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Objective To investigate the effects and related risk factors of different vascular access types on new atrial fibrillation in maintenance hemodialysis (MHD) patients.Methods This was a single-center prospective cohort study.Patients who established long-term dialysis access and were voluntarily followed up in the Second Hospital of Tianjin Medical University from January 1,2013 to June 30,2013 were enrolled to follow-up for 5 years.Patients were divided into fistula group (patients with autogenous arteriovenous fistula) and catheter group (patients with tunneled cuffed internal jugular vein catheter).The incidences of new atrial fibrillation in the two groups were compared by Kaplan-Meier survival analysis.Cox regression analysis and receiver operator characteristic curve (ROC) were used to assess the risk factors of new atrial fibrillation.Results A total of 315 eligible patients were enrolled,including 150 males (47.62％).There were 189 patients (60.00％) in the fistula group,and 126 patients (40.00％) in the catheter group.Multivariate Cox regression analysis showed that older age (HR=1.021,95％CI 1.003-1.040),arteriovenous fistula (HR=1.899,95％CI 1.019-3.539),increased dialysis blood flow (HR=1.030,95％CI 1.010-1.051) and left atrial diameter (HR=1.097,95％CI 1.022-1.177) were independent risk factors for new atrial fibrillation in MHD patients (all P ＜ 0.05).Kaplan-Meier survival analysis showed that the incidence of new atrial fibrillation in fistula group was higher than that in catheter group (Log-rank A2=9.53,P=0.002).ROC curve analysis showed that age [the area under the curve (AUC)=0.608,P=0.008],arteriovenous fistula (AUC=0.594,P=0.021),dialysis blood flow (AUC=0.659,P＜0.001) and left atrial diameter (AUC=0.604,P=0.011) could predict the occurrence of new atrial fibrillation.Condusions Older age,arteriovenous fistula,increased blood flow during dialysis and left atrial diameter are independent risk factors for new atrial fibrillation in MHD patients,which can predict the occurrence of atrial fibrillation.The incidence of new atrial fibrillation in patients with arteriovenous fistula is higher than that in patients with catheter.
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One hundred and twenty maintenance hemodialysis patients with secondary hyperparathyroidism were randomly assigned to receive cinacalce,calcitriol or combination of cinacalce and cacitriol for treatment,with 40 cases in each group.Patients were followed up for 12 months;and the blood tests,echocardiography,examinations for osteoporosis and soft tissue calcification were performed every month.After 3 months of treatment,the serum levels of parathyroid hormone were decreased in all three groups (P ＜ 0.01);while the parathyroid hormone decreased more markedly with less influence on serum calcium and phosphorus levels in combination group.There were no significant changes in alkaline phosphatase,osteoporosis and cardiac valve calcification after treatment,compared with before treatment.There were no cases of hypercalcemia and hypocalcemia appearing in combination group after treatment.The study indicates that the combination of cinacalcet with calcitriol has better therapeutic effect for treatment of secondary hyperparathyroidism in maintenance dialysis patients.
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Objective To investigate the efficacy and safety of neurotropin in the treatment of restless legs syndrome and sleep disorder in patients with maintenance hemodialysis. Methods Sixty eight patients who met the inclusion criteria were randomly assigned to control group (n=34) and treatment group (n=34). The trial lasted for 16 weeks, and all patients undergone thorough dialysis. 7.2 units (2 branches) neurotropin were slowly injected to the patients in the treatment group at the end of each hemodialysis and they were stopped after 8 weeks. The patients in the control group had no treatment for restless leg syndrome on the basis of adequate dialysis. All patients were assessed regularly as regards their biochemical indexes, restless legs syndrome rating scale and Pittsburgh sleep quality index. Results All the patients completed the experiment, and restless legs syndrome scores were decreased in two groups. Compared with the baseline, the restless legs syndrome scores decreased significantly in patients treated with neurotropin, and the differences between two groups were significant (P<0.01). In the Pittsburgh sleep quality index scores, the patients in the treatment group decreased in all scores and the difference was statistically significant (P<0.01). Conclusions Neurotropin can relieve the symptoms of restless legs syndrome and sleep disturbance in patients on maintenance hemodialysis and is safe, but symptoms may occur again after withdrawal.
