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Objectives@#. We aimed to develop a new calculation model for calcium requirements in dialysis patients following parathyroidectomy. @*Methods@#. A total of 98 patients with secondary hyperparathyroidism receiving parathyroidectomy from January 2014 to January 2022 were enrolled in this study. Among these patients, 78 were randomly selected for construction of the calcium requirement calculation model, and the remaining 20 patients were selected for model validation. The calcium requirement model estimated the total calcium supplementation for 1 week after surgery using variables with significant relationships in the derivation group by stepwise multiple linear regression analysis. Bias, precision, and accuracy were measured in the validation group to determine the performance of the model. @*Results@#. The model was as follows: calcium requirement for 1 week after surgery=33.798–8.929×immediate postoperative calcium+0.190×C-reactive protein–0.125×age+0.002×preoperative intact parathyroid hormone+0.003×preoperative alkaline phosphatase (R2=0.8). The model was successfully validated. @*Conclusion@#. We generated a novel model to guide calcium supplementation. This model can assist in stabilizing the serum calcium levels of patients during the early postoperative period. Furthermore, it contributes to the individualized and precise treatment of hypocalcemia in patients following parathyroidectomy.
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Objective:To explore the risk factors of hypocalcemia and the correlation between calcium supplementation and clinical parameters after parathyroidectomy (PTX) in maintenance hemodialysis patients with secondary hyperparathyroidism (SHPT), and to analyze the effect of calcium supplementation after PTX on the long-term prognosis of patients.Methods:This study was a single-center retrospective study. The patients who underwent PTX in maintenance hemodialysis patients with SHPT in the Huashan Hospital affiliated to Fudan University from October 2014 to March 2021 were retrospectively enrolled. Total PTX with auto transplantation or total PTX alone were the surgical procedures. According to the postoperative requirement of calcium in the first week, the patients were divided into two groups: high calcium supplement (>16.05 g/week) group and low calcium supplement group (≤16.05 g/week). According to the average serum calcium level in the first week after operation, the patients were divided into hypocalcemia group (≤2.1 mmol/L) and non-hypocalcemia group (>2.1 mmol/L) and the differences of clinical parameters between the two groups were compared. The correlation between clinical parameters and the postoperative calcium requirement was examined through Pearson or Spearman correlation analysis. The influencing factors for hypocalcemia after PTX were examined through logistic regression analysis. The survival curve was made by Kaplan-Meier method, and the difference of cumulative survival rate between the two groups was compared by log-rank test.Results:A total of 98 maintenance hemodialysis patients with SHPT were enrolled. The levels of serum calcium, phosphorus, and intact parathyroid hormone (iPTH) after the operation decreased significantly than those of preoperation (all P<0.05). Multiple linear regression analysis showed age ( β=-0.160, P=0.030), iPTH ( β=0.004, P=0.025) and C-reactive protein ( β=0.186, P=0.011) were correlated with postoperative calcium requirement. Preoperative alkaline phosphatase ( OR=1.002, 95% CI 1.000-1.004, P=0.018) and hemoglobin ( OR=0.977, 95% CI 0.954-1.000, P=0.048) independently predicted the occurrence risk of postoperative hypocalcemia through multivariate logistic regression analysis. The recurrence rate of high calcium supplement group was higher than that of low calcium supplement group (10.26% vs 0, P=0.023) and there was no significant difference in all-cause mortality between the two groups (17.95% vs 5.08%, P=0.086). The recurrence rate between the hypocalcemia group and non-hypocalcemia group was no significantly different (8.3% vs 1.8%, P=0.451) and there was no significant difference in all cause mortality between the two groups (12.5% vs 12.7%, P=1.000). Kaplan-Meier survival curve showed that the cumulative survival rate between the two groups was no significantly different (log-rank test χ2=0.147, P=0.702). Conclusions:PTX is a safe and effective therapeutic method to reduce the level of iPTH and improve the metabolism of calcium and phosphorus in SHPT patients. Age, iPTH and C-reactive protein are correlated with the postoperative requirement of calcium in the first week. Preoperative alkaline phosphatase and hemoglobin are independent risk factors for postoperative hypocalcemia. Correcting preoperative electrolyte disorder, improving infection and anemia can reduce the incidence of hypocalcemia after PTX.
