Chinese Journal of Blood Purification

12 July 2013, Volume 12 Issue 07 Previous Issue    Next Issue

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Study progress of High volume hemofiltration 2013, 12 (07):  0-0.  Abstract ( 221 )   HTML ( 1 )   High-volume hemofiltration is a kind of blood purification technology that developed on the basis of continuous renal replacement therapy.As a highly efficient nonspecific blood purification method HVHF has attracted more and more scholars and clinicians.Many clinical and experimental research demonstrate that, compared with the traditional continuous veno - venous hemofiltration , HVHF can better remove inflammatory medium, improve blood flow dynamics, reduce vascular active drug dosage, regulate immune disorders, and improve the survival rate. high volume hemofiltration concept, mechanism of action, clinical experiment research will be stated in this paper. Metrics

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Plasma bone morphogenetic protein-2 and related influence factors in patients of chronic kidney disease 2013, 12 (07):  349-352.  doi: 10.3969/j.issn.1671-4091.2013.06.00 Abstract ( 160 )   HTML ( 0 )   PDF (4271KB) ( 419 )   Objectives: To investigate the level and variation of serum BMP-2, and how the eGFR, calcium-phosphate metabolism, inflammmation, lipids profile and nutrition index affact the production of BMP-2 in different phases of CKD. Methods: 154 patients with different phases of CKD were enrolled by a cross –section design. BMP-2 was measured by Elisa and clinical biochemistry parameters were evaluated at the same time . Results:The total of 154 patients come from 26 patients in CKD1, 22 in CKD2, 26 in CKD3, 20 in CKD4, 28 in pre-dialysis CKD5 and 32 patients who were undergoing maintenance hemodialysis. 28 healthy subjects was served as control. As a result: ① It demonstrated that the level of seru BMP-2 increased significantly in patients of CKD4, 5 and hemodialysis. ② The level of BMP-2 wassiginificant high in those patients such as，plasma phosphate > 1.62mmol/l or Ca × PO4 product > 55 mg2/dl2 ；serum albumin 3000 mg/l. ③BMP-2 level were positively correlated to serum phosphate, calcium phosphate product, CRP, BUN, creatinine and negatively correlated to seru albumin and glomerular filtration rate. Conclusions: The level of seru BMP-2 gradually increased in patients of advanced CKD and hemodialysis.The variation of BMP-2 is associated with renal function, calcium-phosphate metabolism, inflammation and albumin. Metrics

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Effect of high-flux hemodialysis on insulin resistance and cardiac function in non-diabetic patients maintained on hemodialysis. 2013, 12 (07):  353-357.  doi: 10.3969/j.issn.1671-4091.2013.07.00 Abstract ( 280 )   HTML ( 0 )   PDF (557KB) ( 411 )   Objective To investigate the effects of high-flux hemodialysis on insulin resistance and cardiac function in non-diabetic patients maintained on hemodialysis.Methods Sixty patients with maintenance hemodialysis were selected,who had undergone hemodialysis for more than one year and were in a stable clinic status without signs of acute infections or other progressive diseases. These patients were divided into two groups.Patients in each group were treated using either Fx 60(high-flux dialyzer) or F7 HPS(low-flux dialyzer) for 6 months. Serum IL-6 and hsCRP were measured at the start and end of the study.Insulin resistance was assessed by using the homeostasis model assessment(HOMA-IR).The left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDd), left ventricular end-diastolic dimension(LVEDs),interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPWT) and left ventricular ejection fraction(LVEF), left ventricular mass index(LVMI),ratio of E/A,the cardiac output(CO)were measured by ultrasonic cardiography at the start and end of the study. Results In patients with maintenance hemodialysis ,the average serum hsCRP、IL-6 and HOMA-IR were positively correlated with the values of LAD,LVEDd,LVEDs,IVST,LVPWT and LVMI（P <0.05）,but negatively correlated with the value of LVEF，E/A and CO（P <0.05）.After 6 month observation,the levels of HOMA-IR、IL-6 and hsCRP in high-flux group were significantly decreased according to HD group （P <0.05）. Conclusion This study demonstrates that high-flux dialyser provides a better effect on insulin resistance than does the low-flux dialyser for non-diabetic patients maintained on hemodialysis. Metrics

