Chinese Journal of Blood Purification

12 July 2016, Volume 15 Issue 07 Previous Issue    Next Issue

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Application of continuous renal replacement for the treatment of severely burned patients 2016, 15 (07):  321-324.  doi: 10.3969/j.issn.1671-4091.2016.07.001 Abstract ( 285 )   HTML ( 0 )   PDF (383KB) ( 233 )   Severely burned patients remain to have high mortality and serious prognosis, and are in need of efforts to improve their treatment. Strong systemic response to burn injury manifested as stress status, hypercytokinemia and hypermetabolism plays an important role in the deterioration to severe clinical condition and unfavorable outcome in these patients. Acute kidney injury (AKI) in burned patients has some characteristics such as apparent glomerular and tubular damages, of which the malfunctional status and damage severity may not be exactly reflected by conventional parameters such as the increase of serum creatinine. Rhabdomyolysis and associated AKI may also be common in these patients. Despite the lack of clinical experience on evidence- based medicine about continuous renal replacement of therapy (CRRT) for severely burned patients, CRRT may stabilize clinical conditions and obtain a better outcome by alleviating stress reactions and hypermetabolism, continuously removing toxins from circulation, and maintaining homeostasis from the point of view of pathological changes and clinical course in burn injury. However, several practical issues about CRRT including catheter-related infection, anticoagulation and drug dose adjustment need to be studied further. Metrics

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How to improve the prognosis of patients on maintenance hemodialysis 2016, 15 (07):  325-328.  doi: 10.3969/j.issn.1671-4091.2016.07.002 Abstract ( 237 )   HTML ( 0 )   PDF (362KB) ( 298 )   The number of patients on maintenance hemodialysis (MHD) is increasing rapidly in association with the progress of blood purification technology. The improvement of prognosis in MHD patients becomes a clinically important issue. Many studies indicated that the risk factors for MHD patients included primary disease, hypertension, mineral and bone disorders, malnutrition, uremic complications, etc. Comprehensive treatment may be the best way to improve their prognosis. Metrics

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Medical ethics relating to the modality selection of kidney replacement therapy in end stage renal disease patients 2016, 15 (07):  329-331.  doi: 10.3969/j.issn.1671-4091.2016.07.003 Abstract ( 225 )   HTML ( 0 )   PDF (335KB) ( 258 )   Patients with end stage renal disease (ESRD) are treated with one of the three kidney replacement therapies, hemodialysis, peritoneal dialysis and kidney transplantation. Social background, economic condition and living style should be considered in the modality selection of kidney replacement therapies. Medical ethics involved in the selection need to be investigated. Based on the clinical evaluation of ESRD patients, treatment progress, and the results of therapeutic efficacy studies, the author suggests in this paper that the fundamental principles of medical ethics including justice, respect, health guidance combined with psychological counseling, best medical skills and ethics are the rules necessarily for the modality selection, Metrics

