维持性血液透析患者营养状况的评价与分析

对43例维持性血液透析患者的营养状况进行评估与影响因素分析。方法 采用膳食分析、人体学测量和生化免疫测定,并对可能影响营养状况的常见因素进行分析。结果 血液透析患者的能量摄入,一些主要的人体学指标,生化和免疫指标均显著低于对照组。蛋白质和能量摄入、酸中毒及红细胞生成素对营养指标有影响。结论 血液透析患者中存在着营养不良,纠正有关的影响因素有助于改善患者的营养状况。     

血液透析患者炎症反应对rhu-EPO治疗剂量的影响

目的 观察尿毒症血液透析患者是否存在炎症反应及其对促红细胞生成素治疗效果的影响。方法 采用ELISA的方法测定43例维持性血液透析患者和60例健康对照血清IL-6和TNF-α水平．计算两组血红蛋白水平维持在100g/L时所需促红细胞生成素的剂量．研究影响促红细胞生成素治疗剂量的因素。结果 (1)血液透析患者的血清IL-6和TNF-α水平较正常对照组明显升高。(2)多元回归分析表明影响促红细胞生成素治疗剂量的因素是血清IL-6和TNF-α炎症介质。结论 血液透析患者存在炎症反应，其炎症介质水平的升高与促红细胞生成素治疗剂量的增加密切相关。     

红细胞分布宽度对维持性血液透析患者脑卒中的预测价值

目的:探究红细胞分布宽度(red blood cell distribution width, RDW)对维持性血液透析(maintenance hemodialysis, MHD)患者发生脑卒中的预测价值。方法:选择2018年09月—2021年04月在西南医科大学附属医院肾病内科血液净化中心行维持性血液透析治疗的242例患者。收集患者人口学特征、实验室指标等资料。按照是否发生脑卒中分为脑卒中组(n=45)和非脑卒中组(n=197)。采用单因素分析及二元Logistic回归分析对患者资料进行处理，筛选维持性血液透析患者发生脑卒中的独立危险因素。采用受试者工作特征(receiver operating characteristic curve, ROC)曲线分析RDW对MHD患者发生脑卒中的预测价值。结果:经Logistic回归分析发现，红细胞分布宽度-变异系数(RDW-CV)、红细胞分布宽度-标准差(RDW-SD)为MHD患者发生脑卒中的独立危险因素(P<0.05)。ROC分析发现，当RDW-CV截断值为13.65%时，曲线下面积为0.773,预测MHD患者发生脑卒中的敏感度为9...     

血液透析患者营养不良的研究现状

营养不良在维持性血液透析（ＭＨＤ）患者中相当常见，与患者的发病率和死亡率增高有关，也是影响患者预后及生存质量的重要因素。本文综述了血液透析患者营养不良的发生率、后果、判断指标、影响因素及其治疗方面的研究进展。     

血液透析患者性功能障碍临床研究

目的：探讨男性血液透析患者性功能障碍的影响因素.方法：对164例维持性血液透析患者（MHD）采用自我行为量表（SCS）、抑郁自评量表（SDS）及勃起功能国际指数问卷（IIEF-5）进行问卷调查.结果：发现年龄、糖尿病和高BDI得分是独立的影响性功能障碍的指标,在性功能指标得分较低的患者其健康相关生活质量量表的各项得分也显著降低,得分均具有统计学意义.结论：男性血液透析患者性功能障碍与抑郁程度、高龄、糖尿病及生活质量均有关系.     

