Chinese Journal of Blood Purification

12 June 2015, Volume 14 Issue 06 Previous Issue    Next Issue

Select

The relationship between oral health condition and micro-inflammatory state in maintenance hemodialysis patients 2015, 14 (06):  320-324.  doi: 10.3969/j.issn.1671-4091.2015.06.001 Abstract ( 258 )   HTML ( 0 )   PDF (404KB) ( 262 )   【Abstract】Objective To investigate oral changes and oral diseases and the relationship between oral health condition and micro- inflammatory state in maintenance hemodialysis (MHD) patients. Methods We recruited 85 MHD patients and 85 healthy adults as controls for this study. Their general condition, serum hsCRP, other laboratory examinations, and oral status were recorded. The relationship between periodontal disease index (PDI) and hsCRP was analyzed in MHD patients. MHD patients were then divided into healthy dental condition with mild caries group (group A), and healthy dental condition with severe caries group (group B), healthy periodontal condition or mild periodontal disease group (group C), and moderate and severe periodontal disease group (group D). Results of laboratory examinations were compared between MHD patients and healthy controls. Results The prevalence of caries was 68.2% in MHD patients. There were no statistically differences in prevalence of caries, caries not filled yet, missing teeth, and decayed, missing and filled teeth index (DMFT) between MHD patients and healthy controls (P>0.05). Filled teeth were lower in MHD patients (1.3) than in healthy controls (1.7) (P<0.05). The prevalence of periodontal disease was 83.5% in MHD patients. Debris index was 2.1 and 1.2, calculus index was 1.5 and 0.8, PDI was 3.9 and 1.9 in MHD patients group and healthy control group, respectively, significantly higher in MHD patients group (P<0.05). In MHD patients, the aggravation of periodontal disease was related to gender, diabetes mellitus, and dialysis age (P<0.05). Logistic regression demonstrated that dialysis age and diabetes mellitus were the risk factors for the aggravation of periodontal disease (P＜0.01) in MHD patients. Dialysis age was positively correlated with PDI (P＜0.05). Serum hsCRP was indifferent between group A and group B (P＞0.05), but was higher in group D (16.0±6.9 mmol/L) than in group C (11.1±7.4 mmol/L) (P＜0.01). Serum hsCRP and PDI were positively correlated (P＜0.05). In the nutrition indices, MBI was 24.2±1.3 and 22.1±1.5, ALB was 40.8±4.5g/L and 38.7±3.6g/L in group D and group C, respectively (P＜0.05). Conclusions Poor oral hygiene and higher prevalence of periodontal disease were frequently seen in MHD patients. Their periodontal disease aggravated with the increase of dialysis age. Chronic and severe periodontal disease may be one of the factors resulting in micro-inflammation status in MHD patients. Metrics

Select

Analyses on the factors relating to the abnormal bone mineral density in maintenance hemodialysis patients 2015, 14 (06):  325-327.  doi: 10.3969/j.issn.1671-4091.2015.06.002 Abstract ( 259 )   HTML ( 0 )   PDF (342KB) ( 230 )   【Abstract】Objective To observe the abnormal bone mineral density (BMD) in maintenance hemodialysis (MHD) patients, and to correlate BMD with age, sex, dialysis vintage, and bone metabolic related indicators including serum iPTH, calcium and phosphorus. Methods This was a cross-sectional study to measure BMD value by quantitative ultrasound in 263 MHD patients and to observe their age, gender, dialysis vintage, and bone metabolism related indicators. Results ①Abnormal BMD was found in 90.12% MHD patients, including osteoporosis in 45.62% patients and low bone mass in 44.48% patients. ②Age was negatively correlated with BMD value (r=-0.242, P=0.000). The risk of osteoporosis increased 1.352 folds with the increase of age. The prevalence of osteoporosis was 58.62% in females significantly higher than that in males (34.69%; χ2=14.980, P=0.000). The risk of osteoporosis in females was 2.46 times higher than that in males. Hemodialysis vintage was negatively correlated with BMD value (r=-0.198, P=0.198). The risk of osteoporosis increased 1.33 folds with the increase of serum phosphorus. Conclusion The prevalence of abnormal BMD was higher in MHD patients. Age, female, hemodialysis vintage and hyperphosphatemia were the risk factors for osteoporosis. Metrics

