Chinese Journal of Blood Purification

12 October 2014, Volume 13 Issue 10 Previous Issue    Next Issue

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Home environmental related-factors and the history of peritonitis, a cross-sectional survey 2014, 13 (10):  677-680.  doi: 10.3969/j.issn.1671-4091.2014.10.001 Abstract ( 240 )   HTML ( 1 )   PDF (350KB) ( 408 )   Background and objective Since PD is a self-care mode at home, we aimed to explore whether home environment-related factors is associated with the history of peritonitis through a cross-sectional survey. Design Our study enrolled 266 prevalent patients, who were willing to be surveyed between May and August, 2011. A self-designed questionnaire consisted of the detailed description of location for bag exchange, the usage of ultraviolet radiation, the frequency of room cleaning with disinfectant, and whether pets were raised. Eight well-trained primary nurses completed the questionnaire in one-to-one way. The history of peritonitis and causative organisms was also recorded. Results The mean age of subjects was 60.1±13.6 years, with 57.6% of female and 27.1% of diabetes. The dialysis duration was 38.7±28.5 months. The location for bag exchange was the bed room for 123 (46.9%) patients, and separated room 139(53.1%). According to the actual practice in ultraviolet radiation, 33（12.6%）,79（30.1%）and 150（57.3%） patients performed bag exchange with ultraviolet radiation in low-, middle- and high-frequency. The risk of peritonitis history was significantly higher in patients who had long dialysis duration （RR=1.016, 95%CI 1.005~1.027，P=0.004）and who performed bag exchange in the bed room （RR=1.841, 95%CI 1.040~3.260，P=0.036）. The risk of peritonitis history caused by Staphylococcus aureus or Staphylococcus epidermidis was significantly higher in patients who had a long dialysis duration（RR=1.015, 95%CI 1.001~1.029，P=0.040） or used ultraviolet radiation in low-frequency（RR=4.148, 95%CI 1.536~11.204，P=0.005）. Conclusions The associations of bag exchange location, frequency of ultraviolet radiation and peritonitis risk were observed and need to be explored further. Metrics

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The telephone call from peritoneal dialysis patients for consultation：a retrospective study from a single center 2014, 13 (10):  681-685.  doi: 10.3969/j.issn.1671-4091.2014.10.002 Abstract ( 294 )   HTML ( 0 )   PDF (383KB) ( 304 )   Objectives Follow-up by telephone is a supplementary method for home peritoneal dialysis (PD) patients to communicate with medical staffs. It is very important for PD doctors and nurses to get the message from patients about their conditions and then to guide the patients how to adjust their diet, medication, processing method and therapeutic schedule. We investigated the telephone record from PD patients to analyze the information and frequency of consultation by telephone in order to provide the evidences for individualized training and retraining. Methods We searched for the follow-up record by telephone from all PD patients treated at the PD center of Peking University People's Hospital from Oct. 1st, 2010 to Sept. 30th, 2012. Their demographic data were collected, and the characteristics, content and frequency of the telephone calls from the PD patients were analyzed. Chi-square test was used to compare the frequencies of telephone call from the PD patients with different characteristics. Results ①In the period of two years, there were totally 3,936 telephone calls, of which 1,983 calls (50.4%) asked for consultation. These calls were from 194 patients, accounting for 91.9% of the treated PD patients. ② The main item for consultation was PD-related dietary, followed by cardiovascular symptoms and related subjects, and volume overload. ③ Further stratified analyses were carried out based on primary disease, season, age, and telephone call frequency. Patients with diabetic nephropathy called more frequent than those with other primary diseases. Volume overload was the common topic in winter, and infection related complications were more frequent in summer than in other seasons. Most calls were from the patients of 61～80 years old. The call frequency was higher in patients of >80 years old than in those of 61～80 years old. Conclusions primary disease, season and age affected the frequency and topic of telephone calls. Education and retraining should be emphasized in specific seasons such as winter and summer, especially to diabetic nephropathy patients, elderly patients. Metrics

