Chinese Journal of Blood Purification

12 May 2019, Volume 18 Issue 05 Previous Issue    Next Issue

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Effect of parathyroidectomy on insulin resistance and microinflammatory status in uremic patients with secondary hyperparathyroidism 2019, 18 (05):  291-294.  doi: 10.3969/j.issn.1671-4091.2019.05.001 Abstract ( 321 )   PDF (405KB) ( 705 )   【Abstract】Objective To observe the effect of parathyroidectomy with forearm autograft (PTX+AT) on insulin resistance and microinflammatory status in uremic patients with secondary hyperparathyroidism. Methods A total of 38 uremic patients with secondary hyperparathyroidism but without diabetes undergoing PTX+AT in the period from March 2017 to June 2108 in Guangzhou Panyu Central Hospital were retrospectively analyzed. Their intact parathyroid hormone (iPTH), blood phosphate (P), blood cholesterol (CH), triglyceride (TG), low density lipoprotein (LDL), high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6) and tumor necrosis factor Q (TNF-Q), fasting blood glucose (FBG) and fasting blood insulin (FINS) were compare before and after PTX+AT. Results ① After PTX+AT for 3 months, CH, TG , LDL, P and iPTH decreased significantly (t=-3.717, -2.261, -3.980, -3.541 and -9.807 respectively; P=0.013, 0.039, 0.011, 0.019 and ＜0.001 respectively) as compared to those before PTX+AT. After PTX+AT for 6 months, CH, TG, LDL, P and iPTH decreased significantly (t=-4.023, -2.097, -4.106, -4.004 and -9.921 respectively; P=0.009, 0.040, 0.010, 0.011 and ＜0.001 respectively) as compared to those before PTX+AT, but without statistical signifi-cance (t=-0.080, 0.376,-0.004, -0.055 and 1.043 respectively; P=0.058, 0.072, 0.064, 0.059 and 0.088 respectively) as compared to those after PTX+AT for 3 months. ② After PTX+AT for 3 months, hs-CRP, IL-6, TNFɑ and the insulin resistance index (IR) decreased significantly (t=-1.096, -1.849, -2.396 and -2.887 respectively; P=0.038, 0.028, 0.015, and 0.045 respectively) as compared to those before PTX+AT. After PTX+AT for 6 months, hs-CRP, IL-6, TNF-Q and IR decreased significantly (t=-2.315, -2.421, -3.225 and -3.000 respectively; P=0.027, 0.019, 0.006 and 0.037 respectively) as compared to those before PTX+AT; hs-CRP, IL-6 and TNF-Q decreased significantly (t=-2.011, -2.376 and -3.333 respectively; P=0.031, 0.022 and 0.005 respectively) but IR had no significant change (t=-0.006; P=0.679) as compared to those after PTX+AT for 3 months. Conclusion PTX+AT is effective to treat severe secondary hyperparathyroidism in uremic patients, which can also improve microinflammation, IR and derangement of lipid metabolism. Metrics

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Energy obtained from glucose in dialysate doesn’t contribute to new-onset diabetes/impaired glucose tolerance in peritoneal dialysis patients 2019, 18 (05):  295-299.  doi: 10.3969/j.issn.1671-4091.2019.05.002 Abstract ( 327 )   PDF (438KB) ( 709 )   【Abstract】Objectives To identify the relationship between energy absorbed from glucose in dialysate and new-onset diabetes/impaired glucose tolerance (NODI) in patients on peritoneal dialysis (PD). Methods In this retrospective and single center-based cohort study, all non-diabetic incident PD patients between August 2007 and August 2011 were enrolled. Their demographic and laboratory data were recorded at baseline. Repeated measurements for laboratory, dialysis prescription, and nutrition parameters were recorded at regular intervals. Multivariate Cox regression models built from baseline and time-dependent variables were used to calculate the hazard ratio (HR) of potential predictors for NODI. Results Of the 256 PD patients in a mean follow-up period of 32.4 (12.9～60.8) months, 25 (4.1%) and 7 (1.1%) patients were identified with new-onset diabetes and impaired glucose tolerance, respectively. The average energy absorbed from dialysate was 310.9±120.1 kcal/d. Using multivariate Cox regression analysis, we found that time- dependent BMI (HR= 1.194, 95% CI 1.067～1.335, P=0.002) independently predicted the risk for NODI, but energy absorbed from dialysate (HR=1.000, 95% CI 0.996～1.005, P=0.883) and other laboratory parameters either of the baseline or the time-dependent ones were not correlated with the risk for NODI. Conclusions Energy absorbed from dialysate doesn’t contribute to NODI in PD patients. Metrics

