Chinese Journal of Blood Purification

12 August 2012, Volume 11 Issue 8 Previous Issue    Next Issue

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The divergence between policy and guidelines about the isolation and         administration of dialysis patients with positive hepatitis C virus         infection WANG Wen-jian, LIANG Xin-ling, SHI Wei 2012, 11 (8):  407-408.  Abstract ( 195 )   HTML ( 0 )   PDF (133KB) ( 238 )   Metrics

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The characteristics, prevention and treatment of hepatitis C virus infection          in hemodialysis patients CAO Ya-li, ZHANG You-kang 2012, 11 (8):  409-412.  Abstract ( 193 )   HTML ( 0 )   PDF (175KB) ( 253 )   Metrics

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Association between hepatitis C virus infection and coronary artery disease         in maintenance hemodialysis patients XIE Jian-teng, LI Zhi-lian, LIANG Xin-ling, WANG Wen-jian, LI Rui-zhao, LIANG Hua-ban, DONG Wei, SHI Wei 2012, 11 (8):  413-416.  doi: 10.3969/j.issn.1671-4091.2012.08.00 Abstract ( 305 )   HTML ( 11 )   【Abstract】Objective To investigate the association between hepatitis C virus (HCV) infection and coronary artery disease (CAD) in maintenance hemodialysis (MHD) patients.  Methods We did a cross-sectional survey in MHD patients according to the infection control screening data in July 2011. Patients were divided into two groups (HCV positive group, and HCV negative group). The prevalence of CAD was compared between the two groups, and logistic regression analysis was used to find out the possible risk factors.  Results Among 377 MHD patients, HCV positive patients accounted for 9.0% patients, and the prevalence of CAD was 23.9%. The prevalence of CAD was 41.2% in HCV positive group, whereas 22.8% in HCV negative group (P=0.013). Logistic regression analysis showed that age, hemoglobin and low density lipoprotein were associated with increased risk of CAD, indicating that HCV infection was not an independent risk factor for CAD.  Conclusion Our study did not demonstrate HCV infection as a risk factor for CAD. Whether HCV infection predicts CAD needs more prospective evidences. Metrics

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Analysis of virus hepatitis infection in maintenance hemodialysis patients LIU Qiang, YAO Li, LIU Xiao-dan, ZHU Xin-wang, GENG Ye, FENG Mao-ling, WANG Li-ning 2012, 11 (8):  417-420.  doi: 10.3969/j.issn.1671-4091.2012.08.00 Abstract ( 234 )   HTML ( 0 )   PDF (243KB) ( 155 )   【Abstract】 Objective To observe the prevalence of virus hepatitis infection in maintenance hemodialysis (MHD) patients, and to investigate the methods to prevent and control virus hepatitis infection in dialysis unit. Methods A total of 6 assays for the detection of antibodies for HCV and antibodies and antigens for hepatitis B were performed by chemiluminescence immunoassay method in 125 MHD patients on regular hemodialysis for more than one year (2009-2011). Clinical data were analyzed retrospectively. Results The incidence of HBV hepatitis and HCV hepatitis in MHD patients were 23.2% and 5.6%, respectively, without significant correlation of the incidences with age or gender (P＞0.05). For HBV infection, there was no difference in blood transfusion times between positive infection group and negative infection group (P＞0.05), but there was significant difference in hemodialysis age between positive infection group and negative infection group (60.1±25.7 months in the former group, and 43.0±25.3 months in the latter group, P＜0.01). For HCV infection, positive infection group and negative infection group showed significant differences in blood transfusion times (85.7% in the former group, and 15.7% in the latter group, P＜0.05) and hemodialysis age (65.9±35.9 months in the former group and 43.0±25.3 months in the latter group, P＜0.05). Conclusion MHD patients are at high risk to infection of hepatitis viruses. The incidence of HBV infection increases in MHD patients with longer hemodialysis age, but seems to be unrelated to blood transfusion times. The chance of HCV infection increases in patients with multiple blood transfusion and longer hemodialysis age. Strict isolation procedures must be carried out to prevent HBV and HCV cross-infection in dialysis unit. Metrics

