Loading...

Chinese Journal of Blood Purification

    12 April 2010, Volume 9 Issue 4 Previous Issue    Next Issue
    讲座
    Central arterial pressure and its clinical application value
    WANG Fang;ZUO Li
    2010, 9 (4):  175-177. 
    Abstract ( 352 )   HTML ( 0 )   PDF (215KB) ( 173 )  
    Metrics
    临床研究
    Dysfunction of long-term indwelling central venous catheterization for hemodialysis: Its incidence and analysis of related factors
    LI Jing;DAI Xiao-xia;ZHANG Yi-mo;ZUO Li;JIN Qi-zhuang
    2010, 9 (4):  178-181. 
    Abstract ( 556 )   HTML ( 0 )   PDF (276KB) ( 173 )  
    【Abstract】 Objectives To investigate the primary patency rate (from catheter setting to the first intervention) of long-term cuffed central venous catheter for hemodialysis and its related factors. Methods The cuffed central venous catheter was indwelled in right internal jugular vein in 30 cases. The primary patency rate of the catheters was calculated based on the catheter dysfunction rate, i.e., blood flow (BF) <200 ml/min for three times and requirement of intervention measures including body position adjustment, inversion of tube connection during hemodialysis, and thrombolysis therapy in the first 3 months. The patients were then assigned into patent group and blocked groups. Their ages, gender, blood pressure, Hb, hematocrit (Hct), prothrombin time (PT), activated partial thromboplastin time (APTT), platelet (Plt), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), albumin (Alb) were collected. The average BF, ultrafiltration volume (UF) and venous pressure in tube during hemodialysis from 3 observations, as well as central venous pressure (CVP) before and after hemodialysis from 3 observations were recorded when the patients reached to dry body weight and the hemodialysis was running on a steady status. T test was used for the comparison of continuous variables, and Chi square test was performed for the comparison of classified variables between the two groups. Results (A) In the first 3 months of catheterization, 7 of the 30 cases were found to have catheter dysfunction beginning from the 17-89th days after the operation. The patency rate was 76.7% in the first 3 months. (B) There were no differences in age, gender and diabetes between the 2 groups. (C) Lower Hb and Hct, and higher APTT and pre-hemodialysis CVP were found in patent group, as compared with those of blocked group. There were no differences in blood pressure, PT, Plt, TC, TG, LDL-C, Alb, BF, UF, venous pressure in tube, and post-hemodialysis CVP between the two groups. Conclusions The major factors relating to dysfunction of cuffed long-term indwelling central venous catheter are higher Hct and Hb, and lower APTT and pre-hemodialysis CVP.
    Metrics
    Relapsing peritonitis in peritoneal dialysis patients can be effectively terminated by catheter exchange: Clinical experiences from 6 cases with relapsing peritonitis
    CUI Li-wen;GAN Hong-bing;WANG Xin;ZUO Li
    2010, 9 (4):  182-185. 
    Abstract ( 838 )   HTML ( 0 )   PDF (273KB) ( 173 )  
    【Abstrat】Objective To explore the treatment of peritoneal dialysis (PD)-related recurrent peritonitis. Methods Recurrent peritonitis was diagnosed when the peritonitis recurred in 4 weeks after the completion of antibiotic therapy caused by the same organism or without bacteria in bacterial culture. We retrospectively analyzed the recurrent peritonitis cases in the Peritoneal Dialysis Center, Peking University First Hospital from Nov. 2005 to Oct. 2008. Their demographic data, clinical features, laboratory findings, treatment and outcome were collected. Results The 6 recurrent peritonitis cases were 3 males and 3 females, with the median age of 60.5±12.8 years. Three of them were complicated with diabetes. The median dialysis vintage when they first experienced peritonitis was 17.5 (1 to 88) months. There were totally 20 episodes of peritonitis in the 6 cases, and every case had more than one episode of peritonitis. Bacterial culture for peritoneal fluid showed staphylococcus epidermidis in 3 cases and staphylococcus aureus in 2 cases. Regular antibiotics therapy was administered in the first few days of infection, and then the therapy was changed to the antibiotics sensitive to the pathogen according to laboratory result. Symptoms were minor and easy to be controlled by antibiotic therapy. The disease severity score (DSS) was 1 in 5 patients and 0 in one patient. All of them recovered to the score of 0 within 3 days after antibiotic therapy. Peritonitis recurred after withdrawal of antibiotic therapy with the average interval between the 2 episodes of 2.4 weeks (4 days to 4 weeks). Change the catheter with a new one was performed in 5 cases, and insertion of a new catheter after removal of the catheter for 2 weeks was conducted in one case. These cases had no recurrent peritonitis any more for more than 8 months after catheter exchange. Conclusions Catheter exchange combined with optimal antibiotic therapy is an effective way to eradicate recurrent peritonitis in PD patients.
