Chinese Journal of Blood Purification

12 April 2013, Volume 12 Issue 04 Previous Issue    Next Issue

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Impact of hemoperfusion combined with hemodialysis on the left ventricular function in patients with maintenance hemodialysis 2013, 12 (04):  175-179.  doi: 10.3969/j.issn.1671-4091.2013.04.00 Abstract ( 287 )   HTML ( 5 )   【Abstract】 Objective To investigate whether the combination of maintenance hemodialysis (MHD) with hemoperfusion (HP) improves left ventricular function in MHD patients. Methods This study was a prospective, randomized, controlled clinical trial. Fifty-nine MHD patients were selected and randomly divided into two groups. Group HD was given hemodialysis (HD) 3 times a week, and group HP+HD received HD 2 times a week and HD combined with HP once a week. This study lasted for 6 months. Left ventricular structure and function of the patients were measured by echocardiography before and after the study. Clinical and laboratory data were also collected. Results Before the study, there were no differences in antihypertensive drugs, systolic blood pressure (SBP), diastolic blood pressure (DBP), serum concentrations of CRP, iPTH and β2-MG, and left ventricular mass index (LVMI) between the two groups. At the end of the six months observation, serum β2-MG and LVMI decreased significantly in group HD+HP (P =0.017 and 0.035, respectively), but showed no differences in group HD. There is a positive correlation between serum β2-MG level and LVMI in group HD+HP (P =0.034). Conclusion MHD combined with HP could reduce LVMI in MHD patients, probably due to the better clearance of middle and large molecular uremic toxins. Objective: To investigate whether the combination of maintenance hemodialysis (MHD) with hemoperfusion (HP) could improve the left ventricular function of MHD patients. Methods: This study was a prospective, randomized, controlled clinical trial. 59 MHD patients were selected and then randomly divided into two groups. Group HD was given HD alone 3 times a week, whereas Group HP+HD received HD alone 2 times a week and the combined treatment of HD with HP once a week. This study was followed up for 6 months and the patients’ left ventricular structure and function was measured by echocardiography before and after the study. The clinical and laboratory data were also collected. Results: There are no difference in the types of antihypertensive drugs, systolic blood pressure (SBP), diastolic blood pressure (DBP), serum concentration of CRP, iPTH, β2-MG, left ventricular mass index (LVMI) of the two groups before the study. At the end of the 6-months’ observation, the serum level of β2-MG and LVMI of the group HD+HP decreased significantly (P=0.017 and 0.035 respectively) while there is no difference in the group HD. There is a significant correlation between the level of β2-MG and LVMI in the HD and HP group (p=0.034)。 Conclusion: Maintenance hemodialysis combined with hemoperfusion could reduce the LVMI of MHD patients. It may be due to the clearance of middle and large molecular uremic toxins. Metrics

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An analysis and comparison of the two methods for implanting peritoneal dialysis catheters 2013, 12 (04):  180-183.  doi: 10.3969/j.issn.1671-4091.2013.04.002 Abstract ( 324 )   HTML ( 0 )   PDF (266KB) ( 200 )   【Abstract】 Objective To explore the clinical effect of the improved method for insertion of peritoneal dialysis (PD) catheters in patients with end-stage renal disease (ESRD). Methods From February 2009 to April 2012, sixty-nine ESRD patients who needed catheterization for PD were prospectively and randomly divided into two groups, group A (improved method, using the sector dispelling apparatus to guide PD catheter insertion, n=35) and group B (conventional method for PD catheter insertion, n=34). Clinical data at baseline and follow-up information were collected. Complications including catheter dislocation, obstruction, leakage and pain were compared between the two groups. Results At the baseline, clinical conditions including age and primary disease had no differences between the two groups (P＞0.05). No differences in superficial infection and tunnel infection around the catheter (χ2=4.899,P＞0.05), catheter obstruction, leakage and pain were found between the two groups (χ2=4.417,P＞0.05). Catheter dislocation occurred in 3 cases (8.57%) in group A and 10 cases (29.41%) in group B (P<0.05). Re-insertion of the catheter was performed in 2 cases (5.71%) in group A and in 8 cases (23.53%) in group B (P <0.05). Conclusion The improved method for insertion of PD catheters can reduce the rates of catheter dislocation and re-insertion without increase of infection and complication due to mechanical injuries. Metrics

