Better correction of metabolic acidosis, blood pressure control, and phagocytosis with bicarbonate compared to lactate solution in acute peritoneal dialysis

Lactate solution has been the standard dialysate fluid for a long time. However, it tends to convert back into lactic acid in poor tissue-perfusion states. The aim of this study was to evaluate the efficacy of magnesium (Mg)- and calcium (Ca)-free bicarbonate solution compared with lactate solution in acute peritoneal dialysis (PD). Renal failure patients who were indicated for dialysis and needed acute PD were classified as shock and nonshock groups, and then were randomized to receive either bicarbonate or lactate solution. Twenty patients were enrolled in this study (5 in each subgroup). In the shock group, there were more rapid improvements and significantly higher levels of blood pH (7.40 +/- 0.04 versus 7.28 +/- 0.05, p < 0.05), serum bicarbonate (23.30 +/- 1.46 versus 18.37 +/- 1.25 mmol/L, p < 0.05), systolic pressure (106.80 +/- 3.68 versus 97.44 +/- 3.94 mm Hg, p < 0.05), mean arterial pressure (80.72 +/- 2.01 versus 73.28 +/- 2.41 mm Hg, p < 0.05), percentages of phagocytosis of circulating leukocytes (65.85% +/- 2.22 versus 52.12% +/- 2.71, p < 0.05), and percentages of positive nitroblue tetrazolium (NBT) reduction test without and with stimulation (14.43 +/- 1.93 versus 9.43 +/- 2.12, p < 0.05 and 65.08 +/- 6.80 versus 50.23 +/- 4.21, p < 0.05, respectively) in the bicarbonate subgroup compared with the lactate subgroup. In the nonshock group, blood pH, serum bicarbonate, and phagocytosis assays in both subgroups were comparable. Lactic acidosis was more rapidly recovered and was significantly lower with bicarbonate solution for both shock and nonshock groups (3.63 +/- 0.37 versus 5.21 +/- 0.30 mmol/L, p < 0.05 and 2.92 +/- 0.40 versus 3.44 +/- 0.34 mmol/L, p < 0.05, respectively). Peritoneal urea and creatinine clearances in both subgroups were comparable for both shock and nonshock groups. There was no peritonitis observed during the study. Serum Mg and Ca levels in the bicarbonate subgroup were significantly lower, but no clinical and electrocardiographic abnormality were observed. We concluded that Mg- and Ca-free bicarbonate solution could be safely used and had better outcomes in correction of metabolic acidosis, blood pressure control, and nonspecific systemic host defense with comparable efficacy when compared to lactate solution. It should be the dialysate of choice for acute PD especially in the poor tissue-perfusion states such as shock, lactic acidosis, and multiple organ failure.     

低温透析对血透中血压及透析质量的影响

目的 探讨低温透析对透析过程中低血压的发生、尿素氮的清除、超滤量以及患者血透感觉的影响。方法 选取在血透时易发生低血压的20名患者为一组，在透析期间及透后均保持稳定血压的20名患者为另一组，分别进行自身对照研究。每位患者分别进行8次低温（35．5℃）透析，8次常温（37℃）透析。观察尿素消除指数（Kt／V）、尿素下降率（URR）、透析超滤体积（UF）、血压、脉搏、体温和低血压发生情况及患者自我感觉的表述。结果 在低血压组用低温透析能提高超滤量和透析期间及透后的平均动脉压，降低低血压的发生率，而对稳定组则无影响。透析期间两组的脉率、尿素氮的清除、Kt／V相似。而两组中75％的患者感觉低温透析后精力更充沛。结论 低温透析能减少低血压的发生，提高超滤，透析充分，且患者对低温透析感觉良好，是一种简单、有用、经济的透析方法，透析室环境温度适宜的情况下可适当降低透析液温度，既不影响透析质量，又可节约电能。     

烧伤患者肾脏透析排出液中头孢他啶的含量测定

目的 :测定烧伤患者肾脏透析排出液中头孢他啶的含量。方法 :采用高效液相色谱法 ,色谱柱 :μ Bondapak -C18 柱 ;流动相 :甲醇 -醋酸胺 (17∶83 ,V/V ) ;流速 :1 0ml/min ;检测波长 :254nm。结果 :头孢他啶在0 5～100μg/ml的范围内线性关系良好 ,r=0 9999 ;日内、日间RSD≤3 ,平均回收率100 30 %。结论 :本法简便、快速、准确     

Hydrostatic Ultrafiltration During Hemodialysis Using Decreasing Sodium Dialysate

Twelve patients underwent hemodialysis using dialysate containing 130 mEq/L sodium, and, on a separate occasion, dialysis using a dialysate of constantly decreasing sodium concentration (from 150 to 133 mEq/L). Hydrostatic ultra-filtration during dialysis was performed at a constant rate (900 ml/hr) during both treatments, and was continued until a substantial drop in mean arterial pressure (-15%) or symptoms were observed. A double-blind comparison of the two treatment modalities was thus achieved.
At the end of ultrafiltration, significantly more fluid had been removed using decreasing sodium dialysate (2.9 ± 0.3 kg) than when using the low-sodium dialysate (1.9 ± 0.2 kg, P<0.001). Plasma sodium concentration at the end of ultra filtration using decreasing sodium dialysate was not significantly different from the predialysis level.
Hydrostatic ultrafiltration using a dialysate of decreasing sodium level may prove to be a useful means of removing excess fluid asymptomatically from dialysis patients.     

