Chinese Journal of Blood Purification

12 December 2016, Volume 15 Issue 12 Previous Issue    Next Issue

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Follow-up study of the peri-operative, short-term and medium-term outcomes after coronary artery bypass grafting in patients with dialysis-dependent end-stage renal disease 2016, 15 (12):  656-659.  doi: 10.3969/j.issn.1671-4091.2016.12.002 Abstract ( 315 )   HTML ( 0 )   PDF (411KB) ( 355 )   Objective To follow up the peri-operative, short-term and medium-term outcomes after coronary artery bypass grafting (CABG) and to analyze the relevant influencing factors in patients with dialysisdependent end-stage renal disease (ESRD). Methods The survival rate during perioperative period and after CABG surgery for 1, 3 and 5 years in 26 dialysis-dependent ESRD patients undergoing CABG were retrospectively analyzed. Kaplan-Meier survival curve was used to show survival rate, and Log-rank (Mantel-Cox) test was used for identifying relevant influencing factors. Results Three patients died during perioperative period (mortality 11.5%), and 23 patients discharged from the hospital successfully. The average follow-up time is 2.9±2.4 years. The survival rate is 90% in one year, 76.9% in 2 years after surgery (there is no survival rate in three years after surgery, approximate 2-year survival rate is then used), and 54.7% in 5 years after surgery. Log-rank(Mantel-Cox) test shows that hypertension is the only risk factor for postoperative survival rate (χ2=5.870, P=0.015). Conclusions Perioperative mortality after CABG in dialysis-dependent ESRD patients undergoing CABG is high, and the short and medium term survival rates (1 year, 2 years, 3 years after surgery) are not satisfactory. Hypertension is the only risk factor influencing postoperative survival rate. Metrics

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Prognostic value of average real variability of interdialytic blood pressure in maintenance hemodialysis patients 2016, 15 (12):  660-663.  doi: 10.3969/j.issn.1671-4091.2016.12.003 Abstract ( 324 )   HTML ( 0 )   PDF (475KB) ( 412 )   Objective To evaluate the prognostic value of average real variability (ARV) of interdialytic blood pressure for cardiovascular mortality in patients on maintenance hemodialysis (MHD). Methods A total of 103 MHD patients were enrolled and 44-hour ambulatory blood pressure monitoring was carried out after the second hemodialysis session in a week. Standard deviation (SD), coefficient of variation (CV), and ARV of the interdialytic ambulatory systolic blood pressure in the 44-hour period (44h-SBP) was calculated. Patients were followed up for two years and the relevant indexes were analyzed. Results Kaplan- Meier analysis demonstrated that the survival curves were not significantly different between groups divided by means of the averaged SD (P=0.647) or CV (P=0.098) of 44h-SBP. However, the survival rate was significantly lower in the group with higher ARV of 44h- SBP than in that with lower ARV of 44h- SBP (77.8% vs.98.0%, P=0.002). Multivariate Cox regression demonstrated that ARV of 44h-SBP (HR=1.132, P=0.017) and hs-CRP (HR=1.179, P=0.009) were the independent risk factors for cardiovascular death. Conclusions The ARV of 44h-SBP had a higher prognostic value for cardiovascular death, superior to the averaged SD or CV of 44h-SBP. Metrics

