between FGF-23 and VC in MHD patients was analyzed. Results Calcium content in vascular smooth muscle cells (VSMCs), ALP activity and FGF-23 level in peripheral blood were significantly higher in MHD group than in control group (P<0.01). In MHD group, FGF-23 level in peripheral blood was positively correlated to calcium content in VMSCs and ALP activity (P<0.01). Conclusion VC is extensively presented in MHD patients, accompanied by the increase of serum FGF-23. FGF23 level is positively correlated to VC in MHD patients. These results imply that the increase of plasma FGF-23 may be involved in the pathogenesis of VC, and may be an important early warning indicator to MHD patients. Metrics

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Advantages of heroin detoxification using combined hemoperfusion-hemodialysis method compared to the conventional methadone method: a prospective and randomized clinical study HOU Qiao-qiao;KONG Yao-zhong;XIAO Guan-qing;YE Yan;WANG Hong-sheng;SHAO Yong-hong;LI Dao;HUANG Xue-fang;LI Yan;LIN Ai-zhen;WU Bi-hong;TAN Jia-ju 2011, 10 (02):  62-66.  doi: 10.3969/j.issn.1671-4091.2011..00 Abstract ( 462 )   HTML ( 0 )   PDF (255KB) ( 338 )   Objective To evaluate the advantages of heroin detoxification using the combined hemoperfusion-hemodialysis method. Methods Thirty-five heroin-addictive patients were randomly divided into the treatment group (n=16) and the control group (n=19). Patients in treatment group were treated with the combined hemoperfusion-hemodialysis regimen 3 hours daily for 3 days, while patients in control group received the 10-day methadone treatment regimen. The Short Opiate Withdrawal Scale (SOWS) was used to compare the withdrawal symptoms. Concentrations of morphine in blood and urine were detected by radioimmunoassay method before the treatment and after the treatment for 1, 2, 3, 5, 7, 10, 14, 21 and 30 days. Results Compared to the control group, the combined hemoperfusion-hemodialysis regimen had significantly lower mean SOWS score (4.3±3.8 vs. 10.1±4.5, P<0.001). From the second day after treatment, the withdrawal symptoms in the treatment group were less severe than those in the control group (P<0.05 to all observation days after treatment). The difference of mean blood morphine concentration between the two groups was insignificant in the first 2 days (P>0.05), but became significant from 3rd day to 7th day (P<0.05, respectively). From the 3rd day after the treatment, urinary morphine concentration was significantly lower in treatment group than in control group (P<0.05 to all observation days after treatment). Conclusion The combined hemoperfusion-hemodialysis regimen is a safe and effective method for heroin detoxification, and has better outcomes than methadone therapy. Metrics

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Meta analysis on feasibility of sealing central venous catheter using pure heparin in hemodialysis patients CUI Wen-peng;DU Bing;ZHOU Wen-hua;XU Feng;XU Zhong-gao;MIAO Li-ning 2011, 10 (02):  67-70.  doi: 10.3969/j.issn.1671-4091.2011..00 Abstract ( 815 )   HTML ( 0 )   PDF (220KB) ( 374 )   Objective To assess the feasibility of sealing central venous catheter using pure heparin in hemodialysis patients. Methods We searched the Cochrane Central Register of Controlled Trials (Issue 2, 2010), MEDLINE (1995 to August, 2010), CNKI (1995 to August, 2010) and WanFang databases (1995 to August, 2010) for this issue. We also manually searched relevant journals and conference proceedings. Randomized controlled trials (RCTs) in which pure heparin was used to treat central venous catheter in hemodialysis patients were collected. Then we screened the retrieved studies according to predefined inclusion and exclusion criteria, evaluated the quality of included studies, and performed meta analyses by using RevMan 4.2 software. Results A total of 98 articles were found, and 5 articles with 516 patients were finally included. All of these articles were regarded as grade C. We chose fixed-effect model to make meta analysis because no heterogeneity was found among the RCTs studying the rates of thrombosis, infection and bleeding; while random-effect model was used to make meta analysis because significant heterogeneity was found among the RCTs studying catheter retention time. The results of meta analysis confessed that there were significant increase in catheter retention time [WMD=14.31, 95%CI (8.67~19.96), P＜0.00001], and significant decrease in thrombosis rate [OR=0.29, 95%CI (0.17~0.51), P＜0.0001] and infection rate [OR=0.21, 95%CI (0.10~0.45), P＜0.0001] in observation group compared with control group. While the bleeding rate [OR=0.80, 95%CI (0.32~2.01), P=0.64] in observation group was similar to that in control group. Funnel-plot displayed a symmetrical figure, indicating no publication bias. Conclusion The evidence currently available showed that sealing central venous catheter in hemodialysis patients with pure heparin may decrease the thrombosis rate and infection rate, and increase the catheter retention time, without increasing bleeding risk. However, as the insufficient quality and quantity of the present data, more articles with high quality are needed to obtain more rigorous and objective clinical evidences. Metrics