左旋卡尼汀对血液透析患者异常红细胞形态的影响

尿毒症血液透析患者由于左旋卡尼汀摄入、合成减少，丢失增加，导致其体内含量减少。左旋卡尼汀对于维持红细胞膜的功能具有重要作用，缺乏时会导致异型红细胞增多、红细胞脆性增加、红细胞寿命缩短。目前，国内尚缺乏相关报道。笔者应用左旋卡尼汀治疗尿毒症血液透析患者，旨在观察左旋卡尼汀对异常红细胞（棘红细胞和裂红细胞）形态的影响，报道如下。     

血常规检验在肠炎诊断中的应用价值分析

目的：分析血常规检验在肠炎患者诊断中的应用价值。方法：选取100例肠炎患者行血常规检验,并将其设为观察组,另纳入100名健康人员,同时行血常规检验,并将其设为对照组,比较2组患者相关检测指标水平,并将诊断结果与最终病理进行核对,计算得出其诊断准确率。结果：通过观察血常规检验结果发现,观察组患者的血红蛋白浓度、平均红细胞比容以及平均红细胞血红蛋白浓度均低于对照组（P <0.05）,血小板计数与C反应蛋白含量水平显著高于对照组（P <0.05）;经临床最终病理确认,血常规检验的诊断准确率均>90%,与病理结果比较差异无统计学意义（P>0.05）。结论：血常规检验能够明显提高肠炎患者的诊断准确率,对促进患者快速接受治疗具有重要的临床意义。     

血液透析对慢性肾功能衰竭病人红细胞变形能力的改善作用

本文对慢性肾功能衰竭病人及经血液透析治疗后的红细胞变形能力进行了测定。结果表明：与正常红细胞的椭园形衍射环相比，慢性肾衰病人红细胞的衍射环长轴明显缩短，短轴明显增宽，形成一个橄榄形。经过血液透析后红细胞的衍射环有明显改善，趋于正常。提示肾衰后硬化的红细胞数量明显增多，红细胞的变形能力及红细胞膜的稳定性明显降低。这些改变与机体长期处于酸中毒、水和电解质紊乱、内毒素增加及ＳＯＤ水平增高等环境有密切关系，可导致和加重肾脏微循环障碍。血液透析可有效地改善红细胞的变形能力。     

血液透析及腹膜透析患者生活质量评价及相关因素分析

目的：评估血液透析及腹膜透析患者的生活质量及相关影响因素。方法：随机抽取腹膜透析患者28例及血液透析患者28例,采用肾脏疾病生存质量专用量表KDQOL-SFTM量表对透析患者进行生活质量评估。比较血液透析患者和腹膜透析患者健康相关生活质量（HRQOL）的差异,并采用多元回归分析法探索分析透析人群HRQOL的影响因素。结果：血液透析患者和腹膜透析患者在KDQOL-SFTM量表各维度得分上差异无统计学意义,除外社会功能（SF）。血液透析患者SF得分高于腹膜透析患者（63.94±25.08vs48.66±23.41,P〈0.05）。影响血液透析患者生活质量的因素包括：性别、年龄、透析龄、文化程度、钙磷乘积、血红蛋白（Hb）、甲状旁腺激素（PTH）等。上述因素对血液透析患者的HRQOL影响占14.1%～55.6%。影响腹膜透析患者生活质量的因素包括：性别、年龄、透析龄、体重指数（BMI）、糖尿病（DM）、Hb、血白蛋白（Alb）、PTH、铁蛋白、腹透方式、每日交换液量等。上述因素对腹膜透析患者的HRQOL影响占14.7%～58.6%。结论：透析患者的骨矿物质代谢紊乱、贫血严重影响生活质量。除此之外,腹膜透析患者的生活质量还受BMI、DM、营养状态、腹透龄的影响。临床中应积极纠正上述影响因素以提高透析患者的生活质量。     

