Chinese Journal of Blood Purification

12 February 2018, Volume 17 Issue 02 Previous Issue    Next Issue

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Clinical characteristics and risk factors of peritoneal dialysis-related peritonitis 2018, 17 (02):  73-77.  doi: 10.3969/j.issn.1671-4091.2018.02.001 Abstract ( 634 )   PDF (441KB) ( 641 )   Objective To investigate the causes, characteristics and risk factors of peritoneal dialysis(PD)-related peritonitis. Methods We recruited 34 cases with PD-related peritonitis treated in the First Affiliated Hospital of Xinxiang Medical College from Jun. 2015 to Dec. 2016 as the observation group, and 83 PD cases without peritonitis as the control group. The causes, characteristics and risk factors of peritonitis were analyzed. Results ①The main causes of peritonitis were intestinal infection (12 cases, 35.29%) and wrong operation of dialysate change (9 cases, 26.47%). ②The culture of peritoneal fluid found Gram-positive cocci in 20 cases (58.82%), Gram-negative bacilli in 13 cases (38.24%), and fungi in one case (2.94%). Grampositive bacteria were mainly epidermal staphylococcus and staphylococcus aureus, while Gram-negative baclli were mainly E. coli. Gram-positive cocci were sensitive to vancomycin, teicoplanin, and linazolamide in all cases, and the sensitivity rate to cefazolin was 70%. Gram-negative bacteria were sensitive to imipenem and meropenem in all cases, and the sensitivity rate to ceftazidime was 80%. ③Multivariate logistic regression analysis showed that dialysis duration (OR=1.106, 95% CI 1.027~1.192, P=0.008), plasma protein level (OR=20.720, 95% CI 1.954~219.728, P=0.012) and serum calcium level (OR=113.847, 95% CI 9.012~1438.214, P<0.001) were the independent risk factors for PD-related peritonitis. ④cefazolin plus ceftazidime were used as the initial treatment in all cases, and then the therapeutic schedule was adjusted based on the culture results of peritoneal fluid. Thirty-one cases (91.18%) recovered. Conclusions The main causes of PDrelated peritonitis were intestinal infection and wrong operation of dialysate changes. Longer dialysis duration, lower plasma protein and serum calcium were the independent risk factors for PD- related peritonitis. Most patients in our center had a better prognosis, and only a few patients had to take out the Tenkhoff catheter. Metrics

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The effect of continuous renal replacement therapy on patients with early hepatic dysfunction induced by sepsis 2018, 17 (02):  78-81.  doi: 10.3969/j.issn.1671-4091.2018.02.002 Abstract ( 366 )   PDF (401KB) ( 580 )   Objective To investigate the clinical effects of continuous renal replacement therapy (CRRT) for the treatment of patients with early hepatic dysfunction induced by sepsis. Methods A total of 287 cases with liver dysfunction after severe pulmonary infection and sepsis and treated in the ICU of First People's Hospital of Yangjiang city from Jan. 2013 to Dec. 2016 were recruited. The patients were randomly divided into CRRT group (n=156) and control group (routine treatment group, n=131). Blood samples were collected at the 1st, 3rd and 7th day in the early morning after the presence of hepatic dysfunction for the measurement of alanine aminotransfease (ALT), aspartate aminotransferase (AST), serum total bilirubin (STB), albumin (ALB) and prothrombin time (PT). Laboratory parameters were used for statistical analyses. Results After the treatment for 3 days, changes of AST (F=8.705, P=0.014) and STB (F=9.016, P=0.009) were statistically significant (P＜0.05) in CRRT group as compared with those in control group, but ALB, ALT and PT had no statistical differences (P＞0.05). After the treatment for 7 days, changes of ALT (F=8.413, P=0.016), AST (F=7.812, P=0.023) and STB (F=9.413, P=0.005) were statistically significant (P＜0.05) as compared with those in control group, but ALB and PT had no statistical differences (P＞0.05). Conclusion CRRT can improve the patients with early liver dysfunction induced by sepsis. Metrics

