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Chinese Journal of Blood Purification

    12 February 2009, Volume 8 Issue 2 Previous Issue    Next Issue
    论著
    The appropriate period and blood purification method for the treatment of acute kidney injury caused by sepsis
    LI Jia-rui;WANG Yong-ming;WU Zi-xia;WANG Hao;WANG Qing-shu;ZHANG Hong-yan;YOU Xi-lei;QIAO You-jie.
    2009, 8 (2):  62-66. 
    Abstract ( 580 )   HTML ( 0 )   PDF (234KB) ( 191 )  
    【Abstract】 Objective To evaluate the appropriate period and blood purification method for the treatment of sepsis-induced acute kidney injury by using Risk, Injury, Failure, Loss, and End-stage Kidney Classification for acute kidney injury (RIFLE criteria for AKI) and APACHE II score. Methods We retrospectively analyzed 96 sepsis-induced acute kidney injury patients treated in the ICU of Tianjin Tianhe Hospital during the period from March 2004 through September 2006. They were assigned in the continuous renal replacement therapy (CRRT) group (54 cases) or the intermittent hemodialysis (IHD) group (42 cases). In the CRRT group, patients were evaluated by RIFLE criteria for AKI, from which 14 cases were at stage I, 19 cases at stage II, and 21 cases at stage III. Their vital signs, laboratory parameters, dynamic change of APACHE II score and prognosis were observed. Results ①Before the treatment, there were no differences in APACHE II score and serum creatinine level between the two groups (P>0.05). After the treatment, APACHE II score, mean arterial pressure and oxygen saturation rate were lower in the CRRT group than in the IHD group (P<0.05). The lowered mean arterial pressure and oxygen saturation rate improved after the treatment (P<0.05). ②The mortality rate was 51.9% and 52.4% (P>0.05), and the recovery rate of renal function was 92.3% and 65.0% (P<0.05), in the CRRT group and the IHD group, respectively. ③ In the CRRT group, the survival rate was 78.6% and 38.1%, APACHE II score before the treatment was 25.4±2.5 and 36.1±5.7, recovery rate of renal function was 90.9% and 62.5%, the range of APACHE II score change was -13.6±4.3 and -7.1±4.2, in patients at stage I and stage III, respectively. These differences were statistically significant (P<0.05). Conclusion RIFLE criteria of AKI in association with APACHE II score are useful to estimate the appropriate time for blood purification. CRRT is an effective method to prevent and treat sepsis-induced acute kidney injury.
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    The efficacy and safety of intravenous iron sucrose in the treatment of anemia in maintenance hemodialysis patients
    MI Xu-hua;RAN Jian-ping;ZHANG Jie
    2009, 8 (2):  67-69. 
    Abstract ( 583 )   HTML ( 0 )   PDF (195KB) ( 215 )  
    【Abstract】Objective To determine the efficacy and safety of intravenous iron sucrose (iv group), and to compare with those of oral polysaccharide iron complex (oral group) in maintenance hemodialysis patients treated with recombinant human erythropoietin. Methods This was a randomized and controlled clinical study. Forty patients were equally divided into the iv group and oral group. Results All the baseline parameters were comparable between the two groups. At the end of the trial, hemoglobin, hemotocrit, serum ferritin and transferrin saturation were significantly increased in both groups. However, the increment of these laboratory parameters was significantly higher in iv group than in oral group (P<0.05). There were less adverse effects in iv group than in oral group (P<0.05). No differences were found in liver function and serum CRP between the two groups before and after the treatment. Conclusions Intravenous iron sucrose is effective and safe in treating anemic hemodialysis patients
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    Effects of coupled plasma filtration adsorption on serum cytokines in patients with multiple organ dysfunction syndromes
    MAO Hui-juan;YU Shu;YU Xiang-bao;ZHANG Bo;HU Jian-ming;ZHANG Li;XU Xian-rong;SHEN Xia;WANG Xiao-yun;XING Chang-ying
    2009, 8 (2):  70-75. 