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Objective:To explore the effects of dietary phosphate restriction education on serum phosphorus level, dietary phosphate intake and the knowledge of hyperphosphatemia in maintenance hemodialysis (MHD) patients.Methods:This study was a retrospective cohort study. A total of 116 hemodialysis patients in Huashan Hospital, Huadong Hospital and Tongji Hospital from October 2019 to December 2020 were enrolled in this study. They were divided into short-term group (84 cases) and long-term group (32 cases). The short-term group did not receive education or received education≤60 minutes. Meanwhile, the long-term group received education>60 minutes. Serum phosphorus level, dietary phosphate intake and knowledge of hyperphosphatemia were compared between the two groups after 4 weeks.Results:At baseline, age [64(56, 69) years old vs 65(60, 73) years old, Z=-1.493, P=0.136], the proportion of males [58.3%(49/84) vs 56.3%(18/32), χ2=0.041, P=0.839], dialysis age [55(26, 130) months vs 53(20, 132) months, Z=-0.062, P=0.951], body mass index, diabetes history, single-pool Kt/V, proportion of calctriol used, blood calcium, blood phosphorus, intact parathyroid hormone and dietary protein, dietary phosphorus and dietary phosphorus protein ratio had no statistical significance between short-term group and long-term group (all P>0.05). Adequate dietary phosphate restriction education reduced dietary phosphate intake [777.98(653.81, 943.16) mg/d vs 896.56(801.51, 1 015.51) mg/d, Z=-2.903, P=0.004], phosphate/protein ratio [13.16(11.52, 14.21) mg/g vs 15.27(13.31, 17.48) mg/g, Z=-3.929, P<0.001] and serum phosphorus level [(1.42±0.37) mmol/L vs (1.85±0.44) mmol/L, t=4.984, P<0.001]. Meanwhile, such education significantly improved achievement rate of serum phosphorus (62.5% vs 41.7%, χ2=4.034, P=0.045). In addition, patients in long-term group answered more questions correctly (completely correct plus partially correct) about the causes (93.8% vs 72.6%, χ2=6.120, P=0.013), poor prognosis (78.1% vs 52.4%, χ2=6.372, P=0.012) of hyperphosphatemia as well as the types of food with high phosphate (65.6% vs 52.4%, χ2=1.650, P=0.199). Conclusion:Adequate dietary phosphate restriction education reduces serum phosphorus level and dietary phosphate intake, and improves the knowledge of hyperphosphatemia in MHD patients.
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Closed-loop hospital management can effectivly cope with the COVID-19 pandemic. In order to ensure the continuity of treatments for hemodialysis patients under closed-loop management and minimize possible medical and infection risks, Huashan Hospital affiliated to Fudan University and 9 hospitals in Shanghai established a hemodialysis alliance in January 2021.The alliance optimized hemodialysis resources within the region through overall planning by preparing sites, materials and personnel shifts in advance, and establishing management systems and work processes to ensure that patients could be quickly and orderly diverted to other blood dialysis centers for uninterrupted high-quality hemodialysis services, in case that some hemodialysis centers in the alliance under closed-loop management.From November 2021 to April 2022, 317 of 1 459 hemodialysis patients in the alliance were diverted to other centers for treatment, accumulating 1 215 times/cases of treatments without obvious adverse reactions. The practice could provide a reference for medical institutions to quickly establish mutual support mode under major public health events.
