Chinese Journal of Blood Purification

12 July 2008, Volume 7 Issue 7 Previous Issue    Next Issue

专家笔谈

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Incompliance with doctor's advices in dialysis patients and its educational measures JIA Qiang 2008, 7 (7):  349-350.  Abstract ( 403 )   HTML ( 0 )   PDF (481KB) ( 285 )   Metrics

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Psychological problems in patients with end stage kidney diseases ZHU Bin;LIU Zi-dong 2008, 7 (7):  351-353.  Abstract ( 466 )   HTML ( 0 )   PDF (486KB) ( 291 )   Metrics

论著

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Daytime continuous veno-venous hemodiafiltration in the treatment of renal failure following cardiac surgery YU Lei;PAN Xiao-xue;GU Tian-xiang;SHI En-yi;FAN Qiu-ling;WANG Bo 2008, 7 (7):  354-356.  Abstract ( 689 )   HTML ( 0 )   PDF (588KB) ( 298 )   【Abstract】Objective To summarize the experiences about daytime continuous veno-venous hemodiafiltration (CVVHDF) as a post-operational treatment for renal dysfunction following cardiac surgery. Methods During the period from Feb. 2002 to Mar. 2008, a total of 12 patients with renal dysfunction following cardiac surgery underwent daytime CVVHDF. We observed their changes in heart rate (HR), central vein pressure (CVP), mean artery blood pressure (MAP), PaO2, renal function, pressor medication used, perioperative manifestations and prognosis after the treatment. Results In the 12 patients, 8 cases underwent on-pump coronary artery bypass grafting (CABG), 2 cases received off-pump CABG, and 2 cases underwent on-pump valve replacement. Daytime CVVHDF was performed for the 12 patients, and the dialysis lasted for 8～12 hours. After the first dialysis for 6 hours, HR, CVP, creatinine, BUN and dopamine used decreased significantly (P<0.05, as compared with those before dialysis), and MAP and PaO2 increased (P<0.05, as compared with those before dialysis). Two cases died in the perioperative period, 7 patients discharged from the hospital with renal function and urine volume recovering to the preopeartive levels and without the dialysis anymore, and the other 3 patients still needed regular dialysis treatment. The mean follow-up period was 36.90+29.06 months, and their life quality improved remarkably. Conclusion Daytime CVVHDF is an effective measure in the treatment of renal dysfunction following cardiac surgery. Metrics

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Analysis of psychological factors in patients with uremic encephalopathy DENG Ying-hui;JIA Qiang 2008, 7 (7):  357-360.  Abstract ( 1131 )   HTML ( 2 )   PDF (598KB) ( 347 )   【Abstract】 Objective To evaluate psychological factors in the pathogenesis of uremic encephalopathy. Methods We recruited 23 chronic kidney disease patients with uremic encephalopathy (CKD at 5th stage) as the illness group (group A), and 23 CKD patients without uremic encephalopathy as the control group (group B). Their psychological problems were evaluated by using the symptom checklist 90 (SCL-90), self-rating depression scale (SDS) and self-rating anxiousness scale (SAS) before the presence of uremic encephalopathy. Results The illness group had significant higher scores of SCL-90 in global indices and every symptom scales, SDS and SAS evaluations (P＜0.01 or P＜0.05, as compared with those of the control group). Patients in the illness group had higher positive rates in SCL-90 scores of global indices and symptom scales of somatization, obsession, interpersonal sensitivity, depression, anxiety and phobia, as well as higher scores of SDS and SAS (OR 3.56～7.39; P＜0.01 or P＜0.05, as compared with those of the control group). Conclusion Negative emotional changes such as depression and anxiety may be the risk factors for the presence of uremic encephalopathy in CKD patients Metrics

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Investigation and analysis of cardiovascular complications in maintenance hemodialysis patients in Henan province WANG Kai;ZHAO Xian-guo;LI Su-zhen;YAN Guo-sheng;WANG Xin-fang;ZHANG Hong-tao;ZHANG Bei-hao 2008, 7 (7):  361-362.  Abstract ( 697 )   HTML ( 0 )   PDF (642KB) ( 273 )   【Abstract】Objective To investigate and analyze the morbidity rates and factors relating to cardiovascular complications in maintenance hemodialysis patients in Henan province. Methods We collected 3278 maintenance hemodialysis patients from 17 cities in Henan province within the period from June 2006 to December 2007. We investigated and analyzed ① their general clinical data and hemodialysis parameters, ② the incidence of cardiovascular complications including left ventricular hypertrophy, heart muscle ischemia and congestive heart failure, and ③ the factors possibly relating to cardiovascular complications including renal anemia, hypertension and insufficient dialysis. Results In these patients, the incidence of left ventricular hypertrophy was 58.49%, and that of heart muscle ischemia 39.82%, congestive heart failure 29.61%, arrhythmia 22.58%, coronary artery disease 18.43%, and hydropericardium 17.54%. The incidence of cardiovascular complications was significantly higher in patients with renal anemia, hypertension and insufficient dialysis than those without anemia and hypertension and with adequate dialysis. Conclusion The morbidity rate of cardiovascular complications was high in maintenance hemodialysis patients in Henan province. Renal anemia, hypertension and insufficient dialysis were the important risk factors for the complication of cardiovascular diseases. Therefore, prevention and management of cardiovascular complications and their related factors are important measures in improving their living quality. Metrics

