Advances on pathogenesis of acquired peritoneal ultrafiltration failure in peritoneal dialysis / 中华肾脏病杂志

Peritoneal ultrafiltration failure is a common reason for peritoneal dialysis (PD) withdrawal as well as mortality in PD patients. Based on the three-pore system, inter-cellular small pores and trans-cellular ultra-small pores (aquaporin-1) are mainly responsible for water transfer across the peritoneum. Both small and ultra-small pores-dependent water (free water) transport decline accompanied with time on PD, with more significant decrease in free water, resulting in peritoneal ultrafiltration failure. The reduction of free water transport is associated with fast peritoneal solute transfer, reduced crystalloid osmotic gradient due to increased interstitial glucose absorption, and declined osmotic conductance to glucose resulted from impaired aquaporin-1 function and peritoneal interstitial fibrosis. The decline of small pore-based water is mainly because of fast loss of crystalloid osmotic gradient, decrease of hydrostatic pressure mediated by peritoneal vasculopathy, as well as reduced absolute number of small pores. The current review discusses the advance on pathogenesis of acquired peritoneal ultrafiltration failure in long-term PD.

Intervention of modified Shenling Baizhu San on peritoneal fibrosis induced by peritoneal dialysate with different sugar concentration in rats / 中华危重病急救医学

Objective:To investigate the effect of modified Shenling Baizhu San on the pathological changes and extracellular matrix (ECM) in rats with peritoneal fibrosis induced by peritoneal dialysate fluid (PDF) with different sugar concentration and its mechanism.Methods:Seventy male Sprague-Dawley (SD) rats were randomly divided into control group, different sugar content PDF model groups and corresponding traditional Chinese medicine intervention groups, with 10 rats in each group. Peritoneal fibrosis model was reproduced by intraperitoneal injection of 100 mL·kg -1·d -1 PDF containing 1.5%, 2.5% and 4.25% sugar once a day for 8 weeks. The rats in the control group were given the same amount of normal saline. The rats in the traditional Chinese medicine intervention groups were treated with gavage of 10 mL/kg of modified Shenling Baizhu San (containing 2.014 g crude drug per liter) immediately after modeling. The PDF model groups and the control group were given the same amount of normal saline by gavage. After 8 weeks, the peritoneal ultrafiltration volume of rats in each group was measured. The peritoneal tissues were collected and stained with hematoxylin-eosin (HE), and the structural changes and thickness of the parietal peritoneum were observed under a light microscope. After Masson staining, the deposition of collagen fibers was observed under a light microscope. Western blotting was used to detect the protein expressions of E-cadherin,?α-smooth muscle actin (α-SMA) and Vimentin, the main components of ECM in parietal peritoneum. The positive expressions of matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), and transforming growth factor-β1 (TGF-β1) were detected by immunohistochemical staining. Results:Compared with the control group, PDF with different sugar contents could induce peritoneal fibrosis in rats, and the degree of fibrosis was gradually aggravated with the increase of sugar content, which was manifested as peritoneal thickening, increased collagen fiber deposition, decreased peritoneal ultrafiltration volume, down-regulated expressions of E-cadherin and MMP-9 in peritoneal tissue, and up-regulated expressions of α-SMA, Vimentin, TIMP-1 and TGF-β1, and the pathological changes and ECM accumulation in peritoneal tissues were more serious in 4.25% PDF model group. After the intervention of modified Shenling Baizhu San, compared with the corresponding PDF model groups, the peritoneal fibrosis of rats was improved to varying degrees, and the effect of the 4.25% PDF+traditional Chinese medicine intervention group was more significant, the parietal peritoneum was significantly thinner (μm: 101.86±16.01 vs. 140.65±10.13, P < 0.05), collagen fiber deposition was significantly reduced, peritoneal ultrafiltration volume was significantly increased (mL: -0.01±3.45 vs. -3.53±1.84, P < 0.05), the expressions of E-cadherin and MMP-9 in peritoneal tissues were significantly up-regulated [E-cadherin protein (E-cadherin/β-actin): 0.84±0.08 vs. 0.28±0.05, MMP-9 ( A value): 0.60±0.15 vs. 0.37±0.01, both P < 0.05], and the expressions of α-SMA, Vimentin, TIMP-1 and TGF-β1 were significantly down-regulated [α-SMA protein (α-SMA/β-actin): 0.36±0.08 vs. 1.05±0.09, Vimentin protein (Vimentin/β-actin): 0.53±0.07 vs. 1.19±0.04, TIMP-1 ( A value): 0.49±0.06 vs. 0.87±0.02, TGF-β1 ( A value): 0.67±0.04 vs. 0.89±0.10, all P < 0.05]. Conclusions:The degree of peritoneal fibrosis gradually increased with the increase of PDF sugar content in rats. Modified Shenling Baizhu San can improve peritoneal fibrosis induced by PDF with different sugar contents in rats, and the mechanism is related to the changes in the expression of fibrosis markers and ECM accumulation.

