Study On High-Flux Hemodialysis And Low-Flux Hemodialsys On Microinflammation And Vascular Endothelial Function In Maintence Hemodialysis Patients

Chronic Kidney Disease(CKD) is a global public health problem. Studies indicate that the incidence of CKD has reached more than 11%.CKD will progress to end-stage renal disease(ESRD) regardless of the pathogensis of the disease. ESRD is clinically characterized as uremia and pathologically characterized as kidney damage. ESRD patients require lifelong renal replacement therapy or renal transplantation. Hemodialysis(HD) is a safe and effective therapy which has become one of the frequestly used treatment for ESRD patients. Uremic patients can have large number of uremic toxins in the body. According to molecular mass, uremic toxins can be classified to large, medium and small molecules. Large or median molecular weight uremic toxins are the major causes of uremic symptoms. However maintenance hemodialysis could not achieve satisfactory clearance of those toxins.These accumulated toxins could cause dialysis related complications and affect long-term prognosis. In this sense, how to improve the clearance of uremic toxins in the hemodialysis patients and improve their prognosis are of great importance. High flux hemodialysis(HF-HD) refers to a technique with the high flux hemofilter in the dialysis machine. Its major advantage is its biocompatibility membrane and the removal of large or median molecular weight uremic toxins by increasing dialysis membrane pore size. Our study aims to observe the effect of HF-HD to conventional hemodialysis(LF-HD) in uremic patients, investigate the possible mechanisms and provide research foundation for further HF – HD treatment.In the first part of current study, we prospectively select uremic hemodialysis patients and divided them into HF-HD group and LF-HD group. Our results showed that short-term dialysis complications, short-term survival rate, anemia, calcium phosphorus metabolism, nutrition of patients in HF- HD group are comparable to those in LF-HD group. But regarding the removal of β2-MG and NT-pro BNP, HF- HD group pastients had lower level thatn those in LF-HD group and the differences were statistically difference.In the second part of current study, we performed ELISA and plasma biochemical tests. The level of MCP-1 and v W factors in HF-HD patients significantly lower than those of LF-HD group.In the third part of current study, we used HF-HD group and LF-HD group patients serum to stimulate human umbilical vein endothelial cells(HUVEC). We applied iTRAQ regents to differently label the samples and then performed the HPLC-MS/MS. By ProteinPilo, We identified 166 differential expressed proteins including 84 down-regulated proteins and 82 up-regulated proteins.By bioinformatic analysis, We analysed the function of up-regulated proteins.In conclusion, our current study demonstrated that HF-HD had better removal of large or median molecular weight uremic toxins in comparison with conventional hemodialysis patients. Furthermore, HF-HD patients had less severe micro-inflamation status which might be associated with better vascular-endothelial protection. This study thus provides basis for future study regarding HF-HD.