Chinese Journal of Blood Purification

12 May 2017, Volume 16 Issue 05 Previous Issue    Next Issue

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Concern for the diagnosis and treatment of pulmonary arterial hypertension in hemdialysis patients 2017, 16 (05):  289-292.  doi: 10.3969/j.issn.1671-4091.2017.05.001 Abstract ( 349 )   PDF (397KB) ( 401 )   Pulmonary arterial hypertension (PAH) is a chronic and progressive disease leading to right heart failure and death if untreated. It is a common abnormality in patients with dialysis-dependent chronic kidney disease, especially those having arteriovenous fistula. With the increase of chronic kidney disease patients, the prevalence of severe PAH and the mortality of cardiac diseases are significantly increasing. Several factors cause the development and progression of PAH. Clinically, PAH should be identified and treated earlier to mitigate the susceptible factors and to prevent the development of PAH. Metrics

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Management of intra-dialytic hypotension Zhan-Hui GAO 2017, 16 (05):  293-296.  doi: 10.3969/j.issn.1671-4091.2017.05.002 Abstract ( 469 )   PDF (377KB) ( 617 )   Although the advances of hemodialysis (HD) technology have been made in recent years, the incidence of intra-dialytic hypotension (IDH) is still as high as 20～30%. The incidence of IDH increases associated the prevalence of aged patients, hypertensive nephropathy and diabetic nephropathy in HD patients. In 2007, the European Best Practice Guidelines (EBPG) emphasized the compliance with the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines, and proposed that the definition of IDH was the decrease of intra-dialysis systolic blood pressure to ≥20mmHg for more than 2 times as compared with the pre-dialysis blood pressure or the decrease of mean arterial pressure to ≥10mmHg, accompanied by clinical events requiring medical intervention. In a retrospective study in 2014, Stefansson et al. analyzed the medical records of 39, 497 HD patients between 2007 and 2008 in the United States Renal Data System (USRDS) and hemodialysis centers in order to determine prognosis of the patients, and found that IDH was associated with increased risks of cardiovascular disease morbidity and mortality in HD patients. Metrics

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The pathogenesis and treatment strategy of refractory hypertension in uremic patients 2017, 16 (05):  297-299.  doi: 10.3969/j.issn.1671-4091.2017.05.003 Abstract ( 384 )   PDF (390KB) ( 529 )   Refractory hypertension (RFH) is a common manifestation, which is a serious threat to the prognosis and quality of life in uremic patients. Many studies have revealed that water/sodium retention, activation of renin-angiotensin system, excessive excitement of sympathetic nerve, and other participating factors are the main factors for uremic RFH. Strict control of water and sodium intake, judiciously using hemodialysis for antihypertension, and comprehensive application of antihypertensives and other auxiliary drugs are the measures to treat RFH. Percutaneous transluminal renal artery stenting for patients with local renal artery stenosis, and renal denervation for those refractory to drug treatment may be required. Metrics

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Characteristics and prognosis of blood pressure in hemodialysis patients: cardian rhythm, seasonal changes and changes between predialysis and postdialysis 2017, 16 (05):  300-302.  doi: 10.3969/j.issn.1671-4091.2017.05.004 Abstract ( 392 )   PDF (351KB) ( 398 )   Hypertension is a comorbidity in most hemodialysis patients, and is the important risk factor for cardiovascular disease death in these patients. Blood pressure in hemodialysis patients possesses many characteristics including disordered cardian rhythm, seasonal changes and changes between predialysis and postdialysis, which may relate to their prognosis. In this paper we review the characteristics of blood pressure changes in hemodialysis patients. Metrics

