Chinese Journal of Blood Purification

12 June 2018, Volume 17 Issue 06 Previous Issue    Next Issue

Select

Recent advances in vascular calcification in chronic kidney disease patients 2018, 17 (06):  361-365.  doi: 10.3969/j.issn.1671-4091.2018.06.001 Abstract ( 923 )   PDF (364KB) ( 1112 )   【Abstract】Chronic kidney disease (CKD) is an important risk factor for cardiovascular disease. Calcification of vascular wall promotes the development of cardiovascular disease. Elevated levels of calcium and phosphorus in CKD patients stimulate the calcification of vascular smooth muscle cell (VSMC). Vascular calcification is a complex process with the balance of calcification promoting factors and inhibitory factors, similar to the process of ossification. In this paper, we reviewed the physiological mechanism of vascular calcification, the in vitro and in vivo research models and the hot topics in the research field of vascular calcification. Metrics

Select

The diagnosis and treatment of bone disease in patients with chronic kidney disease 2018, 17 (06):  366-369.  doi: 10.3969/j.issn.1671-4091.2018.06.002 Abstract ( 825 )   PDF (440KB) ( 789 )   【Abstract】Bone disease was one of the main components of the chronic kidney disease-mineral and bone disorder (CKD-MBD). Early diagnosis and evaluation could be helpful for the prevention and treatment of bone disease. The markers of bone turnover in CKD-MBD, several types of bone diseases (especially osteitis fibrosa cystica, adynamic bone disease, osteoporosis, etc.) would be discussed, and the progresses of the diagnosis and treatment of bone diseases were reviewed in this article. Metrics

Select

The use of active vitamin D and its analogues in chronic kidney disease-mineral and bone disorder 2018, 17 (06):  370-373.  doi: 10.3969/j.issn.1671-4091.2018.06.003 Abstract ( 783 )   PDF (351KB) ( 990 )   【Abstract】Chronic kidney disease-mineral and bone disorder (CKD-MBD) is one of the major complications and one of the major death causes in CKD patients. Currently, the treatment of CKD-MBD mainly includes phosphorus binding agent, active vitamin D and its analogues, calcimimetics and parathyroidectomy. Active vitamin D and its analogues are widely used clinically, which can reduce parathyroid hormone level and alleviate bone damage of osteoporosis and high transport bone disease. However, inappropriate use of these medications may cause hypercalcemia, hyperphosphatemia and aggravation of vascular calcification. This article introduces recent progresses in the treatment of CKD-MBD using active vitamin D and its analogues as well as the renewal of KDIGO guide 2017 for CKD-MBD. Metrics

Select

Investigation of systemic antibiotics therapy combined with blocking dialysis catheters using low concentration of povidone-iodine for the treatment of refractory peritoneal dialysis-related peritonitis 2018, 17 (06):  374-377.  doi: 10.3969/j.issn.1671-4091.2018.06.004 Abstract ( 732 )   PDF (379KB) ( 666 )   【Abstract】Objective To evaluate the effect of systemic antibiotics therapy combined with blocking dialysis catheters with low concentration of povidone-iodine (PVP-I) on refractory peritoneal dialysis (PD)-related peritonitis. Methods We retrospectively analyzed 7 patients with refractory PD-related peritonitis treated in the recent 2 years. Their dialysis catheters were planned to take off according to the latest ISPD recommendations, but they refused to do this. In addition to systemic antibiotics therapy, low concentration of PVP-I (1:1 of PVP-I and normal saline, 10ml) was gradually injected into the external short tube to block the catheter after infusion of 2000ml of peritoneal dialysate. After 30 minutes, the infused dialysate was drained out, and the external short tube was changed. This manipulation performed every other day for 3 times but without change of the external short tube anymore. The systemic antibiotics therapy lasted 14～21 days. Results Bacterial culture for peritoneal dialysate was positive in 6 of the 7 patients (85.71%). The bacteria detected included E. coli 3 cases, Gemella mobillorum one case, staphylococcus aureus one case and staphylococcus epidermidis one case. After the treatment for 4 days, bacterial culture became negative in 5 cases. After the treatment for one week, WBC in peritoneal dialysate [5.64 (2.18, 2.05)×109/L vs. 0.25 (0.20, 0.29)×109/L, Z=-2.666, P=0.008], WBC in blood [10.50 (9.73, 13.82)×109/L vs. 6.82 (5.69, 10.72)×109/L, Z=-2.108, P=0.035], neutrophil percentage [89.90 (77.20, 92.50)% vs. 69.80 (62.10, 85.70)% , Z=- 2.108, P=0.035] and CRP [85.30 (65.22, 105.89)mg/L vs. 34.30 (31.36, 46.65)mg/L, Z=-2.364, P=0.018] decreased significantly. At the end of the treatment, the peritonitis cured and the patients discharged from the hospital in 5 cases, and the catheters had to be taken off in 2 cases. Conclusion Systemic antibiotics therapy combined with low concentrations of PVP-I to block the catheters was effective for the treatment of refractory PD-related peritonitis. This treatment protocol is especially useful for the patients living far from big cities, in underdeveloped areas or unavailable access to hemodialysis. Metrics

