Chinese Journal of Blood Purification

12 November 2013, Volume 12 Issue 11 Previous Issue    Next Issue

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Inflammatory cytokine TNF-α/IL-6 related to muscle wasting and up-regulated expression of myostatin and Atrogin-1 in hemodialysis patients 2013, 12 (11):  581-585.  doi: 10.3969/j.issn.1671-4091.2013.11.00 Abstract ( 289 )   HTML ( 5 )   PDF (537KB) ( 467 )   Objective Although a lot of research confirmed elevated systemic inflammation related to malnutrition in advanced chronic kidney disease (CKD), few clinic research revealed the mechanism of inflammatory cytokines impacted muscle wasting in patients with CKD. This study investigates the serum cytokines level and muscle wasting of patients with underlying maintenance hemodialysis (HD) and the expression of genes involved in the regulation of muscle atrophy. mass and that for the inflammatory cytokine TNF-α /IL-6 in muscle biopsies. Methods HD patients were selected according to the enrolled standard as HD group, 30 healthy adults with gender and age matched as control（Ctl）. We collected the biochemical and anthropometry data, measured inflammatory cytokine such as C-reactive protein( CRP), interleukin-6(IL-6) and tumor necrosis factor alpha(TNF-α) by ELISA with their serum samples. Then we got muscle sample from 6 HD patients and 4 non-HD patients, observed the muscle histology by light scope after HE staining, and analyzed the transcriptional levels of myostatin and Atrogin-1, TNF-α and IL-6 by real-time PCR. Results 42 patients enrolled in the study. The HD patients showed lower body weight and body mass index, the plasma total protein, albumin level and pre-albumin showed lower though still kept in normal limits. Also, HD had an abnormal renal function ( elevated of BUN, Serum creatinin and urea acid), slightly anemia, and higher levels of serum inflammatory cytokines such as CRP, TNF-α and IL-6(p<0.05~0.01). The morphologic observation showed muscle fibers were tenuous and atrophy in an extent, the space between fibers was widen. The muscle fiber diameter was decreased compared with Ctl. Interestingly, the muscle myostatin and Atrogin-1 mRNA levels was elevated 5.96 fold and 2.43 fold respectively; and the TNF-α, Il-6 mRNA increased 8.37 fold and 3.36 fold respectively measured by RT-PCR. Conclusions CKD patients underlying hemodialysis present elevated inflammatory cytokines level and obviously muscle wasting. Up-regulation of TNF-α and IL-6 expression, stimulating the transcription of myostatin and Atrogin-1, might be an important mechanism of muscle wasting in CKD. Metrics

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Evaluation of ischemia modified albumin for cardiovascular events in patients on peritoneal dialysis 2013, 12 (11):  586-589.  doi: 10.3969/j.issn.1671-4091.2013.11.00 Abstract ( 150 )   HTML ( 0 )   PDF (383KB) ( 198 )   Objective To analysis the relationship between dynamic changes of ischemia modified albumin (IMA) and major adverse cardiovascular events (MACE) in patients on peritoneal dialysis. Methods A total of 78 end stage renal disease patients on peritoneal dialysis over 3 months were enrolled. According IMA level, they were divided into high IMA group(IMA≥85.56KU/L) and normal IMA group(IMA<85.56KU/L). IMA level was repeated measurement in 6th month、12th month、18th month, 24th month after enrollment, and MACEs were recorded, non cardiovascular events survival were calculated. Results: There were 30 patients in high IMA group, and 19 cases suffered MACE during 24 months following-up. There were 48 patients in normal IMA group, and 6 cases suffered MACE during 24 months following-up（?2=21.91，P<0.001）. In high IMA group, IMA level measured in 18th months and 24th months were significantly higher than that measured when enrolled（96.69±18.18 KU/L vs 86.67±19.34 KU/L, t=2.28 P=0.03;98.03±18.56 KU/L vs 86.67±19.34 KU/L，t=2.56，P=0.01）. Non cardiovascular events survivals calculated in 6th month、12th month、18th month、 24th month were 0.77、0.60、0.43、0.37 in high IMA group. There were no significant changes of IMA level in normal IMA group. Survival analysis showed that there were significant difference between two groups in non-MACE survival（Log rank statistic ?2=22.66，P<0.001）. Conclusions: There is an increasing trend of IMA level in high IMA group, and MACE occurs gradually increased during following-up. IMA can be used as a good predictor of peritoneal dialysis patients with MACE. Metrics