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Clinical value of urinary NAG associated with serum creatinine in predicting acute kidney injury in critically ill patients 2017, 16 (05):  303-306.  doi: 10.3969/j.issn.1671-4091.2017.05.005 Abstract ( 291 )   PDF (494KB) ( 342 )   Objective To explore the clinical value of urinary N-Acetyl-β-D-glucosaminidase (uNAG) associated with serum creatinine (sCr) in predicting acute kidney injury (AKI) in adult critically ill patients. Methods In this prospective study, we enrolled 124 adult critically ill patients who admitted to the mixed ICU of Xiaolan Hospital of Southern Medical University during September 2015 to January 2016. According to the Kidney Disease Improving Global Outcomes (KDIGO) criterion, the patients were divided into non- AKI group and AKI group (including mild AKI and severe AKI)． The receiver operating characteristic (ROC) curve and the area under curve (AUC) were used to evaluate the capabilities of the biomarkers in predicting AKI. Results Of the 124 patients, 34 patients (27.4%) developed AKI. The levels of uNAG and sCr were significantly higher in AKI group than in non-AKI group (P＜0.001)．In this cohort, 15 patients (12.1%) developed severe AKI. The levels of uNAG and sCr were significantly higher in severe AKI patients than in non- AKI and mild AKI patients (P＜0.05). The AUC value was higher in combined uNAG and sCr (0.933 & 0.946) than uNAG or sCr alone in predicting AKI and severe AKI. In-hospital mortality was 9.7% and renal replacement therapy rate was 4.0%. AKI group had higher renal replacement therapy rate and longer ICU stay than non AKI group (P＜0.05). Conclusions uNAG is a sensitive biomarker for predicting AKI in adult critically ill patients. When uNAG combined with sCr, AKI prediction can be further improved. Metrics

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The effect of care model for chronic diseases on nutritional status, anxiety and depression in patients with chronic kidney disease at stage 3 or 4 2017, 16 (05):  307-309.  doi: 10.3969/j.issn.1671-4091.2017.05.006 Abstract ( 324 )   PDF (389KB) ( 313 )   Objective To evaluate the effect of care model for chronic diseases on nutritional status, anxiety and depression in patients with chronic kidney disease at stage 3 or 4. Methods A total of 71 stage 3 to 4 chronic kidney disease patients chosen with convenience sampling method accepted the evaluation of nutrition status ,anxiety and depression. Then the professional nurse offered chronic care model nursing for them. After 6 months, we gave the patients aftertest, and manipulated paired-sample T test to explore the effect of chronic care model on patients’nutritional status, anxiety and depression. Result The urea nitrogen(t=3.325, P=0.001), anxiety(t=2.026,P=0.047) and depression(t=3.571,P=0.001) of patients were significantly lower after the intervention, and their blood albumin (t=-2.035, P=0.046) and blood calcium (t=-2.328,P=0.023) were significantly improved. Conclusion Chronic care model can significantly improve CKD3-4 stage patients’nutritional status and their anxiety, depression. Metrics

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Comparative study on quality of life and medical expenses of patients on hemodialysis and peritoneal dialysis in rural area 2017, 16 (05):  310-312.  doi: 10.3969/j.issn.1671-4091.2017.05.007 Abstract ( 360 )   PDF (353KB) ( 347 )   Objective To compare quality of life and medical expenses of hemodialysis and peritoneal dialysis patients in rural area in order to provide a rational selection of blood purification modalities for patients in rural areas and a basis for the required payment for the single disease by the health adminidtration department. MethodsWe recruited 33 patients on maintenance hemodialysis (MHD) and 18 patients on peritoneal dialysis (PD) treated in the Department of Nephrology, Yutian County Hospital during the period between Aug. 2014 to Nov. 2014. The Short Form 36 Health Survey Questionnaire (SF-36) was used to evaluate their quality of life. Their direct medical expenses and indirect medical-related expenses in a period of 12 weeks were rcorded. Results (a) There were no significant differences in physiological and psychological scores between MHD and PD patients, but the energy score was higher in PD patients than in MHD patients (t=-2.507, P=0.013). (b) The expenses were significantly higher in MHD patients than in PD patients (t=75.999, P＜0.001), including the expenses of dialysis itself (t=3.352, P＜0.001), drugs (t=32.106, P＜0.001), traffic (t=29.756, P＜0.001) and food (t=14.623, P＜0.001). Conclusions There was no significant difference in quality of life between PD and MHD patients in rural areas. However, the total expenses were significantly lower in PD patients than in MHD patients. Metrics

