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Chinese Journal of Blood Purification

    12 April 2009, Volume 8 Issue 4 Previous Issue    Next Issue
    论著
    Estimation of dry body weight using bioelectrical impedance vector analysis in maintenance hemodialysis patients
    ZHAO Xin-Ju;CAI Li;ZUO Li
    2009, 8 (4):  185-191. 
    Abstract ( 591 )   HTML ( 0 )   PDF (430KB) ( 190 )  
    【Abstract】 Object To probe the possibility of bioelectrical impedance vector analysis (BIVA) as a tool to estimate dry weight (DW) in maintenance hemodialysis patients. Methods Maintenance hemodialysis patients with adequate DW appreciated based on clinical experience in the Hemodialysis Center of Peking University First Hospital were included in this study. Single frequency (50kHz) and whole-body impedance vector were measured before and after hemodialysis (HD) sessions. Vector distribution was compared with that of healthy subjects living in the Shijingshan District in Peking. The 95% confidence ellipses for MHD patients and healthy subjects and the tolerance ellipses for healthy subjects were drawn on the resistance-reactance vector graph. Before HD session, the patients were divided into group A (overhydration) and group B (normohydration) according to their vector tolerance analysis, and the occurrence of hypertension was compared between the two groups. After HD session, the patients were divided into overhydration, normohydration and dehydration groups according to their vector tolerance analysis. The prediction of DW adjustment was then made based on hydration status, and their blood pressure levels before and after HD session were compared. Results In this study, 290 healthy subjects (male : female = 149:141) and 37 adult maintenance hemodialysis patients (male : female = 13:24) were included. Compared with those of healthy subjects, the vector was shorter and the phase angle was smaller in patients before HD, and the vector became longer and the phase angle became larger after HD. The vector displacement after HD indicates the improvement of hydration status in patients. Before HD, hypertension was found in 39.3% patients in group A, and in 22.2% patients in group B. Blood pressure was lower in dehydration group than in overhydration and normohydration groups, but the differences had no statistical significance. The consistent rate between DW assessed by BIVA and that by clinical assessment was 70.3%. By BIVA, 11 patients were suggested to have DW readjusted. After observation for 2 weeks, DW was readjusted with the same direction based on BIVA prediction in 5 of the 11 patients. Conclusions Before HD, overhydration prevailed even in patients with adequate DW. BIVA is useful for the assessment of inadequate DW earlier than the presence of clinical symptoms, and is thus a helpful method for physicians to evaluate DW in maintenance hemodialysis patients.
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    Arterial Stiffness and its Related Factors in Diabetic Nephropathy Patients with Peritoneal Dialysis
    LIU Sha;ZHANG Dong-liang;DAI Wen-di;Yin Dao-xin. Liu Wen-hu
    2009, 8 (4):  192-195. 
    Abstract ( 942 )   HTML ( 0 )   PDF (243KB) ( 203 )  
    【Abstract】 Objective To explore arterial stiffness and its related factors in diabetic nephropathy patients treated with peritoneal dialysis (PD). Methods Serum albumin (ALB), C reactive protein (CRP), hemoglobin (Hb), triglycerides (TG), total cholesterol (TC), fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), intact PTH (iPTH), Ca+2, Kt/V, malondialdehyde (MDA), advanced oxidation protein products (AOPP), myeloperoxidase (MPO) and superoxide dismutase (SOD) levels were assayed, and intima-media thickness (IMT), pressure-strain elastic modulus (Ep) and stiffness index (SI) of carotid arteries were measured by ultrasound examination in 45 diabetic nephropathy patients and 53 non-diabetic nephropathy patients with PD. Results ALB, CRP ,Hb, FPG, HbA1c, Kt/V, MDA, AOPP, MPO, SOD, IMT, Ep and SI were significantly different between the two groups (P<0.05). Multiple linear stepwise regression analysis revealed that EP and SI were influenced by the levels of HbA1c, MDA, AOPP, MPO and SOD. In diabetic nephropathy patients with PD, correlation analysis showed that IMT, Ep and SI were positively correlated with the levels of HbA1c, MDA, AOPP and MPO, and were negatively correlated with SOD level, while HbA1c was positively correlated with the levels of MDA, AOPP and MPO, and was negatively correlated with SOD level. Conclusion Arterial stiffness is worse in diabetic nephropathy patients with PD than in non-diabetic nephropathy patients with PD. HbA1c and oxidative stress closely relate to the arterial stiffness degree in diabetic nephropathy patients with PD.
