Chinese Journal of Blood Purification

12 July 2017, Volume 16 Issue 07 Previous Issue    Next Issue

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The research progress in encapsulating peritoneal sclerosis 2017, 16 (07):  433-436.  doi: 10.3969/j.issn.1671-4091.2017.07.001 Abstract ( 303 )   PDF (385KB) ( 507 )   Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication with high mortality rate in long- term peritoneal dialysis patients. It is characterized by progressive and extensive fibrotic thickening and sclerosis of the peritoneum, leading to encapsulation of bowel and intestinal obstruction, but is hard to be recognized at its early stage. The pathogenesis of EPS remains elusive. No specific treatment has been developed, and a multidisciplinary combination therapy is adopted at the present time. In this paper, we introduce the pathogenesis, diagnosis and treatment of EPS. Metrics

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Dietary protein intake assessment in continuous ambulatory peritoneal dialysis patients 2017, 16 (07):  437-441.  doi: 10.3969/j.issn.1671-4091.2017.07.002 Abstract ( 314 )   PDF (317KB) ( 412 )   Malnutrition is a common problem in peritoneal dialysis patients, which is closely correlated with mortality. Assessing the dietary protein intake of PD patients regularly and directing them to take proper diet accordingly is important for preventing malnutrition, improving patients’quality of life, and decreasing complications and mortality. In this review, we summarized the dietary protein intake assessments, including direct and indirect methods, analyzed the advantage and disadvantage of each method, and pointed out the research focus in future. Metrics

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Advances in the treatment of hepatitis C virus infection in chronic kidney disease patients 2017, 16 (07):  442-445.  doi: 10.3969/j.issn.1671-4091.2017.07.003 Abstract ( 250 )   PDF (693KB) ( 397 )   Hepatitis C virus (HCV) infection can cause renal injury, increase the all-cause and cardiovascular mortality in the dialysis population, and decrease the graft survival among kidney transplant patients. Control of HCV infection is therefore critical to these patients. Interferon-based therapy is rarely used among dialysis and kidney transplant patients due to its frequent side effects, low virological responses, higher rejection and graft failure. The presence of highly efficacious, well-tolerated direct-acting antiviral agents provides an ideal way to cure HCV infection in chronic kidney disease patients. Metrics

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Pathogenesis, prevention and treatment of muscle cramps in hemodialysis 2017, 16 (07):  446-450.  doi: 10.3969/j.issn.1671-4091.2017.07.004 Abstract ( 470 )   PDF (389KB) ( 1386 )   Muscle cramps is one of the most common complications in hemodialysis, leading to lower tolerance and adequacy of the dialysis treatment. Here we review the pathogenesis, prevention and treatment of muscle cramps in hemodialysis in order to find out effective treatment for patients suffered from this complication. Metrics

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Dosing regimen of β-lactams for septic shock patients receiving continuous renal replacement therapy 2017, 16 (07):  451-454.  doi: 10.3969/j.issn.1671-4091.2017.07.005 Abstract ( 315 )   PDF (409KB) ( 422 )   Objective To investigate whether the routine regimen of β-lactams is appropriate for patients with septic shock receiving continuous renal replacement therapy (CRRT). Methods Septic shock patients treated with CRRT and receiving either imipene (IPM), piperacillin- tazobactam (TZP) or cefepime (FEP) were enrolled in this study. Serum concentrations of β- lactams were measured by high- performance liquid chromatography for samples taken before and after use of the antibiotics for 0.5, 1, 2, 4, 6 or 12 hours. Blood samples were then separated into early phase (samples taken＜48 hours after the first dose) and late phase (＞48 hours). Results Twenty-four patients (IPM, n=9; TZP, n=8; FEP, n=7) were enrolled in this study. Fortyfive blood samples (IPM, n=15; TZP, n=16; FEP, n=14) were collected. Serum concentrations more than 4 times above the minimal inhibitory concentration (MIC) for pseudomonas aeruginosa were found in 47% of the patients treated with IPM, in 75% with TZP, and in 0% with FEP. Conclusion In septic shock patients receiving CRRT, serum β-lactams concentrations for killing pseudomonas aeruginosa were insufficient in some cases. Higher doses or extended infusions should be considered for required serum concentrations. Metrics

