Effect of Hemodialysis on Intraocular Pressure

Abstract: Intraocular pressure (IOP) was determined in 13 dialysis patients before, during, and after dialysis. The values were compared with those obtained in an age-, sex-, and time-matched normal control group. The IOP values obtained in dialysis patients were significantly lower than those in the control group. An insignificant decrease in IOP was noted during the first 2 h of dialysis. This was followed by a slight rise above the base line by the end of dialysis. Although the middialysis IOP was significantly lower than the postdialysis value, the latter was not significantly different from the predialysis value. Our results are at variance with several earlier studies demonstrating marked increase in IOP during dialysis. Lack of significant rise in IOP during dialysis in our study seems to be due to improved dialytic technique and better uremia control employed here as compared with the earlier studies.     

Oral Glucose Tolerance Test After High-Dose i.v. Biotin Administration in Normoglucemic Hemodialysis Patients

Abnormal glucose metabolism in uremia may result from a complex interplay between decreased insulin secretion and insulin resistance. Recent studies report beneficial effect of biotin administration in glucose metabolism in diabetic animals and in a small number of patients with diabetes mellitus. The aim of the present study was to evaluate the response of oral glucose tolerance test (OGTT) to the i.v. administration of large doses of biotin in hemodialysis patients. Eleven hemodialysis patients aged 56.90 ± 11.20 (32–76) years on regular hemodialysis thrice a week for 2.72 ± 1.79 (1–7) years were studied. Fasting venous plasma glucose, glucosylated hemoglobin (%GH), and plasma glucose concentration 2 h after the administration of a 75-g glucose load were measured before, and 2 weeks and 2 months after administration of 50 mg of biotin i.v. postdialysis, and after a 2-month washout period. During the study, dialysis schedule and patients' medication, diet, and dry weight were kept unchanged. OGTT was abnormal in 4 patients before biotin administration and became normal in 3 patients (75%). Our results offer support to the findings of other studies about the beneficial effect of biotin in experimental or clinical diabetes mellitus, and argue for the involvement of biotin in glucose metabolism.     

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。     

番茄红素对血液透析患者静脉铁剂诱导微炎症状态的影响

目的：观察维持性血液透析（MHD）患者由静脉铁剂诱导的微炎症状态,探讨番茄红素对其的干预作用。方法：60例MHD患者,随机分为对照组和试验组,每组各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周后的血红蛋白（Hb）、红细胞比容（Hct）、血清铁（SI）、铁蛋白（SF）、转铁蛋白饱和度（TSAT）以及白细胞介素-1β（IL-18）、白细胞介素-6（IL-6）、白细胞介素-10（IL-10）、肿瘤坏死因子（TNF—α）、C反应蛋白（CRP）等指标的变化。结果：两组患者治疗后IL-18、IL-6、TNF—α及CRP水平较治疗前均有显著性升高（P〈0．01或P〈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）;两组血清IL-6、TNF—α水平均与SF呈正相关（P〈0．01）：两组Hb、Hct、SI、SF、TSAT较治疗前均有显著性升高（P〈0．01）,并且两组升高幅度相似,差异无统计学意义。结论：静脉铁剂治疗加剧了MHD患者的微炎症状态。番茄红素可减轻这种微炎症状态。     

空腹血糖异常相关因素调查分析

目的 了解空腹血糖（FPG）异常的相关因素，指导健康教育工作。方法 从3885名健康查体人员中检出315例FPG异常者，并与血糖正常者进行比较分析。结果 年龄＞40岁、体重指数（BMI）≥25、高血脂、高血压者FPG异常的发生率明显高于年龄≤40岁，BMI＜25，血脂、血压正常者（均P＜0．005）。结论 40岁以上、BMI≥25、高血脂、高血压者FPG异常发生率高，是糖尿病高危人群，应加强筛查和开展针对性的健康教育，指导其控制体重、血脂、血压于正常范围。     

Improvement of Clinical Outcome by Early Nephrology Referral in Type II Diabetics on Hemodialysis

