Chinese Journal of Blood Purification

12 May 2014, Volume 13 Issue 05 Previous Issue    Next Issue

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The effect of continuous veno- veno hemofiltraion in patients with severe acute pancreatitis and abdominal compartment syndrome 2014, 13 (05):  361-366.  doi: 10.3969/j.issn.1671-4091.2014.05.002 Abstract ( 243 )   HTML ( 0 )   PDF (397KB) ( 259 )   To evaluate the effect of continuous veno-veno hemofiltraion (CVVH) on intra-abdominal pressure (IAP) in patients with severe acute pancreatitis and abdominal compartment syndrome. Methods A total of 54 patients admitted to the intensive care unit of our hospital due to severe acute pancreatitis and acute compartment syndrome in the period from 2003 to 2013 were enrolled in this study. They were divided into CVVH group (n=22) and control group (n=32). Patients in the CVVH group were additionally treated with CVVH after admitted to the ICU. Baxter portable continuous hemofiltration machine and AV600S hemofiltrator were used in the treatment. IAP, APACHE II score, sequential organ failure assessment (SOFA) score, oxygenation index (OI), mean arterial pressure (MAP), dopamine used (DA), and serum levels of creatinine (Scr), amylase (AMS), TNF-α, C-reactive protein (CRP) were assayed during the treatment. The days treated in ICU, the period on mechanical ventilation, and the 28-day mortality were compared between the two groups. Results ① After the treatment for 7, 14 and 28 days, IAP decreased significantly in CVVH group than in control group (P＜0.05); ② after the treatment for 3, 7 and 14 days, serum AMS was lower in CVVH group than in control group (P＜0.05); ③ after the treatment for 7 and 14 days, APACHE II score and SOFA score were lower in CVVH group than in control group (P＜0.05); ④ after the treatment for 3, 7 and 14 days, DA used and serum Scr were lower and MAP and OI were higher in CVVH group than in control group (P＜0.05); ⑤ after the treatment for 3, 7 and 14 days, serum TNF-α and CRP decreased more in CVVH group than in control group (P＜0.05); ⑥ the days treated in ICU and the period on mechanical ventilation were shorter in CVVH group than in control group, but the 28-day mortality was similar between the two groups. Conclusion CVVH effectively decreased APACHE Ⅱ score, SOFA score, and IAP level, with the reversal of organ dysfunctions in patients with acute compartment syndrome and severe acute pancreatitis. However, it did not change the 28-day-mortality significantly. Metrics

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The impact of RIFLE grading on the evaluation of clinical outcomes in acute renal injury patients treated with continuous renal replacement therapy 2014, 13 (05):  367-371.  doi: 10.3969/j.issn.1671-4091.2014.05.003 Abstract ( 246 )   HTML ( 0 )   PDF (377KB) ( 391 )   Objective To evaluation the relationship between the initiation of continuous renal replacement therapy (CRRT) guided by RIFLE grading and clinical outcomes in critically ill patients with acute kidney injury (AKI). Methods We recruited 87 AKI patients treated with CRRT in the period from 2010 to 2013. They were divided into early (RIFLE classified as risk, n=31) and late (RIFLE classified as injury or failure, n=56) initiation of CRRT by RIFLE criteria. Their demographic data and biochemistry parameters were collected. Clinical outcomes including mortality and renal function recovery were recorded. Results After the initiation of CRRT, the mortality rate at the 28th day was 64.52% and 57.14% in the early group and late group, respectively, and that at the 90th day was 67.74% and 66.07% in the early group and late group, respectively (P＞0.05). Kaplan- Meier curve revealed that the survival estimates were similar between the two groups (P=0.67). The relative death risks at the 28th and 90th days were also similar between the two groups (RR=0.724 and 0.921, respectively; P＞0.05). Renal function recovery at the 28th day was 38.70% and 30.36% in the early group and late group, respectively, and that at the 90th day was 38.70% and 32.14% in the early group and late group, respectively (P＞0.05). The relative risks for renal function recovery at the 28th and 90th days were also similar between the two groups (RR=1.449 at the 28th day, P=0.430; RR=1.333 at the 90th day, P=0.538). Cox multivariate analyses revealed that APACHE II score was the death risk factor for AKI patients. Conclusions RIFLE classification as the guide for the initiation of CRRT could not be used to predict the mortality at the 90th day and the renal function recovery in AKI patients. Metrics

