Chinese Journal of Blood Purification

12 August 2017, Volume 16 Issue 08 Previous Issue    Next Issue

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The effect of inflammation on the anemia in chronic kidney disease patients Lei WANG 2017, 16 (08):  505-508.  doi: 10.3969/j.issn.1671-4091.2017.08.001 Abstract ( 326 )   PDF (469KB) ( 503 )   Anemia is one of the common complications in chronic kidney disease (CKD) patients, mainly caused by iron and erythropoietin (EPO) deficiency. There are evidences that both inhibition and chronic activation of immune system are present in CKD patients. Higher inflammatory cytokine levels disturb iron metabolism and erythropoiesis, resulting in anemia resistant to erythropoiesis stimulating agents (ESAs) and more hurdles in treatment of these patients. In this situation, increase of iron and EPO doses has negative effect on prognosis and produces more side effects of these medications. Understanding the effects of inflammation on anemia in CKD patients will help us appropriately manage anemia in these patients. Metrics

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Causes and management of low responses to erythropoietin 2017, 16 (08):  509-511.  doi: 10.3969/j.issn.1671-4091.2017.08.002 Abstract ( 431 )   PDF (368KB) ( 411 )   Erythropoietin (EPO) is used in clinical treatment of anemia in chronic kidney disease patients. Hyporesponsiveness of EPO occurs in some patients due to iron deficiency, inflammation, oxidative stress, etc. Adequate dialysis, improvement of nutritional status, and the use of long-acting EPO may have effect on the EPO hyporesponsiveness. Metrics

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Recent advances in the erythropoietin resistance and the pure red cell aplasia induced by anti-erythropoietin antibody 2017, 16 (08):  512-515.  doi: 10.3969/j.issn.1671-4091.2017.08.003 Abstract ( 270 )   PDF (394KB) ( 556 )   Anemia is one of the common complications in chronic kidney disease (CKD) patients. Although erythropoietin- stimulating agents (ESAs) have been widely applied and are effective for anemia in CKD patents, it is impossible for some patients to maintain hemoglobin to the recommended level. Pure red cell aplasia (PRCA) induced by anti- erythropoietin antibody is present in a few cases. The pathogenesis of EPO resistance and anti-EPO antibody induced PRCA are unclear, and the prevalence of these abnormalities become increased. Here we discuss the recent advances in EPO resistance and anti-erythropoietin antibody induced PRCA. Metrics

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The influence of vitamin D level on iron metabolism in patients on continuous ambulatory peritoneal dialysis 2017, 16 (08):  516-518.  doi: 10.3969/j.issn.1671-4091.2017.08.004 Abstract ( 267 )   PDF (336KB) ( 386 )   The prevalence of vitamin D deficiency or inadequate vitamin D intake is very high in patients on continuous ambulatory peritoneal dialysis (CAPD). Iron metabolism disturbance is aggravated due to the accumulation of hepcidin, which is resulted from the vitamin D deficiency induced abnormal bone mineral metabolism, micro-inflammation and malnutrition in CAPD patients. Supplement of vitamin D may be useful for iron metabolism disturbance through improvement of abnormal metabolism and malnutrition status and decrease of hepcidin in CAPD patients. Metrics

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Standard-reaching rate after treatment and its influencing factors in maintenance hemodialysis patients complicated with anemia 2017, 16 (08):  519-521.  doi: 10.3969/j.issn.1671-4091.2017.08.005 Abstract ( 302 )   PDF (345KB) ( 364 )   Objective To explore the standard-reaching rate of hemoglobin after the treatment and its influencing factors in maintenance hemodialysis (MHD) complicated with anemia. Methods A total of 314 MHD patients with anemia were divided into standard- reaching group (n=106) and non- standard- reaching group (n=208) after the treatment. The factors relating to the standard-reaching rate were analyzed using univariate and multivariate logistic regression methods. Results The standard-reaching rate was only 33.8% in MHD patients with anemia (106/314) after the treatment. Multivariate logistic regression indicated that age of dialysis (OR=2.115, 95% CI 1.386～2.844, P=0.006), frequency of dialysis (OR=2.472, 95% CI 1.660～3.283, P=0.001), serum albumin (OR=1.872, 95% CI 1.076～2.668, P=0.002), iPTH (OR=1.846, 95% CI1.183～2.508, P=0.006) and serum iron (OR=3.504, 95% CI 2.385～4.623, P＜0.001) were the influencing factors for standard-reaching rate in MHD patients with anemia. Conclusion The standard reaching-rate of hemoglobin was low after the treatment for MHD patients with anemia. The independent factors relating to standard- reaching rate of hemoglobin included longer dialysis age, lower dialysis frequency, lower serum albumin and iron, and higher iPTH. Intervention measures to improve these factors may be useful for the increase of standard-reaching rate of hemoglobin. Metrics

