Chinese Journal of Blood Purification

12 July 2019, Volume 18 Issue 07 Previous Issue    Next Issue

Select

The developmental history of blood purification–hemodialysis 2019, 18 (07):  439-441.  doi: 10.3969/j.issn.1671-4091.2019.07.001 Abstract ( 932 )   PDF (385KB) ( 1435 )   【Abstract】Hemodialysis has been developed for more than one hundred years since the modern concept of dialysis was established. Currently, hemodialysis has become an important modality of renal replacement therapy in clinical practice. Here we summarize the developmental history of hemodialysis with emphasis on the progress in China in the recent 70 years, from which it is anticipated that more advanced hemodialysis technologies will arise in the nearly future period. Metrics

Select

The relationship between platelet/lymphocyte ratio and inflammation status in patients on continuous ambulatory peritoneal dialysis#br# 2019, 18 (07):  473-476.  doi: 10.3969/j.issn.1671-4091.2019.07.003 Abstract ( 270 )   PDF (409KB) ( 598 )   【Abstract】Objective To investigate the relationship between platelet/lymphocyte ratio (PLR) and inflammation status in patients on continuous ambulatory peritoneal dialysis (CAPD) in order to explore a new biomarker for the inflammation status of CAPD patients. Methods A total of 70 CAPD patients treated in the First People's Hospital of Changzhou and 35 healthy individuals as the controls were enrolled in this study. PLR and other laboratory parameters were compared between CAPD patients and controls. CAPD patients were further divided into two subgroups according to the mean value of PLR. Neutrophil/lymphocyte ratio (NLR), high sensitive C- reactive protein (hs- CRP) and other parameters were compared between the two CAPD patient subgroups. The relationship between PLR and NLR, albumin and hs-CRP was assessed using Spearman correlation. Results Neutrophil (t=-3.709, P＜0.001), urea nitrogen (t=-19.858, P＜0.001), creatinine (t=-27.883, P＜0.001), triacylglycerol (t=-5.929, P＜0.001), PLR (t=-4.320, P＜0.001), NLR (t=-10.224, P＜0.001) and hs-CRP (t=- 9.478, P＜0.001) were significantly higher in CAPD patients than in controls. Lymphocyte (t=9.369, P＜0.001), platelet (t=5.263, P＜0.001), hemoglobin (t=15.108, P＜0.001), albumin (t=11.231, P＜0.001) and high density lipoprotein cholesterol (t=7.164, P＜0.001) were significantly lower in CAPD patients than in controls. The mean value of PLR was 136 in CAPD patients. Neutrophil (t=2.155, P=0.035) and lymphocyte (t=4.434, P＜0.001) count were significantly lower in CAPD patients with PLR ≥136 than in those with PLR＜136. Platelet count (t=-4.408, P＜0.001), NLR (t=-2.707, P=0.009) and hs-CRP (t=-2.948, P=0.005) were significantly higher in the CAPD patients with PLR ≥136 than in those with PLR＜136 (P<0.05). PLR was negatively correlated with hemoglobin (r=- 0.307, P=0.001), lymphocyte count (r=-0.588, P＜0.001) and albumin (r=-0.246, P＜0.012), and positively correlated with platelet count (r=0.281,P=0.004), urea nitrogen (r=0.278, P=0.004), creatinine (r=0.196, P= 0.045), hs-CRP (r=0.354, P＜0.001) and NLR (r=0.460, P＜0.001) in CAPD patients. Conclusion PLR can be used as a new biomarker of inflammation status in CAPD patients. Metrics

