Chinese Journal of Blood Purification

12 April 2018, Volume 17 Issue 04 Previous Issue    Next Issue

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Application of regional citrate anticoagulation in hemoperfusion therapy for patients with severe poisoning 2018, 17 (04):  217-221.  doi: 10.3969/j.issn.1671-4091.2018.04.001 Abstract ( 673 )   PDF (420KB) ( 489 )   【Abstract】Objective To compare the three anticoagulant methods, regional citrate anticoagulation (RCA), unfractionated heparin (UFH) anticoagulation and low molecular weight heparin (LMWH) anticoagulation, in hemoperfusion therapy for severe poisoning patients, and to assess the efficacy and safety of RCA in hemoperfusion therapy. Methods Thirty severe poisoning patients treated with hemoperfusion therapy from Jan. 2014 to Sept. 2017 were randomly divided into RCA group (n=10), UFH group (n=10) and LMWH group (n=10). Blood coagulation, bleeding, blood platelet count (BPC), activated partial thromboplastin time (APTT), prothrombin time (PT) and fibrinogen (Fib) were compared between the 3 groups. Serum ionized Ca+2, total calcium and blood pH were compared before and after hemoperfusion in RCA group. Results Blood coagulation in perfusion apparatus was not found in RCA group, but occurred in 2 cases in UFH group and in one case with level III blood clotting in LMWH group. There was no bleeding at puncture site in RCA group. In IFH group, bleeding happened in 3 cases at puncture site, 3 cases in subcutaneous tissues and 2 cases at other sites (χ2=9.436, P=0.022, as compared with that in RCA group). In LMWH group, bleeding was found in 3 cases at puncture site, 2 cases in subcutaneous tissues and one case at other sites (χ2=8.556, P=0.036, as compared with that in RCA group). After hemoperfusion therapy, Fib and BPC decreased in the 3 groups; APTT, PT, BPC, and Fib changed more in UFH group than in RCA group (t=2.722, P=0.009 for APTT; t=2.234, P=0.016 for PT; t=3.893, P=0.001 for BPC; t=4.056, P＜0.001 for Fib) and more in LMWH group than in RCA group (t=2.459, P=0.012 for APTT; t=2.168, P=0.021 for PT; t=3.608, P=0.001 for BPC; t=3.892, P=0.001 for Fib). Serum ionized Ca + 2, total calcium, blood pH changed insignificantly in RCA group (t=0.452, P=0.594 for serum ionized Ca + 2; t=0.307, P=0.681 for serum total calcium; t=0.260, P=0.758 for blood pH). Conclusion RCA was better than UFH and LMWH in anticoagulation effect, lower incidence of bleeding and safety for use. Thus RCA is suitable for routine use in hemoperfusion therapy. Metrics

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The effect of strength model of case management on the nutritional inflammatory state and residual renal function in peritoneal dialysis patients 2018, 17 (04):  222-225.  doi: 10.3969/j.issn.1671-4091.2018.04.002 Abstract ( 393 )   PDF (404KB) ( 557 )   【Abstract】Objective To explore the effect of strength model of case management (SMCM) on nutritional inflammatory state and residual renal function (RRF) in peritoneal dialysis (PD) patients. Methods A randomized digital table method was used to select 110 PD patients in the PD Center of The First Affiliated Hospital of Guangxi Medical University. They were randomly divided into control group (n=55) and intervention group (n=55). Routine care was used for both groups, and SMCM for 6 months on the basis of routine care was performed for intervention group. Nutritional inflammatory state related body measurements, biochemical indicators and residual renal function were compared after the intervention between the two groups. Results In intervention group after the intervention, malnutrition- inflammation (MIS) scores (t=6.672, P＜0.001), mid-upper arm circumference (MAC, t=-2.949, P=0.004), triceps skin fold (TSF, t=-2.002, P=0.048), pre-albumin (PA, t=-2.072, P=0.041) and high sensitive C-reactive protein (hs-CRP, t=6.064, P＜0.001) improved significantly. Conclusion SMCM for PD patients can significantly improve their malnutrition and inflammatory state. However, SMCM changed RRF insignificantly. Metrics

