Chinese Journal of Blood Purification

12 February 2016, Volume 15 Issue 02 Previous Issue    Next Issue

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The correlation between the changes of serum NT-proBNP after hemodialysis and the body fluid distribution evaluated by whole-body bioimpedance spectroscopy in maintenance hemodialysis patients 2016, 15 (02):  68-71.  doi: 10.3969/j.issn.1671-4091.2016.02.003 Abstract ( 206 )   HTML ( 0 )   PDF (361KB) ( 357 )   Objective To evaluate the significance of N- terminal pro- brain natriuretic peptide (NTproBNP) changes after a hemodialysis session in the assessment of body fluid distribution by comparing these changes with the values from whole-body bioimpedance spectroscopy in maintenance hemodialysis (MHD)patients. Method Whole-body bioimpedance spectroscopy and serum NT-proBNP were measured before and after hemodialysis sessions in 84 MHD patients. Body fluid content and distribution calculated from whole- body bioimpedance spectroscopy and the changes of NT- proBNP were compared in these patients. Results Before hemodialysis, serum NT- proBNP was insignificantly correlated with total body water (TBW), extracellular water (ECW), intracellular water (ICW) and ECW/TBW. After hemodialysis, serum NTproBNP was positively correlated with ECW/TBW (r=0.251, P=0.025), and negatively correlated with ICW (r=-2.333, P=0.037). Correlation analyses also demonstrated that the changes of serum NT-proBNP after hemodialysis were negatively correlated with ECW (r=-0.235, P=0.036), ECW/TBW (r=-0.252, P=0.024) and ECW/ICW (r=-0.228, P=0.042), but had no correlations with TBW (r = -0.121, P = 0.284) and ICW (r = 0.018, P = 0.871). Conclusion The changes of serum NT-proBNP after hemodialysis were comparable with the changes of water distribution after hemodialysis, which may provide a new approach for the evaluation of volume overload in MHD patients. Metrics

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Effect of different combinations of blood purification technologies on mineral and bone disorder in maintenance hemodialysis patients 2016, 15 (02):  72-76.  doi: 10.3969/j.issn.1671-4091.2016.02.004 Abstract ( 271 )   HTML ( 4 )   PDF (422KB) ( 286 )   Objective To investigate the effects of different combinations of blood purification technologies on mineral and bone disorder (MBD) in maintenance hemodialysis (MHD) patients through observing their bone metabolism and prevalence of osteoporosis. Methods Ninety MHD patients with chronic kidney disease (CKD) and MBD were randomly divided into three groups, HD group (hemodialysis, control group, n=30), HD+HDF group (HD and hemodiafiltration group, n=30), and HD+HP group (HD and hemoperfusion, n=30). After the treatment for six months, the changes of serum calcium (Ca), phosphorus (P), intact parathyroid hormone (iPTH), β-type I collagen carboxy-terminal peptide (β-CTX), type I procollagen amino-terminal peptide (PINP), fibroblast growth factor 23 (FGF-23), and prevalence of osteoporosis were compared in the groups and among the 3 groups to evaluate the effects of different combinations of dialysis methods on MHD patients with MBD. Results After the treatment for 6 months, serum P increased in HD group (2.64±1.04 vs. 2.21±0.55 mmol/l, t=2.047, P= 0.049 for serum P; 452.1±43.00 vs. 427.7±44.00 pg/ml, t=2.140, P=0.038 for iPTH); iPTH decreased in HD+HDF group (431.0±37.39 vs. 465.3±43.02 pg/ml, t=3.298, P=0.007); iPTH, β- CTX, PINP, and FGF-23 decreased in HD+HP group (389.1±29.89 vs. 457.4±60.01 pg/ml, t=5.598, P=0.0006 for iPTH; 2.13±1.51 vs. 2.73±1.16 ng/ml, t=2.278, P=0.031 for β-CTX; 140.76±36.13 vs. 157.92±31.16 ng/ ml, t=2.106, P=0.047 for PINP; 397.30±63.18 vs. 461.16±101.69 ng/ml, t=2.922, P=0.011 for FGF-23). After the treatment for 6 months, PINP was lower in HD+HDF group than in HD group (147.33±40.72 vs. 165.32± 43.11 ng/ml, t=1.969, P =0.048); FGF-23, serum P, β-CTX, PINP and iPTH were lower in HD+HP group than in HD group (397.30±63.18 vs. 465.38±101.36 ng/ml t=3.114, P=0.003 for FGF-23; 2.02±0.81 vs. 2.64±1.04 mmol/l, t=3.221, P=0.003 for serum P; 2.13±1.51 vs. 2.95±1.28 ng/ml, t=2.278, P=0.031 for β-CTX; 140.76± 36.13 vs. 165.32±43.11 ng/ml, t=2.339, P=0.028 for PINP; 389.1±29.89 vs. 452.1±43.0 pg/ml, t=6.661, P= 0.005 for iPTH); iPTH was lower in HD+HP group than in HD+HDF group (389.1±29.89 vs. 431.0±37.39 ng/ ml, t=7.303, P=0.000). After the treatments for 6 months, the cases of osteoporosis and bone mass reduction were increased in HD group and were decreased in HD+HDF group and HD+HP group but without statistical significances. Comparison The combined use of different hemodialysis methods has different effects on MBD in MHD patients. HD+HDF and HD+HP are better than HD, and HD+HP is the best for the improvement of MBD. Metrics