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Objective:To investigate the risk factor of renal anemia in maintenance hemodialysis patients (MHD) and the association of N-terminal pro-brain natriuretic (NT-proBNP) level with renal anemia.Methods:Patients who received MHD for more than 3 months at Huashan Hospital affiliated to Fudan University from August 2018 to November 2018 were selected as the subjects. The patients were divided into anemia group and non-anemia group according to the hemoglobin level. The patients' general data, the laboratory examination and dialysis related data during the observation period were collected. Pearson correlation analysis was used to analyze the correlation between anemia indicators, dialysis-related indicators and blood NT-proBNP levels. Stepwise multiple linear regression analysis was used to analyze the risk factors for anemia in MHD patients.Results:A total of 160 patients with MHD were included in this study, aged (63.11±11.35) years. There were 79 males (49.4%) and 81 females (50.6%). The dialysis age was (118.01±82.32) months, hemoglobin was (110.09±13.48) g/L, and the median NT-proBNP was 3 985 ng/L. There were 73 cases (45.6%) in anemia group and 87 cases (54.4%) in non-anemic group, and NT-proBNP levels were significantly higher in anemia group than that in the non-anemia group ( t=-3.714, P<0.001). Hemoglobin levels were positively correlated with weekly dialysis time ( r=0.228) and albumin ( r=0.349), and negatively correlated with NT-proBNP levels ( r=-0.318). Hematocrit was positively correlated with weekly dialysis time ( r=0.283), serum calcium ( r=0.317), phosphorus ( r=0.264) and albumin ( r=0.513) with significance (all P<0.05). Univariate regression analysis showed that the level of ln (NT-proBNP) was negatively correlated with hemoglobin ( P<0.001). Stepwise multiple linear regression results showed that low albumin level and high NT-proBNP level were independent risk factors for renal anemia in MHD patients. Conclusions:The increase level of NT-proBNP in MHD patients is independently associated with the decrease level of hemoglobin. Low albumin level and high NT-proBNP level are risk factors for renal anemia, suggesting that the treatment of renal anemia needs to consider improving the factors such as malnutrition and high volume.
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0bjective To investigate the occurrence of frequent intradialytic hypotension in hemodialysis patients and Analyzed influencing factors. Methods The 1 933 hemodialysis sections of 156 maintenance hemodialysis patients in the Huashan hospital affiliated to Fudan University in Shanghai were selected, and divided into frequent intradialytic hypotension and non- frequent intradialytic hypotension depending on whether the incidence of intradialytic hypotension is greater than 20%, and the patients' dialysis data and biochemical examination data are collected for the analysis of influencing factors. Results The incidence of frequent IDH in maintenance hemodialysis patients was 62.18%(97/156), and the pre-dialysis blood pressure of frequent IDH patients were higher than non-frequent IDH patients, frequent IDH patients: (134.02±21.01)/(73.85±10.73) mmHg(1 mmHg=0.133 kPa), non-frequent IDH patients: (124.66 ± 17.89)/(69.32 ± 10.65) mmHg, (t=-2.851,-2.558, P＜0.05), but lower in post-dialysis, frequent IDH patients:(114.91±19.21)/(68.38±11.41) mmHg, non-frequent IDH patients: (127.90± 20.58)/(74.46±11.79) mmHg, (t=3.989, 3.189, P＜0.01). Binary Logistic regression analysis showed that hemoglobin ( OR=0.354, P=0.015) and high-density lipoprotein ( OR=0.155, P=0.003) were protective factors for the occurrence of frequent IDH, and ultrafiltration volume/weight ( OR=6.021, P=0.002) and N-terminal pro-brain natriuretic peptide ( OR=2.687, P=0.020) were risk factors. Conclusions The incidence of frequent IDH in hemodialysis patients is high, and patients with high filtration rate, high N-terminal pro-brain natriuretic peptide, low hemoglobin and high density lipoprotein should be paid close attention to. It is recommended to regularly monitor patients' biochemical indicators, strengthen blood pressure monitoring for high-risk groups, and timely deal with the symptoms of low blood pressure.