Status of hemodialysis and qualified status of dialysis water and dialysate in a city / 中国感染控制杂志

Objective To investigate current status of hemodialysis,and qualified status of dialysis water and dia-lysate in a city. Methods Status of hemodialysis in 36 medical institutions in a city which conducted blood purifica-tion programme was surveyed,dialysis water and dialysate were collected to perform microbial detection(including conventional and low temperature culture methods)and on-site ATP detection.Results 13.89% of equipments for water treatment were used less than 1 year,5.56% were used for more than 10 years. 77.78% of medical institu-tions didn't replace sand filtration which had been used for more than 1 year,the replacement time of 72.22% of fil-ter core was less than 3 months,2.78% of reverse water supply pipeline was used for more than 10 years.77.78%of medical institutions used finished A solution,72.22% used finished B solution,22.22% used centrally provided A solution,19.44% used centrally provided B solution,and 8.34% used self-made B solution. Routine microbial detection in 36 medical institutions were qualified,but 80.56% of detection results were"0" value for long period;ATP detection of on-site collected dialysis water and dialysate were all qualified. One specimen for microbial detec-tion under normal temperature exceeded the standard,2 reached the intervention value;4 specimens for microbial detection under low temperature exceeded the standard,6 reached the intervention value;qualified rates of 3 kinds of detection methods among different levels of medical institutions weren't significantly different(all P>0.05).Con-clusion The overall quality of hemodialysis water and dialysate in this city is good,the majority of medical institutions pay attention to the routine maintenance of water treatment equipment,detect the quality of hemodialysis water and dialysate regularly,but microbial detection technique needs to be improved,causes for abnormal results or intervention value of rou-tine detection needs to be analyzed and improved continuously.

Design and application of central preparation and supply system of dialysate for hemodialysis / 中国医学装备

Objective:To design and produce the device of central preparation and supply system of dialysate according to the clinical requirement as the relative standards which this system should abide, and to enhance the medical quality of dialysate.Methods: The optimal design and process program of every section were discussed according to the requirement of national standards and industrial standards and the technical requirement of researching central preparation and supply system of dialysate. The requirements of quality system were implemented in every section of the design and application in the central preparation and supply system of dialysate and these requirements were continuously improved, and finally, they were applied in the blood purifying center of hospital.Results: After the central preparation and supply system of dialysate was installed and applied in the blood purifying center, a series of contaminations of the system, such as air contamination, particle contamination, microorganism contamination and endotoxin contamination, were efficiently controlled, and the purity of concentrated solution of dialysate was increased to higher level. Therefore, the dialysate of high quality were obtained.Conclusion: The central preparation and supply system of dialysate is a development tendency in large dialysate center, and it can efficiently increase work quality and work efficiency. A better central preparation and supply system will achieve ultra pure dialysate in real meaning, and it can make profits for patients, achieve medical safety, enhance efficiency, cost saving and achieve clean and tidy. It represents the industrial development direction, and it can contribute the whole development and outside influence of hospital.

