Chinese Journal of Blood Purification

12 January 2016, Volume 15 Issue 01 Previous Issue    Next Issue

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Measurement and clinical significance of morning hypertension in maintenance hemodialysis patients 2016, 15 (01):  1-4.  doi: 10.3969/j.issn.1671-4091.2016.01.001 Abstract ( 313 )   HTML ( 0 )   PDF (378KB) ( 246 )   Objective To explore the occurrence of morning hypertension and its correlation with cardiovascular disease in maintenance hemodialysis (MHD) patients. Methods Fifty-three MHD patients dialyzed in the morning (7-11 am) were enrolled in this study. Blood pressure was measured before hemodialysis and the values measured in the 3 dialysis sessions in a week were averaged. The patients were then divided into two groups according to the blood pressure level: morning hypertension group (>140/90mmHg) and morning normal pressure group (< 140/90mmHg). Medical history, blood biochemistry tests and echocardiogram were compared between the 2 groups by using t test. Results A total of 53 MHD patients (31 males and 22 females, 60.70±12.38 years of age, mean hemodialysis duration 5.96±5.15 years) were investigated. The prevalence of morning hypertension was 58.49%. Left ventricular mass index (LVMi) was significantly different between the two groups (132.40±36.77 vs. 111.62±20.71, P =0.012). Pearson correlation analysis showed that morning systolic blood pressure was significantly correlated with LVMi (r=0.386, P=0.004). Conclusion Morning hypertension occurred higher in hemodialysis patients and correlated with LVMi. Appropriate control of morning hypertension may be useful for the decrease of cardiovascular complications in MHD patients. Metrics

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Higher red blood cell distribution width is the independent risk factor for cardiovascular mortality in hemodialysis patients 2016, 15 (01):  5-9.  doi: 10.3969/j.issn.1671-4091.2016.01.002 Abstract ( 326 )   HTML ( 0 )   PDF (403KB) ( 354 )   Objectives Studies have found that red blood cell distribution width (RDW) is a powerful predictor for all- cause mortality and cardiovascular mortality in a variety of primary cardiovascular disease (CVD) patients. However, no data were available about the association between RDW and cardiovascular events and their outcomes in maintenance hemodialysis (MHD) patients. We have conducted a study to correlate RDW with CVD and all-cause mortality in MHD patients. Methods Baseline clinical data and RDW were collected from 286 MHD patients treated in the Hemodialyis Center of Guangdong General Hospital in the period from Jan. 1, 2009 to Dec. 31, 2012. The incidences of CVD events, all-cause death and CVD death were recorded. Results In a median follow-up period of 57.2 months 96 (33.5%) died of all-cause mortality, in which 57 (19.9%) died of CVD, and new-onset CVD events happened in 119 (42 %) cases. In a multivariate Cox proportional hazard model, RDW remained an independent risk factor for all-cause mortality, CVD mortality and CVD events after adjustment of multi-factors, and the adjusted hazard ratio for all-cause mortality, CVD mortality and CVD events was 1.36 (95% CI 1.17～1.58), 1.38 (95% CI 1.16～1.64), and 1.22 (95% CI 1.06～1.40), respectively. Conclusion Higher RDW was independently associated with the increased risk of all-cause mortality, CVD mortality and CVD events in MHD patients. Metrics