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The effect of interdialysis blood pressure on residual renal function in hemodialysis patients 2018, 17 (04):  226-228.  doi: 10.3969/j.issn.1671-4091.2018.04.003 Abstract ( 560 )   PDF (343KB) ( 577 )   【Abstract】Objective To investigate the effect of interdialysis blood pressure on residual renal function(RRF) in hemodialysis patients. Methods A total of 188 patients treated in the Blood Purification Center,The First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science & Technology and beginning hemodialysis during the period between Mar. 2013 and Mar. 2017 were recruited. At the 3rd month of hemodialysis, cystatin C (CysC) was assayed and interdialysis blood pressure was measured for one week. Based on the average systolic blood pressure they were divided into group A: <110mmHg, group B:110～160mmhg and group C: >160mmHg; based on the average diastolic blood pressure they were divided into group a: <60mmHg, group b: 60～90mmHg and group c: >90mmHg as well. RRF was compared among different groups, and RRF was calculated from the equation RRF=0.70+22×1/CysC. Results RRF was significantly lower in group A and group C than in group B (P＜0.001), and RRF was lower in group A than in group C, but without statistical difference (P=0.075). Moreover, RRF was significantly lower in group a than in group b and group c (P＜0.001), and was lower in group c than in group b (P＜0.001). Conclusion Maintenance of interdialysis blood pressure in a normal range and prevention of hypertension and hypotension can protect RRF. Lower diastolic blood pressure may accelerate the reduction of residual renal function. Metrics

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Effect of hemoperfusion on the clearance of protein bound uremic toxins and the quality of life in maintenance hemodialysis patients 2018, 17 (04):  229-233.  doi: 10.3969/j.issn.1671-4091.2018.04.004 Abstract ( 451 )   PDF (445KB) ( 748 )   【Abstract】Objective To observe the effect of long-term hemodialysis (HD) combined with hemoperfusion (HP) on the clearance of protein bound uremic toxins and the quality of life in maintenance hemodialysis (MHD) patients. Methods A total of 36 MHD patients were randomly and equally divided into HD and HD+HP groups. Patients in HD group were treated with low-flux hemodialysis three times a week, while those in HD+HP group were treated with low-flux hemodialysis twice a week and hemodialysis combined with hemoperfusion once a week. They were followed up for 36 weeks. Urea clearance index (Kt/V) and the concentrations of protein bound uremic toxins including hippuric acid (HA), indoxyl sulphate (IS) and p-cresyl sulphate (PCS) were compared before and after the treatment. The Kidney Disease Quality of Life Short Form (KDQOL-SF1.3) scale was used to assess the quality of life. Result ①After the treatment for 36 weeks, HA and PCS had no statistical significances in HD group (HA: t=-0.328, P=0.747; PCS: t=-0.178, P=0.861) but decreased significantly in HD+HP group (HA: t=2.221, P=0.040; PCS: t=2.207, P=0.041) as compared with those before the treatment. HA and PCS were significantly lower in HD+HP group than in HD group (HA: t=2.139, P=0.045; PCS: t=2.051, P=0.048) at the end of the study. ②After the treatment for 36 weeks, IS was significantly higher (z=-2.298, P=0.035) in HD group but had no statistical difference in HD+HP group (z=- 0.970, P=0.332) as compared with that before the treatment. IS had no significant difference between the two groups (z=-1.485, P=0.137) at the end of the study. ③After the treatment for 36 weeks, bodily pain and vitality scores, the two parameters of quality of life, were significantly lower in HD group (bodily pain: t=2.136, P=0.049; vitality: t=2.947, P=0.009), while dialysis related symptoms, effects of kidney disease and vitality scores were significantly higher in HD+HP group (dialysis related symptoms: t=-2.345, P=0.032; effects of kidney disease: t=-2.467, P=0.025; vitality: t=-2.315, P=0.034) as compared with those before the treatment. The effects of kidney disease, cognitive function, sleep, physical function, bodily pain, general health, social function and vitality scores were better in HD+HP group than in HD group (effects of kidney disease: t=-2.111, P=0.043; cognitive function: t=2.051, P=0.049; sleep: t=-2.062, P=0.047; physical function: t=-2.241, P=0.032; bodily pain: t=- 2.122, P=0.042; general health: t=- 2.374, P=0.024; social function: t=- 2.110, P=0.043; vitality: t=-2.560, P=0.015). Conclusion Long-term use of HD+HP is better than conventional HD in the removal of protein bound uremic toxins and the improvement of quality of life in MHD patients. Metrics

