Chinese Journal of Blood Purification

12 May 2016, Volume 15 Issue 05 Previous Issue    Next Issue

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Vitamin D level and disease outcome in patients with chronic kidney disease 2016, 15 (05):  257-259.  doi: 10.3969/j.issn.1671-4091.2016.05.001 Abstract ( 324 )   HTML ( 0 )   PDF (320KB) ( 307 )   Vitamin D is an important nutrient involved in bone mineral metabolism. In most cases, serum total 25-hydroxyvitamin D (25[OH]D) level represents vitamin D content in the body. Genetic polymorphism in vitamin D binding protein affects the bioavailability of 25(OH)D. There is no consensus about the definition of vitamin D insufficiency and deficiency. Vitamin D insufficiency or deficiency is highly prevalent in patients with chronic kidney disease (CKD) and is closely related to the development and progression of CKD. Vitamin D insufficiency or deficiency is also the risk factor for the progression of renal insufficiency finally to end-stage renal disease necessary to be treated with renal replacement therapy, and also for the renal anemia, cardiovascular events and death in CKD patients. Supplement of vitamin D can increase serum total 25- hydroxyvitamin D concentration, decrease the elevated parathyroid hormone concentration, and improve proteinuria, risk of falls, cardiac and vascular function and prognosis in CKD patients. Metrics

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The prevention of vascular calcification in maintenance hemodialysis patients 2016, 15 (05):  263-265.  doi: 10.3969/j.issn.1671-4091.2016.05.003 Abstract ( 304 )   HTML ( 1 )   PDF (298KB) ( 407 )   Vascular calcification is an independent risk factor for cardiovascular disease, and is prevalent among maintenance hemodialysis (MHD) patients. Over 50% of MHD patients die of cardiovascular disease, and the incidence of cardiovascular disease is 20 to 30 times in MHD patients than in general population of the same age. Consequently, prevention of vascular calcification may significantly decrease the incidence of cardiovascular disease and its mortality rate in MHD patients. Ectopic deposition of calcium and phosphate in blood vessels is the main type of vascular calcification in MHD patients. Treatment of the vascular calcification includes the traditional therapies such as regulation of calcium phosphate metabolism, adequate dialysis, vitamin D preparations, and phosphate binders not containing calcium. Recently, the new phosphate binder preparations, calcium-sensing receptor agonist, and dialysate containing lower calcium concentration effectively stabilize serum calcium and phosphorus levels, maintain normal parathyroid function, and improve the prevention and treatment of vascular calcification in MHD patients. Metrics

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Comparison of the efficacy of lanthanum carbonate and calcium acetate with low phosphorus dietary on hyperphosphatemia among patients on peritoneal dialysis 2016, 15 (05):  269-274.  doi: 10.3969/j.issn.1671-4091.2016.05.005 Abstract ( 474 )   HTML ( 0 )   PDF (476KB) ( 396 )   Objective To compare the efficacy of lanthanum carbonate and calcium acetate with low phosphorus dietary on hyperphosphatemia among patients on peritoneal dialysis (PD). Methods PD patients with hyperphosphatemia treated in the PD center of our hospital between Dec. 2014 and May 2015 were recruited into this study according to the inclusion and exclusion criteria. They were randomized into lanthanum carbonate group and calcium acetate group. Low calcium dialysate was prescribed appropriately during the study period. The drug doses were adjusted according to serum calcium and phosphorus levels. Serum calcium, phosphorus and intact parathyroid hormone were compared at baseline, after the treatment for one month, 2 months and 3 months. Dietary phosphorus intake, and phosphorus removed from urine and dialysate were measured. Results A total of 51 patients were recruited and randomized into lanthanum carbonate group (n=25) and calcium acetate group (n=26). They completed the study except for 3 patients who dropped out due to gastrointestinal symptoms. At the end of the study, lanthanum carbonate was 1500 (750～1875) mg/d and calcium acetate was 2001 (2001～4002) mg/d. Demographic data, biochemistry parameters, and dialysis adequacy were similar at baseline between the two groups. In the study period of 3 months, serum phosphorus decreased significantly in both groups, and the changes of serum calcium (F=1.122, P=0.293), phosphorus (F=1.118, P=0.732) and iPTH (F=1.638, P=0.206) had no differences between lanthanum carbonate group and calcium acetate group. After the education about dietary phosphorus restriction, lower phosphorus intake from dietary maintained during the study period in both groups. The net phosphorus accumulations at the baseline and at the 3rd month of therapy were similar between lanthanum carbonate group and calcium acetate group [at baseline: 175.98 (84.12～414.93) vs. 256.66 (101.15～443.74), t=2.065, P=0.735; at the 3rd month: 418.74 (214.04～531.20) vs. 361.0 (210.48～394.37), t=0.965, P=0.349]. Conclusion By the appropriate use of lower phosphorus dietary and low calcium dialysate for PD, both lanthanum carbonate and calcium acetate treatment could effectively decrease serum phosphorus of similar extent. No extra risk of higher serum calcium was observed in calcium acetate group. Metrics

