Chinese Journal of Blood Purification

12 May 2021, Volume 20 Issue 05 Previous Issue    Next Issue

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The technical issues in clinical application of plasma exchange 2021, 20 (05):  289-293.  doi: 10.3969/j.issn.1671-4091.2021.05.001 Abstract ( 608 )   PDF (437KB) ( 1184 )   【Abstract】Plasma exchange (PE) is a blood purification method aiming at removing circulating pathogenic proteins or protein-bound substances, which has been widely applied in treating various diseases, including autoimmune diseases. It has two technical forms: membrane separation(MPE) and centrifugal separation (CPE). The technical issues include prescription of treatment dose and frequency, choice of plasma separator, setup of treatment parameters including blood flow rate, plasma separation rate, choice of replacement fluid, anticoagulation, prevention of clinical and technical complications. In this paper, we reviewed all of the issues mentioned above in detail. Metrics

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Blood pressure management in maintenance hemodialysis patients 2021, 20 (05):  294-296.  doi: 10.3969/j.issn.1671-4091.2021.05.002 Abstract ( 483 )   PDF (351KB) ( 991 )   【Abstract】Maintenance hemodialysis is an important treatment for patients with end-stage renal disease. Too low or too high blood pressure during treatment can increase mortality. Therefore, blood pressure management in hemodialysis patients is very important. However, due to individual differences and differences in medical resources, it is still difficult to reach an optimal consensus on blood pressure management in maintenance hemodialysis patients. In this paper, we briefly reviewed the blood pressure monitoring methods, treatment targets, volume management, drug application and patient education in maintenance hemodialysis patients. Metrics

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Huashan Residual Renal Function Cohort Study design and preliminary results 2021, 20 (05):  297-301.  doi: 10.3969/j.issn.1671-4091.2021.05.003 Abstract ( 465 )   PDF (569KB) ( 878 )   【Abstract】Objective To investigate the characteristics of maintenance hemodialysis patients with residual renal function (RRF), explore the influencing factors and biomarkers of RRF, and analyze the association of RRF on prognosis. Methods Huashan Residual Kidney Function Cohort Study (HRKCS) enrolled incident hemodialysis patients with RRF in out- patient clinic with a prospective cohort design. The enrollment and follow-up are conducted between January 2016 and December 2026. Questionnaire interview, physical examination, biochemical testing, RRF measurement, biological specimen collection, and outcome are included in the baseline or follow-up survey. Results Forty-six incident patients were enrolled between January 2016 and January 2020. The average age of enrolled patients was (61±18) years old, with 50% males. 57 % of them were treated with 2 times/week hemodialysis. During a median follow-up of 1.2 years, 46% of patients with 2 time/week hemodialysis changed their hemodialysis frequency from 2 times/week to 3 times/week. All enrolled patients had an average initial urea nitrogen clearance rate of (3.37± 2.16) ml/(min·1.73m2) (Z=-5.924, P＜0.001), which decreased to (1.81±2.05)ml/(min·1.73m2) after onEyear hemodialysis. All patients had stable control of complications in the first year. During the average follow-up period of 1.8 years, the mortality rate was 1.2/100 person-years, and the incidence of cardiovascular events was 8.5/100 person-years. Conclusion 57% of the patients in this cohort initiated with incremental dialysis, which had benefits to delay the decline of residual renal function, control the complications, and decrease the risk of all-cause death. HRKCS establishes a fundamental database and guidance for RRF studies. Metrics