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Body composition monitor for dry weight in long-term hemodialysis patients 2018, 17 (04):  234-237.  doi: 10.3969/j.issn.1671-4091.2018.04.005 Abstract ( 567 )   PDF (361KB) ( 531 )   【Abstract】"Dry weight" is the simplest and most important indicator to evaluate the adequacy of dialysis in hemodialysis patients, and is crucial for patient survival and the quality of life. There are many approaches to clinically evaluate "dry weight" for dialysis patients. Body composition monitor is the“dry weight”measurement method widely used in clinical practice due to its non-invasive, low expense, intuitive and objective results obtained in a short period of time, and easy to operate along bedside. Metrics

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Factors affecting postoperative recurrence after parathyroidectomy in sever secondary hyperparathyroidism patients 2018, 17 (04):  238-240.  doi: 10.3969/j.issn.1671-4091.2018.04.006 Abstract ( 351 )   PDF (392KB) ( 598 )   【Abstract】Secondary hyperparathyroidism (SHPT) is one of the major complications in chronic renal failure patients, and seriously affects their prognosis. Parathyroidectomy (PTX) is necessary when serious SHPT is refractory to medical treatment. PTX can effectively ameliorate the signs and symptoms of SHPT, survival rate and the quality of life. Pre-operative imaging, surgical modality and thymectomy are the key factors influencing the postoperative recurrence. According to current literature and our own experiences, preoperative imaging for localization is occasionally helpful to reduce postoperative recurrence. Operative approaches include subtoatal PTX, total PTX with autotransplantation and PTX without autotransplantation. Although there is no strong evidence to prove which operation is the best, we think total PTX is the first choice. Total PTX can effectively reduce postoperative recurrence. Delayed parathyroid autotransplantation may be necessary to avoid complications. Thymectomy is effective in the cases that four glands are not identified and removed. Metrics

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The benefits of active vitamin D in the treatment of patients with chronic kidney disease 2018, 17 (04):  241-243.  doi: 10.3969/j.issn.1671-4091.2018.04.007 Abstract ( 514 )   PDF (350KB) ( 476 )   【Abstract】Vitamin D deficiency is a common complication in patients with chronic kidney disease(CKD). In uremic patients with maintenance dialysis, vitamin D deficiency rate is as high as 79%. Numerous studies have shown that vitamin D supplementation in CKD patients can treat the abnormal calcium and phosphorus metabolism, prevent secondary hyperparathyroidism, improve bone mineral density, reduce the risk of fractures and reduce the risk of cardiovascular disease. Vitamin D supplementation is also useful for immune regulation, inhibition of inflammatory response, blood pressure control, and reducing urinary protein. Metrics

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The impact of emotional management on the quality of life and dialysis effectiveness in hemodialysis patients 2018, 17 (04):  247-250.  doi: 10.3969/j.issn.1671-4091.2018.04.009 Abstract ( 455 )   PDF (406KB) ( 516 )   【Abstract】Objective To explore the impact of emotional management on the quality of life and dialysis effectiveness in hemodialysis patients. Method A total of 112 patients with uremia were randomly divided into emotional management group (58 cases) and control group (54 cases). The former was treated with emotional management in addition to maintenance hemodialysis, while the latter was treated with maintenance hemodialysis only. After one month, the changes of SF-36 scale in SF36 (questionnaire SF36), serum creatinine (Scr), blood urea nitrogen (BUN), β2-microglobulin (β2-MG) and urea clearance index (Kt/V) were compared between the two groups. Results After the treatment, physical fitness (t=2.892, P=0.042; t=2.652, P=0.048), energy (t=3.832, P=0.032; t=3.536, P=0.035), total health (t=3.685, P=0.034; t=3.362, P=0.036) and total score (t=3.754, P=0.033; t=3.625, P=0.034) were significantly higher than before treatment in both groups. Psychological health increased only in emotional management group (t=3.568, P=0.035). The scores of psychological health (t=3.0368, P=0.03) and energy (t=2.658, P=0.048) were significantly higher in emotional management group than in control group. β2-MG decreased more in emotional management group than in control group (t=2.228, P=0.024). Conclusion Emotional management can improve the quality of life in hemodialysis patients, especially in terms of mental health and energy. It also has the potential value to improve dialysis efficiency. Therefore, emotional management can be used in clinical practice. Metrics

