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Chinese Journal of Blood Purification

    12 August 2010, Volume 9 Issue 8 Previous Issue    Next Issue
    专题
    Rational application of peritoneal dialysis in acute kidney injury patients
    YU Yu-sheng
    2010, 9 (8):  407-409. 
    Abstract ( 335 )   HTML ( 0 )   PDF (194KB) ( 191 )  
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    临床研究
    Peritoneal dialysis in chronic kidney disease patients complicated with acute kidney injury
    LIU Jun;HAO Jing;BAO Jin-fang
    2010, 9 (8):  410-413.  doi: 10.3969/j.issn.1671-4091.2010.08.002
    Abstract ( 535 )   HTML ( 0 )   PDF (234KB) ( 196 )  
    【Abstract】Objective The aim of this study was to investigate the effects of peritoneal dialysis (PD) and intermittent hemodialysis (IHD) in chronic kidney disease patients complicated with acute kidney injury. Methods We retrospectively reviewed 183 chronic kidney disease patients complicated with acute kidney injury, of whom 35 patients were treated with PD (PD group) and 45 patients with IHD (IHD group). Clinical data including age, sex, type of dialysis, underlying kidney disease, biochemistry indices and dialysis related complications were recorded. Results There were no differences in age, sex, underlying disease and severity of the disease before treatment between the 2 groups (P>0.05). After dialysis, serum creatinine and blood urea nitrogen were higher in PD group than in IHD group (P<0.05), but the survival rate and renal function recovery rate had no differences between the 2 groups. Dialysis related complications were found in 11.4% PD patients similar to the rate in IHD patients (14.0%, P>0.05). Conclusion PD may have the same effect as IHD in the improvement of kidney function in chronic kidney disease patients complicated with acute kidney injury.
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    The prevalence of cardiovascular disease in inpatients with type 2 diabetic kidney disease
    YAO Luan-di;NI Zhao-hui;CHE Xia-jing;
    2010, 9 (8):  414-417.  doi: 10.3969/j.issn.1671-4091.2010.08.003
    Abstract ( 540 )   HTML ( 0 )   PDF (265KB) ( 220 )  
    The prevalence of cardiovascular disease in inpatients with type 2 diabetic kidney disease YAO Luan-di, NI Zhao-hui, CHE Xia-jing, WANG Qin, CAO Li-ou, MOU Shan, ZHANG Min-fang, WU Qing-wei, YAN Yu-cheng, DAI Hu-ili, GONG Cheng-ping, QIAN Jia-qi. Renal Division, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 20012, China
    Corresponding author: NI Zhaohui; Email: profnizh@126.com
    【Abstract】 Objective To evaluate the prevalence of cardiovascular disease (CVD) in inpatients with type 2 diabetic kidney disease (DKD) by analyzing their CVD history, carotid atherosclerosis and left ventricular hypertrophy (LVH). Methods We recruited 245 inpatients with type 2 DKD, and assigned them based on GFR into early-medium stage group (GFR>30 ml/min/1.73m2), medium-advanced stage without dialysis group (GFR≤30 ml/min/1.73m2), or dialysis group. Results A total of 245 cases were enrolled, of which 146 cases were males and 99 were females. The average age was 64 (55-70) years. Carotid artery examination was conducted by Doppler ultrasonography in 150 cases, of which 88 cases (58.3%) were found to have carotid artery plaques. In the 33 cases in early-medium stage group, 21 (63.6%) cases already had the arterial plaques. All patients exhibited increased intima-media thickness (IMT) of carotid artery and increased common carotid artery resistance index, as compared with the normal reference values. Cardiac ultrasonography was performed in 153 patients, of which 120 cases (78.43%) showed left ventricular hypertrophy (LVH). In the 36 cases in early-medium stage group, 21 cases (58.33%) already had LVH. A total of 147 cases had a history of CVD (60%), much higher than the prevalence rate in general population in USA (36.3%), and the higher CVD history rate was present in all of the 3 groups. In early-medium stage group, the prevalence rate of CVD already reached to 47.8%. With the progress of diabetic kidney disease, the prevalence rate of CVD became higher in medium-advanced stage group (67.9%, P=0.011, as compared with the rate in early-medium stage group). Conclusion Carotid atherosclerosis and LVH are very frequently found in patients with type 2 DKD. The prevalence rate of CVD is significantly higher in these patients than in general population. CVD occurs earlier even in the early-medium stage of the disease.