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Clinical application of percutaneous placement of peritoneal dialysis catheter 2014, 13 (10):  686-688.  doi: 10.3969/j.issn.1671-4091.2014.10.003 Abstract ( 567 )   HTML ( 1 )   PDF (887KB) ( 613 )   Objective To compare the clinical efficacy of percutaneous placement of peritoneal dialysis (PD) catheter and open surgery for PD catheter placement. Methods A total of 66 PD patients were enrolled in this retrospective single-center study. Thirty-six patients were treated with surgical incision, and 30 patients with percutaneous method for the placement of peritoneal catheter. Catheter placement procedure, catheter-related complications, and PD related infections within one month after catheter placement were compared between the two groups. Results The time required for the placement, incision length and the number of patients treated with analgetics were significantly lower in percutaneous placement group than in surgical incision group (P<0.05). Severe hemorrhage and visceral injury did not occur in the two groups. The prevalence of catheter-related complications and infections within one month after catheter placement were statistically insignificant between the two groups (P＞0.05). Conclusion Percutaneous placement of PD catheter is easier to be operated by nephrologists. It brings slight damage and less complications to the patients. Metrics

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Comparison of coiled versus straight end peritoneal dialysis catheters on complication incidence and catheter survival: a meta analysis 2014, 13 (10):  689-694.  doi: 10.3969/j.issn.1671-4091.2014.10.004 Abstract ( 275 )   HTML ( 0 )   PDF (2735KB) ( 234 )   Objective Peritoneal dialysis (PD) is an effective treatment for end stage renal disease. A well-functioning catheter is the key to successful PD. We conducted a meta analysis of the literature to compare the clinical outcome of the patients using coiled versus straight end PD catheters. Methods Comprehensive search relevant to the outcome of coiled or straight end PD catheter was carried out in PubMed, Embase, Springer, CNKI, VP, CBM and CENTRAL (the Cochrane Library) published up to September 2013. Reference lists were searched manually. The methodology was in accordance with the Cochrane handbook for interventional systematic reviews, and the reporting of meta analysis was written based on the PRISMA statement. The quality of the studies was assessed, and data were extracted. The results were summarized as odds ratios (ORs) for dichotomous outcomes. We also carried out a subgroups analysis based on ethnicity. Results In this meta-analysis, 11 randomized controlled trials with 843 patients were identified. In the 10 clinical observation parameters, only catheter tip migration had significant difference between coiled versus straight end PD catheters (based on 9 trials and 685 patients: OR 2.33; 95% CI 1.46-3.71; P=0.0004). Subgroup analysis revealed that coiled end catheters were associated with the increased risk of catheter tip migration in Asians (based on 5 trials and 422 patients: OR 2.96; 95% CI 1.59-5.51; P= 0.0006), but not in Europeans. There were no significant differences in mechanical related complications, infection related complications, and one and two years of technical catheter survival rate between the two groups and different races. Conclusions Displacement of coiled end PD catheters was significantly higher than that of straight end catheters in Asians, but not in Europeans. Hence, straight end catheters should be more suitable for Asians. Metrics

