Chinese Journal of Blood Purification

12 December 2015, Volume 14 Issue 12 Previous Issue    Next Issue

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Health information technology management in a hemodialysis center 2015, 14 (12):  706-709.  doi: 10.3969/j.issn.1671-4091.2015.12.002 Abstract ( 256 )   HTML ( 2 )   PDF (1124KB) ( 326 )   Objective To explore the management model of health information technology (HIT) suitable for hemodialysis (HD) center. Methods We analyzed the requirement of HIT construction, and defined the necessary functions of HIT for the HD center of Peking University People's Hospital. We then specifically designed the HIT management protocols linked to the established HIT management platform in the hospital. Results According to the delineated designation and requirement, the aim and idea of the HIT construction were set up. The HIT was scheduled and programmed to be built up, and was connected to the hospital information system, laboratory information system, and dialysis apparatus. Therefore, dialysis and clinical data can be collected automatically and managed in a closed-circuit environment to improve the efficiency and quality of medial care. Conclusions A management model of HIT suitable for HD center can be built up, which is implanted into the information system of the hospital and cooperates with other systems in the hospital. Metrics

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The practice of dialysis information management system and its impact on dialysis quality 2015, 14 (12):  710-712.  doi: 10.3969/j.issn.1671-4091.2015.12.003 Abstract ( 254 )   HTML ( 3 )   PDF (377KB) ( 443 )   Objective This study aims to evaluate the impact of the dialysis information management system on quality of dialysis center. Methods The dialysis information management system (Beijing Huibaitong Company) has been used in the Dialysis Center, the First People’s Hospital of Foshan since 2012. We compare the data before and after the application of this system, including change of manpower resource, integrity of treatment records, and the dialysis quality for patients. Results The application of this information management system increases work efficiency, improves the integral quality of dialysis, saves manpower resources, and ensures the integrity and accuracy of hemodialysis records. After use of this information management system for one year, the levels arriving to the standard requirements change from 34.6% to 55.9% (χ2=25.180, P=0.000) for hemoglobin, from 44.8% to 70.7% (χ2=37.895, P=0.000) for dialysis adequacy, and from 38.2% to 45.5% (χ2=2.980, P=0.05) for control of hyperphosphatemia. Conclusion The application of the dialysis information management system promotes service efficiency and dialysis quality. However, there are still some obstacles to be solved. Metrics

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Clinical characteristics of the first episode of peritonitis and the risks of extubation in peritoneal dialysis patients 2015, 14 (12):  713-717.  doi: 10.3969/j.issn.1671-4091.2015.12.004 Abstract ( 351 )   HTML ( 0 )   PDF (372KB) ( 179 )   Objectives For better prevention and treatment of peritonitis in patients with continuous ambulatory peritoneal dialysis (CAPD), we investigated the pathogens, inducing factors, clinical features and prognosis of the first episode of peritonitis in these patients. Methods A total of 67 patients experienced the first episode of peritonitis from Aug. 2002 to Oct. 2013 were recruited and divided into 2 groups based on clinical outcomes. Forty-one patients cured and 26 patients were treated with extubation. All patients were empirically treated with antibiotics after diagnosis. Antibiotic regimen was then adjusted according to the results of culture and drug sensitivity tests. Demographic data, primary kidney disease, dialysis age, inducing factors, clinical indexes, bacterial culture results, therapies and clinical outcomes were collected for analyses. Results Patients with peritonitis were older than the controls (53.1±14.9 yr vs. 46.6±14.3 yr). Hypoproteinemia aggravated after the onset of peritonitis (ALB: 27.4±4.0 g/L vs. 32.5±5.7 g/L) . A higher incidence of inappropriate operation (53.7%) was found in patients with peritonitis. Extubation patients had longer dialysis age [24(11.4, 42) months vs. 13.2 (4.8, 18.84) months, P=0.020] and more severe hypoproteinemia (24.5±5.8 g/L vs. 29.3± 4.1 g/L, P=0.000) than the cured patients. In most extubation patients, the extubation was unrelated to mis-operation (61%vs. 36%, P=0.01) and the pathogens were non-Gram+ bacteria (74%vs. 41%, P＜0.001) as compared with the cured patients. Conclusions The first episode of peritonitis is related to older age, malnutrition, and inappropriate operation. Patients with longer dialysis age, severe hypoproteinemia, non-Gram+bacterial infection, and less mis-operation tend to have a higher risk of extubation. Metrics

