Chinese Journal of Blood Purification

12 September 2020, Volume 19 Issue 09 Previous Issue    Next Issue

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Management of hemoglobin variation in peritoneal dialysis patients 2020, 19 (09):  577-580.  doi: 10.3969/j.issn.1671-4091.2020.09.001 Abstract ( 471 )   PDF (399KB) ( 919 )   【Abstract】Anemia is a common complication of peritoneal dialysis (PD) patients. The compliance rate of anemia treatment is still lower in China. The mechanisms of anemia in PD patients include the deficiency of erythropoietin (EPO) production and lower EPO response due to abnormal oxygen sensing pathway, iron deficiency, inflammation, malnutrition and many others. In addition to maintain hemoglobin within the target range, to reduce hemoglobin variation is also essential in the treatment of anemia in PD patients. Hemoglobin variation is a clinical phenomenon affected by many factors including drug related factors, patient related factors, inflammation, iron deficiency, infection and many others. Hemoglobin variation and its related management must be concerned during the treatment of anemia in PD patients to improve their prognosis. Metrics

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Current status in the diagnosis and treatment of anemia in patients on peritoneal dialysis 2020, 19 (09):  581-584.  doi: 10.3969/j.issn.1671-4091.2020.09.002 Abstract ( 485 )   PDF (376KB) ( 1061 )   【Abstract】In China, maintenance peritoneal dialysis (PD) is used in about 15% of the maintenance dialysis patients. Renal anemia is successfully treated in only 40% of the PD patients. The target hemoglobin level for PD population recommended by the international guidelines is ≥115g/L and ＜130g/L, similar to the target level for hemodialysis patients. However, many evidences have showed that the target of upper hemoglobin level should be higher in PD patients than in hemodialysis patients. The management of renal anemia has experienced three stages: blood transfusion, erythropoietin stimulator and iron supplements. Recently, the hypoxia- inducible factor prolyl hydroxylase inhibitor (HIF-PHI) is introduced, providing a new era of treatment on renal anemia. Clinically, different treatment modalities have different indications and side effects, and individualized strategy based on conditions of the patients should be carried out. Metrics

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Clinical characteristics of the patients at initial dialysis stage 2020, 19 (09):  585-588.  doi: 10.3969/j.issn.1671-4091.2020.09.003 Abstract ( 438 )   PDF (360KB) ( 1075 )   【Abstract】Chronic kidney disease is an important illness that endangers human health. With the increase of patients with end-stage renal disease (ESRD), more patients have to use renal replacement therapy. This article reviews the characteristics of the dialysis patients at the initial stage combined with the previous research about this issue. At present, controversy still exists among experts on the appropriate stage to start dialysis. The disease stage that dialysis begins is relatively late in ESRD patients in China. Hemodialysis is the renal replacement therapy most widely used in the world. Most patients use central venous catheterization as the first vascular access to start hemodialysis. The mortality rate of dialysis patients at the initial stage differs among different countries and different races. The most common cause of death is cardiovascular disease. The major risk factors that affect the mortality of dialysis patients at the initial stage include old age, short time of kidney care before dialysis, diabetic patients, complications, central venous catheterization as the first vascular access, and hypoproteinemia. Metrics

