Chinese Journal of Blood Purification

12 January 2021, Volume 20 Issue 01 Previous Issue    Next Issue

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The effect of loop diuretic on fluid load in maintenance hemodialysis patients with residual renal function:a pilot study  2021, 20 (01):  1-5.  doi: 10.3969/j.issn.1671-4091.2021.01.01 Abstract ( 484 )   PDF (392KB) ( 984 )   【Abstract】Objective To explore the effect of loop diuretic on the fluid load of maintenance hemodialysis (MHD) patients with residual renal function. Methods Twenty- five MHD patients with residual renal function were enrolled and given the titration dose of furosemide tablets. 24-hour urine output(24hUO), urine electrolytes, blood biochemical tests and home blood pressure were measured at three time points: before the use of furosemide tablets (furosemide 0, F0), 1 month after 100mg treatment (furosemide 100mg, F100mg) and 1 month after 200mg treatment (furosemide 200mg, F200mg). Bioimpedance analysis (BIA) is used to measure body composition at two time points (F0 and F200mg), including overhydration (OH) and extracellular water (ECW). Results There were significant differences in home systolic blood pressure [F0: 151.6±17.9, F100mg: 150.8±18.5, F200mg: (146.5±12.3)mmHg, P=0.048] and home diastolic blood pressure [F0: 84.4±8.1, F100mg: 81.9±6.4, F200mg: (81.6± 7.4)mmHg, P=0.020] among three time points. There were significant differences in 24hUO [F0: 626±567, F100mg:689±577, F200mg:759±699ml, P=0.030] between three time points, which showed an increasing trend of urine volume. There were significant differences in both OH [2.47±1.34 vs. (2.15±1.36L), P=0.049] and ECW [16.62±2.67 vs. (16.10±2.89)L, P=0.015] between the two time points of F0 and F200mg. Conclusion The use of furosemide tablets in MHD patients with residual renal function can increase urine volume and improve fluid load and blood pressure. Metrics

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Analysis of Coagulation function and its influencing factors in Peritoneal Dialysis patients 2021, 20 (01):  6-10.  doi: 10.3969/j.issn.1671-4091.2021.01.02 Abstract ( 461 )   PDF (406KB) ( 905 )   【Abstract】Objective To investigate the status of coagulation function status and its influencing factors in peritoneal dialysis (PD) patients. Methods Patients who received peritoneal dialysis for more than 3 months in the Department of Nephrology, Renmin Hospital of Wuhan University from January 2017 to October 2019 were included, and their clinical data were retrospectively analyzed. According to the value of fibrinogen (FIB), patients were divided into group H (FIB＞4g/L, n=64) and group N (FIB ≤ 4g/L, n=108). The clinical data of the two groups were compared. Spearman correlation analysis was used to explore the relationship between clinical data and FIB, and logistic regression was used to analyze the risk factors of FIB elevation. Results 172 PD patients were included. FIB increased in 37.21% patients. Logistic regression analysis showed that total cholesterol (OR=2.394, 95% CI 1.410～4.064, P=0.001), high- density lipoprotein (OR= 23.731, 95% CI 2.518～242.900, P=0.006), lipoprotein-a (OR= 1.002, 95% CI 1.000～1.004, P=0.010), highsensitive C-reactive protein (OR=1.548,95% CI 1.307～1.83, P=0.000) and diabetes mellitus (OR=8.614, 95% CI 1.657～44.792, P=0.010) were risk factors for high FIB. Conclusion PD patients are in a hypercoagulable state, and coagulation function is related to diabetes mellitus, lipid metabolism and micro-inflammation. The regulation of lipid metabolism and the control of micro-inflammation may be helpful to the treatment of coagulation disorder in PD patients. Metrics

