Chinese Journal of Blood Purification

12 March 2016, Volume 15 Issue 03 Previous Issue    Next Issue

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Factors that contribute to the erythropoietin hyporesponsiveness in patients on maintenance hemodialysis 2016, 15 (03):  149-153.  doi: 10.3969/j.issn.1671-4091.2016.03.007 Abstract ( 281 )   HTML ( 2 )   PDF (2157KB) ( 333 )   Objective This study was carried out to identify the factors that contribute to the erythropoietin hyporesponsiveness in patients on maintenance hemodialysis (MHD). Methods Demographic data, hemoglobin, dose of erythropoietin, biochemical and other related indicators were collected from 80 MHD patients and analyzed retrospectively. They were followed up for 12 months. Erythropoietin resistance index (ERI) calculated by means of dividing the weekly weight (kg) adjusted dose of ESA (IU) by the hemoglobin level (g/dL) was used to evaluate the response to erythropoietin in MHD patients. Logistic regression was used to determine the key variables that might be independently involved in the erythropoietin hyporesponsiveness in MHD patients. Results The mean ERI for the entire study population was 16 IU/kg/week/g/dl, and 20% of the patients had erythropoietin hyporesponsiveness. Patients were them divided into two groups according to ERI: ERI ＜25 IU/week/kg/g/dl group and ERI ≥25 IU/week/kg/g/dl group. In ERI ≥25 group, the proportion of female was higher (χ2=3.972, P=0.046), and hemoglobin and 25(OH)D were significantly lower than those in ERI ＜25 group (t=3.123 vs. 2.606; P=0.003 vs. 0.011). In addition, body mass index (BMI) and serum cholesterol were lower in ERI ≥25 group than in ERI ＜25 group (t=1.969, P=0.053). Logistic regression demonstrated that adjusted gender, dialysis vintage, BMI, Kt/V, serum cholesterol, serum albumin, alkaline phosphatase, and 25(OH)D deficiency were the independent factors for erythropoietin hyporesponsiveness (HR: 4.590; 95% CI: 1.277～16.503). Conclusion The prevalence of erythropoietin hyporesponsiveness was higher among MHD patients in our hemodialysis center. Female gender and malnutrition correlated to erythropoietin hyporesponsiveness, and 25(OH)D deficiency was the main risk factor for erythropoietin hyporesponsiveness. Improving 25(OH)D deficiency and malnutrition will raise erythropoietin respon siveness in MHD patients. Metrics

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Efficacy of elcitonin in the treatment of chronic kidney disease-mineral and bone disorder 2016, 15 (03):  154-157.  doi: 10.3969/j.issn.1671-4091.2016.03.008 Abstract ( 523 )   HTML ( 0 )   PDF (2058KB) ( 210 )   Objective To observe the efficiency and safety of calcitonin (elcitonin) in the treatment of chronic kidney disease-mineral and bone disorder. Methods A total of 30 patients with bone and joint pain, hypercalcemia, skin itch, and skin metastatic calcification nodules were enrolled in this study. All of them were on maintenance hemodialysis for more than 2 years. Elcitonin 20U was intramuscularly or subcutaneously injected once per day for one week and then 3 times per week after dialysis for a therapeutic course of 12 weeks. They also had low salt and low purine diet. Active vitamin D3 and calcium supplement were withdrawn in patients with hypercalcemia. Blood routine examination (hemoglobin, white blood cells and platelets), liver functions (direct and indirect bilirubin, alanine aminotransferase and aspartate aminotransferase), serum calcium, serum phosphate, intact parathyroid hormone (iPTH), and bone mineral density of the 3rd and 4th lumbar vertebrae were examined. Visual analogue score (VAS) was used to record the pain. Adverse reaction of elcitonin was monitored. Results After the treatment, serum calcium decreased overtime, and decreased significantly after the treatment for 8 weeks as compared with the baseline (t=2.424, P= 0.019). Serum phosphate and VAS also decrease overtime, and decreased significantly after the treatment for 12 weeks as compared with the baseline (t= 2.061, P=0.044 for phosphate; χ2=51.463, P＜0.0001 for VAS). However, iPTH decrease after the treatment but without statistical significance (χ2=11.120, P=0.069). Bone mineral density was observed in 3 cases, and the density increased after the treatment. Conclusion Elcitonin can decrease serum calcium and phosphate, increase bone mineral density, and alleviate joint pain. Elcitonin can be used in the treatment of renal osteodystrophy. Metrics