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A new method for estimating Kt/Vurea 2019, 18 (05):  300-303.  doi: 10.3969/j.issn.1671-4091.2019.05.003 Abstract ( 302 )   PDF (675KB) ( 662 )   【Abstract】Objective Kt/Vurea is currently a preferential method for measuring dialysis dose. The calculation of Kt/Vurea is based on the single-compartment kinetic model or the approximate two-compartment kinetic model. The aim of this study is to compare theKt/Vurea value from pharmacokinetic software and multiparameter method with that from traditional method and to prove the feasibility of the new method. Methods Thirty long-term hemodialysis patients with stable status were treated with one session of high-flux dialysis using FX60 or FX80 high-flux dialyzer. Blood samples were collected at the beginning, after 15, 30, 60, 90, 120, 180 and 240 minutes at the end of the session. Urease method was used to measure the concentration of blood urea. SpKt/Vurea, eKt/VureaD and eKt/VureaT were calculated by the second generation of Daugirdas formula and equilibrated Kt/Vurea equations of Daugirdas and Tattersall, respectively. They were compared with Kt/Vurea W-single pool and Kt/Vurea W-two pools fitted by pharmacokinetic software (WinNonlin software). Results After one session of high-flux dialysis, blood urea concentrations could be reduced to 30.0±6.0% of the value before the session. The AIC values fitted by WinNonlin software with two-compartment model were lower than those with singlecompartment model, indicating that the dynamic changes of blood urea during dialysis were better in line with the two-compartment model. The value of Kt/Vurea W-two pools (1.23±0.21) was significantly lower than that of sp-Kt/Vurea (1.48±0.21) (t=4.784, P＜0.001). In addition, the two values were statistically correlated (R2=0.911, P＜0.001). The difference betweenKt/Vurea W- two pools and eKt/Vurea D (1.28 ± 0.18) was not significant (t=0.935, P=0.352), so wasn’t the difference between Kt/Vurea W-two pools and eKt/Vurea T (1.31±0.19) (t=1.578, P=0.117). Conclusions By using the pharmacokinetic software, we identified that the dynamics of blood urea during dialysis was better in line with the two-compartment model and that the eKt/Vurea value could be accurately obtained by this method. Metrics

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Investigation on post- traumatic growth and social support in caregivers of maintenance hemodialysis patients 2019, 18 (05):  304-307.  doi: 10.3969/j.issn.1671-4091.2019.05.004 Abstract ( 254 )   PDF (392KB) ( 754 )   【Abstract】Objective To investigate the post-traumatic growth and the correlation with perceived social support in caregivers of maintenance hemodialysis (MHD) patients. Methods The general data questionnaire, Posttraumatic Growth Inventory (PTGI) and Perceived Social Support Scale (PSSS) were used to investigate the caregivers of 120 MHD patients in the blood purification center of our hospital. The factors related to post-traumatic growth in caregivers and their correlation with the comprehension of social support were analyzed. Results The total scores of post-traumatic growth was 39.73±22.59 and the score of perceived social support ability was 46.08±13.53 in caregivers of MHD patients. The post-traumatic growth was related to caregiver's gender, the relationship with the patient, patient's dialysis-age, the time spent on care, caregiver's education level and family monthly income, and was positively related to perceived social support ability (r=0.883, P<0.001). Conclusions The post- traumatic growth of caregivers of MHD patients was at a medium level. The enhancement of social support for caregivers should be focused on the relevant influencing factors. Effective psychological intervention should be provided to the caregivers to improve their post-traumatic growth. Metrics

