Mechanisms of albumin loss during peritoneal dialysis in man.

Albumin loss in the dialysate was evaluated during a total of 5 peritoneal dialyses carried out on 3 uraemic patients. The measurements were made by two different methods, the first based on the evaluation in the dialysate of intravenously injected radioiodinated albumin, the second one based on a radioimmunoassay of the protein in the dialysate. The results obtained showed three main mechanisms of protein loss during peritoneal dialysis: 1) albumin shift from extravascular sites adjacent to the peritoneum, 2) direct passage of albumin from blood stream to peritoneal cavity, and 3) tendency of the inter-dialysis peritoneal fluid to equilibrate with plasma proteins. Furthermore, the observations made on a patient with evident peritonitis proved the importance of the intrinsic biological properties of the peritoneum in determining the amplitude of protein wasting by the dialysate.     

碳酸氢盐血液透析浓缩物B液/粉中氯化钠含量测定方法的探讨

提出了对对碳酸氢盐血液透析浓缩物B液，粉中氯化钠含量测定方法进行改进，使滴定终点颜色变化明显．提高测定结果的准确度。     

不同钙浓度透析液对维持性血液透析患者钙磷代谢的影响

目的探讨不同钙浓度透析液对维持性血液透析(MHD)患者钙磷代谢紊乱的影响。方法溧水县人民医院157例MHD患者随机分为2组,分别采用钙浓度1.25及1.75mmol/l透析液连续进行3个月透析治疗,分别检测治疗前后血钙及血磷浓度。结果实验结束后,高钙浓度组血钙水平明显升高(P<0.05),血钙×磷浓度水平降低(P<0.05),血磷水平无明显变化(P>0.05)。结论高钙透析液能有效的提高MHD患者血钙浓度,减少钙磷代谢紊乱发生。     

低钙透析对血液透析患者血管结构和心脏功能的影响

目的观察低钙透析对维持性血液透析患者血管结构和心脏功能的影响。方法测定2007年6月至12月在安徽医科大学第三附属医院肾内科血液透析中心30例维持性血液透析（maintenance hemodialysis,MHD）患者,所有患者入组前均使用标准钙1．5mmol／L（dCa^2＋1．5）透析,透析过程平稳。入组后改用低钙1．25mmol／L（dCa^2＋1．25）透析液,余治疗方案不变。入组前及改用低钙透析液6个月后行血生化检查。采用GE ViVid 7型彩色多普勒超声诊断仪检测颈总动脉内膜-中层厚度（intima medial thickness,IMT）、左心室射血分数（left ventricular ejectian fraction,LVEF）,测量舒张早期和舒张晚期最大血流速度。并根据公式计算心脏输出指数,舒张早期和舒张晚期最大血流速度的比值（E／A）等指标。结果在使用dCa^2＋1．25透析液6个月后,患者血清钙值和钙磷乘积与使用dCa^2＋1．5透析液相比明显下降,甲状旁腺激素（parathyroid hormone,PTH）水平明显上升（P〈0．05）,有统计学差异,而其它的血清生化指标的变化无统计学差异。使用低钙透析6个月后,患者颈动脉IMT较使用dCa^2＋1．5透析液相比明显下降,（E／A）比值水平明显上升（P〈0．05）,而左心室射血分数及心脏输出指数在使用dCa^2＋1．25透析液6个月后变化无统计学差异（P〉0．05）。结论低钙透析可改善维持性血液透析患者动脉粥样硬化和动脉顺应性的下降,促进左室舒张功能,并推测其作用可能与纠正钙磷代谢紊乱有关。     

某市血液透析现状及透析用水和透析液质量合格情况调查

目的了解某市血液透析现状及透析用水和透析液合格情况。方法对该市36所开展血液净化项目的医疗机构血液透析现状进行调查,并同时采集透析用水及透析液分别进行微生物检验(包括常规和低温培养方法)及现场ATP水样检测。结果 13.89%的水处理设备使用时间在1年内,5.56%的设备使用超过10年。砂滤等净化设备超过1年未更换的机构占77.78%,72.22%的滤芯式过滤器更换时间3个月,反渗水供水管道使用时间超过10年的占2.78%。77.78%的医疗机构使用成品A液,72.22%使用成品B液,集中提供A液的医疗机构占22.22%,集中提供B液的医疗机构占19.44%,自配桶装B液的医疗机构达8.34%。36所医疗机构微生物日常检测均合格,但有80.56%检测结果长期为"0"值;现场采集的透析用水及透析液ATP检测均合格;常温微生物检验1份超标,2份达干预值;低温培养法4份超标,6份达干预值;不同级别医疗机构之间3种检测方法合格率比较,差异均无统计学意义(均P0.05)。结论该市透析用水及透析液的质量总体较好,大部分医疗机构重视水处理设备的日常维护,定期检测透析用水和透析液的质量,但是微生物检测技术有待提高,日常检测结果异常或达到干预值需要分析原因和不断改进。     

Proteomic Analysis of Peritoneal Dialysate Fluid in Patients with Dialysis-Related Peritonitis

