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Chinese Journal of Blood Purification

    12 October 2013, Volume 12 Issue 10 Previous Issue    Next Issue
    Bone histology in 25 ESRD patients with high turnover renal bone disease
    2013, 12 (10):  534-537.  doi: 10.3969/j.issn.1671-4091.2013.09.00
    Abstract ( 122 )   HTML ( 0 )   PDF (452KB) ( 252 )  
    Objective To investigate the characteristics of renal bone disease especially the high turnover bone disease and to evaluate the significance of various clinical biomarkers for renal bone disease by histological observation of bone biopsies from chronic kidney disease (CKD) patients at stage 5 and on maintenance hemodialysis. Methods Bone biopsy was performed in 40 CKD patients at stage 5 as well as 3 normal persons. Bone biopsies were studied by histomorphometric measurement using an automatic image analysis system. Serum level of biomarkers and bone pathological parameters were studied by correlation analysis. Results Twenty-five of the 40 uremic patients (62.5%) were found to have high turnover bone disease based on bone histological changes. High turnover bone disease was characterized by the hyperactivity of osteoclasts with or without bone mineral deposit impairment. There was a close relationship between serum levels of calcium and osteocalcin and histomorphometric parameters. Conclusions High turnover bone disease is the major type of bone disease in CKD patients at stage 5. Serum levels of calcium and osteocalcin may be predictive for high turnover bone disease in clinical practice. Bone biopsy is still the essential approach for the diagnosis.
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    Risk factors for cardiac valve calcification in maintenance hemodialysis patients
    2013, 12 (10):  538-542.  doi: 10.3969/j.issn.1671-4091.2013.09.00
    Abstract ( 200 )   HTML ( 0 )   PDF (477KB) ( 256 )  
    Objective To explore the risk factors for cardiac valve calcification in maintenance hemodialysis (MHD) patients. Method Patients on hemodialysis for at least 3 months in Ruijin Hospital before July 2011, aged over 18 years, and without history of surgery or catheterization for cardiac valve disease were enrolled in this study. Echocardiography was used to detect the calcification. Fibroblast growth factor 23 (FGF23) was measured by ELISA. The risk factors for valve calcification were analyzed by logistic regression method. Results One hundred and ten MHD patients (64 men and 46 women) with the mean dialysis duration of 41.7 months were enrolled in the study. In the 110 patients, cardiac valve calcification was found in 28 patients (25.5%), in which aortic valve calcification was found in 25 patients (22.7%), mitral valve calcification in 10 patents (9.1%), and both aortic and mitral valve calcification in 6 patients (5.5%). Patients with valve calcification had older age, longer dialysis duration, lower albumin level, higher serum phosphate and higher FGF23, as compared with the patients without valve calcification. Multivariate logistic regression showed that age (OR=1.106), dialysis duration (OR=1.031), albumin level (OR=0.852), serum phosphate (OR=7.420) were independently correlated with cardiac valve calcification (backward stepwise, P<0.001; Nagelkerke R2 0.555). Conclusion Cardiac valve calcification is prevalent in MHD patients, especially aortic valve calcification. Older age, longer dialysis duration, lower albumin and hyperphosphatemia are the independent risk factors for cardiac valve calcification.
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    The characteristics and related factors of cardiac structure and function in patients with refractory secondary hyperparathyroidism
    2013, 12 (10):  543-546. 
