Chinese Journal of Blood Purification

12 June 2008, Volume 7 Issue 6 Previous Issue    Next Issue

专家笔谈

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More opinions on a sufficiency of hemodialysis<FONT face= <FONT face= 2008, 7 (6):  291-292.  Abstract ( 461 )   HTML ( 0 )   PDF (485KB) ( 501 )   Metrics

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Protection of residual renal function in peritoneal dialysis LIU Fu-you 2008, 7 (6):  293-295.  Abstract ( 458 )   HTML ( 0 )   PDF (464KB) ( 290 )   Metrics

论著

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Causes of discontinuing hemodialysis therapy in 125 patients with maintenance hemodialysis Xiao-ni;YU Long-li;GAO Ai-qin;ZOU Zuo-jun 2008, 7 (6):  296-299.  Abstract ( 1173 )   HTML ( 1 )   PDF (568KB) ( 334 )   【Abstract】 Objective To analyze the causes of discontinuing hemodialysis therapy and the factors relating to their survival rate and living quality in patients with maintenance hemodialyis. Methods We retrospectively analyzed 235 maintenance hemodialysis patients in this hospital during the period from Jan. 2002 through Jan. 2007. Results In these patients, 125 cases (53.19%) discontinued hemodialysis therapy, of which the main causes were death (38.40%), renal transplantation (21.60%) and economic problems (20.80%). The main cause of death was cerebrovascular diseases (31.25%), which were resulted from nephropathic hypertension in 80.0% of these death cases. The next cause of death was cardiovascular diseases (25.0%), which were the end stage of diabetic nephropathy in 75.0% of these death cases. The death cases had older age, and had deterioration of general condition and malignant tumors in more cases (P<0.01, as comparison with those of the living cases). In addition, patients died of cardiovascular diseases, serious infections and deterioration of general condition experienced shorter period of hemodialysis (P<0.05 and P<0.001). Conclusion In patients with maintenance hemodialysis, death and economic problems were the major causes leading to discontinuation of this therapy. Cerebrovascular diseases were the main cause of death. Hypertension, diabetes and older age were the factors relating to the higher mortality rate. Deterioration of general condition and malignant tumor often happened in elder cases. Appropriate dialysis method and dosage will improve their life expectation and living quality. Metrics

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Pulse pressure directly correlating with the stiffness of large arteries in maintenance hemodialysis patients GAN Liang-ying;WANG Mei;YANG Jing-hua;TAN Min;TAN Yi-yi;ZHANG Da-wei 2008, 7 (6):  300-302.  Abstract ( 1082 )   HTML ( 0 )   PDF (597KB) ( 289 )   【Abstract】 Objective Pulse pressure (PP) has been shown as a risk factor for mortality and cardiovascular events in maintenance hemodialysis (MHD) patients. However, the impact of clinical factors on PP and it correlation with pulse wave velocity (PWV) in these patients has not been sufficiently studied. The objective of this study was to investigate PP in MHD patients and it correlation with clinical factors. Methods Ninety MHD patients were enrolled, and 36 sex and age matched healthy people were used as controls. Demographic data were collected. Blood pressure and biochemical parameters were measured. Automatic PWV measuring system was applied to examine carotid-femoral PWV (CFPWV) as the parameter reflecting elasticity and stiffness of large central arteries. Backward multiple linear regression analysis was used to assess the influencing factors of PP. A value of P<0.05 was regarded as significant. Results PP, systolic blood pressure (SBP), mean arterial pressure (MAP) and CFPWV in MHD patients were greater than those in healthy controls (59.8+16.8 mmHg vs 47.5+14.7 mmHg; 140.9+20.4 mmHg vs 124.9+15.1 mmHg; 101.1+14.7 mmHg vs 93.3+10.5 mmHg and 13.22+3.23 m/s vs10.67+2.11 m/s, respectively, P<0.05). A backward multiple regression analysis demonstrated that age, diabetes mellitus and CFPWV were positively related to PP. The SBP, PP and CFPWV in diabetic MHD patients were significantly higher than those in non-diabetic MHD patients (P<0.05). Conclusions This study demonstrates that PP is elevated in MHD patients due to increased SBP. Age, DM and CFPWV are major determinants of PP. PP in MHD patients correlates significantly with CFPWV which is an aortic stiffness marker. Metrics