Ultrapure dialysis fluid slows loss of residual renal function in new dialysis patients.

BACKGROUND: Residual renal function is beneficial for adequacy of haemodialysis, quality of life and mortality in dialysis patients. Our prospective randomised investigation aimed to analyse the effects of the microbiological quality of dialysis fluid on the course of residual renal function after initiation of haemodialysis. METHODS: Thirty patients starting haemodialysis were randomly assigned to ultrapure or conventional dialysate. During the 24-month study period, creatinine clearance, CRP and IL-6 levels, hydration status, number of hypotensive episodes and blood pressure recordings were assessed every 6 months. RESULTS: Residual renal function declined in both groups during the study period, although there were no statistically significant differences in demographic (age, gender), renal (cause of end-stage renal disease, residual renal function, hypertension, ACE inhibitors) and treatment characteristics (Kt/V urea) at recruitment. The use of mildly contaminated (up to 300 CFU/ml) dialysate resulted in higher CRP and IL-6 levels and more pronounced loss of residual renal function. Multiple regression analysis showed that the microbiological quality of the dialysate is an independent determinant of the loss of residual renal function. CONCLUSIONS: Ultrapure dialysis fluid combined with high-flux synthetic membranes are effective components of renal replacement therapy to slow the loss of residual renal function in haemodialysis patients. These improvements of haemodialysis are desirable, but add to treatment costs.     

持续非卧床腹膜透析患者血清及透出液中CA125的变化及意义

目的探讨持续非卧床腹膜透析(CAPD)患者透出液中癌抗原125(CA125)浓度变化的临床意义.方法用ELISA方法分别检测20例健康对照组人员及35例CAPD治疗组患者血清CA125浓度,CAPD治疗组患者透出液CA125浓度;比较健康对照组与CAPD治疗组患者血清CA125浓度的关系;分析腹膜炎、透析时间、腹膜转运特性对CAPD患者透出液CA125浓度的影响.结果健康对照组与CAPD治疗组血清CA125浓度无显著差异(P＞0.05);腹膜炎组治疗前CA125浓度[(58.12±10.16)u/ml]显著高于非腹膜炎组[(34.86±3.96)u/ml](P＜0.01),治疗后透出液CA125浓度[(37.5±.16)u/ml]显著降低,与治疗前有显著差异(P＜0.01),但与非腹膜炎组无显著异(P＞0.05);随着透析时间延长,透出液中CA125浓度[逐渐下降,两者呈负相关(r=-0.67、P＜0.001);高腹膜转运组CA125浓度[(46.86±9.88)u/ml]与高平均及低平均转运组CA125浓度[(43.96±7.98)u/ml]之间无显著差异(P＞0.05).结论腹透液中CA125主要由腹膜间皮细胞分泌;腹膜转运特性对透出液CA125浓度无影响;动态监测CAPD患者透出液CA125浓度变化,对于评价腹膜转运功能,判断预后有重要意义.     

Radioimmunoassay for human osteocalcin using an antibody raised against the synthetic human (h37–49) sequence

Summary Radioiodination of synthetic human 37–49 osteocalcin requires optimal labeling conditions in order to obtain a maximum of mono- and di-iodinated tracer with little contamination by tri-and tetra-iodinated products or “radio-damage.” The antibody raised against osteocalcin(h37–49) had the highest affinity for the C-terminal peptide used for iodination and the larger peptide (h30–49). The intact bovine osteocalcin (b1–49) revealed less immunoreactivity. This C-terminal specific radioimmunoassay detected the intact human osteocalcin in HPLC purified plasma and peritoneal dialysate from patients with terminal renal insufficiency and in extracted human bone. Some quantities of osteocalcin peptides with a higher hydrophobicity were predominantly detected in uremic plasma. These peptides that had a higher molecular weight than the intact human molecule might represent aggregated forms of the intact bone-derived osteocalcin. Immunoreactivity in plasma samples from healthy individuals revealed a remarkable difference as to which substance was employed for anticoagulation. Compared to heparin, the addition of EDTA largely reduced the osteocalcin immunoreactivity, implying that conformational changes within the N-terminal portion (containing the Gla- and Cys-residues) are extended to the C-terminal portion.     

