Chinese Journal of Blood Purification

12 July 2021, Volume 20 Issue 07 Previous Issue    Next Issue

Select

Advances in the diagnosis and management of cardiovascular diseases in dialysis patients 2021, 20 (07):  433-436.  doi: 10.3969/j.issn.1671-4091.2021.07.001 Abstract ( 438 )   PDF (391KB) ( 625 )   【Abstract】The number of hemodialysis and peritoneal dialysis patients increase yearly in China. The incidence of cardiovascular disease (CVD) is higher in dialysis patients, causing higher mortality in these patients. This article focuses on CVD, including coronary atherosclerotic heart disease and heart failure, in dialysis patients. The principles of diagnosis and management of CVD in dialysis patients are similar to those in non-renal patients. However, some of the examinations, treatment indicators and effects, and medication side effects are specific to dialysis patients. Metrics

Select

Research progress in BNP/NT-proBNP in chronic kidney disease 2021, 20 (07):  437-440.  doi: 10.3969/j.issn.1671-4091.2021.07.002 Abstract ( 424 )   PDF (389KB) ( 519 )   【Abstract】Cardiovascular disease (CVD) is a common complication in chronic kidney disease (CKD) patients and the main cause of death in patients with end-stage renal disease. Early identification and intervention of CVD is therefore essential to CKD patients. The two cardiac biomarkers, B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), have been used to diagnose heart failure and to assess the severity and prognosis of CVD. However, CKD itself and dialysis treatment often affect serum levels of BNP/NT-proBNP and thus the usefulness of BNP/NT-proBNP in the diagnosis of heart failure and the assessment of severity and prognosis of CVD in CKD patients. This review analyzes the serum levels of BNP/NT-proBNP and their influencing factors in CKD patients through a survey of BNP/NT-proBNP, and briefly discusses the application prospects of BNP/NT-proBNP in CKD patients with CVD. Metrics

Select

Therapies for patients with heart failure and end-stage renal disease  2021, 20 (07):  441-444.  doi: 10.3969/j.issn.1671-4091.2021.07.003 Abstract ( 272 )   PDF (384KB) ( 410 )   【Abstract】The number of patients with chronic renal disease (CKD) and heart failure (HF) is increasing, leading to higher rates of hospitalization, disability and mortality in these patients. Most clinical trials for HF excluded the patients with end-stage renal disease (ESRD). Few HF studies involved patients with ESRD. This review focuses on the study results relating to the treatment of HF and the feasibility of clinical application in ESRD patients. Metrics

Select

Pre- operativemaintenance hemodialysis reduced the 30-day mortality of severe renal dysfunction patients after cardiac surgery 2021, 20 (07):  449-454.  doi: 10.3969/j.issn.1671-4091.2021.07.005 Abstract ( 474 )   PDF (458KB) ( 343 )   【Abstract】Objectives Patients with severe renal dysfunction undergoing cardiac surgery still are associated with many complications and higher mortality. The present study aimed to investigate the relationship between prEoperative maintenance hemodialysis (MHD) and 30-day mortality after cardiac surgery in patients with estimated glomerular filtration rate (eGFR) <30ml/min/1.73m2. Methods A total of 272 severe renal dysfunction patients undergoing cardiac surgery during the period between Jan. 2010 and Oct. 2020 were retrospectively studied. Multivariate COX proportional hazard was used to estimate hazard ratio (HR) and 95% confidence interval (CI) of the risk for 30-day mortality after the surgery. Results In the 272 severe renal dysfunction patients undergoing cardiac surgery, 73.2% were male, the average age was 61.4±9.5years, 85 patients (31.3%) had regular MHD before the surgery, and their 30-days mortality after the surgery was 16.9%. COX regression analyses showed that prEoperative MHD reduced the 30-day mortality (HR=0.399, 95% CI 0.160～0.996, P=0.049), and that rEoperation (HR=4.287, 95% CI 1.717～10.705, P=0.002), lower post-operative left ventricular ejection fraction (LVEF<40%) (HR=3.251, 95% CI 1.581～6.685, P=0.001), more intraoperative blood loss (HR=1.133, 95% CI 1.033～1.242, P=0.008), and longer post-operative ventilator time (HR=1.457, 95% CI 1.230～0.909, P=0.024) were the risk factors for higher 30-day mortality, but male patients (HR= 0.457, 95% CI 0.230～0.909, P=0.024) had a lower risk of mortality. Conclusions Patients with severe renal dysfunction undergoing cardiac surgery were associated with many complications and higher mortality. PrEoperative MHD before cardiac surgery reduced the 30-day mortality. Metrics

