A Quality and Cost-Benefit Analysis of Dialyzer Reuse in Hemodialysis Patients

Background. To evaluate the benefits of dialyzer reuse for hemodialysis (HD) patients, including the cost of HD treatment and patient's survival, a comparison was made regarding the standard practice of single-use dialysis. Methods. From January 1, 2005, to December 31, 2005, a total of 128,232 successive HD treatments in 822 patients in Chang Gung Memorial Hospital-Kaohsiung Medical Center were included in this study. Results. Approximately 54.25% (446/822) of patients reused dialyzers. The average times of dialyzer reuse was 2.54. The annual hollow fiber cost is reduced by $241,054.08 U.S. dollars (NT $7,834,257.60). The annual cost of hollow fiber was reduced by $540.48 U.S. dollars (NT $17,565.60) in one patient with dialyzer reuse. The mortality rates in dialyzer reuse and single use groups were 3.1% and 10.9% within one year (p < 0.0001). Multiple logistic regressions showed that single use compared with reuse was associated with higher mortality after adjusting co-morbid conditions including age, diabetes mellitus, etc. Conclusions. We concluded that the benefits of dialyzer reuse included safety in our center and reduction in cost during a 12-month period. Dialyzer reuse may be a safe alternative.     

Ethylene-Vinyl Alcohol Copolymer Dialyzer Membrane Reduces Protein Oxidation in Hemodialysis Patients

Background: Oxidative stress has been implicated in the cardiovascular complications that affect hemodialysis (HD) patients. Ethylene-vinyl alcohol copolymer (EVAL) dialyzer membrane induces less production of reactive oxygen species as compared to conventional dialyzers. We evaluated the impact of EVAL membrane on plasma protein oxidation in HD patients.?Methods:?HD patients treated with cellulose triacetate (CTA) dialyzers were selected. In the first study performed in a 2-month crossover design alternating between CTA and EVAL, nonmercaptalbumin and advanced oxidation protein products levels were measured in the predialysis blood from 10 subjects. In the second study, predialysis plasma myeloperoxidase levels were measured before and after a 2-week EVAL treatment on 12 patients.?Results:?Plasma advanced oxidation protein products levels were reduced after a 2-month EVAL treatment and increased again after CTA treatment, although the nonmercaptalbumin proportions were not affected significantly by the change in dialyzer membranes. The following study, a 2-week EVAL treatment, showed the decrease in myeloperoxidase levels immediately before HD.?Conclusion:?The frequent use of EVAL dialyzers has been shown to reduce protein oxidation, possibly through the suppression of circulating phagocytes. This novel biocompatible dialyzer is expected to protect cardiovascular mortality in HD patients.     

血液透析病人透析器首次使用综合征预处理的探讨

目的探讨减少血液透析病人出现透析器首次使用综合征 (FUS)的护理方法。方法将首次使用透析器的 10 8例病人随机分为治疗组与对照组各 5 4例。治疗组在血液透析前予地塞米松 5mg加入 0 .9%氯化钠注射液 5 0 0ml中循管 10min ;对照组仅用 0 .9%氯化钠注射液 5 0 0ml循管 10min。结果治疗组FUS发生率 3.7% ,对照组31.5 % ,两组比较 ,差异有显著性意义 (P <0 .0 1) ;两组均无出血征象 ,透析开始后 1、2hAPTT值比较 ,差异均无显著性意义 (P >0 .0 5 )。结论血液透析病人第 1次透析或更换不同类型透析器时使用地塞米松 5mg加入 0 .9%氯化钠注射液 5 0 0ml中循管 10min的预处理方式能减少FUS的发生 ,且不增加出血风险。     

Eluted Substances From Hemodialysis Membranes Elicit Positive Skin Prick Tests in Bioincompatible Patients

