Chinese Journal of Blood Purification

12 January 2015, Volume 14 Issue 01 Previous Issue    Next Issue

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Analysis of the editorial board play a role in promoting the quality of academic journals by“A periodical influence Statistics Database” 2015, 14 (01):  1-4.  doi: 10.3969/j.issn.1671-4091.2015.01.001 Abstract ( 238 )   HTML ( 0 )   PDF (293KB) ( 254 )   Objective The publishing content of article，the quality of academic and author has analyzed published papers of the "Chinese Journal of Blood Purification" by“A periodical influence Statistics Database” of CNKI,and Play the role of member of the journal's editorial board in order to promote the quality of academic journals. Methods The publishing content of article，the quality of academic and author has analyzed published papers of the "Chinese Journal of Blood Purification" by the " A periodical influence Statistics Database" of CNKI in 2007～2011. Results ① in 2007-2011 Published papers of the "Chinese Journal of Blood Purification" in the distribution of each subject involving 10 subjects. The largest proportion of clinical medicine. There are total of 679 published papers of clinical medicine in 5 years. ②There are total of 1355 published papers of"Chinese Journal of Blood Purification"in 2007-2011. There are the fund sponsored 202, accounted for 14.9% and the national fund 47 in published papers. ③ There are18 editorial board of "Chinese Journal of Blood Purification"In 20 authors in the largest published papers. Conclusion The academic quality is the life of academic journals. To encourage and support the editorial board for the contribution, full play to the leading role of the editorial board, is the core of improving the competitiveness of the "Chinese Journal of Blood Purification". Metrics

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The evaluation study of improved elbow arteriovenous fistula and traditional elbow arteriovenous fistula 2015, 14 (01):  18-21.  doi: 10.3969/j.issn.1671-4091.2015.01.00 Abstract ( 263 )   HTML ( 1 )   PDF (742KB) ( 250 )   Objective To compare vascular access and complications between improved elbow arteriovenous fistula (AVF) and traditional elbow AVF in maintenance hemodialysis patients. Methods Eight-four patients with improved elbow AVF surgery and 79 patients with traditional elbow AVF surgery were followed up for 4 years. Fistula diameter, vascular length useful for blood access, average blood flow, and fistula patency during dialysis period were compared between the two groups. Thrombus, aneurysm, forearm edema, heart failure were recorded to evaluate complications in the two groups. Results Both of the two kinds of AVFs met the requirements for hemodialysis. In improved elbow AVF group and traditional elbow AVF group after the surgery for 3 months, the average blood flow was 1101.66±189.66 ml/min and 1199.46±197.23 ml/min (P =0.002), respectively; vascular length available for blood access was 20.59±1.63 cm and 15.24±1.17 cm (P＜0.001), respectively; blood vessel diameter was 6.30±0.59 mm and 6.20±0.62 mm (P =0.284), respectively. The fistula patency rate was similar (P＞0.05) in the first two years between the two groups, but was higher (P=0.045) in the first three years in the improved elbow AVF group. The incidence of thrombosis was higher in traditional elbow AVF group (P=0.047), but the incidence of forearm edema was higher in improved elbow AVF group (P=0.037). The incidence of heart failure and aneurysm were similar between the two groups (P＞0.05). Conclusions Both of the two groups yielded sufficient blood flow and higher patency rate. The improved AVF surgical method obtained longer vessel for blood access but with higher rate of forearm edema. Metrics

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Clinical observation of blood vessel elasticity and inner diameter after far infrared radiation in maintenance hemodialysis patients 2015, 14 (01):  22-24.  doi: 10.3969/j.issn.1671-4091.2015.01.00 Abstract ( 277 )   HTML ( 0 )   PDF (313KB) ( 434 )   Objective To analyze the efficacy of far infrared (FIR) radiation on blood vessel elasticity and inner diameter in chronic renal failure patients on hemodialysis. Methods Forty-seven hemodialysis patients with failed arteriovenous fistula (AVF) or difficults to establish AVF were retrospectively analyzed. They were then divided into FIR radiation group (n=27) and non-FIR radiation group (n=20). Diameter and damping index of the blood vessels and prognosis of the patients were compared between the two groups before and after the therapy for 3 weeks. Results Diameter and damping index of the vessels were apparently different between the two groups (P ＜0.05). After the therapy for 3 weeks, AVF surgery was successful in 25 cases in FIR group and in 13 cases in non-FIR group, and was failed in 2 cases in FIR group and in 7 cases in non-FIR group, significantly different between the two groups (P ＜0.05). Conclusion In renal failure patients with unfavorable vascular condition for AVF establishment, the success rate of AVF surgery increased significantly after FIR radiation. Metrics

