Chinese Journal of Blood Purification

12 April 2015, Volume 14 Issue 04 Previous Issue    Next Issue

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Factors affecting prognosis of the patients with renal replacement therapy after cardiac surgery 2015, 14 (04):  196-198.  doi: 10.3969/j.issn.1671-4091.2015.04.002 Abstract ( 237 )   HTML ( 0 )   PDF (363KB) ( 247 )   Objective To explore the risk factors affecting prognosis of the patients with renal replacement therapy after cardiac surgery. Methods We retrospectively analyzed the clinical data of the patients with renal replacement therapy after cardiac surgery treated in Adult Surgery ICU of Fuwai Hospital in the period from May 2011 to Oct. 2014. Results The mortality rate was 31.5% (68/216). Coronary artery bypass grafting (CABG) combined with valve surgery had the highest mortality rate (56.1%), followed by cardiac transplantation (35.7%), CABG (28.0%), and valve surgery (15.2%). Multivariate logistic regression analyses showed that basic cardiac function, intra- operative hypotension, low cardiac output syndrome after surgery, and extracorporeal membrane oxygenation (ECMO) were the risk factors for death in renal replacement therapy patients after cardiac surgery. Renal injury recovered in 33.8% patients, and progressed to chronic renal disease in 18.9% patients. Baseline level of serum creatinine, intra-operative hypotension, re-operation, and the recovery period of urinary output were the important risk factors for recovery from acute renal injury. Conclusion The mortality in renal replacement therapy patients after cardiac surgery was high, and was closely related to many risk factors in the peri-operative period. Metrics

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The levels of serum FGF23 and Klotho in maintenance hemodialysis patients and the relationship with left ventricular hypertrophy 2015, 14 (04):  199-202.  doi: 10.3969/j.issn.1671-4091.2015.04.003 Abstract ( 226 )   HTML ( 0 )   PDF (371KB) ( 353 )   Objective To detect the levels of serum fibroblast growth factor 23 (FGF-23) and Klotho in MHD patients and find the relationship to left ventricular hypertrophy(LVH). Methods 46 MHD patients and 10 healthy persons(control group) were enrolled in the study. Serum FGF-23 and Klotho were measured using enzyme-linked immunosorbent assay. Other circulating parameters include: intact parathyroid hormone, calcium, phosphate, albumin, brain natriuretic peptide, hemoglobin, renal function, and so on. LVH patients were found using echocardiography. Results The level of serum FGF23 was significantly higher than that in healthy persons[(1829.29±1947.05)ng/L vs. (10.48±8.93 )ng/L](P<0.01)。The level of serum Klotho was significantly lower than that in healthy persons [（283.26±219.06）ng/L vs. (1125.50±126.96 )ng/L] (P<0.01)。Log Klotho was negatively associated with Log FGF23（r=-0.929，P<0.01）. Sixty-one percent of MHD patients had LVH. LVMI was positively associated systolic blood pressure, brain natriuretic peptide and the average ultrafiltration volume.In the multivariable linear regression model, brain natriuretic peptide and the average ultrafiltration volume were independent risk factors for LVH. Conclusions The level of serum FGF23 increases, while Klotho decreases significantly in MHD patients. The prevalence of LVH in MHD patients is high. Brain natriuretic peptide and the average ultrafiltration volume were the independent risk factors for lVH. We did not find any relationship between FGF23 and LVH, or klotho and LVH. Metrics

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Effect of oral health education on micro-inflammatory state in maintenance hemodialysis patients 2015, 14 (04):  203-205.  doi: 10.3969/j.issn.1671-4091.2015.04.004 Abstract ( 206 )   HTML ( 0 )   PDF (404KB) ( 249 )   Objective To explore the effect of oral health education on micro-inflammatory state in maintenance hemodialysis (MHD) patients. Methods Eighty patients were randomly divided into the treatment group (n=40) or the control group (n=40). Oral health education was carried on for 3 months in patients in the treatment group but not in those in the control group. Oral health condition and micro- inflammatory state were then observed in the two groups of MHD patients. Results Gingival bleeding index (SBI), plaque index (PLI), gingival index (GI), and serum TNF- α and hs-CRP decreased in the treatment group after oral health education for 3 months (2.35±0.88 vs. 2.83±0.71, t=2.684, P=0.009 for SBI; 1.63±0.46 vs. 1.99±0.51, t=3.323, P =0.001 for PLI; 1.49±0.39 vs. 1.88±0.41, t=3.289, P =0.002 for GI; 5.72±1.68 ng/L vs. 6.60±2.01 ng/L, t=2.123, P=0.037 for TNF-α; 30.36±9.25 mg/L vs. 38.12±12.59 mg/L, t=3.141, P=0.002 for hs-CRP). These indices were unchanged in the control group (P＞0.05). Conclusion Oral health education could alleviate micro-inflammatory state in MHD patients. Therefore, oral health education should be considered as an important measure in these patients. Metrics

