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Chinese Journal of Blood Purification

Chinese Journal of Blood Purification

    12 October 2021, Volume 20 Issue 10 Previous Issue    Next Issue
    The technology and application status of hemodiafiltration
    2021, 20 (10):  649-653.  doi: 10.3969/j.issn.1671-4091.2021.10.001
    Abstract ( 835 )   PDF (515KB) ( 674 )  
    【Abstract】Hemodiafiltration has gradually become a common renal replacement therapy. The solute removal method in the hemodiafiltration process includes both diffusion and convection, which can simultaneously achieve the effective removal of small molecules and medium and large molecular weight toxins. Recent reports from China and international researches show that the total number of patients using online hemodiafiltration therapy is gradually increasing. According to the current research and clinical application situation, the clinical experience and practice mode in the Asia-Pacific region are different from those in Europe,
    and specific studies are needed to be carried out according to the actual situation. In this paper, we reviewed the technical requirements, clinical researches and application status of hemodiafiltration in this article.
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    Advance in mechanism of muscular dystrophy in chronic kidney diseases
    2021, 20 (10):  654-656.  doi: 10.3969/j.issn.1671-4091.2021.10.002
    Abstract ( 342 )   PDF (360KB) ( 306 )  
    【Abstract】Muscle atrophy is a common complication in the middle and late stage of chronic kidney disease (CKD), which mainly manifested as decreased muscle mass, decreased muscle strength, and decreased muscle function. The main cause of muscle atrophy is the enhancement of muscle protein degradation. The muscle protein degradation pathway can be stimulated by CKD pathological conditions such as the accumulation of toxic metabolites and the decrease of plasma pH value, then lead to muscle atrophy. This paper reviewed the research progress of muscle atrophy in CKD from the following five aspects: uremia toxin, metabolic acidosis, inflammation, hormones and intestinal flora.
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    Recent advances in the relationship between arterial calcification and vitamin k in maintenance hemodialysis patients
    2021, 20 (10):  657-660.  doi: 10.3969/j.issn.1671-4091.2021.10.003
    Abstract ( 296 )   PDF (413KB) ( 182 )  
    【Abstract】The incidence of arterial calcification is higher in maintenance hemodialysis (MHD) patients with chronic kidney disease. Arterial calcification is closely related to the cardiovascular events in these patients. Matrix γ-carboxyglutamate protein (MGP) is a vitamin K dependent protein, which inhibits the progression of arterial calcification through multiple pathways. Studies have confirmed that dephosphorylated and uncarboxylated MGP (dp-ucMGP) is a type of inactive MGP, which is related to the risk of death in MHD patients. Vitamin K is an important substrate for the activation of vitamin K dependent proteins (VKDPs), and
    determines the level of circulating VKDPs. Vitamin K supplementation for MHD patients can significantly reduce the level of dp-ucMGP. However, prospective studies providing confirmed data that MHD patients with arterial calcification benefited from vitamin K supplementation are yet insufficient.
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    Elevated Cathepsin K is a Risk Factor for Cardiovascular Death in Maintenance Hemodialysis Patients
    2021, 20 (10):  661-664.  doi: 10.3969/j.issn.1671-4091.2021.10.004
    Abstract ( 379 )   PDF (468KB) ( 234 )  
    【Abstract】Objective To investigate the relationship between Cathepsin K level and cardiovascular disease (CVD) death in maintenance hemodialysis (MHD) patients. Methods From Jan 2017 to Dec 2019, 96 MHD patients in the blood purification center of Lianyungang first people's hospital were selected as the research objects (MHD group, n=96). Another 96 healthy people in the physical examination center were selected as the control group (healthy control group, n=96). The serum cathepsin K level was detected by electrochemiluminescence. The correlation between serum cathepsin K level and clinicopathological features and laboratory parameters was analyzed by Pearson correlation. The risk factors of CVD death were analyzed by logistic regression. Results The serum Cathepsin K level of MHD group was 280.75±36.84 ng/L, which was significantly higher than that in healthy control group (112.95±20.14 ng/L，t=39.158, P＜0.001). The serum Cathepsin K level of MHD survival group was 224.56±38.95 ng/L, which was significantly lower than that in CVD death group (417.21±35.99ng/L, t=23.273, P＜0.001). The serum Cathepsin K level was negatively correlated with diabetes and white blood cell count (r=-0.324, P=0.011; r=-0.311, P=0.009), and positively correlated with parathyroid hormone, alkaline phosphatase and C-reactive protein(r=0.411, P=0.002; r=0.487, P＜0.001; r=0.418, P=0.002). Low hemoglobin level and high Cathepsin K level were independent risk factors of CVD death in MHD patients (OR= 1.125, 95% CI:1.014~1.944, P=0.041; OR=2.012, 95% CI:1.411~6.254, P=0.003). Conclusion The serum Cathepsin K level is significantly increased in MHD patients and CVD death patients, and Cathepsin K is a potential biomarker of CVD death in MHD patients.