Select

The influence of different blood purification methods on intraocular pressure in maintenance hemodialysis patients 2015, 14 (06):  328-331.  doi: 10.3969/j.issn.1671-4091.2015.06.003 Abstract ( 232 )   HTML ( 0 )   PDF (420KB) ( 218 )   【Abstract】Objective To observe the change pattern of intraocular pressure and the effect of hemodialysis and hemofiltration on intraocular pressure in maintenance hemodialysis (MHD) patients. Methods A total of 78 MHD patients treated in Beijing Hospital were divided into hemodialysis group (n=63) and hemofiltration group (n=15). Systolic and diastolic blood pressure and the derived average artery pressure were measured before and after dialysis. The dehydration volume after dialysis was calculated. Intraocular pressure at supine position was recorded before dialysis, after the initiation of dialysis for 2 hours, and after dialysis. Osmotic pressure, hemoglobin, hematocrit, serum creatinine (Scr), blood urea nitrogen (BUN), blood glucose and sodium were assayed before and after dialysis. t-test and Pearson correlation analysis were used for statistical analyses. Results Systolic blood pressure and average artery pressure decreased remarkably after dialysis in both groups. Intraocular pressure increased at the beginning of dialysis then decreased afterwards to a level lower than that before dialysis in both groups. Intraocular pressure after the treatment was significantly lower than that during dialysis in hemodialysis group (P＜0.01), but was unchanged in hemofiltration group. Changes of Scr and BUN after dialysis were significantly higher in hemodialysis group than in hemofiltration group (P＜0.01), but changes of other blood biochemistry parameters were similar between the two groups. The decrease of intraocular pressure in right and left eyes was positively correlated with the dehydration volume after dialysis (r=0.305 and 0.343, respectively; P＜0.05). Conclusions Intraocular pressure increased at the beginning of dialysis then decreased afterwards in both groups. Intraocular pressure at the end of dialysis was lower than that before dialysis. Intraocular pressure during dialysis increased more in hemodialysis group and stabilized significantly in hemofiltration group, suggesting that hemofiltration resulted in less hemodynamics disturbances and thus less intraocular pressure changes. Metrics

Select

The relationship between heart rate variability and atherosclerosis in non-diabetic hemodialysis patients 2015, 14 (06):  332-336.  doi: 10.3969/j.issn.1671-4091.2015.06.004 Abstract ( 259 )   HTML ( 0 )   PDF (460KB) ( 218 )   Objective To determine the relationship between heart rate variability（HRV) and atherosclerosis(AS) in nondiabetic hemodialysis patients(MHD). Methods 108 nondiabetic MHD patients were enrolled in this study . Carotid initial-medial thickness(IMT) was measured by high-resolution B-mode echocardiography and HRV parameters were detected by 24-hour electrocardiogram monitoring on a day without hemodialysis .The relationship between HRV parameters and carotid IMT are analyzed . Results (1)Cartid IMT[(1.11±0.24)mm vs（0.72±0.17）mm ) ]and the prevalence of atherosclerosis plaques(48%vs9%) were significantly higher in108 nondiabetic MHD patients than those in the healthy controls (P＜0.05). (2)SDNN[（64.6±22.4）ms VS（90.5±23.9）ms], SDANN[（66.2±15.9）msVS（99.2±16.3）ms],RMDSS[（17.6±9.8）ms VS（25.1±10.1）ms], PNN50[（5.4±3.8）% VS（10.3±4.7）%],HRVI[（16.9±5.0）VS（25.7±7.9）]of 24hours HRV were significantly lower in nondiabetic MHDwith AS patients than those in the MHD without AS patients.(P＜0.05). (3) Univariate analysis showed that SDNN,SDANN,RMSSD,PNN50,HRVI of 24hours HRV were negtively correlated with IMT（t=-0.421，-0.381，-0.371，-0.451，-0.397, P＜0.05，Respectively） in nondiabetic MHD patients. (4) Multivariate stepwise regression indicated that HRV parameters ,LDL ,SBP were the independent risk factors for cardiovascular diseases in nondiabetic MHD patients. Conclusion The results indicate that autonomic nerve dysfunction is closely related to atherosclerosis cardiovascular diseases in nondiabetic MHD patients. Metrics

