Chinese Journal of Blood Purification

12 December 2014, Volume 13 Issue 12 Previous Issue    Next Issue

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Effects of low protein diet supplemented with α-ketoacids on nutritional status and urinary protein excretion in patients with diabetic nephropathy 2014, 13 (12):  805-809.  doi: 10.3969/j.issn.1671-4091.2014.12.001 Abstract ( 206 )   HTML ( 0 )   PDF (717KB) ( 380 )   Objective To explore the effects of low-protein diet supplemented with α-ketoacids (KA) on nutritional status and urinary protein excretion in patients with diabetic nephropathy (DN). Methods A total of 61 patients with DN of type II diabetes at chronic kidney disease stages 3～4 were included in this study. They were randomly divided into two groups, low protein diet group [LPD group, 0.6 g protein/kg/day and 30 kcal/(kg·day)] and LPD+KA group [0.6 g protein/kg/day, 30 kcal/kg/day, and 100mg KA/(kg·day)]. Blood and 24h urine samples were collected at baseline and every 3 months for routine examinations to evaluate the efficacy of LPD+KA diet. Results After 12 months of the treatment, there was no statistical difference in daily protein intake estimated by 24h urinary urea nitrogen between LPD group and LPD+KA group (P＞0.05). There was also no statistical difference in the decline of GFR [-2.41±2.53 ml/min/1.73m2 vs. -2.26± 2.03 ml/(min·1.73m2), P＞0.05] between LPD group and LPD+KA group. Proteinuria decreased more in LPD+KA group (0.43±0.35 g/24h) than in LPD group (0.15±0.36 g/24h; P＜0.01). Patients in both groups were in a good nutritional condition. However, serum albumin and prealbumin increased only in LPD+KA group (P＜0.05). Conclusion Low protein diet supplemented with KA is associated with a greater decrease of proteinuria under a good nutrition status, as compared with low protein diet alone. Metrics

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Protein intake and nutrition assessment in patients on maintenance hemodialysis 2014, 13 (12):  810-814.  doi: 10.3969/j.issn.1671-4091.2014.12.002 Abstract ( 221 )   HTML ( 1 )   PDF (554KB) ( 340 )   【Abstract】Purpose The K/DOQI nutrition guidelines recommend that maintenance hemodialysis (MHD) patients should have a dietary protein intake (DPI) of at least 1.2 g/kg/day to avoid malnutrition. However, there were conclusions different from this recommendation from many studies in recent years. In this study, we compared the nutritional and clinical status in MHD patients using different DPI to discuss the most appropriate protein intake and provide the basis for nutritional therapy in MHD patients. Methods A total of 189 MHD patients treated in our dialysis center and with stable dietary were enrolled in this study. The patients were asked to record their diet in detail for 3 days, and the records were analyzed by dietitians using Keto nutritional assessment software. Nutritional evaluation including subjective global assessment (SGA), anthropometric and laboratory examinations were collected. Results In the 189 patients, 126 patients with DPI ≥0.8 g/(kg·d) were selected and divided into three groups: ①DPI >0.8 g/(kg·d) and ＜1.0 g/(kg·d), n= 43; ②DPI >1.0 g/(kg·d) and ＜1.2 g/(kg·d), n=61; ③DPI ≥1.2 g/(kg·d), n=38. Dietary energy intake was lower than the recommendation in all 3 groups, and the proportion of nutrient intake including protein, carbohydrate and lipids was similar among the three groups. SGA, anthropometric data and laboratory examinations including hemoglobin, albumin and total cholesterol showed no differences among the three groups. However, BUN, serum creatinine, serum phosphate and acidosis increased along with the increase of DPI, and were significantly different among the three groups. Conclusion DPI between 0.8 and 1.2 g/(kg·d) can maintain better nutritional status and ameliorate hyperphosphatemia and acidosis in Chinese MHD patients using low-flux dialyzers. Metrics