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The impact of different blood purification methods on residual renal function among maintenance hemodialysis patients ZHAO Jing-yu;WU Ji;WANG Nai-ping 2011, 10 (02):  71-73.  doi: 10.3969/j.issn.1671-4091.2011..00 Abstract ( 790 )   HTML ( 2 )   PDF (198KB) ( 334 )   Objective To study the impact of different blood purification methods on residual renal function (RRF) among maintenance hemodialysis (MHD) patients. Methods Uremic patients on hemodialysis in the Blood Purification Division of this hospital were randomly divided into three groups, low flux hemodialysis (LFHD) group, high-flux hemodialysis (HFHD) group and hemodialysis combined hemoperfusion (HD+HP) group using F6 dialyzer, F60 dialyzer, and F6 dialyzer combined with HA130 blood perfusion dialyzer, respectively. Before the treatment and after the treatments for 6 months, blood and urine specimens were collected, RRF was calculated, and cholesterol, triglycerides, β2-microglobulin (β2-MG) and serum phosphate levels were examined. Results RRF had no significant difference among the 3 groups (P>0.05) before the treatment. After the treatment, RRF was significantly lower than that before the treatment in the 3 groups (P<0.05), RRF was significantly different between HFHD and HD+HP groups and LFHD group (P<0.05), but had no difference between HFHD group and HD+HP group (P>0.05). Serum cholesterol, triglycerides, β2-MG and phosphate levels showed no differences among the 3 groups before the treatment (P> 0.05), became significantly lower in HFHD and HD+HP groups than in LFHD group after the treatment for 6 months (P<0.05), but had no differences between HFHD group and HD+HP group after the treatment for 6 months (P> 0.05). Conclusion RRF declined in hemodialysis patients after dialysis. The decline rate was lower in HFHD and HD+HP groups than in LFHD group, suggesting that HFHD and HD+HP are better than LFHD in the protection of RRF. HFHD and HD+HP also reduced the blood lipids, β2-MG and serum phosphate levels in hemodialysis patients. Metrics

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Analysis of the factors relating to the low blood flow in autogenous arteriovenous fistula in maintenance hemodialysis patients JIANG Xia;FU Jian-qun 2011, 10 (02):  74-76.  doi: 10.3969/j.issn.1671-4091.2011..00 Abstract ( 450 )   HTML ( 0 )   PDF (187KB) ( 346 )   Objective To study the factors relating to the low blood flow in autogenous arteriovenous fistula (AVF) in maintenance hemodialysis (MHD) patients, and to find out useful clues to early clinic intervention. Methods A total of 159 MHD patients with autogenous AVF and treated in this hospital from Jun, 2006 to Dec, 2009 were included in this study. In 21 cases of these patients, disease condition could not be improved by MHD due to inadequate vascular access resulting from low blood flow in AVF. Age, sex, body mass index, primary disease, fistula maturity, hypotension, vascular access thrombosis, fistula narrow index and fistula usage time that may relate to the failure of AVF were collected in these patients and compared with those in the other 133 cases with normal blood flow in AVF using binary logistic regression analysis. Results Low blood flow in AVF was found in 21 (13.21%) patients. Age, body mass index, primary disease, low blood pressure, vascular access thrombosis, fistula stenosis, fistula maturity and fistula usage time were significantly different between patients with low blood flow in AVF and those with normal blood flow in AVF (P<0.05). Conclusion Body mass index, diabetes, vascular access thrombosis and fistula usage time are important factors relating to blood flow in AVF in MHD patients. Improvement of patient’s nutritional status and regularly monitoring the AVF situation can be helpful for the adequate blood flow in AVF. Metrics