Select

Hemoglobin variation is associated with cardio- cerebro- vascular events and thrombosis in arteriovenous fistula in hemodialysis patients 2015, 14 (06):  337-341.  doi: 10.3969/j.issn.1671-4091.2015.06.005 Abstract ( 235 )   HTML ( 0 )   PDF (431KB) ( 301 )   【Abstract】Objective To investigate the relationship between hemoglobin variation and incidents of cardiocerebro-vascular events and thrombosis in arteriovenous fistula in maintenance hemodialysis (MHD) patients. Methods A total of 116 MHD patients treated in Peking University Third Hospital in Jan., 2011 were enrolled in this study, and were followed up from July, 2011 to Dec, 2013 or to the end-point events including cardio-cerebro vascular events, arteriovenous fistula thrombosis, and all-cause mortality. Hemoglobin variation was defined as the coefficient of variation of mean hemoglobin in the six months before follow-up period. We then analyzed the relationship between hemoglobin variation and end-point events. Results Cardio-cerebro-vascular events, arteriovenous fistula thrombosis, and all-cause mortality occurred in 56 patients during the follow-up period. All-cause mortality happened in 19 patients, cardiovascular mortality in 9 patients, cardio- cerebro-vascular events in 26 patients, and arteriovenous fistula thrombosis in 11 patients. Kaplan-Meier survival curve analysis indicates that the incidences of cardio-cerebra-vascular events and arteriovenous fistula thrombosis increase in patients with higher hemoglobin variation (coefficient of variation of hemoglobin ＞6.2%) and lower serum albumin (＜38.1g/L). Cox regression analysis shows that coefficient of variation of hemoglobin ＞6.2%, serum albumin ＜38.1g/L and Charlson comorbidity index are the independent risk factors for cardio-cerebro-vascular events and arteriovenous fistula thrombosis. Conclusions Hemoglobin variation and low serum albumin are associated with cardio-cerebro-vascular events and arteriovenous fistula thrombosis in MHD patients. Metrics

Select

Risk factors for early death due to hemorrhagic stroke in maintenance dialysis patients 2015, 14 (06):  342-347.  doi: 10.3969/j.issn.1671-4091.2015.06.006 Abstract ( 199 )   HTML ( 0 )   PDF (455KB) ( 281 )   【Abstract】Objective Hemorrhagic stroke (HS) is a severe complication causing death and disability in maintenance dialysis patients. This study retrospectively investigated the incidence of HS, 30-day mortality and the risk factors for death in hemodialysis (HD) and peritoneal dialysis (PD) patients in a single center. Methods A total of 711 dialysis patients in our center were enrolled in this study. Twenty-nine patients with HS were divided by the outcome within 30 days into death group and survival group. Clinical and laboratory characteristics were compared between the two groups. Results HS occurred in 29 patients (26 cases on HD, 3 cases on PD), significantly higher in HD patients than in PD patients (66.5/10,000 vs. 10.5/10,000 patient per year, P=0.002). Its mortality was 73.1% in HD patients and 67.7% in PD patients. Systolic blood pressure (SBP) at admission, diastolic blood pressure (DBP) at admission, size of hemorrhage area, incidence of intraventricular hematoma, and serum iPTH were significantly higher, and Glasgow coma score (GCS) were significantly lower (P<0.05) in death group than in survival group. The 30-day mortality was correlated with SBP at admission (r=0.562, P=0.004), DBP at admission (r=0.569, P=0.004), intraventricular hematoma (r= 0.402, P=0.042), size of hemorrhage area (r=0.612, P=0.001), iPTH (r=0.510, P=0.011), and GCS (r=-0.567, P=0.001). Kaplan-Meier curve showed that dialysis modality after HS had no impact on survival time of the patients (Log-rank test, P=0.545). Conclusion The 30-day mortality of HS was related to blood pressure at admission, severity of hemorrhagic stroke, and serum iPTH level in maintenance dialysis patients. Continuous renal replacement therapy and peritoneal dialysis after HS had no impact on their early outcome. Metrics