滤膜法与涂抹法检测血液透析相关用水微生物的效果

目的 探讨滤膜法和涂抹法检测血液透析相关用水微生物的效果,为选择合适的检测方法提供依据。方法 回顾性收集某三级甲等综合性医院2018年1-12月同时采用滤膜法和涂抹法检测血液透析相关用水微生物的结果,对比分析滤膜法和涂抹法检测细菌检出率、单位菌落数、超干预值检出率和微生物合格率。结果 共收集274份血液透析相关用水微生物检测结果,其中透析液131份,反渗水39份,B浓缩液（下简称B液）14份,置换液34份,其他透析用水56份。滤膜法细菌检出率均高于涂抹法,其中透析液、反渗水、置换液、其他透析用水标本使用两种方法的细菌检出率比较,差异有统计学意义（均P<0.05）。透析液、B液、其他透析用水标本单位菌落数滤膜法数值上低于涂抹法,但仅其他透析用水标本使用两种方法检测结果单位菌落数差异有统计学意义（t=-3.011,P=0.004）。超干预值检出率其他透析用水滤膜法低于涂抹法,差异有统计学意义（χ²=6.596,P=0.010）。置换液、反渗水标本微生物合格率滤膜法数值上低于涂抹法,但仅置换液标本微生物合格率差异有统计学意义（χ²=18.987,P<0.001）。结论 滤膜法检出细菌的能力高于涂抹法,但其在血液透析相关用水微生物检测中存在一定局限性,除用于置换液比较适合外,应用在其余血液透析相关用水微生物的检测效果并不优于涂抹法。     

The association between soluble intercellular adhesion molecule-1 levels in drained dialysate and peritoneal injury in peritoneal dialysis

Background: Chronic inflammation of the peritoneum causes peritoneal injury in patients on peritoneal dialysis. Intercellular adhesion molecule-1 and its circulating form, soluble intercellular adhesion molecule-1, play pivotal roles in inflammation. However, their role in peritoneal injury is unclear.

Methods: We measured changes in intercellular adhesion molecule-1 expression in the peritoneum of a peritoneal injury model in rats. The associations between soluble intercellular adhesion molecule-1 levels in drained dialysate and the solute transport rate (D/P-Cr and D/D0-glucose) determined by the peritoneal equilibration test, and matrix metalloproteinase-2 levels in drained dialysate were investigated in 94 peritoneal drained dialysate samples.

Results: Intercellular adhesion molecule-1 expression was increased in the peritoneum of rats with peritoneal injury. Soluble intercellular adhesion molecule-1 levels in drained dialysate were significantly positively correlated with D/P-Cr (r?=?.51, p?r?=??.44, p?r?=?.86, p?Conclusions: Intercellular adhesion molecule-1expression is increased in the peritoneum of a peritoneal injury model in the rat, and soluble intercellular adhesion molecule-1 levels in drained dialysate are associated with peritoneal injury in patients on peritoneal dialysis. These results suggest that soluble intercellular adhesion molecule-1 could be a novel biomarker of peritoneal injury in patients on peritoneal dialysis.     

邯郸地区应用生理钙透析液对持续性腹膜透析患者钙磷代谢的影响

目的观察邯郸地区持续性腹膜透析患者随腹膜透析时间延长,应用生理钙透析液(Dianeal PD4)对其血钙、血磷及全段甲状旁腺素(intact parathyroid hormone,iPTH)水平的影响。方法回顾性分析2006年2月至2014年3月在我院住院首次诊断为终末期肾脏疾病(end-stage renal disease,ESRD)并行持续性不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPE))治疗大于12个月的77例资料完整患者的临床资料,在应用生理钙透析液(钙浓度为1.25 mmol/L)进行维持性腹膜透析,并配合口服碳酸钙及骨化三醇条件下,观察透析后3、6、12个月血钙、血磷、iPTH、碱性磷酸酶(alkaline phosphatase,ALP)和血白蛋白、总白蛋白、尿素氮、肌酐、尿酸等各项生化指标水平,分析透析前后校正血钙、血磷、iPTH、ALP等指标变化情况,同时观察患者使用生理钙透析液有无低血压、抽搐、不宁腿、瘙痒等不适。结果患者血钙、磷、尿素、肌酐、尿酸、白蛋白、血红蛋白在生理钙透析液透析后3、6、12个月与透析初始比较,差异均有统计学意义(P0.05),而透析后3、6、12个月之间比较,差异均无统计学意义(P0.05)。患者iPTH在腹透开始后逐渐上升,但在透析后3、6个月与透析前比较,差异无统计学意义(P0.05),而透析12个月后与透析前比较差异有统计学意义(P0.05)。患者ALP和总白蛋白水平在透析前后无明显变化。结论邯郸地区应用生理钙透析液进行维持性腹膜透析的患者,在配合口服钙剂及活性维生素D制剂情况下,可有效改善患者钙磷代谢紊乱,从而防治继发性甲状旁腺功能亢进症及肾性骨病的发生。