Chinese Journal of Blood Purification

12 March 2019, Volume 18 Issue 03 Previous Issue    Next Issue

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Novel understanding of the strategies to preserve peritoneal membrane function in patients on peritoneal dialysis 2019, 18 (03):  145-148.  doi: 10.3969/j.issn.1671-4091.2019.03.001 Abstract ( 378 )   PDF (358KB) ( 753 )   【Abstract】Peritoneal dialysis (PD) is a widely used renal replacement therapy. As the increase of PD age in the patients, changes of peritoneal function occur, which is characterized by the increase of solute transport and decrease of ultrafiltration. Ultrafiltration failure (UFF) will eventually lead to PD failure. Recurrent peritonitis, prolonged exposure to bioincompatible dialysate and long dialysis age are the major contributors to peritoneal dysfunction. Corresponding anatomical changes in the peritoneum include peritoneal fibrosis, hyalinizing vasculopathy and angiogenesis. Many biomarkers are clinically used to effectively assess and predict changes of peritoneal function. Implementing effective measures to protect peritoneal function can prolong PD age and improve survival rate of PD patients. Recently, strategies to preserve peritoneal membrane function in PD patients have become a new research hotspot. This review briefly describes the latest research progress in strategies to preserve peritoneal membrane function. Metrics

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Automatic peritoneal dialysis for the treatment of critical patients with acute renal failure 2019, 18 (03):  149-152.  doi: 10.3969/j.issn.1671-4091.2019.03.002 Abstract ( 420 )   PDF (392KB) ( 751 )   【Abstract】Because of the advantages of convenience and flexibility, automated peritoneal dialysis (APD) is becoming the choice for many end- stage renal disease (ESRD) patients, especially for those of young adults, infants, elderly, and peritoneal dialysis patients with inadequate clearance of solutes and recurrent peritonitis. APD has the advantages of labor- saving and prevention of peritoneal dialysis associated complications, and can be used in urgent start dialysis. APD has less hemodynamic disturbance and does not need anticoagulant and extracorporeal circulation, with lower medical risks and expenses. Recently, APD has been successfully used in the treatment of many acute and severe diseases, such as congestive heart failure, acute cardio-cerebrovascular disease and acute pancreatitis. Percutaneous catheterization at bedside facilitates the application of APD in acute kidney injury patients, but the efficacy and safety need to be further studied by comprehensive comparisons of APD and hemodialysis. As a new dialysis modality, APD in peritonitis diagnosis and treatment, water clearance and nutritional influence remain unknown and more investigations are required. Metrics

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Application of peritoneal dialysis in adult acute kidney injury 2019, 18 (03):  153-156.  doi: 10.3969/j.issn.1671-4091.2019.03.003 Abstract ( 338 )   PDF (389KB) ( 805 )   【Abstract】Acute kidney injury (AKI) is one of the most common critical illnesses. Renal replacement therapy is an important measure for the treatment of AKI patients. The application of peritoneal dialysis (PD) in AKI is often overlooked. PD has the advantages of easy operation, no need for special equipment and anticoagulation, and little influence on hemodynamics. It has been recommended by the International Society of Peritoneal Dialysis (ISPD) as one of the ideal renal replacement methods for AKI treatment. This article reviews the current status, advantages, appropriate time for emergency dialysis, access and dialysate, dialysis dose and complications of PD in adult AKI. Metrics