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The interaction between volume status and solute clearance in PD patients 2013, 12 (07):  358-361.  doi: 10.3969/j.issn.1671-4091.2013.06.00 Abstract ( 151 )   HTML ( 0 )   PDF (672KB) ( 304 )   Urea clearance, adjusted for total body water using the Watson formula (Kt/Vurea) is widely used to guide peritoneal dialysis prescription and ensure dialysis adequacy. The impact of body composition on determining body water using the Watson formula (TBWWatson) is well established, but the effect of hydration on TBWWatson and Kt/V is not well understood. We therefore in the present study tried to estimate the magnitude of errors in using Kt/V to assess dialysis adequacy in peritoneal dialysis patients. 195 stable adult peritoneal dialysis patients were enrolled. Total body water was measured by multiple-frequency bioelectrical impedance spectroscopy (MF-BIS) and compared with the TBW calculated using the Watson formula. Furthermore we calculated Kt/V by two methods — one is normalized to total body water according to Watson formula and the other is normalized to total body water according to MF-BIS. Patients were divided into three groups according to their degree of overhydration (Δhydration status (OH, L)): normally hydrated group (n=101, OH4.0L). Compared with MF-BIS, the Watson formula overestimated TBW in normally hydrated patients but underestimated TBW in severely overhydrated patients. On the other hand, compared with the Kt/V normalized to total body water according to MF-BIS, the Kt/V normalized to total body water according to Watson formula clearly underestimated Kt/V in normally hydrated patients but overestimated Kt/V in severely overhydrated patients. Our study suggested that hydration status strongly affect total body water estimation by the Watson formula in peritoneal dialysis patients, potentially leading to inappropriate dialysis prescription and failure to achieve recognized Kt/Vurea adequacy targets. Key words: bio-impedance, peritoneal dialysis, hydration status, Watson formula, dialysis adequacy Metrics

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Preservation of residual renal function by not removing water in new hemodialysis patients 2013, 12 (07):  362-366.  doi: 10.3969/j.issn.1671-4091.2013.07.00 Abstract ( 222 )   HTML ( 0 )   PDF (875KB) ( 179 )   Objective To investigate the effect of no water removal (NWR) on preservation of residual renal function (RRF) in new hemodialysis patients. Methods Fifty-six patients with a daily urine volume ≥1000 ml were included. Patients were randomized to different fluid management groups of NWR or water removal (WR) for 6 months. If predialysis BP was >150/90 mmHg, patients could take antihypertensive drugs. The primary endpoints included death, cardio-cerebral vascular disease, refractory hypertension, and edema or an auxiliary examination indicating obvious fluid retention. The secondary endpoint was oliguria. A daily urine volume, 24-h urine creatinine clearance, the defined daily dose (DDD) index of antihypertensive drugs, erythropoietin resistance index, cardiothoracic ratio, and left ventricular mass index (LVMI) were recorded. Results Eight patients in the NWR group reached the primary endpoints. Nine patients in the WR group reached the secondary endpoint. At the end of the study, patients in the NWR group had more increased systemic blood pressure (9.0 ± 8.3 vs. -2.4 ± 2.0 mmHg, p<0.001), DDD index (1.2 ± 1.02 vs. -0.9 ± 0.51, p< 0.001), daily urine volume (164 ± 351 vs. -726 ± 342 ml, p<0.001), cardiothoracic ratio (0.02 ± 0.04 vs. -0.03 ± 0.03, p<0.001), LVMI (9.6 ± 17.0 vs. -12.0 ± 21.4 g/m2, p<0.001), and less decreased urine creatinine clearance (-1.0 ± 0.4 vs. -2.0 ± 1.0, p<0.001), compared with those patients in the WR group. Conclusions Preservation of RRF by NWR is warranted in new HD patients, but is not appropriate for all patients. Metrics

