The effects of continuous ambulatory peritoneal dialysis and hemodialysis on serum pepsinogen concentrations in patients with chronic renal failure

Pepsinogen, the precursors of pepsin, is classified into two subtypes: pepsinogen I (PG I) and pepsinogen II (PG II). Patients with impaired renal function are associated with elevated concentrations of serum pepsinogen. Contradictory results have been reported about the effect of dialysis on the serum pepsinogen levels, as the previous studies were conducted only in a particular period of dialysis. We therefore investigated the effect of continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis on serum pepsinogen levels in patients with chronic renal failure (CRF) before and after dialysis treatment. Thirty-four patients with CRF were enrolled in this study and were treated by CAPD (n=22) or hemodialysis (n=12). As a control group, subjects with normal renal function were included (n=20). Serum PG I and PG II levels were measured in control subjects and CRF patients before dialysis treatment and after three-month dialysis treatment. Before dialysis treatment, serum PG I levels were significantly higher in CRF patients than control subjects. In patients treated by CAPD, the serum PG I levels were significantly decreased but its levels were still higher than the values of the control subjects, whereas PG I levels remained unchanged in patients treated by hemodialysis. There were no differences in serum PG II levels between control subjects and CRF patients before or after dialysis treatment. Thus, CAPD is more effective than hemodialysis in the clearance of PG I.     

Pregnancy-associated plasma protein A in dialysis patients.

BACKGROUND: Pregnancy-associated plasma protein A (PAPP-A) was recently described as a new marker of cardiovascular events and of inflammation in uremic patients. The aim of this study was to determine levels of PAPP-A in chronic dialysis patients and its possible relationships with renal osteodystrophy. METHODS: A total of 99 adult chronic hemodialysis patients, 14 peritoneal dialysis patients and 41 control subjects were included in the study. Serum PAPP-A, intact parathormone (iPTH), calcium, phosphorus and alkaline phosphatase (ALP) were measured. The correlations between PAPP-A and iPTH, calcium, phosphorus and ALP were determined. RESULTS: PAPP-A levels were significantly higher in peritoneal dialysis [4.5 (3.2-6.7) mU/L, median (interquartile range)], and hemodialysis patients [4.7 (3.8-6.5) mU/L] in comparison to control subjects [3.4 (3.0-5.0) mU/L] (p<0.05). In hemodialysis patients, post-dialysis PAPP-A levels [6.2 (4.7-9.4) mU/L] were significantly higher than pre-dialysis levels [4.7 (3.8-6.5) mU/L] (p<0.05). There was a weak but statistically significant positive correlation between serum PAPP-A and iPTH (r=0.216; p=0.041) and ALP (r=0.205; p=0.044) in the hemodialysis group. Correlation between the duration of dialysis therapy and PAPP-A levels was also significant (r=0.267; p=0.008) in the hemodialysis group. CONCLUSIONS: PAPP-A levels are elevated in acute coronary syndromes and are closely related to inflammation and oxidative stress. We conclude that PAPP-A levels are increased in dialysis patients and may reflect a greater degree of chronic inflammation than osteodystrophy in uremic patients.     

睡眠质量与维持性血液透析患者心包脏层脂肪体积相关性研究

目的探讨血液透析患者睡眠障碍与心包脏层脂肪组织(EAT)体积的潜在关系。方法选择透析时间超过3个月且病情比较稳定的维持性血液透析(MHD)患者82例,根据匹兹堡睡眠质量量表(PSQI)积分分为两组,睡眠障碍组(PQSI5分)和对照组(PQSI≤5分)。观察两组PQSI、爱泼沃思嗜睡量表(ESS)、心包脏层脂肪的体积,并探讨血液透析患者睡眠质量与心包脏层脂肪的体积的相关性。结果两组患者性别和年龄均差异无统计学意义(P0.05),但睡眠障碍组患者CRP,瘦素较对照组更高,差异有统计学意义。睡眠障碍组EAT体积(170.0±17.0)cm3,对照组EAT体积(141.9±22.4)cm3,两组EAT差异有统计学意义(P0.05)。结论维持性血液透析患者发生睡眠质量与EAT体积的改变存在相关关系。     

