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Chinese Journal of Blood Purification

Chinese Journal of Blood Purification

    12 April 2021, Volume 20 Issue 04 Previous Issue    Next Issue
    Respiratory dysfunction and rehabilitation in maintenance hemodialysis patients
    2021, 20 (04):  217-220.  doi: 10.3969/j.issn.1671-4091.2021.04.001
    Abstract ( 532 )   PDF (385KB) ( 1066 )  
    【Abstract】The metabolic disorders and dialysis-related factors in maintenance hemodialysis(MHD) patients may result in dysfunction in all aspects of the respiratory process. Respiratory dysfunction reduces quality of life and increases the risk of poor prognosis in MHD patients. Pulmonary rehabilitation can improve patients' exercise endurance and reduce dyspnea. In this paper, we will discuss the pathophysiological mechanisms and rehabilitation treatment of respiratory dysfunction in MHD patients, aiming to provide new insights into the pathophysiology of respiratory dysfunction and improve clinical management of MHD patients.
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    Preliminary clinical study of home hemodialysis in the treatment of Chinese end-stage renal disease patients
    2021, 20 (04):  224-228.  doi: 10.3969/j.issn.1671-4091.2021.04.003
    Abstract ( 471 )   PDF (417KB) ( 1149 )  
    【Abstract】Objective Home hemodialysis (HHD) is one of the most important treatment methods for endstage renal disease (ESRD) in the world. The purpose of this study was to investigate the efficacy and safety of HHD in Chinese ESRD patients, and to provide evidence for HHD treatment in China. Methods The preliminary preparations include the establishment of HHD training center, the formulation of corresponding rules and regulations, management norms, and emergency plans. We selected ESRD patients from our dialysis center. The patients were trained and assessed regularly by specific medical staff and engineers. After passing the examination, patients could go home for HHD independently. A monitoring method that combines realtime Internet monitoring and traditional 24-hour telephone online services is adopted for patients. Full-time medical staff and engineers conduct regular home visits to patients to ensure their safety to the greatest extent. Collect clinical data and biochemical indicators of patients in this process. Results Four patients were included, and they received HHD training and passed the examination. After 15.0 (15.0~18.0) months of training, albumin (Alb), blood phosphorus (P), patients’dialysis adequacy and brain natriuretic peptide (BNP), hemoglobin (Hgb) and parathyroid hormone (PTH) remained stable. The fistula function was monitored by ultrasound. After the patients injected the arteriovenous fistula by themselves, the fistula flow was stable without obvious change. Two adverse events occurred during the treatment. One was that the puncture of the artery tunnel was not smooth. This was solved by reconstructing the artery tunnel and guiding the fistula online. The other was that the chlorine content of tap water increased suddenly, and the technicians solved this by installing activated carbon tank. No treatment- related adverse events were reported during the follow- up period. Conclusion This study preliminarily shown that the development of HHD treatment in China is feasible and safe, but large-scale long-term studies need to be further confirmed.
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    Clinical features and prognosis of the patients with heart failure undergoing continuous renal replacement therapy
    2021, 20 (04):  229-233.  doi: 10.3969/j.issn.1671-4091.2021.04.004
    Abstract ( 288 )   PDF (414KB) ( 782 )  
    【Abstract】Objective To study the clinical characteristics, prognosis and risk factors of patients with heart failure (HF) receiving continuous renal replacement therapy (CRRT). Methods The clinical data of HF patients treated with CRRT in Beijing Anzhen Hospital from January 2008 to December 2019 were recruited. Their clinical characteristics and risk factors for death in hospital were analyzed. Results A total of 85 patients with complete data were enrolled in this study. The overall mortality rate in hospital was 35.3% (30/85), 45.9% (39/85) patients could get rid of CRRT, and 18.8% (16/85) patients were dependent on maintenance dialysis. Logistic regression analysis was performed based on the comparison of death in hospital and survival patients using the factor of P<0.05. The independent risk factor for overall death was ejection fraction (EF) value <40% (OR: 4.610, 95% CI: 1.323～16.058, P=0.016), chronic HF history (OR: 8.448, 95% CI: 2.071～34.464, P=0.003), and CRRT start time (OR: 4.114, 95% CI: 1.224～13.830, P=0.022). The hospital mortality of HF patients with reduced ejection fraction (HFrEF) and HF patients with preserved ejection fraction (HFpEF) was 44.9% (22/49) and 22.2% (8/36), respectively, which was statistically different (F=4.673, P=0.031). Conclusion Early initiation of CRRT may reduce hospital mortality. History of chronic HF, frequent hypotension events during CRRT and the application of vasoactive drugs were the risk factors for mortality in HF patients. The mortality of HFrEF patients receiving CRRT was significantly higher than that of HFpEF patients.
