Chinese Journal of Blood Purification

12 November 2014, Volume 13 Issue 11 Previous Issue    Next Issue

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Experimental study on the effect of high volume hemofiltration to septic shock induced acute kidney injury 2014, 13 (11):  741-746.  doi: 10.3969/j.issn.1671-4091.2014.11.001 Abstract ( 211 )   HTML ( 0 )   PDF (6180KB) ( 220 )   Objective To investigate the effect and mechanisms of high volume hemofiltration (HVHF) to septic shock induced acute kidney injury (AKI). Methods Eighteen pigs were randomly divided into control group, continuous renal replacement therapy (CRRT) group or HVHF group, and then intravenously infused with Escherichia coli lipopolysaccharide (LPS) to induce septic shock. Animals were given fluid resuscitation and vasoactive drugs to maintain tissue perfusion. After successful resuscitation, animals in the control group were managed without specific measures, and those in the other two groups were treated with continuous venovenous hemofiltration (CVVH, ultrafiltration rate 25 ml/kg/h) or HVHF (ultrafiltration rate 85 ml/kg/ h). DATA about hemodynamic parameters, vasoactive drug dosage and therapeutic duration, plasma IL-6 and IL-10, NF-kB expression in kidney tissue, and kidney pathological changes were collected. Results Animal shock model was established after LPS administration for 40～60 min. Hemodynamic parameters were statistically different at 30 min, 40 min, 50 min and 60 min time points compared with the baseline status in each of the three groups (P＜0.05). The dPmax at T4, T5 and T6 time points were significantly higher in HVHF group than in the other two groups (P＜0.05). Fluid resuscitation volume was significantly lower in HVHF group than in the other two groups (P＜0.01), and was significantly lower in CRRT group than in control group (P＜0.05). Norepinephrine dosage decreased more at T4, T5, T6 time points than at baseline (P＞0.05) in HVHF group, and the difference was statistically significant as compared with that in the other two groups (P＜0.01). Plasma IL-6 decreased more at T3-T6 time points and plasma IL-10 decreased more at T2-T6 time points in HVHF group than in CRRT group (P＜0.05). NF-kB mRNA in kidney was lower in HVHF group than in the other two groups (P＜0.01), and was lower in CRRT group than in the control group (P＜0.05). Kidney pathology score was lower in HVHF than in the other two groups (P＜0.01). Conclusion HVHF led to the decreases of vasoactive drug dosage, fluid volume for resuscitation, NF-kB expression in kidney, inflammatory cytokine expression, and kidney pathological changes, thus protected the kidney from AKI during septic shock. Metrics

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Prognostic analysis of acute kidney injury after cardiac surgery with continuous renal replacement therapy 2014, 13 (11):  747-750.  doi: 10.3969/j.issn.1671-4091.2014.11.002 Abstract ( 213 )   HTML ( 0 )   PDF (328KB) ( 241 )   Objectives To analyze the prognosis of patients with cardiac surgery associated-acute kidney injury (CSA-AKI) requiring continuous renal replacement therapy (CRRT). Methods Clinical data of 114 patients with CSA-AKI receiving CRRT from Jan. 2013 to Dec. 2013 in Beijing Anzhen Hospital of Capital Medical University were analyzed. Results In the 114 patients, 73 patients were male with the mean age of 55.8±13.1 years (21 to 83 years). According to the risk prediction score system we established to predict postoperative AKI, 64.9% were high-risk patients with the score of ≥12 points (mean 12.9±3.3). The initiation of CRRT was 2～144 h after the surgery with the median of 26.5 h (20.0, 68.0). CRRT totally lasted 24～692 h with the median of 77 h (36.0, 148.5). In the 114 patients, 63 patients (55.3%) died, renal function recovered in 36 patients (31.6%), and 15 patients (13.1%) required maintenance renal replacement therapy. There were statistical significance in age (61.4±13.4 vs. 56.5±12.2 years), risk prediction score (14.4±2.9 vs. 11.2±2.8) and CRRT duration (54.0 vs. 96.0 h) between death group (n=63) and survival group (n=51). Combined surgery and important complications such as low cardiac output syndrome were more prevalent in death group than in survival group (P<0.05). Forty-four patients treated with CRRT at early or middle AKI stage (within 24 h after surgery or urine output ≤30 ml/h for less than 12 h) had higher renal function recovery rate than the 60 patients treated with CRRT at late AKI stage (urine output ≤ 30 ml/h for >24 h) (P＜0.05). Multivariate logistic regression showed that postoperative mechanical ventilation time ＞24h (0.09; 95%CI, 0.02～0.33), postoperative hypotension (0.081; 95% CI, 0.02～0.28) were the independent risk factors for death in patient with CSA-AKI (P＜0.05). Conclusion CSA-AKI is accompanied by a very high mortality, especially in those requiring renal replacement therapy. The risk prediction score can be used to predict the occurrence of AKI and risk of death. Postoperative mechanical ventilation for more than 24 h and postoperative hypotension are the independent risk factors for death. Older age, combined operation and low cardiac output syndrome after operation are also related to death. Early implementation of CRRT is useful for renal function recovery in CSA-AKI patients. Metrics

