Chinese Journal of Blood Purification

12 September 2013, Volume 12 Issue 09 Previous Issue    Next Issue

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The Cardiac structural abnormalities and its effct on the prognosis of maintenance hemodialysis patients 2013, 12 (09):  465-469.  doi: 10.3969/j.issn.1671-4091.2013.09.00 Abstract ( 287 )   HTML ( 1 )   PDF (335KB) ( 350 )   Objective To investigate the changes of cardiac structure and function in maintenance hemodialysis（MHD） patients, as well as to explore the relationship between the changes and cardiocerebrovascular events. Methods The study included two parts:Cross-sessional study and prospective cohort study. 115 MHD patients were enrolled.Baseline anthropometric and laboratory parameters were measured and echocardiography was performed to assess the cardiac structure and function.The cardiocerebrovascular events during the 2 year follow-up period were documented. Results In all patients, valve calcification were observed in 92 (80%) patients, left ventricular hypertrophy in 80 (69.6%) patients, left atrial enlargement in 75 (65.2%) patients, pulmonary hypertension in 13(11.3%) patients.98 (85.6%) patients had cardiac diastolic dysfunction while only 9 (7.83%) patients had cardiac systolic dysfunction.Multivariate logistic regression analysis revealed that the independent associations of the different echocardiographic abnormalities were: valve calcification – increased age and lower serum triglyceride; left ventricular hypertrophy – higer systolic blood pressure; left atrial enlargement – lower blood diastolic pressure and urea reduction ratio. During the follow-up period ,there were 23(20.0%) cardiocerebrovascular events,18（15.7%） deaths, of which 12 were attributable to cardiovascular disease.In event group , the incidence of hypoalbuminemia and C- reactive protein (CRP) positive , left atrial size and LVMI were significantly higher than those of in control group(P <0.05).The independent risk factors for cardiocerebrovascular event were decreased serum albumin, positive CRP and left atrial enlargement. Conclusions Echocardiographic cardiovascular disease are already present in a very high proportion of MHD patients and are independent risk factor for adverse outcomes. Echocardiography should be performed periodically to detect early structural and functional changes in MHD patients . Metrics

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A research of Macromolecules toxin removal and clinical efficacy of pruritus of hemodialysis combined with hemoperfusion on uremia patients 2013, 12 (09):  470-474.  doi: 10.3969/j.issn.1671-4091.2013.09.00 Abstract ( 141 )   HTML ( 0 )   PDF (360KB) ( 396 )   A research of Macromolecules toxin removal and clinical efficacy of pruritus of hemodialysis combined with hemoperfusion on uremia patients HUANG Yong-zhang , XIAO Jie , XU Mi-qing . Department of Nephrology , The First Affiliated Hospital of Guangzhou Medical College ,Guangzhou 510120 , China Corresponding author：XU Mi-qing , Email: gyeyxu@163.com [ Abstract ] Objective To observe the effect of hemodialysis combined with hemoperfusion on uremic treatment effect. Methods 40 cases of maintenance hemodialysis (MHD) patients with uremia were randomly divided into hemodialysis ( HD ) group and hemodialysis combined with hemoperfusion ( HD+HP ) group. There were 20 cases in each group. Advanced glycation end products( AGEs ), homocysteine( Hcy ), parathyroid hormone( PTH ), β 2-Microglobulin( beta 2-MG ) of all patients were tested before and after the first treatment, before and after 12 weeks of treatment during serum. The efficacy of itching on MHD patients with uremia of both group were clinical observed. The correlation of changes of indexes and complications were analyzed. Results AGEs, Hcy, PTH,β 2-MG index in HD+HP group were lower than that of HD group after 12 treatments, P 0.05（0.867,0.054,0.727 in turn）. rs =0 ~ 1 between the reducing of PTH and β 2-MG and the remission of skin itching, P<0.05（0.045,0.037 in turn）. Conclusion HD+HP can effectively remove AGEs, Hcy, PTH and β 2-MG and remarkably release intractable pruritus in MHD patients. Level of blood PTH and β2-MG had positive correlation with uremic pruritus symptom. Metrics

