Chinese Journal of Blood Purification

12 September 2015, Volume 14 Issue 09 Previous Issue    Next Issue

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Automated peritoneal dialysis for peritoneal dialysis patients in the postoperative period of hernioplasty for abdominal wall hernia 2015, 14 (09):  521-524.  doi: 10.3969/j.issn.1671-4091.2015.09.004 Abstract ( 217 )   HTML ( 0 )   PDF (391KB) ( 235 )   【Abstract】Objective To investigate automated peritoneal dialysis (APD) for peritoneal dialysis (PD) patients in the postoperative period of hernioplasty for abdominal wall hernia. Methods We recruited PD patients treated with APD in the postoperative period of hernioplasty for abdominal wall hernia from June 2006 to January 2013 in Ren Ji Hospital affiliated to Shanghai Jiao Tong University School of Medicine. PDrelated complications, cases transferred to hemodialysis, and mortality within one month, 6 months and 12 months after operation were observed. Results In the 511 PD patients in our center, 20 patients were treated with APD in the postoperative period of hernioplasty for inguinal (n=15), umbilical (n=3) or incision hernia (n=2). None of the patients were found to have wound infection, hernia recurrence, leakage, catheter-related complications, or peritonitis within one month after operation. Peritonitis occurred in one patient after the operation for 6 months and in 4 patients after the operation for 12 months; they recovered completely after antibiotics treatment. None of the patients were changed to hemodialysis. Conclusions Postoperative dialysis with APD can be applied to PD patients after hernioplasty. Metrics

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Clinical study of the relationship between serum soluble Klotho protein and the abnormalities of mineral-bone metabolism and abdominal aortic calcification in peritoneal dialysis patients 2015, 14 (09):  525-529.  doi: 10.3969/j.issn.1671-4091.2015.09.005 Abstract ( 193 )   HTML ( 0 )   PDF (772KB) ( 460 )   【Abstract】Objective To assess the relationship between serum soluble Klotho protein (sKL) and the abnormalities of mineral-bone metabolism and abdominal aortic calcification in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods Fifty eight CAPD patients were prospectively studied. Their clinical data and biochemical indicators including serum calcium, phosphorus, intact parathyroid hormone (iPTH), and 25-hydroxy vitamin D were analyzed. Serum sKL, fibroblast growth factor 23 (FGF23), and bone-specific alkaline phosphatase (BAP) were detected by ELISA. The diagnosis of abdominal aortic calcification was based on the images on abdomen lateral X-ray plain film, from which the abdominal aortic calcification score (AAC) was calculated. Linear correlation was used to analyze the relationship between sKL and biochemical indicators and AAC. Logistic regression analysis was performed to determine the risk factors for abdominal aortic calcification in CAPD patients. The receiver operating characteristic (ROC) curve was applied to evaluate the diagnostic value of sKL for abdominal aortic calcification. Results Fifty patients (86.2%) had abdominal aortic calcification, and serum sKL was 157.87±33.49 pg/mL. Serum sKL concentration was negatively correlated with AAC, phosphorus, and FGF23 (r=-0.73, P＜0.05; r=-0.26, P＜0.05; r=-0.33, P＜0.05; respectively), positively correlated with 25- hydroxy vitamin D (r=0.48, P＜0.05), but not correlated withBAP, iPTH, and corrected serum calcium (r=-0.17, P=0.21; r=-0.23, P=0.09; r=-0.04, P=0.75; respectively). Multivariate logistic regression analysis showed that lower serum sKL level and FGF23 were the independent risk factors for abdominal aortic calcification. ROC analyses for serum sKL in the diagnosis of abdominal aortic calcification showed that the sensitivity and specificity was 87.5% and 58.0%, respectively, when serum sKL was set at 153.78 pg/ml (AUC=0.91). Conclusions In CAPD patients, serum sKL was correlated with mineral-bone metabolism, and the lower serum sKL was associated with risk of abdominal aorta calcification. Serum sKL may have diagnostic value for abdominal aorta calcification in CAPD patients. Metrics

