Chinese Journal of Blood Purification

12 May 2013, Volume 12 Issue 05 Previous Issue    Next Issue

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Brachial-basilic arteriovenous fistula versus arteriovenous graft in vascular access for mainteinance hemodialysis patients 2013, 12 (05):  0-0.  Abstract ( 486 )   HTML ( 2 )   Abstract Objective: To compared the outcomes of autogenous brachial-basilic arteriovenous fistula (BBAVF) and AV graft (AVG) in patients undergoing long-term hemodialysis. Methods: We analyzed 61 complex patients, 30 randomized to receive AVG and 31 received BBAVF. We compared patency rates of BBAVF and AVG in 3 months, 1 year, 2years, 3years, and complication rates. Results: Patency rates of BBAVF in 1 year, 2years, 3years were higher than patency rates of AVG. The complication rates of infection and thrombosis were significantly higher for BBAVF than for AVG（P<0.05, respectively）. Conclusions: BBAVF has the advantage of a higher patency rate, a lower complicantion rates of infection and thrombosis, should be served as a favourable choice in building the vascular access in maintenance hemodialysis patients. Metrics

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A comparative study of the prognosis in end-stage diabetic kidney disease patients treated with hemodialysis and those treated with peritoneal dialysis 2013, 12 (05):  238-342.  doi: 10.3969/j.issn.1671-4091.2013.05.00 Abstract ( 254 )   HTML ( 4 )   PDF (253KB) ( 355 )   [Abstract] Objectives To investigate the clinical outcome and survival rate of diabetic end stage renal disease (ESRD) patients treated with continuous ambulatory peritoneal dialysis (CAPD) or maintenance hemodialysis (HD). Methods Our retrospective study collected datas included 115 dialysis patients secondary to diabetic nephropathy (73 on HD, 42 on CAPD) treated in Xinhua hospital during the period between January 2007 and May 2012. Patients on dialysis for less than 3 months were excluded. We compared the clinical parameters, complications, survival rate, mortality and its causes between HD and CAPD groups before and after dialysis. Results There were no significant differences in the baseline characteristics between the two groups of pre-dialysis patients, such as age when first dialysis, serum creatinine, blood urea nitrogen, glomerular filtration rate, hemoglobin, serum albumin, uric acid (P＞0.05). There were no significant differences in the level of hemoglobin, serum calcium, phosphorus and iPTH between the two groups at the end time of observation (P＞0.05), while the level of Serum albumin were significantly higher in HD group compared with CAPD group (P＜0.05). The level of serum albumin was significantly increased in HD group at the end time of observation(P＜0.05). The incidence of cardiac insufficiency, bleeding events, cerebral infarction were higher in HD patients than in CAPD patients (P＜0.05), while the incidence of infection was similar(P＞0.05). There were no significant differences on mortality rate between the two groups (P> 0.05). The main causes of death in two groups were heart failure, severe infections, bleeding and cerebrovascular disease. There were no statistically significant differences in the causes of death constitution (P>0.05). 1-, 3-,5-year survival rate in CAPD group were significant higher than HD group (P＜0.05). When performed subgroup analysis, 1-, 3-,5-, 7-year survival rate of CAPD patients with age≥65 years were significant lower compared with HD patients (P＜0.05). Conclusion In this study, CAPD has demonstrated 5 year-survival advantages over HD in the younger diabetic ESRD patients (less than 65 years old). HD elderly patients (above 65 years old) have better survival than CAPD patients, then HD may be a better dialysis modality for elderly diabetic ESRD patients. Metrics

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Relationship between carotid intima-media thickness and 25-hydroxy vitamin D3 in maintenance hemodisysis uremic patients. 2013, 12 (05):  243-246.  doi: 10.3969/j.issn.1671-4091.2013.05.00 Abstract ( 109 )   HTML ( 0 )   PDF (228KB) ( 152 )   [Abstract] Objective To investigate the relationship between carotid intima-media thickness and25-hydroxy vitamin D3 in maintenance hemodisysis uremic patients. Methods carotid intima-media thickness was examined by ultrasonograph. According to the carotid intima-media thickness value the maintenance hemodisysis uremic patients were divided into two sub-groups: IMT more than and equal 1.0mm, IMT less than 1.0mm. serum amyloid A and tumor necrosis factor-α were determined by ELISA. 25-hydroxy vitamin D3 were determined by Radioimmunoassay. Clinical data were collected. Results Among 63 the maintenance hemodisysis uremic patients, IMT more than and equal 1.0mm was revealed in 19 cases, IMT less than 1.0mm in 44 cases. 25-hydroxyvitamin D3 was negatively correlated with IMT. Serum amyloid A , tumor necrosis factor-α, age, hemodialysis time, systomic pressure, pulse pressure and low density lipoprotein cholesterol increased significantly in patients of IMT more than and equal 1.0mm,as compared with patients of IMT less than 1.0mm. Pearson correlation analysis showed IMT had the strongest correlation with 25-hydroxyvitamin D3 , serum amyloid A and tumor necrosis factor-α. Conclusion 30.2% patients, IMT was more than and equal 1.0mm. IMT had the strongest correlation with 25-hydroxyvitamin D3 , which may associate with advanced cardiovascular diseases in the maintenance hemodisysis patients. Metrics