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Long-term prognosis of end stage diabetic kidney disease patients treated with automated peritoneal dialysis 2019, 18 (03):  160-165.  doi: 10.3969/j.issn.1671-4091.2019.03.005 Abstract ( 367 )   PDF (622KB) ( 725 )   【Abstract】Objective To investigate the clinical characteristics, prognosis and the risk factors for longterm survival in end-stage renal disease patients including end-stage diabetic kidney disease patients treated with automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). Method This is a retrospective cohort study. Adult peritoneal dialysis patients (peritoneal dialysis over 3 months) from September 1st, 2002 to June 30th, 2018 were enrolled in this study. Their baseline data were collected. These patients were followed up to September 30th, 2018 and death was defined as end point. Survival of APD patients and CAPD patients, diabetic kidney disease (DKD) and non-DKD patients were compared. Univariate and multivariate Cox regression were used to identify the risk factors for long-term prognosis. Results A total of 534 PD patients (92 APD patients and 442 CAPD patients; 198 DKD patients and 336 non-DKD patients) were enrolled in this study. Compared to non-DKD patients, DKD patients were older with a higher ratio of cardiovascular disease. DKD patients started dialysis earlier (creatinine at the time of dialysis: DKD 620.4±228.9 vs. non-DKD 808.0±352.0μmol/L, t=-6.556, P＜0.001). The cumulative survival rate after 1, 3, 5, and 10 years were 92%, 78%, 65% and 42% respectively in APD patients, and were 83%, 65%, 42% and 22%, respectively in CAPD patients. APD patients had longer median survival time (92.3 months vs. 64.3 months, χ2=8.675, P=0.003). DKD patients had shorter median survival time than non-DKD patients (47.9 months vs. 92.3 months, χ2=46.379, P＜0.001), and DKD patients treated with CAPD had the shortest median survival time (45.2 months, χ2=55.545, P＜0.001). Multivariate Cox regression identified that age (β=0.086, HR=1.090, 95% CI 1.039-1.144, P＜0.001), diabetes (β =1.126, HR=3.084, 95% CI 1.157- 8.221, P=0.024) and albumin level (β =- 0.099, HR=0.906, 95% CI 0.836-0.9983, P=0.017) were the risk factors for all-cause mortality in APD patients. Conclusion DKD patients treated with APD showed better long-term survival than those treated with CAPD. However, APD itself may not be the independent impact factor for survival. Metrics

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Detrimental roles of chronic kidney disease and hemoglobin abnormalities in hospitalized patients with chronic obstructive pulmonary disease 2019, 18 (03):  166-169.  doi: 10.3969/j.issn.1671-4091.2019.02.006 Abstract ( 129 )   PDF (396KB) ( 190 )   【Abstract】Purpose The roles of chronic kidney disease (CKD) and chronic obstructive pulmonary disease (COPD) on hemoglobin level are mutually contradicted. The aim of this study was to analyze the hemoglobin level in hospitalized patients with the both conditions and the detrimental effect of abnormal hemoglobin levels. Methods Clinical data were recruited from electronic medical records in the 12 hospitals. CKD was diagnosed by the creatinine estimated glomerular filtration rate. The mean hemoglobin level during hospitalization was used for the investigation. Results CKD occurred in 12.7% of hospitalized COPD patients. The incidences of anemia and polycythemia were 39.5% and 2.9%, respectively. With the progression of CKD, the incidence of anemia increased, while the incidence of polycythemia decreased. Univariate regression showed that CKD and both types of abnormal hemoglobin levels were associated with in-hospital mortality. After adjusted by elderly and the Charlson comorbidity score, anemia increased the risk of in- hospital mortality in patients without CKD (odds ratio 1.460, 95% CI 1.278～1.667,P＜0.001). However, anemia was not related to the mortality in CKD patients. Polycythemia was associated with the mortality in patients without CKD, early CKD and advanced CKD (odds ratios were 2.191, 2.034 and 3.687, respectively; 95% CIs were 1.654～2.902, 1.169～3.541,P=0.012 and 1.432～9.490,P＜0.007, respectively). Conclusion CKD aggravated anemia in hospitalized COPD patients. Anemia was a risk factor for in-hospital mortality in patients without CKD. Polycythemia was associated with the mortality in all COPD patients. Metrics

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Proteinuria increases nutritional risk of hospitalized kidney disease patients 2019, 18 (03):  170-172.  doi: 10.3969/j.issn.1671-4091.2019.02.007 Abstract ( 198 )   PDF (352KB) ( 195 )   【Abstract】Objective To evaluate the nutritional risk and its related risk factors in hospitalized kidney disease patients. Methods A total of 120 hospitalized patients in the nephrology ward were recruited. Their nutritional risks were evaluated using nutritional risk screening 2002 (NRS2002). Logistic regression model was used to analyze the risk factors. Results The prevalence of patients at nutritional risk in our nephrology ward was 60.8%. Compared with those without nutritional risk, patients with nutritional risk had lower BMI (t=2.542, P=0.012), lower serum albumin (t=6.155, P<0.001) and higher urina ry protein (Z=- 2.406, P=0.016). Serum albumin (OR=0.643, 95% CI 0.521～0.794, P<0.001) and 24- hour urinary protein (OR=0.264, 95% CI 0.119～0.588, P=0.001) were the risk factors for nutritional risk, and both of them were mutually interacted. Conclusions The prevalence of nutritional risk in hospitalized patients in our department was relatively high. Proteinuria was a risk factor for nutritional risk that may cause poor outcome. Regular nutritional screening and early intervention are required for these patients. Metrics

