Chinese Journal of Blood Purification

12 July 2010, Volume 9 Issue 7 Previous Issue    Next Issue

专题

Select

The etiology, prevention and treatment of acute kidney injury DUAN Shao-bin;ZHANG Hui;PENG You-ming 2010, 9 (7):  349-351.  Abstract ( 527 )   HTML ( 0 )   PDF (206KB) ( 180 )   Metrics

Select

The treatment of acute kidney injury complicated with pyemia DING Feng 2010, 9 (7):  352-356.  Abstract ( 492 )   HTML ( 0 )   PDF (369KB) ( 196 )   Metrics

Select

Acute kidney injury and blood purification YAN Hai-dong 2010, 9 (7):  357-360.  Abstract ( 462 )   HTML ( 0 )   PDF (266KB) ( 210 )   Metrics

Select

The treatment dosage in the continuous renal replacement therapy WAN Jian-xin;CUI Jiong 2010, 9 (7):  361-363.  Abstract ( 490 )   HTML ( 0 )   PDF (205KB) ( 188 )   Metrics

临床研究

Select

General or AKI-specific scoring systems are superior to RIFLE criteria for predicting prognosis in acute kidney injury patients YANG Yan-jiao;XIE Qiong-hong;XU Zhong-ye;KUANG Ding-wei;LIU Jun-feng;YOU Huai-zhou;ZHOU Ying;LAI Ling-yun;ZHENG Yin;GU Yong;HAO Chuan-ming;LIN Shan-yan;DING Feng 2010, 9 (7):  364-367.  doi: 10.3969/j.issn. 1671-4091.2010.07.005 Abstract ( 754 )   HTML ( 0 )   PDF (255KB) ( 351 )   【Abstract】Objective To evaluate the value of the three general scoring systems (SOFA, APACHE II and SAPS II), the AKI-specific scoring system (Liano), and the RILFE criteria for predicting prognosis in acute kidney injury (AKI) patients. Methods In this prospective and single center study, AKI patients with different causes and hospitalized in this hospital from December 2008 to November 2009 were enrolled. AKI was diagnosed based on the serum creatinine of RIFLE criteria. Patients were excluded from this study if the AKI was due to obstructive uropathy, interstitial nephritis, primary or secondary glomerulonephritis. The primary end point of the study was the mortality after 28 days. Scores from RIFLE classification, SOFA, APACHE II, SAPS II and Liano scoring systems were compared between the survival and non-survival patients. Receiver operating characteristic (ROC) curve for predicting death was used for the evaluation of scoring systems with and without stratification based on RIFLE classification. Results A total of 194 AKI patients were enrolled in this study. No significant differences were found in RIFLE classification, cause of AKI and dialysis between survivor and death groups. However, ventilation therapy, and scores from SOFA, APACHE II, SAPS II and Liano systems were significantly different between survivors and non-survivors. Area under ROC (AUROC) curves for predicting death by SOFA, APACHE II, SAPS II and Liano scores were 0.900, 0.885, 0.888 and 0.875, respectively (P<0.001), which were all higher than the AUROC of RIFLE (0.566, P>0.05). Stratification of AKI based on RIFLE classification revealed that patients in the failure group had higher AUROC of the 4 scoring systems, especially the AUROC of Liano scoring system. Conclusions General or AKI-specific scoring systems including SOFA, APACHE II, SAPS II and Liano systems are superior to RIFLE criteria for predicting prognosis in AKI patients. Metrics