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Analysis of the hemodialysis quality and the relevant factors in elderly patients with end-stage renal disease 2021, 20 (01):  11-15.  doi: 10.3969/j.issn.1671-4091.2021.01.03 Abstract ( 398 )   PDF (439KB) ( 944 )   【Abstract】Objective To investigate the hemodialysis quality of elderly patients with end- stage renal disease (ESRD) and the relevant factors. Methods We included patients who started hemodialysis after 60 years of age at the Lanzhou University Second Hospital's Hemodialysis Center from July 2018 to February 2020. A total of 76 patients with complete data and their pre-dialysis and post-dialysis clinical data were collected. Results Elderly ESRD patients with comorbidities can reach as high as 50%, with the average estimated glomerular filtration rate (eGFR) level of (5.71±3.23)ml/(min·1.73m2) when starting hemodialysis treatment. After treatment, the control rates of hemoglobin(Hb) (χ2=6.930, P=0.014), serum calcium (Ca) (χ2= 8.528，P=0.006), serum phosphate (P) (χ2=7.617, P=0.009), serum albumin (Alb) (χ2=14.729, P<0.001) were increased, and the rate of high intact parathyroid hormone (iPTH) is lower (χ2=6.233，P=0.019). According to the level of Hb, Ca, P, Alb, patients were divided into the standard group and the non-standard group. There was no significant difference in the eGFR level o (Z were -1.841, -1.128, -0.153, -1.629, -0.402, P values were 0.066, 0.259, 0.878, 0.103, 0.687, respectively), gender (χ2 were 1.690, 0.472, 0.471, 0.091, 0.169, P values were 0.194, 0.492, 0.493, 0.763, 0.681, respectively), course (t/Z were -0.944, -1.868, 1.036, -0.223, -1.047, P values were 0.345, 0.062, 0.306, 0.823, 0.295, respectively), vascular access (χ2 were 0.056, 0.153, 0.091, 2.487, 0.329, P values were 0.812, 0.696, 0.763, 0.115, 0.566, respectively), dialysis vintage (Z were -0.040, -1.798, -0.456, -0.008, -0.914, P values were 0.966, 0.072, 0.648, 0.994, 0.361) and hemodialysis methods (χ2 were 1.749, 0.220, 0.248, 1.513, 0.003, P values were 0.186, 0.639, 0.619, 0.219, 0.958, respectively) between two groups. Conclusion By strengthening late-stage individualized treatment and active and effective management of comorbidities, and improving the standard rate of clinical indicators, the timing of HD in elderly ESRD patients can be appropriately delayed. Metrics

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A survey of the cognition to consume soybean products in peritoneal dialysis patients 2021, 20 (01):  16-18.  doi: 10.3969/j.issn.1671-4091.2021.01.04 Abstract ( 566 )   PDF (424KB) ( 752 )   【Abstract】Objective To understand the current attitude to consume soy products in peritoneal dialysis (PD) patients. Methods A questionnaire survey of the knowledge about taking soy products was conducted among PD patients treated in the PD centers in two Chinese traditional medical hospitals. Results A total of 125 valid questionnaires were collected, and the effective response rate was 82.78% (125/151). In these respondents, 91.2% had heard of high- quality protein diets necessary for kidney disease patients; 94.4% had heard that kidney disease patients could not eat soy products; 90.4% indicated that the knowledge about soy product food was obtained from doctors and nurses and also from internet, television, relatives and other patients; 77.6% ate soy products occasionally, 68% felt unsuitable to eat soy products, and 20% never ate soy products; 17.6% took soy products to partially or completely substitute their meat diet. Serum albumin was lower in 32% of the respondents, in which serum albumin level was statistically different between PD patients younger than 60 years old and those older than 60 years old (P=0.041). Conclusion Many patients in the two PD centers were in the shortage of correct knowledge about the consumption of soy products. Therefore, dietary education must be reinforced for PD patients. Metrics

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Removal of blood lactic acid by blood purification versus by conventional treatment in lactic acidosis patients: a meta analysis 2021, 20 (01):  19-23.  doi: 10.3969/j.issn.1671-4091.2021.01.05 Abstract ( 329 )   PDF (991KB) ( 761 )   【Abstract】Objective To systematically review the removal effect of blood lactic acid by blood purification (BP) versus by conventional treatment in the patients with lactic acidosis. Methods The databases of Web of science, PubMed, CNKI, WanFang, VIP and CBMDisc were retrieved from the establishment of the database to January 2020 for the randomized controlled trials of lactic acidosis treatment by BP and conventional methods. The control group used conventional treatment, and the trial group used BP on the basis of conventional treatment. The software of STATA12.0 was used for meta analysis. The continuous variables were expressed as SMD and 95% CI. Funnel plot was used to evaluate the publication bias. Results There were totally 10 randomized controlled trials including 296 cases in trial group and 267 cases in control group. Meta- analysis showed that the reduction of lactate levels after the treatment for 12, 24 and 48 hours were more in trial group than in control group, and the differences were significant (12h: SMD＝-1.14, 95% CI＝-2.15～-0.13, P=0.027; 24h: SMD＝-2.06, 95% CI＝-3.09～-1.02, P=0.000; 48h: SMD＝-2.60, 95% CI＝-4.00～-1.19, P=0.000). Conclusion Both BP and conventional treatment removed blood lactic acid effectively in lactic acidosis patients, but the curative effect using BP was better. These results have therapeutic implications in clinical practice. Metrics