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Effect of various blood purification methods on intradialytic hypotension and the changes of cardiac structure and function 2017, 16 (08):  522-527.  doi: 10.3969/j.issn.1671-4091.2017.08.006 Abstract ( 266 )   PDF (469KB) ( 414 )   Objective To explore the efficacy of different blood purification methods on intradialytic hypotension (IDH) and the changes of cardiac structure and function in maintenance hemodialysis (MHD) patients. Methods Thirty IDH patients were randomly divided into hemodialysis (HD) group (n=10), hemodiafiltration combined with hemodialysis (HDF+HD) group (n=10), hemoperfusion combined with hemodialysis (HP+HD) group (n=10), and they were observed for 24 weeks. ①The changes of blood pressure in hemodialysis sessions and the frequency of IDH were compared between the 3 groups. ②Serum parathyroid hormone (PTH), NT-probrain natriuretic peptide (NT-proBNP) and high sensitivity C-reactive protein (hs-CRP) were measured before and after the treatment for 24 weeks. ③Left ventricular diastolic diameter (LVDd), interventricular septal thickness (IVST) and left ventricular ejection fraction (LVEF) were examined by echocardiography after the treatment for 24 weeks. Results ①The frequency of IDH was significantly lower in HDF+HD and HP+HD groups than in HD group (χ2=510.693, P=0.001). ②Serum PTH, NT-proBNP, Hs-CRP levels decreased significantly in HP+HD and HDF+HD groups after the treatment for 24 weeks as compared with those before treatment (for HD group: t1=0.304, P1=0.761; t2=0.401, P2=0.748; t3=0.312, P3=0.756; for HDF+HD group: t1=4.780, P1＜0.001; t2=4.813, P2＜0.001; t3=3.950, P3＜0.001; for HP+HD group: t1=4.586, P1＜0.001; t2=4.802, P2＜0.001; t3=3.961, P3＜0.001), and were lower in HP+HD and HDF+HD groups than in HD group after the treatment for 24 weeks (for PTH: F=3.161, P=0.017; for NT-proBNP: F=4.130, P=0.021; for Hs-CRP: F=3.100, P= 0.015). ③LVEF increased significantly in HDF+HD and HP+HD groups after the treatment for 24 weeks as compared with that in HD group (F=6.926, P= 0.002). Conclusion HP+HD and HDF+HD were better than HD for the improvement of cardiac function and hemodynamic stability in IDH patients. HP+HD and HDF+HD may be used as a long-term therapy for IDH patients. Metrics