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Analysis of readmission causes in 71 maintenance hemodialysis patients 2017, 16 (07):  455-458.  doi: 10.3969/j.issn.1671-4091.2017.07.006 Abstract ( 308 )   PDF (402KB) ( 332 )   Objective To retrospectively analyze the readmission causes in 71 maintenance hemodialysis (MHD) patients. Methods Seventy-one MHD patients readmitted to the hospital during the period from Jan. 2014 to Dec. 2015 were recruited. Their readmission causes were analyzed by comparison of clinical data with 65 MHD outpatients in the same period. Results The main readmission cause in the 71 MHD patients was infections (17 cases, 23.94%) followed by cardiovascular complications (15 cases, 21.13%) and poor blood pressure control (6 cases, 8.45%). There are statistically differences between the two patient groups in number of elders (χ2=4.980, P=0.026), BMI (t=2.915, P=0.004), Kt/V (t=3.953, P＜0.001), Hb (t=5.714, P＜0.001), serum albumin (t=4.008, P＜0.001), TG (t=3.821, P＜0.001), LDLC (t=2.968, P=0.004), infection (χ2=8.225, P=0.004), and cardiovascular complications (χ2=4.883, P=0.027). The risk factors for readmission were older age (OR=2.566, 95% CI 1.118～5.890, P=0.026), low Kt/V (OR=2.610, 95% CI 1.157～5.887, P=0.021), anemia (OR=2.409, 95% CI 1.054～5.507, P=0.037), and hypoalbuminemia (OR=2.634, 95% CI 1.177～5.893, P=0.018). Conclusion Improvement of nutritional status, anemia, dialysis adequacy, blood pressure and blood glucose control, and the management for elderly patients may be helpful to reduce the hospitalization rate in MHD patients. Metrics

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The relationship between platelet/lymphocyte ratio and inflammation status in patients on maintenance hemodialysis 2017, 16 (07):  459-462.  doi: 10.3969/j.issn.1671-4091.2017.07.007 Abstract ( 292 )   PDF (478KB) ( 483 )   Objective To investigate the relationship between platelet/lymphocyte ratio (PLR) and inflammation status in patients on maintenance hemodialysis (MHD) in order to explore a new biomarker for the inflammation status in MHD patients. Methods A total of 72 stable MHD patients treated in Beijing Tongren Hospital and 22 healthy individuals as controls were enrolled in this study. SPSS17.0 software was used for statistical analyses. PLR and other laboratory parameters were compared between MHD patients and controls. MHD patients were further divided into two groups according to the mean value of PLR. Serum high sensitivity C reactive protein (hsCRP), neutrophil/lymphocyte ratio (NLR), albumin and other parameters were compared between the two MHD patient groups. The relationship between PLR, NLR and hsCRP was assessed using Spearman correlation. Results Platelet and lymphocyte counts were significantly lower in MHD patients than in normal controls (t=5.903, P<0.001 for platelet; t=12.914, P<0.001 for lymphocyte). PLR was 116.01+41.49 in MHD patient, significantly higher than 75.31+19.44 in normal controls (t=-4.441, P<0.001). NLR and hsCRP were also higher in MHD patients than in normal controls (t=-6.731, P<0.001 for NLR; t=-2.752, P=0.008 for hsCRP). The mean value of PLR was 116 in MHD patients. Platelet count, PLR, NLR, and hsCRP were significantly higher in the MHD patients with PLR ≥116 than in the MHD patients with PLR＜116 (t=-3.676, P=0.001 for platelet; t=-9.81, P<0.001 for PLR; t=-4.114, P<0.001 for NLR; t=-2.352, P=0.022 for hsCRP); lymphocyte count was significantly lower in those with PLR ≥116 than in those with PLR＜116 (t=4.190, P<0.001). PLR was negatively correlated with lymphocyte count (r=- 0.574, P<0.001) and positively correlated with platelet count (r=0.516, P<0.001), NLR (r=0.625, P<0.001) and hsCRP (r=0.251, P=0.036) in MHD patients. Conclusion PLR may be used as a new biomarker of systemic inflam-mation status in MHD patients. Metrics

