Chinese Journal of Blood Purification

12 October 2016, Volume 15 Issue 10 Previous Issue    Next Issue

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Peritoneal dialysis for diabetic patients with end-stage renal disease 2016, 15 (10):  513-516.  doi: 10.3969/j.issn.1671-4091.2016.10.001 Abstract ( 255 )   HTML ( 0 )   PDF (313KB) ( 437 )   Diabetes mellitus (DM) is the leading cause of end-stage renal disease (ESRD) in many countries. Most diabetic patients with ESRD are maintained on renal replacement therapy. Compared with patients without diabetes, patients with diabetes on dialysis generally have poorer survival rates because of a higher incidence of complications and comorbidities.The question on timing of start of dialysis and optimal first choice of dialysis modality in diabetes mellitus patients remains a matter of debate. Peritoneal dialysis (PD) offers multiple benefits for the treatment of ESRD patients with diabetes, however PD is also associated with certain negative factors inherent to the use of this modality. The present review addresses the strategies for the care of diabetic PD patients.With improved fluid balance, better glycemic control, optimal preservation of residual renal function and peritoneal function as well as the reducing risk factors of cardiovascular disease, there is hope for improving the long-term outcomes of diabetic PD patients. Metrics

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Pathway to improve the hypoalbuminemia status in patients on peritoneal dialysis and its clinical effect 2016, 15 (10):  517-521.  doi: 10.3969/j.issn.1671-4091.2016.10.002 Abstract ( 453 )   HTML ( 1 )   PDF (739KB) ( 288 )   Objective Hypoalbuminemia is prevalent in patients on maintenance peritoneal dialysis (PD), which can predict cardiovascular events and mortality. Amelioration of the hypoalbuminemia is critical for the improvement of clinical outcome in PD patients. Our aim is to develop and implement a clinical pathway to improve the hypoalbuminemia and then to observe its efficacy. Methods This was a self- control study. Between May 1, 2014 and Oct. 31, 2014, we enrolled clinically stable PD patients from Peking University First Hospital. According to the mechanism for hypoalbuminemia, we developed a clinical pathway to root for the causes of hypoalbuminemia and then took measures including dietary counseling, dialysis regime adjustment, volume control, and dealing with comorbidities to improve serum albumin. We aimed to explore if these interventions could improve serum albumin after 3 months and 6 months. Results ①The average age of participants was 63.35 ±13.48 years, with 58 (44.3%) men, and 76 (58%) diabetes. The median dialysis duration was 35 (11～70) months. The causes for hypoalbuminemia were comorbidities (45, 34.4%), insufficient protein and calorie intake (43, 32.8%), inadequate dialysis (4, 3.1%), volume overload (4, 3.1%), loss of protein (1, 0.8%), other factors (17, 13%), and miscellaneous (17, 13%). ②By general linear model analysis, serum albumin significantly increased to 33.3±4.2 g/L at the 3rd month and 34.6±3.7g/L at the 6th month from the baseline value after adjusting for age, gender and dialysis duration. Serum albumin values at the 6th month were also higher than those at the 3rd month (P=0.021) and at the baseline (P=0.032). Further analysis showed that the increasing trend of serum albumin was comparable between non-diabetes and diabetes, patients with dialysis duration longer and shorter than 36 months, and patients with high- sensitive C-reactive protein higher and lower than 4.06 g/L. Conclusions Based on the clinical pathway for ameliorating hypoalbuminemia in PD patients, we can significantly increase the value of serum albumin. The finding needs to be verified in further studies with large sample sizes. Metrics

