Chinese Journal of Blood Purification

12 September 2021, Volume 20 Issue 09 Previous Issue    Next Issue

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Current status of research about antibiotic courses of peritoneal dialysis associated peritonitis 2021, 20 (09):  581-585.  doi: 10.3969/j.issn.1671-4091.2021.09.002 Abstract ( 371 )   PDF (408KB) ( 98 )   【Abstract】Peritonitis is an important complication of peritoneal dialysis (PD), commonly affecting the prognosis of patients on peritoneal dialysis. The appropriate course of antibiotics is essential to the therapeutic effect, in terms of reducing manpower and expenditure, and drug resistance rate as well. We reviewed the literature on the antibacterial course of peritonitis associated with PD and summarized limitations with the existing evidence and provided relevant suggestions. Future researches are warranted to elucidate it. Metrics

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The correlation and clinical application of Kt and cystatin C clearance rate in high-flux hemodialysis 2021, 20 (09):  586-590.  doi: 10.3969/j.issn.1671-4091.2021.09.003 Abstract ( 385 )   PDF (437KB) ( 140 )   【Abstract】Objective To analyze the association between Kt and the clearance of medium molecular toxin in uremia. Methods We collected the data of high-flux maintenance hemodialysis patients in the dialysis center of Tong Ren Hospital. The target Kt was calculated by the formula: target Kt =1/[0.0069+(0.0237/BSA)]. Calculate the actual Kt according to Kt/V; Univariate analysis was performed for prEdialysis cystatin C level and cystatin C reduction ratio (CCRR). The CCRR was analyzed by multiple linear regression. The analysis was performed by SPSS (Version 22.0). Results Among 56 patients, 31 were males and 25 were females. The prEdialysis cystatin C was not affected by the characteristics of dialysis patients. Compared with the patients who meet both the target of Kt/V and Kt, the patients who only meet the target of Kt/V had lower CCRR(t=3.394, P =0.001) and higher parathyroid hormone (Z=-2.621, P=0.008). In univariate analysis, there were many factors correlated with CCRR, but after multiple regression analysis, only Kt difference (the actual Kt value - the target Kt value) had a linear correlation with CCRR (β=0.797, P=0.014). Conclusion Cystatin C can be used to evaluate the level of medium molecular toxin in dialysis patients. Kt can be used to evaluate the medium molecular clearance in high-flux hemodialysis patients, to make up the restrictions of Kt/V in accessing adequacy. Metrics

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Urinary biomarkers predict acute kidney injury in patients with mechanical ventilation 2021, 20 (09):  591-594.  doi: 10.3969/j.issn.1671-4091.2021.09.004 Abstract ( 334 )   PDF (1271KB) ( 88 )   【Abstract】Objective To analyze the predictive ability of early urinary biomarkers for the occurrence of acute kidney injury (AKI) in patients with mechanical ventilation. Methods Urine samples were collected from the patients with invasive mechanical ventilation for 24 hours in the ICU of the First Affiliated Hospital, Xi’an Jiaotong University from June to September 2019. The concentrations of liver fatty acid binding protein (L-FABP), tissue inhibitor of metalloproteinasE2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP-7), the three novel biomarkers for AKI, were determined in the urine samples in order to predict the presence of AKI earlier. Results Of the 31 patients with invasive mechanical ventilation, 11 (35.48%) were diagnosed with AKI and 20 (64.52%) without AKI. The rates of older age, higher score of sequential organ failure assessment (SOFA), and more than 3 kinds of underlying diseases were higher in the patients with AKI than those without AKI (t/c2=-5.670, -4.810 and 16.439 respectively, P=0.003, 0.001 and ＜0.001 respectively). Logistic regression showed that invasive mechanical ventilation was the main risk factor for AKI (OR=1.58, 95% CI 1.124～1.739, P=0.009). The risk of AKI increased with the duration of mechanical ventilation. There was no difference in prognosis between the patients with AKI and those without AKI. The product of TIMP-2 and IGFBP-7 predicted closely the presence of AKI; and the receiver operating characteristic (ROC) revealed that the AUC was 0.803 (95% CI 0.627～0.978, P=0.005), the sensitivity was 0.750, and the specificity was 0.895. Conclusion The product of urinary biomarker TIMP-2 and IGFBP-7 can effectively predict the presence of AKI in patients with mechanical ventilation. Metrics