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Comparison of the relationship between different nutrition assessment methods and mortality in maintenance hemodialysis patients 2014, 13 (12):  815-818.  doi: 10.3969/j.issn.1671-4091.2014.12.003 Abstract ( 184 )   HTML ( 2 )   PDF (475KB) ( 334 )   Objective To study the relationship between different nutrition assessment methods and mortality in maintenance hemodialysis (MHD) patients. Methods A total of 83 MHD patients were enrolled in the nutrition assessment including subjective global assessment (SGA), malnutrition- inflammation score (MIS), and short form mini nutritional assessment (MNA-SF) methods. General disease history and laboratory findings were collected. Patients were followed up for 48 months (40±13 months). Kaplan-Meier method and Cox regression analysis were used to compare the relationship between different nutritional evaluation methods and the risk of all-cause mortality. Results Kaplan-Meier method showed that the risk of death was higher in patients with SGA <25 than in those with SGA ≥25 (P<0.05), was higher in patients with MIS > 10 than those with MIS ≤10 (P＞0.05), and was lower in patients with MNA-SF ≥11 than those with NASF <11 (P>0.05). Multivariate Cox regression analysis showed that SGA and MIS scores correlated to the risk of all- cause mortality in MHD patients (P<0.05). Conclusions Different nutritional assessment methods have different ability for predicting long-term prognosis in MHD patients. Nutritional status assessed by SGA method or MIS method correlates better with the long-term risk of all-cause mortality in MHD patients. Metrics

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The relationship between home blood pressure measurement and dialysis-center blood pressure in hemodialysis patients 2014, 13 (12):  819-823.  doi: 10.3969/j.issn.1671-4091.2014.12.004 Abstract ( 183 )   HTML ( 0 )   PDF (717KB) ( 192 )   Objective To investigate the association between home blood pressure monitoring and dialysis-center blood pressure in hemodialysis patients. Methods Fifty-six patient on hemodialysis participated in the study. Their blood pressures measured at home, before and after the initiation of a dialysis session were measured for association analysis. Results The patients were divided into hypertension and controlled hypertension groups according to their home blood pressures. In both groups, blood pressures measured at 1 hour on dialysis were best matched with those of home blood pressure monitoring (agreement were 81.8% and 61.8%, respectively). Conclusion Both hypertension groups and controlled groups in dialysis for 1 hour matched those in home blood pressure status best. The blood pressure measured at 1 hour on dialysis could be used to assess patients’ home blood pressure status. Metrics

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The factors affecting left ventricular hypertrophy in hemodialysis patients 2014, 13 (12):  824-827.  doi: 10.3969/j.issn.1671-4091.2014.12.005 Abstract ( 299 )   HTML ( 0 )   PDF (379KB) ( 261 )   Objective T o investigate the factors affecting left ventricular hypertrophy (LVH) in endstage renal disease patients with hemodialysis (HD). Method A total of 175 HD patients treated in the Kidney Disease Center were enrolled in this cross-section study. General information, laboratory measurements, and ultrasonography data for left ventricular hypertrophy were collected. Patients were divided into two groups according to left ventricular mass index (LVMI), left ventricle thickening (LVT) group (n=90) and normal left ventricle group (n=85). General information and laboratory findings were analyzed between the two groups, and the factors affecting LVH were analyzed using Spearman rank correlation and multivariate linear regression. Results Age and systolic pressure were significantly higher and hemoglobin was significantly lower in LVT group than in normal left ventricle group (P＜0.05). Spearman rank correlation indicated that LVH was positively correlated with age, hypertension history, diabetes mellitus history, systolic pressure, and fasting blood glucose (r=0.192, 0.237, 0.173, 0.284 and 0.198, respectively; P＜0.05). LVH was negatively correlated with dialysis age and Kt /V (r= -0.184 and -0.233, respectively; P＜0.05). Multivariate linear regression showed that age, hypertension history, systolic pressure and Kt/V correlated with LVH (β=0.165, 0.205, 0.196 and -0.184, respectively; P＜0.05). Conclusion Older age, higher systolic pressure, and hypertension history were the risk factors for LVH, while sufficient Kt/V was a protective factor. Control of systolic pressure and sufficient dialysis may reduce the prevalence of LVH. Metrics

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The role of 99mTc-MIBI SPECT-CT in reoperation therapy for persistent hyperparathyroidism patients 2014, 13 (12):  828-831.  doi: 10.3969/j.issn.1671-4091.2014.12.006 Abstract ( 190 )   HTML ( 0 )   PDF (999KB) ( 211 )   Objective To compare the role of 99mTc-MIBI SPECT-CT image and ultrasonography in reoperation therapy for persistent secondary hyperparathyroidism patients. Methods Eight persistent secondary hyperparathyroidism patients underwent parathyroidectomy. The sensitivity and accuracy of 99mTc-MIBI image and ultrasonography before operation were compared. Results Nine of the 14 surgically resected tissues from the 8 persistent secondary hyperparathyroidism patients were confirmed to be parathyroid hyperplasia. The sensitivity was 77.8% and 100% for ultrasonography and 99mTc-MIBI SPECT-CT image, respectively, and the accuracy was 50% and 78.6% for ultrasonography and 99mTc-MIBI dual time planar image and SPECT-CT, respectively. These differences were statistically significant (P=0.021). The glands located in superior and inferior poles could be detected by either ultrasonography or the scintigraphy, and two ectopic parathyroid nodules were found only by 99mTc-MIBI SPECT-CT but not by ultrasonography. However, the two methods for the detection of nodules were statistically similar (P=0.300). Despite the absence of pathological findings, the nodules located in the paraesophagus sulcus and ascending aorta were detected by 99mTc-MIBI SPECT-CT in two cases who had high iPTH of 800 and 1,429 pg/ml, respectively, higher than the iPTH of < 400 pg/ml in other 4 cases. Conclusion Re-operation for parathyroidectomy is a safe and effective treatment for patients with persistent secondary hyperparathyroidism. 99mTc-MIBI planar and SPECT-CT imaging based on fusion of anatomical and functional images is better than ultrasonography in localization of hyperparathyroidism glands. This method can display ectopic parathyroid glands and help clinicians accurately localize the hyperparathyroidism glands. Metrics