Three methods for microbiological monitoring on dialysate and dialysis water for hemodialysis / 中国感染控制杂志

Objective To evaluate detection effect of three methods on monitoring microbes in dialysate and dialysis water for hemodialysis.Methods Seventy-two dialysate and dialysis water specimens were collected from 36 medical institutions,specimens were cultured with three methods: blood agar plate incubated at 35℃ for 72 hours,Tryptic soy agar(TSA)plate incubated at 35℃ for 72 hours,and Reasoner's 2A agar(R2A agar)plate incubated at 23℃ for 168 hours,colony counts,isolation of colony,and detection rate of colony exceeding action level(≥50 CFU/mL)were compared among three methods.Results The colony isolation rates of microbes in dialysate and dialysis water detected by blood agar plate,TSA plate and R2A plate were 40.28%,63.89%,and 69.44%respectively,difference was significant(x2=14.16,P<0.05);pairwise comparison showed that isolation rates of colony on R2A agar plate and TSA plate were higher than blood agar plate.There was significant difference in isolated colony count between blood agar plate and R2A agar plate,TSA plate and R2A agar plate respectively(Z=-4.515,-6.970 respectively,both P<0.05).The rates of isolated colony exceeding action level in dialysate and dialysis water detected by blood agar plate,TSA plate,and R2A agar plate were 1.39%,4.17%,and 20.83%respectively,difference was significant(x2=19.83,P<0.05),detection rate of R2A agar plate was higher than the other two methods.Conclusion The detection rate of colony by R2A agar plate and TSA plate are better than blood agar plate,detection rate of colony exceeding action level by R2A agar plate is higher than TSA plate and blood agar plate,R2A agar plate for microbial monitoring(23℃,168 h)on dialysate and dialysis water is superior to the other two methods.

Design and application of duplex peritoneal dialyzer with controllable dialysate volume / 医疗卫生装备

Objective To develop a duplex peritoneal dialyzer with controllable dialysate volume.Methods The dialyzer was designed with considerations on safety and convenience,which was composed of a dialysate feeding bag,a drainage bag,a dialysate changing opening,a dialysate taking opening,a dialysate outlet,a delivery flask,a flow control valve and a compensating bar.There were scales calibrated on the dialysate feeding bag and drainage bag to facilitate flux controlling.The openings of the dialysate feeding bag and drainage bag were connected with the dialysate changing opening by adapting pipe,and the dialysate changing opening could fulfill dialysate input and used dialysate drainage.Results The dialyzer realized dialysis based on actual requirements of the patient,decreased the times for connection to prevent infection due to frequent changing,and lowered the incidence rates of corresponding complications such as peritonitis.Conclusion The disposable dialyzer has easy operation,convenience and high safety,and thus is worthy promoting practically.

Application value of standard curve of K+ concentration in dialysis solution in personalized dialysis therapy / 医疗卫生装备

Objective To investigate the linear relationship and standard curve equation between acidic concentrated solution added KCl and the changes of K+ concentration in dialysate,and to apply it in personalized dialysis.Methods The speed of concentrated liquid pump of Fresenius 4008S hemodialysis machine was calibrated,the ratio of the concentration solution to the reverse osmosis water was determined,KCl was added to the concentrated A solution by an equal increment method to detect K+ concentration in the corresponding dialysate,and the K+ concentration standard curve of dialysate was mapped.This study is based on blood K+ concentration of adams-stokes syndrome patients before dialysis,referring to the standard curve,the most suitable dialysate K+ concentration was selected to personalized dialysis,the blood K+ concentration of the patients was measured after dialysis,and ECG monitoring and clinical symptoms observation were carried out.Results There was a linear relationship between acidic concentrated solution added KCl and the changes of K+ concentration in dialysate,the curve equation was y =0.384 lx + 0.002 3,R2 =0.999 4.There was no obvious change in the concentration of other electrolyte ions in the dialysate.Referring to the standard curve,the concentration of dialysate K+ could be adjusted accurately.The blood K+ concentration of adams-stokes syndrome patients could be corrected in time after several times of K+ concentration of personalized dialysis,and ECG recovered eventually,and arrhythmia,syncope,chest tightness and other symptoms disappeared.Conclusion There is a linear relationship between the concentration of dialysate K + and the concentration of KCl added in acidic concentrated solution in the Fresenius 4008S hemodialysis machine.Personalized dialysis is performed by the standard curve with obvious clinical application value,and references are provided for precise regulation of dialysate ion concentration.