Select

The effects of hemodialysis with central venous catheterization on the urgent-start peritoneal Dialysis 2019, 18 (07):  477-481.  doi: 10.3969/j.issn.1671-4091.2019.07.004 Abstract ( 211 )   PDF (408KB) ( 597 )   【Abstract】Objective To investigate the effects of hemodialysis with central venous catheterization (HDCVC) on urgent-start peritoneal dialysis (USPD). Methods This was a retrospective analysis on patients receiving USPD. According to whether the patient had HD-CVC before USPD, they were divided into USPD group (without HD-CVC before USPD) and HD-PD group (pretreated with HD-CVC for less than 2 weeks and then with USPD) and followed up for one year. Clinical biochemical indexes, dialysis dose, urine volume, residual renal function, dialysis adequacy, peritoneal dialysis complications and technical survival rate were compared between the two groups. Results ①A total of 482 patients were enrolled in this study, including 315 (average age 48.56±14.92 years) in USPD group and 167 (average age 48.87±14.49 years) in HD-PD group. The gender, age, proportion of diabetic nephropathy, and creatinine, glomerular filtration rate and blood potassium before admission had no statistical significances between the two groups (χ2 or t=0.727, -0.223, 0.410, -1.824, -0.581 and -1.506 respectively; P=0.394, 0.824, 0.522, 0.069, 0.562 and 0.133 respectively). ② After PD for one month, residual renal function, UKt/V and TKt/V were significantly higher in USPD group than in HD-PD group (4.41±4.0ml/min, 0.79±0.44, and 2.17±1.39 respectively in USPD group; 3.67±2.39ml/min, 0.64±0.42 and 1.92±0.55 respectively in HD-PD group; t=2.026, 3.342 and 2.134 respectively; P=0.043, 0.001 and 0.033 respectively); blood urea nitrogen and creatinine were significantly lower in USPD group than in HD-PD group (17.79 ± 4.96mmol/L and 663.15 ± 182.03μmol/L respectively in USPD group; 19.08±8.21 mmol/L and 711.02±280.3μmol/L respectively in HD-PD group; t=-2.085 and -2.194 respectively; P=0.038 and 0.029 respectively). After PD for 6 months, urine volume was significantly higher in USPD group than in HD- PD group (964.84 ± 539.95ml/d in USPD group; 794.39 ± 569.17ml/d in HD- PD group; t=3.082, P=0.002). ③ Orifice infection rate, peritonitis infection rate, mechanical complications and technical survival rate were similar between the two groups (after PD for one month: χ2=1.434, 0.435, 0.199, and 0.059 respectively; P=0.231, 0.509, 0.656 and 0.807 respectively; after PD for 6 months: χ2=0.632, 0.532, 0.081 and 0.486 respectively; P=0.426, 0.466, 0.775 and 0.486 respectively; after PD for one year: χ2=0.847, 0.005, ＜0.000 and 1.254 respectively; P=0.357, 0.945, 0.997 and 0.263 respectively). Conclusion HD-CVC before USPD affected residual renal function and dialysis adequacy of the patients. Therefore, HD-CVC as a pretreatment is not recommended in end-stage renal disease patients required PD but without the indication of emergency dialysis. Metrics

Select

The correlation between interdialytic ambulatory blood pressure and intradialytic blood pressure 2019, 18 (07):  482-485.  doi: 10.3969/j.issn.1671-4091.2019.07.005 Abstract ( 267 )   PDF (390KB) ( 585 )   【Abstract】Objective To determine the situation of interdialytic ambulatory blood pressure monitoring(ABPM) and its correlation with intradialytic blood pressure (BP) in maintenance hemodialysis (MHD) patients. Methods Fifty-one MHD patients treated in Peking University People’s Hospital from Dec. 2014 to Dec. 2017 were recruited. Their interdialytic ABPM values for 44 hours and the BP values before, during and after dialysis for 3 sessions in this week were collected. Paired sample t test was used to compare interdialytic BP values and the BP values in the dialysis day. Pearson correlation analysis was used to evaluate the correlation between interdialytic ABPM values and BP values at different stages in the dialysis day. Bland-altman difference method was used to test the consistency of the two measurement methods. Results There was a difference between interdialytic ABPM values and the BP values in the dialysis day (t＝- 3.854, P＜0.001). There were weak correlations of interdialytic systolic BP (SBP) with the SBP before (r＝0.381, P＝0.007), during (r＝0.442, P＝0.001) and after dialysis (r＝0.374, P＜0.001) in the dialysis day, in which significant relationship was present between interdialytic 44 hours SBP and the SBP during dialysis. Bland-Altman analysis showed that the 95% confidence interval for the difference between interdialytic 44 hours SBP and the SBP during dialysis was -32.42, 35.64 mmHg. Conclusion Interdialytic BP was different from the BP in the dialysis day. BP in the dialysis day cannot replace ABPM for evaluating interdialytic BP in MHD patients. Metrics