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Clinical observation of different L-carnitine doses for the treatment of heart failure in maintenance hemodialysis patients 2017, 16 (05):  313-317.  doi: 10.3969/j.issn.1671-4091.2017.05.008 Abstract ( 323 )   PDF (423KB) ( 458 )   Objective To observe different L-carnitine doses for patients on maintenance hemodialysis (MHD) complicated with heart failure. Methods This prospective study enrolled 44 patients on MHD for chronic renal failure and complicated with heart failure. They were treated with continuous renal replacement therapy (CRRT) at bedside and intravenous injection of L-carnitine for hear failure. They were randomly divided into 2 groups based on L-carnitine dose. Patients in groupA were treated with higher L-carnitine dose (2g L-carnitine in 20 ml 0.9% NaCl intravenously per day for 14 days); those in group B were treated with routine L-carnitine dose at the end of CRRT (1g L-carnitine in 0.9% NaCl intravenously per day for 14 days). Brain natriuretic peptide (BNP) and cardiac structure and function by echocardiography were examined before and after the treatment. Results In group A after the treatment, left ventricular end-diastolic diameter (t= 6.382, P＜0.001) and end-systolic diameter (t=3.174, P=0.003) decresed, left ventricular ejection fraction (t= 2.978, P=0.007) increased, and BNP decreased (t=- 3.489, P=0.001). In group B after the treatment, blood BNP decreased (t=6.125, P＜0.001), left ventricular ejection fraction increased (t=-2.324, P=0.037); left ventricular end-systolic volume (t=1.401, P=0.115) and left ventricular end-diastolic volume (t=1.799, P=0.062) decreased but without statisitcal significance. When comparison was made between group A and group B, BNP (t=2.699, P=0.023), left ventricular end- diastolic volume (t=2.332, P=0.031), and left ventricular endsystolic volume (t=2.713, P=0.012) decreased more in group A than in group B, while left ventricular ejection fraction (t=2.224, P=0.042) increased more in groupA than in group B. Eventually, the patients back to the routine hemodialysis department were more in group A than in group B (χ2=4.041, P=0.044). Conclusion Higher L-carnitine dose combined with CRRT were effective in a shorter period time to promote heart fuctions and left ventricular remodeling, to reduce clinical adverse events, and to improve prognosis in MHD patients with heart failure. Metrics

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Comparison of immune function between end-stage renal disease patients and healthy adults 2017, 16 (05):  318-321.  doi: 10.3969/j.issn.1671-4091.2017.05.009 Abstract ( 340 )   PDF (439KB) ( 338 )   Objective To compare immune function between end-stage renal disease (ESRD) patients and healthy adults in order to explore the mechanism of abnormal immune function in ESRD patients. Methods ESRD patients from Department of Nephrology, Beijing Boai Hospital, China Rehabilitation Research Center during Jan to Jun. 2016 were enrolled in this study, and healthy adults were used as the controls. Innate immune and acquired immune functions were evaluated in ESRD patients and controls. Innate immune functions included counts of blood leukocytes, neutrophils, eosinophils, basophils and natural killer (NK), percentage of NK cells, and serum C3 and C4. Acquired immune functions included count and percentage of lymphocytes, CD4+ and CD8+ lymphocyte counts, CD4+/CD8+ cell ratio. Results A total of 40 ESRD patients [mean age (56.8±12.0) years] and 18 heathy adults [mean age (51.3±12.4) years] were enrolled in this study. For innate immune parameters, white blood cell count (F=2.130, t=2.008. P=0.049), neutrophil count (F=4.587, t= -3.997, P<0.001), neutrophil percentage (F=0.685, t=-3.726, P<0.001) and the serum C4 (F=0.425, t=3.181, P=0.002) were higher in ESRD patients than in healthy adults; NK cell count (F =0.864, t =2.034, P=0.011) and serum C3 (F=0.425, t=3.181, P=0.002) were lower in ESRD patients than in healthy adults. For acquired immune parameters, blood lymphocyte count [(1.32±0.39)×109/L vs. (1.94±0.43)×109/L; F=0.274, t =5.419, P <0.001], blood lymphocyte percentage [(21.39±5.73)% vs. (35.53± 6.10)%; F=0.164, t=8.528, P<0.001], and CD4+ T lymphocyte count [(733.10±298.76)/UL vs. (915.88±289.05)/UL; F=0.903, t=2.160, P=0.035] were significantly lower in ESRD patients than in healthy adults. Conclusion Abnormal innate and acquired immune functions existed in ESRD patients. The abnormal immune functions presented as the increase of white blood cell count, neutrophil count and neutrophil percentage, and the decrease of NK cell count, lymphocyte count, lymphocyte percentage, CD4+ T lymphocyte count, and serum C3 level. Metrics