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Clinical Observation and Analysis of Corneal and Conjunctival Calcification in Patients with Refractory Secondary Hyperthyroidism 2016, 15 (05):  275-279.  doi: 10.3969/j.issn.1671-4091.2016.05.006 Abstract ( 485 )   HTML ( 0 )   PDF (506KB) ( 303 )   Objective To observe the condition of conjunctival and corneal calcification refractory secondary hyperparathyroidism (SHPT) patients，and explore the relationship between conjunctival and corneal calcification (CCC)，abdominal aortic calcification (AAC) and cardiac valve calcification (CVC). Methods CCC was evaluated by slitlamp eye photographs，and was graded and scored according to Porter’S classification system in the literature．Abdominal lateral X-ray examination were used as criteria to determine the AAC．The AAC score was calculated．Echocardiographic was applied evaluate CVC. Spearman correlation coefficient was used to analyze the relationship between CCC and AAC, CVC．Single factor analysis of variance was used to determine the influence factor of CCC in refractory SHPT patients． Results Forty-three refractory SHPT patients were recruited．Their average age were (49.51±9.66) years and dialysis age were 96 (12，204) months . The CCC was positively correlated with AAC (r=0．337，P＜0.05)，the CCC was positively correlated with CVC (r=0.321，P＜0.05)． As for age (t=- 2.258，P=0.029), smoking history (t=- 2.332，P=0.025)and CVC score (t=-2.835，P=0.007), there were statistically significant difference between the patients in AAC＜5 group and AAC acuity group (all P＜0.05);There was statistically significant difference between the CVC score ＜1 group and CVC＞ 1 group in age (t=-2.283，P=0.028), dialysis age (t=-2.235，P=0.023), blood phosphorus (t=2.927，P=0.006), urea (t=2.330，P=0.025), uric acid (t=2.541，P=0.015), blood HDL (t=-2.634，P=0.012), and AAC score (t=-2.595，P=0.013). Single factor analysis of variance showed that the score of AAC (F=6.803，P=0．003)、CVC (F=6.227，P=0.004)、Smoking history (F=3.334，P=0.046) and Dialysis age (F=4.772，P=0.014) were significant impact on CCC． Conclusions Coniunctival and corneal calcification is common in refractory SHPT patients，and CCC is positively associated with AAC and CVC , The risk of CCC will increase as a result of severer AAC、CVC and dialysis age． Metrics

