Chinese Journal of Blood Purification

12 September 2017, Volume 16 Issue 09 Previous Issue    Next Issue

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The regularity of intracellular and extracellular water changes in maintenance hemodialysis patients during dialysis 2017, 16 (09):  582-586.  doi: 10.3969/j.issn.1671-4091.2017.09.002 Abstract ( 396 )   PDF (415KB) ( 488 )   Objective This study aimed to explore the regularity of intracellular and extracellular water changes in maintenance hemodialysis (MHD) patients during dialysis. Methods We selected 55 MHD patients as the subjects and measured their total body water (TBW), intracellular water (ICW) and extracellular water (ECW) before dialysis and every hour during dialysis, i.e., a total of 5 measurements for a patient. Results ①Both ICW and ECW decreased during dialysis as compared with those before dialysis, and ICW decreased more than ECW. ② The ratio of ICW/ECW was 2:1 in the first two hours during the dialysis, without significant difference with that before dialysis (t=- 5.620, P=0.580; t=- 2.048, P=0.053); the ratio increased slightly to 2.1:1 in the last two hours during the dialysis (t=-3.269, P=0.030; t=-4.696, P＜0.001). ③The ratios of ΔICW/ΔECW were 1.9, 1.8, 1.5 and 1.4 at the 1st, 2nd, 3rd and 4th hour respectively during the dialysis, and this ratio decreased significantly at the 4th hour as compared with that at the 1st hour (t=2.279, P= 0.036). ④After dialysis, the reduction rate of ICW and ECW were 5.4% and 8.4% respectively (t=3.994, P＜0.001). Conclusion ①Dialysis by ultrafiltration decreased the water retention in both extracellular and intracellular spaces, and the intracellular water decreased more than the extracellular water, resulting in slight increase of ICW/ECW ratio at the end of dialysis. ②The ratio of ΔICW/ΔECW decreased gradually along with the hour of the dialysis, and the reduction rate of ICW was less than that of ECW, suggesting that the excessive water in intracellular space moves to extracellular space through osmotic gradient and removes from the body with ECW during dialysis. Metrics

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Therapeutic effects of hemoperfusion on hypertriglyceridemia- induced acute pancreatitis 2017, 16 (09):  587-591.  doi: 10.3969/j.issn.1671-4091.2017.09.003 Abstract ( 412 )   PDF (487KB) ( 508 )   Objective To evaluate the effects of hemoperfusion (HP) for the treatment of hyperlipidemia and hypertriglyceridemia- induced acute pancreatitis (HTG- AP). Methods Twelve patients suffering from HTG-AP were retrospectively analyzed. They were treated with HP in addition to routine treatment. The improvement of hyperlipidemia, clinical symptoms, local and systemic complications, hospitalization days and mortality rate were analyzed. Results In the 12 patients at the time of admission, serum triglyceride (TG) was 54.542±19.019 mmol/L, and serum cholesterol (CHOL) was 13.158±5.242 mmol/L. After the first session of HP, serum TG reduced to 12.957±9.934 mmol/L (reduction rate of 77.740±11.668%, P＜0.001) and serum CHOL reduced to 8.294±6.960 mmol/L (reduction rate of 36.482±12.783%, P=0.016). Five of the 12 patients reached a TG level <10 mmol/L after two sessions of HP, and all of the patients had the serum TG level < 5.65 mmol/L within 1-3 days. The duration in ICU was 2.917±1.730 days, and hospitalization period was 11.500±8.939 days. None of them died. Conclusion HP can effectively reduce serum TG level and improve clinical outcomes in HTG-AP patients. Metrics

