Chinese Journal of Blood Purification

08 October 2008, Volume 7 Issue 10 Previous Issue    Next Issue

论著

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Effect of high-flux hemodialysis on event-related potentials P300 in patients with maintenance hemodialysis WANG Jie;LI Xue-bin;LIN Xu 2008, 7 (10):  526-528.  Abstract ( 666 )   HTML ( 0 )   PDF (382KB) ( 194 )   Objective To explore high-flux hemodialysis (HFHD) on changes of event-related potentials P300, and the value of HFHD in improving cognition function in maintenance hemodialysis patients. Methods We treated 68 patients with end stage renal disease on maintenance hemodialysis and assigned them into 2 groups: high-flux hemodialysis group (n=38) and conventional hemodialysis group (CHD, n=30). The latency and amplitude of P300 were examined before treatment and after the treatment for one year. Results Before the treatment, the latency and amplitude of P300 were 398.6±38.5ms and 7.3±1.21μv, respectively, in HFHD group, and were 410.3±49.7ms and 6.9±1.03μv, respectively, in CHD group. No significant differences were found between the 2 groups (P>0.05). After the treatment, the latency and amplitude of P300 were 320.6±31.95ms and 8.5±1.02μv, respectively, in HFHD group, and were 390.6±42.8ms and 6.5±1.12μv, respectively, in CHD group. The differences between the 2 groups were statistically significant (P<0.01). Conclusions In maintenance hemodialysis patients using HFHD, changes of P300 latency and amplitude were significant, as compared with those using CHD. Therefore, HFHD may improve cognition function in maintenance hemodialysis patients. Metrics

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The modality of renal replacement therapy on serum lipid levels in uremic patients WANG Gang;LIU Wen-hu 2008, 7 (10):  529-533.  Abstract ( 967 )   HTML ( 0 )   PDF (359KB) ( 388 )   Objective To compare the renal replacement modalities of high permeable hemodialysis (HPD), conventional hemodialysis (CHD) and continuous ambulatory peritoneal dialysis (CAPD) on lipid metabolism in patients with end stage renal disease of non-diabetic causes. Methods Ninety patients with end stage renal disease were treated with maintenance renal replacement therapy of HPD (n=30), CHD (n=30) or CAPD (n=30) for 3 years. Serum lipids were measured every 3 months. Of the 10 cases changed from hemodialysis to CAPD and the 10 cases changed from CAPD to hemodialysis, we observed their alterations in serum lipids before the change and after the new renal replacement therapy for 1 year. Results At the beginning of the treatment, no significant differences in serum lipids were found among the 3 groups. In patients treated with HPD, serum total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL) and apolipoprotein B (Apo-B) decreased, and high-density lipoprotein (HDL) and apolipoprotein A (Apo-A) increased gradually after the treatment. However, in those treated with CHD and CAPD, TC, TG, LDL and Apo-B increased, HDL and Apo-A decreased gradually after the treatment, and the increase of TG was most remarkable (P<0.01). In the 10 patients first treated with CHD and then changed to CAPD for one year, TC and TG increased significantly (P<0.01). In contrast, in those first treated with CAPD and then changed to CHD for one year, no significant alterations in serum lipids were found, except the increase of Apo-B from 0.81±0.61 to 0.94.±0.35g/L (P<0.05). Conclusion The derangement of lipid metabolism in uremic patients was aggravated by CHD and especially by CAPD, but was improved by HPD. After renal replacement therapy for 3 years, the increase of TC and TG was higher in patients treated with CAPD than in those treated with CHD. Metrics

