The Influence Of High Flux Hemodialysis On Microinflammatory State In Maintenance Hemodialysis Patients

Objective: To observe the influence of high and low flux hemodialysis on microinflammatory state in maintenance hemodialysis patients, to study the function of high flux hemodialysis on of microinflammatory state maintenance hemodialysis patients.Method: To selected 36 uremic patients who were treated in the blood purification center and kidney medical department of the Fourth hospital of Hebei medical university from January to October in 2006, which included 18 uremic patients who were treated with hemodialysis (dialysis group) and 18 uremic patients who weren't dialyzed(nondialysis group). To selected 18 health persons as control group. In 18 uremic patients who were treated with hemodialysis, 12 patients were male, 6 paitients were female. A total of 18 uremic patients were divided into two groups: high flux hemodialysis(HFHD) group, there were 9 patients, the average age was 62.89±12.45 years, the average duration of dialysis was 17.89±14.99 months. Polysulphone dialyzer F60 with an ultrafiltration coefficient of 40ml/h·mmHg and membrane space of 1.3m2 was used;low flux hemodialysis(LFHD) group, there were 9 patients,the average age was 60.56±14.21 years, the average duration of dialysis was 14.78±4.87 months. Polysulphone dialyzer F6 with an ultrafiltration coefficient of 5.5ml/h·mmHg and membrane space of 1.3m2 was used. HFHD and LFHD was used three times every week. The two groups both used bicarbonate dialysate. LMWH was used as anticoagulant. All patients used internal arteriovenous fistula. The blood flow was 250ml/min and the dialysate flow was 500ml/min. It was continued 4 to 4.5 hours every dialysis. The dialysis machine was Fresenius 4008S. All the patients had dialyzed more than three months and were in stable status. In 18 uremic patients who weren't dialyzed, 14 patients were male, 4 paitients were female, the average age was 54.39±13.69 years. The effects of lung infection or systemic infection and immunity disease were ruled out in the two groups in one month. All patients didn't applied transfusion,hormone or immunosuppressant in two months, and hadn't have operation and trauma. In 18 health persons, 13 patients were male, 5 paitients were female, the average age was 54.89±12.58 years. The sex and age in the three groups were no significant difference. Pre-dialysis,post-dialysis and after 8 months blood samples of HFHD and LFHD group patients were collected each time. The volume of blood sample was 2ml each time. Moreover, 18 nondialysis uremic patients and 18 health persons'blood sample were selected. The serums were collected after centrifugation and kept in -80℃.The concentration of CRP was determined by immunoturbidimetric method, IL-6 was determined by RIA method, ALB and Cr were determined by biochemical method. To compare the serum levels of CRP,IL-6,ALB and Cr in dialysis group and nondialysis group with control group. To observe the serum levels of CRP,IL-6 and Cr before and just after hemodialysis as well as the serum levels of CRP,IL-6,ALB and Cr 8 months after hemodialysis in HFHD group and LFHD group. To study the correlation between the serum levels of CRP and the serum levels of ALB in uremic patients. All data was expressed as average±standard deviation(x±s), to check up the datas of all groups with normal test and anova test. To accord with normal test and anova test, the compare between two groups with T-test, the compare between before and after oneself with Paired comparison. To not accord with normal test and anova test, the compare among many groups with Kruskal Wallis test, the compare between two groups with Wilcoxon scores ranks, the compare between before and after oneself with Signed rank test. The correlated compare between the serum levels of CRP and the serum levels of ALB with Spearman correlation. p<0.05 was significantly different, analysed with SAS statistical software ver. 6.12.Results1 The serum CRP,IL-6 and Cr levels in nondialysis and dialysis groups were significant higher than those in control group(P<0.01), the serum ALB levels were significant lower than those in control group(P<0.01); There were no significant difference between nondialysis and dialysis groups(P>0.05).2 Each of clinical datas levels in HFHD and LFHD groups were no significant difference(P>0.05), which hint there was comparability between HFHD and LFHD groups.3 The post-hemodialysis levels of CRP,IL-6 in HFHD and LFHD group were no significant difference than pre-hemodialysis(P>0.05). The post-hemodialysis levels of Cr in HFHD and LFHD group were significant lower than pre-hemodialysis(P<0.01).4 After 8 months'treatment, the serum levels of CRP,IL-6 in HFHD group were lower than before(P<0.01), the levels of ALB in HFHD group were higher than before(P<0.05).The serum levels of CRP,IL-6 and ALB in LFHD group were no significant difference than before(P>0.05). To compare the chang rates between HFHD and LFHD groups after dialyzing, the decrease extent of CRP in HFHD group was higher than LFHD group, there was significant difference on the decrease rates of CRP between HFHD and LFHD groups(P<0.05); The decrease extent of IL-6 in HFHD group was higher than LFHD group, there was significant difference on the decrease rates of IL-6 between HFHD and LFHD groups(P<0.01); The increase extent of ALB in HFHD group was higher than LFHD group, there was significant difference on the increase rates of ALB between HFHD and LFHD groups(P<0.05). After 8 months'treatment, the levels of Cr in HFHD and LFHD groups were no significant difference than before(P>0.05).5 The negative correlation between serum CRP levels and serum ALB levels was significant (rs=-0.498, P=0.002). Conclusion1 The uremic patients exist microinflammatory state.2 The decrease of serum CRP and IL-6 levels as shown in our investigation may indicate that HFHD exhibits favourable effects possiblly on microinflammatory state in maintenance hemodialysis patients.3 The increase of serum ALB evels as shown in our investigation may indicate that HFHD exhibits favourable effects possiblly on nutritional state in maintenance hemodialysis patients.4 The negative correlation between serum CRP levels and serum ALB levels in uremic patients.