Chinese Journal of Blood Purification

12 February 2010, Volume 9 Issue 2 Previous Issue    Next Issue

专题

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The approaches of anti-hypertension treatment for dialysis patients: Where shall we start from? CHEN Xiang-mei;ZHANG Li 2010, 9 (2):  60-62.  Abstract ( 505 )   HTML ( 2 )   Metrics

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Risk factors to hypertension in end-stage renal failure patients SUN Xue-feng 2010, 9 (2):  63-65.  Abstract ( 429 )   HTML ( 1 )   Metrics

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Prevention and treatment of hypertension in peritoneal dialysis patients CHENG Li-tao;WANG Tao 2010, 9 (2):  66-68.  Abstract ( 479 )   HTML ( 0 )   Metrics

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The rule and method of combined antihypertensives therapy for the end- stage renal failure patients complicated with hypertension LI Ming-xi;GAO Bi-xia;ZHENG Fa-lei 2010, 9 (2):  69-71.  Abstract ( 504 )   HTML ( 0 )   Metrics

临床研究

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The China-made electrodes can be used for the measurement of extracellular water but not for intracellular water by bioimpedance GUO Xue;ZhAO Xin-ju;CAO Li-yun;ZUO Li 2010, 9 (2):  72-75.  Abstract ( 556 )   HTML ( 0 )   【Abstract】 Objective To investigate if the original electrodes can be replaced by China-made electrodes for the measurement of extracellular water (ECW) and intracellular water (ICW) by bioimpedance. Methods Twelve healthy subjects and 23 patients on maintenance hemodialysis (MHD) were included in this study. Examinees were asked to keep in a supine position for at least 5 minutes. Xitron surface bioimpedance analyzer was used to measure resistance and reactance under different frequencies. ECW and ICW were calculated using the software provided by Xitron. The examination for an examinee included ECW and ICW measurements using the electrodes in the original instrument package and the electrodes made in china. The examination was performed once for healthy subjects, and performed once before dialysis session and once after the session for MHD patients. Results were compared using paired t test and Bland-Altman plot. A P value less than 0.05 was considered to be statistically significant. The absolute value of a mean difference and its standard deviation less than 0.5L was considered to be acceptable. Results ECW measured by original electrodes was (15.41±4.53)L, while by China-made electrodes was (15.18±4.46)L; ICW measured by original electrodes was (17.87±6.03)L, while by China-made electrodes was (19.93±6.09)L. The mean difference was (-0.23±0.43)L for ECW, and was (2.06±3.05)L for ICW. Conclusion The China-made electrodes can replace the original electrodes for ECW but not for ICW measurement. Metrics

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Serial intradialytic measurement of access flow in autogenous arteriovenous fistula YAN Yu;MENG Xian-hua;BAI Li;WANG Mei 2010, 9 (2):  76-79.  Abstract ( 526 )   HTML ( 0 )   【Abstract】 Objective To consecutively measure the access flow (Qa) change in arteriovenous fistula during a hemodialysis session using ultrasound dilution technique in order to understand the appropriate period for Qa measurement in a hemodialysis session. Methods We consecutively monitored the parameters of Qa in arteriovenous fistula, cardiac output and cardiac index during a hemodialysis session at 30, 90, 150 and 210 minutes by using a Transonic HD02 hemodialysis monitor in 49 maintenance hemodialysis patients. The changes of Qa and the effect of hemodynamic changes on Qa were then evaluated. Results There were no significant differences among the average Qa values and the Qa values adjusted with mean arterial pressure (MAP), which were measured at the 4 time points. Qa correlated positively with MAP, so did the change of Qa with the change of MAP in a hemodialysis session. MAP was the independent impact factor of its respective Qa at every time point. After a hemodialysis session for 210min, Qa change was significantly bigger in the patients with ultrafiltration volume more than 5% of their dry body weight than those with ultrafiltration volume less than 5% of their dry body weight. Conclusion Qa can be measured at any time in a hemodialysis session, but not suitable for patients with significantly lower MAP during hemodialysis. For patients with the ultrafiltration volume more than 5% of their dry body weight, Qa measurement was not recommended after 150min or longer in a hemodialysis session. Metrics