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Correlation between pulmonary arterial hypertension and vascular endothelial dysfunction in maintenance hemodialysis patients 2014, 13 (10):  695-698.  doi: 10.3969/j.issn.1671-4091.2014.10.005 Abstract ( 240 )   HTML ( 0 )   PDF (391KB) ( 404 )   Objective To investigate the correlation between pulmonary arterial hypertension (PAH) and vascular endothelial dysfunction in maintenance hemodialysis (MHD) patients. Methods We enrolled 60 MHD patients and assigned them into 2 groups, PAH group with pulmonary artery systolic pressure (PASP) > 35 mmHg, and non-PAH group with PASP <35 mmHg. Laboratory and clinical data were collected. Flow-mediated dilatation (FMD) was measured in brachial artery, and asymmetric dimethylarginine (ADMA) was measured at the mid-interdialysis day. Results Seventeen patients (28.3%) were diagnosed as PAH. Ratio of interval dialysis weight gain and dry weight (IDWG/DW) and high sensitivity C-reactive protein (hs-CRP) were significantly higher in PAH group than in non-PAH group (P＜0.05). After excluding other factors possibly related to endothelial dysfunction by analysis of covariance, FMD was 12.2±1.3% in PAH group, significantly higher than 6.9±1.2% in non-PAH group (F=63.8, P＜0.001), and ADMA was 2.97±0.31 μmol/L in PAH group, significantly higher than 2.10±0.29 μmol/L in non-PAH group (F=16.832, P＜0.01). Logistic regression revealed that left ventricular mass index (LVMI) (B=0.037, P=0.043) and ADMA (B=9.519, P=0.006) were the major factors for PAH. Conclusions PAH was significantly correlated with vascular endothelial dysfunction in MHD patients. LVMI and ADMA were the major factors for PAH. Metrics

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The association between the timing of peritoneal dialysis and the survival of end stage renal disease patients 2014, 13 (10):  699-702.  doi: 10.3969/j.issn.1671-4091.2014.10.006 Abstract ( 253 )   HTML ( 0 )   PDF (1015KB) ( 517 )   Objective To explore the relationship between the timing of peritoneal dialysis (PD) and the survival of end stage renal disease patients. Methods We studied the patients diagnosed as uremia and treated with PD in our hospital from January 1st, 2004 to 31st December, 2011. They were divided into early group and late group based on estimated glomerular filtration rate calculated by MDRD formulation. We then analyzed the differences in demographic and laboratory data and compared the survival rate between the two groups. Results This study consisted of 177 patients with the median eGFR of 6.5 ml/min· (1.73m2). Eightfive patients were in the early group with a mean eGFR of 8.77±3.44 ml/min· (1.73m2), and 92 patients in the late group with a mean eGFR of 5.54±1.35 ml/min· (1.73m2). Differences between the two groups were found in serum creatinine (t= -10.270，P＜0.01), BUN (t=-2.910，P＜0.01), eGFR (t=10.050，P＜0.01), diabetic nephropathy (χ2=7.540，P＜0.05), and diabetes comorbidity (χ2=2.600，P＜0.01). Kaplan-Meier analysis showed no significant difference in survival rate between the two groups (χ2=0.360，P=0.191). Conclusion There was no relationship between the timing of PD and the survival of end stage renal disease patients. Metrics