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The use of high pressure balloon in the treatment of arteriovenous graft stenosis 2015, 14 (01):  25-28.  doi: 10.3969/j.issn.1671-4091.2015.01.07 Abstract ( 339 )   HTML ( 1 )   PDF (651KB) ( 590 )   Objectives To summarize the clinical experience and outcome of the endovascular treatment of arteriovenous graft stenosis by high pressure balloon. Methods All the cases of arteriovenous graft stenosis treated by high pressure balloon in our department were analyzed retrospectively. The efficacy, patency and complication rate were followed. Results From Mar 2013 to Nov 2013, 24 cases (mean age of 65.9±14.6 yrs, 7 males and 17 females) were treated. 60% of the lesions were graft- to- vein anastomosis stenosis and 33.4% of the lesions were intra-graft stenosis. The technical success rate was 100%, and the inflation pressure was 10-18 atm, without complications. The 6-month primary patency of circuit was 75%. The 6-month primary lesion patency was 69.8±9.5%, and primary assistant lesion patency was 91.3±5.9%. Conclusions The results suggest that the high pressure balloon is effective for the treatment of arteriovenous graft stenosis with a better technical success rate. However, a longer patency depends on the postoperative surveillance and new materials and techniques. Metrics

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Effect of statins on internal arteriovenous fistuia function in elderly uremic patients 2015, 14 (01):  29-32.  doi: 10.3969/j.issn.1671-4091.2015.01.008 Abstract ( 272 )   HTML ( 0 )   PDF (377KB) ( 401 )   Objective To study the effects of atorvastatin calcium on internal arteriovenous fistula in elderly uremic patients, and thereby to understand the effects of statins on vascular intima. Methods A total of 90 elderly uremic patients on hemodialysis were randomly divided into statin treatment group (n=45) and control group (n=45). 20mg of atorvastatin calcium were given orally every night to the patients in treatment group but not to those in control group. Changes of lipids indexes, vessel diameters, fistula orifice size, and blood flow were evaluated in treatment group before and after the therapy. Complications and fistula function were compared between treatment group and control group. Results In treatment group, TC, TG, LDL-C and HDL-C changed significantly after stain therapy compared to those indexes before treatment (P=0.027, 0.014, 0.032, and 0.011, respectively), diameters of radial artery and cephalic vein of the fistula, blood volume in fistula, and fistula orifice size changed significantly after stain therapy compared to those in control group (P=0.003, 0.012, 0.039 and 0.007, respectively). In treatment group and control group, fistula complications within 2 years were 6.7% and 55.6%, respectively (P=0.002), functional fistula rate was 97.8% and 2.2%, respectively (P=0.012), and dysfunctional fistula rate was 71.1% and 26.7%, respectively (P=0.027). Conclusion Statins can improve the function and lifespan of internal arteriovenous fistula in elderly uremic patients. Metrics

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Retrospective study of arteriovenous fistula used in pediatric patients with end- stage renal disease Ying LIANG Ning SUN Hui WANG Ying SHEN 2015, 14 (01):  33-36.  doi: 10.3969/j.issn.1671-4091.2015.01.009 Abstract ( 241 )   HTML ( 3 )   PDF (358KB) ( 416 )   Objectives To obtain baseline data for further research we summarized the use of arteriovenous fistula for blood access in pediatric maintenance hemodialysis patients. Methods We retrospectively reviewed the clinical data of 62 pediatric patients with autologous arteriovenous fistula for maintenance hemodialysis during the period from June 2007 to April 2014 in the Department of Nephrology, Beijing Children’s Hospital. Results ①in the 62 cases, 41 were males and 21 were females with the age of 5～9 years old in 9 cases, 9～13 years old in 33 cases, and 13～17 years old in 20 cases. The average age at surgery was 13 years and 5 months (5y8m to 16y2m). The primarily resident place was southern China in 4.8% cases and northern China in 95.2% cases. The primary disease was chronic glomerulonephritis in 29.03% cases, and kidney abnormality or dysplasia in 27.40% cases. ②The average interval from diagnosis of chronic renal disease to arteriovenous fistula surgery was 30.8 days. ③ Anesthesia modalities: general anesthesia in 42 cases, and brachial plexus block in 17 cases. ④Side selection: left side in 58 cases, and right side in 4 cases. All patients were subjected to forearm arteriovenous fistula surgery, in which radio- cephalic end- to- lateral anastomosis was performed in 55 cases and radio-noncephalic anatomosis in 7 cases. ⑤Inner diameter of the fistula at surgery: 2mm in 22 cases (35.5%), 2.5mm in 3 cases (4.8%), 3mm in 31 cases (50%), 4mm in 3 cases (4.8%), and size unknown in 3 cases. ⑥The presence of tremor and vascular bruit at the operation site after surgery for one week was regarded as surgery success. Fistula was established in 50 cases (80.65%), and was failed to establish in 12 cases (19.35%). The success rate to establish a fistula was 81.8% (18/22) in patients with fistula in-ner diameter of 2mm, and was 86.5% (32/37) in those with the diameter of >2mm, without significant difference between the two groups. The success rate of the second surgery was 87.5%. ⑦The tremor at the operation site after the surgery was relatively strong in 52 case (83.9%), weak in 3 cases (4.8%), and none in 7 cases (11.3%). The vascular bruit was relatively intense in 53 cases (85.5%), slight in 2 cases (3.2%), and none in 7 cases (11.3%). ⑧Complications immediately after surgery: thrombosis in 6 cases (9.7%), errhysis in 5 cases (8.0%), swollen and pain in 4 cases (6.5%), hemorrhage in one case (1.6%), and finger numbness in one case (1.6%). ⑨Arteriovenous fistula was used at the first hemodialysis session in only one case (1.6%). Conclusion The time interval from diagnosis of chronic renal disease to fistula surgery was 30.8 day, much shorter than 6～12 months suggested by the vascular access guideline in 2006 NKF-KDOQI. We preferred to make ratio- cephlic end- to- lateral anastomosis in left wrist. Success rate of the operation was 80.65% (50 cases), which was unrelated to the inner diameter of fistula orifice. The most common acute complications in this series of patients were thrombosis and errhysis. Metrics