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The optimal timing of continuous venovenous hemofiltration combined with hemoperfusion for the treatment of patients with acute pancreatitis 2016, 15 (12):  664-668.  doi: 10.3969/j.issn.1671-4091.2016.12.004 Abstract ( 284 )   HTML ( 0 )   PDF (471KB) ( 343 )   Objective To investigate the optimal timing of continuous venovenous hemofiltration (CVVH) combined with hemoperfusion (HP) for the treatment of patients with acute pancreatitis (AP). Methods A total of 50 AP patients treated in ICU with the disease conditions not improved after conventional treatment for 48 hours and the presence of secondary organ dysfunction were recruited for this study. They were randomly divided into group A (n=25) and group B (n=25). Group A received CVVH+HP in the presence of one organ dysfunction, and group B received CVVH+HP when dysfunctions of two organs emerged. The disappearance of abdominal pain and the improvement of organ functions (Marshall score increased for at least one score) were the indicators for the discontinuing of CVVH + HP. Changes of physiological parameters, clinical efficacy and prognosis before and after CVVH+ HP were compared between the two groups. Results In group A, the period from onset to the treatment was significantly shorter than that in group B [(69.3±5.4)h vs. (89.4±6.9)h, t=11.446, P=0.000]. APACHE II score had no difference between the two groups before the treatment [(15.7±3.2) vs. (17.4±3.3), χ2=1.893, P=0.064]. The score became decreased after the treatment in both groups [(10.5±1.9) vs. (15.7±3.2), t=10.157, P=0.000 for group A; (13.6±3.9) vs. (17.4±3.3), t=7.192, P=0.000 for group B], and was lower in group A than in group B after the treatment [(10.5±1.9) vs. (13.6±3.9), t=2.388, P=0.024]. The mortality with 28 days was lower in group A than in group B (12.0% vs. 36.0%, χ2=3.947, P=0.047), but the rate of surgical treatment within 28 days had no difference between the two groups (12.0% vs. 32.0%, χ2= 2.914, P=0.088). Compared between groups A and B, length of stay in ICU [(7.8±1.8)d vs. (9.5±2.6)d, t=2.659, P=0.011], duration of mechanical ventilation [(5.6±1.6)d vs. (7.0±2.4)d, t=2.385, P= 0.021] and blood purification [(65.4±14.6)h vs. (78.8±4.7)h, t=4.388, P=0.000] were significantly shorter in group A. After the treatment, oxygenation index (OI) (t=10.715, P=0.000 for group A; t=11.634, P=0.000 for group B), respiratory rate (RR) (t= 11.974, P=0.000 for group A; t=9.721, P=0.001 for group B), blood serum creatinine (Scr) (t=13.910, P=0.000 for group A; t=13.939, P=0.000 for group B) and blood lactic acid (BLA) (t=11.886, P=0.000 for group A; t=9.494, P=0.000 for group B) improved in both groups, and the improvement was more significant in group A than in group B (t=2.388, P=0.024 for OI; t=4.211, P=0.008 for RR; t= 4.823, P=0.006 for Scr; t=4.950, P=0.004 for BLA). The mean arterial pressure (MAP) and heart rate had no differences before and after the treatment in both groups (P＞0.05). Conclusion CVVH+HP is an effective method for the treatment of patients with AP. The treatment should be initiated as soon as possible when conventional treatment fails and dysfunction of one organ appears. Metrics

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Analysis of the influencing factors on quality of life in patients with chronic kidney disease before dialysis 2016, 15 (12):  669-673.  doi: 10.3969/j.issn.1671-4091.2016.12.005 Abstract ( 316 )   HTML ( 0 )   PDF (411KB) ( 334 )   Objective To investigate the effect of family income, gender, age, hemoglobin and disease stage on quality of life in patients with chronic kidney disease (CKD) before dialysis. Methods The quality of life of 150 CKD patients before dialysis in our hospital was evaluated by using the MOS 36- Item Short Form Health Survey (SF-36). Clinical data and laboratory test results were collected. Results The quality of life scores of physiological function (t=2.121, P=0.017), physiological performance (t=2. 321, P=0.041), bodily pain (t=2.412, P=0.025) and mental health (t=2.121, P=0.017) were significantly higher in male pre-dialysis CKD patients than in the female patients. Age ≤47 years patients had higher physiological function scores (t=2.891, P=0.015) and lower social function scores (t=1.981, P=0.021) than age ＞47 patients. Patients with hemoglobin ≤90g/L had lower scores in the field of social function (F=1.432, P=0.015). Stage 4 CKD patients had lower scores of physiological function (F=3.121, P=0.004), bodily pain (F=1.781, P=0.045), vitality (F=1.456, P=0.034) and social function (F=2.651, P=0.021) than stage 1~3 CKD patients. The quality of life decreased significantly in patients with family income less than 2 times of the minimum standard, especially in physiological function (F=3.213, P=0.001), social function (F=2.231, P=0.013), emotional function (F=3.657, P=0.001), and mental health (F=2.476, P=0.012). Conclusion Family income, gender, age, hemoglobin and disease stage are the critical factors influencing quality of life in CKD patients before dialysis. These factors have important values for early assessment and intervention of the quality of life in CKD patients. Metrics

