Chinese Journal of Blood Purification

12 January 2017, Volume 16 Issue 01 Previous Issue    Next Issue

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Recent advances in the pathological mechanism of renal tubular epithelial cells in acute kidney injury 2017, 16 (01):  1-3.  doi: 10.3969/j.issn.1671-4091.2017.01.001 Abstract ( 267 )   PDF (357KB) ( 430 )   Acute kidney injury (AKI) induced by many pathogenic factors is an acute and severe clinical syndrome with higher incidence and mortality. Its mortality remains high due to the limited therapeutic measures. To understand its pathological mechanism is essential for the prevention and treatment of AKI. The injury and repair of renal tubular epithelial cells play an important role in the development of AKI. In this review, autophagy, regulated cell death and cell cycle changes in tubular epithelial cells are discussed. Metrics

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Research advances in acute kidney injury in patients with cancer 2017, 16 (01):  4-7.  doi: 10.3969/j.issn.1671-4091.2017.01.002 Abstract ( 288 )   PDF (429KB) ( 582 )   Acute kidney injury (AKI) is a critical syndrome with high morbidity and mortality. Cancer patients often have the risk factors for AKI, such as older age, chronic kidney disease, pre-renal factors, sepsis, exposure to nephrotoxins, and obstructive. In addition, anti-cancer treatment and the diagnostic procedure for cancer may also induce AKI. AKI causes serious consequences and affects the anti-cancer therapy. Although AKI is frequently seen in cancer patients, research on this population is limited in China. Here we summarize the etiology of AKI in this population and the clinical characteristics of AKI in critical cancer patients. Metrics

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Epidemiology of acute kidney injury 2017, 16 (01):  8-10.  doi: 10.3969/j.issn.1671-4091.2017.01.003 Abstract ( 432 )   PDF (365KB) ( 789 )   Acute kidney injury (AKI) is a common and severe clinical syndrome associated with higher mortality, tremendous medical expenditure, and higher long-term mortality and morbidity. During the past 3 years, nephrologists have conducted a serial of surveys on the epidemiology of AKI in China. It is estimated that about 2.9 million adult AKI patients were hospitalized and 700,000 patients of them died in 2013 in China, resulting in a huge burden to the medical institutes, the society, and the economy. Meanwhile, there has been a common situation of misdiagnosis and inappropriate treatment to AKI patients in clinical practice. Serious attention should be paid to the prevention an treatment of AKI to reduce mortality and to improve outcome of AKI patients. Metrics

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Roles of substance P in septic acute kidney injury 2017, 16 (01):  11-13.  doi: 10.3969/j.issn.1671-4091.2017.01.004 Abstract ( 307 )   PDF (341KB) ( 507 )   Inflammatory factors play an important role in sepsis-induced AKI. Substance P (SP) level is elevated significantly in sepsis patients as compared with that in the control group. Higher SP level contributes to renal damage possibly via enhancing oxidative stress and macrophage infiltration to the kidney, and NK1 receptor antagonists alleviate the renal injury. It is suggested that SP promotes inflammation, ROS production and immunosuppression through the recruitment of leukocytes and the regulation of different types of macrophages. Metrics