Select

Meta analysis of the prevalence and influencing factors of sarcopenia in maintenance hemodialysis patients in Asia 2021, 20 (07):  455-459.  doi: 10.3969/j.issn.1671-4091.2021.07.006 Abstract ( 312 )   PDF (582KB) ( 506 )   【Abstract】Objective A systematic review of the prevalence and influencing factors of sarcopenia in maintenance hemodialysis (MHD) patients in Asia. Methods Computer search of PubMed, Embase, Web of Science, Cochrane Library, CNKI, China Biomedical Literature Database, VIP and Wanfang Database from the establishment of the database to October 2020 for the prevalence and influencing factors of sarcopenia in maintenance hemodialysis (MHD) patients in Asia was conducted. Stata 15.1 software was used for meta analysis. Results A total of 10 articles were enrolled, including 1,830 subjects, and the quality of the literature was medium to high. Meta analysis showed that the prevalence of sarcopenia in MHD patients in Asia was 33% (95% CI 0.227～0.428), and the prevalence of sarcopenia in MHD patients in China was 32% (95% CI 0.198～0.437). The influencing factors of sarcopenia included age (OR=0.850, 95% CI 0.630～1.070, P＜0.001), dialysis duration (OR=0.396, 95% CI 0.090～0.701, P= 0.011), modified quantitative subjective global nutrition evaluation assessment (MQSGA) score (OR=0.886, 95% CI 0.694～1.077, P＜0.001) and serum phosphorus (OR=-0.613, 95% CI -0.877～-0.349, P＜0.001). Conclusion The prevalence of sarcopenia in MHD patients in Asia was high. Older age, longer dialysis age, malnutrition, and lower serum phosphorus level were the risk factors for sarcopenia in MHD patients. Sarcopenia in MHD patients should be treated as early as possible. Metrics

Select

Clinical characteristics and related factors of abdominal aorta and cardiac valve calcification in end stage renal disease patients  2021, 20 (07):  460-464.  doi: 10.3969/j.issn.1671-4091.2021.07.007 Abstract ( 528 )   PDF (437KB) ( 491 )   【Abstract】Objective To assess the status and related factors of abdominal aorta calcification (AAC) and cardiac valve calcification (CVC) in end stage renal disease (ESRD) patients. Methods A total of 277 ESRD patients admitted to the Department of Nephrology, Cangzhou Central Hospital from October, 2019 to December, 2020 were enrolled in this study. They were divided into AAC group and non-AAC group, CVC group and non-CVC group, AAC and CVC group and non-AAC and non-CVC group, based on AAC score and CVC status. Clinical characteristics and related factors were compared among the groups. Results The rates of elderly, female, diabetes, coronary atherosclerotic heart disease (CHD), peritoneal dialysis (PD), CVC and higher C-reactive protein (CRP) level were significantly higher in AAC group than in non-AAC group (P＜0.001, ＜0.001, =0.002, =0.001, =0.042, ＜0.001 and =0.005 respectively). More elderly, diabetes, CHD, and higher diastolic blood pressure, mean arterial pressure, platelet and AAC score were found in CVC group (P＜0.001,＜0.001,＜0.001,＜0.001, =0.001, =0.006 and ＜0.001 respectively). The rates of elderly, diabetes, CHD, higher diastolic blood pressure, higher serum phosphorus increased in AAC and CVC groups (P＜0.001, ＜0.001, ＜0.001, ＜0.001 and =0.001 respectively). Multivariate logistic regression showed that age and dialysis were the independent risk factors for AAC, that age, white blood cell, history of diabetes and CHD, and AAC score were the independent risk factors for CVC, and that age and PD were the independent risk factors for both AAC and CVC. Conclusions AAC and CVC were clinically correlated. However, clinical characteristics and related factors of the two vascular calcifications were different. Active prevention, treatment and individualized management are required. Metrics

