Chinese Journal of Blood Purification

12 August 2016, Volume 15 Issue 08 Previous Issue    Next Issue

Select

Prophylactic blood purification for contrast-induced acute kidney injury in elderly patient with chronic renal failure 2016, 15 (08):  388-391.  doi: 10.3969/j.issn.1671-4091.2016.08.002 Abstract ( 274 )   HTML ( 0 )   PDF (400KB) ( 383 )   Objective To investigate the effect of intermittent venovenous hemofiltration (IVVH) for the prevention of contrast-induced acute kidney injury (CI-AKI) in elderly patients with chronic renal failure (CRF) as well as the current situation about this clinical issue. Methods A total of 39 elderly (≥60 years old) CRF patients treated with coronary angiography and /or percutaneous coronary intervention (PCI) in Beijing Hospital during the period from Jun. 2014 to Dec. 2015 were retrospectively studied. There were divided into IVVH group (with preventive IVVH after PCI) and non-IVVH group (without preventive IVVH after PCI). The prevalence of CI-AKI and its related clinical data were compared between the two groups. Results The average age was 74.03±7.65 years old in the 39 elderly CRF patients, of whom 18 were in the IVVH group and 21 in the non-IVVH group. In the 18 patients in IVVH group, the primary diseases for CRF were hypertensive nephropathy (n=8), diabetic nephropathy (n=3), ischemic nephropathy (n=2), and other renal diseases (n=5); before PCI, serum cretinine was 188.83 ± 76.68 mmol/l, and eGFR was 30.89±12.38 ml/(min·1.73m2); the average iodinated contrast agent used was 176.67±69.11ml; the parameters of IVVH used were blood flow rate 155.56±9.84 ml/min, hemofiltration fluid replacement rate 29.73±6.42 ml/(kg·h), and ultrafiltration volume 386.72 ±265.75 ml/time. The prevalence of CI-AKI was 5.56% in IVVH group and was 42.86% in non- IVVH group (χ2=5.252, P=0.022). Conclusions Preventive IVVH after PCI is probably an effective measure to reduce the prevalence of CI-AKI in elderly patients with chronic renal failure. Metrics

Select

Predictive value of ischemia modified albumin for cardiovascular events in patients with chronic kidney disease 2016, 15 (08):  392-395.  doi: :10.3969/j.issn.1671-4091.2016.08.003 Abstract ( 186 )   HTML ( 0 )   PDF (468KB) ( 126 )   Objective The aim of this study was to evaluate the efficiency of ischemia-modified albumin (IMA) for predicting major adverse cardiovascular events (MACE) in chronic kidney disease (CKD) patients. Methods A total of 222 CKD patients were enrolled in this study. Baseline characteristics, IMA level and other laboratory measurements were collected and analyzed. The primary end point was the occurrence of MACE. Results A total of 213 participants finally completed this study, and 9 CKD patients were excluded because of dialysis treatment. They were divided into normal IMA group (IMA <85 KU/L, n=159, average IMA=77.12±10.43 KU/L) and high IMA group (IMA >85 KU/L, n=54, average IMA=90.33±12.20 KU/L). At the end of follow-up, the prevalence of MACE was 20.75% (33 cases) in normal IMA group and was 35.19% (19 cases) in high IMA group (χ2=4.549, P=0.033). Logistic regression analysis showed that IMA (OR=1.104, 95% CI 1.033 ~1.178; P=0.028) and hs-CRP (OR=1.232, 95% CI 1.109~1.342; P=0.001) were the independent risk factors for MACE in CKD patients. Kaplan-Meier survival analysis showed that the CKD patients with higher IMA level had lower non-MACE survival rate (Log-rank test, χ2=15.830, P＜0.001), indicating that the CKD patients with higher IMA level have higher prevalence of MACE. Conclusions CKD patients with higher IMA level had higher prevalence of MACE. IMA was the independent risk factors for MACE. Therefore, IMA may be a predictive marker for MACE in CKD patients. Metrics