维持性血液透析患者发生阻塞性睡眠呼吸暂停低通气综合征与血脂水平关系研究

目的 探讨维持性血液透析患者发生阻塞性睡眠呼吸暂停低通气综合征（OSAHS）与血脂水平的关系。方法 选取2015年7月至2016年7月来我院肾内科治疗的维持性透析患者74例,根据多导睡眠仪监测结果,分为OSAHS组32例和非OSAHS组42例。检测两组呼吸暂停低通气指数（AHI）、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇(HDL C)、低密度脂蛋白胆固醇(LDL C )、载脂蛋白A(ApoA)、载脂蛋白B（ApoB）并进行比较。采用Logistic回归分析维持性血液透析患者合并OSAHS的影响因素。结果 OSAHS组透析时间长于OSAHS组,但两组BMI比较差异无统计学意义（P>0.05）;OSAHS组TC、TG、LDL C、ApoB高于非OSAHS组（P<0.05）;Pearson相关分析发现,AHI与TC、ApoB呈正相关（P＜0.05）;Logistic回归分析显示,ApoB和TC为维持性血液透析患者发生OSAHS的危险因素（P＜0.05）。 结论 透析时间越长,出现OSAHS的概率越高,且OSAHS与血脂代谢紊乱有相互协同作用。     

Hemodialysis disrupts basic sleep regulatory mechanisms: building hypotheses

BACKGROUND: The proposition that hemodialysis may induce alterations in the sleep-wake cycle is based on two clinical observations: (a) Patients on dialysis frequently sleep during and after dialysis, and (b) the procedure often is associated with temperature elevations. A review of pertinent literature showed that sleepiness and temperature are physiologically related, and that these two variables are important indicators of sleep and circadian regulatory processes. OBJECTIVES: To describe possible associations among hemodialysis, body temperature, and sleepiness; to assist in building hypotheses; and to provide direction for future research. METHODS: Three exploratory studies were performed to investigate (a) dialysis-associated elevations in body temperature, (b) changes in body temperature patterns across the day, and (c) alterations in daytime sleepiness. RESULTS: The current study demonstrated that many patients manifest dialysis-associated episodic elevations of body temperature, changes in the circadian pattern of body temperature, and increases in daytime sleep propensity. In the context of the Two-Process Model of Sleep Regulation, these alterations provide a parsimonious explanation for the poor subjective sleep quality, prolonged sleep latency, and daytime sleepiness reported by these patients. CONCLUSIONS: These preliminary studies lead to the suggestion that hemodialysis may disrupt basic sleep regulatory mechanisms, and that further investigation in this area is warranted.     

Acute effects of hemodialysis on lung function in patients with end-stage renal disease

Impaired lung function in hemodialysis patients may be caused by an underlying pulmonary disease; however, the impact of uremia and the effects of dialysis treatment are not well understood. Our investigation aimed to characterize the acute effects of bicarbonate hemodialysis using membranes differing in biocompatibility on various parameters of lung function in unselected uremic patients maintained on regular hemodialysis. Fourteen clinically stable hemodialysis patients without acute lung disease were included in the study. Restrictive lung disease was present in eight of 14 cases and obstructive lung disease in one patient. A cellulose dialyzer membrane and a synthetic high-flux dialyzer membrane were each tested twice (two sessions one week apart). Spirometry (VCmax, FEV1, FEF(25-75%), PEF) was carried out before and after hemodialysis. Resistance was determined with the interrupter technique and with the impulse oscillation system (R5Hz, R20Hz) before, during and after hemodialysis. Our comparative investigation of two dialyzer membranes found that bioincompatibility of dialysis had no acute adverse effects on lung function in our heterogeneous population of dialysis patients. None of our patients experienced bronchoconstriction or aggravation of obstructive lung disease as a result of poor biocompatibility of the dialyzer membrane. Spirometric data and resistance measurements by two different methods showed no relevant changes during the dialysis procedure. There was no correlation between lung function parameters and interdialytic changes in body weight or duration on hemodialysis. Regardless of the membrane used, the hemodialysis procedure does not acutely affect lung function in uremic patients on maintenance hemodialysis. Hemodialysis is a safe procedure even in uremic patients with pre-existing lung disease.     

Sleep disorders in dialysis patients

By means of standardized interviews and a self-rating scale, information was obtained from 51 dialysis patients concerning their duration of sleep, fitness, working capacity, interests, quality of life, etc. 34 of the subjects reported sleep disorders: 2 had difficulties falling asleep, 21 in sleeping through, and 11 experienced both. Severity of the sleeping problems increases with prolonged hemodialysis therapy; the same seems to apply to lack of an active lifestyle. 9 patients, apart from repeated nocturnal urination, no longer complained about sleeping problems following kidney transplantation.     