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Secondary peritonitis in patients treated with continuous ambulatory peritoneal dialysis ZHOU Fu-de;LIO We-nin;LI Chiu-leong;ZHANG Jian;GUO Wan-yi;WANG Hai-yan 2008, 7 (6):  302-306.  Abstract ( 1040 )   HTML ( 0 )   PDF (620KB) ( 397 )   Objective We investigated the clinical features of secondary peritonitis in patients receiving continuous peritoneal dialysis (CAPD) in order to improve its diagnosis and management. Methods We retrospectively analyzed the clinical data of secondary peritonitis complicated with CAPD in 3 cases, who were admitted to Division of Nephrology, CHCSJ Hospital of Macau between January and April 2003. We also recruited 8 CAPD related peritonitis patients, who were admitted at the same period. We then statistically analyzed their age, duration of CAPD and laboratory data in the two groups. Results In the 3 patients with secondary peritonitis, they were all females with the mean age of 75.3+5.5 years. They had no history of peritonitis before admission, and had been misdiagnosed as CAPD related peritonitis. Abdominal X-ray examination in 2 cases revealed free air in sub-diaphragm area and signs of intestinal obstruction. Surgical treatment was delayed for 3 to 28 days, and finally they were diagnosed as ileum perforation, ischemic necrosis of sigmoid colon, and strangulated incision hernia. Age, hemoglobin, WBC, serum albumin, C-reactive protein, and WBC count in effluent peritoneal dialysate on admission (D1) were similar between the two groups (P>0.05). Patients with secondary peritonitis had the following features as compared with those of CAPD related peritonitis patients: ①longer duration of CAPD (24.6+7.5 months vs 10.5+8.2 months, P =0.035), ② pink effluent peritoneal dialysate found in most cases at the early stage of secondary peritonitis,③ poor response to antibiotic therapy (P <0.05), and ④ higher mortality rate (67% vs 0). Conclusion Patients with secondary peritonitis have clinical features different from those with CPAD related peritonitis. Due to the higher misdiagnosis rate and mortality rate in CAPD patients with secondary peritonitis, differential diagnosis between secondary peritonitis and CAPD related peritonitis should be carefully made in CAPD patients with peritonitis manifestations. Metrics

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Oral supplementation of α ketoacid improves nutritional status in elderly dialysis patients TANG Zhi-huan;HAO jin;YU Qian;YUAN Wei-jie 2008, 7 (6):  307-310.  Abstract ( 935 )   HTML ( 0 )   PDF (632KB) ( 238 )   Objective There are only a few studies on the supplement of -ketoacid for the improvement of nutritional status in dialysis patients evaluated by the subjective methods. In this study, we used the objective parameters and the subjective nutritional assessment for the evaluation of -ketoacid to the nutrition status of dialysis patients. Methods Twelve hemodialysis patients and 12 CAPD patients, who were >60 years old with serum albumin <35g/L, received daily oral supplemental -ketoacid for 6 months. Their body mass index (BMI), serum albumin, pre-albumin, C-reactive protein, cholesterol and triglycerides, Kt/V, dietary protein intake (DPI) and dietary energy intake (DEI) were monitored. Meanwhile, we used the Subjective Global Assessment (SGA) and the Mini Nutritional Assessment (MNA) for the evaluation of nutritional status in these patients. Results ① In the malnutrition patients, the scores from SGA and MNA were lower, indicating the consistency between the two results from the objective and subjective methods. ② After the -ketoacid treatment, their appetite and serum albumin were improved. These effects began after 3 months, and further improvement was found after 6 months of the treatment. After the -ketoacid supplementation, DPI and DEI increased, and scores from SGA and MNA rose, suggesting the improvement of their nutritional status. Conclusion Oral supplemental -ketoacid significantly improves the low serum albumin and the overall nutritional status in elderly and malnutritional dialysis patients. Metrics