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The effect of high-efficiency on-line hemodiafiltration combined with hemodialysis on quality of life and survival rate in maintenance hemodialysis patients 2016, 15 (05):  280-284.  doi: 10.3969/j.issn.1671-4091.2016.05.007 Abstract ( 281 )   HTML ( 1 )   PDF (511KB) ( 284 )   Objective To evaluate the effect of high-efficiency on-line hemodiafiltration combined with hemodialysis on quality of life (QOL) and survival rate in maintenance hemodialysis (MHD) patients. Methods Eighty MHD patients were enrolled in this study. They were randomly divided into high-efficiency online hemodiafiltration combined with hemodialysis group (HDF+HD group, n=50) and hemodialysis group (HD group, n=30). Urea clearance index (Kt/V), phosphorus (Pi), HCO3 -, β2-microglobulin (β2-MG), C-reactive protein (CRP), serum albumin (ALB), subjective global nutritional assessment (SGA) and the MOS item short from health survey SF-36 (SF-36) were evaluated at the beginning, and at the 3rd, 6th, 12th, 36th and 60th months of the treatment. The five- year survival rate was calculated. Results At the beginning of the study, there were no significant differences in these related parameters between the two groups (P＞0.05). When comparison was performed between the two groups at the 12th, 36th and 60th month of the treatment, Kt/V, HCO3-, ALB, SGA and SF-36 were significantly increased in HDF+HD group (t=2.604 and P=0.011, t= 2.600 and P=0.011, t=2.598 and P=0.011 for Kt/V, respectively; t=7.693 and P＜0.001, t=12.917 and P＜ 0.001, t=8.145 and P＜0.001 for HCO3- , respectively; t=6.618 and P＜0.001, t=7.688 and P＜0.001, t=7.519 and P＜0.001 for ALB, respectively; t=7.104 and P＜0.001, t=8.933 and P＜0.001, t=6.381 and P＜0.001 for SGA, respectively; t=17.366 and P＜0.001, t=13.971 and P＜0.001, t=11.748 and P＜0.001 for SF-36, respectively); Pi, β2-MG and CRP were significantly decreased in HDF+HD group (t=- 3.080 and P=0.003, t=-3.172 and P=0.002, t=-4.733 and P＜0.001 for Pi, respectively; t=-20.369 and P＜0.001, t=-21.205 and P＜0.001, t=-23.658 and P＜0.001 for β2-MG, respectively; t=-12.983 and P＜0.001, t=-19.689 and P＜0.001, t=- 17.395 and P＜0.001 for CRP, respectively.). In addition, Kaplan- Meier survival curve showed that the five- year survival rate was significantly higher in HDF+HD group than in HD group (χ2=3.917, P=0.048). Multivariate regression analysis demonstrated that SF-36 was negatively correlated with β2-MG (B＝-0.352, P＜0.001), and was positively correlated with SGA (β ＝0.772, P＜0.001). Conclusion Comparing with the conventional hemodialysis, high-efficiency on-line hemodiafiltration combined with hemodialysis can significantly enhance QOL and survival rate in MHD patients. The increased clearance of medium/large molecules toxins and better nutritional status may be the key factors for improved QOL. Metrics

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Clinical effect of total parathyroidectomy combined with forearm autograft in uremic patients complicated with secondary hyperparathyroidism 2016, 15 (05):  285-288.  doi: 10.3969/j.issn.1671-4091.2016.05.008 Abstract ( 264 )   HTML ( 0 )   PDF (405KB) ( 258 )   0bjective To observe the clinical effect of parathyroidectomy (PTX) combined with autograft in forearm in end-stage renal disease (ESRD) patient complicated with refractory secondary hyperthyroidism (SHPT). Methods We retrospectively reviewed 15 MHD patients treated with PTX during the period from Apr. 2014 to Oct. 20l5. Symptoms before and after operation, operation complications, pathological findings of the surgical samples, biochemical parameters, serum iPTH, recurrence of SHPT, and prognosis were analyzed. Results Total PTX was successfully performed in 14 of the 15 cases (93.3%), and one patients with ectopic parathyroid in mediastinum failed to total removal of the gland. No patient died after the operation. SHPT recurred in one patient after 6 months (7.14%). In the 14 patients after total PTX for 6 months, serum iPTH decreased from 2017.21±561.52 ng/L to 122.47±78.74 ng/L (t=-6.460, P＜0.001), serum phosphorus decreased from 2.37 ± 0.70 mmol/L to 1.41 ± 0.98 mmol/L (t=- 2.172, P=0.045), serum calcium changed insignificantly from 2.51±0.25 mmol/L to 2.34±0.27 mmol/L (t=-1.246, P=0.231), ALP decreased from 534.61 ± 321.12 IU/L to 205.32 ± 134.63 IU/L (t=- 2.443, P=0.034), hemoglobin increased from 108 ±21.62 g/L to 118.8±9.98 g/L (t=0.951, P=0.046), ALB increased from 38.01±5.83 g/L to 40.25±3.45 g/L (t=1.02, P=0.042), bone pain and itching alleviated or disappeared, and the SF- 36 score for quality of life increased from 80.91±15.62 to 120.85±25.50 (t=-0.737, P=0.047). Conclusions PTX is a relatively safe and effective method for the treatment of MHD patients with SHPT. PTX can significantly improve biochemical indices, bone pain, itching and quality of life. Total PTX and autograft of a part of the surgical tissue in forearm is an important measure to prevent the recurrence of SHPT. Metrics

