Chinese Journal of Blood Purification

12 April 2016, Volume 15 Issue 04 Previous Issue    Next Issue

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Body mass index and technical survival in patients undergoing peritoneal dialysis 2016, 15 (04):  205-210.  doi: 10.3969/j.issn.1671-4091.2016.04.005 Abstract ( 227 )   HTML ( 0 )   PDF (534KB) ( 264 )   Objective To investigate the relationship between body mass index (BMI) and technical survival in peritoneal dialysis (PD) patients. Methods A total of 348 PD patients (aged 48.2±15.5 years, 62% males) treated in Peking University Shenzhen Hospital from 2000 to 2014 were enrolled in this retrospective and cohort study. BMI was calculated using the first recorded body height and weight within 2~6 months after the initiation of PD. Patients were grouped according to the recommendation by World Health Organization for Asians. All patients were followed up until death, transferring to hemodialysis, kidney transplantation, loss of follow-up, or Oct. 31, 2014. The main endpoint included technical failure (death or permanently transferred to hemodialysis), and the secondary endpoint consisted of all-cause mortality, cardiovascular and cerebrovascular mortality, coronary heart disease event, stroke, and the first episode of peritonitis. Cox regression was used for data analysis. Results After the adjustment of age, sex, education, primary disease and heart failure, the hazard ratio (HR) for technical failure was 3.590 (95% CI 1.526~8.447, P=0.003) in low BMI group and was 0.932 (95% CI 0.493~1.762, P=0.829) in high BMI group, as compared with that in normal BMI. Allcause mortality, and cardiovascular and cerebrovascular mortality were higher in low BMI group than in normal BMI group (in low BMI group, total mortality HR=5.462, 95% CI 1.743~17.110, P=0.004; cardiovascular and cerebrovascular mortality HR=9.403, 95% CI 2.409~36.700; P=0.001), but were similar between high BMI group and normal BMI group (P＞0.05). No statistical significance was found in the relationship between BMI and the secondary endpoint including coronary heart disease event, stroke, and the episode of peritonitis (P＞0.05). Subgroup analyses revealed that the relationship between BMI and technical failure was not affected by age, sex, education, primary disease and cardiovascular diseases (interacted P＞0.05). Conclusions In PD patients, low BMI was independently associated with technical failure, all-cause mortality, and cardiovascular and cerebrovascular mortality, but not with coronary heart disease event, stroke and the episode of peritonitis. However, high BMI was unrelated to the events of main endpoint and secondary endpoint. Metrics

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The relationship between self-efficacy and quality of life/negative emotion in peritoneal dialysis patients 2016, 15 (04):  211-213.  doi: 10.3969/j.issn.1671-4091.2016.04.006 Abstract ( 227 )   HTML ( 0 )   PDF (339KB) ( 213 )   Objective To investigate the relationship between self-efficacy and quality of life/negative emotion in peritoneal dialysis (PD) patients. Methods Sixty-eight patients with the dialysis age less than 12 months and treated in the period from Jan. 2014 to Dec. 2014 were enrolled in this study. These patients were evaluated by self- efficacy scale, World Health Organization the quality of life- BREF (WHO QOLBREF), Hamilton anxiety scale (HAMA), and Hamilton depression scale (HAMD). The relationship between self-efficacy and quality of life/negative emotion in PD patients were then analyzed. Results The total scores of physical dimension, psychological dimension, environmental dimension, social dimension, and the total scores of quality of life were higher in the high self-efficacy group (≥7) than in the low self-efficacy group (＜7), while the scores of HAMA and HAMD were lower in the high self-efficacy group than in the low self-efficacy group. Pearson correlation analysis found that self-efficacy was positively correlated with psychological dimension (r=0.325, P=0.012), social dimension (r=0.412, P=0.000), and total scores of quality of life (r= 0.347, P=0.005), and was negatively correlated with the scores of HAMA (r=-0.348, P=0.010) and HAMD (r=-0.392, P=0.008). Conclusions The self-efficacy of PD patients was closely related to quality of life/negative emotion. Through health education in the clinical nursing practice, their self- efficacy can be enhanced, the negative emotion can be diminished, and the quality of life can be improved. Metrics