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The prevalence of left ventricular hypertrophy in maintenance hemodialysis patients 2017, 16 (05):  322-325.  doi: 10.3969/j.issn.1671-4091.2017.05.010 Abstract ( 332 )   PDF (392KB) ( 314 )   Objective To investigate the prevalence of left ventricular hypertrophy(LVH) in maintenance hemodialysis (MHD) patients. Methods A total of 81 MHD patients (38 males and 43 females; 23-83 years old) treated in the First Blood Purification Center, Shengjing Hospital, Chinese Medical University from June 2006 to June 2016 were retrospectively analyzed. They were treated with regular hemodialysis of 4 hours/time and 2-3 times/week with the average dialysis age of 56± 39.1 months. Echocardiography was used for the diagnosis of LVH. The effects of age, blood pressure, fluid load, ultrafiltration volume, anemia, nutritional status, and secondary hyperparathyroidism on LVH were analyzed. Results Age (F=5.697, t=-3.557, P=0.000), systolic blood pressure (F=0.338, t=5.171, P=0.000), diastolic blood pressure (F=4.990, t=3.971, P=0.000), mean arterial pressure (F=1.110, t=5.119, P=0.000), brain natriuretic peptide (BNP, F=35.531, t=0.000, P=0.000), and hemoglobin (F=0.029, t=-4.696, P=0.000) were statistically different between MHD patients with LVH and those without LVH; systolic blood pressure, diastolic blood pressure, mean arterial pressure and BNP were positively correlated with LVH, and age and hemoglobin were negatively correlated with LVH. When comparison of related factors was made at the maximum value and minimum value of left ventricular mass index for every patient, there were significant differences in systolic blood pressure (t=2.528, P= 0.015), ultrafiltration volume (t=- 2.472, P=0.016), BNP (t=3.059, P=0.006) and hemoglobin (t=- 2.889, P= 0.006); systolic blood pressure and BNP were positively correlated with left ventricular mass index, and ultrafiltration volume and hemoglobin were negatively correlated with left ventricular mass index. Logistic regression analysis showed that systolic blood pressure (OR=1.033, 95% CI 1.011~1.057, P=0.004) and BNP (OR= 1.001, 95% CI 1.000~1.001, P<0.001) were the independent risk factors for LVH. In addition, serum calcium (F=0.660, t=0.141, P=0.888) and phosphorus (F=1.337, t=0.907, P=0.365), intact parathyroid hormone (F=0.579, t=-0.149, P=0.881), serum albumin (F=1.419, t=-1.615, P=0.108) and body mass index (F=1.806, t=0.043, P=0.966) showed no significant differences between MHD patients with LVH and those without LVH. When comparison of related factors was made at the maximum value and minimum value of left ventricular mass index, serum calcium (t=- 1.051, P=0.299), serum phosphorus (t=- 1.763, P=0.084), intact parathyroid hormone (t=-1.381, P=0.174), serum albumin (t=-1.602, P=0.116) and body mass index (t=-1.583, P=0.119) also showed no statistical significances. Conclusion LVH was closely related to blood pressure, fluid over load and anemia in MHD patients. Therefore, reducing blood presure especial systolic blood pressure and fluid load, and treatment of anemia will be helpful for the improvement of LVH in MHD patients. Metrics

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Advances in molecular genetic mechanism of peritoneal solute transport 2017, 16 (05):  329-332.  doi: 10.3969/j.issn.1671-4091.2017.05.012 Abstract ( 276 )   PDF (319KB) ( 338 )   During peritoneal dialysis, the peritoneum is used as a dialysis membrane. Peritoneal solute transport function is closely related to adequacy of the peritoneal dialysis and prognosis of the patients. There is greater heterogeneity in the baseline peritoneal solute transport status and the changes of peritoneal solute transport rate (PSTR) after dialysis. Significant difference in PSTR is also present in different geographic regions and ethnic groups. In responses to various stimuli, the peritoneum produces more inflammatory cytokines and angiogenic factors, leading to changes of peritoneal blood flow, angiogenesis and vasculapathy. Subsequently transport rate for small solutes increases owing to the increase of effective peritoneal vascular surface. Recently, several researchers have performed the association study of PSTR (initial and longitudinal PSTR changes) with candidate genes. Polymorphisms in the candidate genes encoding inflammatory cytokines such as IL-6, IL-10 and TGF-β1 and encoding inflammation and angiogenesis related factors such as ENOS, RAGE and VEGF were found to be related to initial and longitudinal PSTR changes. Results of current studies have suggested the effect of genetic factors on peritoneal transport function, but the role of these factors needs to be identified in different population groups and races. Genome-wide association study may help discover new genes, contribute to further understand the genetic characteristics of peritoneal solute transport, and provide clues for the study of peritoneal transport function and the improvement of peritoneal transport function in patients. Metrics