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    Relationship between the levels of urinary microRNA miR-34a and serum uric acid and the renal function and prognosis in continuous ambulatory peritoneal dialysis patients
    2021, 20 (04):  234-238.  doi: 10.3969/j.issn.1671-4091.2021.04.005
    Abstract ( 350 )   PDF (573KB) ( 728 )  
    【Abstract】Objective To explore the relationship between the levels of urinary microRNA-34a (miR-34a) and serum uric acid (UA) and the renal function and prognosis in end stage renal disease (ESRD) patients undergoing continuous ambulatory peritoneal dialysis (CAPD) treatment. Methods A total of 200 cases of ESRD patients undergoing CAPD from January 2016 to October 2017 were assigned as the observation group and they were subdivided into mild, moderate and severe subgroups; a total of 100 volunteers were recruited as the control group. Urinary miR- 34a, serum uric acid, blood urea nitrogen and serum creatinine
    (SCr) were measured, and eGFR was calculated. The weekly urea clearance index (Kt/V) and weekly creatinine clearance rate (CCR) after CAPD for one month were recorded, and residual renal function (RRF) was calculated. The effects of urinary miR-34a and serum UA on prognosis were then explored. Results ①Hemoglobin and serum albumin were significantly higher in the control group than in the observation group (F=94.867 and 44.315 respectively; P＜0.001), and serum phosphorus was significantly lower in the control group than in the observation group (F=17.589, P＜0.001). Hemoglobin and serum albumin were significantly
    decreased and serum phosphorus was significantly increased along with aggravation of the disease (P＜0.05). ②eGFR, Kt/V, CCR and RRF decreased (F=9573.09, 27.499, 240.636 and 1095.17 respectively; P＜0.001), and BUN and SCr increased (F=721.543 and 2170.64 respectively; P＜0.001) along with aggravation of the disease. ③Urinary miR-34a and serum UA were significantly higher in the observation group than in the control group (χ2=49.352 and 341.151 respectively，P＜0.001), and were increased along with aggravation of the disease. ④Urinary miR-34a and serum UA were negatively correlated with eGFR, Kt/V, CCR and RRF (For miR-34a: r=-0.193, -0.147, -0.192 and -0.178 respectively; P=0.001, 0.038, 0.007 and 0.012 respectively. For UA: r=-0.175, -0.201, -0.183 and -0.254 respectively; P=0.002, 0.004, 0.010 and ＜0.001 respectively). Urinary miR-34a and serum UA were positively correlated with BUN and SCr (For miR-34a: r=0.125 and 0.160 respectively; P=0.030 and 0.006 respectively. For UA: r=0.121 and 0.149 respectively; P=0.036 and 0.009 respectively). ⑤The 3-year survival curve was statistically different between patients with higher levels of urinary miR-34a and serum UA and those with lower levels of urinary miR-34a and serum UA (χ2= 4.647 and 9.775 respectively; P=0.031 and 0.002 respectively). Conclusion Urinary miR-34a and serum UA were significantly
    correlated with renal function and RRF. Higher levels of urinary miR-34a and serum UA suggest the unfavorable prognosis in ESRD patients with CAPD.