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The effect of blood lipid-regulating treatment on atherosclerosis in patients with maintenance hemodialysis 2013, 12 (09):  475-478.  doi: 10.3969/j.issn.1671-4091.2013.09.00 Abstract ( 98 )   HTML ( 0 )   PDF (343KB) ( 290 )   【Abstract】Objective To evaluate the effect of blood lipid-regulating treatment on atherosclerosis in patients with maintenance hemodialysis.(MHD). Methods Sixty-three patients on maintenance hemodialysis in our dialysis center in Jan 1,2009-Jan 30,2010 were choiced in this study. Patients were divided into cntrol group and treatment group ,36 patients in treatment group were given lipid-lowering drugs for 3 years, Alll patients underwent a carotid artery examination. Intima-medial thickness ( IMT) of carotid arteries and the presence of atherosclerotic plaques were determined by the 3-9MHZ cobr Doppler ultrasonography(IU22). total cholesterol ( TC) , triglyceride(TG), high density lipoprotein cholesterol(HDLC), low density lipoprotein cholesterol(LDLC ) were determined as well. Results In the 3 years of follow-up, The average IMT were significantly increased in cntrol group patients (0.95±0.91 vs 1.37±0.89，P <0.05；0.95±0.91 vs 1.41±0.93，P <0.05；0.95±0.91 vs 1.57±0.99，P <0.01), and only in 3th year in treatment group patients(1.17±0.87 vs 1.50±0.55，P<0.05). The average IMT were significantly lower in patients with treatment group compare to cntrol group (1.18±0.75 vs 1.37±0.89， 1.13±0.78 vs 1.41±0.93 1.36±0.55 vs 1.57±0.99， P < 0. 01). The positive rate of atherosclerotic plaque were significantly lowered in patients with treatment groupcompare to cntrol group ( P < 0. 05), Carotid artery stenosis rate in patients with treatment group were significantly lower than in in patients with control group ( P < 0. 05). Conclusion The lipid lowering treatment can reduce the level of IMT ,decrease occurrence rate of atherosclerotic plaque and allivate The rate of carotid artery stenos in patients with maintenance hemodialysis. Metrics

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Effects of continuous venovenous haemodiafltration on levels of HMGB-1 and TGF-β in dogs with multiple organ dysfunction syndrome 2013, 12 (09):  479-482.  doi: 10.3969/j.issn.1671-4091.2013.09.00 Abstract ( 105 )   HTML ( 0 )   PDF (366KB) ( 174 )   【Abstract】Objective To investigate the effects of continuous venovenous haemodiafltration (CVVHDF) on levels of LPS、CD14、HMGB-1 and TGF-β in multiple organ dysfunction syndrome (MODS )dogs, and explore the treatment mechanism of CVVHDF. Methods Dogs were subjected to hemorrhasie shock plus resuscitation and endotoxemia to set up MODS model, then they were randomly divided into 2 groups：MODS group (n = 6) and CVVHDF group (n = 6). After endotoxin injection complete ，the CVVHDF group received CVVHDF treatment for 24 h; MODS group did not receive CVVHDF treatment. The concentrations of LPS、CD14、HMGB-1 and TGF-β in plasma and ultrafiltrate were measured with different time points. Results P了asma levels of LPS、CD14 and HMGB-1 were signmcantly decreased in the CVVHDF group at T6、T7、T8 and T9 after endotoxin injection as compared with MODS group (P<0．05). TGF-β levels were increased in the CVVHDF group at T5、T6、T7、T8 and T9 after endotoxin injection as compared with MODS group (P<0．01). The sieving coeffcients (SC) for CD14、HMGB-1 and TGF-β were 0．78±0．10、0．7.±0．09 and 0．82±0．09.LPS could not be detected in the ultrafiltrate. CVVHDF treatment were significantly reduced the heart and the liver tissue damage. Conclusion CVVHDF could effectively reduce the levels of pro-inflammatory mediator and anti-inflammatory cytokine related to MODS, rebuild the immune steady-state and protect or gans injured further in the prevention and treatment of MODS. Metrics