Select

Clinical study of CRRT on critical disease patients combined with ARDS. 2016, 15 (08):  396-400.  doi: 10.3969/j.issn.1671-4091.2016.08.004 Abstract ( 287 )   HTML ( 0 )   PDF (408KB) ( 312 )   Objective To observe the effect of continuous renal replacement therapy (CRRT) on prognosis, hemodynamics and respiratory mechanics in critical disease patients combined with ARDS. Methods A total of 68 critical disease patients combined with ARDS were randomized into control group (n=34) and CRRT group (n=34). They were all received conventional therapy. Patients in CRRT group underwent continuous veno- venous hemofiltration (CVVH) as well at the earlier disease stage. Blood biochemistry, critical scores (APACHEⅡ, MODS, Murray lung injury and SIRS), inflammatory cytokines (TNF-α and IL-6) in serum and ultrafiltrate, parameters of hemodynamics and respiratory mechanics, and clinical indicators (MODS rate, fatality, duration of mechanical ventilation, length of stay in ICU) were observed at 24, 48 and 72 hours after CVVH. Results In CRRT group after CRRT for 72h, clinical and biochemical indicators, parameters of hemodynamics and respiratory mechanics, levels of inflammatory cytokines, and critical scores tended to be improved. When comparisons were made between CRRT group and control group, WBC (t=2.456, P= 0.039), procalcitonin (t=2.508, P=0.037), endotoxin (t=2.546, P=0.036), BUN (t=2.361, P=0.043), SCr (t= 2.135, P=0.048), ALT (t=2.387, P=0.041), and NT- proBNP (t=2.316, P=0.045) decreased significantly and urine volume increased significantly (t=2.223, P=0.047) in CRRT group; cardiac index (t=2.391, P=0.041), intrathoracic blood volume index (ITBVI) (t=2.317, P=0.045), global end diastolic volume index (GEDVI) (t= 2.234, P=0.047), extravascular lung water index (EVLWI) (t=2.379, P=0.041), pulmonary vascular permeabili-ty index (PVPI) (t=2.216, P=0.047), and lactic acid (LAC) (t=2.297, P=0.046) decreased significantly in CRRT group; while oxygenation index (t=2.484, P=0.038) increased significantly in CRRT group; peak inspiratory pressure (PIP) (t=2.310, P=0.045), plateau airway pressure (Pplat) (t=2.384, P=0.041), mean pressure of airway (MPaw) (t=2.351, P=0.043), and effective static compliance (Cst) (t=2.230, P=0.047) decreased significantly in CRRT group; serum TNF-α (t=2.495, P=0.037) and IL-6 (t=2.392, P=0.041) decreased significantly in CRRT group, and TNF-α and IL-6 were found in ultrafiltrate; scores of APACHEⅡ (t=2.452, P = 0.039), multiple organ dysfunction syndrome (MODS) (t=2.487, P=0.038), Murray lung injury (t=2.460, P= 0.039) and systemic inflammatory response syndrome (SIRS) (t=2.320, P=0.045) decreased significantly in CRRT group. After the treatment for 2 weeks, the prevalence of MODS (χ2=4.542, P=0.037), fatality (χ2= 4.032, P=0.045), length of stay in ICU (t=2.389, P=0.041), duration of mechanical ventilation (t=2.367, P= 0.040) were lower in CRRT group than in control group. Conclusion CRRT can decreased the levels of inflammatory cytokines, reverse the abnormal hemodynamics and respiratory mechanics, and improve the prognosis in critical disease patients combined with ARDS. Metrics