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Study on the influencing factors of the phase angle and its predictive significance for malnutrition in continuous ambulatory peritoneal dialysis patients 2021, 20 (09):  595-598.  doi: 10.3969/j.issn.1671-4091.2021.09.005 Abstract ( 384 )   PDF (515KB) ( 90 )   【Abstract】Objective Bioelectrical impedance analysis (BIA) can be used to evaluate the nutrition status by phase angle (PA) and the volume status of overhydration (OH). This study investigated the nutrition status and the volume status by BIA in patients with continuous ambulatory peritoneal dialysis (CAPD), to explore the influencing factors of PA and the prediction of malnutrition by PA. Methods 200 CAPD patients in the Peritoneal Dialysis Center of the Second Hospital, Jilin University during October 2017 to October 2020 were enrolled. Patients subjected to BIA 3 months after peritoneal dialysis. Patients were then divided into malnutrition group (PA＜4.5° ) and normal nutrition group (PA≥4.5° ) based on the reference PA value. Their clinical and laboratory data were collected and compared. The factors affecting PA in CAPD patients and the optimal value for the prediction of malnutrition were explored. Results The prevalence of malnutrition was 55.50% in the 200 CAPD patients. Compared with normal nutrition group, the prevalence of OH was higher (Z=-5.984, P<0.001), while the levels of albumin and lean tissue index (LTI) were lower (t=3.823 and 6.719, P<0.001) in malnutrition group. Univariate correlation analyses showed that PA was positively correlated with albumin (r=0.232, P=0.003) and LTI (r=0.556, P <0.001), and was negatively correlated with OH (r=- 0.583, P<0.001). ROC curve shows that when the values are set at >2.85L for OH, <12.85kg/m2 for LTI and <35.05g/L for albumin for the prediction of malnutrition in CAPD patients, the specificities are 67.50%, 74.70% and 40.30% respectively, and the sensitivities are 71.40%, 67.10% and 86.30% respectively. Conclusion Malnutrition is relatively prevalent in CAPD patients. Clinically, the values of OH, LTI and albumin are useful to estimate nutrition status in CAPD patients. In addition to nutritional support, correction of OH is also important to treat malnutrition in CAPD patients. Metrics

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The relationship between seasonal changes and peritoneal dialysis-associated peritonitis in the coastal area of southern China 2021, 20 (09):  599-603.  doi: 10.3969/j.issn.1671-4091.2021.09.006 Abstract ( 313 )   PDF (513KB) ( 70 )   【Abstract】Objectives To explore the effects of seasonal changes on peritoneal dialysis-associated peritonitis (PDAP) in the coastal area of southern China. Methods A retrospective analysis was conducted in the PDAP patients treated during 1st January, 2014 to 31st December, 2020. They were divided into four groups based on the four seasons. OnEway ANOVA and chi square test were used to compare the incidence of PDAP and clinical indexes among the four groups. Pearson correlation analysis was used to analyze the relationship between the incidence of PDAP and climate factors, including monthly mean temperature, humidity and rainfall in the coastal area of southern China. The pathogens of PDAP were also compared among the four groups. Results A total of 323 PDAP episodes in the 178 patients (0.24 episodes/risk year) were recorded during the follow-up period of 6 years. There was no significant difference in the incidence of PDAP among the four groups (χ2=0.019, P=0.995). The incidence of PDAP also had no correlations with monthly mean temperature (r=0.226，P=0.479), monthly mean humidity (r=- 0.180, P=0.576), and monthly mean rainfall (r=0.070, P=0.828). Gram-positive bacteria caused more than half (51.4%) of the PDAP, especially in summer. Gramnegative bacteria were found higher in PDAP in autumn than in other seasons. However, the component of bacterial pathogens was similar among the four groups (χ2=19.004, P=0.088). Conclusion The incidence of PDAP had no correlations with the four seasons, monthly mean temperature, monthly mean humidity and monthly mean rainfall, and the bacterial pathogens of PDAP also had no correlations with the four seasons in CAPD patients in the coastal area of southern China. More investigations are required to explore the risk factors for PDAP. Metrics

