Chinese Journal of Blood Purification

12 March 2014, Volume 13 Issue 03 Previous Issue    Next Issue

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Efficacy of Paricalcitol Therapy for Hemodialysis Patients with Secondary Hyperparathyroidism: A Meta-analysis 2014, 13 (03):  129-133.  doi: 10.3969/j.issn.1671-4091.2014.03.001 Abstract ( 293 )   HTML ( 0 )   PDF (1430KB) ( 408 )   Objective To systematically evaluate the effect of paricalcitol on secondary hyperparathyroidism in chronic hemodialysis patients. Methods According to the collaborative search strategy, MEDLINE (1996- 2013.9), OVID (1963- 2013.9), Chinese Wanfang database (1996- 2013.9), CNKI (1996- 2013.9), and the clinical control test database of Cochrane Library were searched. Published and unpublished literature and abstracts in academic meetings were also searched by hand. Quality assessment and data extraction were conducted by two independent investigators. Meta-analysis was performed by the software RevMan 5.0. Results Five randomized controlled trials including 452 patients were analyzed. Meta- analysis showed that the decrease of parathyroid hormone was similar between chronic hemodialysis patients with paricalcitol therapy and those with alfacalcidol/calcitriol therapy (WMD = -0.63, 95% CI -2.20～0.93, P=0.43), and paricalcitol could effectively increase serum calcium (WMD = -2.92, 95% CI -16.64～10.8, P=0.007) and decrease serum phosphorus (WMD = -0.05, 95% CI  0.08～-0.03, P=0.0001). However, the remission rates of hypercalcemia and hyperphosphatemia were similar between the two therapies (RR = 0.95, 95% CI 0.83～1.08, P=0.45). Conclusion The meta-analysis suggests that paricalcitol suppresses parathyroid hormone and decreases serum phosphorus without the increase of adverse events in chronic hemodialysis patients. Metrics

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A clinical research of parathyroidectomy in uremic pruritus patients with secondary hyperparathyroidism 2014, 13 (03):  134-136.  doi: 10.3969/j.issn.1671-4091.2014.03.002 Abstract ( 351 )   HTML ( 0 )   PDF (397KB) ( 297 )   Objective To observe the clinical effect of parathyroidectomy on pruritus in uremic patients with secondary hyperparathyroidism (SHPT). Methods Thirty uremic patients with SHPT and pruritus were recruited in this study. Their serum calcium, phosphorus, calcium and phosphorus product (Ca×P), intact parathyroid hormone (iPTH), and β2-microglobulin (β2-MG) were measured, and their pruritus scores were recorded before and after parathyroidectomy for one month. Results Serum iPTH, calcium, phosphorus and Ca×P decreased after parathyroidectomy for one month, as compared with those before the treatment (tiPTH = - 9.790, P = 0.000; t Ca = -6.285, P = 0.000; t p = -10.501, P = 0.000; t Ca×p = -11.140, P = 0.000), but serum β 2-MG did not change significantly (P ＞0.05).  Pruritus improved in 29 of 30 cases (96.7%) with the decrease of average pruritus score from 27.2±12.0 to 5.2±8.4 (t =-9.584, P=0.000) after parathyroidectomy for one month. Conclusion Parathyroidectomy is effective on prurutis in uremic patients with SHPT. Metrics

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Bone density measurement in patients on maintenance hemodialysis 2014, 13 (03):  137-139.  doi: 10.3969/j.issn.1671-4091.2014.03.003 Abstract ( 288 )   HTML ( 0 )   PDF (368KB) ( 335 )   Objective To explore bone mineral loss and osteoporosis in patients on maintenance hemodialysis (MHD). Methods We recruited 141 MHD patients treated in the Blood Purification Center of Nephrology Department, China-Japan Friendship Hospital. They were then grouped based on sex, MHD age, and serum intact parathyroid hormone (iPTH) level. Their age, body weight and height were recorded, serum iPTH was measured, and calcaneal bone mineral density was assayed by a calcaneal quantitative ultrasound instrument. Data were analyzed by the software SPSS. Result The prevalence of osteoporosis was 51.77%, and that of osteopenia was 41.84%. The prevalence of osteoporosis was higher in females (65.00%) than in males (34.42%; χ2 = 13.07, P <0.05), increased gradually with MHD age, but was indifferent among the groups with various iPTH levels. Conclusion Calcaneal osteopenia and osteoporosis were prevalent in MHD patients. Metrics