    Abstract ( 589 )   HTML ( 0 )   PDF (362KB) ( 155 )  
    【Abstract】 Objective To investigate the effect of a novel extracorporeal blood purification therapy, coupled plasma filtration adsorption (CPFA), on serum cytokines in multiple organ dysfunction syndromes (MODS) patients with severe infection. Methods This was a prospective, randomized and crossover clinical trial. A total of 7 patients diagnosed as MODS with severe infection were selected in this study. Patients were randomly allocated to both 10h of coupled plasma filtration adsorption plus hemodialysis (CPFA, treatment A) and 10h of high volume hemofiltration (HVHF, treatment B) with a 12h interval in between. The order of treatment A and B was randomly arranged, i.e., patients received treatment A+B or B+A randomly. Serum levels of seven inflammation mediators including tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-1β(IL-1β), interleukin-10 (IL-10), interleukin-1 receptor antagonist (IL-1Ra), soluble tumor necrosis factor receptor 1 and 2 (sTNFR1, sTNFR2) were measured at 0, 5, 10h of each treatment. Results ①CPFA resulted in the decrease of serum TNF-α and the increase of serum IL-1Ra, sTNFR2/TNF-α ratio and IL-1Ra/IL-1βratio (P<0.05). During HVHF, serum IL-1βdecreased at 5h and increased to baseline value at 10h, and serum IL-1Ra and IL-1Ra/IL-1βratio increased at 5h and then decreased to baseline value at 10h. The changes of serum TNF-α, IL-1Ra, sTNFR2/TNF-α ratio and IL-1Ra/IL-1β ratio were different between treatment A and treatment B (P<0.05). ②During CPFA, serum TNF-α, L-1β and IL-6 were decreased by 38.95%, 41.76% and 44.39%, respectively, at 0h after flow through the aparatus; the 3 cytokines were decreased by 23.55%, 16.18% and 7.53%, respectively, at 5h. During HVHF, no changes of these cytokines were found between the arterial and venous ends of the hemofiltrator at 0h and 5h, except that serum IL-1β was decreased by 45.52% through the device at 0h. Conclusions CPFA was superior to HVHF in lowering pro-inflammatory mediators and increasing the ratios of anti-inflammatory mediators / pro-inflammatory mediators. Our findings suggest a potential role of CPFA in the treatment of MODS.
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    Bone mineral density at different sites and its correlation to vascular calcification in chronic kidney disease patients
    WANG Mi;WANG Mei
    2009, 8 (2):  76-79. 
    Abstract ( 515 )   HTML ( 0 )   PDF (260KB) ( 198 )  
    【Abstract】 Object To study bone mineral density at different sites and its correlation to vascular calcification in chronic kidney disease (CKD) patients without dialysis treatment. Methods Bone mineral density (BMD) was measured with dual-energy X-ray absorptionmeter. Vascular calcification was quantitatively evaluated by plain radiographic film from abdomen, pelvis and hands. Biochemical parameters and serum intact parathyroid hormone (iPTH) were assayed. Results (a) In CKD patients at stage 5 without dialysis treatment, the BMD at femora and distal radiuses was lower than that in the patients at stages 3 and 4 and in normal controls (P<0.05), and the BMD at lumbar vertebrates was lower than that in patients at stage 3 and in the normal controls (P<0.05). In CKD patients at stages 3 and 4, the BMD at these sites had no significant differences as compared with that of the normal controls. (b) The prevalence of lower BMD at femora and osteoporosis at radiuses was higher in the CKD patients at stage 5 than in those at stage 3 and in normal controls (P<0.05). (c) In the 100 CKD patients without dialysis treatment, 25 cases were found to have various degrees of vascular calcification at different sites. The BMD at lumbar vertebrates, femora and distal radiuses was significantly lower in the patients with vascular calcification than those without the calcification (P<0.05). Logistic regression analysis showed that the lower BMD at radiuses was the independent risk factor for vascular calcification. Conclusion The BMD at lumbar vertebrates, femora and radiuses was significantly decreased in CKD patients without dialysis treatment at stage 5, but not in the patients at stage 3 and stage 4. Patients with vascular calcification were found to have lower BMD. The BMD at radiuses had closer correlation to vascular calcification than that at other sites.
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    The relationship between serum brain natriuretic peptide and left ventricular remodeling in elderly patients treated with maintenance hemodialysis
    WU Bi-bo;ZHANG Li-ming;TANG Qi;YU Yong;HE Yun-lan;HAO Xiao-ping.
    2009, 8 (2):  80-83. 
