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Chinese Journal of Blood Purification

    12 September 2008, Volume 7 Issue 9 Previous Issue    Next Issue
    论著
    A lower normalized protein catabolic rate is associated with increased mortality in peritoneal dialysis patients
    YU Zan-zhe;NI Zhao-hui;LIN Ai-wu;FANG Wei;CAO Li-ou;GU Leyi;GU Ai-ping;PANG Hui-hua;QIAN Jia-qi
    2008, 7 (9):  468-470. 
    Abstract ( 768 )   HTML ( 0 )   PDF (588KB) ( 389 )  
    Objective Malnutrition is closely related to the outcome of peritoneal dialysis patient. In the clinically stable patient, nPCR provides a valid estimate of protein intake. The present research was to evaluate the influence factors of nPCR and examine its predictive power of clinical outcomes in peritoneal dialysis patients. Methods A prospective observational cohort study was performed in 86 clinically stable peritoneal dialysis patients followed-up in hemodialysis center. The routine biochemical tests including albumin, prealbumin, glucose, lipid, calcium and phosphorus, and the levels of C-reaction protein (CRP) and interleukin-6 (IL-6) were estimated. The nPCR was calculated by Baxter PD Adquest, version 2.0 for Windows. The stepwise regression method was enrolled to estimate the independent parameters of nPCR. Patients were followed up for a mean±SD duration of (32±13) mo. Results The mean level of nPCR was 0.90·d)]. The level of nPCR was inversely related to age, and directly related to albumin and HDL. It was inversely related to the levels of CRP and IL-6. There were inverse correlations between nPCR and total Ccr, residual renal Ccr, total Kt/V and residual renal Kt/V. While the relationships between nPCR and peritoneal Ccr and peritoneal Kt/V were not significant. The multiple stepwise regression analysis showed the independent effect of total Kt/V on the level of nPCR. Patients in the lower tertiles of nPCR [<0.82g/(kg·d)] were in higher risk of subsequent mortality. Conclusion A lower nPCR is associated with increased mortality. Dialysis adequacy has independent effect on the level of nPCR.
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    Impact of angiotensin II receptor blocker Losartan on insulin resistance and serum adiponectin in continuous ambulatory peritoneal dialysis patients
    PAN Yu;JIN Hui-min
    2008, 7 (9):  471-474. 
    Abstract ( 729 )   HTML ( 0 )   PDF (580KB) ( 223 )  

    Objective To observe the impact of angiotensin II receptor blocker Losartan on insulin resistance and dialysis adequacy in continuous ambulatory peritoneal dialysis (CAPD) patients, and to evaluate the correlation of serum adiponectin (ADPN) to insulin resistance and dialysis adequacy. Method We recruited 25 CAPD patients treated in this hospital and randomly divided them into two groups: peritoneal dialysis (PD) group (N=12) and Losartan+PD group (N=13). Eight end stage renal disease (ESRD) patients without dialysis were used as the control group. The homeostasis model assessment-insulin resistance index (HOMA-IR), blood lipids, residual renal function and dialysis adequacy were evaluated at 0, 3 and 6 months after the treatment. Result In Losartan+PD group, HOMA-IR, triglyceride, cholesterol and low density lipoproteins (LDL) were decreased, whereas total Ccr, peritoneal Ccr, total Kt/V and peritoneal Kt/V were increased, as compared with those in PD group and control group. Serum ADPN was positively correlated to triglyceride, cholesterol and LDL, and negatively correlated to peritoneal Ccr and peritoneal Kt/V. Conclusions Losartan improves insulin resistance and dialysis adequacy, and decreases serum ADPN levels in CAPD patients. Serum ADPN positively correlates to triglyceride, cholesterol and LDL, and negatively correlates to peritoneal Ccr and peritoneal Kt/V.

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    Impact of malnutrition, inflammation and cardiovascular diseases on prognosis of elder peritoneal dialysis patients
    REN Hong;XIE Jing-yuan;LI Xiao;HUANG Xiao-ming;ZHANG Chun-yan;CHEN Nan
    2008, 7 (9):  475-479. 
    Abstract ( 1059 )   HTML ( 1 )   PDF (602KB) ( 472 )  

