Chinese Journal of Blood Purification

12 September 2014, Volume 13 Issue 09 Previous Issue    Next Issue

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Clinical value of pathological examination of uremic patients with refractory secondary hyperparathyroidism 2014, 13 (09):  613-616.  doi: 10.3969/j.issn.1671-4091.2014.09.001 Abstract ( 227 )   HTML ( 0 )   PDF (384KB) ( 242 )   Objective To analyze the pathology results of excised hyperplastic parathyroid glands for detecting uremic patients with refractory secondary hyperparathyroidism (SHPT). Methods Eighty-two uremic patients were analyzed retrospectively. The diagnosis of hyperparathyroidism was confirmed by surgery and pathological examination. Total parathyroidectomy was performed in 67 patients, in whom 53 patients accepted parathyroid imaging of color Doppler ultrasonography and 99mTc-MIBI biphasic scintigraphy, and 14 patients were examined only by color Doppler ultrasonography before surgery. The diagnostic sensitivity of the two parathyroid imaging methods were compared base on the pathology of excised parathyroid samples. The correlation between serum intact parathyroid hormone (iPTH) just before the surgery and the volume and calcification of excised hyperplastic parathyroid was evaluated. Results Pathologically, hyperplasia or hyperplasia with calcification was found in all excised parathyroid samples. Serum iPTH level was positively correlated with the size of hyperplastic parathyroid (r=0.365, P=0.006), but not with the size of the hyperplastic parathyroid with calcification (r=-0.308, P=0.356). The sensitivity for the localization of hyperplastic parathyroid was 60.38% (128/212 samples), 78.37% (203/259 samples), and 81.19% (172/212 samples) by color Doppler ultrasonography, 99mTc-MIBI biphasic scintigraphy, and combination of the two methods, respectively. The sensitivity by color Doppler ultrasonography was higher than that by 99mTc- MIBI biphasic scintigraphy (χ2=18.084, P=0.000). The sensitivity by combination of the two methods was higher than that by 99mTc-MIBI biphasic scintigraphy (χ2=22.066, P=0.000), but was statistical indifferent from that by color Doppler ultrasonography (χ2=0.545, P=0.460). Conclusions Serum iPTH level was absolutely unrelated to the illness degree of uremic patients. While 99mTc-MIBI biphasic scintigraphy is an effective method for the localization of refractory SHPT, color Doppler ultrasonography is simpler and more sensitive than 99mTc-MIBI biphasic scintigraphy and can be used preferably for the diagnosis of refractory SHPT in uremic patients. Metrics

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Therapeutic effect of parathyroidectomy for 70 uremic patients with secondary hyperparathyroidism 2014, 13 (09):  617-619.  doi: 10.3969/j.issn.1671-4091.2014.09.002 Abstract ( 216 )   HTML ( 0 )   PDF (305KB) ( 221 )   Objective To retrospectively analyze the therapeutic effect of total parathyroidectomy (TPTX) on uremic patients with secondary hyperparathyroidism (SHPT). Methods Seventy SHPT patients treated with T-PTX in our hospital were enrolled in this study. Serum parathyroid hormone (PTH), calcium (Ca), phosphorus (P) and alkaline phosphatase (ALP) obtained in the preoperative, postoperative and followup periods were collected and compared. Their symptoms, postoperative complications and relapse were recorded. Results ①T- PTX operation performed successfully in 67/70 patients (95.7%). ①After T- PTX, bone pain, itching, weakness, insomnia and anorexia improved rapidly, with the improvement of nutritional status. Ten cases can walk freely without wheelchair within one year after T-PTX. ③Serum PTH, Ca, P, and ALP decreased significantly after PTX for one week, one month and 6 months as compared with those before PTX (P＜0.05).④ Hoarseness was found in 2 cases (2.85%) in postoperative period, and improved spontaneously within one week. Postoperative hypocalcemia was frequently seen (59/70, 84.3%) but could be effectively controlled by intravenous calcium infusion. ⑤ SHPT recurred in the 6 months after T- PTX in 2 cases (2.9%). One of them accepted PTX again, and PTH decreased to 15.0 pg/ml after the operation. Conclusion T-PTX can effectively decrease PTH level and improve symptoms, and is a safe measure for the treatment of uremic patients with SHPT. Metrics