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Urinary Tamm-Horsfall protein level combined with urinary complement factor H level can predict IgA nephropathy Haas classification and renal outcome 2018, 17 (02):  82-87.  doi: 10.3969/j.issn.1671-4091.2018.02.003 Abstract ( 337 )   PDF (684KB) ( 544 )   Objectives To investigate whether urinary Tamm- Horsfall protein (uTHP) level combined with urinary complement factor H (uCFH) level can correlate with IgA nephropathy histology Haas classification and renal outcome. Methods A total of 351 IgA nephropathy patients followed up from Sep. 2003 to Sep. 2014 were enrolled in this study. Histological changes were evaluated by using the Haas classification of IgA nephropathy. Enzyme linked immunosorbent assay (ELISA) was used to measure uTHP and uCFH levels at the renal biopsy day. Composite endpoint of renal outcome was defined as ①end-stage renal disease (ESRD), ②≥ 50% decline of estimated glomerular filtration rate (eGFR), and ③doubling of plasma creatinine level. Results In this cohort, patients with lower uTHP level and higher uCFH level had more proteinuria (χ2=37.899, P＜0.001), lower blood albumin (χ2=37.487, P＜0.001), lower eGFR(F=16.333, P＜0.001), severer histological lesion (χ2=52.304, P＜0.001) and worse renal outcome (χ2=35.678, P＜0.001). Kaplan-Meier curve analysis indicated that lower uTHP level with higher uCFH level predicted the worse renal outcome during follow-up (Log Rank test, χ2=31.938, P＜0.001). Conclusions uTHP level combined with uCFH level can predict renal outcome in IgA nephropathy patients. Patients with lower uTHP and higher uCFH will have severer morphological lesions (Haas classification) and worse renal outcome. Metrics

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The correlation of plasma thrombomodulin level to inflammatory cytokines and carotid atherosclerosis in maintenance hemodialysis patients 2018, 17 (02):  88-92.  doi: 10.3969/j.issn.1671-4091.2018.02.004 Abstract ( 378 )   PDF (450KB) ( 697 )   Objective To investigate the plasma thrombomodulin (Tm) level and to explore its correlation to inflammatory cytokines and carotid atherosclerosis in maintenance hemodialysis (MHD) patients. Methods A total of 102 stable MHD patients undergoing hemodialysis for at least three months as well as 40 healthy controls were enrolled in the study. Blood levels of Tm, IL-1β, IL-6 and TNF-α were determined by ELISA. Serum levels of ceratinine, triglycerides, cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, albumin, hemoglobin and C-reactive protein (CRP) were measured by routine methods. The intima-media thickness (IMT) of bilateral common carotid arteries and atheromatous plaque in carotid arteries were measured by high-resolution ultrasonography. Correlation analyses of Tm with cytokines, atherosclerosis and other parameters were performed. Results Plasma Tm level (16.06 ± 6.68mg/L vs. 5.45 ± 2.14mg/L, t=10.015, P＜0.001), and serum levels of IL-1β (t=6.455, P＜0.001), IL-6 (t=5.650, P＜0.001), TNF-α (t=7.252, P＜0.001) and CRP (t=4.588, P＜0.001) were significantly higher in MHD patients than in healthy controls. The prevalence of atheromatous plaques and the IMT value of carotid arteries increased significantly in MHD patients as compared with those in healthy controls. Plasma Tm level was higher in MHD patients with carotid atherosclerosis than in patients without carotid atherosclerosis (t=7.034, P＜0.001). Tm was positively correlated to IL-1β (r=0.296, P=0.004), IL-6 (r=0.328, P=0.001), TNF-α (r=0.288, P=0.005), CRP (r=0.287, P=0.005), IMT (r=0.585, P=0.003) and carotid atherosclerosis (r=0.588, P＜0.001). Multiple stepwise regression analyses showed that Tm (OR=1.166, 95% CI 1.042～1.305, P＝0.008), IL- 1β (OR=1.005, 95% CI 1.000～1.009, P=0.030), IL-6 (OR=1.025, 95% CI 1.006～1.212, P=0.018), SBP (OR=1.040,95% CI 1.010～1.219, P=0.023) and age (OR=1.036, 95% CI 1.467～2.009, P=0.019) were the independent risk factors for carotid atherosclerosis in MHD patients. Conclusion Plasma Tm level is significantly higher in MHD patients and is positively correlated with IL-1β, IL-6, TNF-α, CRP, and carotid atherosclerosis, indicating that Tm is an independent risk factor for carotid atherosclerosis in MHD patients. Plasma Tm may be used as a marker to evaluate endothelial damage. Metrics

