Chinese Journal of Blood Purification

12 June 2009, Volume 8 Issue 6 Previous Issue    Next Issue

专题

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Pay attention to the long-term complications and treatment of blood access YUAN Wei-jie 2009, 8 (6):  291-293.  Abstract ( 495 )   HTML ( 0 )   PDF (213KB) ( 189 )   Metrics

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Strategy and techniques in the blood access establishment for hemodialysis patients WANG Li;HE Qiang 2009, 8 (6):  294-296.  Abstract ( 462 )   HTML ( 0 )   PDF (197KB) ( 154 )   Metrics

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The causes and treatment of permanent catheter dysfunction in dialysis patients LI Hai-ming;CHEN Jing 2009, 8 (6):  297-300.  Abstract ( 496 )   HTML ( 0 )   PDF (280KB) ( 173 )   Metrics

论著

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Aneurysm-like dilatation of internal arteriovenous fistula in maintenance hemodialysis patients: Its cause and prevention YU Qing;ZHANG Yu-ran;CHI Qi;YU Pei-qing;YUAN Wei-jie 2009, 8 (6):  301-304.  Abstract ( 1063 )   HTML ( 0 )   PDF (257KB) ( 266 )   【Abstract】 Objecitve To investigate the causes and prevention of aneurysm-like dilatation of internal arteriovenous fistula in hemodialysis patients. Methods A total of 350 patients treated with hemodialysis for 1~32 years in this hospital were recruited and divided into two groups. Patients in group A had aneurysm-like dilatation of internal arteriovenous fistula, and those in group B had no dilatation. Local or multistep puncture to the fistula were applied during hemodialysis. After dialysis, adhesive tape round the arm combined with pressure by fingers or elastic bandage were used on the puncture site. Results Aneurysm-like dilatation of arteriovenous fistula (group A) was found in 42 cases (12%), of which 29 cases (69%) had hypertension, similar to the hypertension incidence (61%, P＞0.05) in group B. In the 42 patients with the dilatation, 24 (57.1%) cases were treated with hemodialysis for more than 10 years; fistula was in forearm in 35 cases, in upper arm in 6 cases, and PTFE graft in one case. Aneurysm-like dilatation presented at puncture site in 29 cases, at anastomotic site in 8 cases, along the venous portion in 3 cases, and as pseudoaneurysm in 2 cases. Local puncture was applied in 69% cases in group A, but in 21% in group B (P<0.01). About 2/3 patients with fistula in upper arm were complicated with the aneurysm-like dilatation. The way of anastomotic operation, pressure on puncture site after dialysis, and plasma calcium, phosphorus and parathyroid hormone (PTH) had no differences between two groups. Conclusion The causes of aneurysm formation of arterialvenous fistula may relate to repeated punctures at local site, the site of fistula, hypertension and vascular pathological changes. Prevention of aneurysm-like dilatation is essential to the persistent protection of the fistula Metrics

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Causes and treatment of central venous catheter dysfunction in hemodialysis patients SHI Hong-bin;XU Hang;LIANG Bin-qiong;WEI Le 2009, 8 (6):  305-308.  Abstract ( 667 )   HTML ( 0 )   PDF (268KB) ( 215 )   【Abstract】 Objective To improve the recognition, treatment and prognosis of central venous catheter (CVC) dysfunction in hemodialysis patients. Methods We analyzed 156 maintenance hemodialysis patients with CVC, of which 36 used long-term indwelling cuffed catheter, and 120 used temporary CVC. Results Access dysfunction and catheter related infection were the two major causes leading to CVC dysfunction. Access dysfunction was found in 22 cases, of which 59% were thrombosis formation in CVC. Fibrinous sheath was another important cause of access dysfunction usually found on long-term indwelling cuffed catheter. Catheter related infection was frequently found in central vein catheterization through femoral vein and in patients complicated with diabetic nephropathy. The infection rate was higher in patients using temporary CVC than in those using long-term indwelling CVC. In temporary central vein catheterization, the longer the indwelling duration, the more the infection rate. Conclusion Thrombosis formation in catheter was the most common cause leading to CVC dysfunction. Fibrinous sheath was frequently found on long-term indwelling cuffed catheter. Catheter related infection is related to the patients with diabetic nephropathy, the catheterization site, the duration using temporary catheter. Catheter with a cuff was suitable for long-term indwelling CVC with less infection. Metrics