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Bone metabolism and bone mineral density in maintenance hemodialysis patients with secondary hyperparathyroidism 2016, 15 (07):  332-335.  doi: 10.3969/j.issn.1671-4091.2016.07.004 Abstract ( 318 )   HTML ( 0 )   PDF (397KB) ( 331 )   Objective To observe the changes of bone metabolism and bone mineral density (BMD) in the maintenance hemodialysis (MHD) patients with secondary hyperparathyroidism (SHPT). Methods Eighty-six MHD patients with SHPT were enrolled in this study and were assigned according to their serum intact parathyroid (iPTH) level into 4 groups, group A (150～300 pg/ml, n=23), group B (300～600 pg/ml, n=21), group C (600～1000 pg/ml, n=24) and group D (＞1000 pg/ml, n=18), and according to the presence or absence of diabetes into diabetes group and non-diabetes group. BMD and serum albumin, calcium, phosphorus, alkaline phosphatase (ALP) and iPTH were assayed. Changes of these parameters in different groups and their relevance to iPTH levels were analyzed. Results Serum phosphorus (LSD-t=2.030, P=0.049), L1-L4 BMD (LSD-t=4.591, P＜0.001) and young adult L1-L4 T value (LSD-t=4.813, P＜0.001) were significantly different between group B and group C. iPTH was significantly higher in non-diabetes group than in diabetes group (t=-7.387, P＜0.001), while left femur BMD (t=2.414, P =0.018), young adult left femur T value (t= 5.477, P＜0.001), left femoral Wards triangle BMD (t=3.252, P=0.020) and young adult left femoral Wards triangle T value (t=7.758, P＜0.001) were significantly lower in non-diabetes group than in diabetes group ( P＜ 0.05). In groups A, B, C and D, left femur BMD (1.07±0.18, 1.00±0.16, 0.84±0.15 and 0.78±0.43 respectively; F=5.616, P =0.001), young adult left femur T value (1.00±0.25, 0.12±1.24, -1.08 ±1.20 and -1.05±30 respectively; F=16.377, P =0.001), left femoral Wards triangle BMD (1.00±0.25, 0.91±0.25, 0.66±0.09 and 0.62±0.03 respectively; F=6.915, P＜0.001) and young adult left femoral Wards triangle T value (0.84±1.68, 0.18±1.62, -1.45±0.60 and -1.75±0.19 respectively; F=14.928, P＜0.001) decreased gradually along with the increase of serum iPTH level (P＜0.01). Correlation study revealed that iPTH level was positively correlated with ALP (r=0.782, P＜0.001), and negatively correlated with left femur BMD (r=-0.532, P=0.025), young adult left femur T value (r=- 0.520, P=0.004), left femoral Wards triangle BMD (r=- 0.514, P＜0.001), and young adult left femoral Wards triangle T value (r=-0.512, P＜0.001). Conclusions In MHD patients with SHPT, hyperphosphatemia may become a marker of lumbar bone metabolism abnormalities, and serum iPTH level can be used to estimate bone metabolism of femur, especially that of femoralWards triangle. Metrics

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Effect of Non-surgical Periodontal therapy on Periodontal Status and hs-CRP in Maintenance Hemodialysis Patients with Chronic Periodontitis 2016, 15 (07):  336-340.  Abstract ( 177 )   HTML ( 0 )   PDF (356KB) ( 192 )   Abstract Objective To investigate the maintenance hemodialysis (MHD) patients with chronic periodontal disease . This intervention study was designed to evaluate the effects of non-surgical periodontal therapy on the clinical response and systemic status of MHD patients. and to explore its possible mechanism of influence. Methods Choosing 85 patients with MHD，and other 85 adults from healthy controls group. Record the general conditiongs, have the correlation analysis on periodontal disease index(PDI) and hs-CRP of the patients with MHD. The 40 patients with moderate or severe chronic periodontal disease were treated with non surgical periodontal therapy. The patients were treated with baseline and 1 and 3 months after treatment. The serum hs-CRP was measured by enzyme-linked immunosorbent assay. Results The MHD patients with periodontal disease prevalence rate was 83.5%, debris index (DI) 2.1 (1.2), calculus index (CI) 1.5 (0.8), PDI 3.9 (1.9) were higher than those of healthy control group (P < 0.05). In moderate and severe periodontal disease group, the level of hs-CRP 16 + 6.9mmol/L was higher than that of periodontal health and mild periodontal disease group 11.1 + 7.4mmol/L (P < 0.05). Periodontal clinical parameters and hs-CRP levels were significantly lower in patients with MHD after non-surgical periodontal therapy (P < 0.05). Conclusions Non-surgical periodontal therapy could decrease the local and systemic inflammatory state of MHD patients with chronic periodontal disease, which is beneficial to prevent and treat micro-inflammation of dialysis. Metrics

