Chinese Journal of Blood Purification

12 November 2016, Volume 15 Issue 11 Previous Issue    Next Issue

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Executive function of maintenance hemodialysis patients under Flanker task: behavioral and event-related potential evidence 2016, 15 (11):  587-590.  doi: 10.3969/j.issn.1671-4091.2016.11.002 Abstract ( 231 )   HTML ( 0 )   PDF (383KB) ( 370 )   Objective To investigate the executive function in maintenance hemodialysis (MHD) patients. Method The event-related potential (ERP) of 16 MHD patients (MHD group) and 15 health people (healthy group) under Flanker task were analyzed. The accuracy and reaction time of key-press action were automatically recorded. We performed analysis of variance (ANOVA) and simple effect test for the repeated measures to compare the differences in accuracy, reaction time, and the components of N200 and P300. Result There were no significant differences in accuracy (F [1,29]=0.881, P=0.176) and reaction time in consistency situation between MHD group and healthy group. The reaction time under inconsistency situation was significantly longer in MHD group than in healthy group (P=0.028). The reaction time difference under Flanker interference was also significantly longer in MHD group than in healthy group (t=34.514,P<0.001). In both MHD and healthy groups under consistent/inconsistent situations, the peak of N200 [F(1,28) =17.851, P< 0.001) and the amplititude of P300 [F(1, 29)=4.348, P=0.046] had the interaction between task type and group effect. Under consistent situation, the peak of N200 (P=0.912) and amplititude of P300 (P=0.049) had no significant differences between MHD group and healthy group. Under inconsistent situation, however, the peak of N200 (P=0.048) and the amplititude of P300 (P=0.049) were significant higher in MHD group than in healthy group. The group main effect of P300 latency was significant [F(2,56)=17.482, P<0.001]. Conclusion  The basic identification and basic reaction time were normal in MHD patients. However, their cognitive inhibition ability and conflict monitoring ability were impaired. Metrics

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Evaluation of cardiac structural and functional alterations by echocardiography in patients undergoing peritoneal dialysis or hemodialysis 2016, 15 (11):  591-594.  doi: 10.3969/j.issn.1671-4091.2016.11.003 Abstract ( 229 )   HTML ( 1 )   PDF (378KB) ( 299 )   Objective To investigate the effects of hemodialysis and peritoneal dialysis on cardiac structure and function in patients with end-stage renal disease by color Doppler echocardiography (ECHO) and tissue velocity imaging (TVI) technologies. Methods Chronic kidney disease 5 stage group (CKD5), maintenance hemodialysis group (MHD), and continuous ambulatory peritoneal dialysis (CAPD) group were enrolled in this cross-sectional study. ECHO and TVI technologies were used to acquire the changes of cardiac structure and function in different groups. Results ①Interventricular septum thickness (IVST), left ventricular end- diastolic diameter (LVDd), left ventricular wall thickness (LVPW), left ventricular mass index (LVMI), left atrial diameter (LAD), E/A ratio, ejection fraction (EF), and peak late diastolic velocity (Am) showed no significant differences among the three groups (F=1.595, P=0.211 for IVST; F=0.146, P=0.864 for LVDd; F=1.543, P=0.222 for LVPW; F=0.904, P=0.410 for LVMI; F=0.986, P=0.379 for LAD; F=0.543, P=0.588 for E/A; F=1.038, P=0.360 for EF; F=1.330, P= 0.270 for Am). Peak early diastolic velocity (Em) and Em/ Am ratio were higher in CAPD group than in MHD group (t=2.375, P=0.021 for Em; t=2.940, P= 0.005 for Em/Am).②The prevalence of left ventricular diastolic dysfunction (LVDD) in CKD5, MHD, CAPD groups were 77%, 83% and 66% respectively, and the prevalence of left ventricular hypertrophy (LVH) in CKD5, MHD, CAPD groups were 73%, 83% and 69% respectively, without statistical differences among the three groups (c2=2.570, P=0.277 for LVDD; c2=1.735, P=0.420 for LVH). The main reflux changes were mitral regurgitation (MR) followed by tricuspid regurgitation (TR), and the reflux rates had no significant differences among the three groups (c2=3.344, P=0.188 for MR; c2=2.067, P=0.356 for TR). Conclusions ① Cardiac structure and function alterations mainly manifested left ventricular hypertrophy, diastolic dysfunction, mitral valvular regurgitation, tricuspid regurgitation in end- stage renal disease patients regardless of renal replacement therapy. TVI technology was more sensitive than ECHO in the evaluation of left ventricular diastolic dysfunction. ②Hemodialysis and peritoneal dialysis did not improve left ventricular hypertrophy and ventricular systolic and diastolic dysfunction, but peritoneal dialysis may be better than hemodialysis to delay the onset and progression of ventricular diastolic dysfunction. Metrics