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The influence factors on the prognosis in type 1 cardiorenal syndrome treated with continuous renal replacement treatment 2017, 16 (08):  528-532.  doi: 10.3969/j.issn.1671-4091.2017.08.007 Abstract ( 267 )   PDF (531KB) ( 406 )   Objective To explore clinical features and influence factors on the prognosis in type 1 cardiorenal syndrome (CRS) patients treated with continuous renal replacement therapy (CRRT). Methods Fiftythree patients admitted to Beijing Anzhen Hospital due to type I CRS and treated with CRRT from January 2008 to March 2016 were enrolled in this retrospective study. They were divided into two groups according to survival or death. Patients in the survival group were further divided into two subgroups according to their prognosis, renal replacement therapy (RRT) independent subgroup and RRT dependent subgroup. Baseline features, diagnosis, complications, combined drug therapy, cardiac function and renal function before CRRT and at the beginning of CRRT were compared respectively between the two subgroups. Results The average age of the 53 patients (36 males and 17 females) was 65.8 years old. Thirty of them were survival with the mortality rate of 43.4%. Twenty-one of the 30 survival patients improved without the need of dialysis anymore, and 9 cases must rely on maintenance dialysis. Compared with the patients in the survival group, patients in the death group had lower urine volume before CRRT (t=-2.336, P=0.023), later CRRT beginning time (t=2.187, P=0.038), higher prevalence of intradialytic hypotension (χ2=16.246, P＜0.001), higher proportion of using vasoactive drugs (χ2=12.106, P=0.001), and less decrease of serum BNP after CRRT (t=15.931, P＜0.001). In the RRT independent subgroup, serum creatinine at baseline (t=- 4.796, P=0.001) and before CRRT (t=-2.502, P=0.018) were significantly lower than those in the RRT dependent subgroup. Conclusion The mortality was relatively high in type I CRS treated with CRRT. The risk factors for death were lower urine volume, late beginning of CRRT, intradialytic hypotension, and persistent higher BNP level after CRRT. The risk factor for RRT dependence was the higher baseline serum creatinine before CRRT. Metrics

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Effect of continuous quality improvement on mineral bone metabolism in maintenance hemodialysis patients 2017, 16 (08):  533-536.  doi: 10.3969/j.issn.1671-4091.2017.08.008 Abstract ( 243 )   PDF (435KB) ( 459 )   Objective To investigate the effect of continuous quality improvement (CQI) on bone mineral metabolism in maintenance hemodialysis (MHD) patients. Methods We observed 97 MHD patients with abnormal bone mineral metabolism in our hospital during July 2014 to 2015 June. According to the "Guidance for Diagnosis and Treatment of Mineral and Bone Disorder in Chronic Kidney Disease”issued by Nephrology Association of Chinese Medical Association in September 2013, they were managed with CQI to intensify supervision and intervention of the treatment, to establish continuous quality improvement team, and to attract patients and their families taking part into the administration of treatment through the four steps called PDCA (plan, do, check and act). The observation period lasted 12 months. Changes of serum Ca, P and PTH levels and the compliance rate of serum Ca, P and iPTH were evaluated before and after CQI. Results After CQI, the abnormal calcium and phosphorus metabolism in MHD patients improved in our hospital. Serum phosphorus decreased from 2.42±0.76 mmol/L to 2.13±0.80 mmol/L (t=2.589, P=0.011) with the increase of compliance rate from 24.74% to 41.24% (χ2=5.969, P=0.014); average serum iPTH decreased from 445.97± 407.22ng/ml to 335.21 ± 386.23 ng/ml (t=1.942, P=0.043), with the increase of compliance rate from 34.02% to 48.45% (χ2=3.312，P=0.041); average serum Ca increased from 2.23±0.40 mmol/L to 2.24±0.25 mmol/L (t=0.212, P=0.901) with the increase of compliance rate from 45.36% to 56.70% (χ2=2.490, P= 0.114). In addition, the number of patients accepting new therapeutic measures increased; the number of patients using non-Ca-P binders increased from 1.03% to 12.37% (χ2=9.976, P=0.001); the number of patients used combined blood purification methods from 36.08% to 57.73% (χ2=9.168, P=0.002); the number of patients having parathyroid surgery increased from 2.06% to 11.34% (χ2=6.678, P=0.001); the number of patients using active vitaminD decreased from 64.95% to 55.67% (χ2=1.744, P=0.187). Conclusion Continuous quality improvement can effectively improve the abnormal Ca-P metabolism in MHD patients. Metrics