Select

The effect of Roxadustat on iron metabolism in hemodialysis patients with microinflammatory state jia qiangliu 2021, 20 (07):  465-468.  doi: 10.3969/j.issn.1671-4091.2021.07.008 Abstract ( 321 )   PDF (395KB) ( 376 )   【Abstract】Objective To investigate the effects of Roxadustat on iron metabolism in maintenance hemodialysis (MHD) patients with microinflammation state and renal anemia, in order to provide theoretic bases for the diagnosis and treatment of these patients. Methods A total of 68 MHD patients with microinflammation state and renal anemia admitted to Linyi Central Hospital from May to October, 2020 were enrolled in this study. They were equally divided into control group and study group by random number table method. The control group was treated with recombinant human erythropoietin (rhEPO) after hemodialysis, while the study group was treated with Roxadustat. They were treated for 3 months. Hemoglobin (Hb), serum iron (SI), total iron binding capacity (TIBC), transferrin saturation (TSAT), transferrin, serum ferritin (SF) and hepcidin were compared before and after 3 months of treatment between the two groups. Results There were no significant differences in age, gender, dialysis age, and the levels of Hb, SI, TIBC, TSAT, transferrin, SF, hepcidin, CRP and PTH between the two groups before treatment (P＞0.05). In the study group after the treatment, Hb, SI, transferrin, and TIBC increased significantly (for Hb, t=4.245, P<0.001 after 2 months, and t=6.433, P<0.001 after 3 months; for SI, t=2.984, P<0.001 after 2 months, and t=5.433, P<0.001 after 3 months; for transferrin, t=3.254, P<0.001 after 2 months, and t=4.329, P<0.001 after 3 months; for TIBC, t=3.854, P< 0.001 after 2 months, and t=5.322, P<0.001 after 3 months), while SF, TSAT and hepcidin decreased significantly (for SF, t=2.245, P<0.030 after one month, t=3.851, P<0.001 after 2 months, and t=6.433, P<0.001 after 3 months; for TSAT, t=2.268, P<0.032 after one month, t=3.567, P<0.001 after 2 months, and t=4.852, P<0.001 after 3 months; for hepcidin, t=3.445, P<0.001 after 2 months, and t=7.343, P<0.001 after 3 months), as compared with those in the control group. Conclusion Compared with rhEPO, Roxadustat treatment can significantly correct abnormal iron metabolism, increase iron utilization, and improve renal anemia in MHD patients with microinflammation state and renal anemia. This study also provides theoretic bases for the diagnosis and treatment of these patients. Metrics

Select

Clinical characteristics and treatment of catheter-related tunnel infection in peritoneal dialysis patients: the results from a singlEcentered study 2021, 20 (07):  469-472.  doi: 10.3969/j.issn.1671-4091.2021.07.009 Abstract ( 402 )   PDF (403KB) ( 411 )   【Abstract】Objective To investigate the epidemiology and clinical outcome of catheter-related tunnel infection (TI) in peritoneal dialysis (PD) patients. Methods The PD patients with and without TI and peritonitis identified during 2010-2021 in Xijing Hospital were retrospectively studied. Their baseline characteristics, pathogenic microorganisms, antibiotics susceptibility/resistance and treatment outcome were analyzed. Results A total of 41 TI episodes happened in 36 PD patients, of which 28 were males and 8 were females with an average age of 41.44±13.75 years. The incidence rate of TI was once every 278 patient months. Ultrasonography was conducted in 14 patients, of which 11 cases were found to have defined sonolucent zones around the outer cuffs with an average thickness of 2.89±1.97mm. Pathogenic microorganism culture was positive in 68.3% samples, in which 75.0% were Gram positive bacteria, especially Staphylococcus aureus (60.7%). After admission, the patients were empirically given gentamicin drip at the entrance of the tunnel and local treatment with Mupirocin ointment, and then the treatment was adjusted according to the results of drug sensitivity of the pathogens. The total cure rate was 85.4%, including the empirical cure rate of 63.4%. Catheter removal was required in 4 (9.8%) patients, and one patient (2.4%) died of catheter-related peritonitis. Conclusions TI is one of the common complications of PD. Better PD training program and nursing care of the catheter exit are the key measures to prevent TI. Ultrasonography of the tunnel sites is an effective tool for the diagnosis of TI. Gram-positive organisms are the major pathogens of the infections. Active treatment can extend the survival time of the catheter in most PD patients. Metrics

