Chinese Journal of Blood Purification

12 February 2019, Volume 18 Issue 02 Previous Issue    Next Issue

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Clinicopathological characteristics in patients with essential and secondary cryoglobulinemia related glomerulonephritis 2019, 18 (02):  73-76.  doi: 10.3969/j.issn.1671-4091.2019.02.001 Abstract ( 317 )   PDF (388KB) ( 710 )   【Abstract】Objective To analyze the clinicopathological characteristics in patients with essential and secondary cryoglobulinemia related glomerulonephritis (CGN). Methods A total of 35 patients diagnosed as CGN in Peking University People's Hospital during 2009-2017 were recruited. Their clinical and pathological data were investigated. Results Twenty-three CGN patients with specific causes were divided into secondary CGN group, and 12 patients without any underlying disease were divided into essential CGN group. Extra-renal manifestations were uncommon (0～17.1%) in both groups. The false negative rate of serum cryoglobulin was 48.5%. The decrease of C3 was more common than the decrease of C4. Compared with essential CGN group, more females, higher serum globulin level and lower serum complement levels were found in secondary CGN group. Multiple immune compound deposits were mainly seen in secondary CGN group. Half of the essential CGN patients had a renal pathology manifested as IgA nephropathy. Conclusion ①Since renal involvement in cryoglobulinemia often happened before other organ damages and the result of serum cryoglobulin may be false negative, renal biopsy is a useful tool to confirm the speculation especially to those with negative serum cryoglobulin. ②The decrease of C3 was commonly seen in both groups, indicating that cryoglobulin may not only activate complement by the classical pathway. ③Secondary CGN should be considered in patients with significantly higher globulin level, lower complement level and renal pathological changes characterized by multiple immune compound deposits. Metrics

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Changes of dendritic cells and inflammatory factors in uremic patients before and after hemodialysis 2019, 18 (02):  77-82.  doi: 10.3969/j.issn.1671-4091.2019.02.002 Abstract ( 267 )   PDF (499KB) ( 601 )   【Abstract】Objective To explore the changes of dendritic cells and inflammatory factors in hemodialysis patients before and after dialysis. Method Twenty- two uremia patients treated in our hospital for ≥3 months were recruited as the observation group, and 25 healthy people were selected as the control group. Changes of blood urea nitrogen (BUN), serum creatinine (SCr), hemoglobin (Hb), C reactive protein (CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor (TNF) and dendritic cells (CD80+, CD86+, CD83+ , and CD40+ cells) were observed before and after hemodialysis in the patients in observation group. Results In observation group before hemodialysis, BUN, SCr, CRP, IL-6, IL-10 and TNF-α were significantly higher than those of control group (P=0.001, ＜0.001, ＜0.001, ＜0.001, ＜0.001 and＜0.001 respectively); after hemodialysis, CRP, IL-6, IL-10, TNF-α, BUN and SCr were significantly lower than those before hemodialysis (P=0.001, ＜0.001, ＜0.001, ＜0.001, ＜0.001 and ＜0.001 respectively). In observation group before hemodialysis, CD80+ , CD86+ , CD83+ and CD40+ cells and IL-12 were significantly lower than those of control group (P=0.001, 0.001, 0.001, 0.001 and ＜0.001 respectively); after hemodialysis, they became significantly higher than those before hemodialysis (P=0.001, 0.001, 0.001, 0.001 and 0.001 respectively) but were still lower than those of control group (P<0.001). Conclusion Maintenance hemodialysis can significantly increase the number of mature dendritic cells in the peripheral blood of uremic patients, which may contribute to the improvement of microinflammation and clinical status of the patients. Metrics