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The effect of early enteral nutritional support on critical patients with continuous renal replacement therapy 2019, 18 (05):  308-311.  doi: 10.3969/j.issn.1671-4091.2019.05.005 Abstract ( 230 )   PDF (369KB) ( 679 )   【Abstract】Objective The aim of the study was to evaluate the influence of early enteral nutrition support on critically ill patients treated with continuous renal replacement therapy (CRRT) in intensive care unit. Methods This was a retrospective cohort study of 90 critical patients treated with CRRT in ICU in the period between January 2013 and January 2016. They were divided into two groups; EEN group (n=46) in which patients began to have enteral nutrition support within 48 hours after CRRT, and EN group (n=44) in which patients began to have enteral nutrition support more than 48 hours after CRRT. Serum prealbumin, hemoglobin, albumin, prothrombin time, fibrinogen, blood urea nitrogen, creatinine and Acute Physiology and Chronic Health Evaluation Ⅱ score (APACHE Ⅱ score) were assayed at baseline and after the nutritional support for 1, 3, 7, 14 and 28 days. These parameters were compared between the two groups. Results There were statistical significances in the levels of albumin (Fbetween=6.786, P=0.012), hemoglobin (Fbetween=4.308, P=0.043), prealbumin (Fbetween=4.699, P=0.035), prothrombin time (Fbetween=4.650, P=0.036) and APACHE Ⅱ score (Fbetween=4.186, P=0.046) between the two groups. Conclusion Early enteral nutrition has positive effects on albumin level, blood coagulation function and APACHE Ⅱ score in critical patients on CRRT. Metrics

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A retrospective analysis of clinico-pathological features and etiology in C3 glomerulopathy: a single center study 2019, 18 (05):  312-315.  doi: 10.3969/j.issn.1671-4091.2019.05.006 Abstract ( 329 )   PDF (375KB) ( 928 )   【Abstract】Objective To study the clinico- pathological features and the etiology of patients with C3 glomerulopathy (C3G) in our cohort. Methods The clinico- pathological data of patients with C3G diagnosed in Peking University First Hospital from 1998 to 2015 were retrospectively analyzed. Concentrations of Bb, C3a, C5a, sC5b-9 and the presence of autoantibodies were detected by enzyme-linked immunosorbent assay. Mutations in complement-related genes CFH, CFB, C3, CFI and MCP were screened by using a target enrichment strategy for next-generation sequencing. Results Thirty-five patients with C3G were involved in this study. There were 27 males and 8 females with an average age of 35 years old. Their clinical symptoms and renal pathological types were variable. Concentrations of Bb, C3a, C5a and sC5b-9 in plasma and urine were significantly higher than healthy controls (in plasma: Z=-6.900, -4.881, -5.322 and -3.963, respectively; in urine: Z=-5.375, -5.527, -5.530 and -5.651, respectively; all P values ＜0.001). Etiologic analyses found that 18 patients (51.4% ) had genetic abnormalities and/or autoantibodies. During a median time of 26.5 months, 5 patients reached endpoints. Multivariate Cox proportional-hazard analysis revealed that serum creatinine level at onset was identified as the independent risk factor for the endpoints (HR: 1.010, 95% CI: 1.001～1.019, P=0.034). Conclusions Our study showed that dysregulation of the complement alternative pathway due to inherited and/or acquired defects was associated with C3G. Serum creatinine level at onset was an independent risk factor for prognosis in patients with C3G. Metrics

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The impact of medical management through mobile internet on the quality of peritoneal dialysis 2019, 18 (05):  316-318.  doi: 10.3969/j.issn.1671-4091.2019.05.007 Abstract ( 287 )   PDF (377KB) ( 719 )   【Abstract】Objective To investigate the medical management through mobile internet on the quality of peritoneal dialysis (PD). Methods A total of 78 patients undergoing PD in the Second Affiliated Hospital of Harbin Medical University from June 2016 to June 2018 were randomly divided into experimental group (n=39) and control group (n=39). The control group was followed up once every 3 months, and the experimental group used mobile electronic devices to receive medical management through mobile internet. The differences in dialysis quality including Kt/V, hemoglobin, serum albumin, serum calcium, and the compliance rate of serum phosphorus were compared between the two groups. Results The compliance rate of hemoglobin was 0.56±0.24 in experimental group and 0.34±0.27 in control group (t=3.718, P＜0.001). The compliance rate of serum albumin was 0.73±0.27 in experimental group and 0.51±0.28 in control group (t=3.142, P＜0.001). The compliance rate of serum calcium was 0.83±0.24 in experimental group and 0.70±0.30 in control group (t=2.132, P=0.041). The compliance rate of serum phosphorus was 0.68±0.25 in experimental group and 0.39±0.27 in control group (t=4.913, P＜0.001). The compliance rate of Kt/V was 0.90±0.18 in experimental group and 0.70±0.30 in control group (t=3.473, P＜0.001). The adverse event was found in one case in experimental group and 7 cases in control group (c2=5.007, P=0.031). The compliance rates of all parameters were higher in experimental group than in control group. Conclusion Medical management through mobile internet can improve the quality of PD. Metrics