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The catheter-related complications in peritoneal dialysis using different catheters: experience from 820 peritoneal dialysis cases 2016, 15 (12):  674-677.  doi: 10.3969/j.issn.1671-4091.2016.12.006 Abstract ( 371 )   HTML ( 0 )   PDF (835KB) ( 527 )   Objective To seek a suitable type of peritoneal dialysis (PD) catheter by comparing catheterrelated complications in patients used Tenckhoff coiled catheter, swan- neck coiled catheter or swan- neck straight catheter. Methods A total of 820 end- stage renal disease patients with catheterization for maintenance PD in this center from Jan. 2002 to Aug. 2011 were enrolled in this study. The catheter used included Tenckhoff coiled catheter (n=231), swan-neck coiled catheter (n=126) and swan-neck pipe (n=463). Open surgery was used for the placement of the catheters. The incisions located at 2.5cm aside from the center line, 12cm above pubic symphysis for Tenckhoff coiled and swan-neck straight catheters, and 13cm, 15cm or 17cm above pubic symphysis for swan-neck coiled catheter according to the catheterization stage. They were followed up for more than three months, and catheter-related complications were observed. Results In the 820 patients, 490 cases were males and 330 cases were females with the average age of 42.3±14.7 years (13-92 years of age). The primary diseases for PD included chronic glomerulonephritis (n=622), lupus nephritis (n= 52), diabetic nephropathy (n=65), chronic interstitial nephritis (n=22), hypertensive renal damage (n=19), polycystic kidney disease (n=10), and other (n=30). Catheter dislocation was found in 12 cases (5.2%), 19 cases (15.1%) and 9 cases (1.9%) in Tenckhoff coiled, swan-neck coiled, and swan-neck straight catheter groups, respectively (χ2=36.900, P=0.001), and was found in 5 cases, 6 cases and 8 cases in swan-neck coiled catheter group placed the catheters 13cm, 15cm, and 17cm above pubic symphysis respectively (χ2=3.121, P=0.268). In Tenckhoff coiled, swan-neck coiled, and swan-neck straight catheter groups, catheter obstruction was found in 7 cases (3.0%), 6 cases (4.8%), and 9 cases (1.9%) respectively (χ2=3.161, P=0.206), re-catheterization was performed in 6 cases, 10 cases, and 7 cases respectively (χ2=12.255, P=0.002), reset of the dislocated catheters occurred in one case, 6 cases, and 4 cases respectively (χ2=10.364, P=0.006), and tunnel orifice infection occurred in 2 cases in every groups (χ2=3.857, P=0.145). Conclusion The rate of catheter dislocation was lowest in swan-neck straight catheter group, and was highest in swan-neck coiled catheter group. In swan-neck coiled catheter group, the catheter dislocation was relatively difficult to be reset with higher rate of re-catheterization. Metrics

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Coronary arteriosclerosis morbidity and its related risk factors in maintenance hemodialysis patients 2016, 15 (12):  678-681.  doi: 10.3969/j.issn.1671-4091.2016.12.007 Abstract ( 290 )   HTML ( 0 )   PDF (434KB) ( 526 )   Objective To investigate the correlation of nutritional and inflammatory state with coronary arteriosclerosis disease (CAD) in maintenance hemodialysis (MHD) patients. Methods MHD patients treated in Beijing Tongren Hospital for more than 3 months with stable conditions were enrolled in this study. They were divided into CAD group and non-CAD group according to the presence or absence of CAD. General conditions, blood routine and serum biochemical indexes were compared between the two groups using SPSS18.0 software. Results A total of 68 patients (36 males and 32 females; average age 61.3±14.0 years) were recruited, including 19 patents in CAD group (27.94%) and 49 patients in non-CAD group (72.06%). Age (72.21±7.64 vs. 57.04±13.69, t=4.549, P＜0.001), diabetes (63.16% vs. 26.53%, χ2=7.901, P=0.010), serum albumin (33.42±4.22 vs. 36.19±3.38, t=-2.825, P=0.007), serum creatinine (754.05±216.86 vs. 963.06± 240.15, t=-3.305, P=0.002), high sensitive C-reactive protein (11.26±17.05 vs. 4.29±5.23, t=2.588, P=0.013) and neutrophil/lymphocyte ratio (3.65±1.61 vs. 2.72±0.90, t=3.027, P=0.002) differed significantly between the two groups. While gender, serume triglyceride, total cholesterol, low density lipoprotein cholesterol (LDLC) and high density lipoprotein cholesterol (HDL-C) had no differences between the two groups (P＜0.05). Logistic regression indicated that age (OR=1.150, 95% CI 1.042~1.257, P=0.010) and diabetes (OR=9.721, 95% CI 8.006~11.436, P=0.009) independently correlated with CAD in MHD patients. Conclusion In MHD patients, nutritional and inflammatory indices differed significantly in patients with CAD and those without CAD. However, they were not the independent risk factor for CAD, while age and diabetes independently correlated with CAD. Metrics