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Analysis of prognosis and its influencing factors in peritoneal dialysis-associated peritonitis 2021, 20 (09):  604-607.  doi: 10.3969/j.issn.1671-4091.2021.09.007 Abstract ( 460 )   PDF (415KB) ( 150 )   【Abstract】Objective To investigate the independent risk factors for poor prognosis of peritoneal dialysis-associated peritonitis (PDAP). Methods The data of peritoneal dialysis (PD) patients from February 2015 to January 2021 in our department were retrospectively analyzed. Results Among the 142 cases of PDAP in this study, 100 cases cured, 19 cases relapsed, and 23 cases withdrew the treatment (extubation/death). Logistic regression showed that white blood cell count (OR=1.195, P=0.024) and serum albumin (OR=0.878, P=0.019) were the independent influencing factors for withdrawal (extubation/death) from PD (P<0.05). Compared with the PDAP patients of negative bacterial culture, those of pathogenic cocci bacteria had a better prognosis (OR=0.113, P=0.051). Among the cured patients, the remission days were longer in those with delayed treatment (>48h) than in those with earlier treatment (<24h) (Z=17.849, P<0.001). Conclusion The white blood cell count and serum albumin are the independent influencing factors for technical failure in PDAP patients. Delayed treatment prolongs the disease course. Metrics

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Study on the relationship between the abnormally elevated level of parathyroid hormone and the status of nutrition and debilitating in uremia patients#br# 2021, 20 (09):  608-611.  doi: 10.3969/j.issn.1671-4091.2021.09.008 Abstract ( 416 )   PDF (426KB) ( 114 )   【Abstract】Objective To investigate the relationship between abnormally elevated parathyroid hormone level and nutritional status in uremia patients with parathyroid adenoma undergoing parathyroidectomy (PTX). Methods A total of 118 uremia patients with uremia hyperparathyroidism undergoing PTX treated in the Affiliated Hospital of Qingdao University during September 2015 to July 2020 were retrospectively analyzed. Their intact parathyroid hormone (iPTH), serum calcium, phosphate and alkaline phosphatase and the nutrition-related indexes of BMI and serum albumin one week before PTX and after PTX for 6 months were collected and analyzed. Subjective global assessment (SGA) and Edmonton scoring for debilitating were used for the assessment of nutritional status. Results There were significant differences in serum iPTH (Z=-7.940, P＜0.001), calcium (Z=-9.101, P＜0.001), phosphate (Z=-8.396, P＜0.001), alkaline phosphatase (Z=-8.367, P＜0.001), albumin (Z=-7.940, P＜0.001) prealbumin (Z= -5.102, P＜0.001) and BMI (Z=-7.341, P＜0.001) before and after PTX. The changes of SGA score and Edmonton score indicated the improvement of nutrition and debilitating status after PTX. The preoperative iPTH level was negatively correlated with BMI (r=-0.272, P=0.003), serum albumin (r=-0.630, P＜0.001), prealbumin (r=-0.165, P=0.020) and SGA scores (r=-0.781, P＜0.001), and positively correlated with Edmonton score (r=0.611, P＜0.001). Conclusion The nutritional status was significantly different before and after PTX in uremia patients with hyperparathyroidism. Serum iPTH reduced, and nutrition indexes and debilitating status improved significantly after PTX. Metrics

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The construct of common carotid artery-external jugular vein arteriovenous fistulas in rabbit model by a modified no-touch technique 2021, 20 (09):  612-616.  doi: 10.3969/j.issn.1671-4091.2021.09.009 Abstract ( 328 )   PDF (656KB) ( 88 )   【Abstract】Objective To explore the construct of common carotid artery-external jugular vein arteriovenous fistulas in rabbit model using the modified no-touch technique. Methods Ten male New Zealand rabbits were randomly divided into experimental group and sham operation group. Common carotid artery-external jugular vein arteriovenous fistula was created in experimental group by the modified no-touch technique, the perivenous vascular tissue was not stripped off in the operation. The vessels were not anastomosed in sham operation group. After the operation for 14 days, color Doppler ultrasonography was used to evaluate the inner diameter change of the arteriovenous fistula and the spectrum of blood flow in it, blood gas was analyzed in the external jugular vein, and the intimal thickness was observed by hematoxylin-eosin staining of the vessel slides. Results The common carotid artery-external jugular vein arteriovenous fistula was successfully constructed in all rabbits in experiment group. After the operation for 14 days, color Doppler ultrasonography found that the inner diameter of external jugular vein was 7.162±2.332 mm in experimental group and was 2.992±0.277 mm in sham operation group (t=3.582, P=0.016), the peak systolic velocity (PSV) in the external jugular vein was 81.480±38.746 cm/s in experimental group and was 10.334±1.802 cm/s in sham operation group (t=3.032, P=0.015), and the bidirectional blood-flow spectrum suggesting spiral laminar flow was observed in the common carotid artery and external jugular vein in experimental group. H-E staining of the vessels showed that the internal elastic membrane of the external jugular vein was destroyed in experimental group, and the intimal thickness was 26.360±3.769 μm in experimental group and was 10.239±2.960 μm in sham operation group (t=−9.516, P<0.001). The partial pressure of oxygen (PO2) in the external jugular vein was 78.800 ± 5.890 mmHg in experimental group, and was 49.000 ± 4.183 mmHg in sham group (t=9.223, P=0.006). Conclusion The common carotid artery- external jugular vein arteriovenous fistula can be constructed by the modified no-touch technique with a high success rate and an excellent repeatability in rabbit model. This study provides an ideal animal model for the application of modified no-touch technique in arteriovenous fistula surgery. Metrics