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The role of parathyroid hyperplasia in all- cause death and major adverse cardiovascular events of maintenance hemodialysis patients 2020, 19 (09):  592-597.  doi: 10.3969/j.issn.1671-4091.2020.09.005 Abstract ( 339 )   PDF (625KB) ( 757 )   【Abstract】Objective To study the risk factors for all- cause death and major cardiovascular events (MACE) in maintenance hemodialysis (MHD) patients, especially the role of parathyroid (PT) hyperplasia in the death and MACE in MHD patients. Methods We recruited the MHD patients treated in our dialysis center from July 2013 to July 2019. Their prognosis, MACE, coronary artery calcium score (CACS), and PT hyperplasia from ultrasonography were collected and analyzed by statistical methods. Results A total of 70 MHD patients were enrolled in this study. The median follow-up period was 71 months, the mean age of the patients was 60.07±13.62 years, and the mean dialysis duration was 58.37±50.17 months. During the followup period, 44.3% of the patients died, and 34.3% of the patients had MACE. Age (t=-3.707, P<0.001), prevalence of PT hyperplasia (χ2=8.504, P=0.004) and CACS (Z=-3.536, P＜0.001) were significantly higher in the death patients than in the survival patients (P＜0.05); but serum phosphorus (t=- 1.222, P=0.226) and iPTH (t=1.877, P=0.065) were similar between the two groups of patients. Multivariant Cox regression analysis showed that PT hyperplasia and age were the independent risk factors for all-cause death (PT hyperplasia: HR=2.422, 95% CI 1.081~5.427, P=0.032; age: HR=1.054, 95% CI 1.013~1.097, P=0.032) and MACE (PT hyperplasia: HR= 9.117, 95%CI 2.195~37.877, P=0.002; age: HR=1.055, 95%CI 1.003~1.110, P=0.036). Survival analysis showed that the rates of all- cause death (P=0.016) and MACE (P=0.009) were significantly higher in patients with PT hyperplasia than in those without PT hyperplasia. Analysis of the related factors for PT hyperplasia found that higher serum phosphorus (OR=125.805, 95% CI 5.009 ~ 3159.418, P=0.003) and longer duration of dialysis (OR=1.023, 95% CI 1.000~1.046, P=0.047) were the independent risk factors for PT hyperplasia. Conclusion PT hyperplasia is a risk factor for all-cause death and MACE, and higher serum phosphorus is an independent risk factor for PT hyperplasia. These results suggest that early clinical intervention of risk factors for PT hyperplasia, such as hyperphosphatemia, are useful measures for reducing allcause mortality and MACE. Metrics

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Evaluation of the influencing factors for the peritoneal dialysis patients dropped out of peritoneal dialysis 2020, 19 (09):  598-601.  doi: 10.3969/j.issn.1671-4091.2020.09.006 Abstract ( 332 )   PDF (418KB) ( 733 )   【Abstract】Objective To analyze laboratory indexes and clinical characteristics of the patients dropped out of peritoneal dialysis (PD) at different dialysis age before rEentering PD, and to evaluate the influencing factors for PD, so as to choose an appropriate way of dialysis and to improve the quality of life of these patients. Methods We retrospectively analyzed the clinical data of 262 PD patients who dropped out of PD in the Department of Nephrology, The Second Affiliated Hospital of Harbin Medical University from January 2009 to December 2019. They were treated with 2000 ml Baxter 1.5% or 2.5% peritoneal dialysate at least three times a day. They were divided into three groups according to the dialysis age: group A, dialysis age ≤1 year (n=96); group B, dialysis age >1 year and <3 years (n=100); and group C, dialysis age ≥3 years (n=66). Their laboratory indexes and clinical characteristics before rEentering PD were compared. Results Compare with those in group C, patients in group A had lower plasma albumin and total protein, lower proportion of female(t, Z and χ2=9.204, -2.503 and 3.905 respectively; P=0.002, 0.013 and 0.048 respectively), and higher prevalence of cardiovascular complications (palpitation and chest tightness after exercise) (29.17% vs. 6.06%, χ2=13.311, P=0.001) and digestive system complications (nausea, constipation, diarrhea) (41.67% vs. 13.64%, χ2= 15.567%, P=0.001). Multivariate logistic regression analysis showed that plasma albumin level was the independent risk factor for early PD withdrawal(OR:1.106,95% CI:1.004～1.217，P=0.040). In addition, linear correlation analysis showed that plasma albumin and dialysis age were positively correlated (r=0.153, P=0.015). Conclusion Male patients, and patients with poor nutritional status before dialysis and apparent cardiovascular and digestive system complications were more likely to drop out of PD earlier. Hemodialysis may be suitable for them. Plasma albumin level was an independent risk factor for early withdrawal of PD. Metrics