Select

Acute-on-chronic kidney disease patients : a clinical analysis 2015, 14 (06):  348-352.  doi: 10.3969/j.issn.1671-4091.2015.06.007 Abstract ( 509 )   HTML ( 0 )   PDF (515KB) ( 257 )   【Abstract】Objective To investigate the clinical information, induced factors, therapies, and prognosis in patients with acute renal injury on the basis of chronic kidney disease (CKD) (acute-on-chronic kidney disease, ACKD) in order to reduce morbidity in these patients. Methods Data from ACKD patients during the period from Jan., 2011 to Feb., 2012 were collected, and their induced factor, underlying disease, therapy and outcome were retrospectively analyzed. Results Fifty-five ACKD patients accounting for 4.6% of hospitalized patients in the same period were included in this study. Nephrotic syndrome, chronic interstitial nephritis and diabetic nephropathy were highly susceptible to ACKD. The common causes inducing ACKD included infection (30.9%), aggravation of underlying diseases (29.1%), and nephrotoxic drug (12.7%). Thirty- eight ACKD patients responded effectively to therapies, and the effective therapies to reverse the renal function included control of the primary diseases (59.5%), treatment of infections (10.5%), and interruption of nephrotoxic drug administration (2.6%). The therapies were ineffective in 17 ACKD patients, in which the prevalence of hypertension, hypertensive nephropathy and its comorbidities were higher than that in effective ACKD patients (P＜0.05). Twenty- nine effective patients and 15 ineffective patients were followed up for 7.1 ± 3.8 months. In the effective patients and ineffective patients, percentage of renal function improvement was 34.2% and 5.9% , respectively (P＜0.05), percentage of doubling serum creatinine level was 23.7% and 29.4%, respectively, percentage of end-stage renal failure was 7.9% and 29.4%, respectively (P＜0.05), and the mortality was 10.5% and 23.5%, respectively. The incidence of doubling serum creatinine in 12 months was 17% and 62% in the effective patients and ineffective patients, respectively (P＜0.05). Hypertension and its comorbidities were the risk factors for doubling serum creatinine level. Conclusions The prognosis of ACKD is poor in patients with nephrotic syndrome, chronic interstitial nephritis and diabetic nephropathy when no effective treatment is administered. The risk factors for ACKD including infections, inappropriate therapies and nephrotoxic drugs should be managed promptly. Metrics

Select

Effect of lanthanum carbonate on vascular calcification in maintenance hemodialysis patients without diabetes: a prospective and pilot study 2015, 14 (06):  353-357.  doi: 10.3969/j.issn.1671-4091.2015.06.008 Abstract ( 256 )   HTML ( 0 )   PDF (434KB) ( 298 )   【Abstract】Objective To explore the effect of lanthanum carbonate on vascular calcification in maintenance hemodialysis (MHD) patients without diabetes. Methods A total of 60 MHD patients treated in Beijing Chaoyang Hospital were divided into two groups, the calcium carbonate (CC) group and the lanthanum carbonate (LC) group. We compared the indices of serum calcium, phosphate, fibroblast growth factor - 23 (FGF23), homocysteine, endothelin, matrix gla protein (MGP), hsCRP, lipids, etc., and evaluated the coronary artery calcification score (CACS) by multi-slice spiral computed tomography at baseline and after the treatment for 12 months. SPSS 17.0 for Windows was used for statistical analyses. Results Serum calcium, phosphate, FGF23 and MGP decreased significantly and serum endothelin increased significantly in LC group after 12 months therapy as compared with those at baseline (P＜0.05). In contrast in CC group, serum phosphate and MGP decreased significantly, serum calcium and endothelin increased significantly (P＜0.05), but FGF23 was unchanged after the treatment for 12 months. When comparisons were made between the two groups, serum calcium, phosphate and FGF23 were significantly lower and MGP were significantly higher in LC group than in CC group (P＜0.05). Pearson’s correlation analyses revealed that the change of CACS was negatively correlated with the changes of serum phosphate and FGF23, and was positively correlated with the change of serum MGP in MHD patients without diabetes (P＜0.05). Changes of serum phosphate and FGF23 were the independent influence factors for CACS change. Conclusions CACS progressed slower in LC group than in CC group. Lanthanum carbonate can decrease serum phosphate, FGF23 but not increase serum calcium as compared with calcium carbonate. In addition, lanthanum carbonate can influence serum MGP level in MHD patients without diabetes. Metrics

