Chinese Journal of Blood Purification

12 December 2017, Volume 16 Issue 12 Previous Issue    Next Issue

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The correlation analysis of serum sclerostin and vascular calcification in maintenance hemodialysis patients 2017, 16 (12):  793-797.  doi: 10.3969/j.issn.1671-4091.2017.012.001 Abstract ( 612 )   PDF (945KB) ( 456 )   Objective To observe the incidence of vascular calcification and to analyze the relationship between serum sclerostin and vascular calcification in maintenance hemodialysis (MHD) patients. Methods A total of 30 cases on long-term MHD treated from June 2015 to June 2016 in the First Affiliated Hospital of China Medical University were recruited as the experiment group; 30 normal individuals were selected as the control group. Their abdominal aorta calcification was evaluated by abdominal X-ray. Serum sclerostin, calcium, phosphorus, immunoreactive parathyroid hormone (iPTH), magnesium, 25- hydroxyvitamin D, albumin and other indices were recorded. Results Vascular calcification rate was significant different between experiment group and control group (χ2=9.317, P=0.005), and so did the vascular calcification score (t=2.330, P=0.023). Serum sclerostin was 3- 4 times higher in experiment group than in control group (t=14.162, P＜0.001). In experiment group, serum sclerostin level was lower in the MHD patient with vascular calcification than those without vascular calcification (t=2.697, P=0.012). Spearman correlation analysis showed that vascular calcification in MHD patients was negatively correlated with sclerostin level (r=-0.500, P=0.005), and was positively correlated with age (r=0.588, P=0.001), dialysis age (r=0.417, P=0.022), phosphorus (r=0.741, P＜0.001), calcium and phosphorus product (r=0.612, P＜0.001), total parathyroid hormone (r=0.588, P=0.001) and magnesium (r=0.470,P=0.009). Vascular calcification score was lower in MHD patients with higher serum sclerostin than in those with lower serum sclerostin (t=- 2.324, P =0.026). ROC curve analysis showed that the area under the curve of serum Sclerostin for prediction of vascular calcification was 0.707(95% CI: 0.579～0.834, P=0.020) with the optimal cut-off value of 2.03 ng/mL, the sensitivity of 100% and specificity of 60.9%. Conclusion The incidence and the degree of vascular calcification were higher in MHD patients. Vascular calcification was negatively correlated with serum sclerostin level, and positively correlated with age, dialysis age, phosphorus, calcium and phosphorus product, iPTH and magnesium. Serum sclerostin may be a protective factor for vascular calcification and a relatively accurate marker for the prediction of vascular calcification. Metrics

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A multi-center investigation on the acceptance and adherence to rehabilitation exercise during hemodialysis in maintenance hemodialysis patients 2017, 16 (12):  798-802.  doi: 10.3969/j.issn.1671-4091.2017.012.002 Abstract ( 482 )   PDF (462KB) ( 522 )   Objective To investigate the acceptance and adherence to rehabilitation exercise during hemodialysis for the better management and education of rehabilitation exercise in maintenance hemodialysis (MHD) patients. Methods This was a prospective study in the organization of Beijing Hemodialysis Union based on a multi-center randomized controlled trial (RCT) for the effect of rehabilitation exercise on quality of life (EREQL) in MHD patients. A questionnaire investigation, including the composition of patients in each center, the general information of patients who meet the inclusion criteria, and the specific reasons from patients who meet the inclusion criteria but do not accept rehabilitation exercise, was carried out in the centers that participated in the RCT. Results Six dialysis centers participated in this study with a total of 586 MHD patients, among them 265 patients met the inclusion criteria and 220 of the 265 patients (83.0%) accepted the rehabilitation exercise during hemodialysis and 45 cases (17.0%) refused to do this. There were no significant differences in patient age, work status, marital status, educational level, duration of dialysis, with or without diabetes, type of vascular access, history of fracture, sleep score, family support, and falling down rate between the patients who accepted the rehabilitation exercise and those who did not. However, the total number of complication and puncture failure during dialysis in the recent month were significant different between accepting group and rejecting group (5.21±5.89 vs. 7.67±7.87, Z= -2.290, P=0.022). In the patients who rejected the rehabilitation exercise during hemodialysis, subjective reasons accounted for 63 times (75.0%), and objective reasons 21 times (25.0%). Conclusions In China, a large proportion of MHD patients accepted the rehabilitation exercise during hemodialysis. The higher prevalence of puncture failure and complication may lead patients to reject the rehabilitation exercise in a subjective way. Most patients had better adherence after accepting the rehabilitation exercise. Therefore, the basis for carrying out rehabilitation exercise during hemodialysis in MHD patients is fairly good in China. Metrics