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Risk factors for peritoneal non-infection complications in patients with open surgery for catheter implantation: the experience of 14 years in a single center 2016, 15 (10):  522-526.  doi: 10.3969/j.issn.1671-4091.2016.10.003 Abstract ( 284 )   HTML ( 0 )   PDF (545KB) ( 275 )   Objective To explore the peritoneal non-infection complications in patients with open surgery for catheter implantation and its risk factors. Methods This was a retrospective cohort study. Patients with open surgery for implantation of peritoneal dialysis catheter in our hospital from Jan. 1, 2002 to Jan. 31, 2016 were enrolled in this study. Demographic data, clinical laboratory parameters, catheters, follow-up frequency, non-infection complications due to catheters, treatment, and outcome were collected. Clinical features and the risk factors for the complications were compared between the patients with and without the complications. Results ①A total of 677 patients were included. The average age was 51.03±12.77 years and the median dialysis vintage was 22 (7.00, 45.00) months. ② Non- infection complications were identified in 125 (18.46%) cases. The most common complication was catheter migration (79 cases, 11.66%), followed by obstruction in catheter, hernia (5.47%), thoracoabdominal fistula (0.74%), and dialysate leakage (0.29%). Regarding outcome of the complications, 109 (87.20% ) patients were cured by conservative treatment, 10 (8.69%) were re-implanted with the catheter, and 6 (5.22%) were transferred to hemodialysis. ③Compared with non-complication group, the patients with complications had a shorter vintage (Z=-14.725, P＜0.001), less follow-up frequency (χ2=7.820, P=0.020), and the operation by less experienced doctors (χ2=9.291, P=0.010). ④Multivariate Cox regression analysis showed that advanced age (HR 1.015, 95% CI 1.01～1.030, P=0.038), less follow-up frequency (HR 1.147, 95% CI 1.010～1.303, P=0.034), and operation by less experienced doctor (HR 1.328, 95% CI 1.096～1.609, P=0.004) were the independent risk factors for non-infectioncomplications after adjustment for confounders. Conclusion The most common non-infection complications were catheter migration and catheter blockage in peritoneal dialysis patients. Most of the patients could be cured by conservative treatment. Advanced age, less follow-up frequency, and operation by less experienced doctors were the independent risk factors for the noninfection complications. Metrics

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The treatment effectiveness of peritoneal dialysis- related peritonitis in outpatient clinic 2016, 15 (10):  527-530.  doi: 10.3969/j.issn.1671-4091.2016.10.004 Abstract ( 232 )   HTML ( 0 )   PDF (646KB) ( 270 )   Objectives We aimed to investigate the treatment effectiveness of peritoneal dialysis (PD)-related peritonitis in outpatient clinic through a retrospective study. Methods We reviewed all episodes of PD-related peritonitis in maintenance PD patients followed up in outpatient clinic from Jan 1, 2008 to Dec 31, 2013 in Peking University People’s Hospital. Peritonitis occurred during hospitalization were not included in this study. Patients admitted to the hospital because of severe symptoms and poor general conditions were also excluded. The effect of treatment included cured and ineffective patients. Their demographic data, episode of peritonitis, clinical outcome and laboratory indices were recorded. Results ① During six years, a total of 103 times of peritonitis occurred in the 63 PD patients during home PD, and 80 episodes (77.7%) were treated in outpatient clinic. ②Among the 80 episodes of peritonitis treated in outpatient clinic, 75 episodes were cured (93.8%), 5 were ineffective. ③Compared with the cured patients, the ineffective patients had higher dialysate leukocyte count at the beginning of follow-up in outpatient clinic (t=-2.176, P=0.033). The proportion of Staphylococcus aureus and negative bacterial culture were higher in ineffective patients than in cured patients (Staphylococcus aureus 20% and negative bacterial culture 60% in ineffective patients; Staphylococcus aureus 8.0% and negative bacterial culture 29.3% in cured patients), but without statistical significance (χ2=4.102, P=0.392). Conclusions Under the premise of standardized diagnosis, treatment, and follow-up procedures about peritonitis, outpatient treatment of mild peritonitis is safe and effective. We should pay more attention to those with poor nutrition state, more dialysate leukocytes, and the peritonitis infected with specific pathogens. If necessary, these patients should be admitted to the hospital in time for further management. Metrics

