Chinese Journal of Blood Purification

12 January 2013, Volume 12 Issue 01 Previous Issue    Next Issue

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Effects of continuous blood purification in the treatment of rhabdomyolysis combined with acute renal failure after surgery for DeBakey I aortic dissection 2013, 12 (01):  8-11.  doi: 10.3969/j.issn.1671-4091.2013.01.00 Abstract ( 240 )   HTML ( 0 )   PDF (238KB) ( 249 )   【Abstract】Objective To study the effects and hemodynamics of continuous blood purification(CBP) in treatment of rhabdomyolysis induced by lower extremity ischemic injury combined with acute renal failure after surgery for DeBakey I acute aortic disscetion. Methods 8 patients who diagnosed as rhabdomyolysis after surgery of DeBakey I aortic disscetion were enrolled.Their features were serum creatine phosphokinase(CK) increased to more than 5 times of normal or more than 1000U per liter,myohemoglobin increased significantly,and acute renal failure occurred. CBP treatment of continuous venous-venous hemodiafiltration (CVVHDF) was performed in 8 patients.Hemodynamics improvement, oxygenation index(PaO2/FiO2),serum concentration of myohemoglobin,CK,creatine phosphokinase isoenzyme-MB(CK-MB) and lactate dehydrogenase(LDH) were detected before and 6 days,12 days after the treatment. Results After surgery,CK,CK-MB,LDH and myohemoglobin of 8 patients were increased significantly,in which 4 patients had obvious leg swelling, 3 patients underwent unilateral lower limb compartment incision.CBP started after surgery 22±12.6h, the average treatment time was 15 ± 5.2days, the average blood flow was 235 ± 143.9ml per hour.During treatment,one person was amputated and no mortality. Compared with before treatment , oxygenation index improved significantly (P <0.05), myohemoglobin, CK-MB, and LDH decreased significantly (P <0.05) after 6 days and 12 days of treatment. Hemodynamics were stable during the treatment and vasoactive drugs decreased,urine output increased significantly.Conclusions CBP was effective in the treatment of rhabdomyolysis combined with acute renal failure after surgery for aortic disscetion,which might related to removal of inflammatory mediators and excessive myohemoglobin, maintain balance of water, electrolyte and acid-base,control of volume overload,amiliated hemodynamics and prognosis of patients with aortic dissection. Metrics

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Establishment and preliminary evaluation of a prediction score system for the prognosis of acute kidney injury patients developed during hospitalization 2013, 12 (01):  12-16.  doi: 10.3969/j.issn.1671-4091.2013.01.00 Abstract ( 112 )   HTML ( 0 )   Abstract Objective: This study was designed to establish a clinical prediction score for the prognosis of acute kidney injury (AKI) in hospitalized patients. Methods: A total of 363 hospitalized patients were enrolled in Huashan hospital from January 2011 to March 2012. A prospective cohort study was performed on 261 patients of AKI in the development set, and 102 patients of AKI were selected for the validation set. Multivariate logistic regression analysis was applied to identify the risk factors of AKI and derivate a new prediction score based on the odds ratio . Thus the prediction curve for the mortality of AKI 90 days was established. The ROC curves and Hosmer-Lemeshow goodness-of-fit chi-squared test were used to assess the accuracy and efficacy of the scoring system. Results: (1)Five variables were identified as the independent risk factors of AKI: the total number of complications, vasopressor support (dopamine), mechanical ventilation, blood urea nitrogen(BUN) and serum prealbumin. (2) The total score was calculated for each patient. The incidence of AKI was 16.8%in the low-risk group(≤4 points), 48.0% in the moderate-risk groups(5-10 points), 76.0% in the high-risk group(11-16 points) and 100% in the very-high-risk group(17-30 points). The area under the ROC curve was 0.801(p<0.001). (3) Good discriminative power was found in the validation population, and the risk score was strongly correlated with AKI (χ2=4.149 , p=0.657). Conclusion: The scoring system could predict the mortality of hospital-acquired AKI patients accurately. Clinical application of this score may support decision making for protective kidney interventions and improve the prognosis of AKI patients in hospital. Metrics