Select

The comparison of clinical effects and outcome in patients with high-flux hemodialysis and those with low- flux hemodialysis combined with hemodiafiltration#br# 2019, 18 (07):  486-490.  doi: :10.3969/j.issn.1671-4091.2019.07.006 Abstract ( 150 )   PDF (563KB) ( 148 )   【Abstract】Objective To compare the efficiency and safety of high-flux hemodialysis (HFHD) and lowflux hemodialysis (LFHD) combined with hemodiafiltration (HDF) in maintenance hemodialysis (MHD) patients. Methods A total of 315 MHD patients were recruited and divided into trial group (HFHD, 3 times per week) and control group (LFHD 2 times per week and HDF once a week). They were followed up for 24 months. Results ①There were no significant differences in mortality rate (5.66% vs. 9.55%, χ2=1.701, P=0.191) and hospitalization rate (27.04% vs. 25.48%, χ2=0.100, P=0.752) between the trial group and the control group. ②The after dialysis single pool Kt/V values in the trial and control group were 1.70±1.03 and1.37±0.24 respectively (t=1.782, P=0.079), while urea reduction rates in the two groups were 75.08±13.15% and 70.31±10.69% respectively (t=1.760, P=0.082). After the treatment, serum β2 microglobulin in the trial group was significantly lower than that in the control group (21.52±9.94mg/L vs. 27.28±16.51mg/L, t=-2.148, P=0.034). ③ No dialyzer- related acute complications and dialyzer- related adverse events occurred in both groups. Conclusion The two hemodialysis methods were equally effective and safe. HFHD had a better clearance of medium macromolecular toxins and is recommended to be used clinically. Metrics

Select

The clinical efficacy of hemodiafiltration on peripheral neuropathy in uremic patients 2019, 18 (07):  491-494.  doi: 10.3969/j.issn.1671-4091.2019.07.007 Abstract ( 293 )   PDF (396KB) ( 725 )   【Abstract】Objective To explore the clinical efficacy of hemodiafiltration on peripheral neuropathy in uremic patients. Methods Sixty- nine maintenance hemodialysis patients complicated with peripheral neurological impairment were randomly assigned to the control group (n=35) in which patients were treated with conventional hemodialysis (HD), or the observation group (n=34) in which patients were treated with hemodiafiltration (HDF). The symptoms of peripheral neuropathy, sensory nerve conduction velocity (SCV), and serum leptin, β2-microglobulin (β2-MG) and parathyroid hormone (PTH) were observed before and after treatment, and the clinical effects were then compared between the two groups. Results The effectiveness rate of peripheral neuropathy symptoms, including disappearance or improvement of the symptoms, was 91.18% in the observation group and 28.57% in the control group (χ2=16.793, P=0.019). After the treatment, serum leptin, β2-MG and PTH were significantly lower in the observation group than in the control group (t=5.374, 9.605 and 8.327 respectively; P＜0.001, 0.001 and＜0.001 respectively). Correlation analyses showed that β2- MG was negatively correlated with tibial nerve SCV and common peroneal nerve SCV (r=-0.789 and -0.832 respectively; P=0.015 and P=0.004 respectively); leptin was negatively correlated with tibial nerve SCV and common peroneal nerve SCV (r=-0.819 and -0.867 respectively; P=0.006 and P＜0.001 respectively); PTH had no significant correlation with tibial nerve SCV and common peroneal nerve SCV (r=-0.327 and -0.359 respectively;P=0.119 and P=0.087 respectively). Conclusion Hemodiafiltration can effectively reduce leptin, β2-MG and PTH levels and improve peripheral neuropathy in uremic patients. Metrics

Select

Cognitive Impairment in Patients with Chronic Kidney Disease 2019, 18 (07):  495-498.  doi: 10.3969/j.issn.1671-4091.2019.07.008 Abstract ( 317 )   PDF (387KB) ( 802 )   【Abstract】Patients with chronic kidney disease (CKD) are frequently afflicted with neurological complications. Among those, cognitive impairment (CI) is common and negatively affects health-related quality of life and other health-related outcomes. While the pathophysiology and etiology are complex and far from completely understood, CI may relate with vascular injury and some non-conventional cardiovascular risk factors. Some other non- conventional risk factors caused by ESRD, like anemia, oxidative stress, homocysteinemia and microinflammation, may aggravate the CI. In addition, hemodialysis and peritoneal dialysis may impact the brain by various mechanisms. Metrics

