Chinese Journal of Blood Purification

12 January 2018, Volume 17 Issue 01 Previous Issue    Next Issue

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Review of the guidelines and consensus about the treatment of renal anemia 2018, 17 (01):  1-5.  doi: 10.3969/j.issn.1671-4091.2018.01.001 Abstract ( 663 )   PDF (412KB) ( 781 )   Anemia is one of the common complications in chronic kidney disease patients. The standardized treatment of renal anemia relates to anemia monitoring, rational use of iron and erythropoietin, anemia treatment targets, etc. The guidelines and consensus are highly significant to renal anemia treatment. We aim to provide clinicians with the advices through reassessment of the guidelines in EBPGs, K/DOQI, K/DIGO and NICE. Metrics

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Renal anemia and hypoxia inducible factor 2018, 17 (01):  6-8.  doi: 10.3969/j.issn.1671-4091.2017.01.002 Abstract ( 272 )   PDF (346KB) ( 228 )   In anemia associated with renal disease, erythropoiesis is suppressed due to inadequate erythropoietin(EPO) production in kidney, inflammation and iron deficiency. Studies have found that hypoxia inducible factor (HIF) is a key regulator for erythropoiesis and iron metabolism and an effective stimulant for the production of endogenous erythropoietin, through which ferritin level is reduced and iron metabolism is balanced. This review discusses the regulatory effects of HIF on EPO, iron metabolism and bone marrow hematopoiesis, and also introduces the HIF pathway as a novel target for the treatment of renal anemia. Metrics

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Studies on the dosage variation of erythrocyte-forming stimulant agents (ESAs) in different dialysis centers 2018, 17 (01):  9-12.  doi: 10.3969/j.issn.1671-4091.2018.01.003 Abstract ( 425 )   PDF (408KB) ( 548 )   Erythrocyte-forming stimulant agents (ESAs) are widely used in the treatment of renal anemia. Recently, the dosage of ESAs is changed dramatically and is varied in different dialysis centers. However, higher dosage of ESAs will raise the all-cause death risk. This article analyzes the cause of ESAs dosage variation focused in the baseline characteristics of patients, reactivity to ESAs and clinical needs. Metrics

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Anemia Management for Hemodialysis Patients 2018, 17 (01):  13-15.  doi: 10.3969/j.issn.1671-4091.2017.01.004 Abstract ( 482 )   PDF (358KB) ( 344 )   Anemia is a common complication in end-stage renal disease patients. Currently, the percentage of hemodialysis patients with targeted hemoglobin concentration is still low in many areas in China. Appropriate anemia management is an important issue in the care of hemodialysis patients. For clinicians, awareness of anemia treatment, assessment of the interference factors on hemopoiesis, careful monitoring of hematological parameters, individualized management, and all efforts to achieve targeted hemoglobin concentration should be emphasized to raise the quality of life and to reduce complications and mortality in these patients. Metrics

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Research advances in erythropoietin for treatment of anemia in chronic kidney disease 2018, 17 (01):  16-18.  doi: 10.3969/j.issn.1671-4091.2018.01.00 Abstract ( 398 )   PDF (338KB) ( 731 )   Endogenous erythropoietin deficiency is the main cause of anemia in chronic kidney disease (CKD) patients. Recombinant human erythropoietin (rHuEPO) is the most effective medicine for treatment of anemia in CKD. The new generation of long-acting EPO has the advantages of longer half-life and stability, which reduces the mortality risk due to high EPO dosage for hyporesponsiveness patients. Hypoxia inducible factor is the main regulatory factor for EPO production. The hypoxia inducible factor proline hydroxylase inhibitor (FG-4592) provides a new way for the treatment of renal anemia. Metrics