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    Relationship between serum dentin matrix protein 1 and the status of mineral metabolism and bone mineral density in hemodialysis patients 
    2021, 20 (10):  665-668.  doi: 10.3969/j.issn.1671-4091.2021.10.005
    Abstract ( 292 )   PDF (495KB) ( 89 )  
    【Abstract】Objective To investigate the relationship between serum level of dentin matrix protein 1(DMP1) and the status of mineral metabolism and bone density in maintenance hemodialysis (MHD) patients. Methods A total of 95 MHD patients treated at the Blood Purification Center of Qingdao Municipal Hospital from July 2019 to July 2020 were recruited as the research objects. Their clinical data and laboratory test results were collected, serum DMP1 was determined by ELISA, and femoral neck bone mineral density was assayed by dual-energy X-ray absorptiometry. The influencing factors for serum DMP1 level were evaluated by Spearman correlation analysis and multivariate linear regression, and the influencing factors for low bone mineral density were assessed by binary logistic regression. Results ①Serum DMP1 level was lower in the MHD patients than in the healthy controls (Z=-3.218, P=0.001). ②Spearman correlation analysis showed that DMP1 level was negatively correlated with age and dialysis duration, and positively correlated with eGFR, PTH, and T-score of femoral neck bone mineral density (r=-0.226, -0.223, 0.210, 0.294 and 0.370, respectively; P=0.028, 0.030, 0.041, 0.004 and <0.001, respectively). Multivariate linear regression demonstrated that PTH and T-score of femoral neck bone mineral density were the independent influencing factors for serum
    DMP1 level (β=0.211 and 0.399, respectively; P=0.032 and 0.001, respectively). ③Binary logistic regression found that higher serum DMP1 level was an independent protective factor for the lower bone mineral density in MHD patients (OR=0.913, 95% CI 0.845~0.986, P=0.020) after adjusting the confounding factors including age, dialysis age, albumin, alkaline phosphatase and serum calcium. Conclusions Serum DMP1 level in MHD patients is lower than that in healthy controls, and the lower serum level is related to the changes of mineral metabolism and bone density.
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    MicroRNA-30b inhibits vascular smooth muscle cell calcification by down-regulating NFATc1
    2021, 20 (10):  669-673.  doi: 10.3969/j.issn.1671-4091.2021.10.006
    Abstract ( 218 )   PDF (527KB) ( 84 )  
    【Abstract】Objective To investigate the effect of microRNA (miRNA)-30b on vascular smooth muscle cells (VSMCs) calcification through the down-regulation of nuclear factor of activated T- cell c1 (NFATc1). Methods Primary rat VSMCs were cultured in vitro and divided into control group and high phosphorus group. Alkaline phosphatase (ALP) in VSMCs was assayed by ELISA. The calcification of VSMCs was determined by alizarin red staining and calcium content measurement. The extent of miRNA-30b, NFATc1 mRNA and Runx2 mRNA in VSMCs were evaluated by quantitative real-time PCR. NFATc1 and Runx2 in VSMCs were measured by western blot. To verify the effect of miR-30b, VSMCs were treated with a miR-30b analogue, mimic-30b, or a miR-30b inhibitor, inhibitor-30b, and the changes of alizarin red staining, calcium content, NFATc1 and Runx2 expression level and ALP activity in the cells were then observed. Results Compared with the control group, high phosphorus environment induced the calcification of VSMCs (t=-13.324, P<0.001), the increase of NFATc1 mRNA (t=- 4.621, P=0.010) and its protein (t=- 4.684, P= 0.009), the increase of Runx2 mRNA (t=- 4.340, P=0.005) and its protein (t=- 3.860, P=0.018), the higher ALP activity (t= -12.636, P<0.001), but the decrease of miR-30b (t=3.822, P=0.019) in the cells. After transfection of the inhibitor-30b, the VSMCs showed the changes very similar to the high phosphorus-treated VSMCs including the increase of calcification (F=606.554, P< 0.001), the increase of NFATc1 mRNA (F=36.427, P<0.001) and its protein (F=22.512, P=0.002), the increase of Runx2 mRNA (F=44.225, P=0.005) and its protein(F=42.832, P<0.001), as well as the higher ALP activity (F=347.356, P<0.001). After transfection with the mimic-30b, however, the VSMCs revealed the opposite changes including the decrease of calcification (F= 93.341, P<0.001), the decrease of NFATc1 mRNA (F=69.841, P<0.001) and its protein (F=6.090, P=0.036), the decrease of Runx2 mRNA (F=44.780, P=0.005) and its protein (F=841.081, P<0.001), as well as the lower ALP activity (F=197.829, P<0.001). Conclusion miRNA- 30b inhibits the calcification of VSMCs, probably through the down-regulation of NFATc1 expression and thus the down-regulation of Runx2 expression to increase the phenotypic transformation of VSMCs.
