Chinese Journal of Blood Purification

12 July 2014, Volume 13 Issue 07 Previous Issue    Next Issue

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The influence of peritoneal transport types on nutrition status, inflammation and cardiovascular complications in peritoneal dialysis patients 2014, 13 (07):  485-488.  doi: 10.3969/j.issn.1671-4091.2014.07.001 Abstract ( 231 )   HTML ( 0 )   PDF (333KB) ( 258 )   Objective To investigate the influence of peritoneal transport types on nutrition status, inflammation and cardiovascular complications in peritoneal dialysis (PD) patients. Methods A total of 101 chronic renal failure patients on PD were divided into 4 groups according to the peritoneal PET, group A (high transport), group B (average high transport), group C (average low transport) and group D (low transport). The nutritional status, inflammation and cardiovascular complications of the PD patients in the 4 groups were investigated. Results ①The prevalence of malnutrition was 62.5% (n=5) in group A, 58.1 % (n=25) in group B, 35% (n=14) in group C, and 0% in group D. Therefore, the nutritional status was significantly different among PD patients with different peritoneal transport types (P=0.003), with the best in low transport group (group D) and the worst in high transport group (group A). ②As for inflammation, high-sensitivity C-reactive protein (hs-CRP) was higher in groups A and B as compared with that in group C (P=0.020 and 0.021, respectively). ③ The prevalence of cardiovascular complications was 62.50 %, 55.81%, 47.5%, and 30% in group A, B, C and D, respectively, significantly different among PD patients with different peritoneal transport types (P = 0.038) with the highest in group A and the lowest in group D. ④ Pearson’s correlation analysis showed that the degree of peritoneal transport was positively correlated with cardiovascular complications (r=0.268, P= 0.007) and hs-CRP (r=0.312, P=0.002) and was negatively correlated with the SGA score for nutritional status assessment (r=-0.348, P=0.000). Conclusion Peritoneal transport function closely relates to nutritional status, inflammation and cardiovascular complications. Poor nutritional status and MIA syndrome are frequently seen in PD patients with higher peritoneal transport. Clinically, adjustment of treatment regimen based on the results from routine evaluation of peritoneal transport function may be useful to improve nutritional status and reduce cardiovascular complications in PD patients. Metrics

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The value of normalized extracellular fluid volume by body height in the estimation of volume overload and ventricular remodeling in patients with continuous ambulatory peritoneal dialysis 2014, 13 (07):  489-492.  doi: 10.3969/j.issn.1671-4091.2014.07.002 Abstract ( 159 )   HTML ( 0 )   PDF (383KB) ( 192 )   Objective To explore the value of normalized extracellular fluid volume by body height (ECW/h) in the estimation of volume overload and ventricular remodeling in patients with continuous ambulatory peritoneal dialysis (CAPD). Methods Data about body composition and echocardiography were collected and used to analyze the correlation of ECWh with volume overload and ventricular remodeling. We also analyzed the differences of volume overload and ventricular remodeling in patients with ECW/h ＞9.04 L/m and those with ECW/h＜9.04L/m. Results Pearson’s analysis showed that ECWh was positively correla-ted with the volume load parameters of LVEDD and LAD (r=0.507 and 0.492, respectively; P＜0.001) and the ventricular remodeling parameters of LVPWT, LVM, IVST and LVMI (r =0.463, 0.581, 0.403 and 0.404, respectively; P＜0.001. Volume overload and ventricular remodeling indicators including LVEDD, LAD, LVPWT, LVM, IVST, and LVMI were higher in patients with ECW/h＞9.04 L/m than in those with ECW/h＜ 9.04L/m. Conclusion ECW/h is valuable in the clinical evaluation of volume overload and ventricular remodeling in CAPD patients. Metrics