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A study on reducing urinary protein by astaxanthin in patients with IgA nephropathy 2015, 14 (12):  718-722.  doi: 10.3969/j.issn.1671-4091.2015.12.005 Abstract ( 634 )   HTML ( 4 )   PDF (610KB) ( 337 )   【Abstract】Objective The aim of the current study was to investigate whether astaxanthin could reduce urinary protein excretion in patients with IgA nephropathy. Methods This was a self- controlled study. Patients diagnosed with IgA nephropathy and treated in our hospital in the period between Dec. 2014 and Jun. 2015 were recruited. They had stable urinary protein excretion for at least 3 months, stable renal function and steady doses of antihypertensives. Seventeen patients met the criteria and were willing to accept astaxanthin treatment, and 16 (45.4±13.4 years, 7 males and 9 females) of them completed the study. All patients received oral astaxanthin 1～2 tablets each time, twice daily for 3 month. 24h urinary protein (24hUP), serum albumin (Alb), creatinine (Scr), estimated glomerular filtration rate (eGFR), total cholesterol (TChol), high density lipoprotein (HDL), low density lipoprotein (LDL) and triglyceride (TG) were measured before taking astaxanthin and re-examined after the treatment once a month for 3 months. Normally distributed data (TChol, HDL and LDL) were analyzed using one- way analysis of variance (ANOVA). Non- normally distributed data (24hUP, Alb, Scr, eGFR and TG) were analyzed using Friedman non-parametric test. Wilcoxon rank sum test was used for pairwise comparison. Jonckheere-Terpstra was used for trend analysis. Results At baselines, 24hUP, Alb, Scr, TChol, eGFR, HDL, LDL and TG was 2.65 (1.43, 5.02) g/d, 41.0 (37.6, 44.2) g/L, 135.0 (95.0, 224.0) μmol/L, 47.81 (32.91, 65.39) ml/min.1.73m2, 5.83±1.43 mmol/L, 1.29±0.37 mmol/L, 3.20±0.86 mmol/L and 1.26 (1.03,3.78) mmol/L, respectively, and changed to 1.35 (0.86,2.96) g/d, 42.3 (40.5,42.7) g/L, 154.0 (70.0,192.0) μmol/L, 41.49 (32.50,100.51) ml/min.1.73m2, 5.32 ± 1.12 mmol/L, 1.12 ± 0.32 mmol/L, 3.28±0.82 mmol/L and 1.49 (1.04,2.75) mmol/L, respectively, after the treatment for 3 months. After astaxanthin treatment, 24hUP and eGFR had a significantly downward trend (P＜0.001), Scr had a significantly up- ward trend (P＜0.001), but change trends of Alb, TChol, HDL, LDL and TG were not found. Conclusions These results suggested that urinary protein excretion could be reduced by adding astaxanthin to traditional treatment in patients with IgA nephropathy. Metrics

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The effect of heterozygous blood purification on intradialytic blood pressure variability in patients with maintenance hemodialysis 2015, 14 (12):  723-724.  doi: 10.3969/j.issn.1671-4091.2015.12.006 Abstract ( 253 )   HTML ( 0 )   PDF (352KB) ( 252 )   Objective To explore the clinical effect of heterozygous blood purification on intradialytic blood pressure variability. Method Forty maintenance hemodialysis (MHD) patients with stable disease status were recruited in Hemodialysis Center of the 150th PLA Hospital. Patients were treated with routine hemodialysis for 8 weeks followed by heterozygous blood purification for 8 weeks. Blood pressure at the first hemodialysis session of every week was recorded. The mean and standard deviation of systolic and diastolic pressure were calculated. Coefficient of variation was used to express blood pressure variation (BPV). BPV under different treatment stages were calculated and compared. Result A total of 40 patients were enrolled. In routine hemodialysis stage, intradialytic systolic BPV was 6.45±1.78, and intradialytic diastolic BPV was 4.85±2.12; in heterozygous blood purification stage, intradialytic systolic BPV was 2.97±0.82 (P＜0.05), and intradialytic diastolic BPV was 1.67±0.43 (P＜0.05). The mean systolic and diastolic blood pressure changed insignificantly between the two treatment stages (P>0.05). Conclusion After heterozygous blood purification, intradialytic systolic BPV and diastolic BPV reduced significantly. This blood purification method needs to be further studied. Metrics

