Therapeutic observation of continuous renal replacement therapy plus hemoperfusion on patients with diabetes and uremic encephalopathy_West China Medical Journal

Authors：

LIAO Yujie , SHU Ying ,  GONG Rong , HAN Tianzhao , TONG Yuna , LI Youqin , YOU Chang

Department of Nephrology, the Third People’s Hospital of Chengdu, the Second Affiliated Chengdu Clinical College of Chongqing Medical University, Chengdu, Sichuan 610031, P. R. China;

Corresponding author：

GONG Rong, Email: gongr2006@sina.com

Keywords：

Uremic encephalopathy; Diabetes; Continuous renal replacement therapy; Hemoperfusion; Hemodialysis

DOI：

10.7507/1002-0179.201806106

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the therapeutic effect of continuous renal replacement therapy (CRRT) plus hemoperfusion (HP) on patients with diabetes and uremic encephalopathy. Methods Fifty-five patients with diabetes and uremic encephalopathy from January 2010 to December 2017 were retrospectively collected in this study and divided into CRRT plus HP (CRRT+HP) group (n=28) and hemodialysis (HD) plus HP (HD+HP) group (n=27). The changes of vital signs, related biochemical indicators before and after treatment and curative effects were compared between the two groups. Results The two groups were comparable in general. No significant differences were found in blood pressure or heart rate before and after treatment between the two groups (P>0.05). The incidence of hypotension events in CRRT+HP group was significantly lower than that in HD+HP group (P<0.05), and the effective rate of cardiac function improvement in CRRT+HP group was significantly higher than that in HD+HP group (P<0.05). After treatment, the blood urea nitrogen, creatinine, parathyroid hormone, β2-microglobulin, phosphorus, C-reactive protein and brain natriuretic peptide in the two groups were significantly decreased than those before treatment (P<0.05). Parathyroid hormone, β2-microglobulin, C-reactive protein and brain natriuretic peptide were significantly decreased in CRRT+HP group as compared with those in HD+HP group (P<0.05). The remission rate of uremic encephalopathy in CRRT+HP group was significantly higher than that in HD+HP group (P<0.05). Conclusions As compared with HD+HP pattern, CRRT+HP pattern is more stable in the hemodynamics, and more effective in the improvement of heart failure and the clearance of inflammatory mediators, middle molecular and macromolecular substances associated with uremic encephalopathy. CRRT+HP pattern is suitable for the treatment of patients with diabetes and uremic encephalopathy.

Citation： LIAO Yujie, SHU Ying, GONG Rong, HAN Tianzhao, TONG Yuna, LI Youqin, YOU Chang. Therapeutic observation of continuous renal replacement therapy plus hemoperfusion on patients with diabetes and uremic encephalopathy. West China Medical Journal, 2018, 33(7): 843-847. doi: 10.7507/1002-0179.201806106 Copy

1.	Seifter JL, Samuels MA. Uremic encephalopathy and other brain disorders associated with renal failure. Semin Neurol, 2011, 31(2): 139-143.
2.	Baumgaertel MW, Kraemer M, Berlit P. Neurologic complications of acute and chronic renal disease. Handb Clin Neurol, 2014, 119: 383-393.
3.	王红月, 李贞兰, 陈燕, 等. 尿毒症脑病的危险因素分析. 中风与神经疾病杂志, 2010, 27(10): 935-937.
4.	Yakush Williams JK. Management strategies for patients with diabetic kidney disease and chronic kidney disease in diabetes. Nurs Clin North Am, 2017, 52(4): 575-587.
5.	曾立, 杨琴. 尿毒症脑病的诊治进展. 现代医药卫生, 2016, 32(3): 377-380.
6.	葛均波, 徐永健. 内科学. 8 版. 北京: 人民卫生出版社, 2014.
7.	盛晓华, 汪年松, 简桂花, 等. CVVH 治疗慢性肾功能不全伴充血性心力衰竭患者的疗效观察. 中国血液净化, 2005, 4(8): 440-442.
8.	马爽, 李兵, 王松岩, 等. CVVH 治疗老年尿毒症脑病患者的疗效. 中国老年学杂志, 2015, 9(35): 2547-2548.
9.	Scaini G, Ferreira GK, Streck EL. Mechanisms underlying uremic encephalopathy. Rev Bras Ter Intensiva, 2010, 22(2): 206-211.
10.	De Deyn PP, Vanholder R, Eloot S, et al. Guanidino compounds as uremic (neuro)toxins. Semin Dial, 2009, 22(4): 340-345.
11.	Liu MC, Liang YD, Chigurupati S, et al. Acute kidney injury leads to inflammation and functional changes in the brain. J Am Soc Nephrol, 2008, 19(7): 1360-1370.
12.	张奉莲, 王松, 汪嘉莉, 等. 连续性肾脏替代治疗联合血液灌流治疗重度尿毒症脑病的临床疗效观察. 临床内科杂志, 2017, 34(4): 278-279.
13.	Barichello T, Sayana P, Giridharan VV, et al. Long-term cognitive outcomes after sepsis: a translational systematic review. Mol Neurobiol, 2018. doi: 10.1007/s12035-018-1048-2.
14.	宋金雁, 魏巧兰. 慢性肾衰竭患者尿毒症期并发脑病的发生率和危险因素分析. 国际医药卫生导报, 2016, 22(21): 3248-3250.
15.	Mcintyre CW. Haemodialysis-induced myocardial stunning in chronic kidney disease: a new aspect of cardiovascular disease. Blood Purif, 2010, 29(2): 105-110.
16.	Selvin E, Lazo M, Chen Y, et al. Diabetes mellitus, prediabetes, and incidence of subclinical myocardial damage. Circulation, 2014, 130(16): 1374-1382.
17.	程明, 杨明, 王海兵, 等. 维持性血液透析相关心肌抑顿危险因素分析. 国际移植与血液净化杂志, 2015, 13(6): 23-28.
18.	Polinder-Bos HA, Garcia DV, Kuipers J, et al. Hemodialysis induces an acute decline in cerebral blood flow in elderly patients. J Am Soc Nephrol, 2018, 29(4): 1317-1325.

