Chinese Journal of Blood Purification

12 August 2019, Volume 18 Issue 08 Previous Issue    Next Issue

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The developmental history of blood purification―vascular access 2019, 18 (08):  513-516.  doi: 10.3969/j.issn.1671-4091.2019.08.001 Abstract ( 445 )   PDF (626KB) ( 993 )   【Abstract】In the developmental processes of blood purification, vascular access undergoes a long period of progression. The application of Quinton-Scribner shunt and Brescia-Cimino fistula is a milestone in the developmental history of blood access. Currently, internal arteriovenous fistula is the preferential and essential method of permanent blood access. Arteriovenous graft provides an alternative for patients without suitable vessels for autologous fistula; polytetrafluoroethylene is widely used for the graft and bioengineered blood vessels are expected to be used clinically in the nearly future. Central vein catheterization played an important role for blood access and nowadays is commonly used as a transitional measure. The continuous improvement of material and structure of the graft and long-term patency of the graft are imperative. Medical staff working for blood access should put their focuses on early protection of vascular resources and rational planning, monitoring and maintenance of the blood access after establishment of vascular access route. Metrics

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The association between residual renal function and symptom burden in maintenance hemodialysis patients 2019, 18 (08):  524-526.  doi: 10.3969/j.issn.1671-4091.2019.08.003 Abstract ( 373 )   PDF (408KB) ( 884 )   【Abstract】Objective To explore the association between residual renal function (RRF) and symptom burden in maintenance hemodialysis (MHD) patients. Methods A total of 152 MHD patients were enrolled in this study. Patients were divided into two groups according to urine volume. Their dialysis related data were collected. Symptom burden was evaluated by Dialysis Symptom Index. Multvariate liner regression and multivariate logistic regression analyses were used for exploring the association between RRF and symptom burden. Results ①The burdens of top five occurred symptoms were trouble staying asleep, decreased libido, tired, dry skin and itching. The burdens of top five severe symptoms were bone or joint pain, insomnia, anxious, sad and constipation. ②Multivariate linear regression revealed that RRF was negatively correlated with the total score of symptoms (t=-2.670, P=0.009) and patients with RRF had lower prevalence of several symptom burdens, including the burdens of vomiting (OR=0.071, z=- 2.200, P=0.028), diarrhea (OR=0.064, z=-2.130, P=0.033), restless legs (OR=0.053, z=-2.260, P=0.024), foot numbness and tingling (OR=0.123, z=-2.540, P=0.011), tired (OR=0.187, z=-2.920, P=0.003) and anxious (OR=0.132, z=-2.410, P=0.016). Conclusion MHD patients with RRF had less symptom burdens. Metrics

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Correlation analysis between seasonal variation and peritoneal dialysis associated peritonitis in Xiangtan area#br# 2019, 18 (08):  527-530.  doi: 10.3969/j.issn.1671-4091.2019.08.004 Abstract ( 243 )   PDF (423KB) ( 618 )   【Abstract】Objective To investigate the correlation between seasonal variation and peritoneal dialysis associated peritonitis (PDAP) in Xiangtan area. Methods A total of 219 episodes of PDAP between Jan.2011 and Dec. 2017 were retrospectively analyzed. The episodes of PDAP were divided into four groups according to the occurrence in the four seasons. The prevalence of PDAP in the four seasons was compared. The correlation between the spectrum of pathogenic bacteria and the seasonal variation, including monthly average temperature, monthly average humidity and monthly average precipitation, was analyzed. Results The prevalence of PDAP had no statistical difference in the four seasons (F=0.944, P=0.435) and had no significant correlation with monthly average temperature, monthly average humidity and monthly average precipitation. The prevalence of PDAP caused by coagulase negative staphylococcus (CoNS) was the highest in winter (F=6.416, P=0.005) and was negatively correlated with monthly average temperature (r=-0.525, P=0.017) and monthly average precipitation (r=-0.497, P=0.026). The prevalence of PDAP caused by other pathogens had no differences in the four seasons. Conclusions In Xiangtan area, seasonal variation had no significant correlation with the prevalence of PDAP, but was correlated with the prevalence of PDAP caused by CoNS, which was the highest in winter and was negatively correlated with monthly average temperature and monthly average precipitation. Specific measures should be carried out to prevent PDAP in winter. Metrics

