Chinese Journal of Blood Purification

12 September 2016, Volume 15 Issue 09 Previous Issue    Next Issue

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Comparison of the sensitivity of mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) for the diagnosis of cognitive impairment in maintenance hemodialysis patients 2016, 15 (09):  451-454.  doi: 10.3969/j.issn.1671-4091.2016.09.002 Abstract ( 333 )   HTML ( 1 )   PDF (362KB) ( 349 )   Objective To compare the sensitivity of mini-mental state examination (MMSE), and Montreal cognitive assessment (MoCA) for the diagnosis of cognitive impairment in maintenance hemodialysis (MHD) patients, and to explore the characteristics of cognitive impairment in MHD patients. Methods A total of 89 MHD patients were examined with MMSE and MoCA between Oct. 2015 to Jan. 2016, and at the same time their cognitive impairment was assessed by neurologists. We then evaluated the specificity and sensitivity of MMSE and MoCA for the diagnosis of cognitive impairment in these patients. Results For the diagnosis of cognitive impairment, the sensitivity was 30.23% and the specificity was 100% by MMSE, and the sensitivity was 97.67% and the specificity was 76.32% by MoCA. The patients diagnosed with cognitive impairment had lower scores in attention and calculation (t=- 4.995, P=0.000), retelling ability (t=- 2.284, P=0.021), reading ability (t=-2.322, P=0.023), writing ability (t=-4.156,P＜0.001), and construction (t=-3.921, P＜0.001) by MMSE, and had lower scores in visual-spatial and executive capacities (t=-4.636, P＜0.001), attention and calculation (t=-5.654, P＜0.001), language (t=-9.214, P＜0.001), abstract ability (t=-4.910, P＜ 0.001), and delayed recall ability (t=-2.306, P=0.024) by MoCA, as compared those with the patients without cognitive impairment. Conclusions The sensitivity of MoCA was higher than that of MMSE for the diagnosis of cognitive impairment in MHD patients. The patients diagnosed with cognitive impairment had lower scores in some specific executive abilities such as executive capacity,attention,construction,and abstract ability. Metrics

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Efficacy comparison of the three parathyroidectomy methods in 425 patients with secondary hyperparathyroidism 2016, 15 (09):  455-458.  doi: 10.3969/j.issn.1671-4091.2016.09.003 Abstract ( 277 )   HTML ( 0 )   PDF (360KB) ( 421 )   Objective To analyze the short and long- term effects of the three parathyroidectomy (PTX) methods in the treatment of chronic kidney diseases patients with secondary hyperparathyroidism (SHPT). Methods A total of 425 SHPT patients treated with one of the three PTX methods were analyzed. Before the operation and after the operation for one week, 3 months, one years and 4 years, the data about serum intact parathyroid hormone (iPTH), calcium, phosphorus, alkaline phosphatase, clinical symptoms, postoperative complications and relapse were collected. Results PTX was successfully operated in all of the patients. After the operation, symptoms such as bone pain, skin itching, myasthenia gravis, restless legs symptoms relieved significantly. Shrinkage of body height ceased in 53 cases with shrinking men syndrome, and facial deformities stopped progressing in 35 cases with Sagliker syndrome. Walking by themselves gradually became possible after the operation for one year in 30 cases with severe skeletal deformities and inability to walk. Serum iPTH decreased significantly (1802.602 ± 5.418 pg/ml vs. 25.838±0.190 pg/ml, F=24.526, P=0.000) after the operation for one week. Serum iPTH remained at low levels for a long time, and maintained at 62.120±0.096 pg/ml after the operation for 4 years. There were no statistical differences among the 3 PTX methods in shortterm successful rate (χ2=2.655, P=0.265), mortality (χ2=2.548, P=0.280), prevalence of hypocalcemia in one week after the operation (χ2=0.066, P=0.968), relapse rate in one year after the operation (χ2=0.236, P=0.889), and relapse rate in 4 years after the operation (χ2=0.616, P=0.735). For long-term evaluation of PTX effects, the prevalence of higher serum iPTH was more in patients after subtotal PTX than those after total PTX with or without autologous parathyroid transplantation (χ2=20.525, P=0.000), and mortality was higher in those with higher serum iPTH. Conclusions PTX is a safe and effective therapeutic method for chronic kidney diseases patients with refractory SHPT. Serum iPTH level is more stable in patients undergoing total PTX with or without autologous parathyroid transplantation than in those treated with subtotal parathyroidectomy. After PTX, serum iPTH, calcium and phosphorus can be maintained at reasonable ranges for a long time. Metrics