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Effect of sulodexide on high glucose induced inflammation and fibrosis in human peritoneal mesothelial cells 2018, 17 (02):  93-98.  doi: 10.3969/j.issn.1671-4091.2018.02.005 Abstract ( 332 )   PDF (583KB) ( 482 )   Objective To explore the effects of high glucose on the expression of glycocalyx including hyaluronic acid (HA) and decorin (DCN), inflammatory and fibrosis factors including IL-6 and TGF-β1 in human peritoneal mesothelial cells (HPMCs), and to observe the effects of sulodexide (SLX) on these changes in HPMCs. Methods HPMCs were randomly assigned into control group, high glucose group and high glucose+ SLX group. In the high glucose group, HPMCs were divided into different concentrations of glucose subgroups (HPMCs stimulated with 1.5%, 2.5% and 4.25% glucose for 48 hours) and different stimulation time subgroups (HPMCs stimulated with 2.5% glucose for 0, 6, 12, 24, 48 and 72 hours). In the high glucose+ SLX group, HPMCs were treated with 2.5% glucose and 50, 400, 800, 1200 μg/ml SLX for 48 hours. HA, DCN, IL-6 and TGF-β1 in the cultured media were assayed by ELISA. Results ①Compared to the control group, different concentrations of high glucose up-regulated the expressions of HA (172.074±3.223pg/ml vs. 147.000±1.667pg/ml, F=20.410, P=0.036), DCN (2.435±0.150ng/ml vs. 1.021±0.138ng/ml, F=219.555, P=0.000), IL-6 (67.981±1.655ng/l vs. 45.637±1.143ng/l, F=160.674, P=0.000) and TGF-β1 (204.691±2.829ng/l vs. 112.716±7.484ng/l, F=1692.284, P =0.000) in HPMCs. High concentrations of glucose for different hours also up- regulated the expression of HA (205.986 ± 2.746pg/ml vs. 147.000 ± 1.667pg/ml, F=1225.533, P=0.000), DCN (1.422±0.134ng/ml vs. 1.021± 0.138ng/ml, F=112.124, P=0.001), IL-6 (68.078±2.944ng/l vs.45.637±1.143ng/l, F=69.690, P=0.000), and TGF-β1 (194.816±1.854ng/l vs. 112.716±7.484ng/l, F=1160.819, P =0.000) in HPMCs. ② Compared to the high glucose group, treatment of SLX further increased the expression of HA (196.119±2.260pg/ml vs. 172.074±3.223pg/ml, F=120.845, P=0.013) and DCN (3.227±0.067ng/ml vs. 2.859±0.175ng/ml, F=15.413, P=0.008), but down-regulated the expression of IL-6 (67.927±2.467ng/l vs. 75.371 ± 2.386ng/l, F=50.643, P=0.002) and TGF- β1 (232.778 ± 31.029ng/l vs. 292.347 ± 3.857ng/l, F=21.458, P=0.002). Conclusion HPMCs expressed HA and DCN. Treatment of SLX further increased the high glucose induced up- regulation of HA and DCN, which may repair the injured activity of glycocalyx. SLX could reverse the high glucose induced up-regulation of IL-6 and TGF-β1 in HPMCs, which may protect peritoneal function through the inhibition of peritoneal inflammation and fibrosis. Metrics

