Effect Of Removed Uremia Toxins By Different Ways Of Blood Puridication And Influence On Atherosclerosis In MHD Patients

Objective:To evaluate the effect of uremic toxin clearance by different ways of blood purification treatment and the change on degree of atherosclerosis in patients with maintenance hemodialysis(MHD),and provide clinical evidence for selecting appropriate blood purification therapy in patients with MHD.Methods:Clinical research 72 patients with MHD in our hospital were invesgated and divided into 3 groups:①hemodialysis group (HD,n=25),②hemodialysis and hemodiafiltration group(HD+HDF, n=30),③hemodialysis combined by continuous renal replacement therapy (HD+CRRT,n= 17).25 healthy people had matched with MHD patients in sex and age(C,n=25).The levels of haemoglobin(Hb),albumin(Alb), total cholesterol(TC),triglyceride(TG),high density lipoprotein(HDL), low density lipoprotein(LDL),Lipoprotein(a)[Lp(a)],blood urea nitrogen (BUN),Creatinine(Cr),interleukin-6(IL-6),monocyte chemotactic protein-1(MCP-1),high sensitivity C-reactive protein(hs-CRP), homocysteine(Hcy),advanced oxidation protein products(AOPP), advanced glycation endproducts(AGEs)and parathyroid hormone(PTH) were detected in all groups before and after blood purification,and after one-year treatment.The intima-medial thickness(IMT)and atheromatous plaque in MHD patients were examined by the carotid color Doppler ultrasonography before and after one-year treating.Experimental research Human monocytes(THP-1)were cultured with extracted uremic sera of patients before and after the treatment by different ways of blood purification respectively for 24 hours.The levels of IL-6 and MCP- 1 in THP- 1 cultured supernatant were measured.Results:Clinical research The levels of serum uremic toxins in MHD patients were significantly higher than those of healthy control group(P＜0.001),and had the positive correlation with the carotid IMT value and mass of atheromatous plaque.Single treatment of HDF and CRRT could remove effectively the UToxs(P＜0.05),but HD couldn't. The degree of atherosclerosis in group HD got worse(P＜0.05)after one -year treatment,but them were improved in group HDF and CRRT.Experimental research The levels of IL-6 and MCP-1 induced(?)y MHD patients sera were significantly higher than which of healthy control group(P＜0.001).Comparing between pre- and post-treatment,the levels of IL-6 and MCP-1 decreased in group HDF and CRRT(P＜0.05)after treatment,but HD got the reverse result. Conslusion:There were UToxs(especially large and middle molecule)retention in MHD patients.The study indicated that UToxs might accelerate atherosclerosis by the mechanism of immunoinflammatory reaction and oxidative stress.The toxins could be removed effectively by HDF or CRRT.The result suggests that therapy of HD combined with HDF or CRRT may improve the degree of atherosclerosis,and has important effect on preventing and curing cardiovascular disease.