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Analysis of hospitalized patients with acute kidney injury 2017, 16 (01):  14-19.  doi: 10.3969/j.issn.1671-4091.2017.01.005 Abstract ( 292 )   PDF (484KB) ( 689 )   Objectives To improve the treatment and prognosis of AKI patients, we retrospectively analyzed the mortality, incidence rate, etiology, prognosis, and risk factors for mortality and severity of acute kidney injury (AKI) in hospitalized patients. Methods We analyzed the hospitalized patients treated in the First Affiliated Hospital of Xi’an Jiaotong University during July 2012 to June 2014, and used the KDIGO clinical practice guideline for AKI as the criterion for the diagnosis of AKI to pick out AKI patients. Their clinical features, general information, laboratory data and prognosis were then collected. Logistic regression was conducted to investigate the risk factors for mortality and severity of AKI patients. Results There were 129,624 hospitalized patients during this study period, and 727 of them were diagnosed as AKI. The overall incidence of AKI was 0.561%, and the mortality of AKI was 26.135%. The ratios of stage I, II and Ⅲ AKI were 28.198%, 31.637%, and 40.165% respectively in these AKI patients, and the mortality rates in stage I, II and Ⅲ AKI were 9.268%, 30.000% and 34.932% respectively (P＜0.001). Hospital-acquired AKI was diagnosed in 153 patients (21.045% ). Multivariate logistic regression showed that multiple organ dysfunction syndrome (MODS) (OR=4.328, 95% CI 2.643～7.087, P＜0.001), older age (OR=1.523, 95% CI 1.023～2.267, P= 0.038), hepatic cirrhosis (OR= 3.321, 95% CI 1.724～6.397, P＜0.001), cancer (OR=2.044, 95% CI 1.187～3.518, P=0.01) were the independent risk factors for death, and that MODS (OR= 2.314, 95% CI 1.550～3.455, P＜0.001) and epidemic hemorrhagic fever (OR=2.205, 95% CI 1.124～4.325, P=0.021) were the independent risk factors for stage II and Ⅲ AKI. Conclusions AKI is a clinical syndrome with higher incidence and mortality. MODS, older age, hepatic cirrhosis, cancer, and epidemic hemorrhagic fever were the factors seriously affecting the prognosis of AKI. For early detection of AKI, we should keep awareness of the presence of AKI and frequently monitor renal function in related patients. Metrics

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Effects of continuous blood purification on the PYK2 signaling pathway activity in severe lupus nephritis patients combined with acute renal injury 2017, 16 (01):  20-25.  doi: 10.3969/j.issn.1671-4091.2017.01.006 Abstract ( 180 )   PDF (759KB) ( 245 )   Objective To investigate the effects of continuous blood purification (CBP) on the PYK2 signaling pathway activity in severe lupus nephritis patients combined with acute renal injury, and to explore the treatment mechanism of CBP. Methods A total of 48 severe lupus nephritis patients combined with acute renal injury admitted to our hospital from January 2012 to April 2016 were randomly divided into 2 groups: observation group (n=24) and control group (n=24). In addition to the conventional therapy for both groups, CBP treatment was conducted for patients in observation group, and intermittent hemodialysis (IHD) treatment was conducted for those in control group. Systemic lupus erythematosus disease activity index (SLE-DAI), serum urea nitrogen (BUN), creatinine (SCr), and effectiveness were compared between the two groups. p-PYK2, CD40L and CTLA4 protein levels in peripheral blood mononuclear cells were assayed before and after the treatment. Results After the treatment for 30 days, SLEDAI, BUN and SCr were significantly lower in observation group than in control group (3.4±2.8 vs. 7.7±2.3, t=2.334, P=0.023 for SLEDAI; 6.4±3.8 vs. 16.7±5.3, t=3.930, P＜0.001 for BUN; 86.2±17.3 vs. 127.1±31.2, t=2.482, P=0.016 for SCr). The ratios of therapeutic effectiveness were 91.7% and 58.3% in observation group and control group respectively (χ2=4.552, P=0.013). After the treatment for 30 days, p-PYK2, CD40L and CTLA4 levels were significantly lower in observation group than in control group (0.732 ± 0.206 vs. 1.110 ± 0.152, t=3.196, P=0.007 for p-PYK2; 9.4% vs. 18.6%, χ2=3.516, P=0.027 for CD40L; 7.2% vs. 16.3%, χ2=3.950, P=0.018 for CTLA4). Conclusion CBP can inhibit the activated PYK2 signaling pathway in severe lupus nephritis combined with acute renal injury, rebuild the homeostasis of immunological system, prevent kidney from further injuries, and thus improve the acute renal injury. Metrics