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    The factors affecting the outcome of acute respiratory distress syndrome patients treated with ECMO combined with CRRT
    2021, 20 (04):  239-243.  doi: 10.3969/j.issn.1671-4091.2021.04.006
    Abstract ( 324 )   PDF (416KB) ( 806 )  
    【Abstract】Objective To evaluate the clinical characteristics and risk factors affecting the outcome of severe acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI) patients treated with extracorporeal membrane oxygenation (ECMO) combined with continuous renal replacement therapy (CRRT). Methods The severe ARDS and AKI patients required ECMO and CRRT and treated in the Intensive Care Unit (ICU) of Tongji Hospital from October 2016 to October 2020 were retrospectively studied. Clinical characteristics of the patients were analyzed. According to the survival situation within 28 days after VV-ECMO treatment, the patients were divided into survival group and death group. We compared the clinical data of the two groups at the time transferred to ICU, before and after VV-ECMO and CRRT treatment. Unconditioned logistic regression analysis was carried out to determine the independent prognostic risk factors. Results Fiftyfour patients were enrolled in the study, of whom 26 patients survived and 28 patients died. Compared with the death group, the sequential organ failure assessment (SOFA) of the survival group was significantly lower (11.8±2.4 vs. 13.7±1.9, t=-2.550, P=0.015), and the ECMO to CRRT interval was significantly shortened (4.7±3.3h vs. 11.4±6.7h, t=-3.024, P=0.005). During treatment processes, the fluid balance at ECMO day 3 in the
    survival group was statistically reduced than death group (373±210ml vs. 987±482ml, t=-4.990, P=0.001). Unconditioned logistic regression analysis showed that the ECMO to CRRT interval, the fluid balance at ECMO day 3, and the SOFA score were the independent risk factors affecting patient prognosis (OR=0.254, 0.302 and 0.467, respectively; 95% CI=0.085～0.656, 0.025～0.498 and 0.217～0.887, respectively; P=0.009, 0.012 and 0.029, respectively). Conclusions The prognosis of severe ARDS and AKI patients required ECMO combined with CRRT depends mainly on the ECMO to CRRT interval, the fluid balance at ECMO day 3 and the SOFA score.
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    The influence of different dialysis membrane composition on bisphenol A exposure in maintenance hemodialysis patients
    2021, 20 (04):  244-247.  doi: 10.3969/j.issn.1671-4091.2021.04.007
    Abstract ( 395 )   PDF (401KB) ( 1109 )  
    【Abstract】Objective To evaluate the exposure of bisphenol A (BPA) and the influence of different dialysis membrane composition on BPA exposure in maintenance hemodialysis (MHD) patients. Methods A total of 66 chronic kidney disease patients with MHD were recruited and randomly divided into group A or group B. Group A was treated with polysulfone (PS) membrane dialyzer, and group B was treated with polyethersulfone (PES) membrane dialyzer for hemodialysis for 3 months. The dialyzer types for the two groups were then exchanged and used for hemodialysis for another 3 months. Fifteen healthy people were selected as the control group. EnzymElinked immunosorbent assay was used to measure serum BPA before and after the first dialysis, 3 months and 6 months after the treatment as well as serum BPA in healthy people for comparison. Results Serum BPA of the two MHD patient groups was significantly higher than that of healthy people (t=9.378, P＜0.001; t=8.784, P＜0.001). In group A after the first hemodialysis, serum BPA was significantly higher than that before hemodialysis (t=2.794, P=0.009); while in group B after the first hemodialysis, serum level did not change significantly as compared with the level before hemodialysis (t=- 0.631, P=0.533). In
    group A after hemodialysis using PS membrane dialyzer for 3 months, serum level did not change significantly as compared with that of the value (t=1.721, P=0.095); after switching to hemodialysis using PES membrane dialyzer for 3 months, serum level decreased significantly as compared with that of the value and the value at the third month of the treatment (t=-4.690, P＜0.001; t=-6.378, P＜0.001). In group B after hemodialysis using PES membrane dialyzer for 3 months, serum level decreased significantly as compared with that of the value (t=-3.604, P=0.001); after switching to hemodialysis using PS membrane dialyzer for 3months, serum level increased significantly as compared with that before 3 months (t=4.412, P＜0.001) and similar to that of the baseline level (t=-0.679, P=0.502). After the treatment for 3 months, serum BPA was statistically different between the two groups (t= 3.367, P=0.002). Correlation analysis showed that serum BPA was positively correlated with dialysis age (r=0.391, P=0.001), body mass index (r=0.355, P=0.003), diabetes (r=0.364, P=0.003), and hyperlipidemia (r=0.405, P=0.001), and negatively correlated with residual urine volume (r=-0.721, P<0.001). Conclusions MHD patients are at the high risk of BPA accumulation, potentially
    causing damage to multiple systems and affecting long- term prognosis. Long-term application of PS membrane dialyzer for hemodialysis increases the accumulation of BPA, while the application of PES membrane dialyzer for hemodialysis decreases this risk.