    Abstract ( 184 )   HTML ( 0 )   PDF (333KB) ( 301 )  
    Objective To analyze the characteristics of cardiac structure and function and the related factors in patients with refractory secondary hyperparathyroidism (SHPT). Methods A total of 82 end-stage renal disease cases with refractory SHPT and treated with parathyroidectomy (PTX) were retrospectively studied. There were 44 males and 38 females with average age of 46.7±14.1 years old and average dialysis duration of 128.5±49.6 months (36~216 months). Thirty maintenance hemodialysis (MHD) patients treated at the same period were used as the control group. Serum creatinine (Scr), albumin (Alb), calcium (Ca2+), phosphorus (P), alkaline phosphatase (ALP), hemoglobin (Hb) and intact parathyroid hormone (iPTH) were assayed before hemodialysis. LVDd, IVS, PWTH, EF and E/A were measured by echocardiography. LVMI was calculated by a formula, and the relationship between LVMI and clinical indices was then analyzed. Results Compared with the control group, the PTX group had significantly higher rates of left ventricular hypertrophy (96.3% vs. 63.33%), left ventricular systolic dysfunction (79.27% vs. 43.33%), left ventricular diastolic dysfunction (75.6% vs. 26.6%), and valve calcification (P<0.05 or <0.01). Multivariate linear regression analysis showed a positive correlation between LVMI and the values of dialysis duration, serum P and iPTH (r=0.47, 0.76, and 0.68, respectively; P<0.05). Conclusion End-stage renal disease patients with refractory SHPT had higher incidences and severer degrees of left ventricular hypertrophy and left ventricular dysfunction than other MHD patients. PTX should be considered for patients with refractory SHPT to reduce their cardiovascular mortality.
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    Fibroblast growth factor-23 may predict coronary artery calcification and adverse clinical outcome in chronic kidney disease patients at moderate to advanced stage
    2013, 12 (10):  547-551.  doi: 10.3969/j.issn.1671-4091.2013.09.00
    Abstract ( 145 )   HTML ( 0 )   PDF (416KB) ( 254 )  
    Objective To elucidate the relationship between fibroblast growth factor-23 (FGF23) and coronary artery calcification, and the prognostic value of FGF23 in chronic kidney disease (CKD) patients at moderate to advanced stage. Methods Serum intact FGF23 was measured by using ELISA in 150 CKD patients at stages 3-5. The relationship between FGF23 and coronary artery calcification was evaluated. Patients were followed up for 35±3 months, and the occurrence of cardiovascular disease (CVD) and death were recorded. Results Serum FGF23 level was significantly higher in CKD patients than in healthy controls (P<0.01), and was much higher in dialyzed patients than non-dialyzed patients (P<0.01), especially higher in hemodialysis patients. Serum FGF23 level was positively correlated with coronary artery calcification score (CaS) (r=0.177, P<0.05). Logistic regression analysis showed that age, dialysis duration and FGF23 level were the independent risk factors for coronary artery calcification in CKD patients at moderate to advanced stage. During the follow-up, CVD in 21 (14%) patients and death in 13 (8.7%) patients were recorded. Patients were then stratified to two groups by the median FGF23 level (675.8pg/ml). Kaplan-Meier survival curves showed that patients with FGF23 levels ≥675.8pg/ml had significantly higher CVD incidence rate (P<0.01) and all-cause mortality (P<0.05) than those with FGF23 levels below the cut-off value. Cox regression analysis showed that FGF23 ≥675.8pg/ml and severe coronary artery calcification (CaS >400) were the independent risk factors for CVD in CKD patients, and that FGF23 level and severe coronary artery calcification (CaS >400) were the independent risk factors for all-cause mortality in CKD patients. Conclusion Serum FGF23 level in CKD patients at moderate to advanced stage was significantly higher than that in normal population. Serum FGF23 level may relate to coronary artery calcification and adverse clinical outcomes in CKD patients at moderate to advanced stage.
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    Cross-sectional screening on chronic kidney disease-mineral and bone disorder in maintenance hemodialysis (MHD) patients in a single center
    2013, 12 (10):  552-556. 