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    Clinical study on arterial stiffness in chronic kidney disease patients without dialysis
    HE Lian;ZENG Jing;TIAN Shunli;WANG Tao
    2009, 8 (4):  196-199. 
    Abstract ( 578 )   HTML ( 0 )   PDF (258KB) ( 197 )  
    【Abstract】 Objective To assess arterial stiffness, its related risk factors and the roles of these factors in chronic kidney disease (CKD) patients without dialysis. Methods We recruited 378 outpatients with CKD treated in the Renal Clinic of Peking University Third Hospital from March, 2006 to Oct., 2007. Arterial stiffness was evaluated by measuring carotid-femoral artery pulse wave velocity (CF-PWV). Clinical information and biochemical data were collected. The correlation of these data was then analyzed. Results Among the 378 CKD patients, CF-PWV was positively correlated with age (P<0.001), systolic blood pressure (P<0.001), pulse pressure (P<0.001), blood glucose (P<0.001), amount of 24 hours urine protein (P=0.003), and metabolic syndrome (P=0.001), and was negatively correlated with creatinine clearance (P<0.001) and HDL-C (P=0.018). CF-PWV was unrelated with sex (P=0.052), body mass index (P=0.156), triglycerides (P=0.951), and product of calcium and phosphorus (P=0.932). Multiple regression analysis found that CF-PWV was positively and independently associated with age (B=0.063, P<0.001), pulse pressure (B=0.047, P=0.004) and amount of 24 hours urine protein (B=0.6, P=0.001). Conclusion In CKD patients without dialysis, CF-PWV correlates with a number of traditional risk factors to cardiovascular disease, urine protein amount, and creatinine clearance. Therefore, CF-PWV may be a useful method to early predict the risk of cardiovascular disease in CKD patients. Arterial stiffness may also play an important role in cardiovascular disease in CKD patients.
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    Influence of calcium concentration in dialysate on calcium, phosphate, intact parathyroid hormone and aldosterone during hemodiafiltration
    YAO Ping;ZHAO Xiang-yan g;LI Peng-fei;HAO Li-rong
    2009, 8 (4):  200-202. 
    Abstract ( 618 )   HTML ( 0 )   PDF (178KB) ( 182 )  
    【Abstract】 Objective To evaluate the effect of calcium concentration in dialysate on serum ionized Ca (iCa), phosphate (P), intact parathyroid hormone (iPTH) and aldosterone (ALD) during hemodiafiltration (HDF) in chronic renal failure patients. Methods Sixty patients were assigned into 3 groups based on the calcium concentration in dialysate. Serum iCa, P, iPTH, ALD and blood pressure were measured before and after HDF session. Results In the group using Ca+2 1.25mmol/l in dialysate, iCa, P, ALD and blood pressure decreased significantly, and iPTH remained unchanged. In the group using Ca+2 1.5mmol/l in dialysate, iCa unchanged but P, iPTH and ALD decreased. In the group using Ca+2 1.75mmol/l in dialysate, iCa increased significantly but P, iPTH and ALD decreased. Conclusions Treatment with the addition of low calcium dialysate to hemodiafiltration is beneficial to reduce calcium load and serum ALD, to prevent iPTH from increase, and to decrease blood pressure.
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    Effect of the parathyroid hormone on the responsiveness to erythropoietin in hemodialysis patients
    ZHANG Lei;CUI Mei-yu;XU Dong-mei;LI Wen-bin;WANG Zun-song;WEI Yong;ZHU Zhu-xian
    2009, 8 (4):  203-205. 
    Abstract ( 685 )   HTML ( 0 )   PDF (197KB) ( 209 )  
    【Abstract】 Objective To investigate the correlation of serum immunoreactive parathyroid hormone (iPTH) with anemia and hypo-responsiveness to erythropoietin (EPO) in maintenance hemodialysis patients. Methods We studied 46 maintenance hemodialysis patients (28 males and 18 females, aged 61.00 +15.59 years). Blood samples were collected at the day on hemodialysis for the determination of serum hemoglobin (Hb), hematocrit (Hct), albumin, ferritin, Ca, P, creatinine and iPTH. Higher ratio of recombinant human erythropoietin (r-HuEPO) dosage to Hct (EPO/Hct) was defined as hypo-responsiveness to EPO. Results Patients with elevated serum iPTH (20 cases, 43.5%) showed higher EPO/Hct ratio, serum P and Ca x P product, but lower Hb and Hct, as compared with those of the patients with normal serum iPTH (26 cases, 56.5%). Multiple stepwise regression analysis found that serum iPTH level, patient’s age and hemodialysis duration were the best predictors for EPO/Hct ratio (R2=0.388, P=0.039). Conclusions Secondary hyperparathyroidism is one of the complications in maintenance hemodialysis patients. Oversecretion of PTH is the most important factor causing hypo-responsiveness to EPO.