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The effect of ultrafiltration and diuretic therapy on decompensated heart failure: a meta-analysis 2017, 16 (07):  463-468.  doi: 10.3969/j.issn.1671-4091.2017.07.008 Abstract ( 270 )   PDF (928KB) ( 435 )   Objective To evaluate the effect of ultrafiltration (UF) and intravenous diuretics on patients with congestive heart failure. Methods PubMed, CBM and other databases were searched from inception to Nov. 2016 for randomized controlled trials that used diuretics as control group. Inclusion and exclusion criteria were defined. After quality assessment and data extraction the records were analyzed with Rev Man 5.3 software for mete-analysis. Results Eleven studies including 870 cases (n=434 in UF group, n=436 in diuretics group) were enrolled in this study. UF therapy led to greater weight loss (WMD=1.390, 95% CI 0.640～2.150, P <0.001), more fluid remove (WMD=1.220, 95% CI 0.490～1.960, P=0.001), and less rehospitalization rate (OR=0.600, 95% CI -0.430～0.840, P=0.003) as compared with the patients in diuretic group. However, there were no significant differences in mortality (OR=0.990, 95% CI 0.660～1.470, P=0.960), creatinine (WMD=0, 95% CI -0.250～0.250, P=0.980), LVEF (WMD=-0.020, 95% CI -0.070～0.020, P=0.280) and NT-ProBNP (WMD=2327.610, 95% CI -5215.360～560.130, P=0.110) between the two groups. No serious adverse events were reported in the two groups. Conclusion UF is more efficient and safer than diuretics for heart failure patients with fluid overload. Heart failure related rehospitalization rate was lower after UF. However, survival was similar between patients treated with UF and those with diuretics. Serious adverse events were not found in UF patients. Metrics

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Correlation analyses of blood pressure and calcium changes in maintenance hemodialysis patients after parathyroidectomy 2017, 16 (07):  469-473.  doi: 10.3969/j.issn.1671-4091.2017.07.009 Abstract ( 434 )   PDF (493KB) ( 354 )   Objective To evaluate the effect of parathyroidectomy (PTX) on blood pressure in maintenance hemodialysis (MHD) patients, to understand the correlation between serum calcium and blood pressure, and to compare the incidence of intradialytic hypotension before and after PTX. Methods A total of 31 MHD patients treated with PTX due to secondary hyperparathyroidism (SHPT) were enrolled in this study. Laboratory parameters, predialytic and intradialytic blood pressure, and the incidence of intradialytic hypotension were compared before and after PTX. The correlation between blood pressure difference and serum calcium difference before and after PTX was analyzed. Results Systolic blood pressure (SBP) after PTX for 1, 2, 4 and 8 weeks was significantly lower than that before operation in a week (156.81±28.27 mmHg; LSD-t=5.992, P<0.001 after PTX for one week; LSD-t=6.621, P<0.001 after PTX for 2 weeks; LSD-t=7.318, P<0.001 after PTX for 4 weeks; LSD-t=9.210, P<0.001 after PTX for 8 weeks). SBP decreased gradually after PTX and to the nadir after PTX for 8 weeks (117.37±12.16 mmHg). There was significant difference in SBP after PTX for one week (130.38±16.65 mmHg) and that after PTX for 8 weeks (LSD-t=3.268, P=0.002). Diastolic blood pressure (DBP) after PTX for 4 and 8 weeks was significantly lower than that after PTX for one week (LSD-t=4.046, P=0.002 after PTX for 4 weeks; LSD-t=6.421, P<0.001 after PTX for 8 weeks). DBP decreased to the nadir after PTX for 8th weeks (67.52±8.38 mmHg). There was significant difference in DBP after PTX for one week (79.83±11.17 mmHg) and that after PTX for 8 weeks (LSD-t=4.678, P＜0.001). The in-cidence of hypotension was 1.8% in the 558 hemodialysis sessions in the 6 weeks before PTX, and the incidence was 8.6% in the 558 hemodialysis sessions in the 6 weeks after PTX (χ2=26.260, P<0.001). The change of serum calcium was positively correlated with the change of SBP before and after PTX (r=0.630, P=0.006). The change of serum calcium was also positively correlated with the change of DBP but without statistical significance (r=0.331, P=0.070). Conclusion PTX effectively ameliorates SHPT with the decrease of iPTH, serum calcium, serum phosphorus, and blood pressure in MHD patients. SBP decreased more than DBP after PTX. The decrease of SBP was positively correlated with the decrease of serum calcium. However, the incidence of intradialytic hypotension increased after PTX. Metrics