    Abstract ( 207 )   HTML ( 0 )   PDF (363KB) ( 399 )  
    【ABSTRACT】Objective: To explore the morbidity and the management of the chronic kidney disease-mineral and bone disorder (CKD-MBD) in maintenance hemodialysis (MHD) patients at our hospital center, to analyze the related risk factors. Methods: The target population was the 217 patients who receive treatment of hemodialysis inhemodialysis center of our hospital during Jul.2010 to Mar.2011. We gathered the demographic information and the CKD-MBD related indicators,such as serum calcium, phosphorus, PTH, Vascular calcifications were determined by lateral abdominal, frontal pelvic and hands X-rays, counted the vascular calcification scores by the method of Kauppila and finally analyzed the morbidity ,the control rate and the potential relative risk factors of the abnormalities of the indicators by the multi-variance Logistic regression analysis. Results: 217 patients were evaluable for this study; The morbidity of hyperphosphatemia, hypercalcinemia, hypocalcemia, reduced PTH and elevated PTH were 45.16%, 31.80%, 21.66%, 20.74% and 48.39% respectively. On X-rays, 154 patients (70.94% of the whole population) had evidence of vascular calcification, The proportion of patients meeting the criteria of CKD-MBD was as high as 96.31%. The percentage of patients who achieved the recommended standard levels of serum calcium, phosphorus, PTH were 45.16%、44.7% and 30.88% respectively. Only 20 patients achieved all the recommended standard levels of serum calcium, phosphorus, PTH, accounting for 9.22% of the whole population. The control rates of serum Ca and P were lower the results in DOPPS4.From the multi-variance Logistic regression analysis, The potential relative risk factors were as follows: elevated PTH: hyperphosphatemia and hypocalcemia; reduced PTH: advanced age and history of taking activated vitamin D; vascular calcification were as follows: advanced age, ALP, hyperphosphatemia and CRP. Conclusion: CKD-MBD is prevalent in MHD patients.The control rates of the CKD-MBD related targets were lower than the results in DOPPS4.
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    Correlation between fibroblast growth factor 23 level and intact parathyroid hormone in maintenance hemodialysis patients
    2013, 12 (10):  557-560.  doi: 10.3969/j.issn.1671-4091.2013.10.00
    Abstract ( 188 )   HTML ( 0 )   PDF (326KB) ( 183 )  
    Objective We investigated the significance of fibroblast growth factor 23 (FGF23) in maintenance hemodialysis (MHD) patients by measuring serum FGF23 and correlating FGF23 with intact parathyroid hormone levels (iPTH) and other biochemical markers in these patients. Methods Forty-one MHD patients were enrolled in this study, and 12 healthy individuals were used as the control group. Demographic information, serum FGF23 and other laboratory indexes were collected and analyzed. Results ① Serum FGF23 was significantly higher in MHD group than in control group (P<0.01). ② When MHD patents were sub-grouped into group A (with lower iPTH level), group B (with normal iPTH level), and group C (with higher iPTH level). Serum FGF23 in the group A, B and C was 477.44±2293.53pg/ml, 176.57±402.39pg/ml and 1433.1±1984.76pg/ml, respectively, significantly different among the 3 groups (P=0.016). ③ When MHD patients were sub-grouped into hyperphosphatemia group and normal serum phosphate group. Compared to the normal serum phosphorus group, iPTH and FGF23 in the hyperphosphatemia group increased significantly (1319.66±1015.96pg/ml vs. 583.36±980.81pg/ml for iPTH, P<0.05; 1506.83±957.97pg/ml vs. 452.31±696.12pg/ml for FGF23, P<0.001). ④ Serum FGF23 was positively correlated with serum calcium, phosphorus, ALP and calcium-phosphorus product (r=0.381, P<0.01 for calcium; r=0.593, P<0.001 for phosphorus; r=0.276, P<0.05 for ALP; r=0.656, P<0.001 for calcium-phosphorus product). iPTH was positively correlated with FGF23 in groups B and C (r=0.384, P<0.01), but not in group A. Conclusions In MHD patients, FGF23 was closely related to serum calcium, phosphorus, calcium-phosphorus product, ALP and iPTH. Therefore, FGF23 plays an important role in the presence of secondary hyperparathyroidism.