血透患者血清瘦素水平与贫血的关系（附83例临床分析）

目的：探讨血液透析（血透）患者血清瘦素水平以及瘦素与贫血的关系。方法：83例血透患者分为促红细胞生成素（EPO）治疗组及非EPO治疗组，28例未行血透治疗的慢性肾脏病患者及24例健康体检者为透析前及健康对照组。ELISA法测定血清瘦素水平，计算各组体重指数（BMI）。测定血常规、血液生化、铁蛋白、转铁蛋白、C反应蛋白及甲状旁腺激素，用SPSS11．0统计软件进行统计分析。结果：血透患者血清瘦素水平高于透析前肾脏病患者及健康人，后二者之间血清瘦素水平无明显差异；女性血清瘦素水平高于男性患者；血透患者的血清瘦素水平与血红蛋白及转铁蛋白正相关（P〈0．05）。结论：血透患者血清瘦素水平高于透析前的慢性肾脏病患者及健康成人，女性高于男性。血透患者的血清瘦素水平与患者的血清胆固醇水平、BMI以及血红蛋白正相关。透析治疗对血清瘦素无影响。血透患者血清瘦素水平的升高，不仅仅是GFR下降引起，也是对慢性肾衰竭时血红蛋白减少的一种代偿。     

Massive hemorrhage due to hemodialysis-associated thrombocytopenia

Marked declines in platelet numbers were noted in association with hemodialysis. This resulted in gastrointestinal bleeding and the need for packed RBC and platelet transfusions. This hemodialysis-associated thrombocytopenia was ameliorated by changing the dialyzer in use. The gastrointestinal bleeding stopped and the need for platelet transfusions was obviated. The degree of platelet loss during hemodialysis is probably affected by the composition of the dialyzer membrane used as well as other factors. Hemodialysis-associated thrombocytopenia may be a contributing factor in the increased bleeding tendency noted in hemodialysis patients.     

维持性血液透析患者发生急性冠脉综合征的危险因素分析

目的 探讨影响维持性血液透析患者发生急性冠脉综合征（ACS）的危险因素。方法 回顾性分析2015年3月至2018年4月在河北省承德市中心医院和滦平县中医院血液净化中心行维持性血液透析的175例患者的临床资料,根据是否发生ACS分成两组,其中发生ACS患者57例（ACS组）,未发生ACS的118例（非ACS组）。收集患者的性别、年龄、肾衰竭的基础疾病、透析龄、发生ACS前1个月的收缩压、舒张压、脱水量及发生ACS时的血红蛋白（Hb)、C反应蛋白(CRP)、甲状旁腺素(PTH)、血白蛋白(ALB)、血脂、血尿酸(UA)、肺动脉压(PH)等指标进行比较分析;应用多因素的logistic回归分析导致ACS的危险因素。结果 ACS组的男性居多[38例（66.67%）],而房颤病史、透析前的收缩压和舒张压、超流量、红细胞分布宽度（RDW）、血钾（K⁺）低于非ACS组,ALB高于非ACS组,差异均有统计学意义（均P<0.05）。二元logistic回归分析显示：透析前的收缩压≥160 mmHg（OR=3.240,95%CI：1.255～5.367,P<0.05）和超流量≥3 500 mL/次（OR=2.797,95%CI：1.033～4.574,P<0.05）是影响维持性血液透析患者发生ACS的相关影响因素。结论 透析前血压控制不良（收缩压≥160 mmHg）、超流量过大（超流量≥3 500 mL/次）使维持性血液透析患者发生ACS的风险增加。     

Renal complications of high-dose chemotherapy and peripheral blood stem cell transplantation

Following bone marrow transplantation, acute renal failure and proteinuria are common complications with a high mortality, particularly in patients requiring hemodialysis. Incidence, potential predisposing factors, and outcome of acute renal complications in patients with hematological malignancies receiving autologous peripheral blood stem cell transplantation were prospectively studied in 53 patients. Eight patients developed acute renal failure. Three of them required hemodialysis. Of all patients with acute renal failure, only those requiring hemodialysis died, due to nonrenal causes. Only 1 of the 45 patients without renal failure died. Mild proteinuria of predominantly tubular origin occurred in 16 patients, in 3 with and in 13 without acute renal failure. As predisposing factors for acute renal failure were identified: renal hypoperfusion due to systemic inflammatory response syndrome, sepsis or septic shock, and combined administration of nephrotoxic drugs. Especially those patients receiving high numbers of nephrotoxic drugs in combination with renal hypoperfusion were likely to develop acute renal failure. These results suggest that patients receiving high-dose chemotherapy and autologous peripheral blood stem cell transplantation have a low risk of developing acute renal failure and proteinuria.     

