ABSTRACT
Objective To analyze the related factors of influencing deep vein indwelling catheter dysfunction in hemodialysis patients.Methods A total of 37 cases with deep vein indwelling catheter in hemodialysis patients were selected.They were divided into patent group and blocked group according to the appearance of catheter dysfunction (hemodialysis blood flow less than three times 180 ml/min,adjustment of body position,inversion of tube connection during hemodialysis,requirement of thrombolytic therapy and so on) in 5 months.The common data and biochemical indicator were compared between two groups.Results Patent group had 28 cases,and blocked group had 9 cases.There was no significant difference in age,diabetes mellitus ratio,platelet,low density lipoprotein cholesterol and albumin between two groups (P ＞0.05).Hemoglobin in patent group was lower than that in blocked group [(90.1 ± 13.8) g/L vs.(108.3 ± 11.6) g/L],and there was significant difference(P＜ 0.05).Conclusion Hemoglobin is the correlated factor that effects deep vein indwelling catheter dysfunction after hemodialysis.
ABSTRACT
Objective To investigate whether the combination of maintenance hemodialysis (MHD) with hemoperfusion(HP) can improve the clearance rate of middle- and largemolecule uremic toxins so as to improve the quality of life and reduce the mortality in MHD patients. Methods A prospective, randomized and controlled clinical trial was carried out. One hundred MHD patients were selected and then randomly divided into two groups after four weeks of run-in period. HD+HP group received MHD alone 2 times a week and the combined treatment of HD with HP (HD+HP) once a week, whereas HD group received MHD alone 3 times a week. The follow up lasted for mean 2 years. The primary outcome was the death of patients. Secondary end points included clinical data, leptin, high sensitive C-reactive protein (hsCRP), interleukin 6 (IL-6),β2 microglobulin (β2-MG), parathyroid hormone (PTH), tumor necrosis factor α (TNF-α) and the indexes of dimensions of Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36Chinese Edition ). Results At the end of the two-year observation, the serum concentration of leptin, hsCRP, PTH, IL-6, β2-MG and TNF-α, systolic blood pressure (SBP), diastolic blood pressure(DBP), heart rate(HR), cardiothoracie ratio, left ventricular mass index (LVMI), EPO dose and the types of antihypertensive drugs used were lower in HD +HP group as compared to HD group (all P＜0.05). HD+HP group had higher hemoglobin (Hb), ejection fraction (EF) and body mass index (BMI) (all P＜0.05). No significant differences between two groups were found in terms of serum albumin (Alb), serum iron (SI), total iron binding capacity (TIBC), cardiac output (CO),Kt/V, early/atrial mitral inflow velocities (E/A) (all P＞0.05). Besides, the SF-36 indicated that the total score of overall dimensions in HD+HP group was higher (P＜0.05) and the quality of life of HD+HP group was evidently better as compared to HD group. The Kaplan-Meier survival curves for the 2-year observation period showed that patients in HD +HP group had obvious survival advantage, while Log-rank test results showed P＜0.05. No serious adverse incidents occurred during the HD+HP treatment. Conclusion HD+HP is superior to HD in eliminating regularly middleand large-molecules uremic toxins and has a potential role in improving the quality of life and survival rate of MHD patients.
ABSTRACT
Objective To evaluate the fluid balance and dry weight with whole body bioelectrical impedance analysis (BIA) in patients with maintenance hemodialysis ( MHD). Methods Twenty patients in stable condition with MHD for more than one year were selected ( MHD group). Extra-cellular water ( ECW) and intra-cellular water (ICW) were measured by BIA before hemodialysis, after hemodialysis and at intervals of hemodialysis (24 h and 48 h after hemodialysis), and related parameters were calculated. Whether patients with MHD achieved dry weight at 0 h was analysed, and the effects of average daily urine volume on ECW and ICW were explored. Another 20 healthy volunteers were served as controls. Results Compared with control group, ECW retrieved by ideal body weight was significantly higher before hemodialysis in MHD group (P<0.05). In MHD group, ECW was significantly lower after hemodialysis than that before hemodialysis (P < 0.05). ECW/total body water (TBW) was significantly lower and ICW/TBW was significantly higher after hemodialysis than those before hemodialysis and at intervals of hemodialysis ( P < 0.05). ICW and ECW at each time point were significantly related to body weight. ICW and ECW retrieved by ideal body weight at 0 h and 24 h of those who achieved dry weight were significantly higher than those who did not achieve dry weight ( P < 0.05). ECW and ICW before hemodialysis and 24 h after hemodialysis were significantly lower in those with urine volume <400 mL/d than those with urine volume ≥400 mL/d (P <0.05). Conclusion BIA analysis indicates that changes of fluid balance before hemodialysis, after hemodialysis and at intervals of hemodialysis in patients with MHD are characterized by ECW, and ECW/TBW is a more sensitive parameter. ICW and ECW retrieved by ideal body weight may be sensitive parameters to determine the dry weight in patients with MHD.