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Clinical investigation on the relationship between thyroid hormones and residual urine volume in maintenance hemodialysis patients 2016, 15 (03):  159-163.  doi: 10.3969/j.issn.1671-4091.2016.03.009 Abstract ( 281 )   HTML ( 0 )   PDF (2276KB) ( 202 )   Objective To investigate the relationship between thyroid hormones (TH) and residual urine volume (RUV) and their reciprocal influences in maintenance hemodialysis (MHD) patients. Methods We recruited 79 MHD patients treated twice a week for more than 12 months in the period from Oct. 2012 to Oct. 2014 in our hospital. Their clinical parameters including RUV and TH were collected. They were then divided into two groups based on RUV: RUV group (RUV ＞100ml/d, n=22) and NRUV group (RUV ＜100ml/d, n= 49). Clinical parameters were compared between the two groups. Factors influencing RUV were analyzed by using multivariate logistic regression. The relationship between TH and RUV was evaluated. The RUV group was further divided into two subgroups based on free triiodothyronine (FT3): subgroup A (FT3 ＞3.8 pmol/l) and subgroup B (FT3 ≤3.8 pmol/l). The two subgroups were followed up for one year (48 weeks), and the end points was the event of RUV ＜100ml/d. The probability difference about the occurrence of end points was evaluated by using Kaplan- Meier method. Results A total of 71 MHD patients with RUV of 70(130) ml were enrolled in this study. FT3 was 3.67±0.56 pmol/l in these patients, including 43 patients (60.6%) with lowered FT3. FT4 was 8.65(1.5) pmol/l in these patients, including 8 patients (11.3%) with lowered FT4. Six patients (8.5%) had both lowered FT3 and FT4. Seventy-one patients were assayed for TSH, and they were all normal. In RUV group, dialysis vintage was shorter (1.75±2.03 vs. 4.23± 2.89 years; t=-4.153, P＜0.001), FT3 was higher (3.87±0.41 vs. 3.58±0.54 pmol/l; t=2.444, P=0.018), Kt/V was higher (1.27±0.06 vs. 1.23±0.08; t=2.183, P= 0.032), PTH was lower [181.95(244.35) vs. 324.0(370.8) pg/ml; z=2.102, P=0.036], and the occurrence of interdialytic hypotension was lower [0.024(0.073) vs. 0.097(0.150); z=2.166, P=0.030], as compared with those in NRUV group. Multivariate logistic regression found that FT3 and dialysis vintage were correlated significantly with RUV (B=1.983, P=0.002 for FT3; B=-0.388, P=0.007 for dialysis vintage). Spearman rank partial correlation analysis revealed that FT3 was positively correlated with RUV (R=0.603, P＜0.001) after excluding the factor of dialysis vintage. In the follow-up period we found that RUV decreased frequently in the B subgroup of RUV group (χ2=9.748, P=0.002). Conclusions FT3 and dialysis vintage were significantly correlated with RUV in MHD patients. Clinically, we should pay attention to the change of FT3 in MHD patients. Metrics

