Chinese Journal of Blood Purification

12 November 2021, Volume 20 Issue 11 Previous Issue    Next Issue

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Renal recovery in peritoneal dialysis patient – a single center cohort study 2021, 20 (11):  728-731.  doi: 10.3969/j.issn.1671-4091.2021.11.002 Abstract ( 704 )   PDF (427KB) ( 215 )   【Abstract】Objective Peritoneal dialysis (PD) is mostly used as a long term renal replacement therapy for end stage renal disease (ESRD). Data from the dialysis registration systems of various countries shown that a certain number of patients experience renal recovery after on peritoneal dialysis for a while. However, the characteristics of these patients are far from clear. This paper is to explore the characteristics of these patients. Methods This is a single center cohort study. The long term PD patients in our center were followed up until death or withdraw PD. We analyzed the characteristics of the patients who start PD for ESRD and withdraw PD for renal function recovery. Results There were 1623 patients started PD between June, 1986 to January, 2018 in our PD center. 10 patients (including 6 males; mean age: 56±22) were included in the analysis. 8 of the 10 patients started PD after their first presenting in nephrology clinic. The time phase from renal replacement therapy until renal recovery was between 60 to 634 days (medium (quartiles): 343 (142, 467) days). Most of these patients had anemia, hypocalcemia, and hyperphosphatemia when they started PD, and some had decreased urine output, but the kidney size was generally preserved in most cases. Conclusions A few patients diagnosed with ESRD at the beginning of dialysis may still have renal function recovery after a considerable period of replacement therapy, especially in those without clear past disease history and with preserved kidney size. It is important recognize these patients and protect residual renal function and avoid renal damage factors. Metrics

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The association between serum magnesium and cardiovascular and cerebrovascular mortality in hemodialysis patients 2021, 20 (11):  732-736.  doi: 10.3969/j.issn.1671-4091.2021.11.003 Abstract ( 384 )   PDF (454KB) ( 131 )   【Abstract】Objective To investigate the association between serum magnesium and cardiovascular and cerebrovascular events and all-cause mortality in maintenance hemodialysis (MHD) patients. Methods The clinical data of patients who underwent hMHD in Yijishan Hospital of Wannan Medical College from June 1, 2017 to December 30, 2020 were collected. Patients were divided into 3 groups according to the tertiles of mean serum magnesium. The differences of clinical data were compared among the three groups. COX regression was used to determine the factors influencing the mortality in MHD patients. Results In the 384 MHD patients, 135 patients in the low magnesium group (Mg≤0.98 mmol/L), 120 patients in the normal magnesium group (Mg 0.98～1.1 mmol/L)，129 patients in the high magnesium group (Mg≥1.1 mmol/L). The prevalence of cardiovascular and cerebrovascular diseases and the proportion of cardiovascular and cerebrovascular mortality were significantly different among the three groups (Z=6.506, P=0.039; Z=9.348 P=0.009); Log-Rank test showed that cardiovascular and cerebrovascular mortality was statistically significant (Log-rank c2=8.313, P=0.016) among the three groups. The univariate COX regression analysis showed that serum magnesium and hypermagnesemia (Mg>0.98mmol/L) were the protective factors for cardiovascular and cerebrovascular mortality (HR=0.060, 95% CI: 0.005～0.703, P=0.025; HR=0.421, 95% CI: 0.220~0.807, P=0.009), but the COX regression after adjusting for many mixed factors showed that hypomagnesemia is not an independent risk factor for cardiovascular and cerebrovascular mortality (HR=1.066，95% CI: 0.339～3.352，P=0.912). Conclusion The cardiovascular and cerebrovascular mortality in MHD patients with hypomagnesemia is higher than the other two groups, but it may not be an independent risk factor. Metrics