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Cohort study of quality of life and its influence factors in diabetes nephropathy patients on peritoneal dialysis 2013, 12 (04):  184-188.  doi: 10.3969/j.issn.1671-4091.2013.04.00 Abstract ( 166 )   HTML ( 0 )   PDF (244KB) ( 462 )   [Abstract] Objective: Using historical prospective cohort study method, to evaluate the quality of life(QOL) of peritoneal dialysis (PD) patients, and compare the difference of in QOL between diabetes and non-diabetes patients, as well as analysis the factors impacting on QOL of diabetes peritoneal dialysis patients. Methods: 238 patients on maintenance peritoneal dialysis in our center were included from January 2005 to March 2012. General information、chemical test、complication、residual renal function and peritonitis of 118 diabetes and 120 non-diabetes patients were evaluated . QOL and endpoints events were also followed-up. Results: (1) In contracting with non-diabetes patients, the diabetes patients had shorter dialysis age（30.34±27.03 vs 38.52±22.14，Ｐ＜0.01）、higher eGFR （11.26±3.67 vs 8.88±4.01，Ｐ＜0.01）and lower serum albumin level（28.09±4.61 vs 32.41±5.17，Ｐ＜0.05）; (2) During one to three years of dialysis, SF-36 and the most QOL scales were much lower in diabetes patients than in non-diabetes patients. And the difference was more significant in two to three years after dialysis; (3) Qol of non-diabetes patients was improved in the first dialysis year and declinded in the following two years, while that of diabetes patients consisted declining in three years; (4) Different PD operators had influence on QOL of patients. In two groups, QOL of patients who operated by themselves were highest while by family members were lower and by housemaids were lowest（Ｐ＜0.01）; (5) Charlson complication index（r=-0.752，P =0.000）、peritonitis （r=-0.481，P =0.002）and the quantity of urine protein（r=-0.532， P =0.000） were all negtively related with QOL. Conclusion: (1) QOL of diabetes patients were much lower than that of non-diabetes patients;(2)There were differences of QOL changing trend between diabetes patients and non- diabetes patients;(3) QOL of diabetes patients were influenced by many factors such as operators、complications、peritonitis and urine protein. Metrics

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Abdominal aortic calcification score to estimate the degree of coronary artery calcification in hemodialysis patients 2013, 12 (04):  189-194.  doi: 10.3969/j.issn.1671-4091.2013.04.00 Abstract ( 319 )   HTML ( 0 )   PDF (278KB) ( 766 )   [Abstract] Objective: To determine the relationship between the abdominal aortic calcification and coronary artnary calcification in maintenance hemodialysis patients and to explore the possibility of diagnosing coronary artery calcification (CAC) by abdominal aortic calcification(AAC) score. Methods: Maintenance Hemodialysis Patients were selected. Abdominal lateral plain radiograph and Multislice spiral CT (MSCT) were used to detect the calcification of abdominal aorta and coronary artery respectively. Kauppila score was used to assess the degree of AAC while Agaston score for CAC. Pearson correlation Coefficient was used to analyze the relationship between AAC and CACs. We also assess the accuracy and sensitivity of AAC score in diagnosing coronary artery calcification using receiver operator characteristic (ROC) curves. Results: 66 patients were enrolled. Average age, dialysis vintage and Kt/V were 57.65±13.10 years, 95.50 (28.00-143.00) months and 1.61(1.41-1.88) respectively. 30.3% patients were with diabetes mellitus. 72.7% patients were detected abdominal artery calcification with the median AAC of 8.5(0-15.00) while 78.3% patients were detected coronary artery calcification with the median CACs of 400.8 (4.2-1476.23). Correlation analysis showed that AAC were positively related with CACs (r=0.664, P400) were 84.4% and 81.2% respectively. Logistic regression analysis showed that with the increasing of the abdominal aorta calcification, the risk of patients with severe coronary artery calcification are increasing. United AAC，traditional cardiovascular risk factors and CKD-related cardiovascular risk factors have a stronger ability to predict severe coronary artery calcification in maintenance hemodialysis patients Conclusions: There is a significant correlation between abdominal aortic calcification and coronary artery calcification. AAC can well predict the degree of coronary artery calcification in maintenance hemodialysis patients. Metrics