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Peritoneal dialysis investigation of 166 cases and research on factors for PD-related peritonitis 2016, 15 (11):  595-599.  doi: 10.3969/j.issn.1671-4091.2016.11.004 Abstract ( 278 )   HTML ( 1 )   PDF (409KB) ( 440 )   Objective To investigate the family caring support,the environment and sanity,the life quality and family economic burden to afford the medical expenses of peritoneal dialysis patients,we discussed about the risk factors for peritonitis taking place in patients accepting peritoneal dialysis. Method Questionnaire on peritoneal patients who ungerwent the peritoneal dialysis in our center for at least 3 months and followed up steadily with regularly evaluating results for their dialysis effects.Combined with the patients' personal clinical information,including the results of experimental tests,the follow-up evaluation on dialysis,and the total occurence of peritonitis,related statistics were analyzed to find out risk factors for peritonitis.Results Among the 166 PD patients,103 cases were males(62.4%),the average age at the beginning of PD was 57.88±17.31 years.Up to December 2015, totally 55 cases(33.13%) went on peritonitis in the observing period.LOGISTIC proportional hazards model analysis indicated that the risk factors for peritonitis were ：age at the beginning of PD (OR=1.054，95% CI 1.007～1.104，P=0.025),high blood level of 1,25-OH-D3(P=0.033, 95%CI: 1.003～1.090，OR=1.045),and the influence of PD expenditure on family economics (OR=0.371，95% CI 0.149～0.923，P=0.037). Compared with the non-peritonitis,the peritonitis group had longer duration of peritoneal dialysis (Z=-6.796，P＜0.001),higer value of kt/v and CCR (Z=-2.174，P=0.030),and higher rate of involvement in social work and study (Z=-2.286，P=0.022). Conclusion In the PD patients treated in our center, family caring support, environment and sanity, and quality of life were basically in good conditions, and medical expenses were acceptable to most PD families. Older age at the beginning of PD, higher plasma 1,25-OH-D3 before PD were the risk factors for PD-related peritonitis. The peritonitis rate was relatively lower in the families considering PD as a big financial burden. More involvement in social work or study, longer PD duration, and insufficient clearance of toxic solutes also contributed to the presence of peritonitis. Metrics

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The association of malnutrition, inflammation and cardiovascular disease with cognitive function in peritoneal dialysis patients 2016, 15 (11):  600-604.  doi: 10.3969/j.issn.1671-4091.2016.11.005 Abstract ( 254 )   HTML ( 0 )   PDF (517KB) ( 371 )   Objective This study was to explore the association of malnutrition - inflammation - atherosclerosis syndrome (MIA) with cognitive function in peritoneal dialysis (PD) patients. Methods A total of 240 clinically stable patients who performed PD for at least 3 months were enrolled. The global cognitive function and specific cognitive functions were investigated. Demographic and biochemical data were recorded. Serum albumin ≤35g/L and high sensitive C-reactive protein ≥3mg/L were used to diagnose malnutrition and inflammation respectively in these patients. MIA0 referred to those without any of the 3 abnormalities, and MIA1 and MIA2 referred to those with one and 2～3 abnormalities respectively. Results The prevalence of malnutrition, inflammation and cardiovascular disease was 15.0% (n=36), 47.5% (n=114), and 35.8% (n=86) respectively. The numbers of patients in MIA0, MIA1, and MIA2 group were 79 (32.9%), 87 (36.3%), and 74 (30.8%) respectively. The prevalence of global cognitive impairment was 6 (7.6%), 16 (18.4%), and 15 (20.3%) in MIA0, MIA1, and MIA2 groups respectively. As compared to MIA0 group, patients in MIA2 and MIA1 groups had significantly lower 3MS scores (t=3.629, P＜0.001; t=-2.518, P=0.013), higher prevalence of cognitive impairment (χ2=5.184, P=0.023; χ2=4.197, P=0.040) and executive dysfunction (χ2=14.574, P＜0.001; χ2=6.817, P=0.009), and longer time on completing trails B (χ2=9.317, P=0.002; χ2=4.236, P=0.040). The time on completing trails A (χ2=7.281, P=0.007; χ2=15.028, P＜0.001) was longer and the scores of visuospatial skills (t=2.122, P=0.035; t=2.893, P=0.004) were lower in MIA2 group than in MIA1 and MIA0 groups. The scores of immediate memory were lower in MIA2 group than in MIA0 group (t=2.071, P=0.040). Conclusion The MIA syndrome was closely associated with cognitive impairment in PD patients. Patients with two factors of MIA were prone to have severer cognitive impairment than those without MIA or with one factor of MIA. Metrics

