Chinese Journal of Blood Purification

12 February 2013, Volume 12 Issue 02 Previous Issue    Next Issue

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Heparin sodium caused hemodialysis patients headache 2013, 12 (02):  0-0.  Abstract ( 493 )   HTML ( 10 )   A male patient, aged 40 was admitted for malaise, less appetite and nausea for one week. He was diagnosed with Chronic Renal Failure, CKD stage 5 through examination after admission and hemodialysis treatment was applied. The no-heparin dialysis method was used for the first time with no adverse reactions occurring. Later the heparin anticoagulation hemodialysis was uesd and he had excruciating headaches which disappeared after two hours of hemodialysis end. After two monthes the no-heparin method of dialysis was applied again due to upper gastrointestinal bleeding and the headache disappeared. But the headache reoccurred when we used heparin again.So we conclude that the headache was related to heparin sodium. Therefore no-heparin hemodialysis has been used to sustain the patient s life so far. Metrics

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study of cardiac arrhythmias during internal jugular vein catheter procedure in hemodialysis patients 2013, 12 (02):  63-65.  doi: 10.3969/j.issn.1671-4091.2013.02.00 Abstract ( 313 )   HTML ( 2 )   PDF (209KB) ( 294 )   【Abstract】Objectives To observe the incidence and related influencing factors of arrhythmias during internal jugular vein catheterization in hemodialysis patients . Methods 100 cases underwent internal jugular central venus catheterization in our hospital from January 2010 to June 2012 were selected . Arrhythmias was recorded by the application of ECG monitor in the puncture process . The correlative data of patients , such as general information of patients、blood gas analysis、electrolytes、 renal function 、the effect of local anesthesia 、the succese rate of puncture and the length of insert guide wire ，were collected and analysed the relationship with arrhythmias . Results 29 cases of arrhythmia in the puncture process related with the length of insert guide wires (p <0.05), unrelated with age、 height、the effect of local anesthetic、 the succese rate of puncture、 electrolyte、PH value、PO2 and SPO2. The express of arrhythmias is atrial and ventricular premature beats, atrial premature beat mainly. Conclusions The incidence of arrhythmias during internal jugular vein catheterization in hemodialysis patients is more and related with the insertion of guide wires too deep , which to avoid over-insert the guide wire can reduce the incidence of arrhythmias. Metrics

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Cognitive function in patients with different stages of chronic kidney disease 2013, 12 (02):  66-69.  doi: 10.3969/j.issn.1671-4091.2013.02.00 Abstract ( 138 )   HTML ( 0 )   PDF (219KB) ( 166 )   Objective To evaluate the cognitive function in patients with different stages of chronic kidney disease (CKD). Methods 103 CKD patients from nephrology department, China Rehabilitation Research Center, Beijing Boai Hospital were enrolled in this study. They were divided into four groups according to eGFR, including CKD1~2 stages group, CKD3~4 stages group, CKD 5 stage non-dialysis group and CKD 5 stage dialysis group. Cognitive function was evaluated by Wechsler Adult Intelligence Scale-Revised by China. Cognitive function in patients with different stages of CKD was compared by using the statistical analysis of one-way ANOVA. Results 103 CKD patients were enrolled. There were 31 patients in the CKD1~2 stages group, the mean age was 54.77±12.70 years; there were 25 patients in the CKD3~4stages group, the mean age was 62.24±14.36 years; there were 10 patients in the CKD5 stage non-dialysis group, the mean age was 60.03 ±12.10 years; there were 37 patients in the CKD5 stage dialysis group, the mean age was 65.00 ±14.41 years; there was a partly decline tendency in cognitive function with eGFR declined. The differences were no statistic significant among the four groups in Full scale Intelligence quotient, Verbal Intelligence quotient and Performance Intelligence quotient（P > 0.05）. Conclusion With the decreasing of eGFR, there was a partly decline tendency in cognitive function in different stages of CKD. Metrics

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The quality of life of patients with chronic kidney disease measured by EQ-5D-3L and its influencing factors 2013, 12 (02):  70-73.  doi: 10.3969/j.issn.1671-4091.2013.02.00 Abstract ( 144 )   HTML ( 0 )   PDF (223KB) ( 164 )   【Abstract】 Objective: To investigate the health- related quality of life in patients with chronic kidney disease(CKD), and analysis the possible relating factors of this disease. Methods：The Chinese version of the EuroQol Group’s 5-domain 3 level questionnaire(EQ-5D-3L) was used to interview the CKD patients. At the same time we collected the general messages and clinical laboratory testing results of these patients, then found out the factors that affected the quality of life in patients with CKD using correlation analysis. Results: The visual analogue scale(VAS) scores were consistent with the health description system evaluation results. The VAS scores were negative related to age, Scr, BUN, CysC, p, Ca•P, ferritin and Up/Ucr, while had a positive correlation with eGFR, Hb, Alb and ApoA1. Conclusion: The survey in our center showed that female patients of CKD were more prone to anxiety and depression status. The renal function, anemia and micro inflammation state had significant influence to the quality of patients’ life, which verified that this simple and feasible scale can reflect the health related quality of life of CKD patients in a good way. Metrics