    Metrics
    Neurotoxicity induced by Ceftazidime treatment in chronic renal failure patients on maintenance hemodialysis
    LIU Shuang-xin;SHI Wei;HE Shi-min;CHEN Tie-feng;LIANG Xin-lin;LAO Hai-yan;YE Zhi-ming;ZHANG Bing;HE Chao-sheng;LIANG Yong-zhen;XIA Yun-feng;MA Jian-chao;XU Li-xia;TAO Yi-ming
    2010, 9 (4):  186-189. 
    Abstract ( 890 )   HTML ( 0 )   PDF (271KB) ( 204 )  
    【Abstract】 Objective Ceftazidime-induced neurotoxicity is often underestimated or misinterpreted by clinicians. To understand this ailment, we described 21 hemodialysis cases with ceftazidime-related neurotoxicity, and compared the effect of ceftazidime clearance by different blood purification methods. Methods We recruited the maintenance hemodialysis (MHD) patients complicated with psychiatric symptoms after ceftazidime treatment in Guangdong General Hospital from 1999 to 2008. Their neurotoxic symptoms induced by ceftazidime, and blood ceftazidime concentrations before and after hemodialysis were observed. Their clinical symptoms were then analyzed along with the efficiency of ceftazidime clearance by different blood purification methods. Results The involvement of central nervous system induced by ceftazidime treatment was found in 21 chronic renal failure patients on MHD. Their average age was 69.1±6.4 years old, indicating the higher incidence in older patients. The frequent findings included confusion and spatial disorientation (81% patients), myoclonus (62%), and psychiatric disturbances (52%). The average Glassgow score increased, and recovery from neurotoxicity began after blood purification in all these patients. Neurotoxocity improved in less than 24 hours after blood purification. Blood ceftazidim concentrations before and after blood purification were measured in 13 cases, of which 5 cases were treated with hemodialysis, and 8 cases with on-line hemodiafiltration. The ceftazidime clearance was more efficient by hemodiafiltration than by hemodialysis, in accordance with the differences of symptom improvement by the two blood purification methods. Conclusions Ceftazidime can induce neurotoxicity in MHD patients. For elderly MHD patients, ceftazidime dose should be adjusted to avoid neurotoxicity. Awareness of the potential nervous system complications following ceftazidime administration should be emphasized.
    Metrics
    The observation on short-term therapeutic effects of double-filtration plasmapheresis in the treatment of Waldenstrom macroglobulinemia
    WANG Jun;CHEN Ying;FAN Qiu-ling;WANG Li-ning;LIU Lin-lin;FENG Mao-ling
    2010, 9 (4):  190-192. 
    Abstract ( 547 )   HTML ( 0 )   PDF (169KB) ( 221 )  
    【Abstract】Objective To investigate the clinical effect of double-filtration plasmapheresis (DFPP) for Waldenstrom macroglobulinemia. Methods We retrospectively analyzed 16 cases with Waldenstrom macroglobulinemia treated in this hospital, and they were divided into DFPP group (8 cases) and routine chemotherapy group (8 cases). Their short-term therapeutic effect was analyzed. Results After 3 months of treatment, serum IgM was remarkably lower in DFPP group than in routine chemotherapy group (P<0.01). Of the 8 cases in DFPP group, 7 were given DFPP combined with chemotherapy, complete remission was found in 2 cases and partial remission in 5 cases; one case was treated with DFPP only without chemotherapy due to damaged liver function, and had no improvement. Of the 8 cases in routine chemotherapy group, partial remission was found in 5 cases, and no remission in 3 cases. Conclusion DFPP is a safe and effective in a short period of time method for the treatment of Waldenstrom macroglobulinemia. DFPP combined with chemotherapy can quickly alleviate the symptoms, improve the biochemical parameters, and achieve better therapeutic effect.