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The influence of ultrapure dialysate on several main indicators in maintenance hemodialysis patients 2016, 15 (10):  531-535.  doi: 10.3969/j.issn.1671-4091.2016.10.005 Abstract ( 301 )   HTML ( 1 )   PDF (413KB) ( 353 )   Purpose To evaluate the effects of ultrapure dialysate on several main indicators in patients with maintenance hemodialysis (MHD). Methods Fifty patients (25 in nephritis group and 25 in diabetic nephropathy group) treated with MHD for more than one year were followed-up for six months for the monitoring of microbial indices, nutrition related indices, inflammatory indices, microbial quality of the dialysate, β2-microglobulin (β2-MG), blood biochemical indices, C-reactive protein (CRP), dialysis adequacy, and protein catabolic rate (PCR) after using ultrapure dialysate for six months. Results After using ultrapure dialysate for six months, bacterial and endotoxin levels improved (t=3.465, P=0.000), hemoglobin (Hb) and albumin (Alb) increased (t=-1.275, P=0.001), PCR increased (t=-3.332, P=0.000), and β2-MG decreased (t=3.574, P=0.001), while dialysis adequacy (t=0.155, P=0.879) and CRP (t=0.022, P=0.881) showed no significant changes. After using ultrapure dialysate, CRP in nephritis group was significantly lower than that in diabetic nephropathy group (t=-1.757, P=0.000), but other indices had no significant differences between the two groups (P＞0.05). Multivariate analysis revealed that diabetes (OR=1.566, 95% CI 1.086～2.257, P=0.016) and dry body weight (OR=1.007, 95% CI 1.002～1.013, P=0.009) were related to the change of CRP. Conclusions After using the high quality of ultrapure dialysate, the microbial parameters in the dialysate increased, nutritional status improved in MHD patient with nephritis and diabetic nephropathy, and the improvement of inflammation status was more significant in MHD patient with nephritis. Metrics

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Single center and cross sectional study on chronic kidney disease-mineral and bone disorder in maintenance hemodialysis patients 2016, 15 (10):  536-539.  doi: 10.3969/j.issn.1671-4091.2016.10.006 Abstract ( 281 )   HTML ( 1 )   PDF (507KB) ( 242 )   Objective To investigate the incidence and control of chronic kidney disease- mineral and bone disorder (CKD-MBD) in maintenance hemodialysis (MHD) patients. Method A total of 126 MHD patients in our dialysis center were recruited. Their serum calcium (Ca), phosphorus (P) and intact parathyroid hormone (iPTH) were collected to analyze the compliance status with the required levels and to compare with the average levels of the patients in 70 hemodialysis centers in Shanghai in 2014. Calcification of abdominal aorta was evaluated by lateral plain film, and bone mineral density was measured by ultrasonic examination of the calcaneus. Results In the 126 MHD patients, 116 patients (92%) met the diagnosis criteria of CKDMBD. In the 126 MHD patients, the average levels of serum P, Ca and iPTH were 2.3±3.71 mmol/L, 2.23± 0.33 mmol/L, and 401±421 pg/ml respectively. Serum P, Ca and iPTH compliant with the required levels were 41.85%, 35.71% and 58.73%, respectively, of the patients, lower than the average levels of serum Ca and P and higher than the average level of serum iPTH in the patients in 70 hemodialysis centers in Shanghai in 2014 (35.71% vs. 48.86%, χ2=4.188, P=0.042 for serum Ca; 41.85% vs. 61.36%, χ2=21.094, P＜0.001 for serum P; 58.73% vs. 44.91%, χ2= 9.581, P＜0.001 for serum iPTH). The prevalence of abdominal aorta calcification was 74.6%, and the prevalence of CKD-MBD with low bone mineral density was 72.22%. Conclusions CKD-MBD was prevalent in MHD patients. CKD-MBD was frequently associated with low bone density, vascular calcification, and lower compliance with the required serum Ca, P and iPTH levels. Nephrologists should pay more attention to these abnormalities in MHD patients. Metrics

