Chinese Journal of Blood Purification

12 June 2014, Volume 13 Issue 06 Previous Issue    Next Issue

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The relationship between hemoglobin variation and cardiovascular prognosis in peritoneal dialysis patients 2014, 13 (06):  428-432.  doi: 10.3969/j.issn.1671-4091.2014.06.003 Abstract ( 318 )   HTML ( 0 )   PDF (471KB) ( 251 )   Objective To understand the effect of hemoglobin (Hb) fluctuation on cardiovascular prognosis in peritoneal dialysis (PD) patients. Methods We recruited clinical and laboratory data of the PD patients treated in Division of Nephrology, Renji Hospital for more than 3 months in the period from May 1st, 2006 to Sept. 1st, 2011. They were followed up until Dec. 1st, 2011. The absolute value of Hb variation, the trend of Hb variation, and the response of Hb variation to erythropoietin (EPO) were used to analyze the effect of Hb variation on cardiovascular prognosis in PD patients. Results After PD for 3 months, Hb variation could be analyzed in 333 of the 398 PD patients. In patients with the increase of absolute Hb value of <10g/L and >10g/L, the incidence of new cardiovascular disease (CVD) patients was 27.2% and 12.2% (P<0.05), respectively, and the presence of CVD event was 1/76.2 patients/month and 1/120.1 patients/month, respectively. The percentage of recurrent CVD events in the 3 months of PD was significantly higher in the patients with sustained higher Hb than those in the other 3 Hb variation trend groups (66.7%, P＜0.05). The presence of CVD event was 1/59.2 patients/month in patients with Hb response of <0.01g/L/100IU to EPO treatment, significantly higher than that in the patients with higher Hb response to EPO treatment. Conclusions Hb variation affected the cardiovascular prognosis in PD patients. Our findings suggest that anemia should be treated in PD patients without history of CVD events, and Hb should not be maintained at a higher level in patients with the history CVD events. CVD events occurred more likely in PD patients with lower response to EPO. However, further investigations need to be conducted to confirm our findings. Metrics

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Influence of blood purification modality on the efficacy of erythropoietin in patients on maintenance hemodialysis 2014, 13 (06):  437-440.  doi: 10.3969/j.issn.1671-4091.2014.06.005 Abstract ( 225 )   HTML ( 0 )   PDF (348KB) ( 374 )   【Abstract】Objective To compare the clearance ability for middle molecular uremic toxins, like inflammatory mediators and parathyroid hormone (PTH), in maintenance hemodialysis patients (MHD) of three blood purification modalities and also evaluate the effect of recombinant human erythropoietin (r-HuEPO)in this study. Methods Fifty-four maintenance hemodialysis patients were randomly divided into three groups, namely hemodialysis (HD) group , hemodiafiltration (HDF) group , hemoperfusion (HD+HP) group，eighteen in each group. Routine blood test was checked every 4 weeks and EPO dosage according to the correction of anemia adjusted.The follow-up lasted for three months. The level of C-reactive protein (CRP), PTH, interleukin-6 (IL-6) and indicators of renal anemia were measured at the beginning and just after the trial，while r-HuEPO amount and hematocrit (Hct) ratio (EPO/Hct) was defined as r-HuEPO resistance indicators. Results Before and after the treatment, comparising in group , EPO/Hct, CRP, IL-6, PTH of patients in HDF and HD+HP group decreased obviously (P<0.05), while no significant change in each indicators was observed in HD group(P>0.05); Comparising between groups , rHuEPO dosage , EPO/Hct, CRP, IL-6 and PTH decreased obviously in HD+HP and HDF group and the CRP, IL-6 concentration was evidently lower in HD+HP group (P<0.05).correlation analysis found that CRP, IL-6 and PTH were associated with the EPO/Hct ratio. Conclusions HDF and HD+HP can improve the treatment efficacy and reduce dosage of EPO in uremic patients, while the mechanism probably has part relationship with the improvement of hyperparathyroidism and micro-inflammation status of the population. Metrics