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Peritoneal catheter fixation combined with vertical tunnel and low implant position to prevent catheter malfunction 2017, 16 (01):  26-29.  doi: 10.3969/j.issn.1671-4091.2017.01.007 Abstract ( 252 )   PDF (587KB) ( 318 )   Objective To evaluate the effect of catheter fixation combined with vertical tunnel and low implant position for the prevention of peritoneal catheter malfunction. Methods End stage renal disease (ESRD) patients treated with peritoneal dialysis (PD) in our center from Jan. 2013 to Sep. 2015 were enrolled in this study. They were randomly divided to catheter fixation group and traditional open surgery group, and were followed up for six months after surgery. Catheter-related complications were recorded. Results A total of 99 patients (50 patients in catheter fixation group and 49 patients in traditional open surgery group) were enrolled in this study. During the 6-month follow-up period, no patients in catheter fixation group developed catheter malfunction, significantly lower than that in traditional open surgery group (0 vs. 16.33%, χ2=6.819, P=0.009). There were no significant differences in episodes of peritonitis (χ2=1.070, P=0.301), exit- site and tunnel infections (χ2=0.990, P=0.320), bleeding (χ2=0.990, P=0.320), leakage (χ2=1.031, P=0.310), inflow or outflow pain (χ2=0.000, P=0.984), hernia (χ2=1.031, P=0.310) and delayed wound healing (χ2=0.990, P=0.320) between the two groups. Conclusions Catheter fixation combined with vertical tunnel and low implant position can effectively prevent catheter malfunction in PD patients. Metrics

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Plasma hepcidin level and its related factors in maintenance hemodialysis patients 2017, 16 (01):  30-34.  doi: 10.3969/j.issn.1671-4091.2017.01.008 Abstract ( 350 )   PDF (794KB) ( 596 )   Objective To investigate plasma hepcidin level, the potential factors relating to hepcidin level, and its association with anemia and vascular calcification in maintenance hemodialysis (MHD) patients. Methods The MHD patients treated in Shanghai Ruijin Hospital from Jan. 1st, 2011 to Dec. 31st, 2011 were enrolled in this study. Clinical characteristics and biochemical indices at baseline were collected. Blood samples at baseline were collected to determine plasma hepcidin level using ELISA method. The relationship between hepcidin level and anemia parameters and abdominal aortic calcification (AAC) was analyzed. Results A total of 216 MHD patients were enrolled in this study. The median plasma hepcidin level was 2,952.66 (1,131.38～6,076.72) pg/ml. Spearman analysis showed that significant negative correlations were observed between hepcidin level and red blood cell (r=-0.203, P=0.003), hemoglobin (r=-0.165, P=0.015), hematocrit (r=-0.182, P=0.007), total iron binding capacity (r=-0.467, P＜0.001) and transferrin (r=-0.362, P＜0.001); significant positive correlations were found between hepcidin level and mean corpuscular hemoglobin (r= 0.163, P=0.017), mean corpuscular hemoglobin concentration (r=0.156, P=0.022), transferrin saturation (rr= 0.193, P=0.004), ferritin (r=0.681, P＜ 0.001), C- reactive protein(CRP) (r=0.301, P＜0.001), and weekly ESA dose (r=0.146, P=0.032). Stepwise multivariate regression analysis showed that BMI (β=1.360, 95% CI 0.437～2.283, P=0.004), ferritin (β =0.061, 95% CI 0.046～0.077, P＜0.001), and CRP (β =3.532, 95% CI 0.887～6.177, P=0.009) were the independent risk factors for the increase of hepcidin level, and total iron binding capacity (β=-0.729, 95%CI -1.170～-0.288, P=0.001) was the independent inhibition factor for the increase of hepcidin level. Hepcidin level was positively correlated with AAC. Conclusion Plasma hepcidin level was related to anemia and iron metabolism parameters, inflammation factors and AAC, implying that hepcidin may participate in the pathogenesis of micro-inflammation state and vascular calcification. Metrics

