Chinese Journal of Blood Purification

12 August 2008, Volume 7 Issue 8 Previous Issue    Next Issue

论著

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The effect of Valsartan on erythropoietin in the treatment of maintenance hemodialysis patients LIU Xue-mei;LIU Zi-dong;WANG li;LIU Xiao-hong;JING Yong-sheng;ZHU Bin;WANG Xiao-ping 2008, 7 (8):  407-409.  Abstract ( 698 )   HTML ( 0 )   PDF (624KB) ( 222 )   Objective To investigate Valsartan on the effect of erythropoietin (EPO) in the treatment of maintenance hemodialysis patients with anemia. Methods A total of 55 patients undergoing hemodialysis with stable clinical conditions and a hemoglobin level of 70-100g/L were enrolled in this study. They were assigned into 4 groups. Patients in groups A (n=20) and B (n=20) received EPO therapy, and those in groups C (n=8) and D (n=7) without the EPO therapy. In addition, patients in groups A and C were treated with Valsartan, and those in groups B and D with Amlodipine. Hb, hematocrit (Hct), and EPO levels were measured before and after the therapy. Results In groups A, B and D, no significant differences were found in the average Hb, Hct and EPO levels before and after the treatment for 6 months. In group C, however, Hb and EPO levels were significantly decreased after the treatment for 6 months. In group A, the decrease of Hb after the treatment was found in the 11 patients receiving higher dose of Valsartan. Conclusions Valsartan may cause the inhibition of endogenous EPO in hemodialysis patients. Lower dose of Valsartan does not alter the effect of exogenous EPO, but higher dose of Valsartan reduces the therapeutic effect of exogenous EPO in hemodialysis patients with anemia. Metrics

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The prediction of risk factors relating to the decline of residual renal function in peritoneal dialysis patients FENG Jing-xi CHENG Li-tao WANG Tao CHEN Bo-jun 2008, 7 (8):  410-413.  Abstract ( 641 )   HTML ( 0 )   PDF (628KB) ( 244 )   Objective To predict the risk factors relating to the decline of residual renal function (RRF) in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods All patients with baseline urine volume exceeding 750ml/24h were included, and the primary outcome was defined as the occurrence of oliguria (urine volume ≤ 400ml/24h). A total of 76 CAPD patients were included in this study. We established regression models to analyze the relationship between the decline of RRF and the baseline indices of hemodynamics, blood biochemistry, dialysis adequacy, blood pressure and pulse wave velocity. Results The mean follow-up time was (10.32±1.73) months. Primary outcome occurred in 24 patients (31.6%), and their average period progressed to the primary outcome was (5.1±2.0) months. The 24 patients had lower GFR (P＜0.05), higher percentage of peritonitis (P＜0.05), higher serum creatinine (P＜0.005), and lower hemoglobin (P＜0.005), as compared with those of the patients without the primary outcome. Based on the results of multivariable Cox regression analysis, serum albumin (B=-0.118, P＜0.05), GFR (B=-0.371, P＜0.05) and systolic pressure (B=0.031, P＜0.01) contributed to the decline of RRF significantly. Conclusion In CAPD patients, normal serum albumin and GFR are the factors to protect RRF from decline, and the higher systolic pressure predicts rapid decline of RRF. Metrics

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Effect of low molecular weight heparin on blood lipids and dilatation function of vascular endothelia in hemodialysis patients 2008, 7 (8):  414-416.  Abstract ( 985 )   HTML ( 0 )   PDF (623KB) ( 236 )   Objective To investigate the effect of low molecular weight heparin on blood lipids and dilatation function of endothelial function in maintenance hemodialysis patients. Methods We recruited 38 pre-dialysis and uremic patients, and assigned them into two groups: unfractionated heparin group (UFH, n=18) and low molecular weight heparin (Fragmin) group (LMWH, n=20). Individualized dose of UFH or Fragmin was injected to the arterial route before dialysis. At the time before dialysis and after dialysis for 6 and 12 months, plasma lipids and lipoproteins were measured, and high-resolution ultrasound examination was performed to measure the baseline diameter and the endothelium-dependent flow-mediate dilation (FMD) of brachial artery. We also included 20 adults with normal serum lipids as the controls. Results Significant increase in serum triglycerides (TG), total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C) were observed in both groups before hemodialysis. In LMWH group after the dialysis for 12 months, serum TG was decreased, and serum high density lipoprotein cholesterol (HDL-C) and LDL-C remained unchanged as compared with those before dialysis. In UFH group, however, serum TG and LDL-C were elevated, and serum HDL-C was decreased. In the 2 groups, baseline diameter of brachial artery became larger, and the FMD of brachial artery was impaired. After the dialysis for 12 months, the FMD was much lower in UFH group than in LMWH group. Conclusion The long-term use of LMWH instead of conventional heparin during dialysis is beneficial to improve the abnormal serum lipid profiles, to stabilize vascular endothelial function, and to prevent the endothelial function from further injury in hemodialysis patients. Metrics