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Clinical Analysis on Pulmonary Function in Patients with Refractory Secondary Hyperparathyroidism 2015, 14 (04):  206-209.  doi: 10.3969/j.issn.1671-4091.2015.04.005 Abstract ( 270 )   HTML ( 0 )   PDF (355KB) ( 233 )   Objective To evaluate pulmonary function and its related factors in patients with refractory secondary hyperparathyroidism (R-SHPT) in maintenance hemodialysis (MHD) patients. Methods Pulmonary function was measured in 50 MHD patients with R-SHPT before parathyroidectomy, and in 50 MHD patients with SHPT in whom parathyroidectomy was not required. Factors affecting pulmonary function in these patients were analyzed. Results ①Pulmonary function was significantly lower in R-SHPT group than in SHPT groups (P＜0.05). ② Serum calcium, phosphorus, and ALP were significantly higher in R-SHPT group than in SHPT group (P＜0.05), but Scr, Hb, CRP, and ferritin were similar between the two groups (P＞ 0.05). Conclusion ①Pulmonary ventilation function and small airway function decreased significantly in RSHPT group. ② iPTH and Hb may relate to the decrease of pulmonary function in R-SHPT patients. Metrics

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Studies on the appropriate time for grip strength measurement in maintenance hemodialysis patients 2015, 14 (04):  210-212.  doi: 10.3969/j.issn.1671-4091.2015.04.006 Abstract ( 306 )   HTML ( 0 )   PDF (357KB) ( 219 )   Objective To study the appropriate time for regular grip strength measurement in maintenance hemodialysis (MHD) patients. Methods A total of 112 MHD patients were divided into young group (n=18), middle age group (n=63), and old age group (n=31). Grip strength values were measured in the longest time gap and the shortest time gap before and after a hemodialysis (HD) session. Result ①The average grip strength was 30.90±12.63 kg before a HD session, and was 28.95±12.08 kg after a HD session (t =5.999, P=0.000) in the MHD patients. ②Grip strength reached 30.90±12.63 kg in the longest dialysis time gap, and 31.62 ± 12.17 kg in the shortest dialysis time gap before HD session (t =-2.388, P=0.019) in the MHD patients. ③In young group, grip strength was 44.56±13.63 kg in the longest dialysis time gap, and was 42.81±13.25 kg in the shortest dialysis time gap; in middle age group, grip strength was 31.11±10.31 kg in the longest dialysis time gap, and was 32.24±10.56 kg in the shortest dialysis time gap; in old age group, grip strength was 22.55± 9.04 kg in the longest dialysis time gap, and was 23.84±8.93 kg in the shortest dialysis time gap (F=24.087 and 17.948; t =0.000). ④The average grip strength was 32.44±12.22 kg measured from the predominant handed side in 100 MHD patients, and was 24.13±9.59 kg measured from the non-predominant handed side in 12 (10.7%) MHD patients (t =2.105, P=0.038). Conclusion The shortest dialysis time gap before HD session was the appropriate time for grip strength measurement in MHD patients. Grip strength at this time point reached maximal value, well reflecting the nutritional status in MHD patients Metrics

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Clinical study of hepatitis C infection in hemodialysis patients in Changshu district 2015, 14 (04):  213-215.  doi: 10.3969/j.issn.1671-4091.2015.04.007 Abstract ( 198 )   HTML ( 0 )   PDF (348KB) ( 233 )   Objective  The aim of the study was to observe the prevalence of hepatitis C (HCV) infection, its related risk factors, and changes of serum aminotransferases in maintenance hemodialysis (MHD) patients in Changshu district. Methods We recruited blood samples for blood examinations from 229 MHD patients in 3 hemodialysis centers in Changshu district. Their clinical data including demography, hemodialysis duration, blood transfusion history, and laboratory examination results were collected and analyzed. Patients were divided into HCV serologically positive (HCV+) group and HCV serologically negative (HCV-) group. Results The prevalence of hepatitis C infection in MHD patients in Changshu district was 6.55%, without differences in age and gender between HCV+ group and HCV- group (P＞0.05). Hemodialysis duration and the incidence of blood transfusion history were significantly higher in HCV+ group than in HCV group (P＜0.05 and P＜0.01, respectively). The average levels of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ- glutamyl transpeptadase (GGT) were within the normal ranges in HCV+ group. Normal ALT, AST and GGT levels were found in 73.3%, 84.6% and 69.2% patients, respectively, in HCV+ group. Conclusions Blood transfusion history and longer hemodialysis duration were the risk factors for HCV infection in MHD patients. The levels of serum aminotransferases may not be the sensitive markers for HCV infection in MHD patients. Metrics