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Analysis of drug resistance of pathogenic bacteria and disease prognosis in Peritoneal Dialysis-Related Peritonitis: a study of 91cases 2013, 12 (11):  590-593.  doi: 10.3969/j.issn.1671-4091.2013.11.00 Abstract ( 153 )   HTML ( 0 )   PDF (333KB) ( 222 )   【Abstract】 Objective To investigate the correlation between drug resistance of pathogenic bacteria and patient prognosis in peritoneal dialysis-related peritonitis in a single peritoneal dialysis center. Methods Ninety-one peritonitis episodes in 61 patients from January 2008 to January 2013 were analyzed. The incidence of peritonitis, pathogenic bacteria and drug-resistant strain distribution, and the relationship between drug-resistant bacteria and prognosis were retrospectively analyzed. Results There are 71 cases culture-positive and 20 cases culture-negative in bacterial culture. The culture positive rate and negative rate occupy 78.0% and 22.0% respectively. Among the culture positive peritonitis episodes, there are 32 cases with gram-positive bacteria infection, 31 cases with Gram-negative bacteria infection, 1 cases with mixed bacteria infection and 9 cases with fungal infection. Staphylococcus epidermidis and Escherichia coli are the most common pathogens in gram-positive bacteria and gram-negative bacteria separately. Gram-positive bacteria are resistance to Oxacillin and Cefazolin (80.8%) and susceptible to Vancomycin and Teicoplanin. Gram-negative bacteria are resistance to Ceftazidime and Aztreonam (23.1% to 26.9%) and susceptible to Amikacin. There is no statistically significant change in drug resistance rate among the dropout patients (66.7%（8/12）), relapsed patients (50.0（5/10）) and cured patients (58.1%（25/43）)（p>0.05）.Conclusion The characteristics of peritoneal dialysis related peritonitis caused by different pathogens are varied from drug resistance, antibiotic selection and curative efficacy and prognosis. The initial treatment of peritonitis should be based on the principles of “individualized treatment” to choose appropriate antibiotics, which is according to the analysis of etiology, clinical feature and drug susceptibility of patient. Bacterial resistance to empirical antibiotics is not the main reason contributes to the disease recurrence and exit. Metrics

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To investigate the use of long-term central venous catheter in maintenance hemodialysis patients 2013, 12 (11):  594-597.  doi: 10.3969/j.issn.1671-4091.2013.11.00 Abstract ( 143 )   HTML ( 0 )   PDF (356KB) ( 220 )   Objective To investigate the complications and the treatments of long-term central venous catheter in maintenance haemodialysis patients. Method To retrospective review 339 cases of long-term central venous catheter indwelled in our hospital,and analyse the complications and management during catheterization and use . Results The success of catheterization is 100%.35 patients dead during follow-up process, non of them is catheter-associated.The catheters’ average retention time of the rest 304 patients is 20.0±15.9 months. The major complications during catheterization:the guide wire can not enter the blood vessels in 2 cases,errhysis in 3 cases,palpitate in 4 cases,subclavian vein injuried 1 case,angle of torsion 1 case.Complications in catheter use process:catheter infection in 11 cases,lack of flow 24 cases,the head tube cracks in 1 case.The total of extubation is 25cases. Conclusion For the persistent hemodialysis patients who were not suitable to establish the arteriovenous fistula, the long-term tunneled central venous catheter could be used as vascular access ideally, except that we should pay attention to preventing and treating the complications. Metrics

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Endovascular therapy to the upper extremity edema syndrome and analyzing to recurrence. 2013, 12 (11):  598-601.  doi: 10.3969/j.issn.1671-4091.2013.11.00 Abstract ( 231 )   HTML ( 0 )   PDF (528KB) ( 187 )   Objective To analyze the clinical characters of upper extremity edema syndrome in hemodialysis patients, explore the endovascular therapy way to this syndrome and investigate the recur causes . Methods Eighty eight upper extremity edema syndrome patients were recruited. And 116 percutaneous transluminal angioplasty therapies were carried out. The subjects were classified into two groups according to whether the edema symptoms were emerged once more. If central vein stenosis or obstruction were diagnosed with X ray, endovascular therapies including angioplasty or stent placement. Evaluate the relation between the central vein stenosis and the history of central venous catheter inserted and investigate the influencing factors to recurrence. Results All patients received endovascular therapy were recovered unless fifteen patients received other therapies and central vein stenosis were not found in three patients. Fifty patients had the history of ipsilateral central vein catheter inserted. From the fistulation to the symptom of upper extremity edema appeared , 26.4±32.5 months had been passed. Central vein stenosis or obstruction in subclavian vein and brachiocephalic vein were mostly been seen among all causes. In the investigating duration, 23 patients had to face the recurrence of the edema and total recur were 35 times within 7 months after endovascular therapy. And statistical difference were not found between two groups (P＞0.05). But the ratio of stent placement in recurrence group was higher though statistical difference wasn’t existed (P＞0.05). Conclusion The upper extremity edema syndrome in hemodialysis patients was caused by the insertion of the central vein catheter and the change of hemodynamics in the central vein after fistula. Recurrence often be seen in these patients even if they had been received endovascular therapy, especially in the patients who received stent placement. Metrics