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Clinical observation of protein A immunoadsorption in treatment of myasthenia gravis WANG Ming-jun;LIAO Yun-hua;ZHOU Hong-wei 2008, 7 (8):  417-419.  Abstract ( 712 )   HTML ( 0 )   PDF (622KB) ( 369 )   Objective To evaluate the efficacy of protein A immunoadsorption on myasthenia gravis. Methods A total of 24 myasthenia gravis cases were divided into two groups: the treatment group (n=12) and the control group (n=12). Patients in both groups were treated with the traditional therapy, but those in the treatment group received protein A immunoadsoption 3 times per week for 4 weeks. Serum immunoglobulins of IgG, IgA and IgM, complements of C3 and C4, and antibodies against nicotinic acetylcholine receptor were determined before and after the treatment. The efficacy of protein A immunoadsorption on myasthenia gravis patients was evaluated by a scoring system based on physical examinations. Results The overall rate of effectiveness was 91.67% in the treatment group and 75% in the control group (p<0.05). The numbers of patients showing complete recovery, significant recovery, improvement, response and no response were 5, 2, 3, 1 and 1, respectively, in the treatment group, and were 2, 2, 2, 3 and 3, respectively, in the control group. Serum IgG, IgA and IgM and antibodies against the nicotinic acetylcholine receptor decreased more remarkably in the treatment group than in the control group (p＜0.01). Conclusions Protein A immunoadsorption significantly lowered serum IgG, IgA, IgM and antibodies against the nicotinic acetylcholine receptor, and shortened the disease course in myasthenia gravis patients. Therefore, it is an effective method and can be used in association with the traditional therapy for myasthenia gravis patients. Metrics

基础研究

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MMP-9 and TIMP-1 are associated with vascular medial calcification in uremic patients WANG Lu;LIN Hong-li;WANG Ke-ping;XIE Hua;HUANG Lin 2008, 7 (8):  420-423.  Abstract ( 1071 )   HTML ( 0 )   PDF (706KB) ( 273 )   Objective To study the relationship between the medial calcification of arteries and the expressions of matrix metallopeptidase 9 (MMP-9) and tissue inhibitor of metalloproteinase 1 (TIMP-1) in uremic patients. Methods Pieces of radial arteries were taken from 80 uremic patients at the time of arteriovenous fistula operation. The control radial arteries were taken from trauma patients with normal kidney function at the time of amputation operation. Vascular calcification was evaluated histomorphometrically on Von Kossa-stained sections, and the expressions of MMP-9, TIMP-1, osteopontin (OPN), collagen I, core binding factor a-1 (Cbfa-1) were determined immunohistochemically. Other related factors including serum calcium, phosphate, cholesterol, triglyceride (TG), low-density lipoproteins (LDL), albumin (ALB), hemoglobin, intact parathyroid hormone (iPTH) and C-reactive protein (CRP) were also detected. Results Vascular calcification was found in 36 uremic patients (45%), while no vascular calcification in the control group. Mild to moderate calcification was found in 25 uremic patients, and severe calcification in 11 cases. All of the radial arteries with calcification showed positive immunostaining of MMP-9, TIMP-1, OPN, collagen I and Cbfa1 (p<0.01). In some uremic radial arteries without morphologically obvious calcification, immunostaining of OPN and collagen I were also positive, but immunostaining of Cbfa1 was negative. Mean arterial blood pressure, serum phosphate, serum calcium-phosphate product, serum iPTH and CRP were significantly higher in uremic patients than in controls (p＜0.01), but body mass index, serum calcium, TG, total cholesterol, LDL and ALB had no differences between the two groups. Conclusion We have demonstrated, for the first time, that expressions of MMP-9 and TIMP-1 in arteries are correlated to vascular calcification in uremic patients. Our results suggest that the imbalance expression of MMP-9/TIMP-1 may cause, at least partially, vascular medial calcification in uremic patients. Metrics

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ffect of glucose degradation products on AQP1 and eNOS expression in cultured endothelial cells LIN Xing-hui;QIAN Jia-qi;NI Zhao-hui;Alessandro Amore;Rosanna Coppo 2008, 7 (8):  424-426.  Abstract ( 638 )   HTML ( 0 )   PDF (655KB) ( 211 )   Objective To analysis the effect of glucose degradation products (GDPs) on aquaporin-1(AQP1) and endothelial nitric oxide synthase (eNOS) expression in cultured endothelial cells. Methods Endothelial cell line (t End.1) was incubated for 24 hours with two relevant GDPs - methylglyoxal (MGly) or 2-furaldehyde (Fur) at the concentrations reported in traditional peritoneal dialysis fluid (Fur 0.8 μM; MGly 35 μM). AQP1 and eNOS gene expression was detected by reverse transcription-polymerase chain reaction (RT-PCR). AQP1 protein was detected by western blot. Moreover, the effect of GDPs on AQP1 gene expression was assayed in time- and dose-dependent manners. Results Fur and MGly at the concentrations reported in traditional peritoneal dialysis fluid (Fur 0.8μM; MGly 35μM) significantly up-regulated eNOS mRNA and tended to down-regulate AQP1 mRNA in cultured endothelial cells. Western blot revealed similar results. Conclusion GDPs stimulate eNOS expression in endothelial cells without up-regulating AQP1 expression. These effects may be involved in ultrafiltration failure in long run peritoneal dialysis. Metrics