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Postoperative complications after surgery with general anesthesia in maintenance hemodialysis patients 2014, 13 (11):  751-754.  doi: 10.3969/j.issn.1671-4091.2014.11.003 Abstract ( 311 )   HTML ( 0 )   PDF (357KB) ( 221 )   Objective To analyze the complications after general anesthesia surgery (excluding renal transplantation) and the related factors in maintenance hemodialysis (MHD) patients. Methods We recruited the clinical data of 54 end-stage renal disease on MHD patients who underwent general anesthesia surgery for other diseases and were treated in our hospital in the period between Jan. 2009 and Dec. 2013. Their postoperative complications and the related factors were retrospectively analyzed. We also recruited 60 patients with normal renal function and subjected general anesthesia surgery during the same period as the controls.Results Postoperative complication rate was significantly higher in MHD patients than in controls (48.1% vs. 10.0%, P＜0.01). The most common complication was hypertension (20.4%), followed by pulmonary infection (14.8%) and heart events (13.0%) with longer hospitalization period (22.37±13.57 vs. 10.82±6.09 days, P＜0.01). However, the postoperative mortality was statistically indifferent as compared with that of the controls (7.4% vs. 1.7%, P=0.188). Diabetic nephropathy as the primary disease, preoperative hypoalbuminemia, and intraoperative hemorrhage >400 ml caused the increase of postoperative complications. Multivariate logistic regression suggested that diabetic nephropathy was the independent risk factor to predict whether postoperative complications occurred (OR=17.914; 95% CI: 1.164～275.802; P=0.039). Conclusions MHD patients subjected to general anesthesia surgery usually have longer hospitalization period and higher prevalence of postoperative complications, especially those with preoperative hypoalbuminemia, intraoperative bleeding, and diabetic nephropathy. Diabetic nephropathy is the independent risk factor for postoperative complications in MHD patients Metrics

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The effect of oral low-dose calcitriol on FGF-23 and vascular calcification in maintenance hemodialysis patients 2014, 13 (11):  755-758.  doi: 10.3969/j.issn.1671-4091.2014.11.004 Abstract ( 303 )   HTML ( 0 )   PDF (386KB) ( 251 )   【Abstract】Objective To investigate the relationship between serum FGF-23 level and vascular calcification, and the effects of oral low-dose calcitriol on FGF-23 and vascular calcification in maintenance hemodialysis (MHD) patients. Methods A total of 63 MHD patients were enrolled in this study, and 33 cases of them (52.38%) took oral low-dose calcitriol for more than 3 months. Serum FGF-23 was determined by ELISA. Liver and kidney functions, blood glucose and lipids, parathyroid hormone (iPTH), ferritin (FER), and highsensitive C-reactive protein (hsCRP) were measured in these patients. Myocardial and valvular calcification, carotid artery intima media thickness (IMT), and arterial plaques were examined by ultrasonography. Abdominal aortic calcification was detected by lateral lumbar X-ray imaging. Statistical analysis was performed by using SPSS 17.0 statistical software package, and P＜0.05 was regarded as statistically significant difference. Results Among the 63 MHD cases, vascular calcification was found in 31 cases (calcification group). Multivariate logistic regression demonstrated that age (OR=1.066, P=0.163), hsCRP (OR=1.195, P=0.065), calciumphosphorus product (OR=1.154, P=0.011), serum FGF-23 (OR=1.048, P=0.012) were the major risk factors of vascular calcification, while higher serum albumin (OR=0.575, P=0.0.016) and calcitriol administration (OR= 0.004, P=0.006) were the protective factors. Conclusions Oral low-dose calcitriol has no significant effect on serum FGF-23 level, but may reduce the incidence of vascular calcification. Metrics