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Parathyroidectomy in the treatment of 15 maintenance dialysis patients with secondary hyperparathyroidism 2014, 13 (12):  832-834.  doi: 10.3969/j.issn.1671-4091.2014.12.007 Abstract ( 243 )   HTML ( 0 )   PDF (383KB) ( 233 )   Objective To investigate the clinical effect of parathyroidectomy (PTX) on maintenance dialysis patients with refractory secondary hyperparathyroidism (SHPT). Methods Fifteen refractory SHPT patients undergoing PTX treated in our hospital from 2007 to 2013 were retrospectively analyzed to compare serum intact parathyroid hormone (iPTH), calcium, phosphate and alkaline phosphate (ALP) before and after the operation, and to assess the changes of hyperparathyroidism symptoms after PTX. Results No patient died in the perioperative period, but one patient had transient injury of recurrent laryngeal nerve. Serum iPTH was 2,269 pg/ml before PTX, and was 93.9, 195, 83.2, and 61 pg/ml after PTX for 7 days, 1 month, 3 months, and 6 months, respectively (P<0.001, 0.001, 0.008 and 0.018, respectively, compared the value before PTX). Serum iPTH, phosphorus, calcium and ALP decreased significantly after PTX (P＜0.05, compared the values before PTX). Clinical symptoms and signs including bone pain, fractures, joint deformity, skin itching, muscle weakness and heart palpitations also improved remarkably after PTX. Conclusions Parathyroidectomy is a safe and reliable measure with confirmed effects for the treatment of uremia patients with SHPT. However, the long-term effects remain to be followed up. Metrics

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Effect of far infrared radiation on arteriovenous fistula maturation 2014, 13 (12):  845-847.  doi: 10.3969/j.issn.1671-4091.2014.12.011 Abstract ( 314 )   HTML ( 2 )   PDF (379KB) ( 535 )   Objective To evaluate the effect of far infrared radiation on the maturation of newly created arteriovenous fistula (AVF) in patients with end stage renal disease. Methods We enrolled 80 patients who were randomly allocated to the intervention group (n =40) or control group (n=40). The operations of arteriovenous fistula formation were done by one surgeon. Far infrared radiation was used for the intervention group, 40 minutes 3 times weekly, but not for the control group. Blood flow in AVF (Qa) and fistula diameter were measured by Doppler ultrasonography after the surgery for 1, 2 and 3 months. The physiologically maturated fistula was then used for dialysis, and the pump blood flow and puncture injury were observed. Results Compared the patients in control group, patients in the intervention group had higher Qa values after far infrared radiation for 2 months (525.4 ± 175.8ml/min vs. 487.8 ± 187.4ml/min; P=0.000) and 3 months (574.2 ± 204.3ml/min vs. 23.2±238.2ml/min; P=0.010). In addition, they had larger AVF diameters after far infrared radiation for 2 months (0.45 ± 0.12mm vs. 0.42 ± 0.11mm; P=0.040) and 3 months (0.47 ± 0.11mm vs. 0.43 ± 0.19mm; P=0.030), more physiological maturation rate (97.4% vs. 84.2%; P = 0.040) at 3 months, and higher clinical success rate (94.9% vs. 84.2%; P= 0.010) within 3 months. Conclusions Far infrared radiation improves blood access flow, and promotes maturation of newly created AVFs in patients with end stage renal disease. Metrics