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Clinical study of regional citrate anticoagulation in hemodialysis with routine dialysate containing calcium 2017, 16 (07):  474-476.  doi: 10.3969/j.issn.1671-4091.2017.07.010 Abstract ( 374 )   PDF (407KB) ( 546 )   Purpose To assess the efficacy and safety of regional citrate anticoagulation (RCA) with routine dialysate containing calcium in hemodialysis patients. Methods Sixty-three hemodialysis patients at high risk of bleeding were randomly divided into two groups: RCA group (30 patients, 87 dialysis sessions) and heparin-free group (33 patients, 68 dialysis sessions). In RCA group, electrolyte concentrations were adjusted on-line, and 4% sodium citrate was infused into the arterial line and vein line in the dialyzer. Kt/V, function of the coagulation system, acid-base and electrolyte were monitored pre- and post- hemodialysis. The vital signs of the patients during hemodialysis, dialyzer clotting and bleeding episodes were recorded. Results ①Kt/V was significantly higher and the mean treatment time was significantly longer in RCA group than in heparin-free group (1.2±0.3 vs. 0.9±0.2, t=-3.257, P=0.002 for Kt/V; 4.0±0.0 h vs. 3.1±0.5 h, t=5.177, P＜0.001 for treatment time). ②Clotting in dialyzer occurred more frequently in heparin-free group than in RCA group (P＜0.001). ③In RCA group, there were no significant differences in the function of the coagulation system and ionized calcium before and after the hemodialysis (t=1.708, P=0.097). pH (t=-4.590, P＜0.001), Na+ (t=-2.431, P=0.021) and HCO3- (t=-4.630, P＜0.001) increased after the hemodialysis but remained in the normal ranges. ④Vital signs were stable and no bleeding episodes were found in both groups. Conclusions It is feasible to use RCA with routine dialysate containing calcium for hemodialysis patients at high risk of bleeding by adjusting electrolyte concentrations on-line and infusing sodium citrate into the arterial line before dialyzer and vein dropper. Complications can be prevented by close monitoring of arterial blood gas and electrolytes. Metrics

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The challenge of chronic kidney disease and acute kidney injury in a low income rural region in Southern China 2017, 16 (07):  477-481.  doi: 10.3969/j.issn.1671-4091.2017.07.011 Abstract ( 277 )   PDF (1506KB) ( 371 )   Objectives To investigate the epidemiological status of chronic kidney disease (CKD) and acute kidney injury (AKI) in a low income rural region in Southern China. Methods Electronic medical records were retrospectively studied in a representative county-level hospital in Guangdong province. CKD was classified and staged by the estimated glomerular filtration rate according to the lowest blood creatinine level, and AKI was diagnosed and graded by the KDIGO criteria. Results In the 5 345 cases for CKD evaluation, 37.437% cases were complicated with CKD. The percentages of CKD stage 3, 4 and 5 were 31.993%, 2.806% and 2.601%, respectively. Most of the patients with stage 5 CKD were treated in the division of nephrology attached to internal medicine department. CKD incidence was 43.093%, 24.783% and 19.808% (χ2=430.0, P＜0.001) in the internal medicine department, the surgical department, and other departments, respectively. The percentages of CKD at the age of 20～39, 40～59, 60～79 and 80 years and older were 2.498%, 13.794%, 41.402% and 65.207% (χ2=1309.5, P＜0.001), respectively. In the 5 158 patients for AKI analyses, 9.442% were in accordance with the KDIGO-AKI criteria; the community- and hospital-acquired AKI were 5.428% and 4.013%, respectively; the percentages of stage 2 and 3 AKI were 27.721%. The incidence of AKI among different department was similar. However, the incidence of AKI increased with age. The diagnosed AKI patients were only 7.004% according to diagnostic code at discharge. Conclusion The incidence of CKD and AKI is high, but this situation is largely ignored in the low income rural region in Southern China. This is a big challenge to the prevention and therapy system of renal diseases in county-level areas. Metrics

