Chinese Journal of Blood Purification

12 October 2015, Volume 14 Issue 10 Previous Issue    Next Issue

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Paraquat Intoxication and Treatment: A Literature Review 2015, 14 (10):  583-586.  doi: 10.3969/j.issn.1671-4091.2015.10.003 Abstract ( 427 )   HTML ( 1 )   PDF (393KB) ( 268 )   【Abstract】The incidence of paraquat intoxication in Taiwan is unknown; however it is not uncommon in a clinical setting. The high mortality rate of paraquat intoxication results from its high acute toxicity, low lethal dose, and lack of effective therapies. After ingestion, absorption of paraquat is rapid. Once paraquat invades cells, it activates reactive oxygen species, and then causes lipid peroxidation, activation of NF-kB, mitochondrial damage and apoptosis, finally leading to multiorgan damage. The clinical manifestations of paraquat intoxication depend upon the dose of ingestion. Plasma concentration of paraquat, urine dithionite test and clinical presentation are good predictors of outcome. Medical management includes supportive treatment and gastrointestinal decontamination with active charcoal. Hemodialysis and hemoperfusion can enhance elimination of paraquat; however, the benefit is limited except for early initiation after ingestion. Several new therapies have been proposed, including immunosuppression with glucocorticoids and cyclophosphamide. Antioxidants such as acetylcysteine and salicylate might be effective because of free radical scavenging, anti-inflammatory action and NF-kB inhibition. This review provides the mechanisms, clinical features, diagnosis and latest medical progress in the treatment of paraquat intoxication. Metrics

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The effect of compound α- ketoacids on the nutritional status and metabolism of dialysis patients 2015, 14 (10):  587-590.  doi: 10.3969/j.issn.1671-4091.2015.10.004 Abstract ( 365 )   HTML ( 2 )   PDF (443KB) ( 317 )   【Abstract】Objective This study aimed to explore the effect of compound α-ketoacids on the dialysis patients with malnutrition assessed by Mini Nutritional Assessment - short form (MNA-SF). Methods We investigated 2,252 patients who suffered from end-stage renal disease (ESRD) in the dialysis centers of 150 hospitals. These patients were treated with hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) for more than 3 months and compound α-ketoacids tablets orally for 6 months. The nutrition status before taking compound α-ketoacids tablets was used as control group. MNA-SF method combined with objective indexes including body mass index (BMI), triceps skinfold (TSF), mid-arm circumference (AMC), serum albumin (ALB) were used for monitoring nutrition status. Frideman test and paired rank test were used for statistical analyses. Results After 6 months of oral compound α-ketoacids treatment, MNA-SF score increased from 11.13±2.35 to 12.44±1.58 (P＜0.001), and the number of malnutrition and risk of malnutrition cases decreased from 181 patients (8.04%) and 952 cases (42.27%) to 33 patients (1.48%) and 474 cases (21.24%), respectively. BMI rose from 21.86±3.38 kg/m2 to 22.18±3.32 kg/m2 and serum ALB from 35.93± 5.31 g/L to 38.27±5.04 g/L, with statistical differences. TSF, AMC and lymphocyte count also increased obviously. Conclusion Compound α- ketoacids supplement could increase serum ALB and BMI and improve malnutrition status in dialysis patients. Metrics

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Application of the double plasma molecular absorption system for the multiple organ failure patients due to bee stings injury 2015, 14 (10):  591-595.  doi: 10.3969/j.issn.1671-4091.2015.10.005 Abstract ( 299 )   HTML ( 0 )   PDF (431KB) ( 311 )   Objective To investigate the prognosis of patients with bee stings induced multiple organ failure (MOF) and treated with double plasma molecular absorption system (DPMAs). Methods A total of 58 cases of patients with bee stings injury and MOF were retrospectively analyzed. They were treated with blood purification and divided into three groups: DPMAs and continuous veno- venous hemofiltration (CVVH) (DPMAs-CVVH) group (n=20), hemoperfusion and CVVH (HP-CVVH) group (n=21), and plasma exchange and CVVH (PE-CVVH) group (n=17). Before treatment and after treatment for 3 days, serum myoglobin, creatinekinase, AST, total bilirubin, creatinine and procalcitonin were determined, and APACH II score and clinical conditions were evaluated. Results APACH II score and serum myoglobin, creatinekinase, AST, total bilirubin, creatinine and procalcitonin reduced significantly after the treatment in the three groups (P＜0.05). After the treatment for 3 days, myoglobin, creatinekinase, AST, total bilirubin, creatinine, procalcitonin and APACH II score decreased more in DPMAs-CVVH group than in HP-CVVH and PE-CVVH groups (P＜0.05). Additionally, clinical symptoms and patients’prognosis also improved more in DPMAs-CVVH group than in HP-CVVH and PE-CVVH groups (P＜0.05). Conclusions DPMAs can effectively prevent organ dysfunction and improve clinical symptoms and prognosis through clearance of the toxicants. Therefore, DPMAs-CVVH is an important measure in the comprehensive treatments for MOF patients due to bee stings. Metrics