Select

Correlation between serum 25-hydroxyvitamin D level and erythropoietin hyporesponsiveness in maintenance hemodialysis patients 2018, 17 (06):  378-382.  doi: 10.3969/j.issn.1671-4091.2018.06.005 Abstract ( 749 )   PDF (355KB) ( 670 )   【Abstract】Objective To investigate the relationship between serum 25- hydroxyvitamin D (25(OH)D) level and erythropoietin (EPO) hyporesponsiveness in maintenance hemodialysis (MHD) patients. Methods A total of 80 MHD patients were recruited and divided into three groups according to serum 25(OH)D level, severe deficiency group (＜5ng/ml, n=14), mild deficiency group (5～15ng/ml, n=38) and normal group (＞15ng/ml, n=28). Gender, age, body mass index (BMI), EPO dose, serum 25(OH)D, hemoglobin (Hb), highsensitivity C reactive protein (hsCRP), urea clearance rate (kt/V), creatinine clearance rate (Ccr) and other biochemical indexes were collected and analyzed. EPO resistance index (ERI) was used for the evaluation of EPO responseness. The difference of ERI and its correlation with serum 25(OH)D level were analyzed among the groups. Results The mean ERI was 13.514IU/(w?kg?g?dl) in all the MHD patients. EPO resistance was found in 15% of the patients. ERI was significantly different among the 3 groups (F=21.212, P＜0.001). Pearson correlation analysis showed that ERI was correlated with 25(OH)D (r=- 0.633, P=0.013), albumin (r=-0.330, P=0.003) and hsCRP (r=0.238, P=0.032). Multivariate logistic regression demonstrated that adjusted age, gender, dialysis vantage, Kt/V, intact parathyroid (iPTH), BMI, hsCRP, serum albumin and 25(0H)D deficiency were the independent factors for EPO hyporesponsiveness (HR: 3.355, 95% CI: 0.136～43.731, P=0.016). Conclusion Serum 25(OH)D deficiency is an independent risk factor for EPO hyporesponsiveness in MHD patients. Metrics