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Studies on the prevalence and influence factors of vascular calcification in maintenance peritoneal dialysis patients 2018, 17 (01):  19-24.  doi: 10.3969/j.issn.1671-4091.2017.01.006 Abstract ( 554 )   PDF (462KB) ( 617 )   Objective To investigate the prevalence, severity and related factors of vascular calcification in maintenance peritoneal dialysis (PD) patients. Methods This cross-section study enrolled the PD patients at stable status and treated in Peking University People’s Hospital for more than 6 months. We used plain X-ray films of abdomen, pelvis and hands to quantitatively evaluate vascular calcification of large artery (abdominal aorta), medium arteries (iliac arteries, femoral arteries), and small arteries (radial arteries and digital arteries). Two radiologists blindly read and scored the vascular calcification. Demographic data, clinical characteristics, Charlson comorbidity index (CCI), baseline and time- averaged laboratory indexes including parameters of calcium phosphorus metabolism, serum albumin and PD adequacy were collected. The factors related to vascular calcification were analyzed by logistic regression. The factors relating to the degree of vascular calcification were analyzed by multiple linear regression method. Results ①A total of 154 PD patients (78 male patients, mean age 60.41±13.88 years, average PD duration 30.63±20.74 months) were enrolled in this study. The major primary disease was diabetic nephropathy (39%). ② A total of 111 patients (72.07%) were found to have vascular calcifications, including abdominal aorta calcification (83.78%), medium artery calcification (61.26%) and small artery calcification (35.13%). Moderate to severe degree of vascular calcifications were detected in 45.04% patients. ③ Logistic regression showed that diabetes (OR 12.982, 95% CI 3.258～51.722, P＜0.001), older age (OR 1.092, 95% CI 1.047～1.139, P＜0.001), longer dialysis duration (OR 1.049, 95% CI 1.017～1.081, P=0.002), and lower baseline intact parathyroid hormone (iPTH) (OR 0.996, 95% CI 0.992～0.999, P=0.010) were the independent risk factors for vascular calcification. (d) Compared to patients with mild calcification, patients with moderate to severe degree of calcification had higher proportion of diabetes (χ2=9.617, P=0.002), higher CCI ( t=- 4.575, P＜0.001) and higher baseline alkaline phosphatase (t=-2.018, P=0.047). Multiple linear regression results demonstrated that CCI (Β =0.258, P=0.003), gender (Β=1.136, P=0.042), and diabetes (Β=0.242, P=0.008) were the independent factors for calcification severity. Conclusions Vascular calcification is commonly present in maintenance PD patients. Vascular calcification in abdominal aorta is most frequently seen. It is more likely to occur in patients with diabetes, older age, male, longer dialysis duration, and lower baseline iPTH. In patients with vascular calcification, the degree of vascular calcification is severer in male patients and the patients with diabetes and more comorbidities. Metrics

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Effect of case management based on Omaha system on peritoneal dialysis-related peritonitis in patients undergoing peritoneal dialysis 2018, 17 (01):  25-29.  doi: 10.3969/j.issn.1671-4091.2018.01.007 Abstract ( 337 )   PDF (452KB) ( 661 )   Objective To explore the effects of case management based on Omaha system model on peritoneal dialysis (PD)-related peritonitis in PD patients. Methods We used the random number table method to enrolled 210 PD patients who met the inclusion criteria and were treated in Nephrology Department of the First Affiliated Hospital, Guangxi Medical University. A total of 103 patients in intervention group and control group finally completed the study. Patients in control group received routine nursing care, and those in intervention group accepted the case management based on Omaha system in addition to routine nursing care. Their“Quality check dimension of PD-related peritonitis prevention”scores, incidence and cause of PD-related peritonitis were compared between the two groups before the intervention and after the intervention for one year. Results There was no statistical differences in baseline information and“Quality check dimension of PD-related peritonitis prevention”scores, which included personal hygiene (t=-0.213, P=0.832), operating environment(t=-0.278, P=0.781), quality of products (t=0.543, P=0.588), operation process (t=0.113, P=0.910), orifice and tunnel conditions (t=0.223, P=0.824), ductal preservation (t=0.155, P=0.877), operator condition (t=-0.102, P=0.919), concurrent infection (t=-0.213, P=0.832), nutritional status (t=-0.486, P=0.627), problemfinding promptness (t=0.060, P=0.952), and review frequency and re-training (t=0.221, P=0.825). In intervention group after the intervention for one yeaar, the“Quality check dimension of PD-related peritonitis prevention”scores increased significantly in all dimensions, including personal hygiene (t=6.817, P＜0.001), operating environment (t=4.293, P＜0.001), quality of products (t=5.797, P＜0.001), operation process (t=7.046, P＜0.001), orifice and tunnel conditions (t=4.791, P＜0.001), ductal preservation (t=3.566，P＜0.001), operator condition (t=16.356, P＜0.001), concurrent infection (t=3.238, P=0.001), nutritional status (t=6.727, P＜0.001), problem- finding promptness (t=2.680, P=0.008), review frequency and re- training (t=6.628, P＜0.001)], and decrease of PD- related peritonitis (χ2=30.171, P＜0.001) as compared with those in control group. Conclusion The case management based on Omaha system model can enhance the aseptic consciousness of PD patients, standardize liquid exchange operation, and reduce the incidence of PD-related peritonitis. Metrics