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Influences of different hemodialysis induction pattern on mental state and serum electrolytes in endstage renal disease patients 2016, 15 (09):  459-461.  doi: 10.3969/j.issn.1671-4091.2016.09.004 Abstract ( 209 )   HTML ( 0 )   PDF (343KB) ( 194 )   Objective In this article we investigated the influences of different hemodialysis induction pattern on mental state and serum electrolytes in end-stage renal disease patients. We also aimed to define the relationship between mental state and serum electrolytes in these patients. Methods We analyzed 44 patients beginning to use hemodialysis for chronic renal failure in the period from 2013 to 2014. In these patients, Patients were treated with daily hemodialysis (DHD group, n=22) or conventional hemodialysis (CHD group, n= 22). Carbon dioxide combining power (CO2- CP), serum sodium, potassium, calcium and phosphorus were measured at admission day, and at seventh day after the treatment. Symptom checklist 90 (SCL-90) scores during the hemodialysis induction period were recorded. Results Scores of somzatization, obsession, interpersonal relation disturbance, depression, anxiety, horror and other items as well as the total score were lower in DHD group than in CHD group (t=2.528, P=0.015; t=2.570, P=0.014; t=2.057, P=0.046; t=2.391, P=0.021; t= 2.389, P=0.021; t=2.634, P=0.012; t=2.451, P=0.018; t=2.616, P=0.012, respectively). On admission, CO2- CP, serum sodium, potassium, calcium, and phosphorus had no differences between the two groups. At the seventh day after the treatment, serum potassium was lower in DHD group than in CHD group (t=2.086, P=0.047), and serum calcium was higher in DHD group than in CHD group (t=-2.218, P=0.036). Conclusions DHD, rather than CHD, could improve the mental state of the patients in the hemodialysis induction period. Maintenance of serum potassium and calcium within normal ranges may improve the mental state of the patients. Metrics

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Impact of vascular endothelial injury and sex hormone level on erectile function in male hemodialysis patients 2016, 15 (09):  462-465.  doi: 10.3969/j.issn.1671-4091.2016.09.005 Abstract ( 398 )   HTML ( 0 )   PDF (377KB) ( 281 )   Objective To analyze the impact of vascular endothelial injury and sex hormone level on erectile function in male hemodialysis patients. Methods A total of 83 cases of male patients undergoing maintenance hemodialysis were enrolled in this study, and were divided into normal group (group A, n=15), mild erectile dysfunction (ED) group (group B, n=19), moderate ED group (group C, n=25), and severe ED group (group D, n=24) based on the International Index for Erectile Function-5 (IIEF-5) scale. Serum ICAM-1, VCAM-1, vWF and prolactin (PRL), estradiol (E2), and testosterone (T) were measured. Results Serum phosphorus in group C and serum phosphorus and systolic blood pressure in group D were higher than the reference levels.With the deterioration of erectile function, ICAM-1, VCAM-1 and vWF increased gradually, significantly different among the groups (F=267.308, 182.514, and 123.929 respectively, P＜0.001); PRL and E2 increased gradually, significantly different among the groups (F=18.756 and 136.561 respectively, P＜0.001); while serum T level decrease significantly (F= 24.715, P＜0.001). Correlation analysis exhibited that ICAM-1 was significantly correlated with PRL, E2 and T (r=0.298, 0.367 and -0.394 respectively; P=0.032, 0.015 and 0.023 respectively), VCAM-1 was significantly correlated with E2 and T (r=0.314 and -0.308 respectively; P= 0.026 and 0.037 respectively), and vWF was significantly correlated with E2 and T (r=0.295 and -0.317 respectively; P=0.044 and 0.032 respectively). Conclusion Vascular endothelial injury is closely related to sex hormone disturbances, which are the important factors for ED in male hemodialysis patients. Metrics