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The leverage of simvastatin on serum prohepcidin in patients with maintenance hemodialysis：A preliminary clinical study LI Xiang-yang;LI Jiu-hong;CHANG Ju-ping;ZHANG Jun;PENG Bo-shen;ZHU Sheng-lang;CHEN Jie-hui;JIANG Ying. Nephrology 2008, 7 (10):  534-537.  Abstract ( 683 )   HTML ( 0 )   PDF (356KB) ( 183 )   Objective To prospectively study the leverage of simvastatin on serum prohepcidin in maintenance hemodialysis (MHD) patients. Methods We assigned 26 MHD patients equally into experiment group and control group. Patients in the experiment group took 20mg simvastatin orally per night for 8 weeks, and those in the control group treated without statins and any other lipid modulating drugs. Before and after experiment, serum prohepcidin, plasma IL-6, and serum C-reactive protein (CRP), ferritin, hemoglobin, albumin, cholesterol, triglycerides, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) were determined. Results Of the 26 MHD patients before the experiment, serum prohepcidin was 173.6±52.7ng/ml. In the experiment group, serum prohepcidin was 156.7±51.9ng/ml before the treatment, and was 180.5±33.7ng/ml after the treatment for 8 weeks (P=0.127). In the control group, serum prohepcidin was 190.6±49.6ng/mL at the beginning, and was 193.5±36.0ng/ml after 8 weeks (P=0.728). In the experiment group after simvastatin treatment for 8 weeks, serum cholesterol and triglycerides decreased by 18.6% (P=0.004) and 55.1% (P= 0.007), respectively. In the 2 groups, plasma IL-6 and serum CRP, ferritin, hemoglobin, albumin, LDL and HDL remained unchanged. Conclusion Our preliminary study demonstrated that simvastatin 20mg per day did not change serum prohepcidin significantly in MHD patients. Metrics

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Dialysate of lower temperature on left ventricular function in intradialytic hypotension patients 2008, 7 (10):  538-541.  Abstract ( 668 )   HTML ( 0 )   PDF (337KB) ( 273 )   Objective This study evaluated the dialysate of lower temperature on regional left ventricular function in intradialytic hypotension patients. Methods To understand the development of dialysis-induced left ventricular regional wall motion abnormalities (RWMA), we randomly assigned 20 patients, who were at adequate dialysis for more than 6 months and showed repeated intradialytic hypotension episodes in recent months, to use dialysate for hemodialysis at the temperature of 370C (HD37) or 350C (HD35). During every dialysis, echocardiography was performed before dialysis, at the end of dialysis and after the dialysis for 30 minutes. Blood pressure and hemodynamic variables were monitored as well. Score of subjective feeling relating to the lower temperature was recorded. The treatment to the 2 groups of patients was switched every 2 weeks, i.e., patients treated with HD37 for 2 weeks were then switched to receive HD35 for 2 weeks, and vice versa. Routine blood examination and blood biochemistry were conducted before the dialysis and after the dialysis for 2 weeks. Result No differences in biochemical parameters were found between patients treated with HD37 and those with HD35. Patients treated with HD35 had higher mean blood pressure (P<0.001), less heart rate (P<0.001) and lower incidence of symptomatic or asymptomatic intradialytic hypotension (P<0.001), as compared with these variables in patients treated with HD37. Left ventricular short axis fractional shortening (P<0.001) and ejection fraction (P<0.001) were higher, the presence of RWMA was less (P<0.001), and the ratio of recovery from RWMA was greater (P<0.001) in patients using HD35 than those using HD37. The number of patients complaining of cold feeling was the same in patients treated with HD35 and in those with HD37 (P>0.05). Conclusion Our results show that dialysis-induced regional left ventricular dysfunction can be improved by using dialysate of lower temperature. Metrics