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Effect of low calcium dialysate combined with active vitamin D and sevelamer hydrochloride on secondary hyperparathyroidism in hemodialysis patients 2014, 13 (07):  493-496.  doi: 10.3969/j.issn.1671-4091.2014.07.003 Abstract ( 211 )   HTML ( 0 )   PDF (386KB) ( 252 )   objective To observe the effect of low calcium dialysate combined with active vitamin D and sevelamer hydrochloride on secondary hyperparathyroidism in chronic renal failure patients with maintenance hemodialysis (MHD). Methods We recruited 30 cases of chronic renal failure patients with MHD treated in the Nephrology Department of Qinghai Province People's Hospital using low calcium dialysate (1.25 mmol/ L) combined with pulse treatment of active vitamin D and oral administration of sevelamer hydrochloride. Changes of serum calcium, phosphorus, calcium-phosphorus product, and intact parathyroid hormone (iPTH) were recorded after the treatment for 6 months. Results In the 30 cases before the treatment, after the treatment for 3 months and for 6 months, serum calcium was 2.34 ± 0.17 mmol/L, 2.36 ± 0.21 mmol/L and 2.37 ± 0.20 mmol/L, respectively, all within the normal serum range; serum phosphate was 2.27 ± 0.39 mmol/L,17 5 ± 0.41 mmol/L and 1.41 ± 0.35 mmol/L, respectively; calcium- phosphorus product was 63.21 ± 10.13 mg2/dl2, 53.27 ± 9.57 mg2/dl2 and 48.51 ± 9.74 mg2/dl2, respectively; serum iPTH was 650.80 ± 119.40 pg/ml, 376.10 ± 117.40 pg/ml and 211.90±109.40 pg/ml, respectively. As compared with those before the treatment, serum phosphate, calcium- phosphorus product and iPTH decreased after the treatment for 3 months (F=1.10, P= 4.97×10-6 for serum phosphate; F=0.89, P=0.0002 for calcium-phosphorus product; F=0.97, P=1.40×10-12 for iPTH), and decreased further after the treatment for 6 months (F=0.81, P=1.38×10- 12 for serum phosphate; F=0.92, P=3.79×10-7 for calcium-phosphorus product; F=0.84, P=2.06×10-21 for iPTH). Four patients were found to have adverse gastrointestinal reactions that disappeared after appropriate treatment. Conclu-sion Dialysis with low calcium dialysate combined with sevelamer hydrochloride and pulse doses of active vitamin D can significantly decrease serum phosphorus and calcium-phosphorus product for secondary hyperparathyroidism in chronic renal failure patients on MHD. This combination therapy prevents the patients from hypercalcemia and metastatic calcification, and is effective to renal osteopathy of high transport type. Metrics

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The level of cardiac troponin T and its possible influence factors in maintenance hemodialysis patients 2014, 13 (07):  497-501.  doi: 10.3969/j.issn.1671-4091.2014.07.004 Abstract ( 189 )   HTML ( 0 )   PDF (520KB) ( 228 )   Objective To study the level of cardiac troponin T(cTnT) and its possible influence factors in maintenance hemodialysis(MHD) patients. Methods Blood was obtained from 123 MHD patients before undergoing hemodialysis, cTnT was measured by electro- chemoluminiscence immunoassay. Spearman correlation and linear regression were used to assess the relationship between cTnT and other parameters. Receiver operating characteristic (ROC) curves were used to assess the correlation with cTnT,amino-terminal pro-brain-natriuretic peptide (NT-proBNP), high-sensitive C reactive protein(hsCRP) and cardiovascular disease(CVD ) as well as left ventricular hypertrophy(LVH). Results The median value of serum cTnT was 0.046（0.028-0.066）ng/ml in 123 MHD patients, patients with cardiovascular disease(CVD) had higher cTnT levels than those without CVD(0.062[0.044-0.083]ng/ml vs 0.031[0.020-0.046]ng/ml, P=0.002), patients with diabetes mellitus(DM) had higher cTnT levels than those non-DM (0.061[0.042-0.102]ng/ml vs 0.044[0.025-0.064]ng/ml, P=0.003). In all MHD patients cTnT correlated positively with age(ρ=0.309, P=0.001), glycated albumin (ρ=0.192, P=0.040), NT-proBNP (ρ=0.448, P<0.001), hsCRP(ρ=0.335, P<0.001), carotid artery intima-media thickness (ρ=0.315, P=0.004) and left ventricular mass index(LVMI)(ρ=0.369, P<0.001); negatively with pre-albumin(ρ=-0.280, P=0.002), high density lipoprotein cholesterol(ρ=-0.201, P=0.047). Linear regression analysis showed age (β=0.204, P=0.043), NT-proBNP (β=0.299, P=0.010) and LVMI (β=0.345, P=0.003) were independently associated cTnT. ROC curves analysis showed the correlation between cTnT and CVD was more closely than NT-proBNP and hsCRP, the correlation between cTnT and LVH was lower than NT-proBNP,and higher than hsCRP. Conclusions Serum cTnT is markedly elevated in MHD patients; Serum cTnT is associated with advanced age, fluid overload, malnutrition, microinflammation, LVH and CVD in MHD patients. Metrics