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Clinical observation on the ACUSEAL graft for hemodialysis access in 29 cases 2018, 17 (02):  99-101.  doi: 10.3969/j.issn.1671-4091.2018.02.006 Abstract ( 530 )   PDF (387KB) ( 542 )   Objective To investigate the implementation of the ACUSEAL graft for hemodialysis access and early cannulation. Methods The clinical data of the patients who underwent ACUSEAL graft for hemodialysis access were collected. The internal diameters of brachial artery and upper arm vein in surgical side were determined by ultrasonography. Artificial blood vessel and autovessel were connected by side and end anastomosis to construct a U-shaped artificial vascular loop. Forearm swelling was observed after the operation. ACUSEAL graft fistula was punctured in the case of forearm swelling or treatment need. The puncture site was pressed for 15- 20 minutes after hemodialysis access. Results Seventeen patients (58.6%) were found to have diabetes. Most of the patients had the history of central venous catheterization or arteriovenous fistula. The mean diameter of the anastomostic arteries was 3.81±0.67mm, and the mean diameter of veins after applying tourniquet was 4.46±1.47mm. All the operations were completed successfully. No obvious limb swelling was found. The ACUSEAL graft was used for hemodialysis access after the operation for one week in 24 patients (82.8%), and the central venous catheters were removed after the operation for one week in 76.2% patients. Conclusion The use of ACUSEAL graft to establish arteriovenous fistula avoided limb swelling, shortened the placement of central venous catheters, and provided the possibility to earlier use the arteriovenous fistula. Metrics

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Application of Donabedian quality theory in continual quality improvement of vascular access in hemodialysis patients 2018, 17 (02):  102-106.  doi: 10.3969/j.issn.1671-4091.2018.02.007 Abstract ( 476 )   PDF (410KB) ( 450 )   Objectives To construct the structure-process-outcome index of vascular access in maintenance hemodialysis (MHD) patients by using Donabedian quality theory, and to explore whether this theory can improve the quality of vascular pathways under the guidance of quality theory. Methods Continuous quality improvement was achieved in the vascular pathways of MHD patients in our center. Prior to intervention, routine quality improvement was used to prioritize the outcome measures. The intervention was mainly aimed at the three-dimensional index of the structure-process-outcome of vascular pathways in MHD patients under the guidance of Donabedian quality theory to observe whether the effect of improved methods on the quality of vascular access is valuable as compared with that of conventional continuous quality improvement. Results Before and after the intervention, the total number of patients was 148 cases and 203 cases, respectively. The ratio of arteriovenous fistula increased from 73.0% to 81.8% (χ2=3.871，P=0.049), and the ratio of central venous catheterization decreased from 24.3% to 14.3% (χ2=5.717,P=0.017). The incidence of central venous catheter malfunction decreased from 0.94/1,000 patients/day to 0.40/1,000 patients/day (χ2=9.786,P=0.002), and the incidence of fistula stenosis decreased from 0.29/1,000 patients/day to 0.08/1000 patients/day (χ2=7.703,P=0.006). In the fistula puncture method, the ratio of area puncture reduced from 94.5% to 77.7% (P=0.000), and the ratio of rope-ladder puncture increased from 3.7% to 13.7% (χ2=13.162,P=0.000). Hospitalization due to complications of vascular access reduced from 23.8% to 10.0% (χ2=9.037,P=0.003). Conclusion The management under the guidance of Donabedian quality theory significantly improved the vascular access quality in MHD patients, and this is the management model worthwhile to be widely introduced. Metrics

