Chinese Journal of Blood Purification

12 November 2017, Volume 16 Issue 11 Previous Issue    Next Issue

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The study on the correlation between 25-hydroxy vitamin D3 and iron metabolism in peritoneal dialysis patients 2017, 16 (11):  721-724.  doi: 10.3969/j.issn.1671-4091.2017.011.001 Abstract ( 427 )   PDF (399KB) ( 552 )   Objective To study the correlation between 25-hydroxy vitamin D3 and the status of iron metabolism in patients with continuous ambulatory peritoneal dialysis (CAPD). Methods A total of 50 patients treated with CAPD for more than one year with a stable disease condition in the Peritoneal Dialysis Clinic of this hospital were enrolled in this study (CAPD group). A total of 30 healthy subjects from the Health Checkup Center were selected as the control group. Serum 25-hydroxy vitamin D3 and hepcidin were measured by enzyme- linked immunosorbent assay (ELISA). Hemoglobin (HB), blood biochemistry, serum iron, ferritin (Fer) and total iron binding capacity (TIBC) were assay by routine laboratory methods. Pearson correlation analysis was used to analyze the correlation between serum 25-hydroxy vitamin D3 and clinic indices. Results As compared with control group, CAPD group had significantly lower serum 25-hydroxy vitamin D3 (t=1.947, P=0.029), HB (t=6.676, P＜0.001), iron (t=8.463, P＜0.001) and TIBC (t=6.173, P＜0.001), significantly higher serum Fer (t=3.084, P= 0.003), higher hepcidin but without statistical significance (t=1.280, P=0.204), and significantly higher serum creatinine (t=22.810, P＜0.001), blood urea nitrogen (t=16.580, P＜0.001), phosphorus (t=3.372, P＜0.001) and parathyroid hormone (t=8.010, P＜0.001). Pearson correlation analysis revealed that serum 25- hydroxy vitamin D3 was negative correlated with hepcidin (r=- 0.382, P=0.003). Conclusion The lower level of serum 25-hydroxy vitamin D3 is associated with the abnormal iron metabolism and anemia in CAPD patients. Metrics

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Effects of Levosimendan on Acute Kidney Injury in patients undergoing coronary artery bypass grafting 2017, 16 (11):  725-727.  Abstract ( 330 )   PDF (587KB) ( 467 )   Objective To investigate the effects of Levosimendan on acute kidney injury in patients undergoing coronary artery bypass grafting. Methods Patients with severe coronary artery bypass grafting were prospectively enrolled during December 2013 to June 2015 in Fuwai Hospital,randomized to levosimendan-treated group and control group.Results : 79patients were enrolled in the research,44patients in levosimendan-treated group and 35patients in control group.The creatinine were both increased in the two groups compared to baseline.The levosimendan group had lower creatinine than control group from Day 3,p<0.05 .The incidence of AKI in levosimendan group was less than control group.Multivariate logistic regression showed that levosimendan was the protective factor of postoperative AKI, OR :0.68(0.42~0.87). Conclusion Levosimendan reduced the incidence of AKI in the patients undergoing severe coronary artery bypass grafting. Metrics