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Effects of resveratrol on the expression of MCP-1 and TGF-β1 in mice with high-fat diet-induced renal injury 2017, 16 (07):  482-487.  doi: 10.3969/j.issn.1671-4091.2017.07.012 Abstract ( 222 )   PDF (2757KB) ( 369 )   Objective To investigate the effect of resveratrol (Res) on the expression of monocyte chemotactic protein-1 (MCP-1) and transforming growth factor-β1 (TGF-β1) in mice with high-fat diet-induced renal injury, and to explore the mechanism of renal protection. Methods A total of 24 healthy C57BL/6 male mice were randomly divided into 3 groups (n=7 each): normal control (NC) group, high-fat diet (HFD) group, and high-fat diet with Res intervention (HFD+Res) group. Mice in HFD+Res group were treated with resveratrol [35 mg/(kg·d)] by lavage everyday, and mice in NC and HFD groups were treated with the same volume of carboxymethylcellulose by lavage. After 12 weeks, serum total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), creatinine (Scr), blood urea nitrogen (BUN), HE staining for histopathological changes, immunohistochemistry and western blotting for the expressions of MCP-1 and TGF-β1 were assayed. Results There were statistically differences in TC (F=48.688, P<0.001), TG (F=15.361, P=0.001), LDL (F= 50.401, P<0.001), Scr (F=27.143, P＜0.001) and BUN (F=23.369, P＜0.001) between NC, HFD and HFD+ Res groups. TC, TG, LDL, Scr and BUN increased significantly in HFD group as compared with those in NC group (P＜0.001 for TC; P=0.002 for TG; P＜0.001 for LDL; P＜0.001 for Scr; P＜0.001 for BUN) and with those in HFD+Res group (P=0.022 for TC; P=0.027 for TG; P＜0.001 for LDL; P=0.001 for Scr; P=0.001 for BUN). HE staining revealed evident histopathological lesions including slight increase of mesangial cells and matrix and proliferation of renal tubular epithelial cells in HFD group. In contrast, less pathological changes were found in HFD+Res group. Immunohistochemistry demonstrated that MCP-1 and TGF-β1 expressions were higher in HFD group than in NC group (P=0.004 for MCP-1; P＜0.001 for TGF-β1) and HFD+Res group (P=0.023 for MCP-1; P=0.007 for TGF-β1). Western blotting also demonstrated the higher expressions of MCP-1 and TGF-β1 in HFD group than in NC group (P=0.013 for MCP-1; P=0.002 for TGF-β1) and HFD+Res group (P=0.044 for MCP-1; P=0.039 for TGF-β1). Conclusion MCP-1 and TGF-β1 may be involved in the pathogenesis and progression of HFD-induced renal injury. Res can ameliorate the renal injury in mice by decreasing the expressions of MCP-1 and TGF-β1. Metrics

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Observation on the effect of vein superficializing surgery on the promotion of autologous arteriovenous fistula maturation 2017, 16 (07):  488-490.  doi: 10.3969/j.issn.1671-4091.2017.07.013 Abstract ( 310 )   PDF (1238KB) ( 413 )   Objective To observe the effect of vein superficializing surgery on the promotion of autologous arteriovenous fistula maturation. Methods Eleven end-stage renal disease patients who had an autologous arteriovenous fistula surgery 1-3 month ago with a distance of > 6mm between the anterior wall of the internal fistula vein and skin by ultrasound were selected for vein superficializing surgery. After the surgery, the possible complications including bleeding, hematoma and infection were monitored. After the surgery for 4 weeks, the distance between anterior wall of the internal fistula vein and skin, diameter of the internal fistula vein, natural blood flow rate, and puncturable length were measured by color ultrasound, and compared with those before the surgery. After use of the internal fistula for blood access for 2 weeks, dialysis adequacy Kt/V was evaluated. Results None of the patients had bleeding, hematoma and infection due to the surgery, and 3 of them had temporal arm edema which disappeared after 2 weeks. After the surgery for one month, the distances between anterior wall of the internal fistula vein and skin reduced from 6.2～12.5mm (average 8.87±2.00mm) before the surgery to 0.8～1.8mm (average 1.28±0.33mm; t=13.616, P=0.000); the diameters of the internal fistula vein increased from 4.4～6.8mm (average 5.55±0.67mm) before the surgery to 4.8～7.5mm(average 5.77±0.76mm; t=2.915, P=0.015); the natural blood flow rate increased from 681.55±167.93 ml/min before the surgery to 781.00±170.34 ml/min (t= 4.105, P=0.002); the puncturable length was 9～14cm (average 10.91±1.45cm); and the average dialysis adequacy of Kt/V was 1.59±0.24. By Feb. 2017, no thrombosis occurred in the 11 patients, and the internal fistulas were satisfactorily used for blood access 3 times a week with a longest normal usage period of 13 months. Conclusions Superficializing surgery of internal arteriovenous fistula provides a possibility for hemodialysis patients to effectively use autologous arteriovenous fistulas. This is a simple, safe and effective method without requirements of specific instruments and devices. Metrics