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Arteriovenous Fistula Creation in Pediatric hemodialysis Patients 2013, 12 (05):  247-250.  doi: 10.3969/j.issn.1671-4091.2013.05.00 Abstract ( 112 )   HTML ( 0 )   PDF (259KB) ( 111 )   Objective The aim of the study was to report our experience with arteriovenous fistulas (AVFs) in children and adolescents with end-stage renal disease (ESRD) on hemodialysis(HD).Assess the complication rates of and reasons for access failure in a group of children on HD Methods This was a retrospective cohort study to assess HD vascular access type, complications and causes of failure in children aged less than 18 years, who started HD during the 2006.1-2012.1 period. 19 children (7 females, 12 males) with ESRD received HD treatment. Hemodialysis was an initial renal replacement therapy in 16 out of the 19 children. Results 31 accesses were studied in 19 patients.A total of 21/31 (67.7%) of the AVFs were placed in the left forearm, 7/31 (22.6%) of them in the right forearm,and3/31 (9.6%) in the cubital fossa. AVF primary failure was detected in 22.6% of the fistulas. The complications of the remaining 77.4% (24/31) of the functionalAVFs were thrombosis in 4/24 (16.7%),stenosis in 1/24 (4.2%), aneurysm formation in 1/24(4.2%),High output in 1/24 (4.2%),venous hypertension in 1/24 (4.2%),The main cause of failure of the functioning AVFs was thrombosis (84%). Patients` mean age at AVF creation was 12.21±3.17 years（7-17 years）. Mean weight was 31.16±9.85Kg（16.7-45.4 Kg） The mean time from the construction of the AVF to its usage for hemodialysis was9.84±5.6weeks （4-25weeks）.The mean patency of the AVF was 18.95±17.32months （3-64 months）. Conclusions AVF usage rates and longterm patency rates can be quite high with proper vascular access team and microsurgery in gaining paediatric vascular access. Keywords: Pediatric hemodialysis Arteriovenous fistula construction Metrics

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The in vitro study on bacteria DNA transfer across dialyzers of different dialysis membrane 2013, 12 (05):  251-253.  doi: 10.3969/j.issn.1671-4091.2013.05.00 Abstract ( 114 )   HTML ( 0 )   PDF (212KB) ( 149 )   【Abstract】Objective To assess the transfer of bacteria DNA across cellulose triacetate(CTA, low-flux) and polysulfone(low-flux) membranes. Methods Two groups based on the dialyzer of different membrane were used in this study. Experiments were carried out in saline-saline model. The dialysate was contaminated with E.Coli at 4 levels(2.06×102，1.603×103，2.671×103，1.336×104cells/ml), in vitro dialysis was performed under diffusive condition for 4 hours. ultraviolet spectrophotometry and LAL test were used respectively to detect bacteria DNA and endotoxin level in blood side samples. Comparing the difference of bacteria DNA levels in blood side samples between two groups. Results Dialysate challenged with E.Coli at 4 levels, Increased bacteria DNA concentration were observed in all blood side samples, whereas LAL negative after 4-hour dialysis. Bacteria DNA concentration in blood side samples increased along with the elevated extent of E.Coli in dialysate. E.Coli level in dialysate from 103～104cells/ml, higher bacteria DNA concentrations were observed in 130G group than in F6hps group. The difference is significant between them(P<0.05). Conclusion Under identical conditions for two dialyzers, bacteria DNA have better permeabitlity across membrane than endotoxin. CTA low-flux dialyzer has more permeability of bacteria DNA than Polysulfone low-flux dialyzer. Metrics

