Chinese Journal of Blood Purification

12 June 2019, Volume 18 Issue 06 Previous Issue    Next Issue

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The relationship between lean body mass and risk of mortality in maintenance hemodialysis patients 2019, 18 (06):  382-385.  doi: 10.3969/j.issn.1671-4091.2019.06.002 Abstract ( 417 )   PDF (397KB) ( 693 )   【Abstract】Objective To investigate the relationship between lean body mass (LBM) and risk of mortality in maintenance hemodialysis (MHD) patients. Methods We retrospectively analyzed the MHD patients treated in the Dialysis Center, Tianjin Union Medical Center and matched the research criteria. Their LBM and others parameters were collected. A validated creatinine-based formula, LBM(kg)=0.34×serum creatinine (mg/dl)+5.58×gender (1 for female and 0 for male)+0.30×body weight(kg)+0.67×body height (inch)-0.23×URR (urea reduction ratio)-5.75(linch=0.1254m), was used to estimate LBM. The relationship between LBM and risk of mortality was then assessed. Results This cohort enrolled 187 MHD patients. Higher LBM was related to younger age (H=3.273, P=0.049), male (χ2=4.174, P=0.041), higher body weight (F=6.438, P=0.027) and body mass index(BMI)(F=5.997,P=0.029), higher serum albumin (F=3.811, P=0.043), creatinine(F=4.778,P=0.031), phosphorus(F=3.766,P=0.044) and intact parathyroid hormone(iPTH) (F=3.498, P=0.047). We divided the patients into 5 groups based on the 20th percentile of LBM values (＜36.3, 36.3～40.7,40.7～44.9,44.9～49. 4and＞49.4 kg). Patients in the 40.7～44.9 kg group was used as the reference group. After adjustment by multiple factors, we found that higher LBM was associated with lower mortality. Compared to the reference group, the risk of mortality increased by 31% in the lowest LBM group (HR: 1.31, 95% CI 1.11-1.53, P=0.043), while the risk decreased by 15% in the highest LBM group (HR: 0.85, 95% CI 0.72-0.95, P=0.038). Conclusions In MHD patients, higher LBM was associated with lower risk of mortality. We therefore have the possibility to predict risk of mortality by LBM in MHD patients. Metrics

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Efficacy and safety of paricalcitol on secondary hyperparathyroidism in hemodialysis patients: a retrospective study 2019, 18 (06):  386-389.  doi: 10.3969/j.issn.1671-4091.2019.06.003 Abstract ( 620 )   PDF (408KB) ( 847 )   【Abstract】Objectives To investigate the efficacy and safety of paricalcitol in the treatment of hemodialysis patients complicated with secondary hyperparathyroidism (SHPT). Methods Eleven maintenance hemodialysis patients with SHPT treated in Beijing Sixth Hospital were enrolled in this study. Their initial dose of paricalcitol was 0.04-0.10 μg/kg. During the treatment period, serum levels of intact parathyroid hormone (iPTH), calcium, phosphorus, alkaline phosphatase (ALP) were monitored, and the score of visual analogue scale (VAS) was used to assess patient’s condition. The major efficacy parameter was the decrease of iPTH more than 50% of baseline value after 12 weeks of the treatment. The secondary efficacy parameters included the average range of iPTH below baseline value, the proportion of the patients with the iPTH level within 150～300pg/ml after 12 weeks of the treatment, as well as the incidence of adverse events at the end of the study. Results The average baseline iPTH level of the 11 patients was 1283.56 ± 443.71pg/ml. After 12 weeks of paricalcitol treatment, the average iPTH level decreased by 73.01% of the baseline value to 346.38±223.72 pg/ml (t=6.578, P＜0.001). In all of the 11 patients, the endpoint iPTH level decreased by more than 50% of the baseline value. At the endpoint of the study, iPTH levels reduced to 150-300pg/ml in 7 of the 11 patients and reached the compliance rate in 63.64% patients; serum calcium (t=2.952, P=0.088), phosphorus (t=1.305, P=0.206) and ALP (t= 1.513, P=0.145) had no significant differences compared to the baseline values in the 11 patients; VAS score was significantly lower than baseline value (t=15.976, P＜0.001). One patient developed hypercalcemia (serum calcium 2.64mmol/L). Conclusions This study confirmed that paricalcitol can effectively treat SHPT in hemodialysis patients. It can reduce serum iPTH level and the bone pain VAS score, without changes of serum calcium and phosphorus. Metrics

