Chinese Journal of Blood Purification

12 May 2008, Volume 7 Issue 5 Previous Issue    Next Issue

专家笔谈

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Recent advances in the diagnosis and management of vascular calcifica- tion in chronic kidney diseases FU Ping;TANG Wan-xin 2008, 7 (5):  233-235.  Abstract ( 335 )   HTML ( 0 )   PDF (490KB) ( 432 )   Metrics

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Prevention and treatment of cardiovascular diseases in dialysis patients HONG Da-qing;WANG Li 2008, 7 (5):  236-238.  Abstract ( 328 )   HTML ( 0 )   PDF (490KB) ( 260 )   Metrics

论著

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Low birth weight influences glomerular filtration rate: a meta analysis XU Rong;ZUO Li;WANG Hai-yan 2008, 7 (5):  243-247.  Abstract ( 1081 )   HTML ( 0 )   PDF (622KB) ( 190 )   【Abstract】 Objective To study the effect of low birth weight on glomerular filtration rate (GFR) in adulthood. Methods We searched the database PubMed for related literature by using the keywords birth weight, creatinine clearance, glomerular filtration rate and renal function. According to our study purposes, 7 clinical study reports were included and analyzed. Revman 4.2 was used for data analysis. Results GFR of individuals with a low birth weight was normal, however, their GFR was 4ml/min/1.73m2 lower than that of those with a normal birth weight. This finding is still evident after we exclude 2 studies measured in childhood. Conclusion GFR of adult individuals with a low birth weight is in the normal range, but is lower than that of those with a normal birth weight. Metrics

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The effects of ultrapure dialysate on serum inflammatory cytokines, C-reactive protein, ?-microglobulin and lipoprotein(a) in long-term hemodialysis patients TAO Jian-ling;SUN Yang;LI Xue-mei;LIU Shi-qin;XIA Jing-hua;SHI Tao;DUAN Lin;LI Yan;LI Xue-wang 2008, 7 (5):  248-251.  Abstract ( 693 )   HTML ( 0 )   PDF (609KB) ( 398 )   【Abstract】 Objective The aim was to observe the effects of ultrapure dialysate (UPD) on serum interleukin-6, interleukin-1 (IL-1), C-reactive protein, β2-microglobulin, and lipoprotein(a) [Lp(a)]. Methods A controlled prospective randomized study was carried out on 21 stable patients dialyzed on low-flux synthetic polysulphone membrane and assigned to either UPD or conventional dialysate (CD). Blood samples were collected at pre-dialysis, 120 minutes later during the dialysis and immediately post-dialysis. The variables were measured one week before the study, and one week, one month, six months and twelve months during the study. Results All parameters were not changed during the session. Lp(a) was significantly higher in CD group (283.88+145.80 vs 120.90+122.11mg/L, p <0.05), and IL-1βwas lower in UPD group (49.22+14.18 vs 68.05+20.34 pg/ml, p <0.05) at the end of study. Conclusions Biocompatible membrane is first of all to lessen dialysis related chronic inflammation, and ultrapure dialysate should further decrease the high risk of inflammation related atherosclerosis through decreasing IL-1β and preventing rise of Lp(a). Metrics

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Factors related to the higher serum fibroblast growth factor 23 in maintenance hemodialysis patients YANG Tao;CAI Mei-shun;WANG Mei;WEI Tao;WANG Yu-zhu;LI Xin;LIAN Li-chao 2008, 7 (5):  252-255.  Abstract ( 665 )   HTML ( 0 )   PDF (572KB) ( 190 )   【Abstract】 Objective We examined serum calcium, phosphate, intact parathyroid hormone and 1,25(OH)2-D3 as well as serum fibroblast growth factor 23 (FGF-23), and investigated whether these factors influence serum FGF-23 in maintenance (MHD) hemodialysis patients. Methods We recruited 98 MHD patients and 28 controls with normal renal function in this study. Their serum alkaline phosphatase, calcium, phosphate and intact parathyroid hormone were determined, and their serum 1,25(OH)2-D3 and FGF-23 were measured by ELISA. We then divided the MHD patients into 3 groups: hypophosphatemia group, normal serum phosphate group and hyperphosphatemia group. Results In MHD patients, serum 1,25(OH)2-D3 was lower than that of control group (P <0.001), but FGF-23 was significantly higher that of control group (P <0.001). Serum FGF-23 had no significant differences among hypophosphatemia group, normal serum phosphate group and hyperphosphatemia group (P = 0.804). Multiple linear regression analysis revealed that serum 1,25(OH)2-D3 was the factor that influences serum FGF-23 in MHD patients (r =0.481, P <0.001). Conclusions In MHD patients, serum FGF-23 increases significantly, and serum 1,25(OH)2-D3 is the factor relating to the increase of serum FGF-23. However, serum phosphate seems to have no impact on the increase of serum FGF-23 in MHD patients. Metrics