安神热庵包足浴结合耳穴压豆对诱导透析患者睡眠质量的影响

目的观察安神热庵包足浴结合耳穴压豆对诱导透析期血液透析患者睡眠质量的改善效果。方法选取2018年2月至2019年4月本院收治的诱导透析期血液透析患者60例为研究对象,按照随机数字表法将其等分为对照组与研究组,对照组采取常规护理方法,研究组在常规护理方法的基础上,采取安神热庵包足浴结合耳穴压豆干预。比较两组患者焦虑、抑郁、睡眠质量和护理满意度评分。结果干预前,两组焦虑、抑郁、睡眠质量评分比较差异无统计学意义(P>0.05),干预后两组患者焦虑、抑郁、睡眠质量评分均较干预前降低(P<0.05),研究组焦虑、抑郁、睡眠质量评分均低于对照组(P<0.05);出院时研究组护理满意度评分高于对照组(P<0.05)。结论对诱导透析期血液透析患者,采取安神热庵包足浴结合耳穴压豆干预,可明显减轻焦虑和抑郁,改善睡眠质量,提高护理满意度。     

分析维持性血液透析患者睡眠障碍的影响因素

目的:分析维持性血液透析患者睡眠障碍的影响因素.方法:选取2019年1月至2020年11月南方医科大学第七附属医院收治的维持性血液透析患者80例作为研究对象,按照有无睡眠障碍分为观察组和对照组,其中对照组30例,未合并无睡眠障碍;观察组50例,合并睡眠障碍.采用匹兹堡睡眠指数量表(Pittsburgh Sleep Qu...     

单中心维持性血液透析患者睡眠质量的随访调查

目的 通过对单中心患者睡眠质量进行纵向分析,以探讨维持性血液透析(Maintenance haemodialysis,MHD)患者睡眠障碍的动态变化规律及其影响因素. 方法 以本中心稳定透析大于3个月的忠者为研究对象,采用匹兹堡睡眠指数(Pittsburgh sleep quality index,PSQI)量表及爱泼沃斯嗜睡量表(Epworth sleepiness scale,ESS)间隔15个月前后对本组病例的睡眠情况进行2次评估,并记录当月的血液生化相关指标以进行统计学分析. 结果 ①第1次评估中有60例患者完成调查,其存在睡眠障碍者占60％(PSQI＞5),日间嗜睡发生率为58.3％(ESS＞ 6);②第2次评估60例患者中有55例完成调查,其存在睡眠障碍者占89％,日 间嗜睡发生率为87.3％.本组病例15个月前后的比较,随着PSQI和ESS得分数值的升高,与其甲状旁腺激素(iPTH)、钙磷乘积,C反应蛋白(CRP)、血红蛋白(Hb)存在相关性,且具有统计学意义(P＜0.05). 结论 ①随着透析龄的增加睡眠障碍存在恶化的趋势.②睡眠障碍的恶化与 iPTH、钙磷乘积,CRP、Hb存在相关性.     

透析病人的疲劳状态测定和相关因素分析

目的 了解透析患者疲劳状态的严重程度,并筛选出影响透析患者疲劳的可能相关因素。方法 使用SF-36量表中的活力维度测量312例透析患者的疲劳得分,采用二元分析和多元线性回归方法筛选影响透析患者疲劳感受的独立危险因素。结果 在透析人群中,轻度、重度疲劳人群比例分别是46.2%,22.4%;血白蛋白水平、是否服用抗焦虑药物和睡眠质量得分是透析患者疲劳状态的独立危险因素。结论 尿毒症人群存在较严重的疲劳体验,应该主要从营养状况、情绪状态、睡眠质量三个角度来加以干预,从而减轻透析患者的疲劳状态。     

Pharmacokinetics of Amikacin During Hemodialysis and Peritoneal Dialysis

The pharmacokinetics of amikacin were examined in six bilaterally nephrectomized patients undergoing hemodialysis and in four patients with a minimal residual renal function undergoing peritoneal dialysis. The mean elimination half-life before the dialysis was 86.5 h in the anephric patients and 44.3 h in the patients with minimal residual kidney function. The results from the anephric patients suggest that some extrarenal elimination of amikacin may occur. The mean volume of distribution was about 25% of the total body weight. This is in accordance with values reported from subjects with normal renal function. During hemodialysis the half-life decreased to less than 10% (5.6 h) of the pretreatment value. The effectiveness of peritoneal dialysis was less as the half-life decreased to only about 30% (17.9 h) of the pretreatment value. During the dialyses a significant correlation between the half-life of amikacin and the decrease in blood urea and serum creatinine was demonstrated. The pharmacokinetic data were used to make dosage regimen recommendations for the treatment of patients undergoing intermittent hemodialysis or peritoneal dialysis.     