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    A meta-analysis about the effect of preoperative grip strength exercise on forearm vascular diameter in patients with chronic kidney disease preparing for arteriovenous fistula surgery
    2021, 20 (10):  696-701.  doi: 10.3969/j.issn.1671-4091.2021.10.014
    Abstract ( 222 )   PDF (2337KB) ( 126 )  
    【Abstract】Objective To systematically evaluate the effect of preoperative grip strength exercise on forearm vascular diameter in chronic kidney disease (CKD) patients preparing for arteriovenous fistula (AVF) surgery. Methods We searched the China Biology Medicine disc, China National Knowledge Infrastructure, VIP database, Wanfang data, PubMed, Medline and Cochrane library for relevant literature from inception to February 26, 2021. Literature screening, data extraction and bias assessment of all eligible studies were conducted independently by two reviewers. Meta-analysis was conducted by using the RevMan 5.3 software. Results
    A total of 12 studies including 343 participants were analyzed. Meta-analysis showed that ①the blood vessel diameter after exercise was larger than that before exercise (SMD=1.03, 95% CI 0.62～1.45, P<0.01); ② pressurized exercises increased the diameter of blood vessels (SMD=1.31, 95% CI 0.26～2.36, P=0.01), and non-pressurized exercise also increased the endovascular meridian (SMD=0.92, 95% CI 0.49～1.34, P＜0.01). ③ comparison of vascular diameter at different exercise time nodes and before exercise found that the vascular diameter was statistically greater after exercise at the second week (SMD=0.72, 95% CI 0.05～1.38, P=0.03), the fourth week (SMD=1.60, 95% CI 0.75～2.45, P＜0.01) and the sixth to eighth week (SMD=1.47, 95% CI 0.77～2.18, P＜0.01); and ④ there was no significant difference between the vascular diameter at the fourth week and that at the eighth week of the exercise (SMD=0.31, 95% CI - 0.43～1.05, P=0.41). Conclusion Preoperative grip strength exercise can increase the forearm vascular diameter in CKD patients preparing for AVF surgery. Both pressurized exercise and non-pressurized exercise were beneficial to the increase of vascular diameter. Grip exercise should be preceded by 4-8 weeks of the surgery.
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    Effect of nursing intervention based on self- determination theory on the exercise at home in maintenance hemodialysis patients
    2021, 20 (10):  702-706.  doi: 10.3969/j.issn.1671-4091.2021.10.015
    Abstract ( 248 )   PDF (499KB) ( 109 )  
    【Abstract】Objective To explore the effect of nursing intervention based on self-determination theory on the exercise behavior at home in maintenance hemodialysis (MHD) patients, in order to improve the home exercise strength in these patients. Methods A total of 72 MHD patients treated in the Hemodialysis Center of Huzhou First People's Hospital during August 2020 to December 2020 were enrolled in this study. They were divided into control group in which patients were given routine nursing and experiment group in which patients were treated with self-determination theory- based nursing intervention. After the intervention for 4 months, home exercise behavior stage, exercise self-efficacy (ESE), six-minute walk test (6MWT) and Kidney Disease Questionnaire (KDQ) were compared between the two groups. Results Home exercise behavior stage after the intervention improved in both groups, with the rate of regular exercise at home from 38.9% to 72.2% in experiment group better than that from 41.7% to 44.4% in control group (Z=-1.971, P=0.049). The scores of ESE and KDQ were better in experiment group than in control group (t=3.382, P=0.001; t=3.504, P=0.001), but 6MWT had no statistical difference between the two groups (t=1.925, P=0.058). Conclusion Nursing intervention based on self- determination theory increased the ESE, improve the exercise level at
    home, and promoted the quality of life in MHD patients.