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The incidence and prognosis of symptomatic pulmonary embolism associated with the wire-guided exchange of tunneled cuffed catheters complicated with superior vena cava thrombosis 2017, 16 (09):  592-595.  doi: 10.3969/j.issn.1671-4091.2017.09.004 Abstract ( 288 )   PDF (753KB) ( 389 )   Objective To analyze the incidence and prognosis of symptomatic pulmonary embolism due to the operation of wire-guided exchange of tunneled cuffed dialysis catheters (TCC) with superior vena cava thrombosis. Methods We retrospectively analyzed 31 patients undergoing hemodialysis using TCC as the long-term vascular access and complicated with superior vena cava thrombosis in West China Hospital of Sichuan University from January 2015 to September 2016. These patients were treated with wire- guided exchange of TCC under the guidance of digital subtraction angiography (DSA) because of the TCC dysfunction. Symptoms of acute pulmonary embolism, such as chest tightness, chest pain, dyspnea, hemoptysis, accelerated heart rate, hypotension and lower oxygen saturation were recorded during the operation and after the operation for 24 hours. Thoracic CT angiography (CTA) was performed for the symptomatic patients to determine whether pulmonary embolism happened. Results A total of 31 patients with the average age of 64.16 ±15.77 years old were enrolled in this study. Nine patients (29.03%) presented with pulmonary embolism related symptoms: 6 cases with different degrees of dyspnea, in which 2 patients felt chest tightness and one case had accelerated heart rate and transient lowering of oxygen saturation; 3 cases with accelerated heart rate. No patients had chest pain, hemoptysis and hypotension. Thoracic CTA examination revealed pulmonary embolism in one case (1/9). All patients were followed up by telephone, and no one died. Conclusions Wire-guided exchange of TCC under the guidance of DSA for the patients with TCC complicated with superior vena cava thrombosis is relatively safe. The incidence of symptomatic pulmonary embolism and severe adverse consequences is low. Metrics

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Investigation of protein-energy wasting and its effect on quality of life in maintenance hemodialysis patients 2017, 16 (09):  596-600.  doi: 10.3969/j.issn.1671-4091.2017.09.005 Abstract ( 446 )   PDF (409KB) ( 644 )   Objective To investigate the protein-energy wasting (PEW) and its impact on quality of life in maintenance hemodialysis (MHD) patients. Methods A total of 205 MHD patients treated in our hospitals were enrolled in this study. They were followed up. Laboratory examinations, body measurements, body composition monitor, and normalized protein catabolic rate (nPCR) to evaluate PEW, and kidney disease and quality of life (KDQOLTM-36) were conducted. They were then divided into PEW group and non-PEW group for statistical analyses. Results In the 194 MHD patients 40 cases were diagnosed as PEW. Lean tissue index, body cell mass, mid-arm circumference and hand-grips were lower in PEW group than in non-PEW group. Logistic regression showed that C- reactive protein was the risk factor for PEW (OR=1.064, 95% CI 1.023～1.109, P=0.001), while spKt/V＞1.2 and nPCR＞0.8g/(kg·d) were the protect factors for PEW (OR=0.638, 95% CI 0.430-0.954, P=0.029 for spKt/V; OR=0.017, 95% CI 0.005～0.059, P＜0.001 for nPCR). The scores of all dimensions in the KDQOLTM- 36 were lower in PEW group than in non-PEW group, especially the scores of general health (t=2.432, P=0.018), social emotions (t=2.510, P=0.012), energy/fatigue (t=2.361, P=0.020) and symptoms/problems (t=3.337, P=0.001). Conclusion The incidence of PEW in MHD patients was 20.6% in Zhengzhou city. Wasting of muscle tissue was the characteristic of PEW. Dietary intake, dialysis adequacy and inflammatory state were the influence factors for PEW. PEW affected the quality of life in MHD patients. Metrics

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SM22α mediates the oxidative stress in podocytes via p47phox 2017, 16 (09):  601-606.  doi: 10.3969/j.issn.1671-4091.2017.09.006 Abstract ( 256 )   PDF (994KB) ( 435 )   Objective Oxidative stress is the main cause of podocyte apoptosis, and accelerates the disease course of chronic kidney disease. However, the mechanism of podocyte apoptosis by oxidative stress remains elusive. Here we investigated the induction of oxidative stress in podocytes through the phosphorylation of p47phox by smooth muscle 22 alpha (SM22α) to regulate angiotensinⅡ(AngII). Methods The expression of SM22α, p47phox and other proteins in normal podocytes and podocytes stimulated with AngII were measured by quantitative real time PCR and western blot. Changes of p47phox expression was evaluated under the knockdown of SM22α expression. Results After the stimulation of AngII for 12 hours, SM22α mRNA in podocytes decreased significantly (t=2.215, P=0.041), while p47phox mRNA increased significantly (t=3.955, P =0.025); the down-regulation of SM22α (t=2.215, P=0.041) prompted oxidative stress in podocytes and the oxidative stress reached the peak after 12 hours (tDHE=2.547, PDHE=0.042; tTBA=3.689, PTBA=0.022). Conclusion AngII induced the dysfunction of SM22α and the phosphorylation of SM22α activated p47phox, which suggests that SM22α plays important role in the oxidative stress in podocytes. Metrics