1. Seifter JL, Samuels MA. Uremic encephalopathy and other brain disorders associated with renal failure. Semin Neurol, 2011, 31(2): 139-143.
2. Baumgaertel MW, Kraemer M, Berlit P. Neurologic complications of acute and chronic renal disease. Handb Clin Neurol, 2014, 119: 383-393.
3. 王红月, 李贞兰, 陈燕, 等. 尿毒症脑病的危险因素分析. 中风与神经疾病杂志, 2010, 27(10): 935-937.
4. Yakush Williams JK. Management strategies for patients with diabetic kidney disease and chronic kidney disease in diabetes. Nurs Clin North Am, 2017, 52(4): 575-587.
5. 曾立, 杨琴. 尿毒症脑病的诊治进展. 现代医药卫生, 2016, 32(3): 377-380.
6. 葛均波, 徐永健. 内科学. 8 版. 北京: 人民卫生出版社, 2014.
7. 盛晓华, 汪年松, 简桂花, 等. CVVH 治疗慢性肾功能不全伴充血性心力衰竭患者的疗效观察. 中国血液净化, 2005, 4(8): 440-442.
8. 马爽, 李兵, 王松岩, 等. CVVH 治疗老年尿毒症脑病患者的疗效. 中国老年学杂志, 2015, 9(35): 2547-2548.
9. Scaini G, Ferreira GK, Streck EL. Mechanisms underlying uremic encephalopathy. Rev Bras Ter Intensiva, 2010, 22(2): 206-211.
10. De Deyn PP, Vanholder R, Eloot S, et al. Guanidino compounds as uremic (neuro)toxins. Semin Dial, 2009, 22(4): 340-345.
11. Liu MC, Liang YD, Chigurupati S, et al. Acute kidney injury leads to inflammation and functional changes in the brain. J Am Soc Nephrol, 2008, 19(7): 1360-1370.
12. 张奉莲, 王松, 汪嘉莉, 等. 连续性肾脏替代治疗联合血液灌流治疗重度尿毒症脑病的临床疗效观察. 临床内科杂志, 2017, 34(4): 278-279.
13. Barichello T, Sayana P, Giridharan VV, et al. Long-term cognitive outcomes after sepsis: a translational systematic review. Mol Neurobiol, 2018. doi: 10.1007/s12035-018-1048-2.
14. 宋金雁, 魏巧兰. 慢性肾衰竭患者尿毒症期并发脑病的发生率和危险因素分析. 国际医药卫生导报, 2016, 22(21): 3248-3250.
15. Mcintyre CW. Haemodialysis-induced myocardial stunning in chronic kidney disease: a new aspect of cardiovascular disease. Blood Purif, 2010, 29(2): 105-110.
16. Selvin E, Lazo M, Chen Y, et al. Diabetes mellitus, prediabetes, and incidence of subclinical myocardial damage. Circulation, 2014, 130(16): 1374-1382.
17. 程明, 杨明, 王海兵, 等. 维持性血液透析相关心肌抑顿危险因素分析. 国际移植与血液净化杂志, 2015, 13(6): 23-28.
18. Polinder-Bos HA, Garcia DV, Kuipers J, et al. Hemodialysis induces an acute decline in cerebral blood flow in elderly patients. J Am Soc Nephrol, 2018, 29(4): 1317-1325.

West China Medical Journal

Therapeutic observation of continuous renal replacement therapy plus hemoperfusion on patients with diabetes and uremic encephalopathy

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content