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Exploring the relationship between the serum vitamin C concentration and parameter values reflecting the Mineral and Bone Disorder in hemodialysis patients 2017, 16 (08):  537-541.  doi: 10.3969/j.issn.1671-4091.2017.08.009 Abstract ( 260 )   PDF (394KB) ( 381 )   Purpose To explore the relationship between the serum concentration of vitamin C (VC) and parameter values reflecting the Mineral and Bone Disorder (MBD) in Maintenance hemodialysis (MHD) patients. Method This study employs a pre-post self-comparison design. 92 patients were selected and divided into two groups based on the level of the serum VC concentration at the beginning of the study: a normal-VC group (VC＞=4mg/L, the control group) and a deficient-VC group (VC＜4mg/L, the intervention group). At the same times, all patients’intact Parathyroid hormone (iPTH), Alkaline Phosphatase (ALP), Calcium (Ca), Phosphate (P), and Ca×P were examined and recorded at the beginning of the study. During the study, the intervention group was given an injection of 300mg vitamin C at the end of each dialysis, while the normal group got no treatment. The patients were monitored for 3 months and then examined again on the serum concentration of VC, iPTH, ALP, Ca, P and Ca×P at the end of the observation period. The data was analyzed with SPSS 19.0. Results ①VC deficiency was common in the MHD patients (78.3%). There was a significant difference in the base serum vitamin C level between the normal-VC group and the deficient-VC group [5.644(2.200) vs.1.312(1.940) mg/L，Z=- 6.895，P＜0.001], as well as in the serum iPTH [99.00(230.72)vs. 206.30(315.10)pg/ml，Z=-1.049，P=0.029] and ALP [82.00(42.50)vs.123.00(234.00)U/L, Z=-2.367，P=0.018]. ②After the three-month observation period: ① The serum VC concentration of the control group was reduced than before, but the difference was not statistically significant (5.64(4.29，6.49) vs. 5.11 (3.94，6,15)P=0.057). The VC concentration of the intervention group was statistically significantly increased (mg/L ，(1.31(0.80，2.02) vs. 4.59(2.46，5.70)，P＜0.001). ②The serum MBD indicators: the serum iPTH, ALP, P, and Ca×P of the patients in the control group were increased, but none of the difference was statistically significant. The intervention group showed statistically significant reduce in serum iPTH [206.30(133.40，428.50) vs.154.00(76.50, 388.00)pg/mL, Z= - 2.207 ，P<0.001] and serum ALP [123.00(78.00，312.00) vs. 95.00(60.00，140.00) U/L, Z=-3.749，P=0.011]. The Serum Ca, P, and Ca×P were also slightly lower than before, but the differences were not statistically significant. 3. The Pearson/Spearman correlation coefficients, as well as the coefficients of the linear regressions suggested that there was a negative correlation between the plasma vitamin C level and ALP level of the MHD patients(B=-8.538, P=0.014). Conclusion Vitamin C deficiency is a common phenomenon in MHD patients. Regular dialysis can cause the loss of vitamin C. Providing supplementary Vitamin C to MHD patients can reduce the level of iPTH and ALP. There is a negative correlation between the plasma vitaminC level and ALP level. The deficiency of Vitamin C in MHD patients may be correlated with MBD. Metrics

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Effect of PDCA management on mineral metabolism disorder in maintenance hemodialysis patients 2017, 16 (08):  542-546.  doi: 10.3969/j.issn.1671-4091.2017.08.010 Abstract ( 223 )   PDF (440KB) ( 352 )   Objective To explore the effect of PDCA (plan, do, check and act) management on the improvement of mineral metabolism disorder in maintenance hemodialysis (MHD) patients in order to improve quality management for hemodialysis patients. Methods Since Jan. 1st, 2013, the PDCA, a 4-step problemsolving irame work of continuous quality improvement (CQI), was carried out for the management of mineral metabolism disorder in MHD patients who were stable for more than 3 months in one hospital in Beijing. A total of 90 MHD patients treated in the hospital with complete clinical data within 12 months from Jan. 2011 to Dec. 2012 (control group) and from Jan. 2014 to Dec. 2015 (intervention group) were enrolled in this study. Clinical characteristics and mineral metabolism parameters including serum Ca, P and intact parathyroid hormone (iPTH) were extracted from digital clinical record system. Variability and mean of the parameters were calculated. Changes of mineral metabolism parameters were compared between the two groups. Results In intervention group and control group before PDCA management, serum Ca increased from 2.23±0.19 mmol/L to 2.27±0.14 mmol/L (t=1.347, P=0.178), serum P decreased from 1.90±0.45 mmol/L to 1.71±0.35 mmol/L (t=-1.791, P=0.073), and serum iPTH decreased from 297.63±233.25 mmol/L to 293.46±227.44 mmol/L (t= 0.049, P=0.961). These changes had no statistical significances. After the intervention, the variation of serum P between the two groups decreased from 1.16±0.59 mmol/L to 0.98±0.48 mmol/L (t=-2.089, P=0.037), the coefficient of variation (CV) of serum iPTH between the two groups decreased from 0.47±0.23% to 0.35± 0.20% (t=-2.528, P=0.011). The mean, range and CV of serum Ca, the mean and CV of serum P, the mean and range of serum iPTH, and the abnormal ratio of serum Ca, P and iPTH were similar between the two groups.Conclusions PDCA management improves mineral metabolism in MHD patients, and is thus useful for the management of MHD patients. Metrics