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A prospective study on the evaluation method about changes of filter ability in removing inflammatory mediators during continuous renal replacement therapy (CRRT) 2016, 15 (09):  466-469.  doi: 10.3969/j.issn.1671-4091.2016.09.006 Abstract ( 254 )   HTML ( 0 )   PDF (340KB) ( 305 )   Objective To evaluate the ability changes of the CRRT filter in removing inflammatory mediators at different time points in order to determine whether the filter should be changed. Methods The patients on CRRT therapy for the treatment of multiple organ dysfunction syndrome (MODS) were prospectively studied. Each filter was used for 1h, 24h, 48h, or longer, and the instrument was converted to the after-filter continuous veno-venous hemofiltration (CVVH) mode using the same parameters. Blood flow rate was set at 100 ml/min, and post-replacement volume plus dehydration volume was set at 1,000 ml/h. After the dialysis for 10-30 minutes, blood samples before the filter and after the filter and the ultrafiltration fluid were collected for TNFα concentration measurement. The instrument was then adjusted to the original treatment mode. The TNFα concentrations at each time-point of a filter were recruited, from which the filtration coefficient and adsorption rate of a filter were derived. Results Five MODS patients were involved in this study. Each patient used one filter for the examination. The CRRT filter was used for <24 hours in cases 1～3, for >24 hours in case 4, and for >48 hours in case 5. Serum TNFα concentration before the filters was 20.9～86.3 ng/L, higher than the normal value (Normal TNFα concentration was 14.6～19.5 ng/L in this laboratory). TNFα could be detected in ultrafiltration fluids in the 5 cases with the average concentration of 12.2～26.4 ng/L. The filtration coefficient at early stage (after one hour) was 44.3～73.6% in the 5 patients. The filtration coefficient of the filter was 71.2% and 48.1% in case 4 after one hour and 4 hours respectively, and was 44.3%, 44.8%, 66.2% in case 5 after one hour, 24 hours and 48 hours respectively, reflecting the dynamic changes of the filters’ability. Adsorption was present in filters based on the calculation of TNFα concentrations in the blood samples before and after the filter as well as in ultrafiltration fluids, and the adsorption rate was 306.7-5448.3 pg/min at the 8 time-points of the 5 filters. The clearance rates in case 5 after 48 hours (filtration coefficient 66.2% and adsorption rate 616.7 pg/min) and in case 1 after one hour (filtration coefficient 68.5% and adsorption rate 638.3 pg/min) were similar, but were higher than the clearance rate in case 4 after 24 hours (filtration coefficient 48.1% and adsorption rate 595.0 pg/min). Conclusions TNFα can be filtered and adsorbed by the filters used in CRRT, but the clearance rate among filters was uncomparable. The filtration coefficient and adsorption rate at different time-points of a filter can be used to evaluate the dynamic change of the filter in removing inflammatory mediators. To determine how long the filter can be used during CRRT when removal of inflammatory mediators is clinically critical and the parameters such as the pipeline clotting function and the pressure across the filter are maintained in reasonable ranges, the concentrations of inflammatory mediators in ultrafiltration fluid, the filtration coefficient and the adsorption rate can be recognized as the objective indices, rather than simply based on the elapsed time the filter being used. Metrics