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Cross- sectional investigation of the intradialytic blood pressure variability and its related factors in maintenance hemodialysis patients#br# 2019, 18 (08):  531-534.  doi: 10.3969/j.issn.1671-4091.2019.08.005 Abstract ( 281 )   PDF (389KB) ( 913 )   【Abstract】Objective To explore the factors relating to intradialytic blood pressure variability and to analyze the relationship between blood pressure variability and cardiac functional indices in maintenance hemodialysis (MHD) patients. Methods MHD patients treated in the Hemodialysis Division of Peking University People’s Hospital from October 1 to 31, 2017 were recruited. Their demographic data, biochemical examinations,echocardiography and intradialytic blood pressure were collected. Pearson and multivariate regression analyses were performed using intradialytic systolic blood pressure variability (SBPV) and diastolic blood pressure variability (DBPV) as the dependent variables, and age, dialysis age and cardiac functional indices as the independent variables. Results A total of 111 MHD patients were recruited in this study. The intradialytic SBPV was positively correlated with patient age (r=0.332, P=0.000), ultrafiltration volume (r=0.261,P=0.049) and iPTH (r=0.375, P=0.003), and was negatively correlated with creatinine level (r=- 0.212,P=0.013). The intradialytic DBPV was positively correlated with end-diastolic left ventricle mass index (LVMI) (r= 0.199, P=0.040). The intradialytic SBPV was positively correlated with age (t= 2.911, P=0.004) after the adjustment of ultrafiltration volume, iPTH and creatinine. Conclusion The age of MHD patients was an independent risk factor for intradialytic SBPV, and the intradialytic DBPV influenced the end- diastolic left ventricle mass index in these patients. Metrics

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The relationship between serum 25(OH)D level and the changes of serum α-Klotho and aortic arch calcification in hemodialysis patients#br# 2019, 18 (08):  535-538.  doi: 10.3969/j.issn.1671-4091.2019.08.006 Abstract ( 267 )   PDF (427KB) ( 625 )   【Abstract】Objectives To evaluate the relationship between serum 25(OH)D level and the changes of serum soluble α-Klotho and aortic arch calcification in hemodialysis (HD) patients. Methods This was a crosssectional study enrolled in 152 HD patients from the Dialysis Center of Beijing Friendship Hospital. Fasting blood samples were collected prior to hemodialysis at the second hemodialysis session in a week. Serum 25(OH)D and intact parathyroid hormone (iPTH) were assayed by an automatic electrochemiluminescence immunoassay instrument. Serum α-Klotho was determined using a sandwich enzyme-linked immunosorbent assay (ELISA) kit. Posterior-anterior chest X-ray examination was used to assess aortic arch calcification. Results The average serum 25(OH)D level was 19.97±8.30 ng/ml in the HD patients, in which vitamin D deficiency was found in 106 patients (69.7%). The average serum α-Klotho level was 421.69±185.28 pg/ml. Aortic arch calcification was found in 89 patients (58.6%). In patients with vitamin D deficiency, females were more than males (54.7% vs. 28.3%, c2=9.660, P= 0.006); serum α-Klotho levels were lower (399.16±179.62 pg/ml vs. 473.61±189.62 pg/ml, t=-2.308, P=0.022); and the prevalence of aortic arch calcification was higher but without statistical significance (63.2% vs. 47.8%, c2=3.127, P=0.077). Linear stepwise regression analysis showed that serum 25(OH)D level was independently correlated with serum α-Klotho level (P=0.022). Binary logistic regression analysis confirmed that age (OR=1.115, 95% CI=1.069- 1.163, P＜0.001) and serum 25 (OH)D (OR=0.948, 95% CI=0.901-0.998, P=0.041) were the independent risk factors for aortic arch calcification. Conclusions Vitamin D deficiency was prevalent in HD patients. Serum 25(OH)D was the independent risk factor for both circulating α- Klotho and aortic arch calcification. Therefore, serum 25(OH)D assay for HD patients is clinically valuable. Metrics