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Influence of the first cannulation time for newly established arteriovenous fistula on vascular access failure: a systematic review and meta-analysis 2018, 17 (02):  107-113.  doi: 10.3969/j.issn.1671-4091.2018.02.008 Abstract ( 500 )   PDF (1340KB) ( 727 )   Objective To systematically review the influence of the first cannulation time for newly established arteriovenous fistula (AVF) on vascular access failure. Methods Databases including PubMed, Medline, the Cochrane Library (Issue 6, 2017) and CNKI were searched up to June 2017 to collect cohort studies about the influence of first cannulation time for newly established arteriovenous fistula on vascular access failure. According to the inclusion and exclusion criteria, the related cohort studies were screened, data were extracted and cross-checked, and quality of included studies was independently evaluated by two reviewers. Meta-analysis was then conducted using Stata 12.0 software. Results A total of 9 studies involving 5,045 AVFs were included to the systematic review, showing that the first cannulation time for newly established arteriovenous fistula is associated with fistula failure. Four studies involving 2,450 AVFs were finally included in our meta- analysis. When the primary patency rates were compared between patients with the first cannulation time within 14 days and those more than 14 days, the differences were statistically significant after 3 months(RR=2.124, P=0.030), after 12 months (RR=2.172, P＜0.001), after 18 months (RR=2.276, P=0.003), and after 24 months (RR=2.087, P=0.008), but without significance after 36 months (RR=2.093, P=0.337). When the primary patency rates were compared between patients with the first cannulation time within 30 days and those more than 30 days, the differences were statistically significant after 24 months (RR=2.952, P＜0.001) and after 36 months (RR=2.336, P＜0.001), but without significance at other time points of follow-up. When the primary patency rates were compared between patients with the first cannulation time within 14 days and those within 15～30 days, the difference was statistically significant after 24 months (RR=1.146, P=0.442), but without significance at other time points of follow-up. When the primary patency rates were compared between patients with the first cannulation time within 15～30 days and those more than 30 days, the differences were statistically significant after 3 months (RR=2.893, P=0.030), 24 months (RR=2.834, P＜0.001) and 36 months (RR=2.232, P＜0.001), but without significance at other time points of follow-up. Conclusions The first cannulation time of the newly established AVF was an important risk factor for long-term patency. Cannulation of AVF within 14 days should be avoided. Cannulation between 2 and 4 weeks was performed only at emergency condition, and the maturation degree of the fistula must be evaluated by physical and ultrasound examinations before cannulation. Maturation of AVF was completed after 30 days. Metrics

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Assessment of nutritional status and body composition in hemodialysis patients 2018, 17 (02):  114-117.  doi: 10.3969/j.issn.1671-4091.2018.02.009 Abstract ( 432 )   PDF (412KB) ( 534 )   Objective To investigate the nutritional status and body composition in maintenance hemodialysis(MHD) patients, and to explore the factors affecting the body composition. Methods A total of 123 MHD patients completed the body composition analyses by body composition monitoring (BCM), and nutritional assessment by biochemical and anthropometric measurements. Results Malnutrition was defined in 36.6% patients by prealbumin level. A significant difference Significant difference in lean tissue index (LTI) was noted between malnutrition group and well-nourished group, with lower LTI (11.598±2.700 vs. 12.958±2.531, t=- 2.801, P=0.006) in patients in malnutrition group. Higher hypersensitive C- reactive protein (hs-CRP) was identified as an independent risk factor for lower LTI (OR=2.431, 95% CI 1.136～5.201, P=0.022),while handgrip strength was found to be a protective factor for LTI (OR=0.219, 95% CI 0.097～0.497, P＜0.001) in MHD patients. Conclusion Malnutrition patients tended to have lower lean tissue mass accompanied by higher inflammation markers. Handgrip strength could be used to monitor muscle mass in MHD patients. Metrics

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Patient education in the incident patients on peritoneal dialysis: the effectiveness of the mind map 2018, 17 (02):  118-122.  doi: 10.3969/j.issn.1671-4091.2018.02.010 Abstract ( 454 )   PDF (910KB) ( 1210 )   Objective To determine the effectiveness of the mind map for imparting knowledge to incident peritoneal dialysis (PD) patients. Methods One hundred incident PD patients were enrolled in this study. Participants were randomly assigned to receive traditional training (control group) or the mind map for knowledge of PD (observation group). The knowledge was assessed by the exam twice. The ability of self-management, laboratory parameters and PD complications were compared between the two groups after the surgery for one month and after discharge from hospital for 3 months. Results The scores of peritoneal dialysate exchange (t/χ2=2.231, P=0.028), change of dressing (t/χ2=3.043, P=0.003) and theoretical tests (t/χ2=2.627, P=0.010) were significantly higher in observation group than in control group before discharge. The scores of peritoneal dialysate exchange (t/χ2=2.520, P=0.013), change of dressing (t/χ2=2.044, P=0.044) and theoretical tests (t/χ2=3.044, P=0.003) were significantly higher in observation group than in control group after discharge for one month. The scores of self-management scale after discharge for one month (t=5.444, P＜0.001) and three months (t=6.056, P＜0.001) were both significantly higher in observation group than in control group. Serum potassium (t/χ2=2.128, P=0.036) and albumin (t/χ2=2.444, P=0.016) were significantly higher in observation group than in control group after discharge for one month. Serum potassium (t/χ2=3.293, P=0.001) and albumin (t/χ2=3.117, P=0.002) were significantly higher in observation group than in control group after discharge for three months. The incidence of peritonitis (χ2=7.440, P=0.006), exit infection (χ2=5.316, P=0.021) and edema (χ2=9.000, P=0.003) were lower in observation group after discharge for six months. Conclusion Mind map education may be more effective for knowledge acquisition, resulting in the comprehension of PD performance and the decrease of complication rate in PD patients. Metrics