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Effects of intradialytic exercise on inflammation, oxidative stress and endothelial function in patients with maintenance hemodialysis 2019, 18 (06):  390-393.  doi: 10.3969/j.issn.1671-4091.2019.06.004 Abstract ( 329 )   PDF (379KB) ( 781 )   【Abstract】Objective To investigate the effects of intradialytic exercise on inflammation, oxidative stress and endothelial function in maintenance hemodialysis (MHD) patients. Methods Forty patients undergoing MHD for more than 6 months in Tongji Hospital Affiliated to Tongji University from March 2015 to March 2016 were enrolled in this study. They were randomly divided into experimental group in which patients did intradialytic exercise (n=20) and control group (n=20). Clinical data and biochemical results including hemoglobin, high sensitive c- reactive protein (hsCRP), serum albumin, urea clearance index (Kt/V), serum calcium and phosphorus and parathyroid hormone (PTH) were recruited. Blood samples were collected before and after the intervention for the assay of interleukin-6 (IL-6), oxidized low density lipoprotein (ox-LDL), serum soluble intercellular adhesion molecule (sICAM) and serum soluble vascular cell adhesion molecule (sVCAM) by ELISA. Results After the intervention for 24 weeks, there were no significant differences in hemoglobin, serum albumin, urea clearance index Kt/V, IL-6 and oxLDL before and after the intervention in the experimental group (t=- 0.110, - 1.396, - 0.889, - 0.229 and 0.385 respectively; P=0.913, 0.171, 0.380, 0.820 and 0.702 respectively); but there were statistical differences in serum phosphorus, hsCRP, sICAM and sVCAM before and after the intervention in the experimental group (t=2.039, 2.219, 2.309 and 2.211 respectively; P=0.048, 0.033, 0.026 and 0.033 respectively). There were also statistical differences in serum Kt/V, hsCRP, sICAM and sVCAM after the intervention between the experimental group and control group (t =3.706,  -3.144, -2.570 and -3.272 respectively; P=0.001, 0.003, 0.014 and 0.002 respectively). Conclusion Intradialytic exercise can improve inflammation and endothelial function but has no definite effect on oxidative stress in MHD patients. Metrics

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Clinical characteristics at the initiation of hemodialysis of end stage renal disease patients 2019, 18 (06):  394-396.  doi: 10.3969/j.issn.1671-4091.2019.06.005 Abstract ( 405 )   PDF (410KB) ( 709 )   【Abstract】Objective To investigate the differences of clinical characteristics at the initiation of hemodialysis of end-stage renal disease (ESRD) patients in order to obtain the information relating to continuous improvement of management of pre- dialysis chronic kidney disease (CKD) patients. Methods This was a retrospective single center study. A total of 272 ESRD patients beginning hemodialysis at the Affiliated Hospital of Jiangsu University between March 2015 and August 2018 were recruited. They were divided into diabetic nephropathy group (DN group, n=120) and non-DN group (n=152). The main cause directly leading to dialysis, vascular access and laboratory parameters were compared between the two groups. Results Before dialysis, more outpatients were found in DN group than in non-DN group (P＜0.001). The main cause directly leading to the initiation of hemodialysis was heart failure/edema in DN group and was uremic symptoms in non-DN group. In DN group, hemoglobin and eGFR were higher than in non-DN group (t=3.190 and 7.155; P=0.002 and ＜0.001), and blood urea nitrogen, serum creatinine, serum phosphorus and iPTH were lower than in non-DN group (t=- 5.736, - 8.231, - 3.785 and - 3.116 respectively; P=＜0.001, ＜0.001, ＜0.001 and 0.002 respectively). The implement of blood access was significant different between the two groups (χ2= 4.917, P=0.027). Conclusions DN was the first primary cause for initiating hemodialysis in ESRD patients in the past 3 years. DN patients initiated hemodialysis earlier and often due to refractory heart failure. The use of central vein catheterization for blood access was higher during the initiation of hemodialysis. Therefore, clinical management of CKD patients at the outpatient department should be reinforced. In addition, arteriovenous fistula operation should be considered before initiating hemodialysis to decrease the temporary vascular catheterization. Metrics