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Application of high frequency color Doppler to arteriovenous fistula operation for hemodialysis in uremic patients LI Chen;ZHANG Hong;YANG Demin;WANG Yong;YANG Yuhui;SU Rong 2008, 7 (7):  363-365.  Abstract ( 731 )   HTML ( 0 )   PDF (618KB) ( 316 )   【Abstract】 Objective To study high frequency color Doppler in the selection and localization of the vessels suitable for internal arteriovenous fistula operation. Methods We recruited 68 uremic patients who needed the operation of internal arteriovenous fistula, and assigned them randomly into two groups. The target vessels for internal arteriovenous fistula operation were selected and localized by high frequency color Doppler in group A patients and by the routine method in group B patients. After one month of the operation, function and maturation of the internal fistula were evaluated by high frequency color Doppler examination. Results In group A, the cephalic vein and radial artery in the forearm at non-preference side could be matched for fistula operation in 30 of the 36 cases (83.3%). In comparison with group B, patients in group A had smaller incision, less operation time, higher maturation rate for use after operation for one month and less thrombosis in the earlier period (p<0.05). Conclusion High frequency color Doppler examination is a useful method for the selection of vessels for internal arteriovenous fistula operation for hemodialysis in uremic patients. Metrics

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The influence factors to the selection of dialysis method in patients with end stage renal disease QIAO Jie;LAI Xiao-bin;LU Li-xia;LI Yue-hong;ZHAO Hui-ping 2008, 7 (7):  366-369.  Abstract ( 720 )   HTML ( 1 )   PDF (621KB) ( 280 )   【Abstract】 Objective For the carrying out educational program to patients with end stage renal disease (ESRD) before dialysis, we retrospectively reviewed the selection of dialysis method at the beginning of dialysis in ESRD patients, and investigated the factors relating to the selection of dialysis method in these patients. Method We recruited 60 patients who received hemodialysis (HD) or peritoneal dialysis (PD) for 6~18 months, and retrospectively studied their primary diseases, the reason for dialysis, emergent dialysis treatment, final decision of the dialysis method, the person making decision to the dialysis method, and their knowledge about his/her dialysis. Results (a) Forty of the 60 patients (66.7%) had received emergent dialysis. Patients without emergent dialysis had higher knowledge scores about dialysis than those with emergent dialysis. (b) Emergent dialysis was more frequently encountered in the patients finally selecting HD as the treatment method than in those selected PD as the final method. (c) The decision of dialysis method was made by patients themselves in 43.3% patients, by physicians in 36.7% patients, and by physicians as well as their families in 20% patients. The patients selecting dialysis by themselves had higher scores about dialysis knowledge and higher scores about active acquisition of the information. Conclusion The factors relating to the selection of dialysis method are patients’ knowledge about dialysis, their attitude towards acquisition of dialysis information, and their emergent dialysis experiences. Metrics

基础研究

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Advanced oxidation protein products induce human peritoneal mesothelial cells expressing transforming growth factor-beta 1 via the generation of reactive oxygen species CHEN Ji-lin;SHI Quan-ming;ZHAO Jiu-yang;ZHANG Yi-ling;ZHANG Li-hua;XU Mao-lan 2008, 7 (7):  370-374.  Abstract ( 749 )   HTML ( 0 )   PDF (714KB) ( 215 )   【Abstract】 Objective To investigate advanced oxidation protein products (AOPP) on the expression of transforming growth factor-β1 (TGF-β1) in human peritoneal mesothelial cells (HPMCS) in vitro, and the regulatory effect of endogenous reactive oxygen species (ROS) in this process. Method The model of AOPP-human serum albumin (HSA) was prepared in vitro. TGF-β1 in cultured primary HPMCS was measured by ELISA, TGF-β1 mRNA was determined by RT-PCR, and intracellular ROS was assessed by flow cytometry. Result AOPP-HSA induced the secretion and gene expression of TGF-β1 and the increase of intracellular ROS production in cultured HPMCs in a time- and dose-dependent manner (P＜0.01). Pretreatment of HPMCs with antioxidant vitamin E and N-acetyl-cyteine inhibited the AOPP-induced ROS production and the secretion and gene expression of TGF-β1 in the cells in a dose-dependent manner (P＜0.01). Cells treated with 50μmol/L vitamin E and 10mmol/L N-acetyl-cyteine exhibited the strongest inhibition. Conclusion AOPP induces the expression of TGF-β1 in HPMCs in vitro, which may be mediated, at least partially, by the ROS-dependent cell signaling pathway. Vitamin E and N-acetyl-cyteine significantly inhibit the secretion and gene expression of TGF-β1 via scavenging ROS in HPMCs. The results of this study may provide a therapeutic strategy for the prevention of peritoneal fibrosis. Metrics