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The correlation between the effect of losartan on left ventricular  hypertrophy and the status of inflammation and oxidative stress in maintenance hemodialysis patients 2012, 11 (8):  421-424.  doi: 10.3969/j.issn.1671-4091.2012.08.00 Abstract ( 228 )   HTML ( 0 )   PDF (210KB) ( 328 )   【Abstract】 Objective To study the effect of losartan on left ventricular hypertrophy (LVH) in maintenance hemodialysis (MHD) patients, and the correlation between the effect of losartan and the status of inflammation and oxidative stress. Methods MHD patients with LVH in our dialysis center were assigned into losartan group or placebo group. Patients took losartan 50～100 mg/d or placebo for 6 months．Left ventricular mass index (LVMI) was measured by echocardiography. Hs-CRP and MDA level were detected at the baseline, and after the treatment for 3 months and 6 months.  Results Compared the parameters at baseline condition, all parameters we tested decreased significantly after losartan treatment for 6 months, LVMI from 140.16±22.13 g/m2 to 125.21±19.39 g/m2 (F=5.13, P＜0.01), hs-CRP from 6.22±2.03 mg/L to 3.79±1.73 mg/L (F=6.14, P＜0.01), and MDA from 5.45±1.87 mol/L to 4.36±1.62 mol/L (F=5.47, P＜0.01). There was a correlation between the decrease magnitude of LVMI and the decrease magnitude of CRP or MAD (r= 0.805, t=2.91, P＜0.01 and r=0.778, t=2.72, P＜0.01, respectively). In placebo group, these parameters changed insignificantly. Conclusion Losartan is effective to reverse LVH. There is a the correlation between the effect of losartan and the status of inflammation and oxidative stress. Metrics

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The effect of lower sodium concentration in dialysate on arterial stiffness in hemodialysis patients SUN Fang, ZHOU Yi-lun, LIU Jing, MA Li-jie, SHEN Yang, HUANG Jing, CUI Tai-gen, Liu Miao-bing 2012, 11 (8):  425-428.  doi: 10.3969/j.issn.1671-4091.2012.08.00 Abstract ( 258 )   HTML ( 0 )   PDF (206KB) ( 164 )   【Abstract】 Objective Aortic stiffness, as evaluated by pulse wave velocity (PWV), is an independent predictor for all-cause mortality and cardiovascular mortality in hemodialysis (HD) patients. In general population, dietary salt loading increases PWV significantly, and lower sodium intake decreases PWV. In this study, we investigated whether the increase of sodium removal during dialysis by lower sodium concentration in dialysate could improve arterial stiffness in HD patients.  Methods A total of 16 stable HD patients without chronic volume overload were enrolled. After one month period of dialysis using routine dialysate (138 mmol/L sodium), patients were treated with dialysate of lower sodium concentration (136 mmol/L sodium) in HD for 4 months, without change of instructions about dietary sodium control. During the study period, dry weight was adjusted monthly with the help of bioimpedance spectroscope to maintain post-dialysis volume status in a steady state. PWV and 44-hour ambulatory blood pressure were measured. Results After the treatment for 4 months, PWV significantly decreased from 12.61±2.30 to 11.74±2.65 m/s (P=0.005). The 44-hour systolic and diastolic blood pressures were significantly lower than those at baseline (-10 mmHg and -6 mmHg, respectively), without change of post-dialysis volume parameters. Interdialytic weight gain decreased slightly from 2.89±0.66 to 2.67±0.63 kg (P=0.051). Conclusion Lower sodium concentration in dialysate improves arterial stiffness and blood pressure in HD patients.  Metrics

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Relationship between inflammation status and uremic pruritus in maintenance hemodialysis patients ZHANG Nan, LIAO Wen-hui, ZENG Rui, TONG Hui, LIU Shen-wei, LIU Xiao-cheng, XU Gang 2012, 11 (8):  429-432.  doi: 10.3969/j.issn.1671-4091.2012.08.00 Abstract ( 185 )   HTML ( 0 )   【Abstract】 Objective To investigate the correlation between inflammation status and uremic pruritus in maintenance hemodialysis (MHD) patients. Methods Thirty-nine MHD patients and twelve healthy controls were recruited to the study. We inquired of MHD patients about the severity of their pruritus by visual analog scale (VAS). Blood samples were taken before and after hemodialysis during the inquiry day. Inflammatory factors including interleukin (IL) -2, IL-6, IL-10, tumor necrosis factor (TNF) were measured by Cytometric Bead Array. Results Pre- and after-dialysis levels of IL-2, IL-6, IL-10 and TNF and pre-dialysis level of hsCRP were significantly higher in MHD patients than in healthy controls, and these levels had no significant correlation with age or sex. Spearman rank correlation analysis and linear regression analysis showed that pre-dialysis IL-2 level was positively correlated with VAS score (β=0.586, t=4.399, F=19.354, P＜0.01). Based on VAS score, MHD patients could be divided into 3 groups, no pruritus group (VAS=0.38%), mild to moderate pruritus group (VAS=1～5.41%), and severe pruritus group (VAS＞5.21%). Pre- and after-dialysis IL-2 levels were significantly higher in severe pruritus group than in no pruritus group. Conclusion A higher prevalence of uremic pruritus was found in MHD patients. Inflammation plays an important role in the pathogenesis of uremic pruritus. IL-2 closely relates to uremic pruritus in MHD patients. Metrics