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Application of 10% Cefazolin-30% sodium citrate lock solution in maintenance hemodialysis patients with long-term catheter indwelling 2013, 12 (11):  602-604.  doi: 10.3969/j.issn.1671-4091.2013.11.00 Abstract ( 258 )   HTML ( 0 )   PDF (313KB) ( 147 )   [Abstract]:OBJECTIVE To determine whether 1% Cefazolin-30% sodium citrate prevents the catheter-related bacteremia and influences the incidence of the dysfunction of catheter.METHODS A randomized prospective controlled study was undertaken.25 hemodialysis patients were randomly divided into two groups,13 of group patients receive 1% Cefazolin-30% sodium citrate into each lumen of the catheter three times a week,12 of control group patients receive heparin locks only three times a week for 6 months.The incidence rates of the catheter-related bacteremia,the catheter dysfunction,and other adverse reactions were recorded. RESULTS The incidence of catheter-related bacteremia was 0.85/1000 catheter days in the group and 2.29/1000 catheter days in the control group, The incidence of catheter dysfunction was 1.17% in the group and 2.87% in the control group, The incidence of catheter-related bacteremia and catheter dysfunction between the two groups was statistically significant(p＜0.01）.The serum Ca2+、Mg2+、ALT、AST between the two groups showed no obvious changes before and after treatment(p＞0.05）.The main side effect in the group was 4.2‰,the symptom was spontaneous remission.CONCLUSION As compare with the heparin catheter locks, 1% Cefazolin-30% sodium citrate can effectively reduce the catheter-related bacteremia and catheter dysfunction,and it was safer. Metrics

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Non-traumatic rhabdomyolysis induced acute renal failure clinic and prognosis analysis of 18 cases 2013, 12 (11):  605-607.  doi: 10.3969/j.issn.1671-4091.2013.11.00 Abstract ( 174 )   HTML ( 2 )   PDF (304KB) ( 182 )   Objective To investigate the etiological factors, clinical characteristics and prognosis of acute kidney injury (AKI) due to non-traumatic rhabdomyolysis (RM). Methods A total of 18 patients (mean age 55.3±11.2 years; 10 males and 8 females) with RM-AKI were enrolled in this study. Serum creatine phosphokinase (CPK), lactate dehydrogenase (LDH), serum myoglobin (Mb), electrolytes, liver function (GPT, GOT and AKP), renal function (BUN, and Scr), uric acid (UA), blood gas, and electrocardiogram were assayed. The comprehensive therapy included quick volume restoration and alkalifying urine, local treatment of swollen limb, diuretics, and correction of acid-base imbalance and electrolyte disturbances, and blood purification treatment. Results After volume restoration and blood purification treatment, 2 cases (13.33%) died of underlying diseases and multiple organ failure, and 16 cases completely recovered from AKI and discharged from the hospital. Conclusion RM is a major cause of AKI. RM is not an uncommon disease, and the proportion of RM due to non-traumatic causes becomes higher recently. Serum CPK and blood biochemical parameters can be used for the early diagnosis of RM-AKI. Early comprehensive therapy including blood purification treatment can improve the prognosis. Higher mortality rate was found in older patients with underlying diseases. Metrics