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Effects of lanthanum carbonate on serum phosphorus in maintenance hemodialysis patients receiving calcitriol pulse therapy due to secondary hyperparathyroidism 2017, 16 (11):  728-731.  doi: 10.3969/j.issn.1671-4091.2017.011.003 Abstract ( 1224 )   PDF (417KB) ( 465 )   Objective To investigate the effect of lanthanum carbonate on calcium and phosphorus metabolism in maintenance hemodialysis (MHD) patients treated with calcitriol pulse therapy due to secondary hyperparathyroidism (SHPT). Methods Sixty MHD patients with SHPT were randomly divided into control group 1 and treatment group 1 (for patients with iPTH 300-600 pg/mL), and control group 2 and treatment group 2 (for patients with iPTH 600-1000 pg/mL). Patients in control group 1 were given oral calcitriol of 2μg 2 times/week and calcium carbonate 750mg 2 times/day; patients in control group 2 were given oral calcitriol of 2μg 3 times/week and calcium carbonate 750mg 2 times/day. Patients in treatment group 1 were given oral calcitriol of 2μg 2 times/week and lanthanum carbonate 500μg 3 times/day; those in treatment group 2 were given oral calcitriol of 2μg 3 times/week and lanthanum carbonate 500μg 3 times/day. Serum iPTH, calcium and phosphorus were examined in the treatment period at 4th, 8th and 12th weeks. Results Compared with the levels before treatment, serum iPTH decreased significantly (P＜0.05) and serum calcium increased significantly in the treatment period at 4th, 8th and 12th weeks in control and treatment groups. The increase of serum calcium was more in control groups using calcium carbonate than in treatment groups using lanthanum carbonate (P＜0.05). The decrease of serum phosphorus was more in treatment groups using lanthanum carbonate than in control groups using calcium carbonate, but without statistical significance (P>0.05). Conclusion Lanthanum carbonate can reduce serum phosphorus level in MHD patients treated with calcitriol pulse therapy due to SHPT. Metrics

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The value of sternoclavicular joint ultrasonography in the diagnosis of dialysis- related amyloidosis 2017, 16 (11):  732-735.  doi: 10.3969/j.issn.1671-4091.2017.011.004 Abstract ( 343 )   PDF (1182KB) ( 447 )   Objective To evaluate the usefulness of high frequency ultrasonography of sternoclavicular (SC) joint for the diagnosis of dialysis-related amyloidosis (DRA). Methods Sixty-eight maintenance hemodialysis (MHD) patients and forty normal individuals as the controls were enrolled in this study. MHD patients were then subdivided into three groups by MHD duration: group I ≤5 years, group II 5～10 years and group III ＞10 years. Ultrasonography of the SC joint was performed bilaterally for patients and controls. The maximum distance (D) between anterior periosterum surface of clavicle and the outer edge of joint capsule and the smoothness of the articular surface were determined by high frequency ultrasonography. D value ＞2mm at any side was defined as a positive finding. Serum β2 microglobulin (β2-M) level was measured at the same time. Results D value of SC joint was significantly higher in MHD patients than in normal controls, and was also significantly different among the four groups (right, F=16.895, P＜0.001; left, F=19.812, P＜0.001). There was no different between left side and right side (P＞0.05). The positive rate of SC joint was 5% in control group, 50.0% in group I, 61.5% in group II and 86.4% in group III (χ2=43.628, P＜0.001), indicating a correlation between D value and hemodialysis duration (r=0.412, P＜0.05). Serum β2-M was significantly higher than the normal value in MHD patients. There was no significant difference in serum β2-M among the three groups of MHD patients (F=1.855, P=0.167). Conclusions The capsule and synovium of the SC joint become thicker as the dialysis duration prolonged. High frequency ultrasonography of SC joint is a less expensive and noninvasive method for the early diagnosis and fellow-up of DRA. Metrics