Select

Providing nutrition for protein-energy wasting during hemodialysis treatment 2019, 18 (07):  499-502.  doi: 10.3969/j.issn.1671-4091.2019.07.009 Abstract ( 296 )   PDF (365KB) ( 655 )   【Abstract】Most maintenance hemodialysis patients have protein energy wasting (PEW). PEW is an independent risk factor for death of these patients and is also closely related to the poor prognosis and quality of life. To provide nutritional therapy during hemodialysis has been controversial. This article reviews the nutritional intervention of PEW during hemodialysis. Metrics

Select

The analysis of current situation and related factors of vascular access in a single hemodialysis center 2019, 18 (07):  503-506.  doi: 10.3969/j.issn.1671-4091.2019.07.010 Abstract ( 300 )   PDF (401KB) ( 637 )   【Abstract】Objective To investigate the current situation and influencing factors of vascular access in patients with maintenance hemodialysis (MHD) in the Blood Purification Center of the Second Xiangya Hospital of Central South University, and to explore the effect of temporary central venous catheterization on arteriovenous fistula (AVF). Methods We retrospectively investigated the clinical data, laboratory examination and vascular access of 343 MHD patients as of January 1, 2017. Patients were divided into three groups (ipsilateral catheterization group, contralateral catheterization group and AVF group) according to the presence or absence of the temporary catheterization through neck veins and its side relating to the first mature AVF. Results ① The vascular access modalities at the initial of dialysis were temporary venous catheter (TVC) 73.18% and AVF 14.29%. After MHD for more than 3 months, the proportion of AVF increased to 89.21-96.5%. ②Analyses of the patients in the 3 groups found that the times of AVF surgery were higher in ipsilateral catheterization group (2.05±1.41) than in contralateral catheterization group (1.37±0.73, H=3.618, P=0.001) and AVF group (1.29 ± 0.74, H=3.846, P＜0.001); the primary failure rate of AVF was higher in ipsilateral catheterization group(23.26%) than in contralateral catheterization group (3.95%, χ2＝14.126, P＜0.001) and AVF group (4.08%, χ2＝7.242, P=0.011); the one-year patency rate was lower in ipsilateral catheterization group (73.68%) than in contralateral catheterization group (92.14%, χ2＝8.093, P=0.004) and AVF group (97.56%, χ2＝9.381, P=0.003). The presence of aneurysm and the 3-year and 5 year patency rates were similar among the three groups (H=4.191, 4.045 and 3.717 respectively; P= 0.128, 0.134 and 0.150 respectively). Conclusions ①AVF is the first choice of vascular access modality in this blood purification center. ②The long-term patency of vascular access is not affected by the presence or absence of temporary venous catheterization and its side, whereas the increased times of AVF surgery, higher primary failure rate and lower shortterm patency rate are related to the ipsilateral catheterization. AVF surgery at the opposite side of venous catheterization will reduce the times of AVF surgery and primary failure rate and increase the short-term patency rate. Metrics

Select

Correlation between the health attainment and the self-management and self- efficacy in maintenance hemodialysis patients 2019, 18 (07):  509-512.  doi: 10.3969/j.issn.1671-4091.2019.07.012 Abstract ( 240 )   PDF (381KB) ( 669 )   【Abstract】Objective To investigate the status quo of health attainment in maintenance hemodialysis (MHD) patients and to explore the correlation between their health attainment and their self-management and self-efficacy activities, so as to provide a theoretical basis for improving the health management mode and enhancing the self-efficacy and self-management abilities in MHD patients. Methods A total of 239 MHD patients admitted to the Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University were investigated by the convenience sampling method. Results The total score of health attainment survey was (19.19 3.34), the total score of self-management was (60.05 10.53), and the total score of self-efficacy was (6.94 2.04). Therefore, the level of health attainment was positively correlated with the patients' selfmanagement(r=0.270, P＜ 0.001) and self-efficacy (r=0.257, P＜0.001). Conclusion There was a close relationship between the health attainment level and the self-management and self-efficacy in MHD patients. Metrics