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The effect of case management based on strengths model on self-perceived burden and compliance in maintenance hemodialysis patients 2017, 16 (12):  803-806.  doi: 10.3969/j.issn.1671-4091.2017.012.003 Abstract ( 315 )   PDF (424KB) ( 494 )   Objective To explore the effect of strengths model of case management (SMCM) on selfperceived burden and compliance in maintenance hemodialysis (MHD) patients. Methods A total of 92 patients were randomly divided into intervention group in which patients received SMCM plus routine care and routine group in which patients received routine care only. Scores of self-perceived burden scale and compliance scale were compared between the two groups. Results Patients in the intervention group had higher scores of self- perceived burden scale (t=- 10.785, P＜0.001) and compliance scale in every dimension (t=7.739, P＜0.001 for diet compliance; t=5.817, P＜0.001 for liquid intake compliance; t=3.616, P＜0.001 for drug compliance; t=3.458, P=0.001 for dialysis protocol compliance). Conclusion SMCM intervention can effectively lower self-perceived burden level and improve compliance in MHD patients. Metrics

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The difference between Kt/V values calculated by two methods 2017, 16 (12):  807-810.  doi: 10.3969/j.issn.1671-4091.2017.012.004 Abstract ( 611 )   PDF (649KB) ( 475 )   Objective To compare the difference between Kt/V values calculated by two methods (volume method which puts total body water into the variant form of Daugirdas’second generation equation, and weight method based on Daugirdas’second generation equation) and to investigate the impact factors contributing to the difference. Methods The outpatients dialyzed at our department from September 2016 to November 2016 were enrolled. The clinical indices including age, gender, predialysis weight, predialysis and postdialysis plasma urea, predialysis total body water, lean tissue mass (LTM) and adipose tissue mass (ATM) and other clinical data were collected. The Kt/V values calculated by volume method and weight method were compared using paired-t test. Using the difference ratio (the difference of two values divided by the Kt/V value calculated by volume method) of 2% as the boundary, we divided the participants into two groups: non-difference group and difference group. Clinical indices were compared between the two groups. Linear regression was applied to analyze the potential impact factors of the difference between Kt/V values calculated from the two methods. Results A total of 58 outpatients with an average age of 57.603±14.788 years old were enrolled, and 58.621% (34/58) of them were males. The Kt/V values calculated by volume method and weight method were significantly different (1.591±0.401 vs. 1.557±0.390, t=-9.154, P＜0.001) and were positively correlated (r=0.998, P＜0.001). Male ratio (81.481% vs. 38.710% , χ2=10.884, P=0.001), ATM/weight (42.170±10.898% vs. 56.765±6.808%, t=6.200, P＜0.001), LTM/weight (58.428±9.555% vs. 44.729±6.625%, t=-6.410, P＜0.001) and total body water (33.722±6.752 vs. 27.568±5.378, t=-3.861, P＜0.001) were significantly different between non-difference group and difference group, while age (57.111±16.078 vs. 58.032±13.824, t=0.235, P=0.815), postdialysis weight (67.663±13.52 vs. 66.461± 11.344, t=-0.368, P=0.714) had no differences between the two groups. Furthermore, we found male patients had bigger difference between Kt/V values calculated by the two methods (0.0202±0.0166 vs. 0.0538±0.0301, t=-5.451, P＜0.001). Linear regression analysis showed that ATM/weight (r=0.2705, P＜0.001) and ATM/LTM (r=0.0542, P＜0.001) were positively correlated with the difference, while LTM/weight was negatively correlated with the difference (r=-0.2091, P＜0.001). Conclusion There was statistically significant difference between Kt/V values calculated by volume method and weight method, and the Kt/V value calculated by volume method was always higher than that calculated by weight method in the same patient. The difference between Kt/V values calculated by the two methods was influenced by sex, LTM/weight, ATM/weight and ATM/LTM. Metrics

