| Background: The people has been widely recognized chronic renal failure is common in patients with end-stage micro-inflammatory state,and the micro is an important cause of increased mortality in patients with end-stage renal disease,which is closely related to the occurrence of many complications in patients with end-stage renal disease,such as malnutrition,atherosclerosis,coronary artery calcification,heart failure,anemia,mineral and skeletal diseases,etc.At present,hemodialysis and peritoneal dialysis are the most commonly used dialysis methods in clinic.Different dialysis methods have different effects on the level of microinflammation in patients with end-stage renal disease due to their different efficiency of removing toxins in the body and the existing inflammation-inducing factors.At present,there is no unanimous conclusion on the difference between peritoneal dialysis and hemodialysis in the effect of microinflammatory state in patients.The prevalence of hyperuricemia in patients with chronic kidney disease(CKD)in China is about 36.6%-50.0%,and the prevalence is gradually increasing with the deterioration of kidney function in patients with CKD.Meanwhile,hyperuricemia is of great harm to the continuous progress of CKD.Gout is a disease in which urate crystals accumulate in the joints and surrounding tissues and cause repeated episodes of severe joint pain.Its nature is aseptic inflammation,and the inflammatory response runs through the beginning and end of the attack of gouty arthritis.At present,studies have found that there are differences in the occurrence of cardiovascular diseases,nutritional status and other complications in patients with different dialysis methods,and such differences may be related to the different microinflammatory states in patients.So is there any difference in the effect of different dialysis modes on gout attacks in patients with uremia complicated with hyperuricemia?The acute attack of gout in CKD patients with hyperuricemia has a great impact on the quality of life and the development of the disease,so it is of great significance to select a more appropriate dialysis mode for such patients.Objective:To study the effect of peritoneal dialysis and hemodialysis on the microinflammatory state of uremic patients and the acute attack of gouty arthritis in uremic patients with hyperuricemia,so as to provide theoretical support for these patients to choose the appropriate dialysis method.Methods:98 patients with uremia and hyperuricemia were selected from Suizhou Central Hospital Affiliated to Hubei University of Medicine.Among them,51 patients received hemodialysis(HD group),47 patients received peritoneal dialysis(PD group).Before the follow-up,age,gender,body mass index,blood pressure(after taking antihypertensive drugs,take the side with the highest value)and Kt/V of all patients were recorded,and serum uric acid concentration,fasting venous blood glucose,hemoglobin and serum creatinine levels were detected in the laboratory of our hospital.The levels of micro-inflammatory factors(CRP,IL-6)routinely detected in all patients before the start of dialysis were tracked,and the baseline levels of above indicators in HD group and PD group were compared.All patients were followed up for 6 months.The levels of inflammatory factors(CRP,IL-6,IL-1β,TNF-α)and serum uric acid concentration were measured at the beginning of follow-up and once a month after follow-up,and the frequency of acute attacks of gouty arthritis during follow-up was recorded.After the follow-up,seven inflammatory factors(CRP,IL-6,IL-1β,TNF-α)and the mean blood uric acid levels were calculated in each patient.According to whether patients had acute attack of gouty arthritis during follow-up,they were divided into attack group(group A)and non-attack group(group NA),and they were divided into four grades according to the number of attacks: 0,1 or 2,3 or 4 and ≥5 times.Finally,the average micro-inflammatory factors and serum uric acid levels of 7 times were compared between HD and PD group,A and NA group respectively,and the differences in the number of cases of acute gout attacks between HD and PD group were compared.Results:There was no significant difference in baseline data including age,gender,dialysis age,body mass index,blood pressure,serum uric acid,fasting blood glucose,hemoglobin and kt/V between HD group and PD group before dialysis(P > 0.05).There were no significant differences in the levels of C-reactive protein and IL-6 before dialysis(P > 0.05).After 6 months of follow-up,the average CRP level of HD group was(12.42 ±1.31)mg/L,PD group was(9.97 ± 1.20)mg/L;the average IL-6 level of HD group was(14.19 ± 0.82)pg/m L,PD group was(11.61 ± 0.77)pg/m L;the average IL-1β level of HD group was(32.47 ± 1.15)ng/L,PD group was(30.00 ± 1.05)ng/L.The average level of IL-1β was(52.52 ± 15.43)ng/L,the average level of TNF-α in HD group was(13.91 ± 0.63)mg/d L,the average level of TNF-α in PD group was(12.28 ± 0.69)mg/d L,the average level of each micro inflammatory factor in PD group was lower than that in HD group,the difference was statistically significant(P < 0.05),and the average level of SUA in HD group was(379.62 ± 13.59)μmol/L,The mean level of SUA in PD group was(383.77 ± 10.99)μmol/L,and there was no significant difference between the two groups(P > 0.05).The average level of CRP was(13.18 ± 1.22)mg/L in group A and(10.64 ± 1.43)mg/L in group NA;the average level of IL-6 was(14.32 ± 1.10)pg/m L in group A and(12.53 ± 1.38)pg/m L in group NA;the average level of IL-1β was(32.80 ± 1.05)ng/L in group A and(30.80 ± 1.52)ng/L in group NA(The average level of TNF-α in group A was(14.02 ± 0.54)mg/d L,and that in group Na was(12.85 ± 1.02)mg/d L.The average level of each microinflammatory factor in group NA was lower than that in group A(P< 0.05),while the average level of SUA in group A was(381.08 ± 11.89)μmol/L,and that in group NA was(381.77 ± 12.89)μmol/L,and there was no significant difference between the two groups(P > 0.05).During the follow-up,there were 33 cases without acute gout in HD group,4 cases with 1 or 2 times,5 cases with 3 or 4 times,and 8 cases with 5 times or more.There were 40 cases without acute gout in PD group,3 cases with 1 or 2 times,2 cases with 3or 4 times,and 1 case with 5 times or more.The number of gout attacks in HD group was significantly higher than that in PD group(Z =-2.551,P = 0.011).Conclusion: Compared with hemodialysis patients,peritoneal dialysis has a lower level of microinflammation,and peritoneal dialysis can better reduce the risk of acute attack of gouty arthritis in patients with uremia complicated with hyperuricemia compared with hemodialysis.Microinflammatory state may play a certain promoting role in this. |
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