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The significance of serum fractalkine and TIMP-1 changes in maintenance hemodialysis patients WANG Ling;LIN Hong-li;ZHAO Guang-ben;QIAO Shi-yan;WANG Ke-ping;HANG Hong-dong;YU Chang-qing 2008, 7 (10):  542-545.  Abstract ( 735 )   HTML ( 0 )   PDF (370KB) ( 197 )   Objective To measure the changes of serum fractalkine (FKN) and tissue inhibitors of metalloproteinase-1 (TIMP-1) in maintenance hemodialysis (MHD) patients, and to discuss the relationship between inflammation and serum concentrations of FKN and TIMP-1. Methods We measured serum FKN and TIMP-1 by ELISA before and after hemodialysis in 30 MHD patients. Their serum high-sensitivity C-reactive protein (Hs-CRP) before hemodialysis was measured by immunonephelometry. Serum albumin (ALB), hemoglobin (HB), body mass index (BMI) and the dialysis adequacy marker Kt/V were also determined. BUN and serum creatinine (Scr) were assayed before and after hemodialysis. Results Serum FKN and TIMP-1 increased after hemodialysis (P<0.01, as compared with their respective values before hemodialysis). Before hemodialysis, their serum FKN and Hs-CRP were positively correlated (r=0.387, P<0.05), but their serum FKN did not correlated to serum TIMP-1 or to hemodialysis duration (P>0.05), nor did their serum TIMP-1 to Hs-CRP or to dialysis duration (P>0.05). The differences of serum FKN concentrations before and after hemodialysis were positively correlated to Hs-CRP (r= 0.291, P<0.05), but had no correlation with the differences of serum TIMP-1 concentrations before and after hemodialysis or to dialysis duration (P>0.05). The differences of serum TIMP-1 concentrations before and after hemodialysis were also positively correlated to Hs-CRP (r=0.226, P<0.05), and had no correlation with dialysis duration (P>0.05). Conclusion Serum FKN and TIMP-1 increase after hemodialysis in MHD patients. The instantaneous changes of serum FKN and TIMP-1 after hemodialysis may relate to the microinflammatory state. Metrics

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Clinical analysis of 1234 cases with mannitol-induced acute renal failure LIU Zhi-hui;YU Guo-qing;XIE Fu-an;CHEN Jian 2008, 7 (10):  546-548.  Abstract ( 644 )   HTML ( 0 )   PDF (346KB) ( 266 )   Objective To study the clinical characteristics, manifestations, mortality, lethal causes and prognosis of mannitol (MT)-induced acute renal failure (ARF). Methods We retrospectively analyzed the data of 1234 MT-induced ARF cases published in mainland China in 81 literatures during the period of 1980 to 2002. Results ① In 5981 cases treated with MT, the incidence of MT-induced ARF was 6.73%. The average age of MT-induced ARF cases was 60.85±10.38 years. In 76.19% of MT-induced ARF cases, the primary diseases were cerebral hemorrhage and cerebral infarction. ② In MT-induced ARF cases, the average daily dosage and cumulative dosage of MT were 253.82±42.46g and 1034.37±104.82g, respectively. ③ Oliguria was found in 80%, and hematuria in 50% of the patients. ④ The mortality rate of MT-induced ARF was 26.15%, and the main causes leading to death were multi-organ function failure (41.07%) and cerebral hernia (28.57%). ⑤ The mortality rate was 45.31% in patients treated with MT more than 200g daily, much higher than the rate of 10.87% in those used MT less than 200g daily. ⑥ The mortality rate was 17.01% in MT-induced ARF patients treated with dialysis. In contrast, the rate was 26.69% in those without dialysis. Conclusions ① Factors prone to MT-induced ARF are age of more than 60, cerebral hemorrhage and cerebral infarction. ② The principal manifestations of MT-induced ARF are oliguria and hematuria. ③ The mortality rate of MT-induced ARF was 26.15%, and multi-organ function failure and cerebral hernia are the two main causes leading to death. ④ The mortality rate increases in patients treated with mannitol more than 200g daily. Dialysis is useful in improving their prognosis. Metrics