Objectives. To evaluate the influence of early nephrology referral on clinical outcome in type II diabetes mellitus patients on maintenance hemodialysis dialysis. Patients and Methods.?This study retrospectively analyzed the type II diabetic patients entering our PD program from 02 1988 to 06 2001. Patients who were presented to a nephrologist more than 6 months before starting dialysis were defined as early referral (ER). Patients were considered late referral (LR) if they were transferred to the nephrology department within 6 months before initial dialysis. Results.?Hundred and fifteen type II diabetic patients receiving HD for at least 3 months were enrolled in this study. Sixteen of the 53 patients (46.1%) were in the ER group and 62 of the 115 (53.9%) were in the LR group. In univariate analysis by Cox proportional hazards mode, the early referral (Exp (Coef) = 0.423, p<0.01), good glycemic control (Exp (Coef) = 0.16, p<0.05), and age at dialysis (Exp (Coef) = 1.026, p<0.05 (had significantly influenced the patient survival. The residual renal function in the ER group, estimated by creatinine clearance (Ccr), significantly exceeded that of the LR group (ER vs. LR: 4.46 ± 1.56 vs. 2.51 ± 1.70 mL/min, p<0.001). The patients with early referral had significantly better survival (p<0.05). Five-year survival improved significantly in the early referral group compared to the late referral group (ER: 72.4%; LR: 35.2%, p<0.05). Conclusions.?We demonstrate that the time of referral before starting dialysis is a predictor of survival for type II diabetics on HD. Patients with early referral are associated with longer survival. The beneficial effect might be associated with the timely initiation of the chronic HD program. These results suggest that early referral before dialysis is important in determining the long-term prognosis in type II diabetics on HD.     

Exercise Training During Hemodialysis Reduces Blood Pressure and Increases Physical Functioning and Quality of Life

Hypertension and cardiovascular diseases are highly prevalent in hemodialysis patients and are associated with the reduction of physical functioning and quality of life. We evaluated the effects of supervised aerobic exercise training on physical functioning, blood pressure, quality of life, and laboratory data in hemodialysis patients. Fourteen patients were evaluated at the beginning and after 12 weeks of stretching exercises (control phase) and at the end of 12 weeks of aerobic exercise training performed during hemodialysis sessions (intervention phase). Patients underwent a 6‐min walking test (6MWT), 24‐h ambulatory blood pressure monitoring, a Medical Outcomes Study 36—Item Short‐Form Health Survey (SF‐36) quality of life questionnaire, and blood sample collections. After the intervention phase, the 6MWT distance increased from 508.7 ± 91.9 m to 554.9 ± 105.8 m (P = 0.001), systolic and diastolic blood pressure decreased respectively from 150.6 ± 18.4 mm Hg to 143.5 ± 14.7 mm Hg and from 94.6 ± 10.5 mm Hg to 91.4 ± 9.7 mm Hg (P < 0.05), while hemoglobin levels increased from 10.8 ± 1.2 g/dL to 11.6 ± 0.8 g/dL (P < 0.05). Moreover, there was a significant increase in the physical functioning, social functioning, and mental health dimensions of the SF‐36. Aerobic exercise training during hemodialysis increased physical functioning, reduced blood pressure levels, and improved the control of anemia and quality of life in patients with end‐stage renal disease.     

Patient and nursing experience of flash glucose monitoring following kidney transplantation