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Correlation between anthropometric parameters and muscle mass in hemodialysis patients 2017, 16 (11):  736-740.  doi: 10.3969/j.issn.1671-4091.2017.011.005 Abstract ( 367 )   PDF (456KB) ( 509 )   Objective Malnutrition which we prefer to call protein energy wasting (PEW) is an independent risk factor for mortality in maintenance hemodialysis (MHD) patients. Muscle tissue is the largest protein storage pool in human body and is also an indicator for PEW. The relationship between traditional anthropometric parameters and lean tissue mass (LTM) was rarely reported. This study aims at identifying the correlation between anthropometric indices and LTM and at finding a simple method for clinical assessment of muscle mass. Methods MHD patients were recruited in the hemodialysis unit of Peking University People’s Hospital. Patients’demographics and primary cause of ESRD were collected. Body mass index (BMI) was calculated. Upper arm circumference, arm muscle circumference, triceps skinfold thickness, grip strength (HGS) and body composition monitor (BCM) were examined pre- dialysis. LTM and lean tissue index for patients (LTI, LTM/height2) were recorded, and serum albumin was assayed. Independent t-testing was used to compare mean values between males and females. Pearson correlation was performed to correlate anthropometric and serum variables with LTM and LTI.Regression method was used to derive an estimation equation. Results A total of 52 MHD patients (28 males and 24 females) were included in this study. The average age of the patients was 51.6±12.2 years, and the median dialysis vintage was 65.5 months. There were significant differences between genders in albumin, HGS, LTM and LTI (t=2.400, 6.412, 5.485 and 3.330, respectively; P=0.020, ＜0.001, ＜0.001 and 0.002, respectively). Pearson correlation analysis showed that only HGS correlated with LTM and LTI (r=0.686 and 0.486, respectively; P＜0.001 and ＜0.001, respectively). Regression method was used to derive an estimation equation. Conclusions There were significant differences in nutritional indices and body composition between males and females. HGS had a better correlation with LTM and LTI, and may be used to evaluate muscle volume simply and noninvasively. Metrics

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The efficiency of ultrasound guided microwave ablation therapy for secondary hyperparathyroidism 2017, 16 (11):  741-745.  doi: 10.3969/j.issn.1671-4091.2017.011.006 Abstract ( 373 )   PDF (599KB) ( 443 )   Objective To explore the safety and efficacy of microwave ablation (MWA) in uremic patients with secondary hyperparathyroidism (SHPT). Methods Eighteen patients with end-stage renal disease and SHPT received microwave ablation guided by color Doppler ultrasound. Laboratory tests including serum parathyroid hormone (PTH), calcium, phosphorus and alkaline phosphatase (ALP) were conducted before the therapy and after the therapy for 2 hours, one day, one week, one month, 6 months and one year. Improvement of SHPT- related symptoms after ablation and complications during and after MWA were recorded. Results Fifty-six hyperparathyroidism nodules in 18 patients were treated by MWA. In patients treated with MWA, serum PTH was 460.47±473.79 ng/L after 2 hours, 448.92±306.36 ng/L after one day, 354.69±325.87 ng/L after one week, 275.60±232.95 ng/L after one month, 304.60±277.67 ng/L after 6 months and 293.76±277.68 ng/L after one year, significant different as compared with the value before treatment (1593.72±567.40 ng/L; t= 6.504, 5.849, 7.976, 5.745, 4.757 and 3.467, respectively; P＜0.001 for all the PTH values). However, there was no significant difference between the PTH levels after MWA (F=0.194, P=0.9640). After MWA, hypocalcaemia occurred in 10 patients (55.56%) and was rapidly corrected with calcium supplement, arteriovenous fistula occlusion was found in 3 patients (16.67%), and transient hoarseness happened in 3 patients (16.67%). Conclusion MWA is a safe and effective measure to manage SHPT. Metrics