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Fluid status assessment by multi-frequency bioelectrical impedance analysis and serum NT-proBNP in maintenance hemodialysis patients 2016, 15 (11):  605-608.  doi: 10.3969/j.issn.1671-4091.2016.11.006 Abstract ( 251 )   HTML ( 1 )   PDF (424KB) ( 345 )   Objective To assess the ideal dry body weight of maintenance hemodialysis (MHD) patients using multi-frequency bioelectrical impedance analysis (MBIA), and to evaluate the diagnostic value of serum N-terminal pro brain natrinuretic peptide (NT-proBNP) for the volume overload of MHD patients. Methods A total of 105 MHD patients with ideal dry body weight from our blood purification center were enrolled in this study. MBIA was used to obtain the body fluid composition, the ratio of extracellular water (ECW%), and the total body water (TBW), from which the fluid status of the patient was determined. Serum NT-proBNP before dialysis was also measured. We then analyzed the influence factors for ECW% and the value of serum NT-proBNP for the diagnosis of fluid overload by ROC curve. Results The average ECW% was 0.39±0.01 by MBIA. Using the formula to correct the ECW%, fluid overload was found in 51.4% (54/105) of the patients. ECW% was positively correlated with age (r= 0.578, P =0.000). ECW% was negatively correlated with gender (r=- 0.251, P=0.010), dehydration volume (r =- 0.226, P=0.020), and diastolic pressure at each time point (r=-0.336, -0.374, -0.281 respectively, and P=0.000, 0.000, 0.004 respectively). Multivariate linear regression showed that age was the independent risk factor for ECW% (β=0.451, t=4.892, P=0.000). Serum NT-proBNP was positively correlated with ECW% (r= 0.340, P =0.000). The median value of serum NT-proBNP was 3,321pg/ml in the patients with ideal dry body weight, and was 5,407pg/ml in the patients without ideal dry body weight (z=-3.802, P =0.000). The ROC curve showed that the area under the curve of serum NTproBNP for the diagnosis of fluid overload was 0.715 (P =0.000); when serum NT-proBNP was set at 3,937pg/ml as the cut-off value for the diagnosis of ideal dry body weight, the sensitivity was 0.704 and the specificity was 0.627. Conclusion Age and serum NT-proBNP level were closely correlated with ECW% in MHD patients. NT- proBNP was a useful marker for evaluating volume status in MHD patient, and NT- proBNP 3, 937pg/ml was the optimal cut-off value for the evaluation of ideal dry body weight. Metrics

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Comparison of quality of life score in patients with high-flux hemodialysis and those with conventional hemodialysis combining hemodiafiltration 2016, 15 (11):  609-611.  doi: 10.3969/j.issn.1671-4091.2016.11.007 Abstract ( 281 )   HTML ( 0 )   PDF (350KB) ( 594 )   To compare the efficacy and quality of life score in uremic patients with high-flux hemodialysis (HFHD) and those with conventional hemodialysis (HD) combining hemodiafiltration (HDF). Methods Forty-one maintenance hemodialysis (MHD) patients were randomly divided into experimental group (HFHD3 times/week) and control group (HD 2 times/week plus HDF one time/week). They were followed up for an average of 36 months. Kt/V, URR, and the SF-36 scale were measured at baseline and after the treatment for 36 months. Results The SF- 36 score (including physical functioning, role- physical, bodily pain, general health, energy, social functioning, role-emotional, mental health scores), Kt/V, and URR had no significant differences between the two groups (P＞0.05). However, physical functioning, role-physical, bodily pain, general health, social functioning, role-emotional, and mental health scores in experimental had an increasing trend compared with the control group. Conclusion The long- term efficacy of the two dialysis patterns may be comparable. HFHD may have more clinical potentials regarding its lower expenses and relatively simple nursing operation. Metrics