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Analysis of the related factors for acute renal injury caused by acute pancreatitis and the prognosis of renal function 2017, 16 (12):  811-815.  doi: 10.3969/j.issn.1671-4091.2017.012.005 Abstract ( 595 )   PDF (448KB) ( 565 )   Objective To investigate the related factors for acute renal injury caused by acute pancreatitis and the prognosis of renal function. Methods A total of 343 patients with acute pancreatitis diagnosed at Shengjing Hospital Affiliated to China Medical University were selected. Eight-five of the 343 patients had no follow-up data of renal function, and 258 patients were then retrospectively analyzed in this study. The 258 patients were divided into group A (eGFR＜125ml/min) and group B (eGFR≥125ml/min). Patients in group A were subdivided into group C (eGFR decreased after treatment) and group D (eGFR increased after treatment). Results The mortality rate was 0% in mild acute pancreatitis patients, 9.7% in moderately severe acute pancreatitis patients, and 60% in severe acute pancreatitis patients. The mortality rate was 85.7% in patients with sustained renal injury after 48 hours from onset of acute pancreatitis, significantly higher than that of 42.2% in patients with improved renal injury after 48 hours. In group A, age (t=5.709, P＜0.001), APACHE II score (t=4.557,P＜0.001), aspartate aminotransferase (Z=-4.225, P＜0.001), lactate dehydrogenase (t=6.085,P＜0.001), serum amylase (t=3.505, P=0.001), NT-proBNP (Z=-2.120, P=0.034), serum procalcitonin (Z=-3.870, P=0.000), and rate of pleural effusion (x2=6.529, P=0.011) were significantly higher than those in group B, while serum calcium (t=-6.507, P＜0.001) was significantly lower in group A than in group B. Multivariate regression analysis showed that high blood procalcitonin (β =-1.340, t=-2.562, P=0.019) was related to low eGFR, and low systolic blood pressure (β=-0.008, t=-2.651, P＜0.001), high C-reactive protein (β=0.001, t=3.321, P=0.001) and high APACHE II score (β=0.035, t=2.670, P=0.008) were related to higher 24-hours urine protein. When comparisons of the indices were made between group C and group D, hematocrit at admission (t=2.588, P=0.011) was higher in group C than in group D; after the treatment, 24-hour urine protein (Z=- 2.791, P=0.005), aspartate aminotransferase (Z=- 2.861, P=0.004) and blood procalcitonin (Z=-2.095, P=0.036) were higher in group C than in group D, while systolic blood pressure (Z=-2.633, P=0.008) was lower in group C than in group D. There were no statistical differences in the treatment time of CRRT/day- time CRRT (x2=0.018, P=1.000) and number of hemoperfusion (x2=0.850, P=0.361) between the two groups. Conclusions Acute pancreatitis complicated with acute renal injury has a high fatality rate. Older age, severe infection, serious pancreatic injury and tissue fluid exudation were often associated with kidney and multiple organ damages. Infection was not only the cause of kidney injury, but also the factor for unfavorable prognosis of renal function. It needs to be further studied whether blood purification is helpful for the recovery of renal function in acute pancreatitis patients complicated with acute kidney injury. Metrics