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The relationship between epicardial fat volume and changes of biochemical and inflammatory indices in chronic kidney disease patients 2017, 16 (11):  746-750.  doi: 10.3969/j.issn.1671-4091.2017.011.007 Abstract ( 269 )   PDF (483KB) ( 413 )   Objective To evaluate whether epicardial fat volume (EFV) is related to biochemical and inflammatory indices in chronic kidney disease (CKD) patients. Method A total of 30 healthy people from medical checkup center as the control group and 120 CKD patients were subjected to heart scanning by multislice computed tomography. Cross-sectional tomographic cardiac slices from base to apex were traced semiautomatically using a volume viewer of AW4.3 off-line workstation. EFV was measured by assigning Hounsfield units ranging from -30 to -250 for fat. Serological indicators including serum albumin, creatinine (Scr), calcium, phosphorus (P), alkaline phosphatase, fasting glucose, parathyroid hormone (iPTH), high-sensitivity C-reactive protein (hs-CRP), high density lipoprotein (HDL) and low density lipoprotein (LDL) were measured. Age and body mass index (BMI) were collected. The relationship between EFV and changes of biochemical and inflammatory indices was then analyzed in CKD patients. Results ①EFV was apparently higher in CKD patients at stage 4, 5 and 5D compared with the control group (140.03 ± 54.71, 145.01 ± 64.56, 141.45±62.04 and 92.42±39.56 cm³ for stage 4, 5 and 5D CKD patients and healthy controls, respectively; P=0.007, 0.015 and 0.001 compared with control for stage 4, 5 and 5D patients, respectively). ②In CKD patients at stage 3, 4, 5, and 5D, EFV was positively correlated with Scr, hs-CRP and age (for Scr: r=0.675, P=0.006; r=0.512, P=0.043; r=0.794, P=0.011; r=0.449, P=0.013; for hs-CRP: r=0.723, P=0.005; r=0.604, P=0.022; r=0.593, P=0.020; r=0.574, P=0.005; for age: r=0.292, P=0.005; r=0.605, P=0.013; r=0.502, P=0.008; r=0.662, P=0.005), and was negatively correlated with HDL (r=- 0.625, P=0.013; r=- 0.608, P=0.012; r=-0.679, P=0.005; r=- 0.433, P=0.024). In CKD patients at stage 4, 5 and 5D, EFV was positively correlated with P, iPTH and BMI (for P: r=0.556, P=0.025; r=0.713, P=0.031; r=0.417, P=0.022; for iPTH: r=0.510, P=0.044; r=0.811, P=0.001; r=0.399, P=0.032; for BMI: r=0.256, P=0.026; r=0.521, P=0.046; r=0.648, P=0.009). (c) Multiple linear regression showed that EFV was significantly correlated with age (β =0.250, P=0.005), BMI (β=0.192, P=0.020), P (β=0.309, P＜0.001), HDL (β =-0.335, P＜0.001) and hs-CRP (β=0.186, P= 0.023). Conclusions Measurement of EFV may provide a useful and noninvasive indicator for coronary artery calcification in CKD patients with mineral and bone disorder. Metrics

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The risk factors for cardiac valve calcification in peritoneal dialysis patients 2017, 16 (11):  751-754.  doi: 10.3969/j.issn.1671-4091.2017.011.008 Abstract ( 371 )   PDF (315KB) ( 477 )   Cardiovascular disease is the leading cause of death in patients with end-stage renal disease, and cardiovascular calcification is closely related to the occurrence of cardiovascular events. With progression of the disease, the incidence of cardiac valve calcification patients increases significantly in chronic kidney disease patients. This paper focuses on the risk factors for cardiac valve calcification in peritoneal dialysis patients based on the traditional factors and non-traditional factors associated with peritoneal dialysis. Metrics

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The effect of niacin and nicotinamide on hyperphosphatemia in hemodialysis patients 2017, 16 (11):  755-757.  doi: 10.3969/j.issn.1671-4091.2017.011.009 Abstract ( 382 )   PDF (441KB) ( 516 )   Hyperphosphatemia is a common complication in patients with end-stage renal disease. Niacin and nicotinamide effectively reduce serum phosphorus and improve dyslipidemia in maintenance hemodialysis patients. Metrics

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Dialysate bicarbonate concentration on prognosis in dialysis patients 2017, 16 (11):  758-760.  doi: 10.3969/j.issn.1671-4091.2017.011.010 Abstract ( 349 )   PDF (240KB) ( 496 )   Metabolic acidosis is a common complication in chronic kidney disease patients. It is funda mental for the treatment of multiple systemic complications of chronic kidney disease to correction of metabolic acidosis. For the patients undergoing hemodialysis, the acid-base balance depends on many factors, including body net acid generation, the total amount of the alkali obtained from the dialysate,duration of the interdialytic period,and residual renal function.This paper will mainly discuss the effect of dialysate bicarbonate concentration on prognosis in dialysis patients. Metrics