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CChanges of parathyroid hormone and 25-OH vitamin D3 levels and their related factors in maintenance hemodialysis patients 2016, 15 (12):  682-685.  doi: 10.3969/j.issn.1671-4091.2016.12.008 Abstract ( 413 )   HTML ( 1 )   PDF (412KB) ( 349 )   Objective To analyze the changes of serum intact parathyroid hormone (iPTH) and 25-hydroxyvitamin D3 [25(OH)D3] levels and their related factors in maintenance hemodialysis (MHD) patients with or without diabetes mellitus. Method A total of 180 MHD patients without parathyroidectomy and treated in the period from Jan. to Dec. 2015 in the Blood Purification Center of the First Affiliated Hospital of Nanjing Medical University were enrolled in this study. They were divided into DH group (MHD patients with diabetes) and NDH group (MHD patients without diabetes). Their clinical data, including general information, dialysis age, history of diabetes, and laboratory data were compared between the two groups to analyze the influence factors for serum iPTH and 25(OH)D3 levels in these patients. Results Serum iPTH level was 219.7 (164.1～275.2) pg/ml in DH group significantly lower than the level of 500.39 (398.1～602.7) pg/ml in NDH group (Z=- 4.473, P＜0.001). Similarly, serum 25(OH)D3 level was also lower in DH group than in NDH group (30.9±16.0 pg/ml vs. 45.2±25.1 pg/ml, t=-3.327, P=0.001). Serum iPTH level was negatively correlated with history of diabetes (r=- 0.339, P＜0.001), and positively correlated with dialysis age (r=0.386, P＜0.001), serum phosphatase, (r=0.437, P＜0.001), alkaline phosphatase (r=0.426, P＜0.001) and 25-OH D3 (r=0.254, P=0.016). Multivariate linear regression analysis showed that history of diabetes (βa=-0.173, P=0.012) and dialysis age (βa=0.147, P=0.028) were the independent factors for iPTH. Serum 25-OH D3 level was negatively correlated with history of diabetes (r=-0.296, P=0.004), and positively correlated with dialysis age (r= 0.228, P=0.030), serum phosphatase (r=0.237, P=0.023), serum magnesium (r=0.286, P=0.007), serum albumin (r=0.263, P=0.012) and iPTH (r=0.254, P=0.016). Multivariate linear regression analysis showed that history of diabetes (βa=-0.317, P=0.004) was the independent factor for 25-OH D3. Conclusion The levels of iPTH and 25-OH D3 were significantly lower in NH group than in NDH group. History of diabetes was the independent factor for iPTH and 25-OH D3. Metrics

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Observational study of segmented citrate anticoagulation in high flux hemodialysis with calcium-containing dialysate 2016, 15 (12):  686-690.  doi: 10.3969/j.issn.1671-4091.2016.12.009 Abstract ( 409 )   HTML ( 1 )   PDF (396KB) ( 574 )   Target To observe the safety and efficacy of segmented citrate anticoagulation (SCA) in high flux hemodialysis (HFHD) with calcium-containing dialysate. Methods The maintenance hemodialysis patients with high risk of bleeding were treated by SCA-HFHD. Clinical parameters were observed regularly during the treatment, including blood pressure, pulse, dialysis parameters, and blood ionized calcium levels (Ca2 + ) at different points in the dialysis pipeline. The urine reduction ratio (URR) and Kt/V were calculated, and the coagulation situation in dialyzers and tubes were recorded. The above parameters were compared between sessions with and without coagulation. Results A total of 133 SCA-HFHD sessions in 19 patients were studied. The mean effective blood volume was 205.8±22.5 ml/min, mean dialysate volume was 370.7± 105.0 ml/min, and mean volume of 4% trisodium citrate was 314.6±14.2 ml/h before dialyzer and 53.5±6.3 ml/h after dialyzer. The mean blood Ca2+ level was 0.76±0.16 mol/L at inlet point of blood line and 0.45±0.14 mmol/L at outlet point of blood line. The mean URR was 65.9%±9.8% and Kt/V was 1.38±0.31 in a session. Hemoglobin levels before and after SCA-HFHD treatments were stable (94.8±13.8 g/L vs. 94.3±12.0 g/L, t= 0.481, P=0.639). There were 80 sessions (60.2%) without coagulation. Venous pressures were significantly lower in sessions without coagulation than in sessions with coagulation (72.0 ± 37.7 mmHg vs. 91.1 ± 31.5 mmHg, t=-3.055, P=0.003). Conclusion SCA-HFHD is a safe and effective treatment for patients with high risk of bleeding. Metrics