Select

Renal prognosis of hemodialysis patients with renal artery stenosis after interventional therapy 2021, 20 (07):  473-476.  doi: 10.3969/j.issn.1671-4091.2021.07.010 Abstract ( 443 )   PDF (409KB) ( 369 )   【Abstract】Objective The renal benefit of renal arterial interventional therapy in hemodialysis patients with renal artery stenosis remains unclear. The purpose of this study was to investigate the effect of renal artery interventional therapy on renal prognosis in hemodialysis patients with renal artery stenosis. Methods The clinical data of 19 hemodialysis patients with renal artery stenosis admitted to the Renal Division, Peking University First Hospital from February 1993 to January 2021 were retrospectively analyzed. The primary endpoints were postoperative dialysis discontinuation, death, or kidney transplantation. The secondary endpoints were blood pressure control before and after intervention, renal artery restenosis, or rEentry to dialysis. Results Ten of the 19 patients (53%) discontinued dialysis after interventional therapy. Serum creatinine (P＜0.001), estimated glomerular filtration rate (P=0.095), length of renal diameter (P=0.012) and maintenance time of dialysis before interventional therapy (P=0.065) were the factors for the efficacy of interventional therapy. No serious complications occurred in any of the patients. Conclusion For hemodialysis patients with renal artery stenosis, renal artery interventional therapy may help patients free from dialysis. This is especially true for patients with low serum creatinine value preoperatively, incomplete renal atrophy, and shorter maintenance time of dialysis before intervention. Metrics

Select

Effect of diphosphonates on vascular calcification in chronic kidney disease patients: a meta- analysis 2021, 20 (07):  477-482.  doi: 10.3969/j.issn.1671-4091.2021.07.011 Abstract ( 331 )   PDF (1314KB) ( 398 )   【Abstract】Objective To evaluate the effects of diphosphonates on vascular calcification in chronic kidney disease (CKD) patients. Methods PubMed, Embase, Cochrane library, CNKI and Wanfang databases up to September, 2020 were searched for the randomized controlled trials (RCT) and observational studies on the treatment of diphosphonates for vascular calcification in CKD patients. Pieces of literature were screened according to the inclusion and exclusion criteria and quality. Data extracted from the literature were analyzed using Review Manager software version 5.4. Results A total of 5 RCTs and 1 cohort study including 222 patients were enrolled. No significant differences were found between diphosphonates group and control group in terms of the progress of vascular calcification (P=0.06), aortic artery calcification (P=0.09) and coronary artery calcification (P=0.38) in CKD patients. Etidronate could significantly reduce vascular calcification in CKD patients (P=0.03). The treatment of diphosphonates had no significant changes in serum calcium (P=0.34), phosphate (P=0.63), and parathyroid hormone (PTH) (P=0.70) in CKD patients. Conclusion Diphosphonates have an effect on vascular calcification in CKD patients, and etidronate is the most promising therapeutic agent. Metrics

Select

Research progress on the effect of hemodialysis on microinflammatory state in patients with MHD 2021, 20 (07):  483-485.  doi: 10.3969/j.issn.1671-4091.2021.07.012 Abstract ( 227 )   PDF (260KB) ( 717 )   Metrics

Select

Research progress on adverse reactions of proton pump inhibitors in hemodialysis patients 2021, 20 (07):  490-492.  doi: 10.3969/j.issn.1671-4091.2021.07.015 Abstract ( 206 )   PDF (240KB) ( 522 )   Metrics

