Background: The efficacy of hemodialysis (HD) is closely associated with patient survival time and quality of life. The classical method (CLM) to calculate the urea clearance index (Kt/V) and urea reduction rate (URR)...Background: The efficacy of hemodialysis (HD) is closely associated with patient survival time and quality of life. The classical method (CLM) to calculate the urea clearance index (Kt/V) and urea reduction rate (URR) requires multiple blood tests. A novel method that may be used as a noninvasive alternative to CLM is required.Methods: Based on the urea kinetic model, a new method, named the "assessment method" (ASM), was established to calculate blood urea nitrogen after HD, based on parameters obtained during HD. The consistency of the Kt/V and URR values between the ASM and CLM was evaluated in 41 patients from the China-Japan Friendship Hospital between September 2017 and December 2018.Results: Forty-one patients (24 males and 17 females;mean age, 55.7 ± 14.2 years) undergoing regular HD in our hospital were randomly selected for this study. The blood flow rate was 244.5 ± 19.6 mL/min and the dialysate flow rate was 500 mL/min. We obtained Kt/V (CLM = 1.40 ± 0.06, ASM = 1.37 ± 0.07) and URR (CLM = 68.6 ± 6.4%, ASM = 67.7 ± 7.2%) values. Pairedt-test indicated no significant differences between the ASM- and CLM-derived values. The intraclass correlation coefficients were 0.907 and 0.916 for Kt/V and URR, respectively. Similarly, Bland-Altman plots suggested good concordance between the 2 methods.Conclusions: The Kt/V and URR values calculated using the ASM and CLM were in significant agreement, and both can be used to effectively assess the adequacy of HD in patients undergoing maintenance HD. The ASM is an effective, rapid, inexpensive, and noninvasive alternative to the CLM for obtaining Kt/V and URR values. The ASM has good potential for clinical application, particularly for patients in areas of low socioeconomic status.展开更多
Background A multi-center large scale study is needed to confirm the efficacy and safety of domestic peritoneal dialysis （PD） solutions. Some researchers believe that 6 Lid is enough for adequate dialysis, but there...Background A multi-center large scale study is needed to confirm the efficacy and safety of domestic peritoneal dialysis （PD） solutions. Some researchers believe that 6 Lid is enough for adequate dialysis, but there is no multi-center prospective study on Chinese population to confirm this. In this study, we evaluated the efficacy and safety of domestic PD solution （Changfu） and its difference between 6 L and 8 L dosage. Methods Adult PD patients who had taken PD therapy for at least one month were selected and divided into four groups according to two dialysis solution brands and two dialysis dosages, i.e., 6 L dose with Changfu dialysis solution, 6 L dose with Baxter dialysis solution, 8 L dose with Changfu dialysis solution, and 8 L dose with Baxter dialysis solution. After 48 weeks, the changes of primary and secondary efficacy indices were compared between different types and different dosages. We also analyzed the changes of safety indices. Results Changes of Kt/V from baseline to 48 weeks between Changfu and Baxter showed no statistical differences; so did those of creatinine clearance rate （Ccr）. Normalized protein catabolic rate （nPCR） from baseline to 48 weeks between Changfu and Baxter showed no statistical differences; so did those of net ultrafiltration volume （nUF） and estimated glomerular filtration rate （eGFR）. Changes of nPCR from baseline to 48 weeks between 6 L and 8 L showed no statistical differences; so did those of nUF and eGFR. The decline of Kt/V from baseline to 48 weeks in 6 L group was more than that in 8 L group. Change of Ccr was similar. During the 48-week period, the mean Kt/V was above 1.7/w, and mean Ccr was above 50 L.1.73 m-2.w1. More adverse events were found in Changfu group before Changfu Corporation commenced technology optimization, and the statistical differences disappeared after that. Conclusions The domestic PD solution （Changfu） was proven to be as effective as Baxter dialysis solution. During 48- week period, a dosage of 6 L/d was enough for these patients to reach adequate PD. Clinical study promotes technological optimization, further helps to improve the safety indices of the medical products.展开更多
The peritoneum response to peritoneal dialysis can lead to fibrosis. The transforming growth factor-β1 （TGF-β1） plays an important role in regulating tissue repair and remodeling after injury. Excessive synthesis ...The peritoneum response to peritoneal dialysis can lead to fibrosis. The transforming growth factor-β1 （TGF-β1） plays an important role in regulating tissue repair and remodeling after injury. Excessive synthesis and deposition of matrix proteins by peritoneal mesothelial cells can lead to structural and functional changes in the peritoneal membrane, jeopardizing the long-term efficacy of peritoneal dialysis （PD）. Prolonged exposure to high glucose concentrations in PD fluid has been implicated as a major stimulus to matrix accumulation, through the induction of transforming growth factor-β1 （TGF-β1）.展开更多