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Serum beta-2 microglobulin is associated with carotid atherosclerosis in patients with chronic kidney disease 2014, 13 (09):  620-624.  doi: 10.3969/j.issn.1671-4091.2014.09.003 Abstract ( 217 )   HTML ( 0 )   PDF (409KB) ( 298 )   Objective To investigate the serum beta-2 microglobulin (ß2MG) level and to explore its correlation with atherosclerosis (AS) in chronic kidney disease (CKD) patients. Methods Clinical and laboratory data of 168 CKD patients stratified by their GFR (based on the National Kidney Foundation/Kidney Dialysis Outcomes Quality Initiatives) were recruited and analyzed. Fifty healthy individuals were used as the controls. Serum ß2MG was determined by electrochemiluminescence immunoassay (ECLIA). High- sensitivity C- reactive protein (hsCRP) was measured by immunoturbidimetry. AS was detected by carotid ultrasonography. Logistic regression was used to analyze the relationship between ß2MG level and carotid AS in CKD patients. Results Serum ß2MG level was significantly higher in CKD patients even in the early stage of CKD as compared with that in the healthy controls (18.6±2.91 vs. 2.18±0.49 μg/mL, P＜0.01). Serum ß2MG increased with the progression of renal dysfunction. In the CKD2~5 groups, serum ß2MG was negatively related to GFR (P＜0.05) and positively related to proteinuria (P＜0.05), while in the CKD5D group, ß2MG level was positively related to dialysis duration (P＜0.05). Serum ß2MG was higher in CKD patients with carotid AS than in the patients without carotid AS (P＜0.05 or ＜0.01). Carotid intimal medial thickness (IMT) and the prevalence of carotid AS were significantly higher in CKD patients even at the early stage of CKD as compared with those of healthy controls (0.71 ± 0.18 vs. 0.67 ± 0.21 mm, P＜0.01; 32.9% vs. 12.0%, P＜0.01). Linear correlation analyses showed that serum ß2MG level was positively correlated with hsCRP, TG, Lp(a), phosphate, iPTH, 24 h urinary protein, dialysis vintage, IMT, AS formation, and prevalence of carotid AS (P＜0.05 or ＜0.01), and was negatively correlated with GFP, serum albumin, Hb, and serum calcium (P＜0.05 or ＜0.01). Multivariate regression analyses demonstrated that ß2MG, hsCRP and age were the independent risk factors for carotid AS in CKD patients. Conclusion Serum ß2MG increases significantly in CKD patients at every stage, and is correlated with the increases of hsCRP and carotid AS. Serum ß2MG level is an independent risk factor for carotid AS in CKD patients. Metrics

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Surgical treatment of carpal tunnel syndrome due to dialysis-related amyloidosis: clinical analysis of 20 cases 2014, 13 (09):  625-628.  doi: 10.3969/j.issn.1671-4091.2014.09.004 Abstract ( 247 )   HTML ( 0 )   PDF (1128KB) ( 254 )   Objective To study the clinical features of carpal tunnel syndrome (CTS) caused by dialysis-related β2 microglobulin amyloidosis, and to evaluate the effectiveness of surgical treatment. Methods A total of 20 cases (male 11 cases, female 9 cases) subjected to operation due to carpal tunnel syndrome during the period from March 2010 to March 2014 were retrospectively studied. They were 58.45±8.95 (46 to 75) years old with the dialysis duration of 18.05±2.60 (14 to 23) years. CTS affected both hands in 16 patients, left hand in 2 patients, and right hand in 2 patients. The mean nerve conduction velocity was 18.1±3.2 m/s and the mean latency was 5.1±1.2 m/s. Operation was done under local axillary nerve block (n=18) or general anesthesia (n= 2). Results Symptoms and strength improved after the surgery in all patients. Nerve conduction velocity recovered gradually. BCTQ score became lower than that before surgery in all patients. Conclusion With the increase of dialysis patients, the incidence of dialysis-related CTS increases. Carpal tunnel release surgery is the effective measure for the treatment of CTS. Metrics