Blood Color Is Influenced by Inflammation and Independently Predicts Survival in Hemodialysis Patients: Quantitative Evaluation of Blood Color

Blood color of dialysis patients can be seen routinely. Darkened blood color is often observed in critically ill patients generally because of decreased oxygen saturation, but little is known about the other factors responsible for the color intensity. In addition, quantitative blood color examination has not been performed yet. Therefore, no one has evaluated the predictive power of blood color. The aim of this study was to evaluate if blood color darkness reflects some medical problems and is associated with survival disadvantage. Study design is a prospective cohort study. One hundred sixty‐seven patients were enrolled in this study. Quantification of blood color was done using a reflected light colorimeter. Demographic and clinical data were collected to find out the factors that can be related to blood color. Follow‐ups were performed for 2 years to analyze the risk factors for their survival. Regression analysis showed that C‐reactive protein and white blood cell count were negatively correlated with blood color. In addition, blood color was positively correlated with mean corpuscular hemoglobin concentration and serum sodium concentration as well as blood oxygen saturation. During a follow‐up, 34 (20.4%) patients died. Cox regression analysis revealed that darkened blood color was an independent significant risk factor of mortality in hemodialysis patients as well as low albumin and low Kt/V. These results suggest that inflammation independently affects blood color and quantification of blood color is useful to estimate prognosis in patients undergoing hemodialysis. It is possible that early detection of blood color worsening can improve patients' survival.     

Peripheral blood dendritic cells and GM-CSF as an adjuvant for hepatitis B vaccination in hemodialysis patients

BACKGROUND: Dysfunctional antigen presentation may underlie the impaired antibody response to hepatitis B vaccination in hemodialysis patients. Dendritic cells are considered to be the most important antigen presenting cells, but their presence and function in hemodialysis patients is unclear. Granulocyte-monocyte-colony stimulating factor (GM-CSF) has been given successfully to hemodialysis patients to increase the proportion of responders to hepatitis B vaccination. Although GM-CSF acts on both monocytes and dendritic cells, the mechanisms underlying its adjuvant quality are largely unknown. METHODS: In this study we analyzed monocytes and dendritic cells in the peripheral blood of hemodialysis patient that had responded to a standard hepatitis B vaccination procedure (responders), patients who had not responded (nonresponders), and healthy controls. The nonresponders were given two additional booster vaccines, both preceded by administration of GM-CSF the day before. RESULTS: After two booster vaccinations with GM-CSF, six out of seven patients developed a protective antibody response to hepatitis B. The memory T-cell response to tetanus toxoid was significantly lower in nonresponders compared to controls. The monocytes of dialysis patients and healthy controls showed a similar expression of relevant cell surface molecules. However, the numbers of circulating dendritic cells were on average 50% reduced compared to healthy controls, with a further reduction after GM-CSF administration. This was accompanied by a decrease of T-cell proliferation in antigen presentation assays. Monocytes showed increased major histocompatibility complex (MHC) class II, CD54, and CD40 expression, while their antigen-presenting capacity remained unchanged. CONCLUSION: GM-CSF is an effective adjuvant for hepatitis B vaccination in primary nonresponding hemodialysis patients, but paradoxically decreases the antigen presenting capacity of peripheral blood mononuclear cells and the number of circulating dendritic cells.     