Select

The effects of optimized dietary protein on peritoneal dialysis patients 2018, 17 (06):  383-387.  doi: 10.3969/j.issn.1671-4091.2018.06.006 Abstract ( 598 )   PDF (398KB) ( 656 )   【Abstract】Objective To analyze the effects of optimized dietary protein on nutrition status and related parameters in peritoneal dialysis (PD) patients and to explore the independent factors for high quality protein intake. Methods A retrospective analysis was performed on patients with stable PD for more than one month. Patients were divided into optimized group (n=51) for those with high quality protein intake rate ≥50% and non-optimized group (n=41) for those with high quality protein intake rate ＜50%. Education mode, food diary in 3 days, dietary protein intake (DPI), calorie intake, ratio of egg white protein in total protein intake, serum albumin, hemoglobin, phosphorus, parathyroid hormone and fibroblast growth factor 23 (FGF23) were compared between the two groups. Urea clearance index (Kt/V), total creatinine clearance (Ccr), residual renal function (RRF) and normalized protein catabolic rate (nPCR) were calculated. Results Dietary protein intake (t=3.097, P=0.003), high quality protein intake (t=6.321, P＜0.001), percentage of egg white protein in-take (χ2=80.126, P=0.012), serum albumin (39.54 ± 4.09 vs. 36.08 ± 4.71g/L, t=3.769, P＜0.001), Kt/V (t= 2.500, P=0.014), Ccr (t=2.176, P=0.032), RRF (z=4.093, P=0.043) and ratio of education with intensified We-Chat management (76.47% vs. 26.83%, χ2=22.574, P＜0.001) were higher in optimized group than in non-optimized group. Serum phosphorus (t=0.646, P=0.519), parathyroid hormone and FGF23 (z=1.701, P=0.192) had no statistical differences between the two groups. Multiple regression revealed that high quality protein intake (P=0.001), percentage of egg white protein intake (P=0.033), nPCR (P=0.009), dialysis age (P=0.002), serum albumin (P=0.031) and WeChat management (P＜0.001) were the independent factors for high-quality protein intake rate. Conclusion The conventional education contents of higher ratio of egg protein intake for lower phosphorus intake, communication using WeChart and high quality protein intake ≥50% are useful for the increase of serum albumin and dialysis adequacy, protection of RRF and lower risk of hyperphosphatemia. The independent factors for higher quality protein intake can be used as references for the optimization of dietary protein intake in PD patients. Metrics

Select

The risk factors for coronary artery calcification in maintenance hemodialysis patients 2018, 17 (06):  388-390.  doi: 10.3969/j.issn.1671-4091.2018.06.007 Abstract ( 769 )   PDF (298KB) ( 572 )   【Abstract】Objective The risk factors for coronary artery calcification and cardiovascular death in maintenance hemodialysis (MHD) patients in a hemodialysis center were investigated. Methods The primary event (cardiovascular death) and secondary event (coronary artery calcification) were analyzed in a total of 340 MHD patients who were followed up between June 2008 and June 2017. Cox regression models were used to investigate the risk factors for end events. Results The independent risk factors for coronary artery calcification were dialysis vintage (HR=1.218, 95% CI 0.987～1.586, P＜0.001), serum phosphorus level (HR=1.126, 95% CI 0.092～2.638, P=0.005) and intact parathyroid hormone level (HR=1.112, 95% CI 0.806～1.132, P=0.032). A negative correlation was found between the risk of coronary artery calcification and the administration of non-calcium phosphate binder (HR=0.627, 95% CI 0.223～1.164, P=0.037). The independent risk factors for cardiovascular death were age (HR=1.016, 95% CI 0.935～1.062, P=0.014), dialysis vintage (HR=1.233, 95% CI 0.872～1.418, P＜0.001) and serum phosphorus level (HR=1.146, 95% CI 0.898～2.674, P= 0.007). Hemoglobin level was negatively correlated with the risk of cardiovascular death (HR=0.880, 95% CI0.806～1.203, P=0.033). Conclusion The risk for coronary artery calcification increased in MHD patients with longer dialysis vintage, higher levels of serum phosphorus and intact parathyroid hormone, while decreased in MHD patients using non-calcium phosphate binder. The risk for cardiovascular death increased in MHD patients with older age, longer dialysis vintage, lower hemoglobin and higher serum phosphorus. Metrics