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The effect of visits by Wechat on anxiety in adult patients with maintenance hemodialysis 2018, 17 (04):  251-254.  doi: 10.3969/j.issn.1671-4091.2018.04.010 Abstract ( 382 )   PDF (413KB) ( 469 )   【Abstract】Objective To explore the clinical effect of visits by Wechat on anxiety in adult patients with maintenance hemodialysis (MHD). Methods A total of 84 MHD cases from Jan. to Aug., 2016 were recruited as the research subjects. They were divided into experimental group (n=42) and control group (n=42) by using a random number table. Patients in experimental group established a Wechat group to conduct visits by Wechat for 8 months, while patients in control group were treated with routine health care. Results Anxiety in patients in experimental group alleviated after the intervention. Compared with control group, the self-rating anxiety scale (SAS) scores were statistically better in experimental group (46.79±6.09 vs. 59.55±4.74, t=10.710, P＜0.001); the cognitive level of the disease was statistically higher in experimental group (χ2=10.918,P =0.001； χ2=7.941，P =0.005； χ2=7.375，P =0.007； χ2=9.143，P =0.002； χ2=13.123，P ＜0.001； χ2=15.774，P ＜0.001； χ2=6.943，P ＜0.008); blood urea nitrogen (BUN) index (9.01 ± 3.33 vs.18.01±2.68, t=5.399, P=0.021), serum creatinine (Scr) index (336.45±82.31 vs. 426.45±70.26, t=3.984, P=0.026) and β2-microglobulin (β2-MG) index (14.81±1.35 vs. 17.23±3.12, t=3.612, P=0.030) were statistically lower in experimental group. Conclusion Through visits by Wechat, the anxiety in adult MHD patients improved, and the cognitive level of the disease enhanced. The therapeutic effect and the quality of life improved as well. Metrics

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Knowledge, attitude, belief and practice towards phosphorus-based additives among hemodialysis patients 2018, 17 (04):  255-258.  doi: 10.3969/j.issn.1671-4091.2018.04.011 Abstract ( 377 )   PDF (395KB) ( 556 )   【Abstract】Objective To investigate knowledge, attitude, belief and practice towards phosphorus-based additives among hemodialysis patients in order to improve the health education of phosphorus-based additives for the patients. Methods We used self-designed questionnaire and convenient sampling method to investigate knowledge, attitude, belief and practice towards phosphorus- based additives in hemodialysis patients. Results The total score of the questionnaire was 29.15±5.43 points, corresponding to a moderate level. The score of pain knowledge was 8.36±3.55, the score of pain attitude was 13.72±1.81, and the score of analgesic behavior was 7.07±2.18. According to Pearson correlation analyses, knowledge and attitude were positively correlated with attitude and behavior (P<0.01), but no correlation was found between knowledge and behavior (P>0.05). Conclusion Knowledge, attitude, belief and practice health education model should be adopted to improve knowledge, attitude and behavior towards phosphorus-based additives to control serum phosphorus level in hemodialysis patients. Metrics

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Application of group visits on fluid status in peritoneal dialysis patients 2018, 17 (04):  259-261.  doi: 10.3969/j.issn.1671-4091.2018.04.012 Abstract ( 369 )   PDF (382KB) ( 470 )   【Abstract】Objective To evaluate the effectiveness of group visits on fluid status in peritoneal dialysis (PD) patients. Methods One hundred and twenty PD patients were randomly and equally assigned into two groups. Patients in experimental group received group visits and routine health care, while those in control group only received routine health care. Their fluid status was compared before intervention and after intervention for 3 months. Results Before intervention, there were no significant differences in blood pressure, dialysis dose, urine volume, ultrafiltration volume, glucose concentration in dialysate, body weight, fluid intake, serum creatinine, serum protein and edema in lower extremities between the two groups. After intervention, patients in the experimental group had lower systolic blood pressure (t=2.650, P=0.01), less fluid intake (z=-2.140, P=0.032) and fewer extremity edema (c2=10.985, P=0.012) as compared with the control group. Conclusion The group visits program is an effective model to improve volume status, to promote communication with medical staffs, and to increase the compliance with water and salt management in PD patients. It is a valuable management model for chronic diseases to be used in clinical practice. Metrics