Preservation of Blood Pressure Stability with Hypertonic Mannitol during Hemodialysis Initiation

Background: Intradialytic hypotensive events are common among hemodialysis patients and are associated with a variety of patient- and procedure-related factors, including intradialytic decline in plasma osmolality. Prior studies and practice have suggested that administration of osmotically active drugs may ameliorate blood pressure decline during chronic hemodialysis. Methods: Clinical and treatment data were collected for 102 consecutive patients requiring initiation of renal replacement therapy in 2 major teaching hospitals. Routine administration of mannitol differed according to institutional protocols, allowing its examination as the primary exposure of interest. Generalized linear models were fit to estimate associations of mannitol use during dialysis initiation with intradialytic blood pressure, as assessed by: (1) intradialytic blood pressure decline; (2) nadir intradialytic blood pressure; (3) absolute systolic blood pressure <90 mm Hg or decline >20 mm Hg. Results: Mean age was 62 years (±16), 70% were male and 44% were diabetic. Mean predialysis and nadir systolic blood pressure were 142 mm Hg (±29) and 121 mm Hg (±26), respectively. Mannitol administration was associated with a lesser decline in intradialytic blood pressure, a higher nadir blood pressure and fewer hypotensive events requiring intervention. No effect modification was evident according to diabetes or acuity of kidney disease (chronic vs. acute). Conclusions: Mannitol administration appears to preserve hemodynamic stability during hemodialysis initiation. Randomized controlled trials are needed to confirm these findings and identify optimal management strategies to prevent intradialytic hypotension.     

Determinants of soluble CD23 antigen levels in hemodialysis patients: effect of 1.25 dihydroxyvitamin D3 and recombinant human erythropoietin treatment.

BACKGROUND: The immunodeficiency of end-stage renal disease (ESRD) paradoxically coexists with T cell and monocyte activation. In spite of well known defective antibody responses in ESRD, the functional status of B cells in the immune system dysregulation of uremia is still controversial. Soluble CD23 (sCD23) antigen is a recently identified B cell activation marker and is also involved in T cell activation process. Effects of parathyroid hormone (PTH), red blood cells and ferritin on T and B cell functions have been shown both in vivo and in vitro. PATIENTS AND METHODS: In this study, serum levels of sCD23 in hemodialysis patients were determined to evaluate the functional status of B cells and possible linkages between this cytokine and PTH levels, ferritin levels, red blood cell counts were investigated. RESULTS: Serum sCD23 levels were significantly elevated in hemodialysis patients relative to healthy controls (12.5+/-8.4 micro/l vs. 2.4+/-1.1 micro/l, p<0.001). Serum sCD23 levels were negatively correlated with red blood cell count (r = -0.61, p = 0.009) and serum PTH levels (r = -0.62, p = 0.008), while positively correlated with serum ferritin levels (r = 0.63, p = 0.007) in hemodialysis patients. We also investigated the immunumodulator effects of 1.25 dihydroxyvitamin D3 (1.25OHD3) and recombinant human erythropoietin (rHu-Epo) treatment in hemodialysis patients. 1.25OHD3 treatment for eight weeks did not change serum sCD23 levels in hemodialysis patients (n = 8). On the other side, rHu-Epo administration for 16 weeks led to a decrease in serum sCD23 levels (17.7+/-8.6 microg/l vs. 9.8+/-3.5 microg/l, p = 0.007) in these patients (n = 9). CONCLUSION: These results suggests that similar to T cells, B cells are activated in uremia and the degree of this activation is correlated with red blood cell count, serum parathyroid hormone levels and iron status of the hemodialysis patients. Moreover, B cell activation could be altered by recombinant human erythropoietin therapy in hemodialysis patients.     

Multistate outbreak of hemolysis in hemodialysis patients traced to faulty blood tubing sets