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Analysis of biochemical variables under the influence of serum intact parathyroid hormone level and other associated factors of patients undergoing maintenance hemodialysi 2013, 12 (04):  195-198.  doi: 10.3969/j.issn.1671-4091.2013.04.00 Abstract ( 189 )   HTML ( 0 )   PDF (413KB) ( 193 )   【Abstract】Objective To investigate and analyze the biochemical variables under the influence of different levels of serum intact parathyroid hormone and other associated factors of patients undergoing maintenance hemodialysis. Methods 93 CKD patients undergoing maintenance HD were divided into 3 groups according to their serum iPTH level (group A 300 ng/L) Compare the age, prevalence of diabetes, duration on dialysis, body weight, BMI and other serum biochemical variables of patients in 3 groups. The relation between age, gender, diabetes mellitus, duration on dialysis, serum calcium (Ca), phosphorus (P), alkaline phosphates (ALP) were examined by multiple linear regression analysis. Results The serum creatinine and P were significantly higher in group B and C than those in group A (P<0.05). In group C, duration on dialysis, serum Ca and ALP were remarkably higher than those in group A and B (P <0.05). The duration on dialysis and serum albumin(ALB) in group B were obviously elevated as compared with those in group C(P <0.05). From group A to C, There was a decline of diabetes morbidity (P =0.003). There was a positive correlation between duration on dialysis, serum P and iPTH (b=0.102, b=3.077) while a negative correlation between diabetes mellitus and iPTH(b =-1.294).Conclusions the prognoses of patients on maintenance hemodialysis were under the influence of iPTH level. iPTH level was positively related with duration on dialysis and serum P, while it was negatively related with diabetes. [Key words] Chronic kidney disease; Hemodialysis; Intact parathyroid hormone Metrics

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Clinical application of plasma exchange in treatment of patients with dermatitis medicamentosa like of trichloroethylene accompanied with severe hepatitis 2013, 12 (04):  199-202.  doi: 10.3969/j.issn.1671-4091.2013.04.00 Abstract ( 144 )   HTML ( 0 )   PDF (265KB) ( 112 )   【Abstract】 Objective　To explore the therapeutic effect of plasma exchange in the treatment of patients with dermatitis medicamentosa like of trichloroethylene(DMLT) accompanied with severe hepatitis．Methods 21 patients were treated with plasma exchange on the basis of conventional therapy．The hepatic function makers，coagulation tests and improvements of clinical symptoms were compared．Results After treatment，the patients total bilirubin，alanine aminotransferase，aspartate amino transferase，Tumor necrosis factor-α，prothrombin time decreased(P<0.05)，albumin increased(P<0.05)，and clinical symptoms improved. There were no significant difference in activeated partial thromboplastin time、thrombin time and Human Fibrinogen．The effective rates were 100%. 1 patient died of pulmonary infection because of Nocadia. 20cases(95.2%) out of the 21 patients survived. 81 times of plasma exchange treatments were done in all 21 cases，and that with adverse reaction was 2 times．Conclusions　Plasma exchange is safe and effective in treatment of patients with DMLT． Metrics

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Study of changes and clinical significances of serum cytokines in the maintenance hemodialysis patients with depression 2013, 12 (04):  203-206.  doi: 10.3969/j.issn.1671-4091.2013.04.00 Abstract ( 168 )   HTML ( 0 )   Objective To investigate the changes and clinical significance of serum cytokines in the maintenance hemodialysis (MHD) patients with depression. Method 79 cases of MHD patients were enrolled in this study, and by Hamilton Rating Scale for Depression (HAMD) scores, divided into two groups, depressive group and non-depressive group. Serum levels of cytokines including IL-1β, IL-6 and TNF-α were measured by enzyme-linked immunosorbent assay. Results The incidence of depression in MHD patients was 57%. The serum levels of IL-1β and IL-6 in depression group were much higher than those in non-depressive group (P<0.05), while TNF-α had no differences between these two groups. The serum levels of IL-6 were significant increased with the degrees of depression in MHD patients (P<0.05), and correlated positively with severity of depression in MHD patients. Conclusion The cytokines IL-1β，IL-6 may play important roles in the depression of MHD patients, especially IL-6, and the latter may used as predictive index for severity of depression in MHD patients. Metrics