Recently, hypotension and malaise during hemodialysis using polysulfone (PS) membranes have been reported. This study aimed to evaluate the bioincompatibility of eluted substances from PS hemodialysis membranes that can induce hypotension, malaise, and anaphylactic shock. Polyvinylpyrrolidone (PVP) elution from five hemodialysis membranes was measured in an in vitro experimental circulation. Skin prick tests (SPTs) with PVP or the priming fluid of hemodialysis membranes were carried out for seven PS membrane‐incompatible patients and seven healthy volunteers. Skin reactivity for histamine was compared in patients and healthy volunteers. The symptoms of PS membrane‐incompatible cases were hypotension, dyspnea, nausea, or vomiting. One patient had gone into shock. PVP was eluted from hemodialysis membranes, but the SPT for PVP was negative in all patients. SPTs with priming fluid (or priming fluid effluxed during priming) were positive in four out of six patients. However, the SPT with bisphenol A was positive in one patient. The area of the flare reaction against histamine in patients was smaller than that of healthy subjects. In conclusion, eluted substances apart from PVP from hemodialysis membranes could cause bioincompatibility with PS membranes.     

Hemodialysis with Regenerated Cellulosic Membranes Does Not Reduce Plasma Selenium Levels in Chronic Uremic Patients

Abstract: Selenium (Se) is considered an essential and very important trace element for humans. Se blood levels are frequently low in end-stage renal disease (ESRD) patients, but very little has been established concerning the mechanisms that could modify Se status in uremia, including a supposed dialysis-mediated Se depletion. In order to verify whether hemodialysis (HD) can induce a loss of Se, thereby leading or contributing to a low plasma Se concentration, we investigated the effect of HD procedure with the most commonly used regenerated cellulosic membrane (Cuprophan) on plasma Se levels in 20 uremic patients on HD for 62.5 ± 49.4 months. Plasma Se levels were also determined in 15 chronic renal failure (CRF) nondialyzed patients and in 28 age-matched healthy controls. Se concentration was determined by atomic absorption spectrophotometry. Plasma Se levels of both HD patients (61.3 ± 8.5 μ/L) and CRF nondialyzed patients (56.4 ± 10.1 μg/L) were significantly lower than in normal subjects (78.3 ± 9.7 μg/L, p < 0.001). In CRF nondia-lyzed patients, a significant (p < 0.05) negative correlation was found between the plasma Se concentration versus serum creatinine values. Within the HD group, plasma Se levels significantly increased after the HD procedure (72.8 ± 17.2 μg/L, p < 0.02) together with hemat-ocrit and total plasma protein values (p < 0.05 and p < 0.001, respectively). In the hollow fiber dialyzer during an HD session, the Se concentration increased but not significantly from the blood inflow site (64.6 ± 12.5 μg/L) to the outflow site (72.6 ± 17 μg/L) and decreased, again not significantly, from the dialysate entrance (5 ± 1.9 μg/L) to the outlet (4.8 ± 2.5 μ?.). In HD with low-flux regenerated cellulosic dialyzer, very likely due to the high molecular weight of Se-binding proteins, the replacement treatment did not induce a Se loss in chronic uremic patients with a low plasma Se concentration.     

左旋卡尼丁治疗维持性血液透析患者微炎症状态的初步研究

目的:通过观察静脉注射左旋卡尼丁对维持性血液透析(maintenance hemodialysis,MHD)患者相关营养和炎症指标的影响,探讨左旋卡尼丁对MHD患者微炎症的治疗作用.方法:选择透析龄超过6个月的MHD患者62例,随机分为治疗组和对照组,已排除急性感染及其他活动性疾病,每次透析结束后,治疗组给予静脉注射左旋卡尼丁1 g,进行为期3个月随访,分别检测治疗前、治疗1月后、治疗3月末患者的主要人体学指标、改良SGA评分、血生化指标、C反应蛋白(CRP)、透析充分性(Kt/V)和蛋白分解代谢率(PCR).结果:(1)治疗组1月后,MHD患者的干体重、上臂肌围(MAMC)就有上升;治疗组3个月后,患者平均干体重、MAMC平均值较治疗前显著升高(均P＜0.05).改良SGA评分较治疗前明显下降(P＜0.01);对照组以上各项均无变化,治疗组与对照组比较有统计学差异(均P＜0.05).(2)治疗组3个月后,MHD患者的血白蛋白(Alb)(P＜0.05)、前白蛋白(PA)和血红蛋白(Hb)(均P＜0.01)较治疗前明显升高;对照组以上各项均无变化,治疗组与对照组比较有统计学差异(均P＜0.05).(3)治疗组CRP平均值较治疗前明显下降、与对照组相比差异十分显著(P＜0.01).(4)两组血总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和脂蛋白(a)[Lp(a)]水平治疗前后无统计学差异(P＞0.05).(5)治疗组PCR值较治疗前明显上升,与对照组相比有统计学差异(均P＜0.01);两组Kt/V治疗前后无明显变化(P＞0.05).结论:左旋卡尼丁可明显改善患者的营养状态,同时降低血CRP浓度及微炎症状态,这种作用可能通过调整由前炎症因子和氧化应激造成的特异性胞内信号传导级联的激活,从而提高细胞对慢性炎症和氧化应激的防御功能.     