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Relationship between micro-inflammation and cardiovascular events in uremic patients undergoing hemodialysis HE Chao-sheng;SHI Wei;LIANG Xin-ling;ZHANG Bin;YE Zhi-ming;LIU Shuang-xin;MA Jian-chao;FENG Zhong-lin 2008, 7 (5):  256-259.  Abstract ( 608 )   HTML ( 0 )   PDF (580KB) ( 388 )   【Abstract】 Objective In uremic patients undergoing hemodialyis, higher serum high sensitive C-reactive protein (hs-CRP) indicates the presence of micro-inflammation status. Here we studied the micro-inflammation in relation to cardiovascular events and prognosis in these patients. Methods We retrospectively analyzed 178 uremic patients undergoing maintenance hemodialysis. Their serum hs-CRP, hemoglobin, albumin, lipids, urea nitrogen, creatinine, Kt/V and blood pressure were determined at the beginning of study. They were then assigned into high hs-CRP group (hs-CRP >3mg/L, n = 91) or normal hs-CRP group (hs-CRP <3mg/L, n = 87). Meanwhile, echocardiography was performed. Total mortality rate, cardiovascular mortality rate and frequency of cardiovascular events were recorded during the follow-up period. Results Echocardiographic studies showed that left atrial diameter (LAD), interventricular septal thickness (IVST), left ventricular diameter (LVD), and left ventricular mass index (LVMI) were higher in the high hs-CRP group (P <0.05), and the left ventricular ejection fraction (LVEF) was lower in the high hs-CRP group (P<0.05). Serum hs-CRP was positively correlated with LAD, IVST, LVD, LVMI (r＝0.298, r = 0.331, r = 0.321 and r = 0.342, respectively, P <0.05), and negatively correlated with LVEF (r = -0.343, P <0.01). Total mortality rate, cardiovascular mortality rate and frequency of cardiovascular events were higher in the high hs-CRP group than in the normal hs-CRP group (P <0.05). Conclusion In uremic patients undergoing maintenance hemodialysis, persistent increase of hs-CRP indicates the presence of micro-inflammation. The increase of serum hs-CRP is the independent risk factor for cardiovascular events, and is also one of the important issues for the prediction of prognosis. Metrics

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Clinical efficacy of continuous blood purification in the treatment of severe heart failure patients with renal failure 2008, 7 (5):  260-262.  Abstract ( 647 )   HTML ( 0 )   PDF (588KB) ( 261 )   【Abstract】 Objective To investigate the therapeutic value of continuous blood purification (CBP) in the treatment of severe heart failure patients with renal failure. Methods We retrospectively analyzed 19 cases of severe heart failure complicated with renal failure and treated in our intensive care unit during the period of June, 2003 through Sept., 2007. Blood pressure, heart rate, respiration rate, blood biochemistry, arterial blood gas, oxygenic index (PaO2/FiO2) and left ventricle ejection fraction (LVEF) were monitored before and during the treatment. Score of Boston criteria for diagnosing heart failure and APACHE II score were recorded. Results After CBP, heart function were significantly improved in 14 patients with an effective rate of 73.7%. Serum creatinine and blood urea nitrogen decreased quickly, and homeostasis was re-established. The oxygenic index improved gradually, and the score of Boston criteria for diagnosing heart failure and APACHE II score decreased significantly after the treatment. Their vital signs stabilized, and hypotension and arrhythmia were rarely encountered during CBP. Conclusions CBP maintains a stable hemodynamics situation during cleaning excess water and solute. Therefore, CBP is an effective and safe method for the treatment of severe heart failure with renal failure. Metrics