Select

The relationship between blood pressure and body fluid distribution measured by multi-frequency bioelectrical impedance at several time points during dialysis sessions in maintenance hemodialysis patients 2016, 15 (08):  401-406.  doi: 10.3969/j.issn.1671-4091.2016.08.005 Abstract ( 275 )   HTML ( 0 )   PDF (456KB) ( 341 )   Objective To explore the significance of blood pressure at specific time points during dialysis sessions in maintenance hemodialysis (MHD) patients, we compared the body fluid distribution measured by multi-frequency bio-electrical impedance before and after dialysis with the blood pressure at several time points during dialysis sessions. Methods The human body composition analyzer was used to record body fluid distribution before and after dialysis in 74 MHD patients. Blood pressure was measured at several time points including clinic blood pressure, blood pressure after recumbent position for 5 minutes, after 0 minutes, one hour and 2 hours in dialysis sessions, and after completion of dialysis for 30 minutes. The relationship between blood pressure values and body fluid distribution was analyzed by using Spearman correlation method. Results ①Systolic blood pressure (SBP) was the highest before dialysis, and reduced gradually to the lowest after 3 hours in dialysis sessions. SBP then increased after completion of dialysis for 30 minutes, when the blood pressure value ranged between the values after 0 hour and one hour in dialysis sessions. ②Before dialysis, TBW, ECW, ICW, and overhydration (OH) values were significantly correlated with the SBP after 2 hour in dialysis sessions (r=0.248, P= 0.033 for TBW; r=0.251, P=0.031 for ECW; r=0.233, P=0.046 for ICW; r= 0.233, P=0.046 for OH), were significantly correlated with the diastolic pressure after the completion of dialysis for 30 minutes (r=0.305, P=0.008 for TBW; r=0.244, P=0.036 for ECW; r=0.265, P= 0.023 for ICW; r= 0.218, P=0.023 for OH), but had no correlations with the clinic blood pressure, blood pressure after recumbent position for 5 minutes, dialysis for 0 minutes and one hour, and the diastolic pressure after 2 hours in dialysis sessions (P>0.05). ③After dialysis, TBW, ECW, ICW and OH were significantly correlated with the diastolic pressure after the completion of dialysis for 30 minutes (r=0.286, P=0.014 for TBW; r=0.283, P=0.015 for ECW; r=0.239, P=0.040 for ICW; r=0.284, P=0.014 for OH); TBW, ECW and OH were significantly correlated with the SBP after the completion of dialysis for 30 minutes (r=0.230, P=0.049 for TBW; r=0.240, P=0.039 for ECW; r =0.380, P=0.001 for OH); TBW, ECW and ICW were significantly correlated with the SBP after 2 hour in dialysis sessions (r=0.321, P=0.005 for TBW; r=0.287, P=0.013 for ECW; r=0.264, P=0.264 for ICW). Conclusions ①It will be misjudged if only the clinic blood pressure, blood pressure after recumbent position for 5 minutes, and the blood pressure just before dialysis sessions are used to determine the capacity load. ②The blood pressure after 2 hours in dialysis sessions should be closely monitored, and is helpful for timely and accurate adjustment of ultrafiltration volume. ③The blood pressure after completion of dialysis for 30 minutes will be better to reflect the patients' capacity load. Metrics

Select

The relationship between hemoglobin variability and prognosis in maintenance hemodialysis patients 2016, 15 (08):  407-410.  doi: 10.3969/j.issn.1671-4091.2016.08.006 Abstract ( 320 )   HTML ( 1 )   PDF (531KB) ( 474 )   Objective A retrospective study of hemoglobin variability in maintenance hemodialysis (MHD) patients to understand the relationship between hemoglobin variability and prognosis. Methods Patients newly initia between Jan 1, 2009 and May 31, 2013 were enrolled in this study. They were followed up until May 31, 2015. According to their hemoglobin levels throughout the 12 months observation period after they entered hemodialysis, they were classified into three hemoglobin variability groups: the rise type group, the wave type group, and the continuous low type group. Results This retrospective study was conducted in 205 patients newly treated with hemodialysis with the mean age of 60.45±13.26 years old. At the time of dialysis initiation, hemoglobin level was 92.60 ± 16.35 g/L, and hemoglobin level ≥110 g/L was found in 33 (16.10%) patients. Sixty-two patients were hospitalized during the follow-up period, and the cause of hospitalization was cardiovascular disease (CVD) in 41 (66.13%) patients. Thirty-nine died during the follow-up period, and 27 (69.23%) of them died of CVD. Multivariate Cox regression analysis showed that the hemoglobin variability of wave type and continuous low type were the risk factors for all-cause and CVD hospitalization; age and the hemoglobin variability of wave type and continuous low type were the risk factors for all-cause and CVD mortality. The risk of all-cause mortality in the continuous low type patients was 3.502 times higher that in the rise type patients (95%CI 1.293~9.485, P=0.014), while the risk of all-cause hospitalization was also higher in the continuous low type patients than in the rise type patients (RR=3.639, 95% CI 1.778~7.451, P＜0.001). The continuous low type patients had a higher risk of CVD mortality (RR=4.759, 95% CI 1.357~ 16.689, P=0.015) and CVD hospitalization (RR=8.424, 95% CI 2.511~28.259, P=0.001). Conclusions Correction of anemia and maintenance of a stable hemoglobin level can prolong survival time and reduce the risks of all-cause and CVD hospitalization in MHD patients. Metrics