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The association between serum iPTH and left ventricular hypertrophy in peritoneal dialysis patients 2015, 14 (09):  530-534.  doi: 10.3969/j.issn.1671-4091.2015.09.006 Abstract ( 254 )   HTML ( 0 )   PDF (398KB) ( 436 )   【Abstract】Objective To study the association between serum iPTH and left ventricular hypertrophy (LVH) and to explore the incidence and related factors of LVH in peritoneal dialysis (PD) patients in a single dialysis center. Methods Clinical data of the 122 PD patients admitted to Shenzheng Second People’s Hospital during the period from Jan. 2006 to Aug. 2013 were recruited and retrospectively analyzed. Subjects were divided into three groups, group A (iPTH＜150 pg/ml, n=36), group B (iPTH 150～300 pg/ml, n=36), and group C (iPTH＞300 pg/ml, n=50). Correlation analysis was conducted between serum iPTH and the echocardiographic indicators of EF, IVST, and LVMI. Regression analysis was used to determine the relationship between LVH and the parameters of gender, age, hypertension, diabetes, serum iPTH, CRP, uric acid, BNP and homocysteine, Kt/V, and PD duration. Results LVH was found in 74 (60.7%) cases including 41 males (55.4%) and 33 females (44.6%). In the 74 LVH patients, 38 patients (51.4%) were >60 years old and 36 patients (48.6%) were <60 years old. The average age was 56.20±14.57 years old in LVH patients and was 54.17±15.21 years old in patients without LVH (t = 2.452; P = 0.230). Serum iPTH correlated negatively with EF (P = 0.004) and positively with IVST (P = 0.001) and LVMI (P = 0.020). Multivariate logistic regression analysis showed that hypertension (P=0.013), diabetes (P=0.015), and iPTH (P=0.035) were the independent risk factors for LVH in PD patients. Conclusion The incidence of LVH in this series of PD patients was 60.7%. Higher serum iPTH contributed to cardiovascular complications in PD patients. Metrics

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Serum vitamin D level is correlated to muscle strength in peritoneal dialysis patients 2015, 14 (09):  535-539.  doi: 10.3969/j.issn.1671-4091.2015.09.007 Abstract ( 364 )   HTML ( 0 )   PDF (432KB) ( 206 )   【Abstract】Objective To investigate the relationship between serum 25(OH)D level and muscle strength in peritoneal dialysis (PD) patients. Method This cross-sectional study included 206 PD patients treated in our nephrology center. Serum 25(OH)D was measured by enzyme- linked immunosorbent assay. Handgrip strength was measured by using an adjustable handheld dynamometer for dominant arm. Demographic data, comorbidity and other clinical variables were also collected. Result The mean age of this cohort was 56.3± 12.5 years. The median of dialysis duration was 33.17 (9～52.3) months. Diabetes and cardiovascular disease was present in 33% and 46.1% of the patients, respectively. The median concentration of serum 25(OH)D was 17.2 (12.8～23.9) nmol/L. Serum 25(OH)D level was positively correlated with handgrip strength after adjustment for demographic data, comorbidity and clinical variables. Patients with middle or higher serum 25(OH) D level were predicted to have higher handgrip strength. Conclusion Serum vitamin D level was positively associated with muscle strength in PD patients. Metrics

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Comparative efficacy and safety of different paricalcitol regimens on secondary hyperparathyroidism in hemodialysis patients: a retrospective study 2015, 14 (09):  540-544.  doi: 10.3969/j.issn.1671-4091.2015.09.008 Abstract ( 358 )   HTML ( 2 )   PDF (733KB) ( 470 )   【Abstract】Objective The objective of this study was to examine efficacy and safety of two dosing regimens of selective vitamin D receptor activator paricalcitol for the treatment of secondary hyperparathyroidism (SHPT) in maintenance hemodialysis (MHD) patients. Methods This retrospective study recruited 32 MHD patients with SHPT. Patients were randomized to two treatment arms by initial dose of paricalcitol package insert (PI): US group (initial dose 0.04 μg/kg) and EU group (initial dose iPTH (pg/mL)/80μg). After a wash out period of 2- 4 weeks, they received initial dose of US or EU regimen three times weekly for 12 weeks and one month follow-up after drug withdrawal. The dose of paricalcitol was adjusted biweekly according to serum iPTH, calcium (Ca) and phosphorus (P) levels in the monitoring weeks. The efficacy and safety of paricalcitol were evaluated between the two groups by comparison of the primary endpoint (iPTH reduced by ≥ 30% of baseline in two consecutive assays) and the tendency to adverse effects including hypercalcemia, hyperphosphatemia, elevated Ca-P product, hypoparathyroidism and drug suspension. Results The effective rate was similar (88.2% vs. 73.3%, P＞0.05), and no inferiority was demonstrated between the two groups. In the prior 6 weeks in EU group with relatively higher initial dose of paricalcitol, patients were more likely to have adverse events and withdrawal due to adverse events than the patients in US group; hypercalcemia was 47.1% and 42.2% (P＜0.05), elevated Ca-P product was 58.5% and 37.8% (P＜0.05), in EU group and US group, respectively. In the posterior 6 weeks in US group with increasing cumulative dose of paricalcitol, patients were more likely to have adverse events and withdrawal due to adverse events than the patients in EU group; hypercalcemia was 44.4% and 27.5% (P＜0.05), elevated Ca-P product was 60.0% and 35.3% (P＜ 0.05), in US group and EU group, respectively. Conclusions Both EU and US PI paricalcitol dosing strategies effectively reduced iPTH level in Chinese subjects with SHPT with minimal impact on serum Ca and P levels, but patients with higher dose of paricalcitol had increased possibility of dose adjustment and drug withdrawal due to adverse events including hypercalcemia, hyperphosphatemia, elevated Ca-P product and hypoparathyroidism. To get the best clinical benefits of paricalcitol, different initial dose and personalized regimen are required. Metrics