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Clinical analysis of acute pancreatitis in maintenance hemodialysis patients 2019, 18 (03):  173-176.  doi: 10.3969/j.issn.1671-4091.2019.02.008 Abstract ( 165 )   PDF (396KB) ( 236 )   【Abstract】Objective To explore the clinical features and possible etiology of acute pancreatitis in maintenance hemodialysis (MHD) patients. Method A total of 125 MHD patients in our dialysis center from July 2017 to September 2018 were enrolled in this study and divided into pancreatitis group and control group. The clinical manifestations and biochemical examination results of the patients in pancreatitis group were analyzed. Results Five MHD cases (4%) with acute pancreatitis are analyzed. The main clinical manifestations are abdominal pain and vomiting. As compared with the control group, patients in pancreatitis group have significantly higher levels of serum calcium (2.52±0.07mmol/L vs. 2.13±0.03mmol/L, t=3.534, P＜0.001), fasting blood glucose (12.93±1.96mmol/L vs. 8.37±0.36mmol/L, t=2.529, P=0.013) and hemoglobin (123.80±7.77g/L vs. 113.26±1.15g/L, t=2.197, P=0.028). There are no significant differences in age, kt/v, serum albumin, serum creatinine, serum phosphorus, serum cholesterol, serum triglycerides, serum parathyroid hormone, left ventricular ejection fraction and average between the two groups. Conclusion Higher levels of serum calcium, fasting blood glucose and hemoglobin may be responsible for the complication of acute pancreatitis in MHD patients. Continuous blood purification treatment is effective in severe acute pancreatitis. Metrics

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Investigation of the factors affecting plasma ADMA level in maintenance hemodialysis patients 2019, 18 (03):  177-180.  doi: 10.3969/j.issn.1671-4091.2019.03.009 Abstract ( 244 )   PDF (398KB) ( 616 )   【Abstract】Objective To study blood pressure change during dialysis and the factors influencing the level of plasma asymmetric dimethylarginine (ADMA). Methods We recruited 237 maintenance hemodialysis (MHD) patients from multiple centers. They were divided into intradialytic blood pressure stable group, hypotension group and hypertension group; dialysis age was comparable in the 3 groups. Intradialytic blood pressure fluctuation was recorded. Clinical biochemical indicators before dialysis, plasma ADMA and nitric oxide productions (N0x) before and after dialysis were recruited. Multivariate linear regression was used to analyze the independent factors associated with ADMA. Results Compared with the mean arterial pressure before dialysis, there were significant differences in dialysis time and basal levels between hypotension group and hypertension group (P<0.05). Age, female proportion, intact parathyroid hormone (iPTH) and brain natriuretic peptide (BNP) were significantly higher in hypotension group than in hypertension group (P=0.008, 0.252, 0.018 and <0.001, respectively) and stable group (P=0.018, 0.005, 0.006 and <0.001, respectively). Interdialytic body weight gain was higher in hypotension group than in hypertension group (P=0.014), while sodium ion concentration was significantly lower in hypotension group than in hypertension group (P=0.038) and stable group (P=0.007). BNP was higher in hypertension group than in stable group (P<0.001). ADMA before dialysis was higher in hypotension group (P＜0.001) and hypertension group (P＜0.012) than in stable group. Multiple linear regression revealed a positive correlation of ADMA with age, iPTH and BNP (t=3.236, 4.616 and 2.430, respectively; P=0.005, 0.000 and 0.027, respectively). Conclusion The prevalence of intradialytic blood pressure fluctuation was high. Age, iPTH and BNP were the independent factors for elevated ADMA in MHD patients. Metrics

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Effect of exercise guidance based on cross- theoretical model on quality of life of hemodialysis patients 2019, 18 (03):  181-184.  doi: 10.3969/j.issn.1671-4091.2019.03.010 Abstract ( 232 )   PDF (400KB) ( 664 )   【Abstract】Objective To explore the effect of regular exercise guided by cross- theoretical model (CTM) on quality of life in maintenance hemodialysis (MHD) patients. Methods Sixty-two MHD patients were randomly divided into experimental group and control group. The control group was given routine exercise health guidance, and the experimental group was given the CTM-based health guidance. Regular exercise, physical fitness, hemoglobin, serum albumin and other indicators as well as SF-36 score of health status survey at baseline and after the treatment for 6 months were recorded. Results Regular exercise had no statistical difference at baseline status between the two groups (t=0.069, P=0.793), but became different after the treatment (t=5.391, P=0.002). The improvement of normal walking speed, maximum stride speed, hemoglobin and serum albumin were statistically significant (t=2.021, 2.870, 3.741 and 4.587 respectively; P=0.046, 0.006, 0.024 and 0.018 respectively). The scores of overall health, mental health, emotional function, social function, energy, body pain, physiological function, physiological function in the SF-36 survey were statistically different (t=3.698, 4.325, 10.362, 2.946, 3.498, 4.264, 3.026 and 4.125 respectively; P=0.025, 0.019, ＜0.001, 0.045, 0.027, 0.012, 0.031 and 0.015 respectively). Conclusion Health guidance based on CTM can improve the quality of life of MHD patients, which is worthwhile to be used in clinical practice. Metrics