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Evaluation of volume load by using the change rate of N terminal brain natriuretic peptide in hemodialysis patients 2016, 15 (05):  289-293.  doi: 10.3969/j.issn.1671-4091.2016.05.009 Abstract ( 293 )   HTML ( 0 )   PDF (421KB) ( 257 )   Objective To explore the diagnostic value of N-terminal pro- brain natriuretic peptide (NTproBNP) change rate in the estimation of volume load and ultrafiltration volume in maintenance hemodialysis (MHD) patients through the analyses of the correlation among NT-proBNP change rate, serum NT-proBNP concentration, blood pressure and water content in the body. Method The change rate of serum NT-proBNP concentration before and after a dialysis session was calculated in 103 maintenance hemodialysis (MHD) patients. These patients were then divided into 2 groups based on the median value of the change rate. NT-proBNP concentration before dialysis, blood pressure, total body water (TWB), extracellular water (ECW), intracellular water (ICW) and serum were compared between the 2 groups. Result ① Serum NT-proBNP concentration decreased significantly after dialysis as compared with the value before dialysis (P=0.001). ② The decrease rate of serum NT-proBNP was less than zero in 32.1% patients, and was more than zero in 67.9% patients. ③ The change rate of NT-proBNP was negatively correlated with the blood pressure at the 2nd hour of a dialysis session (r=-0.198, P=0.045), and was positively correlated with the blood pressure differences between pre- dialysis and at the 2nd hour of a dialysis session (r=0.265, P=0.007). Patients in the group with more NT-proBNP change rate had lower blood pressure at the 2nd (t=2.466, P=0.015) and 3rd hour (t=2.113, P=0.037) in a dialysis session than those in the group with less NT-proBNP change rate. ④ Patients in the group with more NT-proBNP change rate had lower TBW (t=2.579, P=0.012), ECW(t=2.297, P=0.006), ICW (t=2.126, P=0.036) and NT-proBNP (z=1.829, P=0.002) than those in the group with less NT-proBNP change rate. Conclusion Serum NT-proBNP change rate is a useful marker for the determination of volume load and the evaluation of water retention clearance in a defined period of time in MHD patients. Metrics

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The association of bone mineral density and peripheral artery disease in maintenance hemodialysis patients 2016, 15 (05):  294-298.  doi: 10.3969/j.issn.1671-4091.2016.05.010 Abstract ( 275 )   HTML ( 0 )   PDF (430KB) ( 206 )   Objectives Osteoporosis is associated with peripheral artery disease (PAD) in populations, but the relationship is scarcely studied in maintenance hemodialysis (MHD) patients. The ankle-brachial index (ABI) is used to diagnose PAD and is a strong predictor for cardiovascular mortality in MHD patients. This study aims to explore the relationship between bone mineral density (BMD) and ABI in MHD patients. Methods A total of 84 non-diabetic MHD patients were included in this cross-sectional study. An ABI-form device was used to measure the patient’s ABI. Calcaneal BMD was measured by ultrasound bone densitometer. Other clinical and laboratory data were also collected. Results Patients were grouped according to ABI: low group (ABI＜0.9), normal group (0.9≤ ABI ≤1.4), and high group (ABI＞1.4). Patients with low or high ABI were present in 30% of the patients. ANOVA analysis showed that there were significant differences among low group, normal group and high group in age (73.1±11.9, 61.4±11.3 and 72.3±8.4 years, respectively; F= 9.196, P＜0.001), serum C reactive protein (CRP) (30.8±75.3, 5.3±7.1 and 48.4±101.0 mg/L, respectively; F= 4.192, P=0.019), and BMD (-2.4±0.7, -0.9±1.0, -1.1±1.5, respectively; F=14.385, P＜0.001). Univariate correlation showed that PAD was positively associated with age (r=0.43, P＜0.001), serum albumin (r=-0.281, P= 0.010), CRP (r=0.298, P=0.006), and BMD (r=- 0.423, P＜0.001). Multivariate regression analysis showed that age (β=0.013, 95% CI 0.004~0.023, P＜0.001) and BMD (β= -0.153, 95% CI -0.243~-0.064, P＜0.001) were the independent determinants for PAD. Conclusion The prevalence of PAD is high in MHD patients. Osteoporosis is related to PAD, suggesting that osteoporosis is a strong predictor for cardiovascular mortality in MHD patients. Metrics