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Nutritional assessment of peritoneal dialysis patients by bioelectrical impedance analysis 2014, 13 (10):  703-707.  doi: 10.3969/j.issn.1671-4091.2014.10.007 Abstract ( 231 )   HTML ( 0 )   PDF (420KB) ( 369 )   Objective Malnutrition is a major complication in peritoneal dialysis (PD) patients. However, there are no efficient and accurate approaches for nutritional assessment in these patients so far. The aim of this study was to validate the bioelectrical impedance analysis (BIA) for malnutrition assessment in PD patients and to analyze malnutrition in PD patients. Methods Clinically stable patients with PD for more than 3 months, willing to take part in this study, and without acute coronary syndrome, surgery, and intravenous antibiotics treatment for severe infection in recent days were recruited. Nutrition status was evaluated by malnutrition inflammation score (MIS) that consists of 10 items with a total score ranging from 0～30 points. Patients were divided into two groups, well- nutritional group (MIS 0～8) and malnutritional group (MIS≥9). BIA was performed to evaluate body composition of the PD patients. Clinical and laboratory data including age, residual renal function, Kt/V and nutritional biomarkers (albumin, hs-CRP, feritin and creatinine) at the beginning of PD were recorded. Results We recruited 183 PD patients (113 males and 70 females) with an average age of 51.9±16.15 years and an average PD period of 23 (10～46) months. The primary diseases for end-stage renal disease included glomerulonephritis (67.2%), diabetic nephropathy (7.7%), hypertensive nephropathy (9.3%), other diseases (14.2%) and unknown origin (1.6%). Forty-one patients (22.4%) had moderate to severe malnutrition evaluated by MIS. MIS level was positively correlated with age (r= 0.249), hs-CRP (r= 0.285), feritin (r=0.168), edema index (EI) (r=0.354) and ECW/BCM (r=0.358), and negatively correlated with BMI (r=-0.227), mean arterial pressure (r=-0.254), albumin (r=-0.208), residual renal function (r=-0.214) and body cell mass (r=-0.270). Multiple linear regression analysis found that elder (β=0.172, P=0.038), elevated feritin (β=0.226, P=0.001) and higher ECW/BCM (β=2.494, P=0.04) were the independent risk factors for malnutrition; while female (β=-0.336, P=0.003), higher level of skeletal muscle (β=-0.592, P=1.79E-08), and higher percentage of body fat (β =-0.183, P=0.041) were the protect factors for malnutrition. ROC analysis showed that the BIA parameters including ECW/BCM, EI, skeletal muscle and body fat percentage could effectively predict malnutrition. Conclusion In this study, the malnutrition rate evaluated by MIS system was 22.4% in PD patients. BIA parameters including ECW/BCM, EI, skeletal muscle and body fat percentage are useful for the assessment of nutrition status in PD patients. Metrics

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Clinical observation of oral sodium levothyroxine in the treatment of intradialytic hypotension complicated with low serum thyroid hormone in maintenance hemodialysis patients 2014, 13 (10):  708-712.  doi: 10.3969/j.issn.1671-4091.2014.10.008 Abstract ( 307 )   HTML ( 1 )   PDF (463KB) ( 250 )   Objective To investigate the clinical efficacy and mechanism of oral sodium levothyroxine (LT4) in the treatment of intradialytic hypotesion (IDH) complicated with low thyroid hormone (TH) in maintenance hemodialysis (MHD) patients. Methods We recruited 40 MHD patients with IDH and low serum TH for at least 3 months during the period from June 2012 to June 2013. The relationship between serum TH level and IDH frequency in MHD patients was evaluated. The patients were then divided into two groups, LT4 treatment group (n=19) and control group (without LT4 treatment, n=18). Changes of IDH frequency and clinical parameters after the therapy for 24 weeks were observed in the two groups. LT4 was administrated orally 25μg/day for one week at the beginning, and then increased to 50μg/day for 24 weeks if no side-effects were found. LT4 should be reduced to 1/2～1/4 of the original dosage when side-effects were present, and should be terminated when serious adverse reactions occurred. Results Low serum TH level was found in 72.7% MHD patients with IDH. In the 40 MHD patients with IDH and low TH, free thyroxine (FT4) was negatively correlated with IDH frequency (R=-0.443, P=0.004). LT4 therapy terminated in 3 patients because of chest distress and palpitation in one case and no IDH anymore in 2 cases. In LT4 treatment group, IDH frequency reduced (0.10±0.052 vs. 0.20 ± 0.127, P=0.003) with the increases of free triiodothyronine (FT3) (4.63±0.765 vs. 3.84±0.697 pmol/l, P=0.003) and serum albumin (40.86±3.148 vs. 39.06±1.990 g/L, P=0.045), as compared with those in control group. Compared with the parameters before LT4 treatment, MHD patients after LT4 therapy showed the changes of FT4 (7.33 ± 1.190pmol/L, to 8.54 ± 1.399 pmol/L, P=0.009), FT3 (3.59 ± 0.603pmol/L to 4.63±0.765 pmol/L, P＜0.001), hemoglobin (69.89 ± 21.891 g/L to 82.61±11.49 g/L P=0.007), albumin (38.01±3.050g/L to 40.86±3.148 g/L, P=0.009), serum iron (7.26±3.27mmol/L to 9.39±1.56 mmol/L, P=0.006), left ventricular ejection fraction (49.32%±6.67% to 51.63%±6.87%, P=0.014), and IDH frequency (0.22±0.118 to 0.10±0.052, P＜0.001). Conclusion Oral LT4 therapy can reduce IDH frequency in MHD patients with low serum TH level. The effects of LT4 may relate to the increase of LVEF and improvement of anemia and nutrition status in these patients. Metrics

