Chinese Journal of Blood Purification

12 December 2018, Volume 17 Issue 12 Previous Issue    Next Issue

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Advances in basic and clinical knowledge of vascular access for hemodialysis 2018, 17 (12):  793-797.  doi: 10.3969/j.issn.1671-4091.2018.12.001 Abstract ( 469 )   PDF (423KB) ( 911 )   【Abstract】Vascular access is the "lifeline" to hemodialysis patients. The basic and clinical knowledge of vascular access progresses rapidly in recent years. Neointimal hyperplasia is now recognized as the main cause of vascular access dysfunction. Upstream events such as vascular wall injury, hemodynamic changes and endothelial dysfunction trigger a series of downstream pathophysiological processes in the context of chronic kidney disease. Eventually, the secondary neointimal hyperplasia leads to vascular access dysfunction or maturation failure. Surgical modification and percutaneous transluminal plasty of the dysfunctional AVF are the hot spots in the field of vascular access reconstruction. Endovascular technologies such as balloon-assisted maturation, accessory vein occlusion and stent placement are gradually opening up new prospects for maintenance and repair of vascular access. A variety of systemic drug intervention and local vascular wrap technologies have obtained some achievements for the clinical prevention and treatment of neointimal hyperplasia in vascular access. Tissue-engineered blood vessel grafts as vascular access have showed better safety and patency, and are worthy of further clinical study. Metrics

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Peritoneal dialysis in acute kidney injury 2018, 17 (12):  798-800.  doi: 10.3969/j.issn.1671-4091.2018.12.002 Abstract ( 264 )   PDF (365KB) ( 609 )   【Abstract】Peritoneal dialysis (PD) is a useful method of renal replacement therapy for acute kidney injury (AKI). Flexible catheter for PD access is the gold standard in this situation. At present, the best catheterization method for PD in AKI patients is unavailable. The lowest weekly Kt/V of PD can be set at 2.1 for relatively stable AKI patients and at 3.5 for critically ill patients. Automated peritoneal dialysis (APD) is more labor- saving than manual PD in the treatment of AKI with high volume peritoneal dialysis (HVPD). However, there remain some limitations for PD in treatment of AKI. High quality clinical studies are required for further confirmation. Metrics

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Utilization of peritoneal dialysis in acute kidney failure on chronic kidney disease 2018, 17 (12):  801-805.  doi: 10.3969/j.issn.1671-4091.2018.12.003 Abstract ( 314 )   PDF (529KB) ( 719 )   【Abstract】Objective To evaluate the effect of peritoneal dialysis (PD) in acute kidney injury on chronic kidney disease (AKI on CKD). Methods Patients undergoing PD due to AKI on CKD in Renji Hospital, School of Medicine, Shanghai Jiao Tong University between March 2013 and February 2016 were enrolled and prospectively followed up for 2 years. Results A total of 23 patients (14 males; median age 68 years) were enrolled. By the end of the study, PD terminated and renal function recovered in 11 patients (47.8%), 5 patients (21.7%) died, follow-up lost in one patient (4.3%), and PD continued in 6 patients (26.1%). Prevalence of peritonitis in this cohort was 1 episode/38.9 patient-months. CKD etiology differed among patients with and without renal recovery (x2=18.381, P=0.031). In patients with renal recovery, preexisting CKD at stage 1-3 was more prevalent (x2=11.967, P=0.001); cardiovascular disease (x2=11.294, P=0.001) and diabetes mellitus (x2=5.977, P=0.014) were less prevalent; additionally, they had lower Charlson comorbidity index scores (Z=-2.128, P=0.033), lower plasma BNP (Z=-2.985, P=0.003) and higher serum creatinine (t=2.103, P=0.048) at the beginning of PD; Average PD vintage was 5.4±4.3 months (10 days~13.3 months). Conclusions PD can be used as a renal replacement therapy in AKI on CKD. Metrics