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The meta analysis of influence of online hemodiafiltration on survival rate of maintenance hemodialysis patients 2014, 13 (05):  372-376.  Abstract ( 184 )   HTML ( 2 )   PDF (655KB) ( 241 )   Objective To evaluate the effect of online hemodiafiltration(OL-HDF)in the survival rate of maintenance hemodilysis(MHD) patients.Methods Randomized controlled trials(RCT),prospective controlled trials(PCT) and prospective cohort trials studying the effect of OL-HDF on survival rate of MHD patients were searched in the Pubmed /Medline, EMBASE、and Cochrane Library electronic databases, then the odds ratio was calculated. Results 5009 patients were included in this study: the effect of survival rate was compared in the OL-HDF and HD group. Compared with the HD group, the survival rate of OL-HDF group wasn not improved (Fixed effect model, OR=0.53,Z=5.51,P<0.00001,I2=38%). The subgroup of OL-HDF patients treated with a high substitution volume per session had better overall mortality compared with the HD group. There were no significant difference of overall mortality rate between low volume OL-HDF group and HD group（OR=1.0,Z=0.01,P=0.99,I2=0%）. Conclusions High volume OL-HDF may not improve the survival rate of MHD patients, associated with OL-HDF substitution volume. Metrics

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The relationship between highly sensitive cardiac troponin T and cardiac structure and function in patients on maintenance hemodialysis 2014, 13 (05):  377-379.  doi: 10.3969/j.issn.1671-4091.2014.05.005 Abstract ( 173 )   HTML ( 0 )   PDF (338KB) ( 193 )   Objective To investigate the relationship between highly sensitive cardiac troponin T and cardiac structure and function in patients on maintenance hemodialysis (MHD). Methods Highly sensitive cardiac troponin T (hs-cTnT) and B-type natriuretic peptide (BNP) were measured in 86 patients (MHD group), who were treated with MHD for at least 6 months before the study and were in a stable clinic status without signs of acute myocardial infarction, acute myocarditis and hypertrophic cardiomyopathy. Left ventricular ejection fraction (LVEF), left ventricular diameter (LVD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT) were evaluated by ultrasonic cardiography. The results were compared to those from 60 healthy people (control group). The relationship between hs-cTnT level and left heart structure and function was then analyzed. Results The mean hs-cTnT level was higher in MHD group than in control group (0.263±0.038 ng/ml vs. 0.016±0.008 ng/ml; P＜0.05). In MHD group, hs-cTnT level was positively correlated with the levels of BNP, LVMI and LVH (P<0.05), and was negatively correlated with the level of LVEF (P=0.015). Conclusions The determination of hs-cTnT is helpful for the early diagnosis of cardiovascular events in patients undergoing maintenance hemodialysis. Metrics

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Clinical Investigation of Various Hemoperfusion Frequencies on Cleaning the Parathyroid Hormone, the Serum Calcium and Phosphorus in Maintenance Hemodialysis Patients . 2014, 13 (05):  380-383.  doi: 10.3969/j.issn.1671-4091.2014.05.006 Abstract ( 208 )   HTML ( 0 )   PDF (330KB) ( 214 )   Objective To investigate the best frequency of hemoperfusion (HP) on cleaning parathyroid hormone (PTH), calcium (Ca2+) and phosphorus (P3+) in maintenance hemodialysis (MHD) patients. Methods A total of 78 MHD patients were recruited. They were randomly assigned into 4 groups: patients in group A were treated with hemodialysis only as the control group (n=18); patients in group B, C and D were treated with the combination of hemoperfusion and hemodialysis (HP+HD), in which HP was performed once a week in group B (n=22), HP twice a week in group C (n=20), and HP once every two weeks in group D (n=18). The treatments were lasted for 12 weeks. Serum Ca2+, P3+, and PTH were measured at the time points of before treatment, 2nd, 4th, 6th, 8th, 10th, and 12th weeks after the treatments. Results Serum PTH decreased after the treatments in all of the 4 groups (P＜0.05). Serum PTH decreased more in groups B, C and D (HP+ HD groups) than in group A (P＜0.05), and more in groups B and C than in group D (P＜0.05). The therapeutic effect was better in group C than in group B at the 4th and 6th weeks after treatment (P<0.05), but was similar between groups B and C at the 2nd, 8th, 10th, and 12th weeks after the treatment. Calcium-phosphorus product decreased gradually in the 4 groups after the treatment, but without significant differences at different time points (P>0.05). Conclusion HP once a week can achieve the cleaning of PTH with relatively lower cost. The higher the HP frequency, the faster the PTH concentration falls at the early stage. The combination of HP+HD can reduce the calcium-phosphorus product, but whether this therapeutic effect is related to HP frequency is uncertain. Metrics