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Related factors for intradialytic blood pressure variability in hemodialysis patients 2016, 15 (11):  612-615.  doi: 10.3969/j.issn.1671-4091.2016.11.008 Abstract ( 234 )   HTML ( 1 )   PDF (516KB) ( 295 )   Objective To evaluate intradialytic blood pressure variability (BPV) in patients on maintenance hemodialysis (MHD), and to investigate the related factors for BPV during MHD sessions. Methods A total of 182 MHD patients were divided into two groups according to the percentage of BPV (systolic blood pressure coefficient of variation, SBP- CV), high BPV group (SBP-CV ≥9.48) and low BPV group (SBPCV＜9.48). Associated factors for BPV were analyzed. To further study the relationship between inter-dialysis weight gain rate (IDWG%) and BPV, we defined the median IDWG% 4.1% as the cut-off value, and divided the patients into higher IDWG% group and lower IDWG% group. Results More females, more ultrafiltration volume, and higher IDWG% were found in the high BPV group (t=2.133 and P=0.048 for gender; t =2.667 and P =0.008 for ultrafiltration volume; t =2.265, P =0.025 for IDWG%). Lower levels of serum albumin (Alb) and LDL-C were found in the low BPV group (t=2.416 and P=0.017 for Alb; t=2.317 and P=0.022 for LDL-C). Multivariate regression analyses showed that BPV was positively correlated with IDWG%, Alb and diabetes (β=0.194 and P=0.008 for IDWG%; β=0.166 and P =0.023 for Alb; β=0.179 and P=0.015 for diabetes). Dialysis duration, phosphorus and PTH levels, SBP-CV, diastolic blood pressure coefficient of variation (DBP-CV) were significantly higher in the higher IDWG% group than in the lower IDWG% group (t =2.265 and P =0.025 for dialysis duration; t=3.763 and P＜0.001 for phosphorus; t =2.707 and P =0.007 for PTH, t = 3.831 and P＜0.001 for SBP-CV: t =2.087 and P =0.038 for DBP-CV), while age was younger in the higher IDWG% group (t =2.696, P =0.008). Conclusion IDWG% is an independent risk factor for BPV. Younger age, long dialysis duration, high levels of phosphorus and PTH are associated with higher IDWG%. Control of IDWG% is an important method for the improvement of BPV in MHD patients. Metrics

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The interplay of vitamin D deficiency and anemia in CKD 2016, 15 (11):  620-623.  doi: 10.3969/j.issn.1671-4091.2016.11.010 Abstract ( 392 )   HTML ( 1 )   PDF (731KB) ( 389 )   Patients of chronic kidney disease usually suffer from anemia and hyperparathyroidism secondary to deficiency of EPO and vitamin D as CKD progresses. The outcome of CKD is significantly influenced by the management of anemia and secondary hyperparathyroidism. Recently the association of vitamin D and anemia has been found in many researches no matter the population, the CKD patients and the patients on dialysis, but the mechanism is undefined. The relevance of vitamin D deficiency and anemia is partially dependent on parathyroid hormone (PTH). Besides, hepcidin and inflammation independent of PTH also play a significant role. The above possible aspects contribute to anemia via a common VDR pathway. This review focuses on current situation and probable mechanism of the interplay between vitamin D and anemia in order to provide a suggestion that administration of vitamin D or its analogues may improve the anemia state in CKD patients. Metrics

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The relationship between autologous arteriovenous fistula palpation and fistula flow rate 2016, 15 (11):  624-627.  doi: 10.3969/j.issn.1671-4091.2016.11.011 Abstract ( 326 )   HTML ( 2 )   PDF (324KB) ( 599 )   Object To analyze the relationship between the location of thrill due to autologous arteriovenous fistula (AVF) obtained by palpation and the flow rate in AVF measured by ultrasound. Methods Physical examination and Doppler ultrasound were used to examine the AVF in maintenance hemodialysis patients.Well-used wrist AVFs were included for the study. Palpation examination should cover all areas of the AVF. The most proximal site on which thrill was still perceptible was marked and divided into mid-forearm group, forearm near elbow group, elbow group, and upper arm group. Doppler ultrasound was used to examine the diameter and flow rate in brachial artery, radial artery, and ulnar artery. Diameters of the cephalic vein at midforearm, forearm near elbow, and upper arm were measured. Result Seventy patients were enrolled in this study. They were divided into mid-forearm group (n=20), forearm near elbow group (n=21), elbow group (n=18), and upper arm group (n=11) based on the most proximal site where thrill was still perceptible. In the midforearm group, forearm near elbow group, elbow group, and upper arm group, the average diameters of brachial artery were 5.42±0.16, 5.73±0.17, 6.32±0.26, and 6.60±0.32 mm respectively, significantly different among the 4 groups (F=5.553, P=0.002); the average flow rates in brachial artery were 543 (382.5, 626), 748.62±66.79, 924.06±69.57, and 1253.73± 98.74ml/min respectively, significantly different among the 4 groups (F= 12.407, P=0.000); the 95% confidence interval of lower flow rate limits in brachial artery were 432.91, 609.30, 777.28, and 1033.71ml/min respectively. Conclusion Significant relationship was found between palpation of AVF and flow rate in AVF. Thrill palpated at more proximal site suggests the higher blood flow rate in AVF and a forearm fistula with thrill at elbow or upper arm can be viewed as a well-functional fistula. Metrics