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Beraprost sodium in elderly patients with uremia arteriovenous fistula Applied Research 2013, 12 (09):  483-486.  doi: 10.3969/j.issn.1671-4091.2013.09.00 Abstract ( 134 )   HTML ( 0 )   PDF (338KB) ( 189 )   Objective Observation of beraprost sodium on elderly patients action and effect of arteriovenous fistula .Methods The study included 82 elderly patients action venous fistula surgery were randomly divided into the beraprost sodium therapy group (n = 42), control group (n = 40) , the success rate of the two groups of arteriovenous fistula , the incidence of complications, fistula after the blood vessels and blood flow changes , blood and coagulation analyzer change, adverse drug reactions , clinical observation and comparison.Results Treatment of arteriovenous fistula after 2 weeks and 4 weeks of success rate (97.6%, 97.6%) higher than in the control group, the difference was statistically significant (x2=12.48 P=0.002; x2=11.72 P=0.014), the treatment group the incidence of postoperative complications (4.8%) than in the control group the incidence of postoperative complications (55%), the difference is statistically significance (x2=21.45 P=0.012), fistula postoperative around blood flow (406.4 ± 106.4) and the control group after around blood flow (228.20 ± 88.6), the difference was statistically significant (F=246.238, P=0.000), the treatment group before and after the blood and the blood coagulation analysis comparison, no significant difference (P>0.05).Conclusion Beraprost sodium can improve the intemal arteriovenous fistula operation success rate in elderly patients and curative effect. Metrics

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Clinical study on calcium-phosphorous metabolism in uremic patients on peritoneal dialysis or hemodialysis 2013, 12 (09):  487-490.  doi: 10.3969/j.issn.1671-4091.2013.09.00 Abstract ( 146 )   HTML ( 8 )   PDF (329KB) ( 418 )   Objective To observe the changes of calcium-phosphorous metabolism in patients with peritoneal dialysis or hemodialysis. Methods Serum calcium, phosphorus and parathyroid hormone (PTH) were measured in 45 peritoneal dialysis and 97 hemodialysis patients after the treatments for 0, 3, and 6 months. Their residual urine output was recorded. Patients with higher PTH were treated with calcitriol, and were treated with low calcium (1.25 μmol/l) dialysate for hemodialysis patients. Results At the beginning of the treatments, the prevalence rate of hyperphosphatemia, higher PTH, and lower PTH was 51.5%, 37.1% and 8.2%, respectively, in hemodialysis group, and was 22.2%, 17.8% and 24.4%, respectively, in peritoneal dialysis group, and the residual urine output >500 ml/day was found in 6.2% patients in hemodialysis group, and in 55.6% patients in peritoneal dialysis group, significantly different between the two groups. In hemodialysis and peritoneal dialysis groups, serum PTH decreased after the treatment with calcitriol and low calcium dialysate for 3 and 6 months (F=23.803 and 4.9896, respectively, P＜0.05). In hemodialysis group, serum calcium was lower than that before the treatment (F=19.879, P＜0.05). Conclusion For uremic patients, peritoneal dialysis was better than hemodialysis in maintenance of normal calcium phosphorus metabolism and protection of residual renal function. Appropriate diet, low calcium dialysate, and calcitriol therapy should be considered for improvement of calcium-phosphorus metabolism in dialysis patients. Metrics

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Multi-center investigation of life quality and its influence factors in patients with maintenance hemodialysis in the Deyang area 2013, 12 (09):  491-495.  doi: 10.3969/j.issn.1671-4091.2013.09.00 Abstract ( 88 )   HTML ( 0 )   PDF (339KB) ( 127 )   Purpose: To evaluate the quality of life (QoL) of maintenance hemodialysis (MHD) patients in Deyang area, as well as analysis which factor impact on QoL of MHD patients. Method: To adopt the method of multicenter questionnaire survey, 253 MHD patients coming from six blood purification centers in Deyang area were included. The survey investigated the general conditions and clinical data of the patients. QoL were investigated by using KDQOL-SFTM questionnaire. The research results were compared with the results in Beijing suburb and Guangzhou area, meanwhile, Stepwise multiple regression analysis was adopted to analyze the important factors that influence the QoL of MHD patients in Deyang area. Result: 1. The scores of MHD patients in Deyang Area are higher than MHD patients in Beijing suburb on Overall health, Physical functioning, Role limitations- physical, Role limitations- emotional, energy,symptom/problem list and Dialysis staff encouragement, while their scores were lower than MHD patients in Beijing suburb on Cognitive function, Quality of social interaction, Sexual function ,Working status and Patient satisfaction, the differences were statistically significant（P<0.05）;2. The scores of MHD patients in Deyang Area were higher than MHD patients in Guangzhou Area on Burden of kidney disease, Sleep, Social support, Dialysis staff encouragement and Patient satisfaction, while their scores were lower than MHD patients in Guangzhou Area on Social function, Role limitations- physical, Role limitations- emotional, Pain, Energy, Cognitive function, Quality of social interaction and Working status, the differences were statistically significant（P<0.05）; 3. The results of Stepwise multiple regression analysis indicated a negative correlation between the need for family members to accompany, the experience of 5.12 earthquake and scores on the Overall health. The scores of male patients on Overall health were higher than that of female patients.Conclusion: The QoL of MHD patients in Deyang Area was generally lower than the Guangzhou Area. The scores of MHD patients in Deyang Area on some fields of QoL were higher than MHD patients in Beijing suburb and Guangzhou Area. There was a negative correlation between the need for family members to accompany, the experience of 5.12 earthquake and scores on the Overall health. The scores of male patients on Overall health were higher than that of female patients. Metrics