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The value of plasma brain natriuretic peptide level for the prediction of fluid overload in maintenance hemodialysis patients 2019, 18 (08):  539-542.  doi: 10.3969/j.issn.1671-4091.2019.08.007 Abstract ( 352 )   PDF (405KB) ( 674 )   【Abstract】Objective To assess the value of plasma brain natriuretic peptide (BNP) for the prediction of fluid overload after the measurements of volume load status by bioimpedance analysis (BIA) and plasma brain natriuretic peptide (BNP) level in maintenance hemodialysis (MHD) patients. Methods We enrolled 74 MHD patients treated in the Blood Purification Center of Peking University International Hospital in this study. Overhydration before hemodialysis in the day of plasma BNP assay (OHbnp) was evaluated by BIA.Echocardiography was performed within two weeks after BIA. The patients were then divided into two groups, the normal fluid load group (OHbnp ≤2.5L) and the fluid overload group (OHbnp＞2.5L). Plasma BNP level and other parameters were compared between the two groups. Multivariate linear regression was used to assess the variables related to BNP. Receiver operating characteristic (ROC) curve was used to investigate the BNP level for the diagnosis of fluid overload in MHD patients. Results BNP was significantly higher in the fluid overload group than in the normal fluid load group [209 (116,395) pg/ml vs. 339 (172, 843) pg/ml,t=-2.197, P=0.028]. Multivariate linear regression revealed that plasma BNP was closely related to the levels of OHbnp (β =0.107 ± 0.037, P=0.005), hemoglobin (β =-0.012±0.004, P=0.005) and lean tissue index(β=-0.046±0.019, P=0.016). ROC curve revealed that the sensitivity and specificity for the diagnosis of fluid overload were 0.548 and 0.698 respectively, when the cut-off value of BNP was set at 309 pg/ml. Conclusion Plasma BNP level was affected by the levels of fluid load, hemoglobin and lean tissue index. Plasma BNP >309 pg/ml suggests the presence of fluid overload. Metrics

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Analysis of related factors affecting long- term survival of hemodialysis patients 2019, 18 (08):  543-546.  doi: 10.3969/j.issn.1671-4091.2019.08.008 Abstract ( 295 )   PDF (443KB) ( 703 )   【Abstract】Objective To analyze the potential risk factors that influence the survival of maintenance hemodialysis (MHD) patients. Methods A follow-up study was conducted on 1,597 patients undergoing MHD for more than 3 months and registered in the Registration System of Blood Purification Cases (CNRDS) in 2013. The following parameters were analyzed: ① baseline data including gender, age, age of dialysis, type of vascular access, type of dialyzer and anticoagulant; ②distribution of primary disease, treatment outcome and cause of death; ③clinical and laboratory examination results including pre-dialysis blood pressure, urea reduction rate (URR), urea clearance index (spKt/V), hemoglobin, calcium, phosphate and albumin. Results ①The most common primary disease was primary glomerular disease (53.2%). The proportion of diabetic nephropathy patients were significantly higher in patients ≤50 years old than in those < 50 years old (31.5% vs. 7.4%, χ2=160.520, P＜0.001). ②The first cause of death was cardiovascular events (42.19%), followed by cerebrovascular events (25.78%) and infection (10.94%). ③Primary glomerular disease (RR=0.532, 95% CI 0.366～0.772, P=0.001), Hb ≥100g/L (RR=0.510, 95% CI 0.373～0.696, P<0.001), Alb ≥35g/L (RR=0.355, 95% CI 0.266～0.472, P＜0.001), and pre- dialysis blood pressure ≤ 140/90 mmHg (RR=0.689, 95% CI 0.496～0.957, P=0.026) were the protective factors for outcome. Conclusion Cardiovascular events were the leading cause of death in MHD patients. The proportion of diabetic nephropathy is significantly increased in MHD patients over 50 years old. Primary disease type, anemia, hypoproteinemia, and pre-dialysis hypertension can affect the long-term survival of MHD patients. Metrics