Design and application of duplex peritoneal dialyzer with controllable dialysate volume / 医疗卫生装备

Objective To develop a duplex peritoneal dialyzer with controllable dialysate volume.Methods The dialyzer was designed with considerations on safety and convenience,which was composed of a dialysate feeding bag,a drainage bag,a dialysate changing opening,a dialysate taking opening,a dialysate outlet,a delivery flask,a flow control valve and a compensating bar.There were scales calibrated on the dialysate feeding bag and drainage bag to facilitate flux controlling.The openings of the dialysate feeding bag and drainage bag were connected with the dialysate changing opening by adapting pipe,and the dialysate changing opening could fulfill dialysate input and used dialysate drainage.Results The dialyzer realized dialysis based on actual requirements of the patient,decreased the times for connection to prevent infection due to frequent changing,and lowered the incidence rates of corresponding complications such as peritonitis.Conclusion The disposable dialyzer has easy operation,convenience and high safety,and thus is worthy promoting practically.

Application value of standard curve of K+ concentration in dialysis solution in personalized dialysis therapy / 医疗卫生装备

Objective To investigate the linear relationship and standard curve equation between acidic concentrated solution added KCl and the changes of K+ concentration in dialysate,and to apply it in personalized dialysis.Methods The speed of concentrated liquid pump of Fresenius 4008S hemodialysis machine was calibrated,the ratio of the concentration solution to the reverse osmosis water was determined,KCl was added to the concentrated A solution by an equal increment method to detect K+ concentration in the corresponding dialysate,and the K+ concentration standard curve of dialysate was mapped.This study is based on blood K+ concentration of adams-stokes syndrome patients before dialysis,referring to the standard curve,the most suitable dialysate K+ concentration was selected to personalized dialysis,the blood K+ concentration of the patients was measured after dialysis,and ECG monitoring and clinical symptoms observation were carried out.Results There was a linear relationship between acidic concentrated solution added KCl and the changes of K+ concentration in dialysate,the curve equation was y =0.384 lx + 0.002 3,R2 =0.999 4.There was no obvious change in the concentration of other electrolyte ions in the dialysate.Referring to the standard curve,the concentration of dialysate K+ could be adjusted accurately.The blood K+ concentration of adams-stokes syndrome patients could be corrected in time after several times of K+ concentration of personalized dialysis,and ECG recovered eventually,and arrhythmia,syncope,chest tightness and other symptoms disappeared.Conclusion There is a linear relationship between the concentration of dialysate K + and the concentration of KCl added in acidic concentrated solution in the Fresenius 4008S hemodialysis machine.Personalized dialysis is performed by the standard curve with obvious clinical application value,and references are provided for precise regulation of dialysate ion concentration.

The working principle of the dialysate heating and mixture ratio system and the effect of dialysate temperature on renal fibrosis in dialysis patients with end-stage renal / 中国医学装备

Objective:To explore the significance of blood dialysis device for real-time monitoring of dialysate temperature.Methods: Nikkiso DBB-27-type hemodialysis device was selected as a subject for discussion, analyzed and discussed the working principle, main structure and functional characteristics of the mixture ratio of dialysate and temperature monitor and combined with one case of temperature troubleshooting case.Results: Temperature monitoring was essential to ensure the stable running of dialysate mixture ratio and the temperature of the dialysate.Conclusion: The dialysate temperature has an important effect on renal fibrosis in end-stage hemodialysis patients, it is necessary to monitor the dialysate temperature and mixture ratio. Dialysis device heating degas proportioning system through surveillance system linked to the dialysis unit normal, stable operation, provide safe and reliable dialysis treatment for patients.

