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：

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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

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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.	張奉蓮, 王松, 汪嘉莉, 等. 連續性腎臟替代治療聯合血液灌流治療重度尿毒癥腦病的臨床療效觀察. 臨床內科雜志, 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, 魏巧蘭. 慢性腎衰竭患者尿毒癥期并發腦病的發生率和危險因素分析. 國際醫藥衛生導報, 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, 楊明, 王海兵, 等. 維持性血液透析相關心肌抑頓危險因素分析. 國際移植與血液凈化雜志, 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. 王紅月, 李貞蘭, 陳燕, 等. 尿毒癥腦病的危險因素分析. 中風與神經疾病雜志, 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, 楊琴. 尿毒癥腦病的診治進展. 現代醫藥衛生, 2016, 32(3): 377-380.
6. 葛均波, 徐永健. 內科學. 8 版. 北京: 人民衛生出版社, 2014.
7. 盛曉華, 汪年松, 簡桂花, 等. CVVH 治療慢性腎功能不全伴充血性心力衰竭患者的療效觀察. 中國血液凈化, 2005, 4(8): 440-442.
8. 馬爽, 李兵, 王松巖, 等. CVVH 治療老年尿毒癥腦病患者的療效. 中國老年學雜志, 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. 張奉蓮, 王松, 汪嘉莉, 等. 連續性腎臟替代治療聯合血液灌流治療重度尿毒癥腦病的臨床療效觀察. 臨床內科雜志, 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, 魏巧蘭. 慢性腎衰竭患者尿毒癥期并發腦病的發生率和危險因素分析. 國際醫藥衛生導報, 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, 楊明, 王海兵, 等. 維持性血液透析相關心肌抑頓危險因素分析. 國際移植與血液凈化雜志, 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

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