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Objective To investigate the survival rate in elderly patients with long-term catheters hemodialysis.Methods A total of 127 elderly patients receiving maintained hemodialysis were included in this study.Patients were divided into two groups according to catheter location:long term indwelling internal jugular vein catheter group and long term indwelling vena iliac external catheter group.The baseline anthropometric and laboratory parameters were measured.The catheter dysfunction and catheter related complications were observed.Results The incidence of catheter dysfunction was higher in iliac vein catheter group than in internal jugular vein catheter group (51.5 ％ vs.24.5％,x2 =8.459,P=0.015),and there were no significant differences in the catheter related infection rate and cardiovascular (CVD) event rate between the two groups.Kaplan-Meier survival curves showed that mean survival time was lower in vena iliac external catheter group than in internal jugular vein catheter group (1.9 years vs.2.5 years,x2 =10.847,P=0.001),and still was lower after controlling the catheter dysfunction and cardiovascular events (x2 =9.915,P=0.002;x2=4.368,P =0.037).Multivariate logistic regression analysis showed that levels of hemoglobin,creatinine,systolic blood pressure,parathormone and age were the independent risk factors for mortality in elderly patients with long term catheter hemodialysis.Conclusions There is a high incidence of CVD events in elderly patients with long-term catheter hemodialysis.The incidence of catheter dysfunction is higher and the survival rate is lower in elderly patients with long-term indwelling vena iliac external catheter hemodialysis.
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Objective To investigate the survival of older patients with iliac vein tunneled cuffed catheters on maintenance hemodialysis. Methods A total of 70 older patients with external iliac vein tunneled cuffed catheters on maintenace hemodialysis were included in this study, there were 94 patients with internal jugular vein tunneled cuffed catheters as control group. The baseline anthropometric and 1aboratory parameters were measured. The catheter dysfunction and catheter related complications were documented. Results There were lower survival rate and catheter survival in the external iliac vein group compared with internal jugular vein group(χ2=13.714, P<0.01; χ2=13.093, P<0.01). Compared with internal jugular vein group, there was lower rate of catheter infection in external iliac vein group(χ2=9.416, P<0.01); In addition, there were higher rate of cardiovascular disease(CVD) events and catheter dysfunction among patients in external iliac vein group (χ2=7.492, P<0.01; χ2=5.912, P<0.05). Furthermore, the incidence of catheter dysfunction and cardiovascular disease events were the independent risk factors of mortality for older patients with iliac vein tunneled cuffed catheters on maintenance hemodialysis by Cox regression model. Conclusions Patients with iliac vein tunneled cuffed catheters have a shorter survival time. Those with catheter dysfunction or cardiovascular disease events are in higher risk of mortality.
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Objective: To study the effect of serum from maintenance hemodialysis(MHD) patients on the expression of intercellular adhesion molecule-1(ICAM-1) in human umbilical vein endothelial cells(HUVEC) cultured in vitro, and the mechanism of endothelial cells dysfunction caused by serum from MHD patients thereof. Methods: HUVEC were incubated for 1 h, 3 h, 6 h and 12 h in RPMI 1640 culture media containing 10 % fetal cattle serum(FCS )(group A), 10% normal human serum (group B) and 10% MHD patient serum (group C) respectively. The immunocytochemical method was used to determine the expression of ICAM-1. Results: There were significant differences in the expression of ICAM-1 in HUVEC among stimulation groups with different serums(P < 0.05). Compared with groups A and B, the expression of ICAM-1 was significantly increased in HUVEC of group C. There was significant difference in the expression of ICAM-1 at the different stimulation times(P < 0.05). There was significant interaction between the expression of ICAM-1 in HUVEC and stimulation groups with different serum and the stimulation times(P < 0.05). Conclusion: The serum from MHD patients with chronic renal failure can promote the expression of ICAM-1 in HUVEC cultured in vitro, thus causing the dysfunction of endothelial cell.