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The effect of daytime high-volume hemofiltration for the treatment of septic shock patients complicated with acute kidney injury 2016, 15 (09):  470-474.  doi: 10.3969/j.issn.1671-4091.2016.09.007 Abstract ( 195 )   HTML ( 0 )   PDF (440KB) ( 243 )   Objective To assess the therapeutic effect of daytime high-volume hemofiltration (HVHF) on septic shock patients combined with acute kidney injury (AKI). Methods A total of 50 septic shock cases complicated with AKI and treated in the ICU during the period from Oct. 2013 to Jun. 2015 were enrolled in this study. They were randomly divided into treatment group (treated with daytime HVHF, n=25) or control group (treated with CVVH, n=25). Serum tumor necrosis factor alpha (TNFα), interleukin-10 (IL-10), lactic acid (Lac), BUN and creatinine were measured. Central venous pressure (CVP) was monitored. The norepinephrine dose needed to maintain average arterial pressure at 65-70 mmHg and the normal oxygenation indices were recorded. APACHE II score, mechanical ventilation duration, days in ICU, hospitalization days, and mortality in hospital were also collected. Results After the treatment, serum TNF-α and IL-10 levels decreased in both groups. The decrease of TNF-α and IL-10 levels was more in treatment group than in control group. Serum IL-10 levels were 62.32±11.39 μg/l and 70.82 ± 13.31 μg/l (t=2.425, P=0.019) in treatment group and control group respectively at the 48th hour after the treatment, and were 57.36±13.83 μg/l and 68.23 ±12.73 μg/l (t=2.893; P=0.006) in treatment group and control group respectively at the 72nd hour after the treatment. Serum TNF-α levels were 94.16±15.11 μg/l and 104.81±13.30 μg/l (t=2.646, P=0.011) in treatment group and control group respectively at the 72nd hour after the treatment. Hemodynamics, respiration, renal function and APACHE II score improved after the treatment in both groups, and improved more in treatment group than in control group. Norepinephrine doses used were 0.67±0.14 μg/kg/min and 0.75±0.10 μg/kg/min (t=2.228, P=0.031) in treatment group and control group respectively at the 24th hour after the treatment, and APACHE II scores were 24.20±2.83 and 27.44±3.30 (t= 3.732, P=0.001) in treatment group and control group respectively at the 24th hour after the treatment. The oxygenation indices were 270.40 ± 37.72 mmHg and 244.76±39.66 mmHg (t=-2.343; P=0.023) in treatment group and control group respectively at the 48th hour after the treatment. Mechanical ventilation duration, days in ICU, and hospitalization days were 63.2±12.8 hours, 81.8±7.2 hours, and 6.3±2.1 days respectively in treatment group, and were 7.8±2.3 days, 12.8±4.1 days, and 15.6±3.9 days respectively in control group (t=6.363, P＜0.001 for mechanical ventilation duration; t=2.409, P=0.020 for days in ICU; t=2.527, P=0.015 for hospitalization days). Conclusion Daytime HVHF can significantly improve the prognosis of severe septic shock patients, clinically showing recovery of respiration/ circulation failure, alleviation of systemic inflammation, and decrease of APACHEII score. Metrics

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Multi-center investigation of Internet use by maintenance hemodialysis patients 2016, 15 (09):  475-477.  doi: 10.3969/j.issn.1671-4091.2016.09.008 Abstract ( 196 )   HTML ( 2 )   PDF (346KB) ( 321 )   Objective To investigate the prevalence and predictors of Internet use by maintenance hemodialysis (MHD) patients. Methodology A questionnaire surveying Internet use was delivered in person to MHD patients in five dialysis centers in four different cities in Sichuan Province. The survey results were then statistically analyzed. Results A total of 355 patients completed the questionnaires with the response rate of 88.3%. The average age of the respondents was 49.5±15.4 years old. There were 323 patients (91.%) aged over 30 years old, 333 patients (93.8%) with education level below high school, 331 patients (93.2%) without a stable job, and 265 patients (74.6%) with a family income under 50,000 yuan per year. The participants were divided into Internet user group and non-Internet user group. Age (t=12.830, P＜0.001), educational level (t= 5.440, P＜0.001), and family income (t=7.276, P＜0.001) were significantly different between the two groups, but gender (t=0.119, P=0.906), marital status (t=-0.545, P=0.586), and jobs (t=-1.298, P=0.052) had no differences between the two groups. Cox regression model showed that age (OR=-0.078, 95% CI 0.907～ 0.945, P＜0.001), educational level (OR=0.194, 95% CI 1.030～1.425, P=0.019) and family income (OR= 1.331, 95% CI 2.015～6.921, P＜0.001) were the independent factors for Internet use in MHD patients. Conclusion Internet use should be encouraged further in MHD patients. Age, education level and family income are the independent factors for Internet use in these patients. Internet plus medical technology have shown increasing importance in the integrated management of chronic diseases, requiring more exploration and social support. Metrics