Severe lithium intoxication requires intensive and prolonged hemodialysis as a definitive therapeutic measure. Such an aggressive stand is often needed to prevent the post-dialytic rebound in plasma lithium levels as ...Severe lithium intoxication requires intensive and prolonged hemodialysis as a definitive therapeutic measure. Such an aggressive stand is often needed to prevent the post-dialytic rebound in plasma lithium levels as a result of the drug＇s relatively slow equilibration across cellular membranes. Use of a conventional, phosphorus-free, bicarbonate-based dialysis solution in the course of a dialytic treatment may engender hypophosphatemia in these individuals.展开更多
Background: A simplified protocol for regional citrate anticoagulation (RCA) using a commercial calcium-containing replacement solution, without continuous calcium infusion, is more efficient for use in continuous ren...Background: A simplified protocol for regional citrate anticoagulation (RCA) using a commercial calcium-containing replacement solution, without continuous calcium infusion, is more efficient for use in continuous renal replacement therapy (CRRT). We aim to design a randomized clinical trial to compare the safety and efficacy between calcium-free and calcium-containing replacement solutions in CRRT with RCA.Methods: Of the 64 patients receiving RCA-based postdilution continuous venovenous hemodiafiltration (CVVHDF) enrolled from 2017 to 2019 in West China Hospital of Sichuan University, 35 patients were randomized to the calcium-containing group and 29 to the calcium-free replacement solution group. The primary endpoint was circuit lifespan and Kaplan-Meier survival analysis was performed. Secondary endpoints included hospital mortality, kidney function recovery rate, and complications. The amount of 4% trisodium citrate solution infusion was recorded. Serum and effluent total (tCa) and ionized (iCa) calcium concentrations were measured during CVVHDF.Results: A total of 149 circuits (82 in the calcium-containing group and 67 in the calcium-free group) and 7609 circuit hours (4335 hvs. 3274 h) were included. The mean circuit lifespan was 58.1 h (95% CI 53.8-62.4 h) in the calcium-containing groupvs. 55.3 h (95% CI 49.7-60.9 h, log rankP = 0.89) in the calcium-free group. The serum tCa and iCa concentrations were slightly lower in the calcium-containing group during CRRT, whereas the postfilter iCa concentration was lower in the calcium-free group. Moreover, the mean amounts of 4% trisodium citrate solution infusion were not significantly different between the groups (171.1 ± 15.9 mL/hvs. 169.0 ± 15.1 mL/h,P = 0.49). The mortality (14/35 [40%]vs. 13/29 [45%],P = 0.70) and kidney function recovery rates of AKI patients (19/26, 73%vs. 14/24, 58%,P = 0.27) were comparable between the calcium-containing and calcium-free group during hospitalization, respectively. Six (three in each group) patients showed signs of citrate accumulation in this study.Conclusions: When compared with calcium-free replacement solution, RCA-based CVVHDF with calcium-containing replacement solution had a similar circuit lifespan, hospital mortality and kidney outcome. Since the calcium-containing solution obviates the need for a separate venous catheter and a large dose of intravenous calcium solution preparation for continuous calcium supplementation, it is more convenient to be applied in RCA-CRRT practice.展开更多
基金Trans- verse Research Project of China-Japan Friendship Hospital(No: 2017-HX-9)。
文摘Background: The efficacy of hemodialysis (HD) is closely associated with patient survival time and quality of life. The classical method (CLM) to calculate the urea clearance index (Kt/V) and urea reduction rate (URR) requires multiple blood tests. A novel method that may be used as a noninvasive alternative to CLM is required.Methods: Based on the urea kinetic model, a new method, named the "assessment method" (ASM), was established to calculate blood urea nitrogen after HD, based on parameters obtained during HD. The consistency of the Kt/V and URR values between the ASM and CLM was evaluated in 41 patients from the China-Japan Friendship Hospital between September 2017 and December 2018.Results: Forty-one patients (24 males and 17 females;mean age, 55.7 ± 14.2 years) undergoing regular HD in our hospital were randomly selected for this study. The blood flow rate was 244.5 ± 19.6 mL/min and the dialysate flow rate was 500 mL/min. We obtained Kt/V (CLM = 1.40 ± 0.06, ASM = 1.37 ± 0.07) and URR (CLM = 68.6 ± 6.4%, ASM = 67.7 ± 7.2%) values. Pairedt-test indicated no significant differences between the ASM- and CLM-derived values. The intraclass correlation coefficients were 0.907 and 0.916 for Kt/V and URR, respectively. Similarly, Bland-Altman plots suggested good concordance between the 2 methods.Conclusions: The Kt/V and URR values calculated using the ASM and CLM were in significant agreement, and both can be used to effectively assess the adequacy of HD in patients undergoing maintenance HD. The ASM is an effective, rapid, inexpensive, and noninvasive alternative to the CLM for obtaining Kt/V and URR values. The ASM has good potential for clinical application, particularly for patients in areas of low socioeconomic status.