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Virtual reality somatosensory games integrated into the home exercise management and its effects on fall risk and quality of life in dialysis patients 2021, 20 (05):  302-305.  doi: 10.3969/j.issn.1671-4091.2021.05.004 Abstract ( 292 )   PDF (519KB) ( 737 )   【Abstract】Objective To explore the impact of virtual reality (VR)-based somatosensory games integrated into the home exercise management on fall risk and quality of life in dialysis patients. Methods A total of 42 hemodialysis patients from the Blood Purification Center of the Army Special Medical Center were randomly designated into the study group or the control group. Patients in both groups were treated with conventional hemodialysis and nursing management including diet and nutrition guidance and treatment of complications. VR-based somatosensory games were integrated into the home exercise management in the study group,while exercise and daily activities were allowed ad libitum in the control group. They were followed up for 6 months. The confidence of self and regular exercise, the fall risk, and the quality of life were evaluated before and after the intervention between the two groups. Result Six months after the enrollment, the self-efficacy for exercise (SEE) scores and overall scores were significantly higher in the study group than in the control group. The Morse fall score decreased significantly in the study group than in the control group [(40.38 ±10.73) vs. (29.23 ± 7.46), t=3.068, P<0.001] after 3 months of intervention, and so did [(37.09 ± 9.40) vs. (18.42±6.88), t=4.063, P<0.001] after 6 months of intervention. The scores of the eight dimensions in the SF-36 quality of life scale were lower in both groups at the beginning of the enrollment. After 6 months of intervention, physical function(PF) [(42.00±12.85) vs. (55.71±12.34), t=-3.525, P=0.001], restriction problem due to physical function(RP) [(42.23 ± 12.87) vs. (59.90 ± 17.34), t=- 3.748, P<0.001], body perturbation (BP) [(42.76±11.76) vs. (51.38±11.91), t=-2.358, P=0.023], general health prediction (GHP) [(41.28±10.82) vs. (50.47±8.20), t=3.101, P=0.003], vital test (VT) [(38.85±13.52) vs. (55.00±11.99), t=-4.091,P<0.001], and mental health (MH) [(34.23±14.24) vs. (51.80±22.45), t=-3.028, P=0.004] scores were higher in the study group than in the control group. Conclusion The integration of VR- based somatosensory games into the home exercise management is beneficial to improve the confidence and initiative of self- and regular- exercise, to reduce fall risks, and to increase the quality of life. Therefore, this method is worthwhile to be used clinically. Metrics

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Serum intermedin and its influence factors in maintenance hemodialysis patients 2021, 20 (05):  306-309.  doi: 10.3969/j.issn.1671-4091.2021.05.005 Abstract ( 298 )   PDF (411KB) ( 768 )   【Abstract】Objective Intermedin (IMD) is a novel vasodilator peptide. Many studies have confirmed that IMD also attenuates renal fibrosis, inhibits oxidative stress, promotes angiogenesis and many others. IMD is therefore considered to be a potential renal protective factor. However, most of these functions were derived from in vitro cell experiments and animal studies, without studies on the function of endogenous IMD in humans. This study investigates the level of serum IMD and its influence factors in maintenance hemodialysis (MHD) patients. Methods MHD patients treated in our hospital for more than 3 months with stable clinical condition were enrolled in this study. Serum IMD levels were compared between MHD patients and healthy controls. Linear regression analysis was utilized to explore the influence factors for IMD in MHD patients. Results Serum IMD was significantly lower in MHD patients than in the healthy controls (Z=- 7.666, P<0.001). Univariate analysis displayed that blood phosphorus was negatively correlated with the natural logarithm of serum IMD (Ln IMD) (r=-0.207, P=0.039). Multivariate analysis also found that lower LnIMD was associated with higher serum phosphorus (β=-0.19, 95% CI -0.696～-0.006, P=0.046). Conclusions Serum IMD was lower in MHD patients. Higher serum phosphorus was independently associated with the lower serum IMD in MHD patients. Metrics

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Correlation between red blood cell distribution width and acute heart failure in hemodialysis patients 2021, 20 (05):  310-314.  doi: 10.3969/j.issn.1671-4091.2021.05.006 Abstract ( 276 )   PDF (467KB) ( 781 )   【Abstract】Objective To investigate the relationship between red blood cell distribution width (RDW) and acute heart failure (AHF)) in hemodialysis patients. Methods A total of 180 hemodialysis patients treated in the Blood Purification Center, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology were retrospectively analyzed. They were divided into AHF group (n=78) and non AHF group (n=102). Their general information and laboratory indexes were recruited and compared between the two groups. The correlation between AHF and RDW and other clinical indicators was analyzed. Results Patients in the AHF group had higher RDW (14.96±0.81)% as compared with that in the non-AHF group (t=-9.042, P<0.001). Pearson correlation analysis showed that RDW (r=0.584, P<0.001) and hypersensitive C- reactive protein (r=0.219, P=0.003) were positively correlated with AHF, and albumin (r=0.159, P=0.033) was negatively correlated with AHF. Multivariate logistic regression analysis revealed that RDW (OR=5.763, 95% CI 3.334～9.961, P<0.001), albumin (OR=1.104, 95% CI 0.984～1.238, P=0.091), and hypersensitive C- reactive protein (OR=1.065, 95% CI 1.002～1.133, P=0.044) were the risk factors for AHF. ROC curve analysis found that the area under curve (AUC) of RDW for predicting AHF was 0.840, with the sensitivity of 74.4% and specificity of 83.3%. Conclusion Higher RDW is a risk factor and a predictive indicator for hemodialysis patients complicated with AHF. Metrics