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Prevalence and risk factors of peripheral artery disease in maintenance hemodialysis patients 2016, 15 (07):  341-344.  doi: 10.3969/j.issn.1671-4091.2016.07.006 Abstract ( 208 )   HTML ( 1 )   PDF (393KB) ( 255 )   Aim To investigate the prevalence and risk factors of peripheral artery disease (PAD) in maintenance hemodialysis patients (MHD) by ankle brachial index (ABI). Methods A total of 254 MHD were enrolled and received questionnaire, physical examinations and laboratory examinations. PAD was diagnosed when ABI＜0.9. Results The prevalence of PAD in MHD patients in our center was 22.04% (56/254) without significant difference between genders, but was higher in older aged group (>65 years) than in younger group (39% vs. 13.9%, P＜0.05). Logistic regression showed that age (OR 1.822～19.029, P=0.003), dialysis age (OR 1.035～1.127, P＜0.001), diabetes (OR, 1.070～9.200, P=0.037), low albumin level (OR 3.472～ 24.16, P＜0.001), cerebral vascular disease history (OR 1.338～38.654, P =0.002), abdominal obesity (OR 2.149～24.689, P =0.001), hypertriglyceridemia (OR 1.050～10.102, P=0.041), Kt/V (OR 2.235～553.415, P= 0.011), alkaline phosphatase (OR 1.249～16.635, P=0.022), and C-reactive protein (OR 1.383～18.793, P = 0.014) were the independent risk factors for PAD. Conclusions MHD patients of older age, longer dialysis age, diabetes, lower Kt/v, abdominal obesity, lower albumin level, higher alkaline phosphatase, increased C-reactive protein, hypertriglyceridemia, and cerebral vascular disease history had a relatively higher risk of PAD. Metrics

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Contrast study of the dialyzers with polysulfone membranes and with cellulose diacetate membrane on the outcome of acute kidney injury 2016, 15 (07):  345-349.  doi: 10.3969/j.issn.1671-4091.2016.07.007 Abstract ( 353 )   HTML ( 0 )   PDF (433KB) ( 307 )   Objective To compare the outcome of acute kidney injury (AKI) patients using dialyzers with different membranes, and to estimate the clinical significance of membrane permeability by comparing the efficacies of high-flux membrane and low-flux membrane dialyzers. Methods This prospective, randomized, single-centered study included 102 AKI patients treated with hemodialysis (HD). Patients were stratified according to age, gender, and APACHE II score, and then randomized into three dialysis membrane groups: low- flux polysulfone group, high- flux polysulfone group, and modified cellulose diacetate group. Results Baseline characteristics were similar among the 3 groups. All-cause mortality by day 80 was 41.1% (14/34) in the modified cellulose diacetate group, 58.8% (20/34) in the low-flux polysulfone group, and 61.8% (21/34) in the high-flux polysulfone group. Survival rate was significant different among the three groups (multivariate Cox's proportional hazards model, HR 0.781, 95% CI 0.621~0.827, P=0.028), while the period necessary for renal function recovery (P=0.852), the flux of the membrane (HR 0.856, 95% CI 0.432～1.121, P=0.745), and the number of dialysis sessions required before recovery (P=0.764) had no differences among the three groups. Conclusions The survival rate was significantly different in AKI patients using modified cellulose diacetate membrane dialyzer and those using more biocompatible high-flux or low-flux polysulfone membrane dialyzers, while their outcomes were not influenced by the flux of the membrane. Metrics

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Comparison of two empirical therapies for the treatment of peritoneal dialysis related peritonitis 2016, 15 (07):  350-352.  doi: 10.3969/j.issn.1671-4091.2016.07.008 Abstract ( 259 )   HTML ( 0 )   PDF (364KB) ( 204 )   Objective To investigate the effect of two empirical therapies for the treatment of peritoneal dialysis (PD)- related peritonitis. Methods Bacterial culture and drug resistance tests were performed for 134 patients with PD- related peritonitis. Fifty- nine patients were treated with cefazolin plus ceftazidime (group CC), and 75 patients were treated with vancomycin plus ceftazidime (group VC). Therapeutic efficacy was compared between the two groups. Results the rate of drug resistance was 39.42% to cefazolin, and was 45.08% to ceftazidime. No strains resistant to vancomycin were found. The infection rate of Gram-positive bacteria was 57.63% in group CC and was 52% in group VC (χ2=0.924, P=1.026). Effective rates at the early period of the treatment and after 2 weeks were 79.66% and 91.53% respectively in group CC, and were 82.67% and 93.33% respectively in group VC, without significant difference in efficacy between the two groups (χ2=1.041, P=0.873 for early period of treatment; χ2=0.985, P=0.926 after the treatment for two weeks). Conclusion Both the two kinds of therapies were effective for the treatment of PD-related peritonitis, and can be recommended for clinical use. Metrics