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A therapeutic analysis of the effectiveness of peritoneal dialysis in 22 neonatal babies with acute kidney injury 2018, 17 (12):  806-809.  doi: 10.3969/j.issn.1671-4091.2018.12.004 Abstract ( 368 )   PDF (450KB) ( 678 )   【Abstract】Aim To analyze the clinical outcome and complication of emergent peritoneal dialysis (PD) in neonatal babies with acute kidney injury (AKI). Method This was a retrospective and cohort study. AKI neonatal babies treated with PD in the ICU, Department of Daping Hospital, Amy Medical University were analyzed. Apgar score, clinical stage of AKI, organs involved in multiple organ failure, vasoactive drugs, mechanical ventilation, dose, frequency and complications of PD, and 30～day survival rate in these babies were recruited. The indices of therapeutic effectiveness included renal function, electrolyte levels and lactate levels. Cox regression model was used to analyze the factors affecting survival rate. Results A total of 22 AKI newborns (12 males and 10 females) were enrolled in this study. Their average gestational age was (34.95±4.34) weeks, average weight was (2.44±0.92) kg, and Apgar score at birth was (7.32±3.05). Three neonatal babies (13.64%) had AKI at stage I, 5 babies (22.73%) at stage II, and 14 babies (63.64%) at stage III. The primary disease for AKI included neonatal pneumonia (9 cases), sepsis (6 cases), intrauterine asphyxia (4 cases) and other diseases (3 cases). Seventeen of them (77.27%) had multiple organ failure, including failure of two organs in 6 cases (27.27%) and failure of 3 or more than 3 organs in 11 cases (50.0%). Mechanical ventilation was conducted in 16 cases (72.73%) and vasoactive agents were used in 15 cases (68.18%). The average duration of PD was (154±103.76)h and the average dose was (388.71±28.48)ml/(kg· d). Nine cases survived and 13 cases died with the 30-day survival rate of 40.9%. Cox regression model analyses revealed that the key factors affecting the survival rate were AKI stage III, use of vasoactive drugs, mechanical ventilation and failure of more than 3 organs. Multivariate regression analyses showed that the use of vasoactive agents was an independent risk factor for prognosis. The PD related complications included leakage of dialysate (2 cases), exitsite bleeding (2 cases) and obstruction of the catheters due to omental wrap (3 cases). No PD associated peritonitis occurred. Conclusions Emergent PD was a safe and effective treatment for AKI in newborns. The prognosis of these neonatal babies depended mainly on their general conditions. Metrics

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The dropout rate of intradialysis exercise rehabilitation in patients with maintenance hemodialysis: a muliti-center survey 2018, 17 (12):  810-813.  doi: 10.3969/j.issn.1671-4091.2018.12.005 Abstract ( 284 )   PDF (446KB) ( 651 )   【Abstract】Purpose The status of quo and dropout of intradialysis exercise in maintenance hemodialysis (MHD) patients was investigated in order to provide better strategies for the clinical management of exercise rehabilitation in MHD patients. Methods Questionnaire were designed to ask patients to participate in a multicenter randomized controlled study called "exercise rehabilitation on the quality of life in MHD patients" to investigate the situation and cause of dropout of intradialytic exercise. Results ①A total of 202 patients (99 in exercise group and 103 in non-exercise group) were recruited from 6 hemodialysis centers, and 29 of them (14.4%) dropped out of intradialytic exercise during the study. ②Twenty-one patients (21.2%) in the exercise group and 8 patients (7.8%) in the control group dropped out of intradialytic exercise (χ2=7.422 and P=0.006 between the two groups). In the dropout causes, objective causes accounted for 82.8% and subjective causes accounted for 17.2%. ③ The differences were statistically significant in dialysis age ( U = 1835.500, Z = - 2.311, P=0.021) and the score of falling down to the ground (U=2043.500, Z=-2.618, P=0.009) between dropout patients and non-dropout patients. There were no statistical differences in sleep score, family support and total number of complications in a recent month. Conclusion The overall dropout rate of intradialytic exercise rehabilitation was lower. Objective causes accounted mainly for the dropout both in exercise group and non-exercise group. Moderate intensity of intradialysis exercise was safe. Education and systematic management of the patient are necessary to the implementation of long-term intradialytic exercise rehabilitation. Metrics