Different calcium concentration Citrate dialysate consequences on calcium and PTH in hemodialysis patients / 中华肾脏病杂志

Objective To evaluate the effects on the mineral bone disorder using different calcium concentration citrate-based dialysate in maintenance hemodialysis (MHD) patients.To compare the concentrations of intact parathyroid hormone(PTH) with biointact PTH(1-84) in these patients.Methods Citrate dialysate with different calcium concentration (DCa 1.75,DCa 1.5,DCa 1.25 mmol/L)were used in turn in 15 stable MHD patients each week.Serum tCa and iCa were measured by automatic biochemistry analyzer.The concentrations of iPTH and bio-iPTH were compared.Results (1) The patients treated with DCa 1.75 citrate dialysate had increased serum iCa and tCa after dialysis,and PTH did not change significantly as compared to those findings before the dialysis.With the DCa 1.5 citrate dialysate,serum iCa and tCa were kept stable and PTH level was increased.With DCa 1.25 citrate dialysate,serum iCa and tCa decreased significantly and PTH decreased.(2)iPTH and bioPTH had excellent correlations.Variation of bio-iPTH was more correlated with the changes of calcium than iPTH.Conclusions Serum levels of iPTH,tCa and iCa can be kept stable in MHD patients treated with DCa 1.75 ～ 1.5 citrate dialysate.Bio-iPTH is a more sensitive marker for mineral bone disease than iPTH.

Insulin resistance in non-diabetic peritoneal dialysis patients and its influencing factors / 中华肾脏病杂志

Objective To observe insulin resistance (IR) in non-diabetic peritoneal dialysis (PD) patients,and analyze its related factors.Methods The non-diabetic PD patients who had been on stable PD at least three months were eligible to enroll.The patients were measured for their height,weight,waist to hip ratio,fasting glucose,fasting insulin,lipids and other biochemical indicators,dialysis adequacy indicators in August 2012,and divided into two groups depended on median HOMA-IR in August 2012.Results A total of 56 patients were enrolled and divided into two groups according to median HOMA-IR,including high IR group (HOMA-IR≥ 1.79,n=29) and low IR group (HOMA-IR ＜ 1.79,n=27).Compared to low IR group,high IR group were older [(57.9±14.2) years vs (48.7±14.5) years],had higher daily dialysate glucose load [(138.7±28.5) mmol/L vs (114.0± 21.5) mmol/L],higher waist-to-hip ratio [(0.91±0.08) vs (0.86±0.07)],higher BMI [(23.0±3.0) kg/m2 vs (21.2±3.1) kg/m2],higher triglycerides [(2.51±1.36) mmol/L vs (1.42±0.48) mmol/L],lower high-density lipoprotein cholesterol [(1.00±0.27) mmol/L vs (1.23±0.32) mmol/L],and lower Kt/V [(1.74±0.37) vs (2.08±0.56)].Multivariate logistic regression showed that age (β=0.122,P=0.033),triglycerides (β=1.798,P=0.030) and daily dialysate glucose load (β=0.094,P=0.031) associated with the degree of insulin resistance.Conclusion More dialysate glucose exposure is a risk factor of the occurrence of insulin resistance in non-diabetic patients with peritoneal dialysis.

Working principles and maintenance of different dialysate proportioning systems / 中国医学装备

Objective:This paper analyzes different dialysate proportioning systems, when facing various types of system, we take different methods of maintenance to make the right proportion of dialysate. Methods: According to the different working principles, different dialysate proportioning systems need different ways to maintenance. Results:During the dialysis sessions, it makes proportioning of concentrations more stable. Conclusion:Maintenance can provide the safe operation of hemodialysis machines, and ensure high quality dialysis for patients.

Discussion on the influence of dialysate conductivity and method of disposition / 中国医学装备

Objective: To discuss the influence of the dialysate conductivity of Several of the most common situation,and the method of disposition. Methods:To analyze the composition of each ion in the dialysate, the content of various components;The role of dialysate in the treatment process. Results:Affect the dialysate conductivity will directly affect the quality of dialysis and the safety of dialysis, it must be strictly monitored. Conclusion:In the daily inspection work, we should grasp the key and requirements about dialysate conductivity.

Resolution of uremic tumoral calcinosis in a patient on peritoneal dialysis with long-term low-calcium dialysate treatment

Tumoral calcinosis is a rare complication in uremic patients. An in-depth review of published literature suggests that most patients with uremic tumoral calcinosis do not respond to medical treatment. Here, we report the case of a patient on peritoneal dialysis who presented with infected multifocal masses on both hip joints and was successfully treated by medical intervention. The patient was diagnosed with uremic tumoral calcinosis by physical examination and radiologic imaging, and treated with low-calcium dialysis and a non-calcium phosphate binder, sevelamer, without increasing the dose of dialysis. At the 36-month follow-up, the majority of masses had disappeared and the patient was asymptomatic.