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Application of virtual touch tissue imaging quantification on the secondary hyperparathyroidism 2016, 15 (10):  540-544.  doi: 10.3969/j.issn.1671-4091.2016.10.007 Abstract ( 201 )   HTML ( 1 )   Objective To investigate the application of virtual touch tissue imaging quantification (VTIQ) on the secondary hyperparathyroidism (SHPT). Methods A total of 107 hemodialysis patients with chronic kidney disease were recruited as the research group and were divided into 3 groups according to the serum iPTH level, group A (>300pg/ml), group B (300pg/ml～800pg/ml), and group C (≥800pg/ml). Thirty volunteers served as healthy controls. VTIQ that determined the shear wave velocity (SWV) of the parathyroid glands was performed in the 4 groups. The differences and characteristics of SWV in different groups were analyzed by the performance of comparison among groups, correlation test, and receiver operator characteristic (ROC) curve. Result SWV had no statistical significance between group A and group control (LSDt= 0.792, P=0.430), but was significantly higher in group B than in group control (LSD- t=3.518, P=0.001), and in group C than in group control (LSD-t =8.066, P＜0.001). There were also significant differences in SWV between groups A and B (LSD- t=2.830, P=0.005), groups B and C (LSD- t=4.845, P＜0.001), and groups A and C (LSD-t=7.571, P＜0.001). SWV was positively correlated with iPTH (r=0.680, P＜0.001). When we set iPTH at 300 pg/ml as the cutoff value for the diagnosis of SHPT, and at 800 pg/ml as the cutoff value for surgical treatment of SHPT, the areas under ROC curve were 0.798 and 0.842 (P＜0.001), the SWV cutoff values were 2.260 m/s and 2.720 m/s, the sensitivity of SWV value were 79.17% and 80.00%, and the specificity of SWV value were 77.14% and 83.33%, respectively. Conclusions VTIQ can noninvasively and quantitatively assess the changes of parathyroid gland in patients with SHPT Metrics

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Correlation between the renin-angiotensin-aldosterone system and variation of intradialytic blood pressure in patients during maintenance hemodialysis and the analysis of related factors 2016, 15 (10):  545-549.  doi: 10.3969/j.issn.1671-4091.2016.10.008 Abstract ( 242 )   HTML ( 0 )   PDF (405KB) ( 315 )   Objective The aim of this study was to investigate the relationship between serum renin-angiotensin-aldosterone system (RAAS) level and the variation of intradialytic blood pressure in maintenance hemodialysis patients during dialysis sessions. Methods Fifty-three MHD patients were enrolled in this trial. Fifteen of them had intradialytic hypotension, 20 of them had intradialytic hypertension, and the rest of the patients had intradialytic stable BP. Plasma levels of angiotensin- II (Ang-II), aldosterone (ALD), angiotensinconverting enzyme (ACE), endothelin-1 (ET-1), and nitric oxide (NO) were measured. Results Serum Ang-II, ACE, and ALD were significantly higher in intradialytic hypertension group than in intradialytic stable BP group (97.269±47.256 ng/L vs. (75.334±27.205)ng/L, t=-1.727, P=0.018 for Ang-II; (37.022±9.482)U/L vs. (25.415 ± 10.215)U/L, t=- 3.618, P=0.023 for ACE; [(176.469 ± 67.070)ng/L vs. (124.093 ± 42.642)ng/L, t=-2.901, P=0.007 for ALD]. Serum levels of Ang-II, ACE and ALD were higher in intradialytic hypotension group than in intradialytic stable BP group, but only ALD level was statistically significant [(163.034±53.266) ng/L vs. (124.093 ± 42.642)ng/L, t=2.286, P=0.030]. Serum NO was the highest in intradialytic stable BP group (74.371±27.650) μmol/L, followed by intradialytic hypotension group (65.566±16.785) μmol/L and intradialytic hypertension group [(60.430 ± 17.906) μmol/L; F=2.024, P=0.143]. In contrast, serum ET-1 was the lowest in intradialytic stable BP group (3.650 ± 1.291 pg/ml), followed by intradialytic hypotension group (4.313±1.414 pg/ml) and intradialytic hypertension group [(4.819±1.938) pg/ml; F=2.539, P=0.089]; serum ET- 1 was significantly lower in intradialytic stable BP group than in intradialytic hypertension group (t=-2.208, P=0.034). NO/ET-1 ratio was significantly lower in intradialytic hypotension group and intradialytic hypertension group than in intradialytic stable BP group (15.756±3.257 vs. 20.614±7.485, t=-2.486, P=0.026 between intradialytic hypotension group and intradialytic stable BP group; 14.035±4.845 vs. 20.614±7.485, t= 3.178, P=0.003 between intradialytic hypertension group and intradialytic stable BP group). Multiple stepwise regression analysis found that interdialysis weight gain (IDWG; B=1.482, P=0.001), cardiac complications (B= 4.578, P=0.001), diabetes mellitus (B=3.038, P=0.024), gender (B=- 2.183, P=0.035), and dialysis vintage (B= -0.167, P=0.018) correlated with intradialytic BP changes, but serum RAAS parameters and NO/ET-1 ratio did not correlated with intradialytic BP changes. Conclusion Activation of RAAS and endothelial dysfunction relate to the variation of intradialytic blood pressure in MHD patients during dialysis sessions. Fluid overload may play a role in the pathogenesis of intradialytic hypertension. IDWG, diabetes mellitus, gender, cardiac complications and dialysis vintage affect the level of blood pressure during dialysis sessions. Metrics