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Clinical analysis of ANCA associated vasculitis with pulmonary damage in 11 cases DING Lei;ZHANG Zhi-gang;LI Hong;JIAO Hong-mei;LIU Xinmin;ZHAO Ming-hui 2010, 9 (2):  80-83.  Abstract ( 554 )   HTML ( 3 )   【Abstract】 Objective To retrospectively analyze the clinical features of ANCA associated vasculitis with pulmonary damage in elderly patients in an attempt to raise the awareness of this disease. Methods Clinical data of ANCA associated vasculitis with pulmonary damage in elderly patients (≥60yr) were retrospectively analyzed. Results The average age of the 11 elderly patients was 75.9 (60～89) years, and all had chronic underlying diseases. The median interval between onset and the diagnosis was 4 months (2 weeks～1 year). The common symptoms of vasculitis were cough and expectoration (90.9%), dyspnea or exertion intolerance (63.6%), hemoptysis (36.4%), and fever (45.5%). The most common imaging manifestations were interstitial pulmonary lesions (91.9%), which were found to be evident interstitial pulmonary fibrosis in 8 cases. Two cases displayed multiple large patches of exudative shadow, indicating diffuse alveolar hemorrhage. One case had nodule lesions. Renal damage was not detected at presentation in 8 cases (72.7%). Diagnosis was confirmed by serum ANCA assay and tissue biopsy. Although the majority achieved clinical remission after immunosuppressive therapy, 5 cases (45.5%) died of respiratory failure or severe infections within the induction therapy period or during follow-up. Conclusion Pulmonary involvement in patients with ANCA associated vasculitis was common and may be the first presentation. The symptoms and radiological manifestations of pulmonary involvement were variable, and interstitial pulmonary lesions were notable. Early diagnosis and appropriate treatment may improve the prognosis. Metrics

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Application of modified segmental bioimpedance spectroscopy for estimation of volume status in hemodialysis patients LIU Jing;ZHOU Yi-un;SUN Fang;MA Li-jie;SHEN Yang;HAN Bin;LIU Wen-hu;CUI Tai-gen 2010, 9 (2):  84-87.  Abstract ( 513 )   HTML ( 0 )   【Abstract】 Objective To evaluate volume status in hemodialysis (HD) patients by modified bioimpedance spectroscopy - calf bioimpedance ratio (CBIR). Methods Calf bioimpedance was measured by bioimpedance spectroscopy. As an index of volume status, CBIR was calculated as follows: CBIR = impedance of 200 kHz / impedance of 5kHz. Reference CBIR range was obtained from 157 healthy volunteers. The volume status of 117 HD patients post-dialysis was assessed using the CBIR from healthy volunteers as the reference CBIR range. Results CBIR of the healthy volunteers was 0.774±0.028, the reference range was thus defined as 0.746～0.802 (mean±SD). CBIR was significantly higher in patients post-hemodialysis than in healthy volunteers（0.790±0.033 vs 0.774±0.028, P＜0.001). HD patients were divided into three groups according to the CBIR: high CBIR group (＞0.802), normal CBIR group (0.746 ~ 0.802), and low CBIR group (＜0.746). There were 43 patients in high CBIR group (36.8%), 62 patients in normal CBIR group (53.0%), and 12 patients in low CBIR group (10.2%). The doses of antihypertensive agents were not significantly different among the three groups. Nevertheless, hypertension was significantly higher in high CBIR group than in normal CBIR group (p=0.008) and low CBIR group (p=0.003). Conclusions Calf bioimpedance measurement may be an effective method for the evaluation of volume status in hemodialysis patients. Metrics