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Study on the correlation between the serum level of C- terminal fibroblast growth factor 23 (cFGF23) and the severity and progression of vascular calcification in hemodialysis patients 2021, 20 (11):  737-741.  doi: 10.3969/j.issn.1671-4091.2021.11.004 Abstract ( 271 )   PDF (482KB) ( 139 )   【Abstract】Objective To investigate the correlation between the serum levels of C-terminal fibroblast growth factor 23 (cFGF23) and intact fibroblast growth factor 23 (iFGF23) and the severity and progression of coronary artery calcification (CAC) in patients on maintenance hemodialysis (MHD). Methods The MHD patients treated in Beijing Anzhen Hospital during the last 5 years were enrolled as the research subjects. Their baseline data and laboratory examination results were collected. Serum cFGF23 and iFGF23 were measured by ELISA. CAC score was estimated based on the CT scan image. Results A total of 37 patients were subjected to CAC examination. Patients in the severe CAC group had higher serum cFGF23 level than those in the non-severe CAC group [1128.6 (1073.2, 1252.8) RU/ml vs. 1036.9 (927.7, 1121.8) RU/ml, Z=-2.431, P=0.014], while serum iFGF23 level had no statistical difference between the two groups of patients (1892.4±951.8 pg/ml vs. 1506.8±1094.9 pg/ml, Z=-1.151, P=0.258). Logistic regression analysis revealed that serum cFGF23 level was independently correlated with the severity of CAC (OR=1.026, 95% CI 1.003~1.048, P=0.024), while serum iFGF23 level had no correlation with the severity of CAC (OR=0.999, 95% CI 0.998~ 1.001, P=0.466), after adjusting gender, age, dialysis vintage, iPTH, serum calcium and serum phosphorus of the patients. Twenty-six of the 37 patients completed the follow-up for 5 years. There were statistical differences in average iPTH within the 5 years [506.7 (166.8, 567.5) pg/ml vs. 684.6 (349.7, 1388.1) pg/ml, Z=-2.102, P=0.036], baseline CAC scores [45 (0, 142) vs. 317 (174, 964), Z=-2.943, P=0.003], serum cFGF23 at the end of follow-up [954.7 (891.3, 1073.2) RU/ml vs. 1128.6 (1093.9, 1252.8) RU/ml, Z=-3.192, P=0.001], CAC score at the end of follow-up [189 (106, 488) vs. 2228 (1159, 3104), Z=-3.971, P<0.001], and △cFGF23 [-55.4 (- 212.5, 71.1) RU/ml vs. 146.8 RU/ml (38.2, 399.7), Z=-2.31, P=0.021] between patients in rapid progress group and those in non-rapid progress group. Univariate correlation analysis found that △cFGF23 was positively correlated with CAC progression (r=0.399, P=0.043), and CAC progression rate was positively correlated with the occurrence of cardiovascular events (r=0.464, P=0.017). Conclusions Higher serum cFGF23 or rapid elevation of serum cFGF23 may indicate the MHD patient with severer or progressive CAC. In MHD patients, higher serum cFGF23 was independently correlated with the severity of CAC, △cFGF23 was positively correlated with the progression of CAC, while serum iFGF23 had no correlation with the severity and progression of CAC. Metrics

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Evaluation of the quality of life in patients with refractory secondary hyperparathyroidism based on the EQ-5D-5L scale 2021, 20 (11):  742-745.  doi: 10.3969/j.issn.1671-4091.2021.11.005 Abstract ( 368 )   PDF (428KB) ( 149 )   【Abstract】Objective To use the Five- level EuroQol Five- dimensional Questionnaire (EQ- 5D- 5L) scale to measure the health utility value and to evaluate the quality of life and its related influencing factors in hemodialysis patients complicated with refractory secondary hyperparathyroidism (SHPT). Methods The ED-5Q-5L scale was used to evaluate the quality of life from multiple dimensions and to calculate the health utility values in a total of 150 hemodialysis patients with SHPT who received surgery and cinacalcet in China-Japan Friendship Hospital in Beijing. Multivariate regression analysis was used to analyze the related influencing factors. Results A total of 144 valid questionnaires were collected. The patients had an average age of 48.17± 10.95 years. The overall health utility value was 0.84±0.19, and the visual analogue scale (VAS) score was 80 (62.5, 90.0). Various degrees of pain or discomfort were present in 66.1% patients, and no difficulties in self-care were found in 86.3% patients. Regression analysis showed that treatment method, intact parathyroid hormone (iPTH) level and age impacted on the results. Patients in drug treatment group had higher health utility values (β=0.231, -0.176 and -0.188 respectively, P=0.039, 0.007 and 0.049 respectively). Conclusion The overall quality of life was improved in treated patients with refractory SHPT. However, pain, discomfort and psychological disorders are still problematic and should be taken into consideration. The data of converted utility value can be used to support the disease-related economic research. Metrics