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The Impact of dyslipidemia on ultrafiltration failure in peritoneal dialysis patients 2013, 12 (07):  367-370.  doi: 10.3969/j.issn.1671-4091.2013.07.00 Abstract ( 125 )   HTML ( 0 )   PDF (566KB) ( 185 )   Abstrac Objective To explore the impact of  dyslipidemia on ultrafiltration failure(UFF)  in peritoneal dialysis patients. Method Choosed 124 patients who accepted  peritoneal dialysis regularly  for more than 12 months. Measured  ALB,Hb,T-Ch,TG,LDL-C,HDL-C,BUN,Cr,Glu of the patients. Recorded  the age of the patients. Patients were divided into dyslipidemia group and  normal lipid group according to the results of the blood lipid. The incidence of UFF in two groups was compared.Divided into the groups according to UFF or not. The differences of the level of  lipid 、renal function、Glu、ALB、Hb in two groups were compared. Results he incidence rate of UFF through the peritoneal dialysis in dyslipidemia group was obviously higher than in the normal blood lipids group（P=0.008）.The duration of dialysis in UFF group was longer than in the ultrafiltration normal group（T=7.93,P=0.000）.The systolic blood pressure and diastolic blood pressure in UFF group was obviously higher than in the ultrafiltration normal group（TSBP=7.36, PSBP=0.000,TDBP=4.51,PDBP=0.000）.The level of TG and T-Ch in UFF group was apparently higher than in the normal group（TT-Ch=3.45,PT-Ch=0.001；TTG=6.76,PTG=0.000）,while the level of HDL-C was obviously lower（T=－7.53,P=0.000）,The incidence rate of low peritoneal transport in dyslipidemia group was obviously higher than in the normal blood lipids group（P=0.021）.Multivariate analysis showed that long duration of dialysis and the low level of HDL were independent risk factors for ultrafiltration failure through the peritoneal dialysis.(p=0.034、0.048). Conclusion 1 Dyslipidemia in peritoneal dialysis patients is one of the causes of UFF.UFF in dyslipidemia patients is related to high TG、T-Ch level and low HDL-C level. 2. UFF in dyslipidemia patients maybe caused by deducing the turn-over capacity of the peritoneum. 3.Long term of dialysis and low HDL level are independently dangerous risks for peritoneal dialysis. Metrics

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Clinical Efficacy of Levocarnitine Combined with Hemodialysis on Treating Uremic Peripheral Neuropathy 2013, 12 (07):  371-374.  doi: 10.3969/j.issn.1671-4091.2013.07.00 Abstract ( 224 )   HTML ( 0 )   PDF (537KB) ( 223 )   [Abstract] Objective To observe the effect of Levocarnitine combined with hemodialysis in treating uremic perpheral neuropathy. Methods Eighty-four patients with uremic peripheral neuropathy were assigned randomly to hemodialysis group(HD， n＝30),hemodiafiltration group(HDF,n＝27) and Levocarnitine combined with hemodialysis(L-CN+HD,n＝27). The hemodialysis group received regular hemodialysis three times a week.hemodiafiltration group received regular hemodialysis twice a week and hemodiafiltration once a week. Levocarnitine treated group on the basis of regular hemodialysis were given Levocarnitine 2.0g,diluted with 250ml of 0.9% sodium chloride solution,ivgtt,3 times/week)．The treatment lasted 8 weeks.The clinical symptoms and the sensory nerve conduction velocity(SNCV) of median nerve,tibial nerve and peroneal nerve were observed in each group before and after treatment respectively. Results After treatment,the clinical symptoms showed significantly improvement in hemodiafiltration group and Levocarnitine combined with hemodialysis group(P＜0.05).SNCV showed significantly improvement than before treatment(P＜0.01) ，but more significantly improvement than the control group of hemodialysis (P＜0.05). The different in SNCV of hemodiafiltration group and Levocarnitine combined with hemodialysis group was not significantly after treatment（P＞0.05）.Conclusion Uremic peripheral neuropathy patients with conventional HD treatment while combined Levocarnitine or hemodiafiltration therapy can effectively improve peripheral neuropathy, more cost effective treatment can be choosed in accordance with the specific circumstances of the patients. Metrics