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Application of continuous blood purification in the treatment of pregnancy with acute renal failure HANG Qing-hong;ZHANG Jian-e;LI Tao;LUO Chang-xia;FEI Pei;YE Yan 2010, 9 (2):  88-90.  Abstract ( 526 )   HTML ( 0 )   【Abstract】 Objective To evaluate continuous blood purification in the treatment of pregnancy with acute renal failure. Methods Eighteen pregnant women with acute renal failure were treated with continuous venovenus hemodiafiltration. APACHE II score and plasma BUN, Cr, K+, Na+, Cl-, Ca2+, CRP and pH were measured before and after the treatment. IL-6 and TNF-α concentrations in serum and in outflow fluid were measured by radioimmunoassay before the treatment and after the treatment for 12 and 24h. Results Among the 18 patients, 16 cases recovered, one case died, and one case progressed to become chronic renal failure. After the treatment, plasma BUN and Cr decreased (P<0.05), WBC, plasma electrolytes and pH returned to be normal, and APACHE II score, and plasma CRP, IL-6 and TNF-α were lower than those before the treatment (P<0.05). Conclusion Early continuous venovenus hemodiafiltration can improve the clinical conditions of pregnant women with acute renal failure. The therapeutic benefit may relate to the clearance of over-expressed IL-6 and TNF-α, resulting in the decrease of inflammatory activity and the balance between inflammatory and anti-inflammatory factors. Metrics

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Influence of glucose-added dialysate on intradialytic hypoglycemia and hypotension in hemodialysis patients with diabetic nephropathy ZHOU Fan-li;ZOU Gui-mian;Che Wen-ti;WANG Jun;JIANG Yu-hong;LIAO Qi 2010, 9 (2):  90-93.  Abstract ( 659 )   HTML ( 4 )   【Abstract】 Objective To explore the influence of glucose-added dialysate on incidences of intradialytic hypoglycemia and hypotension and on metabolic parameters in hemodialysis patients with diabetic nephropathy. Methods Self-control study was conducted in 17 patients with diabetic nephropathy on hemodialysis. The patients were dialyzed with glucose-free dialysate for a period of 2 months, and then were changed to glucose-added dialysate for another period of 2 months. The incidences of intradialytic hypoglycemia and hypotension and the changes of metabolic parameters were compared between the two periods. Results The incidences of intradialytic hypoglycemia and hypotension were 7.6% and 18.3%, respectively, after the period using glucose-free dialysate; the incidences decreased to 1% (P<0.01) and 10.7% (P<0.05), respectively, after the period using glucose-added dialysate. Metabolic parameters including glycosylated hemoglobin and blood lipid profiles remained unchanged (P>0.05). Conclusion Hemodialysis with glucose-added dialysate is beneficial to maintain normal blood glucose and blood pressure in patients with diabetic nephropathy during hemodialysis, but their metabolic parameters remain unchanged. Metrics

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L-carnitine supplementation improves insulin resistance in non-diabetic patients on hemodialysis Zhang Bi -Gu;Guo Li-Li. 2010, 9 (2):  94-96.  Abstract ( 501 )   HTML ( 0 )   Metrics

基础研究

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Experiment study of portable continuous blood purification machine ZHOU Chun-hua;HE Ping;MENG Jian-zhong;YU Yong-wu;LI Hong-yan;DONG Zhen;ZHAO Jun;WEN Yuan-yuan;WANG Xue 2010, 9 (2):  97-99.  Abstract ( 593 )   HTML ( 2 )   【Abstract】 Objective To comprehensively evaluate the safety, stability and validity of the portable continuous blood purification machine in continuous renal replacement treatment (CRRT) by animal experiments. Methods We conducted dog experiments to evaluate the safety, stability and validity of the portable continuous blood purification machine by running the machine for CRRT under a stable land environment and a simulated concussion environment for short period of time (8h), relatively long period of time (24h), and long period of time (72h). Results The safety and stability of the machine were perfect when it worked under a stable land environment and a simulated concussion environment for short and long period of time. The control of fluid replacement volume and dehydration accuracy fulfilled the national industrial standards. During the CRRT using this machine, the experimental dogs showed stable vital signs, decrease of serum K+, Cr and BUN (P＜0.05, as compared with those before the treatment), but no changes in serum Na+ and Cl- (P>0.05, as compared with those before the treatment). Conclusions The stability, safety and effectiveness of the portable continuous blood purification machine are satisfactory either under a stable land environment or under a simulated concussion environment. Metrics

血液净化中心管理与技术

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Analysis the calcium and phosphorus metabolism disorders in Beijing chronic maintenance hemodialysis patients LI Yue-hong;WANG Mei 2010, 9 (2):  112-115.  Abstract ( 445 )   HTML ( 0 )   Metrics