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Application of automated peritoneal dialysis in patients with urgent-started peritoneal dialysis 2019, 18 (06):  397-401.  doi: 10.3969/j.issn.1671-4091.2019.06.006 Abstract ( 274 )   PDF (445KB) ( 757 )   【Abstract】Objective To observe the clinical application of automated peritoneal dialysis (APD) in urgent-started peritoneal dialysis patients. Methods We recruited 54 end-stage renal disease (ESRD) patients with newly placed peritoneal tubes and treated in the Second Affiliated Hospital of Hebei Medical University. They were divided into manual exchange peritoneal dialysis group (MPD group) and APD group. The general situation, biochemical indicators, average daily dialysis volume, ultrafiltration volume, urine output and catheter complications were recorded. They were observed for one week. Results ①There were no significant differences in baseline parameters between the two groups. ②For patients in the two groups after one week of the treatment, systolic blood pressure, blood urea nitrogen, serum creatinine and phosphorus were decreased (For APD group, t=2.481, 6.911, 3.191 and 3.603 respectively; P=0.023, ＜0.001, 0.005 and 0.002 respectively. For MPD group, t=2.168, 7.661, 3.363 and 4.043 respectively; P=0.038, ＜0.001, 0.002 and 0.000 respectively), and hemoglobin, serum calcium and sodium were increased (For PAD group, t=2.351, 3.008 and 2.289 respectively; P=0.030, 0.007 and 0.034 respectively. For MPD group, t=2.352, 2.933 and 2.691 respectively; P=0.025, 0.006 and 0.011 respectively) as compared to the baseline values. ③During the dialysis treatment, appetite improved more in APD group than in MPD group (t=2.711, P=0.012). ④There were no catheter complications in both groups. ⑤Ultrafiltration volume, urine volume, body mass and blood urea nitrogen improved more in APD group than in MPD group (t=4.067, 2.173, 2.093 and 3.257 respectively; P＜0.001, 0.035, 0.044 and 0.002 respectively). Conclusions In ESRD patients required urgent-started peritoneal dialysis, APD method had the advantages in toxin clearance, symptom improvement and compliance with the dialysis method. Metrics

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A comparative study of peritoneal dialysis and hemodialysis for end- stage renal disease children 2019, 18 (06):  402-405.  doi: 10.3969/j.issn.1671-4091.2019.06.007 Abstract ( 299 )   PDF (408KB) ( 708 )   【Abstract】Objectives To investigate the clinical characteristics and outcome of end- stage renal disease (ESRD) children treated with peritoneal dialysis (PD) and hemodialysis (HD). Methods Clinical data of ESRD children who received PD or HD in Children’s Hospital of Fudan University from January 2011 to June 2018 were collected. Clinical parameters, ESRD complications, time to transplantation and outcome were compared between PD and HD groups. Results A total of 231 cases who received PD and 50 cases who received HD were enrolled in this study. The mean age was younger in PD group than in HD group (t=-4.998, P＜0.001). There were no significant differences in parameters during dialysis period, including hemoglobin (t=0.560, P=0.576), serum calcium (t=0.000, P=1.000) and phosphate (t=0.448, P=0.657), PTH (t=-1.828, P=0.069) and left ventricular mass index (Z=-0.750, P=0.455). The time to transplantation (t=-0.733, P=0.467) and outcome (P=0.334) were similar between PD and HD groups. Conclusion Most cases (82%) received PD as the first dialysis modality. ESRD complications, time to transplantation and outcomes were similar for children initiated on PD or HD therapy. Metrics