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The association between serum total bilirubin and mortality in patients with continuous ambulatory peritoneal dialysis 2021, 20 (01):  24-29.  doi: 10.3969/j.issn.1671-4091.2021.01.06 Abstract ( 363 )   PDF (624KB) ( 816 )   【Abstract】Objective To explore the relationship between serum total bilirubin (TBIL) level and allcause mortality and cardiovascular disease (CVD)-related mortality in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods We reviewed patients undergoing CAPD at the First Affiliated Hospital of Zhengzhou University from September 1, 2012 to May 31, 2019. They were followed up until August 31, 2019. Baseline demographics and laboratory test results were collected. Patients were divided into three groups according to baseline serum TBIL: low bilirubin group (≤4.0 μmol/L), moderate bilirubin group (4.0～5.4 μmol/L), and high bilirubin group (>5.4 μmol/L). Kaplan-Meier survival curve was used to compare the survival rates of the three groups. Cox regression model was used to evaluate the risk factors for all-cause mortality and CVD-related mortality. Results A total 217 CAPD patients were enrolled in this study, with the median age of 45 (35.5, 52) years old and 136 (62.7%) males. The overall median survival time was 70(37,＞81)months. The median survival periods of low bilirubin group (n=72), moderate bilirubin group (n=75) and high bilirubin group (n=70) were >75（56，＞75）months, 63（28，＞81）months and 58（30，70）months, respectively. There were statistical differences in diastolic blood pressure, albumin, blood magnesium, white blood cells, dot total protein, left ventricular diameter, total urea clearance index (Kt/V), and proportion of diabetes among the three groups (R <0.05, respectively). Kaplan-Meier survival curves showed higher survival rate in low bilirubin group (R <0.05). After adequate adjustment, multivariate Cox regression analysis showed that low serum TBIL level was an independent protective factor for all-cause mortality (HR=0.365, 95% CI: 0.140～0.952,R =0.039) and CVD-related mortality (HR=0.208, 95% CI: 0.051～0.858, R =0.030) in CAPD patients. Conclusion Serum TBIL is associated with mortality risk of all-cause mortality and CVD-related mortality in CAPD patients and can be a valuable indicator for the prognosis of CAPD patients. Metrics

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The incidence of vitamin D deficiency and its correlation with iron metabolism in female adolescents with iron deficiency anemia 2021, 20 (01):  30-33.  doi: 10.3969/j.issn.1671-4091.2021.01.07 Abstract ( 299 )   PDF (436KB) ( 892 )   【Abstract】Objective To investigate the incidence of vitamin D deficiency (VDD) in female adolescents with iron deficiency anemia (IDA) and the correlation of VDD with iron metabolism. Methods A total of 80 female adolescents admitted to the Outpatient Department of Lianyungang First People's Hospital in the period from Jan. 2019 to Dec. 2019 were enrolled in this study. Among them, 50 IDA cases were assigned as the IDA group, and 30 healthy women were recruited as the control group. The incidence of VDD was analyzed in IDA group. The iron metabolism indexes including serum iron, serum ferritin and total iron binding capacity (TIBC) as well as serum vitamin D levels were compared between the two groups. The iron metabolism indexes were also compared in IDA group with different serum vitamin D levels. The correlation between serum vitamin D level and iron metabolism indexes in IDA group was analyzed by Pearson's correlation. Results There were significant differences in body mass index (BMI), hemoglobin, mean corpuscular volume (MCV), hematocrit, serum iron, serum ferritin, TIBC and serum vitamin D between IDA group and control group (t=2.096, P=0.039; t=11.856, P＜0.001; t=7.591, P＜0.001; t=4.194, P＜0.001; t=12.492, P＜0.001; t=12.572, P＜0.001; t=3.152, P=0.002; t=3.626, P=0.001). There were 21 cases (42%) and 5 cases (16.67%) of VDD in IDA group and control group respectively (χ2=5.485, P=0.019). Pearson's correlation analysis showed that there were no correlations between serum vitamin D level and serum ferritin, TIBC(r=-0.081, P=0.658; r=0.029, P=0.883; r=0.141, P=0.394). In IDA group, TIBC and serum vitamin D were significantly different between patients with vitamin D＜30 nmol/L and those with vitamin D＞30 nmol/L (t=2.244, P=0.029; t=12.993, P＜0.001). Conclusion The incidence of VDD in female adolescents with IDA was higher than that in healthy controls. However, serum vitamin D level had no significant correlation with iron metabolism indexes. Metrics