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Retrospective analysis of continuous blood purification treatment effect of HELLP syndrome combined MODS 2013, 12 (11):  608-611.  doi: 10.3969/j.issn.1671-4091.2013.11.00 Abstract ( 112 )   HTML ( 0 )   PDF (345KB) ( 217 )   【Abstract】 Objective To investigate the effect of continuous blood purification(CBP) for the treatment of HELLP syndrome combined MODS. Methods Retrospective analysis of 15 patients, timely termination of pregnancy, given comprehensive treatment and other medical intensive care at the same time, plus CBP treatment,the clinical data with the discharge admission and peak were statistically analyzed and compared,these projects included: APPCHEⅡscore,HR, RR, MAP, oxygenation index, LDH, ALT, total bilirubin, platelet count, and other physical and chemical indicators, as well as patients with an average days of ICU stay, days of mechanical ventilation and CBP times. Results 15 patients, 12 had been cured, CBP (4.2±1.6) times, days of mechanical ventilation (4.9±2.1,n=9)d, days of ICU stay (7.3±2.3)d; patients with poor organ function at admission, during hospitalization further increase until it reaches peak, after CBP treatment, these patients turned clear consciousness, breathed steady, normal diet, gradually eliminated the headache, dizziness, blurred vision, nausea, jaundice, bleeding ,oliguria and other symptoms; compared with admission and peak, various physical and chemical indicators of the discharge had a greater degree of improvement, the difference was statistically significant p<0.05,as TBIL, BUN, CR, etc. decreased significantly, LDH, PT, liver enzymes, low platelet count recovery faster, anemia had been corrected, MAP had returned to normal;APACHEII score discharge(12.1±9.8)points, admission(21.9±8.7)points,and peak(32.5±6.4)points, compared respectively, There were statistically significant difference, p<0.05, CBP treatment significantly. Conclusion The treatment with CBP can reduce the clinical symptoms, reverse rapidly deteriorating physical and chemical indicators, improve the cure rate and can be an effective treatment of HELLP syndrome combined MODS. Metrics

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Effects of individualized interventions on home blood pressure and blood pressure variability in maintenance hemodialysis patients with hypertension 2013, 12 (11):  612-616.  doi: 10.3969/j.issn.1671-4091.2013.11.00 Abstract ( 133 )   HTML ( 0 )   PDF (260KB) ( 235 )   【Abstract】 Objective To investigate home blood pressure variability in maintenance hemodialysis patients(MHD) with hypertension , and then observe the effects of individualized therapeutic interventions on home blood pressure variability in these patients. Methods Home blood pressure monitoring was carried out in stable MHD in our hospital. The coefficient of variation(CV) was used as indicator parameters for variability of home blood pressure. Home systolic blood pressure ≥ 150mmHg was defined as uncontrolled hypertension. Patients with uncontrolled hypertension were subject to bioimpendance analysis, serum sodium measurement, and antihypertensive agent evaluation. Individualized interventions including reducing dry body weight, negative sodium gradient dialysis and re-adjusting antihypertensive agents were applied accordingly. The patients were followed for 2 months, home blood pressure and blood pressure variability were monitored. Results Total 105 MHD patients conducted home blood pressure monitoring. The average CV of home blood pressure was 4.8±2.2/5.0±2.4%. Among the 105 patients, 60 patients were determined as uncontrolled hypertensive patients(57.1%). After the individualized interventions, home blood pressure fell from 166.3±12.6/87.5±11.7mmHg to 154.1±14.2/82.6±11.4mmHg（P<0.001,T=7.223,P<0.001,T=4.796）， home systolic blood pressure variability fell from 4.9±2.2% to 4.6±2.5%. Thirty overhydrated patients had their dry body weight reduced under guidance of bioimpedance technique, which resulted in significant decreases in home blood pressure, CV of home systolic and diastolic blood pressure (0.4% and 0.1%) and dose of antihypertensive agents. Twelve patients were subject to negative sodium gradient dialysis, significant decrease in home blood pressure were discovered, however, there is no difference in home blood pressure variability was detected. The other 18 patients had their home blood pressure significantly reduced by re-adjusting antihypertensive drugs; no siginificant change in coefficient of variation of home blood pressure was found. Conclusions Individualized interventions can improve home blood pressure control and blood pressure variability. Metrics