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    Clinical analysis of peritoneal dialysis as an adjuvant therapy for severe lupus nephritis patients complicated with acute kidney injury
    ZHOU Yan;YU Yu-sheng;TANG Zheng;
    2010, 9 (8):  418-422.  doi: 10.3969/j.issn.1671-4091.2010.08.004
    Abstract ( 501 )   HTML ( 0 )   PDF (293KB) ( 191 )  
    【Abstract】Objective The purpose of this study was to evaluate the clinical efficacy of continuous ambulatory peritoneal dialysis (CAPD) for severe lupus nephritis (LN) patients complicated with important organ dysfunctions. Methods Eight patients diagnosed as severe LN complicated with multiple organ dysfunctions and undergoing CAPD from November 2003 to June 2008 were enrolled in this study. They were characterized by the following features: ①Methylprednisolone pulse therapy was required due to active lupus and progressive renal failure, but immunosuppressant could not be continuously applied due to high catabolism; ②Regular therapy failed due to severe edema, cardiac insufficiency and severe malnutrition; and ③Severe gastrointestinal symptoms. Catheterization surgery was carried out, and CAPD was conducted at 2,000ml/time and 3-4 times/day. Immunosuppressant was re-administered when the above features improved. Changes of renal function, nutrition status and systemic lupus erythematosus disease activity index (SLE-DAI), and the administration of immunosuppressant in these patients were followed up for at least 4 months. Results ①Clinical effects: Better general condition, regression of edema, and improvement of heart function, mental status and physical strength were found in the 8 patients. Renal function recovered significantly in all patients, and the CAPD discontinued in 5 of the 8 patients. ②Nutrition indices: Remarkable improvement was present in all patients. ③Immunological indices: In patients taking prednisone and other immunosuppressant therapy such as mycophenolate mofetil (MMF) after CAPD, ANA and anti-dsDNA antibody titers decreased significantly in 5 patients, and remained unchanged in 2 patients, and ANA titer increased in one patient. SLE-DAI decreased significantly after CAPD in all patients. ④Complications: Peritonitis occurred in one patient. Conclusion Peritoneal dialysis can be used in severe LN patients complicated with important organ dysfunctions. After peritoneal dialysis, edema, heart failure and azotemia improved, the residual renal function preserved, and the nutritional status ameliorated in these patients. When the patient’s condition improves, immunosuppressant should be resumed to treat the primary disease and to help recover the residual renal function.
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    A correlation study on life quality with malnutrition and chronic inflammation in patients on continuous ambulatory peritoneal dialysis
    2010, 9 (8):  423-425.  doi: 10.3969/j.issn.1671-4091.2010.08.005
    Abstract ( 457 )   HTML ( 0 )   PDF (184KB) ( 190 )  
    【Abstract】 Objective Patients on continuous ambulatory peritoneal dialysis (CAPD) often have lower quality of life level (QOL) than general population. Malnutrition status and inflammation make important impacts on their morbidity and mortality. However, the factors contributing to the lower QOL remain unclear. This study attempted to assess the correlation of QOL with malnutrition and inflammation. Methods In this cross-sectional study, we collected clinical data, sociodemographic information and laboratory findings from patients' monthly records in this hospital in the period from January to May, 2009. The SF-36 and Subjective Global Assessment (SGA) were used to assess QOL and nutrition status, respectively. Results A total of 212 CAPD patients were enrolled in this study. SGA score was positively correlated with physical functioning (PF), bodily pain (BP), general health (GH), vitality (VT), social function (SF) and mental health (r=0.287, 0.225, 0.344, 0.348, 0.286 and 0.227, respectively; P<0.01). C-reactive protein was negatively correlated with physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT) and social function (SF) (r=-0.359, -0.178, -0.271, -0.253, -0.236 and -0.198, respectively; P<0.01). Conclusion Malnutrition and inflammation play important roles in QOL. Further studies are necessary to explore the approaches to improve QOL in CAPD patients.
