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Objective To estimate dry weight (DW) and prevent dialysis-related hypotension and hypertension with the on-line monitoring of relative blood volume (RBV) and other judgments.Methods One hundred and eight maintenance hemodialysis patients were assigned to three groups according to their blood pressure:normal blood pressure group (A group,n=43),hypotension group (B group,n=35) and hypertension group (C group,n=35).The level of hemoglobin,serum albumin,dialysis adequacy were determined.Systolic blood pressure,diastolic blood pressure,mean arterial pressure,heart rate,ultrafiltration volume,relative blood volume changes and the corresponding clinical symptoms were monitored during hemodialysis in all patients.Each of the patients was continuously monitored of the indicators above for 10-12 times.At the observing period,the inferior vena cava diameter (IVCD),brain natriuretic peptide (BNP) and cardiothoracic ratio(CTR) were measured.Then according to the monitoring results,appropriate clinical interventions were given under on-line blood volume monitoring guidance.Results (1)The shape of RBV curve in group A showed doubleexponential curve early,then down to the final linear decling ended during hemodialysis.(2)The RBV curve in group B was stable in the former two hours,then rapidly linear declined.RBV changes were significantly higher in group B than group A (P ＜ 0.05),but when changes in RBV were plotted against ultrafiltration volume,there was no significant difference in the two groups.The level of RBV reduction at which symptomatic hypotension occurred showed considerable inter-individual variability (P ＜ 0.05,coefficient of variation=0.28).(3)The RBV curve in group C slowly linear declined.At the end of dialysis,RBV changes were significantly lower in group C than group A (P ＜ 0.05).(4)The IVCD values in three groups of patients before dialysis were greater than normal,significantly decreased after the dialysis (P ＜ 0.05),but that in group B and group C were still greater than that in group A (P ＜ 0.05).The BNP values were significantly greater in three groups before and after dialysis (P ＜ 0.05),but after dialysis,the values decreased significantly than that before dialysis (P ＜ 0.05).(5)After appropriate clinical intervention were given under on-line blood volume monitoring in hemodialysis,the patients of group B controlled weight gain,and even cut dry weight,the RBV change significantly decreased at the end of dialysis and significantly reduced the incidence of hypotension events (P ＜ 0.05); When the patients of group C cut dry weight,increased ultrafiltration,the RBV change increased,the mean arterial pressure decreased significantly than before (P＜ 0.05).Conclusions (1)Hemodialysis patients with symptomatic hypotension show larger RBV decline rate in the forth hour and lager total RBV changes,which provides important information for forecasting the symptomatic hypotension in hemodialysis.(2)IVCD and CTR have certain significance to the adjustment of dry weight,but the BNP has guiding significance to volume change.(3)On-line monitoring of RBV can effectively guide the adjustment of dry weight,reduction of symptomatic hypotension occruence,and controlling of refractory hypertension in hemodialysis.
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To explore the relationship between serum 1,25(OH)2D3 and oxidative stress in patients with diabetic nephropathy (DN).The serum levels of 1,25(OH)2D3 in DN patients were significantly lower than those in DM and healthy controls.And the 1,25(OH)2D3 level was negatively correlated with advanced oxidation protein products ( AOPP ) , reactive oxygen species ( ROS ) and positively correlated with superoxide dismutase (SOD) in DN patients.1,25(OH)2D3, low density lipoprotein-cholesterol (LDL-C), body mass index ( BMI) , serum creatinine and age were associated with the level of oxidative stress in DN patients.With the progression of CKD , the serum levels of AOPP and ROS increased significantly while those of SOD and 1,25(OH)2D3 decreased markedly.
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Objective To assess the effect of continuous renal-replacement therapy (CRRT) dose on the outcome of acute renal failure (ARF) patients with meta-analysis of randomized controlled trials (RCTs). Methods Studies were identified by systematic search of peer-reviewed publications in Medline, EMBASE and Cochrane library database through June 2010. All the RCTs that compared the incidence of clinical outcome such as mortality, need for chronic dialysis between standard and low dose CRRT were eligible. The pooled relative risk (RR) for clinical outcome was compiled using a random-effects model. Heterogeneity was evaluated by means of subgroup and sensitivity analysis. Results Six eligible studies were identified. By meta-analysis, standard dose CRRT was associated with non-significant 13% mortality risk reduction (RR 0.87, 95%CI 0.70-1.07, P=0.19)and 13% composite outcome risk reduction of chronic dialysis dependence and mortality (RR 0.87, 95%CI 0.69-1.09, P=0.21), but the trend toward increased chronic dialysis dependence risk among survivors (RR 1.43, 95%CI 0.94-2.18, P=0.09). The overall test for heterogeneity among cohort studies was significant (P=0.001, I2=76.2%). The risk of mortality was modality was significantly lower in some studies of which delivered dose was moer than 35 ml·kg-1·min-1,modality was continuous venous-venous hemofiltration (CVVH) and major cause was non-sepsis treated with standard dose CRRT. Conclusions Standard dose CRRT in patients with ARF does not improve survival, renal recovery and composite outcome, but decreases mortality in important subgroups including those with higher delivered dose, CVVH and non-sepsis.
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Objective To determine whether plasma Leptin level is associated with atherosclerosis in maintenance hemodialysis(MHD)patients.Methods During 1997-01~2003-06,plasma Leptin levels in MHD patients and healthy volunteers were measured and intima-media thickness(IMT)and prevalence of atherosclerotic plaques of the extracranial common carotid artery were also measured.Results Plasma Leptin levels in the MHD patients were higher than those in the healthy volunteers(P
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0.05). In RAC group, the Na +,K + ATPase activity of the left kidney decreased compared with that of the right kidney (1.96?0.42 vs 5.33?0.77, P