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Intervention therapy using high flux hemodialyzer on serum calcium, phosphorus, and intact parathyroid hormone in maintenance hemodialysis patients 2014, 13 (09):  629-631.  doi: 10.3969/j.issn.1671-4091.2014.09.005 Abstract ( 223 )   HTML ( 0 )   PDF (342KB) ( 370 )   Objective To improve the abnormal changes of calcium and phosphorus and intact parathyroid hormone (iPTH) in maintenance hemodialysis (MHD) patients using high flux hemodialyzer. Methods In a total of 82 MHD patients the hemodialyzer for hemodialysis was changed from low flux hemodialyzer to high flux hemodialyzer for 3 months. Serum calcium, phosphorus and iPTH were compared before and after using high flux hemodialyzer. Patients were further divided into parathyroid hyperplasia group and normal parathyroid group based on the findings from Doppler ultrasonography. Serum calcium, phosphorus and iPTH were further compared between the two groups. Results After using high flux hemodialyzer, serum calcium levels increased (t =-4.786, P＜0.05), and phosphorus and iPTH decreased (t =2.341, P＜0.05 for phosphorus; t =2.937, P＜0.05 for iPTH). These effects were more prominent in parathyroid hyperplasia group than in normal parathyroid group (t =-3.583/-3.207 P=0.001/0.003 for serum Ca; t =1.74/1.619, P =0.089/0.113 for serum P; t =2.408/1.830, P=0.001/0.074 for serum iPTH). Conclusion High flux hemodialyzer was better than low flux hemodialyzer to improve serum calcium and phosphorus and iPTH changes in MHD patients. Metrics

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Effects of lanthanum carbonate on serum phosphate and serum FGF23 in maintenance hemodialysis patientswith hyperphosphatemia 2014, 13 (09):  632-635.  doi: 10.3969/j.issn.1671-4091.2014.09.006 Abstract ( 229 )   HTML ( 0 )   PDF (354KB) ( 235 )   Objective To evaluate the short- term efficacy of lanthanum carbonate in treating maintenance hemodialysis (MHD) patients with hyperphosphatemia. Methods A single center, open- labeled study from Peking Union Medical College Hospital was performed. Phosphate binders were discontinued during a two-week washout period. Patients with more than 1.78 mmol/L serum phosphorus after two-week washout period were eligible for the study. The dose was adjusted after first two weeks as necessary to achieve lower serum phosphorus. Lanthanum carbonate was administered to 12 MHD patients for 4 weeks, followed by taking the original dose of calcium carbonate for 4 weeks. Results All patients fulfilled the whole study. After 4 weeks of treatment with lanthanum carbonate, serum phosphorus decreased significantly in 10 patients, and serum phosphorus was controlled to less than 1.78 mmol/L in 6 patients (2.33±0.09 vs. 1.51±0.06 mmol/L, P= 0.003). After continued use of the original dose of calcium carbonate for 4 weeks, serum phosphorus increased in 9 patients (1.76±0.10 vs. 2.23± 0.10 mmol/L, P=0.040). However, the levels of serum calcium and serum intact parathyroid hormone kept steady after the 10 weeks’observation. The levels of serum FGF23 and α-Kloth decreased after taking lanthanum carbonate in all 12 patients (P<0.05), and the level of FGF23 slightly increased after taking calcium carbonate for 4 weeks. Conclusions Lanthanum carbonate can control serum phosphorus, reduce the levels of serum FGF23 in a short term. Metrics

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Changes of calcium-phosphorus metabolism and parathyroid function in maintenance hemodialysis children 2014, 13 (09):  636-638.  doi: 10.3969/j.issn.1671-4091.2014.09.007 Abstract ( 191 )   HTML ( 0 )   PDF (297KB) ( 208 )   Objective To investigate the changes of serum calcium-phosphorus metabolism and parathyroid function in maintenance hemodialysis (MHD) children. Methods A total of 19 MHD children treated in our blood purification center were enrolled in this study. Serum calcium, phosphate and intact parathyroid hormone (iPTH)  were measured before and after MHD for 3 months. Results Before MHD, hyperphosphatemia was found in 16 patients (84.21%), hypocalcemia in 17 patients (89.47%), elevated alkaline phosphatase in 11 patients (57.69%), and iPTH level ＞600 pg/ml in 13 patients (66.42%). After MHD for 3 months, the mean level of serum phosphorus, calcium, alkaline phosphatase, and iPTH was 1.83±0.76 mmol/L, 2.27±0.26 mmol/L, 401.63±315.61 U/L, and 675.97±581.66 ng/L, respectively, approaching the target level of serum phosphorus, calcium, alkaline phosphatase, and iPTH in 10 patients (52.63% ), 15 patients (78.95% ), 5 patients (26.32%), and 10 patients (52.63%), respectively. While serum alkaline phosphatase changed insignificantly (t =-1.497，P＞0.05), serum phosphorus and iPTH decreased (t =3.477, P＜0.01, and t =2.397, P＜0.05, respectively) and serum calcium increased (t =-7.392, P＜0.01) after MHD for 3 months as compared to those before MHD. Conclusions MHD children are frequently complicated with calcium-phosphorus metabolic derangements and secondary hyperparathyroidism, which should be carefully monitored. MHD combined with hemodiafiltration may be more effective to improve these derangements. Whether alkaline phosphatase can be used as the indicator for calcium-phosphorus metabolic changes in children needs to be further studied. Metrics