Select

Analyses of APACHE score and risk factors in patients under continuous renal replacement therapy XU Jing;SHEN Ping-yan;MA Xiao-bo;CHEN Xiao-nong;ZHU Ping;CHEN Nan;ZHANG Wen 2010, 9 (7):  368-371.  Abstract ( 714 )   HTML ( 0 )   PDF (236KB) ( 190 )   【Abstract】Objective To analyze the APACHE score and risk factors in patients under continuous renal replacement therapy (CRRT), and to investigate the clinical application of acute physiology and chronic health evaluation (APACHE) scoring in CRRT patients. Subjects and method We studied the severe patients under CRRT in the departments of Shanghai Ruijin Hospital Affiliated to Shanghai JiaoTong University, School of Medicine in 2006. Their APACHE II and III scores were calculated 24 hours before CRRT, and their coefficient of mortality risk was also estimated. SPSS 15.0 was used for statistics. Measurement data was showed as X±S, Chi-square test was used for the comparison of ratios, and one sample t-test was used to compare the data among different groups. P<0.05 was considered to be significant. Multinomial logistic regression was applied to explore the risk factors. Results A total of 113 severe patients under CRRT were collected. Their age ranged 60.42±17.44 yrs, and the male to female ratio was 74/39. Forty-seven patients were treated in ICU, and 66 were treated outside ICU. Forty-seven cases survived, and the mortality rate was 58.4%. The average APACHE II score was 26.3±7.7, and the coefficient of mortality risk was 0.47±0.26. The APACHE II score was 29.2±8.1 and 22.4±4.8 (P<0.001) in death and survival groups, respectively. The average APACHE III score was 91.4±29.0, and the coefficient of mortality risk was 0.77±0.27. The APACHE III score was 104.7±28.6 and 72.3±16.6 (P<0.001) in death and survival groups, respectively. Logistic regression analysis showed that mechanical ventilation (P=0.000), hyperbilirubinemia (P=0.022) and hypotension (P=0.030) were the risk factors affecting the prognosis of CRRT patients. Conclusion The prognosis of CRRT patients was closely correlated to APACHE score, and the score was significantly different between death and survival groups. APACHE scoring can be applied to predict mortality of CRRT patients earlier. Metrics

Select

A study of RIFLE classification based on estimated baseline creatinine value for the evaluation of acute kidney injury in patients undergoing coronary artery bypass graft LI Jiang-tao;XU Chen;JIANG Xiao-feng;CUI Cun-li;WANG Hui-fang;WU Yi-tai;YUAN Ai-hong;MA Jun 2010, 9 (7):  372-374.  doi: 10.3969/j.issn. 1671-4091.2010.07.007 Abstract ( 667 )   HTML ( 0 )   PDF (187KB) ( 201 )   【Abstract】Background The RIFLE classification scheme for the evaluation of acute kidney injury (AKI) is based on relative changes in serum creatinine (SCr) and on urine output. The SCr criteria, therefore, require a pre-morbid baseline value. When the baseline SCr is unknown, it is currently estimated by using the MDRD equation. However, the MDRD approach assumes a glomerular filtration rate of 75 mL/min/1.73 m2, which has been seldom validated. Methods Patients undergoing coronary artery bypass graft from January 2007 to January 2009 were retrospectively evaluated. The RIFLE class was determined by using the observed pre-operation SCr values and the estimated baseline SCr values. The diagnosis sensitivity and specificity for prediction of mortality in hospital were compared between the RIFLE criteria based on the observed pre-operation values and the estimated baseline SCr values. Results One hundred and nineteen patients were included in this study. There was no significant difference in the prevalence of AKI between patients after coronary artery bypass graft diagnosed by RIFLE criteria based on the observed pre-operation values and those based on the estimated baseline SCr values (44.50% vs. 43.70%, P > 0.05). Logistic regression analysis suggested that the relative risk of hospital mortality for AKI was similar between patients diagnosed by RIFLE criteria based on the observed pre-operation values and those based on the estimated baseline SCr values. The area under the ROC curve for hospital mortality was 0.829 for RIFLE based on the observed pre-operation SCr values and 0.853 for RIFLE based on the estimated baseline SCr values (P>0.05). Conclusions When pre-operation SCr value is unavailable, RIFLE criteria based on the estimated baseline SCr by the MDRD equation can be used for the AKI diagnosis in patients after coronary artery bypass graft with nearly normal pre-operation glomerular filtration rate. Metrics