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Impact of parathyroidectomy on cardiovascular calcification in maintenance hemodialysis patients 2014, 13 (11):  759-762.  doi: 10.3969/j.issn.1671-4091.2014.11.005 Abstract ( 260 )   HTML ( 0 )   PDF (473KB) ( 314 )   【Abstract】Objective To observe the impact of parathyroidectomy (PTX) on calcium and phosphorus metabolism, arterial calcification and arterial stiffness in maintenance hemodialysis (MHD) patients complicated with secondary hyperparathyroidism (SHPT). Methods A total of 21 MHD patients with SHPT were subjected to PTX. Their coronary artery calcification score based on the multi-slice spiral CT images, brachial-ankle pulse wave velocity (baPWV), serum calcium, phosphorus, calcium-phosphorus product, and serum PTH were compared before PTX and after PTX for one year. Results After PTX for one year, coronary artery calcification score decreased significantly (P=0.0236), so did the mean baPWVs of bilateral limbs (P=0.0034 and 0.0012 for left and right limbs, respectively), as compared with those before PTX. Serum calcium, phosphorus, calcium-phosphorus product, and PTH also reduced after PTX (P=0.0004, 0.0002, <0.0001 and <0.0001, respectively). Conclusions PTX improved calcium and phosphorus metabolism, and reduced arterial calcification and stiffness in MHD patients with SHPT. Metrics

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The risk factors of acute kidney injury following vascular surgeries 2014, 13 (11):  763-766.  doi: 10.3969/j.issn.1671-4091.2014.11.006 Abstract ( 217 )   HTML ( 1 )   PDF (408KB) ( 208 )   Objective To evaluate the incidence of acute kidney injury and its risk factors after vascular surgery. Method The clinical, surgery and laboratory data of 1,332 patients undergoing vascular surgery in the year of 2011 were collected from electronic medical records and retrospectively reviewed. Result Fiftyfour (4.1%) of 1332 patients developed AKI after the surgery, including 16/61 aortic aneurysm, 10/57 acute limb arterial embolism, and 15/451 arterial stenosis/embolism. Nine of the 54 AKI patients (16.7%) died. The morbidity of chronic kidney disease (CKD) before the surgery was 17%. Logistic regression analysis revealed that radio-contrast media, a history of CKD, intraoperative hypotension and multiple organ dysfunction syndrome (MODS) were the risk factor of AKI (OR=1.149, 2.432, 5.126 and 6.645, respectively; P＜0.05). Conclusion Higher morbidity of AKI was found after vascular surgery, especially after aortic aneurysm and acute arterial embolism. A history of CKD, intraoperative hypotension and MODS were the major risk factors of AKI. Therefore, we should pay attention to the presence of CKD before surgery and changes of renal function after the surgery, to facilitate early diagnosis and appropriate treatment of AKI. Metrics

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A study on the relationship between body-fluid distribution and intradailytic-hypotension among maintenance hemodialysis patients 2014, 13 (11):  767-771.  doi: 10.3969/j.issn.1671-4091.2014.11.007 Abstract ( 191 )   HTML ( 0 )   PDF (466KB) ( 253 )   【Abstract】 Objective To analysis the relationship between body-fluid distribution before hemodialysis and intradialytic-hypotension (IDH) among maintenance hemodialysis (MHD) patients，and to provide clinically basis for preventing IDH. MethodsDataofbody-fluid distributionpre-hemodialysis measured by Bio-impedance Electrical Spectroscopy（BIS）and blood pressure changes during hemodialysis were recorded in 620 hemodialysissessionsof 42 MHD patients in 6 weeks. According to the occurrence of IDH，620 hemodialysis sessions were divided into hypotension group and Non-hypotension group. Body-fluid distribution and blood pressure changes were compared between the two groups. Furthermore Logistic regression analysis was use to access the risk factors of IDH among body-fluid distribution. 143 IDHs occurred in 620 hemodialysis sessions, incidence rate of IDH was 23.06%. Logistic regression analysis revealed that Extracellular Fluid (ECV)、systolic pressure、total water/weight ratio(TW/W) of pre-hemodialysis and ultrafiltration speed(UFS) calculated by TW removed （ml/kg.min）were risk factors for IDH（P＜0.05）. ROC curve was used to predict IDH among risk factors pre-hemodialysis. UFS was correlated with IDH, the area under the ROC curve (AUC) of IDH was 0.680 (95% CI: 0.632～0.727，P=0,000),the sensitivity and specificity for IDH were 89.5% and60.5% respectively when the cutoff value was 0.198ml/kg.min. Conclusion Higher ultrafiltration speed、higher systolic pressure、total water/weight ratio of pre- hemodialysis were risk factors for IDH. Ultrafiltration speed calculated by TW removed of pre-hemodialysis can be used for predicting IDH. Metrics