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Study on the influencing factors of exercise self- efficacy in maintenance hemodialysis patients 2018, 17 (12):  814-817.  doi: 10.3969/j.issn.1671-4091.2018.12.006 Abstract ( 269 )   PDF (407KB) ( 776 )   【Abstract】Objective To investigate the exercise self-efficacy level and its influencing factors in patients with maintenance hemodialysis (MHD) in order to provide a reliable reference for the exercise intervention in MHD patients. Methods A cross-sectional survey of 199 patients in the dialysis center was conducted using self- designed general data questionnaire, sports self- efficacy scale and social support rating scale. Results The total self-efficacy was 40 (12.22, 58.33) points in the MHD patients in this center. The highest score was “after the disease stopped me and the body recovered”(1.78±0.25 points), and the lowest score was“when I exercised I felt uncomfortable”(1.61±0.30 points). Multiple linear regression analyses showed that gender (β =-0.184, P=0.008), body mass index (BMI) (β =-0.244, P＜0.001), number of dialysis per week (β=0.131, P=0.049) and social support (β=0.317, P＜0.001) were the factors affecting exercise self-efficacy in MHD patients. Conclusion The exercise self-efficacy was low in MHD patients. Medical staffs should develop personalized exercise plans based on different influencing factors to improve the exercise self-efficacy and physical activity in MHD patients. Metrics

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Influence of glucose-added dialysate on blood glucose level in diabetic nephropathy patients during hemodialysis: a meta-analysis 2018, 17 (12):  818-823.  doi: 10.3969/j.issn.1671-4091.2018.12.007 Abstract ( 379 )   PDF (1042KB) ( 703 )   【Abstract】Objective To systematically evaluate the effect of glucose-added dialysate on blood glucose level in diabetic nephropathy (DN) patients during hemodialysis (HD). Methods We searched PubMed, Cochrane Library, EMbase, CNKI, VIP and WanFang databases to collect randomized controlled trials (RCTs) that studied the effects of dialysate with different glucose concentrations on blood glucose level in DN patients during hemodialysis. Meta-analysis was performed by RevMan5.3 software. Results Ten trials involving 51 patients in 3 self-control trials and 281 patients in 7 RCTs were included and assessed. Meta-analysis suggested three groups of information. (a) The group of 0-3 mmol/L glucose included a study containing 3mmol/L glucose; there were no statistical differences in blood glucose and incidence of hypoglycemia during hemodialysis between the two groups. (b) The group of 3-6 mmol/L glucose included 5 studies containing 5.5mmol/L glucose and 2 studies containing 5 mmol/L glucose; compared with the group using glucose-free dialysate, the group using glucose-added dialysate had lower incidence of hypoglycemia (MD=0.16, 95% CI 0.06-0.48, P<0.001) and higher blood glucose level, including blood glucose after beginning of dialysis for one hour (MD=3.04, 95% CI 2.42-3.67, P<0.001), 2 hours (MD=3.50, 95% CI 3.08-3.91, P<0.001), 3 hours (MD=5. 59, 95% CI 5.07-6.11, P<0.001) and 4 hours (MD=3.94, 95% CI 3.31-4.56, P<0.001). (c) The group of 9-12 mmol/L glucose included 2 studies containing 11.1 mmol/L glucose; this group used glucose-added dialysate and blood glucose was significantly higher than that of the group using glucose-free dialysate, resulting in significant hyperglycemia and parasympathetic hyperactivity. Conclusion The dialysate containing 5 mmol/L or 5.5 mmol/L glucose not only increases blood glucose and prevents the occurrence of hypoglycemia but also avoids excessive high blood glucose and parasympathetic hyperactivity. If the conditions of the medical units permit, we recommend using dialysate containing 5 mmol/L or 5.5 mmol/L glucose, which are similar to the physiological concentration. Due to limitation of quantity and quality of the included studies, more high quality studies are needed to verify the above conclusion. Metrics

