Chinese Journal of Blood Purification

12 August 2015, Volume 14 Issue 08 Previous Issue    Next Issue

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The correlation between plasma metalloproteinase ADAMTS7 and vascular calcification in maintenance hemodialysis patients 2015, 14 (08):  465-468.  doi: 10.3969/j.issn.1671-4091.2015.08.006 Abstract ( 192 )   HTML ( 0 )   PDF (565KB) ( 206 )   【Abstract】Objective To investigate the correlation between plasma metalloproteinase ADAMTS7 and vascular calcification in maintenance hemodialysis (MHD) patients. Methods A total of 73 MHD patients were divided into high ADAMTS7 group (n=29) and low ADAMTS7 group (n=44) according to their plasma metalloproteinase ADAMTS7 levels. Vascular calcification was evaluated by plain X-ray films of pelvis and hands. Demographic data, clinical features, biochemical parameters, and vascular calcification were then compared between the two groups. Results Vascular calcification was detected in 23 patients in the high ADAMTS7 group (86%) and in 25 patients in the low ADAMTS7 group (57%, P=0.048). Patients with higher ADAMTS7 level had longer dialysis duration (72.5±67.8 months vs. 46.7±37.1 months, P=0.04) and higher plasma calcium (2.50±0.30 mmol/L vs. 2.23±0.23 mmol/L, P=0.002) than those with lower ADAMTS7 level. Regression analysis showed that higher plasma ADAMTS7 level was one of the vascular calcification risk factors in MHD patients. Conclusion Plasma metalloproteinase ADAMTS7 level is probably a risk factor of vascular calcification in MHD patients. Metrics

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Maintaining serum phosphorus in the target range and its correlation with carotid atherosclerosis in maintenance hemodialysis patients with hyperphosphatemia 2015, 14 (08):  469-473.  doi: 10.3969/j.issn.1671-4091.2015.08.007 Abstract ( 228 )   HTML ( 0 )   PDF (387KB) ( 299 )   【Abstract】Objective To investigate the achievement of serum phosphorus in the target range, and its correlation with carotid atherosclerosis (AS) in maintenance hemodialysis (MHD) patients with hyperphosphatemia and treated with phosphate binders. Methods We recruited 80 patients subjected to MHD for at least 3 months and with serum phosphorus >1.78 mmol/L. They were given one of the three phosphate binders for 2 years. Phosphate binder and its doses were adjusted to obtain serum phosphorus in target range. Serum phosphorus, calcium and intact parathyroid hormone (iPTH) were assayed every 6 months during the treatment period. Carotid ultrasonography was performed to detect AS. After the therapy for 2 years, the patients were divided into high serum phosphorus group (≥1.78 mmol/L, n=50) and normal serum phosphorus group (＜1.78 mmol/L, n=30). Results After the treatment for 6 months, serum phosphorus and iPTH decreased significantly and serum calcium increased significantly in all patients as compared with these parameters before treatment (P＜0.05 or ＜0.01). Serum phosphorus and iPTH decreased gradually with the duration of phosphate binder therapy. Serum phosphorus and iPTH, carotid intimal medial thickness (IMT), and the prevalence of AS were lower in normal serum phosphorus group than in high serum phosphorus group (P＜0.05 or ＜0.01). Serum phosphorus was positively correlated with the levels iPTH and IMT and the prevalence of AS in all MHD patients with hyperphosphatemia (P＜0.05 or ＜0.01). A negative correlation was found between serum levels of phosphorus and calcium (P＜0.05). Conclusion Hyperphosphatemia is a significant and independent risk factor of the advanced arteriosclerosis in MHD patients. Maintaining serum phosphorus concentration in the target range is effective to decrease the prevalence of AS in MHD patients. Metrics