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The alteration of T-lymphocyte subsets in hemodialysis patients with chronic hepatitis B and its influencing factor 2013, 12 (07):  375-378.  doi: 10.3969/j.issn.1671-4091.2013.07.00 Abstract ( 133 )   HTML ( 1 )   PDF (549KB) ( 145 )   【Abstract】Objective To investigate the alteration of T-lymphocyte subsets in hemodialysis patients with chronic hepatitis B (CHB-HD) and its influencing factor. Methods Two groups of patients were included for investigation: 43 HD patients with CHB (CHB-HD group) as study group, and 46 HD patients with non-CHB (HD group) as control group. T-lymphocyte subsets were measured by flow cytometry. Biochemical parameters, hs-CRP and iPTH were also measured. The differences between two groups were analyzed and influencing factors of T-lymphocyte subsets in CHB-HD patients were determined. Results Compared with ordinary HD patients, the alteration of T-lymphocyte subsets in CHB-HD patients were mark: CD3+T-lymphocytes were greatly reduced（883.12±331.74 / mm3 vs 1060.94±337.01 / mm3, P＜0.05）;CD8+ T-lymphocytes were also dramatically decreased（336.65±153.95 / mm3 vs 441.89±209.76 / mm3, P＜0.05. Pearson correlation analysis showed that the count of CD3+,CD8+ T-lymphocyte and the level of PALB were positively correlated. Conclusion The disorders of T-lymphocyte subsets in hemodialysis patients with chronic hepatitis B were further aggravated than ordinary hemodialysis patients, and the levels of ALB and PALB maybe positively correlated with these change Metrics

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Effect of different dialysis membrane on mineral metabolism and micro-inflammatory status of maintenance hemodialysis patients 2013, 12 (07):  379-383.  doi: 10.3969/j.issn.1671-4091.2013.07.00 Abstract ( 400 )   HTML ( 1 )   PDF (497KB) ( 357 )   Objective The aim of this study is to compare the effect of three dialyzers with different dialysis membranes and membrane area on mineral metabolism and micro-inflammation status of maintenance hemodialysis(MHD) patients. Method 40 MHD patients were recruited and randomly assigned to 3 groups: 16 patients in FX group (German Fresenius company FX60 high-flux dialyzer, membrane area of 1.3 m2), 14 patients in TS group (Japanese TORAY company TS-1.3S high-flux dialyzer, membrane area of 1.3 m2), 10 patients in CA group (United States Baxter company CA-HP-170 low-flux dialyzer, membrane area of 1.7 m2). All patients received four-hour dialysis three times per week. Serum level of urea nitrogen(BUN), creatinine(Cr), uric acid(Ua), albumin(ALB), calcium(Ca), phosphorus(P), intact PTH(iPTH), beta2-micro-globulin concentration(β2-MG), high-sensitive C-reactive protein (Hs-CRP), superoxide dismutase(SOD), interleukin-6( IL-6), malondialdehyde (MDA), tumor necrosis factor-α（TNF-α）， at baseline and the end of 3rd and 6th month were compared. Results There is no significant change in serum levels of BUN, Cr, Ua, P, iPTH, Hs-CRP and IL-6 from baseline to the end of 3rd and 6th month(P＞0.05). In all groups serum levels of β2-MG decreased significantly at the end of 3rd month and kept stable(P＜0.05). In all groups serum levels of ALB increased at the 3rd, but in CA group it decreased significantly at 6rd(P＜0.05). Serum level of TNF-α increased in CA group while decreased in FX group and TS group(P＜0.05). In CA group serum level of MDA increased significantly(P＜0.05), level of SOD decreased insignificantly. In FX group and TS group serum levels of MDA decreased significantly(P＜0.05)，serum levels of SOD decreased significantly at 3th month(P＜0.05), and they both further decreased significantly from the 3rd to the 6th month(P＜0.05). Conclusion (1)Small-area high-flux dialysis is comparable with low-flux hemodialysis on the removing of small molecular uremic toxins. (2)High-flux dialysis may improve micro-inflammation state, reduce oxidative stress, and keep the balance of nutritional status of MHD patients. (3)Using superior dialyser and high quality dialysate, avoiding contamination during dialysate can reduce the risk of dialysis-related amyloid(DRA). Metrics