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Objective The aim of the study was to investigate the early failure of newly created arteriovenous fistula(AVF) in patients on maintenance hemodialysis and the factors responsible for the failure. Methods The clinical data were retrospectively reviewed, preoperative examination and laboratory biochemical indicators of 88 patients with newly created AVF for maintenance hemodialysis in our hospital through Hospital Management Information System and telephone follow-ups. Binary Logistic regression was used to analyze the protective factors for early failure. Results In 88 patients, early failure of the AVF was found in 15 patients. Twenty-three factors, including gender, were involved in statistical analysis. There were statistical differences between the two groups in hypertension (χ2=7.689, P=0.006) and whether they had early referral to nephrologists (χ2=5.334, P=0.021). Further regression analysis showed hypertension ( OR=0.192, 95% CI=0.0538-0.692, P=0.012) was protective factor and without early referral ( OR=3.651, 95% CI=1.068-18.302, P=0.039) was the risk factor of early failure. Conclusion This study shows that no early referral and combined hypertension is an important factor affecting the early failure, emphasizing the clinical work, for the diagnosis of patients with chronic kidney disease, early nephrological referral should be established, and blood pressure monitoring should be done to help reduce the incidence of complications.
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Objective To evaluate the muscle mass in maintenance hemodialysis (MHD) patients and analyze the influential factors.Methods Ninety-seven patients on MHD and 34 healthy people were recruited.Muscle mass was measured by bioelectrical impedance analysis and compared.Patients'age,sex,height,body weight,walking activity,modified quantitative subjective global assessment (MQSGA) score and laboratory tests were recorded.The relationship of appendicular skeletal muscle mass/height2 (ASM/H2) and other factors were analyzed using multivariate linear regression.Results Compared with normal cohort,the MHD patients showed lower body fat rate and lower ASM/H2 (both P ＜ 0.05).In 97 MHD patients,21.4％ of male patients suffered from sarcopenia,and 24.4％ of female patients suffered from sarcopenia.Patients were divided into two groups according to the level of ASM/H2 (male ＜ 7.0 kg/m2,female ＜ 5.8 kg/m2).The grip strength,serum creatinine,1,25(OH)2D and mid-arm muscle circumference in low ASM/H2 group were lower than those in normal ASM/H2 group,and the differences were significant (all P ＜ 0.05).In multivariable regression model,male (β=0.534,P=0.003),1,25(OH)2D (β=0.582,P=0.024),creatinine (β=0.421,P=0.037),grip strength (β=0.681,P=0.001),and lg[NT-proBNP] (β=-1.760,P=0.042) were independently associated with ASM/H2 in MHD patients.Conclusion The prevalence of sarcopenia is much higher in MHD patients than in healthy people.The levels of grip strength,NT-proBNP,creatinine and 1,25(OH)2D are the important influential factors for muscle mass in MHD patients.
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Objective To observe the effects of three treatment methods on renal anemia in maintenance hemodialysis patients with hyperparathyroidism secondary to uremia and analyze the influencing factors of erythropoietin (EPO) dosage. Methods A total of 55 maintenance hemodialysis patients with secondary hyperparathyroidism at the hemodialysis center of Huashan Hospital affiliated to Fudan University from January 2015 to December 2016 were retrospectively divided into three groups according to different treatment methods, parathyroidectomy +forearm transplantation group (surgery group, n=16), cinacalcet treatment group (n=6), and calcitriol treatment group (n=33), respectively. The hemoglobin level and erythropoietin dosage were measured before treatment and in the 3rd month, the 6th month and the 12th month after treatment. The changes of hemoglobin and erythropoietin dosage in the three groups before and after treatment were observed, and the mixed effect model was used to analyze the difference of the change of hemoglobin and erythropoietin dosage among three groups. Multiple linear regression analysis was used to analyze the influencing factors of EPO dosage after one year. Results The levels of intact parathyroid hormone (iPTH) in the surgery group and the cinacalcet group before treatment were significantly higher than that in the calcitriol group (both P<0.05). In the 12th month after treatment, the levels of iPTH decreased significantly in the patients of surgery group and the cinacalcet group compared with those before treatment (both P<0.05). The levels of serum alkaline phosphatase, serum calcium and serum phosphorus in the surgery group also decreased significantly compared with those before treatment (all P<0.05). The mixed effect model analysis showed that the hemoglobin level of surgery group was on an upward trend after the treatment, and the overall level was significantly higher than cinacalcet and calcitriol treatment group (P=0.007). There was no significant difference in the dosage change of erythropoietin (EPO) in the three groups over time. However, the intra-group comparison of the mixed effect model showed that the dosage of EPO in the 12th month was significantly lower than that of before the treatment in surgery group (P=0.007). Multiple linear regression analysis showed that dialysis vintage (B=-0.064, P=0.012) and ferritin ≥ 500 μg/L (B=0.645, P=0.032) were independent influencing factors of EPO dosage. The longer the dialysis vintage, the less EPO dosage, and more EPO dosage were observed in patients with ferritin ≥ 500 μg/L. Conclusions Parathyroidectomy and forearm transplantation is more effective in reducing EPO dosage and improving renal anemia in maintenance hemodialysis patients with secondary hyperparathyroidism. Dialysis vintage and ferritin are independent influencing factors for the dosage of EPO.