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Effects of accessory vein on the early fistula failure of forearm arteriovenous fistulas 2017, 16 (07):  491-493.  doi: 10.3969/j.issn.1671-4091.2017.07.014 Abstract ( 255 )   PDF (656KB) ( 441 )   Objective To investigate the effect of accessory vein on the early failure of forearm arteriovenous fistula. Methods A total of 38 uremia patients who underwent arteriovenous fistula surgery for the first time were randomly divided into experimental group (n=19) and control group (n=19). During the surgery, the accessory vein was blocked by thread ligation in the experimental group, and had no treatment in the control group. Both groups received standard end-to-side arteriovenous anastomosis in forearm. After operation for 8 and 20 weeks, the effects of the two surgical methods on blood flow and early fistula failure were compared. Results After operation for 8 weeks, blood flow rate was higher in the experimental group than in the control group (t=3.402, P=0.002); early fistula failure ratio was lower in the experimental group than in the control group (χ2=4.502, P=0.034). After operation for 20 weeks, blood flow rate was still higher in the experimental group than in the control group (t=3.102, P=0.004), and early fistula failure ratio was lower in the experimental group than in the control group (χ2=5.246, P=0.022). Conclusion The presence of the accessory vein can decrease the blood flow in arteriovenous fistula and increase the ratio of early fistula failure. The treatment of the accessory vein is important for the forearm arteriovenous fistula. Metrics

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Treatment of thrombosis in arteriovenous graft for hemodialysis 2017, 16 (07):  494-497.  doi: 10.3969/j.issn.1671-4091.2017.07.015 Abstract ( 498 )   PDF (373KB) ( 463 )   Objective Thrombosis is the main cause of arteriovenous graft (AVG) dysfunction. This research evaluated the long-term results of thrombectomy for AVG thrombosis and summarized the treatment experience. Methods This study retrospectively analyzed 51 patients who received thrombectomy and interventions for AVG thrombosis in our center from Aug. 2009 to Nov. 2016. The primary patency and second patency were analyzed. Cox regression was used to evaluate the risk factors for primary patency and second patency. Results The mean time of follow-up was 32.3 months. The primary patency rates were 54.9% and 36.1% after the treatment for one and two years respectively. The secondary patency rates were 94.1% and 72.2% after the treatment for one and two years respectively. Multivariate Cox regression demonstrated that balloon angioplasty in the first thrombectomy operation was the protective factor for primary patency (HR=0.361, 95% CI 0.135～0.968, P=0.043), and male gender was the risk factor for secondary patency (HR=3.008, 95% CI 1.010～9.032, P=0.049). Conclusion Thrombectomy and interventions were the effective treatment for AVG thrombosis. The long-term patency after thrombectomy was acceptable. Metrics

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Selection of activated carbon canister for dialysis water treatment 2017, 16 (07):  500-503.  doi: 10.3969/j.issn.1671-4091.2017.07.017 Abstract ( 303 )   PDF (355KB) ( 398 )   In this paper, the relevant factors affecting the effluent effect of activated carbon tank are theoretically analyzed to provide the basis for the selection and maintenance of activated carbon tanks. The activated carbon tank can prevent patients from hemolytic anemia by effective removal of residual chlorine, and also help prolong the usage of reverse osmosis membrane and resin by preventing chlorine oxidation. In order to protect the resin and reverse osmosis membrane and to ensure the safety of dialysis water quality, parameters of activated carbon should be carefully considered in the preparation of activated carbon tanks. Metrics