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Effects of different doses of continuous veno-venous hemofiltration on outcome of critically ill children 2017, 16 (01):  35-38.  doi: 10.3969/j.issn.1671-4091.2017.01.009 Abstract ( 253 )   PDF (423KB) ( 398 )   Objective The aim of this study is to evaluate the effect of different doses of continuous venovenous hemofiltration (CVVH) on outcome of critically ill children. Methods The clinical data of critically ill children treated with CVVH in the Pediatric Intensive Care Unit of Guangdong General Hospital between Jan. 2010 and Dec. 2015 were retrospectively analyzed. They were divided into two groups based on the prescribed effluent volume: lower dose group (prescribed effluent volume ≤35 ml/kg/h) and higher dose group (prescribed effluent volume ＞35ml/kg/h). The in-hospital outcomes including 30 days in-hospital mortality, lengths of stay in hospital and in ICU were compared between the two groups. Results A total of 39 critically ill children were enrolled in this study. The 28 days in-hospital mortality was 43.6%, and the median lengths of stay in hospital and in ICU were 16 (10,24) and 19 (12,30) days respectively. There were no significant differences in 30 days in-hospital mortality (38.5% vs. 46.2%, 0.265, P=0.607), lengths of stay in hospital [15 (13,21) vs. 17 (9,24), Z=-0.239, P=0.811] and in ICU [13 (6,21) vs. 12 (6,17), Z=-0.448, P= 0.654] between the two groups. Multivariate Cox’s proportional hazards regression found that the higher dose group was not associated with the lower risk of in-hospital death (HR=0.768; 95% CI 0.261～2.264, P=0.632). Conclusions Effluent volume ＞35ml/kg/h was not related to the better outcome in hospital. Therefore, the CVVH dose for critically ill children can follow the guideline for adults that recommends the practical effluent volume of 20～25 ml/(kg•h) or prescribed effluent volume of 30～35ml/(kg•h). Metrics

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Effect of parathyroidectomy combined with autograft in forearm on left ventricular hypertrophy in uremic patients with secondary hyperparathyroidism 2017, 16 (01):  39-43.  doi: 10.3969/j.issn.1671-4091.2017.01.010 Abstract ( 309 )   PDF (422KB) ( 521 )   Objective To observe the effect of total parathyroidectomy combined with autologous transplantation in forearm (tPTX+AT) on the left ventricular hypertrophy in uremia patients with secondary hyperparathyroidism (SHPT). Methods A total of 28 SHPT patients were divided into two groups, operation group (n=13) and non-operation group (n=15). Before the operation and after the operation for 6 months, serum calcium (Ca), phosphorus (P), serum parathyroid hormone (iPTH) levels, left ventricular end diastolic diameter (LVED), interventricular septum diastolic thickness (IVST)，left ventricular posterior wall diastolic thickness(LVPWT), left ventricular ejection fraction (LVEF), and left ventricular mass index (LVMl) were measured. The number of calcified valves in each patient was recorded, and the ratio of calcified valves / total valves (%) in each group was calculated. Results After the operation for 6 months in operation group, serum Ca, P and iPTH levels decreased significantly as compared with the pre- operative values (P＜0.001), and LVMI decreased from (169.21±51.58)g/m2 to (118.67± 42.52)g/m2 (t=8.026, P=0.049). The number of patients with valvular calcification decreased from 9 patients to 7 patients, but the number of calcified valves had no change (12 valves). In non-operation group before and after the regular treatment, serum Ca, P and iPTH levels had no significantly changes (P＞0.05), LVMI showed the tendency of deterioration and increased from 161.85± 62.43g/m2 to 208.57±74.61 g/m2 but without statistical significance (t=0.484, P=0.334). The number of patients with valvular calcification increased from 9 patients to 13 patients, the total number of calcified valves increased from 11 valves to 21 valves, and the ratio of calcified valves / total valves increased significantly (46.67% vs. 24.44%, χ2=4.849, P=0.028). Conclusion Parathyroidectomy can effectively improve the left ventricular hypertrophy in uremic patients with SHPT, while patients in non-operation group showed the deterioration of valvular calcification. Metrics