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Fluid status assessment in peritoneal dialysis patients by multifrequency bioelectrical impedance analysis 2016, 15 (10):  550-553.  doi: 10.3969/j.issn.1671-4091.2016.10.009 Abstract ( 282 )   HTML ( 2 )   PDF (436KB) ( 367 )   Objective The aim of this study was to validate the multifrequency bioelectrical impedance analysis (MBIA) for assessment of fluid status and volume overload in peritoneal dialysis (PD) patients. Methods Sixty-one clinically stable patients undergoing PD were enrolled in the study. In addition to routine blood tests, various body fluid components were measured in PD patients by using the InBody 720 instrument. Dialysis adequacy, renal function and N-terminal pro brain natriuretic peptide (N-proBNP) level were also assessed in these patients. Results In this cross-sectional study, the ratio of extracellular water (ECW) to total body water (TBW) was positively correlated with age (r=0.514, P=0.000) and negatively correlated with serum albumin concentration (r=-0.483, P=0.000). The ECW/TBW ratio was higher in diabetic patients (t=-3.488, P=0.001), cardiovascular disease patients(t=-2.176, P=0.034) and edema patients (t=-2.546, P=0.014) than in other patients (P＜0.05). Multiple stepwise regression model showed that lower serum Alb (β = - 0.386, P＜0.001) and older age (β =0.426, P＜0.001) were the independent influential factors for higher ECW/TBW ratio. ECW/TBW ratio was positively correlated with NT-proBNP (r=0.397, P=0.002). ROC analysis showed that ECW/TBW ratio and NT-proBNP level could effectively predict volume overload, and ECW/ TBW ratio may be better for the prediction. Conclusions Normal ECW/TBW ratio may be affected by age, albumin level and associated diseases. ECW/TBW ratio and serum NT-proBNP level are closely correlated. Both of them can be used to diagnose volume overload in PD patients, and ECW/TBW ratio may be better than NT-proBNP for the diagnosis. ECW/TBW ratio appears to be an easy and useful marker for the estimation of dry body weight in PD patients with various clinical backgrounds. Metrics