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Progress in the diagnosis and treatment of myeloma-associated renal injury 2019, 18 (05):  319-321.  doi: 10.3969/j.issn.1671-4091.2019.05.008 Abstract ( 236 )   PDF (444KB) ( 800 )   【Abstract】Renal injury is a common complication of hematologic tumor and renal function is closely related to the quality of life and prognosis in these patients. Due to nephrotoxicity of chemotherapy drugs, toxic substances produced by tumors, dehydration and infection complications, the renal injury is irreversible in most patients. However, with the advances of research, better comprehension of the renal injury mechanism and application of various new drugs with low nephrotoxicity, this renal injury is expected to be improved, or to be reversed to normal level in some cases. The improvement of renal function is of great benefit to the prognosis of tumors. Meanwhile, multiple myeloma differs from other hematologic tumors in that it secretes excessive free light chains that bind to the Tamm-Horsfall protein in distal convoluted tubules to form casts, which deposit in kidney resulting in cast nephropathy and renal injury. Recent advances in management indicate that chemotherapy combined with blood purification have a better effect on myeloma nephropathy, even better than the renal injuries in other related hematological diseases. Metrics

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Research progresses in the treatment of cardiorenal syndrome by using peritoneal dialysis 2019, 18 (05):  322-324.  doi: 10.3969/j.issn.1671-4091.2019.05.009 Abstract ( 298 )   PDF (390KB) ( 640 )   【Abstract】Cardiorenal syndrome (CRS) is a disease in which heart and kidney dysfunction coexist and interact with each other. Peritoneal dialysis can effectively relieve the volume load of CRS patients, improve cardiac function, reduce hospitalization period and re-hospitalization rate, and increase survival chance. This article reviews the international research progress in the pathogenesis of this disease and the treatment of type II and IV CRS by using peritoneal dialysis. Metrics

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Research progresses in chronic kidney disease patients complicated with pulmonary hypertension 2019, 18 (05):  328-331.  doi: 10.3969/j.issn.1671-4091.2019.05.011 Abstract ( 256 )   PDF (365KB) ( 688 )   【Abstract】Pulmonary hypertension is a progressive disease characterized by elevated blood pressure and vascular resistance in pulmonary arteries finally leading to right heart failure. It is a common complication in chronic kidney disease (CKD) patients. CKD patients with pulmonary hypertension have higher risk of hospitalization and death. Therefore, pulmonary hypertension is a unfavorable predictor for survival in CKD patients. The pathogenesis of pulmonary hypertension in CKD patients is complicated and remains elusive. Early identification and active treatment are clinically essential. This article reviews the research progresses in pulmonary hypertension in CKD patients. Metrics

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Analysis of preoperative factors for vein anastomotic stenosis of arteriovenous graft fistula 2019, 18 (05):  335-338.  doi: 10.3969/j.issn.1671-4091.2019.05.013 Abstract ( 362 )   PDF (451KB) ( 735 )   【Abstract】Objective To investigate the patency and the preoperative factors for vein anastomotic stenosis of arteriovenous graft (AVG) fistulas in end-stage renal disease patients. Method A total of 138 cases treated with AVG fistula operation at the Renal Department of Haidian Hospital in 2016 were enrolled in this study. Their clinical data were collected. They were followed up after the operation to investigate their primary patency rate, assisted primary patency rate and secondary patency rate. The preoperative factors for vein anastomotic stenosis were identified through the analyses of preoperative clinical data of the patients with vein anastomotic stenosis and those without vein anastomotic stenosis. Result After the operation for 6 months, the primary patency, assisted primary patency and secondary patency rates were 81.1%, 88.1% and 95.7%, respectively. After the operation for one year, the primary patency, assisted primary patency and secondary patency rates were 52.1% , 64.2% and 91.0% , respectively. Cox multivariate regression analysis showed that smoking (HR: 2.713, 95% CI: 1.324～5.56, P=0.006) was an independent risk factor and antiplatelet therapy (HR: 0.242, 95% CI: 0.102～0.572, P=0.001)) was an independent protective factor for vein anastomotic stenosis of AVG fistulas. Conclusion The secondary patency rate of AVG fistulas was acceptable after interventions. Smoking was a risk factor and antiplatelet therapy was a protective factor for vein anastomotic stenosis of AVG fistulas. Metrics