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Comparison of different blood purification modalities for removal of serum protein-bound uremic toxins in maintenance hemodialysis patients 2014, 13 (09):  639-642.  doi: 10.3969/j.issn.1671-4091.2014.09.008 Abstract ( 277 )   HTML ( 0 )   PDF (354KB) ( 347 )   Objective To compare the removal efficiencies of protein-bound uremic toxins including indoxyl sulphate (IS), p-cresyl sulphate (PCS) and hippuric acid (HA) by hemodialysis (HD), hemodiafiltration (HDF) and hemoperfusion associated with hemodialysis (HP + HD). Methods Forty- eight MHD patients were enrolled in this study. They were randomly assigned into HD group, HDF group or HP+HD group. IS, PCS and HA in serum samples before and after the treatment were determined using high-performance liquid chromatography electrospray ionization tandem mass spectrometry (HPLC-ESI-MS/MS), to compare the removal of protein-bound uremic toxins by the three dialysis modalities. Results ①Serum IS decreased from 30.96±12.55 μg/ml to 21.03±10.42 μg/ml (reduction rate [RR]=33.10±12.87%, P＜0.05) in HD group, from 32.24±17.11 μg/ml to 17.11±8.94 μg/ml (RR=43.96±14.96%, P＜0.01) in HDF group, and from 33.52±19.30 μg/ml to 14.33±9.81 μg/ml (RR=57.96±11.95%, P＜0.01) in HP+HD group. Therefore, HDF and HP+HD are more effective than HD (P＜0.05 and ＜0.01, respectively), and HP+HD is more effective than HDF (P＜ 0.05) in IS clearance. ②Serum PCS decreased from 24.87±13.64 μg/ml to 16.80±8.48 μg/ml (RR = 30.24 ± 9.27%, P＜0.05) in HD group, from 30.60±19.18 μg/ml to 15.59±12.39 μg/ml (RR=43.20±11.87%, P＜0.05) in HDF group, and from 38.92±17.24 μg/ml to 17.71±10.22 μg/ml (RR=54.22±14.37%, P＜0.01) in HP+HD group. Therefore, HDF and HP+HD are more effective than HD (P＜0.01), and HP+HD is more effective than HDF (P＜0.05) in PCS clearance. ③Serum HA decreased from 18.65±14.24 μg/ml to 7.38±5.27 μg/ml (RR=59.36±7.46%, P＜0.01) in HD group, from 27.62±16.07 μg/ml to 7.75±4.56 μg/ml (RR=69.70±11.93%, P＜0.01) in HDF group, and from 20.48±11.02 μg/ml to 6.33±4.78 μg/ml (RR= 71.20 ± 10.28%, P＜0.01) in HP+HD group. Consequently, HDF and HP+HD are more effective than HD (P＜0.01), but HP+HD and HDF are similar in HA clearance (P>0.05). Conclusion HD, HDF and HP+HD can partially remove proteinbound uremic toxins. HP+HD is better than HDF and HD in removal of these uremic toxins. Metrics

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Effect of total parathyroidectomy on shrinking man syndrome : Clinical analysis of 16 cases 2014, 13 (09):  643-646.  doi: 10.3969/j.issn.1671-4091.2014.09.009 Abstract ( 242 )   HTML ( 0 )   PDF (488KB) ( 237 )   Abstract Objective To investigate the effect of total parathyroidectomy on patients with shrinking man syndrome undergoing maintenance hemodialysis. Methods 16 patients with shrinking man syndrome undergoing hemodialysis were recruited. Parameters including general status, clinical manifestations, height, biochemical examinations (serum total calcium, inorganic phosphate, intact parathyroid hormone) were collected before and after operation.Results Their body weights increased from 2kg to 10kg and their body height changed little 3 month after operation. Bone malformation was remitted to some degree. Bone pain and skin pruritus were remitted rapidly within one day. Intact parathyroid hormone decreased significantly at 1 week after operation and maintained at low levels 1 month and 3 month after operation(20.4 ± 13.5pg/ml,36.3 ±17.4pg/ml,41.7 ± 23.9pg/ml vs 4120.7 ± 865.4pg/ml,respectively. t=18.95,18.88,18.85,respectively.P＜0.01).Compared with serum calcium levels before operation,those decreased rapidly at 1 week after operation. They were elevated slowly within 3 months after operation. However, compared those before operation, they remained lower levels(2.02 ± 0.19mmol/L, 2.28 ± 0.37 mmol/L,2.20 ±0.21 mmol/L vs 2.71 ± 0.22 mmol/L，respectively.t=9.49,4.00,6.71, respectively. P＜0.01). Compared with serum phosphate levels before operation, those after operation decreased rapidly at 1 week and maintained at normal levels 1 month and 3 month after operation (1.05 ± 0.21mmol/L, 1.08 ± 0.24mmol/L, 1.25 ± 0.31mmol/L vs 2.39 ± 0.29mmol/L, respectively. t=14.97,13.92,10.74, respectively. P＜0.01). Conclusions Total parathyroidectomy may be a effective and safely method on shrinking man syndrome in maintenance hemodialysis patients. Metrics