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Research progress on the mechanism of 1,25 (OH) 2D3 alleviating microinflammatory state in MHD patients 2021, 20 (09):  617-620.  doi: 10.3969/j.issn.1671-4091.2021.09.010 Abstract ( 239 )   PDF (299KB) ( 118 )   Metrics

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The analysis of balloon pressure during percutaneous transluminal angioplasty for hemodialysis access stenosis#br# 2021, 20 (09):  624-627.  doi: 10.3969/j.issn.1671-4091.2021.09.012 Abstract ( 591 )   PDF (436KB) ( 231 )   【Abstract】Objective To investigate the balloon pressure required during percutaneous transluminal angioplasty (PTA) in the treatment of hemodialysis access stenosis at different locations. Methods Patients with hemodialysis access stenosis and received PTA in Jinshan Hemodialysis Access Center, the First Affiliated Hospital of Chongqing Medical University during April 2020 to September 2020 were enrolled in this study. Demographic and surgical data were collected. The balloon pressure used at different positions was analyzed. Results A total of 259 patients (102 males and 157 females) were enrolled. They had 300 stenosis lesions including 242 in arteriovenous fistulas and 58 in arteriovenous grafts. The clinical success rate was 100% (300/300), the surgical success rate was 98.7% (296/300), and the incidence of surgical complications was 7.333%, including 13 cases of hematoma and 9 cases of vascular rupture. The total mean balloon pressure was 16.693±6.237 atm, and 58.34% (175/300) of the patients used the pressure of >14 atm for full dilation of the lesions. There was no significant difference in pressure required for full dilation between arteriovenous fistulas and arteriovenous grafts, and among different lesion sites in arteriovenous grafts. However, the mean balloon pressure for lesions in juxta-anastomotic sites of arteriovenous fistulas was 18.467±5.706 atm, significantly higher than that for lesions in puncture area (t=2.070, P=0.040) and outflow vein (t=4.969, P<0.001). Conclusion The hemodialysis access stenosis requires higher pressure during PTA to achieve full dilation, and the pressure required at different lesion sites is different. According to these characteristics, appropriate selection of balloon makes the endovascular intervention economical and efficient. Metrics

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Dialysis catheter replacement in patients with occluded right innominate by Nelf Percutaneous Acces Set#br# 2021, 20 (09):  628-631.  doi: 10.3969/j.issn.1671-4091.2021.09.013 Abstract ( 452 )   PDF (487KB) ( 90 )   【Abstract】Objective The purpose of this study was to assess the feasibility and safety of placement of tunneled cuffed catheters by Nelf Percutaneous Acces Set in patients with occluded right and left innominate veins. Method It was a retrospective review of the use of Nelf Percutaneous Acces Set in tunneled catheter placement in patients with right and left innominate vein occlusions between April 2018 and August 2019. In all cases, the puncture needle was directed and advanced toward the angiographic catheter placed on the central side of the superior vena cava under fluoroscopic guidance. And then exchanged the guidewire and placed a tunneled central venous catheter. The outcome measures evaluated were technical success rate, catheter patency, and complication rate. Results The procedure succeeded in all 35 patients. During follow-up [10 (6, 20) months], access failure was observed in two patients. The remained patients functioned well until the end of the follow-up period or until the death of the patient (n=1). No procedurErelated major complication occurred. The most common complication was mediastinal hematoma after puncture failure in three patients. The diameter of the maximum hematoma was 1.8 cm, and all resolved spontaneously. Conclusion In patients with exhaustion access, a tunneled central venous catheter can be safety placed by Nelf Percutaneous Acces Set through the transcutaneous route. Metrics