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The relationship between cardiac valve calcification and carotid atherosclerosis and its influential factors in hemodialysis patients 2016, 15 (09):  478-482.  doi: 10.3969/j.issn.1671-4091.2016.09.009 Abstract ( 279 )   HTML ( 0 )   PDF (400KB) ( 298 )   Objective To investigate the relationship between cardiac valve calcification (CVC) and carotid atherosclerosis (CAS) and its influential factors in maintenance hemodialysis (MHD) patients. Methods MHD patients with dialysis duration of ≥1 year were enrolled in this study. Cardiac echocardiography and carotid artery color Doppler ultrasound examination were performed in the patients. Mineral metabolism, lipid metabolism, inflammation and malnutrition related indicators were collected and analyzed. Results Eighty MHD patients (50 males and 30 females) were included in this study. The average age was 61.2±13.2 years, and the average dialysis duration was 64.8±55.8 months. Age, body mass index (BMI), hypersensitive C-reactive protein (hsCRP), hypertriglyceridemia and hypercalcinemia were significantly different between 41 patients with CVC and CAS and 20 patients without CVC and CAS (P＜0.05). Age, dialysis duration, hsCRP, hypercalcinemia and subjective global assessment (SGA) were significantly different between 47 patients with CVC and 33 patients without CVC (P＜0.05). Age, diabetes, BMI, hsCRP, serum albumin (Alb), hypertriglyceridemia, Ca, SGA and Kt/V were significantly different between 54 patients with CAS and 26 patients without CAS (P＜0.05). Logistic regression analysis showed that age and hsCRP were the common risk factors for CVC and CAS (P＜0.05), hsCRP and serum Ca were the independent risk factors for CVC (P＜0.05), and age and hsCRP were the independent risk factors for CAS (P＜0.05). Conclusion CVC often accompanied with CAS. The presence of CVC and CAS in MHD patients was related to their age, hsCRP level and hypercalcinemia. Metrics

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Protein-energy wasting and its related factors in maintenance dialysis patients 2016, 15 (09):  483-487.  doi: 10.3969/j.issn.1671-4091.2016.09.010 Abstract ( 255 )   HTML ( 3 )   PDF (426KB) ( 299 )   Objective To investigate protein- energy wasting (PEW) status and its related factors in maintenance dialysis patients. Methods A total of 154 maintenance dialysis patients (88 males and 66 females; 25-72 years old; 56 peritoneal dialysis patients and 98 hemodialysis patients) treated in Taixing People's Hospital during the period from Mar. 2012 to Mar. 2015 were enrolled in this study. PEW status was assessed by Modified Quantitative Subjective and Global Assessment (MQSGA), Malnutrition- Inflammation Score (MIS) and serum albumin level. Inflammation status including serum hypersensitive C-reactive protein (hsCRP), tumor necrosis factor (TNF-α) and interleukin 6 (IL-6) were measured by enzyme-linked immunoassay (ELISA). Anthropometrical parameters including body height, body weight, body mass index (BMI), mid- arm circumference (MAC), triceps skin-fold (TSF), and mid-arm muscle circumference (MAMC) were measured. Serological markers including total protein (TP), albumin, prealbumin (PA), hemoglobin (Hb), transferring (TF), creatinine (Scr), urea nitrogen (BUN), total cholesterol (Tch) were also assayed. The diagnosis of PEW was made base on the standards from International Society of Renal Nutrition and Metabolism (ISRNM). The patients were then divided into PEW group (n=61) and non-PEW group (n=93). Results ①PEW was found in 61 (39.6%) maintenance dialysis patients. PEW was found in 40 (40.8%) hemodialysis patients and 21 (37.5%) peritoneal dialysis patients without statistical significance between the two groups (χ2=0.163, P=0.685). ②The ratio of diabetic nephropathy was more in PEW group than in non-PEW group (χ2=5.750, P= 0.016). Age (t=5.666, P＜0.001), dialysis duration (t=7.718, P＜0.001), hsCRP (t=5.849, P＜0.001), TNF-α (t=7.384, P＜0.001), and IL-6 (t=7.650, P＜0.001) were higher in PEW group than in non-PEW group, while BMI (t=2.514, P =0.006), TP (t=7.237, P＜0.001), Alb (t=2.905, P =0.001), PA (t=9.168, P＜0.001), TF (t= 2.890, P=0.002), Hb (t=5.791, P＜0.001), Tch (t=3.048, P=0.001), MAC (t=2.640, P =0.004), MAMC (t= 1.781, P=0.038), and the proportion of Kt/V≥1.2 (χ2=9.518, P= 0.002) were lower in PEW group than in non- PEW group. ③ Multifactorial analyses showed that advanced age (OR=1.442, 95% CI=1.234～4.031, P= 0.027), longer dialysis duration (OR=1.442, 95% CI=1.234～4.031, P=0.027), inflammatory state, hypoalbuminemia (OR=3.231, 95% CI=1.453～4.346, P=0.028), and Kt/V<1.2 were the independent risk factors for PEW. Conclusion PEW was frequently seen in maintenance dialysis patients. Advanced age, longer dialysis duration, inflammatory state, and inadequate dialysis were the independent risk factors for PEW. Metrics