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Analyses of different parathyroidectomy surgical modalities on the treatment of secondary hyperparathyroidism in uremic patients 2017, 16 (01):  44-47.  doi: 10.3969/j.issn.1671-4091.2017.01.011 Abstract ( 297 )   PDF (378KB) ( 330 )   Objective To investigate the clinical effects of subtotal parathyroidectomy (S- PTX), total parathyroidectomy (T-PTX), and parathyroidectomy combined with autotransplantation (PTX+AT) on the secondary hyperparathyroidism (SHPT) in uremic patients. Methods A total of 33 SHPT patients treated with SPTX, T-PTX, or PTX+AT in our hospital during the period April 2014 to April 2015 were retrospectively analyzed. The changes of intact parathyroid hormone (iPTH), serum phosphorus (P), serum calcium (Ca), bone pain and skin itch, and postoperative complications in these patients were studied after the operations. Results ① Surgical operations were successfully performed in all patients. Bone pain, skin itch, and calcification of subcutaneous soft tissue were alleviated with different degrees, with the most effectiveness on bone pain. T-PTX was the most effective modality for relief of SHPT symptoms. ②Serum Ca, P and iPTH reduced significantly after the operation for one week, one month and 6 months in all patients as compared with those before the operation (In T-PTX group, t=3.922, P＜0.001 for Ca after one week; t=3.463, P＜0.001 for Ca after one month; t=3.114, P=0.006 for Ca after 6 months; t=8.871, P＜0.000 for P after one week; t=8.021, P＜0.001 for P after one month; t=7.752, P＜0.001 for P after 6 months; t=8.175, P＜0.001 for iPTH after one week; t=8.175, P＜0.001 for iPTH after one month; t =6.817, P＜0.001 for iPTH after 6 months. In S-PTX group, t=4.213, P＜0.001 for Ca after one week; t=3.277, P=0.0041 for Ca after one month; t=2.816, P=0.021 for Ca after 6 months; t=7.783, P＜0.001 for P after one week; t=7.742, P＜0.001 for P after one month; t= 7.742, P＜0.001 for P after 6 months; t=5.933, P＜0.001 for iPTH after one week; t=4.875, P＜0.001 for iPTH after one month; t=4.886, P＜0.001 for iPTH after 6 months. In PTX+AT group, t=3.114, P=0.006 for Ca after one week; t=3.206, P=0.005 for Ca after one month; t=4.027, P＜0.001 for Ca after 6 months; t= 8.922, P＜0.001 for P after one week; t=7.811, P＜0.001 for P after one month; t=7.774, P＜0.001 for P after 6 months; t=7.947, P＜0.001 for iPTH after one week; t=7.335. P＜0.001 for iPTH after one month; t=7.220, P＜0.001 for iPTH after 6 months). Serum Ca and P after the operation for one week, one month and 6 months had no statistical significances among the 3 groups (F=2.498, P=0.074 for Ca after one week; F= 3.080, P=0.065 for Ca after one month; F=2.771, P=0.069 for Ca after 6 months; F=1.094, P=0.195 for P after one week; F=1.933, P=0.178 for P after one month; F=2.011, P=0.169 for P after 6 months). Serum iPTH levels were statistically higher in S-PTX group than in T-PTX group (t=6.855, P=0.006 after one week; t= 7.288, P=0.003 after one month, t=6.732, P=0.006 after 6 months). Serum iPTH levels had no differences after the operation for one week between PTX+AT group and T-PTX group (t=2.317, P=0.083), but were higher after the operation for one month and 6 months in PTX+AT group than in T-PTX group (t=6.609, P=0.008 after one month; t=5.985, P=0.011 after 6 months). ③No obvious complications were found after the operations. Conclusion The operations of T-PTX, S-PTX and PTX+AT are safe and can all treat uremia SHPT effectively. The reduction of serum Ca and P showed no difference among the 3 groups, but the reduction of iPTH was most effectively in T-PTX group. Metrics