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The application of ultrasound pretreatment for the plasma endotoxin assay by limulus lysate test 2017, 16 (09):  607-611.  doi: 10.3969/j.issn.1671-4091.2017.09.007 Abstract ( 328 )   PDF (445KB) ( 412 )   Objective To explore the effect of ultrasound pretreatment for the detection of plasma endotoxin. Methods We used the platelet rich plasma and platelet poor plasma as the research objects. These plasma samples were pretreated with ultrasound or other methods and divided into 6 groups with 5 samples in every group: group A (platelet rich plasma pretreated with ultrasound), group B (platelet rich plasma pretreated with vortex), group C (platelet rich plasma pretreated with endotoxin reagent), group D (platelet poor plasma pretreated with ultrasound), group E (platelet poor plasma pretreated with vortex), and group F (platelet poor plasma pretreated with endotoxin reagent). Trace endotoxin in plasma was assayed by limulus lysate reagent using end point azo chromogenic method. Results ①The recovery rate for endotoxin was significantly different, but the optimal recovery rate had no significant difference between group A and group B (t= 9.424, P＜0.001 for recovery rate; x2=1.111, P=0.500 for optimal recovery rate), and between group D and group E (t=30.395, P＜0.001 for recovery rate; x2=2.500, P=0.222 for optimal recovery rate). The recovery rate for endotoxin had no significant difference, so did the optimal recovery rate between group A and group C (t= - 0.815, P=0.439 for recovery rate; x2=0.000, P=0.778 for optimal recovery rate), between group D and group F (t= - 0.375, P=0.717 for recovery rate; x2=0.000, P=0.527 for optimal recovery rate), and between group A and group D (t=0.355, P=0.732 for recovery rate; x2=0.476, P=0.500 for optimal recovery rate). ② The variation coefficient of the results from the groups pretreated with ultrasound was narrower (2.7% and 3.5%), and the recovery rate was 90-100%, more accurate than the national standard of 50～200%. Conclusions The pretreatment with ultrasound for the detection of endotoxin in plasma has the advantages of lower cost, higher sensitivity, reliable result and higher efficiency. Metrics

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The effect of acute kidney injury on other organs 2017, 16 (09):  612-615.  doi: 10.3969/j.issn.1671-4091.2017.09.008 Abstract ( 335 )   PDF (363KB) ( 388 )   Acute kidney injury (AKI) is the most common complication in critically ill patients, and is also an independent risk factor for unfavorable outcomes. There are no specific drugs for AKI at the present time. The mortality rate is higher in dialysis dependent AKI patients. It is insufficient to improve the outcome of AKI patients by merely focusing on kidney injury and renal dysfunction. Recent basic and clinical researches show that there is a complex cross-talk between kidney and other organs. This review aims to give a brief introduction about the recent progress and potential therapeutic targets in organ cross-talk between kidney and other organs (heart, lung and liver) in AKI, in order to provide new ideas for clinical treatment and prevention of multiple organ failure after AKI. Metrics

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The effect of acute kidney injury on other organs 2017, 16 (09):  616-618.  doi: 10.3969/j.issn.1671-4091.2017.09.008 Abstract ( 198 )   PDF (248KB) ( 311 )   Acute kidney injury (AKI) is the most common complication in critically ill patients, and is also an independent risk factor for unfavorable outcomes. There are no specific drugs for AKI at the present time. The mortality rate is higher in dialysis dependent AKI patients. It is insufficient to improve the outcome of AKI patients by merely focusing on kidney injury and renal dysfunction. Recent basic and clinical researches show that there is a complex cross-talk between kidney and other organs. This review aims to give a brief introduction about the recent progress and potential therapeutic targets in organ cross-talk between kidney and other organs (heart, lung and liver) in AKI, in order to provide new ideas for clinical treatment and prevention of multiple organ failure after AKI. Metrics