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Lysine methyltransferase SET8 mediates damage regulated autophagy modulator 1 (DRAM1 ) to regulate apoptosis of vascular smooth muscle cells 2021, 20 (11):  746-750.  doi: 10.3969/j.issn.1671-4091.2021.11.006 Abstract ( 227 )   PDF (1003KB) ( 110 )   【Abstract】Objective To investigate the role and mechanism of lysine methyltransferase SET8 mediated damage regulated autophagy modulator 1 (DRAM1) in regulating the apoptosis of vascular smooth muscle cells (VSMCs). Methods VSMCs were cultured in vitro and treated with liposome transfection. The cells were divided into three groups: normal group, SET8-NC group (Transfection of control NS shRNA plasmid), and SET8-shRNA group (Transfection of SET8 shRNA plasmid). MTT colorimetry was used to detect cell proliferation in each group, and apoptosis was detected by in situ end labeling and TUNEL staining, and Western blot was used to detect the protein expression of SET8, DRAM1, B-cell lymphoma / leukemia-2 (Bcelllymphoma2, Bcl-2), bcl-2 associated X protein (Bcl-2 Associated X protein, Bax) in each group. In order to verify the effect of DRAM1 on the apoptosis of VSMCs, we transfected DRAM1 to make it highly expressed, then divided the cells into three groups: the normal group, the DRAM1-NC group, and the DRAM1 group. The proliferation and apoptosis of each group and the protein expression of DRAM1, Bax and Bcl-2 were detected. Results ①Compared with the normal group and the SET8-NC group, MTT results showed that the proliferation of cells in set8 shRNA group decreased significantly at 12h, 24h, 36h and 48h (F=267.649, P＜0.001; F= 477.534，P＜0.001; F=28.938，P=0.001; F=145.849，P＜0.001), and the TUNEL staining results showed that the apoptosis of the SET8-shRNA group was significantly increased. Western blot results showed that, compared with the normal group and the SET8-NC group, the expression of SET8 and Bcl-2 in the SET8-shRNA group decreased (F=34.247, P=0.001; F=39.218, P＜0.001), and the expression of DRAM1 and Bax increased significantly (F=84.517, P＜0.001; F=15.570, P=0.004). ② Compared with the normal group and the DRAM1-NC group, MTT results showed that the proliferation of cells in DRAM1 group decreased significantly at 12h, 24h, 36h and 48h (F= 347.170, P＜0.001; F=74.621, P＜0.001; F=56.427, P＜0.001; F=393.547, P＜0.001). TUNEL staining showed that the green fluorescent particles in DRAM1 group increased significantly. Western blot results showed that, compared with the normal group and the DRAM1- NC group, the expression of DRAM1 and Bax in the DRAM1 group was increased (F=26.456, P=0.001; F=25.217, P=0.001), and the expression of Bcl- 2 was significantly decreased (F=626.70, P＜0.001). Conclusion The low expression of SET8 can promote the apoptosis of vascular smooth muscle cells. The possible mechanism is that the low expression of SET8 promotes the expression of DRAM1 and promote the expression of apoptotic protein Bax, which in turn causes the apoptosis of vascular smooth muscle cells. Metrics

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Usage of oXiris hemofilter for patients with systemic inflammatory response syndrome and multiple organ dysfunctions syndrome associated with tumor lysis syndrome 2021, 20 (11):  766-768.  doi: 10.3969/j.issn.1671-4091.2021.11.011 Abstract ( 222 )   PDF (295KB) ( 213 )   Metrics

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Therapeutic effects of ultrasound-guided intraluminal intervention to treat thrombosis occlusion of internal fistulas 2021, 20 (11):  769-772.  doi: 10.3969/j.issn.1671-4091.2021.11.012 Abstract ( 321 )   PDF (1010KB) ( 208 )   【Abstract】Objective To explore the therapeutic effect of ultrasound-guided intraluminal balloon intervention to treat thrombo-occlusive disease in autologous arteriovenous fistula (AVF) and artificial arteriovenous graft (AVG). Methods This was a retrospective study. Ultrasound-guided intraluminal intervention was used to treat thrombotic occlusion due to fistula stenosis in 139 cases with AVF and 76 cases with AVG for the first time at the Blood Purification Center, the Second Affiliated Hospital of Nanjing Medical University during January 2018 to December 2019. Their clinical characteristics, treatment and follow- up data were analyzed and compared with those of interventional therapy for simple fistula stenosis in this blood purification center. Results Immediate opening of the fistulas after the treatment was acquired in all 139 cases with AVF and in 74 of the 76 cases with AVG. There was no difference in patency rate after the treatment for 12 months between the first ultrasound-guided intraluminal balloon interventional therapy for fistula thrombosis occlusion and the first interventional therapy for simple fistula stenosis (For re-intervention cases, AVF: χ2=0.235, P=0.651; AVG: χ2=0.013, P=0.946. For time required for re- intervention, AVF: t=0.612, P=0.485; AVG: t=0.759, P=0.697). Conclusion Breaking up the thrombosis in occluded fistulas by using ultrasound-guided intraluminal balloon intervention has the advantages of simple manipulation, minimal invasiveness, safety and a higher immediate patency rate. This method can completely remove pathological causes, maintain integrity and prolong lifespan of the internal fistulas. Metrics