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A qualitative study on the psychological experience of maintenance hemodialysis patients during waiting for renal transplantation 2017, 16 (05):  333-335.  doi: 10.3969/j.issn.1671-4091.2017.05.013 Abstract ( 300 )   PDF (367KB) ( 310 )   Objective To explore the psychological experience of the maintenance hemodialysis patients during waiting for renal transplantation. Methods Phenomenological methodology was adopted in this study. In-depth interview was conducted to 11 patients between August 2015 and July 2016. Data were analyzed by Colaizzi method. Results Four themes including waiting in torment, survival hope, burden and uncertainty were extracted. Conclusion Patients underwent a complex psychological experience during waiting for renal transplantation. Medical staffs should concern the psychological state of these patients and give them intervention timely. Metrics

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Treatment of arteriovenous fistula rupture during percutaneous transluminal angioplasty (PTA) with covered stent 2017, 16 (05):  340-342.  doi: 10.3969/j.issn.1671-4091.2017.05.015 Abstract ( 330 )   PDF (536KB) ( 482 )   Objecctive To evaluate the treatment of arteriovenous fistula rupture during endovascular manipulationt for graft and fistula. Methods In the period from April 2012 to July 2016, arteriovenous fistula rupture happened 7 times in 200 patients during endovascular manipulation in our hospital. Six ruptures happened intraoperatively, and one was of delayed rupture. Covered stents were implanted in 4 of these ruptures, 2 patients refused further treatment, and one patient was treated with compression. Results Covered stents were successfully implanted for the 4 patients, and the fistulas could be used for blood access immediately, However, dysfunctioning of the fistula due to vascular proliferation occurred in one patient after stent implantation for 6 months. The other 3 patients were followed up for 1 to 20 moths without recurrence of rupture and stenosis. Conclutions Hemodialysis access rupture is a rare but serious complication during endovascular manipulation. Covered stent provided a safe and effective treatment for this complication. Metrics

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Studies on comfortable degree of arteriovenous fistula puncture and its effects on adverse events in maintenance hemodialysis patients 2017, 16 (05):  343-346.  doi: 10.3969/j.issn.1671-4091.2017.05.016 Abstract ( 300 )   PDF (446KB) ( 372 )   Objective To investigate the factors affecting the comfortable degree during arteriovenous fistula puncture and its effects on adverse events in maintenance hemodialysis (MHD) patients. Methods A total of 200 MHD patients were recruited at the Hemodialysis Center of Daping Hospital in Chongqing from September 2013 to October 2015. They were divided into subjective feeling of comfortable group and uncomfortable group using visual analogue scale. The qulity of life in the two groups was assessed by numerical pain rating scale, punctured limb activity form, and anxiety self-rating scale. The comfortable degree of puncture was obtained through questionnaire survey. The related adverse events during the whole investigation period in the 2 groups were then retrospectively analyzed. Results A total of 116 patients felt comfortable, and 84 patients felt uncomfortable during puncture. Pain scores (χ2=14.854, P=0.002), punctured limb activity scores (χ2=19.277, P＜0.001) and fear scores (χ2=9.059, P=0.029) were significantly lower in comfortable group than in the uncomfortable group. Puncture (β =-1.743, P=0.042), posture (β =-1.869, P=0.043), withdrawing the needle (β =- 1.961, P=0.043), emotion (β =- 1.824, P=0.027), support from medical staffs (β =-1.673, P=0.045) were closely related to the subjective comfortable feeling during puncture in MHD patients. The prevalence of thrombus formation (χ2=4.886, P=0.003), arteriovenous fistula occlusion (χ2=5.109, P=0.024), induration at puncture site (χ2=4.694, P=0.044), vascular stenosis (χ2=4.574, P=0.032) and hematoma (χ2=4.75, P=0.029) were significantly lower in comfortable group than in uncomfortable group (P<0.05). Conclusions Puncture, posture, withdrawing the needle, emotion and support from medical staffs impacted on the subjective comfortable degree during puncture in MHD patients. MHD patients with uncomfortable feeling had more pain and fear sensations and less activity at punctured side, resulting in the increase of adverse events after puncture and the decrease of dialysis effects and quality and life. Metrics