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Effect of pre-, pro-, and synbiotics on uremic toxins and inflammation among hemodialysis patients: a meta-analysis 2020, 19 (09):  602-605.  doi: 10.3969/j.issn.1671-4091.2020.09.007 Abstract ( 294 )   PDF (621KB) ( 704 )   【Abstract】Objective To explore the effects of microbiological preparations on inflammation and uremic toxins among hemodialysis patients. Methods We searched CNKI, CBM, WanFang Data, VIP, PubMed, Embase, Cochrane library, Web of Science, from inception to February 2019 to collect the related literature. RevMan 5.3 software was used for meta-analysis. Results A total of 10 articles involving 481 cases were included. Meta-analysis showed that the reduction of P-cresyl sulfate (PCS) was different between microbial preparations group and placebo group, with the mean differences (MDs) of -0.71 (95% CI -1.37~-0.06, P= 0.030). There were no significant changes in indoxyl sulfate (IS), CRP, urea and creatinine between the two groups, withMDs of -0.38 (95% CI -0.98~ 0.22, P=0.220) for IS,MDs of -1.49 (95% CI-8.00~5.01, P=0.650) for CRP, MDs of 1.48 (95% CI - 3.79~ 6.75, P=0.580) for urea, and MDs of - 0.15 (95% CI - 1.21~0.92, P=0.790) for creatinine. Conclusion Prebiotics, probiotics and synbiotics may have an effect on hemodialysis patients. However, more rigorous design, large scale, multi-center and randomized controlled clinical trials are needed to verify the study. Metrics

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Relationship between blood pressure variability and hospitalization of hemodialysis patients 2020, 19 (09):  606-609.  doi: 10.3969/j.issn.1671-4091.2020.09.008 Abstract ( 257 )   PDF (413KB) ( 697 )   【Abstract】Objective To investigate the relationship between blood pressure variability (BPV) and hospitalization of hemodialysis patients. Methods A total of 92 patients undergoing maintenance hemodialysis (MHD) in the period between Dec 2012 and Dec 2014 were included in this study. Blood pressure was measured during each visit. Visit-to-visit BPV was quantified by calculating the standard deviation (SD). The hospitalization status of the patients was recorded and the relationship between prEdialysis BPV and the hospitalization status was analyzed. Results The annual hospitalization frequency of the patients with high prEdialysis systolic BPV was significantly higher than that of the patients with low prEdialysis systolic BPV (t=2.662, P=0.009). PrEdialysis systolic BPV (t=3.007, P=0.003) and prEdialysis diastolic BPV (t=4.431, P＜0.001) were significantly higher in hospitalized patients than in non-hospitalized patients. Logistic regression analysis showed that higher prEdiastolic BPV was the independent risk factor for hospitalization (OR=2.694, 95% CI1.034~7.023, P=0.043). Conclusion The visit-to-visit BPV was related to hospitalization in MHD patients. Controlling prEdialysis BPV, especially the prEdiastolic BPV, may help reduce hospitalization rate in MHD patients. Metrics

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Analysis of the influencing factors on circuit survival during continuous renal replacement therapy 2020, 19 (09):  610-613.  doi: 10.3969/j.issn.1671-4091.2020.09.009 Abstract ( 309 )   PDF (448KB) ( 855 )   【Abstract】Objective To study the effects of continuous extracorporeal circuit pressure and other factors on extracorporeal circuit lifespan during continuous renal replacement therapy (CRRT). Methods Eightyfive patients with 251 episodes of CRRT and a total of 10,322.2h were recruited in the intensive care unit. We extracted the pressure/minute data of extracorporeal circuit from CRRT machine, treatment parameters, and laboratory data to investigate the effects on extracorporeal circuit lifespan. Results Mild access outflow dysfunction (AOD) event did not affect the circuit lifespan. ModeratEto-severe AOD events had different effects on extracorporeal circuit life using various anticoagulants; moderatEto-severe AOD events significantly shortened the circuit lifespan when no anticoagulant or citrate was used (t=3.179, P=0.002; t=1.949 P=0.054) but had no effect on the circuit lifespan when low molecular weight heparin (LMWH) or heparin was used (t=0.630, P=0.950). Cox analysis suggested that moderatEto-severe AOD event was a risk factor for extracorporeal circuit survival (β=0.638, HR=1.893, 95% CI 1.300～2.756, P=0.001), while citrate (β =- 0.906, HR=0.404, 95% CI 0.304~0.537, P＜0.001) and CVVHDF (β =- 0.722, HR=0.486, 95% CI 0.335～0.704, P＜0.001) were the protective factors. Conclusions Using citrate as the anticoagulant and CVVHDF can prolong the lifespan of CRRT. Clinically, when moderatEto-severe AOD event occurred and citrate or no anticoagulant was used, we should adjust access outflow to extend the circuit lifespan rather than the increase of anticoagulant dose. Metrics