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Objective To investigate the natural infection of Theiler's murine encephalomyelitis virus (TMEV) in mice,and to survey the distribution of virus in tissues and the changes of serum antibody in the experimentally TMEV-infected mice.Methods Enzyme linked immunosorbent assay (ELISA) and fluorescence quantitative RT-PCR (qRT-PCR) assay were used to detect the antibody and nucleic acid of TMEV in clinical samples.These samples included SPF mice collected from Guangdong area in 2010-2015,mice obtained from a non-barrier laboratory rodent colony,and wild Rattus norvegicus live-trapped around the non-barrier laboratory rodent colony.36 ICR mice were intracerebrally inoculated with TMEV BeAn strain.The clinical signs of the animals were observed daily post-inoculation.Three mice were euthanatized at day 0,3,7,10,17,21,31,39 and 46 post-inoculation (dpi),respectively.Tissue and serum samples were collected for TMEV detection.Results The TMEV antibody and nucleic acid positive rates of SPF mice collected from Guangdong area in 2010-2015 were 5.29％ (n=2834) and 27.27％ (n=457),respectively.The TMEV antibody and nucleic acid positive rates of the mice obtained from a non-barrier laboratory rodent colony were 71.95％ (n=82) and 53.66％ (n=82),respectively.The TMEV nucleic acid positive rate of wild Rattus norvegicus was 25.93％ (n=27).In the TMEV positive mice,only two mice showed obvious clinical symptoms.The cecal contents,feces and brain samples were the best candidates for qRT-PCR assay.The viral nucleic acid could be detected in the brain,heart,liver,lung and stomach of ICR mice at 3 dpi,but no viral nucleic acid was detected in the spleen,kidney,and cecum.The viruses in liver,heart,lungs and stomach were completely cleared at 10 dpi,and the viruses persisted in the brain throughout the experiment.The TMEV antibody could be detected at 7 dpi,and then the antibody positive rate reached 100％ at 17 dpi.The antibody level increased gradually and maintained up to 46 days.ICR mice showed latent infection after TMEV inoculation,with no obvious symptoms and eye pathological changes.Conclusions The experimental mice and wild Rattus norvegicus in Guangdong area are both infected with TMEV,and the infection rate is high.The mice inoculated with TMEV BeAn strain show latent infection.The TMEV antibody produced in mice can be detected at 7 dpi and persisted until the end of the experiment.The viruses are found in the liver,heart,lung and stomach for a short time,but are persisted in the brain for a long time.There is a good consistency of TMEV detection between qRT-PCR and ELISA.The qRT-PCR assay can be used as a powerful complement method for the national standard of laboratory animals.
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Objective To establish a rapid,specific and sensitive TaqMan real-time fluorescence quantitative PCR assay for detection of murine polyomavirus ( MPyV) .Methods The specific primers and TaqMan probe were designed based on genome sequence of MPyV.The primers amplified a 69 bp fragment.After optimizing the reaction system and reaction condition, the standard curve was plotted by detecting recombinant plasmid standards.The specificity, sensitivity and reproducibility of this method were evaluated.In addition, samples of lungs, spleens and feces obtained from experimentally infected mice and 86 clinical samples were used to validate the efficacy of this real-time PCR assay.Results The specificity assay showed that this assay could specifically detect MPyV and the sensitivity for MPyV was about 100 copies/well.The coefficients of variation ( CV) of both intra-assay and inter-assay were less than 1.13%.All of the samples from experimentally infected mice were positive for MPyV and 3 out of 86 clinical samples were positive by this TaqMan-PCR detection with a positive rate of 3.5%.Conclusions The real-time fluorescence quantitative TaqMan-PCR assay established in this study has high specificity, sensitivity and stability.It can be used for clinical diagnosis, routine detection and epidemiological investigation of murine polyomavirus infections.