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Effects of different blood purification methods on serum fetuin A and apelin levels in uremic patients 2021, 20 (01):  34-37.  doi: 10.3969/j.issn.1671-4091.2021.01.08 Abstract ( 270 )   PDF (461KB) ( 686 )   【Abstract】Objective To investigate the effects of different blood purification methods on serum fetuin A and apelin levels in uremic patients. Methods A total of 114 of uremic patients admitted to Chengde Central Hospital from February 2017 to February 2019 were recruited as the research subjects. They were assigned into high throughput hemodialysis (HFHD, n=38), hemodiafiltration (HDF, n=38), and hemodialysis plus hemoperfusion (HD+HP, n=38) by the random number list method. After the treatment, serum fetuin A and apelin, urea nitrogen (BUN), serum creatinine (Scr), Kt/V, serum phosphorus and calcium, calcium-phosphorus product, β2- microglobulin (β2-MG) and parathyroid gland (PTH) levels, and overall therapeutic efficiency were compared among the three groups. Results After the treatment, serum fetuin A was significantly higher (F=48.814, P<0.001) and serum apelin was significantly lower (F=8.578, P <0.001) in HD+HP group than in HFHD group and HDF group; BUN was lower (F=3.001, P =0.053) and Scr was higher (F=1.206, P =0.303) in HD+HP group than in HFHD group and HDF group. There were no significant differences in Kt/V index among the three groups (F=1.942, P=0.148). After the treatment, serum phosphorus and phosphorus-calcium product were significantly different among the three groups (serum phosphorus: F=14.144, P=0.000; calcium-phosphorus product: F=11.590, P =0.000), but there were no significant differences in serum calcium level among the three groups (F=0.045, P =0.956); serum β2-MG and PTH were significantly lower in HD+ HP group than in HFHD group and HDF group (F=355.820, P<0.001; F=182.270, P<0.001). The overall effective rates were 92.11%, 89.47% and 63.16% in HD+HP group, HFHD group and HDF group respectively (χ2=34.100, P<0.001). Conclusion Uremic patients treated with either HD+HP, HFHD or HDF showed better effects, with the increase of serum fetuin A and decrease of serum apelin. HD+HP had the best blood purification effects, followed by HFHD and HDF methods. Metrics