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Construction and implementation of the management evaluation system for peritoneal dialysis centers in Beijing 2020, 19 (09):  614-617.  doi: 10.3969/j.issn.1671-4091.2020.09.010 Abstract ( 265 )   PDF (439KB) ( 704 )   【Abstract】Objective To explore the evaluation standards for the management in peritoneal dialysis (PD) centers and their management level in Beijing. Methods Under the organization of Beijing Blood Purification Quality Control and Improvement Center, we designed the "2018 PD center management quality evaluation system". According to this system, all medical institutions engaged in PD in Beijing reported their quality data of PD management from January 1, 2017 to December 31, 2017. These data were summarized and analyzed. Result This system includes 10 dimensions involving various aspects of PD management. By the end of 2017, a total of 2,057 PD patients were treated; 37 medical institutions and 116 PD professionals engaged in PD in Beijing. Cardiovascular and cerebrovascular diseases were the main causes of death in PD patients, accounting for 44.3% of the total deaths. PD associated infection was the main reason for transfer to hemodialysis, accounting for 42.2% of all these patients. Most PD centers established a relatively complete training system for patients, and 84.5% of the PD patients could be followed up once every 1-3 months but the follow-up contents were significantly different among the centers. The incidence of PD-associated peritonitis in Beijing was 83.1/patient month. A quality control meeting was organized at least once a quarter in 46.1% of the PD centers. Conclusion The "2018 PD center management quality evaluation system" primarily reflects the level of clinical work and management of PD in Beijing and plays an important role in the sustainable development of PD in Beijing. Metrics

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Efficacy and prognosis of double-filtration plasmapheresis therapy for anti-neutrophil cytoplasm antibody-associated vasculitis which requires renal replacement therapy 2020, 19 (09):  618-622.  doi: 10.3969/j.issn.1671-4091.2020.09.011 Abstract ( 254 )   PDF (420KB) ( 778 )   【Abstract】Objective The objective of this study was to investigate the effect of double-filtration plasmapheresis (DFPP) therapy on anti- neutrophil cytoplasmic antibody (ANCA)- associated vasculitis that requires renal replacement therapy (RRT) and its effect on survival rate. Methods A total of 25 patients with ANCA-associated vasculitis diagnosed in the First People's Hospital of Zigong from January 2015 to March 2017 were enrolled in this study. RRT was required at the time of diagnosis. Patients were randomly divided into the DFPP group (n=12) and the control group (n=13). Both groups received glucocorticoid and cyclophosphamide immunosuppressive therapy; the DFPP group also treated with DFPP therapy. Demographic data and clinical parameters of the patients were collected. ANCA and IgG levels were measured before and after DFPP therapy for three times. Their survival rate was calculated after follow-up for 12 months. Results In the DFPP group, myeloperoxidase (MPO)- ANCA and IgG levels after the treatment decreased by 53.2% (t=12.131, P＜0.001) and 47.4% (t=10.798, P＜0.001) respectively. In the control group, MPO-ANCA level after the treatment decreased 16.7% (t=10.319, P=0.069), and IgG level decreased by 14.1% (t=10.134, P=0.035). In the DFPP group, IgG level decreased by 33.8% as compared with that in the control group (t=5.334, P=0.012). During the follow-up period of 12 months, the cumulative survival rate was 61.5% in the DFPP group and 58.3% in the control group (c2= 0.193, P=0.046). All survival patients still relied on dialysis during the follow-up study. Conclusion DFPP can effectively reduce the levels of IgG and MPO-ANCA and improve one year survival rate. However, DFPP cannot change dialysis dependence of the patients. Metrics