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Application of indwelling central venous catheterization in hemodialysis FU Xiao;ZHU Xiao-ping;WU Hong;YUAN Fang;CHEN Xing 2009, 8 (6):  309-312.  Abstract ( 644 )   HTML ( 0 )   PDF (273KB) ( 206 )   【Abstract】 Objective To analyze the complications resulting from central vein catheterization and their treatment in hemodialysis patients. Methods A retrospective study was performed on 1269 cases treated with hemodialysis using central venous catheters during January, 2005 to September, 2007. Of them, 409 had catheterizations through femoral vein, 544 through external jugular vein, 285 through internal jugular vein, and 31 had permanent catheterizations. Result The average indwelling time of the catheters was 3 weeks for catheterizations through femoral vein, 4 months for those through internal or external jugular vein, and 11 months for permanent catheterizations. The acute complications of the catheterizations included inadvertent puncture to arteries (2.36%), hematoma (2.13%) and local blood infiltration (1.26%). The complications of long-term indwelling catheterizations were infection (6.38%) and insufficient blood flow through catheter (5.04%). Infections included local infection (6.38%) and catheter infection (2.83%). The local infection rate and catheter infection rate were highest (10.27% and 3.67%, respectively) in patients with catheterization through femoral vein, resulting in shorter indwelling duration in these patients. The infection rate had no difference between patients through internal and external jugular vein catheterizations. We changed dressing everyday for local infection, and sealed the catheter with gentamicine 80,000 units and urokinas 10,000 units for catheter infection. If the catheter infection improved after this sealing method for 2-3 times, we continued to use this method for 2 weeks. If this sealing method was no useful, we removed the catheter. The causes of insufficient blood flow through catheter included the catheters adhered to vessel wall, angled and blocked by thrombosis in it, which were usually seen in patients using cuffed catheter. Change of catheter position was usually found in catheterization through external jugular vein (2.57%), probably due to the local anatomical features. Conclusion Central venous catheterization is an ideal vascular access for hemodialysis. However, careful must be paid to the appropriate indications, skilled operation technique, and prevention and treatment of its complications. Metrics

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The impact of pump controlled blood flow on blood flow in arteriovenous fistula during hemodialysis BAI Li;WANG Li-yan;MENG Xian-hua;TAN Min;YAN Yu 2009, 8 (6):  313-315.  Abstract ( 625 )   HTML ( 1 )   PDF (184KB) ( 170 )   【Abstract】 Objective To study the impact of pump controlled blood flow (Qb) on blood flow in arteriovenous fistula (Qa) during hemodialysis. Methods A total of 21 maintenance hemodialysis patients with arteriovenous fistula were observed. After access to the fistula by successful puncture, the HD02 ultrasound hemodialysis monitor was connected to it. Thirty minutes after the beginning and 30 minutes before the end of a hemodialysis session, the Qb was sequentially adjusted to 200, 250 and 300ml/min in 4 minutes apart. When blood flow was stable for 2 minutes after every change of Qb, Qa was measured by HD02 hemodialysis monitor. Patients’ heart rate and blood pressure were recorded. Results Under the Qb of 200, 250 and 300ml/min, the Qa at 30 minutes after the beginning of the hemodialysis session were 1123.0±457.9, 1093.9±449.8 and 1153.9±436.3ml/min (P＞0.05), respectively, and the Qa at 30 minutes before end of the hemodialysis session were 1083.9±420.9, 1042.3±413.8 and 1039.2±392.7ml/min (P＞0.05), respectively. Patients’ heart rate and blood pressure remained unchanged. Conclusion At the beginning and the end of hemodialysis sessions, Qb in the range of 200～300ml/min did not affect the Qa significantly. Patients’ heart rate and blood pressure were stable. These results also demonstrate the stable cardiac function during hemodialysis sessions. Metrics

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Thromboelastograph for the detection of blockage in internal fistula in hemodialysis patients LIU Fang;REN Wan-jun;JING Yong-sheng;WANG Xiao-ping;LIU Zi-dong 2009, 8 (6):  316-318.  Abstract ( 645 )   HTML ( 0 )   PDF (191KB) ( 178 )   【Abstract】 Objective To determine the relationship between conventional coagulation examinations and thromboelastograph (TEG) parameters and blockage in internal fistula by thrombosis in hemodialysis patients. Methods We recruited 50 hemodialysis patients in this Blood Purification Center and divided them into the presence of internal fistula embolism group (group A) and the absence of internal fistula embolism group (group B). TEG, conventional coagulation examinations and blood routine tests were measured retrospectively. Results There were no differences in hemoglobin and conventional coagulation parameters between the 2 groups, and the international normalized ratio (INR) was identical between the two groups (0.98±0.05 vs. 0.98±0.09, P=0.48). There were also no statistical significances between two groups regarding activated partial thromboplastin time (33.78±4.85 vs. 32.05±4.15 seconds, P=0.21), prothrombin time (11.92±0.64 vs. 11.90±1.15 seconds, P=0.48) and platelet number (190.7±40.07 x 109/l vs. 189.7±42.01 x 109/l, P=0.04). In the 14 cases in group A, hypercoagulation state was found in 10 patients and hyper-activated platelets in 4 patients by TEG. In the 36 cases in group B, hypercoagulation state was found by TEG in 30 patients, of whom 16 cases also showed increased function of platelets, and 6 cases had hyper-activated platelets and blood coagulation factors. There were significant differences in the TEG parameters of R, K, ANGLE and CI values between the 2 groups, suggesting the presence of hypercoagulation status in group A. Conclusion TEG disclosed the hypercaogulation status more accurately than other conventional coagulation examinations in hemodialysis patients. TEG is helpful for the prediction of thrombosis formation predisposition in internal fistula in uremic patients under hemodialysis. Metrics