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The application of automated peritoneal dialysis in patients with urgent dialysis indication 2019, 18 (02):  83-89.  doi: 10.3969/j.issn.1671-4091.2019.02.003 Abstract ( 349 )   PDF (470KB) ( 629 )   【Abstract】Objective To investigate the efficiency, complications and long- term prognosis of urgentstart automated peritoneal dialysis (urgent-APD). Methods This retrospective study enrolled 16 urgent-APD patients treated in Peking Union Medical College Hospital from March 1996 to December 31, 2017. In addition, we randomly chose 32 peritoneal dialysis (PD) patients who matched the urgent- start APD patients in age, gender and dialysis time from 187 urgent-start intermittent peritoneal dialysis (urgent-IPD) and 464 conventional- start PD patients. The efficiency, mechanical and infectious complications, technique survival and patient survival were compared between the groups. Results There were no differences in baseline characteristics between the groups except that the period from catheter insertion to PD initiation was shorter in urgent-APD patients than in conventional- start PD patients (5 days vs. 15 days, P＜0.001). After PD initiation for one month, the mean daily ultrafiltration volume was greater in urgent-APD patients than in urgent-IPD patients (730ml vs. 125ml, P=0.010). After PD initiation for 3 months, weekly Kt/V was lower in urgent-APD patients than in conventional- start PD patients (2.10±0.22 vs. 2.70±0.63, P=0.001), and weekly creatinine clearance rate (Ccr) and residual glomerular filtration rate (rGFR) were comparable between urgent-APD, urgent-IPD and conventional-start PD patients. In the first 180 days after PD initiation, there were no differences in peritonitis- free survival, technique survival, and mechanical and infectious complications between urgent-APD, urgent-IPD and conventional-start PD patients. In urgent-APD patients, the 6-month, one- and 3-year survival rates were 85.1%, 69.6% and 60.9% respectively. Multivariate Cox hazard model showed that urgent-APD was not the independent risk factor for mortality (P=0.804 and 0.173, compared to urgent-IPD and conventional-start PD patients respectively). Conclusions Urgent-start APD has comparable efficiency, incidence of complications, technique survival and patient survival with urgent-start IPD and conventional-start PD. Therefore, urgent-start APD can be used as an alternative in the patients with urgent dialysis indication. Metrics

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The effect of different renal replacement therapy on cognitive function in patients with end-stage renal disease: a meta-analysis 2019, 18 (02):  90-97.  doi: 10.3969/j.issn.1671-4091.2019.02.004 Abstract ( 238 )   PDF (1793KB) ( 853 )   【Abstract】Objective To assess the effect of different renal replacement therapy on cognitive function in patients with end-stage renal disease (ESRD). Methods We searched the databases of CBM, CNKI, VIP, PubMed, Medline, Embase, Cinahl and PsycARTICLES from inception to March 31, 2018 for English and Chinese literature including cross-sectional studies, cohort studies and case-control studies that studied the effect of different renal replacement therapy on cognitive function in ESRD patients. Literature screening, data extraction and bias assessment of all eligible studies were conducted independently by two reviewers. Metaanalysis was conducted by using the RevMan 5.3 software. Results A total of 18 studies which included 1, 787 participants were analyzed. Meta-analysis showed that ①the cognitive function score of hemodialysis patients was lower than that of peritoneal dialysis patients (SMD=-0.660, 95% CI -1.020~-0.290, P＜0.001); ② the cognitive function score of hemodialysis patients was lower than that of renal transplantation patients (SMD=-1.510, 95% CI -2.990~-0.030, P=0.050); and ③the cognitive function score of peritoneal dialysis patients was lower than that of renal transplantation patients (SMD=-2.160, 95% CI -4.220~-0.090, P=0.040). Conclusion Our results suggested that the cognitive function was different in ESRD patients treated by different renal replacement therapy. Cognitive function score of renal transplantation patients was greater than that of hemodialysis and peritoneal dialysis patients, and the score of peritoneal dialysis patients was greater than that of hemodialysis patients. Metrics