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The value of Procalcitonin for Catheter related bloodstream infection in Hemodialysis Patients 2013, 12 (02):  74-77.  doi: 10.3969/j.issn.1671-4091.2013.02.00 Abstract ( 86 )   HTML ( 0 )   PDF (240KB) ( 251 )   Objective: To study the value of procalcitonin for catheter related bloodstream（CRBSI）infection in hemodialysis patients. Methods: Blood samples of 62 hemodialysis patients who suspected catheter related bloodstream infection were obtained for procalcitonin level、c-reactive protein level、hemoculture and blood routine examination, catheter were also obtained for culture. Results: The procalcitonin level of Patients with CRBSI and without CRBSI were 7.16±5.84μg/L and 0.97±1.44μg/L（P<0.001）, there is no significant difference Between Patients with CRBSI and without CRBSI in the level of white blood cells and C-reactive protein. Conclusions: PCT was a valuable early diagnostic parameter for CRBSI. Metrics

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A matched study on influential factor of thrombosis in arteriovenous fistula in maintenance hemodialysis patients 2013, 12 (02):  78-81.  doi: 10.3969/j.issn.1671-4091.2013.02.00 Abstract ( 112 )   HTML ( 0 )   PDF (229KB) ( 336 )   【Abstract】Objective To investigate the influential factors of thrombosis in native arteriovenous fistula (AVF) in maintenance hemodialysis patients. Methods 46 patients were recruited as case group when their AVF were thrombed at the first time. 92 patients whose AVF were conducted at the same time with the ratio 2:1 of each matched case were also recruited as control group. The clinical and biochemical data of the two groups were analyzed by analysis of variance, binary logistic regression analysis and survival analysis. Result Age, diabetes, AVF location, anastomosis, hemodialysis frequency, hemodialysis time, hypotension, hemoglobin, hematocrit, platelet, triglyceride, calcium-phosporous product, cardio-cerebrovascular disease and carnitine were statistically significant difference between the two groups. By logistic regression analysis, diabetes and calcium-phosporous product were the risk factors of AVF thrombosis, but carnitine was the protective factor. The median survival of AVF was 496 days for patients who had regularly injected carnitine, while for the non-carnitine injected patients the median survival time was 272 days, p value was 0.001. Conclusion Diabetes and calcium-phosporous product could be the risk factors of AVF thrombosis, and carnitine injected may be a protective factor. Metrics

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Analyses of the cause of hospitalization and related risk factor in patients with maintenance hemodialysis 2013, 12 (02):  82-85.  doi: 10.3969/j.issn.1671-4091.2013.02.00 Abstract ( 176 )   HTML ( 0 )   PDF (220KB) ( 337 )   [Abstract] Objective: To analysis the cause of hospitalization and related risk factor in patients with maintenance hemodialysis. Method: 99 hemodialysis patients were enrolled. Age, dialysis age, blood pressure, hemoglobin, blood glucose, serum creatinin, serum potassium, serum calcium, serum phosphorus, albumin, iPTH and KT/V were compared in hospitalization and non-hospitalization groups. The main cause and related risk factor for hospitalization were reviewed. Result: 59 out of 99 patients were hospitalized and they have 106 hospitalizations in observed period. Average hospitalization was 1.07±1.22 per patient and hospitalized days were 28.27±24.73 days per hospitalized patients. The main causes of hospitalization were cardiovascular disease, vascular access stenosis and pulmonary infection. Compare with non-hospitalization group, age of patient hospitalization group was older and the levels of albumin and serum creatinin were lower than those in MHD patients. （66.6±12.62 vs.56.63±13.16 years,p=0.00; 804.05±226.01 vs.954.80±226.35μmol/L，p=0.03; 33.13±4.16 vs.37.30±3.33 g/L，p=0.000）. Stepwise multivariate regression analysis showed hypoablbuminia and short dialysis age were risk factors to influence the hospitalization patients undergoing maintenance hemodialysis. Stepwise multivariate regression analysis showed hypoablbuminia and short dialysis age were risk factors to influence the hospitalization in patients undergoing maintenance hemodialysis. Conclusion: Cardiovascular disease, vascular access stenosis and pulmonary infection were the important causes for hospitalization in hemodialysis patient. Cardiovascular disease was the leading cause of hospitalization in patients with maintenance hemodialysis. Metrics

