Chinese Journal of Blood Purification

01 January 2009, Volume 8 Issue 7 Previous Issue    Next Issue

论著

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Comparison of dialysis adequacy and access-related complications among hemodialysis patients with different vascular access CHEN Xiao-nong;XIE Jing-yuan;ZHU Ping;SHEN Ping-yan;SHI Hao;QIAN Ying;ZHANG Qian-ying;CHEN Nan 2009, 8 (7):  362-364.  Abstract ( 546 )   HTML ( 0 )   PDF (195KB) ( 206 )   【Abstract】Objective To compare the dialysis adequacy and complications in hemodialysis patients with different vascular access, and try to find out an ideal vascular access approach. Methods Patients who underwent an operation of long-term hemodialysis access between Jan. 2006 and Mar. 2008 were enrolled in this study. Kt/V value and the morbidity of access-related complications were evaluated and compared in a follow-up period of 12～38 months among patients using vascular access of native arteriovenous fistula (AVF), polytetrafluoroethylene (PTFE) grafts, and cuffed and tunneled catheter (CTC) in an internal jugular vein. Results In the 98 maintenance hemodialysis patients, 68 cases used native AVF, 12 used PTFE grafts, and 18 cases used CTC as the long-term vascular access for hemodialysis. Patients accepted hemodialysis by native AVF were younger and had lower infection rate, compared with those used PTFE grafts and CTC as the vascular access (P< 0.01). Thrombosis formation was less in patients with native AVF than in those with PTFE grafts (P<0.01). In patients with CTC, no access thrombosis was found, but inadequate access flow presented in 3 cases. Kt/V value was more than 1.2 in all patients, but was highest in native AVF group (P <0.01, as compared with that in CTC group). Conclusion Patients using native AVF for vascular access for hemodialysis were younger, and had lower rate of thrombosis and infection. Therefore, native AVF is preferable for long-term vascular access. When this type of vascular access is difficult to be established, PTFE grafts or CTC can also be chosen with relatively satisfactory effect of dialysis. Metrics

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Early failure of the first native arteriovenous fistula and its related factors MI X-uhua;TANG Wan-xin;FU Ping;SU Bai-hai;ZENG Wen-tong 2009, 8 (7):  365-368.  Abstract ( 546 )   HTML ( 0 )   PDF (247KB) ( 204 )   【Abstract】Objectives This study was aimed to identify early failure of the first native arteriovenous fistula (AVF) in patients on maintenance hemodialysis (HD) and the factors responsible for the failure, for the planning on early intervention strategies. Methods A retrospective study was conducted in 214 patients (aged 4814years, 132 males), who received the first native AVF operation for maintenance HD in West China Hospital from Jan, 2008 to Feb, 2009. Early failure was defined as (a) a blood flow volume ＜200ml/min inadequate to support dialysis therapy with a venous diameter of ≤0.4cm detected by ultrasound, and (b) the AVF failure occurring within the first 3 months of its use. Factors potentially relating to the failure of the first AVF including age, gender, primary disease, surgical procedure, and dwelling duration of central vein catheterization (CVC) before use of the AVF were collected and studied using binary Logistic regression analysis. Results Early failure of the AVF was found in 38 (17.8%) patients, of whom the major risk factors included hypotension status (RR=4.2, P=0.009), diabetes (RR=2.8, P=0.041), low body mass index (BMI) (RR=1.1, P=0.000), and surgical techniques (RR=0.86, P=0.036). Although CVC before the use of AVF showed no correlation with the early failure of AVF (RR=2.6, 95% CI=0.28-25.29, P=0.401), the dwelling duration of CVC was a risk factor (RR=1.1, 95% CI=1.03-6.72, P=0.001). Conclusion Early failure of the first native AVF correlates with hypotension, diabetes, BMI of the patient, surgical techniques, and dwelling duration of CVC. Native AVF should be established before the commencement of maintenance HD, so that the possibility of CVC and its dwelling duration can be reduced, and the patency of AVF can be improved with the decrease of its complications. Metrics

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Research on the factors affecting the maturation of arteriovenous fistula HE Qiang;LI Gui-sen;KANG Zhi-min;WANG Fang;CHEN Xiu-ling;ZOU Yu-rong;ZHANG Yuan;LIAO Chang-zhi;WANG Li. 2009, 8 (7):  369-371.  Abstract ( 566 )   HTML ( 0 )   PDF (201KB) ( 227 )   【Abstract】Objective To investigate the factors affecting the maturation of arteriovenous fistula (AVF) and its complications. Methods A total of 390 cases with end stage renal disease (ESRD) and AVF operation were prospectively studied. Factors relating to the maturation of AVF and its complications, such as primary cause of ESRD, diameter of the artery and vein, and anastomosis size of AVF, were analyzed during the follow-up period of more than four months. Results A total of 413 AVF operations were performed in the 390 patients, of which 370 were the operation for the first time, and 43 were the operation of second time. The operation failed in 43 cases (10.4%), due to immaturation of the AVF in 34 cases and dysfunction of the AVF after use for 6-12 months in 8 cases. Of the 43 cases, ultrasound Doppler examination revealed thrombosis in the AVF in 22 cases. AVF failure correlated with diabetes mellitus, arterial thickening, and anastomosis size of AVF, but unrelated with age, sex, diameter of artery and vein, anastomosis site and postoperative anticoagulation therapy. Diabetes mellitus (OR=2.72, 95% CI=1.18-6.28, P=0.019) and anastomosis size (OR=0.12, 95% CI = 0.02- 0.62, P=0.011) were the independent risk factors for the fistula failure. Conclusion Fistula failure occurred in 10.4% patients. The major cause of fistula failure was thrombosis. Diabetes mellitus and anastomosis size were the independent risk factors for the fistula failure. Metrics