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The study of adventitia applied slow-releasing rapamycin inhibiting intima hyperplasia of vascular grafts 2013, 12 (09):  496-500.  doi: 10.3969/j.issn.1671-4091.2013.09.00 Abstract ( 105 )   HTML ( 0 )   PDF (1156KB) ( 213 )   Objective Establish a model of rabbit PTFE artificial vascular grafts on infrarenal abdominal aorta and investigate the mechanism of rapamycin inhibiting restenosis. Methods 18 healthy male New Zealand rabbits weighted 2.5~3.0kg were randomly divided into 3 groups and established models of PTFE artificial vascular graft on abdominal aorta. Group A: the grafts accepted no any management; Group B: 0.5ml 20% pluronic F-127 gel was locally applied to the adventitia of the grafts and anastomoses; Group C: 0.5ml 20% pluronic F-127 gel containing 0.5mg rapamycin was locally applied to the adventitia of the grafts and anastomoses. The grafts were acquired one month after the experiment. Histomorphologic methods were used to detect the intima hyperplasia of the specimen. Electronic imaging system was used to measure the thickness of intima and media of the grafts followed by calculating the degree of intima hyperplasia (thickness of intima/thickness of media). α-actin, PCNA and p27kip1 were investigated by using immunohistochemistry. Data were analyzed by using SPSS13.0 statistics software and then were compiled in the form of（ ）. Results 1. One month after the operation, the intima of Group A and B thickened obviously （P＜0.05）in comparison to C. 2. Result of α-actin immunohistochemistry: the hyperplastic intima was marked obviously, which is consistent with the smooth muscle cells of blood vessels. 3. Result of PCNA and p27kip1 immunohistochemistry: both of them were stained in brown in cell nucleus, and expressed in the thickened intima of every group to study the difference. 4. Compared to A and B, the expression of α-actin and PCNA in C were remarkably inhibited（P＜0.05）, while the expression of p27kip1 was remarkably enhanced（P＜0.05）. No significant deviation was found among A and B（P＞0.05）. Conclusion 1. Smearing rapamycin mixed with pluronic F-127 gel on graft adventitia can effectively inhibit the hyperplasia of vascular smooth muscle cells. 2. The mechanism of rapamycin inhibiting restenosis may be related to increase the expression of p27kip1 and inhibition cell generation cycle. Metrics

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Current situation of clinical application in selective plasmapheresis 2013, 12 (09):  503-505.  Abstract ( 148 )   HTML ( 0 )   PDF (534KB) ( 507 )   Metrics

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Diagnosis and Treatment of edema-Hand Syndrome in 89 Hemodialysis Patients 2013, 12 (09):  513-514.  Abstract ( 280 )   HTML ( 0 )   PDF (245KB) ( 202 )   Abstract Purpose The experience of diagnosis and treatment of hemodialysis patients’ affected extremities edema was summarized. Method After the internal arteriovenous fistula operation, there were 89 patients suffered from edema-hand syndrome, who had to make branches ligated by an operation, have boles frapped by suture set, make braces implanted, even internal fistula shut. Result The edema of hands disappeared in 89 patients after treatment. Conclusion It is a best way for edema-hand syndrome patients to take routine physical examinations and ligate branches by an operation. If there was deep phlebostenosis or thrombus, and reducing impulse of internal orificium fistulae still couldn’t make the edema disappeared, it would be more beneficial to shut the internal fistula down than to implant braces, or expand saccules. Key words: Hemodialysis，Edema-hand syndrome, Operation, Ligating- branch braces Metrics

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Understanding and Interpretation on the Guideline of Dialyzer Priming of SOP 2010 2013, 12 (09):  520-521.  Abstract ( 192 )   HTML ( 2 )   PDF (264KB) ( 284 )   Combined with the pratice of herself, The author interpreted the keypoints and principals of the guidelines for dialyzer priming in SOP 2010. Metrics