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Calcium dobesilate can alleviate diabetes-induced endothelial dysfunction and inflammation 2019, 18 (02):  98-103.  doi: 10.3969/j.issn.1671-4091.2019.02.005 Abstract ( 267 )   PDF (443KB) ( 681 )   【Abstract】Objective The aim of the present study was to elucidate the protective effects of calcium dobesilate (CaD) against diabetes-induced endothelial dysfunction and inflammation as well as the safety and efficacy of CaD in the treatment of diabetic kidney disease (DKD). Methods This was a prospective and casecontrol study to observe the differences in endothelial and inflammation related markers among DKD patients, diabetic patients without proteinuria and healthy individuals. DKD patients were then randomly divided into the treatment group (CaD 500mg, 3 times daily) and the observation group. They were treated for 3 months. Endothelial function markers including vascular endothelial growth factor (VEGF), endothelin-1(ET-1), endothelial nitric oxide synthase (eNOS) and nitric oxide (NO) and inflammation markers including monocyte chemotactic protein 1 (MCP-1), intercellular cell adhesion molecule-1 (ICAM) and pentraxin 3 (PTX3) were assayed. Results In the 100 DKD patients, PTX3, MCP-1, ICAM, VEGF and ET-1 were significantly higher than those in diabetic patients without proteinuria (P＜0.001) and were positively correlated with the microamount of albuminuria (r=0.356, 0.254, 0.247, 0.267, 0.216 respectively; P=0.001, 0.003, 0.004, 0.002 and 0.012 respectively). NO was significantly lower in DKD patients than in diabetic patients without proteinuria (P＜0.001) and was negatively correlated with the micro-amount of albuminuria (r=-0.229, P=0.027). Logis-tic regression analysis showed that PTX3 (OR=2.761, 95% CI: 1.358～5.615, P=0.017), NO (OR=0.941, 95% CI: 0.905～0.979, P=0.003) and HbAlc (OR=3.304, 95% CI: 1.228～8.884, P=0.019) were the influence factors for DKD. ROC curve showed that PTX3, NO and HbAlc levels were the predictive markers for the presence of DKD in diabetic patients. In the prospectively study of DKD patients treated with CaD for 3 months, their 24 hours urinary albumin and 24 hours urinary protein decreased significantly (P=0.010 and 0.014 respectively) but their cystatin C based GFR did not change. In DKD patients after CaD treatment, inflammation markers of PTX3, MCP-1, hsCRP and ICAM and endothelial markers of VEGF, NO and ET-1 ameliorated significantly as compared with those before CaD treatment (P=0.008, 0.009, 0.040, 0.013, 0.003, 0.001 and 0.004 respectively). Conclusion CaD can improve renal function in DKD patients through the improvement of their micro-inflammation status and endothelial function to reduce proteinuria. Metrics

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Clinical effect and analysis of different parathyroid hormone level on the patients after total parathyroidectomy 2019, 18 (02):  104-106.  doi: 10.3969/j.issn.1671-4091.2019.02.006 Abstract ( 376 )   PDF (300KB) ( 605 )   【Abstract】Objective To investigate the relationship between different parathyroid hormone level and clinical cardiovascular events in the consecutive dialysis patients with secondary hyperparathyroidism after parathyroidectomy，and to explore the reasonable control range of postoperative iPTH level. Method Sixty patients undergoing maintenance hemodialysis with secondary hyperparathyroidism after parathyroidectomy were divided into three groups: iPTH < 60 pg/ml, iPTH 60-150 pg/ml and iPTH 150-300 pg/ml. Statistical analysis of the relevant data. Result The level of Ca,P,Ca×P,iPTH,CCS of the patients after parathyroidectomy were lower than those before operation (P=0.018, P=0.034, P =0.023, P =0.007, P =0.006). Postoperatively, as the iPTH gradually decreases ,the coronary calcification score gradually increases,the difference had statistical significance (P=0.014, P =0.026). but the cardiovascular events in group iPTH < 60 pg/ml were significantly higher than the above two groups, the difference had statistical significance (P =0.023, P =0.037, P =0.014, P =0.046). Conclusion Coronary artery calcification and hyperphosphatemia can be significantly alleviated after parathyroidectomy in CKD5 patients with secondary hyperparathyroidism. However, too low iPTH can significantly increase the incidence of cardiovascular events and mortality in postoperative patients. Metrics