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The efficacy of paricalcitol combined with hemoperfusion on secondary hyperparathyroidism in hemodialysis patients 2021, 20 (01):  38-42.  doi: 10.3969/j.issn.1671-4091.2021.01.09 Abstract ( 402 )   PDF (714KB) ( 758 )   【Abstract】Objectives To observe the efficacy of paricalcitol combined with hemoperfusion on secondary hyperparathyroidism (SHPT) in maintenance hemodialysis (MHD) patients. Methods Thirty MHD patients with SHPT were randomly divided into group A (treated with paricalcitol) and group B (treated with paricalcitol plus hemoperfusion). They were followed up for 12 weeks. During the 12 weeks treatment period, biochemical markers were assayed at baseline and every 4 weeks, and serum intact parathyroid hormone (iPTH), calcium, phosphorus and alkaline phosphatase (ALP) were assayed every 2 weeks. The efficacy parameter was set at the decrease of iPTH more than 30% of baseline value after 12 weeks treatment. The incidence of adverse events was also observed. Results ① Compared to the baseline levels, serum iPTH and ALP were significantly declined after the treatment for 4 weeks in both groups (in group A: t=6.048 and 3.459, P＜0.001 and 0.004; in group B: t=6.776 and 3.366, P＜0.001 and 0.005). After the treatment for 8 weeks, paricalcitol dosage, serum iPTH and serum ALP were markedly declined in group B than in group A (t=3.298, 2.635 and 2.508, P=0.003, 0.014 and 0.018). ②After the treatment for 12 weeks, the number of patients with the decrease of iPTH more than 30% of the baseline value were 10 in group A and 12 in group B. ③Compared with the baseline values, serum phosphorus and calcium-phosphorus product were markedly declined after the treatment for 4 weeks in group B (t=19.176 and 4.801, P＜0.001), and serum calcium was higher after the treatment for 2 weeks in both groups (group A: t=2.926, P=0.011; group B: t=2.756, P=0.015). After the treatment for 4 weeks, serum phosphorus and calcium-phosphorus product were apparently lower in group B than in group A (t=3.889 and 3.510, P=0.001 and 0.002). Conclusions Paricalcitol therapy is effective for lowering serum iPTH in MHD patients with SHPT; paricalcitol combined with hemoperfusion will have better effects in lowering paricalcitol dosage, serum phosphorus and calcium-phosphorus product. Metrics

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Recent progresses in the pathogenesis of pruritus in maintenance hemodialysis patients 2021, 20 (01):  43-46.  doi: 10.3969/j.issn.1671-4091.2021.01.10 Abstract ( 437 )   PDF (411KB) ( 1161 )   【Abstract】skin pruritus is a common symptom in end-stage renal disease patients undergoing maintenance hemodialysis (MHD). Pruritus affects the quality of life, causes anxiety, depression, sleep disorders, and unfavorable prognosis of the patients. Although many kinds of treatment can be used clinically, the curative effect is limited. The pathogenesis of pruritus is complicated. This paper expounds the pathogenesis of skin pruritus in MHD patients from the perspectives of dry skin, immune inflammation hypothesis, histamine, bivalent ions, opioid hypothesis, parathyroid hormone, peripheral neuropathy, dialysis adequacy and mode, and glycosylation hypothesis. Metrics

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Home hemodialysis: potential needs and solution  2021, 20 (01):  47-49.  doi: 10.3969/j.issn.1671-4091.2021.01.11 Abstract ( 287 )   PDF (352KB) ( 706 )   【Abstract】Home hemodialysis is a dialysis modality performed at home under the guidance of professional medical staff. It is an individualized treatment according to the needs of clinical situation and the patients, and is one of the most promising dialysis methods. Home hemodialysis effectively reduces the overburden of many hemodialysis centers and decreases the cost of hemodialysis, presumably becoming a part of the overall renal replacement therapy plan in all dialysis centers. This paper briefly describes the treatment and solution of home hemodialysis for end stage renal disease patients. Metrics

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Clinical analysis of hypotension during hemodialysis 2021, 20 (01):  50-53.  doi: 10.3969/j.issn.1671-4091.2021.01.12 Abstract ( 413 )   PDF (382KB) ( 997 )   【Abstract】The incidence of renal disease is increasing nowadays in China; as a result, the treatment burden for end-stage renal disease patients is greatly increased. Hemodialysis plays an important role in renal replacement therapy. Intradialytic hypotension (IDH) has become one of the main risk factors for the prognosis of maintenance hemodialysis patients. IDH is clinically characterized by nausea, vomiting, abdominal discomfort, anxiety, headache, syncope, angina, severe shock, myocardial infarction and other threats to the patient's life. Prevention and treatment of IDH is of vital importance. This paper systematically introduces the mechanism, high risk factors, prevention and treatment of IDH. Comprehension and active intervention of IDH are essential to reduce the incidence and the adverse effects of IDH and to improve the quality of life and the survival period of the patients. Metrics

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Evaluation of the implementation status of renal rehabilitation program in hemodialysis centers 2021, 20 (01):  54-58.  doi: 10.3969/j.issn.1671-4091.2021.01.13 Abstract ( 255 )   PDF (383KB) ( 912 )   【Abstract】Physical and psychological functions are severely impaired in maintenance hemodialysis (MHD) patients. Renal rehabilitation program (RRP) for MHD patients can significantly improve the quality of life. Evaluation of the implementation status of RRP can promote the successful implementation of RRP in hemodialysis centers. This article introduces the assessment method of RRP implementation in hemodialysis centers. Metrics