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Bone mineral density and it’s correlation with clinical and laboratory factors in maintenance hemodialysis patients 2015, 14 (10):  596-599.  doi: 10.3969/j.issn.1671-4091.2015.10.006 Abstract ( 309 )   HTML ( 0 )   PDF (377KB) ( 314 )   Objective To observe bone mineral density (BMD) at different sites and its correlation with clinical and laboratory indices in maintenance hemodialysis (MHD) patients. Methods In this observational study, BMD at lumbar spine (L1-L4), femoral neck and radius were measured by dual energy X-ray absorptiometry (DEXA) in MHD patients. Clinical and laboratory indices including age, body mass index (BMI), dialysis duration, albumin, corrected calcium (corrected Ca), serum phosphorus (P), calcium phosphorus product (Ca×P), C reactive protein (CRP), intact parathyroid hormone (iPTH), and alkaline phosphatase (ALP) were investigated. Stepwise multiple linear regression analysis was used to identify risk factors for BMD. Results A total of 62 patients on MHD for 27.7+29.78 months (30 males and 32 females) were included in this study. The mean T-scores of lumbar spine, femoral neck and radius were -0.80 ±1.65, -1.12 ± 1.15, and -1.80 ± 2.06, respectively. T-score of radius was significantly lower than that of lumbar spine (P=0.011). The prevalence of osteoporosis was 14.5%, 16.1% and 38.7% and the prevalence of osteopenia was 35.5%, 35.5% and 19.4%, in lumbar spine, femoral neck and radius, respectively. Stepwise multiple linear regression analysis demonstrated that sex and BMI were the independent factors for lumbar spine T-score; sex, age and BMI were the independent factors for femoral neck T-score; and ALP was the independent factor for radius T-score. In patients with aortic calcification, lumber spine T-score had no correlation with radius T-score. Conclusion The incidence of osteoporosis is high in MHD patients. Lumbar spine and femoral neck BMD are correlated with patient’s sex, age and BMI, but radius BMD is predominantly correlated with the specific factors for CKD such as ALP. Aortic calcification may influence the measurement of lumbar BMD by DEXA. Metrics

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The relationship between plasma N-terminal pro-B-type natriuretic peptide and cardiovascular function in maintenance hemodialysis patients 2015, 14 (10):  600-603.  doi: 10.3969/j.issn.1671-4091.2015.10.00 Abstract ( 324 )   HTML ( 0 )   PDF (396KB) ( 348 )   Objective To investigate the relationship between N-terminal pro-B-type natriuretic peptide(NT- proBNP) and cardiovascular function in maintenance hemodialysis (MHD) patients. Methods Fortyone MHD patients were divided into 2 groups based on plasma NT-proBNP level before hemodialysis: low NT-proBNP group (NT-proBNP ＜7,000 pg/ml) and high NT-proBNP group (NT-proBNP >7,000 pg/ml). Clinical and biochemical indicators, echocardiography, and average blood pressure during hemodialysis were recorded. Results Plasma NT-proBNP level higher than normal was found in 93.8% MHD patients. NT-proBNP level correlated positively with left ventricular end diastolic diameter, left ventricular diameter, interventricular septal thickness, left ventricular posterior wall thickness, left ventricular mass index, and systolic blood pressure (P＜0.05), and negatively with left ventricular ejection fraction (P＜0.05). Left ventricular diameter (t=- 3.631), interventricular septal thickness (t=- 3.665), left ventricular posterior wall thickness (t=- 3.396), left ventricular mass index (t=- 3.396), pulse pressure (t=- 2.048), and systolic blood pressure (t=- 2.199) were significantly higher in the high NT-proBNP group than in the low NT-proBNP group (P＜0.05). When the cut-off value of plasma NT-proBNP was set at 7,000 pg/ml, the sensitivity and specificity for detecting left ventricular hypertrophy were 82.4% and 91.7%, respectively, and the AUC was 0.878 (P＜0.05). Conclusions plasma NT-proBNP is an important biomarker for the diagnosis of left ventricular hypertrophy and for the evaluation of left ventricular function and reconstruction in MHD patients. Left ventricular hypertrophy and reconstruction are prevalent in patients with NT-proBNP ＞7,000 pg/ml. The increase of plasma NT-proBNP is correlated with the degree of hypertension. Metrics

