Chinese Journal of Blood Purification

12 May 2015, Volume 14 Issue 05 Previous Issue    Next Issue

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Effects of parathyroidectomy on phosphate and bone metabolism in maintenance hemodialysis patients with secondary hyperparathyroidism 2015, 14 (05):  256-260.  doi: 10.3969/j.issn.1671-4091.2015.05.001 Abstract ( 423 )   HTML ( 1 )   PDF (750KB) ( 365 )   Objective To explore the effects of parathyroidectomy (PTX) on serum phosphate level and bone metabolism in uremic hemodialysis patients, and to analyze the primary factors which affect serum phosphate level. Method Uremic patients with secondary hyperparathyroidism treated with PTX in our hospital during the period from Jan. 2008 to Dec. 2013 were enrolled in this study. Serum and plasma samples were collected before PTX and after PTX for 1, 3 and 7 days and clinical data were recruited. Correlations among these data were analyzed. Result Serum PTH significantly decreased after PTX for one day as compared with the level before PTX. Serum phosphate decreased from 2.26±0.55 mmol/L before PTX to 1.37± 0.40 mmol/L after PTX for 3 days (P＜0.01). Plasma FGF23 also decreased gradually after PTX. Plasma FGF23 decreased from 680.75±307.71 pg/mL before PTX to 418.65±280.74 pg/mL after PTX for 7 days (P＜0.01). Serum bone- specific alkaline phosphatase (BAP) reduced from 727.50 ± 30.14 U/L before PTX to 551.25±60.61 U/L after PTX for one day (P＜0.01). Serum type I collagen cross-linked C-terminal peptide (ICTP) decreased from 20.11±2.56 μg/L before PTX to 13.75±2.95 μg/L after PTX for one day (P＜0.05).Pearson correlation analysis found that serum phosphate level correlated with the levels of serum PTH, calcium, FGF23, 25(OH)D3 BAP and ICTP. Multivariate regression analysis demonstrated that FGF23 was the factor determining serum phosphate level. Conclusion Parathyroidectomy significantly alleviates the higher serum phosphate and improves bone metabolism. Bone derived FGF23 is a decisive factor on serum phosphate level. Metrics

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Evaluation of intermittent high volume on-line hemofiltration versus hemodialysis in the treatment of critically ill patients with acute kidney injury 2015, 14 (05):  261-265.  doi: 10.3969/j.issn.1671-4091.2015.05.002 Abstract ( 221 )   HTML ( 0 )   PDF (507KB) ( 388 )   Objective To compare clinical effects of intermittent high volume predilution on-line hemofiltration (HF) and standard hemodialysis (HD) in the treatment of critically ill patients with acute kidney injury (AKI). Methods This was a prospective, randomized controlled, and single-centered clinical study. Mortality and recovery of kidney function were compare in critically ill patients with AKI treated with HF (n=50) and HD (n=45). The outcome included all-cause mortality and in- hospital all-cause mortality, and recovery rate from AKI within 60 days. Results Baseline characteristics were similar in the HF group and HD group. All-cause mortality within 60 days was 68.0% (34/50) in the HF group and 82.2% (37/45) in the HD group (hazard ratio 0.75; 95% confidence interval 0.80～1.28; P=0.036), while in- hospital mortality and recovery rate from AKI were statistically indifferent between the two groups (P=0.274 and 0.565, respectively). The recovery time from AKI and the ratio of patients required dialysis were lower in HF group than in HD group but without statistical significance (P=0.223 and 0.687, respectively). Conclusion HF was better than HD in lowering mortality in critically ill patients with AKI. HF also reduced the recovery time from AKI and the requirement for dialysis support, but without statistical significances as compare with those in HD group. Metrics