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Investigation on the data of endotoxin content in dialysis water 2021, 20 (01):  59-61.  doi: 10.3969/j.issn.1671-4091.2021.01.14 Abstract ( 288 )   PDF (387KB) ( 710 )   【Abstract】Objective Dialysis water compliant with the safety standards is fundamental to the daily work in hemodialysis centers. This study aimed to explore the management methods to limit the endotoxin content in dialysis water using the changes of endotoxin content data from hemodialysis centers as the reference. Method The data of endotoxin content in dialysis water from March 2019 to February 2020 in 21 blood purification centers in Shanghai were recruited and analyzed. Result Endotoxin content in dialysis water increased in the spring and summer in a part of the samples. Endotoxin content >0.25 EU/ml accounted for 0.57% and endotoxin content of 0.03～0.25 EU/ml accounted for 7.34% in the water samples detected in the spring, while endotoxin content >0.25 EU/ml accounted for 1.13% and endotoxin content of 0.03～0.25 EU/ml accounted for 3.39% in the water samples detected in the summer. The difference of endotoxin content was statistically significant between the water samples detected in the summer and those detected in the winter (F=11.392, P=0.001). Conclusion To reduce the adverse reactions relating to hemodialysis and to promoting the hemodialysis quality, care must be focused on rigorous control of every steps in production and transportation of dialysis water, standardized processes of sampling, daily maintenance and management of the reverse osmosis machines, and thorough disinfection of the water treatment and pipe system. Metrics

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The utilization of internal arteriovenous fistula at the beginning of hemodialysis in end-stage renal disease patients in China: a meta analysis 2021, 20 (01):  62-65.  doi: 10.3969/j.issn.1671-4091.2021.01.15 Abstract ( 280 )   PDF (597KB) ( 846 )   【Abstract】Objective The utilization of internal arteriovenous fistula (AVF) from the beginning of hemodialysis in end-stage renal disease (ESRD) patients was evaluated by using a meta analysis in order to provide scientific bases for the improvement of intervention measures. Methods We searched the Chinese and English databases. A total of 18 articles were found to meet the requirements. One-group rate meta-analysis was adopted, and Stata 12SE was used for statistical analysis. Results In the 4,738 patients included in the 18 observational studies, 795 patients used AVF from the beginning of hemodialysis. Meta analysis results showed that the combined rate of AVF from the beginning of hemodialysis in Chinese ESRD patients was 18.0% (95% CI=13.9～22.0%). Conclusion The utilization rate of AVF from the beginning of hemodialysis was lower in Chinese ESRD patients. Therefore, intervention should be carried out as early as possible to increase the rate of using AVF at the beginning of hemodialysis. Metrics

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Knowledge and behavior of mineral and bone disorder in maintenance hemodialysis patients 2021, 20 (01):  66-70.  doi: 10.3969/j.issn.1671-4091.2021.01.16 Abstract ( 258 )   PDF (443KB) ( 789 )   【Abstract】Objective To investigate the present status and related factors about the knowledge and behavior of chronic kidney disease- mineral and bone disorder (CKD- MBD) in maintenance hemodialysis (MHD) patients in order to provide the evidence for the improvement of intervention strategies. Methods A total of 303 MHD patients were investigated cross- sectionally using the general data questionnaire and the knowledge and behavior of CKD-MBD questionnaire. Results The score of knowledge about CKD-MBD was 21.21±10.14 and the score index was 46.11%; the behavior score was 99.43±8.22 and the score index was 82.86%. Our data indicate that the knowledge is affected by education (β=0.463, P<0.001), age (β=-0.243, P< 0.001), the amount of the medications the patients took (β=-0.211, P<0.001), and dialysis time (β=0.160, P< 0.001). The factors regulating the patients’behavior include gender (β=0.245, P<0.001), the amount of medications the patients took (β=-0.193, P<0.001), age (β=0.177, P=0.00), and complications (β=0.169, P=0.002). Conclusion The knowledge and behavior of CKD-MBD were insufficient and were affected by multiple factors in MHD patients. To improve the knowledge and behavior of CKD-MBD in MHD patients, nurses must adopt the interventions individually based on these factors. Metrics