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Objective To evaluate the accuracy of Sysmex XT-4000i automated hematology analyzer on neonatal leukocytes count and classification results.Methods 213 cases of neonatal blood specimens were analyzed respectively by Sysmex XT-4000i automated hematology analyzer and microscope counting and staining of two categories of methods.Results The instrument that immature granulocyte,primitive cell,shift to the left,three kind of tip in any one or more specimens have 112,accounted for 52.58% (112/213),and staining immature cell or shift to the left of the specimens was 91,accounted for 42.72% (91/213).The instrument to nucleated erythrocyte specimens were 109,accounting for 51.17% (109/213),and staining of nucleated erythrocyte were 66,accounting for 30.99% (66/213).Classify or classification of incomplete instrument failed to leukocytes were 11,ac-counting for 5.16% (11/213).When the specimens without nucleated erythrocytes interference or the number of nucleated eryth-rocytes is low [≤ 10/100 white blood cells(WBC)],Instruments on leukocyte count and manual counting results,there was not statistically significant differences between the two groups(P >0.05 ),when the sample number of nucleated erythrocytes (>10/100 WBC),When the specimens were nucleated erythrocyte number for a long time(>10/100 WBC),Instruments on leukocyte count and manual counting results,there was significant difference between the two groups(P <0.05).Correlation analysis on the instrument detection and manual dyeing classification of leukocytes,neutrophils,lymphocytes,monocytes,eosinophils,basophils, the correlation coefficient is respectively 0.95,0.93,0.78,0.86,0.14.Conclusion Some errors exist in Sysmex XT-4000i auto-mated hematology analyzer to count and classification of leukocytes.On neonatal blood tests should be carried out at the same time man-ual microscopy,and on the basis of nucleated erythrocytes were corrected,to ensure the clinical blood routine reporting results.
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Hemodialysis monitoring and information management software was used to establish an intelligent electronic system to manage hemodialysis patients' information,with hardware and software moderations.The electronic information management system for hemodialysis functioned steadily since 2008.This system changed not only the existing medical process of the center,but also contributed to safer treatments,more accurate operations of doctor’ s instructions,and better medical information records as well The results indicate that the electronic information management system in hemodialysis centers not only irnproves work efficiency and management quality significantly,but also effectively ensures the safety and caliber of hemodialysis treatment with less manpower costs.
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Objective To report a simple formula to estimate phosphate removal by standard four-hour hemodialysis in Chinese patients.Methods A total of 165 MHD patients in Huashan Hospital were enrolled.Effluent dialysate samples were collected during treatment to estimate the total amount of phosphate removal.Pre-dialysis levels of serum phosphate,potassium (K+),hematocrit(Hct),parathyroid hormone(iPTH),carbon dioxide combining power(CO2CP),alkaline phosphatase (AKP),Kt/V,and ultrafiltration volume,age,gender,dry body weight,blood flow,phosphate clearance of dialyser,phosphate concentration of dialysate at 60 min after the start of HD were obtained.80％ observations were randomly selected for formula building by backward stepwise and the remaining 20％ observations were used to validate the formula.Results The formula was described as Tpo4 =88.6 ×C60-0.03 ×Age + 1.07 ×Gender +0.06 ×Clearance-4.59,where C60 was phosphate concentration in dialysate measured 60 min into HD and Clearance was the phosphate clearance of dialyser.Formula validation further suggested good predictive ability.Conclusion This study derives an approach to quantify phosphate removal by a simple formula,which will be helpful for clinicians to treat patient individually.