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Observation of medium and long term efficacy of hemodialysis combined with hemoperfusion in the treatment of maintenance hemodialysis patients with resistant hypertension 2015, 14 (05):  266-270.  doi: 10.3969/j.issn.1671-4091.2015.05.003 Abstract ( 514 )   HTML ( 0 )   PDF (389KB) ( 388 )   Objective To assess the medium and long term efficacy of hemodialysis combined with hemoperfusion in the treatment of maintenance hemodialysis (MHD) patients with refractory hypertension. Methods Seventy- five MHD patients with persistent and refractory hypertension for more than 6 months were randomly divided into two groups: hemoperfusion (HP) group (n=45) and control group (n=30). In control group, hemodialysis was performed 3 times a week and hemodiafiltration was performed once every 2 weeks. In HP group, hemoperfusion was performed once every 2 weeks in addition to the therapeutic protocol in control group. Plasma rennin, angiotensinⅡ (ATⅡ) and aldosterone were measured by radioimmunoassay. Blood pressure was measured before and after the treatment. Result ①Plasma rennin, ATⅡ and aldosterone changed insignificantly after the treatment for 0, 3, 6 and 12 months in control group. ②With continuing the treatment, plasma rennin and systolic blood pressure (values before and after the treatment), diastolic blood pressure (value before the treatment), plasma AT Ⅱ and aldosterone (values after the treatment) decreased gradually in HP group (P＜0.01 or 0.05). Plasma ATⅡ and aldosterone after the treatment for 6 months and 12 months were significantly lower than those at the beginning and after the treatment for 3 months (P＜0.01). ③After the treatment for 6 months and 12 months, plasma rennin, ATⅡ, aldosterone and blood pressure were lower in HP group than in control group (P＜0.01 or 0.05). ④Plasma rennin, ATⅡ and aldosterone correlated with mean arterial pressure before and after the treatment. Conclusion Hemodialysis combined with hemoperfusion with an appropriate frequency and for a medium or long period is a safe, convenient, and effective approach for MHD patients with refractory hypertension. Metrics

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Prognosis of peritoneal dialysis and the effects of blood pressure and variability of blood pressure on mortality 2015, 14 (05):  271-276.  doi: 10.3969/j.issn.1671-4091.2015.05.004 Abstract ( 1234 )   HTML ( 0 )   PDF (772KB) ( 293 )   Objective To analyze the prognosis of peritoneal dialysis (PD) patients and to investigate the association between blood pressure (BP), the variability of BP and mortality. Methods We included 482 PD patients who had regular visits in our PD center from 1999 to Jan. 1, 2015 for survival analysis and to identify the risk factors for mortality. Sixty-nine of the PD patients who had been on PD for more than 3 months before Jan. 31, 2008 were involved in the analysis of the relationship between BP variability and mortality. Consecutive 6 office BP measurements once a month during 2008 were collected from every patient, and the coefficient of variation (CV) for BP was used as an indicator of BP variability. Baseline clinical data and laboratory tests were also reviewed. Patients were followed up for 72 months. All-cause mortality and cardiovascular mortality were analyzed by Cox regression. Results Two hundred and twenty-four PD patients died in the follow-up period for 16 years. Diabetes (HR 2.245, 95% CI 1.718～2.932, P＜0.001) and advanced age (HR 2.840, 95% CI 2.065～3.906, P＜0.001)were the risk factors for mortality. Cardiovascular event (52.2%) and infection (25%) were the two major causes of death. The CV for systolic blood pressure was 9.8±4.7%. Among the 69 PD patients, 33 patients died. Systolic BP ≥153mmHg was an independent predictor for allcause mortality (HR 2.848, 95% CI 1.156～7.015, P=0.023) and cardiovascular mortality (HR 3.122, 95% CI 1.012～.635, P=0.048). BP variability was not a predictor for mortality in PD patients. Conclusion Hypertension was an independent predictor for all-cause and cardiovascular mortality for PD patients, but BP variability could not be proved to be a factor affecting the prognosis of PD patients. Metrics