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Clinical observation of low molecular weight heparin on calcium-phosphate metabolism in maintenance hemodialysis patients HE Yun-lan;WU Bi-bo;ZHANG Li-ming;TANG Qi;YU Yong;HAO Xiao-ping 2009, 8 (7):  372-374.  Abstract ( 523 )   HTML ( 0 )   PDF (203KB) ( 173 )   【Abstract】Objective To observe the effect of low molecular weight heparin (LMWH) on calcium-phosphate metabolism in maintenance hemodialysis (MHD) patients. Methods We recruited 78 patients who had undergone hemodialysis for at least three months without hemorrhage risk, and were randomly divided into LMWH treatment group (38 cases) and unfractionated heparin (UFH) treatment group (40 cases). Serum calcium, phosphate, parathyroid hormone (PTH) and alkaline phosphatase (AKP) were measured. Changes of bleeding, coagulation status in the extracorporeal circuit, and adverse effects were recorded. Results In the 12 months of treatment, lower serum levels of phosphate and PTH were observed in LMWH group (P＜0.05 for phosphate and PTH), but not in UFH group (P＞0.05). Serum calcium and AKP had no differences between the 2 groups (P＞0.05). Bleeding was more in UFH group than in LMWH group (P＜0.01), leading to the change of heparin treatment in 6 cases in UFH group. Conclusion LMWH used as the anticoagulant in hemodialysis may associate with the improvement of calcium-phosphate metabolism in MHD patients. Metrics

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Assessment of fluid distribution in patients on maintenance hemodialysis by bio-impedance spectrum analysis SUN Fang;ZHOU Yi-lun;LIU Jing;MA Li-jie;HAN Bin;SHEN Yang;CUI Tai-gen 2009, 8 (7):  375-378.  Abstract ( 511 )   HTML ( 0 )   PDF (262KB) ( 199 )   【Abstract】 Objective To evaluate the fluid distribution in patients on maintenance hemodialysis by the whole-body bio-impedance spectroscopy. Methods A total of 119 patients with stable hemodialysis for more than 3 months were enrolled in this study. Pre- and post-dialysis intracellular water (ICW) and extracellular water (ECW) were measured by whole-body multi-frequency bio-impedance spectroscopy (Bodystat, UK), and standardized by body weight to produce ICW% and ECW%. Eighty-two normal individuals of matched sex, age and body weight were used as controls. Results Patients on maintenance hemodialysis had significantly higher ECW% and ECW/ICW ratio compared with normal controls (P＜0.01). ECW% and ECW/ICW ratio decreased significantly after hemodialysis, but were still higher than those of controls. By contrast, pre- and post-dialysis ICW% values in HD patients were similar to those of controls. Lower ECW after dialysis was positively correlated with ultrafiltration volume (r=0.572, P＜0.01 for males; r=0.556, P＜0.01 for females). Patients with hypertension had higher pre- and post-dialysis ECW% values than those without hypertension. In patients with normal blood pressure, post-dialysis ECW% was similar to that of controls. Conclusions Hemodialysis patients have higher pre-dialysis ECW%. Fluid ultrafiltration is mainly derived from extracellular water during hemodialysis. Post-dialysis ECW% may be a useful parameter for the evaluation of dry weight in HD patients. Metrics

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Analysis of Risk Factors of Hypokalemia in Elder Peritoneal Dialysis Patients HAN Qing-feng;LU Xin-hong 2009, 8 (7):  379-381.  Abstract ( 641 )   HTML ( 0 )   PDF (173KB) ( 199 )   【Abstract】Objective Discussion hypokalemia situation in elderly peritoneal dialysis (PD) patients, and the possible risks for hypokalemia in these patients. Methods Cross-sectional study. 184 cases of PD patients were involved and 100 cases were elderly patients. The general information of patients, serum potassium levels, level of potassium, dietary intake of potassium, loss of potassium from urine and PD fluid, and occurrence of complications had been investigated. Results The incidence of hypokalemia in old age group PD patients was 27.0%. The level of potassium and PD dose was negatively correlated (r=-0.257，p=0.021). The dose of PD patients was the only independence affects factors to hypokalemia (p=0.009). Conclusion Hypokalemia in the elderly PD patients was related to PD dose. Metrics