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Clinical investigation on carotid arterial pulse wave velocity measured by UltraFast imaging in maintenance hemodialysis patients 2015, 14 (04):  216-218.  doi: 10.3969/j.issn.1671-4091.2015.04.008 Abstract ( 233 )   HTML ( 0 )   PDF (1335KB) ( 338 )   Objective To assess the application value of Ultrafast imaging (UltraFast) for quantitative evaluation of carotid arterial pulse wave velocity (PWV) in maintenance hemodialysis (MHD) patients. Methods Routine carotid ultrasonography and UltraFast were performed in 35 MHD patients and 28 normal controls. The 35 MHD patients were classified into carotid arterial plaque (CAP) group or non-carotid arterial plaque (non-CAP) group by two dimensional gray scale features. Carotid arterial PWV was measured by UltraFast, including beginning of systolic (BS) value and end of systolic (ES) value. Results BS and ES values of carotid arterial PWV were significantly different between MHD patients and normal controls (P<0.05). However, BS and ES values were statistically indifferent between CAP group and non-CAP group (P>0.05). Conclusion UltraFast is a safe, convenient, fast, noninvasive, and non- radioactive imaging technique by which carotid arterial PWV can be automatically and accurately assayed. BS and ES values may be the new imaging indicators to quantitatively assess the carotid arterial stiffness in MHD patients. Metrics

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A retrospective study of peritoneal dialysis and continuous vena-vena hemodialysis / hemofiltration in treatment of severe bee venom intoxication patients 2015, 14 (04):  219-223.  doi: 10.3969/j.issn.1671-4091.2015.04.009 Abstract ( 251 )   HTML ( 0 )   PDF (472KB) ( 297 )   Objective To compare the effect of peritoneal dialysis (PD) and continuous vena-vena hemodialysis/ hemofiltration (CVVH) on the patients with bee venom-induced multiple organ dysfunction syndrome(MODS). Methods We retrospectively reviewed 30 cases with bee venom-induced MODS, among whom 12 patients were treated with PD (PD group) and 18 patients with CVVH (CVVH group). Clinical data including age, sex, dialysis type, disease severity (APACHEⅡ score), Hb, WBC, serum Cr, ALT, TBil and CK, dialysis related complications, and dialysis expenses per day were collected. Results There were no differences in age, sex, disease severity, and serum biochemical changes between the two groups (P＞0.05), nor in renal recovery rate and mortality between the two groups (P＞0.05). However, dialysis related complications were found in 55% patients in CVVH group, but was only 15.3% patients in PD group (P＞0.05). Therapeutic doses (58.68±12.53 L/d vs. 11.45±6.62 L/d, P＞0.05), dialysis duration (7.25±9.65 L/d vs. 13.23±11.75 d, P＞0.05), and daily ultrafiltration volume (3264.3±1421.68 ml/d vs. 1747.36±826.14 ml/d, P＞0.05) were significantly different between CVVH group and PD group. Patients in the two groups were followed up for 3 months. Kaplan- Meier survival curves showed no overall survival difference between the two groups (P＞0.05). Dialysis expenses per day were 6020.34±1201.32 yuan in CVVH patients, higher than 592.92±138.62 yuan in PD patients. Conclusion CVVH and PD had similar effect in treatment of bee venom- induced MODS. PD is simpler and less expenses than CVVH. Therefore, PD should be used as the preferential method for bee venom-induced MODS. Metrics

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Higher thrombomodulin level is a risk factor for cardiovascular diseases in maintenance hemodialysis patients 2015, 14 (04):  224-226.  doi: 10.3969/j.issn.1671-4091.2015.04.010 Abstract ( 473 )   HTML ( 0 )   PDF (356KB) ( 380 )   Objective To study the relationship between cardiovascular diseases (CVD) and serum thrombomodulin (Tm) level in maintenance hemodialysis (MHD) patients. Methods A total of 112 MHD cases were retrospectively analyzed. Serum Tm was measured by enzyme-linked immunosorbent assay (ELISA). The relationship between serum Tm level and other related laboratory parameters was analyzed. Logistic regression was used to analyze the risk factors for CVD. Results Serum Tm level increased in MHD patients as compared with that in normal controls (15.34±4.07 mg/L vs. 3.58±1.26 mg/L, P＜0.05). MHD patients with CVD had significantly higher Tm level (P＜0.05). Tm was positively correlated with left ventricular end- diastolic diameter (LVDd; r=0.427, P=0.037), interventricular septal thickness (IVSTd; r=0.486, P= 0.032), posterior wall diameter of left ventricle at end-diastolic period (LVPWd; r=0.579, P= 0.023), and left ventricular mass index (LVMI; r= 0.516, P=0.025), and was negatively correlated with ejection fraction of left ventricle (r=-0.394, P=0.002). Multivariate logistic regression showed that Tm, CRP, low Hb were the independent risk factors for CVD. Conclusions Serum Tm level was significantly higher in MHD patients. Higher Tm was an independent risk factor for CVD in MHD patients. Metrics