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Correlation between morning hypertension and cardiovascular and cerebrovascular events in maintenance hemodialysis patients 2015, 14 (08):  474-477.  doi: 10.3969/j.issn.1671-4091.2015.08.008 Abstract ( 207 )   HTML ( 0 )   PDF (381KB) ( 452 )   【Abstract】Objective To investigate the correlation between morning hypertension (MH) and cardiovascular and cerebrovascular events in maintenance hemodialysis (MHD) patients. Methods Ambulatory blood pressure monitoring was done in 174 MHD patients with hypertension. They were classified as MH group (n= 104) and non-MH group (n=70) based on the morning blood pressure. MH group was further classified into 3 types: sustained type, non-sustained type, and surge type. They were followed up for 2 years, and cardiovascular and cerebrovascular events were recorded. General information, mortality and the incidence of cardiovascular and cerebrovascular events were compared between the two groups. Results Compared to non-MH group, weight gain in dialysis interval, the incidence of sleep disorders, morning systolic blood pressure (MSBP), the incidence of cardiovascular and cerebrovascular events (67.3% vs. 40%) and mortality (13.5% vs. 2.9%) were significantly increased (P＜0.05) but spKt/V was significantly decreased (t =10.743, P＜0.01) in MH group. The incidence of cardiovascular and cerebrovascular events was significantly higher in sustained type (75.4%) than in surge type (66.7%) and non-sustained type (40%) (c2= 8.815, P＜0.05), but the mortality was indifferent among the 3 types in MH group (c2=0.798, P＞0.05). The value of MSBP was positively correlated with the incidence of cardiovascular and cerebrovascular events in MH group (r=0.700, P＜0.01). Conclusion MH closely correlates with the incidence of cardiovascular and cerebrovascular events in MHD patients with hypertension. MH may be an independent risk factor of cardiovascular and cerebrovaseuar events. Metrics

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The present status and the related factors of abnormal calcium- phosphorous metabolism in maintenance hemodialysis patients 2015, 14 (08):  478-481.  doi: 10.3969/j.issn.1671-4091.2015.08.009 Abstract ( 270 )   HTML ( 0 )   PDF (360KB) ( 368 )   【Abstract】Objective To investigate the current situation and the related factors of abnormal calciumphosphorous metabolism in maintenance hemodialysis (MHD) patients. Methods A total of 127 MHD patients in our hemodialysis center during the period of June to July 2013 were included in this study. Their demographic data and knowledge about calcium-phosphate metabolism were investigated by questionnaire. Laboratory examination results of the patients were collected from the hospital information system. Results In the 127 patients, the rate of serum phosphate in the target range was 33.1%, much lower than that of DOPPS4; the rate of serum calcium in the target range was 43.3%; the prevalence of hypocalcemia was 20.5%, higher than that of DOPPS4. The rate of iPTH in the target range was nearly the same as that of DOPPS4, but with higher rate of reduced iPTH (47.2%) and lower rate of elevated iPTH (18.1%) compared to those of DOPPS4. Only 6 patients(4.7%)reached the three target ranges of serum phosphate, calcium and iPTH. The score of calciumphosphorous metabolism knowledge was relatively low in these patients (37.19 ± 17.00). Seventythree patients (57.5%) had a habit of eating high phosphorus food; only 21 patients (16.5%) followed the suggestions from medical staffs to have appropriate food. Twenty-three patients (19.1%) took phosphate binder improperly, and 79 patients (62.2%) said that they sometimes forgot taking phosphate binders. Logistic regression analyses demonstrated that the influencing factors of hyperphosphatemia were predialysis serum BUN, dialysis duration, age, and body mass index (BMI). Conclusion The prevalence of abnormal calciumphos-phorous metabolism was high in MHD patients. Many factors may influence this abnormality. Comprehensive interventions involving dialysis, drugs and diet management need to be implemented for MHD patients with abnormal calcium-phosphorous metabolism. Metrics