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The efficacy of immunoabsorption therapy for ankylosing spondylitis 2019, 18 (08):  547-549.  doi: 10.3969/j.issn.1671-4091.2019.08.009 Abstract ( 549 )   PDF (358KB) ( 790 )   【Abstract】Objective To investigate the efficacy of immunoadsorption therapy for ankylosing spondylitis (AS). Methods A total of 60 patients with AS were recruited and allocated into control group (n=30) or immunoadsorption group (n=30). Erythrocyte sedimentation rate (ESR), C- reaction protein (CRP) and the score of Bath AS disease activity index (BASDAI) were assessed before the treatment and at the first week, first month and 3rd month after the treatment. Results At the first week after the treatment, ESR (Z=2.692,P=-0.007), CRP (Z=2.511, P=0.012) and BASDAI score (Z=3.866, P=0.000) were significantly lower in immunoadsorption group than in control group. At the 3rd month after the treatment, ESR (Z=2.905, P=0.004), CRP (Z= 6.427, P=0.000) and BASDAI score (Z=2.000, P=0.045) were still lower in immunoadsorption group than in control group; in addition, the doses of non-steroid anti-inflammatory drugs (NSAIDs) reduced in immunoadsorption group as compared with those in control group (Z=4.296, P=0.000). Conclusion Immunoadsorption treatment for AS has the advantages of fast improvement of inflammatory biomarkers and clinical conditions with stable efficacies. Immunoadsorption therapy can also alleviate the inflammation responses in AS patients. Metrics

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Chronic kidney disease women complicated with pregnancy 2019, 18 (08):  556-559.  doi: 10.3969/j.issn.1671-4091.2019.08.012 Abstract ( 266 )   PDF (365KB) ( 740 )   【Abstract】The number of pregnant women with various degrees of renal dysfunction becomes increasing, as the incidence of chronic kidney disease (CKD) is going up worldwide. CKD and pregnancy are mutually affected, in which the pregnancy and fetus are adversely affected by the renal dysfunction, and the processes of CKD may deteriorate due to the pregnancy. Both clinicians and the patients are concerned about the appropriate time for pregnancy and how to monitor and manage the pregnancy in CKD women. In this review, we review the recent progresses in CKD women with pregnancy, introduce the outcomes of pregnancies and fetuses in women with several common nephropathies such as IgA nephrology, lupus nephritis and diabetic nephropathy, and summarize the protocols to adjust CKD-related drugs during pregnancy. Metrics

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An in vitro study about the remaining rate of sealing fluid in central venous catheters 2019, 18 (08):  564-567.  doi: 10.3969/j.issn.1671-4091.2019.08.014 Abstract ( 279 )   PDF (498KB) ( 643 )   【Abstract】Objective To observe the gradient concentration of sealing fluid sealed in central vein catheters for 0-96 hours, and to summarize the concentration-time changing rule of the sealing fluid. Methods A catheters was placed vertically in a flask containing 1,000ml reverse-osmosis water of secondary grade. The scaled volume of sealing fluid was injected into the venous end of the catheter. Samples were collected from tip to tail of the catheter in six parts, and the procedure was repeated 10 times. The average concentration was calculated, the concentration-time curve was drawn, and the parameters were obtained by fitting the four-parameter model curve. Results Immediately after tube closure, the concentration remained in the tip segment was 15.8 ± 0.8mmol/L, rapidly decreased to 9.9 ± 0.9mmol/L in 5 minutes, then slowly decreased to 0.7 ±0.1mmol/L after 96 hours. The concentration remained in the second segment gradually decreased from 22.4±0.6mmol/L immediately after tube closure to 2.7±0.4mmol/L after 96 hours. The decline rate slowed down along the first to sixth segments. The concentration of remained sealing fluid was similar in the fourth, fifth and sixth segments after 96 hours. Fitting equation Y=(A- D)/[1 + (T/C)B] +D can mesh with the propellant curve (R2＞90). Conclusion Immediately after sealing, the sealing fluid at the tip of the tube lost and quickly and further lost within 5 minutes, associated with significant decrease of sealing fluid concentration. According to the fitting equation, the suitable concentration and effective time of sealing fluid can be calculated and a reasonable sealing strategy can be worked out. Metrics