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The association of serum uric acid level with dialysis adequacy and nutritional status in peritoneal dialysis patients 2016, 15 (04):  214-218.  doi: 10.3969/j.issn.1671-4091.2016.04.007 Abstract ( 283 )   HTML ( 0 )   PDF (393KB) ( 284 )   Objective To investigate the association of serum uric acid (SUA) level with dialysis adequacy and nutritional status in peritoneal dialysis (PD) patients. Methods This was a retrospective study involving 266 subjects who started PD in our center from January 2008 to July 2014 and were followed up for more than 12 months. Patients were divided into hyperuricemia group and normal SUA group based on SUA level. The association of SUA with nutritional status including prealbumin, total protein, albumin, normalized protein catabolic rate, blood urea nitrogen and with PD adequacy indices including Kt/V, total creatinine clearance (Ccr) and residual renal function (RRF) were analyzed. Results As compared with normal SUA group at baseline, patients in hyperuricemia group at baseline had higher prealbumin (367.076±75.734 vs. 344.644± 72.750 mg/L, t=2.428, P=0.016), total protein (62.713±8.223 vs. 59.807±6.916 g/L, t=3.058, P=0.002), albumin (33.671 ± 4.307 vs. 31.025 ± 4.812 g/L, t=4.678, P＜0.001), serum creatinine (728.096 ± 271.527 vs.647.550 ± 242.555 μmol/L, t=2.525, P=0.012), blood urea nitrogen [18.000 (14.300, 22.450) vs. 14.850 (12.150, 18.200) mmol/L, Z=- 4.205, P＜0.001], triglyceride [1.805 (1.285, 2.537) vs. 1.475 (1.129, 2.382) mmol/L, Z=- 2.241, P=0.025] and phosphorus [1.545 (1.288, 1.803) vs. 1.335 (1.130, 1.530) mmol/L, Z=- 4.519, P＜0.001]. After PD for 12 months, SUA decreased obviously (410.335±86.769 vs. 387.966±79.638 μmol/L, t=4.640, P＜0.001). Multiple regression analyses showed that SUA was positively correlated with male gender (β=28.473, P=0.011), body mass index (β=3.903, P=0.015), systolic blood pressure (β=0.882, P= 0.010), albumin level (β=3.205, P=0.013), and phosphorus level (β=42.248, P=0.005), and negatively correlated with age (β=-0.966, P=0.011), history of diabetes mellitus (β=-25.427, P=0.047), and Kt/V (β=-21.214, P= 0.019). Logistic regression analyses indicated that male, history of diabetes, hyperuricemia, higher body mass index, lower hemoglobin, and lower RRF were significantly correlated with inadequate dialysis. Conclusions PD can effectively improve hyperuricemia. SUA level was closely correlated with nutritional status and dialysis adequacy. Higher SUA in PD patients may suggest the relatively good nutritional status, but hyperuricemia may also associate with inadequate dialysis. Metrics