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The factors relating to intradialytic hypotension and hypertension during hemodialysis session in patients with diabetic nephropathy 2014, 13 (07):  502-505.  doi: 10.3969/j.issn.1671-4091.2014.07.005 Abstract ( 256 )   HTML ( 1 )   PDF (329KB) ( 401 )   Objective To evaluate the factors relating to intradialytic abnormal blood pressure through observation of the incidence of hypotension and hypertension during hemodialysis sessions in patients with diabetic nephropathy. Methods Patients with diabetic nephropathy treated with maintenance hemodialysis were recruited in this study. The effects of gender, age, dialysis age, blood flow, dialyzer and ultrafiltration rate on blood pressure were observed. Results Dialysis age was the main factor relating to intradialytic abnormal blood pressure in patients with diabetic nephropathy. The patients were divided into four groups based on dialysis age, group A (≤1 year), group B (1 to 3 years), group C (3 to 5 years) and group D (≥5 years). The incidence of intradialytic hypotension was 13.8%, 22.5%, 26.7% and 37.2% in group A, B, C and D, respectively, significant different between the four groups (χ2=23.129, P＜0.001 for group A vs. group B;χ2=22.889, P＜0.001 for group B vs. group D; χ2=9.072, P =0.003 for group C vs. group D). The incidence of intradialytic hypertension was 22.3%, 14.2%, 12.2% and 8.1% in group A, B, C and D, respectively, significant different between group A and other groups (χ2=20.399, P＜0.001 for group A vs. group B; χ2=22.774, P＜0.001 for group Avs. group C; χ2=24.811, P＜0.001 for group A vs. group D). Ultrafiltration rate was related to intradialytic hypotension (P=0.006), but not related to intradialytic hypertension (P=0.585). While gender, age, dialyser flux and blood flow were unrelated to intradialytic hypotension (P=0.568, 0.059, 0.572, and 0.447, respectively) and hypertension (P=0.346, 0.337, 0.121, and 0.479, respectively). Conclusion With the increase of dialysis age, the incidence of intradialytic hypotension significantly increased but the incidence of hypertension significantly reduced. Ultrafiltration rate was related to intradialytic hypotension. To raise the tolerance to he-modialysis, preventive measures should be conducted to the dialysis age-related intradialytic abnormal blood pressure in patients with diabetic nephropathy under hemodialysis. Metrics