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The prevalence of chronic kidney disease and its risk factors in first-degree relatives and spouses of maintenance dialysis patients: a survey in a single center 2019, 18 (03):  185-187.  doi: 10.3969/j.issn.1671-4091.2019.03.011 Abstract ( 315 )   PDF (409KB) ( 652 )   【Abstract】Objective The prevalence and risk factors for chronic kidney disease (CKD) among firstgrade relatives and spouses of maintenance dialysis (MD) patients were investigated. Methods The subjects were divided into three groups: first-degree relative group (124 cases), spouse group (95 cases) and control group (823 cases). Clinical characteristics and prevalence of CKD in the three groups were compared, and the risk factors were analyzed. Results The proportion of CKD in the first- degree relative group and spouse group was higher than that in the control group (23.4% vs. 16.2%, χ2=3.894, P=0.049; 30.5% vs. 16.2%, χ2=11.916, P＜0.001). Multiple logistic regression analysis for the risk factors for CKD in all participants found that the risk factor for CKD in first-degree relatives was 1.86 times higher than that in non first- degree relatives (OR=1.86, 95% CI: 1.12～3.11, P=0.004), the risk factor for CKD in spouses was 2.16 times higher than that in non-spouses (OR=2.16, 95% CI: 1.27～3.67, P=0.018), and older age, diabetes and hypertension were the independent risk factors for 2%, 21% and 112% increases of CKD risk respectively (OR=1.02, 95% CI: 1.01～1.03, P=0.005 for older age; OR=1.21, 95% CI: 1.11～1.31, P＜0.001 for diabetes; OR=2.12, 95% CI : 1.49～3.03, P＜0.001 for hypertension). Conclusion First-degree relatives and spouses of MD patients are at higher risk for CKD. Diabetes, hypertension and older age are the risk factors for CKD. Metrics

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Clinical study on percutaneous puncture Seldinger technique for peritoneal dialysis catheterization 2019, 18 (03):  188-191.  Abstract ( 281 )   PDF (1031KB) ( 781 )   Objective: By improving method in the percutaneous puncture Seldinger technique for peritoneal dialysis catheterization, the success rate of catheterization is improved, and the surgical complications during the puncture process are avoided. Materials and Methods: 24 patients with end-stage renal disease dialysis who underwent Seldinger puncture peritoneal dialysis catheterization were enrolled, 10 patients with conventional puncture group,14 patients with modified percutaneous group. The modified method includes the assistance of preoperative and intraoperative ultrasound techniques, and the interventional vascular sheath puncture set is used instead of the conventionally used puncture needle or Veress needle. The success rate of the conventional group and the modified group is compared. RESULTS: There was no significant difference in age, sex ratio, and primary disease between the modified puncture group and the conventional puncture group (P>0.05). The success rate of routine puncture was 70%, and it was 100% after improvement, which was significantly improved (70% vs. 100%, P<0.05). Catheterization-related complications occurred in 2 patients in the routine group, 1 patient developed catheter dysfunction, and 1 patient in the modified group developed bleeding. There was no difference in catheter-related complications between the two groups (30% vs. 7.1%, P >0.05), there was no major bleeding requiring intervention, leakage of peritoneal fluid, infection, abdominal organ injury. Conclusion: The improved percutaneous peritoneal dialysis catheterization technique and procedure can improve the success rate of puncture and avoid complications such as catheter related bleeding and abdominal organ injury. Metrics