    Metrics
    Cross-sectional investigation on renal bone disease in hemodialysis patients from a single center
    JU Xiao-yan;LIU Li-qiu;Xu Yan.
    2010, 9 (4):  193-197. 
    Abstract ( 489 )   HTML ( 0 )   PDF (328KB) ( 224 )  
    【Abstract】 Objective To understand the bone metabolism, the controlling situation of the bony disease, and their related factors in maintenance hemodialysis (MHD) patients. Methods We investigated renal bone disease in 113 MHD patients in the Hemodialysis Center of the Affiliated Hospital of Qingdao University Medical College, and compared these data with the guidelines of bone metabolism and controlling of bony disease in Kidney Disease Outcome Quality Initiative (K/DOQI) recommended by National Kidney Foundation of the United States. We also analyzed age, gender, Kt/V, body mass index (BMI), years for dialysis, renal function, blood pressure, Hb, and high sensitivity C-reactive protein (hs-CRP) in these patients. Results In the 113 cases, normal serum Ca was found in 61 (54.0%) cases, normal phosphate in 45 (39.8%) cases, normal Ca x P product in 72 (63.7%) cases, and normal iPTH in 35 (31.0%) cases. However, normal values of the above 4 parameters recommended by K/DOQI were only found in 20 (17.7%) cases. Single and multiple variable regression analyses showed that renal osteodystrophy did not correlate with gender, age, hs-CRP, Kt/V, and years for dialysis. However, higher serum creatinine, lower Hb, lower BMI, and blood pressure ≥140/90mm Hg (1mm Hg=0.133 kPa) were the risk factors for renal osteodystrophy. Among these risk factors, higher serum creatinine, lower Hb and hypertension were the independent risk factors. Conclusion The bone metabolism and the control of the bony disease could not conform to the standards in the K/DOQI guidelines in most hemodialytic patients. The presence of renal osteodystrophy closely relates to higher serum creatinine, lower Hb and hypertension
    Metrics
    Efficacy and safety study of continuous veno-venous hemofiltration in the treatment of pregnancy-induced hypertension complicated with acute left heart failure
    ZHENG Zhen-xiang;YE Guang-fu;WU Zhi-xiong;YANG Ya-dong;LIN Yang-dong;YANG Bo;LUO Zheng-chao
    2010, 9 (4):  198-201. 
    Abstract ( 516 )   HTML ( 0 )   PDF (262KB) ( 165 )  
    【Abstract】Objective To investigate the efficacy and safety of continuous veno-venous hemofiltration (CVVH) in the treatment of pregnancy-induced hypertension complicated with acute left heart failure. Methods Twenty-six pregnancy-induced hypertension patients complicated with acute left heart failure and without improvement after routine therapy were treated with CVVH combined with the routine therapy for at least 2 days. Their clinical manifestations, vital signs, plasma B-type natriuretic peptide (BNP), and ejection fraction (EF) before and after CVVH treatment were compared. Complications during CVVH were also monitored. Results After CVVH, clinical symptoms improved in association with the decrease of heart rate, respiratory rate, blood pressure, central venous pressure and plasma BNP, and the increase of EF and arterial oxygen saturation. Meanwhile, left ventricle end-diastolic diameter (LVEDD) was also improved. No significant complications and acid-base imbalance were found after CVVH. Conclusions CVVH is an effective and safe method for the treatment of pregnancy-induced hypertension complicated with acute left heart failure. It can improve clinical symptoms and heart function in a short period of time without significant complications.