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Analysis of risk factors and development of a predictive model for tunnel-cuffed catheter-related bloodstream infection in hemodialysis patients 2021, 20 (11):  773-777.  doi: 10.3969/j.issn.1671-4091.2021.11.013 Abstract ( 267 )   PDF (594KB) ( 133 )   【Abstract】Objective To explore the risk factors and to establish a predictive model for catheter-related bloodstream infection in hemodialysis patients with long-term intravenous catheters. Methods We retrospectively analyzed the clinical data of end-stage renal disease patients undergoing hemodialysis using long-term indwelling intravenous catheters. Logistic regression analysis was performed to detect the risk factors for catheter-related bloodstream infection in the training group. R-studio was used to create the predictive model, and performance of the model was examined in the validation group. Results Smoking history, anemia and diabetes were the risk factors for catheter-related bloodstream infections. The C-indices of the training group and validation group from the established predictive model were 0.761 and 0.714, respectively. Conclusion The predictive model we established can effectively find out the high-risk group of catheter-related bloodstream infection in hemodialysis patients using long-term tunnel-cuffed catheters. Metrics

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Application of multi- criteria decision analysis in the optimization of bundle nursing strategy for patients with thrombus in autologous arteriovenous fistulas 2021, 20 (11):  778-781.  doi: 10.3969/j.issn.1671-4091.2021.11.014 Abstract ( 217 )   PDF (410KB) ( 138 )   【Abstract】Objective To optimize the clustered nursing strategy for patients with autologous arteriovenous fistula thrombus (AVFT) so as to improve clinical compliance with medical workers, reduce the incidence of AVFT, and increase the quality of life in patients with the fistulas. Methods We invited 10 clinically experienced experts from different fields to score every criterion and to screen out high-quality evidences in the multi-criteria decision analysis (MCDA), and thus to form the recommendations to clustered nursing strategy for AVFT based on the final rank of scoring. Results The recommended opinions suitably contained in the clustered nursing strategy for AVFT and their corresponding scores were as follows: guiding patient self-management (1482.56), personalized prevention of low blood pressure (1478.52), fine regulation of far- infrared exposure (1435.35), systematic planning puncture points (1397.86), personalized ultrasound examinations (1368.11), and intra- path arterial pressure monitoring (1325.79). Conclusion After optimization, the clustered nursing strategy for AVFT needs to be refined and upgraded and its effects should be further inspected during clinical applications, so as to reduce the incidence of AVFT and promote the quality of life in hemodialysis patients with fistulas. Metrics

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Study on the diversity and growth characteristics of culturable bacteria in hemodialysis water in Qinghai Province 2021, 20 (11):  785-790.  doi: 10.3969/j.issn.1671-4091.2021.11.016 Abstract ( 245 )   PDF (750KB) ( 76 )   【Abstract】Objective To study the diversity and growth characteristics of culturable microorganisms in hemodialysis water in Qinghai Province and to identify their contamination risk, in order to provide data support for improving the quality of dialysis water. Methods Hemodialysis water samples were collected from the delivery port of the reverse osmosis unit and the return port of the water pipeline in the hemodialysis centers of 18 hospitals. The bacteria in water were enriched by a membrane filtration method and then cultured in tryptone glucose extract agar (TGEA) and R2A agar medium (R2A) at 21℃ for 7 days. Colonies were dynamically observed and counted. The culturable bacteria were identified by mass spectrometry and PCR methods. Results Twelve Gram- negative bacteria and 7 Gram- positive bacteria were detected. The proportions of Gram-negative bacteria were 79.78% and 95.76%, higher than the proportions of Gram-positive bacteria of 20.22% and 4.24%, in water from return port and delivery port respectively. The number of Methylobacterium fujisawasense was 31.32 CFU/mL in water from delivery port, higher than that of 0.36 CFU/mL in water from return port (U=5026.500, P<0.001). The numbers of Ralstonia pickettii, Sphingomonas echinoides and Methylobacterium fujisawasense growing on TGEA were 10.64, 7.10 and 62.16 CFU/ml respectively, more than the numbers growing on R2A of 0.82, 6.10 and 29.36 CFU/mL respectively (U=29721.000, 127168.000 and 1808717.5 respectively, P<0.001). Most bacteria entered the stabilization stage at the 5th day of incubation, but Methylobacterium fujisawasense and Sphingomonas echinoides progressed into the logarithmic growth stage at the 6th day of incubation. Conclusions The culturable microorganisms in dialysis water from delivery port and return port are mainly G- bacteria with substantial differences in the distribution of genus and species. The delayed growth peak in some bacteria suggests that incubation for 168 hours (7 days) may underestimate the level of microbial contamination in water. If the determination of bacterial species were solely based on morphological characteristics of the colonies in the processes of colony growth, the results would be biased. The knowledge about the diversity, species distribution and growth characteristics of bacteria in hemodialysis water is useful for the detection of bacterial contamination risk and the improvement of surveillance standards for dialysis water quality. Metrics