Chinese Journal of Blood Purification

12 May 2009, Volume 8 Issue 5 Previous Issue    Next Issue

专家述评

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Topics about volume loading in patients with peritoneal dialysis LIU Fu-you 2009, 8 (5):  238-240.  Abstract ( 436 )   HTML ( 0 )   PDF (199KB) ( 204 )   Metrics

论著

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Peripheral arterial disease and its related risk factors in patients on continuous ambulatory peritoneal dialysis JIA Ting;CHEN Hui-min;CHENG Li-tao;WANG Tao 2009, 8 (5):  241-244.  Abstract ( 553 )   HTML ( 0 )   PDF (265KB) ( 178 )   【Abstract】 Objective To study the prevalence of peripheral arterial disease (PAD) and its related risk factors in patients on continuous ambulatory peritoneal dialysis (CAPD). Methods We studied 150 CAPD patients with stable clinical status in a single center. Ankle-brachial index (ABI) was measured in these patient, and ABI < 0.9 was considered as having PAD. However, patients with ABI ＞1.3 were excluded because of the false negative rate. Correlation and logistic regression analysis were performed to disclose the risk factors of PAD in these CAPD patients. Results Significant differences in diabetic status, history of cerebro- and cardio- vascular diseases, diastolic blood pressure, blood urea nitrogen, serum albumin, blood sugar and C-reactive protein (CRP) were found between patients with PAD and those without PAD. Logistic regression analysis showed that serum albumin (β= -0.139, P<0.05) and CRP (β＝0.064, P<0.05) were the independent determinants of PAD in CAPD patients. Conclusion Serum albumin and CRP were the determinant factors of PAD in CAPD patients. Therefore, care should be paid to the CAPD patients with malnourishment or inflammation for the prevention of PAD. Metrics

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Ultrasound dilution: A new method to evaluate dry body weight by monitoring central blood volume in hemodialysis patients DAI Wen-di;ZHANG Dong-liang;LIU Wen-hu;JI Dan-ying 2009, 8 (5):  245-248.  Abstract ( 1018 )   HTML ( 0 )   PDF (244KB) ( 269 )   【Abstract】 Objective To investigate the related factors for blood pressure changes in hemodialysis patients, and to measure central blood volume (CBV) by ultrasound dilution method for the prevention of hypotension and the adjustment of dry body weight during dialysis. Methods Sixty patients were assigned in 3 groups based on their previous blood pressure in patients’ dialysis records: high blood pressure (HBP) group, low blood pressure (LBP) group and normal blood pressure (NBP) group. CBV, cardiac output (CO), cardiac index (CI), and peripheral vascular resistance (PVR) were examined by ultrasound dilution method during the dialysis at one hour and 3 hours. Results In the 60 patients, CO (-12.3±15.8%), CI (-18.2±21.0%) and CBV (-0.12±0.16%) were significantly decreased (p＜0.01), but without significant changes in blood pressure and PVR. However, the decreases of CO, CI and CBV were only detected in LBP group but not in HBP and NBP groups. In a dialysis session, change of CBV was positively correlated with that of CO (r=0.648, P＜0.001), and was negatively correlated with changes of PVR (r = -0.487, P＜0.001) and ultrafiltration volume (r = -0.524, P＜0.005). By using CBV to monitor patient’s dry body weight in 101 dialysis sessions for 10 hypertension patients and 10 hypotension patients, we observed normal blood pressure during and after dialysis sessions. Conclusions CBV is a useful marker for circulating blood volume. During a dialysis session, the decrease of CBV reflects the decrease of extracellular fluid, and is also related to hypotension. CBV correlates positively with CO, and negatively with PVR and ultrafiltration volume. Blood pressure change positively correlates with the change of heart rate. In the 3 groups, factors relating to PVR change are uncertain. By measuring CBV, CO and CI using ultrasound dilution method before and after a dialysis session, we can estimate the appropriate ultrafiltration volume and dry body weight, and perform the dialysis under a normal and stable blood pressure condition. Metrics