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The reliability and validity of Kidney Disease Questionnaire (KDQ) on measuring life quality in patients on maintenance hemodialysis WANG Ying;LIN Ke-ke 2008, 7 (10):  549-551.  Abstract ( 1104 )   HTML ( 5 )   PDF (330KB) ( 453 )   Objective To explore the reliability and validity of Kidney Disease Questionnaire (KDQ) on measuring life quality in patients on maintenance hemodialysis. Method Convenient sampling was used. A total of 100 patients on maintenance hemodialysis from the Hemodialysis Center of People’s Hospital were tested. The self-designed questionnaire includes three parts, namely the demographical data, SF-36 short form, and KDQ. Data regarding life quality of the patients were calculated to assess the reliability and validity of KDQ. Results The test-retest reliability of KDQ was 0.706, and the split-half reliability was 0.821. Except for the subscale of physical symptoms, Cronbach’s a coefficient of subscales ranged from 0.508～0.852. The questionnaire also showed good construction validity and criterion-related validity. Conclusion KDQ can be served as a proper scale to measure life quality in patients on hemodialysis. Metrics

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Clinical experiences in peritoneal dialysis using different types of catheters ZHOU Yan;YU Yu-sheng; WANG Jin-quan;TANG Zheng;JI Da-xi;LI Lei-shi. 2008, 7 (10):  552-554.  Abstract ( 670 )   HTML ( 1 )   PDF (355KB) ( 283 )   Objective To investigate the clinical indication and complication of peritoneal dialysis using different types of dialysis catheters. Methodology Sixty-eight patients with end stage renal disease on peritoneal dialysis were divided into two groups. Twenty-eight patients used Tenckhoff-coil catheter were assigned in group 1, and 40 patients used swan-neck straight type catheter were in group 2. They were followed up for more than 6 months. Their in/out flow rate of dialysate, infection at tunnel and exit-site, catheter dislocation and dialysate leakage were observed. Results There were no differences in flow rate of dialysate drainage and infection rate at tunnel and exit-site between group 1 and group 2 (P>0.05). Tenckhoff-coil catheter was often replaced by swan-neck straight type catheter due to the higher dislocation rate associated with the former catheter (17.8% vs. 5%). Conclusion Catheter dislocation rate was lower in patients using swan-neck straight type catheter than in those using Tenckhoff-coil catheter. However, swan-neck straight type catheter was often associated with inadequate drainage or blockage. The drainage efficiency of swan-neck straight type catheter can be significantly improved after adjustment of the angle between outer segment of the tube and abdomen median line during insertion of the catheter. Metrics

基础研究

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Effects of sera from different dialysis modalities on TGF-β1 expression in human renal tubular epithelial cells TAO Jing-li;LIANG Zi-jie;LIU Hua-feng;MO Zhan-yu;LIU Hai-yan;CHEN Xiao-wen 2008, 7 (10):  555-557.  Abstract ( 667 )   HTML ( 0 )   PDF (401KB) ( 194 )   Objective To explore the effects of sera from different dialysis modalities on TGF-β1 expression in human renal tubular epithelial cells. Methods We randomly assigned 24 uremic patients into hemodialysis (HD), high-flux hemodialysis (HFHD) and hemodiafiltration (HDF) groups. Blood sample was collected from the patients before and after the dialysis. Diacetylmonoxime method was used to determine the ratio of urea nitrogen before and after the dialysis, from which Kt/V value was calculated and the adequacy of hemodialysis was estimated. HK-2 cells were cultured with the patient sera before and after dialysis. TGF-β1 mRNA in these cells was measured by RT-PCR, and TGF-β1 protein in cultured supernatant of HK-2 cells was determined by ELISA. Results The Kt/V values of the 3 blood purification methods exceeded 1.2, indicating the adequate hemodialysis. The sera after HDF showed less effects on TGF-β1 mRNA expression in HK-2 cells and less TGF-β1 secretion from the cells (P<0.05) than the sera before HDF. However, these changes were not found from sera before and after HD and HFHD (P>0.05). Conclusion HDF can effectively eliminate the uremic toxin inducing fibrosis-associated cytokine expression. Therefore, we presume that HDF is capable to efficiently postpone the interstitial fibrosis in kidney. Metrics