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Features and related factors of cardiovascular magnetic resonance imaging native T1 mapping in patients on maintenance hemodialysis 2017, 16 (12):  816-821.  doi: 10.3969/j.issn.1671-4091.2017.012.006 Abstract ( 373 )   PDF (510KB) ( 417 )   Objective This study applies the native T1 mapping technology in cardiovascular magnetic resonance imaging (CMRI) to explore myocardial fibrosis and its related factors in maintenance hemodialysis (MHD) patients. Methods We recruited 32 MHD patients and 14 healthy individuals as the normal controls to perform CMRI examination. Ambulatory blood pressure and laboratory tests of the MHD patients were collected. The CMRI native T1 value was compared between MHD patients and controls. The correlation between native T1 value and the related factors including ambulatory blood pressure and laboratory tests was explored in MHD patients. Results The CMRI native T1 value was higher in MHD patients than in normal controls (1,208.9±90.9ms vs. 1,134.5± 28.1ms, F=4.270, P=0.045). In MHD patients, there were no signif-icant differences (F=0.186, P=0.831) between the native T1 values of left ventricular basal segment (1,213.1±89.1ms), medial segment (1,200.6±89.8ms) and distal segment (1,213.1±10.3ms). The CMRI native T1 value was positively correlated to intact parathyroid hormone (iPTH; r=0.418, P=0.017) and negatively correlated to triglycerides (r=-0.366, P=0.039), but had no linear correlations to the average systolic blood pressure in 44hours (r=0.204, P=0.320), the average diastolic blood pressure in 44 hours (r=0.316, P=0.208), systolic blood pressure variation (r=0.259, P=0.402) and diastolic blood pressure variation (r=0.135, P=0.662). The native T1 value was positively correlated to left ventricular end-diastolic volume/body surface area (LVEDV/BSA; r=0.528, P=0.014), left ventricular end systolic volume/body surface area (LVESV/BSA; r=0.506, P=0.019) and left ventricular mass index (LVMI; r=0.600, P=0.005) and negatively correlated to ejection fraction (EF; r=- 0.551, P=0.010), but had no correlation to cardiac index (CI; r=- 0.210, P=0.357). Conclusion The CMRI native T1 value was higher in MHD patients than in normal controls, suggesting that significant myocardial fibrosis is present in MHD patients. The native T1 value was closely related to heart structure and function. iPTH and triglyceride may play important roles in the presence and development of cardiac fibrosis. Metrics

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Advances in antiviral therapy for hepatitis C virus infection in chronic kidney disease patients 2017, 16 (12):  822-826.  doi: 10.3969/j.issn.1671-4091.2017.012.007 Abstract ( 474 )   PDF (384KB) ( 427 )   The treatment of chronic hepatitis C virus (HCV) infection has been improved significantly in the past few years. However, there still remain therapeutic difficulties in this area for several specific populations such as renal insufficiency and cirrhosis patients. The incidence of HCV infection in chronic kidney disease (CKD) patients is higher than that in the average population, resulting in increased morbidity and mortality in CKD patients. Therefore, CKD patients with HCV infection should be treated with antiviral therapy in time. The emergence of directly-acting antiviral drugs (DAAs) has made a breakthrough for the infection in CKD patients. However, the optimal DAAs regimen for CKD patients is yet controversial. This review focuses on the progress of anti-HCV therapy for CKD patients in the past few years. Metrics

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Calcitriol resistance: a review 2017, 16 (12):  827-829.  doi: 10.3969/j.issn.1671-4091.2017.012.008 Abstract ( 584 )   PDF (341KB) ( 511 )   Secondary hyperparathyroidism (SHPT) is one of the serious complications of chronic kidney disease. SHPT may cause other complications such as bone metabolic diseases, vascular calcification and cardiovascular disease, resulting in the increase of mortality rate. Clinically, SHPT can be treated with calcitriol, but insensitivity to calcitriol treatment is found in 20%～30% patients. Calcitriol resistance is possibly related to FGF23 level, parathyroid size, vitamin D receptor and gene polymorphism in vitamin D receptor. Change of oral drugs (paricalcitol or calcimimetics) and parathyroidectomy may achieve better therapeutic effect in these patients. Metrics

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Advances in the treatment of encapsulating peritoneal sclerosis 2017, 16 (12):  830-833.  doi: 10.3969/j.issn.1671-4091.2017.012.009 Abstract ( 519 )   PDF (369KB) ( 581 )   Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication in long-term peritoneal dialysis patients. The incidence of EPS increases with the duration of peritoneal dialysis treatment. In the early stage, the clinical manifestations tend to be atypical and few specific methods can be used for the diagnosis. When EPS develops to the end stage, it is characterized by intestinal obstruction and the mortality is extremely high. This article reviews the recent literature and summarizes the advances in the treatment of EPS. Metrics

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Studies on the care burden of primary caregivers for maintenance hemodialysis patients 2017, 16 (12):  838-841.  doi: 10.3969/j.issn.1671-4091.2017.012.011 Abstract ( 385 )   PDF (390KB) ( 405 )   Objective To investigate the care burden level of the primary caregivers for maintenance hemodialysis (MHD) patients and to analyze their influencing factors. Methods A convenient sampling method was used to investigate 95 MHD cases and their primary caregivers. The care burden was assessed by Zarit Caregiver Burden Interview. Results The caregivers from 71 patients (74.7%) had varying degrees of care burden, mainly with a slight burden (56 cases, 58.9%). Multiple regression analysis showed that the activities of patients (β =- 6.575, P＜0.001), caregivers living condition (β =13.883, P=0.017) and the caregiver's health status (β=9.636, P＜0.001) were the influence factors for care burden of the caregivers. Conclusions Most of the primary caregivers for MHD patients face different levels of care burden. The care burden varies among patients with different activities of the patients and caregivers of their living and health conditions. We should pay attention to the dynamic assessment of caregiver burden, and take measures to alleviate the care burden. Metrics