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Effect of Low calcium dialysate on calcium and phosphate metabolism in continuous ambulatory peritoneal dialysis SUN Jing;ZHANG Yan;ZHANG Hong;YU Ke-zhou;Wang Qun;WANG Rong 2009, 8 (5):  249-252.  Abstract ( 543 )   HTML ( 0 )   PDF (250KB) ( 205 )   【Abstract】 Objective To compare the effects of low calcium dialysate (LCD) with standard calcium dialysate (SCD) in patients with continuous ambulatory peritoneal dialysis (CAPD). Methods Fifty-seven CAPD patients randomly received LCD or SCD for a period of 6 months. Serum calcium was evaluated before and after the treatment for 6 months. Serum phosphate, magnesium and parathyroid hormorne (PTH) were also measured. Uncomfortable events, if any, were recorded. Results Fifty-three patients completed the study. After the treatment for 6 months, serum calcium, phosphate, magnesium and calcium-phosphate product showed no change in the patients receiving SCD (P＞0.05), but decrease significantly in the patients treated with LCD (P＜0.05). Serum PTH increased significantly in patients with LCD as compared with that in patients with SCD (P＜0.05). In patients treated with LCD, skin itch improved, and no hypotension and spasms due to hypocalcemia happened. Conclusions LCD satisfactorily controlled serum calcium, decreased serum phosphate, and alleviated the inhibition of parathyroid. Thus LCD for CAPD may be useful in the prevention of adynamic bone diseases. Metrics

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The relationship between calcium and phosphate product and nutritional status in maintenance hemodialysis patients ZHOU Wen-xiang;ZHENG Wen-bin;HUANG Xiao-mei;ZHANG Ying;NIE Xiang-zhi;LI Hong-bin;HE Da;XIE Lan-qian 2009, 8 (5):  253-255.  Abstract ( 599 )   HTML ( 0 )   PDF (172KB) ( 195 )   【Abstract】Objective To analyze the relationship between calcium and phosphate product and nutritional status in maintenance hemodialysis (MHD) patients. Methods A retrospective study was performed to assess calcium and phosphorus metabolism and nutritional status in 110 MHD patients in The First Hospital of Wuhan City from Jan. 2007 to Dec. 2007. Patients were assigned to group A (calcium and phosphate product ≤55mg/dl) or group B (calcium and phosphate product >55mg/dl). Comparison was made between the two groups. Results Higher levels of serum phosphate (P＜0.01), albumin, pre-dialysis BUN, total cholesterol and triglyceride (P<0.05) were found in group B, as compared with those of group A, whereas serum calcium, hemoglobin and iPTH had no differences between the two groups. Conclusion Elevated calcium and phosphorus product in MHD patients may result from the improvement of nutritional status and the increase of phosphate intake. Metrics

基础研究

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Protective roles of calcitriol on overload of intracellular calcium and hypertrophy of cardiomyocytes induced by parathyroid hormone ZHAO Wei-hong;ZHANG Xiao-wen;WANG Xiao-yun 2009, 8 (5):  256-259.  Abstract ( 575 )   HTML ( 0 )   PDF (236KB) ( 199 )   【Abstract】 Objective To observe the effects of calcitriol on intracellular calcium concentration ([Ca2+]i) and hypertrophy of cardiomyocytes induced by parathyroid hormone (PTH). Materials and Methods Cultured neonatal rat cardiomyocytes were loaded with Fluo-3/AM, and [Ca2+]i was determined by a laser confocal microscope. Hypertrophic response of neonatal rat cardiomyocytes was assayed by measuring cell surface area and protein content. Results (a) When the extracellular Ca2+ was 2.5mmol/L, rapid stimulation of PTH1-34 at the concentration of 0.1 and 1μmol/L significantly elevated fluorescence intensity of [Ca2+]i in cardiomyocytes (P＜0.01). However, when the extracellular fluid contained no calcium or the cardiomyocytes were pre-treated with 10μmol/L nifedipine, 1μmol/L PTH1-34 did not induce the increase of fluorescence intensity any more. (b) When the cardiomyocytes were treated in 0.01 and 0.1μmol/L PTH1-34 for 7 days, their surface area, protein content and [Ca2+]i increased significantly, especially those treated in 0.1μmol/L PTH1-34. If the cells were co-treated with 0.001μmol/L calcitriol and 0.1μmol.L-1 PTH1-34, their surface area, protein content and [Ca2+]i attenuated significantly. However, when the calcitriol concentration increased to 0.1μmol/L in the co-treatment experiment, these changes remained. Conclusion Cardiomyocyte hypertrophy was induced by PTH1-34, and was inhibited by appropriate concentration of calcitriol. Calcium influx through voltage-dependent channel induced by PTH may be one of the important mechanisms leading to cardiomyocyte hypertrophy. Metrics