Select

The clinical value of ultrasonography measurement for autologous arteriovenous fistula on the estimation of urea clearance index in hemodialysis patients 2018, 17 (06):  391-396.  doi: 10.3969/j.issn.1671-4091.2018.06.008 Abstract ( 731 )   PDF (450KB) ( 639 )   【Abstract】Objectives To study the measurement of arteriovenous fistula (AVF) by ultrasonography for the estimation of AVF maturation and hemodialysis (HD) adequacy. Methods HD patients with forearm AVF in the 8 HD centers were enrolled into this cross-sectional study. AVFs were measured by ultrasonography to obtain the parameters of diameter (D), systolic peak flow velocity (SPV), end-diastolic flow velocity (EDV) and blood flow volume (BFV) at the sites of end segment of brachial artery (a1), beginning segments of radial artery (a2) and ulnar artery (a3), upper segment of radial artery before anastomotic stoma (a4) and segment of cephalic vein near the blood access suite (a5). Urea clearance index (Kt/V) was measured in one stable HD session in the middle of a week. An AVF with D-a5 ≥0.5cm and BFV-a5＞500ml/min was regarded as a maturated AVF. The adequacy of HD was identified as Kt/V ≥1.2. Logistic regression was done to analyze the parameters affecting maturation of AVF and the rate of compliance with the target Kt/V value. Receiver operating characteristic curve (ROC) was performed to estimate the rate of compliance with the target Kt/V value based on the formula from logistic regression analyses. Patients were then divided into 3 groups according to maturation of AVF and compliance with the target Kt/V value, group one with maturated AVF and compliance with the target Kt/V value, group 2 with maturated AVF and without compliance with the target Kt/V value, and group 3 without maturated AVF but with compliance with the target Kt/V value. The parameters were compared among the three groups. Results A total of 324 patients were enrolled in this study, including 223 patients (68.83%) with maturated AVFs and 310 patients (95.68%) with Kt/V compliant with the target level. The independent correlation parameter for AVF maturation was D-a2 (RR=5.779, OR=0.003, P=0.003). The independent correlation parameters for Kt/V compliant with the target level were body weight (RR=-0.057, OR=1.059, P=0.000), diabetes (RR=0.983, OR=0.374, P=0.035) and D-a5 (RR=6.137, OR=0.002, P=0.000). The area under the curve to estimate the rate of compliance with target Kt/V value based on the formula from logistic regression was 0.849 (P=0.000, 95% CI 0.784～0.914). There were 209 patients (64.5%) in group one, 14 patients (4.3%) in group 2 and 101 patients (31.2%) in group 3. Compared to the other two groups, patients in group 2 had more diabetes patients (78.6% vs. 40.2%, χ2=15.234, P=0.000, compared to group one; 78.6% vs. 35.6%, χ2=84.236, P=0.000, compared to group 3), higher height [(173.64±8.35)cm vs. (167.37±7.86)cm, P=0.003, 95% CI 2.15～10.39, compared to group one; (173.64±8.35)cm vs. (166.10±6.89)cm, P=0.001, 95% CI 3.29～11.80, compared to group 3), heavier weight [(85.04±22.19)kg vs. (66.63±10.72)kg, P=0.000, 95% CI -24.88～11.93, compared to group one; (85.04±22.19)kg vs. (65.31±12.37)kg, P=0.000, 95% CI - 26.41～13.03, compared to group 3), and lower Kt/V [(1.04±0.13) vs. (1.31±0.28), P=0.000, 95% CI 0.12～0.42, compare to group one; (1.04±0.13) vs. (1.29±0.27), P=0.001, 95% CI 0.101～0.406, compared to group 3]. Compared to group one, patients in group 3 had less values of D-a1, D-s2, D-a3 and D-a4 [(0.54± 0.11)cm vs. (0.61±0.13)cm, P=0.000, 95% CI -0.063～0.072 for D-a1; (0.41±0.10)cm vs. (0.48±0.13)cm, P=0.000, 95% CI -0.062～0.016 for D-a2; (0.41±0.09)cm vs. (0.46±0.11)cm, P=0.000, 95% CI -0.071～-0.021 for D- a3; (0.31 ± 0.08)cm vs. (0.35 ± 0.10)cm, P=0.001, 95% CI - 0.062～- 0.016 for D- a4], lower SPV- a1 [(112.01 ± 48.70)cm/s vs. (129.45±48.12)cm/s, P=0.003, 95% CI -28.78~6.097) and lower EDV- a1 (55.34±31.20)cm/s vs. (69.08±43.19)cm/s, P=0.004, 95% CI -23.050～-4.415]. Compared to groups one and 2, patients in group 3 had less value of D-a5 [(0.46±0.15)cm vs. (0.75±0.31)cm, P=0.000, 95% CI -0.349～-0.221, compared to group one; 0.46 ± 0.15cm vs. (0.63 ± 0.26)cm, P=0.037, 95% CI - 0.311～- 0.010, compared to groups 2] and less BFV- a5 [(587.67±413.08)ml/min vs. (2,039.28±1,550.72)ml/min, P=0.000, 95% CI - 1, 762.72~1,140.502, compared to group one; 587.67±413.08ml/min vs. 1,695.37±401.58ml/min, P=0.003, 95% CI -1,839.843～-375.571, compared to group 2]. Conclusion Maturation of AVF can be assessed by ultrasonography measurement. The value of D-a2 is an independent factor for AVF maturation. Logistic formula including D- a5, body weight and diabetes can be used to estimate Kt/V in a HD ssession. There exists unmatched situation between AVF maturation and compliance with target Kt/V value. Metrics

