Chinese Journal of Blood Purification

12 March 2015, Volume 14 Issue 03 Previous Issue    Next Issue

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Appropriate transferrin saturation is beneficial for continuous achievement of targeted hemoglobin level in hemodialysis patients 2015, 14 (03):  141-144.  doi: 10.3969/j.issn.1671-4091.2015.03.00 Abstract ( 400 )   HTML ( 3 )   PDF (361KB) ( 614 )   【Abstract】 Objective To study the relationship between transferrin saturation and the achievement of targeted hemoglobin level in hemodialysis patients. Methods One hundred thirteen hemodialysis patients (mean age 63±13 years; 62 males and 51 females) were treated in the dialysis center in Jan. 2011, and were followed up until July 2011. Their hemoglobin was measured every month, and their serum iron, ferrtin and total iron-binding capacity were examined every three months. The targeted hemoglobin level was set at 110-125 g/l. Patients were classified based on their hemoglobin level in the 6 months into two groups: continuous achievement of targeted hemoglobin group and discontinuous achievement of targeted hemoglobin group. Results Nineteen patients were in the continuous achievement of targeted hemoglobin group and ninety-four patients in the discontinuous achievement of targeted hemoglobin group. The variation of hemoglobin level was significantly lower and the transferin saturation was significantly higher in continuous achievement of targeted hemoglobin group than in discontinuous achievement of targeted hemoglobin group. Serum albumin, iron, ferrtin, total iron-binding capacity, intact PTH, pre-dialysis calcium and phosphate, and dialysis adequacy were statistically indifferent between the two groups. Conclusions Appropriate transferrin saturation (mean=32.8%) is beneficial for continuous achievement of targeted hemoglobin level in hemodialysis patients Metrics

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The correlation between 25-hydroxy vitamin D deficiency and anemia in a cohort of hemodialysis patients 2015, 14 (03):  145-147.  doi: 10.3969/j.issn.1671-4091.2015.03.00 Abstract ( 159 )   HTML ( 0 )   PDF (337KB) ( 346 )   【Abstract】 Objective To determine the correlation between 25-hydroxy vitamin D (25(OH) D) deficiency and anemia in a cohort of hemodialysis (HD) patients. Methods In this cross-sectional study, we assessed the levels of 25(OH) D, hemoglobin (Hb) and C-reactive protein (CRP) in 116 HD patients in a dialysis center (Kidney Disease Center, Shanghai Changhai Hospital). Patients were classified into three groups according to the level of 25(OH)D: ＜5 ng/ml (n=32), >5 and 15 and ＜30 ng/ml. We compared hemoglobin and CRP levels among the three groups. Results In the HD patients, hemoglobin was positively correlated with 25(OH)D (r=0.367, P＜0.01) in a linear fashion, meanwhile CRP was negatively correlated with 25(OH)D (r=-3.123, P＜0.01). Conclusion The evidence that 25(OH)D deficiency was independently associated with the lower hemoglobin level in HD patients may have clinical significance. Metrics

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Hemoglobin measurement frequency on the detection of hemoglobin variation and the correlation between hemoglobin variation and mortality in maintenance hemodialysis patients 2015, 14 (03):  148-151.  doi: 10.3969/j.issn.1671-4091.2015.03.00 Abstract ( 176 )   HTML ( 0 )   PDF (355KB) ( 327 )   【Abstract】 Objective To investigate the hemoglobin (Hb) measurement frequency on the detection of Hb variation, and the correlation between Hb variation and mortality in maintenance hemodialysis (MHD) patients. Methods Maintenance hemodialysis patients treated in the Department of Nephrology, Shanghai Ruijin Hospital from Jan. 1st, 2011 were followed up. Hb measurement was performed once every 2 months from Jan. 2011 to Dec. 2012, and once every month from Jan. 2013 to July. 2014. Hb measurement frequency on the detection of Hb variation in these patients was then evaluated. Hb variation was described by residual standard deviation (Res-SD), fluctuation across threshold of the Hb level, and Hb variation amplitude. In the retrospective study, we analyzed Hb variation in MHD patients treated in the period from Jan. 2013 to June 2013, as well as the correlation between Hb variation and mortality using cardiovascular events and all-cause death as the study endpoints. Results Hb variation was higher in the patients with Hb measurement once every 2 months than in those with Hb measurement once every month (P＜0.05). Hb fluctuated in low amplitude around the lower limit of the targeted Hb level in 56.7% patients with Hb measurement once every 2 months and in 68.7% patients with Hb measurement once every month. Correlation analysis showed that age was the major and statistically significant influencing factor for Hb variation. After exclusion of age factor, the patients with low Hb level had higher mortality rate as compared to those with high amplitude Hb fluctuation (OR=6.186, 95% CI 1.277～29.956, P=0.024). Conclusion The increase of Hb measurement frequency can obviously reduce the possibility of Hb variation. Higher Hb variation was unrelated to mortality. However, mortality increased in MHD patients with low amplitude fluctuation around the lower limit of the targeted Hb level Metrics