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The study of serum concentrations of free protein binding uremic toxins and their plasma protein binding rate 2015, 14 (10):  604-607.  doi: 10.3969/j.issn.1671-4091.2015.10.00 Abstract ( 171 )   HTML ( 0 )   PDF (520KB) ( 191 )   Objective To detect the serum levels of free protein binding uremic toxins including hippuric acid (HA), indoxyl sulfate (IS), p-cresyl sulfate (PCS), and 3-carboxy-4-methyl-5-propyl-2-furanpropionic acid (CMPF) in patients with chronic kidney disease (CKD) and to calculate their albumin binding rates in order to understand the relationship between the serum concentrations of free protein binding uremic toxins, the protein binding rate, and renal function change. Method Free and total concentrations of serum HA, IS, PCS, and CMPF were measured in 10 healthy volunteers and 40 CKD patients. CKD patients were divided into CKD 3rd stage group, CKD 4th stage group, CKD 5th stage group, and maintenance hemodialysis (MHD) group. Free HA, IS, PCS and CMPF in serum were separated by ultrafiltration and measured by high performance liquid chromatography tandem mass spectrometry (HPLC-MS/MS). Serum albumin binding rates were then calculated. Results The serum levels (μg/ml) of free HA, IS, PCS and CMPF were 2.13 (1.36～3.53), 0.11 (0.07～017), 0.43 (0.14～0.59), and 0.26 (0.24～0.28), respectively, in healthy controls, 2.88 (1.76～ 5.63), 0.23 (0.05～0.48), 0.96 (0.56～2.08), and 0.30 (0.25～0.31), respectively, in CKD 3rd stage group, 8.78 (3.32～17.88), 0.55 (0.26～0.91), 1.21 (0.53～4.33), and 0.32 (0.29～0.50), respectively, in CKD 4th stage group, 24.05 (3.56～62.55), 3.16 (0.96～8.10), 5.42 (0.62～12.83), and 0.28 (0.25～0.35), respectively, in CKD 5th stage group, and 101.95 (23.23～125.25), 6.29 (2.06～12.98), 7.53 (2.66～12.98), and 0.30 (0.28～0.33), respectively, in MHD group. The protein binding rate was >60% for HA, and >90% for IS, PCS and CMPF. Conclusion Serum levels of free HA, IS, and PCS elevated in late CKD stages, and their protein- binding rates reduced as well. However, the serum level of free CMPF and its protein- binding rate changed insignificantly. HA, IS, PCS and CMPF bind to serum albumin tightly. Metrics

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The effect of Sevelamer hydrochloride on hyperphosphatemia in chronic renal failure patients on maintenance hemodialysis 2015, 14 (10):  608-611.  doi: 10.3969/j.issn.1671-4091.2015.10.00 Abstract ( 530 )   HTML ( 0 )   PDF (363KB) ( 336 )   Objective The purpose of this study was to evaluate the efficacy and safety of Sevelamer hydrochloride in the treatment of maintenance hemodialysis (MHD) patients with hyperphosphatemia. Methods Twenty-four MHD patients treated in the Affiliated Hospital of Guangdong Medical College between July 2013 and July 2014 were enrolled in this study. They were randomly divided into 2 groups according to randomized list. The control group (n=12) received calcium carbonate, while the treatment group (n=12) received Sevelamer hydrochloride for 12 weeks. Efficacy of the treatment was evaluated by changes of serum phosphorus, calcium, calcium-phosphate product, and iPTH. Safety of the treatment was assessed by vital signs and laboratory examination results. Results Twenty-three of the 24 patients completed the study. After Sevelamer hydrochloride treatment for 4 weeks, 8 weeks and 12 weeks, serum phosphorus and calcium- phosphate product decreased significantly (for serum phosphorus, F=6.222 and P=0.001 in treatment group vs. F=3.821 and P =0.016 in control group; for calcium-phosphate product, F=6.222 and P=0.001 in treatment group vs. F= 2.944 and P=0.043 in control group). Serum calcium increased significantly in the control group (F=4.240, P= 0.008), but changed insignificantly in the treatment group (F=1.074, P=0.370). Serum iPTH level changed insignificantly in both groups (F=0.578 and P=0.633 in treatment group vs. F=0.538 and P=0.659 in control group). Vital signs and laboratory indexes had no significant changes in both groups (for ALB, F=0.108 and P=0.955 in treatment group vs. F=0.771 and P=0.517 in control group; for SCr, F=0.105 and P=0.957 in treatment group vs. F=1.111 and P=0.356 in control group; for BUN, F=0.123 and P=0.946 in treatment group vs. F=2.409 and P=0.073 in control group; for HGB, F=0.591 and P = 0.624 in treatment group vs. F=0.518 and P= 0.672 in control group). The common adverse reactions of Sevelamer were gastrointestinal symptoms such as constipation, ventosity and nausea. Conclusion Sevelamer hydrochloride can effectively reduce serum phosphorus and calcium-phosphorus product levels with higher safety. It is therefore worthwhile to be used clinically. Metrics