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Effect of plasma exchange on anti-neutrophil cytoplasmic autoantibody-associated vasculitis in children 2020, 19 (09):  623-626.  doi: 10.3969/j.issn.1671-4091.2020.09.012 Abstract ( 265 )   PDF (481KB) ( 795 )   【Abstract】Objective To observe the effect of plasma exchange on anti-neutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis in children. Methods A total of 13 patients with ANCA-associated vasculitis treated in Hunan Children's Hospital from January 2017 to January 2020 were enrolled in this study, They were divided into two groups: control group (n=7), treated with glucocorticoid and immunosuppressive therapy; observation group (n=6), treated with plasma exchange other than the treatment in control group. Birmingham vasculitis activity score (BVAS), high resolution CT (HRCT) score, rate of negative ANCA, and renal function were compared between the two groups. Results After the treatment,BVAS and HRCTscore were significantly lower than those before treatment in the two groups (For BVAS: 19.71±4.33 vs. 11.57±2.64, t=4.247, P=0.001 in control group; 20.50 ± 5.85 vs. 7.17 ± 2.56, t=3.552, P=0.005 in observation group. For HRCT score: 4.57±1.40 vs. 2.57±1.51, t=2.384, P=0.034 in control group; 4.17±1.17 vs. 0.83±0.65, t=5.583, P<0.001 in observation group). The decreases of BVAS and HRCT score were more in observation group than in control group (For BVAS: 7.17 ± 2.56 vs. 11.57 ± 2.64, t=3.037, P=0.011; for HRCT score: 0.83 ± 0.65 vs. 2.57 ± 1.51, t=2.413, P=0.034). The rate of negative ANCA was significantly higher in observation group than in control group (P=0.007). No significant improvement of renal function was found in both groups [Glomerular filtration rate before and after the treatment: 76.30(129.90, 30.59) vs. 98.88(141.89, 43.10)ml/(min·1.73m2), Z=0.943, P=0.346 for control group; 19.99(126.40, 15.02) vs. 17.80(145.19, 12.45) ml/(min·1.73m2), Z=0.689, P=0.491 for observation group]. Conclusion Plasma exchange combined with glucocorticoid and immunosuppressive therapy, can efficiently clear ANCA, reduce the activity of vasculitis and promote the recovery of lung lesions in children with ANCA-associated vasculitis. Metrics

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Advances in the research of vitamin D binding protein 2020, 19 (09):  634-636.  doi: 10.3969/j.issn.1671-4091.2020.09.015 Abstract ( 547 )   PDF (350KB) ( 973 )   【Abstract】Vitamin D binding protein (DBP) is synthesized in liver and distributed in tissues and organs throughout the body. In recent years, it has been reported that DBP not only binds, dissolves and transports vitamin D and its metabolites in circulation, but also has immune regulation function independent of vitamin D transport, which is related to the transformation and development of inflammation and tumor. Therefore, we summarized the recent progresses in DBP research, in order to provide reference for further study in this field. Metrics

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Effects of setting up a vascular access nursing post in a blood purification center 2020, 19 (09):  637-640.  doi: 10.3969/j.issn.1671-4091.2020.09.016 Abstract ( 287 )   PDF (397KB) ( 789 )   【Abstract】Objective To explore the effect of setting up a full-time nursing post for blood purification vascular access center in our hospital. Methods A total of 1,529 patients undergoing vascular access surgery for hemodialysis from July to December 2018 in First Affiliated Hospital of Zhengzhou University were selected as the control group, and the perioperative routine nursing mode was implemented by the ward nurses. A total of 1,824 patients undergoing vascular access surgery from January to June 2019 were recruited as the intervention group; a vascular access full-time nursing post was established, and standardized vascular access management process was implemented in the intervention group. The intervention effects of the two groups were compared after follow-up for six months. Results There were significant differences both in ratios of current vascular access type (c2=12.546, P=0.002) and access type for new patients (c2=17.526, P=0.002) between the two groups; in current vascular access type, AVF rate increased from 67.5% to 72.9% (c2=11.743, P=0.001) and central venous catheterization (CVC) rate reduced from 31.1% to 25.5% (c2=12.544, P<0.001); in access type for new patients, AVF rate increased from 49.3% to 56.8% (c2=11.849, P=0.001) and CVC rate reduced from 40.5% to 36.2% (c2=4.097, P=0.043). Fistula patency rate within 6 months after operation increased from 85.1% to 89.2% (c2=8.928, P=0.003). Follow-up rate increased from 30.1% to 50.1% (c2=98.558, P<0.001). Conclusion The vascular access full-time nurses involved in blood access management of the patients. Their work effectively increased the AVF rate, fistula patency rate and follow- up compliance. Metrics