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The effect and mechanism of parathyroid hormone induced endothelial-mesenchymal transition of vascular endothelial HAEC cells 2014, 13 (09):  647-649.  doi: 10.3969/j.issn.1671-4091.2014.09.010 Abstract ( 200 )   HTML ( 0 )   PDF (762KB) ( 197 )   Objective To investigate whether the increased parathyroid hormone (PTH) as a uremic toxin induces the endothelial-mesenchymal transition (EndMT) of vascular endothelial cells (HACE cells) and its related mechanisms. Methods The vascular endothelial HACE cells were cultured to logarithmic phase, and PTH at the concentration of 10-12, 10-11, 10-10, 10- 9, and 10-8 mol/L was added into the medium for 48 h. Additionally, HACE cells were cultured in the medium containing 10-8 mol/L PTH for 12, 24, 36, and 60 h. Cells were then harvested for morphological examination and for VECadherin, CD31, α-SMA, TGF-β1 and ILK expression determinations by western blot. Results Morphological examination showed that the HACE cells tended to have fibrosis changes after the PTH induction. Western blot displayed that PTH reduced the expression of vascular endothelial cell markers CD31 and VECadherin and increased the expression of fiber cell markers α-SMA in timE and dosEdependent manners. At the same time the expressions of TGF-β1 and ILK increased. Conclusion PTH induced the HAEC cells to have less endothelial cell characteristics and more fibrosis characteristics, indicating the presence of EndMT in HACE cells. The TGF-β1-ILK pathway may be involved in the PTH-induced changes. Metrics

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A research into argatroban in the prevention of thrombosis in semipermanent double channel catheter in MHD patients 2014, 13 (09):  669-672.  doi: 10.3969/j.issn.1671-4091.2014.09.018 Abstract ( 210 )   HTML ( 0 )   PDF (432KB) ( 332 )   Objective To examine argatroban in the Prevention of thrombosis of semipermanent double channel catheter in MHD patients,and compare the effect of preventing thrombosis between in using urokinase group，LMWH group and argatroban group,and investigate further the efficacy and safety of argatroban in preventing thrombosis.Methods The 60 patients of semipermanent double channel catheter were collected since Jan.2011 to Dec.2012,including 20 patients using urokinase group , 20 patients using argatroban group and 20 patients the control group using LMWH,and drugs were taken monthly,a total of 12 months. The adverse events of pre-dialysis and intervention,blood flow, transmembrane pressure and venous pressure of dislysis were observed in three groups ,and three groups were controled respectively before and after treatments. The changes of CRP were observed in three groups after treatments.Results Argatroban group, the incidence of complications is 17.5%, urokinase group is 29.16% and the control group is 25.83% ; argatroban group and urokinase group,the adverse events rate before and after treatments are 14.1%vs 4.3%（p<0.05） and 14.2%vs10.3% （p<0.05）, and the control group is 13.8%vs13.2% （p>0.05）, and argatroban group and urokinase group, intervention rate before and after treatments are17.2%vs 4.8%（p<0.05） and 14.2%vs10.3% （p<0.05），the control is and 17.5%vs17.1% （p>0.05）, argatroban group and urokinase group, the blood flow are all increaseed before and after treatments,and transmembrane pressure and venous pressure are all reduced（p<0.05）, while the control（p>0.05）; argatroban group,the CRP gradually is reduced after 12 months treatments（p<0.05）.Conclusion Argatroban or urokinase could prevent the thrombosis of semipermanent double channel catheter,which are dripped at regular period,and the blood flow of dialysis is increased; argatroban group has higher safety,less thrombosis incidence and inflammatory reaction than urokinase group,the long-time argatroban application can reduce inflammatory. Metrics