Chinese Journal of Blood Purification

12 June 2010, Volume 9 Issue 6 Previous Issue    Next Issue

专家述评

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Paying attention to disorders of lipid metabolism benefiical to slowingthe progression of chronic kidney disease YUAN Wei-jie 2010, 9 (6):  291-293.  Abstract ( 451 )   HTML ( 0 )   PDF (209KB) ( 183 )   Metrics

临床研究

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A clinical study relating to the use of tunneled cuffed venous catheter for central venous indwelling catheterization SU Wei;SHANG You-quan;LI Xi-sheng 2010, 9 (6):  294-297.  Abstract ( 1035 )   HTML ( 0 )   PDF (275KB) ( 185 )   【Abstract】 Objective Tunneled cuffed catheter (TCC) has been widely used for hemodialysis for many years in China. Here we summarize and analyze its practical value, operation method, standardized management, and the prevention and treatment of its complications. Methods We collected 61 maintenance hemodialysis dialysis patients (male 21, female 40), including diabetic nephropathy 30 cases, chronic nephritis 23 cases, obstructive nephropathy 2 cases, aristolochic acid nephropathy 3 cases, lupus nephritis one case, and hypertension nephropathy 2 cases for this study. Results TCC for hemodialysis was used in 27 patients, accounting for 23% of total patients in the dialysis center in the study period. The longest duration using TCC lasted for 36 months, with the average of 12±1.08 months. Blood flow rate in the catheter ranged 200-300ml/min. Complications consisted of (a) exit site infection in 3 cases, and catheter related bacteremia in 3 cases, and (b) TCC dysfunction including twist or cacothesis of TCC in 7 cases, thrombosis in 19 cases, partially coming off of TCC in 2 cases, and coming away of TCC in 3 cases. All complications could be treated properly. Conclusion TCC possesses important and practical values for maintenance hemodialysis. It can be used as a long-term vascular access, or as a provisional measure before the maturation of A-V fistula. Compared with graft fistula, TCC has the advantages of easy manipulation and lower cost, and is also suitable for emergency patients. Care must be paid to the prevention and treatment of its complications, and the appropriate management of TCC. Metrics

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Application of extracorporeal membrane oxygenation in critical influenza type H1N1 infection patients with respiratory failure: report of 4 cases XIONG Hao-feng;GUO Li-min;LI Xing-wang;JIAO Yi-qing;LI Bao-shun 2010, 9 (6):  298-301.  Abstract ( 574 )   HTML ( 0 )   PDF (253KB) ( 175 )   【Abstract】 Objective To evaluate the effectiveness of extracorporeal membrane oxygenation (ECMO) in the treatment of critical influenza type H1N1 infection patients. Methods We treated 4 critical influenza type H1N1 infection patients with ECMO during the period of Oct. 3 to Dec. 25, 2009. Results After the ECMO treatment, 3 of the 4 patients evacuated from ECMO devices successfully. Two patients died, and two patients discharged from hospital. During the treatment, the oxygenation index increased from 48~77mmHg (mean 59.8mmHg) to 122~254mmHg (mean 191.8mmHg). The complications included hemorrhage, catheter related infection, and thrombosis in oxygenation membrane. Conclusion ECMO support may be helpful for some influenza infection patients with severe pulmonary failure refractory to conventional management. Metrics

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Evaluation of bone mineral density and risk factors for fractures in CAPD patients WU Pei;REN Hong;XIE Jing-yuan;LI Xiao;WANG Xiao-min;CNEN Nan 2010, 9 (6):  302-306.  Abstract ( 881 )   HTML ( 0 )   PDF (333KB) ( 188 )   【Abstract】 Objective In order to investigate the determinant factors for bone mineral density (BMD) and the risk factors for osteoporotic fractures in CAPD patients. Methods Eight-four CAPD patients were included in this study. BMD was assessed by dual energy X-ray absorptiometry (DEXA) of lumbar spine and femoral neck. Clinical data and laboratory indices as well as X-ray plain were collected. Results Osteoporosis was found in 11.9% of the 84 patients, and osteopenia in 36.3% patients. Independent variables entering into logistic regression of osteoporosis were sex, age, BMI, Kt/V（P<0.01）and daily urine output (P<0.05). The overall prevalence of fractures since the initiation of peritoneal dialysis was 9.52%. In Cox regression model, fractures were associated with lumbar spine Z-score, femoral neck Z score and BMI. Conclusions Inadequacy of dialysis, low BMI, older age, female and reduced daily urine output may be the important risk factors for osteoporosis in CAPD patients. Lumbar spine and femoral neck Z scores can predict the occurrence of fractures. Among these factors, low BMI is the most important risk factor for fractures in chronic PD patients. Metrics

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Diagnostic significance of urinary N-acety-?D-glucosaminidase/creatinine ratio for acute kidney injury in elderly patients with severe community-acquired pneumonia HUANG Bao-zhuan;LI Yue-hua;BU Jian-hong;QIU Wei 2010, 9 (6):  307-310.  Abstract ( 632 )   HTML ( 0 )   PDF (273KB) ( 193 )   【Objective】 To investigate the value of urinary N-acety-β-D-glucosaminidase (NAG)/creatinine (Cr) ratio for the early diagnosis of acute kidney injury (AKI) in elderly patients with severe community-acquired pneumonia (CAP). Methods We retrospectively analyzed the changes of urinary NAG/Cr ratio in 19 elderly patients with severe CAP and AKI. We also analyzed the ratio in 19 elderly people without renal disease and pneumonia as controls. Urinary NAG and Cr were measured before AKI and after the presence of AKI for 48 hours and 7 days. NAG was assayed by spectrophotometry, and urinary Cr by biochemistry method on automatic analyzer. Results In the 19 patients after presence of AKI for 48 hours, 15 cases were identified as stage I AKI, 3 cases as stage II, and one case as stage III AKI, based on the criteria from the Acute Kidney Injury Network (AKIN). In elderly patients with severe CAP after presence of AKI for 48 hours, urinary NAG/Cr ratio was significantly higher than that before the presence of AKI (P<0.01). In the 12 elderly patients with severe CAP after presence of AKI for 7 days, urinary NAG/Cr ratio was significantly lower in the 7 patients recovering from AKI than the 5 patients having acute renal failure. Conclusion Urinary NAG/Cr ratio may be useful for the early diagnosis of AKI in elderly patients with severe CAP. Metrics