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    Effect of high flux hemodialysis on lipid metabolism and micro-inflammatory state in maintenance hemodialysis patients
    2013, 12 (10):  566-569. 
    Abstract ( 169 )   HTML ( 2 )   PDF (370KB) ( 245 )  
    ABSTRACT Objective To investigate the effect of high flux hemodialysis on lipid metabolism and micro-inflammatory state in maintenance hemodialysis patients. Methods A total of 80 MHD patients were randomly divided into two groups :high flux hemodialysis (HFHD)group ,and low flux hemodialysis (LFHD) group .the treatment lasted 6 months .Changes of the parameters for lipid metabolism and micro-inflammatory state were observed before and after the treatment in two groups . Results After 6 months ,high sensitive creactive protein ( hsCRP)、 intact parathyroid hormone (iPTH )、triglyceride (TG)、 total cholesterol (TC)、β2-microglobulin (β2MG)、 Apolipoprotein A(APOP-A) were significantly lower in HFHD group than those in LFHD group ,and than those in HFHD group before treatment (P<0.01),while hemoglobin(HGB) were significantly higher in HFHD. The incidence of acute infection and cardiovascular events were lower in HFHD group than in LFHD group (P<0.01). Conclusions High flux hemodialysis can not only improve micro-inflammatory state and dyslipidema but also
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    Evaluation on the Applicability of Poly (ethylene terephthalate) (PET) Barrels for Hemodialysis Concentrates Packaging
    2013, 12 (10):  570-575. 
    Abstract ( 153 )   HTML ( 0 )   PDF (553KB) ( 188 )  
    To explore the applicability of poly (ethylene terephthalate) (PET) barrels for hemodialysis concentrates packaging. Methods To evaluate the applicability of PET barrels for hemodialysis concetrates packaging according to the Polyester Bottles for Oral Liquid Medicine and relevant standards. Results Physical and chemical properties tests and extraction test with hemodialysis concentrates as extraction medium indicated that the physical and chemical properties and extractables of PET barrels well met requirements of the standard. Antimony levels of the extracts using acetic acid solution (pH=2) as extraction medium was 0.093μg/ml, which equals to 47.7μg of antimony in a 5L of A concentrate. When calculated with a dilution by a factor of 35 for concentrate A and for a dialysis duration of five hours, then the amount of concentrate A used for a single hemodialysis treatment is 4.28L, and the maximum antimony in the hemodialysis concentrate for a single hemodialysis course would be 40.8μg, which is far below the Daily Tolerable Intake for adults (60kg) of 360μg calculated with the Daily Tolerable Intake of 6μg/kg specified by WHO. Biological evaluation tests results revealed that, the PET barrel material showed no in vitro cytotoxicity, negative skin sensitization reaction, and no intradermal reaction. The stacking simulation tests showed no deformation, fracture or collapse of the PET barrels which contained hemodilaysis concentrates. Conclusion The results showed that all tests well complied with requirements of appropriate standards or application requirements, and that the PET barrels can be used for hemodialysis concentrates packaging.
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    The erasons of A-V fictula plug and the care measures in maintain hemodialysis patients
    2013, 12 (10):  576-578. 
    Abstract ( 262 )   HTML ( 3 )   PDF (293KB) ( 731 )  
    【Abstract】: Objective Purpose:Analysising the reasons of A-V fistula plug in maintain hemodialysis patients and then to improve the care measures. Methods: Retrospective analysis the hemodialysis records of 109 patients in our hospital from Jan. 2011 to Dec. 2011. Results:There were 10 patients occurring A-V fistula plug(9.17%).Bad vascular conditions were 2,excessive ultrafiltration were 4,repeated fixed-point puncture were 3,and oppression improper was 1 of them all. Conclusion:Inappropriate care may cause the A-V fistula plug.
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    cefoselis-related neurotoxicity in four patients
    2013, 12 (10):  579-579. 
    Abstract ( 132 )   HTML ( 0 )   PDF (197KB) ( 261 )  
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