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The value of AKICS score for the prediction of acute kidney injury after cardiac surgery in Chinese elderly patients  2013, 12 (01):  17-20.  doi: 10.3969/j.issn.1671-4091.2013.01.00 Abstract ( 130 )   HTML ( 0 )   【Abstract】 Objective The purpose of present study was to validate externally AKICS score for acute kidney injury (AKI) after cardiac surgery in Chinese elderly patients. Method We conducted a retrospective research in patients undergoing coronary artery bypass grafting surgery and (or) valve replacement at our center between January 1, 2007 and December 31, 2009. The primary outcome was AKI according to RIFLE criteria. The baseline serum creatinine was defined as the latest serum creatinine before surgery. For evaluation of the performance of model, the discrimination and calibration of AKICS score were measured in elderly patients undergoing surgery and patients who did not expose contrast media less than 7 days prior to surgery. Results Among 227 patients included in present study, 141 patients did not expose contrast media less than 7 days before surgery. The incidences of AKI between total elderly patients and patients who did not expose contrast media less than 7 days before surgery were 63.9% (145/227) and 66.7% (94/141), respectively. In total elderly patients, the discrimination of score using the area under the receiver operating characteristic (ROC) curve was 0.702 (95%CI 0.631-0.772); the calibration using Hosmer- Lemeshow goodness- of-fit test was 0.704. And in patients who did not expose contrast media less than 7 days before surgery, the area under ROC was 0.764 (95%CI 0.684-0.844) ; the calibration was 0.906. Conclusion AKICS score offers good performance, accurately predicting AKI according to RIFLE criteria, in elderly patients undergoing cardiac surgery. And this score is more suitable to be used in elderly patients who did not expose contrast media 7 days before cardiac surgery. Metrics

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Preliminary research on acute kidney injury after cardiac surgery in elderly people 2013, 12 (01):  21-24.  doi: 10.3969/j.issn.1671-4091.2013.01.00 Abstract ( 132 )   HTML ( 1 )   PDF (201KB) ( 132 )   【Abstract】Background The aim of the present study was to analyze the current situation of AKI after cardiac surgery of adults with different age to investigate the possibility of prophylaxis and treatment. Methods We prospectively collected data from patients who underwent cardiac surgery from April 2009 to May 2011 and analyze the incidence and risk factors of AKI after surgery and short-term clinical outcomes of different ages. Results 3896 patients were included. There were 3086 patients in young and middle-aged group(18~65), 772 patients in elderly group(65~80) and 38 patients in senile group(≥80). The male proportion, preoperative serum creatinine, NYHA III grade, preoperative diabetes mellitus, hypertension and coronary angiography, proportion of CABG surgery, proportion of use of adrenaline and noradrenaline for hypotension in elderly group were significantly higher than in young and middle-aged group(all P1.2mg/dl, post-operative use of adrenaline for hypotension were independent risk factors of AKI after cardiac surgery of people over 65years old. Conclusions The AKI incidence after cardiac surgery in elderly people was increased with age and with high mortality. The incidence of AKI was related to a number of perioperative risk factors. Elderly people that occurred AKI after cardiac surgery should also get positive treatment to improve outcomes. Metrics

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Calcium mass balance in maintenance hemodialysis patients treated by dialysate with different calcium concentration 2013, 12 (01):  25-29.  doi: 10.3969/j.issn.1671-4091.2013.01.00 Abstract ( 408 )   HTML ( 0 )   PDF (232KB) ( 258 )   Abstract Target To compare the differences on calcium mass balance in maintenance hemodialysis patients treated by dialysates with different calcium concentration. Methods In a single hemodialysis center, 20 maintenance hemodialysis patients were rolled into the study randomly. Different calcium dialysates, 1.50mmol/L and 1.75mmol/L, were used for 20 patients in standard hemodialysis treatment for three times, respectively. The calcium mass transfer (CMT) during one hemodialysis session by using different calcium dialysates were calculated respectively. The calcium intake of diet and calcium binder was recorded. The calcium absorption from intestine (CaAbs) and calcium mass balance during 48 hours (CMB48h) was calculated. The relationships among CMT, CMB48h and other parameters were tested. Results There were no significant differences on total calcium mass transfer (tCMT) , CaAbs, and CMB48h between two different calcium dialysate treatments, 3.44±8.58（mmol） vs. 7.43±10.97（mmol）, P=0.256, 145.6±92.1（mg） vs. 146.3±92.7（mg）, P=0.388, 268.2±364.9（mg）vs. 443.4±438.1（mg）, P=0.215, respectively. The correlated factors of tCMT were spent dialysate volume and ΔtCaF-S, B = -1.50 and 120.24, respectively, P<0.001. The tCMT was the only correlated factor of CMB48h, B = 39.51, P<0.001. Conclusions The calcium mass transfers from dialysate to blood during hemodialysis treatment by using 1.50mmol/L and 1.75mmol/L calcium dialysates. The differences on tCMT between the different calcium dialysates therapy were no significant. The tCMT was the important factor for CMB48h. The tCMT during hemodialysis were affected by ultrafiltration volume and the calcium concentration of dialysate. Metrics

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Hemodialysis-related muscle cramps is associated with endothelial dysfunction 2013, 12 (01):  30-32.  doi: 10.3969/j.issn.1671-4091.2013.01.00 Abstract ( 108 )   HTML ( 0 )   PDF (198KB) ( 121 )   Subjective The mechanism of muscle cramp in hemodialysis patients is not well understood. This study aimed to determine the association between endothelial dysfunction and hemodialysis-related muscle cramps. Methods: Ten hemodialysis patients with frequent muscle cramps(group A), twelve hemodialysis patients without muscle cramps(group B) were enrolled. The episodes of hemodialysis-related muscle cramps were recorded over a 2-month period. Flow-mediated dilatations were measured in the brachial arteryand plasma levels of vWF were measured on a mid-interdialysis day in second month of the period. Results: The incidence of symptomatic muscle cramps in group A was significnatly higher that in group B. Flow-mediated dilatations were lower significantly in group A, when comparing with group B. While, plasma vWF concentrations were significantly higher in group A. The frequents of hemodialysis-related cramps were associated with values of flow-mediated dilations and the concentrations of plasma vWF in group B. Conclusion: Endothelial dysfunction is associated with frequent hemodialysis-related cramps. Improving endothelial dysfuction may be helpful to reduce the incidence of hemodialysis-related cramps. Metrics