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Effect of continuous quality improvement on hemoglobin level in maintenance hemodialysis patients 2015, 14 (03):  152-154.  doi: 10.3969/j.issn.1671-4091.2015.03.00 Abstract ( 132 )   HTML ( 1 )   PDF (571KB) ( 399 )   【Abstract】Objective To explore the effect of continuous quality improvement (CQI) strategy on hemoglobin (Hb) level in maintenance hemodialysis (MHD) patients. Methods A total of 299 MHD patients treated in Hemodialysis Center of Peking University People's Hospital from Jan. 2006 to Dec. 2013 and with complete clinical data were enrolled in this study. The PDCA, a 4-step problem-solving frame work of CQI based on NKF-K/DOQI and KDIGO guidelines, was used for the management of Hb level in MHD patients. Average Hb level, proportion and frequency of patients with targeted Hb level were compared every year. Results In 2006, average Hb was 105.0±18.6 g/L, Hb level reached the target level was 37.5% in 96 MHD patients, and the frequency of Hb level reached the target level was 41.7% in 204 Hb measurements. After the performance of CQI strategy, average Hb increased to 111.1±10.3 g/L in 109 patients (P=0.000) in 2011, Hb level reached the target level was 61.8% in 152 MHD patients (P=0.000) in 2013, and the frequency of Hb level reached the target level was 59.9% in 1147 Hb measurements (P=0.000) in 2013. Conclusions The implementation of CQI strategy resulted in the increase of Hb level in MHD patients and was thus useful for the management of anemia complication in MHD patients. Metrics

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Analysis of risk factor for acute kidney injury after lung transplantation and its prognosis 2015, 14 (03):  155-158.  doi: 10.3969/j.issn.1671-4091.2015.03.00 Abstract ( 234 )   HTML ( 0 )   PDF (358KB) ( 248 )   【Abstract】Objective To determine the incidence, risk factor and outcome of acute kidney injury (AKI) after lung transplantation (LT). Methods Clinical data of adult patients undergone LT were retrospectively analyzed. Acute Kidney Injury Net (AKIN) criteria were applied to define and classify the postoperative AKI. Logistic regression analysis was used to determine the risk factor for AKI. Results Of the 88 patients in the period of investigation, 47 patients (53.4%) presented AKI. The percentage of stage I, stage II, and stage III AKI was 30.7%, 12.5%, and 10.2%, respectively. Three patients with AKI (6.4%) needed renal replacement therapy. Multivariate logistic regression analysis showed that intraoperative blood loss (OR=1.238) and change of mean artery pressure (OR=3.221) were the independent risk factors for stage I AKI. Preoperative proteinuria (OR=3.185), RBC transfusion during operation (OR=1.653), and hypertension (OR=2.285) were the independent risk factors for stage II and stage III AKI. The support of ECOM (OR=0.113) was a protect factor for AKI. Conclusions The incidence of AKI after LT is quite high and the prognosis is poor. We should pay more attention to the potential risk factors for AKI to improve the prognosis of LT patients. Metrics