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Maintained Haemodynamic change and associated factors analysis in maintenance hemodialysis patients with different cardiac function 2013, 12 (05):  254-258.  doi: 10.3969/j.issn.1671-4091.2013.05.00 Abstract ( 103 )   HTML ( 0 )   PDF (233KB) ( 196 )   Abstract Objective To investigate maintained haemodynamic change during hemodialysis and analyze effects of cardiac index (CI) on hemodynamic parameters and associated influencing factors in maintenance hemodialysis(MHD) patients. Methods Seventy-five patients bearing an arteriovenous fistula (AVF) entered the study. Cardiac output (CO), cardiac index (CI), central blood volume (CBV) and peripheral vascular resistance (PR) were determined by ultrasound dilution technique at the end of 1 hour, 2 hours and 3 hours of dialysis. AVF blood flow (Qa) was also measured with the same device before maintained haemodynamic parameters investigation. Results Systolic arterial pressure, SV, CO, CI and CBV were significantly declined and no significant change for diastolic arterial pressure and heart rates at the end of 2 hour and 3 hour hemodialysis, whereas PR was increased gradually during hemodialysis. Patients were divided into there groups with CI less than 2.5 L/min?m2, 2.5-4.2 L/ min?m2 and more than 4.2 L L/ min?m2 at the end of 1 hour dialysis. Statistically significant decreasing SV, CO and increasing PR were detected in patients with CI4.2 L/min?m2 group (P4.2 L/min?m2 group. Some factors were found to be associated to CI values. Qa and systolic arterial pressure had positive relationship with CI, while age and diabetes had negative relationship with CI. Conclusions Systolic arterial pressure, CO, CI and CBV decrease and PR increases during hemodialysis. Obvious change occurs when CI is less than 2.5 L/min?m2. CI is associated with Qa, systolic arterial pressure, age and diabetes. Metrics

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The clinical observation of the survival of the first autologous arteriovenous fistula in the elderly hemodialysis patients 2013, 12 (05):  259-263.  doi: 10.3969/j.issn.1671-4091.2013.05.00 Abstract ( 143 )   HTML ( 0 )   PDF (250KB) ( 314 )   Objective: To analyzes the opening rate of the first autologous arteriovenous fistula (AVF) in elderly hemodialysis (HD) patients, especially those more than 70 years old. Methods: According to the age, HD patients were divided into two groups: the elderly group: age≥70 years, 61 cases; the young group: 18 years≤age≤55 years old, 64 cases. Followed by18 months, the clinical data, surgical approach, primary and secondary opening rate of AVF were recorded. Results: In the young group, wrist autologous AVF was established in 58 cases, while elbow autologous AVF was done in 6 cases (9.3%). In the elderly group, wrist autologous AVF was established in 44 cases, while elbow autologous AVF was done in 17 cases (27.9%). The prevalence of diabetes mellitus in the elderly group was 42.6% (26/64), significantly higher than the young group (14.1%). (P <0.001) There was no significant difference of the primary and secondary opening rate of autologous AVF between the two groups. Both univariate analysis and multivariate analysis showed that diabetes mellitus was a major factor to the primary and secondary opening rate of the autologous AVF. Conclusion: There is no significant difference of the opening rate of autologous between the young group and the elderly group. Diabetes mellitus is the main factor affecting the opening rate of the AVF. Metrics

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Validity of using direct segmental multi-frequency bioimpedance analysis method for estimating body volume status change in maintenance hemodialysis patients 2013, 12 (05):  264-267.  doi: 10.3969/j.issn.1671-4091.2013.05.008 Abstract ( 141 )   PDF (243KB) ( 176 )   【Abstract】 Object To evaluate the accuracy of direct segmental multi-frequency bioimpedance analysis (DSM-BIA) method for estimation of body volume status changes during hemodialysis in maintenance hemodialysis patients. Methods Total body water were measured using each of DSM-BIA (TBWDSM-pre、TBWDSM-post) method and body composition spectroscopy equations (BCSE) method according to the whole body wrist -ankle protocol (TBWBCSE-pre、TBWBCSE-post) before and after the same hemodialysis session. The change of TBW detected using each of these two methods was compared to actual ultrafiltration volume(AUV) that was calculated as weight loss during hemodialysis session. Results DSM-BIA method detected TBW change (⊿TBWDSM:TBWDSM-pre-TBWDSM-post)was significantly different from AUV(2.32±1.1 vs 2.65±1.04,t=2.962,P＜0.01), but ⊿STBWDSM has a better agreement with AUV than ⊿TBWBCSE (-0.3±1.4 L vs -0.65±1.65 L). Conclusions DSM-BIA provides a more accurate estimate of AUV during HD in maintenance hemodialysis patients than BCSE. Metrics