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Red blood cell distribution width may be a novel prognostic marker for mortality in patients on continuous renal replacement therapy due to acute kidney injury following cardiac surgery 2014, 13 (06):  441-444.  doi: 10.3969/j.issn.1671-4091.2014.06.006 Abstract ( 211 )   HTML ( 0 )   PDF (485KB) ( 275 )   Objectives To evaluate the value of red blood cell distribution width (RDW) for the prediction of mortality in patients on continuous renal replacement therapy (CRRT) due to acute kidney injury (AKI) following cardiac surgery. Methods Patients without any history of chronic kidney diseases but with AKI following cardiac surgery and underwent continuous veno-venous hemodiafilitration (CVVHDF) in our medical center from January 2012 to June 2013 were enrolled in this study. They were assigned into either survival group or death group. Data from pre-surgery and pre-CVVHDF were collected and analyzed. The value of RDW for mortality prediction was assessed by receiver operator curve, and the 28- day survival rate between high-level and low-level RDW groups was further compared. Results Seventeen adult patients with AKI following cardiac surgery and underwent CVVHDF were enrolled in this study. Six patients survived and 11 patients died, with the mortality of 64.7%. The death group showed a higher level of RDW and SOFA score than those in the survival group (P=0.048 and 0.014, respectively). The area under receiver operator curve (AUC) for mortality prediction was 0.765 for RDW and 0.848 for SOFA score (P=0.024 and 0.0002, respectively), and there was no statistical significance between RDW and SOFA scores (P=0.541). Patients with a RDW level >15% exhibited significantly higher 28-day mortality rate than those with lower RDW level (P= 0.038). Conclusions The present study demonstrated that RDW may be an additive predictor for mortality in patients on CRRT due to AKI following cardiac surgery. Metrics

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Value of plasma B-type natriuretic peptide in assessing fluid overload in hemodialysis patients 2014, 13 (06):  445-449.  doi: 10.3969/j.issn.1671-4091.2014.06.007 Abstract ( 236 )   HTML ( 0 )   PDF (424KB) ( 247 )   【Abstract】 Objective To explore the value of plasma B-type natriuretic peptide in assessing fluid volume in hemodialysis patients. Methods Eighty-seven hemodialysis patients were divided into four groups according to the plasma BNP level. The relationship between plasma BNP level and post-dialysis body weight of MHD patients was analyzed. Results The plasma BNP level and post-dialysis body weight decreased significantly in groups with higher plasma BNP level（p＜0.05）. There was significant difference of BNP and post-dialysis body weight among different groups. The baseline plasma BNP level was positively correlated with decreasing of post-dialysis body weight（R=0.763，p＜0.001）. The changes of post-dialysis body weight, systolic BP, albumin and hemoglobin were correlated with the change of plasma BNP（R=0.823，R2=0.678）.The area under ROC curve was 0.918（p＜0.001）. Conclusions The plasma BNP level could be the effective index to determine chronic volume overload in hemodialysis patients. Metrics

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Evaluation of Ambulatory Blood Pressure Monitoring on Outcome of Patients with Maintenance Hemodialysis 2014, 13 (06):  450-453.  doi: 10.3969/j.issn.1671-4091.2014.06.008 Abstract ( 176 )   HTML ( 0 )   PDF (366KB) ( 284 )   【Abstract】Objective：To investigate the prognostic value of ambulatory blood pressure monitoring (ABPM) on outcome of patients with maintenance hemodialysis. Methods：45 maintenance hemodialysis patients from March to July in 2010 in our hospital were recruited . The data on the demographic, serum biochemical parameters as well as ABPM results of these patients were collected. The patients were followed up until death or December 2013. The long-term survival rates and impact factors were analyzed. Univariate and multivariate analysis Cox regression proportional hazard model were used to analysis the risk factors. Results：Over an average follow-up of 3.5 years，9 patients died. 7 were died of cardiovascular and cerebrovascular disease. Adjusted multivariate analyses showed mean arterial pressure (MAP)，minimum value of diastolic blood pressure (DBP) at night，nighttime DBP variability and non-dipper blood pressure as well as age were independent risk factors for death (HR： 1.248，1.577，2.101，0.000，1.461，respectively). Conclusions：The elevated MAP, minimum value of DBP at night，nighttime DBP variability and the non-dipper blood pressure pattern obtained by ABPM might be of prognostic importance for patients with maintenance hemodialysis. Metrics

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Corelation of urinary angiotensinogen with formation of crescent in IgA nephropathy patients 2014, 13 (06):  454-457.  doi: 10.3969/j.issn.1671-4091.2014.06.009 Abstract ( 187 )   HTML ( 0 )   PDF (370KB) ( 218 )   Objective To analyze the relationship between urinary angiotensinogen(AGT) and the formation of crescent in IgA nephropathy(IgA N) patients. Methods Between March 2011 and June 2013, 45 patients who were diagnosed with IgA nephropathy by renal biopsy in the Peking University Third Hospital were chosen in the study. Enzyme linked immunosorbent assay ( ELISA ) was applied to detect the levels of urinary AGT. Crescent index was calculated and correlation analysis was processed between urinary AGT and crescent index. Results T he urinary level of AGT in IgA N group increased significantly compared with that of control group (212.3±276.1 vs. 6.6 ± 4.9 μg/g, p<0.05). The level of urinary AGT in IgA N patients with crescent formation increased compared with that of non crescent group (272.3±329.7 vs.143.6±187.2μg/g, p<0.05).The level of urinary AGT of index o f crescent≥10% group increased compared with that of the index of crescent <10% group (375.8±391.9 vs. 201.3±186.3 μg/g, p<0.05). T he level of urinary AGT was positively correlated with index o f crescent(r=0.483，p=0.001) and 24-h urine protein (r=0.618, p=0.000), and negatively correlated with serum albumin(r= - 0.535, p=0.000).Conclusion The levels of urinary AGT may reflect the renal tissue of crescent formation in IgA N patients. Metrics