Select

The effects of stricter stenosis intervention threshold and surveillance by Doppler ultrasound on arteriovenous graft (AVG) patency rate 2018, 17 (06):  397-400.  doi: 10.3969/j.issn.1671-4091.2018.06.009 Abstract ( 644 )   PDF (485KB) ( 762 )   【Abstract】Objective To evaluate the secondary patency and outcomes of arteriovenous graft (AVG) when stricter stenosis intervention threshold and surveillance by Doppler ultrasound were used. Method A total of 26 patients with AVG and monitored by Doppler ultrasound between June 2011 and July 2016 were enrolled in this study. They were divided into two groups, conventional intervention group (group A, n=12) and stricter stenosis intervention threshold group (group B, n=14). The intervention indication in group B was stricter than that in group A. AVG secondary patency, thrombosis event, intervention frequency per year, and AVG access outcome were compared between the two groups. Results Clinical characteristics, AVG outcomes and thrombosis events were similar between the two groups. However, intervention frequency per year was lower in group B than group A (0.54±0.34 vs. 0.94±0.42, t=2.720, P=0.017). Meanwhile, the secondary patency was similar between the two groups (P=0.941). The secondary patency rates after 12 months, 24months and 36 months were 100% vs. 100%, 68.2±15.4% vs. 78.6±11.0%, and 51.1±18.7% vs. 61.1±13.8% (log rank test, χ2=0.007, P=0.941) in group A and group B, respectively. Conclusions Under ultrasound surveillance, stricter stenosis intervention threshold gets similar AVG secondary patency and reduces intervention frequency per year. Metrics

Select

A preliminary study on the determination of subcutaneous tunnel length during catheterization in left internal jugular vein under the guidance of digital subtraction angiography 2018, 17 (06):  401-404.  doi: 10.3969/j.issn.1671-4091.2018.06.010 Abstract ( 701 )   PDF (1307KB) ( 589 )   【Abstract】Objective To study the determination method of subcutaneous tunnel length during left internal jugular vein catheterization under the guidance of digital subtraction angiography (DSA). Methods Forty- four maintenance hemodialysis patients were enrolled in this study. In the experimental group (n=22), catheter sheath was indwelled after puncture of left internal jugular vein. The 4F endovascular angiographic catheter was then inserted through the catheter sheath under the guidance of DSA, ensuring that the catheter tip was located in the middle upper part of right atrium. The site of angiographic catheter out of the catheter sheath was labeled on body surface. The angiographic catheter was then withdrawn and the length of the catheter entering the body was measured. Based on this length, subcutaneous tunnel length of the dialysis catheter with cuff was determined. In the control group (n=22), subcutaneous tunnel length of the dialysis catheter with cuff was roughly determined by the osseous marker on body surface. Results In the 22 patients in experimental group, the tips of left internal jugular vein catheters were located in middle or middle upper part of right atrium. The subcutaneous tunnel length was appropriate and no longer or shorter length occurred. In the 22 patients in control group, the tips of the catheters were located in middle or middle upper part of atrium in 14 cases, in inferior atrium in 7 cases and in superior vena cava near atrium in one case. The dialysis blood flow was >250 ml/min in all cases on the day of operation and the second day. Within 6 months after operation, catheter tips moved upward in 3 cases (two females and one male). Catheter tips moved slightly upward in 39 of the 44 cases. The dialysis catheter slipped out and must be replaced in one case in control group. Conclusions The subcutaneous tunnel length during left internal jugular vein catheterization can be accurately determined through insertion of an endovascular angiographic catheter under the guidance of DSA. Most of the tip of dialysis catheter with cuff via left internal jugular vein may move upward slightly after catheterization. Metrics