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Effect of hemoperfusion on the clearance of protein-bound uremic toxins in maintenance hemodialysis patients 2016, 15 (02):  77-81.  doi: 10.3969/j.issn.1671-4091.2016.02.005 Abstract ( 311 )   HTML ( 1 )   PDF (403KB) ( 406 )   Objective To observe the clearance of protein-bound uremic toxins in maintenance hemodialysis (MHD) patients by combination of hemodialysis (HD) and hemoperfusion (HP). Methods A total of 60 MHD patients were randomly divided into 2 groups: HD+HP group (low-flux hemodialysis two times a week and the combined treatment of HD and HP once a week, n=30) and HD group (low-flux hemodialysis three times a week, n=30). High performance liquid chromatography tandem mass spectrometry (HPLC-MS/ MS) method was used to determine the serum concentrations of hippuric acid (HA), indoxyl sulfate (IS), pcresyl sulphate (PCS), and 3-carboxyl-4-methyl-5-2-methyl propyl furfuryl propionate (CMPF) before and after treatment, and the clearance rates of these toxins were calculated. These toxins were also determined in dialysate in HD group and in hemoperfusion apparatus in HD+HP group. Results After the treatment, serum HA decreased from 31.68±19.41mg/L to 11.63±9.48mg/L (t=6.652, P=0.000) in HD group, and from 32.34± 25.60mg/L to 12.60±8.42mg/L (t=6.114, P=0.000) in HD+HP group, with the HA clearance rate of 62.21± 10.01% in HD+HP group and 57.03±18.79% in HD group (t=-1.155, P=0.025). Serum PCS decreased from 28.87±10.51mg/L to 19.05±7.50mg/L (t=8.175, P=0.000) in HD group, and from 31.04±18.93mg/L to 15.61± 10.85mg/L (t=7.738, P=0.000) in HP+HD group, with the PCS clearance rate of 49.92±10.42% in HD+HP group and 34.13±10.13% in HD group (t=-5.302, P=0.003). Serum IS decreased from 31.96±16.30mg/L to 19.98±11.97mg/L (t=8.175, P=0.000) in HD group and from 32.89±16.66mg/L to 16.72±8.02mg/L (t=7.864, P=0.000) in HP+HD group, with the IS clearance rate of 47.67±11.37% in HD+HP group and 37.58±15.13% in HD group (t = -2.754, P = 0.008). Serum CMPF was unchanged in HD group (26.86 ± 19.93mg/L before HD and 28.97±14.40mg/L after HD; t=-2.013, P＞0.05), but decreased from 23.03±18.33mg/L to 11.79±12.07mg/L (t=5.324, P= 0.001) in HP+HD group, with the CMPF clearance rate of -4.79±23.44% in HD group and31.18±11.79% in HD+HP group (t=-3.384, P=0.002). The total solute clearance of HA, PCS, IS, and CMPF were 93.05 ± 61.87mg, 30.57 ± 10.93mg, 27.18 ± 15.55mg, and 0mg, respectively, in HD group, and were 126.14 ± 76.61 mg, 74.95±28.67mg, 82.36±26.96mg and 10.96±6.70mg, respectively, in HD+HP group, higher in HD+HP group than in HD group (P＜0.01). Conclusion HD + HP is better than HD in clearance of proteinbound uremic toxins. Metrics