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Clinical analysis of Hypothyroidism and anemia in patients with maintenance hemodialysis 2013, 12 (04):  207-209.  doi: 10.3969/j.issn.1671-4091.2013.04.00 Abstract ( 191 )   HTML ( 0 )   PDF (211KB) ( 305 )   ABSTRACT Objective: To analyze the incidence of hypothyroidism, and its relevance with anemia in maintenance hemodialysis (MHD). Methodology：The clinical records of MHD patients in our hemodialysis center in the past 7 years (Jul 1, 2005~ Jul 1, 2012) were retrospectively studied by chi-square test and Mann–Whitney U test. Correlation coefficients between hypothyroidism and anemia were assessed by logistic regression analysis. Paired t-test was done to assess hypothyroidism treatment effectiveness on anemia. Results: In our study, 19(6.9%) of 274 MHD patients had hypothyroidism, including 7 male (4.9%) and 9 female (9.1%). Patients without hypothyroidism had a higher level of hemoglobin(Hb) than those hypothyroidism patients (u=15.262,ν=∞, P<0.001). Furthermore, statistically significant correlations could be found between Hb and Kt/V, Ferritin and hypothyroidism. Hb level increased obviously after hypothyroidism treatment(t=5.115, ν=18, P<0.0001). Conclusion: Patients with maintenance hemodialysis had a high incidence of hypothyroidism, which might result in secondary anemia as effective hypothyroidism treatment could reduce the anemia. Metrics

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MONITORING AND EVALUATION ON THE ENVIRONMENTAL CLEAN LEVEL OF HEMODIALYSIS ROOM 2013, 12 (04):  222-224.  Abstract ( 162 )   HTML ( 0 )   PDF (205KB) ( 180 )   Abstract：Objective Adenosine triphosphate (ATP) bioluminescence and microbiological culture methods were used for evaluation of cleaning procedure changed before or after in hemodialysis room. These provide a real-time and effective method on monitoring and evaluation of the environmental clean level of hemodialysis room. Methods Choose five sites from the hemodiaylsis room and use ATP bioluminescence and microbiological culture methods to monitor and record the clean level of those sites before and after changing clean procedure, comparison of two results and evaluation of a new clean procedure. Results The mean of ATP bioluminescence method before changing clean procedure respectively is 788. 310. 530. 600 and 900RLU, after cleaning procedure changed is 176. 130. 120. 220 and 239RLU.The mean of microbiological culture method respectively is 12. 4. 9. 6 and 8cfu, after cleaning procedure changed is 2. 1. 1. 1 and 2cfu. The surface contaminated level of homedialysis room was significantly reduced, the monitoring results of ATP bioluminescence are similar with microbiological culture method. Conclusions Effectively surface cleaning procedure can dramatically reduced the surface contaminated condition, ATP bioluminescence is much more quick and efficient technology used in monitoring and evaluation on the nosocomial environmental clean level. Metrics

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Use BeiLang Diapact C R R T realize continuity plasma filtration adsorption our treatmentCan research 2013, 12 (04):  225-225.  Abstract ( 184 )   HTML ( 3 )   PDF (179KB) ( 290 )   Objective： Explore BeiLang use Diapact CRRT blood purification devices in the original continuity static-static hemofiltration treatment on the basis of the model of, realize the continuity of plasma filtration adsorption treatment of new functions, Methods： through to the BeiLang Diapact C R R T continuity static-static hemofiltration pipeline for simple modification treatment, increase the tee connecting pipe a root, extended the original treatment mode. Results: A good way to realize the CPFA treatment. Conclusions: Use BeiLang DDiapact CRRT blood purification devices original continuity static-static hemofiltration treatment mode as the foundation. Combined with the design characteristics of the machine, and realize the continuity of plasma filtration adsorption treatment, the principle of the new function method and clinical application. Metrics

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The realization of diagnosis of subclavian vein stenosis in the aged hemodialysis patients 2013, 12 (04):  226-227.  Abstract ( 234 )   HTML ( 0 )   PDF (176KB) ( 274 )   Objectives To explore the diagnosis and management experiences of subclavian vein stenosis in the aged hemodialysis patients. Methods We retrospectively analyzed two cases with subclavian vein stenosis in the aged hemodialysis patients from April to July 2012, analyzed and summarized the experiences of diagnosis and treatment. Results The two hemodialysis patients with edema in upper limbs were diagnosed by venograpy, and the symptoms were resolved by simple angioplasty and angioplasty plus stent implantation. Conclusions The interventional stent implantation is a minimally invasive and efficient method for subclavian vein stenosis in the aged hemodialysis patients. Metrics