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The variability of pre-dialysis blood pressure on long-term prognosis in maintenance hemodialysis patients 2018, 17 (01):  30-34.  doi: 10.3969/j.issn.1671-4091.2017.01.008 Abstract ( 215 )   PDF (400KB) ( 235 )   Objective Blood pressure variability (BPV) is a putative risk factor for cardiovascular disease and mortality in maintenance hemodialysis (MHD) patients. The purposes of this study are to determine whether pre-dialysis BPV correlates to all-cause mortality in this cohort of MHD patients. Methods A total of 50 MHD patients were enrolled in this study. During the period from March 1st, 2011 to May 1st, 2011, their systolic pressure (SBP) and diastolic pressure (DBP) were recorded before every dialysis session for 2 weeks, and the mean systolic pressure (SBP) and mean diastolic pressure (DBP) were calculated. BPV was expressed as coefficient of variability, and their survival status and the cause of death were recorded in the next 5 years. The patients were then divided into survival group and death group. Results Systolic blood pressure variability (SBPV) and diastolic blood pressure variability (DBPV) were 8.5±2.1% and 9.3±2.8%, respectively. Twelve of the 50 patients (24.0%) died in the 5 years of follow-up period. Analyses using one-way ANOVA showed that age (F=19.817, P＜0.001), BMI (F=8.012, P=0.007), IVS (F=7.655, P=0.008), LAD (F=4.379, P=0.042), SBPV (F=21.977, P＜0.001) and DBPV (F=22.433, P＜0.001) were significantly higher in death group than in survival group. Meanwhile, SBP (F=4.081, P=0.049), DBP (F=5.871, P=0.019) and serum creatinine (F=8.375, P=0.006) were lower in death group than in survival group. Patients with diabetes had higher mortality than those without diabetes (c2=5.852, P=0.016). Multivariate binary logistic regression to analyze the statistically significant variables using death and survival as the dependent variables found that age (OR=1.186, 95% CI 1.108～1.381, P=0.028), diabetes (OR=3.250, 95% CI 1.235～8.554, P=0.017), serum creatinine (OR=0.993, 95% CI -0.985～0.000, P=0.046), SBPV (OR=2.622, 95% CI 1.346～5.109, P=0.005) and DBPV (OR=2.147, 95% CI 1.059～4.352, P=0.034) were independently correlated with all-cause mortality. SBP and DBP were not included in the regression analyses. Conclusion Pre- dialytic SBPV and DBPV may be the independent risk factors for all-cause mortality in MHD patients. Metrics