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The significance of artery tree images in different regions on plain X-ray films to evaluate vascular calcification in hemodialysis patients 2015, 14 (09):  545-549.  doi: 10.3969/j.issn.1671-4091.2015.09.009 Abstract ( 368 )   HTML ( 0 )   PDF (334KB) ( 163 )   【Abstract】Objective To investigate the significance of artery tree images in different regions on plain X-ray films to evaluate vascular calcification in maintenance hemodialysis patients. Methods Eighty-two patients were enrolled in this cross- sectional study. Their demographic and clinical data were collected and biochemical parameters relating to vascular calcification were examined. We used plain X-ray films of postanterior chest, pelvis and hands to determine the vascular calcification of aortic arch, medial and radial arteries. We then compared these indicators in patients with various types of artery calcification and those without vascular calcification, analyzed the risk factors for various types of vascular calcification, and evaluated the significance of calcification in different arteries on vascular calcification and diagnosis of cardiovascular complications. Results The prevalence of arterial calcification was 64.6% (53/82), 48.8% (40/82) and 26.8% (22/82) in aortic arch, medial artery and radial artery, respectively. Regression analysis showed that age was the risk factor for aortic arch calcification, dialysis duration and diabetes history were the risk factors for medial and radial artery calcification, and medial and radial artery calcification were the risk factors for cardiovascular disease (OR=9.580, P=0.001 for medial artery calcification; OR=3.104, P=0.044 for radial artery calcification). The total calcification score was 4, 6 and 8 for aortic arch, medial artery and radial artery (P=0.006), respectively. The overall vascular calcification was higher in patients with radial artery calcification. ROC curve analysis found that the total calcification score for medial arteries was useful for the diagnosis of cardiovascular complications (AUC=0.720, P=0.006). Conclusion The incidence of aortic arch calcification was the highest in various types of arterial calcification in hemodialysis patients. The overall calcification was higher in patients with radial artery calcification than in those with aortic arch or medial artery calcification. Dialysis duration was the risk factor for medial artery calcification and radial artery calcification. The total calcification score for medial arteries was useful to predict cardiovascular complications. Metrics

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Effect of oral nutrition supplement on nutritional status in maintenance hemodialysis patients with protein-energy wasting 2015, 14 (09):  550-553.  doi: 10.3969/j.issn.1671-4091.2015.09.010 Abstract ( 283 )   HTML ( 0 )   PDF (382KB) ( 324 )   【Abstract】Objective To study the effect of oral nutrition supplement on nutritional status in maintenance hemodialysis (MHD) patients with protein-energy wasting (PEW). Method We investigated the prevalence of PEW by the 7-point subjective global assessment (SGA) in 192 MHD patients treated in the Blood Purification Center of Guangzhou Red Cross Hospital in the duration from Jan. 2013 to Dec. 2014. Sixty-two MHD patients with PEW were randomly divided into control group (n=31) or oral nutrition supplement group (ONS, n=31). Changes of SGA score and nutritional status markers after intervention were compared between the two groups. Result The prevalence of PEW was 39.1% (75/192) in our center. After intervention in ONS group, serum albumin (37.19±1.54 vs. 35.18±5.11 g/L), prealbumin (305.74±43.20 vs. 275.68±65.23 mg/ L), and transferrin (1.43±0.25 vs. 1.28±0.25 g/L) increased significantly (P＜0.05) as compared with those in control group. SGA score, body weight, body mass index, upper arm circumference, and arm muscle circumference increased and C reactive protein level decreased in ONS group but without statistical significance (P＞ 0.05). Triceps skinfold thickness, total serum triglyceride and cholesterol levels were indifferent between the two groups (P＞0.05). Conclusion The prevalence of PEW was higher in MHD patients. Oral nutrition supplement can improve the nutritional status in MHD patients with PEW. Metrics