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    Difference and correlation analysis of serum GDF-15 level in patients with different types of nephropathy
    2021, 20 (04):  248-253.  doi: 10.3969/j.issn.1671-4091.2021.04.008
    Abstract ( 309 )   PDF (672KB) ( 789 )  
    【Abstract】Objective To investigate the serum growth differentiation factor-15 (GDF-15) level in patients with different types of renal diseases and its correlation with renal function. Methods We recruited 122 patients with different types of nephropathy treated in the Department of Nephrology, Shandong Provincial Hospital from December 2019 to August 2020 in this study, and 15 healthy people from physical examination center as the control group. Serum GDF-15 was detected by ELISA. Clinical data and laboratory parameters were collected, and analyzed in association with serum GDF-15 and other factors. Results Serum GDF-15
    was significantly higher in patients with diabetic nephropathy than that in control group (t=6.522, P＜0.001), IgA nephropathy (t=4.322, P=0.004) and lupus nephritis patients (t=3.884, P=0.001). Serum GDF-15 was significantly higher in multiple myeloma patients than in control group (t=5.678, P＜0.001), IgA nephropathy (t=4.532, P=0.004) and lupus nephritis patients (t=4.244, P=0.008). Age (r=0.395, P<0.001), abnormal immunofixation electrophoresis (r=0.251, P=0.003), blood glucose (r=0.205, P= 0.016), CRP (r=0.178, P=0.038), free light chain ratio (r=0.324, P<0.001), and MM (r=0.225, P=0.008) were positively correlated with serum GDF-15 level. Linear regression analysis showed that serum GDF-15 level was significantly associated with age (β= 0.395, P<0.001), elevated CRP (β=0.175, P=0.040), MM (β=0.192, P=0.025), abnormal immunofixation electrophoresis (β=0.251, P=0.003), and abnormal free light chain ratio (β=0.299, P<0.001). Conclusions Serum GDF-15 level varied in different renal diseases and was correlated with age, blood glucose, CRP,MM, free light chain ratio and abnormal immunofixation electrophoresis. Serum GDF-15 level is a useful index reflecting the extent of kidney injury.
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    The influence factors of blood pressure fluctuation and its correlation with chronic kidney diseasEmineral and bone disorder in maintenance hemodialysis patients
    2021, 20 (04):  254-257.  doi: 10.3969/j.issn.1671-4091.2021.04.009
    Abstract ( 370 )   PDF (449KB) ( 977 )  
    【Abstract】Objective To explore the factors affecting intradialytic blood pressure fluctuation in maintenance hemodialysis (MHD) patients, and to analyze the relationship between intradialytic pressure fluctuation and chronic kidney diseasEmineral and bone disorder (CKD-MBD). Methods A total of 217 MHD patients treated in the 904th Hospital of the Joint Logistics Support Force from March 2015 to March 2020 were retrospectively analyzed. They were divided into high fluctuation group (n=119) and low fluctuation group (n=98). The general data, dialysis parameters and biochemical indicators were compared between the two groups. The risk factors for intradialytic blood pressure fluctuation, and the correlation of intradialytic blood pressure fluctuation
    with serum calcium, phosphorus, intact parathyroid hormone (iPTH) and alkaline phosphatase (ALP) were then analyzed. Results Compared to the patients in low fluctuation group, patients in high fluctuation group had lower body mass index (BMI) (t=2.077, P=0.039), longer dialysis time (t=5.043, P＜0.001), higher CKD- MBD prevalence (t=6.663, P=0.010), lower ultrafiltration volume and urea clearance index (Kt/V) (t=2.213 and 2.972, P=0.028 and 0.003), lower serum 25- hydroxyvitamin D level (t=2.433, P= 0.016), and higher serum phosphorus and iPTH levels (t=2.868 and 3.426, P=0.005 and 0.001). Dialysis time, phosphorus and iPTH were the independent risk factors for intradialytic blood pressure fluctuation in MHD patients (OR=1.218, 1.294 and 1.230 respectively; 95% CI:1.055~1.405, 1.058~1.584 and 1.027~1.473 respectively;P=0.007, 0.013 and 0.025 respectively); Kt/V was a protective factor for intradialytic blood pressure fluctuation (OR=0.225, 95% CI: 0.058~0.864, P=0.030). The difference of systolic blood pressure (ΔSBP) was significantly higher in patients with CKD-MBD than those without CKD-MBD (t=6.764, P＜0.001). The intradialytic blood pressure fluctuation was positively correlated with serum phosphorus and iPTH levels (r=0.255 and 0.183, P=0.029 and 0.013). Conclusion Dialysis time and dialysis adequacy affected the intradialytic blood pressure fluctuation in MHD patients. Higher blood pressure fluctuation was correlated with serum phosphorus and iPTH levels, which may be involved in the pathogenesis of CKD-MBD in MHD patients.