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Dialysis modality on clinical indicators and insulin resistance in non-diabetic patients with end-stage renal disease 2016, 15 (04):  219-225.  doi: 10.3969/j.issn.1671-4091.2016.04.008 Abstract ( 257 )   HTML ( 0 )   PDF (544KB) ( 227 )   Objective To compare the effect of hemodialysis (HD) and peritoneal dialysis (PD) on clinical indicators and insulin resistance (IR) in non-diabetic patients with end-stage renal disease (ESRD) in order to provide guidelines for non-diabetic patients with ESRD to select appropriate dialysis modality and to improve the comprehensive treatment. Methods A total of 62 non- diabetic adult (>18 years old) patients with ESRD were enrolled in this study. They hospitalized in our hospital between Sept. 2012 and Feb. 2014, had stable blood pressure (<140/90 mmHg), and were ready for dialysis. They were then divided into HD (n= 32) group and PD group (n=30). Clinical indicators including body mass index (BMI), abdominal circumference (AC), hemoglobin (HGB), hypersensitive c-reactive protein (hsCRP), serum albumin (ALB), urea nitrogen (BUN), serum creatinine (Scr), uric acid (UA), serum calcium (Ca), phosphorus (P), calcium-phosphorus product (Ca×P), intact parathyroid hormone (iPTH), albumin (ALB), triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) glycosylated hemoglobin (HbA1C), fasting blood glucose (FBG), true fasting insulin (FINS), and insulin resistance index (IRI) were examined before dialysis and after the dialysis for 6 months and 12 months. The effects of HD and PD on clinical indicators and IR were then assayed. Results ①There were no statistical differences in these clinical indicators between HD and PD groups before dialysis. When clinical indicators after 6 months of dialysis were compared between HD group and PD group, hsCRP (6.91±4.75 mg/L vs. 4.20±3.68 mg/L, t=2.494, P=0.015) and ALB (33.07±2.10 g/L vs. 30.31±3.47 g/L, t=3.851, P= 0.000) were higher in HD group than in PD group; Ca (2.27± 0.15 mmol/L vs. 2.43±0.15 mmol/L, t=-4.150, P=0.000), Ca×P (57.38±7.17 mg2/dl2 vs. 61.49± 7.83 mg2/dl2,  t=-2.159, P=0.035), TC (4.94 ± 0.72 mmol/L vs. 5.50 ± 1.04 mmol/L, t=-2.482, P=0.016), TG (1.52±0.40 mmol/L vs. 1.87±0.72 mmol/L, t=-2.351, P= 0.023),  LDL (2.62±0.54 mmol/L vs. 3.08±0.57 mmol/L, t=-3.294, P= 0.002), and HDL (1.08±0.20 mmol/L vs. 1.29±0.26 mmol/L, t=-3.667, P=0.001) were lower in HD group than in PD group. ②There was no statistical difference in IRI between HD group and PD group (1.16±0.30 vs. 1.06±0.21). After the dialysis for 12 months, IRI increased in PD group (1.34±0.21 vs. 0.98±0.30), and IRI increased more in PD group than in HD group (1.34±0.21 vs. 0.98±0.30). Therefore, PD aggravated IR status. Conclusion In non-diabetic patients with ESRD, anemia, malnutrition, abnormal carbohydrate and lipid metabolism are more common in those after PD than in those after HD. PD may also aggravate IR. Consequently, abnormal metabolism and IR should be emphasized in dialysis period, and corresponding interventionsshould be carried out to improve patients’prognosis. Metrics

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Studies on the senescent processes of human peritoneal mesothelial cells relating to peritoneal dialysis fluid and the intervention effect of bone marrow derived mesenchymal stem cells 2016, 15 (04):  226-229.  doi: 10.3969/j.issn.1671-4091.2016.04.009 Abstract ( 206 )   HTML ( 0 )   PDF (541KB) ( 228 )   Objective To investigate the replicative senescence of human peritoneal mesothelial cells (HPMCs) induced by peritoneal dialysis fluid (PDF) and the intervention effect of bone marrow derived mesenchymalstem cells (MSCs). Methods HPMCs were isolated from peritoneal tissue and cultured in RPMI 1640 medium. PDF was added to the cultured HPMCs. The effects of PDF on senescence of HPMCs were examined by observing number of cell passages, cell proliferation, cell cycle and telomere length. After the addition of MSCs into the culture medium, the effects of MSCs on the senescence of HPMCs were observed, and the related mechanism was evaluated by observing number of cell passages, cell growth rate, cell cycle and telomere length. Results PDF treated HPMCs showed reduction of cell passage number by four to five, suppression of growth rate by 42%, and cease of cell cycle at G1 phase, as compared with the HPMCs cultured in RPMI 1640. Telomere length was shortened (4.35±0.12 kb vs. 5.45±0.10 kb, t=2.228, P=0.000]. Morphological characteristics of senescent cells appeared earlier. The senescence process delayed in HPMCs with the addition of MSCs. Conclusion MSCs may delay cellular senescence of the HPMCs induced by PDF treatment, which provides a new theoretical basis and a treatment method for delaying peritoneal fibrosis and improving longterm efficacy of peritoneal dialysis. Metrics