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The correlation of plasma total homocysteine concentration and intima-medial thickness of extracranial common carotid artery to the arterial-venous fistulae thrombosis in maintenance hemodialysis patients YI Yang;LU Jian-rao;TIAN Jun;YAO Jie-jie;LU Wen-juan;WU Li-qun;GU Bo;WANG Han-qing;ZHANG Jin-yuan 2008, 7 (5):  263-265.  Abstract ( 646 )   HTML ( 0 )   PDF (567KB) ( 256 )   【Abstract】 Objective To evaluate the relationship between plasma total homocysteine concentration (tHcy) and intima-medial thickness of extracranial common carotid artery (IMT), and their roles in arterial-venous fistulae thrombosis in maintenance hemodialysis (MHD) patients. Methods Based on the presence of arterial-venous fistulae thrombosis within 6 months, we assigned 120 MHD patients into arterial-venous fistulae thrombosis group (AVFT) or non-arterial-venous fistulae thrombosis group (NAVFT). IMT measurement using Phillips Iu22 Doppler Ultrasonics, and blood chemistry including plasma tHcy were assayed in all patients. Results In MHD patients, the frequency of hyperhomocysteinmia was 90%, which is 34.6 times higher than that in normal individuals (P <0.01). Plasma tHcy and the average IMT value were higher in AVFT group than in NAVFT group (P <0.01). The number of patients with plasma tHcy >40umol/L was more in AVFT group than in NAVFT group (P <0.05). Linear regression analysis showed a significant positive correlation between plasma tHcy and IMT (r =0.362, P <0.01). Conclusions Hyperhomocysteinmia presents frequently in MHD patients, and may be a risk factor for arterial-venous fistulae thrombosis in these patients. Metrics

基础研究

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Effect of ischemic postconditioning on expression of HIF-1α in the kidney after ischemia-reperfusion injury in rats LI Su-tong;WANG Hai-min;LI Man;LIU Guang-hou;HE Li-jie;CHEN Guang-lei;ZHANG Peng 2008, 7 (5):  266-269.  Abstract ( 729 )   HTML ( 0 )   PDF (665KB) ( 403 )   Objective To investigate the effect of ischemic postconditioning on HIF-1Methods Seventy-two Sprague-Dawley rats were randomized into 3 groups: sham operation group (S group), ischemia-reperfusion group (IR group) and ischemic postconditioning group (IPO group). For rats in S group, we ligated the right renal artery, and separated and exposed the left kidney for 45min. For those in IR group, we ligated the right renal artery, and clamped the left renal artery for 45min. For those in IPO group, we also ligated the right renal artery and clamped the left renal artery for 45min, but we then sequentially loosed the clamp for 20sce and closed the clamp for 20sec for 10 cycles before recovery of the left kidney from ischemia. After the operation for 0.5h, 1h, 3h, 6h, 12h, 24h, 48h and 72h, rats were sacrificed, plasma creatinine and blood urea nitrogen were measured, and kidney samples were examined for HIF-1Results HIF-1ase at 12h. In IPO group, renal HIF-1Conclusion Ischemic postconditioning increases HIF-1 Metrics

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The regulation effects of fibroblast growth factor on podocyte proliferation and expressions of bone morphogenetic protein-7 and cytoskeletal proteins in podocytes WANG Song;SHUI Chao-xiang;WANG Yao-yao;A La-ta;ZHANG Ai-hua;WANG Yue;WANG Tao;FAN Min-hua 2008, 7 (5):  270-274.  Abstract ( 519 )   HTML ( 0 )   PDF (697KB) ( 313 )   Objective To investigate the effect of fibroblast growth factor (bFGF) on podocyte proliferation and on expressions of bone morphogenetic protein-7 (BMP-7) and cytoskeletal proteins in podocytes. Method We employed a cell line of mouse podocytes immortalized with the simian virus 40 large tumor antigen gene, and examined the cell proliferation using colony-forming and MTT assays following treatment with various concentrations of bFGF. BMP-7, alpha-smooth muscle actin (e podocytes were detected by western blot. Methyl blue staining was used for the observation of cell morphology. Results After being treated with 1.25 to 20 ng/ml bFGF for 10 days, the podocytes showed significant increase of colony formation in a dose-dependent manner (r = 0.844). When bFGF in culture reached 20ng/ml, the number of colonies was 4.2 times higher than that of the controls. Similar results were obtained from MTT assay. On methyl blue staining, the colonies showed larger diameter and contained higher cell density after bFGF stimulation. A part of the cells also had vacuolation change. Western blot demonstrated that bFGF (1.25 to 20 ng/ml) treatment for 96 hours caused the decrease of BMP-7 in a dose-dependent manner, and that 20ng/ml bFGF stimulation resulted in the decrease of BMP-7 by >90%. bFGF treatment for 96 hours also inhibited Conclusion Our data suggest that bFGF induces podocyte proliferation and vacuolation, and down-regulates BMP-7 and Metrics