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The application superiority of daytime continuous high-volume hemofiltration in patients with multiple organ dysfunction syndrome HE Tie-niu;LIU Bao;TAO Xiao-gen;ZHANG Lin-lin;SHAO Min 2010, 9 (6):  311-314.  Abstract ( 563 )   HTML ( 0 )   PDF (245KB) ( 185 )   【Abstract】Object To investigate the clinical effects and safety of daytime continuous high-volume hemofiltration in patients with multiple organ dysfunction syndrome (MODS) in ICU. Methods We recruited 36 patients with MODS treated in ICU during the period of April 2008 to Sept. 2009. Patients were randomly asigned into continuous normal-volume hemofiltration group (group A, n=16) or daytime high-volume hemofiltration group (group B, n=36). Mortality rate, critical care score, the days staying in ICU, and the days without organ failure within 28 days were compared between the 2 groups. Result There were no difference in mortality rate within 28 days between the 2 groups (25.0% in group A, and 31.25% in group B; 2=0.173, P=0.667). In group A, however, the days without organ failure were longer (18±8 days in group A, and 11±8 days in group B; t=2.21, P=0.036), and the days staying in ICU were shorter (8±5 days in group A and 11±5 days in group B; t=2.30, P=0.029). Conclusion Daytime continuous high-volume hemofiltration is a safe and efficient method for the treatment of MODS in ICU. Metrics

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The relationship between different blood pressure subtypes and left ventricular hypertrophy in CAPD patients JIANG Lan;CHENG Li-tao;ZHU Xiang-ming;ZHANG Ai-hua;HAN Qing-feng;ZHENG Dan-xia;WANG Tao 2010, 9 (6):  315-320.  Abstract ( 609 )   HTML ( 0 )   PDF (356KB) ( 221 )   【Abstract】 Objective To explore the correlation of blood pressure subtype with the prevalence of left ventricle hypertrophy (LVH) and the left ventricle remodeling in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods One hundred and twenty-seven CAPD patients were enrolled in this study. Patients were divided into four groups: (1) normotension group (n=46): systolic blood pressure (SBP) <140mmHg and diastolic blood pressure (DBP) <90mmHg; (2) isolated systolic hypertension (ISH) group (n=42): SBP ≥140mmHg and DBP <90mmHg; (3) systolic-diastolic hypertension (SDH) group (n= 39): SBP ≥140mmHg and DBP≥90mmHg; (4) isolated diastolic hypertension (IDH) group (n=0): SBP <140 mmHg and DBP ≥90 mmHg. Cardiac function and cardiovascular hemodynamic indices were assessed by echocardiography. Blood biochemical examinations were conducted. Results There were no differences in basic information, lipid metabolism status and anemia among the 3 groups (P>0.05). SBP, DBP, mean arterial pressure and pulse pressure were greater in SDH group than in ISH group, and were greater in ISH group than in normotension group (P<0.01). Left ventricular mass (LVM) and left ventricular mass index (LVMI) were higher in ISH and SDH groups than in normotension group (P<0.05). The prevalence of LVH was 76.2% in ISH group, and was 71.8% in SDH group, higher than that in normotension group (50%, P<0.01). Left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were lower in SDH and ISH groups than in normotension group (P<0.01). Left ventricular end diastolic dimension (LVEDD) and left ventricular end systolic dimension (LVESD) were higher in SDH and ISH groups than in normotension group (P<0.01). The ratio between early (E) and late (atrial, A) ventricular filling velocity (E/A ratio) was higher in SDH group than in ISH and normotension groups (P<0.01). Total peripheral resistance (TPR) and total peripheral resistance index (TPRI) were higher in SDH group than in ISH and normotension groups (P<0.01). Multivariate logistic regression analysis showed that the risk to develop LVH was 2.01 folds higher in ISH group and 1.74 folds higher in SDH group than in normotension group. Other risk factors for LVH included female (B=1.36, P<0.012) and dialysis duration (B=0.029, P<0.045). Conclusions In CAPD patients, the risk for LVH was higher in SDH and ISH groups than in normotension group. Blood pressure subtype was an independent risk factor for LVH. Patients with ISH and SDH had a higher risk for left ventricular remodeling. ISH had a greater impact on cardiac remodeling and a higher risk for LVH. Metrics

血液净化中心管理与技术

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Current status for the treatment of maintenance hemodialysis patients in 15 blood purification centers in urban areas of Guangxi TANG Sheng;GONG Zhi-feng;PENG Xiao-mei;BI Min;WU Chao-qing;ZHANG Wen-xin;ZENG Xi;WANG Hao-yu 2010, 9 (6):  339-341.  Abstract ( 503 )   HTML ( 0 )   PDF (201KB) ( 188 )   Metrics