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Applied study on different test method for bacterial monitoring in dialysis water 2019, 18 (05):  341-344.  doi: 10.3969/j.issn.1671-4091.2019.05.015 Abstract ( 277 )   PDF (465KB) ( 655 )   【Abstract】Objective To evaluate the feasibility of tryptone glucose extract agar (TGEA) medium for the detection of bacteria number in dialysis water in order to provide a reliable method for routine examination of bacterial contamination in dialysis water. Methods Seventy-four samples of dialysis water were collected from 20 hemodialysis centers at outlet of water treatment system, backwater point of water treatment system, and inlet hose connected to hemodialysis machine. Pour plate method, spreading method and membrane filtration method were used for the incubation of water samples in TGEA medium (20℃, 168h) and conventional nutrient agar medium (36℃ , 48h). After incubation, number of bacterial colonies was quantified. Result The detection rate of bacteria and the value of log10 colony counts had no significant differences between TGEA pour plate method, TGEA spreading method and TGEA membrane filtration method (χ2=0.115 and 0.843 respectively; P=0.944 and 0.656 respectively), but were higher than the results of conventional nutrient agar medium using the three inoculation methods (χ2=19.140 and 29.691 respectively; P=0.002 and <0.001 respectively). Bland- Altman analysis showed that the results from TGEA medium (20℃ , 168h) and those from nutrient agar medium (36℃, 48h) using the three inoculation methods were less consistent, but the results from TGEA pour plate method, TGEA spreading method and TGEA membrane filtration method had better consistency. Conclusions The method of conventional nutrient agar medium (36℃, 48h) can interfere with the detection of bacteria number in dialysis water, while TGEA medium (20℃, 168h) is applicable for clinical use. The reagent kit using membrane filtration method has the characteristics of simple and fast operation with high efficiency and accuracy, suitable for routine surveillance of bacterial contamination in dialysis water. Metrics

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Nursing and training of exit-site care in nurses working for peritoneal dialysis patients in Beijing 2019, 18 (05):  345-348.  doi: 10.3969/j.issn.1671-4091.2019.05.016 Abstract ( 245 )   PDF (359KB) ( 712 )   【Abstract】Objective To investigate nursing and training of exit-site care for peritoneal dialysis (PD) patients in professional nurses working in the PD centers in Beijing. Methods This was a cross- sectional study. A self-designed questionnaire of“Investigation on Nursing Practice of Exit-site Care for PD Patients” was used to investigate 34 professional PD nurses from 17 hospitals in Beijing. Results The incidence of exit-site infection was 0.05 episode/ patient/year in these hospitals. The number of nurse-to-patient ratio was 1: 46.15. Thirty-three nurses (97.06%) could strictly follow the aseptic manipulation; 91.18% of the nurses were able to complete the exit- site assessment; 26 nurses used normal saline plus iodophor to disinfect the exitsites. About 50% of the nurses trained the patients or their caregivers to do exit-site care twice a week around the period of exit-site maturation. Only 4 nurses trained the patients to routinely use antibacterial ointment to prevent exit-site infection. The training time was 16.96±9.95 hours for new patients. All nurses re-trained exitsite care in the patients, but no one did home visit. Conclusion The exit-site care practice and training following the ISPD guidelines were well conducted in professional PD nurses. The use of antibacterial ointment to prevent infection was different from the ISPD guidelines. Further investigation in this area is warranted. Metrics