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Research progress in the effect of cold dialysis for hemodialysis patients 2018, 17 (12):  824-826.  doi: 10.3969/j.issn.1671-4091.2018.12.008 Abstract ( 335 )   PDF (348KB) ( 776 )   【Abstract】Cold dialysis has become a concerning issue in hemodialysis patients. It has the advantages of simplicity, economy and effectiveness. It plays a role in preventing intradialytic hypotension, improving fatigue of the patients, and protecting heart and brain functions. In this review, we summarize the effect of cold dialysis in hemodialysis patients in order to provide reference for the implementation and further research of cold dialysis. Metrics

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Clinical value and research progress of peritoneal dialysis in the treatment of acute kidney injury 2018, 17 (12):  827-830.  doi: 10.3969/j.issn.1671-4091.2018.12.009 Abstract ( 272 )   PDF (392KB) ( 619 )   【Abstract】Acute kidney injury (AKI) is a common, acute and critical illness with high mortality. Renal replacement therapy including extracorporeal blood purification and peritoneal dialysis (PD) is an effective method for the treatment of AKI. Peritoneal dialysis is less expensive and convenient, especially suitable for the patients in developing countries. However, it is now less used in western countries and in China. In recent years, many studies have proved that PD is effective and safe for the treatment of AKI. This article discusses its clinical value in the context of advantages, disadvantages and prognosis in AKI patients treated with PD. Metrics

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Endothelial-to-mesenchymal transition and stenosis of arteriovenous fistula 2018, 17 (12):  831-834.  doi: 10.3969/j.issn.1671-4091.2018.12.010 Abstract ( 279 )   PDF (358KB) ( 649 )   【Abstract】Stenosis is the main cause of occlusion and malfunction of arteriovenous fistula (AVF). Pathologically, AVF stenosis is characterized by intimal hyperplasia, of which the mechanism remains unclear. Endothelial-to-mesenchymal transition results in plenty of myofibroblasts and extracellular matrix, which may relate to the pathological features of AVF stenosis. This paper summarizes the relationship between endothelialto- mesenchymal transition and AVF stenosis, providing a new idea useful for the understanding, clinical prevention and treatment of AVF stenosis. Metrics

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Factors associated with access blood flow in maintenance hemodialysis patients 2018, 17 (12):  835-838.  doi: 10.3969/j.issn.1671-4091.2018.12.011 Abstract ( 350 )   PDF (495KB) ( 903 )   【Abstract】Objective The aim of this cross-sectional study was to investigate clinical factors associated with access blood flow in maintenance hemodialysis (MHD) patients. Methods Ultrasound dilution (UD) was used to measure access flow (Qa), recirculation rate and cardiac output (CO). Multivariate logistic regression was performed to evaluate the contribution of the variables on access flow. Results A total of 117 MHD patients were included in this study. Their mean Qa was 896±454 ml/min. UD measurements classified 21 cases (17.9%) having Qa ＜500 ml/min, 85 cases (72.6%) having Qa 500~1,500 ml/min, and 11 cases (9.4%) having Qa ≥1,500 ml/min. Patients with diabetes had significantly lower Qa (t=4.615, P＜0.001) and higher prevalence of stenosis (t=5.356, P=0.029). Logistic regression analyses showed that diabetes history (OR 8.782, 95% CI: 1.862～41.412, P=0.006) and previous access surgery (OR 4.087, 95% CI: 1.082～15.437, P=0.04) were independently associated with lower access flow (Qa＜500 ml/min). Conclusions History of diabetes is the most important independent risk factor for lower access flow in MHD patients and may indicate long-term poor access patency. Access flow surveillance may be helpful in these patients. A prospective cohort study is on our schedule to further validate the findings from this study. Metrics