Select

The clinical significance of fibrin monomer measurement in maintenance hemodialysis patients 2016, 15 (08):  411-414.  doi: 10.3969/j.issn.1671-4091.2016.08.007 Abstract ( 314 )   HTML ( 0 )   PDF (348KB) ( 213 )   Objective To investigate the serum fibrin monomer level and its clinical significance in maintenance hemodialysis (MHD) patients. Methods Blood coagulation factors including prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT), fibrin degradation products including fibrinogen degradation product (FDP), D dimmer (DDI) and fibrin monomer (FM), and biochemistry indices including triacylglycerol (TG), cholesterol (TC), high density lipoprotein cholesterol (HDL) and low density lipoprotein cholesterol (LDL) were assayed in MHD patients with and without cerebral infarction, and normal controls. Cardiac functional grading was performed according to the classification standards from New York Heart Association. Results There were obvious differences in TG, TC, HDL, and LDL between MHD patients without cerebral infarction and normal controls and between MHD patients with cerebral infarction and normal controls (For comparison between MHD patients without cerebral infarction and normal controls: LSD-t=9.701, P＜0.001 for TG; LSD-t=5.779, P＜0.001 for TC; LSD-t=4.742, P＜0.001 for HD; LSDt= 3.152, P＜0.001 for LDL. For comparison between MHD patients with cerebral infarction and normal controls: LSD-t=9.791, P＜0.001 for TG; LSD-t=13.509, P＜0.001 for TC; LSD-t=5.251, P＜0.001 for HDL; LSD-t=3.152, P＜0.001 for LDL). There were no statistical differences in TT, PT and APTT, but obvious differences in FDP, DDI and FM between MHD patients without cerebral infarction and normal controls and between patients with cerebral infarction and normal controls (For comparison between MHD patients without cerebral infarction and normal controls: LSD-t=8.524, P＜0.001 for FDP; LSD-t=16.269, P＜0.001 for DDI; LSD-t=31.144, P＜0.001 for FM. For comparison between MHD patients with cerebral infarction and normal controls: LSD-t=49.621, P＜0.001 for FDP; LSD-t=16.757, P＜0.001 for DDI; LSD-t=46.445, P＜0.001 for FM). There were no statistical differences in TG, TC, HDL, LDL, FDP and DDI, but significant difference in FM (LSD-t=15.017, P＜0.001) between patients with cerebral infarction and those without cerebral infarction. There was significant difference in FM between MHD patients without cerebral infarction with cardiac function I- II grades and those with cardiac function III-IV grades (t=16.097, P＜0.001) and between MHD patients with cerebral infarction with cardiac function I-II grades and those with cardiac function III-IV grades (t=19.769, P＜0.001). Conclusion FM level may be a sensitive and accurate marker for the diagnosis of cerebral infarction in MHD patients. Metrics