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Effect of different calcium concentrations in dialysate on peritoneum injury and abdominal inflammation markers 2016, 15 (10):  554-558.  doi: 10.3969/j.issn.1671-4091.2016.10.010 Abstract ( 295 )   HTML ( 0 )   PDF (412KB) ( 397 )   Objective To evaluate the effects of calcium 1.25 mmol/L (PD4) and calcium 1.75 mmol/L (PD2) in dialysate on peritoneum injury and abdominal local microinflammatory state by comparing the changes of carcinoembryonic antigen 125 (CA125), vascular endothelial growth factor (VEGF), endothelial nitric oxide synthase (eNOS), and interleukin- 6 (IL- 6) in the effluent from maintenance peritoneal dialysis (PD) patients. Method A total of 48 PD patients treated with PD2 for more than 2 months and followed-up regularly in Dalian Central Hospital from Jun. 2013 to Aug. 2013 were randomly divided into PD4 group and PD2 group. The PD4 group started to use PD4 instead of PD2, and the PD2 group maintained the PD2 dialy -sate. We defined the start time as 0 month and the end time as 6th month. We recorded the clinical indices and stored the effluent samples overnight to measure CA125, VEGF, eNOS and IL-6 by ELISA. Results Thirtyfour patients (n=17 in PD4 group; n=17 in PD2 group) finished the study course. The baseline clinical data were comparable between the two groups. After the treatment for 6 months, CA125 in the effluent decreased in PD2 group (41.54±12.27 U/ml vs. 32.84±9.10 U/ml, t=2.760, P=0.014); eNOS increased in both groups (32.25±7.37 U/ml vs. 46.85±10.04 U/ml, t=-5.463, P＜0.001 for PD4 group; 29.83±8.13 U/ml vs. 52.10±9.49 U/ml, t=-9.918, P＜0.001 for PD2 group); IL-6 increased in both groups (74.67±22.67 ng/L vs. 83.16±23.08 ng/L, t=4.871 P＜0.001 for PD4 group; 70.98±21.59 ng/L vs. 80.05±20.82 ng/L, t=6.804 P＜0.001 for PD2 group); CA125 declined in PD4 group and VEGF increased in both groups, but without statistical significance (P＞0.05). The decrease range of CA125 was less in PD4 group than in PD2 group [-0.05 (-1.15. 1.30) U/ml vs. 2.50 (0.03, 4.85) U/ml, Z=-2.242, P=0.045]. The increase range of eNOS was less in PD4 group than in PD2 group [-13.68 (-19.02, -5.95) U/ml vs. -22.37 (-27.76, -15.77) U/ml, Z=2.197, P=0.04]. There were no statistical differences in the increase rate of VEGF and IL-6 between the two groups (P＞0.05). Conclusion For maintenance PD patients, using 1.25mmol/L calcium dialysate for a short time of period may protect peritoneal mesothelial cells and microvascular endothelial cells without significant influences on peritoneal angiogenesis and local abdominal microinflammation. Metrics

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The dialysis effect of three different molecular weight glucose polymer peritoneal dialysis fluids on healthy New Zealand rabbits 2016, 15 (10):  559-562.  doi: 10.3969/j.issn.1671-4091.2016.10.011 Abstract ( 318 )   HTML ( 0 )   PDF (1142KB) ( 560 )   Objectives Three different molecular weights of glucose polymers, namely large, medium, and small were prepared. Using New Zealand rabbit model for peritoneal dialysis (PD), the effect of those glucose polymers peritoneal dialysis fluids on the net ultrafiltration and the capacity of creatinine and urea nitrogen removal and its effect on peritoneal biocompatibility were evaluated. Methods In pharmacological experiment, healthy New Zealand white rabbits were randomly divided into three groups, i.e. low, middle and high molecular glucose polymer PD groups (8 animals in each group). After dwelling of the dialysate for 240 min, blood and effluent fluids were collected, and the concentration of creatinine and urea nitrogen in plasma and effluent fluids were measured. Furthermore, the effect of middle molecular weight glucose polymer for three consecutive days on peritoneal histomorphology was evaluated for biocompatibility study. Results Three different molecular weights of glucose polymers were developed by controlling synthesis conditions and the glucose polymer peritoneal dialysis fluids were prepared. In vivo studies showed that there were statistically differences in net ultrafiltration (F=8.875, P=0.002), urea nitrogen clearance (F=13.090, P< 0.001), and creatinine clearance (F=6.429, P=0.007) among the three groups. In addition, the middle molecular had a higher ultrafiltration efficiency (63±9 ml vs. 45±8 ml, q=5.910, P=0.001, compared to low moelcular; 63±9 ml vs. 52±8 ml, q=3.612, P=0.047, compared to high molecular) and the better clearance of urea nitrogen (0.485± 0.051 ml/min vs. 0.372±0.046 ml/min, q=6.562, P<0.001, compared to low molecular; 0.485±0.051 ml/min vs. 0.383±0.049 ml/min, q=5.923, P=0.001, compared to high molecular) and creatinine (0.536±0.064 ml/min Metrics