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The value of neutrophil and lymphocyte ratio in the evaluation of inflammation status in patients with chronic kidney disease 2015, 14 (08):  482-485.  doi: 10.3969/j.issn.1671-4091.2015.08.010 Abstract ( 273 )   HTML ( 2 )   PDF (466KB) ( 408 )   【Abstract】Objective To investigate the relationship between neutrophil / lymphocyte ratio (NLR) and inflammation in patients with chronic kidney disease (CKD) in order to provide a simple method to evaluate inflammation status in CKD patients. Methods Sixty-four CKD patients (at stage 3-5) before dialysis and 72 CKD patients on maintenance hemodialysis (MHD) with stable clinical conditions treated in Bejing Tongren Hospital were recruited for this study. Twenty-two healthy individuals were used as the controls. Statistical differences of laboratory parameters among the 3 groups were compared using one-way ANOVA. The predialysis CKD patients and MHD patients were further divided into 2 groups according to the median value of NLR. hsCRP, ALB and other laboratory parameters were compared between the 2 groups using Student’s ttest. The relationship between NLR and other parameters was assessed using Spearman correlation. Results Lymphocyte count, NLR and hsCRP were 1.76±0.61×109/L, 2.78±1.75 and 4.95±5.31 mg/L, respectively, in predialysis patients, and were 1.53±0.48×109/L, 3.73±1.75 and 12.02±9.84 mg/L, respectively, in MHD patients; the three values were significantly higher in pre- dialysis patients and MHD patients than in controls, and the values of NLR and hsCRP were significantly higher in MHD patients than in pre-dialysis patients (P＜ 0.05). ALB was 29.91± 6.83 g/L in pre-dialysis patients, and was 35.39±5.61g/L in MHD patients, significantly lower in pre-dialysis patients and MHD patients than in controls (P＜0.05). In predialysis patients, laboratory parameters had no differences between patients with NLR ≥2.25 and those with NLR ＜2.25. In MHD patients, ALB and triglyceride were 33.65 ± 4.69 g/L and 1.43 ± 0.53 mmol/L, respectively, in patients with NLR ≥3.5, significantly lower than those in patients with NLR ＜3.5 (P＜0.05); hsCRP was 19.81±14.80 mg/L in patients with NLR≥3.5, significantly higher than that in patients with NLR＜3.5 (P＜0.05). NLR was negatively correlated with ALB (r=-0.294, P=0.014) and positively correlated with hsCRP (r=0.317, P =0.008) in MHD patients but not in pre-dialysis patients. Conclusion NLR may be used as a marker of systemic inflammation in MHD patients. Metrics

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The initiation time of continuous renal replacement therapy for severe acute pancreatitis patients complicatedwith acute kidney injury 2015, 14 (08):  486-489.  doi: 10.3969/j.issn.1671-4091.2015.08.011 Abstract ( 189 )   HTML ( 0 )   PDF (373KB) ( 414 )   【Abstract】Objective To explore the initiation time of continuous renal replacement therapy (CRRT) for severe acute pancreatitis (SAP) patients complicated with acute kidney injury (AKI). Methods SAP patients with AKI admitted to West China Hospital of Sichuan University and received CRRT during the period from Jan. 2010 to Dec. 2013 were retrospectively analyzed. They were divided into early CRRT group (initiated at AKI stage 1 or 2) and late CRRT group (initiated at AKI stage 3). Demographic information and clinical data at the initiation of CRRT, and prognosis including the 60～day-ICU mortality and the retained days in ICU were compared between the two groups. Results A total of 84 patients were analyzed, 30 patients in the early CRRT group and 57 patients in the late CRRT group. The 60-day-ICU mortality was 30% (9/27) in the early CRRT group and was 59.3% (32/57) in the late CRRT group (c2=6.608, P=0.010). The retained days in ICU was shorter in the early CRRT group than in the late CRRT group (HR=0.392, 95% CI: 0.169～0.776; P=0.009). Conclusion CRRT performed at the early stage (at AKI stage 1 or 2) may be optimal for the treatment of SAP patients complicated with AKI. Metrics