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Interventional effect of hepatocyte growth-promoting factor on interstitial fibrosis in rat kidney after ligation of unilateral ureter CHEN Li-ping;YE Fan;WANG Bao-xing 2009, 8 (5):  260-263.  Abstract ( 580 )   HTML ( 0 )   PDF (272KB) ( 194 )   Interventional effect of hepatocyte growth-promoting factor on interstitial fibrosis in rat kidney after ligation of unilateral ureter CHEN Liping, YE Fan, WANG Baoxing 1Pharmaceutical Preparation Section, 2Department of Nephrology, Third Hospital, He Bei Medical University, Shijiazhuang 050051, China 【Abstract】 Objective To study the effects of hepatocyte growth-promoting factor (pHGF) on the expression of hepatocyte growth factor (HGF) and transforming growth factor β1 (TGF-β1) in rat kidney with interstitial fibrosis, and to explore the possible mechanism of pHGF in the improvement of renal interstitial fibrosis in rats for providing useful clues to the prevention and treatment of clinical renal fibrosis. Methods Fifty-four male Wistar rats were randomly divided into 3 groups: sham operation group, unilateral ureteral obstruction (UUO) group, and UUO treated with pHGF (UUO + pHGF) group. Rats were sacrificed after the surgery for 3, 7 and 14 days. Histological change in the obstructed kidney was observed by HE stain and Masson stain. HGF and TGF-β1 in tissues were examined by immunohistochemical method. Results, TGF-β1 expression and injury in tubular interstitium were more prominent in UUO group than in sham operation group (P＜0.05) and in UUO + pHGF group (P＜0.05). In UUO group, HGF expression in kidney was high in the first 3 days after the surgery, decreased at 7th day, and then became weaker at 14th day after the surgery. In UUO + pHGF group, however, HGF expression was higher than that in UUO group at 3rd, 7th and 14th day after the surgery (P＜0.05), in association with less pathological change and smaller area of tubulointestitial injury (P＜0.05). Conclusion pHGF improves the tubulointerstitial injury due to ureteral obstruction in rats, possibly through the inhibition of TGF-β1 over-expression and stimulation of HGF expression in renal interstitium. Metrics

人工肝

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Clinical study on plasma perfusion using HB-H-6 resin for the treatment of severe jaundice LI Tao;DU Zhi;YUAN Ping;HAN Tao;LI Juan;FANG Shu-chang;LUO Li-qun. 2009, 8 (5):  264-266.  Abstract ( 560 )   HTML ( 0 )   PDF (187KB) ( 195 )   【Abstract】 Objective To observe the effect of HB-H-6 resin plasma perfusion in the treatment of severe jaundice. Methods Sixty-one patients (male 52 and female 9; 44-71 years of age with mean age of 55 years) with severe jaundice were enrolled in this study. They were diagnosed with hepatocellular jaundice caused by acute or chronic liver function failure or severe hepatitis. Patients were treated with HB-H-6 resin plasma perfusion unit. Plasma bilirubin, protein, electrolyte and blood routine examinations were assayed before perfusion and 2 hours after plasma perfusion. Blood pressure, heart rate, respiration and temperature were monitored regularly. Results Perfusion continued for 2 hours. After the perfusion, plasma total bilirubin decreased by 29 %, indirect bilirubin decreased by 26 %, direct bilirubin decreased by 31 % (P＜0.05), plasma protein decreased by 7 %, albumin decreased by 9 %, and globulin decreased by 4 % (P＜0.05), but without significant changes in serum K+, Na+, Ca2+, Mg2+ and Phosphate (P＞0.05). After the perfusion, WBC increased by 2 %, RBC decreased by 1%, and platelet decreased by 6 % (P＞0.05). During the perfusion, heart rate, blood pressure, respiration and body temperature remained stable. Conclusion Plasma perfusion with HB-H-6 resin is an effective and safe approach for the treatment of severe hepatocellular jaundice. Metrics

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Clinical application of plasma exchange combined with hemodiafiltration in patients with liver failure YU Yong-wu;LI Ming-xu;DONG Zhen 2009, 8 (5):  267-269.  Abstract ( 444 )   HTML ( 0 )   PDF (188KB) ( 212 )   Metrics