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The factors to influence TNF-α sieving coefficient in continuous veno-venous hemofiltration analyzed by factorial design 2016, 15 (09):  488-490.  doi: 10.3969/j.issn.1671-4091.2016.09.011 Abstract ( 237 )   HTML ( 0 )   PDF (328KB) ( 339 )   Objective To investigate the factors to influence tumor necrosis factor α (TNF-α) sieving coefficient in continuous veno-venous hemofiltration (CVVH) analyzed by factorial design. Method A total of 48 patients with severe sepsis were randomly divided into 8 groups (6 patients in each group). CVVH ultrafiltration rate was set at 30ml/(kg· h) or 70ml/(kg· h), plasma flow at 100ml/min or 180ml/min, and treatment time at 6h or 12h. The patients were then divided into 8 groups according to the 2×2×2 factorial design to evaluate the impacts of the three factors on TNF-α sieving coefficient. Results Ultrafiltration rate and treatment time had interacted effect on TNF-α sieving coefficient (P=0.001). TNF-α sieving coefficient was the highest in the group with ultrafiltration rate of 30ml/h and treatment time of 6h (0.162±0.002). TNF-α sieving coefficient increased in ultrafiltration rate of 30ml/kg.h as compared to that of 70ml/(kg· h), and in treatment time of 6h as compared to that of 12h (P＜0.001). TNF-α sieving coefficient decreased in plasma flow of 100ml/min as compared to that of 180ml/min (P 0.001). Conclusion Ultrafiltration rate and treatment time have interacted effect on TNF-α sieving coefficient. TNF-α sieving coefficient becomes decreased when ultrafiltration rate increases and treatment time is prolonged. TNF-α sieving coefficient becomes increased when plasma flow rises. Metrics

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Study on early failure of autologous arteriovenous fistula due to artery stenosis at anastomosis site 2016, 15 (09):  494-497.  doi: 10.3969/j.issn.1671-4091.2016.09.013 Abstract ( 262 )   HTML ( 1 )   PDF (626KB) ( 288 )   Object To retrospectively study the clinical and radiological features of stenosis in autologous arteriovenous fistula (AVF), and the relationship between clinical features and stenosis site in order to improve the autologous AVF surgery. Method We retrospectively analyzed the clinical and radiological data of the patients who were examined with angiography due to AVF stenosis in the Third Hospital of Hebei Medical University during the period from Jan. 1st, 2011 to Dec. 31st, 2014. Patients had complete disease history and radiological records, and their autologous AVFs adopted end-to-side anastomosis technique in forearms. Two nephrologists responsible for construction and care of AVFs reviewed the radiological images, identified the stenosis type, analyzed their clinical characteristics, and performed statistical analyses. Result A total of 64 patients having 81 angiography examinations were involved in this study, including 39 angiography examinations for 29 females and 42 angiography examinations for 35 males. Their average age was 55.52±1.71 (26- 80) years old, and their average dialysis duration was 31.22±3.67 months. Twenty-seven cases (having 40 angiography examinations) were found to have defined stenosis at arterial site, including artery stenosis proximal to anastomosis site 23 cases (10 cases had stenosis proximal to anastomosis site combined with partial vein stenosis, and 13 cases had stenosis proximal to anastomosis site combined with a long length of vein stenosis). Two cases had distal artery stenosis, and two cases had artery stenosis proximal and distal to the anastomosis site. The average maturation period of the AFVs was 59.94±4.36 days in patients with stenosis, and was 37.83±3.59 days in patients without stenosis (t=3.918, P＜0.001). The average period for blood access of the AVFs was 27.12±5.45 weeks in patients with stenosis, and was 129.44±19.77 weeks in patients without stenosis (t=-4.990, P＜0.001). Conclusion Artery stenosis at the anastomosis site may lead to a prolonged mature period of the AVFs, and a shorter period for blood access due to early failure of the AFVs. Inappropriate surgical manipulation at the anastomosis site during the surgery may be the cause of the artery stenosis. Metrics