Flash glucose monitoring (FGM) is increasingly used for blood glucose assessment due to ease of use and is now subsidized in Australia for blood glucose measurement for patients with Type 1 Diabetes Mellitus. Dysglycaemia is common following kidney transplantation and is associated with worse outcomes and there are data to support the use of FGM post-transplant to better detect and manage changes in blood glucose levels. There is, however, no data on patient or staff perceptions of FGM, or resource implications in this setting. We prospectively evaluated patients and nursing staff experiences of FGM compared to traditional capillary glucose measurement in the immediate post-transplant setting, along with resource utilization, cost of testing, staff time taken to test and accuracy. Twenty-one kidney transplant recipients had a FGM sensor applied in the post-operative period and results compared to capillary blood glucose monitoring (CBGM) measured at least four times a day. Six-hundred-fifty-six glucose measurements were obtained, median per patient of 30 readings (IQR 10). Pearson's correlation between FGM and CBGM readings is 0.95 (p < .001). FGM readings were lower than CBGM by an average of 1.2 mmol/L (SD 0.7). Using a 5-point preference questionnaire (with ratings varying from strongly disagree-strongly agree), both patients and nurses were highly satisfied with the usability and convenience of FGM, with all preferring FGM over CBGM. Average time to perform FGM was 3.6 s versus 64 s for CBGM. In average, cost of FGM was $58 less than traditional testing per patient. FGM is an accurate, convenient and cost-effective tool that may support optimal management of glycaemic control in the post-transplant period.     

番茄红素对血液透析患者静脉铁剂诱导氧化应激的影响

目的：观察维持性血液透析（MHD）患者由静脉铁剂诱导的氧化应激状态，探讨番茄红素对其的干预作用。方法：30例MHD患者，随机分为对照组和试验组，各15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周后的血红蛋白（m）、红细胞比容（Hct）、血清铁（SI）、铁蛋白（SF）、转铁蛋白饱和度（TSAT）以及超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH—px）、丙二醛（MDA）等指标的变化。结果：两组患者治疗后SOD和GSH—px水平较治疗前均有显著下降（P〈0．01）；但是试验组下降幅度显著性小于对照组（P〈0．01）。两组患者治疗后MDA水平较治疗前有显著性升高（P〈0．01）；但是试验组升高幅度显著性小于对照组（P〈0.01）。治疗后两组血清MDA水平与SF呈正相关（P〈0.01）。治疗后两组Hb、Hct、SI、SF、TSAT较治疗前均有显著性升高（P〈0．01），并且两组升高幅度相似，无统计学差异。结论：静脉铁剂治疗加剧了MHD患者的氧化应激状态。番茄红素可减轻这种氧化应激状态。     

木糖醇对糖尿病病人血糖及胰岛素释放的影响

目的探讨糖尿病病人静脉注射木糖醇注射液后血糖及C 肽变化。方法对 45例糖尿病病人在用药前、后各采集静脉血 1次 ,观察用药前后血糖及C 肽的变化 ,结果用药前血糖 (11 31± 4 72 )mmol/L ,用药后(10 97± 5 2 7)mmol/L ,两者比较 ,P >0 0 5 ,差异无显著性意义 ;血C 肽浓度用药前 2 0mg/L ,用药后 5 μg/L ,用药前后比较 ,P <0 0 5 ,差异有显著性意义。结论静脉注射木糖醇注射液不会升高糖尿病病人的血糖 ,并可以刺激胰岛细胞分泌胰岛素。     

Low Dose Intravenous Ascorbic Acid for Erythropoietin-Hyporesponsive Anemia in Diabetic Hemodialysis Patients with Iron Overload