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Clinical study of albumin dialysis combined with bilirubin adsorption in the treatment of acute liver failure after cardiac surgery 2017, 16 (11):  771-773.  doi: 10.3969/j.issn.1671-4091.2017.011.014 Abstract ( 329 )   PDF (578KB) ( 434 )   Objective To evaluate the safety and efficacy of albumin dialysis combined with bilirubin adsorption in the treatment of acute liver failure after cardiac surgery. Methods Seven patients with acute liver failure after cardiac surgery treated in Fuwai Hospital between Aug. 2014 to Dec. 2016 were retrospectively analyzed. Results of liver enzymes, bilirubin and blood coagulation tests were recorded before and after treatment. Results Liver function recovered in all the 7 patients, of whom 6 discharged from hospital and one died of nosocomial infection. After the treatment, alanine aminotransferase (ALT) decreased from (632±197) U/L to (516±149) U/L (t=4.692, P=0.017), aspartate aminotransferase (AST) decreased from (384±125)U/L to (277±112) U/L (t=3.012, P=0.033), total bilirubin from (759±144) μmol/L to (441±97) μmol/L (t=8.240, P＜0.001), and direct bilirubin from (544±115) μmol/L to 299±67 μmol/L (t=6.119, P=0.001). Circulation status of the patients was stable during the treatment, and no serious complications happened. Conclusion Albumin dialysis combined with bilirubin adsorption is a safe and effective method for acute liver failure after cardiac surgery. Metrics

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Studies on the correlation of anxiety and depression to simple coping style and post-traumatic growth in maintenance hemodialysis patients 2017, 16 (11):  774-777.  doi: 10.3969/j.issn.1671-4091.2017.011.015 Abstract ( 414 )   PDF (400KB) ( 364 )   Objective Anxiety and depression are common negative emotions in dialysis patients, which affect quality of life and mental health. The anxiety and depression, coping styles and psychological changes after "trauma (hemodialysis)" were investigated in maintenance hemodialysis patients in order to provide the evidences for clinical psychological nursing. Methods A total of 83 patients were observed. We adopted hospital anxiety and depression mood scale, simple coping style questionnaire, and posttraumatic growth scale for the investigation to these patients. SPSS 18.0 software was used for statistical analyses. Results ①Fifteen cases (18.07%) were suspected of or diagnosed as having anxiety symptoms, and 35 (42.17%) cases were suspected of or diagnosed as having depression. ②Anxiety in the patients was negatively correlated to positive coping factor (r=-0.254, P=0.021) in the simple coping style questionnaire, positively correlated to the negative coping factors (r=0.257, P=0.019), and negatively correlated to self- transformation in posttraumatic growth (r=-0.221, P=0.045), new possibilities (r=-0.227, P=0.013) and relationship with others (r=-0.247, P=0.025) in all dimensions. ③Depression in the patients was positively correlated to medical expense burden (F=5.39, P=0.006), negatively correlated to positive coping factor in simple coping style questionnaire (r=-0.368, P=0.001), positively correlated to negative coping factor (r=0.312, P=0.004), and negatively correlated to total score of posttraumatic growth (PGTI, r=-0.353, P=0.001), self-transformation (r=-0.217, P=0.049), new possibilities (r=-0.371, P=0.001), personal power (r=-0.228, P=0.038), inspiration of life (r=-0.329, P=0.002) and relationship with others (r=-0.250, P=0.023) in all dimensions. Conclusion Anxiety and depression are common symptoms in hemodialysis patients. Positive psychological counseling should be given in clinical nursing work to help the patients recover their physical and mental health. Metrics