    Abstract ( 566 )   HTML ( 0 )   PDF (251KB) ( 214 )  

    【Abstract】 Objective To investigate the correlation of serum levels of brain natriuretic peptide (BNP), interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and c-reactive protein (CRP) to left ventricular remodeling in elderly patients treated with maintenance hemodialysis (MHD). Methods We recruited 64 elderly MHD patients who had treated with hemodialysis for at least 3 months before the study and were in a stable clinic status without signs of infection or other active diseases. Serum BNP was assayed by chemiluminescence, and serum IL-1β, IL-6 and TNF-α were measured by enzyme-linked immunosorbent assay. Left atrial diameter (LAD), left ventricular end diastolic diameter (LVDd), left ventricular end systolic diameter (LVDs), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT) and left ventricular ejection fraction (LVEF) were evaluated by ultrasonic cardiography. Results In elderly MHD patients, the average serum BNP, IL-1β, IL-6, TNF-α and CRP were higher than those of normal control group (P<0.05 or <0.01), LAD, LVDd, IVST, LVPWT (P<0.05 or <0.01) and calculated left ventricular mass index (LVMI) (P<0.01) increased, and LVEF decreased (P<0.05). In these patients, serum BNP level was positively correlated with the levels of LAD, LVDd, IVST, LVPWT and LVMI (P<0.05 or <0.01), and the serum levels of CRP, IL-1β, IL-6, TNF-α and lipoprotein (a) (P<0.05 or <0.01). Serum BNP level was negatively correlated with the level of LVEF (P<0.05) and also with serum levels of albumin, total cholesterol and high-density lipoprotein cholesterol (HDL-C) (P<0.05 or <0.01). Conclusion Higher serum BNP was frequently seen in elderly MHD patients, and this increase was closely related with left ventricle remodeling.

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    Control of hypertension and factors relating to hypertension in maintenance hemodialysis patients
    WANG Lei;WANG Mei
    2009, 8 (2):  84-87. 
    Abstract ( 540 )   HTML ( 0 )   PDF (253KB) ( 272 )  
    【Abstract】 Objective To evaluate the prevalence of hypertension in maintenance hemodialysis (MHD) patients, and to analyze the clinical and biochemical variables relating to hypertension. Methods We retrospectively analyzed the characteristics of hypertension and tried to find out the causes leading to unsatisfactory control of hypertension in 108 MHD patients in authors’ hospital. We observed their blood pressure change after individualized anti-hypertension therapy for 6 months. We also monitored their clinical and biochemical variables, blood pressure and body weight after each dialysis session for 2 weeks. Result The prevalence of hypertension was 85.2% in this cohort of patients, of which 52.2% were systolic hypertension, 2.1% were diastolic hypertension, and 22.8% were systolic and diastolic hypertension. Logistic regression analyses indicated that the independent risk factors for systolic hypertension before dialysis were intradialysis weight gain (β=1.932, P=0.012), percentage of body weight gain (β=9.85, P=0.030), serum iPTH (β=0.005, P=0.002), and inadequate dialysis (β= -3.448, P=0.008). After the individualized therapy for 6 months, blood pressure returned to satisfactory level in 57.4% patients; intradialysis weight gain (2.90±0.92kg vs. 3.43±1.15kg), percentage of body weight gain (4.17±1.59% vs. 4.75±1.90%), and the daily dose of anti-hypertension drugs (3.55±1.31 vs 3.00±1.26) decreased significantly (P<0.05). Conclusion The independent risk factors for hypertension before dialysis in MHD patients were higher intradialysis body weight gain, inadequate dialysis, and increased serum parathyroid hormone. Therefore, the essential measures for hypertension control in MHD patients are reduction of intradialysis body weight gain and prevention of volume overload.
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    基础研究
    Effect of rosiglitazone on aquaporin-1 expression in human peritoneal mesothelial cells and human umbilical vein endothelial cells
    HUANG Cong-yang;ZHANG Xiao-juan;YAO Qiang;DAI Hui-li;NI Zhao-hui;QIAN Jia-lin..
    2009, 8 (2):  88-91. 
    Abstract ( 529 )   HTML ( 0 )   PDF (275KB) ( 191 )  
    【Abstract】Objective To study the effect of rosiglitazone (RGZ), a ligand of peroxisome proliferator-activated receptor γ (PPAR-γ), on the cell-proliferation and expression of aquaporin-1 mRNA in human peritoneal mesothelial cells (HPMCs) and human umbilical vein endothelial cells (HUVECs) in vitro. Methods Each kind of cells were divided into 4 groups: the control group, the RGZ group (10μM RGZ), the GW9662 group (GW9662, a PPAR-γ antagonist, 20μM) and the GW9662+RGZ group (cells were cultured for 1 h in the medium containing 20μM GW9662 and then in the medium containing 10μM RGZ). Cell-proliferation affected by RGZ was assayed by using a CCK-8 cell-counting kit. Aquaporin-1 mRNA in HPMCs and HUVECs was measured by quantitative real-time PCR. Results Proliferation of HPMCs was inhibited in the GW9662+RGZ group (P<0.01) as compared with that of the control group. The inhibition was not found in the RGZ group and the GW9662 group (P>0.05). However, proliferation of HUVECs presented in the 3 treated groups (P<0.01). RGZ up-regulated aquaporin-1 mRNA in HPMCs and HUVECs. Conclusion RGZ can up-regulate the expression of aquaporin-1 at the mRNA level, probably through the activation of the PPARγ pathway in HPMCs and HUVECs.
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