The Influence Of Dialysate With Chinese Herbal Medicine On Biocompatibility Of Hemodialysis Membrane

ObjectiveTo investigate the influence of dialysate which conclude Chinese herbal medicine on hemodialysis membrane' s biocompatibility.And to clarify the function mechanism of dialysate with Chinese herbal medicine to blood dialysissufferers.Thus to Provide clinical and experimental bases for this special dialysate being used for a treatment of maintenance hemodialysis patients.MethodsThe study include two groups:TCM group——30 uremic patients underwent dialysate which conclude Chinese herbal medicine.Control group——30 uremic patientsunderwent common dialysate.Both groups have a single hemodialysis session using cellulose acetate membrane(CA), another hemodialysis session using hemophan membrane(HE),and a hemodialysis session using polyamide membrane(PA).Each session conclude 10 patients.Informed consents were obtained from all the participants.All these clinical matirals,coming from dialysis center of Guangdong province hospital of TCM,were maintenance hemodialysis patients with chronic renal failure.The randomized and interval grouping design. the controlled observation method was adopted in this clinical research.(random comparison 1:1).There were no differences in age, gender,and duration of dialysis among the groups.Blood samples were collected in pre-,30 minutes and post-hemodialysis.ELISA Was performed for detecting the levels of plasma interleukin-1β(IL-1β). interleukin-6(IL-6)and tumor necrosis factor alpha(TNF-a).And the serum levels of plasma C-reactive protein(CRP)were determined with immuno-turbidimetry.Results1 The level of CRP of ESRD patients was increased significantly after hemodialysis compared with that in group pre-hemodialysis(P＜0.05). While,The increase of CPR in the group of 30 minutes is not obvious(P＞0.05); The rising extent of CRP was significantly less inusing dialysate with Chinese herbal medicine than that in using common dialysate(P＜0.05).In addition,there was negative correlation between dialysis time and dialysate.2 The expression of Ih-1,IL-6 and TNF-a of ESRD patients,both 30 minutes after hemodialysis and 4hours after hemodialysis,was greater than that in group of pre-hemodialysis(P＜0.05).And the level of IL-1,IL-6 and TNF-a in the groups of post-hemodialysis are increased significantly compared with that in group 30 minutes-hemodialysis(P＜0.05) However,While the rising extent oY serum IL-1,IL-6 and TNF-a had no significant difference between groups using dialysate with Chinese herbal medicine and groups using common dialysate(P＞0.05).In addition,there was negative correlation between dialysis time and dialysate.3 The comparison ofplasma interleukin-1(IL-1).interleukin-6(IL-6) and tumor necrosis factor alpha(TNF-α)between groups using dialyzer with CA.HE and PA displayed:there' s no significant difference when using these three different dialysis membranes(P＞0.05).Conclusion1 C-reactive protein(CRP)is one of th e sensitive marks for acute stage of inflammation reaction,and it is also an important serum mark of chonic inflammation status in patients undergoing maintenance hemodialysis.The increase of CRP in patients undergoing maintenance hemodialysis is closely related to hemodialysis itself,using hemodialysis membranes with good biocompatibility can reduce the expression of CRP.Dialysate with Chinese herbal medicine,which called Yi Qi Gu Shen Ye,decreased the rising extent of CRP significantly,these fact shows that dialysate with Chinese herbal medicine can improve the biocompatibility of dialysis membrane,Thus relieve theinflammation reaction during hemodialysis.2 The effect of dialysate with Chinese herbal medicine to the level of IL-1,IL-6 and TNF-a is not obvious,we consider that it is related to the mRNA of cytokine having not be expressed.The producing process of Cytokines need the stimulation of the first signal(such as adhesion of C5a or cells to membrane)and the second signal(Most of these are endotoxin,which existed in dialysate and then moving into blood through dialysis membranes,some of the second signal is soluble LAL positive material which released by dialysis membranes).By these stimulations, cytokines completed the course of mRNA transcription.translation to protein and then released to external of membrane.3 When using different dialysis membranes——CA,HE and PA,the expression of IL-1,IL-6 and TNF-αof maintenance hemodialysis patients (MHD)are not exactly similar,but the difference has no statistical significance.So weconcluded that the biocompatibility of these three hemodialysis membranes,which are used in this research,has no significant difference.