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Use of the early cannulation prosthetic graft (Gore Acuseal) as a lower extremity prosthetic hemodialysis access 2017, 16 (11):  778-780.  doi: 10.3969/j.issn.1671-4091.2017.011.016 Abstract ( 384 )   PDF (382KB) ( 462 )   Objectives To report the safety and effectiveness of the Gore Acuseal Graft used as a lower extremity prosthetic vascular access for chronic hemodialysis patients who have exhausted upper extremity vascular access or have central venous stenosis. Methods Between December 2016 and May 2017, 15 patients who underwent implantation of the Gore Acuseal prosthetic AV access were included in the study. The graft configuration was superficial femora-saphenous for all patients. Follow-up studies including the time to first cannulation, patency rate, seroma rate, access thrombosis, steal syndrome, pseudo-aneurysm and infection were recorded. Results Graft implantation was technically successful in all 15 patients. No patient was lost during a mean follow-up time of 3.6±1.6 months (1.7～6 months). Mean time to first cannulation was 136.8±97.2 hrs (24～384 hrs). Primary functional potency rate was 100%. Primary blood flow rate was 200～230 ml/min. First puncture time was 136.8±97.2 hrs (24～384 hrs), and average follow-up period was 3.6±1.6 months (1.7～6.0 months). Seroma, thrombosis, pseudo- aneurysm and graft infection were never observed. Steal syndrome occurred in one patient and the graft was removed. Cannulation is easier than other types of regular prosthetic access reported by nurses. Cannulation site usually stop bleeding in 15 minutes with pressure on the site, and no hematoma was observed. Central venous catheter was removed, or the dysfunctional fistula was ligated at early postoperatively stage in 12 patients. Central venous stenosis complications were not observed. Follow-up found that blood flow rate was greater than 250 ml/min in all patients. Conclusion Lower extremity Gore Acuseal graft implantation was safe and effective with less complication. It can be widely applied for chronic hemodialysis patients who have exhausted upper extremity vascular access or have central venous stenosis. Metrics

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The clinical application of ultrasound dilution technology for vascular access flow detection among maintenance hemodialysis patients 2017, 16 (11):  781-785.  doi: 10.3969/j.issn.1671-4091.2017.011.017 Abstract ( 358 )   PDF (421KB) ( 491 )   Objective The primary purpose of this study is to explore the clinical value of ultrasound dilution (UD) technology for vascular access flow detection among patients undergoing maintenance hemodialysis (MHD) by conducting a single-center retrospective study. Methods We retrospectively studied the clinical characteristic data and detection results from Transonic HD02 hemodialysis monitor, collected from a cohort of 213 patients undergoing MHD longer than six months in our hemodialysis center. UD was applied to detect the blood flow, access flow (Qa), cardiac output (CO), Qa/CO, cardiac index (CI) in MHD patients with arteriovenous fistula (AVF). Results ①Comparative results from two independent samples grouped by access flow (Qa ＜500 ml/min vs. Qa ≥500ml/min) indicated that significantly higher prevalence of fistula thrombus and vascular stenosis could be found in patients with Qa＜500 ml/min when compared to those with Qa≥ 500ml/min (38.235% vs. 11.173%; c2=15.983; P＜0.001 and 20.588% vs. 1.676%; c2=22.840; P＜0.001, respectively),②Results from multivariate logistic regression analysis indicated that vascular stenosis was a significant risk factor for Qa insufficiency (OR=14.192, 95% CI 3.410～59.056, P＜0.001), while the associations of Qa insufficiency with age, diabetes mellitus and time of AVF use were insignificant; ③Both actual flow in fistula and Qa were significantly improved after the intervention towards AVF stenosis; ④For patients with Qa ≥500ml/min, no significant differences were found between baseline results and the figures one year later concerning left ventricular volume and left ventricular ejection fraction (t=-0.424, P=0.681; t=0.497, P=0.631). Conclusion For patients with AVF, AVF thrombus and vascular stenosis were associated with lower AVF flow, and notably vascular stenosis acted as an independent risk factor. It is of great clinical value to detect Qa based on UD technology among MHD patients to maintain vascular access, especially for effectively recognizing access dysfunction. A multi- center prospective cohort study based on a larger scale is on our schedule to further validate the findings from this study. Metrics