Chinese Journal of Blood Purification

12 September 2009, Volume 8 Issue 9 Previous Issue    Next Issue

专题

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APD, a therapeutic alternative for the improvement of patients?living quality FAN Min-hua 2009, 8 (9):  465-467.  Abstract ( 491 )   HTML ( 0 )   PDF (207KB) ( 163 )   Metrics

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The clinical problems that must be concerned about in peritoneal dialysis YU Yu-sheng 2009, 8 (9):  468-470.  Abstract ( 520 )   HTML ( 0 )   PDF (215KB) ( 206 )   Metrics

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Application progresses in animal models for peritoneal dialysis related studies YAN Hao;FANG Wei 2009, 8 (9):  470-473.  Abstract ( 512 )   HTML ( 0 )   PDF (296KB) ( 150 )   Metrics

论著

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Effect of preventive local application of mupirocin on exit-site score in peritoneal dialysis patients TANG Zhi-huan;PENG Yan;MIAO Wen;LIU Jun;YUAN Wei-jie 2009, 8 (9):  474-476.  Abstract ( 944 )   HTML ( 0 )   PDF (196KB) ( 176 )   【Abstract】 Objective Catheter infections including exit-site and tunnel infections can result in peritoneal dialysis-related infections, leading to catheterization failure. Recently, the Exit-Site Score (ESS) has been used in children to diagnose the infection at the exit site. ESS may be more convenient and practical than microbiological methods. The objective of this study was to evaluate the effect of mupirocin on ESS in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods We used cross-section method to study 80 CAPD patients treated in this dialysis center. ESS was judged by 5 clinical presentations: erythema (none, 0; ＜0.5cm, 1; ＞0.5cm, 2), crust (none, 0; ＜0.5cm, 1; ＞0.5cm, 2), tenderness (none, 0; moderate, 1; severe, 2), swelling (none, 0; moderate, 1; severe, 2), and discharge (none, 0; clear, 1; purulent, 2). ESS score 4 or greater was considered as having exit-site infection, and that of less than 4 may or may not have infection. We chose 21 patients with ESS score 2 or 3, and randomly assigned them into treatment group (n = 10) or control group (n = 11). For treatment group, mupirocin was applied on the exit of peritoneal catheter everyday. For control group, only routine clean procedure was used. ESS was judged again after one month. Results ① In the 80 peritoneal dialysis patients, ESS score 4 or more than 4 were found in 3 cases (3%), ESS scores 2-3 were found in 21 cases (26%) with the average score of 2.7±0.6, and ESS score 0 was found in 40 cases (50%). ② In the treatment group, the average ESS score decreased from 2.7±0.6 to 2.2±0.5 (P＜0.05) after the treatment for one month. In control group, however, ESS score had no significant change after one month. ③ In diabetic patients on peritoneal dialysis with the distance less than 1.5cm between superficial cuff and skin, ESS score was usually greater than that in non-diabetic patients, and their ESS score decreased significantly (P＜0.05) after local application of mupirocin. Conclusion ① Local application of mupirocin on the tube exit site was useful for the improvement of ESS score in patients with ESS score 2-3. ② More studies are needed to elucidate whether this treatment can lower the peritonitis incidence in CAPD patients and to find out the treatment for the patient with refractory infection at the exit site. Metrics