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The relationship between transforming growth factor-β1 and intimal hyperplasia in autologous arteriovenous fistula 2016, 15 (12):  691-693.  doi: 10.3969/j.issn.1671-4091.2016.12.010 Abstract ( 317 )   HTML ( 0 )   PDF (1288KB) ( 413 )   Objective To investigate the relationship between TGF- β1 and intimal hyperplasia in the dysfunction of autologous arteriovenous fistula (AVF). Methods We collected clinical data of 21 uremia patients. The hyperplasia group included 11 cases with AVF failure, and the control group included 10 cases before AVF surgery. For patients in hyperplasia group, a segment of non-functional hyperplastic vein as a sample and a piece of branch vein (not hyperplasia by naked eyes) as a self-control were taken during AVF neoplasty. For patients in control group, we took a segment of vein as controls during AVF surgery. Immunohistochemistry was used to observe intravascular TGF-β1 expression level in the vein samples. Results TGF-β1 mainly located in cytoplasm, and expressed highly in hyperplasia veins and weakly in veins of self-controls and control group. The expression of TGF-β1 in hyperplasia veins was higher than that in veins of self-controls and control group (P＜0.01), but without significant difference between veins of self-controls and control group (P>0.05). Conclusion The high expression of TGF-β1 in hyperplasia veins may correlate with the intimal hyperplasia in AVF. Inhibition of TGF-β1 in local veins may beome a measure for the treatment of AVF dysfunction. Metrics

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Recent advances in blood purification for the treatment of multiple myeloma nephropathy 2016, 15 (12):  694-696.  doi: 10.3969/j.issn.1671-4091.2016.12.011 Abstract ( 388 )   HTML ( 2 )   PDF (331KB) ( 409 )   Multiple myeloma (MM) is a hematological malignancy. The acute kidney injury associated with MM is a cast nephropathy due to the increase of free monoclonal light chains (FLC) in plasma. Early and effective reduction of FLC by hemopurification can promote the recovery from kidney injury and improve the outcome in most patients. Here we review the current situation of hemopurification for MM nephropathy, in order to find an effective hemopurification therapy for acute kidney injury in MM. Metrics