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    Dynamic changes of Klotho protein in ischemia- reperfusion of acute kidney injury patients 
    2021, 20 (04):  258-262.  doi: 10.3969/j.issn.1671-4091.2021.04.010
    Abstract ( 299 )   PDF (1123KB) ( 876 )  
    【Abstract】Objective To observe the dynamic changes of Klotho protein in acute kidney injury (AKI) during ischemia- reperfusion, and to further explore the role of Klotho protein in AKI. Methods A total of 120 Wistar male rats were randomly divided into Norm+NS group (normal rats + normal saline), Sham+NS group (sham operation + normal saline), Sham+Klotho group (sham operation +Klotho), I/R+NS group (ischemia-reperfusion + normal saline), and I/R+Klotho group (ischemia- reperfusion + Klotho) to establish the ischemia- reperfusion AKI groups and control groups. After the establishment of the models for 1h, 5h, 12h and 24h, six rats in each group were sacrificed. Blood urea nitrogen (BUN), serum creatinine (Scr), serum and kidney Klotho protein (ELISA method) and Klotho mRNA (RT-PCR method) were assayed. Pearson linear correlation method was used to analyze the relationship between serum and kidney Klotho protein levels and Scr level during AKI. Results After ischemia-reperfusion for 24h in I/R+NS group, Scr and BUN levels and renal tubular injury score increased as compared with those in Norm+NS group and Sham+ NS group (for Scr: t=3.767 and 4.145, P=0.013 and 0.009; for BUN: t=14.533 and 15.047, P<0.001; for renal tubular injury score: t=153.093 and 7.261, P<0.001 and t=0.008), and renal tubular epithelial cells showed significant degeneration and necrosis. In contrast in I/R+Klotho group in which exogenous Klotho protein was supplied, Scr and BUN levels and renal tubular injury score decreased (t=10.220, 9.571 and 11.076; P<0.001) and vacuolar degeneration of the renal tubular epithelial cells decreased, as compared with those in I/R+NS group. The content of Klotho protein and the expression of Klotho mRNA in sera and kidney tissues were lower in I/R+NS group than in Norm+NS group and Sham+NS group(P＜0.05). Conclusion In rats with ischemia-reperfusion AKI, Klotho protein and the expression of Klotho gene in serum and kidney decreased significantly. The decrease
    of Klotho protein level is closely related to AKI. Klotho protein may be a protective factor for AKI.
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    Effect of extracorporeal immune cell intervention therapy on septic pigs
    2021, 20 (04):  263-268.  doi: 10.3969/j.issn.1671-4091.2021.04.011
    Abstract ( 300 )   PDF (5420KB) ( 923 )  
    【Abstract】Objective To observe the effect of extracorporeal immune cell intervention therapy(EICIT)on clinical and immunological indexes in a septic pig model. Methods The sepsis model was established by intraperitoneal injection of autologous incubated feces. After 24 hours, the pigs were treated with general fluid therapy (control group) or with EICIT in addition to the general fluid therapy (experimental group). Extracorporeal blood cell separation was conducted via right internal jugular vein catheter using the white blood cell acquisition program of the COBE Spectra Blood Cell Separator. Arterial blood gas, cytokine measurement, and immune cells by flow cytometry were performed at the points before building the model (T1), after building up the model for 24 hours but before treatment (T2), immediately after treatment (T3), and after treatment for 24 hours (T4). At the T4 time point, pathological examinations were performed under anesthesia and the animals were sacrificed. Results At T2 time point, we successfully established the sepsis model and the pigs showed lower mean arterial pressure, tachycardia, hypoxemia and higher blood lactic acid. Pro-inflammatory factors including procalcitonin (PCT), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) increased, and interleukin (IL)-6 decreased significantly (t=-3.067, P=0.025), accompanied by a
    reduced tendency of IL- 10. At T4 time point in the experimental group, hemodynamics parameters, partial pressure of blood oxygen, lactic acid level and infiltration of inflammatory cells improved significantly, as compared with those in the control group. In experimental group, the number of circulated CD8+ T-cells increased (t=4.373, P=0.006), granulocytic myeloperoxidase (MPO) activity became higher (t=3.637,P=0.005), but the numbers of CD4+T cells, B cells, dentric cells, monocytes and neutrophils had no significant changes. Conclusion We proved that EICIT combined with basic fluid treatment could improve the clinical symptoms of sepsis, including the improvement of hemodynamics, oxygenation status, blood lactic acid level, and the infiltration of inflammatory cells in organs in a septic pig model.