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Observation of clinical efficacy of hemofiltration adsorption 2021, 20 (09):  637-639.  doi: 10.3969/j.issn.1671-4091.2021.09.016 Abstract ( 486 )   PDF (431KB) ( 247 )   【Abstract】Objective To observe the efficacy of hemodiafiltration with endogenous reinfusion (HFR) in maintenance hemodialysis (MHD) patients. Methods A total of 20 MHD patients were collected from Blood Purification Center, Zhongda Hospital Affiliated to Southeast University. After hemodialysis (HD) treatment for 4 weeks as the washout period, they were treated with the HD-HFR-HD mode as the three times of dialysis in a week for 4 weeks. Blood pressure, β2-microglobulin, C-reactive protein and inflammatory cytokines were examined before and after the HFR treatment. Dialysis adequacy and fatigue were observed in the HD and HFR treatment periods. Results Blood pressure was stable before and after HFR treatment. β2-microglobulin (t=1.557, P=0.040) decreased significantly. C-reactive protein (t=0.152, P=0.945), interleukin-2 (t=0.074, P=0.866), interleukin-6 (t=0.392, P=0.619), tumor necrosis factor-α (t=2.042, P=0.068) were also reduced but without statistical significance. After HFR, dialysis adequacy had no significant change (t=0.815, P=0.431), but fatigue score decreased significantly (t=3.834, P=0.001) as compared with those after HD. Conclusion Compared with HD, HFR significantly alleviates the microinflammatory status of the patients but without difference in dialysis adequacy. Metrics

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A visual analysis of continuous renal replacement therapy based on literature data 2021, 20 (09):  640-644.  doi: 10.3969/j.issn.1671-4091.2021.09.017 Abstract ( 324 )   PDF (1205KB) ( 277 )   【Abstract】Objective To analyze the hot spots in the studies of continuous renal replacement therapy(CRRT) by bibliometric analysis. Methods Pubmed-covered papers on CRRT from 2011 to 2020 were retrieved and analyzed by BLCOMS and gCLUTO to generate subject heading clustering curve and subject heading clustering matrix. Results Five hot spots were detected from 1912 papers from which 31 subject headings were extracted with a frequency ≥18, including the application of regional citrate anticoagulation in CRRT, the effect of renal replacement therapy on the prognosis of critically ill patients with acute kidney injury, the research on clinical application of CRRT, the study about the influence of CRRT on the application of antibacterial drugs, and the research on ECMO combined with CRRT treatment. Conclusion Recently, foreign and domestic scholars attach importance to the studies on CRRT related issues, especially on drugs, methods and prognosis of CRRT. Metrics

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The application of ward round handover mode based on case management in maintenance hemodialysis patients 2021, 20 (09):  645-648.  doi: 10.3969/j.issn.1671-4091.2021.09.018 Abstract ( 360 )   PDF (535KB) ( 90 )   【Abstract】Objective To explore the effect of case management-based ward round handover mode applied in maintenance hemodialysis (MHD) patients. Methods A total of 236 patients with regular MHD in The Second Affiliated Hospital of Soochow University from January to December in 2019 were enrolled in this study. Routine nursing intervention was taken from January to June as the control group, and then the nursing intervention of case management-based ward round handover mode was taken from July to December as the experimental group. The self-management ability, treatment compliance, inter-dialysis weight gain (IDWG), serum phosphorus compliance rate, incidence of vascular access complications and dialysis adequacy were compared between the two groups. Results After 6 months of intervention, the scores of self-management ability, food compliance, fluid intake compliance, drug compliance and dialysis protocol compliance were higher in the experimental group than in the control group (t=8.581, 13.093, 10.349, 10.469 and 6.022, respectively; P=0.012, 0.004, 0.011, 0.009 and 0.018, respectively). The compliance rate of serum phosphorus and dialysis adequacy were better in the experimental group than in the control group (t=26.578 and 3.716, respectively; P=0.006 and 0.023, respectively). Besides, the incidence of vascular access complications (χ2=4.594, P=0.032) and the IDWG (t=6.819, P=0.021) were lower in the experimental group than in the control group. Conclusion The case management- based ward round handover mode applied to MHD patients can improve their self-management ability, treatment compliance, compliance rate of serum phosphorus, incidence of vascular access complications, dialysis adequacy and interdialytic weight gain. This nursing intervention mode is worthy of wide use in the nursing work for MHD patients. Metrics