Evaluation of the application of regional citrate anticoagulation in sustained low efficiency hemodialysis / 中华内科杂志

Objective To compare the anticoagulation effect of regional citrate and heparin in patients with sustained low-efficiency hemodialysis (SLED).Method This study was conducted in the teaching hospital of Sichuan University between November 2011 and January 2013.Sixty-three patients suffering from acute kidney injury or end-stage renal diseases (ESRD) were enrolled and further randomized to 2 groups:citrate and heparin anticoagulation treatment groups in SLED.SLED was conducted by Fresenius 4008sARrTplus dialyzer for 8 hours each session,and blood flow was set at 150 ml/min.Prothrombin time (PT),activated partial thromboplastin time (APTT) and platelet (PLT) count were analyzed.Result Sixty-three patients underwent 118 sessions of SLED.Among them,59 patients (93.7％) was discharged after treatment or converted to outpatient intermittent hemodialysis,and 4 patients died of multiple organ failure during hospitalization.Compared with that in the citrate group,both PT and APTT in heparin group was significantly higher [PT:(15.5 ± 2.0) s vs (12.3 ± 2.7) s,P ＜ 0.001 ; APTF:(56.0 ± 10.9) s vs (32.8 ± 6.1) s,P ＜ 0.001 ; respectively] at 2 h during SLED.However,the PT and APTT levels in heparin group decreased afterwards and were similar with those in the citrate groups at 5 h during treatment.There is no difference on PLT counts between these two groups after treatment.Conclusion The anticoagulation effect of regional citrate and heparin was similar in patients when receiving SLED.Regional citrate may be an alternative anticoagulant approach for the patients at high risk of bleeding who require the treatment of SLED.

Sodium Balance in Maintenance Hemodialysis

Sodium is the principal solute in the extracellular compartment and the major component of serum osmolality. In normal persons in the steady state, sodium homeostasis is achieved by a balance between the dietary intake and the urinary output of sodium, whereas in intermittent hemodialysis patients, sodium balance depends on dietary intake and sodium removal during hemodialysis. Thus, the main goal of hemodialysis is to remove precisely the amount of sodium that has accumulated during the interdialytic period. Sodium removal during hemodialysis occurs via convective (~78%) and diffusive losses (~22%) between dialysate and plasma sodium concentration. The latter (the sodium gradient) is an important factor in the 'fine tuning' of sodium balance during intermittent hemodialysis. Most use fixed dialysate sodium concentrations, but each patient has his/her own plasma sodium concentrations pre-hemodialysis, which are quite reproducible and stable in the long-term. Thus, in many patients, a fixed dialysate sodium concentration will cause a persistent positive sodium balance during dialysis, which could possibly cause increased thirst, interdialytic weight gain, and mortality. Several methods will be discussed to reduce positive sodium balance, including sodium alignment.

Effect of chloride dialysate concentration on metabolic acidosis in aintenance hemodialysis patients

Hyperchloremia is one of the multiple etiologies of metabolic acidosis in hemodialysis (HD) patients. The aim of the present study was to determine the influence of chloride dialysate on metabolic acidosis control in this population. We enrolled 30 patients in maintenance HD program with a standard base excess (SBE) ≤2 mEq/L and urine output of less than 100 mL/24 h. The patients underwent dialysis three times per week with a chloride dialysate concentration of 111 mEq/L for 4 weeks, and thereafter with a chloride dialysate concentration of 107 mEq/L for the next 4 weeks. Arterial blood was drawn immediately before the second dialysis session of the week at the end of each phase, and the Stewart physicochemical approach was applied. The strong ion gap (SIG) decreased (from 7.5 ± 2.0 to 6.2 ± 1.9 mEq/L, P = 0.006) and the standard base excess (SBE) increased after the use of 107 mEq/L chloride dialysate (from -6.64 ± 1.7 to -4.73 ± 1.9 mEq/L, P < 0.0001). ∆SBE was inversely correlated with ∆SIG during the phases of the study (Pearson r = -0.684, P < 0.0001) and there was no correlation with ∆chloride. When we applied the Stewart model, we demonstrated that the lower concentration of chloride dialysate interfered with the control of metabolic acidosis in HD patients, surprisingly, through the effect on unmeasured anions.