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The importance of acute renal failure in old patients: analysis of the clinical features in 507 cases with acute renal failure 2016, 15 (03):  164-167.  doi: 10.3969/j.issn.1671-4091.2016.03.010 Abstract ( 226 )   HTML ( 0 )   PDF (1773KB) ( 248 )   Purpose To summarize the clinical characters of patients with acute renal failure (ARF) and compare the difference among different age groups. Method The clinical data of 507 ARF patients with complete medical records were reviewed. Patient data were sorted by different age groups and then analyzed to summarize the clinical characters of ARF patients and compare the difference among different age groups. Results Young group consisted of 146 cases (28.8%), middle-aged group consisted of 172 cases (33.9%), and old group consisted of 189 cases (37.3%). ① The dominant causes were prerenal in the old group, but were intrinsic in the young group. The old group differed from other age groups in the frequency of underlying diseases, including hypertension (χ2=86.804, P＜0.001), diabetes (χ2=30.163, P＜0.001), coronary heart disease (χ2= 70.752, P＜0.001), heart failure (χ2=13.494, P=0.001), and cerebrovascular disease (χ2=31.387, P＜0.001). ②The prevalence of acidosis as a complication of ARF was significantly different among the three age groups (χ2=10.393, P=0.006), which tended to happen more frequently in the old group. ③ The mortality (χ2=54.835, P＜0.001), as well as the prevalence of multiple organ dysfunction syndrome (χ2=31.061, P＜0.001), heart dysfunction (χ2=32.593, P＜0.001), and lung dysfunction (χ2=15.447, P＜0.001) were also significantly different among the three age groups, ranking the highest in the old group. ④Models were established to predict the prognosis of ARF after multivariate logistic regression analysis. The models interpreted that acidosis, even in the compensation stage, was the risk factor for ARF (P＜0.05). Multiple organ dysfunction syndrome (P＜0.001) and oliguria (P＜0.01) were also the risk factors for ARF, while albumin (P＜0.01) was the protective factor. Conclusion Elderly patients with poorer baseline renal function and higher frequency of underlying diseases were more likely to develop ARF, and the prevalence of acidosis and organ dysfunction were more likely to occur after ARF, resulting in the higher mortality in the old group. Metrics

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Effect of parathyroidectomy on renal anemia in maintenance hemodialysis patients 2016, 15 (03):  168-171.  doi: 10.3969/j.issn.1671-4091.2016.03.011 Abstract ( 302 )   HTML ( 0 )   PDF (1656KB) ( 250 )   Objective To investigate the effect of parathyroidectomy (PTX) on the progression of renal anemia in maintenance hemodialysis (MHD) patients. Methods A total of 25 MHD patients with secondary hyperparathyroidism treated with PTX in the recent 7 years were retrospectively analyzed. The changes of serum intact parathyroid hormone (iPTH), calcium (Ca) and phosphorus (P) after PTX were evaluated. The supplement doses of recombinant human erythropoietin (EPO) were recorded. Results Serum iPTH, Ca, and P levels were significantly decreased after PTX. No significant difference of hemoglobin level was found after the operation for 1, 3 and 6 months, but the dose of EPO decreased after the operation. There was a positive correlation between the dose of EPO and the level of serum iPTH in MHD patients (r=0.48, P=0.00). Conclusion PTX can significantly reduce the dose of EPO and delay the progression of renal anemia in MHD patients with renal anemia. Metrics

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The effects of incentive health education mode on the improvement of volume control and life quality in hemodialysis patients 2016, 15 (03):  172-175.  doi: 10.3969/j.issn.1671-4091.2016.03.012 Abstract ( 229 )   HTML ( 0 )   PDF (1856KB) ( 208 )   Objective To investigate the effect of incentive health education mode on the improvement of volume control and life quality in maintenance hemodialysis (MHD) patients. Methods A total of 152 MHD patients (88 males and 64 females, 20~75 years old) were recruited in this study. They were randomly divided into control group (n=76) and incentive group (n=76). The traditional health education mode was used in control group, while the novel incentive mode of health education was used incentive group. The volume control rate, BP control rate, and BNP level were evaluated after the health education mode for 0, 3, 6, and 12 months. The quality of life in patients was assessed by SF-36 scale. Results At the 3rd month of education, the volume control rate was significantly higher in incentive group than in control group (χ2=9.581, P=0.031). At the 6th month of education, incentive group had a higher BP control rate (χ2=15.692, P＜0.001), a higher physical functioning score (74.92 ± 20.86 vs. 64.43 ± 24.26; t=2.412, P=0.021), a higher role- physical score (55.22±19.09 vs. 43.19±27.68; t=2.414, P=0.020), and a higher role-emotional perception score (71.31±33.41 vs. 60.67 ± 41.11; t=2.042, P=0.007); BNP level was also lower in incentive group than in control group (139.78 ± 46.62 pg/ml vs. 200.09 ± 26.21 pg/ml; t=5.689, P＜0.001). Conclusion The incentive mode of health education is better than the traditional education mode in improvement of volume control and life quality in MHD patients. Metrics