Select

Clinical application of vascular access grafts in lower extremities for hemodialysis 2016, 15 (08):  424-426.  doi: :10.3969/j.issn.1671-4091.2016.08.011 Abstract ( 220 )   HTML ( 1 )   PDF (303KB) ( 262 )   Objective To assess the clinical application of arteriovenous grafts in lower extremities in end-stage renal disease patients. Methods The clinical data of 11 patients treated with arteriovenous grafts in lower extremities for hemodialysis vascular access in our hospital were analyzed retrospectively. Results All operations were successfully performed, and all of the fistula were used for blood access in hemodialysis after the operation for 4～8 weeks. Primary patency rate was 100%, and the blood flow ranged from 200 ml/ min to 360ml/min. Patients had no postoperative complications such as graft infection during the follow-up period of 3～19 months. Conclusions Lower extremity arteriovenous graft is feasible for end-stage renal disease patients with exhausted arm access sites. Metrics

Select

The investigation of vascular access for diabetic patients in a hemodialysis center in Shanghai 2016, 15 (08):  430-432.  doi: 10.3969/j.issn.1671-4091.2016.08.013 Abstract ( 223 )   HTML ( 0 )   PDF (386KB) ( 426 )   Objective To retrospectively compare the vascular access between diabetic and non-diabetic maintenance hemodialysis (MHD) patients in a center in Shanghai. Method We compared the type and function of vascular access between diabetic and non- diabetic MHD patients treated in Yangpu Hospital in 2015. The complications relating to blood access were recorded as well. Result We recruited 188 MHD patients including 116 non-diabetic MHD patients and 72 diabetic MHD patients for this investigation. Temporary catheter was used in most diabetic and non-diabetic patients for the first hemodialysis, and fistula was used more in non-diabetic patients than in diabetic patients for the first hemodialysis. The blood flow volume was the same between non-diabetic and diabetic patients. The prevalence of infection, thrombosis and stenosis relating to vascular access was higher in diabetic patients than in non-diabetic patients. Conclusion Most patients used temporary catheters at the beginning of hemodialysis. More diabetic patients used long-term catheters as the permanent vascular access than non-diabetic patients in our center. The prevalence of complications relating to vascular access was higher in diabetic patients than in non-diabetic patients. Metrics

Select

Surgical transposition of collateral branch of cephalic vein to treat the swelling hand syndrome caused by arteriovenous fistula 2016, 15 (08):  433-435.  doi: 10.3969/j.issn.1671-4091.2016.08.014 Abstract ( 302 )   HTML ( 0 )   PDF (535KB) ( 282 )   Objective To evaluate the effect of surgical transposition of collateral branch of cephalic vein to reconstruct arteriovenous fistula for the treatment of swelling hand syndrome caused by proximal blockage of the fistula. Methods In the duration from Jan. 2014 to Jun. 2015, we have collected 11 cases of swelling hand syndrome caused by proximal blockage of autologous arteriovenous fistula in maintenance hemodialysis (MHD) patients. All cases underwent the transposition surgery. Results After the surgery, hand swelling disappeared rapidly with gradually improvement of ulcer symptoms. Reconstructed fistulas were used for MHD in 10 of the 11 cases within 4 weeks after the surgery, and one reconstructed fistula could not be used because of the clog in fistula. After 3 months, another reconstructed fistula was clogged and a new fistula was built in the elbow. Conclusion Proximal blockage of autologous arteriovenous fistula caused the swelling hand syndrome, and surgical transposition of collateral branch of cephalic vein effectively eliminated the swelling hand and reconstructed a new fistula at the same time. Metrics