维持性血液透析患者主动脉钙化相关影响因素分析

目的：探讨维持性血液透析（MHD）患者主动脉钙化的相关影响因素。方法：采用胸部正位X线成像技术检测183例MHD患者主动脉钙化情况,将入选患者分为主动脉钙化组（A组）和主动脉无钙化组（B组）,透析前抽血检测血钙、血磷、全段甲状旁腺激素（iPTH）、C反应蛋白（CRP）和血清白蛋白（Alb）等指标,并计算钙磷乘积,比较两组年龄、透析龄和血清学指标的差异,将上述指标与主动脉钙化进行相关性分析,并对筛选出来的危险因素进行非条件Logistic回归分析。结果：A组和B组在年龄、透析龄、血磷、钙磷乘积和CRP水平方面,差异均有统计学意义（P〈0.01或P〈0.05）;MHD患者主动脉钙化的相关影响因素包括：年龄、透析龄、血磷、钙磷乘积及CRP;Logistic回归分析表明,年龄、透析龄和血磷是主动脉钙化的独立危险因素（P〈0.01）。结论：MHD患者主动脉钙化相当常见,主动脉钙化与年龄、透析龄、钙磷代谢和炎症状态有关。     

维持性血液透析患者营养状况的评价

目的：评价维持性血液透析(MHD）患的营养状况。方法：对57例维持性血透患进行人体测量、生化指标的测定、饮食评估、主观综合营养评估(SGA)及综合性营养评估(GNA)。结果：不同指标评估营养不良的发生率分别为：三头肌皮皱厚度(TSF)66．7％，上臂中段肌肉周径(MAMC)33．3％，白蛋白(Alb)31．6％，前白蛋白(PA)45．6％，转铁蛋白(TRF)63．2％，饮食蛋白摄入(DPI)33．3％，SGA38．6％，GNA47．4％。各项指标均属正常仅占14，0％。依据GNA评分，营养不良组与营养良好组进行比较，Alb、PA、蛋白分解率(nPCR)、DPI、SGA评分均有统计学差异。结论：综合评价结果表明86．0％透析患存在不同程度的营养不良。GNA对血透患具有良好的营养评价作用。对MHD患进行常规的营养评价及合理的营养指导对预后有重要意义。     

Improvement of Intradialytic Hypotension in Diabetic Hemodialysis Patients Using Vitamin E‐Bonded Polysulfone Membrane Dialyzers

Currently, there are no detailed reports on the effects of vitamin E‐bonded polysulfone (PS) membrane dialyzers on intradialytic hypotension (IDH) in diabetic hemodialysis (HD) patients. This study was designed to evaluate changes in intradialytic systolic blood pressure (SBP) using “VPS‐HA” vitamin E‐bonded super high‐flux PS membrane dialyzers. The subjects were 62 diabetic HD patients whose intradialytic SBP fell by more than 20%. Group A comprised patients who required vasopressors to be able to continue treatment or who had to discontinue therapy due to their lowest intradialytic SBP being observed at 210 min (28 patients). Group B comprised patients who showed no symptoms and required no vasopressors but showed a gradual reduction in blood pressure, with the lowest intradialytic SBP seen at the end of dialysis (34 patients). The primary outcome was defined as the lowest intradialytic SBP after 3 months using VPS‐HA. Secondary outcomes included changes in the following: lowest intradialytic diastolic blood pressure, pulse pressure, pulse rate, plasma nitric oxide and peroxynitrite, serum albumin, and hemoglobin A1c. Group A's lowest intradialytic SBP had significantly improved at 3 months (128.0 ± 25.1 mm Hg vs. 117.1 ± 29.2 mm Hg; P = 0.017). Group B's lowest intradialytic SBP had significantly improved at 1 month (134.4 ± 13.2 mm Hg vs. 121.5 ± 25.8 mm Hg; P = 0.047) and 3 months (139.1 ± 20.9 mm Hg vs. 121.5 ± 25.8 mm Hg; P = 0.011). We conclude that VPS‐HA may improve IDH in diabetic HD patients.     