Great influence of peritoneal transport characteristics on ultrafiltration of icodextrin / 中华肾脏病杂志

Objective To observe the long dwell ultrafiltration volume after using 7.5% icodextrin in different peritoneal transport characteristics of peritoneal dialysis patients. Methods Subgroup analysis of a perspective multicenter randomized double blind and parallel control study was performed. Continuous ambulatory peritoneal dialysis (CAPD) patients were divided into high transport (H) group, high-average transport (HA) group, low-average transport (LA) group and low transport (L) group according to D/Pcr and Twardoski standard. Ultrafiltration volume of night long dwell dialysate was calculated before and after clinic trial for 2 weeks and 4 weeks to evaluate the different effect of transporters on ultrafiltration volume. Results A total of 201 CAPD patients were enrolled in the study, including 98 patients in icodextrin group (ICO group) and 103 patients in glucose group (GLU group). Male and female cases were 96 and 105 respectively. Age was (56.1±13.7) years old (range from 18 to 81). One hundred and ninety-eight patients finished peritoneal equilibrium test (PET), including 24 (12.1%) of H, 72(36.2%)of HA, 81(40.7%)of LA,and 21 (11.0%)of L. After follow-up for four weeks, the ultrafiltration volume was much higher than baseline in H, HA and LA groups. Also ultrafiltration volume in icodextrin group was much higher than that in glucose-based dialysate. Howerve, the increased volume was not significantly difference in L group. Ultrafiltration volume of icodextrin was positively correlated to D/Pcr (R2=0.1681,P＜0.01), while ultratration volume of dextrose was negatively correlated to D/Pcr (R2=0.0949,P＜0.01). Conclusion Compare to glucose-based dialysate (Dineal), 7.5% icodextrin dialysate (Extraneal) improves the ultrafiltration and peritoneal creatinine clearance of long dwell notabily in H, HA and LA group.

Effects of different dialysates on apoptosis and expression of PKCδ of U937 cell line / 上海交通大学学报（医学版）

Objective To investigate the effects of different dialysates on expression of protein kinase C-δ (PKCδ) and apoptosis of U937 cell line. Methods Different dialysates were added into culture fluid with U937 cell line at exponential phase of growth, and groups were divided: fluid A+fluid B group (dialysate A+dialysate B), fluid A+fluid B+rottlerin (PKCδ specific inhibitor)group, fluid A+powder B group (dialysate A+powder B) and fluid A+powder B + rottlerin group. Besides, blank control group and normal control group were established. Cells were harvested 24 h and 48 h after treatment, morphological changes were observed by Hoechst33258 fluorescence staining, cell apoptosis was measured by Annexin-V-FITC/PI double staining, and expression of PKCδ mRNA and protein was detected by RT-PCR and Western blotting, respectively. Results Cell apoptosis significantly increased in fluid A+powder B group, with typical morphology of apoptosis. After treatment for 24 h and 48 h, cell apoptosis rates in fluid A+powder B group were significantly higher than those at corresponding time points in blank control group , normal control group and fluid A+powder B+rottlerin group (P<0.05). Compared with normal control group, blank control group and fluid A+powder B+rottlerin group, the expression of PKCδ mRNA and protein of U937 cells in fluid A+powder B group were significantly increased (P<0.05). There was no significant difference in cell apoptosis rates and expression of PKCδ mRNA and protein between fluid A+fluid B group and blank control group, normal control group and fluid A+fluid B+rottlerin group (P＞0.05). Conclusion Fluid A+powder B can significantly increase apoptosis of U937 cell line, the mechanism of which may be associated with the up-regulation of expression of PKCδ. Compared with fluid A+powder B, fluid A+fluid B is superior in reducing apoptosis of peripheral blood monouclear cells.