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Application of covered stent in arteriovenous graft stenosis for hemodialysis access 2016, 15 (11):  628-630.  doi: 10.3969/j.issn.1671-4091.2016.11.012 Abstract ( 282 )   HTML ( 0 )   PDF (393KB) ( 417 )   Objective To investigate the treatment efficacy of covered stent for arteriovenous graft (AVG) stenosis in hemodialysis patients. Methods The clinical data of AVG stenosis treated by covered stent in our center were retrospectively analyzed. Results This method was used in 6 cases. Before stent placement, they had received average 2.7 times of percutaneous transluminal angioplasty. The stenosis located at the veins near anastomosis in 4 cases and at the venous outflow tracts in 2 cases. They were followed up for 13±3.3 months. The primary patency rates at 3, 6 and 12 months were 83%, 67% and 40%, and the secondary patency rates were 100%. Conclusion Short-term patency rate of covered stent treatment for AVG stenosis is satisfactory. Covered stent also has the advantages of treating other AVG complications. Metrics

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Ultrasound- guided percutaneous transluminal angioplasty for the stenosis in arteriovenous fistulas 2016, 15 (11):  631-634.  doi: 10.3969/j.issn.1671-4091.2016.11.013 Abstract ( 271 )   HTML ( 1 )   PDF (786KB) ( 426 )   Objective To determine whether percutaneous transluminal angioplasty (PTA) guided by ultrasound is a safe and effective method for treating arteriovenous fistula stenosis in hemdialysis patients. Methods The need for angioplasty intervention was determined by computed tomography angiography (CTA) and duplex ultrasound. Patients with the luminal narrowing ≥50% or the vascular diameter <2.5mm were referred to the treatment. The balloon was introduced to the lesion site through a guide wire under the guide of ultrasound. The balloon was then inflated by infusion of normal saline at the pressure increase rate of one atmosphere per 2 seconds until the disappearance of the stenosis. Results A total of 1,244 operations of PTA for 569 patients were performed in our hospital from Jun. 2009 to Dec. 2015. The technical and clinical success rates were 98%. The average vascular diameter was 2.094±0.599mm before the intervention, and was 3.916±0.720mm after the intervention (t=20.933, P＜0.001). Local and small amount of extravasation happened in 10 cases, and disappeared within a week after gentle pressure dressing. There was no vessel rupture and thrombosis due to the PTA manipulation. Conclusion Ultrasound guided PTA for the treatment of arteriovenous fistula stenosis has the advantage of no X-ray radiation, no contrast agent injection, and using relatively simple equipment. Ultrasound equipment is also available for vascular imaging and blood flow measurement. PTA under ultrasound guidance for arteriovenou fistula stenosis can be performed safely, simply and effectively, and is a valuable tool for the treatment of superficial vessel stenosis but not for the stenosis in central vein. Metrics

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An introduction of the clinical work for dialysis technicians and the clinical engineer technician system in Japan: probably helpful for the development of professional dialysis technician system in China 2016, 15 (11):  635-638.  doi: 10.3969/j.issn.1671-4091.2016.11.014 Abstract ( 310 )   HTML ( 0 )   PDF (749KB) ( 347 )   Dialysis technician system is relatively well-developed and well-organized in Japan. In this paper, we introduce the responsibility, administration, and working processes for Japanese dialysis technicians as well as the certification and qualification system for clinical engineer technicians in Japan. We then discussed its significance for the development of professional dialysis technician system in China. Metrics