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Self-perceived burden and its correlation with coping style, self-efficacy and self-esteem in maintenance hemodialysis patients 2018, 17 (04):  262-264.  doi: 10.3969/j.issn.1671-4091.2018.04.013 Abstract ( 409 )   PDF (382KB) ( 482 )   【Abstract】Objective To investigate the status of self-perceived burden and its correlation with coping style, self- efficacy and self- esteem in maintenance hemodialysis (MHD) patients. Methods A total of 114 MHD patients treated during the period from March to May in 2017 in one of the blood purification centers in Chengdu were recruited by convenience sampling method. The self- perceived burden scale (SPBS), medial coping modes questionnaire (MCMQ), general self-efficacy scale (GSES) and self-esteem scale (SES) were investigated in these patients. Results The total SPBS score of the MHD patients was 25.89±8.32, which is a mild level. Different degrees of self-perceived burden, mainly financial burden, were detected in 74.6% (85 cases) MHD patients. Self-perceived burden was positively correlated with the yield response of coping style (r=0.499, P<0.001), and negatively correlated with self- efficacy (r=- 0.312, P=0.001) and self- esteem (r=-0.308, P= 0.001). Conclusions Self-perceived burden is commonly present in MHD patients. Self-perceived burden can be alleviated by reducing the yield response of coping style and enhancing their confidence and self-efficacy to face the disease. Metrics

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The research of continuous quality improvement method on standard–reaching rate of hemoglobin in maintenance hemodialysis patients 2018, 17 (04):  265-267.  doi: 10.3969/j.issn.1671-4091.2018.04.014 Abstract ( 388 )   PDF (424KB) ( 527 )   【Abstract】Objective To investigate the continuous quality improvement method on standard- reaching rate of hemoglobin in maintenance hemodialysis (MHD) patients. Method We set up a group of 50 MHD patients for this study and carried out the plan-do-check-action (PDCA) cycle twice to find out the causes of anemia in most patients at different stages and to observe the standard-reaching rate of hemoglobin after the performance of continuous quality improvement method. Result The standard-reaching rate of hemoglobin in these MHD patients improved gradually by a series of methods (P=0.00045). Conclusion The continuous quality improvement method is a valuable management worthwhile to be used clinically. Metrics

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Implement and effect analysis of buttonhole puncture to arteriovenous fistulas in 48 hemodialysis patients 2018, 17 (04):  268-271.  doi: 10.3969/j.issn.1671-4091.2018.04.015 Abstract ( 608 )   PDF (395KB) ( 643 )   【Abstract】Objective To explore the procedure and the effect of blunt needle puncture to autogenous arteriovenous fistulas in order to provide a guidance for clinical practice. Methods We retrospectively summarized 48 hemodialysis patients treated with buttonhole puncture to arteriovenous fistulas for blood access, and analyzed the tunnel formation, the technique of blunt needle puncture and the management of obstacles during puncture. Results Blood access was successfully performed in 43 of the 48 patients using buttonhole puncture method of blunt needles. Two of them had embolisms in fistulas and underwent another arteriovenous fistula surgery in the contralateral limb. Ladder puncture was then used. Infections occurred in 3 patients; the symptoms disappeared after the change to ladder puncture in one cases, and pseudo-tunnel formation was found in 2 cases and ladder puncture was then used. Conclusion The critical techniques for buttonhole puncture include tunnel formation, the time for the replacement of sharp needle puncture to blunt needles puncture, procedures for blunt needle puncture, and taking off the scars. In patients with pseudo-aneurysm on fistulas, buttonhole puncture should be carefully manipulated to establish a tunnel far from the pseudo-aneurysm. When blunt needle puncture is interrupted and has to be reused, the original tunnel should be punctured several times with a sharp needle and then a blunt needle is used for the puncture. When infection occurs at the puncture site, local treatment with iodophor is used 3 times daily and this site can be used until the infection disappears completely. When obstacles happen during blunt needle puncture, the puncture must be stopped to explore the causes before continuing the manipulation. When hematoma forms, the puncture site must be changed. When bleeding at the puncture site occurs, intervention and investigation of the bleeding cause must be immediately conducted. Metrics

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Endovascular treatment of thrombosis in arteriovenous graft under the guidance of ultrasound 2018, 17 (04):  272-276.  doi: 10.3969/j.issn.1671-4091.2018.04.016 Abstract ( 463 )   PDF (651KB) ( 812 )   【Abstract】Objective Fistula occlusion caused by thrombosis is one of the common arteriovenous graft (AVG) complications. This article summarizes the success rate and our experiences about endovascular treatment of thrombosis in AVG under the guidance of ultrasound. Methods A total of 148 patients with AVG thrombosis were treated in our hospital in the period from Jan. 2014 to Jun. 2017, including 78 patients using ultrasound assisted endovascular treatment and 70 patients using ultrasound assisted incision treatment. The two groups were compared for success rate, operation time, surgical trauma and primary patency after the intervention for 3 and 6 months. Results Ultrasound assisted endovascular treatment and ultrasound assisted incision treatment effectively resolved the AVG thromboses in 74 of the 78 patients (95%) and 68 of the 70 patients (97%), respectively. The operation time was 74.95±5.78min for endovascular treatment patients, and was 109.6±7.85min for incision and thrombectomy patients (t=3.55, P=0.001). The surgical trauma was less in endovascular treatment patients than in incision and thrombectomy patients. The primary patency rates in endovascular treatment patients and incision and thrombectomy patients were 84±1% and 85±2%, respectively, after the operation for 3 months (t=0.58, P=0.29), and were 73±1% and 75±2%, respectively, after the operation for 6 months (t=0.34, P=0.37). No serious complications occurred in the two groups. Conclusion Endovascular treatment of thrombosis in AVG under the guidance of ultrasound is a safe, minimally invasive and effective method. Metrics