BACKGROUND: Hemolysis associated with hemodialysis is rare. The most frequent causes of hemodialysis-associated hemolysis are chemical contamination, heat, or mechanical injury of erythrocytes from occluded or kinked hemodialysis blood lines. When patients in three states developed hemolysis while undergoing hemodialysis between May 13 and 23, 1998, an investigation was initiated. METHODS: A case-patient was defined as any patient at healthcare facilities A (Nebraska), B (Maryland), or C (Massachusetts) during May 13 through 23, 1998 (epidemic period), who had hemolysis diagnosed > or =48 hours after undergoing hemodialysis. To identify case-patients and to determine background rates, the medical records of patients from facilities A, B, and C who were undergoing hemodialysis during the epidemic and pre-epidemic (that is, May 5 through 19, 1998) periods were reviewed. Experiments simulating hemodialysis with the same lot numbers of hemodialysis blood tubing cartridge sets used on case- and control-patients were conducted. RESULTS: The rates of hemolysis among patients at facilities A, B, and C were significantly higher during the epidemic than the pre-epidemic period (13 out of 118 vs. 0 out of 118, P < 0.001; 12 out of 298 vs. 0 out of 298, P = 0.001; and 5 out of 62 vs. 0/65, P = 0.03, respectively). All case-patients had hemolysis. Twenty (66%) had hypertension. Eighteen (60%) had abdominal pain, and 10 (36%) were admitted to an intensive care unit. There were two deaths. The only commonality among the three outbreaks was the use of the same lot of disposable hemodialysis blood tubing from one manufacturer. Examination of the implicated hemodialysis blood tubing cartridge sets revealed narrowing of an aperture through which blood was pumped before entering the dialyzers. In vitro experiments with the hemodialysis blood tubing revealed that hemolysis was caused by increased pressure on erythrocytes as they passed through the partially occluded hemodialysis blood tubing. CONCLUSIONS: Our investigation traced the multiple hemolysis outbreaks to partially occluded hemodialysis blood tubing produced by a single manufacturer. On May 25, 1998, the manufacturer issued a voluntary nationwide recall of the implicated lots of hemodialysis blood tubing cartridge sets.     

Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients

BACKGROUND: The relationship between blood pressure (BP) and mortality in hemodialysis patients has remained controversial. Some studies suggested that a lower pre- or postdialysis BP was associated with excess mortality, while others showed poorer outcome in patients with uncontrolled hypertension. We conducted a multicenter prospective cohort study to evaluate the impact of hemodialysis-associated hypotension on mortality. METHODS: We recruited 1244 patients (685 males; mean age, 60 +/- 13 years) who underwent hemodialysis in 28 units during the two-year study period beginning in December 1999. Pre-, intra-, and postdialysis BP, and BP upon standing soon after hemodialysis, were measured in all patients at entry. Logistic regression analysis was used to assess the effect on mortality of pre-, intra-, and postdialysis BP, a fall in BP during hemodialysis, and a fall in BP upon standing soon after hemodialysis. RESULTS: During the study period, 149 patients died. Logistic models identified the lowest intradialysis systolic blood pressure (SBP) and degree of fall in SBP upon standing soon after hemodialysis as significant factors affecting mortality, but not pre- or postdialysis SBP and diastolic BP. The adjusted odds ratio for death was 0.79 (95% CI 0.64-0.98) when the lowest intradialysis SBP was analyzed in increments of 20 mm Hg, and was 0.82 (95% CI 0.67-0.98) when the fall in SBP upon standing soon after hemodialysis was analyzed in increments of 10 mm Hg. CONCLUSION: These results suggest that intradialysis hypotension and orthostatic hypotension after hemodialysis are significant and independent factors affecting mortality in hemodialysis patients.     

回血方向对血液透析患者残血红细胞存数的影响

目的 比较单向回血法透析器不同方向回血对血液透析患者残血红细胞存数的影响.方法 选择血液透析患者35例,采用自身对照方法,每例患者分别实施动脉端向上回血法和静脉端向上回血法各5次.评估血液透析器凝血状况,测量透析器及管路中残血红细胞存数及回血时间等.结果 在回水量相同的情况下,动脉端向上回血法与静脉端向上回血法相比,透析器凝血状况回血时间以及透析器管路中残血红细胞存数差异均有统计学意义(P＜0.05).结论 动脉端向上回血法能最大限度降低透析器中残血红细胞存数,减少回血时间.