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Continuous plasma adsorption filtration and other intervention strategies for the treatment of acute drug intoxication 2016, 15 (07):  353-357.  doi: 10.3969/j.issn.1671-4091.2016.07.009 Abstract ( 241 )   HTML ( 1 )   PDF (365KB) ( 269 )   Objective To study continuous plasma adsorption filtration and other intervention strategies including monitoring of vital signs, pressure measurement in blood purification instrument, and anticoagulant during extracorporeal circulation for the treatment of acute drug poisoning. Methods This was a retrospective study for acute drug poisoning patients treated in the period of Jan. 2010 to May 2010 in the Center for Intoxication Emergency, Affiliated Hospital of Logistics College of Armed Police Force. Patients were treated with continuous plasma filtration adsorption (CPFA; group A, n=89), continuous venovenous hemofiltration (CVVH; group B, n=89), or continuous plasma adsorption (group C, n=89). Systolic blood pressure, heart rate and venous pressure before continuous blood purification (CBP) and after CBP for 10, 30, and 60 minutes, blood coagulation function before CBP and after CBP for 3, 6, 12 hours, and blood flow velocity, arterial pressure, pressure before the filter, venous pressure, transmembrane pressure, and pressure difference across the filter after CBP for 0.5, 3, 6, and 12 hours were compared among the 3 groups. Results There were no differences in gender, age, and clinical diagnosis among the 3 groups (for gender: χ2=0.069, P=0.753; for age: χ2= 0.012, P=0.893; for clinical diagnosis: χ2=0.173, P=0.236). However, anticoagulation method was statistically different among the 3 groups (χ2=6.596, P=0.013). There were no statistical differences in systolic blood pressure, heart rate and venous pressure before CBP and after CBP for 10, 30 and 60 minutes among the 3 groups (for systolic blood pressure: F=1.154, 2.732, 2.132 and 1.117, P=0.532, 0.367, 0.473 and 0.532; for hear rate: F= 2.183, 1.105, 1.127 and 1.165, P=0.463, 0.537, 0.517 and 0.537; for venous pressure: F=2.132, 1.974, 2.118 and 2.734, P=0.162, 0.423, 0.397 and 0.476, before CBP and after CBP for 10, 30 and 60 minutes respectively). There were no statistical differences in activated clotting time (ACT), activated partial thromboplastin time (APPT), and venous free Ca+2 before CBP and after CBP for 3, 6 and 12 hours among the 3 groups (for ACT: F=1.389, 0.832, 0.764 and 0.967, P=0.132, 0.475, 0.619 and 0.397; for APPT: F=0.893, 1.287, 1.769 and 1.197, P=0.513, 0.195, 0.096 and 0.197; for venous free Ca+2: F=2.174, 2.165, 1.135 and 0.973, P=0.093, 0.089, 0.298 and 0.498, before CBP and after CBP for 3, 6 and 12 hours respectively). There were no differences in blood flow velocity, arterial pressure and venous pressure after CBP for 0.5, 3, 6, and 12 hours among the 3 groups (for blood flow velocity: F=0.985, 1.125, 0.932 and 0.845, P=0.316, 0.367, 0.513 and 0.579; for arterial pressure: F=0.983, 0.875, 0.927 and 1.107, P=0.326, 0.516, 0.321 and 0.225; for venous pressure: F=1.832, 1.974, 0.893 and 1.134, P=0.187, 0.129, 0.132 and 0.176, after CBP for 30 minutes, 3, 6, and 12 hours respectively). However, there were statistical differences in pressure before the filter and pressure difference across the filter after CBP for 30 minutes, 3, 6, and 12 hours among the 3 groups (for pressure before the filter: F= 17.985, 20.125, 18.932, 25.845, P＜0.001; for pressure difference across the filter: F=19.983, 23.875, 19.927, 17.107, P＜0.001, after CBP for 30 minutes, 3, 6, and 12 hours respectively). Conclusion Although anticoagulation method was dissimilar, the coagulation function at several time points during CBP had no differences among the 3 groups. Pressure before the filter and pressure difference across the filter after CBP were statistically different among the 3 groups, but they were still in the normal ranges of CBP. The extracorporeal blood volume in CPFA is larger than that of CVVH and continuous plasma adsorption, but it can still be used for the treatment of drug intoxication through sophisticated intervention strategies. Metrics