Dialysis in Rats with Acute Renal Failure: Evaluation of Three Different Dialyzer Membranes

Abstract: Exposure to complement-activating cellulosic dialysis membranes has been claimed to adversely affect the course of acute renal failure (ARF). To test this hypothesis, male Sprague-Dawley rats were allocated to 2 groups: in Group t, ARF was induced by bilateral renal artery clamping whereas in Group 2, animals underwent a sham procedure. In each group, rats were further allocated to undergo hemodialysis with either a Cu-prophan, a Hemophan, or a polyacrylonitrile minidialyzer on Days 4 and 8 after surgery, or no dialysis. Renal function was measured by inulin clearance on the days after dialysis. Additionally, total complement activity (CH₅₀) was estimated on Days 1, 2, 4, and 8, and complement factor C3 was detected immunohistochemically. The degree of renal failure and the rate of recovery of renal function were similar in all the ARF groups irrespective of whether they had undergone dialysis or not, or of the type of the dialysis membrane. Furthermore, there were no significant differences in the course of CH₅₀ or in the amount and distribution of complement factor C3 in the kidney tissue between the rats of Groups 1 and 2. Our findings refute the hypothesis that in ischemic ARF exposure to complement-activating cellulosic dialysis membranes impairs the recovery of renal function in rats.     

血液灌流对维持性血透患者微炎症和营养不良的影响

目的：观察血液灌流对尿毒症血液透析患者微炎症和营养不良的影响。方法：选择维持性血液透析患者46例,随机分为两组：血液灌流联合血液透析组（HD＋唧组）24例和单纯血液透析组（m组）22例,分别于治疗前、治疗3个月后采血检测C反应蛋白（CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、血清白蛋白、转铁蛋白（TF）、血红蛋白、尿素氮、肌酐等生化指标;使用改良定量主观整体评估法（MQSGA）评估营养状况;健康人16例作为对照组。结果：两组患者血CRP、IL-6、TNF-α水平均高于正常对照组（P〈0．01）,两组之间各因子水平无统计学差异（P〉0．05）;两组患者均存在营养不良,两组之间营养不良发生率无统计学差异（P〉0．05）。HD＋HP治疗后各因子水平较治疗前显著降低（P〈0．01）。营养不良发生率显著下降,MQSGA评分显著降低（P〈0．01）;HD组治疗前后无统计学差异（P〉0．05）。结论：血透患者存在着微炎症状态和营养不良,血液灌流可有效清除炎症介质,改善营养状况,降低营养不良的发生率。     

高通量透析对维持性血液透析患者中医证候的影响

目的：观察高通量透析（HFHD）对维持性血液透析（MHD）患者中医证候以及营养不良和微炎症状态的影响。方法：采用随机对照,A组应用高通量透析,B组应用普通透析,比较治疗前及治疗后中医证候积分（TCM syndromes cores）,及治疗后血红蛋白（Hb、血浆白蛋白（Alb）、前白蛋白（PAB）、超敏C反应蛋白（hs-CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、肱三头肌皮皱厚度（TSF）、上臂中段肌肉周径（MAMC）等指标变化。结果：（1）治疗4周、8周后,A组中医实证积分、虚证积分、总积分与治疗前相比有降低趋势,但差异尚无统计学意义（P〉0.05）。12周后与治疗前比较,A组中医证候积分均明显下降（P〈0.05）,B组证候积分与治疗前相比差异无统计学意义（P〉0.05）。治疗12周A组临床疗效优于B组（P〈0.01）。（2）治疗12周时,A组Hb、Alb、PAB明显上升（P〈0.05）,hs-CRP、IL-6、TNF-α水平与治疗前相比明显下降（P〈0.01）,TSF升高（P〈0.01）,MAMC有升高趋势,但差异尚无统计学意义。B组患者Hb、Alb、PAB、hs-CRP、IL-6、TNF-α水平与治疗前相比差异无统计学意义（P〉0.05）,两组治疗12周后,A组IL-6水平低于B组患者（P〈0.05）。结论：HFHD可减少MHD患者中医证候临床积分,改善患者营养不良及微炎症状态。     