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A symptom assessment instrument for peritoneal dialysis patients: Dialysis Symptom Index (DSI) 2015, 14 (05):  277-280.  doi: 10.3969/j.issn.1671-4091.2015.05.005 Abstract ( 222 )   HTML ( 3 )   PDF (365KB) ( 362 )   【Abstract】Objective Little is known about the prevalence, severity, overall impact of physical and emotional symptoms in patients with continuous ambulatory peritoneal dialysis (CAPD) due to the lack of a valid symptom assessment instrument. Previous studies suggested that the Dialysis Symptom Index (DSI) could be a useful tool for the assessment of physical and emotional symptom burden in patients receiving hemodialysis.This study aimed to understand total symptom burden among CAPD patients by using DSI, and to investigate the relationship between symptom burden, depression and quality of life. Methods This was a cross-sectional study. Demographic information, clinical data and laboratory findings in CAPD patients were collected in our PD center from Oct. 2013 to Oct. 2014. DSI was used to identify patients’emotional and physical symptom burden. Depression and quality of life were assessed using the Beck Depression Inventory (BDI) and Short Form 36 (SF-36), respectively. DSI which includes 28 items highlights the important points about symptom burden and symptom assessment in CAPD patient. Results A total of 403 CAPD patients (54.3% males and 45.7% females, median age 60.5 years) were investigated. The mean duration of PD was 23.3±15.2 months. By DSI assessment, the prevalence of symptoms in CAPD patients were dry skin (71%), fatigue/tiredness (70%), pruritus (65%), constipation (32%), anorexia (38%), anxiety (36%), dyspnea (28%), nausea (33%), restless legs (28%), cough (45%), muscle cramps (36%), decreased interest in sex (24%), numbness or tingling in feet (30%), muscle soreness (31%), light headedness or dizziness (39%), swelling in legs (61%), trouble staying asleep (70%), bone or joint pain (46%), trouble falling asleep (63%), worrying(39%), irritable feeling (41%), headache (31%), sad feeling (21%), nervous feeling (33%), diarrhea (17%), chest pain (19%), concentration difficulties (38%), and vomiting (22%). Total DSI score was negatively correlated with SF-36 physical component score (PCS) (r =-0.416, P＜0.01), mental component score (MCS) (r=-0.479, P＜0.01), and positively correlated with BDI score (r=0.558, P＜0.01). Conclusion The symptom burden was closely related to depression, and significantly affected the quality of life in CAPD patient. DSI was a useful tool to evaluate the physical and emotional situations in CAPD patients, and may be useful for the design of specific intervention strategies to improve quality of life in CAPD patients. Metrics

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Comparison of different methods for the assessment of nutritional status and the prediction of risks during hospitalization in peritoneal dialysis patients 2015, 14 (05):  281-285.  doi: 10.3969/j.issn.1671-4091.2015.05.006 Abstract ( 209 )   HTML ( 0 )   PDF (416KB) ( 372 )   【Abstract】Objective Nutritional status can be evaluated by serum albumin, modified quantitative subjective global assessment (MQSGA) and malnutrition-inflammation score (MIS). This study sought to determine the value of these methods for malnutrition assessment in peritoneal dialysis (PD) patients. Methods Fifty-seven clinically stable patients undergoing PD were recruited for the evaluation of nutritional status by serum albumin, MQSGA and MIS. Their anthropometry and biochemical assays were evaluated. Correlation among the results from the 3 methods was conducted. Receiver operating characteristic (ROC) curve was applied to study the sensitivity and specificity of the 3 methods for the evaluation of malnutrition status. Logistic proportional hazard regression model was used to assess the risks during hospitalization. Results ①Malnutrition status was found in all PD patients by MIS, in 70.2% patients by MQSGA, and 57.9% patients by serum albumin. ②MQSGA and MIS correlated to anthropometry, biochemical assays and hospitalization frequency. Nutritional assessments by MQSGA, MIS and serum albumin were significantly correlated (P＜0.01). ③Area under the curve of MQSGA, MIS and serum albumin was 0.966, 0.961 and 0.028, respectively, for malnutrition diagnosed by PEW. ④Logistic proportional hazard regression demonstrated that MQSGA score had the highest correlation with the risks during hospitalization (RR 2.559, CI 1.498～4.372, P=0.001). Conclusions MIS is a sensitive method for the evaluation of malnutrition in PD patients. MQSGA is similar to MIS for malnutritional assessment in PD patients. MQSGA may be a better predictor for risks during hospitalization in PD patients. Metrics