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In-center nocturnal hemodialysis on phosphorus metabolism in uremic patients 2014, 13 (03):  140-142.  doi: 10.3969/j.issn.1671-4091.2014.03.004 Abstract ( 306 )   HTML ( 3 )   PDF (943KB) ( 578 )   Objective To observe the effect of in-center nocturnal hemodialysis (INHD) on hyperphosphatemia in uremic patients. Methods fifty-six patients who received INHD more than 6 months were investigated. The predialysis serum phosphorus, serum calcium and serum iPTH before and after entering INHD were collected. And the uses of phosphate binders were recorded. Results Within the 3 months before entering INHD, there was no significant difference in average serum phosphate levels. The average phosphorus levels significantly decreased (p<0.05) from 1 month after entering INHD and was steady at <1.67 mmol/L. Hypophosphatemia were detected in 31 cases (6.5%) of 15 patients. It occurred in patients with older age, less body mass index (BMI) and longer NHD duration (p<0.05). After entering INHD, withdrawal of phosphate binders were observed in 14 patients (25%). Conclusion INHD can effectively and stably control hyperphosphatemia in dialysis patients,whit the lower prevalence of  hypophosphatemia . Metrics

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The clinical significance of parathyroid ultrasound screening in hemodialysis patients 2014, 13 (03):  143-145.  doi: 10.3969/j.issn.1671-4091.2014.03.005 Abstract ( 290 )   HTML ( 0 )   PDF (1102KB) ( 235 )   Objective To investigate maintenance hemodialysis （MHD）for patients with parathyroid (PT) ultrasound clinical significance; Methods Collection MHD patients over one year of therapy and general information related laboratory examination, according to iPTH levels divided into group A (≥ 600pg/ml) and group B (<600pg/ml) implementation PT ultrasound. Results 73 patients were enrolled, including 55 cases of group A, B group 18 cases. Ultrasound PT detection rate: A group of 90.9% (50/55), B group of 33.3% (6/18), there was a significant difference between the two groups (P <0.001), PT total volume of significant differences also exit（t=4.171, P=0.021）. Univariate analysis showed that iPTH levels were positively correlated with PT volume (γ = 0.543, P = 0.039). Conclusion iPHT levels above 600pg/ml of MHD patients is highly suggestive of the possible presence of PT hyperplasia. Metrics

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Effect of nicotinic acid and nicotinamide on serum phosphorus levels in dialysis patients: a systematic 2014, 13 (03):  146-151.  doi: 10.3969/j.issn.1671-4091.2014.03.006 Abstract ( 259 )   HTML ( 2 )   PDF (1757KB) ( 259 )   Objective To assess the effect and safety of nicotinic acid and nicotinamide in treatment of hyperphosphatemia in dialysis patients by meta analysis. Methods Cochrane Library, PubMed, EMbase, CNKI, Wanfang Database and Weipu Database were used to do literature search on clinical trials studies in the treatment of hyperphosphatemia in dialysis patients by nicotinic acid or nicotinamide. After quality assessments and data extractions, all clinical trials accorded with standard were given a Mata analysis. Results A total of 328 maintenance dialysis patients (13 in peritoneal dialysis and the rest of patients in hemodialysis) in the 13 reports were analyzed. The results of Meta analysis showed that the level of serum phosphorus and calcium-phosphorus product decreased significantly after the treatment of nicotinic acid and nicotinamide, and there was no statistically difference in serum calcium, iPTH , platelet count between the treatment (or post-treatment) group and the control (or pre-treatment) group. Conclusion The current limited evidence suggests that nicotinic acid and nicotinamide are effective and safe in controlling serum phosphorus in dialysis patients. Because of the limits of the sample and quality of included studies, this conclusion has to be verified with more strictly desigened large clinical trials. Metrics