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Regulation effect of 1,25- dihydroxy Vitamin D3 on interleukin-4 in rat with IgA Nephropathy 2014, 13 (11):  772-774.  doi: 10.3969/j.issn.1671-4091.2014.11.008 Abstract ( 179 )   HTML ( 0 )   PDF (336KB) ( 234 )   【Abstract】Objective To explore the regulation effect of 1,25-dihydroxy vitamin D3 (1,25-OH2D3) on interleukin-4 (IL-4) in rat with IgA nephropathy. Method Fifty-two Wistar rats were divided into group A (normal control group), group B (no intervention group), group C (prednisone treatment group), group D (1, 25-OH2D3 treatment group), and group E (prednisone + 1,25-OH2D3 treatment group). Urine protein/24 h, IL-4 levels in spleen and lymph nodes were assayed. Result ①Urine protein/24 h was 7.03±0.99, 51.49± 3.04, 12.15±0.75, 23.0±2.27, and 9.99±0.79 mg/24 h in group A, B, C, D, and E, respectively. After the treatment, the decrease of urine protein/24 h was more in groups C, D and E than in group B (P＜0.05), and was more in group E than in groups C and D (P＜0.05). ② IL-4 level in spleen was 1.428±0.60, 5.10±0.08, 2.93± 0.13, 4.56±0.19, and 1.44±0.56% in group A, B, C, D, and E, respectively. ③ IL-4 level in lymph nodes was 1.50±0.13, 15.4±3.11, 2.74±0.29, 6.55±0.66, and 2.32±0.34% in group A, B, C, D, and E, respectively. After the treatment, the decrease of IL-4 levels in spleen and lymph nodes were more in groups C, D and E than in group B (P＜0.05), and were more in group E than in groups C and D (P＜0.05). Conclusion 1,25-OH2D3 treatment may down-regulate IL-4 expression and thus affect the regulation by Th2 lymphocytes in rats with IgA nephropathy. Metrics

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A clinical study on prophylactic efficacy of povidone iodine cap for long-term indwelling catheter-related infection in hemodialysis patients 2014, 13 (11):  790-792.  doi: 10.3969/j.issn.1671-4091.2014.11.013 Abstract ( 206 )   HTML ( 0 )   PDF (391KB) ( 215 )   【Abstract】Objective To explore the preventive effect of povidone iodine cap for long-term indwelling catheter- related infection in hemodialysis patients. Method A total of 68 hemodialysis patients were randomly assigned into blank control group (group A, n=23) in which heparin cap was applied to seal catheter end and 0.5% heparin was used as the lock solution, condition control group (group B, n=23) in which 0.4% gentamycin/0.5% heparin was used as the lock solution, or the treatment group (group C, n=23) in which home-made povidone iodine cap was applied to seal catheter end and heparin was used as the lock solution. The presence of catheter-related infection was observed for one year, and the incidence was compared among the 3 groups. Result In the observation period of 6 months, catheter-related infection was 8, 3 and 2 cases in group A, B and C (P=0.026), respectively. In the observation period of 12 months, catheter - related infection was 13, 6 and 2 cases in group A, B and C (χ2=7.510, P=0.023), respectively. Conclusion The povidone iodine cap can effectively reduce the long-term indwelling catheter-related infection in hemodialysis patients. Metrics