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Correlation and mediating effects of depression, sleep quality and fatigue in maintenance hemodialysis patients 2019, 18 (05):  349-351.  doi: 10.3969/j.issn.1671-4091.2019.05.017 Abstract ( 319 )   PDF (354KB) ( 864 )   【Abstract】Objective To understand the status of depression, sleep quality and fatigue in maintenance hemodialysis (MHD) patients as well as the correlation and mediation effects between the three symptoms. Methods The general data questionnaire, Self-rating Depression Scale, Functional Assessment of Chronic Illness Therapy-Fatigue, and Athen’s Insomnia Scale were used to investigate 209 MHD patients in 3 top level hospitals. Correlation analysis was performed using Spearman correlation coefficient analysis, and mediating effect was analyzed by linear regression analysis. Results The incidence of depression and sleep disorder in the MHD patients were 40.2% and 77.5% respectively, and the score of fatigue scale was 8-52 points [median 38.00 (32.00, 44.00)]. Statistical analysis showed that depression score was negatively correlated with fatigue score (r=-0.590, P＜0.001), sleep quality score was negatively correlated with fatigue score (r=-0.404, P＜0.001), and sleep quality score was positively correlated with depression score (r=0.416, P＜0.001). The depression score had a negative predictive effect on fatigue score (β =-0.621, P＜0.001), and a positive predictive effect on sleep quality score (β=0.214, P＜0.001). After adding sleep quality score, the effect of depression scores on fatigue scores decreased and the beta value changed from - 0.621 to - 0.552, suggesting that sleep quality plays a partial mediating role in the relationship between depression and fatigue. Conclusions Improving fatigue in MHD patients should focus on the presence of depression as well as the quality of sleep. Improving depression and sleep disorders are the important measures to decrease fatigue. Metrics

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Subtyping of young hemodialysis patients based on cluster analyses 2019, 18 (05):  352-355.  doi: 10.3969/j.issn.1671-4091.2019.05.018 Abstract ( 220 )   PDF (398KB) ( 643 )   【Abstract】Objective To explore the possible subtypes of young maintenance hemodialysis patients based on patients’self-management ability, self-efficacy and hope. Methods A total of 198 young maintenance hemodialysis patients were assessed by Self-management Scale for Hemodialysis (SMSH), Self-Efficacy Scale for Chronic (SESC) and Herth Hope Index (HHI). Cluster analysis was performed to categorize patients based on their scores using SPSS 22.0 software. Results Four different subtypes could be found in these patients. Type I patients (24.7% of the patients) showed very good self-management abilities, positively and optimistically. Type II patients (16.7% of the patients) showed blind permissive management and good self- efficacy and hope but with poor self-management ability. Type Ⅲ patients (41.4% of the patients) performed poorly in emotional accommodation but with good self-management ability. Type Ⅳ patients (17.2% of the patients) were pessimistic with poor self-management ability, self- efficacy and hope. Education level (χ2=16.707, P=0.010), job (χ2=9.312, P=0.025), primary caregivers (χ2=57.570, P＜0.001) and dialysis duration (χ2=44.584, P＜0.001) were significant different between the four subtypes of patients. Conclusion To divide young hemodialysis patients into four subtypes can help medical staff develop better targeted interventions and provide a basis for standardization of disease management. Metrics

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A study on the relationship between response, coping style and depression in the primary caregivers of hemodialysis patients 2019, 18 (05):  361-364.  doi: 10.3969/j.issn.1671-4091.2019.05.021 Abstract ( 272 )   PDF (399KB) ( 650 )   【Abstract】Objective To understand the reaction, coping style and depression and to analyze the relationship between reaction, coping style and depression in the primary caregivers of hemodialysis patients. Methods A total of 118 primary caregivers of hemodialysis patients in a hospital were investigated by general information questionnaire, Caregiver Response Rating Scale, Simplified Coping Style and Self Rating Depression Scale (SDS). Results In the primary caregivers of hemodialysis patients, self-esteem was negatively correlated with depression (r=-0.195, P=0.034); health and economic problems were positively correlated with depression (r=0.219 and 0.315 respectively, P=0.017 and 0.001 respectively); and negative coping style was positively correlated with depression (r=0.216, P=0.019). Conclusions Depression status exists in the primary caregivers of hemodialysis patients. Medical workers should adopt effective measures to reduce their depression and raise their positive feelings, from which the quality of care for patients can then be improved. Metrics