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    Research progress in ferroportin in renal anemia
    2021, 20 (04):  273-276.  doi: 10.3969/j.issn.1671-4091.2021.04.013
    Abstract ( 571 )   PDF (373KB) ( 1240 )  
    【Abstract】Ferroportin (Fpn) is currently the unique iron export transfer protein, playing an important role in controlling the absorption of iron in diet and the excretion of iron from macrophages and other cells. Iron is an indispensable element in the body, participating in hemoglobin synthesis. If the expression of Fpn is disturbed, iron metabolism disorder and many related diseases will inevitably occur, red blood cell production is decreased, and chronic kidney disease (CKD) anemia is aggravated. This article reviews the research progress in Fpn, an important protein in the regulation of iron metabolism, in renal anemia.
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    Progress in incremental hemodialysis
    2021, 20 (04):  277-280.  doi: 10.3969/j.issn.1671-4091.2021.04.014
    Abstract ( 548 )   PDF (374KB) ( 884 )  
    【Abstract】Early mortality is higher in maintenance hemodialysis (HD) patients, probably due to the frequent dialysis at the initial stage. Conventional HD of threEtimes per week at the initial stage is currently adopted by most countries, which may neglect the role of residual renal function (RRF) in these patients. The simple way to estimate the RRF is explored in recent years, and at the same time the value of incremental HD has been emphasized. Most studies showed that incremental HD was useful for the preservation of RRF, with the long-term survival rate similar to that using conventional HD. However, the research about early mortality in the patients undergoing incremental HD was scant. This article briefly describes the latest research progress in incremental HD.
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    Analysis of the fear of disease progression and its influencing factors in maintenance hemodialysis patients
    2021, 20 (04):  285-288.  doi: 10.3969/j.issn.1671-4091.2021.04.016
    Abstract ( 402 )   PDF (394KB) ( 1033 )  
    【Abstract】Objective To understand the fear of disease progression in maintenance hemodialysis (MHD) patients and to explore its influencing factors, so as to provide a new theoretical basis for follow-up study. Methods A total of 172 MHD patients treated in The First Affiliated Hospital of Dalian Medical University from November 2019 to February 2020 were selected by means of the convenience sampling method. Questionnaires, including the General Data Questionnaire, the Fear of Progression QuestionnairEshort form, and the Experiences in Close Relationships Inventory, were used. Results The overall score of fear of disease progression was 30.58±4.31 in the 172 MHD patients. The overall score of fear of disease progression and the two dimensions of physical health and social family were positively correlated with the attachment anxiety dimension of adult attachment (r=0.219, 0.185 and 0.152 respectively; P=0.004, 0.015 and 0.047 respectively), and were also positively correlated with the attachment avoidance (r=0.273, 0.197 and 0.222 respectively; P<0.001, 0.009 and 0.003 respectively). Multiple linear regression analysis showed that education level, primary caregivers, hobbies and two dimensions of adult attachment were the influencing factors for fear of disease progression (β=-0.224, 0.210, -0.249, 0.184, and 0.267 respectively; P=0.001, 0.003, 0.001,
    0.011 and <0.001 respectively). Conclusion The degree of fear of disease progression in MHD patients was in a medium level. We should take appropriate measures based on the influencing factors to reduce the fear of disease progression and to promote the physical and mental health in MHD patients.
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