Select

A multi-center clinical study of contrast-induced nephropathy in inpatients in cardiology department after coronary artery intervention ZHANG Pian;NI Zhao-hui;WANG Ling;HE Ben;WANG Xiao-long;QIU Jian-ping;ZHENG Chang-zhu;YANG Guang-min;ZHU Ai-guo 2010, 9 (7):  375-379.  doi: 10.3969/j.issn. 1671-4091.2010.07.008 Abstract ( 1021 )   HTML ( 0 )   PDF (302KB) ( 189 )   【Abstract】 Objective To investigate the incidence and risk factors of contrast-induced nephropathy (CIN) in patients underwent coronary angiography (CAG). Methods From April 2009 to July 2009, patients admitted to the six centers in Pudong area in Shanghai for CAG were prospectively collected. Overall incidence of CIN and the incidences under different conditions were analyzed. Patients were divided into CIN group and non-CIN group based on the presence of CIN, and the two groups were compared. Risk factors for CIN were analyzed. Results Of the 197 patients, 17 experienced CIN, and the overall incidence was 8.63%. The CIN incidences of the aged, female, patients with type 2 diabetes, myocardial infarction, heart function>II, and contrast media volume>180ml were 18.1% (13/72), 14.9% (10/67), 14.1% (10/71), 17.4% (4/23), 21.7% (5/22), 22.2%(8/36) ( p<0.05), respectively, much higher than those of non-aged, male, patients without type 2 diabetes, myocardial infarction and heart function I～II, and contrast media volume<180ml. There were significant differences in age, hemoglobin, hematocrit, cholesterol, two-hour postprandial plasma glucose, and creatinine clearance before CAG (P<0.05) between CIN and non-CIN patients. Multivariate analysis indicated that age>70 (relative ratio [RR]=7.02, P=0.003), myocardial infarction (RR=4.67, P=0.042), and contrast volume>180ml (RR=4.17, P=0.022) were the risk factors for CIN. Conclusion We should pay attention to the presence of CIN in hospitalized patients undergoing CAG. The incidence of CIN was higher in aged patients, and patients with type 2 diabetes, hypertension, anemia, or hyperlipidemia. Therefore, measures should be performed to prevent CIN, especially in the patients undergoing CAG. Metrics

Select

The comparison study on different immunoadsorption methods for the treatment of systemic lupus erythematosus HAN Zhi-wu;YAO Guo-qian;LI Jing;XIAO Qiong;WANG Jing;XU You-ping 2010, 9 (7):  380-384.  doi: 10.3969/j.issn. 1671-4091.2010.07.001 Abstract ( 1038 )   HTML ( 0 )   PDF (313KB) ( 354 )   【Abstract】Objective To investigate the clinically curative effects of different therapeutic methods of immunoadsorption (protein A immunoadsorption, PH350 immunoadsorption, DNA immunoadsorption) for systemic lupus erythematosus (SLE). Methods A total of 98 SLE patients were divided into three groups according to the immunoadsorption method used. Before and after the therapy, 24-hour urinary protein, serum creatinine (Cr), urea nitrogen (UN), albumin, immunoglobulin level, complement C3 and C4, autoantibodies (ANA and anti-dsDNA autoantibody) and SLEDAI score were measured. Results There were significant changes in 24-hour urinary protein, serum creatinine (Cr), urea nitrogen (UN), albumin, immunoglobulin level, autoantibodies (anti-dsDNA autoantibody), and SLEDAI score before and after the therapy (all P<0.05). Furthermore, the clearance of immunoglobulin was more efficient in protein A group than in PH350 group and DNA group (P<0.05). However, there were no differences in lupus activity control among patients using different immunoadsorption methods after longer period of observation. Conclusion The curative effects of immunoadsorption methods on SLE were significant. Among the immunoadsorption methods we used, protein A was more effective in autoantibody clearance. In clinical practice, a variety of factors should be considered in choosing the best immunoadsorption methods. Metrics