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A survey of marital status on quality of life in maintenance hemodialysis patients 2015, 14 (04):  227-229.  doi: 10.3969/j.issn.1671-4091.2015.04.011 Abstract ( 230 )   HTML ( 0 )   PDF (350KB) ( 488 )   Objective  To evaluate marital status on quality of life so as to provide scientific intervention and health education in maintenance hemodialysis (MHD) patients. Methods Using the quality of life questionnaire (SF-36) and marriage quality questionnaire, we studied quality of life and marital status in 60 MHD patients as well as 60 healthy individuals for control. Results The multiple dimension scores including general health, physical function, physical performances and emotional function were higher in MHD patients having spouses than those without spouses (P＜0.05), and the general health score was significantly higher in the patients having spouses (P＜0.0011). Marriage quality questionnaire showed that the marital satisfaction score was similar in MHD patients and in healthy controls, but the sexual life score was significantly lower in male and female MHD patients than in healthy controls (P=0.0241 for males, and P=0.003 for females). Conclusions Marital status is an important factor affecting quality of life in MHD patients. Metrics

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A survey on resources of professionals for hemodialysis and hemodialysis equipment in Shanxi province 2015, 14 (04):  237-239.  doi: 10.3969/j.issn.1671-4091.2015.04.014 Abstract ( 191 )   HTML ( 0 )   PDF (296KB) ( 422 )   Objective To investigate the human resources of doctors, nurses, and technicians for hemodialysis and the hemodialysis equipment in Shanxi province. Methods Information about human resources and blood purification equipment in Shanxi province were collected from the website of Nationwide Registration System of Hemodialysis Cases and the content in the tables of current situation of professional staff in hemodialysis centers in Shanxi province. Results A total of 119 hospitals in Shanxi province served hmodialysis. In the 428 hemodialysis doctors, chief physicians, attending doctors and resident doctors each accounted for 1/3 of the physicians. More than 90% of them had bachelor degree or higher than bachelor degree, and most of them were 30-49 years of age. In the 760 hemodialysis nurses, most of them had bachelor degree or graduated from medical colleges, part of the nurses had postgraduate educational experiences, and about 50% of them were 20-29 years of age. Currently, there were 1362 hemodialysis instruments in Shanxi province. Hemodialysis could be carried out in 45% of the counties in Shanxi province. Conclusion The professional team engaged in blood purification in Shanxi province is expanding continuously in recent years. The education level ratios are relatively optimal in both doctor and nurse teams. They have greater development potentials. Many young nurses need standardized training and re-education. Blood purification equipment is growing rapidly. The number of counties in which hemodialysis can be carried out needs to be further increased Metrics

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The value of vascular ultrasound for the pre-operative evaluation prior to arteriovenous fistula formation for haemodialysis 2015, 14 (04):  246-249.  doi: 10.3969/j.issn.1671-4091.2015.04.017 Abstract ( 239 )   HTML ( 0 )   PDF (1156KB) ( 282 )   Objective To discuss the value of pre-operative vascular ultrasound evaluation of arteriovenous fistula (AVF) formation for haemodialysis. Methods Vascular ultrasound was performed in 101 candidates for AVF. Factors such as diameter and velocity of radial artery and cephalic vein were analyzed according to the results of AVF operation. Results There were 89 patients among 101 candidates received AVF operation after ultrasound scan, and 75 cases had successful haemodialysis using AVF after 4 months. There was significant difference in diameters and peak systolic velocity of radial artery between successful and fail groups (2.266±0.410 mm vs. 1.975±0.300 mm, P=0.017, t=2.434; 0.706±0.165 m/s vs. 0.558±0.241 m/s, P= 0.009, t=2.686), while the intima- media thickness and the resistance index during reactive hyperemia were similar in two groups (0.319±0.073 mm vs. 0.364±0.090 mm, P=0.081, t=1.770; 0.778±0.078 vs. 0.814± 0.099, P=0.358, t=0.932). The diameter of cephalic vein was the same between two groups (2.348±0.690 mm vs. 2.221±0.765 mm, P=0.591, t=0.539), but significant difference was found between diameters of congestive dilated veins and those with cephalic vein less than 2 mm (2.363±0.344 mm vs. 1.987), but signP=0.017, t=2.605). Conclusions Vascular ultrasound is valuable in pre-operative evaluation for arteriovenous fistula operation, especially evaluating the diameters and peak systolic velocity of radial artery and diameters of congestive dilated veins in those with cephalic vein less than 2 mm. Metrics