Chinese Journal of Blood Purification

12 July 2015, Volume 14 Issue 07 Previous Issue    Next Issue

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Effect of peritoneal dialysis adequacy on cardiac structure and function in peritoneal dialysis patients 2015, 14 (07):  400-403.  doi: 10.3969/j.issn.1671-4091.2015.07.005 Abstract ( 251 )   HTML ( 0 )   PDF (405KB) ( 250 )   【Abstract】Objective To investigate the effect of peritoneal dialysis adequacy on cardiac structure and function in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods Eighty-six patients treated with CAPD for at least 3 months in our department were enrolled in this study. Patients were divided into two groups according to the adequacy of peritoneal dialysis: group A (n=44), urea clearance index (Kt/V total) ≥ 1.7 and creatinine clearance weekly (WCcr total) ≥50L/(w•1.73m2), and group B (n=42), urea clearance index (Kt/V total) ＜1.7 and creatinine clearance weekly (WCcr total) ＜50L/(w•1.73m2). Forty-four healthy individuals were recruited as controls (group C). Blood pressure was measured, and blood BUN, Scr, Ca, P, PTH, Hb and Alb were also measured in all patients. IVST, LVPWT, LAD, LVDd, LVDs, EF and E/A were determined by echocardiography. Kt/V total, Kt/V renal, WCcr total and rGFR were calculated. Results ① LVMI, IVST, LVPWT and LAD were significantly lower in group A than in group B (139.8±29.7 g/m2 vs. 178.4±30.5 g/m2, F=1.053, P =0.003 for LVMI; 11.9±2.01 mm vs. 13.5±1.7 mm, F=1.396, P =0.012 for IVST; 11.3±2.1 mm vs. 13.0±1.8 mm, F=1.358, P =0.011 for LVPWT; 34.2±5.6 mm vs. 40.0±6.3 mm, F=1.258, P= 0.011 for LAD). EF was significantly higher in group A than in group B (61.4±5.6% vs. 57.8±7.4% F=1.754, P=0.041). There was no significant difference in diastolic function between the two groups (F=1.778, P=0.821). ② Group A had lower levels of BUN, Scr and PTH (P＜0.01), lower SBP and DBP (P＜0.05), higher Alb and Hb (P＜0.05), higher Kt/V values of residual renal function and rGFR (P＜0.01) as compared with whose in group B. The Kt/v value of residual renal function was 35% of total Kt/V in group A, and was 12% of total Kt/V in group B (P＜0.01). ③ Cardiac structure and function were correlated with uremic toxins, malnutrition, anemia, hypertension and residual renal function. Conclusions There is a close relationship between peritoneal dialysis adequacy and cardiac structure and function. Cardiac structure and function can be improved by maintaining a rational peritoneal dialysis adequacy. Protecting the residual renal function and maintaining the dialysis adequacy can reduce the incidence of cardiovascular disease and the mortality in CAPD patients. Metrics

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Application of continuous renal replacement therapy with regional citrate anticoagulation in patients at high risk of bleeding 2015, 14 (07):  404-407.  doi: 10.3969/j.issn.1671-4091.2015.07.006 Abstract ( 226 )   HTML ( 1 )   PDF (383KB) ( 397 )   【Abstract】Objective To investigate the efficacy and safety of continuous renal replacement therapy (CRRT) using regional citrate anticoagulation in patients at high risk of bleeding. Methods A total of 40 patients at high risk of bleeding treated with CRRT in Fuzhou General Hospital of Nanjing Military Command during the period from Jan. 2014 to Jan. 2015 were enrolled in this study. They were divided into citrate group (n=20) and control group (n=20). Patients in citrate group were given citrate for anticoagulation, and patients in control group were given low molecular weight heparin for anticoagulation. The efficacy and safety were compared between the two groups. Results Before treatment, there were no significant differences in demographic characteristics and laboratory data between the two groups (P＞0.05). After treatment at different time periods (12h, 24h and 72h), APTT in citrate group was lower than that in control group (F=83.280, 61.676 and 83.836, respectively; P＜0.01). Serum calcium, platelet and hemoglobin had no significant differences between the two groups (P＞0.05). Filter life was longer in citrate group than in control group (38.1±13.7h vs. 26.4±10.1h; t=0.381, P＜0.01). The incidence of clotting in circuit was lower in citrate group than in control group (12.8% vs. 29.2%; χ2=6.736, P＜0.01). The incidence of bleeding had no significant differences between the two groups (P＞0.05). In citrate group after the treatment at different time periods (12h and 24h), ionized calcium behind filter was lower than that before treatment (F=49.510, P＜0.01), pH (F=4.102, P＜0.05) and HCO3 - (F=4.502, P＜0.05) values were higher than those before treatment, and ionized calcium before filter changed insignificantly compared to that before treatment (P＞0.05). Conclusion Regional citrate anticoagulation is a safe and effective option for CRRT in patients at high risk of bleeding. Metrics