Select

Observation of peritoneal dialysis combined with hemodialysis in the treatment of chronic renal failure patients with refractory hypertension 2015, 14 (06):  358-361.  doi: 10.3969/j.issn.1671-4091.2015.06.009 Abstract ( 243 )   HTML ( 0 )   PDF (378KB) ( 398 )   【Abstract】Objective To observe the curative effect of peritoneal dialysis combined with hemodialysis in the treatment of chronic renal failure associated with refractory hypertension. Method Sixteen patients were enrolled in this study. 24-hour ambulatory blood pressure monitoring, echocardiography, brain natriuretic peptide (BNP), and solute clearance rates were compared before the combination therapy and after the therapy for 6 months. Results After the combination therapy for 6 months, average number of antihypertensive drugs reduced from 4.2 to 2.8; average systolic pressure in 24 hours (t=15.602, P =0.000), average diastolic pressure in 24 hours (t =12.358, P =0.000), average systolic pressure in daytime (t =19.457, P =0.000), average diastolic pressure in daytime (t =49.694, P =0.000), average systolic pressure in night time (t =31.379, P = 0.000), and average diastolic pressure in night time (t =17.777, P =0.000) were lower than those before the combined therapy; BNP (t=-2.172, P=0.030) and mass index of left ventricle (t=10.429, P=0.000) were also lower than those before the therapy; total Kt/V was higher (t=-16.801, P=0.000) than that before the therapy. Conclusion Peritoneal dialysis combined with hemodialysis can increase dialysis adequacy, reduce blood pressure, and improve left ventricle hypertrophy. Metrics

Select

Factors relating to the dysfunction of autologous arteriovenous fistula in diabetic nephropathy patients 2015, 14 (06):  367-370.  doi: 10.3969/j.issn.1671-4091.2015.06.012 Abstract ( 310 )   HTML ( 1 )   PDF (410KB) ( 345 )   【Abstract】Objective To analyze the characteristics of arterioveneous fistula (AVF) in maintenance hemodialysis (MHD) patients with diabetes and its relevant factors. Methods A total of 98 MHD patients including 36 diabetic and 62 non-diabetic patients were enrolled in this study. Information about the time of fistula surgery, the potency of the fistula, and the period of fistula dysfunction were collected and analyzed. Results ①n the diabetic group, the survival time of arterioveneous fistula was 55.14±6.58 month, significantly shorter than that in non-diabetic group. ②IOne way analysis of variance showed that CRP was 11.75±1.21mg/L and 5.68±3.16mg/L (P＜0.05), and PLT was (207.00±10.28)×109/L and (176.20±8.78)×109/L (P＜0.05) in diabetic group and non-diabetic group, respectively. ③Vascular ultrasound examination showed that vessel diameter was 2.01±0.11mm in diabetic patients narrower than that in non-diabetic group (2.38±0.12mm). Vascular intima hyperplasia was more prominent in diabetic group. Conclusions The survival time of autologous AVF was relatively shorter in MHD patients with diabetes. Vascular endothelial hyperplasia, and higher CRP and PLT may relate to the shorter survival time of AVF in these patients. Metrics

Select

The effect of heparin concentration for catheter lock on conventional coagulation functions and thromboelastograph 2015, 14 (06):  371-374.  doi: 10.3969/j.issn.1671-4091.2015.06.013 Abstract ( 270 )   HTML ( 0 )   PDF (496KB) ( 388 )   【Abstract】Objective To investigate the effect of heparin concentration for catheter lock on conventional coagulation functions and thromboelastograph (TEG). Methods Fifty patients treated with continuous renal replacement therapy (CRRT) using local citrate anticoagulation were randomly divided into two groups according to lock heparin concentration: group A (6,250U/ml) and group B (3,125U/ml). Blood routine tests, conventional coagulation tests and TEG were performed before CRRT, after CRRT and before catheter lock, and after catheter lock for 30 min. TEG disposable heparinase cups and pins were measured 30 min after lock. The incidences of bleeding and thrombosis in 24 hours were recorded. Results ① There were no significant differences in PLT, prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) between before CRRT and after CRRT (P＞0.05). PT, APTT and TT were significantly prolonged after lock for 30 min in both groups (P＜0.05), and APTT and TT were longer in group A than in group B (P＜ 0.05). ②There were no significant differences in TEG R values before CRRT and after CRRT in both groups (P＞0.05). The R values were significantly extended after lock for 30 min in both groups, especially in group A (P＜0.05). No blood clot was found in 9 cases in group A and 5 cases in group B. After neutralization with heparinase, the R values returned to normal in both groups. ③There was no thrombosis in both groups, but bleeding episodes were found in both groups especially in group A (P＜0.05). In 7 cases with remarkable bleeding, bleeding ceased after protamine treatment through monitoring TEG. Conclusions CRRT patients are at high risk of bleeding after catheter lock with 6,250U/ml or 3,125U/ml heparin. TEG can be used to analyze the cause of bleeding and to guide protamine therapy in case of coagulation dysfunction. Metrics