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The application of mind map in the health education for patients with arteriovenous fistula operation 2016, 15 (07):  358-360.  doi: 10.3969/j.issn.1671-4091.2016.07.010 Abstract ( 272 )   HTML ( 1 )   PDF (421KB) ( 359 )   Objective To evaluate the application of mind map in the health education for patients with arteriovenous fistula operation. Methods Sixty patients with regular autologous arteriovenous internal fistula were randomly divided into observation group (n=30) and control group (n=30). Observation group used mind map for health education, and control group adopted the traditional way for health education. Awareness of protective knowledge about arteriovenous fistula, psychological status before and after the vascular operation, and satisfactory feelings of the patients were compared between the two groups. Results As for the protective knowledge about arteriovenous fistulas, observation group was better than control group, and the difference was statistically significant (judging the patency of internal fistula: χ2=9.017, P=0.003; times of functional exercise: χ2=8.366, P=0.004; emergency management: χ2=7.954, P=0.005; avoidance of invasive operation: χ2=13.017, P=0.000; avoidance of lifting heavy objects: χ2=15.864, P=0.000; avoidance of compression on internal fistula: χ2=16.484, P=0.000). The satisfactory feelings were also better in observation group than in control group (Wilcoxon W=715.000, P=0.000). After the intervention, Self- Rating Anxiety Scale (SAS) score and Self- Rating Depression Scale (SDS) score were lower in observation group than in control group (for SAS: t=3.457, P=0.000; for SDS: t=4.162, P=0.018). Conclusion Mind map in health education can improve the awareness of knowledge about protecting arteriovenous fistula, negative psychology, and satisfactory feelings, potentially useful in clinical practice. Metrics

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Application of blood pressure monitoring cloud platform in patients on hemodialysis 2016, 15 (07):  361-365.  doi: 10.3969/j.issn.1671-4091.2016.07.011 Abstract ( 262 )   HTML ( 0 )   PDF (874KB) ( 197 )   Background Monitoring blood pressure is not easily accessible to doctors for patients on hemodialysis. The development of telemedicine has made mobile blood pressure monitor on the cloud possible. Methods A mobile blood pressure monitor and cloud platform, named H-cloud (Hypertension-cloud) was developed, which consists of portable blood pressure devices and background recording cloud platform. Blood pressure was first measured by sphygmomanometer and then sent to mobile devices via wire or blue- tooth. The mobile devices then sent the data to the background cloud platform under 3G networks. The data, graph depicts, medication information and interaction between doctors and patients could be checked on the mobile devices or on the website. Local patients on regular hemodialysis willing to participate in the study were recruited and trained for use of the system for a period of 3 months. A questionnaire was handed out at the end of the study as the feedback. Results There were 23 patients participating in the study. Their median dialysis duration was 22 months, and their mean dialysis time was 11.7±0.9 hours/week. 39.1% patients were caused by hypertensive nephropathy. 22 patients received antihypertensive treatment. In the three months monitoring, the average number of days to measure was 37.0, and the maximal day of continuous monitoring was 81.0. 34.8% patients were monitored three times a day. The average proportion of hypertension in monitoring data was 60.0%. At the end of the research, 22 patients participated in the questionnaire. The item of‘the safety of the system’had the highest score (4.5±0.5), while the item of‘the convenience of the system’and‘the reliability of the data transmission’had the lowest score, with 3.8±1.0 and 3.8±0.9 for each. However, all of them spoke highly of the potential of the system. Conclusions The H-cloud system with mobile blood pressure monitor and cloud platform can be potentially used among patients on hemodialysis at home. However, a more advanced system has to be developed in the future. Metrics