Adsorption of Nafamostat Mesilate by Hemodialysis Membranes

The adsorption of the anticoagulant nafamostat mesilate (FUT-175) by five different hemodialysis membranes was studied in vivo and in vitro. In vivo, FUT-175 was adsorbed strongly by a polyacrylonitrile (AN69) membrane and slightly by another polyacrylonitrile (J-PAN) membrane but not by Cuprophan (CU), hemophan (HE), or polymethylmethacrylate (PMMA) membranes during hemodialysis performed in 4 patients in whom FUT-175 was used as an anticoagulant. Only during hemodialysis using the AN69 membrane did FUT-175 not induce a significant prolongation of celite-activated coagulation time. In vitro studies showed that FUT-175 was adsorbed by the AN69, J-PAN, and PMMA membranes but not by the CU and HE membranes. Methylene blue, a dye that possesses a cationic portion in its chemical structure, stained AN69, J-PAN, and PMMA membranes. Since FUT-175 also possesses a cationic portion, we conclude that FUT-175 is adsorbed by negatively charged membranes via an ionic bond and is unsuited for use as an anticoagulant in hemodialysis using an AN69 membrane because of that membrane's marked capacity to adsorb FUT-175.     

维持性血液透析患者的睡眠与生存质量的相关研究

目的：了解维持性血液透析患者的睡眠质量,分析睡眠质量与生存质量的关系。方法：采用便利抽样的方法,使用匹兹堡睡眠质量指数量表（PSQI）、简明健康调查问卷（SF-36）及一般情况调查表、对我院等七家医院血液透析患者进行调查与分析。结果：有93.2%的患者PSQI总分≥5分,患者在各方面的生存质量较低,睡眠质量各因子得分与生存质量各因子得分均呈负相关,即PSQI得分越低,生存质量越高。结论：维持性透析患者的睡眠质量较差,睡眠质量影响生活质量,提高他们的睡眠质量对治疗和生存都有极为重要的意义。     

Dialyzer Performance in the Clinic: Comparison of Six Low-Flux Membranes

The aim of this study is to assess the clinical performance of 6 different low-flux dialysis membranes under steady-state conditions in terms of urea and phosphate clearances. Ten stable hemodialysis patients were examined. The following dialyzers were studied, all in 1.5- to 1.6-m2 format: cuprammonium, cellulose acetate, cellulose diacetate, hemophane, polysulfone (low-flux), and polysynthane. The following parameters were examined: urea reduction ratio, phosphate reduction ratio, "instantaneous dialyzer clearance" for urea and phosphate, and total amount of urea and phosphate removed in the dialysate over a 1-week (three dialyses) period. Although there were differences between the membranes, all produced results within a narrow range. There was no one membrane that produced superior clearances in all categories. The cellulose acetate membrane was the least satisfactory membrane. Phosphate clearances were at best one third that of urea clearances. When choosing a low-flux dialysis membrane, urea and phosphate clearances are so similar amongst different membranes that other criteria are likely to have a greater influence on the choice of membrane.     