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Clinical characteristics of relapsing, recurrent and repeated peritonitis relating to peritoneal dialysis ZHOU Jun 2011, 10 (02):  77-79.  doi: 10.3969/j.issn.1671-4091.2011..00 Abstract ( 738 )   HTML ( 1 )   PDF (199KB) ( 394 )   Objective To identify the clinical characteristics of relapsing, recurrent and repeated peritoneal dialysis-related peritonitis. Methods A retrospective analysis was conducted in the 116 peritonitis patients undergoing peritoneal dialysis (PD) from January 2005 to December 2009 in this hospital. They were divided into four groups: relapsing group, recurrent group, repeated group and single group. Clinical data, pathogenic bacteria and clinical outcomes of the four groups were compared. Results The relapsing and repeat peritonitis were usually caused by coagulase negative staphylococcus species, whereas recurrent peritonitis was often caused by Gram-negative organisms. In the relapsing, recurrent, repeated and single groups, the response rate to therapy was 88.37%, 66.67%, 80.65% and 86.67%, respectively, the complete cure rate was 62.79%, 41.67%, 67.74% and 73.33%, respectively, and the mortality rate was 6.98%, 16.67%, 9.68% and 6.67%, respectively. Therefore, patients in recurrent group had a lower response rate to therapy, lower complete cure rate and higher mortality rate. Conclusions Relapsing, recurrent and repeated peritonitis were of distinct clinical significances. Recurrent peritonitis had lower rate of primary response to therapy, increased rate of catheter extubation and higher rate of mortality. Clinically, more attention should be paid to the recurrent peritonitis in PD-related peritonitis. Metrics

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The effect of ultrafiltration rate on the intradialytic hypotension in patients with end stage diabetic nephropathy LI Rui-zhao;LIANG Xin-ling;CHEN Yuan-han;LIU Shuang-xin;XIA Yun-feng;LI Zhi-lian;LI Zhuo;SHI Wei 2011, 10 (02):  80-82.  doi: 10.3969/j.issn.1671-4091.2011..00 Abstract ( 426 )   HTML ( 0 )   PDF (194KB) ( 269 )   Objectives To evaluate the effect of ultrafiltration rate on the hypotension during hemodialysis session in patients with end stage diabetic nephropathy. Methods Seventy-three patients with end stage diabetic nephropathy receiving maintenance hemodialysis were selected in the study. They were treated with different dialysis modality, dialyzer, blood flow and ultrafiltration rate according to the individual condition. The occurrence of hypotension during hemodialysis session was analyzed. Results The intradialytic hypotension rate was 19.8% in patients with the individual ultrafiltration rate <10 ml/kg/h, and was 25.5% in patients with the rate >10ml/kg/h. Logistic regression analysis indicated that the individual ultrafiltration rate was an independent risk factor for intradialytic hypotension in patients with end stage diabetic nephropathy receiving maintenance hemodialysis. Conclusion A lower individual ultrafiltration rate can effectively reduce the occurrence of hypotension and can improve the tolerance to hemodialysis in patients with end stage diabetic nephropathy. Metrics

基础研究

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Effects of probucol on the expression of IL-18 and oxidative stress product in rat peritoneal mesothelial cells stimulated with lipopolysaccharide LI Cheng-cheng;MA Jian-fei;PENG Xia;FAN Yi;LAN Hai-hua 2011, 10 (02):  83-86.  doi: 10.3969/j.issn.1671-4091.2011..00 Abstract ( 715 )   HTML ( 0 )   PDF (273KB) ( 158 )   Objective To observe the effects of probucol on the expression of interleukin-18 (IL-18) and oxidative stress product malondialdehyde (MDA) in rat peritoneal mesothelial cells treated with lipopolysaccharide (LPS). Methods Primary culture of rat peritoneal mesothelial cells (RPMCs) were randomly divided into 3 groups: cells growing in serum-free DMEM/F12 medium (normal control group), cells stimulated with different concentrations of LPS (1, 10 and 100mg/L) for 6h or stimulated with 10mg/L LPS for 3, 6, 12 and 24h (LPS group), and cells pretreated with probucol (20, 40 and 80μmol/L) for 1h and then stimulated with 10mg/L LPS for 11h (probucol group). IL-18 mRNA was measured by quantitative real time-PCR, IL-18 in medium was assayed by ELISA, and MDA was determined by thiobarbituric acid method. Results The expressions of IL-18 and MDA increased in RPMCs (P<0.05), and the increases were dependent on the LPS concentration used and the period of LPS stimulation lasted. The peak of IL-18 expression arrived after LPS stimulation for 12h (P<0.01). The expressions of IL-18 and MDA were significantly inhibited in probucol group (P<0.05) as compared with those in LPS group stimulated with 10mg/L LPS, and the inhibition was dependent on the probucol concentration used. Conclusions The expressions of proinflammatory cytokine IL-18 and oxidative stress product MDA were increased in RPMCs stimulated with LPS. Probucol inhibited the two changes, facilitating the repair of cell damage and the reduction of peritoneal inflammation. Metrics