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Diagnosis and management of true aneurysms of hemodialysis access fistulas 2015, 14 (01):  37-40.  doi: :10.3969/j.issn.1671-4091.2015.01.010 Abstract ( 243 )   HTML ( 0 )   PDF (398KB) ( 326 )   Objective This study was designed to determine the clinical presentations, characteristics, and management of true aneurysms in dialysis access fistula. Methods Patients presenting arteriovenous ? fistula (AVF) functional problems or symptoms and aneurysmal enlargement of the outf low vein were reviewed. Dilatation to more than three times of the native vessel diameter was considered to be aneurysm. Pseudoaneurysms were excluded from the study. Patients’demographics, aneurysm characteristics (location, diameter, thrombus, association with stenosis, and outf low obstruction), symptoms, type of treatment, and followup data were recorded. Results Fifty-two patients were found to have aneurysms of the outf low vein in upper extremities, accounting for 2.44% (52/2,131) of all hemodialysis access related complications. The average aneurysm size was 3.12±1.24cm, and the mean time from fistula establishment to presence of aneurysm was 24±20 months. Aneurysms located in cannulation areas in 23 patients (44.23%), along the venous outflow tract in 15 patients (28.85%), and in the juxta-anastomotic areas in 14 patients (26.92%). 7 patients (14.46%) were asymptomatic and the aneurysms were repaired for normal outlook. 45 patients (86.54%) were symptomatic, including skin changes (25%), venous hypertension (11.54%), high-output heart failure (11.54%), insufficient blood flow (11.54%), steal syndrome (9.62%), limited area for cannulation (7.69%), infections (5.77%),and rupture with hemorrhage (3.85%). 9 patients (19.25%) presented vein stenosis in cannulation areas, 2 patients (3.85%) had venous outflow tract stenosis/occlusion not in the cannulation vein, and 4 patients (7.69%) had central venous stenosis/occlusion. In the 5 patients with well- functional transplantation kidney, fistulawere ligated and the aneurysms were excised. In 30 patients, a new fistula at the same side or at opposite side was created with or without aneurysm excision. In 9 patients with stenosis at the aneurysm site, outflow tract venous angioplasty was conducted. In 3 patients with central venous stenosis/occlusion, angioplasty or stenting was used. In 5 patients with higher flow in fistula, banding aimed to restrict blood flow in the fistula was conducted. The immediate success rate was 98.08% without severe complications. Conclusion True aneurysm of autologous AVF is uncommon developing later after fistula creation with various clinical manifestations. This complication can be treated individually according to aneurysm site and vascular condition of the patient. Metrics

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Investigation of uromodulin gene mutations for the diagnosis of familial interstitial nephropathy 2015, 14 (01):  41-46.  doi: 10.3969/j.issn.1671-4091.2015.01.011 Abstract ( 351 )   HTML ( 0 )   PDF (713KB) ( 251 )   Objectives To explore the clinical significance of uromodulin (Tamm Horsfall protein) gene mutations in the diagnosis of familial hyperuricemia and/or familial renal tubular interstitial nephropathy. Methods Mutations in the Tamm-Horsfall protein gene were screened by PCR and sequencing in the 20 patients clinically diagnosed with familial hyperuricemia or familial renal tubular interstitial nephropathy. Results We found 5 patients with mutations in the Tamm Horsfall protein gene. Two of them have been reported by us, and 3 of them carried two new missense mutations (c.1153C>T, p.Arg385Trp; c.197T>C, p.Leu66Pro) and one new deletion mutation (272delC) that have not been reported previously. Conclusion We found 3 new mutations in Tamm Horsfall protein gene by mutation screening in Chinese patients, which extends the mutation spectrum of Tamm Horsfall protein gene. Metrics