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Blood dialysis room clinical engineers present situation and development trend 2016, 15 (07):  366-368.  doi: 10.3969/j.issn.1671-4091.2016.07.012 Abstract ( 355 )   HTML ( 0 )   PDF (311KB) ( 312 )   This paper from the foreign development experience of clinical engineers launches the research, combined with domestic clinical engineers present situation came to the conclusion that the lack of system is the leading cause of domestic clinical engineers awkward situation. Therefore, establish and improve the clinical engineers professional qualification certification system is urgently needed. Clinical engineers and future need from maintenance to maintain the main work mode, which is the trend of the development of clinical engineers at home and abroad. Metrics

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An investigation on the related factors for adherence behaviors in maintenance hemodialysis patients 2016, 15 (07):  372-376.  doi: 10.3969/j.issn.1671-4091.2016.07.014 Abstract ( 263 )   HTML ( 2 )   PDF (402KB) ( 431 )   Objective To investigate the adherence to medical therapies, the related factors, and the relationship between the adherence and clinical outcomes in maintenance hemodialysis (MHD) patients. Methods We performed a survey to evaluate the adherence in MHD patients in two tertiary hospitals in Beijing using the end-stage renal disease-adherence questionnaire (ESRD-AQ). One-way ANOVA was used to analyze the relationship between adherence and clinical outcome. Logistic regression was used to analyze the related factors for non- adherence behaviors. Results A total of 189 patients participated in this survey and valid questionnaires were collected from 182 patients (males 87; average age 57.8+14.4 years; dialysis vintage >5 years in 51.1% patients). The adherence rates of treatment, medication, fluid and diet were 70.9%, 93.4%, 79.1% and 76.9% respectively. Gender (OR=2.298, 95% CI 1.127～4.683, P=0.022), income (OR=2.539, 95% CI 1.123～5.740, P=0.025), education level (OR=3.453, 95% CI 1.080～11.039, P=0.037), employment state (OR=3.286, 95% CI 1.272～8.489, P=0.014), and race (OR=7.611, 95% CI 1.815～31.922, P=0.006) were the positively related factors for adherence. Conclusion The adherence in MHD patients is insufficient, especially for men, working patients, minority patients, patients with lower education level and low economic level. This study suggests that health care workers should pay more efforts on health education to improve the clinical indicators of MHD patients, and thus to improve their quality of life and health condition. Metrics

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Investigation and analysis of the factors influencing the compliance in peritoneal dialysis patients 2016, 15 (07):  377-380.  doi: 10.3969/j.issn.1671-4091.2016.07.015 Abstract ( 223 )   HTML ( 0 )   PDF (397KB) ( 227 )   Objective By understanding the current situation and influencing factors for compliance in peritoneal dialysis (PD) patients, so as to develop strategies to improve their compliance. Method A total of 89 PD patients treated in our hospital between Feb. 2012 and Oct. 2013 were enrolled in this study. The compliance and its influencing factors were investigated by self-designed questionnaire. Result The compliance of scheduled visiting, prescribed medication, self management ability of daily life, social and family support, presence of complications were better in PD patients with dialysis age >12 months than in those with dialysis age <12 months (for scheduled visiting: χ2=4.352, P=0.045; for prescribed medication: χ2=7.290, P=0.007; for self management ability of daily life: χ2=6.977, P=0.008; for social and family support: χ2=4.903, P=0.032; for presence of complications: χ2=3.817, P=0.049). The compliance was better in PD patients of >65 years old and <75 years old (χ2=3.470, P=0.028), and worse in PD patients with lower income (χ2=4.971, P=0.046). Conclusion The compliance was different in PD patient with different age and dialysis vintage. Corresponding measures should be carried out to improve their compliance and to postpone the progress of their disease course. Metrics