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Venous injection filling method combined with modified end-to-side anastomosis in arteriovenous fistula surgery: a clinical study 2019, 18 (08):  568-570.  doi: 10.3969/j.issn.1671-4091.2019.08.015 Abstract ( 200 )   PDF (404KB) ( 929 )   【Abstract】Objective To explore the clinical application value of venous injection filling combined with modified end-to-side anastomosis in arteriovenous fistula (AVF) surgery. Methods The end-stage renal disease patients treated with autologus AVF surgery in the period from October 2012 to August 2018 were retrospectively analyzed. During AVF surgery, venous injection filling method combined with modified end-toside anastomosis was used in 86 patients (venous injection filling method group), conventional end- to- side anastomosis was used in 43 patients (conventional end-to-side anastomosis group). The vascular suture time, anastomotic length, fistula matured rate after three months, fistula maturation time, and the rate of remedial vascular suture were analyzed. Results The vascular suture time (18.2±4.5 min vs. 21.4±4.9 min; F=14.276, P=0.000), fistula maturation time (33.3±5.4 days vs. 37.7±5.2 days; F=5.179, P=0.031), remedial vascular suture rate (4.6% vs.16%; c2=4.963, P=0.032) were significantly lower in venous injection filling method group than in conventional end-to-side anastomosis group. The anastomotic length [7 (8-6) mm vs. 5 (6-5) mm; z=-7.086, P=0.000), anastomotic stoma fistula matured rate after three months (92.1% vs. 78.3%; c2=4.203, P=0.043) were significantly higher in venous injection filling method group than in conventional end- to- side anastomosis group. The successful rate of AVF surgery had no statistical significance between the two groups (88.4% vs. 86.0%; c2=0.028, P=0.415). Conclusion venous injection filling method combined with modified end-to-side anastomosis has the advantages of shorter vascular suture time, better exposure field, simple and reliable vascular suture, suitable anastomotic length and earlier mature of the AVF, as compared with those in conventional end-to-side anastomosis group. This method is especially suitable for the patients with veins of smaller diameter in autologus AVF surgery. Metrics

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Investigation of mental resilience and its influencing factors in young and middle-aged maintenance hemodialysis patients 2019, 18 (08):  571-574.  doi: 10.3969/j.issn.1671-4091.2019.08.016 Abstract ( 224 )   PDF (382KB) ( 680 )   【Abstract】Objective To investigate the status quo of mental resilience and its influencing factors in young and middle-aged maintenance hemodialysis (MHD) patients, so as to provide bases for improving mental resilience in these patients. Methods General data of the patients, the mental resilience scale (CD-RISC) and the hemodialysis self-management scale were used to investigate 110 young and middle-aged MHD patients treated in our hospital. Results The total mental resilience score was 63.87±15.400; the dimension scores were resilience 25.91±7.320, optimism 29.72±7.104, and strength 7.80±2.797. Self-management scores were 60.05±10.53; the dimension scores were problem solving 15.55±2.52, self-care activities 20.57 ± 4.01, partnerships 12.25±2.53, and emotional processing 11.68±4.73. In the general data area, educational level, economic status and work status were closely related to the scores of mental resilience (F=3.903, 3.083 and 2.140 respectively; P=0.011, 0.012 and 0.035 respectively). Pearson correlation analysis showed that the scores of psychological resilience and its dimensions were positively correlated with the scores of self-management and its dimensions (P＜0.05) in young and middle- aged MHD patients. Multivariate linear regression revealed that economic status was the influencing factor for psychological resilience (t=3.616, P＜0.001). Conclusion The mental resilience and self-management abilities were relatively low in young and middle-aged MHD patients. Appropriate measures based on the different influencing factors should be taken to enhance mental resilience and self-management abilities, from which their psychological health, disease management abilities and the quality of life can be improved in these MHD patients. Metrics