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Pulse wave velocity and its prognostic value in maintenance hemodialysis patients 2016, 15 (01):  10-13.  doi: 10.3969/j.issn.1671-4091.2016.01.003 Abstract ( 313 )   HTML ( 1 )   PDF (457KB) ( 221 )   Objective To explore the predictive value of aortic stiffness for cardio- cerebral vascular (CV) mortality and all-cause mortality in maintenance hemodialysis (MHD) patients. Methods A cohort of 76 MHD patients from Peking University People’s Hospital was recruited. Demographic data was collected. Laboratory examinations and carotid-femoral pulse wave velocity (CFPWV) were performed. Results In a follow-up period of 5 years 17 fatal and 9 non-fatal CV events occurred, and 33 patients died. Patients with a CFPWV >13m/s had lower all-cause and CV survival rates by Kaplan-Meier survival analysis, as compared those with a CFPWV <13m/s. Age and diabetes were the independent predictors for all-cause survival, and age, diabetes, mean arterial pressure, pulse pressure and CFPWV were the independent predictors for CV survival. Conclusions MHD patients with higher CFPWV have lower all-cause and CV survival rates. Higher CFPWV is an independent predictor for CV survival in MHD patients. Metrics

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Assessment of nutritional status using body composition monitor and modified quantitative subjective global assessment in hemodialysis patients 2016, 15 (01):  14-17.  doi: 10.3969/j.issn.1671-4091.2016.01.004 Abstract ( 196 )   HTML ( 2 )   PDF (451KB) ( 315 )   Objective To evaluate nutrition status and its related factors in maintenance hemodialysis (MHD) patients. Method We respectively used modified quantitative subjective global assessment (MQSGA) and body composition monitor (BCM) to evaluate the nutritional status in MHD patients for more than one year. Biochemical markers were collected, and food intake in a period of 3 days was measured by food records. Results We performed an observational study on 87 MHD patients (49 males and 38 females). The prevalence of malnutrition was 32.18% by using MQSGA. The prevalence of malnutrition was 39.08% by using BCM (lean tissue index <10% of the normal value). There was no difference in evaluating nutrition status between MQSGA and BCM (kappa=0.768). Forty-nine patients had the food intake records, and the average daily protein intake (DPI) was 1.05±0.30 g/(kg· d). According to MQSGA scores, patients were classified into well-nourished group and mal-nourished group. Age, DPI, serum albumin (Alb), serum creatinine (SCr), uricacid (UA), body mass index (BMI), lean tissue index (LTI), and overhydration were significantly different between the two groups (P＜0.05). Logistic analysis revealed that MQSGA score was negatively correlated with Alb(r=-0.38, P=0.001), SCr(r=-0.33, P=0.00), UA(r=-0.32, P=0.01), Kt/V(r=-0.243, P=0.02), BMI (r=-0.338, P=0.001), and LTI (r=-0.471, P= 0.000), and positively correlated with age (r=0.37, P=0.00). In addition, overhydration was independently correlated with age, ALB and BMI (r=0.33, P=0.00) in MHD patients. Conclusions Our data indicate that the assessment of nutritional status by BCM is highly consistent with that by MQSGA. Age, Alb and BMI are the independent factors for malnutrition in MHD patients. Metrics

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The prevalence of cardiac valve calcification and left ventricular hypertrophy in hemodialysis patients 2016, 15 (01):  18-21.  doi: 10.3969/j.issn.1671-4091.2016.01.005 Abstract ( 330 )   HTML ( 0 )   PDF (382KB) ( 247 )   Objective To investigate the prevalence of cardiac valve calcification (CVC) and left ventricular hypertrophy (LVH) in maintenance hemodialysis (MHD) patients. Methods A total of 199 MHD patients treated in Hospital of Shenyang Military Area Command were randomly selected. They were 18- 75 years old without heart valve diseases, and were treated with hemodialysis 3 times/week and 4 hours/session for 6 months- 10years. Aortic valve calcification (AVC), mitral valve calcification (MVC), left atrial size (LAD), were measured by echocardiography. iPTH was determined by radioimmunoasssy. Results Patients with LVH had higher rates of CVC (c2=9.534, P=0.002) and hypoalbuminemia (t=2.814, P=0.035). Patients with CVC had higher systolic BP (t=3.012, P=0.032), older age (t=5.060, P=0.001), and higher rates of LVH (c2=9.534, P=0.002) and hypoalbuminemia (t=2.031, P=0.025). Left ventricular mass index (LVMI) was negatively associated with albumin and LVEF, and was positively associated with systolic and diastolic BP. Age, diabetes history, systolic BP, albumin were the independent risk factors for CVC. Conclusion CVC is associated with LVH in MHD patients. Control of hypertension and maintenance of an adequate nutritional status may delay the processes of LVH and CVC. Metrics