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Clinical effect of re- operation treatment for uremic patients complicated with persistent or recurrent secondary hyperparathyroidism 2018, 17 (01):  35-40.  doi: 10.3969/j.issn.1671-4091.2018.01.009 Abstract ( 361 )   PDF (918KB) ( 487 )   Objective To analyze the clinical effect of re-operation treatment for uremic patients complicated with persistent or recurrent secondary hyperparathyroidism (SHPT). Methods A total of 14 persistent or recurrent SHPT patients treated with re- operation of parathyroidectomy (PTX) or resection of the grafts in neck or forearm in our hospital during the period from Aug. 2012 to Dec. 2016 were enrolled in this study. Before re-operation, location of the remaining parathyroid gland in neck was identified by ultrasonography, dualphase 99Tcm-sestamibi scintigraphy (99Tcm-MIBI), computed tomography (CT) and magnetic resonance imaging (MRI). We resected the parathyroid gland in situ and grafts, especially the ectopic parathyroid gland and lymphatic adipose tissue by superior mediastinal and central compartment dissection. The changes of clinical symptoms, intact parathyroid hormone (iPTH), calcium (Ca), phosphorus (P), calcium and phosphorus product (Ca×P), alkaline phosphatase (ALP), hemoglobin (HB) and hematocrit (HCT) after the surgery were observed. Surgery complications and recurrence of SHPT were also analyzed. Results All of the 14 patients underwent the operation successfully. Pathological examination of the surgical samples found hyperplastic parathyroid issues. We resected 27 parathyroid glands, including 14 glands in situ in neck, 6 recurrent grafts and 7 ectopic glands in thymus, which located in thymus, superior mediastinum or thyroid parenchyma. The detection rates of ectopic parathyroid glands in neck by ultrasonography, 99Tcm-MIBI, CT and MRI were 33%, 72%, 56% and 60%, respectively. After the operation, clinical symptoms including ostealgia, skin itching and limb weakness improved significantly. Serum iPTH levels after the operation for 20 minutes, 24 hours, 48 hours, one month, 6 months and one year were significantly lower than the levels before operation (t=5.264, P＜0.001 after 20 minutes; t=4.836, P=0.001 after 24 hours; t=5.091, P＜0.001 after 48 hours; t=5.183, P＜0.001 after one month; t=5.398, P＜0.001 after 6 months; t=5.217, P＜0.001 after one year). After the operation for one week, serum Ca, P and Ca x P decreased significantly as compared those before the operation (t= 6.984, P＜0.001 for Ca; t=2.979, P=0.011 for P; t=4.983, P＜0.001 for Ca x P), but ALP, HB and HCT changed insignificantly (t=0.693, P=0.501 for ALP; t=1.048, P=0.319 for HB; t=1.693, P=0.129 for HCT). After the operation, hypocalcemia appeared in 13 patients and improved after calcium supplement. Temporary injury of laryngeal nerve was found in 5 cases and 2 of them had transient bucking. There was no dyspnea and death. No recurrence was found in a follow-up period of one year. Conclusion In uremic patients complicated with persistent or recurrent SHPT, accurate localization of residual parathyroid glands is essential before reoperation. During operation, ectopic parathyroid glands are explored according to the concept of superior mediastinum and central compartment dissection. The success rate of re-operation will be significantly increased after complete resection of all residual parathyroid glands. Metrics