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Clinical analysis of mineral and bone disease pattern in elderly hemodialysis patients 2015, 14 (12):  725-727.  doi: 10.3969/j.issn.1671-4091.2015.12.007 Abstract ( 268 )   HTML ( 0 )   PDF (405KB) ( 210 )   Objective To analyze the clinical characteristics of mineral and bone disease pattern in elderly hemodialysis patients. Materials and Methods This cross-sectional study was based on clinical records of 109 maintenance hemodialysis patients. They were divided into two groups by age: elderly group (age >65, median age =72 years, n=46) and non-elderly group (age <65, median age =50 years, n=63). Serum phosphorus, calcium, parathyroid hormone (PTH), albumin, and C- reactive protein were measured. Urea clearance rate (URR) and Kt/V were calculated. These parameters were compared between the two groups. Results Elderly patients exhibited lower serum phosphorus (1.65 + 0.52 mmol/L vs. 2.03 + 0.65 mmol/L; t=3.270, P= 0.001), serum alkaline phosphatase [74.50 (60.75～74.50) U/L vs. 91.00 (69.00～135.00) U/L; Z=-2.7777, P= 0.005] and parathyroid hormone [74.50(60.75～74.50) pg/ml vs. 91.00 (69.00～135.00) pg/ml; Z=-2.7777, P= 0.005) as compared with those in the non-elderly group. However, serum calcium, hemoglobin, URR, Kt/V, dry body weight and hemodialysis age were similar between the two groups. Elderly patients also had lower serum albumin (37.23±3.23 g/l vs. 38.93±2.78 g/l; t=2.933, P=0.004) and serum triglyceride (1.49±0.79 mmol/ L vs. 1.87 ± 0.92 mmol/l; t=2.260, P=0.026), and less a Cctive vitamin D derivatives usage (39.13% vs. 68.25%; χ2=9.150, P=0.002) and active vitamin D dosage [0.50 (0.25～0.50) μg/d vs. 0.50 (0.50～1.00) μg/d; Z = -3.544, P=0.000). Conclusions Serum phosphorus, iPTH and alkaline phosphatase levels were lower in elderly hemodialysis group than in non-elderly hemodialysis group. But serum calcium was similar between the two groups. Metrics

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Risk factors for restless legs syndrome in patients with maintenance hemodialysis 2015, 14 (12):  728-731.  doi: 10.3969/j.issn.1671-4091.2015.12.008 Abstract ( 235 )   HTML ( 0 )   PDF (389KB) ( 213 )   Objectives To explore the risk factors for restless legs syndrome (RLS) in patients with maintenance hemodialysis (MHD). Methods An epidemiological investigation was carried out on MHD patients. Basic information and clinical laboratory examinations were collected and the associations with RLS was explored. Grouped data were compared using Student’s t or t’test or chi square test for univariate analyses. Binary logistic analysis was used for exploring multivariate factors. Results The prevalence rate of RLS was 21.5% (95% CI 15.60～27.41%). No differences existed between RLS group and none-RLS group in personal factors (age, gender, BMI and MHD duration), personal habits (smoking and drinking), nutrition condition (serum total protein), liver injury (GOT, GPT, GGT and ALP), MHD effectiveness (SCr, BUN and UA), blood gas (CO2CP), serum electrolytes (anion gap, K, Ca, P and Fe), metabolism conditions (triglyceride and cholesterol), and endocrinal levels (PTH and EPO). However, binary logistic analysis showed that BMI (OR=0.68，95% CI 0.49～0.94) and anion gap (OR=0.48, 95% CI 0.28～0.83) were the protective factors for RLS, and smoking (OR=4031.32, 95% CI 25.99～625413.34), serum total protein (OR=1.40, 95% CI 1.02～1.92), BUN (OR=1.59, 95% CI 1.19～2.52) and serum potassium (OR=8.86, 95% CI 1.39～56.38) were the risk factors for RLS. Conclusion The occurrence of RLS may relate to the coexistence of multivariate factors including personal factors, personal habits, nutrition condition, MHD effectiveness, and serum electrolytes. Metrics