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Design and application of a training device to promote maturation of internal arteriovenous fistula 2018, 17 (04):  277-280.  doi: 10.3969/j.issn.1671-4091.2018.04.0017 Abstract ( 506 )   PDF (522KB) ( 554 )   【Abstract】Objective To observe the effect of a self- designed device for training grip strength on the maturation of internal arteriovenous fistulas. Methods A total of 49 patients on maintenance hemodialysis treated with autologous arteriovenous fistula surgery in the period from Jan. 2016 to Dec. 2016 were recruited as observation group, and a total of 58 patients on maintenance hemodialysis treated with the surgery in the period from Jan. 2015 to Dec. 2015 were used as control group. After the surgery for 2 weeks, they were asked to train grip strength: squeezing the palm squeezer for 15 seconds then relaxing slowly, repeating this training for 10 minutes and 5-10 times/day. A conventional grip device was used for the training in control group. For observation group, a grip device with grip strength monitor was used. Parameters of standard grip strength, exercise times and duration were input in the device before training. After the training, the actual training parameters including grip strength, exercise times and duration were displayed on the device or alerted by voice or lights. When the standard parameters were not achieved, required parameters were reset in the device, and the patient was asked to continue the exercise to meet the standard parameters. Diameter of the cephalic vein, blood flow, maturation degree, maturation period of the fistula, and compliance of grip training were evaluated after the surgery for 4, 8 and 12 weeks. Results After the surgery for 4, 8 and 12 weeks, diameters of the cephalic vein were 4.73±0.51mm, 4.89±0.65 and 5.15±0.95mm respectively in observation group, bigger than the diameters of 4.30±0.65mm, 4.41±0.71mm and 4.65±0.89mm respectively in control group (t=-2.970, -2.298 and - 2.928 respectively; P=0.004, 0.025 and 0.041 respectively); blood flows in cephalic vein were (501.12±125.32)ml/min, (568.13±183.39)ml/min, (675.33±213.04)ml/min respectively in observation group, higher than the blood flows of (443.64±112.21)ml/min, (496.88±164.74)ml/min, 538.84±190.08 ml/min re-spectively in control group (t=3.003, 2.932 and 2.765 respectively; P=0.005, 0.006 and 0.001 respectively). The maturation rate of fistula was 97.96% in observation group and was 87.94% in control group (χ2=3.861, P=0.049). The maturation duration was 1.75 weeks earlier in observation group than in control group. The compliance of grip strength training was higher in observation group than in control group (χ2=12.365, P=0.002). Conclusion The use of self-designed device is helpful for patients to actively train grip strength, to standardize the training, to improve compliance and training efficiency, and thus promotes fistula maturation after the surgery. Metrics

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Diagnosis, Nursing and intervention of premature clotting during continuous veno-venous hemodialysis in a patient with type I cryoglobulinemia 2018, 17 (04):  281-283.  doi: 10.3969/j.issn.1671-4091.2018.04.018 Abstract ( 416 )   PDF (372KB) ( 522 )   【Abstract】An elderly male was diagnosed as monoclonal immunoglobulin (IgM, kappa), type I cryoglobulinemia and renal failure due to cryoglobulinemia. After renal biopsy, his hemoglobin decreased progressively, and renal ultrasound showed a hematoma of 108×76mm around right kidney. After DSA examination, he was immediately treated with continuous veno-venous hemodialysis (CVVHD). During the treatment, pre-filtration pressure rose to 450mmHg, and premature clotting in filter due to cold agglutination of cryoglobulin was identified. The clotting disappeared after external heating of the circuit before the filter. We report this case her to be aware of the similar patients clinically and to treat this situation appropriately in the future. Metrics