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The application of urokinase and heparin mixture for sealing double- cavity catheters with Dacron sleeve 2017, 16 (12):  842-845.  doi: 10.3969/j.issn.1671-4091.2017.012.012 Abstract ( 680 )   PDF (437KB) ( 571 )   Objective To investigate the patency and safety of the urokinase and heparin mixture for sealing double-cavity catheters with Dacron sleeve. Method A total of 42 patients using double-cavity catheter with Dacron sleeve for hemodialysis and treated in the Blood Purification Center of Beijing PuRen Hospital were recruited and divided into study group and control group. The dialysis catheter was sealed with urokinase and heparin mixture in study group and with heparin solution in control group. Average blood flow velocity, venous pressure, numbers of patients with patent catheter, with catheter dysfunction and with catheter replacement, and numbers of monitoring for spontaneous bleeding and coagulation function were observed to analyze the patency and safety of the double-cavity catheters with Dacron sleeve sealed with the mixture. Results Blood flow volume (ml/min) in catheter was significantly higher in study group than in control group (207.813±27.397 vs. 172.877±21.072, t=4.632, P＜0.001 after the treatment for 6 months; 177.885±23.421 vs. 151.836±28.817, t=3.215, P=0.001 after the treatment for 12 months). Venous pressure (mmHg) was lower in study group than in control group (50.684±21.081 vs. 66.211±18.669 mmHg, t=2.527, P=0.008 after the treatments for 6 months; 76.919±32.543 vs. 113.937±43.864 mmHg, t=3.106, P=0.002 after the treatments for 12 months). The number of patients with normal catheter function was more in study group than in control group (18 vs. 10, χ2=5.250, P=0.022 for number of patients with normal catheter function; 2 vs. 7, χ2=5.091, P=0.024 for number of patients with abnormal catheter function). The number of patients with replacement of dialysis catheters was one in study group and 4 in control group (χ2=3.872, P=0.049). There was no spontaneous bleeding and no significant difference in blood coagulation function in study group and control group (12.769± 2.733s vs. 12.580±1.346s, t=0.284, P=0.389 for prothrombin time; 1.032±0.139 vs. 1.021±0.154, t=0.243, P=0.405 for international standardized ratio; 18.501±1.439s vs. 17.903±0.895s, t=1.617, P=0.057 for thrombin time; 2.696±0.928g/L vs. 2.704±1.437g/L, t=0.021, P=0.492 for fibrinogen; 35.926±6.544s vs. 34.406±7.327, t=0.709, P=0.241 for activated partial thrombin time). Conclusion The urokinase and heparin mixture for sealing dialysis catheters can reduce the dysfunction of the double-cavity catheters with Dacron sleeve and ensure dialysis adequacy without adverse effects on coagulation function of the whole body. Metrics

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Fouling and cleaning of reverse osmosis membrane in hemodialysis water treatment system 2017, 16 (12):  853-855.  doi: 10.3969/j.issn.1671-4091.2017.012.015 Abstract ( 472 )   PDF (409KB) ( 498 )   Objective To develop the detection of fouling and the methods of cleaning for reverse osmosis membrane in hemodialysis water treatment system. Methods According to the working principal of hemodialysis water treatment system, the nature of the pollutants on reverse osmosis membrane, and our working experience of cleaning reverse osmosis membrane, we have developed cleaning methods for reverse osmosis membrane in hemodialysis water treatment system. Results We first washed the reverse osmosis membrane with 0.1% sodium hydroxide solution followed by 2% citric acid solution, and then sterilized the system by using the sterilization procedure settled in the water treatment system. This cleaning procedure worked well and restored the performance of reverse osmosis system. Conclusions This method provides a reference for the cleaning of reverse osmosis membrane for hemodialysis providers. Metrics