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Plasma exchange in the treatment of pediatric neurological diseases mediated by immunological abnormalities 2015, 14 (03):  159-162.  doi: 10.3969/j.issn.1671-4091.2015.03.00 Abstract ( 140 )   HTML ( 1 )   PDF (347KB) ( 226 )   【Abstract】 Objective To observe the efficacy and side-effect of plasma exchange (PE) in the treatment of pediatric neurological diseases mediated by immunological abnormalities. Methods We retrospectively analyzed pediatric neurological patients treated with PE in Beijing Children's Hospital Affiliated to Capital Medical University between Jan. 2008 and Dec. 2013. Results Twenty-seven neurological patients mediated by immunological abnormalities and treated with PE were recruited in this study, which included dysimmunological neuropathy (anti-NMDA receptor encephalitis 7 cases, and Hashimoto's encephalitis one case), acute inflammatory demyelinating polyneuropathy (AIDP 7 cases), chronic inflammatory demyelinating neuropathy (CIDP 4 cases), myasthenia gravis (MG 3 cases), and CNS demyelinating diseases (multiple sclerosis 2 cases, acute disseminated encephalomyelitis 2 cases, and neuromyelitis optica one case). A total of 63 PE were performed (2～4 times/case). Nineteen cases improved after PE. The effective rate was 100% (7/7), 100% (4/4), 66.67% (2/3), 50.0% (4/8), and 40.0% (2/5) in AIDP, CIDP, MG, dysimmunological neuropathy, and CNS demyelinating diseases, respectively. Adverse reactions occurred in 7 case-times (12.70%), and were mainly allergic reactions and hypotension. Conclusions PE was effective in pediatric AIDP, MG, and the induction stage of CIDP with better tolerance. PE can be used in the treatment of severe and refractory pediatric neurological diseases mediated by abnormal immunological function. Metrics

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Treatment of recurrent and persistent hyperparathyroidism after total parathyroidectomy and forearm autotransplantation: report of 16 cases from a single center 2015, 14 (03):  163-167.  doi: 10.3969/j.issn.1671-4091.2015.03.00 Abstract ( 192 )   HTML ( 0 )   PDF (611KB) ( 232 )   【Abstract】 Objective To review the efficacy of re-operation, traditional medication therapy, and new vitamin D (VD) analogue combined with phosphate binder on the recurrent and persistent hyperparathyroidism after total parathyroidectomy and forearm autotransplantation (tPTX+AT). Methods The uremic patients with recurrent (13 cases) and persistent (3 cases) hyperparathyroidism after tPTX+AT from May 2013 to May 2014 in our hospital were analyzed. The treatment of these patients included re-operation to excise residual parathyroid gland in neck or forearm autotransplanted gland (group A, 5 cases), traditional medication therapy (group B, 6 cases), and new VD analogue combined with phosphate binder (group C, 5 cases). The effects of the three therapies were compared. Results Serum iPTH decreased significantly in all of the three groups after the treatment (P＜0.05) with the decrease rate and amplitude greater in group C than in group B (P＜0.05); iPTH was unchanged in the 2 cases in group A because of the failure of re-operation. In group A, serum calcium decreased significantly after re-operation (P0.05). In group B, serum calcium and phosphate increased significantly after routine medication therapy (P<0.05). In group C after new VD analogue + phosphate binder therapy, serum calcium increased slightly but was still in the normal range, and changed insignificantly as compared to the level before the therapy (P<0.05); serum phosphate decreased (P<0.05); the four-dimension scores of physiological functions, physical pain, emotional function, and mental health were significantly higher than those in groups A and B (P<0.05). Conclusion The therapy for group C (new VD analogue + phosphate binder) was better than the therapies for group A (re-operation) and B (routine medication) in lowering iPTH, reducing the risks for hypercalcemia and hyperphosphatemia, and improving quality of life in patients with recurrent and persistent hyperparathyroidism after tPTX+AT. Metrics