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    Application of peritoneal dialysis in the treatment of acute kidney injury
    DUAN Shao-bin;LIU Qing;ZHOU Qiao-yan;PAN Peng;LI Ying-juan;ZOU Qin;LING Guang-hui;LI Jun;PENG You-ming;LIU Fu-you
    2010, 9 (8):  426-428.  doi: 10.3969/j.issn.1671-4091.2010.08.006
    Abstract ( 494 )   HTML ( 0 )   PDF (199KB) ( 225 )  
    【Abstract】 Objective To evaluate the therapeutic effect of peritoneal dialysis (PD) for acute kidney injury (AKI). Methods Clinical data from 42 AKI patients undergoing PD were retrospectively analyzed. Their blood urea nitrogen (BUN), creatinine (Cr), potassium ion ([K+]) and carbon dioxide combining power (CO2CP) before and after PD were compared. Results Twenty-nine patients recovered (70.73%), one patient remained on PD treatment (2.38%), one patient discharged without recovery (2.38%), and 11 patients died (26.19%). After PD treatment renal function recovered in 2~38 days, [K+] declined to normal level in 1~2 days, and CO2CP returned to normal level in 2~4 days. BUN and SCr lowered by 30.99% and 53.29%, respectively, within 3~4 days, and by 33.92% and 57.36%, respectively, within 5~7 days. Acute Tubular Necrosis Individual Severity Score (ATNISS) was remarkably higher in died patients than in recovered patients. Conclusion PD has better therapeutic effects for AKI patients, and is the best choice for pediatric AKI. The prognosis of AKI patients mainly depends on the primary disease, the number of failed organs, and the level of ATNISS score.
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    A randomized controlled clinical trial on safety and effectiveness of PES14HF polyethersulfone high-flux dialyzer in hemodialysis patients
    ZHANG Wei-ming;JIANG Geng-ru;QIAN Jia-qi;WANG Bing-shun;ZHU Chun;WANG Yong-mei;HUANG Hai-dong;YAN Yu-cheng;NI Zhao-hui.
    2010, 9 (8):  429-432.  doi: 10.3969/j.issn.1671-4091.2010.08.009
    Abstract ( 773 )   HTML ( 3 )   PDF (264KB) ( 253 )  
    【Abstract】Objective To evaluate the safety and efficacy of PES14HF polyethersulfone high-flux dialyzer. Methods Seventy-two patients with stable end stage renal disease and receiving hemodialyis 3 times weekly were enrolled in this randomized parallel control study. High-flux hemodialysis was performed for 4h using PES14HF dialyzer (experiment group) or PES-150DS dialyzer (control group), and the study lasted for one week. The clearances of urea, creatinine, phosphate and β2-microglobulin were calculated. Reactions and adverse events were recorded. Results No significantly differences in serum level changes and clearances of urea, creatinine and phosphate were found between the 2 groups. β2-microglobulin clearance was significantly higher in experiment group (44.50±29.57ml/min) than in control group 25.75±11.27ml/min, P<0.05), so did the decrease magnitude of serum β2-microglobulin (38.87±12.48% vs. 29.53±17.71%, P<0.05). Urea clearance and the higher blood urea improved after the treatment in both groups, and the lowering of blood urea was more significant in experiment group (100%) than in control group (88.57%, P<0.05). Conclusion PES14HF dialyzer is efficient and safe for clinical application.