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Comparison of life quality and analysis of its related factors in elder patients on peritoneal dialysis and those on hemodialysis BAO Jin-fang;HAO Jing;ZHU Nan;LIU Jun;TANG Zhi-huan;YUAN Wei-jie 2009, 8 (9):  477-480.  Abstract ( 593 )   HTML ( 0 )   PDF (251KB) ( 198 )   【Abstract】 Objective Patients’ life quality is an important indicator reflecting the effectiveness of the medical care they received. Patients with end-stage renal disease are often elder and complicated with various other diseases. The objectives of this study were to evaluate life quality and its related factors in elder patients on peritoneal dialysis and those on hemodialysis. Methods We recruited 52 patients on maintenance hemodialysis (HD) and 46 patients on maintenance peritoneal dialysis (PD) treated in this hospital during the period between 2007～2008. These patients were 60 years of age or older, and survived for more than 3 months after dialysis. The 36-item Short Form Health Survey Questionnaire (SF-36) was used for the life quality assessment. Clinical parameters were examined. Means and deviations for the 8 scales were calculated, and correlation analysis was performed to determine the effect of these variables on life quality in these patients. Results There were no differences in physical component summary score (PCS) and mental component summary score (MCS) between patients on HD and those on PD (P＞0.05). In the first 2 years of dialysis, body pain was less and emotional function was better in patients on PD than those on HD. After the dialysis for more than 2 years, the vital ability was better in patients on HD than those on PD, but body pain was less in patients on PD than those on HD. Dialysis adequacy, residual renal function, and hemoglobin level positively correlated with life quality (P＜0.05). Conclusion There were no differences in life quality between patients on HD and those on PD. Life quality in patients on HD or PD positively correlated with dialysis adequacy, residual renal function and hemoglobin level. Metrics

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Effect of intradialytic parenteral nutrition on nutrition status of hemodialysis patients IANG Jie;LIU Yan;ZHONG Xiao-shi;ZHOU Dao-yuan;LI Yan-sheng. 2009, 8 (9):  481-485.  Abstract ( 469 )   HTML ( 0 )   PDF (317KB) ( 179 )   Metrics

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Analysis of death causes and related factors in patients with maintenance hemodialysis GAO Ai-qin;ZOU Zuo-jun;LI Yang;SUI Xiao-ni;LIN Chun-hua 2009, 8 (9):  486-489.  Abstract ( 1266 )   HTML ( 0 )   PDF (243KB) ( 241 )   【Abstract】 Objective To investigate the causes of death and their related factors in maintenance hemodialysis (MHD) patients. Methods We retrospectively analyzed 306 patients who had treated with MHD for more than 3 months during the period between January 2000 and January 2008. At the end of the observation period, 71 of the patients died, 134 remained to be treated with MHD, and 101 went out of the MHD treatment course for various reasons. Age, sex, primary diseases, blood pressure, inter-dialysis weight gain, Kt/V, hemoglobin (HGB), hematocrit (HCT), serum creatinine before hemodialysis (Scr.PHD), and serum albumin (ALB), total cholesterol (CHO), triglyceride (TG), calcium (Ca), phosphorus (P) and parathyroid hormone (PTH) were compared between the death cases and the survival cases. Correlation analysis was also made for the risk factors relating to death. Results The causes of death were cardiac complications (25 cases, 35.21%), cerebrovascular diseases (23 cases, 32.39%), generalized failure (8 cases, 11.27%), serious infections (8 cases, 11.27%), and malignant tumors (6 cases, 8.45%). Older mean age (P＜0.01), lower values of HGB, HCT, ALB, Kt/V, Scr.PHD and PTH (P＜0.001 or P＜0.05) and higher serum CHO (P＜0.01) were found in the death cases than in the survival cases. Conclusions Cardiac complications, cerebrovascular diseases, generalized failure and serious infections are the common causes leading to death in HMD patients. The main risk factors relating to death include elder age, anemia, hypoalbuminemia, hypercholesterolemia, insufficient Kt/V and lower Scr. PHD. Metrics