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Clinical Application of Automatic Pressure Control Mode to Patients with Hemodiafiltration 2015, 14 (05):  286-288.  Abstract ( 198 )   HTML ( 0 )   PDF (336KB) ( 248 )   【Abstract】Objective To investigate the effect of the automatic pressure control mode on patients with hemodiafiltration. Methods We enrolled 70 maintenance hemodialysis patients in a single hemodialysis center for this study. They were treated with hemodiafiltration once every two weeks. The volume control mode for 6 times and automatic pressure control mode for 6 times were used sequentially. Duo pruritus score, the times of high pressure alarm and coagulation were recorded and compared by setting a self crossover control group during treatment. Results The volume of convection was significantly higher in automatic pressure control mode than in volume control mode (16.1±1.8L vs. 13.5±1.4L, t =14.49, P＜0.001). Duo pruritus score was significantly reduced (12.3±1.0 vs. 16.1±2.2, t =-13.57, P＜0.001). The times of high pressure alarm were lower in automatic pressure control mode than in volume control mode (0% vs. 15.47%; P＜0.001). The incidence of coagulation in dialyzer and dialysis tubing were significantly reduced (0 vs. 2.1%, P＜0.001). Conclusions Automatic pressure control mode can increase the amount of convection in hemodiafiltration, reduce the risk of blood clotting, and relieve pruritus symptom. Metrics

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Immunoadsorption in Combination with Recombinant Human Tumor Necrosis Factor Receptor Fusion Protein in the Treatment of Rheumatoid Arthritis 2015, 14 (05):  289-293.  doi: 10.3969/j.issn.1671-4091.2015.05.008 Abstract ( 312 )   HTML ( 0 )   PDF (468KB) ( 564 )   【Abstract】Objective To investigate the efficacy and safety of immunoadsorption combined with recombinant human tumor necrosis factor receptor fusion protein for the treatment of active rheumatoid arthritis. Methods We analyzed 65 active rheumatoid arthritis patients in this study. In combined group, 38 patients were treated with immunoadsorption combined with recombinant human tumor necrosis factor receptor fusion protein and disease- modifying anti- rheumatic drugs (DMARDs, LEF or MTX); In biological agent group, 27 patients were treated with recombinant human tumor necrosis factor receptor fusion protein and DMARDs (LEF or MTX). Clinical symptoms and laboratory examination changes were collected before and after treatment for 4 weeks and 24 weeks. Clinical assessments used the American College of Rheumatology criteria (ACR). Adverse events were evaluated during the treatment. Results All patients completed the treatment. At the treatment for 4 weeks, the improvement of tender joint counts, swollen joint counts, time of morning stiffness, ESR and CRP were greater in combined group than in biological agent group (Z=2.733, 2.604, 2.366, 4.137, 2.952, respectively, P＜0.05), and the improvement of DAS28 and HAQ scores were also greater in combined group than in biological agent group (Z=4.134 and 3.262, respectively, P＜0.05). At thetreatment for 24 weeks, the rates of ACR20, ACR50, and ACR70 were 94.7%, 92.1% and 81.5%, respectively, in combined group, and were 74.1%, 59.3% and 44.4%, respectively, in biological agent group (χ2=4.050, 10.077 and 9.721, respectively; P＜0.05). Conclusion Immunoadsorption in combination with recombinant human tumor necrosis factor receptor fusion protein significantly altered the signs and symptoms of rheumatoid arthritis, suggesting that this therapy may be an alternative for the remission induction of rheumatoid arthritis. Metrics

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The correlation between arteriovenous fistula access flow and the changes of cardiac output and mean arterial pressure in maintenance hemodialysis patients 2015, 14 (05):  300-303.  doi: 10.3969/j.issn.1671-4091.2015.05.011 Abstract ( 214 )   HTML ( 0 )   PDF (453KB) ( 366 )   【Abstract】Objective To observe the relationship between blood access from arteriovenous fistula (Qa) and the changes of cardiac output (CO) and mean arterial pressure (MAP) in maintenance hemodialysis (MHD) patients. Method A total of 54 MHD patients with arteriovenous fistula (AVF) were enrolled in this study. Variations of Qa by ultrasound dilution technique, CO, and MAP were observed at 30 minutes, 2 hours, and 3 hours after starting a hemodialysis session to study Qa affected by the changes of CO and MAP in a hemodialysis session. Result Qa, CO and MAP changed insignificantly at the 3 time points in a hemodialysis session (P>0.05). Qa was positively correlated with CO and MAP at the same time point (P<0.05)., The percentage of Qa variation within the 3 time points (△Qa1-3%) was positively correlated with the percentage of CO variation (△CO1-3%) (r=0367, P=0.009), and the percentage of MAP variation (△MAP1-3%) (r=0.455, P=0.001). The variation of Qa and CO were significantly greater in patients having ultrafiltration volume of > 5% dry body weight than in those having ultrafiltration volume of <5% dry body weight (P＜0.05). Conclusion Qa, CO and MAP were relatively stable in a hemodialysis session. Qa was positively correlated with CO and MAP. The increase of ultrafiltration volume in a session may result in the changes of Qa and CO and thus interfere with the stability of hemodynamics. Metrics

