Annual Congress of the Blood Purification Management Branch of Chinese Hospital Society, August 11-14, 2016, Nanjing, China: Selected Abstracts

2017 Blood Purification  
Objective: To evaluate the effect of continuous renal replacement therapy (CRRT) on the prognosis of cardio-renal syndromes (CRS) type 1. Methods: We retrospectively analyzed the clinical data of 53 patients who were treated with CRRT for CRS type 1 between January 20 08 to December 2015 in Beijing anzhen hospital, to assess the prognosis of these patients (death, out of RRT or rely on RRT) and its influencing factors. CRRT was performed by the form of s continuous veno-venous hemodiafiltration
more » ... s hemodiafiltration (CVVHDF) technique using a standard femoral vein catheter and sodium citrate or heparin anticoagulation. The ratio of dialysate to replacement fluid was 1:1 ( replacement fluid volume 2 L/h). The ultrafiltration rate was 50~200 ml/h. Results: There were 36 males and 17 females with an average age of 65.5 ± 15.2 years. The exclusion criteria were: cardiac shock, intra-aortic balloon pump and end stage renal disease. The primary cardiovascular diseases were: chronic heart failure 13 cases, acute myocardial infarction 22 cases, cardiomyopathy 11 cases, hypertension 4 cases, and rheumatic heart disease 3 cases. Hospital mortality was 43.4% (23/53). 21 of the 53 patients (39.6%) who did not need hemodialysis anymore after the CRRT treatment. The initiate time from onset of acute heart failure to the beginning of RRT was 0~22 days [(4.43 ± 7.00) days]. The average duration of CRRT was (82.16 ± 73.90) h. Basic serum creatinine (Scr) (212.02 ± 131.57 vs. 128.93 ± 72.52 μmol/L, P < 0.05), diuretics using (69.6% vs 57.1%, P < 0.05), output of urine [(313.78 ± 236.20) ml vs. (484.10 ± 298.31) ml, P < 0.05], CRRT initiate time [(7.00 ± 9.59) days vs. (2.00 ± 1.35) days, P < 0.05] and inotropes and/or va sopressors using (57.1% vs 38.1%, P < 0.05) had significant difference between death group (23 patients) and out of hemodialysis group (21 patients); however, age, gender, history of CHF, diabetes and hypertension, useing of ACEI/ ARB, B-type brain natriuretic peptide (BNP), left ventricular ejection fraction (EF) and left ventricular diameter (LVDH) had not significant difference between the two group. The patients had lower in-hospital mortality (27.6% vs 62.5%), lower percentage of rely on RRT (8.3%vs 24.1%), shorter duration of CRRT (57.05 ± 38.49 vs. 112.50 ± 93.75 h) and more liquid removal (6.05 ± 5.28 vs. 12.07 ± 11.02 L) in the early CRRT group (iniation of CRRT less than 2 days after onset of acute heart failure) when compared to the lately CRRT group (iniation of CRRT more than 2 days after onset of acute heart failure). Logistics regression analysis showed that only inotropes and/or vasopressors using was independent risk factors of death (P < 0.05). Conclusions: The patients with CRS type 1 often require CRRT intervention. Early CRRT could rapidly reduce fluid overload, increase cardiac output and decrease mortality. Renal insufficiency, lately CRRT, or inotropes and/or va sopressors using affect prognosis of patients with type 1 CRS. Therefore, early CRRT, precise volume evaluation and hemodynamic monitoring can effectively prevent the occurrence of hypotension and improve survival rate. in the first affiliate hospital of Nanjing Medical University were screened by the Lab Administration Network. All adult patients met KDIGO AKI criteria were enrolled. Demographic characteristics, laboratory examination, clinical data, clinical outcomes were recorded. Results: The incidence of AKI was 1.6% (1401/87196). Patients with AKI stage 1, 2, 3 and renal replacement therapy (RRT) accounted for 38.0% (532/1401), 22.0% (309/1401), 40.0% (560/1401) and 16.3% (228/1401), respectively. The average age was 63.2 ± 37.2 and urban population made up 58.3%. The median length of hospital stay was 18 (11, 28) days and median cost was 57.2 (25.0, 121.6) thousand RMB. The 30-day mortality was 35.3%. Renal, other internal, surgery and ICU department accounted for 7.4%, 37.1%, 30.1% and 25.4% of the study patients. The timely diagnosis rate, delayed diagnosis rate and missed diagnosis rate were 44% (616/1401), 3.3% (46/1401) and 52.7% (739/1401), respectively. Patients hospitalized in renal department had the highest AKI diagnosis rate (89.3%, 88/103), while missed diagnosis rate of the surgical patients was as high as 75.1% (317/422). Conclusions: AKI was characterized by high incidence, high short-term mortality and high missed diagnosis rate in hospitalized adult patients in our hospital. Electronic alert system for AKI was urgently needed for timely diagnosis and intervention. Objective: The volume overload of patients with cardiac surgery is common, which is closely related to the occurrence, development and prognosis of cardiac surgery associated acute kidney injury (CSA-AKI). Dilution effect of volume overload of cardiac surgery patients could delay early diagnosis of CSA-AKI. The purpose of the study was to investigate the effect of volume overload on the timing of diagnosis and prognosis of AKI with off pump coronary artery bypass grafting (OPCABG). Methods: That was a retrospective analysis and single center study. 