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The effect of red blood cell distribution width on anemia and prognosis in maintenance hemodialysis patients 2017, 16 (08):  547-550.  doi: 10.3969/j.issn.1671-4091.2017.08.011 Abstract ( 305 )   PDF (408KB) ( 490 )   Objective To study the effect of red blood cell distribution width (RDW) on anemia and prognosis in maintenance hemodialysis (MHD) patients. Methods A total of 252 end stage renal disease (ESRD) cases (18 years of age or older) treated with MHD in the Blood Purification Center of Xuanwu Hospital for more than 3 months were enrolled in this study. Medical history, laboratory parameters including blood routine and renal function tests, and recombinant human erythropoietin (rHuEPO) dosage were recruited. They were followed up, and the end-point of this study was the all-cause death. According to renal anemia diagnosis and treatment of Chinese expert consensus recommendations, the standard of hemoglobin level is greater than or equal to 110g/L. Patients with standard hemoglobin level were divided into RDW normal group and RDW elevated group based on the normal RDW limit of 15.0%. General situation, the amount of rHuEPO used, and the recombinant human erythropoietin/hemoglobin (rHuEPO/Hb) ratio were analyzed between the two groups. COX regression analysis was carried out for the risk factors of all-cause death in MHD patients. Results In patients with standard hemoglobin level, rHuEPO dosage and rHuEPO/Hb ratio were higher in RDW elevated group than in RDW normal group (t=7.279, P＜0.001 for rHuEPO dosage; t=5.762, P＜0.001 for rHuEPO/Hb ratio). Multivariate COX regression demonstrated that RDW was the risk factors while Hb and ALB were the protection factors for all- cause death in MHD patients (RR=1.752, 95% CI 1.320～2.325, P＜0.001 for RDW; RR=0.951, 95% CI 0.934～0.968, P＜0.001 for Hb; RR=0.900, 95% CI 0.850～0.954, P＜0.001 for ALB). Conclusions Patients with elevated RDW were less responsive to rHuEPO than those with normal RDW. Higher RDW was the risk factors while Hb and ALB were the protective factors for all-cause death. Metrics

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Symptom clusters and their development in hemodialysis patients 2017, 16 (08):  555-557.  doi: 10.3969/j.issn.1671-4091.2017.08.013 Abstract ( 227 )   PDF (336KB) ( 355 )   We analyze the instruments for the evaluation of symptom clusters in hemodialysis patients, explore the predictive and outcome variables for symptom clusters, and examine their developmental trajectory in order to help researchers select most suitable measure with good validity and reliability and develop effective intervention strategies for symptom management. Metrics

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Recent advances in low-dose aspirin for the prevention of cardiovascular events in chronic kidney disease patients 2017, 16 (08):  558-561.  doi: 10.3969/j.issn.1671-4091.2017.08.014 Abstract ( 214 )   PDF (392KB) ( 517 )   The incidence of chronic kidney disease (CKD) is high, about 10～15% of adults have CKD, and the incidence is even increasing. CKD is also an independent risk factor for cardiovascular events. On the other hand, cardiovascular disease (CVD) is the first cause of death in CKD patients. Clinical research has now confirmed that aspirin has important role in the primary and secondary prevention of CVD. However, clinical research has no conclusion about aspirin in the prevention of CVD in CKD patients. Here we review available literature and summarize that the effect of low-dose aspirin is unknown for the prevention of cardiovascular events in CKD patients without hemodialysis and on hemodialysis. Therefore, high quality and prospective clinical trials are required in the future. Metrics