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The effect of dry weight adjustment on the pulmonary hypertension in maintenance hemodialysis patients 2014, 13 (05):  384-386.  doi: 10.3969/j.issn.1671-4091.2014.05.007 Abstract ( 241 )   HTML ( 1 )   PDF (298KB) ( 334 )   Objective To investigate the effect of dry body weight adjustment on the pulmonary hypertension in maintenance hemodialysis (MHD) patients. Methods In the 120 uremic patients treated with MHD in our hospital in the period from March, 2012 to April, 2013, pulmonary hypertension was found in 18 cases. They had the dialysis age of more than one year (3.41±1.23 years), 12 were males and 6 were females, and the average age was 47.44±6.13 years old. The primary diseases leading to MHD were chronic glomerulonephritis in 10 cases, diabetic nephropathy in 5 cases, hypertensive benign arteriolar nephrosclerosis in 2 cases, and renal tuberculosis in one case. They were treated with conventional hemodialysis using polysulfon membrane 1.4 m2 dialyzer 3 times a week. Pulmonary artery hypertension (systolic pulmonary artery pressure ≥ 35 mmH) was estimated by Doppler echocardiography. Dry weight adjustment was conducted in patients with pulmonary artery hypertension for one month. Blood pressure, hemoglobin, serum phosphorus, parathyroid hormone, plasma brain natriuretic peptide, transverse and longitudinal diameters of right atrium, inner diameter of pulmonary artery, and pulmonary artery systolic blood pressure by echocardiography were compared before and after the dry weight adjustment. Results After the down-regulation of dry weight, pulmonary arterial pressure decreased from 48.00±8.15 mmHg before treatment to 42.00±6.75 mmHg after the treatment (P＜0.05), and plasma brain natriuretic peptide concentration from 7467.8±2357.4 pg/ml to 4759.2±1367.9 pg/ml. In addition, transverse diameter of right atrium decreased from 32.19±7.93 mm before the treatment to 26.84± 4.23 mm after the treatment, longitudinal diameter of right atrium from 43.09±8.95 mm to 35.96±8.69 mm, pulmonary artery diameter from 25.18±4.06 mm to 21.64± 2.49 mm, left ventricular diameter from 56.15± 6.28 mm to 50.25±5.39 mm, and left ventricular ejection fraction increased from 43.2±12.3% to 55.3 ± 13.6%. All of these changes were statistically significant (P＜0.05). The changes of blood pressure, hemoglobin, serum parathyroid hormone, calcium, and phosphate were also statistically significant as compared with those before treatment (P>0.05). Conclusion In MHD patients with pulmonary hypertension treated with the downregulation of dry weight, excessive water can be eliminated, resulting in the decreases of transverse diameter of right atrium, pulmonary artery diameter, pulmonary pressure, right ventricular diameter, the pressure on left ventricle, and left ventricular diameter, and thereby in the improvement of left ventricular function and left ventricular ejection fraction. Metrics

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Color Doppler ultrasonography for parathyroid hyperplasia in 36 cases with refractory secondary hyperparathyroidism 2014, 13 (05):  387-389.  doi: 2010 年北京市科委首都临床特色应用研究资助项目(D101100050010025) Abstract ( 161 )   HTML ( 1 )   PDF (1515KB) ( 233 )   Objective To investigate the clinical value of high-frequency color Doppler ultrasonography in secondary hyperparathyroidism following chronic renal failure. Methods Ultrasonographic characteristics of hyperplastic parathyroid nodules confirmed by pathology after surgery were retrospectively analyzed in 36 patients. Results A total of 134 clinically diagnosed hyperplastic parathyroid nodules were surgically removed from 36 patients. In these surgical samples, pathological examination confirmed to be hyperplastic parathyroid nodules in 120 samples, and non-parathyroid hyperplasia (including thyroid nodules and ectopic thymus) in 14 samples. In the 120 samples of hyperplastic parathyroid nodules, ectopic parathyroid located in thymus in 3 samples and in thyroid in one sample. Hyperplastic parathyroid nodules complicated with thyroid carcinoma was found in 3 cases (3/36, 8.3%). Ultrasonography detected 84 nodules of parathyroid enlargement or hyperplasia (maximal size of 2.6 cm x 1.6 cm x 1.5 cm and minimal size of 0.30 cm x 0.27 cm x 0.21 cm), in which 81 samples (96.4%) had the same diagnosis by pathological examination, with the rate of correct diagnosis of 67.5% (81/120), and the rate of missed nodules of 32.5% (39/120). Misdiagnosed nodules by ultrasonography occurred in 3 samples including lymph node in the lower pole of thyroid in one sample and thyroid nodule in 2 samples, with the rate of misdiagnosis of 3.6% (3/84). Conclusion High-frequency color Doppler ultrasonography can be used as the preferred screening method for the diagnosis and localization of parathyroid hyperplasia before surgery, and for the diagnosis of secondary hyperparathyroidism complicated with thyroid carcinoma. Metrics