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Analysis of the effect of HD02 hemodialysis monitor for vascular access function monitoring 2014, 13 (12):  848-850.  doi: 10.3969/j.issn.1671-4091.2014.12.012 Abstract ( 227 )   HTML ( 1 )   PDF (189KB) ( 207 )   To investigate the effect f HD02 hemodialysis monitor in monitoring vascular access function, Method A total of 148 hemodialysis patients treated in Hemodialysis Center of West China Hospital were included in this study. Vascular access functions including re-circulation rate, fistula blood flow rate, cardiac output and cardiac indexmwere measured using HD02 monitor during hemodialysis sessions. Malfunction of HD02 monitor were also analyzed. Result: In the 57patients with cuff catheter, re-circulation rate >5% was found in 12 (21.1%) patients in the ovservation period. In 91 patients with fistula, 25% re-circulation was found in one patient, fistula blood flow rate  <500ml/min in 11 (12.09%) patients including 4 (36.6%) diabetec patients, and instantly re-corrected re-circulation in 1 patient. Monitor malfunction happened 7 times, including 4 probe disorders, 1 power cord disorder, 1 computer disorder and 1 printer disorder. Conclusion: Ultrasonic dilute method is an easy, safe, non-invasive, fast and reliable method for vascular access measurement. Regular manipulation  should be applied to avoid incorrect results. Metrics

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The trend of the timing at which hemodialysis initiated in Beijing area 2014, 13 (12):  855-859.  doi: 10.3969/j.issn.1671-4091.2014.12.015 Abstract ( 286 )   HTML ( 5 )   PDF (534KB) ( 324 )   Objective It is still a controversial issue about the optimal time of initiation of dialysis for end stage renal disease (ESRD) patients. The aim of this study was to examine the trend of the time at which dialysis initiated for ESRD patients in recent years in Beijing area. Methods The data of all patients were obtained from the annual report of Beijing Blood Purification Quality Control and Improvement Center (BJBPQCIC) registry database. The patients who initiated hemodialysis between 2007 and 2012 were enrolled. Those who did not have the result of serum creatinine in the 90 days before or after dialysis initiation were excluded. eGFR was calculated by the CKD-EPI formula. Patients were stratified into three groups, group 1 [(eGFR 0～4.9 ml/(min•1.73m2)], group 2 [eGFR 5.0～9.9 ml/(min•1.73m2)] and group 3 [(eGFR: >10 ml/ (min•1.73m2)]. Results A total of 7,200 patients met the inclusion criteria, with the age of 57.5±16.0 years old and 56.3% males. During the period between 2007 and 2012, 341, 682, 1,137, 1,577, 1,886 and 1,577 patients initiated hemodialysis annually. From 2007 to 2010, the group 3 percentage gradually increased to 20.7%, and then decreased to 15.6% in 2012. The peak of group 2 percentage was 52.8% in 2012. About half of the patients started dialysis with the eGFR of 5-10 ml/(min•1.73m2), and one third with the eGFR of <5 ml/ min/1.73m2 in every year. The group 1 and 2 percentage was higher than that in the United States. Conclusion The number of ESRD patients increased in Beijing in recent years. The timing of dialysis initiation in ESRD patients in Beijing was later than that in the United States. Metrics

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The relationship between depression and cognitive function in maintenance hemodialysis patients 2014, 13 (12):  860-863.  doi: 10.3969/j.issn.1671-4091.2014.12.016 Abstract ( 234 )   HTML ( 0 )   PDF (349KB) ( 247 )   Objective To explore the relationship between depression and cognitive function in maintenance hemodialysis (MHD) patients. Methods A total of 117 MHD patients were divided into depression group and observation group based on the score from the self- rating depression scale (SDS). Patients in the two groups were assessed by a set of neuropsychological tests including Montreal Cognitive Assessment (Mo- CA), Stroop Test, and Trail Making Tests A and B. Independent sample t test was used to compare the cognitive function between the two groups. Regression analyses of simple linear model, parsimonious model and full-adjusted model were used to predict the relationship between depression and cognitive function. Results There were no significant differences in basic characteristics between the two groups. Patients in the depression group had lower scores for MoCA (t=-2.380, P＜0.05), Stroop C test (t=2.750, P＜0.01), the Picture Arrangement Test of WAIS-RC (t=-2.00, P＜0.05), and Trail Making Test B (t=2.450, P＜0.05) than those in the observation group. Linear regression model, parsimonious model, and full- adjusted model analyses showed that the lower performance of cognitive functions including MoCA, Stroop C test, and Trail Making Test B correlated with the degree of depression symptoms in MHD patients. Conclusion Depressed and none-depressed MHD patients have different cognitive function, especially in the executive functions. Depressed MHD patients are prone to have cognitive impairment. Metrics