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The microstructure of cancellous bone in hemodialysis patients of different bone turnover 2017, 16 (01):  48-53.  doi: 10.3969/j.issn.1671-4091.2017.01.012 Abstract ( 220 )   PDF (1611KB) ( 359 )   Objective To investigate the characteristics of cancellous bone microstructure in maintenance hemodialysis (MHD) patients of different bone turnover. Methods The MHD patients were enrolled if they were 18 years of age or older and agreed to have a bone biopsy in our hemodialysis center. Bone biopsy was performed at iliac crest to obtain cancellous bone samples. The bone sections were analyzed histomorphometrically using computer aided planimetry. According to bone turnover status, the specimens were divided into three groups: high, low, and mixed bone turnover groups. Each specimen was measured by micro-CT(SKYSCAN 1172, Belguim) with a high spatial resolution of 10μm. The main measurement parameters included volume BMD, bone volume/tissue volume (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb.Sp), structure model index (SMI) and degree of anisotropy (DA). The differences of trabecular microstructure among the three groups were analyzed by ANOVA. The correlation between two dimensional structure parameters measured by histomorphometry and three dimensional structure parameters measured by micro-CT in high bone turnover group was analyzed by Pearson correlation method. Results Nine cancellous bone samples were included in this study, including 3 in high bone turnover group, 3 in low bone turnover group, and 3 in mixed bone turnover group. No differences in vBMD, BV/TV, Tb.N, Tb.Th, Tb. Sp, SMI and DA were found among the three groups (F= 1.859, P=0.235; F=2.040, P=0.211; F=0.509, P= 0.625; F=0.126, P=0.883; F=0.436, P=0.666; F=3.311, P=0.107; F=0.304, P=0.749). Bone histomorphometric measurements of trabecular area (Tb.Ar) and trabecular width (Tb.Wi) did not correlate with micro-CT measurements of BV/TV and Tb.Th (P=0.355, P=0.830). Conclusion Despite no differences in trabecular microstructure among the three bone turnover group, the measurement by micro-CT enables us to analyze the spatial conformation of cancellous bone more precisely and covers the shortage of histomorphometry. It has also great significance for us to study the pathophysiology of renal osteodystrophy and evaluate the bone quality. Metrics

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Determination of Endotoxin Content in DialysisWater and Dialysate 2017, 16 (01):  65-68.  doi: 10.3969/j.issn.1671-4091.2017.01.016 Abstract ( 672 )   PDF (494KB) ( 528 )   Objective To determine the content of bacterial endotoxin in dialysis water and dialysate, and develop a new standard for providing reference for the safety of dialysis fluid. Methods According to the requirement of Chinese pharmacopeia (2015 edition, the fourth part chapter 1143), referencing the result of interference test, kinetic turbidimetric assay (KTA) was adopted to determine the content of bacterial endotoxin in 7 batches dialysis water and 19 batches dialysate from 7 hospitals. Results The results showed that the dilution at 1/2 of the dialysis water and 1/64 of the dialysate were effective to eliminate the interference in KTA, The recovery rate of samples in interference test was 50% ~ 200%. The average content of endotoxin in dialysis water was less than 0.019 EU/ml, in dialysate was less than 0.34 EU/ml. Conclusions The content of endotoxin in dialysis water and dialysate is far less than the current standards, which also suggest that the current standard need to be improved. The limit of bacterial endotoxoin in dialysis water should be set less than 0.25EU/ml, in dialysate should be set less than 0.50EU/ml. Metrics