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Distribution and Risk Factors of Venous Thrombosis Following Catheterization in Patients with End-Stage Renal Disease 2013, 12 (02):  86-89.  doi: 10.3969/j.issn.1671-4091.2013.02.00 Abstract ( 157 )   HTML ( 1 )   PDF (221KB) ( 394 )   Objective To determine thrombosis distribution and risk factors of venous thrombosis following catheterization in patients with End-Stage Renal Disease (ESRD). Methods 127 HD patients have a history of right internal jugular catheterization were performed Computed Tomography Angiography (CTA), their clinical characteristics were examined. Patients were divided into thrombotic group and non-thrombotic group according imaging results and their clinical characteristics were compared between two groups, and the thrombosis anatomy positions of thrombotic group were measured. Result There were 66, 61patients in thrombotic group and non-thrombotic group, respectively. In thrombotic group, 43, 15, 4, 4 patients have there venous thrombosis in right internal jugular vein (RIJV), right innominate vein (RIV), right subclavian vein (RSCV) and superior vena cava (SVC),respectively. There were significant difference between CVS group and non-CVS group in catheter days, low-density lipoprotein cholesterol levels, total cholesterol levels; there were no significant difference between two groups in age, gender, hemoglobin levels, albumin levels, catheterization numbers, total cholesterol, triglyceride. Conclusion The most often anatomic locations of venous formation following right internal jugular venous catheterization in patients with ESRD were RIJV, RIV, RSCV and SVC, respectively, to decrease catheters days, low-density lipoprotein cholesterol levels, total cholesterol levels may be useful for reducing occurrence of CVS. Metrics

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The value of lactate substitution fluid for the treatment of critical patients under continuous renal replacement therapy 2013, 12 (02):  90-93.  doi: 10.3969/j.issn.1671-4091.2013.02.00 Abstract ( 140 )   HTML ( 1 )   PDF (196KB) ( 225 )   【Abstract】 Objective to investigate the value of lactate substitution fluid for continuous renal replacement therapy (CRRT) in critical ill patient. Methods sixty-three patients without severe hepatic failure and chronic renal failure in intensive care unit were treated with CRRT, thirty-four patient using lactate containing fluids but twenty-nine using bicarbonate-based fluids. Lactate, PH, base-exess, HCO3-, mean arterial pressure(MAP) were measured before, after 24h and 48h CVVH. Result The plasma lactate concentration was no statistically decreased after 24h and 48h CVVH in lactate group.Lactate was remarkably decreased after 24h and 48h CVVH in bicarbonate group（P＜0.05）.PH, base-excess and HCO3- were improved in both group.Serum creatinine fell significantly in both group after 24h CVVH, even greater afte 48h CVVH. However ,there were no significant difference in mean arterial pressure and serum sodium during CVVH. Lactate and base-excess but not other parameters were greaterly changed in lactate group compared with bicarbonate group.Conclsion Lactate substitution fluid can maintain acid-base balance, pressure and homeostasis but not elevated lactate level .It can be safely used for CVVH in critical ill patients. Metrics

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study the hospitalization and deaths of maintenance hemodialysis patients 2013, 12 (02):  107-109.  Abstract ( 234 )   HTML ( 1 )   PDF (137KB) ( 340 )   [objective] to analyze the occurrence of hospitalization and deaths of the maintenance hemodialysis patients in our hemodialysis center, and the risk factors which affect the maintenance hemodialysis patients hospitalization and death occurred. [methods] we retrospectively analyzed 310 patients who had been treated with MHD for more than 3 months during the period between Aurgust 2010 and December 2012. The occurrence of hospitalization and deaths was recorded in the period. Hospitalization and/or deaths were defined as an adverse event。Age, sex, duration of hemodialysis, body mass index(BMI), blood pressure, kt/v, c reaction protion(CRP), total cholesterol(CHO), triglyceride(TG), high density lipoprotein(HDL), low density lipoprotein(LDL), serum albumin(ALB), hemoglobin(HGB), calcium(Ca), phosphorus(P), parathyroid hormone(PTH), and calcification score were compared between group with endpoint events and group with no endpoint events. Correlation analysis was made for risk factors relating to the endpoint event. [results] 1)At the end of the observation period, there were 146 cases times of hospitalization，annual rate of hospitalization is 1059 hospitalizations per 1000 patients. The top three causes of hospitalization were infection(45.8%), cardiovascular and cerebrovascular complications(22.6%), vascular access(8.9%). 2) 30 patients was died. The rate of death was 69 per 1000 patients year. The first reason of death was cardiovascular and cerebrovascular complications(56.6%), the next reason of death was infection(23.3%). 3) 208 patients were involved in the analysis about the risk factors finally. Older mean age, higher calcification score , lower serum albumin , and lower hemoglobin were founded in group with endpoint events than group with no endpoint events. Logistic regression analysis showed that lower serum albumin, older age and lower hemoglobin were the risk factors of hospitalization and death. [conclusions] cardiovascular and cerebrovascular disease, infection are the common causes leading to hospitalization and death in MHD patients. older age, lower serum albumin and lower hemoglobin were the independent risk factors of hospitalization and death. Metrics