    Objective To investigate the impact of malnutrition, inflammation and cardiovascular diseases on the prognosis of elder peritoneal dialysis patients. Methods A cross-sectional study was performed in 50 clinically stable continuous ambulatory peritoneal dialysis (CAPD) patients. Their nutritional status, chronic inflammation and cardiovascular diseases were evaluated. They were divided into two age groups, group A (>65 years) and group B (<65 years). In group A, patients complicated with malnutrition, inflammation and cardiovascular diseases (arthrosclerosis) (MIA syndrome) were further assigned in group A1, and those without MIA syndrome in group A2. Patients were followed up for 12 months. Results During the 12-month follow-up period, 10 (20%) patients died, and 2 patients (4%) changed to hemodialysis. The follow-up was lost in 1 patient (2%), and CADP was continued in our hospital in 37 patients (74%). The mean survival rate was higher in group B than in group A. Malnutrition (SGA 2 to 3) was found in 64% patients, and C-reactive protein (CRP) higher than normal (8.2 mg/l) indicating inflammation status was detected in 32% patients. Cardiovascular diseases including chronic heart failure, coronary heart disease, cerebral infarction sequelae and peripheral vascular sclerosis were found in 58% patients. The prevalence of malnutrition was 75% in group A and 44.4% in group B, and that of cardiovascular diseases was 68.8% in group A and 38.9% in group B (P<0.05). Serum CRP was 7.6±15.2 mg/L in group A and 2.4±3.9mg/L in group B (P<0.01). MIA syndrome was identified in 22% patients, of whom all were in group A. The survival rate was lower in group A1 than in groups A2 and B (P<0.01), but was similar between group A2 and group B (P>0.05). Conclusion Malnutrition, inflammation and cardiovascular diseases were frequently seen in CAPD of elder patients. MIA syndrome was the principal factor leading to the lower survival rate in CAPD of elder patients than in CAPD of younger patients. Therefore, diagnosis and treatment of MIA syndrome, especially in CAPD of elder patients, should be emphasized.

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    The application of on-line urea clearance monitoring in hemodialysis
    CHENG Li-xin;QIN Wei-hua;CHEN Mei-pu;ZHU Wei-qiu;ZHUANG Li-hua;LI Hong-min
    2008, 7 (9):  480-482. 
    Abstract ( 734 )   HTML ( 0 )   PDF (575KB) ( 575 )  

    Objective To evaluate on-line clearance monitoring (OCM) of urea in the assessment of Kt/V during hemodialysis. Methods Kt/V values of 23 maintenance hemodialysis patients treated in this hospital were assessed by OCM and by single-pool urea kinetic model. The Kt/V values by the two methods were compared. The Kt/V values form the patients using the dialyzer for the first time and at the 7th time were also compared. Results In patients who used the dialyser for the first time, the Kt/V values were (1.25±0.16) by OCM and (1.37±0.23) by single-pool urea kinetic model (r=0.842, P <0. 001). In those who reused the dialyser at the 7th time, the Kt/V values were (1.23±0.15) by OCM and (1.31±0.17) by single-pool urea kinetic model (r=0.667, P<0.01). The Kt/V values from patients using the dialyzer for the first time and those from patients reusing it at the 7th time had no significant differences both by OCM (t=1.908,P>0.05) and by single-pool urea kinetic model (t=1.692,P>0.05). Conclusion Kt/V values by OCM are usually lower than those calculated from urea measurements. This difference has to be considered in application of the results to clinical practice. The dialyser reused for 7 cycles still has unchanged clearance ability to small molecule solutes.

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    Etiology and epidemiology investigation of hemodialysis patients in Henan province
    AN Guo-sheng;ZHAO Xian-guo;LI Su-zhen;WANG Kai;WANG Xin-fang;ZHANG Hong-tao;ZHANG Bei-hao
    2008, 7 (9):  483-484. 
    Abstract ( 710 )   HTML ( 1 )   PDF (620KB) ( 391 )  

    Objective To investigate the primary disease, age, sex, resident place of the patients with end stage renal disease (ESRD) treated with hemodialysis in Henan province. Methods During the period from September 2006 to December 2007, 3278 cases of ESRD were treated with hemodialysis in Henan province. A database was established containing their age, sex, resident place, time of primary disease being identified, pathological diagnosis, and time of ESRD being diagnosed. Results In the 3278 patients, the average age was 52.20±16.77 years old, and the male/female ratio was 1.19:1. The etiology of ESRD included chronic glomerulonephritis 37.19%, diabetic nephropathy 18.79%, hypertensive nephropathy 14.89%, unknown 14.19%, and others 14.94%. Conclusion In patients treated with hemodialysis in Henan province, male patients were more than female patients, and most patients were more than 45 years old. The major cause of ESRD with hemodialysis was chronic glomerulonephritis, followed by diabetic nephropathy and hypertensive nephropathy. Thus, treatment of primary diseases and prevention of ESRD are important topics in clinical practice.