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The effect of hypertonic glucose infusion during hemodialysis on serum amino acids spectrum in maintenance hemodialysis patients 2016, 15 (01):  22-25.  doi: 10.3969/j.issn.1671-4091.2016.01.006 Abstract ( 333 )   HTML ( 0 )   PDF (371KB) ( 222 )   Objective To investigate the effect of hypertonic glucose or amino acids infusion through the dialysis circuit on nutrition status, biochemical indexes and serum amino acids spectrum in maintenance hemodialysis (MHD) patients with malnutrition. Methods Thirty-two MHD patients consistent with the inclusion criteria and exclusion criteria were enrolled in this study. They were randomly divided into control group, glucose infusion group (50% glucose 250ml infusion in every dialysis session) and amino acids infusion group (8.5% amino acids 250ml infusion in every dialysis session). Nutrition status was estimated by using Subjective Global Assessment (SGA) method. Serum biochemical indexes were determined, and serum concentrations of the 22 amino acids were measured. Results Six months later SGA levels were similar with the baseline. Elevation of serum albumin and prealbumin compared with baseline levels were not found in three groups. The glucose infusion group had significantly increased levels for concentrations of essential amino acids (697.0 vs. 590.5nmol/L，P=0.032) wherease concentrations of essential amino acids in amino acid infusion group showed decreasing trend. Conclusion Hypertonic glucose infusion during dialysis may improve protein metabolism, suggesting that sufficient energy supply may be more important than nitrogen balance in MHD patients. Metrics

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Effect of continuous renal replacement therapy on expression of liver-type fatty acid binding proteins (L-FABP) in severe sepsis patients with acute kidney injury 2016, 15 (01):  26-30.  doi: 10.3969/j.issn.1671-4091.2016.01.007 Abstract ( 260 )   HTML ( 0 )   PDF (421KB) ( 229 )   Objective To investigate the effect of continuous renal replacement therapy (CRRT) on liver-type fatty acid binding proteins (L-FABP) levels in severe sepsis patients with acute kidney injury (AKI).Methods Sixty-eight severe sepsis associated with AKI patients admitted to the ICU were divided into conventional drug treatment group (group A, n=33) and CRRT group (group B, n=35). Patients in group A were treat with standard anti-sepsis therapy (SSC protocol, 2012), and those in group B were treated with CRRT in addition to the standard anti-sepsis therapy. Serum creatinine (sCr), serum L-FABP (sL-FABP), and urinary LFABP (uL-FABP) were measured at 0, 12, 24, and 48 hours after the treatment. In group B, sL-FABP in the ultrafiltrate of CRRT was also measured. Results After 48 hours of the treatment, sL-FABP increased in group A (1328±101 μg/g of Cr vs. 700±88 μg/g of Cr, t=5.435, P＜0.02), but did not change obviously in group B (680±74 μg/g of Cr vs. 712±82 μg/g of Cr; t=1.682, P＞0.05); uL-FABP did not change obviously in group A (1428±124 μg/g of Cr vs. 1082±89 μg/g of Cr; t=4.854, P＞0.05), but decreased significantly in group B (1324±123 μg/g of Cr vs. 1978±88 μg/g of Cr; t=2.654, P＜0.02). At 12, 24 and 48 hours after the treatment, sL-FABP was significantly lower in group B than in group A (P＜0.05). No L-FABP cold be detected in ultrafiltrate in group B. Conclusion CRRT induces the decrease of sL-FABP expression, which may improve theprognosis of AKI. CRRT may not remove sL-FABP directly from plasma. sL-FABP level is a reliable indicator to evaluate the therapeutic effectiveness of CRRT. Metrics