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The study on efficiency and safety of disinfection for hemodialysis concentrate fluid container by acidic electrolyzed oxidizing water 2014, 13 (03):  152-155.  doi: 10.3969/j.issn.1671-4091.2014.03.007 Abstract ( 281 )   HTML ( 0 )   PDF (402KB) ( 318 )   Objective The aim of this study was to evaluate the efficiency and safety of acidic electrolyzed oxidizing water (AEOW) for disinfecting the concentrated dialysate containers. Methods A total of 80 containers for bicarbonate concentrated dialysate were collected from one hemodialysis center. The containers were contaminated by the bacteria in tap water, and the efficiency and safety of the four disinfection protocols were then compared. Results The four protocols were all effective for disinfecting the concentrated dialysate containers (P ＜0.05). After the disinfection of protocol A, however, residual chlorine in dialysate was higher than the upper safety limit, and was also higher than that after the disinfection of protocols B, C and D (3.31± 1.69 mg, 0.03±0.02 mg, 0.03±0.08 mg, and 0.07 ± 0.13 mg using protocol A, B, C and D, respectively; P ＜ 0.05). Residual endotoxin was higher using protocols A and B than using protocols C and D (P ＜0.05), but was indifferent between protocols C and D. After the disinfection of protocols C and D, residual chlorine was 0.03±0.08 mg and 0.07±0.13 mg, respectively, and residual endotoxin was 29.54±28.60 EU and 21.87±17.37 EU, respectively, significantly lower than those by protocols A and B, and indifferent between protocols C and D (P >0.05). Conclusions AEOW was effective and safe for disinfecting the concentrated dialysate containers. The optimal disinfection procedure included treatment with AEOW for 5 minutes followed by rinse and lid covering. Metrics

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The relationship between serum adiopocyte fatty acid binding protein and atherosclerosis in hemodialysis patients 2014, 13 (03):  156-160.  doi: 10.3969/j.issn.1671-4091.2014.03.008 Abstract ( 202 )   HTML ( 0 )   PDF (314KB) ( 225 )   Objective To investigate the changes of serum adiopocyte fatty acid binding protein (AFABP, FABP4) and its correlation to atherosclerosis in hemodialysis patients. Methods Twenty-nine hemodialysis patients and 20 health controls were involved in this study. Serum A-FABP, free fatty acids (FFA), IL- 6, monocyte chemotactic protein 1 (MCP-1) were measured by enzyme-linked immunosorbent assay (ELISA). Intima-media thickness was measured by color Doppler ultrasonography. Results Serum A-FABP and FFA were higher in hemodialysis patients than in healthy controls (P＜0.05). In hemodialyis patients, serum A-FABP level was positively correlated with serum FFA level (r=0.939, P＜0.01), IL-6, and MCP-1. Serum AFABP was higher in the 19 hemodialysis patients with vascular atherosclerosis than in the 10 hemodialysis patients without vascular atherosclerosis (P＜0.01). Conclusion Serum A-FABP may play an important role in the progression of vascular atherosclerosis in chronic kidney disease patients. Metrics

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The correlation of the big five structure personality with depression and anxiety in maintenance hemodialysis patients in Chongqing 2014, 13 (03):  161-163.  doi: 10.3969/j.issn.1671-4091.2014.03.009 Abstract ( 235 )   HTML ( 3 )   Objective To survey the big five structure personality in maintenance hemodialysis (MHD) patients in Chongqing, and to explore the relationship between personality and depression and anxiety in these patients. Methods A total of 237 MHD patients were randomly recruited from 3 hospitals in Chongqing as the MHD group. They were assessed by the Chinese Big Five Personality Inventory brief version (CBF-PI-B) and Hospital Anxiety and Depression Scale. Meanwhile, 157 healthy persons were also assessed by CBF-PI-B as the control group. Personality differences were compared between the two groups, and relationship between personality and depression and anxiety was also evaluated in MHD patients using correlation and regression analyses. Results Neuroticism and agreeableness scores were significantly higher in MHD group than in control group (t=2.35, P＜0.05, and t=6.82, P＜0.01, respectively). Extraversion and openness scores were negatively correlated with depression (r=-0.359, P＜0.01 and r=-0.288, P＜0.01, respectively). Neuroticism was positively correlated with depression and anxiety (r=0.388, P＜0.01 and r=0.404, P＜0.01, respectively). The predictability of extraversion, openness and neuroticism for depression was up to 28%. Conclusion MHD patients were prone to contact people, and also to be irritable, sensitive and nervous. MHD patients with higher score of neuroticism, and lower scores of extraversion and openness were susceptible to have depression. Metrics