维持性血液透析治疗对睡眠障碍的影响

睡眠障碍是维持性血液透析患者常见的并发症之一,其发生发展是多种因素共同作用的结果,严重影响患者的生活质量。维持性血液透析的充分性、透析方案、透析的血管通路及透析并发症等都与睡眠障碍的发生密切相关。本文就维持性血液透析睡眠障碍的发病情况及血液透析对睡眠障碍的影响做一综述。     

Impact of early nephrology referral on mortality and hospitalization in peritoneal dialysis patients.

OBJECTIVES: Several studies have examined the possible association between late referral to a nephrologist and mortality on maintenance hemodialysis. However, we lack information on the benefit of early nephrologist referral in patients receiving peritoneal dialysis (PD). PATIENTS AND METHODS: In an inception cohort of 102 consecutive PD patients identified in a single center between 2003 and 2004, we sought to determine whether late nephrologist referral was associated with poor outcomes. The primary end point was all-cause mortality. The effects of early referral to a multidisciplinary low clearance clinic on cardiovascular mortality and length of hospitalization were also evaluated. RESULTS: Of 102 incident PD patients, 61 subjects (59.8%) were referred early to the nephrologist (more than 3 months) before dialysis initiation. During the study period of 284.9 patient-years (median follow-up period 36.8 months), 25 patients died, 12 due to cardiovascular causes. Both cardiovascular and all-cause mortality were significantly increased among PD patients with late referral, but the relationship between late referral and all-cause mortality was mitigated substantially by adjusting for relevant factors. In univariate analysis, late nephrology referral was associated with increased cardiovascular mortality, with a hazard ratio of 5.43 (95% confidence interval 1.46 - 20.21, p = 0.012). Annual adjusted days of hospitalization were similar between the early and late nephrology referral groups. CONCLUSIONS: A comprehensive analysis of incident PD subjects confirmed the significant relationship between late nephrology referral and all-cause and cardiovascular mortality. A causal relationship remains to be established and validated.     

维持性血液透析患者矿物质代谢异常与血管钙化的相关性研究

目的 研究维持性血液透析(maintenance hemodialysis,MHD)患者矿物质代谢异常与血管钙化的关系.方法 纳入四川省人民医院血液透析中心的MHD患者91例,检测其血钙、血磷、全段甲状旁腺激素(intact parathyroid hormone,iPTH)、甲状旁腺激素(parathyroid ho...     

Prevalence and occurrence of infections caused by hepatitis B virus in the dialysis units in the Apulia region

Sera of 803 hemodialysis patients and 413 staff members were tested to evaluate the relationship between infectivity markers and spread of HBV infection in dialysis units. HBsAg was detected in 13.8% patients undergoing chronic hemodialysis and 3.9% staff members. High prevalence of HBeAg and DNA polymerase activity was observed only in HBsAg positive patients. The highest titers of HBsAg and anti-HBc were detected in hemodialysis patients, whereas asymptomatic carriers showed low titers of these markers. A highly significant correlation was recorded between detection of HBeAg in patients and presence of serum DNA activity. These data suggest that in HBsAg hemodialysis patients a more active viral replication occurs and a higher contagiousness of these subjects.     

Pharmacokinetics of mezlocillin in patients with kidney impairment: special reference to hemodialysis and dosage adjustments in relation to renal function

The pharmacokinetics of Mezlocillin were determined after the intramuscular injection of a single 1-gram dose in 10 subjects with normal renal function, in 10 patients with stabilized renal impairment and in 5 patients with end-stage renal disease submitted to repeated hemodialysis. In normal subjects, biological half-life, Tb1/2, was equal to 0.9 h; total clearance (Ct) to 449 ml/min/1.73 m2; renal clearance (Cr) to 263 ml/min/1.73 m2.72.2% of the administered dose was excreted in the urine within 12 h. In patients with renal insufficiency and in patients undergoing long-term hemodialysis, the serum concentration decrease was markedly slower. During a 6-hour dialysis session, 62% of the Mezlocillin present in the central compartment at the start of hemodialysis was removed. In the 25 subjects under study, a significant correlation was found between the values of Ke and those of creatinine clearance, Ccr (Ke = 0.1973+0.0046 Ccr). This relation was used to calculate the loading doses, the maintenance doses and the dosage intervals adjusted to the degree of renal impairment, allowing assessment of useful dosage recommendations.     