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Study on early failure of autologous arteriovenous fistula due to artery stenosis at anastomosis site 2016, 15 (09):  498-500.  doi: 10.3969/j.issn.1671-4091.2016.09.013 Abstract ( 221 )   HTML ( 0 )   PDF (396KB) ( 341 )   Object To retrospectively study the clinical and radiological features of stenosis in autologous arteriovenous fistula (AVF), and the relationship between clinical features and stenosis site in order to improve the autologous AVF surgery. Method We retrospectively analyzed the clinical and radiological data of the patients who were examined with angiography due to AVF stenosis in the Third Hospital of Hebei Medical University during the period from Jan. 1st, 2011 to Dec. 31st, 2014. Patients had complete disease history and radiological records, and their autologous AVFs adopted end-to-side anastomosis technique in forearms. Two nephrologists responsible for construction and care of AVFs reviewed the radiological images, identified the stenosis type, analyzed their clinical characteristics, and performed statistical analyses. Result A total of 64 patients having 81 angiography examinations were involved in this study, including 39 angiography examinations for 29 females and 42 angiography examinations for 35 males. Their average age was 55.52±1.71 (26- 80) years old, and their average dialysis duration was 31.22±3.67 months. Twenty-seven cases (having 40 angiography examinations) were found to have defined stenosis at arterial site, including artery stenosis proximal to anastomosis site 23 cases (10 cases had stenosis proximal to anastomosis site combined with partial vein stenosis, and 13 cases had stenosis proximal to anastomosis site combined with a long length of vein stenosis). Two cases had distal artery stenosis, and two cases had artery stenosis proximal and distal to the anastomosis site. The average maturation period of the AFVs was 59.94±4.36 days in patients with stenosis, and was 37.83±3.59 days in patients without stenosis (t=3.918, P＜0.001). The average period for blood access of the AVFs was 27.12±5.45 weeks in patients with stenosis, and was 129.44±19.77 weeks in patients without stenosis (t=-4.990, P＜0.001). Conclusion Artery stenosis at the anastomosis site may lead to a prolonged mature period of the AVFs, and a shorter period for blood access due to early failure of the AFVs. Inappropriate surgical manipulation at the anastomosis site during the surgery may be the cause of the artery stenosis. Metrics