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The association between parathyroid hormone and cardiac function in patients under maintenance hemodialysis 2014, 13 (07):  506-509.  doi: 10.3969/j.issn.1671-4091.2014.07.006 Abstract ( 328 )   HTML ( 0 )   PDF (492KB) ( 228 )   Objective To investigate the relationship between intact parathyroid hormone (iPTH) and left ventricular structure and function, and to evaluate the clinical value of iPTH for the early diagnosis, treatment and prognosis of heart failure. Methods A total of 186 maintenance hemodialysis (MHD) patients treated in Hospital of Shenyang Military Area Command were recruited in this study. They were treated with maintenance hemodialysis (MHD) 3 times a week and 4 h a session with the dialysis age of 6 months to 10 years, and were 18-75 years old without acute cardiovascular events. Serum iPTH was determined by radioimmunoasssy, and pro- BNP by electro- chemiluminescence. Echocadiography was used to measure left atrial size (LAD), ventricular diastolic diameter (LVDd), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPwT), left ventricular ejection fraction (LVEF), left ventricular mass (LVM) and LVM index (LVMI) for the assay of left ventricular hypertrophy. According to the 2009 KDIGO guidance and 2～9 times of iPTH upper limits (normal range 11.7～61.1 pg/ml), the patients were stratified into three groups, iPTH ≥549.9 pg/ml group, iPTH ≤122.2 pg/ml group and 122.2～549.9 pg/ml group to investigate the relationship between iPTH and left ventricular structure and function. Result LAD, LVMI, LVDd, VST and LVPwT were significantly higher in the iPTH ≥549.9 pg/ml group than those in the iPTH ≤122.2 pg/ml and 122.2～549.9 pg/ml groups (P＜0.05). Serum iPTH was positively correlated with pro-BNP levels (P＜0.05). Serum iPTH increased along with the increase of NYHA class. iPTH level was positively correlated with LAD, LVMI, LVDd, LVDs, IVST, LVPwT, left ventricular systolic function and pro-BNP (P＜0.05), and was negatively correlated with LVEF (P＜0.05). Conclusion In MHD patients, serum iPTH is closely related to left ventricular function. iPTH may become an important factor for the evaluation of heart function. Metrics

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Relationship between fractures and disordered bone mineral metabolism in patients with maintenance hemodialysis 2014, 13 (07):  510-514.  doi: 10.3969/j.issn.1671-4091.2014.07.007 Abstract ( 215 )   HTML ( 0 )   PDF (537KB) ( 187 )   objective: to observe the relationship between new-onset bone fractures and their prognosis, and to assess clinical significance of testing bone mineral metabolism markers in patients with maintenance hemodialysis (MHD). Methods: a perspective cohort study, 158 MHD patients were followed up from 2010 to 2012 in our hemodialysis center. The change of dry body weight, new-onset bone fracture cases, survival and impact of cardiovascular events after fracture were recorded. Serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), intact PTH (i-PTH), total VitD, cross-linked C telopeptide of Collagen I, osteocalcin, and calcitonin were regularly tested. Outcomes above-mentioned and prognosis were compared between patients with and without fractures. Results: there were twenty-one new onset bone fractures in the follow-up period, the average incidence of fracture is: 4.43 per 100 patients-years, all were brittle fracture. Compared with patients without fracture, the new onset patients were older and more likely females, had higher ALP level and lower body mass index (BMI), and more to decline in dry weight (P < 0.05), moreover, had lower ratio （42.86% vs72.26%）of receiving active Vitamin D regular supplementation, and had higher impact of death and cardiovascular events (66.67% vs 18.98% and 52.38% vs 18.98%, respectively). There were no significant differences in the rest markers of bone metabolism between the two groups. Patients un-received fixation treatment after fracture had higher 1 year mortality than those who received treatment (70.59% vs 25.00%). Survival analysis showed that new onset fracture would greatly reduce the accumulative survival rate. Logistic Regression analyses revealed that dry body weight decline and female were independent risk factors for fracture in patients with MHD, the OR were 42.94 (95% CI: 9.31, 196.34) and 9.31 (95% CI: 1.11, 10.84) respectively. Conclusion: aging, female, decreased dry weight, elevated ALP level, and un-receiving active Vitamin D regular supplementation are associated with an increased risk of fracture in hemodialysis patients. It was limited clinical utility of mineral metabolism markers testing for fracture prediction in MHD patients, except ALP. Fractures associated with substantially high mortality and cardiovascular events in MHD patients, quickly treatments on account of multidisciplinary cooperation were urgently needed once fracture occurred. Metrics