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Effect of highflux dialysis with different ultrafiltration volume on solute clearance in uremic patients 2014, 13 (10):  713-716.  doi: 10.3969/j.issn.1671-4091.2014.10.009 Abstract ( 266 )   HTML ( 0 )   PDF (379KB) ( 543 )   Objective To investigate the effect of highflux dialysis with different ultrafiltration volume on the clearance of uremia toxins and the uremic pruritus in uremic patients. Methods Eighty patients were randomly divided into high ultrafiltration volume group and routine ultrafiltration volume group. All patients underwent highflux dialysis thrice weekly and were followed up for six months. The levels of blood creatinine (Cr), phosphate, β2- microglobulin, and parathyroid hormone (PTH) were tested, and solute clearance was calculated before and after the dialysis. Skin itch degree was evaluated by the improved Duo scale system. Transmembrane pressure and adverse events were monitored during the treatment. Results There was no significant difference in the decrease of Cr between high ultrafiltration volume group and routine ultrafiltration volume group (t=1.094, P=0.277), but the decreases of phosphate and β2-microglobulin were more prominent in high ultrafiltration volume group than in routine ultrafiltration volume group (t=-2.138 and -12.815, respectively; P=0.036 and 0.01, respectively). Skin itch improved more in high ultrafiltration volume group than in routine ultrafiltration volume group (t=-3.556, P=0.010). The prevalence of adverse events was statistically insignificant between the two groups (χ2= 0.346, 0.157 and 0.125, respectively; P=0.556, 0.692 and 0.723, respectively), but the transmembrane pressure was higher in high ultrafiltration volume group than in routine ultrafiltration volume group (t=10.22, P=0.001). Conclusion Highflux dialysis with higher ultrafiltration volume increased the clearance of macro and middle molecule toxins, while uremic pruritus was also alleviated significantly. Metrics

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Factors influencing the serum concentration of N-terminal pro brain natrinuretic peptide in peritoneal dialysis patients 2014, 13 (10):  717-721.  doi: 10.3969/j.issn.1671-4091.2014.10.010 Abstract ( 307 )   HTML ( 0 )   PDF (366KB) ( 278 )    To study the factors influencing the serum concentration of N-terminal pro brain natrinuretic peptide (NT-proBNP ) in peritoneal dialysis (PD) patients. Methods Fifty-seven clinically stable PD patients were enrolled in this study. Serum NT-proBNP concentration was measured, the indices of blood pressure, dialysis adequacy, residual renal function and nutritional status were assessed, and echocardiography was performed in these patients. Results In this cross-sectional study, the median NT-proBNP was 5,240 (699.90～35,000) pg/mL. Correlation analysis showed that serum lnNT-proBNP level was positively correlated with MQSGA score, serum phosphorus, cardiac troponin T (cTnT), systolic blood pressure (SBP), mean blood pressure (MAP), SBP index, left atrial diameter (LAD), and left ventricle mass index (LVMI), and was negatively correlated with albumin (ALB), urine volume, residual renal Kt/V, residual renal Ccr, residual GFR (rGFR), ejection fraction (EF), upper arm circumference (MAC) and tricep skin fold thickness (TSF). The levels of MQSGA, cTnT, SBP, MAP, SBP index, LAD, LVMI, ALB, serum phosphorus, triglycerides (TG) and EF were statistically different between the higher NT-proBNP level group and the lower level group. Multiple stepwise regression analysis demonstrated that lower rGFR (β =-0.389, P＜0.001), higher MQSGA (β=0.470, P＜0.001), increased SBP index (β= 0.287, P＜0.001), and larger LAD (β=0.236, P=0.006) were the independent influential factors for increase of serum lnNT-proBNP. Patients with Kt/V ＞2.0 or total Ccr ＞60L/week had lower serum lnNT-proBNP than those with Kt/V ＜2.0 or total Ccr ＜60L/week. Patients with MQSGA＞8.0 or PEW had higher serum lnNT-proBNP than those with MQSGA <8.0 or non-PEW. Patients with left ventricle hypertrophy (LVH) or cardiovascular disease (CVD) had higher serum lnNT-proBNP than those without LVH or CVD. Conclusions Serum NT-proBNP was markedly elevated in PD patients. Its level correlated with blood pressure, nutritional status, residual renal function, dialysis adequacy, and cardiac function. Higher MQSGA, lower rGFR, increased SBP index, and larger LAD were the independent factors for the elevation of serum NT-proBNP.  Metrics