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Impact of parathyroidectomy on the progression of coronary artery calcification in maintenance hemodialysis patients 2015, 14 (07):  408-411.  doi: 10.3969/j.issn.1671-4091.2015.07.007 Abstract ( 343 )   HTML ( 2 )   PDF (341KB) ( 232 )   【Abstract】Objective To observe the impact of parathyroidectomy (PTX) on the progression of coronary artery calcification (CAC) in maintenance hemodialysis (MHD) patients complicated with secondary hyperparathyroidism (SHPT), and to analyze the factors contributing to the progression of CAC. Methods A total of 37 MHD patients were enrolled in this study. Nine of them underwent PTX due to refractory SHPT, and 28 of them without PTX were used as controls.Computed tomographic imaging was performed at baseline and in follow-up period to obtain the changes of CAC score. CAC score, serum calcium, phosphorus and iPTH at baseline and in follow-up period were compared between the two groups. Results In PTX group, serum calcium, phosphorus and iPTH at follow-up period after PTX were 2.1±0.3 mmol/L, 1.3±0.5 mmol/L and 82.1±92.6 mmol/L, respectively, significantly lower than those at baseline (P＜0.05). The general CAC score in follow-up period increased significantly, but the annualized change of CAC score was indifferent between the two groups. Progression of CAC was significantly associated with diabetes and baseline CAC score (P=0.0002 and 0.0001, respectively), but not with serum iPTH. Conclusions PTX improved calcium and phosphorus metabolism, but had no effect on the progression of CAC in MHD patients with SHPT. Diabetes and baseline CAC score may affect the progression of CAC. Metrics

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Retrospective analysis of calcium and phosphorus metabolism disturbances in maintenance hemodialysis patients 2015, 14 (07):  412-417.  doi: 10.3969/j.issn.1671-4091.2015.07.008 Abstract ( 237 )   HTML ( 0 )   PDF (541KB) ( 521 )   【Abstract】Objective There are only a few data at Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, about the prevalence and management of bone and mineral metabolism disorders in patients on maintenance hemodialysis (MHD). In this study, we retrospectively analyzed serum calcium, phosphorus and intact parathyroid hormone (iPTH) in the MHD patients treated in Hemodialysis Center of Ren Ji Hospital, and evaluated their calcium and phosphorus metabolism disturbances. Methods MHD patients treated in Ren Ji Hospital between Jan. 1, 2007 and Dec. 31, 2013 were enrolled in this study. They were followed up to the end-point of death, cessation of hemodialysis, transfer to other blood purification centers, or to the end of follow-up period (Dec. 31, 2013). Laboratory parameters including serum albumin, hemoglobin, phosphorus, calcium, iPTH, and high sensitivity C reactive protein (hs-CRP) were measured every 3 months. Result A total of 528 MHD patients (mean age 55.3±17.6 years, 60.8% males) were recruited in this study. Serum calcium, phosphorus and iPTH met the target levels suggested by the Kidney Disease Outcomes Quality Initiative (K/DOQI) accounted for 51.3%, 39.0% and 26.1%, respectively, of the patients. Serum calcium was higher in females (2.34±0.23 mmol/L) than males (2.28±0.20 mmol/L, P=0.024). Compared with younger patients (age ＜65), older patients (age >65) had relatively lower phosphorus (1.75±0.40 vs. 2.02±0.40 mmol/ L, P＜0.001) and iPTH (223.76 pg/ml vs. 352.36 pg/ml, P＜0.001). iPTH >600 pg/ml was found in 18% patients, and iPTH ＜150 pg/ml in 25.6% patients. Patients with hemodialysis thrice a week had lower serum phosphorus and higher serum calcium than those with hemodialysis twice a week (1.87 ± 0.42 mmol/L vs. 1.95±0.41 mmol/L, P=0.043 for phosphorus; 2.32±0.21 mmol/L vs. 2.27±0.22 mmol/L, P=0.022 for calcium). Patients on MHD for more than 5 years had significantly higher serum calcium, phosphorus, and iPTH than those on MHD for less than 5 years (2.35±0.22 mmol/L vs. 2.23±0.18 mmol/L, P＜0.0001 for calcium; 1.95± 0.41mmol/L vs. 1.84 ± 0.44 mmol/L, P= 0.027 for phosphorus; 443.17±393.76 pg/ml vs. 285.19±282.95 pg/ml, P＜0.0001 for iPTH). Multiple and stepwise linear regression indicated that serum albumin (P=0.001), calcium (P＜0.001), iPTH (P＜0.001), age (P＜0.001) and dialysis vintage (P=0.004) were the independent risk factors for hyperphosphatemia. Conclusions Hyperphosphatemia and hyperparathyroidism were relatively common in MHD patients, especially in those with hemodialysis twice a week and those with hemodialysis vintage for more than 5 years. Serum albumin, calcium, iPTH, age and dialysis vintage were the independent risk factors for hyperphosphatemia. Metrics