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Perioperative prevention and treatment of arteriovenous graft induced distal ischemia 2018, 17 (12):  839-842.  doi: 10.3969/j.issn.1671-4091.2018.12.012 Abstract ( 285 )   PDF (386KB) ( 618 )   【Abstract】Objectives To discuss the early perioperative prevention and treatment of arteriovenous graft (AVG) induced ischemia. Methods The effect of perioperative prevention and treatment of AVG induced ischemia in Department of Vascular Surgery, Shanghai Longhua Hospital was retrospectively analyzed. Results From Jan. 2017 to Apr. 2018, upper limb AVG was performed in a total of 129 cases. Light or moderate hand ischemia was found in 87 cases, with the mean age of 58.9±11.2 yrs and mean dialysis period of 76.3±64.5 months; 59 cases (67.8%) had gradeⅠischemia, and 28 cases (32.2%, 27 cases with numb and one case with ache) had grade Ⅱa ischemia. Capillary filling time immediately after the operation was significantly longer than that of preoperation (3.69±0.45s vs. 1.58±0.14s, P＜0.001). After treatment of warm preservation, alprostadil and papaverine for spasmolysis and vascular dilatation, the symptoms of ischemia relieved. Capillary filling time after operation for 5 days and that of preoperation became no statistically different anymore (P=0.172). The comparison between capillary filling time before operation, immediately after operation and after operation for 5 days by one-way ANOVA showed a result of F=1588.274, P＜0.001. Conclusions Comprehensive evaluation and carefully designing the operation before AVG and warm preservation and drugs for spasmolysis and vascular dilatation after AVG operation can effectively prevent and reduce the postoperative ischemia. Metrics

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Bending-angle is an important factor for the dysfunction of temporary hemodialysis catheters 2018, 17 (12):  843-846.  doi: 10.3969/j.issn.1671-4091.2018.12.013 Abstract ( 313 )   PDF (580KB) ( 584 )   【Abstract】Objective To analyze the causes of catheter dysfunction by observation of the appearance and longitudinal section of the temporary catheters removed from maintaining hemodialysis (MHD) patients. Methods The MHD patients using temporary catheters at the beginning of MHD in Department of Nephrology, Jiangmen Traditional Chinese Medicine Hospital Affiliated to Jinan University from January 2017 to June 2018 were recruited for analyses. We analyzed the cause of catheter dysfunction by observation of the removed temporary catheters about the bending-angle of the main segment, the formation of fibrin sheath and the length of thrombus in the longitudinal section of the catheters. Results A total of 45 patients were available for analyses. The rate of catheter dysfunction was 13.33% (6/45). The bending- angle of the catheter ranged from 5°～44°. The mean bending-angles of the functional catheter group and the dysfunctional catheter group were 13.87±5.42° and 31.67±7.71° respectively (t=-5.449, P=0.002). Blood flow was negatively correlated with age and bending-angle (t=10.027, P＜0.001). The length of venous thrombus was negatively correlated with age and bending-angle (r=0.722, P＜0.001). Conclusion The bending-angle of temporary catheter is an important factor for catheter dysfunction in MHD patients. The larger the bending-angle was, the worse the catheter function was. When the angle is greater than 30 degrees, the possibility of catheter dysfunction increase significantly. Metrics

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A study on the relationship between reaction and coping style in major caregivers of hemodialysis patients 2018, 17 (12):  850-853.  doi: 10.3969/j.issn.1671-4091.2018.12.015 Abstract ( 218 )   PDF (356KB) ( 644 )   【Abstract】Objective To understand the reaction and coping style and the relationship between reaction and coping style in main caregivers for maintenance hemodialysis (MHD) patients. Methods A total of 120 primary caregivers for MHD patients in a hospital were investigated by general information questionnaire, caregiver response rating scale and simplified coping style scale. Results In the major caregivers for MHD patients, self-esteem dimension was positively correlated with positive coping style; negative dimension was positively correlated with negative coping style. Conclusions Nursing staff should take positive and effective measures to reduce the burden of caregivers and enhance their coping ability to improve the quality of life of caregivers and MHD patients. Metrics