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Correlation study between parathyroid hormone level and pathological findings of parathyroid surgical samples in uremic patients with hyperparathyroidism 2015, 14 (12):  732-735.  doi: 10.3969/j.issn.1671-4091.2015.12.009 Abstract ( 277 )   HTML ( 1 )   PDF (4100KB) ( 275 )   Objectives To analyze the relationship between parathyroid hormone (PTH) level and pathological changes in parathyroid of hyperparathyroidism through pathological examination of the surgical samples after parathyroidectomy (PTX). Methods A total of 46 dialysis patients with refractory hyperparathyroidism and treated with PTX in China-Japan Friendship Hospital during the period from Sep. 2009 to Jan. 2012 were enrolled in this study. They were divided into 3 groups based on iPTH level: group A (iPTH ＜1,000 pg/ml), group B (iPTH 1,000～2,000 pg/ml), and group C (iPTH >2,000 pg/ml). They were also divided into dialysis age >10 years group and dialysis age <10 years group. Laboratory examinations and pathological findings in the parathyroid surgical samples were compared among the 3 groups. Pathological findings in the parathyroid surgical samples were also compared in patients with different dialysis age. Results Ca, P and dialysis age had no differences (P＞0.05), but iPTH and alkaline phosphatase (ALP) levels were significantly different among the 3 groups (P =0.000 and 0.014, respectively). Group C had the highest mean ALP value, followed by group B and group A. Old hemorrhagic foci, eosinophilic cells, transparent cells, adenoid structure, tissue calcification, and vascular wall calcification were seen in the 3 groups. The rate of calcification in parathyroid gland and vascular wall was 23.1% in patients with dialysis age of <10 years, and was 78.9% in those with dialysis age of >10 years (P=0.000). Conclusion iPTH levels were positively correlated with the level of ALP. Calcification in parathyroid gland and vascular wall was positively correlated with dialysis age. However, iPTH level was unrelated to the pathological changes of hyperparathyroidism in parathyroid. Metrics

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Effect of astaxanthin on high glucose induced podocyte injury 2015, 14 (12):  736-738.  doi: 10.3969/j.issn.1671-4091.2015.12.010 Abstract ( 272 )   HTML ( 0 )   PDF (679KB) ( 222 )   Objective To investigate the effects of astaxanthin on high glucose induced lesion in human conditional immortalized podocytes. Methods Human podocytes were cultured in vitro. According to the culture conditions, human podocytes were divided into normal glucose group (NG), high glucose group (HG), high permeability group (MA), and HG+astaxanthin (10～6 M, 10～5 M and 10～4 M) groups. Apoptosis of human podocytes in each group was examined by flow cytometry after the culture for 24 hours. Cell adhesion was assayed by centrifugation to determine the effect of astaxanthin on podocyte adhesion. Results The early apoptosis rate of podocytes was higher in HG group than in NG group (7.7±0.9% vs. 2.7±0.74%, P=0.000). Astaxanthin reduced the early apoptosis of podocytes in a dose-dependent manner (5.7±1.0%, P=0.017; 5.2± 0.7%, P=0.006; 4.3±0.9%, P=0.001). High dose of astaxanthin could increase podocyte adhesion (67.2±4.3% vs. 37.9±9%, P=0.017). Conclusion Astaxanthin prevents podocytic apoptosis and reduced adhesion induced by HG. Metrics