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Clinical characteristics and prognosis in maintenance hemodialysis patients with low baseline serum intact parathyroid hormone  2021, 20 (05):  315-319.  doi: 10.3969/j.issn.1671-4091.2021.05.007 Abstract ( 350 )   PDF (496KB) ( 768 )   【Abstract】Objective To investigate clinical characteristics and prognosis in maintenance hemodialysis (MHD) patients with low baseline intact parathyroid hormone (iPTH). Methods A total of 224 MHD patients treated in Ningbo First Hospital were recruited and retrospectively studied. They were divided into two groups according to serum iPTH level, low iPTH group (iPTH<150pg/ml, n=74) and high iPTH group (iPTH≥150pg/ml, n=150). Clinical indicators were compared between the two groups. Kaplan-Meier survival curve was used to analyze the survival time between the two groups. Results Compared with the high iPTH group, patients in the low iPTH group had older age (t=2.943, P=0.004), higher hemoglobin (t=2.210, P=0.028), lower serum albumin (t=-2.297, P=0.023), lower creatinine (t=-3.171, P=0.002), lower total cholesterol (t=-2.136, P=0.034), higher blood calcium (t=5.679, P<0.001) and, lower blood phosphorus (t=- 4.592, P<0.001). The mean survival time was 58.3±6.7 (95% CI: 45.2～71.5) months in the low iPTH group, and was 82.6±4.6 (95% CI: 73.6～91.6) months in the high iPTH group, indicating the shorter survival time in the low iPTH group (χ2=9.313, P=0.002). When the patients in the two group were divided into several subgroups based on the iPTH change during follow- up period, we found that the subgroup with persistently low iPTH had the shortest survival time (χ2=31.059, P<0.001). Conclusions MHD patients with low baseline iPTH had the characteristics of older age, subnormal nutritional status, mild anemia, relatively higher serum calcium and lower serum phosphorus, shorter survival time and unfavorable prognosis, especially those with persistently low iPTH. Metrics

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Vitamin D as a mediator between physical activity and quality of life in hemodialysis patients 2021, 20 (05):  320-323.  doi: 10.3969/j.issn.1671-4091.2021.05.008 Abstract ( 344 )   PDF (443KB) ( 777 )   【Abstract】Objective To explore the mediator effect of vitamin D between physical activity and quality of life in patients undergoing hemodialysis. Methods Physical activity and quality of life in the 94 maintenance hemodialysis patients were measured by the International Physical Activity Questionnaire of Long Version and Brief Health Status Scale. Serum 25(OH)D3 was also measured. Results Both the direct effect of physical activity (logarithm) on physical component summary [C’=7.785 (5.804, 9.766), P<0.001] and the indirect effect through serum 25(OH)D3 [ab=0.452(0.017,1.203)] were significant. Conclusion Vitamin D played as a mediator between physical activity and quality of life. Higher serum 25(OH)D3 level may help improve quality of life in hemodialysis patients. Metrics