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Impact of potassium concentration in dialysate on maximum P wave duration and P wave dispersion 2016, 15 (05):  299-303.  doi: 10.3969/j.issn.1671-4091.2016.05.011 Abstract ( 257 )   HTML ( 0 )   PDF (424KB) ( 282 )   Objective The aim of this study was to investigate the impact of potassium concentration in dialysate on maximum P wave duration (Pmax) and P wave dispersion (Pd). Methods A total of 117 maintenance hemodialysisi (MHD) patients with sinus rhythm and treated in the period from Nov. 2014 to Jan. 2015 were enrolled in this self-controlled study. Dialysate containing 2.5 mmol/L K+ (DK2.5) was used in the first week, and dialysate containing 3.0 mmol/L K+ (DK3.0) was used in the next week, followed by DK2.5 thereafter. Ultrafiltration volume in a dialysis session, serum creatinine, BUN, electrolytes, blood pressure, heart rate, and twelve-lead electrocardiogram were measured at the beginning of study, after DK2.5 for a week, and after DK3.0 for a week. Results In the 117 MHD patients (58 males, average age 56.7 years, and median MHD duration 77.3 months), ultrafiltration volume, blood pressure and heart rate were statistically unchanged between dialysis sessions. Biochemistry parameters before dialysis were similar after DK2.5 period and after DK3.0 period. Serum potassium increased (4.0 ± 0.4mmol/L vs. 3.7 ± 0.3mmol/L, t=10.159, P＜0.001) after DK3.0 for a week. Pmax and Pd were prolonged after dialysis. Pmax and Pd after DK3.0 period were shorter than those after DK2.5 period (for Pmax, 115.8±10.7 ms vs. 121.1±11.6 ms, t=-6.215, P＜0.001; for Pd, 40.4± 9.7 ms vs. 46.2±10.3 ms, t=-5.989, P＜0.001). Changes of serum potassium (ΔK+) had no linear relationship with the changes of Pmax (ΔPmax) before and after a dialysis session during the DK2.5 and DK3.0 periods, nor with the changes of Pd (ΔPd). Conclusion Higher potassium concentration (DK3.0) in dialysate can alleviate the prolonged Pmax and Pd after hemodialysis. However, whether long-term DK3.0 can reduce the incidence of atrial fibrillation in MHD patients remains to be studied. Metrics

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Roles of urotensin II in the injury of human renal tubular epithelial cell induced by contrast medium 2016, 15 (05):  304-308.  doi: 10.3969/j.issn.1671-4091.2016.05.012 Abstract ( 258 )   HTML ( 0 )   PDF (852KB) ( 204 )   Objective Previous study showed that plasma urotensin II (UⅡ) increased in contrast induced nephropathy. However, its pathogenesis is unclear. The aim of this study is to observe the roles of UⅡ in the injury of human renal tubular epithelial cell induced by contrast medium. Methods Human renal tubular epithelial cell (HK-2) was exposed in different concentration of UⅡ, contrast medium (Iopromide), and U Ⅱ combined with iopromide for 2～24 hours. Apoptosis rate by annexin V method, malondialdehyde (MDA) level in the supernatant, and autophgy markers including light chain 3-Ⅱ (LC3Ⅱ) and Beclin-1 by western blot were measured. Results ① Both UⅡ 10- 5 mol/L～10- 8 mol/L and iopromide 50 gI/L could increase MDA level in supernatant. MDA in supernatant was 152.65±18.72 nmol/ml, 149.19±1.17 nmol/ml, 151.12± 3.05 nmol/ml and 116.81±6.85 nmol/ml, respectively from the cell treated with UⅡ10- 5 mol/L～10- 8 mol/L, and was 99.44±12.00 nmol/ml from the cells treated with iopromide 50 gI/L, significantly higher than that from normal control cells (20.32±3.00 nmol/ml, F=41.863, P=0.000). MDA in supernatant was lower from the cells treated with UⅡ10-6 mol/l + iopromide 200gI/l (5.95±1.63 nmol/ml) than from those treated with iopromide 200gI/l (41.70±8.46 nmol/ml; P=0.033, 95% CI -66.688～-4.798 by post hoc test Dunnett T3)； ② Both UⅡ and iopromide could induce apoptosis in Hk-2 cells. The rate of late apoptosis was 9.33±0.23%, 8.63±2.10%, 9.93±2.35%, 10.10±1.97%, respectively in cells treated with UⅡ10- 5～10- 8 mol/L, was 8.20±1.21% in cells treated with iopromide 50gI/L, and was 15.03±0.55% in cells treated with iopromide 200gI/L, significantly higher than that in normal control cells (3.65±1.17%; F=28.322, P=0.000 by ANOVA). The rateof late apoptosis was higher in cells treated with UⅡ10- 6 mol/L + iopromide 50gI/L (15.16±2.27%) than in those treated with iopromide 50gI/L (8.20±1.21%, P=0.031, 95% CI 0.681～12.404). However, the rate of late apoptosis was lower in cells treated with UⅡ10-6 mol/L+iopromide 200 gI/L (10.27±0.61%) than in those treated with iopromide 200 gI/L (15.03±0.55%; P=0.000, 95% CI -6.481～-3.041 by post hoc test Dunnett T3). ③ LC3Ⅱ expression was lower in Hk-2 cell treated with UⅡ10-8 mol/L (LC3Ⅱ/actin = 0.029±0.009) than in untreated Hk-2 cells (LC3Ⅱ/actin=0.05±0.01; t=-2.892, P=0.031), but was higher in Hk-2 cells treated with iopromide 50 gI/L (LC3II/actin = 0.40±0.02) than in untreated Hk-2 cells (0.09±0.02, t=4.989, P=0.000). Conclusions Contrast medium can induce oxidative stress, apoptosis and autophagy renal tubular epithelial cell. UII can also induce oxidative stress and apoptosis but inhibit autophagy in renal tubular epithelial cell. U Ⅱ prevents HK-2 cell from apoptosis induced by high dose of contrast medium. The dual roles of UⅡ in the contrast induced nephropathy need to be further studied. Metrics

