Impact Of Different Type Dialyzers On Micro-inflammatory State Of Maintenance Hemodialysis Patients

Objective: The microinflammatory state is present in patients with end stage renal disease(ESRD), which should be in direct relationship to the delayed complications after hemodialysis, and its'main show is the changes of the serum acute phase proteins and the activation of cell factor. Research indicates that there were close correlation among the microinflammatory state, interleukin-6(IL-6) and the high sensitive C-reactive protein (hs-CRP) in maintenance dialysis patients, while interleukin-10 (IL-10) has a good function to improve the microinflammatory. The study was purposed to investigate the changes of serum IL-6, hsCRP and IL-10 Levels after hemodialysis in uremic patients, the effect of different dialysis membranes types on IL-6, hsCRP and IL-10 Levels, evaluate the biocompatibility of dialysis membranes.Method: 120 cases non-diabetic patients who were under maintenance HD in our hospital were enrolled. The cause of the patients is mainly chronic glomerulonephritis, hypertention nephritis, chronic interstitial nephritis and chronic pyelonephritis. All the patients received bicarbonate dialysis, whose time of dialysis was not less than ten years. They were three sessions every week for 4 hours, had more stable blood pressure in the course of therapy, was no active autoimmune diseases, and no usage of immune adjusting reagent and blood transfusions, had no complication with severe infection and heart failure for nearly three months. The patients were randomly divided into 4 groups: the low-flux cellulose acetate membrane group(CA-LF,n=30), the high-flux cellulose acetate membrane group(CA-HF,n=30), the low-flux polysulfone membrane group(PS-LF,n=30), the high-flux polysulfone membrane group(PS-hF,n=30). Blood samples were taken from the median cubital vein before and after 30 minutes of hemodialysis. The concentration of IL-6, IL-10 and hsCRP in serum were measured by ELISA, and the results were compared in the three groups.Results:No statistical difference was found in ratio of the four diseases, age, sex, hemoglobin (Hb),serum albumin (Alb) and serum creatinine (Scr) between four groups. The level of IL-6,hsCRP and IL-10 did not show significant difference between four groups before treatment, but the level of IL-6 and hsCRP were all remarkably down after treatment, which was lowest in Group PS-HF, second lowest in Group PS-LF and CA-HF, and the third lowest in Group CA-LF . There was a significant difference between Group PS-HF and Group CA-LF (P<0.01). The levels of IL-4, IL-10 and IL-17 in Group PS-HF and Group PS-LF had an upward tendency after dialysis,and were significantly higher than that in Group CA-HF and Group CA-LF, but there is no significant differences (P>0.05). The level of IL-10 in Group CA-HF and Group CA-LF was changeless after dialysis.CONCLUSIONS: The microinflammation in maintenance hemodialysis of HD Patients was in direct relationship to the dialysis membranes'material and permeability. Using better biocompatibility of dialysis membranes can significantly decrease the levels of IL-6 and hsCRP, increase the level of IL-10, and improve the microinflammatory state in HD patients. It is consider to be of utmost importance for the improvement of survival rates and quality of life of the patients.