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Homocysteine aggravates intestinal epithelial barrier dysfunction in rats with experimental uremia 2021, 20 (05):  324-328.  doi: 10.3969/j.issn.1671-4091.2021.05.009 Abstract ( 312 )   PDF (1661KB) ( 747 )   【Abstract】Aims To investigate the effect of intestinal-derived uremic toxin homocysteine (Hcy) on intestinal permeability, barrier structure and barrier function in adeninEinduced uremic rats. Methods SD rats were divided into five groups: normal control (group NC, n=10), Hcy (group H, n=10), uremia (group U, n=10), uremia+Hcy (group UH, n=10), and uremia+Hcy+ probiotic compound preparation VSL#3 (group UHV, n=10). Experimental uremia was induced by intragastric adenine administration and Hcy was injected subcutaneously. Animal models were assessed by renal function and pathological examinations. The pathological changes of intestinal tissue were observed by H-E staining and electron microscopy. The levels of Hcy, interleukin (IL-6), tumor necrosis factor α (TNF-α), superoxide dismutase (SOD) and malondialdehyde (MDA) in serum and intestinal tissue, serum endotoxin, and intestinal permeability were assessed. The tight junction proteins of claudin-1, occludin, and ZO-1 were assessed by western blotting. Results Compared with group NC, serum and intestinal tissue levels of Hcy (serum: F=153.666, P＜0.001; tissue: F=44.456, P＜0.001), IL-6 (serum: F=86.845, P＜0.001; tissue: F=89.946, P＜0.001), TNF- α (serum: F=29.782, P＜0.001; tissue: F=23.629, P＜0.001), and MDA (serum: F=52.367, P<0.001; tissue: F=58.976, P＜0.001), serum endotoxin (F= 37.287, P＜0.001), and intestinal permeability (F=50.539, P＜0.001) were significantly elevated, while serum and tissue SOD activity decreased (serum: F=106.538, P＜0.001; tissue: F=114.599, P＜0.001) in the experimental groups, especially in UH group. The most pathological changes of intestinal structure were also found in group UH. The levels of tight junction proteins decreased in the experimental groups. Supplementation with probiotic compound preparation VSL#3 improved oxidative and inflammatory injuries and the expression levels of tight junction proteins. Conclusion Hcy aggravates the damages of intestinal permeability and epithelial barrier by induction of oxidative and inflammatory injuries in uremic rats. Probiotic administration ameliorates these damages by reduction of Hcy-induced oxidative and inflammatory injuries. Metrics

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The mechanism and safety of Fasudil on the protection of vascular endothelia from injury 2021, 20 (05):  329-332.  doi: 10.3969/j.issn.1671-4091.2021.05.010 Abstract ( 268 )   PDF (403KB) ( 803 )   【Abstract】Reginal vascular endothelial injury is closely related to the dysfunction of arteriovenous fistula. Surgical injury and hemodynamics changes after the surgery may cause vascular endothelial injury of various degrees. Therefore, to protect vascular endothelia from injuries is the key to preserve early function of the arteriovenous fistula. Fasudil, a Rho kinase inhibitor, relieves inflammatory reactions, vasospasm, endothelial dysfunction, thrombosis, vasodilatation, and many other functions to protect vascular endothelial cells from injuries. However, the mechanism of Fasudil remains controversial. This article reviews the vascular protection mechanism of Fasudil and provides the basis for clinical application of Fasudil after arteriovenous fistula surgery. Metrics

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Effects of oxidative stress on islet dysfunction in peritoneal dialysis patients 2021, 20 (05):  333-335.  doi: 10.3969/j.issn.1671-4091.2021.05.011 Abstract ( 313 )   PDF (369KB) ( 805 )   【Abstract】Peritoneal dialysis (PD) is one of the effective methods to treat end-stage renal disease. With the increase of dialysis population and dialysis age, reports about the new onset diabetes mellitus after PD increased significantly. In this paper, the oxidative stress and islet dysfunction in PD patients are analyzed to provide a theoretical basis for further understanding the mechanism and for clinical prevention and treatment of new onset diabetes mellitus in PD patients. Metrics

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Application of vaccines in hemodialysis patients  2021, 20 (05):  336-339.  doi: 10.3969/j.issn.1671-4091.2021.05.012 Abstract ( 592 )   PDF (377KB) ( 828 )   【Abstract】Hemodialysis (HD) patients are susceptible to have various infections, and infections are important causes leading to hospitalization and death in HD patients. Vaccination is the effective way to prevent infections and to protect the susceptible people. Inoculation of hepatitis B vaccine, influenza vaccine and pneumococcal vaccine are highly recommended. This paper summarizes and discusses the latest guidelines and research progresses in order to provide strategies for the management of infection in blood purification centers and the vaccine inoculation in HD patients. Metrics

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Advances in the treatment of immunEmediated neurological disorders using blood purification 2021, 20 (05):  340-342.  doi: 10.3969/j.issn.1671-4091.2021.05.014 Abstract ( 443 )   PDF (397KB) ( 850 )   【Abstract】Currently, blood purification has been the first-line therapy for many immunEmediated neurological disorders. Plasma exchange (PE) and immunoadsorption (IA) are the two blood purification modalities commonly used in the treatment of immunEmediated neurological disorders. PE and IA significantly improve neurological function of the patients with immunEmediated neurological disorders via removing various kinds of pathogenic factors from circulating blood. This paper reviews the research progresses in the treatment of immunEmediated nervous system diseases by using blood purification. Metrics