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Impacts of high flux hemodialysis on skin pruitus and some biochemical indexes in maintenance hemodialysis patients 2013, 12 (05):  268-270.  doi: 10.3969/j.issn.1671-4091.2013.05.009 Abstract ( 175 )   PDF (236KB) ( 301 )   【Abstract】Objective To study the effects of high flux hemodialysis on skin pruitus and some biochemical indexes in hemodialysis patients. Methods The study was perspective and self-controlled. A total of 44 patients on preservation low flux hemodialysis were selected. After changing to high flux dialysis, dialysis prescription was unchanged except the change of dialyzer. Ultrapure dialysate was implied. To compare the skin pruitus, afterdialysis serum creatinine (Cr), blood urea nitrogen (BUN), uric acid (UA), serum phosphorus (P), calcium (Ca), intact parathyroid hormone (iPTH), albumin ( ALB ) , C – reactive protein (CRP) , hemoglobin (Hb),hematocrit(Hct%)level before changing to high flux hemodialysis and after 6,12months entering this study respectively by One-way ANOVA. Results The skin pruitus was improved significantly after changing to high flux hemodialysis 6 and 12 months (F=5.960，P=0.000). There were no differences of serum Cr, BUN, UA, Ca before and after changing to high flux hemodialysis (P＞0.05). But the differences of serum Hb, Hct%, ALB, iPTH, P，CRP were significantly before and after 6,12 months entering the study (P＜0.05). Conclusion The study show that using high flux hemodialysis can improve skin pruritus, microinflammatory state, anima, abnormal calcium and phosphorus metabolism and life quality in hemodialysis patients probably. Metrics

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Effects of Xuebijing on the proliferation, cytokine expression of Rat Peritoneal Mesothelial Cells cultured in High Glucose Concentration 2013, 12 (05):  271-274.  Abstract ( 151 )   HTML ( 0 )   PDF (284KB) ( 165 )   【Abstract】Objective To observe the effects of Xuebijing on the inhibition of cell proliferation and the expression of high mobility group box-1 protein(HMGB-1) and transforming growth factor-β1(TGF-β1) in rat peritoneal mesothelial cells(PMCs) cultured in high glucose concentration. Methods PMCs were isolated from rat colic omentum and cultured in high glucose concentration(2.5%glucose). MTT method was processed to observe the effects of Xuebijing(2,10,20mg/mL)on the cell proliferation. ELISA analysis were performed to investigate the change of HMGB-1 and TGF--β1 concentration in the culture medium. Results High glucose concentration of 2.5% could significantly inhibit cell proliferation as well as induce the expression of HMGB-1 and TGF-β1 in PMCs（P<0.05），which could be partially reversed by Xuebijing of 2～20mg/mL（P<0.05）.Conclusion Xuebijing could reverse both the cell proliferation inhibition and cytokine like HMGB-1 and TGF-β1 induction by high glucose in PMC，and repair the cell damage induced by high glucose consequently. Metrics

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The treatment of endothelial dysfunction in end-stage renal disease patients 2013, 12 (05):  278-281.  Abstract ( 153 )   HTML ( 0 )   PDF (205KB) ( 188 )   The presence of endothelial dysfunction in end-stage renal disease patients is prevalent,which is closely correlated with cardiovascular diseases.Improvement of endothelial function in patients with end-stage renal disease may reduce cardiovascular mortality.Now, we will make a discussion about endothelial dysfunction treatment. Metrics

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Characteristics of HCV Genotyping and Its Clinical Significance in Maintenance Hemodialysis Patients 2013, 12 (05):  282-286.  Abstract ( 155 )   HTML ( 0 )   PDF (235KB) ( 164 )   The epidemiology of hepatitis C virus(HCV) infection in hemodialysis patients has changed dramatically worldwide since the identification of HCV as the major pathogen of non-A non-B hepatitis in 1989. On the basis of the similarity of nucleotide sequences, HCV was classified into six genotypes and approximately seventy subtypes. These genotypes have distinct geographical distributions. The molecular biology approach to detect hepatitis C virus genotype include restriction fragment length polymorphisms, direct sequencing, reverse hybridization line probe assay and so on. HCV genotypes have unique patterns of geographic distribution and are associated with differences in response to interferon treatment . HCV genotypes are also closely associated with pathogenicity, cirrhosis, hepatocarcinogenesis and survival rate of hemodialysis patients. Nosocomial transmission of HCV among hemodialysis patients has been unequivocally demonstrated by molecular virology studies. This article will review characteristics of HCV genotyping and its clinical significance in maintenance hemodialysis patients. Metrics