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Periodic examinations using vascular ultrasound for the early detection of arteriovenous fistula stenosis 2016, 15 (12):  697-700.  doi: 10.3969/j.issn.1671-4091.2016.12.012 Abstract ( 322 )   HTML ( 0 )   PDF (425KB) ( 387 )   Objective To investigate periodic vascular ultrasound examinations for the early detection of stenosis in arteriovenous fistula (AVF) in hemodialysis patients. Methods The hemodialysis patients with AVF and treated in the Hemodialysis Center of Daping Hospital during the period from Jan. 2010 to Dec. 2015 were enrolled in this study. They were divided into group A (patients treated during Jan. 2010 to Dec. 2012 and without periodic vascular ultrasound examinations) and group B (patients treated during Jan. 2013 to Dec. 2015 and with periodic vascular ultrasound examinations). AVF stenosis rate, stenosis degree at the first examination, AVF stenosis derived occlusion and thrombosis within the two years after AVF surgery were retrospectively analyzed. In addition, AVF stenosis degree in group B was also reviewed. Results AVF stenosis was found in 8 cases (5.8%) in group A (n=154), and in 27 cases (15.2%) in group B (n=178) (χ2=6.491, P= 0.010). At the first examination, slight, mild and severe AVF stenoses were detected in 0, 1, and 8 cases respectively in group A, and in 25, 2, and 0 cases respectively in group B, with statistical significance in cases of mild and severe stenoses between the two groups (χ2=21.419, P＜0.001; χ2=6.985, P＜0.001). AVF occlusion and thrombosis in AVF were found in 6 and 9 cases respectively in group A, and in 1 and 2 cases respectively in group B (χ2=3.233, P=0.046 for AVF occlusion; χ2=4.364, P=0.037 for thrombosis in AVF). Percutaneous transluminal angiography to treat AVF stenosis was performed for 3 cases in group A and for 5 cases in group B. AVF must be re-constructed for 6 cases in group A. In contrast, intervention of the stenoses was not needed in 22 cases in group B. In group B, all of the stenoses were of type I stenoses, with the stenosis length of 1mm in 14 cases and 2 mm in 2 cases; the distance between stenosis and AVF orifice was <5cm in 14 cases, and the distance between stenosis and puncture site was 5- 8cm in 13 cases. Conclusion Periodic examination for AVF function by vascular ultrasound can early detect AVF stenosis and its location and range in hemodialysis patients, useful for the early intervention of AVF stenosis and the extension of AVF life. Metrics

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A survey of end- stage renal disease patients with maintenance hemodialysis in Xiangtan district 2016, 15 (12):  701-704.  doi: 10.3969/j.issn.1671-4091.2016.12.013 Abstract ( 321 )   HTML ( 1 )   PDF (382KB) ( 483 )   Objective To investigate etiology, age distribution, complication management, blood- borne diseases, and medical burden of end- stage renal disease (ESRD) patients on maintenance hemodialysis (MHD) in Xiangtan district. Methods A total of 1,166 patients were recruited in the period of Nov. to Dec. 2014 from 9 dialysis centers in Xiangtan district. Questionnaire information, medical records, laboratory tests, case information (including basic patient information, primary renal disease, complications, comorbidities, hemodialysis modalities, medication, pre- dialysis blood pressure, hemoglobin, phosphorus, calcium, serum intact parathyroid hormone, blood-borne diseases, medical expenses, medical insurance,etc) were collected, and then a descriptive study was performed. Results In the 1,166 MHD patients, the male to female ratio was 1.3:1, the average age was 54.4 ± 13.2 years, and the median dialysis age was 2.0 years (3 months-20 years). The top 5 primary diseases were chronic glomerulonephritis (n=487, 41.8% ), diabetic nephropathy (n=279, 23.9%), hypertensive nephropathy (n=260, 22.3%), obstructive nephropathy (n=51, 4.4%), and polycystic kidney disease (n=33,2.8%). The proportion of newly diagnosed diabetic nephropathy in the recent 2 years was 29.7%. Patients spent 6-10 hours/week for dialysis in 54.2% patients and ≥10 hours/week in 38.2% patients. The required levels achieved in 35.8% patients for blood pressure, 41.4% patients for hemoglobin, 30.1% patients for serum phosphorus, 58.3% patients for serum calcium, and 46.8% patients for intact parathyroid hormone (iPTH). The main cause for death in MHD patients was cardiovascular events (42.4%), followed by infections (21.6%), and cerebrovascular events (12.9%). The average medical expense was 4,746.1±1,094.1 yuan/ month. Medical expenses could be covered by rural cooperative medical insurance (48.2%) or medical insurance for employees (40.6%), and only 1.3% patients needed to pay the expenses by themselves. Hepatitis B infection was found in 6.69% patients, hepatitis C in 3.52% patients, and syphilis in 1.03% patients. After hemodialysis, two patients turned to be hepatitis C positive, but none became hepatitis B or syphilis positive. Conclusion The main primary disease for MHD in Xiangtan district was chronic glomerulonephritis, followed by diabetic nephropathy and hypertensive nephropathy. Dialysis began at 36-59 years of age, and the dialysis time was 6-10 hours/week. The ratio of patients achieved the required levels for blood pressure, hemoglobin, phosphorous, calcium and iPTH were still low. Patient compliance and standardization of dialysis need to be improved further. The rate of blood-borne diseases caused by hemodialysis was low, indicating the effectiveness of infection control in dialysis. Metrics