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Investigation of psychological and cognitive functions and their influential factors in maintenance hemodialysis patients 2019, 18 (02):  107-109.  doi: 10.3969/j.issn.1671-4091.2019.02.007 Abstract ( 300 )   PDF (348KB) ( 685 )   【Abstract】Objective To evaluate the psychological and cognitive functions and their influential factors in maintenance hemodialysis (MHD) patients. Methods A total of 113 MHD patients with regular hemodialysis for more than three months in Beijing Bo’ai Hospital of China Rehabilitation Research Center in the period from May 1, 2017 to May 1, 2018 were enrolled in this study. Psychological function was assessed by Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS), and cognitive function was assessed by Simple Mental State Assessment Scale (MMSE). Results For psychological function in MHD patients, the prevalence rate of anxiety was 8.6% (mild anxiety 5.2% and severe anxiety 3.4%); the prevalence of depression was 69% (mild depression 29.3%, moderate depression 21.6% and severe depression 18.1%). For cognitive function in MHD patients, the prevalence of cognitive dysfunction was 33.6%; cerebrovascular disease was an independent risk factor for cognitive impairment, and the risk of cognitive impairment increased significantly in MHD patients with cerebrovascular disease (OR=3.092, 95% CI: 1.192~8.025, P=0.020). Conclusion MHD patients have a higher prevalence rate of psychological disorders and cognitive dysfunction at various degrees. Cerebrovascular disease is an independent risk factor for cognitive dysfunction. Metrics

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A nomogram to predict the maturity of arteriovenous fistulas for hemodialysis 2019, 18 (02):  110-114.  doi: 10.3969/j.issn.1671-4091.2019.02.008 Abstract ( 276 )   PDF (547KB) ( 808 )   【Abstract】 Objective   To develop a nomogram for predicting arteriovenous fistula (AVF) maturity in hemodialysis patients. Methods   A total of 238 hemodialysis patients treated in the period from January 1, 2016 to January 1, 2018 were enrolled in this study as the model group, and a total of 80 uremic patients treated in the period from January 1, 2018 to July 8, 2018 were recruited as the validation group. Baseline characteristics and ultrasound parameters were collected for analyses. We performed logistic regression analysis to identify the independent risk factors for AVF maturity, and then constructed a nomogram according to a regression equation to predict the results. Concordance index (C-index) and calibration curve were used to verify the predictive and discriminative abilities of the nomogram. Results A total of 176 patients (74.8%) achieved AVF maturation during the 8- week study period. Multivariate logistic regression showed that the risk factors for AVF maturity included systolic pressure (OR=0.987, 95% CI: 0.975～0.999, P=0.032), serum phosphate (OR = 0.012, 95% CI: 0.312～0.866, P=0.012), serum cholesterol (OR=0.694, 95% CI: 0.577～0.835,P＜0.001), diabetes (OR=0.226, 95% CI: 0.107～0.477, P＜0.001) and hypertension (OR=0.121, 95% CI: 0.059～0.249, P＜0.001); and that the protective factors significantly associated with the maturity included cephalic vein diameter (OR=7.301, 95% CI: 3.369～15.821, P＜0.001), radial artery diameter (OR=3.225, 95% CI=1.441～7.218, P=0.004), radial artery blood flow (OR=1.086, 95% CI: 1.058～1.115, P＜0.001) and cephalic vein diameter after pressure (OR=2.955, 95% CI: 1.747～4.998, P＜0.001). A nomogram, which included the variances of cephalic vein diameter (β =1.700, P＜0.001), radial artery blood flow (β =0.054, P＜ 0.001), serum cholesterol (β=-0.326, P=0.034), diabetes (β=-1.183, P=0.017) and hypertension (β=-1.624, P= 0.002), was constructed. This nomogram has better discrimination and calibration abilities to predict AVF maturation. Receiver operator curves (ROC) indicated that the area under the curve (AUC) of the nomogram model was higher than that of physical and routine color Doppler ultrasound examinations for predicting AVF maturity among 80 patients. Conclusion The nomogram established in this study is better than preoperative routine vascular ultrasound and physical examinations for predicting AVF maturity. This nomogram provides a simple and direct method for personalized prediction of AVF maturity. Metrics