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Changes of QT dispersion on electrocardiogram in hemodialysis patients with aortic arch calcification 2015, 14 (07):  418-421.  doi: 10.3969/j.issn.1671-4091.2015.07.009 Abstract ( 254 )   HTML ( 0 )   PDF (497KB) ( 281 )   【Abstract】Objective To investigate the QT dispersion (QTd) in maintenance hemodialysis (MHD) patients with aortic arch calcification (AAC). Methods Clinical data in MHD patients were collected, and chest radiography was used to detect AAC. Patients were then divided into two groups based on the presence or absence of AAC. Twelve-lead ECG was performed to measure QTd and corrected QTd (QTcd). Left ventricular ejection fraction (EF) and the ratio of mitral early diastolic peak flow and mitral annular early diastolic velocity (E/E’) were measured by echocardiography. Results A total of 97 MHD patients were included in this study. AAC was detected in 60 (61.9%) patients. There were significant differences between the two groups in age, prevalence of diabetes mellitus, diastolic blood pressure, pulse pressure, serum albumin, iPTH, and cardiothoracic ratio. Compared to the group without AAC, AAC group had significantly longer QTd(51.05±3.01 ms vs. 49.41±2.43 ms, P＜0.01), QTcd (57.18±3.37 ms vs. 54.85±2.69 ms, P＜0.01) and higher E/E’(21.94 ± 4.83 vs. 16.93 ± 4.15,P＜0.01). In AAC group, QTcd was negatively correlated with EF (r= -0.388, P=0.002) and was positively correlated with E/E’(r=0.473, P＜0.001). QTd and QTcd were significantly correlated with age, iPTH and cardiothoracic ratio (P＜0.01) in MHD patients. Conclusions In MHD patients with AAC, QTd and QTcd were prolonged, and their QTcd was significantly correlated to left ventricular function. Metrics

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Valvular calcification can be used to estimate the degree of coronary artery calcification in hemodialysis patients 2015, 14 (07):  422-424.  doi: 10.3969/j.issn.1671-4091.2015.07.010 Abstract ( 322 )   HTML ( 0 )   PDF (338KB) ( 355 )   【Abstract】Objective To observe valvular calcification (VC) and coronary artery calcification (CAC) in maintenance hemodialysis (MHD) patients, and to explore the possibility of VC for the diagnosis of CAC. Methods Sixty- one MHD patients were enrolled in this study. Serum phosphate, calcium and PTH were measured. Echocardiogram was used to detect VC, and multi-slice spiral CT (MSCT) was performed to assess the score of CAC. Agaston score was used for the estimation of CAC degree. Results ①The median CAC score in non-VC group, one-VC group and two-VC group were 524, 1,006.5 and 2,094.5, respectively. ②Patients’age was older in VC group (73.36±9.28 years) than in non-VC group (61.60±14.87 years). The median CAC score was 1,765 in VC group, and was 524 in non-VC group (P＜0.05). ③ Correlation analysis showed that the level of low density lipoprotein cholesterol was positively correlated with CAC score (r=0.308, P= 0.016). ④Patients with VC had a significantly greater likelihood of having a CAC score ＞1,000 (OR=4.995, 95% CI 0.877～28.445). Conclusion VC and CAC are frequently seen in MHD patients. The presence of VC detected by echocardiogram can predict the degree of CAC. Metrics