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Changes in hepcidin during treatment of anemia in patients on maintenance hemodialysis 2014, 13 (06):  458-461.  doi: 10.3969/j.issn.1671-4091.2014.06.010 Abstract ( 216 )   HTML ( 0 )   PDF (311KB) ( 212 )   ABSTRACT Objective: The current study was to investigate the change of hepcidin in the treatment of anemia and its interaction with iron supplement and Erythropoietin (EPO) agents in patients on maintenance hemodialysis (MHD), and to explore the therapy for iron homeostasis. Methods: 32 MHD patients for more than 6 months were enrolled in the study. Their hemoglobin level was lower than 110g/l. We gave them iron supplement and EPO treatment. Serum hepcidin was measured by ELISA. Iron metabolism index such as serum Fe, serum ferritin (SF) and transferrin saturation (TSAT) were measured by routine assays. The relationships between hepcidin with iron metabolism index, erythropoiesis, iron supplement or EPO agents were analyzed. Results: Serum hepcidin levels were significantly higher in patients on MHD than that in healthy control group（324±124.2VS72.4±12.3，p<0.001. It is also positively correlated with serum Fe (r=0.68,p=0.005), SF(r=0.62,p=0.004),TSAT(r=0.7,p=0.001), and negatively with reticulocyte count (r=-0.63,p=0.015). Regular hemodialysis can effectively remove hepcidin, and restore serum level to the original level in 2 weeks before hemodialysis. Treatment with EPO agents rather than iron supplement could decrease serum hepcidin levels.Conclusions: Serum hepcidin levels increasedin patients on MHD. Serum hepcidin may contribute to the abnormal iron metabolism and erythropoiesis. Timely and effectively removingf hepcidin from the body and treating with EPO can improve erythropoiesis and iron recycle, restore iron homeostasis, and prevent the further damage caused by iron overload. Metrics

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Effects of a parathyroidectomy on left ventricular hypertrophy of uremic patients with secondary hyperparathyroidism. 2014, 13 (06):  462-465.  doi: 10.3969/j.issn.1671-4091.2014.06.011 Abstract ( 215 )   HTML ( 0 )   PDF (371KB) ( 251 )   【Abstract】Objective To observe the effect of parathyroidectomy on left ventricular hypertrophy of uremic patients with secondary hyperparathyroidism(SHPT). Methods 21 SHPT patients were divided into two groups. 13 patients received parathyroidectomy; 8 patients received regular treatment. Before and 1 year after parathyroidectomy, the serum calcium(Ca), phosphorus(P), parathyroid(iPTH), left ventricular end diastolic diamete(LVED)、interventricular septum diastolic thickness (IVST)，left ventricular posterior wall diastolic thickness(LVPWT), left ventricular ejection fraction (LVEF)were measured, LVMI were calculated. Results The levels of Ca、P、Ca×P、iPTH were decreased after parathyroidectomy(t= -3.823、-3.873、-4.531、-10.545，P <0.01, respectively).The levels of LVMI were decreased from 153.7±56.7g/m2 to 119.5±29.4 g/m2. The effects of parathyroidectomy to LVMI、IVST、LVPWT were signifant (F=4.180、4.174、5.959，P=0.048、0.048、0.019). Conclusion Parathyroidectomy could improve left ventricular hypertrophy of uremic patients with secondary hyperparathyroidism. Metrics

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Clinical application of radial recurrent artery fistulas in the senile patients 2014, 13 (06):  475-476.  doi: 10.3969/j.issn.1671-4091.2014.06.015 Abstract ( 171 )   HTML ( 0 )   PDF (282KB) ( 213 )   【Abastract】Objectives To summarize our experience about the operation method for radial recurrent artery fistulas(RRAFs)and its clinical effects in the senile patient.Methods We retrospectively analyzed the maturation,patency and complications of the RRAFs performed between August 2007 and October 2013 in our center.Results A total of 66 cases(35 males and 31 females;mean age 71±7.8 yrs)were treated with the radial recurrent artery and intermedian cubital vein(or its cephalic vein) .RRAFs were successfully established in all patients without complications including hemotoma,wound infection,high output cardiac failure and perioperative mortality.The RRAFs were functionally useful for hemodialysis access after the operation for 1-2 months. After the operation for one and two years ,the patent rate was 91.1% and 87.5%,respectively.Conclusion RRAFs is a new method better than the brachial artery in-flow AVF.This method has the advantage of less injury,heart failure,steal blood syndrome and arm edema,a longer and straight conduit for vascular access ,and a high patency rate. Metrics