Select

Influence of hepatitis virus C infection on proinflammatory cytokines and insulin resistance in maintain hemodialysis patients LIU Jun-duo;SONG Wen-li;GAO Min 2010, 9 (7):  385-388.  doi: 10.3969/j.issn. 1671-4091.2010.07.010 Abstract ( 688 )   HTML ( 0 )   PDF (237KB) ( 205 )   【Abstract】Objective Inflammation status and proinflammatory cytokines can led to insulin resistance. Hepatitis C virus infection is often associated with the increase of proinflammatory cytokine levels. Similar changes are seen in maintain hemodialysis patients. Does hepatitis C virus infection in maintain hemodialysis patients aggravate these changes? The purpose of this study was to investigate the influence of hepatitis C virus infection on proinflammatory cytokines and insulin resistance in maintain hemodialysis patients. Method We recruited 72 patients on regular hemodialysis 2-3 times a week for at least 6 months. Twenty-one of them (13 males and 8 females, with average dialysis duration of 53.39±20.88 months) were anti-HCV antibody (+), and defined as the HCV(+) group. The remaining 51 patients (29 males and 22 females, with average dialysis duration of 31.95±18.15 months) were negative for HCV and other hepatitis virus, and were defined as the HCV(-) group. None of the patients had a history of drug use or any other diseases that were related to insulin resistance except uremia. Fasting glucose, fasting insulin, fasting C peptide, TNF-α and CRP were assayed, and the serum samples for the assays were taken after 12 hours of fasting. Insulin resistance was calculated according to the HOMA formula. Patient was defined as HOMA-IR (+) if the score was higher than 2.5. Results There were no significant difference in fasting glucose and C-peptide between the two groups. Fasting insulin and HOMA-IR score were higher in HCV(+) group than in HCV(-) group (insulin 12.18±3.05pmol/L vs. 10.52±2.98pmol/L, P=0.037; HOMA-IR 2.67±0.87 vs. 2.21±0.75, P =0.027). HOMA-IR score higher than 2.5 was found in 11 of 21 (52.38%) HCV(+) patients and 18 of 51 (35.29%) HCV(-) patients. The serum levels of TNF-α and CRP were significantly higher in HCV(+) group (0.34±0.11mg/dl and 22.09±7.16pg/ml, respectively) than in HCV(-) group (0.12±0.04mg/dl and 10.31±4.87pg/ml, respectively). HOMA-IR score was positively correlated with the levels of TNF-α (r=0.537, P=0.003) and CRP (r=0.439, P =0.004). Conclusion In maintain hemodialysis patients, HCV infection can aggravate the microinflammatory status and lead to insulin resistance. Metrics

人工肝

Select

Experimental study of hybrid bioartificial liver therapy for animal model with acute hepatic failure WANG Kai;ZHAO Xian-guo;DUAN Zhong-ping;WANG Xin-fang;LI Su-zhen 2010, 9 (7):  389-392.  doi: 10.3969/j.issn. 1671-4091.2010.07.011 Abstract ( 1109 )   HTML ( 0 )   PDF (255KB) ( 247 )   【Abstract】 Objective To evaluate the therapeutic effects of hybrid bioartificial liver (HBL) on animal acute hepatic failure model. Methods HBL consisted of plasma exchange, hemofiltration and porcine hepatocyte-based bioartificial liver. Six experimental minipigs were induced to have acute hepatic failure by administration of D-galactosamine. After 48 hours the animals were treated with plasma exchange plus hemofiltration then followed by porcine hepatocyte-based bioartificial liver. Clinical manifestations and serum indexes of the animals were observed and compared with those at different treatment stages. Results No significant changes in vital signs were found, and the adverse effects did not occur in these animals during the treatment. Compared with those before HBL treatment, the concentrations of blood total bilirubin, NH3, alanine transferase, endotoxin and creatinine were much lower (P>0.01), and levels of fibrinogen, prothrombin activity and alpha-fetoprotein were much higher (P＜0.01) after HBL treatment. Compared with those after plasma exchange plus hemofiltration, serum fibrinogen and prothrombin activity were higher (P＜0.05), and serum NH3 and total bilirubin were lower after the porcine hepatocyte-based bioartificial liver treatment. Conclusions The treatment of HBL for acute hepatic failure is safe and effective, and is superior to the efficacy of plasma exchange plus hemofiltration. Metrics