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The effect of gremlin content in peritoneal dialysate effluent on peritoneal function 2016, 15 (02):  82-85.  doi: 10.3969/j.issn.1671-4091.2016.02.006 Abstract ( 266 )   HTML ( 0 )   PDF (396KB) ( 270 )   Objective To investigate the gremlin level in peritoneal dialysate effluent and its influence on peritoneal function. Methods A total of 78 cases of continuous ambulatory peritoneal dialysis (CAPD) patients treated in the First Affiliated Hospital of Xinxiang Medical College from Jan. 2010 to Jan. 2015 were enrolled in this study. Gremlin and TGF-β1 in peritoneal dialysate effluent were measured by ELISA, and peritoneal function was assessed by peritoneal equilibrium test. The relationship between gremlin level and peritoneal function was then evaluated. Results ① With the extension of dialysis, peritoneal equilibrium test showed that the proportion of low transport and low average transport were gradually reduced, and some patients transformed into high transport or high average transport. Compared to the baselines, the χ2 values for the peritoneal equilibrium test ratios in the follow- up of 3 years, 4 years, 5 years were 12.219, 9.154 and 10.707, respectively, with the P values of 0.007, 0.027 and 0.013, respectively, indicating that peritoneal solute transport function gradually enhanced. ②In initial stage of peritoneal dialysis (CAPD for one month), gremlin and TGF-β1 in the peritoneal dialysate effluent were 3.54 ± 2.51pg/mL and 4.04 ± 2.58pg/mL, respectively. With the extension of dialysis, gremlin and TGF-β1 levels increased gradually and reached 232.71±55.01pg/mL and 367.25 ± 182.34pg/mL, respectively, in the follow- up of 5 years. The values at the follow- up period of 6 months, one year, 2 years, 3 years, 4 years and 5 years were statistically different from those at the baseline condition (P=0.000). ③Gremlin and TGF-β1 levels in peritoneal dialysate effluent were positively correlated with duration of dialysis, with the correlation coefficient of 0.744 and 0.873, respectively. Conclusions Gremlin may be involved in the pathogenesis of peritoneal fibrosis, resulting in the changes of peritoneal solute transport function. Intervention of gremlin expression may be useful for inhibiting or reversing peritoneal fibrosis. Metrics

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The immediate influence of heparin locking on systemic coagulation system 2016, 15 (02):  86-90.  doi: 10.3969/j.issn.1671-4091.2016.02.007 Abstract ( 388 )   HTML ( 0 )   PDF (408KB) ( 854 )   Hemodialysis, heparin, activated partial thrombin time, dual lumen catheter, anti-coagulation Metrics

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Effect of Hemoperfusion in the Treatment of Systemic Sclerosis 2016, 15 (02):  91-94.  doi: 10.3969/j.issn.1671-4091.2016.02.008 Abstract ( 300 )   HTML ( 1 )   PDF (413KB) ( 451 )   Objective To investigate the clinical effect of hemoperfusion in treating patients with systemic sclerosis (SSc). Methods A total of 36 patients with SSc at the stage of swelling or sclerosis in our hospital during Feb. 2014 to Jun. 2014 were enrolled in this study. They were randomly divided into two groups: hemoperfusion group (n=19) and conventional group (n=17). The patients in conventional group were treated with prednisone 5～15mg/day, penicillamine 0.25～0.5g/day, and the traditional Chinese medicine of blood circulation activation. The patients in hemoperfusion group were treated with hemoperfusion 2~3 hours, once a week for 4 weeks, in addition to the medications in conventional group. Laboratory indexes including erythrocyte sedimentation rate (ESR), immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA), whole-blood viscosity (BV), plasma viscosity (PV) and index of erythrocyte aggregation (IEA) were compared before and after the treatment in the two groups. Moreover, modified Rodnan skin score and Furst’s internal organs score were also compared between the 2 groups. Results In hemoperfusion group, modified Rodnan skin score, Furst’s internal organs score, ESR, IgG, BV, PV and IEA were lower than the scores before the treatment, as well as the scores after the treatment in conventional group (P＜0.05). However, IgM value was statistically indifferent before and after the treatment in hemoperfusion group. Conclusions Hemoperfusion can improve clinical symptoms and laboratory indexes in patients with SSc. Metrics