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Investigation of various blood purification methods on the clearance of serum?-microglobulin and parathyroid hormone in maintenance hemodialysis patients 2012, 11 (8):  433-435.  doi: 10.3969/j.issn.1671-4091.2012.08.00 Abstract ( 219 )   HTML ( 0 )   PDF (206KB) ( 388 )   【Abstract】Objective To investigate the clearance effect of three blood purification methods on serum β2-microglobulin (β2-MG) and parathyroid hormone (PTH) levels in maintenance hemodialysis patients.  Methods A total of 54 patients on maintenance hemodialysis treated in our hospital during the period of May 2008 to September 2010 were recruited. They were randomly assigned into 3 groups, hemodialysis (HD) group (n=18), hemodiafihration (HDF) group (n=18), and hemoperfusion + hemodialysis (HD+HP) group (n=18). Blood samples were taken for the assays of serum β2-MG and PTH before and after the treatment.  Results Serum β2-MG and PTH levels decreased after the treatment in all 3 groups. Serum β2-MG and PTH levels decreased significantly in HP+HD group and HDF group after the treatment (t=12.47, P=0.0034 in HP+HD group; t=8.57, P=0.0082 in HDF group), but insignificantly in HD group (P＞0.05). The clearance effects of β2-MG and PTH were better in HP+HD and HDF groups than in HD group (t=10.19, P=0.0049 for β2-MG clearance; t=9.43, P=0.0071 for PTH clearance), but without significant differences between HP+HD group and HDF group (t=1.41, p=0.33). Conclusion Serum β2-MG and PTH can be cleared efficiently by HD+HP or HDF, but inefficiently by HD. Metrics

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Changes of thyroid function in patients with end stage renal disease ZHAO Lu-jie, LI Chao-lin 2012, 11 (8):  436-438.  doi: 10.3969/j.issn.1671-4091.2012.08.00 Abstract ( 212 )   HTML ( 1 )   PDF (188KB) ( 305 )   【Abstract】 Objective To investigate the changes of thyroid function in patients with end stage renal disease (ESRD) with or without dialysis. Methods Serum free-T3 (FT3), free-T4 (FT4) and thyrotropin (uTSH) concentrations were measured by electrochemiluminescence. These levels were compared in ESRD patients not on dialysis (n=42), those on hemodialysis (n=36), those on hemodialysis before and after hemodialysis sessions (n=12), and normal control subjects (n=30). Results (a) Compared with normal controls, serum levels of FT3 and FT4 were significantly lower (P＜0.05), and uTSH content was significantly higher (P＜0.01) in patients with ESRD. However, the differences of serum FT3 and FT4 levels were insignificant between ESRD patients on dialysis group and not on dialysis group (P＞0.05). (b) Serum FT3 and FT4 changed insignificantly in hemodialysis patients before and after hemodialysis sessions (P＞0.05). (c) The prevalence of hypothyroidism was higher in ESRD patients than in normal controls (P＜0.01), but the prevalence of hyperthyroidism was similar in ESRD patients and normal controls (P＞0.05).  Conclusion Thyroid dysfunction with hypothyroidism is frequently found in ESRD patients. Dialysis can not change this abnormality. Metrics