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Legal issue and consideration about the safety of medical staffs working for hemodialysis 2017, 16 (05):  347-349.  doi: 10.3969/j.issn.1671-4091.2017.05.017 Abstract ( 294 )   PDF (354KB) ( 375 )   The development of hemodialysis technology increases the survival opportunity for patients with chronic renal failure. However, the diseases in most hemodialysis patients are complicated, serious and variable. During hemodialysis, blood has to be taken out from the body and mixed with anticoagulant for extracorporeal circulation. The hemodialysis technology is not perfect yet, leading to many safety problems and unknown risks to the medical and nursing workers. In order to secure the safety of the patients and hospital workers, regulations based on related laws, standards of medical and nursing protocols, education to the patients and their relatives about the disease, the benefits and risks from hemodialysis, and mutual understanding between patients and medical staffs must be established. The author focuses on these issues based on his own understanding, experience and expectations. Metrics

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Analysis and treatment of concentrate related failures of Baxter Gambro AK96 hemodialysis machine 2017, 16 (05):  350-352.  doi: 10.3969/j.issn.1671-4091.2017.05.018 Abstract ( 1097 )   PDF (402KB) ( 514 )   This article briefly describes the fault of“Incorrect bicarbonate concentrate, check concentrate” demonstrated on Baxter Gambro AK96 Hemodialysis Machine, analyzes the operation principle of the equipment in details, and then proposes the treatment schemes about this fault, which have practical operability, and can provide reference for technologists and operators working in dialysis department. Metrics

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The effects of Omaha system on treatment compliance and calcium and phosphorus metabolism in maintenance hemodialysis patients 2017, 16 (05):  353-358.  doi: 10.3969/j.issn.1671-4091.2017.05.019 Abstract ( 291 )   PDF (478KB) ( 320 )   Objective To explore the effects of Omaha system on treatment compliance and calcium and phosphorus metabolism in maintenance hemodialysis (MHD) patients. Methods A total of 80 patients were enrolled in this survey. They were divided into intervention group (n=40) and control group (n=40) according to date of the dialysis. The intervention group accepted Omaha system care, while the control group was only provided regular care. The Treatment Compliance Scale scores, daily fluid intake, daily salt intake, subjective global assessment (SGA) scores, serum albumin (Alb), prealbumin (PA), hemoglobin (Hb), triacylglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), Ca and P were compared before and after intervention between the two groups. Results Before intervention, the Treatment Compliance Scale scores, daily fluid intake, daily salt intake, SGA scores, Alb, PA, Hb, TG, TC, LDL, HDL, Ca and P were not significantly different between the two groups (P＞0.05). After the intervention, the intervention group had higher Treatment Compliance Scale scores (t=4.903, P=0.000 for diet compliance; t=2.630, P=0.010 for liquid intake compliance; t=3.491, P=0.001 for medication compliance; t=3.510, P=0.001 for dialysis treatment compliance), and lower daily fluid intake (t=-5.443, P=0.000) and daily salt intake (t=-5.160, P=0.000) as compared with those of control group. Patients in intervention group also had a better nutritional statue (t=-2.615, P=0.011 for SGA; t=2.263, P=0.026 for PA; t=2.047, P=0.044 for Hb) and improved calcium (t=2.183, P=0.032) and phosphorus metabolism (t=2.183, P=0.032), Scr (t=-2.563, P=0.012), BUN (t=-2.277, P=0.025) and Kt/V (t=1.991, P=0.050) than those of control group. Conclusion Omaha system can effectively improve treatment compliance and calcium and phosphorus metabolism in MHD patients, thus deserves further application. Metrics