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Prognostic analysis of 102 cases of acute kidney injury patients with renal replacement therapy 2013, 12 (07):  384-389.  doi: 10.3969/j.issn.1671-4091.2013.07.00 Abstract ( 126 )   HTML ( 0 )   PDF (914KB) ( 208 )   Purpose： Analyze AKI patients who undertook renal replacement therapy (RRT) to screen the important indicators to decide the appropriate timing of RRT and its influence on prognosis. Method： The clinical data of 507 AKI patients were reviewed. 102 AKI patients who undertook RRT with complete medical records were further analyzed to reveal the relationship between clinical data and prognosis. Statistical methods were used to screen the important indicators of the appropriate timing of RRT. Results： TCO2 and urine volume were screened as predict factors of prognosis after the comparsion of the relationship of data at the onset of RRT and the prognosis. Further analysis revealed that MODS was also a powerful factor. The prediction model for AKI patients who undertook RRT was established after multiple variable Logistic regression analysis. The sensitivity and specifity of the model was respectively 78.8% and 78.0%, and the area under ROC was 0.809. The Hosmer-Lemeshow goodness-of-fit tests of the model was P=0.295. Conclusion： (1) Under the senario of the same disease and clinical background, the recovery of kidney function may benefit from initiating RRT before urine output＜600ml/d and/or TCO2＜22.2mmol/L. (2) As an independent risk factor, MODS indicates a worse prognosis; the determinant of improving clinical outcome of AKI is initiating RRT before MODS occurs. Metrics

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Color doppler ultrasound diagnosis self internal arteriovenous fistula with fresh cephalic vein thrombosis in 1 case 2013, 12 (07):  389-389.  Abstract ( 176 )   HTML ( 0 )   PDF (322KB) ( 191 )   彩色多普勒超声诊断自体动静脉内瘘头静脉新鲜血栓1例 “新鲜血栓灰阶声像图不显示”这种情况在门脉、下肢动脉、颈动脉等血管超声检查中也是如此的，初学者容易 误漏诊，故予以报道。 Metrics

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The assessment of the extended care for hemodialysis patients with hypertension 2013, 12 (07):  404-406.  doi: 10.3969/j.issn.1671-4091.2013.07.00 Abstract ( 108 )   HTML ( 0 )   PDF (491KB) ( 169 )   【Abstract】 Objective To study the effect of the extended care program for hemodialysis patients with hypertension. Methods The extended care program was performed in the intervention group. Knowledge of hypertension, life habits, blood pressure and body mass index in the patients were evaluated after the intervention. Results The level of hypertension knowledge was significantly higher in the intervention group than in the control group (P＜0.05). After the intervention, life habits improved (P＜0.05), and systolic and diastolic blood pressure decreased (P＜0.05). Conclusion The extended care program is beneficial to improve the knowledge of hypertension, life habits, and health conditions, and is worthwhile to be used extensively. Metrics