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Expression of bone morphogenetic protein- 7 in rats with early diabetic nephropathy 2016, 15 (02):  95-99.  doi: 10.3969/j.issn.1671-4091.2016.02.009 Abstract ( 235 )   HTML ( 0 )   PDF (1455KB) ( 292 )   Objective To investigate the expression of bone morphogenetic protein -7 (BMP-7) in ratearly diabetic nephropathy model for the elucidation of the relationship between BMP-7 and diabetic nephropathy. Methods Forty male SD rats were randomly divided into normal control group, diabetic nephropathy for 4 weeks group, diabetic nephropathy for 8 weeks group, and diabetic nephropathy for 12 weeks group. Streptozotocin 65mg/kg was given intraperitoneally to establish the rat model of type 1 diabetic nephropathy, and citrate buffer was injected for rats in normal control group. Rats were weighed at 4 weeks, 8 weeks and 16 weeks after the injection. Metal metabolic cage was used to collect urine for 24-hour urine protein (24h-UP) and 24 hours urine output. Rats were then sacrificed. Serum creatinine (Scr), blood urea nitrogen (BUN), and glucose (BG) were assayed in a Hitachi 7600 automatic biochemical analyzer, BMP-7 in blood and urine were measured using enzyme-linked immunosorbent assay, and BMP-7 mRNA in kidney was quantified by realtime PCR, and BMP-7 protein in kidney was detected by immunohistochemistry. Results There were statistically differences in body weight (F=18.040, P＜0.001), kidney weight/body mass index (F=70.20, P＜0.01), 24 h urine volume (F=249.6, P＜0.001), blood glucose (F=41.240, P＜0.001), 24h-UP (F=18.980, P＜0.01), Scr (F=12.690, P＜0.01), and BUN (F=14.570, P＜0.001) among the groups of normal control group, diabetic nephropathy for 4 weeks, diabetic nephropathy for 8 weeks, and diabetic nephropathy for 12 weeks. BMP-7 (F=1234.380, P＜0.001), urinary BMP-7 (F=34.510, P＜0.001), renal BMP-7 expression area (F=70.24, P0.01) were also different among the 4 groups. In diabetic nephropathy for 12 weeks group, blood BMP-7 (q=75.185, P＜0.01), urinary BMP- 7 (q=13.389, P＜0.01), BMP- 7 mRNA in kidney (q=8.402, P＜0.01) and BMP- 7 protein in kidney (q=17.902, P＜0.01) were decreased as compared with those in normal control group. Conclusion The expression of BMP-7 gene decreased in type 1 diabetes nephropathy rat model. BMP-7 may be involved in the development of diabetic nephropathy. BMP-7 may become an early diagnostic marker for renal function impairment in diabetes nephropathy. Metrics

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Application of the lock solution containing amikacin sulfate for tunnelled-cuffed indwelling catheters in maintenance hemodialysis patients 2016, 15 (02):  116-118.  doi: 10.3969/j.issn.1671-4091.2016.02.015 Abstract ( 320 )   HTML ( 0 )   PDF (362KB) ( 350 )   Objective To determine whether the lock solution of amikacin sulfate/dalteprin sodium injection can prevent catheter- related complications. Methods This was a randomized, prospective and controlled study. Amikacin sulfate/dalteprin sodium injection was applied into catheter lumen in experimental group (n=20), and dalteprin sodium injection was used as the lock solution in control group (n=20). They all received hemodialysis 3 times a week for 3 months. The incidences of catheter-related complications and other adverse reactions were recorded. Results Catheter- related complications including bacteremia, catheter dysfunction, and thrombosis in catheter were lower in experimental group than in control group (P＜0.05). In experimental group, blood flow, Kt/V, hs-CRP and hemoglobin also improved as compared with those before experiment. There were no other adverse reactions in the two groups. Conclusion The lock solution containing amikacin sulfate/dalteprin sodium injection can effectively reduce catheter-related complications and improve dialysis adequacy. Metrics

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The difference of bone metabolism markers in maintenance hemodialysis patients from central city and countryside of Beijing 2016, 15 (02):  121-123.  doi: 10.3969/j.issn.1671-4091.2016.02.017 Abstract ( 230 )   HTML ( 0 )   PDF (406KB) ( 205 )   Object To investigate the effect of life style and nutrition on bone metabolism in maintenance hemodialysis (MHD) patients from central city and countryside of Beijing. Method Eighty- eight MHD patients living in Beijing area were divided according to their living places into two groups, central city group (n=48) and countryside group (n=40). Serum iPTH, Ca, P, albumin (ALB), total protein (TP), total ironbinding capacity (TIBC), cretinine (Scr), BUN, total cholesterol (TC), and Hb, lymphocyte count (LC), Kt/V, and bone mineral density (BMD) were measured. Result The overall up- and to- standard rates of Ca (60.00% vs. 39.58%, χ2=3.640, P=0.045), P (55.00% vs. 33.33%, χ2=4.175, P=0.034) and iPTH (42.50% vs. 22.92%, χ2=3.857, P=0.041) were better in countryside group than in central city group. The average daily physical activity time was longer in countryside group than in central city group (P<0.05). The morbidity of osteoporosis (15.00% vs. 37.50%, χ2=9.697, P=0.002) and osteopenia (55.00% vs. 54.16%, χ2=4.099, P= 0.040) were lower in countryside group than in central city group (P<0.05). There was a positive correlation between bone density and average daily physical activity time (r=0.502, P=0.000). No significant differences in Kt/V and malnutrition-inflammation score were found between the two groups. Conclusion Appropriate diet and physical activity are essential to maintain a normal bone metabolism in MHD patients. Metrics