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Acute kidney injury: a delegate of multiple organ failure in intensive care units 2015, 14 (12):  742-745.  doi: 10.3969/j.issn.1671-4091.2015.12.012 Abstract ( 189 )   HTML ( 0 )   PDF (326KB) ( 230 )   Acute kidney injury (AKI) is a common and serious complication in critically ill patients. The mortality rate remains high despite improved renal replacement techniques. A possible cause of the high mortality rate is that intensive care unit patients tend to be older and more debilitated than before. Pathophysiological factors associated with AKI are also incriminated in the failure of other organs, indicating that AKI is often part of a multiple organ failure syndrome. Until recently, practitioners lacked consensus as to the best definition of AKI. The introduction of the RIFLE (Risk, Injury, Failure, Loss, and End-stage kidney disease) criteria and the modified version proposed by the Acute Kidney Injury Network (AKIN) have increased the conceptual understanding of AKI, and these criteria have been successfully tested in clinical studies. Metrics

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Clinical study of the narrowing operation in the treatment of patients with tumor-like dilatation of arteriovenous fistulas 2015, 14 (12):  746-749.  doi: 10.3969/j.issn.1671-4091.2015.12.013 Abstract ( 183 )   HTML ( 0 )   PDF (363KB) ( 234 )   Purpose To investigate the clinical effect of narrowing operation on the patients with tumorlike dilatation of arteriovenous fistula (AVF). Methods Patients with tumor-like dilatation of AVF from Jan. 2010 to May 2015 were included in this study. We summarized their clinical characteristics, surgical methods, indication of the surgical intervention, and technical indication of the surgical intervention. After narrowing operation, clinical symptoms of the patients were also observed. Results Thirty patients were included in this study. Tumor-like dilatation of AVF occurred for more than one year in all of the 30 cases. Dilated AVFs located near the puncture sites. The successful rate of this operation was 100%. Three patients were unsuitable for this operation and were treated with ligation. Among the 3 patients, the AVF was reconstructed using basilica vein in one patient, the AVF was changed to another limb in one patient, and a polyester cuffed catheter was indwelled in the fistula in one patient. Clinical symptoms improved significantly in the follow-up period of 3- 6 months. The diameter of AVFs reduced from 43.075±1.332 mm to 28.604±3.406 mm (P=0.001). Blood flow velocity measured by color Doppler ultrasound decreased by 60%～70% (from 1987.0 ± 53.73 ml/min to 791.10±28.12 ml/min, P<0.01). Reconstructed AVFs were used for blood access again after 4～8 weeks of operation. Conclusions The narrowing operation is an effective intervention for the tumor- like dilatation of AVF. Metrics

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Appropriate maintenance of ultrafiltration function for hemodialysis machines 2015, 14 (12):  753-755.  doi: 10.3969/j.issn.1671-4091.2015.12.015 Abstract ( 311 )   HTML ( 1 )   PDF (381KB) ( 345 )   Objective To find out suitable maintenance methods for ultrafiltration function of hemodialysis machines. Method We selected the hemodialysis machines in our hospital, and divided them by ultrafiltration pump type into 2 groups: group A (17 machines with fixed capacity membrane pumps), and group B (11 machines with ceramic piston pumps). We measured ultrafiltration errors of the machines in the 2 groups at different situations. We also reviewed and analyzed the ultrafiltration malfunction rate and its causes in the period from Jan. 2004 to Jun. 2012. Result ①There were significant differences in ultrafiltration errors between the 2 groups after calibration for 9 months (t =2.261, P=0.042) and for 12 months (t =2.364, P=0.026). ②There was no significant difference in ultrafiltration malfunction rate between the 2 groups (χ2=0.635, P= 0.425). ③There were significant differences in causes of ultrafiltration malfunction between the 2 groups (χ2= 10.763, P=0.013). Conclusion The causes for ultrafiltration malfunction were significantly different between the 2 groups of hemodialysis machines. We could analyze these causes from the maintenance record, and use appropriate methods to maintain the ultrafiltration function. Metrics