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Relationship between the polymorphisms of T149C and T950C in osteoprotegerin gene and the glucocorticoid-induced osteoporosis SUI Man-shu;NA Shi-ping;XIE Ru-juan;WANG Min-gao;MU Su-hong 2008, 7 (7):  375-379.  Abstract ( 680 )   HTML ( 0 )   PDF (645KB) ( 238 )   【Abstract】 Objective To investigate the effect of polymorphisms of T149C and T950C in the promoter region of osteoprotegerin (OPG) gene on bone mineral density (BMD) in patients treated with glucocorticoids. Methods We determined T149C and T950C polymorphisms in the promoter region of OPG gene by PCR-RFLP in 208 healthy individuals (group 1) and 272 patients treated with large doses of glucocorticoids (group 2). BMD at lumbar spine, femoral neck, trochanter and Ward’s triangle were measured by dual-energy X-ray absorptiometry (DEXA). Several markers relating to bone turnover were also assayed. Results Hardy-Weinberg equilibrium was evident to the two polymorphisms. T149C genotypes in group 1 were TT (81.75%), TC (16.67%) and CC (1.58%), and those in group 2 were TT (82.61%), TC (15.94%) and CC (1.45%). There is no significant difference in the distribution of T149C genotypes between the two groups (P>0.05). T950C genotypes in group 1 were TT (26.98%), TC (48.41%) and CC (24.61%), those in group 2 were TT (27.54%), TC (48.55%) and CC (23.91%). There is also no significant difference in the distribution of T950C genotypes between the two groups (p>0.05). In group 2, however, BMD at femoral neck area was 0.91 + 0.06 g/cm2 and 0.87 + 0.08g/cm2 in patients carrying TT and TC+CC of the T149C genotype, respectively (P<0.05 by ANOVA). This difference is still significant after adjustment by age and body weight index. In group 2, the correlation of T950C genotypes to the magnitude of BMD at all areas was CC＞TC＞TT, but this correlation is statistically insignificant (P>0.05). In group I, no correlation of the genotypes T149C and T950C to the magnitude of BMD was observed. Conclusions There are no differences in the distribution of T149C and T950C genotypes in OPG gene between the two groups. Therefore, these two polymorphisms may not be related to the pathogenesis of glomerulonephritis. The polymorphism T149C may relate to the BMD at femoral neck in patients treated with glucocorticoids, in which allele T may be the protection factor of bone mass and may involve in the loss of bone mass by glucocorticoids. The polymorphism T950C may have no effects on BMD at all areas, and may not involve in the loss of bone mass by glucocorticoids. Metrics

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Experimental study on adsorption of paraquat by hemoperfusion adsorbents ZHANG Xiu-min;HUANG Li-gang;GUO Jian-qin;SUN Xiao-peng 2008, 7 (7):  380-382.  Abstract ( 695 )   HTML ( 0 )   PDF (624KB) ( 302 )   【Abstract】 Objective To study the adsorption of paraquat by different hemoperfusion adsorbents. Methods We added 0.5% paraquat solution 200 ml, 100ml, 50ml and 0.01% paraquat solution 200 ml in the extracorporeal circulation system for adsorption for 2 hours, observed the change of paraquat concentration, and calculated the adsorption rate of paraquat by activated carbon and macroporous resin. Results when paraquat concentration was 0.5% and the circulation volume was 200ml, the adsorption rate of parquet by activated carbon and resin was 46% and 35%, respectively. With the decrease of circulation volume, the adsorption rate was increased. When the paraquat concentration was 0.01% and the circulation volume was 200ml，the adsorption rate by activated carbon and macroporous resin was 95% and 87%, respectively. Conclusion At any paraquat concentrations, the adsorption rate of activated carbon is higher than that of macroporous resin but without statistical significance. Clinically, either charcoal kidney or resin adsorption column can be used for the clearance of paraquat by hemoperfusion therapy. Metrics