122 consecutive patients undergoing elective OPCABG from January to June 2015 in Zhongshan hospital were enrolled in this study. AKIN criteria was used to classify CSA-AKI. Fluid input and output were recorded for 48 hours post-operatively. Urine output was recorded every 6 hours for 24 hours post-operatively. Serum creatinine was daily recorded and adjusted for weight-corrected fluid balance and patients were categorized into three groups: group A (No AKI before or after adjustment); group B (AKI only after adjustment); group C (AKI both before and after adjustment). Results: Among 122 patients with weight and baseline creatinine available, only 1 patient in group C received CRRT treatment and all patients were discharged successfully from hospital. After adjusting for weight and volume balance, the incidence of CSA-AKI increased from 18.8% (23/122) to 30.3% (37/122) (p < 0.05). In patients with AKI only after adjustment (group B), ICU stay and total hospitalization time were significantly higher than those in group A [(3.3 ± 0.9) d vs (1.8 ± 1.5) d, p < 0.05; (13.3 ± 3.7) d vs (11.3 ± 3.3) d, p < 0.05], however no significant difference was observed when compared with group C [(3.3 ± 0.9) d vs (2.5 ± 1.1) d, p > 0.05;(13.3 ± 3.7) vs (14.0 ± 2.5) d, p > 0.05]. Also, the mechanical ventilation time in group B was significantly longer than group A [(2.1 ± 0.6) d vs (1.3 ± 0.9) d, p < 0.05], but approximated that of group C (p > 0.05). Conclusion: The dilution effect of volume overload in the patients with OPCABG could influence the level of serum creatinine concentration, which might delay early classification of AKI. In order to improve the sensitivity of detection of cardiac surgery associated AKI, serum creatinine should be adjusted according to the volume balance and basic weight level. of life. decreased significantly in peripheral blood mononuclear cells in CHD group, and more significantly in CHD + AS group (P < 0.05). Meanwhile, compared with CHD group, VCAM-1 and ICAM-1 levels in plasma increased significantly in CHD + AS group (P < 0.05). Conclusions: PKCs may participate in the development of UAAS by mediating Akt signaling pathways activation and regulating the downstream VCAM-1 and ICAM-1. Abstracts Conclusion: KPI management mode can help us to improve the quality of PD centre management. Annual Congress of the Chinese Blood Purification Center Administration Committee group, the expression of RUNX2 mRNA increased in SET8-siRNA group (P < 0.05) Conclusion: Our datas show that interference SET8 gene expression can promote VSMCs to transform to osteoblast-like cell, and SET8 may involve in regulating vascular calcification. Objectives: The aim is to characterize the possible role of AKt/ mTOR signalling in the vascular smooth muscle cells (VSMC) calcification induced by high phosphate. Methods: Passage 3 to 5 of VSMC were used for experiments. VSMC were divided into two groups: normal phosphate group (Pi 1.3 mmol/L) and high phosphate group (Pi 2.6 mmol/L). Cbfα1 and OPN mRNA levels were determined by Real-Time PCR. p-AKt (ser473), p-mTOR (S2448), Cbfα1 and OPN protein expressions were quantified by Western Blot. When p-Akt and p-mTOR expression of VSMC were enhanced by high phosphate, Akt/mTOR inhibitors were respectively added in high phosphate group. VSMC then were divided into seven groups: high phosphate group (Pi 2.6 mmol/L); high phosphate + Wortmannin (10, 50, 100 nmol/L); high phosphate + rapamycin (1, 10, 100 ng/ml). After 24-48 h, Cbfα1 and OPN mRNA levels were determined, and p-AKt, p-mTOR, Cbfα1 and OPN protein expressions were quantified. All experiments were repeated 3 times. Calcium deposition was visualized by Alizarin stain method at day 7-14. Results: After 7 days, compared with normal phosphate group, calcium deposition was obvious in high phosphate group. Cbfα1 and OPN mRNA expressions were significantly increased and the expressions of p-Akt/p-mTOR, Cbfα1 and OPN protein were significantly increased in high phosphate group (P < 0.05). Cultured for another 7 days, calcium deposition was significantly decreased in high phosphate + Wortmannin (50, 100 nmol/L) groups and high phosphate + rapamycin (100 ng/ml) group, compared with high phosphate group. After 24-48 hours, Cbfα1 and OPN mRNA expressions were significantly decreased; p-AKt, p-mTOR, Cbfα1 and OPN protein expressions were significantly decreased in high phosphate + Wortmannin (50, 100 nmol/L) and high phosphate + rapamycin (10, 100 ng/ml) groups (P < 0.05) compared with high phosphate group. Conclusions: AKt/mTOR inhibitors, may suppress VSMC calcification and expressions of p-AKt/p-mTOR, Cbfα1 and OPN. Akt/ mTOR is involved in VSMC calcification induced by high phosphate. cases with exit-site complications: 1 case of exit-site bleeding and 4 cases of exit-site infection (1 case of which combined by tunnel infection) were included; through Chi-square test, difference between the two groups were of statistical significances (P < 0.05). Conclusion: The use of modified PD tunnel needle could reduce the occurrence of exit-site bleeding, exit-site infection and tunnel infection, and promote the healing of exit site. Exit-site infection may result in an increased occurrence of peritonitis which is a common reason of PD extubation or even quiting from PD. The improved tunnel needle is more smooth for use during surgery operation, which can prevent intraoperative injury, reduce exit-site complications, and was worthy of clinical use.
doi:10.1159/000454755 fatcat:jc3vpxuywjfwrnb6gsz3cdjxca