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The effect of Frank therapy on quality of life in maintenance hemodialysis patients 2017, 16 (09):  623-626.  doi: 10.3969/j.issn.1671-4091.2017.09.011 Abstract ( 289 )   PDF (385KB) ( 350 )   Objective To investigate the clinical value of Frank's meaningful therapy for improving the quality of life in maintenance hemodialysis (MHD) patients. Methods A total of 156 MHD patients (70 males and 86 females with the age of 22-75 years old) were enrolled in this study. They were randomly divided into control group (n=78) and study group (n=78). Patients in the control group were treated with routine psychological nursing, while those in the study group were treated with Frank therapy. The patients were assessed before the therapy and after the therapy for 3, 6 and 12 months. Anxiety scale, depression scale and SF-36 scale were used to evaluate the quality of life. Results The study group had lower anxiety score (t=-2.704, P=0.022), depression score (t=-2.684, P=0.022) and sleep quality index (t=1.945, P=0.035) at 6th month of the therapy as compared those in the control group. The compliance rate of blood pressure control was significantly higher in the study group than in the control group at 3rd month (χ2=0.475, P=0.661), 6th month (χ2=11.952, P=0.001) and 12th month (χ2=21.501, P=0.002) after the therapy. PF (t=1.931, P＜0.001), RP (t=-2.112, P＜0.001), BP (t=0.533, P=0.012), GHP (t=1.931, P=0.031), VT (t=1.324, P=0.013) and REP (t=2.180, P=0.011) scores of the quality of life scales were significantly higher in the study group than in the control group. Conclusion Frank's meaningful therapy can significantly improve mood, sleep quality, quality of life, and the compliance rate of blood pressure control in MHD patients. Metrics

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Polytetrafluoroethylene (PTFE) graft as the fistulas for hemodialysis access: clinical analyses of 286 cases 2017, 16 (09):  627-630.  doi: 10.3969/j.issn.1671-4091.2017.09.012 Abstract ( 305 )   PDF (391KB) ( 524 )   Objective To assess the patency and complication of polytetrafluoroethylene (PTFE) graft as the fistulas for hemodialysis access. Methods A total of 286 uremic patients were implanted with expanded PTFE (ePTFE) grafts as the fistulas for permanent hemodialysis access in the period from Apr. 2012 to Dec. 2016. Success rate of fistula surgery, complications, patency rate relating to different surgical sites and different anastomosis forms were retrospectively analyzed. Results Success rate of the operation was l00%. Patency rates at 1, 2 and 3 year were 95.4%, 88.6% and 78.4% respectively. The common complications were thrombosis (18.5%), pseudoaneurysms (4.5%), infection (3.8%) and others (7.0%). Conclusion ePTFE graft is an ideal alternative for constructing dialysis access in patients with difficulties of direct arteriovenous fistula establishment. Metrics

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Risk factors for arteriovenous fistula complications in hemodialysis patients 2017, 16 (09):  631-634.  doi: 10.3969/j.issn.1671-4091.2017.09.013 Abstract ( 458 )   PDF (388KB) ( 545 )   Objective To discuss the risk factors for arteriovenous fistula (AVF) complications in hemodialysis patients. Methods A total of 89 hemodialysis patients with AVF treated in the blood purification center from Jul. 1, 2016 to Dec. 30, 2016 were recruited. AVF complications including stenosis and thrombosis were examined by color Doppler ultrasonography. Clinical and biochemical data were recorded. Risk factors for the complications were analyzed by logistic regression. Results Ultrasonography showed that 72 (80.9%) were normal in structure, and 17 (19.1%) had complication. There were significant differences in gender(t= 9.108, P= 0.003), parathyroid hormone (t=-2.456, P=0.016), albumin (t=3.297, P=0.001) and pre-albumin (t=2.068, P=0.042) between complication group and non-complication group. Logistic regression revealed that gender (OR=11.474, 95% CI 2.388～56.311, P=0.003) was the risk factor for AVF complications, while albumin (OR=0.683, 95% CI 0.493～0.947, P=0.022) was the protective factor. Conclusions The prevalence of AVF complications was related to gender and serum albumin. Therefore, special care should be paid to the female and hypoalbuminemia patients with AVF. Education to the patients is also useful for the prevention of AVF complications in hemodialysis patients. Metrics