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    基础研究
    Effects of arsenic trioxide on lymphocyte apoptosis and its related genes in MRL-lpr mice with lupus nephritis
    LIU Rui-chan;JIA Xi-bei;XIE Ru-juan;SUN Ting-li.
    2009, 8 (4):  206-210. 
    Abstract ( 554 )   HTML ( 0 )   PDF (325KB) ( 176 )  
    【Abstract】 Objective To investigate the effects of arsenic trioxide on lymphocyte apoptosis in MRL-lpr mice with lupus nephritis, through the observation of apoptotic lymphocytes and gene expression relating to apoptosis. Methods Fourteen MRL-lpr mice were randomly assigned into experimental group or control group. Mice in experimental group were treated with arsenic trioxide and those in control group with saline. Mouse anti-dsDNA antibody titer was detected by ELISA. Apoptotic lymphocytes in spleen were assessed by flow cytometry. Caspase-3 expression was measured by RT-PCR, and bcl-2 expression by western blot. Results Anti-dsDNA antibody titer was significantly lower in experimental group than in control group. More apoptotic cells were found in spleen from mice of experimental group. Caspase-3 RNA was significantly higher in experimental group than in control group, but bcl-2 protein was less in experimental group. Conclusion Arsenic trioxide induces apoptosis of autoimmune lymphocytes in MRL-lpr mice with lupus nephritis, probably through the activation of caspase family and the inhibition of bcl-2 expression.
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    Construction and expression of a pcDNA3.1(-)-hEPO vector in human proximal tubular epithelial cells
    ZHU Bei;ZHAO Wei-hong;WU Jian-qing
    2009, 8 (4):  211-214. 
    Abstract ( 601 )   HTML ( 0 )   PDF (255KB) ( 222 )  
    【Abstrat】 Objective To stably express human erythropoietin (EPO) gene in human proximal tubular epithelial cells (HK-2). Methods Eukaryotic expression vector for human EPO gene was constructed by the standard molecular cloning method. The recombinant pcDNA3.1(-)-hEPO vector was transfected to 293 cells and HK-2 cells by the calcium phosphate coprecipitation method. EPO in cultured supernatant was detected by ELISA. Proliferation of HK-2 cells was assayed by MTT method. Results After successful construction of the recombinant plasmid and transfection of the plasmid to HK-2 cells, EPO was temporarily expressed in transfected HK-2 cells, and was constantly expressed in transfected HK-2 after selection by G418. The expression level of EPO in transfected HK-2 cells was 35.0±5.3 % of that in transfected 293 cells. HK-2 cells stably expressing transfected human EPO did not show any changes of cell growth. Conclusion Human EPO cDNA can be stably expressed in human proximal tubular epithelial cells (HK-2), suggesting a promising approach for EPO gene therapy.
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    透析心理学
    A study on mental health, coping styles and social support in chronic hemodialysis patients
    SHI Yan;LIAO Yuanjiang;GAO Xiao-ling
    2009, 8 (4):  215-218. 
    Abstract ( 996 )   HTML ( 2 )   PDF (260KB) ( 193 )  
    【Abstract】 Objective The aim of this study was to assess mental health condition, coping styles and social support in chronic hemodialysis patients, to compare the 3 parameters with those from healthy control group, and to discuss patients’ coping styles and social support for the prediction of their mental health. Methods Chronic hemodialysis patients and their control subjects were surveyed with Symptom Checklist 90 (SCL-90), Simplified Coping Style Questionnaire (SCSQ) and Social Support Rating System (SSRS). Data were analyzed by t test, product moment correlation and multiple stepwise regression analysis using the software SPSS15.0. Result Mental health condition, social support and positive coping style were significantly lower in patients than in the control group, while passive coping style was higher in patient group. Their positive coping styles, total score for social support, subjective social support and objective social support correlated significantly with their mental health condition. Either two coping styles or subjective social support were accepted by the multiple stepwise regression model. Conclusion The mental health was relatively worse in chronic hemodialysis patients than in control group. Specific coping style and social support were useful for the prediction of mental health condition.
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