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The study of evaluation of dialysis adequacy by online clearance monitoring in hemodialysis patients with end- stage renal disease 2016, 15 (01):  31-35.  doi: 10.3969/j.issn.1671-4091.2016.01.008 Abstract ( 240 )   HTML ( 1 )   PDF (871KB) ( 479 )   Objectives To explore the relationship between the dialysis adequacy measured by online clearance monitoring (OCM)and Kt/V urea from pre- and post- dialysis blood samples, then establish formula to estimate Kt/V urea clearance by the online clearance monitoring, and analyze the clinical factors which affect the OCM. Methods OCM and Kt/V urea values from 111 maintenance hemodialysis patients were measured. The correlation between OCM and Kt/V urea values was analyzed by correlation assay. And formula to estimate Kt/V urea clearance by the online clearance monitoring was established. Clinical factors which affect the value of Kt/V measured by OCM were analyzed by multiple linear regression. Results Dialysis dose measured by OCM was lower than Kt/V urea, correlating well with Kt/V urea (r=0.676, P＜0.001). Conclusions Dialysis dose measured by OCM goes hand in hand with Kt/V urea. The clinical factors that affect OCM include height, post-dialysis weight and body surface area. Metrics

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The trend of hemodialysis patients across the administration district for the treatment in Beijing area 2016, 15 (01):  45-48.  doi: 10.3969/j.issn.1671-4091.2016.01.012 Abstract ( 273 )   HTML ( 0 )   PDF (546KB) ( 242 )   Objective The aim of this study was to examine the trend of maintenance hemodialysis (MHD) patients across the administration district for hemodialysis in recent years in Beijing area. Methods The patients’data were obtained from the Beijing Hemodialysis Quality Control and Improvement Center (BJHDQCIC) in the period from 2007 to 2013. Patients with unknown residential address or unclear location of dialysis unit were excluded. The trend of MHD patients across the administration district for hemodialysis was evaluated by comparing residential address and the location of hemodialysis unit. The specific burden of hemodialysis for an administration district was assessed by the ratio of dialysis patients and the patients living in this district, and the ratio of dialysis patients and hemodialysis equipment number in this district. Results A total of 9,591 patients met the inclusion criteria, and 34.28% of the patients moved across the administration district for hemodialysis (resident address and hemodialysis unit were not in the same district). Hemodialysis treated in the central areas of Beijing was found in 44.62% patients living in the inner suburbs, and 12.23% patients in the outer suburbs. Patients from suburbs for hemodialysis increased the burden of hemodialysis units in the central areas. In the urban districts of Hai Dian, Xi Cheng, Chao Yang and Dong Cheng, the ratio of dialysis patients and the patients residing in this district was 2.37, 1.61, 1.29 and 0.93, respectively, and the ratio of dialysis patients and equipment number was 3.19, 4.57, 3.61 and 3.06, respectively. Conclusion More than one- third MHD patients moved across the administration district for hemodialysis. Most of them were from the suburbs to the central districts of Beijing, which increased the burden of hemodialysis units in the central areas. Metrics