Background.?Recent report demonstrates that inadequate iron mobilization and defective iron utilization may cause recombinant erythropoieitin (rEPO) hyporesponsiveness in hemodialysis (HD) patients with iron overload. The effect of intravenous ascorbic acid (IVAA) in HD patients selected on the basis of iron overload and EPO resistance also has been proven. However, it is uncertain whether IVAA still works in diabetic ESRD patients with hyperferritinemia. Therefore, the aim of this study focusing on diabetic ESRD patients was to analyze the potential effect of low dose IVAA on improvement of anemia and erythropoiesis-related parameters when compared with control period. Patients and Method.?This study consisted of 22 chronic hemodialysis patients with type II diabetes in a single dialysis unit. In studies of this type, all eligible patients are followed up, but the primary comparison is still between different sequentially treatment including control period and post-IVAA period in same patients. IVAA patients received ascorbic acid, 100 mg each administered intravenously three times per week for eight weeks of treatment and four months of post-treatment follow-up. Results.?The demographic characteristics of 22 diabetic uremic patients show that mean age is 63.6 ± 10.2 years old. The ratio of sex (M/F) = 10/12. Mean duration of HD is 46.7 ± 33.2 months. As for the urea kinetic study between these two periods including KT/V, nPCR, and URR, there is no significantly different. As for anemia-related parameters, Hb and Hct increased significantly in post-IVAA period after 3 months compared with control period, while MCV did not increase significantly. Serum ferritin significantly decreased at study completion. The same situation is for iron. As for TS, it significantly increased at one month and further markedly increased at subsequent three months. Conclusion.?This study has demonstrated that short-term low dose IVAA therapy can facilitate iron release from reticuloendothelial system but also increase iron utilization in diabetic hemodialysis patients with iron overload. Therefore, IVAA is a potential adjuvant therapy to treat erythropoeitin-hyporesponsive anemia in iron-overloaded patients.     

智能化全院血糖管理系统的构建与效果评价

目的 构建智能化全院血糖管理系统,评估其在血糖管理中的应用效果。方法 纳入2021年 1月-2022年6月我院各临床科室收治的40例血糖持续异常住院患者为研究对象,依据随机数字表法分为观 察组与对照组,每组20例。观察组应用智能化全院血糖管理系统,对照组应用常规血糖管理,比较两组血 糖控制效果、住院天数、并发症发生情况、预后相关指标、患者及医务人员满意度。结果 两组住院期间 FPG、2 h PG、GA水平比较,差异无统计学意义（P＞0.05）;观察组出院后1周、1个月FPG、2 h PG、GA 水平均低于对照组（P＜0.05）;观察组住院天数短于对照组,并发症总发生率低于对照组（P＜0.05）; 观察组出院后1个月血糖达标率高于对照组,低血糖发生率及再入院率低于对照组（P＜0.05）;观察组满 意度高于对照组（P＜0.05）;观察组血糖监测压力、及时更改治疗的压力和工作效率提高满意度均高于对 照组（P＜0.05）。结论 智能化全院血糖管理系统的构建与应用能够提升血糖控制效果,减少并发症及再 入院率,且患者及医务人员满意度均较高。     

Complement Activation During Hemodialysis: Laboratory Evaluation of Hemodialyzers

A laboratory method that facilitates delineation of the complement-activating characteristics of various dialyzers under defined conditions has been developed. Results obtained by circulating reconstituted human serum through these devices and measuring time-dependent production of both C3a and C5a antigens are entirely consistent with previous clinical observations. For example, the complement-activating potential of dialyzer membranes could be described as high (cuprammonium cellulose), moderate (cellulose acetate), or low (polycarbonate or polyacrylonitrile). Furthermore, these techniques provided the opportunity to identify membrane characteristics that are not readily defined by clinical studies alone. Specifically, membranes that transported and absorbed C5a antigen were readily identified by these methods. Additionally, laboratory evaluation provided the unique ability to define the efficiency of complement activation taking place on the membrane surface. Results of these investigations are compatible with a hypothetical model that not only describes the properties of a typical dialyzer membrane but may be generally applicable to other biomaterials as well.     

记录糖尿病日历对妊娠期糖尿病患者自我管理行为及血糖的影响

目的探讨记录"糖尿病日历"对妊娠期糖尿病患者自我管理行为及血糖的影响。方法将159例门诊妊娠期糖尿病患者按诊断先后顺序分为对照组78例,干预组81例,对照组接受常规自我管理教育,干预组接受自我管理教育后指导患者记录"糖尿病日历"。干预1个月后比较两组自我管理行为评分和血糖水平。结果 1个月后,干预组自我管理行为中饮食依从性、运动、自我血糖监测问题得分显著优于对照组(P0.05,P0.01),餐后2h血糖显著低于对照组(P0.01)。结论记录"糖尿病日历"可提高妊娠期糖尿病患者的自我管理行为,降低其血糖水平。