Effect Of High-flux Hemodialysis On Micro-inflammatory State In Patients With MHD

ObjectiveTo explore the relationship between Heat shock protein(HSP70)and microinflammation in Maintained hemodialysis(MHD)patients.To observe the ability of High flux hemodialysis(HFHD)and Low flux hemodialysis(LFHD)to clear toxins in MHD patients,In order to improve the microinflammatory state of patients and delay the development of hemodialysis complications,a more reasonable and high-quality blood purification mode should be selected.MethodSixty-seven patients with MHD who had dialysis for more than 6 months in the blood purification center of our hospital were selected,they were randomly divided into LFHD group(n = 34)and HFHD group(n = 33).Before the first dialysis,after the first dialysis and 3 months after dialysis treatment,Enzyme-linked immunosorbent assay(ELISA)was used to detect HSP70 and nuclear factor kappa-B(NF-κB),Toll-like receptor 4(TLR4),serum Interleukin-6(IL-6),β2-microglobulin(β2-MG)and High-sensitivity C-reactive protein(hs-CRP).Meanwhile,Serum creatinine(Scr),Blood urea nitrogen(BUN)and Parathyroid hormone(PTH),before and after first dialysis,after first dialysis and before dialysis 3 months after dialysis treatment were determined in the laboratory department of our hospital.Result1.HSP70 was positively correlated with TLR4,IL-6 and Scr(r = 0.4934,0.313,0.533,P<0.05),TLR4 was positively correlated with IL-6(r = 0.4495,P<0.05),and Scr was positively correlated with IL-6(r = 0.2722,P<0.05),there was no significant correlation between HSP70 and NF-κB(r=0.109,P>0.05).HSP70 in HFHD group was positively correlated with IL-6 after three months(r = 0.4522,P<0.05).2.Scr and BUN in LFHD group and HFHD group after the first dialysis and 3months after dialysis respectively compared with before the first treatment,Scr and BUN differences were statistically significant(P<0.05).3.There were no significant differences in β2-MG,PTH,hs-CRP and IL-6 in the LFHD group after the first dialysis and 3 months after dialysis compared with before the first treatment(P>0.05).There were significant differences in β2-MG and PTH in HFHD group after the first dialysis compared with before the first dialysis(P<0.05),but no significant differences in hs-CRP and IL-6 in HFHD group(P>0.05).There were significant differences in β2-MG,PTH,hs-CRP and IL-6 in HFHD group after 3months of dialysis compared with before the first dialysis(P<0.05).4.There were statistically significant differences in HSP70,NF-κB and TLR4 in LFHD group after the first treatment compared with before the first treatment(P<0.05),while there was no statistical significance in other indexes(P>0.05),and there was no statistical significance in all indexes after 3 months dialysis treatment compared with before the first treatment(P>0.05).There were significant differences in HSP70,NF-κB and TLR4 after the first treatment in HFHD group compared with before the first treatment(P<0.05),while there were no significant differences in other indexes(P>0.05).After 3 months of dialysis,there were significant differences in all indexes compared with before the first treatment(P<0.05).Conclusion1.MHD patients have a microinflammatory state.2.HSP70 is positively correlated with TLR4 and IL-6,so it is considered that HSP70 can cause inflammation through the HSP70/TLR4/IL-6 pathway.3.LFHD can remove small molecular toxins represented by Scr and BUN,but has poor scavenging ability on medium and large molecular toxins represented by β2-MG,PTH,IL-6,hs-CRP,HSP70 and TLR4.Long-term LFHD treatment did not improve the microinflammatory status of MHD patients.4.HFHF has a certain ability to clear small molecule and middle molecule toxins,and after 3 months of HFHD treatment,HSP70 also has a certain improvement effect on large molecules.After increasing the dialysis time,HFHD can further eliminate HSP70 and reduce the level of IL-6.HFHD has a certain effect on alleviating the micro-inflammatory state in hemodialysis patients,which is better than LFHD.