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Study on prognosis of refractory heart failure patients treated with blood purification therapy 2015, 14 (08):  490-494.  doi: 10.3969/j.issn.1671-4091.2015.08.012 Abstract ( 223 )   HTML ( 0 )   PDF (499KB) ( 205 )   【Abstract】Objective To study the effect of blood purification therapy on the prognosis of patients with refractory heart failure. Methods Forty refractory heart failure patients treated in Xinjiang Shihezi People's Hospital during the period from March 2013 to February 2015 were enrolled and assigned into blood purification combined with conventional medical treatment (experimental group, n=20) or conventional medical treatment (control group, n=20) according to patients’preferences. Blood urea nitrogen (BUN), serum creatinine (Scr), NT-proBNP (amino-terminal pro-B-type natriuretic peptide), and LVEF (left ventricular ejection fraction) were determined before and after the treatment. Readmission rate and survival status were also recorded. Results After the treatment for 48 hours, BUN and Scr in the experimental group decreased as compared with those at the initial period (P＜0.01); BUN and Scr in the control group increased as compared with those at the initial period (P＜0.05) and those in the experimental group (P＜0.05). The increase of LVEF was observed in both group (P＜0.01), but the rate of increase was more in the experimental group than in the control group (P＜0.001). NT-proBNP decreased in both groups as compared with that before the treatment (P＜ 0.001), but the rate of decline was more in the experimental group than in the control group (P＜0.001). In the follow-up period of 90 days, readmission rate and the number of readmission were lower (P＜0.05), and the period between discharge from the hospital and the first readmission was longer (P＜0.05) in the experimental group as compared with those in the control group. At the end of follow-up period (May 1, 2015), the median survival time was 171.5 days in the experimental group and was 102.5 days in the control group. Kaplan-Meier survival curve and Log-rank test demonstrated that patients in the experimental group had survival advantage (P=0.031). Univariate Cox regression analysis showed that blood purification therapy reduced the risk of death (HR=0.396, 95% CI 0.166～0.946, P=0.031). Conclusion Blood purification therapy decreased the readmission rate and improved survival status in patients with refractory heart failure. Metrics

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The effect of optimization specific to nursing practice on artificial vascular graft fistula and Self –efficacy of maintenance hemodialysis patients 2015, 14 (08):  499-502.  doi: 10.3969/j.issn.1671-4091.2015.08.014 Abstract ( 212 )   HTML ( 5 )   PDF (418KB) ( 287 )   【Abstract】Objective To evaluate the effect of optimization specific to nursing practice on the artificial vascular graft fistula and Self -efficacy of maintenance hemodialysis patients Methods Forty maintenance hemodialysis patients with artificial vascular graft fistula was randomly divided into the control group and the intervention group (n=20, respectively). Patients in the control group received conventional methods of nursing, and patients the intervention group received individualized psychological caring after careful routine nursing and psychological asessment. Then the proportion of fistula obstruction, the incidence of fistula– relevant complication, and the score of Self Efficacy Scale were evaluated. Results 1 year after optimization specific to nursing practice, compared with the control group, the proportion of fistula obstruction, the incidence of fistula-relevant complication in the intervention group were much lower (χ2=4.250, P＜0.05), while the score of Self Efficacy Scale was higher (χ2=8.095, P＜0.05). Conclusion Optimization specific to nursing practice could prolong the life of the artificial vascular graft fistula of maintenance hemodialysis patients hence ensure the hemodialysis sufficiency, and improve the patients’consciousness of self efficacy and the confidence to handle difficulty. Metrics

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Bibliometrics analysis of peritoneal dialysis nursing literature in the period of 1976- 2013 in China 2015, 14 (08):  503-505.  doi: 10.3969/j.issn.1671-4091.2015.08.015 Abstract ( 184 )   HTML ( 0 )   PDF (381KB) ( 218 )   【Abstract】Objective To analyze the literature about the research situation and developmental trend of peritoneal dialysis (PD) nursing in China and to provide information for further PD nursing research. Methods Using bilbiometric method and NoteExpress2 software, we searched China National Knowledge Infrastructure (CNKI) database and WanFang database for PD nursing related publications from 1976 to 2013 in China. Results A total of 1285 publications published in 276 journals have been searched out. The number of articles increased every year, and 648 (50.4%) articles have been published in recent 5 years. These articles mainly focused on peritonitis, complications, health education, Quality of life, and PD management. Thirtyeight articles were cited over 10 times, and one article was cited for 94 times. Thirty-five (1.2%) articles were funded by grants. Conclusion PD nursing related articles have been increasing yearly, and the research about this area has been growing. However, the research needs to be deepened and the quality needs to be improved. Metrics