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Effect of closed-rinse on hemodialysis related eosinophilia HAN Dong-sheng;CAO Li-yun;WANG Fang;LV Ji-cheng;ZUO Li 2009, 8 (9):  490-491.  Abstract ( 638 )   HTML ( 0 )   PDF (132KB) ( 178 )   【Abstract】 Objective To determine the effect of closed-rinse on hemodialysis related eosinophilia. Methods Seven patients on regular hemodialysis and with sustained hemodialysis related eosinophilia were enrolled in this study. We used closed-rinse to clean the dialyzers and tubes for 3 months. Peripheral eosinophil count and percentage, and clinical symptoms were observed every month. Results Eosinophil count and percentage decreased significantly (median count decreased from 0.73 to 0.48, median percentage from 13.0% to 5.6%, P＜0.05) after using the closed-rinse. Conclusion Closed-rinse to clean the dialyzers and tubes may reduce the presence of hemodialysis related eosinophilia. Metrics

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Effect of high flux hemodialysis on lipids metabolism in patients with maintenance hemodialysis LIU Yan;WANG Rong;YUAN Hui-zhong 2009, 8 (9):  492-494.  Abstract ( 872 )   HTML ( 0 )   PDF (184KB) ( 193 )   【Abstract】 Objective To observe the effect of high flux hemodialysis (HFHD) using different membrane on lipid metabolism in patients with maintenance hemodialysis. Method Forty patients with maintenance hemodialysis were randomly divided into two groups. Twenty cases were treated with HFHD using F60 dialyser (HFPD group), and 20 cases were treated with low flux hemodialysis (LFPD) using F6 dialyser (LFHD group). Results In HFPD group, serum cholesterol (CHOL), triglyceride (TG), low-density lipoprotein (LDL) decreased, and high-density lipoprotein (HDL) increased after the dialysis for one year. In LFHD group, however, serum TG and LDL increased, HDL decreased, and CHOL remained unchanged. At the beginning of hemodialysis, there were no significant differences in serum CHOL, TG, HDL, LDL and albumin (ALB) between the 2 groups (P＞0.05). In LFHD group, serum CHOL, TG and LDL increased and HDL decreased (P = 0.041) after the dialysis for one year, as compared with those before the dialysis. In contrast in HFPD group, serum CHOL, TG and LDL decreased (P = 0.035, 0.037 and 0.045, respectively) and serum HDL increased (P = 0.035) after the dialysis for one year, as compared with those before the dialysis. When comparisons of serum lipids were made between the 2 groups after the dialysis for one year, serum CHOL (P = 0.005), TG (P = 0.007) and LDL (P = 0.045) were lower, and serum HDL (P = 0.008) and serum ALB (P = 0.038) were higher in HFPD group than in LFPD group. Conclusion HFPD is effective in improving lipid metabolism in hemodialysis patients. Metrics

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Effects of high volume hemofiltration on cellular immunity in patients with multiple organ dysfunction syndrome KOU Qiu-ye;GUAN Xiang-dong;CHEN Lei;OU Hai-yan;HU Wen-li 2009, 8 (9):  495-498.  Abstract ( 571 )   HTML ( 0 )   PDF (229KB) ( 185 )   【Abstractt】 Objective To evaluate the effects of high volume hemofiltration (HVHF) on cellular immunity in patients with multiple organ dysfunction syndrome (MODS). Methods Fourteen MODS patients subjected to HVHF were enrolled in this study. Five mililiters of blood sample were collected from these patients before HVHF and after 1, 3 and 5 days of HVHF to count blood monocytes and to analyze lymphocyte subsets including CD3+, CD4+, CD8+ and the expression of HLA-DR on monocytes by flow cytometry. Results In the 14 patients, 9 patients survived and 5 died. In the survival patients after HVHF, the ratios of CD3+ and CD4+ and CD4+/CD8+ increased; CD3+ ratio increased significantly (P＜0.05) at the 5th day after HVHF, CD4+ and D4+/CD8+ ratios increased significantly (P＜0.05) at the 3rd and 5th days after HVHF, and CD8+ ratio decreased gradually and significantly (P＜0.05) at the 3rd and 5th days after HVHF. Additionally, blood monocytes count and the ratio of positive HLA-DR on blood monocytes increased at the 1st day after HVHF (P＜0.05) and significantly increased at the 3rd and 5th days after HVHF (P＜0.01). In the death patients after the treatment, however, no remarkable changes were found in the ratios of lymphocyte subsets, blood monocytes count and the ratio of positive HLA-DR on blood monocytes (P＞0.05). Conclusion HVHF may regulate the ratio of lymphocyte subsets, increase blood monocyte count, improve the antigen presenting function, and alleviate the immunosuppressive status in MODS patients. Metrics