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Pathological analysis of 48 parathyroid samples and ultra- structural observation of 8 parathyroid samples from dialysis patients with secondary hyperparathyroidism 2014, 13 (03):  164-168.  doi: 10.3969/j.issn.1671-4091.2014.03.010 Abstract ( 244 )   HTML ( 0 )   【Abstract】 Objective To study the pathological characteristics in secondary hyperparathyroidism(SHPT) among different clinical factors. Methods Totally 48 patients with end-stage renal disease accepted dialysis and were diagnosed as SHPT in China-Japan friendship hospital during 2009 to 2012. The pathological characteristics of 48 cases were analyzed and compared with different clinical factors through retrospective analysis respectively. The ultrastructure of 8 cases fresh parathyroid in dialysis recipients were examined under electron microscope. Results The expression level of parathyroid had no relation to the cell type of parathyroid 、secondary hemorrhage or calcification and M/F ratio（p＞0.05）. Hemorrhage （70.8%,34/48）and/or calcification （62.5%,30/48）appeared evenly in different level group of patients with secondary hyperparathyroidism. Nodular hyperplasia was the predominant growth pattern （95.8%,46/48）in 48 cases secondary hyperparathyroidism patients who accepted dialysis. The calcification in parathyroid became more extensive as dialysis time prolonged（p＜0.05）. Mitochondria and ribosome in hyperplastic parathyroid cell increased remarkably. Conclusions Parathyroid hemorrhage and/or calcification often appear in dialysis recipients who had SHPT. The extent of calcification in parathyroid correlated with dialysis time. Nodular hyperplasia was the important pathologic basis of refractory SHPT in dialysis recipients with end-stage renal disease. The ultrastructure changes in hyperplastic parathyroid gland indicated high activated state of parathyroid cells. Metrics

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Directed mutagenesis of lactobacillus bulgaricus for decomposition of uremic toxins 2014, 13 (03):  169-172.  doi: 10.3969/j.issn.1671-4091.2014.03.011 Abstract ( 284 )   HTML ( 1 )   PDF (669KB) ( 307 )   Objective We aimed to obtain a strain of probiotics from lactobacillus bulgaricus capable to decompose uremic toxins, to provide a new strain of intestinal bacterium for the treatment of chronic renal failure. Method The original lactobacillus bulgaricus was induced by incubation in uremic patients’sera, and then repeatedly induced by physical (ultraviolet radiation) and chemical (diethyl sulfate) methods. We used the decomposition ability to creatinine as the index, to select the strains capable to efficiently decompose creatinine, and then to test their genetic stability and their decomposition abilities to urea, uric acid, serum phosphate, parathyroid hormone, and homocysteine. Result After the inductive and mutagenic treatments, we obtained a strain of DUC3-17. The decomposition rates of this strain for creatinine, urea nitrogen, uric acid, phosphorus, parathyroid hormone and homocysteine were 17.23%, 36.02%, 9.84%, 15.73%, 78.26%, and 12.69%, respectively. These abilities were stable after 5 passages. The original lactobacillus bulgaricus did not have these abilities. Conclusion We used directed induction and physical and chemical methods to lactobacillus bulgaricus, and obtained a mutant strain that has greater abilities to decompose uremic toxins and was genetically stable. Metrics

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Demographic trends in incident maintenance hemodialysis patients in Beijing area 2014, 13 (03):  185-189.  doi: 10.3969/j.issn.1671-4091.2014.03.015 Abstract ( 277 )   HTML ( 1 )   PDF (755KB) ( 1489 )   To analyze the demographic trends and primary disease changes in incident maintenance hemodialysis (MHD) patients in Beijing area. Methods We retrospectively review all the incident MHD patients registered in the Beijing Hemodialysis Quality Control and Improvement Center (BJHDQCIC) from 2007 to 2012. Their demographics and primary causes are investigated. Stratified analyses based on year, sex, age and other factors are conducted. Results There are totally 14,945 patents (8,397 males and 6,548 females; males : females = 1.3:1). The average age is 56.2±17.1 years for the 13,571 patients whose ages were registered. The average age is 54.4 years for males and is 58.5 years for females. The top primary disease for incident MHD patients is diabetes, followed by chronic glomerulonephritis (CGN), hypertension, interstitial nephritis and polycystic kidney disease. The change from CGN to diabetes as the most common cause for MHD in male and female patients occurs in 2009 and 2010 respectively. The average age for incident MHD patients is increasing. Older patients over 40 years of age account for 81.8% of the new MHD patients. The constituent of primary diseases varies with age. CGN is the main cause and accounts for 33.9% in patients less than 50 years old, while diabetes is the leading cause and accounts for 31.6% in those over 50 years old. Conclusion The average age for incident MHD patients is gradually increasing. Older patients over 40 years of age account for the main body of new MHD patients. Males have higher MHD incidence and earlier age to enter MHD than females. The leading cause in MHD patients less than 50 years old is CGN, while that in patients more than 50 years old is diabetes. Diabetes has replaced CGN as the leading cause of incident MHD patients in Beijing area. Metrics