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Research progress in the adverse outcome of dialysis patients with protein energy wasting 2021, 20 (05):  343-346.  doi: 10.3969/j.issn.1671-4091.2021.05.014 Abstract ( 146 )   PDF (360KB) ( 360 )   【Abstract】Protein energy wasting (PEW) is a common abnormality among uremic patients with dialysis, often leading to adverse clinical outcomes including the risk of hospitalization and mortality. This paper reviews the recent progress from China and foreign countries in PEW on clinical outcomes such as mortality, cardiovascular disease, infection, frailty, lower quality of life, depression, and insensitivity to erythropoietin, in order to provide theoretical bases for the awareness, early detection and intervention of PEW in dialysis patients. Metrics

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A study on the application of modified CO2 transfer and automatic injection system for the imaging of arteriovenous access for hemodialysis  2021, 20 (05):  347-350.  doi: 10.3969/j.issn.1671-4091.2021.05.015 Abstract ( 241 )   PDF (557KB) ( 858 )   【Abstract】Objective To explore the application of the CO2 gas delivery system combined with automatic high-pressure injection system for the imaging of arteriovenous access (AVA) for hemodialysis. Methods A total of 33 uremic patients were subjected to angiography using the Philips Allura Xper FD10 digital subtraction angiographer. A self-built CO2 gas delivery system using a sterile medical plastic bag was connected to the Medrad Mark V ProVis automatic high-pressure injection system. The CO2 volume, injection speed, camera frequency, side effects and other technical parameters were recorded when clear vascular images of the target parts were obtained. Results A total of 198 angiographic examinations were conducted safely in the 33 patients, in which 31 patients finished the planned intravascular manipulation, and 2 patients had open surgery. To obtain clear images, CO2 5～20 ml/time with the speed of 5～10 ml/sec were used forAVAperipheral vessel imaging and CO2 60～80 ml/time with the speed of 25～30 ml/sec were used for central vein imaging. No untoward reactions were found, except pain of grade 6 by numeric rating scale at the imaging site in one case. Conclusion It is simple and safe to make aCO2 delivery system using a sterile plastic bag in this study. Combined with the automatic high-pressure injection system, CO2 can be injected accurately and automatically, reducing the radiation exposure of medical staff and providing a safe and reliable angiographic method for patients with residual renal function and allergic to iodine. This system can be widely used clinically. Metrics

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Effect of PDCA (Plan, Do, Check and Action) cycle management on the improvement of mineral metabolism and nutritional indexes in maintenance hemodialysis patients treated in the primary hospitals 2021, 20 (05):  351-355.  doi: 10.3969/j.issn.1671-4091.2021.05.016 Abstract ( 295 )   PDF (448KB) ( 805 )   【Abstract】Objective To investigate the effect of PDCA (Plan, Do, Check and Action) cycle management on the improvement of mineral metabolism and nutritional indexes and cognition of the patients, in order to increase the hemodialysis quality management in maintenance hemodialysis (MHD) patients treated in the primary hospitals. Methods A total of 98 patients undergoing MHD in the Blood Purification Center of Wuxi Nineth People’s Hospital Affiliated to Soochow University were recruited and randomly divided into the routine health education group (n=46), and the PDCA cycle management group (n=52). The compliance rates of mineral metabolism and nutritional indexes, malnutrition-inflammation score (MIS), and knowledge of the patients about calcium and phosphorus metabolism and nutrition were compared before and after the intervention. Results After intervention for 18 months, the compliance rates of hemoglobin, serum phosphorus and parathyroid hormone were 71.15%, 59.62% and 53.85% respectively in the PDCA cycle management group, higher than those of 45.65%, 34.78% and 23.91% respectively in the routine health education group (c2=6.571, 6.031 and 9.138 respectively, P=0.010, 0.014 and 0.003 respectively). MIS score decreased significantly in the PDCA cycle management group (t=-2.926, P=0.005), but had no significant change in the routine health education group (t=1.284, P=0.206). MIS scores after the intervention were statistically different between the two groups (t=-3.226, P=0.002). The scores of patients’knowledge about calcium and phosphorus metabolism and nutrition were improved in both groups (t=-11.395 and -16.299, P<0.001). After the intervention, the scores were significantly better in the PDCA cycle management group than in the routine health education group (t=4.906, P<0.001). Conclusion The PDCA cycle management mode can effectively improve the mineral metabolism and nutritional status, the awareness of selfmanagement, the quality of life and their prognosis in MHD patients treated in primary hospitals. Metrics