文摘Background A multi-center large scale study is needed to confirm the efficacy and safety of domestic peritoneal dialysis （PD） solutions. Some researchers believe that 6 Lid is enough for adequate dialysis, but there is no multi-center prospective study on Chinese population to confirm this. In this study, we evaluated the efficacy and safety of domestic PD solution （Changfu） and its difference between 6 L and 8 L dosage. Methods Adult PD patients who had taken PD therapy for at least one month were selected and divided into four groups according to two dialysis solution brands and two dialysis dosages, i.e., 6 L dose with Changfu dialysis solution, 6 L dose with Baxter dialysis solution, 8 L dose with Changfu dialysis solution, and 8 L dose with Baxter dialysis solution. After 48 weeks, the changes of primary and secondary efficacy indices were compared between different types and different dosages. We also analyzed the changes of safety indices. Results Changes of Kt/V from baseline to 48 weeks between Changfu and Baxter showed no statistical differences; so did those of creatinine clearance rate （Ccr）. Normalized protein catabolic rate （nPCR） from baseline to 48 weeks between Changfu and Baxter showed no statistical differences; so did those of net ultrafiltration volume （nUF） and estimated glomerular filtration rate （eGFR）. Changes of nPCR from baseline to 48 weeks between 6 L and 8 L showed no statistical differences; so did those of nUF and eGFR. The decline of Kt/V from baseline to 48 weeks in 6 L group was more than that in 8 L group. Change of Ccr was similar. During the 48-week period, the mean Kt/V was above 1.7/w, and mean Ccr was above 50 L.1.73 m-2.w1. More adverse events were found in Changfu group before Changfu Corporation commenced technology optimization, and the statistical differences disappeared after that. Conclusions The domestic PD solution （Changfu） was proven to be as effective as Baxter dialysis solution. During 48- week period, a dosage of 6 L/d was enough for these patients to reach adequate PD. Clinical study promotes technological optimization, further helps to improve the safety indices of the medical products.
文摘The peritoneum response to peritoneal dialysis can lead to fibrosis. The transforming growth factor-β1 （TGF-β1） plays an important role in regulating tissue repair and remodeling after injury. Excessive synthesis and deposition of matrix proteins by peritoneal mesothelial cells can lead to structural and functional changes in the peritoneal membrane, jeopardizing the long-term efficacy of peritoneal dialysis （PD）. Prolonged exposure to high glucose concentrations in PD fluid has been implicated as a major stimulus to matrix accumulation, through the induction of transforming growth factor-β1 （TGF-β1）.
文摘Severe lithium intoxication requires intensive and prolonged hemodialysis as a definitive therapeutic measure. Such an aggressive stand is often needed to prevent the post-dialytic rebound in plasma lithium levels as a result of the drug＇s relatively slow equilibration across cellular membranes. Use of a conventional, phosphorus-free, bicarbonate-based dialysis solution in the course of a dialytic treatment may engender hypophosphatemia in these individuals.
基金1·3·5 project for disciplines of excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University(18HXFH018)
文摘Background: A simplified protocol for regional citrate anticoagulation (RCA) using a commercial calcium-containing replacement solution, without continuous calcium infusion, is more efficient for use in continuous renal replacement therapy (CRRT). We aim to design a randomized clinical trial to compare the safety and efficacy between calcium-free and calcium-containing replacement solutions in CRRT with RCA.Methods: Of the 64 patients receiving RCA-based postdilution continuous venovenous hemodiafiltration (CVVHDF) enrolled from 2017 to 2019 in West China Hospital of Sichuan University, 35 patients were randomized to the calcium-containing group and 29 to the calcium-free replacement solution group. The primary endpoint was circuit lifespan and Kaplan-Meier survival analysis was performed. Secondary endpoints included hospital mortality, kidney function recovery rate, and complications. The amount of 4% trisodium citrate solution infusion was recorded. Serum and effluent total (tCa) and ionized (iCa) calcium concentrations were measured during CVVHDF.Results: A total of 149 circuits (82 in the calcium-containing group and 67 in the calcium-free group) and 7609 circuit hours (4335 hvs. 3274 h) were included. The mean circuit lifespan was 58.1 h (95% CI 53.8-62.4 h) in the calcium-containing groupvs. 55.3 h (95% CI 49.7-60.9 h, log rankP = 0.89) in the calcium-free group. The serum tCa and iCa concentrations were slightly lower in the calcium-containing group during CRRT, whereas the postfilter iCa concentration was lower in the calcium-free group. Moreover, the mean amounts of 4% trisodium citrate solution infusion were not significantly different between the groups (171.1 ± 15.9 mL/hvs. 169.0 ± 15.1 mL/h,P = 0.49). The mortality (14/35 [40%]vs. 13/29 [45%],P = 0.70) and kidney function recovery rates of AKI patients (19/26, 73%vs. 14/24, 58%,P = 0.27) were comparable between the calcium-containing and calcium-free group during hospitalization, respectively. Six (three in each group) patients showed signs of citrate accumulation in this study.Conclusions: When compared with calcium-free replacement solution, RCA-based CVVHDF with calcium-containing replacement solution had a similar circuit lifespan, hospital mortality and kidney outcome. Since the calcium-containing solution obviates the need for a separate venous catheter and a large dose of intravenous calcium solution preparation for continuous calcium supplementation, it is more convenient to be applied in RCA-CRRT practice.