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Intradialytic progressive resistance training improved cardio- respiratory endurance, psychological state, and health- related quality of life in maintenance hemodialysis patients 2014, 13 (05):  390-393.  doi: 10.3969/j.issn.1671-4091.2014.05.009 Abstract ( 287 )   HTML ( 2 )   PDF (421KB) ( 319 )   Objectives To explore the effects of intradialytic progressive resistance training on cardio-respiratory endurance, psychological state, and health- related quality of life in maintenance hemodialysis (MHD) patients. Methods The MHD patients in this study were recruited from our dialysis center. At the baseline and after the intradialytic progressive resistance training for 12 weeks, peak oxygen uptake (VO2max) and metabolic equivalents (METs) using treadmill exercise of Bruce sport program were measured. In addition, self-rating anxiety scale (SAS), self-rating depression scale (SDS), and health-related quality of life (short form-36 health survey, SF-36) were completed. We then compared these parameters and statistically analyzed the data before and after the resistance training. Results After the intradialytic progressive resistance training, VO2peak increased by 57.93% (P＜0.01), METs increase by 56.77% (P＜0.01), SAS score decreased by 8.60% (P＜0.05), SDS score decreased by 20.19% (P＜0.01), SF-36 scores for physical function, general health and vitality increased by 47.83%, 72.58% and 47.37%, respectively (P＜0.05). Conclusion Intradialytic progressive resistance training significantly improved cardio-respiratory endurance, psychological state, and health-related quality of life in MHD patients. Metrics

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Retrospective study of the temporary central venous catheter related infection in the hemodialysis patients 2014, 13 (05):  401-404.  doi: 10.3969/j.issn.1671-4091.2014.05.012 Abstract ( 252 )   HTML ( 3 )   PDF (387KB) ( 285 )   Objective To retrospectively investigate the prevalence and risk factors of central venous catheter related infections (CVC-RI) in hemodialysis patients with venous indwelling catheters. Methods A total of 132 hemodialysis patients with short-term indwelling catheters and treated in East Hospital of Tongji University in the period from January, 2010 to June, 2013 were enrolled in this study. Their clinical data and the prevalence and risk factors of CVC-RI were analyzed. Results In the 132 hemodialysis patients, the catheters were located in femoral vein in 41 cases and in internal jugular vein in 91 cases, with a total of 149 venous catheterizations. The median duration of indwelling catheterization was 27 days (8-51 days). CVC-RI was found in 31 cases with the prevalence of 23.5%. In the 31 case, CVC-RI occurred in the first 14 days after catheterization in 4 cases (12.9%), within 15th-2lst days in 9 cases (29%), within 22nd-28th days in 13 cases (41.9%), and after 28 days in 5 cases (16.1%). Therefore, the prevalence of CVC-RI was significantly variable in different duration after catheterization (P＜0.05). The prevalence of CVC-RI was similar in patients with jugular vein catheterization and in those with femoral vein catheterization (41.9% and 58.1%, respectively; P＞0.05). Gram-positive bacteria were detected in 17 cases, and Gram-negative bacteria in 14 cases (54.8% and 45.2%, respectively; P＞0.05). The prevalence of CVC-RI correlated significantly to indwelling duration, age, infections in other sites, puncture manipulation, use of immunosuppressive agents, and diabetes (P＜ 0.05). Conclusions The prevalence of CVC-RI correlated closely to indwelling duration, age, infection in other sites, puncture manipulation, use of immunosuppressive agents, and diabetes. The prevalence of CVC-RI became higher in patients with indwelling catheters for more than two weeks. The prevalence of CVC-RI was similar in patients with jugular vein catheters and in those with femoral vein catheters. The numbers of CVCRI patients due to Gram-positive bacteria and those due to Gram-negative bacteria were approximately equal. Metrics

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Balloon angioplasty for disruption of tunneled dialysis catheter fibrin sheath improve catheter function. 2014, 13 (05):  405-407.  Abstract ( 238 )   HTML ( 0 )   PDF (730KB) ( 219 )   Objective To search for a new management technique to treat fibrin sheaths in tunneled dialysis catheters for the improvement of blood flow during hemodialysis. Methods We studied six maintenance hemodialysis patients, who were unable to create an arteriovenous fistula and had the history of central venous indwelling catheterizations at multiple sites. Digital subtraction angiography (DSA) confirmed the fibrin sheath formation in catheters. Percutaneous transluminal angioplasty (PTA) was then performed to disrupt the catheter sheath, followed by placement of an indwelling cuff-tunneled catheter via an internal jugular or femoral vein after successful angioplasty. Results The new catheters functioned well (blood flow rate >250 ml/ min) during hemodialysis in 5 cases, and the catheter could provide a blood flow of 220 ml/min in the second hemodialysis session in one case. No catheter dysfunction and infection were found in these cases in the following- up period of 2～6 months. Conclusion Balloon angioplasty to disrupt fibrin sheaths improved the patency of catheters and increased the blood flow during hemodialysis. Metrics