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Differentiation of intestinal macrophages towards proinflammatory phenotype aggravated the microinflammatory#br# status in uremia rats 2019, 18 (06):  406-410.  doi: 10.3969/j.issn.1671-4091.2019.06.008 Abstract ( 276 )   PDF (789KB) ( 720 )   【Abstract】Objective To investigate the relationship between the function of intestinal macrophages and the microinflammation in uremic rats. Methods Male Sprague-Dawley rats were randomly divided into sham surgery group and uremia group. Blood levels of endotoxin, hs-CRP, IL-6 and TNF-α were assayed. The ultrastructure of macrophages was examined by transmission electron microscopy. Immunochemistry of the intestinal sections was used to analyze the expression of CD11a and iNOS, the active markers of macrophages, as well as the expression of intercellular adhesion molecule-1 (ICAM-1) and TGF-β. Quantitative real-time PCR and western blot were employed to assess the mRNA and protein levels of early growth response gene 1 (EGR1) and toll-like receptor 4 (TLR4). Results The blood levels of endotoxin, IL-6, TNF-α and hs-CRP were significantly higher in uremia group than in sham surgery group (t=-5.145, -3.776, -3.553 and -10.468 respectively; P=＜0.001, 0.001, 0.002 and ＜0.001 respectively). The macrophages in uremia group showed fewer cytoplasmic protrusions and pseudopodia. The intestinal macrophages in uremia group exhibited heavier staining of CD11a, iNOS, ICAM-1 and TGF-β, and higher mRNA and protein levels of EGR1 and TLR4. Conclusions In uremia rats, intestinal macrophages differentiated towards proinflammatory phenotype, which was related to the microinflammatory status of the rats. Metrics

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Current situation of bioimpedance analysis for body hydration management in maintaining hemodialysis patients 2019, 18 (06):  411-414.  doi: 10.3969/j.issn.1671-4091.2019.06.009 Abstract ( 382 )   PDF (375KB) ( 720 )   【Abstract】Overhydration is closely related to cardiac mortality and all- cause mortality in maintaining hemodialysis (MHD) patients. On the other hand, hypohydration may lead to hypotension-associated adverse events, decrease of residual renal function and even cardiac stunning. Thus, accurate management of body hydration is essential to the outcome of MHD patients. Clinical observation cannot be used for the objective and accurate assessment of body hydration status in MHD patients due to the unwarranted interference of many factors. Bioimpedance analysis (BIA) is accurate, non- invasive, convenient and inexpensive, becoming the most useful method for objective assessment of body hydration status in MHD patients. In this review, we summarize BIA for the management of blood pressure and hydration status as well as the effects of BIA on residual kidney function and long-term outcomes such as cardiovascular complications, hospitalization rate and mortality. Metrics