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    基础研究
    Experimental study on optic nerve injury in rats with acute methanol intoxication
    TONG Zon-gwu;CHEN Jin;YANG Chong-meng;GAO Kun;SU Shao-ming;QIU Ming;GAO Xiu-fang;SUN Yang
    2008, 7 (9):  485-487. 
    Abstract ( 657 )   HTML ( 0 )   PDF (704KB) ( 336 )  

    Objective To study the time course and degree of optic nerve injury in rats with acute methanol intoxication. Methods Sprague-Dawley rats were fed methanol orally and sacrificed at different point of time after the gavage. Blood samples were taken for methanol concentration measurement, and optic nerves were removed for pathological examination. Results In rats taken methanol to the dose of LD50, significant optic nerve injury began after 2 hours. The injury progressed along with time and reached the peak after 4 hours. In rats taken methanol to the dose of LD0, optic nerve injury reached the peak after 8 hours. In both groups of rats, optic nerve injury persisted even though blood methanol concentration became lower after 24h, 48h and 72h of methanol administration. Conclusion Optic nerve injury occurs as early as half an hour after acute methanol intoxication. The injury degree is related to the dose and blood concentration of methanol. Optic nerve injury reaches the peak after the presence of the highest blood methanol concentration for 4 hours. Optic nerve injury persists even though blood methanol concentration goes down after the methanol administration.

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    汶川地震专题
    The clinical analysis on the post-traumatic acute kidney injury after the earthquake
    LIU Man-li;SHE Nin-lan;CHEN Min;WANG Ping
    2008, 7 (9):  507-509. 
    Abstract ( 658 )   HTML ( 0 )   PDF (582KB) ( 225 )  
    AbstractObjective Sumarize the clinical manifestation,treatment and resolution of the post-traumatic acute kidney injury(AKI). Methods 21 post-traumatic acute kidney injury patients(19 male,2 female) aged 10 to 85 (mean:55.8cases of crush syndrome,all patients were check for blood routine,urine routine,serum electrolytes (Na+﹑K+﹑Cl-﹑Ca2+﹑P3+﹑HCO3-), liver function,serum albumin,renal function,serum uric acid and arterial blood gas analysis. Results All patients had bony fracture and crush injury of various degree, the average hemoglobin, albumin, serum calcium and bicarbonate level of the patients were lower than normal,the average serum uric acid and phosphorus level were higher than normal,compared with patients without crash syndrome,patients with crash syndrome had elevated serum potassium, phosphorus and BUN level, the differences were statistically significant; 4 patients had decompression surgery,1 patient had amputation,1 patient had undergone hemodialysis (HD) and haemodiafiltration (HDF ), 5 patients had undergone continuous venous venous hemofiltration (CVVH).After treatment,12 patients had full recovery of their renal function,3 patients had partial recovery of renal function,4 patients had no recovery of renal function and been transferred to other facilities in other provinces to continue their treatment. 1 patient with no recovery of his renal function and continued his treatment in our hospital and 1 patient died. Conclusion The post-traumatic acute kidney injury after the earthquake is the sequel of various pathologic processes,early diagnose,timely and proper manage the local crush trauma and early initiating hemopurification is crucial for the success of the treatment.
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    Therapy of crush syndrome complicating acute renal failure after earthquake injury
    ZHANG Lin; GAN Xiao-Hui;DU Rong; LI Hong.
    2008, 7 (9):  510-511. 
    Abstract ( 745 )   HTML ( 0 )   PDF (570KB) ( 266 )  
    AbstractObjective To explore the treatment of crush syndrome complicating acute renal failure after earthquake injury. Methods A retrospective analysis was made on 23 clinical cases of crush syndrome complicating acute renal failure after 5.12 earthquake injury. Results Of 23 cases,1 died of acute pneumochysis; 17 hyperkalemia were rectified; 3 evolved diuresis stage following improved renal function; and clinical symptoms were improved in the other 19. 22 cases were conveied to many hospitals in other provinces after 7~10 days in our hospital. Conclusion It was effective that combined therapy (conventional hemodialysis, continuous renal replacement therapy and others)to treat crush syndrome complicating acute renal failure , and to assist patients overshoot oliguria stage.
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