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Clinical Application of Continuous Blood Purification in Treatment of Severe Drug Eruption 2013, 12 (01):  33-36.  doi: 10.3969/j.issn.1671-4091.2013.01.00 Abstract ( 126 )   HTML ( 0 )   PDF (247KB) ( 154 )   [Abstract] Objective To study the clinical application of continuous blood purification (hemoperfusion and hemofiltration) in patients with severe drug eruption. Methods 66 patients with severe drug eruption were randomly divided into two groups, general treatment group （n=33） and blood purification group（n=33）. General treatment group was treated by normal treatment, while the blood purification group treated by early continuous blood purification treatment on the basis of normal treatment. Acute physiology and chronic health evaluationⅡ（APACHE II ）score of the two groups recorded on the first day before treatment and post-treatment 8th,15th day, and blood samples collected on the first day and the 8th,15th day after treatment for plasma contents of TNF-a,IL一6 ,and the plasma levels of hs-CRP were compared and analyzed. Observe and compare the improvement of the whole body skin rash condition between the two groups on the 8th day after treatment, and compare the complications and prognosis on the 28th day after treatment. Results After 8days of treatment, drug eruption were improved remarkably, the total efficiency rate of blood purification group was 87.87％,while the general treatment group was 54.54％, the difference was statistically(χ2=31.29,P<0．01). and APAPHEⅡ score after 8days and 15days were all decreased gradually, while the differences between two groups have obvious statistical significance (P<0.05); 8days after treatment ,blood purification group for plasma contents of TNF-a,IL一6 , and the plasma levels of hs-CRP determined were decreased significantly than that general treatment group（P<0．01）;the prognosis within 28 day, the occurrence of septic （χ2=12.16，P<0．01）and MODS（χ2= 7.58，P<0．01) ,and the morbidity of detection decreased obviously (χ2= 6.42，P﹤0．05) in the blood purification group compared with the general treatment group. Conclusion Patients with Severe Drug Eruption received treatment of continuous blood purification have better clinical effective, treatment of continuous blood purification can improve the prognosis of the patients .It is worthy of promotion. Metrics

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Studies on the Adsorption of Middle Molecular Substances and Parathyroid Hormone from Uremic Patients in Vitro with Activated Carbon and Resin 2013, 12 (01):  42-44.  doi: 10.3969/j.issn.1671-4091.2013.01.00 Abstract ( 158 )   HTML ( 0 )   PDF (187KB) ( 176 )   Objective To explore middle molecular substances (MMS) and parathyroid hormone (PTH) removal performance differences on uremic patients of activated carbon and several resin adsorbent. Methods Maintenance hemodialysis patients’ blood were randomly divided into four groups，respectively for AC（activated carbon）、MR1、MR2、MR3（resin）by adsorption in vitro test. Detect blood MMS and PTH before and after adsorption，combined with the sorbent pore structure，to analyze MMS and PTH removal performance differences of activated carbon and resin. Results Within the same group the comparison of before and after adsorption，four groups of blood MMS，PTH level difference has statistics significance(P MR2> MR3 > AC，four group difference has statistics significance (P<0.05). Conclusions Due to wider pore size distribution range，activated carbon is more favorable on removing the middle molecule substances；resin having relatively centralized pore size distribution，removal for the single molecule toxins such as PTH is more favorable. Metrics

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FGF23-PTH axis in CKD-MBD 2013, 12 (01):  48-49.  Abstract ( 179 )   HTML ( 1 )   PDF (115KB) ( 265 )   Metrics

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Warfarin in maintaining the hemodialysis tunneled cuffed catheter free 2013, 12 (01):  50-52.  Abstract ( 484 )   HTML ( 0 )   PDF (150KB) ( 216 )   The tunneled cuffed catheter (TCC) as a kind of important vascular access, currently used to the hemodialysis patients who can not establish arteriovenous fistula or wait for its maturity. But thrombus and fiber formation is the major complication caused dysfunction in the use of catheters. Warfarin is a conventional anticoagulant and usually used for preventing thrombus embolism disease, such as treat thromboembolism sex phlebitis, pulmonary embolism and atrial fibrillation. Under the closely monitoring of INR, the effective and safety of warfarin in preventation the thrombosis and malfunction of TCC had been proved for many studies, and it could prolong the life of the catheter. This paper reviews the effect of warfarin keep free of TCC. Metrics