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Change of pathogens and risk factors for temporary central venous catheter-related infection 2016, 15 (05):  315-318.  doi: 10.3969/j.issn.1671-4091.2016.05.015 Abstract ( 300 )   HTML ( 0 )   PDF (403KB) ( 268 )   Objective To investigate the change of pathogens, drug sensitivity and risk factors of central venous catheter-related infection in hemodialysis patients in order to improve the prevention of catheter-related infection. Methods The main pathogens for catheter- related infection were Gram- positive bacteria (66.7% ) including Staphylococcus aureus (19.6% ), Staphylococcus epidermidis (15.7% ), S.haemolyticus (11.8%) and Enterococcus faecalis (9.8%). Drug sensitivity test showed that these pathogens developed the resistance to multiple drugs including penicillin, amoxicillin, clindamycin and cefazolin with a resistance rate of >79.3%, and were relatively sensitive to vancomycin and linezolid (resistance rate of 0～20.7%). Results showed that albumin level (χ2=5.985, P=0.045), antibiotics before catheterization (χ2=8.535, P=0.017), intubation times (χ2=11.074, P=0.008), catheter indwelling time (χ2=11.861, P=0.004) and underlying disease (χ2=11.264, P=0.007) were significant different between infection group and non-infection group (P＜0.05). Logistic regression showed that albumin level ＜35g/L (OR 1.732, 95% CI 1.084～3.123, P=0.018), intubation times ≥3 (OR 2.011, 95% CI 1.084～3.123, P=0.011), catheter indwelling time ≥2 weeks (OR 1.873, 95% CI 1.108～2.921, P=0.010) and underlying disease (OR 1.793, 95% CI 1.075～2.863, P=0.013) were the independent risk factors for catheter-related infection in patients undergoing blood purification. Results The incidence of catheter-related infection is affected by many factors. The main pathogens for catheter-related infection are Gram-positive bacteria and have the resistance to multiple drugs. In addition to the judicious use of antibiotics and prevention measures, the information about the distribution of pathogens, drug sensitivity test and related risk factors is also useful for the prevention and treatment of catheter-related infection. Conclusions The incidence of catheter-related infection is affected by many factors. The main pathogens for catheterrelated infection are Gram-positive bacteria and have a general drug resistance, based on distribution of pathogens, drug sensitivity test results and related risk factors, which should be taken effective measures to reduce the morbidity of catheter-related infection. Metrics

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Great saphenous vein autograft in the application of arteriovenous internal fistula manual molding experience 2016, 15 (05):  319-320.  doi: 10.3969/j.issn.1671-4091.2016.05.016 Abstract ( 205 )   HTML ( 0 )   PDF (475KB) ( 235 )   Metrics