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Variations of serum peptide spectrum in uremic patients CHEN Jie-jing;ZHANG Yue;SUI Wei-guo;MO Qiu-ju;LIU Hua-ying;DAI Yong 2011, 10 (02):  87-90.  doi: 10.3969/j.issn.1671-4091.2011..00 Abstract ( 764 )   HTML ( 0 )   PDF (449KB) ( 198 )   Objective To compare the serum petidome spectrum between uremic patients and normal controls, and to search for their variability. Methods The serum peptide profiling was determined in 10 uremic patients without dialysis, 10 uremic patients on peritoneal dialysis, 10 uremic patients on hemodialysis, and 12 healthy volunteers by the ClinProt magnetic bead enrichment and matrix assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS). Results Comparing to the data of normal controls, we screened out 7, 7 and 9 significantly expressed polypeptides in patients without dialysis, on peritoneal dialysis and on hemodialysis, respectively. t test was used for group comparisons, and the statistical significance was set at P＜0.05. Conclusions Our study established the serum petidome spectra for uremia by proteomic technology, and provided a new viewpoint to better understand the pathogenesis of uremia. Metrics

人工肝

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The short-term prognosis and the mechanism of non-bioartificial liver support system to the peri-operative liver transplantation of liver failure patients KUANG Yong-ling;YUAN Wei-jie;ZHANG Zheng;YU Qing;LIU Jun;CHEN Lei 2011, 10 (02):  91-96.  Abstract ( 463 )   HTML ( 0 )   PDF (248KB) ( 222 )   Objective To explore the changes of serum cytokines including endotoxin, TNF-α, IL-18, IL-10, IL-4, NO, SVCAM-1 and SICAM-1 in the peri-operative liver transplantation of liver failure patients after artificial liver therapy (plasma exchange combined with continuous veno-venous hemodiafiltration, PE+CVVHDF), and to investigate the short-term prognosis of artificial liver therapy in the treatment of liver failure patients and its possible mechanism. Methods We selected 54 liver failure patients in peri-operative liver transplantation. Twenty-three of them were treated with the artificial liver support system (ALSS) for a total of 61 times (ALSS group), and 31 patients were treated with the routine therapy (routine therapy group). Serum cytokines were determined before and after the treatment. Clinical outcome and changes of serum cytokines including IL-10, IL-4, IL-18, TNF-α, endotoxin, NO, SVCAM-1 and SICAM-1 were analyzed. Results The effectiveness rate in a short period of time was 65.22% in ALSS group, and was 32.26% in routine therapy group (P<0.01). In ALSS group after the treatment, IL-4, IL-18, TNF-α, VCAM-1, SICAM-1, NO and endotoxin decreased significantly (P<0.01), but the change of serum IL-10 was insignificant (P>0.05), as compared with those before the treatment. In routine therapy group after the treatment, however, changes of serum IL-4, IL-18, TNF-α, VCAM-1, SICAM-1, NO, endotoxin and IL-10 were insignificant (P>0.05), as compared with those before the treatment. In effective patients by ALSS or routine therapy, serum IL-4, IL-18, TNF-α, VCAM-1, SICAM-1, NO and endotoxin decreased, predominantly in patients treated with ALSS. In ineffective patients after the treatments, however, these serum contents showed no changes. Conclusion ALSS significantly reduces the levels of serum IL-4, IL-18, TNF-α, VCAM-1, SICAM-1, NO, and endotoxin, alleviates the hepatocyte injury due to inflammatory reaction, and improves the short-term prognosis in liver failure patients. Frequent monitoring serum cytokines will provide useful information for the treatment of liver failure patients. Metrics

护理园地

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Improvement of hypertension control in hemodialysis patients through intensive medical care and health education TIAN Lu;CUI Wen-ying;DING Jia-xiang;ZHANG Yue;LI Li;ZHANG Dong-liang;LIU Wen-hu 2011, 10 (02):  108-110.  doi: 10.3969/j.issn.1671-4091.2011..00 Abstract ( 475 )   HTML ( 0 )   PDF (201KB) ( 220 )   Objective To investigate the risk factors of hypertension in maintenance heamodialysis (MHD) patients, and to improve hypertension control through the intervention of intensive medical care and health education. Methods Questionnaires about hypertension was conducted in a total of 177 patients on MHD. According to the results of questionnaires, the risk factors of hypertension were analyzed. Medical care and health education on these risk factors were then conducted. Results In the 177 patients, 112 were complicated with hypertension. The patients with hypertension were divided into two groups based on the blood pressure before dialysis: controlled group (blood pressure ≤140/90mmHg, n=44) and uncontrolled group (blood pressure >140/90mmHg, n=68). The percentage of weight gain between dialysis was higher in uncontrolled group than in controlled group. After two months of intensive medical care, the amount of weight gain between dialysis reduced in the uncontrolled group, and control of hypertension achieved in more patients. Conclusion Hypertension is a common feature in MHD patients, and uncontrolled hypertension exists in most of them. Medical care and health education are effective for these patients to control the interdialysis weight gain and hypertension. Metrics