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The influence of empowerment education model on calcium-phosphate metabolism and nutritional status in maintenance hemodialysis patients 2018, 17 (02):  123-125.  doi: 10.3969/j.issn.1671-4091.2018.02.00 Abstract ( 375 )   PDF (359KB) ( 476 )   Objective To observe the influence of empowerment education model on calcium- phosphate metabolism and nutritional status in maintenance hemodialysis (MHD) patients with abnormal mineral and bone metabolism. Methods We established a team for empowerment education model. A total of 60 MHD patients treated in our blood purification center from June 2015 to June 2016 were enrolled in this study. After the intervention with empowerment education model for 12 weeks, the values of serum calcium and phosphorus, calcium-phosphorus product, iPTH, hemoglobin, plasma albumin, prealbumin, triceps skinfold thickness, and mid-arm muscle circumference were compared before and after the intervention. Results After the intervention of empowerment education model, the levels of serum calcium and serum phosphorus, calcium-phosphorus product, iPTH decreased (t=0.017, P=0.002), the levels of Hb (t=-1.267, P=0.039), albumin (t=-1.051, P=0.045) and triceps skinfold thickness (t=-2.546, P= 0.009) increased, but the change of midarm muscle circumference was statistically insignificant (t=-1.056, P=0.736). Conclusion Empowerment education model can improve calcium-phosphate metabolism and nutritional status in MHD patients with abnormal mineral and bone metabolism. Metrics

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Acute Hemolysis induced by kinked blood line during hemodialysis and its prevention and management 2018, 17 (02):  133-136.  doi: 10.3969/j.issn.1671-4091.2018.02.014 Abstract ( 659 )   PDF (362KB) ( 727 )   Acute hemolysis induced by linked blood line during hemodialysis is one of the life-threatening complications. The occurrence rate is rare. However, if the kinked blood line cannot be detected and resolved promptly, the outcome is severe due to the complications including hyperkalemia, acute pancreatitis and even death following acute hemolysis. This paper focuses on the mechanism, diagnosis, prevention and management of acute hemolysis based on review of the literature about hemolysis events, in order to strengthen the recognition and the aware of hemolysis risk induced by kinked blood line in dialysis staffs, to protect the patients from hemolysis events, and to ensure safety and optimal efficiency for hemodialysis patients. Metrics

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Correlation between medical coping style and perceived social support in maintenance hemodialysis patients 2018, 17 (02):  141-143.  doi: 10.3969/j.issn.1671-4091.2018.02.016 Abstract ( 393 )   PDF (349KB) ( 483 )   Objective To investigate the status of medical coping style and its correlation with perceived social support in maintenance hemodialysis (MHD) patients. Methods By convenient sampling, a total of 100 patients who underwent MHD in our hospital from July to June in 2017 were followed up for Medial Coping Modes Questionnaire (MCMQ) and Perceived Social Support Scale (PSSS). Results Avoidance was the main coping style in MHD patients (36 case, 36%). The score of face dimension was lower than norm (t=-2.780, P=0.007), and the scores of avoidance and yield dimension were higher than norm (t=7.208 and 6.486 respectively, P＜0.001). The yield dimension was negatively correlated with the total scores and dimensions of perceived social support (r=-0.322, -0.318, -0.256 and -0.260; P=0.001, 0.001, 0.010 and 0.009), and the face dimension was positively correlated with other support dimensions (r=0.249, P=0.013). Conclusion This study suggests that the family and social support system for MHD patients should be improved to reduce their yield responses and improve their health conditions. Metrics