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Application of a vascular sheath technique in the operation of arteriovenous fistula 2017, 16 (08):  566-570.  doi: 10.3969/j.issn.1671-4091.2017.08.016 Abstract ( 381 )   PDF (938KB) ( 436 )   Objective To investigate the application and effect of a vascular sheath technique in the operation of arteriovenous fistula. Methods A total of 102 patients undergone arteriovenous fistula surgery in our hospital from Aug. 2010 to Nov. 2016 were recruited in this study. They were randomly divided into traditional group (n=48), in which the traditional operation of cephalic vein/radial artery anastomosis was used, and improvement group (n=53), in which cephalic vein expanded by intravascular sheath placement/radial artery end to side anastomosis was used. Patency rate of the internal fistula, fistula blood flow and mean blood flow during dialysis were compared between the two groups. Results Fistula surgery failed in 5 cases, of whom all were in traditional group. After the operation for 3, 6 and 12 months, patency rate, blood flow and average blood flow during dialysis were compared between the two groups, and the 3 parameters were better in improvement group than in traditional group, except that the patency rate after the operation for 3 months had no statistical significance (χ2=2.807, 5.636 and 4.508, P=0.094, 0.024 and 0.049 respectively for patency rate; t=2.429, 2.446 and 2.474, P=0.017, 0.016 and 0.015 respectively for blood flow in fistula; t=2.102, 2.099 and 2.199, P=0.038, 0.039 and 0.037 respectively for average blood flow during dialysis). Conclusions The application of a vascular sheath technique in the operation of arteriovenous fistula can significantly improve the blood flow, patency rate and blood access during dialysis. Therefore, this technique can be used as a new method for the operation of arteriovenous fistula. Metrics

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The design and application of a piercing hemostasis device 2017, 16 (08):  571-574.  doi: 10.3969/j.issn.1671-4091.2017.08.017 Abstract ( 221 )   PDF (444KB) ( 333 )   Objective To study the design and application of a new puncture and hemostasis device. Method We compared the new puncture and hemostasis device with the conventional compression method and the standard method. One-way ANOVA was used to compare the hemostatic operation time and number of shedding between the 3 types of hemostasis methods. Dunnett- t test was used to compare between two types of methods. Result The number of pressure shedding was statistically significant between new device group and conventional group (F=7.278, P=0.012), between conventional group and standard group (F=7.278; P=0.004), and between new device group and standard group (F=7.955; P=0.009). Multiple comparisons using Dunnett-t test showed that there were statistical significances between new device group and conventional group (tD=-0.125, P=0.487), between conventional group and standard group (tD=-0.061, P=0.022), and between new device group and standard group (tD=0.027, P=0.013). Additionally, the hemostatic operation time in new device group reduced by 35.35% as compared with that in conventional group. Conclusion Our new device is more convenient and efficient for hemostasis with a shorter hemostatic operation time. Metrics

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The importance of periodic maintenance and preventive repair for dialyzers in hemodialysis centers 2017, 16 (08):  575-576.  doi: 10.3969/j.issn.1671-4091.2017.08.018 Abstract ( 362 )   PDF (317KB) ( 392 )   Objectives Periodic maintenance and preventive repair for hemodialysis dialyzers are critical to ensure high quality of hemodialysis, efficient use of dialyzers, reduction of consumable parts and running cost, and untoward response control in patients due to dialyzer dysfunction. Methods Through the strict rules for management of dialyzers, the training for nurses working in hemodialysis center, and the enforced responsibility and technical abilities of the technicians, passive repair after breakdown of dialyzers can be changed to periodic maintenance and preventive repair before the presence of troubles in dialyzers. Results After the implement of periodic maintenance and preventive repair, the breakdown rate of dialyzers reduced significantly, the cost for repair and performance decreased, and daily work in hemodialysis center could be carried out more efficiently. Conclusion Periodic maintenance and preventive repair are important for dialyzers working in a safe and best condition. Consequently, the running cost can be reduced, and the hemodialysis center can be run smoothly with lower incident rate and higher satisfaction from patients. Metrics