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Early dysfunction of arteriovenous fistula after total parathyroidectomy and autotransplantation in uremic patients with secondary hyperparathyroidism 2019, 18 (06):  420-423.  doi: 10.3969/j.issn.1671-4091.2019.06.012 Abstract ( 286 )   PDF (389KB) ( 808 )   【Abstract】Objective To retrospectively analyze the causes and risk factors for the early dysfunction of arteriovenous fistula (AVF) after total parathyroidectomy (PTX) and autotransplantation surgery (PTX +AT). Methods In our hospital, 14 of 497 patients undergoing total PTX+AT during the period from September 2011 to May 2015 lost patency of AVFs within 24 hours after the surgery. In this retrospective study, we analyzed the potential risk factors for early AVF dysfunction in the 14 patients. Simultaneously, 28 patients with functional AVFs after PTX were also included as a matched group. Patient characteristics and biochemical parameters associated with increased risk for AVF failure were analyzed. Results Of the 14 patients in AVF dysfunction group, 2 had hematoma during the postoperative dialysis, and one patient had thyroid cancer and received thyroidectomy at the same time. Two patients had a significant decrease of blood pressure during the procedure. One case lost her AVF function 6 times in the past 7 years due to poor cardiac function. The decrease of systolic blood pressure after PTX+AT was greater in AVF dysfunction group (20.28±17.72mmHg) than in control group (3.11±17.58mmHg; t=2.978, P=0.005). The decrease of systolic blood pressure correlated to the decrease of serum calcium level after the surgery (r=0.385, P=0.012). Regression analysis suggested that the decrease of systolic blood pressure after PTX+AT was a risk factor for early AVF dysfunction (HR=1.053, 95% CI 1.012～1.095, P=0.010). Conclusions Early AVF dysfunction may occur in patients undergoing PTX+AT. The decrease of systolic blood pressure after PTX+AT is a risk factor for early AVF dysfunction. The presence of hematoma during postoperative dialysis also needs to be closely monitored. Metrics

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Correlation analysis of dialysis knowledge and self-management in hemodialysis patients in Gansu province 2019, 18 (06):  428-430.  doi: 10.3969/j.issn.1671-4091.2019.06.015 Abstract ( 234 )   PDF (379KB) ( 762 )   【Abstract】Objective To understand the present situation of dialysis knowledge and self-management ability and their relationship in maintenance hemodialysis (MHD) patients. Methods A total of 273 MHD patients in Gansu province were investigated using self-designed general data questionnaire, hemodialysis patients' knowledge level questionnaire and self-management scale. Results The total score of hemodialysis knowledge level was 2~24, with an average total score of 13.94±5.00; this score was also related to age. The total score of self-management ability was 31~80, with an average total score of 59.12±10.46. The scores of the four dimensions ranged from high to low as emotion handling, partnership, self-care implementation and problem solving. Dialysis knowledge level was positively correlated with self-management ability (r=0.433, P＜0.001). Conclusion The education of dialysis knowledge during dialysis in hospital should be emphasized to improve self-management ability and quality of life in MHD patients. Metrics

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Study on the application of symptom management consultants for the management of symptoms in maintenance hemodialysis patients 2019, 18 (06):  431-434.  doi: 10.3969/j.issn.1671-4091.2019.06.016 Abstract ( 213 )   PDF (392KB) ( 710 )   【Abstract】Objective To investigate the effect of setting up symptom management consultants for symptom management in patients with maintenance hemodialysis (MHD). Methods A total of 130 patients undergoing hemodialysis from June 2017 to June 2018 in the Hemodialysis Center, Jingzhou Second People's Hospital were enrolled in this study. Sixty- five patients treated in the period from June to December 2017 without symptom management by the symptom management consultants were included in the control group, and 65 patients treated in the period from January to June 2018 and subjected to symptom management by the symptom management consultants were assigned in the intervention group. The presence of symptom groups, quality of life and satisfaction of the patients were compared between the two groups. Results In the intervention group, the incidences of symptom groups were lower than those in the control group (for general symptom group of uremia, χ2=43.973, P<0.001; for symptom group of cardiopulmonary symptoms, χ2=26.252, P<0.001; for symptom group of digestive symptoms, χ2=57.754, P< 0.001; for symptom group of emotional symptoms, χ2=34.001, P<0.001; for symptom group of water electrolyte, χ2=43.726, P<0.001); the quality of life score was higher than that in the control group (after intervention for one month, t=4.435, P<0.001; for 3 months, t=15.809, P<0.001; for 6 months, t=30.225, P<0.001); and the satisfaction score was also higher than that in the control group (after intervention for one month, t=19.139, P<0.001; for 3 months, t=20.919, P< 0.001; for 6 months, t=5.882, P<0.001). Conclusion The symptom management consultants for symptom management in MHD patients can reduce the incidence of symptoms and improve their quality of life and satisfaction, suitable to be widely used in clinical practice. Metrics