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    The expression of endogenous H2S in the kidney of diabetic nephropathic rats
    The expression of endogenous HS in the kidney of diabetic nephropathic rats
    2010, 9 (8):  433-435.  doi: 10.3969/j.issn.1671-4091.2010.08.007
    Abstract ( 494 )   HTML ( 0 )   PDF (220KB) ( 218 )  
    【Abstract】Objective The aim of the study was to explore the role and expression of H2S in the kidney of diabetic nephropathic rats. Methods Glomerular pathology, H2S generating enzyme activity in kidney, and relative amount of cystathionine -γ-lyase (CSE) mRNA and cystathionine-β-synthase (CBS) mRNA, the mRNAs of the two endogenous H2S synthesis enzymes, in kidney were compared among diabetic nephropathic group (DN group), DN+ NaHS group (H2S group) and control group. Results H2S generating enzyme activity and the relative amount of CSE mRNA were significantly decreased in kidney in DN group (p<0.01), but CBS mRNA was similar in the 3 groups (p>0.05). Glomerular pathology was less severe in H2S group than in DN group. Conclusion The decrease of endogenous H2S in DN group may result from the lower expression of CSE in the kidney. Exogenous H2S treatment may delay the progression of diabetic nephropathy.
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    The role of reactive oxygen species in the promotion of monocyte chemoattractant protein-1 (MCP-1) production by advanced glycation end products-human serum albumin (AGE-HSA ) in human peritoneal mesothelial cells
    HONG Fu-yuan;SUN Fang;LIU Jun;YAO Jian;HUANG Yi-xin;TANG Zhi-huan
    2010, 9 (8):  436-410.  doi: 10.3969/j.issn.1671-4091.2010.08.008
    Abstract ( 567 )   HTML ( 0 )   PDF (306KB) ( 257 )  
    【Abstract】 Objective To study the effects of advanced glycation end products-human serum albumin (AGE-HSA) on the production of monocyte chemoattractant protein-1 (MCP-1) in human peritoneal mesothelial cells (HPMC) and the role of reactive oxygen species (ROS) in this process. Methods AGE-HSA (0, 100, 500 and 1000μg/mL) with or without 30mM N-acetyl-L-cysteine (NAC) were added to the cell culture medium to stimulate HPMC. MCP-1 mRNA was measured by semi-quantitative RT-PCR, and MCP-1 protein in HPMC was determined by ELISA. The cells were marked with oxidation–susceptible flurorescent probe 2,7-dichorofluoresin diacetate (DCFH) and then were assayed by flow cytometry. Results AGE-HSA increased the concentration of ROS in HPMC with a dose-dependent manner. AGE-HSA also stimulated the production of MCP-1 in dose- and time- dependent manners. The effects of AGE-HSA on HPMC could be blocked by antioxidant NAC. Conclusion The induction of ROS by AGE-HSA in HPMC stimulates the expression of MCP-1. This process may play an important role in the inflammatory reaction and may lead to the ultrafiltration failure.
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    人工肝
    Clinical application of non-biologic artificial liver for acute severe toxic hepatopathy
    LI Xiao-qiang;CHEN Yun-chao;XU Ming
    2010, 9 (8):  441-443.  doi: 10.3969/j.issn.1671-4091.2010.07.010
    Abstract ( 486 )   HTML ( 0 )   PDF (201KB) ( 173 )  
    【Abstract】Objective To study the effectiveness and the optimal disease course in the application of non-biologic artificial liver support system in patients with acute severe toxic hepatopathy. Methods A total of 61 patients diagnosed with acute severe toxic hepatopathy were enrolled in this study. Twenty-eight of them were treated with the non-biologic artificial liver support system in addition to routine medicinal therapy as the treatment group, and 33 patients were treated with routine medicinal therapy as the control group. Results In the treatment group, the improvement of clinical manifestations and laboratory indices including transaminases, total bilirubin, blood ammonia, cholinesterase and coagulation time was obviously better than that in the control group (P<0.01). Mortality rate and hospitalization day decreased (P< 0.01), and no severe complications occurred in the treatment group. Conclusion Non-biologic artificial liver support system is effective for acute severe toxic hepatopathy. Artificial liver support should be considered when the patients exhibit the increase of transaminases and total bilirubin more than two folds, significant prolongation of coagulation time, and hepatic encephalopathy after routine medicinal therapy.
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