老年维持性血液透析患者生存分析

目的分析老年维持性血液透析患者的生存情况,探讨影响老年维持性血液透析患者生存的主要危险因素。方法对2005年1月1日～2009年12月31日新进入维持性血液透析且年龄≥60岁的终末期肾病患者进行回顾性研究,随访至2010年12月31日。应用Kaplan-Meier法、Cox回归模型分析患者的生存资料。结果共131例血液透析患者,中位随访时间为25(14～41)月,死亡52例,中位生存期48(37.72～58.28)月。主要死因为充血性心力衰竭、感染、脑血管疾病。死亡患者的透始年龄、透析前合并脑血管疾病比例、合并充血性心力衰竭比例、Charison合并症指数(Charlson comorbidity index,CCI)≥5比例、首次透析血管通路为临时导管比例、透析原因为心力衰竭比例、透始eGFR均显著高于非死亡患者,而CCI=3～4比例、透始尿量、血肌酐、血白蛋白均显著低于非死亡患者。Kaplan-Meier生存曲线显示老年维持性血液透析患者1年、2年、3年、4年、5年生存率分别为80.9%、74.6%、63.2%、48.0%、33.9%。Cox回归分析显示透始年龄(HR=1.070,95%CI1.015～1.127,P<0.05)、透析前合并脑血管疾病(HR=2.052,95%CI1.035～4.068,P<0.05)、合并充血性心力衰竭(HR=1.888,95%CI1.029～3.463,P<0.05)、CCI≥5(HR=2.675,95%CI1.323～5.411,P<0.05)、透始血白蛋白(HR=0.949,95%CI0.901～0.999,P<0.05)是影响老年维持性血液透析患者生存的主要危险因素。结论老年维持性血液透析患者的主要死因为心血管疾病、感染、脑血管疾病。透始年龄、营养状况、合并疾病状况可能是影响老年维持性血液透析患者生存的主要危险因素。     

深静脉长期留置导管在维持性血液透析患者中的临床应用

目的比较以深静脉长期留置导管(导管组)与动静脉内瘘(内瘘组)为血管通路的血液透析患者营养状况、透析充分性及并发症的差异,探讨深静脉长期留置导管在维持性血液透析患者的临床意义。方法选择海军总医院肾脏病科2006年7月至2007年7月新建立导管组透析患者39例,新建立内瘘组透析患者40例,血管通路均使用3个月以上,随访36～48个月,观察2组透析患者入组年龄、最大血流量及观察终点前一月内每周红细胞生成素总量、射血分数(ejection fraction,EF)、透析前实验室指标、尿素清除率(Kt/V)、尿素下降率(urea reduction ratio,URR),以及观察期间2组感染、血栓、死亡发生情况,并进行比较。结果导管使用时间(21.5±7.7)月,内瘘使用时间(29.8±10.3)月,导管组与内瘘组患者比较,实验室检测指标间差异均无统计学意义(均P>0.05),内瘘组透析患者最大血流量、通路使用时间、Kt/V、URR、EF均显著高于导管组(均P<0.05),导管组感染率、血栓发生率及病死率均显著高于内瘘组(均P<0.05)。结论导管组与内瘘组患者营养状况相当,均可达到充分透析,尽管导管组血液透析患者有更高的感染率和血栓发生率,深静脉长期留置导管仍为维持性透析患者建立血管通路的极好补充形式。     

不同透析方式尿毒症患者抑郁症发病的研究

目的评价进行血液透析和腹膜透析治疗的尿毒症患者抑郁症的发病情况.方法采用汉密尔顿抑郁量表(HAMD)对40例血液透析患者和36例腹膜透析患者评估,比较评分的差异,同时比较程度的差异.结果血液透析组的抑郁症发生率(80%)明显高于腹膜透析组(69%),重度患者的百分比(25%)也高于腹膜透析组(12%).结论血液透析在治疗尿毒症的同时可以产生躯体症状,加重患者心理障碍.