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The relationship between plasma homocysteine and stenosis of internal arteriovenous fistula in maintenance hemodialysis patients CHEN Wei-dong;ZHANG Yan;CHANG Bao-chao;YAN Ping 2009, 8 (6):  319-321.  Abstract ( 488 )   HTML ( 0 )   PDF (213KB) ( 178 )   Metrics

基础研究

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A rat model of autogenous internal arteriovenous fistula and the experimental study on internal fistula stenosis HUA Can;YE Chaoyang;Dong Zhe-yi;GAO Xiang;JI Chen-chen;FU Li-li;HUA Zhen-hao. 2009, 8 (6):  322-325.  Abstract ( 608 )   HTML ( 0 )   PDF (346KB) ( 195 )   【Abstract】 Objective Intimal hyperplasia at the anastomosis site may cause the failure of autogenous arteriovenous fistula. We designed a rat model to study this process and its mechanism. Methods Wistar rats were subjected to end-to-end anastomosis of the right carotid artery and internal jugular vein. After the operation for 14 and 28 days, rats were sacrificed, and the artery and vein near the anastomosis site were examined for histological changes after staining with HE, combined staining for elastic and collagen fibers, and immunohistochemical staining for PCNA, TGF-β1 and NF-κB. Results After the operation for 14 days, apparent intimal hyperplasia was found at the venous end near the anastomosis site, appearing as polypoid hyperplasia. Vascular smooth muscle cells proliferated with the prominent deposition of collagen fibers. After the operation for 28 days, stenosis of the lumen occurred. The inner elastic layer discontinued at the anastomosis site even after the operation for 28 days. PCNA and NF-κB were highly expressed in medial and adventitial layers of the vein near the anastomosis site after the operation for 14 days and remained highly expressed after 28 days. TGF-β1 was highly expressed in the matrix of adventitial layer. Conclusion This rat model can mimic the local hemodynamic changes in internal fistula. Apparent intimal hyperplasia was seen in this model within 28 days, being useful as an autogenous arteriovenous fistula model. We also found that TGF-β1 and NF-κB were involved in the pathological processes of intimal proliferation in internal fistula. Metrics

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Expression of PiT-1 in hyperphosphatemia induced arterial calcification in chronic renal failure rats IANG Ying;WANG Mei 2009, 8 (6):  326-330.  Abstract ( 593 )   HTML ( 1 )   PDF (310KB) ( 186 )   【Abstract】 Objective To evaluate the expression of PiT-1 in hyperphosphatemia induced thoracic aorta calcification and its underlying mechanism in chronic renal failure (CRF) rats. Methods A total of 36 male Wistar rats were subjected to nephrectomy of 5/6 kidneys (n=27) or sham operation group (n=9). After the operation, rats were fed with regular diet for 4 weeks, and then with high phosphorous diet for 10 weeks. From beginning of the high phosphorous diet, rats were divided into 3 groups: (a) Model group (nephrectomy + high phosphorous diet, n=9), (b) phosphonoformic acid (PFA) treated group (nephrectomy + high phosphorous diet + intraperitoneal PFA 0.15 g/kg/every other day, n=7) (c) Control group (nephrectomy + high phosphorous diet + intraperitoneal normal saline infection/every other day, n=6). At the end of high phosphorous diet, rats were sacrificed. Serum creatinine, Ca, inorganic phosphorous and 1,25(OH)2D3 were measured. The upper part of thoracic aorta was used for calcium content assay, the middle part was stored at -800C for the measurement of Pit-1 and Cbfα-1 and their mRNAs by western blot and quantitative real-time PCR, and the paraffin slides of the lower part were treated with von Kossa staining. Results There were no significant differences in serum creatinine, Ca, inorganic phosphorous and 1,25(OH)2D3 among CRF rats at the beginning and end of high phosphorous diet. In PFA treated group, Pit-1 and its mRNA in aorta decreased, as compared with those in model and control group (P<0.001), and Cbfα-1 and its mRNA also decreased (P<0.001), in accompanying with the less degree of aorta calcification. Conclusions In rats with CRF and hyperphosphatemia, PiT-1 in thoracic aorta mediated the transportation of phosphate, induced the over-expression of Cbfα-1, and promoted vascular calcification. Metrics