Select

Application of 6F urinary catheter in the autogenous arteriovenous fistula operation 2018, 17 (06):  405-406.  doi: 10.3969/j.issn.1671-4091.2018.06.011 Abstract ( 734 )   PDF (296KB) ( 605 )   【Abstract】Objective To evaluate the 6F urinary catheter used in the autogenous arteriovenous fistula (AVF) surgery. Methods Patients who used 6F urinary catheter during AVF surgery in the Department of Nephrology, Qianfoshan Hospital Affiliated to Shandong University from October 2016 to March 2017 were recruited. Thirty-eight cases underwent AVF reconstruction (group A), and twenty cases had primary AVF surgery (group B). During primary AVF surgery, the distal end of the cephalic vein was ligated and a 6F urinary catheter was inserted from the venous stump to proximal end and 0.3～0.5 ml of normal saline was injected into the balloon at the tip of the catheter to repeatedly expand the vessel. During AVF reconstruction surgery, a 6F urinary catheter was inserted into the proximal end of the vein, and 0.5～0.8ml of normal saline was injected into the balloon at the tip of the catheter. The normal saline volume may be adjusted according to the venous diameter. Fresh thrombus can be taken out. In case of stenosis, the catheter can be reintroduced into the vein and indwelled in the stenosis site for more than 10 seconds, and the volume of normal saline may be increased. Results In group A, the rate of internal fistula recanalization was 100%. In group B, the diameters of the vessel before and after expansion were significant different (t=3.552, P＜0.001). Conclusion The use of 6F urinary catheter during AVF surgery was convenient and especially effective for the expansion of small veins. The tip balloon of the catheter can be used for dilatation of mild stenosis lesion and also for thrombectomy in some cases. This method is worthwhile to be widely used in clinical practice Metrics

Select

Research progress in star fruit intoxication in chronic renal disease patients 2018, 17 (06):  407-411.  doi: 10.3969/j.issn.1671-4091.2018.06.012 Abstract ( 737 )   PDF (351KB) ( 663 )   【Abstract】Star fruit contains neurotoxins that often cause intoxication with high mortality in chronic renal disease patients. Clinical manifestations of star fruit intoxication include hiccup, nausea, vomiting, limb numbness, consciousness disturbance, seizure and coma. The neurotoxin of star fruit is a liposoluble molecule called caramboxin, which has potent excitatory, convulsant and neurodegenerative properties. Currently, there is no consensus about the optimal strategy against star fruit intoxication. Comprehensive treatment strategy may be necessary and blood purification may be useful. In this paper, we introduce the pathogenesis, clinical manifestations, diagnosis and treatment of star fruit intoxication. Metrics

Select

The important parts to reduce intestinal phosphorus load in CKD patients: phosphate-containing medications and low dietary phosphate/protein ratio 2018, 17 (06):  412-415.  doi: 10.3969/j.issn.1671-4091.2018.06.013 Abstract ( 714 )   PDF (334KB) ( 810 )   【Abstract】Chronic kidney disease-mineral and bone disorder (CKD-MBD) is one of the common complications in patients with chronic kidney disease (CKD), and the control of hyperphosphatemia is the key to the prevention and treatment of CKD- MBD. However, drugs are often overlooked as the potential sources of phosphorus burden in patients with chronic kidney disease. Therefore, the research progresses in phosphate content of drugs, low dietary phosphorus to protein ratio are reviewed in this article. Metrics