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The relationships between serum CHI3L1, FABP4, volume overload and protein energy wasting in peritoneal dialysis patients 2018, 17 (01):  41-45.  doi: 10.3969/j.issn.1671-4091.2018.01.010 Abstract ( 319 )   PDF (461KB) ( 430 )   Objective To investigate the association between serum CHI3L1, FABP4, volume overload and protein energy wasting (PEW) in peritoneal dialysis (PD) patients. Methods A total of 160 clinically stable PD patients in Peking University Third Hospital were enrolled in this study. Serum CHI3L1 and FABP4 levels were measured by ELISA method. Volume overload was assessed by multiple-frequency bioelectrical impedance analysis to evaluate overhydration (OH) value. OH＞2 liters is volume overload, and OH ＜2 liters is a normal volume status. Biochemical indices, such as serum albumin, blood urea nitrogen, serum creatinine, serum triglycerides, total cholesterol lipoprotein, low density lipoprotein cholesterol, and high density lipoprotein cholesterol were determined with standard methods. PD patients were divided into PEW group and non-PEW group according to the PEW diagnosis criteria. Results Serum CHI3L1 and FABP4 levels were positively correlated (r=0.273, P=0.001) in PD patients. Serum CHI3L1 levels were negatively correlated with volume overload (r=- 0.191, P=0.020) and muscle mass (r=- 0.443, P=0.000); FABP4 levels were also negatively correlated with volume overload (r=-0.172, P=0.040) and muscle mass (r=-0.188, P=0.025). Compared to PD patients with normal volume load, those with volume overload had lower CHI3L1 levels (289.6±117.9 ng/ml vs. 335.3±119.3 ng/ml, t=2.349, P=0.020), lower serum FABP4 levels [152.0 (131.6, 194.6) ng/ml vs. 170.0 (132.0, 374.9) ng/ml, z=-2.051, P=0.040] and higher prevalence of PEW (61.7% vs. 42.3%, χ2=5.756, P=0.013). However, there were no significant differences in serum CHI3L1 and FABP4 levels between PEW and non- PEW group. Logistic regression found that volume overload (OR=2.744, 95% CI 1.190～6.327, P=0.018), serum albumin (OR=0.837, 95% CI 0.734～0.955, P=0.008) and muscle mass (OR=0.936, 95% CI 0.891～0.982, P=0.007) were the independent risk factors for PEW. Conclusions Serum CHI3L1 and FABP4 levels were significantly higher in PD patients as compared with normal controls. We firstly verified that CHI3L1 and FABP4 were positively correlated, and both were negatively correlated with volume overload. Volume overload, low serum albumin and low muscle mass were the independent risk factors for PEW, but CHI3L1 and FABP4 levels were not included in the risk factors for PEW. Metrics

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Significance of red blood cell distribution width in the progression and development of chronic kidney disease 2018, 17 (01):  46-50.  doi: 10.3969/j.issn.1671-4091.2018.01.011 Abstract ( 368 )   PDF (464KB) ( 455 )   Red cell distribution width (RDW) is a quantitative marker for the heterogeneity of red blood cell (RBC) in circulation. RDW is used along with mean corpuscular volume (MCV) for the differential diagnosis of anemia. Recent studies indicated that RDW may have strong predictive value for prognosis in patients with acute kidney injury, kidney transplantation and chronic kidney disease (CKD). However, the potential mechanism of RDW as an important predictor of prognosis in both acute and chronic kidney disease was not elucidated. It may reflect a series of potential pathophysiological processes. In patients with CKD, RDW was found to be related to anemia, inflammation, malnutrition, endothelial dysfunction and oxidative stress. This paper focuses on the update study results of RDW in CKD. Metrics

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Diagnosis and management of upper extremity edema syndrome due to non-central venous stenosis in hemodialysis patients 2018, 17 (01):  65-69.  doi: 10.3969/j.issn.1671-4091.2018.01.016 Abstract ( 441 )   PDF (1257KB) ( 463 )   Objective To investigate the pathogenesis and treatment of upper extremity edema syndrome due to non-central venous stenosis. Methods A total of 42 patients with upper extremity edema and treated between July 2015 and July 2017 in our department were retrospectively studied. The characteristics of lesion, clinical features and method of management were summarized. Results The causes of the 41 patients were peripheral venous stenosis or obstruction, and one of them was attributed to retrograde blood flow through the perforating vein following creation of a new arteriovenous fistula. Seventeen of the 42 patients were managed with percutaneous transluminal angioplasty (PTA), 20 with surgery, and 5 with surgery combined with transluminal angioplasty. All patients had a successful outcome after the management. Conclusion The upper extremity edema syndrome due to non-central venous stenosis is mainly caused by peripheral venous stenosis and retrograde blood flow into the peripheral venous branch of the fistula. Detailed physical and imaging examinations are essential to make a better operation plan. The goal of the treatment is to correct the stenosis, restore centripetal reflux and protect the fistula vascular resource as much as possible. Metrics