The prognosis of uremia patients on continuous ambulatory peritoneal dialysis (CAPD) is related to frequent peritonitis rate. Frequent peritonitis will lead to peritoneum failure, making CAPD unfeasible. We have performed proteomic profiling of peritoneal dialysis effluent samples from a cross-section of CAPD patients with and without peritonitis in order to identify biomarkers of peritonitis. We performed 2D gel electrophoresis and surface-enhanced laser esorption/ionization time of flight mass spectrometry (SELDI-TOF MS) on peritoneal dialysis effluent from 16 subjects with peritonitis. A genetic algorithm search of principal component space revealed a group of a peak distinguishing peritonitis-positive subjects, with mass/charge (m/z) values of 11,117.4. Our analyses identified the peak at m/z 11,117.4 with an accuracy of 95% for classifying peritonitis. Mass spectrometric analysis of peritonitis PDE samples identified the 11,117.4 protein as β2-microglobulin (B2M). Using an unbiased protein profiling approach, we have validated previously reported findings of B2M as a biomarker associated with CAPD peritonitis. Prospective studies are warranted to establish additional biomarkers that would be predictive of peritoneal dialysis peritonitis. Besides, extending the study to a larger number of patients with subgroup analyses may yield additional information of the peritoneal dialysate proteins in association with dialysis adequacy, residual renal function, nutritional status, and risk of peritoneal infection.     

离子色谱法测定血液透析液中乳酸根的含量

目的：建立离子色谱法测定血液透析液中乳酸根的含量测定方法并进行方法验证,为乳酸盐透析液的质量控制和市场监管提供重要的技术参考。方法用DIONX ICS?1100离子色谱仪进行检测,色谱柱为AS9?HC柱（4 mm×250 mm）,淋洗液为9 mmol／L碳酸钠,流速1 mL／min,电导检测器,外标法定量。结果乳酸根的线性范围为5?03～80?54μg／mL（ r＝0?9999）,定量限为0?1007μg／mL,平均加样回收率为101?4％。结论该方法准确,分析时间短,样品无需前处理,不受样品中其他组分的干扰,可用于血液透析液中乳酸根的含量测定。     

High Glucose Concentrations in Peritoneal Dialysate Are Associated with All-Cause and Cardiovascular Disease Mortality in Continuous Ambulatory Peritoneal Dialysis Patients

♦ Background: The effect of high peritoneal dialysate glucose concentration (PDGC) on all-cause and cardiovascular disease (CVD) mortality in peritoneal dialysis (PD) patients is unclear.♦ Objective: Our study aimed to investigate the effect of high PDGC on all-cause and CVD mortality in continuous ambulatory PD (CAPD) patients.♦ Methods: The study enrolled 716 patients newly initiated on CAPD therapy between January 2006 and December 2010. We allocated the patients to low (<1.56%), medium (≥1.56% to <1.74%), and high (≥1.74%) average PDGC groups according to the tertile of average PDGC in the first 6 months after PD initiation. Cox regression and ordinal logistic regression were used to analyze determinants of mortality and of PDGC use respectively.♦ Results: Mean follow-up in the study cohort was 31 ± 15 months. The all-cause mortality was 4.7 events per 100 patient-years, and the leading cause of death was CVD. Patients with a higher PDGC had significantly higher cumulative rates of all-cause (log-rank p < 0.001) and CVD mortality (log-rank p < 0.001). In Cox regression analysis, high PDGC independently predicted higher all-cause (hazard ratio: 2.63; p = 0.004) and CVD mortality (hazard ratio: 2.78; p = 0.01). Compared with a lower PDGC, a higher PDGC was significantly associated with older age [odds ratio (OR): 1.02; p < 0.001], low residual renal function (OR: 0.91; p < 0.001), and high dialysate-to-plasma ratio of creatinine (OR: 28.61; p < 0.001) in ordinal logistic regression.♦ Conclusions: Higher PDGC is associated with higher allcause and CVD mortality in CAPD patients.     

HT-ED联合UPLC-MS/MS技术分析白头翁皂苷B4的大鼠血浆蛋白结合率

目的:建立血浆中白头翁皂苷B4的分析方法,测定白头翁皂苷B4大鼠血浆蛋白结合率。方法:采用96通道高通量平衡透析系统(HTD 96b)进行透析,利用UPLC-MS/MS测定透析内外液中白头翁皂苷B4的浓度,研究白头翁皂苷B4在大鼠血浆中的血浆蛋白结合率,使用Waters XTerra MS C18色谱柱(2.1 mm×50 mm,5μm),流动相0.1%甲酸水溶液-乙腈梯度洗脱,流速0.7 m L·min~(-1),柱温40℃,进样量5μL。结果:白头翁皂苷B4在5~2 000 ng·L-1线性关系良好,其精密度RSD及准确度均8.0%,重复性RSD9.0%,稳定性的RSD均15%;提取回收率和基质效应均在80%~115%。白头翁皂苷B4在低、中、高(6,12,24 mg·L-1)3个质量浓度下大鼠血浆蛋白结合率分别为(95.32±0.37)%,(94.32±0.63)%,(88.64±0.37)%。结论:白头翁皂苷B4与大鼠血浆具有较强的蛋白结合率,且结合率不具有质量浓度依赖性。