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Relationship between V249I polymorphism in CX3CR1 gene and inflammatory mediators in diabetic nephropathy 2014, 13 (07):  515-519.  doi: 10.3969/j.issn.1671-4091.2014.07.008 Abstract ( 182 )   HTML ( 0 )   PDF (1009KB) ( 206 )   Objective To investigate the relationship between the polymorphism in fractalkine receptor CX3CR1 gene and inflammation mediators including NF-κB, FKN, IL-6 and TNF-α in diabetic nephropathy (DN) patients. Methods By polymerase chain reaction and restriction fragment length polymorphism (PCRRFLP) and sequencing methods, the V249I polymorphism in CX3CR1 gene was determined in 80 DN patients, 119 diabetes mellitus (DM) patients and 118 control individuals. The genotype frequency of V249I polymorphism in CX3CR1 gene was compared among the groups. Serum levels of NF-κB, FKN, IL-6, and TNF-α were measured. Results The allele frequency of V249I polymorphism was higher in control group (20.33%) than in DN group (8.75%; χ2=9.698, P=0.002) and DM group (17.23%; P< 0.05). Serum levels of NF-κB, FKN, IL-6, TNF-α were higher in DN group than in DM and were higher in DM group than in control group (F=23.318, P<0.001 for NF-κB; F=52.507, P<0.001 for FKN; F=8.821, P=0.001 for IL-6; F=12.013, P＜0.001 for TNF-α). In the DN and DM groups, serum FKN increased significantly in patients carrying V/I or I/I genotype than those carrying V/V genotype (F=21.216; P=0.000); serum NF-κB decreased obviously in those carrying V/I or I/I genotype than those carrying V/V genotype (F=15.361; P=0.000); serum IL-6 was unchanged among the patients carrying different genotypes (V/I, I/I and V/V genotypes) (F=1.387; P=0.053). Conclusion The V249I allele in fractalkine receptor CX3CR1 gene may associate with a lower risk of diabetic nephropathy. This polymorphism in CX3CR1 gene may be involved in the pathogenesis of DN through involving inflammation processes. Metrics

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The treatment of swelling hand syndrome caused by proximal blockage of arteriovenous fistula 2014, 13 (07):  534-536.  doi: 10.3969/j.issn.1671-4091.2014.07.013 Abstract ( 241 )   HTML ( 0 )   PDF (438KB) ( 213 )   Objective To investigate the treatment of swelling hand syndrome caused by proximal blockage of autogenous arteriovenous fistula. Methods In the duration from March 2011 to November 2013, we have treated 13 cases of swelling hand syndrome caused by proximal blockage of autogenous arteriovenous fistula in maintenance hemodialysis patients. Nine of the 13 cases had hand ischemia and treated with surgery. All of the 13 case underwent ligation of the arteriovenous fistula. Results The success rate of fistula ligation was 100%. After the ligation, hand swelling disappeared rapidly with gradually improvement of ischemia symptoms. Conclusion Proximal blockage of autogenous arteriovenous fistula caused swelling hand syndrome, and surgical ligation of the fistula effectively eliminated swelling hand and ischemia symptoms. Metrics

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A retrospective analysis of in situ conversion of temporary internal jugular vein catheter to tunneled caffed catheter 2014, 13 (07):  537-539.  doi: 10.3969/j.issn.1671-4091.2014.07.014 Abstract ( 197 )   HTML ( 0 )   PDF (393KB) ( 267 )   Objective To explore the clinical outcomes and complications of in situ conversion of temporary catheters to tunneled caffed catheters. Method We collected the patients treated with tunneled caffed catheterization in internal jugular vein from 2012.1～2012.12 in our center. Complications, maximum blood flow and dialysis adequacy were compared between in situ conversion group and control group. Result There are totally 62 times operating. In in situ conversion group (n=30), the technical success ratio was 100%, maximum blood flow was 366.9±37.2 ml/min, urea reduction ratio was 67.2±7.1% and the Kt/V value was 1.45±0.12. In control group (n=32), the technical success ratio was 100%, maximum blood flow was 367.6±40.3 ml/min, urea reduction ratio was 65.5±8.5% and the Kt/V value was 1.46±0.13. No statistical differences were observed between these two groups. Conclusion Based on strictly control of indications, in situ conversion of temporary catheter to tunneled caffed catheter is a safe, simple and effective method. Metrics