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An innovative water sampling method for quality monitoring of dialysis water 2016, 15 (09):  501-503.  doi: 10.3969/j.issn.1671-4091.2016.09.015 Abstract ( 229 )   HTML ( 0 )   PDF (301KB) ( 375 )   Objective To explore the application of the innovative water sampling method for endotoxin and bacterial colony count assays in the quality monitoring of dialysis water. Method The investigation was carried out on 36 units of blood dialysis machine during Nov. 1, 2015 to Feb. 1, 2016. Three water sampling methods for water quality monitoring were used: ①Conventional method taking water sample from the bypass port. After sterilization of the bypass port with iodine volts, water sample was taken by a sterilized syringe from the sterilized bypass port. ②The innovative method taking water sample from water quality monitoring sampler. The bypass port end was filled with dialysate, sterilized with iodine volts and then with ethanol after 2 minutes to take off iodine. A 5ml sterilized syringe was inserted into the sampler end to get water sample. ③ Standard method for water sampling. After the bypass port end filled with dialysate, water sample was taken from the dialyser bypass water outlet end, taking care of the needle not touching the outlet wall. No more than 3 water samples in a week were taken from a dialysis machine. Endotoxin and bacterial colonies in water samples were examined continuously for 3 months. The time used for water sampling was statistically analyzed. The examination accuracy of the samples taken by standard method was recognized as the golden standard to compare with that taken by conventional method and that taken by the innovative method. Results Analysis of variance for single factor and Dunnett t test for further comparison of two variables found that endotoxin increased by 29.7% (n=36, P=0.006) and bacterial colonies increase by 32.2% in water samples by conventional method as compared with those by standard method; endotoxin increased by 4.5% (n=36, P= 0.976) and bacterial colonies increased by 7.6% in water samples by the innovative method as compared with those by standard method. The time used for water sampling reduced by 1.88% by using the innovative method as compared with that by using conventional method. Conclusion Water samples taken by the innovative method and those taken by standard method had no differences in water quality monitoring results. However, the time for water sampling using the innovative method was the shortest among the three water sampling methods. Therefore, the innovative method increased the working efficiency and preserved the same examination accuracy. This method also reduced the working strength and working procedures for the technicians and other professionals in the infection- control department, reduced the false negative and false positive results due to cumbersome procedures, improved the treatment safety for the patients, and also increased the satisfaction of the medical professionals. Metrics

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Comparison on training exam scores in different dialysis duration in peritoneal dialysis operators 2016, 15 (09):  504-507.  doi: 10.3969/j.issn.1671-4091.2016.09.016 Abstract ( 229 )   HTML ( 0 )   PDF (423KB) ( 206 )   Objectives The training for peritoneal dialysis(PD) patients and their families is an essential factor to ensure home PD progress smoothly. In our retrospective study, we investigated the examination scores of PD training in different dialysis duration in early stage of PD to find main problems in different PD duration, thus provide targeted training, so as to avoid and reduce the occurrence of PD-related complications. Methods The general data of PD patients from January 1, 2012 to December 31, 2014 were collected. The training exam scores at first time of training (0 month) and retraining (6months and 12months after PD) were assessed by using self-design table for PD operators. Then main problems in different PD duration were compared. Result ①A total of 72 operators were enrolled in this study. The average score at 0 month was 74.32± 13.52. All operators passed the examination. ②The total score was 62.33±10.15 after 6 months, 62.49±9.2 after 12 months, significantly lower than the score at 0 month, (6 months vs 0 month：t=6.445，P=0.000；12 months vs 0 month：t=6.499，P=0.000). The individual part scores of the examination after 6 and 12 months were significantly lower than those at 0 month, except the exit-site care scores after 12 months compared to 0 month, P＞0.05 (6 months vs. 0 month，environmental and hygiene：t=4.971，P=0.000，exchange procedure：t= 2.575，P=0.012，exit-site care：t=2.970，P=0.004，complication management：t=9.944，P=0.000，self-monitoring：t=5.795，P=0.000，diet knowledge：t=4.481，P=0.000. 12 months vs 0 month，environmental and hygiene：t=4.046，P=0.000，exchange procedure：t=2.665，P=0.010，complication management：t=8.992，P=0.000，selfmonitoring：t=3.357，P=0.001，diet knowledge：t=6.927，P=0.000). Compared the scores after 6months with those after 12 months, the scores of diet knowledge after 12 months were significantly lower than that after 6 months (t=13.648，P=0.000). There were no statistical difference among scores of other parts. ③ After 0month、6 months and 12 months, the percentage of actual scores of total scores in exchange procedures and treatment of PD complications were the lowest. ④Between assisted PD and self-operating PD patients, no significant difference were seen in total scores and individual part scores. Conclusions Although all operators were qualified for passing the training examination after the initial training, exchange procedures and treatment of PD complications were still weak points for PD operators, thus related training should be strengthened. After 6 months and 12 months, all PD-related knowledge and skills assessment scores were significantly decreased, that suggested comprehensive retraining need to be strengthened, especially for exchange procedures and treatment of PD complications. The time point of first retraining should be earlier than 6 months, but the exact time needs further research. Metrics