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Adipocytes promote the expression of ICAM-1 in endothelial cells through TNF-α - p38 MAPK signal pathway 2016, 15 (04):  230-234.  doi: 10.3969/j.issn.1671-4091.2016.04.010 Abstract ( 222 )   HTML ( 0 )   PDF (1376KB) ( 202 )   Objectives Endothelial dysfunction is the main cause of cardiovascular disease (CVD) in peritoneal dialysis (PD) patients. This study mimicked the high glucose condition of dialysate, and observed the role of adipocytes on the expression of ICAM-1 in endothelial cells, aiming to explore the mechanism of endothelial dysfunction. Methods 3T3-L1 cells were differentiated into mature adipocytes. Endothelial cells (ECs) were divided into six groups according to the medium used: blank control group (ECs cultured in DMEM), high glucose group (ECs treated with 139 mmol/L glucose), high mannitol group (ECs treated with 139 mmol/L mannitol), control-adipocyte group (ECs treated with the supernatant of adipocytes in DMEM), glucose-adipocyte group (ECs treated with the supernatant of adipocytes in higher glucose concentration), and mannitol-adipocyte group (ECs treated with the supernatant of adipocytes in higher mannitol concentration). Proliferation of ECs in 24h was measured by cell counting kit-8 (CCK-8) assay. Expression of tumor necrosis factor-α (TNF-α) by adipocytes was measured by enzyme-linked immunosorbent assay (ELISA). ICAM-1 level with or without the addition of SB203580 (a blocker of p38 mitogen-activated protein kinase, MAPK) in ECs was detected by western blot. Results More than 90% of the 3T3-L1 cells differentiated into adipocytes. The proliferation of ECs was promoted by the treatment of ECs with high glucose, high mannitol, super-natant of adipocytes in high glucose or high mannitol (high glucose group/control group, 1.600 ± 0.104 vs. 1.000±0.000, t=9.954, P=0.010; high mannitol group/control group, 1.240±0.100 vs. 1.000±0.000, t=4.157, P= 0.014; glucose- adipocyte group/control- adipocyte group, 1.563 ± 0.181 vs. 1.213 ± 0.097, t=2.945, P=0.042; mannitol- adipocyte group/control- adipocyte group, 1.520±1.473 vs. 1.213±0.097, t=3.010, P=0.040). High glucose significantly promoted the production of TNF- α in adipocytes (2515.313 ± 277.434 vs. 788.683 ± 167.267, t=9.232, P=0.001). The supernatant of high glucose treated adipocytes significantly promoted the expression of ICAM-1 in endothelial cells (1.533±0.058 vs. 1.133±0.153, t=4.243, P=0.013), and this promotion was partially inhibited by the p38 MAPK blocker SB203580 (0.850±0.111 vs. 1.124±0.108, t=- 3.053, P= 0.038). Conclusion Adipocytes exposed to high glucose promoted the expression of ICAM-1 in endothelial cells through TNF-α - p38 MAPK signal pathway. This process may relate to endothelial dysfunction and cardiovascular events in PD patients. Metrics

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Roles of urotensin II in the regulation of blood pressure in Dah1 salt resistant rat 2016, 15 (04):  235-240.  doi: 10.3969/j.issn.1671-4091.2016.04.011 Abstract ( 211 )   HTML ( 0 )   PDF (2541KB) ( 200 )   Objective Our previous study suggests that urotensin II (UII) plays a role in vasodilation when fluid volume in the body increases. To elucidate the role of UII in blood pressure regulation, we conducted this study using animal models that resemble the hemodynamic profiles of volume resistant and volume sensitive patients. In addition, a UII receptor knockout mouse model was established. Methods Dahl salt resistant (SR) rats, Dah1 salt sensitivity (SS) rats, wild type (WT) mice, and UII receptor knock out (KO) mice were used in this study. After placing these four groups of animals on a high salt diet for 6 or 8 weeks, renal tissue was used to perform immunochemistry staining, real time PCR, and western blot to measure UII level in kidney. Results After high salt diet for 6 weeks, systolic blood pressure was significantly higher in SS group than in SR group (160±13 mmHg vs. 114±6 mmHg, t=8.191, P＜0.001). Compared with SS rats, SR rats had higher plasma UII (60.3±3.8 vs. 51.6±13.5 pg/ml, t=2.450, P=0.021), urinary UII (236.9±27.89 ng/g vs. 114.70 ± 6.28 ng/g, t=3.898, P=0.003), 24 hours urinary sodium excretion (4w: 3.243 ± 0.306 mmol vs. 1.753±0.127 mmol, t=3.942, P=0.010; 6w: 2.870±0.134 mmol vs. 1.713±0.077 mmol, t=3.942, P＜0.001), and urinary creatinine clearance (6w: 6.532±0.269 ml/min vs. 2.632±0.172 ml/min, t=12.210, P＜0.001). After high salt diet for 6 weeks, more UII receptor was expressed in renal tubular epithelia of SR rats as compared with those of SS rats (0.059±0.008 vs. 0.036±0.001, t=4.540, P=0.010). After high salt diet for 8 weeks, systolic blood pressure was significantly higher in KO mice than in WT mice (113 ± 3 mmHg vs. 102 ± 4mmHg, t=4.750, P=0.003). Conclusions The present results first demonstrate that UII can play a role in the regulation of blood pressure in Dah1 SR rats, probably through the effects of UII on ateriole dilatation and promotion of sodium excretion from renal tubules. Metrics