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The reliability and validity of the 14- item uremic pruritus in dialysis patients scale (Chinese version scale) 2019, 18 (08):  575-578.  doi: 10.3969/j.issn.1671-4091.2019.08.017 Abstract ( 472 )   PDF (439KB) ( 855 )   【Abstract】Objective To introduce the 14-item uremic pruritus in dialysis patients scale (14-item Updial scale), translate the scale, test the reliability and validity of the scale, and then evaluate its usefulness in Chinese patients. Methods We translated and back-translated the original scale to set up the Chinese version scale. Reliability and validity of the Chinese version scale was examined in 270 dialysis patients with uremic pruritus. Reliability was tested by Cronbach's α coefficient, test- retest reliability, and correlation coefficient between each item and the total score of the scale. Content validity of the scale was evaluated by content validity index (CVI). Criterion related validity was tested by the correlation between the Chinese version scale and the visual analogue scale. Construct validity was tested by exploratory factor analysis. Results The scale is composed of 14 questions, which are divided into 3 dimensions: symptoms and signs (itch duration, itching degree, itching size, lesions from scratching, feel numb, crawling like ants or insects, and dry skin), sleep (difficulty to fall asleep, waking up during the night, interfere sleep quality), and social psychology (work/study, social interaction, mood, and any sexual difficulties). The Cronbach's α of the 3 subscales and the whole scale were 0.749, 0.710, 0.845 and 0.894 respectively. The test-retest reliability coefficients of the 3 subscales and the whole scale were 0.968, 0.951, 0.977 and 0.976 respectively (P<0.001). The correlation coefficients between each item and its dimensional subscale and the whole scale were 0.413～0.892 (P<0.001). The item-level content validity index (CVI) of item 5 (feel numb) and item 14 (any sexual difficulties) were both 0.83, and the remaining items were all 1.00. The average scale-level CVI was 0.98. Criterion related validity was 0.809 (P＜0.001). KMO test value was 0.907. The spherical Bartlett test obtained χ2=1837.141 (υ =91, P＜0.001). The result of exploratory factor analysis showed that three common factors explained 61.81% of the total variance. Conclusion The Chinese version of 14-item uremic pruritus in dialysis patients scale has good reliability and validity, which can be used to evaluate uremic pruritus in dialysis patients in China. Metrics

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A survey on the ratio of pre-pump arterial pressure and blood flow rate during hemodialysis treatment 2019, 18 (08):  579-581.  doi: 10.3969/j.issn.1671-4091.2019.08.018 Abstract ( 378 )   PDF (490KB) ( 771 )   【Abstract】Objective To investigate the normal range of the ratio of pre-pump arterial pressure (PreAP) to blood flow rate (BFR) during hemodialysis and to explore its clinical significance. Methods A total of 527 patients with hemodialysis from two tertiary hospitals were enrolled. The pressure measurement indexes of PreAP, venous pressure, transmembrane pressure and BFR were collected every hour in the dialysis session. The correlation of PreAP and BFR, and the 95% reference range of PreAP to BFR ratio were analyzed. Result The absolute value of PreAP was significantly correlated with BFR (b=10.09, t=65.241, Ptrend＜0.001). The statistical description of the absolute value of PreAP to BFR ratio was 0.43±0.12, and the 95% reference range was 0.20, 0.66. Conclusion Defining the reference range of PreAP to BFR ratio can early detect and prevent the stenosis in internal fistulas, and provide a rapid screening tool for clinical care and a theoretical basis for continuous monitoring and early intervention. The ratio continuously to exceed the 95% reference range suggests the poor function of vascular access, requiring to carefully examine whether stenosis is present in the vascular access. Metrics

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The important content of the technical documents for the registration of single-use bilirubin plasma adsorbers 2019, 18 (08):  582-584.  doi: 10.3969/j.issn.1671-4091.2019.08.019 Abstract ( 233 )   PDF (356KB) ( 679 )   【Abstract】In recent years, China has paid more and more attention to the treatment of diseases such as hepatitis by using blood purification technologies. The number of application for single-use bilirubin plasma adsorbers has been increasing. In order to facilitate the supervision department to accurately evaluate their safety and effectiveness before marketing, this paper summarizes the recent experiences of technical review, and refers to the relevant laws and technical standards to compile the important content of technical documents for registration, which may be useful references for production, technical review and other related units. Metrics