基础研究

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Urinary proteomic research based on two dimensional fluorescence differential gel electrophoresis WANG Ling;NI Zhao-hui;MOU Shan;YAN Yu-chen;GU Le-yi;LI Dao 2009, 8 (7):  382-385.  Abstract ( 603 )   HTML ( 0 )   PDF (308KB) ( 188 )   【Abstract】 Objective To investigate the methods of urine sample collection and storage, concentrating of protein, fluorescence labeling and several key problems about two dimensional electrophoresis (2DE) for urinary proteomic research, and to provide the methodology for related clinical research. Methods Male patients with diabetes mellitus, hypertension, and less than 0.15g protein in 24 hour urine were included. Fresh urine samples were collected bedside. Urine samples were pooled together and were divided into 7 groups based on with and without adding cocktail protease inhibitors, storage temperature, protein desalting method, and types of immobilized pH gradient iso-electric focusing strips. 2-DE was used for comparison and analysis of samples from the groups. A part of the samples were analyzed by 2D fluorescence differential gel electrophoresis (2D-DIGE). Results From the 2-DE results, the number of protein spots was more in urine samples treated with protease inhibitors, stored at -80℃ and desalted by repeated ultrafiltration. The nonlinear IPG strips with pH 4-7 and 24cm long or pH 3-10 and 11cm long were suitable for urine 2DE. Urinary 2D-DIGE could provide repeatable results useful for clinical and laboratory research after labeling the samples with various Cydyes. Conclusion 2D-DIGE may give ideal results of urinary proteomics for clinical research, if appropriate methodology was adopted. Metrics

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Experiment study on albumin loss during on-line hemodiafiltration with the new polysulfone high-flux membrane REXEED-15UC dialyzer DAI Hui-li;WANG Yong-mei;ZHANG Wei-ming;WU Qing-wei;LI Yi;WANG Jie;YAN Yu-cheng;QIAN Jia-qi 2009, 8 (7):  386-389.  Abstract ( 1014 )   HTML ( 1 )   PDF (232KB) ( 200 )   【Abstract】 Objectives To evaluate albumin loss during on-line hemodiafiltration (HDF) by using the new polysulfone high-flux membrane REXEED-15UC dialyzer. Methods An in vitro isovolemic online HDF model was established using bovine blood. REXEED-15UC dialyzer was used, and its effect was compared with that using HF-80S high-flux dialyzer. The experiment was divided into two groups: post-dilution HDF group (Quf=40mL/min and 60mL/min; N=3), and pre-dilution HDF group (Quf=80mL/min and 120mL/min; N=3). HDFwas lasted for 240 minutes and repeated for 3 times. Hemodiafiltrate fluid was taken out at different points (after 0, 1, 2, 4, 6, 8, 10, 20, 30, 40, 50, 60, 120, 180, and 240 minutes from the beginning of the experiment) during a single on-line HDF session. Albumin in hemodiafiltrate was measured by ELISA, and the total albumin loss in a HDF session was calculated using the area under the curve from the HDF using the REXEED-15UC dialyzer and HF-80S dialyzer. Results In the 2 groups using REXEED-15UC dialyzer or HF-80S dialyzer, albumin loss was less than 1.0g (0.261- 0.963g) in a single on-line HDF session. No statistical significance in albumin loss was found between the 2 doses used for post-dilution HDF group and pre-dilution HDF group in a single HDF session. In the two groups, the peak of albumin loss appeared in the first 10 minutes from beginning of the experiment. Conclusions REXEED-15UC dialyzer shows lower and clinically acceptable albumin loss in an on-line HDF session. Metrics

透析心理学

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Correlation factors causing anxious and depression among the hemodialysis nurses XUE Xiu-zhen DONG Fu-you 2009, 8 (7):  393-394.  Abstract ( 425 )   HTML ( 0 )   PDF (114KB) ( 170 )   Metrics

血液净化相关产品与技术

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Catheterization in uremia patients combined with hepatic cirrhosis and portal hypertension. AN Qingfeng;WANG Jiwei;Fu Gang 2009, 8 (7):  401-403.  Abstract ( 982 )   HTML ( 0 )   PDF (192KB) ( 194 )   【Abstract】Objective To discuss the method of catheterization and handling process in peroperative period in the uremia patients combined with hepatic cirrhosis and portal hypertension. Methods 6 uremia and hepatic cirrhosis and portal hypertension patients had been involved. They had their catheterization by this sequence in the operation: purse-string suture - discussion of peritoneal cavity - implantation of catheter close peritoneal cavity. After the operations, the input and output volume of peritoneal dialysate had been controlled, and the limits of ascites had been evaluated. Results The loss of ascites in the operation were only 100ml to 600ml in these patients, and their vital sign were stable. Their ascites had been controlled during 5 to 15 days, and no more complication had been found. Conclusion It is feasible for catheterization to uremia patients combined with hepatic cirrhosis and portal hypertension. Metrics