维持性血液透析患者颈动脉钙化相关因素分析

目的：探讨慢性肾衰竭维持性血液透析（MHD）患者颈动脉钙化情况并分析相关因素。方法：对35例MHD患者应用彩色B型超声仪观测双侧颈动脉内膜-中膜厚度（IMT）及钙化情况,同时记录透析龄、收缩压、脉压差,抽血检测血钙、磷、血胆固醇、三酰甘油、白蛋白、C反应蛋白（CRP）、甲状旁腺素,并计算钙磷乘积。结果：35例终末期肾病（ESRD）患者18例（51.4%）存在颈动脉钙化。钙化组IMT值较无钙化组显著增高（P〈0.01）,透析龄、收缩压、脉压差、血磷、钙磷乘积、CRP较无钙化组明显增高（P〈0.05）,而钙化组血浆白蛋白较无钙化组显著降低（P〈0.05）。结论：IMT值、透析龄、血磷、钙磷乘积增高是颈动脉钙化的主要影响因素,收缩压、脉压差、CRP升高和低血浆白蛋白与颈动脉钙化密切相关。MHD患者存在较高的颈动脉钙化率。     

比索洛尔对维持性血液透析患者高血压及心率变异性的影响

目的:观察比索洛尔对维持性血液透析患者高血压及心率变异性的疗效。方法:选取2010年6月～12月在我科行维持性血液透析患者33例,在常规高血压治疗基础上加用比索洛尔5～10mg/d,观察时间为6个月,治疗前和治疗6月后检测动态心电图和生化指标。结果:比索洛尔能明显降低维持性血液透析患者的血压(P<0.05),改善心率变异性(P<0.05),减少心律失常的发生率(P<0.05),而对血清总胆固醇、尿酸、血糖没有明显影响(P>0.05)。结论:比索洛尔能改善维持性血液透析患者的心率变异性,是安全有效的治疗措施。     

番茄红素对血液透析患者静脉铁剂诱导细胞因子的影响

目的：观察维持性血液透析（MHD）患者由静脉铁剂诱导的细胞因子,探讨番茄红素对其的干预作用。方法：60例MHD患者,随机分为两组（对照组和试验组,各30例）。对照组：在患者透析时给予蔗糖铁注射液100mg,2次/周,共10次,观察时间8周。试验组：除蔗糖铁注射液使用外,同时口服番茄红素胶囊,2粒/次,2次/d,用药8周,观察时间8周。观察并比较两组患者治疗前及治疗8周后的白细胞介素-1β（IL-1β）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、白细胞介素-10（IL-10）、白细胞介素-18（IL-18）、肿瘤坏死因子（TNF-α）等细胞因子指标的变化。结果：两组患者治疗后IL-1β、IL-6、IL-8、TNF-α、IL-18水平较治疗前均有显著性升高（P〈0.01或〈0.05）;但是试验组升高幅度显著性小于对照组（P〈0.01）。试验组患者治疗后IL-10水平较治疗前有显著性升高（P〈0.01）;并且试验组升高幅度显著性大于对照组（P〈0.05）。治疗后两组血清IL-1β、IL-6、IL-8、TNF-α、IL-18水平均与铁蛋白（SF）呈正相关（P〈0.01）。结论：静脉铁剂治疗加剧了MHD患者免疫细胞因子的调节;番茄红素可减少细胞因子过度调节而起到抗炎症作用。     

维持性血液透析患者血清瘦素水平与细胞因子关系的研究

目的：探讨维持性血液透析（MHD）患者血清瘦素（1eptin）水平与肿瘤坏死因子-α（TNF—α）及白细胞介素-6（IL-6）的关系。方法：选择维持性血液透析患者30例、非血液透析患者20例终末期肾衰竭（ESRD）患者和正常人15例，检测其血浆瘦素和TNF—α、IL-6水平及其相关性分析。结果：血液透析患者血清瘦素、TNF—α、IL-6水平明显高于正常人群（P〈0．01，P〈0．05，P〈0．05），但血液透析组和非透析组比较虽有增加的趋势，但无统计学意义（P〉0，05）。血液透析组和非透析组血浆瘦素水平均与TNF—α、IL-6水平呈正相关（r=0．492，P〈0，05；r=0.481，P〈0．01：r=0．503，P〈0，02；r=0，404，P〈0，05）。结论：血液透析组和非透析组血浆瘦素、TNF—α和IL-6水平均明显升高，且血浆瘦素水平与TNF—α和IL-6水平明显相关，提示瘦素水平与促炎症因子的关系值得进一步研究。两者相互作用可能参与ESRD患者心血管并发症的发生。