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Water quality control is the fundamental quality management of hemodialysis 2019, 18 (02):  118-120.  doi: 10.3969/j.issn.1671-4091.2019.02.010 Abstract ( 261 )   PDF (369KB) ( 846 )   【Abstract】The quality of water and fluid for hemodialysis (HD) is correlated to the mortality and quality of life in HD patients because they have to be contact with huge amount of dialysate during HD. The new quality standards have been announced for one year. However, there are so many problems in the real circumstances. These problems are often ambiguous due to the unmatched evidence between clinical work and quality control (QC) of dialysis water. Therefore, it is necessary to review the references about QC of water and fluid for HD, the core and origin of QC for HD. To achieve the target of continuous quality improvement of water and fluid for HD, the comprehension of the importance of water QC in all personnel, monitoring water QC in every process and at all time, and early warning intervention when it reaches‘50% level’must be emphasized. Metrics

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Current situation and prospect of centralized liquid supply system in China 2019, 18 (02):  121-123.  doi: 10.3969/j.issn.1671-4091.2019.02.011 Abstract ( 685 )   PDF (446KB) ( 997 )   【Abstract】The clinical use of centralized liquid supply system (CDS system) for dialysis has increased year by year. In China, the set-up of centralized liquid supply equipment is delayed, and no relevant national standards have yet been established. At present, different CDS systems in China have different advantages and disadvantages in clinical use. This paper introduces the basic principles of the two kinds of centralized liquid supply equipment in China, central dialysis concentrate supply system (CCDS) and central dialysis fluid delivery system (CDDS), briefly describes the current situation of clinical use, and expects to develop the centralized liquid supply equipment in the future. Metrics

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Correlation between blood magnesium level and vascular calcification and calciphylaxis in chronic kidney disease patients 2019, 18 (02):  124-126.  doi: 10.3969/j.issn.1671-4091.2019.02.012 Abstract ( 353 )   PDF (341KB) ( 617 )   【Abstract】Magnesium is an important ion in the human body and participates in many metabolic processes including bone metabolism, nerve conduction, heart rhythm and vasoconstriction. Studies have focused on calcium, phosphorus, parathyroid hormone and abnormal bone metabolism in patients with chronic kidney disease (CKD) and end stage renal disease (ESRD). Recent studies find that dialysis patients with hypomagnesemia have increased risks of vascular calcification, cardiovascular disease and all-cause mortality rate. ESRD patients, especially those complicated with diabetes, hyperphosphatemia, hypercalcemia and uremia environment, have high risk of calciphylaxis. In this review, we introduce the correlation and mechanism between blood magnesium level and vascular calcification and calciphylaxis in CKD patients. Metrics

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Design and implementation of the training mode based on VARK learning style for peritoneal dialysis patients 2019, 18 (02):  137-141.  doi: 10.3969/j.issn.1671-4091.2019.01.016 Abstract ( 130 )   PDF (474KB) ( 170 )   【Abstract】Objective To probe into the impact of the training mode of different learning style on the main monitoring indexes in peritoneal dialysis (PD) patients. Methods By convenience sampling method, 156 PD cases in the period from February 2016 to June 2017 were recruited and randomly divided into observation group (n=78) and control group (n=78). The traditional 7 days training method was applied to the control group, while the observation group received Fleming's visual aural read/write kinesthetic (VARK) questionnaire to assess their learning style in order to set up a VARK learning style, the individualized training mode, for each of them. During the following 6-month of follow-up, the changes of the main monitoring indexes were statistically analyzed between the two groups. Results The scores of self- management skills, qualification rate of PD knowledge and operation, incidence of peritonitis, and rate of hospitalization due to clinical events were statistically different between the two groups after 6 months. No dramatic differences of infection rate around the exit and satisfaction of patients were found between the two groups after 6 months. Conclusion The individualized training method with distinguished learning style for PD patients can improve their training quality and patient self-management skills, reduce the incidence of PD-related peritonitis, decrease the rate of hospitalization due to clinical events, and improve the efficiency of PD. Metrics