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Epidemiological investigation of maintenance hemodialysis patients in 2013 in a single center in Kunshan area 2014, 13 (05):  410-412.  doi: 10.3969/j.issn.1671-4091.2014.05.015 Abstract ( 233 )   HTML ( 0 )   PDF (443KB) ( 232 )   Objective To investigate the situation of maintenance hemodialysis (MHD) patients, a cross-sectional study was conducted and data were analyzed. Methods We invstigated 242 MHD patients whose dialysis age more than 3 months and treated in this hemodialysis centre in August 2013 and compared these data with the guidelines. We also analyzed age, gender, years for dialysis, Hb, renal function, serum Ca, serum phosphate, Ca×P product and iPTH in these patients. Results In the 242 patients, there are 134 (55.4%) male, 108 (44.6%) of female, and the male to female ratio was 1.24:1. The most common causes of end-stage renal diseases (ESRD) in these hemodialysis patients were chronic glomerulonephritis(54.54%)，diabetic nephropathy(10.33)，and hypertensive renal damage (7.85%). 148(61.16%) cases of Hb, 208(85.12%) cases of calcium and phosphorus metabolism（Including patients with hypercalcemia, hypocalcemia, hyperphosphatemia and hypophosphatemia）, 96(39.66%)cases Ca×P product and 110(46.61%)cases of iPTH couldn’t meet the requirements of the guidelines. Conclusions In Kunshan, there are more male patients and MHD patients are more younger. The main causes of ESRD patients on hemodialysis are still chronic glomerulonephritis. There are large number of patients with low compliance rate of Hb and disorders of calcium and phosphorus metabolism and secondary hyperparathyroidism. Metrics

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THE dietary investigation of 30 cases of maintenance hemodialysis patients 2014, 13 (05):  413-416.  doi: 10.3969/j.issn.1671-4091.2014.05.016 Abstract ( 293 )   HTML ( 3 )   PDF (379KB) ( 256 )   Objective: By dietary investigation, the common dietary problems and relative factors of the maintenance hemodialysis(MHD) patients are analyzed, and the importance in the dietary investigation of the nutrition assessment of MHD patients is discussed. Methods 30 cases of MHD patients are randomly selected, 3-days weight dietary record method is adopted, 3-days nutritional intake amount is caculated, in reference to the nutritional treatment plan and EBPG guideline on nutrition in the《Consensus on Cronic Kidney Disease Nutrition(2005)》[1] and recommended intake amount in the《EBPG Guideline on Nutrition (2007) 》[2] according to the patients'food categories, the the dietary guidance and analysis are carried out. In the 30 patients, 18 are with hyperphosphatemia. According to the blood phosphorus level, the group 1 (8 cases, blood phosphorus level before dialysis is 1.7-1.9mmol/L), and the group 2 (10 cases, blood phosphorus level before dialysis is 2.01-2.65mmol/L) are devided. Results ① The BMI of 30 patients are between 18.5-33.6kg/m2 (24.10±4.43), 5 were of emaciation, 6 were of obesity. ② The total calorie and protein intake is irrational in some patients. 8 cases intake too much calorie and protein, and 13 cases intake too less calorie and protein. ③ The average dietary intakes of protein (65.01±4.29g)and phosphorus (883.37±60.32mg) among of 18 hyperposphatemic patients are greater than control group (51.10±3.87g,t=2.263,P=0.032；699.67±57.36mg,t=2.097,P= 0.045). ④ In the hyperphosphatemia group 1, the mean dietary phosphorus intake (1041.51 ± 87.62mg, F= 6.857 ,P=0.004), mean dietary protein intake (73.76±5.49g, F=5.177, P=0.012), and mean animal-related protein intake(171.50±20.00g, F=3.429,P=0.047) are all higher than the other groups.There are statistics difference; In the hyperphosphatemia group 2, the mean dietary rich intake(133.85±17.29，F=4.439，P=0.022)are higher than the other groups,There is statistics difference. Conclusion By dietary investigation, the patients'food composition and dietary habbit can be comprehended, the main cause for malnutrition can be discovered. Metrics