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The influence factors of calcification at anastomotic orifice of arteriovenous fistula in maintenance hemodialysis patients 2014, 13 (11):  793-796.  doi: 10.3969/j.issn.1671-4091.2014.11.014 Abstract ( 448 )   HTML ( 1 )   PDF (371KB) ( 383 )   【Abstract】Objective To investigate the influence factors of calcification at the anastomotic orifice of arteriovenous fistula (AVF) in maintenance hemodialysis (MHD) patients. Method A total of 35 uremic patients undergoing hemodialysis with AVF were enrolled in this study. The calcification at anastomotic orifice was examined by color Doppler ultrasonography. We then divided the patients into calcification group and non- calcification group. Diameter of the anastomotic orifice, mean blood flow velocity, the derived blood flow volume, and other hemodynamic parameters were assayed by color Doppler ultrasonography. We also collected the data about hemoglobin, serum calcium, phosphorus, cholesterol, triglyceride, high density lipoprotein (HDL), low density lipoprotein (LDL), age, AVF service time, mean arterial pressure, etc. Univariate regression was used to individually analyze these factors, and multivariate non-conditional logistic regression was used to analyze the factors with statistical significance between the two groups. Result Compared to the non-calcification group, the calcification group had longer AVF service time (29.4±18.66 vs. 16.4±9.62 months, P=0.019), higher mean arterial pressure (117.15±5.86 vs. 112.33±7.14 mmHg, P=0.036), higher mean blood flow velocity at anastomotic orifice (157.30±9.47 vs. 150.38±10.32 cm/s, P=0.048), increased Ca-P product (59.09±7.77 vs. 53.12±8.76 mg2/dL2, P=0.041), and higher LDL (2.49±0.55 vs. 2.11±0.48 mmol/L, P= 0.044), but had insignificant differences in age (55.3±9.23 vs. 51.2±7.99 years, P>0.05), diameter of anastomotic orifice (0.43 ± 0.08 vs. 0.43 ± 0.09 cm, P>0.05), blood flow volume at anastomotic orifice (1439.32 ± 496.8 vs. 1370.01±579.47 ml/min, P>0.05), hemoglobin (105.25±20.52 vs. 106.87±16.36 g/L, P>0.05), serum calcium (2.30±0.17 vs. 2.19±0.16 mmol/L, P>0.05), serum phosphorus (2.07±0.21 vs. 1.97±0.47 mmol/L, P> 0.05), cholesterol (3.80±0.85 vs. 3.73±1.15 mmol/L, P>0.05), triglyceride (1.55±0.87 vs. 1.66±2.00 mmol/L, P>0.05), and HDL (1.02±0.22 vs. 0.96±0.15 mmo/L, P>0.05). Multivariate non-conditional logistic regression revealed that AVF sever time (OR=1.150, P=0.041), mean blood flow velocity (OR=1.230, P=0.029), and LDL (OR=174.706, P=0.016) were the risk factors of calcification at anastomotic orifice. Conclusion The risk of calcification at anastomotic orifice increased with the increase of AVF service time in MHD patients. Higher blood velocity in anastomotic orifice and increased LDL may promote anastomotic calcification and increase the risk of anastomotic stenosis. Metrics

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The clinical application of semi-permanent femoral vein double-lumen catheter in maintaining dialysis patients 2014, 13 (11):  797-799.  doi: 10.3969/j.issn.1671-4091.2014.11.00 Abstract ( 248 )   HTML ( 0 )   PDF (370KB) ( 195 )   Objective Discussion the clinical application of the semi- permanent double- lumen vein cuffed-tunneled catheters in maintaining hemodialysis (MHD) patients. Methods 10 cuffed- tuneled catheters were indwelled in femoral vein as femoral vein group and the other 52 catheters were indwelled in internal jugular vein as jugular vein group in the same period.The catheter survival time,related complications of catheters, mean blood flow during hemodialysis and Kt/V in the two groups were observed. Results There was 70.0%(7/10) catheters sustainable using over 6 months in femoral vein group, while 86.5%(45/52) catheters in jugular vein group. There were no significant differences between the two groups in catheter infection and catheter dysfunction aspects (P＞0.05). Catheter blood flow and dialysis adequacy also have no significant differences between the two groups (P＞0.05). Conclusions Semi-permanent femoral vein double-lumen catheter can also be an ideal choice, when the patients have poor vascular conditions or poor general conditions, or have difficult to be indwelled internal jugular vein catheter. Metrics

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Appreciation education to improve self-care ability in hemodialysis patients 2014, 13 (11):  800-802.  doi: 10.3969/j.issn.1671-4091.2014.11.016 Abstract ( 166 )   HTML ( 0 )   PDF (380KB) ( 219 )   【Abstract】Objective To explore the effect of appreciation education on the performance of high quality care for maintenance hemodialysis (MHD) patients. Method Appreciation education was applied in the health education for 80 MHD cases. Result Compliance increased significantly in MHD patients and their family members accepted the appreciation education. Nursing ability scores became higher in every area in the observation group than in the control group, including gain of knowledge (97.51±1.01 vs. 92.34±1.39, compared to control group, P=0.034), self-care skills (97.51±1.01 vs. 92.34±1.39, compared to control group, P=0.019), self-care responsibility (94.15±1.77 vs. 88.86±1.89, compared to control group, P=0.040) and self care effects (94.58±1.58 vs. 90.38±2.12, compared to control group, P=0.037). Control of complications was statistically greater in observation group than in control group. Optimistic, self-confident and accomplishment feelings facilitated the improvement of high quality care, convalescence of the disease, and self-care ability in the patients. Conclusion Appreciation education promotes the self-confidence and initiatives of the patients, which create an atmosphere favorable to disease treatment and recovery. Metrics