Select

Investigation of dialysis status and symptoms in 1,012 maintenance hemodialysis patients in Shanxi Province 2021, 20 (07):  493-497.  doi: 10.3969/j.issn.1671-4091.2021.07.007 Abstract ( 104 )   PDF (413KB) ( 361 )   【Abstract】Objective To understand the current status and its influencing factors of dialysis and symptom distress in maintenance hemodialysis (MHD) patients in Shaanxi Province. Methods During October to December, 2020, a total of 1,012 MHD patients treated in Shaanxi Province were investigated using a combination of medical records and questionnaires, including demographic data, complications, and dialysis-related information. The degree of symptom distress was assessed by the Dialysis Symptom Index (DSI). Results Among the 1,012 MHD patients in Shaanxi Province, 65.6% were males, and 64.7% were over 40 years old. The top 3 primary causes of the MHD patients were hypertension (290 cases, 28.7%), chronic glomerulonephritis (201 cases, 19.9%), and diabetic nephropathy (189 cases, 18.7%). The main blood access method was autologous arteriovenous internal fistula (89.3%). Dialysis age ＜5 years was in 45.3% patients, and 5 times/2 weeks of dialysis was performed in 42.2% patients. The compliance rates of serum calcium, phosphorus and parathyroid hormone (PTH) were 50.1%, 45.8% and 29.9% respectively. The incidence of symptom distress ranged from 35.1% to 81.1% in the 1,012 MHD patients, with a total symptom distress score of (57.10±20.09). There was a statistically difference in symptom distress among patients with different residence place (H= 25.041, P＜0.001), educational level(H=9.414, P=0.024), income(H=7.816, P=0.021), and levels of serum calcium(H= 31.138, P＜0.001), phosphorus (H=33.784, P＜0.001) and PTH(H=45.365, P＜0.001) (P＜0.05). Conclusion Most MHD patients in Shanxi Province were middle and old age person. The top 3 primary causes of the MHD patients were hypertension, chronic glomerulone-phritis and diabetic nephropathy. Arteriovenous internal fistula was the main blood access route. The compliance rates of serum calcium, phosphorus and PTH were lower. A variety of symptoms distressed most MHD patients, and the presence of symptoms was influenced by many factors. Metrics

Select

Effect of IV3000 dressing on the prevention of early catheter-related infection in peritoneal dialysis patients 2021, 20 (07):  498-500.  doi: 10.3969/j.issn.1671-4091.2021.07.016 Abstract ( 761 )   PDF (397KB) ( 345 )   【Abstract】Objective To investigate the effect of IV3000 dressing on the prevention of early catheter-related infection in peritoneal dialysis (PD) patients. Methods A total of 43 patients with peritoneal dialysis catheters were randomly divided into experimental group or control group. The experimental group used IV3000 dressing for catheter outlet nursing, and the control group used 3L wound dressing. The exit site score, catheter-related infection, skin abnormalities, comfort degree of the patients, dressing integrity, dressing exchange frequency, and expense of the dressing were compared after the treatment for 6 weeks between the two groups. Results Compared with the control group, the experimental group had lower exit site score (Z=-4.644, P<0.001), lower catheter-related infection rate (x2=8.419, P=0.016), lower skin abnormality rate (x2=23.872, P＜0.001), less dressing exchange frequency (t=-16.321, P＜0.001), better comfort degree of the patients (x2=14.614, P＜0.001) and higher dressing integrity (x2=21.428, P＜0.001). The expense of the dressing was similar between the two groups (t=-1.453, P=0.154). Conclusion IV3000 dressing used in the early nursing of peritoneal dialysis catheter outlet had a better effect on the prevention of catheter-related infection and unplanned dressing exchange. IV3000 dressing was relatively comfortable and safe, and can be widely used clinically. Metrics

Select

The control of medical quality indexes and its effect on prognosis in elderly maintenance hemodialysis patients 2021, 20 (07):  501-504.  doi: 10.3969/j.issn.1671-4091.2021.07.017 Abstract ( 294 )   PDF (362KB) ( 382 )   【Abstract】Objective To analyze the control status of medical quality indexes in elderly maintenance hemodialysis (MHD) patients and its effect on prognosis of the patients. Methods A total of 64 MHD patients over 60 years old treated in our hospital in 2019 were enrolled in this study. Medical quality indexes evaluated every 3 months in 2019 were analyzed. They were followed up for one year. Cox proportional hazard model was used to assess the risk of death. Results In the 64 MHD patients, the medical quality indexes that met the control standards in the 4 evaluations in 2019 were hemoglobin (16 cases, 25.0%), serum albumin (30 cases, 46.9%), serum calcium (45 cases, 70.3%), serum phosphorus (20 cases, 31.3%), parathyroid hormone (29 cases, 45.3%) and Kt/V (26 cases, 40.6%). The increase of control rates of hemoglobin and parathyroid hormone could reduce the risk of death with the risk ratio of 0.05 (95% CI 0.00～0.74, P=0.029) and 0.03 (95% CI 0.00～0.69, P=0.029), respectively. Conclusion The control rates of medical quality indexes were low in elderly MHD patients. Patients with a higher control rates of hemoglobin and other medical quality indexes had a relatively lower risk of death in one year. Strict control of medical quality indexes has a great clinical significance in elderly MHD patients. Metrics