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The effects of family members participating in nursing in a blood purification center 2020, 19 (09):  641-644.  doi: 10.3969/j.issn.1671-4091.2020.09.017 Abstract ( 216 )   PDF (441KB) ( 738 )   【Abstract】Object To explore the effects of family members participating in nursing in a blood purification center. Methods A total of 80 maintenance hemodialysis (MHD) patients treated in the Department of Blood Purification of Dandong Central Hospital in the period from January 1, 2018 to December 31, 2018 were randomly divided into control group (n=40) and observation group (n=40). Patients in control group were treated with routine care, and those in observation group were treated with the model of nursecentered care plus family members participating in nursing. Before and after the intervention, dialysis effect, renal function index, nutrition index, self-rating depression scale (SDS) score, self-rating anxiety scale (SAS) score, and kidney disease quality of life short form (KDQOL-SFTM) score were compared between the two groups. Results After 12 months of intervention, the compliance rates of urea clearance index (Kt/V) and urea reduction rate (URR) were significantly higher in observation group than in control group (χ2=42.105 and 56.597, P＜0.001); body mass index, online clearance monitoring (OCM) value, hemoglobin and albumin levels were significantly higher in observation group than in control group (t=25.043, 24.845, 41.337 and 32.714 respectively, P＜0.001); malnutrition inflammation score (MIS) was significantly lower in observation group than in control group (t=38.256, P＜0.001). After 6 and 12 months of intervention, SDS score and SAS score were significantly lower in observation group than in control group (t=11.469 and 9.224, P＜0.001, after 6 months of intervention; t=32.962 and 22.965, P＜0.001, after 12 months of intervention); KDQOL-SFTM scores were significantly higher in observation group than in control group (t=18.556 and 16.268 respectively, P<0.001). Conclusion The model of nursing-centered care plus family members actively participating in nursing can improve dialysis sufficiency, nutrition index, psychological status and quality of life of the MHD patients. Metrics

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Related factors of unexpected interruption of continuous renal replacement therapy in critical care patients 2020, 19 (09):  645-648.  doi: 10.3969/j.issn.1671-4091.2020.09.018 Abstract ( 323 )   PDF (475KB) ( 894 )   【Abstract】Objective T o explore the related factors of unexpected interruption of continuous renal replacement therapy (CRRT), and to provide the information about clinical CRRT quality management. Methods This was a prospective study using the convenient sampling method.Atotal of 159 patients undergoingCRRTdue to severe illnesses from March 2019 to June 2019 were enrolled in this study. The number of unexpected interruptions of CRRT was recorded and the related factors were analyzed. Results In the 346 CRRT treatments, 50 patientstimes of unplanned cessation of CRRT (14.45%) occurred, and the average treatment time was 19.00 ± 15.58 hours. Multivariate regression analysis revealed that venous pressure (OR=1.022, 95% CI=1.002～1.043, P=0.043), transmembrane pressure (TMP; OR=1.045, 95% CI=1.023～1.078, P=0.014), prothrombin time (PT; OR=0.537, 95% CI=0.326～0.885, P=0.016), activated partial thromboplastin time (APTT; OR=0.502, 95% CI=0.298～0.818, P=0.019), hematocrit (OR=4.422, 95% CI=4.035~4.972, P=0.027), anticoagulation method (OR=12.611, 95% CI= 9.900 ~16.223, P=0.043), and number of nurses responsible for the machine (OR=1.021, 95% CI=0.810~1.265, P=0.001) were the risk factors for unplanned cessation of CRRT. Conclusion During the implementation of CRRT, changes of pressure value, coagulation indicators and hematocrit indicators must be carefully monitored, anticoagulants and their doses must be appropriately adjusted, and the workload of the nurses must be properly arranged to reduce the rate of unexpected interruption of CRRT. Metrics