人工肝

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Primary study on changes of plasma proteomics in chronic severe hepatitis B treated with plasma exchange OU Qiang;YIN Ke-shan;PEN Xia;CHEN Liang;ZHANG Li-jun 2009, 8 (9):  499-502.  Abstract ( 1018 )   HTML ( 0 )   PDF (267KB) ( 269 )   【Abstract】 Objective To study plasma protein changes in chronic severe hepatitis B after plasma exchange (PE), to provide new clues for the understanding of PE mechanism, and to seek the new therapeutic targets for patients with chronic severe hepatitis B. Methods Plasma samples were obtained from chronic severe hepatitis B patients before and after PE. After removal of high abundance proteins in plasma, proteins in samples were separated by two-dimensional electrophoresis. The gels were then stained by silver nitrate or Coomassie blue, and analyzed by the Imagemaster software. Proteins in the spots showing remarkable intensity difference before and after PE were identified by electrospray ionization mass spectrometry (ESI-MS/MS). Results After the pretreatment procedures, the high abundance proteins such as albumin and IgG in the samples were mostly removed, and the low abundance proteins were enriched. From the silver stained gels, 297 protein spots from samples before PE and 305 protein spots from samples after PE were separated. From these spot, 15 proteins were found to have 3-fold differences before and after PE, and 5 proteins were identified. After PE, complement factor B precursor, CD5 antigen-like precursor, fibrinogen beta chain precursor and haptoglobin precursor were up-regulated, and apolipoprotein E precursor was down-regulated. Conclusion We have identified 5 plasma proteins showing remarkable difference in expression level before and after PE. These proteins are involved in lipoprotein metabolism, protein synthesis and catabolism, and activation of complement bypass route. They are worthwhile to be further investigated for understanding the mechanism of PE Metrics

透析心理学

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Correlation study among sleep quality, depression and life quality in maintenance hemodialysis patients ZHANG Jun;WANG Chen;TANG Ying;LOU Tan-Qi 2009, 8 (9):  508-511.  Abstract ( 969 )   HTML ( 0 )   PDF (255KB) ( 200 )   【Abstract】 Objective to explore the correlation among sleep quality, depression and life quality in maintenance hemodialysis (MHD) patients. Methods Seventy-one patients fitting the criteria of MHD were recruited in this study. Subjective sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Life quality and depression condition were evaluated by SF-36 and Beck Depression Inventory (BDI), respectively. Patients’ age, gender, marital status, dry weight, blood hemoglobin, and serum ferritin, transferring saturation, calcium, phosphorus, intact parathyroid hormone, albumin, C-reactive protein, creatinine and urea nitrogen were collected before and after dialysis. Results Poor sleep quality as defined by PSQI＞5 was found in 76.1% MHD patients. Patients with poor sleep quality had lower SF-36 scores, physical component summary score (PCS) and mental component summary score (MCS) (P＜0.01), as well as higher BDI score and older age (P＜0.05). Moderate to severe depressive symptoms as defined by BDI ≥ 8 were found in 63.4% MHD patients. Patients with moderate to severe depression also had lower SF-36 scores, PCS and MCS (P＜0.01), and higher PSQI score, as compared with those in patients without moderate to severe depression (P＜0.01). SF-36 score, PCS and MCS were closely related with PSQI score and BDI score (P＜0.01). Depression and sleep quality were the independent risk factors for life quality. Conclusion Our MHD patients had poor sleep quality and a high prevalence of depressive symptoms, which influenced each other and led to poor life quality. Metrics