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An in vitro study about the leakage of catheter locking solution from central venous catheter 2016, 15 (03):  176-179.  doi: 10.3969/j.issn.1671-4091.2016.03.013 Abstract ( 296 )   HTML ( 1 )   PDF (1910KB) ( 324 )   Objective To observe the in vitro leakage of catheter lock solution from the clinically used central venous catheters after lock with the solution for 1 min to 96 hrs. Methods The side holes of the catheter were horizontally placed in advance. The catheter was flushed and locked with distilled water. The tip of the catheter was placed in a beaker containing 100ml distilled water. The volume of lock solution (50% dextrose solution) injected into the catheter (artery access) equaled the catheter nominal capacity. The leak ratio was calculated from the concentration of dextrose in the beaker. The experiment was repeated for 15 times, and the average data were then calculated. Results After injection of lock solution into the artery access, the leak ratio was 26.6%～46.0% after 1min, 39.2%～67.2% after 2 hrs, 56.5%～71.5% after 24 hrs, 63.7%～ 82.1% after 48 hrs, and 71.4%～87.9% after 96 hrs. Hence, there were a rapid early leak and a slower later leak of the lock solution. Conclusion After injection of the lock solution a large quantity of lock solution leaked into the beaker, indicating that a great deal of lock solution may infiltrate into body circulation and interfere with blood coagulation. Therefore, heparin concentration in lock solution should be individualized based on clinical status of the patients. Metrics

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Application of the new type and domestic made temporary hemodialysis catheter 2016, 15 (03):  180-182.  doi: 10.3969/j.issn.1671-4091.2016.03.014 Abstract ( 278 )   HTML ( 0 )   PDF (1411KB) ( 154 )   Objective To evaluate the efficacy and safety of the new type and domestic made temporary hemodialysis catheter for hemodialysis patients. Methods A total of 140 patients in need of temporary central vein catheterization for hemodialysis from Oct. 2013 to Oct. 2014 in the two clinical centers were enrolled in this study. Patients were randomly divided into two groups. Half of the patients used the new type temporary hemodialysis catheter, and the rest of the patients used arrow temporary hemodialysis catheter for hemodialysis. The quality, manipulation, blood flow, dialysis adequacy and complications were compared between the two groups. Results The average age of the patients was 61.06±16.02 years. In test group, the average blood flow was 215.43±10.03 ml/min, indwelling duration was 30.49±15.65 days, spKt/V was 1.23±0.04, URR was 66.16±2.11%, and the scores of quality and ease of use were 99.84%, which had no differences from the control group (t=- 1.865, P=0.064 for blood flow; t=- 0.827, P=0.409 for indwelling duration; t= -1.601, P=0.112 for spKt/V; t=-1.791, P=0.075 for URR; and χ2=-1.000, P=0.321for the scores of quality and ease of use). The incidence of adverse event was 2.86% in test group and 1.43% in control group (χ2=0.000, P=1.000). There was no treatment-related serious adverse effect in both groups. Conclusion This clinical study shows that the new type and domestic made temporary hemodialysis catheter is effective and safe for temporary blood access in hemodialysis patients. Metrics