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The study of the effect of low calcium dialysate on cadiac function in CAPD patients BAO Jin-fang;LIU Jun;HAO jing;TANG Zhi-huan;YUAN Wei-jie 2008, 7 (6):  311-313.  Abstract ( 636 )   HTML ( 0 )   PDF (566KB) ( 261 )   Objective To investigate the effect of low calcium dialysate on cadiac function in CAPD patients. Methods Thirty-one CAPD patients were selected in this study.Standard calcium dialysate solution was changed to lower calcium dialysate solution.The cardiac function were echocardiographically examined at the beginning and the end of this study,respectively.The serum biochemical indicators and standed 12-lead electrocardiogram were examined at the beginning and the end of this study,respectively. 15 age- and sex-matched controls were also observed. Rusults After changing to PD4,secrum calcium concentration decreased, and PTH increased significantly.The changes in QTd、QTcd were not statistically significant.The changes in E/Amax、IRT were statistically significant.The change in serum calcium has negtive relation with the change in E/Amax and positive relation with the change in IRT. Conclusion There were favorable changes in left ventricular diastolic function after treatment with low calcium dialysate.The changes may be associated with the ameliorate of calcium phosphate metabolism and calcium overload. Metrics

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Analysis of insulin resistance in elderly patients with chronic renal failure HAO Li-jie;Cheng Bing-liang. 2008, 7 (6):  314-316.  Abstract ( 692 )   HTML ( 0 )   PDF (564KB) ( 288 )   Objective To investigate insulin resistance (IR) in elderly patients with chronic renal failure (CRF) and the correlation of IR with plasma albumin, leptin, cholesterol, triglycerides and creatinine (Scr), body mass index (BMI) and percentage of body fat. Methods We recruited 23 elderly patients with CRF and 28 healthy elderly people for this study. Plasma glucose, insulin, leptin, BUN, Scr, cholesterol and triglycerides were measured. The reciprocal value of fasting plasma glucose multiplied by insulin product was used as the insulin sensitivity index (ISI). Results ISI was significantly lower in elderly patients with CRF than in the elderly control subjects(-4.24+0.78 vs -3.81+0.47, taken from the values of natural logarithm, P<0.05). The mean plasma leptin was significantly higher in elderly CRF patients than in the elderly control subjects (P<0.01). There was a strong negative correlation of ISI with Scr, plasma leptin, BMI and percentage of body fat. Conclusions IR presents in elderly patients with CRF. IR may be related to the decreased renal function, leptin resistance, obesity and the decreased compensation ability of -cells to IR Metrics

基础研究

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he effect of phosphate on PTH release from parathyroid tissue and cultured cells in vitro YANG Bing;WANG Mei 2008, 7 (6):  317-320.  Abstract ( 981 )   HTML ( 0 )   PDF (618KB) ( 285 )   Objective To observe the levels of PTH secretion in primary cultured parathyroid cells and parathyroid tissues stimulated by high phosphate. Methods The parathyroid glands of 28 Wistar female rats were successfully resected by surgical operation under dissection microscope and were prepared for primary parathyroid cell culture and tissue culture. The cells and tissues were identified by histomorphology and PTH measurement and then cultured.Parathyroid tissues and cells were divided into 2 groups respectively as below: tissue groups：control group(TN，Pi 1.0mml/l，Ca 1.25mmol/l), experimental group (TH， Pi 3.5mmol/l，Ca 1.25mmol/l)；cell groups：control group（CN， Pi 1.0mml/l，Ca 1.25mmol/l）and experimental group（CH，Pi 3.5mmol/l，Ca 1.25mmol/l）.The medium was changed every two days. And the parathyroid hormone obtained from the supernatant for 0h,4h,12h,24h,48,72h,5d,7d,9d was measured. Results Parathyroid glands were identified by histomorphology and PTH measured. The PTH secretion curves of parathyroid cells and tissues incubated in normal phosphate and normal calcium medium were similar , and the peak time was 48h.Varing medium phosphate (1mM or 3.5mM) have no effect on PTH secretion (P＞0.05) in cell groups .But when PTG tissues were incubated in high phosphate medium, PTH levels could increase to 10-fold higher than baseline at 48h.There was a significant difference between group TH and group TN at the same time except H0 (P＜0.01).Conclusion High phosphate had a direct effect on PTH release from parathyroid tissue but not from dispersed parathyroid cells. Parathyroid tissues should be chosen to study the effect of phosphate on parathyroid function in vitro, and the time selected should be within 48h. Metrics