Select

Research progress in the relationship between hyperuricemia and chronic kidney disease 2018, 17 (06):  416-419.  doi: 10.3969/j.issn.1671-4091.2018.06.014 Abstract ( 741 )   PDF (377KB) ( 705 )   【Abstract】The relationship between hyperuricemia (HUA) and chronic kidney disease (CKD) has been widely investigated. Current findings tend to conclude that hyperuricemia can be regarded as an“independent and modifiable”risk factor for the deterioration of renal disease. However, the cause-effect relationship cannot be confirmed to date. Many researchers have focused on this issue. This review elaborates the links between HUA and CKD in a rather novel and comprehensive perspective, seeking to retard the progression of CKD by control of uric acid. Metrics

Select

Effect of professional medical cluster for kidney diseases on medial quality in a hemodialysis center 2018, 17 (06):  420-423.  doi: 10.3969/j.issn.1671-4091.2018.06.015 Abstract ( 617 )   PDF (376KB) ( 605 )   【Abstract】Objective To investigate the effect of a professional medical cluster for kidney diseases on medical quality in the hemodialysis center in Beijing East District First People's Hospital. Methods A total of 199 maintenance hemodialysis (MHD) patients treated in the Hemodialysis Center of Beijing East District First People's Hospital from Jan. 1, 2016 to Oct. 31, 2016 were assigned into a group before establishment of the professional medical cluster (pre-medical cluster group). A total of 181 MHD patients treated in the period between Nov. 1, 2016 and Aug. 31, 2017 were enrolled into a group after establishment of the professional medical cluster (post-medical cluster group). Hemodialysis management indicators, adverse events and medical expenses in a period of 10 months were compared between the two groups. Results In the MHD patients treated in the Hemodialysis Center of Beijing East District First People’s Hospital, the rates of satisfaction of target levels were significantly higher in post-medical cluster group than in pre-medical cluster group, which included hemoglobin, serum ferritin, serum potassium and intact parathyroid hormone (70.2% vs. 51.3%, χ2＝14.153, P＜0.001 for hemoglobin; 43.1% vs. 25.1%, χ2＝13.700, P＜0.001 for ferritin; 87.3% vs. 79.4%, χ2＝4.219, P＝0.040 for potassium; 43.6% vs. 25.6%, χ2＝13.673, P＜0.001 for iPTH). Rate of adverse event was significantly lower in post- medical cluster group than in pre- medical cluster group (26.5% vs. 37.2%, χ2＝4.948, P＝0.026). Hospitalization expenses due to adverse events were significantly less in post-medical cluster group than in pre-medical cluster group. Conclusion The professional medical cluster for kidney diseases can improve hemodialysis management indicators, reduce adverse events and hospitalization expenses due to adverse events, and save medical insurance expenses, confirming that this medical cluster is feasible and useful. Metrics

Select

Sodium thiosulfate combined with lanthanum carbonate as a therapy for severe calciphylaxis: report of a case 2018, 17 (06):  430-432.  doi: 10.3969/j.issn.1671-4091.2018.06.018 Abstract ( 1034 )   PDF (1596KB) ( 730 )   【Abstract】Calciphylaxis, also named as uremic arterioles disease, is a rare but life- threatening obliterative vasculopathy occurring in dialysis patients. It is frequently seen in abdomen, breast and extremities. Early lesions can appear as indurations, erythematous papules, nodules, plaques or bullae, finally becoming necrotic foci and painful ulcers with high mortality. In this paper, we report a case with calciphylaxis and severe secondary hyperparathyroidism. We treated this patient with sodium thiosulfate as well as calcium-free phosphate binder (lanthanum carbonate) and her painful skin ulcers improved significantly soon after the treatment. Parathyroidectomy was carried out after several months. Until now, no recurrence of calciphylaxis has been observed and her serum calcium and phosphorous levels remain in normal ranges. This case demonstrates that sodium thiosulfate combined with lanthanum carbonate is an effective therapy for calciphylaxis. Metrics