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The influence of mutagenesis lactobacilli on serum creatinine and urea nitrogen concentrations and renal pathology in renal failure rats Wang fangFang 2015, 14 (10):  612-616.  doi: 10.3969/j.issn.1671-4091.2015.10.00 Abstract ( 188 )   HTML ( 0 )   PDF (1068KB) ( 246 )   Objectives Using the 5/6 nephrectomy rat as an animal model, we explored the capacity of creatinine and urea nitrogen removal of mutagenesis lactobacilli via gastrointestinal tract and its effect on renal pathology. Methods Sixty SD rats were randomly divided into 4 groups: sham group, model group, lactobacilli (LB) group, and mutagenesis lactobacilli (mut-LB) group. Rats were undergone 5/6 nephrectomy except the rats in sham group. Eight weeks after the surgery, 24h-urine, orbital blood and digestive juice were collected to determine creatinine (Cr) and urea nitrogen (UN) concentrations. Pathological changes of nephridial tissue were examined by HE and Masson staining. The expressions of TGF-β1 and FN in nephridial tissue were detected by immunohistochemistry. Results In mut-LB group, urinary Cr and UN levels had no significant changes (P＞0.05), serum and digestive Cr and UN levels decreased significantly (P＜0.01), renal tubular injury and renal interstitial fibrosis reduced significantly, and TGF-β1 and FN expressions decreased (P＜ 0.05), as compared with those in sham group and LB group. Conclusion Mutagenesis lactobacilli can decrease serum Cr and UN levels, reduce the expressions of TGF-β1 and FN in renal tissue, and alleviate renal interstitial injury and fibrosis, probably through the decomposition of small molecules in the gastrointestinal tract. Metrics

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Hydrogen sulfide protects the high glucose induced injury through inhibition of autophagy in human peritoneal mesothelial cells 2015, 14 (10):  617-621.  Abstract ( 224 )   HTML ( 0 )   PDF (589KB) ( 293 )   Objective To investigate the protective effect and possible mechanism of hydrogen sulfide (H2S) on high glucose induced injury in human peritoneal mesothelial cell line HMrSV5 cells. Methods HMrSV5 cells were incubated in 4.25% D-glucose (high glucose) medium to induce the injury. The cells were then treated with a H2S donor sodium bisulfide (NaHS) (10-3 mol/L) for 24 h. Cell viability was measured by MTT assay. Lactate dehydrogenase (LDH) in cultured medium was determined by spectrophotometric method. The molecular markers of autophagy Beclin-1 and microtubule-associated protein light chain-3 (LC3) and the autophagy substrates p62/SQSTM1 were determined by western blot. Results Cell viability decreased significantly and LDH level in cultured medium increased significantly in high glucose group as compared with those in control group. Cell viability became increased significantly and LDH level in cultured medium became decreased significantly in NaHS (5×10- 4, 10- 3 and 5×10- 3 mol/L) groups as compared with those in high glucose group. The expressions of Beclin-1 and LC3 increased significantly and the expression of p62 decreased significantly in high glucose group as compared with those in control group. The expressions of Beclin- 1 and LC3 became significantly decreased and the expression of p62 became significantly increased in NaHS (5×10- 4, 10- 3 and 5×10- 3 mol/L) groups as compared with those in high glucose group. Conclusions H2S protects the high glucose induced injury through the inhibition of autophagy in human peritoneal mesothelial cell line HMrSV5 cells. Metrics