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The clinical effect of recombinant tissue plasminogen activator on prevention of thrombokinesis in tunneled cuffed catheter 2016, 15 (01):  51-54.  doi: 10.3969/j.issn.1671-4091.2016.01.014 Abstract ( 223 )   HTML ( 0 )   PDF (413KB) ( 260 )   Objective To explore the clinical effect of recombinant tissue plasminogen activator (rt-PA) on the prevention of thrombokinesis in tunneled cuffed catheter (TCC). Methods A total of 62 cases of maintenance hemodialysis patients were randomly divided into control group, urokinase group, and rt- PA group. The difficulties of blood access before dialysis, the intervention rate during dialysis, blood flow volume, venous pressure, and other complications were compared among the 3 groups. Results The difficulties of blood access before dialysis, the intervention rate during dialysis, and venous pressure were lower in rt-PA group than in urokinase group (5.1% vs. 10.7%, χ2=58.643, P=0.000 for difficulties of blood access before dialysis; 5.8% vs. 11.0%, χ2=48.027, P=0.000 for intervention rate during dialysis; 113.0±14.1 mmHg vs. 123.0±14.4 mmHg, q=3.154, P=0.037 for venous pressure) and control group (5.1% vs. 13.7%, χ2= 115.387, P=0.000 for difficulties of blood access before dialysis; 5.8% vs. 17.8%, χ2=187.411, P=0.000 for intervention rate during dialysis; 113.0±14.1 mmHg vs. 135.2±15.1 mmHg, q=6.854, P=0.005 for venous pressure). These parameters were also lower in urokinase group than in control group (P＜0.05). Blood flow volume was higher in rt-PA group than in urokinase group (248.1±14.9 ml/min vs. 239.1±14.2 ml/min, q=2.906, P=0.042) and control group (248.1±14.9 ml/min vs. 227.9±13.4 ml/min, q=6.378, P=0.006), and was higher in urokinase group than in control group (q=3.508, P＜0.05). The rates of bleeding and infection were similar among the 3 groups (χ2=0.233, P=0.890 for bleeding; χ2=1.541, P=0.463 for infection). Conclusion In addition to heparin, regular use of rt-PA for blocking TCC can safely and effectively prevent thrombokinesis in TCC and increase dialysis blood volume. Metrics

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Survey of psychological resilience level and coping style in maintenance hemodialysis patients 2016, 15 (01):  55-57.  doi: 10.3969/j.issn.1671-4091.2016.01.015 Abstract ( 222 )   HTML ( 1 )   PDF (343KB) ( 318 )   Objective The aim of this study was to explore the resilience and coping modes in maintenance hemodialysis (MHD) patients in order to provide a basis for their rehabilitation. Methods A total of 212 MHD patients were tasted with Connor-Davidson resilience scale (CD-RISC) and Medical Coping Modes Questionnaire (MCMQ). Result The score of resilience was 63.80±11.35, lower than the score in normal people (t=-2.049, P=0.042), and resignation was the main coping style in these patients. The score of resilience was significantly different in MHD patients with different education level, income, relationship in family, other complicated diseases, and job (P＜0.05). Conclusion The results let us understand more about the psychological conditions in MHD patients and take specific measures to reduce their negative emotions to keep them psychologically healthy. Metrics

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The effect of collaborative care model on self-care agency and medical treatment adherence in maintenance hemodialysis patients 2016, 15 (01):  58-62.  doi: 10.3969/j.issn.1671-4091.2016.01.016 Abstract ( 227 )   HTML ( 2 )   PDF (426KB) ( 273 )   Objective To evaluate the effect of collaborative care model on self-care agency and medical treatment adherence in maintenance hemodialysis (MHD) patients. Methods A total of 119 MHD patients were recruited from Chongqing Ninth People’s Hospital by using convenience sampling method, and randomly assigned into experimental group (n=71) or control group (n=48). Patients in both groups were assessed with the Exercise of Self- care Agency Scale (ESCA) and the specific medical treatment adherence scale. Patients in experimental group received collaborative care and those in control group were treated with routine care. After 4-5 months, they were assessed with the scales again. Independent t test and paired sample t test were used to explore the effect of collaborative care on patients’self-care agency and treatment adherence. Result Self- care agency (t =-5.140, P=0.000) and medical treatment adherence (t =-6.948, P=0.000) were significantly improved in the experimental group after the intervention. Additionally, self-care agency (t= 3.376, P=0.001) and medical treatment adherence (t=3.509, P=0.001) were also significantly higher in experimental group after the intervention than in control group. Conclusion Collaborative care model can significantly improve self-care agency and medical treatment adherence in MHD patients. Metrics