Select

Primary patency rate of native arteriovenous fistulas reconstructed by vascular stripping and pathologic changes of vein in hemodialysis patients with venous neointimal hyperplasia 2016, 15 (08):  436-440.  doi: 10.3969/j.issn.1671-4091.2016.08.015 Abstract ( 353 )   HTML ( 0 )   PDF (771KB) ( 517 )   Objective To compare primary patency rate of native arteriovenous fistulas (AVF) restored by vascular stripping or by percutaneous transluminal angioplasty (PTA) in hemodialysis patients with venous neointimal hyperplasia (VNH), and to study pathological changes of the stripped veins. Methods Clinical data of 17 patients who underwent AVF reconstruction by VNH stripping (group A) and 12 patients who underwent PTA (group B) from Jan 1, 2012 to Jan 1, 2014 were retrospectively studied. Primary patency rate and survival rate of the two groups were compared. Pathological changes of the vein before and after vascular stripping were studied by hematoxylin and eosin (HE) staining and immunohistochemical staining. Results Primary patency rate of group A were 100%, 94.1%, 88.2%, 41.2% and 11.8% after 3 months, 6 months, 12 months, 24 months and 36 months respectively, better than that of group B after 6 months, 12 months and 24 months (41.7%, 8.3% and 0% respectively, P＜0.05). AVF survival rate of group A was also better than that of group B (P＜0.001). Restored AVFs could be used for hemodialysis after the operation for 24h. Pathological examination of the VNH specimens revealed the proliferation of myofibroblasts, smooth muscle cells and fibrous tissue. The line of venous endothelial cells was destroyed. Immunohistochemical staining revealed a disordered growth pattern of cells with positive staining of SAM and COL-IV in VNH specimens. The veins after vascular stripping were only left with medial membrane and adventitia. Conclusions AVF reconstruction by VNH stripping is an effective technique for some hemodialysis patients, with the advantages of maximal preservation of blood vessels and higher primary patency rate within 24 months. Metrics

Select

Determination of total actual dialysate flow for hemodialysis machines 2016, 15 (08):  441-443.  doi: 10.3969/j.issn.1671-4091.2016.08.016 Abstract ( 328 )   HTML ( 0 )   PDF (388KB) ( 262 )   Objective To investigate whether there is a difference between actual dialysate flow and set dialysate flow of hemodialysis machines. Methods There are 37 hemodialysis machines in our center.We divided the three brands of machines into A, B and C groups. We selected stable patients on conventional hemodialysis. Total waste dialysate during a 4-hour hemodialysis session was collected. The actual total dialysate flow is equal to the total waste dialysate minus the total ultrafiltration volume. We compared the difference between the actual total dialysate flow and the set dialysis flow (120L). Result The actual total dialysate flow was 117.78±5.97L for all machines, less than 120L in 25 hemodialysis machines (67.6%) and more than 120L in 12 machines (32.4%). There was a significant difference between the 3 groups (ANOVA, F=4.150, P= 0.024). After debugging, the total dialysate flow in Group C improved significantly [120.075 ± 0.529L (119.4- 121.0L) vs. 113.717 ± 4.588 L(105～117L)]. Conclusion Deviation of actual total dialysate flow existed among hemodialysis machines, and most of them had negative deviation. There were differences in the actual total dialysate flow among machines of different manufactures, and the set dialysate flow can be achieved after debugging Metrics

Select

Research on application effect of comfort nursing care in chronic renal failure patients with hemodialysis 2016, 15 (08):  444-446.  doi: 10.3969/j.issn.1671-4091.2016.08.017 Abstract ( 244 )   HTML ( 1 )   PDF (377KB) ( 350 )   Objective To explore the application value of comfort nursing care in chronic renal failure patients with hemodialysis. Methods From Jun. 2011 to Dec. 2014, a total of 126 chronic renal failure patients with hemodialysis treated in the blood purification center of our hospital were randomized into observation group (n=63) and control group (n=63). Comfort nursing care was applied to observation group, and routine nursing was carried out for control group. Complications, life quality and satisfaction degree toward nursing were observed in the two groups. Results Compared with the control group, the case-times of arrhythmia, dyspnea, infection, hypertension, and hypotension decreased significantly in the observation group within a year (P＜0.05), and the overall quality of life scores increased significantly in the observation group (P＜0.05). The satisfaction degree toward nursing was significant higher in the observation group than in the control group (χ2=12.365, P=0.000). Conclusion Comfort nursing care model has a significant effect for chronic renal failure with hemodialysis, This care model improves the quality of life, and deserves further study in clinical practice. Metrics