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The research on flush methods for preventing coagulation and clot formation during continuous renal replacement therapy without anticoagulation 2017, 16 (09):  635-642.  doi: 10.3969/j.issn.1671-4091.2017.09.014 Abstract ( 356 )   PDF (503KB) ( 418 )   Objectives To investigate the effects on blood coagulation, circulation status and filter life in critically ill patients with high bleeding risk requiring continuous renal replacement therapy (CRRT) without anticoagulation. Methods Patients with high risk of bleeding requiring CRRT without anticoagulation in the ICU were randomly divided into saline flushes group and no-rinse group. Levels of prothrombin fragment 1+2 (PF1+2) and β-thromboglobulin (β-TG) were measured, and the transmembrane pressure (TMP), pressure before the filter (PBE) and filter pressure decrease value (ΔP) were observed. Changes of heart rate and blood pressure were monitored during CRRT. Results There was no significant difference in the levels of PF1+2 and β-TG between saline flushes group and no-rinse group. In no-rinse group the TMP at 3h (t=3.813, P＜0.001), 4h (t=4.230, P＜0.001) and at the end of CRRT (t=7.014, P＜0.001) were significantly higher than that at the start of CRRT. In saline flushes group, the TMP at 4h (t=3.296, P=0.002) and at the end of CRRT (t=3.930, P＜0.001) were significantly higher than that at the start of CRRT. Filter pressure in the two groups showed significant differences after 1h (u=3.056, P=0.002), 2h (u=2.788, P=0.005), 3h (u=2.009, P=0.045) and at the end of CRRT (u=2.201, P=0.043). In no- rinse group the filter pressure decrease value at 1h (t=2.738, P=0.009), 2h (t=3.590, P＜0.001), 3h (t=4.771, P＜0.001), 4h (t=4.754, P＜0.001) and at the end of CRRT (t=5.144, P＜0.001) were significantly higher than that at the start of CRRT. In saline flushes group, the filter pressure decrease value at 3h (t=3.013, P=0.005), 4h (t=3.020, P=0.005) and at the end of CRRT (t=3.814, P=0.001) were significantly higher than that at the start of CRRT. Filter pressure decrease value in the two groups showed significant differences at the end of CRRT (u=2.155, P=0.031). The CRRT treatment time were more than 5 hours in all patients in the two groups. CRRT treatment was terminated in 5 patients (one case in saline flushes group and 4 cases in no-rinse group) due to high pressure limit alarm. The rest of the patients completed continuous veno-venous hemofiltration (CVVH) for 6～10h following doctor's advice. Compared between the two groups, there were significant differences in systolic pressure changes at 1h (t=2.845, P=0.007), 2h (t=3.353, P=0.002), 3h (t=3.367, P=0.002), 4h (t=3.745, P=0.001), 5h (t=3.355, P=0.002) and at the end of CRRT (t=2.711, P=0.010), significant differences in mean arterial blood pressure changes at 2h (t=2.508, P=0.016), 3h (t=3.078, P=0.004), 4h (t=3.023, P=0.004), 5h (t=2.412, P=0.021), significant differences in pulse pressure values at 2h (t=2.635, P=0.012), 3h (t=2.805, P=0.008), 4h (t=3.070, P=0.004), 5h (t=2.893, P=0.006) and at the end of CRRT (t=2.254, P= 0.030), and significant differences in pulse pressure changes at 1h (t=2.769, P=0.008), 2h (t=3.154, P=0.003), 3h (t=2.614, P=0.013), 4h (t=2.973, P=0.005), 5h (t=3.063, P=0.004) and at the end of CRRT (t=2.672, P=0.011). Conclusion Physiological saline irrigation is conducive to slow down the rise of pressure value in the machine and to prevent blood coagulation in extracorporeal circuit in CRRT for more than 5h. Patients with acute or chronic renal failure with high risk of bleeding associated with cardiovascular disease should be treated with saline irrigation without anticoagulation during CRRT. Metrics

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The frequent reasons for manuscript revision by authors during the editing stage: analysis and suggestions 2017, 16 (09):  643-645.  doi: 10.3969/j.issn.1671-4091.2017.09.015 Abstract ( 290 )   PDF (354KB) ( 393 )   Objectives This paper analyzed the reasons for author’s revision of the manuscript asked by the editorial board before published in order to promote author’s writing skills and to provide suggestions for higher academic quality of medical papers on journals. Methods We reviewed and summarized the suggestions to authors for manuscript revision during the editing period from Aug. 2015 to Jul. 2016 before published on Chinese Journal of Blood Purification. Results The main reasons for revision by authors during the editing period were ①big abstract and the conclusion drawn without objective bases, ②no Chinese and English full name for English abbreviation when it first appears, ③ inappropriate description of statistical methods, ④charts and tables only for reiteration of text content and without self-clarity, and ⑤informal format for references. Conclusion Higher quality of the medical manuscript is a key issue to speed up editing process cycle and publication period. The authors should be familiar with the formats of medical thesis, abstract, chart, table and references, and the description of statistical method. Metrics