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The effect of anxiety and depression on quality of life in female patients with maintenance hemodialysis 2015, 14 (10):  622-625.  doi: 10.3969/j.issn.1671-4091.2015.10.00 Abstract ( 218 )   HTML ( 0 )   PDF (385KB) ( 327 )   Objective The maintenance hemodialysis (MHD) patients have a higher incidence of anxiety and depression, which are more severe in female patients and affect quality of life, dialysis, and prognosis of the disease. Here we explored the occurrence of anxiety and depression in female MHD patients and their effects on quality of life, in order to effectively prevent and treat anxiety and depression. Methods Self-rating anxiety scale (SAS), self-rating depression scale (SDS), and short form 36 questionnaire (SF-36) were applied to psychological analysis of anxiety, depression and quality of life in 134 female patients on MHD. Results The mean scores of SAS and SDS in female MHD patients were 43.45±9.23 and 48.34±11.65, respectively. The incidence was 13.43% for anxiety (SAS score ≥50) and was 23.88% for depression (SDS score ≥ 50), with the highest incidence in patients on MHD for 3～5 years. The scores of SF-36 were obviously lower in female MHD patients with anxiety than in those without anxiety (P＜0.05), except the social skills score of SF-36. Also, the scores of SF-36 were obviously lower in female MHD patients with depression than those without depression (P＜0.05), except the role and vitality scores of SF-36. Conclusion There is a higher prevalence of anxiety and depression symptoms in female MHD patients, especially those with longer MHD duration. The symptoms of anxiety and depression have negative impact on quality of life even leading to seriously adverse events. Therefore, it is necessary to prevent and manage anxiety and depression in female MHD patients to improve their quality of life. Metrics

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Epidemiological analysis of initial maintenance hemodialysis patients in Hainan province during 2010-2014 2015, 14 (10):  626-629.  doi: 10.3969/j.issn.1671-4091.2015.10.013 Abstract ( 280 )   HTML ( 0 )   PDF (742KB) ( 500 )   Objective To analyze the demographic trends and primary disease changes in initial maintenance hemodialysis (MHD) patients in Hainan Province. Methods We retrospectively reviewed all the initial MHD patients in Hainan province from January 2010 to December 2014 registered in the Chinese National Renal Data System. Their clinical data were collected from the Chinese National. Renal Data System. Results There are totally 2,607 patients (1,720 males and 887 females; males: females=1.9:1) during 2010-2014. The annual incidence in 2010, 2011, 2012, 2013 and 2014 was 44.2, 59.7, 61.7, 64.7 and 63.4/per million populations, respectively. The top primary disease for initial hemodialysis patients was glomerulonephritis, followed by diabetes, hypertension, obstructive nephropathy and polycystic kidney disease. The average age for initial MHD patients was increasing. Patients over 40 years of age accounted for 72.5% of the initial MHD patients. Cardiovascular, cerebrovascular and infected events were the leading causes of death. Conclusions In Hainan province, the number of initial hemodialysis patients rises annually, and there are more male patients. The average age for initial MHD patients is gradually increasing. Patients over 40 years of age account for the main body of new MHD patients. The leading primary diseases for initial hemodialysis patients are glomerulonephritis, diabetes, and hypertension, in which diabetes patients are increasing. Metrics

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Implementing hierarchical management approach to prevent from peritonitis 2015, 14 (10):  636-638.  doi: 10.3969/j.issn.1671-4091.2015.09.016 Abstract ( 177 )   HTML ( 2 )   PDF (595KB) ( 186 )   Objective To explore the hierarchical management approach (HMA) using for prevention from peritonitis among out patients with periloneal dialysis． Methods According to hierarchical management criteria, the patient from different groups received different intervention respectively. The intervention was based on the primary nurse follow-up management model and the social support system of the patient. Results During 2009 to 2012, patients’number for each primary nurse increascd from 80 tO 90～110, whilet the rate of peritonitis did not increased and the rate of drop out declined in our PD center. Conclusion HMA could increase PD nurse's work efficiecy and ensure care quality at the same time．It would work as an effective method for controlling peritonitis for PD program. Metrics