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The feasibility of EBV-immortalized B cells for study of IgA nephropathy 2015, 14 (03):  173-176.  doi: 10.3969/j.issn.1671-4091.2015.03.00 Abstract ( 145 )   HTML ( 0 )   PDF (608KB) ( 228 )   【Abstract】Objective Increasing evidences indicated that the initial pathogenic factor for IgA nephropathy (IgAN) was the abnormal IgA molecule. IgA molecules are produced from peripheral B-lymphocytes. However, the limited availability of B-lymphocytes greatly hindered the studies in depth on mechanisms in IgAN. Recently, EBV (Epstein-Barr virus)-immortalized B-cells were reported to maintain the characteristic of secreting aberrant glycosylated IgA1 molecules, and were regarded as a useful cell model for studies on mechanisms leading to aberrant IgA1 glycosylation in IgAN. A recent genome-wide association study in IgAN identified a proliferation-inducing ligand (APRIL) as one of IgAN susceptible genes. The objective of this study was to investigate the feasibility of EBV-immortalized B-cells for study of APRIL in IgAN. Methods We established three EBV-immortalized B-cell lines from three individuals with distinct diseases. After treated with different doses of APRIL (1.56-200 ng/ml) for 48 hours, conditioned media from these EBV-immortalized B-cells were collected for detection of IgA level by ELISA. Meanwhile, primary B-lymphocytes isolated from peripheral blood of a healthy control were treated with 25 ng/ml APRIL, and IgA in the conditioned media were also detected. Results APRIL significantly promoted the secretion of IgA in primary B-lymphocytes (294.3±35.7 ng/ml vs. 368.2±36.2 ng/ml, P=0.043), but not in EBV-immortalized B-cells (P value >0.05 was observed in APRIL of 1.56-200 ng/ml). Conclusion Our study identified the different effect on IgA secretion induced by APRIL between primary B-lymphocytes and EBV-immortalized B-cells, suggesting that EBV-immortalized B-cells may not be suitable for the study of APRIL on IgA in IgAN. Metrics

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A research on endotoxin in hemdialysis water and dialysate from 36 hemodialysis centers in Shanghai 2015, 14 (03):  183-185.  Abstract ( 215 )   HTML ( 1 )   PDF (419KB) ( 266 )   【Abstract】 Objective To investigate endotoxin (ET) in hemdialysis water and dialysate used in the hemodialysis centers in Shanghai, and the factors relating to the ET contamination. Methods Specimens of hemdialysis water and dialysate were collected from 36 hemodialysis centers in Shanghai during Nov. 2010 to Oct. 2012. ET contamination in hemdialysis water and dialysate were evaluated. Results (a) Of the 4438 samples obtained, 3790 (85.40%) contained ET＜0.1 EU/ml, 482 (10.86%) samples contained ET 0.1-0.5 EU/ml, and 166 (3.75%) contained ET＞0.5EU/ml. (b) In the 36 hemodialysis centers, 14 centers used double osmosis water treatment system and 22 centers used single osmosis water treatment system. In water samples from single osmosis system and double osmosis system, ET <0.1 EU/ml was found in 76.93% and 90.32% samples, respectively, and ET 0.1-0.5 EU/ml was detected in 15.48% and 6.93% samples, respectively. These differences were statistically significant. (c) The average ET level was significantly higher in August than in other months of the year. Conclusion The quality of hemdialysis water and dialysate was consistent with the national standards in most hemodialysis centers in Shanghai. Double osmosis system is better than single osmosis systems in treatment of water for hemodialysis. Seasonal influence also determined ET contamination in hemodialysis water. Metrics

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Quality control circle in reducing the dynamic application of arteriovenous internal fistula puncture complications in 2015, 14 (03):  189-191.  Abstract ( 189 )   HTML ( 0 )   PDF (521KB) ( 350 )   Objective: to investigate the application effect of quality control circle (QCC) activity in reducing complications of arteriovenous fistula puncture .Methods: Established QCC activity groups, selected "Reducing arteriovenous fistula puncture complications" as the theme, to survey the times of complications in 10000 times arteriovenous fistula puncture operation in dialysis patients from February 1, 2014 to March 31,2014 in our blood purification department. We set the target , analyze causes of complication , finally , take measures to improve. Results: through this improvement, the incidence of complications of arteriovenous fistula puncture per ten thousand decline from (540/10000) 5.4% to (230/10000) 2.3%. Compared to before QCC, retreat pin times (166 vs 61), inferior blood flow times (128 vs 48), bleeding times (135 vs47) after QCC show significant difference (P<0.05).Circle members show significant improvements in teamwork, communication skills, professional competence, responsibility, problem-solving skills, self-confidence , ability to use quality control circles and work enthusiasm. Conclusion: QCC can not only reduce incidence of complications of arteriovenous fistula puncture, but also improve the management level of QCC members and individual overall quality. Metrics