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Expression of ubiquitin-proteasome components in the aorta of rats with chronic renal failure FENG Bing;YANG Xu;ZHANG Yao-quan;YE Zi-lin;YUAN Fa-huan;YANG Hui-biao 2008, 7 (6):  321-324.  Abstract ( 671 )   HTML ( 0 )   PDF (611KB) ( 230 )   Objective To investigate the expression of ubiquitin-proteasome components in the aorta of rats with chronic renal failure. Methods The animal model was established by partial ligation of renal pedicle artery at one side and nephroectomy at the opposite side. Ub and E2 mRNA was surveyed by RT-PCR, Ub protein was detected by immunohistochemistry, and the amount of ubiquitinated protein was surveyed by western blot. Results In the aorta of rats with chronic renal failure, Ub mRNA increased significantly at fourth month (1.436+ 0.142) and at sixth month (1.480+0.124) after operation (P<0.01, as compared with those of the control group), E2 mRNA also increased significantly at fourth month (2.253+0.689) and at sixth month (2.002+0.383) after operation (P<0.01, as compared with those of the control group), and Ub protein increased to 8.20+1.15 at fourth month and 9.48+2.80 at sixth month (P<0.01, as compared with those of the control group). Conversely, the amount of ubiquitinated protein decreased significantly to 1.46+0.26 at fourth month and to 2.32+0.83 at sixth month (P<0.01, as compared with those of the control group). The mRNA and protein expression of Ub and E2 in the aorta were significantly inhibited by the treatment of a proteasome inhibitor MG-132, and as a result, ubiquitinated protein increased significantly in the aorta. Conclusion The ubiquitin-proteasome pathway is activated in the aorta of rats with chronic renal failure. Metrics

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Effects of norcantharidin on proliferation and fibronectin expression in HK-2 cells induced by albumin YE Kun;LIU Fu-you;LI Ying;PENG You-ming;DUAN Shao-wu;LIU Hong 2008, 7 (6):  325-328.  Abstract ( 680 )   HTML ( 0 )   PDF (636KB) ( 215 )   Objective To observe the effects of norcantharidin (NCTD) on proliferation and fibronectin (FN) expression in human renal proximal tubular epithelial cell line (HK-2) induced by albumin, and to investigate the mechanism of NCTD in the prevention of renal interstitial fibrosis. Methods Appropriate NCTD concentration which did not significantly injure HK-2 cells was determined by cytotoxicity test. HK-2 cells were divided into 5 groups: control group (1640 group), albumin group (1640 + albumin 5g/L), and NCTD 0.5 mg/L, 1mg/L and 2.5mg/L groups (1640 + albumin 5g/L + NCTD 0.5, 1 or 2.5mg/L). HK-2 cells were incubated with respective concentrations of NCTD and albumin for 24 hours. Proliferation of HK-2 cells was determined by MTT, and FN protein in culture media by enzyme-linked immunosorbent assay (ELISA). FN mRNA in HK-2 cells was analyzed by RT-PCR. Results ①Cytotoxicity test showed that there were no significant differences in lactate dehydrogenase (LDH) concentration among NCTD 0.5 mg/L，1.0 mg/L and 2.5 mg/L groups as well as control group (P>0.05); ② MTT score was higher in albumin group (0.438+0.073) than in 1640 group (0.330+0.060) (P<0.05), but MTT score decreased to 0.327+0.080 in NCTD 2.5mg/L group (P<0.05, as compared with that of albumin group); ③FN protein was down-regulated in NCTD 2.5mg/L group (P<0.01, as compared with that of albumin group), and FN mRNA significantly decreased in NCTD 1mg/L and 2.5mg/L groups (P<0.01, as compared with that of albumin group). Conclusion NCTD inhibits the albumin-induced cell proliferation and FN over-expression in HK-2 cells. Metrics