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The in vitro study on endotoxin transfer across dialyzers of different dialysis membrane and flux CHEN Huan, LIU Xin, CHEN Wei, YAN Yu,WANG Mei 2012, 11 (8):  439-442.  doi: 10.3969/j.issn.1671-4091.2012.08.00 Abstract ( 241 )   HTML ( 0 )   PDF (230KB) ( 282 )   【Abstract】Objective To assess the transfer of endotoxin across cellulose triacetate (CTA, low-flux) and polysulfone (high- or low-flux) membranes. Methods Three groups based on the dialyzer of different membrane and flux were used in this study. Experiments were carried out in saline-saline model. The dialysate was contaminated with purified lipopolysaccharide (LPS) (2EU/ml, 10EU/ml or 20EU/ml). Samples were drawn from blood side and dialysate outflow every 1 hour during dialysis process. Endotoxin level was detected by kinetic turbidimetric LAL method. We compared the decrease degree of endotoxin in dialysate among groups.  Results All blood side samples were LAL negative after 4-hour dialysis. Endotoxin concentration in dialysate decreased along with dialysis time, and F60S was significant faster than 130G in decrease degree of endotoxin in dialysate (59.99±13.68% vs. 83.37±9.14%, P=0.036).  Conclusion Within the limit of 20EU/ml in dialysate, no transfer of endotoxin was observed across high-/low- flux polysulfone and low-flux CTA dialyzers. Polysulfone high-flux dialyser has an advantage of endotoxin absorbility more than CTA low-flux dialyser. No significant difference was observed between high- and low-flux polysulfone dialysers. Metrics

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The study of continuous albumin circulating absorbent system as the treatment for critically ill patients with liver failure  ZHENG Shi-Xiang, ZOU Zhi-Qiang, WENG Qin-Yong 2012, 11 (8):  443-445.  Abstract ( 199 )   HTML ( 1 )   PDF (204KB) ( 178 )   【Abstract】 Objective To investigate the efficacy and safety of applying Continuous Albumin Circulating Absorbent System (CACAS) in treatment for critically ill patients with liver failure. Method Thirty critically ill patients with liver failure were treated with CACAS. Patients’ vital signs, liver function, coagulation changes were compared before and after the treatment, and after termination of the treatment for 12h. Results After the treatment, serum bilirubin level (485.46±34.85 μmol/L before treatment, and 305.89±43.54 μmol/L after treatment; P＜0.01), conjugated bilirubin (293.62±25.67 μmol/L before treatment, and 190.85±32.13 μmol/L after treatment; P＜0.01), unconjugated bilirubin (212.98±16.18 μmol/L before treatment, and 159.70±23.57 μmol/L after treatment; P＜0.01) decreased significantly, and prothrombin activity (42±8% before treatment, and 80±3% after treatment; P＜0.01) increased significantly. Consciousness turned to be clear in all patients. Changes of other indicators were insignificant. There were no significant changes of the parameters immediately after treatment and after termination of treatment for 12h. Conclusion CACAS system has ideal efficacy and safety when used in treatment for critically ill patients with liver failure, thus is a choice way of artificial liver as the treatment for liver failure. Metrics

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Compare Two methods without heparin during continuous renal replacement therapy iang Jing,Zeng Li,Ma Zhi-fang 2012, 11 (8):  455-456.  Abstract ( 194 )   HTML ( 1 )   PDF (164KB) ( 266 )   Metrics

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Serum calcium, phosphate, and iPTH levels of dialysis patients in Zhejiang Province Xu Chun-ping, Yu Bi-ying, Yang Yi, Zhang Ping, Chen Jiang-hua. 2012, 11 (8):  457-459.  doi: 10.3969/j.issn.1671-4091.2012.07.00 Abstract ( 180 )   HTML ( 0 )   PDF (177KB) ( 157 )   【Abstract】 Objective To analyze serum calcium, phosphate, and intact parathyroid hormone (iPTH) levels of dialysis patients in Zhejiang Province in 2011.  Methods We collected these data from hemodialysis and peritoneal dialysis patients in Zhejiang Province in 2011. We then analyzed the compliance rate of serum calcium, phosphorus, iPTH according to the Kidney Disease: Improving Global Outcomes (KDIGO) guideline standards. Results The compliance rate of serum calcium, phosphorus and iPTH was 58.1%, 27.2% and 56.3%, respectively, in hemodialysis patients, and was 71.1%, 44.2% and 65.6%, respectively, in peritoneal dialysis patients. Conclusion Serum calcium, phosphorus and iPTH should be carefully monitored and controlled in dialysis patients, especially in hemodialysis patients. Metrics