    Metrics
    A retrospective analysis of central vein catheterization for hemodialysis in 866 cases
    HANG Fan;WANG Tao;GUO Dong-yang;ZHENG Yu;ZHANG Guang-ming;CHENG Yue
    2010, 9 (4):  202-204. 
    Abstract ( 506 )   HTML ( 0 )   PDF (173KB) ( 197 )  
    【Abstract】Objective To explore the safe method of central vein catheterization for hemodialysis and the measures to reduce the early complications. Methods We retrospectively analyzed 866 cases using central vein catheterization for hemodialysis. Different catheterization methods were adopted, including blind catheterization, and internal jugular vein, femoral vein and external jugular vein catheterization by ultrasound localization or ultrasound guidance. Complications and the rate of successful catheterization were also evaluated. Results Central vein catheterization was performed for a total of 866 cases, including 617 cases of internal jugular vein catheterization, 245 cases of femoral vein catheterization, and 4 cases of external jugular vein catheterization. Of the 512 cases using blind catheterization, successful catheterization was found in 421 (82.2%) cases, local hematoma in 10 (1.9%) cases, misplacement into arteries in 33 (6.4%) cases, nerve injury in 4 (0.8%) cases, and subcutaneous emphysema in 1 (0.2%) case. Of the 257 cases using ultrasound localization for catheterization, successful catheterization was found in 238 (92.6%) cases, hematoma in 1 (0.4%) case, and misplacement into arteries in 2 (0.8%) cases. Of the 97 cases using ultrasound guidance for catheterization, successful catheterization was found in 92 (94.8%) cases, and no complications occurred. Central vein catheterization by ultrasound localization or by ultrasound guidance was associated with a higher successful rate (P<0.001 and P<0.002, respectively, as compared with that of blind catheterization) and a lower complication rate. Conclusion Central vein catheterization for hemodialysis is a traumatic operation with risks. Corrected manipulation and vein puncture guided by ultrasound are helpful for successful catheterization and avoidance of risks and complications.
    Metrics
    血液净化中心管理与技术
    The incidence of cerebro-cardiovascular diseases in hemodialysis patients at the beginning of hemodialysis treatment: analysis of the data in Beijing area in 2007 from Beijing Hemodialysis Quality Control & Improvement Center (BJHDQCIC)
    LI Ming-xu;CHEN Hong;Zhou Chun-hua
    2010, 9 (4):  227-229. 
    Abstract ( 449 )   HTML ( 0 )   PDF (202KB) ( 206 )  
    【Abstract】 Objective To investigate the prevalence of cerebro-cardiovascular diseases in maintenance hemodialysis (MHD) patients at the beginning of hemodialysis treatment in Beijing area in 2007. Methods The data of MHD patients in hemodialysis centers in Beijing area in 2007 were collected by Beijing Hemodialysis Quality Control & Improvement Center (BJHDQCIC). Most hemodialysis centers used the Hemodialysis Management Software from Hui Bai Tong Co. Beijing, and some centers used Access as the software for data management. BJHDQCIC combined the 2 kinds of data into a database using Hemodialysis Management Software. Results In 2007 in Beijing area, 7795 cases were on MHD treatment. Gender record was found in 92.4% patients, and 51.9% of them were males and 48.1% were females. The first 4 disease causes which accounted for 77.2% MHD patients were chronic nephritis (30.8%), diabetic nephropathy (21.0%), hypertension (14.7%), and chronic interstitial nephritis (10.7%). Patients’ age ranged mainly in 41-70 years old, which accounted for 63.6% of MHD patients. At the beginning of MHD treatment, 43.5% patients were found to be complicated with ischemic heart disease, 13.8% with myocardial infarction, 30.5% with arrhythmia, 48.4% with congestive heart failure, 87.7% with hypertension, 19.6% with cerebrovascular disease, and 12.9% with peripheral vascular disease. Conclusion The incidence of cerebro-cardiovascular diseases was higher in patients on MHD treatment. Therefore, the risks of cerebro-cardiovascular diseases and cerebrovascular accidents should always be considered in end stage renal disease patients, and the risk factors for cerebro-cardiovascular diseases, such as hypertension and diabetes, must be carefully controlled and prevented.
    Metrics