Research Of Association Between Micro-inflammation And Nutritive Index In Patients With End-stage Renal Disease Under Different Therapies

Objective: The primary and secondary damage in ESRD patients, including dialysis factors, are involved in micro-inflammatory response, which may induce and aggravate malnutrition. This topic is to investigate whether the level of micro-inflammatory factors change in PD and HD patients. Then, discuss the relationship between micro-inflammation and malnutrition in chronic kidney disease.Methods: We selected 101 cases of ESRD patients, which were divided into pre-dialysis group 26 cases, PD group 33 cases and HD group 42 cases. Serum CRP, IL-6,TNF-α and other indicators(Hb, total protein, Alb, PA, globulin, BUN, Scr, HDL-C, LDL-C, TG and TCh) were detected and multiply compared in the three groups. All those factors were further compared between low level of serum inflammation(CRP<0.3 mg/dl) and high level of serum inflammation(CRP≥0.3 mg/dl) in PD group and HD group. The correlation between micro-inflammatory factors and nutrition indicators was also analyzed.Results:1.Comparison among the three groups:Compared with pre-dialysis group: PD group had higher levels of Hb and TCh,but lower levels of BUN and GFR, which was statistical significantly(P<0.05). HD group had higher levels of Hb, total protein, albumin and glucose, but lower level of BUN and uric acid(P<0.05).Compared with PD group: HD group had higher levels of total protein, albumin, globulin, GFR, glucose and TNF-α, but lower level of HDL-C, Scr and uric acid(P<0.05).CRP and IL-6 were not statistically different among the groups(P>0.05).2. Comparison between different models of dialysisCompared with low level of serum inflammation in PD group: the high state of inflammation group in PD group had lower HDL-C and Tch level, but higher IL-6 and UA level(P<0.05). The low state of inflammation group in HD group had higher levels of Hb、total protein and albumin, but lower levels of Tch, HDL-C, LDL-C and AST( P<0.05).Compared with high level of serum inflammation in PD group: The high state of inflammation group in HD group had higher levels of total protein, albumin, globulin GFR, glucose and TNF-α, but lower levels of BUN、Scr and UA( P<0.05).Compared with low level of serum inflammation in HD group: The high state of inflammation group in HD group had higher levels of globulin, GGT, IL-6, TNF-α and CRP( P<0.05).3. Correlation: CRP had a negative correlation with Alb and HDL-C( P<0.05), and a positive correlation with age, globulin, IL-6, TNF-α and GGT( P<0.05). IL-6 had a negative correlation with albumin, and a positive correlation with age, globulin, TNF-α, GGT and Glu( P<0.05). TNF-α had a positive correlation with total protein, globulin and Glu, and a negative correlation with PA and BUN( P<0.05).Conclusions:1.Patients of hemodialysis have more serious micro-inflammation than peritoneal dialysis. But dialysis treatment may induced micro-inflammatory response, meanwhile, improve the status on the contrary, which would not aggravate the existing micro-inflammation.2. Patients of peritoneal dialysis has lower level of albumin than hemodialysis. It is necessary to strengthen the nutrition therapy in the early time of peritoneal dialysis.3. Micro-inflammatory factors were negative correlated with serum Alb. Early intervention should be given to control micro-inflammation, which can improve nutritional status of CKD patients.4. Micro-inflammatory factors were negative correlated with HDL-C, which may increase the occurrence of cardiovascular events.5. Patients of pre-dialysis have lower level of Hb,, which should be early diagnosed and clinical treated.