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    Comparison of the preventive effects of hydrocolloid dressing and 3M dressing on tunnel orifice infection in peritoneal dialysis patients and analysis of the risk factors for catheter exit infection
    2021, 20 (10):  707-710.  doi: 10.3969/j.issn.1671-4091.2021.10.016
    Abstract ( 337 )   PDF (476KB) ( 87 )  
    【Abstract】Objective To explore the preventive effect of hydrocolloid dressing and 3M dressing on tunnel orifice infection in peritoneal dialysis (PD) patients, and to analyze the risk factors for the catheter orifice infection. Methods A total of 154 PD patients admitted to the Department of Nephrology of Chengde Central Hospital from June 2018 to December 2020 were recruited and divided into hydrocolloid dressing group (n=86) and 3M dressing group (n=68) according to the type of tunnel orifice dressing at the time the dialysis started. The infection control rate and cure rate before discharge from the hospital were compared between the two groups. The cure time, the number of dressing changes and adverse reactions were analyzed. Patients were also divided into infection group and non-infection group according to the situation of tunnel orifice infection. Logistic regression was used to analyze the risk factors for tunnel orifice infection. Results The infection rate was statistically lower in the hydrocolloid dressing group than in the 3M dressing group (4.65% vs. 14.71%; U=2.005, P=0.045). The proportions of poor tube fixation, incompliance with orifice care procedures and orifice mechanical compression were significantly lower in the non-infection group than in the infection group (χ2=6.755, 4.200 and 5.468 respectively; P=0.009, 0.040 and 0.019 respectively). Logistic regression
    showed that poor fixation of the tube (OR=1.793, 95% CI:1.060~3.032, P=0.029) and dressing type (OR=1.592, 95% CI: 1.065~ 2.379, P=0.023) were the risk factors for tunnel orifice infection. Conclusion The hydrocolloid dressing reduced the incidence of tunnel orifice infection in PD patients and facilitated healing of the infection with safety. Careful should be paid to fix the PD tube, to guide the patients following the orifice nursing processes, and to avoid mechanical pressure on the orifice during nursing PD patients.
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    Design and application of a balloon compression tourniquet for arteriovenous fistula
    wu qingfeng zhang li sun qiuying
    2021, 20 (10):  711-713.  doi: 10.3969/j.issn.1671-4091.2021.10.017
    Abstract ( 295 )   PDF (840KB) ( 101 )  
    【Abstract】Objective To investigate the effect of a balloon compression tourniquet for arteriovenous fistula. Methods A total of 60 maintenance hemodialysis (MHD) patients using arteriovenous fistula as the blood access route and treated in the Blood Purification Center of Hangzhou Red Cross Hospital from August 2020 to October 2020 were enrolled as the research subjects. They were randomly and equally divided into the observation group, in which the balloon compression tourniquet was used to prevent from bleeding at the puncture site, and the control group, in which elastic bandage or manual pressure was applied to the puncture site. The hemostasis effects including the presence of bleeding at the puncture site, swelling, pseudoaneurysm and hypodermic ecchymosis were compared between the two groups after the intervention for 3 months. Results A total of 2,282 times of pressure hemostasis were performed in the two groups. The hemostatic effects including the absence of bleeding at the puncture site, swelling, pseudoaneurysm and hypodermic hemorrhage were significantly better in the experimental group than in the control group (χ2=25.356, 18.355, 28.762 and 25.287 respectively; P=0.047, 0.033, 0.036 and 0.050 respectively). Conclusion The hemostasis function of the balloon compression tourniquet for the prevention of arteriovenous fistula bleeding after puncture can be regulated by controling pressure level in the tourniquet, with the effect better than the traditional hemostasis methods. This tourniquet is easy to be manipulated, relatively comfortable for the patients, and worthwhile to be widely used clinically.
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