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The effect of Tai Chi exercise on the state of anxiety and depression and sleep quality in hemodialysis patients 2016, 15 (04):  241-243.  doi: 10.3969/j.issn.1671-4091.2016.04.012 Abstract ( 301 )   HTML ( 2 )   PDF (353KB) ( 335 )   Objective To investigate the effect of Tai Chi exercise on the improvement of anxiety, depression and sleep quality in hemodialysis patients. Methods This was a non- randomized and concurrent control trial. A total of 40 patients willing to take part in this study were enrolled as the intervention group. At the same time, 40 patients with age and body mass index matched to those in intervention group were selected as the control group. Patients in the two groups received regular hemodialysis and nursing. Tai Chi training provided by the researchers was conducted in the intervention group, but not in the control group. The anxiety and depression scores and sleep quality were measured after 6 months. Results Seventy-one patients (in intervention group 6 cases dropped out; in control group 3 cases dropped out) completed this study. After 6 months, the intervention group had lower scores of self- rating anxiety scale (SAS) (46.36±8.21 vs. 50.49± 9.88, t=3.848, P=0.001), self-rating depression scale (SDS) (41.39±9.04 vs. 51.39±10.25, t=4.862, P=0.001), Pittsburgh sleep quality index (7.15±4.27 vs. 9.29±4.02, t=2.194, P=0.032), sleep continuity (0.91±0.83 vs. 1.39±1.08, t=2.110, P=0.038), and sleep efficiency (0.71±0.94 vs. 1.53±1.16, t=3.281, P=0.002), as compared with those in the control group. Conclusion Tai Chi exercise can improve the state of anxiety and depression and sleep quality in hemodialysis patients. This exercise mode can be used in hemodialysis patients and can be carried out widely. Metrics

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A survey of the prevalence of chronic kidney disease and its related risk factors in adults from rural area of Langfang 2016, 15 (04):  247-250.  doi: 10.3969/j.issn.1671-4091.2016.04.014 Abstract ( 260 )   HTML ( 2 )   PDF (385KB) ( 214 )   Objective To investigate the prevalence of chronic kidney disease (CKD) in adults from rural area of Langfang and its related risk factors. Methods A random sample of adults older than 18 years and resident in the rural area of Langfang for more than 6 months was selected by multi- stage cluster sampling method. Clinical data including sex, age, educational level, hypertension, diabetes, blood lipids, uric acid and obesity were compared to assess the risk factors relating to CKD. The positive factors were then analyzed by logistic regression method. Results A total of 18,062 subjects were enrolled in this study, and the prevalence of CKD was 10.75%. Analysis of the factors relating to CKD showed that female (P=0.000), age (P=0.000), hypertension (P=0.000), diabetes (P=0.000), blood lipids (P=0.021), uric acid (P=0.026) were the influencing factors. Multivariate logistic regression analyses showed that age (OR=1.440, 95% CI 1.732～2.194), hypertension (OR=3.734, 95%CI 2.764～6.423) and diabetes (OR=4.560, 95%CI 2.650～5.850) were the independent influencing factors for CKD patients. Conclusion The prevalence of CKD in adults from rural area of Langfang is higher. Female, hypertension, and diabetes are closely related to the prevalence of CKD. Early preventive measures should be emphasized to improve prognosis of the patients. Metrics