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Epidemiological survey of the new hemodialysis cases in urban and rural areas of Hebei province in 2013 2015, 14 (05):  307-310.  doi: 10.3969/j.issn.1671-4091.2015.05.013 Abstract ( 216 )   HTML ( 0 )   PDF (411KB) ( 320 )   【Abstract】Objective To analyze the differences in age, primary cause, and area distribution in the new hemodialysis cases from urban and rural areas of Hebei province in 2013, and to explore the risk factors of end stage renal disease (ESRD) for the build-up of its prevention strategies. Method The information about new hemodialysis cases in Hebei province from Jan. 1, 2013 to Dec. 31, 2013 was recruited and retrospectively analyzed. Data acquisition was performed from the National Hemodialysis Patient Information Registration System. Result ① In the new hemodialysis cases in 2013, 1032 (58.27% ) were from rural area, 739 (41.73%) from urban area; ② cases from rural area were significantly younger than those from urban area (50.61±15.18y vs. 55.28±15.76y; P<0.01); ③ the most important primary cause of ESRD was chronic glomerulonephritis, followed by diabetic nephropathy and hypertensive nephrosclerosis; ④at the beginning of hemodialysis, 65.80% in rural cases and 52.16% in urban cases used temporary central venous catheter for vascular access, and 33.84% in rural cases and 41.76% in urban cases used arteriovenous fistula for blood access. Conclusion The main causes leading to hemodialysis in Hebei province were in the order of glomerulonephritis, diabetic nephropathy and hypertensive nephrosclerosis. The new hemodialysis cases were younger in rural area than in urban area. Temporary central venous catheter for vascular access was used more in rural ar-ea than in urban area. Metrics

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The application of psychological family therapy in depression and treatment adherence of maintenance hemodialysis patients in initial period 2015, 14 (05):  311-314.  doi: 10.3969/j.issn.1671-4091.2015.05.014 Abstract ( 227 )   HTML ( 0 )   PDF (378KB) ( 338 )   【Abstract】Objective To investigate the depression, treatment adherence condition of maintenance hemodialysis patient(MHD) in initial period, and to explore the effect of family therapy on their depression and treatment adherence. Method 53 MHD in initial period were assessed with self-rating depression scale, the specific medical treatment adherence scale for ESRD clients with maintenance hemodialysis, alone with their interdialysis weight gain(IDWG), we evaluate their depression and treatment adherence condition, then we gave the patents family therapy of 4-6 times, and the aftertests. The one-sample T test and the regression analysis with control variables were manipulated to patents’depression, treatment adherence, and the relationship of the two; paired-sample T test were manipulated to explore the effect of family therapy on patients’depression and adherence. Result 86.79% of the patients were checked out with depression symptom；the SDS of the patients could be an independent factor to predict their treatment adherence both before and after the family therapy (Rbefore 2= 0.134, P=0.009, Rafter 2=0.379, P=0.000). The patients’SDS (SDbefore=57.45 ± 6.33, SDafter= 47.29±4.97, t=12.825, P=0.000), treatment adherence (SDbefore= 68.70±7.23, SDafter=76.74±5.52, t=-14.423, P= 0.000) and IDWG (SDbefore=2.75±1.28, SDafter=2.53±1.20, t=6.383, P=0.000)were significantly improved after family therapy. Conclusion Depression could be as prevalent among MHD in initial period, their treatment adherence are not ideal too, and depression could be an independent factor to predict their adherence. However, family therapy could be a useful way to improve their depression symptom and treatment adherence. Metrics