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The clinical characteristics and the gene polymorphisms of the receptor for advanced glycation end product in patients with intrinsically high peritoneal transport rate 2015, 14 (09):  554-557.  doi: 10.3969/j.issn.1671-4091.2015.09.011 Abstract ( 225 )   HTML ( 0 )   PDF (403KB) ( 196 )   【Abstract】Objective To investigate the clinical characteristics and single nucleotide polymorphisms of the receptor for advanced glycation end product (RAGE) in peritoneal dialysis (PD) patients with intrinsically high peritoneal transport rate in the peritoneum. Methods During the period from January 2011 to June 2014, 194 newly started PD patients were included in this study. Patients were divided into four groups: low (L), low average (LA), high average (HA), and high (H) peritoneal transport rate groups, according to their categories of peritoneal transport rate defined by the result of peritoneal equilibration test (PET) at 8-12 weeks after PD. The clinical data and RAGE genotypes were compared across the groups. Multiple logistic regression analysis (backward stepwise) was used to determine the independent factors associated with high peritoneal transport rate. Results Significant difference in gender, history of cardiovascular complications, and serum C-reaction protein level were found among the groups (P＜0.05). Among the four most common polymorphisms in RAGE gene, only -374T/A polymorphism was found to be associated with the peritoneal transport status. RAGE -374TA/AA genotype had a significantly lower prevalence in patients with H/HA transport status than did -374T/T genotype (P＜0.05). Logistic regression analysis showed that the history of cardiovascular complications, serum C-reaction protein level, and RAGE -374T/A polymorphism were the independent risk factors for high peritoneal transport rate (P＜0.05). Conclusion The history of cardiovascular complications, higher serum C-reaction protein level, and RAGE -374T/A polymorphism may be useful markers in predicting the high peritoneal transport rate before PD. Metrics

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Critically ill cirrhotic patients with renal insufficiency 2015, 14 (09):  558-561.  doi: 10.3969/j.issn.1671-4091.2015.09.012 Abstract ( 266 )   HTML ( 0 )   PDF (477KB) ( 206 )   【Abstract】Cirrhotic patients admitted to intensive care units (ICUs) have high mortality rates. Due to the characteristics of liver cirrhosis, cirrhotic patients frequently have multi-organ dysfunctions including hepatic encephalopathy, hepato- renal syndrome, hepato- pulmonary syndrome, etc. The prognosis is even worse in ICU cirrhotic patients with extra- hepatic organ system failure or dysfunction. Moreover, renal insufficiency which is widely discussed is a common complication of cirrhosis. According to literature reviews, the incidence of acute kidney injury (AKI) is up to 40-60% in ICU cirrhotic patients. The occurrence of AKI represents poor prognosis and increased mortality rate. Therefore, we can use the severity of the renal function impairment as the outcome predictor among these patients. Metrics

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The clinical value of regular endotoxin detection to decrease risk of hemodialysis treatment 2015, 14 (09):  569-571.  doi: 10.3969/j.issn.1671-4091.2015.09.015 Abstract ( 479 )   HTML ( 0 )   PDF (355KB) ( 233 )   【Abstract】Objective To establish system of regular water of hemodialysis and detecting toxin in dialysate,and to probe into the reasonable limiting range of water of hemodialysis and detecting toxin in dialysate, in purpose of decreasing the risk of hemodialysis treating. Methods According to Bacterial endotoxin photometricdetection method which is included in Chinese Pharmacopoeia(Ch.p) 2010 second edition, experimenting by adopting ATI dynamic test tube apparatus to quantitive determinate reverse osmosis(RO) and volumeof toxin in dialysate(reference to ISOStandard). Results after scrutiny for fifteen hospital in total, it is found that toxin in dialysate of above including fourteen hospital is Below 0.25EU/ml, qualified rate reach93.3 percent, and eight hospital is below 0.50 EU/ml, qualified rate reach53.3 percent. after rectification，rate of RO and dialysate reach 100 percent. Conclusions As a result of strengthening persistent quality control in each progress for hemodialysis, taking intervention timely,and improving quality of hemodialysis, to decrease treating risk of hemodialysis is wholly possible and feasible. Metrics