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MicroRNA- 302C modulates peritoneal dialysis- associated fibrosis by targeting connective tissue growth factor 2019, 18 (03):  192-196.  doi: 10.3969/j.issn.1671-4091.2019.03.013 Abstract ( 236 )   PDF (1655KB) ( 623 )   【Abstract】Object To explore the effect and mechanisms of miRNA-302c on the expression of connective tissue growth factor (CTGF) and epithelial-to-mesenchymal transition (EMT) in peritoneal mesothelial cells from peritoneal dialysis (PD) patients. Methods Human peritoneal mesothelial cells were isolated by collection of overnight peritoneal lavage from PD patients and centrifugation of the lavage. The expression of miR-302c, CTGF and EMT related factors were assayed. Human peritoneal mesothelial cells were transfected with miR-302c and cultured containing 5ng/ml transforming growth factor-β1 (TGF-β1) for 48h, and the expression of CTGF and EMT related factors were then measured by western blot. Results There was a marked reduction of miR-302c level in human peritoneal mesothelial cells from prolonged PD patients (F=443.165, P＜0.001). miR-302c level was negatively correlated with Vimentin (r=-0.887) and CTGF (r=-0.840), and was positively correlated with Zonula occludens-1 (Zo-1) (r=0.873). Over-expression of miR-302c inhibited the down-regulation of E-cadherin (F=13.910，P=0.043) and upregulation of anti-α smooth muscle actin (α-SMA) (F=11.833, P=0.026), collagen I (F=10.673, P=0.031) and CTGF (F=8.34, P=0.044) induced by TGF-β1 in cultured human peritoneal mesothelial cells. Conclusion MiR-302c is a vital factor protecting peritoneal mesothelial cells from undergoing EMT and fibrosis in PD patients, probably through inhibition of CTGF expression. Metrics

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Research advances in mitophagy in kidney disease 2019, 18 (03):  197-200.  doi: 10.3969/j.issn.1671-4091.2019.03.014 Abstract ( 404 )   PDF (347KB) ( 769 )   【Abstract】Mitophagy specifically regulates autophagosome to engulf, degrade and eliminate damaged mitochondria, which is a repair mechanism of mitochondrial injury and plays an important role in maintaining mitochondrial function and cell survival. Mitophagy can also promote cell differentiation and decrease senility. Recently, mitophagy is widely studied in tumors, nervous system diseases and heart diseases. Mitophagy is a hot topic in kidney disease research. The purpose of this review is to give a brief introduction of the mechanism and physiological function of mitophagy and the recent advances in mitophagy in kidney diseases. Metrics

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Bibliometric analysis of arteriovenous fistula based on the data in CNKI database 2019, 18 (03):  207-210.  doi: 10.3969/j.issn.1671-4091.2019.03.017 Abstract ( 262 )   PDF (523KB) ( 694 )   【Abstract】Objective To analyze the status of clinical study and progress trend of arteriovenous fistula published in CNKI through bibliometric analysis in order to provide references for the study of arteriovenous fistula. Methods The literature about internal arteriovenous fistula in the period from January 1, 2013 to December 31, 2017 in CNKI database was retrieved. The software Note Express was used to conduct metrology analysis on publication time, keywords, periodicals, funds, institutions and highly quoted literature, Excel was used to depict results. Results In the recent 5 years, number of the publications has been increasing year by year. Nursing and complications of internal arteriovenous fistula are the hot spots in this field. The journal“Chinese Journal of Blood Purification”ranks the first to publish research results in the field. National and local governments have also supported this study. Conclusion The study of internal arteriovenous fistula will have a prosperous future and fruitful contributions. The journal“Chinese Journal of Blood Purification”should continue to promote the spread of theresearch results. We hope the government gives further support for the research of arteriovenous fistula. Metrics

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Nursing experience of the infections relating to internal jugular vein catheterization in maintenance hemodialysis patients 2019, 18 (03):  213-214.  doi: 10.3969/j.issn.1671-4091.2019.03.019 Abstract ( 295 )   PDF (313KB) ( 633 )   【Abstract】Objective To investigate the causes and nursing strategies of infections relating to indwelling internal jugular vein catheters in maintenance hemodialysis (MHD) patients. Methods Thirty MHD patients with internal jugular vein indwelling catheters were observed for one year, and the causes, prevention and treatment of catheter- related infections were analyzed. Results In this group, 6 patients had skin infection at the exit sites of the catheters and the shallow layer of the tunnels (8 times). Improper management and local contamination of the exit sites were the causes of the infections. Conclusions Local contamination at the exit of the catheter was one of the common causes of catheter-related infections. Hygiene habits of the patients, local clean of the exit sites and correct treatment of the infections are essential to prevent these infections. Metrics