Influence Of High-flux Hemodialysis On Advanced Oxidation Protein Products In Maintenance Hemodialysis Patients

Background:Oxidative stress (OS) is very important in the progressment and complication of renal disease,particularly for those patients in maintenance hemodialysis. To relieave the oxidative state of those patients in maintenance hemodialysis may regard to the survival quality at a long term. Advanced oxidation protein products (AOPPs) are the oxidative products of albumin and hypochlorous acid, and it is an important marker for the damages of the protein through oxidation introduction. AOPPs as an important indicator of oxidation refer to albumin are superior to those classical indicator such as malondialdehyde (MDA), not only in the specificity and sensitivity of estimation, but also in the portability and popularity of detectation. Researches have shown that AOPPs not only act as an indicator for oxidative stress but also play an important role in the occurrence and development of pathological, physiological and dialysis-related complications of CKD patients. And their relation with CVD attracts our attention. Many researches approach how to lessen the level of AOPPs and alleviate the OS state of patients, but few researches are about the high-flux hemodialysis. Based on the study of MHD patients by means of determining the AOPPs levels and biochemical indicators, this research is expected to investigate the related affecting factors of plasma AOPPs and the influenc of HFHD on the level of AOPPs.Methods:Plasma AOPPs of MHD group,observed group,CKD group and control group are tested.And for observed group and MHD group, biochemical indicators are tested and the clinical basical data such as age, hemodialysis stage, primary disease and drug prescription are collected.For observed group, three months LFHD sequential three months HFHD are performed.This research lasts six months. Plasma AOPPs and other biochemical indicators are tested at 0 month, the 3th month, the 6th month. The statistical processes are conducted through SPSS12.0. The comparisons between the variables are made by t test. The comparisons among three variables are made by one-way ANOVA. The correlation analysis is made by Pearson method. Multi-regression analysis is made by means of multiple linear stepwise regressions. The differences are considered to be statistically significant when P<0.05. Results:(1) The plasma AOPPs level of the MHD group is obviously higher than the CKD group and control group (P=0.000),and CKD group is higher than the control group.(2) Correlation analysis are performed between the serum AOPPs level of MHD with other indicators such as albumin,hemoglobin,serum creatinine,uric acid,triglyceride,cholesterin,calcium,phosphorus,age,hemodialysis time,etc.The result shows that positive correlation exists between AOPPs level with triglyceride (r =0.701, P=0.000),calcium (r=0.254, P=0.011), creatinine(r=0.310,P=0.002) and albumin(r=0.236, P=0.019). Multiple linear stepwise regressions analysis shows that triglyceride,calcium,creatinine are the independently risk factors of AOPPs level. Regression equation is AOPPs=10.070xTG+0.012xCr+13.437xCa-12.037.(3)Three months LFHD sequential three months HFHD are performed for twenty patients, then the plasma AOPPs level and other biochemical indicators are tested at 3rd month and 6th month. There is a downturn in LFHD, but no statistically significant (42.94±18.70v,s39.56±16.09umol/L, P=0.418).And there is a statistically significant in HFHD (39.56±16.09 vs 30.09±8.39 umol/L, P=0.000). The plasma AOPPs level rise after one dialysis.(4) There is a uptrend in triglyceride after three months LFHD,but no statistically significant (1.70±0.94 vs 1.72±0.91,P=0.851). There is a statistically significant downturn in HFHD (1.72±0.91 vs 1.43±0.54, P=0.037)Conclusion:1. CKD 5 stage patients generally have higher AOPPs levels generally,and patients in maintenance hemodialysis have higher AOPPs level than Non-dialytic CKD patients 2. Correlation analysis showes that AOPPs level has positive correlation with triglyceride,calcium,creatinine,and albumin,but no correlation with other indicators. multiple linear stepwise regressions analysis shows that triglyceride,calcium,creatinine are the independently risk factors of AOPPs level.3. Every hemodialysis may increase AOPPs level, but long-term HFHD can ameliorate AOPPs level and TG level.This may be regard to the improvement of triglyceride and inflammation.