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Discussion about how to select peritoneal dialysis catheter and the methods of insertion 2016, 15 (10):  566-568.  doi: 10.3969/j.issn.1671-4091.2016.10.013 Abstract ( 405 )   HTML ( 3 )   PDF (291KB) ( 339 )   Peritoneal Dialysis is an effective method to treat the End Stage of Renal Disease (ESRD).The catheter of peritoneal dialysis is the lifeline for those patients. Recently many evidence-based clinic results about peritoneal dialysis have been published worldwide, so it is very important to select the optimal catheter and the methods of insertion according to those updated evidences. Metrics

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The long-term results of percutaneous transluminal angioplasty and stentin for stenosis in central vene in maintenance hemodialysis patients 2016, 15 (10):  569-572.  doi: 10.3969/j.issn.1671-4091.2016.10.014 Abstract ( 263 )   HTML ( 4 )   PDF (472KB) ( 255 )   Objective To investigate the long-term patency and the expense of the percutaneous transluminal angioplasty (PTA) and stentin (PTS) for central vene stenosis (CVS) in maintenance hemodialysis patients. Methods We retrospectively analyzed the patients receiving PTA or PTS in our center. Results the primary patency rates after PTA for 3, 6, 12 and 24 months were 88.2%, 73.3%, 57.1% and 37.5% respectively, and the secondary patency rates were 94.1%, 86.7%, 71.4% and 50.0% respectively. The primary patency rates after PTA+PTS for 3, 6, 12 and 24 months were 88.9%, 66.7%, 33.3% and 0% respectively, and the secondary patency rates were 100%, 83.3%, 66.7% and 33.3% respectively. The average expense for the first PTA was 2,0938.50 yuan, and the average expense for the first PTS was 3,2599.58 yuan. Conclusion Currently, the endovascular interventional treatment for CVS is expensive. The long-term patency still depends on the development of advanced technology and devices. Metrics

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Clinical investigation on the effect of diabetes on maturation of arteriovenous fistula 2016, 15 (10):  573-575.  doi: 10.3969/j.issn.1671-4091.2016.10.015 Abstract ( 247 )   HTML ( 0 )   PDF (389KB) ( 507 )   Objective To investigate whether diabetes mellitus affects the maturation of autologous arteriovenous fistula (AVF) after the operation for 3 months in patients with end stage renal disease (ESRD). Methods We selected patients with ESRD in the Nephrology Department of Beijing Haidian Hospital, divided them into diabetes group and non-diabetes group, collected their general information, primary disease and vascular calcification to decide the operation plan after comprehensive evaluation, and record the corresponding parameters for vessel anastomosis before AVF operation. After the operation for 3 months, fistulas were examined by ultrasound, and the related parameters were recorded. The maturation of AVF was determined by physical and ultrasound examinations. Results This study included 118 patients. The maturation rate was significantly lower in diabetes group than in non-diabetes group (72.0% vs. 95.6%, c2= 13.001, P=0.000). The prevalence of vascular calcification was significantly higher in diabetes group than in non-diabetes group (c2= 5.002, P=0.025).Univariate logistic regression analysis showed that diabetes (OR 8.426, 95% CI 2.270～ 31.283, P=0.001) and radial artery diameter <1.5mm (OR 6.257, 95% CI 2.020～19.381, P=0.001) affected the maturation of AVF (P<0.05). Binary logistic regression analysis showed diabetes (OR 9.086, 95% CI 2.302～35.866, P=0.002) and radial artery diameter <1.5mm (OR 6.789, 95% CI 2.022, P=0.002) were the independent risk factors for delayed maturation of AVF. Conclusions The prevalence of vascular calcification and delayed maturation of AVF are relatively high in patients with diabetes. Diabetes and radial artery diameter<1.5mm are the independent risk factors for delayed maturation of AVF. Metrics