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The characteristics of body fluid distribution in maintenance hemodialysis patients by using bioelectrical impedance 2015, 14 (07):  425-42.  doi: 10.3969/j.issn.1671-4091.2015.07.011 Abstract ( 474 )   HTML ( 0 )   PDF (361KB) ( 395 )   【Abstract】Objective of this study was to study the characteristics of fluid distribution by using multifrequency bioelectrical impedance in maintenance hemodialysis (MHD) patients before and after dialysis. Methods A total of 86 MHD patients who reached the target of clinical dry weight were selected as the experiment group. Meanwhile, a total of 258 healthy cases were recruited as the control group. Body weight (W), total body water (TBW), intracellular water (ICW) and extracellular water (ECW) before and after a dialysis session were measured by using a multi-frequency body composition analyzer. ICW/W, ICW/TBW, ICW/ H2, ECW/W, ECW/TBW, ECW/H2 and ICW/ECW before and after a dialysis session were then calculated. Results Before dialysis, ECW/H2 was significantly higher in experiment group than in control group (4.77± 0.58 vs. 4.52±0.36 in males, P＜0.01; 4.16±0.47 vs. 3.97±0.32 in females, P＜0.01). After dialysis in experiment group, ECW/H2 approximated to that of control group. Before and after a dialysis session in experiment group, there were no significant differences in ICW/TBW, ICW/ECW and ECW/TBW. Between experiment group and control group. For ICW/H2 in males, the level in experiment group before dialysis was higher than that in control group (9.42±1.26 vs. 9.03±0.75, P＜0.05), and the level after dialysis approximated to that of control group (8.83±1.15 vs. 9.03±0.75, P＞0.05). For ICW/H2 in females, the level before dialysis was significantly higher than that after dialysis (8.07±0.79 vs. 7.52±1.49, P＜0.05). Conclusion ①In MHD patients, water was retained not mainly in extracellular space but in both extracellular and intracellular spaces. Dialysis by ultrafiltration decreased the water retention in both extracellular and intracellular spaces. ②ECW/ H2 and ICW/H2 decreased closely to those of normal persons after dialysis. Therefore, ECW/H2 and ICW/H2 may represent water load status in MHD patients, and need to be further studied. Metrics

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The therapeutic effect of plasmapheresis in the treatment of chronic severe hepatitis B 2015, 14 (07):  429-432.  doi: 10.3969/j.issn.1671-4091.2015.07.012 Abstract ( 426 )   HTML ( 0 )   PDF (387KB) ( 217 )   【Abstract】Objective This retrospective study aimed to discuss the effect of plasmapheresis (PE) in the clearance of serum inflammatory mediators and recovery of liver function in chronic severe hepatitis B (CSHB). Methods CSHB patients treated in our hospital in the period between 2013 and 2014 were retrospectively analyzed. Comprehensive therapy combined with PE was used to treat these patients. Every PE used 3L fresh frozen plasma of same blood type. Serum inflammatory mediators and liver function were compared before and after the treatment. Results A total of 45 patients (mean age 42.3 years old) were retrospectively analyzed. After the treatment, serum inflammatory mediators decreased significantly as compared with those before the treatment: CRP (20.4 ± 14.3 mg/L vs. 28.5 ± 11.3 mg/L; t=3.613, P＜0.001), TNF- α (181.0±39.0 vs. 275.4±50.9; t=8.765, P＜0.001), IL-6 (252.9±34.8 pg/mL vs. 351.9±41.5 pg/mL; t=12.262, P＜0.001), and IL-8 (458.4±86.4 pg/mL vs. 665.9±84.6 pg/mL; t=11.513, P＜0.001). After the treatment, serum total cholesterol (2.5 ± 0.8 mmol/L vs. 2.1 ± 0.3 mmol/L; t=3.141, P＜0.001), cholineasterase activity (3448.4±566.3 U/mL vs. 2635.9±984.6 U/mL; t=5.442, P＜0.001), and albumin (31.2± 2.7g/L vs. 28.6±3.5 g/ L; t=8.753, P＜0.001) increased, and PT (26.6±4.3 vs. 34.6±6.7; t=6.741, P＜0.001), ALT (55.9±5.0 IU/L vs. 82.0±5.7 IU/L; t= 16.531,P＜0.001), AST (53.4±2.4 IU/L vs. 80.0±3.1 IU/L; t=15.563, P＜0.001), and TBIL (13.4±1.3 mmol/L vs. 15.7±0.82 mmol/L; t=10.326, P＜0.001) decreased as compared with those before the treatment. Conclusion The PE treatment can significantly improve liver function and inflammatory status in CSHB patients. Metrics