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The risk factors of maintenance hemodialysis patients with hepatitis C virus infection 2013, 12 (11):  617-620.  doi: 10.3969/j.issn.1671-4091.2013.11.00 Abstract ( 123 )   HTML ( 0 )   PDF (340KB) ( 156 )   [Abstract] Objective The aim was to investigate the incidence of hepatitis C virus infection among hemodialysis patients and find out the related risk factors. Methods We take 183 patients who are treated in our hemodialysis center over 3 months as the object of study and collect the information to analyze. Results 19 patients(10.38%) have infection in our center. Positive anti-HCV antibody was found in 13 patients, and HCV-RNA was found in 19 patients. Univariate analysis of the 2 groups indicated that the HCV infention was associated with more times of allopatric hemodialysis, longer duration on hemodialysis, total times on hemodialysis, dialyzer reuse, history of hepatitis B (P＜0.05 ). Logistic analysis indicated that allopatric hemodialysis（OR=1.060，95%CI=1.019~1.103，P=0.004）and infection of HBV（OR=3.816，95%CI=1.119~13.009，P=0.032）were the independent risk factors of HCV infection. Conclusion Maintenance hemodialysis patients are high-risk groups of HCV infection. Adopting strict isolation and comprehensive measures（establish the specialzed rooms for HCV positive patients and HCV negative patients with separated machines, proper P/N ratio, avoid from sharing the same intravenous drug and reusing dialyzer, reducing allopatric hemodialysis）can reduce the HCV infection rate among hemodialysis patients. Metrics

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The clinical outcomes of four different kinds and different doses’ phosphate binders on maintenance hemodialysis patients 2013, 12 (11):  632-634.  Abstract ( 404 )   HTML ( 0 )   PDF (241KB) ( 229 )   【Abstact】 objective To assess the effects and side effects of four kinds of phosphate binder on changes of serum phosphorate、serum total calcium、calcium-phosphorus product、intact parathyroid hormone in maintenance hemodialysis patients. Methods 43 patients with serum phosphorus > 1.78 mmol/L and non-use active vitamin D3 more than one week were randomly divided into 4 groups, group A includes twelve patients who taking calcium carbonate (300 mg, bid); Group B includes thirteen patients who taking lanthanum carbonate (500 mg, bid); groups C includes ten 10 people who taking sevelamer hydrochloride (800 mg, bid); groups D includes eight people who taking aluminum hydroxide (300 mg, tid); Group E includes nine patients who not taking any phosphate binder as control group. All of medicines were chewed at meals. Two weeks later, we compared the changes of serum phosphate、serum total calcium、calcium-phosphorus product、parathyroid hormone with themselves and different groups. The date was analyzed by the spss 13.0 software. Results (1) self-control before and after treatment, the serum phosphate reductions and serum iPTH reductions was statistically significant in all four groups; the serum calcium reductions was statistically significant in group B and group D; the serum calcium-phosphorus product reductions were statistically significant in group B,C,D.(2) compared with different groups on the serum phosphate reductions and serum iPTH reductions , B group, C group, D group were significant higher than group A (P < 0.01) , the group B,C,D were not statistical different; on the serum calcium-phosphorus product reductions , group B ,C, D were significant higher than group A (P < 0.01) , group D was significant higher than group B (P < 0.01), group B, C was not statistically different; on the serum total calcium reductions, group D was significantly higter than group B, C that was not statistically different (3) All the four groups were not statistically different on side effects. Conclusions All the four different kinds of phosphate binders have effects on serum phosphate and serum iPTH reductions using the above doses in the same time； calcium carbonate is weaker than others on serum phosphorus, calcium-phosphate product and iPTH reductions. Lanthanum carbonate and sevelamer hydrochloride have no significant difference on the contrast items; aluminum hydroxide is better than others on serum calcium and calcium-phosphate product reductions. Metrics

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Application of Nursing Skills in the Non-Operative Treatment of Peritoneal Dialysis Catheter Migration 2013, 12 (11):  635-637.  doi: 10.3969/j.issn.1671-4091.2013.11.00 Abstract ( 237 )   HTML ( 2 )   PDF (302KB) ( 204 )   Objective: To summarize the incidence of peritoneal dialysis catheter migration and nursing experience of non-operative catheter replacement. Methods: We calculated the success rate of non-operative replacement, analyzed related risk factors of catheter displacement, discussed the importance of nursing instruction in catheter reset. Results: Catheter shift occurred in 48 (14.96%) patients during follow-up. Constipation was the main reason causes catheter displacement. The success rate of reposition by non-operative nursing methods was higher in straight group than that in curly group (97.1% vs 15.4%, p<0.05). Conclusions: Curled catheter had a higher catheter tip migration rate and was less likely to be repositioned by non-operative methods than straight catheter. The nursing experience played an important role during the catheter reposition. Metrics