Effect Of Hemoperfusion Combined With Hemodialysis On Micro-inflammatory State And Calcium And Phosphorus Metabolism In Patients With End-stage Renal Disease

Objective Chronic kidney disease（CKD）has become a major global health problem.When CKD develops to end-stage renal disease（ESRD）,the renal function dramatically declines.Hemodialysis is the most common treatment for ESRD patients.However,studies have showed that conventional hemodialysis has obvious limitations.ESRD patients often suffer from complications including adverse cardiovascular events,osteoporosis,and vascular calcification.Micro-inflammatory state and disorder of calcium and phosphorus metabolism are considered to be important factors for the development of ESRD.Hemoperfusion combined with hemodialysis is currently a widely used blood purification method.This study aims to explore the effect of hemoperfusion combined with hemodialysis on the micro-inflammatory state and calcium and phosphorus metabolism of ESRD patients,and to provide a reference for improving the micro-inflammatory state and calcium and phosphorus metabolism of ESRD patients.Methods ESRD patients undergoing maintenance hemodialysis at Qingdao central hospital from May 2018 to December 2018 were recruited.According to the dialysis treatment,the subjects were divided into hemodialysis group（HD,50 cases）,hemodiafiltration group（HDF,26 cases）,and hemoperfusion combined with hemodialysis group（HP+HD,25 cases）.Twenty healthy adults who underwent physical examinations during the same period were recruited as control group.The blood samples（5 ml）were collected from the arterial end of the patients before and after the treatment.Enzyme linked immunosorbent assay（ELISA）method was used to determine the levels of serum IL-37,IL-6,FGF-23.Immunoturbidimetric method was used to detect the level of serum hs-CRP.Automatic biochemical analyzer was used to detect the level of serum creatinine,urea,calcium,and phosphorus.Automatic chemiluminescence analyzer was used to determine the levels ofβ2-MG and PTH.At the same time,the levels of the above indicators in the blood samples of the control group were measured with same methods.Results There were no statistically significant differences in gender,age,and dialysis time among groups（P>0.05）.The levels of IL-37,IL-6,and FGF-23 in MHD groups before treatment were higher than those in the control group（P<0.05）.There were no significant differences in the levels of IL-37,IL-6,FGF-23 among HD group,HDF group and HP+HD group（P>0.05）.The levels of urea,creatinine after treatment in HD group were lower than before treatment（P<0.05）.The levels of urea,creatinine after treatment in HDF group were lower than before treatment（P<0.05）.The levels of urea,creatinine,hs-CRP after treatment in HP+HD group were lower than before treatment（P<0.05）.The levels of IL-37 and IL-6 after treatment in HD group were not significantly different from those before treatment（P>0.05）;the level of IL-37 and IL-6 in HDF group after treatment were lower than those before treatment（P<0.05）.The level of IL-37 after treatment in the HP+HD group was lower than that before treatment（P<0.05）,and the level of IL-6 was significantly lower than that before treatment（P<0.01）.The levels of phosphorus after treatment in HD group were lower than before treatment（P<0.05）.The levels of phosphorus,β₂microglobulin,and i PTH after treatment in HDF group were lower than before treatment（P<0.05）,and level of calcium was slightly higher than that before treatment（P<0.05）.The levels of phosphorus,β2 microglobulin,i PTH after treatment in HP+HD group were lower than before treatment（P<0.05）,and level of calcium was slightly higher than that before treatment（P<0.05）.The FGF-23levels after treatment in the HFHD group were not significantly different from those before treatment（P>0.05）;the FGF-23 levels in the HDF group after treatment were lower from before treatment（P<0.05）;the FGF-23 level after treatment in the HP+HD group was lower than that before treatment（P<0.01）.Pairwise comparison results showed that the level of IL-37 after treatment in HDF group and HP+HD group was lower than that in HD group（P<0.05）.The level of IL-6 in the HDF group was lower than that in the HD group（P<0.05）,The level of IL-6 after treatment in the HP+HD group was significantly lower than that in the HD group（P<0.01）,and The level of IL-6 after treatment in the HP+HD group was lower In the HDF group（P<0.05）.The level of FGF-23 in the HDF group was lower than that in the HD group（P<0.05）,the level of FGF-23 in the HP+HD group was significantly lower than that in the HD group（P<0.01）,and the level of FGF-23 in the HP+HD group was lower after treatment In the HDF group（P<0.05）..Conclusion The serum levels of IL-37,IL-6,and FGF-23 in ESRD patients were significantly higher than those in healthy people.It suggested that micro-inflammatory state and abnormal calcium and phosphorus regulation were common in ESRD patients.Hemoperfusion combined with hemodialysis treatment can remove IL-37,IL-6 and hs-CRP.It indicated that hemoperfusion combined with hemodialysis can improve the patient’s micro-inflammatory state,and it can adjust the FGF-23 level and reduceβ2-MG,calcium,phosphorus,PTH levels,regulate the calcium and phosphorus metabolism of patients.