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Effects of 1α,25-dihydroxyvitamin D3 on IFN-γ of IgA Nephropathy Rats 2014, 13 (10):  722-724.  doi: 10.3969/j.issn.1671-4091.2014.10.011 Abstract ( 211 )   HTML ( 0 )   PDF (370KB) ( 203 )   Objective Explore the mechanism of 1α,25-dihydroxyvitaminD3 regulation on Th1 cells in IgA nephropathy rats. Method The model of 32 IgA nephropathy rats were randomly divided into prednisone treatment group, 1α,25- dihydroxyvitaminD3 treatment group,prednisone + 1α,25- dihydroxyvitaminD3 treatment group and non treatment group.At the same time,we set up the normal control group.24 hours urine protein,serum creatinine value and IFN- γwere measured in each group. Results ①The level of 24-hour urine protein in group A,B,C,D and E, are respectively 7.03±0.99mg/d,51.49±3.04mg/d,12.15±0.75mg/d,23.0± 2.27mg/d and 9.99±0.79mg/d, in which the group A,C,D and E decreased significantly compared with the group B (F=47.778, P<0.05). ②The level of IFN-γin spleen of group A,B,C,D and E are respectively 0.64%± 0.05%,3.63%±0.22%,2.11%±0.13%,1.33%±0.10% and 0.97%±0.17%.The level of IFN-γin Lymph Node of group A,B,C,D and E are respectively 2.13%± 0.42%,17.32%± 0.65%,8.44%± 0.38%,6.39%± 0.57% and 3.01%±0.27%, among the group A,C,D and E decreased significantly compared with the group B(F=479.381，P＜0.05). Conclusion 1α,25-dihydroxyvitaminD3 can reduce the level of urinary protein and IFN-γ in IgA nephropathy rats. Metrics

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Preoperative venography for evaluating upper limb veins in patients before arteriovenous fistula surgery 2014, 13 (10):  733-735.  doi: 10.3969/j.issn.1671-4091.2014.10.014 Abstract ( 216 )   HTML ( 0 )   PDF (336KB) ( 354 )   Objective To study the value of preoperative venographic mapping in patients who require arteriovenous fistulas. Methods From June 2012 to Jan. 2014, venography was performed in 21 uremia cases. Arteriovenous fistula was then created based on the venography image. Vasodilators and anti-platelet therapy were administered postoperatively. Results Arteriovenous fistulas were successfully accomplished in the 21 cases. A total of 36 veins were found to be suitable for arteriovenous fistula. In the 21 cases, 4 forearm arteriovenous fistulas, 8 elbow arteriovenous fistulas, and 9 arteriovenous fistula grafts were created with surgical success rate of 100% and primary patency rate of 100%. Conclusion Venography is a useful tool for venous mapping prior to vascular access surgery. It can identify clinically occult veins usable for hemodialysis access, and is worthy of clinical application. Metrics